Nursing Elites

1. A patient is being treated for shock after a motor vehicle accident. The provider orders 6% dextran 75 to be given intravenously. The nurse should expect which outcome as the result of this infusion?

• A. Decreased urine output
• B. Improved blood oxygenation
• C. Increased interstitial fluid
• D. Stabilization of heart rate and blood pressure

Correct answer: D

Rationale: 6% Dextran 75 is a high molecular-weight colloidal solution used to treat shock from burns or trauma. Colloids like 6% dextran 75 are plasma expanders that help increase blood volume, leading to improved heart rate and blood pressure stabilization. The infusion of plasma expanders does not typically decrease urine output. It primarily aims to stabilize circulation rather than affect blood oxygenation or increase interstitial fluid levels.

2. The patient is receiving sulfadiazine. The healthcare provider knows that this patient’s daily fluid intake should be at least which amount?

• A. 1000 mL/day
• B. 1200 mL/day
• C. 2000 mL/day
• D. 2400 mL/day

Correct answer: C

Rationale: Sulfadiazine may lead to crystalluria, a condition where crystals form in the urine. Adequate fluid intake helps prevent this adverse effect by ensuring urine is dilute enough to prevent crystal formation. The recommended daily fluid intake for a patient receiving sulfadiazine is at least 2000 mL/day. Choices A, B, and D are incorrect because they do not provide a sufficient amount of fluid intake to prevent crystalluria in patients on sulfadiazine.

3. The nurse is preparing to administer trimethoprim-sulfamethoxazole (TMP-SMX) to a patient who is being treated for a urinary tract infection. The nurse learns that the patient has type 2 diabetes mellitus and takes a sulfonylurea oral antidiabetic drug. The nurse will monitor this patient closely for which effect?

• A. Headaches
• B. Hypertension
• C. Hypoglycemia
• D. Superinfection

Correct answer: C

Rationale: When a patient takes oral antidiabetic agents (sulfonylurea) along with sulfonamides like trimethoprim-sulfamethoxazole, it can lead to an increased hypoglycemic effect. Therefore, the nurse should monitor the patient closely for hypoglycemia. Headaches, hypertension, and superinfection are not typically associated with the interaction between sulfonamides and sulfonylureas. Examples of antidiabetic sulfonylurea medications include glipizide, glimepiride, glyburide, tolazamide, and tolbutamide.

4. After a transsphenoidal hypophysectomy, the nurse should assess the client for:

• A. Cerebrospinal fluid (CSF) leak.
• B. Fluctuating blood glucose levels.
• C. Cushing's syndrome.
• D. Cardiac arrhythmias.

Correct answer: A

Rationale: Following a transsphenoidal hypophysectomy, assessing the client for a cerebrospinal fluid (CSF) leak is crucial due to the risk of this serious complication. A CSF leak can lead to infection and increased intracranial pressure, which must be promptly identified and managed to prevent further complications. Fluctuating blood glucose levels (Choice B) are not directly associated with a transsphenoidal hypophysectomy. Cushing's syndrome (Choice C) is a condition related to prolonged exposure to high levels of cortisol and is not a common immediate concern post-transsphenoidal hypophysectomy. Cardiac arrhythmias (Choice D) are not typically a direct complication of this surgical procedure, making it a less relevant concern compared to a CSF leak.

5. A client is receiving a continuous infusion of normal saline at 125 ml/hour post abdominal surgery. The client is drowsy and complaining of constant abdominal pain and a headache. Urine output is 800 ml over the past 24 hours with a central venous pressure of 15 mmHg. The nurse notes respiratory crackles and bounding central pulse. Vital signs: temperature 101.2 F (38.4 C), heart rate 96 beats/minute, respiration 24 breaths/minute, and blood pressure of 160/90 mmHg. Which intervention should the nurse implement first?

• A. Calculate total intake and output for the last 24 hours.
• B. Administer a PRN dose of acetaminophen.
• C. Decrease IV fluids to a keep vein open (KVO) rate.
• D. Review the last administration of IV pain medication.

Correct answer: C

Rationale: In this scenario, the client is showing signs of fluid volume excess, such as drowsiness, abdominal pain, headache, crackles in the lungs, bounding pulse, and elevated blood pressure. Decreasing the IV fluids to a keep vein open (KVO) rate is crucial to prevent further fluid overload. This intervention helps in balancing fluid intake and output to prevent complications associated with fluid volume excess. Calculating total intake and output (Choice A) may be necessary but not the immediate priority in managing fluid overload. Administering acetaminophen (Choice B) may help with managing the fever but does not address the underlying issue of fluid overload. Reviewing the last administration of IV pain medication (Choice D) is not the priority in this situation where fluid overload is a concern.

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