Nokea
The nurse receives a health care provider's prescription to change a patient's IV from D5. half-normal saline with 40 mEq KCl/L to DSNS with 20 mEq KCl/L. Which set of serum laboratory values supports the rationale for this IV prescription change?
- A. Sodium level of 136 mEq/L, potassium level of 4.5 mEq/L.
- B. Sodium level of 145 mEq/L, potassium level of 4.8 mEq/L.
- C. Sodium level of 135 mEq/L, potassium level of 3.6 mEq/L.
- D. Sodium level of 144 mEq/L, potassium level of 3.7 PROTOCOL mEq/L.
Correct Answer: C
Rationale: Normal sodium (135 mEq/L) and potassium (3.6 mEq/L) levels support changing to a lower potassium IV (20 mEq KCl/L) to prevent hyperkalemia while maintaining hydration.
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A patient who smokes reports chest pain while at rest. Which condition would the nurse suspect the patient is experiencing?
- A. Silent ischemia.
- B. Angina decubitus.
- C. Prinzmetal angina.
- D. Chronic stable angina.
Correct Answer: C
Rationale: Prinzmetal angina, also known as variant angina, typically occurs at rest due to coronary artery spasms, which aligns with the patient's symptoms of chest pain at rest.
Which component forms an adhesive bridge between platelets and vascular subendothelial structures in the clotting process?
- A. Serotonin.
- B. Platelet factor III.
- C. Von Willebrand factor.
- D. Adenosine diphosphate.
Correct Answer: C
Rationale: Von Willebrand factor forms an adhesive bridge between platelets and vascular subendothelial structures, crucial for hemostasis at sites of vascular injury.
A healthy 70-year-old patient has low hemoglobin levels and no signs of gastrointestinal bleeding. The nurse recognizes which item is an effect of aging that could be the reason for the low hemoglobin level?
- A. Low level of hepcidin.
- B. Increase in iron-binding capacity.
- C. Decrease in intestinal absorption of iron.
- D. Decrease in erythropoietin secretion from the kidneys.
Correct Answer: C
Rationale: Aging often leads to a decrease in the efficiency of nutrient absorption, including iron. This decrease in intestinal absorption of iron can result in low hemoglobin levels in elderly individuals. It's a common cause of anemia in the elderly population.
A patient's blood pressure (BP) reading is 142/91 mm Hg. How would the nurse classify the BP?
- A. Normal.
- B. Prehypertension.
- C. Hypertension, stage 1.
- D. Hypertension, stage 2.
Correct Answer: C
Rationale: A BP of 142/91 mm Hg is classified as stage 1 hypertension, with systolic 140-159 mm Hg or diastolic 90-99 mm Hg.
The nurse is teaching a patient about the administration of liquid iron supplements. Which response by the patient indicates the need for additional teaching?
- A. I will take my iron supplement with a straw.
- B. I will take my iron supplement at bedtime.
- C. I will take my iron supplement along with meals.
- D. I will take my iron supplement along with orange juice.
Correct Answer: C
Rationale: Taking iron supplements with meals decreases absorption, indicating a need for further teaching; iron should be taken on an empty stomach or with vitamin C.