Which fluid is most appropriate for a patient with dehydration?
D5W (dextrose 5% in water).
0.9% normal saline.
0.45% saline.
Packed red blood cells.
The Correct Answer is B
Choice A rationale
D5W (dextrose 5% in water) is an isotonic solution in the bag but becomes hypotonic in the body as dextrose is metabolized, leading to free water redistribution. This fluid is not ideal for dehydration as it does not contain electrolytes and can potentially dilute existing electrolytes, which is counterproductive for replacing lost volume and salts.
Choice B rationale
0.9% normal saline is an isotonic solution, meaning it has a similar concentration of solutes to the body's plasma. It is the most appropriate choice for treating dehydration, as it replenishes both fluid volume and sodium chloride, which are commonly lost during dehydration, effectively expanding the intravascular compartment without causing major fluid shifts.
Choice C rationale
0.45% saline, or half-normal saline, is a hypotonic solution with half the sodium concentration of normal saline. This fluid is used to replace free water deficits and for hypernatremia, but it is not the first-line choice for general dehydration as it does not effectively expand the intravascular volume and can cause fluid shifts into cells.
Choice D rationale
Packed red blood cells (PRBCs) are blood products used for anemia or significant blood loss to increase oxygen-carrying capacity. They are not a fluid replacement for dehydration. Administering blood when it's not clinically indicated for fluid volume deficit is inappropriate and carries risks of transfusion reactions and fluid overload.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Metoprolol is a beta-blocker that reduces myocardial oxygen demand by decreasing heart rate, contractility, and blood pressure. While it is effective for long-term management and prevention of angina, it is not the preferred choice for immediate relief of an acute anginal attack due to its slower onset of action. Its primary role is prophylaxis.
Choice B rationale
Nitroglycerin is a potent vasodilator that works by relaxing vascular smooth muscle, primarily affecting veins, which reduces venous return (preload) and myocardial oxygen demand. It also dilates coronary arteries, increasing blood flow and oxygen supply to the heart muscle. Its rapid onset makes it the drug of choice for acute angina.
Choice C rationale
Amlodipine is a calcium channel blocker that works by inhibiting the influx of calcium into vascular smooth muscle and myocardial cells, causing vasodilation and reduced peripheral resistance. Although it is used for the long-term management of chronic stable angina, its onset of action is not rapid enough for immediate relief during an acute attack.
Choice D rationale
Aspirin is an antiplatelet agent that works by irreversibly inhibiting cyclooxygenase (COX) enzyme, preventing the formation of thromboxane A2. This reduces platelet aggregation and clot formation, which is crucial in preventing myocardial infarction in the setting of unstable angina, but it does not provide immediate relief from chest pain.
Correct Answer is B
Explanation
Choice A rationale
Insulin lispro is a rapid-acting insulin. It is used to cover mealtime blood sugar spikes due to its rapid onset of action, typically within 15 to 30 minutes, and a short duration of action of approximately 3 to 5 hours.
Choice B rationale
Insulin glargine (Lantus) is a long-acting insulin. It has a slow, sustained absorption and provides a relatively constant basal insulin level over 24 hours with no pronounced peak. This makes it ideal for controlling blood sugar between meals and overnight.
Choice C rationale
Insulin aspart (Novolog) is another rapid-acting insulin. It is designed to be injected just before or at mealtime to quickly control the rise in blood glucose levels that occurs after eating. Its onset is rapid, and its duration is short.
Choice D rationale
Regular insulin is a short-acting insulin. It is often used for mealtime coverage, but its slower onset (30 to 60 minutes) and peak (2 to 4 hours) make it less flexible than rapid-acting insulins. It is also used in insulin drips for acute management.
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