Fluid, Electrolyte, and Acid-Base Imbalances (Lewis Med-Surg CH. 16)
Exam Questions And 100% Correct Answers
A client with heart failure inadvertently abused diuretics as directed. For what potential
respiratory complication should the nurse monitor?
A) Tachypnea
Clients with a fluid volume deficit have impaired tissue perfusion and hypoxia that cause
tachypnea. Pulmonary edema, dyspnea, and coarse crackles on inspiration are all
manifestations of a fluid volume excess, not deficit.
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When assessing a patient with Cushing syndrome, which clinical manifestation would
the nurse observe?
A) Dyspnea
- The nurse would anticipate observing dyspnea in a patient with Cushing syndrome
(hyperadrenocorticism) because this condition can cause excess extracellular volume
accumulation, which blocks interstitial air and tissue spaces and results in dyspnea,
crackles, and peripheral edema. Hypoglycemia, weight loss, and hypotension are the
common manifestations of Addison's disease (hypoadrenocorticism).
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patient disorder has a potential complication of developing increased extracellular
,fluids?
A) Renal impairment
It is one-third contributed by the extracellular fluid, which includes the interstitial fluid,
plasma, and the transcellular fluid. This becomes excessive when the elimination of
water becomes impaired, especially during kidney failure. The fistula drainage, osmotic
diuresis, and intestinal obstruction are some of those conditions that result in the loss of
body fluid.
Which of the following interventions would the nurse implement when the pregnant
patient expresses complaints of headaches and dyspnea, and the nurse auscultates
bibasilar crackles and a bounding pulse? The nurse should:
A) Restrict dietary sodium intake.
A pregnant woman with increased extracellular fluid can lead to hypertension and
complications in pregnancy. Limitation of intake of dietary sodium controls the
accumulation of fluid and may maintain the fluid balance. Application of warm and cold
compresses will not relieve the patient's symptoms. Change of position does not benefit
the patient and the ice chips can increase the volume of fluid and worsen the condition.
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Which mechanism would the nurse use to explain a patient's insensible water loss of an
estimated 900 mL/day?
A) Vaporized by the lungs and skin
- An average of 600-900 mL is lost daily through the process of insensible water loss,
that is, vaporization via the lungs and skin. An average of 1500 mL are excreted in urine
and 100 mL in the feces. An average of 8000 mL of digestive fluids are secreted daily,
but most are reabsorbed by the GI tract.
,The nurse taught a caregiver about the care of an older adult patient with dementia and
the maintenance of fluid balance in the home. Which of the following statements by the
caregiver indicate that the caregiver understands the nurse's teachings?
1) "I should increase fluids and decrease dietary sodium."
2) "I should offer fluids only when the client expresses thirst."
3) "I should support the client while he is holding utensils and cups."
4) "I would want to encourage the patient to void before retiring to
bed."
5) "I would see that the patient keeps a glass of milk available at all
times."
A) 1, 3, 4
-The caregiver would reduce the amount of sodium in the patient's diet. Musculoskeletal
changes include stiffness of the hands and fingers which can result in difficulty holding
containers and assistance is needed. The patient should get into a routine of voiding
prior to bedtime to decrease nocturia (4). Changes in mental status are a concern in
older age and can contribute to reduced capability in expressing thirst and receiving
fluids. For this reason it is always suggested for the older adult patient to drink fluids,
even when not requested (2). The patient would need to increase the intake of other
fluids, with water being the better fluid source.
5.
The nurse would refer to intracellular fluid and extracellular fluid that are at the same
, osmolality as
A) Isotonic
Intracellular fluid and extracellular fluid have the same osmolality; this characteristic is
termed isotonic, meaning there is no net movement of fluids. Hypotonic refers to fluids
with low osmolality; thus, when a cell is bathed in a hypotonic fluid, water goes into the
cell. Hypertonic fluids are those with high osmolality; thus, when cells are bathed in a
hypertonic solution, water moves out of the cells. Oncotic pressure refers to the
pressure of plasma colloids in a solution.
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Which of the following would the nurse use as an indicator to evaluate the patient's fluid
balance who is receiving treatment for heart failure?
A) Daily weight
Daily body weight measurement is the most specific, accurate measure of fluid volume
status. Skin turgor; intake and output; and BUN, sodium, and hematocrit levels are also
indicators of fluid volume status; however, they are not as specific or helpful in gaining
information as is daily weight.
Of the movements of molecules which would occur if a patient is experiencing pedal
edema due to blood pressure of 160/90 mm Hg?
A) Osmosis
- A patient with blood pressure of 160/90 mm Hg has hypertension and develops pedal
edema because excess sodium in the blood causes water moving down the gradient.
The water in the blood vessels therefore diffuses through the semipermeable membrane
into higher concentration from lower concentration with the help of osmotic pressure,
thus causing accumulation of water in the extracellular spaces. This movement of water
across a semipermeable membrane to balance the solute is called osmosis. Passive
transport, such as diffusion and facilitated diffusion, refers to the movement of
molecules from higher to lower concentration, whereas active transport refers to the
movement of molecules from lower to higher concentration.
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