ATI LPN
Fundamentals of Nursing: The Art and Science of Person-Centered Care Tenth, North American Edition
Chapter 41 : Fluid, Electrolyte, and Acid?Base Balance Questions
Question 1 of 5
How will the nurse interpret the patient's arterial blood gas values: pH, 7.30; PaCO2, 36 mm Hg; HCO3-, 14 mEq/L?
Correct Answer: C
Rationale: Low pH (7.30) indicates acidosis. Normal PaCO2 (36 mm Hg) rules out respiratory causes, and low HCO3- (14 mEq/L) indicates metabolic acidosis. Respiratory acidosis (
A) involves high PaCO2. Respiratory alkalosis (
B) involves low PaCO2 and high pH. Metabolic alkalosis (
D) involves high HCO3- and high pH.
Question 2 of 5
A patient with dehydration has been encouraged to increase fluid intake. Which measure would be most effective for the nurse to implement?
Correct Answer: B
Rationale: Keeping preferred fluids readily available promotes intake by making it convenient and appealing. Explaining mechanisms (
A) is too complex for immediate action. Long-term benefits (
C) are less motivating than immediate access. Evening fluid intake (
D) may disrupt sleep due to increased urination.
Question 3 of 5
A nurse is flushing a patient's peripheral venous access device. The nurse finds that the access size is leaking fluid during flushing. What action will the nurse take next?
Correct Answer: A
Rationale: Leaking fluid indicates infiltration, requiring removal of the IV and restarting at a new site. Notifying the provider (
B) is unnecessary unless complications arise. Outlining the area (
C) is a follow-up action after removal. Aspirating and flushing again (
D) risks further tissue damage.
Question 4 of 5
A nurse is monitoring a patient who is receiving an IV infusion of normal saline at 250 mL/hr. The patient is apprehensive and presents with a pounding headache, rapid pulse, chills, and dyspnea. What would be the nurse's priority intervention related to these symptoms?
Correct Answer: A
Rationale: Symptoms suggest speed shock from rapid infusion. Discontinuing the infusion, monitoring vital signs, and reporting to the provider are priority actions. Slowing the infusion (
B) is insufficient. Pinching the catheter (
C) addresses air embolism, not speed shock. Warm compresses (
D) are irrelevant to speed shock.
Question 5 of 5
A nurse carefully assesses the acid-base balance of a patient whose bicarbonate (HCO3-) level is decreased on the ABG results. This typically occurs in patients with damage to which organ?
Correct Answer: A
Rationale: The kidneys regulate bicarbonate levels, and damage can lead to decreased HCO3-, causing metabolic acidosis. Lungs (
B) regulate CO2. Adrenal glands (
C) affect hormones, not bicarbonate directly. The brain (
D) regulates respiration, not bicarbonate.