MCQ for FLuid and Electrolytes

CA 2 (2nd Semester 2019-2020)

Mr. Don Leonardo Dacumos

1. The renal medulla is composed of tissue called ______.

1. Renal pyramids 
2. Nephrons
3. Renal sinus
4. Renal pelvis

Ans. A. Renal pyramids - Since it is composed of conical masses of tissue. Test taking strategy
was choosing from the same word (Renal), then identifying which has the tissue.

b. Juxtaglomerular cells combine with _______ cells to form the juxtaglomerular apparatus
in the kidney.
a. Macula densa 
b. Renal pelvis
c. Nephron 
d. Renal sinus

Ans. A. Macula densa - collection of specialized epithelial cells in the distal convoluted tubule
that detect sodium concentration of the fluid in the tubule. The other choices were parts of the
kidney, while this isn’t and it’s a complicated word so I thought it might be a cell.

3. Which of the following is not in the sequence of proper kidney blood flow? The starting
point is the renal artery and the finishing point is the renal vein.
a. Arciform artery
b. Afferent arteriole
c. Interlobar vein
d. Arciform vein

Ans. C. Interlobar vein - Since arteries come first then capillaries, to vasa recta then to the
vein. 

4. Which is found in the highest concentration in the urine?

a. Uric acid
b. Urea
c. Glucose
d. Creatinine

Ans. B. Urea -The concentration of urea in glomerular filtrate is less than that in urine, because
of water reabsorption by the renal tubules, as a result concentration of urea increases in urine.

5. The primary function of the ascending loop of Henle in the kidney is?
a. The active reabsorption of sodium
b. The active reabsorption of chloride ions
c. The passive reabsorption of potassium
d. The passive reabsorption of urea

Ans. B. The active reabsorption of chloride ions - Its main function is to reabsorb water and
sodium chloride from the filtrate which then conserves water for the organism, producing highly
concentrated urine.

6. The middle layer of the urinary bladder is identified as ___________.

a. Mucous coat
b. Submucous coat
 c. Muscular Coat
d. Sphincter Coat

Ans. B. Submucous coat - a supporting layer of loose connective tissue directly under a
mucous membrane, since  the urinary bladder is composed of four layers of tissue coats-
namely, mucosa layer, submucosa layer, muscularis layer, and serosa or adventitia. And I have
to Identify which is the midde layer among the layers.

7. The micturition reflex center is located in the _____.

a. Pons
b. Midbrain
c. Lumbar plexus
d. Sacral plexus

Ans. D. Sacral plexus -

8. The primary function of the descending loop of Henle in the kidney is?
a. Reabsorption of sodium ions
b. Reabsorption of water by osmosis
c. Secretion of hydrogen ions
d. Secretion of potassium ions

Ans. B. Reabsorption of water by osmosis - Ions transport along the nephron which is
essential for the reabsorption of sodium and water, maintenance of plasma volume and blood
pressure and production of urine. The Loop of Henle contributes to the absorption of
approximately 25% of filtered sodium and can be targeted by diuretic therapy.

9. Which of the following is not considered a component of kidney stones?

a. Calcium phosphate
b. Uric Acid
c. Calcium oxalate
d. HCO3

Ans. D. HCO3 - Calcium oxalate, calcium phosphate, uric acid, and struvite are the common
crystalline materials found in kidney stones.

10. One of the functions occurring at the distal convoluted tubule in the kidney is?
a. Passive secretion of hydrogen ions
b. Passive secretion of potassium ions
c. Limited re-absorption of water
d. No re-absorption of sodium

Ans. B. Passive secretion of potassium ions - reabsorbs calcium, sodium, and chloride and
regulates the pH of urine by secreting protons and absorbing bicarbonate.

11. ADH has which of the following effects on the distal convoluted tubule?
a. Decrease water re-absorption
b. Increase water re-absorption
c. Decrease the concentration of urine
d. Increase the urine volume

Ans. B. Increase water reabsorption - ADH acts in the kidney to regulate the volume and
osmolarity of the urine. Specifically, it acts in the distal convoluted tubule (DCT) and collecting
ducts (CT) cells. This increases the water reabsorbed from the urine, in order to decrease
plasma osmolality and increase total blood volume
 12. Which of the following is not associated with the role of the kidneys?
a. Release of erythropoietin (hormone)
b. Release of renin (enzyme)
c. Release of Vitamin E
d. Activate Vitamin D

Ans. C. Release of Vitamin E - Release of erythropoietin (hormone), Release of renin (enzyme)

& Activate Vitamin D are those associated  in the role of the kidney, however the release of
vitamin e is found in food.

13. The release of Angiotension II causes which of the following to occur?

a. Increased filtration rate
b. Decreased glomerular hydrostatic pressure
c. Increase synthesis of Vitamin E
d. Increased release of erythropoietin

Ans. A. Increased filtration rate - 

14. Which of the following is an effect of a diuretic?

a. Decreased Cardiac Output
b. Increased fluid volume
c. Increased sodium reabsorption
d. Increased chloride ion re-absorption

Ans. A. Decreased Cardiac Output - 

15. A client with very dry mouth, skin, and the mucous membrane are diagnosed with having
dehydration. Which intervention should the nurse perform when caring for a client
diagnosed with a fluid volume deficit?
a. Assessing urinary intake and output
b. Obtaining the client’s weight weekly at different times of the day
c. Monitoring arterial blood gas (ABG) results
d. Maintaining I.V. therapy at the keep-vein-open rate

Ans. A. Assessing urinary intake and output - For the client with fluid volume deficit.
assessing the client’s urine output (using a durometer if necessary) is essential to ensure an
output of at least 30 ml/hour. The client should be weighed daily. not weekly. and at same time
each day. usually in the morning. Monitoring ABGs is not necessary for this client. Rather. serum
electrolyte levels would most likely be evaluated. The client also would have an I.V. rate at least
75 ml/hour. if not higher. to correct the fluid volume deficit.

16. Nurse John Joseph is totaling the intake and output for Elena Reyes, a client diagnosed
with septicemia who is on a clear liquid diet. The client intakes 8 oz of apple juice, 850 ml
of water, 2 cups of beef broth, and 900 ml of half-normal saline solution and outputs
1,500 ml of urine during the shift. How many milliliters should the nurse document as the
client’s intake?
a. 2,230
b. 2,740
c. 2,470
d. 2,320

Ans. C. 2,470 - The fluid intake includes 8 oz (240 ml) of apple juice. 850 ml of water. 2 cups
(480 ml) of beef broth. and 900 ml of I.V. fluid for a total of 2.470 ml intake for the shift.

17. You have a patient that might have a urinary tract infection (UTI). Which statement by the
patient suggests that a UTI is likely?
 a. “I pee a lot.”
b. “It burns when I pee.”
c. “I go hours without the urge to pee.”
d. “My pee smells sweet.”

Ans. B. It burns when I pee. A common symptom of a UTI is dysuria. A patient with a UTI often
reports frequent voiding of small amounts and the urgency to void. Urine that smells sweet is
often associated with diabetic ketoacidosis.

18. Which patient is at greatest risk for developing a urinary tract infection (UTI)?
a. A 35 y.o. woman with a fractured wrist
b. A 20 y.o. woman with asthma
c. A 50 y.o. postmenopausal woman
d. A 28 y.o. with angina

Ans. C. A 50 y.o. postmenopausal woman. Women are more prone to UTI's after menopause
due to reduced estrogen levels. Reduced estrogen levels lead to reduced levels of vaginal
Lactobacilli bacteria, which protect against infection. Angina, asthma and fractures don't increase
the risk of UTI.

19. A patient returns from surgery with an indwelling urinary catheter in place and empty. Six
hours later, the volume is 120ml. The drainage system has no obstructions. Which
intervention has priority?
a. Give a 500ml bolus of isotonic saline
b. Evaluate the patient’s circulation and vital signs
c. Flush the urinary catheter with sterile water or saline
d. Place the patient in the shock position, and notify the surgeon

Ans. B. Evaluate the patient’s circulation and vital signs. A total UO of 120ml is too low.
Assess the patient’s circulation and hemodynamic stability for signs of hypovolemia. A fluid bolus
may be required. but only after further nursing assessment and a doctors order.

20. You’re preparing for urinary catheterization of a trauma patient and you observe bleeding
at the urethral meatus. Which action has priority?
a. Irrigate and clean the meatus before catheterization
b. Check the discharge for occult blood before catheterization
c. Heavily lubricate the catheter before insertion
d. Delay catheterization and notify the doctor

Ans. D. Delay catheterization and notify the doctor. Bleeding at the urethral meatus is
evidence that the urethra is injured. Because catheterization can cause further harm. consult
with the doctor.

21. Your patient returns from the operating room after abdominal aortic aneurysm repair.
Which symptom is a sign of acute renal failure?
a. Anuria
b. Diarrhea
c. Oliguria
d. Vomiting

Ans. C. Oliguria. Urine output less than 50ml in 24 hours signifies oliguria. an early sign of renal
failure. Anuria is uncommon except in obstructive renal disorders.

22. Khaleesi is admitted to the hospital due to having lower than normal potassium levels in
her bloodstream. Her medical history reveals vomiting and diarrhea prior to
hospitalization. Which foods should the nurse instruct the client to increase?
 a. Whole grains and nuts
b. Milk products and green, leafy vegetables
c. Pork products and canned vegetables
d. Orange juice and bananas

Ans. D. Orange juice and bananas. The client with hypokalemia needs to increase the intake of
foods high in potassium. Orange juice and bananas are high in potassium. along with raisins.
apricots. avocados. beans. and potatoes. Whole grains and nuts would be encouraged for the
client with hypomagnesemia

23. A 22-year-old lady is displaying facial grimaces during her treatment in the hospital due to
burn trauma. Which nursing intervention should be included for reducing pain due to
cellular injury?
a. “I do not have to see my doctor unless I have problems.”
b. “I can stop taking my antibiotics once I am feeling better.”
c. “If I have redness, drainage, or fever, I should call my healthcare provider.”
d. “I can return to my normal activities as soon as I go home.”

Ans. N/A

24. Tom is ready to be discharged from the medical-surgical unit after 5 days of
hospitalization. Which client statement indicates to the nurse that Tom understands the
discharge teaching about cellular injury?
a. “I do not have to see my doctor unless I have problems.”
b. “I can stop taking my antibiotics once I am feeling better.”
c. “If I have redness, drainage, or fever, I should call my healthcare provider.”
d. “I can return to my normal activities as soon as I go home.”

Ans. C. “If I have redness, drainage, or fever, I should call my healthcare provider.” The
knowledge that redness. drainage. or fever signs of infection associated with cellular injury
require reporting indicates that the client has understood the nurse’s discharge teaching. Follow-
up checkups should be encouraged with an emphasis on antibiotic compliance even if the client
feels better. There are usually activity limitations after cellular injury.

25. A patient with tented skin turgor, dry mucous membranes, and decreased urinary output
is under nurse Mark’s care. Which nursing intervention should be included in the care
plan of Mark for his patient?
a. Administering I.V. and oral fluids
b. Clustering necessary activities throughout the day
c. Assessing color, odor, and amount of sputum
d. Monitoring serum albumin and total protein levels

Ans. A. Administering I.V. and oral fluids. The client’s assessment findings would lead the
nurse to suspect the client is dehydrated. Administering I.V. fluids is appropriate.While ssessing
sputum would be appropriate for a client with problems associated with impaired gas exchange
or ineffective airway clearance. Monitoring albumin and protein levels are appropriate for clients
experiencing inadequate nutrition. Clustering activities help with energy conservation and
promote rest.

26. . Marie Joy’s lab test revealed that her serum calcium is 2.5 mEq/L. Which assessment
data does the nurse document when a client diagnosed with hypocalcemia develops a
carpopedal spasm after the blood-pressure cuff is inflated?
a. Positive Trousseau’s sign
b. Positive Chvostek’s sign
c. Tetany
d. Paresthesia
Ans. A. Positive Trousseau’s sign. In a client with hypocalcemia. a positive Trousseau's sign
refers to a carpopedal spasm that develops usually within 2-5 minutes after applying and inflating
a blood pressure cuff to about 20 mm Hg higher than systolic pressure on the upper arm. This
spasm occurs as the blood supply to the ulnar nerve is obstructed. Chvosteks sign refers to the
twitching of the facial nerve when tapping below the earlobe. Paresthesia refers to the numbness
or tingling. Tetany is a clinical manifestation of hypocalcemia denoted by tingling in the tips of the
fingers around the mouth. and muscle spasms in the extremities and face.

27. Lab tests revealed that patient Z’s [Na+] is 170 mEq/L. Which clinical manifestation would
nurse Natty expect to assess?
a. Tented skin turgor and thirst
b. Muscle twitching and tetany
c. Fruity breath and Kussmaul’s respirations
d. Muscle weakness and paresthesia

Ans. A. Tented skin turgor and thirst. Hypernatremia refers to elevated serum sodium levels,
usually above 145 mEq/L. Typically. the client exhibits tented skin turgor and thirst in conjunction
with dry. sticky mucous membranes. lethargy. and restlessness. Muscle weakness and
paresthesia are associated with hypokalemia

28. Which clinical manifestation would lead the nurse to suspect that a client is experiencing
hypermagnesemia?
a. Muscle pain and acute rhabdomyolysis
b. Hot, flushed skin and diaphoresis
c. Soft-tissue calcification and hyperreflexia
d. Increased respiratory rate and depth

Ans. B. Hot. flushed skin and diaphoresis. Hypermagnesemia is manifested by hot. flushed
skin and diaphoresis. The client also may exhibit hypotension. lethargy. drowsiness. and absent
deep tendon reflexes. Muscle pain and acute rhabdomyolysis are indicative of
hypophosphatemia. Soft-tissue calcification and hyperreflexia are indicative of
hyperphosphatemia. Increased respiratory rate and depth are associated with metabolic
acidosis.

29. Jon has a potassium level of 6.5 mEq/L, which medication would nurse Wilma anticipate?
a. Potassium supplements
b. Kayexalate
c. Calcium gluconate
d. Sodium tablets

Ans. B. Kayexalate.The client’s potassium level is elevated

30. Which client situation requires the nurse to discuss the importance of avoiding foods high
in potassium?
a. 14-year-old Elena who is taking diuretics
b. 16-year-old John Joseph with an ileostomy
c. 16-year-old Gabriel with metabolic acidosis
d. 18-year-old Albert who has renal disease

Ans. D. 18-year-old Albert who has a renal disease - Clients with renal disease are
predisposed to hyperkalemia & should avoid foods high in potassium. Clients receiving diuretics.
with ileostomies. or with metabolic acidosis may be hypokalemic and should be encouraged to
eat foods high in potassium.

31. Which cause of hypertension is the most common in acute renal failure?
a. Pulmonary edema
b. Hypervolemia
 c. Hypovolemia
d. Anemia

Ans. B. Hypervolemia. Acute renal failure causes hypervolemia as a result of overexpansion of

extracellular fluid and plasma volume with the hypersecretion of renin. Therefore. hypervolemia
causes hypertension.

32. Which of the following symptoms do you expect to see in a patient diagnosed with acute
pyelonephritis?
a. Jaundice and flank pain
b. Costovertebral angle tenderness and chills
c. Burning sensation on urination
d. Polyuria and nocturia

Ans. B. Costovertebral angle tenderness and chills. Costovertebral angle tenderness, flank
pain, and chills are symptoms of acute pyelonephritis. Jaundice indicates gallbladder or liver
obstruction. A burning sensation on urination is a sign of lower urinary tract infection.

33. Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient?
a. Dysuria, frequency, and urgency
b. Back pain, nausea, and vomiting
c. Hypertension, oliguria, and fatigue
d. Fever, chills, and right upper quadrant pain radiating to the back

Ans. C. Hypertension, oliguria, and fatigue. Mild to moderate hypertension may result from
sodium or water retention and inappropriate renin release from the kidneys. Oliguria and fatigue
also may be seen. Other signs are proteinuria and azotemia.

34. You expect a patient in the oliguric phase of renal failure to have a 24-hour urine output
less than:
a. 200ml
b. 400ml
c. 800ml
d. 1000ml

Ans. B. 400ml. Oliguria is defined as urine output of less than 400ml/24hours.

35. The most common early sign of kidney disease is:

a. Sodium retention
b. Elevated BUN level
c. Development of metabolic acidosis
d. Inability to dilute or concentrate urine

Ans. B. Elevated BUN level. Increased BUN is usually an early indicator of decreased renal
function.

36. Immediately post-op after a prostatectomy, which complications require priority

assessment of your patient?
a. Pneumonia
b. Hemorrhage
c. Urine retention
d. Deep vein thrombosis

Ans. B. Hemorrhage. Hemorrhage is a potential complication. Urine retention isn't a problem

soon after surgery because a catheter is in place. Pneumonia may occur if the patient doesn't
cough and deep breathe. Thrombosis may occur later if the patient doesn't ambulate.
 37. The most indicative test for prostate cancer is:
a. A thorough digital rectal examination
b. Magnetic resonance imaging (MRI)
c. Excretory urography
d. Prostate-specific antigen 

Ans. D. Prostate-specific antigen. An elevated prostate-specific antigen level indicates prostate

cancer. but it can be falsely elevated if done after the prostate gland is manipulated. A digital
rectal examination should be done as part of the yearly screening and then the antigen test is
done if the digital exam suggests cancer. MRI is used in staging the cancer.

38. Which intervention do you plan to include with a patient who has renal calculi?
a. Maintain bed rest
b. Increase dietary purines
c. Restrict fluids
d. Strain all urine

Ans. D. Strain all urine. All urine should be strained through gauze or a urine strainer to catch
stones that are passed. The stones are then analyzed for composition. Ambulation may help the
movement of the stone down the urinary tract. Encourage fluid to help flush the stones out.

39. An 18 y.o. student is admitted with dark urine, fever, and flank pain and is diagnosed with
acute glomerulonephritis. Which would most likely be in this student’s health history?
a. Renal calculi
b. Renal trauma
c. Recent sore throat
d. Family history of acute glomerulonephritis

Ans. C. Recent sore throat. The most common form of acute glomerulonephritis is caused by
group A beta-hemolytic streptococcal infection elsewhere in the body.

40. Which drug is indicated for pain related to acute renal calculi?
a. Narcotic analgesics
b. Nonsteroidal anti-inflammatory drugs (NSAIDs)
c. Muscle relaxants
d. Salicylates

Ans. A. Narcotic analgesics. These usually needed to relieve the severe pain of renal calculi.
Muscle relaxants are typically used to treat skeletal muscle spasms. NSAIDS and salicylates are
used for their anti-inflammatory and antipyretic properties and to treat less severe pain.

41. Which of the following causes the majority of UTIs in hospitalized patients?
a. Lack of fluid intake
b. Inadequate perineal care
c. Invasive procedures
d. Immunosuppression

Ans. C. Invasive procedures such as catheterization can introduce bacteria into the urinary
tract. A lack of fluid intake could cause concentration of urine. but wouldn’t necessarily cause
infection.

42. Clinical manifestations of acute glomerulonephritis include which of the following?

a. Chills and flank pain
b. Oliguria and generalized edema
c. Hematuria and proteinuria
d. Dysuria and hypotension
Ans. C. Hematuria and Proteinuria. These findings result from increased permeability of the
glomerular membrane due to the antigen-antibody reaction.

43. Immunosuppression following Kidney transplantation is continued:

a. For life
b.  24 hours after transplantation
c.  A week after transplantation
d. Until the kidney is not anymore rejected

Ans. A. For Life. 1.11E+35

44. Which criterion is required before a patient can be considered for continuous peritoneal
dialysis?
a. The patient must be hemodynamically stable
b. The vascular access must have healed
c. The patient must be in a home setting
d. Hemodialysis must have failed

Ans. A. The patient must be hemodynamically stable. Hemodynamic stability must be

established before continuous peritoneal dialysis can be started.

45. Which statement correctly distinguishes renal failure from prerenal failure?
a. With prerenal failure, vasoactive substances such as dopamine (Intropin) increase
blood pressure
b. With prerenal failure, there is less response to such diuretics as furosemide
(Lasix)
c. With prerenal failure, an IV isotonic saline infusion increases urine output
d. With prerenal failure, hemodialysis reduces the BUN level

Ans. C. With prerenal failure, an IV isotonic saline infusion increases urine output. Prerenal
failure impairs kidney perfusion. Isotonic solutions help increase urine output.

46. A 22 y.o. patient with diabetic nephropathy says, “I have two kidneys and I’m still young.
If I stick to my insulin schedule, I don’t have to worry about kidney damage, right?” Which
of the following statements is the best response?
a. “You have little to worry about as long as your kidneys keep making urine.”
b. “You should talk to your doctor because statistics show that you’re being
unrealistic.”
c. “You would be correct if your diabetes could be managed with insulin.”
d. “Even with insulin, kidney damage is still a concern.”

Ans. D. “Even with insulin, kidney damage is still a concern.” Microvascular changes occur
in both of the patient's kidneys as a complication of the diabetes. Diabetic nephropathy is the
leading cause of end-stage renal disease. The kidneys continue to produce urine until the end
stage. Nephropathy occurs even with insulin management.

47. Genevieve is diagnosed with hypomagnesemia, which nursing intervention would be

appropriate?
a. Instituting seizure precaution to prevent injury
b. Instructing the client on the importance of preventing infection
c. Avoiding the use of tight tourniquet when drawing blood
d. Teaching the client the importance of early ambulation

Ans. A. Instituting seizure precaution to prevent injury. Clients with hypomagnesemia are at
risk for seizures. 
 48. Joshua is receiving furosemide and Digoxin, which laboratory data would be the most
important to assess in planning the care for the client?
a. Sodium level
b. Magnesium level
c. Potassium level
d. Calcium level

Ans. C. Potassium level. Furosemide, a diuretic causes depletion in serum potassium which
may lead to hypokalemia. Hypokalemia may potentiate digoxin making the patient at risk for
digoxin toxicity.

49. Which electrolyte would the nurse identify as the major electrolyte responsible for
determining the concentration of the extracellular fluid?
a. Potassium
b. Phosphate
c. Chloride
d. Sodium

Ans. D. Sodium. The sodium ions in the extracellular fluid and associated anions are the
principal determinants of fluid move-ment across the cell membrane.

50. Lee Angela’s lab test just revealed that her chloride level is 96 mEq/L. As a nurse, you
would interpret this serum chloride level as:
a. high
b. low
c. within normal range
d. high normal

Ans. C. Within normal range. The normal chloride level is 96-106mEq/L of blood.