ATI RN
ATI Fluid Electrolyte and Acid-Base Regulation Questions
Question 1 of 5
A nurse assesses a client who is admitted with an acid-base imbalance. The clients arterial blood gas values are pH 7.32, PaO2 85 mm Hg, PaCO2 34 mm Hg, and HCO3 16 mEq/L. What action should the nurse take next?
Correct Answer: A
Rationale: The correct answer is A: Assess clients rate, rhythm, and depth of respiration. The arterial blood gas values indicate a respiratory acidosis due to low pH and low PaCO2. The nurse should assess the respiratory status to determine if the client is hypoventilating, which is causing the retention of CO2 and subsequent acidosis. Assessing the rate, rhythm, and depth of respiration will help determine if the client requires immediate intervention such as oxygen therapy, mechanical ventilation, or respiratory treatment. Choice B is incorrect because measuring pulse and blood pressure does not directly address the underlying cause of the acid-base imbalance. Choice C is incorrect as the nurse should take immediate action to address the imbalance rather than passively monitoring. Choice D is incorrect as immediate intervention is needed to address the respiratory acidosis.
Question 2 of 5
A nurse is caring for a client who is experiencing moderate metabolic alkalosis. Which action should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Teach the client fall prevention measures. In metabolic alkalosis, the client may experience muscle weakness and confusion, increasing the risk of falls. Teaching fall prevention measures is essential to ensure the client's safety. Monitoring hemoglobin and hematocrit values (A) is not directly related to managing metabolic alkalosis. Administering furosemide (B) is not appropriate for metabolic alkalosis. Encouraging deep breaths (C) may not address the underlying cause of the alkalosis.
Question 3 of 5
You are caring for a patient with a secondary diagnosis of hypermagnesemia. What assessment finding would be most consistent with this diagnosis?
Correct Answer: D
Rationale: The correct answer is D: Shallow respirations. Hypermagnesemia can lead to respiratory depression due to its inhibitory effect on the central nervous system. Shallow respirations are a common respiratory manifestation of hypermagnesemia. Hypertension (choice A) is not typically associated with hypermagnesemia. Kussmaul respirations (choice B) are deep, rapid breathing patterns seen in metabolic acidosis, not hypermagnesemia. Increased deep tendon reflexes (DTRs) (choice C) are more indicative of hypomagnesemia, as magnesium deficiency can lead to hyperexcitability of nerves and muscles, resulting in increased DTRs.
Question 4 of 5
You are performing an admission assessment on an older adult patient newly admitted for end-stage liver disease. What principle should guide your assessment of the patients skin turgor?
Correct Answer: C
Rationale: The correct answer is C: Inelastic skin turgor is a normal part of aging. As people age, their skin loses elasticity and becomes less turgid, which can affect skin turgor assessment. Skin turgor assessment is an important indicator of hydration status, and in older adults, it is normal for the skin to be less elastic. This is due to changes in collagen and elastin fibers in the skin with aging. Choices A, B, and D are incorrect because overhydration is not common among healthy older adults, dehydration causes the skin to appear tented rather than spongy, and skin turgor can still be assessed in patients over 70, although it may be less reliable due to natural changes in skin elasticity with aging.
Question 5 of 5
The nurse is providing care for a patient with chronic obstructive pulmonary disease. When describing the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing what process?
Correct Answer: A
Rationale: The correct answer is A: Diffusion. In respiration, oxygen and carbon dioxide are exchanged between the alveoli and pulmonary capillaries through the process of diffusion. Here's the rationale: 1. Diffusion is the movement of molecules from an area of high concentration to an area of low concentration. 2. In the alveoli, oxygen moves from the air (higher concentration) into the blood (lower concentration) and carbon dioxide moves from the blood (higher concentration) into the air (lower concentration). 3. This exchange occurs passively, without the need for energy input, which is characteristic of diffusion. Summary of other choices: B: Osmosis involves the movement of water across a semi-permeable membrane, not gas exchange. C: Active transport requires energy input to move molecules against their concentration gradient, not seen in gas exchange. D: Filtration involves the movement of molecules through a membrane under pressure, not the passive movement of gases in respiration.
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