NURS 285 Exam 1 Questions with Complete Solutions
Your patient has fine crackles in billet lung bases; CVP = 8mmHg (CVP
yesterday was 5mmHg); IV of D5%/0.25 NS @ 75mL/hr; urine output
over last 10 hours = 230mL. Does the data in this case point to FVD or
FVE? Correct Answer-Fluid Volume Excess (FVE)
During the activation of the stress response, there is an increased
secretion of aldosterone. Which finding is not an effect you will see in
the release of this hormone?
A. Calcium excretion
B. Water retention
C. Potassium excretion
D. Sodium retention Correct Answer-A. Calcium excretion
Which assessment finding best indicates that fluid therapy for the patient
with hypertonic dehydration has achieved the desired effect?
A. Peripheral pulses changed from 1+ to 3+
B. Serum osmolality has changed from 312/Osml/kg to 290/Osmol/kg
C. Neck veins slightly distended @ 30 degrees
D. Pulse ox shows O2 of 95% Correct Answer-B. Serum osmolality has
changed from 312/Osml/kg to 290/Osmol/kg
,Which IV solution should you be prepared to administer to a patient
with isotonic dehydration?
A. Dextrose 10% in water
B. 0.9% NS
C. 0.45% NS
D. Dextrose 5% in water Correct Answer-B. 0.9% NS
Your patient is a 37 year old unconscious female in the ICU with a
fever, coarse bilateral lung crackles, and order for 1200mL tube feeding
q24hours. Does the data in this case point to FVD or FVE? Correct
Answer-Fluid Volume Deficit
The unlicensed personnel tells the nurse the patient has a blood pressure
of 78/46 and a pulse of 116 using a vital signs machine. Which action
should the nurse implement first?
A. Notify the physician immediately
B. Place the patient in Trendelenburg position
C. Assess the patient's cardiovascular status
D. Have the UAP re-check the patient's vitals manually Correct Answer-
C. Assess the patient's cardiovascular status
BUN 45; Cr 0.7 Correct Answer-Fluid Volume Deficit
, Na 148; Hct 40% yesterday, 49% today, serum osmolarity 308 Correct
Answer-Fluid Volume Deficit
Hgb 13.2 yesterday; 10.1 today; urine specific gravity 1.001 Correct
Answer-Fluid Volume Excess
Which condition is most likely to cause the formation of peripheral
edema?
A. Decreased albumin; increased BP
B. Increased albumin; decreased BP
C. Decreased albumin; decreased BP
D. Increased albumin; increased BP Correct Answer-A. Decreased
albumin; increased BP
The patient is diagnosed with HF. The nurse finds the patient lying in
bed, SOB, unable to talk and with buccal cyanosis. Which intervention
should the nurse implement first?
A. Call 911 for the paramedics
B. Assist the patient to a sitting position
C. Auscultate the patient's lung sounds
D. Assess the patient's VS Correct Answer-B. Assist the patient to a
sitting position
Your patient has fine crackles in billet lung bases; CVP = 8mmHg (CVP
yesterday was 5mmHg); IV of D5%/0.25 NS @ 75mL/hr; urine output
over last 10 hours = 230mL. Does the data in this case point to FVD or
FVE? Correct Answer-Fluid Volume Excess (FVE)
During the activation of the stress response, there is an increased
secretion of aldosterone. Which finding is not an effect you will see in
the release of this hormone?
A. Calcium excretion
B. Water retention
C. Potassium excretion
D. Sodium retention Correct Answer-A. Calcium excretion
Which assessment finding best indicates that fluid therapy for the patient
with hypertonic dehydration has achieved the desired effect?
A. Peripheral pulses changed from 1+ to 3+
B. Serum osmolality has changed from 312/Osml/kg to 290/Osmol/kg
C. Neck veins slightly distended @ 30 degrees
D. Pulse ox shows O2 of 95% Correct Answer-B. Serum osmolality has
changed from 312/Osml/kg to 290/Osmol/kg
,Which IV solution should you be prepared to administer to a patient
with isotonic dehydration?
A. Dextrose 10% in water
B. 0.9% NS
C. 0.45% NS
D. Dextrose 5% in water Correct Answer-B. 0.9% NS
Your patient is a 37 year old unconscious female in the ICU with a
fever, coarse bilateral lung crackles, and order for 1200mL tube feeding
q24hours. Does the data in this case point to FVD or FVE? Correct
Answer-Fluid Volume Deficit
The unlicensed personnel tells the nurse the patient has a blood pressure
of 78/46 and a pulse of 116 using a vital signs machine. Which action
should the nurse implement first?
A. Notify the physician immediately
B. Place the patient in Trendelenburg position
C. Assess the patient's cardiovascular status
D. Have the UAP re-check the patient's vitals manually Correct Answer-
C. Assess the patient's cardiovascular status
BUN 45; Cr 0.7 Correct Answer-Fluid Volume Deficit
, Na 148; Hct 40% yesterday, 49% today, serum osmolarity 308 Correct
Answer-Fluid Volume Deficit
Hgb 13.2 yesterday; 10.1 today; urine specific gravity 1.001 Correct
Answer-Fluid Volume Excess
Which condition is most likely to cause the formation of peripheral
edema?
A. Decreased albumin; increased BP
B. Increased albumin; decreased BP
C. Decreased albumin; decreased BP
D. Increased albumin; increased BP Correct Answer-A. Decreased
albumin; increased BP
The patient is diagnosed with HF. The nurse finds the patient lying in
bed, SOB, unable to talk and with buccal cyanosis. Which intervention
should the nurse implement first?
A. Call 911 for the paramedics
B. Assist the patient to a sitting position
C. Auscultate the patient's lung sounds
D. Assess the patient's VS Correct Answer-B. Assist the patient to a
sitting position
