After teaching a client who was malnourished and is being discharged, a nurse assesses the clients understanding. Which statement indicates the client correctly understood teaching to decrease risk for the development of metabolic acidosis?

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ATI Fluid Electrolyte and Acid-Base Regulation Questions

Question 1 of 9

After teaching a client who was malnourished and is being discharged, a nurse assesses the clients understanding. Which statement indicates the client correctly understood teaching to decrease risk for the development of metabolic acidosis?

Correct Answer: A

Rationale: The correct answer is A: "I will drink at least three glasses of milk each day." Milk is a good source of calcium and bicarbonate, which can help buffer excess acids in the body and prevent metabolic acidosis. Calcium also plays a role in maintaining the acid-base balance. Option B is incorrect because while eating well-balanced meals is important for overall health, it does not specifically address the prevention of metabolic acidosis. Option C is irrelevant to the prevention of metabolic acidosis. Option D is incorrect because avoiding salting food does not directly address the underlying issue of metabolic acidosis related to malnutrition.

Question 2 of 9

A nurse is caring for a client who is having a subclavian central venous catheter inserted. The client begins to report chest pain and difficulty breathing. After administering oxygen, which action should the nurse take next?

Correct Answer: B

Rationale: The correct answer is B: Prepare to assist with chest tube insertion. Chest pain and difficulty breathing after subclavian central venous catheter insertion could indicate a pneumothorax, a potential complication. Chest tube insertion is indicated to help re-expand the lung and relieve the pressure in the thoracic cavity. This intervention takes priority over the other options because it addresses the potential life-threatening complication of a pneumothorax. Administering nitroglycerin (choice A) is not indicated for chest pain in this scenario. Placing a sterile dressing over the IV site (choice C) is not appropriate for managing chest pain and difficulty breathing. Re-positioning the client into the Trendelenburg position (choice D) is not effective in addressing a pneumothorax and may worsen the client's condition.

Question 3 of 9

A nurse is caring for an older adult client who is admitted with moderate dehydration. Which intervention should the nurse implement to prevent injury while in the hospital?

Correct Answer: D

Rationale: The correct answer is D because dangling the client on the bedside before ambulating helps prevent orthostatic hypotension and potential falls. This step allows the nurse to assess the client's tolerance to changes in position and reduces the risk of injury. A: Asking family members to speak quietly does not directly address the prevention of injury related to dehydration. B: Assessing urine parameters is important for monitoring hydration status but does not directly prevent injury. C: Encouraging fluid intake is important for rehydration but does not directly address the risk of injury during ambulation.

Question 4 of 9

A nurse is caring for a client who has the following laboratory results: potassium 3.4 mEq/L, magnesium 1.8 mEq/L, calcium 8.5 mEq/L, sodium 144 mEq/L. Which assessment should the nurse complete first?

Correct Answer: A

Rationale: The correct assessment for the nurse to complete first is A: Depth of respirations. Potassium and magnesium levels are crucial electrolytes that can affect cardiac function. Hypokalemia (low potassium) and hypomagnesemia (low magnesium) can lead to cardiac dysrhythmias. Checking the depth of respirations can provide valuable information on the client's respiratory status and potential respiratory distress due to electrolyte imbalances. This assessment takes precedence as addressing respiratory issues promptly is essential to prevent further complications. Assessing bowel sounds (B), grip strength (C), and electrocardiography (D) are important but not as immediate as assessing respiratory status in this scenario.

Question 5 of 9

Diagnostic testing has been ordered to differentiate between normal anion gap acidosis and high anion gap acidosis in an acutely ill patient. What health problem typically precedes normal anion gap acidosis?

Correct Answer: D

Rationale: The correct answer is D: Excessive administration of chloride. Normal anion gap acidosis is commonly caused by an excessive intake of chloride-containing solutions like normal saline during treatment. This leads to an increase in the plasma chloride concentration, causing a decrease in the anion gap. Metastases (A) are not typically associated with normal anion gap acidosis. Excessive potassium intake (B) would not lead to normal anion gap acidosis but rather hyperkalemia. Water intoxication (C) can lead to dilutional hyponatremia but not normal anion gap acidosis.

Question 6 of 9

A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. What factors contribute to this phenomenon? Select all that do not apply.

Correct Answer: D

Rationale: The correct answer is D: Increased conservation of sodium. Older adults tend to have an increased conservation of sodium, leading to fluid retention and decreased fluid intake, which can contribute to dehydration. A: Decreased kidney mass is incorrect because it is a factor that can contribute to decreased kidney function but not directly linked to dehydration. B: Decreased renal blood flow can impact kidney function but is not a direct cause of dehydration in older adults. C: Decreased excretion of potassium is not a factor that directly contributes to dehydration in older adults.

Question 7 of 9

You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your patients most recent laboratory reports, you note that the patients magnesium levels are high. You should prioritize assessment for which of the followin

Correct Answer: A

Rationale: Step 1: High magnesium levels can lead to hypermagnesemia, which can cause decreased neuromuscular function. Step 2: Diminished deep tendon reflexes are a sign of neuromuscular impairment, indicating potential hypermagnesemia. Step 3: Assessing for diminished deep tendon reflexes is crucial to monitor neuromuscular function in patients with high magnesium levels. Summary: A is correct because hypermagnesemia affects neuromuscular function. B, C, and D are incorrect as they do not directly relate to the effects of high magnesium levels.

Question 8 of 9

A nurse is assessing a client with hypokalemia and notes that the client's handgrip strength has diminished since the previous assessment 1 hour ago. Which action should the nurse take first?

Correct Answer: A

Rationale: The correct action for the nurse to take first is to assess the client's respiratory rate, rhythm, and depth (Choice A). Diminished handgrip strength in a client with hypokalemia could indicate potential respiratory muscle weakness, which can lead to respiratory distress or failure. By assessing the client's respiratory status, the nurse can determine if immediate intervention is needed to support breathing. Choice B is incorrect because measuring the client's pulse and blood pressure may not address the underlying issue of respiratory muscle weakness. Choice C is incorrect as it delays potential life-saving interventions by simply documenting findings. Choice D is incorrect as calling the healthcare provider should come after addressing the client's immediate respiratory needs.

Question 9 of 9

You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results?

Correct Answer: D

Rationale: To interpret the given ABG results: 1. pH <7.35 indicates acidosis. 2. PaCO2 <35 indicates respiratory alkalosis. 3. HCO3 <22 indicates metabolic acidosis. Therefore, the ABG results show metabolic acidosis (low pH, low HCO3) with compensatory respiratory alkalosis (low PaCO2). This means the body is trying to compensate for the metabolic acidosis by decreasing PaCO2 through hyperventilation. Option D is correct. Options A, B, and C are incorrect as they do not align with the ABG results and the principles of acid-base balance.

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