Nursing Elites

1. . One day after a patient is admitted to the medical unit, you note that the patient is oliguric. You notify the acutecare nurse practitioner who orders a fluid challenge of 200 mL of normal saline solution over 15 minutes. This intervention will achieve which of the following?

• A. Help distinguish hyponatremia from hypernatremia
• B. Help evaluate pituitary gland function
• C. Help distinguish reduced renal blood flow from decreased renal function
• D. Help provide an effective treatment for hypertension-induced oliguria

Correct answer: C

Rationale:

2. You are doing discharge teaching with a patient who has hypophosphatemia during his time in hospital. The patient has a diet ordered that is high in phosphate. What foods would you teach this patient to include in his diet? Select all that do not apply

• A. Milk
• B. Beef
• C. Poultry
• D. Liver

Correct answer: B

Rationale:

3. A nurse assesses a client who is admitted with an acid-base imbalance. The clients arterial blood gas values are pH 7.32, PaO2 85 mm Hg, PaCO2 34 mm Hg, and HCO3 16 mEq/L. What action should the nurse take next?

• A. Assess clients rate, rhythm, and depth of respiration.
• B. Measure the clients pulse and blood pressure.
• C. Document the findings and continue to monitor.
• D. Notify the physician as soon as possible.

Correct answer: A

Rationale:

4. What percentage of body water can be as high as in a newborn?

• A. 80%.
• B. 70%.
• C. 60%.
• D. 90%.

Correct answer: A

Rationale: The correct answer is A: 80%. Newborns can have a body water content as high as 80% due to their higher total body water compared to adults. Choice B (70%) is incorrect because newborns typically have a higher body water percentage. Choice C (60%) is also incorrect as it underestimates the body water content in newborns. Choice D (90%) is incorrect as it overestimates the body water percentage in newborns.

5. The nurse is admitting a patient with a suspected fluid imbalance. The most sensitive indicator of body fluid balance is:

• A. Daily weight
• B. Serum sodium levels
• C. Measured intake and output
• D. Blood pressure

Correct answer: A

Rationale: Daily weight is the most sensitive indicator of body fluid balance because it can show trends over time, helping in assessing the effectiveness of interventions and medications. While serum sodium levels provide objective data on electrolyte balance, they may not accurately reflect fluid balance, especially if a patient is dehydrated. Measured intake and output are crucial for assessing fluid balance, but it can be challenging to match the two due to various ways fluid is lost from the body. Blood pressure and other vital signs may not always be reliable indicators of fluid balance as they can be influenced by other factors beyond fluid status.

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