ATI RN Targeted Medical Surgical Fluid, Electrolyte, and Acid-Base Online Practice 2023

A nurse is caring for a client on a medical-surgical unit. The nurse should first address the client's ___, followed by client's ___.

ECG; calf circumference

When using the airway, breathing, circulation framework, the nurse first should address the client's ECG, followed by the client's calf circumference. The client has manifestations of hypercalcemia, such as dysrhythmias, impaired circulation, decreased perfusion, and hypertension. The nurse needs to correct the calcium imbalance and monitor the client's ECG, heart rate, and blood pressure, and evaluate the client for a possible deep vein thrombosis.

A nurse is reviewing the medical record of a client who has diabetes mellitus and is receiving regular insulin by continuous IV infusion to treat diabetic ketoacidosis. Which if the following findings should the nurse report to the provider?

Urine output 30 mL/hr

Serum potassium 3.0 mEq/L

Blood glucose 180 mg/dL

BUN 18 mg/dL

Serum potassium 3.0 mEq/L

This serum potassium level is below the expected reference range. Hypokalemia is a serious complication that can occur when a client who has diabetic ketoacidosis is receiving insulin to treat the condition. The nurse should report this finding to the provider.

A nurse in a provider's office is caring for a client. The client is at risk for developing ___ and ___.

Hyponatremia; hypomagnesemia

A nurse is caring for a client in the emergency department. The client is at risk for developing ___ due to ___.

Seizures; sodium level

When analyzing cues of dizziness, nausea, vomiting, and headache after prolonged exercise, the nurse should identify the client is at risk for seizures due to hyponatremia. The nurse should administer an oral sodium replacement, an isotonic saline solution, or an antidiuretic receptor antagonist medication, such as tolvaptan, to increase the client's serum sodium level. The nurse should monitor the client for neurological changes caused by cerebral edema due to cellular swelling. Manifestations of increased intracranial pressure include lethargy, confusion, and seizures.

A nurse is caring for a client who reports difficulty breathing and tingling in both hands. Their respiratory rate is 36/min and they appear very restless. Which of the following values should the nurse anticipate to be outside the expected reference range if the client is in respiratory alkalosis?

PaCO2

The nurse should anticipate that a client who has respiratory alkalosis will have a decreased PaCO2 level due to hyperventilation.

A nurse is assessing a client who has a calcium level of 8.1 mg/dL. Which of the following findings is the priority for the nurse to assess?

Deep-tendon reflexes

Cardiac rhythm

Peripheral sensation

Bowel sounds

Cardiac rhythm

When using the airway, breathing, circulation approach to client care, the nurse should first assess the client's cardiac rhythm because this total calcium level is below the expected reference range. Hypocalcemia can cause ECG changes, bradycardia, or tachycardia.

A nurse is assessing a client who has dehydration. Which of the following assessments is the priority?

Mental status

The greatest risk to this client is injury from a fall due to a decline in their mental status. Therefore, assessing the client's mental status is the nurse's priority.

A nurse is planning care for a client who has a potassium level of 3 mEq/L. The nurse should plan to monitor the client for which of the following findings?

Hyperactive deep-tendon reflexes

Orthostatic hypotension

Rapid, deep respirations

Strong, bounding pulse

Orthostatic hypotension

The nurse should plan to monitor the client for orthostatic hypotension, which places them at risk for falls. Orthostatic hypotension is a manifestation of hypokalemia.

Manifestations of hypokalemia include weak hand grip strength and weak deep-tendon reflexes.

Weakening of the respiratory muscles and shallow respirations are manifestations of hypokalemia.

A weak, thready pulse is a manifestation of hypokalemia.

A nurse is reviewing the laboratory report of a female client who has fluid volume excess. Which of the following laboratory values should the nurse expect?

Hct 34%

The nurse should identify that a client who has fluid volume excess can have an Hct level that is below the expected reference range of 37 to 47%. Fluid volume excess can cause hemodilution and a decreased hematocrit level.

Fluid volume excess can cause a decrease in BUN.

Fluid volume excess can cause a decrease in urine specific gravity.

Fluid volume excess can cause hemodilution and a decreased hemoglobin level.

A nurse is caring for a client who has a sodium level of 155 mEq/L. Which of the following IV fluids should the nurse anticipate the provider to prescribe?

3% sodium chloride

0.45% sodium chloride

Dextrose 5% in lactated Ringer's

Dextrose 5% in 0.9% sodium chloride

0.45% sodium chloride

A sodium level of 155 mEq/L is an indication of hypernatremia. The nurse should anticipate a prescription for a hypotonic solution. The 0.45% sodium chloride is a hypotonic solution used to provide free water and treat cellular dehydration, which promotes waste elimination by the kidneys.

A nurse is assessing a client who has hyperkalemia. Which of the following findings should the nurse expect?

Decreased muscle strength

Decreased gastric motility

Increased heart rate

Increased blood pressure

Decreased muscle strength

The nurse should expect the client to experience muscle weakness, fatigue, paresthesia, and nausea.

The nurse should expect the client to experience hypotension.

The nurse should expect the client to experience bradycardia.

The nurse should expect the client to experience increased gastric motility, including abdominal cramps and diarrhea.

A nurse is assessing a client who has hypomagnesemia. Which of the following findings should the nurse expect?

Hyperactive deep-tendon reflexes

Hyperactive deep-tendon reflexes are an expected finding for a client who has hypomagnesemia. Other expected findings include muscle cramps, numbness, and tingling.

Decreased bowel sounds are an expected finding for a client who has hypomagnesemia.

Insomnia is an expected finding for a client who has hypomagnesemia.

Increased blood pressure is an expected finding for a client who has hypomagnesemia.

A nurse is caring for a client who requires nasogastric suctioning. Which of the following sets of laboratory results indicates that the client has metabolic alkalosis?

pH 7.51;

PaO2 94 mm Hg;

PaCO2 36 mm Hg;

HCO3- 31 mEq/L

A nurse is assessing a client who is receiving hydrochlorothiazide and notes that the client is confused and lethargic. Which of the following laboratory values is the priority finding the nurse should report to the provider?

Glucose 130 mg/dL (74 to 106 mg/dL)

Sodium 128 mEq/L (136 to 145 mEq/L)

Calcium 8.8 mg/dL (9 to 10.5 mg/dL)

Magnesium 2.5 mEq/L (1.3 to 2.1 mEq/L)

Sodium 128 mEq/L

This level is below the expected reference range of 136 to 145 mEq/L and is the likely cause of the client's altered mental status. The nurse should report this priority finding to the provider and monitor the client for weakened respiratory effort.

A nurse is caring for a client who is experiencing diabetic ketoacidosis (DKA). Which of the following assessment findings should the nurse expect?

Urine output 450 mL/hr

The expected reference range for urinary output is between 1,500 to 2,000 mL daily. A urine output of 450 mL/hr indicates polyuria or excessive urine output. Polyuria is a manifestation of DKA.

A blood glucose level of > 300 mg/dL in the presence of other manifestations is an indication of DKA.

A pH of < 7.3 is a manifestation of DKA.

Clients experiencing DKA have excessive thirst and oral intake.

A nurse is preparing to administer oral potassium to a client who has a potassium level of 5.5 mEq/L. Which of the following actions should the nurse take first?

Withhold the medication

The greatest risk to the client is bradycardia, hypotension, and life-threatening cardiac complications due to hyperkalemia, defined as a potassium level above 5 mEq/L. Therefore, the nurse's priority action is to withhold the oral potassium and notify the provider.

A nurse is providing dietary teaching to a client who has heart failure and is receiving furosemide. Which of the following foods should the nurse recommend as containing the greatest amount of potassium?

1 cup plain yogurt

One cup of plain yogurt contains 380 g of potassium. Therefore, the nurse should recommend this food as containing the greatest amount of potassium.

One slice of whole grain bread contains 60 g of potassium.

One-half cup of chopped celery contains 132 g of potassium.

One-half cup of cooked tofu contains 164 g of potassium.

A nurse is reviewing the ABG results of four clients. Which of the following findings should the nurse identify as metabolic acidosis?

pH 7.26

PaO2 84 mm Hg

PaCO2 38 mm Hg

HCO3- 20 mEq/L

A pH below 7.35 is an indication of acidosis. An HCO3- below 22 mEq/L is an indication of metabolic acidosis.

A nurse is assessing a client who is using PCA following a thoracotomy. The client is short of breath, appears restless, and has a respiratory rate of 28/min. The client's ABG results are pH 7.52, PaO2 89 mmHg, PaCO2 28 mmHg, and HCO3- 24 mEq/L. Which of the following actions should the nurse take?

Provide calming interventions

The client's respiratory rate is above the expected reference range of 12 to 20/min. The nurse should instruct the client to breathe slowly. Calming the client should decrease the respiratory rate, which will cause the client's carbon dioxide levels to increase to expected levels of 35 to 45 mm Hg and lower the pH to expected levels of 7.35 to 7.45.

A nurse is assessing a client who has respiratory acidosis. Which of the following findings should the nurse expect?

Confusion

A client who has respiratory acidosis will experience confusion from a lack of cerebral perfusion. If acidosis is not reversed, the client's level of consciousness will decrease, and coma can occur.

Pale, cyanotic, dry skin is a manifestation of respiratory acidosis, as ineffective breathing causes a lack of perfusion to the tissues.

A nurse is caring for a client who is experiencing respiratory distress as a result of pulmonary edema. Which of the following actions should the nurse take first?

Assist with intubation.

Initiate high-flow oxygen therapy.

Administer a rapid-acting diuretic.

Provide cardiac monitoring.

Initiate high-flow oxygen therapy

When using the airway, breathing, circulation approach to client care, the nurse should first administer high-flow oxygen therapy by face mask at 5 to 6 L/min to keep the client's oxygen saturation above 90%.

A nurse is providing dietary teaching to a client who has kidney disease. Which of the following food choices should the nurse include in the teaching as containing the lowest amount of magnesium?

1 large, hard-boiled egg

One large, hard-boiled egg contains 5 mg of magnesium. Therefore, the nurse should recommend this food as containing the lowest amount of magnesium.

One-half cup of almonds contains 193 mg of magnesium

One cup of bran cereal contains 112 mg of magnesium.

One cup of cooked spinach contains 157 mg of magnesium

A nurse is caring for a client who has dehydration and is receiving IV fluids. When assessing for complications, the nurse should recognize which of the following manifestations as a sign of fluid overload?

Bounding peripheral pulses

The nurse should recognize that increased vascular volume results in full, bounding peripheral pulses.

The nurse should recognize that an increased respiratory rate is a manifestation of fluid volume overload.

The nurse should recognize that increased gastrointestinal motility is a manifestation of fluid volume overload.(Hyperactive bowel sounds)

The nurse should recognize that an increased urine specific gravity indicates a greater concentration of urine, which occurs with dehydration, not fluid volume overload.

While reviewing a client's laboratory results, a nurse notes a calcium level of 8 mg/dL. Which of the following actions should the nurse take?

Implement seizure precautions

The client is at risk for seizures due to low excitation threshold as a result of a decreased calcium level. The nurse should initiate seizure precautions to prevent injury.

A nurse is admitting a client who takes 40 mg furosemide daily for heart failure and has experienced 3 days of vomiting. The nurse suspects hypokalemia. Which of the following medications should the nurse prepare to administer?

0.9% sodium chloride with 10 mEq/L of potassium chloride at 100 mL/hr

This IV solution will provide adequate fluid and potassium replacement to offset the losses from vomiting. The typical amount of potassium chloride to administer IV is 5 to 10 mEq/hr, not to exceed 20 mEq/hr. The dilution should be 1 mEq of potassium chloride to 10 mL of 0.9% sodium chloride.

A nurse is caring for a client who requires continuous cardiac monitoring. The nurse identifies a prolonged P-R interval and a widened QRS complex. Which of the following laboratory values supports this finding?

Potassium 6.1 mEq/L

Hyperkalemia, defined as a potassium level above 5 mEq/L, can cause a prolonged P-R interval, a wide QRS complex, flat or absent P waves, and tall, peaked T waves.

A nurse is assessing a client who has a phosphorous level of 2.4 mg/dL. Which of the following findings should the nurse expect?

Slow peripheral pulses

This phosphorus level is below the expected reference range. The nurse should expect the client to have slow peripheral pulses. The nurse might also find that the client's pulses are difficult to find and easy to block.

A nurse is evaluating a client who is receiving IV fluids to treat dehydration. Which of the following laboratory findings indicates that the fluid therapy has been effective?

Heart rate of 92/min

A heart rate of 92/minutes is within the normal reference range and indicates that the IV fluid therapy has been effective.

A nurse is caring for a client who is receiving furosemide daily. During the morning assessment, the client tells the nurse they are "feeling weak in the legs." Which of the following actions should the nurse take first?

Auscultate the client's lungs

An adverse effect of many diuretics, including furosemide, is hypokalemia. When using the airway, breathing, circulation approach to client care, the nurse should first auscultate the client's lungs to assess for respiratory changes due to weakness of the respiratory muscles.

A nurse is admitting a client who has status asthmaticus. The client's ABG results are pH 7.32, PaO2 74 mmHg, PaCO2 56 mmHg, and HCO3- 26 mEq/L. The nurse should interpret these laboratory values as which of the following imbalances?

Respiratory acidosis

Status asthmaticus causes inadequate gas exchange, resulting in a low pH and PaO2, an elevated PaCO2, and an HCO3- within the expected reference range. These laboratory values indicate respiratory acidosis.

A nurse is caring for a client on a medical-surgical unit. Client reports a 5-day history of nausea and vomiting; client reports muscle weakness, cramps, and twitching. Client has hyperactive deep tendon reflexes.

Condition most likely experiencing: Metabolic alkalosis

Actions to take: prepare to administer an antiemetic; prepare to administer 0.9% sodium chloride IV

Parameters to monitor: Blood pressure and deep tendon reflexes

A nurse is providing teaching to a client who has venous insufficiency of the lower extremities. Which of the following statements by the client indicated an understanding of the teaching?

"I'll put on my elastic stockings at the first sign of swelling."

"If my stockings feel tight, I'll just roll them down for a while."

"When I sit down to watch television, I'll be sure to put my feet up."

"It's okay to cross my legs as long as it's for less than an hour."

"When I sit down to watch television, I'll be sure to put my feet up."

Venous insufficiency makes it difficult for blood flow to return to the heart. Elevating the feet will increase venous return. The client should elevate their feet for at least 20 min several times per day.