Nursing Elites

1. A nurse is caring for a patient who requires measurement of specific gravity every 4 hours. What does this test detect?

• A. Nutritional deficit
• B. Hyperkalemia
• C. Hypercalcemia
• D. Fluid volume status

Correct answer: D

Rationale: Specific gravity is a test used to determine the concentration of solutes in the urine, reflecting the kidney's ability to concentrate urine. Changes in specific gravity can indicate fluid volume status, such as dehydration (fluid volume deficit) or overhydration (fluid volume excess). Options A, B, and C are incorrect as specific gravity does not directly detect nutritional deficits, hyperkalemia, or hypercalcemia.

2. Which negative ion is most important in intracellular fluid?

• A. Phosphate ions.
• B. Protein molecules.
• C. Chlorine.
• D. Phosphate ions and protein molecules.

Correct answer: D

Rationale: Intracellular fluid contains phosphate ions and protein molecules as essential anions. Phosphate ions play a crucial role in various cellular processes, including energy transfer. Proteins, being large molecules with negative charges, also contribute significantly to the negative ion concentration within cells. Chlorine is primarily an extracellular anion and is not as prominent as phosphate ions and proteins within intracellular fluid, making it a less important negative ion in this context. Therefore, the correct answer is D because both phosphate ions and protein molecules are crucial negative ions in intracellular fluid.

3. The ICU nurse is caring for a patient who experienced trauma in a workplace accident. The patient is complaining of having trouble breathing with abdominal pain. An ABG reveals the following results: pH 7.28, PaCO2 50 mm Hg, HCO3 23 mEq/L. The nurse should recognize the likelihood of what acidbase disorder?

• A. Respiratory acidosis
• B. Metabolic alkalosis
• C. Respiratory alkalosis
• D. Mixed acidbase disorder

Correct answer: D

Rationale:

4. A nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure. The clients arterial blood gas values are pH 6.88, PaO2 50 mm Hg, PaCO2 60 mm Hg, and HCO3 22 mEq/L. Which action should the nurse take first?

• A. . Apply oxygen by mask or nasal cannula
• B. Apply a paper bag over the clients nose and mouth.
• C. Administer 50 mL of sodium bicarbonate intravenously.
• D. Administer 50 mL of 20% glucose and 20 units of regular insulin.

Correct answer: A

Rationale:

5. Which organ has the greatest effect on fluid output?

• A. Kidneys
• B. Lungs
• C. Skin
• D. Intestines

Correct answer: A

Rationale: The correct answer is the kidneys. The kidneys are primarily responsible for regulating fluid balance by filtering blood and adjusting the volume and concentration of urine. The lungs primarily regulate gas exchange, not fluid balance. The skin plays a role in temperature regulation and protection but is not the primary organ for fluid output. The intestines are mainly involved in the absorption of nutrients and water, rather than fluid output.

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