Nokea
Renin plays a role in blood pressure regulation by
- A. activating the renin-angiotensin-aldosterone cascade.
- B. suppressing angiotensin production.
- C. decreasing sodium reabsorption.
- D. inhibiting aldosterone release.
Correct Answer: A
Rationale: The correct answer is A because renin activates the renin-angiotensin-aldosterone cascade. Renin is released by the kidneys in response to low blood pressure or low sodium levels. It acts on angiotensinogen to form angiotensin I, which is then converted to angiotensin II by angiotensin-converting enzyme. Angiotensin II causes vasoconstriction, leading to increased blood pressure, and stimulates aldosterone release, promoting sodium and water retention.
Choice B is incorrect because renin does not suppress angiotensin production; it actually initiates the process. Choice C is incorrect because renin's action leads to increased sodium reabsorption by stimulating aldosterone release. Choice D is incorrect because renin does not inhibit aldosterone release; it promotes it as part of the renin-angiotensin-aldosterone cascade.
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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.
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.
The patient is in the critical care unit and will receive dialysis this morning. The nurse will (Select all that apply.)
- A. evaluate morning laboratory results and report abnormal results.
- B. administer the patient’s antihypertensive medications.
- C. assess the dialysis access site and report abnormalities.
- D. weigh the patient to monitor fluid status.
Correct Answer: A
Rationale: The correct answer is A. By evaluating the morning laboratory results and reporting abnormal results, the nurse can ensure the patient's safety during dialysis by addressing any concerning findings promptly. This step is crucial in monitoring the patient's condition and adjusting the treatment plan as needed.
Incorrect choices:
B: Administering antihypertensive medications is not directly related to the patient's dialysis procedure and does not address the immediate needs of the patient in the critical care unit.
C: While assessing the dialysis access site is important, reporting abnormalities alone may not be sufficient without a comprehensive evaluation of the patient's laboratory results.
D: Weighing the patient to monitor fluid status is important in the context of dialysis, but it is not as critical as evaluating laboratory results for immediate intervention.
A patient with type 1 diabetes who is receiving a continuous subcutaneous insulin infusion via an insulin pump contacts the clinic to report mechanical failure of the infusion pump. The nurse instructs the patient to begin monitoring for signs of:
- A. adrenal insufficiency.
- B. diabetic ketoacidosis.
- C. hyperosmolar, hyperglycemic state.
- D. hypoglycemia.
Correct Answer: B
Rationale: The correct answer is B: diabetic ketoacidosis. When an insulin pump fails, the patient may experience a sudden decrease in insulin delivery, leading to a potential rise in blood glucose levels. This can trigger diabetic ketoacidosis, characterized by hyperglycemia, ketosis, and acidosis. Monitoring for signs such as increased thirst, frequent urination, fruity breath odor, and rapid breathing is crucial.
Incorrect choices:
A: Adrenal insufficiency is not directly related to insulin pump failure.
C: Hyperosmolar, hyperglycemic state is more common in type 2 diabetes and typically occurs with extreme hyperglycemia, not sudden pump failure.
D: Hypoglycemia is less likely with pump failure due to decreased insulin delivery.
Conditions that produce acute kidney injury by directly acting on functioning kidney tissue are classified as intrarenal. The most common intrarenal condition is
- A. prolonged ischemia.
- B. exposure to nephrotoxic substances.
- C. acute tubular necrosis (ATN).
- D. hypotension for several hours.
Correct Answer: C
Rationale: Rationale: Acute tubular necrosis (ATN) is the most common intrarenal condition causing acute kidney injury. ATN is characterized by damage to the renal tubules due to ischemia or nephrotoxic substances. Prolonged ischemia (choice A) and exposure to nephrotoxic substances (choice B) can lead to ATN. Hypotension for several hours (choice D) can result in ischemic injury, which may lead to ATN but is not the direct cause. Therefore, choice C is correct as it directly relates to the primary intrarenal condition of ATN.