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Chapter 40: Fluid, Electrolyte, & AcidBase Balances Potter et al: Canadian
Fundamentals of Nursing, 6th Edition
2024-2025
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Graded A+
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What is the most abundant cation in the blood?
a
...

b
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c
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d
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- ANSa
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7
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Which laboratory
value is of greatest concern?
a
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b
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5 mmol/L (17
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c
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5 mmol/L (3
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d
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- ANSb
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5 mmol/L (17
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11
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The nurse knows that the
child is at greatest risk for which acid-base imbalance? - ANSRespiratory acidosis
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At what time should the infusion be
completed?
a
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b
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c
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d
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- ANSc
...

A nurse is assessing a patient who is receiving a blood transfusion and finds that the
patient is anxiously fidgeting in bed
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The nurse
auscultates crackles in both lung bases and sees jugular vein distension
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A nurse is caring for a patient who is in hypertensive crisis
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Upon assessment, the

nurse notices a red streak near the IV site that is warm to the touch
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A nurse is caring for a patient whose electrocardiogram displays changes characteristic
of hypokalemia
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A nurse is caring for a patient with cancer who presents with anorexia, blood pressure
of 100/60, elevated white blood cell count, and oral candidiasis
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A nurse is caring for a patient with diabetes who has a bowel obstruction and has orders
to ensure that the volume of intake matches the output
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9% sodium chloride through a 22-gauge catheter infusing
at 150 mL/hr and has eaten 200 mL of ice chips
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The
patient has voided 400 mL of urine
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Add a potassium supplement to replace loss
from output
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After
discontinuing the blood transfusion, what is the nurse's next action? - ANSStart normal
saline at to-keep-open (TKO) rate with new tubing
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5 mmol/L (4
...
05 mmol/L (4
...
What
would the nurse expect to find in the assessment? - ANSTingling of the extremities and
tetany
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" The nurse advises the patient to make which dietary change? ANSDrink plenty of fluids throughout the day to stay hydrated
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Arterial blood gas measurements on admission are as follows: pH, 7
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The nurse
understands that the patient's acid-base imbalance is which of the following?
Metabolic acidosis
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Respiratory acidosis
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- ANSMetabolic acidosis
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35 and a normal PaCO2, along with a HCO3- level of less than 22
mmol/L and a normal PaO2, are indicative of metabolic acidosis
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A patient is to receive 1500 mL of 0
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The nurse is using microdrip gravity drip tubing
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A patient presents to the emergency department with the complaint of vomiting and
diarrhea for the past 48 hours
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9% sodium chloride
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Which
assessment question by the nurse is most appropriate?
a
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"How many calories a day do you consume?"
c
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"How many times a day do you urinate?" - ANSd
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The patient's respiratory rate has decreased
to 12 breaths per minute
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pH of 7
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b
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52, PaCO2 of 48 mm Hg, HCO3- level of 28 mmol/L (28 mEq/L)
...
pH of 7
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d
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25, PaCO2 of 47 mm Hg, HCO3- level of 29 mmol/L (29 mEq/L)
...
pH
of 7
...

Rationale
In compensated metabolic alkalosis, the pH and HCO3- (metabolic) values are alkaline,
and CO2 level is slightly acidic (compensatory respiratory acidosis)
...
52 is alkaline (normal, 7
...
45), partial pressure of arterial carbon dioxide
(PaCO2) is acidic (normal, 35 to 45 mm Hg), and HCO3- level is elevated (normal, 22 to
26 mmol/L [22 to 26 mEq/L])
...
78, PaCO2 is 40 mm Hg, and HCO3- is
30 mmol/L (30 mEq/L), the condition is uncompensated metabolic alkalosis
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35, a PaCO2 of 35 mm Hg, and a HCO3- level of 26 mmol/L (26 mEq/L) are within
normal limits
...
25, PaCO2 is 47 mm Hg, and HCO3- is 29 mmol/L (29
mEq/L), the condition is compensated respiratory acidosis
...
The
patient complains of burning at the IV insertion site
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The nurse suspects which of the
following?
a
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b
...

c
...

d
...
- ANSc
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A patient who has AB-positive blood is to receive a blood transfusion
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A positive
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AB positive
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The nurse
understands that blood of which of the following types could be administered to this
patient? (Select all that apply
...

A positive
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AB positive
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The
nurse expects to evaluate which laboratory values?
Albumin and protein levels
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Potassium and blood glucose levels
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- ANSPotassium and blood glucose levels
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Evaluating
blood glucose level when the patient reports weakness is important to ensure that low
blood glucose level is not an issue
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A patient with a lower respiratory infection has a pH of 7
...
The physician has been notified
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An hour ago, the nurse obtained a blood specimen from a patient and sent it to the
chemistry laboratory for electrolyte measurements
...
The nurse interprets this to mean which of the following? ANSThe potassium reading will be abnormally elevated
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An hour ago, the nurse obtained a blood specimen from a patient and sent it to the
chemistry laboratory for electrolyte measurements
...
The nurse interprets this to mean which of the following? (Select
all that apply
...

The results signal a life-threatening situation
...

A laboratory error occurred with regard to the results
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The potassium reading will be abnormally elevated
...

Approximately two thirds of the body's total water volume exists in which fluid? ANSIntracellular
Assessment data indicating IV fluid infiltration include which of the following? ANSEdema and pain
...

Assessment data indicating IV fluid infiltration include which of the following? (Select all
that apply
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Pain and erythema
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Numbness and pain
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- ANSEdema and pain
Pallor and coolness
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Engorged neck vessels
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Full bounding radial pulse
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Dry mucous membranes are a clinical sign of dehydration
...
Engorged neck vessels and a bounding pulse are signs of
fluid overload
...

How does the nurse discontinue peripheral IV access? (Select all that apply
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Use scissors to remove the IV site dressing and tape
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Keep the catheter parallel to the skin while removing it
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Apply firm pressure with sterile gauze during removal
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Stop the infusion before removing the IV catheter
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Wear sterile gloves and a mask
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Apply pressure to the site for 2 to 3 minutes after removal
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Keep the catheter
parallel to the skin while removing it
...
Stop the infusion before removing the IV catheter
...
Apply pressure to the site for 2 to 3 minutes after removal
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A 7-year-old child admitted for severe burns
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A 24-year-old adult admitted for chronic alcohol abuse
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A 50-year-old patient admitted for an acute exacerbation of hyperparathyroidism
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A 75-year-old patient admitted for a broken hip related to osteoporosis
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A 24year-old adult admitted for chronic alcohol abuse
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25 to 2
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5 mg/dL to 10
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5 to 5
...
5 to 5
...
30; PaCO2, 52 mm Hg; PaO2, 75 mm Hg; HCO3- level, 27 mmol/L
...

Metabolic alkalosis
...

Respiratory alkalosis
...

PaCO2 is elevated and, as CO2 is an acid when mixed with water, this contributes to
the lowering of the pH (to a more acidic state)
...
In this example, it is slightly elevated, which suggests that the
body is retaining bicarbonate in an attempt to return the pH to within normal limits (7
...
45)
...
However, because the pH is in the low range, a condition of acidosis
exists
...

In respiratory alkalosis, the PaCO2 would be low
...

The following blood gas results return for a patient recently admitted to the respiratory
care unit: pH, 7
...
The
nurse interprets these results to indicate which of the following? - ANSRespiratory
acidosis
...
Which of the patients
should the nurse see first?
An 88-year-old patient with a fractured femur who is scheduled for surgery
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A 65-year-old patient with a recent diagnosis of heart failure
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- ANSA 65year-old patient with a recent diagnosis of heart failure
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Fluid overload in this patient could quickly cause life-threatening
problems
...

The following four patients are all at risk for fluid volume excess
...

The nurse anticipates that the physician will order which intravenous (IV) fluid for a
patient who is dehydrated? - ANS0
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Because a 0
...
A 3% sodium chloride solution is hypertonic and thus
would cause water to move out of the cells into the cardiovascular space, which would
dehydrate the cells even more
...
9% sodium chloride solution and lactated
Ringer's solution are isotonic
...

The nurse assesses the four following patients
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A 40-year-old patient with systemic lupus erythematosus
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A 65-year-old patient with hypertension taking beta-adrenergic blockers
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The patient with acute renal failure is at the highest risk for hypocalcemia
...


The nurse assesses the four following patients
...

The nurse is assessing a patient and finds crackles in the lung bases and neck vein
distension
...
What electrolyte imbalance is the
nurse most concerned about?
a
...

b
...

c
...

d
...
- ANSa
...

The nurse is assisting a physician in obtaining a sample for blood gas analysis from a
patient's left wrist
...

The nurse is assisting a physician in obtaining a sample for blood gas analysis from a
patient's left wrist
...

Sealing the end of the syringe prevents atmospheric air from diffusing into the
specimen
...
The syringe already
contains heparin (liquid or dehydrated)
...
Samples
for blood gas analysis must be transported immediately to the laboratory, or the results
will not be accurate
...
Which
laboratory findings would the nurse expect?
a
...
3, PaCO2 of 36 mm Hg, HCO3- level of 19 mEq/L (19 mmol/L)
...
pH of 7
...

c
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3, PaCO2 of 47 mm Hg, HCO3- level of 23 mEq/L (23 mmol/L)
...
pH of 7
...
- ANSpH of
7
...

The nurse is caring for a patient with hyperkalemia
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The nurse is caring for a patient with sepsis
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What device will be used to
administer these antibiotics? - ANSA peripherally inserted central catheter (PICC) line
...

Today is March 9
...
The nurse determines which of the
following about the tubing? - ANSIt requires changing because it is beyond the 3-day
recommended limit
...
S
...
The Intravenous Nurses Society
recommends changing the tubing every 72 hours or more frequently if catheter
infections and phlebitis rates exceed 5%
...
Transparent IV dressings may be left in place for 7 days but not the tubing
...
Peripheral IV sites are rotated
every 3 days, but this is not necessary for central lines
...

The nurse is conducting an assessment of a peripheral IV site on the hand
...
Which of the following is considered a
normal finding? - ANSThe temperature of the hand above the insertion site is slightly
cool to touch
...
Swelling
of the site indicates that the IV has become interstitial
...
Blood backing up into the tubing indicates that the IV is not running
properly
...

The nurse knows that edema in a patient who has venous congestion from right-sided
heart failure is facilitated by an imbalance with regard to which pressure? ANSHydrostatic
...

The nurse selects appropriate tubing for a blood transfusion by ensuring that the tubing
has which of the following?
a
...

b
...

c
...

d
...
- ANSd
...

The nurse understands that administering a hypertonic solution to a patient will shift
water from which space to which space? - ANSIntracellular to extracellular
The nurse would expect a patient with increased levels of serum calcium to also have
which abnormal values? - ANSDecreased phosphate levels
...
A 2-year-old child
...
A 22-year-old adult
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A 50-year-old patient
...
An 80-year-old patient
...

The physician asks the nurse to monitor the fluid volume statuses of a patient with heart
failure and a patient at risk for clinical dehydration
...

The physician has ordered that a patient with hypertension begin receiving a thiazide
diuretic
...

Thiazide diuretics cause the loss of water and potassium through the kidneys
...
Hypokalemia can cause muscle weakness and dysrhythmias
...
The calcium level would be unaffected by thiazide diuretics
...

The unit secretary has just returned from the blood bank, where she obtained a unit of
packed red blood cells that was ordered for a patient
...
When evaluating the IV site, the nurse
notes that the size of the needle in the IV line is 22 gauge
...
)
Return the blood to the blood bank
...

Continue with the blood check at the bedside
...

Start another IV line with a 20-gauge needle or larger
...

Start another IV line with a 20-gauge needle or larger
...
The nurse enters the room with a
colleague to check the blood at the bedside
...
What actions should the
nurse take at this time? (Select all that apply
...

Hang the blood on the IV apparatus as soon as possible
...

Place the blood in the medication refrigerator
...
- ANSReturn the blood to the
blood bank
...

What is the process of passively moving water from an area of lower particle
concentration to an area of higher particle concentration? - ANSOsmosis
When selecting a site to insert an IV catheter on an adult, the nurse should follow which
procedure? (Select all that apply
...
Start proximally and move distally on the arm
...
Choose a vein with minimal curvature
...
Choose the patient's dominant arm
...
Check for contraindications to using the extremity
...
Select a vein that is rigid
...
Avoid areas of flexion
...
Choose a vein with minimal curvature
...
Check for contraindications to using the extremity
...
Avoid areas of flexion
...
Blood pressure of 102/58
...
Dry mucous membranes
...
Poor skin turgor
...
Pitting edema
...
Pitting edema
...
45% sodium chloride
...
Partial pressure of arterial oxygen (PaO2)
...
Anion gap
...
PaCO2
...
HCO3-
...

Which of the following activities can be properly delegated to unregulated care
providers? (Select all that apply
...


Preparing IV tubing for systematic change
...

Discontinuing an IV infusion per the health care provider's orders
...
) - ANSMeasuring intake and output
...

Which of the following assessments would indicate infiltration of a patient's IV line?
(Select all that apply
...
Edema of the extremity near the insertion site
...
Skin discoloured or bruised in appearance
...
Pain and warmth at the insertion site
...
Skin cool to the touch
...
Reddish streak proximal to the insertion site
...
Numbness or loss of sensation
...
Palpable venous cord
...
Edema of the extremity near the insertion site
...
Skin discoloured or bruised in appearance
...
Skin cool to the touch
...
Numbness or loss of sensation
...
A 7-year-old child with asthma
...
A 24-year-old adult with constipation
...
A 56-year-old patient with gastroenteritis
...
An 80-year-old patient with pneumonia
...
An 80-year-old patient with
pneumonia

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