Med Surg Adaptive Quizzing and Rationale

Med Surg Adaptive Quizzing and Rationale The nurse is planning care for a patient with a new diagnosis of hypercalcemia resulting from treatment for hypocalcemia. Which change to the plan of care should the nurse anticipate? - weight bearing exercises A patient with hypercalcemia as a result of treatment for hypocalcemia would require the addition of weight -bearing exercises to the plan of care. These exercises will facilitate the movement of extra calcium ions in the blood to the bone. Teaching the patient to breathe into a bag, administering ca lcium gluconate, and administering a thiazide diuretic are all appropriate for hypocalcemia; therefore these actions should be removed from the plan of care, not added The nurse is caring for a group of patients. Which patient is at greatest risk for incr eased extracellular fluid accumulation? 1.A patient with drainage from a rectal fistula 2.A patient with osmotic diuresis 3.A patient with renal impairment 4.A patient with an intestinal obstruction 3 Extracellular fluid accounts for one -third of total bo dy fluids, which consist of interstitial fluid, plasma, and transcellular fluid. The extracellular fluid may become excessive when the elimination of water is impaired, especially during kidney failure. Conditions such as fistula drainage, osmotic diuresis , and intestinal obstruction result in a loss of body fluid. A patient asks why the primary health care provider prescribed a b -type natriuretic peptide (BNP). Which response by the nurse is accurate? 1.It is a diagnostic procedure to rule out urine reten tion. 2.It is a blood test that is elevated in patients with hyponatremia. 3.It is a blood test that shows if there is excess fluid in the heart. 4.It is an x -ray that helps determine the presence of stomach ulcers. 3 BNP is a hormone that is produced when the atrial pressure increases. This blood test is used to diagnose the severity and treatment outcomes of congestive heart failure (CHF). The atrial pressure increases because of increased venous return and hypernatre mia. The test gives no information to rule out urine retention or the presence of stomach ulcers. A serum sodium level is needed to determine hyponatremia. The nurse reviews the arterial blood gases for a patient that has taken an overdose of barbiturates . The results are: pH 7.32; PaCO 2 52; HCO 3 - 24. What does the nurse interpret these results to mean? respiratory acidosis Normal pH is 7.35 to 7.45. Values less than 7.35 indicate acidosis. Normal value for PaCO 2 is 35 to 45 mm Hg. Because the HCO 3 - is normal and the PaCO 2 is elevated, the source of the acidosis is respiratory. The patient is in respiratory acidosis. The nursing instructor is discussing peripherally implanted catheters (PICC) with a nursing student. Which nursing student statement wo uld indicate a need for further teaching? Blood pressure should not be taken on an arm with a PICC line because inflation of the cuff can lead to the risk of vein damage or thrombosis. Nurses do need to check for phlebitis for up to 10 days after the PICC is inserted. PICC lines are typically used for access for up to six months, and they can be left longer. PICC lines have fewer side effects than central venous catheters. The nurse is caring for a patient with acute kidney failure due to severe dehydratio n. When evaluation of the arterial blood gases is done, what condition does the nurse likely interpret the findings to indicate? metabolic acidosis Renal failure will make the blood more acidic because of the inability of the kidneys to excrete acid. Ther efore the nurse suspects that the patient would develop metabolic acidosis. Metabolic alkalosis is caused by excess bicarbonate intake and a potassium deficit. Respiratory acidosis is caused by hypoventilation. Respiratory alkalosis is caused by hyperventi lation. A patient has been admitted for dehydration. What is a priority nursing intervention? a) Perform daily weights. b) Reorient the patient hourly. c) Restrict sodium intake to 2 grams per day. d) Provide continuous oxygen saturation monitoring A Measuring weight is the most reliable means of detecting changes in fluid balance. Weight loss would indicate that the dehydration is worsening, whereas weight gain would indicate restoration of fluid volume. The nurse would recall that a 1 -kg weight gain indicates a gain of approximately 1000 mL of body water. This patient is not disoriented, and that is not a common assessment finding in the patient with dehydration. Continuous oxygen saturation monitoring is not indicated. Sodium intake does not need to be restricted. When assessing a patient admitted with nausea and vomiting, which finding supports a determination of deficient fluid volume? General restlessness Restlessness is an early cerebral sign that dehydration has progressed to the point where an intracellular fluid shift is occurring. If the dehydration is left untreated, cerebral signs could progress to confusion and later coma. Polyuria, decreased pulse, and difficulty breathing do not support a determination of deficient fluid volume. A patient with cancer is found to have a serum phosphate level of 5.4 mg/dL. What does the nurse determine is the probable reason for the increase in phosphate levels in t his patient? Chemotherapy Insulin therapy