NACE Physiological Adaptation 2 — Questions and Answers
Question 1: A patient with heart failure is prescribed furosemide 40 mg IV. Which electrolyte imbalance should the nurse monitor for most closely?
- Hypernatremia
- Hypokalemia (Correct answer)
- Hypermagnesemia
- Hypercalcemia
Correct answer: Hypokalemia
Furosemide is a loop diuretic that causes significant potassium loss through increased urinary excretion, leading to hypokalemia.
Furosemide inhibits sodium-potassium-chloride cotransporter in the ascending loop of Henle, causing significant diuresis with loss of potassium. Hypokalemia can cause life-threatening cardiac dysrhythmias, muscle weakness, and paralytic ileus.
Question 2: A patient with cirrhosis develops ascites and peripheral edema. Which laboratory finding would the nurse expect?
- Elevated serum albumin
- Decreased serum albumin (Correct answer)
- Elevated hemoglobin
- Decreased BUN
Correct answer: Decreased serum albumin
The cirrhotic liver cannot produce adequate albumin, leading to decreased oncotic pressure and fluid shifting into the interstitial space and peritoneal cavity.
Cirrhosis impairs hepatic synthesis of albumin, the primary plasma protein maintaining oncotic pressure. Normal albumin is 3.5-5.0 g/dL; cirrhotic patients often have levels below 2.5 g/dL. Reduced oncotic pressure causes fluid to shift from the intravascular space into tissues and the peritoneal cavity.
Question 3: Which finding is a classic sign of diabetic ketoacidosis (DKA)?
- Shallow, slow respirations
- Fruity odor to the breath (Correct answer)
- Bradycardia
- Hypertension
Correct answer: Fruity odor to the breath
The fruity or acetone breath odor in DKA results from the breakdown of fatty acids into ketone bodies as the body attempts to use fat for energy without insulin.
Diabetic ketoacidosis occurs primarily in Type 1 diabetes when insulin deficiency forces the body to metabolize fat for energy, producing ketone bodies. Classic signs include fruity breath odor, Kussmaul respirations, polyuria, polydipsia, and altered mental status.
Question 4: A nurse is caring for a patient in septic shock. Which set of vital signs is most consistent with early (warm) septic shock?
- BP 80/40, HR 120, Temp 103 degrees F, warm flushed skin (Correct answer)
- BP 160/90, HR 60, Temp 97 degrees F, cool pale skin
- BP 120/80, HR 72, Temp 98.6 degrees F, normal skin
- BP 80/40, HR 40, Temp 95 degrees F, mottled skin
Correct answer: BP 80/40, HR 120, Temp 103 degrees F, warm flushed skin
Early septic shock (hyperdynamic/warm phase) presents with hypotension, tachycardia, fever, and vasodilation causing warm, flushed skin.
Septic shock progresses through two hemodynamic phases. Early (warm/hyperdynamic) shock: massive vasodilation causes decreased SVR, hypotension, and warm/flushed skin. The heart compensates with increased cardiac output and tachycardia.
Question 5: A patient recovering from surgery develops sudden onset dyspnea, chest pain, and tachycardia. Which complication should the nurse suspect?
- Atelectasis
- Pulmonary embolism (Correct answer)
- Pneumonia
- Heart failure
Correct answer: Pulmonary embolism
Sudden onset of dyspnea, pleuritic chest pain, and tachycardia in a post-surgical patient are classic signs of pulmonary embolism, a life-threatening emergency.
Pulmonary embolism occurs when a thrombus, typically from deep veins of the legs, travels to the pulmonary vasculature. Classic triad: sudden dyspnea, pleuritic chest pain, and tachycardia. Diagnosis is confirmed by CT pulmonary angiography.
Question 6: A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. Which cardiac rhythm change should the nurse anticipate?
- Prolonged QT interval
- Peaked T waves (Correct answer)
- ST elevation
- Absent P waves with regular rhythm
Correct answer: Peaked T waves
Hyperkalemia characteristically produces tall, peaked T waves on ECG as one of the earliest changes, followed by widened QRS and eventual sine wave pattern.
Hyperkalemia produces progressive ECG changes as levels rise: mild (5.5-6.5): peaked T waves, shortened QT; moderate (6.5-8.0): flattened P waves, prolonged PR, widened QRS; severe (above 8.0): sine wave pattern, ventricular fibrillation, asystole.
NACE Physiological Adaptation 2
A patient with heart failure is prescribed furosemide 40 mg IV.
Which electrolyte imbalance should the nurse monitor for most closely?