Fluid, Electrolyte, And Acid Base Problems (Practice Mode)
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- 1.A client’s nursing diagnosis is Deficient Fluid Volume related to excessive fluid loss. Which action related to the fluid management should be delegated to a nursing assistant?
- A.
Administer IV fluids as prescribed by the physician.
- B.
Provide straws and offer fluids between meals.
- C.
Develop plan for added fluid intake over 24 hours
- D.
Teach family members to assist client with fluid intake
- 2.The client also has the nursing diagnosis Decreased Cardiac Output related to decrease plasma volume. Which finding on assessment supports this nursing diagnosis?
- A.
Flattened neck veins when client is in supine position
- B.
Full and bounding pedal and post-tibial pulses
- C.
Pitting edema located in feet, ankles, and calves
- D.
Shallow respirations with crackles on auscultation
- 3.The nursing care plan for the client with dehydration includes interventions for oral health. Which interventions are within the scope of practice for the LPN/LVN being supervised by the nurse? (Choose all that apply.)
- A.
Remind client to avoid commercial mouthwashes.
- B.
Encourage mouth rinsing with warm saline.
- C.
Assess lips, tongue, and mucous membranes
- D.
Provide mouth care every 2 hours while client is awake
- E.
Seek dietary consult to increase fluids on meal trays.
- 4.The physician has written the following orders for the client with Excess Fluid volume. The client’s morning assessment includes bounding peripheral pulses, weight gain of 2 pounds, pitting ankle edema, and moist crackles bilaterally. Which order takes priority at this time?
- A.
Weight client every morning.
- B.
Maintain accurate intake and output.
- C.
Restrict fluid to 1500 mL per day
- D.
Administer furosemide (Lasix) 40 mg IV push
- 5.You have been pulled to the telemetry unit for the day. The monitor informs you that the client has developed prominent U waves. Which laboratory value should you check immediately?
- A.
Sodium
- B.
Potassium
- C.
Magnesium
- D.
Calcium
- 6.The client’s potassium level is 6.7 mEq/L. Which intervention should you delegate to the student nurse under your supervision? .
- A.
Administer Kayexalate 15 g orally
- B.
Administer spironolactone 25 mg orally
- C.
Assess WCG strip for tall T waves
- D.
Administer potassium 10 mEq orally
- 7.A client is admitted to the unit with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). For which electrolyte abnormality will you be sure to monitor?
- A.
Hypokalemia
- B.
Hyperkalemia
- C.
Hyponatremia
- D.
Hypernatremia
- 8.The charge nurse assigned in the care for a client with acute renal failure and hypernatremia to you, a newly graduated RN. Which actions can you delegate to the nursing assistant?
- A.
Provide oral care every 3-4 hours
- B.
Monitor for indications of dehydration
- C.
Administer 0.45% saline by IV line
- D.
Assess daily weights for trends
- 9.The experienced LPN/LVN reports that a client’s blood pressure and heart rate have decreased and that when the face is assessed, one side twitches. What action should you take at this time?
- A.
Reassess the client’s blood pressure and heart rate
- B.
Review the client’s morning calcium level
- C.
Request a neurologic consult today
- D.
Check the client’s papillary reaction to light
- 10.You are preparing to discharge a client whose calcium level was low but is now just slightly within the normal range (9-10.5 mg/dL). Which statement by the client indicates the need for additional teaching?
- A.
“I will call my doctor if I experience muscle twitching or seizures.”
- B.
“I will make sure to take my vitamin D with my calcium each day.”
- C.
“I will take my calcium pill every morning before breakfast.”
- D.
“I will avoid dairy products, broccoli, and spinach when I eat.”
- 11.A nursing assistant asks why the client with a chronically low phosphorus level needs so much assistance with activities of daily living. What is your best response?
- A.
“The client’s low phosphorus is probably due to malnutrition.”
- B.
“The client is just worn out form not getting enough rest.”
- C.
“The client’s skeletal muscles are weak because of the low phosphorus.”
- D.
“The client will do more for herself when her phosphorus is normal”
- 12.You are reviewing a client’s morning laboratory results. Which of these results is of most concern?
- A.
Serum potassium 5.2 mEq/L
- B.
Serum sodium 134 mEq/L
- C.
Serum calcium 10.6 mg/dL
- D.
Serum magnesium 0.8 mEq/L
- 13.You are the charge nurse. Which client is most appropriate to assign to the step-down unit nurse pulled to the intensive care unit for the day?
- A.
A 68-year-old client on ventilator with acute respiratory failure and respiratory acidosis
- B.
A 72-year-old client with COPD and normal arterial blood gases (ABGs) who is ventilator-dependent
- C.
A 56-year-old new admission client with diabetic ketoacidosis (DKA) on a n insulin drip
- D.
A 38-year-old client on a ventilator with narcotic overdose and respiratory alkalosis
- 14.A client with respiratory failure is receiving mechanical ventilation and continues to produce ABG results indicating respiratory acidosis. Which action should you expect to correct this problem?
- A.
Increase the ventilator rate from 6 to 10 per minute
- B.
Decrease the ventilator rate from 10 to 6 per minute
- C.
Increase the oxygen concentration fro 30% to 40%
- D.
Decrease the oxygen concentration fro 40% to 30%
- 15.Which action should you delegate to the nursing assistant for the client with diabetic ketoacidosis? (Choose all that apply.)
- A.
Check fingerstick glucose every hour.
- B.
Record intake and output every hour.
- C.
Check vital signs every 15 minutes.
- D.
Assess for indicators of fluid imbalance.
- 16.You are admitting an elderly client to the medical unit. Which factor indicates that this client has a risk for acid-base imbalances?
- A.
Myocardial infarction 1 year ago
- B.
Occasional use of antacids
- C.
Shortness of breath with extreme exertion
- D.
Chronic renal insufficiency
- 17.A client with lung cancer has received oxycodone 10 mg orally for pain. When the student nurse assesses the client, which finding should you instruct the student to report immediately?
- A.
Respiratory rate of 8 to 10 per minute
- B.
Pain level decreased from 6/10 to 2/10
- C.
Client requests room door be closed.
- D.
Heart rate 90-100 per minute
- 18.The nursing assistant reports to you that a client seems very anxious and that vital signs included a respiratory rate of 38 per minute. Which acid-base imbalance should you suspect?
- A.
Respiratory acidosis
- B.
Respiratory alkalosis
- C.
Metabolic acidosis
- D.
Metabolic alkalosis
- 19.A client is admitted to the unit for chemotherapy. To prevent an acid-base problem, which of the following would you instruct the nursing assistant to report?
- A.
Repeated episodes of nausea and vomiting
- B.
Complaints of pain associated with exertion
- C.
Failure to eat all food on breakfast tray
- D.
Client hair loss during morning bath
- 20.A client has a nasogastric tube connected to intermittent wall suction. The student nurse asks why the client’s respiratory rate has increased. What your best response?
- A.
“It’s common for clients with uncomfortable procedures such as nasogastric tubes to have a higher rate to breathing.”
- B.
“The client may have a metabolic alkalosis due to the NG suctioning and the increased respiratory rate is a compensatory mechanism.”
- C.
“Whenever a client develops a respiratory acid-base problem, increasing the respiratory rate helps correct the problem.”
- D.
“The client is hyperventilating because of anxiety and we will have to stay alert for development of a respiratory acidosis.”
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