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Fluid and electrolyte balance plays an important role in homeostasis, and critical care nurses
assume a vital role in identifying and treating the physiologic stressors experienced by critically
ill patients that disrupt homeostasis.
This nursing exam covers the concepts of fluids and electrolytes. Test your knowledge with this
30-item exam and feel confident to soar high in your NCLEX with this questionnaire.
Topics
Homeostasis
Fluids and Electrolytes
Guidelines
Follow the guidelines below to make the most out of this exam:
Questions
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1. Lee Angela’s lab test just revealed that her chloride level is 96 mEq/L. As a nurse, you
would interpret this serum chloride level as:
A. high
B. low
C. within normal range
D. high normal
2. Which of the following conditions is associated with elevated serum chloride levels?
A. cystitis
B. diabetes
C. eclampsia
D. hypertension
A. compound
B. ion
C. anion
D. cation
4. Nursing intervention for the patient with hyperphosphatemia include encouraging intake
of:
A. amphojel
B. Fleets phospho-soda
C. milk
D. vitamin D
5. Etiologies associated with hypocalcemia may include all of the following except:
A. renal failure
B. inadequate intake calcium
C. metastatic bone lesions
D. vitamin D deficiency
6. Which of the following findings would the nurse expect to asses in hypercalcemia?
7. Which of the following is not an appropriate nursing intervention for a patient with
hypercalcemia?
A. administering calcitonin
B. administering calcium gluconate
C. administering loop diuretics
D. encouraging ambulation
A. insulin shock
B. hyperadrenalism
C. nausea and vomiting
D. renal failure
10. For a patient with hypomagnesemia, which of the following medications may become
toxic?
A. Lasix
B. Digoxin
C. calcium gluconate
D. CAPD
11. Which of the following is the most important physical assessment parameter the nurse
would consider when assessing fluid and electrolyte imbalance?
A. skin turgor
B. intake and output
C. osmotic pressure
D. cardiac rate and rhythm
A. urine
B. gastric drainage
C. bleeding
D. perspiration
13. Which of the following intravenous solutions would be appropriate for a patient with
severe hyponatremia secondary to syndrome of inappropriate antidiuretic hormone
(SIADH)?
A. hypotonic solution
B. hypertonic solution
C. isotonic solution
D. normotonic solution
14. Aldosterone secretion in response to fluid loss will result in which one of the following
electrolyte imbalances?
A. hypokalemia
B. hyperkalemia
C. hyponatremia
D. hypernatremia
15. When assessing a patient for signs of fluid overload, the nurse would expect to observe:
A. bounding pulse
B. flat neck veins
C. poor skin turgor
D. vesicular
16. The physician has ordered IV replacement of potassium for a patient with severe
hypokalemia. The nurse would administer this:
A. by rapid bolus
B. diluted in 100 cc over 1 hour
C. diluted in 10 cc over 10 minutes
D. IV push
17. Which of the following findings would the nurse exp[ect to assess in a patient with
hypokalemia?
A. hypertension
B. pH below 7.35
C. hypoglycemia
D. hyporeflexia
18. Vien is receiving oral potassium supplements for his condition. How should the
supplements be administered?
A. undiluted
B. diluted
C. on an empty stomach
D. at bedtime
A. hydrogen
B. hydroxide
C. oxygen
D. carbon dioxide
21. To determine if a patient’s respiratory system is functioning, the nurse would assess
which of the following parameters:
A. respiratory rate
B. pulse
C. arterial blood gas
D. pulse oximetry
22. Which of the following conditions is an equal decrease of extracellular fluid (ECF)
solute and water volume?
A. hypotonic FVD
B. isotonic FVD
C. hypertonic FVD
D. isotonic FVE
23. When monitoring the daily weight of a patient with fluid volume deficit (FVD), the
nurse is aware that fluid loss may be considered when weight loss begins to exceed:
A. 0.25 lb
B. 0.50 lb
C. 1 lb
D. 1 kg
24. Dietary recommendations for a patient with a hypotonic fluid excess should include:
26. A rise in arterial pressure causes the baroreceptors and stretch receptors to signal an
inhibition of the sympathetic nervous system, resulting in:
28. When assessing a patient for electrolyte balance, the nurse is aware that etiologies for
hyponatremia include:
A. water gain
B. diuretic therapy
C. diaphoresis
D. all of the following
A. acidosis
B. alkalosis
C. homeostasis
D. neutrality
2. Answer: C. eclampsia
3. Answer: C. anion
Chloride is a major anion found in the extracellular fluid. A compound occurs when two ions are
bound together. Chloride is an ion, but this choice is too general. HCO3 is a cation.
4. Answer: A. amphogel
Administration of phosphate binders (amphogel and basagel) will reduce the serum phosphate
levels.
Metastatic bone lesions are associated with hypercalcemia due to accelerated bone metabolism
and release of calcium into the serum. Renal failure, inadequate calcium intake, and vitamin D
deficiency may cause hypocalcemia.
Urinary calculi may occur with hypercalcemia. Shortened, not prolonged QRS complex would
be seen in hypercalcemia. Tetany and petechiae are signs of hypocalcemia.
Calcium gluconate is used for replacement in deficiency states. Calcitonin and loop diuretics are
used to lower serum calcium.
Cardiac rate and rhythm are the most important physical assessment parameter to measure. Skin
turgor, intake and output are physical assessment parameters a nurse would consider when
assessing fluid and electrolyte imbalance, but choice d is the most important.
Perspiration and the fluid lost via the lungs are termed insensible losses; normally, insensible
losses equal about 1000 cc/day.
When hyponatremia is severe, hypertonic solutions may be used but should be infused with
caution due to the potential for development of CHF. In SIADH, isotonic and hypotonic
solutions are not indicated, because urine output is minimal, so water is retained. this water
retention dilutes serum sodium levels, making the patient hyponatremic and necessitating
administration of hypertonic solutions to balance sodium and water. Normotonic solutions do not
exist.
Aldosterone is secreted in response to fluid loss. Aldosterone causes sodium reabsorption and
potassium elimination, further exacerbating hypokalemia.
Bounding pulse is a sign of fluid overload as more volume in the vessels causes a stronger
sensation against the blood vessel walls. Flat neck veins and vesicular breath sounds are normal
findings. Poor skin turgor is consistent with dehydration.
Potassium must be well diluted and given slowly because rapid administration will cause cardiac
arrest.
17. Answer: D. hyporeflexia
Oral potassium supplements are known to irritate gastrointestinal (GI) mucosa and should be
diluted.
Normal venous blood pH ranges from 7.31 to 7.41. Normal arterial blood pH ranges from 7.35 to
7.45.
Arterial blood gases will indicate CO2 and O2 levels. This is an indication that the respiratory
system is functioning. Respiratory rate can reveal data about other systems, such as the brain,
making letter c a better choice. Pulse rate is not measure of respiratory status. Pulse oximetry
yields oxygen saturation levels, which is not a measure of acid-base balance.
Isotonic FVD involves an equal decrease in solute concentration and water volume.
Hypotonic fluid volume excess (FVE) involves an increase in water volume without an increase
in sodium concentration. Increased sodium intake is part of the management of this condition.
In diffusion, the solute moves from an area of higher concentration to one of lower
concentration, creating osmotic pressure. Osmotic pressure is related to the process of osmosis.
Filtration is created by hydrostatic pressure. Capillary dynamics are related to fluid exchange at
the intravascular and interstitial levels.
26. Answer: D. increased urine output
Arterial baroreceptors and stretch receptors help maintain fluid balance by increasing urine
output in response to a rise in arterial pressure.
See Also