Nursing Elites

1. A nurse is caring for a client who has the following arterial blood values: pH 7.12, PaO2 56 mm Hg, PaCO2 65 mm Hg, and HCO3 22 mEq/L. Which clinical situation should the nurse correlate with these values?

• A. . Diabetic ketoacidosis in a person with emphysema
• B. Bronchial obstruction related to aspiration of a hot dog
• C. Anxiety-induced hyperventilation in an adolescen
• D. Diarrhea for 36 hours in an older, frail woman

Correct answer: A

Rationale:

2. A nurse is caring for a client who has the following laboratory results: potassium 3.4 mEq/L, magnesium 1.8 mEq/L, calcium 8.5 mEq/L, sodium 144 mEq/L. Which assessment should the nurse complete first?

• A. Depth of respirations
• B. Bowel sounds
• C. Grip strength
• D. Electrocardiography

Correct answer: A

Rationale: The correct answer is 'Depth of respirations.' In a client with electrolyte imbalances like low potassium (hypokalemia) and low magnesium (hypomagnesemia), respiratory changes, such as shallow respirations or respiratory muscle weakness, can occur and lead to respiratory compromise. Assessing the depth of respirations is crucial to evaluate respiratory function in this client. Bowel sounds, grip strength, and electrocardiography are also important assessments in different situations, but in this case, respiratory assessment takes priority due to the potential impact of electrolyte imbalances on breathing.

3. A 73-year-old man who slipped on a small carpet in his home and fell on his hip is alert and oriented; PERRLA (pupils equally round and reactive to light and accommodation) is intact, and he has come by ambulance to the emergency department (ED). Heart rate elevated, he is anxious and thirsty. A Foley catheter is in place and 40mL of urine is present. The nurse's most likely explanation for the urine output is:

• A. The man urinated prior to his arrival in the ED and will probably not need to have the Foley catheter kept in place.
• B. The man has a brain injury, lacks ADH, and needs vasopressin.
• C. The man is in heart failure and is releasing atrial natriuretic peptide, which results in decreased urine output.
• D. He is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output.

Correct answer: D

Rationale: Renin is released by the juxtaglomerular cells of the kidneys in response to decreased renal perfusion. Angiotensin-converting enzyme converts angiotensin I to angiotensin II. Angiotensin II, with its vasoconstrictor properties, increases arterial perfusion pressure and stimulates thirst. As the sympathetic nervous system is stimulated, aldosterone is released in response to an increased release of renin, which decreases urine production. Based on the nursing assessment and mechanism of injury, this is the most likely cause of the lower urine output. Choices A, B, and C are incorrect because there is no indication of urination prior to arrival, brain injury, lack of ADH, or heart failure present in the scenario provided. The symptoms and context described point more towards a physiological response related to the sympathetic nervous system and the renin-angiotensin-aldosterone system rather than the other conditions mentioned.

4. You are the nurse evaluating a newly admitted patients laboratory results, which include several values that are outside of reference ranges. Which of the following would cause the release of antidiuretic hormone (ADH)?

• A. Increased serum sodium
• B. Decreased serum potassium
• C. Decreased hemoglobin
• D. Increased platelets

Correct answer: A

Rationale:

5. A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. What factors contribute to this phenomenon? Select all that do not apply.

• A. Decreased kidney mass
• B. Decreased renal blood flow
• C. Decreased excretion of potassium
• D. Increased conservation of sodium

Correct answer: D

Rationale:

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