Module 13

A nurse is caring for a client who has hyponatremia. Which of the following findings or interventions should the nurse expect? (Select all that apply.)

• Sodium level of 127 mEq/L

• Sodium Level of 147 mEq/L

• A client reporting headache and fatigue

• A prescription for the client to drink as much water as possible

A nurse is calculating a clients I&O for the last 4 hrs. The client consumed 480 mL of water and 240 mL of coffee. The client has also received IV fluids for 4 hrs infusing at 100mL/hr. What is the total amount of the clients intake over the last 4 hrs?

A nurse is receiving report on four clients. The nurse should identify that which of the following clients might be experiencing hypomagnesemia?

• A client who has vomited 4 times in the last 8 hrs

• A client who requested an extra breakfast tray to eat

• A client who can ambulate w/o assistance

• a client who reports extreme thurst

A nurse has completed collecting data for a client who has an acid-base imbalance. which of the following steps of the nursing process should the nurse take next?

• Implementation

• Re-collection of data

• Evaluate

• Planning

A nurse is assisting in the care for a client who requires a replacement peripheral IV. The client is dehydrated and requires a smaller gauge catheter than the #20-gauge being replaced. Which of the following gauge catheters should the nurse recommend using?

• 16 Gauge

• 14 Gauge

• 22 Gauge

• 12 gauge

A nurse is caring for a client who has an acid-base imbalance and is experiencing hypoxia. Which of the following actions should the nurse take?

• Initiate continuous cardiac monitoring

• Elevate the head of the clients bed

• Instruct the client to deep breathe and cough

• Initiate continuous SpO2 monitoring

A nurse is monitoring a client who has metabolic acidosis after interventions have been initiated. Which step of the nursing process is next?

• Data collection

• Planning

• Evaluation

• Implementation

A nurse is educating a group of newly licensed nurses about manifestations of Metabolic Acidosis. Which of the following manifestations should the nurse include?

• Severe diarrhea that leads to bicarbonate loss.

• Low pH and low bicarbonate

• Antacid overuse is a cause factor

• High pH and high bicarbonate

A nurse is taking care of a client who has a PICC line in place. The client is due for a medication to be given through the PICC line, along with a dressing change to the site. The nurse is unsure if this is within their scope of practice. Which of the following actions should the nurse take?

• Administer the medication so it will not be administered late

• Change the dressing and ask another nurse to give the medication

• Refer to the state’s Nurse Practice Act

• Refuse to carry out the orders

A nurse receives the following prescription: Infuse 3,000 mL of normal saline over 15 hours. At what hourly rate should the nurse set the IV pump?

• 200mL/hr

• 3500ml/hr

• 1234mL/hr

• 150mL/hr