NCLEX-PN Test #10 1 — Questions and Answers
Question 1: A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Arterial blood gas results show pH 7.22, PaCO2 28 mmHg, HCO3 10 mEq/L. How should the nurse interpret these results?
- Respiratory acidosis with metabolic compensation
- Metabolic alkalosis with respiratory compensation
- Metabolic acidosis with respiratory compensation (Correct answer)
- Respiratory alkalosis with metabolic compensation
Correct answer: Metabolic acidosis with respiratory compensation
DKA causes metabolic acidosis (low pH 7.22, low HCO3 10 mEq/L). The body compensates by increasing respiratory rate to blow off CO2, resulting in a low PaCO2 (28 mmHg) — this is respiratory compensation (Kussmaul respirations). The primary disorder is metabolic acidosis with partial respiratory compensation.
Question 2: A nurse is caring for a client who had a thyroidectomy yesterday. The client reports circumoral tingling and muscle cramping in the hands. Which laboratory value should the nurse check first?
- Serum potassium
- Serum calcium (Correct answer)
- Blood glucose
- Serum sodium
Correct answer: Serum calcium
Circumoral tingling and muscle cramps/tetany after thyroidectomy are classic signs of hypocalcemia due to inadvertent removal or damage to the parathyroid glands. Calcium levels must be checked immediately. The nurse should also have IV calcium gluconate available for emergency treatment.
Question 3: A client with Addison's disease is admitted with nausea, vomiting, and profound weakness. Blood pressure is 82/50 mmHg. Which intervention should the nurse anticipate first?
- Administer IV hydrocortisone as ordered (Correct answer)
- Insert a nasogastric tube for electrolyte replacement
- Provide a high-potassium diet and oral fluid replacement
- Administer vasopressin for blood pressure support
Correct answer: Administer IV hydrocortisone as ordered
The client is experiencing an Addisonian crisis (acute adrenal insufficiency), characterized by severe hypotension, weakness, nausea, and vomiting. The priority treatment is IV hydrocortisone (corticosteroid replacement), along with IV saline for fluid resuscitation. High-potassium diet is contraindicated because Addison's causes hyperkalemia.
Question 4: A nurse is teaching a client newly diagnosed with hypothyroidism about levothyroxine therapy. Which instruction is most important?
- 'Take the medication with a high-fiber meal to improve absorption.'
- 'Take the medication on an empty stomach 30–60 minutes before breakfast.' (Correct answer)
- 'You can stop taking the medication once your symptoms improve.'
- 'Double the dose if you miss a day to maintain therapeutic levels.'
Correct answer: 'Take the medication on an empty stomach 30–60 minutes before breakfast.'
Levothyroxine is best absorbed on an empty stomach, 30–60 minutes before the first meal of the day. Food, calcium, iron, and antacids significantly reduce its absorption. This medication is for lifelong thyroid replacement — clients must never stop it when symptoms improve. Double-dosing can cause cardiac arrhythmias.
Question 5: A client with SIADH has a serum sodium of 118 mEq/L and is becoming increasingly lethargic and confused. Which intervention does the nurse anticipate the provider will order?
- Administer 0.45% NaCl (hypotonic saline) IV rapidly
- Encourage the client to increase oral fluid intake
- Administer 3% NaCl (hypertonic saline) at a slow, controlled rate (Correct answer)
- Prepare the client for immediate hemodialysis
Correct answer: Administer 3% NaCl (hypertonic saline) at a slow, controlled rate
SIADH causes dilutional hyponatremia from water retention. A sodium of 118 mEq/L with neurological symptoms (lethargy, confusion) is a medical emergency. Hypertonic saline (3% NaCl) administered slowly corrects severe symptomatic hyponatremia. Rapid correction can cause osmotic demyelination syndrome (central pontine myelinolysis). Hypotonic saline would worsen the condition.
Question 6: A nurse is assessing a client with hyperthyroidism. Which clinical findings are consistent with this diagnosis? (Select the best answer)
- Bradycardia, constipation, and weight gain
- Tachycardia, heat intolerance, and exophthalmos (Correct answer)
- Bradycardia, cold intolerance, and dry skin
- Tachycardia, weight gain, and periorbital edema
Correct answer: Tachycardia, heat intolerance, and exophthalmos
Hyperthyroidism (excess thyroid hormone) causes an increased metabolic rate manifesting as tachycardia, heat intolerance, weight loss, increased sweating, anxiety, and exophthalmos (in Graves' disease). Bradycardia, cold intolerance, dry skin, constipation, and weight gain are signs of hypothyroidism.
NCLEX-PN Test #10 1
A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA).
Arterial blood gas results show pH 7.22, PaCO2 28 mmHg, HCO3 10 mEq/L.
How should the nurse interpret these results?