Nokea
The patient is in the critical care unit and will receive dialysis this morning. The nurse will (Select all that apply.)
- A. evaluate morning laboratory results and report abnormal results.
- B. administer the patient’s antihypertensive medications.
- C. assess the dialysis access site and report abnormalities.
- D. weigh the patient to monitor fluid status.
Correct Answer: A
Rationale: The correct answer is A. By evaluating the morning laboratory results and reporting abnormal results, the nurse can ensure the patient's safety during dialysis by addressing any concerning findings promptly. This step is crucial in monitoring the patient's condition and adjusting the treatment plan as needed.
Incorrect choices:
B: Administering antihypertensive medications is not directly related to the patient's dialysis procedure and does not address the immediate needs of the patient in the critical care unit.
C: While assessing the dialysis access site is important, reporting abnormalities alone may not be sufficient without a comprehensive evaluation of the patient's laboratory results.
D: Weighing the patient to monitor fluid status is important in the context of dialysis, but it is not as critical as evaluating laboratory results for immediate intervention.
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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.
The nurse is caring for a patient with a diagnosis of head trauma. The nurse notes that the patient’s urine output has increased tremendously over the past 18 hours. The nurse suspects that the patient may be developing
- A. diabetes insipidus.
- B. diabetic ketoacidosis.
- C. hyperosmolar hyperglycemic syndrome.
- D. syndrome of inappropriate secretion of antidiuretic hormone.
Correct Answer: A
Rationale: Rationale: A patient with head trauma may develop diabetes insipidus due to damage to the hypothalamus or pituitary gland, leading to decreased secretion of antidiuretic hormone (ADH). This results in excessive urine output and thirst. Other options are incorrect because:
B: Diabetic ketoacidosis is associated with high blood sugar and ketones, not increased urine output.
C: Hyperosmolar hyperglycemic syndrome is characterized by extreme hyperglycemia, not increased urine output.
D: Syndrome of inappropriate secretion of antidiuretic hormone results in decreased urine output due to excess ADH.
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.
The patient is diagnosed with acute kidney injury and has been getting dialysis 3 days per week. The patient complains of general malaise and is tachypneic. An arterial blood gas shows that the patient’s pH is 19, with a PCO of 30 mm Hg and a bicarbonate level of 13 mEq/L. The nurse prepares to
- A. administer morphine to slow the respiratory rate.
- B. prepare for intubation and mechanical ventilation.
- C. administer intravenous sodium bicarbonate.
- D. cancel tomorrow’s dialysis session.
Correct Answer: B
Rationale: The correct answer is B: prepare for intubation and mechanical ventilation. The patient's arterial blood gas results indicate metabolic acidosis (low pH, low bicarbonate) with respiratory compensation (low PCO). In this scenario, the patient is likely experiencing respiratory fatigue due to tachypnea from metabolic acidosis. Intubation and mechanical ventilation are needed to support the patient's respiratory effort and correct the acid-base imbalance. Administering morphine (choice A) can further depress the respiratory drive. Administering intravenous sodium bicarbonate (choice C) can temporarily correct the pH but does not address the underlying respiratory distress. Canceling dialysis (choice D) is not indicated as it does not address the acute respiratory compromise.
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.