NURS 347 01 SP26 Quiz 3 University of Maryland School of Nursing.
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1. A 98-year-old client is brought to the emergency department by a home health aide. The nurse reviews the client's laboratory results and 24-hour intake and output record. Which finding should the nurse identify as the priority concern?
Normal Adult Ranges: Potassium (K⁺): 3.5–5.0 mEq/L Sodium (Na⁺): 135–145 mEq/L Chloride (Cl⁻): 98–106 mEq/L
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Urine output of 10 mL over 24 hours
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Serum sodium level of 138 mEq/L
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Serum chloride level of 104 mEq/L
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Serum potassium level of 4 mEq/L
Explanation
Explanation
Correct Answer: (A) Urine output of 10 mL over 24 hours
A urine output of only 10 mL over 24 hours represents severe oliguria bordering on anuria — the normal minimum acceptable urine output is 30 mL/hour, equating to at least 720 mL over 24 hours. This finding indicates acute kidney injury (AKI) or renal failure, which is a life-threatening emergency requiring immediate intervention. In a 98-year-old client, this level of urinary output signals critical organ dysfunction, possible sepsis, severe dehydration, or cardiovascular failure, and is by far the most urgent priority concern among the findings presented.
Why the other options are incorrect:
B. Serum sodium level of 138 mEq/L — A sodium level of 138 mEq/L falls well within the normal range of 135–145 mEq/L and requires no intervention. This is a normal and reassuring finding.
C. Serum chloride level of 104 mEq/L — A chloride level of 104 mEq/L is within the normal range of 98–106 mEq/L and does not represent an abnormal or concerning finding requiring priority attention.
D. Serum potassium level of 4 mEq/L — A potassium level of 4 mEq/L is normal, falling comfortably within the range of 3.5–5.0 mEq/L. This finding is reassuring and does not require intervention.
Correct Answer: (A) Urine output of 10 mL over 24 hours
A urine output of only 10 mL over 24 hours represents severe oliguria bordering on anuria — the normal minimum acceptable urine output is 30 mL/hour, equating to at least 720 mL over 24 hours. This finding indicates acute kidney injury (AKI) or renal failure, which is a life-threatening emergency requiring immediate intervention. In a 98-year-old client, this level of urinary output signals critical organ dysfunction, possible sepsis, severe dehydration, or cardiovascular failure, and is by far the most urgent priority concern among the findings presented.
Why the other options are incorrect:
B. Serum sodium level of 138 mEq/L — A sodium level of 138 mEq/L falls well within the normal range of 135–145 mEq/L and requires no intervention. This is a normal and reassuring finding.
C. Serum chloride level of 104 mEq/L — A chloride level of 104 mEq/L is within the normal range of 98–106 mEq/L and does not represent an abnormal or concerning finding requiring priority attention.
D. Serum potassium level of 4 mEq/L — A potassium level of 4 mEq/L is normal, falling comfortably within the range of 3.5–5.0 mEq/L. This finding is reassuring and does not require intervention.
2. A nurse is teaching a newly licensed nurse about informed consent. Which of the following should be included as a responsibility of the nurse in this process?
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Confirm that the client is competent to sign for the procedure.
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Discuss the risks of the procedure with the client.
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Explain alternatives to the procedure to the client.
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Inform the client about what will occur during the procedure.
Explanation
Explanation
Correct Answer: (A) Confirm that the client is competent to sign for the procedure.
The nurse's primary responsibility in the informed consent process is to confirm that the client has decision-making capacity — that they are alert, oriented, and able to understand information and communicate their decision. Ensuring competency protects the client's autonomy and legal rights. If the nurse assesses that the client does not appear to have decision-making capacity (due to sedation, confusion, or altered mental status), the nurse must report this to the provider before the consent form is signed. Witnessing the client's signature and confirming competency at the time of signing is the nurse's specific legal role.
Why Other Options are Incorrect:
B. Discuss the risks of the procedure with the client — Explaining the risks, benefits, and nature of the procedure is the legal and ethical responsibility of the physician or licensed independent practitioner performing the procedure, not the nurse. The nurse does not provide this information as part of the consent process.
C. Explain alternatives to the procedure to the client — Presenting treatment alternatives is also the provider's responsibility as part of obtaining informed consent. The nurse may clarify or reinforce information the provider has given, but the initial explanation of alternatives falls outside the nurse's scope in the consent process.
D. Inform the client about what will occur during the procedure — Detailed procedural explanation is the provider's responsibility. The nurse's role is to confirm that the provider has given the information, that the client understands it, and that the client is competent and voluntarily consenting — not to re-explain the procedure itself.
Correct Answer: (A) Confirm that the client is competent to sign for the procedure.
The nurse's primary responsibility in the informed consent process is to confirm that the client has decision-making capacity — that they are alert, oriented, and able to understand information and communicate their decision. Ensuring competency protects the client's autonomy and legal rights. If the nurse assesses that the client does not appear to have decision-making capacity (due to sedation, confusion, or altered mental status), the nurse must report this to the provider before the consent form is signed. Witnessing the client's signature and confirming competency at the time of signing is the nurse's specific legal role.
Why Other Options are Incorrect:
B. Discuss the risks of the procedure with the client — Explaining the risks, benefits, and nature of the procedure is the legal and ethical responsibility of the physician or licensed independent practitioner performing the procedure, not the nurse. The nurse does not provide this information as part of the consent process.
C. Explain alternatives to the procedure to the client — Presenting treatment alternatives is also the provider's responsibility as part of obtaining informed consent. The nurse may clarify or reinforce information the provider has given, but the initial explanation of alternatives falls outside the nurse's scope in the consent process.
D. Inform the client about what will occur during the procedure — Detailed procedural explanation is the provider's responsibility. The nurse's role is to confirm that the provider has given the information, that the client understands it, and that the client is competent and voluntarily consenting — not to re-explain the procedure itself.
3. The nurse is assessing a client with suspected hyperkalemia. Which client statement would be most concerning?
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"My muscles feel weak today, and my heart feels like it's skipping beats."
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"My joints feel stiff when I wake up in the morning."
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"I've been extra thirsty and going to the bathroom more often."
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"I've had occasional headaches after reading."
Explanation
Explanation
Hyperkalemia elevates potassium levels, which directly affects the electrical conduction of the heart and neuromuscular function. Muscle weakness combined with cardiac irregularities such as palpitations or skipped beats are hallmark signs of dangerous hyperkalemia and require immediate intervention.
Why the other options are incorrect:
B. "My joints feel stiff when I wake up in the morning." — Morning joint stiffness is more characteristic of inflammatory conditions such as arthritis and is not associated with hyperkalemia.
C. "I've been extra thirsty and going to the bathroom more often." — Polydipsia and polyuria are classic signs of hyperglycemia or diabetes, not hyperkalemia.
D. "I've had occasional headaches after reading." — This is a nonspecific complaint more likely related to eye strain and has no direct link to elevated potassium levels.
Hyperkalemia elevates potassium levels, which directly affects the electrical conduction of the heart and neuromuscular function. Muscle weakness combined with cardiac irregularities such as palpitations or skipped beats are hallmark signs of dangerous hyperkalemia and require immediate intervention.
Why the other options are incorrect:
B. "My joints feel stiff when I wake up in the morning." — Morning joint stiffness is more characteristic of inflammatory conditions such as arthritis and is not associated with hyperkalemia.
C. "I've been extra thirsty and going to the bathroom more often." — Polydipsia and polyuria are classic signs of hyperglycemia or diabetes, not hyperkalemia.
D. "I've had occasional headaches after reading." — This is a nonspecific complaint more likely related to eye strain and has no direct link to elevated potassium levels.
4. A nurse is caring for a client who is postoperative and whose respirations are shallow and 9/min. Which of the following acid-based imbalances should the nurse identify the client as being at risk for developing initially?
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Respiratory acidosis
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Metabolic acidosis
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Metabolic alkalosis
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Respiratory alkalosis
Explanation
Explanation
Correct Answer: (A) Respiratory acidosis
Shallow respirations at a rate of only 9 breaths per minute (normal is 12–20) indicate hypoventilation. When a client hypoventilates, carbon dioxide (CO₂) is not adequately expelled from the lungs and accumulates in the bloodstream. CO₂ combines with water in the blood to form carbonic acid (H₂CO₃), which dissociates to lower blood pH. The resulting imbalance — elevated PaCO₂ with decreased pH — is the definition of respiratory acidosis. This is the initial and most direct acid-base consequence of postoperative hypoventilation, commonly caused by residual anesthetic agents and opioid analgesics.
Why the other options are incorrect:
B. Metabolic acidosis — Metabolic acidosis results from accumulation of non-carbonic acids or loss of bicarbonate, such as in diabetic ketoacidosis, renal failure, or severe diarrhea. It is not the initial expected consequence of hypoventilation.
C. Metabolic alkalosis — Metabolic alkalosis results from excess bicarbonate or loss of acid (such as from prolonged vomiting) and is not caused by respiratory depression or hypoventilation.
D. Respiratory alkalosis — Respiratory alkalosis results from hyperventilation, where excessive CO₂ is blown off, raising pH. A patient with slow, shallow respirations is hypoventilating, not hyperventilating, making respiratory alkalosis the opposite of what would be expected here.
Correct Answer: (A) Respiratory acidosis
Shallow respirations at a rate of only 9 breaths per minute (normal is 12–20) indicate hypoventilation. When a client hypoventilates, carbon dioxide (CO₂) is not adequately expelled from the lungs and accumulates in the bloodstream. CO₂ combines with water in the blood to form carbonic acid (H₂CO₃), which dissociates to lower blood pH. The resulting imbalance — elevated PaCO₂ with decreased pH — is the definition of respiratory acidosis. This is the initial and most direct acid-base consequence of postoperative hypoventilation, commonly caused by residual anesthetic agents and opioid analgesics.
Why the other options are incorrect:
B. Metabolic acidosis — Metabolic acidosis results from accumulation of non-carbonic acids or loss of bicarbonate, such as in diabetic ketoacidosis, renal failure, or severe diarrhea. It is not the initial expected consequence of hypoventilation.
C. Metabolic alkalosis — Metabolic alkalosis results from excess bicarbonate or loss of acid (such as from prolonged vomiting) and is not caused by respiratory depression or hypoventilation.
D. Respiratory alkalosis — Respiratory alkalosis results from hyperventilation, where excessive CO₂ is blown off, raising pH. A patient with slow, shallow respirations is hypoventilating, not hyperventilating, making respiratory alkalosis the opposite of what would be expected here.
5. A nurse is caring for a client who has the following arterial blood gas results: HCO3 32 mEq/L, PaCO2 48 mm Hg, and pH 7.48. The nurse recognizes the client is experiencing which acid-base imbalance?
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Metabolic acidosis
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Metabolic alkalosis
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Respiratory alkalosis
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Respiratory acidosis
Explanation
Explanation
The pH of 7.48 is above the normal range of 7.35–7.45, indicating alkalosis. The HCO3 is elevated at 32 mEq/L (normal 22–26), pointing to a metabolic cause. The PaCO2 is slightly elevated at 48 mm Hg, which represents compensatory hypoventilation by the body to retain CO2 and bring the pH back toward normal. Together these findings confirm metabolic alkalosis.
Why the other options are incorrect:
A. Metabolic acidosis — This would present with a low pH and low HCO3, neither of which is present here.
C. Respiratory alkalosis — This would show a low PaCO2 due to hyperventilation, but PaCO2 here is elevated, not decreased.
D. Respiratory acidosis — This would present with a low pH and elevated PaCO2. Although PaCO2 is elevated, the pH is high, ruling out acidosis.
The pH of 7.48 is above the normal range of 7.35–7.45, indicating alkalosis. The HCO3 is elevated at 32 mEq/L (normal 22–26), pointing to a metabolic cause. The PaCO2 is slightly elevated at 48 mm Hg, which represents compensatory hypoventilation by the body to retain CO2 and bring the pH back toward normal. Together these findings confirm metabolic alkalosis.
Why the other options are incorrect:
A. Metabolic acidosis — This would present with a low pH and low HCO3, neither of which is present here.
C. Respiratory alkalosis — This would show a low PaCO2 due to hyperventilation, but PaCO2 here is elevated, not decreased.
D. Respiratory acidosis — This would present with a low pH and elevated PaCO2. Although PaCO2 is elevated, the pH is high, ruling out acidosis.
6. A nurse is reviewing a client's 24-hour intake and output record. Which action best helps the nurse determine the client's overall fluid balance?
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Comparing the client's total fluid intake with total fluid output
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Documenting the findings in the electronic health record.
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Asking the next shift nurse to continue monitoring output
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Reporting the client's urine output to the health care provider immediately
Explanation
Explanation
Correct Answer: (A) Comparing the client's total fluid intake with total fluid output
Fluid balance is determined by calculating the difference between total fluid intake (all oral fluids, IV fluids, tube feedings, and any other fluid inputs) and total fluid output (urine, emesis, wound drainage, nasogastric output, and other losses) over the 24-hour period. A positive balance indicates fluid retention, while a negative balance indicates fluid deficit. This comparison is the definitive method to assess whether a client is in fluid balance, overhydrated, or dehydrated, and guides clinical decision-making regarding fluid management.
Why Other Options are Incorrect:
B. Documenting the findings in the electronic health record — Documentation is an important professional responsibility and ensures continuity of care, but recording data alone does not help the nurse analyze or determine the client's fluid balance status. Documentation follows assessment and analysis, it does not replace it.
C. Asking the next shift nurse to continue monitoring output — Delegating ongoing monitoring is appropriate for continuity of care, but it does not help the current nurse determine the client's present fluid balance from the 24-hour record already in hand.
D. Reporting the client's urine output to the health care provider immediately — Reporting is appropriate when an abnormal finding is identified, but it is premature before the nurse has reviewed and analyzed the complete intake and output data to determine whether the urine output represents an imbalance. Reporting should follow assessment and analysis, not precede it.
Correct Answer: (A) Comparing the client's total fluid intake with total fluid output
Fluid balance is determined by calculating the difference between total fluid intake (all oral fluids, IV fluids, tube feedings, and any other fluid inputs) and total fluid output (urine, emesis, wound drainage, nasogastric output, and other losses) over the 24-hour period. A positive balance indicates fluid retention, while a negative balance indicates fluid deficit. This comparison is the definitive method to assess whether a client is in fluid balance, overhydrated, or dehydrated, and guides clinical decision-making regarding fluid management.
Why Other Options are Incorrect:
B. Documenting the findings in the electronic health record — Documentation is an important professional responsibility and ensures continuity of care, but recording data alone does not help the nurse analyze or determine the client's fluid balance status. Documentation follows assessment and analysis, it does not replace it.
C. Asking the next shift nurse to continue monitoring output — Delegating ongoing monitoring is appropriate for continuity of care, but it does not help the current nurse determine the client's present fluid balance from the 24-hour record already in hand.
D. Reporting the client's urine output to the health care provider immediately — Reporting is appropriate when an abnormal finding is identified, but it is premature before the nurse has reviewed and analyzed the complete intake and output data to determine whether the urine output represents an imbalance. Reporting should follow assessment and analysis, not precede it.
7. Fill in the blanks by selecting the best option from the drop down boxes. The nurses assess a patient and notes lower leg edema. The nurse understands this is a fluid imbalance caused by a (1) ____ into the (2) ____.
Blank 1 options: fluid shift from intracellular space to extracellular space fluid shift from extracellular to intracellular space
Blank 2 options: Intracellular space Interstitial space
- fluid shift from intracellular space to extracellular space
- fluid shift from extracellular to intracellular space
- Intracellular space
- Interstitial space
Explanation
Explanation
Correct Answer: (1) fluid shift from intracellular space to extracellular space, (2) Interstitial space
Lower leg edema is the visible accumulation of excess fluid in the tissues of the lower extremities. This occurs when fluid moves from the intracellular space into the extracellular compartment and subsequently accumulates in the interstitial space — the space between cells and surrounding tissues. This fluid shift is driven by factors such as increased hydrostatic pressure, decreased oncotic pressure (from low albumin), increased capillary permeability, or impaired lymphatic drainage. When fluid accumulates in the interstitial space rather than being reabsorbed into the capillaries or lymphatics, edema becomes clinically visible and palpable.
Why the other options are incorrect:
Blank 1 — fluid shift from extracellular to intracellular space: A fluid shift from the extracellular to the intracellular space would cause cellular swelling, not peripheral edema. Edema specifically results from fluid accumulating outside of cells in the tissue spaces, not moving into them.
Blank 2 — Intracellular space: The intracellular space refers to the fluid inside cells. Edema is not caused by fluid accumulation inside cells; it results from fluid building up in the interstitial space surrounding the cells, which is what creates the visible swelling observed in lower leg edema.
Correct Answer: (1) fluid shift from intracellular space to extracellular space, (2) Interstitial space
Lower leg edema is the visible accumulation of excess fluid in the tissues of the lower extremities. This occurs when fluid moves from the intracellular space into the extracellular compartment and subsequently accumulates in the interstitial space — the space between cells and surrounding tissues. This fluid shift is driven by factors such as increased hydrostatic pressure, decreased oncotic pressure (from low albumin), increased capillary permeability, or impaired lymphatic drainage. When fluid accumulates in the interstitial space rather than being reabsorbed into the capillaries or lymphatics, edema becomes clinically visible and palpable.
Why the other options are incorrect:
Blank 1 — fluid shift from extracellular to intracellular space: A fluid shift from the extracellular to the intracellular space would cause cellular swelling, not peripheral edema. Edema specifically results from fluid accumulating outside of cells in the tissue spaces, not moving into them.
Blank 2 — Intracellular space: The intracellular space refers to the fluid inside cells. Edema is not caused by fluid accumulation inside cells; it results from fluid building up in the interstitial space surrounding the cells, which is what creates the visible swelling observed in lower leg edema.
8. A nurse is reviewing surgical screening lab work with a client who has arrived for an elective procedure. During which of the following phases is this task performed?
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Perioperative
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Intraoperative
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Preoperative
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Postoperative
Explanation
Explanation
The preoperative phase begins when the decision for surgery is made and ends when the client is transferred to the operating room. Reviewing screening lab work upon arrival for an elective procedure falls within this phase, as it is part of the preparation and assessment conducted before surgery begins.
Correct Answer Is:
(C) Preoperative
Why the other options are incorrect:
A. Perioperative — This is an umbrella term encompassing all three phases and is not specific enough to describe when lab review occurs.
B. Intraoperative — This phase begins when the client enters the operating room and ends when they are transferred to the recovery area; lab review does not occur here.
D. Postoperative — This phase begins after surgery is completed; reviewing pre-admission labs at this point would be too late.
The preoperative phase begins when the decision for surgery is made and ends when the client is transferred to the operating room. Reviewing screening lab work upon arrival for an elective procedure falls within this phase, as it is part of the preparation and assessment conducted before surgery begins.
Correct Answer Is:
(C) Preoperative
Why the other options are incorrect:
A. Perioperative — This is an umbrella term encompassing all three phases and is not specific enough to describe when lab review occurs.
B. Intraoperative — This phase begins when the client enters the operating room and ends when they are transferred to the recovery area; lab review does not occur here.
D. Postoperative — This phase begins after surgery is completed; reviewing pre-admission labs at this point would be too late.
9. A nurse is reviewing preoperative data for several clients scheduled for surgery. Which client should the nurse identify as being at greatest risk for a postoperative venous thromboembolism (DVT)?
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A client with a BMI of 19 scheduled for cataract surgery
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A client with seasonal allergies scheduled for hernia repair
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A client with controlled hypertension scheduled for an endoscopy
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A client with limited mobility following a hip fracture
Explanation
Explanation
Correct Answer: (D) A client with limited mobility following a hip fracture
Venous thromboembolism risk is assessed using Virchow's Triad: venous stasis, hypercoagulability, and endothelial injury. This client has all three risk factors converging simultaneously. Limited mobility causes venous stasis — slowed blood flow in the deep veins of the lower extremities. Hip fractures cause endothelial trauma to surrounding vessels. Surgical intervention for hip fracture induces a hypercoagulable state. Hip fracture surgery is one of the highest-risk procedures for DVT and pulmonary embolism, and prophylactic anticoagulation is a standard of care. This client has the greatest cumulative risk profile.
Why Other Options are Incorrect:
A. A client with a BMI of 19 scheduled for cataract surgery — A BMI of 19 is in the normal range, and cataract surgery is a brief, minimally invasive procedure with very limited postoperative immobility. DVT risk is minimal in this scenario.
B. A client with seasonal allergies scheduled for hernia repair — Seasonal allergies are not a VTE risk factor. While hernia repair involves some immobility, the risk is significantly lower than that of hip fracture surgery with pre-existing limited mobility.
C. A client with controlled hypertension scheduled for an endoscopy — Controlled hypertension and endoscopy (a non-surgical diagnostic procedure) carry minimal VTE risk. The client ambulates normally and undergoes no significant surgical intervention.
Correct Answer: (D) A client with limited mobility following a hip fracture
Venous thromboembolism risk is assessed using Virchow's Triad: venous stasis, hypercoagulability, and endothelial injury. This client has all three risk factors converging simultaneously. Limited mobility causes venous stasis — slowed blood flow in the deep veins of the lower extremities. Hip fractures cause endothelial trauma to surrounding vessels. Surgical intervention for hip fracture induces a hypercoagulable state. Hip fracture surgery is one of the highest-risk procedures for DVT and pulmonary embolism, and prophylactic anticoagulation is a standard of care. This client has the greatest cumulative risk profile.
Why Other Options are Incorrect:
A. A client with a BMI of 19 scheduled for cataract surgery — A BMI of 19 is in the normal range, and cataract surgery is a brief, minimally invasive procedure with very limited postoperative immobility. DVT risk is minimal in this scenario.
B. A client with seasonal allergies scheduled for hernia repair — Seasonal allergies are not a VTE risk factor. While hernia repair involves some immobility, the risk is significantly lower than that of hip fracture surgery with pre-existing limited mobility.
C. A client with controlled hypertension scheduled for an endoscopy — Controlled hypertension and endoscopy (a non-surgical diagnostic procedure) carry minimal VTE risk. The client ambulates normally and undergoes no significant surgical intervention.
10. A nurse is preparing a client for surgery. Which of the following is a priority when completing an assessment preoperatively?
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To identify possible surgical risks
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To determine understanding of the procedure
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To establish the need for psychological support
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To recognize resources needed postoperatively
Explanation
Explanation
The primary purpose of a preoperative assessment is patient safety. Identifying surgical risks such as allergies, comorbidities, abnormal lab values, or medication interactions allows the surgical team to take preventive measures and reduce the likelihood of intraoperative or postoperative complications.
Correct Answer Is:
(A) To identify possible surgical risks
Why the other options are incorrect:
B. To determine understanding of the procedure — Patient education and informed consent are important but are secondary to identifying risks that could directly endanger the patient's life.
C. To establish the need for psychological support — Emotional readiness is assessed but is not the priority over physical safety risks.
D. To recognize resources needed postoperatively — Discharge planning is valuable but occurs after safety risks have been addressed preoperatively.
The primary purpose of a preoperative assessment is patient safety. Identifying surgical risks such as allergies, comorbidities, abnormal lab values, or medication interactions allows the surgical team to take preventive measures and reduce the likelihood of intraoperative or postoperative complications.
Correct Answer Is:
(A) To identify possible surgical risks
Why the other options are incorrect:
B. To determine understanding of the procedure — Patient education and informed consent are important but are secondary to identifying risks that could directly endanger the patient's life.
C. To establish the need for psychological support — Emotional readiness is assessed but is not the priority over physical safety risks.
D. To recognize resources needed postoperatively — Discharge planning is valuable but occurs after safety risks have been addressed preoperatively.
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