Review Practice Exercise 2

Fluids and Electrolytes & Acid-Base Balance > Fundamentals

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Practice Exercise 2

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Total Questions : 5

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Question 1:

An older nursing home resident has refused to eat or drink for several days and is admitted to the hospital. The nurse should expect which assessment finding?

A. Increased blood pressure B. Weak, rapid pulse C. Moist mucous membranes D. Jugular vein distention

Answer and Explanation

Choice A:

Increased blood pressure: With decreased intravascular volume, BP typically falls (or shows orthostatic drops). Hypertension would not be expected unless there’s another cause.

Choice B:

Weak, rapid pulse: Tachycardia is a compensatory response to low stroke volume; the pulse feels weak (thready) due to reduced preload.

Choice C:

Moist mucous membranes: Dehydration causes dry, sticky mucous membranes and often a coated tongue.

Choice D:

Jugular vein distention: Hypovolemia produces flat/collapsed neck veins; JVD suggests fluid overload or right-sided heart issues, not dehydration.

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Question 2:

The intake and output (I&O) record of a client with a nasogastric tube who has been attached to suction for 2 days shows greater output than input. Which nursing diagnoses are most applicable? Select all that apply

A. Deficient Fluid Volume B. Risk for Deficient Fluid Volume C. Impaired Oral Mucous Membranes D. Impaired Gas Exchange E. Decreased Cardiac Output

Answer and Explanation

Choice A:

Deficient Fluid Volume: Negative I&O over 2 days with GI suction results in actual hypovolemia.

Choice B:

Risk for Deficient Fluid Volume: “Risk for” is used when a problem hasn’t occurred yet; here the deficit is present.

Choice C:

Impaired Oral Mucous Membranes: NPO/NG suction commonly cause dry, irritated oral mucosa.

Choice D:

Impaired Gas Exchange: No evidence of oxygenation/ventilation issues provided.

Choice E:

Decreased Cardiac Output: Could occur with severe hypovolemia, but no VS or perfusion findings provided.

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Question 3:

Which client statement indicates a need for further teaching regarding treatment for hypokalemia?

A. “I will use avocado in my salads.” B. “I will be sure to check my heart rate before I take my digoxin.” C. “I will take my potassium in the morning after eating breakfast.” D. “I will stop using my salt substitute.”

Answer and Explanation

Choice A:

“I will use avocado in my salads.” Avocados are rich in potassium and are an appropriate dietary choice for someone with hypokalemia. This statement reflects correct understanding of incorporating potassium-rich foods.

Choice B:

“I will be sure to check my heart rate before I take my digoxin.” Hypokalemia increases sensitivity to digoxin, putting the client at risk for digoxin toxicity, which manifests as bradycardia, nausea, and visual disturbances. Checking the heart rate before taking digoxin is an essential safety practice.

Choice C:

“I will take my potassium in the morning after eating breakfast.” Potassium supplements can irritate the gastrointestinal tract, so they should be taken with food or after meals to reduce GI upset. Taking them in the morning after breakfast is appropriate.

Choice D:

“I will stop using my salt substitute.” Most salt substitutes are made with potassium chloride, which can actually help correct hypokalemia. Stopping the use of salt substitutes would decrease potassium intake and worsen hypokalemia.

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Question 4:

An older man is admitted to the medical unit with a diagnosis of dehydration. Which sign or symptom is most representative of a sodium imbalance?

A. Hyperreflexia B. Mental confusion C. Irregular pulse D. Muscle weakness

Answer and Explanation

Choice A:

Hyperreflexia: More typically associated with disorders that increase neuromuscular excitability (for example, hypocalcemia or hypomagnesemia). It is not a classic or specific sign of sodium imbalance.

Choice B:

Mental confusion: Sodium disturbances (both hyponatremia and hypernatremia) cause changes in neuronal cell volume and cerebral function, so altered mental status/confusion is a hallmark sign.

Choice C:

Irregular pulse: Cardiac rhythm disturbances are most classically linked to potassium abnormalities (hyper- or hypokalemia). Sodium imbalance is less likely to present primarily as an irregular pulse.

Choice D:

Muscle weakness: Can occur with several electrolyte problems (notably potassium disorders). Severe hypernatremia may cause weakness, but muscle weakness is a less specific/typical sign of sodium imbalance than CNS changes like confusion.

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Question 5:

Which of the following is the most common etiologic factor related to the nursing diagnosis of Excess Fluid Volume?

A. Increased need for fluids secondary to fever B. Abnormal fluid loss from vomiting C. Excessive IV infusion D. Decreased fluid intake secondary to depression

Answer and Explanation

Choice A:

Increased need for fluids secondary to fever: Fever increases insensible losses and fluid need; if anything, fever predisposes to deficit, not excess.

Choice B:

Abnormal fluid loss from vomiting: Vomiting causes fluid loss and dehydration, not excess volume.

Choice C:

Excessive IV infusion: Administering IV fluids too rapidly or in inappropriate amounts is a common iatrogenic cause of fluid volume excess, especially in patients with impaired cardiac or renal function who cannot handle the added load.

Choice D:

Decreased fluid intake secondary to depression: Decreased intake produces deficit, not excess.

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Practice Exercise 2

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