Nursing Elites

1. A nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure. The clients arterial blood gas values are pH 6.88, PaO2 50 mm Hg, PaCO2 60 mm Hg, and HCO3 22 mEq/L. Which action should the nurse take first?

• A. . Apply oxygen by mask or nasal cannula
• B. Apply a paper bag over the clients nose and mouth.
• C. Administer 50 mL of sodium bicarbonate intravenously.
• D. Administer 50 mL of 20% glucose and 20 units of regular insulin.

Correct answer: A

Rationale:

2. After providing discharge teaching, a nurse assesses the clients understanding regarding increased risk for metabolic alkalosis. Which statement indicates the client needs additional teaching?

• A. . I dont drink milk because it gives me gas and diarrhea
• B. I have been taking digoxin every day for the last 15 years
• C. . I take sodium bicarbonate after every meal to prevent heartburn
• D. In hot weather, I sweat so much that I drink six glasses of water each day.

Correct answer: C

Rationale:

3. Which substance dissociates into ions in a water solution?

• A. Intracellular fluid
• B. Interstitial fluid
• C. Plasma
• D. Electrolyte

Correct answer: D

Rationale: The correct answer is 'Electrolyte.' Electrolytes are substances that dissociate into ions when dissolved in water. Intracellular fluid, interstitial fluid, and plasma are not substances that dissociate into ions in a water solution. Intracellular fluid is the fluid inside cells, interstitial fluid is the fluid between cells, and plasma is the liquid component of blood. These choices do not dissociate into ions in a water solution, unlike electrolytes.

4. While assessing clients on a medical-surgical unit, which client is at risk for hypokalemia?

• A. Client with pancreatitis who has continuous nasogastric suctioning
• B. Client who is prescribed an angiotensin-converting enzyme (ACE) inhibitor
• C. Client in a motor vehicle crash who is receiving 6 units of packed red blood cells
• D. Client with uncontrolled diabetes and a serum pH level of 7.33

Correct answer: A

Rationale: Continuous nasogastric suctioning can lead to hypokalemia due to the loss of gastric contents rich in potassium. Therefore, a client with pancreatitis who has continuous nasogastric suctioning is at risk for hypokalemia. Option B is incorrect because ACE inhibitors may lead to hyperkalemia, not hypokalemia. Option C is incorrect as receiving packed red blood cells can lead to hyperkalemia due to the potassium content in the blood product. Option D is incorrect because a serum pH level of 7.33 indicates acidosis, which is not directly associated with hypokalemia.

5. A nurse develops a plan of care for a client who has a history of hypocalcemia. What interventions should the nurse include in this clients care plan? (Select all that apply.)

• A. Use a draw sheet to reposition the client in bed.
• B. . Strain all urine output and assess for urinary stones.
• C. Provide nonslip footwear for the client to use when out of bed.
• D.

Correct answer: B

Rationale:

Similar Questions