Nursing Elites

1. During a visit to an 84-year-old woman recovering from hip surgery, the nurse notices signs of confusion and poor skin turgor. The woman mentions she limits water intake to avoid nighttime bathroom trips. The nurse should explain to the woman that:

• A. She will need her medications adjusted and be readmitted for a complete workup.
• B. Limiting fluids can lead to body imbalances causing confusion; perhaps adjusting fluid intake timing is necessary.
• C. Post-surgical confusion is common, and it's safe not to urinate at night.
• D. Confusion after surgery is typical in the elderly due to sleep loss.

Correct answer: B

Rationale: The correct answer is B. In elderly patients, fluid and electrolyte imbalances can manifest with subtle signs like confusion. Limiting fluids can lead to such imbalances, affecting cognitive function. Adjusting the timing of fluid intake can help maintain hydration without causing nighttime disruptions. Choices A, C, and D are incorrect. Choice A suggests unnecessary hospital readmission and medication adjustments without addressing the root cause. Choice C wrongly normalizes the confusion and fails to address the potential issue of fluid restriction. Choice D incorrectly attributes confusion solely to sleep loss without considering the impact of fluid balance.

2. A nurse is assessing clients for fluid and electrolyte imbalances. Which client should the nurse assess first for potential hyponatremia?

• A. A 34-year-old on NPO status who is receiving intravenous D5W
• B. A 50-year-old with an infection who is prescribed a sulfonamide antibiotic
• C. A 67-year-old who is experiencing pain and is prescribed ibuprofen (Motrin)
• D. A 73-year-old with tachycardia who is receiving digoxin (Lanoxin)

Correct answer: A

Rationale: The correct answer is the 34-year-old on NPO status receiving intravenous D5W because D5W is a hypotonic solution that can dilute the blood's sodium levels, leading to hyponatremia. Patients on NPO status rely solely on intravenous fluids for hydration, making them more susceptible to electrolyte imbalances. Choices B, C, and D are less likely to cause hyponatremia. Choice B, the 50-year-old with an infection on a sulfonamide antibiotic, is at risk for allergic reactions or renal issues. Choice C, the 67-year-old taking ibuprofen, is at risk for gastrointestinal bleeding or kidney problems. Choice D, the 73-year-old on digoxin with tachycardia, is more likely to experience digoxin toxicity, affecting the heart's rhythm.

3. A nurse sees a variety of patients in the community health clinic. Which of the following patients would be at the greatest risk of dehydration?

• A. An 18-year-old basketball player with a stress fracture of the right foot
• B. An infant with diarrhea
• C. A 45-year-old with stomach flu
• D. An elderly patient living alone

Correct answer: B

Rationale: The correct answer is B. Infants are particularly vulnerable to dehydration due to diarrhea because they have a higher fluid turnover and less reserve. Option A, the 18-year-old basketball player with a stress fracture, is less likely to be at the greatest risk of dehydration compared to an infant with diarrhea. Option C, the 45-year-old with stomach flu, may experience dehydration but is not at the same level of risk as an infant with diarrhea. Option D, the elderly patient living alone, could be at risk of dehydration, but infants with diarrhea are at the greatest risk due to their unique physiological characteristics.

4. The community health nurse is performing a home visit to an 84-year-old woman recovering from hip surgery. The nurse notes that the woman seems uncharacteristically confused and has dry mucous membranes. When asked about her fluid intake, the patient states, I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom. What would be the nurses best response?

• A. I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete workup
• B. Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids.
• C. It is normal to be a little confused following surgery, and it is safe not to urinate at night.
• D. If you build up too much urine in your bladder, it can cause you to get confused, especially when your body is under stress.

Correct answer: B

Rationale:

5. Retention of electrolytes (especially sodium) in the interstitial fluid can result from:

• A. decreased aldosterone secretion.
• B. increased ADH secretion.
• C. increased aldosterone secretion.
• D. decreased ADH secretion.

Correct answer: C

Rationale: The correct answer is C: increased aldosterone secretion. Aldosterone, a hormone produced by the adrenal glands, increases sodium reabsorption in the kidneys, leading to retention of sodium and water in the interstitial fluid. Increased aldosterone secretion enhances the reabsorption of sodium, thereby increasing its retention. Choice A is incorrect because decreased aldosterone secretion would lead to less sodium reabsorption and increased excretion. Choice B is incorrect because increased ADH secretion primarily affects water reabsorption rather than sodium. Choice D is incorrect because decreased ADH secretion would lead to increased water excretion but not necessarily affect sodium retention.

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