MIDTERM EXAM

Maria, 68 years old, has vomiting and diarrhea for 2 days. She appears weak, dizzy, and her BP drops from 110/70 lying to 90/60 sitting. Her HR is 110 bpm, mucous membranes are dry, and urine output is scanty.

1. Which assessment finding supports fluid volume deficit?

• A. Bounding pulse

• B. Orthostatic hypotension

• C. Distended neck veins

• D. Crackles on lung bases

2. Which IV fluid should the nurse expect to administer initially?

• A. D5W

• B. 3% NaCl

• C. 0.9% NaCl (Normal Saline)

• D. D10W

3. As a nurse, which nursing measure best evaluates improvement in Maria’s condition?

• A. Skin turgor only

• B. Decreased thirst

• C. Urine output ≥ 30 mL/hour and stable vital signs

• D. Warm, dry skin

4. Nurse Miguel understands fluid volume deficit can lead to:

• A. Pulmonary edema

• B. Increased venous return

• C. Decreased tissue perfusion

• D. Hypertension

Mr. Caisip, 74 years old, with congestive heart failure on diuretics.

He reports weakness and irregular heartbeat. Serum Na⁺ = 128 mEq/L, K⁺ = 2.9 mEq/L.

5. Which symptom most likely results from his hyponatremia?

• A. Lethargy and confusion

• B. Thirst and dry tongue

• C. Flushed skin

• D. Increased deep tendon reflexes

6. Nurse Angel knows that hypokalemia is commonly caused by:

• A. ACE inhibitor use

• B. Excessive potassium intake

• C. Diuretic therapy (furosemide)

• D. Kidney failure

7. Which dietary instruction is appropriate for Mr. Caisip’s low potassium level?

• A. Eat more bananas and oranges

• B. Limit spinach and tomatoes

• C. Avoid citrus fruits

• D. Decrease green leafy vegetables

8. The nurse should monitor the patient’s ECG closely for:

• A. Peaked T waves

• B. Flat T waves and U waves

• C. Shortened QT interval

• D. ST elevation

Patient: Lito M., 82 years old, on potassium supplement and restricted fluids.

Serum Na⁺ = 152 mEq/L; K⁺ = 6.1 mEq/L. Lito appears restless with irregular heartbeat.

9. What is the most likely cause of Lito’s hypernatremia?

• A. Excess free water loss

• B. SIADH

• C. Overhydration

• D. Adrenal insufficiency

10. Which medication might the nurse anticipate to lower Lito’s serum potassium?

• A. Potassium chloride

• B. Sodium polystyrene sulfonate (Kayexalate)

• C. Spironolactone

• D. Lisinopril