Question

The nurse is caring for a group of clients. Which of the following clients is at risk for cardiogenic shock

Answer 1

Correct Answers:

A client who has a ventricular dysthymia.

Rationale :

❤️Cardiogenic shock results from severe impairment of cardiac output, often due to myocardial dysfunction.

❤️ Ventricular dysrhythmias, such as ventricular tachycardia or fibrillation, lead to ineffective ventricular contraction, reducing perfusion.

❤️Unlike neurogenic shock (e.g., spinal injury), cardiogenic shock stems from cardiac failure.

❤️Clients with PE may develop obstructive shock, not cardiogenic.

❤️Tissue perfusion is compromised, resulting in hypotension, cold extremities, and altered mental status.

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Answer 2

Correct Answers:

"All my medications can be given through the A line."
"The pressure in the left side of my heart can be measured with the A line

Rationale :

🟢 A-lines (arterial lines) are used for blood pressure monitoring and arterial blood sampling, not for medication administration.

🟢 They measure systemic arterial pressure, not left heart pressure (which requires a PA catheter).

🟢 Statements about blood draws and transducer position changes are accurate and do not reflect misunderstanding.

🟢 Medications in an A-line may cause tissue ischemia if infiltrated, as they are high-pressure lines.

🟢 Teaching must emphasize limitations of the line and proper use.

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Answer 3

Correct Answers:

Muscle cramps

Rationale :

♦ After hemodialysis, clients often experience fluid and electrolyte shifts, leading to muscle cramping.

♦ Cramping is caused by rapid fluid removal and electrolyte changes, especially sodium.

♦ Peritonitis and hernias are complications of peritoneal dialysis, not hemodialysis.

♦ Neuropathy is more chronic and typically develops from long-term kidney disease, not immediately post-dialysis.

♦ Monitoring includes assessing for fatigue, BP changes, cramping, and bleeding from the access site.

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Answer 4

Correct Answers:

Draw lactate and blood cultures

Rationale :

🔶 Per Sepsis Bundle Guidelines, the nurse should first obtain blood cultures and lactate levels before administering antibiotics.

🔶 Early labs help determine the severity of sepsis (lactate >2) and guide targeted antibiotic therapy.

🔶Administering antibiotics before cultures may mask causative organisms.

🔶Norepinephrine is used later if fluid resuscitation fails.

🔶 A fluid bolus of 30 mL/kg NS is also part of the bundle, but not the first step.

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Answer 5

Correct Answers:

10

Rationale :

🐷 To find mL: Dose ordered ÷ Concentration available = Volume to give.

🐷 100 mg ÷ 10 mg/mL = 10 mL.

🐷 Rounding was not necessary here.

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Answer 6

Correct Answers:

Glomerular filtration rate (GFR) 14 mL/min

Rationale :

🎀A GFR <15 mL/min indicates stage 5 (end-stage) kidney disease, but 14 mL/min falls into stage 4.

🎀 BUN 15 is normal; this would be unexpected in CKD.

🎀Creatinine of 11 mg/dL is severely elevated and consistent with advanced CKD.

🎀 Normal potassium is 3.7, but in CKD, you’d expect hyperkalemia, not normokalaemia.

🎀 The most specific marker of renal filtration decline is GFR.

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Answer 7

Correct Answers:

Insulin
Sodium Bicarb
Calcium gluconate
Sodium polystyrene sulfonate

Rationale :

✅Insulin + glucose drives potassium into cells temporarily.

✅ Sodium bicarb alkalinizes serum and helps shift K+ into cells.

✅ Calcium gluconate stabilizes the cardiac membrane—prevents dysrhythmias.

✅ Sodium polystyrene sulfonate (Kayexalate) promotes GI excretion of potassium.

✅ Potassium chloride would worsen hyperkalemia; naloxone and atropine are unrelated.

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Answer 8

Correct Answers:

Disability

Rationale :

💙Glucose administration in trauma addresses neurologic status—part of the "D" (Disability) in ABCDE trauma survey.

💙A sudden drop in consciousness may be due to hypoglycemia.

💙Airway, breathing, circulation are assessed before glucose unless neuro signs are prominent.

💙Disability involves evaluating LOC, glucose, and neurologic deficits.

💙Prompt correction avoids irreversible brain damage.

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Answer 9

Correct Answers:

After life threatening injuries have been identified and addressed.

Rationale :

🎀The primary survey (ABCDE) handles all immediate threats to life.

🎀 Secondary survey includes a full body exam, history (AMPLE), and focused diagnostics.

🎀 It is performed after stabilization, not upon arrival.

🎀 Family requests or triage category do not dictate timing.

🎀 Following proper trauma protocols ensures prioritization of critical needs.

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QLexNursing

1 :
The nurse is caring for a group of clients. Which of the following clients is at risk for cardiogenic shock

2 :
The nurse is providing care to a client with a newly inserted A line. Which statement by the client demonstrates a need for further education of the A Line? Select all that apply.

3 :
The nurse is providing care to a client who just returned from hemodialysis. The nurse should assess for the following

4 :
The nurse is proving care to a client who triggered the sepsis criteria. Which action should the nurse complete first?

5 :
The healthcare provider ordered phenobarbital 100 mg PO. The medication available is phenobarbital 10 mg/mL. How many milliliters will the nurse administer? mL (If needed, round to the nearest whole number.)

6 :
Anurse is reviewing client laboratory data. Which of the following findings is expected for a client who has stage 4 chronic kidney disease?

7 :
The nurse is providing care to a client in the critical care unit with a potassium level of 71 mEq. The client is alert and oriented x 4 and on cardiac monitor. Drag and drop the medications the nurse should request from the provider.

8 :
A client presents to the emergency department after being involved in a motor vehicle crash. Which aspect of the primary survey is being addressed when the nurse administered glucose as an intervention?

9 :
The nurse educator is teaching about the primary and secondary survey for trauma victims. When should the secondary survey be performed?

QLexNursing

1 : The nurse is caring for a group of clients. Which of the following clients is at risk for cardiogenic shock

2 : The nurse is providing care to a client with a newly inserted A line. Which statement by the client demonstrates a need for further education of the A Line? Select all that apply.

3 : The nurse is providing care to a client who just returned from hemodialysis. The nurse should assess for the following

4 : The nurse is proving care to a client who triggered the sepsis criteria. Which action should the nurse complete first?

5 : The healthcare provider ordered phenobarbital 100 mg PO. The medication available is phenobarbital 10 mg/mL. How many milliliters will the nurse administer? mL (If needed, round to the nearest whole number.)

6 : Anurse is reviewing client laboratory data. Which of the following findings is expected for a client who has stage 4 chronic kidney disease?

7 : The nurse is providing care to a client in the critical care unit with a potassium level of 71 mEq. The client is alert and oriented x 4 and on cardiac monitor. Drag and drop the medications the nurse should request from the provider.

8 : A client presents to the emergency department after being involved in a motor vehicle crash. Which aspect of the primary survey is being addressed when the nurse administered glucose as an intervention?

9 : The nurse educator is teaching about the primary and secondary survey for trauma victims. When should the secondary survey be performed?

1 :
The nurse is caring for a group of clients. Which of the following clients is at risk for cardiogenic shock

2 :
The nurse is providing care to a client with a newly inserted A line. Which statement by the client demonstrates a need for further education of the A Line? Select all that apply.

3 :
The nurse is providing care to a client who just returned from hemodialysis. The nurse should assess for the following

4 :
The nurse is proving care to a client who triggered the sepsis criteria. Which action should the nurse complete first?

5 :
The healthcare provider ordered phenobarbital 100 mg PO. The medication available is phenobarbital 10 mg/mL. How many milliliters will the nurse administer? mL (If needed, round to the nearest whole number.)

6 :
Anurse is reviewing client laboratory data. Which of the following findings is expected for a client who has stage 4 chronic kidney disease?

7 :
The nurse is providing care to a client in the critical care unit with a potassium level of 71 mEq. The client is alert and oriented x 4 and on cardiac monitor. Drag and drop the medications the nurse should request from the provider.

8 :
A client presents to the emergency department after being involved in a motor vehicle crash. Which aspect of the primary survey is being addressed when the nurse administered glucose as an intervention?

9 :
The nurse educator is teaching about the primary and secondary survey for trauma victims. When should the secondary survey be performed?