Review Test Submission: Final Review No
Points PN2
Content
1 out of 1 points
A nurse is evaluating a patient who is being treated for dehydration. Which assessment
result does the nurse correlate with a therapeutic response to the treatment plan?
Selected Answer: b.
Decreased orthostatic light-headedness and dizziness
Answers: a.
Increased respiratory rate from 12 to 22 breaths/min
b.
Decreased orthostatic light-headedness and dizziness
c.
Decreased skin turgor on the patient’s posterior hand and forehead
d.
Increased urine specific gravity from 1.012 to 1.030 g/mL
Response The focus of management for patients with dehydration is to increase
Feedback: fluid volumes to normal. When fluid volumes return to normal, patients
should perfuse the brain more effectively, therefore improving confusion
and decreasing orthostatic light-headedness or dizziness. Increased
respiratory rate, decreased skin turgor, and increased specific gravity are
all manifestations of dehydration.
Question 2
1 out of 1 points
After teaching a patient who is prescribed a restricted sodium diet, a nurse assesses the
patient’s understanding. Which food choice for lunch indicates that the patient correctly
understood the teaching?
Selected Answer: c.
Grilled chicken breast with glazed carrots
Answers: a.
Bowl of tomato soup with a grilled cheese sandwich
, b.
Salami and cheese on whole-wheat crackers
c.
Grilled chicken breast with glazed carrots
d.
Slices of smoked ham with potato salad
Response Patients on restricted sodium diets generally should avoid processed,
Feedback: smoked, and pickled foods and those with sauces and other condiments.
Foods lowest in sodium include fish, poultry, and fresh produce. The
ham, tomato soup, salami, and crackers are often high in sodium.
Question 3
1 out of 1 points
A nurse is assessing a patient with hypokalemia, and notes that the patient’s handgrip
strength has diminished since the previous assessment 1 hour ago. What action does the
nurse take first?
Selected Answer: a.
Assess the patient’s respiratory rate, rhythm, and depth.
Answers: a.
Assess the patient’s respiratory rate, rhythm, and depth.
b.
Measure the patient’s pulse and blood pressure.
c.
Call the healthcare provider.
d.
Document findings and monitor the patient.
Response In a patient with hypokalemia, progressive skeletal muscle weakness is
Feedback: associated with increasing severity of hypokalemia. The most life-
threatening complication of hypokalemia is respiratory insufficiency. It is
imperative for the nurse to perform a respiratory assessment first to make
sure that the patient is not in immediate jeopardy. Cardiac dysrhythmias
are also associated with hypokalemia. The patient’s pulse and blood
pressure should be assessed after assessing respiratory status. Next, the
nurse would call the healthcare provider to obtain orders for potassium
replacement. Documenting findings and continuing to monitor the
patient should occur during and after potassium replacement therapy.
Question 4
, 1 out of 1 points
After teaching a patient to increase dietary potassium intake, a nurse assesses the
patient’s understanding. Which dietary meal selection indicates that the patient correctly
understands the teaching?
Selected a.
Answer: Sausage, one slice of whole-wheat toast, half cup of raisins (120 gm),
and a glass of milk
Answers: a.
Sausage, one slice of whole-wheat toast, half cup of raisins (120 gm),
and a glass of milk
b.
Two scrambled eggs, a slice of white toast, and a half cup (120 gm)
of strawberries
c.
Bowl of oatmeal with brown sugar, a half cup of sliced peaches (120
gm), and coffee
d.
Toasted English muffin with butter and blueberry jam, and tea with
sugar
Response Meat, dairy products, and dried fruit have high concentrations of
Feedback: potassium. Eggs, breads, cereals, sugar, and some fruits (berries,
peaches) are low in potassium. The menu selection of sausage, toast,
raisins, and milk has the greatest number of items with higher potassium
content.
Question 5
1 out of 1 points
A patient at risk for developing hyperkalemia states, “I love fruit and usually eat it every
day, but now I can’t because of my high potassium level.” How will the nurse respond?
Selected Answer: a.
“Berries, cherries, apples, and peaches are low in potassium.”
Answers: a.
“Berries, cherries, apples, and peaches are low in potassium.”
b.
“You are correct. Fruit is very high in potassium.”
c.
“If you cook the fruit, the amount of potassium will be lower.”
, d.
“Potatoes and avocados can be substituted for fruit.”
Response Not all fruit is potassium rich. Fruits that are relatively low in potassium
Feedback: and can be included in the diet include apples, apricots, berries, cherries,
grapefruit, peaches, and pineapples. Fruits high in potassium include
bananas, kiwi, cantaloupe, oranges, and dried fruit. Cooking fruit does
not alter its potassium content.
Question 6
1 out of 1 points
A nurse is caring for a patient who has a serum calcium level of 14 mg/dL (3.5 mmol/L).
Which provider order does the nurse implement first?
Selected Answer: d.
Connect the patient to a cardiac monitor.
Answers: a.
Encourage oral fluid intake.
b.
Administer oral calcitonin (Calcimar).
c.
Assess urinary output.
d.
Connect the patient to a cardiac monitor.
Response This patient has hypercalcemia. Elevated serum calcium levels can
Feedback: decrease cardiac output and cause cardiac dysrhythmias. Connecting the
patient to a cardiac monitor is a priority to assess for lethal cardiac
changes. Encouraging oral fluids, assessing urine output, and
administering calcitonin are treatments for hypercalcemia, but are not the
highest priority.
Question 7
1 out of 1 points
A nurse assesses a patient who is experiencing an acid–base imbalance. The patient’s
arterial blood gas values are pH 7.34, PaO2 88 mm Hg, PaCO2 38 mm Hg, and HCO3- 19
mEq/L (19 mmol/L). Which assessment would the nurse perform first?
Selected Answer: b.
Cardiac rate and rhythm
Points PN2
Content
1 out of 1 points
A nurse is evaluating a patient who is being treated for dehydration. Which assessment
result does the nurse correlate with a therapeutic response to the treatment plan?
Selected Answer: b.
Decreased orthostatic light-headedness and dizziness
Answers: a.
Increased respiratory rate from 12 to 22 breaths/min
b.
Decreased orthostatic light-headedness and dizziness
c.
Decreased skin turgor on the patient’s posterior hand and forehead
d.
Increased urine specific gravity from 1.012 to 1.030 g/mL
Response The focus of management for patients with dehydration is to increase
Feedback: fluid volumes to normal. When fluid volumes return to normal, patients
should perfuse the brain more effectively, therefore improving confusion
and decreasing orthostatic light-headedness or dizziness. Increased
respiratory rate, decreased skin turgor, and increased specific gravity are
all manifestations of dehydration.
Question 2
1 out of 1 points
After teaching a patient who is prescribed a restricted sodium diet, a nurse assesses the
patient’s understanding. Which food choice for lunch indicates that the patient correctly
understood the teaching?
Selected Answer: c.
Grilled chicken breast with glazed carrots
Answers: a.
Bowl of tomato soup with a grilled cheese sandwich
, b.
Salami and cheese on whole-wheat crackers
c.
Grilled chicken breast with glazed carrots
d.
Slices of smoked ham with potato salad
Response Patients on restricted sodium diets generally should avoid processed,
Feedback: smoked, and pickled foods and those with sauces and other condiments.
Foods lowest in sodium include fish, poultry, and fresh produce. The
ham, tomato soup, salami, and crackers are often high in sodium.
Question 3
1 out of 1 points
A nurse is assessing a patient with hypokalemia, and notes that the patient’s handgrip
strength has diminished since the previous assessment 1 hour ago. What action does the
nurse take first?
Selected Answer: a.
Assess the patient’s respiratory rate, rhythm, and depth.
Answers: a.
Assess the patient’s respiratory rate, rhythm, and depth.
b.
Measure the patient’s pulse and blood pressure.
c.
Call the healthcare provider.
d.
Document findings and monitor the patient.
Response In a patient with hypokalemia, progressive skeletal muscle weakness is
Feedback: associated with increasing severity of hypokalemia. The most life-
threatening complication of hypokalemia is respiratory insufficiency. It is
imperative for the nurse to perform a respiratory assessment first to make
sure that the patient is not in immediate jeopardy. Cardiac dysrhythmias
are also associated with hypokalemia. The patient’s pulse and blood
pressure should be assessed after assessing respiratory status. Next, the
nurse would call the healthcare provider to obtain orders for potassium
replacement. Documenting findings and continuing to monitor the
patient should occur during and after potassium replacement therapy.
Question 4
, 1 out of 1 points
After teaching a patient to increase dietary potassium intake, a nurse assesses the
patient’s understanding. Which dietary meal selection indicates that the patient correctly
understands the teaching?
Selected a.
Answer: Sausage, one slice of whole-wheat toast, half cup of raisins (120 gm),
and a glass of milk
Answers: a.
Sausage, one slice of whole-wheat toast, half cup of raisins (120 gm),
and a glass of milk
b.
Two scrambled eggs, a slice of white toast, and a half cup (120 gm)
of strawberries
c.
Bowl of oatmeal with brown sugar, a half cup of sliced peaches (120
gm), and coffee
d.
Toasted English muffin with butter and blueberry jam, and tea with
sugar
Response Meat, dairy products, and dried fruit have high concentrations of
Feedback: potassium. Eggs, breads, cereals, sugar, and some fruits (berries,
peaches) are low in potassium. The menu selection of sausage, toast,
raisins, and milk has the greatest number of items with higher potassium
content.
Question 5
1 out of 1 points
A patient at risk for developing hyperkalemia states, “I love fruit and usually eat it every
day, but now I can’t because of my high potassium level.” How will the nurse respond?
Selected Answer: a.
“Berries, cherries, apples, and peaches are low in potassium.”
Answers: a.
“Berries, cherries, apples, and peaches are low in potassium.”
b.
“You are correct. Fruit is very high in potassium.”
c.
“If you cook the fruit, the amount of potassium will be lower.”
, d.
“Potatoes and avocados can be substituted for fruit.”
Response Not all fruit is potassium rich. Fruits that are relatively low in potassium
Feedback: and can be included in the diet include apples, apricots, berries, cherries,
grapefruit, peaches, and pineapples. Fruits high in potassium include
bananas, kiwi, cantaloupe, oranges, and dried fruit. Cooking fruit does
not alter its potassium content.
Question 6
1 out of 1 points
A nurse is caring for a patient who has a serum calcium level of 14 mg/dL (3.5 mmol/L).
Which provider order does the nurse implement first?
Selected Answer: d.
Connect the patient to a cardiac monitor.
Answers: a.
Encourage oral fluid intake.
b.
Administer oral calcitonin (Calcimar).
c.
Assess urinary output.
d.
Connect the patient to a cardiac monitor.
Response This patient has hypercalcemia. Elevated serum calcium levels can
Feedback: decrease cardiac output and cause cardiac dysrhythmias. Connecting the
patient to a cardiac monitor is a priority to assess for lethal cardiac
changes. Encouraging oral fluids, assessing urine output, and
administering calcitonin are treatments for hypercalcemia, but are not the
highest priority.
Question 7
1 out of 1 points
A nurse assesses a patient who is experiencing an acid–base imbalance. The patient’s
arterial blood gas values are pH 7.34, PaO2 88 mm Hg, PaCO2 38 mm Hg, and HCO3- 19
mEq/L (19 mmol/L). Which assessment would the nurse perform first?
Selected Answer: b.
Cardiac rate and rhythm
