NUR 1400 Fluid, Electrolytes, and Acid-
Base Imbalances Practice Questions with
Rationales.
Targeted ATI Fluid, Electrolyte, and Acid-Base
1. A nurse is assessing a client who has dehydration. Which of the following assessments is the priority?
a. Skin turgor
i. The nurse should assess skin turgor to monitor the client's hydration status. Poor skin turgor is
a manifestation of dehydration. However, another assessment is the nurse's priority.
b. Urine output
i. The nurse should assess urine output to monitor the client's hydration status. Decreased urine output
is a manifestation of dehydration. However, another assessment is the nurse's priority.
c. Weight
i. The nurse should weigh the client because weight loss is a manifestation of dehydration.
Decreased weight is the best indication of the client's fluid status. However, another assessment is
the nurse's priority.
d. Mental status
i. The greatest risk to this client is injury from a fall due to a decline in their mental status.
Therefore, assessing the client's mental status is the nurse's priority.
2. A nurse is reviewing the laboratory report of a client who has fluid volume excess. Which of the following laboratory
values should the nurse expect?
a. Hgb 20 g/dL
i. The nurse should identify that a client who has dehydration can have a Hgb level that is above the
expected reference range of 12 to 16 g/dL for females or 14 to 18 g/dL for males. Fluid volume
excess can cause hemodilution and a decreased hemoglobin level.
b. Hct 34%
i. The nurse should identify that a client who has fluid volume excess can have a Hct level that is below
the expected reference range of 37% to 47% for females or 42% to 52% for males. Fluid volume
excess can cause hemodilution and a decreased hematocrit level.
c. BUN 25 mg/dL
i. The nurse should identify that a client who has dehydration can have a BUN that is above the
expected reference range of 10 to 20 mg/dL. Fluid volume excess can cause a decrease in BUN.
d. Urine specific gravity 1.050
i. The nurse should identify that a client who has dehydration can have a urine specific gravity that
is above the expected reference range of 1.010 to 1.025. Fluid volume excess can cause a
decrease in urine specific gravity.
3. A nurse is assessing a client who is receiving hydrochlorothiazide and notes that the client is confused and lethargic.
Which of the following laboratory values should the nurse report to the provider?
a. Sodium 128 mEq/L
i. This level is below the expected reference range of 136 to 145 mEq/L and is the likely cause of the
client's altered mental status. The nurse should report this finding to the provider and monitor
the client for weakened respiratory effort.
b. Potassium 4.8 mEq/L
i. This finding is within the expected reference range. However, the nurse should continue to monitor
for hypokalemia while the client is taking hydrochlorothiazide.
c. Calcium 9.1 mg/dL
i. This finding is within the expected reference range. However, the nurse should continue to monitor
for hypercalcemia while the client is taking hydrochlorothiazide.
d. Magnesium 2.0 mEq/L
i. This finding is within the expected reference range. However, the nurse should continue to monitor
for hypomagnesemia while the client is taking hydrochlorothiazide.
4. A nurse is providing dietary teaching to a client who has kidney disease. Which of the following food choices should
the nurse include in the teaching as containing the lowest amount of magnesium?
a. One large, hard-boiled egg
i. One large, hard-boiled egg contains 5 mg of magnesium. Therefore, the nurse should recommend
this food as containing the lowest amount of magnesium.
b. 1 cup bran cereal
i. One cup of bran cereal contains 112 mg of magnesium. Therefore, the nurse should include a
, different food as containing the lowest amount of magnesium.
c. ½ cup almonds
, i. One-half cup of almonds contains 193 mg of magnesium. Therefore, the nurse should include
a different food as containing the lowest amount of magnesium.
d. 1 cup cooked spinach
i. One cup of cooked spinach contains 157 mg of magnesium. Therefore, the nurse should include
a different food as containing the lowest amount of magnesium.
5. A nurse is assessing a client who has a serum calcium level of 8.1 mg/dL. Which of the following findings is the priority
for the nurse to assess?
a. Deep-tendon reflexes
i. The nurse should assess the client's deep-tendon reflexes because this total serum calcium level is
below the expected reference range of 9 to 10.5 mg/dL, and hypocalcemia can cause
neuromuscular changes. However, there is another assessment the nurse should make first.
b. Cardiac rhythm
i. When using the airway, breathing, circulation approach to client care, the nurse should first assess
the client's cardiac rhythm because this total serum calcium level is below the expected reference
range. Hypocalcemia can cause ECG changes, bradycardia, or tachycardia.
c. Peripheral sensation
i. The nurse should assess the client's peripheral sensation to check for paresthesia because this
total serum calcium level is below the expected reference range, and hypocalcemia can cause
neuromuscular changes. However, there is another assessment the nurse should make first.
d. Bowel sounds
i. The nurse should assess the client's bowel sounds to check for hypermotility because this total serum
calcium level is below the expected reference range, and hypocalcemia can cause increased
peristalsis. However, there is another assessment the nurse should make first.
6. A nurse is caring for a client who has a sodium level of 155 mEq/L. Which of the following IV fluids should the
nurse anticipate the provider to prescribe?
a. Dextrose 5% in 0.9% sodium chloride
i. A sodium level of 155 mEq/L is an indication of hypernatremia. Dextrose 5% in 0.9% sodium chloride
is a hypertonic solution. The nurse should anticipate a prescription for a hypotonic solution.
b. Dextrose 5% in lactated Ringer’s
i. A sodium level of 155 mEq/L is an indication of hypernatremia. Lactated Ringer's contains sodium
and other electrolytes and is not indicated for hypernatremia.
c. 3% sodium chloride
i. A sodium level of 155 mEq/L is an indication of hypernatremia, and 3% sodium chloride is a
hypertonic solution. The nurse should anticipate a prescription for a hypotonic solution.
d. 0.45% sodium chloride
i. A sodium level of 155 mEq/L is an indication of hypernatremia. The nurse should anticipate a
prescription for a hypotonic solution. The 0.45% sodium chloride is a hypotonic solution used to
provide free water and treat cellular dehydration, which promotes waste elimination by the
kidneys.
7. A nurse is assessing a client who has hypomagnesemia. Which of the following findings should the nurse
expect? a. Hyperactive deep-tendon reflexes
i. Hyperactive deep-tendon reflexes are an expected finding for a client who has hypomagnesemia. Other
expected findings include muscle cramps, numbness, and tingling.
b. Increased bowel sounds
i. Decreased bowel sounds are an expected finding for a client who has hypomagnesemia.
c. Drowsiness
i. Insomnia is an expected finding for a client who has hypomagnesemia.
d. Decreased blood pressure
i. Increased blood pressure is an expected finding for a client who has hypomagnesemia.
8. A nurse is assessing a client who has a phosphorous level of 2.4 mg/dL. Which of the following findings should the
nurse expect?
a. Hepatic failure
i. This phosphorus level is below the expected reference range of 3 to 4.5 mg/dL. The nurse should
assess a client who has hypophosphatemia for manifestations of kidney failure, not hepatic failure.
b. Abdominal pain
i. This phosphorus level is below the expected reference range. Hypophosphatemia causes weakness
of skeletal muscles and rhabdomyolysis, which is acute muscle breakdown. It does not cause
abdominal pain.
c. Slow peripheral pulses
, i. This phosphorus level is below the expected reference range. The nurse should expect the client to
have slow peripheral pulses. The nurse might also find that the client's pulses are difficult to find
and easy to block.
d. Increase in cardiac output
i. This phosphorus level is below the expected reference range. The nurse should expect a decrease
in cardiac output.
9. A nurse is caring for a client who is experiencing respiratory distress as a result of pulmonary edema. Which of
the following actions should the nurse take first?
a. Assist with intubation
i. The nurse should be prepared to assist the provider with intubation and mechanical ventilation if
less invasive measures are ineffective. However, there is another action the nurse should take first.
b. Initiate high flow oxygen therapy
i. When using the airway, breathing, circulation approach to client care, the nurse should first
administer high-flow oxygen therapy by face mask at 5 to 6 L/min to keep the client's oxygen
saturation above 90%.
c. Administer a rapid-acting diuretic
i. The nurse should administer a rapid-acting diuretic IV bolus to the client to relieve
pulmonary congestion. However, there is another action the nurse should take first.
d. Provide cardiac monitoring
i. The nurse should provide cardiac monitoring because premature ventricular contractions and
dysrhythmias are manifestations of pulmonary edema. However, there is another action the
nurse should take first.
10. A nurse is planning care for a client who has a potassium level of 3.0 mEq/L. The nurse should plan to monitor the client
for which of the following findings?
a. Hyperactive deep-tendon reflexes
i. The nurse should plan to monitor the client for hyporeflexia. Manifestations of hypokalemia
include weak hand grip strength and weak deep-tendon reflexes.
b. Orthostatic hypotension
i. The nurse should plan to monitor the client for orthostatic hypotension, which places them at risk
for falls. Orthostatic hypotension is a manifestation of hypokalemia.
c. Rapid, deep respirations
i. The nurse should plan to monitor the client for respiratory distress. Weakening of the
respiratory muscles and shallow respirations are manifestations of hypokalemia.
d. Strong, bounding pulse
i. The nurse should plan to monitor the client for a weak and thready pulse. A weak, thready pulse is
a manifestation of hypokalemia.
11. A nurse is providing teaching to a client who is at risk for developing respiratory acidosis following surgery. Which of
the following statements by the client indicates an understanding of the teaching?
a. “I should conserve energy by limiting my physical activity.”
i. The nurse should encourage the client to ambulate and change positions frequently to
prevent postoperative complications.
b. “I will wait until my pai is at least 6 out of 10 before I use the PCA.”
i. The nurse should encourage the client to use the PCA when feeling acute pain to prevent the pain
from worsening.
c. “I will limit my daily fluid intake to two to three glasses.”
i. Dehydration can cause metabolic acidosis. The nurse should encourage the client to take in
approximately 2,200 mL of fluid daily. This includes fluid intake of six to eight glasses containing 240
mL each, as well as liquids obtained from eating solid foods. Limiting fluid intake to two to three 8 oz
glasses would not meet the client's total daily intake needs.
d. “I will use the incentive spirometer every hour.”
i. Respiratory depression and limited chest expansion are both causes of respiratory acidosis. Using
an incentive spirometer will promote adequate chest expansion.
12. A nurse is assessing a client who is using PCA following a thoracotomy. The client is short of breath, appears restless, and
has a respiratory rate of 28/min. The client's ABG results are pH 7.52, PoO2 89 mm hg, and HCO3- 24 mEq/L. Which of
the following actions should the nurse take?
a. Instruct the client to cough forcefully
i. Coughing forcefully will not treat the underlying cause of the ABG results.
b. Assist the client with ambulation
Base Imbalances Practice Questions with
Rationales.
Targeted ATI Fluid, Electrolyte, and Acid-Base
1. A nurse is assessing a client who has dehydration. Which of the following assessments is the priority?
a. Skin turgor
i. The nurse should assess skin turgor to monitor the client's hydration status. Poor skin turgor is
a manifestation of dehydration. However, another assessment is the nurse's priority.
b. Urine output
i. The nurse should assess urine output to monitor the client's hydration status. Decreased urine output
is a manifestation of dehydration. However, another assessment is the nurse's priority.
c. Weight
i. The nurse should weigh the client because weight loss is a manifestation of dehydration.
Decreased weight is the best indication of the client's fluid status. However, another assessment is
the nurse's priority.
d. Mental status
i. The greatest risk to this client is injury from a fall due to a decline in their mental status.
Therefore, assessing the client's mental status is the nurse's priority.
2. A nurse is reviewing the laboratory report of a client who has fluid volume excess. Which of the following laboratory
values should the nurse expect?
a. Hgb 20 g/dL
i. The nurse should identify that a client who has dehydration can have a Hgb level that is above the
expected reference range of 12 to 16 g/dL for females or 14 to 18 g/dL for males. Fluid volume
excess can cause hemodilution and a decreased hemoglobin level.
b. Hct 34%
i. The nurse should identify that a client who has fluid volume excess can have a Hct level that is below
the expected reference range of 37% to 47% for females or 42% to 52% for males. Fluid volume
excess can cause hemodilution and a decreased hematocrit level.
c. BUN 25 mg/dL
i. The nurse should identify that a client who has dehydration can have a BUN that is above the
expected reference range of 10 to 20 mg/dL. Fluid volume excess can cause a decrease in BUN.
d. Urine specific gravity 1.050
i. The nurse should identify that a client who has dehydration can have a urine specific gravity that
is above the expected reference range of 1.010 to 1.025. Fluid volume excess can cause a
decrease in urine specific gravity.
3. A nurse is assessing a client who is receiving hydrochlorothiazide and notes that the client is confused and lethargic.
Which of the following laboratory values should the nurse report to the provider?
a. Sodium 128 mEq/L
i. This level is below the expected reference range of 136 to 145 mEq/L and is the likely cause of the
client's altered mental status. The nurse should report this finding to the provider and monitor
the client for weakened respiratory effort.
b. Potassium 4.8 mEq/L
i. This finding is within the expected reference range. However, the nurse should continue to monitor
for hypokalemia while the client is taking hydrochlorothiazide.
c. Calcium 9.1 mg/dL
i. This finding is within the expected reference range. However, the nurse should continue to monitor
for hypercalcemia while the client is taking hydrochlorothiazide.
d. Magnesium 2.0 mEq/L
i. This finding is within the expected reference range. However, the nurse should continue to monitor
for hypomagnesemia while the client is taking hydrochlorothiazide.
4. A nurse is providing dietary teaching to a client who has kidney disease. Which of the following food choices should
the nurse include in the teaching as containing the lowest amount of magnesium?
a. One large, hard-boiled egg
i. One large, hard-boiled egg contains 5 mg of magnesium. Therefore, the nurse should recommend
this food as containing the lowest amount of magnesium.
b. 1 cup bran cereal
i. One cup of bran cereal contains 112 mg of magnesium. Therefore, the nurse should include a
, different food as containing the lowest amount of magnesium.
c. ½ cup almonds
, i. One-half cup of almonds contains 193 mg of magnesium. Therefore, the nurse should include
a different food as containing the lowest amount of magnesium.
d. 1 cup cooked spinach
i. One cup of cooked spinach contains 157 mg of magnesium. Therefore, the nurse should include
a different food as containing the lowest amount of magnesium.
5. A nurse is assessing a client who has a serum calcium level of 8.1 mg/dL. Which of the following findings is the priority
for the nurse to assess?
a. Deep-tendon reflexes
i. The nurse should assess the client's deep-tendon reflexes because this total serum calcium level is
below the expected reference range of 9 to 10.5 mg/dL, and hypocalcemia can cause
neuromuscular changes. However, there is another assessment the nurse should make first.
b. Cardiac rhythm
i. When using the airway, breathing, circulation approach to client care, the nurse should first assess
the client's cardiac rhythm because this total serum calcium level is below the expected reference
range. Hypocalcemia can cause ECG changes, bradycardia, or tachycardia.
c. Peripheral sensation
i. The nurse should assess the client's peripheral sensation to check for paresthesia because this
total serum calcium level is below the expected reference range, and hypocalcemia can cause
neuromuscular changes. However, there is another assessment the nurse should make first.
d. Bowel sounds
i. The nurse should assess the client's bowel sounds to check for hypermotility because this total serum
calcium level is below the expected reference range, and hypocalcemia can cause increased
peristalsis. However, there is another assessment the nurse should make first.
6. A nurse is caring for a client who has a sodium level of 155 mEq/L. Which of the following IV fluids should the
nurse anticipate the provider to prescribe?
a. Dextrose 5% in 0.9% sodium chloride
i. A sodium level of 155 mEq/L is an indication of hypernatremia. Dextrose 5% in 0.9% sodium chloride
is a hypertonic solution. The nurse should anticipate a prescription for a hypotonic solution.
b. Dextrose 5% in lactated Ringer’s
i. A sodium level of 155 mEq/L is an indication of hypernatremia. Lactated Ringer's contains sodium
and other electrolytes and is not indicated for hypernatremia.
c. 3% sodium chloride
i. A sodium level of 155 mEq/L is an indication of hypernatremia, and 3% sodium chloride is a
hypertonic solution. The nurse should anticipate a prescription for a hypotonic solution.
d. 0.45% sodium chloride
i. A sodium level of 155 mEq/L is an indication of hypernatremia. The nurse should anticipate a
prescription for a hypotonic solution. The 0.45% sodium chloride is a hypotonic solution used to
provide free water and treat cellular dehydration, which promotes waste elimination by the
kidneys.
7. A nurse is assessing a client who has hypomagnesemia. Which of the following findings should the nurse
expect? a. Hyperactive deep-tendon reflexes
i. Hyperactive deep-tendon reflexes are an expected finding for a client who has hypomagnesemia. Other
expected findings include muscle cramps, numbness, and tingling.
b. Increased bowel sounds
i. Decreased bowel sounds are an expected finding for a client who has hypomagnesemia.
c. Drowsiness
i. Insomnia is an expected finding for a client who has hypomagnesemia.
d. Decreased blood pressure
i. Increased blood pressure is an expected finding for a client who has hypomagnesemia.
8. A nurse is assessing a client who has a phosphorous level of 2.4 mg/dL. Which of the following findings should the
nurse expect?
a. Hepatic failure
i. This phosphorus level is below the expected reference range of 3 to 4.5 mg/dL. The nurse should
assess a client who has hypophosphatemia for manifestations of kidney failure, not hepatic failure.
b. Abdominal pain
i. This phosphorus level is below the expected reference range. Hypophosphatemia causes weakness
of skeletal muscles and rhabdomyolysis, which is acute muscle breakdown. It does not cause
abdominal pain.
c. Slow peripheral pulses
, i. This phosphorus level is below the expected reference range. The nurse should expect the client to
have slow peripheral pulses. The nurse might also find that the client's pulses are difficult to find
and easy to block.
d. Increase in cardiac output
i. This phosphorus level is below the expected reference range. The nurse should expect a decrease
in cardiac output.
9. A nurse is caring for a client who is experiencing respiratory distress as a result of pulmonary edema. Which of
the following actions should the nurse take first?
a. Assist with intubation
i. The nurse should be prepared to assist the provider with intubation and mechanical ventilation if
less invasive measures are ineffective. However, there is another action the nurse should take first.
b. Initiate high flow oxygen therapy
i. When using the airway, breathing, circulation approach to client care, the nurse should first
administer high-flow oxygen therapy by face mask at 5 to 6 L/min to keep the client's oxygen
saturation above 90%.
c. Administer a rapid-acting diuretic
i. The nurse should administer a rapid-acting diuretic IV bolus to the client to relieve
pulmonary congestion. However, there is another action the nurse should take first.
d. Provide cardiac monitoring
i. The nurse should provide cardiac monitoring because premature ventricular contractions and
dysrhythmias are manifestations of pulmonary edema. However, there is another action the
nurse should take first.
10. A nurse is planning care for a client who has a potassium level of 3.0 mEq/L. The nurse should plan to monitor the client
for which of the following findings?
a. Hyperactive deep-tendon reflexes
i. The nurse should plan to monitor the client for hyporeflexia. Manifestations of hypokalemia
include weak hand grip strength and weak deep-tendon reflexes.
b. Orthostatic hypotension
i. The nurse should plan to monitor the client for orthostatic hypotension, which places them at risk
for falls. Orthostatic hypotension is a manifestation of hypokalemia.
c. Rapid, deep respirations
i. The nurse should plan to monitor the client for respiratory distress. Weakening of the
respiratory muscles and shallow respirations are manifestations of hypokalemia.
d. Strong, bounding pulse
i. The nurse should plan to monitor the client for a weak and thready pulse. A weak, thready pulse is
a manifestation of hypokalemia.
11. A nurse is providing teaching to a client who is at risk for developing respiratory acidosis following surgery. Which of
the following statements by the client indicates an understanding of the teaching?
a. “I should conserve energy by limiting my physical activity.”
i. The nurse should encourage the client to ambulate and change positions frequently to
prevent postoperative complications.
b. “I will wait until my pai is at least 6 out of 10 before I use the PCA.”
i. The nurse should encourage the client to use the PCA when feeling acute pain to prevent the pain
from worsening.
c. “I will limit my daily fluid intake to two to three glasses.”
i. Dehydration can cause metabolic acidosis. The nurse should encourage the client to take in
approximately 2,200 mL of fluid daily. This includes fluid intake of six to eight glasses containing 240
mL each, as well as liquids obtained from eating solid foods. Limiting fluid intake to two to three 8 oz
glasses would not meet the client's total daily intake needs.
d. “I will use the incentive spirometer every hour.”
i. Respiratory depression and limited chest expansion are both causes of respiratory acidosis. Using
an incentive spirometer will promote adequate chest expansion.
12. A nurse is assessing a client who is using PCA following a thoracotomy. The client is short of breath, appears restless, and
has a respiratory rate of 28/min. The client's ABG results are pH 7.52, PoO2 89 mm hg, and HCO3- 24 mEq/L. Which of
the following actions should the nurse take?
a. Instruct the client to cough forcefully
i. Coughing forcefully will not treat the underlying cause of the ABG results.
b. Assist the client with ambulation
