Nursing Elites

1. . A medical nurse educator is reviewing a patients recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis?

• A. The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance.
• B. The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance
• C. The kidneys react rapidly to compensate for imbalances in the body
• D. The kidneys regulate the bicarbonate level in the intracellular fluid.

Correct answer: B

Rationale:

2. When does dehydration begin to occur?

• A. the body reduces fluid output to zero.
• B. the body increases the release of ANH.
• C. the salivary secretions decrease.
• D. the salivary secretions increase.

Correct answer: C

Rationale: Dehydration leads to a decrease in the body's fluid levels, causing the salivary glands to produce less saliva, resulting in a dry mouth. Therefore, when dehydration begins to occur, salivary secretions decrease. Choice A is incorrect because the body does not reduce fluid output to zero during dehydration; it tries to conserve fluids. Choice B is incorrect as dehydration does not directly increase the release of ANH (Atrial Natriuretic Hormone). Choice D is incorrect because salivary secretions do not increase but decrease during dehydration.

3. A nurse is visiting an 84-year-old woman living at home and recovering from hip surgery. The woman seems confused and has poor skin turgor, and she states that 'she stops drinking water early in the day because it is too difficult to get up during the night to go to the bathroom.' The nurse explains to the woman that:

• A. She will need to have her medications adjusted and be readmitted to the hospital for a complete workup.
• B. Limiting fluids can create imbalances in the body that can result in confusion; maybe we need to adjust the timing of your fluids.
• C. It is normal to be a little confused following surgery and it is safe not to urinate at night.
• D. Confusion following surgery is common in the elderly due to loss of sleep.

Correct answer: B

Rationale: The correct answer is B. In elderly patients, fluid deficits can lead to confusion and cognitive impairment. Limiting fluids can disrupt the body's balance, leading to such symptoms. Adjusting the timing of fluids can help maintain hydration without causing nighttime interruptions. Choices A, C, and D are incorrect because they do not address the underlying issue of fluid imbalance causing confusion. Choice A suggests unnecessary hospital readmission and medication adjustments. Choice C incorrectly normalizes confusion post-surgery and suggests it is safe not to urinate at night, which can exacerbate the issue. Choice D inaccurately attributes confusion to sleep loss rather than fluid imbalance.

4. What happens first in dehydration?

• A. Intercellular fluid volume drops first.
• B. Plasma volume drops first.
• C. Interstitial fluid drops first.
• D. Neither interstitial nor intracellular fluid volume are affected.

Correct answer: C

Rationale: In dehydration, the body first draws fluid from the interstitial space to maintain blood volume, leading to a decrease in interstitial fluid volume. This is why choice C is correct. Choice A is incorrect because intracellular fluid is not the first to be affected. Choice B is also incorrect as plasma volume reduction typically occurs after interstitial fluid loss. Choice D is incorrect as dehydration impacts both interstitial and intracellular fluid volumes.

5. Which electrolyte is important in the formation of the thyroid hormones?

• A. Sodium
• B. Iodine
• C. Iron
• D. Chloride

Correct answer: B

Rationale: Iodine is the correct answer because it is essential for the synthesis of thyroid hormones. The thyroid gland incorporates iodine into thyroid hormones such as thyroxine (T4) and triiodothyronine (T3). These hormones are crucial for regulating metabolism, growth, and development. Sodium, iron, and chloride are not directly involved in the formation of thyroid hormones, making them incorrect choices.

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