Nokea
A client with hypervolemia asks the nurse what mechanism in the sodium potassium pump will move the excess body fluid. What is the correct answer from the nurse?
- A. Passive osmosis
- B. Free flow
- C. Passive elimination
- D. Active transport
Correct Answer: D
Rationale: Active transport is the physiologic pump that moves fluid from an area of lower concentration to one of higher concentration. Active transport requires adenosine triphosphate for energy. Passive osmosis does not require energy for transport. Free flow is transport of water naturally. Passive elimination is a filter process carried out in the kidneys.
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The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction. Which acid-base imbalance is most likely to occur?
- A. Respiratory alkalosis
- B. Metabolic alkalosis
- C. Respiratory acidosis
- D. Metabolic acidosis
Correct Answer: B
Rationale: Metabolic alkalosis results in increased plasma $\mathrm{pH}$ because of an accumulated base bicarbonate or decreased hydrogen ion concentration. Factors that increase base bicarbonate include excessive oral or parenteral use of bicarbonate- containing drugs, a rapid decrease in extracellular fluid volume and loss of hydrogen and chloride ions as with gastric suctioning. Acidotic states are from excess carbonic acid and hydrogen ions in the system. Respiratory alkalosis results from a carbonic acid deficit that occurs when rapid breathing releases more $\mathrm{CO}_2$ than necessary.
The nurse is instructing on the body's negative feedback loop to ensure homeostasis to a group of students. Which action by bases keeps the blood $\mathrm{pH}$ nearly neutral?
- A. Bases cast off acids.
- B. Bases bind with hydrogen.
- C. Bases hold acidic properties.
- D. Bases have no contact with acids.
Correct Answer: B
Rationale: Acids are substances that release hydrogen into fluid, bases are substances that bind with hydrogen. The delicate balance between acids and bases, as well as fluids and electrolytes, maintains the nearly neutral blood $\mathrm{pH}$.
The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation?
- A. Kidney and liver
- B. Heart and lungs
- C. Lungs and kidney
- D. Pancreas and stomach
Correct Answer: C
Rationale: The lungs and kidneys facilitate the ratio of bicarbonate to carbonic acid. Carbon dioxide is one of the components of carbonic acid. The lungs regulate carbonic acid levels by releasing or conserving $\mathrm{CO}_2$ by increasing or decreasing the respiratory rate. The kidneys assist in acid-base balance by retaining or excreting bicarbonate ions.
The nurse is conducting a lecture on the difference between hypovolemia and dehydration. When completing a verbal comparison, which point needs clarified?
- A. Similar causes are present in both conditions.
- B. Hypovolemia contains only low blood volume.
- C. In dehydration, only extracellular is depleted.
- D. Both conditions result in abnormal laboratory studies.
Correct Answer: C
Rationale: In clients diagnosed with dehydration, all fluid compartments including the intracellular and extracellular compartment are reduced. The other options are correct. Both states can be from similar disease process such as vomiting, fever, diarrhea and difficulty swallowing and also have abnormal lab work. It is correct that hypovolemia relates to low blood volume.
The nurse is caring for a client with severe hypokalemia. The physician has prescribed IV potassium to be administered at $10 \mathrm{mEq} / \mathrm{hr}$. The client complains of burning along the vein. What should the nurse do?
- A. Seek a physician's prescription to dilute the infusion.
- B. Switch to an oral formulation.
- C. Increase the speed of transfusion.
- D. Change the electrolyte.
Correct Answer: A
Rationale: Treatment of severe hypokalemia requires treatment with IV infusion of potassium. Clients may experience burning along the vein with IV infusion of potassium in proportion to the infusion's concentration. If the client can tolerate the fluid, consult with the physician about diluting the potassium in a larger volume of IV solution. Oral potassium may not be enough in severe cases hypokalemia. Hypokalemia requires treatment with potassium and not any other electrolyte.