Nokea
The patient has been admitted to the hospital with nausea and vomiting that started 5 days earlier. Blood pressure is 80/44 mm Hg and heart rate is 122 beats/min; the patient has not voided in 8 hours, and the bladder is not distended. The nurse anticipates a prescription for “stat” administration of
- A. a blood transfusion.
- B. fluid replacement with 0.45% saline.
- C. infusion of an inotropic agent.
- D. an antiemetic.
Correct Answer: B
Rationale: The correct answer is B: fluid replacement with 0.45% saline. The patient's symptoms suggest dehydration and hypovolemia, indicated by low blood pressure, elevated heart rate, and lack of urine output. Fluid replacement with isotonic saline would help restore intravascular volume and improve blood pressure. Blood transfusion (A) is not indicated without evidence of significant blood loss. Inotropic agents (C) are used to improve cardiac function, which is not the primary issue in this case. Antiemetics (D) may help with nausea and vomiting but do not address the underlying cause of hypovolemia.
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Acute adrenal crisis is caused by
- A. acute renal failure.
- B. deficiency of corticosteroids.
- C. high doses of corticosteroids.
- D. overdose of testosterone.
Correct Answer: B
Rationale: The correct answer is B: deficiency of corticosteroids. Acute adrenal crisis is caused by a sudden and severe deficiency of cortisol and aldosterone, which are essential corticosteroids produced by the adrenal glands. Without these hormones, the body cannot regulate blood pressure, electrolyte balance, and respond to stress adequately. Acute renal failure (choice A) does not directly lead to adrenal crisis. High doses of corticosteroids (choice C) can suppress the adrenal glands but do not cause acute adrenal crisis. Overdose of testosterone (choice D) does not impact the production of cortisol and aldosterone, thus not causing acute adrenal crisis.
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.
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.
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.
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.