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Question 1 of 10
1. Question
A patient with heart failure is cared for by a nurse. On evaluation, the nurse notes that on auscultation, the patient is dyspneic and crackles are audible. What additional manifestations the nurse would expect if the excess fluid volume is present in this patient?
Correct
Overhydration or fluid overload is also known as fluid volume excess and occurs when the fluid intake or fluid retention exceeds the body’s fluid needs.
Incorrect
Overhydration or fluid overload is also known as fluid volume excess and occurs when the fluid intake or fluid retention exceeds the body’s fluid needs.
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Question 2 of 10
2. Question
The nurse is reviewing an electrolyte laboratory report from a patient. After reviewing the report carefully, she notes that the level of potassium is 2.5 mEq/L (2.5 mmol/L). As a result of the laboratory value, which patterns should the nurse look for on the electrocardiogram (ECG)? Select all that is applicable.
Correct
3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L) is the normal serum potassium level. A level of serum potassium lower than 3.5 mEq/L (3.5 mmol/L) shows hypokalemia.
Incorrect
3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L) is the normal serum potassium level. A level of serum potassium lower than 3.5 mEq/L (3.5 mmol/L) shows hypokalemia.
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Question 3 of 10
3. Question
A patient with hypokalemia is prescribed potassium chloride intravenously. In order to plan for the preparation and administration of potassium, what actions should the nurse take? Select all that is applicable.
Correct
Intravenously administered potassium chloride must always be diluted in the IV fluid and infused by means of an infusion pump. Bolus never provides potassium chloride (IV push). The IV push to give potassium chloride can result in cardiac arrest.
Incorrect
Intravenously administered potassium chloride must always be diluted in the IV fluid and infused by means of an infusion pump. Bolus never provides potassium chloride (IV push). The IV push to give potassium chloride can result in cardiac arrest.
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Question 4 of 10
4. Question
The nurse provides instructions about foods that are high in potassium to a patient with a low level of potassium and tells the patient to consume what foods? Select all that is applicable.
Correct
3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L) is the normal potassium level. Avocado, bananas, melon, carrots, fish, mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, and tomatoes are common food sources of potassium.
Incorrect
3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L) is the normal potassium level. Avocado, bananas, melon, carrots, fish, mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, and tomatoes are common food sources of potassium.
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Question 5 of 10
5. Question
The nurse reviews the laboratory findings and notes that the serum sodium level of a patient is 150 mEq/L (150 mmol/L). The nurse reports to the health care provider (HCP) the level of serum sodium and the HCP prescribes dietary instructions for the patients to follow based on the level of sodium. What acceptable food products does the nurse instruct the customer to eat? Select all of those that apply.
Correct
The normal level of serum sodium is 135 to 145 (135 to 145 mmol/L) mEq/L. A 150 mEq/L (150 mmol/L) serum sodium level indicates hypernatremia. The nurse would instruct the patient to avoid foods high in sodium, based on this finding. Peas, nuts, and cauliflower are good phosphorus food sources and are not high in sodium (unless they are canned or salted).
Incorrect
The normal level of serum sodium is 135 to 145 (135 to 145 mmol/L) mEq/L. A 150 mEq/L (150 mmol/L) serum sodium level indicates hypernatremia. The nurse would instruct the patient to avoid foods high in sodium, based on this finding. Peas, nuts, and cauliflower are good phosphorus food sources and are not high in sodium (unless they are canned or salted).
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Question 6 of 10
6. Question
The nurse is caring for a hypocalcemic patient. As a result of the laboratory value, which patterns would the nurse monitor for on the electrocardiogram? Select all that is applicable.
Correct
9 to 10.5 mg/dL (2.25 to 2.75 mmol/L) is the normal serum calcium level. Hypocalcemia indicates a serum calcium level lower than 9 mg/dL (2.25 mmol/L). A prolonged QT interval and prolonged ST segment include electrocardiographic changes that occur in a client with hypocalcemia. With hypercalcemia, a shortened ST segment and a widened T wave occur. Hypokalemia occurs with ST depression and significant U waves.
Incorrect
9 to 10.5 mg/dL (2.25 to 2.75 mmol/L) is the normal serum calcium level. Hypocalcemia indicates a serum calcium level lower than 9 mg/dL (2.25 mmol/L). A prolonged QT interval and prolonged ST segment include electrocardiographic changes that occur in a client with hypocalcemia. With hypercalcemia, a shortened ST segment and a widened T wave occur. Hypokalemia occurs with ST depression and significant U waves.
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Question 7 of 10
7. Question
The nurse evaluates an assigned patient’s electrolyte outcomes and notes that the level of potassium is 5.7 mEq/L (5.7 mmol/L). As a result of the laboratory value, which patterns would the nurse watch for on the cardiac monitor? Select all that is applicable.
Correct
3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L) is the normal potassium level. Hyperkalemia indicates a serum potassium level greater than 5.0 mEq/L (5.0 mmol/L). Flat P waves, prolonged PR intervals, widened QRS complexes, and tall peaked T waves are electrocardiographic changes associated with hyperkalemia. Hypokalemia occurs in ST depression and a prominent U wave. In hypocalcemia, a prolonged ST segment takes place.
Incorrect
3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L) is the normal potassium level. Hyperkalemia indicates a serum potassium level greater than 5.0 mEq/L (5.0 mmol/L). Flat P waves, prolonged PR intervals, widened QRS complexes, and tall peaked T waves are electrocardiographic changes associated with hyperkalemia. Hypokalemia occurs in ST depression and a prominent U wave. In hypocalcemia, a prolonged ST segment takes place.
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Question 8 of 10
8. Question
Which client is at risk of developing a 5.5 mEq/L (5.5 mmol/L) potassium level?
Correct
3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L) is the normal potassium level. Hyperkalemia indicates a serum potassium level higher than 5.0 mEq/L (5.0 mmol/L). In the early stages of massive cell destruction, such as trauma, burns, sepsis, or metabolic or respiratory acidosis, patients who experience cellular shifting of potassium are at risk of hyperkalemia. Hypokalemia is at risk for patients with Cushing’s syndrome or colitis and patients who have overused laxatives.
Incorrect
3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L) is the normal potassium level. Hyperkalemia indicates a serum potassium level higher than 5.0 mEq/L (5.0 mmol/L). In the early stages of massive cell destruction, such as trauma, burns, sepsis, or metabolic or respiratory acidosis, patients who experience cellular shifting of potassium are at risk of hyperkalemia. Hypokalemia is at risk for patients with Cushing’s syndrome or colitis and patients who have overused laxatives.
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Question 9 of 10
9. Question
The nurse looks after a patient with diabetic ketoacidosis and documents that Kussmaul’s respirations are experienced by the patient. What patterns were observed by the nurse? Select all that is applicable.
Correct
The respirations of Kussmaul are abnormally deep and increased in rate. These occur as a consequence of the lungs’ compensatory action. Respirations are regular but abnormally slow in bradypnea. Apnea is characterized as breathing that stops for several seconds.
Incorrect
The respirations of Kussmaul are abnormally deep and increased in rate. These occur as a consequence of the lungs’ compensatory action. Respirations are regular but abnormally slow in bradypnea. Apnea is characterized as breathing that stops for several seconds.
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Question 10 of 10
10. Question
The nurse notes that the results of a patient’s arterial blood gas (ABG) show a pH of 7.50 and a PaCO2 of 30 mm Hg Hg (30 mm Hg). Which clinical manifestations associated with these ABG outcomes are monitored by the nurse? Select all that is applicable.
Correct
Respiratory alkalosis is defined as a carbonic acid deficiency or a decrease in the concentration of hydrogen ions resulting from the accumulation of base or acid loss without a comparable loss of base in the fluids of the body. This happens in conditions that cause respiratory system overstimulation. Lethargy, lightheadedness, confusion, tachycardia, hypokalemia-related dysrhythmias, nausea, vomiting, epigastric pain, and limb numbness and tingling are clinical manifestations of respiratory alkalosis. Tachypnea (hyperventilation) happens. Bradypnea describes regular but abnormally slow respirations. Acidosis is associated with hyperkalemia.
Incorrect
Respiratory alkalosis is defined as a carbonic acid deficiency or a decrease in the concentration of hydrogen ions resulting from the accumulation of base or acid loss without a comparable loss of base in the fluids of the body. This happens in conditions that cause respiratory system overstimulation. Lethargy, lightheadedness, confusion, tachycardia, hypokalemia-related dysrhythmias, nausea, vomiting, epigastric pain, and limb numbness and tingling are clinical manifestations of respiratory alkalosis. Tachypnea (hyperventilation) happens. Bradypnea describes regular but abnormally slow respirations. Acidosis is associated with hyperkalemia.