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1. You are working on a burn unit. One of your patients is exhibiting signs and symptoms of third spacing, which occurs when fluid moves out of the intravascular space but not into the intracellular space. Based upon this fluid shift, what would the nurse expect the patient to demonstrate?
2. You are an emergency room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results?
A) Respiratory acidosis with no compensation
B) Metabolic alkalosis with a compensatory alkalosis
C) Metabolic acidosis with no compensation
D) Metabolic acidosis with a compensatory respiratory alkalosis
3. You are doing an admission assessment on an elderly patient newly admitted for end-stage liver disease. You must assess the patients skin turgor. What should you remember when evaluating skin turgor?
A) Overhydration causes the skin to tent.
B) Dehydration causes the skin to appear edematous and spongy.
C) Inelastic skin turgor is a normal part of aging.
D) Normal skin turgor is moist and boggy.
4. A nurse in the Medical ICU has orders to infuse a hypertonic solution into a patient with low blood pressure. This solution will increase the number of dissolved particles in the patients blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. What term or terms are associated with this process?
A) Hydrostatic pressure
B) Osmosis and osmolality
D) Active transport
5. You are caring for a 65-year-old male patient admitted to your unit 72 hours ago with pyloric stenosis. A nasogastric tube was placed upon admission and has been on low intermittent suction ever since. You notice that the patients potassium is very low. What would you be concerned that the patient may be at risk for?
B) Metabolic acidosis
C) Metabolic alkalosis
D) Respiratory acidosis
6. A patient in the ICU starts complaining of being short of breath. An arterial blood gas (ABG) is drawn. The ABG has the following values: pH = 7.21, PaCO2 = 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect?
A) Respiratory acidosis
B) Metabolic alkalosis
C) Respiratory alkalosis
D) Metabolic acidosis
7. A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; PERRLA is intact. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed and 40 ml of urine is present. What is the nurses most likely explanation for the urine output?
A) The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place.
B) The man has a brain injury, lacks antidiuretic hormone (ADH), and needs vasopressin.
C) The man is in heart failure and is releasing atrial natriuretic peptide that results in decreased urine output.
D) He is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output.
8. A nurse assesses a patients IV lines on an hourly basis. When checking the IVs this hour, the nurse finds localized pain, redness, warmth, and swelling around the insertion site of a 25-year-old female patient. What is the nurses first priority?
A) Elevate the extremity
B) Apply a warm compress
C) Restart the line in the opposite extremity
D) Apply a cold compress
E) Discontinue the IV infusion
9. As the ICU nurse caring for a patient with multiple trauma from an ATV accident you draw arterial blood gases (ABGs) every 4 hours. What are you primarily assessing in this patient with the ABGs?
A) The bicarbonatecarbonic acid buffer system
B) The patients electrolyte balance
C) The patients intracellular buffer systems
D) The patients fluid balance
10. You are called to your patients room by a family member who voices concern about the patients status. On assessment, you find the patient tachypneic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance would you suspect?
11. A 43-year-old patient with a history of alcohol abuse has been admitted to an acute medical unit with complications resulting from liver failure. Upon assessment, the patients abdomen is distended, firm to touch, and nontender. The nurse recognizes that the patient has excess fluid in his peritoneal space (ascites), a problem that results from the disruption of normal movement of water and electrolytes. What process is primarily responsible for maintaining fluid balance along a concentration gradient?
A) Hydrostatic pressure
B) Active transport
12. A patient with a history of poorly controlled type 1 diabetes has begun displaying the characteristic signs and symptoms of diabetic nephropathy. The patients nurse recognizes that the patient is at risk of disruptions to fluid balance. What role do the kidneys play in the maintenance of normal fluid balance?
A) Secreting or withholding antidiuretic hormone in response to extracellular fluid volume
B) Selectively retaining needed substances and excreting waste products
C) Synthesizing and releasing angiotensin in cases of fluid volume deficit
D) Maintaining the correct concentration of H+ ions in the blood
13. An elderly patient has developed Clostridium difficile-related diarrhea and been subsequently diagnosed with fluid volume deficit (FVD). The nurse providing care for this patient should anticipate:
A) A decreased level of blood urea nitrogen (BUN)
B) An increased level of serum potassium
C) The administration of a hypertonic IV solution
D) The administration of hypotonic or isotonic IV solution
14. A 77-year-old woman with a diagnosis of congestive heart failure has experienced a downward trend in her hemoglobin levels in recent days, and her care team ordered the administration of two units of packed red blood cells. In the hours following her blood transfusion, the patient complained of increasing shortness of breath, and chest auscultation revealed diffuse crackles. The nurse also noted an increase in the patients peripheral edema, and fluid volume excess (FVE) is suspected. What assessment should the nurse prioritize in the care of this patient?
A) Close monitoring of the patients intake and output
B) Assessment of the patients hemoglobin, hematocrit, and red blood cell levels
C) Neurovital signs q1h
D) Assessment of the patients electrolyte levels
15. A 22-year-old man with a diagnosis of schizophrenia has been transferred from the psychiatric unit to the medical unit after drinking 5 liters of water over the past hour. Assessment reveals that the patient is oriented to person but not to time or place and that he is drowsy but rousable by touch. When reviewing this patients most recent blood work, the nurse should pay particular attention to the patients levels of:
C) Blood urea nitrogen (BUN)
16. A patient with a diagnosis of colon cancer has undergone a bowel resection with the creation of an ileostomy. The patients ileostomy output has been unexpectedly high in the 2 days since surgery, and the patients most recent blood work indicates a K+ level of 2.7 mEq/L. This potassium level should prompt the nurse to assess for which of the following physical manifestations?
A) Confusion and decreased level of consciousness
B) Shortness of breath, rales, and peripheral edema
C) Dysphagia, tetany, and emotional lability
D) Fatigue, cramps, and weakness
17. A patient with a diagnosis of thyroid cancer is postoperative day 1 following a total thyroidectomy in which her parathyroid gland was also removed. When assessing for related electrolyte imbalances, what question should the nurse ask the patient?
A) Do you feel like youre having heart palpitations where your heart feels like it skips a beat?
B) How thirsty are you feeling right now?
C) Are you feeling any tingling in your hands or around your mouth?
D) How would you rate your energy level right now?
18. A nurse who provides care on the oncology unit of the hospital is aware of the high incidence of hypercalcemia among patient with cancer. What factors contribute to this fact? Select all that apply.
A) Bone demineralization
B) Secretion of parathyroid hormone (PTH)-related protein by tumors
C) Consequences of immobility
D) Use of artificial nutrition and hydration
E) Use of chemotherapeutic agents
19. A patients most recent arterial blood gases reveal pH = 7.5; HCO3- = 29 mEq/L, and PaCO2 = 51 mm Hg. What health problem could account for these findings?
A) Volume depletion from vomiting
B) Diabetic ketoacidosis (DKA)
20. The actions of buffer systems allow the body to rapidly and effectively respond to alterations in the H+ concentration of body fluids. How do the kidneys primarily contribute to a stable balance between acids and bases?
A) By regulating the combination of water and carbon dioxide, thus controlling levels of carbonic acid
B) By selectively reabsorbing HCO3- ions, which in turn act as H+ ion receptors
C) By regulating the ventilation rate and consequent blood levels of CO2
D) By controlling the process of erythropoiesis and consequent hemoglobin levels
21. Hypomagnesemia is a common yet often overlooked imbalance in acutely and critically ill patients. Which of the following patients is most likely at the highest risk of experiencing low serum magnesium levels?
A) An obese male patient who has a history of atherosclerosis and a previous non-ST wave elevation myocardial infarction
B) A patient who is temporarily receiving total parenteral nutrition (TPN) as a result of complications from gastric bypass surgery
C) A female patient who has liver cirrhosis and who is experiencing withdrawal from heavy alcohol use
D) A teenage patient who is currently being treated for non-Hodgkins lymphoma (NHL)
22. Mrs. Kruger is a 53-year-old woman who has been admitted to the surgical unit following urethral sling surgery that was performed to treat her recurrent stress incontinence. The nurse notes that Mrs. Kruger was treated for breast cancer 3 years earlier and had a left unilateral mastectomy and axillary node biopsy performed. How will Mrs. Krugers medical history affect the nurses care during this admission?
A) The nurse should monitor Mrs. Kruger closely for signs and symptoms of hypercalcemia due to her history of cancer.
B) The nurse should use Mrs. Krugers right arm for IV access and blood pressure assessment.
C) Venous access should be established using a central vein rather than a peripheral vein.
D) Mrs. Kruger should be placed on strict intake and output monitoring.
23. As part of a large hospitals IV team, two nurses are responsible for inserting peripherally inserted central catheters (PICCs) at the bedside for patients who require this form of venous access. Which of the following patients would most likely require a PICC?
A) A woman who recently suffered a pelvic fracture in a motor vehicle accident
B) An elderly man who has been admitted from the community with a fluid volume deficit
C) A man whose hypocalcemia requires a stat infusion of calcium gluconate
D) A woman who has just been ordered total parenteral nutrition (TPN)
24. A patient has been admitted to the medical unit from the emergency department with a peripheral IV in situ and normal saline infusing by gravity. How should the nurse best ensure that the patients ordered solution infuses at the correct rate?
A) Change from gravity infusion to an electronic IV pump.
B) Monitor the patients IV infusion hourly.
C) Label the patients bag of IV solution with a time-calibrated strip of tape.
D) Assess the patient often for signs and symptoms of fluid overload.
25. A patients scheduled dose of furosemide (Lasix) 20 mg IV has recently finished infusing, and the nurse is preparing to administer metoclopramide (Reglan) 10 mg IV, which has just been ordered. Before administering this drug, the nurse should:
A) Reassess the patients allergy status.
B) Flush the patients IV tubing.
C) Aspirate 1 to 2 mL of blood.
D) Clean the area around the patients IV cannula with normal saline.
18. A, B, C
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