Fluid and Electrolytes Notes

1. Which of the following statements about fluid balance is true?

   • A. Fluid balance is regulated only by kidneys.

   • B. Thirst is a physiological response that influences fluid intake.

   • C. Fluid balance is not important for cognition.

   • D. Fluid balance does not affect blood pressure.

2. A nurse is monitoring a patient for signs of fluid volume deficit. Which of the following findings would the nurse anticipate? (Select all that apply)

   • A. Decreased skin turgor

   • B. Elevated BUN

   • C. Bradycardia

   • D. Weight gain

   • E. Dry mucous membranes

3. Hypernatremia may result from which of the following?

   • A. Excessive sodium intake

   • B. Overhydration

   • C. Water loss from the body

   • D. Both A and C

4. The nurse assesses a patient with hyponatremia. Which of the following symptoms may the nurse find?

   • A. Excessive thirst

   • B. Muscle weakness

   • C. Confusion

   • D. Elevated heart rate

5. Which intervention is most appropriate for a patient with hypovolemia?

   • A. Administering diuretics

   • B. Providing free water

   • C. Administering isotonic IV fluids

   • D. Limiting oral fluid intake

6. What laboratory finding is commonly seen in fluid volume excess?

   • A. Increased hematocrit

   • B. Decreased serum sodium

   • C. Increased urine specific gravity

   • D. Decreased BUN levels

7. A patient with renal failure is at risk for which electrolyte imbalance?

   • A. Hypernatremia

   • B. Hyperkalemia

   • C. Hypocalcemia

   • D. Hypomagnesemia

8. A nurse is educating a group on signs of hyperkalemia. Which of the following should be included? (Select all that apply)

   • A. Muscle weakness

   • B. Hypotension

   • C. Confusion

   • D. Elevated glucose levels

9. Which type of IV fluid is best to treat dehydration?

   • A. Hypertonic solution

   • B. Isotonic solution

   • C. Hypotonic solution

   • D. Colloids

10. In assessing a patient with hypervolemia, which finding is expected?

    • A. Dizziness

    • B. Dry mucous membranes

    • C. Edema

    • D. Weight loss

11. Hypercalcemia can lead to which of the following symptoms?

    • A. Muscle cramps

    • B. Bone pain

    • C. Bradycardia

    • D. Hyperreflexia

12. A patient with hypomagnesemia may exhibit which of the following?

    • A. Muscle spasms

    • B. Decreased reflexes

    • C. Diarrhea

    • D. Hypotension

13. For which of the following patients would isotonic fluids be contraindicated?

    • A. Patient with dehydration

    • B. Patient with head injury

    • C. Patient with hypovolemic shock

    • D. Patient with hypotension

14. What is the normal range for serum potassium?

    • A. 2.5-3.5 mEq/L

    • B. 3.5-5.0 mEq/L

    • C. 4.0-6.0 mEq/L

    • D. 3.0-4.5 mEq/L

15. A nurse is monitoring a patient with severe hyponatremia. Which symptom should prompt immediate intervention?

    • A. Weakness

    • B. Confusion

    • C. Seizures

    • D. Nausea

16. In managing patients with fluid volume excess, the nurse’s priority assessment should include:

    • A. Urine output

    • B. Breath sounds

    • C. Bowel sounds

    • D. Skin turgor

17. Regarding the causes of fluid volume deficit, which is true?

    • A. Fluid volume deficit can be caused by excess fluid intake.

    • B. Fever can contribute to fluid loss.

    • C. Excessive water consumption leads to hypovolemia.

    • D. Fluid shifting can only occur in trauma patients.

18. A patient with hyperphosphatemia may experience which of the following? (Select all that apply)

    • A. Muscle cramps

    • B. Osteoporosis

    • C. Seizures

    • D. Tachycardia

19. Which nursing intervention is appropriate for a patient receiving hypertonic IV fluids?

    • A. Monitor vital signs only

    • B. Assess for fluid overload symptoms

    • C. Limit oral intake

    • D. Administer insulin

20. How does osmosis affect fluid movement in the body?

    • A. Moves fluids from high to low concentrations

    • B. Moves fluids driven by osmotic pressure

    • C. Requires energy for fluid transport

    • D. Moves water across the semipermeable membrane based on solute concentration

21. A patient is being treated for hypervolemia. Which intervention is most appropriate?

    • A. Increase sodium intake

    • B. Administer hypertonic IV fluids

    • C. Restrict fluid and sodium intake

    • D. Monitor for decreased blood pressure

22. What is a major concern with administering diuretics to a patient with fluid volume deficit?

    • A. Weight gain

    • B. Dehydration

    • C. Hyponatremia

    • D. Hypertensive crisis

23. A 75-year-old patient is at high risk for fluid imbalances due to:

    • A. Increased thirst

    • B. Decreased renal function

    • C. Increased hydration demands

    • D. Decreased daily activity

24. To assess for dehydration in older adults, the nurse should focus primarily on:

    • A. Blood pressure changes

    • B. Urine output

    • C. Skin turgor

    • D. Heart rate

25. For which population is it most important to monitor fluid balance closely?

    • A. Young adults

    • B. Elderly patients

    • C. Middle-aged patients

    • D. Healthy individuals without comorbidities

Answers

1. B

2. A, B, E

3. D

4. B, C

5. C

6. B

7. B

8. A, B, C

9. B

10. C

11. B

12. A

13. B

14. B

15. C

16. B

17. B

18. A, C

19. B

20. D

21. C

22. B

23. B

24. C

25. B

1. A patient with heart failure is experiencing fluid volume excess. Which assessment finding is expected? a) Hypotension
   b) Weight loss
   c) Distended neck veins
   d) Dry mucous membranes

2. Which of the following IV fluids is considered isotonic?
   a) 0.45% NaCl
   b) 5% dextrose in water (D5W)
   c) 0.9% NaCl
   d) 3% NaCl

3. Which patient is at the highest risk for dehydration?
   a) A 45-year-old with controlled hypertension
   b) A 30-year-old with a urinary tract infection
   c) A 76-year-old experiencing vomiting and diarrhea
   d) A 25-year-old with seasonal allergies

4. A nurse is caring for a patient with severe diarrhea. Which electrolyte imbalance is the patient most at risk for?
   a) Hyperkalemia
   b) Hypokalemia
   c) Hypernatremia
   d) Hypocalcemia

5. Which symptom is associated with hypercalcemia?
   a) Muscle spasms
   b) Tetany
   c) Constipation
   d) Positive Trousseau’s sign

6. A nurse reviews a patient’s lab results: Sodium 128 mEq/L. Which clinical manifestation is most concerning?
   a) Dry skin
   b) Muscle cramps
   c) Seizures
   d) Nausea

7. Which of the following conditions is most likely to cause hyperkalemia?
   a) Diuretic therapy
   b) Acute kidney failure
   c) Excessive vomiting
   d) Hypothyroidism

8. A patient with fluid volume deficit will exhibit which of the following?
   a) Hypertension
   b) Bounding pulse
   c) Increased urine output
   d) Tachycardia

9. A nurse is preparing to administer a hypertonic IV solution. What is an appropriate nursing intervention?
   a) Monitor for signs of pulmonary edema
   b) Encourage oral fluid intake
   c) Monitor for signs of dehydration
   d) Administer via peripheral IV

10. Which condition is most likely to cause hypomagnesemia?
    a) Chronic alcoholism
    b) Hyperparathyroidism
    c) Decreased renal function
    d) Excessive milk intake

Select All That Apply (SATA)

11. Which of the following are symptoms of fluid volume excess? (Select all that apply)
    a) Crackles in lungs
    b) Peripheral edema
    c) Hypotension
    d) Weight gain
    e) Increased urine output

12. A patient has hyperkalemia. Which ECG changes are expected? (Select all that apply)
    a) Peaked T waves
    b) Prolonged PR interval
    c) ST segment depression
    d) U waves

13. Which foods should a patient with hypokalemia be encouraged to eat? (Select all that apply)
    a) Bananas
    b) Oranges
    c) Potatoes
    d) Cheese
    e) Spinach

14. Which of the following conditions can cause hypocalcemia? (Select all that apply)
    a) Hypoparathyroidism
    b) Pancreatitis
    c) Hyperthyroidism
    d) Multiple blood transfusions
    e) Chronic kidney disease

15. A nurse is caring for a patient with metabolic acidosis. Which electrolyte imbalance is most likely? (Select all that apply)
    a) Hyperkalemia
    b) Hypokalemia
    c) Hypercalcemia
    d) Hyperphosphatemia
    e) Hypomagnesemia

16. Which interventions are appropriate for a patient with hypernatremia? (Select all that apply)
    a) Administer IV hypotonic fluids
    b) Encourage oral water intake
    c) Increase sodium intake
    d) Monitor for neurological changes
    e) Administer diuretics if needed

17. A patient is receiving colloids. What is the expected effect? (Select all that apply)
    a) Pull fluid from the interstitial space into circulation
    b) Increase vascular volume
    c) Decrease urine output
    d) Treat hypovolemia
    e) Increase risk for edema

18. Which assessment findings indicate hypophosphatemia? (Select all that apply)
    a) Muscle weakness
    b) Confusion
    c) Seizures
    d) Hyperactive reflexes
    e) Dysrhythmias

19. A patient with chronic alcoholism is admitted for confusion and tremors. Which electrolyte imbalance is suspected? (Select all that apply)
    a) Hypokalemia
    b) Hypermagnesemia
    c) Hypomagnesemia
    d) Hyperphosphatemia
    e) Hypocalcemia

20. The nurse is monitoring a patient receiving IV magnesium sulfate. Which signs indicate hypermagnesemia? (Select all that apply)
    a) Hypotension
    b) Cardiac arrest
    c) Increased deep tendon reflexes
    d) Respiratory depression
    e) Tachycardia

Case-Based Questions

21. A patient has severe burns and is at risk for third-spacing. Which IV fluid type is most appropriate?
    a) Isotonic
    b) Hypotonic
    c) Hypertonic
    d) Colloids

22. A patient receiving loop diuretics is at risk for which electrolyte imbalance?
    a) Hyperkalemia
    b) Hyponatremia
    c) Hypermagnesemia
    d) Hyperphosphatemia

23. A patient with SIADH (Syndrome of Inappropriate Antidiuretic Hormone) is likely to develop:
    a) Hypernatremia
    b) Hyponatremia
    c) Hyperkalemia
    d) Hypercalcemia

24. Which of the following patients is most at risk for hyperphosphatemia?
    a) A patient with hypoparathyroidism
    b) A patient receiving IV calcium
    c) A patient in end-stage kidney disease
    d) A patient with chronic diarrhea

25. A nurse is assessing a patient with dehydration. Which lab values are expected?
    a) Low serum osmolality
    b) Increased hematocrit
    c) Decreased sodium
    d) Decreased BUN

Answers

1. c

2. c

3. c

4. b

5. c

6. c

7. b

8. d

9. a

10. a

11. a, b, d

12. a, b

13. a, b, c, e

14. a, b, d, e

15. a, d, e

16. a, b, d, e

17. a, b, d

18. a, b, c, e

19. a, c, e

20. a, b, d

21. d

22. b

23. b

24. c

25. b