MASTERY SERIES (CMS) EXAM PRACTICE QUESTIONS
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A nurse is caring for several clients. Which client does the nurse assess most
carefully for hyperkalemia?
a. client with type 2 diabetes taking an oral anti-diabetic agent
b. client with heart failure using a salt substitute
c. client taking a thiazide diuretic for hypertension
d. client taking non-steroidal anti-inflammatory drugs daily - ANSWER: B
Many salt substitutes are composed of potassium chloride. Heavy use cna
contribute to the development of hyperkalemia. The client should be taught to read
labels and to choose a salt substitute that does not contain potassium. NSAIDs
promote the retention of sodium but not potassium.
An older adult client presents with signs and symptoms related to dig toxicity.
Which age related change may have contributed to this problem?
a. decreased renal blood flow
b. increased gastrointestinal motility
c. decreased ratio of adipose tissue to lean body mass
d. increased total body water - ANSWER: A
Decreased renal blood flow and reduced glomerular filtration can result in slower
medication excretion time, potentially leading to toxic drug accumulation. Aging
,results in decreased total body water and gastrointestinal motility and an increase
in the ratio of adipose tissue to lean body mass, but is not related to dig toxicity.
A client is being treated for dehydration. Which statement made by the client
indicates understanding of this condition?
a. I will use a salt substitute when making and eating my meals. I
b. must drink a quart of water or other liquid each day.
c. I will not drink liquids after 6 PM so I won't have to get up at night.
d. I will weigh myself each morning before I eat or drink. - ANSWER: D
Because 1 L of water weighs 1 kg, change in body weight is a good measure of
excess fluid loss or fluid retention. Weight loss greater than 0.5 lb daily is
indicative of excessive fluid loss. The other statements are not indicative of
practices that will prevent dehydration.
The nurse notes that the handgrip of the client with hypokalemia has diminished
since the previous assessment one hour ago. Which intervention by the nurse is the
priority?
a. assess the client's respiratory rate, rhythm, and depth
b. document findings and monitor the client
c. measure the client's pulse and blood pressure
d. call the health care provider - ANSWER: A
In a client with hypokkalemia, progressive skeletal muscle weakness is associated
with increasing severity of hypokalemia. The most lifethreatening complication of
hypokalemia is respiratory insufficiency. It is imperative for the nurse to perform a
respiratory assessment first to make sure that the client is not in immediate
,jeopardy. Next, the nurse would call the health care provider to obtain orders for
potassium replacement.
The physician orders Lasix (furosemide) 60 mg po every day for your patient. On
hand you have Lasix 40 mg. How many tablets will you give the patient?
a. 3
b. 1
c. 1 1/2
d. 2 1/5 - ANSWER: C
60/40 (desired/have)
A client has been taught to restrict dietary sodium. Which food selection by the
client indicates to the nurse that teaching has been effective?
a. a grilled cheese sandwich with tomato soup
b. Chinese take-out, including steamed rice
c. a chicken leg, one slice of bread with butter, and steamed carrots
d. slices of ham and cheese on whole grain crackers - ANSWER:
ANSWER C
Clients on restricted sodium diets generally should avoid processed, smoked, and
pickled foods and those with sauces and other condiments. Foods lowest in sodium
include fish, poultry, and fresh produce. The chinese food likely would have soy
sauce, the tomato soup is processed, and the crackers are a snack food - a category
of foods often high in sodium.
, When a client is assessed, which behavior best indicates that he or she is
experiencing changes associated with acute pain?
a. inability to concentrate
b. expressed hopelessness
c. psychosocial withdrawal
d. anger and hostility - ANSWER: A
The characteristics most common to chronic pain are psychosocial withdrawal,
anger and hostility, depression, and hopelessness. The inability to concentrate is
associated much more with acute pain, before any physiologic or behavioral
adaptation has occurred.
A nurse is caring for several clients at risk for overhydration. The nurse assesses
the older client with which finding first?
A) Has had diabetes mellitus for 12 years
B) Had abdominal surgery and has a nasogastric tube
C) Just received 3 units of packed red blood cells
D) Uses sodium-containing antacids frequently - ANSWER:
C
Blood replacement therapy involves intravenous fluid administration, which
inherently increases the risk for overhydration. The fact that the fluid consists of
packed red blood cells greatly increases the risk, because this fluid increases the
colloidal oncotic pressure of the blood, causing fluid to move from interstitial and
intracellular spaces into the plasma volume. An older adult may not have sufficient
cardiac or renal reserve to manage this extra fluid.