Page 263 - Saunders Comprehensive Review For NCLEX-RN

Practice Questions

39. The nurse is caring for a client with heart failure. On assessment, the nurse
notes that the client is dyspneic, and crackles are audible on auscultation.
What additional manifestations would the nurse expect to note in this client
if excess fluid volume is present?
1. Weight loss and dry skin
2. Flat neck and hand veins and decreased urinary output
3. An increase in blood pressure and increased respirations
4. Weakness and decreased central venous pressure (CVP)
40. The nurse reviews a client’s record and determines that the client is at risk for
developing a potassium deficit if which situation is documented?
1. Sustained tissue damage
2. Requires nasogastric suction
3. Has a history of Addison’s disease
4. Uric acid level of 9.4 mg/dL (557 mcmol/L)
41. The nurse reviews a client’s electrolyte laboratory report and notes that the
potassium level is 2.5 mEq/L (2.5 mmol/L). Which patterns should the nurse
watch for on the electrocardiogram (ECG) as a result of the laboratory value?
Select all that apply.
1. U waves
2. Absent P waves
3. Inverted T waves
4. Depressed ST segment
5. Widened QRS complex
42. Potassium chloride intravenously is prescribed for a client with heart failure
experiencing hypokalemia. Which actions should the nurse take to plan for
preparation and administration of the potassium? Select all that apply.
1. Obtain an intravenous (IV) infusion pump.

263