1.) A nurse is assessing a client who is receiving intravenous therapy. The nurse should

identify which of the following findings as a manifestation of fluid volume excess?

a. Decreased bowel sounds

b. Distended neck veins

c. Bilateral muscle weakness

d. Thread pulse

2.) A nurse is caring for a client who has hyponatremia and is receiving an infusion of a

prescribed hypertonic solution. Which of the following findings should indicate to the

nurse that the treatment is effective?

a. Absent Chvostek’s sign

b. Improved cognition

c. Decreased vomiting

d. Cardiac arrhythmias absent

3.) A nurse is teaching a client who has a new prescription for a nitro-glycerine transdermal

patch.

Which of the following instructions should the nurse include?

a. “Discontinue the patch if you experience a headache.”

b. “Apply a new patch if you have chest pain.”

c. “Cover the patch with dry gauze when taking a shower.”

d. “Remove the patch prior to going to bed.”

4.) A nurse is reviewing he laboratory results of a client who has a prescription for sodium

polystyrene sulfonate (Kayexalate) every 6 hr. which of the following should the nurse

report to the provider?

a. Creatinine 0.72 mg/dL

b. Sodium 138 mEq/L

c. Magnesium 2 mEq/L

d. Potassium 5.2 mEq/L

- Hyperkalaemia (serum potassium level greater than 5.0 mEq/L)

increases the client risk for fatal cardiac dysrhythmias. Kayexalate is used to

decrease the serum potassium level, so the PN should monitor the client's serum

potassium level

5.) A nurse is caring for a client who has tuberculosis and is taking isoniazid and

revamping. Which of the following outcomes indicates that the client is adhering to the

medication regimen?