Quiz: Fluids, Electrolytes, Acid-Base, and Renal Function

An older adult client has blood pressure 88/55 mm Hg, heart rate 112/minute, dry mucous membranes, and poor skin turgor. Which laboratory finding would the nurse expect?

Increased serum hematocrit

Fluid volume deficit causes hemoconcentration. With less plasma volume, hematocrit may increase.

A client has difficulty starting the urine stream, nocturia, incomplete bladder emptying, decreased urine output, and rising creatinine. Which type of acute kidney injury is most likely?

Postrenal AKI

Postrenal AKI occurs when urine flow is obstructed after urine is produced. Bladder outlet obstruction can cause urine backup and impaired kidney function.

A client reports burning with urination, urinary frequency, urgency, and suprapubic discomfort. The client denies fever, chills, flank pain, nausea, or vomiting. Which condition is most likely?

Cystitis

Cystitis is a lower urinary tract infection and commonly causes dysuria, urgency, frequency, and suprapubic discomfort.

A client has urinary frequency, flank pain, fever, chills, and nausea. Which condition is most likely?

Pyelonephritis

Pyelonephritis involves the upper urinary tract/kidney and commonly causes flank pain, fever, chills, nausea, and vomiting.

Which lab pattern best supports worsening chronic kidney disease?

GFR decreases and creatinine increases

As kidney function worsens, GFR falls and serum creatinine generally rises.

A client with chronic kidney disease develops decreased urine output. Which electrolyte and acid-base problem is most concerning?

Hyperkalemia and metabolic acidosis

As kidney function declines, the kidneys have difficulty excreting potassium and acid. This can lead to hyperkalemia and metabolic acidosis.

A client has edema, severe proteinuria, low serum albumin, and hyperlipidemia. Which syndrome is most likely?

Nephrotic syndrome

Nephrotic syndrome is characterized by severe proteinuria, hypoalbuminemia, edema, and often hyperlipidemia/lipiduria.

A client has sodium 122 mEq/L and new-onset confusion. Which explanation best describes the pathophysiology?

Water shifts into brain cells, causing cellular swelling

Hyponatremia lowers extracellular osmolality. Water moves into cells, including brain cells, which can cause confusion, seizures, or coma.

A client has sodium 154 mEq/L after several days of poor oral intake. Which finding is most consistent with this imbalance?

Intracellular dehydration

Hypernatremia increases extracellular osmolality. Water moves out of cells, causing intracellular dehydration.

A client taking furosemide reports muscle weakness. The potassium level is 2.8 mEq/L. Which assessment finding is the priority concern?

Cardiac dysrhythmia

Hypokalemia can cause muscle weakness and dangerous cardiac dysrhythmias.

A client with chronic kidney disease has potassium 6.4 mEq/L. Which finding requires immediate attention?

Peaked T waves on ECG

Hyperkalemia can cause life-threatening cardiac conduction changes. Peaked T waves are an important ECG finding.

A client has the following ABG results:

pH 7.28
PaCO2 56 mmHg
HCO3 24 mEq/L

Which acid-base imbalance is present?

Respiratory acidosis

The pH is low, indicating acidosis. PaCO2 is high and moving opposite the pH, which indicates a respiratory cause.

A client who has been vomiting for 2 days has the following ABG results:

pH 7.50
PaCO2 43 mmHg
HCO3 34 mEq/L

Which acid-base imbalance is present?

Metabolic alkalosis

The pH is high, indicating alkalosis. HCO3 is elevated and moving in the same direction as pH, indicating metabolic alkalosis. Vomiting causes loss of gastric acid.

A client with diabetic ketoacidosis has the following ABG results:

pH 7.24
PaCO2 32 mmHg
HCO3 14 mEq/L

Which acid-base imbalance is present?

Metabolic acidosis

The pH is low, indicating acidosis. HCO3 is low and moving in the same direction as pH, indicating metabolic acidosis. DKA is a classic cause.

A client has severe dehydration, decreased urine output, BUN 48 mg/dL, and creatinine 2.1 mg/dL. Which type of acute kidney injury is most likely?

Prerenal AKI

Prerenal AKI occurs when renal perfusion decreases. Severe dehydration and low circulating volume reduce blood flow to the kidneys.