vSim - Rashid Ahmed

When assessing a patient's altered fluid status, the nurse expects to assess/review which of the following?

Fluid intake and urine output Capillary refill and mucous membranes Vital signs and skin turgor Hematocrit and electrolytes

After completing the initial nursing assessment, the nurse recognizes Rashid Ahmed's ____ as a priority finding, which would require the following additional intervention:

hypokalemia of 3.1 mEq/L, call to provider

Rashid Ahmed requires education regarding fall prevention and safety. Which of the following client response(s) indicate further teaching is required?

I don't need my side rails while I am in bed.' 'I will wear my personal socks when ambulating.' 'I will walk slowly to the bathroom.'

Hypokalemia is confirmed by what serum blood result?

Potassium 3.0 mEq/L

The nurse is completing the physician's orders by preparing the patient's IV fluid therapy. When infusing supplemental potassium, the nurse knows that checking which of the following is the first priority before beginning the infusion?

Potassium level

What determines the acidity of substances such as body fluids?

The number of existing H+ ions

Which diagnostic test serves as the basis for determining acid-base imbalances?

Arterial blood gas (ABG)

The nurse is assessing Rashid Ahmed after admission to the medical unit. The nurse understands which of the following are expected outcomes following the administration of isotonic IV fluid?

Blood pressure values increase Urine output increases

Hyponatremia is associated with a decrease of which electrolyte?

Sodium

What pathology is responsible for metabolic acidosis?

A decrease in bicarbonate or an increase in hydrogen ions

The nurse begins caring for Rashid Ahmed, who was admitted from the emergency department for dehydration and hypokalemia. The nurse recognizes which of the following assessment finding(s) as related to his dehydration?

Decreased weight Dizziness and weakness Decreased elasticity

Which of the following concerning the measurement of intake and output is true for a patient admitted for dehydration?

When possible, intake and output should be measured rather than estimated.

The nurse is providing care for Rashid Ahmed, who is receiving continuous IV fluids for dehydration. The nurse must first secure what information in preparation for administering the new order of IV potassium?

The volume of the potassium piggyback The status of the client's IV reservoir The pump designated for infusion The medication compatibility

The nurse begins Rashid Ahmed's nursing assessment. The nurse understands which of the following are significant when assessing for the presence of orthostatic hypotension?

Assessing a diastolic drop of 10 mm Hg after the client has stood for 2 minutes Assessing a pulse rate of 30 beats per minute or more after the client has stood for 2 minutes Assessing a systolic blood pressure drop of 20 mm Hg or more after the client has stood for 2 minutes