PrepU Exam 3
A nurse is caring for a 4-year-old child who developed acute renal failure after a traumatic injury with hemorrhaging. Place the following events in the order in which they most likely occurred during progression of the severe renal deterioration. All options must be used. 1) azotemia 2) severe hypocalcemia 3) acidosis 4) oliguria
4) oliguria 1) azotemia 3) acidosis 2) severe hypocalcemia
Which glands regulate calcium and phosphorous metabolism? A) Parathyroid B) Adrenal C) Pituitary D) Thyroid
A)
The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis? A) pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L B) pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L C) pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 mEq/L D) pH: 7.42, PaCO2: 45 mm Hg, HCO3-: 22 mEq /L
A) pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L
A 15-year-old client is brought to the emergency department by his friends. He reports visual changes, drowsiness, and tinnitus. He is confused and hyperventilating. These symptoms may be attributable to which condition? A) Ibuprofen overdose B) Salicylate intoxication C) Caffeine abuse D) Acute acetaminophen poisoning
B)
Which of the following medications is classified as a proton pump inhibitor (PPI)? A) Famotidine B) Omeprazole C) Nizatidine D) Cimetidine
B) Omeprazole
High levels of acid in the gastrointestinal (GI) tract decrease the secretion of which enzyme? A) Trypsin B) Lipase C) Gastrin D) Pancrease
C) Gastrin
Because of the action of methazolamide, the nurse would assess a patient closely for signs and symptoms of which acid-base imbalance? A) Respiratory acidosis B) Metabolic alkalosis C) Metabolic acidosis D) Respiratory alkalosis
C) Metabolic acidosis
An experienced nurse has observed that female clients sometimes experience a drug's effects for a longer time than male clients of similar age and size. The nurse should attribute this to what factor? A) Men commonly lack certain enzyme systems that are necessary for metabolizing a drug. B) Women more often experience electrolyte imbalances, prolonging a drug's effect. C) Women have more fat cells so drugs depositing in fat will have a prolonged effect. D) Men have more vascular muscle so drug effects will take longer to occur.
C) Women have more fat cells so drugs depositing in fat will have a prolonged effect.
The client is a 1-year-old girl from a low-income family presenting with a vitamin D deficiency and anemia. What assistance program would you recommend to the child's young mother? A) ECI B) CHIP C) SCHIP D) WIC
D) WIC
As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased: A) hydrogen/potassium binding. B) intracellular albumin. C) sodium/phosphate anion absorption. D) bicarbonate/carbonic acid regulation.
D) bicarbonate/carbonic acid regulation
While reviewing the basic information related to hemodialysis, the professor explains that water molecules move through adjacent phospholipid molecules in the cell membrane by: A) vesicular transport. B) active transport. C) secondary active transport. D) diffusion. E) osmosis.
E)
The primary function of the thyroid gland includes which of the following? A) Control of cellular metabolic activity B) Reabsorption of water C) Facilitation of milk ejection D) Reduction of plasma level of calcium
a
A newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client? A) Dehydration B) Hypoglycemia C) Bleeding tendency D) Excessive cortisone secretion
A)
An older adult client with acute myelocytic leukemia has been prescribed sargramostim. What is a priority nursing action for this client? A) ensuring adequate fluid intake B) providing a quiet environment C) encouraging appropriate dietary intake D) providing comfort measures related to anxiety
A)
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 A) 155 mEq/L (155 mmol/L) B) 145 mEq/L (145 mmol/L) C) 125 mEq/L (125 mmol/L) D) 135 mEq/L (135 mmol/L)
A)
The nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows that what minimal daily intake of fluids is required? A) 1.5 L B) 1.0 L C) 2.0 L D) 2.5 L
A)
The parents of an infant born with hydrocephalus are concerned about the size of the baby's head. The doctors are telling them that the infant needs the surgical placement of a shunt. The nurse caring for the infant in the neonatal intensive care unit explains that placement of a shunt will: A) decrease the likelihood of further neurological deficits. B) not affect the size of the infant's head. C) increase intracranial pressure. D) reverse any neurologic deficits that are present.
A)
The physician places his client with liver failure on spironolactone to decrease sodium absorption by the kidney. Which hormone is this medication affecting? A) Aldosterone B) Vasopressin C) Adrenocorticotropic hormone (ACTH) D) Cortisol
A)
When the postcardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia, slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression, the nurse suspects which electrolyte imbalance? A) Hypermagnesemia B) Hyperkalemia C) Hypokalemia D) Hypomagnesemia
A)
The nurse that ascribes to the gate control theory of pain would be most likely to prescribe which of the following for the relief of pain? (Select all that apply.) A) Heat B) Cold C) Acetaminophen D) Percocet E) Massage
A) B) E)
A client who is blind is admitted for treatment of a small bowel obstruction and has been vomiting for days. Which nursing diagnosis takes highest priority for this client? A) Deficient fluid volume B) Impaired physical mobility C) Activity intolerance D) Risk for injury
A) Deficient fluid volume
Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes mellitus. Which of the following explains the cause of this secondary diabetes? A) Dysfunction of the pancreatic islet cells B) Inability for the liver to reabsorb serum glucose C) Renal failure D) Ingestion of foods high in sugar
A) Dysfunction of the pancreatic islet cells
A client has a serum calcium level of 7.2 mg/dl (1.8 mmol/L). During the physical examination, the nurse expects to assess: A) Trousseau's sign. B) Goodell's sign. C) Hegar's sign. D) Homans' sign.
A) Trousseau's sign.
A 4-year-old child is receiving dextrose 5% in water and half-normal saline solution at 100 ml/hour. The nurse should suspect that the child's I.V. fluid intake is excessive if assessment reveals A) a temperature of 102° F (38.9° C). B) worsening dyspnea. C) gastric distention. D) nausea and vomiting.
B)
A 50-year-old client with hypertension is being treated with a diuretic. The client reports muscle weakness and falls easily. The nurse should assess which electrolyte? A) Chloride B) Potassium C) Sodium D) Phosphorous
B)
The nurse is caring for an 8-year-old client who has cystic fibrosis. What aspect of client care should the nurse prioritize? A) Nutritional status B) Airway clearance C) Pain control D) Infection control
B)
The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: A) Protein 15 mg/dL B) Specific gravity 1.035 C) Creatinine 0.7 mg/dL D) Bright yellow urine
B)
In describing the ideal analgesic, what factors would be included? Select all that apply. A) Addictive B) Inexpensive C) Have minimal adverse effects D) Effective E) Decrease the level of consciousness
B) C) D)
To calculate the H2CO3 content of the blood, the nurse needs to measure the PCO2 (partial pressure of CO2) by its solubility coefficient. What is the solubility coefficient of CO2? A) 0.3 B) 0.03 C) 0.4 D) 0.04
B) 0.03
A home care nurse is visiting a client with renal failure who is on fluid restriction. The client tells the nurse, "I get thirsty very often. What might help?" What would the nurse include as a suggestion for this client? A) Use an alcohol-based mouthwash to moisten your mouth. B) Avoid salty or excessively sweet fluids. C) Eat crackers and bread. D) Use regular gum and hard candy.
B) Avoid salty or excessively sweet fluids.
When the nurse notes that, after cardiac surgery, the client demonstrates low urine output (less than 25 mL/h) with high specific gravity (greater than 1.025), the nurse suspects which condition? A) Normal glomerular filtration B) Inadequate fluid volume C) Anuria D) Overhydration
B) Inadequate fluid volume
A client has these arterial blood gas values: anion gap 20 mEq/L (20 mmol/L), pH 7.29, PCO2 37 mm Hg (4.92 mmol/L), HCO3- 11 mEq/L (11 mmol/L), base excess -6 mEq/L (-6 mmol/L). With what condition do these values correspond? A) lithium toxicity B) Lactic acidosis C) Multiple myeloma D) Hyperkalemia
B) Lactic acidosis
The nurse observes that a postsurgical client has hemorrhaged and is in hypovolemic shock. Which nursing intervention will manage and minimize hemorrhage and shock? A) Encouraging the client to breathe deeply B) Reinforcing dressings or applying pressure if bleeding is frank C) Elevating the head of the bed D) Rubbing the back
B) Reinforcing dressings or applying pressure if bleeding is frank
A 3-year-old who has just been admitted with pneumonia needs to have an intravenous (IV) line inserted for antibiotic therapy. What is the best nursing action? A) Tell the patient to stay with the mother in his room while the IV is inserted. B) Tell the patient that it will feel like a bumble bee sting when inserted. C) Take the patient to the treatment room to have the IV inserted. D) Inform the patient's mother that she can stay in the room and hold the child while the IV is inserted.
C)
A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse most likely expect to address? A) Hypomagnesemia B) Hyperkalemia C) Hypocalcemia D) Hyponatremia
C)
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? A) Magnesium B) Phosphorus C) Calcium D) Sodium
C)
A physician orders spironolactone, 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? A) blood pH of 7.25 B) serum sodium level of 135 mEq/L C) loss of 2.2 lb (1 kg) in 24 hours D) serum potassium level of 3.5 mEq/L
C)
One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: A) allowing liberal use of sodium. B) eating protein liberally. C) restricting sources of potassium usually found in fresh fruits and vegetables. D) limiting iron and folic acid intake.
C)
The nurse advises a pregnant client to keep a small high-carbohydrate, low-fat snack at the bedside. The nurse should point out this will assist with which condition? A) Heartburn B) Faintness C) Nausea and vomiting D) Slowed GI transit time
C)
The nurse is reviewing the following lab results of a client diagnosed with renal failure:pH: 7.24PCO2: 38 mm Hg (5.05 kPa)HCO3:18 mEq/L (18 mmol/L)The nurse would interpret this as: A) Respiratory acidosis B) Metabolic alkalosis C) Metabolic acidosis D) Respiratory alkalosis
C) Metabolic acidosis
A client with chronic renal disease has severe pruritus. Which interventions should the nurse include in the teaching plan for the client? Select all that apply. A) Wear clothing to keep the skin warm B) Drinking alcoholic beverages will decrease stimulation of the itch receptors C) Moisturize the skin frequently D) Keep fingernails trimmed E) Take a cool shower before bed
C) Moisturize the skin frequently D) Keep fingernails trimmed E) Take a cool shower before bed
When the postcardiac surgery client demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the client's serum electrolytes, anticipating which abnormality? A) Hypercalcemia B) Hyponatremia C) Hypomagnesemia D) Hyperkalemia
D) Hyperkalemia
A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, "I feel very short of breath all of a sudden." What is the nurse's primary action? A) Stop the infusion. B) Assess the client's vital signs. C) Slow the infusion. D) Call the health care provider.
a
A client has been prescribed disopyramide (Norpace) to treat a tachyarrhythmia. Which factor would necessitate that the dose be reduced? A) Chronic diarrhea B) Renal impairment C) Hypertension D) Immobility
b
A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having? A) Sodium B) Magnesium C) Potassium D) Calcium
c
Which diagnostic study is usually performed to confirm the diagnosis of heart failure? A) Blood urea nitrogen (BUN) B) Serum electrolytes C) Echocardiogram D) Electrocardiogram (ECG)
c
A nurse is teaching a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority? A) constipation prevention B) consumption of a low-fat diet C) administration of immunoglobulins D) avoidance of infection
d
The nurse is caring for a client with renal failure experiencing shortness of breath and increased respiratory rate. The arterial blood gas reflects a pH of 7.10 and HCO3 level of 18 mEq/L (18 mmol/L). How does the nurse interpret these findings? A) Metabolic acidosis B) Respiratory alkalosis C) Metabolic alkalosis D) Respiratory acidosis
A) Metabolic acidosis
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? A) Metabolic alkalosis B) Metabolic acidosis C) Respiratory acidosis D) Respiratory alkalosis
A) Metabolic alkalosis
A client is admitted to the unit with a diagnosis of intractable vomiting for 3 days. What acid-base imbalance related to the loss of stomach acid does the nurse observe on the arterial blood gas (ABG)? A) Metabolic alkalosis B) Metabolic acidosis C) Respiratory acidosis D) Respiratory alkalosis
A) Metabolic alkalosis
The renal control mechanism of restoring the acid-base balance is accomplished through which process? A) Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms. B) Reabsorption of hydrogen and excretion of carbonic acid C) Regulation of the production of carbonic acid D) Stimulation of the chemoreceptors in the brain stem
A) Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms.
During a lecture about the function of the intestine related to food digestion, the faculty mentions that when the students consume foods high in acid, the intestines will: A) stimulate the release of secretin, which then inhibits release of gastrin. B) stimulate the release of glucagon-like peptide 1 to lower blood glucose levels. C) inhibit the release of glucose-dependent insulinotropic peptide to slow gastric emptying. D) stimulate pancreatic enzymes to release more insulin.
A) stimulate the release of secretin, which then inhibits release of gastrin.
The nurse caring for the client with respiratory alkalosis and renal compensation determines that which diagnostic finding is consistent with this disorder? A) Normal PCO2, and increased HCO3 and pH B) Decreased PCO2 and HCO3, and increased pH C) Normal PCO2, and decreased HCO3 and pH D) Increased PCO2 and HCO3, and decreased pH
B) Decreased PCO2 and HCO3, and increased pH
Oliguria occurs in the progressive stage of shock because the kidneys decompensate. Which of the following are signs or symptoms that indicate decompensation? Select all that apply. A) Bradycardia with a heart rate of 60 beats/min B) Decreased capillary permeability and fluid and electrolyte shifts C) Acid-base imbalance D) Increased blood urea nitrogen and serum creatinine E) A mean arterial blood pressure of 70 mm Hg
B) Decreased capillary permeability and fluid and electrolyte shifts C) Acid-base imbalance D) Increased blood urea nitrogen and serum creatinine
A client has been taking famotidine at home. What teaching should the nurse include with the client? A) Famotidine will shorten the time required for digestion in the stomach. B) Famotidine will inhibit gastric acid secretions. C) Famotidine will improve the mixing of foods and gastric secretions. D) Famotidine will neutralize acid in the stomach.
B) Famotidine will inhibit gastric acid secretions.
The nurse is caring for a client with acute primary respiratory acidosis. When determining the cause of the acidosis the nurse is aware that which imbalance is most common? A) Renal bicarbonate retention B) Impaired alveolar ventilation C) Increased metabolic acids D) Decreased CO2 retention
B) Impaired alveolar ventilation
A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level? A) Decreases arterial pH B) Increases arterial pH C) No effect D) Provides long-term pH regulation
B) 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? A) Administer an ordered decongestant. B) Instruct the client to breathe into a paper bag. C) Offer the client fluids frequently. D) Administer ordered supplemental oxygen.
B) Instruct the client to breathe into a paper bag.
A client has an increase in her anion gap (AG). What does the nurse determine is the significance of this finding? A) It indicates the client has respiratory alkalosis. B) It indicates the client has metabolic acidosis. C) It indicates the client has metabolic alkalosis. D) It indicates the client has respiratory acidosis.
B) It indicates the client has metabolic acidosis.
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? A) Metabolic alkalosis B) Metabolic acidosis C) Respiratory acidosis D) Respiratory alkalosis
B) Metabolic acidosis
The nurse is assessing a client who is receiving mechanical ventilation. Which assessment data obtained by the nurse may indicate that the client is experiencing respiratory alkalosis? A) Negative Trousseau sign B) Positive Chvostek sign C) Hypotonia D) Negative Homans sign
B) Positive Chvostek sign
A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? A) Glargine B) Regular C) NPH D) Lente
B) Regular
The nurse is caring for a client who complains of headache and blurred vision. The nurse recognizes that these symptoms, accompanied by increased plasma partial pressure carbon dioxide (PCO2) level and decreased pH level, are consistent with which diagnosis? A) Metabolic acidosis B) Respiratory acidosis C) Respiratory alkalosis D) Metabolic alkalosis
B) Respiratory acidosis
The nurse is conducting a review class for a group of perinatal nurses about factors that place a pregnant woman at risk for infection in the postpartum period. The nurse determines that additional teaching is needed when the group identifies which factor? A) loss of protection with premature rupture of membranes B) increased vaginal acidity leading to growth of bacteria C) prolonged labor with multiple vaginal examinations to evaluate progress D) retained placental fragments
B) increased vaginal acidity leading to growth of bacteria
An adolescent is admitted for treatment of bulimia nervosa. When developing the care plan, the nurse anticipates including interventions that address which metabolic disorder? A) metabolic acidosis B) metabolic alkalosis C) hypoglycemia D) hyperkalemia
B) metabolic alkalosis
The nurse has received lab reports for several clients undergoing care. Which set of arterial blood gas (ABG) results will the nurse investigate first? A) pH 7.34, partial pressure of arterial carbon dioxide (PaCO2) 36 mmHg, partial pressure of arterial oxygen (PaO2) 95 mmHg, bicarbonate (HCO3-) 20 mEq/L B) pH 7.49, PaCO2 30 mmHg, PaO2 75 mmHg, and HCO3- 22 mEq/L C) pH 7.35, PaCO2 48 mmHg, PaO2 91 mmHg, and HCO3- 28 mEq/L D) pH 7.47, PaCO2 43 mmHg, PaO2 99 mmHg, and HCO3- 29 mEq/L
B) pH 7.49, PaCO2 30 mmHg, PaO2 75 mmHg, and HCO3- 22 mEq/L
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: A) metabolic alkalosis. B) respiratory alkalosis. C) metabolic acidosis. D) respiratory acidosis.
B) respiratory alkalosis.
The nurse is caring for a client who reports pain as 10, on a 0 to 10 scale. After the administration of an opioid anesthesia, the nurse observes the client's respiratory rate decrease to 8 breaths per minute. What is the priority action by the nurse? A) Administer a lower dose of the analgesic for the next dose B) Place the client in the supine position C) Administration of 0.4 mg of naloxone D) Begin CPR
C) Administration of 0.4 mg of naloxone
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? A) PO2 B) PaO2 C) Bicarbonate D) Carbonic acid
C) Bicarbonate
When explaining how carbon dioxide combines with water to form carbonic acid as part of an acid-base lecture, the faculty instructor emphasizes that which enzyme is needed as a catalyst for this reaction? A) Hydrolases B) Phenylalanine hydroxylase C) Carbonic anhydrase D) Trypsin
C) Carbonic anhydrase
Which of the following clients is at highest risk for peptic ulcer disease? A) Client with blood type AB B) Client with blood type B C) Client with blood type O D) Client with blood type A
C) Client with blood type O
A client has been diagnosed with metabolic acidosis. What assessment finding does the nurse expect? A) Increased PCO2 above 45 mm/Hg (5.99 kPa) B) Increased pH above 7.45 C) Decreased pH below 7.35 D) Decreased PCO2 below 35 mm/Hg (4.66 kPa)
C) Decreased pH below 7.35
When caring for a client with psoriatic arthritis, the nurse assesses for which altered laboratory studies frequently associated with this disease? A) Positive antinuclear antibody test B) Positive bone scan C) Elevated uric acid level D) Metabolic acidosis
C) Elevated uric acid level
A nurse is caring for a client undergoing antineoplastic chemotherapy for acute leukemia. Which diagnostic study does the nurse monitor to detect the consequences of the rapid lysis of cancer cells? A) Antinuclear antibody B) Hypophosphatemia C) Hyperuricemia D) Hypokalemia
C) Hyperuricemia
The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux? A) A partial or complete intestinal obstruction occurs. B) There are recurrent paroxysmal bouts of abdominal pain. C) In this disorder the sphincter that leads into the stomach is relaxed. D) A thickened, elongated muscle causes an obstruction at the end of the stomach.
C) In this disorder the sphincter that leads into the stomach is relaxed.
A woman who is 10 weeks' pregnant calls the physician's office reporting "morning sickness" but, when asked about it, tells the nurse that she is nauseated and vomiting all the time and has lost 5 pounds. What interventions would the nurse anticipate for this client? A) Since morning sickness is a common problem for pregnant women, the nurse will suggest the woman drink more fluids and eat crackers. B) An ultrasound will be done to reassess the correctness of gestational dates. C) Lab work will be drawn to rule out acid-base imbalances. D) The nurse will encourage the woman to lie down and rest whenever she feels ill.
C) Lab work will be drawn to rule out acid-base imbalances.
A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37 mEq/L (37 mmol/L). The nurse suspects the client may be experiencing: A) Respiratory alkalosis B) Respiratory acidosis C) Metabolic alkalosis D) Metabolic acidosis
C) Metabolic alkalosis
The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? A) Metabolic acidosis B) Respiratory alkalosis C) Metabolic alkalosis D) Respiratory acidosis
C) Metabolic alkalosis
A young male client has muscular dystrophy. His PaO2 is 42 mm Hg with a FiO2 of 80%. Which of the following treatments would be least invasive and most appropriate for this client? A) Continuous positive airway pressure (CPAP) B) Positive-pressure ventilator C) Negative-pressure ventilator D) Bilevel positive airway pressure (Bi-PAP)
C) Negative-pressure ventilator
As status asthmaticus worsens, the nurse would expect which acid-base imbalance? A) Respiratory alkalosis B) Metabolic alkalosis C) Respiratory acidosis D) Metabolic acidosis
C) Respiratory acidosis
The nurse is caring for a client with chronic obstructive pulmonary disease. The client reports that he is having difficulty breathing and is feeling fatigued. The nurse realizes that this client is at high risk for which condition? A) Metabolic alkalosis B) Respiratory alkalosis C) Respiratory acidosis D) Metabolic acidosis
C) Respiratory acidosis
The nurse is assessing a client with abnormal blood gas values. Which of these interpretations does the nurse make regarding the client's physiologic status? A) The client has a decreased hemoglobin. B) The client has alterations in vital signs. C) The client has abnormalities in his buffer system. D) The client has abnormalities in his cardiovascular system.
C) The client has abnormalities in his buffer system.
Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? A) The client has been exercising more than usual. B) The client continues medication therapy despite adequate food intake. C) The client has eaten and has not taken or received insulin. D) The client has not consumed sufficient calories.
C) The client has eaten and has not taken or received insulin.
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? A) The lungs have ineffective cilia from years of smoking. B) The lungs are unable to exchange oxygen and carbon dioxide. C) The lungs are not able to blow off carbon dioxide. D) The lungs are unable to breathe in sufficient oxygen.
C) The lungs are not able to blow off carbon dioxide.
The nurse teaches the client with end-stage kidney disease and hyperphosphatemia to take sevelamer HCl, a phosphate binder, with meals. How does the nurse explain the rationale for the timing of this medication? A) "The medication should be taken at meal time to increase the potassium level." B) "The medication should be taken at meal time to decrease the absorption of calcium." C) "The medication should be taken at meal time to allow the binding of phosphate." D) "The medication should be taken at meal time to prevent gastrointestinal upset."
C) The medication should be taken at meal time to allow the binding of phosphate."
The nurse is preparing clients for diagnostic testing for cancer. Which test is used to differentiate a neuroblastoma from other tumors? A) Complete blood count (CBC) with differential B) Serum chemistries C) Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) D) Urinalysis
C) Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA)
A nurse is caring for a newborn whose chest X-ray reveals marked hyperaeration mixed with areas of atelectasis. The infant's arterial blood gas analysis indicates metabolic acidosis. For which dangerous condition should the nurse prepare when providing care to this newborn? A) diaphragmatic hernia B) choanal atresia C) meconium aspiration syndrome D) pneumonia
C) meconium aspiration syndrome
The nurse is caring for a client with metabolic alkalosis whose breathing rate is 8 breaths/min. Which arterial blood gas data does the nurse anticipate finding? A) pH: 7.32; PaCO2: 28 mm Hg (3.72kPa); HCO3: 24 mEq/l (24 mmol/l) B) pH: 7.28; PaCO2: 52 mm Hg (6.92 kPa); HCO3: 32 mEq/l (32 mmol/l) C) pH: 7.60; PaCO2: 64 mm Hg (8.51 kPa); HCO3: 42 mEq/l (42 mmol/l) D) pH: 7.32; PaCO2: 26 mm Hg (3.46 kPa); HCO3: 18 mEq/l (18 mmol/l)
C) pH: 7.60; PaCO2: 64 mm Hg (8.51 kPa); HCO3: 42 mEq/l (42 mmol/l)
A client's arterial blood gas analysis reveals an excess of carbon dioxide. The nurse should recognize that this is consistent with which condition? A) metabolic alkalosis B) respiratory alkalosis C) respiratory acidosis D) metabolic acidosis
C) respiratory acidosis
A nurse is providing care for several clients on an acute medicine unit. Which client should the nurse recognize as being at the highest risk for metabolic alkalosis? A) A client with acquired immunodeficiency syndrome (AIDS) who has developed tuberculosis and is receiving antibiotics B) A postoperative client who developed sepsis after the dehiscence of an abdominal wound C) A client in alcohol withdrawal who is being treated with intravenous anticonvulsants D) A client on continuous nasogastric suction and whose hypertension is being treated with diuretics
D) A client on continuous nasogastric suction and whose hypertension is being treated with diuretics
The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for? A) Respiratory alkalosis B) Respiratory acidosis C) Metabolic alkalosis D) Metabolic acidosis
D) Metabolic acidosis
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? A) Respiratory acidosis B) Respiratory alkalosis C) Metabolic acidosis D) Metabolic alkalosis
D) Metabolic alkalosis
The ICU nurse is concerned with her client's arterial blood gas (ABG) results—especially the pH 7.30; and PCO2 49 mmHg (6.52 kPa). The nurse interprets these ABG results and assesses her client for which clinical manifestations of respiratory acidosis? Select all that apply. A) Hyperactive deep tendon reflexes B) Complaints of paresthesia sensations around lips/mouth C) Numbness in fingers and toes D) Muscle twitching E) Headache with complaints of blurred vision
D) Muscle twitching E) Headache with complaints of blurred vision
A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? A) Metabolic alkalosis B) Metabolic acidosis C) Respiratory acidosis D) Respiratory alkalosis
D) Respiratory alkalosis
A woman with poorly controlled type 1 diabetes has been admitted to a hospital unit for the treatment of ketoacidosis. Place the following events in the pathophysiology of ketoacidosis in the correct chronological order. Use all the options. 1) Breakdown of triglycerides 2) Ketone production by the liver 3) Low serum insulin levels 4) Production of fatty acids and glycerol 5) Decrease in pH
3) Low serum insulin levels 1) Breakdown of triglycerides 4) Production of fatty acids and glycerol 2) Ketone production by the liver 5) Decrease in pH
A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution administered via an infusion pump set at 10 ml/hour. The nurse determines that the client is receiving how many units of insulin each hour? Record your answer using a whole number.
5
A client with metabolic syndrome is encouraged to implement nonpharmacologic measures improve his risk factors. What do those non-pharmacologic measures include? (Select all that apply.) A) Begin a low-fat diet B) Increase sodium intake C) Walk regularly D) Decrease intake of soluble fiber
A) Begin a low-fat diet C) Walk regularly
The nurse recognizes the role of the lungs in acid-base balance is regulation of which of the following? A) CO2 B) H2O C) HCO3 D) Hydrogen
A) CO2
A client is receiving a diuretic as the first-line treatment of mild hypertension. The nurse monitors the client for signs and symptoms of hypokalemia with which agent? A) Hydrochlorothiazide B) Amiloride C) Triamterene D) Spironolactone
A) Hydrochlorothiazide
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? A) pH, 7.29; PaCO2 30 mm Hg B) pH, 7.25; PaCO2 50 mm Hg C) pH, 7.35; PaCO2 70 mm Hg D) pH, 7.5; PaCO2 30 mm Hg
B) pH, 7.25; PaCO2 50 mm Hg
The nurse tests the pH of fluid found on the vaginal exam and determines that the woman's membranes have ruptured based on which result? A) 5.5 B) 6.0 C) 6.5 D) 5.0
C) 6.5
The nurse observes a client's uric acid level of 9.3 mg/dL. When teaching the client about ways to decrease the uric acid level, which diet would the nurse suggest? A) A low-sodium diet B) A diet high in fruits and vegetables C) A low-purine diet D) A diet high in calcium
C) A low-purine diet
Which is a true statement regarding pharmacologic aspects of aging? A) Potential for drug-drug reactions decreases with the number of drugs prescribed. B) Aged population tends to be compliant with their medication regimen. C) Absorption may be affected by changes in gastric pH. D) Elderly have a decreased percentage of body fat.
C) Absorption may be affected by changes in gastric pH.
The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis. A) An 18-year-old female who has overdosed on narcotics B) A 45-year-old male with pneumothorax after a car accident C) A 63-year-old male with a 40-year history of smoking and chronic lung disease D) A 26-year-old female with anxiety who has been hyperventilating
D) A 26-year-old female with anxiety who has been hyperventilating
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? A) renin-angiotensin-aldosterone system B) bicarbonate-carbonic acid buffer system C) sodium-potassium pump D) ADH-ANP buffer system
B) bicarbonate-carbonic acid buffer system
The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? A) pH 7.20, PaCO2 36, HCO3 14- B) pH 7.50, PaCO2 29, HCO3 22- C) pH 7.47, PaCO2 45, HCO3 33- D) pH 7.31, PaCO2 48, HCO3 24-
A) pH 7.20, PaCO2 36, HCO3 14-
The nurse caring for a client with metabolic acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's metabolic acidosis is improving? A) pH has increased B) O2 has increased C) CO2 has increased D) HCO3- has decreased
A) pH has increased
The nurse assesses an adolescent client with lethargy, retractions of the intercostal spaces, a persistent expiratory wheeze, diminished breath sounds, tachycardia, and tachypnea. Arterial blood gas results are pH 7.10; PCO2 80 mm Hg (10.64 kPa); PO2 35 mm Hg (4.66 kPa), HCO3 29 mEq/l (29 mmol/l). What is the priority condition the nurse must address? A) respiratory acidosis B) change in mental status C) breathing pattern D) increased heart rate
A) respiratory acidosis
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 A) respiratory alkalosis. B) metabolic acidosis. C) respiratory acidosis. D) metabolic alkalosis.
A) respiratory alkalosis.
A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer? A) Lispro B) Regular insulin C) NPH D) Detemir
B) Regular insulin
Respiratory alkalosis can be caused by a respiratory rate in excess of that which maintains normal plasma PCO2 levels. What is a common cause of respiratory alkalosis? A) Hyperventilation B) Hypoventilation C) Kussmaul breathing D) Cluster breathing
A) Hyperventilation
The nurse is caring for a patient with severe pain related to ureteral colic. What medication can the nurse administer with a physician's order that will inhibit the synthesis of prostaglandin E, thereby reducing swelling and facilitating passage of the stone? A) Ketoralac (Toradol) B) Aspirin C) Morphine sulfate D) Meperidine (Demerol)
A) Ketoralac (Toradol)
Which conditions place clients at risk for developing respiratory acidosis? Select all that apply. A) Kyphoscoliosis B) Drug overdose C) Pneumonia D) Morbid obesity E) Diabetes mellitus
A) Kyphoscoliosis B) Drug overdose C) Pneumonia D) Morbid obesity
A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man's most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man's serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings? A) The man may be allergic to aspirin B) The man may be experiencing liver toxicity from the aspirin C) The man may be experiencing a paradoxical effect of aspirin D) The man may be experiencing nephrotoxic effects of aspirin
D) The man may be experiencing nephrotoxic effects of aspirin
Which is a psychological factor affecting the body's response to a drug? A) diurnal rhythm B) electrolyte balance C) hydration D) compliance
D) compliance
A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? A) hyperosmolar hyperglycemic nonketotic syndrome B) All options are correct. C) hepatic disorder D) ketoacidosis
D) ketoacidosis
A male client tells the nurse that he takes antacid tablets several times each day. Knowing that the brand of antacid he uses contains calcium carbonate, the nurse cautions the client that overuse could place him at risk for: A) hypercholesterolemia. B) hypocalcemia. C) metabolic acidosis. D) metabolic alkalosis.
D) metabolic alkalosis.
The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? A) Pancreas and stomach B) Lungs and kidney C) Kidney and liver D) Heart and lungs
B) Lungs and kidney
For which acid-base imbalance will the nurse monitor for a client taking large doses of loop diuretics? A) Respiratory alkalosis B) Metabolic alkalosis C) Respiratory acidosis D) Metabolic acidosis
B) Metabolic alkalosis
A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis
A) Metabolic acidosis
In which client would the nurse be most likely to assess the signs and symptoms of an acid-base imbalance? A) A client with a fluid volume deficit who has been receiving intravenous 0.45% NaCl for over 48 hours B) A client with chronic obstructive pulmonary disease (COPD) whose most recent arterial blood gases reveal a PCO2 of 51 mm Hg C) A laboring client who is receiving an oxytocin infusion and who has been in the second stage of labor for 7 hours D) A client who has been admitted with a traumatic head injury and whose intracranial pressure is 18 mm Hg
B) A client with chronic obstructive pulmonary disease (COPD) whose most recent arterial blood gases reveal a PCO2 of 51 mm Hg
It is known that high levels of uric acid in the blood can cause gout, while high levels in the urine can cause kidney stones. What medication competes with uric acid for secretion into the tubular fluid, thereby reducing uric acid secretion? A) Ibuprofen B) Aspirin C) Naproxen D) Acetaminophen
B) Aspirin
The nurse caring for a client with respiratory acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's respiratory acidosis is improving? A) pH has decreased B) CO2 has decreased C) O2 has decreased D) HCO3- has decreased
B) CO2 has decreased
At what point in shock does metabolic acidosis occur? A) Compensation B) Irreversible C) Early D) Decompensation (Progressive)
D) Decompensation (Progressive)
Vomiting results in which of the following acid-base imbalances? A) Metabolic alkalosis B) Respiratory acidosis C) Metabolic acidosis D) Respiratory alkalosis
A) Metabolic alkalosis
One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which electrolyte? A) Sodium B) Potassium C) Glucose D) Hydrogen
A) Sodium
A client reports nausea, vomiting, and diarrhea for 5 days. The nurse assesses the mucous membranes as pale and dry. The client has sunken eyes with the following vital signs: pulse 122 and thready, respirations 23, blood pressure 78/55, temperature 101.8°F oral. Which is the priority nursing intervention? A) Request an order from the physician for IV rehydration therapy. B) Initiate oral rehydration therapy at 100 mL/kg of oral rehydration solution over 4 hours. C) Obtain stool specimen for analysis. D) Assess vital signs every 15 minutes.
A) Request an order from the physician for IV rehydration therapy
Which of the following arterial blood gas results would be consistent with metabolic alkalosis? A) Serum bicarbonate of 28 mEq/L B) PaCO2 less than 35 mm Hg C) pH 7.26 D) Serum bicarbonate of 21 mEq/L
A) Serum bicarbonate of 28 mEq/L
A 77-year-old female hospital client has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which statement best conveys a risk that this woman faces? A) She is susceptible to isotonic fluid volume deficit. B) She could develop third-spacing edema as a result of plasma protein losses. C) She is at risk of compensatory fluid volume overload secondary to gastrointestinal water and electrolyte losses. D) She is prone to isotonic fluid volume excess.
A)
A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? A) Serum potassium level of [2.6 mEq/L (2.6 mmol/L)} B) Sodium level of [142 mEq/L (142 mmol/L)] C) Urine output of 400 ml in 8 hours D) Blood pressure of 120/64 to 130/72 mm Hg
A)
A client with suspected multiple myeloma is reporting back pain. What is the priority nursing action? A) Send the client for a spinal x-ray study. B) Have the client lie on a hard surface. C) Encourage ambulation. D) Have the client rest.
A)
A middle-age client with cancer has been prescribed patient-controlled analgesia (PCA). The nurse caring for the client explains the functioning of PCA. What is the main advantage of PCA? A) The client is actively involved in pain management. B) The client obtains pain relief slowly and steadily. C) The client requires less nursing care. D) The client is able to have long hours of rest.
A)
A patient who has undergone surgery and received spinal anesthesia is reporting a headache. Which of the following would be most appropriate? A) Encourage increased fluid intake. B) Notify the anesthesiologist immediately. C) Turn on the television for distraction. D) Position the patient on the side.
A)
Acute dialysis is indicated during which situation? A) Impending pulmonary edema B) Metabolic alkalosis C) Hypokalemia D) Dehydration
A)
The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time? A) Improving hydration B) Maintaining skin integrity C) Promoting comfort D) Preparing family for home care
A)
When caring for the neonate of a mother with gestational diabetes, which finding is most indicative of a hypoglycemic episode? A) jitteriness B) positive Babinski's reflex C) serum glucose level of 60 mg/dl (3.3 mmol/L) D) hyperalert state
A)
The nurse is monitoring intake and output (I&O) for a client who recently had surgery. Which will the nurse document on the I&O record? Select all that apply. A) vomiting B) client's urination C) infusion of intravenous solution D) client drinking milk E) client eating a sandwich
A) B) C) D)
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) Compare ABG findings with previous results. B) Maintain intake and output records. C) Administer IV bicarbonate. D) Suction the client's airway. E) Document presenting signs and symptoms.
A) B) E)
The nurse is performing assessments for an assigned client. Which methods are appropriate ways for the nurse to gather objective data related to a client's pain? Select all that apply. A) By checking the vital signs B) By using pain assessment questionnaires C) By observing facial expressions D) By eliciting factual information E) By diagnostic tests and procedures
A) C) E)
A client has a significant history of congestive heart failure. What should the nurse specifically assess during the client's semiannual cardiology examination? Select all that apply. A) Examine the client's neck for distended veins. B) Examine the client's eyes for excess tears. C) Examine the client's joints for crepitus. D) Monitor the client for signs of lethargy or confusion.
A) D)
The nurse is caring for a client with ketoacidosis who is complaining of increasing lethargy and occasional confusion following several weeks of rigid adherence to a carbohydrate-free diet. The nurse understands which phenomenon is most likely occurring? A) In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids. B) High fat, low carbohydrate dietary intake is associated with respiratory acidosis. C) Metabolism of dietary fats without the buffer action of carbohydrates results in the catabolism of ketoacids. D) Decreased carbohydrate intake induces insulin deficiency and consequent ketoacidosis.
A) In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids.
A client visits a clinic complaining of excessive perspiration. Which of the following actions helps to remove sebum and reduce the acid mantle of protection? A) Wash with alkaline soaps. B) Use tepid bathwater. C) Prevent exposure to sun. D) Use hot soaks.
A) Wash with alkaline soaps.
Which of these ions plays an important role in pH homeostasis? A) bicarbonate B) potassium C) chloride D) sodium
A) bicarbonate
A client with emphysema is at a greater risk for developing which acid-base imbalance? A) chronic respiratory acidosis B) metabolic acidosis C) respiratory alkalosis D) metabolic alkalosis
A) chronic respiratory acidosis
A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The client's physician would anticipate that which phenomenon is most likely occurring? A) Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system. B) The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption. C) Vasopressin is exerting an effect on his chemoreceptors and baroreceptors, resulting in vasoconstriction. D) The client's juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation.
B)
A client comes in for a therapy session and begins to have a panic attack. The therapist asks the client to relax in the chair and then gently asks the client to imagine the client in a very safe and calm place. This technique, often useful in anxiety disorders, is called what? A) Problem-solving B) Deep breathing C) Cognitive therapy D) Desensitization
B)
A client has been experiencing lower GI difficulties that have increased in severity, and the gastroenterologist is concerned that the client's bowel is not functioning properly. What function of the lower GI tract is most likely to be affected by the client's disorder? A) All options are correct. B) water and electrolyte absorption C) fat digestion D) protein digestion
B)
A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy would the nurse expect to administer to the client? A) monoamine oxidase inhibitors (MAOIs) B) restricted sodium intake C) methadone therapy D) ginger therapy
B)
A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. The client's spouse reports that the client acted confused and was extremely weak upon waking that morning. The client's blood pressure is 90/58 mm Hg, pulse is 116 beats/minute, and temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by I.V. infusion? A) insulin B) hydrocortisone C) hypotonic saline D) potassium
B)
A client with a superficial partial-thickness solar burn (sunburn) of the chest, back, face, and arms is seen in urgent care. The nurse's primary concern should be: A) infection. B) pain management. C) body image. D) fluid resuscitation.
B)
A client with chronic open-angle glaucoma is now presenting with eye pain and intraocular pressure of 50 mm Hg. An immediate iridotomy is scheduled. Which of the following describes the desired effects of this procedure? A) Restore vision B) Improve outflow drainage C) Reverse optic nerve damage D) To relieve pain
B)
A client's intravenous catheter has become occluded. The nurse knows that the reason for the occlusion is: A) dressing and tape above the I.V. insertion site. B) thrombosis at the site. C) an I.V. infusion rate of 75 mL per hour. D) localized infection.
B)
An appropriate goal for a client newly admitted to the unit for alcohol withdrawal is what? A) Demonstrate knowledge of the deleterious effects of alcohol. B) Verbalize feeling safe and comfortable. C) Attend two Alcoholics Anonymous meetings each week. D) Make amends to people in his or her life that he or she has harmed.
B)
The nurse is caring for a client with kidney disease who has an estimated glomerular filtration rate of 75 mL/minute. The nurse interprets this data in which way? A) The client's low blood pressure is causing the reduced glomerular filtration rate. B) The client has reduced glomerular filtration, reflecting damage to the kidney. C) The rate is normal. D) The client's diabetes is causing the reduced glomerular filtration rate.
B)
The nurse is caring for an adolescent client after an overdose on barbiturate drugs and alcohol. The client is hypotensive with a mean arterial pressure below 30 mm Hg and a urine output of 5 mL/hr. Serum creatinine and potassium are elevated. The parents of the client ask why there is so little urine in the indwelling catheter drainage bag. What is the best response by the nurse? A) "Oliguria is common after a barbiturate overdose." B) "There is not enough blood circulating to the kidneys." C) "The body is conserving fluids to dilute the barbiturates." D) "Dialysis is needed to clear the toxins from the blood."
B)
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? A) "I need to check to see whether my cola beverage has potassium in it." B) "I will not salt my food; instead I'll use salt substitute." C) "Bananas have a lot of potassium in them; I'll stop buying them." D) "I'll drink cranberry juice with my breakfast instead of coffee."
B)
Three days after surgery, a client continues to have moderate to severe incisional pain. Based on the gate-control theory, what action should the nurse take? A) Administer pain medications in smaller doses but more frequently. B) Reposition the client and gently massage the client's back. C) Advise the client to try to sleep following administration of pain medication. D) Decrease external stimuli in the room during painful episodes.
B)
Which general nursing measure is used for a client with a fracture reduction? A) Examine the abdomen for enlarged liver or spleen B) Encourage participation in ADLs C) Promote intake of omega-3 fatty acids D) Assist with intake of immune-enhancing tube feeding formulas
B)
Which is a classic sign of cardiogenic shock? A) Hyperactive bowel sounds B) Tissue hypoperfusion C) High blood pressure D) Increased urinary output
B)
Which nursing intervention demonstrates proper use of cutaneous stimulation to relieve pain in pediatric clients? A) Use of a cold pack for 20 minutes to achieve a muscle temperature of 104°F (40°C). B) Gently massaging a preterm infant's leg for 2 minutes prior to obtaining a blood sample from a heel stick. C) Use of a cold pack for the treatment of cellulitis on an extremity. D) Use of a heat pack after abdominal surgery for a 2-week-old infant with necrotizing enterocolitis.
B)
Which statement most accurately describes the process of osmosis? A) Water shifts from high-solute areas to areas of lower solute concentration. B) Water moves from an area of lower solute concentration to an area of higher solute concentration. C) Plasma proteins facilitate the reabsorption of fluids into the capillaries. D) Solutes pass through semipermeable membranes to areas of lower concentration.
B)
A client is brought to the emergency department after a motor vehicle accident. The client is hemorrhaging, indicating that which hormone is being secreted to restore blood volume? A) follicle-stimulating hormone (FSH) B) adrenocorticotropic hormone (ACTH) C) antidiuretic hormone (ADH) D) growth hormone (GH)
C)
A client who has been taking furosemide has a serum potassium level of 3.2 mEq/L. Which assessment findings by the nurse would confirm an electrolyte imbalance? A) mental status changes and poor tissue turgor B) tetany and tremors C) muscle weakness and a weak, irregular pulse D) diarrhea and cramps
C)
A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms? A) Hyperkalemia B) Hypercalcemia C) Hypokalemia D) Hypocalcemia
C)
A primigravid with severe gestational hypertension has been receiving magnesium sulfate IV for 3 hours. The latest assessment reveals deep tendon reflexes (DTR) of +1, blood pressure of 150/100 mm Hg, a pulse of 92 beats/minute, a respiratory rate of 10 breaths/minute, and a urine output of 20 ml/hour. Which action should the nurse perform next? A) Decrease the infusion rate by 5 gtt/minute. B) Increase the infusion rate by 5 gtt/minute. C) Stop the magnesium sulfate infusion. D) Continue monitoring per standards of care.
C)
On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right-sided heart failure. Which manifestation exhibited by the father does the nurse know might have preceded this diagnosis? A) Weakness, palpitations B) Dyspnea, cough C) Peripheral edema, weight gain D) Vertigo, headache
C)
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Which is an example of how urine concentration is affected? A) A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has scant urine output with a high specific gravity. B) On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. C) On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. D) When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity may vary widely.
C)
Which of the following nonsedating antihistamines is appropriate for daytime pruritus? A) Lorazepam (Ativan) B) Hydroxyzine (Atarax) C) Fexofenadine (Allegra) D) Diphenhydramine (Benadryl)
C)
A client who has been admitted to the emergency room with symptoms of a STEMI is given nitroglycerine. The nurse explains to the client's wife that this medication is given for which reason? Select all that apply. A) For diuretic purposes B) To relieve anxiety C) To relieve coronary pain D) For its vasodilation effect
C) D)
A client has a risk for skin breakdown due to incontinence. Which nursing actions for the client will help with decreasing this risk? Select all that apply. A) Apply adult briefs for the client and change every 8 hours. B) Encourage the client to decrease fluid intake. C) Maintain a voiding record to determine any patterns of incontinence. D) Have scheduled toileting every 2 hours. E) Cleanse the perineal area daily and after each incontinent episode.
C) D) E)
The nurse is caring for a patient with hyperparathyroidism and observes a calcium level of 16.2 mg/dL. What interventions does the nurse prepare to provide to reduce the calcium level? Select all that apply. A) Administration of calcium carbonate B) Administration of a bronchodilator C) Administration of calcitonin D) Monitoring the patient for fluid overload E) Intravenous isotonic saline solution in large quantities
C) D) E)
A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client? A) "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use." B) "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated." C) "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." D) "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort."
D)
A client has chronic renal failure. As the disease progresses, the client is experiencing increasing shortness of breath. The nurse suspects that the client is experiencing symptoms associated with: A) hypoglycemia. B) thrombocytopenia. C) hypertension. D) anemia.
D)
A client has experienced severe hemorrhage and is in prerenal failure. The nurse anticipates the client's blood urea nitrogen (BUN) and serum creatinine laboratory results will be in which range? A) Creatinine level increase to 5 mg/dL (442 µmol/L) and BUN decreases to 4 mg/dL (1.4 mmol/L). B) The BUN-to-creatinine ratio is 10:1. C) BUN elevates above 60 mg/dL (21.4 mmol/L) and creatinine decreases to <0.3 mg/dL (<27 µmol/L). D) The BUN-to-creatinine ratio is 20:1.
D)
A client is hypotensive secondary to hypovolemia resulting from dehydration. Based on the nurse's knowledge about intravenous solutions, the nurse would expect the physician to prescribe which type of solution? A) Hypotonic B) Hypertonic C) Volume expander D) Isotonic
D)
A client presents to the clinic with severe edema. Which type of deficiency should be suspected in this client? A) Carbohydrates B) Water C) Fats D) Protein
D)
A client who has had an intestinal bypass has developed a kidney stone. Which type of kidney stone does the nurse recognize that this client will most likely be treated for? A) Uric acid B) Cystine C) Magnesium ammonium D) Calcium
D)
A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? A) Observe for swelling of the neck, tracheal deviation, and severe pain. B) Evaluate the quality of the client's voice postoperatively, noting any drastic changes. C) Monitor laboratory values daily for elevated thyroid-stimulating hormone. D) Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.
D)
A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching? A) "I'll call my physician if I notice tingling around my lips." B) "I'll schedule a follow-up visit with my physician as soon as I get home." C) "I will take my pain medications according to the schedule we developed." D) "I will increase my fluid and calcium intake."
D)
A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague best respond to this suggestion? A) "Maybe, but hydrochlorothiazide affects the bladder more than the kidneys." B) "That would probably help, but we'd have to do blood work first." C) "That would only work if he could come in twice a day to get it intravenously." D) "Actually, patients with renal failure usually can't take hydrochlorothiazide."
D)
A person with severe lymphedema is asking the nurse where specifically the lymph vessels are located in the skin layers. What would the nurse would respond? A) Merkel cell layer B) Subcutaneous tissue layer C) Basement membrane D) Papillary dermis layer
D)
The health care provider is concerned that the client has hypokalemia. During the physical examination, which question should the nurse ask the client? A) "Have you been experiencing difficulty breathing?" B) "Have you been experiencing chest pain?" C) "Have you been having diarrhea?" D) "Have you been experiencing muscle weakness or leg cramps?"
D)
The nurse is assessing deep tendon reflexes on a child admitted for severe dehydration. The assessment reveals hyperactive reflexes. How should the nurse document this finding? A) 3+ B) 2+ C) 1+ D) 4+
D)
The nurse is caring for four clients on a medical unit. The nurse is most correct to review which client's laboratory reports first for an electrolyte imbalance? A) A 7-year-old with a fracture tibia B) A 65-year-old with a myocardial infarction C) A 72-year-old with a total knee repair D) A 52-year-old with diarrhea
D)
When caring for a client after ear surgery, what is an important aspect of nursing care? A) Assess social support. B) Feed small frequent meals to minimize nausea. C) Fit for a hearing aid. D) Validate client's feelings of discomfort.
D)
When caring for a client with dehydration, the nurse anticipates the client will have an alteration in which substance in the blood? A) Bicarbonate B) Erythropoietin C) Uric acid D) Blood urea nitrogen
D)
When fluid intake is normal, the specific gravity of urine should be: A) 1.000 B) Less than 1.010 C) Greater than 1.025 D) 1.010 to 1.025
D)
Which substance reduces the transmission of pain? A) Serotonin B) Substance P C) Acetylcholine D) Endorphins
D)
Trousseau's sign is elicited by which of the following? A) A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. B) The patient complains of pain in the calf when his foot is dorsiflexed. C) After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery. D) Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.
D) Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.
After teaching a group of students about endocrine disorders, the instructor determines that the teaching was successful when the students identify insulin deficiency, increased levels of counterregulatory hormones, and dehydration as the primary cause of which condition? A) Ketone bodies B) Glucosuria C) Ketonuria D) Diabetic ketoacidosis
D) Diabetic ketoacidosis
A patient who has been treated for uric acid stones is being discharged from the hospital. What type of diet does the nurse discuss with the patient? A) Low-calcium diet B) High-protein diet C) Low-phosphorus diet D) Low-purine diet
D) Low-purine diet
A 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for this client? A) Yes, this will correct the sodium deficit. B) No, start with the sodium chloride IV. C) Yes, along with the hypotonic IV. D) No, sodium intake should be restricted.
D) No, sodium intake should be restricted.
A client with neurological infection develops cerebral edema from syndrome of inappropriate antidiuretic hormone (SIADH). Which is an important nursing action for this client? A) Maintaining adequate hydration B) Administering prescribed antipyretics C) Hyperoxygenation before and after tracheal suctioning D) Restricting fluid intake and hydration
D) Restricting fluid intake and hydration
A client with a traumatic amputation of the lower leg has lost >40% of blood volume and is currently not producing any urine output. The nurse bases this phenomena on which humoral substance that is responsible for causing severe vasoconstriction of the renal vessels? A) Aquaporin-2 channels B) Angiotensin II and antidiuretic hormone C) Albumin and norepinephrine D) Renin and potassium ions
b
The nurse is caring for a postoperative client with an indwelling urinary catheter. The hourly urinary output is 80 mL at 9 am. At 10 am, the nurse assesses the hourly urinary output as 20 mL. What is the priority action by the nurse? A) Irrigate the catheter with sterile normal saline. B) Notify the primary care provider immediately. C) Document the findings. D) Reassess the output at 11 am.
b
The nurse is planning the care of a patient with a major thermal burn. What outcome will the nurse understand will be optimal during fluid replacement? A) A urinary output of 100 mL/hr B) A urinary output of 30 mL/hr C) A urinary output of 80 mL/hr D) A urinary output of 10 mL/h
b
A client comes to the clinic reporting vaginal discharge with itching. Which statement would alert the nurse to the possibility that the client's reports are related to a superinfection? A) "For the last 2 months I have been taking a water pill that the doctor prescribed." B) "I've been exhausted and overworked for the past several weeks." C) "I just completed a course of antibiotics prescribed by my dentist to treat a tooth abscess." D) "I've been taking aspirin several times a day for the past few months for my back pain."
c
A client has been diagnosed with heart failure. What is the major nursing outcome for the client? A) Sleep 8 hours per night. B) Walk 30 minutes three times a week. C) Reduce the workload on the heart. D) Maintain a healthy diet.
c
What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen? A) Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis. B) Take measures to acidify the urine and prevent uric acid crystallization. C) Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. D) Encourage fluid intake to dilute the urine.
d
