NURS MISC EXAM ch 38-fluids,electrolytes,&acid-
base balance QUESTIONS WITH ANSWERS 2023
A+
MULTIPLE CHOICE
A patient is admitted to the emergency department (ED) in respiratory
distress. The results of his first arterial blood gases were pH = 7.30;
PCO2 = 40; HCO3 = 19 mEq/L; PO2 = 80. The nurse evaluates the
patient’s treatment plan by examin- ing repeat arterial blood gases
(ABGs). The results are pH = 7.38; PCO2 = 32; HCO3 = 19 mEq/L. The
nurse concludes which of the following?
a) Respiratory acidosis; the
treatment plan is ineffective.
b) Metabolic alkalosis; the
treatment plan is effective.
c) Partial compensation; the
treatment plan is ineffective.
d) Complete compensation; the
treat- ment plan is effective.
ANS: D
Complete compensation has occurred as the PCO2 has returned the pH
to the normal range. This change indicates that the treatment plan is
effective. Partial compensation would be indicated by changes in the
PCO2 but the pH would still be outside the normal range. The ABG is
now complete compensation metabolic acidosis.
Difficulty: Difficult
Nursing Process:
Evaluation Client Need:
PHSI Cognitive Level:
Analysis
PTS: 1
When a patient has metabolic acidosis, which body system influences
the acid– base imbalance to produce the compensatory changes in
the arterial blood gases?
a) Respiratory system
b) Renal system
c) Vascular system
d) Neurological system
ANS: A
In a metabolic problem, the respiratory system compensates. In a
respiratory problem, the renal system must compensate. The
respiratory system compen- sates early in the disorder, but it may
take up to 3 days for the renal system to compensate fully.
,NURS MISC EXAM ch 38-fluids,electrolytes,&acid-
base balance QUESTIONS WITH ANSWERS 2023
A+
Difficulty: Moderate
Nursing Process:
Evaluation Client Need:
PHSI Cognitive Level:
Analysis
PTS: 1
A patient’s arterial blood gas results are as follows: pH = 7.30; PCO2 =
40; HCO3
= 19 mEq/L; PO2 = 80. An appropriate nursing diagnosis for the
patient is which of the following?
a) Impaired Gas Exchange
b) Metabolic Acidosis
c) Risk for Impaired Gas Exchange
d) Risk for Acid–Base Imbalance
ANS: A
An appropriate diagnosis is Impaired Gas Exchange. The arterial blood
gas (ABG) results provide the defining characteristics for Impaired Gas
Exchange. The ABG results demonstrate metabolic acidosis; however,
this is not a nursing diagnosis. The patient has an actual problem;
therefore, the “risk for” nursing di- agnoses are incorrect. Additionally,
there is no nursing diagnosis of Acid–Base Imbalance or Risk for Acid–
Base Imbalance.
Difficulty: Moderate
Nursing Process:
Diagnosis Client Need:
PHSI Cognitive Level:
Analysis
PTS: 1
The nurse is caring for a patient with a medical diagnosis of
hypernatremia. The following prescriptions are written in the client’s
electronic health record. Which one should the nurse question?
a) Administer an IV of D5W at 125
mL/hr.
b) Strict I&O monitoring.
c) Restrict oral intake to 900 mL
every 24 hr.
d) Monitor serum electrolytes every
4 hr.
ANS: C
,NURS MISC EXAM ch 38-fluids,electrolytes,&acid-
base balance QUESTIONS WITH ANSWERS 2023
A+
Restricting the oral intake of a patient with hypernatremia (Na+ greater
than 145 mEq/L) would lead to further elevation in the serum sodium
level. Infusing D5W IV fluid is appropriate, as this solution does not
contain sodium. Hydrating the pa- tient with D5W would reduce the
serum sodium level. Strict I&O monitoring and laboratory evaluation of
electrolytes every 4 hr would ensure that the patient is safely
rehydrated.
Difficulty: Difficult
Nursing Process:
Interventions Client Need:
PHSI
Cognitive Level: Application
PTS: 1
Which process requires energy to maintain the unique composition of
extracellu- lar and intracellular compartments?
a) Diffusion
b) Osmosis
c) Filtration
d) Active transport
ANS: D
Active transport occurs when molecules move across cell membranes
from an area of low concentration to an area of high concentration.
Active transport re- quires energy expenditure for the movement to
occur against a concentration gradient. In the presence of ATP, the
sodium–potassium pump actively moves sodium from the cell into the
extracellular fluid. Active transport is vital for main- taining the unique
composition of both the extracellular and intracellular compart- ments.
Diffusion, osmosis, and filtration are passive processes.
Difficulty: Difficult
Nursing Process:
NA Client Need:
PHS
Cognitive Level: Comprehension
PTS: 1
The nurse records a patient’s hourly urine output from an indwelling
catheter as follows:
0700: 36 mL
0800: 45 mL
0900: 85 mL
1000: 62 mL
1100: 50 mL
, NURS MISC EXAM ch 38-fluids,electrolytes,&acid-
base balance QUESTIONS WITH ANSWERS 2023
A+
1200: 48 mL
1300: 94 mL
1400: 78 mL
1500: 60 mL
The nurse can conclude that the patient’s urine output should be
described as which of the following?
a) Low
b) Within normal limits
c) High
d) Inconclusive
ANS: B
Urine accounts for the greatest amount of fluid loss. Normal urine
output for an average-sized adult is approximately 1,500 mL in 24
hr. Urine output varies ac- cording to intake and activity but should
remain at least 30 to 50 mL per hour. The patient’s urine output is
within the normal range. This patient has an in- dwelling catheter,
which will result in continual flow of urine.
Difficulty: Moderate
Nursing Process:
Evaluation Client Need:
PHSI Cognitive Level:
Analysis
After morning care, the nurse lowered the height of the IV container
infusing via gravity flow, at the patient’s request. What is the nurse’s
next best action?
a) Calculate the new infusion rate.
b) Readjust the infusion rate, as
needed.
c) Change the IV site and move it
to the other arm.
d) Instruct the client to call when
the IV bag is empty.
ANS: B
The rate of an IV infusing via gravity draining will be altered by raising
or lowering the IV solution. Thus, if the IV pole is lowered, the rate will
need to be verified and adjusted as needed. The drip rate is based on
the administration set and prescribed rate and is not affected by the
height of the IV solution. The IV site will need to be changed only when
clinically indicated. The nurse should not rely on the patient, but
should monitor the infusion amount.
base balance QUESTIONS WITH ANSWERS 2023
A+
MULTIPLE CHOICE
A patient is admitted to the emergency department (ED) in respiratory
distress. The results of his first arterial blood gases were pH = 7.30;
PCO2 = 40; HCO3 = 19 mEq/L; PO2 = 80. The nurse evaluates the
patient’s treatment plan by examin- ing repeat arterial blood gases
(ABGs). The results are pH = 7.38; PCO2 = 32; HCO3 = 19 mEq/L. The
nurse concludes which of the following?
a) Respiratory acidosis; the
treatment plan is ineffective.
b) Metabolic alkalosis; the
treatment plan is effective.
c) Partial compensation; the
treatment plan is ineffective.
d) Complete compensation; the
treat- ment plan is effective.
ANS: D
Complete compensation has occurred as the PCO2 has returned the pH
to the normal range. This change indicates that the treatment plan is
effective. Partial compensation would be indicated by changes in the
PCO2 but the pH would still be outside the normal range. The ABG is
now complete compensation metabolic acidosis.
Difficulty: Difficult
Nursing Process:
Evaluation Client Need:
PHSI Cognitive Level:
Analysis
PTS: 1
When a patient has metabolic acidosis, which body system influences
the acid– base imbalance to produce the compensatory changes in
the arterial blood gases?
a) Respiratory system
b) Renal system
c) Vascular system
d) Neurological system
ANS: A
In a metabolic problem, the respiratory system compensates. In a
respiratory problem, the renal system must compensate. The
respiratory system compen- sates early in the disorder, but it may
take up to 3 days for the renal system to compensate fully.
,NURS MISC EXAM ch 38-fluids,electrolytes,&acid-
base balance QUESTIONS WITH ANSWERS 2023
A+
Difficulty: Moderate
Nursing Process:
Evaluation Client Need:
PHSI Cognitive Level:
Analysis
PTS: 1
A patient’s arterial blood gas results are as follows: pH = 7.30; PCO2 =
40; HCO3
= 19 mEq/L; PO2 = 80. An appropriate nursing diagnosis for the
patient is which of the following?
a) Impaired Gas Exchange
b) Metabolic Acidosis
c) Risk for Impaired Gas Exchange
d) Risk for Acid–Base Imbalance
ANS: A
An appropriate diagnosis is Impaired Gas Exchange. The arterial blood
gas (ABG) results provide the defining characteristics for Impaired Gas
Exchange. The ABG results demonstrate metabolic acidosis; however,
this is not a nursing diagnosis. The patient has an actual problem;
therefore, the “risk for” nursing di- agnoses are incorrect. Additionally,
there is no nursing diagnosis of Acid–Base Imbalance or Risk for Acid–
Base Imbalance.
Difficulty: Moderate
Nursing Process:
Diagnosis Client Need:
PHSI Cognitive Level:
Analysis
PTS: 1
The nurse is caring for a patient with a medical diagnosis of
hypernatremia. The following prescriptions are written in the client’s
electronic health record. Which one should the nurse question?
a) Administer an IV of D5W at 125
mL/hr.
b) Strict I&O monitoring.
c) Restrict oral intake to 900 mL
every 24 hr.
d) Monitor serum electrolytes every
4 hr.
ANS: C
,NURS MISC EXAM ch 38-fluids,electrolytes,&acid-
base balance QUESTIONS WITH ANSWERS 2023
A+
Restricting the oral intake of a patient with hypernatremia (Na+ greater
than 145 mEq/L) would lead to further elevation in the serum sodium
level. Infusing D5W IV fluid is appropriate, as this solution does not
contain sodium. Hydrating the pa- tient with D5W would reduce the
serum sodium level. Strict I&O monitoring and laboratory evaluation of
electrolytes every 4 hr would ensure that the patient is safely
rehydrated.
Difficulty: Difficult
Nursing Process:
Interventions Client Need:
PHSI
Cognitive Level: Application
PTS: 1
Which process requires energy to maintain the unique composition of
extracellu- lar and intracellular compartments?
a) Diffusion
b) Osmosis
c) Filtration
d) Active transport
ANS: D
Active transport occurs when molecules move across cell membranes
from an area of low concentration to an area of high concentration.
Active transport re- quires energy expenditure for the movement to
occur against a concentration gradient. In the presence of ATP, the
sodium–potassium pump actively moves sodium from the cell into the
extracellular fluid. Active transport is vital for main- taining the unique
composition of both the extracellular and intracellular compart- ments.
Diffusion, osmosis, and filtration are passive processes.
Difficulty: Difficult
Nursing Process:
NA Client Need:
PHS
Cognitive Level: Comprehension
PTS: 1
The nurse records a patient’s hourly urine output from an indwelling
catheter as follows:
0700: 36 mL
0800: 45 mL
0900: 85 mL
1000: 62 mL
1100: 50 mL
, NURS MISC EXAM ch 38-fluids,electrolytes,&acid-
base balance QUESTIONS WITH ANSWERS 2023
A+
1200: 48 mL
1300: 94 mL
1400: 78 mL
1500: 60 mL
The nurse can conclude that the patient’s urine output should be
described as which of the following?
a) Low
b) Within normal limits
c) High
d) Inconclusive
ANS: B
Urine accounts for the greatest amount of fluid loss. Normal urine
output for an average-sized adult is approximately 1,500 mL in 24
hr. Urine output varies ac- cording to intake and activity but should
remain at least 30 to 50 mL per hour. The patient’s urine output is
within the normal range. This patient has an in- dwelling catheter,
which will result in continual flow of urine.
Difficulty: Moderate
Nursing Process:
Evaluation Client Need:
PHSI Cognitive Level:
Analysis
After morning care, the nurse lowered the height of the IV container
infusing via gravity flow, at the patient’s request. What is the nurse’s
next best action?
a) Calculate the new infusion rate.
b) Readjust the infusion rate, as
needed.
c) Change the IV site and move it
to the other arm.
d) Instruct the client to call when
the IV bag is empty.
ANS: B
The rate of an IV infusing via gravity draining will be altered by raising
or lowering the IV solution. Thus, if the IV pole is lowered, the rate will
need to be verified and adjusted as needed. The drip rate is based on
the administration set and prescribed rate and is not affected by the
height of the IV solution. The IV site will need to be changed only when
clinically indicated. The nurse should not rely on the patient, but
should monitor the infusion amount.
