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PNUR124 Quizlet Questions
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Quizlet QuestionsWeek 10: Fluid and Electrolyte Imbalances
1. The nurse is caring for a client with deficient fluid volume caused by a massive burn
injury. Which of the following assessment data will be of greatest concern to the nurse?
a. The blood pressure is 90/40 mm Hg.
b. Urine output is 30 mL over the last hour.
c. Oral fluid intake is 100 mL for the last 8 hours.
d. There is prolonged skin tenting over the sternum.
2. The nurse is caring for a client recently admitted with small cell carcinoma of the lung and the syndrome of
inappropriate antidiuretic hormone (SIADH). Which of the following
assessments should the nurse carefully monitor?
a. Increased total urinary output
b. Elevation of serum hematocrit
c. Decreased serum sodium level
d. Rapid and unexpected weight loss
3. The nurse is evaluating the fluid balance for a client admitted for hypovolemia associated with multiple
draining wounds. Which of the following assessments is the most accurate to evaluate volume status in this
client?
a. Skin turgor
b. Daily weight
c. Presence of edema
d. Hourly urine output
4. The nurse is caring for an alert and oriented older-adult client with a history of
dehydration. Which of the following information should the home health nurse teach the client as to when to
increase fluid intake?
a. In the late evening hours
b. If the oral mucosa feels dry
c. When the client feels thirsty
d. As soon as changes in level of consciousness (LOC) occur
5. The nurse is caring for a client who is taking a potassium-wasting diuretic for treatment of hypertension.
Which of the following assessment data would the nurse include in the teaching plan?
a. Personality changes
b. Frequent loose stools
c. Facial muscle spasms
d. Lower extremity weakness
6. The nurse is teaching a client about spironolactone as a diuretic. Which statement by the client indicates that
the teaching about this medication has been effective?
a. "I will try to drink at least 8 glasses of water every day."
b. "I will use a salt substitute to decrease my sodium intake."
, c. "I will increase my intake of potassium-containing foods."
d. "I will drink apple juice instead of orange juice for breakfast."
7. The nurse is caring for a client admitted with hyponatremia. Which of the following
actions should the nurse anticipate implementing?
a. Restrict client's oral free water intake.
b. Avoid use of electrolyte-containing drinks.
c. Infuse a solution of 5% dextrose in 0.45% saline.
d. Administer vasopressin (antidiuretic hormone, ADH).
8. The nurse is caring for a client with severe hypokalemia and is preparing to administer
intravenous potassium chloride (KCl) 40 mmol as prescribed by the health care provider.
Which of the following actions should the nurse take?
a. Administer the KCl as a rapid IV bolus.
b. Infuse the KCl at a rate of 20 mEq/hour.
c. Give the KCl only through a central venous line.
d. Add no more than 40 mEq/L to a litre of IV fluid.
9. The nurse is caring for a client who has required prolonged mechanical ventilation and has the following
arterial blood gas results: pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and
HCO3 25 mmol/L. Which of the following interpretations would the nurse document?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
10. The nurse is caring for a client who was admitted with diabetic ketoacidosis and has rapid, deep respirations.
Which of the following actions should the nurse implement?
a. Notify the client's health care provider.
b. Give the prescribed PRN lorazepam.
c. Start the prescribed PRN oxygen at 2-4 L/min.
d. Encourage the client to take deep, slow breaths.
11. The home health nurse is visiting an older-adult client who has a low serum protein level. Which of the
following assessment areas should the nurse assess?
a. Pallor
b. Edema
c. Confusion
d. Restlessness
12. The nurse is caring for a client who is receiving 3% NaCl solution for correction of
hyponatremia. During administration of the solution, which of the following assessments
is a priority for the nurse to monitor?
a. Lung sounds
b. Urinary output
c. Peripheral pulses
d. Peripheral edema
,13. The nurse is caring for a client who has a low serum total protein level and is taking
protein supplements. Which of the following data indicate that the client's condition has
improved?
a. Hematocrit 28%
b. Good skin turgor
c. Absence of peripheral edema
d. Blood pressure 110/72 mm Hg
14. The nurse is caring for a client who has the following arterial blood gas (ABG) results: pH
7.32, PaO2 88 mm Hg, PaCO2 37 mm Hg, and HCO3 16 mmol/L. Which of the following
interpretations would the nurse document?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
15. The nurse is caring for a client who has been receiving diuretic therapy and is admitted to
the emergency department with a serum potassium level of 3.1 mmol/L. Of the following
medications that the client has been taking at home, which of the following would be of
most concern to the nurse?
a. Oral digoxin 0.25 mg daily
b. Ibuprofen 400 mg every 6 hours
c. Metoprolol 12.5 mg orally daily
d. Lantus insulin 24 U subcutaneously every evening
16. The nurse is caring for a client with hypercalcemia. Which of the following actions would be included in the
client's nursing care plan?
a. Maintain the client on bed rest.
b. Auscultate lung sounds every 4 hours.
c. Monitor for Trousseau's and Chvostek's signs.
d. Encourage fluid intake up to 3 000 mL every day.
17. The nurse is teaching a client with renal failure about a low phosphate diet. Which of the
following foods would the nurse teach the client to restrict?
a. Dairy products
b. High-fat foods
c. Fruits and juices
d. Green, leafy vegetables
18. The nurse is caring for a client in the outpatient clinic who has a decreased serum
magnesium level. Which of the following assessment areas should the nurse include in the health history?
a. Daily alcohol intake
b. Intake of dietary protein
c. Multivitamin/mineral use
d. Use of over-the-counter (OTC) laxatives
, 19. The nurse is preparing a client for an intravenous infusion of 50% dextrose and the client asks the nurse why a
peripherally inserted central catheter must be inserted. Which of the following explanations is the basis for
the nurse's response?
a. The prescribed infusion can be given much more rapidly when the client has a
central line.
b. There is a decreased risk for infection when 50% dextrose is infused through a
central line.
c. The 50% dextrose is hypertonic and will be more rapidly diluted when given
through a central line.
d. The required blood glucose monitoring is more accurate when samples are
obtained from a central line.
20. The nurse is caring for a client who is receiving iso-osmolar continuous tube feedings who has developed
nausea, vomiting, and tachycardia. Which of the following laboratory results is most important for the nurse
to report to the health care provider?
a. K+ 3.4 mmol/L
b. Ca+2 1.95 mmol/L
c. Na+ 128 mmol/L
d. PO4-3 1.55 mmol/L
21. The nurse is assessing a client with increased extracellular fluid (ECF) osmolality. Which
of the following assessment areas is the priority assessment for the nurse to obtain?
a. Skin turgor
b. Heart sounds
c. Mental status
d. Capillary refill
22. The nurse is caring for a client with a CVAD who suddenly develops chest pain,
hypotension, and tachycardia. Which of the following positions should the nurse
immediately put the client in?
a. Prone
b. High Fowler's
c. Left lateral with head down
d. Sims
23. The nurse is caring for a client postoperative after a thyroidectomy and the client states "I
have a tingling feeling around my mouth." Which of the following data is priority for the
nurse to assess?
a. An elevated serum potassium level
b. The presence of Chvostek's sign
c. A decreased thyroid hormone level
d. Bleeding on the client's dressing
24. The nurse is caring for a client with advanced lung cancer who has been admitted to the emergency
department with urinary retention caused by renal calculi. Which of the following laboratory values will
require the most immediate action by the nurse?
a. Arterial blood pH is 7.32.
b. Serum calcium is 3.45 mmol/L.
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