med surg nursing for exam 1 practice questions

Which intervention would the nurse plan for a patient with hypercalcemia? A. Monitor cardiac rhythm for changes B. Limit activities to protect against injury C. Assess oxygen saturation levels every 4 hours D. Avoid invasive procedures because of increased bleeding risk

A

Which arterial blood gas laboratory values would be seen in metabolic alkalosis? A. pH 7.49, bicarbonate 32 B. pH 7.28, carbon dioxide 54 C. pH 7.53, carbon dioxide 28 D. pH 7.31, bicarbonate 18

A

Which assessment would the nurse make immediately if a patient's serum potassium is reported to be 5.6 mEq/L? A. Heart rate B. Bowel sounds C. Paresthesia D. Recent diarrhea

A

Which electrolyte abnormality would the nurse anticipate when reviewing laboratory data for a patient admitted with metabolic acidosis? A. Hyponatremia B. Hypernatremia C. Hypokalemia D. Hyperkalemia

D

A nurse is admitting an older adult client who reports a weight gain of 2.3 kg (5lb) in 48 hours. Which is the following manifestations of fluid volume excess should the nurse expect? Select all that apply, letter only. A. Dyspnea B. Edema C. Bradycardia D. Hypertension E. Weakness

A, B, D, E

A patient who recently experienced an anterior neck injury reports frequent and painful muscle spasms in the calf during sleep. Which condition would the nurse suspect? A. Hypokalemia B. Hypocalcemia C. Hyponatremia D. Hypophosphatemia

B

A client is receiving an intravenous infusion of 100 mEq of potassium chloride in 1000 mL of normal saline. How many mEq of potassium per hour does the nurse calculate the client will receive if the IV is infused at a rate of 150mL/hour? A. 12 mEq B. 15 mEq C. 18 mEq D. 20 mEq

B

Which ECG finding is consistent with hyperkalemia? A. Absent T waves B. Elevated P waves C. Prolonged PR intervals D. Shortened QRS complexes

C

The healthcare provider writes prescriptions for a patient who is admitted with a serum potassium (K) level of 6.9 mEq/L. Which action would the nurse implement first? A. Place the patient on a cardiac monitor B. Administer sodium polystyrene sulfonate orally C. Ensure that a potassium-restricted diet is prescribed D. Teach the patient about foods that are high in potassium.

A

How does the corresponding increase in carbon dioxide levels that occurs when arterial pH drops assist in maintaining acid-base balance? A. Carbon dioxide loss through exhalation can raise arterial pH levels. B. Carbon dioxide retention during exhalation can lower arterial pH levels. C. Carbon dioxide is a base that can convert free hydrogen ions into a neutral substance. D. Carbon dioxide is a buffer that can bind free hydrogen ions and form a neutral substance.

A

The primary health care provider prescribes IV administration of 100 ml of 20% glucose along with 20 unites of insulin. Which condition would the nurse expect the patient to have? A. Hyperkalemia B. Hyperglycemia C. Hypernatremia D. Hypercalcemia

A

A charge nurse is teaching a group of nurses about conditions related to metabolic acidosis. Which of the following statements by a unit nurse indicated the teaching has been effective? A. "Metabolic acidosis can occur due to diabetic ketoacidosis" B. "Metabolic acidosis can occur in a client who has myasthenia gravis." C. "Metabolic acidosis can occur in a client who has asthma" D. "Metabolic acidosis can occur due to cancer."

A

A nurse is assessing a client who has hyperkalemia. The nurse should identify which of the following conditions as being associates with this electrolyte imbalance? A. Diabetic ketoacidosis B. Heart failure C. Cushing's syndrome D. Thyroidectomy

A

A nurse is caring for a client who has a blood potassium of 5.4 mEq/L. The nurse should assess for which of the following manifestations? A. ECG changes B. Constipation C. Polyuria D. Paresthesia

A

A nurse is caring for a patient who has a blood sodium level 133 mEq/L and blood potassium level 3.4 mEq/L. The nurse should recognize that which of the following treatments can results in these laboratory findings? A. Three tap water enemas B. 0.9% sodium chloride solution IV at 50ml/hr C. 5% dextrose with 0.45% sodium chloride solution with 20 mEq of K+ IV at 80 mL/hr D. Antibiotic therapy

A

A patient has a low serum potassium level and is prescribed a dose of parenteral potassium chloride (KCl). Which administration method would the nurse use? A. Infuse 10 mEq over a 1-hour period B. Administer 5 mEq IM. C. Push 5 mEq through a central access line D. Dilute 200 mEq in 1L of normal saline, and infused at 100ml/hr.

A

A patient reports painful muscles spasms in the lower legs at rest, a tingling sensation in the hands and lips, and abdominal cramping and diarrhea. Which disorder would the nurse suspect? A. Hypocalcemia B. Hypernatremia C. Hypermagnesemia D. Hypophosphatemia

A

Deep and rapid breaths consistent with Kussmaul respiration are found in patients with which type of acid-base imbalance A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A

What responses does the nurse expect as a result of infusing 500 mL of a 3% saline intravenous solution into a client over a 1-hour time period? A. Plasma volume osmolarity increases; blood pressure increases B. Plasma volume osmolarity decreases; blood pressure increases C. Plasma volume osmolarity increases; blood pressure decreases D. Plasma volume osmolarity decreases; blood pressure decreases

A

Which acid-base imbalance would be expected in a patient who has been having acute diarrhea for more than 24 hours? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A

Which assessment has the highest priority for the nurse to perform for a client with syndrome of inappropriate antidiuretic hormone (SIADH) receiving tolvaptan therapy for 24 hours? A. Evaluating serum sodium levels B. Evaluating serum potassium levels C. Examining the skin and sclera for jaundice D. Examining the IV site for indications of phlebitis

A

Which patient would be appropriate to assign to the new nurse working on the medical-surgical unit? A. Patient with COPD with a partial pressure of arterial carbon dioxide level of 50 mm hg B. Patient with reactive airway disease, wheezing, and partial pressure of arterial oxygen level of 62 mm Hg C. Patient with diabetic ketoacidosis and change in mental status who has a pH of 7.18 D. Patient with an irregular heart rate and prolonged vomiting with bicarbonate level of 40 mEq/L

A

Which physiologic imbalance is the patient at risk for developing if he or she has chronically low hemoglobin? A. Acidosis B. Alkalosis C. Hypokalemia D. Ineffective ventilation

A

Which nursing intervention is consistent with safe administration of IV potassium to a patient with hypokalemia? Select all that apply, letter only. A. Evaluate the heart rate and regularity B. Establish and evaluate the patency of a large vein C. Obtain an IV controller device (pump) D. Plan to assess the respiratory rate and oxygen saturation every hour E. Prepare to administer potassium IV push to reduce the risk for infiltration F. Encourage the patient to ambulate independently to relieve muscle cramps.

A, B, C, D

A nurse is admitting a client who reports nausea, vomiting, and weakness. The client has dry oral mucous membranes and blood pressure 102/64 mm Hg. which of the following findings should the nurse identify as manifestations of fluid volume deficit? Select all that apply, letter only A. Decreased skin turgor B. Concentrated urine C. Bradycardia D. Low-grade fever E. Tachypnea

A, B, D, E

A 30-year-old male client having an annual health physical reports that all of the following changes have developed during the past year. Which ones alert the nurse to possible pituitary hyperfunction. Select all that apply letter only. A. 15lb weight gain B. Decreased libido C. Four sinus infections D. Frequent constipation E. Increased foot callus formation F. Occasional dripping of clear fluid from both breasts G. Severely sprained angle from a volleyball injury

A, B, F

Which electrolytes are most detrimentally affected by low magnesium levels? Select all that apply, letter only. A. Calcium B. Chloride C. Hydrogen D. Potassium E. Sodium F. Sulfate

A, D

Which assessment parameter is useful for identifying magnesium toxicity during IV magnesium administration? A. Measuring urine output B. Monitoring serum calcium levels C. Checking deep tendon reflexes D. Asking the patient about mood changes

C

Which clinical indicators are most relevant for the nurse to monitor during IV fluid replacement for a client with dehydration? Select all that apply, letter only. A. Blood pressure B. Deep tendon reflexes C. Hand-grip strength D. Pulse rate and quality E. Skin turgor F. Urine output

A, D, F

Which normal physiologic process contributes most to the need for acid-base balance? A. Continuous organ production of bicarbonate from carbonic acid B. Continuous alveolar exchange of oxygen and carbon dioxide C. Continuous metabolic production of free hydrogen ions D. Continuous kidney formation of urine from blood.

C

A nurse is caring for a client who has a nasogastric tube attached to low intermittent suctioning. The nurse should monitor for which of the following electrolyte imbalance? A. Hypercalcemia B. Hyponatremia C. Hyperphosphatemia D. Hyperkalemia

B

Which assessment data is most relevant for the nurse to obtain from a client who has a serum potassium level of 2.9 mEq/L? A. Asking about the use of sugar substitutes B. Determining what drugs are taken daily C. Measuring the client's response to Chvostek testing D. Asking about a history of kidney disease

B

Which electrolyte laboratory values indicate to the nurse monitoring a client with adrenal insufficiency undergoing IV therapy with hydrocortisone that the client is responding positively to this drug therapy? A. serum sodium 147 mEq/L; serum potassium 7.1 mEq/L B. serum sodium 137 mEq/L; serum potassium 4.9 mEq/L C. serum sodium 127 mEq/L; serum potassium 2.8 mEq/L D. serum sodium 119 mEq/L; serum potassium 6.2 mEq/L

B

The handgrasp strength of a client with metabolic acidosis has diminished since the previous assessment 1 hour ago. What is the nurse's best first action? A. Measure the client's pulse and blood pressure B. Apply humidified oxygen by nasal cannula C. Assess the client's oxygen saturation D. Notify the rapid response team

C

A hypertensive patient was brought to the emergency department with a hear rate of 115 beats/min and an abnormal ECG showing shortened QT interval. The laboratory findings show a serum calcium level of 11mg/dL. Which nursing intervention would help stabilize the patient, select all that apply letter only. A. Administering thiazide diuretics B. Administering high-ceiling or loop diuretics C. Administering 0.9% normal saline IV D. Administering NSAIDs E. Administering lactated Ringer's solution IV

B, C

A 77-year-old women who has CHF is brought to the emergency department after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well but that she has been taking her diuretics and other medications. Her laboratory results include a potassium level of 3.0 mEq/L. Which of the information would the nurse include in the patient's medication teaching? Select all that apply, letter only. A. Diuretics' increase fluid retention B. Laxatives can lead to fluid imbalance C. It is important to weigh daily at the same time D. Diuretics can lead to fluid and electrolyte imbalances. E. Daily weights are a poor indicator of fluid loss or gain.

B, C, D

The nurse is reviewing serum electrolytes and blood chemistry for a newly admitted patient. Which result is of concern? A. Glucose: 97 mb/dL B. Sodium 145 mEq/L C Potassium 5.9 mEq/L D. Magnesium 2.1 mEq/L

C

A client with severe diarrhea reports tingling lips and foot cramps. What is the nurse's best first action to prevent harm? A. Hold the next does of the prescribed antidiarrheal drug B. Assess bowel sounds in all four abdominal quadrants C. Assess the client's response to the Chvostek test D. Increase the IV flow rate of the normal saline infusion.

C

A laboratory report for a patient shows the following results: pH 7.32; bicarbonate 24 mEq/L; partial pressure of arterial oxygen 77 mm Hg; and partial pressure of arterial carbon dioxide 48 mm Hg. These findings are consistent with which acid-base imbalance? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C

A nurse is assessing a client for Chvostek's sign. Which of the following techniques should the nurse use to perform the test? A. Apply a blood pressure cuff to the client's arm B. Place the stethoscope bell over the client's carotid artery C. Tap lightly on the clients cheek D. Ask the client to lower their chin to their chest

C

A nurse is caring for a client admitted with confusion and lethargy. The client was found at home unresponsive with an empty bottle of aspirin lying next to the bed. Vital signs reveal blood pressure 104/72 mm Hg, heart rate 116/min with regular rhythm, and respiratory rate 42/min and deep. Which of the following arterial blood gas findings should the nurse expect? A. pH: 7.68 pao2 (Pulse ox): 96 mm Hg paco2: 38 mm Hg hco3: 23 mEq/L B. ph: 7.48 pao2: 100 mm hg paco2: 28 mm hg hco3: 23 mEq/l C. ph: 6.98 pao2: 100 mm hg paco2: 30 mm hg hco3: 18 mEq/l D. ph: 7.58 pao2: 96 mm hg paco2 :38 mm hg hco3: 29 mEq/l

C

A patient is receiving insulin and glucose infusion therapy for hyperkalemia now has a serum potassium level of 3.6 mEq/L. Which action would the nurse take? A. Stop the infusion immediately. B. Continue the infusion at the prescribed rate C. Assess the patient's heart rate, rhythm, and respiratory status D. Slow the infusion, and increase the frequency of the vital sign assessment.

C

A postoperative patient has the following ABG results: pH 7.30; PaCO2 60 mm Hg, PaO2 80 mm Hg; Bicarbonate 24 mEq/L and o2 sat at 96%. Which action would the nurse take? A. Administer ox by nasal cannula B. Inform the charge urse that no changes in therapy are needed C. Encourage the patient to do deep breathing, and assist with repositioning D. Request a prescription for sodium bicarbonate from the health care provider

C

In reviewing the electrolytes of a client, the nurse notes the serum potassium level has increased from 4.6 mEq/L to 6.1 mEq/L. Which assessment does the nurse perform first to prevent harm? A. Deep tendon reflexes B. Oxygen saturation C. Pulse rate and rhythm D. Respiratory rate and depth

C

Laboratory results for a patient with a large draining wound show a serum sodium decrease from 138 mEq/L to 131 mEq/L. Which action would the nurse take first? A. Establish IV access B. Assess for orthostatic hypotension C. Assess the patient's respiratory status D. Notify the health care provider of laboratory results

C

Positive Trousseau and Chvostek signs are consistent with which electrolyte imbalance? A. Hypokalemia B. Hyperkalemia C. Hypocalcemia D. Hypercalcemia

C

The client who is confined to bed in the recumbent position has gained 5lb in the past 24 hours. In which area does the nurse assess skin turgor for more accurate determination of dependent edema? A. Foot and ankle B. Forehead C. Sacrum D. Chest

C

Which nursing action for a patient with hypocalcemia is appropriate to delegate to assistive personnel? A. Evaluating the patient's laboratory results B. Implementing seizure precautions for the patient C. Transferring the patient from the bed to a stretcher using a lift sheet D. collaborating with the dietitian to prescribe calcium-rich foods for this patient

C

Which nursing action is the greatest priority in the plan of care for a patient recovering from an acute episode of chronic obstructive pulmonary disease (COPD)? A. Assess nail beds every 2 hours for cyanosis B. Assess orientation every 4 hours C. Monitor the respiratory rate and effort hourly D. Monitor ABG's results as ordered

C

Which patient is at high risk for hypernatremia? A. 30-year-old on a low-salt diet B. 42-year-old receiving hypotonic fluids C. 54-year-old who is sweating profusely D. 17-year-old with a serum blood glucose level of 189 mg/dl

C

Which two electrolyte imbalances does the nurse suspect based on the following assessment data of a patient? -Hyperactive deep tendon reflexes -Numbness and tingling in hands and feet -Painful muscles contractions -Peripheral pulse is weak,thready -Reports feeling depressed -Confusion -Egg allergy -Lactose intolerance -Vegan diet A. Hypercalcemia and hypernatremia B. Hypokalemia and hypermagnesemia C. Hypomagnesemia and hypocalcemia D. Hyperphosphatemia and hypercalcemia

C

Which urine characteristics indicate to the nurse that the client being managed for diabetes insipidus is responding appropriately to interventions? A. Urine output volume increased; urine specific gravity increased b. Urine output volume increased; urine specific gravity decreased C. Urine output volume decreased; urine specific gravity increased D. Urine output volume decreased; urine specific gravity decreased.

C

With which clients does the nurse remain alert for the possibility of metabolic alkalosis? Select all that apply, letter only. A. client who has been NPO for 36 hours without fluid replacement B. Client receiving a rapid infusion of normal saline C. Client who has been self-managing indigestion with chronic ingestions of bicarbonate D. Client who has had continuous gastric suction for 48 hours E. Client having a sudden and severe asthma attack F. Client with uncontrolled diabetes mellitus

C, D

A nurse is assessing a client who is dehydrated. Which of the following findings should the nurse expect? A. moist skin B. Distended neck veins C. Increased urinary output D. Tachycardia

D

A nurse is caring for a client in a long-term care facility who has become weak, confused, and experienced dizziness when standing. The clients temperature is 39.3C (100.9F), pulse 92/min, respirations 20/min, and blood pressure 108/60 mm Hg. Which of the following actions should the nurse take? A. Initiate fluid restrictions to limit intake B. Check for peripheral edema C. Encourage the client to ambulate to promote oxygenation D. Monitor for orthostatic hypotension

D

A nurse is obtaining arterial blood gasses for a client who has vomited for 24 hours. The nurse should expect which of the following acid-base imbalances to result from vomiting for 24 hours? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

D

A patient with mild hypokalemia caused by a diuretic used is discharged home. Which intervention would the RN delegate to the home health aide. A. Instruction on proper use of the drugs B. Education about potassium-rich foods C. Assessment of muscle tone and strength D. Measurement of the patient's urine output

D

For which classification of drug would the nurse instruct a patient to increased intake of dietary potassium? A. Beta blockers B. Corticosteroids C. Alpha antagonists D. Loop diuretics

D

Which assessment finding would require priority nursing interventions in a patient with metabolic or respiratory acidosis? A. Dry skin B. Rapid respiratory rate C. Lethargy and confusion D. Bradycardia with widened QRS complex

D

Which condition or manifestation in the client with a serum sodium level of 149 mEq/L indicates to the nurse that this electrolyte imbalance may be cause by excessive fluid loss? A. the client has a calf muscles cramping B. The serum chloride level is low C. The urine specific gravity is high. D. The hematocrit is 52%

D

Which intervention would the nurse expect to be prescribed for a patient with hyponatremia? A. 2-g sodium diet B. Administration of furosemide C. IV administration of 0.45% normal saline D. Small-volume IV infusions of 3% normal saline

D

Which laboratory value requires the nurse to notify the primary health care provider? A. Sodium 133 mEq/L B. Calcium 9.0 mg/dL C. Potassium 3.6 mEq/L D. Magnesium 4.2 mEq/L

D

Which newly written prescription does the nurse administer first? A. oral calcium supplements to a patient with severe osteoporosis B. Oral phosphorus supplements to a patient with acute hypophosphatemia C. IV normal saline to a patient with serum sodium level of 134 mEq/L D. Oral potassium chloride to a patient whose serum potassium level is 3 mEq/L

D

Which prescribed action for a patient with serum sodium level of 149 mEq/L would the nurse clarify with the health care provider? A. Weigh the patient daily B. Monitor I & O C. Institute seizure precautions D. Ensure NPO status

D

With which client does the nurse remain alert for and assess most frequently for signs and symptoms of hypokalemia to prevent harm? A. 72-year-old taking the diuretic spironolactone for control of hypertension B. 62-year-old receiving IV solution of Ringer's lactate at a rate of 200 mL/hr C. 42-year-old trauma victim receiving a third infusion of packed red blood cells in 12 hours. D. 22-year-old receiving an IV infusion of regular insulin to manage an episode of ketoacidosis.

D

A nurse is assessing a client who has pancreatitis. The client's arterial blood gases reveal metabolic acidosis. Which of the following are expected findings? Select all that apply, letter only. A. Tachycardia B. Hypertension C. Bounding pulses D. Hyperreflexia E. Dysrhythmia F. Tachypnea

E, F

When is aldosterone secreted by the adrenal cortex?

When sodium levels in the extracellular fluid are low. (Aldosterone also promotes kidney potassium excretion)