1.

A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH,
7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values
indicate?
- Respiratory alkalosis (A client with pneumonia may hyperventilate in an effort to increase
oxygen intake. Hyperventilation leads to excess carbon dioxide (CO2) loss, which causes alkalosis
— indicated by this client's elevated pH value. With respiratory alkalosis, the kidneys'
bicarbonate (HCO3-) response is delayed, so the client's HCO3- level remains normal. The below-
normal value for the partial pressure of arterial carbon dioxide (PaCO2) indicates CO2 loss and
signals a respiratory component. Because the HCO3- level is normal, this imbalance has no
metabolic component. Therefore, the client is experiencing respiratory alkalosis.)
2. The nurse is reviewing client lab work for a critical lab value. Which value is called to the
physician for additional orders?
- Potassium: 5.8 mEq/L
3. To evaluate a client for hypoxia, the physician is most likely to order which laboratory test?
- Arterial blood gas (ABG) analysis
4. The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe
pneumonia. Which of the following ABG results indicates respiratory acidosis?
- pH: 7.20, PaCO2: 65 mm Hg, HCO3–: 26 mEq/L
5. A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204
mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L;
Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse
identify as critical and report immediately?
- Potassium
6. The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum
potassium concentration of 2.9 mEq/L (2.9 mmol/L). Which statement made by the client
indicates the need for further teaching?
- “I can use laxatives and enemas but only once a week.”
7. A patient with abnormal sodium losses is receiving a regular diet. How can the nurse
supplement the patient’s diet to provide 1,600 mg of sodium daily?
- One beef cube and 8 oz of tomato juice
8. Which of the following electrolytes is the primary determinant of extracellular fluid (ECF)
osmolality?
- Sodium
9. Which of the following arterial blood gas results would be consistent with metabolic alkalosis?
- Serum bicarbonate of 28 mEq/L
10. A client has been admitted to the hospital unit with signs and symptoms of hypovolemia;
however, the client has not lost weight. The client exhibits a localized enlargement of her
abdomen. What condition could the client be presenting?
- third-spacing
11. A client was admitted to the unit with a diagnosis of hypovolemia. When it is time to complete
discharge teaching, which of the following will the nurse teach the client and family? Select all
that apply.
- Drink water as an inexpensive way to meet fluid needs.
- Respond to thirst
- Drink at least eight glasses of fluid each day.
12. A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55;
partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide
(PaCO2), 27 mm Hg; and bicarbonate (HCO3–), 24 mEq/L. Based on these values, the nurse
suspects:
- respiratory alkalosis (This client's above-normal pH value indicates alkalosis. The below-normal
PaCO2 value indicates acid loss via hyperventilation; this type of acid loss occurs only in
respiratory alkalosis. These ABG values wouldn't occur in metabolic acidosis, respiratory
acidosis, or metabolic alkalosis.)
13. Hypokalemia can cause which symptom to occur?
- Excessive thirst
14. The nurse is correct to state that a client’s body needs to have adequate nutrition to maintain
energy. Which type of transport of dissolved substances requires adenosine triphosphate (ATP)?
- Active transport
15. An elderly client takes 40 mg of furosemide twice a day. Which electrolyte imbalance is the most
serious adverse effect of diuretic use?
- Hypokalemia
16. With which condition should the nurse expect that a decrease in serum osmolality will occur?
- Kidney failure
17. The nurse is caring for a 72-year-old client who has been admitted to the unit for a fluid volume
imbalance. The nurse knows which of the following is the most common fluid imbalance in older
adults?
- Dehydration
18. Oral intake is controlled by the thirst center, located in which of the following cerebral areas?
- Hypothalamus
19. Which condition might occur with respiratory acidosis?
- Increased intracranial pressure
20. A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very
slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl,
a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium
level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms
are most likely associated with which electrolyte imbalance?
- Hypercalcemia
21. The calcium concentration in the blood is regulated by which mechanism?
- Parathyroid hormone (PTH)
22. A patient has been involved in a traumatic accident and is hemorrhaging from multiple sites. The
nurse expects that the compensatory mechanisms associated with hypovolemia would cause
what clinical manifestations? (Select all that apply.)
- Tachypnea
- Oliguria
- Tachycardia
23. Which electrolyte is a major cation in body fluid?
- Potassium
24. Clients diagnosed with hypervolemia should avoid sweet or dry food because it
- increases the client's desire to consume fluid.
25. A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis.
Which clinical findings commonly accompany respiratory alkalosis?
- Light-headedness or paresthesia
26. Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the
client's medical history. Which condition is a predisposing factor for respiratory alkalosis?
- Extreme anxiety
27. Air embolism is a potential complication of IV therapy. The nurse should be alert to which
clinical manifestation associated with air embolism?
- Chest pain
28. At which serum sodium concentration might convulsions or coma occur?
- 145 mEq/L (145 mmol/L)
29. When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?
- pH 7.48
30. A client with pneumonia presents with the following arterial blood gases: pH of 7.28, PaCO2 of
74, HCO3 of 28 mEq/L, and PO2 of 45, which of the following is the most appropriate nursing
intervention?
- Place client in high-Fowler's position
31. A client with COPD feels short of breath after walking into the bathroom on 2 liters of oxygen
nasal cannula. The morning's ABGs were pH of 7.36, PaCO2 of 62, HCO3 of 35 mEq/L, O2 at 88%
on 2 liters. Which of the following should be the nurse's first intervention?
- Encourage the client to rest and to use pursed-lip breathing technique
32. A client with renal failure enters the emergency room after skipping three dialysis treatment to
visit family out of town. Which set of ABGs would indicate to the nurse that the client is in a
state of metabolic acidosis?
- pH of 7.33, PCO2 of 35, HCO3 of 17
33. A client with a small bowel obstruction has had a nasogastric tube connected to low intermittent
suction for two days. The nurse should monitor for clinical manifestations of which acid-base
disorder?
- Metabolic Alkalosis
34. A client who suffers from an anxiety disorder is very upset, has a respiratory rate of 32, and is
complaining of lightheadedness and tingling in the fingers. ABG values are pH of 7.48, PaCO2 of
29, HCO3 of 24 and O2 is at 93% on room air. The nurse performs which of the following as a
priority nursing intervention?
- Provide reassurance to the client and administer sedatives
35. A male client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced
alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory
acidosis?
- pH, 7.25; PaCO2 50 mm Hg
36. Which of the following would be most appropriate for a male client with an arterial blood gas
(ABG) of pH 7.5, PaCO2 26 mm Hg, O2 saturation 96%, HCO3 24 mEq/L, and PaO2 94 mm Hg?
- Instruct the client to breathe into a paper bag
37. A female client is receiving supplemental oxygen. When determining the effectiveness of oxygen
therapy, which arterial blood gas value is most important?
- PaO2
38. A nurse is providing client teaching about the body's plasma pH and the client asks the nurse
what is the major chemical regulator of plasma pH. What is the best response by the nurse?
- bicarbonate–carbonic acid buffer system
39. The nurse is caring for a patient with a diagnosis of hyponatremia. Which nursing intervention is
appropriate to include in the plan of care for this patient? Select all that apply.
- Assessing for symptoms of nausea and malaise
- Monitoring neurologic status
- Restricting tap water intake
40. The weight of a client with congestive heart failure is monitored daily and entered into the
medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this
client retaining?
- 1L
41. Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a
partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%,
bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg?
- Instruct the client to breathe into a paper bag.
42. The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the
nurse administer?
- 0.45% sodium chloride
43. A client with a suspected overdose of an unknown drug is admitted to the emergency
department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do
first?
- Prepare to assist with ventilation.
44. A priority nursing intervention for a client with hypervolemia involves which of the following?
- Monitoring respiratory status for signs and symptoms of pulmonary complications.
45. The nurse is caring for a client with a serum potassium concentration of 6.0 mEq/L (6.0 mmol/L)
and a fluid volume excess. The client is ordered to receive oral sodium polystyrene sulfonate
and furosemide. What other order should the nurse anticipate giving?
- Discontinue the intravenous lactated Ringer solution.
46. A client is taking spironolactone to control hypertension. The client's serum potassium level is 6
mEq/L. What is the nurse's priority during assessment?
- electrocardiogram (ECG) results
47. A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The
following are the client's laboratory values.
sodium 137 mEq/L (137 mmol/L)
potassium 4.6 mEq/L (4.6 mmol/L)
chloride 94 mEq/L (94 mmol/L)
calcium 12.9 mg/dL (3.2 mmol/L)
What laboratory value is of highest concern to the nurse?
- calcium 12.9 mg/dL (3.2 mmol/L)
48. When a client's ventilation is impaired, the body retains which substance?
- Carbon dioxide
49. A client has chronic hyponatremia, which requires weekly laboratory monitoring to prevent the
client lapsing into convulsions or a coma. What is the level of serum sodium at which a client can
experience these side effects?
- 114 mEq/L
50. Which solution is hypotonic?
- 0.45% NaCl
51. The nurse is reviewing lab work on a newly admitted client. Which of the following diagnostic
studies confirm the nursing diagnosis of Deficient Fluid Volume?
- An elevated hematocrit level Electrolyte imbalance
52. A client in the emergency department reports that he has been vomiting excessively for the past
2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon
dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and
bicarbonate (HCO3–) of 42 mEq/L. Based on these findings, the nurse documents that the client
is experiencing which type of acid-base imbalance?
- Metabolic alkalosis
53. A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial
carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3–), 15 mEq/L. These ABG values
suggest which disorder?
- Metabolic acidosis
54. A nurse is conducting an initial assessment on a client with possible tuberculosis. Which
assessment finding indicates a risk factor for tuberculosis?
- the client had a liver transplant 2 years ago
55. Which is a correct route of administration for potassium?
- Oral
56. The calcium concentration in the blood is regulated by which mechanism?
- Parathyroid
57. Which is the most common cause of symptomatic hypomagnesemia?
- Alcholism
58. A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The
following are the client's laboratory values. Na + 130 mEq/L K + 4.6 mEq/L Cl - 94 mEq/L Mg ++
2.8 mg/dL Ca ++ 13 mg/dL Which of the following alterations is consistent with the client's
findings?
- Hypercalcemia
59. A group of nursing students are studying for a test over acid-base imbalance. One student asks
another what the major chemical regulator of plasma pH is. What should the second student
respond?
- Bicarbonate–carbonic acid buffer system
60. Fluid and electrolyte balance is maintained through the process of translocation. What specific
process allows water to pass through a membrane from a dilute to a more concentrated area?
- Osmosis
61. To confirm an acid–base imbalance, it is necessary to assess which findings from a client’s
arterial blood gas (ABG) results?
- pH PaCO2 HCO3
62. The nurse is caring for four clients on a medical unit. The nurse is most correct to review which
client’s laboratory reports first for an electrolyte imbalance?
- 52 year old with Diarrhea
63. The major cation in extracellular fluid is
- Sodium
64. Which of the following medications are used to suppress viral load of the HSV-2 infection?
- Acyclovir (Zovirax)
65. During flu season, a nurse is teaching clients about the chain of infection. What components are
considered “links” in this chain? Select all that apply.
- infectious agent
- susceptible host
- portal of entry
66. The nurse observes a nursing assistant leave the room of client diagnosed with Clostridium
difficile infection without washing hands. Which is the priority action by the nurse?
- Have the nursing assistant wash hands with soap and water.
67. After teaching a group of students about sexually transmitted infections (STIs), the instructor
determines that additional teaching is necessary when the students identify which STI as curable
with treatment?
- Genital herpes
68. A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client
about disease transmission and advises the client to inform sexual partners of the infection. The
client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't
cause any harm like the other STIs." How should the nurse proceed? Select all that apply.
- Educate the client about why it's important to inform sexual contacts so they can receive
treatment.
- Inform the health department that this client contracted a chlamydia infection.
69. The nurse is caring for a client with genital herpes experiencing a reoccurrence. Which nursing
diagnosis would be the priority?
- Impaired Skin Integrity
70. A client admitted with bacterial meningitis must be transported to the radiology department for
a repeat computed tomography scan of the head. His level of consciousness is decreased, and
he requires nasopharyngeal suctioning before transport. Which infection control measures are
best when caring for this client?
- Put on gloves, a mask, and eye protection during suctioning, and then apply a mask to the
client's face for transport.
71. The nurse is caring for a patient with a meningococcus infection. What type of precautions
should be used for this patient?
- Droplet
72. The parent of a child diagnosed with chickenpox asks when the child can go to play group again.
What is the best response by the nurse?
- “When the vesicles and pustules have crusted.”
73. You are a school nurse teaching a health class about the chain of infection in the transmission of
sexually transmitted diseases (STDs). A student asks you which part of the chain of infection can
be missing when transmission occurs. What would be your best answer?
- “All parts of the chain of infection have to be present for the disease to be passed to another
human.”
74. The nurse observes a physician leave the room of a client in isolation for infection with
Clostridium difficile. The physician uses the alcohol-based hand sanitizer hanging on the wall to
wash her hands and leaves the door open. Which action should the nurse take?
- Ask the physician to wash her hands with soap and water.
75. The nurse is caring for a client diagnoses with severe acute respiratory syndrome (SARS). A
family member asks what causes SARS. Which response by the nurse is accurate?
- Coronavirus
76. Which of the following is the medication of choice for early syphilis?
- Penicillin G benzathine
77. A 36-year-old client is in the clinic for an annual physical. The client asks the nurse, "Should I get
a flu shot?" Which is the best response by the nurse?
- “The flu shot is recommended for all people over 6 months of age.”
78. A pregnant patient asks the nurse if it is all right for her take the varicella immunization for
entrance into nursing school. What is the best response by the nurse?
- “It is not recommended that pregnant women take the live virus. You should wait until after
your child is born.”
79. A nurse is caring for a client in the clinic. Which sign or symptom may indicate that the client has
gonorrhea?
- Burning on urination
80. Which of the following is the most effective treatment for trichomoniasis?
- Metronidazole (Flagyl)
81. A family member of a client in a long-term care facility asks the nurse why he cannot insert a
catheter so the client will not develop skin breakdown from being wet. What should the
explanation include when the nurse responds to the family member?
- The invasive nature of the catheter provides a portal for infection.
82. Which organism is responsible for impetigo?
- Staphylococcus aureus
83. The nurse is discussing childhood immunization recommendations with a pediatric patient’s
parent. Where would the nurse find the most current information on this topic?
- CDC
84. The nurse is meeting with the mother of an 11-year-old girl to provide decision making support
and education regarding human papillomavirus (HPV) vaccination. The mother states, "I am
confused about why my 11 year old needs to be protected from a sexually transmitted infection.
She is so young and not sexually active. Why does she need the vaccination now?" What is the
nurse's best response?
- "The vaccination helps to prevent cervical cancer in adult women. It works better if she has it
before she becomes sexually active. Let's talk about some of the concerns you have about the
vaccination"
85. The nurse is caring for a client who has just been diagnosed with chlamydia and is very upset.
The client says, “I don’t understand this. The person I had sex with did not have any symptoms
at all. How could I have known?” What is the best response by the nurse to this client?
- “Many people with chlamydia won’t have symptoms for up to 3 weeks after being infected.”
86. A patient has developed chickenpox and asks the nurse what the incubation period would be.
What should the nurse inform the patient?
- It is 10 to 21 days.
87. Painless chancres are associated with which systemic disease?
- Syphilis
88. The nurse is working in the labor and delivery suite when a client with active herpes simplex
virus type 2 (HSV-2) appears in active labor. Which adjustment in the plan of care will the nurse
prepare for?
- Prepare for a cesarean section.
89. A client comes to the emergency department complaining of sudden onset of diarrhea,
anorexia, malaise, cough, headache, and recurrent chills. Based on the client's history and
physical findings, the physician suspects legionnaires' disease. While awaiting diagnostic test
results, the client is admitted to the facility and started on antibiotic therapy. What's the drug of
choice for treating legionnaires' disease?
- Azithromycin (Zithromax)
90. Which stage or period of syphilis occurs when the infected person has no signs or symptoms of
syphilis?
- Latency
91. A client is diagnosed with scabies in a long-term care facility. Which type of client care
precautions would the nurse institute?
- contact
92. A client is admitted with bacterial meningitis. Which hospital room is the best choice for this
client?
- An isolation room three doors from the nurses' station
93. The nurse is caring for a group of clients at a public health clinic. Which sexually transmitted
disease would the nurse focus the client education on curative goals?
- Chlamydia
94. When a hospitalized client is in contact precautions, which action is necessary?
- The client should be placed in a private room when possible.
95. An 82-year-old client is admitted to the hospital with a diagnosis of pneumonia. The nurse learns
that the client lives alone and hasn't been eating or drinking properly. When assessing the client
for dehydration, the nurse would expect to find:
- tachycardia
96. Painless chancres or ulcerated lesions are associated with which systemic disease?
- Syphilis
97. A nurse is assessing a client who may be in the early stages of dehydration. Early manifestations
of dehydration include:
- thirst or irritability
98. When developing a teaching plan for a client with syphilis, which of the following would be most
important to include?
- With proper treatment, the disease can eventually be cured.
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