Nokea
A client with chronic kidney disease (CKD) is scheduled for hemodialysis. Which pre-dialysis assessment finding should the nurse report to the healthcare provider?
- A. Serum potassium of 5.5 mEq/L.
- B. Blood pressure of 180/90 mm Hg.
- C. Heart rate of 80 beats per minute.
- D. Serum sodium of 140 mEq/L.
Correct Answer: B
Rationale: The correct answer is B: Blood pressure of 180/90 mm Hg. High blood pressure can worsen kidney function and increase the risk of cardiovascular complications during hemodialysis. The nurse should report this finding to the healthcare provider for prompt management.
A: Serum potassium of 5.5 mEq/L is slightly elevated but not an immediate concern before hemodialysis.
C: Heart rate of 80 beats per minute is within normal range and not a priority assessment for pre-dialysis.
D: Serum sodium of 140 mEq/L is within normal limits and does not require immediate attention before hemodialysis.
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A client diagnosed with dementia is disoriented, wandering, has a decreased appetite, and is having trouble sleeping. What is the priority nursing problem for this client?
- A. Disturbed thought processes.
- B. Altered sleep pattern.
- C. Imbalanced nutrition: less than.
- D. Risk for injury.
Correct Answer: D
Rationale: The correct answer is D: Risk for injury. The client's symptoms of disorientation, wandering, decreased appetite, and difficulty sleeping indicate an increased risk for falls, accidents, or getting lost. Ensuring the client's safety and preventing any potential harm is the priority.
A: Disturbed thought processes may contribute to the client's disorientation but do not pose an immediate threat to their safety.
B: Altered sleep pattern is concerning but is secondary to the risk of injury in this scenario.
C: Imbalanced nutrition: less than is important, but the immediate priority is addressing the client's safety due to the risk of injury.
In summary, the priority nursing problem for this client is the risk for injury due to their disorientation and wandering behavior, which could lead to accidents or harm.
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.
In a patient with a history of chronic iron deficiency anemia requiring a recent blood transfusion and an extensive GI work-up, which statement is true based on their medications?
- A. A dedicated small bowel series has a high likelihood of being positive
- B. 81 mg of aspirin per day decreases the benefit of using a COX II inhibitor
- C. The patient should have a provocative arteriogram with heparin infusion to identify the source of blood loss
- D. Hormonal therapy has been shown to be effective in decreasing blood loss due to arteriovenous malformations
Correct Answer: B
Rationale: The correct answer is B: 81 mg of aspirin per day decreases the benefit of using a COX II inhibitor. Aspirin, a non-selective COX inhibitor, can interfere with the action of selective COX II inhibitors by competing for the same binding site on the COX enzyme. This competition can limit the effectiveness of the COX II inhibitor in reducing inflammation and pain. This is particularly important in patients with a history of chronic iron deficiency anemia who may require NSAIDs for pain management.
Option A is incorrect because a dedicated small bowel series may not necessarily be positive for identifying the source of blood loss in this patient. Option C is incorrect as a provocative arteriogram with heparin infusion is an invasive procedure and not typically indicated as a first-line investigation for blood loss in patients with iron deficiency anemia. Option D is incorrect as hormonal therapy is not typically used to decrease blood loss from arteriovenous malformations.
In a 45-year-old woman with a history of arthritis experiencing severe heartburn and indigestion refractory to antacids, which findings on an esophageal manometry study are consistent with her diagnosis?
- A. Vigorous peristalsis and elevated lower esophageal sphincter (LES) pressure
- B. Absent peristalsis and elevated LES pressure
- C. Absent peristalsis and decreased LES pressure
- D. Vigorous peristalsis and decreased LES pressure
Correct Answer: C
Rationale: The correct answer is C: Absent peristalsis and decreased LES pressure. In a patient with severe heartburn and indigestion refractory to antacids, these findings are consistent with achalasia, a motility disorder characterized by impaired esophageal peristalsis and decreased LES pressure. Absent peristalsis leads to poor esophageal clearance and retention of food, causing symptoms like heartburn. Decreased LES pressure results in inadequate closure of the LES, leading to reflux of gastric contents into the esophagus. Choices A, B, and D are incorrect because they do not match the typical findings seen in achalasia. Vigorous peristalsis and elevated LES pressure are not consistent with achalasia, while absent peristalsis with increased LES pressure is not a common presentation.
A 70-year-old man presents with sudden onset of severe abdominal pain. He has a history of atrial fibrillation. Physical examination reveals a soft abdomen with minimal tenderness. What is the most likely diagnosis?
- A. Acute pancreatitis
- B. Mesenteric ischemia
- C. Peptic ulcer disease
- D. Diverticulitis
Correct Answer: B
Rationale: The most likely diagnosis in this case is B: Mesenteric ischemia. Given the sudden onset of severe abdominal pain in an elderly patient with atrial fibrillation, mesenteric ischemia is a crucial consideration due to the risk of thromboembolism from the heart condition leading to inadequate blood supply to the intestines. Acute pancreatitis (A) typically presents with epigastric pain radiating to the back and elevated serum amylase/lipase levels. Peptic ulcer disease (C) usually presents with a history of dyspepsia and is less likely to cause sudden severe abdominal pain. Diverticulitis (D) commonly presents with left lower quadrant pain and tenderness, which contrasts with the soft abdomen and minimal tenderness seen in this case.