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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)
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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)
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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.
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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
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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)
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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.
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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
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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.
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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
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REF: White (2010)
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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
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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
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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.
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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.
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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
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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
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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
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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