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A client in acute renal failure has a serum potassium level of 6.3 mEq/L. What intervention can the nurse expect the healthcare provider to prescribe?
- A. Nitrofurantoin (Macrodantin) orally.
- B. Erythropoietin (Epogen) intravenously.
- C. Kayexalate retention enema.
- D. Azathioprine (Imuran) orally.
Correct Answer: C
Rationale: The correct answer is C: Kayexalate retention enema. In acute renal failure with high serum potassium levels, the priority is to lower potassium levels to prevent cardiac complications. Kayexalate works by exchanging sodium ions for potassium ions in the intestines, promoting potassium excretion in the feces. This intervention helps reduce serum potassium levels quickly.
A: Nitrofurantoin is an antibiotic used to treat urinary tract infections, unrelated to managing hyperkalemia.
B: Erythropoietin is a hormone used to stimulate red blood cell production, not indicated for reducing potassium levels.
D: Azathioprine is an immunosuppressant used for various conditions like autoimmune diseases, not for managing hyperkalemia.
In summary, the correct intervention is to administer a Kayexalate retention enema to lower serum potassium levels effectively in acute renal failure. Other options are not appropriate for managing hyperkalemia.
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A 60-year-old woman presents with pruritus, jaundice, and xanthomas. Laboratory tests reveal elevated cholesterol and alkaline phosphatase levels. What is the most likely diagnosis?
- A. Primary biliary cirrhosis
- B. Primary sclerosing cholangitis
- C. Gallstones
- D. Pancreatic cancer
Correct Answer: A
Rationale: The most likely diagnosis is A: Primary biliary cirrhosis.
Rationale:
1. Pruritus, jaundice, and xanthomas are classic symptoms of cholestatic liver disease.
2. Elevated cholesterol and alkaline phosphatase levels are characteristic of primary biliary cirrhosis.
3. Primary biliary cirrhosis is an autoimmune disease affecting small bile ducts, leading to liver damage.
4. Primary sclerosing cholangitis (B) presents with similar symptoms but typically affects larger bile ducts.
5. Gallstones (C) could cause jaundice but would not explain the elevated cholesterol levels.
6. Pancreatic cancer (D) may present with jaundice but is less likely given the specific lab findings.
A client is receiving chemotherapy and is at risk for neutropenia. Which precaution should the nurse implement?
- A. Encourage regular visitors to boost morale.
- B. Ensure the client receives live vaccines.
- C. Place the client in a private room.
- D. Provide a diet high in fresh fruits and vegetables.
Correct Answer: C
Rationale: The correct answer is C: Place the client in a private room. This is important to reduce the risk of infection for the client with neutropenia, as being in a private room minimizes exposure to pathogens from other individuals. Neutropenia is a condition where there is a low level of neutrophils, a type of white blood cell that helps fight infections. By placing the client in a private room, the nurse can control the environment and limit the client's exposure to potential sources of infection.
Choice A is incorrect because regular visitors may introduce pathogens that could increase the client's risk of infection. Choice B is incorrect as live vaccines are contraindicated in clients receiving chemotherapy due to their weakened immune system. Choice D is incorrect because while fresh fruits and vegetables are important for overall health, in this case, the risk of infection outweighs the benefits of a diet high in these foods.
A 70-year-old woman presents with fatigue, anorexia, and weight loss. She has noticed darkening of her skin, particularly in sun-exposed areas. Laboratory tests reveal hyponatremia, hyperkalemia, and low cortisol levels. What is the most likely diagnosis?
- A. Cushing's syndrome
- B. Addison's disease
- C. Hypothyroidism
- D. Pheochromocytoma
Correct Answer: B
Rationale: The most likely diagnosis for the 70-year-old woman is Addison's disease. The symptoms of fatigue, anorexia, weight loss, darkened skin, along with hyponatremia, hyperkalemia, and low cortisol levels indicate adrenal insufficiency. Addison's disease is characterized by inadequate production of cortisol and aldosterone by the adrenal glands. The darkening of the skin, known as hyperpigmentation, is a classic sign of Addison's due to increased ACTH levels stimulating melanin production. In contrast, Cushing's syndrome presents with weight gain, hypertension, and high cortisol levels. Hypothyroidism typically presents with weight gain, cold intolerance, and constipation. Pheochromocytoma presents with hypertension, palpitations, and headaches due to excess catecholamine production. Therefore, the correct diagnosis in this case is Addison's disease.
What is the most likely diagnosis in a 30-year-old woman with right upper quadrant pain, fever, and jaundice, along with elevated white blood cell count and bilirubin levels?
- A. Acute hepatitis
- B. Acute cholecystitis
- C. Acute cholangitis
- D. Pancreatic cancer
Correct Answer: C
Rationale: The correct answer is C: Acute cholangitis. In a 30-year-old woman with right upper quadrant pain, fever, jaundice, elevated white blood cell count, and bilirubin levels, acute cholangitis is the most likely diagnosis. This condition is characterized by inflammation of the bile ducts, often due to obstruction, leading to symptoms such as pain, fever, and jaundice. The combination of right upper quadrant pain, fever, jaundice, and elevated white blood cell count and bilirubin levels suggests an infection in the biliary system, which is typical of acute cholangitis. Acute hepatitis (choice A) typically presents with elevated liver enzymes but may not have the same degree of biliary obstruction symptoms. Acute cholecystitis (choice B) usually presents with gallbladder inflammation and may not cause jaundice. Pancreatic cancer (choice D) typically presents with different symptoms and is less common in a
A 65-year-old man presents with weight loss, jaundice, and a palpable mass in the right upper quadrant. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. What is the most likely diagnosis?
- A. Gallstones
- B. Hepatitis
- C. Pancreatic cancer
- D. Primary biliary cirrhosis
Correct Answer: C
Rationale: The most likely diagnosis for a 65-year-old man with weight loss, jaundice, palpable mass in the right upper quadrant, elevated bilirubin, and alkaline phosphatase levels is pancreatic cancer. This is because the symptoms and findings are classic for pancreatic cancer, which commonly presents with obstructive jaundice due to compression of the common bile duct by the tumor. Weight loss is also a common symptom of pancreatic cancer. Gallstones typically present with acute episodes of biliary colic, not a palpable mass. Hepatitis typically presents with elevated liver enzymes, but not a palpable mass. Primary biliary cirrhosis presents with chronic cholestasis and autoimmune features, not a palpable mass.