Nursing Elites

1. One of the major functions of the kidneys in maintaining normal fluid balance is:

• A. the manufacture of antidiuretic hormone.
• B. the regulation of calcium and phosphate balance.
• C. the regulation of the pH of the extracellular fluid.
• D. the control of aldosterone levels.

Correct answer: C

Rationale: The correct answer is 'the regulation of the pH of the extracellular fluid.' The kidneys play a crucial role in maintaining normal fluid balance by regulating extracellular fluid and osmolarity through selective retention and excretion of fluids. Additionally, they regulate the pH of the extracellular fluid by retaining hydrogen ions and excreting metabolic wastes and toxic substances. Choice A is incorrect because antidiuretic hormone (ADH) is manufactured by the pituitary gland, not the kidneys. Choice B is incorrect as the regulation of calcium and phosphate balance is primarily controlled by the parathyroid gland. Choice D is incorrect as aldosterone levels are controlled by the adrenal glands, not the kidneys.

2. Which of the following statements should the nurse use to best describe a very low-calorie diet (VLCD) to a client?

• A. "This diet can be used when there is close medical supervision."?
• B. "This is a long-term treatment measure that assists obese people who can't lose weight."?
• C. "The VLCD consists of solid food items that are pureed to facilitate digestion and absorption."?
• D. "A VLCD contains very little protein."?

Correct answer: A

Rationale: The correct answer is, "This diet can be used when there is close medical supervision."? Very low-calorie diets (VLCDs) are used in the clinical treatment of obesity under close medical supervision. The diet is low in calories, high in quality protein, and has a minimum of carbohydrates to spare protein and prevent ketosis. Choice B is incorrect because VLCDs are typically short-term interventions. Choice C is incorrect because VLCDs usually consist of nutritionally complete liquid formulations, not solid food items that are pureed. Choice D is incorrect because VLCDs actually contain a high quality of protein, although the overall caloric content is very low.

3. Which of the following classifications of medications is used to help decrease tremors for clients with hyperthyroidism?

• A. Steroids
• B. Anticonvulsants
• C. Beta blockers
• D. Iodine compounds

Correct answer: C

Rationale: The correct answer is Beta blockers. Beta blockers are commonly used to help decrease tremors in clients with hyperthyroidism by blocking the action of adrenaline. This helps to control symptoms such as rapid heart rate, tremors, and anxiety. Steroids (Choice A) are not typically used to treat tremors in hyperthyroidism. Anticonvulsants (Choice B) are primarily used to control seizures and are not the first-line treatment for tremors in hyperthyroidism. Iodine compounds (Choice D) are used in the treatment of hyperthyroidism by reducing the production of thyroid hormones but are not specifically indicated for tremor relief.

4. The client is being discharged after a concussion. Which of the following symptoms should be reported?

• A. Difficulty waking up
• B. Headache (3/10 on the pain scale)
• C. Bruising on knees and elbows
• D. Achy feeling all over

Correct answer: A

Rationale: The correct answer is 'Difficulty waking up' because it indicates a change in consciousness, which is a concerning symptom following a concussion. Reporting this symptom is crucial as it may signify a more severe head injury. 'Headache (3/10 on the pain scale)' may be common after a concussion but is not as urgent as a change in consciousness. 'Bruising on knees and elbows' is likely unrelated to the concussion and not a priority for reporting. 'Achy feeling all over' is a vague symptom and not specific to a concerning change in the client's condition post-concussion.

5. A client arrives in the emergency department after severely lacerating the left hand with a knife. HR 96, BP 150/88, R36. The client is extremely anxious and crying uncontrollably. Based on this assessment, the nurse anticipates that this client would be in which acid-base imbalance?

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

Correct answer: B

Rationale: The correct answer is respiratory alkalosis. Hyperventilation due to anxiety, pain, shock, severe infection, fever, or liver failure can lead to respiratory alkalosis. In this scenario, the client is extremely anxious and crying uncontrollably, indicating an increased respiratory rate and CO2 loss. Respiratory acidosis (choice A) is incorrect as it is characterized by an increase in CO2 levels, not a loss. Metabolic acidosis (choice C) involves a decrease in blood pH due to an accumulation of acids or loss of bicarbonate, which is not the case here. Metabolic alkalosis (choice D) results from excess bicarbonate or a loss of acids, not from increased CO2 loss due to hyperventilation.

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