Page 474 - Critical Care Nursing Demystified

CORRECT ANSWERS AND RATIONALES 459

3. C. Patients with an Addison’s crisis present with symptoms of hypotension. Giving anti-
hypertensive medications is an unacceptable treatment measure.
4. D. Positive Trousseau’s and Chvostek’s signs indicate tetany as a result of low calcium
levels and hypoparathyroidism.
5. D. Cushing’s syndrome is associated with excessive production of corticosteroids. Dos-
ages of steroid therapy could be re-evaluated and either tapered down or given every
other day, but not increased.
6. B. The patient will have deep, rapid Kussmaul’s respirations in an effort to remove exces-
sive carbon dioxide buildup from the body.
7. D. Synthroid is used to treat hypothyroidism.
8. B. Regular insulin is the only type of insulin that can be used intravenously and still be
effective.
9. C. Tolinase is a first-generation sulfonylurea. Glucophage is a biguanide. Prandin is a
meglitinide, and Avandia is a thiazolidinedione.
10. C. Euthyroid is the descriptive term used for a normal thyroid gland.

Chapter 8

1. B, C, and F. Folic acid and vitamin B6 are water-soluble and HD can remove them. Procrit
is removed by dialysis. The other medications are commonly given to a patient in CRF. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
2. B. In chronic renal failure, the kidneys retain potassium leading to a hyperkalemia. All
other values are normal. In CRF the serum creatinine is usually elevated. The hemoglo-
bin and urine creatinine clearance are lower than normal.
3. C. When an artery and vein are anastomosed as with an AV fistula, turbulence of
increased arterial flow through this area creates a swishing sound (bruit) that can be
heard on auscultation and a pulsatile vibration under the site during palpation (thrill).
4. D. Kayexalate is a phosphate and potassium-binding resin and works in the intestines
to remove those substances. One of the side effects is constipation, which can be
relieved by sorbitol and/or enemas.
5. C. Both CRRT and HD require that a patient have a temporary central venous access
site. PD requires an internally inserted catheter.
3
6. B, C, and D are indicative of peritonitis. Elevated WBCs greater than 10,000 mm indicate
an infection, cloudy dialysate output shows organisms growing in the peritoneum, and
tenderness is a symptom of infection. Clotting of the site is usually due to fibrin depos-
its or kinking of the PD catheter. A temperature of less than 100°F is considered normal
as with bloody dialysate after the initial catheter insertion.
7. A. SCUF therapy requires that a patient has enough systolic BP to drive the dialysis.
Therefore, its best use is for fluid removal. A patient in cardiogenic shock would not
have a systolic BP high enough for this type of therapy and might need CVVHDF. It
acts slowly, and therefore problems with disequilibrium do not occur as with HD. Sol-
utes are not removed in this therapy, so it would not filter out particles needed for
azotemia.