Electrolytes
ACID BASE
Fluid Imbalances
Perioperative
Fluids
100

A client is admitted with a serum potassium level of 6.5 mEq/L. Which of the following orders should the nurse question?

  • A. Administer sodium polystyrene sulfonate (Kayexalate).
  • B. Administer potassium chloride IV push.
  • C. Administer 10 units of regular insulin IV with dextrose.
  • D. Obtain an ECG.

Answer: B. Administer potassium chloride IV push. (This would worsen the hyperkalemia.)

100

A patient with chronic respiratory disease has the following ABG: pH 7.36, PaCO2 52 mmHg, HCO3 28 mEq/L. What does this indicate?

  • A. Uncompensated respiratory acidosis
  • B. Compensated respiratory acidosis
  • C. Compensated metabolic acidosis
  • D. Normal ABG

B. Compensated respiratory acidosis (The pH is normal but on the acidic side, PaCO2 is high, and HCO3 is elevated, indicating compensation.)

100

Which clinical manifestation would the nurse expect to see in a client with hypervolemia?

  • A. Hypotension and tachycardia
  • B. Crackles in the lungs and edema
  • C. Poor skin turgor and dry mucous membranes
  • D. Weak, thready pulse

B. Crackles in the lungs and edema. (These are classic signs of fluid overload.)

100

A nurse is educating a postoperative patient about DVT prevention. Which statement by the patient indicates understanding?

  • A. "I should rest as much as possible and avoid walking to prevent clots."
  • B. "I need to wear compression stockings and perform leg exercises regularly."
  • C. "I should cross my legs frequently to promote circulation."
  • D. "I will take aspirin instead of my prescribed blood thinner to prevent bleeding."
  • B. "I need to wear compression stockings and perform leg exercises regularly."

(Compression stockings and leg exercises improve circulation and reduce the risk of DVT.)

100

Which of the following are classified as isotonic IV fluids? SATA

  • A. Normal Saline (0.9% NaCl)
  • B. Lactated Ringer’s (LR)
  • C. 5% Dextrose in Water (D5W)
  • D. 0.45% NaCl (Half Normal Saline)
  • E. 3% Saline
  • Normal Saline (0.9% NaCl) and Lactated Ringer’s (LR) are both isotonic solutions because they have a similar osmolarity to the blood, and they don't cause fluid shifts between compartments.
  • D5W (5% Dextrose in Water) is initially isotonic but becomes hypotonic once the dextrose is metabolized, which is why it is often debated for classification. However, it's commonly used as an isotonic fluid for initial administration before metabolism.
200

The nurse is caring for a client with hypermagnesemia. Which of the following symptoms would the nurse expect?

  • A. Hyperreflexia and muscle spasms
  • B. Hypotension and respiratory depression
  • C. Tetany and laryngeal stridor
  • D. Increased bowel sounds and diarrhea


  • Answer: B. Hypotension and respiratory depression.
    (Hypermagnesemia causes decreased neuromuscular activity, leading to hypotension and respiratory issues.)
200

A client’s ABG results are: pH 7.35, PaCO2 48 mmHg, HCO3 30 mEq/L. What does this indicate?

  • A. Compensated respiratory acidosis.
  • B. Partially compensated metabolic acidosis.
  • C. Uncompensated respiratory acidosis.
  • D. Fully compensated metabolic alkalosis.

Answer:

  • A. Compensated respiratory acidosis.
    (Explanation: The pH is normal but leaning acidic, with elevated PaCO2 and HCO3. This indicates full compensation for respiratory acidosis.)
200

A client with a sodium level of 156 mEq/L is confused and thirsty. What is the priority nursing action?

  • A. Offer water to drink.
  • B. Administer a diuretic.
  • C. Monitor the client’s weight daily.
  • D. Restrict dietary sodium intake.
  • A. Offer water to drink.
    (Explanation: Rehydration is the priority to correct hypernatremia. A diuretic is unnecessary unless there is fluid overload.)
200

Which intervention is most effective in preventing atelectasis in a postoperative patient?

  • A. Administering oxygen via nasal cannula.
  • B. Encouraging the patient to use an incentive spirometer every hour.
  • C. Restricting fluids to prevent aspiration.
  • D. Encouraging bed rest for 24 hours after surgery.

B. Encouraging the patient to use an incentive spirometer every hour.

200

Which condition is most likely to require the administration of hypotonic IV fluids?

  • A. Hypernatremia
  • B. Dehydration without electrolyte imbalance
  • C. Cerebral edema
  • D. Hypertension

Correct Answer: B. Dehydration without electrolyte imbalance

Rationale:

  • Hypotonic fluids (like 0.45% NaCl) are used to treat dehydration without electrolyte imbalance, as they will shift fluid into the cells to correct fluid volume deficits in the intracellular space.
300

A nurse is caring for a client with hypernatremia. Which of the following would the nurse prioritize in the care plan?

  • A. Administering a diuretic to remove excess sodium.
  • B. Providing oral fluids and monitoring intake and output.
  • C. Administering sodium chloride IV to maintain balance.
  • D. Increasing dietary sodium intake to balance losses.

Answer: B. Providing oral fluids and monitoring intake and output.
(The primary treatment for hypernatremia is restoring fluid balance.)

300

A client is admitted with a respiratory rate of 28 breaths per minute due to anxiety. What intervention should the nurse implement first?

  • A. Administer oxygen at 2 L/min.
  • B. Encourage slow, deep breathing.
  • C. Prepare to administer a sedative.
  • D. Check the client’s arterial blood gases (ABGs).


Answer:

  • B. Encourage slow, deep breathing.
    (Explanation: Hyperventilation from anxiety leads to respiratory alkalosis. Slow, deep breathing helps retain CO2 and correct the imbalance.)
300

A client is admitted with a heart rate of 115 bpm, low blood pressure, and dry mucous membranes. What is the priority intervention?

  • A. Encourage oral fluid intake.
  • B. Administer IV fluids as prescribed.
  • C. Monitor daily weights.
  • D. Assess for orthostatic hypotension.

Answer:

  • B. Administer IV fluids as prescribed.
    (Explanation: IV fluids quickly restore fluid volume in hypovolemia, which is the priority action. Oral fluids and monitoring are important but less immediate in acute cases.)
300

A patient who had abdominal surgery 4 hours ago reports nausea and has an absent bowel sound upon assessment. What is the nurse’s priority action?

  • A. Administer antiemetic medication as prescribed.
  • B. Encourage the patient to drink small amounts of clear liquids.
  • C. Notify the provider of the absent bowel sounds.
  • D. Maintain the patient on NPO status and monitor.

Answer:

  • D. Maintain the patient on NPO status and monitor.
    (Postoperative ileus is common after abdominal surgery; keeping the patient NPO prevents complications like vomiting or aspiration.)
300

A client’s IV rate is set to deliver 1,000 mL over 8 hours with tubing that has a drip factor of 15 gtt/mL. What is the drip rate in drops per minute (gtt/min)?

  • A. 25 gtt/min
  • B. 31 gtt/min
  • C. 45 gtt/min
  • D. 50 gtt/min

Answer: B. 31 gtt/min. (1,000 ÷ 480 × 15 = 31.25, rounded to 31.)

400

A client with a sodium level of 118 mEq/L is being treated with hypertonic saline (3%). Which of the following symptoms would indicate rapid correction of hyponatremia?

  • A. Confusion and lethargy
  • B. Nausea and vomiting
  • C. Flaccid paralysis
  • D. Neurological symptoms such as seizures

Answer: D. Neurological symptoms such as seizures.
(Rapid correction of sodium levels can lead to osmotic demyelination syndrome.)

400

A client with COPD is admitted with ABGs showing pH 7.31, PaCO2 60 mmHg, and HCO3 24 mEq/L. What is the priority intervention?

  • A. Administer bronchodilators as prescribed.
  • B. Encourage pursed-lip breathing.
  • C. Begin oxygen therapy at 4 L/min.
  • D. Prepare the client for intubation.

Answer:

  • A. Administer bronchodilators as prescribed.
    (Explanation: COPD often causes respiratory acidosis due to CO2 retention. Bronchodilators can improve ventilation and reduce CO2 levels.)
400

Which finding is the most reliable indicator of a client’s hydration status?

  • A. Skin turgor.
  • B. Urine output.
  • C. Blood pressure.
  • D. Body weight.


Answer:

  • D. Body weight.
    (Explanation: Body weight changes accurately reflect fluid loss or gain. Skin turgor and urine output are useful but less reliable.)
400

A nurse is assessing a postoperative patient and suspects hemorrhage. Which of the following signs would support this suspicion?

  • A. Increasing heart rate and decreasing blood pressure.
  • B. Increased urine output and warm, flushed skin.
  • C. Decreasing respiratory rate and dilated pupils.
  • D. Elevated temperature and bounding pulse.

Answer:

  • A. Increasing heart rate and decreasing blood pressure.
    (These are early signs of hemorrhagic shock due to blood loss.)
400

A nurse notices that a patient has a red, swollen, and warm IV insertion site. What is the most likely cause?

  • A. Fluid overload
  • B. Phlebitis
  • C. Air embolism
  • D. Hypotension

Correct Answer: B. Phlebitis

Rationale:

  • Phlebitis is the inflammation of the vein, often caused by irritation from the IV catheter or solution. The symptoms include redness, swelling, warmth, and tenderness at the insertion site.
500

A 45-year-old client with chronic kidney disease presents with muscle weakness and an irregular heartbeat. Their potassium level is 6.8 mEq/L. Which nursing interventions are appropriate? (Select all that apply.)

  • A. Administer sodium polystyrene sulfonate (Kayexalate).
  • B. Administer IV potassium chloride.
  • C. Place the client on cardiac monitoring.
  • D. Prepare to administer IV insulin with dextrose.
  • E. Restrict foods high in potassium.
  • F. Administer a loop diuretic as prescribed.


  • Answer:
    • A. Administer sodium polystyrene sulfonate (Kayexalate).
    • C. Place the client on cardiac monitoring.
    • D. Prepare to administer IV insulin with dextrose.
    • E. Restrict foods high in potassium.
    • F. Administer a loop diuretic as prescribed.

  • (Explanation: Hyperkalemia requires urgent interventions like cardiac monitoring, insulin with dextrose to shift potassium intracellularly, Kayexalate to remove potassium, and dietary restrictions. IV potassium chloride would worsen the hyperkalemia.)

500

A nurse is caring for a client with COPD. Which findings are consistent with respiratory acidosis? (Select all that apply.)

  • A. Confusion.
  • B. pH 7.30.
  • C. PaCO2 58 mmHg.
  • D. Hyperventilation.
  • E. Hypoxemia.
  • F. HCO3 20 mEq/L.

Answers:

  • A. Confusion. (Neurological changes, like confusion, can result from high CO2 levels.)
  • B. pH 7.30. (A low pH indicates acidosis.)
  • C. PaCO2 58 mmHg. (Elevated CO2 levels indicate respiratory acidosis.)
  • E. Hypoxemia. (Low oxygen levels often occur with COPD and respiratory acidosis.)
500

An 82-year-old client is admitted with dehydration and reports dizziness and fatigue. Which assessment findings are consistent with fluid volume deficit? (Select all that apply.)

  • A. Capillary refill > 3 seconds.
  • B. Flattened neck veins.
  • C. Blood pressure 90/60 mmHg.
  • D. Bounding radial pulse.
  • E. Dry tongue and oral mucosa.

Answer:

  • A. Capillary refill > 3 seconds.
  • B. Flattened neck veins.
  • C. Blood pressure 90/60 mmHg.
  • E. Dry tongue and oral mucosa.

(Explanation: Dehydration causes delayed capillary refill, flattened neck veins, hypotension, and dry oral mucosa. Bounding pulses are associated with fluid volume excess.)

500

The nurse is educating a patient on preventing postoperative complications. Which of the following should be included in the teaching?

  • A. Perform deep breathing and coughing exercises.
  • B. Use the incentive spirometer every 2 hours while awake.
  • C. Limit fluid intake to prevent swelling.
  • D. Ambulate early and often to promote circulation.
  • E. Avoid using pain medications to prevent addiction.

Correct answers: A, B, D

500

Which of the following are indications for the administration of hypotonic IV fluids?

  • A. Hypernatremia
  • B. Dehydration (without electrolyte imbalance)
  • C. Hypertension
  • D. Hyperglycemia
  • E. Cellular dehydration (e.g., hyperglycemic crisis)

Correct answers: A, B, E

Rationale:

  • Hypotonic fluids are used to treat conditions where there is a need for fluid to move into cells to correct cellular dehydration.
  • Hypernatremia (high sodium levels) can cause cells to shrink, and hypotonic fluids help correct this imbalance by pushing water back into the cells.
  • Dehydration without electrolyte imbalance (e.g., dehydration from poor fluid intake or environmental factors) may be treated with hypotonic fluids to restore fluid balance within the cells.
  • Cellular dehydration seen in hyperglycemic crisis (e.g., in DKA) may also be corrected with hypotonic fluids.
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