Fluid and Electrolytes and Pain Management C.

Instructing the client to establish a bowel evacuation

schedule that changes every day.
1] D. Instructing the client to fill a 2-L bottle with water every
1. Patient X is diagnosed with constipation. As a night and drink it the next day.
knowledgeable nurse, which nursing intervention is 6. Mr. McPartlin suffered abrasions and lacerations after a
appropriate for maintaining normal bowel function? vehicular accident. He was hospitalized and was treated for a
couple of weeks. When planning care for a client with cellular
A. Assessing dietary intake injury, the nurse should consider which scientific rationale?
B. Decreasing fluid intake
C. Providing limited physical activity A. Nutritional needs remain unchanged for the well-
D. Turning, coughing, and deep breathing nourished adult.
2. A 12-year-old boy was admitted in the hospital two days B. Age is an insignificant factor in cellular repair.
ago due to hyperthermia. His attending nurse, Dennis, is quite C. The presence of infection may slow the healing process.
unsure about his plan of care. Which of the following nursing D. Tissue with inadequate blood supply may heal faster.
intervention should be included in the care of plan for the 7. A 22-year-old lady is displaying facial grimaces during her
client? treatment in the hospital due to burn trauma. Which
nursing intervention should be included for reducing pain due
A. Room temperature reduction to cellular injury?
B. Fluid restriction of 2,000 ml/day
C. Axillary temperature measurements every 4 hours A. Administering anti-inflammatory agents as prescribed
D. Antiemetic agent administration B. Elevating the injured area to decrease venous return to
3. Tom is ready to be discharged from the medical-surgical the heart
unit after 5 days of hospitalization. Which client statement C. Keeping the skin clean and dry
indicates to the nurse that Tom understands the discharge D. Applying warm packs initially to reduce edema
teaching about cellular injury? 8. Lisa, a client with altered urinary function, is under the care
of nurse Tine. Which intervention is appropriate to include
A. “I do not have to see my doctor unless i have problems.” when developing a plan of care for Lisa who is experiencing
B. “I can stop taking my antibiotics once I am feeling urinary dribbling?
better.”
C. “If I have redness, drainage, or fever, I should call my A. Inserting an indwelling Foley catheter
healthcare provider.” B. Having the client perform Kegel exercises
D. “I can return to my normal activities as soon as I go C. Keeping the skin clean and dry
home.” D. Using pads or diapers on the client
4. Nurse Katee is caring for Adam, a 22-year-old client, in a 9. Jeron is admitted in the hospital due to bacterial
long-term facility. Which nursing intervention would be pneumonia. He is febrile, diaphoretic, and has shortness of
appropriate when identifying nursing interventions aimed at breath and asthma. Which goal is the most important for the
promoting and preventing contractures? Select all that apply. client?
A. Clustering activities to allow uninterrupted periods of
rest
A. Prevention of fluid volume excess
B. Maintaining correct body alignment at all times
B. Maintenance of adequate oxygenation
C. Monitoring intake and output, using a urometer if
C. Education about infection prevention
necessary
D. Pain reduction
D. Using a footboard or pillows to keep feet in correct
10. Mang Rogelio, a 32-year-old patient, is about to be
position
discharged from the acute care setting. Which nursing
E. Performing active and passive range-of-motion exercises
intervention is the most important to include in the plan of
F. Weighing the client daily at the same time and in the
care?
same clothes
5. A 36-year-old male client is about to be discharged from
A. Stress-reduction techniques
the the hospital after 5 days due to surgery. Which
B. Home environment evaluation
intervention should be included in the home health care
C. Skin-care measures
nurse’s instructions about measures to prevent constipation?
D. Participation in activities of daily living
11. Mrs. dela Riva is in her first trimester of pregnancy. She
A. Discouraging the client from eating large amounts of
has been lying all day because her OB-GYN requested her to
roughage-containing foods in the diet.
have a complete bed rest. Which nursing intervention is
B. Encouraging the client to use laxatives routinely to
ensure adequate bowel elimination.
appropriate when addressing the client’s need to maintain B. Milk products and green, leafy vegetables
skin integrity? C. Pork products and canned vegetables
D. Orange juice and bananas
A. Monitoring intake and output accurately 17. Mary Jean, a first year nursing student, was rushed to the
B. Instructing the client to cough and deep-breathe every 2 clinic department due to hyperventilation. Which nursing
hours intervention is the most appropriate for the client who is
C. Keeping the linens dry and wrinkle free subsequently developing respiratory alkalosis?
D. Using a foot board to maintain correct anatomic position
12. Maya, who is admitted in a hospital, is scheduled to have A. Administering sodium chloride I.V.
her general checkup and physical assessment. Nurse Timothy B. Encouraging slow, deep breaths
observed a reddened area over her left hip. Which should the C. Preparing to administer sodium bicarbonate
nurse do first? D. Administer low-flow oxygen therapy
18. Nurse John Joseph is totaling the intake and output for
A. Massage the reddened are for a few minutes Elena Reyes, a client diagnosed with septicemia who is on a
B. Notify the physician immediately clear liquid diet. The client intakes 8 oz of apple juice, 850 ml
C. Arrange for a pressure-relieving device of water, 2 cups of beef broth, and 900 ml of half-normal
D. Turn the client to the right side for 2 hours saline solution and outputs 1,500 ml of urine during the shift.
13. Pierro was noted to be displaying facial grimaces after How many milliliters should the nurse document as the
nurse Kara assessed his complaints of pain rated as 8 on a client’s intake.
scale of 1 (no pain) 10 10 (worst pain). Which intervention
should the nurse do? A. 2,230
B. 2,740
A. Administering the client’s ordered pain medication C. 2,470
immediately D. 2,320
B. Using guided imagery instead of administering pain 19. Marie Joy’s lab test revealed that her serum calcium is 2.5
medication mEq/L. Which assessment data does the nurse document
C. Using therapeutic conversation to try to discourage pain when a client diagnosed with hypocalcemia develops a
medication carpopedal spasm after the blood-pressure cuff is inflated?
D. Attempting to rule out complications before
administering pain medication A. Positive Trousseau’s sign
14. Nurse Marthia is teaching her students about bacterial B. Positive Chvostek’s sign
control. Which intervention is the most important factor in C. Tetany
preventing the spread of microorganism? D. Paresthesia
20. Lab tests revealed that patient Z’s *Na++ is 170 mEq/L.
A. Maintenance of asepsis with indwelling catheter Which clinical manifestation would nurse Natty expect to
insertion assess?
B. Use of masks, gowns, and gloves when caring for clients
with infection A. Tented skin turgor and thirst
C. Correct handwashing technique B. Muscle twitching and tetany
D. Cleanup of blood spills with sodium hydrochloride C. Fruity breath and Kussmaul’s respirations
15. A patient with tented skin turgor, dry mucous membranes, D. Muscle weakness and paresthesia
and decreased urinary output is under nurse Mark’s care. 21. Mang Teban has a history of chronic obstructive
Which nursing intervention should be included the care plan pulmonary disease and has the following arterial blood gas
of Mark for his patient? results: partial pressure of oxygen (PO2), 55 mm Hg, and
partial pressure of carbon dioxide (PCO2), 60 mm Hg. When
A. Administering I.V. and oral fluids attempting to improve the client’s blood gas values through
B. Clustering necessary activities throughout the day improved ventilation and oxygen therapy, which is the client’s
C. Assessing color, odor, and amount of sputum primary stimulus for breathing?
D. Monitoring serum albumin and total protein levels
16. Khaleesi is admitted in the hospital due to having lower A. High PCO2
than normal potassium level in her bloodstream. Her medical B. Low PO2
history reveals vomiting and diarrhea prior to hospitalization. C. Normal pH
Which foods should the nurse instruct the client to increase? D. Normal bicarbonate (HCO3)
22. A client with very dry mouth, skin and mucous
A. Whole grains and nuts membranes is diagnosed of having dehydration. Which
intervention should the nurse perform when caring for a mm Hg, partial pressure of arterial carbon dioxide of 49 mm
client diagnosed with fluid volume deficit? Hg, and a bicarbonate level of 24 mEq/L. Based on these
results, which intervention should the nurse implement?
A. Assessing urinary intake and output
B. Obtaining the client’s weight weekly at different times of A. Instructing the client to breathe slowly into a paper bag
the day B. Administering low-flow oxygen
C. Monitoring arterial blood gas (ABG) results C. Encouraging the client to cough and deep breathe
D. Maintaining I.V. therapy at the keep-vein-open rate D. Nothing, because these ABG values are within normal
23. Which client situation requires the nurse to discuss the limits.
importance of avoiding foods high in potassium? 30. A client is diagnosed with metabolic acidosis, which would
the nurse expect the health care provider to order?
A. 14-year-old Elena who is taking diuretics
B. 16-year-old John Joseph with ileostomy A. Potassium
C. 16-year-old Gabriel with metabolic acidosis B. Sodium bicarbonate
D. 18-year-old Albert who has renal disease C. Serum sodium level
24. Genevieve is diagnosed with hypomagnesemia, which D. Bronchodilator
nursing intervention would be appropriate? 31. Lee Angela’s lab test just revealed that her chloride level is
96 mEq/L. As a nurse, you would interpret this serum chloride
A. Instituting seizure precaution to prevent injury level as:
B. Instructing the client on the importance of preventing
infection A. high
C. Avoiding the use of tight tourniquet when drawing blood B. low
D. Teaching the client the importance of early ambulation C. within normal range
25. Which electrolyte would the nurse identify as the major D. high normal
electrolyte responsible for determining the concentration of 32. Which of the following conditions is associated with
the extracellular fluid? elevated serum chloride levels?

A. Potassium A. cystitis
B. Phosphate B. diabetes
C. Chloride C. eclampsia
D. Sodium D. hypertension
26. Jon has a potassium level of 6.5 mEq/L, which medication 33. In the extracellular fluid, chloride is a major:
would nurse Wilma anticipate?
A. compound
A. Potassium supplements B. ion
B. Kayexalate C. anion
C. Calcium gluconate D. cation
D. Sodium tablets 34. Nursing intervention for the patient with
27. Which clinical manifestation would lead the nurse to hyperphosphatemia include encouraging intake of:
suspect that a client is experiencing hypermagnesemia?
A. amphogel
A. Muscle pain and acute rhabdomyolysis B. Fleets phospho-soda
B. Hot, flushed skin and diaphoresis C. milk
C. Soft-tissue calcification and hyperreflexia D. vitamin D
D. Increased respiratory rate and depth 35. Etiologies associated with hypocalcemia may include all of
28. Joshua is receiving furosemide and Digoxin, which the following except:
laboratory data would be the most important to assess in
planning the care for the client? A. renal failure
B. inadequate intake calcium
A. Sodium level C. metastatic bone lesions
B. Magnesium level D. vitamin D deficiency
C. Potassium level 36. Which of the following findings would the nurse expect to
D. Calcium level asses in hypercalcemia?
29. Mr. Salcedo has the following arterial blood gas (ABG)
values: pH of 7.34, partial pressure of arterial oxygen of 80 A. prolonged QRS complex
 B. tetany 44. Aldosterone secretion in response to fluid loss will result
C. petechiae in which one of the following electrolyte imbalances?
D. urinary calculi
37. Which of the following is not an appropriate nursing A. hypokalemia
intervention for a patient with hypercalcemia? B. hyperkalemia
C. hyponatremia
A. administering calcitonin D. hypernatremia
B. administering calcium gluconate 45. When assessing a patient for signs of fluid overload, the
C. administering loop diuretics nurse would expect to observe:
D. encouraging ambulation
38. A patient in which of the following disorders is at high risk A. bounding pulse
to develop hypermagnesemia? B. flat neck veins
C. poor skin turgor
A. insulin shock D. vesicular
B. hyperadrenalism 46. The physician has ordered IV replacement of potassium
C. nausea and vomiting for a patient with severe hypokalemia. The nurse would
D. renal failure administer this:
39. Nursing interventions for a patient with
hypermagnesemia include administering calcium gluconate A. by rapid bolus
to: B. diluted in 100 cc over 1 hour
C. diluted in 10 cc over 10 minutes
A. increase calcium levels D. IV push
B. antagonize the cardiac effects of magnesium 47. Which of the following findings would the nurse exp[ect to
C. lower calcium levels assess in a patient with hypokalemia?
D. lower magnesium levels
40. For a patient with hypomagnesemia, which of the A. hypertension
following medications may become toxic? B. pH below 7.35
C. hypoglycemia
A. Lasix D. hyporeflexia
B. Digoxin 48. Vien is receiving oral potassium supplements for his
C. calcium gluconate condition. How should the supplements be administered?
D. CAPD
41. Which of the following is the most important physical A. undiluted
assessment parameter the nurse would consider when B. diluted
assessing fluid and electrolyte imbalance? C. on an empty stomach
D. at bedtime
A. skin turgor 49. Normal venous blood pH ranges from:
B. intake and output
C. osmotic pressure A. 6.8 to 7.2
D. cardiac rate and rhythm B. 7.31 to 7.41
42. Insensible fluid losses include: C. 7.35 to 7.45
D. 7.0 to 8.0
A. urine 50. Respiratory regulation of acids and bases involves:
B. gastric drainage
C. bleeding A. hydrogen
D. perspiration B. hydroxide
43. Which of the following intravenous solutions would be C. oxygen
appropriate for a patient with severe hyponatremia D. carbon dioxide
secondary to syndrome of inappropriate antidiuretic hormone 51. To determine if a patient’s respiratory system is
(SIADH)? functioning, the nurse would assess which of the following
parameters:
A. hypotonic solution
B. hypertonic solution A. respiratory rate
C. isotonic solution B. pulse
D. normotonic solution C. arterial blood gas
 D. pulse oximetry C. restricting fluid intake
52. Which of the following conditions is an equal decrease of D. restricting sodium intake
extracellular fluid (ECF) solute and water volume? 60. The nurse would analyze an arterial pH of 7.46 as
indicating:
A. hypotonic FVD
B. isotonic FVD A. acidosis
C. hypertonic FVD B. alkalosis
D. isotonic FVE C. homeostasis
53. When monitoring the daily weight of a patient with fluid D. neutrality
volume deficit (FVD), the nurse is aware that fluid loss may be ANSWER KEY:
considered when weight loss begins to exceed: 1. 1Answer: A. Assessing dietary intake. Assessing dietary
intake provides a foundation for the client’s usual
A. 0.25 lb practices and may help determine if the client is prone to
B. 0.50 lb constipation or diarrhea. Limited physical activity may
C. 1 lb contribute to constipation due to decreased peristalsis.
D. 1 kg Turning, coughing and deep breathing help promote gas
54. Dietary recommendations for a patient with a hypotonic exchange. Fluid intake should be increased to aid bowel
fluid excess should include: elimination.
2. Answer: A. Room temperature reduction. For patient
A. decreased sodium intake with hyperthermia, reducing the room temperature may
B. increased sodium intake help decrease the body temperature. Tepid baths, cool
C. increased fluid intake compresses, and cooling blanket may also be necessary.
D. intake of potassium-rich foods Antipyretics, and not antiemetics, are indicated to
55. Osmotic pressure is created through the process of: reduce fever. Oral or rectal temperature measurements
are generally accepted and are more accurate than
A. osmosis axillary measurements. Fluids should be encouraged, not
B. diffusion restricted to compensate for insensible losses.
C. filtration 3. Answer: C. “If I have redness, drainage, or fever, I should
D. capillary dynamics call my healthcare provider.”. Knowledge that redness,
56. A rise in arterial pressure causes the baroreceptors and drainage, or fever — signs of infection associated with
stretch receptors to signal an inhibition of the sympathetic cellular injury — require reporting indicates that the
nervous system, resulting in: client has understood the nurse’s discharge teaching.
Follow-up checkups should be encouraged with an
emphasis of antibiotic compliance even if the client feels
A. decreased sodium reabsorption
better. There are usually activity limitations after cellular
B. increased sodium reabsorption
injury.
C. decreased urine output
4. Answer: B, D, E. Correct body alignment, preventing
D. increased urine output
footdrop, and range-of-motion exercises will help
57. Normal serum sodium concentration ranges from:
prevent contractures. Clustering activities will help
promote adequate rest. Monitoring intake and output
A. 120 to 125 mEq/L
and weighing the client will help maintain fluid and
B. 125 to 130 mEq/L electrolyte balance.
C. 136 to 145 mEq/L 5. Answer: D. Instructing the client to fill a 2-L bottle with
D. 140 to 148 mEq/L water every night and drink it the next day. Adequate
58. When assessing a patient for electrolyte balance, the fluids and fiber in the diet are key to preventing
nurse is aware that etiologies for hyponatremia include: constipation. Having the client fill a 2-L bottle with water
every night and drink it the next day is one method for
A. water gain ensuring the client receives at least 2,000 ml of water
B. diuretic therapy daily. The client also should be instructed to drink any
C. diaphoresis other fluids throughout the day. High fiber or roughage
D. all of the following foods are encouraged. Laxatives should not be used
59. Nursing interventions for a patient with hyponatremia routinely for bowel elimination. They should be used
include: only as a last resort, because clients may become
dependent on them. A regular bowel evacuation
A. administering hypotonic IV fluids schedule should be established.
B. encouraging water intake
6. Answer: C. The presence of infection may slow the 12. Answer: D. Turn the client to the right side for 2
healing process. Infection impairs wound healing. hours. Turning the client to the right side relieves the
Adequate blood supply is essential for healing. If pressure and promotes adequate blood supply to the left
inadequate, healing is slowed. Nutritional needs, hip. A reddened area is never massaged, because this
including protein and caloric needs, increase for all may increase the damage to the already reddened,
clients undergoing cellular repair because adequate damaged area. The health care provider does not need
protein and caloric intake is essential to optimal cellular to be notified immediately. However, the health care
repair. Elderly clients may have decreased blood flow to provider should be informed of this finding the next time
the skin, organ atrophy and diminished function, and he is on the unit. Arranging for a pressure-relieving
altered immunity. These conditions slow cellular repair device is appropriate, but this is done after the client has
and increase the risk of infection. been turned.
7. Answer: A. Administering anti-inflammatory agents as 13. Answer: D. Attempting to rule out complications before
prescribed. Anti-inflammatory agents help reduce edema administering pain medication. When intervening with a
and relieve pressure on nerve endings, subsequently client complaining of pain, the nurse must always
reducing pain. Elevating the injured area increases determine if the pain is expected pain or a complication
venous return to the heart. Maintaining clean, dry skin that requires immediate nursing intervention. This must
aids in preventing skin breakdown. Cool packs, not warm be done before administering the medication. Guided
packs, should be used initially to cause vasoconstriction imagery should be used along with, not instead of,
and reduce edema. administration of pain medication. The nurse should
8. Answer: B. Having the client perform Kegel medicate the client and not discourage medication.
exercises. Kegel exercises, which help strengthen the 14. Answer: C. Correct handwashing
muscles in the perineal area, are used to maintain technique. Handwashing remains the most effective
urinary continence. To perform these exercises, the procedure for controlling microorganisms and the
client tightens pelvic floor muscles for 4 seconds 10 incidence of nosocomial infections. Aseptic technique is
times at least 20 times each day, stopping and starting essential with invasive procedures, including indwelling
the urinary flow. Inserting an indwelling Foley catheter catheters. Masks, gowns, and gloves are necessary only
increases the risk for infection and should be avoided. when the likelihood of exposure to blood or body fluids
The nurse should encourage the client to develop a is high. Spills of blood from clients with acquired
toileting schedule based on normal urinary habits. immunodeficiency syndrome should be cleaned with
However, suggesting bathroom use every 8 hours may sodium hydrochloride.
be too long an interval to wait. Pads or diapers should be 15. Answer: A. Administering I.V. and oral fluids. The client’s
used only as a resort. assessment findings would lead the nurse to suspect that
9. Answer: B. Maintenance of adequate oxygenation. For the client is dehydrated. Administering I.V. fluids is
the client with asthma and infection, oxygenation is the appropriate. Assessing sputum would be appropriate for
priority. Maintaining adequate oxygenation reduces the a client with problems associated with impaired gas
risk of physiologic injury from cellular hypoxia, which is exchange or ineffective airway clearance. Monitoring
the leading cause of cell death. A fluid volume deficit albumin and protein levels is appropriate for clients
resulting from fever and diaphoresis, not excess, is more experiencing inadequate nutrition. Clustering activities
likely for this client. No information regarding pain is helps with energy conservation and promotes rest.
provided in this scenario. Teaching about infection 16. Answer: D. Orange juice and bananas. The client with
control is not appropriate at this time but would be hypokalemia needs to increase the intake of foods high
appropriate before discharge. in potassium. Orange juice and bananas are high in
10. Answer: B. Home environment evaluation. After potassium, along with raisins, apricots, avocados, beans,
discharge, the client is responsible for his own care and and potatoes. Whole grains and nuts would be
health maintenance management. Discharge includes encouraged for the client with hypomagnesemia; milk
assessing the home environment for determining the products and green, leafy vegetables are good sources of
client’s ability to maintain his health at home. calcium for the client with hypocalcemia. Pork products
11. Answer: C. Keeping the linens dry and wrinkle and canned vegetables are high in sodium and are
free. Keeping the linens dry and wrinkle-free aids in encouraged for the client with hyponatremia.
preventing moisture and pressure from interfering with 17. Answer: B. Encouraging slow, deep breaths. The client
adequate blood supply to the tissues, helping to who is hyperventilating and subsequently develops
maintain skin integrity. Using a foot board is appropriate respiratory alkalosis is losing too much carbon dioxide.
for maintaining normal body function position. Measures that result in the retention of carbon dioxide
Monitoring intake and output aids in assessing and are needed. Encourage slow, deep breathing to retain
maintaining bladder function.. Coughing and deep carbon dioxide and reverse respiratory alkalosis.
breathing help promote gas exchange. Administering low-flow oxygen therapy is appropriate for
 chronic respiratory acidosis. Administering sodium at risk for seizures. Hypophosphatemia may produce
bicarbonate is appropriate for treating metabolic changes in granulocytes, which would require the nurse
acidosis, and administering sodium chloride is to instruct the client about measures to prevent
appropriate for metabolic alkalosis. infection. Avoiding the use of a tight tourniquet when
18. Answer: C. 2,470. The fluid intake includes 8 oz (240 ml) drawing blood helps prevent pseudohyperkalemia. Early
of apple juice, 850 ml of water, 2 cups (480 ml) of beef ambulation is recommended to reduce calcium loss from
broth, and 900 ml of I.V. fluid for a total of 2,470 ml bones during hospitalization.
intake for the shift. 25. Answer: D. Sodium. Sodium is the electrolyte whose
19. Answer: A. Positive Trousseau’s sign. In a client with level is the primary determinant of the extracellular fluid
hypocalcemia, a positive Trousseau’s sign refers to concentration. Sodium a cation (e.g., positively charged
carpopedal spasm that develops usually within 2 to 5 ion), is the major electrolyte in extracellular fluid.
minutes after applying and inflating a blood pressure cuff Chloride, an anion (e.g., negatively charged ion), is also
to about 20 mm Hg higher than systolic pressure on the present in extracellular fluid, but to a lesser extent.
upper arm. This spasm occurs as the blood supply to the Potassium (a cation) and phosphate (an anion) are the
ulnar nerve is obstructed. Chvostek’s sign refers to major electrolytes in the intracellular fluid.
twitching of the facial nerve when tapping below the 26. Answer: B. Kayexalate. The client’s potassium level is
earlobe. Paresthesia refers to the numbness or tingling. elevated; therefore, Kayexalate would be ordered to
Tetany is a clinical manifestation of hypocalcemia help reduce the potassium level. Kayexalate is a cation-
denoted by tingling in the tips of the fingers around the exchange resin, which can be given orally, by nasogastric
mouth, and muscle spasms in the extremities and face. tube, or by retention enema. Potassium is drawn from
20. Answer: A. Tented skin turgor and thirst. Hypernatremia the bowel and excreted through the feces. Because the
refers to elevated serum sodium levels, usually above client’s potassium level is already elevated, potassium
145 mEq/L. Typically, the client exhibits tented skin supplements would not be given. Neither calcium
turgor and thirst in conjunction with dry, sticky mucous gluconate nor sodium tablets would address the client’s
membranes, lethargy, and restlessness. Muscle elevated potassium level.
weakness and paresthesia are associated with 27. Answer: B. Hot, flushed skin and
hypokalemia; fruity breath and Kussmaul’s respirations diaphoresis. Hypermagnesemia is manifested by hot,
are associated with diabetic ketoacidosis. Muscle flushed skin and diaphoresis. The client also may exhibit
twitching and tetany may be seen with hypercalcemia or hypotension, lethargy, drowsiness, and absent deep
hyperphosphatemia. tendon reflexes. Muscle pain and acute rhabdomyolysis
21. Answer: B. Low PO2. A chronically elevated PCO2 level are indicative of hypophosphatemia. Soft-tissue
(above 50 mmHg) is associated with inadequate calcification and hyperreflexia are indicative of
response of the respiratory center to plasma carbon hyperphosphatemia. Increased respiratory rate and
dioxide. The major stimulus to breathing then becomes depth are associated with metabolic acidosis.
hypoxia (low PO2). High PCO2 and normal pH and HCO3 28. Answer: C. Potassium level. Diuretics such as furosemide
levels would not be the primary stimuli for breathing in may deplete serum potassium, leading to hypokalemia.
this client. When the client is also taking digoxin, the subsequent
22. Answer: A. Assessing urinary intake and output. For the hypokalemia may potentiate the action of digoxin,
client with fluid volume deficit, assessing the client’s placing the client at risk for digoxin toxicity. Diuretic
urine output (using a urometer if necessary) is essential therapy may lead to the loss of other electrolytes such as
to ensure an output of at least 30 ml/hour. The client sodium, but the loss of potassium in association with
should be weighed daily, not weekly, and at same time digoxin therapy is most important. Hypocalcemia is
each day, usually in the morning. Monitoring ABGs is not usually associated with inadequate vitamin D intake or
necessary for this client. Rather, serum electrolyte levels synthesis, renal failure, or use of drugs, such as
would most likely be evaluated. The client also would aminoglycosides and corticosteroids. Hypomagnesemia
have an I.V. rate at least 75 ml/hour, if not higher, to generally is associated with poor nutrition, alcoholism,
correct the fluid volume deficit. and excessive GI or renal losses, not diuretic therapy.
23. Answer: D. Albert who has renal disease. Clients with 29. Answer: C. Encouraging the client to cough and deep
renal disease are predisposed to hyperkalemia and breathe. The ABG results indicate respiratory acidosis
should avoid foods high in potassium. Clients receiving requiring improved ventilation and increased oxygen to
diuretics, with ileostomies, or with metabolic acidosis the lungs. Coughing and deep breathing can accomplish
may be hypokalemic and should be encouraged to eat this. The nurse would administer high oxygen levels
foods high in potassium. because the client does not have chronic obstructive
24. Answer: A. Instituting seizure precaution to prevent pulmonary disease. Breathing into a paper bag is
injury. Instituting seizure precaution is an appropriate appropriate for a client hyperventilating and
intervention, because the client with hypomagnesemia is experiencing respiratory alkalosis. Some action is
 necessary, because the ABG results are not within 42. Answer: D. perspiration. Perspiration and the fluid lost
normal limits. via the lungs are termed insensible losses; normally,
30. Answer: B. Sodium bicarbonate. Metabolic acidosis insensible losses equal about 1000 cc/day.
results from excessive absorption or retention of acid or 43. Answer: B. hypertonic solution. When hyponatremia is
excessive excretion of bicarbonate. A base is needed. severe, hypertonic solutions may be used but should be
Sodium bicarbonate is a base and is used to treat infused with caution due to the potential for
documented metabolic acidosis. Potassium, serum development of CHF. In SIADH, isotonic and hypotonic
sodium determinations, and a bronchodilator would be solutions are not indicated, because urine output is
inappropriate orders for this client. minimal, so water is retained. this water retention
31. Answer: C. within normal range. Normal serum dilutes serum sodium levels, making the patient
concentrations of chloride range from 95 to 108 mEq/L. hyponatremic and necessitating administration of
32. Answer: C. eclampsia. Eclampsia is associated with hypertonic solutions to balance sodium and water.
increased levels of serum chloride. Normotonic solutions do not exist.
33. Answer: C. anion. Chloride is a major anion found in the 44. Answer: A. hypokalemia. Aldosterone is secreted in
extracellular fluid. A compound occurs when two ions response to fluid loss. Aldosterone causes sodium
are bound together. Chloride is an ion, but this choice is reabsorption and potassium elimination, further
too general. HCO3 is a cation. exacerbating hypokalemia.
34. Answer: A. amphogel. Administration of phosphate 45. Answer: A. bounding pulse. Bounding pulse is a sign of
binders (amphogel and basagel) will reduce the serum fluid overload as more volume in the vessels causes a
phosphate levels. stronger sensation against the blood vessel walls. Flat
35. Answer: C. metastatic bone lesions. Metastatic bone neck veins and vesicular breath sounds are normal
lesions are associated with hypercalcemia due to findings. Poor skin turgor is consistent with dehydration.
accelerated bone metabolism and release of calcium into 46. Answer: B. diluted in 100 cc over 1 hour. Potassium must
the serum. Renal failure, inadequate calcium intake, and be well diluted and given slowly because rapid
vitamin D deficiency may cause hypocalcemia. administration will cause cardiac arrest.
36. Answer: D. urinary calculi. Urinary calculi may occur with 47. Answer: D. hyporeflexia. Hyporeflexia is a symptom of
hypercalcemia. Shortened, not prolonged QRS complex hypokalemia
would be seen in hypercalcemia. Tetany and petechiae 48. Answer: B. diluted. Oral potassium supplements are
are signs of hypocalcemia. known to irritate gastrointestinal (GI) mucosa and should
37. Answer: B. administering calcium gluconate. Calcium be diluted.
gluconate is used for replacement in deficiency states. 49. Answer: B. 7.31 to 7.41. Normal venous blood pH ranges
Calcitonin and loop diuretics are used to lower serum from 7.31 to 7.41. Normal arterial blood pH ranges from
calcium. 7.35 to 7.45.
38. Answer: D. renal failure. Renal failure can reduce 50. Answer: D. carbon dioxide. Respiratory regulation of
magnesium excretion, leading to hypermagnesemia. acid-base balance involves the elimination or retention
Diabetic ketoacidosis, not insulin shock is a cause of of carbon dioxide.
hypermagnesemia. Hypoadrenalism, not 51. Answer: C. arterial blood gas. Arterial blood gases will
hyperadrenalism is a cause of hypermagnesemia. Nausea indicate CO2 and O2 levels. This is an indication that the
and vomiting lead to hypomagnesemia. respiratory system is functioning. Respiratory rate can
39. Answer: B. antagonize the cardiac effects of reveal data about other systems, such as the brain,
magnesium. In a patient with hypermagnesemia, making letter c a better choice. Pulse rate is not measure
administration of calcium gluconate will antagonize the of respiratory status. Pulse oximetry yields oxygen
cardiac effects of magnesium. Although calcium saturation levels, which is not a measure of acid-base
gluconate will raise serum calcium levels, that is not the balance.
purpose of administration. Calcium gluconate does not 52. Answer: B. isotonic FVD. Isotonic FVD involves an equal
lower calcium or magnesium levels. decrease in solute concentration and water volume.
40. Answer: B. Digoxin. In hypomagnesemia, a patient on 53. Answer: B. 0.50 lb. Weight loss of more than 0.50 lb. is
digoxin is likely to develop digitalis toxicity. Neither A nor considered to be fluid loss.
C has toxicity as a side effect. CAPD is not a medication. 54. Answer: B. increased sodium intake. Hypotonic fluid
41. Answer: D. cardiac rate and rhythm. Cardiac rate and volume excess (FVE) involves an increase in water
rhythm are the most important physical assessment volume without an increase in sodium concentration.
parameter to measure. Skin turgor, intake and output Increased sodium intake is part of the management of
are physical assessment parameters a nurse would this condition.
consider when assessing fluid and electrolyte imbalance, 55. Answer: B. diffusion. In diffusion, the solute moves from
but choice d is the most important. an area of higher concentration to one of lower
concentration, creating osmotic pressure. Osmotic
 pressure is related to the process of osmosis. Filtration is C) Elevated central venous pressure (CVP).
created by hydrostatic pressure. Capillary dynamics are D) Reduced levels of serum potassium.
related to fluid exchange at the intravascular and
interstitial levels. 4. You are working in the emergency department and are
56. Answer: D. increased urine output. Arterial responsible for administering blood products to patients as
baroreceptors and stretch receptors help maintain fluid needed. John, a 52-year-old male, has just been admitted
balance by increasing urine output in response to a rise with severe bleeding due to a motor vehicle accident.
in arterial pressure. Different blood products are considered for rapid infusion to
57. Answer: C. 136 to 145 mEq/L. Normal serum sodium manage his condition. Which among the following blood
level ranges from 136 to 145 mEq/L. products is typically infused quickly to be effective?
58. Answer: D. all of the following. Water gain, diuretic
therapy, and diaphoresis are etiologies of hyponatremia. A) Platelets
59. Answer: C. restricting fluid intake. Hyponatremia B) Fresh frozen plasma (FFP)
involves a decreased concentration of sodium in relation C) Packed red blood cells (PRBC)
to fluid volume, so restricting fluid intake is indicated. D) Dextran
60. Answer: B. alkalosis. Alkalosis is indicated by a pH above
7.45. 5. Maria, a 72-year-old patient, has been admitted to the
hospital for treatment of fluid volume deficit (FVD) following
2] an episode of severe diarrhea. The medical team is
1. Lisa, a registered nurse, is conducting a wound assessment contemplating the use of a hypotonic solution as part of her
of a patient who has a pressure ulcer on the sacral area. The fluid replacement therapy. As a nursing professional, what
wound has full-thickness tissue loss in which adipose (fat) is rationale would you provide for choosing a hypotonic solution
visible, but bone, tendon, or muscle are not exposed. Slough in treating Maria’s FVD?
may be present but does not obscure the depth of tissue loss.
How should Lisa stage this pressure ulcer?
A) A hypotonic solution delivers an abundance of sodium and
chloride ions.
A) Stage 1 Pressure Ulcer B) Hypotonic solutions are advised in large volumes
B) Stage 2 Pressure Ulcer immediately after surgery.
C) Stage 3 Pressure Ulcer C) A hypotonic solution offers free water, aiding in renal
D) Stage 4 Pressure Ulcer solute excretion.
D) A hypotonic solution is employed to manage low sodium
2. Emily, a 58-year-old patient with a history of chronic kidney levels in the blood.
disease, is admitted to the medical unit for evaluation. Upon
reviewing her lab results, you notice signs of metabolic 6. Keane, a 46-year-old patient with anemia, is undergoing a
alkalosis. As a nursing professional, you know that the body blood transfusion. About 30 minutes into the transfusion, you
tries to naturally compensate for such imbalances. What notice that Keane’s body temperature has risen. As a nurse
would be the body’s physiological response to compensate well-versed in the potential complications associated with
for Emily’s metabolic alkalosis? blood transfusions, how would you interpret this elevation in
body temperature?
A) Slowing down the respiratory rate.
B) Speeding up the respiratory rate. A) A routine reaction to the blood transfusion.
C) Enhancing urine output. B) An indication of systemic infection (sepsis).
D) Reducing urine output. C) A typical bodily function unrelated to the transfusion.
D) A potential sign of a transfusion reaction.
3. You are conducting a head-to-toe assessment on Lisa, a 45-
year-old female who was admitted with complaints of nausea 7. You are caring for a patient who is receiving intravenous
and prolonged vomiting. The admitting physician suspects she fluids following a surgical procedure. The physician explains
might have metabolic alkalosis. As a nurse with a strong that the type of fluid chosen is meant to restore cellular
understanding of acid-base imbalances, what clinical hydration. Intrigued by the process, a nursing student with
manifestation would you particularly look out for in assessing you asks how water moves from one concentration to
Lisa for metabolic alkalosis? another across cell membranes. What term describes the net
movement of water from a higher concentration to a lower
A) Low blood pressure. concentration through a semipermeable membrane?
B) Variability in urine production.
A) Brownian motion potentially lead to a decrease in serum phosphate levels like
B) Osmosis you suspect in Martin?
C) Filtration
D) Diffusion A) Chronic alcohol abuse.
B) Paget’s disease of the bone.
8. Nina, a 60-year-old patient with chronic kidney disease, is C) Advanced liver cirrhosis.
experiencing electrolyte imbalances. You’re explaining to her D) End-stage renal failure.
family that her endocrine system plays a role in maintaining
electrolyte homeostasis. Specifically, what does the endocrine 13. You’re closely monitoring Emily, a 59-year-old patient with
system typically regulate when it comes to electrolyte balance multiple health concerns. You’re especially attentive to her
in the body? risk for imbalances in electrolytes. Which among the following
medical conditions would heighten Emily’s risk for developing
A) Reabsorption of chloride and excretion of sodium. an excess of phosphate, also known as hyperphosphatemia?
B) Reabsorption of potassium and excretion of sodium.
C) Reabsorption of sodium and excretion of chloride. A) Elevated levels of potassium (Hyperkalemia).
D) Reabsorption of sodium and excretion of potassium. B) Decreased levels of calcium (Hypocalcemia).
C) Raised levels of blood sugar (Hyperglycemia).
9. You are teaching a group of nursing students about fluid D) Reduced levels of sodium (Hyponatremia).
and electrolyte balance. During the discussion, you focus on
the intracellular fluid (ICF) composition. One of the students 14. During morning rounds, you’re discussing lab results with
asks which anion is predominantly present in the ICF. How Dr. Williams. She emphasizes the importance of interpreting
would you answer? calcium levels in a specific context for accurate diagnosis and
treatment. In medical practice, normal calcium levels should
A) Chloride generally be considered in conjunction with which of the
B) Phosphorus following?
C) Potassium
D) Sodium A) Blood fats
B) Serum protein levels
10. Katherine, a 50-year-old patient, comes to the emergency C) Sodium concentration
department complaining of severe diarrhea and dehydration. D) Blood glucose levels
As a nurse experienced in identifying fluid imbalances, you are
tasked with assessing her for fluid volume deficit (FVD). What 15. During a nutritional education session, you’re discussing
clinical manifestation would you specifically anticipate in with your patient Sarah about the importance of absorbing
Katherine? essential nutrients for overall health. Sarah is especially keen
on optimizing her bone health and queries you on how
A) Strong, bounding pulse. calcium is absorbed. What specific substance plays a central
B) Rapid heart rate. role in facilitating calcium absorption within the
C) Distended neck veins. gastrointestinal tract?
D) Crackles in the lungs.
A) The role of Vitamin D.
11. You’re supervising a group of nursing students in a clinical B) Influence of Vitamin C.
setting, and the topic of intracellular fluid (ICF) comes up. One C) Presence of Hydrochloric Acid (HCl).
of the students is curious about the major cation present in D) Levels of Blood Glucose.
the ICF. As an experienced nurse, how would you answer?
16. You’re conducting a comprehensive health assessment on
A) Phosphorus Mark, a 42-year-old male patient. Part of the assessment
B) Magnesium involves calculating his total body water percentage. You
C) Potassium know that multiple factors influence this calculation. Which of
D) Sodium the following elements is not a significant influencer of total
body water percentage?
12. You are caring for Martin, a 65-year-old man who has
been admitted with muscle weakness and confusion. Blood A) The presence of fat tissue.
tests are ordered, and you suspect he may have B) Gender of the individual.
hypophosphatemia. Which of the following conditions could C) Age of the patient.
D) Amount of muscle mass.
17. You are reviewing the lab results for Julia, a 65-year-old C) Reclaiming bicarbonate ions.
patient who has just been diagnosed with hypocalcemia. D) Transporting hydrogen ions towards the renal tubules.
You’re considering appropriate nursing diagnoses to address
her condition. Which of the following nursing diagnoses is 22. During a clinical rotation in the respiratory unit, you’re
most fitting for a patient experiencing low levels of calcium? explaining to nursing students the different physiological
systems that maintain the body’s acid-base balance. One
A) High risk for injury due to confusion. student is curious about the specific role of the respiratory
B) Elevated risk for injury related to bleeding. system in this regulation. How does the respiratory system
C) Bowel constipation. contribute to acid-base balance?
D) Ineffective airway clearance.
A) Through the formation of bicarbonate.
18. Samantha, a 54-year-old woman, is admitted to the B) By altering the rate and depth of breathing.
hospital and is receiving hypertonic fluids as part of her C) By ramping up mucus production.
treatment plan. As a nurse responsible for her care, you are D) Through the reabsorption of bicarbonate.
aware that monitoring for potential complications is crucial.
Which of the following is not a potential complication that 23. You’re caring for Emma, a patient in the ICU with severe
you need to monitor for while she is on hypertonic fluids? pneumonia. The physician orders an arterial blood gas (ABG)
test to better understand her respiratory status. While
A) Shrinkage of cells. reviewing the ABG results, you take note of various
B) Dehydration at the cellular level. components. Which of the following is the gaseous element
C) Excess in fluid volume. measured in an ABG?
D) Risk of water intoxication.
A) Presence of Hydrogen.
19. You’re caring for a patient who recently had a B) Level of Bicarbonate.
parathyroidectomy. Knowing the interplay of hormones that C) Concentration of Carbon Dioxide.
regulate calcium levels is critical in managing her D) Measure of pH.
postoperative care. Which hormone is released when there is
an increase in serum calcium levels? 24. You’re assigned to the care of Lisa, a 58-year-old patient
who has a history of chronic kidney disease. As you review her
A) Release of parathyroid hormone. lab results, you note a fluctuation in her chloride levels.
B) Secretion of aldosterone. Understanding the role of chloride in acid-base balance is
C) Emission of calcitonin. crucial for her management. What role does chloride play in
D) Production of renin. maintaining acid-base balance?

20. You are managing the care of Robert, a 72-year-old A) Stabilizing the balance of cations within the intracellular
patient who has been admitted with respiratory issues. After and extracellular fluid.
reviewing his arterial blood gas (ABG) results, you suspect B) Engaging in the chloride shift process.
acidosis. Which electrolyte’s presence is a contributing factor C) Accompanying sodium to regulate serum osmolarity.
to the development of acidosis? D) Facilitating the disassociation of carbonic acid.

A) Involvement of chloride. 25. You’re taking care of Jack, a 62-year-old patient with
B) Inclusion of potassium. hypertension who is on diuretic therapy. As part of his
C) Presence of sodium. electrolyte management, understanding how chloride
D) Concentration of hydrogen. reabsorption is regulated is vital. Which hormone plays a role
in the reabsorption of chloride ions?
21. You are precepting a group of nursing students and
discussing the respiratory system’s role in maintaining acid- A) Aldosterone
base balance. One of the students asks how the lungs B) Estrogen
participate in this crucial function. How would you explain the C) Renin
lungs’ role in regulating acid-base balance? D) Antidiuretic Hormone (ADH)

A) Dividing carbonic acid into two components. 26. You are providing care for Grace, a patient who recently
B) Utilizing carbon dioxide (CO2) to control hydrogen ion underwent abdominal surgery. While monitoring her
levels. electrolyte levels, you note a decrease in her chloride levels.
To make appropriate clinical decisions, you consider where
chloride is typically absorbed in the body. Where does this C) Albumin
occur? D) Whole blood

A) Within the liver. 31. John, a male patient diagnosed with bipolar disorder, has
B) Within the kidney. been consuming large amounts of water and urinating often.
C) In the stomach. He is experiencing symptoms like muscle cramps, twitching,
D) In the bowel. and dizziness. As his nurse, what laboratory work would you
primarily focus on?
27. Mia, a 74-year-old patient with a history of congestive
heart failure, has come in for her regular check-up. Her labs A) Evaluate the electrolyte levels, paying special attention to
indicate that her chloride levels are below 95 mEq/L. As her serum sodium.
nurse, you consider the implications of this on the B) Analyze urine, specifically looking for the presence of white
reabsorption of other electrolytes. When chloride blood cells.
concentration falls below this level, the reabsorption of which C) Consider the results of an EEG.
electrolyte increases proportionately? D) Examine the complete blood count, focusing on platelet
counts.
A) Potassium
B) Sodium 32. Sara, a patient with chronic fatigue, is advised to increase
C) Hydrogen her magnesium intake. As her nurse, you plan to educate her
D) Bicarbonate on dietary sources of magnesium. What foods would you
recommend Sara include in her diet for a higher magnesium
28. Jonas has been admitted to the hospital with a history of intake?
substantial diarrhea, losing about 1,000 ml of fluid per day for
the past three days. The physician orders an IV of 0.45% NaCl A) Spread butter on her toast.
combined with 5% dextrose. As his nurse, what is the most B) Consume more green vegetables.
appropriate nursing intervention you should consider? C) Incorporate cheese into her meals.
D) Add tomatoes to her salads.
A) Evaluate Jonas’s potassium levels and consult the physician
for potential IV additives. 33. Lisa, a 28-year-old ICU patient, has been diagnosed with a
B) Prepare all antibiotic infusions using the prescribed 0.45% complex electrolyte imbalance. As a nurse who is responsible
NaCl with 5% dextrose. for her care, you understand that her cellular processes
C) Monitor Jonas for any indicators of hyperkalemia. depend on maintaining a balance of negatively and positively
D) Secure an infusion controller device from the central charged ions across the cell membranes. What is this balance
supply. termed as?

29. Emily, a 68-year-old patient, is on daily digoxin and Lasix. A) Electrical stability.
During your shift, she reports feeling nauseous, and you find B) Sodium-potassium exchange mechanism.
her apical pulse to be 130 and irregular. As her nurse, what is C) Electrical neutrality.
the most suitable course of action to take? D) Osmotic action.

A) Eliminate the orange juice from Emily’s meal tray. 34. Mr. Johnson, an 85-year-old patient with a feeding tube,
B) Flag Emily as a patient with high risk for hyperkalemia. presents with symptoms of severe diarrhea, lethargy, poor
C) Withhold the digoxin dosage and assess Emily’s potassium skin turgor, tachycardia, and hyperactive reflexes. As the
levels. nurse in charge of his care, what intervention should be your
D) Evaluate Emily for additional symptoms of hypernatremia. priority?

30. Mark, a 50-year-old patient with acute kidney injury, A) Utilize wrist restraints to prevent feeding tube
requires manipulation of fluid shifts between intravascular dislodgement.
and interstitial compartments. As the attending nurse, you B) Accurately measure and document both fluid intake and
consider the most effective type of fluid to achieve this. What output as well as daily weights.
fluid is commonly used for manipulating fluid shifts among C) Provide salt tablets and oversee hypertonic parenteral fluid
compartments? administration.
D) Prescribe sedative medications to calm the patient.
A) Ensure
B) Total Parenteral Nutrition (TPN)
35. As a nurse, you are preparing an educational module influenced by the secretion of which of the following
about the importance of maintaining fluid balance in the hormones?
body. To make your point, you plan to include the various
functions that body fluids perform. Which of the following is A) Vasopressin (ADH) and Follicle-Stimulating Hormone (FSH).
NOT a function of body fluids? B) Progesterone alongside aldosterone.
C) Antidiuretic Hormone (ADH) and Aldosterone.
A) Conveying electrical charges throughout the body. D) Extracellular Fluid (ECF) levels and Adrenocorticotropic
B) Providing a cushioning effect for internal organs. Hormone (ACTH).
C) Facilitating the transport of essential nutrients.
D) Aiding in fat metabolism processes. 41. Nurse Jordan is working in the emergency department and
is responsible for Sarah, a 36-year-old woman exhibiting signs
36. Nurse Emily is reviewing a patient’s case history, who has of electrolyte imbalance. After assessing Sarah’s lab results,
chronic electrolyte imbalances. She suspects that a Nurse Jordan notes a significant reduction in bicarbonate
malfunction in one of the renal structures could be affecting levels. Which clinical condition is most commonly associated
electrolyte reabsorption. Which renal structure is most likely with the depletion of bicarbonate?
to influence electrolyte reabsorption?
A. Profuse sweating or diaphoresis.
A) The renal tubules. B. Persistent diarrhea episodes.
B) The renal glomerulus. C. Repeated vomiting incidents.
C) The urinary bladder. D. Excessive urinary output or diuresis.
D) The renal pelvis.
42. Nurse Taylor is caring for Mark, a 58-year-old patient who
37. Nurse Riley is assessing Mrs. Johnson, who has recently has been diagnosed with hypomagnesemia. Mark’s physician
been diagnosed with hypermagnesemia. The nurse is vigilant has requested that his magnesium levels be closely
for symptoms that could arise due to elevated magnesium monitored. Nurse Taylor needs to understand the renal
levels. What symptoms could Mrs. Johnson potentially physiology behind magnesium reabsorption to better manage
display? Mark’s condition. What anatomical or hormonal element
chiefly regulates the reabsorption of magnesium?
A) Increased heart rate or tachycardia.
B) Elevated blood pressure or hypertension. A. Renal Glomerulus.
C) Irregular heartbeats or cardiac arrhythmias. B. Secretion of Parathyroid Hormone.
D) Overactive deep-tendon reflexes. C. Nephron’s Loop of Henle.
D. Anterior Pituitary Gland.
38. Nurse Alex is caring for Tim, a marathon runner, who is at
a heightened risk for experiencing fluid volume deficit. Which 43. Nurse Casey is overseeing the care of Olivia, a 72-year-old
of the following factors contributes to Tim’s risk? patient with a nursing diagnosis indicating a fluid volume
deficit. Olivia is on multiple medications for various chronic
A) An underlying disease process. conditions. Nurse Casey is concerned that one of Olivia’s
B) Lowered diuresis rates. current medications might worsen her fluid imbalance. Which
C) Elevated levels of breathing and perspiration. medication could potentially aggravate Olivia’s fluid volume
D) Reduced rates of breathing and perspiration. deficit?

39. Nurse Emily is attending to Mr. Goggins, who has been A. Digoxin (Lanoxin)
diagnosed with Fluid Volume Deficit (FVD). Which of the B. Insulin (Humulin, Novolin, Lantus)
following nursing diagnoses is most appropriate for Mr. C. Lasix (Furosemide)
Goggins’ condition? D. Synthroid (Levothyroxine)

A) Decreased cardiac output. 44. You’re caring for Emily, a 48-year-old patient who has
B) Vomiting been admitted for hypertension and is suspected to have
C) Altered urinary elimination. renal impairment. The healthcare team discusses the role of
D) Increased cardiac output. angiotensin II in Emily’s renal regulation of water balance. As
a nursing student studying renal physiology, what functions
40. In assessing the homeostatic control of sodium levels, would you attribute to angiotensin II in this context?
Nurse Riley recognizes that the regulation of sodium is
A. Promoting the secretion of progesterone into the renal 49. You are caring for Maria, a 78-year-old patient admitted
tubules. with severe dehydration. As part of educating her family on
B. Facilitating blood coagulation within the nephron. the importance of fluid balance, you explain the various fluid
C. Selective constriction of specific arteriolar segments within compartments in the body. You ask them, “Do you know
the nephron. where the majority of the body’s water is primarily
D. Enabling the catalysis of calcium-rich nutrients within the contained?”
kidney.
A. Interstitial compartment
45. You’re working in the emergency department, and a 33- B. Intracellular compartment
year-old patient named Mark comes in with symptoms of C. Extracellular compartment
dehydration. You suspect that he might be experiencing D. Intravascular compartment
isotonic fluid volume deficit (FVD). To confirm your suspicion,
you consider the various ways isotonic FVD can occur. Which 50. You are tending to John, a 45-year-old patient who has
of the following could be a reason for Mark’s isotonic FVD? been experiencing persistent vomiting due to a
gastrointestinal infection. As his nurse, you are concerned
A. Dysfunction in the regulation of thirst. about the potential electrolyte imbalances that may arise
B. Loss of gastrointestinal fluids due to diarrhea. from frequent vomiting. Which electrolytes are primarily lost
C. Unperceived water loss during an extended fever. due to this condition?
D. Insufficient intake of both fluids and electrolytes.
A) Calcium and Potassium
46. You’re caring for Sarah, a 55-year-old patient in the B) Calcium and Magnesium
cardiac unit who has been diagnosed with hypertonic fluid C) Chloride and Potassium
volume excess (FVE). As you evaluate Sarah’s condition and D) Phosphorus and Sodium
plan her nursing care, which nursing diagnosis is most likely
relevant to her hypertonic FVE status? 51. You are reviewing the lab results for Clara, a 60-year-old
patient in the medical-surgical unit, and notice that her
A. Ineffective breathing pattern. magnesium levels are below the normal range. You start
B. Potential for increased cardiac output. thinking about the potential underlying causes that could lead
C. Ineffective airway clearance. to her hypomagnesemia. What are the possible etiologies
D. Potential for decreased cardiac output. associated with this condition?

47. You’re preparing an educational seminar on fluid balance A. Malabsorption syndrome.

for nursing students. One of the topics is the composition of B. Kidney failure
the intracellular fluid compartment. You ask the students, C. Chronic constipation
“Besides water, what else is primarily stored in the D. Insufficient vitamin D intake.
intracellular compartment?”
52. You are caring for Henry, a 72-year-old patient who has
A. Sodium ions just undergone abdominal surgery. Post-operatively, you
B. Glucose molecules notice signs of third-spacing, a phenomenon where fluid
C. Protein molecules accumulates in compartments that are not easily accessible
D. Uric acid molecules by the circulatory system. What is the primary concern
regarding fluid being sequestered in the third space in Henry’s
48. You’re caring for Lisa, a 64-year-old patient with chronic case?
gastrointestinal issues that have led to fluid imbalances.
Understanding the gastrointestinal tract’s role in water A. Enriched with acidic substances.
absorption will help you manage her care effectively. Where B. Inaccessible for circulatory function.
does the majority of water reabsorption occur in the C. Excessive solute concentration leading to hypervolemia.
gastrointestinal system? D. Diluted concentration leading to water intoxication.

A. Esophageal lining 53. As a nurse on the intensive care unit, you are managing
B. Colonic mucosa Emily, a 50-year-old patient with severe sepsis. Due to her
C. Gastric lining critical condition, maintaining proper extracellular fluid
D. Small intestinal mucosa balance is crucial. You are explaining the composition of
extracellular fluid to a nursing student. Besides water,
electrolytes, and proteins, what else is predominantly found 1. Nurse Emily is reviewing the medication charts of various
in the extracellular fluid? patients in her unit. She recognizes that different conditions
may require different pain management strategies. Emily
A) Fatty Acids contemplates which among her current roster of patients is
B) Glucose most likely to be on opioid medication for an extended
C) Hormones period.
D) Oxygen
A. A patient experiencing phantom limb pain after an
54. You are working in the cardiology ward and attending to amputation.
Robert, a 68-year-old patient with coronary artery disease. B. A patient diagnosed with advanced pancreatic cancer that
During your discussion with the medical team, the topic of is progressing.
magnesium and its various physiological functions comes up. C. A patient suffering from episodes of trigeminal neuralgia.
Which of the following is NOT a function performed by D. A patient dealing with chronic fibromyalgia.
magnesium in the body?
2. Nurse Jennifer, the charge nurse in a medical-surgical unit,
A. Aiding in the metabolism of proteins. is confronted by Mr. Anderson, a patient with chronic pain.
B. Enabling the transport of sodium ions. He looks upset and shares that the nursing staff has been
C. Facilitating the contraction of cardiac muscle. neglecting his requests for pain medication. Faced with this
D. Contributing to the narrowing of blood vessels. urgent issue, Jennifer considers her immediate next steps.

55. You’re caring for Karen, a 52-year-old patient recovering A) Ignore Mr. Anderson’s complaint and proceed with her
from abdominal surgery. She has multiple surgical drains in other responsibilities.
place, and you’re closely monitoring her electrolyte levels. B) Document Mr. Anderson’s complaint and plan to address it
Among the options below, which clinical condition is likely to during the next staff meeting.
exacerbate the excretion of electrolytes? C) Assess Mr. Anderson’s pain level and medication history,
then consult with the healthcare team.
A. Utilization of surgical drains. D) Advise Mr. Anderson to file a formal complaint with the
B. Prolonged consumption of water. hospital administration.
C. Administration of nasogastric feedings.
D. Physical immobility due to fractures. 3. Charge Nurse William is reviewing patient charts completed
by Sarah, a newly graduated RN, in the acute care unit. He
56. You’re consulting with Lisa, a 65-year-old patient with notices that Sarah has accurately documented the dose and
hypertension, about dietary changes to manage her timing of medications administered. However, there is no
condition. She is interested in knowing what the minimum mention of non-pharmaceutical interventions or alternative
daily sodium requirement for an adult is. What type of diet pain management techniques in her charting. William
would contain this minimum requirement? considers the best initial action to support Sarah’s
professional development.
A. A diet consisting of 1500 calories aimed at weight loss.
B. A diet completely devoid of salt. A. Commend Sarah for accurately charting the dose and time
C. A diet that incorporates 2 grams of sodium. of medications while addressing the omission of non-
D. A diet that includes 4 grams of sodium. pharmaceutical interventions.
B. Document the observation in Sarah’s personnel file and
57. You are working in the Emergency Department, and continue to monitor her clinical performance for future
Jennifer, a 38-year-old patient comes in with dehydration. The evaluations.
physician orders an isotonic solution to be administered. C. Initiate a discussion with Sarah to assess her understanding
Which of the following options is an example of an isotonic and knowledge of comprehensive pain management
solution suitable for Jennifer? approaches.
D. Refer Sarah to the in-service education department for
additional training in holistic pain management.
A. 0.9% Sodium Chloride
B. 0.45% Sodium Chloride
C. 3% Sodium Chloride 4. Nurse Lucy is assigned to the pediatric unit and is
D. Dextrose 10% in Water (D10%W) responsible for caring for Timmy, a young child experiencing
pain post-surgery. Aware that children may have difficulty
articulating their pain, she ponders which assessment tool
PAIN
would be most suitable for capturing Timmy’s pain intensity.
A. Utilize a 0-10 numeric pain scale to have Timmy rate his 8. Nurse Olivia is overseeing an educational session on non-
pain. pharmaceutical pain management techniques for a group of
B. Employ the McGill-Melzack pain questionnaire to patients. She wants to delegate one of the topics to a
document the characteristics of Timmy’s pain. seasoned LPN/LVN on her team. Olivia considers which topic
C. Use a simple description pain intensity scale asking Timmy could be competently handled by the LPN/LVN while she
to describe his pain as mild, moderate, or severe. continues to provide support and supervision.
D. Apply the Faces pain-rating scale, which uses facial
expressions to help Timmy indicate his pain level. A. Education on Transcutaneous Electrical Nerve Stimulation
(TENS) as a pain relief method.
5. Nurse Karen is attending a seminar on pain management B. Discussion about the principles and techniques of
and learns about the guiding principles for treating pain Therapeutic Touch.
effectively. As she reviews her notes and reflects on her C. Teaching meditation techniques for relaxation and pain
experiences with patients in various pain situations, she management.
contemplates what the initial consideration should be in D. Instruction on the appropriate use of heat and cold
applying these principles for pain treatment. applications for pain relief.

A. Prioritizing the prevention and management of drug side 9. Nurse Ethan is preparing for a lecture on pain management,
effects. specifically focusing on the World Health Organization (WHO)
B. Employing a multidisciplinary approach that involves analgesic ladder. He knows this model serves as a guide for
various healthcare professionals. the stepwise pharmacological management of pain. He plans
C. Formulating a treatment plan based on the specific goals to discuss the use of different medications and aims to place
set by the client. them in the correct sequence according to the WHO ladder.
D. Accepting and believing the client’s own perceptions and
reports of pain. 1) Morphine, hydromorphone, acetaminophen, and
lorazepam
6. Nurse Mark is caring for Mrs. Johnson, who is recovering 2) NSAIDs and corticosteroids
from a complex surgical procedure. She is in severe pain, and 3) Codeine, oxycodone, and diphenhydramine
immediate analgesia is required. Mark is aware that rapid
titration of the medication is also necessary to control her A. 2,3,1
pain effectively. He ponders which route of administration B. 2,1,3
would best meet these needs. C. 1,2,3
D. 3,1,2
A. Administer the analgesic sublingually for quick absorption.
B. Use intravenous (IV) administration for immediate onset 10. Nurse Emily is caring for Mr. Smith, who is experiencing
and easy titration. significant post-surgical pain. Despite his discomfort, Mr.
C. Set up a Patient-Controlled Analgesia (PCA) pump for self- Smith is avoiding pain medication due to his family’s concerns
administered relief. about the risk of addiction. They are encouraging him to
D. Utilize intraspinal administration to deliver medication near “tough it out,” and he is stoically following their advice. Emily
the spinal cord. considers what aspect of Mr. Smith’s pain experience should
be the primary focus of her nursing interventions.
7. Nurse Amanda is caring for Mr. Williams, a patient who has
recently undergone knee replacement surgery. She’s working A. Cognitive
on titrating his analgesic medication to manage his B. Behavioral
postoperative pain effectively. Amanda reviews her options C. Sensory
and contemplates what her priority goal should be in this D. Sociocultural
titration process.
11. Nurse Rachel is assessing four clients who are candidates
A. Make sure the analgesic is potent enough to meet Mr. for opioid analgesia. Aware of the potential for respiratory
Williams’ subjective description of his pain. depression, a serious side effect of opioid use, she evaluates
B. Increase the medication dosage until Mr. Williams reports which client is at the greatest risk for this adverse outcome.
being entirely free of pain.
C. Decrease the dosage to minimize the risk of toxicity. A. A 40-year-old male with a broken leg who smokes 1 pack of
D. Administer the lowest effective dose that provides relief cigarettes a day.
while minimizing side effects. B. A 28-year-old female postpartum with episiotomy pain, no
history of respiratory issues.
C. A 65-year-old male with chronic obstructive pulmonary A. Reach out to the charge nurse to discuss concerns and seek
disease (COPD) and mild hip pain. guidance.
D. A 35-year-old female with migraines and a history of B. Preload the syringe with the placebo and give it to the
seasonal allergies. physician for administration.
C. Adhere to personal ethical beliefs and refuse to administer
12. Nurse Matthew is caring for a client who appears visibly the placebo.
distressed and tearful. Upon questioning, the client denies D. Consult the healthcare facility’s policy manual on the use of
experiencing pain and refuses pain medication, citing a placebos.
sibling’s drug addiction as a life-ruining event for their family.
Matthew considers what the best priority nursing 16. Nurse Sarah is caring for a client with cognitive
intervention would be for this emotionally conflicted client. impairment who is unable to effectively communicate about
pain. Sarah is unsure how to best assess and manage this
A. Involve the family to help resolve the client’s concerns client’s pain symptoms. She thinks about her first course of
about pain medication. action in this situation.
B. Encourage the client to express their fears and experiences
related to their sibling’s addiction. A. Consult the Medication Administration Record (MAR) and
C. Offer accurate and comprehensive information about the previous charting to determine the timing and effectiveness
purpose and safe use of pain medication. of the last pain medication dose.
D. Inform the client that the likelihood of addiction is B. Carefully observe for nonverbal cues like grimacing,
generally low for acute care patients receiving short-term moaning, or rocking that may indicate pain or discomfort.
pain management. C. Consult with family members to establish a baseline for
behavioral indicators of pain.
13. Nurse Lisa is closely monitoring a client who is undergoing D. Administer the maximum as-needed (PRS) dose of pain
a tapering regimen to discontinue opioid use. She knows that medication within the minimum time frame to quickly provide
withdrawal symptoms can manifest and wants to identify relief.
early signs to provide timely intervention. She considers what
could be one of the initial symptoms to appear during opioid 17. Nurse Emily is considering the most appropriate route for
withdrawal. administering daily analgesics to a client whose body systems
are all functional. She evaluates which route would be most
A. Onset of nausea sensations. preferable under these circumstances.
B. Elevated body temperature or fever.
C. Spasmodic abdominal cramping. A. Intravenous (IV)
D. Excessive or profuse sweating (diaphoresis). B. Patient-controlled analgesia (PCA)
C. Oral
14. Nurse Karen is managing multiple clients experiencing D. Transdermal
various levels of pain and discomfort. She considers
delegating one of the tasks to a nursing assistant on her team 18. Nurse Daniel is caring for a client who underwent surgery
to ensure efficient care. Which of the following tasks would yesterday and is currently using a Patient-Controlled
be most suitable to delegate? Analgesia (PCA) pump for pain management. The client
reports that the pain control is insufficient. Daniel considers
A) Administering intravenous (IV) pain medication to a post- his first step in addressing the client’s concern.
operative patient.
B) Assessing a new patient’s pain level and medical history. A. Implement non-pharmacological methods for comfort,
C) Assisting a stable patient with ambulation to prevent such as positioning or massage.
pressure ulcers. B. Conduct a thorough pain assessment, including location,
D) Developing a pain management plan for a patient with quality, and intensity.
chronic pain. C. Reach out to the attending physician to request an increase
in the analgesic dose.
15. Nurse Alex, a newly hired nurse, is assigned to care for a D. Administer a bolus dose of medication as per the standing
client with chronic pain. The physician has ordered a placebo order.
for the client, and Alex is uncomfortable with administering it.
He ponders his first course of action in this ethically 19. Nurse Olivia is caring for a client with acute pancreatitis
challenging situation. and is contemplating which non-pharmacological pain
management technique would be most appropriate for this
specific condition.
A. Use of Transcutaneous Electrical Nerve Stimulation (TENS) C. Sodium level of 142 mEq/L.
device. D. Blood urea nitrogen (BUN) of 20 mg/dL.
B. Massage the client’s back and neck using warmed lotion.
C. Engage the client in diversional activities like card games or 24. Nurse Andrea is planning assignments for the day shift
board games. and has a newly graduated RN who recently completed
D. Position the client in a side-lying posture, with knees drawn orientation. She is contemplating which client would be best
up to the chest and a pillow against the abdomen. suited for the new RN to manage.

20. Nurse Ethan is caring for a client experiencing constant A. A client diagnosed with HIV presenting with headache,
pain and needs to decide on the best medication scheduling abdominal pain, and pleuritic chest pain.
strategy to effectively manage the client’s symptoms. B. A client on the second postoperative day requiring pain
medication before dressing changes.
A. Administer medication on an around-the-clock basis. C. A chronically anxious client experiencing chronic pain and
B. Provide medication prior to any procedures that may frequently using the call button.
exacerbate pain. D. A client about to be discharged with a newly implanted
C. Give medication on a PRN (as needed) basis at the client’s surgical catheter.
request.
D. Use an intravenous (IV) bolus method following a thorough 25. Nurse Sarah is attending to a client who is in significant
pain assessment. pain. A family member approaches her and inquires, “Why
can’t you administer more medicine? He’s still in considerable
21. Nurse Caroline is caring for a client with diabetic pain.” Sarah contemplates her best response to address the
neuropathy who describes a burning, electrical-type pain in family member’s concerns while adhering to medical
the lower extremities that hasn’t responded well to NSAIDs. guidelines.
Based on her knowledge and experience, she anticipates that
the physician will likely order which adjuvant medication for A. “It’s not my decision; I’m just following the doctor’s
managing this specific type of pain? orders.”
B. “Administering more medication could lead to adverse
A. Lorazepam (Ativan) effects like respiratory depression.”
B. Amitriptyline (Elavil) C. “I think the current dosage is enough; your family member
C. Methylphenidate (Ritalin) needs to build tolerance to pain.”
D. Corticosteroids D. “The medication is probably not effective; we might need
to try a different medication.”
22. Nurse William is coordinating assignments and has an
LPN/LVN available to assist. He’s considering which client LAST
would be most appropriately cared for by the LPN/LVN under 1. A client’s nursing diagnosis is Deficient Fluid Volume related
the supervision of an RN or team leader. to excessive fluid loss. Which action related to the fluid
management should be delegated to a nursing assistant?
A. A client with a leg cast requiring neurologic checks and PRN
hydrocodone administration. A. Administer IV fluids as prescribed by the physician.
B. A client in need of preoperative teaching about the use of a B. Provide straws and offer fluids between meals.
Patient-Controlled Analgesia (PCA) pump. C. Develop plan for added fluid intake over 24 hours
C. A client with terminal cancer experiencing severe pain but D. Teach family members to assist client with fluid intake
refusing medication. 2. The client also has the nursing diagnosis Decreased Cardiac
D. A client recently postoperative with a tracheostomy, Output related to decrease plasma volume. Which finding on
requiring frequent suctioning and monitoring of arterial blood assessment supports this nursing diagnosis?
gasses.
A. Flattened neck veins when client is in supine position
23. Nurse Emily is caring for a client who is taking aspirin for B. Full and bounding pedal and post-tibial pulses
pain management. She reviews the client’s recent laboratory C. Pitting edema located in feet, ankles, and calves
results and contemplates which value should be promptly D. Shallow respirations with crackles on auscultation
communicated to the physician. 3. The nursing care plan for the client with dehydration
includes interventions for oral health. Which interventions are
A. Hemoglobin of 14 g/dL. within the scope of practice for the LPN/LVN being supervised
B. Platelet count of 90,000/uL. by the nurse? (Choose all that apply.)
 A. Remind client to avoid commercial mouthwashes. B. Review the client’s morning calcium level
B. Encourage mouth rinsing with warm saline. C. Request a neurologic consult today
C. Assess lips, tongue, and mucous membranes D. Check the client’s papillary reaction to light
D. Provide mouth care every 2 hours while client is awake 10.You are preparing to discharge a client whose calcium level
E. Seek dietary consult to increase fluids on meal trays. was low but is now just slightly within the normal range (9-
4. The physician has written the following orders for the client 10.5 mg/dL). Which statement by the client indicates the
with Excess Fluid volume. The client’s morning assessment need for additional teaching?
includes bounding peripheral pulses, weight gain of 2 pounds,
pitting ankle edema, and moist crackles bilaterally. Which A. “I will call my doctor if I experience muscle twitching or
order takes priority at this time? seizures.”
B. “I will make sure to take my vitamin D with my calcium
A. Weight client every morning. each day.”
B. Maintain accurate intake and output. C. “I will take my calcium pill every morning before
C. Restrict fluid to 1500 mL per day breakfast.”
D. Administer furosemide (Lasix) 40 mg IV push D. “I will avoid dairy products, broccoli, and spinach when I
5. You have been pulled to the telemetry unit for the day. The eat.”
monitor informs you that the client has developed prominent 11.A nursing assistant asks why the client with a chronically
U waves. Which laboratory value should you check low phosphorus level needs so much assistance with activities
immediately? of daily living. What is your best response?

A. Sodium A. “The client’s low phosphorus is probably due to

B. Potassium malnutrition.”
C. Magnesium B. “The client is just worn out form not getting enough
D. Calcium rest.”
6. The client’s potassium level is 6.7 mEq/L. Which C. “The client’s skeletal muscles are weak because of the
intervention should you delegate to the student nurse under low phosphorus.”
your supervision? D. “The client will do more for herself when her phosphorus
is normal”
A. Administer Kayexalate 15 g orally 12.You are reviewing a client’s morning laboratory results.
B. Administer spironolactone 25 mg orally Which of these results is of most concern?
C. Assess WCG strip for tall T waves
D. Administer potassium 10 mEq orally A. Serum potassium 5.2 mEq/L
7. A client is admitted to the unit with a diagnosis of B. Serum sodium 134 mEq/L
syndrome of inappropriate antidiuretic hormone secretion C. Serum calcium 10.6 mg/dL
(SIADH). For which electrolyte abnormality will you be sure to D. Serum magnesium 0.8 mEq/L
monitor? 13. You are the charge nurse. Which client is most appropriate
to assign to the step-down unit nurse pulled to the intensive
A. Hypokalemia care unit for the day?
B. Hyperkalemia
C. Hyponatremia A. A 68-year-old client on ventilator with acute respiratory
D. Hypernatremia failure and respiratory acidosis
8. The charge nurse assigned in the care for a client with acute B. A 72-year-old client with COPD and normal arterial blood
renal failure and hypernatremia to you, a newly graduated gases (ABGs) who is ventilator-dependent
RN. Which actions can you delegate to the nursing assistant? C. A 56-year-old new admission client with diabetic
ketoacidosis (DKA) on a n insulin drip
A. Provide oral care every 3-4 hours D. A 38-year-old client on a ventilator with narcotic
B. Monitor for indications of dehydration overdose and respiratory alkalosis
C. Administer 0.45% saline by IV line 14.A client with respiratory failure is receiving mechanical
D. Assess daily weights for trends ventilation and continues to produce ABG results indicating
9. The experienced LPN/LVN reports that a client’s blood respiratory acidosis. Which action should you expect to
pressure and heart rate have decreased and that when the correct this problem?
face is assessed, one side twitches. What action should you
take at this time? A. Increase the ventilator rate from 6 to 10 per minute
B. Decrease the ventilator rate from 10 to 6 per minute
A. Reassess the client’s blood pressure and heart rate C. Increase the oxygen concentration fro 30% to 40%
 D. Decrease the oxygen concentration fro 40% to 30% C. “Whenever a client develops a respiratory acid-base
15.Which action should you delegate to the nursing assistant problem, increasing the respiratory rate helps correct
for the client with diabetic ketoacidosis? (Choose all that the problem.”
apply.) D. “The client is hyperventilating because of anxiety and we
will have to stay alert for development of a respiratory
A. Check fingerstick glucose every hour. acidosis.”
B. Record intake and output every hour. 21. George Kent is a 54 year old widower with a history of
C. Check vital signs every 15 minutes. chronic obstructive pulmonary disease and was rushed to the
D. Assess for indicators of fluid imbalance. emergency department with increasing shortness of breath,
16.You are admitting an elderly client to the medical unit. pyrexia, and a productive cough with yellow-green sputum.
Which factor indicates that this client has a risk for acid-base He has difficulty in communicating because of his inability to
imbalances? complete a sentence. One of his sons, Jacob, says he has been
unwell for three days. Upon examination, crackles and
A. Myocardial infarction 1 year ago wheezes can be heard in the lower lobes; he has a tachycardia
B. Occasional use of antacids and a bounding pulse. Measurement of arterial blood gas
C. Shortness of breath with extreme exertion shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2
D. Chronic renal insufficiency 60 mm Hg. How would you interpret this?
17.A client with lung cancer has received oxycodone 10 mg
orally for pain. When the student nurse assesses the client, A. Respiratory Acidosis, Uncompensated
which finding should you instruct the student to report B. Respiratory Acidosis, Partially Compensated
immediately? C. Metabolic Alkalosis, Uncompensated
D. Metabolic Acidosis, Partially Compensated
A. Respiratory rate of 8 to 10 per minute 22. Carl, an elementary student, was rushed to the hospital
B. Pain level decreased from 6/10 to 2/10 due to vomiting and a decreased level of consciousness. The
C. Client requests room door be closed. patient displays slow and deep (Kussmaul breathing), and he
D. Heart rate 90-100 per minute is lethargic and irritable in response to stimulation. He
18.The nursing assistant reports to you that a client seems appears to be dehydrated—his eyes are sunken and mucous
very anxious and that vital signs included a respiratory rate of membranes are dry—and he has a two week history of
38 per minute. Which acid-base imbalance should you polydipsia, polyuria, and weight loss. Measurement of arterial
suspect? blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg,
and HCO3 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5
A. Respiratory acidosis mmol/L, and Cl- 95 mmol/L. What is your assessment?
B. Respiratory alkalosis
C. Metabolic acidosis A. Respiratory Acidosis, Uncompensated
D. Metabolic alkalosis B. Respiratory Acidosis, Partially Compensated
19.A client is admitted to the unit for chemotherapy. To C. Metabolic Alkalosis, Uncompensated
prevent an acid-base problem, which of the following would D. Metabolic Acidosis, Partially, Compensated
you instruct the nursing assistant to report? 23. A cigarette vendor was brought to the emergency
department of a hospital after she fell into the ground and
A. Repeated episodes of nausea and vomiting hurt her left leg. She is noted to be tachycardic and
B. Complaints of pain associated with exertion tachypneic. Painkillers were carried out to lessen her pain.
C. Failure to eat all food on breakfast tray Suddenly, she started complaining that she is still in pain and
D. Client hair loss during morning bath now experiencing muscle cramps, tingling, and paraesthesia.
20.A client has a nasogastric tube connected to intermittent Measurement of arterial blood gas reveals pH 7.6, PaO2 120
wall suction. The student nurse asks why the client’s mm Hg, PaCO2 31 mm Hg, and HCO3 25 mmol/L. What does
respiratory rate has increased. What your best response? this mean?

A. “It’s common for clients with uncomfortable procedures A. Respiratory Alkalosis, Uncompensated
such as nasogastric tubes to have a higher rate to B. Respiratory Acidosis, Partially Compensated
breathing.” C. Metabolic Alkalosis, Uncompensated
B. “The client may have a metabolic alkalosis due to the NG D. Metabolic Alkalosis, Partially Compensated
suctioning and the increased respiratory rate is a 24. Ricky’s grandmother is suffering from persistent vomiting
compensatory mechanism.” for two days now. She appears to be lethargic and weak and
has myalgia. She is noted to have dry mucus membranes and
her capillary refill takes >4 seconds. She is diagnosed as
having gastroenteritis and dehydration. Measurement of 7.61, PaCO2 22 mmHg and HCO3 25 mEq/L. What is the ABG
arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 interpretation based on the findings?
mm Hg, and HCO3 34 mmol/L. What acid-base disorder is
shown? A. Metabolic Acidosis, Uncompensated
B. Respiratory Alkalosis, Partially Compensated
A. Respiratory Alkalosis, Uncompensated C. Respiratory Alkalosis, Uncompensated
B. Respiratory Acidosis, Partially Compensated D. Metabolic Alkalosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated 29. Three-year-old Adrian is admitted to the hospital with a
D. Metabolic Alkalosis, Partially Compensated diagnosis of asthma and respiratory distress syndrome. The
25. Mrs. Johansson, who had undergone surgery in the post- mother of the child reports to the nurse on duty that she has
anesthesia care unit (PACU), is difficult to arouse two hours witnessed slight tremors and behavioral changes in her child
following surgery. Nurse Florence in the PACU has been over the past four days. The attending physician orders
administering Morphine Sulfate intravenously to the client for routine ABGs following an assessment of the ABCs. The ABG
complaints of post-surgical pain. The client’s respiratory rate results are pH 7.35, PaCO2 72 mmHg and HCO3 38 mEq/L.
is 7 per minute and demonstrates shallow breathing. The What acid-base disorder is shown?
patient does not respond to any stimuli! The nurse assesses
the ABCs (remember Airway, Breathing, Circulation!) and A. Respiratory Acidosis, Uncompensated
obtains ABGs STAT! Measurement of arterial blood gas shows B. Respiratory Acidosis, Fully Compensated
pH 7.10, PaCO2 70 mm Hg and HCO3 24 mEq/L. What does C. Respiratory Alkalosis, Fully Compensated
this mean? D. Metabolic Alkalosis, Partially Compensated
30. Anne, who is drinking beer at a party, falls and hits her
A. Respiratory Alkalosis, Partially Compensated head on the ground. Her friend Liza dials “911” because Anne
B. Respiratory Acidosis, Uncompensated is unconscious, depressed ventilation (shallow and slow
C. Metabolic Alkalosis, Partially Compensated respirations), rapid heart rate, and is profusely bleeding from
D. Metabolic Acidosis, Uncompensated both ears. Which primary acid-base imbalance is Anne at risk
26. Baby Angela was rushed to the Emergency Room following for if medical attention is not provided?
her mother’s complaint that the infant has been irritable,
difficult to breastfeed and has had diarrhea for the past 3 A. Metabolic Acidosis
days. The infant’s respiratory rate is elevated and the B. Metabolic Alkalosis
fontanels are sunken. The Emergency Room physician orders C. Respiratory Acidosis
ABGs after assessing the ABCs. The results from the ABG D. Respiratory Alkalosis
results show pH 7.39, PaCO2 27 mmHg and HCO3 19 mEq/L. 31. Dave, a 6-year-old boy, was rushed to the hospital
What does this mean? following her mother’s complaint that her son has been
vomiting, nauseated and has overall weakness. After series of
A. Respiratory Alkalosis, Fully Compensated tests, the nurse notes the laboratory results: potassium: 2.9
B. Metabolic Acidosis, Uncompensated mEq. Which primary acid-base imbalance is this boy at risk for
C. Metabolic Acidosis, Fully Compensated if medical intervention is not carried out?
D. Respiratory Acidosis, Uncompensated
27. Mr. Wales, who underwent post-abdominal surgery, has a A. Respiratory Acidosis
nasogastric tube. The nurse on duty notes that the B. Respiratory Alkalosis
nasogastric tube (NGT) is draining a large amount (900 cc in 2 C. Metabolic Acidosis
hours) of coffee ground secretions. The client is not oriented D. Metabolic Alkalosis
to person, place, or time. The nurse contacts the attending 32. An old beggar was admitted to the emergency
physician and STAT ABGs are ordered. The results from the department due to shortness of breath, fever, and a
ABGs show pH 7.57, PaCO2 37 mmHg and HCO3 30 mEq/L. productive cough. Upon examination, crackles and wheezes
What is your assessment? are noted in the lower lobes; he appears to be tachycardic
and has a bounding pulse. Measurement of arterial blood gas
A. Metabolic Acidosis, Uncompensated shows pH 7.2, PaCO2 66 mm Hg, HCO3 27 mmol/L, and PaO2
B. Metabolic Alkalosis, Uncompensated 65 mm Hg. As a knowledgeable nurse, you know that the
C. Respiratory Alkalosis, Uncompensated normal value for pH is:
D. Metabolic Alkalosis, Partially Compensated
28. Client Z is admitted to the hospital and is to undergo brain A. 7.20
surgery. The client is very anxious and scared of the upcoming B. 7.30
surgery. He begins to hyperventilate and becomes very dizzy. C. 7.40
The client loses consciousness and the STAT ABGs reveal pH D. 7.50
33. Liza’s mother is seen in the emergency department at a A. Respiratory Acidosis
community hospital. She admits that her mother is taking B. Respiratory Alkalosis
many tablets of aspirin (salicylates) over the last 24-hour C. Metabolic Acidosis
period because of a severe headache. Also, the mother D. Metabolic Alkalosis
complains of an inability to urinate. The nurse on duty took 38. A mountaineer attempts an assault on a high mountain in
her vital signs and noted the following: Temp = 97.8 °F; apical the Andes and reaches an altitude of 5000 meters (16,400 ft)
pulse = 95; respiration = 32 and deep. Which primary acid- above sea level. What will happen to his arterial PCO2 and
base imbalance is the gentleman at risk for if medical pH?
attention is not provided?
A. Both will be lower than normal.
A. Respiratory Acidosis B. The pH will rise and PCO2 will fall.
B. Respiratory Alkalosis C. Both will be higher than normal due to the physical
C. Metabolic Acidosis exertion.
D. Metabolic Alkalosis D. The pH will fall and PCO2 will rise
34. A patient who is hospitalized due to vomiting and a 39. A young woman is found comatose, having taken an
decreased level of consciousness displays slow and deep unknown number of sleeping pills an unknown time before.
(Kussmaul breathing), and he is lethargic and irritable in An arterial blood sample yields the following values: pH 6.90,
response to stimulation. The doctor diagnosed him of having HCO3- 13 meq/liter and PaCO2 68 mmHg. This patient’s acid-
dehydration. Measurement of arterial blood gas shows pH base status is most accurately described as:
7.0, PaO2 90 mm Hg, PaCO2 22 mm Hg, and HCO3 14 mmol/L;
other results are Na+ 120 mmol/L, K+ 2.5 mmol/L, and Cl- 95 A. Metabolic Acidosis
mmol/L. As a knowledgeable nurse, you know that the normal B. Respiratory Acidosis
value for PaCO2 is: C. Simultaneous Respiratory and Metabolic Acidosis
D. Respiratory Acidosis with Complete Renal Compensation
A. 22 mm Hg 40. A mother is admitted in the emergency department
B. 36 mm Hg following complaints of fever and chills. The nurse on duty
C. 48 mm Hg took her vital signs and noted the following: Temp = 100 °F;
D. 50 mm Hg apical pulse = 95; respiration = 20 and deep. Measurement of
35. A company driver is found at the scene of an automobile arterial blood gas shows pH 7.37, PaO2 90 mm Hg, PaCO2 40
accident in a state of emotional distress. He tells the mm Hg, and HCO3 24 mmol/L. What is your assessment?
paramedics that he feels dizzy, tingling in his fingertips, and
does not remember what happened to his car. Respiratory A. Hyperthermia
rate is rapid at 34/minute. Which primary acid-base B. Hyperthermia and Respiratory Alkalosis
disturbance is the young man at risk for if medical attention is C. Hypothermia
not provided? D. Hypothermia and Respiratory Alkalosis

A. Respiratory Acidosis ANSWER KEY:

B. Respiratory Alkalosis 1. ANSWER B – The nursing assistant can reinforce
C. Metabolic Acidosis additional fluild intake once it is part of the care plan.
D. Metabolic Alkalosis Administering IV fluids, developing plans, and teaching
36. An elderly client was admitted to hospital in a coma. families require additional education and skills that are
Analysis of the arterial blood gave the following values: PCO2 within the scope of practice for the RN.
16 mm Hg, HCO3- 5 mmol/L and pH 7.1. As a well-rounded 2. ANSWER A – Normally, neck veins are distended when
nurse, you know that the normal value for HCO3 is: the client is in the supine position. The veins flatten as
the client moves to a sitting position. The other three
A. 20 mmol/L responses are characteristic of Excess Fluid Volume.
B. 24 mmol/L 3. ANSWER A, B, C, D – The LPN/LVN’s scope of practice
C. 29 mmol/L and educational preparation includes oral care and
D. 31 mmol/L routine observation. State practice acts vary as to
37. In a patient undergoing surgery, it was vital to aspirate the whether LPN/LVNs are permitted to perform
contents of the upper gastrointestinal tract. After the assessment. The client should be reminded to avoid
operation, the following values were acquired from an arterial most commercial mouthwashes that contain alcohol, a
blood sample: pH 7.55, PCO2 52 mm Hg and HCO3- 40 drying agent. Initiating a dietary consult is within the
mmol/l. What is the underlying disorder? purview of the RN or physician.
4. ANSWER D – Bilateral moist crackles indicate fluid-filled 15. ANSWER B, C – The nursing assistant’s training and
alveoli, which interferes with gas exchange. Furosemide education include how to take vital signs and record
is a potent loop diuretic that will help mobilize the fluid intake and output. The need to take vital signs this
in the lungs. The other orders are important but not frequently indicates that the client maybe unstable. The
urgent. nurse should give the nursing assistant reporting
5. ANSWER B – Suspect hypokalemia and check the client’s parameters when delegating this action, should also
potassium level. Common ECG changes with check the vital signs for indications in instability.
hypokalemia include ST depression, inverted T waves, Performing fingerstick glucose checks and assessing
and prominent U waves. Client with hypokalemia may clients require additional education and skill that are
also develop heart block. appropriate to licensed nurses. Some facilities may train
6. ANSWER A – The client’s potassium level is high (normal experienced nursing assistants to perform fingerstick
range 3.5-5.0). Kayexalate removes potassium from the glucose checks and change their role descriptions to
body through the gastrointestinal system. designate their new skills, but this is beyond the normal
Spironolactone is a potassium-sparing diuretic that may scope of practice for a nursing assistant.
cause the client’s potassium level to go even higher. The 16. ANSWER D – Risk factors for acid-base imbalances in the
nursing student may not have the skill to assess ECG older adult include chronic renal disease and pulmonary
strips and this should be done by the RN. disease. Occasional antacid use will not cause
7. ANSWER C – SIADH causes a relative sodium deficit due imbalances, although antacid abuse is a risk factor for
to excessive retention of water. metabolic alkalosis.
8. ANSWER A – Providing oral care is within the scope of 17. ANSWER A – A decreased respiratory rate indicates
practice for the nursing assistant. Monitoring and respiratory depression which also puts the client at risk
assessing clients, as well as administering IV fluids, for respiratory acidosis, All of the other findings are
require the additional education and skill of the RN. important and should be reported to the RN, but the
9. ANSWER B – A positive Chvostek’s sign (facial twitching respiratory rate is urgent.
of one side of the mouth, nose, and cheek in response to 18. ANSWER B – The client is most likely hyperventilating
tapping the face just below and in front of the ear) is a and blowing off CO2. This decrease in CO2 will lead to an
neurologic manifestation of hypocalcemia. The LPN/LVN increase in pH, causing respiratory alkalosis. Respiratory
is experienced and possesses the skills to take accurate acidosis results from respiratory depression and retained
vital signs. CO2. Metabolic acidosis and alkalosis result from
10. ANSWER D – Clients with low calcium levels should be problems related to renal acid-base control.
encouraged to consume dairy products, seafood, nuts, 19. ANSWER A – Prolonged nausea and vomiting can result
broccoli, and spinach. Which are all good sources of in acid deficit that can lead to metabolic alkalosis. The
dietary calcium. other findings are important and need to be assessed
11. ANSWER C – A musculoskeletal manifestation of low but are not related to acid-base imbalances.
phosphorous is generalized muscle weakness that may 20. ANSWER B – Nasogastric suctioning can result in a
lead to acute muscle breakdown (rhabdomyolysis). Even decrease in acid components and metabolic alkalosis.
though the other statements are true, they do not The client’s increase in rate and depth of ventilation is an
answer the nursing assistant’s question. attempt to compensate by blowing off CO2. the first
12. ANSWER D – While all of these laboratory values are response maybe true but does not address all the
outside of the normal range, the magnesium is most components of the question. The third and fourth
outside of normal. With a magnesium level this low, the answers are inaccurate.
client is at risk for ECG changes and life-threatening 21. Answer: B. Respiratory Acidosis, Partially
ventricular dysrhythmias. Compensated. The patient has respiratory acidosis
13. ANSWER B – The client with COPD, although ventilator (raised carbon dioxide) resulting from an acute
dependent, is the most stable of this group. Clients with exacerbation of chronic obstructive pulmonary disease,
acid-base imbalances often require frequent laboratory with partial compensation.
assessment and changes in therapy to correct their 22. Answer: D. Metabolic Acidosis, Partially,
disorders. In addition, the client with DKA is a new Compensated. The student was diagnosed having
admission and will require an in-depth admission diabetes mellitus. The results show that he has
assessment. All three of these clients need care from an metabolic acidosis (low HCO3 -) with respiratory
experienced critical care nurse. compensation (low CO2).
14. ANSWER A – the blood gas component responsible for 23. Answer: A. Respiratory Alkalosis, Uncompensated. The
respiratory acidosis is CO2 (Carbon dioxide). Increasing primary disorder is acute respiratory alkalosis (low CO2)
the ventilator rate will blow off more CO2 and decrease due to the pain and anxiety causing her to
the acidosis. Changes in the oxygen setting may improve hyperventilate. There has not been time for metabolic
oxygenation but will not affect respiratory acidosis. compensation.
24. Answer: C. Metabolic Alkalosis, Uncompensated. The 35. Answer: B. Respiratory Alkalosis. Hyperventilation is
primary disorder is uncompensated metabolic alkalosis typically the underlying cause of respiratory alkalosis.
(high HCO3 -). As CO2 is the strongest driver of Hyperventilation is also known as overbreathing. When
respiration, it generally will not allow hypoventilation as someone is hyperventilating, they tend to breathe very
compensation for metabolic alkalosis. deeply or very rapidly.
25. Answer: B. Respiratory Acidosis, Uncompensated. The 36. Answer: B. 24 mmol/L. The normal value for bicarbonate
results show that Mrs. Johansson has respiratory acidosis (HCO3) is 22-26 mmol/L or mEq/L. It may vary slightly
because of decreased pH and increased PaCO2 which among different laboratories. The given values show the
mean acidic in nature. Meanwhile, it is uncompensated common measurement range of results for these tests.
because HCO3 is within the normal range. Some laboratories use different measurements or may
26. Answer: C. Metabolic Acidosis, Fully Compensated. Baby test different specimens.
Angela has metabolic acidosis due to decreased HCO3 37. Answer: D. Metabolic Alkalosis. NGT suctioning,
and slightly acidic pH. Her pH value is within the normal vomiting, hypokalemia and overdosage of NaHCO3 are
range which made the result fully compensated. considered risk factors of metabolic alkalosis.
27. Answer: B. Metabolic Alkalosis, Uncompensated. The 38. Answer: B. The pH will rise and PCO2 will fall. The
postoperative client’s ABG results show that he has mountaineer will suffer from a respiratory alkalosis. The
metabolic alkalosis because of an increased pH and decline in the PO2 with altitude will stimulate breathing
HCO3. It is uncompensated due to the normal PaCO2 to offset the hypoxia. Carbon dioxide is driven from the
which is within 35 to 45 mmHg. blood faster than it is produced in the tissues so PCO2
28. Answer: C. Respiratory Alkalosis, Uncompensated. The falls and pH rises.
results show that client Z has respiratory alkalosis since 39. Answer: C. Simultaneous Respiratory and Metabolic
there is an increase in the pH value and a decrease in Acidosis. Whenever the PCO2 and HCO3 are abnormal in
PaCO2 which are both basic. It is uncompensated due to opposite directions, ie, one above normal while the
the normal HCO3 which is within 22-26 mEq/L. other is reduced, a mixed respiratory and metabolic acid-
29. Answer: B. Respiratory Acidosis, Fully Compensated. The base disorder exists. When the PCO2 is elevated and the
patient has respiratory acidosis (raised carbon dioxide) [HCO3-] reduced, respiratory acidosis and metabolic
resulting from asthma and respiratory distress acidosis coexist.
syndrome, with compensation having normal pH value 40. Answer: A. Hyperthermia. An individual is considered to
within 7.35to 7.45, increased PaCO2 which is acidic and have hyperthermia if he or she has a temperature of
increased HCO3 which is basic. >37.5 or 38.3 °C (99.5 or 100.9 °F). Measurement of
30. Answer: C. Respiratory Acidosis. One of the risk factors arterial blood gases are normal.
of having respiratory acidosis is hypoventilation which
may be due to brain trauma, coma, and hypothyroidism
or myxedema. Other risk factors include COPD,
Respiratory conditions such as pneumothorax,
pneumonia and status asthmaticus. Drugs such as
Morphine and MgSO4 toxicity are also risk factors of
respiratory acidosis.
31. Answer: D. Metabolic Alkalosis. Vomiting, hypokalemia,
overdosage of NaHCO3 and NGT suctioning are
considered risk factors of metabolic alkalosis.
32. Answer: C. 7.40. Normal blood pH must be maintained
within a narrow range of 7.35-7.45 to ensure the proper
functioning of metabolic processes and the delivery of
the right amount of oxygen to tissues. Acidosis refers to
an excess of acid in the blood that causes the pH to fall
below 7.35, and alkalosis refers to an excess of base in
the blood that causes the pH to rise above 7.45.
33. Answer. C. Metabolic Acidosis. Salicylate overdose
causes a high anion gap metabolic acidosis in both
children and adults. Adults commonly develop a mixed
acid-base disorder as a respiratory alkalosis due to direct
respiratory centre stimulation occurs as well. This second
disorder is uncommon in children.
34. Answer: B. 36 mm Hg. The normal range for PaCO2 is
from 35 to 35 mm Hg.