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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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An 82-year-old woman with no past medical history presents to your clinic complaining of arthritic symptoms. She is not taking any medications but needs something for her arthritis. You want to start her on a nonsteroidal anti-inflammatory drug (NSAID) but are concerned about her age and the risk of peptic ulcers. As she has to pay for her medications out-of-pocket and requests the most cost-effective option, what is the most appropriate treatment plan?
- A. Prescribe an inexpensive NSAID alone
- B. Prescribe an inexpensive NSAID and misoprostol
- C. Prescribe celecoxib
- D. Prescribe an inexpensive NSAID and sucralfate
Correct Answer: A
Rationale: The correct answer is A: Prescribe an inexpensive NSAID alone. This option is the most appropriate because it balances the need for cost-effectiveness with the concern for peptic ulcers in an elderly patient. Starting with a simple NSAID reduces the risk of adverse effects and minimizes the financial burden on the patient. Option B adds misoprostol, which may help protect the stomach but increases the cost. Option C, prescribing celecoxib, is more expensive and carries a higher cardiovascular risk. Option D, adding sucralfate, does not have strong evidence for preventing NSAID-induced ulcers and adds unnecessary cost. Therefore, option A is the most suitable choice for this scenario.
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.
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.
A 65-year-old woman presents with difficulty swallowing, weight loss, and a history of long-standing heartburn. She has been on proton-pump inhibitors for years, but her symptoms have worsened. What is the most likely diagnosis?
- A. Peptic stricture
- B. Esophageal cancer
- C. Achalasia
- D. Esophageal spasm
Correct Answer: B
Rationale: The correct answer is B: Esophageal cancer. Given the patient's age, symptoms of difficulty swallowing and weight loss, along with a history of chronic heartburn not responding to proton-pump inhibitors, esophageal cancer is the most likely diagnosis. Esophageal cancer commonly presents with dysphagia, weight loss, and a history of chronic reflux. Peptic stricture (A) typically presents with dysphagia but is less likely given the worsening symptoms despite treatment. Achalasia (C) presents with dysphagia and regurgitation, but not typically with weight loss. Esophageal spasm (D) presents with chest pain and dysphagia, but not typically with weight loss or chronic heartburn.
Which regimen is most effective for treating H. pylori infection?
- A. Metronidazole, bismuth subsalicylate, amoxicillin for 14 days
- B. Clarithromycin and omeprazole for 14 days
- C. Metronidazole, lansoprazole, and clarithromycin for 14 days
- D. Metronidazole, clarithromycin, and omeprazole for 7 days
Correct Answer: C
Rationale: The correct answer is C - Metronidazole, lansoprazole, and clarithromycin for 14 days. This regimen includes a proton pump inhibitor (lansoprazole) to reduce stomach acid, clarithromycin to kill the bacteria, and metronidazole as an alternative antibiotic. This combination therapy is recommended by guidelines as it targets H. pylori effectively, reducing the risk of resistance.
Choice A is incorrect as bismuth subsalicylate is not included in the recommended regimen. Choice B is incorrect because omeprazole is not the preferred proton pump inhibitor, and using clarithromycin alone can lead to resistance. Choice D is incorrect as the duration of treatment is insufficient for eradication. Overall, choice C is the most effective option based on current guidelines and best practices for treating H. pylori infection.