ATI Fluid Electrolyte and Acid-Base Regulation

Question 1 of 5

The community health nurse is performing a home visit to an 84-year-old woman recovering from hip surgery. The nurse notes that the woman seems uncharacteristically confused and has dry mucous membranes. When asked about her fluid intake, the patient states, I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom. What would be the nurses best response?

A. I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete workup B. Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids. C. It is normal to be a little confused following surgery, and it is safe not to urinate at night. D. If you build up too much urine in your bladder, it can cause you to get confused, especially when your body is under stress.

Correct Answer: B

Rationale: The correct answer is B because limiting fluids can lead to dehydration, which can cause confusion and dry mucous membranes. Adjusting the timing of fluids can help maintain hydration without causing frequent nighttime bathroom trips.
Choice A is incorrect because hospital readmission is not necessary at this point.
Choice C is incorrect as it normalizes confusion post-surgery and dangerous practice of avoiding urination at night.
Choice D is incorrect because urine accumulation in the bladder does not directly cause confusion; dehydration is the primary concern.

Question 2 of 5

A nurse is caring for a client who is experiencing excessive diarrhea. The clients arterial blood gas values are pH 7.28, PaO2 98 mm Hg, PaCO2 45 mm Hg, and HCO3 16 mEq/L. Which provider order should the nurse expect to receive?

A. Furosemide (Lasix) 40 mg intravenous push B. Sodium bicarbonate 100 mEq diluted in 1 L of D5W C. Mechanical ventilation D. Indwelling urinary catheter

Correct Answer: B

Rationale: The correct answer is B: Sodium bicarbonate 100 mEq diluted in 1 L of D5W. In this case, the client is experiencing metabolic acidosis due to low HCO3 levels (16 mEq/L) with a low pH (7.28). Sodium bicarbonate helps correct metabolic acidosis by increasing the HCO3 levels. Furosemide (
A) is a diuretic and can worsen the client's electrolyte imbalance. Mechanical ventilation (
C) is not indicated for metabolic acidosis. Indwelling urinary catheter (
D) does not address the underlying acid-base imbalance.
Therefore, the nurse should expect the provider to order sodium bicarbonate to correct the metabolic acidosis.

Question 3 of 5

You are called to your patients room by a family member who voices concern about the patients status. On assessment, you find the patient tachypnic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this patients signs and symptoms?

A. Hypocalcemia B. Hyponatremia C. Hyperchloremia D. Hypophosphatemia

Correct Answer: C

Rationale: The correct answer is C: Hyperchloremia. In this scenario, the patient's symptoms point towards fluid overload, which can lead to hyperchloremia due to excessive chloride intake. 3+ pitting edema suggests fluid retention, a common symptom of hyperchloremia. Additionally, tachypnea can occur as a compensatory mechanism for metabolic acidosis seen in hyperchloremia. Lethargy, weakness, and diminished cognitive ability can be attributed to electrolyte imbalances impacting nerve and muscle function.

Choice A: Hypocalcemia is less likely as it typically presents with neuromuscular irritability, not lethargy.

Choice B: Hyponatremia usually presents with neurological symptoms like confusion and seizures, not the symptoms described.

Choice D: Hypophosphatemia typically presents with muscle weakness, not the full constellation of symptoms described.

Question 4 of 5

After providing discharge teaching, a nurse assesses the clients understanding regarding increased risk for metabolic alkalosis. Which statement indicates the client needs additional teaching?

A. . I dont drink milk because it gives me gas and diarrhea B. I have been taking digoxin every day for the last 15 years C. . I take sodium bicarbonate after every meal to prevent heartburn D. In hot weather, I sweat so much that I drink six glasses of water each day.

Correct Answer: C

Rationale: The correct answer is C because taking sodium bicarbonate after every meal can actually increase the risk of metabolic alkalosis due to its alkaline nature. Sodium bicarbonate can lead to an excessive build-up of bicarbonate in the bloodstream, causing alkalosis.

Choice A is not directly related to metabolic alkalosis.
Choice B, taking digoxin, is unrelated to metabolic alkalosis as well.
Choice D, drinking six glasses of water due to sweating, does not contribute to metabolic alkalosis as it helps maintain hydration and electrolyte balance.

Question 5 of 5

1.A nurse prepares to insert a peripheral venous catheter in an older adult client. Which action should the nurse take to protect the clients skin during this procedure?

A. Lower the extremity below the level of the heart. B. Apply warm compresses to the extremity. C. Tap the skin lightly and avoid slapping. D. Place a washcloth between the skin and tourniquet

Correct Answer: D

Rationale: The correct answer is D: Place a washcloth between the skin and tourniquet. This step helps protect the client's skin by providing a barrier between the tourniquet and the skin, reducing the risk of skin irritation or damage. Lowering the extremity below the heart (
A) can increase venous pressure and make it harder to insert the catheter. Warm compresses (
B) can dilate blood vessels and increase the risk of bruising. Tapping the skin lightly (
C) can irritate the skin and is unnecessary for skin protection.

Nurselytic

ATI RN

ATI RN