, Question 1
A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA).
The provider orders an IV insulin infusion at 0.1 units/kg/hr. The client weighs
80 kg. The pharmacy supplies insulin 100 units in 100 mL 0.9% NaCl. What
rate (mL/hr) should the nurse set on the infusion pump?
A. 8 mL/hr
B. 0.8 mL/hr
C. 80 mL/hr
D. 4 mL/hr
Correct Answer: A - 8 mL/hr
RATIONALE
Dose = 0.1 units/kg/hr × 80 kg = 8 units/hr. Concentration = 100
units/100 mL = 1 unit/mL, so 8 units/hr = 8 mL/hr. Options B, C, and
D reflect miscalculations (decimal error, factor-of-10 error, or using
0.05 units/kg/hr).
Question 2
A client with an acute ischemic stroke is being evaluated for thrombolytic
therapy. Which finding would most likely exclude the client from receiving IV
alteplase?
A. Blood pressure 186/102 mm Hg
B. INR 1.1
C. Platelet count 210,000/mm³
D. Serum glucose 140 mg/dL
Correct Answer: A - Blood pressure 186/102 mm Hg
Page 2
, RATIONALE
IV alteplase is contraindicated when BP exceeds 185/110 mm Hg
despite treatment, due to hemorrhagic transformation risk. INR 1.1,
platelet count 210,000, and glucose 140 are within acceptable limits
and do not exclude thrombolysis.
Question 3
Which arterial blood gas values indicate uncompensated respiratory acidosis?
A. pH 7.28, PaCO 55 mm Hg, HCO 24 mEq/L
B. pH 7.32, PaCO 48 mm Hg, HCO 28 mEq/L
C. pH 7.48, PaCO 30 mm Hg, HCO 22 mEq/L
D. pH 7.35, PaCO 40 mm Hg, HCO 24 mEq/L
Correct Answer: A - pH 7.28, PaCO 55 mm Hg, HCO 24 mEq/L
RATIONALE
Uncompensated respiratory acidosis shows low pH (<7.35) with
elevated PaCO (>45) and normal HCO (22-26). Option B shows
partial compensation (elevated HCO), C is respiratory alkalosis, and D
is normal.
Question 4
A client with chronic kidney disease (CKD) stage 5 has a serum potassium of
6.8 mEq/L. Which intervention should the nurse anticipate as the priority?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Administer IV calcium gluconate
C. Administer regular insulin IV with dextrose
D. Prepare for emergency hemodialysis
Correct Answer: B - Administer IV calcium gluconate
Page 3
A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA).
The provider orders an IV insulin infusion at 0.1 units/kg/hr. The client weighs
80 kg. The pharmacy supplies insulin 100 units in 100 mL 0.9% NaCl. What
rate (mL/hr) should the nurse set on the infusion pump?
A. 8 mL/hr
B. 0.8 mL/hr
C. 80 mL/hr
D. 4 mL/hr
Correct Answer: A - 8 mL/hr
RATIONALE
Dose = 0.1 units/kg/hr × 80 kg = 8 units/hr. Concentration = 100
units/100 mL = 1 unit/mL, so 8 units/hr = 8 mL/hr. Options B, C, and
D reflect miscalculations (decimal error, factor-of-10 error, or using
0.05 units/kg/hr).
Question 2
A client with an acute ischemic stroke is being evaluated for thrombolytic
therapy. Which finding would most likely exclude the client from receiving IV
alteplase?
A. Blood pressure 186/102 mm Hg
B. INR 1.1
C. Platelet count 210,000/mm³
D. Serum glucose 140 mg/dL
Correct Answer: A - Blood pressure 186/102 mm Hg
Page 2
, RATIONALE
IV alteplase is contraindicated when BP exceeds 185/110 mm Hg
despite treatment, due to hemorrhagic transformation risk. INR 1.1,
platelet count 210,000, and glucose 140 are within acceptable limits
and do not exclude thrombolysis.
Question 3
Which arterial blood gas values indicate uncompensated respiratory acidosis?
A. pH 7.28, PaCO 55 mm Hg, HCO 24 mEq/L
B. pH 7.32, PaCO 48 mm Hg, HCO 28 mEq/L
C. pH 7.48, PaCO 30 mm Hg, HCO 22 mEq/L
D. pH 7.35, PaCO 40 mm Hg, HCO 24 mEq/L
Correct Answer: A - pH 7.28, PaCO 55 mm Hg, HCO 24 mEq/L
RATIONALE
Uncompensated respiratory acidosis shows low pH (<7.35) with
elevated PaCO (>45) and normal HCO (22-26). Option B shows
partial compensation (elevated HCO), C is respiratory alkalosis, and D
is normal.
Question 4
A client with chronic kidney disease (CKD) stage 5 has a serum potassium of
6.8 mEq/L. Which intervention should the nurse anticipate as the priority?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Administer IV calcium gluconate
C. Administer regular insulin IV with dextrose
D. Prepare for emergency hemodialysis
Correct Answer: B - Administer IV calcium gluconate
Page 3
