ATI RN
ATI Fluid Electrolyte and Acid-Base Regulation Questions
Question 1 of 9
A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased intracranial pressure. This solution will increase the number of dissolved particles in the patients blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following?
Correct Answer: B
Rationale: The correct answer is B: Osmosis and osmolality. When a hypertonic solution is infused, it increases the number of dissolved particles in the blood, creating an osmotic pressure gradient. This causes fluids in the tissues to shift into the capillaries, increasing blood volume. Osmosis is the movement of solvent (water) across a semi-permeable membrane to equalize solute concentrations. Osmolality refers to the concentration of solutes in a solution. Hydrostatic pressure (choice A) is the force exerted by a fluid against a wall when it is under pressure, not related to the movement of solutes. Diffusion (choice C) is the movement of solute molecules from an area of high concentration to low concentration, not involving a semi-permeable membrane. Active transport (choice D) requires energy to move molecules across a membrane against their concentration gradient, not the mechanism described in the scenario.
Question 2 of 9
The physician has ordered a peripheral IV to be inserted before the patient goes for computed tomography. What should the nurse do when selecting a site on the hand or arm for insertion of an IV catheter?
Correct Answer: B
Rationale: The correct answer is B because considering potential effects on the patient's mobility is crucial when selecting a site for IV insertion. Mobility can be affected if the IV is placed in a joint area or on the dominant hand. This could limit the patient's ability to move freely during and after the procedure. Therefore, it is important to choose a site that will not hinder the patient's movement. A: Choosing a hairless site is not the most important factor when selecting a site for IV insertion. C: Having the patient hold his arm over his head before insertion is not necessary and may cause discomfort for the patient. D: Leaving the tourniquet on for at least 3 minutes is not recommended as it can lead to complications such as venous stasis.
Question 3 of 9
A patient has questioned the nurses administration of IV normal saline, asking whether sterile water would be a more appropriate choice than saltwater. Under what circumstances would the nurse administer electrolyte-free water intravenously?
Correct Answer: A
Rationale: The correct answer is A because electrolyte-free water, such as sterile water, can rapidly enter red blood cells due to osmotic differences, causing them to swell and potentially rupture, leading to hemolysis. This can result in severe harm to the patient. Choice B is incorrect because electrolyte-free water is not indicated for severely dehydrated patients with neurologic signs and symptoms. They require electrolytes to correct their imbalances. Choice C is incorrect as administering electrolyte-free water would not address excess calcium and/or magnesium ions in the body. Specific treatments for hypercalcemia or hypermagnesemia are needed. Choice D is incorrect because patients with fluid deficits due to renal failure require electrolyte-balanced solutions to manage their condition effectively. Electrolyte-free water would not address the electrolyte imbalances associated with renal failure.
Question 4 of 9
A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause
Correct Answer: B
Rationale: The correct answer is B: Respiratory alkalosis. Hyperventilation leads to excessive elimination of carbon dioxide, causing a decrease in PaCO2 levels, resulting in respiratory alkalosis. This is the most common cause of hyperventilation. Respiratory acidosis (choice A) occurs when there is retention of carbon dioxide. Increased PaCO2 (choice C) is a consequence of respiratory acidosis, not alkalosis. CNS disturbances (choice D) can lead to abnormal breathing patterns but are not the most common cause of hyperventilation.
Question 5 of 9
A newly graduated nurse is admitting a patient with a long history of emphysema. The new nurses preceptor is going over the patients past lab reports with the new nurse. The nurse takes note that the patients PaCO2 has been between 56 and 64 mm Hg for several months. The preceptor asks the new nurse why they will be cautious administering oxygen. What is the new nurses best response?
Correct Answer: D
Rationale: The correct answer is D: Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia. In patients with chronic emphysema, their respiratory drive is often triggered by low oxygen levels rather than high carbon dioxide levels. Administering supplemental oxygen can suppress their respiratory drive, leading to carbon dioxide retention (carbon dioxide narcosis) and worsening hypoxemia. This phenomenon is known as "hypoxic drive." Choice A is incorrect because administering oxygen does not lead to a dramatic rise in calcium levels due to pituitary stimulation. Choice B is incorrect because administering oxygen does not typically increase intracranial pressure or cause confusion. Choice C is incorrect because administering oxygen does not directly cause hyperventilation and acidosis in this scenario.
Question 6 of 9
A nurse is caring for an older adult client who is admitted with moderate dehydration. Which intervention should the nurse implement to prevent injury while in the hospital?
Correct Answer: D
Rationale: The correct answer is D because dangling the client on the bedside before ambulating helps prevent orthostatic hypotension and potential falls. This step allows the nurse to assess the client's tolerance to changes in position and reduces the risk of injury. A: Asking family members to speak quietly does not directly address the prevention of injury related to dehydration. B: Assessing urine parameters is important for monitoring hydration status but does not directly prevent injury. C: Encouraging fluid intake is important for rehydration but does not directly address the risk of injury during ambulation.
Question 7 of 9
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 8 of 9
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?
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 9 of 9
A nurse is assessing clients who have intravenous therapy prescribed. Which assessment finding for a client with a peripherally inserted central catheter (PICC) requires immediate attention?
Correct Answer: D
Rationale: The correct answer is D because upper extremity swelling could indicate a potential complication such as deep vein thrombosis, which is a serious condition requiring immediate attention to prevent further complications. Swelling can impede blood flow and lead to clot formation. A: The initial site dressing being 3 days old is concerning for infection but not an immediate threat. B: The PICC being inserted 4 weeks ago may increase infection risk but does not require immediate attention. C: A missing securement device may increase the risk of dislodgement but is not an immediate threat compared to potential vascular compromise indicated by upper extremity swelling.