CPNRE Complex Care 4 — Questions and Answers
Question 1: A client with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2 mEq/L. Which dietary instruction is the priority?
- Limit fluid intake to 1500 mL/day
- Avoid high-potassium foods such as bananas and potatoes (Correct answer)
- Increase protein intake to support kidney function
- Restrict sodium to prevent fluid retention
Correct answer: Avoid high-potassium foods such as bananas and potatoes
Hyperkalemia in CKD is life-threatening and requires immediate dietary restriction of high-potassium foods to prevent cardiac dysrhythmias.
Question 2: A nurse is caring for a client on mechanical ventilation with a PEEP of 10 cmH2O. The client's blood pressure drops suddenly to 80/50 mmHg. What is the most likely cause?
- Pulmonary embolism
- Tension pneumothorax
- Ventilator-induced lung injury
- Decreased venous return from high PEEP (Correct answer)
Correct answer: Decreased venous return from high PEEP
High PEEP increases intrathoracic pressure, reducing venous return to the heart and causing decreased cardiac output and hypotension.
Question 3: A client with a traumatic brain injury (TBI) has a GCS score of 8 and demonstrates Cushing's triad. Which set of vital signs is consistent with Cushing's triad?
- HR 120, BP 90/60, RR 24 irregular
- HR 48, BP 180/100, RR 8 irregular (Correct answer)
- HR 100, BP 140/90, RR 20 regular
- HR 60, BP 110/70, RR 14 regular
Correct answer: HR 48, BP 180/100, RR 8 irregular
Cushing's triad indicates increased intracranial pressure and presents with bradycardia, hypertension (widened pulse pressure), and irregular respirations.
Question 4: A client receiving total parenteral nutrition (TPN) develops fever, chills, and glucose of 22 mmol/L. The most appropriate initial nursing action is to:
- Discontinue the TPN and hang dextrose 10%
- Administer insulin per sliding scale and monitor closely
- Change the TPN bag and tubing and notify the physician (Correct answer)
- Decrease the TPN rate by half and reassess in one hour
Correct answer: Change the TPN bag and tubing and notify the physician
Fever and chills with TPN suggest catheter-related bloodstream infection; changing the bag and tubing and notifying the physician addresses both the potential contamination source and escalates care.
Question 5: A client with acute respiratory distress syndrome (ARDS) is being ventilated with a tidal volume of 6 mL/kg ideal body weight. What is the rationale for this low tidal volume strategy?
- To reduce oxygen consumption and metabolic demand
- To prevent ventilator-induced lung injury and volutrauma (Correct answer)
- To facilitate weaning from mechanical ventilation
- To decrease the work of breathing for the client
Correct answer: To prevent ventilator-induced lung injury and volutrauma
Lung-protective ventilation with low tidal volumes in ARDS prevents overdistension of alveoli (volutrauma) and reduces ventilator-induced lung injury.
Question 6: A client with septic shock is receiving norepinephrine. The nurse notes the infusion site is cool, pale, and mottled. What is the immediate action?
- Slow the infusion rate and apply a warm compress
- Stop the infusion and notify the physician immediately (Correct answer)
- Flush the IV line with normal saline and reassess
- Elevate the extremity and document the finding
Correct answer: Stop the infusion and notify the physician immediately
Norepinephrine extravasation can cause severe tissue necrosis; stopping the infusion and notifying the physician immediately is required to prevent serious tissue damage.
Question 7: A nurse is caring for a postoperative client who develops sudden onset chest pain, dyspnea, and SpO2 of 88%. The nurse notes the client had a total hip replacement 3 days ago. What condition is most suspected?
- Myocardial infarction
- Pulmonary embolism (Correct answer)
- Pneumothorax
- Acute pulmonary edema
Correct answer: Pulmonary embolism
Sudden onset chest pain, dyspnea, and hypoxia in a post-orthopedic surgery client are classic signs of pulmonary embolism due to venous thromboembolism risk.
CPNRE Complex Care 4
A client with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2 mEq/L.
Which dietary instruction is the priority?