Which of the following contributes to metabolic acidosis in acute kidney injury?

Decrease in secretion of hydrogen ions

Increase in production of bicarbonate from the kidneys

Rapid breathing

Increased blood pressure

Answer and Explanation

The Correct Answer is A

A. Decrease in secretion of hydrogen ions is correct because in acute kidney injury (AKI), the kidneys lose their ability to excrete hydrogen ions effectively. This leads to accumulation of acids in the blood, resulting in metabolic acidosis. Additionally, impaired kidney function reduces bicarbonate reabsorption, further worsening acidosis.

B. Increase in production of bicarbonate from the kidneys is incorrect because bicarbonate production is reduced in AKI, not increased. Adequate bicarbonate is necessary to buffer acids, and its reduction contributes to metabolic acidosis.

C. Rapid breathing is incorrect because rapid breathing (Kussmaul respirations) is a compensatory response to metabolic acidosis, not a cause. It occurs as the body attempts to blow off CO₂ to reduce acid levels.

D. Increased blood pressure is incorrect because while hypertension may be associated with kidney injury, it does not directly contribute to metabolic acidosis. The acid-base imbalance is primarily due to renal failure to excrete hydrogen ions and conserve bicarbonate.

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Correct Answer is C

Explanation

A. They will likely need ICP monitoring is incorrect because a simple scalp laceration does not typically cause increased intracranial pressure. ICP monitoring is reserved for patients with suspected or confirmed brain injury, not isolated scalp injuries.

B. They will need continuous blood pressure and oxygen saturation monitoring is incorrect because while vital signs are routinely monitored in the ED, continuous cardiac and oxygen monitoring is not generally required for a minor scalp lacerationunless there are signs of hemodynamic instability or other injuries.

C. Holding pressure on the laceration because profuse bleeding can occur is correct. The scalp is highly vascular, and even a relatively small laceration can lead to significant blood loss. Immediate nursing care focuses on applying direct pressure, controlling bleeding, and preparing for wound closure(sutures, staples, or adhesive strips). Proper hemorrhage control is essential to prevent hypovolemia and shock.

D. You will need to make sure they have warm blankets to prevent temperature from decreasing is incorrect because hypothermia prevention is not a primary concernfor a patient with an isolated scalp laceration. While warming measures may be used in trauma patients with extensive blood loss or environmental exposure, it is not the main priorityin this scenario.

A. Hold patient's eyelids open and turn their head to left or right while assessing direction of eye movement B. Instill cold water into patient's auditory canal and assess eye movement C. Shine light in patient's eye to assess for pupillary constriction D. Tap patient's knee to assess for a knee-jerk response

Correct Answer is A

Explanation

A. Hold patient's eyelids open and turn their head to left or right while assessing direction of eye movement is correct. The oculocephalic reflex (doll’s eyes reflex)tests the integrity of the brainstemin comatose patients. When the head is turned, the eyes should move in the opposite directionof head rotation if the brainstem is intact. Absence of this movement indicates possible brainstem dysfunction.

B. Instill cold water into patient's auditory canal and assess eye movement is incorrect for the oculocephalic reflex; this describes the oculovestibular reflex (caloric test). In this test, cold or warm water or air is instilled into the external auditory canal to stimulate the vestibular system, and eye movement is observed. It is also a test of brainstem function, but it is more invasive, requires intact tympanic membranes, and is not the same as the doll’s eyes maneuver.

C. Shine light in patient's eye to assess for pupillary constriction is incorrect because this tests the pupillary light reflex, which involves the optic nerve (CN II) and oculomotor nerve (CN III). While important for neurological assessment, it does not evaluate the brainstem pathways responsible for the oculocephalic reflex, and it cannot replace assessment of the doll’s eyes maneuver in a comatose patient.

D. Tap patient's knee to assess for a knee-jerk response is incorrect because this evaluates a spinal reflex (patellar reflex)mediated by local spinal cord circuits, not the brainstem. It is useful for assessing peripheral and spinal cord integrity, but it does not provide information about brainstem function or the oculocephalic reflex.

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Which of the following contributes to metabolic acidosis in acute kidney injury?

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Naxlex Comprehensive Predictor Exams

You are working in the ED and receive a patient with a scalp laceration. What do you anticipate will be part of your care with this patient?

Correct Answer is C

Explanation

Which of the following is the correct way to test for the Oculocephalic reflex?

Correct Answer is A

Explanation

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