Nursing Elites

1. The nurse caring for a patient post colon resection is assessing the patient on the second postoperative day. The nasogastric tube (NG) remains patent and continues at low intermittent wall suction. The IV is patent and infusing at 125 mL/hr. The patient reports pain at the incision site rated at a 3 on a 0-to-10 rating scale. During your initial shift assessment, the patient complains of cramps in her legs and a tingling sensation in her feet. Your assessment indicates decreased deep tendon reflexes (DTRs) and you suspect the patient has hypokalemia. What other sign or symptom would you expect this patient to exhibit

• A. Diarrhea
• B. Dilute urine
• C. Increased muscle tone
• D. Joint pain

Correct answer: B

Rationale:

2. The triage nurse notes upon assessment in the emergency room that the patient with anxiety is hyperventilating. The nurse is aware that hyperventilation is the most common cause of which acid-base imbalance?

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

Correct answer: B

Rationale: The correct answer is B: Respiratory alkalosis. Hyperventilation is the most common cause of acute respiratory alkalosis. When a patient hyperventilates due to anxiety or other causes, they blow off excessive carbon dioxide, leading to a decrease in PaCO2 and a rise in pH. Choices A, C, and D are incorrect because hyperventilation leads to a decrease in PaCO2, causing respiratory alkalosis, not respiratory acidosis, metabolic acidosis, or metabolic alkalosis.

3. You are performing an admission assessment on an older adult patient newly admitted for end-stage liver disease. What principle should guide your assessment of the patient's skin turgor?

• A. Overhydration is common among healthy older adults.
• B. Dehydration causes the skin to appear spongy.
• C. Inelastic skin turgor is a normal part of aging.
• D. Skin turgor cannot be assessed in patients over 70.

Correct answer: C

Rationale: Inelastic skin is a normal change of aging. However, this does not mean that skin turgor cannot be assessed in older patients. Dehydration, not overhydration, causes inelastic skin with tenting. Overhydration, not dehydration, causes the skin to appear edematous and spongy. Choice A is incorrect because overhydration is not common among healthy older adults. Choice B is incorrect because dehydration leads to inelastic skin, not sponginess. Choice D is incorrect as skin turgor assessment can be done in patients of any age, including those over 70.

4. A nurse admitting a patient with a history of emphysema reviews her past lab reports and notes that the patient's PaCO2 has been 56 to 64 mmHg. The nurse will be cautious administering oxygen because:

• A. The patient's calcium will rise dramatically due to pituitary stimulation.
• B. The oxygen will increase the patient's intracranial pressure and create confusion.
• C. The oxygen may cause the patient to hyperventilate and become acidotic.
• D. Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.

Correct answer: D

Rationale: When PaCO2 chronically exceeds 50 mm Hg, it creates insensitivity to CO2 in the respiratory medulla, and the use of oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia. Choice A is incorrect because administering oxygen does not lead to a dramatic rise in calcium due to pituitary stimulation. Choice B is incorrect because administering oxygen does not directly increase intracranial pressure or create confusion. Choice C is incorrect because administering oxygen to a patient with emphysema and high PaCO2 levels is more likely to cause respiratory depression than hyperventilation and acidosis.

5. You are the nurse caring for a 77-year-old male patient who has been involved in a motor vehicle accident. You and your colleague note that the patients labs indicate minimally elevated serum creatinine levels, which your colleague dismisses. What can this increase in creatinine indicate in older adults?

• A. Substantially reduced renal function
• B. Acute kidney injury
• C. Decreased cardiac output
• D. ) Alterations in ratio of body fluids to muscle mass

Correct answer: A

Rationale:

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