while assessing a clients peripheral iv site the nurse observes a streak of red along the vein path and palpates a 4 cm venous cord how should the nur

ATI RN

ATI Fluid Electrolyte and Acid-Base Regulation

1. While assessing a clients peripheral IV site, the nurse observes a streak of red along the vein path and palpates a 4-cm venous cord. How should the nurse document this finding?

A. Grade 3 phlebitis at IV site
B. infection at IV site
C. Thrombosed area at IV site
D. infiltration at IV site

Correct answer: A

Rationale:

2. . You are caring for a patient who has a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Your patients plan of care includes assessment of specific gravity every 4 hours. The results of this test will allow the nurse to as

A. Nutritional status
B. Potassium balance
C. Calcium balance
D. Fluid volume status

Correct answer: D

Rationale:

3. Which of the following is not considered an extracellular fluid?

A. Cerebrospinal fluid
B. The humors of the eye
C. Lymph
D. Cerebrospinal fluid and the humors of the eye

Correct answer: D

Rationale: The correct answer is D. Cerebrospinal fluid and the humors of the eye are not considered extracellular fluids. Extracellular fluids are fluids found outside the cells, such as interstitial fluid and lymph. Cerebrospinal fluid is found within the central nervous system, while the humors of the eye (aqueous humor and vitreous humor) are located within the eyeball, making them distinct from extracellular fluids.

4. The nurse caring for a patient post colon resection is assessing the patient on the second postoperative day. The nasogastric tube (NG) remains patent and continues at low intermittent wall suction. The IV is patent and infusing at 125 mL/hr. The patient reports pain at the incision site rated at a 3 on a 0-to-10 rating scale. During your initial shift assessment, the patient complains of cramps in her legs and a tingling sensation in her feet. Your assessment indicates decreased deep tendon reflexes (DTRs) and you suspect the patient has hypokalemia. What other sign or symptom would you expect this patient to exhibit

A. Diarrhea
B. Dilute urine
C. Increased muscle tone
D. Joint pain

Correct answer: B

Rationale:

5. Which mineral is important in hemoglobin production?

A. Sodium
B. Iodine
C. Iron
D. Chloride

Correct answer: C

Rationale: Iron (Fe) is a critical mineral in hemoglobin production. Hemoglobin is a protein found in red blood cells that is essential for transporting oxygen throughout the body. Sodium (Choice A), Iodine (Choice B), and Chloride (Choice D) are not directly involved in hemoglobin production. Sodium is an electrolyte that helps maintain fluid balance, Iodine is essential for thyroid hormone production, and Chloride is an electrolyte that helps regulate fluid balance and acidity in the body.