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The nurse is preparing to administer 20 mEq of potassium
chloride to a client who has been vomiting. Which
information about the purpose of this medication should
the nurse explain to the client?
A)It is vital in regulating muscle contraction and relaxation.
B) It is needed to maintain skeletal, cardiac, and
neuromuscular activity.
C)It controls and regulates water balance in the body.
D)It is used to synthesize protein and DNA within the
body's cells. Correct Answer B) It is needed to maintain
skeletal, cardiac, and neuromuscular activity.
The nurse is concerned that a client diagnosed with a fluid
imbalance is at risk for an alteration in perfusion. Which
assessment data should indicate to the nurse that the
client is not currently experiencing an alteration in
perfusion? Select all that apply.
A)Skin turgor 20 seconds
B)Peripheral pulses present and full
C)Capillary refill of nail beds 3 seconds
D)Oriented to person, place, and time
,E)Bowel sounds sluggish in all four quadrants Correct
Answer B) Peripheral pulses present and full
C) Capillary refill of nail beds 3 seconds
D) Oriented to person, place, and time
The nurse reviewing lab results on one of her adult clients
notices the client's serum sodium level is 150 mg/dL.
Based on this data, which interventions should the nurse
plan for this client? Select all that apply.
A)Monitor heart rate and rhythm.
B)Elevate the head of the bed.
C)Instruct on a low-sodium diet.
D)Administer diuretics as prescribed.
E)Administer potassium supplement as prescribed.
Correct Answer C) Instruct on a low-sodium diet.
D) Administer diuretics as prescribed.
During an assessment, the nurse becomes concerned that
an older adult client is at risk for dehydration. Which of the
following assessment findings would cause the nurse to
come to this conclusion?
A)The client has poor skin turgor.
B)The client reports ingesting two glasses of water each
day.
C)The client's blood pressure is 140/98 mmHg.
D)The client's body mass index is 20.5. Correct Answer B)
The client reports ingesting two glasses of water each day.
,The nurse is reviewing laboratory values for a female
client suspected of having a fluid imbalance. Which
laboratory value should indicate a diagnosis of
dehydration to the nurse?
A)Serum osmolality 230 mOsm/kg
B)Hematocrit 30%
C)Hematocrit 53%
D)Serum potassium 3.8 mEq/L Correct Answer C)
Hematocrit 53%
A client is brought to the emergency department (ED) after
passing out in a local department store. The client has
been fasting and has ketones in the urine. Which acid-
base imbalance would the nurse expect to assess in this
client?
A)Metabolic acidosis
B)Respiratory alkalosis
C)Metabolic alkalosis
D)Respiratory acidosis Correct Answer A) Metabolic
acidosis
The nurse is reviewing the latest arterial blood gas results
for a client with metabolic alkalosis. Which result indicates
that the metabolic alkalosis is compensated?
A)pH 7.32
B)PaCO2 18 mmHg
C)HCO3 8 mEq/L
D)PaCO2 48 mmHg Correct Answer D) PaCO2 48 mmHg
, The most common disorder that increases a client's risk
for respiratory alkalosis is:
A)a respiratory disorder.
B)an anxiety disorder.
C)a cardiovascular disorder.
D)a congenital disorder. Correct Answer B) an anxiety
disorder.
A client is admitted to the hospital with sudden, severe
abdominal pain. The client is diagnosed with respiratory
alkalosis. Which arterial blood gas value does the nurse
document to support this diagnosis?
A)pH is 7.33 and PaCO2 is 36.
B)pH is 7.51 and HCO3 is 30.
C)pH is 7.47 and PaCO2 is 25.
D)pH is 7.35 and PaO2 is 88. Correct Answer C) pH is
7.47 and PaCO2 is 25.
The nurse suspects a client with one functioning lung is
developing chronic respiratory acidosis. Which
manifestation did the nurse most likely assess in this
client?
A)Warm, flushed skin
B)Daytime sleepiness
C)Irritability
D)Blurred vision Correct Answer B) Daytime sleepiness