Nokea
The nurse is caring for a patient who is diaphoretic from a fever. The amount of sodium excreted in the urine will:
- A. Decrease
- B. Increase
- C. Remain unchanged
- D. Fluctuate
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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The patient asks the nurse if he will die if air bubbles get into the IV tubing. What is the nurse's best response?
- A. The system is closed and that is impossible.
- B. Only relatively large volumes of air administered rapidly are dangerous.
- C. There is a risk of complication with IV administration.
- D. You watch too many movies.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse preparing a site for the insertion of an IV catheter should treat excess hair at the site by:
- A. Leaving the hair intact
- B. Shaving the area
- C. Clipping the hair in the area
- D. Removing the hair with a depilatory
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Third spacing occurs when fluid moves out of the intravascular space but not into the intracellular space. Based upon this fluid shift, the nurse will expect the patient to demonstrate:
- A. Hypertension
- B. Bradycardia
- C. Hypervolemia
- D. Hypovolemia
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A nurse in the medical-surgical unit has a newly admitted patient who is oliguric; the acute care nurse practitioner orders a fluid challenge of 100 to 200 mL of normal saline solution over 15 minutes. The nurse is aware this intervention will help:
- A. Distinguish hyponatremia from hypernatremia
- B. Evaluate pituitary gland function
- C. Distinguish reduced renal blood flow from decreased renal function
- D. Provide an effective treatment for hypertension-induced oliguria
Correct Answer: C
Rationale: If a patient is not excreting enough urine, the health care provider needs to determine whether the depressed renal function is the result of reduced renal blood flow, which is a fluid Volume deficit (FVD) or prerenal azotemia, or acute tubular necrosis that results in necrosis or cellular death from prolonged FVD. A typical example of a fluid challenge involves administering 100 to 200 mL of normal saline solution over 15 minutes. The response by a patient with FVD but normal renal function is increased urine output and increased blood pressure.
A nurse admitting a patient with a history of emphysema reviews her past lab reports and notes that the patient's PaCO2 has been 56 to 64 mmHg. The nurse will be cautious administering oxygen because:
- A. The patient's calcium will rise dramatically due to pituitary stimulation.
- B. The oxygen will increase the patient's intracranial pressure and create confusion.
- C. The oxygen may cause the patient to hyperventilate and become acidotic.
- D. Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.