After days of vomiting and diarrhea, a patient is dizzy and has dark, concentrated urine. Which additional findings support hypovolemia?
Flat neck veins and a rapid heart rate
✓
Distended neck veins and lung crackles
Bounding pulses and high blood pressure
Pitting edema and weight gain
Correct Answer
Flat neck veins and a rapid heart rate
Hypovolemia lowers the volume in the vessels, so the neck veins flatten and the heart speeds up to maintain blood pressure. Distended neck veins and lung crackles point to fluid volume excess. Bounding pulses and high blood pressure also signal excess volume. Pitting edema and weight gain occur when fluid is retained, not lost.
Category: Fluid Volume Imbalances
Question 2
A postoperative patient with a history of heart failure is receiving IV normal saline and develops new crackles and shortness of breath. What should the nurse do first?
Increase the infusion rate
Slow the infusion and notify the provider
✓
Encourage more oral fluids
Lower the head of the bed flat
Correct Answer
Slow the infusion and notify the provider
New crackles and dyspnea during an infusion suggest fluid volume excess, so the nurse reduces the incoming fluid and reports the findings so treatment such as a diuretic and oxygen can be ordered. Increase the infusion rate would add to the overload. Encourage more oral fluids would also add volume. Lower the head of the bed flat worsens breathing when the lungs are congested; an upright position helps.
Category: Fluid Volume Imbalances
Question 3
A patient with hypovolemia from vomiting is receiving isotonic IV fluid. Which finding shows that the treatment is working?
Darker, more concentrated urine
A heart rate that keeps rising
Lighter urine and rising urine output
✓
New crackles in both lungs
Correct Answer
Lighter urine and rising urine output
As vascular volume is restored, the kidneys receive more blood flow and produce more, lighter urine, along with improving mental status, moist mucous membranes and steadier vital signs. Darker, more concentrated urine shows that the deficit is continuing. A heart rate that keeps rising suggests ongoing volume loss. New crackles in both lungs suggest that the fluid is now causing overload.
Category: IV Fluid Therapy
Question 4
For which patient does the nurse watch most closely for fluid overload during an infusion of isotonic saline?
An athlete with mild dehydration
A patient with acute diarrhea
A young adult with an ankle sprain
A patient with heart failure
✓
Correct Answer
A patient with heart failure
Isotonic fluids stay in the extracellular space and expand vascular volume, so they are used cautiously in patients at risk of overload such as those with heart failure or kidney failure. An athlete with mild dehydration needs volume and has a healthy heart and kidneys. A patient with acute diarrhea is losing fluid. A young adult with an ankle sprain has no condition that limits fluid handling.
Category: IV Fluid Therapy
Question 5
A runner drinks large amounts of plain water after a long race in the heat and becomes confused, nauseated and headachy. Which imbalance does the nurse suspect?
Hyponatremia
✓
Hypernatremia
Hyperkalemia
Hypercalcemia
Correct Answer
Hyponatremia
Heavy sweating loses sodium, and replacing it with plain water alone dilutes the remaining sodium; water then shifts into brain cells, causing headache, nausea and confusion. Hypernatremia would follow water loss without replacement, not excess water intake. Hyperkalemia mainly causes muscle weakness and dysrhythmias, usually from reduced kidney excretion. Hypercalcemia causes constipation, thirst and weakness and is not caused by drinking water.
Category: Sodium and Potassium
Question 6
Why must a long-standing low serum sodium be raised slowly?
Rapid correction causes hyperkalemia
Rapid correction can cause osmotic demyelination
✓
Rapid correction causes kidney stones
Rapid correction causes hypoglycemia
Correct Answer
Rapid correction can cause osmotic demyelination
Raising sodium too quickly pulls water out of adapted brain cells and can cause osmotic demyelination syndrome, which produces severe and sometimes permanent neurologic damage. Rapid correction causes hyperkalemia is not the danger of sodium correction. Rapid correction causes kidney stones is unrelated to sodium replacement. Rapid correction causes hypoglycemia is also unrelated, because sodium correction does not lower blood glucose.
Category: Sodium and Potassium
Question 7
In an alert patient, which is often the earliest sign of a rising serum sodium?
Seizures
Coma
Thirst
✓
Muscle twitching
Correct Answer
Thirst
Rising sodium raises blood osmolarity, and the thirst response is often the first sign in a patient who is awake and able to sense it. Seizures are a late, severe neurologic sign. Coma is also late and severe. Muscle twitching can develop as the imbalance worsens but typically appears after thirst.
Category: Sodium and Potassium
Question 8
A patient taking a potassium-wasting diuretic has muscle weakness, leg cramps and constipation. Which ECG change does the nurse expect?
Tall, peaked T waves
A shortened PR interval
Elevated ST segments
Flattened T waves with U waves
✓
Correct Answer
Flattened T waves with U waves
Low potassium slows repolarization, producing flattened or inverted T waves and prominent U waves, so the patient needs continuous cardiac monitoring. Tall, peaked T waves are the classic sign of high potassium. A shortened PR interval is not expected; low potassium can prolong it. Elevated ST segments suggest myocardial injury rather than an electrolyte loss.
Category: Sodium and Potassium
Question 9
A patient with hypovolemia feels dizzy when sitting up and wants to go to the bathroom. Which nursing action promotes safety?
Assist the patient to rise slowly and walk with support
✓
Encourage the patient to go alone to build strength
Limit oral fluids to reduce trips to the bathroom
Raise the bed to its highest position first
Correct Answer
Assist the patient to rise slowly and walk with support
Low vascular volume can make blood pressure drop when the patient stands, causing dizziness and falls, so the nurse has the patient change position slowly and stays at the patient's side while walking. Encourage the patient to go alone to build strength risks a fall. Limit oral fluids to reduce trips to the bathroom worsens the fluid deficit. Raise the bed to its highest position first increases the risk of injury if the patient falls; the bed is kept low.
Category: Fluid Volume Imbalances
Question 10
A patient with kidney failure has a high serum potassium level. Which finding needs the nurse's immediate follow-up?
Dry, itchy skin
A new irregular pulse
✓
Mild ankle swelling unchanged from yesterday
Reports of a poor appetite
Correct Answer
A new irregular pulse
High potassium disturbs the heart's electrical activity and can lead to bradycardia, heart block and life-threatening dysrhythmias, so a new irregular pulse calls for cardiac monitoring and prompt notification of the provider. Dry, itchy skin is common in chronic kidney failure and is not an emergency. Mild ankle swelling unchanged from yesterday is a stable finding. Reports of a poor appetite are common in kidney failure and do not signal immediate danger.
Category: Sodium and Potassium
Question 11
A patient with acute hypocalcemia reports tingling around the mouth and has muscle cramps. Which nursing action is a priority?
Encourage walking in the hallway
Restrict dairy products in the diet
Initiate seizure precautions
✓
Apply a heating pad to the legs
Correct Answer
Initiate seizure precautions
Low calcium increases neuromuscular excitability and can progress to tetany, laryngospasm and seizures, so the nurse keeps the bed low, suction and oxygen at hand, and the patient under close observation. Encourage walking in the hallway risks a fall if a seizure or tetany occurs. Restrict dairy products in the diet would lower calcium intake further. Apply a heating pad to the legs does not address the underlying danger.
Category: Calcium, Magnesium, Phosphorus
Question 12
A patient on prolonged bed rest develops constipation, nausea and muscle weakness, and the serum calcium is high. Which nursing intervention addresses the cause?
Increase calcium-rich foods in the diet
Keep the patient on strict bed rest
Give vitamin D supplements with meals
Encourage frequent ambulation as tolerated
✓
Correct Answer
Encourage frequent ambulation as tolerated
Immobility releases calcium from bone into the blood, and weight-bearing activity moves calcium back into bone. Increase calcium-rich foods in the diet would add calcium when the level is already high. Keep the patient on strict bed rest continues the cause. Give vitamin D supplements with meals increases calcium absorption from the gut.
Category: Calcium, Magnesium, Phosphorus
Question 13
Which patient is at risk for hypomagnesemia?
A patient with chronic alcohol use
✓
A patient who takes magnesium antacids daily
A patient with chronic kidney failure
A patient receiving magnesium replacement
Correct Answer
A patient with chronic alcohol use
Chronic alcohol use lowers magnesium through poor diet and impaired absorption; other causes include loop diuretics, laxative abuse and malnutrition. A patient who takes magnesium antacids daily is at risk of a high level. A patient with chronic kidney failure cannot excrete magnesium and tends toward a high level. A patient receiving magnesium replacement is having the level raised.
Category: Calcium, Magnesium, Phosphorus
Question 14
A patient with kidney disease has a high serum phosphorus level. Which findings should the nurse also watch for?
Signs of high calcium, such as constipation
Signs of low calcium, such as tetany
✓
Signs of high sodium, such as thirst
Signs of low potassium, such as U waves
Correct Answer
Signs of low calcium, such as tetany
Phosphorus and calcium are inversely related, so a high phosphorus level tends to lower calcium and can produce tetany, paresthesia and other signs of hypocalcemia. Signs of high calcium, such as constipation, are not expected, because a high phosphorus level lowers calcium. Signs of high sodium, such as thirst, are not linked to phosphorus. Signs of low potassium, such as U waves, are not caused by high phosphorus.
Category: Calcium, Magnesium, Phosphorus
Question 15
An arterial blood gas shows a low pH and a low bicarbonate level. Which imbalance does this pattern indicate?
Metabolic alkalosis
Respiratory acidosis
Metabolic acidosis
✓
Respiratory alkalosis
Correct Answer
Metabolic acidosis
A low pH means acidosis, and when bicarbonate moves in the same direction as pH the cause is metabolic. Metabolic alkalosis would show a high pH and a high bicarbonate. Respiratory acidosis would show a low pH with a high carbon dioxide level. Respiratory alkalosis would show a high pH with a low carbon dioxide level.
Category: Acid-Base Imbalances
Question 16
A patient with long-standing COPD has an arterial blood gas with a high carbon dioxide level, a high bicarbonate level and a pH within the normal range but on its acidic side. How does the nurse interpret it?
Uncompensated respiratory acidosis
Compensated metabolic alkalosis
Uncompensated metabolic acidosis
Compensated respiratory acidosis
✓
Correct Answer
Compensated respiratory acidosis
Retained carbon dioxide is the primary problem, and over time the kidneys retain bicarbonate until the pH returns to the normal range, leaning toward the acidic side of the original disorder. Uncompensated respiratory acidosis would show a pH below normal. Compensated metabolic alkalosis would lean toward the alkaline side and fits a primary bicarbonate gain, not lung disease. Uncompensated metabolic acidosis would show a low pH and a low bicarbonate.
Category: Acid-Base Imbalances
Question 17
Which condition can cause respiratory alkalosis in its early stage as the patient breathes rapidly to improve oxygenation?
Pulmonary embolism
✓
Opioid overdose
Prolonged vomiting
Severe diarrhea
Correct Answer
Pulmonary embolism
Early in a pulmonary embolism or acute asthma attack the patient breathes fast, blowing off carbon dioxide and raising the pH; if breathing muscles tire, carbon dioxide can later build up. Opioid overdose depresses breathing and causes respiratory acidosis. Prolonged vomiting removes stomach acid and causes metabolic alkalosis. Severe diarrhea removes bicarbonate and causes metabolic acidosis.
Category: Acid-Base Imbalances
Question 18
How do the lungs compensate for metabolic alkalosis?
Breathing speeds up to remove carbon dioxide
Breathing slows to retain carbon dioxide
✓
The lungs excrete excess bicarbonate
The lungs retain extra hydrogen ions
Correct Answer
Breathing slows to retain carbon dioxide
Slower breathing keeps carbon dioxide in the blood, adding carbonic acid that lowers the pH, although this compensation is limited because breathing cannot slow very far. Breathing speeds up to remove carbon dioxide is the compensation for metabolic acidosis. The lungs excrete excess bicarbonate is wrong because bicarbonate is handled by the kidneys. The lungs retain extra hydrogen ions is also a kidney function, not a lung function.
Category: Acid-Base Imbalances
Question 19
A patient receiving IV opioids after surgery is hard to arouse and has slow, shallow respirations. Which action is the nurse's priority?
Document the findings and recheck later
Give the next scheduled opioid dose
Assess airway and breathing and call for urgent help
✓
Encourage the patient to drink fluids
Correct Answer
Assess airway and breathing and call for urgent help
Oversedation reduces ventilation, so carbon dioxide builds up and respiratory acidosis develops; the nurse addresses airway and breathing first and gets help to reverse sedation and support ventilation. Document the findings and recheck later delays care for a worsening emergency. Give the next scheduled opioid dose would depress breathing further. Encourage the patient to drink fluids is unsafe in a patient who cannot stay awake and does nothing for ventilation.
Category: Acid-Base Imbalances
Question 20
A patient with diabetic ketoacidosis is breathing rapidly and deeply. What does the nurse recognize about this breathing pattern?
It shows the lungs are retaining carbon dioxide
It is caused by anxiety and needs only reassurance
It means the acidosis has fully resolved
It removes carbon dioxide to raise the pH
✓
Correct Answer
It removes carbon dioxide to raise the pH
In metabolic acidosis the lungs compensate by blowing off carbon dioxide, which lowers carbonic acid and pushes the pH back up, so rapid breathing is often the first clue to the imbalance. It shows the lungs are retaining carbon dioxide describes the opposite change. It is caused by anxiety and needs only reassurance misses a serious metabolic emergency. It means the acidosis has fully resolved is wrong because the breathing pattern signals ongoing acidosis.
Category: Acid-Base Imbalances