PREP U's preparation for Exam 1
The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium concentration of 2.9 mEq/L (2.9 mmol/L). Which statement made by the client indicates the need for further teaching?
"I can use laxatives and enemas but only once a week."
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 will not salt my food; instead I'll use salt substitute."
The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed?
"The nurse will explain the details of the surgery before I sign a consent."
A client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering?
0.45% NaCl
The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer?
0.45% sodium chloride
The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining?
1 L
At which serum sodium concentration might convulsions or coma occur?
130 mEq/L (130 mmol/L)
The nurse is caring for a client in the intensive care unit (ICU) following a near-drowning event in saltwater. The client is restless, lethargic, and demonstrating tremors. Additional assessment findings include swollen and dry tongue, flushed skin, and peripheral edema. The nurse anticipates that the client's serum sodium value would be
155 mEq/L (155 mmol/L)
A client weighing 160.2 pounds (72.7 kg), who has been diagnosed with hypovolemia, is weighed every day. The health care provider asked to be notified if the client loses 1,000 mL of fluid in 24 hours. What weight would be consistent with this amount of fluid loss?
158.0 lbs (71.7 kg)
The nurse knows which is the normal serum value for potassium?
3.5-5.0 mEq/L (3.5-5.0 mmol/L).
For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery?
7
The nurse is triaging surgical clients. Which client would the nurse document as in need of urgent surgical care?
A client with an acute gallbladder infection
The nurse is completing a preoperative assessment with an older adult. Which preoperative testing will the nurse anticipate being used to determine the client's risk of developing cardiovascular complications from anesthesia? Select all that apply. A. Basic metabolic panel B. Echocardiogram C. Blood pressure screening D. Electrocardiogram E. Cardiac catheterization
A. Basic metabolic panel C. Blood pressure screening D. Electrocardiogram
A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution?
Acidic
A client with hypervolemia asks the nurse by what mechanism the sodium-potassium pump will move the excess body fluid. What is the nurse's best answer?
Active transport
To evaluate a client for hypoxia, the physician is most likely to order which laboratory test?
Arterial blood gas (ABG) analysis
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. Crackles on auscultation B. Cyanosis C. Hypertension D. Shoulder pain E. Dyspnea F. Tachycardia
B. Cyanosis D. Shoulder pain E. Dyspnea F. Tachycardia
When a client's ventilation is impaired, the body retains which substance?
Carbon dioxide
Upon shift report, the nurse states the following laboratory values: pH, 7.44; PCO2, 30 mm Hg; and HCO3, 21 mEq/L for a client with noted acid-base disturbances. Which acid-base imbalance do both nurses agree is the client's current state?
Compensated respiratory alkalosis
A client scheduled for surgery follows a vegan eating plan. For which potential postoperative complication will the nurse plan care for this client?
Delayed wound healing
The nurse is caring for a client with a serum potassium concentration of 6.0 mEq/L (6.0 mmol/L) and a fluid volume excess. The client is ordered to receive oral sodium polystyrene sulfonate and furosemide. What other order should the nurse anticipate giving?
Discontinue the intravenous lactated Ringer solution.
What action by the nurse best encompasses the preoperative phase?
Educating clients on signs and symptoms of infection
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?
Extracellular fluid volume deficit
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
An elderly client takes 40 mg of furosemide twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use?
Hypokalemia
Oral intake is controlled by the thirst center, located in which of the following cerebral areas?
Hypothalamus
A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level?
Increases arterial pH
The nurse is assessing residents at a summer picnic at the nursing facility. The nurse expresses concern due to the high heat and humidity of the day. Although the facility is offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned about which?
Insensible fluid loss
A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action?
Jugular vein distention
A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?
Light-headedness or paresthesia
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?
Metabolic alkalosis
A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance?
Metabolic alkalosis
A client is undergoing preoperative assessment. During admission paperwork, the client reports having enjoyed a hearty breakfast this morning to be ready for the procedure. What is the nurse's next action?
Notify the surgeon
When is the ideal time to discuss preoperative teaching
Preadmission visit
A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first?
Prepare to assist with ventilation.
Which of the following arterial blood gas results would be consistent with metabolic alkalosis?
Serum bicarbonate of 28 mEq/L
Treatment of FVE involves dietary restriction of sodium. Which of the following food choices would be part of a low-sodium diet, mild restriction (2 to 3 g/day)?
Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad
A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse:
continuously monitors the sedated client.
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
malignancy is causing the electrolyte imbalance
A client who complains of an "acid stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid-base imbalance?
metabolic alkalosis
Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by:
muscle weakness
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
pH, PaCO2, HCO3
A client is scheduled to have surgery to address a cleft palate. What type of surgery would the nurse be preparing this client for?
reconstructive
An example of a curative surgical procedure is
tumor excision
A client will undergo abdominal surgery. The nurse provides preoperative education regarding the importance of diaphragmatic breathing exercises to prevent postoperative complications. The nurse will educate the client about the risk for developing 1._____________, 2._______________, and 3.________________, if the client does not implement diaphragmatic breathing exercises in the postoperative period of care.
1. atelectasis 2. pneumonia 3. bronchospam
The nurse assesses a client who is diagnosed with bulimia nervosa and at risk for alterations in both fluid and electrolyte balance. Complete the following sentence by choosing from the lists of options. During the assessment, the nurse focuses on monitoring the client for 1.______________as evidenced by 2._______________.
1. hypokalemia 2. cardiac arrythmias
Which of the following would be appropriate nursing interventions for a client with hypokalemia? Select all that apply. A. Offer a diet with fruit juices and citrus fruits. B. Administer the ordered Kayexalate enema. C. Administer the ordered furosemide 60 mg po. D. Monitor intake and output every shift. E. Administer the ordered potassium 40 mg IV push.
A. Offer a diet with fruit juices and citrus fruits. D. Monitor intake and output every shift.
The policies and procedures on a preoperative unit are being amended to bring them closer into alignment with the focus of the Surgical Care Improvement Project (SCIP). What intervention most directly addresses the priorities of the SCIP?
Actions aimed at preventing surgical site infections
Which of the following is the most common cause of symptomatic hypomagnesemia in the United States?
Alcoholism
The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition?
Confusion
A fractured skull would be classified under which category of surgery based on urgency?
Emergent
A gunshot wound would be classified under which category of surgery based on urgency?
Emergent
Informed consent from the surgical client is essential in all of the following categories of surgery except:
Emergent surgery
An anxious client being prepared for surgery is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used?
Imagery
Which is the preferred route of administration for potassium?
Oral
The calcium concentration in the blood is regulated by which mechanism?
Parathyroid hormone (PTH)
A nurse is witnessing a client sign the consent form for surgery. After signing the consent form, the client starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate?
Request that the surgeon come and answer the questions.
A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects:
Respiratory alkalosis
When does the nurse understand the patient is knowledgeable about the impending surgical procedure?
The patient participates willingly in the preoperative preparation.
At what point does the preoperative period end?
When the client is transferred onto the operating table
Clients diagnosed with hypervolemia should avoid sweet or dry food because it
increases the client's desire to consume fluid.
A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?
pH, 7.25; PaCO2 50 mm Hg