SAS 21
Situation: the following questions pertains to the clinical decision making skills and knowledge of a registered
nurse caring for various patients with calcium, magnesium and phosphate imbalances
1. If your patient has hyperphosphatemia, he or she may also have the secondary electrolyte disturbance:
A. hypermagnesemia.
B. hypocalcemia.
C. hypernatremia.
D. hyperkalemia
2. For a patient with hyperphosphatemia and renal failure, avoid giving the phosphatebinding antacid:
A. aluminum hydroxide.
B. calcium carbonate.
C. calcium acetate.
D. magnesium oxide.
3. Many of the signs and symptoms of hypophosphatemia are related to:
A. low energy stores.
B. hypercalcemia.
C. extensive diuresis.
D. hypocalcemia
4. If your patient is hypercalcemic, you would expect to:
A. administer I.V. sodium bicarbonate.
B. administer vitamin D.
C. hydrate the patient.
D. administer digoxin.
5. Hypercalcemia would be most likely to develop in:
A. a 60-year-old man who has squamous cell carcinoma of the lung.
B. an 80-year-old woman who has heart failure and is taking furosemide (Lasix).
C. a 25-year-old trauma patient who has received massive blood transfusions.
D. a 40-year-old man with hypoalbuminemia.
6. You’re told during shift report that your patient has a positive Chvostek’s sign. You would expect his
laboratory test results to reveal:
A. a total serum calcium level below 8.9 mg/dl.
B. a total serum calcium level above 10.1 mg/dl.
C. an ionized calcium level above 5.3 mg/dl.
D. an ionized calcium level between 4.4 and 5.3 mg/dl.
7. Your patient with Crohn’s disease develops tremors while receiving TPN. Suspecting she might have
hypomagnesemia, you assess her neuromuscular system. You should expect to see:
,8. When teaching your patient with hypomagnesemia about a proper diet, you should recommend that he
consume plenty of:
A. seafood.
B. fruits.
C. corn products.
D. dairy products.
9. The doctor prescribes I.V. magnesium sulfate for your patient with hypomagnesemia. Before giving the
magnesium preparation, you review the practitioner’s order to make sure it specifies the:
A. number of grams or milliliters to give.
B. number of ampules to give.
C. number of vials to give.
D. number of uses per vial.
10. Your patient is diagnosed with hypermagnesemia. To treat this imbalance, the practitioner is likely to
order:
A. magnesium citrate.
B. magnesium sulfate diluted in fluids.
C. potassium-sparing diuretics.
D. oral and I.V. fluids.
SAS 22
Situation: the following questions pertains to the clinical decision making skills and knowledge of a registered
nurse caring for various patients with acid-base imbalances
1. 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?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
2. A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for
continued mechanical ventilation. How should the nurse interpret the following arterial blood gas results:
pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
3. A patient who is lethargic and exhibits deep, rapid respirations has the following arterial blood gas (ABG)
results: Ph 7.32, PaO2 88 mm Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. How should the nurse interpret
these results?
a. Respiratory acidosis
, a. achieve optimal compensation immediately.
b. are unable to compensate.
c. can achieve optimal compensation in about 3 days.
d. will compensate within 24 hours.
5. Hypercalcemia would be most likely to develop in:
a. a 60-year-old man who has squamous cell carcinoma of the lung.
b. an 80-year-old woman who has heart failure and is taking furosemide (Lasix).
c. a 25-year-old trauma patient who has received massive blood transfusions.
d. a 40-year-old man with hypoalbuminemia.
6. A cigarette vendor was brought to the emergency department of a hospital after she fell into the ground
and hurt her left leg. She is noted to be tachycardic and tachypneic. Painkillers were carried out to lessen her
pain. Suddenly, she started complaining that she is still in pain and now experiencing muscle cramps,
tingling, and paraesthesia. Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31
mm Hg, and HCO3 25 mmol/L. What does this mean?
a. Respiratory Alkalosis, Uncompensated
b. Respiratory Acidosis, Partially Compensated
c. Metabolic Alkalosis, Uncompensated
d. Metabolic Alkalosis, Partially Compensated
7. The nurse assesses that the client admitted in respiratory acidosis has compensated when the arterial
blood gas (ABG) readings are
a. carbon dioxide level of 50 mm Hg and bicarbonate level of 30 mEq/L.
b. carbon dioxide level of 50 mm Hg and bicarbonate level of 20 mEq/L.
c. carbon dioxide level of 30 mm Hg and bicarbonate level of 30 mEq/L.
d. carbon dioxide level of 30 mm Hg and bicarbonate level of 24 mEq/L.
8. For a 34-year-old client in renal failure who develops acidosis, the nurse would assess for
a.drowsiness.
b.hypoventilation.
c.muscle hyperactivity.
d.paresthesias.
9. Age-related physiologic changes the nurse would consider when planning care for an elderly client
admitted with an acid-base abnormality include (Select all that apply)
a. decreased pulmonary and renal function limit the ability to compensate.
b. hypermetabolism predisposes the elderly to metabolic acidosis.
c. hypoventilation can easily cause respiratory acidosis in the elderly.
d. renal perfusion is diminished because of decreased cardiac output.
e.there is decreased alveolar surface area for gas exchange.
10. When evaluating the laboratory results of a patient with diabetic ketoacidosis, which lab value indicates
Situation: the following questions pertains to the clinical decision making skills and knowledge of a registered
nurse caring for various patients with calcium, magnesium and phosphate imbalances
1. If your patient has hyperphosphatemia, he or she may also have the secondary electrolyte disturbance:
A. hypermagnesemia.
B. hypocalcemia.
C. hypernatremia.
D. hyperkalemia
2. For a patient with hyperphosphatemia and renal failure, avoid giving the phosphatebinding antacid:
A. aluminum hydroxide.
B. calcium carbonate.
C. calcium acetate.
D. magnesium oxide.
3. Many of the signs and symptoms of hypophosphatemia are related to:
A. low energy stores.
B. hypercalcemia.
C. extensive diuresis.
D. hypocalcemia
4. If your patient is hypercalcemic, you would expect to:
A. administer I.V. sodium bicarbonate.
B. administer vitamin D.
C. hydrate the patient.
D. administer digoxin.
5. Hypercalcemia would be most likely to develop in:
A. a 60-year-old man who has squamous cell carcinoma of the lung.
B. an 80-year-old woman who has heart failure and is taking furosemide (Lasix).
C. a 25-year-old trauma patient who has received massive blood transfusions.
D. a 40-year-old man with hypoalbuminemia.
6. You’re told during shift report that your patient has a positive Chvostek’s sign. You would expect his
laboratory test results to reveal:
A. a total serum calcium level below 8.9 mg/dl.
B. a total serum calcium level above 10.1 mg/dl.
C. an ionized calcium level above 5.3 mg/dl.
D. an ionized calcium level between 4.4 and 5.3 mg/dl.
7. Your patient with Crohn’s disease develops tremors while receiving TPN. Suspecting she might have
hypomagnesemia, you assess her neuromuscular system. You should expect to see:
,8. When teaching your patient with hypomagnesemia about a proper diet, you should recommend that he
consume plenty of:
A. seafood.
B. fruits.
C. corn products.
D. dairy products.
9. The doctor prescribes I.V. magnesium sulfate for your patient with hypomagnesemia. Before giving the
magnesium preparation, you review the practitioner’s order to make sure it specifies the:
A. number of grams or milliliters to give.
B. number of ampules to give.
C. number of vials to give.
D. number of uses per vial.
10. Your patient is diagnosed with hypermagnesemia. To treat this imbalance, the practitioner is likely to
order:
A. magnesium citrate.
B. magnesium sulfate diluted in fluids.
C. potassium-sparing diuretics.
D. oral and I.V. fluids.
SAS 22
Situation: the following questions pertains to the clinical decision making skills and knowledge of a registered
nurse caring for various patients with acid-base imbalances
1. 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?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
2. A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for
continued mechanical ventilation. How should the nurse interpret the following arterial blood gas results:
pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
3. A patient who is lethargic and exhibits deep, rapid respirations has the following arterial blood gas (ABG)
results: Ph 7.32, PaO2 88 mm Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. How should the nurse interpret
these results?
a. Respiratory acidosis
, a. achieve optimal compensation immediately.
b. are unable to compensate.
c. can achieve optimal compensation in about 3 days.
d. will compensate within 24 hours.
5. Hypercalcemia would be most likely to develop in:
a. a 60-year-old man who has squamous cell carcinoma of the lung.
b. an 80-year-old woman who has heart failure and is taking furosemide (Lasix).
c. a 25-year-old trauma patient who has received massive blood transfusions.
d. a 40-year-old man with hypoalbuminemia.
6. A cigarette vendor was brought to the emergency department of a hospital after she fell into the ground
and hurt her left leg. She is noted to be tachycardic and tachypneic. Painkillers were carried out to lessen her
pain. Suddenly, she started complaining that she is still in pain and now experiencing muscle cramps,
tingling, and paraesthesia. Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31
mm Hg, and HCO3 25 mmol/L. What does this mean?
a. Respiratory Alkalosis, Uncompensated
b. Respiratory Acidosis, Partially Compensated
c. Metabolic Alkalosis, Uncompensated
d. Metabolic Alkalosis, Partially Compensated
7. The nurse assesses that the client admitted in respiratory acidosis has compensated when the arterial
blood gas (ABG) readings are
a. carbon dioxide level of 50 mm Hg and bicarbonate level of 30 mEq/L.
b. carbon dioxide level of 50 mm Hg and bicarbonate level of 20 mEq/L.
c. carbon dioxide level of 30 mm Hg and bicarbonate level of 30 mEq/L.
d. carbon dioxide level of 30 mm Hg and bicarbonate level of 24 mEq/L.
8. For a 34-year-old client in renal failure who develops acidosis, the nurse would assess for
a.drowsiness.
b.hypoventilation.
c.muscle hyperactivity.
d.paresthesias.
9. Age-related physiologic changes the nurse would consider when planning care for an elderly client
admitted with an acid-base abnormality include (Select all that apply)
a. decreased pulmonary and renal function limit the ability to compensate.
b. hypermetabolism predisposes the elderly to metabolic acidosis.
c. hypoventilation can easily cause respiratory acidosis in the elderly.
d. renal perfusion is diminished because of decreased cardiac output.
e.there is decreased alveolar surface area for gas exchange.
10. When evaluating the laboratory results of a patient with diabetic ketoacidosis, which lab value indicates
