CHAPTER 39: Fundamentals of Nursing, 2nd Edition – Active Learning for Collaborative Practice by Yoost & Crawford

Fundamentals of Nursing, 2nd Edition – Active Learning for Collaborative Practice by Yoost & Crawford Chapter 39: Fluid, Electrolytes, and Acid-Base Balance Multiple Choice Questions 1. What assessment finding would the nurse expect in a severely malnourished patient with critically low albumin levels? A. Generalized 3+ pitting edema B. Confusion and disorientation C. Dark, concentrated urine D. Diminished lung sounds Answer: A Explanation: Low albumin reduces oncotic pressure, causing fluid to leak into interstitial spaces and resulting in pitting edema. Why Other Options Are Wrong: B suggests neurological issues; C indicates dehydration; D reflects respiratory compromise, none of which are directly caused by hypoalbuminemia. 2. Which laboratory result requires immediate physician notification due to life threatening risk? A. Serum chloride 85 mEq/L B. Serum sodium 134 mEq/L C. Serum potassium 6.8 mEq/L D. Serum magnesium 2.3 mEq/L Answer: C Explanation: Potassium 5.0 mEq/L risks cardiac arrhythmias; 6.8 mEq/L is critically high. Why Other Options Are Wrong: A and B are mildly low; D is slightly elevated but not urgent. 3. What home monitoring strategy should a nurse teach a heart failure patient at risk for fluid overload? A. Check for bright yellow urine B. Weigh daily before breakfast C. Count evening heart rate D. Drink plain water only Answer: B Explanation: Daily weights detect fluid retention early (e.g., 2 kg gain in 3 days signals overload). Why Other Options Are Wrong: A is unreliable; C doesn't reflect fluid status; D is general advice, not monitoring. 4. Which finding in a diabetic ketoacidosis (DKA) patient shows compensatory pH correction? A. Deep, rapid respirations B. Dark, concentrated urine C. Pale, diaphoretic skin D. Somnolence Answer: A Explanation: Kussmaul respirations eliminate CO₂ (converted to carbonic acid) to reduce acidosis. Why Other Options Are Wrong: B indicates dehydration; C suggests shock; D reflects worsening acidosis. 5. Which electrolyte imbalance is most likely in a patient taking furosemide (Lasix) for heart failure? A. Hypocalcemia B. Hypernatremia C. Hypokalemia D. Hyperphosphatemia Answer: C Explanation: Loop diuretics like furosemide cause renal potassium wasting. Why Other Options Are Wrong: A, B, and D are not typical diuretic-induced imbalances. 6. Which ABG results would the nurse expect in a narcotic-overdose patient with respiratory arrest? A. pH 7.56, PaCO₂ 32 mm Hg, HCO₃ 32 mEq/L B. pH 7.35, PaCO₂ 45 mm Hg, HCO₃ 26 mEq/L C. pH 7.45, PaCO₂ 38 mm Hg, HCO₃ 28 mEq/L D. pH 7.27, PaCO₂ 58 mm Hg, HCO₃ 24 mEq/L Answer: D Explanation: Respiratory acidosis (↓pH, ↑PaCO₂) occurs due to hypoventilation; low PaO₂ reflects hypoxia. Why Other Options Are Wrong: A shows alkalosis; B is normal; C is compensated. 7. What likely caused a dehydrated patient with gastroenteritis to faint upon standing? A. Orthostatic hypotension B. Circulatory overload C. Hemolytic reaction D. Catheter embolism Answer: A Explanation: Hypovolemia reduces venous return, causing BP drop and syncope upon standing. Why Other Options Are Wrong: B, C, and D are unrelated to dehydration. 8. Which condition causes ABGs showing pH 7.56, PaCO₂ 32 mm Hg, HCO₃ 42 mEq/L? A. Gastroenteritis with vomiting B. Cardiogenic shock C. Pneumonia with effusions D. Panic attack Answer: A Explanation: Vomiting loses gastric acid, causing metabolic alkalosis (↑pH, ↑HCO₃) with respiratory compensation (↓PaCO₂). Why Other Options Are Wrong: B causes lactic acidosis; C causes respiratory acidosis; D causes respiratory alkalosis. 9. How much fluid may a patient consume if they have a 1200 mL restriction and have already had 1050 mL? A. 100 mL B. 150 mL C. 250 mL D. 300 mL Answer: B Explanation: 1200 mL - 1050 mL = 150 mL remaining. Why Other Options Are Wrong: A, C, and D miscalculate the remaining allowance. 10. Which goal is highest priority for a hypervolemic heart failure patient? A. Clear lung sounds B. Urine output ≥30 mL/hr C. Understanding fluid restrictions D. Resolving pedal edema in 72 hours Answer: A Explanation: Pulmonary edema threatens oxygenation, making respiratory status the priority. Why Other Options Are Wrong: B, C, and D are important but secondary to airway/breathing. 11. Which IV fluid corrects hyponatremia and fluid overload in SIADH? A. 0.33% saline B. 0.45% saline C. 0.9% saline D. 3% saline Answer: D Explanation: 3% saline is hypertonic, raising serum sodium and pulling fluid into vasculature. Why Other Options Are Wrong: A and B are hypotonic and worsen overload; C is isotonic and insufficient. 12. Which IV is best for intermittent furosemide boluses in heart failure? A. PICC line B. Midline catheter C. Central venous catheter D. Peripheral angiocatheter Answer: D Explanation: Peripheral IVs are sufficient for short-term, non-vesicant medications like furosemide. Why Other Options Are Wrong: A, B, and C are for long-term/vesicant therapies. 13. What is the most critical intervention for a central venous catheter (CVC)? A. Document site assessments B. Use sterile technique for dressing changes C. Label dressings with date/time D. Discontinue CVC ASAP Answer: B Explanation: Sterile technique prevents catheter-related bloodstream infections. Why Other Options Are Wrong: A, C, and D are important but less critical than infection prevention. 14. What should the nurse do for a painful, puffy IV site? A. Restart IV in another arm B. Aspirate for blood return C. Redress with chlorhexidine D. Change tubing and give analgesics Answer: A Explanation: Pain and puffiness indicate infiltration, requiring immediate discontinuation. Why Other Options Are Wrong: B, C, and D are inappropriate for infiltrated IVs. 15. What is the priority when administering dopamine (Intropin) IV? A. Check for blood return B. Use new tubing per dose C. Document administration D. Wear sterile gloves Answer: A Explanation: Vesicants like dopamine must be confirmed intravascularly to avoid tissue necrosis. Why Other Options Are Wrong: B, C, and D are standard practices but secondary to line patency. 16. What should the nurse verify before obtaining packed RBCs for transfusion? A. Blood type compatibility B. IV patency C. Infusion pump settings D. Availability of microdrip tubing Answer: B Explanation: A patent IV is essential before blood retrieval to ensure timely administration. Why Other Options Are Wrong: A is checked after obtaining blood; C and D are post-retrieval steps. 17. What is the priority action for a transfusion reaction with hypotension and headache? A. Administer antipyretics B. Recheck BP after analgesics C. Stop transfusion and run saline D. Reconfirm blood type Answer: C Explanation: Immediate cessation prevents further reaction; saline maintains IV access. Why Other Options Are Wrong: A and B delay treatment; D is a pre-transfusion step. 18. Which finding confirms resolution of dehydration? A. 1300 mL light yellow urine/24h B. Clear lung sounds C. No jugular distention D. Verbalized fluid intake understanding Answer: A Explanation: Adequate, light-colored urine reflects restored hydration and renal perfusion. Why Other Options Are Wrong: B and C assess for overload; D is educational, not clinical. 19. What is the priority intervention for serum sodium of 120 mEq/L? A. Neurologic checks/seizure precautions B. High-sodium diet encouragement C. Hypotonic IV administration D. Digoxin toxicity monitoring Answer: A Explanation: Severe hyponatremia risks seizures; neurologic monitoring is critical. Why Other Options Are Wrong: B is adjunctive; C worsens hyponatremia; D is unrelated. 20. How should a nurse advise a heart failure patient who stopped furosemide due to nocturia? A. Request a dose reduction B. Take it in the morning C. Increase potassium/salt limits D. Restrict evening fluids Answer: B Explanation: Morning dosing minimizes nocturnal diuresis while maintaining therapeutic effect. Why Other Options Are Wrong: A risks fluid overload; C and D are less effective than timing adjustment. 21. Why would insulin/dextrose be given to a non-diabetic with renal failure and potassium 7.1 mEq/L? A. Promote kidney healing B. Lower potassium to prevent arrhythmias C. Prevent magnesium-deficient seizures D. Increase urine output Answer: B Explanation: Insulin shifts potassium intracellularly, reducing serum levels and cardiac risks. Why Other Options Are Wrong: A, C, and D are unrelated to insulin's role in hyperkalemia. 22. What is the priority nursing diagnosis for hyperparathyroidism with calcium 14.5 mg/dL? A. Risk for injury from fractures B. Need for calcium education C. Risk for constipation D. Activity intolerance Answer: A Explanation: Chronic hypercalcemia weakens bones, increasing fracture risk. Why Other Options Are Wrong: B, C, and D are secondary concerns. 23. What is the highest priority goal for a patient with magnesium 0.8 mEq/L? A. Urine output ≥30 mL/hr B. Verbalize magnesium-rich diet importance C. Maintain intact oral mucosa D. Remain alert/seizure-free Answer: D Explanation: Hypomagnesemia causes neurologic dysfunction (seizures, confusion). Why Other Options Are Wrong: A, B, and C are important but less critical than CNS stability. 24. What is the priority intervention for hypercalcemia (14.2 mg/dL) in hyperparathyroidism? A. Call for assistance before ambulating B. Change diaphoretic clothing C. Teach relaxation techniques D. Monitor urine output Answer: A Explanation: Hypercalcemia causes muscle weakness/bone fragility, increasing fall risk. Why Other Options Are Wrong: B, C, and D are unrelated to hypercalcemia's primary risks. MULTIPLE RESPONSE QUESTION 1. Which blood types can a B-positive patient receive? (Select all that apply.) A. AB positive B. AB negative C. B negative D. B positive E. O positive F. O negative Answer: C, D, E, F Explanation: B-positive patients can receive B or O blood (positive or negative) due to antigen compatibility. Why Other Options Are Wrong: AB blood contains A antigens, which would cause incompatibility.