CSLB General Building (B) — All Questions
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A nurse reviews a client's laboratory results. Which serum potassium value is within the normal range?
- a.6.5 mEq/L
- b.2.8 mEq/L
- c.4.0 mEq/L✓
- d.7.2 mEq/L
The normal serum potassium range is approximately 3.5 to 5.0 mEq/L, so 4.0 mEq/L is normal. Values of 6.5 and 7.2 indicate hyperkalemia, and 2.8 indicates hypokalemia.
A client with heart failure gains 3 pounds in two days and has new crackles in the lungs. Which condition does the nurse suspect?
- a.Dehydration
- b.Hypokalemia
- c.Metabolic alkalosis
- d.Fluid volume overload✓
Rapid weight gain and pulmonary crackles indicate fluid volume overload, common in a heart failure exacerbation. Prompt recognition allows diuretic and fluid management.
A nurse is caring for a client with diabetic ketoacidosis. Which arterial blood gas finding is expected?
- a.Metabolic acidosis✓
- b.Respiratory alkalosis
- c.Metabolic alkalosis
- d.Respiratory acidosis
Diabetic ketoacidosis produces excess ketoacids, causing metabolic acidosis with a low pH and low bicarbonate. Kussmaul respirations develop as compensation.
A client with chronic obstructive pulmonary disease has an oxygen saturation of 90%. Which oxygen delivery approach is appropriate?
- a.Administer high-flow oxygen at 10 L/min immediately
- b.Provide low-flow oxygen and titrate to the target saturation✓
- c.Withhold all oxygen to preserve respiratory drive
- d.Place the client on a nonrebreather mask routinely
Clients with COPD are given controlled low-flow oxygen titrated to a target saturation, often around 88 to 92 percent, to avoid suppressing respiratory drive while treating hypoxemia.
A nurse assesses a client with hypocalcemia. Which finding is expected?
- a.Decreased deep tendon reflexes
- b.Constipation and lethargy
- c.Positive Trousseau and Chvostek signs✓
- d.Warm, flushed skin
Hypocalcemia increases neuromuscular excitability, producing positive Trousseau and Chvostek signs, muscle cramps, and tingling. Hypercalcemia causes the opposite findings.
A client presents with slurred speech, facial droop, and right-sided weakness. What is the nurse's priority action?
- a.Administer aspirin immediately
- b.Encourage the client to rest and reassess in an hour
- c.Give the client oral fluids
- d.Activate the stroke protocol and note the time of symptom onset✓
These signs suggest an acute stroke. Rapid activation of the stroke protocol and documenting the symptom onset time are critical because treatment such as thrombolytics is time-dependent.
A nurse is caring for a client after a myocardial infarction. Which laboratory marker is most specific for cardiac muscle damage?
- a.Troponin✓
- b.Total white blood cell count
- c.Serum sodium
- d.Blood urea nitrogen
Troponin is the most specific and sensitive biomarker for myocardial injury and rises within hours of an infarction, guiding diagnosis and treatment.
A client has a nasogastric tube to continuous suction and develops muscle weakness. Which disturbance is most likely?
- a.Metabolic acidosis with hyperkalemia
- b.Metabolic alkalosis with hypokalemia✓
- c.Respiratory acidosis with hypernatremia
- d.Respiratory alkalosis with hypercalcemia
Loss of gastric acid and potassium through continuous suction leads to metabolic alkalosis and hypokalemia, which can cause muscle weakness and dysrhythmias.
A nurse reviews an arterial blood gas: pH 7.30, PaCO2 55 mm Hg, HCO3 24 mEq/L. How should the nurse interpret this?
- a.Metabolic acidosis
- b.Respiratory alkalosis
- c.Respiratory acidosis✓
- d.Metabolic alkalosis
A low pH with an elevated PaCO2 and a normal bicarbonate indicates uncompensated respiratory acidosis, often from hypoventilation.
A client with cirrhosis develops confusion and asterixis. Which laboratory value best explains these findings?
- a.Decreased serum glucose
- b.Elevated serum calcium
- c.Decreased white blood cell count
- d.Elevated serum ammonia✓
Impaired liver function raises serum ammonia, causing hepatic encephalopathy with confusion and asterixis. Treatment such as lactulose lowers ammonia levels.
A nurse cares for a client with acute kidney injury and a serum potassium of 6.8 mEq/L. Which finding is the priority concern?
- a.Peaked T waves on the electrocardiogram✓
- b.Mild peripheral edema
- c.Decreased urine output
- d.Fatigue
Hyperkalemia can cause life-threatening cardiac dysrhythmias; peaked T waves signal cardiac effects and require immediate intervention. The other findings are important but less urgent.
A client is admitted with dehydration. Which assessment finding supports this diagnosis?
- a.Bounding pulse and elevated blood pressure
- b.Poor skin turgor and elevated urine specific gravity✓
- c.Moist mucous membranes
- d.Jugular vein distention
Dehydration produces poor skin turgor, dry mucous membranes, and concentrated urine with a high specific gravity. Jugular distention and bounding pulses suggest fluid overload.
A nurse assesses a client with hypothyroidism. Which finding is expected?
- a.Weight loss and heat intolerance
- b.Tachycardia and exophthalmos
- c.Fatigue, cold intolerance, and bradycardia✓
- d.Diarrhea and tremors
Hypothyroidism slows metabolism, causing fatigue, cold intolerance, weight gain, and bradycardia. Weight loss, heat intolerance, and tachycardia occur in hyperthyroidism.
A client with type 1 diabetes is diaphoretic, shaky, and confused with a blood glucose of 54 mg/dL. What is the priority intervention?
- a.Administer long-acting insulin
- b.Encourage the client to exercise
- c.Withhold all food until the provider is notified
- d.Give 15 grams of a fast-acting carbohydrate✓
These are signs of hypoglycemia. For a conscious client, giving about 15 grams of fast-acting carbohydrate raises the glucose quickly; the level is then rechecked.
A nurse is monitoring a client after a total hip replacement. Which finding suggests a possible pulmonary embolism?
- a.Sudden dyspnea, chest pain, and tachycardia✓
- b.Gradual improvement in mobility
- c.Mild incisional soreness
- d.Decreased appetite
Sudden dyspnea, pleuritic chest pain, and tachycardia after orthopedic surgery suggest a pulmonary embolism, a medical emergency requiring immediate action.
A client's laboratory results show a hemoglobin of 7.2 g/dL. Which assessment finding is most consistent with this value?
- a.Bradycardia and hypertension
- b.Fatigue, pallor, and tachycardia✓
- c.Warm, ruddy skin
- d.Increased energy and alertness
A hemoglobin of 7.2 g/dL indicates anemia, producing fatigue, pallor, and compensatory tachycardia due to reduced oxygen-carrying capacity.
A nurse cares for a client with increased intracranial pressure. Which finding is an early sign?
- a.Fixed and dilated pupils
- b.Cushing's triad
- c.A change in level of consciousness✓
- d.Deep coma
A change in level of consciousness is the earliest and most sensitive sign of increased intracranial pressure. Fixed pupils and Cushing's triad are late, ominous findings.
A client with Addison's disease is at risk for adrenal crisis. Which finding requires immediate intervention?
- a.Mild fatigue
- b.Slightly bronzed skin
- c.Salt craving
- d.Severe hypotension and hyperkalemia✓
Adrenal crisis causes profound hypotension, hyperkalemia, and hyponatremia and is life-threatening, requiring immediate fluids and hydrocortisone. Bronzing and salt craving are chronic features.
A nurse reviews arterial blood gases: pH 7.50, PaCO2 30 mm Hg, HCO3 24 mEq/L. Which condition does this represent?
- a.Respiratory alkalosis✓
- b.Respiratory acidosis
- c.Metabolic acidosis
- d.Metabolic alkalosis
An elevated pH with a low PaCO2 and a normal bicarbonate indicates respiratory alkalosis, often caused by hyperventilation.
A client with gastroenteritis has had severe diarrhea for two days. Which electrolyte imbalance is most likely?
- a.Hyperkalemia
- b.Hypokalemia✓
- c.Hypercalcemia
- d.Hypernatremia
Prolonged diarrhea causes significant potassium loss through the stool, leading to hypokalemia, which can produce weakness and cardiac dysrhythmias.
A nurse assesses a client in the compensatory stage of hypovolemic shock. Which finding is expected?
- a.Bradycardia and warm skin
- b.Elevated blood pressure and flushed skin
- c.Increased heart rate and cool, clammy skin✓
- d.Slow, deep respirations
In compensated shock, the body increases the heart rate and constricts peripheral vessels, producing tachycardia and cool, clammy skin as it attempts to maintain perfusion.
A client with pneumonia has a fever and thick secretions. Which intervention best promotes airway clearance?
- a.Restrict oral fluids
- b.Keep the client flat in bed
- c.Suppress the cough with medication
- d.Encourage fluids and provide chest physiotherapy as ordered✓
Adequate hydration thins secretions and chest physiotherapy mobilizes them, promoting airway clearance. Restricting fluids and suppressing a productive cough would worsen secretion retention.
A nurse cares for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which finding is expected?
- a.Hyponatremia and fluid retention✓
- b.Hypernatremia and increased urine output
- c.Dehydration and excessive thirst
- d.High serum osmolality
SIADH causes excessive water retention, leading to dilutional hyponatremia, low serum osmolality, and concentrated urine. Fluid restriction is a key treatment.
A client with a history of gout has an elevated serum uric acid level. Which dietary teaching is appropriate?
- a.Increase intake of organ meats and shellfish
- b.Limit purine-rich foods and increase fluid intake✓
- c.Avoid all dairy products
- d.Restrict water to reduce swelling
Limiting purine-rich foods such as organ meats and shellfish and increasing fluids helps lower uric acid and prevent gout attacks. Adequate hydration promotes uric acid excretion.
A nurse reviews a client's coagulation results. Which value indicates the client is at increased risk for bleeding?
- a.INR of 1.0
- b.Platelet count of 250,000/microliter
- c.INR of 5.0✓
- d.Hemoglobin of 14 g/dL
An INR of 5.0 is well above the therapeutic range and indicates a high bleeding risk. An INR of 1.0 and a normal platelet count reflect normal clotting ability.
A client with liver failure has a prolonged prothrombin time. Which nursing action is appropriate?
- a.Encourage vigorous tooth brushing
- b.Administer intramuscular injections freely
- c.Ignore minor bruising as unimportant
- d.Implement bleeding precautions and use a soft toothbrush✓
A prolonged prothrombin time indicates impaired clotting, so bleeding precautions such as a soft toothbrush and avoiding unnecessary injections reduce the risk of hemorrhage.