NCLEX-PN Test #17 2

Question 1

A client's ABG results show: pH 7.50, PaCO₂ 36 mmHg, HCO₃ 30 mEq/L. What is the correct interpretation?

Accepted Answer

Metabolic alkalosis, uncompensated

Answer

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?

Accepted Answer

Anorexia, nausea, vomiting, and visual disturbances (halos around lights)

Answer

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?

Accepted Answer

Intrinsic renal damage (glomerulonephritis)

Answer

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?

Accepted Answer

Lateral recumbent (fetal position) with spine flexed

Answer

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?

Accepted Answer

Troponin I has risen to 2.8 ng/mL (significantly elevated)

Answer

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.

NCLEX Practice Test

NCLEX Practice Test

NCLEX-PN Test #17 2