NACE Fluid and Electrolyte Balance 4 — Questions and Answers
Question 1: A client receiving IV fluids develops pitting edema, crackles in the lungs, and a bounding pulse. Which condition does the nurse suspect?
- Fluid volume deficit
- Fluid volume excess (Correct answer)
- Hyponatremia
- Hyperkalemia
Correct answer: Fluid volume excess
Pitting edema, pulmonary crackles, and bounding pulse are classic signs of fluid volume excess (hypervolemia).
Question 2: A nurse is caring for a client with a serum potassium of 6.2 mEq/L. Which food should the nurse instruct the client to avoid?
- White rice
- Bananas (Correct answer)
- White bread
- Iceberg lettuce
Correct answer: Bananas
Bananas are high in potassium and should be avoided by clients with hyperkalemia.
Question 3: Which clinical finding is most consistent with hypocalcemia?
- Hypertension
- Positive Trousseau's sign (Correct answer)
- Bradycardia
- Decreased deep tendon reflexes
Correct answer: Positive Trousseau's sign
Trousseau's sign (carpal spasm with BP cuff inflation) is a hallmark of hypocalcemia due to increased neuromuscular excitability.
Question 4: A post-operative client has a urine output of 20 mL/hr for 2 consecutive hours. What is the nurse's priority action?
- Document findings and continue monitoring
- Notify the provider (Correct answer)
- Encourage oral fluid intake
- Increase the IV flow rate independently
Correct answer: Notify the provider
Urine output below 30 mL/hr indicates oliguria and possible renal hypoperfusion; the provider must be notified promptly.
Question 5: Which IV fluid is considered isotonic and is most appropriate for replacing extracellular fluid losses?
- 0.45% NaCl
- 0.9% NaCl (Correct answer)
- 3% NaCl
- D10W
Correct answer: 0.9% NaCl
0.9% NaCl (normal saline) is isotonic and expands extracellular fluid without shifting water into or out of cells.
Question 6: A client with chronic kidney disease has a serum phosphate of 6.5 mg/dL. The nurse anticipates which secondary electrolyte imbalance?
- Hyperkalemia
- Hypercalcemia
- Hypocalcemia (Correct answer)
- Hypernatremia
Correct answer: Hypocalcemia
Elevated phosphate binds calcium in the bloodstream, causing hypocalcemia in clients with chronic kidney disease.
Question 7: The nurse is infusing D5W 0.45% NaCl. How does this solution behave once the dextrose is metabolized?
- It remains isotonic
- It becomes hypotonic, shifting fluid into cells (Correct answer)
- It becomes hypertonic, pulling fluid from cells
- It acts as a colloid
Correct answer: It becomes hypotonic, shifting fluid into cells
After dextrose is metabolized, the remaining 0.45% NaCl is hypotonic, causing free water to shift into cells.
NACE Fluid and Electrolyte Balance 4
A client receiving IV fluids develops pitting edema, crackles in the lungs, and a bounding pulse.
Which condition does the nurse suspect?