1.A nurse is assessing who has dehydration. Which of the following assessments is the
priority?
a.Mental status
i.The greatest risk to this client is injury from a fall due to a decline in their
mental status. Therefore, assessing the client’s mental status is the
nurse’s priority.
2.A nurse is reviewing the laboratory report of a client who has fluid volume excess. Which
of the following laboratory values should the nurse expect?
a.Hct 34%
i.The nurse should identify that a client who has fluid volume excess can
have a HCT level that is below expected reference range of 37% to 47%
for females or 42% to 52% for males. Fluid volume excess can cause
hemodilution and a decreased hematocrit level.
3.A nurse is assessing a client who is receiving hydrochlorothiazide and notes that the
client is confused and lethargic. Which of the following laboratory values should the
nurse report to the provider?
a.Sodium 128 mEq/L
i. This level is below the expected reference range of 136 to 145 mEq/L and
is the likely cause of the client's altered mental status. The nurse should
report this finding to the provider and monitor the client for weakened
respiratory effort.
4.A nurse is providing dietary teaching to a client who has kidney disease. Which of the
following food choices should the nurse include in the teaching as containing the lowest
amount of magnesium?
a.1 large, hard-boiled eggs
i.One large, hard-boiled egg contains 5 mg of magnesium. Therefore, the
nurse should recommend this food as containing the lowest amount of
magnesium.
5. A nurse is assessing a client who has a serum calcium level of 8.1 mg/dL. Which of the
following findings is the priority for the nurse to assess?
a.Cardiac rhythm
i.When using the airway, breathing, circulation approach to client care, the
nurse should first assess the client's cardiac rhythm because this total
serum calcium level is below the expected reference range. Hypocalcemia
can cause ECG changes, bradycardia, or tachycardia.
6.A nurse is caring for a client who has a sodium level of 155 mEq/L. Which of the
following IV fluids should the nurse anticipate the provider to prescribe?
a.0.45% sodium chloride
i.A sodium level of 155 mEq/L is an indication of hypernatremia. The nurse
should anticipate a prescription for a hypotonic solution. The 0.45%
sodium chloride is a hypotonic solution used to provide free water and
treat cellular dehydration, which promotes waste elimination by the
kidneys.
7.A nurse is assessing a client who has hypomagnesemia. Which of the following findings
should the nurse expect?
a.Hyperactive deep-tendon reflexes