2023-2024 ATI Medical Surgical Practice Exam With Answers-105 Solved Questions

ATI Medical Surgical Test Questions Fluid and Electrolytes Balance and DisturbanceWith 100% Verified Solutions-2023-2024

Question 1: An elderly client takes 40 mg of Lasix twice a day. Which electrolyte imbalance
is the most serious adverse effect of diuretic use?
Answer: Hypokalemia
Explanation: Hypokalemia (potassium level below 3.5 mEq/L) usually indicates a defict in
total potassium stores. Potassium-losing diuretics, such as loop diuretics, can induce
hypokalemia.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 255.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 255
Question 2: The nurse is reviewing client lab work for a critical lab value. Which value is
called to the physician for additional orders?
Answer: Potassium: 5.8 mEq/L
Explanation: Normal potassium level is 3.5 to 5.5 mEq/L. Elevated potassium levels can
lead to muscle weakness, paresthesias, and cardiac dysrhythmias.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 254.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 254
Question 3: A client with pancreatic cancer has the following blood chemistry profile:
Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl;
Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which
result should the nurse identify as critical and report immediately?
Answer: Potassium
Explanation: The nurse should identify potassium: 2.2 mEq/L as critical because a normal
potassium level is 3.8 to 5.5 mEq/L. Severe hypokalemia can cause cardiac and respiratory
arrest, possibly leading to death. Hypokalemia also depresses the release of insulin and
results in glucose intolerance. The glucose level is above normal (normal is 75 to 110 mg/dl)
and the chloride level is a bit low (normal is 100 to 110 mEq/L). Although these levels should

be reported, neither is life-threatening. The BUN (normal is 8 to 26 mg/dl) and creatinine
(normal is 0.8 to 1.4 mg/dl) are within normal range. (less).
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 255.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 255
Question 4: Which nerve is implicated in the Chvostek’s sign?
Answer: Facial
Explanation: Chvostek’s sign consists of twitching of muscles supplied by the facial nerve
when the nerve is tapped about 2 cm anterior to the earlobe, just below the zygomatic arch.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 259.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 259
Question 5: A client has the following arterial blood gas (ABG) values: pH, 7.12; partial
pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO–), 15 mEq/L.
These ABG values suggest which disorder?
Answer: Metabolic acidosis
Explanation: This client's pH value is below normal, indicating acidosis. The HCO – value
also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of
base, which suggests metabolic acidosis. The PaCO2 value is normal, indicating absence of
respiratory compensation. These ABG values eliminate respiratory alkalosis, respiratory
acidosis, and metabolic alkalosis. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 268.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 268
Question 6: The nurse is caring for a client with laboratory values indicating dehydration.
Which clinical symptom is consistent with the dehydration?
Answer: Dark, concentrated urine

Explanation: Dehydration indicates a fluid volume deficit. Dark, concentrated urine
indicates a lack of fluid volume. Adding more fluid would dilute the urine. The other options
indicate fluid excess. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 246.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 246
Question 7: To compensate for decreased fluid volume (hypovolemia), the nurse can
anticipate which response by the body?
Answer: Tachycardia
Explanation: Fluid volume deficit, or hypovolemia, occurs when the loss of extracellular
fluid exceeds the intake of fluid. Clinical signs include oliguia, rapid heart rate,
vasoconstriction, cool and clammy skin, and muscle weakness. The nurse monitors for rapid,
weak pulse and orthostatic hypotension. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 245-246.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 245
Question 8: Air embolism is a potential complication of IV therapy. The nurse should be alert
to which clinical manifestation associated with air embolism?
Answer: Chest pain
Explanation: Manifestations of air embolism include dyspnea and cyanosis; hypotension;
weak, rapid pulse; loss of consciousness; and chest, shoulder, and low back pain. Jaundice is
not associated with air embolism. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 280.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 280
Question 9: The nurse is analyzing the arterial blood gas (AGB) results of a patient diagnosed
with severe pneumonia. Which of the following ABG results indicates respiratory acidosis?
Answer: pH: 7.20, PaCO2: 65 mm Hg, HCO3–: 26 mEq/L

Explanation: Respiratory acidosis is a clinical disorder in which the pH is less than 7.35 and
the PaCO2 is greater than 42 mm Hg and a compensatory increase in the plasma HCO3–
occurs. It may be either acute or chronic. The ABG of pH: 7.32, PaCO2: 40 mm Hg, HCO3–:
18 mEq/L indicates metabolic acidosis. The ABGs of pH: 7.50, PaCO2: 30 mm Hg, and
HCO3–: 24 mEq/L indicate respiratory alkalosis. The ABGs of pH 7.42, PaCO2: 45 mm Hg,
and HCO3–: 22 mEq/L indicate a normal result/no imbalance. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed., Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 269.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 269
Question 10: Below which serum sodium level may convulsions or coma can occur?
Answer: 135 mEq/L
Explanation: Normal serum concentration level ranges from 135 to 145 mEq/L. When the
level dips below 135 mEq/L, there is hyponatremia. Manifestations of hyponatremia include
mental confusion, muscular weakness, anorexia, restlessness, elevated body temperature,
tachycardia, nausea, vomiting, and personality changes. Convulsions or coma can occur if the
deficit is severe. Values of 140, 142, and 145 mEq/L are within the normal range. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 253.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 253
Question 11: Which intervention is most appropriate for a client with an arterial blood gas
(ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO 2) of 26 mm Hg, oxygen
(O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg?
Answer: Instruct the client to breathe into a paper bag.
Explanation: The ABG results reveal respiratory alkalosis. The best intervention to raise the
PaCO2 level would be to have the client breathe into a paper bag. Administering a
decongestant, offering fluids frequently, and administering supplemental oxygen wouldn't
raise the lowered PaCO2 level. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 271.

Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 271
Question 12: A 64-year-old client is brought in to the clinic feeling thirsty with dry, sticky
mucous membranes; decreased urine output; fever; a rough tongue; and is lethargic. Serum
sodium level is above 145 mEq/l. Should the nurse start salt tablets when caring for this
client?
Answer: No, sodium intake should be restricted.
Explanation: The symptoms and the high level of serum sodium suggest hypernatremia,
(excess of sodium). It is necessary to restrict sodium intake. Salt tablets and sodium chloride
IV can only worsen this condition but may be required in hyponatremia (sodium deficit).
Hypotonic solution IV may be a part of the treatment but not along with the salt tablets. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 253.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 253
Question 13: A client with a suspected overdose of an unknown drug is admitted to the
emergency department. Arterial blood gas values indicate respiratory acidosis. What should
the nurse do first?
Answer: Prepare to assist with ventilation.
Explanation: Respiratory acidosis is associated with hypoventilation; in this client,
hypoventilation suggests intake of a drug that has suppressed the brain's respiratory center.
Therefore, the nurse should assume the client has respiratory depression and should prepare
to assist with ventilation. After the client's respiratory function has been stabilized, the nurse
can safely monitor the heart rhythm, prepare for gastric lavage, and obtain a urine specimen
for drug screening. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 270.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 270
Question 14: A nurse is conducting an initial assessment on a client with possible
tuberculosis. Which assessment finding indicates a risk factor for tuberculosis?
Answer: The client had a liver transplant 2 years ago.

Explanation: A history of immunocompromised status, such as that which occurs with liver
transplantation, places the client at a higher risk for contracting tuberculosis. Other risk
factors include inadequate health care, traveling to countries with high rates of tuberculosis
(such as southeastern Asia, Africa, and Latin America), being a health care worker who
performs procedures in which exposure to respiratory secretions is likely, and being
institutionalized. (less)
Reference: Smeltzer, S.C., and Bare, B. Brunner & Suddarth's Textbook of Medical- Surgical
Nursing, 12th ed. Philadelphia: Lippincott Williams & Wilkins, 2010, Chapter 14: Fluid and
Electrolytes: Balance and Disturbance, p. 567.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 567
Question 15: Your client has a diagnosis of hypervolemia. What would be an important
intervention that you would initiate?
Answer: Limit sodium and water intake.
Explanation: Implement prescribed interventions such as limiting sodium and water intake
and administering ordered medications that promote fluid elimination. Assessing for
dehydration and teaching to decrease urination would not be appropriate interventions. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 249.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 249
Question 16: Oral intake is controlled by the thirst center, located in which of the following
cerebral areas?
Answer: Hypothalamus
Explanation: Oral intake is controlled by the thirst center located in the hypothalamus. The
thirst center is not located in the cerebellum, brainstem, or thalamus.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 242.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 242
Question 17: A nurse can estimate serum osmolality at the bedside by using a formula. A
patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of:

Answer: 280 mOsm/kg.
Explanation: Serum osmolality can be estimated by doubling the serum sodium or using the
formula: Na × 2 = glucose/18 + BUN/3. Therefore, the nurse could estimate a serum
osmolality of 280 mOsm/kg by doubling the serum sodium value of 140 mEq/L. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 241.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 241
Question 18: A priority nursing intervention for a client with hypervolemia involves which of
the following?
Answer: Monitoring respiratory status for signs and symptoms of pulmonary complications.
Explanation: Hypervolemia, or fluid volume excess (FVE), refers to an isotonic expansion
of the extracellular fluid. Nursing interventions for FVE include measuring intake and output,
monitoring weight, assessing breath sounds, monitoring edema, and promoting rest. The most
important intervention in the list involves monitoring the respiratory status for any signs of
pulmonary congestion. Breath sounds are assessed at regular intervals. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 249.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 249
Question 19: The nurse is assessing residents at a summer picnic at the nursing facility. The
nurse expresses concern due to the high heat and humidity of the day. Although the facility is
offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned
about which?
Answer: Insensible fluid loss
Explanation: Due to the high heat and humidity, geriatric clients are at a high risk for
insensible fluid loss through perspiration and vapor in the exhaled air. These losses are noted
as unnoticeable and unmeasurable. Those with respiratory deficits and allergies may be only
able to be outside for a limited period. Those with cardiovascular compromise may need to
alternate outdoor activities with indoor rest. (less)

Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, pp. 239-240.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 239
Question 20: A patient has been involved in a traumatic accident and is hemorrhaging from
multiple sites. The nurse expects that the compensatory mechanisms associated with
hypovolemia would cause what clinical manifestations? (Select all that apply.)
Answer: • Oliguria
• Tachycardia
• Tachypnea
Explanation: Hypovolemia, or fluid volume deficit, is indicated by decreased, not increased,
blood pressure (hypotension), oliguria, tachycardia (not bradycardia), and tachypnea.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 246.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 246
Question 1: A nurse reviews blood gases from a patient diagnosed with metabolic acidosis.
Select the reading that is most consistent with that diagnosis.
Answer: pH, HCO3, or normal PaCO2.
In metabolic acidosis, you would expect a decreased blood pH (below 7.35) and a decreased
bicarbonate level (HCO₃⁻) typically below 22 mEq/L.
Explanation: Arterial blood gas measurements reveal a low pH and a low plasma
bicarbonate concentration.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 268.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 268
Question 2: To evaluate a client for hypoxia, the physician is most likely to order which
laboratory test?
Answer: Arterial blood gas (ABG) analysis

Explanation: Red blood cell count, sputum culture, total hemoglobin, and ABG analysis all
help evaluate a client with respiratory problems. However, ABG analysis is the only test that
evaluates gas exchange in the lungs, providing information about the client's oxygenation
status. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 271.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 271
Question 3: Which of the following electrolytes is the primary determinant of extracellular
fluid (ECF) osmolality?
Answer: Sodium
Explanation: Sodium is the primary determinant of ECF osmolality. Sodium plays a major
role in controlling water distribution throughout the body because it does not easily cross the
intracellular wall membrane and because of its abundance and high concentration in the body.
Potassium, calcium, and magnesium are not primary determinants of ECF osmolality. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 251.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 251
Question 4: A client hospitalized for treatment of a pulmonary embolism develops respiratory
alkalosis. Which clinical findings commonly accompany respiratory alkalosis?
Answer: Light-headedness or paresthesia
Explanation: The client with respiratory alkalosis may complain of light-headedness or
paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain,
and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are
associated with respiratory alkalosis or any other acid-base imbalance. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 270.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 270

Question 5: A nurse correctly identifies a urine specimen with a pH of 4.3 as being which
type of solution?
Answer: Acidic
Explanation: Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals acidic urine pH. A pH
above 7.0 is considered an alkaline or basic solution. A pH of 7.0 is considered neutral.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, pp. 241-242.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 241
Question 1: The physician has prescribed a hypotonic IV solution for a patient. Which IV
solution should the nurse administer?
Answer: 0.45% sodium chloride
Explanation: Half-strength saline (0.45% sodium chloride) solution is frequently used as an
IV hypotonic solution.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 273.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 273
Question 2: A patient with cancer is being treated on the oncology unit for bilateral breast
cancer. The patient is undergoing chemotherapy. The nurse notes the patient’s serum calcium
level is 12.3 mg/ dL. Given this laboratory finding, the nurse should suspect which of the
following statements?
Answer: The patient’s malignancy is causing the electrolyte imbalance.
Explanation: The patient’s laboratory findings indicate hypercalcemia. Hypercalcemia is
defined as a calcium level greater than 10.2 mg/dL (2.6 mmol/L).The most common causes of
hypercalcemia are malignancies and hyperparathyroidism. Malignant tumors can produce
hypercalcemia by a variety of mechanisms. The patient’s calcium level is elevated; there is no
indication that the patient’s diet is lacking in calcium-rich food products. Hyperaldosteronism
is not associated with a calcium imbalance. Alcohol abuse is associated with hypocalcemia.
(less)

Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed., Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 260.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 260
Question 3: A nurse is reviewing a report of a client's routine urinalysis. Which value requires
further investigation?
Answer: Urine pH of 3.0
Explanation: Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal and
requires further investigation. Urine specific gravity normally ranges from 1.010 to 1.025,
making this client's value normal. Normally, urine contains no protein, glucose, ketones,
bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power
field; white blood cells, 0 to 4 per high-power field. Urine should be clear, with color ranging
from pale yellow to deep amber. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 241.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 241
Question 4: The nurse is caring for a patient with hypernatremia. What complication of
hypernatremia should the nurse continuously monitor for?
Answer: Cerebral edema
Explanation: Treatment of hypernatremia consists of a gradual lowering of the serum
sodium level by the infusion of a hypotonic electrolyte solution (e.g., 0.3% sodium chloride)
or an isotonic nonsaline solution (e.g., dextrose 5% in water [D5W]). D5W is indicated when
water needs to be replaced without sodium. Clinicians consider a hypotonic sodium solution
to be safer than D5W because it allows a gradual reduction in the serum sodium level,
thereby decreasing the risk of cerebral edema. It is the solution of choice in severe
hyperglycemia with hypernatremia. A rapid reduction in the serum sodium level temporarily
decreases the plasma osmolality below that of the fluid in the brain tissue, causing dangerous
cerebral edema. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 254.

Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 254
Question 5: The nurse is analyzing the arterial blood gas (AGB) results of a patient diagnosed
with severe pneumonia. Which of the following ABG results indicates respiratory acidosis?
Answer: pH: 7.20, PaCO2: 65 mm Hg, HCO3–: 26 mEq/L
Explanation: Respiratory acidosis is a clinical disorder in which the pH is less than 7.35 and
the PaCO2 is greater than 42 mm Hg and a compensatory increase in the plasma HCO3–
occurs. It may be either acute or chronic. The ABG of pH: 7.32, PaCO2: 40 mm Hg, HCO3–:
18 mEq/L indicates metabolic acidosis. The ABGs of pH: 7.50, PaCO2: 30 mm Hg, and
HCO3–: 24 mEq/L indicate respiratory alkalosis. The ABGs of pH 7.42, PaCO2: 45 mm Hg,
and HCO3–: 22 mEq/L indicate a normal result/no imbalance. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed., Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 269.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 269
Question 6: A client was admitted to your unit with a diagnosis of hypovolemia. When it is
time to complete discharge teaching, which of the following will the nurse teach the client
and his family? Select all that apply.
Answer: • Drink at least eight glasses of fluid each day.
• Drink water as an inexpensive way to meet fluid needs.
• Respond to thirst
Explanation: In addition, the nurse teaches clients who have a potential for hypovolemia and
their families to respond to thirst because it is an early indication of reduced fluid volume;
consu ... (more)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, pp. 245, 247, 249.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 245
Question 7: Which of the following electrolytes is a major cation in body fluid?
Answer: Potassium
Explanation: Potassium is a major cation that affects cardiac muscle functioning. Chloride is
an anion. Bicarbonate is an anion. Phosphate is an anion.

Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 238
Question 8: A patient is ordered to receive hypotonic IV solution to provide free water
replacement. Which of the following solutions will the nurse anticipate administering?
Answer: 0.45% NaCl
Explanation: Half-strength saline (0.45%) is hypotonic. Hypotonic solutions are used to
replace cellular fluid because it is hypotonic compared with plasma. Another is to provide
free water to excrete body wastes. At times, hypotonic sodium solutions are used to treat
hypernatremia and other hyperosmolar 3 conditions. Lactated Ringer’s solution and normal
saline (0.9% NaCl) are isotonic. A solution that is 5% NaCl is hypertonic. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed., Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 273.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 273
Question 9: To confirm an acid–base imbalance, it is necessary to assess which of the
following findings from the results of a client’s arterial blood gas (ABG) results? Select all
that apply.
Answer: • PaCO2
• HCO3
• pH
Explanation: Arterial blood gas (ABG) results are the main tool for measuring blood pH,
CO2 content (PaCO2), and bicarbonate (HCO3). The two types of acid–base imbalances are
acidosis and alkalosis. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 267.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 267
Question 10: A client in the emergency department reports that he has been vomiting
excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial
pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen

(PaO2) of 75 mm Hg, and bicarbonate (HCO3–) of 42 mEq/L. Based on these findings, the
nurse documents that the client is experiencing which type of acid-base imbalance?
Answer: Metabolic alkalosis
Explanation: A pH over 7.45 with a HCO – level over 26 mEq/L indicates metabolic
alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by
decreased amounts of acid or increased amounts of base HCO3–. The client isn't experiencing
respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or
metabolic acidosis because the pH is greater than 7.35. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 269.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 269
Question 11: Which of the following arterial blood gas results would be consistent with
metabolic alkalosis?
Answer: Serum bicarbonate of 28 mEq/L
Explanation: Evaluation of arterial blood gases reveals a pH greater than 7.45 and a serum
bicarbonate concentration greater than 26 mEq/L.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 269.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 269
Question 12: Which of the following is a correct route of administration for potassium?
Answer: Oral
Explanation: Potassium may be administered through the oral route. Potassium is never
administered by IV push or intramuscularly to avoid replacing potassium too quickly.
Potassium is not administered subcutaneously. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 257.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 257
Question 13: Which of the following solutions is hypotonic?

Answer: 0.45% NaCl
Explanation: Half-strength saline is hypotonic. Lactated Ringer's solution is isotonic.
Normal saline (0.9% NaCl) is isotonic. A solution that is 5% NaCl is hypertonic.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 248.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 248
Question 14: Early signs of hypervolemia include
Answer: increased breathing effort and weight gain
Explanation: Early signs of hypervolemia are weight gain, elevated blood pressure, and
increased breathing effort. Eventually, fluid congestion in the lungs leads to moist breath
sounds. An earliest symptom of hypovolemia is thirst. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 249.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 249
Question 15: The nurse is caring for four clients on a medical unit. The nurse is most correct
to review which client’s laboratory reports first for an electrolyte imbalance?
Answer: A 52-year-old with diarrhea
Explanation: Electrolytes are in both intracellular and extracellular water. Electrolyte
deficiency occurs from an inadequate intake of food, conditions that deplete water such as
nausea and vomiting, or disease processes that cause an excess of electrolyte amounts. The
52-year-old with diarrhea would be the client most likely to have an electrolyte imbalance.
The orthopedic patients will not likely have an electrolyte imbalance. Myocardial infarction
patients will occasionally have electrolyte imbalance, but this is the exception rather than the
rule. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 245.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 245

Question 16: A client admitted with acute anxiety has the following arterial blood gas 3
(ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial
pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO–), 24 mEq/L.
Based on these values, the nurse suspects:
Answer: respiratory alkalosis.
Explanation: This client's above-normal pH value indicates alkalosis. The below-normal
PaCO2 value indicates acid loss via hyperventilation; this type of acid loss occurs only in
respiratory alkalosis. These ABG values wouldn't occur in metabolic acidosis, respiratory
acidosis, or metabolic alkalosis. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 270.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 270
Question 17: A patient is diagnosed with hypocalcemia. The nurse advises the patient and his
family to immediately report the most characteristic manifestation. What is the most
characteristic manifestation?
Answer: Tingling or twitching sensation in the fingers
Explanation: All the choices are signs and symptoms of hypocalcemia, but tetany is the most
characteristic manifestation that occurs when the calcium level is less than 4.4 mg/dL.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 259.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 259
Question 18: A 73-year-old male client was admitted to your hospital unit after 2days of
vomiting and diarrhea. His wife became alarmed when he demonstrated confusion and
elevated temperature and reported “dry mouth.” You suspect the client is experiencing which
of the following conditions?
Answer: Dehydration
Explanation: Dehydration results when the volume of body fluid is significantly reduced in
both extracellular and intracellular compartments. In dehydration, all fluid compartments
have decreased volumes; in hypovolemia, only blood volume is low. The most common fluid
imbalance in older adults is dehydration. Hypervolemia is caused by fluid intake that exceeds

fluid loss, such as from excessive oral intake or rapid IV infusion of fluid. Early signs of
hypervolemia are weight gain, elevated BP, and increased breathing effort. Hypercalcemia
occurs when the serum calcium level is higher than normal. Some of its signs include tingling
in the extremities and the area around the mouth (circumoral paresthesia) and muscle and
abdominal cramps. Hyperkalemia is an excess of potassium in the blood. Symptoms include
diarrhea, nausea, muscle weakness, paresthesias, and cardiac dysrhythmias. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 244.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 244
Question 19: Upon shift report, the nurse states the following laboratory values: pH, 7.44;
PCO2, 30mmHg; and HCO3,21 mEq/L for a client with noted acid–base disturbances. Which
acid–base imbalance do both nurses agree is the client’s current state?
Answer: Compensated respiratory alkalosis
Explanation: The question states that the client has a history of acid–base disturbance. The
nurse would first note that the pH has returned to close to normal indicating compensation.
The nurse then assess the PCO2 (normal: 35 to 45 mm Hg) and HCO3 (normal: 22 to
27mEq/L) levels. In a respiratory condition, the pH and the PCO2 move in opposite direction;
thus, the pH rises and the PCO2 drops (alkalosis) or vice versa (acidosis). In a metabolic
condition, the pH and the bicarbonate move in the same direction; if the pH is low, the
bicarbonate level will be low, also. In this client, the pH is at the high end of normal,
indicating compensation and alkalosis. The PCO2 is low, indicating a respiratory condition
(opposite direction of the pH). (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, pp. 271-272.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 271
Question 20: When evaluating arterial blood gases (ABGs), which value is consistent with
metabolic alkalosis?
Answer: pH 7.48

Explanation: Metabolic alkalosis is a clinical disturbance characterized by a high pH and
high plasma bicarbonate concentration. The HCO value is below normal. The PaCO value
and the oxygen saturation level are within a normal range. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 269.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 269
Question 1: The nurse is caring for a patient with a serum sodium level of 113 mEq/L. The
nurse should monitor the patient for the development of which of the following?
Answer: Confusion
Explanation: Normal serum concentration level ranges from 135 to 145 mEq/L.
Hyponatremia exists when the serum level decreases below 135 mEq/L, there is. When the
serum sodium level decreases to less than 115 mEq/L (115 mmol/L), signs of increasing
intracranial pressure, such as lethargy, confusion, muscle twitching, focal weakness,
hemiparesis, papilledema, seizures, and death, may occur. General manifestations of
hyponatremia include poor skin turgor, dry mucosa, headache, decreased saliva production,
orthostatic fall in blood pressure, nausea, vomiting, and abdominal cramping. Neurologic
changes, including altered mental status, status epilepticus, and coma, are probably related to
cellular swelling and cerebral edema associated with hyponatremia. Hallucinations are
associated with increased serum sodium levels. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed., Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 251.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 251
Question 2: A nurse is caring for a client with metastatic breast cancer who is extremely
lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium
level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101
mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse
determines that the client's symptoms are most likely associated with which electrolyte
imbalance?
Answer: Hypercalcemia

Explanation: The normal reference range for serum calcium is 9 to 11 mg/dl. A serum
calcium level of 12 mg/dl clearly indicates hypercalcemia. The client's other laboratory
findings are within their normal ranges, so the client doesn't have hypernatremia,
hypochloremia, or hypokalemia. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 260.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 260
Question 3: When evaluating arterial blood gases (ABGs), which value is consistent with
metabolic alkalosis?
Answer: pH 7.48
Explanation: Metabolic alkalosis is a clinical disturbance characterized by a high pH and
high plasma bicarbonate concentration. The HCO value is below normal. The PaCO value
and the oxygen saturation level are within a normal range. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 269.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 269
Question 4: A 77-year-old retired male client visits your general practice office twice monthly
to maintain control of his congestive heart failure. He measures his weight daily and phones it
to your office for his medical record. In a 24-hour period, how much fluid is this client
retaining if his weight increases by 2 lb?
Answer: 1 L
Explanation: A 2-lb weight gain in 24 hours indicates that the client is retaining 1L of fluid.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 247.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 247
Question 5: With which condition should the nurse expect that a decrease in serum osmolality
will occur?
Answer: Kidney failure

Explanation: Failure of the kidneys results in multiple fluid and electrolyte abnormalities.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 242.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 242
Question 6: Early signs of hypervolemia include
Answer: increased breathing effort and weight gain
Explanation: Early signs of hypervolemia are weight gain, elevated blood pressure, and
increased breathing effort. Eventually, fluid congestion in the lungs leads to moist breath
sounds. An earliest symptom of hypovolemia is thirst. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 249.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 249
Question 7: A nurse is reviewing a report of a client's routine urinalysis. Which value requires
further investigation?
Answer: Urine pH of 3.0
Explanation: Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal and
requires further investigation. Urine specific gravity normally ranges from 1.010 to 1.025,
making this client's value normal. Normally, urine contains no protein, glucose, ketones,
bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power
field; white blood cells, 0 to 4 per high-power field. Urine should be clear, with color ranging
from pale yellow to deep amber. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 241.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 241
Question 8: Which of the following solutions is hypotonic?
Answer: 0.45% NaCl
Explanation: Half-strength saline is hypotonic. Lactated Ringer's solution is isotonic.
Normal saline (0.9% NaCl) is isotonic. A solution that is 5% NaCl is hypertonic.

Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 248.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 248
Question 9: What foods can the nurse recommend for the patient with hypokalemia?
Answer: Fruits such as bananas and apricots
Explanation: Sources of potassium include fruit juices and bananas, melon, citrus fruits,
fresh and frozen vegetables, lean meats, milk, and whole grains (Crawford & Harris, 2011b).
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 256.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 256
Question 10: A patient with severe hypervolemia is prescribed a loop diuretic. The nurse
knows that this drug can cause a significant loss of sodium and has to be carefully monitored.
Which of the following drugs is most likely the one that was prescribed?
Answer: Lasix
Explanation: Lasix is the only loop diuretic choice. The other choices are thiazide diuretics
that block sodium reabsorption.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 249.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 249
Question 11: A patient is ordered to receive hypotonic IV solution to provide free water
replacement. Which of the following solutions will the nurse anticipate administering?
Answer: 0.45% NaCl
Explanation: Half-strength saline (0.45%) is hypotonic. Hypotonic solutions are used to
replace cellular fluid because it is hypotonic compared with plasma. Another is to provide
free water to excrete body wastes. At times, hypotonic sodium solutions are used to treat
hypernatremia and other hyperosmolar conditions. Lactated Ringer’s solution and normal
saline (0.9% NaCl) are isotonic. A solution that is 5% NaCl is hypertonic. (less)

Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed., Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 273.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 273
Question 12: Which of the following is a function of calcitonin? Select all that apply.
Answer: • Increases deposition of calcium in bones
• Increases urinary excretion of calcium
• Reduces bone resorption
Explanation: Calcitonin reduces bones resorption, increasing deposition of calcium and
phosphorous in the bones, and increases urinary excretion of calcium and phosphate.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 261.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 261
Question 13: The physician has prescribed a hypotonic IV solution for a patient. Which IV
solution should the nurse administer?
Answer: 0.45% sodium chloride
Explanation: Half-strength saline (0.45% sodium chloride) solution is frequently used as an
IV hypotonic solution.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 273.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 273
Question 14: Which of the following is a correct route of administration for potassium?
Answer: Oral
Explanation: Potassium may be administered through the oral route. Potassium is never
administered by IV push or intramuscularly to avoid replacing potassium too quickly.
Potassium is not administered subcutaneously. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 257.

Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 257
Question 15: Which of the following arterial blood gas results would be consistent with
metabolic alkalosis?
Answer: Serum bicarbonate of 28 mEq/L
Explanation: Evaluation of arterial blood gases reveals a pH greater than 7.45 and a serum
bicarbonate concentration greater than 26 mEq/L.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 269.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 269
Question 16: A client was admitted to your unit with a diagnosis of hypovolemia. When it is
time to complete discharge teaching, which of the following will the nurse teach the client
and his family? Select all that apply.
Answer: • Respond to thirst
• Drink at least eight glasses of fluid each day.
• Drink water as an inexpensive way to meet fluid needs.
Explanation: In addition, the nurse teaches clients who have a potential for hypovolemia and
their families to respond to thirst because it is an early indication of reduced fluid volume;
consume at least 8 to 10 (8 ounce) glasses of fluid each day and more during hot, humid
weather; drink water as an 3 inexpensive means to meet fluid requirements; and avoid
beverages with alcohol and caffeine because they increase urination and contribute to fluid
deficits. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, pp. 245, 247, 249.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 245
Question 17: A patient’s serum sodium concentration is within the normal range. What should
the nurse estimate the serum osmolality to be?
Answer: 275–300 mOsm/kg
Explanation: In healthy adults, normal serum osmolality is 270 to 300 mOsm/kg (Crawford
& Harris, 2011c).

Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 241.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 241
Question 18: A client admitted with acute anxiety has the following arterial blood gas (ABG)
values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of
arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO–), 24 mEq/L. Based on
these values, the nurse suspects:
Answer: respiratory alkalosis.
Explanation: This client's above-normal pH value indicates alkalosis. The below-normal
PaCO2 value indicates acid loss via hyperventilation; this type of acid loss occurs only in
respiratory alkalosis. These ABG values wouldn't occur in metabolic acidosis, respiratory
acidosis, or metabolic alkalosis. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 270.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 270
Question 19: The nurse is reviewing lab work on a newly admitted client. Which of the
following diagnostic studies confirm the nursing diagnosis of Deficient Fluid Volume? Select
all that apply.
Answer: • Electrolyte imbalance
• An elevated hematocrit level
Explanation: Dehydration is a common primary or secondary diagnosis in health care. An
elevated hematocrit level reflects low fluid level and a hemo-concentration. Electrolytes are
in an imbalance as sodium and potassium levels are excreted together in client with
dehydration. The urine specific gravity, due to concentrated particle level, is high. Protein is
not a common sign of dehydration. Ketones are always present in the urine. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, pp. 241, 251.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 241

Question 20: The nurse is caring for four clients on a medical unit. The nurse is most correct
to review which client’s laboratory reports first for an electrolyte imbalance?
Answer: A 52-year-old with diarrhea
Explanation: Electrolytes are in both intracellular and extracellular water. Electrolyte
deficiency occurs from an inadequate intake of food, conditions that deplete water such as
nausea and vomiting, or disease processes that cause an excess of electrolyte amounts. The
52-year-old with diarrhea would be the client most likely to have an electrolyte imbalance.
The orthopedic patients will not likely have an electrolyte imbalance. Myocardial infarction
patients will occasionally have electrolyte imbalance, but this is the exception rather than the
rule. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 245.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 245
Question 1: A nurse can estimate serum osmolality at the bedside by using a formula. A
patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of:
Answer: 280 mOsm/kg. Correct 3
Explanation: Serum osmolality can be estimated by doubling the serum sodium or using the
formula: Na × 2 = glucose/18 + BUN/3. Therefore, the nurse could estimate a serum
osmolality of 280 mOsm/kg by doubling the serum sodium value of 140 mEq/L. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 241.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 241
Question 2: A client has the following arterial blood gas (ABG) values: pH, 7.12; partial
pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3–), 15 mEq/L.
These ABG values suggest which disorder?
Answer: Metabolic acidosis
Explanation: This client's pH value is below normal, indicating acidosis. The HCO – value
also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of
base, which suggests metabolic acidosis. The PaCO2 value is normal, indicating absence of

respiratory compensation. These ABG values eliminate respiratory alkalosis, respiratory
acidosis, and metabolic alkalosis. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 268.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 268
Question 3: Which medication does the nurse anticipate administering to antagonize the
effects of potassium on the heart for a patient in severe metabolic acidosis?
Answer: Sodium bicarbonate
Explanation: IV administration of sodium bicarbonate may be necessary in severe metabolic
acidosis to alkalinize the plasma, shift potassium into the cells, and furnish sodium to
antagonize the cardiac effects of potassium (Crawford & Harris, 2011b). (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 258.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 258
Question 4: Which of the following would be a potential cause of respiratory acidosis?
Answer: Hypoventilation
Explanation: Respiratory acidosis is always due to inadequate excretion of CO, with
inadequate ventilation, resulting in elevated plasma CO concentration, which causes
increased levels of carbonic acid. In addition to an elevated PaCO, hypoventilation usually
causes a decrease in PaO. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 270.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 270
Question 5: A client with emphysema is at a greater risk for developing which of the
following acid–base imbalances?
Answer: Chronic respiratory acidosis
Explanation: Respiratory acidosis, which may be either acute or chronic, is caused by excess
carbonic acid, which causes the blood pH to drop below 7.35. Chronic respiratory acidosis is

associated with disorders such as emphysema, bronchiectasis, bronchial asthma, and cystic
fibrosis. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 270.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 270
Question 6: You are caring for a client who has been admitted with a possible clotting
disorder. The client is complaining of excessive bleeding and bruising without cause. You
know that you should take extra care to check for signs of bruising or bleeding in what
condition?
Answer: Hypocalcemia
Explanation: Hypocalcemia or low serum calcium levels can affect clotting. Therefore, in
this condition, the nurse should take extra care to check for bruising or bleeding. There is no
such risk in dehydration, hypokalemia, or hypomagnesemia. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 259.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 259
Question 7: Which findings indicate that a client has developed water intoxication secondary
to treatment for diabetes insipidus?
Answer: Confusion and seizures
Explanation: Classic signs of water intoxication include confusion and seizures, both of
which are caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and
increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are
unrelated to water intoxication. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 246.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 246
Question 8: What foods can the nurse recommend for the patient with hypokalemia?
Answer: Fruits such as bananas and apricots

Explanation: Sources of potassium include fruit juices and bananas, melon, citrus fruits,
fresh and frozen vegetables, lean meats, milk, and whole grains (Crawford & Harris, 2011b).
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 256.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 256
Question 9: It is important for a nurse to know how to calculate the corrected serum calcium
level for a patient when hypocalcemia is seen along with low serum albumin levels. Calculate
the corrected serum calcium when the serum calcium is 9 mg/dL and the serum albumin is 3
g/dL.
Answer: 9.8 mg/dL
Explanation: To calculate corrected serum calcium, subtract the normal serum albumin level
of 4 g/dL from the reported albumin level of 3 g/dL, multiply that value (1) by 0.8 (constant
factor) and then add that result (0.8 mg) to the reported serum level of 9 mg/dL. Therefore, 9
+ 0.8 = 9.8 mg/dL (corrected value). Note: a constant factor of 0.8 is used because, for every
decrease in serum albumin of 1 g/dL below 4 g/dL, the total serum calcium level is
underestimated by 0.8 mg/dL. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 260.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 260
Question 10: A nurse is caring for an adult client with numerous draining wounds from
gunshots. The client's pulse rate has increased from 100 to 130 beats per minute over the last
hour. The nurse should further assess the client for which of the following?
Answer: Extracellular fluid volume deficit
Explanation: Fluid volume deficit (FVD) occurs when the loss extracellular fluid (ECF)
volume exceeds the intake of fluid. FVD results from loss of body fluids and occurs more
rapidly when coupled with decreaesd fluid intake. A cause of this loss is hemorrhage. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 245.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 245

Question 11: Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as
indicated by:
Answer: muscle weakness.
Explanation: Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands,
feet, tongue, and face are findings associated with hyperkalemia, which is transient and
results from transient hypoaldosteronism when the adenoma is removed. Tremors,
diaphoresis, and constipation aren't seen in hyperkalemia. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 246.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 246
Question 12: A nurse is caring for a client admitted with a diagnosis of exacerbation of
myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely
depressed respirations. The nurse would expect to identify which acid-base disturbance?
Answer: Respiratory acidosis
Explanation: Respiratory acidosis is always from inadequate excretion of CO2 with
inadequate ventilation, resulting in elevated plasma CO2 concentrations. Respiratory acidosis
can occur in diseases that impair respiratory muscles such as myasthenia gravis. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 270.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 270
Question 13: The emergency department (ED) nurse is caring for a client with a possible
acid–base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of
the most important indications of an acid–base imbalance that is shown in an ABG?
Answer: Bicarbonate
Explanation: Arterial blood gas (ABG) results are the main tool for measuring blood pH,
CO2 content (PaCO2), and bicarbonate. An acid–base imbalance may accompany a fluid and
electrolyte imbalance. PaO2 and PO2 are not indications of acid–base imbalance. Carbonic
acid levels are not shown in an ABG. (less)

Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 268.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 268
Question 14: Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly
reviews the client's medical history. Which condition is a predisposing factor for respiratory
alkalosis?
Answer: Extreme anxiety
Explanation: Extreme anxiety may lead to respiratory alkalosis by causing hyperventilation,
which results in excessive carbon dioxide (CO2) loss. Other conditions that may set the stage
for respiratory alkalosis include fever, heart failure, injury to the brain's respiratory center,
overventilation with a mechanical ventilator, pulmonary embolism, and early salicylate
intoxication. Type 1 diabetes may lead to diabetic ketoacidosis; the deep, rapid respirations
occurring in this disorder (Kussmaul's respirations) don't cause excessive CO2 loss.
Myasthenia gravis and opioid overdose suppress the respiratory drive, causing CO2 retention,
not CO2 loss; this may lead to respiratory acidosis, not alkalosis. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 270.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 270
Question 15: With which condition should the nurse expect that a decrease in serum
osmolality will occur?
Answer: Kidney failure
Explanation: Failure of the kidneys results in multiple fluid and electrolyte abnormalities.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 242.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 242
Question 16: A client presents with fatigue, nausea, vomiting, muscle weakness, and leg
cramps. Laboratory values are as follows:
• Na + 147 mEq/L

• K + 3.0 mEq/L
• Cl - 112 mEq/L
• Mg ++ 2.3 mg/dL
• Ca ++ 1.5 mg/dL
Which of the following is consistent with the client's findings?
Answer: Hypokalemia
Explanation: Potassium is the major intracellular electrolyte. Hypocalemia (below 3.5
mEq/L) usually indicates a deficit in total potassium stores. Potassium deficiency can result
in derangements in physiology. Clinical signs include fatigue, anorexia, nausea, vomiting,
muscles weakness, leg cramps, decreased bowel motility, and paresthesias. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 255.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 255
Question 17: The nurse is caring for a client in heart failure with signs of hypervolemia.
Which vital sign is indicative of the disease process?
Answer: Elevated blood pressure
Explanation: Indicative of hypervolemia is a bounding pulse and elevated blood pressure
due to the excess volume in the system. Respirations are not typically affected unless there is
fluid accumulation in the lungs. Temperature is not generally affected. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 246.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 246
Question 18: A client is diagnosed with syndrome of inappropriate antidiuretic hormone
(SIADH). The nurse should anticipate which laboratory test result?
Answer: Serum sodium level of 124 mEq/L
Explanation: In SIADH, the posterior pituitary gland produces excess antidiuretic hormone
(vasopressin), which decreases water excretion by the kidneys. This, in turn, reduces the
serum sodium level, causing hyponatremia, as indicated by a serum sodium level of 124
mEq/L. In SIADH, the serum creatinine level isn't affected by the client's fluid status and

remains within normal limits. A hematocrit of 52% and a BUN level of 8.6 mg/dl are
elevated. Typically, the hematocrit and BUN level decrease. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 251.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 251
Question 19: A patient with a magnesium level of 2.6 mEq/L is being treated on a medicalsurgical unit. Which of the following treatments should the nurse anticipate will be used?
Answer: IV furosemide (Lasix)
Explanation: The nurse should anticipate the administration of Lasix for the treatment of
hypermagnesemia. Administration of loop diuretics (e.g., furosemide) and sodium chloride or
lactated Ringer’s IV solution enhances magnesium excretion in patients with adequate renal
function. Fluid restriction is contraindicated. The patient should be encouraged to increase
fluids to promote the excretion magnesium by way of the urine. MagOx is contraindicated as
it would further elevate the patient’s serum magnesium level. In acute emergencies, when the
magnesium level is severely elevated, hemodialysis with a magnesium-free dialysate can
reduce the serum magnesium to a safe level within hours. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed., Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 264.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 264
Question 20: Which intervention is most appropriate for a client with an arterial blood gas
(ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO 2) of 26 mm Hg, oxygen
(O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg?
Answer: Instruct the client to breathe into a paper bag.
Explanation: The ABG results reveal respiratory alkalosis. The best intervention to raise the
PaCO2 level would be to have the client breathe into a paper bag. Administering a
decongestant, offering fluids frequently, and administering supplemental oxygen wouldn't
raise the lowered PaCO2 level. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 271.

Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 271
Question 1: A 160-pound patient, diagnosed with hypovolemia, is weighed every day. The
health care provider asked to be notified if the patient loses 1,000 mL of fluid in 24 hours.
Choose the weight that would be consistent with this amount of fluid loss.
Answer: 158 lbs
Explanation: A loss of 0.5 kg or 1 lb represents a fluid loss of about 500 mL. Therefore, a
loss of 1,000 mL would be equivalent to the loss of 2 lbs (160 – 2 = 158 lbs).
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 247.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 247
Question 2: A client has a respiratory rate of 38 breaths/min. What effect does breathing
faster have on arterial pH level?
Answer: Increases arterial pH
Explanation: Respiratory alkalosis is always caused by hyperventilation, which is a decrease
in plasma carbonic acid concentration. The pH is elevated above normal as a result of a low
PaCO2. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, pp. 270-271.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 270
Question 3: A client with respiratory acidosis is admitted to the intensive care unit for close
observation. The nurse should stay alert for which complication associated with respiratory
acidosis?
Answer: Shock
Explanation: Complications of respiratory acidosis include shock and cardiac arrest. Stroke
and hyperglycemia aren't associated with respiratory acidosis. Seizures may complicate
respiratory alkalosis, not respiratory acidosis. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 270.

Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 270
Question 4: A physician orders an isotonic I.V. solution for a client. Which solution should
the nurse plan to administer?
Answer: Lactated Ringer's solution
Explanation: Lactated Ringer's solution, with an osmolality of approximately 273 mOsm/L,
is isotonic. The nurse shouldn't give half-normal saline solution because it's hypotonic, with
an osmolality of 154 mOsm/L. Giving 5% dextrose and normal saline solution (with an
osmolality of 559 mOsm/L) or 10% dextrose in water (with an osmolality of 505 mOsm/L)
also would be incorrect because these solutions are hypertonic. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 248, 273.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 248
Question 5: Upon shift report, the nurse states the following laboratory values: pH, 7.44;
PCO2, 30mmHg; and HCO3,21 mEq/L for a client with noted acid–base disturbances. Which
acid–base imbalance do both nurses agree is the client’s current state?
Answer: Compensated respiratory alkalosis
Explanation: The question states that the client has a history of acid–base disturbance. The
nurse would first note that the pH has returned to close to normal indicating compensation.
The nurse then assess the PCO2 (normal: 35 to 45 mm Hg) and HCO3 (normal: 22 to
27mEq/L) levels. In a respiratory condition, the pH and the PCO2 move in opposite direction;
thus, the pH rises and the PCO2 drops (alkalosis) or vice versa (acidosis). In a metabolic
condition, the pH and the bicarbonate move in the same direction; if the pH is low, the
bicarbonate level will be low, also. In this client, the pH is at the high end of normal,
indicating compensation and alkalosis. The PCO2 is low, indicating a respiratory condition
(opposite direction of the pH). (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, pp. 271-272.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 271
Question 6: Oncotic pressure refers to the

Answer: osmotic pressure exerted by proteins.
Explanation: Oncotic pressure is a pulling pressure exerted by proteins, such as albumin.
Osmolality refers to the number of dissolved particles contained in a unit of fluid. Osmotic
diuresis occurs when the urine output increases due to excretion of substances such as
glucose. Osmotic pressure is the amount of pressure needed to stop the flow of water by
osmosis. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 239.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 239
Question 7: The nurse is assessing residents at a summer picnic at the nursing facility. The
nurse expresses concern due to the high heat and humidity of the day. Although the facility is
offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned
about which?
Answer: Insensible fluid loss
Explanation: Due to the high heat and humidity, geriatric clients are at a high risk for
insensible fluid loss through perspiration and vapor in the exhaled air. These losses are noted
as unnoticeable and unmeasurable. Those with respiratory deficits and allergies may be only
able to be outside for a limited period. Those with cardiovascular compromise may need to
alternate outdoor activities with indoor rest. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, pp. 239-240.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 239
Question 8: Treatment of FVE involves dietary restriction of sodium. Which of the following
food choices would be part of a low-sodium diet, mild restriction (2 to 3 g/day)?
Answer: Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad
Explanation: Ham (1,400 mg Na for 3 oz) and bacon (155 mg Na/slice) are high in sodium
as is tomato juice (660 mg Na/¾ cup) and low fat cottage cheese (918 mg Na/cup). Packaged
meals are high in sodium. (less)

Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 250.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 250
Question 9: Which of the following electrolyte imbalances occur with adrenal insufficiency?
Answer: Hyperkalemia
Explanation: Hyperkalemia occurs with adrenal insufficiency. Hypokalemia occurs with
gastrointestinal and renal losses. Hyponatremia occurs with increased thirst and antidiuretic
hormone (ADH) release. Hypernatremia results from increased insensible losses and diabetes
insipidus. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 245.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 245
Question 10: The nurse is conducting a lecture on the difference between hypovolemia and
dehydration. When completing a verbal comparison, which point needs clarified?
Answer: In dehydration, only extracellular is depleted.
Explanation: In clients diagnosed with dehydration, all fluid compartments including the
intracellular and extracellular compartment are reduced. The other options are correct. Both
states can be from similar disease process such as vomiting, fever, diarrhea and difficulty
swallowing and also have abnormal lab work. It is correct that hypovolemia relates to low
blood volume. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 245.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 245
Question 11: Which of the following may occur with respiratory acidosis?
Answer: Increased intracranial pressure (ICP)
Explanation: If respiratory acidosis is severe, intracranial pressure may increase, resulting in
papilledema and dilated conjunctival blood vessels. Increased blood pressure, increased
pulse, and decreased mental alertness occur with respiratory acidosis. (less)

Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 270.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 270
Question 12: In which of the following medical conditions would administering IV normal
saline solution be inappropriate? Select all that apply.
Answer: • Renal impairment
• Heart failure
• Pulmonary edema
Explanation: Normal saline is not used for heart failure, pulmonary edema, renal
impairment, or sodium retention. It is used with administration of blood transfusions and to
replace large sodium losses, as in burn injuries. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 273.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 273
Question 13: The nurse is assigned to care for a patient with a serum phosphorus level of 5.0
mg/dL. The nurse anticipates that the patient will also experience which of the following
electrolyte imbalances?
Answer: Hypocalcemia
Explanation: The patient is experiencing an elevated serum phosphorus level.
Hyperphosphatemia is defined as a serum phosphorus level that exceeds 4.5 mg/dL (1.45
mmol/L). Because of the reciprocal relationship between phosphorus and calcium, a high
serum phosphorus level tends to cause a low serum calcium concentration. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed., Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 265.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 265
Question 14: A patient is being treated in the ICU 24 hours after having a radical neck
dissection completed. The patient’s serum calcium level is 7.6 mg/dL. Which of the following
physical examination findings is consistent with this electrolyte imbalance?

Answer: Presence of Trousseau’s sign
Explanation: A patient status post radical neck resection is prone to developing
hypocalcemia. Hypocalcemia is defined as a serum values lower than 8.6 mg/dL [2.15
mmol/L]. Signs and symptoms of hypocalcemia include: Chvostek’s sign, which consists of
muscle twitching enervated by the facial nerve when the region that is about 2 cm anterior to
the earlobe, just below the zygomatic arch, is tapped, and a positive Trousseau’s sign can be
elicited by inflating a blood pressure cuff on the upper arm to about 20 mm Hg above systolic
pressure; within 2 to 5 minutes, carpal spasm (an adducted thumb, flexed wrist and
metacarpophalangeal joints, and extended interphalangeal joints with fingers together) will
occur as ischemia of the ulnar nerve develops. Slurred speech and muscle weakness are signs
of hypercalcemia. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed., Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 259.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 259
Question 15: A 75-year-old client who complains of an “acid stomach” has been taking
baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at
risk for which of the following acid–base imbalances?
Answer: Metabolic alkalosis
Explanation: Metabolic alkalosis results in increased plasma pH because of accumulated
base bicarbonate or decreased hydrogen ion concentrations. The client’s regular use of baking
soda (sodium bicarbonate) may place him at risk for this condition. Metabolic acidosis refers
to decreased plasma pH because of increased organic acids (acids other than carbonic acid) or
decreased bicarbonate. Respiratory acidosis, which may be either acute or chronic, is caused
by excess carbonic acid. Respiratory alkalosis results from a carbonic acid deficit that occurs
when rapid breathing releases more CO2 than necessary with expired air. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 266.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 266 3

Question 16: A febrile patient's fluid output is in excess of normal because of diaphoresis.
The nurse should plan fluid replacement based on the knowledge that insensible losses in an
afebrile person are normally not greater than:
Answer: 600 mL/24h.
Explanation: Continuous water loss by evaporation (approximately 600 mL/day) occurs
through the skin as insensible perspiration, a non-visible form of water loss.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 240.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 240
Question 17: A client in the emergency department reports that he has been vomiting
excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial
pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen
(PaO2) of 75 mm Hg, and bicarbonate (HCO3–) of 42 mEq/L. Based on these findings, the
nurse documents that the client is experiencing which type of acid-base imbalance?
Answer: Metabolic alkalosis
Explanation: A pH over 7.45 with a HCO – level over 26 mEq/L indicates metabolic
alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by
decreased amounts of acid or increased amounts of base HCO3–. The client isn't experiencing
respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or
metabolic acidosis because the pH is greater than 7.35. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 269.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 269
Question 18: A client has been diagnosed with an intestinal obstruction and has a nasogastric
tube set to low continuous suction. Which acid-base disturbance is this client at risk for
developing?
Answer: Metabolic alkalosis
Explanation: Metabolic alkalosis is a clinical disturbance characterized by a high pH and a
high plasma biacarbonate concentration. The most common cuase of metabolic alkalosis is

vomiting or gastric suction with loss of hydrogen and choloride ions. Gastric fluid has an acid
pH, and loss of this acidic fluid increases the alkalinity of body fluids. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 269.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 269
Question 19: Which of the following is considered an isotonic solution?
Answer: 0.9% normal saline
Explanation: An isotonic solution is 0.9% normal saline (NaCl). Dextran in NS is a colloid
solution, 0.45% normal saline is a hypotonic solution, and 3% NaCl is a hypertonic solution.
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 273.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 273
Question 20: The nurse is caring for a patient with diabetes type I who is having severe
vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low
plasma bicarbonate concentration should the nurse assess for?
Answer: Metabolic acidosis
Explanation: Metabolic acidosis is a common clinical disturbance characterized by a low pH
(increased H+ concentration) and a low plasma bicarbonate concentration. Metabolic
alkalosis is a clinical disturbance characterized by a high pH (decreased H+ concentration)
and a high plasma bicarbonate concentration. Respiratory acidosis is a clinical disorder in
which the pH is less than 7.35 and the PaCO2 is greater than 42 mm Hg and a compensatory
increase in the plasma HCO3 occurs. Respiratory alkalosis is a clinical condition in which the
arterial pH is greater than 7.45 and the PaCO2 is less than 38 mm Hg. (less)
Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of MedicalSurgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 13:
Fluid and Electrolytes: Balance and Disturbance, p. 268.
Chapter 13: Fluid and Electrolytes: Balance and Disturbance - Page 268