Nursing Elites

1. 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:

2. The renin and angiotensin systems help to maintain the balance of sodium and water in the body. What other functions do these systems serve?

• A. Regulating hemoglobin levels
• B. Maintaining a healthy blood volume
• C. Releasing platelets when tissues are injured
• D. Lowering blood volumes

Correct answer: B

Rationale: The correct answer is B: Maintaining a healthy blood volume. The renin and angiotensin systems not only help to regulate sodium and water balance in the body but also play a crucial role in maintaining an adequate blood volume. This is essential for normal blood pressure regulation and overall cardiovascular health. Choices A, C, and D are incorrect because hemoglobin levels are primarily regulated by the bone marrow and erythropoietin, platelets are released in response to blood vessel injury by a different mechanism, and the systems do not focus on lowering blood volumes but rather on maintaining them.

3. You are working on a burns unit, and one of your acutely ill patients is exhibiting signs and symptoms of third spacing. Based on this change in status, you should expect the patient to exhibit signs and symptoms of what imbalance?

• A. Metabolic alkalosis
• B. Hypermagnesemia
• C. Hypercalcemia
• D. Hypovolemia

Correct answer: D

Rationale: When a patient exhibits signs and symptoms of third-spacing, where fluid moves out of the intravascular space but not into the intracellular space, hypovolemia is expected. This leads to a decreased circulating blood volume. Increased calcium and magnesium levels are not typically associated with third-spacing fluid shift. Burns usually result in acidosis rather than alkalosis, making metabolic alkalosis an incorrect choice. Therefore, hypovolemia is the correct answer in this scenario.

4. A client with a serum potassium of 7.5 mEq/L and cardiovascular changes needs immediate intervention. Which prescription should the nurse implement first?

• A. Prepare to administer sodium polystyrene sulfate (Kayexalate) 15 g by mouth.
• B. Provide a heart-healthy, low-potassium diet.
• C. Prepare to administer dextrose 20% and 10 units of regular insulin IV push.
• D. Prepare the client for hemodialysis treatment.

Correct answer: C

Rationale: In a client with a serum potassium level of 7.5 mEq/L and cardiovascular changes, the priority intervention is to lower the potassium level quickly to prevent life-threatening complications like arrhythmias. The correct answer is to prepare to administer dextrose 20% and 10 units of regular insulin IV push. This combination helps shift potassium from the extracellular to the intracellular space, reducing serum potassium levels rapidly. Administering sodium polystyrene sulfate (Kayexalate) by mouth may take several hours to work, making it a less effective immediate intervention. Providing a heart-healthy, low-potassium diet is important for long-term management but is not the most urgent action in this situation. While hemodialysis is a definitive treatment for hyperkalemia, it is not the first-line intervention for acute management of high potassium levels with cardiovascular manifestations.

5. Diagnostic testing has been ordered to differentiate between normal anion gap acidosis and high anion gap acidosis in an acutely ill patient. What health problem typically precedes normal anion gap acidosis?

• A. Metastases
• B. Excessive potassium intake
• C. Water intoxication
• D. Excessive administration of chloride

Correct answer: D

Rationale:

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