NAME: ________________________________________ SCORE: ________

MULTIPLE CHOICE
Read each question carefully. Choose the best answer and state your rationale for choosing your
answer.

1. The average daily urinary output in an adult is:

a. 0.5 L. b. 1.0 L.
c. 1.5 L. d. 2.5 L.

2. A febrile patient’s fluid output is in excess of normal because of diaphoresis. The nurse should
plan fluid replacement based on the knowledge that insensible losses in an afebrile person are
normally not greater than:
a. 300 mL/24 h. b. 600 mL/24 h.
c. 900 mL/24 h. d. 1200 mL/24 h.

3. A patient’s serum sodium concentration is within the normal range. The nurse estimates that the
serum osmolality should be:
a. less than 136 mOsm/kg. b. 275 to 300 mOsm/kg.
c. greater than 408 mOsm/kg. d. 350 to 544 mOsm/kg.

4. The nurse expects that a decrease in serum osmolality would occur with:
a. diabetes insipidus. b. hyperglycemia.
c. renal failure. d. uremia.

5. A nurse can estimate that a patient has a serum osmolality of ______________ if the patient’s
serum sodium is 140 mEq/L.
a. 70 mOsm/kg b. 140 mOsm/kg
c. 210 mOsm/kg d. 280 mOsm/kg

6. The nurse notes that a patient’s urine osmolality is 980 mOsm/kg. The nurse knows to assess for
the possible cause of:
a. acidosis. b. fluid volume excess.
c. diabetes insipidus. d. hyponatrenia.

7. One of the best indicators of renal function is:

a. blood urea nitrogen. b. serum creatintine.
c. specific gravity. d. urine osmolality

8. A patient is hemorrhaging from multiple trauma sites. The nurse expects that compensatory
mechanisms associated with hypovolemia would cause all of the following symptoms EXCEPT:
a. hypertension. b. oliguria.
c. tachycardia. d. tachypnea.

9. A clinical manifestation not found in hypovolemia is:

a. muscle weakness. b. oliguria.
c. postural hypotension. d. bradycardia.
10. Laboratory findings consistent with hypovolemia in a female would include all of the following
EXCEPT:
a. hematocrit level of 47%. b. BUN–serum creatinine ratio of 12:1.
c. urine specific gravity of 1.027. d. urine osmolality of 450 mOsm/kg.

11. The nurse should expect that a patient with mild fluid volume excess would be prescribed a
diuretic that blocks sodium reabsorption in the distal tubule, such as:
a. Bumex. b. Demadex.
c. HydroDIURIL. d. Lasix.

12. When assessing the weight of a patient who is on a sodium-restricted diet, the nurse knows that
a weight gain of approximately 2 lb (2.2 lb 1 kg) is equivalent to a gain of how much fluid?
a. 0.5 L b. 1.0 L
c. 1.5 L d. 2.0 L

13. Nursing intervention for a patient with a diagnosis of hyponatremia includes all of the following
except:
a. assessing for symptoms of nausea and malaise.
b. encouraging the intake of low-sodium liquids, such as coffee or tea.
c. monitoring neurologic status.
d. restricting tap water intake.

14. A patient with abnormal sodium losses is receiving a house diet. To provide 1,600 mg of sodium
daily, the nurse could supplement the patient’s diet with:
a. one beef cube and 8 oz of tomato juice.
b. four beef cubes and 8 oz of tomato juice.
c. one beef cube and 16 oz of tomato juice.
d. one beef cube and 12 oz of tomato juice.

15. One of the dangers of treating hypernatremia is:

a. red blood cell crenation. b. red blood cell hydrolysis.
c. cerebral edema. d. renal shutdown.

16. A nurse is directed to administer a hypotonic intravenous solution. Looking at the following
labeled solutions, she should choose:
a. 0.45% sodium chloride. b. 0.90% sodium chloride.
c. 5% dextrose in water. d. 5% dextrose in normal saline solution.

17. An isotonic solution that contains electrolytes similar to the concentration used in plasma is:
a. 5% dextrose in water. b. lactated Ringer’s solution.
c. 3% NaCl solution. d. 5% NaCl solution.

18. A patient is admitted who has had severe vomiting for 24 hours. She states that she is
exhausted and weak. The results of an admitting electrocardiogram (ECG) show flat T waves and
ST-segment depression. Choose the most likely potassium (K) value for this patient.
a. 4.0 mEq/L b. 8.0 mEq/L
c. 2.0 mEq/L d. 2.6 mEq/L
19. The ECG change that is specific to hypokalemia is:
a. a depressed ST segment. b. a flat T wave.
c. an elevated U wave. d. an inverted T wave.

20. To supplement a diet with foods high in potassium, the nurse should recommend the addition of:
a. fruits such as bananas and apricots. b. green leafy vegetables.
c. milk and yogurt. d. nuts and legumes.

21. If a patient has severe hyperkalemia, it is possible to administer calcium gluconate intravenously
to:
a. immediately lower the potassium level by active transport.
b. antagonize the action of potassium in the heart.
c. prevent transient renal failure (TRF).
d. accomplish all of the above.

22. Cardiac effects of hyperkalemia are usually present when the serum potassium level reaches:
a. 5 mEq/L. b. 6 mEq/L.
c. 7 mEq/L. d. 8 mEq/L.

23. The most characteristic manifestation of hypocalcemia and hypomagnesemia is:

a. anorexia and nausea. b. constipation.
c. lack of coordination. d. tetany.

24. A patient complains of tingling in his fingers. He has positive Trousseau’s and Chvostek’s signs.
He says that he feels depressed. Choose the most likely serum calcium value for this patient.
a. 11 mg/dL b. 9 mg/dL
c. 7 mg/dL d. 5 mg/dL

25. Management of hypocalcemia includes all of the following actions except administration of:
a. fluid to dilute the calcium levels.
b. the diuretic furosemide (Lasix), without saline, to increase calcium excretion through the kidneys.
c. inorganic phosphate salts.
d. intravenous phosphate therapy.
26. Cardiac arrest will probably occur with a serum calcium level of:
a. 9 mg/dL. b. 12 mg/dL.
c. 15 mg/dL. d. 18 mg/dL.

27. A patient is admitted with a diagnosis of renal failure. He also mentions that he has had stomach
distress and has ingested numerous antacid tablets over the past 2 days. His blood pressure is
110/70 mm Hg, his face is flushed, and he is experiencing generalized weakness. Choose the most
likely magnesium value for this patient.
a. 11 mEq/L b. 5 mEq/L
c. 2 mEq/L d. 1 mEq/L

28. Management of the foregoing patient should include:

a. a regular diet with extra fruits and green vegetables.
b. potassium-sparing diuretics.
c. discontinuance of any oral magnesium salts.
d. all of the above measures.
29. A clinical indication of hypophosphatemia is:
a. bone pain. b. paresthesia.
c. seizures. d. tetany.

30. The most common buffer system in the body is the:

a. plasma protein buffer system.
b. hemoglobin buffer system.
c. phosphate buffer system.
d. bicarbonate–carbonic acid buffer system.

31. The kidneys regulate acid–base balance by all of the following mechanisms EXCEPT:
a. excreting hydrogen ions.
b. reabsorbing or excreting HCO3 into the blood.
c. reabsorbing carbon dioxide into the blood.
d. retaining hydrogen ions.

32. The lungs regulate acid–base balance by all of the following mechanisms EXCEPT: a. excreting
HCO3 into the blood.
b. slowing ventilation.
c. controlling carbon dioxide levels.
d. increasing ventilation.

33. Choose the condition that exhibits blood values with a low pH and a low plasma bicarbonate
concentration.
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
34. The nursing assessment for a patient with metabolic alkalosis includes evaluation of laboratory
data for all of the following EXCEPT:
a. hypocalcemia. b. hypoglycemia.
c. hypokalemia. d. hypoxemia.

35. Choose the condition that exhibits blood values with a low pH and a high PCO2.
a. Respiratory acidosis b. Respiratory alkalosis
c. Metabolic acidosis d. Metabolic alkalosis

36. A normal oxygen saturation value for arterial blood is:

a. 65%. b. 75%.
c. 85%. d. 95%.