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Which of the ff. interventions can help minimize complications related to Hypercalcemia?
- A. Encourage 3 to 4 L of fluid daily
- B. Place the patient on bed rest
- C. Have the patient cough and deep
- D. Apply heat to painful areas breathe every 2 hours
Correct Answer: A
Rationale: Encouraging a high fluid intake, typically around 3 to 4 liters daily, is an intervention that can help minimize complications related to hypercalcemia. Adequate hydration helps prevent the formation of kidney stones, a common complication of hypercalcemia. The increased fluid intake can also promote renal excretion of excess calcium, aiding in its elimination from the body. Additionally, adequate hydration supports overall kidney function and can help prevent renal damage that may result from high calcium levels.
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Which of the ff must the nurse consider when administering IV fluids to clients with hypertension?
- A. The nurse checks the clients BP every hour
- B. The nurse checks the site and progress of the infusion every hour
- C. The nurse checks the progress of the infusion once a day
- D. The nurse checks the client's pulse rate every hour
Correct Answer: B
Rationale: When administering IV fluids to clients with hypertension, the nurse must closely monitor the site and progress of the infusion every hour to ensure proper hydration and detect any signs of complications such as infiltration or infection. Checking the blood pressure every hour, as in choice A, may not be necessary unless specifically indicated by the healthcare provider. Checking the progress of the infusion once a day, as in choice C, does not provide adequate monitoring for a client with hypertension who may be at higher risk for fluid volume overload. Checking the client's pulse rate every hour, as in choice D, is important but does not directly address the immediate monitoring needs related to the administration of IV fluids.
Which is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?
- A. Pulmonary congestion
- B. Congenital heart defect
- C. Heart failure
- D. Systemic venous congestion
Correct Answer: C
Rationale: Heart failure is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures. This results in the inefficient delivery of oxygen and nutrients to the body's tissues, leading to symptoms such as fatigue, shortness of breath, and fluid retention. Pulmonary congestion, systemic venous congestion, and congenital heart defects can be associated with heart failure but are not the primary definition of the condition.
The nurse is aware that the following laboratory values support a diagnosis of pyelonephritis?
- A. Myoglobinuria
- B. Ketonuria
- C. Pyuria
- D. Low white blood cell (WBC) count
Correct Answer: C
Rationale: Pyelonephritis is a bacterial infection of the kidney. One of the key indicators of pyelonephritis is the presence of pyuria, which refers to white blood cells in the urine. White blood cells in the urine suggest inflammation and infection in the urinary tract, particularly in the kidneys. Therefore, the presence of pyuria supports a diagnosis of pyelonephritis. Myoglobinuria (choice A) is the presence of myoglobin in the urine and is associated with muscle breakdown, not specifically with pyelonephritis. Ketonuria (choice B) refers to the presence of ketones in the urine and may be seen in conditions such as diabetic ketoacidosis. A low white blood cell count (choice D) is not typically associated with pyelonephritis, as an infection would generally result in an elevated white blood cell count in response to the infection.
Regarding physical growth of middle childhood (6-11 years), all are true EXCEPT
- A. 3-3.5 kg weight increment/yr
- B. 6-7 cm height increment/yr
- C. brain stops myelinization by 8 years
- D. risk for future obesity falls by 6 years
Correct Answer: D
Rationale: Risk for obesity does not necessarily fall by 6 years.
The nurse needs to obtain blood for ongoing assessment of a high-risk newborn's progress. Which tests should the nurse monitor? (Select all that apply.)
- A. Blood glucose
- B. Complete blood count (CBC)
- C. Calcium
- D. Serum electrolytes
Correct Answer: A
Rationale: Blood glucose: Monitoring blood glucose levels is crucial in high-risk newborns to ensure they are within the normal range. High or low blood glucose levels can indicate various conditions that require prompt intervention.