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Which role is attributed to the base in the acid-base balance?
- A. Does not interact with acids.
- B. Promotes the excretion of acid.
- C. Activates the system of acid-base balance.
- D. Increases the action of the hydrogen ions.
Correct Answer: B
Rationale: Bases, like bicarbonate, promote acid excretion by neutralizing hydrogen ions, aiding in maintaining acid-base balance.
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The nurse receives a health care provider's prescription to change a patient's IV from D5. half-normal saline with 40 mEq KCl/L to DSNS with 20 mEq KCl/L. Which set of serum laboratory values supports the rationale for this IV prescription change?
- A. Sodium level of 136 mEq/L, potassium level of 4.5 mEq/L.
- B. Sodium level of 145 mEq/L, potassium level of 4.8 mEq/L.
- C. Sodium level of 135 mEq/L, potassium level of 3.6 mEq/L.
- D. Sodium level of 144 mEq/L, potassium level of 3.7 PROTOCOL mEq/L.
Correct Answer: C
Rationale: Normal sodium (135 mEq/L) and potassium (3.6 mEq/L) levels support changing to a lower potassium IV (20 mEq KCl/L) to prevent hyperkalemia while maintaining hydration.
The nurse provides education to a patient about the symptoms of uncontrolled hypertension. Which symptom would the nurse include? Select all that apply.
- A. Fatigue.
- B. Dizziness.
- C. Palpitations.
- D. Cluster headaches.
Correct Answer: A,B,C
Rationale: Fatigue, dizziness, and palpitations are symptoms of uncontrolled hypertension due to cardiovascular strain and vascular effects; cluster headaches are not directly related.
Which change occurs first, making patients susceptible to coronary artery disease?
- A. Formation of thrombus in the coronary artery.
- B. Formation of fibrous plaque in the endothelium.
- C. Reduction of blood flow through the coronary arteries.
- D. Development of fatty streaks in the smooth muscles of the endothelium.
Correct Answer: D
Rationale: Development of fatty streaks in the endothelium is the initial change in atherosclerosis, predisposing patients to coronary artery disease.
Which goal is a primary objective for a patient who has chronic heart failure (HF)?
- A. Maximizing cardiac output.
- B. Maintaining ideal body weight.
- C. Performing daily aerobic exercises.
- D. Maintaining a steady pulse oximetry reading.
Correct Answer: A
Rationale: Maximizing cardiac output is a primary goal for patients with chronic heart failure (HF) because it helps improve tissue perfusion and oxygen delivery to meet the body's demands. It is a crucial aspect of managing heart failure and preventing further complications.
The nurse receives information about the assigned patients during shift report. Which patient would the nurse assess first?
- A. A patient who reports dizziness with a blood pressure (BP) of 150/92 mm Hg.
- B. A patient who reports a severe headache and has begun vomiting.
- C. A patient with a hip fracture who reports a pain level of 2 on a 1-to-10 scale.
- D. A patient who received an angiotensin-converting enzyme (ACE) inhibitor 30 minutes previously and reports fatigue.
Correct Answer: B
Rationale: A severe headache and vomiting could be indicative of a serious neurological condition such as a stroke, intracranial bleeding, or increased intracranial pressure. This patient needs urgent assessment and intervention to prevent potential complications.