Pharm Chapter 33

26) A nurse is providing care to several postsurgical clients. Which prescription would the nurse question? 1. Infuse potassium chloride 40 mEq, IV push over 1 minute, once. 2. Infuse potassium chloride 40 mEq in 250 mL NaCl, over 4 hours, once. 3. Administer potassium chloride 20 mEq, by mouth, once. 4. Administer potassium chloride, 20 mEq diluted in 90 mL juice, by mouth, once.

Answer: 1 Explanation: Never give potassium as an IV push or in concentrated amounts by any route. Page Ref: 573

31) A nurse is scheduled to administer a potassium supplement to a client. Which action should the nurse take prior to administering the drug? 1. Check the client's potassium level from the morning labs. 2. Tell the client that the infusion will burn. 3. Place the client in a low Fowler's position. 4. Ask the client why the medication is ordered.

Answer: 1 Explanation: Serial serum potassium levels should be monitored before and during therapy. Page Ref: 573

23) A nursing instructor asks a student at what point it is appropriate to treat hyponatremia. Which response by the student is accuratNeU?RSINGTB.COM 1. "When serum levels fall below 130 mEq/L." 2. "When serum levels fall below 140 mEq/L." 3. "When serum levels fall below 145 mEq/L." 4. "When serum levels fall below 155 mEq/L."

Answer: 1 Explanation: Sodium chloride is administered for hyponatremia when serum levels fall below 130 mEq/L. Page Ref: 570

24) When infusing 3% NaCl solutions, which clinical manifestation will the nurse continuously check for? 1. Signs of pulmonary edema 2. Hyponatremia 3. Signs of thirst 4. Signs of depression

Answer: 1 Explanation: Solutions of 3% NaCl can cause increased intravascular fluid volume, which can lead to pulmonary edema. Page Ref: 570

30) A client is prescribed ammonium chloride. Which statement indicates an appropriate understanding after medication teaching? 1. "I will report sleepiness right away." 2. "It's okay if this medication makes me a little shaky." 3. "Confusion will be normal for a day or so." 4. "The IV infusion is going to be painful."

Answer: 1 Explanation: Symptoms of excessive drowsiness or confusion should be reported immediately because they are signs of overdose. Page Ref: 577

2) A client is prescribed a transfusion of fresh frozen plasma (FFP). The nurse plans care based on the knowledge that the transfusion will complete which process? 1. Replace multifactor deficiency states. 2. Rehydrate cells. 3. Dehydrate cells. 4. Cause fluid to shift out of the intravascular space.

Answer: 1 Explanation: Transfusing FFP will replace multifactor deficiency states when specific factors are not available. Page Ref: 564-565

10) When a nurse administers a hypotonic intravenous solution to a client, how will the water move? 1. By osmosis from the plasma compartment to the interstitial compartment 2. By diffusion from the plasma compartment to the interstitial compartment 3. By diffusion from the interstitial compartment to the plasma compartment 4. By osmosis from the interstitial compartment to the plasma compartment

Answer: 1 Explanation: Water will move from the plasma compartment to the interstitial compartment, by osmosis, in response to administration of hypotonic intravenous solutions. Page Ref: 563

7) When treating fluid imbalances, which is the ultimate goal of care? 1. To diagnose and correct the underlying cause of the disorder 2. To maintain normal vital signs 3. To keep clients normothermic 4. To administer intravenous fluids

Answer: 1 Explanation: When treating fluid imbalances, the ultimate goal of the healthcare team is to diagnose and correct the underlying cause of the disorder. Page Ref: 563

37) The nurse is preparing to administer normal serum albumin (Plasbumin) to a client with an albumin level of 3.2 g/dL. Which are appropriate classifications of Plasbumin? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Blood product 2. Colloid 3. Crystalloid 4. Vitamin 5. Electrolyte

Answer: 1, 2 Explanation: Plasbumin is an albumin product. Albumin is considered a blood product. Plasbumin is an albumin product. Albumin is considered a colloid. Page Ref: 565

21) The nurse is caring for a client with severe electrolyte imbalances that have occurred as a result of kidney failure. The nurse knows that this client is at risk for which disorders as a result of this electrolyte imbalance? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fluid retention 2. Muscle spasms 3. Fractures 4. High cholesterol 5. Depression

Answer: 1, 2, 3 Explanation: Electrolytes are responsible for membrane permeability and water balance. An electrolyte imbalance, especially too much sodium, can result in fluid retention. Electrolytes are essential for muscle contractions. An imbalance in electrolytes can result in muscle spasms. Electrolytes are essential for bone growth and remodeling and may place a client at risk for fractures, especially when there is an imbalance of calcium. Page Ref: 569

33) The nurse is preparing to administer magnesium sulfate to a pregnant client with preeclampsia. Which conditions must the nurse assess this client for while administering this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Level of consciousness 2. Deep tendon reflexes 3. Urine output 4. Neuromuscular depression 5. Magnesium level

Answer: 1, 2, 3, 5 Explanation: The nurse must monitor the client's level of consciousness while administering magnesium to determine the presence of adverse effects. The nurse must monitor the client's deep tendon reflexes while administering magnesium to determine the presence of adverse effects. The nurse must monitor the client's urine output while administering magnesium to determine the presence of adverse effects. The nurse would monitor the client's magnesium level in order to assess for toxicity. Page Ref: 574

38) The nurse is reviewing the client's medical record in preparation to administer 5% dextrose solution. Which findings would indicate a contraindication for this intravenous fluid? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Heart failure 2. Hypoglycemia 3. Increased intracranial pressure 4. Hypernatremia 5. Hypercalcemia

Answer: 1, 3 Explanation: Heart failure is a contraindication for the administration of 5% dextrose solution. Increased intracranial pressure is a contraindication for the administration of 5% dextrose solution. Page Ref: 567

29) The nurse is caring for a client with a pH of 7.32. Which medications would be appropriate to administer to a client with this condition? Note: Credit will be given only if all corrNeUcRt SchINoGicTeBs.CanOdMno incorrect choices are selected. Select all that apply. 1. Oral bicarbonate 2. Sodium chloride 3. Citrate salts 4. Potassium chloride 5. Ammonium chloride

Answer: 1, 3 Explanation: Oral bicarbonate is an agent used to treat acidosis. Citrate salts are an agent used to treat acidosis. Page Ref: 576

12) A seasoned nurse is caring for a client receiving intravenous fluid therapy for dehydration. The nurse knows that the osmolarity or tonicity of a fluid causes water to move to a different compartment. The nurse is caring for a client who weighs 40 kg. The osmolality of the body fluids for this client is between 11,000 and ________ milliosmoles .Record your answer rounding to the nearest whole number.

Answer: 11,800 Explanation: The normal osmolality of body fluids ranges from 275 to 295 milliosmoles per kilogram (mOsm/kg). Page Ref: 565

39) The nurse is preparing to administer a 5% dextrose in water (D5W) infusion to a client. Which explanation as to why the infusion is ordered is the most accurate? 1. "This is a colloid, and will increase the client's blood pressure." 2. "This medication is isotonic in its container, but when infused, the solution becomes hypotonic." 3. "This medication is hypotonic and will cause fluid to shift from the intravascular space into the interstitial and intracellular spaces." 4. "This medication is hypertonic and will cause fluid to shift from the extravascular space into the vascular space."

Answer: 2 Explanation: D5W is isotonic in the container. When infused, the dextrose is quickly metabolized in the body, leaving only water, and the solution becomes hypotonic. Page Ref: 567

14) A client diagnosed with diabetes insipidus is suffering from severe hypernatremia. The nurse anticipates the use of which type of intravenous solution? 1. A hypertonic crystalloid 2. A hypotonic crystalloid 3. An isotonic crystalloid 4. Albumin

Answer: 2 Explanation: Hypotonic crystalloids are indicated for clients with hypernatremia and cellular dehydration. Page Ref: 566

15) A client has vomited several times and continues to be nauseated. To correct mild hypovolemia, the nurse plans to complete which intervention? 1. Ask the client to drink 8 ounces of water every hour. 2. Administer an isotonic crystalloid. 3. Administer a hypotonic crystalloid. 4. Ask the client to drink 8 ounces of an electrolyte solution every 30 minutes for 4 hours.

Answer: 2 Explanation: Isotonic solutions are often used to tread fluid loss due to vomiting. Page Ref: 566

11) The nurse is reviewing a client's lab values, which indicate normal serum osmolality. Which intravenous solutions will not cause a fluid shift in this client? 1. Colloids 2. Isotonic solutions 3. Hypertonic solutions 4. Hypotonic solutions

Answer: 2 Explanation: Isotonic solutions will likely cause no fluid shift in this client. Page Ref: 563

18) A client prescribed 100 mL of 3% normal saline solution received 1,000 mL of 3% normal saline. Which is the priority assessment for this client? 1. Skin integrity 2. Blood pressure 3. Capillary refill 4. Coagulation profile

Answer: 2 Explanation: Overtreatment with hypertonic crystalloids such as 3% normal saline can lead to excessive expansion of the intravascular compartment, fluid overload, and hypertension. Page Ref: 566

22) A client has a serum potassium of 2.5 mEq/L. While reviewing the client's medical administration record, the nurse suspects that which medication might have contributed to this imbalance? 1. Metoprolol 2. Hydrochlorothiazide 3. Aspirin 4. Acetaminophen

Answer: 2 Explanation: The most frequent cause of hypokalemia is pharmacotherapy with loop and thiazide diuretics. Page Ref: 572

20) A nurse is caring for a client with a serum potassium level of 6.9 mEq/L. When planning care, which body system will be most profoundly affected by this value? 1. The respiratory system 2. The cardiovascular system 3. The hematologic system 4. The genitourinary system

Answer: 2 Explanation: This value represents hyperkalemia. Both hyperkalemia and hypokalemia are associated with fatal dysrhythmias and serious neuromuscular disorders. Page Ref: 572

8) The nurse is caring for a group of clients on a medical—surgical unit. For which clients would the nurse anticipate the need for intravenous fluid therapy to correct fluid depletion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A client suffering from constipation 2. A client exhibiting nausea and vomiting following a surgical procedure 3. A client with a severe burn 4. A client with heart failure with edema to the lower extremities and rales 5. A client with uncontrolled diabetic ketoacidosis

Answer: 2, 3, 5 Explanation: A client exhibiting nausea and vomiting may require intravenous fluid to avoid dehydration. A client with a severe burn will often require intravenous fluid due to fluid depletion that occurs from fluid shifts. A client with uncontrolled diabetic ketoacidosis often requires intravenous fluid administration for fluid depletion. Page Ref: 563

17) The nurse is reviewing the tonicity of the different intravenous fluids on the medical— surgical unit in preparation for an in-service presentation. Which fluids are considered to be isotonic and appropriate in the treatment of fluid loss due to a surgical procedure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. 5% dextrose in lactated Ringer's 2. 0.9% sodium chloride (NS) 3. 0.45% sodium chloride 4. Lactated Ringer's 5. 5% dextrose in water

Answer: 2, 4, 5 Explanation: This is an isotonic solution and is appropriate for the treatment of fluid loss due to a surgical procedure. This is an isotonic solution and is appropriate to treat fluid loss caused by a surgical procedure. This is an isotonic solution and is appropriate to treat fluid loss caused by a surgical procedure. Page Ref: 564

4) The nurse is caring for a client who was admitted to the hospital for the treatment of dehydration. The nurse is discussing the difference between intracellular fluid and extracellular fluid and states that intracellular fluid accounts for ________ of the total amount of water in the body. Record your answer as a fraction.

Answer: 2/3 Explanation: The intracellular fluid (ICF) compartment, which contains water that is inside cells, accounts for about two thirds of the total body water. The remaining one third of body fluid resides outside cells in the extracellular fluid (ECF) compartment. Page Ref: 562

34) The nurse would question administering sodium bicarbonate to which client? 1. A client taking methotrexate 2. A client in chronic renal failure 3. A client on continuous nasogastric suctioning 4. A client diagnosed with metabolic acidosis

Answer: 3 Explanation: A client on continuous nasogastric suctioning might experience base excess secondary to loss of stomach acid, which predisposes the client to metabolic alkalosis. Page Ref: 576

28) Nurses must administer sodium bicarbonate with caution to clients with hypertension to avoid which adverse effect? 1. Respiratory acidosis 2. Metabolic acidosis 3. Retention of fluid 4. Unexpected diuresis

Answer: 3 Explanation: Administer sodium bicarbonate with caution to clients with hypertension, because this drug will promote retention of fluids. Page Ref: 576

40) The nurse is assessing a client being treated with 3% normal saline solution. Which assessment finding should be reported to the healthcare provider immediately? 1. Temperature of 100.1°F 2. Blood pressure of 146/92 mmHg 3. Presence of auscultated crackles 4. Presence of auscultated rhonchi

Answer: 3 Explanation: Crackles are a sign of pulmonary edema, which can occur with the use of 3% normal saline solution. This assessment finding should be reported to the healthcare provider immediately. Page Ref: 566

42) A client is scheduled receive a parenteral dose of magnesium sulfate. The nurse tests patellar reflexes and determines them to be absent. Which action by the nurse is the most appropriate? 1. Administer the drug as ordered, because this is a normal finding. 2. Hold the medication for 1 hour, then reassess. 3. Hold the medication and notify the healthcare provider. 4. Administer the drug after placing the client on a cardiac monitor.

Answer: 3 Explanation: Depression or absence of reflexes can indicate early magnesium intoxication. Page Ref: 573

9) A client is prescribed a hypertonic intravenous solution. Administration of this solution will most likely cause which manifestation to occur? 1. A shift of fluid from the vascular space to the interstitial space 2. No fluid shift 3. The plasma to have more solutes than the interstitial fluid 4. The plasma to have fewer solutes than the interstitial fluid

Answer: 3 Explanation: If a hypertonic solution is administered, the plasma gains more solutes than does the interstitial fluid. Page Ref: 563

25) The nurse is caring for a client with a serum sodium level of 110 mEq/L. The nurse anticipates that the client will require an infusion of ________% sodium chloride solution. Record your answer rounding to the nearest whole number

Answer: 3 Explanation: Normal saline consists of 0.9% NaCl and is used to treat mild hyponatremia. When serum sodium falls below 115 mEq/L, a highly concentrated 3% NaCl solution may be infused. Page Ref: 571

36) Which is not an indication for the use of potassium chloride? 1. Prevention of hypokalemia 2. Treatment of hypokalemia 3. Treatment of peptic ulcer disease 4. Treatment of mild alkalosis

Answer: 3 Explanation: Potassium chloride supplements can cause peptic ulcers. Page Ref: 564

41) A nurse is providing medication teaching to a client who is prescribed potassium tablets. Which information should be included? 1. Allow potassium tablets to dissolve completely in the mouth. 2. Licorice helps alleviate the bad taste of the potassium tablets. 3. Avoid salt substitutes. 4. Add lots of potassium-rich foods to your diet.

Answer: 3 Explanation: Salt substitutes contain potassium and electrolytes other than sodium, and they could cause hyperkalemia. Page Ref: 572

35) The nurse would be most concerned about administering which blood product to a client? 1. Fresh frozen plasma 2. Albumin 3. Whole blood 4. Packed red cells

Answer: 3 Explanation: The administration of whole blood is uncommon due to potential adverse reactions and the small possibility of transmitting infectious disease. Page Ref: 564

3) A client has a severe fluid and electrolyte imbalance. The nurse is aware that in order for the body to move large molecules and molecules with electrical charges, which two processes are required? 1. Active transport and tonicity 2. Osmosis and active transport 3. Diffusion and active transport 4. Osmosis and diffusion

Answer: 3 Explanation: The processes of diffusion and active transport govern the movement of large molecules and those with electrical charges. Page Ref: 563

43) The nurse is caring for a client diagnosed with hyperkalemia. Which interventions are appropriate to include in the client's plan of care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A calcium supplement 2. A potassium supplement 3. Hypotonic fluids 4. Buffering agents 5. Citrus fruits in the diet

Answer: 3, 4 Explanation: Hypotonic fluids are often used in the treatment of hyperkalemia. Buffering agents are often used in the treatment of hyperkalemia. Page Ref: 572

16) The nurse is caring for a client in the emergency department who has experienced a below- the-knee traumatic amputation. The nurse anticipates the use of a whole blood transfusion because the client has lost ________% of the total blood volume in the accident. Record your answer rounding to the nearest whole number.

Answer: 30 Explanation: Blood loss can be treated with a number of different intravenous fluids. The nurse knows that whole blood will be used when the client loses 30% or more of the total blood volume. Page Ref: 565

6) When planning care, the nurse anticipates that which client will most likely require intravenous fluid replacement? 1. A client with a minor burn to the left arm 2. A client diagnosed with heart failure 3. A client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) 4. A client diagnosed with shock

Answer: 4 Explanation: A client in shock will require intravenous fluid replacement secondary to hypotension and fluid shifting. Page Ref: 563-564

32) A client is receiving an infusion of magnesium sulfate. The healthcare provider should be notified immediately if which response is observed? 1. A pulse rate of 99 beats/min 2. A blood pressure of 90/60 mmHg 3. Pain at the IV site 4. A respiratory rate of 9 breaths/min

Answer: 4 Explanation: A respiratory rate below 12 breaths/min should be reported to the healthcare provider immediately. This can indicate magnesium toxicity. Page Ref: 574

1) The nurse is aware that body fluids are exchanged between which compartments? 1. Intravascular and interstitial 2. Intravascular and extracellular 3. Interstitial and extracellular 4. Intracellular and extracellular

Answer: 4 Explanation: Body fluids are exchanged between intracellular and extracellular compartments. Page Ref: 562

19) A client has a serum sodium level of 157 mEq/L. Which area of assessment is the priority? 1. Muscle pain 2. Daily weight 3. Thirst level 4. Level of consciousness

Answer: 4 Explanation: Hypernatremia can cause increased intracranial pressure. This should be reported to the healthcare provider immediately. Page Ref: 570

13) A client with long-standing hepatic cirrhosis might receive which intravenous solution to correct hypoproteinemia? 1. Dextrose 5% 2. Packed red cells 3. Whole blood 4. Albumin

Answer: 4 Explanation: Normal serum albumin is the preferred treatment for hypoproteinemia in a client with hepatic cirrhosis. Page Ref: 565

27) A client being treated long term with oral sodium bicarbonate should be monitored for which acid—base imbalance? 1. Metabolic acidosis 2. Respiratory acidosis 3. Respiratory alkalosis 4. Metabolic alkalosis

Answer: 4 Explanation: Overdose or long-term use of sodium bicarbonate results in metabolic alkalosis. Page Ref: 576

5) A nurse is evaluating a client's serum osmolality. Which solute is not factored into this value? 1. Sodium 2. Glucose 3. Urea 4. Water

Answer: 4 Explanation: Water is not a solute. Page Ref: 563