Nurs 342 Test #1 - Ch. 16 Fluid, Electrolyte & Acid-Base Imbalances - Lewis 10th ed. practice NCLEX questions

Nurs 342 Test #1 - Ch. 16 Fluid, Electrolyte & Acid-Base Imbalances - Lewis 10th ed. practice NCLEX questions Leave the first rating Students also studied Terms in this set (12) Science MedicineNursing Save

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mamma2twoPreview Fluid an 36 terms quiz During the postoperative care of a 76-year-old patient, the nurse monitors the patient's intake and output carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because

• older adults have an impaired thirst mechanism and

need reminding to drink fluids.

• water accounts for a greater percentage of body

weight in the older adult than in younger adults

• older adults are more likely than younger adults to lose

extracellular fluid during surgical procedures

• small losses of fluid are significant because body fluids

account for 45% to 50% of body weight in older adults

Correct answer: d

Rationale: In the older adult, body water content averages 45% to 50% of body

weight; therefore small losses can lead to a greater risk of fluid-related problems.During administration of a hypertonic IV solution, the mechanism involved in equalizing the fluid concentration between ECF and the cells is

• osmosis.
• diffusion.
• active transport.
• facilitated diffusion.

Correct answer: a

Rationale: Osmosis is the movement of water between two compartments

separated by a semipermeable membrane. Water moves through the membrane from an area of low solute concentration to an area of high solute concentration.

An older woman was admitted to the medical unit with GI bleeding and fluid volume deficit. Clinical manifestations of this problem are (select all that apply)

• weight loss.
• dry oral mucosa.
• full bounding pulse.
• engorged neck veins.
• decreased central venous pressure.

Correct answers: a, b, e

Rationale: Body weight loss, especially sudden change, is an excellent indicator of overall fluid volume loss. Other clinical manifestations of fluid volume deficit include dry mucous membranes and a decreased central venous pressure, which reflect fluid volume loss.The nursing care for a patient with hyponatremia and fluid volume excess includes

• fluid restriction.
• administration of hypotonic IV fluids.
• administration of a cation-exchange resin.
• placement of an indwelling urinary catheter

Correct answer: a

Rationale: In hyponatremia that is caused by water excess, fluid restriction often is all that is needed to treat the problem. The patient would only require an indwelling urinary catheter if the patient is unable to assist with maintaining an accurate output record.The nurse should be alert for which manifestations in a patient receiving a loop diuretic?

• Restlessness and agitation
• Paresthesias and irritability
• Weak, irregular pulse and poor muscle tone
• Increased blood pressure and muscle spasms

Correct answer: c

Rationale: Loop diuretics may result in renal loss of potassium and hypokalemia.Clinical manifestations of hypokalemia include fatigue, muscle weakness, leg cramps, nausea, vomiting, paralytic ileus, paresthesias, decreased reflexes, weak, irregular pulse, polyuria, hyperglycemia, and ECG changes.Which patient is at greatest risk for developing hypermagnesemia?

• 83-year-old man with lung cancer and hypertension
• 65-year-old woman with hypertension taking β-

adrenergic blockers

• 42-year-old woman with systemic lupus erythematosus

and renal failure

• 50-year-old man with benign prostatic hyperplasia and

a urinary tract infection

Correct answer: c

Rationale: Causes of hypermagnesemia include renal failure (especially if the

patient is given magnesium products), excessive administration of magnesium for treatment of eclampsia, and adrenal insufficiency.It is important for the nurse to assess for which clinical manifestation(s) in a patient who has just undergone a total thyroidectomy (select all that apply

• Confusion
• Weight gain
• Depressed reflexes
• Circumoral numbness
• Positive Chvostek's sign

Correct answers: a, d, e

Rationale: Inadvertent removal of a portion of or injury to the parathyroid glands during thyroid or neck surgery can result in a lack of parathyroid hormone, leading to hypocalcemia. A positive Chvostek's sign, confusion, and circumoral numbness are manifestations of low serum calcium levels.

The nurse expects the long-term treatment of a patient with hyperphosphatemia secondary to renal failure will include

• fluid restriction.
• calcium supplements.
• magnesium supplements.
• increased intake of dairy products.

Correct answer: b

Rationale: The major conditions that can lead to hyperphosphatemia are acute

kidney injury and chronic kidney disease that alter the ability of the kidneys to excrete phosphate. For the patient with renal failure, long-term measures to reduce serum phosphate levels include phosphate-binding agents or gels, such as calcium carbonate, fluid replacement therapy, and dietary phosphate restrictions.The lungs act as an acid-base buffer by

• increasing respiratory rate and depth when CO2 levels

in the blood are high, reducing acid load.

• increasing respiratory rate and depth when CO2 levels

in the blood are low, reducing base load.

• decreasing respiratory rate and depth when CO2 levels

in the blood are high, reducing acid load.

• decreasing respiratory rate and depth when CO2

levels in the blood are low, increasing acid load.

Correct answer: a

Rationale: As a compensatory mechanism, the respiratory system acts on the CO2

• H2O side of the reaction by altering the rate and depth of breathing to "blow

off" (through hyperventilation) or "retain" (through hypoventilation) CO2.

A patient has the following arterial blood gas results:

pH 7.52, PaC02 30 mm Hg, HCO3- 24 mEq/L. The nurse determines that these results indicate

• metabolic acidosis

b.metabolic alklalosis c.respiratory acidosis d.respiratory alkalosis

Correct answer: d

Rationale: Respiratory alkalosis (carbonic acid deficit) occurs with

hyperventilation. The primary cause of respiratory alkalosis is hypoxemia from acute pulmonary disorders. Anxiety, central nervous system (CNS) disorders, and mechanical overventilation also increase ventilation rate and decrease the partial pressure of arterial carbon dioxide (PaCO2). This leads to a decrease in carbonic acid level and to alkalosis.The typical fluid replacement for the patient with a fluid volume deficit is

• dextran.
• 0.45% saline.
• lactated Ringer's.
• 5?xtrose in 0.45% saline

Correct answer: c

Rationale: Administration of an isotonic solution expands only the extracellular fluid (ECF). There is no net loss or gain from the intracellular fluid (ICF). An isotonic solution is the ideal fluid replacement for a patient with an ECF volume deficit. Examples of isotonic solutions include lactated Ringer's solution and 0.9% NaCl.The nurse is unable to flush a central venous access device and suspects occlusion. The best nursing intervention would be to

• apply warm moist compresses to the insertion site.
• attempt to force 10 mL of normal saline into the device.
• place the patient on the left side with head-down

position.

• instruct the patient to change positions, raise arm and

cough.

Correct answer: d

Rationale: Interventions for catheter occlusion include instructing the patient to change position, raise an arm, and cough; assessing for and alleviating clamping or kinking of the tube; flushing the catheter with normal saline through a 10-mL syringe (do not force flush); using fluoroscopy to determine cause and site of occlusion; and instilling anticoagulant or thrombolytic agents.