Nokea
A 100-kg patient gets hemodialysis 3 days a week. In planning the care for this patient, the nurse recommends
- A. a diet of 2500 to 3500 kcal per day.
- B. protein intake of less than 50 grams per day.
- C. potassium intake of 10 mEq per day.
- D. fluid intake of less than 500 mL per day
Correct Answer: A
Rationale: The correct answer is A: a diet of 2500 to 3500 kcal per day. During hemodialysis, patients often experience increased energy expenditure due to the treatment process. Therefore, maintaining a higher caloric intake is crucial to prevent malnutrition and support the body's needs. Options B, C, and D are incorrect as limiting protein intake to less than 50 grams per day may lead to malnutrition in a patient undergoing hemodialysis, restricting potassium intake to 10 mEq per day may not be appropriate as individual needs vary, and restricting fluid intake to less than 500 mL per day can lead to dehydration and electrolyte imbalances in a patient undergoing hemodialysis.
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The patient has just returned from having an arteriovenous fistula placed. The patient asks, “When will they be able to use this and take this other catheter out?” The nurse should reply,
- A. “It can be used immediately, so the catheter can come out anytime.”
- B. “It will take 2 to 4 weeks to heal before it can be used.”
- C. “The fistula will be usable in about 4 to 6 weeks.”
- D. “The fistula was made using graft material, so it depends on the manufacturer.”
Correct Answer: C
Rationale: The correct answer is C: “The fistula will be usable in about 4 to 6 weeks.” This is because arteriovenous fistulas typically require a maturation period of 4 to 6 weeks before they can be used for dialysis. During this time, the fistula will develop into a strong, durable access point for hemodialysis.
Choice A is incorrect because the fistula needs time to mature before it can be used, and immediate use may damage it. Choice B is incorrect as it underestimates the maturation period required. Choice D is incorrect as the maturation time does not depend on the manufacturer but on the patient's physiology and healing process.
A patient is receiving hydrocortisone sodium succinate for adrenal crisis. What other medication does the nurse prepare to administer?
- A. Regular insulin
- B. A proton pump inhibitor
- C. Canagliflozin
- D. Propranolol
Correct Answer: B
Rationale: The correct answer is B: A proton pump inhibitor. When a patient is receiving hydrocortisone for adrenal crisis, it can lead to increased gastric acid secretion. A proton pump inhibitor helps reduce acid production and prevents gastric ulcers. Regular insulin (A) is not typically indicated in this scenario. Canagliflozin (C) is a medication used for diabetes management and is not relevant here. Propranolol (D) is a beta-blocker and may mask signs of hypoglycemia when used with insulin, which is not suitable in this case.
The nurse is providing insulin education for an elderly patient with long-standing
diabetes. A prescription has been written for the patient to take 20 units of insulin glargine at 10
PM nightly. The nurse should instruct the patient that the peak of the insulin action for this agent
is
- A. 200
- B. 400
- C. 800
- D. peakless
Correct Answer: D
Rationale: The correct answer is D: peakless. Insulin glargine is a long-acting insulin with a smooth, consistent release of insulin over 24 hours, providing a steady level of insulin without a pronounced peak. This characteristic helps in maintaining stable blood glucose levels. Options A, B, and C are incorrect as they refer to peak values that do not apply to insulin glargine.
What is a minimally acceptable urine output for a patient weighing 75 kg?
- A. Less than 30 mL/hour
- B. 37 mL/hour
- C. 80 mL/hour
- D. 150 mL/hour
Correct Answer: C
Rationale: The correct answer is C (80 mL/hour) as it is considered a minimally acceptable urine output for a patient weighing 75 kg. Adequate urine output is crucial for kidney function and fluid balance. The general rule is to maintain a urine output of at least 0.5 mL/kg/hour, which in this case would be 37.5 mL/hour for a 75 kg patient. Option C (80 mL/hour) exceeds this minimum requirement, ensuring proper kidney perfusion and waste elimination. Options A (Less than 30 mL/hour) and D (150 mL/hour) are incorrect as they fall below or exceed the recommended urine output range, potentially indicating renal impairment or fluid overload, respectively. Option B (37 mL/hour) is close to the minimum requirement but does not provide a sufficient margin for variations in fluid status or kidney function.
The nurse is caring for a patient who has undergone major abdominal surgery. The nurse notices that the patient’s urine output has been less than 20 mL/hour for the past 2 hours. The patient’s blood pressure is 100/60 mm Hg, and the pulse is 110 beats/min. Previously, the pulse was 90 beats/min with a blood pressure of 120/80 mm Hg. The nurse should
- A. contact the provider and expect a prescription for a normal saline bolus.
- B. wait until the provider makes rounds to report the assessment findings.
- C. continue to evaluate urine output for 2 more hours.
- D. ignore the urine output, as this is most likely postrenal in origin.
Correct Answer: A
Rationale: Rationale:
1. Urine output < 20 mL/hour indicates potential hypoperfusion.
2. Decreased urine output with hypotension and tachycardia suggests inadequate fluid resuscitation.
3. Administering a normal saline bolus can help improve perfusion and stabilize blood pressure.
4. Contacting the provider promptly for orders is crucial in managing this acute situation.
Summary of Incorrect Choices:
B. Delaying reporting to the provider risks worsening the patient's condition.
C. Continuing to evaluate urine output without intervention can lead to further deterioration.
D. Ignoring the urine output due to potential postrenal causes overlooks the urgent need for fluid resuscitation.