Nursing Elites

1. A client is vomiting. For which acid-base imbalance does the nurse assess the client?

• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Respiratory acidosis
• D. Respiratory alkalosis

Correct answer: B

Rationale: In a client who is vomiting, the loss of gastric fluid containing hydrochloric acid can lead to metabolic alkalosis. Metabolic alkalosis is caused by the loss of acids such as hydrochloric acid from the body. Therefore, in this scenario, the nurse should assess the client for metabolic alkalosis. Choices A, C, and D are incorrect because vomiting does not typically lead to metabolic acidosis, respiratory acidosis, or respiratory alkalosis.

2. In a patient with diabetes mellitus, which of the following is a sign of hypoglycemia?

• A. Polydipsia.
• B. Polyuria.
• C. Sweating.
• D. Dry skin.

Correct answer: C

Rationale: Sweating is a common sign of hypoglycemia in diabetic patients. When blood sugar levels drop too low, the body releases stress hormones like adrenaline, which can cause sweating as a response to the perceived danger. Polydipsia (excessive thirst) and polyuria (excessive urination) are actually more commonly associated with hyperglycemia, not hypoglycemia. Dry skin is not typically a sign of hypoglycemia.

3. The provider has ordered Kayexalate and sorbitol to be administered to a patient. The nurse caring for this patient would expect which serum electrolyte values prior to administration of this therapy?

• A. Sodium 125 mEq/L and potassium 2.5 mEq/L
• B. Sodium 150 mEq/L and potassium 3.6 mEq/L
• C. Sodium 135 mEq/L and potassium 6.9 mEq/L
• D. Sodium 148 mEq/L and potassium 5.5 mEq/L

Correct answer: C

Rationale: Severe hyperkalemia, with a potassium level of 6.9 mEq/L, requires aggressive treatment with Kayexalate and sorbitol to increase the body’s excretion of potassium. The normal range for serum potassium is 3.5 to 5.5 mEq/L, so patients with the other potassium levels would not be treated aggressively or would need potassium supplementation. Therefore, option C (Sodium 135 mEq/L and potassium 6.9 mEq/L) is the correct choice as it indicates severe hyperkalemia warranting the administration of Kayexalate and sorbitol. Options A, B, and D have either potassium levels within normal limits, which would not necessitate this aggressive treatment, or potassium levels that are lower than what would typically prompt the need for Kayexalate and sorbitol.

4. A client with histoplasmosis has the following arterial blood gas (ABG) results: pH 7.30, PCO2 58 mm Hg, PO2 75 mm Hg, HCO3 27 mEq/L. Which of the following acid-base disturbances does the nurse recognize in these results?

• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Respiratory acidosis
• D. Respiratory alkalosis

Correct answer: A

Rationale: The client's ABG results show a low pH (acidosis) and an elevated PCO2, indicating respiratory acidosis. In respiratory acidosis, there is inadequate excretion of CO2, leading to increased PCO2 levels and a decrease in pH. Therefore, the correct answer is 'Metabolic acidosis'. Choices B, C, and D are incorrect. Metabolic alkalosis is characterized by elevated pH and bicarbonate levels. Respiratory acidosis involves low pH and high PCO2 levels, as seen in this case. Respiratory alkalosis is associated with high pH and low PCO2 levels.

5. A client's urinalysis results show a urine osmolality of 1200 mOsm/L. What action should the nurse take?

• A. Encourage the client to drink more fluids.
• B. Contact the provider and recommend a low-sodium diet.
• C. Prepare to administer an intravenous diuretic.
• D. Obtain a suction device and implement seizure precautions.

Correct answer: A

Rationale: The correct action for the nurse to take when the client has a urine osmolality of 1200 mOsm/L, indicating dehydration, is to encourage the client to drink more fluids. Dehydration can lead to elevated urine osmolality, and increasing fluid intake can help rehydrate the client. A low-sodium diet is not the priority in this scenario as it would not directly address the dehydration indicated by the high urine osmolality. Administering an intravenous diuretic would further concentrate the urine, exacerbating the dehydration. Obtaining a suction device and implementing seizure precautions are not indicated based on the client's urine osmolality results and would not address the underlying issue of dehydration.

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