Nokea
Which of the following laboratory values would be more common in patients with diabetic ketoacidosis?
- A. Blood glucose >1000 mg/dL
- B. Negative ketones in the urine
- C. Normal anion gap
- D. pH 7.24
Correct Answer: A
Rationale: The correct answer is A (Blood glucose >1000 mg/dL) because diabetic ketoacidosis is characterized by severe hyperglycemia. High blood glucose levels (>1000 mg/dL) are common due to insulin deficiency leading to increased glucose production.
B: Negative ketones in the urine would be incorrect as DKA results in ketone production, leading to ketonuria.
C: Normal anion gap would be incorrect as DKA typically presents with an elevated anion gap metabolic acidosis due to ketone accumulation.
D: pH 7.24 would be incorrect as DKA would present with a lower pH due to metabolic acidosis.
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The patient is in need of immediate hemodialysis, but has no vascular access. The nurse prepares the patient for insertion of
- A. a percutaneous catheter at the bedside.
- B. a percutaneous tunneled catheter at the bedside.
- C. an arteriovenous fistula.
- D. an arteriovenous graft.
Correct Answer: A
Rationale: The correct answer is A: a percutaneous catheter at the bedside. In this urgent situation, a percutaneous catheter can be quickly inserted at the bedside to provide immediate vascular access for hemodialysis. This option allows for rapid initiation of treatment without the need for surgical placement or waiting for a more permanent access like an arteriovenous fistula or graft.
Incorrect Choices:
B: A percutaneous tunneled catheter may require more time for insertion due to tunneling and may not be suitable for immediate use.
C: An arteriovenous fistula is a more permanent access created surgically and requires time to mature before being used for hemodialysis.
D: An arteriovenous graft is also a surgical option that requires time to heal and mature before being used for hemodialysis.
Continuous venovenous hemofiltration is used to
- A. remove fluids and solutes through the process of convection.
- B. remove plasma water in cases of volume overload.
- C. remove plasma water and solutes by adding dialysate.
- D. combine ultrafiltration, convection, and dialysis.
Correct Answer: A
Rationale: The correct answer is A because continuous venovenous hemofiltration primarily removes fluids and solutes through convection. Convection involves the movement of solutes across a semi-permeable membrane by the force of the fluid flow. This process helps to achieve fluid balance and manage electrolyte levels in patients with renal failure.
Choice B is incorrect because hemofiltration does not specifically target plasma water; it aims to remove both fluids and solutes. Choice C is incorrect as hemofiltration does not involve adding dialysate; it relies on the patient's blood passing through a filter to remove waste products. Choice D is incorrect because while hemofiltration may involve aspects of ultrafiltration and dialysis, the primary mechanism is convection for removing fluids and solutes.
The patient is on intake and output (I&O), as well as daily weights. The nurse notes that output is considerably less than intake over the last shift, and daily weight is 1 kg more than yesterday. The nurse should
- A. draw a trough level after the next dose of antibiotic.
- B. obtain an order to place the patient on fluid restriction.
- C. assess the patient’s lungs.
- D. insert an indwelling catheter.
Correct Answer: C
Rationale: The correct answer is C: assess the patient's lungs. The discrepancy between intake, output, and weight gain indicates a potential fluid imbalance. By assessing the patient's lungs, the nurse can identify signs of fluid overload, such as crackles or difficulty breathing, which could explain the weight gain and imbalance. This step is crucial in determining the underlying cause and guiding further interventions. Drawing a trough level (A) or inserting an indwelling catheter (D) are not necessary at this point and may not address the immediate issue. Placing the patient on fluid restriction (B) should only be considered after a thorough assessment to determine the cause of the imbalance.
The patient’s potassium level is 0 mEq/L. Besides dialysis, which of the following actually reduces plasma potassium levels and total body potassium content safely in a patient with renal dysfunction?
- A. Sodium polystyrene sulfonate
- B. Sodium polystyrene sulfonate with sorbitol
- C. Regular insulin
- D. Calcium gluconate
Correct Answer: A
Rationale: The correct answer is A: Sodium polystyrene sulfonate. It works by exchanging sodium ions for potassium ions in the colon, leading to potassium excretion. A is the safest option without the risk of causing hypernatremia or intestinal necrosis like B. Regular insulin (C) may cause hypoglycemia and is not as effective as A in reducing potassium levels. Calcium gluconate (D) does not directly reduce potassium levels and is used for treating hyperkalemia-related cardiac toxicity.
Acute kidney injury from postrenal etiology is caused by
- A. obstruction of the flow of urine.
- B. conditions that interfere with renal perfusion.
- C. hypovolemia or decreased cardiac output.
- D. conditions that act directly on functioning kidney tissue
Correct Answer: A
Rationale: The correct answer is A because acute kidney injury from postrenal etiology is caused by obstruction of the flow of urine, leading to back pressure and damage to the kidneys. Choices B and C relate to prerenal causes, affecting renal perfusion and volume status. Choice D refers to intrinsic renal causes, directly affecting kidney tissue function, not postrenal obstruction. Therefore, A is correct due to the nature of postrenal etiology.