O

Which medication can help prevent a life threatening crisis when administered immediately to a client with severe hyperkalemia who develops acidosis? 50% dextrose Furosemide Sodium bicarbonate Epinephrine

3

Which outcome is the main focus of treatment for a client with Addison disease? Decrease in eosinophils Increase in lymphoid tissue Restoration of electrolyte balance Improvement of carbohydrate metabolism

3

The nurse notes a client has dependent edema around the area of the feet and ankles. To characterize the severity of the edema, the nurse presses the medial ,alveolus area, noting an 8mm depression after release. In which way would the nurse document the edema? 1+ 2+ 3+ 4+

4

Which sign or symptom would be concerning for fluid volume excess in a child with a diagnosis of acute post streptococcal glomerulonephritis? Dysuria Diarrhea Hypotension Periorbital edema

4

Which action would the nurse take to properly prepare the site for insertion when assessing a clients forearm for a potential intravenous (IV) catheter insertion site reveals an excessive amount of hair? Clip the hair Shave the area Apply a securement device Prepare the skin with a protectant solution

Clip the hair

Which action will the urgent care clinic nurse anticipate taking for a 24-year-old client who is dehydrated after a long run and has a pulse rate of 103 and blood pressure 102/56 mmHg? -Offer oral fluids at frequent intervals -Give fluid blouses through a nasogastric tube -Administer intravenous antiemetic medications -Insert a peripheral intravenous line for fluid infusion

Offer oral fluids at frequent intervals

Which purpose would potassium chloride added to the intravenous solution of a client with diabetic ketoacidosis serve? Treats hyperpnea Prevents flaccid paralysis Prevents hypokalemia Treats cardiac dysrhythmias

Prevents hypokalemia

Which reason describes the purpose of restricting sodium for a client with hypertension? To chemically stimulate the loop of Henley To diminish the thirst response of the client To prevent reabsorption of water in the distal tubules To cause fluid to move toward the interstitial compartment

To prevent reabsorption of water in the distal tubules

Which clinical indicator would the nurse monitor for when a client developed the syndrome of inappropriate antidiuretic hormone (SIADH) after a craniotomy to remove a brain tumor? Select all that apply Polyuria Insomnia Bradycardia Increased weight Decreased serum sodium Decreased level consciousness

Increased weight Decreased serum sodium Decreased level consciousness

Which action by the nurse will be most effective in determining whether fluid overload is improving when caring for a client who was admitted with heart failure? Weighing the client Monitoring the intake and output Assessing the extent of pitting edema Asking the client about subjective symptoms

Weighing the client

Which action would the nurse take to identify hyponatremia in an adolescent client with a perceived inability to ingest food? Select all that apply. One,some, or all responses may be correct. Monitor vital signs Monitor behavior Monitor electrolyte status Monitor for targeted daily caloric intake Monitor activities for detrimental behaviors

Monitor vital signs Monitor electrolyte status

To prevent thrombophlebitis in the immediate postoperative period, which action is important for the nurse to include in the clients plan of care? Increase fluid intake Restrict fluids Encourage early mobility Elevate the foot of the bed

Encourage early mobility

Which nursing intervention would the nurse consider a priority for clients with fluid overload? Ensuring client safety Providing medication therapy Providing nutritional therapy Preventing future fluid overload

Ensuring client safety

A client is admitted to the intensive care unit with pulmonary edema. Which clinical finding would the nurse expect when performing the assessment? Weak, rapid pulse Decreased blood pressure Radiating anterior chest pain Crackles at bases of the lungs

Crackles at bases of the lungs

Which finding by the nurse when assessing a client who is receiving intravenous (IV) fluids indicates need for a change in the fluid infusion rate? Crackles in the lungs Supple skin turgor Urine output of 480mL over 8 hrs Heart trade decreases from 126 beats/minute to 96 beats/minute

Crackles in the lungs

Which clinical manifestations indicate to the nurse that the client has an adequate fluid volume? Select all that apply. One some or all may be correct. Decreased urine Hypotension Dyspnea Dry mucous membranes Lung crackles Poor skin turgor

Decreased urine Hypotension Dry mucous membranes Poor skin turgor

Which concern when caring for a client prescribed furosemide 40 mg every day in conjunction with digoxin would prompt the nurse to ask the health care provider about potassium supplements? Digoxin causes significant potassium depletion The liver destroys potassium as digoxin is detoxified Lasix requires adequate serum potassium to promote diuresis Digoxin toxicity occurs rapidly in the presence of hypokalemia

Digoxin toxicity occurs rapidly in the presence of hypokalemia

Which response would the nurse expect a client to exhibit who is in Addison crisis? Select all that apply. One,some ,or all may be correct. Bradycardia Hypertension Hyperkalemia hyponatremia postural hypotension

Hyperkalemia hyponatremia postural hypotension

An infant with persistent diarrhea is subject to significant fluid and electrolyte alterations. Which physiology imbalance would the nurse most likely encounter? Select all that apply. One, some, or all may be correct. Hypovolemia Hyperkalemia Hypercalcemia Metabolic acidosis Decreased hematocrit

Hypovolemia Metabolic Acidosis

Which client statement indicates that the teaching about furosemide is understood? Select all that apply. One, some, or all may be correct. It may take 2 or 3 days for this medication to take effect I should wear dark glasses when outdoors during the day I should avoid lying flat in bed I need to change my positions slowly I should eat more food that is high in potassium

I need to change my positions slowly I should eat more food that is high in potassium

Which element would the nurse conclude is likely to have contributed to the development of hyponatremia in an older client found unconscious at home and admitted to the hospital with a fractured hip, renal failure, and dehydration who received 3L of intravenous fluid in the 24 hours since admission? Reduced dietary salt intake Intravenous fluid infusion Potassium reabsorption rate Increased glomerular filtration

Intravenous fluid infusion

When the nurse is teaching a client with hypertension about a sodium-restricted diet, which information would be included? Using salt-free natural seasonings can taste the same as salt Substituting table salt with potassium chloride can be done freely Desiring the taste for salt is inherent but can be overcome with help Liking the taste of table salt is learned, but it can be modified with practice

Liking the taste of table salt is learned, but it can be modified with practice

Which statement about administration of IV potassium would a nurse make to a client with a diagnosis of hypokalemia? Oliguria is an indication for withholding IV potassium Rapid infusion of potassium prevents burning at the IV site Clients with severe deficits should be given IV push potassium Average IV dosage of potassium should not exceed 60 mEq in 1 h

Oliguria is an indication for withholding IV potassium

Which substance is released in response to low serum levels of calcium? Renin Erythropoietin Parathyroid hormone Atrial natriuretic peptide

Parathyroid hormone

Which interventions would the nurse implement in caring for a client with diabetes insipidus (DI) after a head injury ? Select all that apply. One, some, or all may be correct. Provide adequate fluids within easy reach Report an increasing urine specific gravity Administer prescribed erythromycin Assess for report changes in neurological status Monitor for constipation, weight loss, hypotension, and tachycardia

Provide adequate fluids within easy reach Assess for report changes in neurological status Monitor for constipation, weight loss, hypotension, and tachycardia

A client with ascites has a paracentesis, and 1500mL of fluid is removed. The nurse providing immediate post procedural care would monitor for which signs of complications? Select all that apply. One, some, or all may be correct. Rapid, threads pulse Decreased peristalsis Respiratory congestion Increase in temperature Decreased blood pressure

Rapid, threads pulse Decreased blood pressure

Which assessment will provide the nurse with the most significant data when assessing the adequacy of a clients intravenous fluid replacement therapy during the first 2-3 days after sustaining full-thickness burns to the trunk and right thigh? Weights every day Urinary output every hour Blood pressure every 15 min Extent of peripheral edema every 4 hours

Urinary output every hour

Which food selection by the client indicates to the nurse that dietary teaching about thiazides diuretics is successful? Apples Kidney beans Cherries Brussels sprouts

Kidney beans

Which hormonal deficiency would increase a client's risk for fractures? Growth hormone Follicle-stimulating hormone Thyroid-stimulating hormone Adrenocorticotropic hormone

1

Which example is associated with third spacing in a burn injury? Blister formation Edema formation Fluid mobilization Fluid accumulation

Blister formation

Which findings are consistent with hypercalcemia after prolonged immobility? Select all that apply. One, some, or all may be correct. Bone pain Convulsions Muscle spasms Tingling of extremities Depressed deep tendon reflexes

Bone pain Depressed deep tendon reflexes

A registered nurse (RN) is teaching a nursing student how to assess for edema. Which statement made by the student is incorrect? Edema results in the separation of the skin from pigmented and vascular tissue Pitting edema leaves an indentation on the site of application of pressure Trauma or impaired venous return should be suspected in,clients with edema If the pressure on an edematous site leaves an indentation of 2mm, a score of 2+ is given

If the pressure on an edematous site leaves an indentation of 2mm, a score of 2+ is given

Which disease increases the risk of hyperkalemia? Crohn's disease Cushing disease End-stage renal disease Gastroesophageal reflux disease

End-stage renal disease

Which statement made by the client identifies a regulatory function of the kidney? Select all that apply. One, some, or all may be correct. Erythropoiesis Acid-base balance Vitamin D activation Blood pressure control Fluid and electrolyte balance

2,5