Title: ASN 210 Week 1 Pre-Quiz
Course: 16SP-ASN-210-GH1A1-ADV NUR THROUGH LIFESPAN I > Section: Week 1

Q: A nurse assesses a client who is admitted with an acid-base imbalance. The client’s arterial blood gas values are pH 7.32, PaO<sub>2 </sub>85 mm Hg, PaCO<sub>2</sub> 34 mm Hg, and HCO<sub>3</sub><sup>–</sup> 16 mEq/L. What action should the nurse take next?
- Assess client’s rate, rhythm, and depth of respiration.
- Measure the client’s pulse and blood pressure.
- Document the findings and continue to monitor.
- Notify the physician as soon as possible.
A: Assess client’s rate, rhythm, and depth of respiration.
If right: Progressive skeletal muscle weakness is associated with increasing severity of acidosis. Muscle weakness can lead to severe respiratory insufficiency. Acidosis does lead to dysrhythmias (due to hyperkalemia), but these would best be assessed with cardiac monitoring. Findings should be documented, but simply continuing to monitor is not sufficient. Before notifying the physician, the nurse must have more data to report.
If wrong: Progressive skeletal muscle weakness is associated with increasing severity of acidosis. Muscle weakness can lead to severe respiratory insufficiency. Acidosis does lead to dysrhythmias (due to hyperkalemia), but these would best be assessed with cardiac monitoring. Findings should be documented, but simply continuing to monitor is not sufficient. Before notifying the physician, the nurse must have more data to report.

Q: A nurse assesses a client who is experiencing an acid-base imbalance. The client’s arterial blood gas values are pH 7.34, PaO<sub>2 </sub>88 mm Hg, PaCO<sub>2</sub> 38 mm Hg, and HCO<sub>3</sub><sup>–</sup> 19 mEq/L. Which assessment should the nurse perform first?
- Cardiac rate and rhythm
- Skin and mucous membranes
- Musculoskeletal strength
- Level of orientation
A: Cardiac rate and rhythm
If right: Early cardiovascular changes for a client experiencing moderate acidosis include increased heart rate and cardiac output. As the acidosis worsens, the heart rate decreases and electrocardiographic changes will be present. Central nervous system and neuromuscular system changes do not occur with mild acidosis and should be monitored if the acidosis worsens. Skin and mucous membrane assessment is not a priority now, but will change as acidosis worsens.
If wrong: Early cardiovascular changes for a client experiencing moderate acidosis include increased heart rate and cardiac output. As the acidosis worsens, the heart rate decreases and electrocardiographic changes will be present. Central nervous system and neuromuscular system changes do not occur with mild acidosis and should be monitored if the acidosis worsens. Skin and mucous membrane assessment is not a priority now, but will change as acidosis worsens.

Q: A client at risk for developing hyperkalemia states, “I love fruit and usually eat it every day, but now I can’t because of my high potassium level.” How should the nurse respond?
- “Potatoes and avocados can be substituted for fruit.”
- “If you cook the fruit, the amount of potassium will be lower.”
- “Berries, cherries, apples, and peaches are low in potassium.”
- “You are correct. Fruit is very high in potassium.”
A: “Berries, cherries, apples, and peaches are low in potassium.”
If right: Not all fruit is potassium rich. Fruits that are relatively low in potassium and can be included in the diet include apples, apricots, berries, cherries, grapefruit, peaches, and pineapples. Fruits high in potassium include bananas, kiwi, cantaloupe, oranges, and dried fruit. Cooking fruit does not alter its potassium content.
If wrong: Not all fruit is potassium rich. Fruits that are relatively low in potassium and can be included in the diet include apples, apricots, berries, cherries, grapefruit, peaches, and pineapples. Fruits high in potassium include bananas, kiwi, cantaloupe, oranges, and dried fruit. Cooking fruit does not alter its potassium content.

Q: A nurse assesses a client who is admitted for treatment of fluid overload. Which manifestations should the nurse expect to find? <b>(Select all that apply.)</b>
- Increased pulse rate
- Distended neck veins
- Decreased blood pressure
- Warm and pink skin
- Skeletal muscle weakness
A: Increased pulse rate; Distended neck veins; Skeletal muscle weakness
If right: Manifestations of fluid overload include increased pulse rate, distended neck veins, increased blood pressure, pale and cool skin, and skeletal muscle weakness.
If wrong: Manifestations of fluid overload include increased pulse rate, distended neck veins, increased blood pressure, pale and cool skin, and skeletal muscle weakness.

Q: A nurse assesses a client who is prescribed a medication that inhibits aldosterone secretion and release. For which potential complications should the nurse assess? <b>(Select all that apply.)</b>
- Urine output of 25 mL/hr
- Serum potassium level of 5.4 mEq/L
- Urine specific gravity of 1.02 g/mL
- Serum sodium level of 128 mEq/L
- Blood osmolality of 250 mOsm/L
A: Serum potassium level of 5.4 mEq/L; Blood osmolality of 250 mOsm/L
If right: Aldosterone is a naturally occurring hormone of the mineralocorticoid type that increases the reabsorption of water and sodium in the kidney at the same time that it promotes excretion of potassium. Any drug or condition that disrupts aldosterone secretion or release increases the client’s risk for excessive water loss (increased urine output), increased potassium reabsorption, decreased blood osmolality, and increased urine specific gravity. The client would not be at risk for sodium imbalance.
If wrong: Aldosterone is a naturally occurring hormone of the mineralocorticoid type that increases the reabsorption of water and sodium in the kidney at the same time that it promotes excretion of potassium. Any drug or condition that disrupts aldosterone secretion or release increases the client’s risk for excessive water loss (increased urine output), increased potassium reabsorption, decreased blood osmolality, and increased urine specific gravity. The client would not be at risk for sodium imbalance.