MDC II FINAL EXAM REVIEW
1. A nurse is caring for a client with chronic kidney disease (CKD).
Which lab value should the nurse expect to be elevated?
A. Calcium
B. Hematocrit
C. Creatinine
D. pH
Rationale: In CKD, the kidneys are unable to effectively excrete waste
products, leading to elevated serum creatinine levels.
2. Which finding in a dehydrated client requires immediate
intervention?
A. Dry mucous membranes
B. Urine specific gravity of 1.030
C. BP 88/52 mmHg
D. Skin tenting
Rationale: Hypotension indicates possible hypovolemic shock and requires
immediate intervention to restore circulatory volume.
3. A nurse is reviewing ABG results for a client: pH 7.30, PaCO₂ 50
mmHg, HCO₃⁻ 24 mEq/L. Which condition is present?
A. Metabolic alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis
Rationale: The pH is low (acidosis) and PaCO₂ is high, indicating a respiratory
origin.
4. Which symptom in a client with hyperthyroidism would the nurse
report immediately?
A. Tachycardia
B. Weight loss
C. Irritability
D. Temperature of 103°F
Rationale: A high fever in hyperthyroidism may indicate thyroid storm, a life-
threatening emergency.
5. A client with leukemia is undergoing chemotherapy. Which lab value
requires the nurse’s immediate attention?
A. WBC 2,000/mm³
B. Hemoglobin 11.0 g/dL
C. Platelets 200,000/mm³
D. Neutrophils 65%
Rationale: A critically low WBC count increases the risk of infection and
necessitates protective precautions.
6. A 68-year-old male with a history of COPD is admitted for increasing
confusion and shortness of breath. ABGs show: pH 7.28, PaCO₂ 56,
HCO₃⁻ 26. What is the priority nursing intervention?
A. Administer a bronchodilator
B. Increase the oxygen to 6L/min
C. Encourage deep breathing
, MDC II FINAL EXAM REVIEW
D. Initiate mechanical ventilation
Rationale: The client is experiencing respiratory acidosis due to hypoventilation
from COPD. Bronchodilators help improve airflow and gas exchange.
7. A nurse is teaching a client with hypothyroidism. Which statement
indicates the need for further teaching?
A. "I will take my levothyroxine on an empty stomach."
B. "I should notify the provider if I feel sleepy or gain weight."
C. "I can stop my medication once I feel better."
D. "I will have my TSH levels checked regularly."
Rationale: Levothyroxine therapy is lifelong. Stopping the medication can
cause severe hypothyroidism and complications like myxedema.
8. Findings: pH 7.32, HCO₃⁻ 18, K⁺ 5.6
Diagnosis:
Metabolic acidosis
• Action 1: Monitor potassium
• Action 2: Administer sodium bicarbonate
Rationale: These lab findings indicate metabolic acidosis. Potassium is elevated
as it shifts out of cells during acidosis. Monitoring and treating the acidosis with
sodium bicarbonate are key interventions.
9. Mrs. Thompson is a 72-year-old female admitted for worsening
shortness of breath, lower extremity swelling, and fatigue. She has a
history of Stage 4 Chronic Kidney Disease, hypertension, and Type 2
diabetes mellitus. On assessment, the nurse notes:
• Blood pressure: 170/96 mmHg
• Weight gain of 5 lbs in 3 days
• Bilateral crackles in the lung bases
• 3+ pitting edema in lower extremities
• BUN: 60 mg/dL; Creatinine: 5.6 mg/dL
• Potassium: 5.8 mEq/L
• GFR: 17 mL/min
The client is scheduled for hemodialysis this afternoon. What is
the priority nursing action at this time?
A .Administer a potassium-sparing diuretic to reduce fluid overload
B. Encourage the client to increase fluid intake to promote renal clearance
C. Place the client in high Fowler’s position and monitor respiratory
status
D. Withhold dialysis until potassium levels normalize
Rationale:
This client is exhibiting signs of fluid overload and hyperkalemia in the
setting of advanced CKD. Placing the client in high Fowler’s improves
ventilation and reduces work of breathing. Monitoring respiratory status is
essential as pulmonary edema may develop. Diuretics may be ineffective in
Stage 4 CKD, and potassium-sparing diuretics are contraindicated with elevated
potassium. Dialysis should not be delayed—it will correct the hyperkalemia and
fluid overload.
, MDC II FINAL EXAM REVIEW
10. A client with chronic diarrhea and end-stage renal disease
presents with confusion and deep rapid respirations. Which lab value
confirms metabolic acidosis?
A. pH 7.48
B. HCO₃⁻ 16 mEq/L
C. PaCO₂ 30 mmHg
D. HCO₃⁻ 28 mEq/L
Rationale:
A bicarbonate level <22 mEq/L with a low pH confirms metabolic acidosis. The
lungs may attempt compensation through deep rapid breathing (Kussmaul
respirations).
11. Findings: pH 7.49, PaCO₂ 29 mmHg and Client is breathing rapidly
due to anxiety
• Diagnosis: Respiratory alkalosis
• Action 1: Coach slow, deep breathing
• Action 2: Reassure and reduce anxiety triggers
Rationale:
Respiratory alkalosis results from hyperventilation, commonly due to anxiety or
pain. Coaching breathing and calming the client help correct the imbalance.
12. Mr. Wallace is a 61-year-old male with a history of poorly
controlled hypothyroidism. He is brought to the ED with confusion,
bradycardia (HR 42), cold skin, and hypothermia (94.1°F). His labs
show TSH 58 mU/L and low Free T₄. Which of the following is the most
appropriate initial intervention?
A. Administer oral levothyroxine
B. Provide warming blankets and IV levothyroxine
C. Start propranolol to manage bradycardia
D. Restrict fluids and monitor intake/output
Rationale:
This client is experiencing myxedema coma, a life-threatening complication of
hypothyroidism. Priority is supportive care with passive rewarming and IV
thyroid hormone replacement.
13. A nurse is caring for a client with acute leukemia receiving
chemotherapy. Which nursing intervention is most important?
A. Encourage high-fiber diet
B. Monitor temperature every 4 hours
C. Allow unlimited family visitation
D. Administer routine vaccinations
Rationale:
Clients with leukemia and chemotherapy-induced neutropenia are at high risk
for infection. Fever may be the only early sign of sepsis.
1. A nurse is caring for a client with chronic kidney disease (CKD).
Which lab value should the nurse expect to be elevated?
A. Calcium
B. Hematocrit
C. Creatinine
D. pH
Rationale: In CKD, the kidneys are unable to effectively excrete waste
products, leading to elevated serum creatinine levels.
2. Which finding in a dehydrated client requires immediate
intervention?
A. Dry mucous membranes
B. Urine specific gravity of 1.030
C. BP 88/52 mmHg
D. Skin tenting
Rationale: Hypotension indicates possible hypovolemic shock and requires
immediate intervention to restore circulatory volume.
3. A nurse is reviewing ABG results for a client: pH 7.30, PaCO₂ 50
mmHg, HCO₃⁻ 24 mEq/L. Which condition is present?
A. Metabolic alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis
Rationale: The pH is low (acidosis) and PaCO₂ is high, indicating a respiratory
origin.
4. Which symptom in a client with hyperthyroidism would the nurse
report immediately?
A. Tachycardia
B. Weight loss
C. Irritability
D. Temperature of 103°F
Rationale: A high fever in hyperthyroidism may indicate thyroid storm, a life-
threatening emergency.
5. A client with leukemia is undergoing chemotherapy. Which lab value
requires the nurse’s immediate attention?
A. WBC 2,000/mm³
B. Hemoglobin 11.0 g/dL
C. Platelets 200,000/mm³
D. Neutrophils 65%
Rationale: A critically low WBC count increases the risk of infection and
necessitates protective precautions.
6. A 68-year-old male with a history of COPD is admitted for increasing
confusion and shortness of breath. ABGs show: pH 7.28, PaCO₂ 56,
HCO₃⁻ 26. What is the priority nursing intervention?
A. Administer a bronchodilator
B. Increase the oxygen to 6L/min
C. Encourage deep breathing
, MDC II FINAL EXAM REVIEW
D. Initiate mechanical ventilation
Rationale: The client is experiencing respiratory acidosis due to hypoventilation
from COPD. Bronchodilators help improve airflow and gas exchange.
7. A nurse is teaching a client with hypothyroidism. Which statement
indicates the need for further teaching?
A. "I will take my levothyroxine on an empty stomach."
B. "I should notify the provider if I feel sleepy or gain weight."
C. "I can stop my medication once I feel better."
D. "I will have my TSH levels checked regularly."
Rationale: Levothyroxine therapy is lifelong. Stopping the medication can
cause severe hypothyroidism and complications like myxedema.
8. Findings: pH 7.32, HCO₃⁻ 18, K⁺ 5.6
Diagnosis:
Metabolic acidosis
• Action 1: Monitor potassium
• Action 2: Administer sodium bicarbonate
Rationale: These lab findings indicate metabolic acidosis. Potassium is elevated
as it shifts out of cells during acidosis. Monitoring and treating the acidosis with
sodium bicarbonate are key interventions.
9. Mrs. Thompson is a 72-year-old female admitted for worsening
shortness of breath, lower extremity swelling, and fatigue. She has a
history of Stage 4 Chronic Kidney Disease, hypertension, and Type 2
diabetes mellitus. On assessment, the nurse notes:
• Blood pressure: 170/96 mmHg
• Weight gain of 5 lbs in 3 days
• Bilateral crackles in the lung bases
• 3+ pitting edema in lower extremities
• BUN: 60 mg/dL; Creatinine: 5.6 mg/dL
• Potassium: 5.8 mEq/L
• GFR: 17 mL/min
The client is scheduled for hemodialysis this afternoon. What is
the priority nursing action at this time?
A .Administer a potassium-sparing diuretic to reduce fluid overload
B. Encourage the client to increase fluid intake to promote renal clearance
C. Place the client in high Fowler’s position and monitor respiratory
status
D. Withhold dialysis until potassium levels normalize
Rationale:
This client is exhibiting signs of fluid overload and hyperkalemia in the
setting of advanced CKD. Placing the client in high Fowler’s improves
ventilation and reduces work of breathing. Monitoring respiratory status is
essential as pulmonary edema may develop. Diuretics may be ineffective in
Stage 4 CKD, and potassium-sparing diuretics are contraindicated with elevated
potassium. Dialysis should not be delayed—it will correct the hyperkalemia and
fluid overload.
, MDC II FINAL EXAM REVIEW
10. A client with chronic diarrhea and end-stage renal disease
presents with confusion and deep rapid respirations. Which lab value
confirms metabolic acidosis?
A. pH 7.48
B. HCO₃⁻ 16 mEq/L
C. PaCO₂ 30 mmHg
D. HCO₃⁻ 28 mEq/L
Rationale:
A bicarbonate level <22 mEq/L with a low pH confirms metabolic acidosis. The
lungs may attempt compensation through deep rapid breathing (Kussmaul
respirations).
11. Findings: pH 7.49, PaCO₂ 29 mmHg and Client is breathing rapidly
due to anxiety
• Diagnosis: Respiratory alkalosis
• Action 1: Coach slow, deep breathing
• Action 2: Reassure and reduce anxiety triggers
Rationale:
Respiratory alkalosis results from hyperventilation, commonly due to anxiety or
pain. Coaching breathing and calming the client help correct the imbalance.
12. Mr. Wallace is a 61-year-old male with a history of poorly
controlled hypothyroidism. He is brought to the ED with confusion,
bradycardia (HR 42), cold skin, and hypothermia (94.1°F). His labs
show TSH 58 mU/L and low Free T₄. Which of the following is the most
appropriate initial intervention?
A. Administer oral levothyroxine
B. Provide warming blankets and IV levothyroxine
C. Start propranolol to manage bradycardia
D. Restrict fluids and monitor intake/output
Rationale:
This client is experiencing myxedema coma, a life-threatening complication of
hypothyroidism. Priority is supportive care with passive rewarming and IV
thyroid hormone replacement.
13. A nurse is caring for a client with acute leukemia receiving
chemotherapy. Which nursing intervention is most important?
A. Encourage high-fiber diet
B. Monitor temperature every 4 hours
C. Allow unlimited family visitation
D. Administer routine vaccinations
Rationale:
Clients with leukemia and chemotherapy-induced neutropenia are at high risk
for infection. Fever may be the only early sign of sepsis.
