Nursing Elites

1. A patient has questioned the nurses administration of IV normal saline, asking whether sterile water would be a more appropriate choice than saltwater. Under what circumstances would the nurse administer electrolyte-free water intravenously?

• A. Never, because it rapidly enters red blood cells, causing them to rupture.
• B. When the patient is severely dehydrated resulting in neurologic signs and symptoms
• C. When the patient is in excess of calcium and/or magnesium ions
• D. When a patients fluid volume deficit is due to acute or chronic renal failure

Correct answer: A

Rationale:

2. You are caring for a patient who has a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Your patient's plan of care includes assessment of specific gravity every 4 hours. The results of this test will allow the nurse to assess what aspect of the patient's health?

• A. Nutritional status
• B. Potassium balance
• C. Calcium balance
• D. Fluid volume status

Correct answer: D

Rationale: Assessing the specific gravity in a patient with SIADH helps the nurse evaluate the patient's fluid volume status. Specific gravity indicates the concentration of solutes in the urine and can detect if the patient has a fluid volume deficit or excess. Nutritional status, potassium balance, and calcium balance are not directly assessed through specific gravity testing. Nutritional status is typically evaluated through dietary intake and anthropometric measurements. Potassium balance is assessed through blood tests and ECG monitoring. Calcium balance is evaluated through blood tests and bone density scans. Therefore, the correct answer is assessing fluid volume status through specific gravity testing.

3. A nurse is assessing clients who have intravenous therapy prescribed. Which assessment finding for a client with a peripherally inserted central catheter (PICC) requires immediate attention?

• A. The initial site dressing is 3 days old.
• B. The PICC was inserted 4 weeks ago.
• C. A securement device is absent.
• D. Upper extremity swelling is noted.

Correct answer: D

Rationale:

4. Which of the following are sources of water intake?

• A. Drinking fluids.
• B. Consuming water from the food we eat.
• C. Water from metabolic processes.
• D. Drinking fluids, consuming water from the food we eat, and water from metabolic processes.

Correct answer: D

Rationale: The correct answer is D. The sources of water intake include drinking fluids, consuming water from the food we eat, and water from metabolic processes. Water intake is not solely from the liquids we drink but also from the water content present in the food we consume and the water produced during metabolic processes such as cellular respiration. Therefore, option D is the correct answer as it covers all the sources of water intake. Options A, B, and C alone do not encompass all the sources of water intake, making them incorrect choices.

5. Retention of electrolytes (especially sodium) in the interstitial fluid can result from:

• A. decreased aldosterone secretion.
• B. increased ADH secretion.
• C. increased aldosterone secretion.
• D. decreased ADH secretion.

Correct answer: C

Rationale: The correct answer is C: increased aldosterone secretion. Aldosterone, a hormone produced by the adrenal glands, increases sodium reabsorption in the kidneys, leading to retention of sodium and water in the interstitial fluid. Increased aldosterone secretion enhances the reabsorption of sodium, thereby increasing its retention. Choice A is incorrect because decreased aldosterone secretion would lead to less sodium reabsorption and increased excretion. Choice B is incorrect because increased ADH secretion primarily affects water reabsorption rather than sodium. Choice D is incorrect because decreased ADH secretion would lead to increased water excretion but not necessarily affect sodium retention.

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