SAUNDERS NCLEX-PN1 EXAM 3 FLUID/ELECTROLYTES ACID/BASE QUESTIONS AND EXPERT ANSWERS GUARANTEED PASS A GRADED

SAUNDERS NCLEX -PN1 EXAM 3 FLUID/ELECTROLYTES ACID/BASE QUESTIONS AND EXPERT ANSWERS GUARANTEED PASS A GRADED 2023 -2024 The nurse is caring for a client with heart failure. On assessment, the nurse notes that the client is dyspneic and crackles are audible on auscultation. What additional signs would the nurse expect to note in this client if excess fluid volume is present? a. Weight loss b. Flat neck and hand veins c. An increase in blood pressure d. Decreased central venous pressure (CVP) c. An increase in blood pressure Rationale: Assessment findings associated with f luid volume excess include cough, dyspnea, crackles, tachypnea, tachycardia, elevated blood pressure, bounding pulse, elevated CVP, weight gain, edema, neck and hand vein distention, altered level of consciousness, and decreased hematocrit. The remaining o ptions identify signs noted in fluid volume deficit. The nurse is preparing to care for a client with a potassium deficit. The nurse reviews the client's record and determines that the client was at risk for developing the potassium deficit because of whic h situation? a. Sustained tissue damage b. Requires nasogastric suction c. Has a history of Addison's disease d. Is taking a potassium -retaining diuretic b. Requires nasogastric suction Rationale: Potassium -rich gastrointestinal fluids are lost through gas trointestinal suction, placing the client at risk for hypokalemia. The client with tissue damage or Addison's disease and the client taking a potassium -retaining diuretic are at risk for hyperkalemia. The nurse reviews a client's electrolyte laboratory rep ort and notes that the potassium level is 2.5 mEq/L. Which pattern would the nurse note on the electrocardiogram as a result of the laboratory value? a. U waves b. Absent P waves c. Elevated T waves d. Elevated ST segment a. U waves Rationale: Electrocardiographic changes include inverted T waves, ST segment depression, and prominent U waves. Absent P waves are not a characteristic of hypokalemia but may be noted in a client with atrial fibrillation, junctional rhythms, or ventricular rhythms. The nurse provides instructions to a client with a low potassium level about the foods that are high in potassium and tells the client to consume which foods? Select all that apply. a. Peas b. Raisins c. Potatoes d. Cantaloupe e. Cauliflower f. Strawberries b. Raisins c. Potatoes d. Cantaloupe f. Strawberries Rationale: Common food sources of potassium include avocado, bananas, cantaloupe, carrots, fish, mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, and tomatoes. Peas and ca uliflower are high in magnesium. The nurse is reviewing laboratory results and notes that a client's serum sodium level is 150 mEq/L. The nurse reports the serum sodium level to the health care provider (HCP) and the HCP prescribes dietary instructions bas ed on the sodium level. Which food item does the nurse instruct the client to avoid? a. Peas b. Nuts c. Cauliflower d. Processed oat cereals d. Processed oat cereals Rationale: A serum sodium level of 150 mEq/L indicates hypernatremia. On the basis of this finding, the nurse would instruct the client to avoid foods high in sodium. Nuts, cauliflower, and peas are good food sources of phosphorus. Peas are also a good source of magnesium. Processed foods are high in sodium content. The nurse is assessing a cli ent with a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client? a. Twitching b. Hypoactive bowel sounds c. Negative Trousseau's sign d. Hypoactive deep tendon reflexes a. Twitching Rationale: Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, se izures, irritability, and anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea. The nurse caring for a client with hypocalcemia would expect to note which change on the electrocar diogram (ECG)? a. Widened T wave b. Prominent U wave c. Prolonged QT interval d. Shortened ST segment c. Prolonged QT interval Rationale: Electrocardiographic changes that occur in a client with hypocalcemia include a prolonged ST or QT interval. A shorten ed ST segment and a widened T wave occur with hypercalcemia. Prominent U waves occur with hypokalemia. The nurse reviews the electrolyte results of an assigned client and notes that the potassium level is 5.7 mEq/L. Which finding would the nurse expect to note on the electrocardiogram as a result of the laboratory value? a. ST depression b. Inverted T wave c. Prominent U wave d. Tall peaked T waves d. Tall peaked T waves Rationale: Electrocardiographic changes associated with hyperkalemia include flat P waves, prolonged PR intervals, widened QRS complexes, and tall peaked T waves. The nurse caring for a group of clients reviews the electrolyte laboratory results and notes a sodium le vel of 130 mEq/L on one client's laboratory report. The nurse understands that which client is at highest risk for the development of a sodium value at this level? a. The client who is taking diuretics b. The client with hyperaldosteronism c. The client wi th Cushing's syndrome d. The client who is taking corticosteroids a. The client who is taking diuretics Rationale: Hyponatremia can occur in the client taking diuretics. The client taking corticosteroids and the client with hyperaldosteronism or Cushing's syndrome are at risk for hypernatremia. The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tend on reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in a client with hyponatremia? a. Muscle twitches b. Decreased urinary output c. Hyperactive bowel sounds d. Increased specific gravity of the urine c. Hyper active bowel sounds Rationale: Hyperactive bowel sounds indicate hyponatremia. The remaining options are signs of hypernatremia. In hyponatremia, muscle weakness, increased urinary output, and decreased specific gravity of the urine would be noted. The nur se reviews a client's laboratory report and notes that the client's serum phosphorus level is 2 mg/dL. Which condition most likely caused this serum phosphorus level? a. Alcoholism b. Renal insufficiency c. Hypoparathyroidism d. Tumor lysis syndrome a. Alc oholism Rationale: Causative factors relate to malnutrition or starvation and the use of aluminum hydroxide -based or magnesium -based antacids. Malnutrition is associated with alcoholism. Renal insufficiency, hypoparathyroidism, and tumor lysis syndrome are causative factors of hyperphosphatemia. The nurse is reading a health care provider's (HCP) progress notes in the client's record and reads that the HCP has documented "insensible fluid loss of approximately 800 mL daily." The nurse interprets that this t ype of fluid loss can occur through which route? a. The skin b. Urinary output c. Wound drainage d. The gastrointestinal tract a. The skin Rationale: Insensible losses occur daily through the skin and the lungs. Sensible losses are those of which the perso n is aware, such as through urination, wound drainage, and gastrointestinal tract losses.