Transcript NCLEX review - Fluids and Electrolytes, oxygenation

NCLEX REVIEW - FLUIDS AND
ELECTROLYTES, OXYGENATION AND
ACID/BASE BALANCE
Paula Ruedebusch, ARNP, DNP
QUESTION 1

a.
b.
c.
d.
An elderly client with pneumonia may appear with
which of the following symptoms first?
Altered mental status and dehydration
Fever and chills
Hemoptysis and dyspnea
Pleuric chest pain and cough
QUESTION 2

a.
b.
c.
d.
Which of the following pathophysiological
mechanisms that occurs in the lung parenchyma
allows pneumonia to develop?
Atelectasis
Bronchiectasis
Effusion
Inflammation
QUESTION 3

A 7-year old client is brought to the ED. He’s
tachypneic and afebrile and has a respiratory rate
of 36 breaths per minute and a nonproductive
cough. He recently had a cold. From his history,
the client may have which one of the following?
a.
Acute asthma
Bronchial pneumonia
Chronic obstructive pulmonary disease (COPD)
Emphysema
b.
c.
d.
QUESTION 4

a.
b.
c.
d.
Which of the following assessment findings would
help confirm a diagnosis of asthma in a client
suspected of having the disorder?
Circumoral cyanosis
Increased forced expiratory volume
Inspiratory and expiratory wheezing
Normal breath sounds
QUESTION 5

a.
b.
c.
d.
A client with acute asthma showing inspiratory and
expiratory wheezes and a decreased expiratory
volume should be treated with which of the
following classes of medications right away?
Beta-adrenergic blockers
Bronchodilators
Inhaled steroids
Oral steroids
QUESTION 6

a.
b.
c.
d.
A 58-year old client with a 40-year history of
smoking one to two packs of cigarettes a day has a
chronic cough producing thick sputum, peripheral
edema, and cyanotic nail beds. Based on this
information, he most likely has which of the
following conditions?
Adult respiratory distress syndrome
Asthma
Chronic obstructive bronchitis
Emphysema
QUESTION 7

a.
b.
c.
d.
It is highly recommended that clients with asthma,
chronic bronchitis and emphysema have
Pneumovax and flu vaccines for which of the
following reasons?
All clients are recommended to have these
vaccines
These vaccines produce bronchodilation and
improve oxygenation
These vaccines help reduce the tachypnea these
clients experience
Respiratory infections can cause severe hypoxia
and possibly death in these clients
QUESTION 8

Clients with chronic obstructive bronchitis are given
diuretic therapy. Which of the following reasons
best explains why?
a.
Reducing fluid volume reduces oxygen demand
Reducing fluid volume improves clients’ mobility
Restricting fluid volume reduces sputum
production
Reducing fluid volume improves respiratory
function
b.
c.
d.
QUESTION 9

a.
b.
c.
d.
A client with emphysema should receive only 1 to 3
L/minute of O2, if needed, or he may lose his
hypoxic drive. Which of the following statements is
correct about hypoxic drive?
The client doesn’t notice he needs to breathe
The client breathes only when his oxygen levels
climb above a certain point
The client breathes only when his oxygen levels
dip below a certain point
The client breathes only when his carbon dioxide
level dips below a certain point
QUESTION 10

Teaching for a client with chronic obstructive
pulmonary disease (COPD) should include which of
the following topics?
a.
How to have his wife learn to listen to his lungs
with a stethoscope from Wal-Mart
How to increase his oxygen therapy
How to treat respiratory infections without going to
the physician
How to recognize the signs of an impending
respiratory infection
b.
c.
d.
QUESTION 11

a.
b.
c.
d.
Which of the following respiratory disorders is most
common in the first 24-48 hours after surgery?
Atelectasis
Bronchitis
Pneumonia
Pneumothorax
QUESTION 12

a.
b.
c.
d.
Which of the following measure can reduce or
prevent the incidence of atelectasis in a postoperative client?
Chest physiotherapy
Mechanical ventilation
Reducing oxygen requirements
Use of an incentive spirometer
QUESTION 13

a.
b.
c.
d.
Dani was given dilaudid for pain. She’s sleeping
and her respiratory rate is 4 breaths/minute. If
action isn’t taken quickly, she may have which of
the following reactions?
Asthma attack
Respiratory arrest
Be very angry about receiving Narcan.
Wake up on her own
QUESTION 14

a.
b.
c.
d.
What is the nurse's primary concern regarding fluid
& electrolytes when caring for an elderly pt who is
intermittently confused?
risk of dehydration
risk of kidney damage
risk of stroke
risk of bleeding
QUESTION 15

a.
b.
c.
d.
The nurse is planning care for a pt with severe
burns. Which of the following is this pt at risk for
developing?
intracellular fluid deficit
intracellular fluid overload
extracellular fluid deficit
interstitial fluid deficit
QUESTION 16

a.
b.
c.
d.
A patient experiencing multisystem fluid volume
deficit, has the symptoms of tachycardia, pale, cool
skin, & decreased urine output. The nurse realizes
these findings are most likely a direct result of
which of the following?
the body's natural compensatory mechanisms
pharmacological effects of a diuretic
effects of rapidly infused intravenous fluids
cardiac failure
QUESTION 17

a.
b.
c.
d.
A patient recovering from surgery has an indwelling
urinary catheter. The nurse would contact the pt's
primary healthcare provider with which of the
following 24-hour urine output volumes?
600 mL
750 mL
1000 mL
1200 mL
QUESTION 18
A patient is diagnosed with severe hyponatremia. The
nurse realizes this pt will mostly likely need which of
the following precautions implemented?
a.
b.
c.
d.
Neutropenic
infection
Seizure
high-risk fall
QUESTION 19

A pt is diagnosed with hypokalemia. After reviewing
the pt's current medications, which of the following
might have contributed to the pt's health problem?
a. Corticosteroid
b. thiazide diuretic
c. narcotic
d. muscle relaxer
QUESTION 20

a.
b.
c.
d.
The nurse is planning care for a pt with fluid volume
overload & hyponatremia. Which of the following
should be included in this pt's plan of care?
Administer intravenous fluids.
Restrict fluids.
Provide Kayexalate.
Administer intravenous normal saline with
furosemide.
QUESTION 21

a.
b.
c.
d.
When caring for a pt diagnosed with hypocalcemia,
which of the following should the nurse additionally
assess in the pt?
other electrolyte disturbances
Hypertension
visual disturbances
drug toxicity
QUESTION 22

a.
b.
c.
d.
When analyzing an arterial blood gas report of a pt
with COPD & respiratory acidosis, the nurse
anticipates that compensation will develop through
which of the following mechanisms?
The lungs will excrete carbon dioxide.
The kidneys excrete bicarbonate.
The lungs will retain carbon dioxide.
The kidneys retain bicarbonate.
QUESTION 23

a.
b.
c.
d.
The nurse is caring for a pt diagnosed with renal
failure. Which of the following does the nurse
recognize as compensation for the acid-base
disturbance found in pts with renal failure?
The pt breathes rapidly to eliminate carbon
dioxide.
The pt will retain bicarbonate in excess of normal.
The pH will decrease from the present value.
The pt's oxygen saturation level will improve.
QUESTION 24

The nurse is caring for a pt who is anxious & dizzy
following a traumatic experience. The arterial blood gas
findings include: pH 7.48, PaO2 110, PaCO2 25, &
HCO3 24. The nurse would anticipate which initial
intervention to correct this problem?
a.
Encourage the pt to breathe in & out slowly into a
paper bag.
Immediately administer oxygen via a mask & monitor
oxygen saturation.
Prepare to start an intravenous fluid bolus using
isotonic fluids.
Anticipate the administration of intravenous sodium
bicarbonate.
b.
c.
d.
QUESTION 25

a.
b.
c.
d.
A patient is prescribed 20 mEq of potassium
chloride. The nurse realizes that the reason the pt
is receiving this replacement is:
to sustain respiratory function.
to help regulate acid-base balance.
to keep a vein open.
to encourage urine output.
QUESTION 26

a.
b.
c.
d.
An elderly pt does not complain of thirst. What
should the nurse do to assess that this pt is not
dehydrated?
Ask the physician for an order to begin
intravenous fluid replacement.
Ask the physician to order a chest x-ray.
Assess the urine for osmolality.
Ask the physician for an order for a brain scan.
QUESTION 27

a.
b.
c.
d.
A postoperative pt is diagnosed with fluid volume
overload. Which of the following should the nurse
assess in this pt?
poor skin turgor
decreased urine output
distended neck veins
concentrated hemoglobin & hematocrit levels
QUESTION 28

a.
b.
c.
d.
An elderly pt is at home after being diagnosed with
fluid volume overload. Which of the following should
the home care nurse instruct this pt to do?
Wear support hose.
Keep legs in a dependent position.
Avoid wearing shoes while in the home.
Try to sleep without extra pillows.
QUESTION 29

a.
b.
c.
d.
A pt with fluid retention related to renal problems is
admitted to the hospital. The nurse realizes that this
pt could possibly have which of the following
electrolyte imbalances?
Hypokalemia
Hypernatremia
carbon dioxide
magnesium
QUESTION 30

a.
b.
c.
d.
The nurse is admitting a pt who was diagnosed with
acute renal failure. Which of the following
electrolytes will be most affected with this disorder?
Calcium
Magnesium
Phosphorous
potassium
QUESTION 31

a.
b.
c.
d.
A pt is prescribed 40 mEq potassium as a
replacement. The nurse realizes that this
replacement should be administered:
directly into the venous access line.
mixed in the prescribed intravenous fluid.
via a rectal suppository.
via intramuscular injection.
QUESTION 32

a.
b.
c.
d.
An elderly pt with peripheral neuropathy has been
taking magnesium supplements. The nurse realizes
that which of the following symptoms can indicate
hypomagnesaemia?
hypotension, warmth, & sweating
nausea & vomiting
Hyperreflexia
excessive urination
QUESTION 33

a.
b.
c.
d.
An elderly postoperative pt is demonstrating
lethargy, confusion, & a RR of 8 per minute. The
nurse sees that the last dose of pain medication
administered via a pt controlled anesthesia (PCA)
pump was within 30 minutes. Which of the following
acid-base disorders might this pt be experiencing?
respiratory acidosis
metabolic acidosis
respiratory alkalosis
metabolic alkalosis
QUESTION 34

The pt is receiving intravenous potassium (KCl).
Which nursing actions are required? Select all that
apply.
1. Administer the dose IV push over 3 minutes.
2. Monitor the injection site for redness.
3. Add the ordered dose to the IV hanging.
4. Use an infusion controller for the IV.
5. Monitor fluid intake & output.
QUESTION 35

The pt, newly diagnosed with diabetes mellitus, is
admitted to the emergency department with
nausea, vomiting, & abdominal pain. ABG results
reveal a pH of 7.2 & a bicarbonate level of 20
mEq/L. Which other assessment findings would the
nurse anticipate in this pt? Select all that apply
1. tachycardia
2. weakness
3. dysrhythmias
4. Kussmaul's respirations
5. cold, clammy skin