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 - ANS-b. Distended neck veins

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 - ANS-b. Improved cognition

A nurse is teaching a client who has a new prescription for a nitroglycerin 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." - ANS-d. "Remove the patch prior to going

to bed."

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 - ANS-d. Potassium 5.2 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

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 medication

regimen?

a. The client has a negative sputum culture

b. The client tests negative for HIV

c. The client has a positive purified protein derivative test