30. Patient X is diagnosed with constipation. As a 65.
A nurse taking care of a 65-year old female
knowledgeable nurse, which nursing patient in a medical surgical unit who is n renal
intervention is appropriate for maintaining normal failure. During the assessment the patient
bowel function? complains of tingling in her lips and fingers. When
a. Assessing dietary intake the nurse takes her blood pressure, she has a
b. Decreasing fluid intake spasm in her wrist and hand. The nurse suspects:
c. Providing limited physical activity a. Hyperkalemia
d. Turning, coughing, and deep breathing b. Hypermagnesemia
c. Hypocalcemia
33. A patient with tented skin turgor, dry mucous d. hypophosphatemia
membranes, and decreased urinary output is under
nurse Mark's care. Which nursing intervention 70. For a nurse caring for a client during severe
should be included in the care plan of Mark for his episodes of hypocalcemia, one of the
patient? main focus of the teaching would be the inhibition
a. Administering I.V. and oral fluids. which of the following substances :
b. Clustering necessary activities throughout a. Alcohol & Caffeine
the day b. Ascorbic acid
c. Assessing color, odor, and amount of c. Fatty food
sputum d. Vitamin D
d. Monitoring serum albumin and total protein
levels 76. The parathyroid hormone plays a major role in
the calcium regulation of the body. The further
38. Which client situation requires the nurse to effects of the hormone in excess would be
discuss the importance of avoiding foods a. Increased gastric and intestinal absorption
high in potassium? of calcium
a. A 14-year-old who is taking diuretics. b. Decreased intestinal and oral absorption of
b. A 16-year-old with ileostomy calcium
c. A 16-year old with metabolic acidosis c. Increased intestinal and renal calcium
d. 18-year-old who has renal disease absorption
d. None of the above
42. The physician has ordered IV replacement of
potassium for a patient with severe 85. A patient is being discharged home after
hypokalemia. The nurse would administer this: hospitalization with hypocalcemia. Which
a. By rapid bolus statement by the patient indicates she understood
b. Diluted in 100 ce over 1 hour the dietary instructions?
c. Diluted in 10 cc over 10 minutes a. "I will avoid sardines.
d. IV push b. "T'll avoid salt and Vitamin-D supplements."
c. "I will tell my husband to only purchase skim
49. What characterizes the process of diffusion? milk."
a. Solutes move from an area of higher solute d. "I will be sure to eat lots of cheese, tofu and
concentration to an area of lower spinach."
Concentration
b. There is no movement of solutes 92. A nurse is directed to administer a hypotonic
c. Solutes move from an area of lower intravenous solution. Looking at the
concentration to an area of higher following labeled solutions, the nurse should
concentration choose:
d. Hydrostatic pressure forces solutes through a. 0.33% sodium chloride.
a semipermeable membrane b. 0.90% sodium chloride.
ANSWER: c. 5% dextrose in normal saline solution.
d. 5% dextrose in water.
55. nurse caring for a group of clients reviews the
electrolyte laboratory results and noted a sodium
level of 130 mEq/L on one client's laboratory
reports. The nurse understands that which client is
at most risk for the development of sodium value at
this level?
a. the client with renal failure
b. the client who is taking diuretics
c. the client with hyperaldosteronism
d. the client who is taking corticosteroids
62. The nurse is caring for a client with congestive
heart failure. On assessment, the nurse notes that
the client is dyspneic and that crackles are audible
on auscultation. The nurse suspects excess fluid
volume. 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. A decreased central venous pressure (CVP)
36. The nurse is infusing a hypotonic solution into
her client. The nurse knows that this type of
solution will affect her client’s fluid status by:
a. Decreasing water content in the blood
vessels
b. Not changing water content in the blood
vessel
c. Increasing water content in the blood
vessels
d. Drawing water into the blood vessels