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    Exam Review

    1. A nurse is caring for a client admitted to the emergency department with a hemothorax. Lung sounds are clear on the right, diminished on the left. Trachea is midline. Oxygen saturation 92% on room air. Client reports pain 7/10. What is the priority nursing intervention at this time?
      A)
      Prepare for needle thoracostomy.
      B)
      Prepare for chest tube insertion.
      C)
      Prepare oral pain medications.
      D)
      Prepare for mechanical ventilation.
    2. The nurse is assessing a client with an endotracheal tube for readiness to have the tube removed. Which assessment finding is most likely indicative that the client is ready for extubation?
      A)
      Respiratory rate of 10 breaths per minute.
      B)
      Oxygen saturation of 95%.
      C)
      Pink nailbeds with brisk capillary refill.
      D)
      Onset of coughing and gagging.
    3. The nurse works in the emergency department (ED) and is out of IV pumps. Fluids are being administered via gravity. A client is to have 1000 mL of normal saline to be infused over 10 hours. Available tubing has a drip factor of 10 gtt/mL. How many drops per minute will the nurse set the drip rate? Round to the nearest whole number. Record numeric answers only.
      Correct Answer:17 gtt/min
    4. The nurse is evaluating a client's response to hemodialysis. Which laboratory values will indicate the dialysis was effective?
      A)
      White blood cells (WBCs) increase from 5000 to 8000/mm3 (5 to 8 x 109/L).
      B)
      Serum potassium level decreases from 5.4 to 4.6 mEq/L (5.4 to 4.6 mmol/L).
      C)
      Hemoglobin increases from 10 to 12 g/dL (100 to 120 mmol/L).
      D)
      Blood urea nitrogen (BUN) decreases from 110 to 90 mg/dL (39.3 to 32.1 mmol/L).
    Page 1 of 13

    Exam Review

    1. Which dietary modification would the nurse implement for a client with end stage renal failure?
      A)
      Increase potassium.
      B)
      Decrease calcium.
      C)
      Decrease protein.
      D)
      Increase phosphate.
    2. A client with a history of receiving peritoneal dialysis is brought to the emergency department. When assessing the client, which clinical finding would require immediate intervention by the nurse?
      A)
      Rigid abdomen.
      B)
      Peripheral edema.
      C)
      Proteinuria.
      D)
      Anorexia.
    3. A nurse is assessing clients who are at risk for acid-base imbalance. Which acid-base imbalance is correctly paired with the client at risk?
      A)
      Respiratory alkalosis: client with inadequate chest expansion due to muscle weakness.
      B)
      Metabolic alkalosis: client who is mechanically ventilated.
      C)
      Respiratory acidosis: client with hyperventilation due to anxiety.
      D)
      Metabolic acidosis: client who has Kussmaul respirations.
    4. A client in the intensive care unit is on continuous renal replacement therapy (CRRT). Which finding requires immediate action by the nurse?
      A)
      Potassium level 5.2 mEq/L.
      B)
      Blood pressure 76/58 mm Hg.
      C)
      Sodium level 135 mEq/L.
      D)
      Pulse rate 90 beats/min.
    Page 2 of 13

    Exam Review

    1. A nurse is developing a plan of care for a client who is to begin receiving peritoneal dialysis. Which intervention would the nurse implement during the dialysate exchange?
      A)
      Hang the drain bag on an IV pole prior to infusing dialysate.
      B)
      Maintain the client in a left lateral position during exchanges.
      C)
      Monitor vital signs every two hours during the procedure.
      D)
      Warm the dialysate solution prior to instilling into the client.
    2. The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the nurse assess first upon initial rounding?
      A)
      Client with pruritic.
      B)
      Client with a blood pressure of 158/90 mm Hg.
      C)
      Client with muffled heart sounds.
      D)
      Client with oliguria.
    3. Which assessment finding would the nurse expect to document for a client with an open pneumothorax?
      A)
      Sucking sound on inspiration and expiration.
      B)
      Tracheal deviation towards the side of injury.
      C)
      Symmetrical chest movement.
      D)
      Tracheal deviation away from the side of injury.
    4. The client on long-term mechanical ventilation becomes very frustrated when they try to communicate. What intervention would the nurse implement to assist the client?
      A)
      Ask the provider to wean the client off the mechanical ventilator to allow them to talk.
      B)
      Assure the client that everything will be all right and that they should not become upset.
      C)
      Ask a family member to interpret what the client is trying to communicate.
      D)
      Ask the client to write, use a picture board, or spell words with an alphabet board.
    Page 3 of 13

    Exam Review

    1. Which of these clients is a priority to assess?
      A)
      A client who is receiving an initial round of peritoneal dialysis, who complains of mild cramping with instillation of dialysate fluid.
      B)
      A client who is preparing for hemodialysis in one hour and is presenting with heart rate 100 bpm, blood pressure 160/92, and weight increase of 2kg/48 hours.
      C)
      A client who has begun hemodialysis and is presenting with nausea, vomiting, change in level of consciousness, and agitation.
      D)
      A client who is receiving peritoneal dialysis with an order to infuse in 500 mL of dialysate and only drains out 450 mL.
    2. The nurse is to administer a subcutaneous injection of erythropoietin 100 units/kg three times a week for a client on dialysis. The client weighs 156 lbs. Erythropoietin comes from the pharmacy in a vial 10,000 units/1 mL. How many mL will the nurse give to the client? Round to the nearest hundredths place, Record numeric answers only.
    3. A client sustained a chest injury and is experiencing a pleural effusion. What would the nurse expect as assessment findings? Select all that apply.
      A)
      Fever.
      B)
      Dyspnea on exertion.
      C)
      Chest pain with inhalation.
      D)
      Tachypnea.
      E)
      Course crackles.
      F)
      Productive cough.
    4. A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What is the priority action by the nurse?
      A)
      Flush the tubing with normal saline to maintain patency of the catheter.
      B)
      Warm the dialysate solution before instillation.
      C)
      Take a sample of the effluent to send to the laboratory.
      D)
      Check the peritoneal catheter for kinking and curling.
    Page 4 of 13

    Exam Review

    1. The nurse is caring for a post operative client with the following arterial blood gas (ABG) results. Which intervention would the nurse implement based on the results? PH 7.48 PaCO2 36 HC03 29 Pa02 98
      A)
      Administer intravenous pain medication.
      B)
      Assess the amount of suction on the client's nasogastric tube.
      C)
      Assess the client for Kussmaul's respirations.
      D)
      Encourage the client to use the incentive spirometer.
    2. The nurse's assessment of the client includes rapid, shallow respirations, respiratory acidosis, and inspiratory crackles. Which additional assessment finding would confirm a diagnosis of acute respiratory distress syndrome (ARDS)?
      A)
      Asymmetrical chest expansion.
      B)
      Pink, frothy sputum.
      C)
      Hypoxemia unresponsive to oxygen.
      D)
      Circumoral cyanosis.
    3. A client becomes extubated while being turned, and becomes cyanotic with bradycardia. Which action would be the highest priority while waiting for the provider to arrive?
      A)
      Provide oxygen via artificial manual breathing unit (ambu) bag.
      B)
      Immediately begin cardiopulmonary resuscitation.
      C)
      Increase rate of intravenous fluids.
      D)
      Prepare the medications for endotracheal intubation.
    4. A nurse is assessing a client who is two weeks postoperative following a live donor kidney transplant. Which assessment finding would the nurse identity as possible organ rejection?
      A)
      Oliguria.
      B)
      Anorexia.
      C)
      Confusion.
      D)
      Pain.
    Page 5 of 13

    Exam Review

    1. The nurse is caring for a client with chronic kidney disease after hemodialysis. Which action would the nurse delegate to the unlicensed assistive personnel (UAP)?
      A)
      Measure the clients postdialysis weight.
      B)
      Assess for signs of disequilibrium syndrome.
      C)
      Monitor for signs of postdialysis bleeding.
      D)
      Educate the client on renal diet restrictions.
    2. A client with acute respiratory distress syndrome following infection by COVID-19 is on a mechanical ventilator. What are the priority nursing interventions to prevent ventilator associated pneumonia (VAP) for this client? Select all that apply.
      A)
      Maintaining cuff pressure between 20-30 cm H2O..
      B)
      Positioning the client semi-fowlers.
      C)
      Providing frequent oral care.
      D)
      Administering peptic ulcer prophylaxis.
      E)
      Positioning the client supine.
      F)
      Hyperoxygenating the client prior to suctioning.
    3. The nurse is providing discharge teaching to a client recovering from a kidney transplant. Which client statement indicates understanding?
      A)
      I will take my antirejection medications for life.
      B)
      I can stop my medications when my glomerular filtration rate returns to normal.
      C)
      If my urine output decreases, I will drink more fluids.
      D)
      I will drink 8 ounces of water with my medications.
    4. A client with end stage renal disease is refusing to take medications and has missed two hemodialysis appointments in the past week. What is the best initial action for the nurse?
      A)
      Discuss what the treatment regimen means to the client.
      B)
      Reschedule the appointments to another date and time.
      C)
      Discuss the option of peritoneal dialysis.
      D)
      Refer the client for mental health services.
    Page 6 of 13