ATI LPN
Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition
Chapter 16 : Caring for Clients With Fluid, Electrolyte, and Acid? Base Imbalances Questions
Question 1 of 5
The emergency department (ED) nurse is caring for a client with a possible acid- base imbalance. The physician has prescribed an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG?
Correct Answer: D
Rationale: Arterial blood gas (ABG) results are the main tool for measuring blood $\mathrm{pH}, \mathrm{CO}_2$ content $\left(\mathrm{PaCO}_2\right)$, and bicarbonate. An acid-base imbalance may accompany a fluid and electrolyte imbalance. $\mathrm{PaO}_2$ and $\mathrm{PO}_2$ are not indications of acid-base imbalance. Carbonic acid levels are not shown in an ABG.
Question 2 of 5
The nursing instructor is talking with the nursing class about fluid and electrolyte balance. What would the instructor tell the students that the average daily fluid intake for an adult is?
Correct Answer: B
Rationale: In healthy adults, oral fluid intake averages about $2500 \mathrm{~mL} /$ day; however, it can range between 1800 and $3000 \mathrm{~mL} /$ day, with a similar volume of fluid loss. $2000 \mathrm{~mL}, 3000 \mathrm{~mL}$, and $3500 \mathrm{~mL}$ are not the average amounts of fluid a healthy adult takes in daily.
Question 3 of 5
The nurse is instructing on the body's negative feedback loop to ensure homeostasis to a group of students. Which action by bases keeps the blood $\mathrm{pH}$ nearly neutral?
Correct Answer: B
Rationale: Acids are substances that release hydrogen into fluid, bases are substances that bind with hydrogen. The delicate balance between acids and bases, as well as fluids and electrolytes, maintains the nearly neutral blood $\mathrm{pH}$.
Question 4 of 5
The nurse is caring for an older adult client in the home setting who is experiencing decreased thirst. Which type of fluid imbalance should the nurse anticipate?
Correct Answer: A
Rationale: The nurse should anticipate the presence of dehydration, which is the most common fluid imbalance in older adult clients that results from decreased thirst. Hypovolemia is a condition in which only the blood volume is low. Hypervolemia is when the intravascular fluid volume is too high. Third spacing describes the translocation of fluid from the intravascular or intercellular space to tissue compartments, where it becomes trapped and useless. It is associated with the loss of colloids.
Question 5 of 5
The nurse is correct to state that a client's body needs to have adequate nutrition to maintain energy. Which type of transport of dissolved substances requires adenosine triphosphate (ATP)?
Correct Answer: D
Rationale: Active transport requires the use of the body's energy molecule (ATP) to meet body needs for fluid and particle transport. Osmosis is the movement of body fluids through a semipermeable membrane that allows not all substances to pass through. Passive diffusion allows the movement of substances from an area of higher concentration to lower concentration. Facilitated diffusion has certain dissolved substances that require the assistance from a carrier module to pass through the semipermeable membrane.