NCLEX REVIEW FLUIDS AND ELECTROLYTES OXYGENATION AND ACIDBASE

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. b. c. d. 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 history, the client may have which one of the following? Acute asthma Bronchial pneumonia Chronic obstructive pulmonary disease (COPD) Emphysema

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 It is highly recommended that clients with asthma, chronic bronchitis and emphysema have Pneumovax and flu vaccines for which of the following reasons? a. 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 b. c. d.

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 client with emphysema should receive only 1 to 3 L/minute of O 2, if needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive? a. 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 b. c. d.

QUESTION 10 a. b. c. d. Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which of the following topics? 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

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 m. L 750 m. L 1000 m. L 1200 m. L

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 p. H 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: p. H 7. 48, Pa. O 2 110, Pa. CO 2 25, & HCO 3 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 m. Eq 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 m. Eq 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 p. H of 7. 2 & a bicarbonate level of 20 m. Eq/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