1.

After extensive, prolonged surgery it is most important that the nurse observe the client
for the depletion of the electrolyte:
a. Calcium c. Potassium
b. Sodium d. Chloride
2. The most important electrolyte of extracellular fluid is:
a. Calcium c. Potassium
b. Sodium d. Chloride
3. A client is admitted with diarrhea, anorexia, weight loss and abdominal cramps. A
diagnosis of colitis is made. The symptoms of fluid and electrolyte imbalance caused by
this condition that the nurse should report immediately are:
a. Tachycardia and extreme muscle weakness
b. Diplopia, skin rash and diarrhea
c. Leg and stomach cramps, nausea and vomiting
d. Development of tetany with muscle spasms
4. A client is admitted to the hospital for hypocalcemia. Nursing interventions relating to
which system would have the highest priority?
a. Cardiac c. Neuromuscular
b. Renal d. Gastrointestinal
5. A client is receiving digoxin (Lanoxin) and furosemide (Lasix). The client should be
observed for symptoms of electrolyte depletion caused by;
a. Sodium restriction
b. Continuous dyspnea
c. Inadequate oral intake
d. Diuretic therapy
Situation: A nurse is caring for a client who arrives at the emergency room with
the emergency medical services team following a burn injury from an explosion.
The client has sustained thoracic burns and smoke inhalation. (Nos. 6- 10)
6. A nurse assesses the carbon monoxide level of a client following a burn injury and notes
that the level is 14%. Based on this level, which finding would the nurse expect to note
during the assessment of the client?
a. Tachycardia c. Headache
b. Nausea d. Impaired visual acuity
7. The nurse avoids which action in caring for a client who sustained smoke inhalation and
is at risk for impaired gas exchange?
a. Suctioning the airway as needed
b. Repositioning the client from side to side every 2 hours
c. Providing humidified oxygen as prescribed
d. Maintaining the client in a supine position with the head of the bed elevated
8. Which initial finding would indicate the presence of inhalation injury?
a. The presence of sputum tinged with carbon and singed nasal hair
b. Tachycardia
c. Expectoration of sputum tinged with blood
d. Absent breath sounds in the lower lobes bilaterally
9. A nurse assesses the client’s burn injury and determines that the client sustained a
partial-thickness superficial burn. Based on this determination, which finding did the
nurse note?
a. Absence of wound sensation
b. Charring at the wound site
c. A dry wound surface
d. A wet, shiny, weeping wound
10. The patient receives daily doses of furosemide (Lasix) and digoxin (Lanoxin) for
treatment of heart failure. The patient is more likely to develop a toxic reaction to
digoxin if he has concurrent:
 a. Hyponatremia c. Hypernatremia
b. Hyperkalemia d. Hypokalemia
11. His serum potassium level is 3.1 mEq/L. Which associated electrocardiogram changes
would you expect?
a. Peaked T wave
b. Depressed ST segment
c. Narrow QRS complex
d. Absent P waves
12. As part of the patient’s treatment for hypokalemia, the doctor prescribes IV potassium
supplementation. At which rate should it be administered?
a. 5 mEq/hour c. 15 mEq/hour
b. 10 mEq/hour d. 20 mEq/hour
13. The patient calls you to her room because he’s short of breath. You assess him and find
that his heart failure is worsening. Which type of fluid volume excess is the patient
experiencing because of his heart failure?
a. Intravascular c. Intracellular
b. Extracellular d. Interstitial
14. During the fluid accumulation phase of a major burn injury, fluid shifts from the:
a. Intravascular space to the interstitial space
b. Interstitial space to intravascular space
c. Intracellular space to interstitial space
d. Intravascular space to intracellular space
15. You insert an IV line and begin fluid resuscitation. The doctor wants you to use the
Parkland formula. What amount of Lactated Ringer’s solution should you administer over
the first 8 hours?
a.700 mL c. 1,400 mL
b.7,000 mL d. 6,000 mL
16. 48 hours after the burn injury, what physiologic changes can be expected?
a. Edema development
b. Increased blood volume
c. Decreased hemoglobin level
d. Profuse urination
17. During the fluid remobilization phase, the nurse would expect to see signs of which
electrolyte imbalance?
a. Hypokalemia c. Hypernatremia
b. Hyperkalemia d. Hypovolemia
18. Burn wound sepsis develops and mafenide acetate 10% (Sulfamylon) is ordered BID.
While applying Sulfamylon to the wound, it is important for the nurse to prepare the
client for expected responses to the topical application which include
a.Severe burning pain for a few minutes following application
b.Possible severe metabolic alkalosis with continued use
c. Black discoloration of everything that comes in contact with this drug
d.Chilling due to evaporation of solution from the moistened dressings
19. A client is admitted to the hospital after sustaining burns to the chest, abdomen, right
arm, and right leg. Using the “rule of nines,” the nurse would determine that about what
percentage of the client’s body surface has been burned?
a. 18%
b. 27%
c. 45%
d. 64%
20. The nurse assesses the client for fluid shifting. Fluid shifts that occur during the
emergent phase of a burn injury are caused by fluid moving:
a. From the vascular to the interstitial space
 b. From the extracellular to the intracellular space
c. From the intracellular to the extracellular space
d. From the interstitial to the vascular space
21. The nurse should recognize that fluid shift in a client with burn injury results from an
increase in the:
a. Permeability of capillary wash
b. Total volume of intravascular plasma
c. Total volume of circulating whole blood
d. Permeability of the kidney tubules
22. A priority nursing diagnosis for a client with burns during emergent period would be
a. Excess Fluid Volume
b. Imbalanced Nutrition: Less than Body Requirements
c. Risk for Injury (falling)
d. Risk for infection
23. Which of the following activities should the nurse include in the care plan of a client with
burn injuries to be carried out about one- half hour before the daily whirlpool bath and
dressing change?
a. Soak the dressing
b. Remove the dressing
c. Administer an analgesic
d. Slit the dressing with blunt scissors
24. Which of the following questions may lead the nurse to identify a predisposing factor for
hypomagnesemia?
a. “Are you taking calcium supplements?”
b. “Do you have diabetes mellitus?”
c. “Do you have any bowel problems?”
d. “Did you have a thyroid surgery recently?”
25. The physician has ordered 1000ml. TPN in 12 hours to be infused via a subclavian
catheter. When preparing the equipment it would be most important for the nurse to
obtain:
a. A steady IV pole
b. An infusion pump
c. An infusion set delivering 60gtt/mL
d. A set of clamps (hemostats0 taped at the bedside
26. A client is to receive an IV solution containing potassium chloride. When starting this IV
infusion the nurse should select:
a. The antecubital space in the client’s arm
b. The largest possible vein in the client’s arm
c. A vein in the back of the client’s dominant hand
d. A vein in the back of the clients non-dominant hand
27. When evaluating a client’s response to fluid replacement therapy, the observation that
indicates adequate tissue perfusion to vital organs would be:
a. Urinary output of 30ml per hour
b. Central venous pressure reading of 2cm H2O
c. Pulse rates of 120 and 110 in a 15-minute period
d. BP readings of 50/30 and 70/40 mm Hg within 30 minutes
28. Elimination of excess potassium through stools is the action of which medication that will therapeutically
treat hyperkalemia is?
A. Calcium gluconate C. Kayeaxelate
B. Insulin and glucose D. Sodium bicarbonate
29. Which among the following principles of fluid movement is correctly stated?
A. Osmosis is movement of water from an area of low to high solutee concentration
B. Diffusion is movement of fluid from an area of low to high molecular component
 C. Active transport is movement of subtances without energy utilization
D. Filtration is from an area of low hydrostatic pressure to high hydrostatic pressure
30. 6. Which among the following types of intravenous fluid solution/s is considered to be isotonic?
A. PNSS C. PLR
B. D5W D. AOTA
31. PH 7.57. PaCO2 22. HCO3- 17
a. Respiratory Acidosis. Partially Compensated
b. Respiratory Alkalosis. Uncompensated
c. Metabolic Acidosis. Partially Compensated
d. Respiratory Alkalosis. Partially Compensated
32. PH 7.39. PaCO2 44. HCO3- 26
a. Respiratory Acidosis
b. Metabolic Acidosis
c. Respiratory Alkalosis
d. Normal
33. PH 7.55. PaCO2 25. HCO3- 22
a. Respiratory Acidosis. Partially Compensated
b. Respiratory Alkalosis. Uncompensated
c. Metabolic Alkalosis. Partially Compensated
d. Metabolic Acidosis. Uncompensated
34. PH 7.17. PaCO2 48. HCO3- 36
a. Respiratory Acidosis. Uncompensated
b. Metabolic Acidosis. Partially Compensated
c. Respiratory Alkalosis. Partially Compensated
d. Respiratory Acidosis. Partially Compensated
35. PH 7.34. PaCO2 24. HCO3- 20
a. Respiratory Acidosis. Partially Compensated
b. Metabolic Acidosis. Partially Compensated
c. Metabolic Acidosis. Uncompensated
d. Metabolic Alkalosis. Partially Compensated
36. PH 7.64. PaCO2 25. HCO3- 19
a. Respiratory Acidosis. Uncompensated
b. Respiratory Alkalosis. Partially Compensated
c. Respiratory Alkalosis. Uncompensated
d. Metabolic Alkalosis. Partially Compensated
37. PH 7.45. PaCO2 50. HCO3- 30
a. Metabolic Alkalosis. Fully Compensated
b. Respiratory Alkalosis. Fully Compensated
c. Metabolic Alkalosis. Partially Compensated
d. Respiratory Acidosis. Partially Compensated
38. PH 7.6. PaCO2 53. HCO3- 38
a. Metabolic Alkalosis. Partially Compensated
b. Metabolic Alkalosis. Fully Compensated
c. Respiratory Acidosis. Partially Compensated
d. Respiratory Alkalosis. Fully Compensated
39. PH 7.5. PaCO2 19. HCO3- 22
a. Respiratory Alkalosis. Partially Compensated
b. Metabolic Alkalosis. Partially Compensated
c. Respiratory Acidosis. Uncompensated
d. Respiratory Alkalosis. Uncompensated
40. PH 7.4. PaCO2 59. HCO3- 35
a. Respiratory Acidosis. Uncompensated
 b. Metabolic Alkalosis. Uncompensated
c. Respiratory Acidosis. Fully Compensated
d. Metabolic Alkalosis. Partially Compensated
41. Dave, a 6-year-old boy, was rushed to the hospital following her mother’s complaint
that her son has been vomiting, nauseated and has overall weakness. After series of
tests, the nurse notes the laboratory results: potassium: 2.9 mEq. Which primary acid-
base imbalance is this boy at risk for if medical intervention is not carried out?
a. Respiratory Acidosis
b. Respiratory Alkalosis
c. Metabolic Acidosis
d. Metabolic Alkalosis
42. An old beggar was admitted to the emergency department due to shortness of breath,
fever, and a productive cough. Upon examination, crackles and wheezes are noted in
the lower lobes; he appears to be tachycardic and has a bounding pulse. Measurement
of arterial blood gas shows pH 7.2, PaCO2 66 mm Hg, HCO3 27 mmol/L, and PaO2
65 mm Hg. As a knowledgeable nurse, you know that the normal value for pH is:
a. 7.20
b. 7.30
c. 7.40
d. 7.50
43. Liza's mother is seen in the emergency department at a community hospital. She
admits that her mother is taking many tablets of aspirin (salicylates) over the last 24-
hour period because of a severe headache. Also, the mother complains of an inability
to urinate. The nurse on duty took her vital signs and noted the following: Temp =
97.8 °F; apical pulse = 95; respiration = 32 and deep. Which primary acid-base
imbalance is the client at risk for if medical attention is not provided?
a. Respiratory Acidosis
b. Respiratory Alkalosis
c. Metabolic Acidosis
d. Metabolic Alkalosis
44. A patient who is hospitalized due to vomiting and a decreased level of consciousness
displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in
response to stimulation. The doctor diagnosed him of having dehydration.
Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 22 mm
Hg, and HCO3 14 mmol/L; other results are Na+ 120 mmol/L, K+ 2.5 mmol/L, and
Cl- 95 mmol/L. As a knowledgeable nurse, you know that the normal value for
PaCO2 is:
a. 22 mm Hg
b. 36 mm Hg
c. 48 mm Hg
d. 50 mm Hg
45. A company driver is found at the scene of an automobile accident in a state of
emotional distress. He tells the paramedics that he feels dizzy, tingling in his
fingertips, and does not remember what happened to his car. Respiratory rate is rapid
 at 34/minute. Which primary acid-base disturbance is the young man at risk for if
medical attention is not provided?
a. Respiratory Acidosis
b. Respiratory Alkalosis
c. Metabolic Acidosis
d. Metabolic Alkalosis
46. An old man was admitted to hospital in a coma. Analysis of the arterial blood gave
the following values: PCO2 16 mm Hg, HCO3- 5 mmol/L and pH 7.1. As a well-
rounded nurse, you know that the normal value for HCO3 is:
a. 20 mmol/L
b. 24 mmol/L
c. 29 mmol/L
d. 31 mmol/L
47. In a patient undergoing surgery, it was vital to aspirate the contents of the upper
gastrointestinal tract. After the operation, the following values were acquired from an
arterial blood sample: pH 7.55, PCO2 52 mm Hg and HCO3- 40 mmol/l. What is the
underlying disorder?
a. Respiratory Acidosis
b. Respiratory Alkalosis
c. Metabolic Acidosis
d. Metabolic Alkalosis
48. A mountaineer attempts an assault on a high mountain in the Andes and reaches an
altitude of 5000 meters (16,400 ft) above sea level. What will happen to his arterial
PCO2 and pH?
a. Both will be lower than normal.
b. The pH will rise and PCO2 will fall.
c. Both will be higher than normal due to the physical exertion.
d. The pH will fall and PCO2 will rise
49. A young woman is found comatose, having taken an unknown number of sleeping
pills an unknown time before. An arterial blood sample yields the following values:
pH 6.90, HCO3- 13 meq/liter and PaCO2 68 mmHg. This patient’s acid-base status is
most accurately described as:
a. Metabolic Acidosis
b. Respiratory Acidosis
c. Simultaneous Respiratory and Metabolic Acidosis
d. Respiratory Acidosis with Complete Renal Compensation
50. A mother is admitted in the emergency department following complaints of fever and
chills. The nurse on duty took her vital signs and noted the following: Temp = 100 °F;
apical pulse = 95; respiration = 20 and deep. Measurement of arterial blood gas shows
pH 7.37, PaO2 90 mm Hg, PaCO2 40 mm Hg, and HCO3 24 mmol/L. What is your
assessment?
a. Hyperthermia
b. Hyperthermia and Respiratory Alkalosis
c. Hypothermia
d. Hypothermia and Respiratory Alkalosis
RATIONALIZATION 41-50
1. Vomiting, hypokalemia, overdosage of NaHCO3 and NGT suctioning are
considered risk factors of metabolic alkalosis.
2. Normal blood pH must be maintained within a narrow range of 7.35-7.45 to
ensure the proper functioning of metabolic processes and the delivery of the
right amount of oxygen to tissues. Acidosis refers to an excess of acid in the
blood that causes the pH to fall below 7.35, and alkalosis refers to an excess of
base in the blood that causes the pH to rise above 7.45.
3. Salicylate overdose causes a high anion gap metabolic acidosis in both children
and adults. Adults commonly develop a mixed acid-base disorder as a
respiratory alkalosis due to direct respiratory centre stimulation occurs as well.
This second disorder is uncommon in children.
4. The normal range for PaCO2 is from 35 to 45 mm Hg.
5. Hyperventilation is typically the underlying cause of respiratory alkalosis.
Hyperventilation is also known as overbreathing. When someone is
hyperventilating, they tend to breathe very deeply or very rapidly.
6. The normal value for bicarbonate (HCO3) is 22-26 mmol/L or mEq/L. It may
vary slightly among different laboratories. The given values show the common
measurement range of results for these tests. Some laboratories use different
measurements or may test different specimens.
7. NGT suctioning, vomiting, hypokalemia and overdosage of NaHCO3 are
considered risk factors of metabolic alkalosis.
8. The mountaineer will suffer from a respiratory alkalosis. The decline in the
PO2 with altitude will stimulate breathing to offset the hypoxia. Carbon
dioxide is driven from the blood faster than it is produced in the tissues so
PCO2 falls and pH rises.
9. Whenever the PCO2 and HCO3 are abnormal in opposite directions, ie, one
above normal while the other is reduced, a mixed respiratory and metabolic
acid-base disorder exists. When the PCO2 is elevated and the [HCO3-]
reduced, respiratory acidosis and metabolic acidosis coexist.
10. An individual is considered to have hyperthermia if he or she has a temperature
of >37.5 or 38.3 °C (99.5 or 100.9 °F). Measurement of arterial blood gases are
normal.