NUAS 130SP Exam 4 Final Review T02 Mount Aloysius College.
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Free NUAS 130SP Exam 4 Final Review T02 Mount Aloysius College. Questions
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Does not exhibit skin breakdown as a result of edema during hospitalization
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Maintains intake and output balance over 24 hours
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Does not exhibit dryness or cracking of mucous membrane by the end of the shift
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Holds systolic blood pressure between 100 and 130 mm Hg for 24 hours
Explanation
Correct Answer: B) Maintains intake and output balance over 24 hours
The most direct and measurable indicator of fluid balance is an equal intake and output over a 24-hour period. When the amount of fluid taken in equals the amount excreted, it confirms that the body is maintaining homeostasis and that fluid is neither being retained nor lost in excess. This is the gold standard outcome measure for evaluating fluid balance.
Absence of skin breakdown from edema reflects management of a complication of fluid imbalance but does not directly confirm that fluid balance has been achieved. Absence of dry or cracked mucous membranes indicates the client is not dehydrated but does not confirm overall fluid balance. Maintaining systolic blood pressure within a target range reflects cardiovascular status, which is influenced by many factors beyond fluid balance alone.
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Include the patient and family in the teaching session
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Emphasize your role using authority with teaching
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Provide verbal instruction to all clients
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Provide detailed explanations for all ages to enhance understanding
Explanation
Correct Answer: A) Include the patient and family in the teaching session
Including both the patient and family in education sessions significantly improves compliance because family members serve as a support system who can reinforce instructions, assist with implementation at home, and help hold the patient accountable. This collaborative approach addresses multiple learning needs simultaneously and ensures that those who will be supporting the patient's care at home are equally informed.
Using authority or emphasizing the nurse's role creates a power imbalance that can intimidate the client, reduce open communication, and actually decrease engagement and compliance. Providing only verbal instruction is insufficient for all clients, as adults retain information better when multiple modalities are used, such as written materials, demonstrations, and teach-back. Providing detailed explanations for all ages does not account for individual literacy levels, health literacy, cognitive ability, or cultural differences — effective teaching must always be tailored to the individual learner.
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"Tachycardia and hypotension are compensatory responses to hypovolemia"
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"Orthostatic hypertension significantly increases fall risk."
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"Older adults are not affected by dehydration complications"
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"Careful monitoring during rehydration preventing fluid overload is not necessary."
Explanation
Correct Answer: A) "Tachycardia and hypotension are compensatory responses to hypovolemia"
When circulating blood volume drops due to fluid loss from diarrhea and poor intake, the body compensates by increasing heart rate (tachycardia) to maintain cardiac output and oxygen delivery to vital organs. The low blood pressure reflects the reduced intravascular volume. Recognizing these as classic signs of hypovolemia demonstrates accurate pathophysiological understanding.
The correct term is orthostatic hypotension — not hypertension — which does increase fall risk, making option B incorrect in its terminology. Older adults are actually more vulnerable to dehydration complications due to decreased thirst sensation, reduced renal concentrating ability, and lower total body water, making option C false. Careful monitoring during rehydration is absolutely essential in elderly clients to prevent fluid overload and subsequent heart failure or pulmonary edema, making option D dangerously incorrect.
The nurse has instructed the patient to take 20 mL of a medication. How many teaspoons should the patient be instructed to take at home?
Explanation
Correct Answer: 4 teaspoons
One teaspoon equals 5 mL. To convert 20 mL to teaspoons, divide 20 by 5, which equals 4 teaspoons.
A client is reported to be hypernatremic. Choose the laboratory information that best demonstrates this condition.
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A potassium level of 2.3 mEq/L
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A sodium level of 160 mEq/L
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A sodium level of 130 mEq/L
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A potassium level of 6.0 mEq/L
Explanation
Correct Answer: B) A sodium level of 160 mEq/L
Hypernatremia is defined as a serum sodium level above 145 mEq/L. A sodium level of 160 mEq/L clearly exceeds this threshold and directly confirms the hypernatremic state. Hypernatremia causes water to shift out of cells due to increased extracellular osmolarity, leading to cellular dehydration with symptoms such as thirst, confusion, and in severe cases, seizures.
A potassium level of 2.3 mEq/L indicates hypokalemia, not hypernatremia — these are separate electrolyte imbalances. A sodium level of 130 mEq/L is below the normal range of 135–145 mEq/L, indicating hyponatremia, which is the opposite condition. A potassium level of 6.0 mEq/L indicates hyperkalemia and is unrelated to sodium levels or hypernatremia.
Explanation
Correct Answer: 0.7 mL
Using the standard drug calculation formula:
Volume (mL) = Desired dose ÷ Dose on hand × Volume on hand
= 35 mg ÷ 50 mg × 1 mL
= 0.7 mL
The patient reported pain #4, which falls within the PRN range of #1–5, so the medication is appropriate to administer. The vial available contains 50 mg/mL, so to deliver the ordered 35 mg dose, the nurse should draw up 0.7 mL into the syringe for intramuscular injection.
It is important to note that meperidine (Demerol) is an opioid analgesic and the nurse must also assess respiratory rate, blood pressure, and level of consciousness before administration, and document the PRN administration with the pain score that prompted it.
Explanation
Correct Answer: 1.2 mL
The concentration is 250 mcg per 1 mL. To administer 300 mcg, divide 300 by 250, which equals 1.2 mL. This ensures accurate dosing based on the medication concentration provided.
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Apply a cardiac monitor
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Monitor intake and output
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Provide a glass of orange juice
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Obtain a chest x-ray
Explanation
Correct Answer: A) Apply a cardiac monitor
A potassium level of 6.5 mEq/L indicates severe hyperkalemia (normal range 3.5–5.0 mEq/L). Hyperkalemia is a life-threatening emergency because elevated potassium disrupts the cardiac membrane potential, leading to dangerous dysrhythmias including ventricular fibrillation and cardiac arrest. Applying a cardiac monitor is the immediate priority to continuously assess for potentially fatal cardiac changes and allow for rapid intervention.
Monitoring intake and output is important in managing hyperkalemia but is not the immediate life-saving priority. Providing orange juice is contraindicated in hyperkalemia as orange juice is high in potassium and would worsen the condition. Obtaining a chest x-ray is not relevant to the acute management of hyperkalemia.
An older patient has been vomiting for 2 days and has been unable to eat or drink anything during that time. Which health problem should the nurse realize this client is experiencing?
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Hypovolemia
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Hypervolemia
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Hypernatremia
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Hypokalemia
Explanation
Correct Answer: A) Hypovolemia
Prolonged vomiting and inability to intake fluids lead to significant fluid loss, resulting in decreased circulating volume. This places the client at risk for hypovolemia, which can cause hypotension, tachycardia, and decreased organ perfusion.
Hypervolemia involves fluid excess, which is not consistent with fluid loss. While electrolyte imbalances such as hypokalemia or hypernatremia may occur with vomiting, the most immediate and primary problem is fluid volume deficit.
While changing a patient's hospital gown, the extension set on the IV infusion becomes disconnected and ends up on the bed linens. What would the nurse do?
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Reconnect the extension set.
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Clean the end with a cotton ball and reconnect it.
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Pull the IV from the site and insert a new catheter.
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Change the extension set tubing.
Explanation
Correct Answer: D) Change the extension set tubing.
When IV tubing or an extension set becomes contaminated by contact with non-sterile surfaces such as bed linens, the entire extension set must be replaced with new sterile tubing. Reconnecting contaminated tubing directly into the IV site introduces microorganisms into the bloodstream, creating a serious risk of catheter-related bloodstream infection (CRBSI), which can be life-threatening.
Simply reconnecting the extension set ignores the contamination that occurred and places the patient at serious infection risk. Cleaning the end with a cotton ball is insufficient — a cotton ball is not sterile and does not restore the sterility required for IV connections. Pulling the IV catheter and inserting a new one is unnecessary; the catheter at the site remains sterile and intact — only the contaminated extension set needs to be replaced.
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