NCLEX-PN Test #10 1

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?

Accepted Answer

Metabolic acidosis with respiratory compensation

Answer

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?

Accepted Answer

Serum calcium

Answer

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?

Accepted Answer

Administer IV hydrocortisone as ordered

Answer

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?

Accepted Answer

'Take the medication on an empty stomach 30–60 minutes before breakfast.'

Answer

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?

Accepted Answer

Administer 3% NaCl (hypertonic saline) at a slow, controlled rate

Answer

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.

NCLEX Practice Test

NCLEX Practice Test

NCLEX-PN Test #10 1