NCLEX-PN Test #17 2 — Questions and Answers
Question 1: A client's ABG results show: pH 7.50, PaCO₂ 36 mmHg, HCO₃ 30 mEq/L. What is the correct interpretation?
- Respiratory alkalosis, uncompensated
- Metabolic alkalosis, uncompensated (Correct answer)
- Respiratory acidosis, partially compensated
- Metabolic acidosis, compensated
Correct answer: Metabolic alkalosis, uncompensated
pH > 7.45 = alkalosis. PaCO₂ is normal (35–45 mmHg) — no respiratory cause. HCO₃ > 26 mEq/L = metabolic cause (excess bicarbonate). Respiratory system has not yet compensated (PaCO₂ not elevated). This is uncompensated metabolic alkalosis. Causes include vomiting, nasogastric drainage, or excessive antacid use.
Question 2: A client has a serum digoxin level of 2.8 ng/mL. The therapeutic range is 0.5–2.0 ng/mL. Which symptom is most consistent with digoxin toxicity?
- Tachycardia (HR 110 bpm)
- Anorexia, nausea, vomiting, and visual disturbances (halos around lights) (Correct answer)
- Hypertension and edema
- Diarrhea with frank blood
Correct answer: Anorexia, nausea, vomiting, and visual disturbances (halos around lights)
Digoxin toxicity (levels > 2.0 ng/mL) presents with: GI symptoms (anorexia, nausea, vomiting), visual disturbances (yellow-green halos, blurred vision), and cardiac effects (bradycardia, heart block, dysrhythmias). Hypokalemia increases susceptibility to toxicity even at therapeutic levels.
Question 3: A client has a BUN of 42 mg/dL and creatinine of 3.8 mg/dL. The BUN:creatinine ratio is 11:1. What does this most likely indicate?
- Pre-renal acute kidney injury (dehydration)
- Intrinsic renal damage (glomerulonephritis) (Correct answer)
- Post-renal obstruction (urinary obstruction)
- Normal kidney function for an elderly client
Correct answer: Intrinsic renal damage (glomerulonephritis)
A BUN:creatinine ratio of 10–20:1 is considered normal. A ratio > 20:1 suggests pre-renal causes (dehydration, heart failure) where urea is reabsorbed disproportionately. A ratio < 10:1 with elevated creatinine suggests intrinsic renal damage where creatinine rises more than BUN. A ratio of 11:1 with both values elevated indicates intrinsic renal dysfunction.
Question 4: A client requires a lumbar puncture (LP). In which position should the nurse place the client?
- Prone (face down) with a pillow under the abdomen
- Lateral recumbent (fetal position) with spine flexed (Correct answer)
- Supine with neck hyperextended
- Sitting upright with spine fully extended
Correct answer: Lateral recumbent (fetal position) with spine flexed
The lateral recumbent (fetal) position with knees drawn to the chest and chin tucked maximizes lumbar vertebral spacing by flexing the spine, providing the widest access to the interspinous spaces for needle insertion. The sitting position (leaning forward over a table) is an alternative used less commonly. After the procedure, positioning varies by protocol.
Question 5: A client with suspected myocardial infarction has troponin I drawn at ED arrival. Which finding most supports the diagnosis 6 hours later?
- Troponin I remains at baseline (< 0.04 ng/mL)
- Troponin I has risen to 2.8 ng/mL (significantly elevated) (Correct answer)
- CK-MB alone is elevated with normal troponin
- D-dimer is elevated, suggesting PE as the alternate diagnosis
Correct answer: Troponin I has risen to 2.8 ng/mL (significantly elevated)
Troponin I rises 3–6 hours after myocardial injury and peaks at 12–24 hours. An elevated troponin at 6 hours with a normal baseline effectively rules in myocardial infarction (sensitivity approaches 99% with serial troponins). Two serial troponins (0 and 3–6 hours) using high-sensitivity assays can rule in or out NSTEMI rapidly.
Question 6: A client with diabetes has a HbA1c result of 9.2%. What does this tell the nurse about the client's glucose management?
- Blood glucose has been well controlled for the past 3 months (target < 7%)
- Average blood glucose has been elevated for approximately 3 months — consistent with poor glycemic control (Correct answer)
- This result only reflects blood glucose over the past 2 weeks
- A HbA1c of 9.2% is within normal limits for a client with type 2 diabetes
Correct answer: Average blood glucose has been elevated for approximately 3 months — consistent with poor glycemic control
HbA1c measures the percentage of hemoglobin bound to glucose, reflecting average blood glucose over the preceding 2–3 months (the lifespan of an RBC). A value of 9.2% indicates poor glycemic control (target is < 7% for most adults with diabetes). An HbA1c of 9.2% corresponds to an average blood glucose of approximately 218 mg/dL.
NCLEX-PN Test #17 2
A client's ABG results show: pH 7.50, PaCO₂ 36 mmHg, HCO₃ 30 mEq/L.
What is the correct interpretation?