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1.The net diffusion of water from one solution of water from one solution through a semipermeable membrane to another solution containing a lower concentration of water is termed:

A. filtration
B. diffusion
C. osmosis
D. brownian motion

2. When assessing a patient’s total body water percentage, the nurse is aware that all of the following factors influence this except:

A. age
B. fat tissue
C. muscle mass
D. gender

3. Orly Khan is suffering from fluid volume deficit (FVD), which of the following symptoms would the nurse expect to assess in the patient?

A. rales
B. bounding pulse
C. tachycardia
D. bulging neck veins

4. John Reid is admitted in the hospital and is currently receiving hypertonic fluids. Nursing management for the client includes monitoring for all of the following potential complications except:

A. water intoxication
B. fluid volume excess (FVE)
C. cellular dehydration
D. cell shrinkage

5. Mr. Wenceslao is scheduled to receive an isotonic solution; which one of the following is an example of such solution?

A. D10% W
B. 0.45% saline
C. 0.9% saline
D. 3% normal saline W

6. Which of the following arterial blood gas (ABG) values indicates uncompensated metabolic alkalosis?

A. pH 7.48, PaCO2 42, HCO3 30
B. pH 7.48, PaCO2 46, HCO3 30
C. pH 7.48, PaCO2 34, HCO3 20
D. pH 7.48, PaCO2 34, HCO3 26

7. The body’s compensation of metabolic alkalosis involves:

A. increasing the respiratory rate
B. decreasing the respiratory rate
C. increasing urine output
D. decreasing urine output

8. When assessing a patient for metabolic alkalosis, the nurse would expect to find:

A. low serum potassium
B. changes in urine output
C. hypotension
D. increased CVP

9. Which of the following blood products should be infused rapidly?

A. packed red blood cells (PRBC)
B. fresh frozen plasma (FFP)
C. platelets
D. dextran

10. Which of the following statements provides the rationale for using a hypotonic solution for a patient with FVD?

A. A hypotonic solution provides free water to help the kidneys eliminate the solute.
B. A hypotonic solution supplies an excess of sodium and chloride ions.
C. Excessive volumes are recommended in the early postoperative period.
D. A hypotonic solution is used to treat hyponatremia.

11. Redd is receiving a blood transfusion. When monitoring the patient, the nurse would analyze an elevated body temperature as indicating:

A. a normal physiologic process
B. evidence of sepsis
C. a possible transfusion reaction
D. an expected response to the transfusion

12. The process of endocrine regulation of electrolytes involves:

A. sodium reabsorption and chloride excretion
B. chloride reabsorption and sodium excretion
C. potassium reabsorption and sodium excretion
D. sodium reabsorption and potassium excretion

13. The chief anion in the intracellular fluid (ICF) is:

A. phosphorus
B. potassium
C. sodium
D. chloride

14. The major cation in the ICF is:

A. potassium
B. sodium
C. phosphorus
D. magnesium

15. Hypophosphatemia may result from which of the following diseases?

A. liver cirrhosis
B. renal failure
C. Paget’s disease
D. alcoholism

16. A patient with which of the following disorders is at high risk for developing hyperphosphatemia?

A. hyperkalemia
B. hyponatremia
C. hypocalcemia
D. hyperglycemia

17. Normal calcium levels must be analyzed in relation to:

A. sodium
B. glucose
C. protein
D. fats

18. Calcium is absorbed in the GI tract under the influence of:

A. vitamin D
B. glucose
C. HCl
D. vitamin C

19. Which of the following diagnoses is most appropriate for a patient with hypo calcemia?

A. constipation, bowel
B. high risk for injury: bleeding
C. airway clearance, ineffective
D. high risk for injury: confusion

20. When serum calcium levels rise, which of the following hormones is secreted?

A. aldosterone
B. renin
C. parathyroid hormone
D. calcitonin

21. The presence of which of the following electrolytes contributes to acidosis?

A. sodium
B. potassium
C. hydrogen
D. chloride

22. The lungs participate in acid-base balance by:

A. reabsorbing bicarbonate
B. splitting carbonic acid in two
C. using CO2 to regulate hydrogen ions
D. sending hydrogen ions to the renal tubules

23. The respiratory system regulates acid-base balance by:

A. increasing mucus production
B. changing the rate and depth of respirations
C. forming bicarbonate
D. reabsorbing bicarbonate

24. Which of the following is a gas component of the ABG measurement?

A. carbon dioxide
B. bicarbonate
C. hydrogen
D. pH

25. Chloride helps maintain acid-base balance by performing which of the following roles?

A. participating in the chloride shift
B. following sodium to maintain serum osmolarity
C. maintaining the balance of cations in the ICF and ECF
D. separating carbonic acid

26. Which of the following hormones helps regulate chloride reabsorption?

A. antidiuretic hormone
B. renin
C. estrogen
D. aldosterone

27. Chloride is absorbed in the:

A. stomach
B. bowel
C. liver
D. kidney

28. When chloride concentration drops below 95 mEq/L, reabsorption of which of the following electrolytes increases proportionally?

A. hydrogen
B. potassium
C. sodium
D. bicarbonate

29. Jonas is admitted with 1,000 ml of diarrhea per day for the last 3 days. An IV of 0.45% NaCl mixed with 5% dextrose is infusing. Which of the following nursing interventions is the most appropriate?

A. Get an infusion controller from central supply.
B. Mix all antibiotics in 0.45% NaCl with 5% dextrose.
C. Check the patient’s potassium level and contact the doctor for IV additive orders.
D. Assess the patient for signs of hyperkalemia.

30. Mrs. Waltraud is receiving digoxin and Lasix daily. Today, she complains of nausea, and her apical pulse is 130 and irregular. Which of the following nursing interventions is the most appropriate?

A. Hold the digoxin and check the patient’s potassium level.
B. Remove the orange juice from the patient’s tray.
C. Identify the patient as high risk for hyperkalemia.
D. Assess the patient for other signs of hypernatremia.

Answers and Rationale

Here are the answers for this exam. Gauge your performance by counter checking your answers to those below. If you have any disputes or clarifications, please direct them to the comments section.

1. Answer: C. osmosis

Osmosis is defined as the diffusion of water through a semipermeable membrane to a solution with a lower concentration of water. Filtration is the process in which fluids are pushed through biologic membranes by unequal processes. Diffusion (Brownian motion) is the random kinetic motion causing atoms and molecules to spread out evenly.

2. Answer: D. gender

A patient’s gender does not influence the percentage of total body water.

3. Answer: C. tachycardia

Tachycardia, poor tissue turgor, and hypotension are symptoms of FVD. Other choices are symptoms of FVE.

4. Answer: A. water intoxication

Water intoxication is a potential complication associated with hypotonic fluid administration. Other choice are potential complication of hypertonic fluid administration.

5. Answer: C. A solution of 0.9% saline is isotonic.

A solution of 0.9% saline is isotonic. Solutions of 0.33% and 0.45% saline and D5W are hypotonic.

6. Answer: A. pH 7.48, PaCO2 42, HCO3 30

Uncompensated metabolic alkalosis is indicated by ABG values of pH 7.48, PaCO2 42, and HCO3 30. B indicates metabolic alkalosis, partially compensated. C indicates respiratory alkalosis, partially compensated. D indicates respiratory alkalosis, uncompensated.

7. Answer: B. decreasing the respiratory rate

The body attempts to compensate for metabolic alkalosis by decreasing the respiratory rate and conserving carbon dioxide (an acid). Urine volume does not influence acid-base balance.

8. Answer: A. low serum potassium

Decreased serum potassium is a common symptom of metabolic alkalosis.

9. Answer: C. platelets

Platelets and cryoprecipitate can be infused quickly. PRBC and FFP should be administered over 1 ½ to 4 hours. Dextran is not a blood product.

10. Answer: A. A hypotonic solution provides free water to help the kidneys eliminate the solute.

Hypotonic solutions provide free water, which helps the kidneys eliminate solute.

11. Answer: C. a possible transfusion reaction

An increase in the body temperature indicates a possible transfusion reaction and requires immediate discontinuation of the infusion.

12. Answer: D. sodium reabsorption and potassium excretion

ACTH stimulates release of aldosterone, which in turn acts on the tubules to reabsorb sodium. When this occurs, the cation potassium is excreted.

13. Answer: A. phosphorus

Phosphorus is the major ICF cation. Potassium and sodium are cations. Chloride is the chief anion found in the ECF.

14. Answer: A. potassium

Potassium is the major ICF cation. Sodium is the major ECF cation. Phosphorus is the major ICF anion. Magnesium is the second-most abundant cation in the ICF.

15. Answer: D. alcoholism

Hypophosphatemia may occur secondary to alcoholism. Renal failure is usually associated with hyperphosphatemia

16. Answer: C. hypocalcemia

Because calcium and phosphorus ratios are inversely proportional, when phosphorus levels are high, calcium levels are low.

17. Answer: C. protein

Some calcium is bound to protein, so abnormal calcium levels are analyzed in relation to proteins.

18. Answer: A. vitamin D

Calcium is absorbed in the GI tract under the influence of vitamin D in its biologically active form.

19. Answer: B. high risk for injury: bleeding

A patient with hypocalcemia may bleed, since calcium is required for normal blood clotting. A and D are diagnoses appropriate for a patient with hypercalcemia. C is not associated with fluctuating calcium levels.

20. Answer: D. calcitonin

When calcium levels rise, calcitonin is secreted from the thyroid; this hormone moves calcium from plasma into bone. Parathyroid hormone is secreted in response to lowered calcium levels; this hormone moves calcium from bone into plasma.

21. Answer: C. hydrogen

The presence of hydrogen ions determines a solution’s acidity.

22. Answer: C. using CO2 to regulate hydrogen ions

The lungs use carbon dioxide to regulate hydrogen ion concentration.

23. Answer: B. changing the rate and depth of respirations

Through changes in the rate and depth of respirations, acid-base balance is achieved via CO2 elimination and retention. Mucus production is not part of the pulmonary regulatory system. C and D are responses that refer to ways in which kidneys balance acids and bases.

24. Answer: A. carbon dioxide

The gases measured by ABGs are oxygen and carbon dioxide. Bicarbonate and hydrogen are ions; their ratio is measured in the pH.

25. Answer: A. participating in the chloride shift

To maintain acid-base balance, chloride shifts into and out of red blood cells in exchange for bicarbonate.

26. Answer: D. aldosterone

Chloride reabsorption depends on sodium reabsorption, which is regulated by aldosterone in the distal tubule and collecting ducts.

27. Answer: B. bowel

Chloride is absorbed in the bowel, mainly the duodenum and jejunum.

28. Answer: D. bicarbonate

When chloride concentrations drop below 95 mEq/L, bicarbonate reabsorption increases proportionally, causing metabolic alkalosis. Other choices are cations, chloride is an anion; a cation must always exchange for a cation in order to maintain electrical neutrality.

29. Answer: C. Check the patient’s potassium level and contact the doctor for IV additive orders.

Potassium is lost via the GI and renal systems. Prolonged or excessive diarrhea can lead to hypokalemia. In the event of hypokalemia, a potassium additive would likely be prescribed.

30. Answer: A. Hold the digoxin and check the patient’s potassium level.

Patient experiencing hypokalemia are at risk for digitalis toxicity. Nausea and irregular pulse are signs digitalis toxicity.