1. Lee Angela’s lab test just revealed that her chloride level is 96 mEq/L.

As a nurse, you would

interpret this serum chloride level as:

A. high
B. low
C. within normal range
D. high normal

2. Which of the following conditions is associated with elevated serum chloride levels?

A. cystitis
B. diabetes
C. eclampsia
D. hypertension

3. In the extracellular fluid, chloride is a major:

A. compound
B. ion
C. anion
D. cation

4. Nursing intervention for the patient with hyperphosphatemia include encouraging intake
of:

A. amphojel
B. Fleets phospho-soda
C. milk
D. vitamin D

5. Etiologies associated with hypocalcemia may include all of the following except:

A. renal failure
B. inadequate intake calcium
C. metastatic bone lesions
D. vitamin D deficiency

6. Which of the following findings would the nurse expect to asses in hypercalcemia?

A. prolonged QRS complex

B. tetany
C. petechiae
D. urinary calculi

7. Which of the following is not an appropriate nursing intervention for a patient with
hypercalcemia?

A. administering calcitonin
B. administering calcium gluconate
C. administering loop diuretics
D. encouraging ambulation

8. A patient in which of the following disorders is at high risk to develop hypermagnesemia?

A. insulin shock
B. hyperadrenalism
C. nausea and vomiting
D. renal failure

9. Nursing interventions for a patient with hypermagnesemia include administering calcium

gluconate to:

A. increase calcium levels

B. antagonize the cardiac effects of magnesium
C. lower calcium levels
D. lower magnesium levels

10. For a patient with hypomagnesemia, which of the following medications may become
toxic?

A. Lasix
B. Digoxin
C. calcium gluconate
D. CAPD

11. Which of the following is the most important physical assessment parameter the nurse
would consider when assessing fluid and electrolyte imbalance?

A. skin turgor
B. intake and output
C. osmotic pressure
D. cardiac rate and rhythm

12. Insensible fluid losses include:

A. urine
B. gastric drainage
C. bleeding
D. perspiration

13. Which of the following intravenous solutions would be appropriate for a patient with
severe hyponatremia secondary to syndrome of inappropriate antidiuretic hormone (SIADH)?

A. hypotonic solution
B. hypertonic solution
C. isotonic solution
D. normotonic solution
14. Aldosterone secretion in response to fluid loss will result in which one of the following
electrolyte imbalances?

A. hypokalemia
B. hyperkalemia
C. hyponatremia
D. hypernatremia

15. When assessing a patient for signs of fluid overload, the nurse would expect to observe:

A. bounding pulse
B. flat neck veins
C. poor skin turgor
D. vesicular

16. The physician has ordered IV replacement of potassium for a patient with
severe hypokalemia. The nurse would administer this:

A. by rapid bolus
B. diluted in 100 cc over 1 hour
C. diluted in 10 cc over 10 minutes
D. IV push

17. Which of the following findings would the nurse exp[ect to assess in a patient
with hypokalemia?

A. hypertension
B. pH below 7.35
C. hypoglycemia
D. hyporeflexia

18. Vien is receiving oral potassium supplements for his condition. How should the
supplements be administered?

A. undiluted
B. diluted
C. on an empty stomach
D. at bedtime

19. Normal venous blood pH ranges from:

A. 6.8 to 7.2
B. 7.31 to 7.41
C. 7.35 to 7.45
D. 7.0 to 8.0

20. Respiratory regulation of acids and bases involves:

A. hydrogen
B. hydroxide
C. oxygen
D. carbon dioxide

21. To determine if a patient’s respiratory system is functioning, the nurse would assess which
of the following parameters:

A. respiratory rate
B. pulse
C. arterial blood gas
D. pulse oximetry

22. Which of the following conditions is an equal decrease of extracellular fluid (ECF) solute
and water volume?

A. hypotonic FVD
B. isotonic FVD
C. hypertonic FVD
D. isotonic FVE

23. When monitoring the daily weight of a patient with fluid volume deficit (FVD), the nurse is
aware that fluid loss may be considered when weight loss begins to exceed:

A. 0.25 lb
B. 0.50 lb
C. 1 lb
D. 1 kg

24. Dietary recommendations for a patient with a hypotonic fluid excess should include:

A. decreased sodium intake

B. increased sodium intake
C. increased fluid intake
D. intake of potassium-rich foods

25. Osmotic pressure is created through the process of:

A. osmosis
B. diffusion
C. filtration
D. capillary dynamics

26. A rise in arterial pressure causes the baroreceptors and stretch receptors to signal an
inhibition of the sympathetic nervous system, resulting in:

A. decreased sodium reabsorption

B. increased sodium reabsorption
C. decreased urine output
D. increased urine output
27. Normal serum sodium concentration ranges from:

A. 120 to 125 mEq/L

B. 125 to 130 mEq/L
C. 136 to 145 mEq/L
D. 140 to 148 mEq/L

28. When assessing a patient for electrolyte balance, the nurse is aware that etiologies
for hyponatremia include:

A. water gain
B. diuretic therapy
C. diaphoresis
D. all of the following

29. Nursing interventions for a patient with hyponatremia include:

A. administering hypotonic IV fluids

B. encouraging water intake
C. restricting fluid intake
D. restricting sodium intake

30. The nurse would analyze an arterial pH of 7.46 as indicating:

A. acidosis
B. alkalosis
C. homeostasis
D. neutrality

Answers and Rationale

Here are the answers for this exam. Gauge your performance by counter checking your answers
to those below. If you have any disputes or clarifications, please direct them to the comments
section.

1. Answer: C. within normal range

Normal serum concentrations of chloride range from 95 to 108 mEq/L.

2. Answer: C. eclampsia

Eclampsia is associated with increased levels of serum chloride.

3. Answer: C. anion

Chloride is a major anion found in the extracellular fluid. A compound occurs when two ions are
bound together. Chloride is an ion, but this choice is too general. HCO3 is a cation.

4. Answer: A. amphogel

Administration of phosphate binders (amphogel and basagel) will reduce the serum phosphate
levels.
5. Answer: C. metastatic bone lesions

Metastatic bone lesions are associated with hypercalcemia due to accelerated bone metabolism
and release of calcium into the serum. Renal failure, inadequate calcium intake, and vitamin D
deficiency may cause hypocalcemia.

6. Answer: D. urinary calculi

Urinary calculi may occur with hypercalcemia. Shortened, not prolonged QRS complex would be
seen in hypercalcemia. Tetany and petechiae are signs of hypocalcemia.

7. Answer: B. administering calcium gluconate

Calcium gluconate is used for replacement in deficiency states. Calcitonin and loop diuretics are
used to lower serum calcium.

8. Answer: D. renal failure

Renal failure can reduce magnesium excretion, leading to hypermagnesemia. Diabetic

ketoacidosis, not insulin shock is a cause of hypermagnesemia. Hypoadrenalism, not
hyperadrenalism is a cause of hypermagnesemia. Nausea and vomiting lead to
hypomagnesemia.

9. Answer: B. antagonize the cardiac effects of magnesium

In a patient with hypermagnesemia, administration of calcium gluconate will antagonize the

cardiac effects of magnesium. Although calcium gluconate will raise serum calcium levels, that is
not the purpose of administration. Calcium gluconate does not lower calcium or magnesium
levels.

10. Answer: B. Digoxin

In hypomagnesemia, a patient on digoxin is likely to develop digitalis toxicity. Neither A nor C

has toxicity as a side effect. CAPD is not a medication.

11. Answer: D. cardiac rate and rhythm

Cardiac rate and rhythm are the most important physical assessment parameter to measure.
Skin turgor, intake and output are physical assessment parameters a nurse would consider when
assessing fluid and electrolyte imbalance, but choice d is the most important.

12. Answer: D. perspiration

Perspiration and the fluid lost via the lungs are termed insensible losses; normally, insensible
losses equal about 1000 cc/day.

13. Answer: B. hypertonic solution

When hyponatremia is severe, hypertonic solutions may be used but should be infused with
caution due to the potential for development of CHF. In SIADH, isotonic and hypotonic solutions
are not indicated, because urine output is minimal, so water is retained. this water retention
dilutes serum sodium levels, making the patient hyponatremic and necessitating administration
of hypertonic solutions to balance sodium and water. Normotonic solutions do not exist.

14. Answer: A. hypokalemia

Aldosterone is secreted in response to fluid loss. Aldosterone causes sodium reabsorption and
potassium elimination, further exacerbating hypokalemia.

15. Answer: A. bounding pulse

Bounding pulse is a sign of fluid overload as more volume in the vessels causes a stronger
sensation against the blood vessel walls. Flat neck veins and vesicular breath sounds are normal
findings. Poor skin turgor is consistent with dehydration.

16. Answer: B. diluted in 100 cc over 1 hour

Potassium must be well diluted and given slowly because rapid administration will cause cardiac
arrest.

17. Answer: D. hyporeflexia

Hyporeflexia is a symptom of hypokalemia

18. Answer: B. diluted

Oral potassium supplements are known to irritate gastrointestinal (GI) mucosa and should be
diluted.

19. Answer: B. 7.31 to 7.41

Normal venous blood pH ranges from 7.31 to 7.41. Normal arterial blood pH ranges from 7.35 to
7.45.

20. Answer: D. carbon dioxide

Respiratory regulation of acid-base balance involves the elimination or retention of carbon

dioxide.

21. Answer: C. arterial blood gas

Arterial blood gases will indicate CO2 and O2 levels. This is an indication that the respiratory
system is functioning. Respiratory rate can reveal data about other systems, such as the brain,
making letter c a better choice. Pulse rate is not measure of respiratory status. Pulse oximetry
yields oxygen saturation levels, which is not a measure of acid-base balance.

22. Answer: B. isotonic FVD

Isotonic FVD involves an equal decrease in solute concentration and water volume.

23. Answer: B. 0.50 lb

Weight loss of more than 0.50 lb. is considered to be fluid loss.

24. Answer: B. increased sodium intake

Hypotonic fluid volume excess (FVE) involves an increase in water volume without an increase in
sodium concentration. Increased sodium intake is part of the management of this condition.

25. Answer: B. diffusion

In diffusion, the solute moves from an area of higher concentration to one of lower
concentration, creating osmotic pressure. Osmotic pressure is related to the process
of osmosis. Filtration is created by hydrostatic pressure. Capillary dynamics are related to fluid
exchange at the intravascular and interstitial levels.

26. Answer: D. increased urine output

Arterial baroreceptors and stretch receptors help maintain fluid balance by increasing urine
output in response to a rise in arterial pressure.

27. Answer: C. 136 to 145 mEq/L

Normal serum sodium level ranges from 136 to 145 mEq/L.

28. Answer: D. all of the following

Water gain, diuretic therapy, and diaphoresis are etiologies of hyponatremia.

29. Answer: C. restricting fluid intake

Hyponatremia involves a decreased concentration of sodium in relation to fluid volume, so

restricting fluid intake is indicated.

30. Answer: B. alkalosis

Alkalosis is indicated by a pH above 7.45.