ATI RN
Chapter 14 Nutrition and Fluid Balance Answer Key Questions
Question 1 of 5
The respiratory system can compensate completely for metabolic acidosis.
Correct Answer: B
Rationale: The correct answer is B: FALSE. The respiratory system can partially compensate for metabolic acidosis by increasing ventilation to eliminate excess CO2. However, it cannot completely compensate as it cannot directly regulate bicarbonate levels in the blood. The kidneys play a crucial role in fully compensating for metabolic acidosis by excreting hydrogen ions and reabsorbing bicarbonate. Choice A is incorrect because the respiratory system alone cannot fully compensate for metabolic acidosis. Choices C and D are not applicable as they do not provide any relevant information regarding the statement.
Question 2 of 5
An older adult patient who is malnourished presents to the emergency department with a serum protein level of 5.2 g/dL. Which clinical manifestation should the nurse expect?
Correct Answer: B
Rationale: The correct answer is B: Edema. In a malnourished patient with low serum protein levels, particularly albumin, there is a decreased oncotic pressure, leading to fluid shifting into interstitial spaces and causing edema. Pallor (choice A) is associated with anemia, not malnutrition. Restlessness (choice C) is not a typical manifestation of malnutrition. Confusion (choice D) is more commonly seen in severe malnutrition or certain vitamin deficiencies, but it is not the most immediate clinical manifestation in this scenario.
Question 3 of 5
An older adult patient receiving iso-osmolar continuous enteral nutrition develops restlessness, agitation, and weakness. Which laboratory result should the nurse report to the health care provider immediately?
Correct Answer: C
Rationale: The correct answer is C: Na+ 154 mEq/L (154 mmol/L). High sodium levels can indicate hypernatremia, which can lead to neurological symptoms like restlessness, agitation, and weakness in older adults. This condition can be life-threatening if not promptly addressed. A: K+ 3.4 mEq/L is slightly low but not an immediate concern for neurological symptoms. B: Ca+2 7.8 mg/dL is within the normal range, and low calcium levels typically do not present with the described symptoms. D: Base balance is not a specific laboratory result and is not directly related to the symptoms described.
Question 4 of 5
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.
Question 5 of 5
Rapid correction of the acidosis should be avoided, because tetany may occur as a result of
Correct Answer: B
Rationale: The correct answer is B because tachypnea is a compensatory mechanism for metabolic acidosis, helping to blow off excess CO2 and decrease the blood's acidity. Rapidly correcting acidosis can lead to a sudden decrease in CO2 levels, potentially causing tetany due to respiratory alkalosis. Choice A discusses renal replacement therapies, not directly related to the risk of tetany. Choice C mentions intubation, which is not the immediate concern for tetany. Choice D is blank.