Nokea
Continuous renal replacement therapy (CRRT) differs from conventional intermittent hemodialysis in that
- A. a hemofilter is used to facilitate ultrafiltration.
- B. it provides faster removal of solute and water.
- C. it does not allow diffusion to occur.
- D. the process removes solutes and water slowly.
Correct Answer: D
Rationale: Step-by-step rationale:
1. CRRT removes solutes and water slowly to avoid hemodynamic instability.
2. Slow removal better tolerates fluid and electrolyte shifts in critically ill patients.
3. Unlike intermittent hemodialysis, CRRT provides continuous, gentle therapy.
4. Choice A is incorrect as both CRRT and intermittent hemodialysis use a hemofilter.
5. Choice B is incorrect as CRRT does not provide faster solute and water removal.
6. Choice C is incorrect as CRRT allows for diffusion to occur, albeit at a slower rate.
Summary:
Continuous renal replacement therapy (CRRT) removes solutes and water slowly to prevent hemodynamic instability, making it a gentler and more continuous process compared to intermittent hemodialysis. The other choices are incorrect as CRRT does use a hemofilter, does not provide faster removal, and still allows for diffusion to occur.
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Which of the following statements is true about the medical management of diabetic ketoacidosis?
- A. Serum lactate levels are used to guide insulin administration.
- B. Sodium bicarbonate is a first-line medication for treatment.
- C. The degree of acidosis is assessed through continuous pulse oximetry.
- D. Volume replacement and insulin infusion often correct the acidosis.
Correct Answer: D
Rationale: The correct answer is D. Volume replacement and insulin infusion often correct the acidosis in diabetic ketoacidosis (DKA) because volume depletion and insulin deficiency are key factors in its pathophysiology. Volume replacement helps correct dehydration and improve tissue perfusion, while insulin infusion helps lower blood glucose levels and inhibit ketone production, ultimately correcting the acidosis.
A is incorrect because serum lactate levels are not typically used to guide insulin administration in DKA. B is incorrect as sodium bicarbonate is not a first-line medication for DKA treatment as it can worsen metabolic acidosis. C is incorrect as the degree of acidosis in DKA is typically assessed through blood gas analysis, not continuous pulse oximetry.
The patient is complaining of severe flank pain when he tries to urinate. His urinalysis shows sediment and crystals along with a few bacteria. Using this information along with the clinical picture, the nurse realizes that the patient’s condition is
- A. prerenal.
- B. postrenal.
- C. intrarenal.
- D. not renal related.
Correct Answer: C
Rationale: The correct answer is C: intrarenal. The presence of sediment, crystals, and bacteria in the urinalysis indicates an issue within the kidneys themselves. The flank pain suggests renal involvement. Prerenal would involve issues before the kidneys, such as inadequate blood flow. Postrenal would involve issues after the kidneys, such as urinary tract obstruction. Not renal related is incorrect as the symptoms and urinalysis findings clearly point to a renal issue.
The nurse has been assigned the following patients. Which patients require assessment of blood glucose control as a nursing priority? (Select all that apply.)
- A. 18-year-old male who has undergone surgical correction of a fractured femur
- B. 29-year-old female who is undergoing evaluation for pheochromocytoma
- C. 43-year-old male with acute pancreatitis who is receiving total parenteral nutrition (TPN)
- D. 62-year-old morbidly obese female who underwent a hysterectomy for ovarian cancer
Correct Answer: C
Rationale: The correct answer is C because the patient with acute pancreatitis receiving TPN is at risk for hyperglycemia due to the high glucose content in TPN. Monitoring blood glucose levels is crucial to prevent complications.
Explanation for why other choices are incorrect:
A: The 18-year-old male post-surgery for a fractured femur does not have a direct correlation to blood glucose control assessment.
B: The 29-year-old female undergoing evaluation for pheochromocytoma is not directly related to blood glucose control assessment.
D: The 62-year-old morbidly obese female post-hysterectomy for ovarian cancer does not specifically require immediate blood glucose control assessment.
In determining the glomerular filtration rate (GFR) or creatinine clearance, a 24-hour urine is obtained. If a reliable 24-hour urine collection is not possible,
- A. it is not possible to determine the GFR.
- B. the BUN may be used to determine renal function.
- C. an elevated BUN/creatinine ratio can be used.
- D. a standardized formula may be used to calculate GFR.
Correct Answer: D
Rationale: The correct answer is D because if a reliable 24-hour urine collection is not possible, a standardized formula can be used to estimate the GFR. This is typically done using the patient's serum creatinine level, age, sex, and race. It is a validated method when direct measurement is not feasible.
A: Incorrect. It is still possible to estimate GFR using formulas when 24-hour urine collection is not possible.
B: Incorrect. BUN alone is not sufficient to accurately determine renal function.
C: Incorrect. BUN/Creatinine ratio is not a direct measure of GFR and may be influenced by other factors.
An elderly female patient has presented to the emergency department with altered mental status, hypothermia, and clinical signs of heart failure. Myxedema is suspected. Which of the following laboratory findings support this diagnosis?
- A. Elevated adrenocorticotropic hormone
- B. Elevated cortisol levels
- C. Elevated T and T 3 4
- D. Elevated thyroid-stimulating hormone
Correct Answer: C
Rationale: Rationale for Correct Answer (C): Elevated T and T3/T4 levels are indicative of primary hypothyroidism, such as myxedema. In this case, the patient presents with classic symptoms of hypothyroidism, including altered mental status, hypothermia, and heart failure. Elevated T3/T4 levels confirm the diagnosis.
Summary of Incorrect Choices:
A: Elevated adrenocorticotropic hormone is associated with adrenal disorders, not hypothyroidism.
B: Elevated cortisol levels suggest Cushing's syndrome, a condition of excess cortisol production, not hypothyroidism.
D: Elevated thyroid-stimulating hormone is seen in primary hypothyroidism, but in myxedema, the issue is not with TSH but with T3/T4 levels.