Nursing Exam Questions: Identifying Cardiovascular and Electrolyte Conditions, Exams of Nursing

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AH Exam 3 questions with answers

The nurse is evaluating the hydration status of the patient. If the patient is hypovolemic, the nurse expects to observe which type of cardiovascular change? a) Increase in pulse pressure and systolic pressure b) Hypertension with bounding peripheral pulses and flat neck veins c) Bradycardia and distended neck veins d) Tachycardia with weak peripheral pulses and flat neck veins - ANSWER: D The nurse assessing the patient notes a bounding pulse quality, neck vein distention when supine, presence of crackles in the lungs, and increasing peripheral edema. What condition does the nurse suspect? a) Electrolyte imbalance b) Fluid volume excess c) Fluid volume deficit d) Serum protein increase - ANSWER: B A nurse is assigned to care for a group of patients. On review of the client's medical records, the nurse determines that which client is at risk for excess fluid volume? a) The client with a fistula b) The client requiring gastrointestinal suctioning c) The client with renal failure d) The client taking diuretics - ANSWER: C The typical isotonic fluid replacement for the patient with a fluid volume deficit is? a) Dextran b) 0.9% Normal Saline c) 0.45% Normal Saline d) 5% Dextrose in 0.45% Normal Saline - ANSWER: B

The nurse is assessing the patient's serum sodium level and notes that the value is elevated. This could relate to the patient being hypovolemic. a) True b) False - ANSWER: A Signs and symptoms of a patient with a serum Na+ level of 125 meq/mL include: a) weight loss, tachycardia, flushed skin, dry mucous membranes b) chest pain, fever, pericardial rub, chilling c) fever, restlessness, thirst, edema, agitation d) lethargy, weakness (limp muscles), orthostatic hypotension, stomach cramping - ANSWER: D Hyponatremia can be caused by: a) GI vomiting or diarrhea b) Too much salt intake c) Comatose state d) Diabetes insipidus - ANSWER: A When caring for a patient admitted with hypernatremia due to a fluid deficit from diabetes insipidus, which actions will the nurse anticipate taking? a) Infuse 0.45% Normal Saline IV b) Encourage electrolyte containing drinks c) Infuse 3% Normal Saline d) Restrict patient's oral free water intake - ANSWER: A You are teaching a patient with hypernatremia that he needs to restrict his intake of sodium. Which foods high in sodium should you tell him to avoid? a) Canned soups, ketchup and cheese b) Milk, nuts and liver c) Red meat, pork and soy

d) Bananas, peaches, and broccoli - ANSWER: A A normal serum potassium level is? a) 1.5 - 2.5 meq/L b) 8.5 - 10.5 meq/L c) 135 - 145 meq/L d) 3.5 - 5.0 meq/L - ANSWER: D An 83 year old with heart failure develops hypokalemia as a result of her diuretic therapy. You suggest that she increase her dietary intake of potassium. Which foods should she consume? a) Canned soups, peas, and milk b) Apples, whole wheat bread, and oatmeal c) Tomatoes, bananas, and baked potatoes d) Dairy products and whole grain foods - ANSWER: C A nursing student is to administer potassium chloride intravenously as prescribed to a client with hypokalemia. The nursing instructor determines that the student is unprepared for this procedure if the student states that which of the following is part of the plan for preparation and administration of the potassium? a) Monitoring urine output prior to and during administration b) Preparing the medication for IV bolus administration c) Double checking the potassium concentration is no more than 1 mEq/10ml d) Obtaining an IV infusion pump - ANSWER: B A nurse is caring for a client who has a serum potassium of 5.4 mEq/L. The nurse should assess for which of the following? a) Hypotension b) ECG changes c) Constipation d) Polyuria - ANSWER: B

Medications to help treat severe hyperkalemia include: a) Mannitol, Regular insulin, and Kayexelate b) Methylpresnisolone, Mannitol, and Kayexelate c) Calcium gluconate, Regular insulin, and Kayexelate d) Digoxin, diuretics, and Kayexelate - ANSWER: C A normal serum calcium level is? a) 3.0 - 4.5 mg/dL b) 9 - 10.5 mg/dL c) 1.6 - 2.6 mg/dL d) 135 - 145 meq/mL - ANSWER: B Patient teaching on how to take oral calcium supplements should include all but which of the following? a) Take with a full meal to avoid stomach upset b) Take with a Vitamin D supplements c) Take with milk if GI upset occurs d) Take 1 to 1 1/2 hours after meals - ANSWER: A A client is diagnosed with an elevated serum calcium level and is symptomatic. Which of the following interventions would be appropriate for this client? Select all that apply. a) Be gentle when moving the patient b) Administer diuretics as prescribed c) Strain urine for stones d) Restrict fluids e) Administer intravenous fluids as prescribed - ANSWER: ABCE A nurse is assessing a client for Chvostek's sign. Which of the following techniques should the nurse use to perform this test?

a) Place the stethescope's bell over the clients carotid artery b) Apply a BP cuff to the client's arm c) Tap lightly on the client's face just anterior to the ear d) Ask the client to lower the chin to the chest - ANSWER: C A nurse is caring for a client who has a NG tube attached to low intermittent suctioning. The nurse should monitor for which of the following electrolyte imbalances? a) Hyperphosphatemia b) Hypercalcemia c) Hyponatremia d) Hyperkalemia - ANSWER: C A nurse is caring for a client with total parenteral nutrition infusing. Which of the following interventions are appropriate by the nurse? Select all that apply. a) Infusion through a micron filter attached to the tubing b) Infusion administered through a peripheral line c) Administration through an IV pump only d) FSBS assessment every 4 - 6 hours e) IV bag and tubing changed every 48 hours - ANSWER: ACD A normal serum sodium level is? a) 1.5 - 2.5 mg/dL b) 3.5 - 5.0 meq/L c) 135 - 145 meq/mL d) 8 - 10 mg/dL - ANSWER: C A common cause of hypomagnesemia is: a) Renal disease b) Alcohol ingestion

c) Increased consumption of magnesium containing antacids d) Malnutrition - ANSWER: D Which of the following terms describes the force against which the left ventricle must expel blood (systematic vascular resistance), according to the "balloon theory". a) Contractility b) Preload c) Cardiac output d) Afterload - ANSWER: D A client asks the nurse why it is important to be weighed every day if he has heart failure. How will the nurse respond? a) "Weighing you every day will help us make sure that you are eating properly." b) "The hospital requires that all inpatients be weight daily." c) "You need to lose weight to decrease the incidence of heart failure." d) "Weight is the best indication that you are gaining or losing fluid." - ANSWER: D A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client with heart failure. Which instructions should the nurse provide to the UAP when delegating care for this? Select all that apply. a) "Accurately record intake and output." b) "Reposition the client every 2 hours." c) "Place the patient on oxygen if the client becomes short of breath." d) "Teach the client to perform deep breathing exercises." e) "Use the same scale to weigh the client each morning." - ANSWER: ABE A normal cardiac ejection fraction is ______% or higher - ANSWER: 50 Which diagnostic lab test would be the most diagnostic to determine if a patient admitted with acute shortness of breath has heart failure?

a) Serum creatinine kinase (CK) b) Human B-type natriuretic peptide (hBNP) c) 12 lead electrocardiogram d) Arterial blood gasses (ABG) - ANSWER: B Which statement made by a client would alert the nurse to the possibility of right sided heart failure? a) "My shoes fit really tight". b) "I woke up coughing every night". c) "I have trouble catching my breath". d) "I sleep with four pillows at night." - ANSWER: A Which statement by the patient with chronic heart failure should cause the nurse to determine that additional discharge teaching is needed? a) "I should weigh myself every morning and go on a diet if I gain more than 3 pounds in 2 days." b) "I plan to organize my household tasks so I don't have to constantly go up and down stairs." c) "I will call my health clinic if I wake up breathless at night" d) "I will look for sodium content on labels of foods and over the counter medicines." - ANSWER: A A nurse admits a client who is experiencing acute decompensated heart failure. Which action should the nurse take first? a) Draw blood to assess the client's serum electrolytes b) Ask the client about current medications c) Assess the client's respiratory status and lung sounds d) Administer intravenous furosemide (Lasix) - ANSWER: C How do angiotensin-converting enzyme (ACE) inhibitors, such as enalapril (Vasotec), work to reduce heart failure? a) decrease cardiac contractility b) reduce preload c) promote the retention of sodium and water in the renal tubules

d) reduce afterload - ANSWER: D A nurse assesses a client in an outpatient clinic. Which statement alerts the nurse to the possibility of left sided heart failure? a) "I have experienced blurred vision on several occasions." b) "I am awakened by the need to urinate at night." c) "I have been drinking more water than usual." d) "I must stop halfway up the stairs to catch my breath." - ANSWER: D The nurse is implementing a discharge teaching plan for a client with heart failure. When discussing fluid status with the client, the nurse would explain the importance of doing which of the following? a) Taking a single dose of diuretic if there is decreased urination for several days b) Report a weight gain of 4 or more pounds in a week c) Keeping track of daily output and calling the health care provider if it is less than 1 liter on any day d) Restricting fluid intake to approximately 800 ml per day - ANSWER: B The acronym FACES is used to help educate patients to identify symptoms of heart failure. What does this acronym mean? a) Factors of risk: activity,cough, emotional upsets, salt intake b) Fatigue, limitation of activities, chest congestion/cough, edema, shortness of breath c) Follow activity plan, continue exercise, and know signs of problems d) Frequent activity leads to cough in the elderly and swelling - ANSWER: B A nurse is caring for a client who has heart failure and reports increasing shortness of breath. The nurse increases the client's oxygen per protocol. Which of the following actions should the nurse take next? a) Obtain the client's weight b) Assist the client into a high-Fowler's position c) Auscultate the lung sounds d) Check oxygen saturation with pulse oximeter - ANSWER: D

A 45 year old client's blood pressure has been measured at 130/86 mmHg on two separate occasions at two different times of day. The nurse realizes this classifies the patient as Stage 1 hypertensive. a) True b) False - ANSWER: B A student nurse asks what "essential (primary) hypertension" is. What response by the registered nurse is best? a) "It means it is "essential" that it be treated" b) "It is hypertension with both genetic and environmental factors." c) "It refers to severe and life-threatening hypertension." d) "It means it is caused by another disease." - ANSWER: B The systolic blood pressure range for pre-hypertension classification is 120-139 with a diastolic of 80-89. a) True b) False - ANSWER: A Which of the following should the nurse instruct a client who desires to reduce his blood pressure through increasing his physical activity? a) Regular aerobic exercise 3 times/week has the greatest effect on controlling blood pressure. b) Regular exercise has to be done for at least 2 hours each day c) Regular anaerobic exercise can lower the blood pressure by 10 - 20 mmHg d) Regular exercise must be done 7 days a week - ANSWER: A Which of the following assessment questions would be appropriate for the nurse to use when assessing a client for hypertension. Select all that apply. a) Do you wake up with headaches b) Do you use nicotine products c) Do you experience cold sweats d) Do you consume alcohol products e) Do you feel hungry at night - ANSWER: ABD

Which information should the nurse include when teaching a patient with newly diagnosed hypertension? a) Hypertension is usually asymptomatic until target organ damage occurs. b) Annual BP checks are needed to monitor treatment effectiveness c) Increasing physical activity will control blood pressure for most patients d) Most patients are able to control blood pressure through dietary changes - ANSWER: A The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the healthcare provider? a) Serum potassium of 4.5 meq/L b) Blood glucose level of 96 mg/dL c) Serum creatinine of 2.8 mg.dL d) Serum hemoglobin of 14.7g/dL - ANSWER: C A client with hypertension is instructed to reduce his daily intake of sodium to? a) 500 mg/day b) 1500 mg/day c) 200 mg/day d) 2000 mg/day - ANSWER: B A client has been diagnosed with hypertension but does not take the antihypertensive medications because of a lack of symptoms. What response by the nurse is best? a) Most people with hypertension do not have symptoms b) You are lucky. Most people get severe morning headaches c) Do you have trouble affording your medications? d) You need to take your medication or you'll get kidney failure - ANSWER: A A client is 4 hours postoperative after a femoropopliteal bypass. The client reports throbbing leg pain on the affected side, rated as 7/10. What action by the nurse takes priority?

a) Document the findings in the client's chart. b) Assess distal pulses and skin color. c) Administer pain medication as ordered. d) Notify the surgeon immediately. - ANSWER: B Which finding indicates venous insufficiency? a) Dependent rubor b) Bluish discoloration of the toes c) Brownish discoloration of the legs d) Muscle atrophy - ANSWER: C Which findings indicates arterial insufficiency? a) Calf tenderness b) Dependent rubor of the legs c) Bluish, discoloration of the toes d) Dependent edema of the legs - ANSWER: C When a client is experiencing a migraine headache, the nurse will plan to assess for? a) Projectile vomiting b) Tearing of the eyes with a runny nose c) Throbbing, fronto-temporal pain d) Nuchal rigidity - ANSWER: B A nurse is teaching a client with chronic migraine headaches. Which statement should the nurse include in this client's teaching? a) "Lie down in a darkened room with the head of the bed elevated when you experience a headache." b) "Place a warm, dry compress on your forehead at the onset of the headache." c) "If you start experiencing an aura, it is an emergency situation and you should call 911." d) "Set your alarm to ensure you do not sleep longer than 6 hours at a time." - ANSWER: A

A nurse assesses a client who has a history of migraines. Which clinical manifestation should the nurse identify as an early sign of a migraine with aura? a) Lethargy b) Visual disturbances c) Vertigo d) Numbness of the tongue - ANSWER: B The client with seizure disorder develops stiffening of the muscles of the arms and legs, followed by an immediate loss of consciousness and jerking of all extremities. How will the nurse document this seizure activity? a) Generalized absence seizure b) Generalized atonic seizure c) Generalized myoclonic seizure d) Generalized tonic-clonic seizure - ANSWER: D A nurse assesses a client who is experiencing a cluster headache. Which clinical manifestations should the nurse expect to find? a) Exophthalmos b) Lasts 30 minutes to 2 hours c) Abrupt loss of consciousness d) Pain on both sides of the head - ANSWER: B An absence seizure is classified as a: a) Focal seizure b) Complex, partial seizure c) Generalized seizure d) Simple, partial seizure - ANSWER: C

A nurse plans care for a client with epilepsy who is admitted to the hospital. Which interventions should the nurse include in this client's plan of care? Select all that apply. a) Have suction equipment at the bedside b) Ensure that the client has IV access c) Permit only clear liquid fluids d) Maintain the client on strict bedrest e) Place a padded tongue blade between the patient's teeth during a seizure - ANSWER: AB In the client with a history of complex partial seizures, which clinical symptom will the nurse assess for? a) Blank staring b) Brief jerking of all four extremities c) Sudden loss of muscle tone d) Lip smacking, patting and pulling on clothes - ANSWER: D After teaching a client newly diagnosed with a seizure disorder, the nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching? a) "I will wear a medical alert bracelet at all times." b) "While taking my seizure medications, I will not drink alcoholic beverages." c) "I wil tell my doctor about prescription and over the counter medications I take." d) "If I am nauseated, I will not take my seizure medication." - ANSWER: D List four observations you would document for a patient who is experiencing a seizure - ANSWER: a) Duration b) type of seizure c) nursing interventions d) clients VS and LOC after the seizure