Chapter 04: Fluids and Electrolytes, Acids and Bases(FREE) My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 04: Fluids and Electrolytes, Acids and Bases

Test Bank

MULTIPLE CHOICE

1. A nurse is reviewing lab reports. The nurse recalls blood plasma is located in which of the following fluid compartments?

a.

Intracellular fluid (ICF)

b.

Extracellular fluid (ECF)

c.

Interstitial fluid

d.

Intravascular fluid

ANS: D

Blood plasma is the intravascular fluid.

ICF is fluid in the cells.

ECF is all the fluid outside the cells.

Interstitial fluid is fluid between the cells and outside the blood vessels.

REF: p. 100

2. A 35-year-old male weighs 70 kg. Approximately how much of this weight is ICF?

a.

5 L

b.

10 L

c.

28 L

d.

42 L

ANS: D

The total volume of body water for a 70-kg person is about 42 L.

5 L is incorrect because a 70-kg person has about 42 L of body water.

10 L is incorrect because a 70-kg person has about 42 L of body water.

28 L is incorrect because a 70-kg person has about 42 L of body water.

REF: p. 99

3. While planning care for elderly individuals, the nurse remembers the elderly are at a higher risk for developing dehydration because they have a(n):

a.

Higher total body water volume

b.

Decreased muscle mass

c.

Increase in thirst

d.

Increased tendency towards developing edema

ANS: B

The elderly are at higher risk for dehydration due to a decrease in muscle mass.

The elderly have a decrease in total body water, not an increase.

The elderly have a decrease in thirst.

The elderly may develop edema, but this does not lead to dehydration.

REF: p. 100

4. Which of the following patients should the nurse assess for a decreased oncotic pressure in the capillaries? A patient with:

a.

A high-protein diet

b.

Liver failure

c.

Low blood pressure

d.

Low blood glucose

ANS: B

Liver failure leads to lost or diminished plasma albumin production, and this contributes to decreased plasma oncotic pressure.

A high-protein diet would provide albumin for the maintenance of oncotic pressure.

Low blood pressure would lead to decreased hydrostatic pressure.

Decreased glucose does not affect oncotic pressure.

REF: p. 101

5. Water movement between the ICF and ECF compartments is determined by:

a.

Osmotic forces

b.

Plasma oncotic pressure

c.

Antidiuretic hormone

d.

Buffer systems

ANS: A

Osmotic forces determine water movement between the ECF and ICF compartments.

Oncotic pressure pulls water at the end of the capillary, which makes it move between intra and extra as interstitial is considered extra.

The antidiuretic hormone regulates water balance which would make water move between the intra and extra.

Buffer systems help regulate acid balance.

REF: p. 101

6. An experiment was designed to test the effects of the Starling forces on fluid movement. Which of the following alterations would result in fluid moving into the interstitial space?

a.

Increased capillary oncotic pressure

b.

Increased interstitial hydrostatic pressure

c.

Decreased capillary hydrostatic pressure

d.

Increased interstitial oncotic pressure

ANS: D

Increased interstitial oncotic pressure would attract water from the capillary into the interstitial space.

Increased capillary oncotic pressure would attract water from the interstitial space back into the capillary.

Increased interstitial hydrostatic pressure would attract movement of water from the interstitial spaces into the capillary.

Decreased capillary hydrostatic pressure would move water into the capillaries.

REF: p. 101

7. When planning care for a dehydrated patient, the nurse remembers the principle of water balance is closely related to _____ balance.

a.

Potassium

b.

Chloride

c.

Bicarbonate

d.

Sodium

ANS: D

Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance.

Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance, not potassium.

Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance, not chloride.

Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance, not bicarbonate.

REF: p. 103

8. A 70-year-old male with chronic renal failure presents with edema. Which of the following is the most likely cause of this condition?

a.

Increased capillary oncotic pressure

b.

Decreased interstitial oncotic pressure

c.

Increased capillary hydrostatic pressure

d.

Increased interstitial hydrostatic pressure

ANS: C

Increased capillary hydrostatic pressure would facilitate increased movement from the capillary to the interstitial space, leading to edema.

Increased capillary (plasma) oncotic pressure attracts water from the interstitial space back into the capillary.

Decreased interstitial oncotic pressure would keep water in the capillary.

Increased interstitial hydrostatic pressure would facilitate increased water movement from the interstitial space into the capillary.

REF: p. 100

9. A 10-year-old male is brought to the emergency room (ER) because he is incoherent and semiconscious. CT scan reveals that he is suffering from cerebral edema. This type of edema is referred to as:

a.

Localized edema

b.

Generalized edema

c.

Pitting edema

d.

Lymphedema

ANS: A

Cerebral edema is a form of localized edema.

Generalized edema is manifested by a more uniform distribution of fluid in interstitial spaces.

Pitting edema is due to a pit left in the skin.

Lymphedema is due to swelling in interstitial spaces, primarily in the extremities.

REF: p. 102

10. A nurse is teaching the staff about antidiuretic hormone (ADH). Which information should the nurse include? Secretion of ADH is stimulated by:

a.

Increased serum potassium

b.

Increased plasma osmolality

c.

Decreased renal blood flow

d.

Generalized edema

ANS: B

ADH is secreted when plasma osmolality increases or circulating blood volume decreases and blood pressure drops.

ADH is secreted when plasma osmolality increases, not by an increase in potassium.

ADH is secreted when plasma osmolality increases; it is not affected by decreased renal blood flow.

Edema does not affect the secretion of ADH.

REF: p. 104

11. Which statement by the staff indicates teaching was successful concerning aldosterone? Secretion of aldosterone results in:

a.

Decreased plasma osmolality

b.

Increased serum potassium levels

c.

Increased blood volume

d.

Localized edema

ANS: C

Aldosterone promotes renal sodium and water reabsorption and excretion of potassium, thus, increasing blood volume.

Aldosterone secretion would cause increased plasma osmolality.

Secretion of aldosterone decreases potassium levels because it causes potassium excretion.

Secretion of aldosterone does not promote the development of localized edema; it affects blood volume.

REF: p. 104

12. A 25-year-old male is diagnosed with a hormone-secreting tumor of the adrenal cortex. Which finding would the nurse expect to see in the lab results?

a.

Decreased blood volume

b.

Decreased blood K+ levels

c.

Increased urine Na+ levels

d.

Increased white blood cells

ANS: B

Aldosterone is secreted from the adrenal cortex. It promotes renal sodium and water reabsorption and excretion of potassium, leading to decreased potassium levels.

Blood volume actually increases with aldosterone secretion.

Aldosterone promotes sodium reabsorption, leading to normal or decreased Na+ levels.

Aldosterone is not associated with white blood cells.

REF: p. 103

13. A patient has been searching on the Internet about natriuretic hormones. When the patient asks the nurse what do these hormones do, how should the nurse respond? Natriuretic hormones affect the balance of:

a.

Calcium

b.

Sodium

c.

Magnesium

d.

Potassium

ANS: B

Natriuretic hormones are sometimes called a third factor in sodium regulation.

Natriuretic hormones are a factor in sodium balance, not calcium.

Natriuretic hormones are a factor in sodium balance, not magnesium.

Natriuretic hormones are a factor in sodium balance, not potassium.

REF: p. 103

14. A 5-year-old male presents to the ER with delirium and sunken eyes. After diagnosing him with severe dehydration, the primary care provider orders fluid replacement. The nurse administers a hypertonic intravenous solution. Which of the following would be expected?

a.

Symptoms subside quickly

b.

Increased ICF volume

c.

Decreased ECF volume

d.

Intracellular dehydration

ANS: D

A hypertonic solution would cause fluid to move into the extracellular space, leading to intracellular dehydration.

With this solution, his symptoms will not subside quickly because his cells will lose fluid.

His intracellular volume will decrease, not increase.

His extracellular volume will increase, not decrease.

REF: p. 106

15. Which of the following patients is the most at risk for developing hypernatremia? A patient with:

a.

Vomiting

b.

Diuretic use

c.

Dehydration

d.

Hypoaldosteronism

ANS: C

Dehydration leads to hypernatremia because an increase in sodium occurs with a net loss in water.

Vomiting leads to hyponatremia.

Diuretic use would lead to sodium loss.

Hypoaldosteronism leads to hyponatremia.

REF: p. 106

16. The most common cause of pure water deficit is:

a.

Renal water loss

b.

Hyperventilation

c.

Sodium loss

d.

Insufficient water intake

ANS: A

The most common cause of water loss is increased renal clearance of free water as a result of impaired tubular function.

Hyperventilation can cause water loss, but it is not the most common cause.

Sodium loss leads to hyponatremia, not pure water deficit.

Insufficient water intake causes hypernatremia, not water deficit.

REF: p. 106

17. Hyperlipidemia and hyperglycemia are associated with:

a.

Hypernatremia

b.

Hypertonic hyponatremia

c.

Hypokalemia

d.

Acidosis

ANS: B

Hypertonic hyponatremia develops with hyperlipidemia, hyperproteinemia, and hyperglycemia. Increases in plasma lipids displace water volume and decrease sodium concentration.

Hyperlipidemia and hyperglycemia are associated with hyponatremia, not hypernatremia.

Hyperlipidemia and hyperglycemia are associated with hyponatremia, not hypokalemia.

Hyperlipidemia and hyperglycemia are associated with hyponatremia, not acidosis.

REF: p. 107

18. A 52-year-old diabetic male presents to the ER with lethargy, confusion, and depressed reflexes. His wife indicates that he does not follow the prescribed diet and takes his medication sporadically. Lab results indicate hyperglycemia. Which assessment finding is most likely to occur?

a.

Clammy skin

b.

Decreased sodium

c.

Decreased urine formation

d.

Metabolic alkalosis

ANS: B

Hypertonic hyponatremia develops with hyperglycemia. Increases in plasma lipids displace water volume and decrease sodium concentration, leading to the symptoms described.

The patient is experiencing symptoms of hyponatremia and hyperglycemia, not hypernatremia and hypoglycemia.

The patient will have increased ECF and would have increased urine formation.

Metabolic acidosis would occur, not alkalosis.

REF: p. 107

19. When taking care of a patient with hyperkalemia, which principle is priority? Hyperkalemia causes a(n) _____ in resting membrane potential with _____ excitability of cardiac muscle.

a.

Increase; increased

b.

Decrease; increased

c.

Increase; decreased

d.

Decrease; decreased

ANS: A

Hyperkalemia causes an increase in resting membrane potential and increased excitability of cardiac muscle.

Hyperkalemia does cause an increased excitability of cardiac muscle, but the result is an increase in resting membrane potential.

Hyperkalemia does cause an increase in resting membrane potential, but the result is an increase in excitability of cardiac muscle.

Hyperkalemia causes an increase in resting membrane potential and increased excitability of cardiac muscle.

REF: p. 110

20. Which of the following patients is most prone to hypochloremia? A patient with:

a.

Hypernatremia

b.

Hypokalemia

c.

Hypercalcemia

d.

Increased bicarbonate intake

ANS: D

Hypochloremia is the result of elevated bicarbonate concentration, as occurs in metabolic alkalosis.

Hypochloremia is the result of hyponatremia, not hypernatremia.

Hypochloremia is the result of hyponatremia, not hypokalemia.

Hypochloremia is the result of hyponatremia, not hypercalcemia.

REF: p. 106

21. Which of the following conditions would cause the nurse to monitor for hyperkalemia?

a.

Excess aldosterone

b.

Acute acidosis

c.

Insulin usage

d.

Metabolic alkalosis

ANS: B

In acidosis, ECF hydrogen ions shift into the cells in exchange for ICF potassium and sodium; hyperkalemia and acidosis therefore often occur together.

Acidosis causes hyperkalemia, not excess aldosterone.

Insulin would help treat hyperkalemia, not cause it.

It is acidosis, not alkalosis, that leads to hyperkalemia.

REF: p. 110

22. Which organ system should the nurse monitor when the patient has long-term potassium deficits?

a.

Central nervous system (CNS)

b.

Lungs

c.

Kidneys

d.

Gastrointestinal tract

ANS: C

Long-term potassium deficits lasting more than 1 month may damage renal tissue, with interstitial fibrosis and tubular atrophy.

Long-term potassium deficits damage the kidneys, not the CNS.

Long-term potassium deficits damage the kidneys, not the lungs.

Long-term potassium deficits damage the kidneys, not the gastrointestinal tract.

REF: p. 108

23. A 42-year-old female presents to her primary care provider reporting muscle weakness and cardiac abnormalities. Laboratory tests indicate that she is hypokalemic. Which of the following could be the cause of her condition?

a.

Respiratory acidosis

b.

Constipation

c.

Hypoglycemia

d.

Primary hyperaldosteronism

ANS: D

Primary hyperaldosteronism, with excessive secretion of aldosterone from an adrenal adenoma (tumor) also causes potassium wasting.

Acidosis is related to hyperkalemia, not hypokalemia.

Constipation can occur with hypokalemia but does not cause it.

Hypoglycemia is not related to muscle weakness.

REF: p. 108

24. A 19-year-old male presents to his primary care provider reporting restlessness, muscle cramping, and diarrhea. Lab tests reveal that he is hyperkalemic. Which of the following could have caused his condition?

a.

Primary hyperaldosteronism

b.

Acidosis

c.

Insulin secretion

d.

Diuretic use

ANS: B

During acute acidosis, hydrogen ions accumulate in the ICF and potassium shifts out of the cell to the ECF, causing hyperkalemia.

Primary hyperaldosteronism is associated with hypokalemia, not hyperkalemia.

Insulin secretion helps reduce potassium levels in the cell, not cause it.

Diuretics would cause hypokalemia, not hyperkalemia.

REF: p. 110

25. A 60-year-old female is diagnosed with hyperkalemia. Which assessment finding should the nurse expect to observe?

a.

Weak pulse

b.

Excessive thirst

c.

Oliguria

d.

Constipation

ANS: C

Hyperkalemia is manifested by oliguria.

Hypokalemia is manifested by a weak pulse; it is not caused by hyperkalemia.

Hypokalemia is manifested by excessive thirst.

Diarrhea, not constipation, is a manifestation of hyperkalemia.

REF: p. 110

26. Which of the following buffer pairs is considered the major plasma buffering system?

a.

Protein/fat

b.

Carbonic acid/bicarbonate

c.

Sodium/potassium

d.

Amylase/albumin

ANS: B

The carbonic acid/bicarbonate buffer pair operates in both the lung and the kidney and is a major extracellular buffer.

Protein and fat are nutrients not related to the buffering system.

Sodium and potassium are electrolytes for fluid and electrolyte balance, not the major plasma buffering system for acid-base balance.

Amylase is a carbohydrate enzyme, and albumin is a protein; neither is a buffering system.

REF: pp. 111-112

27. A nurse recalls regulation of acid-base balance through removal or retention of volatile acids is accomplished by the:

a.

Buffer systems

b.

Kidneys

c.

Lungs

d.

Liver

ANS: C

The volatile acid is carbonic acid (H2CO3), which readily dissociates into carbon dioxide (CO2) and water (H2O). The CO2 is then eliminated by the lungs.

Buffer systems are throughout the body and operate in the extracellular and intracellular systems.

The kidneys release hydrogen ions, not volatile acids.

The liver does not regulate acid-base balance.

REF: p. 111

28. Physiologic pH is maintained around 7.4 because carbonic acid and bicarbonate exist in a ratio of:

a.

20:1

b.

1:20

c.

10:2

d.

2:10

ANS: A

Normal carbonic acid to bicarbonate ratio is 20:1.

Normal carbonic acid to bicarbonate ratio is 20:1.

Normal carbonic acid to bicarbonate ratio is 20:1.

Normal carbonic acid to bicarbonate ratio is 20:1.

REF: p. 110

29. Which patient is most prone to metabolic alkalosis? A patient with:

a.

Retention of metabolic acids

b.

Hypoaldosteronism

c.

Excessive loss of chloride (Cl)

d.

Hyperventilation

ANS: C

When acid loss is caused by vomiting, renal compensation is not very effective because loss of Cl stimulates renal retention of bicarbonate, leading to alkalosis.

Retention of metabolic acids would lead to acidosis, not alkalosis.

Hypoaldosteronism leads to hyponatremia and does not cause alkalosis.

Hyperventilation leads to respiratory alkalosis, not metabolic alkalosis.

REF: p. 113

30. Which patient should the nurse assess for both hyperkalemia and metabolic acidosis? A patient diagnosed with:

a.

Diabetes insipidus

b.

Pulmonary disorders

c.

Cushing syndrome

d.

Renal failure

ANS: D

Renal failure is associated with hyperkalemia and metabolic acidosis.

Diabetes insipidus results in hypernatremia.

Pulmonary disorders are a cause of respiratory acidosis or alkalosis but do not affect hyperkalemia.

Cushing syndrome results in hypernatremia.

REF: p. 113

31. For a patient experiencing metabolic acidosis, the body will compensate by:

a.

Excreting H+ through the kidneys

b.

Hyperventilating

c.

Retaining CO2 in the lungs

d.

Secreting aldosterone

ANS: B

In an attempt to compensate for metabolic acidosis, the lungs hyperventilate to blow off CO2.

It is the lungs hyperventilating that would compensate for metabolic acidosis, not the kidneys.

CO2 retention would increase the acidotic state.

Aldosterone would conserve water, but does not help compensate for acidosis.

REF: pp. 112-113

32. Which finding would support the diagnosis of respiratory acidosis?

a.

Vomiting

b.

Hyperventilation

c.

Pneumonia

d.

An increase in noncarbonic acids

ANS: C

Respiratory acidosis occurs with hypoventilation, and pneumonia leads to hypoventilation.

Vomiting leads to loss of acids and then to alkalosis.

Hyperventilation leads to respiratory alkalosis, not acidosis.

Metabolic acidosis is caused by an increase in noncarbonic acids.

REF: p. 114

33. A 54-year-old male with a long history of smoking complains of excessive tiredness, shortness of breath, and overall ill feelings. Lab results reveal decreased pH, increased CO2, and normal bicarbonate ion. These findings help to confirm the diagnosis of:

a.

Respiratory alkalosis

b.

Metabolic acidosis

c.

Respiratory acidosis

d.

Metabolic alkalosis

ANS: C

A decreased pH indicates acidosis. With increased CO2, it is respiratory acidosis.

The decreased pH indicates acidosis, not alkalosis.

It is acidosis, but the bicarbonate is normal, so it cannot be metabolic.

The decreased pH indicates acidosis, not alkalosis.

REF: p. 114

34. For a patient with respiratory acidosis, chronic compensation by the body will include:

a.

Kidney excretion of H+

b.

Kidney excretion of HCO3

c.

Prolonged exhalations to blow off CO2

d.

Protein buffering

ANS: A

The kidneys excrete H+ to compensate for respiratory acidosis.

The kidneys do not excrete HCO3 to compensate; this would increase acidosis.

Prolonged exhalations would not be effective for compensation, especially in a chronic state.

Protein buffering is intracellular and will not be effective enough to compensate for respiratory acidosis.

REF: p. 114

35. A 55-year-old female presents to her primary care provider and reports dizziness, confusion, and tingling in the extremities. Blood tests reveal an elevated pH, decreased PCO2, and slightly decreased HCO3. Which of the following is the most likely diagnosis?

a.

Respiratory alkalosis with renal compensation

b.

Respiratory acidosis with renal compensation

c.

Metabolic alkalosis with respiratory compensation

d.

Metabolic acidosis with respiratory compensation

ANS: A

With an elevated pH, the diagnosis must be alkalosis. Since the PCO2 is low, it is likely respiratory with a slight decrease in HCO3 indicating renal compensation.

With an elevated pH, the diagnosis must be alkalosis, not acidosis.

With an elevated pH, the diagnosis must be alkalosis. Since the PCO2 is low, it is likely respiratory since the HCO3 is decreased.

With an elevated pH, the diagnosis must be alkalosis.

REF: p. 115

36. Outcomes of laboratory tests include an elevated level of natriuretic peptides. Which organ is the priority assessment?

a.

Lungs

b.

Heart

c.

Liver

d.

Brain

ANS: B

Elevated natriuretic peptides indicate problems with the heart or the vasculature.

Elevated natriuretic peptides indicate problems with the heart or the vasculature, not the lungs.

Elevated natriuretic peptides indicate problems with the heart or the vasculature, not the liver.

Elevated natriuretic peptides indicate problems with the heart or the vasculature, not the brain.

REF: p. 103

MULTIPLE RESPONSE

1. A 60-year-old male with a 30-year history of smoking is diagnosed with a hormone-secreting lung tumor. Further testing indicates that the tumor secretes ADH. Which of the following assessment findings should the nurse expect? (Select all that apply.)

a.

Confusion

b.

Weakness

c.

Nausea

d.

Muscle twitching

e.

Weight loss

ANS: A, B, C, D

Secretion of ADH leads to water intoxication with symptoms of cerebral edema, with confusion and convulsions; weakness; nausea; muscle twitching; headache; and weight gain, not loss.

REF: p. 107

2. The nurse would anticipate the patient with syndrome of inappropriate ADH (SIADH) to demonstrate which of the following symptoms? (Select all that apply.)

a.

Weakness

b.

Nausea

c.

Headache

d.

Weight loss

e.

Muscle twitching

ANS: A, B, C, E

Weakness, nausea, muscle twitching, headache, and weight gain, not loss, are common symptoms of chronic water accumulation.

REF: p. 107

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

Leave a Reply