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

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: 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: 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: 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 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 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 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 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 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 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: 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: 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 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 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: 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: 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 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 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 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 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.