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full file at http://testbankcorner.eu Chapter 24—Fluid, Electrolyte, and Acid-Base Balance MULTIPLE CHOICE 1. Which of these terms refers to the maintenance of the body’s internal environment within narrow limits? a. homeostasis c. diffusion b. osmosis d. elimination ANS: A Homeostasis is the maintenance of the body’s internal environment within narrow limits. Homeostasis relies on osmosis, diffusion, and elimination to maintain the internal environment. PTS: 1 DIF: Knowledge REF: White (2010) 2. The smallest unit of chemical structure that cannot be altered by chemical change is called: a. an element c. a molecule b. an atom d. a compound ANS: B An atom is the smallest unit of chemical structure. It cannot be altered by chemical change. PTS: 1 DIF: Knowledge REF: White (2010) 3. Compounds that decompose into ions in water are called: a. isotopes c. molecules b. atoms d. electrolytes ANS: D Electrolytes are compounds that decompose or break down into separate ions when placed in water. PTS: 1 DIF: Knowledge REF: White (2010) 4. Which of these terms refers to electrically charged ions present in both intracellular and extracellular fluids? a. electrolytes c. particles b. molecules d. solutes ANS: A Electrolytes are electrically charged ions (cations or anions) that are present in both intracellular and extracellular fluids. PTS: 1 DIF: Knowledge REF: White (2010) 5. Which of these terms describes negatively charged particles within the body? a. anions c. electrolytes b. cations d. elements ANS: A There are two types of ions. Anions are negatively charged particles, while cations are positively charged particles. PTS: 1 DIF: Knowledge REF: White (2010) full file at http://testbankcorner.eu full file at http://testbankcorner.eu 6. Water composes what percentage of adult body weight? a. 10 c. 45 b. 25 d. 60 ANS: D The water percentage for an adult is 60%, for an older adult 45% to 55%, for an embryo 97%, for an infant 70% to 80%, and for a child 60% to 77%. PTS: 1 DIF: Knowledge REF: White (2010) 7. A nurse is caring for a newborn infant and must be aware that what percentage BEST describes the newborn’s weight that is composed of water? a. 35% c. 77% b. 50% d. 90% ANS: C The water percentage for an adult is 60%, for an older adult 45% to 55%, for an embryo 97%, for an infant 70% to 80%, and for a child 60% to 77%. PTS: 1 DIF: Knowledge REF: White (2010) 8. Which of these gases are important in the human body? a. nitrogen and hydrogen c. oxygen and carbon dioxide b. hydrogen and carbon dioxide d. nitrogen and oxygen ANS: C The two most important gases in the human body are oxygen to nourish cells and carbon dioxide, which is the waste product of cells. There is a delicate balance between these two gases in maintaining homeostasis. PTS: 1 DIF: Knowledge REF: White (2010) 9. Which of these terms describes a substance that in solution yields hydrogen ions with a positive charge? a. acid c. salt b. base d. buffer ANS: A When a chemical substance is placed in a solution, the end result is an acid (hydrogen ions with a positive charge). PTS: 1 DIF: Knowledge REF: White (2010) 10. Which of these terms describes a substance that when dissociated produces ions that will combine with hydrogen ions? a. acid c. salt b. base d. buffer ANS: B The chemical result of the dissociation of a substance produces the combination of an ion and hydrogen ions, resulting in a base. PTS: 1 DIF: Knowledge REF: White (2010) full file at http://testbankcorner.eu full file at http://testbankcorner.eu 11. When an acid and a base react with each other, which substance is formed? a. atom c. salt b. ion d. buffer ANS: C The chemical reaction of the combination of an acid and a base results in the formation of a salt. PTS: 1 DIF: Knowledge REF: White (2010) 12. Identify which of these elements determines pH range within the body’s internal environment? a. bicarbonate c. hydrogen b. carbon dioxide d. oxygen ANS: C The normal body pH range of blood is from 7.35 to 7.45; blood pH above or below this range can cause profound physiologic problems. A blood pH level below 7.35 means that the concentration of hydrogen ions is elevated. A blood pH above 7.45 indicates excessive loss of hydrogen ions, resulting in alkalosis. PTS: 1 DIF: Comprehension REF: White (2010) 13. Identify which of these processes is used by sodium to control the body’s fluid balance? a. active transport c. filtration b. diffusion d. osmosis ANS: D The major extracellular fluid electrolyte, sodium, regulates fluid balance through osmotic pressure (osmosis). Normal serum sodium range for an adult is from 135 to 145 mEq/L. PTS: 1 DIF: Application REF: White (2010) 14. The nurse is aware that which of the following results when a decreased concentration of hydrogen ions occurs within body fluids? a. They become acidic. b. They become alkaline. c. Carbon ions are retained. d. Oxygen ions are released into the blood. ANS: A The normal body pH range of blood is from 7.35 to 7.45; blood pH above or below this range can cause profound physiologic problems. A blood pH level below 7.35 means that the concentration of hydrogen ions is elevated, resulting in acidosis, which can cause coma, weak or irregular heartbeat, or severe hypotension. A blood pH above 7.45 indicates excessive loss of hydrogen ions, resulting in alkalosis, with symptoms such as apathy, irritability, delirium, or spasmodic muscle contractions. PTS: 1 DIF: Application REF: White (2010) 15. The nurse is aware that which of the following results when an increased concentration of hydrogen ions occurs within body fluids? a. They become acidic. b. They become alkaline. c. Oxygen ions are released into the blood. full file at http://testbankcorner.eu full file at http://testbankcorner.eu d. Carbon ions are retained. ANS: B The normal body pH range of blood is from 7.35 to 7.45; blood pH above or below this range can cause profound physiologic problems. A blood pH level below 7.35 means that the concentration of hydrogen ions is elevated, resulting in acidosis, which can cause coma, weak or irregular heartbeat, or severe hypotension. A blood pH above 7.45 indicates excessive loss of hydrogen ions, resulting in alkalosis, with symptoms such as apathy, irritability, delirium, or spasmodic muscle contractions. PTS: 1 DIF: Application REF: White (2010) 16. When a solution has a pH of less than 7, what is its classification? a. acid c. neutral b. base d. buffer ANS: A The normal body pH range of blood is from 7.35 to 7.45; blood pH above or below this range can cause profound physiologic problems. A blood pH level below 7.35 means that the concentration of hydrogen ions is elevated, resulting in acidosis. PTS: 1 DIF: Knowledge REF: White (2010) 17. When a client’s blood pH is greater than 7.45, the client is in which of these states? a. acidosis c. neutral b. alkalosis d. buffer ANS: B The normal body pH range of blood is from 7.35 to 7.45; blood pH above (alkalosis) or below (acidosis) this range can cause profound physiologic problems. A blood pH level below 7.45 is within the normal range. PTS: 1 DIF: Knowledge REF: White (2010) 18. A client’s blood pH is 7.5. The nurse should recognize that this is considered to be: a. critically decreased, in need of immediate intervention b. decreased c. normal d. slightly increased ANS: D The normal body pH range of blood is from 7.35 to 7.45; blood pH above or below this range can cause profound physiologic problems. A blood pH above 7.45 indicates excessive loss of hydrogen ions, resulting in alkalosis, with symptoms such as apathy, irritability, delirium, or spasmodic muscle contractions. PTS: 1 DIF: Application REF: White (2010) 19. Which of these buffer systems normally buffers organic acids found in body fluids? a. bicarbonate c. protein b. phosphate d. neutral ANS: B full file at http://testbankcorner.eu full file at http://testbankcorner.eu The phosphate buffer system, composed of sodium monohydrogen phosphate and sodium dihydrogen phosphate, regulates the pH of intracellular fluid and fluid in the kidney tubules by buffering organic acids found in the body. PTS: 1 DIF: Knowledge REF: White (2010) 20. Which of these terms describes the movement of water through a semipermeable or selectively permeable membrane to equalize the concentration of salts or other solutes? a. active transport c. filtration b. diffusion d. osmosis ANS: D Osmosis is the diffusion of a solvent (usually water) through a semipermeable membrane from an area of higher concentration to one of lower concentration. During osmosis, only the water molecules move through the membrane, not the molecules dissolved in the solvent. PTS: 1 DIF: Knowledge REF: White (2010) 21. The osmolality of a solution is determined by which of these? a. density of molecules in water c. percentage of molecules in water b. number of molecules in water d. weight of molecules in water ANS: B Osmolality of a solution is determined by laboratory test measuring the number of molecules within water. PTS: 1 DIF: Comprehension REF: White (2010) 22. The movement of a solute from an area of higher concentration to an area of lower concentration until equilibrium is reached is called: a. active transport c. filtration b. diffusion d. osmosis ANS: B Diffusion, the movement of substances (e.g., molecules of gases, liquids, or solids) from an area of higher molecular concentration to one of lower molecular concentration, occurs because of the kinetic energy in molecules; molecules are constantly moving and colliding with each other, forcing them to move farther apart. An example of diffusion is the movement of oxygen from the lungs to the bloodstream because the oxygen concentration in the blood is lower than that in the lungs. PTS: 1 DIF: Knowledge REF: White (2010) 23. The movement of both water and substances as a result of hydrostatic pressure is called: a. active transport c. filtration b. diffusion d. osmosis ANS: C Filtration is a process in which solvents and the substances dissolved in them are forced through cell membranes by hydrostatic pressure (i.e., the pressure the fluid exerts against the membrane). PTS: 1 DIF: Knowledge REF: White (2010) full file at http://testbankcorner.eu full file at http://testbankcorner.eu 24. The movement of substances across cell membranes using chemical energy and carrier molecules is called: a. active transport c. filtration b. diffusion d. osmosis ANS: A Substances constantly move in and out of cells by passing through the cell membrane without the cell expending energy (passive transport) or by requiring the cell to expend energy (active transport). PTS: 1 DIF: Comprehension REF: White (2010) 25. The process by which substances can pass through the cell membrane without energy expenditure on the part of the cell is called: a. active transport c. permeability b. passive transport d. dialysis ANS: B Substances constantly move in and out of cells by passing through the cell membrane without the cell expending energy (passive transport). PTS: 1 DIF: Comprehension REF: White (2010) 26. Which of these processes is an example of passive transport? a. diffusion c. integration b. buffering d. configuration ANS: A Diffusion, the movement of substances (e.g., molecules of gases, liquids, or solids) from an area of higher molecular concentration to one of lower molecular concentration, occurs because of the kinetic energy in molecules; molecules are constantly moving and colliding with each other, forcing them to move farther apart. An example of diffusion is the movement of oxygen from the lungs to the bloodstream, because the oxygen concentration in the blood is lower than that in the lungs. PTS: 1 DIF: Comprehension REF: White (2010) 27. Which of these terms describes any solution put into the body with the same osmolality as blood plasma? a. hypertonic c. ionic b. hypotonic d. isotonic ANS: D Isotonic solutions have the same molecular concentration or osmolality as those within the cell; they do not affect the size of the cell. PTS: 1 DIF: Knowledge REF: White (2010) 28. A solution with more molecules in solutions than in blood plasma is called: a. hypertonic c. ionic b. hypotonic d. isotonic ANS: A A hypertonic solution has a molecular concentration higher than that within the cell, resulting in the movement of water from the cell and a decrease in cell size. For example, when red blood cells shrivel because of osmosis, they are unable to function. full file at http://testbankcorner.eu full file at http://testbankcorner.eu PTS: 1 DIF: Comprehension REF: White (2010) 29. What is the name of the process where pressure is exerted against the cell membrane by water inside the cell? a. cell pressure c. osmotic pressure b. isotonic pressure d. hydrostatic pressure ANS: C Osmotic pressure is the pressure that is exerted against the cell membrane by the force of water on the inside of the cell. PTS: 1 DIF: Comprehension REF: White (2010) 30. How does active cell transport occur? a. Carrier molecules latch onto specific molecules, and transport them in or out of the cell. b. Fluids and substances are forced through cell membranes by hydrostatic pressure. c. Isotonic solutions move substances in and out of the cell. d. Kinetic energy causes molecules to be in constant motion in and out of the cell. ANS: A Active transport requires the cell to use energy to move molecules in and out of the cells. Carrier molecules are used to move substances in and out of cells during active transport. For example, important ions such as sodium and potassium enter and leave cells by the process of transport. PTS: 1 DIF: Comprehension REF: White (2010) 31. The nurse is aware that to maintain fluid balance between the intracellular and extracellular compartments: a. there is a constant exchange of water between the compartments b. the hypothalamus sends each compartment messages regarding the need for retaining or releasing fluid to the cells c. the kidneys retain and excrete fluid as needed for fluid balance d. the lymph nodes throughout the body regulate fluid balance ANS: A The proportions of extracellular and intracellular fluid vary with age. The balance of fluid between plasma and interstitial fluid is regulated by hydrostatic pressure (blood pressure) and osmotic pressure. If the intracellular fluid becomes hypertonic in relation to the extracellular fluid, water moves by osmosis from the extracellular fluid into the cell to restore balance. If the intracellular fluid becomes hypotonic in relation to the extracellular fluid, the process just described is reversed, resulting in a constant exchange between the compartments. PTS: 1 DIF: Comprehension REF: White (2010) 32. Which of these body fluid compartments contains the largest amount of water in the body? a. intravascular c. intracellular b. interstitial d. extracellular ANS: C full file at http://testbankcorner.eu full file at http://testbankcorner.eu Body fluids are contained in two compartments. The intracellular fluid (ICF) compartment contains the largest amount of water in the body and consists of all of the water and ions within the cells. The extracellular fluid (ECF) compartment contains the body fluids remaining outside the cells: either interstitial fluid (fluid in the tissue spaces around each cell) or intravascular fluid (plasma within blood vessels, lymph within the lymphatic system, and small amounts of specialized fluids such as cerebrospinal fluid or synovial fluid). PTS: 1 DIF: Comprehension REF: White (2010) 33. Which of these elements is the major electrolyte in intracellular fluid? a. chloride c. potassium b. magnesium d. sodium ANS: C Potassium, the major electrolyte in intracellular fluid, maintains normal nerve and muscle activity and osmotic pressure within the cells and aids in the cellular metabolism of carbohydrates and proteins. PTS: 1 DIF: Comprehension REF: White (2010) 34. When fluid accumulates in tissue spaces, the resulting condition is called a. edema c. decompartmentalization b. dehydration d. fluid insufficiency ANS: A The balance of fluid between plasma and interstitial fluid is regulated by hydrostatic pressure (blood pressure) and osmotic pressure. Edema occurs when fluid accumulates in the interstitial fluid compartment. PTS: 1 DIF: Comprehension REF: White (2010) 35. Which of these organs plays the major role in maintaining the body’s fluid and electrolyte balance? a. kidneys c. lungs b. colon d. skin ANS: A The kidneys are major organs of fluid balance, excreting up to 1,500 mL of water daily, based on the amount of fluid ingested and amount of waste or solutes excreted. When an extracellular fluid volume deficit occurs, certain hormones (antidiuretic hormone, aldosterone, and renin) are released to prompt the kidneys to conserve water. The interaction of these hormones with renal function serves as the body’s compensatory mechanism to maintain homeostasis. PTS: 1 DIF: Comprehension REF: White (2010) 36. The nurse is monitoring the intake and output of a client. The nurse is aware that the average adult loses how many milliliters of fluid daily? a. 1,000 c. 2,500 b. 1,800 d. 3,600 ANS: C Approximately 2,500 mL of fluid is normally lost daily through the skin (insensible water loss and perspiration), lungs (insensible water loss), and gastrointestinal tract (feces). The kidneys are major organs of fluid balance, excreting up to 1,500 mL of water daily, based on the amount of fluid ingested and amount of waste or solutes excreted. full file at http://testbankcorner.eu full file at http://testbankcorner.eu PTS: 1 DIF: Comprehension REF: White (2010) 37. The nurse is aware that in an effort to increase reabsorption of water in the distal renal tubules, the body will signal the posterior pituitary gland to secrete which hormone? a. antidiuretic hormone (ADH) c. glucocorticoids b. aldosterone d. parathyroid hormone ANS: A The posterior pituitary gland controls the secretion of the antidiuretic hormone (ADH), which results in the reabsoption of water in the kidney tubules. PTS: 1 DIF: Application REF: White (2010) 38. When a client’s sodium level is low, which of the following occurs? a. Bicarbonate ions move into the intracellular compartment. b. Chloride level is unchanged. c. Chloride level is low. d. Kidneys secrete bicarbonate ions. ANS: C Chloride, the major extracellular anion, functions with sodium to maintain osmotic pressure and aid in maintaining acid-base balance. There is a direct relationship between the values of these electrolytes. PTS: 1 DIF: Application REF: White (2010) 39. The nurse is caring for a client with hyponatremia. When reviewing the client’s health history, the nurse can identify the condition is the result of: a. eating foods high in sodium c. prolonged vomiting or diarrhea b. nasal suctioning d. dehydration ANS: C Hyponatremia, a serum sodium value of less than 136 mEq/L, results from a sodium deficit as a result of prolonged vomiting, diarrhea, or a water excess that results in edema. PTS: 1 DIF: Application REF: White (2010) 40. Increased sodium intake, decreased sodium loss, or excessive water loss can lead to which of these disturbances? a. hypernatremia c. metabolic acidosis b. hyponatremia d. respiratory alkalosis ANS: A Hypernatremia, a serum sodium level greater than 145 mEq/L, results from excess sodium or water loss and movement of water from cells to the extracellular space. PTS: 1 DIF: Comprehension 41. What is a major function of potassium within the body? a. maintaining normal nerve and muscle activity b. regulating cardiac enzymes c. regulating kidney function d. stimulating the excretion or retention of chloride full file at http://testbankcorner.eu REF: White (2010) full file at http://testbankcorner.eu ANS: A Potassium, the major electrolyte in intracellular fluid, maintains normal nerve and muscle activity and osmotic pressure within the cells and aids in the cellular metabolism of carbohydrates and proteins. PTS: 1 DIF: Comprehension REF: White (2010) 42. Potassium is mainly excreted by which of these organs? a. kidneys c. respiratory system b. liver d. skin ANS: A In efforts to maintain homeostasis, the kidneys can either excrete or retain potassium. PTS: 1 DIF: Knowledge REF: White (2010) 43. What term refers to the condition in which a person has a potassium level of less than 3.5 mEq/L? a. hyperkalemia c. hypokalemia b. hypernatremia d. hyponatremia ANS: C Hypokalemia, a serum potassium level of less than 3.5 mEq/L, can result from the use of diuretics or from gastrointestinal tract disturbances. PTS: 1 DIF: Knowledge REF: White (2010) 44. A person who has a serum potassium level of 6.5 mEq/L has which of these conditions: a. hyperkalemia c. hypokalemia b. hyperpotassemia d. normal serum potassium level ANS: A The normal serum potassium range is 3.5 to 5.0 mEq/L. Hyperkalemia, a serum potassium level greater than 5.0 mEq/L, results from inadequate excretion from the kidneys or from excessive trauma; it can be life threatening. PTS: 1 DIF: Knowledge REF: White (2010) 45. Calcium plays an essential role in which of these processes? a. vitamin B absorption c. digestion b. muscle strength d. blood clotting ANS: D Calcium is essential for blood clotting, muscle functioning, nerve impulse transmission, and bone and teeth integrity. PTS: 1 DIF: Comprehension REF: White (2010) 46. Which of these substances is required for calcium absorption within the gastrointestinal (GI) tract? a. albumin c. triglycerides b. glucose d. vitamin D ANS: D Adequate dietary intake of vitamin D is required for calcium absorption. PTS: 1 DIF: Comprehension full file at http://testbankcorner.eu REF: White (2010) full file at http://testbankcorner.eu 47. The nurse is reviewing the laboratory results of an assigned client. The nurse recognizes the normal value of ionized serum calcium for adults is: a. less than 4.5 mEq/L c. 5.7 to 9.0 mEq/L b. 4.5 to 5.6 mEq/L d. 9.1 to 10.5 mEq/L ANS: B The normal range of serum calcium (ionized) is 4.5 to 5.6 mEq/L; the total serum calcium (ionized and bound to albumin) range for adults is 9.0 to 10.5 mg/dL. PTS: 1 DIF: Application REF: White (2010) 48. The nurse is reviewing the laboratory results of an assigned client. The nurse recognizes the normal value for adult total serum calcium is: a. less than 4.5 mg/dL c. 5.7 to 8.4 mg/dL b. 4.5 to 5.6 mg/dL d. 8.5 to 10.5 mg/dL ANS: D The normal range of serum calcium (ionized) is 4.5 to 5.6 mg/dL; the total serum calcium (ionized and bound to albumin) range for adults is 8.5 to 10.5 mg/dL. PTS: 1 DIF: Application REF: White (2010) 49. A client has an elevated total serum calcium level. Which of these health problems may have contributed to this disturbance? a. cardiovascular disease c. hypothyroidism b. excess intake of antacids d. kidney failure ANS: B Hypercalcemia, a total serum calcium level of more than 10.5 mg/dL or ionized serum calcium level of less than 5.6 mEq/L, can result from bone disease such as a metastatic tumor or excessive calcium intake. PTS: 1 DIF: Application REF: White (2010) 50. A client’s calcium level is 9.5 mg/dL. A nurse would expect the client’s phosphate level to be: a. high c. low b. the same as the calcium level d. normal ANS: D Phosphate and calcium have an inverse relationship. If one electrolyte is elevated, the other will be decreased. The normal range of serum calcium (ionized) is 4.5 to 5.6 mEq/L; the total serum calcium (ionized and bound to albumin) range for adults is 9.0 to 10.5 mg/dL. The normal serum phosphorus range is 1.7 to 2.6 mEq/L. PTS: 1 DIF: Application REF: White (2010) 51. Where is most magnesium found in the body? a. bones, teeth, and smooth, skeletal and cardiac muscle b. intracellular fluid, bones, muscle, and soft tissue combined with calcium and phosphorus c. intravascular fluids such as blood, plasma, and lymph d. extracellular fluid, a part of the neuromuscular transmitter system ANS: B full file at http://testbankcorner.eu full file at http://testbankcorner.eu Magnesium, found in intracellular fluid and in combination with calcium and phosphorus in bone, muscle, and soft tissue, is important in the metabolism of carbohydrates and proteins. PTS: 1 DIF: Comprehension REF: White (2010) 52. The client states his serum magnesium level is finally normal. The nurse identifies the client’s normal value range as: a. 1.2 to 1.5 mEq/L c. 2.7 to 4.0 mEq/L b. 1.5 to 2.5 mEq/L d. 4.1 to 6.0 mEq/L ANS: B Normal range of serum magnesium is 1.5 to 2.5 mEq/L. PTS: 1 DIF: Application REF: White (2010) 53. Hypermagnesemia is defined as a serum magnesium level of how many mEq/L? a. less than 1.5 mEq/L c. 3.0 to 4.9 mEq/L b. 1.5 to 2.5 mEq/L d. greater than 2.5 mEq/L ANS: D Hypermagnesemia, a serum magnesium level greater than 2.5 mEq/L, results from ketoacidosis, renal failure, or excessive intake of magnesium antacids. PTS: 1 DIF: Knowledge REF: White (2010) 54. Which of the following may contribute to the development of hypermagnesemia? a. uncontrolled diabetes mellitus c. respiratory failure b. metastatic bone tumors d. alcoholism ANS: A Hypermagnesemia, a serum magnesium level greater than 2.5 mEq/L, results from ketoacidosis, renal failure, or excessive intake of magnesium antacids. PTS: 1 DIF: Application REF: White (2010) 55. Decreased magnesium levels can be associated with which of the following? a. chronic alcoholism c. Addison’s disease b. renal failure d. uncontrolled diabetes mellitus ANS: A Hypomagnesemia, a serum magnesium level of less than 1.5 mEq/L, is most often the result of chronic alcoholism or is secondary to prescribed medications. PTS: 1 DIF: Comprehension REF: White (2010) 56. When caring for a client with hypomagnesemia, the nurse should also expect which of these lab results? a. decreased levels of calcium and potassium b. decreased levels of phosphorus and sodium c. increased levels of calcium and potassium d. increased levels of phosphorus and sodium ANS: A full file at http://testbankcorner.eu full file at http://testbankcorner.eu There is a direct relationship between calcium, potassium, and magnesium. Normal range of serum magnesium is 1.5 to 2.5 mEq/L. A level of 0.9 mEq/L is a decrease; therefore, all levels would be decreased. PTS: 1 DIF: Application REF: White (2010) 57. A client’s magnesium level is 0.9 mEq/L. A nurse would expect the client’s calcium and potassium levels to be: a. elevated c. decreased b. the same as the magnesium level d. normal ANS: C There is a direct relationship between calcium, potassium, and magnesium. Normal range of serum magnesium is 1.5 to 2.5 mEq/L. A level of 0.9 mEq/L is a decrease; therefore, all levels would be decreased. PTS: 1 DIF: Application REF: White (2010) 58. A client is taking medications that include digoxin, baby aspirin, K-Dur, and Lasix. The client complains of muscle cramps and facial tics. The nurse discovers the client has positive Chvostek’s and Trousseau’s signs, has hypotension, and is confused. If the client is exhibiting signs of hypomagnesemia, which of these findings would the nurse also expect the client to exhibit? a. elevated serum calcium and potassium levels b. decreased serum calcium and potassium levels c. impaired acid-base balance d. bradycardia and cardiac dysryhthmias ANS: B Magnesium, found in intracellular fluid and in combination with calcium and phosphorus in bone, muscle, and soft tissue, is important in the metabolism of carbohydrates and proteins. Normal range of serum magnesium is 1.5 to 2.5 mEq/L. Hypomagnesemia, a serum magnesium level of less than 1.5 mEq/L, is most often the result of chronic alcoholism or is secondary to prescribed medications. There is a direct relationship between the levels of magnesium, potassium, and calcium; if one is decreased, the others will also be decreased. PTS: 1 DIF: Application REF: White (2010) 59. Where is phosphate mostly found in the body? a. blood, plasma, and lymph c. cardiac muscle b. bone and teeth d. smooth muscle and nerve tissue ANS: B Phosphate functions with calcium in the bones and teeth. PTS: 1 DIF: Knowledge REF: White (2010) 60. What is the normal range of adult serum phosphate levels? a. 1.5 to 2.0 mg/dL c. 1.7 to 2.6 mg/dL b. 2.5 to 2.9 mg/dL d. 3.5 to 5.5 mg/dL ANS: C The normal serum phosphorus range is 1.7 to 2.6 mg/dL. full file at http://testbankcorner.eu full file at http://testbankcorner.eu PTS: 1 DIF: Knowledge REF: White (2010) 61. When caring for a client with a phosphate level of 4.7 mg/dL, the nurse would expect the client’s calcium level to be: a. elevated c. decreased b. equal to the phosphate level d. normal ANS: C Phosphate and calcium have an inverse relationship. If one electrolyte is elevated, the other will be decreased. The normal serum phosphorus range is 2.5 to 4.5 mg/dL. PTS: 1 DIF: Application REF: White (2010) 62. Chloride is mainly excreted by which body system? a. kidneys c. respiratory b. liver d. skin ANS: A The body’s main method of excretion for most electrolytes is through the kidneys. PTS: 1 DIF: Knowledge REF: White (2010) 63. When caring for a client with a chloride level of 120 mEq/L, the nurse would expect the client’s sodium level to be: a. elevated c. decreased b. the same as the chloride level d. normal ANS: A Chloride, the major extracellular anion, functions with sodium to maintain osmotic pressure and aid in maintaining acid-base balance. There is a direct relationship between the values of these electrolytes. PTS: 1 DIF: Analysis REF: White (2010) 64. Which of these body systems regulate acid-base balance within the body? a. central nervous system and lymphatic system b. heart and lungs c. integumentary system and lungs d. lungs and kidneys ANS: D Body pH is maintained by the buffer systems, the respiratory system, and the kidneys. Chloride, the major extracellular anion, functions with sodium to maintain osmotic pressure and aid in maintaining acid-base balance. There is a direct relationship between the values of these electrolytes. PTS: 1 DIF: Knowledge REF: White (2010) 65. The physician requires more information on the client’s acid-base balance. The nurse anticipates the physician ordering which lab test to measure acid-base balance? a. arterial blood gases (ABG) c. serum hydrogen level b. serum carbon-dioxide level d. serum oxygen level ANS: A Body pH is maintained by the buffer systems, the respiratory system, and the kidneys. The diagnostic test used to evaluate this effectiveness are arterial blood gases. full file at http://testbankcorner.eu full file at http://testbankcorner.eu PTS: 1 DIF: Comprehension REF: White (2010) 66. Which organ regulates the amount of carbon dioxide circulating in the blood? a. blood c. lungs b. kidneys d. pancreas ANS: C The lungs regulates the amount of carbon dioxide circulating in the blood through the retention or excretion of the gas. PTS: 1 DIF: Knowledge REF: White (2010) 67. The client is experiencing an increase in carbonic acid due to the failure of the lungs to adequately eliminate carbon dioxide, which results in: a. metabolic acidosis c. respiratory acidosis b. metabolic alkalosis d. respiratory alkalosis ANS: C Respiratory acidosis is caused by hypoventilation or respiratory depression; if this situation occurs suddenly, the condition is life-threatening. Continual depression of the respiratory rate results in chronic respiratory acidosis. In respiratory acidosis, the blood pH level is below 7.35, the partial carbon dioxide level is greater than 45 mmHg, and there is an excess of carbonic acid. PTS: 1 DIF: Analysis REF: White (2010) 68. The nurse is caring for a client experiencing respiratory alkalosis. Which of these conditions is a causative agent? a. pneumonia c. anxiety b. brain injury d. emphysema ANS: C A client experiences respiratory alkalosis as a result of hypoxia (decrease in H+ ions). The most common causative agent is anxiety. PTS: 1 DIF: Application REF: White (2010) 69. Which of these conditions results from a decreased level of carbonic acid from hyperventilation? a. metabolic acidosis c. respiratory acidosis b. metabolic alkalosis d. respiratory alkalosis ANS: D Respiratory alkalosis is caused by hyperventilation, which can be precipitated by anxiety, fear, pain, fever, rapid mechanical ventilation, hypoxia at high altitudes, or by disease conditions such as brain tumors. In respiratory alkalosis, the blood pH is above 7.45 and the partial carbon dioxide level is less than 35 mmHg. PTS: 1 DIF: Comprehension REF: White (2010) 70. The nurse knows that if a client is retaining too much hydrogen or losing too much bicarbonate, it can result in which of these conditions? a. metabolic acidosis c. respiratory acidosis b. metabolic alkalosis d. respiratory alkalosis full file at http://testbankcorner.eu full file at http://testbankcorner.eu ANS: A Metabolic acidosis is caused by kidney disease, vomiting, diarrhea, diabetes mellitus, or use of diuretics. In metabolic acidosis, the blood pH is below 7.35 (indicating an increase in H+ ions or a loss of bicarbonate). PTS: 1 DIF: Application REF: White (2010) 71. An increase in bicarbonate or a decrease in hydrogen ion concentration in a client results in which of these conditions? a. metabolic acidosis c. respiratory acidosis b. metabolic alkalosis d. respiratory alkalosis ANS: B Metabolic alkalosis is caused by excessive ingestion of antacids or milk, or by excessive oral or parenteral administration of sodium bicarbonate or other alkaline salts. In metabolic alkalosis, the blood pH is greater than 7.45 (indicating a lose of H+ ions) and an increase in bicarbonate. PTS: 1 DIF: Application REF: White (2010) 72. The nurse is caring for a client experiencing metabolic alkalosis. Which of these conditions may cause this? a. overly vigorous mechanical ventilation b. hyperkalemia c. prolonged nasogastric suctioning d. pain ANS: C Metabolic alkalosis is caused by excessive ingestion of antacids or milk, or by excessive oral or parenteral administration of sodium bicarbonate or other alkaline salts and prolonged nasogastric suctioning. Overly vigorous mechanical ventilation and pain result in respiratory alkalosis. Hyperkalemia results in metabolic acidosis. PTS: 1 DIF: Analysis REF: White (2010) 73. A nurse is providing care for a client with Guillain-Barré syndrome. The nurse reviews the results of the arterial blood gases and determines the client is experiencing respiratory acidosis. The nurse would expect to find which of the following on the laboratory results? a. pH 7.40, pCO2 56 mmHg c. pH 7.25, pCO2 58 mmHg b. pH 7.35, pCO2 42 mmHg d. pH 7.50, pCO2 28 mmHg ANS: C The normal pH is 7.35 to 7.45. The normal pCO2 is 34 to 45 mmHg. In the client experiencing respiratory acidosis, the nurse would expect to find the pH range to be decreased and the pCO2 range to be increased. Guillain-Barré syndrome caused the decrease in the respiratory function due to paralysis of the intercostal muscles and the diaphragm. PTS: 1 DIF: Analysis REF: White (2010) 74. The nurse is caring for a client with a critically high potassium level. The client has received sodium polystyrene sulfonate (Kayexalate). The nurse determines the medication’s effectiveness if the client’s repeat serum potassium level is: a. 6.2 mEq/L c. 5.5 mEq/L b. 5.8 meq/L d. 4.9 mEq/L full file at http://testbankcorner.eu full file at http://testbankcorner.eu ANS: D The normal serum potassium level in the adult is 3.5 to 5.0 mEq/L. PTS: 1 DIF: Analysis REF: White (2010) 75. The nurse is caring for a client with respiratory alkalosis. Arterial blood gas results indicate a pH of 7.58 and a pCO2 of 28 mmHg. Which of the following additional laboratory values would the nurse would also expect to find? a. sodium level, 145 mEq/L c. magnesium level, 2.4 mg/dL b. potassium level, 3.2 mEq/L d. phosphorus level, 4.0 mg/dL ANS: B Clinical manifestations of respiratory alkalosis include tachypnea, mental status changes, dizziness, pallor around the mouth, spasms of the muscles of the hands, and hypokalemia. PTS: 1 DIF: Analysis REF: White (2010) 76. The nurse is caring for a client with a diagnosis of pneumonia. The client’s arterial blood gas results indicate a pH of 7.32 and a pCO2 of 32 mmHg. The nurse determines that these results indicate which of the following condition? a. metabolic acidosis c. respiratory alkalosis b. metabolic alkalosis d. respiratory acidosis ANS: D The normal pH range is 7.35 to 7.45. In a client experiencing a respiratory condition, an opposite relationship will be seen between the pH level and the pCO2 levels. In an acidosis condition, the pH value is decreased and the pCO2 value is increased. A client experiencing a diagnosis of pneumonia is at risk for respiratory acidosis as a result of hypoxia (increase in H+ ions). PTS: 1 DIF: Analysis REF: White (2010) 77. A client has had blood drawn for determination of serum electrolyte levels. The nurse identifies which of the following as an abnormal value? a. sodium, 148 mEq/L c. calcium, 95 mg/dL b. potassium, 3.8 mEq/L d. bicarbonate, 26 mEq/L ANS: A The normal serum electrolyte ranges are sodium, 135 to 145 mEq/L; potassium, 3.5 to 5.0 mEq/L; calcium, 8.5 to 10.5 mg/dL; bicarbonate, 22 to 28 mEq/L. The serum sodium level is the only abnormal value. PTS: 1 DIF: Analysis REF: White (2010) 78. The nurse who is caring for a client with a diagnosis of cirrhosis suspects fluid volume excess. The client is experiencing dyspnea, and a respiratory rate of 32, and crackles are heard on the auscultation of the lungs. If a fluid volume excess is present, what additional findings would the nurse expect to note in this client? a. flat hand and neck veins c. elevated blood pressure b. weak and thready pulse d. increased urine output ANS: C full file at http://testbankcorner.eu full file at http://testbankcorner.eu The findings associated in a client experiencing fluid volume excess include cough, dyspnea, crackles, tachypnea, tachycardia, and elevated blood pressure and a bounding pulse, weight gain, edema, neck and hand vein distention, altered level of consciousness, and a decreased hematocrit. PTS: 1 DIF: Synthesis REF: White (2010) 79. The client with a history of hypertension is taking furosemide (Lasix). The nurse reviews the client’s serum potassium levels and would report which of the following before administering the dose of furosemide? a. 3.2 mEq/L c. 4.2 mEq/L b. 3.8 mEq/L d. 4.8 mEq/L ANS: A The normal serum potassium range is 3.5 to 5.0 mEq/L. Hypokalemia, a serum potassium level of less than 3.5 mEq/L, can result from the use of diuretics or from gastrointestinal tract disturbances. Administering furosemide to a client with a low potassium level could result in dysrhythmias in the client. PTS: 1 DIF: Analysis REF: White (2010) 80. The nurse is caring for a client experiencing diabetic ketoacidosis and notes that the client is exhibiting Kussmaul’s respirations. Based on this information, which of the following would the nurse MOST likely have observed? a. respirations that are abnormally deep, regular, and increased in rate b. respirations that are regular but abnormally slow c. respirations that are labored and increased in depth and rate d. respirations that cease for several seconds ANS: A Kussmaul’s respirations are characterized by abnormally deep, regular, and increased in rate. In the remaining answer options, respirations have some but not all the characteristics. PTS: 1 DIF: Analysis REF: White (2010) full file at http://testbankcorner.eu