PN 4003 Midterm Exam and Final Verified Exam Latest
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The nurse is caring for a client in heart failure with signs of
hypervolemia. Which vital sign is indicative of the disease
process?
A. Low heart rate
B. Elevated blood pressure
C. Rapid respiration
D. Subnormal temperature - Answer-B
A nurse is providing an afternoon shift report and relates
morning assessment findings to the oncoming nurse.
Which daily assessment data is necessary to determine
changes in the client's hypervolemia status?
A. vital signs
B. edema
C. intake and output
D. weight - Answer-D
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The nurse is reviewing client lab work for a critical lab
value. Which value is called to the health care provider for
additional prescriptions?
A. Potassium: 5.8 mEq/L
B. Sodium: 138 mEq/L
C. Magnesium:2 mEq/L
D. Calcium: 10 mg/dL - Answer-A
The nurse is assigned a client with calcium level of 4.0
mg/dL. Which system assessment would the nurse ask
detailed questions?
A. Endocrine system
B. Gastrointestinal system
C. Neurological system
D. Musculoskeletal system - Answer-C- this pt has
hypocalcemia. Nurse will monitor for neurological
manifestations such as spasms and seizures
The nurse is caring for a client with multiple organ failure
and in metabolic acidosis. Which pair of organs is
responsible for regulatory processes and compensation?
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A. Kidney and liver
B. Heart and lungs
C. Lungs and kidney
D. Pancreas and stomach - Answer-C
The nurse receives report that a client's pH level is 7.4.
Which nursing action would be most appropriate?
A. Call the health care provider with the report.
B. Encourage the client to practice deep breathing.
C. Finish the head-to-toe assessment.
D. Obtain an ECG. - Answer-C
The nurse is caring for a client who has been diagnosed
with chronic obstructive pulmonary disease (COPD) and is
experiencing respiratory acidosis. The client asks what is
making the acidotic state. What does the nurse identify as
the result of the disease process that causes the fall in
pH?
A. The lungs are unable to breathe in sufficient oxygen.
B. The lungs are unable to exchange oxygen and carbon
dioxide.
C. The lungs have ineffective cilia from years of smoking.
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D. The lungs are not able to regulate carbonic acid levels.
- Answer-D
The nurse is caring for a client with frequent dizziness.
The nurse is evaluating the client for postural hypotension.
Which of the following symptoms would indicate a
potential diagnosis?
A. A blood pressure elevation upon activity
B. A drop in systolic blood pressure (15 mm Hg) upon
rising
C. A pulsating headache
D. A drop in diastolic blood pressure (25 mmHg) upon
rising - Answer-B
A nurse is assessing a client's reflexes. Which condition
does the nurse need to confirm when tapping the facial
nerve of a client who has dysphagia?
A. Hypervolemia
B. Hypercalcemia
C. Hypomagnesemia
D. Hypermagnesemia - Answer-C