MSN Exam for Fluid, Electrolyte, and Acid Base Problems

Practice Mode

Welcome to your MSN Exam for Fluid, Electrolyte, and Acid Base Problems! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 40 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Consider what could lead to an electrolyte or pH imbalance in the body, especially for a patient undergoing chemotherapy.

1 / 40

1. Nurse William is overseeing the care of a client admitted for chemotherapy. To preemptively manage potential acid-base imbalances, he needs to instruct the nursing assistant on what to report immediately. What should that be?

💡 Hint

Reflect on which treatment is commonly used to lower elevated potassium levels and could be safely performed by a student nurse.

2 / 40

2. Nurse Sarah is supervising a student nurse for the day. She reviews a patient's lab results and notes that the potassium level is 6.7 mEq/L, indicating hyperkalemia. Recognizing the need for immediate intervention, Sarah must decide which task can be safely delegated to the student nurse:

💡 Hint

Consider which task focuses on regular hydration support without requiring assessment or teaching skills.

3 / 40

3. In the case of a client suffering from dehydration, the nursing care plan emphasizes oral health measures. Nurse Emily is supervising an LPN/LVN and needs to delegate tasks appropriately.

💡 Hint

Think about which foods are generally beneficial for someone who has a history of low calcium levels.

4 / 40

4. Nurse Olivia is in the process of discharging a client whose calcium levels were previously low but have now slightly normalized to fall within the usual range of 9-10.5 mg/dL. To ensure the patient is well-informed, Olivia asks the client to verbalize their understanding. She must identify which of the following client statements reveals a gap in education:

💡 Hint

Consider the level of skill required for each action and what tasks are within the scope of practice for a nursing assistant.

5 / 40

5. Nurse Emily is overseeing the care of a client diagnosed with Deficient Fluid Volume due to excessive fluid loss. Emily is contemplating which tasks related to fluid management can be delegated to a nursing assistant under her supervision.

💡 Hint

Consider which condition directly affects the body's ability to regulate acid-base balance through filtration and excretion.

6 / 40

6. Nurse Victoria is in the process of admitting an elderly client to the medical unit. She needs to identify any factors that may place the client at risk for developing acid-base imbalances. Which of the following factors should alert her to this possibility?

💡 Hint

Recall the standard reference ranges for pH to identify what is considered normal.

7 / 40

7. An elderly homeless man is rushed to the emergency room, presenting with difficulty breathing, fever, and a cough that produces sputum. On assessment, the nurse hears crackles and wheezes in the lower lung lobes; the patient is also tachycardic with a bounding pulse. Arterial blood gas measurements reveal a pH of 7.2, PaCO2 of 66 mm Hg, HCO3 of 27 mmol/L, and PaO2 of 65 mm Hg. As a well-informed nurse, you should know that the standard reference range for pH is:

💡 Hint

Consider which symptoms directly indicate a reduction in blood volume affecting cardiac output.

8 / 40

8. Nurse Emily is evaluating a client who has a nursing diagnosis of Decreased Cardiac Output, which is linked to reduced plasma volume. She is keen to identify clinical signs that would substantiate this diagnosis.

💡 Hint

Prioritize actions that directly address the immediate and potentially serious changes in the client's condition. Which step lays the foundation for all subsequent interventions?

9 / 40

9. Nurse Emily, an RN, receives a report from an experienced LPN/LVN concerning a client. The LPN/LVN notes that the patient's blood pressure and heart rate have dropped and that there's noticeable twitching on one side of the face. Faced with this information, Emily needs to decide what her immediate action should be:

💡 Hint

Think about the body's physiological response to decreased oxygen availability at high altitudes. What changes in respiration would you expect to occur?

10 / 40

10. An adventurer sets out to climb a towering peak in the Andes, ascending to an elevation of 5,000 meters (about 16,400 feet) above sea level. As a well-informed nurse, what changes would you anticipate in his arterial PCO2 and pH levels at this high altitude?

💡 Hint

Consider the pH, PaCO2, and HCO3 levels together. This will help you to understand if the disorder is respiratory in origin and whether or not the body has managed to fully compensate.

11 / 40

11. Nurse Taylor is caring for 3-year-old Noah, who has been hospitalized for asthma and respiratory distress syndrome. Noah's mother mentions that she has noticed mild tremors and changes in her son's behavior over the past few days. After assessing the ABCs, the attending physician orders standard ABGs. The results indicate a pH of 7.35, PaCO2 of 72 mmHg, and HCO3 of 38 mEq/L. What type of acid-base disorder do these findings suggest?

💡 Hint

Examine the pH and PaCO2 levels closely. These will give you clues about whether the issue is respiratory and if it's compensated or not.

12 / 40

12. Arvin is in the hospital for an impending brain surgery and is exhibiting high levels of anxiety. He starts to hyperventilate, feels dizzy, and suddenly loses consciousness. STAT ABGs are immediately ordered, revealing a pH of 7.61, PaCO2 of 22 mmHg, and HCO3 of 25 mEq/L. How would you interpret these ABG results?

💡 Hint

Consider the temperature and the other vital signs along with the ABG results. Is the temperature elevated? How do the ABG levels align with the concept of hyperthermia or hypothermia?

13 / 40

13. A mother arrives at the emergency department, complaining of feeling feverish and experiencing chills. The nurse on shift records the following vital signs: Temp = 100 °F; apical pulse = 95; respiration = 20 and deep. A subsequent arterial blood gas test reveals: pH 7.37, PaO2 90 mm Hg, PaCO2 40 mm Hg, and HCO3 24 mmol/L. Based on these findings, what is your nursing assessment?

💡 Hint

Consider which electrolyte imbalance is often associated with the appearance of U waves on an ECG.

14 / 40

14. Nurse Emily is temporarily assigned to the telemetry unit for her shift. While observing the cardiac monitor, she notices that the patient's ECG is displaying noticeable U waves. Faced with this situation, Emily must decide which lab value to check without delay:

💡 Hint

Consider the ABG values and George's COPD history when interpreting the type and compensation status of the acid-base imbalance.

15 / 40

15. 54-year-old George, with a history of COPD, arrives in the ER with worsening shortness of breath, fever, and a cough producing yellow-green sputum. He can barely finish a sentence, and his son says he's been sick for three days. Examination reveals lower lobe crackles and wheezes, a fast heartbeat, and a strong pulse. ABG results: pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, PaO2 60 mm Hg. How should these findings be interpreted?

💡 Hint

Focus on the ABG values, especially the pH and HCO3, to determine the type of acid-base imbalance and whether it's compensated or not.

16 / 40

16. Allan, an elementary student, is admitted to the hospital with symptoms of vomiting and decreased consciousness. On exam, he shows Kussmaul breathing, lethargy, and irritability. Signs of dehydration are evident, and he has a recent history of increased thirst, frequent urination, and weight loss. ABG results: pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, HCO3 12 mmol/L; other labs: Na+ 126 mmol/L, K+ 5 mmol/L, Cl- 95 mmol/L. How would you assess these findings?

💡 Hint

Focus on the elevated pH and HCO3 levels, along with the lack of compensatory change in PaCO2, to determine the type of acid-base imbalance.

17 / 40

17. Mark's grandmother has been vomiting for two days and is diagnosed with gastroenteritis and dehydration. She's lethargic, weak, and has myalgia. Physical examination shows dry mucous membranes and delayed capillary refill (>4 seconds). Her ABG results are: pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid-base disorder is indicated based on these findings?

💡 Hint

Focus on the pH and HCO3 values to determine the type of acid-base imbalance and its compensation status.

18 / 40

18. Nurse Sarah is monitoring Mr. Jefferson, a post-abdominal surgery patient with a nasogastric tube (NGT). She observes an alarming 900 cc of coffee-ground secretions draining from the NGT in just 2 hours. Mr. Jefferson is disoriented to time, place, and person. After promptly contacting the physician, STAT ABGs are ordered. The results reveal a pH of 7.57, PaCO2 of 37 mmHg, and HCO3 of 30 mEq/L. What do these results suggest?

💡 Hint

Consider the low potassium level and its potential impact on acid-base balance, particularly in relation to vomiting symptoms.

19 / 40

19. Mike, a 6-year-old, is brought to the hospital by his mother, who reports that he has been experiencing nausea, vomiting, and general fatigue. Upon reviewing the lab results, the nurse finds that his potassium level is at 2.9 mEq/L. If medical action is not promptly taken, which primary acid-base imbalance is Mike most likely to develop?

💡 Hint

Pay attention to the signs of depressed ventilation and consider its immediate impact on acid-base balance.

20 / 40

20. Jane is at a social gathering, consuming alcohol, when she trips and falls, hitting her head hard on the floor. Her friend Clara quickly calls emergency services as Jane becomes unconscious, displays shallow and slow breathing, has an elevated heart rate, and is bleeding severely from her ears. If immediate medical intervention is not provided, which primary acid-base imbalance is Jane most at risk for?

💡 Hint

Think about the potential side effects of opioids like oxycodone on respiratory function, especially in a client with a lung condition.

21 / 40

21. Nurse Ethan is overseeing a student nurse who is caring for a client with lung cancer. The client has just received a 10 mg oral dose of oxycodone for pain management. Ethan must instruct the student nurse on which finding should be reported to him immediately:

💡 Hint

Think about which task is within the nursing assistant's scope of practice and doesn't require advanced clinical judgment or skill.

22 / 40

22. Nurse Alex, a newly graduated RN, has been tasked by the charge nurse to oversee the care of a patient suffering from acute renal failure accompanied by hypernatremia. Considering his responsibilities and the scope of practice, Alex must decide which tasks he can appropriately delegate to the nursing assistant on his team:

💡 Hint

Consider the pH and bicarbonate (HCO3-) levels in relation to the PCO2 levels. What imbalance do these values suggest?

23 / 40

23. During a surgical procedure, aspiration of the upper gastrointestinal tract contents was deemed necessary for patient safety. Postoperatively, arterial blood gas analysis shows the following values: pH of 7.55, PCO2 of 52 mm Hg, and HCO3- of 40 mmol/L. As a competent nurse, what would you identify as the underlying acid-base disorder based on these results?

💡 Hint

Think about the impact of NG suctioning on stomach acid levels and how the body might try to compensate for any resulting imbalances.

24 / 40

24. Nurse Karen is mentoring a student nurse caring for a client with a nasogastric (NG) tube connected to intermittent wall suction. The student notices that the client's respiratory rate has increased and asks why this might be happening. What would be Karen's most accurate response?

💡 Hint

Take note of the rapid respiratory rate and the symptoms of emotional distress. What is the likely impact on his acid-base balance?

25 / 40

25. An employee driving for his company is discovered at an auto accident scene displaying evident emotional distress. He reports to the first responders feeling dizziness, a tingling sensation in his fingertips, and an inability to recall the incident. His respiratory rate is notably rapid at 34 breaths per minute. If immediate medical intervention is not sought, which primary acid-base imbalance is this individual most at risk for?

💡 Hint

Look at the pH and PaCO2 values; they'll give you clues about whether the issue is respiratory and if it's acidosis or alkalosis.

26 / 40

26. Sheila arrives in the ER after a fall, injuring her left leg. Despite receiving painkillers, she continues to experience pain along with muscle cramps, tingling, and paraesthesia. Her vital signs indicate tachycardia and tachypnea. Her ABG results show: pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3 25 mmol/L. What is your assessment based on these findings?

💡 Hint

Refer to your knowledge on standard reference ranges for arterial blood gas components. Specifically, what is considered a normal level for PaCO2?

27 / 40

27. A hospitalized patient suffering from vomiting and altered mental status demonstrates slow, deep breathing (Kussmaul's respiration) and reacts with lethargy and irritability when stimulated. He has been diagnosed with dehydration. Arterial blood gas (ABG) measurements reveal a pH of 7.0, PaO2 of 90 mm Hg, PaCO2 of 22 mm Hg, and HCO3 of 14 mmol/L; additional lab results are Na+ 120 mmol/L, K+ 2.5 mmol/L, and Cl- 95 mmol/L. As an informed nurse, you should be aware that the standard reference range for PaCO2 is:

💡 Hint

Consider the effects of rapid respiration on carbon dioxide levels and how this could lead to a specific type of acid-base imbalance.

28 / 40

28. Nurse Emily receives a report from a nursing assistant concerning a client who appears extremely anxious. The vital signs include a notably elevated respiratory rate of 38 breaths per minute. Emily needs to identify the most likely acid-base imbalance the client could be experiencing:

💡 Hint

Examine the pH and HCO3 levels closely to discern if the baby's acid-base balance issue is metabolic in nature and whether the body has compensated for it.

29 / 40

29. In the ER, Nurse Emily attends to Baby Sophia, brought in by her mother due to three days of fussiness, poor feeding, and diarrhea. The baby shows a high respiratory rate and sunken fontanels. After ensuring ABCs, the ER doctor orders STAT ABGs. The results are pH 7.39, PaCO2 27 mm Hg, and HCO3 19 mEq/L. What do these results indicate?

💡 Hint

Consider which electrolyte is most likely to be diluted in the body due to water retention when ADH levels are abnormally high.

30 / 40

30. Nurse Mark is tending to a newly-admitted patient diagnosed with Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Understanding the complications that can arise from SIADH, he considers which electrolyte imbalance deserves vigilant monitoring:

💡 Hint

Reflect on how adjusting the ventilator rate can impact the removal of carbon dioxide, which in turn may resolve respiratory acidosis.

31 / 40

31. Nurse Sarah is tending to a client in respiratory failure who is on mechanical ventilation. Despite ongoing treatment, the patient's arterial blood gas (ABG) results consistently show respiratory acidosis. Sarah must anticipate which intervention is most likely to correct this issue:

💡 Hint

Consider the physiological role of phosphorus in muscle function when explaining why the client needs more assistance with ADLs.

32 / 40

32. Nurse Liam is working alongside a nursing assistant to care for a client with chronic low phosphorus levels. The nursing assistant is curious about why the client requires extensive assistance for performing activities of daily living (ADLs). Liam must decide how best to explain this situation:

💡 Hint

Think about which client's condition is most stable and would require less intensive nursing skills, making it more suitable for a step-down unit nurse temporarily working in the ICU.

33 / 40

33. As the charge nurse, you are responsible for assigning patients to the appropriate care teams. Today, a nurse from the step-down unit has been pulled to work in the intensive care unit (ICU). You must decide which client is the most suitable for this step-down unit nurse to manage for the day:

💡 Hint

Look at the pH and PaCO2 levels to identify the patient's acid-base status.

34 / 40

34. Nurse Gabriel is in the PACU with Ms. Emily, a post-op patient who's hard to awaken and breathing shallowly at 7 breaths/min. After administering IV Morphine Sulfate, Gabriel obtains STAT ABGs: pH 7.10, PaCO2 70 mm Hg, HCO3 24 mEq/L. What do these findings indicate?

💡 Hint

Think about which intervention will most urgently address the patient's symptoms of fluid overload, particularly concerning the respiratory system.

35 / 40

35. Nurse Jane is reviewing the medical orders for a patient who has been diagnosed with Excess Fluid volume. During her morning assessment, she notes the patient has gained an extra 2 pounds, exhibits pitting edema around the ankles, and has moist crackles upon lung auscultation. Her findings also indicate bounding peripheral pulses. The doctor's orders include:

💡 Hint

Focus on which electrolyte level is most critically out of the normal range and has immediate, serious implications for cardiac and neuromuscular function.

36 / 40

36. Nurse Maya is going through the morning lab reports for one of her clients. Among the results are several electrolyte levels. Knowing the implications of these values, Maya must determine which result should be prioritized for immediate attention:

💡 Hint

Recall the standard reference ranges for arterial blood gas components to determine what is considered a normal bicarbonate level.

37 / 40

37. An elderly patient is rushed to the hospital in a comatose state. Arterial blood gas analysis yields the following results: PCO2 of 16 mm Hg, HCO3- of 5 mmol/L, and pH of 7.1. As a proficient nurse, you should be aware that the standard reference range for bicarbonate (HCO3-) is:

💡 Hint

Think about which task falls within the nursing assistant's scope of practice and does not require specialized training or clinical judgment related to DKA.

38 / 40

38. Nurse Tim is managing the care of a client diagnosed with diabetic ketoacidosis (DKA). To best allocate responsibilities among his team, he must decide which task can be appropriately delegated to the nursing assistant:

💡 Hint

Look at the pH, HCO3-, and PaCO2 values closely. These results indicate more than one issue with the body's acid-base balance. What types of imbalances are suggested by these abnormal levels?

39 / 40

39. A young female is discovered in a comatose state after ingesting an indeterminate quantity of sleeping pills at an unknown time prior. Arterial blood gas analysis reveals the following: pH of 6.90, HCO3- of 13 meq/L, and PaCO2 of 68 mmHg. As an adept nurse, how would you most precisely describe this patient's acid-base status based on these values?

💡 Hint

Focus on the signs of aspirin overdose and its impact on metabolic processes. Remember, aspirin overdose can lead to metabolic imbalances.

40 / 40

40. Susan's elderly mother arrives at a local emergency department. Susan reveals that her mother has ingested a large quantity of aspirin in the past day due to a severe headache and also complains of urinary retention. The attending nurse takes her vital signs: Temp = 97.8°F, apical pulse = 95, and respiration = 32 and deep. If medical intervention is not immediately carried out, which primary acid-base imbalance is this woman most at risk for?

Exam Mode

Welcome to your MSN Exam for Fluid, Electrolyte, and Acid Base Problems! This exam is carefully designed to provide you with a realistic test-taking experience, preparing you for the pressures of an actual nursing exam.

 

Exam Details

  • Number of Questions: 40 items
  • Mode: Exam Mode

Exam Instructions

  1. Exam Mode: This mode is intended to simulate the environment of an actual exam. Questions and choices will be presented one at a time.
  2. Time Limit: Each question must be answered within 90 seconds. The entire exam should be completed within 60 minutes.
  3. Feedback and Grading: Upon completion of the exam, you will be able to see your grade and the correct answers to all questions. This will allow you to evaluate your performance and understand areas for improvement.

This exam is not only a measurement of your current understanding, but also a valuable learning tool to prepare you for your future nursing career.

 

Click 'Start Exam' when you're ready to begin. Good luck!

1 / 40

1. Nurse Liam is working alongside a nursing assistant to care for a client with chronic low phosphorus levels. The nursing assistant is curious about why the client requires extensive assistance for performing activities of daily living (ADLs). Liam must decide how best to explain this situation:

2 / 40

2. Nurse Sarah is tending to a client in respiratory failure who is on mechanical ventilation. Despite ongoing treatment, the patient's arterial blood gas (ABG) results consistently show respiratory acidosis. Sarah must anticipate which intervention is most likely to correct this issue:

3 / 40

3. An employee driving for his company is discovered at an auto accident scene displaying evident emotional distress. He reports to the first responders feeling dizziness, a tingling sensation in his fingertips, and an inability to recall the incident. His respiratory rate is notably rapid at 34 breaths per minute. If immediate medical intervention is not sought, which primary acid-base imbalance is this individual most at risk for?

4 / 40

4. In the case of a client suffering from dehydration, the nursing care plan emphasizes oral health measures. Nurse Emily is supervising an LPN/LVN and needs to delegate tasks appropriately.

5 / 40

5. Nurse Mark is tending to a newly-admitted patient diagnosed with Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Understanding the complications that can arise from SIADH, he considers which electrolyte imbalance deserves vigilant monitoring:

6 / 40

6. Nurse Emily is overseeing the care of a client diagnosed with Deficient Fluid Volume due to excessive fluid loss. Emily is contemplating which tasks related to fluid management can be delegated to a nursing assistant under her supervision.

7 / 40

7. Nurse Ethan is overseeing a student nurse who is caring for a client with lung cancer. The client has just received a 10 mg oral dose of oxycodone for pain management. Ethan must instruct the student nurse on which finding should be reported to him immediately:

8 / 40

8. Nurse Emily is evaluating a client who has a nursing diagnosis of Decreased Cardiac Output, which is linked to reduced plasma volume. She is keen to identify clinical signs that would substantiate this diagnosis.

9 / 40

9. Nurse Olivia is in the process of discharging a client whose calcium levels were previously low but have now slightly normalized to fall within the usual range of 9-10.5 mg/dL. To ensure the patient is well-informed, Olivia asks the client to verbalize their understanding. She must identify which of the following client statements reveals a gap in education:

10 / 40

10. A mother arrives at the emergency department, complaining of feeling feverish and experiencing chills. The nurse on shift records the following vital signs: Temp = 100 °F; apical pulse = 95; respiration = 20 and deep. A subsequent arterial blood gas test reveals: pH 7.37, PaO2 90 mm Hg, PaCO2 40 mm Hg, and HCO3 24 mmol/L. Based on these findings, what is your nursing assessment?

11 / 40

11. Jane is at a social gathering, consuming alcohol, when she trips and falls, hitting her head hard on the floor. Her friend Clara quickly calls emergency services as Jane becomes unconscious, displays shallow and slow breathing, has an elevated heart rate, and is bleeding severely from her ears. If immediate medical intervention is not provided, which primary acid-base imbalance is Jane most at risk for?

12 / 40

12. 54-year-old George, with a history of COPD, arrives in the ER with worsening shortness of breath, fever, and a cough producing yellow-green sputum. He can barely finish a sentence, and his son says he's been sick for three days. Examination reveals lower lobe crackles and wheezes, a fast heartbeat, and a strong pulse. ABG results: pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, PaO2 60 mm Hg. How should these findings be interpreted?

13 / 40

13. Mike, a 6-year-old, is brought to the hospital by his mother, who reports that he has been experiencing nausea, vomiting, and general fatigue. Upon reviewing the lab results, the nurse finds that his potassium level is at 2.9 mEq/L. If medical action is not promptly taken, which primary acid-base imbalance is Mike most likely to develop?

14 / 40

14. Mark's grandmother has been vomiting for two days and is diagnosed with gastroenteritis and dehydration. She's lethargic, weak, and has myalgia. Physical examination shows dry mucous membranes and delayed capillary refill (>4 seconds). Her ABG results are: pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid-base disorder is indicated based on these findings?

15 / 40

15. A young female is discovered in a comatose state after ingesting an indeterminate quantity of sleeping pills at an unknown time prior. Arterial blood gas analysis reveals the following: pH of 6.90, HCO3- of 13 meq/L, and PaCO2 of 68 mmHg. As an adept nurse, how would you most precisely describe this patient's acid-base status based on these values?

16 / 40

16. Nurse Maya is going through the morning lab reports for one of her clients. Among the results are several electrolyte levels. Knowing the implications of these values, Maya must determine which result should be prioritized for immediate attention:

17 / 40

17. Nurse Alex, a newly graduated RN, has been tasked by the charge nurse to oversee the care of a patient suffering from acute renal failure accompanied by hypernatremia. Considering his responsibilities and the scope of practice, Alex must decide which tasks he can appropriately delegate to the nursing assistant on his team:

18 / 40

18. Nurse Sarah is monitoring Mr. Jefferson, a post-abdominal surgery patient with a nasogastric tube (NGT). She observes an alarming 900 cc of coffee-ground secretions draining from the NGT in just 2 hours. Mr. Jefferson is disoriented to time, place, and person. After promptly contacting the physician, STAT ABGs are ordered. The results reveal a pH of 7.57, PaCO2 of 37 mmHg, and HCO3 of 30 mEq/L. What do these results suggest?

19 / 40

19. Nurse Emily, an RN, receives a report from an experienced LPN/LVN concerning a client. The LPN/LVN notes that the patient's blood pressure and heart rate have dropped and that there's noticeable twitching on one side of the face. Faced with this information, Emily needs to decide what her immediate action should be:

20 / 40

20. An adventurer sets out to climb a towering peak in the Andes, ascending to an elevation of 5,000 meters (about 16,400 feet) above sea level. As a well-informed nurse, what changes would you anticipate in his arterial PCO2 and pH levels at this high altitude?

21 / 40

21. Arvin is in the hospital for an impending brain surgery and is exhibiting high levels of anxiety. He starts to hyperventilate, feels dizzy, and suddenly loses consciousness. STAT ABGs are immediately ordered, revealing a pH of 7.61, PaCO2 of 22 mmHg, and HCO3 of 25 mEq/L. How would you interpret these ABG results?

22 / 40

22. Nurse Gabriel is in the PACU with Ms. Emily, a post-op patient who's hard to awaken and breathing shallowly at 7 breaths/min. After administering IV Morphine Sulfate, Gabriel obtains STAT ABGs: pH 7.10, PaCO2 70 mm Hg, HCO3 24 mEq/L. What do these findings indicate?

23 / 40

23. In the ER, Nurse Emily attends to Baby Sophia, brought in by her mother due to three days of fussiness, poor feeding, and diarrhea. The baby shows a high respiratory rate and sunken fontanels. After ensuring ABCs, the ER doctor orders STAT ABGs. The results are pH 7.39, PaCO2 27 mm Hg, and HCO3 19 mEq/L. What do these results indicate?

24 / 40

24. Nurse William is overseeing the care of a client admitted for chemotherapy. To preemptively manage potential acid-base imbalances, he needs to instruct the nursing assistant on what to report immediately. What should that be?

25 / 40

25. Nurse Victoria is in the process of admitting an elderly client to the medical unit. She needs to identify any factors that may place the client at risk for developing acid-base imbalances. Which of the following factors should alert her to this possibility?

26 / 40

26. Nurse Taylor is caring for 3-year-old Noah, who has been hospitalized for asthma and respiratory distress syndrome. Noah's mother mentions that she has noticed mild tremors and changes in her son's behavior over the past few days. After assessing the ABCs, the attending physician orders standard ABGs. The results indicate a pH of 7.35, PaCO2 of 72 mmHg, and HCO3 of 38 mEq/L. What type of acid-base disorder do these findings suggest?

27 / 40

27. Nurse Karen is mentoring a student nurse caring for a client with a nasogastric (NG) tube connected to intermittent wall suction. The student notices that the client's respiratory rate has increased and asks why this might be happening. What would be Karen's most accurate response?

28 / 40

28. A hospitalized patient suffering from vomiting and altered mental status demonstrates slow, deep breathing (Kussmaul's respiration) and reacts with lethargy and irritability when stimulated. He has been diagnosed with dehydration. Arterial blood gas (ABG) measurements reveal a pH of 7.0, PaO2 of 90 mm Hg, PaCO2 of 22 mm Hg, and HCO3 of 14 mmol/L; additional lab results are Na+ 120 mmol/L, K+ 2.5 mmol/L, and Cl- 95 mmol/L. As an informed nurse, you should be aware that the standard reference range for PaCO2 is:

29 / 40

29. An elderly homeless man is rushed to the emergency room, presenting with difficulty breathing, fever, and a cough that produces sputum. On assessment, the nurse hears crackles and wheezes in the lower lung lobes; the patient is also tachycardic with a bounding pulse. Arterial blood gas measurements reveal a pH of 7.2, PaCO2 of 66 mm Hg, HCO3 of 27 mmol/L, and PaO2 of 65 mm Hg. As a well-informed nurse, you should know that the standard reference range for pH is:

30 / 40

30. Nurse Tim is managing the care of a client diagnosed with diabetic ketoacidosis (DKA). To best allocate responsibilities among his team, he must decide which task can be appropriately delegated to the nursing assistant:

31 / 40

31. Nurse Sarah is supervising a student nurse for the day. She reviews a patient's lab results and notes that the potassium level is 6.7 mEq/L, indicating hyperkalemia. Recognizing the need for immediate intervention, Sarah must decide which task can be safely delegated to the student nurse:

32 / 40

32. Nurse Jane is reviewing the medical orders for a patient who has been diagnosed with Excess Fluid volume. During her morning assessment, she notes the patient has gained an extra 2 pounds, exhibits pitting edema around the ankles, and has moist crackles upon lung auscultation. Her findings also indicate bounding peripheral pulses. The doctor's orders include:

33 / 40

33. Sheila arrives in the ER after a fall, injuring her left leg. Despite receiving painkillers, she continues to experience pain along with muscle cramps, tingling, and paraesthesia. Her vital signs indicate tachycardia and tachypnea. Her ABG results show: pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3 25 mmol/L. What is your assessment based on these findings?

34 / 40

34. An elderly patient is rushed to the hospital in a comatose state. Arterial blood gas analysis yields the following results: PCO2 of 16 mm Hg, HCO3- of 5 mmol/L, and pH of 7.1. As a proficient nurse, you should be aware that the standard reference range for bicarbonate (HCO3-) is:

35 / 40

35. During a surgical procedure, aspiration of the upper gastrointestinal tract contents was deemed necessary for patient safety. Postoperatively, arterial blood gas analysis shows the following values: pH of 7.55, PCO2 of 52 mm Hg, and HCO3- of 40 mmol/L. As a competent nurse, what would you identify as the underlying acid-base disorder based on these results?

36 / 40

36. Allan, an elementary student, is admitted to the hospital with symptoms of vomiting and decreased consciousness. On exam, he shows Kussmaul breathing, lethargy, and irritability. Signs of dehydration are evident, and he has a recent history of increased thirst, frequent urination, and weight loss. ABG results: pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, HCO3 12 mmol/L; other labs: Na+ 126 mmol/L, K+ 5 mmol/L, Cl- 95 mmol/L. How would you assess these findings?

37 / 40

37. Susan's elderly mother arrives at a local emergency department. Susan reveals that her mother has ingested a large quantity of aspirin in the past day due to a severe headache and also complains of urinary retention. The attending nurse takes her vital signs: Temp = 97.8°F, apical pulse = 95, and respiration = 32 and deep. If medical intervention is not immediately carried out, which primary acid-base imbalance is this woman most at risk for?

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38. Nurse Emily is temporarily assigned to the telemetry unit for her shift. While observing the cardiac monitor, she notices that the patient's ECG is displaying noticeable U waves. Faced with this situation, Emily must decide which lab value to check without delay:

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39. Nurse Emily receives a report from a nursing assistant concerning a client who appears extremely anxious. The vital signs include a notably elevated respiratory rate of 38 breaths per minute. Emily needs to identify the most likely acid-base imbalance the client could be experiencing:

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40. As the charge nurse, you are responsible for assigning patients to the appropriate care teams. Today, a nurse from the step-down unit has been pulled to work in the intensive care unit (ICU). You must decide which client is the most suitable for this step-down unit nurse to manage for the day: