Nokea
One of the major functions of the kidneys in maintaining normal fluid balance is:
- A. the manufacture of antidiuretic hormone.
- B. the regulation of calcium and phosphate balance.
- C. the regulation of the pH of the extracellular fluid.
- D. the control of aldosterone levels.
Correct Answer: C
Rationale: Major functions of the kidneys in maintaining normal fluid balance include regulation of extracellular fluid and osmolarity by selective retention and excretion of fluids, regulation of pH of the extracellular fluid by retention of hydrogen ions, and excretion of metabolic wastes and toxic substances. ADH is manufactured by the pituitary, and the parathyroid regulates calcium and phosphate balance.
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The nurse completed teaching for the client who will be receiving TPN at home. Which client statement indicates that further teaching is needed?
- A. My refrigerator is big enough to store several bags of parenteral solution.
- B. I will keep my cellular phone with me at all times to use in an emergency.
- C. I plan to use the main floor bedroom; it'll be best with the infusion pump.
- D. I'll sit at the table to remove the IV catheter cap to attach the IV tubing.
Correct Answer: D
Rationale: A: Several total nutrient solution bags are kept on hand and require refrigeration. B: A telephone is necessary for contacting home health personnel, arranging for supply deliveries, and calling emergency services. C: The TPN is delivered through an infusion pump, which can limit the client's mobility. D: The central catheter lumen is capped with a needleless port. The IV infusion tubing is connected to the insertion site cap and not removed to administer the TPN solution. Caps are changed every 3 to 7 days during dressing changes, with the client in a flat position. An air embolus can occur if the cap is removed while the client is in a sitting position.
The HCP prescribes 5% albumin for four clients. The nurse should consult with the HCP if 5% albumin is prescribed for which client?
- A. The client of the Catholic faith who has refractory edema
- B. The African American client experiencing hypovolemic shock
- C. The client of the Jehovah's Witnesses faith who has cerebral edema
- D. The Asian client experiencing adult respiratory distress syndrome (ARDS)
Correct Answer: C
Rationale: A: Persons of the Catholic faith usually accept blood and blood products. B: Persons of African American ethnicity usually accept blood and blood products. C: Albumin is a blood derivative obtained by fractionating pooled venous and placental human plasma. Persons of the Jehovah's Witnesses faith usually do not accept RBCs; some do not accept blood products such as albumin or plasma. D: Persons of Asian ethnicity usually accept blood and blood products.
The hospitalized child who has a blood lead level of 50 mcg/dL is to receive succimer 10 mg/kg oral capsule q8h for 5 days. The child weighs 20 kg. Which intervention by the student nurse should be corrected by the observing nurse?
- A. Prepares to give the total dose of one 100-mg capsule with applesauce
- B. Sprinkles the beads of two 100-mg capsules into pudding for administration
- C. Offers fluids frequently during the shift to increase the child's urine output
- D. Explains to a parent that chelation therapy removes the lead from the blood
Correct Answer: A
Rationale: A: The 20-kg child should receive two capsules of succimer (Chemet), not one. Dose (mg) = 20 kg x 10 mg/kg = 200 mg. B: Succimer capsules can be opened and sprinkled on a small amount of food or in liquid to be swallowed; two 100-mg capsules = 200 mg, which is the correct dose. C: Fluids should be increased to prevent renal damage because succimer is excreted by the kidneys. D: Succimer forms a water-soluble compound with lead, allowing urinary elimination of excessive amounts of lead. Lead is removed from the blood, and theoretically some lead is removed from tissues and organs.
Which of the following injuries, if demonstrated by a client entering the Emergency Department, is the highest priority?
- A. open leg fracture
- B. open head injury
- C. stab wound to the chest
- D. traumatic amputation of a thumb
Correct Answer: C
Rationale: A stab wound to the chest might result in lung collapse and mediastinal shift that, if untreated, could lead to death. Treatment of an obstructed airway or a chest wound is a higher priority than hemorrhage. The principle of ABC (airway, breathing, and circulation) prioritizes care decisions.
A pregnant Asian client who is experiencing morning sickness wants to take ginger to relieve the nausea. Which of the following responses by the nurse is appropriate?
- A. I will call your physician to see if we can start some ginger.'
- B. We don't use home remedies in this clinic.'
- C. Herbs are not as effective as regular medicines.'
- D. Just eat some dry crackers instead.'
Correct Answer: A
Rationale: This statement reveals cultural sensitivity. Ginger is sometimes used to relieve nausea. The other statements are culturally insensitive and do not show an awareness of herbal pharmacology.