1.) A nurse is assessing a client who is receiving intravenous therapy. The nurse should iden9fy
which of the following ;ndings as a manifesta9on of =uid 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 solu9on. Which of the following ;ndings should indicate to the nurse that the
treatment is eFec9ve?
a. Absent Chvostek’s sign
b. Improved cogni?on
c. Decreased vomi9ng
d. Cardiac arrhythmias absent
3.) A nurse is teaching a client who has a new prescrip9on for a nitroglycerin transdermal patch.
Which of the following instruc9ons should the nurse include?
a. “Discon9nue 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 prescrip9on for sodium
polystyrene sulfonate (Kayexalate) every 6 hr. which of the following should the nurse report to
the provider?
a. Crea9nine 0.72 mg/dL
b. Sodium 138 mEq/L
c. Magnesium 2 mEq/L
- Hyperkalemia (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 rifampin. Which of
the following outcomes indicates that the client is adhering to the medica9on regimen?
a. The client has a nega?ve sputum culture
b. The client tests nega9ve for HIV
c. The client has a posi9ve puri;ed protein deriva9ve test
d. The client’s liver func9on test results are within the expected reference range
6.) A client is caring for a client who develops an anaphylac?c reac9on to IV administra9on. A]er
assessing the client’s respiratory status and stopping the medica9on infusion. Which of the
following ac9ons should the nurse take next?
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