411 Exam 2 Questions
The nurse is caring for a client with hypovolemic shock who is bleeding from a traumatic
injury to the upper chest wall. What is the priority nursing action?
A. Insert a large-bore IV catheter
B. Administer supplemental oxygen
C. Elevate the client's feet, keeping the head flat
D. Apply direct pressure to the area of overt bleeding - answerD. Apply direct pressure
to the area of overt bleeding
A client in the progressive stage of hypovolemic shock has all of the following signs,
symptoms, or changes. Which signs will the nurse attribute to ongoing compensatory
mechanisms? Select all that apply.
A. Increasing pallor
B. Increasing thirst
C. Increasing confusion
D. Increasing heart rate
E. Increasing respiratory rate
F. Decreasing systolic blood pressure
G. Decreasing blood pH
H. Decreasing urine output - answerA. Increasing pallor
B. Increasing thirst
D. Increasing heart rate
E. Increasing respiratory rate
H. Decreasing urine output
The nurse is reviewing the laboratory profile of a client with hypovolemic shock. What
laboratory value will the nurse anticipate?
A. pH: 7.51
B. PaO2: 106 mm Hg
C. PaCO2: 49 mm Hg
D. Lactate: 0.4 mmol/L - answerC. PaCO2: 49 mm Hg
The nurse is teaching a client's family regarding the diagnosis of septic shock. Which
teaching will the nurse include? Select all that apply.
A. "The blood cultures will tell us for sure if your loved one has septic shock."
B. "The client's change in behavior and lethargy may be associated with septic shock."
C. "Antibiotics, as prescribed, will be started within the hour to treat the sepsis."
D. "An insulin drip has been started to keep the client's glucose as low as possible."
,E. "Septic shock is easily treated with multiple antibiotics." - answerB. "The client's
change in behavior and lethargy may be associated with septic shock."
C. "Antibiotics, as prescribed, will be started within the hour to treat the sepsis."
A 62-year-old client was admitted 2 days ago with traumatic injuries and hypovolemic
shock. Which lab result is most important for the nurse to report to the health care
provider immediately?
A. Serum sodium 132 mEq/L (mmol/L)
B. Serum potassium 6.9 mEq/L (mmol/L)
C. Blood urea nitrogen 24 mg/dL (mmol/L)
D. Hematocrit 32% (0.32 volume fraction); hemoglobin 9.2 g/dL (92 g/L) - answerB.
Serum potassium 6.9 mEq/L (mmol/L)
The nurse is caring for a 74-year-old client scheduled for a cardiac catheterization with
contrast dye. What nursing action is appropriate? Select all that apply.
A. Assess creatinine clearance using a 24-hour urine collection test.
B. Assess for coexisting conditions of diabetes, heart failure, and kidney disease.
C. Collaborate with the provider about whether IV fluids should be infused before the
test.
D. Notify the provider regarding changes in serum creatinine from 0.2 to 0.4 mg/dL in 24
hours.
E. Alert the provider to a glomerular filtration rate (GFR) below 60 mL/min/1.73 m2. -
answerB. Assess for coexisting conditions of diabetes, heart failure, and kidney
disease.
C. Collaborate with the provider about whether IV fluids should be infused before the
test.
E. Alert the provider to a glomerular filtration rate (GFR) below 60 mL/min/1.73 m2.
The nurse is preparing a client with stage 3 CKD for discharge. Which client statement
indicates the need for further teaching?
A. "I will be sure to attend my follow-up appointment with my nephrologist."
B. "I will increase my protein intake so my body can heal."
C. "I will weigh myself daily and call the doctor if my weight increases by 2 lb or more."
D. "I will take my blood pressure each day and keep a daily log." - answerB. "I will
increase my protein intake so my body can heal."
The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI).
Which condition would the nurse expect to find in the patient's recent history?
a. Pyelonephritis
b. Dehydration
c. Bladder cancer
d. Kidney stones - answerANS: B
, Prerenal causes of AKI are related to a decrease in perfusion, such as in clients who
have prolonged dehydration. Pyelonephritis is an intrinsic or intrarenal cause of AKI
related to kidney damage. Bladder cancer and kidney stones are postrenal causes of
AKI related to urine flow obstruction.
A marathon runner comes into the clinic and states "I have not urinated very much in
the last few days." The nurse notes a heart rate of 110 beats/min and a blood pressure
of 86/58 mmHg. Which action by the nurse is most appropriate?
a. Give the client a bottle of water immediately.
b. Start an intravenous line for fluids.
c. Teach the patient to drink 2 to 3 L of water daily.
d. Perform an electrocardiogram. - answerANS: A
This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood
pressure. The nurse can start hydrating the client with a bottle of water first, followed by
teaching the patient to drink 2 to 3 L of water each day. An intravenous line may be
needed later, after the patient's degree of dehydration is assessed. An
electrocardiogram is not necessary at this time.
A client comes into the emergency department with a serum creatinine of 2.2 mg/dL
(1944 mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What
question would the nurse ask first when taking this client's history?
a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?"
b. "Do you have anyone in your family with renal failure?"
c. "Have you had a diet that is low in protein recently?"
d. "Has a relative had a kidney transplant lately?" - answerANS: A
There are some medications that are nephrotoxic, such as the non-steroidal anti-
inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a good question to
initially ask the patient since both the serum creatinine and BUN are elevated, indicating
some renal problems. A diet high in protein could be a factor in an increased BUN.
A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day.
What is the major concern of the nurse regarding this patient's care?
a. Edema and pain
b. Cardiac and respiratory status
c. Electrolyte and fluid imbalance
d. Mental health status - answerANS: C
This client may have an inflammatory cause of AKI with proteins entering the
glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid
balance are essential. Edema and pain are not usually a problem with fluid loss. There
The nurse is caring for a client with hypovolemic shock who is bleeding from a traumatic
injury to the upper chest wall. What is the priority nursing action?
A. Insert a large-bore IV catheter
B. Administer supplemental oxygen
C. Elevate the client's feet, keeping the head flat
D. Apply direct pressure to the area of overt bleeding - answerD. Apply direct pressure
to the area of overt bleeding
A client in the progressive stage of hypovolemic shock has all of the following signs,
symptoms, or changes. Which signs will the nurse attribute to ongoing compensatory
mechanisms? Select all that apply.
A. Increasing pallor
B. Increasing thirst
C. Increasing confusion
D. Increasing heart rate
E. Increasing respiratory rate
F. Decreasing systolic blood pressure
G. Decreasing blood pH
H. Decreasing urine output - answerA. Increasing pallor
B. Increasing thirst
D. Increasing heart rate
E. Increasing respiratory rate
H. Decreasing urine output
The nurse is reviewing the laboratory profile of a client with hypovolemic shock. What
laboratory value will the nurse anticipate?
A. pH: 7.51
B. PaO2: 106 mm Hg
C. PaCO2: 49 mm Hg
D. Lactate: 0.4 mmol/L - answerC. PaCO2: 49 mm Hg
The nurse is teaching a client's family regarding the diagnosis of septic shock. Which
teaching will the nurse include? Select all that apply.
A. "The blood cultures will tell us for sure if your loved one has septic shock."
B. "The client's change in behavior and lethargy may be associated with septic shock."
C. "Antibiotics, as prescribed, will be started within the hour to treat the sepsis."
D. "An insulin drip has been started to keep the client's glucose as low as possible."
,E. "Septic shock is easily treated with multiple antibiotics." - answerB. "The client's
change in behavior and lethargy may be associated with septic shock."
C. "Antibiotics, as prescribed, will be started within the hour to treat the sepsis."
A 62-year-old client was admitted 2 days ago with traumatic injuries and hypovolemic
shock. Which lab result is most important for the nurse to report to the health care
provider immediately?
A. Serum sodium 132 mEq/L (mmol/L)
B. Serum potassium 6.9 mEq/L (mmol/L)
C. Blood urea nitrogen 24 mg/dL (mmol/L)
D. Hematocrit 32% (0.32 volume fraction); hemoglobin 9.2 g/dL (92 g/L) - answerB.
Serum potassium 6.9 mEq/L (mmol/L)
The nurse is caring for a 74-year-old client scheduled for a cardiac catheterization with
contrast dye. What nursing action is appropriate? Select all that apply.
A. Assess creatinine clearance using a 24-hour urine collection test.
B. Assess for coexisting conditions of diabetes, heart failure, and kidney disease.
C. Collaborate with the provider about whether IV fluids should be infused before the
test.
D. Notify the provider regarding changes in serum creatinine from 0.2 to 0.4 mg/dL in 24
hours.
E. Alert the provider to a glomerular filtration rate (GFR) below 60 mL/min/1.73 m2. -
answerB. Assess for coexisting conditions of diabetes, heart failure, and kidney
disease.
C. Collaborate with the provider about whether IV fluids should be infused before the
test.
E. Alert the provider to a glomerular filtration rate (GFR) below 60 mL/min/1.73 m2.
The nurse is preparing a client with stage 3 CKD for discharge. Which client statement
indicates the need for further teaching?
A. "I will be sure to attend my follow-up appointment with my nephrologist."
B. "I will increase my protein intake so my body can heal."
C. "I will weigh myself daily and call the doctor if my weight increases by 2 lb or more."
D. "I will take my blood pressure each day and keep a daily log." - answerB. "I will
increase my protein intake so my body can heal."
The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI).
Which condition would the nurse expect to find in the patient's recent history?
a. Pyelonephritis
b. Dehydration
c. Bladder cancer
d. Kidney stones - answerANS: B
, Prerenal causes of AKI are related to a decrease in perfusion, such as in clients who
have prolonged dehydration. Pyelonephritis is an intrinsic or intrarenal cause of AKI
related to kidney damage. Bladder cancer and kidney stones are postrenal causes of
AKI related to urine flow obstruction.
A marathon runner comes into the clinic and states "I have not urinated very much in
the last few days." The nurse notes a heart rate of 110 beats/min and a blood pressure
of 86/58 mmHg. Which action by the nurse is most appropriate?
a. Give the client a bottle of water immediately.
b. Start an intravenous line for fluids.
c. Teach the patient to drink 2 to 3 L of water daily.
d. Perform an electrocardiogram. - answerANS: A
This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood
pressure. The nurse can start hydrating the client with a bottle of water first, followed by
teaching the patient to drink 2 to 3 L of water each day. An intravenous line may be
needed later, after the patient's degree of dehydration is assessed. An
electrocardiogram is not necessary at this time.
A client comes into the emergency department with a serum creatinine of 2.2 mg/dL
(1944 mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What
question would the nurse ask first when taking this client's history?
a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?"
b. "Do you have anyone in your family with renal failure?"
c. "Have you had a diet that is low in protein recently?"
d. "Has a relative had a kidney transplant lately?" - answerANS: A
There are some medications that are nephrotoxic, such as the non-steroidal anti-
inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a good question to
initially ask the patient since both the serum creatinine and BUN are elevated, indicating
some renal problems. A diet high in protein could be a factor in an increased BUN.
A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day.
What is the major concern of the nurse regarding this patient's care?
a. Edema and pain
b. Cardiac and respiratory status
c. Electrolyte and fluid imbalance
d. Mental health status - answerANS: C
This client may have an inflammatory cause of AKI with proteins entering the
glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid
balance are essential. Edema and pain are not usually a problem with fluid loss. There
