MedSurge Exam 3

The nurse is instructing a client with recurrent hyperkalemia about following a potassium-restricted diet. Which statement by the client indicates the need for additional instruction? "I'll drink cranberry juice with my breakfast instead of coffee." "I need to check to see whether my cola beverage has potassium in it." "I will not salt my food; instead I'll use salt substitute." "Bananas have a lot of potassium in them; I'll stop buying them."

"I will not salt my food; instead I'll use salt substitute."

Which solution is hypotonic? 0.9% NaCl 0.45% NaCl Lactated Ringer solution 5% NaCl

0.45% NaCl

A client has chronic hyponatremia, which requires weekly laboratory monitoring to prevent the client lapsing into convulsions or a coma. What is the level of serum sodium at which a client can experience these side effects? 135 mEq/L 148 mEq/L 114 mEq/L 130 mEq/L

114 mEq/L

A client who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue; body temperature of 99.3 °F; and a urine specific gravity of 1.020. What is the most likely serum sodium value for this client? 165 mEq/L 145 mEq/L 110 mEq/L 130 mEq/L

165 mEq/L

A client experiencing a severe anxiety attack and hyperventilating presents to the emergency department. The nurse would expect the client's pH value to be 7.35 7.45 7.50 7.30

7.50

A client with excess fluid volume and hyponatremia is in a comatose state. What are the nursing considerations concerning fluid replacement? Administer small volumes of a hypertonic solution. Restrict fluids and salt for 24 hours. Correct the sodium deficit rapidly with salt. Monitor the serum sodium for changes hourly.

Administer small volumes of a hypertonic solution

The Emergency Department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? PO2 Carbonic acid Bicarbonate PaO2

Bicarbonate

The nurse is caring for a client being treated with isotonic IV fluid for hypernatremia. What complication of hypernatremia should the nurse continuously monitor for? Renal failure Red blood cell crenation Red blood cell hydrolysis Cerebral edema

Cerebral edema

Which electrolyte is a major anion in body fluid? Potassium Chloride

Chloride

Which of the following is a clinical manifestation of fluid volume excess (FVE)? Select all that apply. Decreased blood pressure Bradycardia Crackles in the lung fields Shortness of breath Distended neck veins

Crackles in the lung fields Shortness of breath Distended neck veins

The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process? Elevated blood pressure Rapid respiration Low heart rate Subnormal temperature

Elevated blood pressure

Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration? Elevated hematocrit level Low urine specific gravity Low white blood count Abnormal potassium level

Elevated hematocrit level

A nurse is caring for an adult client with numerous draining wounds from gunshots. The client's pulse rate has increased from 100 to 130 beats per minute over the last hour. The nurse should further assess the client for which of the following? Respiratory acidosis Altered blood urea nitrogen (BUN) value Extracellular fluid volume deficit Metabolic alkalosis SUBMIT ANSWER

Extracellular fluid volume deficit

Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? Myasthenia gravis Type 1 diabetes mellitus Opioid overdose Extreme anxiety

Extreme anxiety

A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing? Hyperglycemia Hypernatremia Hyperkalemia Hypercalcemia

Hyperkalemia

Which could be a potential cause of respiratory acidosis? Hypoventilation Hyperventilation Diarrhea Vomiting

Hypoventilation

A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level? Decreases arterial pH Provides long-term pH regulation Increases arterial pH No effect

Increases arterial pH

Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg? Administer an ordered decongestant. Administer ordered supplemental oxygen. Offer the client fluids frequently. Instruct the client to breathe into a paper bag.

Instruct the client to breathe into a paper bag.

The nurse is caring for a geriatric client in the home setting. Due to geriatric changes decreasing thirst, the nurse is likely to see a decrease in which fluid location which contains the most body water? Extracellular fluid Intravascular fluid Interstitial fluid Intracellular fluid

Intracellular fluid

A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action?

JVD

With which condition should the nurse expect that a decrease in serum osmolality will occur? Hyperglycemia Uremia Kidney failure Diabetes insipidus

Kidney failure

The nurse is caring for a client undergoing alcohol withdrawal. Which serum laboratory value should the nurse monitor most closely? Phosphorus Potassium Magnesium Calcium

Magnesium

The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which acid-base imbalance? Metabolic alkalosis Respiratory alkalosis Respiratory acidosis Metabolic acidosis

Metabolic acidosis

The calcium concentration in the blood is regulated by which mechanism? Parathyroid hormone (PTH) Thyroid hormone (TH) Androgens Adrenal gland

Parathyroid hormone (PTH)

A client is being treated in the ICU 24 hours after having a radical neck dissection completed. The client's serum calcium concentration is 7.6 mg/dL (1.9 mmol/L). Which physical examination finding is consistent with this electrolyte imbalance? Muscle weakness Presence of Trousseau sign Slurred speech Negative Chvostek sign

Presence of Trousseau sign

A nurse is caring for a client with acute renal failure and hypernatremia. In this case, which action can be delegated to the nursing assistant?

Provide oral care every 2-3 hours.

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? Pulse Respirations Blood pressure Temperature

Pulse

A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis

The nurse is participating in the care of a client who had a peripherally inserted central catheter (PICC) placed in the right arm. After catheter placement, the nurse should complete which action? Obtain written consent for the procedure. Send the client for a chest x-ray. Assess the client's blood pressure (BP) on the right arm. Administer the prescribed IV fluids.

Send the client for a chest x-ray.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? Serum creatinine level of 0.4 mg/dl Serum blood urea nitrogen (BUN) level of 8.6 mg/dl Serum sodium level of 124 mEq/L Hematocrit of 52%

Serum sodium level of 124 mEq/L

A patient with diabetes insipidus presents to the emergency room for treatment of dehydration. The nurse knows to review serum laboratory results for which of the diagnostic indicators? Potassium level of 3.8 mEq/L Potassium level of 6 mEq/L Sodium level of 150 mEq/L Sodium level of 137 mEq/L

Sodium level of 150 mEq/L

To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body? Increased urine output Bradycardia Tachycardia Vasodilation

Tachycardia

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? Absence of protein Absence of glucose Urine pH of 3.0 Specific gravity of 1.02

Urine pH of 3.0

To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results? Select all that apply. a)PaCO2 b)HCO3 c)K+ d)Glucose e)Na+ f)pH

a,b,f

The physician has prescribed 0.9% sodium chloride IV for a hospitalized client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. a)Administer IV bicarbonate. b)Document presenting signs and symptoms. c)Maintain intake and output records. d)Compare ABG findings with previous results. e)Suction the client's airway.

b,c,d,

A nurse is providing client teaching about the body's plasma pH and the client asks the nurse what is the major chemical regulator of plasma pH. What is the best response by the nurse? renin-angiotensin-aldosterone system bicarbonate-carbonic acid buffer system sodium-potassium pump ADH-ANP buffer system

bicarbonate-carbonic acid buffer system

A client with emphysema is at a greater risk for developing which acid-base imbalance?

chronic respiratory acidosis

A client is experiencing edema in the tissue. What type of intravenous fluid would the nurse expect to be prescribed? no intravenous solution hypertonic solution isotonic fluid hypotonic solution

hypertonic solution

A client reports muscle cramps in the calves and feeling "tired a lot." The client is taking ethacrynic acid (Edecrin) for hypotension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance? hyperkalemia hypocalcemia hypercalcemia hypokalemia

hypokalemia

Early signs of hypervolemia include: thirst. a decrease in blood pressure. increased breathing effort and weight gain. moist breath sounds.

increased breathing effort and weight gain

A client with cancer is being treated on the oncology unit for bilateral breast cancer. The client is undergoing chemotherapy. The nurse notes the client's serum calcium concentration is 12.3 mg/dL (3.08 mmol/L). Given this laboratory finding, the nurse should suspect that the client's diet is lacking in calcium-rich food products. client has a history of alcohol abuse. malignancy is causing the electrolyte imbalance. client may be developing hyperaldosteronism.

malignancy is causing the electrolyte imbalance.

Oncotic pressure refers to the amount of pressure needed to stop the flow of water by osmosis. number of dissolved particles contained in a unit of fluid. osmotic pressure exerted by proteins. excretion of substances such as glucose through increased urine output.

osmotic pressure exerted by proteins

A nurse is monitoring a client being evaluated who has a potassium level of 7 mEq/L (mmol/L). Which electrocardiogram changes will the client display? elevated ST segment peaked T waves prolonged T waves shortened PR interval

peaked T waves

A client is diagnosed with hypocalcemia and the nurse is teaching the client about symptoms. What symptom would the nurse include in the teaching? flank pain polyuria tingling sensation in the fingers hypertension

tingling sensation in the fingers

A nurse is providing an afternoon shift report and relates morning assessment findings to the oncoming nurse. Which daily assessment data is necessary to determine changes in the client's hypervolemia status? edema weight vital signs intake and output

weight

The nurse is assigned to care for a client with a serum phosphorus concentration of 5.0 mg/dL (1.61 mmol/L). The nurse anticipates that the client will also experience which electrolyte imbalance? Hypocalcemia Hyponatremia Hyperchloremia Hypermagnesemia

Hypocalcemia

A nurse caring for a patient who is receiving an IV solution via a central vein suspects the complication of an air embolism. Which of the following are signs and symptoms consistent with that diagnosis? Select all that apply. a)Cyanosis b)Hypertension c)Tachycardia d)Dyspnea e)Crackles on auscultation f)Shoulder pain

a,c,d,f

A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis SUBMIT ANSWER

Metabolic alkalosis

A client was admitted to the unit with a diagnosis of hypovolemia. When it is time to complete discharge teaching, which of the following will the nurse teach the client and family? Select all that apply. a)Respond to thirst b)Drink carbonated beverages to help balance fluid volume. c)Drink water as an inexpensive way to meet fluid needs. d)Drink caffeinated beverages to retain fluid. e)Drink at least eight glasses of fluid each day.

a,c,e

The nurse is caring for a client diagnosed with hyperchloremia. Which are signs and symptoms of hyperchloremia? Select all that apply. a)Tachypnea b)Hypotension c)Weakness d)Dehydration e)Lethargy

a,c,e

A client with hypervolemia asks the nurse what mechanism in the sodium potassium pump will move the excess body fluid. What is the nurse's best answer? free flow passive elimination passive osmosis active transport

active transport

A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. sodium 130 mEq/L (130 mmol/L)potassium 4.6 mEq/L (4.6 mmol/L)chloride 94 mEq/L (94 mmol/L)calcium 12.9 mg/dL (3.2 mmol/L) What laboratory value is consistent with the client's symptoms? calcium 12.9 mg/dL (3.2 mmol/L) chloride 94 mEq/L (94 mmol/L) potassium 4.6 mEq/L (4.6 mmol/L) sodium 137 mEq/L (137 mmol/L)

calcium 12.9 mg/dL (3.2 mmol/L)

The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the fall in pH? The lungs are not able to blow off carbon dioxide. The lungs are unable to breathe in sufficient oxygen. The lungs have ineffective cilia from years of smoking. The lungs are unable to exchange oxygen and carbon dioxide.

The lungs are not able to blow off carbon dioxide.