The nurse notes a serum calcium level of 7.9 mg/dL for a patient who has chronic malnutrition. Which action should the nurse expect to take first?

Correct Answer: A

Rationale: The correct answer is A: Monitor ionized calcium level. Step-by-step rationale: 1. Monitoring ionized calcium level is crucial to assess the patient's current calcium status accurately. 2. In chronic malnutrition, there may be alterations in protein binding of calcium, affecting total calcium levels. 3. Ionized calcium is the physiologically active form and provides a more accurate reflection of calcium status. 4. This action helps guide further interventions and treatment based on the actual calcium levels. Summary: - Choice B: Giving oral calcium citrate tablets may not be appropriate without knowing the patient's ionized calcium level. - Choice C: Checking parathyroid hormone level may be relevant but is not the immediate priority. - Choice D: Administering vitamin D supplements may be beneficial in the long term but does not address the immediate need to assess the patient's calcium status accurately.

Correct Answer: D

Rationale: The correct answer is D because CRRT removes solutes and water slowly over an extended period, providing gentler fluid and solute balance adjustments. A is incorrect because CRRT uses a hemofilter for filtration, not ultrafiltration. B is incorrect because CRRT actually removes solutes and water more slowly than intermittent hemodialysis. C is incorrect because diffusion does occur in CRRT, just at a slower rate compared to intermittent hemodialysis. Therefore, the slower solute and water removal process in CRRT distinguishes it from conventional intermittent hemodialysis.

Correct Answer: C

Rationale: The correct answer is C: Volume overload. In acute kidney injury, impaired kidney function leads to fluid accumulation, causing volume overload. This is a common reason to initiate dialysis to remove excess fluid. Acidosis (choice A) and hyperkalemia (choice D) are also indications for dialysis, but volume overload is more common in acute kidney injury. Hypokalemia (choice B) is not a typical reason for initiating dialysis in acute kidney injury, as it involves low potassium levels rather than fluid overload.

Correct Answer: D

Rationale: The correct answer is D because transcellular fluid refers to fluid that is contained within specific cavities of the body, such as cerebrospinal fluid, synovial fluid, and digestive juices. This fluid is not freely exchangeable with other body fluids, so its volume is generally not affected by changes in overall hydration status. A is incorrect because interstitial fluid in the central nervous system is not considered transcellular fluid. B is incorrect because the volume of transcellular fluid can vary based on specific bodily functions. C is incorrect because while transcellular fluid is a component of extracellular fluid, it does not form the largest percentage.

Correct Answer: C

Rationale: Solution A is 100 times as acidic as Solution B, which means the difference in pH between the two solutions is 2 (since pH is on a logarithmic scale). If Solution A has a pH of 5, Solution B must have a pH that is 2 units higher, resulting in a pH of 7. Therefore, the correct answer is C (pH of 7). Summary: A (pH of 1) and B (pH of 3) are not correct because the difference in acidity between Solution A and B is 2 pH units. D (pH of 10) is not correct as it is not consistent with the given information about the relative acidity of the two solutions.