Fluid and Electrolytes and Acid/Base Balance

1.
The client is admitted with isotonic dehydration. The nurse would anticipate an order for which IV
fluid?
A. 5 % dextrose and water
B. 3 % sodium chloride
C. .9 % sodium chloride
D. .45 % sodium chloride
2.
The client with COPD is admitted with a serum carbon-dioxide content level of 42 mEq/L, oxygen
saturation of 86%, and a blood glucose level of 190 mg/dl. The nurse is aware that the clients condition
might require which of the following?
A. An injection of NPH insulin
B. Oxygen application with a venturi mask
C. Renal dialysis using an arterio-venous shunt
D. A prescription for a bronchodilator
3.
The nurse is caring for a client admitted with a potassium level of 3.9 mEq/L, a blood glucose
level of 98 mg/dL, a serum calcium level of 10.0 mg/dL, and a blood urea nitrogen level of 30 mg/dL.
Which of these values should be reported to the physician immediately?
A. The potassium level of 3.9 mEq/L
B. The serum calcium level of 10.0 mg/dL
C. The blood glucose level of 98 mg/dL
D. The blood urea nitrogen level of 30 mg/dL
4.
The ICU nurse is assessing several clients assigned to his care. Which client should receive
priority of care?
A. A 65-year-old client with emphysema with an oxygen saturation level of 82%
B. A 45-year-old motor vehicle accident client with chest tubes and a CO2 level of 48mE/L
C. An 80-year-old diabetic with a blood glucose level of 430 mg/dl
D. A 50-year-old client with cirrhosis of the liver and a blood urea nitrogen level of 35mg/dl
Fluid and Electrolytes and Acid/Base Balance
5.
The client admitted with hypokalemia has an order for potassium to be administered orally. Prior
to administering the potassium, the nurse should:
A. Check the clients creatinine level
B. Ask the doctor to order an ECG
C. Insert a nasogastric tube
D. Acquire milk to give the oral potassium
6.
The nurse is preparing to administer potassium to the client with hypokalemia. The best liquid for
the nurse to dilute the potassium in is:
A. Cranberry juice
B. Prune juice
C. Tomato juice
D. Chocolate milk
7.
The client is admitted with a sodium level of 100 mEq/L. After checking the other laboratory
values, the nurse should:
A. Chart the finding
B. Contact the doctor
C. Teach the client about low-sodium meal options
D. Check the clients deep tendon reflexes for hypereflexia
8.
The nurse is checking the client for a positive Trousseaus sign. Which finding indicates a positive
Trousseaus sign?
A. Facial grimacing
B. Carpopedal spasms
C. Nuchal rigidity
D. Abdominal tenderness

9.
The client with hypercholesterolemia asked about vitamins that can help to lower his cholesterol.
Which vitamin has been shown to be helpful in lowering the clients cholesterol level?
A. Cyanocobalamine
B. Ascorbic acid
C. Niacin
D. Riboflavin
10.
The client with hypoparathyroidism is admitted with a calcium level of 7.6 mg/dL. The nurse
should anticipate an order for which of the following medications?
A. Furosemide (Lasix)
B. Levothyroxin (Synthyroid)
C. PTH (Forteo)
D. Propanolol (inderal)
11.
The client is admitted with a magnesium level of 10.0 mEq/L. Which sign indicates that the client
has a toxic level of magnesium?
A. Hot flashes
B. Respirations of 10 per minute
C. Deep tendon reflexes of 2+
D. Urinary output of 40 mL per hour
12.
Which staff member would be least appropriate to assign to the client receiving magnesium
intravenously?
A. The nursing assistant
B. The licensed practical nurse
C. The graduate registered nurse
D. The surgical resident
13.
Which of the following should be kept available when intravenous magnesium is ordered?
A. Protamine sulfate
B. Calcium gluconate
C. AquaMEPHYTON
D. Aminocaproic acid
14.
The client is admitted with a pH of 7.48, a HCO3 level of 34 mEq/L, and a CO2 level of 48 mEq/L.
The nurse is aware that these laboratory values reveal:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis
Fluid and Electrolytes and Acid/Base Balance
15.
The client is admitted with chronic obstructive pulmonary disease. The clients laboratory values
reveal a CO2 level of 49 mEq/L. The HCO3 level is 26 mEq/L, and the pH is 7.32. The nurse is aware
that these laboratory values reveal:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis
16.
While the client is taking Digoxin (digitalis), the nurse should check the clients laboratory values.
Which laboratory value should be reported to the doctor?
A. Sodium level of 138 mEq/L B. Chloride level of 98 mEq/L
C. Potassium level of 3.0 mEq/L
D. Magnesium level of 1.8 mEq/L
17.
The client with renal disease has an order for a low-potassium diet. Which food is highest in
potassium?
A. Marshmallows
B. Raisins
C. Cake
D. Mashed potatoes

18.
The client with hypertension and renal disease is admitted to the clinic with a blood pressure of
190/100. The physician decides to order a beta blocker and a potassium-sparing diuretic. The nurse
should anticipate an order for which diuretic?
A. Furosemide (Lasix)
B. Hydrochlorothiazide (HTCZ)
C. Spironolactone (Aldactone)
D. Torsemide (Demadex)
19.
The client is admitted with Cushings disease. The nurse is aware that clients with an adrenal
disorder such as Cushings disease will most likely exhibit signs of:
A. Hypercalcemia B. Hyperkalemia
C. Hypernatremia
D. Hypermagnesemia
20.
The client is admitted to the unit with diabetes insipidus. Which laboratory result supports this
diagnosis?
A. Specific gravity of 1.000
B. Sodium of 140 mEq/L C. Glucose of 110 mg/dL
D. Potassium of 3.8 mEq/dL

Care of the Client with Cardiovascular Disorders

21.
The client is admitted to the intensive care area following a coronary artery bypass graft. The
nurse caring for the client manages the fluid volume status by checking the central venous pressure and
finds a reading of 4 mm Hg. Which action should the nurse take at this time?
A. Increase the rate of IV fluid using the protocol provided
B. Continue her care with no further action
C. Decrease the IV fluid using the protocol provided
D. Administer furosemide (Lasix) as ordered
22.
The client with hypertension is being treated with diuretics and beta blockers for his hypertension.
While taking beta blockers, the client should:
A. Refrain from operating heavy equipment such as a bulldozer

 B. Check his pulse rate daily

C. Allow six weeks for the medication to reach its optimal level
D. Increase his intake of potassium-rich foods
23.
The client has an order for furosemide (Lasix) to be taken every morning. Which food contains
the most potassium?
A. One-half cup of mashed potatoes
B. One-fourth cup of sweet potatoes
C. One baked potato
D. One cup of french-fried potatoes
24.
The client with hypercholesterolemia has an order to decrease the amount of cholesterol in his
diet. Which cooking oil contains the most cholesterol?
A. Safflower
B. Sunflower
C. Palm
D. Canola
25.
The client has been prescribed simvastatin (Zocor) for control of his hypercholesterolemia. When
taking this medication, the client should be taught to:
A. Take the medication with grapefruit juice
B. Have his liver enzyme checked every six months
C. Take the medication in the morning for optimal absorption
D. Report any weakness or drowsiness to the physician
26.
The client with hypertension has an order for lisinopril plus hydrochlorothiazide (HTCZ)
(Zestorectic). Prior to his initial dose, the client should be taught to :
A. Check his pulse rate daily
B. Remain in bed for 34 hours after taking the initial dose
C. Expect a drop in his cholesterol level within six weeks
D. Increase his intake of folic-acidrich food such as orange juice
27.
Which of the following is an untoward effect of angiotensin-converting agents that should be
reported to the doctor?
A. Postural dizziness
B. Occasional nausea
C. 1+ petal edema
D. Persistent hacking cough
28.
The client with angina should be taught to take nitroglycerine sublingually with the onset of the
first signs of chest pain. Which instructions should be included with your teaching plan?
A. Take one tablet every 10 minutes until the pain subsides.
B. If a burning sensation of the tongue occurs, stop the medication immediately.
C. Keep the medication in the brown bottle to preserve the strength of the medication.
D. Refill the supply of nitroglycerine every three months.
29.
The client with a fourth-degree heart block has a permanent pacemaker implanted. Which activity
should be avoided by the client with a pacemaker?
A. Using a cellular phone
B. Wearing a pager
C. Traveling by airplane
D. Having a magnetic resonance imaging test
30.
Which breakfast selection would be best for the client taking digitalis (Lanoxin)?
A. Bran muffin, orange juice, and a cup of coffee
B. A bagel with jelly and a cup of coffee
C. Bacon and egg on toast and a cup of coffee
D. Ham-and-cheese biscuit and coffee
31.
If the client becomes toxic to his digitalis, he will experience which of the following symptoms?
A. Tachycardia
B. Hypotension

 C. Nausea and vomiting

D. Diarrhea
32.
The nurse is performing an ECG tracing on the client with a history of cardiac disease. Where
should the nurse apply the negative lead?
A. On the clients right chest at the second intercostal space
B. On the clients anterior right leg
C. On the clients left chest at the second intercostal space
D. On the clients left chest at the apex of the heart
33.
The nurse is checking the pulse rate of a six-week-old patient with aortic stenosis who has an
order for digitalis. The clients pulse rate is found to be 82 beats per minute. Which action is most
appropriate?
A. Contact the physician prior to administering the medication
B. Administer the medication and recheck the pulse rate 30 minutes later
C. Administer the medication and document the pulse rate
D. Withhold the medication and document the finding
34.The client is admitted to the emergency room following a motor vehicle accident. An ECG reveals
frequent premature ventricular contractions. Which medication is often used to treat premature ventricular
contractions?
A. Amiodarone (Cordarone)
B. Atropine sulfate (Atropine)
C. Epinephrine bitartrate (Epinephryl)
D. Enoxaparin (Lovenox)
35.The client is admitted with ventricular fibrillation. The nurse should begin defibrillation by shocking at:
A. 360 Joules
B. 200 Joules
C. 400 Joules
D. 600 Joules
36.
The nurse is caring for the client admitted with severe chest pain. After checking the vital signs,
the nurses next action should be to:
A. Prepare to administer oxygen by mask
B. Administer morphine
C. Prepare the defibrillator
D. Take a complete history
37.
The client with arteriosclerosis is scheduled for a cardiac catheterization. Which of the following is
the primary responsibility of the nurse prior to the procedure?
A. Explain the procedure to the client
B. Check the laboratory results for a prothrombin time
C. Take the clients vital signs
D. Obtain a permit for the examination
38.
After the clients cardiac catheterization where the femoral artery is used as the access vessel,
the nurse should:
A. Check for allergies to iodine
B. Tell the client to refrain from drinking liquids
C. Explain the need to flex and extend the leg
D. Check the pedal pulse in the operative leg
39.
The client is admitted two weeks after the onset of chest pain. Which laboratory test is the most
indicative for a myocardial infarction?
A. Creatine kinase (CK-MB)
B. Troponin level
C. Lactic acid dehydrogenase (LDH)
D. Blood urea nitrogen (BUN)
40.
The client returns to the intensive care unit following a coronary artery bypass graft. The nurse
notes that the client is suddenly experiencing shortness of breath with muffled heart sounds. The blood
pressure is 90/40, and the pulse rate is 110 beats per minute. Which action is most appropriate initially?

 A. Check the mediastinal tube for drainage

B. Recheck the vital signs
C. Administer pain medication
D. Decrease the intravenous flow rate
41.
Which breakfast cereal choice is the best choice for the client recovering from a myocardial
infarction?
A. Instant-cooking cereals
B. Puffed rice
C. Raisin Bran
D. Cocoa Puffs
42.
The client with congestive heart failure has an order for milrinone (Primacor). If the doctor
decides to check the BNP, the nurse should do which of the following?
A. Slow the rate of the Primacor infusion
B. Administer a diuretic prior to checking the BNP
C. Continue the Primacor as ordered
D. Stop the Primacor for two hours prior to the test
43.
The client is discharged with a prescription for sodium warfarin (Coumadin). The nurse should
instruct the client to:
A. Take the medication with water only
B. Eat green vegetables at least three times per week
C. Avoid constipation by increasing the amount of fiber in the diet
D. Administer the medication in the abdomen with a tuberculin syringe
44.
A 55-year-old female is admitted to the emergency room complaining of indigestion and back and
shoulder pain. She tells the nurse that she has taken several antacids for the past two days without relief
of her symptoms. Which action would be most appropriate at this time?
A. Ask the client if she has a history of gastric ulcers
B. Allow the client to rest undisturbed
C. Take the clients vital signs and contact the physician
D. Obtain a history to rule out a hiatal hernia
45.
The client is receiving Coumadin (warfarin sodium has a Protime level of 44 seconds). The nurse
should anticipate an order for which of the following?
A. AquaMEPHYTON
B. Physostigmine
C. Ropivacaine
D. Methimazole
46.
The client is admitted with a diagnosis of congestive heart failure. Which finding supports the
diagnosis of left-sided congestive heart failure?
A. Pitting edema 3+
B. Ascites
C. Jugular vein distention
D. Fatigue
47.
Which statement, if made by the client, would cause the nurse to suspect a sacular abdominal
aortic aneurysm?
A. I sometimes have indigestion when I lie down.
B. I often have pulsating sensations in my abdomen.
C. I feel fatigue and shortness of breath with minimal exertion.
D. I have extreme pain radiating down my left arm.
48.
The client returns from surgery following a coronary artery bypass graft with a mitral valve
replacement. Which medication will be ordered for the client who has a metal valve replacement?
A.
Chlorothiazide (Diuril)
B.
Clonidine HCl (Catapres)
C.
Sodium warfarin (Coumadin)
D.
Propranolol (Inderal)

49.
The client with peripheral vascular disease is diagnosed with intermittent claudication. Which
action by the nurse would help the client to relieve symptoms of intermittent claudication?
A. Apply antithrombolytic stockings as ordered
B. Encourage the use of a heating pad to the effected leg
C. Massage the effected extremity
D. Encourage the client to ambulate
50.
The client has a femoral popliteal bypass graft. Which instruction should be given to the client
prior to discharge?
A. Rest in high Fowlers position
B. Avoiding crossing the legs at the ankles
C. Keep the procedural leg straight
D. Check the radial pulse rate daily
51.
Which instruction should be given to the client being discharged after a myocardial infarction?
A. You can begin having intercourse when you can climb three flights of stairs without experiencing
breathlessness.
B. You should take nitroglycerine at the first signs of chest pain.
C. You can take sildenafil (Viagra) for erectile dysfunction.
D. You should walk at least three miles every day to increase cardiac output.
52.
The client is admitted with possible thrombophlebitis. Which action should be priority?
A. Ask the client to remain in bed
B. Assess using Homans sign
C. Schedule the client for a Doppler study D. Apply a moist heating pad to the extremity
53.
The client with Raynauds phenomena should be taught to:
A. Keep the feet elevated while resting
B. Wear mittens when she is out in the cold
C. Avoid caffeine intake
D. Drink warm liquids to loosen lung secretions
54.
The client is being treated for Buergers disease. Another name for Buergers disease is:
A. Thrombophlebitis
B. Coronary thrombosis
C. Thromboangiitis obliterans
D. Arteritis
55.
The nurse is preparing to monitor the clients central venous pressure. Which position would
provide the most reliable measurement of the CVP?
A. Supine
B. High Fowlers
C. Left Sims
D. Prone
Emergency Care
158.
The nurse is providing first aid to a client who just received a sting from a yellow jacket. Which
action should the nurse take first?
A. Place the client in a flat supine position
B. Take the client to the nearest hospital
C. Administer diphenhydramine (Benadryl)
D. Remove the stinger and apply ice to the area
159.
The nurse is caring for an adolescent who has been shot with a paint gun. The nurse should
expect:
A. Tissue damage only along the path of wound
B. Limited penetration or dissipation of injury
C. Complete recovery since the wound is not severe
D. High-pressure injury characterized by a minor puncture wound

160.
A client is admitted to the emergency with a temperature of 96.8 F. Which one of the following
findings is characteristic of mild hypothermia?
A. Absence of shivering
B. Diminished fine motor skills
C. Dilated pupils
D. Atrial fibrillation
161.
The nurse is caring for a client with organophosphate poisoning that has produced symptoms of
cholinergic crisis. The nurse should prepare to administer:
A. Adrenalin
B. Vasopressin
C. Atropine
D. Lithium
162.
Which one of the following clients is at greatest risk for developing heat exhaustion?
A. A 17-year-old skateboarder
B. A 30-year-old electrical worker
C. A 45-year-old landscaper
D. A 65-year-old farmer
163.
Which one of the following clients falls into the category of emergent care?
A. A client admitted with a simple fracture of the arm
B. A client admitted with abdominal pain
C. A client admitted with chest pain, dyspnea, and diaphoresis
D. A client admitted with a cough and temp of 101 F
164.
A client with a history of myasthenia gravis is admitted with signs of a myasthenic crisis.
Emergency interventions for the client with a myasthenic crisis focus on:
A. Administering diphenhydramine
B. Maintaining adequate respiratory function
C. Assessing the degree of muscle weakness
D. Administering atropine sulfate
165.
The nurse is assessing a client admitted to the emergency room with a diagnosis of Legionnaires
disease. Which precautions should be used when caring for the client?
A. Standard precautions because it is transmitted by blood and body fluids
B. Airborne precautions because it is transmitted by droplets from the respiratory tract
C. Contact precautions because it is transmitted by articles used by the client
D. No special precautions because there is no evidence of human-tohuman transmission
166.
A client is admitted with protruding abdominal organs after being stabbed. The nurse should give
priority to:
A. Applying a sterile, saline-soaked dressing
B. Administering pain medication
C. Determining the type of weapon used
D. Applying oxygen at 2 liters/ min via nasal cannula
Care of the Client with Integumentary Disorders
51.
Eucerin cream has been prescribed for a client with dry skin and pruritis. When moisturizing
creams are ordered, they should be applied:
A. After completely drying the skin
B. Using vigorous rubbing motions
C. After bathing while the skin is moist
D. Using short, back-and-forth strokes
52.
The physician has prescribed Folex (methotrexate) for a client with psoriatic arthritis. Which lab
finding indicates that the medication is having an adverse effect?
A. Platelet count of 200,000
B. Serum ALT of 60 U/L

 C. Neutrophil count of 200 /cu mm

D. Serum creatinine of 0.6 mg/dL
53.
The nurse is formulating a plan of care for a client with thermal burns of the face, neck, and upper
chest. Which nursing diagnosis should receive priority?
A. Fluid volume deficit R/T increased capillary permeability
B. Risk for impaired gas exchange R/T upper airway swelling
C. Pain R/T tissue and nerve injury
D. Anxiety R/T emotional changes caused by burn injury
Care of the Client with Integumentary Disorders
54.
A client with exfoliative psoriasis is being treated with ultraviolet radiation therapy three times a
week. Which finding indicates overexposure?
A. Lightening of the skin B. Crusting of lesions
C. Appearance of blisters
D. Desquamation
55.
Which snack is suitable for a client recovering from full thickness burns?
A. Orange slices
B. Raisin oatmeal cookies
C. Ice cream
D. Stewed prunes
56.
A client has partial thickness burns to the legs, anterior trunk, and arms. Using the Rule of Nines,
the nurse determines that the clients TBSA is:
A. 90 %
B. 72 %
C. 54 %
D. 36 %
57.
The nurse is changing the dressings of a client with full thickness burns who is being treated with
Sulfamylon (mafenide acetate). When changing the dressing, the nurses actions should include:
A. Administering pain medication
B. Soaking the site with normal saline
C. Checking the white cell count
D. Covering the site with a dermal substitute
58.
The nurse is teaching a client with HSV regarding transmission of the virus. The nurse should tell
the client that she can transmit the virus to others for:
A. 3 5 days
B. 10 14 days
C. 4 6 weeks
D. 8 10 weeks
59.
The physician has ordered hyperbaric oxygen therapy for a client with a stage III pressure ulcer.
Before instituting the therapy, the nurse should:
A. Ask the client whether she has a pacemaker
B. Encourage additional fluid intake
C. Assess the clients ability to lie still for an hour
D. Ask the client if she has claustrophobia
60.
The nurse is teaching a client about immunization with Zostavax (zoster vaccine live solution).
Which statement indicates that the client needs further teaching about the medication?
A. I can transmit chickenpox to those who have not had the illness.
B. I cant take Zostavax if I am taking immunosuppressive drugs.
C. The immunization is used to treat shingles and the pain it causes.
D. Reactions to other vaccines may prevent me from taking Zostavax.
61.
The clients chart notes the presence of a Stage II pressure ulcer over the sacrum. What is the
typical appearance of a Stage II pressure ulcer?
A. Blistered areas with shallow crater
B. Reddened areas with intact skin

 C. Areas of eschar-covered crater

D. Necrotic areas with undermining
62.
Gastrointestinal complications associated with major burn injury include paralytic ileus and
Curlings ulcers. Which medication is commonly prescribed to prevent Curlings ulcers?
A. Maalox (aluminum magnesium hydroxide)
B. Cytotec (misoprostol)
C. PhosLo (calcium acetate)
D. Zantac (rantidine hydrochloride)
63.
While caring for a client with full thickness burns, the nurse finds that the clients urine output has
become burgundy in color. The appearance of burgundy- or brown-colored urinary output is due to:
A. Metabolic acidosis secondary to burn injury
B. Underlying muscle damage and RBC destruction
C. Resuscitative efforts using plasma expanders
D. Dehydration from rapid fluid shifts
64.
A client with a history of HSV II tells the nurse that he uses topical Zovirax ( acyclovir) daily to
prevent recurrent outbreaks. The nurse should give priority to :
A. Determining when the client last had an outbreak of herpes
B. Asking how many times a day the medication is applied
C. Explaining that the medication will not prevent recurrent outbreaks
D. Determining if the client is also taking oral antiviral medication
65.
Which behavior increases the risk of infestation with pediculosis capitis in children?
A. Not washing hands after toileting
B. Sharing combs, brushes, and hats
C. Playing in sandboxes and dirt
D. Not drying the feet after swimming
66.
The physician has prescribed Tazorac (tazaretene) topical for a female client with psoriasis
vulgaris. Which lab study should be done before beginning therapy with Tazorac?
A. Complete blood count
B. Renal profile
C. Liver panel
D. Pregnancy test
67.
Three days after receiving major burns, a clients lab reveals a hematocrit of 30 %. The nurse
recognizes changes in normal hematocrit levels after burns are related to:
A. Hemodilution from fluid resuscitation
B. Lack of sufficient oral intake
C. Hemoconcentration from fluid loss
D. Decreased erythropoietin production