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The nurse is caring for an elderly patient who was admitted with renal insufficiency. An expected laboratory finding for this patient may be
- A. an increased glomerular filtration rate (GFR).
- B. a normal serum creatinine level.
- C. increased ability to excrete drugs.
- D. hypokalemia.
Correct Answer: C
Rationale: Correct Answer: C - Increased ability to excrete drugs.
Rationale:
1. Renal insufficiency impairs kidney function, leading to decreased excretion of drugs.
2. In elderly patients with renal insufficiency, there may be compensatory mechanisms to enhance drug excretion.
3. This increased ability to excrete drugs helps prevent drug accumulation and potential toxicity.
Summary:
A: Increased GFR is not expected in renal insufficiency; it typically decreases.
B: Serum creatinine level would likely be elevated in renal insufficiency, not normal.
D: Hypokalemia is not a typical lab finding in renal insufficiency; hyperkalemia is more common.
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The nurse is caring for a patient with head trauma who was admitted to the surgical intensive care unit following a motorcycle crash. What is an important assessment that will assist the nurse in early identification of an endocrine disorder commonly associated with this condition?
- A. Daily weight
- B. Fingerstick glucose
- C. Lung sound auscultation
- D. Urine osmolality
Correct Answer: D
Rationale: The correct answer is D: Urine osmolality. In head trauma patients, the risk of developing diabetes insipidus (DI) is high due to damage to the posterior pituitary. Monitoring urine osmolality helps identify DI early, as low urine osmolality indicates impaired concentration ability. This is crucial for prompt treatment to prevent dehydration. Choices A and B are important but not specific to endocrine disorders. Choice C is relevant for respiratory assessment, not endocrine disorders.
The most significant clinical finding of acute adrenal crisis associated with fluid and electrolyte imbalance is
- A. fluid volume excess.
- B. hyperglycemia.
- C. hyperkalemia
- D. hypernatremia
Correct Answer: C
Rationale: Step-by-step rationale for the correct answer (C: hyperkalemia):
1. Adrenal crisis leads to adrenal insufficiency, causing decreased cortisol levels.
2. Cortisol plays a crucial role in regulating potassium levels.
3. With decreased cortisol, potassium levels can rise, leading to hyperkalemia.
4. Hyperkalemia can result in life-threatening cardiac arrhythmias.
Summary:
A: Fluid volume excess is not typical in adrenal crisis.
B: Hyperglycemia can be present but is not the most significant finding.
D: Hypernatremia is not a typical feature of adrenal crisis.
The nurse is caring for a patient who has undergone major abdominal surgery. The nurse notices that the patient’s urine output has been less than 20 mL/hour for the past 2 hours. The patient’s blood pressure is 100/60 mm Hg, and the pulse is 110 beats/min. Previously, the pulse was 90 beats/min with a blood pressure of 120/80 mm Hg. The nurse should
- A. contact the provider and expect a prescription for a normal saline bolus.
- B. wait until the provider makes rounds to report the assessment findings.
- C. continue to evaluate urine output for 2 more hours.
- D. ignore the urine output, as this is most likely postrenal in origin.
Correct Answer: A
Rationale: Rationale:
1. Urine output < 20 mL/hour indicates potential hypoperfusion.
2. Decreased urine output with hypotension and tachycardia suggests inadequate fluid resuscitation.
3. Administering a normal saline bolus can help improve perfusion and stabilize blood pressure.
4. Contacting the provider promptly for orders is crucial in managing this acute situation.
Summary of Incorrect Choices:
B. Delaying reporting to the provider risks worsening the patient's condition.
C. Continuing to evaluate urine output without intervention can lead to further deterioration.
D. Ignoring the urine output due to potential postrenal causes overlooks the urgent need for fluid resuscitation.
The critical care nurse is responsible for monitoring the patient receiving continuous renal replacement therapy (CRRT). In doing so, the nurse should
- A. assess that the blood tubing is warm to the touch.
- B. assess the hemofilter every 6 hours for clotting.
- C. cover the dialysis lines to protect them from light.
- D. use clean technique during vascular access dressing changes.
Correct Answer: B
Rationale: Correct Answer: B
Rationale:
1. Hemofilter clotting can affect CRRT efficiency.
2. Assessing every 6 hours allows early detection and intervention.
3. Clotting can lead to treatment interruptions or complications.
4. Regular assessment ensures optimal therapy delivery.
Other Choices:
A: Assessing tubing warmth is not a reliable indicator of CRRT function or complications.
C: Covering dialysis lines to protect from light is not a standard practice in CRRT monitoring.
D: Using clean technique is not sufficient for vascular access dressing changes; aseptic technique is required for infection prevention.
The patient has just returned from having an arteriovenous fistula placed. The patient asks, “When will they be able to use this and take this other catheter out?” The nurse should reply,
- A. “It can be used immediately, so the catheter can come out anytime.”
- B. “It will take 2 to 4 weeks to heal before it can be used.”
- C. “The fistula will be usable in about 4 to 6 weeks.”
- D. “The fistula was made using graft material, so it depends on the manufacturer.”
Correct Answer: C
Rationale: The correct answer is C: “The fistula will be usable in about 4 to 6 weeks.” This is because arteriovenous fistulas typically require a maturation period of 4 to 6 weeks before they can be used for dialysis. During this time, the fistula will develop into a strong, durable access point for hemodialysis.
Choice A is incorrect because the fistula needs time to mature before it can be used, and immediate use may damage it. Choice B is incorrect as it underestimates the maturation period required. Choice D is incorrect as the maturation time does not depend on the manufacturer but on the patient's physiology and healing process.