NUR 233 Exam 2 Review Questions and Correct Answers
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Course
NUR 233
Institution
NUR 233
To promote airway clearance in the patient with pneumonia, what should the nurse instruct the patient to do? A. Maintain adequate fluid intake B. splint the chest when cough C. maintain semi-fowlers position D. cough with expectoration A, B, D
The nurse is planning the care of a client diagnosed w...
NUR 233 Exam 2 Review Questions and
Correct Answers
To promote airway clearance in the patient with pneumonia, what should the nurse
instruct the patient to do?
A. Maintain adequate fluid intake
B. splint the chest when cough
C. maintain semi-fowlers position
D. cough with expectoration ✅A, B, D
The nurse is planning the care of a client diagnosed with pneumonia and writes problem
of "impaired gas exchange". Which is an expected outcome?
A. Perform chest physiotherapy 3 times a day
B. Able to complete activities of daily living
C. Ambulates in the hall several times during shift
D. Alert and oriented to person, place, time ✅D
Clinical assessment of dehydration would be confirmed if you identify
A. 1-pound weight loss
B. Engorged neck veins
C. Dry mucous membranes
D. Full bounding pulse ✅C
In a patient with prolonged vomiting, the nurse monitors for fluid deficit because
vomiting results in
A. Fluid movement from the cells into interstitial space and blood vessels
B. Excretion of large amount if ICF with depletion of ECF
C. An overload of ECF with increase of ICF
D. Fluid movement from vascular system into cells, swelling ✅A
A patient comes into the clinic complaining of frequent, watery stool for the past 2 days.
Which action should the nurse take first
A. Obtain a baseline weight
B. Check the patients BP
C. Draw blood for serum electrolytes
D. Ask about extremity numbness ✅B
An older patient receiving iso-osmolar continuous tube feedings develops restlessness,
agitation, and weakness. Which laboratory result should the nurse report to the health
care provider immediately?
a. K+ 3.4 mEq/L (3.4 mmol/L)
b. Ca+2 7.8 mg/dL (1.95 mmol/L)
c. Na+ 154 mEq/L (154 mmol/L)
, d. PO4-3 4.8 mg/dL (1.55 mmol/L) ✅C
Implementation of nursing care for a patient with hyponatremia includes
A. Fluid Restriction
B. Administration of hypotonic IV fluids
C. Administration of cation-exchange renin
D. Increased water intake for patient on NG suction ✅A - need hypertonic solution
B (hypotonic IV fluids are for someone with hypernatremia)
The nurse is caring for a patient with a medical diagnosis of hypernatremia. The
following orders are written in the clients electronic health record. Which one should the
nurse question?
A. Administer an IV of D5W at 125 mL/hr
B. Strict I&O monitoring
C. Restrict oral intake to 900 mL every 24 hrs
D. Monitor serum electrolytes every 4 hours ✅C
IV potassium chloride 60 mEq is prescribed for treatment of a patient with severe
hypokalemia. Which action should nurse take?
A. Administer KCL as rapid IV bolus
B. Infuse KCL at rate of 10 mEq/hour
C. Only give KCL through central venous line
D. Discontinue cardiac monitoring during infusion ✅B
A (never give bolus)
The nurse is caring for a patient with potassium level of 2.8 mEq/L. Which assessment
related is most concerning?
A. Lightheadedness when getting out of bed
B. Tremors when stretching
C. Bone pain and joint stiffness
D. Palpitations and irregular pulse ✅D
Client with cardiac history is taking potassium-wasting diuretics (furosemide) and is
seen in the ER for complaints of weakness. You except to evaluate which lab values?
A. Albumin and protein
B. Sodium and chloride
C. Hemoglobin and hematocrit
D. Potassium and blood glucose ✅D
After receiving change-of-shift report, which patient should the nurse assess first?
A. Patient with serum potassium level of 5.0 with complaint of abdominal pain
B. Patient with serum sodium level 145 who has dry mouth asking for water
C. Patient with serum magnesium 1.1 who has tremors and hyperactive deep tendon
reflexes
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