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1.
During a period of extreme excess fluid volume, a renal dialysis patient may be administered which type of IV solution to shrink the swollen cells by pulling water out of the cell?
A)
0.9% sodium chloride
B)
5% dextrose and water
C)
3% sodium chloride
D)
Lactated Ringer solution
Ans:
C
Feedback:
When cells are placed in a hypotonic solution, which has a lower effective osmolality than the ICF, they swell as water moves into the cell, and when they are placed in a hypertonic solution, which has a greater effective osmolality than the ICF, they shrink as water is pulled out of the cell.
2.
A 34-year-old male client has diagnoses of liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse. The client's family is questioning the care team as to why his abdomen is so large even though he is undernourished and emaciated. Which of the following statements most accurately underlies the explanation that a member of the care team would provide the family?
A)
An inordinate amount of interstitial fluid is accumulating his abdomen.
B)
The transcellular component of the intracellular fluid compartment contains far more fluid than normal.
C)
Normally small transcellular fluid compartment, or third space, is becoming enlarged.
D)
Gravity-dependent plasma is accumulating in his peritoneal cavity.
Ans:
C
Feedback:
Ascites is characterized by an accumulation of fluid in the transcellular component of the ECF, not ICF. The fluid is not categorized as belonging to the plasma component of the ECF.
3.
Which of the following individuals would be considered to be at risk for the development of edema? Select all that apply.
A)
An 81-year-old man with right-sided heart failure and hypothyroidism
B)
A 60-year-old obese female with a diagnosis of poorly controlled diabetes mellitus
C)
A 34-year-old industrial worker who has suffered extensive burns in a job-related accident
D)
A 77-year-old woman who has an active gastrointestinal bleed and consequent anemia
E)
A 22-year-old female with hypoalbuminemia secondary to malnutrition and anorexia nervosa
Ans:
A, C, E
Feedback:
Right-sided heart failure, burns, and low levels of plasma proteins are all associated with the development of edema. Diabetes and GI bleeds are not identified as contributors to edema.
4.
Recognizing the prevalence and incidence of dehydration among older adults, a care aide at a long-term care facility is in the habit of encouraging residents to drink even though they may not feel thirsty at the time. Which of the following facts underlies the care aide's advice?
A)
Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high.
B)
The metabolic needs for both fluid and sodium in older adults differ from those of younger individuals.
C)
Regulation and maintenance of effective circulating volume by the kidneys is less effective in the elderly.
D)
The renin?angiotensin?aldosterone system (RAAS) is less able to facilitate sodium clearance in older adults.
Ans:
A
Feedback:
The elderly are prone to hypodipsia even when osmolality and serum sodium levels are elevated, a fact that is compounded by sensory and/or neurological deficits. Hypodipsia in the elderly is not related to differing metabolic needs, ineffective kidney function, or compromise of the RAAS.
5.
The nurse is providing teaching to a student nurse about how antidiuretic hormone (ADH) plays a central role in the reabsorption of water by the kidneys. The nursing student is correct to place the following components of the homeostatic action of ADH in the correct sequence. Use all the options.
A) Stored ADH is released into circulation.
B) ADH is transported along a neural pathway to the posterior pituitary gland.
C) Aquaporins are inserted into tubular cell membranes.
D) ADH is synthesized by cells in the supraoptic and paraventricular nuclei of the hypothalamus.
E) Serum osmolality increases.
Ans:
D, B, E, A, C
Feedback:
ADH is produced in the hypothalamus, sequestered in the pituitary, and is released in response to increased serum osmolality. Its influence on tubular cells is exerted by way of the insertion of aquaporins in the tubular membrane.
6.
A patient arrives in the ED very hypovolemic related to excretion of ?at least 3 gallon jugs of urine in the past 24 hours.? He describes the urine as being clear-like water. The physician suspects diabetes insipidus. The nurse should be prepared to administer which of the following medications?
A)
Desmopressin acetate (DDAVP)
B)
Benadryl, an anticholinergic
C)
Calcium gluconate
D)
Prednisone
Ans:
A
Feedback:
Diabetes insipidus is caused by a deficiency of or a decreased response to ADH. The preferred drug for treating chronic DI is desmopressin acetate (DDAVP).
7.
A patient has been diagnosed with a brain tumor that cannot be removed surgically. During each office visit, the nurse will be assessing the patient for syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following assessments would alert the clinic nurse that the patient may be developing this complication?
A)
Complaints that his urine output is decreased, no edema noted in ankles, and increasing headache
B)
Elevated blood glucose levels, dry mucous membranes, and severe projectile vomiting
C)
Fever, diarrhea, and nausea
D)
Muscle cramps, pins and needle sensation around the mouth/lips, and unexplained bruising
Ans:
A
Feedback:
SIADH manifests as a dilutional hyponatremia. Decrease urine output, absence of edema, and headaches are signs of this. Answer choice B relates to s/s of diabetes insipidus; answer choice C is indicative of common flu s/s; answer choice D is relates to s/s of hypocalcemia.
8.
A 77-year-old female hospital patient has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces?
A)
She is susceptible to isotonic fluid volume deficit.
B)
She is prone to isotonic fluid volume excess.
C)
She could develop third-spacing edema as a result of plasma protein losses.
D)
She is at risk of compensatory fluid volume overload secondary to gastrointestinal water and electrolyte losses.
Ans:
A
Feedback:
This woman is at risk of isotonic fluid volume deficit and sodium imbalances as a result of her diarrhea. She is not likely to develop fluid volume excess or third spacing as consequences of diarrhea.
9.
You are volunteering in the medical tent of a road race on a hot, humid day. A runner who has collapsed on the road is brought in with the following symptoms: sunken eyes, a body temperature of 100B0F, and a complaint of dizziness while sitting to have his blood pressure taken (which subsides upon his lying down). These are signs of a fluid volume deficit. Which of the following treatments should be carried out first?
A)
Offer water by mouth.
B)
Begin cooling of his body by ice packs.
C)
Give him a transfusion of FFP.
D)
Give him an electrolyte solution by mouth.
Ans:
D
Feedback:
Fluid volume deficit results in postural hypotension (dizziness while upright) due to decreased blood volume. Sunken eyes and elevated temperature also point to a fluid volume deficit. The most important action to take is to replace fluid; however, pure water would be a mistake, since without accompanying electrolytes such as sodium, hyponatremia (water retention and a decrease in serum osmolality) could result. Thus, an oral electrolyte solution is recommended; in more severe cases, an IV would be appropriate.
10.
A client is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. What is the client's most likely diagnosis?
A)
Hyponatremia
B)
Fluid volume excess
C)
Electrolyte imbalance: hypocalcemia
D)
Hyperkalemia
Ans:
B
Feedback:
Peripheral and pulmonary edema as well as a bounding pulse and dyspnea are indicators of fluid volume overload.
11.
A 26-year-old male patient with a diagnosis of schizophrenia has been admitted with suspected hyponatremia after consuming copious quantities of tap water. Given this diagnosis, what clinical manifestations and lab results should the nurse anticipate the patient will exhibit?
A)
High urine specific gravity, tachycardia, and a weak, thready pulse
B)
Low blood pressure, dry mouth, and increased urine osmolality
C)
Increased hematocrit and blood urea nitrogen and seizures
D)
Muscle weakness, lethargy, and headaches.
Ans:
D
Feedback:
Weakness, lethargy, and nausea are noted manifestations of hyponatremia. High urine specific gravity, tachycardia, and a weak, thread pulse are associated with hypernatremia, while low blood pressure, fever, and increased urine osmolality are manifestations of fluid volume deficit. Increased hematocrit and blood urea nitrogen and seizures are also associated with hypernatremia.
12.
An ECG technician is performing an ECG on a hospital patient who has developed hypokalemia secondary to diuretic use. Which of the following manifestations of the client's health problem will the technician anticipate on the ECG?
A)
Irregular heart rate and a peaked T wave
B)
A low T wave and an absent P wave
C)
A prominent U wave and a flattened T wave
D)
A narrow QRS complex and an absent U wave
Ans:
C
Feedback:
ECG changes associated with hypokalemia include a prominent U wave and a flattening of the T wave. Atrial fibrillation, a low P wave, and the absence of a U wave are not associated with hypokalemia.
13.
A nurse in a medical unit has noted that a client?s potassium level is elevated at 6.1 mEq/L. The nurse has notified the physician, removed the banana from the client?s lunch tray, and is performing a focused assessment. When questioned by the client for the rationale for these actions, which of the following explanations is most appropriate?
A)
?Your potassium level is high, and so I need you let me know if you feel numbness, tingling, or weakness.?
B)
?Your potassium levels in the blood are higher than they should be, which brings a risk of changes in the brain function.?
C)
?I'll need to monitor you today for signs of high potassium; tell me if you feel as if your heart is beating quickly or irregularly.?
D)
?The amount of potassium in your blood is too high, but this can be resolved by changing the intravenous fluid you are receiving.?
Ans:
A
Feedback:
Paresthesia and muscle weakness are manifestations of hyperkalemia. Tachycardia and dysrhythmias are more commonly associated with hypokalemia, and the greatest risks associated with potassium imbalances are cardiac rather than neurological. Hyperkalemia is not normally resolved by correction using IV fluid.
14.
A renal failure patient with severe hyperkalemia (K+ level 7.2 mEq/L) has just been admitted to the nursing unit. Given the severity of this situation, the nurse should be prepared to administer which intravenous infusion stat?
A)
Lactated Ringer solution at 150 mL/hour to maintain blood glucose levels
B)
Regular insulin infusion, rate dependent on lab values
C)
Infusion of Solu-Medrol to decrease irritation to the intravascular system
D)
Dilaudid via patient-controlled device (PCA) to control pain
Ans:
B
Feedback:
The administration of sodium bicarbonate, b-adrenergic agonists, or insulin distributes potassium into the ICF compartment and rapidly decreases the ECF concentration. Lactated Ringer solution, steroids, or narcotics will not help to lower potassium levels.
15.
Vitamin D is integral to the regulation of calcium and phosphate levels. Put the following steps in the action of vitamin D into the correct sequence. Use all the options.
A) Vitamin D is present in the skin or intestine.
B) Vitamin D is concentrated in the liver.
C) Absorption of calcium from the intestine increases.
D) Vitamin D is transported to the kidneys.
E) Calcitriol is produced.
Ans:
A, B, D, E, C
Feedback:
Vitamin D is either synthesized in the skin by ultraviolet exposure or obtained from the intestines following ingestion. It is then concentrated in the liver and transported to the kidneys
16.
A 52-year-old patient has just passed a kidney stone and has high levels of calcium in her urine. Blood tests show high levels of calcium in her blood as well. What subsequent lab results would be most likely to distinguish between primary hyperparathyroidism and hypercalcemia of malignancy?
A)
Parathyroid hormone level
B)
Bone scan
C)
Plasma phosphate levels
D)
Serum magnesium level
Ans:
A
Feedback:
Hyperparathyroidism, in which parathyroid hormone is secreted in excess, may be caused by a parathyroid adenoma. Since parathyroid hormone mobilizes calcium from bone and promotes its transfer to the extracellular fluid, excess calcium is excreted in the urine (promoting the development of kidney stones) and is evident in the plasma. In primary hyperparathyroidism, antibody binding assays of intact PTH would reveal either normal or elevated parathyroid hormone in the face of hypercalcemia, whereas in hypercalcemia of malignancy, levels of intact PTH are suppressed.
17.
An 81-year-old female has a long-standing diagnosis of hypocalcemia secondary to kidney disease. She will be moving into an assisted living facility shortly. Which of the following clinical manifestations would the nursing staff at the facility likely observe in this patient?
A)
Loss of appetite and complaints of nausea
B)
Muscular spasms and complaints of tingling in the hands/feet
C)
High fluid intake and copious amounts of dilute urine output
D)
Lethargy and change in level of consciousness
Ans:
B
Feedback:
Muscular spasms and cramping are common manifestations of low serum calcium. Polydipsia, polyuria, anorexia, lethargy, and stupor are associated with hypercalcemia.
18.
A terminally ill cancer patient with metastasis to the bone has been admitted with elevated calcium levels (hypercalcemic crisis). The patient is very lethargic and exhibiting muscle flaccidity. The nurse should be prepared to administer (Select all that apply.)
A)
pamidronate, a bisphosphonate.
B)
intravenous drip of insulin.
C)
furosemide, a loop diuretic.
D)
gallium nitrate, a gallium salt of nitric acid.
E)
prednisone, a corticosteroid.
Ans:
A, D, E
Feedback:
The bisphosphonates (e.g.,pamidronate, zoledronate), which act mainly by inhibiting osteoclastic activity, provide a significant reduction in calcium levels with relatively few side effects. Calcitonin also inhibits osteoclastic activity. Gallium nitrate is highly effective in the treatment of severe hypercalcemia associated with malignancy. Prednisone, a corticosteroid, inhibits bone resorption.
19.
A 56-year-old female hospital patient with a history of alcohol abuse is receiving intravenous (IV) phosphate replacement. Which of the following health problems will this IV therapy most likely resolve?
A)
The client has an accumulation of fluid in her peritoneal cavity.
B)
The client is acidotic and has impaired platelet function.
C)
The client has an irregular heart rate and a thread pulse.
D)
The client has abdominal spasms and hyperactive reflexes.
Ans:
B
Feedback:
Phosphate is necessary for the normal function of platelets and the excretion of hydrogen ions that contribute to acidosis. Phosphate replacement would be unlikely to resolve ascites and cardiac anomalies, while abdominal spasms and hyperactive reflexes are more likely consequences of low calcium levels.
20.
A patient who has had a prolonged period of nasogastric (NG) suctioning following colon surgery is experiencing electrolyte imbalances. The magnesium level is low (1.2 mg/dL). Knowing that magnesium deficiency occurs in conjunction with low calcium levels, the nurse should assess the patient for which of the following clinical manifestations of hypocalcaemia? Select all that apply.
A)
Personality changes
B)
Hyperactive reflexes
C)
Increase in ventricular arrhythmias
D)
Increase in bouts of atrial fibrillation
E)
Symptomatic hypotension
Ans:
A, B, C
Feedback:
Hypocalcaemia may be evidenced by personality changes and neuromuscular irritability along with tremors, choreiform movements, and positive Chvostek or Trousseau signs. Cardiovascular manifestations include tachycardia, hypertension, and ventricular dysrhythmias.
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