nursing 335 baton rouge college
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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.
A burn patient is placed on enteral feeding. Which diet is most appropriate for promoting wound healing?
- Low protein, low carb
- High protein, high calorie
- High carb, low protein
- Low sodium, low protein
Explanation
Correct Answer: B) High protein, high calorie.
Burn injuries cause a hypermetabolic state with dramatically increased caloric and protein demands. Protein is essential for tissue repair, immune function, and wound healing, while high caloric intake is necessary to meet the energy demands of the hypermetabolic response and prevent catabolism of muscle mass. Burn patients may require 2–3 times their normal caloric needs. Low protein diets would delay wound healing and increase infection risk. High carb without adequate protein does not support tissue repair. Low sodium restrictions are not the priority in acute burn nutritional management.
A patient is diagnosed with a brain abscess and is being prepared for treatment. The nurse is reviewing the patient's medical history. Which of the following factors is most likely to contribute to the development of a brain abscess in this patient?
- History of chronic hypertension.
- History of migraines.
- Recent tick removal.
- Recent head trauma with a skull fracture.
Explanation
Correct Answer: D) Recent head trauma with a skull fracture.
A skull fracture creates a direct pathway for bacteria to enter the brain, making it the most likely contributing factor to brain abscess formation. Brain abscesses typically arise from contiguous spread of infection, hematogenous spread, or direct inoculation — skull fractures represent direct inoculation. Chronic hypertension and migraines are not associated with brain abscess development. While tick bites can transmit certain infections, a recent tick removal without confirmed disease is not as directly causative as a skull fracture.
A patient who is suspected of having an epidural hematoma is admitted to the emergency department. Which action will the nurse plan to take?
- Initiate high-dose barbiturate therapy.
- Prepare patient for immediate craniotomy.
- Type and cross-match for blood transfusion.
- Administer IV furosemide.
Explanation
Correct Answer: B) Prepare patient for immediate craniotomy.
An epidural hematoma is a neurosurgical emergency. It typically results from arterial bleeding (often from the middle meningeal artery) causing rapid accumulation of blood between the skull and dura mater. The classic presentation is a lucid interval followed by rapid neurological deterioration. Immediate surgical evacuation via craniotomy is required to relieve pressure and prevent brain herniation and death. High-dose barbiturates are used for refractory intracranial hypertension, not as a primary intervention. Blood transfusion and furosemide do not address the underlying hematoma.
During the emergent phase of burn care, which nursing action will be most useful in determining if a patient is receiving adequate fluid resuscitation?
- Measure hourly urine output.
- Monitor daily weight.
- Check skin turgor.
- Assess mucous membranes.
Explanation
Correct Answer: A) Measure hourly urine output.
Hourly urine output is the most reliable and sensitive indicator of adequate fluid resuscitation in burn patients during the emergent phase. The goal is to maintain urine output of 0.5–1 mL/kg/hour in adults, which reflects adequate renal perfusion and overall tissue perfusion. Daily weight, skin turgor, and mucous membrane assessment provide useful but less precise and less immediate information about fluid status compared to hourly urine monitoring.
A patient has returned to the medical surgical unit after receiving peritoneal dialysis. Which of the following nursing interventions should the nurse implement to prevent peritonitis?
- Instruct the patient to keep the catheter clean.
- Position patient supine.
- Encourage patient to increase fluid intake.
- Measure abdominal girth.
Explanation
Correct Answer: A and D
Keeping the catheter clean using aseptic technique directly prevents bacterial entry into the peritoneal cavity, reducing infection risk. Measuring abdominal girth allows early detection of distension, a key sign of peritonitis. Positioning the patient supine does not prevent infection. Encouraging increased fluid intake is not an infection-prevention measure and may be contraindicated depending on the patient's fluid status.
The nurse is teaching about fire safety. Which prevention strategy will the nurse focus on?
- Encourage regular work and home fire exit drills.
- Never allow older adults to cook unsupervised.
- Hard wire all smoke detectors.
- Set hot water temp to 140 degrees F.
Explanation
Correct Answer: A) Encourage regular work and home fire exit drills.
Practicing regular fire exit drills at home and work is the most effective and universally applicable fire prevention and safety strategy, ensuring that people know how to evacuate quickly and safely in an emergency. Restricting older adults from unsupervised cooking is overly restrictive and not evidence-based as a primary safety strategy. Hard-wiring smoke detectors is beneficial but not always feasible; battery-operated detectors are equally effective when maintained. Hot water temperature should be set to 120°F or below — 140°F actually increases the risk of scald burns, particularly in children and older adults.
Six hours after a thermal burn, the nurse obtains the following assessment data for a patient who weighs 70 kg and has a 50% total body surface area (TBSA) burn. Which information is most important to communicate to the health care provider?
- Serous exudate is leaking from the burns.
- Urine output is 20 mL per hour for the past 2 hours.
- Pulse rate of 104.
- Blood pressure is 94/46 per arterial line.
Explanation
Correct Answer: B) Urine output is 20 mL per hour for the past 2 hours.
For a 70 kg patient, the minimum acceptable urine output during burn resuscitation is 0.5 mL/kg/hour, which equals 35 mL/hour. A urine output of only 20 mL/hour for the past two hours indicates inadequate fluid resuscitation and compromised renal perfusion — a critical finding that must be reported immediately so the IV fluid rate can be adjusted. While a pulse of 104 and BP of 94/46 are also concerning, low urine output is the most specific and sensitive indicator of inadequate resuscitation in burn patients and directly guides fluid management. Serous exudate from burns is an expected finding and not an urgent concern.
The nurse is assessing a patient with a burn injury using the "rule of nines." Which information will this assessment contribute to future care planning?
- Rehabilitation needs
- Type of intravenous fluids required
- Respiratory needs
- Amount of body surface area burned
Explanation
Correct Answer: D) Amount of body surface area burned.
The "rule of nines" is a standardized tool used to estimate the total body surface area (TBSA) affected by burns. It divides the body into sections each representing 9% (or multiples of 9%) of the body surface. This calculation is critical for care planning because the TBSA burned directly guides fluid resuscitation calculations (such as the Parkland formula), determines severity, and informs decisions about wound management and transfer to a burn center. While rehabilitation, IV fluid type, and respiratory needs are all important, they are determined by other assessments — the rule of nines specifically quantifies the extent of the burn.
A patient who has had a craniotomy is admitted to the ICU. The nurse notes that the patient is having difficulty speaking, and the right pupil is dilated and nonreactive. The nurse suspects increased intracranial pressure (ICP) and plans to assess the patient's neurological status. Which of the following should the nurse assess first?
- Determine a Glasgow Coma Scale score.
- Obtain heart rate and blood pressure.
- Assess reflexes and push pulls of feet.
- Assess for nuchal rigidity.
Explanation
Correct Answer: A) Determine a Glasgow Coma Scale score.
The Glasgow Coma Scale (GCS) is the standardized, priority neurological assessment tool used to evaluate level of consciousness in patients with suspected increased ICP. It assesses eye opening, verbal response, and motor response — providing a rapid, objective baseline of neurological status. In a patient with a dilated nonreactive pupil and speech difficulty following craniotomy, establishing a GCS score is the first priority as it guides all subsequent interventions. While vital signs and reflexes are also important, the GCS directly quantifies neurological deterioration and is the first step in ICP assessment.
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