NURSING DEPARTMENT

INSTRUCTOR: KERWIN RICO L. REYES

NCM 112 (CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS,
INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE AND CHRONIC)

Oxygenation-CARDIO VASCULAR/ FLUIDS AND ELECTROLYTES

MIDTERM EXAMINATION
GENERAL INSTRUCTIONS:
Shade your answers on the answer sheet.
Use Black/Blue-inked colored pen.
Write in BOLD LETTERS your last name first followed by your given name in the space provided.
Strictly no erasures, alterations and superimpositions.(DEDUCTION OF 20 PTS ON YOUR RAW SCORE)
Writing on the questionnaire is allowed.
Answer sheets should be clean, tidy, and wrinkled-free as much as possible.
Read and comprehend each test questions.
If you are caught cheating, the proctor will confiscate your paper and disciplinary action will take place.

INSTRUCTIONS: Select the best answer.

1. Mary had her laboratory tests performed to identify damage to the heart muscle. Which of the test is
elevated the earliest with heart damage?
A. CPK-MB.
B. LDH.
C. lipid profile.
D. troponin.

2. Boy George is scheduled for a heart catheterization. In preparation for this examination, which of the
following should the nurse do?
A. remove all metal objects.
B. give the patient a special heart diet.
C. test arterial blood gases.
D. ask if the patient is allergic to seafood or iodine.

3. Maria Palad has been administered atropine sulfate intravenously to treat a dysrhythmia, which of the
following would the nurse monitors?
A. weight gain.
B. tachycardia.
C. muscle twitching.
D. incontinence of urine.

4. Doggie Doug has atrial fibrillation and placed on amiodarone for the dysrhythmia. Which of the following
assessment should the nurse report as an adverse reaction?
A. ataxia.
B. decreasing pulse rate.
C. decreasing blood pressure.
D. increase in cardiac output.

5. Evan has increased cholesterol level. He has a medication of simvastatin (Zocor) to lower down cholesterol
level. Follow-up lipid levels are reviewed by the nurse. Which of the following is the level that indicates the
desired therapeutic range?
A. HDL, 29 mg/dL; LDL, 160 mg/dL.
B. HDL, 38 mg/dL; LDL, 120 mg/dL.
C. HDL, 56 mg/dL; LDL, 106 mg/dL.
D. HDL, 42 mg/dL; LDL, 98 mg/dL.

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6. Miss Hearty Payn has had an acute MI. Which of the following discharge instruction should the nurse to
include?
A. cautions about use of morphine.
B. detailed symptoms that indicate impending MI.
C. written instructions on diet and follow-up appointments.
D. high-energy exercise program directions.

7. Miss Kathy Miew has acute congestive heart failure presents with jugular vein distention, crackles bilaterally,
and dyspnea. Which of the following nursing diagnosis is the highest priority?
A. activity intolerance.
B. excess fluid volume.
C. anxiety.
D. ineffective coping.

8. Mr Perting Toga has acute congestive heart failure. Which of the following nursing intervention would
decrease the workload of the heart?
A. place the patient in a supine position.
B. encourage group activities to promote rest.
C. have the patient cough and deep breathe every 2 hours.
D. encourage large meals for extra needed calories.

9. Miss Bajo is on diuretic medication for congestive heart failure. Which of the following adverse effect should
the nurse reports?
A. increased urinary output.
B. weight loss.
C. thirst.
D. muscle weakness.

10. Junjun is receiving digoxin, 0.25 mg daily. Which of the following should the nurse do before giving the
medication?
A. count an apical pulse for 15 seconds.
B. hold the dose if the apical rate is 57 beats/min.
C. give the dose if the apical rate is 59 beats/min.
D. double the dose if the rate is 62 beats/min.

11. Miss Delicious Sweet is 46-year-old and receiving propranolol (Inderal), a nonselective beta-adrenergic
blocker for his heart condition. Which of the following should the nurse teach to Miss Delicious Sweet?
A. sit or lie down when taking the drug.
B. limit caffeine intake.
C. double the dose if symptoms occur.
D. not stop the drug abruptly.

12. Mr. Abe, the nurse takes a blood pressure with the 65-year-old patient lying down and then again with the
patient standing, with the resultant readings of 152/92 and 130/62. Which of the following should Mr. Abe
record?
A. normal blood pressure for age.
B. orthostatic hypotension.
C. age-related hypertension.
D. exertional hypertension.

13. Mr. Mondragon, the student nurse uses a picture to demonstrate the conduction pathway through the
chambers of the heart. Arrange the following options in the correct sequence:
1. Atria contract
2. Conduction through bundle branches
3. AV node fires
4. Purkinje fibers conduct
5. SA node fires
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 6. Ventricles contract
A. 132465
B. 513246
C. 532461
D. 134265

14. Mikel is a float nurse from labor and delivery is assigned to the cardiac care unit. Which client is most
appropriate for the charge nurse to assign to the float nurse?
A. Client 3 days following a myocardial infarction who is on 6 L of oxygen and reports nausea
B. Client admitted for hypertensive crisis with blood pressure of 154/92 mmHg on amlodipine PO
C. Client with a demand pacemaker set at 70/min who has a ventricular rate of 65/min
D. Client with angina at rest who has normal troponin levels and normal sinus rhythm on ECG

15. Miss Ganda the nurse is caring for a client on IV heparin infusion and oral warfarin. Current laboratory values
indicate that the client’s aPTT is 5 times the control value and the PT/INR is 2 times the control value. What
action does the nurse anticipate?
A. Clarify vegetable consumption
B. Decrease heparin rate
C. Decrease the warfarin dose
D. Obtain an order for vitamin K injection

16. The nurse receives handoff of care report on four clients. Which client should the nurse see first?
A. Client with atrial fibrillation who reports feeling palpitations and has an irregular pulse of 122/min
B. Client with liver cirrhosis who reports bleeding from an IV insertion site and has a platelet count of 48,000
mm3
C. Client with pericarditis whose blood pressure has decreased from 122/70 mmHg to 98/68 mmHg over
the past hour
D. Client with pneumonia whose white blood cell count has increased from 14,000 mm3 8 hours ago to
30,000 mm3

17. Miss Alma with uncontrolled hypertension is prescribed clonidine. What instruction is most important for the
clinic nurse to give this client?
A. Avoid consuming high-sodium foods
B. Change positions slowly to prevent dizziness
C. Don’t stop taking this medication abruptly
D. Use an oral moisturizer to receive dry mouth

18. Miss Istar, a student nurse has just completed discharge teaching about sublingual nitroglycerine tablets to
a client with stable angina. Which statement by the client indicates the need for further teaching?
A. I will call 911 if my chest pain isn’t relieved by NTG
B. If I have chest pain, I can take up to 3 pills 5 minutes apart
C. I ‘ll call my doctor if I start having chest pin at night
D. I’ll keep one bottle in the house and one in the car

19. Mr. Brainy the experienced registered nurse is mentoring Miss Tangadal, a new nurse in the telemetry unit.
Which assessment technique by the Miss Tangadal, the new nurse requires intervention by the Mr. Brainy the
RN?
A. Nurse carefully auscultated for heart murmurs at Erb’s point
B. Nurse palpates bilateral carotid artery simultaneously to assess for symmetry
C. Nurse places client in semi-Fowler’s position to assess for jugular venous distension
D. Nurse position client supine to assess the point of maximal impulse

20. A 45-year-old client with atrial fibrillation has been prescribed diltiazem. Which client outcome would best
indicate that the medication has had its intended effect?
A. Atrial fibrillation is converted to sinus rhythm
B. Blood pressure is 126/78 mmHg
C. No signs or symptoms of stroke

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 D. Ventricular rate decreased from 158/min to 88/min

21. A home health nurse is visiting a client with chronic heart failure. The nurse observes that the client is having
trouble answering questions due to breathlessness and cough. Which action should the nurse take first?
A. Auscultate breath sounds
B. Check peripheral edema
C. Measure the client’s vital signs
D. Review the client’s weight log over the past several days

22. The nurse enters a client’s room just as the student nurse is completing a bath and placing thigh-high anti-
embolism stockings on the client. Which situation would the nurse to intervene?
A. Student nurse applies the anti-embolism stockings while maintaining the client in supine position
B. Student nurse carefully smoothes out any wrinkles over the length of the stockings
C. Student nurse checks that the toe opening of the stockings is located on the plantar side of the foot
D. Student nurse rolls down and olds over the excess material at the top of the stockings

23. The nurse is supervising a graduate nurse on a telemetry unit. An assigned client develops asystole with no
pulse, and emergency care interventions are initiated. Which action by the GN would cause the supervising
nurse to intervene?
A. Administer IV epinephrine
B. Applies oxygen with bag mask
C. Initiates chest compressions
D. Provides defibrillator shock

24. A client with chronic heart failure developed an intractable cough and an incident of angioedema after
starting enalpril. Which prescription does the nurse anticipate for this client?
A. Alprazolam
B. Dextromethorphan
C. Lisinopril
D. Valsartan

25. Miss Okoy the clinic nurse is providing instructions to a client who will be wearing a Holter monitor for the next
24 hours. Which instructions are important to review with the client?
A. How to transmit the readings over the phone
B. Keep a diary of activities and any symptoms experienced
C. Refrain from exercising while wearing the monitor
D. The monitor may be removed only when bathing

26. The nurse notes muffled heart tones in a client with a pericardial effusion. How would the nurse assess for a
pulsus paradoxus?
A. Check for variation in amplitude of QRS complexes on the electrocardiogram strip
B. Compare apical and radial pulses for any deficit
C. Measure the difference between Korotkoff sounds auscultated during expiration and throughout the
respiratory cycle
D. Multiply diastolic blood pressure by 2, add systolic blood pressure, and divide the result by 3

27. Mr. Choy is diagnosed to have Peripheral venous disease. Which clinical finding would the nurse anticipate
in a client with chronic venous insufficiency?
A. Brownish, hardened skin on lower extremities
B. Diminished peripheral pulses
C. Non-healing ulcer on lateral surface of great toe
D. Shinny hairless lower extremities

28. A client with chronic heart failure calls the clinic to report a weight gain of 3 lb (1.36 kg) over the last 2 days.
Which information is most important for the nurse to ask this client?
A. Diet recall for this current week
B. Fluid intake for the past 2 days

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 C. Medications and dosages taken over the past 2 days
D. Presence of shortness of breath, coughing, or edema

29. The nurse is caring for a client with chronic, stable angina. The client takes the long acting nitrate isosorbide
mononitrate. Which client outcome indicates that the drug is effective?
A. Client is able to shower, dress and fix hair without any chest pain
B. Client reports a reduction in stress level and anxiety
C. Client reports being able to sleep through the night
D. Client’s blood pressure is 128/78 mmHg and heart rate is 82/min
30. A client is brought to the emergency department following a motor vehicle collision. The client’s admission
vital signs are blood pressure 70/50 mmHg pulse 123/min and respirations 8/min. The nurse anticipates the
results of which diagnostic test to best evaluate the client’s oxygenation and ventilation status?
A. Arterial gases
B. Chest x-ray
C. Hematocrit and hemoglobin levels
D. Serum level

31. The nurse is assisting with cardiopulmonary resuscitation of a client in cardiac arrest. The rhythm in the exhibit
is displayed on the cardiac monitor. Which medication administration should the nurse anticipate?

A. Adenosine IV
B. Dopamine IV
C. Magnesium IV
D. Metoprolol IV

32. The nurse working in the intensive care unit hears an alarm coming from a client’s room. On entering the
room, the nurse sees the rhythm displayed in the exhibit on the monitor. The nurse recognizes it as which
rhythm?

A. Asystole
B. Atrial fibrillation
C. Ventricular fibrillation
D. Ventricular tachycardia

33. The telemetry is reviewing a client’s cardiac rhythm strip. What is the correct interpretation for this strip?

A. Atrial paced rhythm

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 B. First degree atrioventricular block with bigeminy
C. Sinus rhythm with premature ventricular contractions
D. Ventricular paced rhythm with failure to sense

34. After the nurse receives the change of shift report, which client should the nurse assess first?
A. Client with asthma who has shortness of breath and high-pitched expiratory wheezing
B. Client with diabetes and a stasis leg ulcer dressing saturated with serosanguineous drainage
C. Client with heart failure who is short of breath and coughing up pink frothy sputum
D. Client with left pleural effusion and absent breath sounds in the left base

35. A client with long term hypertension and hypercholesterolemia comes to the clinic for annual check-up. The
client takes nifedipine, simvastatin, and spironolactone and reports some occasional dizziness. Which
statement by the client would warrant intervention by the nurse?
A. I’ve been better about walking for 20 minutes 3 days a week on my treadmill
B. I’ve been trying to eat more fruits and vegetables I discovered that I rely like grapefruit
C. I’ve heard that having a glass of red wine with dinner every night is good for my heart
D. We no longer add salt when preparing meals. It has really been hard to get used to that

36. The nurse prepares to administer morning medications to assigned clients. Which prescription should the
nurse clarify with the health care provider?
A. Clopidogrel for client with history of stroke and platelet count of 154,000/mm3
B. Losartan for client with hypertension who is 8 weeks pregnant
C. Prednisone for client with herpes simplex lesion and Bell palsy
D. Tiotropium for client with pneumonia and chronic obstructive pulmonary disease

37. A 65-year-old client end-stage renal disease comes to the emergency department after missing 5
hemodialysis session. Serum potassium level is 7.5 mEq/L and ECG shows tall peaked T waves. Which
prescription will immediately protect the client from experiencing dysrhythmias associated hyperkalemia?
A. Intravenous calcium gluconate
B. Intravenous regular insulin with dextrose
C. Oral sodium polystyrene sulfonate
D. Transport to hemodialysis unit
38. A nurse is reviewing the most recent laboratory results of a client on the telemetry floor. The client is currently
asymptomatic, and the telemetry monitor indicates sinus rhythm. Which of the following critical values is
most likely due to laboratory error?
A. Blood urea nitrogen (BUN) of 60 mg/dL
B. Creatinine of 4.0 mg/dL
C. Potassium of 7.0 mEq/L
D. Sodium of 155 mEq/L

39. The nurse has just completed discharge teaching for a client who had aortic valve replacement with a
mechanical heart valve. Which statement by the client indicates that teaching has been effective?
A. I’m glad that I can continue taking my Gingko biloba
B. I will increase my intake of leafy green vegetables
C. I will start applying vitamin E to my chest incision after showering
D. I will shave with an electric razor from now on

40. A client with myocardial infarction underwent successful revascularization with stent placement, is now
chest pain free, and will be attending cardiac rehabilitation as an outpatient. The client is embarrassed to
talk to the health care provider about resuming sexual relations after an MI. what teaching should the nurse
initiate with this client?
A. If the client is able to climb 2 flights of stairs without symptoms, the client may be ready for sexual
activity if approved by HCP
B. Inform the client that medications such as sildenafil or tadalafil are available as prescriptions from HCP
C. It will be 6 months before the heart is healthy enough for sexual activity
D. The client will be ready for sexual activity after completion of cardiac rehabilitation

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41. A client with heart failure is started on furosemide. The laboratory results are shown in the exhibit. The nurse is
most concerned about which condition?

A. Atrial fibrillation
B. Atrial flutter
C. Mobitz II
D. Torsades de pointes

42. The Student nurse on the cardiac floor reports to the registered nurse that during the first vital sign
measurement on the shift, a client’s blood pressure measured 198/102 mmHg on the automated blood
pressure machine. What action should the nurse take first?
A. Have the unlicensed assistive personnel recheck the client’s blood pressure
B. Immediately notify the health care provider
C. Obtain the client’s PRN labetalol from the medication dispensing machine
D. Recheck the client’s blood pressure with a manual cuff

43. A client develops sinus bradycardia with blood pressure of 90/40 mm Hg and a heart rate of 46/min. Which
of the following actions should the nurse take?
A. Give schedule dose of metoprolol 50 mg orally
B. Instruct to cough forcefully
C. Place client in reverse Trendelenburg position
D. Prepare to administer atropine 0.5 mg intravenous push

44. The student nurse observes the respiratory therapist preparing to draw an arterial blood gas from the radial
artery. The RT performs the Allen’s test and the student asks why this test performed before the blood sample
is drawn. Which statement made by the RT is most accurate?
A. The Allen’s test is done to determine if capillary refill is adequate
B. The Allen’s test is done to determine if the radial pulse is palpable
C. The Allen’s test is done to determine the patency of the ulnar artery
D. The Allen’s test is done to determine the presence of a neurologic deficit

45. A nurse in the emergency department is titrating a continuous infusion of nitroglycerine to a client admitted
for acute coronary syndrome. The client’s vital signs, including blood pressure, heart rate, and pain level are
being monitored frequently. Which assessment findings indicate that the current rate of administration
should be maintained?
A. BP 80/50 mmHg, HR 110/min, client reports pain is 0 out of 10
B. BP 100/60 mmHg, HR 90/min, client reports pain is 3 out of 10
C. BP 110/70 mmHg, HR 80/min, client reports pain is 0 out of 10
D. BP 120/80 mmHg, HR 70/min, client reports pain is 5 out of 10

46. What intervention is essential prior to standing a client on atorvastatin therapy?

A. Assessing for muscle strength
B. Assessing the client’s dietary intake
C. Determining if the client is on digoxin therapy
D. Monitoring liver function tests

47. The nurse teaches the client taking atorvastatin to call the health care provider if experiencing which
symptom associated with a serious effect of atorvastatin?
A. Diarrhea
B. Headache
C. Muscle aches

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 D. Numbness in the feet

48. A client diagnosed with heart failure has an 8-hour urine output of 200 mL. What is the nurse’s first action?
A. Auscultate the client’s breath sounds
B. Encourage the client to increase fluid intake
C. Report the findings to the health care provider
D. Start an intravenous line for diuretic administration

49. During assessment of a client who underwent a coronary artery bypass graft 10 hours ago, the nurse notes
that the amount of drainage from the mediastinal chest tube has decreased from 100 mL to 20 mL over the
last hour. Which of the following nursing actions is appropriate?
A. Auscultate the client’s heart sounds
B. Notify the client’s health care provider
C. Position the tubing with a dependent loop
D. Strip the chest tube to remove possible clots

50. An elderly client with depression, diabetes mellitus, and heart failure has received a new digoxin
prescription for daily use. Which client assessment indicates that the nurse should follow up on serum digoxin
levels frequently?
A. Apical heart rate is 62/min
B. Blood sugar level is 240 mg/dL
C. Client is taking 20 mg fluoxetine daily
D. Serum creatinine is 2.3 mg/dL

51. A male client with hypertension was prescribed amlodipine. Which of these adverse effects is most
important to teach the client to watch for?
A. Erectile dysfunction
B. Dizziness
C. Dry cough
D. Leg edema

52. A hospitalized client has been treated for the past 48 hours with a continuous heparin infusion for a deep
vein thrombosis(DVT). When the nurse prepares to administer the evening dose of warfarin, the client’s
spouse says, Wait! My spouse can’t have that. My spouse is already getting heparin for DVT. How should the
nurse response?
A. Both medication will be given for several days until the warfarin has time to take effect
B. I will be discontinuing the heparin infusion as soon as I give this dose of warfarin
C. The two medications work synergistically to help break down the clot in your spouse’s leg
D. We will hold the medication until I can call the health care provider for clarification

53. A client with coronary artery disease was discharged home with a prescription for sublingual nitroglycerin to
treat angina. Which statement by the client indicates that further teaching is required?
A. I may experience flushing but will continue to take the medication as prescribed
B. I should lie down before taking the medication
C. I should not swallow the tablet
D. I will wait to call 911 if I don’t experience relief after the third tablet

54. The cardiac care unit has standing instructions that the health care provider should be notified of an
abnormal mean arterial pressure, the nurse will need to notify the HCP about which client?
A. A client from the cardiac catheterization lab with a blood pressure of 102/58 mmHg
B. A client just admitted from the emergency department with a BP 150/72 mmHg
C. A client with a BP of 92/60 mmHg who just received a dose of nitroglycerin
D. A client with heart failure on metoprolol with a BP of 106/42 mmHg

55. A client is 48 hours post abdominal aneurysm repair. Which assessment by the nurse is cause for greatest
concern?
A. Diminished breath sounds in bilateral lung bases

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 B. Hypoactive bowel sounds in all 4 quadrants
C. Urinary output of 90 mL in the past 4 hours
D. Warm extremities with 1+ bilateral pedal pulses

56. The nurse reviews laboratory data for a client admitted to the emergency department with chest pain.
Which serum value requires the most immediate action by the nurse?
A. Glucose 200 mg/dL
B. Hematocrit 38%
C. Potassium 3.4 mEq/L
D. Troponin 0.7 ng/mL

57. A client with a history of heart failure calls the clinic and reports a 3-lb (1.4 kg) weight gain over the past 2
days and increased ankle swelling. The nurse reviews the client’s medications and anticipates the
immediate need for dosage adjustment of which medication?
A. Bumetanide
B. Candesartan
C. Carvedilol
D. Isosorbide

58. A client with hypertension is prescribed Lisinopril. The nurse instructs the client to notify the health care
provider immediately if which adverse effect occurs when taking this medication?
A. Cough
B. Dizziness
C. Rapid onset confusion
D. Swelling of the lips and tongue

59. The nurse is preparing medications for a group of clients. Which prescription should the nurse clarify with the
health care provider before administering?
A. Client diagnosed with cirrhosis had 2 stools today, laxative lactulose prescribed daily
B. Client is prescribed lisinipril PO daily; serum potassium level is 5.6 mEq/L
C. Client is receiving vancomycin IV; mild facial flushing noted after 30 minutes
D. Client with diabetes has insulin glargine prescribed; current blood glucose is 100 mg/dL

60. The nurse is caring for a client recently diagnosed with an active deep vein thrombosis. Which action by the
client would require an immediate intervention by the nurse?
A. The client has a temperature of 100 F (37.7 C)
B. The client is ambulating up and down the hallways
C. The client is breathing at a rate of 16/min
D. The client is massaging the leg at the site of inflammation

61. A client with a diagnosis of atrial fibrillation has just been placed on warfarin therapy. The registered nurse
overhears a student nurse teaching the client about potential food-drug interactions. Which statement
made by the student nurse requires an intervention by the RN?
A. Do you take any nutritional supplements
B. You will need to monitor your intake of foods containing vitamin K
C. You will not be able to eat green, leafy, vegetables while taking this medication
D. Your blood will be tested at regular intervals

62. A client with coronary artery disease and stable angina is being discharged home on sublingual
nitroglycerine. The nurse has completed discharge teaching related to this medication. Which statement by
the client indicates that the teaching has been effective?
A. I can keep a few pills in a plastic bag in my pocket in case I need them while I’m out
B. I can still take this with my vardenafil prescription
C. I can take up to 3 pills in a 15-minute period if I am experiencing chest pain
D. I should stop taking the pills if I experience a headache

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63. A client has just returned from the cardiac catheterization laboratory for a permanent pacemaker
placement. How should the nurse document the rhythm on the client’s cardiac monitor? Check on the
exhibit for additional information

A. Atrial paced rhythm

B. Atrioventricular paced rhythm
C. Biventricular paced rhythm
D. Ventricular paced rhythm

64. The nurse is caring for a client with newly diagnosed infective endocarditis. Which assessment finding by the
nurse is the highest priority to report the health care provider?
A. Pain and pallor in one foot
B. Pain in both knees
C. Splinter hemorrhage in the nail beds
D. Temperature of 102.2 F (39 C)

65. A female client with liver cirrhosis and chronic anemia is hospitalized for a deep venous thrombosis. The
client is receiving a heparin infusion and suddenly develops epistaxis. Which laboratory value would
indicate that the heparin infusion needs to be turned off?
A. Hematocrit of 30%
B. Partial thromboplastin time of 110 seconds
C. Platelet count of 80,000/mm3
D. Prothrombin time of 11 seconds

66. A client is receiving IV sodium bicarbonate for acute metabolic acidosis. Which of these laboratory values
would best indicate that the sodium bicarbonate has been effective?
A. Serum pH 7.32, HCO3 26 mEq/L, potassium 4.9 mEq/L
B. Serum pH 7.34, HCO3 21 mEq/L, potassium 5.1 mEq/L
C. Serum pH 7.39, HCO3 24 mEq/L, potassium 3.8 mEq/L
D. Serum pH 7.41, HCO3 18 mEq/L, potassium 4.3 mEq/L

67. The nurse is caring for a client with a pulmonary confusion. Assessment reveals restlessness, chest pain on
inspiration diminished breath sounds, and oxygen saturation of 86%. Which acid base imbalance does the
nurse correctly identify?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis

68. The nurse teaches a client a with osteopenia, who is lactose and intolerant, how to increase dietary calcium
and vitamin D intake. Which lunch food is the best choice?
A. Broiled chicken breast
B. Canned sardines
C. Egg white omelet
D. Peanut butter

69. A client is admitted with severe acute pancreatitis. While obtaining the client’s blood pressure, the nurse
notices a carpal spasm. What laboratory result would the nurse assess in response to this symptom?
A. Decreased albumin
B. Elevated troponin
C. Hyperkalemia
D. Hypocalcemia

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70. The nurse assesses diminished lung sounds and high-pitched wheezing in a client with acute asthma
exacerbation. Arterial blood gas (ABG) findings are shown in the exhibit. Which acid-base imbalance does
the nurse correctly identity?

A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis

71. In the intensive care unit, the nurse cares for a client who has been admitted with diabetic ketoacidosis. The
client is on a continuous infusion of regular insulin at 5 units/hr via IV pump. Which action should the nurse
expect to implement?
A. Check serum BUN and creatinine levels every hour
B. Discontinue insulin infusion when blood glucose is <350 mg/dL
C. Increase insulin infusion rate when blood glucose level decreases
D. Initiate potassium IV when serum potassium is 3.5-5.0 mEq/L

72. The nurse reviews the laboratory for an adult male client admitted with septic shock. Which value requires
the most immediate action? Check on the exhibit for additional information.

A. Blood urea nitrogen

B. Creatinine
C. Hematocrit
D. Potassium

73. The nurse assesses a client who had a thyroidectomy 8 hours ago. The nurse finds the client anxious, with
tingling around the mouth and muscle twitching in the right arm. Which action is most important for the
nurse to implement first?
A. Change the surgical dressing to assess for bleeding
B. Document the findings in the electronic medical record
C. Draw arterial blood gases
D. Obtain a serum calcium level

74. The nurse assesses a client 5 minutes after initiating a blood transfusion. The client has shortness of breath,
itching, and chills. The nurse immediately turns off the transfusion and disconnects the tubing at the catheter
hub. What action should the nurse take next?
A. Check vital signs
B. Maintain IV access with normal saline
C. Notify the health care provider
D. Recheck identification labels and numbers

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75. The health care provider has told a client to take over the counter supplemental calcium carbonate 1000
mg/day for treatment of osteoporosis. Which instruction should the clinic nurse give the client?
A. Monthly calcium levels will need to be drawn
B. Stop vitamin D supplements when taking calcium
C. Take calcium at bedtime
D. Take calcium in divided doses with food

76. A nurse is caring for an elderly client who had a colectomy for removal of cancer 2 days ago. The client is
becoming increasingly restless. He has given intravenous morphine every 2 hours for severe pain.
Respirations are 28/min and shallow. Which arterial blood gas results best indicate that the client is in acute
respiratory failure and needs immediate intervention?
A. PaO2 49 mmHg, PaCO2 60 mmHg
B. PaO2 64 mmHg, PaCO2 45 mmHg
C. PaO2 70 mmHg, PaCO2 30 mmHg
D. PaO2 86 mmHg, PaCO2 25 mmHg

77. A client suffering from chronic kidney disease is schedule to received recombinant human erythropoietin
and iron sucrose. The client’s hemoglobin is 9.7 g/dL and hematocrit is 29%. What is the appropriate nursing
action?
A. Administer the erythropoietin in the client’s ventrogluteal muscles
B. Check blood pressure prior to administering the erythropoietin
C. Hold the client’s next scheduled iron sucrose dose
D. Hold the erythropoietin and inform the health care provider

78. A client with chronic heart failure is being discharge home on furosemide and sustained release potassium
chloride tablets. Which instructions related to the potassium supplement should the nurse give to the client?
A. A diet rich in protein and vitamin D will help with absorption
B. If the tablet is too large to swallow, crush and mix it with applesauce or pudding
C. Potassium tablets should be taken, on empty stomach
D. Take it with a full glass of water and stay sitting upright afterward

79. The nurse has two newly admitted patients with dehydration. One patient is dehydrated from heat
exhaustion and the other from an overdose of Lasix. Which finding that will present in both patients?
A. increased skin turgor.
B. decreased pulse and respirations.
C. copious saliva and nasal secretions.
D. increased laboratory values of hemoglobin and hematocrit.

80. The K+ laboratory report shows a level of 5.2 mEq/L. The nurse will assess the patient closely for:
A. excessive thirst.
B. irregular heartbeat.
C. swelling of ankles.
D. frightening hallucinations.

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