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Worksheets2121 exam 1 pt.5
Total questions: 99
Worksheet time: 50mins
A client with severe fluid volume excess is in respiratory distress with crackles and SpO2 86% on room air. Which action should the nurse take first?
Apply oxygen and raise the head of bed
Start a 500 mL NS bolus
Encourage oral fluids
Place the client supine
A client with chronic kidney disease has phosphate 6.2 mg/dL. Which finding is most expected?
Decreased QT interval
Tingling and muscle cramps from secondary hypocalcemia
Hyperactive bowel sounds and diarrhea
Warm flushed skin and bounding pulses
A malnourished client starts tube feedings and develops weakness; phosphate is 1.4 mg/dL. Which complication is the priority risk?
Hypertension crisis
Hyperglycemia only
Respiratory failure from weakened diaphragm
Hyperreflexia
A client with hypercalcemia is most likely to exhibit which ECG change?
Tall peaked T waves
Prolonged QT interval
ST elevation with PR depression
Shortened QT interval
A client receiving furosemide has magnesium 1.2 mg/dL. Which assessment finding is most consistent with hypomagnesemia?
Hyperreflexia and tremors
Bradycardia and hypoventilation
Flaccid paralysis
Dilated fixed pupils
A client with hypermagnesemia is becoming lethargic after magnesium-containing antacids. Which provider order should the nurse anticipate first?
Potassium phosphate IV
IV calcium gluconate
3% NaCl infusion
D5W bolus
A client with suspected SIADH has sodium 121 mEq/L and low serum osmolality. Which urine finding is most expected?
Low specific gravity, dilute urine
Glucosuria
Concentrated urine with high specific gravity
Large urine output with low osmolality
A client with diabetes insipidus has urine output 900 mL/hr and sodium 154 mEq/L. Which medication is most appropriate if the cause is central DI?
Mannitol
Furosemide
Spironolactone
Desmopressin
A client's ABG shows pH 7.49, PaCO2 30, HCO3− 23. The nurse recognizes this as:
Respiratory alkalosis
Metabolic alkalosis
Respiratory acidosis
Metabolic acidosis
A postoperative client is anxious, dizzy, and tingling around the mouth; ABG confirms respiratory alkalosis. What instruction best helps immediately?
Administer sodium bicarbonate
Coach slow breathing / pursed-lip breathing
Give 3% saline
Place supine Trendelenburg
A client has pH 7.31, PaCO2 60, HCO3− 31. What is the best interpretation?
Uncompensated metabolic acidosis
Fully compensated respiratory alkalosis
Partially compensated respiratory acidosis
Uncompensated metabolic alkalosis
A client has pH 7.52, PaCO2 48, HCO3− 38. What is the best interpretation?
Respiratory alkalosis with no compensation
Metabolic acidosis with compensation
Respiratory acidosis with no compensation
Metabolic alkalosis with compensation
Which IV fluid is most appropriate for initial treatment of fluid volume deficit with hypotension (unless contraindicated)?
0.9% normal saline
D5W
3% saline
D10W
A client with heart failure is on fluid restriction. Which outcome best indicates teaching was effective?
“I’ll drink extra water to protect my kidneys.”
“I’ll track daily weights at the same time each day.”
“I’ll increase sodium so I don’t feel weak.”
“I’ll avoid weighing myself because it causes stress.”
A client receiving TPN develops phosphate 1.6 mg/dL. Which dietary teaching is best to support phosphate replacement (if allowed PO)?
Increase oranges and bananas
Increase apples and rice
Increase dairy/eggs/lean meats
Increase cucumbers and lettuce
A client receives PRBCs and develops acute dyspnea, hypotension, and bilateral infiltrates on chest x‑ray; fever present. Which reaction is most likely?
TACO
Febrile non‑hemolytic reaction
Mild allergic reaction
TRALI
A client on continuous NG suction is at highest risk for which acid–base imbalance?
Metabolic alkalosis
Respiratory acidosis
Metabolic acidosis
Respiratory alkalosis
A client with severe thrombocytopenia is actively bleeding from gums. Which product is most appropriate?
PRBCs
Platelets
FFP
Albumin
A client with DIC has PT/PTT prolonged and low fibrinogen with oozing at IV sites. Which blood product addresses clotting factor replacement best?
PRBCs
Platelets only
Fresh frozen plasma (FFP)
Whole blood
A client has phosphate 1.5 mg/dL and is weak. Which ECG finding is most concerning to monitor for?
Ventricular dysrhythmias
Prolonged PR interval only
Short PR interval
ST depression only
A client with hypercalcemia is constipated, lethargic, and dehydrated. Which nursing intervention is most appropriate (if not contraindicated)?
Restrict fluids
Encourage fluids and early ambulation
Encourage calcium supplements
Keep on strict bedrest
A client has magnesium 3.6 mg/dL. Which assessment finding best supports hypermagnesemia?
Hyperactive DTRs
Muscle tetany
Diminished DTRs and hypotension
Severe stridor
A client with hypophosphatemia is ordered IV phosphate. Which additional electrolyte should the nurse monitor closely due to an inverse relationship?
Sodium
Potassium
Magnesium
Calcium
A client has fluid volume excess. Which assessment finding best supports this?
Crackles, JVD, and rapid weight gain
Dry mucous membranes and thirst
Orthostatic hypotension only
Concentrated urine and poor turgor only
A client is receiving platelets and develops hives and itching. What is the priority nursing action?
Increase infusion rate
Stop transfusion and maintain IV with NS
Flush line with LR
Continue transfusion and document later
A client has metabolic acidosis from renal failure. Which lab pattern is most expected?
High pH, low potassium
High pH, low PaCO₂
Low pH, low HCO₃⁻
High pH, high HCO₃⁻
A client has pH 7.36, PaCO₂ 20, HCO₃⁻ 11. What is the best interpretation?
Fully compensated respiratory alkalosis
Fully compensated metabolic acidosis
Uncompensated respiratory acidosis
Uncompensated metabolic alkalosis
A client is at risk for refeeding syndrome. Which lab is the nurse most concerned about dropping quickly?
Calcium
Sodium
Chloride
Phosphate
A client has severe hypercalcemia. Which provider order should the nurse anticipate to lower calcium?
IV isotonic fluids plus a loop diuretic as ordered
Calcium gluconate infusion
KCl replacement
3% saline infusion
A client with hypomagnesemia is also at risk for which associated electrolyte abnormality that can be hard to correct until magnesium is fixed?
Hypernatremia
Hypocalcemia and hypokalemia
Hyperphosphatemia
Metabolic alkalosis only
A client with fluid volume excess is receiving IV furosemide. Which lab is the priority to trend during therapy?
Troponin
Hemoglobin
Potassium
Lipase
A client with respiratory alkalosis is most likely caused by:
Opioid overdose
COPD exacerbation
Diarrhea
Panic attack with hyperventilation
A client’s sodium is 126 and symptomatic with confusion. Which order is highest priority to verify?
Start D5W infusion
Give hypotonic fluids freely
Seizure precautions and controlled hypertonic saline as ordered
Encourage water intake
A client with suspected TACO develops dyspnea and hypertension during transfusion. Which additional assessment supports TACO over TRALI?
Low BNP
Hypotension
No JVD
JVD and S3
A client with metabolic alkalosis has shallow respirations. Which is the best explanation?
The body hypoventilates to retain CO₂ to compensate
The body hyperventilates to blow off CO₂
The kidneys excrete acids to compensate
The lungs excrete bicarbonate to compensate
A client has severe hypophosphatemia. Which nursing outcome is the priority?
Prevent constipation
Prevent seizures from hyponatremia
Prevent respiratory muscle failure
Prevent hearing loss
A client receiving albumin is at greatest risk for which complication?
Hypovolemia
Fluid volume overload / pulmonary edema
Hypoglycemia
Otitis media
A client’s ABG shows pH 7.28, PaCO₂ 28, HCO₃⁻ 13. Which primary disorder is present?
Respiratory alkalosis
Respiratory acidosis
Metabolic acidosis
Metabolic alkalosis
A client with hyperphosphatemia is ordered calcium-based phosphate binders. When should the nurse teach the client to take them?
On an empty stomach at bedtime
Only with water between meals
With meals to bind dietary phosphate
After meals as needed for symptoms
A client has calcium 12.1 mg/dL. Which finding is most expected?
Constipation and lethargy
Carpopedal spasm
Chvostek sign
Laryngospasm
A client with hypocalcemia is ordered IV calcium gluconate. Which assessment is priority during infusion?
Bowel sounds
Cardiac rhythm
Hearing acuity
Visual fields
A client with severe vomiting has metabolic alkalosis. Which urine finding is most expected?
Ketonuria only
Hematuria
Low urine chloride
High urine glucose
A client has pH 7.22, PaCO2 68, HCO3− 26. Which is the best interpretation?
Metabolic acidosis
Respiratory alkalosis
Metabolic alkalosis
Uncompensated respiratory acidosis
A client is receiving platelet transfusion. Which lab value best supports the need?
Platelets 18,000/mm3
Sodium 128 mEq/L
Calcium 7.8 mg/dL
Potassium 2.9 mEq/L
A client with severe hypermagnesemia is at highest risk for which complication?
Seizures
Respiratory depression
Pulmonary embolism
Bleeding gums
A client has hypophosphatemia. Which medication history most increases risk?
Loop diuretics
Chronic opioid use
Albuterol PRN
Long-term antacid use (aluminum/magnesium binders)
A client with diarrhea has metabolic acidosis. Which replacement therapy is most appropriate?
Replace bicarbonate losses as ordered and treat diarrhea cause
Give loop diuretics to excrete bicarbonate
Restrict all electrolytes
Give hypertonic saline rapidly
A client has TRALI during transfusion. What is the priority nursing action?
Increase transfusion rate
Stop transfusion and support oxygenation/ventilation; notify provider/blood bank
Place in Trendelenburg and continue blood
Give oral fluids
A client has sodium 148 and signs of dehydration. Which fluid is most appropriate to correct free-water deficit (as prescribed)?
3% saline
Normal saline
Lactated Ringers
0.45% NS or D5W (depending on plan)
A client has hypercalcemia related to malignancy. Which order should the nurse anticipate?
Calcitonin or bisphosphonate therapy as ordered
Calcium carbonate daily
Potassium phosphate bolus
Restrict fluids strictly
A client with hypomagnesemia is at risk for torsades de pointes. Which ECG feature is most concerning?
Short QT
Prolonged QT
Peaked T waves
Wide QRS from hyperK
A client on phosphate binders asks why they can’t just “take more phosphate.” Best answer?
Phosphate only matters for bones
High phosphate can lower calcium and cause calcifications
High phosphate prevents seizures
High phosphate fixes anemia
A client has pH 7.50, PaCO2 50, HCO3− 38. Which interpretation is most accurate?
Uncompensated metabolic alkalosis
Uncompensated respiratory alkalosis
Fully compensated metabolic alkalosis
Partially compensated metabolic alkalosis
A client with fluid volume excess is prescribed a 2 g sodium diet. Which meal indicates correct understanding?
Grilled chicken, steamed vegetables, no added salt
Ham sandwich and pickles
Canned soup and crackers
Pepperoni pizza
A client’s phosphate is 1.3 mg/dL. Which teaching is most appropriate?
Avoid protein
Report muscle weakness and shortness of breath promptly
Increase free water intake only
Avoid dairy permanently
A client with hypercalcemia is at highest risk for which complication?
Laryngospasm
Tetany
Renal stones and dysrhythmias
Increased ICP
A client has platelet transfusion running and develops wheezing, hypotension, and angioedema. Which action is priority?
Slow the transfusion
Give acetaminophen and continue
Recheck platelet count
Stop transfusion and prepare to treat anaphylaxis
A client has metabolic acidosis. Which respiratory pattern is the nurse most likely to see?
Kussmaul respirations
Bradypnea with shallow breathing
Apnea episodes only
Stridor
A client has suspected fluid volume deficit. Which urine finding best supports dehydration?
Low specific gravity
High specific gravity and concentrated urine
Glucosuria only
Large dilute output
A client has hypomagnesemia after alcohol use disorder. Which provider order is most appropriate?
Magnesium replacement as ordered and seizure precautions if severe
Restrict magnesium intake
Start calcium carbonate only
Encourage high phosphate diet only
A client has hyperphosphatemia. Which diet choice should be limited?
Apples
Cola and processed foods with phosphate additives
White rice
Lettuce
A client has hypermagnesemia. Which medication order should the nurse question?
Loop diuretic
IV calcium gluconate
Magnesium sulfate infusion
Normal saline IV
A client with severe fluid volume excess is ordered IV albumin. Which assessment makes this order most risky?
Albumin 2.0 g/dL
Edema present
Ascites present
Pulmonary crackles and SpO2 88%
A client is receiving whole blood. Which condition most commonly requires it (rather than PRBCs alone)?
Massive acute hemorrhage needing volume plus oxygen-carrying capacity
Iron deficiency anemia
Mild postoperative anemia
Chronic kidney disease anemia
A client’s ABG shows pH 7.33 , PaCO2 33 , HCO3− 17 . What is the primary disorder?
Respiratory acidosis
Metabolic acidosis
Metabolic alkalosis
Respiratory alkalosis
A client with hypophosphatemia is most likely to have which lab association?
Increased calcium due to phosphate drop
Increased sodium due to phosphate drop
Increased potassium due to phosphate drop
Decreased ATP-related energy availability leading to weakness
A client has fluid volume excess. Which provider order is most expected?
Increase maintenance IV fluids
Hold diuretics
Encourage 4 L/day fluids
IV loop diuretic and fluid/sodium restriction as ordered
A client has hypercalcemia. Which nursing assessment is highest priority?
Cardiac rhythm monitoring for dysrhythmias
Hearing screening
Visual acuity testing
Skin turgor only
A client has metabolic alkalosis. Which electrolyte imbalance commonly coexists and worsens dysrhythmia risk?
Hypernatremia
Hypokalemia
Hyperphosphatemia
Hypermagnesemia
A client with hypomagnesemia is receiving digoxin. The nurse is most concerned about which risk?
Digoxin toxicity and dysrhythmias risk increases with low magnesium
Increased hearing loss
Increased IOP
Epistaxis
A client has hyperphosphatemia related to renal failure. Which teaching is best?
“I should increase dairy and cola.”
“I should limit foods high in phosphate and take binders with meals.”
“I should stop all protein.”
“Phosphate doesn’t affect calcium.”
A client has fluid volume deficit. Which daily trend is most sensitive for evaluating fluid changes?
Daily weights
Skin color
Bowel sounds
Pupils
A client receives FFP and develops fever, chills, and headache but no back pain or hemoglobinuria. Which reaction is most likely?
Acute hemolytic reaction
Febrile non-hemolytic reaction
TRALI
Anaphylaxis
A client has pH 7.47 , PaCO2 46 , HCO3− 33 . Which interpretation is best?
Metabolic alkalosis with partial compensation
Respiratory alkalosis with compensation
Respiratory acidosis with compensation
Metabolic acidosis with compensation
A client has hypophosphatemia. Which medication order should the nurse question?
Potassium phosphate IV
Sodium phosphate IV
Vitamin D
Phosphate binder
A client with hypermagnesemia is at greatest risk for which assessment finding?
Bradycardia and hypotension
Hyperactive DTRs
Severe diarrhea
High fever
A client has fluid volume excess and hyponatremia dilutional. Which order is most expected?
Give 3% saline rapidly regardless of symptoms
Fluid restriction and treat the cause (for example, heart failure) as ordered
Encourage free-water intake
D5W bolus
A client has phosphate 7.0 mg/dL and calcium 7.4 mg/dL. Which symptom is most expected?
Tetany and paresthesias from low calcium effect
Constipation from high calcium
Warm flushed skin
Increased appetite
A client is receiving granulocyte (WBC) transfusion. Which client is the best candidate?
Stable anemia with Hgb 10
Thrombocytopenia with petechiae
Hypovolemia
Severe neutropenia with life-threatening infection not responding to antibiotics
A client has metabolic acidosis. Which lab is most useful to evaluate for an anion-gap cause?
Serum lactate level
Serum ketone (beta-hydroxybutyrate) level
Serum chloride level alone
Urinalysis specific gravity
A client has fluid volume excess. Which lab marker supports heart failure involvement?
BNP elevation
Low HbA1c
Low platelets
Low calcium
A client has hypercalcemia. Which medication order would the nurse question?
Loop diuretic therapy as ordered
IV normal saline hydration as ordered
Thiazide diuretic therapy
Bisphosphonate therapy
A client with respiratory alkalosis from pain is post‑op. Which nursing action is best?
Encourage hyperventilation
Treat pain and coach slow breathing
Give sodium bicarbonate
Restrict oxygen
A client has fluid volume deficit. Which IV access is most appropriate for rapid fluid resuscitation?
Large‑bore peripheral IV
24‑gauge in hand only
No IV needed if oral tolerated
PICC only
A client has hypomagnesemia. Which food choice supports magnesium intake?
White bread
Grapes
Nuts/whole grains/leafy greens
Hard candy
A client has hyperphosphatemia. Which nursing action is most appropriate?
Give phosphate supplements
Encourage cola
Administer phosphate binders as ordered
Encourage dairy shakes
A client receiving albumin begins coughing with new crackles and rising BP. What is the priority?
Continue infusion; expected finding
Slow infusion and reassess later
Stop infusion and notify provider (possible overload)
Give hypotonic fluids rapidly
A client has pH 7.38, PaCO2 55, HCO3− 32. Which is most accurate?
Fully compensated respiratory acidosis
Uncompensated respiratory acidosis
Metabolic alkalosis uncompensated
Respiratory alkalosis compensated
A client with suspected fluid volume excess asks why sodium restriction matters. Best response?
"Sodium pulls water with it, so less sodium helps reduce fluid retention."
"Sodium has no effect on fluid balance."
"Sodium only affects potassium."
"Sodium only affects glucose."
A client has phosphate 1.7 mg/dL and is on a ventilator. Which change is most concerning?
Increasing difficulty weaning from ventilator
Improved energy
Decreased urine output only
Increased appetite
A client has hypermagnesemia and renal failure. Which is an expected provider plan?
Give more magnesium
Restrict calcium
Hemodialysis if severe + stop magnesium sources
Encourage high‑mag diet
A client has hypercalcemia. Which assessment finding is most expected?
Constipation and polyuria
Diarrhea and tetany
Carpopedal spasm
Stridor
A client has respiratory alkalosis and is lightheaded. Which action is most appropriate?
Give naloxone
Treat underlying cause (pain/anxiety/fever) and coach breathing
Give 3% saline
Give loop diuretic
A client receives platelets. Which post‑transfusion outcome best indicates effectiveness?
Platelet count increases and bleeding decreases
Hgb rises by 2 g/dL
INR normalizes immediately
Sodium normalizes
A client has hyperphosphatemia. Which complication is the priority long‑term risk?
Hearing loss
Calcification in tissues/blood vessels
Epistaxis
Glaucoma
A client has fluid volume excess with pulmonary edema. Which medication order is most expected?
IV loop diuretic
Large IV bolus
Encourage 3 L PO fluids
Hold oxygen
A client has mixed disorder suspicion: pH 7.10, PaCO2 60, HCO3− 18. What is most accurate?
Pure respiratory acidosis only
Pure metabolic acidosis only
Mixed metabolic + respiratory acidosis
Fully compensated alkalosis
A client has hypomagnesemia and hypokalemia. Which statement is most accurate?
"Potassium may not correct until magnesium is corrected."
"Magnesium doesn’t affect potassium."
"Only sodium affects potassium."
"Give IV potassium push for fastest effect."
A client has phosphate 6.8 mg/dL and CKD. Which teaching is best?
"I should increase dairy and processed meats."
"I can stop binders when I feel better."
"Phosphate doesn’t affect calcium."
"I should take binders with meals and limit high‑phosphate foods."
