Nursing Elites

1. A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause

• A. Respiratory acidosis
• B. Respiratory alkalosis
• C. Increased PaCO2
• D. CNS disturbances

Correct answer: B

Rationale:

2. You are the surgical nurse caring for a 65-year-old female patient who is postoperative day 1 following a thyroidectomy. During your shift assessment, the patient complains of tingling in her lips and fingers. She tells you that she has an intermittent spasm in her wrist and hand, and she exhibits increased muscle tone. What electrolyte imbalance should you first suspect?

• A. Hypophosphatemia
• B. Hypocalcemia
• C. Hypermagnesemia
• D. Hyperkalemia

Correct answer: B

Rationale: The symptoms described, including tingling in the lips and fingers, intermittent spasms, and increased muscle tone, are indicative of tetany, which is a common manifestation of hypocalcemia. Hypocalcemia can lead to neuromuscular irritability, causing symptoms such as paresthesias and muscle spasms. Hypophosphatemia primarily affects the central nervous system, resulting in seizures and coma. Hypermagnesemia typically presents with hypoactive reflexes and somnolence. Hyperkalemia can cause paresthesias and anxiety, but in this case, the patient's symptoms are more suggestive of hypocalcemia.

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. You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results?

• A. Respiratory acidosis with no compensation
• B. Metabolic alkalosis with a compensatory alkalosis
• C. Metabolic acidosis with no compensation
• D. Metabolic acidosis with a compensatory respiratory alkalosis

Correct answer: D

Rationale: A low pH indicates acidosis (normal pH is 7.35 to 7.45). The PaCO2 is also low, which causes alkalosis. The bicarbonate is low, which causes acidosis. The pH bicarbonate more closely corresponds with a decrease in pH, making the metabolic component the primary problem. Therefore, the correct interpretation of the arterial blood gas results is metabolic acidosis with a compensatory respiratory alkalosis. Choices A, B, and C are incorrect because they do not accurately reflect the primary acid-base disturbance and the compensatory response seen in the given results.

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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