CH. 29 Evolve Preparation FOR Nclex EXAM Questions PDF

Preview

Summary

Download CH. 29 Evolve Preparation FOR Nclex EXAM Questions PDF

Description

CHAPTER 29 : PREPARATION FOR THE NCLEX EXAMINATION QUESTIONS : EVOLVE 1.

The nurse has a prescription to administer 500 mL of lactated Ringer’s solution over 4 hours. What is the correct pump setting for this prescription? __ ANS: 125 mL/hr

500 mL divided by 4 hours equals 125 mL/hr. 2.

The nurse has a prescription to administer 250 mL of half-normal saline (0.45%NS) over 4 hours. What is the correct pump setting for this prescription? __ ANS: 63 mL/hr

250 mL divided by 4 hours equals 62.5 mL/hr, which rounds to 63 mL/hr 3.

The nurse is caring for a patient who has peripheral edema and is hypotensive after receiving 5000 mL of normal saline intravenous (IV). The nurse anticipates administering which IV solution to correct the fluid imbalance? a. 3% saline solution b. Hetastarch c. Lactated Ringer’s solution d. D5W ANS: B

The patient needs to increase intravascular fluid volume. Hetastarch will enable this because it is a colloid that will increase osmotic pull from the extravascular spaces to the intravascular space. A 3% saline solution is also hypertonic, but its use is not preferred secondary to risk of hypernatremia. 4.

When caring for a patient with a serum potassium of 2.8 mEq/L, what is the appropriate nursing intervention when giving IV replacement therapy? a. Maintain infusion rate at no greater than 20 mEq/hr b. Administer potassium as a bolus over 10 minutes c. Apply ice packs to site of IV administration d. Teach the patient signs and symptoms of hypokalemia ANS: A

Too rapid an infusion of potassium may cause cardiac arrest. Therefore, IV potassium infusion rates should not exceed 20 mEq/hr. 5.

The nurse is caring for a patient with renal insufficiency and thrombocytopenia. Along with platelet transfusions, the nurse would expect to administer which blood product to increase deficient clotting factors in this patient? a. Whole blood b. Fresh-frozen plasma c. Plasma protein factors d. Albumin ANS: B

Fresh-frozen plasma is indicated to increase clotting factors in patients with a known deficiency. Albumin and plasma protein factors do not contain clotting factors. Although whole blood does contain the same ingredients as fresh-frozen plasma, the amount of volume that must be administered to give the patient the necessary clotting factors may be contraindicated in a patient with renal insufficiency. 6.

During the IV administration of a hypertonic saline solution to treat a patient with severe hyponatremia, the nurse monitors for which signs and symptoms of hypernatremia? a. Mental confusion and seizures b. Vomiting and diarrhea c. Flushed skin and increased thirst d. Lethargy and hypotension ANS: C

Hypertonic saline solutions administered to raise sodium levels may cause hypernatremia. Thus, very close monitoring for signs and symptoms of hypernatremia is needed. Flushed skin and increased thirst are signs and symptoms of hypernatremia. The other choices are signs and symptoms of hyponatremia 7.

A patient receiving an IV infusion of one unit of packed red blood cells suddenly develops shortness of breath, chills, and is feeling hot. What is the nurse’s priority action? a. Maintain a patent IV line with normal saline b. Check the vital signs c. Notify the health care provider d. Stop the blood transfusion ANS: D

These are symptoms of a blood transfusion reaction. Thus, the nurse’s priority action is to immediately stop the blood transfusion 8.

While assessing the patient, the nurse notes edema of the hands and feet at +3 from third spacing. The patient is having signs and symptoms of intravascular dehydration, and the total protein laboratory result is 4.6 g/dL. The nurse anticipates the health care provider will prescribe which IV solution for this patient? a. Whole blood b. Lactated Ringer’s solution c. 5% albumin d. Normal saline ANS: C

If the total protein level falls below 5.3 g/dL, fluid shifts out of blood vessels into the tissues. When this happens, colloid replacement therapy is required to reverse this process by increasing the colloid oncotic pressure. The three

CHAPTER 29 : PREPARATION FOR THE NCLEX EXAMINATION QUESTIONS : EVOLVE most commonly used are 5% albumin, dextran 40, and hetastarch. They all have a very rapid onset of action as well as a long duration of action 9.

While the nurse is providing care to a patient, the health care provider prescribes an IV potassium chloride infusion. For which condition would this prescription be given? a. Multiple sclerosis b. Cirrhosis of the liver c. Hypertension d. Renal failure ANS: D

Potassium replacement therapy is indicated in the treatment or prevention of potassium depletion in patients with severe renal disease, acute dehydration, untreated Addison’s disease, severe hemolytic disease, conditions involving extensive tissue breakdown (e.g., multiple trauma, severe burns), and hyperkalemia from any cause 10. A male patient who has just undergone surgery exhibits tachycardia, a hemoglobin reading of 10 g/100 mL, and a slowly healing wound. Which fluid therapy should the nurse administer to resolve these problems? a. 250 mL of packed red blood cells b. 100 mL of fresh frozen plasma c. 50 mL of 5% albumin d. 450 mL of whole blood ANS: A

The patient has a decreased hemoglobin, which means that the individual has decreased oxygen-carrying capability. Packed RBCs is the best intervention at this time. Fresh frozen plasma will add clotting factors, but not oxygen carrying capabilities. Albumin will not add oxygen-carrying capabilities. Whole blood is not indicated at this time as the volume of fluid loss is not known. 11. A patient has received an infusion of packed red blood cells. What assessment finding(s) would indicate improvement in the patient's status? (Select all that apply.) a. Increased urine output b. Increased energy c. Decreased urine output d. Respiratory rate 16 and unlabored e. Blood glucose levels within normal limits ANS: B, D

Packed RBCs should not impact urine output. Packed RBCs improves the patient's oxygen-carrying capabilities, which can lead to the patient having more energy. Respiratory rate indicates that the patient is receiving adequate oxygenation. Packed RBCs should not impact the blood glucose level and is not given to change the blood glucose level....