The emergency department (ED) nurse cares for a client who reports per

Fluid and Electrolytes NCLEX RN Questions

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Question 1 of 5.

The emergency department (ED) nurse cares for a client who reports persistent nausea and vomiting for three days. Which acid-base imbalance would the nurse expect based on the client's manifestations?

A. A decreased pH and an elevated CO2

B. An elevated pH and a decreased CO2

C. A decreased pH and a decreased HCO3-

D. An increased pH with an increased HCO3-

Explanation: Persistent vomiting causes loss of gastric acid, increasing HCO3- and pH, leading to metabolic alkalosis (D).

Question 2 of 5.

The nurse recognizes which of the following are potential causes of metabolic alkalosis? Select all that apply.

A. Vomiting

B. Diarrhea

C. Antacids

D. Starvation

E. Hypokalemia

Explanation: Metabolic alkalosis is caused by an increase in bicarbonate or loss of acid. Vomiting (A) leads to loss of gastric acid, increasing bicarbonate. Antacids (C) neutralize acid, raising bicarbonate levels. Hypokalemia (E) can cause hydrogen ion shifts, contributing to alkalosis. Diarrhea (B) causes bicarbonate loss, leading to acidosis, not alkalosis. Starvation (D) is associated with ketoacidosis, not alkalosis.

Question 3 of 5.

Based on the results, which of the following orders should the nurse anticipate the physician would order? Laboratory: pH 7.33 [7.35-7.45], PaCO2 53 mm Hg [35-45 mm Hg], HCO3 24 mEq/L [22-28 mEq/L], PaO2 95 mm Hg [80-100 mm Hg]

A. supplemental oxygen

B. bronchodilator

C. regular insulin

D. sodium polystyrene

Explanation: The ABG shows respiratory acidosis (pH 7.33, PaCO2 53 mm Hg). Bronchodilators (B) improve ventilation, reducing PaCO2. Supplemental oxygen (A) is unnecessary as PaO2 is normal. Insulin (C) and sodium polystyrene (D) address metabolic issues, not respiratory acidosis.

Question 4 of 5.

Which essential action should the nurse take based on the results? Laboratory: pH 7.30 [7.35-7.45], PaCO2 66 mm Hg [35-45 mm Hg], HCO3 23 mEq/L [22-28 mEq/L], PaO2 77 mm Hg [80-100 mm Hg]

A. Review the most recent chest radiograph (x-ray)

B. Apply supplemental oxygen

C. Instruct the client how to use incentive spirometry

D. Obtain a prescription to infuse sodium bicarbonate

Explanation: The ABG indicates respiratory acidosis (pH 7.30, PaCO2 66 mm Hg) and hypoxemia (PaO2 77 mm Hg). Supplemental oxygen (B) addresses low PaO2. Chest radiograph (A) and incentive spirometry (C) are secondary. Sodium bicarbonate (D) is for metabolic acidosis, not respiratory.

Question 5 of 5.

The nurse cares for a client receiving mechanical ventilation and reviews the client's most recent arterial blood gas (ABG). The nurse communicates the result with the primary healthcare provider (PHCP) and should recommend a prescription for which medication? Laboratory: pH 7.33 [7.35-7.45], PaCO2 53 mm Hg [35-45 mm Hg], HCO3 24 mEq/L [22-28 mEq/L], PaO2 89 mm Hg [80-100 mm Hg]

A. pancuronium

B. midazolam

C. theophylline

D. famotidine

Explanation: The ABG shows respiratory acidosis (pH 7.33, PaCO2 53 mm Hg) due to hypoventilation. Theophylline (C) improves respiratory drive and ventilation. Pancuronium (A) and midazolam (B) suppress ventilation, worsening acidosis. Famotidine (D) addresses gastric issues, not respiratory.