Nokea
The patient’s potassium level is 0 mEq/L. Besides dialysis, which of the following actually reduces plasma potassium levels and total body potassium content safely in a patient with renal dysfunction?
- A. Sodium polystyrene sulfonate
- B. Sodium polystyrene sulfonate with sorbitol
- C. Regular insulin
- D. Calcium gluconate
Correct Answer: A
Rationale: The correct answer is A: Sodium polystyrene sulfonate. It works by exchanging sodium ions for potassium ions in the colon, leading to potassium excretion. A is the safest option without the risk of causing hypernatremia or intestinal necrosis like B. Regular insulin (C) may cause hypoglycemia and is not as effective as A in reducing potassium levels. Calcium gluconate (D) does not directly reduce potassium levels and is used for treating hyperkalemia-related cardiac toxicity.
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Continuous venovenous hemofiltration is used to
- A. remove fluids and solutes through the process of convection.
- B. remove plasma water in cases of volume overload.
- C. remove plasma water and solutes by adding dialysate.
- D. combine ultrafiltration, convection, and dialysis.
Correct Answer: A
Rationale: The correct answer is A because continuous venovenous hemofiltration primarily removes fluids and solutes through convection. Convection involves the movement of solutes across a semi-permeable membrane by the force of the fluid flow. This process helps to achieve fluid balance and manage electrolyte levels in patients with renal failure.
Choice B is incorrect because hemofiltration does not specifically target plasma water; it aims to remove both fluids and solutes. Choice C is incorrect as hemofiltration does not involve adding dialysate; it relies on the patient's blood passing through a filter to remove waste products. Choice D is incorrect because while hemofiltration may involve aspects of ultrafiltration and dialysis, the primary mechanism is convection for removing fluids and solutes.
Daily weights are being recorded for the patient with a urine output that has been less than the intravenous and oral intake. The weight yesterday was 5 kg. This morning it is 99 kg. The nurse understands that this corresponds to a(n)
- A. fluid retention of 1.5 liters.
- B. fluid loss of 1.5 liters.
- C. equal intake and output due to insensible losses.
- D. fluid loss of 0.5 liters.
Correct Answer: A
Rationale: The correct answer is A: fluid retention of 1.5 liters. The weight gain from 5 kg to 99 kg indicates an increase of 94 kg. Since 1 kg of weight gain is approximately equal to 1 liter of fluid retention, the patient has retained 94 liters of fluid. Therefore, the correct choice is fluid retention of 1.5 liters.
Choice B is incorrect because the weight gain indicates fluid retention, not loss. Choice C is incorrect as it mentions equal intake and output, which does not match the weight gain observed. Choice D is incorrect as it suggests fluid loss, which contradicts the weight gain.
Which of the following would be seen in a patient with myxedema coma?
- A. Decreased reflexes
- B. Hyperthermia
- C. Hyperventilation
- D. Tachycardia
Correct Answer: A
Rationale: The correct answer is A: Decreased reflexes. In myxedema coma, a severe form of hypothyroidism, patients often present with decreased mental status, hypothermia, and bradycardia. Decreased reflexes are a common neurological manifestation due to the slowing of metabolic processes and the central nervous system depression associated with this condition. Hyperthermia (B) is not typically seen in myxedema coma, as patients usually have low body temperature. Hyperventilation (C) is also unlikely, as respiratory depression is more common. Tachycardia (D) is incorrect because bradycardia is more characteristic of myxedema coma.
In the management of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome, when is an intravenous (IV) solution that contains dextrose started?
- A. Never; normal saline is the only appropriate solution in diabetes management
- B. When the blood sugar reaches 70 mg/dL
- C. When the blood sugar reaches 150 mg/dL
- D. When the blood glucose reaches 250 mg/dL
Correct Answer: D
Rationale: Correct Answer: D
Rationale: In diabetic emergencies, starting IV dextrose at 250 mg/dL prevents hypoglycemia while resolving ketoacidosis. Below 250 mg/dL, the body can use endogenous glucose, so IV dextrose is not necessary.
Summary:
A: Incorrect. Normal saline may be used for initial fluid resuscitation but does not address the need for glucose.
B: Incorrect. Starting dextrose at 70 mg/dL may lead to unnecessary hyperglycemia and complications.
C: Incorrect. Waiting until 150 mg/dL delays the provision of necessary glucose for metabolic functions.
Factors associated with the development of nephrogenic diabetes insipidus include which of the following? (Select all that apply.)
- A. Heredity
- B. Medications
- C. Meningitis
- D. Pituitary tumors
Correct Answer: A
Rationale: The correct answer is A: Heredity. Nephrogenic diabetes insipidus can be inherited as a genetic condition. The mutation in genes responsible for regulating water balance in the kidneys can lead to this disorder. Other choices are incorrect: B: Medications like lithium can cause acquired nephrogenic diabetes insipidus, not its development. C: Meningitis is an inflammatory condition that does not directly relate to nephrogenic diabetes insipidus. D: Pituitary tumors are associated with central diabetes insipidus, not nephrogenic.