NU 154 Week 1 part 1

The nurse is assessing four hospitalized clients for deficient fluid volume. Which client should the nurse assess further as the priority?

• 102-kg client; urine output 73 ml in 1 hour

• 98-kg client; urine specific gravity 1.042

• 79-kg client; no urine output recorded in chart

• 106-kg client; pulse 108 beats per minute

The nurse is aware that the patient who suffered a brain injury with cerebral edema will most likely receive a fluid that is:

• isotonic.

• hypertonic.

• hypotonic.

• enhanced with vitamin B

Tags

NGSS.HS-LS1-3

The provider has prescribed isotonic IV solution at a rate of 100 ml/hour to treat the client’s deficient fluid volume status. Which solution does the nurse choose?

• 0.9% sodium chloride (NS)

• 5% dextrose in 0.45% sodium chloride (1/2 NS)

• 5% dextrose in water (D5W)

• 10% dextrose in water (D10W)

A student nurse is giving hand-off report to the registered nurse on four clients who have deficient fluid volume as a nursing diagnosis. Which client should the registered nurse assess first?

• 86-year-old client, IV fluids infusing at 100 ml/hour, bibasilar rales

• 66-kg client, urine output averages 36 ml/hour for the last 4 hours

• 100-kg client, lying BP 128/72 mm Hg, standing BP 118/68 mm Hg

• 76-year-old client, urine specific gravity 1.028

Tags

NGSS.HS-LS1-3

The charge nurse in a long-term care facility wants to decrease the incidence of deficient fluid volume in the facility’s residents. What action by the nurse is best?

• Create a policy mandating monthly urine specific gravity tests.

• Perform comprehensive assessments for deficient fluid volume.

• Weigh the residents weekly on the same scale each morning.

• Institute “fluid rounds” offering beverages every 2 hours.

A 10-month old infant has had watery green stool for 2 days and refuses the bottle. The nurse is aware that the primary concern for this baby is:

• Metabolic acidosis

• metabolic Alkalosis

• Weight loss

• Diaper rash

Tags

NGSS.HS-LS1-3

An isotonic state exists within a patient’s body fluids when the solute concentration of:

• interstitial fluid is less than the transcellular.

• intracellular and extracellular fluid is equal.

• intracellular fluid is greater than extracellular fluid.

• extracellular fluid is lesser than intracellular fluid.

Tags

NGSS.HS-LS1-3

A nurse gets a positive Chvostek sign on a young woman with bulimia who has been giving herself frequent enemas containing phosphate. The nurse anticipates a laboratory finding of:

• sodium 140 mEq/L.

• b. potassium 4.5 mEq/L.

• magnesium 1.6 mEq/L.

• calcium 6.5 mEq/L.

A patient with a history of severe chronic obstructive pulmonary disease (COPD) is most likely to have:

• respiratory alkalosis.

• respiratory acidosis.

• metabolic alkalosis.

  .

• metabolic acidosis.

A patient with a history of severe chronic obstructive pulmonary disease (COPD) is most likely to have:

• respiratory alkalosis.

• respiratory acidosis.

• metabolic alkalosis.

  .

• metabolic acidosis.