An elderly patient has been having copious vomiting for several days and has become lethargic and weak. His mucous membranes are dry. He has poor skin turgor. Lab work shows: sodium of 145, ABGs: pH 7.58, PCO2 38, HCO3 38, PO2 95, SO2 98. Which response best explains the patient’s lethargy and weakness?
The hypokalemia brought on severe muscle spasms, causing exhaustion.
Due to his low potassium, his cells rely on glycolysis.
Due to the hypokalemia, his cells are hyperpolarized.
The hypernatremia caused cellular dehydration, leading to lethargy.
The Correct Answer is D
Choice A rationale
Hypokalemia can cause muscle weakness and cramps, but it does not typically lead to severe muscle spasms causing exhaustion. The patient’s symptoms of lethargy and weakness are more likely related to electrolyte imbalances and dehydration rather than muscle spasms.
Choice B rationale
While low potassium levels can affect cellular metabolism, the primary issue here is not glycolysis. The patient’s symptoms are more consistent with dehydration and electrolyte imbalances rather than a metabolic shift to glycolysis.
Choice C rationale
Hypokalemia can cause cells to become hyperpolarized, leading to muscle weakness and decreased reflexes. However, the patient’s symptoms of lethargy and weakness are more likely due to dehydration and electrolyte imbalances rather than cellular hyperpolarization.
Choice D rationale
Hypernatremia, or high sodium levels, can cause cellular dehydration, leading to symptoms such as lethargy and weakness. The patient’s lab results and clinical presentation are consistent with hypernatremia-induced cellular dehydration, which explains his symptoms.
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Correct Answer is B
Explanation
Choice A rationale
Decreasing the secretion of thyroid stimulating hormone (TSH) by the pituitary gland is not a compensatory response to fluid volume deficit. TSH primarily regulates thyroid function and metabolism, and its secretion is not directly related to fluid balance or osmolality.
Choice B rationale
Increasing renin-angiotensin-aldosterone system (RAAS) activity by the kidneys is the body’s primary compensatory response to fluid volume deficit. When there is a decrease in blood volume or blood pressure, the kidneys release renin, which activates the RAAS. This system increases the reabsorption of sodium and water in the kidneys, leading to an increase in blood volume and blood pressure.
Choice C rationale
Decreasing the secretion of cortisol by the adrenal gland is not a compensatory response to fluid volume deficit. Cortisol is a stress hormone that helps regulate metabolism, immune response, and other functions, but it is not directly involved in fluid balance.
Choice D rationale
Increasing the secretion of natriuretic peptides by the heart is a response to fluid overload, not fluid deficit. Natriuretic peptides promote the excretion of sodium and water by the kidneys, which helps reduce blood volume and pressure. This response is opposite to what is needed in a fluid volume deficit situation.
Correct Answer is C
Explanation
Choice A rationale
Wearing an N95 mask is appropriate for airborne precautions, such as tuberculosis, but not specifically for MRSA, which requires contact precautions.
Choice B rationale
Wearing a facemask is suitable for droplet precautions, such as influenza, but MRSA is primarily spread through direct contact, not droplets.
Choice C rationale
Using a separate disposable blood pressure cuff for patients with draining wounds helps prevent the spread of MRSA. MRSA can be transmitted via contaminated medical equipment.
Choice D rationale
Strict hand washing measures are essential but should be performed more frequently than once every 8-hour shift. Hand hygiene should be practiced before and after patient contact.