A patient's laboratory values indicate hemoconcentration secondary to fluid loss. Which of the following intravenous solutions should the nurse anticipate will be ordered as the most appropriate during initial fluid replacement therapy?
10% dextrose and saline.
5% dextrose and water with 60 mEq KC1.
5% dextrose and water only.
Distilled water.
Initial fluid therapy is directed toward increasing fluid volume and urine output. Answer 1, being a hypertonic solution that would act to increase intracellular dehydration, is therefore contraindicated. Once adequate urinary output has been established, potassium salts are added (Answer 2) to relieve hypokalemia. The amount of added potassium chloride depends on the extent of hypokalemia. Answer 4, distilled water, is a hypotonic solution; that is, it does not contain any additional electrolytes. Hypotonic solutions, such as 0.45% sodium chloride, are frequently given to relieve hypertonic syndromes. However, distilled water is never given in fluid replacement therapy.
The key word is initial. Use H20 to replace fluid loss. Focus on two similar options that have 5% D/W (2, 3). Eliminate the option with KCl (1) because it is added later.
Before surgery, a patient was instructed in the use of an incentive spirometer. The primary purpose of this activity is:
To encourage coughing.
To arouse and stimulate the patient.
To encourage deep breathing.
To measure tidal volume and expiratory reserve volume.
The purpose of the incentive spirometer is to encourage deep breathing. The patient is able to directly visualize progress by the number and height of balls he or she is able to raise. After effects of this activity may indeed be coughing up sputum (Answer 1) and arousal (Answer 2) as the patient competes with himself or herself. Incentive spirometry can be used as a rough measure of tidal volume and expiratory reserve volume (Answer 4) because the patient breathes in deeply and exhales completely into the incentive spirometer
Key word is primary (or first) purpose. Patients are first taught to deep breathe.
The nurse explains to a patient's family that humidification is given with oxygen administration because:
Oxygen is highly permeable in water, thereby increasing gaseous diffusion.
Oxygen is very drying to the mucous membranes.
The partial pressures of oxygen are increased by water dilution, allowing more oxygen to reach the alveoli.
Water acts as a carrier substance facilitating movement of oxygen across the respiratory membrane.
Humidification of oxygen is extremely important in reducing its drying effects on the mucous membranes of the bronchial tree. Humidification of oxygen is generally provided by a water nebulizer. Answers 1, 3, and 4 are incorrect because oxygen is not highly permeable in water; thus, water tends to inhibit rather than facilitate oxygen diffusion across the respiratory membrane. Humidification expands the volume of the inhaled gas, but by doing so it decreases the partial pressure of the gas in the alveoli. Normal alveolar partial pressures of oxygen are approximately 100 mm Hg, whereas the partial pressures of oxygen in the atmosphere are approximately 135 mm Hg
The question is asking why 02 is given with humidification. Look for a simple answer. Humidification provides moisture because 02 is drying.
To correctly administer 1000 mL of 5% dextrose/water in 10 hours using a standard 15-drop administration set, the nurse would adjust the infusion rate to:
32 drops per minute.
25 drops per minute.
20 drops per minute.
15 drops per minute.
Maintenance of infusion rates as ordered is extremely important. In this example, the nurse can use the following equation:<br><u>gtts/mL of given set</u> <br />
60 mins/hr X Total volume/hr =gtts/min <br>
Thus,
<br>
<u>15</u> X 100 = <u>1</u>
X 100 = 25 ggts/min<br>
60 4
Divide 1000 mL by 10 to determine how many mL per hour; then use this formula to calculate drops per minute.
The nurse would conclude that a patient's fasting serum-glucose levels are normal if the results are:
30-60 mg/dL of blood.
80-126 mg/dL of blood.
126-140 md/dL of blood.
140-200 mg/dL of blood.
Normal fasting serumglucose levels are 80126 mg/dL of blood. Levels below 60 (Answer 1) indicate hypoglycemia; levels above 126 mg/dL (Answers 3, 4) indicate hyperglycemia.
Key term is normal. First eliminate the extreme numbers (too low and too high). "Normal" tends to be a low midpoint value.
A laboratory test to measure serum- and urine-glucose levels before and after ingestion of a glucose load has been ordered. The nurse knows that the test to be done is called:
Fasting blood sugar.
Glucose tolerance test.
Postprandial blood glucose.
Tolbutamide response test.
Procedurally, the patient to receive the glucose tolerance test consumes a high-carbohydrate diet for 3 days before the test. All drugs that may influence the test are discontinued during this period (oral contraceptives, aspirin, and steroids). On the day of the test, fasting blood (Answer 1) and urine specimens are collected before the test, to provide control glucose levels. After ingestion of a glucose load, specimens of blood and urine are collected at hourly intervals for 3 hours. In diabetes mellitus, glucose levels are elevated. The postprandial blood glucose (Answer 3) is determined by giving the patient an oral glucose load only. Blood-glucose levels are then evaluated in 2 hours. Usually glucose levels will return to normal during this period of time. The tolbutamide response test (Answer 4) may also be used to confirm diabetes. After the patient fasts overnight, a baseline fasting blood sample is drawn. Intravenous tolbutamide is then given, and blood samples are drawn in 20-30 minutes. After this test the patient should be given orange juice and instructed to eat breakfast.
Key phrase is before and after; FBS (1) is done only before. Postprandial means after a meal. Glucose tolerance (2) has both a "before" and an "after" component.
After a glucose tolerance test, the nurse would look for the blood-glucose levels to return to normal in about how many hours?
One.
Two.
Three.
Four.
Within 3 hours the patient's serum-glucose levels should not only have returned to normal, but some hypoglycemia should be expected. Answers 1, 2, and 4 are incorrect
Eliminate the extremes (1, 4). Recall that the procedure calls for 3 days of high carbohydrate; you will make a good guess by selecting 3 hours.
Following a gastroscopy, the nurse will plan to offer the patient food or fluid:
As soon as he or she returns to the room.
One hour later, or after he or she is fully alert.
Three to 4 hours later, or when the gag reflex returns.
Six to 8 hours later to prevent the electrolyte imbalance that may occur with this procedure.
Following gastroscopy, food and fluids are withheld until the gag reflex returns (generally 2-3 hours) in order to prevent aspiration. The gag reflex is inactivated by either an anesthetic spray or an oral preparation gargled by the patient before insertion of the gastroscopy tube. Inhibition of the gag reflex facilitates insertion. Answers 1 and 2 are incorrect because the period of time is too brief. Answer 4 is incorrect not only because it is generally unnecessary to wait 6-8 hours for the gag reflex to return, but because this procedure does not precipitate an electrolyte imbalance.
Note that timeframe is key here. Eliminate the extremes (1, 2 are too soon; 4 is too long, as well as an incorrect reason).
The nurse knows that a 24-hour urine-for-creatinine clearance measures which of the following kidney functions?
Filtration fraction.
Glomerular filtration rate.
Renal blood flow.
Quantity and specific gravity of urinary output.
Decreased amounts of creatinine in the urine are a reflection of the glomerular filtration rate, indicating the ability of the kidney to clear the renal blood of this substance. The filtration fraction is simply the amount of glomerular filtrate entering the tubules (Answer 1). Renal blood flow is estimated by measuring renal excretion of para-aminohippuric acid (PAH) (Answer 3). Though the amount and specific gravity of urine may be determined, it is not the primary function of this laboratory test (Answer 4).
Key words in the stem: measure kidney functions, meaning measure kidney's ability to "do its job," i.e., to clear (filter). Choose 2 over 1 (both options have "filtration") because 1 is the amount entering.
A patient asks why an intravenous pyelogram (IVP) is being done. The nurse tells the patient the purpose is to:
Determine the size, shape, and placement of the kidneys.
Test renal tubular function and the patency of the urinary tract.
Measure renal blood flow.
Outline the kidney vasculature.
Intravenous pyelogram tests both the function and patency of the kidneys. After the intravenous injection of a radiopaque contrast medium, the size, location, and patency of the kidneys can be observed by roentgenogram, as well as the patency of the urethra and bladder as the kidneys function to excrete the contrast medium. Answer 1 is an example of a KUB. or flat plate of the abdomen, which can reveal gross structural changes in the kidneys and urethra. Renal blood flow (Answer 3) is determined by the injection of para-aminohippuric acid (PAH) and measurement of its excretion in the urine. Answer 4 is an example of renal angiogram
Match other common renal system tests (KUB, PAH, renal angiogram) with the descriptions, to identify one that does not fit. Choose the option that describes a test that gives more than anatomical information (eliminate 1, 4). Answer 2 provides more data (tubular function and patency of urinary tract) than Answer 3 (blood flow).
The nursing care of a patient before an IVP includes:
Telling the patient that the contrast medium may produce a warm, flushed feeling in the face and a salty taste in the mouth.
Administering radiopaque capsules 6 hours before the test.
Ascertaining whether or not the patient has any allergies to mercury.
Pushing fluids until 2 hours before the test, to prevent dehydration.
Patent teaching includes telling the patient that a warm, flushed sensation and salty taste may occur from the contrast medium. The contrast medium is given by IV injection during the procedure, not in capsule form (Answer 2). Answer 3 is incorrect because allergies to iodine, not to mercury, are the concern. Fluids are not pushed before this procedure; they are withheld for up to 8 hours before testing, to produce a slight dehydration that aids in concentrating the contrast medium in the kidneys and urinary system (Answer 4).
Eliminate Answer 2 because the test is done intravenously (intravenous pyelogram), not with capsules. Eliminate Answer 3 because the potential allergy is to iodine. Eliminate Answer 4 because the opposite is needed for the test.
The nurse's preparation of the patient undergoing IV cholangiogram includes:
Administering radiopaque tablets the evening before the examination.
A fatty meal the evening before the examination.
Forcing fluids for 6-8 hours before the examination.
Informing the patient that he or she may experience a feeling of warmth, flushing of face, and/or a salty taste when the contrast medium is injected.
The patient is informed of possible reaction to injection of the contrast medium, which is administered by an IV injection at the time of the test, not by tablets the evening before (Answer 1). Answer 2 is incorrect because if patients are given anything by mouth they are given a low-fat meal the evening before IV cholangiogram or oral cholecystogram. The patient is usually quite ill at this time and may not be able to tolerate oral intake. In order to have a clear visualization of the gallbladder, the bowel is cleansed, and food and fluids are withheld, not forced (Answer 3), for 6-8 hours.
Note the name of the procedure: IV cholangiogram, meaning that the contrast medium will be injected. Eliminate the three other options that refer to oral intake.
The nurse knows that the most important effect of intermittent positive-pressure breathing (IPPB) is:
Mobilization of bronchial secretions.
Increased alveolar ventilation.
Prevention of atelectasis.
Decreased airway resistance.
The most important effect of intermittent positive-pressure breathing (IPPB) is increased alveolar ventilation. It also helps mobilize secretions (Answer 1), decrease the occurrence of atelectasis (Answer 3), and decrease airway resistance (Answer 4) through mechanical bronchodilation.
When all options are correct, choose the one (alveolar ventilation) that encompasses the three other effects.