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A nurse is caring for a postoperative patient following a total knee replacement. Which of the following medications should the nurse anticipate the provider to prescribe to prevent the formulation of a deep vein thrombosis (DVT)?
- Alteplase
- Clopidogrel
- Warfarin
- Enoxaparin
Explanation
Correct Answer: D) Enoxaparin
Enoxaparin (Lovenox), a low molecular weight heparin (LMWH), is the preferred anticoagulant for DVT prophylaxis following total knee replacement. It has a predictable dose response, does not require routine monitoring, and has a well-established safety profile in the postoperative orthopedic setting. Alteplase is a thrombolytic used to dissolve existing clots, not for prevention. Clopidogrel is an antiplatelet agent used primarily in cardiovascular conditions, not DVT prophylaxis. Warfarin, while sometimes used for DVT prevention, has a delayed onset, narrow therapeutic window, and requires frequent INR monitoring, making it less preferred over enoxaparin in the immediate postoperative period.
Due to the patient's worsening acute kidney injury (AKI), the nurse expects the provider to prescribe a . The nurse prepares for b .
- sodium polystyrene / arteriovenous fistula placement
- hemodialysis / continuous renal replacement therapy
- NPO status / peritoneal catheter placement
- lactated Ringer's bolus / arteriovenous graft placement
Explanation
Correct Answer: B) hemodialysis / continuous renal replacement therapy
Given the patient's severely elevated potassium (7.2 mEq/L), rising creatinine, elevated BUN, declining urine output, and worsening fluid overload, the provider would prescribe hemodialysis to urgently remove potassium and waste products the kidneys can no longer excrete. The nurse then prepares for continuous renal replacement therapy (CRRT), which is used in critically ill, hemodynamically unstable patients as a slower, gentler form of dialysis to manage fluid and solute balance continuously over time.
Sodium polystyrene can help reduce potassium but is not sufficient for a critically ill AKI patient. NPO status and lactated Ringer's bolus do not address the underlying renal failure or hyperkalemia. Fistula and graft placements are long-term access options for chronic dialysis patients, not immediate interventions for acute decompensation.
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Administer subcutaneous insulin
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Give oral potassium supplements
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Begin sodium bicarbonate therapy
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Start an IV infusion of insulin
Explanation
Correct answer: D. Start an IV infusion of insulin
Diabetic ketoacidosis occurs because of severe insulin deficiency, leading to hyperglycemia, ketosis, and metabolic acidosis. The priority treatment is continuous IV insulin infusion, which stops ketone production and lowers blood glucose levels.
Potassium levels should be monitored closely, but with a potassium level of 4.5 mEq/L, immediate potassium replacement is not the priority. Sodium bicarbonate is usually reserved for severe acidosis (pH < 6.9).
A patient with extensive electrical burn injuries is admitted to the emergency department. Which of these prescribed interventions would the nurse implement first?
- Apply dressings to burned areas
- Assess for pain at contact points
- Place on a cardiac monitor
- Start two large bore IVs
Explanation
Correct Answer: C) Place on a cardiac monitor.
As established in electrical burn management, cardiac dysrhythmias are the most immediately life-threatening complication of electrical injuries, as current travels through the body and disrupts the heart's conduction system. Cardiac monitoring is the first priority to detect and respond to potentially fatal arrhythmias such as ventricular fibrillation. Starting large bore IVs for fluid resuscitation is the next urgent step, followed by wound assessment and pain management. Addressing the cardiac risk takes precedence over all other interventions.
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Untreated hypothyroidism
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Uncontrolled diabetes
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End-stage Graves’ disease
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Overdose of propylthiouracil
Explanation
Correct answer: A. Untreated hypothyroidism
Myxedema coma is a life-threatening complication of severe, untreated hypothyroidism. It occurs when thyroid hormone levels become extremely low, leading to decreased metabolic activity, hypothermia, bradycardia, edema, lethargy, and altered mental status. The condition represents the most severe form of hypothyroidism and requires immediate treatment with IV thyroid hormone and supportive care.
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Diabetes insipidus
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Addison's disease
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Pheochromocytoma
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Hyperthyroidism
Explanation
Correct Answer Is:
B. Addison's disease
The ACTH stimulation test evaluates how well the adrenal cortex responds to adrenocorticotropic hormone (ACTH). During the test, synthetic ACTH is administered and cortisol levels are measured before and after administration.
In a healthy adrenal gland, ACTH stimulation causes cortisol levels to rise. If cortisol levels fail to increase appropriately, it indicates adrenal insufficiency, most commonly Addison's disease.
Addison's disease occurs when the adrenal glands cannot produce adequate cortisol, often due to autoimmune destruction of the adrenal cortex. Therefore, the ACTH stimulation test is commonly used to diagnose adrenal insufficiency and differentiate primary adrenal failure from secondary causes.
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Constant chest pain that is unrelieved by changes in position.
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Severe sharp chest pain that worsens with deep inspiration.
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Sudden absence of breath sounds in the affected lung.
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Progressive, symmetrical chest wall expansion impairment.
Explanation
Correct answer: B. Severe sharp chest pain that worsens with deep inspiration
Pleurisy is inflammation of the pleural membranes, the layers of tissue that surround the lungs and line the chest cavity. When these inflamed pleural surfaces rub against each other during breathing, they cause sharp, stabbing chest pain. The pain typically worsens with deep inspiration, coughing, or movement because these actions increase friction between the inflamed pleural layers.
The pain may improve when the patient splints the chest or breathes shallowly to reduce pleural movement. This characteristic pleuritic pain is a hallmark sign of pleurisy.
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Administer pain medications.
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Instruct patients about holding their breath or bearing down during removal.
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Gather petroleum gauze, dry sterile gauze and tape.
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Obtain consent from the patient.
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Order a chest X-ray prior to the procedure.
Explanation
Correct answers: A. Administer pain medications, B. Instruct patients about holding their breath or bearing down during removal, C. Gather petroleum gauze, dry sterile gauze and tape
Before chest tube removal, the nurse should administer pain medication because removal can be uncomfortable. The nurse should also teach the patient to hold their breath or perform the Valsalva maneuver (bear down) during removal. This action increases intrathoracic pressure and prevents air from entering the pleural space, reducing the risk of pneumothorax.
The nurse should also prepare the necessary sterile supplies, including petroleum (occlusive) gauze, dry sterile gauze, and tape to immediately seal the site after the tube is removed.
Obtaining consent is the physician’s responsibility, and a chest X-ray is usually ordered after removal to check for pneumothorax, not before the procedure.
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D5W IV rapidly, prednisone PO
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NS IV rapidly, hydrocortisone IV
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D51/2NS IV rapidly, potassium chloride IV
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LR IV rapidly, phentolamine IV
Explanation
Correct answer: B. NS IV rapidly, hydrocortisone IV
Primary adrenal insufficiency (Addison disease) can lead to an Addisonian crisis, a life-threatening emergency characterized by severe hypotension, shock, dehydration, hyponatremia, and hyperkalemia. Emergency treatment focuses on rapid fluid resuscitation and immediate corticosteroid replacement.
Administration of normal saline (NS) rapidly helps restore circulating blood volume and correct hypotension. Intravenous hydrocortisone replaces the deficient cortisol and supports the body’s stress response. Hydrocortisone also has some mineralocorticoid activity, which helps correct electrolyte imbalances and improve blood pressure. Immediate treatment is essential to prevent cardiovascular collapse and death.
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300 mL of bright red blood in the collection chamber over 1 hour
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Subcutaneous emphysema at the insertion site
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Intermittent bubbling in the water-seal chamber
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Lack of tidaling in the water-seal chamber
Explanation
Correct answer: A. 300 mL of bright red blood in the collection chamber over 1 hour
After thoracic surgery such as a lobectomy, chest tubes are used to drain blood and air from the pleural space. While some drainage is expected initially, large amounts of bright red blood indicate possible hemorrhage. Drainage exceeding 100–200 mL per hour, especially if it is bright red and continuous, suggests active bleeding and requires immediate notification of the health care provider.
The other findings are less urgent:
Subcutaneous emphysema may occur from air leakage and should be monitored but is not always emergent.
Intermittent bubbling in the water-seal chamber can be normal, especially with coughing or expiration.
Tidaling may decrease or stop as the lung re-expands or if suction is applied.
Therefore, rapid bright-red drainage is the most concerning finding and requires immediate intervention.
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