Nursing Elites

1. A 65-year-old male patient was admitted to a medical-surgical unit 72 hours ago with pyloric stenosis; a nasogastric tube was inserted upon admission and has been on low intermittent suction since then. The nurse taking care of the patient notices that his potassium is very low and becomes concerned that the patient may be at risk for:

• A. Hypercalcemia
• B. Metabolic acidosis
• C. Metabolic alkalosis
• D. Respiratory acidosis

Correct answer: C

Rationale: The correct answer is C, metabolic alkalosis. The patient with pyloric stenosis has been on low intermittent suction, leading to the loss of hydrogen and chloride ions. This condition causes metabolic alkalosis due to the removal of these ions. Options A (Hypercalcemia) and D (Respiratory acidosis) are incorrect as they are not directly related to the scenario described. Option B (Metabolic acidosis) is also incorrect; in this case, the patient is at risk of metabolic alkalosis due to the loss of hydrogen and chloride ions through gastric suction.

2. Diagnostic testing has been ordered to differentiate between normal anion gap acidosis and high anion gap acidosis in an acutely ill patient. What health problem typically precedes normal anion gap acidosis?

• A. Metastases
• B. Excessive potassium intake
• C. Water intoxication
• D. Excessive administration of chloride

Correct answer: D

Rationale:

3. A female patient is discharged from the hospital after having an episode of heart failure. She's prescribed daily oral doses of digoxin (Lanoxin) and furosemide (Lasix). Two days later, she tells her community health nurse that she feels weak and her heart 'flutters' frequently. What action should the nurse take?

• A. Tell the patient to rest more often.
• B. Tell the patient to stop taking the digoxin and call the physician.
• C. Call the physician, report the symptoms, and request to draw a blood sample to determine the patient's potassium level.
• D. Tell the patient to avoid foods that contain caffeine.

Correct answer: C

Rationale: The correct action for the nurse to take is to call the physician, report the symptoms, and request to draw a blood sample to determine the patient's potassium level. Furosemide is a potassium-wasting diuretic, and low potassium levels can lead to weakness and palpitations. Resting more often won't address the underlying issue of hypokalemia caused by furosemide. While digoxin can have side effects, it is not causing the symptoms described by the patient. Avoiding caffeine may be beneficial, but addressing the potassium level is more critical in this situation.

4. A patient with diabetes insipidus is admitted to the intensive care unit after a motor vehicle accident that resulted in head trauma and damage to the pituitary gland. Diabetes insipidus can occur when there is a decreased production of which of the following?

• A. ADH
• B. Estrogen
• C. Aldosterone
• D. Renin

Correct answer: A

Rationale: The correct answer is A: ADH. Diabetes insipidus is characterized by a deficiency in antidiuretic hormone (ADH), leading to excessive urine output and thirst. In this scenario, the head trauma and damage to the pituitary gland can result in decreased production or release of ADH. Estrogen (Choice B) is not directly related to diabetes insipidus. Aldosterone (Choice C) is a hormone that regulates sodium and potassium levels, not water balance like ADH. Renin (Choice D) is an enzyme involved in the regulation of blood pressure and fluid balance but not directly related to diabetes insipidus.

5. A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased intracranial pressure. This solution will increase the number of dissolved particles in the patient's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following?

• A. Hydrostatic pressure
• B. Osmosis and osmolality
• C. Diffusion
• D. Active transport

Correct answer: B

Rationale: The correct answer is B: Osmosis and osmolality. Osmosis is the movement of fluid from a region of low solute concentration to a region of high solute concentration across a semipermeable membrane. In this case, the hypertonic solution increases the number of dissolved particles in the blood, causing fluids to shift into the capillaries due to the osmotic pressure gradient. Osmolality refers to the concentration of solutes in a solution. Hydrostatic pressure refers to changes in water or volume related to water pressure, not the movement of fluids due to solute concentration differences. Diffusion is the movement of solutes from an area of greater concentration to lesser concentration; in an intact vascular system, solutes are unable to move freely, so diffusion does not play a significant role in this scenario. Active transport involves the movement of molecules against the concentration gradient with the use of energy, typically at the cellular level, and is not related to the vascular volume changes described in the question.

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