Elitestudyvault Stuvia
Adult Health Exam 1-Fluid & Electrolyte Balance, Acid-Base Balance, Care of the Older Adult,
Diabetes/Hypoglycemia, Ethical Reasoning, Skin Integrity & Burns, Acute Pain, & Perioperative Care Review
Questions & Answers
Fluid & Electrolyte Balance
1. You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your patients
most recent laboratory reports, you note that the patient’s magnesium levels are high. You should prioritize
assessment for which of the following health problems?
A. Diminished deep tendon reflexes
B. Tachycardia
C. Cool, clammy skin
D. Acute flank pain
Ans: A. To gauge a patients magnesium status, the nurse should check deep tendon reflexes. If the reflex is absent, this
may indicate high serum magnesium. Tachycardia, flank pain, and cool, clammy skin are not typically associated with
hypomagnesemia.
2. You are working on a burns unit and one of your acutely ill patients is exhibiting signs and symptoms of third
spacing. Based on this change in status, you should expect the patient to exhibit signs and symptoms of what
imbalance?
A. Metabolic alkalosis
B. Hypermagnesemia
C. Hypercalcemia
D. Hypovolemia
Ans: D. Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the
intracellular space, can cause hypovolemia. Increased calcium and magnesium levels are not indicators of third-spacing
fluid shift. Burns typically cause acidosis, not alkalosis.
, Elitestudyvault Stuvia
Adult Health Exam 1
3. A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased
intracranial pressure. This solution will increase the number of dissolved particles in the patients’ blood,
creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process
is best described as which of the following?
A. Hydrostatic pressure
B. Osmosis and osmolality
C. Diffusion
D. Active transport
Ans: B. Osmosis is the movement of fluid from a region of low solute concentration to a region of high solute
concentration across a semipermeable membrane. Hydrostatic pressure refers to changes in water or volume related to
water pressure. Diffusion is the movement of solutes from an area of greater concentration to lesser concentration; the
solutes in an intact vascular system are unable to move so diffusion normally should not be taking place. Active
transport is the movement of molecules against the concentration gradient and requires adenosine triphosphate (ATP)
as an energy source; this process typically takes place at the cellular level and is not involved in vascular volume
changes.
4. You are the surgical nurse caring for a 65-year-old female patient who is postoperative day 1 following a
thyroidectomy. During your shift assessment, the patient complains of tingling in her lips and fingers. She tells
you that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What
electrolyte imbalance should you first suspect?
A. Hypophosphatemia
B. Hypocalcemia
C. Hypomagnesemia
D. Hyperkalemia
Ans: B. Tetany is the most characteristic manifestation of hypocalcemia and hypomagnesemia. Sensations of tingling may
occur in the tips of the fingers, around the mouth, and, less commonly, in the feet. Hypophosphatemia creates central
2
, Elitestudyvault Stuvia
Adult Health Exam 1
nervous dysfunction, resulting in seizures and coma. Hypermagnesemia creates hypoactive reflexes and somnolence.
Signs of hyperkalemia include paresthesia and anxiety.
1
5. A nurse is planning care for a nephrology patient with a new nursing graduate. The nurse states, A patient in
renal failure partially loses the ability to regulate changes in pH. What is the cause of this partial inability? A.
The kidneys regulate and reabsorb carbonic acid to change and maintain pH.
B. The kidneys buffer acids through electrolyte changes.
C. The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH.
D. The kidneys combine carbonic acid and bicarbonate to maintain a stable pH.
Ans: C. The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb
them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete
hydrogen ions and conserve bicarbonate ions to help restore balance. The lungs regulate and reabsorb carbonic acid to
change and maintain pH. The kidneys do not buffer acids through electrolyte changes; buffering occurs in reaction to
changes in pH. Carbonic acid works as the chemical medium to exchange O2 and CO2 in the lungs to maintain a stable
pH whereas the kidneys use bicarbonate as the chemical medium to maintain a stable pH by moving and eliminating H+.
6. When planning the care of a patient with a fluid imbalance, the nurse understands that in the human body,
water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur?
A. Active transport of hydrogen ions across the capillary walls
B. Pressure of the blood in the renal capillaries
C. Action of the dissolved particles contained in a unit of blood
D. Hydrostatic pressure resulting from the pumping action of the heart
Ans: D. An example of filtration is the passage of water and electrolytes from the arterial capillary bed to the interstitial
fluid; in this instance, the hydrostatic pressure results from the pumping action of the heart. Active transport does not
move water and electrolytes from the arterial capillary bed to the interstitial fluid, filtration does. The number of
dissolved particles in a unit of blood is concerned with osmolality. The pressure in the renal capillaries causes renal
filtration.
3
, Elitestudyvault Stuvia
Adult Health Exam 1
7. The baroreceptors, located in the left atrium and in the carotid and aortic arches, respond to changes in the
circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine
activities. Sympathetic stimulation constricts renal arterioles, causing what effect?
A. Decrease in the release of aldosterone
B. Increase of filtration in the Loop of Henle
C. Decrease in the reabsorption of sodium
D. Decrease in glomerular filtration
Ans: D. Sympathetic stimulation constricts renal arterioles; this decreases glomerular filtration, increases the release of
aldosterone, and increases sodium and water reabsorption. None of the other listed options occurs with increased
sympathetic stimulation.
8. The nurse caring for a patient post colon resection is assessing the patient on the second postoperative day.
Your assessment indicates decreased deep tendon reflexes (DTRs) and you suspect the patient has hypokalemia.
What other sign or symptom would you expect this patient to exhibit?
A. Diarrhea
B. Dilute urine
C. Increased muscle tone D. Joint pain
Ans: B. Manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps,
decreased bowel motility, paresthesias (numbness and tingling), and dysrhythmias. If prolonged, hypokalemia can lead
to an inability of the kidneys to concentrate urine, causing dilute urine (resulting in polyuria, nocturia) and excessive
thirst. Potassium depletion suppresses the release of insulin and results in glucose intolerance. Decreased muscle
strength and DTRs can be found on physical assessment. You would expect decreased, not increased, muscle strength
with hypokalemia. The patient would not have diarrhea following bowel surgery, and increased bowel motility is
inconsistent with hypokalemia.
9. You are caring for a patient who is being treated on the oncology unit with a diagnosis of lung cancer with bone
metastases. During your assessment, you note the patient complains of a new onset of weakness with
4
Adult Health Exam 1-Fluid & Electrolyte Balance, Acid-Base Balance, Care of the Older Adult,
Diabetes/Hypoglycemia, Ethical Reasoning, Skin Integrity & Burns, Acute Pain, & Perioperative Care Review
Questions & Answers
Fluid & Electrolyte Balance
1. You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your patients
most recent laboratory reports, you note that the patient’s magnesium levels are high. You should prioritize
assessment for which of the following health problems?
A. Diminished deep tendon reflexes
B. Tachycardia
C. Cool, clammy skin
D. Acute flank pain
Ans: A. To gauge a patients magnesium status, the nurse should check deep tendon reflexes. If the reflex is absent, this
may indicate high serum magnesium. Tachycardia, flank pain, and cool, clammy skin are not typically associated with
hypomagnesemia.
2. You are working on a burns unit and one of your acutely ill patients is exhibiting signs and symptoms of third
spacing. Based on this change in status, you should expect the patient to exhibit signs and symptoms of what
imbalance?
A. Metabolic alkalosis
B. Hypermagnesemia
C. Hypercalcemia
D. Hypovolemia
Ans: D. Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the
intracellular space, can cause hypovolemia. Increased calcium and magnesium levels are not indicators of third-spacing
fluid shift. Burns typically cause acidosis, not alkalosis.
, Elitestudyvault Stuvia
Adult Health Exam 1
3. A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased
intracranial pressure. This solution will increase the number of dissolved particles in the patients’ blood,
creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process
is best described as which of the following?
A. Hydrostatic pressure
B. Osmosis and osmolality
C. Diffusion
D. Active transport
Ans: B. Osmosis is the movement of fluid from a region of low solute concentration to a region of high solute
concentration across a semipermeable membrane. Hydrostatic pressure refers to changes in water or volume related to
water pressure. Diffusion is the movement of solutes from an area of greater concentration to lesser concentration; the
solutes in an intact vascular system are unable to move so diffusion normally should not be taking place. Active
transport is the movement of molecules against the concentration gradient and requires adenosine triphosphate (ATP)
as an energy source; this process typically takes place at the cellular level and is not involved in vascular volume
changes.
4. You are the surgical nurse caring for a 65-year-old female patient who is postoperative day 1 following a
thyroidectomy. During your shift assessment, the patient complains of tingling in her lips and fingers. She tells
you that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What
electrolyte imbalance should you first suspect?
A. Hypophosphatemia
B. Hypocalcemia
C. Hypomagnesemia
D. Hyperkalemia
Ans: B. Tetany is the most characteristic manifestation of hypocalcemia and hypomagnesemia. Sensations of tingling may
occur in the tips of the fingers, around the mouth, and, less commonly, in the feet. Hypophosphatemia creates central
2
, Elitestudyvault Stuvia
Adult Health Exam 1
nervous dysfunction, resulting in seizures and coma. Hypermagnesemia creates hypoactive reflexes and somnolence.
Signs of hyperkalemia include paresthesia and anxiety.
1
5. A nurse is planning care for a nephrology patient with a new nursing graduate. The nurse states, A patient in
renal failure partially loses the ability to regulate changes in pH. What is the cause of this partial inability? A.
The kidneys regulate and reabsorb carbonic acid to change and maintain pH.
B. The kidneys buffer acids through electrolyte changes.
C. The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH.
D. The kidneys combine carbonic acid and bicarbonate to maintain a stable pH.
Ans: C. The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb
them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete
hydrogen ions and conserve bicarbonate ions to help restore balance. The lungs regulate and reabsorb carbonic acid to
change and maintain pH. The kidneys do not buffer acids through electrolyte changes; buffering occurs in reaction to
changes in pH. Carbonic acid works as the chemical medium to exchange O2 and CO2 in the lungs to maintain a stable
pH whereas the kidneys use bicarbonate as the chemical medium to maintain a stable pH by moving and eliminating H+.
6. When planning the care of a patient with a fluid imbalance, the nurse understands that in the human body,
water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur?
A. Active transport of hydrogen ions across the capillary walls
B. Pressure of the blood in the renal capillaries
C. Action of the dissolved particles contained in a unit of blood
D. Hydrostatic pressure resulting from the pumping action of the heart
Ans: D. An example of filtration is the passage of water and electrolytes from the arterial capillary bed to the interstitial
fluid; in this instance, the hydrostatic pressure results from the pumping action of the heart. Active transport does not
move water and electrolytes from the arterial capillary bed to the interstitial fluid, filtration does. The number of
dissolved particles in a unit of blood is concerned with osmolality. The pressure in the renal capillaries causes renal
filtration.
3
, Elitestudyvault Stuvia
Adult Health Exam 1
7. The baroreceptors, located in the left atrium and in the carotid and aortic arches, respond to changes in the
circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine
activities. Sympathetic stimulation constricts renal arterioles, causing what effect?
A. Decrease in the release of aldosterone
B. Increase of filtration in the Loop of Henle
C. Decrease in the reabsorption of sodium
D. Decrease in glomerular filtration
Ans: D. Sympathetic stimulation constricts renal arterioles; this decreases glomerular filtration, increases the release of
aldosterone, and increases sodium and water reabsorption. None of the other listed options occurs with increased
sympathetic stimulation.
8. The nurse caring for a patient post colon resection is assessing the patient on the second postoperative day.
Your assessment indicates decreased deep tendon reflexes (DTRs) and you suspect the patient has hypokalemia.
What other sign or symptom would you expect this patient to exhibit?
A. Diarrhea
B. Dilute urine
C. Increased muscle tone D. Joint pain
Ans: B. Manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps,
decreased bowel motility, paresthesias (numbness and tingling), and dysrhythmias. If prolonged, hypokalemia can lead
to an inability of the kidneys to concentrate urine, causing dilute urine (resulting in polyuria, nocturia) and excessive
thirst. Potassium depletion suppresses the release of insulin and results in glucose intolerance. Decreased muscle
strength and DTRs can be found on physical assessment. You would expect decreased, not increased, muscle strength
with hypokalemia. The patient would not have diarrhea following bowel surgery, and increased bowel motility is
inconsistent with hypokalemia.
9. You are caring for a patient who is being treated on the oncology unit with a diagnosis of lung cancer with bone
metastases. During your assessment, you note the patient complains of a new onset of weakness with
4
