Fluid & Electrolyte balance Certification Test 2025 Exams, Exams of Nursing

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Fluid & Electrolyte balance Certification Test 2025 Exams

Which client is most likely to exhibit dehydration? - ANSWEF-an 8-month-old infant with persistent diarrhea for 24 hours Infants and elderly persons have the grcatest risk of fhiuid-rclated health problems. An infant's Lom. diarrhea Lor body weight is 70% Lo 80% waler conlnl. An infant who is il] and has had pers. 24 hours will quickly lose a significant amount of fluid and electrolytes if the diarrhea is not stopped and replacement fluids given. Healthy young adults have a higher tolerance for fluid loss and can quickly regain their fluid balance when fluids are lost through normal activity. The 75- year-old woman who was placed on NFO status before surgery is not likely to develop a {nid volume deficit within 8 hours, unless there are olher fhiid conditions present that would precipitate fluid loss. The 60-year-old client with pneumonia and a fever should be monitored for a fluid defi through diarrhea. it, but he is not as likely to develop one as a client who is actively losing fluids During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and - ANSWER phosphorus. PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn’t affect sadium, potassium, or magnesium regulation. client has vomited several limes over the past 12 hours. The nurse should recognize the risk of what complication? - ANSWER-metabolic alkalosis Vomiting results in loss of hydrochloric acid (HCI) and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis. Achild is brought to the emergency department with a full-thickness burn involving the epidermis, dermis, and underlying subcutaneous tissue, but does not report pain at this time. Which statements by the nurse are correct about this type of bum? Select all that apply. - ANSWER-This is a scvore burn and nerve endings have been destroyed. The child must be monitored for signs of fluid shift. Rehabilitation and skin grafiing will be nece: This is an example of a third-degree burn, which is very serious. This child must be carefully monitored for complications. The fact that there is no pain is due to the destruction of the nerve endings. Fluid shift can occur and result in shock. A bum of this degree will also require a long rehabilitation with skin grafting. Oral pain medication would not be administered as the child would be NPO and oral medication would not be effective. This burn is not superficial. A client has a nursing diagnosis of fluid volume deficit. Which nursing assessment finding would support this diagnosis? - ANSWER orthostatic blood pressure changes Fluid volume deficit is characterized by hypotension, tachycardia, increased body temperature, and weakness. Leathery, pliable skin may not demonstrate fluid deficit; it may reflect diabetes. Pitting cdema and pedal pulses of 4+ demonstrate localized edema and potontial fuid excess. os that the infant’s scrotum is During a clinic visil, the mother of an infant with hydrocele < smaller now than when he was born. After teaching the mother about the infant’s condition, which statement by the mother indicates that the teaching has been effective? - ANSWER-"It seems like the fluid is being reabsorbed." First, convert the client’s weight from pounds to kilograms:132 lb + 2.2 Ib/kg = 60 ke. Then, to calculate the number of grams to administer, multiply the ordered number of grams by the client's weight in kilograms:0).2g/ke X 60 kg =12 g. The nurse is caring for assigned clients on the oncology unit. Which client is at greatest risk for dehydration? - ANSWER-a 48-year-old having intracavitary radiation for cancer of the cervix Dehydration can occur from fluid loss secondary to tissue destruction at the site of irradiation at any age. Afier radical vulveclomy, wound drains arc generally removed by postoperative day ©. four or five, and don’t create a significant risk of dehydration. Tamoxifen therapy is unrelated to dehydration. Although urine may escape through the vagina as a result of a vesicovaginal fistula, it does not cause the loss of an unusual amount of urine or other fluid. Which type of solution raises serum osmolarity and pulls fluid from the intracellular and intrastitial compartments into the intravascular compartment? - ANSWEI-hypertonic The osmolarity of a hypertonic solution is higher than that of serum. A hypertonic solution draws fluid into the intravascular compartment from the intracellular and interstitial compartments. An isotonic solution's osmolarity is about equal to that of serum. It expands the intravascular and inte: ial compartments. A hypotonic solution’s osmolarity is lower than serum's. A hypotonic solution hydrates the intracellular and interstitial compartments by shifting fluid out of the intravascular compartment. Electrotonic solution is incorrect. The client with preeclampsia asks the nurse why she is receiving magnesium sulfate. The nurse most appropriate response to is to tell the client that the priority reason for giving her magnesium sulfate is to - ANSWER-prevent The chemical makeup of magnesium is similar to that of calcium and, therefore, magnesium will act like calcium in the body. As a result, magnesium will block seizure activity ina hyperstimulated neurologic system caused by preeclampsia by interfering with signal transmission at the neural musculature junction. Reducing blood pressure, slowing labor, and increasing diuresis are secondary effects of magnesium. The nurse is evaluating the effectiveness of fluid resuscitation during the emergency period of burn management. Which finding indicates thal adequate fluid replacement has been achieved? - ANSWER-The urine output is greater than 35 mL/h. A urine output of 30 to 30 mL/h indicates adequate fluid replacement in the client with burns. An increase in body weight may indicate Mnid retention. A urine oulpul greater than fluid intake does not represent a fluid balance. Depending on the client, blood pressure af 90/60 mm Hg could indicate the presence of a hypovolemic state; by itself, it does not indicate adequate fluid replacement. During the first 48 to 72 hours of fluid resuscitation therapy after a major burn injury, the nurse should monitor hourly which information that will be used to determine the IV infusion rate? - ANSWERurrince output During the first. 48 lo 72 hours of fluid resuscitation therapy, hourly urine oulpul is the most accessible and generally reliable indicator of adequate fluid replacement. Fluid volume is also assessed by monitoring mental status, vital signs, peripheral perfusion, and daily body weight. Pulmonary artery end-diastolic pressure (PAEDP) and even central venous pressure (CVP) are preferred guides to fluid administration, but urine output is best when PAEDP or CYP is not used. After the first 48 to 72 hours, urine output is a less reliable guide to fluid needs. The victim enters the diuretic phase as edema reabsorption occurs, and urine output increases dramatically.During the first 48 to 72 hours, fluid replacement is critical and is based on hourly urine output. Daily body weight docs nol provide cnough information on which to base fluid replacement amounts.Body temperature is not a reliable guide for fluid replacement.IV fluid rates will be adjusted to keep urine output greater than 30 mL/h. Specific gravity measures the kidneys’ ability to concentrate urine. Assessment of circulatory status, including observation of the puncture site, is of primary importance after a cardiac catheterization. Laboratory values and skin warmth and turgor are important to monitor but are not the most important initial nursing assessment. Neurologic assessment every 15 mimultes is nol required. A 26-yc tells the nurse that she takes mineral oil for occasional constipation. What should the nurse r-old primigravida visiling the prenatal clinic for hor regular visit at 34 wecks’ gestalion should instruct the client to do? - ANSWER-Avoid mineral oil because it interferes with the absorption of fat-soluble vitamins. Mineral oil is a harsh laxative that is contraindicated during pregnancy because il interferes with absorption of the fat-soluble vitamins A, D, E, and K from the intestinal tract. Dietary , and increased fluid and fiber intake are better choices to prevent measures, exercis constipation. If necessary, a stool softener or mild laxative may be prescribed.Use of fruit Juice is recommended for the clint receiving iron supplementation Lo enhance its absorption. Mineral oil docs nol lead to vitamin C deficiency in pregnant. clicnts.Mineral oil use is contraindicated during pregnancy and therefore should not be used. Increased fluids, fiber, and exercise are better choices to suggest for relief of constipation. The nurse is admilling a clicnt who lakes digoxin daily, reported seen ‘con halos around the lights, and has not wanted to eat breakfast. The laboratory report shows that serum sodium = 135 mEe/L, polassium = 3.2 mEq/L, magnesium = 2.5 mg/dL, and calcium = 10.2 mg/dL. Which nursing action is appropriate? - ANSWER Administer a potassium supplement. This client is exhibiting signs of digoxin toxicity. Hypokalemia can increase the risk of digoxin toxicity and should be replaced, as the value is low. The sodium, magnesium, and calcium levels are all within normal limits and will not require intervention. talional hypertension has been receiving magnesium sulfate TV for A primigravid with sovere gi 3 hours. The latest assessment reveals deep tendon reflexes (DTR) of +1, blood pressure of 156/190 mm Hg, a pulse of 92 beats/minute, a respiratory rate of 10 breaths/minute, and a urine output of 20 ml/hour. Which action should the nurse perform next? - ANSWER-Stop the magnesium sulfate infusion. ithheld if the reflexes are diminished or absent. The client may also show other signs of impending toxicit Magnesium sulfa ient’s respiratory rate or urine output falls or if such as flushing and [ecling warm. Continuing lo moniLor the client won’l resolve the client's suppressed DTRs and low respiratory rate and urine output. The client is already showing central nervous system depression because of excessive magnesium sulfate, so increasing the that the infusion should be infusion rat¢ is inappropriate. Impending toxicily indicate rather than Just slowed down. The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. The nurse should report which finding to the health care provider (HCPi? - ANSWER- urine output: 20 mL/h The decrease in urine output may reflect inadequate renal perfusion and should be reported immediately. Urine ontput of 30 mL/h or greater is considered acceptable. A slight elevation in temperature is expected after surgery. Peristalsis returns gradually, usually the second or third day after surgery. Bowel sounds will be absent until then. A small amount of serosanguineous drainage is to be expecled. Aclient with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client’s discharge teaching plan? - ANSWEF-Inercase daily Mnid intake to at least 2 lo 3 L. Ahigh daily fluid intake is essential for all clients who are at risk for calculi formation because it prevents urinary stasis and concentration, which can cause crystallization. Depending on the composition of the sLone, Lhe clicnt also may be instructed Lo instilnie specific diclary measures aimed al preventing stone formation. Clients may need Lo limit purine, calcium, or oxalate. Urine may need to be either alkaline or acid. There is no need to strain urine regularly. Urine output below 1 ml/hour is a sign of dehydration. Other signs of dehydration include depressed, not bulging, fontanels; excessive weight loss, not gain; decreased skin turgor; dry mucous membranes; and urine specific gravity above, not below, 1.012. A client is receiving spironolactone for treatment of bilateral lower extremity edema. The nurse should instruct the client lo make which nutritional modification Lo prevent an electrolytic imbalance? - ANSWER-Decrease foods high in potassium. Aldactone is a potassium-sparing diuretic often used to counteract potassium loss caused by other diuretics. If foods or Mids are ingested thal arc high in potassium, hyperkalemia may result and lead lo cardiac arrhythmias. Inercasing the intake of milk or milk products docs nat affect the potassium level. Restricting fluid may elevate all electrolytes due to extracellular fluid volume depletion. By increasing foods high in sodium, water would tend to be retained and so would dilute all electrolytes in the extracellular fluid compartment. Which indicator is the best for determining whether a client with Addison’s disease is r the correct amount. of glucacorticoid replacement? - ANSWER daily weight Measuring daily weight is a rcliable, obicctive way Lo monitor fluid balance. Rapid variations in weight reflect changes in fluid volume, which suggests insufficient control of the disease and the need for more glucocorticoids in the client with Addison's disease. Nurses should instruct clients taking oral steroids to weigh themselves daily and to report any unusual weight loss or gain. Skin turgor testing does supply information about fluid status, but daily weight monitoring is more reliable. Temperature is not a direc! measurement of fluid balance. Thirst is a nonspecific and very late sign of weight loss. The nurse is recording information in the electronic health record for a client with dehydration who is at risk for skin broakdown. Which documentation demonstratcs an area of insensible [nid ANSWEF-Lomperauure loss for this client? The client with a fever of 102.5 Fahrenheit (39.2 Celsius) has insensible fluid loss through the skin and it can cause this through the lungs. However, the client’s respiratory rate is within normal limits, as are the blood pressure and heart rate. Urine output and chest tube drainage represen sensible [uid loss, as these can be measured for determining fluid balance. A\nurse is caring for a client diagnosed with pncumonia, a urinary Lr: on, dehydration, and temperature of 101.4” F8.6° C:), The health care provider orders 1,000 ml of DaW to infuse ov er 8 hours. The available drop factor is 20 gtt/ml. The nurse would regulate the intravenous flow rate to deliver how many drops per minute? Round your ANSWER Lo the nearest whole number. - ANSWER-42 Calculate the flow rate using the formula below:(T otal volume ordered) + (Number of hours) = Flow rate1,000 ml/8 hours = 125 ml/h125 ml/h X 1/60 min X 20 gtt/ml = 42 ett/min As a representative of the treatment team, a nurse is reviewing results of diagnostic studies with the family of an adolescent with anorexia nervosa. What explanation should the nurse give the family about the clicnt’s abnormal blood urca nilrogen (BUN) value? - ANSWER-"The BUN is elevated because your daughter is dehydrated.” A client with anorexia nervosa will have an elevated BUN as a result of dehydration. A decreased BUN isn’t associated with anorexia nervosa or with hypothyroidism. An elevated BUN isn't associated with hypoglycemia. A client with anorexia nervosa will have hyperglycemia related to a drastic decrease in nutritional intake. A decreased BUN value isn't associated with anorexia nervosa or with hypertcnsion. A client with anorcxia nervosa will have hypotcnsion caused by impaired cardiac functioning. Aclient is returning from the operating room after inguinal hernia repair. The nurse notes that the client has [nid volume excess from the operation and is al risk for lefi-sided heart failure. oli-sided heart failure? - ANSWEF-bibasilar cracklos Which sign or symptom indicates The client with fluid volume deficit due to dehydration would likely require an IV infusion of fluids as a treatment for this. Having an improved skin turgor with decreased dehydration will reduce the client's risk for impaired skin integrity. The client would have the catheter inserted canscd, and thon and then fished with saline once the appropriate vein was selecied, the skin cl the skin held taut below the site to stabilize the vein for IV insertion. Avoid touching the cleansed area to maintain this antisepsis. A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? - ANSWEFR-hypercaleemia iroyed, cansing hypercalcemia. Multiple mycloma doesn’t sls. Calcium is released when bone is de affect potassium, sodium, or magnesium le The nurse is teaching an older adult with a urinary tract infection about the importance of increasing fluids in the diet. What puts this client at a risk for not obtaining sufficient fluids? - ANSWEF-decreased ability to detect thirst. The sensation of thirst diminishes in those greater than 60 years of age; hence, fluid intake is decreased, and dissolved parLlicles in the extracellular [uid compariment become more concentrated. There is no change in liver function in older adults. nor is there a reduction of ADH and aldosterone as a normal part of aging. Aclient who is recovering from gastric surgery is recciving IV fhuids to be infused at 100 mL/hour. The IV tubing delivers 15 gtt/mL. The nurse should infuse the solution at a flow rate of how many drops per minute to ensure that the client receives 100 mL/hour? Record your ANSWERusing a whole number. - ANSWER-23 To administer IV fluids at 100 mL/hour using tubing that has a drip factor of 15 gtt/mL, the nurse d etts/L mL = 25 ett/min. should use the following formula:100 mL/$0 min X 1: When a client retums from a magnetic resonance imaging (MRI) exam with contrast, which action is appropriate? - ANSWER administering fluids to the client A client that receives an MRI with contrast will need to have fluids offered to facilitate kidney excretion of the contrast medium. There is no need to numb the client’s throat for this procedure Tha The nurse should assess for the presence of metal implants prior to the MRI, not after. > ig no noed to restrict Lhe cliont’s acli so the client's gag reflex should not be aflec Aclient is admitted with full-thickness bums to 30% of the body, including both legs. After establishing a patent airway, which intcrvention is a priority? - ANSWER-rcplacing Mnid and roly tes After establishing a patent airway, fluid resuscitation is critical for the client with a burn injury. The burns will be covered with sterile saline-soaked dressings until the client is stabilized. Positioning to promote normal anatomic alignment is not a priority at this time. There is no reason to suspect that blood flow to the lower extremities is affected, but it might occur if the injury causes circumferential constriction of the legs. To delermine the LV. drip rate, a nurse must know the drip factor, which is - ANSWER-the number of drops in one milliliter. The drip factor is the number of drops in one milliliter, not the number of milliliters in one drop. The drip rate refers Lo the number of drops infused por minute. The flow rate is the number of milliliters, not the number of drops, infused per hour. Aclient who has been vomiting for 2 days has a nasogastric tube inserted. The nurse notes that over the past 10 hours, the tube has drained 2 L of fluid. The nurse should further assess the client for which electrolyte imbalance? - ANSWEF-hypokalemia for what side effect of loop diuretic therapy that could worsen the client’s hypercapnia? - ANSWEF-hypokalemia All the options offered are potential side effects of loop diuretics, but only hypokalemia would directly pose the risk for increasing hypercapnia. When potassium levels are low, hydrogen ions shift into the intracellular space Lo liberate potassium into the extracellular space, and this contributes to metabolic alkalosis. To compensate for metabolic alkalosis, hypoventilation occurs in an attempt to retain carbon dioxide (the respiratory acid) and decrease the client’s pH. Therefore, hypokalemia can worsen hypercapnia. Diurclics must be used wilh caution in clicnts with COPD. However, diuretics may be prescribed to treat peripheral edema that results from right ventricular dysfunction and the resulting systemic venous congestion. Before a cancer client receiving total parenteral nutrition resumes a normal diet, the nurse teaches them about dietary sources of minerals. Which foods are good sources of zinc? - ANSWEFR-whole grains and meats Good sourees of zine include whole grains, meats, dairy products, and seafood. Fruits arc good sources of vitamin C, and vegetables are a good source of many vitamins and minerals, but not zinc. Yeast is a good source of chromium, and legumes are a good source of copper, manganese, and molybdenum. A client is scheduled for a creatinine clearance test. What should the nurse do to prepare the client?- ANSWEF-Instruct the client about the need to collect urine for 24 hours. A creatinine clearance test is a 24-hour urine test that measures the degree of protein breakdown in the body. The collection is not maintained in a sterile container. There is no need to insert an indwelling urinary catheter as long as the client is able to control urination. It is not necessary to inerease Mids 193,000 mL. A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of - ANSWER-sodium and potassium abnormalities. In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium oxerction. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn’t regulale calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency docsn’t affect levels of these electrolytes directly. The nurse is teaching the client with an ileal conduit how to prevent a urinary tract infection. Which measure would be most effective? - ANSWER Maintain a daily fluid intake of 2,000 to 3,000 mL. Maintaining a fluid intake of 2,000 to 3,000 mL/day is likely to be most effective in preventing urinary tract infocuon. A high fluid intake results in high urine output, which prevents urinary stasis and bacterial growth. Avoiding people with respiratory tract infections will not prevent urinary tract infections. Clean, not sterile, technique is used to change the appliance. An ileal conduil stoma is not 1 igaled. The nurse is administering a high dose of furosemide to a client with nephrotic syndrome. What potential complication is the nurse most concerned with for the client? - ANSWERelectrolyte imbalance Furosemide is a loop diuretic that can cause the excretion of potassium, sodium, and magnesium. The client r disturbances and altered levels of consciousness are not common complications. The nurse imbalance. Visual ing high doses should be monitored for electroly s clionts lo have increased urine oulpul. with furosemide. CxPC A nurse is assessing a postsurgical client who has been receiving nasogastric suctioning for 3 days. The client is restless, confused, and has generalized edema. What is the nurse’s best intervention? - ANSWER Stop the infusion of 5% dextrose in water (D5W) at 100 mL/hr. Hyponatremia is decrease in serum Na concentration < 136 mEq/L caused by an excess of water relative to solute. Because the clicnt’s gastric suction has been depleting electrolytes, the client is displaying signs of fluid volume overload and hyponatremia. Clinical manifestations are primarily neurologic due to an osmotic shift of water into brain cells causing edema. They include headache, confusion, and stupor. DSW becames hypotonic as il is metabolized and could worsen fluid volume overload. The action of the nurse should be to recognize the symptoms and stop the DSW 1.V. infusion. Once completed, the LV. solution should be changed to a solution that includes electrol: (sodium) replacement. The client is not in acute pain therefore morphine should not be given. Metoclopramide is given for a clicnt who has nansca and vomiting. Administration of a hypotonic solution would cxacerbate the client’s hyponatremia. Which action has the highest priority in the care ofa client wilh chronic renal failure? - ANSWER Maintain a low-sodium d. It is appropriate for the client to be on a low-sodium diet to help decrease fluid retention. Dry skin and pruritus are common in renal failure. Lotions arc used Lo relieve the dry skin, and antihistamines may be used to control itching: corticosteroids are not used. Pain is not a major problem in chronic renal failure, but analgesics that are excreted by the kidneys must be avoided. Tt is not necessary to measure abdominal girth daily because ascites is not a clinical problem in renal failure. Aclient admitted with a gunshot wound to the abdomen is transferred to the intensive care unit tl/hour. Which a: alter an exploratory laparotomy. LV. [nid is being infused at finding suggests that the client is experiencing acute renal failure (ARF)? - ANSWER-urine output of 250 ml/24 hours ARF, characti characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't ized by abrupt loss of kidney function, commonly causes oliguria, which is diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2" F (87.8° C) wouldn't result from this disorder. Which serum electrolytes findings should the nurse expect to find in an infant with persistent vomiting? - ANSWEFR-K+, 3.2; CL, 92; Nat, 120 Chloride and sodium function together to maintain fluid and electrolyte balance. With vomiting, sodium chloride and water are lost in gastric fluid. As dehydration occurs, potassium moves into the extracellular fluid. For these reasons, persistent vomiting can lead to hypokalemia, hypochloromia, and hyponatremia. The normal potassium lovel is 3.5 Lo 5.5, the normal chloride and 120, respectively, are consistent with persistent vomiting.Each of the other options includes at least level is 98 Lo 106, and the normal sodium level is 135 to 145. The values of 5 tao serum electrolyte levels that are normal or high. These are not consistent with persistent vomiting. A primary health care provider prescribes regular insulin 19 units intravenously (LV) along with 30 tml of de client mast 1 so 50% for a client with acute renal failure. Whal clectroly te imbalance is this sly experiencing? - ANSWER hyperkalemia Administering regular insulin LV. concomitantly with 50 ml of dextrose 59% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia. This combination does not help reverse the effects of hypercalcemia, hypernatremia, or hypermagnesemia. Parents bring a child to the clinic who has not been eating or drinking well for the last few days. What action should the nurse take first to assess the child's overall hydration status? - ANSWER-Weigh the child. When implementing nursing care, the nurse should complete any noninvasive procedures before invasive ones. Therlore, the first slep the nurse should lake is lo weigh the child. A deercase in body weight gives [he most accurate information about the infant’s hydration status. Monitoring