Acute adrenal crisis is caused by

Correct Answer: B

Rationale: The correct answer is B: deficiency of corticosteroids. Acute adrenal crisis is caused by a sudden and severe deficiency of cortisol and aldosterone, which are essential corticosteroids produced by the adrenal glands. Without these hormones, the body cannot regulate blood pressure, electrolyte balance, and respond to stress adequately. Acute renal failure (choice A) does not directly lead to adrenal crisis. High doses of corticosteroids (choice C) can suppress the adrenal glands but do not cause acute adrenal crisis. Overdose of testosterone (choice D) does not impact the production of cortisol and aldosterone, thus not causing acute adrenal crisis.

Correct Answer: C

Rationale: The correct answer is C: notify the provider immediately. Lack of bruit, thrill, and distal pulse indicates potential complications like thrombosis or occlusion in the arteriovenous fistula. Prompt provider notification is crucial for timely intervention to prevent further complications such as ischemia or access failure. Reassessing the patient in an hour (A) may delay necessary intervention. Raising the arm above the level of the patient's heart (B) does not address the underlying issue. Applying warm packs (D) could worsen the situation if there is a clot present.

Correct Answer: D

Rationale: The correct answer is D because continuous venovenous hemodiafiltration (CVVHDF) combines ultrafiltration, convection, and dialysis to maximize fluid and solute removal. Ultrafiltration removes plasma water, convection removes fluids and solutes, and dialysis facilitates solute removal through diffusion. Choice A is incorrect because convection alone does not remove solutes, but CVVHDF combines convection with other methods. Choice B is incorrect because CVVHDF is not specifically used for volume overload, although it does remove fluids. Choice C is incorrect because CVVHDF does not involve adding dialysate to remove solutes; instead, it relies on diffusion for solute removal. In summary, the correct answer D is the best choice as it encompasses all the components needed for comprehensive fluid and solute removal in CVVHDF.

Correct Answer: A

Rationale: The correct answer is A. By evaluating the morning laboratory results and reporting abnormal results, the nurse can ensure the patient's safety during dialysis by addressing any concerning findings promptly. This step is crucial in monitoring the patient's condition and adjusting the treatment plan as needed. Incorrect choices: B: Administering antihypertensive medications is not directly related to the patient's dialysis procedure and does not address the immediate needs of the patient in the critical care unit. C: While assessing the dialysis access site is important, reporting abnormalities alone may not be sufficient without a comprehensive evaluation of the patient's laboratory results. D: Weighing the patient to monitor fluid status is important in the context of dialysis, but it is not as critical as evaluating laboratory results for immediate intervention.

Correct Answer: D

Rationale: The correct answer is D because if a reliable 24-hour urine collection is not possible, a standardized formula can be used to estimate the GFR. This is typically done using the patient's serum creatinine level, age, sex, and race. It is a validated method when direct measurement is not feasible. A: Incorrect. It is still possible to estimate GFR using formulas when 24-hour urine collection is not possible. B: Incorrect. BUN alone is not sufficient to accurately determine renal function. C: Incorrect. BUN/Creatinine ratio is not a direct measure of GFR and may be influenced by other factors.

Correct Answer: A

Rationale: The correct answer is A: sepsis. Sepsis is a leading cause of acute kidney injury in critically ill patients due to the systemic inflammatory response leading to kidney damage. Fluid overload (B) can contribute but is not the primary cause. Medications (C) and hemodynamic instability (D) can also lead to acute kidney injury but are not as common as sepsis in critically ill patients.

Correct Answer: D

Rationale: The correct answer is D because the presence of red blood cells and albumin in the urine indicates kidney damage, as these are not normally found in urine. A: Creatinine levels should be similar in blood and urine for proper kidney function. B: Sodium and chloride are normal components of urine. C: Uric acid levels can vary in urine and serum. Therefore, D is the correct answer as it signals potential kidney injury.

Correct Answer: B

Rationale: The correct answer is B: evaluate the patient for signs and symptoms of infection. After 5 days, infection risk increases. Signs of infection include fever, redness, swelling, and tenderness at the catheter site. Monitoring for these signs is crucial to prevent complications. A: Routine dialysis catheter change is not indicated after 5 days. C: Teaching long-term use is incorrect as temporary catheters are not meant for extended use. D: Using lumens for fluid administration can increase infection risk and is not recommended.

Correct Answer: C

Rationale: Step 1: Syndrome of inappropriate antidiuretic hormone (SIADH) leads to excess water retention, diluting sodium levels in the blood. Step 2: Fluid restriction is the mainstay of treatment to prevent further dilution of sodium. Step 3: Administering 3% normal saline (choice A) can worsen the condition by further increasing sodium levels. Step 4: Exogenous vasopressin (choice B) would exacerbate the problem by increasing water retention. Step 5: Low sodium diet (choice D) may be beneficial in the long term but is not the immediate priority.