Title: ASN 210 UNIT EXAM# 1
Course: 16SP-ASN-210-GH1A1-ADV NUR THROUGH LIFESPAN I > Section: Week 2

This exam will cover the following lessons from Week 1 & 2:

Patients with Fluid & Electrolyte Imbalances

Patients with Acid-Base Imbalances

Infusion Therapy Patients
RN Math

This examination is TIMED and you are allotted 2 hours to complete it.
Be sure you are taking this exam on a reliable computer with reliable internet source, if you lose connection you will NOT be allowed to log into the exam again.
Once you start the exam you will need to complete the exam in one setting.
The exam will shut off automatically after the allotted time has elapsed.
This is NOT an open book exam.  This exam contains 75 NCLEX-RN Style Questions and is worth 150 POINTS (15% of your ASN 210 Grade)
No collaboration allowed during this exam or it will be noted as a breach of academic integrity.
You must send a message to the instructor immediately (within 10 minutes) with any technical issues or irregularities related to the exam.

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 nurse assesses a client who is experiencing an acid-base imbalance. The client’s arterial blood gas values are pH 7.32, PaO<sub>2</sub> 94 mm Hg, PaCO<sub>2</sub> 34 mm Hg, and HCO<sub>3</sub><sup>–</sup> 18 mEq/L. For which clinical manifestations should the nurse assess? <b>(Select all that apply.)</b>
- Reduced deep tendon reflexes
- Drowsiness
- Increased respiratory rate
- Decreased urinary output
- Positive Trousseau’s sign
A: Reduced deep tendon reflexes; Drowsiness; Increased respiratory rate
If right: Metabolic acidosis causes neuromuscular changes, including reduced muscle tone and deep tendon reflexes. Clients usually present with lethargy and drowsiness. The respiratory system will attempt to compensate for the metabolic acidosis; therefore, respirations will increase rate and depth. A positive Trousseau’s sign is associated with alkalosis. Decreased urine output is not a manifestation of metabolic acidosis.
If wrong: Metabolic acidosis causes neuromuscular changes, including reduced muscle tone and deep tendon reflexes. Clients usually present with lethargy and drowsiness. The respiratory system will attempt to compensate for the metabolic acidosis; therefore, respirations will increase rate and depth. A positive Trousseau’s sign is associated with alkalosis. Decreased urine output is not a manifestation of metabolic acidosis.

Q: A nurse assesses a client who is prescribed furosemide (Lasix) for hypertension. For which acid-base imbalance should the nurse assess to prevent complications of this therapy?
- Respiratory acidosis
- Respiratory alkalosis
- Metabolic acidosis
- Metabolic alkalosis
A: Metabolic alkalosis
If right: Many diuretics, especially loop diuretics, increase the excretion of hydrogen ions, leading to excess acid loss through the renal system. This situation is an acid deficit of metabolic origin.
If wrong: Many diuretics, especially loop diuretics, increase the excretion of hydrogen ions, leading to excess acid loss through the renal system. This situation is an acid deficit of metabolic origin.

Q: A nurse assesses a client who is receiving total parenteral nutrition. For which adverse effects related to an acid-base imbalance should the nurse assess? <b>(Select all that apply.)</b>
- Positive Chvostek’s sign
- Elevated blood pressure
- Bradycardia
- Increased muscle strength
- Anxiety and irritability
A: Positive Chvostek’s sign; Anxiety and irritability
If right: A client receiving total parenteral nutrition is at risk for metabolic alkalosis. Manifestations of metabolic alkalosis include positive Chvostek’s sign, normal or low blood pressure, increased heart rate, skeletal muscle weakness, and anxiety and irritability.
If wrong: A client receiving total parenteral nutrition is at risk for metabolic alkalosis. Manifestations of metabolic alkalosis include positive Chvostek’s sign, normal or low blood pressure, increased heart rate, skeletal muscle weakness, and anxiety and irritability.

Q: A nurse assesses a client with diabetes mellitus who is admitted with an acid-base imbalance. The client’s arterial blood gas values are pH 7.36, PaO<sub>2</sub> 98 mm Hg, PaCO<sub>2</sub> 33 mm Hg, and HCO<sub>3</sub><sup>–</sup> 18 mEq/L. Which manifestation should the nurse identify as an example of the client’s compensation mechanism?
- Increased rate and depth of respirations
- Increased urinary output
- Increased thirst and hunger
- Increased release of acids from the kidneys
A: Increased rate and depth of respirations
If right: This client has metabolic acidosis. The respiratory system compensates by increasing its activity and blowing off excess carbon dioxide. Increased urinary output, thirst, and hunger are manifestations of hyperglycemia but are not compensatory mechanisms for acid-base imbalances. The kidneys do not release acids.
If wrong: This client has metabolic acidosis. The respiratory system compensates by increasing its activity and blowing off excess carbon dioxide. Increased urinary output, thirst, and hunger are manifestations of hyperglycemia but are not compensatory mechanisms for acid-base imbalances. The kidneys do not release acids.

Q: A nurse evaluates a client’s arterial blood gas values (ABGs): pH 7.30, PaO<sub>2</sub> 86 mm Hg, PaCO<sub>2</sub> 55 mm Hg, and HCO<sub>3</sub><sup>–</sup> 22 mEq/L. Which intervention should the nurse implement first?
- Assess the airway.
- Administer prescribed bronchodilators.
- Provide oxygen.
- Administer prescribed mucolytics.
A: Assess the airway.
If right: All interventions are important for clients with respiratory acidosis; this is indicated by the ABGs. However, the priority is assessing and maintaining an airway. Without a patent airway, other interventions will not be helpful.
If wrong: All interventions are important for clients with respiratory acidosis; this is indicated by the ABGs. However, the priority is assessing and maintaining an airway. Without a patent airway, other interventions will not be helpful.

Q: A nurse evaluates the following arterial blood gas values in a client: pH 7.48, PaO<sub>2</sub> 98 mm Hg, PaCO<sub>2</sub> 28 mm Hg, and HCO<sub>3</sub><sup>–</sup> 22 mEq/L. Which client condition should the nurse correlate with these results?
- Diarrhea and vomiting for 36 hours
- Anxiety-induced hyperventilation
- Chronic obstructive pulmonary disease (COPD)
- Diabetic ketoacidosis and emphysema
A: Anxiety-induced hyperventilation
If right: The elevated pH level indicates alkalosis. The bicarbonate level is normal, and so is the oxygen partial pressure. Loss of carbon dioxide is the cause of the alkalosis, which would occur in response to hyperventilation. Diarrhea and vomiting would cause metabolic alterations, COPD would lead to respiratory acidosis, and the client with emphysema most likely would have combined metabolic acidosis on top of a mild, chronic respiratory acidosis.
If wrong: The elevated pH level indicates alkalosis. The bicarbonate level is normal, and so is the oxygen partial pressure. Loss of carbon dioxide is the cause of the alkalosis, which would occur in response to hyperventilation. Diarrhea and vomiting would cause metabolic alterations, COPD would lead to respiratory acidosis, and the client with emphysema most likely would have combined metabolic acidosis on top of a mild, chronic respiratory acidosis.

Q: A nurse is assessing a client who has acute pancreatitis and is at risk for an acid-base imbalance. For which manifestation of this acid-base imbalance should the nurse assess?
- Agitation
- Kussmaul respirations
- Seizures
- Positive Chvostek’s sign
A: Kussmaul respirations
If right: The pancreas is a major site of bicarbonate production. Pancreatitis can cause a relative metabolic acidosis through underproduction of bicarbonate ions. Manifestations of acidosis include lethargy and Kussmaul respirations. Agitation, seizures, and a positive Chvostek’s sign are manifestations of the electrolyte imbalances that accompany alkalosis.
If wrong: The pancreas is a major site of bicarbonate production. Pancreatitis can cause a relative metabolic acidosis through underproduction of bicarbonate ions. Manifestations of acidosis include lethargy and Kussmaul respirations. Agitation, seizures, and a positive Chvostek’s sign are manifestations of the electrolyte imbalances that accompany alkalosis.

Q: A nurse is assessing clients who are at risk for acid-base imbalance. Which clients are correctly paired with the acid-base imbalance? <b>(Select all that apply.)</b>
- Metabolic alkalosis – Young adult who is prescribed intravenous morphine sulfate for pain
- Metabolic acidosis – Older adult who is following a carbohydrate-free diet
- Respiratory alkalosis – Client on mechanical ventilation at a rate of 28 breaths/min
- Respiratory acidosis – Postoperative client who received 6 units of packed red blood cells
- Metabolic alkalosis – Older client prescribed antacids for gastroesophageal reflux disease
A: Metabolic acidosis – Older adult who is following a carbohydrate-free diet; Respiratory alkalosis – Client on mechanical ventilation at a rate of 28 breaths/min; Metabolic alkalosis – Older client prescribed antacids for gastroesophageal reflux disease
If right: Respiratory acidosis often occurs as the result of underventilation. The client who is taking opioids, especially IV opioids, is at risk for respiratory depression and respiratory acidosis. One cause of metabolic acidosis is a strict low-calorie diet or one that is low in carbohydrate content. Such a diet increases the rate of fat catabolism and results in the formation of excessive ketoacids. A ventilator set at a high respiratory rate or tidal volume will cause the client to lose too much carbon dioxide, leading to an acid deficit and respiratory alkalosis. Citrate is a substance used as a preservative in blood products. It is not only a base, it is also a precursor for bicarbonate. Multiple units of packed red blood cells could cause metabolic alkalosis. Sodium bicarbonate antacids may increase the risk of metabolic alkalosis.
If wrong: Respiratory acidosis often occurs as the result of underventilation. The client who is taking opioids, especially IV opioids, is at risk for respiratory depression and respiratory acidosis. One cause of metabolic acidosis is a strict low-calorie diet or one that is low in carbohydrate content. Such a diet increases the rate of fat catabolism and results in the formation of excessive ketoacids. A ventilator set at a high respiratory rate or tidal volume will cause the client to lose too much carbon dioxide, leading to an acid deficit and respiratory alkalosis. Citrate is a substance used as a preservative in blood products. It is not only a base, it is also a precursor for bicarbonate. Multiple units of packed red blood cells could cause metabolic alkalosis. Sodium bicarbonate antacids may increase the risk of metabolic alkalosis.

Q: A nurse is caring for a client who has chronic emphysema and is receiving oxygen therapy at 6 L/min via nasal cannula. The following clinical data are available:<br><div style="font-size:2pt"></div><table cellpadding="0" cellspacing="0" width="72%" border="1"><tr valign="top"><td><div style="text-align:center"><b>Arterial Blood Gases</b></div></td><td><div style="text-align:center"><b>Vital Signs</b></div></td></tr><tr valign="top"><td>pH = 7.28</td><td>Pulse rate = 96 beats/min</td></tr><tr valign="top"><td>PaO<sub>2</sub> = 85 mm Hg</td><td>Blood pressure = 135/45</td></tr><tr valign="top"><td>PaCO<sub>2</sub> = 55 mm Hg</td><td>Respiratory rate = 6 breaths/min</td></tr><tr valign="top"><td>HCO<sub>3</sub><sup>–</sup> = 26 mEq/L</td><td>O<sub>2 </sub>saturation = 88%</td></tr><tr height="0" style="border:none"><td width="48%"></td><td width="52%"></td></tr></table>Which action should the nurse take first?
- Notify the Rapid Response Team and provide ventilation support.
- Change the nasal cannula to a mask and reassess in 10 minutes.
- Place the client in Fowler’s position if he or she is able to tolerate it.
- Decrease the flow rate of oxygen to 2 to 4 L/min, and reassess.
A: Notify the Rapid Response Team and provide ventilation support.
If right: The primary trigger for respiration in a client with chronic respiratory acidosis is a decreased arterial oxygen level (hypoxic drive). Oxygen therapy can inhibit respiratory efforts in this case, eventually causing respiratory arrest and death. The nurse could decrease the oxygen flow rate; eventually, this might improve the client’s respiratory rate, but the priority action would be to call the Rapid Response Team whenever a client with chronic carbon dioxide retention has a respiratory rate less than 10 breaths/min. Changing the cannula to a mask does nothing to improve the client’s hypoxic drive, nor would it address the client’s most pressing need. Positioning will not help the client breathe at a normal rate or maintain client safety.
If wrong: The primary trigger for respiration in a client with chronic respiratory acidosis is a decreased arterial oxygen level (hypoxic drive). Oxygen therapy can inhibit respiratory efforts in this case, eventually causing respiratory arrest and death. The nurse could decrease the oxygen flow rate; eventually, this might improve the client’s respiratory rate, but the priority action would be to call the Rapid Response Team whenever a client with chronic carbon dioxide retention has a respiratory rate less than 10 breaths/min. Changing the cannula to a mask does nothing to improve the client’s hypoxic drive, nor would it address the client’s most pressing need. Positioning will not help the client breathe at a normal rate or maintain client safety.

Q: A nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure. The client’s arterial blood gas values are pH 6.88, PaO<sub>2</sub> 50 mm Hg, PaCO<sub>2</sub> 60 mm Hg, and HCO<sub>3</sub><sup>–</sup> 22 mEq/L. Which action should the nurse take first?
- Apply oxygen by mask or nasal cannula.
- Apply a paper bag over the client’s nose and mouth.
- Administer 50 mL of sodium bicarbonate intravenously.
- Administer 50 mL of 20% glucose and 20 units of regular insulin.
A: Apply oxygen by mask or nasal cannula.
If right: The client has experienced a combination of metabolic and acute respiratory acidosis through heavy skeletal muscle contractions and no gas exchange. When the seizures have stopped and the client can breathe again, the fastest way to return acid-base balance is to administer oxygen. Applying a paper bag over the client’s nose and mouth would worsen the acidosis. Sodium bicarbonate should not be administered because the client’s arterial bicarbonate level is normal. Glucose and insulin are administered together to decrease serum potassium levels. This action is not appropriate based on the information provided.
If wrong: The client has experienced a combination of metabolic and acute respiratory acidosis through heavy skeletal muscle contractions and no gas exchange. When the seizures have stopped and the client can breathe again, the fastest way to return acid-base balance is to administer oxygen. Applying a paper bag over the client’s nose and mouth would worsen the acidosis. Sodium bicarbonate should not be administered because the client’s arterial bicarbonate level is normal. Glucose and insulin are administered together to decrease serum potassium levels. This action is not appropriate based on the information provided.

Q: A nurse is caring for a client who has the following arterial blood values: pH 7.12, PaO<sub>2</sub> 56 mm Hg, PaCO<sub>2</sub> 65 mm Hg, and HCO<sub>3</sub><sup>–</sup> 22 mEq/L. Which clinical situation should the nurse correlate with these values?
- Diabetic ketoacidosis in a person with emphysema
- Bronchial obstruction related to aspiration of a hot dog
- Anxiety-induced hyperventilation in an adolescent
- Diarrhea for 36 hours in an older, frail woman
A: Bronchial obstruction related to aspiration of a hot dog
If right: Arterial blood gas values indicate that the client has acidosis with normal levels of bicarbonate, suggesting that the problem is not metabolic. Arterial concentrations of oxygen and carbon dioxide are abnormal, with low oxygen and high carbon dioxide levels. Thus, this client has respiratory acidosis from inadequate gas exchange. The fact that the bicarbonate level is normal indicates that this is an acute respiratory problem rather than a chronic problem, because no renal compensation has occurred.
If wrong: Arterial blood gas values indicate that the client has acidosis with normal levels of bicarbonate, suggesting that the problem is not metabolic. Arterial concentrations of oxygen and carbon dioxide are abnormal, with low oxygen and high carbon dioxide levels. Thus, this client has respiratory acidosis from inadequate gas exchange. The fact that the bicarbonate level is normal indicates that this is an acute respiratory problem rather than a chronic problem, because no renal compensation has occurred.

Q: A nurse is caring for a client who is experiencing excessive diarrhea. The client’s arterial blood gas values are pH 7.28, PaO<sub>2</sub> 98 mm Hg, PaCO<sub>2</sub> 45 mm Hg, and HCO<sub>3</sub><sup>–</sup> 16 mEq/L. Which provider order should the nurse expect to receive?
- Furosemide (Lasix) 40 mg intravenous push
- Sodium bicarbonate 100 mEq diluted in 1 L of D<sub>5</sub>W
- Mechanical ventilation
- Indwelling urinary catheter
A: Sodium bicarbonate 100 mEq diluted in 1 L of D<sub>5</sub>W
If right: This client’s arterial blood gas values represent metabolic acidosis related to a loss of bicarbonate ions from diarrhea. The bicarbonate should be replaced to help restore this client’s acid-base balance. Furosemide would cause an increase in acid fluid and acid elimination via the urinary tract; although this may improve the client’s pH, the client has excessive diarrhea and cannot afford to lose more fluid. Mechanical ventilation is used to treat respiratory acidosis for clients who cannot keep their oxygen saturation at 90%, or who have respirator muscle fatigue. Mechanical ventilation and an indwelling urinary catheter would not be prescribed for this client.
If wrong: This client’s arterial blood gas values represent metabolic acidosis related to a loss of bicarbonate ions from diarrhea. The bicarbonate should be replaced to help restore this client’s acid-base balance. Furosemide would cause an increase in acid fluid and acid elimination via the urinary tract; although this may improve the client’s pH, the client has excessive diarrhea and cannot afford to lose more fluid. Mechanical ventilation is used to treat respiratory acidosis for clients who cannot keep their oxygen saturation at 90%, or who have respirator muscle fatigue. Mechanical ventilation and an indwelling urinary catheter would not be prescribed for this client.

Q: A nurse is caring for a client who is experiencing moderate metabolic alkalosis. Which action should the nurse take?
- Monitor daily hemoglobin and hematocrit values.
- Administer furosemide (Lasix) intravenously.
- Encourage the client to take deep breaths.
- Teach the client fall prevention measures.
A: Teach the client fall prevention measures.
If right: The priority nursing care for a client who is experiencing moderate metabolic alkalosis is providing client safety. Clients with metabolic alkalosis have muscle weakness and are at risk for falling. The other nursing interventions are not appropriate for metabolic alkalosis.
If wrong: The priority nursing care for a client who is experiencing moderate metabolic alkalosis is providing client safety. Clients with metabolic alkalosis have muscle weakness and are at risk for falling. The other nursing interventions are not appropriate for metabolic alkalosis.

Q: A nurse is planning care for a client who is anxious and irritable. The client’s arterial blood gas values are pH 7.30, PaO<sub>2</sub> 96 mm Hg, PaCO<sub>2</sub> 43 mm Hg, and HCO<sub>3</sub><sup>–</sup> 19 mEq/L. Which questions should the nurse ask the client and spouse when developing the plan of care? <b>(Select all that apply.)</b>
- “Are you taking any antacid medications?”
- “Is your spouse’s current behavior typical?”
- “Do you drink any alcoholic beverages?”
- “Have you been experiencing any vomiting?”
- “Are you experiencing any shortness of breath?”
A: “Is your spouse’s current behavior typical?”; “Do you drink any alcoholic beverages?”
If right: This client’s symptoms of anxiety and irritability are related to a state of metabolic acidosis. The nurse should ask the client’s spouse or family members if the client’s behavior is typical for him or her, and establish a baseline for comparison with later assessment findings. The nurse should also assess for alcohol intake because alcohol can change a client’s personality and cause metabolic acidosis. The other options are not causes of metabolic acidosis.
If wrong: This client’s symptoms of anxiety and irritability are related to a state of metabolic acidosis. The nurse should ask the client’s spouse or family members if the client’s behavior is typical for him or her, and establish a baseline for comparison with later assessment findings. The nurse should also assess for alcohol intake because alcohol can change a client’s personality and cause metabolic acidosis. The other options are not causes of metabolic acidosis.

Q: A nurse is planning care for a client who is hyperventilating. The client’s arterial blood gas values are pH 7.30, PaO<sub>2</sub> 94 mm Hg, PaCO<sub>2</sub> 31 mm Hg, and HCO<sub>3</sub><sup>–</sup> 26 mEq/L. Which question should the nurse ask when developing this client’s plan of care?
- “Do you take any over-the-counter medications?”
- “You appear anxious. What is causing your distress?”
- “Do you have a history of anxiety attacks?”
- “You are breathing fast. Is this causing you to feel light-headed?
A: “You appear anxious. What is causing your distress?”
If right: The nurse should assist the client who is experiencing anxiety-induced respiratory alkalosis to identify causes of the anxiety. The other questions will not identify the cause of the acid-base imbalance.
If wrong: The nurse should assist the client who is experiencing anxiety-induced respiratory alkalosis to identify causes of the anxiety. The other questions will not identify the cause of the acid-base imbalance.

Q: A nurse is planning interventions that regulate acid-base balance to ensure the pH of a client’s blood remains within the normal range. Which abnormal physiologic functions may occur if the client experiences an acid-base imbalance? <b>(Select all that apply.)</b>
- Reduction in the function of hormones
- Fluid and electrolyte imbalances
- Increase in the function of selected enzymes
- Excitable cardiac muscle membranes
- Increase in the effectiveness of many drugs
A: Reduction in the function of hormones; Fluid and electrolyte imbalances; Increase in the effectiveness of many drugs
If right: Acid-base imbalances interfere with normal physiology, including reducing the function of hormones and enzymes, causing fluid and electrolyte imbalances, making heart membranes more excitable, and decreasing the effectiveness of many drugs.
If wrong: Acid-base imbalances interfere with normal physiology, including reducing the function of hormones and enzymes, causing fluid and electrolyte imbalances, making heart membranes more excitable, and decreasing the effectiveness of many drugs.

Q: After providing discharge teaching, a nurse assesses the client’s understanding regarding increased risk for metabolic alkalosis. Which statement indicates the client needs additional teaching?
- “I don’t drink milk because it gives me gas and diarrhea.”
- “I have been taking digoxin every day for the last 15 years.”
- “I take sodium bicarbonate after every meal to prevent heartburn.”
- “In hot weather, I sweat so much that I drink six glasses of water each day.”
A: “I take sodium bicarbonate after every meal to prevent heartburn.”
If right: Excessive oral ingestion of sodium bicarbonate and other bicarbonate-based antacids can cause metabolic alkalosis. Avoiding milk, taking digoxin, and sweating would not lead to increased risk of metabolic alkalosis.
If wrong: Excessive oral ingestion of sodium bicarbonate and other bicarbonate-based antacids can cause metabolic alkalosis. Avoiding milk, taking digoxin, and sweating would not lead to increased risk of metabolic alkalosis.

Q: After teaching a client who was malnourished and is being discharged, a nurse assesses the client’s understanding. Which statement indicates the client correctly understood teaching to decrease risk for the development of metabolic acidosis?
- “I will drink at least three glasses of milk each day.”
- “I will eat three well-balanced meals and a snack daily.”
- “I will not take pain medication and antihistamines together.”
- “I will avoid salting my food when cooking or during meals.”
A: “I will eat three well-balanced meals and a snack daily.”
If right: Starvation or a diet with too few carbohydrates can lead to metabolic acidosis by forcing cells to switch to using fats for fuel and by creating ketoacids as a by-product of excessive fat metabolism. Eating sufficient calories from all food groups helps reduce this risk.
If wrong: Starvation or a diet with too few carbohydrates can lead to metabolic acidosis by forcing cells to switch to using fats for fuel and by creating ketoacids as a by-product of excessive fat metabolism. Eating sufficient calories from all food groups helps reduce this risk.

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.

Q: A nurse assesses a client who is prescribed a medication that inhibits angiotensin I from converting into angiotensin II (angiotensin-converting enzyme [ACE] inhibitor). For which expected therapeutic effect should the nurse assess?
- Blood pressure decrease from 180/72 mm Hg to 144/50 mm Hg
- Daily weight increase from 55 kg to 57 kg
- Heart rate decrease from 100 beats/min to 82 beats/min
- Respiratory rate increase from 12 breaths/min to 15 breaths/min
A: Blood pressure decrease from 180/72 mm Hg to 144/50 mm Hg
If right: ACE inhibitors will disrupt the renin–angiotensin II pathway and prevent the kidneys from reabsorbing water and sodium. The kidneys will excrete more water and sodium, decreasing the client’s blood pressure.
If wrong: ACE inhibitors will disrupt the renin–angiotensin II pathway and prevent the kidneys from reabsorbing water and sodium. The kidneys will excrete more water and sodium, decreasing the client’s blood pressure.

Q: A nurse cares for a client who has a serum potassium of 7.5 mEq/L and is exhibiting cardiovascular changes. Which prescription should the nurse implement first?
- Prepare to administer sodium polystyrene sulfate (Kayexalate) 15 g by mouth.
- Provide a heart healthy, low-potassium diet.
- Prepare to administer dextrose 20% and 10 units of regular insulin IV push.
- Prepare the client for hemodialysis treatment.
A: Prepare to administer dextrose 20% and 10 units of regular insulin IV push.
If right: A client with a high serum potassium level and cardiac changes should be treated immediately to reduce the extracellular potassium level. Potassium movement into the cells is enhanced by insulin by increasing the activity of sodium-potassium pumps. Insulin will decrease both serum potassium and glucose levels and therefore should be administered with dextrose to prevent hypoglycemia. Kayexalate may be ordered, but this therapy may take hours to reduce potassium levels. Dialysis may also be needed, but this treatment will take much longer to implement and is not the first prescription the nurse should implement. Decreasing potassium intake may help prevent hyperkalemia in the future but will not decrease the client’s current potassium level.
If wrong: A client with a high serum potassium level and cardiac changes should be treated immediately to reduce the extracellular potassium level. Potassium movement into the cells is enhanced by insulin by increasing the activity of sodium-potassium pumps. Insulin will decrease both serum potassium and glucose levels and therefore should be administered with dextrose to prevent hypoglycemia. Kayexalate may be ordered, but this therapy may take hours to reduce potassium levels. Dialysis may also be needed, but this treatment will take much longer to implement and is not the first prescription the nurse should implement. Decreasing potassium intake may help prevent hyperkalemia in the future but will not decrease the client’s current potassium level.

Q: A nurse develops a plan of care for a client who has a history of hypocalcemia. What interventions should the nurse include in this client’s care plan? <b>(Select all that apply.)</b>
- Encourage oral fluid intake of at least 2 L/day.
- Use a draw sheet to reposition the client in bed.
- Strain all urine output and assess for urinary stones.
- Provide nonslip footwear for the client to use when out of bed.
- Rotate the client from side to side every 2 hours.
A: Use a draw sheet to reposition the client in bed.; Provide nonslip footwear for the client to use when out of bed.
If right: Clients with long-standing hypocalcemia have brittle bones that may fracture easily. Safety needs are a priority. Nursing staff should use a draw sheet when repositioning the client in bed and have the client wear nonslip footwear when out of bed to prevent fractures and falls. The other interventions would not provide safety for this client.
If wrong: Clients with long-standing hypocalcemia have brittle bones that may fracture easily. Safety needs are a priority. Nursing staff should use a draw sheet when repositioning the client in bed and have the client wear nonslip footwear when out of bed to prevent fractures and falls. The other interventions would not provide safety for this client.

Q: A nurse is assessing a client who has an electrolyte imbalance related to renal failure. For which potential complications of this electrolyte imbalance should the nurse assess? <b>(Select all that apply.)</b>
- Electrocardiogram changes
- Slow, shallow respirations
- Orthostatic hypotension
- Paralytic ileus
- Skeletal muscle weakness
A: Electrocardiogram changes; Paralytic ileus; Skeletal muscle weakness
If right: Electrolyte imbalances associated with acute renal failure include hyperkalemia and hyperphosphatemia. The nurse should assess for electrocardiogram changes, paralytic ileus caused by decrease bowel mobility, and skeletal muscle weakness in clients with hyperkalemia. The other choices are potential complications of hypokalemia.
If wrong: Electrolyte imbalances associated with acute renal failure include hyperkalemia and hyperphosphatemia. The nurse should assess for electrocardiogram changes, paralytic ileus caused by decrease bowel mobility, and skeletal muscle weakness in clients with hyperkalemia. The other choices are potential complications of hypokalemia.

Q: A nurse is assessing a client with hypokalemia, and notes that the client’s handgrip strength has diminished since the previous assessment 1 hour ago. Which action should the nurse take first?
- Assess the client’s respiratory rate, rhythm, and depth.
- Measure the client’s pulse and blood pressure.
- Document findings and monitor the client.
- Call the health care provider.
A: Assess the client’s respiratory rate, rhythm, and depth.
If right: In a client with hypokalemia, progressive skeletal muscle weakness is associated with increasing severity of hypokalemia. The most life-threatening complication of hypokalemia is respiratory insufficiency. It is imperative for the nurse to perform a respiratory assessment first to make sure that the client is not in immediate jeopardy. Cardiac dysrhythmias are also associated with hypokalemia. The client’s pulse and blood pressure should be assessed after assessing respiratory status. Next, the nurse would call the health care provider to obtain orders for potassium replacement. Documenting findings and continuing to monitor the client should occur during and after potassium replacement therapy.
If wrong: In a client with hypokalemia, progressive skeletal muscle weakness is associated with increasing severity of hypokalemia. The most life-threatening complication of hypokalemia is respiratory insufficiency. It is imperative for the nurse to perform a respiratory assessment first to make sure that the client is not in immediate jeopardy. Cardiac dysrhythmias are also associated with hypokalemia. The client’s pulse and blood pressure should be assessed after assessing respiratory status. Next, the nurse would call the health care provider to obtain orders for potassium replacement. Documenting findings and continuing to monitor the client should occur during and after potassium replacement therapy.

Q: A nurse is assessing clients for fluid and electrolyte imbalances. Which client should the nurse assess first for potential hyponatremia?
- A 34-year-old on NPO status who is receiving intravenous D<sub>5</sub>W
- A 50-year-old with an infection who is prescribed a sulfonamide antibiotic
- A 67-year-old who is experiencing pain and is prescribed ibuprofen (Motrin)
- A 73-year-old with tachycardia who is receiving digoxin (Lanoxin)
A: A 34-year-old on NPO status who is receiving intravenous D<sub>5</sub>W
If right: Dextrose 5% in water (D<sub>5</sub>W) contains no electrolytes. Because the client is not taking any food or fluids by mouth (NPO), normal sodium excretion can lead to hyponatremia. The sulfonamide antibiotic, ibuprofen, and digoxin will not put a client at risk for hyponatremia.
If wrong: Dextrose 5% in water (D<sub>5</sub>W) contains no electrolytes. Because the client is not taking any food or fluids by mouth (NPO), normal sodium excretion can lead to hyponatremia. The sulfonamide antibiotic, ibuprofen, and digoxin will not put a client at risk for hyponatremia.

Q: A nurse is assessing clients on a medical-surgical unit. Which adult client should the nurse identify as being at greatest risk for insensible water loss?
- Client taking furosemide (Lasix)
- Anxious client who has tachypnea
- Client who is on fluid restrictions
- Client who is constipated with abdominal pain
A: Anxious client who has tachypnea
If right: Insensible water loss is water loss through the skin, lungs, and stool. Clients at risk for insensible water loss include those being mechanically ventilated, those with rapid respirations, and those undergoing continuous GI suctioning. Clients who have thyroid crisis, trauma, burns, states of extreme stress, and fever are also at increased risk. The client taking furosemide will have increased fluid loss, but not insensible water loss. The other two clients on a fluid restriction and with constipation are not at risk for fluid loss.
If wrong: Insensible water loss is water loss through the skin, lungs, and stool. Clients at risk for insensible water loss include those being mechanically ventilated, those with rapid respirations, and those undergoing continuous GI suctioning. Clients who have thyroid crisis, trauma, burns, states of extreme stress, and fever are also at increased risk. The client taking furosemide will have increased fluid loss, but not insensible water loss. The other two clients on a fluid restriction and with constipation are not at risk for fluid loss.

Q: A nurse is assessing clients on a medical-surgical unit. Which client is at risk for hypokalemia?
- Client with pancreatitis who has continuous nasogastric suctioning
- Client who is prescribed an angiotensin-converting enzyme (ACE) inhibitor
- Client in a motor vehicle crash who is receiving 6 units of packed red blood cells
- Client with uncontrolled diabetes and a serum pH level of 7.33
A: Client with pancreatitis who has continuous nasogastric suctioning
If right: A client with continuous nasogastric suctioning would be at risk for actual potassium loss leading to hypokalemia. The other clients are at risk for potassium excess or hyperkalemia.
If wrong: A client with continuous nasogastric suctioning would be at risk for actual potassium loss leading to hypokalemia. The other clients are at risk for potassium excess or hyperkalemia.

Q: A nurse is assessing clients on a medical-surgical unit. Which clients are at increased risk for hypophosphatemia? <b>(Select all that apply.)</b>
- A 36-year-old who is malnourished
- A 42-year-old with uncontrolled diabetes
- A 50-year-old with hyperparathyroidism
- A 58-year-old with chronic renal failure
- A 76-year-old who is prescribed antacids
A: A 36-year-old who is malnourished; A 42-year-old with uncontrolled diabetes; A 76-year-old who is prescribed antacids
If right: Clients at risk for hypophosphatemia include those who are malnourished, those with uncontrolled diabetes mellitus, and those who use aluminum hydroxide–based or magnesium-based antacids. Hyperparathyroidism and chronic renal failure are common causes of hyperphosphatemia.
If wrong: Clients at risk for hypophosphatemia include those who are malnourished, those with uncontrolled diabetes mellitus, and those who use aluminum hydroxide–based or magnesium-based antacids. Hyperparathyroidism and chronic renal failure are common causes of hyperphosphatemia.

Q: A nurse is caring for a client who exhibits dehydration-induced confusion. Which intervention should the nurse implement first?
- Measure intake and output every 4 hours.
- Apply oxygen by mask or nasal cannula.
- Increase the IV flow rate to 250 mL/hr.
- Place the client in a high-Fowler’s position.
A: Apply oxygen by mask or nasal cannula.
If right: Dehydration most frequently leads to poor cerebral perfusion and cerebral hypoxia, causing confusion. Applying oxygen can reduce confusion, even if perfusion is still less than optimal. Increasing the IV flow rate would increase perfusion. However, depending on the degree of dehydration, rehydrating the client too rapidly with IV fluids can lead to cerebral edema. Measuring intake and output and placing the client in a high-Fowler’s position will not address the client’s problem.
If wrong: Dehydration most frequently leads to poor cerebral perfusion and cerebral hypoxia, causing confusion. Applying oxygen can reduce confusion, even if perfusion is still less than optimal. Increasing the IV flow rate would increase perfusion. However, depending on the degree of dehydration, rehydrating the client too rapidly with IV fluids can lead to cerebral edema. Measuring intake and output and placing the client in a high-Fowler’s position will not address the client’s problem.

Q: A nurse is caring for a client who has a serum calcium level of 14 mg/dL. Which provider order should the nurse implement first?
- Encourage oral fluid intake.
- Connect the client to a cardiac monitor.
- Assess urinary output.
- Administer oral calcitonin (Calcimar).
A: Connect the client to a cardiac monitor.
If right: This client has hypercalcemia. Elevated serum calcium levels can decrease cardiac output and cause cardiac dysrhythmias. Connecting the client to a cardiac monitor is a priority to assess for lethal cardiac changes. Encouraging oral fluids, assessing urine output, and administering calcitonin are treatments for hypercalcemia, but are not the highest priority.
If wrong: This client has hypercalcemia. Elevated serum calcium levels can decrease cardiac output and cause cardiac dysrhythmias. Connecting the client to a cardiac monitor is a priority to assess for lethal cardiac changes. Encouraging oral fluids, assessing urine output, and administering calcitonin are treatments for hypercalcemia, but are not the highest priority.

Q: A nurse is caring for a client who has the following laboratory results: potassium 3.4 mEq/L, magnesium 1.8 mEq/L, calcium 8.5 mEq/L, sodium 144 mEq/L. Which assessment should the nurse complete first?
- Depth of respirations
- Bowel sounds
- Grip strength
- Electrocardiography
A: Depth of respirations
If right: A client with a low serum potassium level may exhibit hypoactive bowel sounds, cardiac dysrhythmias, and muscle weakness resulting in shallow respirations and decreased handgrips. The nurse should assess the client’s respiratory status first to ensure respirations are sufficient. The respiratory assessment should include rate and depth of respirations, respiratory effort, and oxygen saturation. The other assessments are important but are secondary to the client’s respiratory status.
If wrong: A client with a low serum potassium level may exhibit hypoactive bowel sounds, cardiac dysrhythmias, and muscle weakness resulting in shallow respirations and decreased handgrips. The nurse should assess the client’s respiratory status first to ensure respirations are sufficient. The respiratory assessment should include rate and depth of respirations, respiratory effort, and oxygen saturation. The other assessments are important but are secondary to the client’s respiratory status.

Q: A nurse is caring for an older adult client who is admitted with moderate dehydration. Which intervention should the nurse implement to prevent injury while in the hospital?
- Ask family members to speak quietly to keep the client calm.
- Assess urine color, amount, and specific gravity each day.
- Encourage the client to drink at least 1 liter of fluids each shift.
- Dangle the client on the bedside before ambulating.
A: Dangle the client on the bedside before ambulating.
If right: An older adult with moderate dehydration may experience orthostatic hypotension. The client should dangle on the bedside before ambulating. Although dehydration in an older adult may cause confusion, speaking quietly will not help the client remain calm or decrease confusion. Assessing the client’s urine may assist with the diagnosis of dehydration but would not prevent injury. Clients are encouraged to drink fluids, but 1 liter of fluid each shift for an older adult may cause respiratory distress and symptoms of fluid overload, especially if the client has heart failure or renal insufficiency.
If wrong: An older adult with moderate dehydration may experience orthostatic hypotension. The client should dangle on the bedside before ambulating. Although dehydration in an older adult may cause confusion, speaking quietly will not help the client remain calm or decrease confusion. Assessing the client’s urine may assist with the diagnosis of dehydration but would not prevent injury. Clients are encouraged to drink fluids, but 1 liter of fluid each shift for an older adult may cause respiratory distress and symptoms of fluid overload, especially if the client has heart failure or renal insufficiency.

Q: A nurse is caring for clients with electrolyte imbalances on a medical-surgical unit. Which clinical manifestations are correctly paired with the contributing electrolyte imbalance? <b>(Select all that apply.)</b>
- Hypokalemia – Flaccid paralysis with respiratory depression
- Hyperphosphatemia – Paresthesia with sensations of tingling and numbness
- Hyponatremia – Decreased level of consciousness
- Hypercalcemia – Positive Trousseau’s and Chvostek’s signs
- Hypomagnesemia – Bradycardia, peripheral vasodilation, and hypotension
A: Hypokalemia – Flaccid paralysis with respiratory depression; Hyponatremia – Decreased level of consciousness
If right: Flaccid paralysis with respiratory depression is associated with hypokalemia. Decreased level of consciousness is associated with hyponatremia. Paresthesia with sensations of tingling and numbness is associated with hypophosphatemia or hypercalcemia. Positive Trousseau’s and Chvostek’s signs are associated with hypocalcemia or hyperphosphatemia. Bradycardia, peripheral vasodilation, and hypotension are associated with hypermagnesemia.
If wrong: Flaccid paralysis with respiratory depression is associated with hypokalemia. Decreased level of consciousness is associated with hyponatremia. Paresthesia with sensations of tingling and numbness is associated with hypophosphatemia or hypercalcemia. Positive Trousseau’s and Chvostek’s signs are associated with hypocalcemia or hyperphosphatemia. Bradycardia, peripheral vasodilation, and hypotension are associated with hypermagnesemia.

Q: A nurse is evaluating a client who is being treated for dehydration. Which assessment result should the nurse correlate with a therapeutic response to the treatment plan?
- Increased respiratory rate from 12 breaths/min to 22 breaths/min
- Decreased skin turgor on the client’s posterior hand and forehead
- Increased urine specific gravity from 1.012 to 1.030 g/mL
- Decreased orthostatic light-headedness and dizziness
A: Decreased orthostatic light-headedness and dizziness
If right: The focus of management for clients with dehydration is to increase fluid volumes to normal. When fluid volumes return to normal, clients should perfuse the brain more effectively, therefore improving confusion and decreasing orthostatic light-headedness or dizziness. Increased respiratory rate, decreased skin turgor, and increased specific gravity are all manifestations of dehydration.
If wrong: The focus of management for clients with dehydration is to increase fluid volumes to normal. When fluid volumes return to normal, clients should perfuse the brain more effectively, therefore improving confusion and decreasing orthostatic light-headedness or dizziness. Increased respiratory rate, decreased skin turgor, and increased specific gravity are all manifestations of dehydration.

Q: A nurse teaches a client who is at risk for mild hypernatremia. Which statement should the nurse include in this client’s teaching?
- “Weigh yourself every morning and every night.”
- “Check your radial pulse twice a day.”
- “Read food labels to determine sodium content.”
- “Bake or grill the meat rather than frying it.”
A: “Read food labels to determine sodium content.”
If right: Most prepackaged foods have a high sodium content. Teaching clients how to read labels and calculate the sodium content of food can help them adhere to prescribed sodium restrictions and can prevent hypernatremia. Daily self-weighing and pulse checking are methods of identifying manifestations of hypernatremia, but they do not prevent it. The addition of substances during cooking, not the method of cooking, increases the sodium content of a meal.
If wrong: Most prepackaged foods have a high sodium content. Teaching clients how to read labels and calculate the sodium content of food can help them adhere to prescribed sodium restrictions and can prevent hypernatremia. Daily self-weighing and pulse checking are methods of identifying manifestations of hypernatremia, but they do not prevent it. The addition of substances during cooking, not the method of cooking, increases the sodium content of a meal.

Q: A nurse teaches clients at a community center about risks for dehydration. Which client is at greatest risk for dehydration?
- A 36-year-old who is prescribed long-term steroid therapy
- A 55-year-old receiving hypertonic intravenous fluids
- A 76-year-old who is cognitively impaired
- An 83-year-old with congestive heart failure
A: A 76-year-old who is cognitively impaired
If right: Older adults, because they have less total body water than younger adults, are at greater risk for development of dehydration. Anyone who is cognitively impaired and cannot obtain fluids independently or cannot make his or her need for fluids known is at high risk for dehydration.
If wrong: Older adults, because they have less total body water than younger adults, are at greater risk for development of dehydration. Anyone who is cognitively impaired and cannot obtain fluids independently or cannot make his or her need for fluids known is at high risk for dehydration.

Q: After administering 40 mEq of potassium chloride, a nurse evaluates the client’s response. Which manifestations indicate that treatment is improving the client’s hypokalemia? <b>(Select all that apply.)</b>
- Respiratory rate of 8 breaths/min
- Absent deep tendon reflexes
- Strong productive cough
- Active bowel sounds
- U waves present on the electrocardiogram (ECG)
A: Strong productive cough; Active bowel sounds
If right: A strong, productive cough indicates an increase in muscle strength and improved potassium imbalance. Active bowel sounds also indicate treatment is working. A respiratory rate of 8 breaths/min, absent deep tendon reflexes, and U waves present on the ECG are all manifestations of hypokalemia and do not demonstrate that treatment is working.
If wrong: A strong, productive cough indicates an increase in muscle strength and improved potassium imbalance. Active bowel sounds also indicate treatment is working. A respiratory rate of 8 breaths/min, absent deep tendon reflexes, and U waves present on the ECG are all manifestations of hypokalemia and do not demonstrate that treatment is working.

Q: After teaching a client to increase dietary potassium intake, a nurse assesses the client’s understanding. Which dietary meal selection indicates the client correctly understands the teaching?
- Toasted English muffin with butter and blueberry jam, and tea with sugar
- Two scrambled eggs, a slice of white toast, and a half cup of strawberries
- Sausage, one slice of whole wheat toast, half cup of raisins, and a glass of milk
- Bowl of oatmeal with brown sugar, a half cup of sliced peaches, and coffee
A: Sausage, one slice of whole wheat toast, half cup of raisins, and a glass of milk
If right: Meat, dairy products, and dried fruit have high concentrations of potassium. Eggs, breads, cereals, sugar, and some fruits (berries, peaches) are low in potassium. The menu selection of sausage, toast, raisins, and milk has the greatest number of items with higher potassium content.
If wrong: Meat, dairy products, and dried fruit have high concentrations of potassium. Eggs, breads, cereals, sugar, and some fruits (berries, peaches) are low in potassium. The menu selection of sausage, toast, raisins, and milk has the greatest number of items with higher potassium content.

Q: After teaching a client who is being treated for dehydration, a nurse assesses the client’s understanding. Which statement indicates the client correctly understood the teaching?
- “I must drink a quart of water or other liquid each day.”
- “I will weigh myself each morning before I eat or drink.”
- “I will use a salt substitute when making and eating my meals.”
- “I will not drink liquids after 6 <span style="font-size:10pt">PM</span> so I won’t have to get up at night.”
A: “I will weigh myself each morning before I eat or drink.”
If right: One liter of water weighs 1 kg; therefore, a change in body weight is a good measure of excess fluid loss or fluid retention. Weight loss greater than 0.5 lb daily is indicative of excessive fluid loss. The other statements are not indicative of practices that will prevent dehydration.
If wrong: One liter of water weighs 1 kg; therefore, a change in body weight is a good measure of excess fluid loss or fluid retention. Weight loss greater than 0.5 lb daily is indicative of excessive fluid loss. The other statements are not indicative of practices that will prevent dehydration.

Q: After teaching a client who is prescribed a restricted sodium diet, a nurse assesses the client’s understanding. Which food choice for lunch indicates the client correctly understood the teaching?
- Slices of smoked ham with potato salad
- Bowl of tomato soup with a grilled cheese sandwich
- Salami and cheese on whole wheat crackers
- Grilled chicken breast with glazed carrots
A: Grilled chicken breast with glazed carrots
If right: Clients on restricted sodium diets generally should avoid processed, smoked, and pickled foods and those with sauces and other condiments. Foods lowest in sodium include fish, poultry, and fresh produce. The ham, tomato soup, salami, and crackers are often high in sodium.
If wrong: Clients on restricted sodium diets generally should avoid processed, smoked, and pickled foods and those with sauces and other condiments. Foods lowest in sodium include fish, poultry, and fresh produce. The ham, tomato soup, salami, and crackers are often high in sodium.

Q: A client has a leg wound that is in the second stage of the inflammatory response. For what manifestation does the nurse assess?
- Noticeable rubor
- Purulent drainage
- Swelling and pain
- Warmth at the site
A: Purulent drainage
If right: During the second phase of the inflammatory response, neutrophilia occurs, producing pus. Rubor (redness), swelling, pain, and warmth are cardinal signs of the general inflammatory process.
If wrong: During the second phase of the inflammatory response, neutrophilia occurs, producing pus. Rubor (redness), swelling, pain, and warmth are cardinal signs of the general inflammatory process.

Q: A client has been on dialysis for many years and now is receiving a kidney transplant. The client experiences hyperacute rejection. What treatment does the nurse prepare to facilitate?
- Dialysis
- High-dose steroid administration
- Monoclonal antibody therapy
- Plasmapheresis
A: Dialysis
If right: Hyperacute rejection starts within minutes of transplantation and nothing will stop the process. The organ is removed. If the client survives, he or she will have to return to dialysis treatment. Steroids, monoclonal antibodies, and plasmapheresis are ineffective against this type of rejection.
If wrong: Hyperacute rejection starts within minutes of transplantation and nothing will stop the process. The organ is removed. If the client survives, he or she will have to return to dialysis treatment. Steroids, monoclonal antibodies, and plasmapheresis are ineffective against this type of rejection.

Q: A client is taking prednisone to prevent transplant rejection. What instruction by the nurse is most important?
- “Avoid large crowds and people who are ill.”
- “Check over-the-counter meds for acetaminophen.”
- “Take this medicine exactly as prescribed.”
- “You have a higher risk of developing cancer.”
A: “Avoid large crowds and people who are ill.”
If right: Prednisone, like all steroids, decreases immune function. The client should be advised to avoid large crowds and people who are ill. Prednisone does not contain acetaminophen. All clients should be taught to take medications exactly as prescribed. A higher risk for cancer is seen with drugs from the calcineurin inhibitor category, such as tacrolimus (Prograf).
If wrong: Prednisone, like all steroids, decreases immune function. The client should be advised to avoid large crowds and people who are ill. Prednisone does not contain acetaminophen. All clients should be taught to take medications exactly as prescribed. A higher risk for cancer is seen with drugs from the calcineurin inhibitor category, such as tacrolimus (Prograf).

Q: A client receiving muromonab-CD3 (Orthoclone OKT3) asks the nurse how the drug works. What response by the nurse is best?
- “It increases the elimination of T lymphocytes from circulation.”
- “It inhibits cytokine production in most lymphocytes.”
- “It prevents DNA synthesis, stopping cell division in activated lymphocytes.”
- “It prevents the activation of the lymphocytes responsible for rejection.”
A: “It increases the elimination of T lymphocytes from circulation.”
If right: Muromonab-CD3 (Orthoclone OKT3) is a monoclonal antibody that works to increase the elimination of T lymphocytes from circulation. The corticosteroids broadly inhibit cytokine production in most leukocytes, resulting in generalized immunosuppression. The main action of all antiproliferatives (such as azathioprine [Imuran]) is to inhibit something essential to DNA synthesis, which prevents cell division in activated lymphocytes. Calcineurin inhibitors such as cyclosporine (Sandimmune) stop the production and secretion of interleukin-2, which then prevents the activation of lymphocytes involved in transplant rejection.
If wrong: Muromonab-CD3 (Orthoclone OKT3) is a monoclonal antibody that works to increase the elimination of T lymphocytes from circulation. The corticosteroids broadly inhibit cytokine production in most leukocytes, resulting in generalized immunosuppression. The main action of all antiproliferatives (such as azathioprine [Imuran]) is to inhibit something essential to DNA synthesis, which prevents cell division in activated lymphocytes. Calcineurin inhibitors such as cyclosporine (Sandimmune) stop the production and secretion of interleukin-2, which then prevents the activation of lymphocytes involved in transplant rejection.

Q: A client’s white blood cell count is 7500/mm<sup>3</sup>. Calculate the expected range for this client’s neutrophils. (<i>Record your answer using whole numbers separated with a hyphen; do not use commas.</i>)<i> </i>______/mm<sup>3</sup>
Feedback: 4125-5625/mm^3 The normal range for neutrophils is 55% to 75% of the white blood cell count. 7500 ´ 0.55 = 4125 7500 ´ 0.75 = 5625 So the range would be expected to be 4125/mm^3 to 5625/mm^3.

Q: A clinic nurse is working with an older client. What assessment is most important for preventing infections in this client?
- Assessing vaccination records for booster shot needs
- Encouraging the client to eat a nutritious diet
- Instructing the client to wash minor wounds carefully
- Teaching hand hygiene to prevent the spread of microbes
A: Assessing vaccination records for booster shot needs
If right: Older adults may have insufficient antibodies that have already been produced against microbes to which they have been exposed. Therefore, older adults need booster shots for many vaccinations they received as younger people. A nutritious diet, proper wound care, and hand hygiene are relevant for all populations.
If wrong: Older adults may have insufficient antibodies that have already been produced against microbes to which they have been exposed. Therefore, older adults need booster shots for many vaccinations they received as younger people. A nutritious diet, proper wound care, and hand hygiene are relevant for all populations.

Q: A nurse is assessing a client for acute rejection of a kidney transplant. What assessment finding requires the most rapid communication with the provider?
- Blood urea nitrogen (BUN) of 18 mg/dL
- Cloudy, foul-smelling urine
- Creatinine of 3.9 mg/dL
- Urine output of 340 mL/8 hr
A: Creatinine of 3.9 mg/dL
If right: A creatinine of 3.9 mg/dL is high, indicating possible dysfunction of the kidney. This is a possible sign of rejection. The BUN is normal, as is the urine output. Cloudy, foul-smelling urine would probably indicate a urinary tract infection.
If wrong: A creatinine of 3.9 mg/dL is high, indicating possible dysfunction of the kidney. This is a possible sign of rejection. The BUN is normal, as is the urine output. Cloudy, foul-smelling urine would probably indicate a urinary tract infection.

Q: A nurse is assessing an older client for the presence of infection. The client’s temperature is 97.6° F (36.4° C). What response by the nurse is best?
- Assess the client for more specific signs.
- Conclude that an infection is not present.
- Document findings and continue to monitor.
- Request that the provider order blood cultures.
A: Assess the client for more specific signs.
If right: Because older adults have decreased immune function, including reduced neutrophil function, fever may not be present during an episode of infection. The nurse should assess the client for specific signs of infection. Documentation needs to occur, but a more thorough assessment comes first. Blood cultures may or may not be needed depending on the results of further assessment.
If wrong: Because older adults have decreased immune function, including reduced neutrophil function, fever may not be present during an episode of infection. The nurse should assess the client for specific signs of infection. Documentation needs to occur, but a more thorough assessment comes first. Blood cultures may or may not be needed depending on the results of further assessment.

Q: A nursing student learning about antibody-mediated immunity learns that the cell with the most direct role in this process begins development in which tissue or organ?
- Bone marrow
- Spleen
- Thymus
- Tonsils
A: Bone marrow
If right: The B cell is the primary cell in antibody-mediated immunity and is released from the bone marrow. These cells then travel to other organs and tissues, known as the secondary lymphoid tissues for B cells.
If wrong: The B cell is the primary cell in antibody-mediated immunity and is released from the bone marrow. These cells then travel to other organs and tissues, known as the secondary lymphoid tissues for B cells.

Q: A student nurse is learning about the types of different cells involved in the inflammatory response. Which principles does the student learn? <b>(Select all that apply.)</b>
- Basophils are only involved in the general inflammatory process.
- Eosinophils increase during allergic reactions and parasitic invasion.
- Macrophages can participate in many episodes of phagocytosis.
- Monocytes turn into macrophages after they enter body tissues.
- Neutrophils can only take part in one episode of phagocytosis.
A: Eosinophils increase during allergic reactions and parasitic invasion.; Macrophages can participate in many episodes of phagocytosis.; Monocytes turn into macrophages after they enter body tissues.; Neutrophils can only take part in one episode of phagocytosis.
If right: Eosinophils do increase during allergic and parasitic invasion. Macrophages participate in many episodes of phagocytosis. Monocytes turn into macrophages after they enter body tissues. Neutrophils only take part in one episode of phagocytosis. Basophils are involved in <i>both</i> the general inflammatory response and allergic or hypersensitivity responses.
If wrong: Eosinophils do increase during allergic and parasitic invasion. Macrophages participate in many episodes of phagocytosis. Monocytes turn into macrophages after they enter body tissues. Neutrophils only take part in one episode of phagocytosis. Basophils are involved in <i>both</i> the general inflammatory response and allergic or hypersensitivity responses.

Q: An older adult has a mild temperature, night sweats, and productive cough. The client’s tuberculin test comes back negative. What action by the nurse is best?
- Recommend a pneumonia vaccination.
- Teach the client about viral infections.
- Tell the client to rest and drink plenty of fluids.
- Treat the client as if he or she has tuberculosis (TB).
A: Treat the client as if he or she has tuberculosis (TB).
If right: Due to an age-related decrease in circulating T lymphocytes, the older adult may have a falsely negative TB test. With signs and symptoms of TB, the nurse treats the client as if he or she does have TB. A pneumonia vaccination is not warranted at this time. TB is not a viral infection. The client should rest and drink plenty of fluids, but this is not the best answer as it does not address the possibility that the client’s TB test could be a false negative.
If wrong: Due to an age-related decrease in circulating T lymphocytes, the older adult may have a falsely negative TB test. With signs and symptoms of TB, the nurse treats the client as if he or she does have TB. A pneumonia vaccination is not warranted at this time. TB is not a viral infection. The client should rest and drink plenty of fluids, but this is not the best answer as it does not address the possibility that the client’s TB test could be a false negative.

Q: For a person to be immunocompetent, which processes need to be functional and interact appropriately with each other? <b>(Select all that apply.)</b>
- Antibody-mediated immunity
- Cell-mediated immunity
- Inflammation
- Red blood cells
- White blood cells
A: Antibody-mediated immunity; Cell-mediated immunity; Inflammation
If right: The three processes that need to be functional and interact with each other for a person to be immunocompetent are antibody-mediated immunity, cell-mediated immunity, and inflammation. Red and white blood cells are not processes.
If wrong: The three processes that need to be functional and interact with each other for a person to be immunocompetent are antibody-mediated immunity, cell-mediated immunity, and inflammation. Red and white blood cells are not processes.

Q: The nurse assesses clients for the cardinal signs of inflammation. Which signs/symptoms does this include? <b>(Select all that apply.)</b>
- Edema
- Pulselessness
- Pallor
- Redness
- Warmth
A: Edema; Redness; Warmth
If right: The five cardinal signs of inflammation include redness, warmth, pain, swelling, and decreased function.
If wrong: The five cardinal signs of inflammation include redness, warmth, pain, swelling, and decreased function.

Q: The nurse understands that which type of immunity is the longest acting?
- Artificial active
- Inflammatory
- Natural active
- Natural passive
A: Natural active
If right: Natural active immunity is the most effective and longest acting type of immunity. Artificial and natural passive do not last as long. “Inflammatory” is not a type of immunity.
If wrong: Natural active immunity is the most effective and longest acting type of immunity. Artificial and natural passive do not last as long. “Inflammatory” is not a type of immunity.

Q: The nurse working with clients who have autoimmune diseases understands that what component of cell-mediated immunity is the problem?
- CD4+ cells
- Cytotoxic T cells
- Natural killer cells
- Suppressor T cells
A: Suppressor T cells
If right: Suppressor T cells help prevent hypersensitivity to one’s own cells, which is the basis for autoimmune disease. CD4+ cells are also known as helper/inducer cells, which secrete cytokines. Natural killer cells have direct cytotoxic effects on some non-self cells without first being sensitized. Suppressor T cells have an inhibitory action on the immune system. Cytotoxic T cells are effective against self cells infected by parasites such as viruses or protozoa.
If wrong: Suppressor T cells help prevent hypersensitivity to one’s own cells, which is the basis for autoimmune disease. CD4+ cells are also known as helper/inducer cells, which secrete cytokines. Natural killer cells have direct cytotoxic effects on some non-self cells without first being sensitized. Suppressor T cells have an inhibitory action on the immune system. Cytotoxic T cells are effective against self cells infected by parasites such as viruses or protozoa.

Q: The nurse working in an organ transplantation program knows that which individual is typically the best donor of an organ?
- Child
- Identical twin
- Parent
- Same-sex sibling
A: Identical twin
If right: The recipient’s immune system recognizes donated tissues as non-self except in the case of an identical twin, whose genetic makeup is identical to the recipient.
If wrong: The recipient’s immune system recognizes donated tissues as non-self except in the case of an identical twin, whose genetic makeup is identical to the recipient.

Q: The student nurse is learning about the functions of different antibodies. Which principles does the student learn? <b>(Select all that apply.)</b>
- IgA is found in high concentrations in secretions from mucous membranes.
- IgD is present in the highest concentrations in mucous membranes.
- IgE is associated with antibody-mediated hypersensitivity reactions.
- IgG comprises the majority of the circulating antibody population.
- IgM is the first antibody formed by a newly sensitized B cell.
A: IgA is found in high concentrations in secretions from mucous membranes.; IgE is associated with antibody-mediated hypersensitivity reactions.; IgG comprises the majority of the circulating antibody population.; IgM is the first antibody formed by a newly sensitized B cell.
If right: Immunoglobulin A (IgA) is found in high concentrations in secretions from mucous membranes. Immunoglobulin E (IgE) is associated with antibody-mediated hypersensitivity reactions. The majority of the circulating antibody population consists of immunoglobulin G (IgG). The first antibody formed by a newly sensitized B cell is immunoglobulin M (IgM). Immunoglobulin D (IgD) is typically present in low concentrations.
If wrong: Immunoglobulin A (IgA) is found in high concentrations in secretions from mucous membranes. Immunoglobulin E (IgE) is associated with antibody-mediated hypersensitivity reactions. The majority of the circulating antibody population consists of immunoglobulin G (IgG). The first antibody formed by a newly sensitized B cell is immunoglobulin M (IgM). Immunoglobulin D (IgD) is typically present in low concentrations.

Q: The student nurse learns that the most important function of inflammation and immunity is which purpose?
- Destroying bacteria before damage occurs
- Preventing any entry of foreign material
- Providing protection against invading organisms
- Regulating the process of self-tolerance
A: Providing protection against invading organisms
If right: The purpose of inflammation and immunity is to provide protection to the body against invading organisms, whether they are bacterial, viral, protozoal, or fungal. These systems eliminate, destroy, or neutralize the offending agents. The cells of the immune system are the only cells that can distinguish self from non-self. This function is generalized and incorporates destroying bacteria, preventing entry of foreign invaders, and regulating self-tolerance.
If wrong: The purpose of inflammation and immunity is to provide protection to the body against invading organisms, whether they are bacterial, viral, protozoal, or fungal. These systems eliminate, destroy, or neutralize the offending agents. The cells of the immune system are the only cells that can distinguish self from non-self. This function is generalized and incorporates destroying bacteria, preventing entry of foreign invaders, and regulating self-tolerance.

Q: Which are steps in the process of making an antigen-specific antibody? <b>(Select all that apply.)</b>
- Antibody-antigen binding
- Invasion
- Opsonization
- Recognition
- Sensitization
A: Antibody-antigen binding; Invasion; Recognition; Sensitization
If right: The seven steps in the process of making antigen-specific antibodies are: exposure/invasion, antigen recognition, sensitization, antibody production and release, antigen-antibody binding, antibody binding actions, and sustained immunity. Opsonization is the adherence of an antibody to the antigen, marking it for destruction.
If wrong: The seven steps in the process of making antigen-specific antibodies are: exposure/invasion, antigen recognition, sensitization, antibody production and release, antigen-antibody binding, antibody binding actions, and sustained immunity. Opsonization is the adherence of an antibody to the antigen, marking it for destruction.

Q: The patient is receiving a nitropursside IV drip.  The prescribed range of nitroprusside that the patient may receive is 0.5 to 8 mcg/kg/min.  The patient weighs 68.3 kg.  The IV bag contains 50 mg nitroprusside in 500 mL D5W.  The IV is currently infusing at 24.4 mL/hr.  Calculate the mcg/min dosage that is currently infusing. Round the final answer to the nearest tenth.
- 40.7 mcg/min
- 24.4 mcg/min
- 41 mcg/min
- 24 mcg/min
A: 40.7 mcg/min

Q: The nurse is to administer a bolus feeding of 240 mL formula over 15 minutes using a 60 mL enteral syringe.  At what mL/min rate should the nurse instill the feeding to ensure that it is administered in the correct amount of time?  Round to the neares whole number.
- 5 mL/min
- 16 mL/min
- 20 mL/min
- 24 mL/min
A: 16 mL/min

Q: A provider orders vancomycin 40 mg/kg/day, IV, in 6 divided doses. The patient weighs 16.3 kg.  Calculate the dosage the nurse will administer.  Round the answer to the neares tenth.
- 108.7 mg
- 108 mg
- 109.7 mg
- 109
A: 108.7 mg

Q: the provider orders dimenhydrinate 25 mg, PO, every 4 hours, PRN nausea.  The pharmacy provides dimenhydrinate in an oral solution containing 12.5 mg in 4 mL.  What is the maximum mL the nurse may administer in one day?
- 32 mL
- 8 mL
- 24 mL
- 48 mL
A: 48 mL

Q: The provider orders morphine sulfate 15 mg PO every 12 hours.  The pharmacy provides liquid morphine sulfate in a solution containing 10 mg in 10 mL.  How many teaspoons will the nurse administer to the patient?
- 1 teaspoon
- 2 teaspoons
- 3 teaspoons
- 4 teaspoons
A: 3 teaspoons

Q: The provider orders guaifenesin 200 mg, PO, every 4 hours.  The pharmacy provides guaifenesin in a syrup containing 100 mg in 5 mL.  How many teaspoons will the nurse administer for one dose?
- 0.5 teaspoon
- 1 teaspoon
- 1.5 teaspoons
- 2 teaspoons
A: 2 teaspoons

Q: The recommended dosage for neonates receiving Tazidime (ceftazidime) is 30 mg/kg IM every 12 hours.  If an infant weighs 2,600 grams how many mg of Tazidime would the neonate receive in one day?
- 10 mg
- 78 mg
- 156 mg
- 30 mg
A: 156 mg

Q: The order reads 125 mcg of Lanoxin (digoxin) PO daily.  How many mg of this cardiac medication will the nurse administer to the patient?
- 1.25 mg
- 125 mg
- 12.5 mg
- 0.125 mg
A: 0.125 mg

Q: The medication order reads: 1,000 mL 5% D/W with 1,000 mcg of a drug at 1 mg/min.  Calculate the flow rate in drops per minute if the drop factor is 15 drops per mL.
- 15 gtt/min
- 10 gtt/min
- 5 gtt/min
- 1 gtt/min
A: 15 gtt/min

Q: A provider ordrs betamethasone 4 mg, IM now.  The pharmacy supplies betamethasone in vials containing 6 mg in 1 mL.  How many mL of betamethasone will the nurse draw up to administer?  Round the answer to the nearest tenth mL.
- 1 mL
- 0.4 mL
- 0.6 mL
- 0.7 mL
A: 0.7 mL

Q: A provider orders morphine sulfate 10 mg, IM, every 4 to 6 hours, PRN pain.  The pharmacy supplies morphine in vials containing 10 mg in 1 mL.  Calculate the amunt of morphine to draw up.  Round the answer to the nearest tenth mL.
- 10 mL
- 1 mL
- 0.5 mL
- 5 mL
A: 1 mL

Q: A provider orders atenolol 75 mg, PO, daily.  The pharmacy provides atenolol in tablets containing 50 mg.  How many tablets will the nurse administer to the patient?  Round to the nearest half tablet.
- 1.5 tablets
- 1 tablet
- 0.5 tablet
- 2 tablets
A: 1.5 tablets