Hydrate or Die-alysis
A patient with CKD has K⁺ 6.2. What is the priority nursing action?
Initiate cardiac monitoring (risk of dysrhythmias comes first)
A cirrhosis patient becomes confused and restless. What is the priority lab?
Ammonia
Reasoning: Liver can’t convert ammonia → toxic to brain → encephalopathy.
Neuro changes = think ammonia first.
A post-op patient has not voided in 8 hours. What is the first action?
Bladder scan
ABG: pH 7.30, CO₂ 55. What is the interpretation?
Respiratory acidosis
Reasoning: CO₂ = acid → high CO₂ = acidic → respiratory cause.
What is the first priority in DKA treatment?
Fluid replacement
Reasoning: Patients are severely dehydrated → fluids restore perfusion before insulin.
A patient is receiving IV fluids and develops crackles and a cough. What should the nurse do first?
Slow/stop infusion and assess for fluid volume overload
A patient on lactulose has 4 loose stools/day. What is the nurse’s interpretation?
Therapeutic effect (ammonia excretion)
Reasoning: Lactulose works by trapping ammonia in stool → diarrhea is expected. Don’t stop it unless severe dehydration.
A patient with an indwelling catheter has cloudy, foul-smelling urine. Which action is most appropriate first?
A. Remove the catheter
B. Obtain a urine sample from the bag
C. Obtain a urine sample from the sampling port
D. Start antibiotics
A: C. Obtain sample from sampling port
Reasoning:
A patient with COPD is given high-flow oxygen and becomes drowsy. Why?
Suppressed respiratory drive
Reasoning: COPD patients rely on low oxygen drive → too much O₂ → ↓ breathing → CO₂ retention → sedation.
A DKA patient’s glucose is improving, but K⁺ is dropping. Why?
Insulin shifts potassium into cells
Reasoning: Insulin pushes K⁺ into cells → can cause dangerous hypokalemia.
A patient on furosemide develops weakness and flat T waves. What is happening?
Hypokalemia from potassium-wasting diuretic
A cirrhosis patient has ascites and hypotension. What is the priority concern?
Decreased perfusion
Reasoning: Fluid is third-spacing (not in vessels) → patient is actually intravascularly depleted → ↓ perfusion despite fluid overload appearance.
A patient with chronic constipation reports using daily laxatives for months. Now they report worsening constipation. What is the priority education?
Stop stimulant laxative overuse and retrain bowel habits
Reasoning:
Chronic stimulant laxative use → bowel dependence + decreased motility
A patient with vomiting has which imbalance?
Metabolic alkalosis
Reasoning: Losing stomach acid → body becomes more alkaline.
A patient with hyperthyroidism has HR 130. What is the priority concern?
Cardiac complications
Reasoning: Thyroid hormone ↑ metabolism → ↑ HR → risk of arrhythmias/storm.
A provider orders spironolactone for a patient with K⁺ 5.5. What is the nurse’s best action?
Hold medication and notify provider (risk of worsening hyperkalemia)
A patient with liver failure has bruising and bleeding gums. What is the cause?
Decreased clotting factor production
Reasoning: Liver produces clotting factors → failure = bleeding risk, not platelet problem primarily.
A patient has abdominal distention, severe pain, hypoactive bowel sounds, and has not passed stool or gas. A PRN laxative is ordered. What is the nurse’s best action?
Hold medication and notify provider
Reasoning:
This suggests possible bowel obstruction
Giving a laxative could → perforation or worsening condition
A patient with DKA has Kussmaul respirations. What is the purpose?
Compensate for metabolic acidosis (blow off CO₂)
Reasoning: Body is trying to blow off CO₂ (acid) to correct metabolic acidosis.
A patient with adrenal insufficiency presents with hypotension. What is the priority?
Fluid resuscitation
Reasoning: Lack of cortisol/aldosterone → volume depletion → shock risk.
A CKD patient receives insulin and dextrose for hyperkalemia. What must the nurse monitor closely?
Potassium and blood glucose (risk of hypoglycemia + K⁺ shift)
A patient with hepatic encephalopathy becomes increasingly lethargic. What is the priority action?
Assess airway and LOC (risk for decreased consciousness and aspiration)
reasoning: Neuro decline → risk of loss of airway + aspiration. Always go back to ABCs (Airway first).
A post-op patient has not voided in 8 hours. Bladder scan shows 650 mL. The provider orders straight catheterization. What is the priority nursing consideration during the procedure?
Drain urine slowly (clamp if needed)
Reasoning:
Rapid decompression of a distended bladder can cause hypotension, bladder spasms, and hematuria.
ABG: pH 7.48, CO₂ 30. What is happening and what caused it?
Respiratory alkalosis from hyperventilation
Reasoning: Low CO₂ = too much breathing (hyperventilation).
A Type 2 diabetic patient is NPO and receives oral hypoglycemics. What is the nurse’s action?
Hold medication (risk of hypoglycemia)
Reasoning: No food + meds = hypoglycemia risk.