Nursing Elites

1. You are the nurse caring for a 77-year-old male patient who has been involved in a motor vehicle accident. You and your colleague note that the patients labs indicate minimally elevated serum creatinine levels, which your colleague dismisses. What can this increase in creatinine indicate in older adults?

• A. Substantially reduced renal function
• B. Acute kidney injury
• C. Decreased cardiac output
• D. ) Alterations in ratio of body fluids to muscle mass

Correct answer: A

Rationale:

2. The nurse is admitting a patient with a suspected fluid imbalance. The most sensitive indicator of body fluid balance is:

• A. Daily weight
• B. Serum sodium levels
• C. Measured intake and output
• D. Blood pressure

Correct answer: A

Rationale: Daily weight is the most sensitive indicator of body fluid balance because it can show trends over time, helping in assessing the effectiveness of interventions and medications. While serum sodium levels provide objective data on electrolyte balance, they may not accurately reflect fluid balance, especially if a patient is dehydrated. Measured intake and output are crucial for assessing fluid balance, but it can be challenging to match the two due to various ways fluid is lost from the body. Blood pressure and other vital signs may not always be reliable indicators of fluid balance as they can be influenced by other factors beyond fluid status.

3. Which positive ion is most prevalent in intracellular fluid?

• A. Calcium
• B. Potassium
• C. Sodium
• D. Magnesium

Correct answer: B

Rationale: The correct answer is Potassium (K+). Potassium is the predominant cation found within cells, making it the most prevalent positive ion in intracellular fluid. Calcium, sodium, and magnesium are also essential ions in the body, but they are not as abundant in intracellular fluid. Calcium is vital for bone health and muscle function, sodium helps in maintaining fluid balance and nerve function, and magnesium is involved in numerous biochemical reactions.

4. A nurse assesses a client who is experiencing an acid-base imbalance. The clients arterial blood gas values are pH 7.34, PaO2 88 mm Hg, PaCO2 38 mm Hg, and HCO3 19 mEq/L. Which assessment should the nurse perform first?

• A. . Cardiac rate and rhythm
• B. Skin and mucous membranes
• C. Musculoskeletal strength
• D. Level of orientation

Correct answer: A

Rationale:

5. A nurse admitting a patient with a history of emphysema reviews her past lab reports and notes that the patient's PaCO2 has been 56 to 64 mmHg. The nurse will be cautious administering oxygen because:

• A. The patient's calcium will rise dramatically due to pituitary stimulation.
• B. The oxygen will increase the patient's intracranial pressure and create confusion.
• C. The oxygen may cause the patient to hyperventilate and become acidotic.
• D. Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.

Correct answer: D

Rationale: When PaCO2 chronically exceeds 50 mm Hg, it creates insensitivity to CO2 in the respiratory medulla, and the use of oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia. Choice A is incorrect because administering oxygen does not lead to a dramatic rise in calcium due to pituitary stimulation. Choice B is incorrect because administering oxygen does not directly increase intracranial pressure or create confusion. Choice C is incorrect because administering oxygen to a patient with emphysema and high PaCO2 levels is more likely to cause respiratory depression than hyperventilation and acidosis.

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