Nursing Elites

1. Extracellular fluid includes:

• A. plasma and intracellular fluid.
• B. interstitial and intracellular fluids.
• C. plasma and interstitial fluid.
• D. plasma, interstitial fluid, and intracellular fluid.

Correct answer: C

Rationale: The correct answer is C: 'plasma and interstitial fluid.' Extracellular fluid consists of all body fluids outside the cells, primarily including plasma (the liquid component of blood) and interstitial fluid (the fluid between cells). Choices A, B, and D are incorrect because intracellular fluid is located within the cells, not in the extracellular fluid compartment.

2. A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. What factors contribute to this phenomenon? Select all that do not apply.

• A. Decreased kidney mass
• B. Decreased renal blood flow
• C. Decreased excretion of potassium
• D. Increased conservation of sodium

Correct answer: D

Rationale:

3. The nurse is caring for a patient who is diaphoretic from a fever. The amount of sodium excreted in the urine will:

• A. Decrease
• B. Increase
• C. Remain unchanged
• D. Fluctuate

Correct answer: A

Rationale: Increased sweating (diaphoresis) causes the loss of sodium and other electrolytes from the body. As a result, the body tries to conserve sodium, leading to a decrease in the amount of sodium excreted in the urine. Choice B is incorrect because increased sweating results in sodium loss, not retention. Choice C is incorrect because with increased sweating, there is a need to conserve sodium, leading to a decrease in its excretion. Choice D is incorrect as there is a clear physiological response to sweating that results in a more consistent decrease in sodium excretion.

4. . A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; his pupils are equal and reactive to light and accommodation. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed, and 40 mL of urine is present. What is the nurses most likely explanation for the low urine output?

• A. The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place.
• B. The man likely has a traumatic brain injury, lacks antidiuretic hormone (ADH), and needs vasopressin.
• C. The man is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide that results in decreased urine output.
• D. The man is having a sympathetic reaction, which has stimulated the reninangiotensinaldosterone system that results in diminished urine output.

Correct answer: D

Rationale:

5. A nurse is caring for a client who has the following laboratory results: potassium 3.4 mEq/L, magnesium 1.8 mEq/L, calcium 8.5 mEq/L, sodium 144 mEq/L. Which assessment should the nurse complete first?

• A. Assess the client's dietary intake of foods high in potassium.
• B. Assess the client's neuromuscular status.
• C. Assess the client's fluid intake and output.
• D. Read food labels to determine sodium content.

Correct answer: D

Rationale: The correct answer is to read food labels to determine sodium content. The client's sodium level is crucial to monitor as it is on the higher side (144 mEq/L), which can indicate hypernatremia. Excessive sodium intake can lead to fluid retention and other complications. Assessing dietary sodium intake can help the nurse and client make necessary adjustments to prevent further sodium imbalances. Choices A, B, and C are not the priority in this situation as the client's sodium level needs immediate attention to prevent potential complications.

Similar Questions