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Fluid, Electrolyte, Acid-Base Balance Test Id: 303010172 (Tutored, Timed) REVIEW
Dehydration QId: 46282 (3376743) Question 1 of 3

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The nurse is caring for an 82-year-old client.  For each finding, click to specify if the finding would be increased or decreased based on the
client's condition.
Nurses' Notes
Finding Increased Decreased

Medical-Surgical Unit
BUN 

The client is admitted from a long-term care facility due to watery diarrhea for the past 3 Heart rate 
days. The client is oriented to person but not to place or time. Skin turgor is poor and
mucous membranes are dry. The eyes appear sunken. Bowel sounds are hyperactive. Hematocrit  
The client reports feeling dizzy and fatigued.
Blood pressure 

Urine specific gravity 

4/5 0/1 Scoring 02 mins, 28 secs 2023

 Scored / Max  Scoring Rule   Time Spent  Version

Explanation

Signs of dehydration

Tachycardia
Postural hypotension
Dry mucous membranes & poor skin turgor
Flat neck & hand veins
Decreased urine output
Weight loss
Confusion & lethargy

Dehydration (eg, loss of body fluid) can occur secondary to gastrointestinal (eg, diarrhea,
vomiting), renal (eg, diuretics), or integumentary (eg, excessive sweating) losses and/or
inadequate fluid intake. Older adults have an increased risk for dehydration due to reduced thirst
response, difficulty obtaining fluids (eg, impaired mobility), and decreased muscle mass (leading to
less free water). Clinical manifestations include dry mucous membranes, poor skin turgor, pallor,
fatigue, decreased urine output, and sunken eyes.

In addition, clients with dehydration may experience:

Decreased blood pressure due to intravascular fluid loss and a compensatory increase in
heart rate (ie, tachycardia)

Increased hematocrit due to hemoconcentration from fluid loss

Increased urine specific gravity, which indicates a high concentration of urine due to fluid
loss

Increased BUN due to low urine output and renal accumulation of waste products that would
normally be excreted in urine

Treatment is typically oral rehydration. However, clients with symptoms of severe dehydration (eg,
lethargy, altered mental status) require IV fluid replacement due to ongoing losses and/or inability
to tolerate oral fluids.

Educational objective:
Older adults have an increased risk for dehydration (ie, loss of body fluid) due to reduced thirst
response, difficulty obtaining fluids (eg, impaired mobility), and decreased muscle mass (leading to
less free water). Clinical manifestations include dry mucous membranes, poor skin turgor,
decreased urine output, decreased blood pressure, tachycardia, increased hematocrit, increased
urine specific gravity, and increased BUN.

Physiological Adaptation
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Fluid, Electrolyte, Acid-Base Balance Test Id: 303010172 (Tutored, Timed) REVIEW
Hypokalemia QId: 46314 (3376743) Question 2 of 3

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The nurse is caring for a 58-year-old client in the emergency department.  Complete the following sentence by choosing from the lists of options.

Nurses' Notes The nurse recognizes that the client is most likely experiencing  Hypokalemia
and, without prompt intervention, is at risk for  Cardiac dysrhythmias .

Initial Clinic Visit

The client monitors blood pressure (BP) at home and reports that it has been elevated for 2/2 0/1 Scoring 01 min, 47 secs 2023
 Scored / Max  Scoring Rule   Time Spent  Version
the past month. Current BP is 157/92 mm Hg. Physical examination is normal. The
client is prescribed a thiazide diuretic for hypertension.

Emergency Department 4 Weeks Later Explanation

The client reports muscle weakness and severe cramping in the lower extremities with
Thiazide diuretics are used to treat hypertension by increasing urine output. Hypokalemia (serum
increased lethargy over the past 3 days. BP is 123/75 mm Hg. Physical examination
potassium <3.5 mEq/L [3.5 mmol/L]) is a complication of thiazide and loop diuretics due to
findings include 1+ deep tendon reflexes bilaterally.
increased renal excretion of potassium. Manifestations depend on the severity of the imbalance
but can include weakness, fatigue, and muscle cramps. Flaccid paralysis, hyporeflexia, and
cardiac dysrhythmias may occur with severe hypokalemia (serum potassium <2.5 mEq/L [2.5
mmol/L]).

(Incorrect) Hypoglycemia (blood glucose <70 mg/dL [3.9 mmol/L]) is a life-threatening deficiency
of glucose in the blood. Manifestations of hypoglycemia include tachycardia, shakiness, sweating,
hunger, anxiety, and pallor. Lack of glucose in the brain results in disorientation, impaired vision
and speech, seizures, and coma. Decreased deep tendon reflexes and muscle cramping are not
the primary manifestations.

(Incorrect) Hypermagnesemia (serum magnesium >2.1 mEq/L [1.05 mmol/L]) can occur due to
renal impairment (decreased magnesium excretion) and increased magnesium intake (eg, IV
magnesium, magnesium-based laxatives). Manifestations include lethargy, weakness, loss of
deep tendon reflexes, hypotension, bradycardia, and respiratory depression. Thiazide diuretics
may cause hypomagnesemia, not hypermagnesemia.

Educational objective:
Hypokalemia (serum potassium <3.5 mEq/L [3.5 mmol/L]) is a complication of diuretic therapy with
thiazide or loop diuretics (eg, furosemide). Symptoms depend on the severity of the imbalance but
can include weakness, fatigue, and muscle cramps. Flaccid paralysis, hyporeflexia, and cardiac
dysrhythmias may occur with severe hypokalemia (serum potassium <2.5 mEq/L [2.5 mmol/L]).

Physiological Adaptation
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Fluid, Electrolyte, Acid-Base Balance Test Id: 303010172 (Tutored, Timed) REVIEW
Acid base balance QId: 46110 (3376743) Question 3 of 3

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The nurse is providing care to a 43-year-old client in the emergency department.  Complete the following sentence/sentences by choosing from the list/lists of options.

Nurses' Notes Vital Signs Laboratory Results The client is most likely experiencing  Metabolic alkalosis and the nurse should
anticipate  Initiating 0.9% sodium chloride continuous IV infusion .

Admission

1800: The client reports fatigue, dizziness, and severe vomiting for the past 2 days. 2/2 0/1 Scoring 02 mins, 22 secs 2023
 Scored / Max  Scoring Rule   Time Spent  Version
Emesis is clear, nonbilious and nonbloody. The client reports no fever or
diarrhea. Mild epigastric tenderness is present but not abdominal distension.
Lungs are clear, and extremities have no edema.
Explanation

Nurses' Notes Vital Signs Laboratory Results

1800

T 98.2 F (36.8 C)

P 90

RR 14

BP 100/70

SpO2 96% on room air

Nurses' Notes Vital Signs Laboratory Results

Laboratory Results and Reference Range

Basic Metabolic Panel

When evaluating an arterial blood gas result, the nurse should:

Evaluate the pH: A pH >7.45 indicates alkalosis, which could be respiratory or metabolic.
Sodium
138 mEq/L
136-145 mEq/L Analyze the respiratory component: An increased PaCO2 (ie, an acid) can occur with
(138 mmol/L)
(136-145 mmol/L) respiratory acidosis or as compensation for metabolic alkalosis.

Analyze the metabolic component: An increased HCO3− (ie, a base) can be caused by loss
Potassium of gastric acid (eg, excessive vomiting) and indicates metabolic alkalosis as the primary
3.0 mEq/L
3.5-5.0 mEq/L disturbance.
(3.0 mmol/L)
(3.5-5.0 mmol/L)
Determine the compensation: An increased PaCO2 indicates that the respiratory system is
attempting to normalize the pH by increasing the amount of acid (eg, hypoventilation [carbon
Chloride
95 mEq/L dioxide gas {CO2} retention]).
98-106 mEq/L
(95 mmol/L)
(98-106 mmol/L) The nurse should administer an antiemetic to treat the underlying cause (ie, severe vomiting) and
initiate a 0.9% sodium chloride continuous IV infusion to treat volume depletion.
Arterial Blood Gas (Incorrect) Metabolic acidosis is identified by a pH <7.35 with a decreased HCO3− and normal
PaCO2. Common causes include diarrhea, diabetic ketoacidosis, and shock. Treatment includes
pH sodium bicarbonate.
7.49
7.35-7.45
(Incorrect) Respiratory acidosis is identified by a pH <7.35 with an increased PaCO2 and normal
HCO3−. The primary cause is CO2 retention secondary to hypoventilation (eg, narcotic overdose,
PaO2
95 mm Hg neuromuscular weakness, chronic obstructive pulmonary disease). Treatment involves the
80-100 mm Hg
(12.6 kPa) administration of oxygen via nasal cannula or ventilatory support.
(10.6-13.3 kPa)
(Incorrect) Respiratory alkalosis is identified by a pH >7.45 with a decreased PaCO2 and normal
HCO3−. The primary cause is increased CO2 excretion due to hyperventilation (eg, pain, anxiety);
PaCO2
48 mm Hg therefore, clients should be instructed to practice pursed-lip breathing to decrease the respiratory
35-45 mm Hg
(6.4 kPa) rate.
(4.66-5.98 kPa)
Educational objective:

HCO3– Metabolic alkalosis is identified by a pH >7.45 with an increased HCO3− and normal (or increased
30 mEq/L if compensated) PaCO2. Severe vomiting is a common cause due to loss of gastric acid. The
21-28 mEq/L
(30 mmol/L) nurse should administer an antiemetic and IV fluids.
(21-28 mmol/L)

Reduction of Risk Potential

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