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The patient is complaining of severe flank pain when he tries to urinate. His urinalysis shows sediment and crystals along with a few bacteria. Using this information along with the clinical picture, the nurse realizes that the patient’s condition is
- A. prerenal.
- B. postrenal.
- C. intrarenal.
- D. not renal related.
Correct Answer: C
Rationale: The correct answer is C: intrarenal. The presence of sediment, crystals, and bacteria in the urinalysis indicates an issue within the kidneys themselves. The flank pain suggests renal involvement. Prerenal would involve issues before the kidneys, such as inadequate blood flow. Postrenal would involve issues after the kidneys, such as urinary tract obstruction. Not renal related is incorrect as the symptoms and urinalysis findings clearly point to a renal issue.
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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.
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.
A college student was admitted to the emergency department after being found unconscious by a roommate. The roommate informs emergency medical personnel that the student has diabetes and has been experiencing flulike symptoms, including vomiting, since yesterday. The patient had been up all night studying for exams. The patient used the last diabetes testing supplies 3 days ago and has not had time to go to the pharmacy to refill prescription supplies. Based upon the history, which laboratory findings would be anticipated in this client? (Select all that apply.)
- A. Blood glucose: 43 mg/dL
- B. Blood glucose: 524 mg/dL
- C. HCO —: 10 mEq/L
- D. PaCO : 37 mm Hg
Correct Answer: B
Rationale: The correct answer is B: Blood glucose: 524 mg/dL. The patient likely has diabetic ketoacidosis (DKA) due to missed insulin doses, stress, and illness leading to high blood glucose levels. DKA is characterized by hyperglycemia, ketosis, and metabolic acidosis. A low blood glucose level (Choice A) is not consistent with DKA. HCO3- of 10 mEq/L (Choice C) indicates metabolic acidosis, but it's not specific to DKA. A PaCO2 of 37 mm Hg (Choice D) is within the normal range and not directly related to DKA.
The nurse is caring for a patient who underwent pituitary surgery 12 hours ago. The nurse will give priority to monitoring the patient carefully for which of the following?
- A. Congestive heart failure
- B. Hypovolemic shock
- C. Infection
- D. Volume overload
Correct Answer: B
Rationale: The correct answer is B: Hypovolemic shock. After pituitary surgery, patients are at risk for hypovolemic shock due to potential intraoperative blood loss and fluid shifts. Monitoring for signs of shock, such as hypotension and tachycardia, is crucial for early intervention. A: Congestive heart failure is less likely immediately post-surgery. C: Infection is a concern but not the highest priority in the immediate postoperative period. D: Volume overload is not a common immediate complication of pituitary surgery.
The most common cause of acute kidney injury in critically ill patients is
- A. sepsis.
- B. fluid overload.
- C. medications.
- D. hemodynamic instability.
Correct Answer: A
Rationale: The correct answer is A: sepsis. Sepsis is a leading cause of acute kidney injury in critically ill patients due to the systemic inflammatory response leading to kidney damage. Fluid overload (B) can contribute but is not the primary cause. Medications (C) and hemodynamic instability (D) can also lead to acute kidney injury but are not as common as sepsis in critically ill patients.