Nokea
The client with newly diagnosed hypertension is being taught about lifestyle modifications. Which recommendation should be made?
- A. Increase your intake of saturated fats.
- B. Limit your alcohol intake to two drinks per day.
- C. Engage in at least 150 minutes of moderate exercise per week.
- D. Use table salt liberally to season your food.
Correct Answer: C
Rationale: The correct answer is C, engaging in at least 150 minutes of moderate exercise per week. Regular exercise helps lower blood pressure by strengthening the heart, improving blood flow, and reducing stress. It also helps with weight management, which is crucial for hypertension. Choice A is incorrect because saturated fats can increase the risk of heart disease and worsen hypertension. Choice B is incorrect because excessive alcohol intake can raise blood pressure. Choice D is incorrect because excessive salt intake can lead to high blood pressure. Overall, regular exercise is a key lifestyle modification for managing hypertension.
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A 55-year-old man presents with jaundice, pruritus, and dark urine. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. 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 Primary biliary cirrhosis (PBC). PBC typically presents with jaundice, pruritus, and dark urine due to impaired bile flow. Elevated bilirubin and alkaline phosphatase levels are common in PBC. Imaging findings of dilated intrahepatic bile ducts and a normal common bile duct support the diagnosis of PBC. Primary sclerosing cholangitis (Choice B) would show strictures and beading of bile ducts on imaging. Gallstones (Choice C) would typically present with a common bile duct obstruction. Pancreatic cancer (Choice D) may present with similar symptoms but is less likely given the specific imaging findings in this case.
A 32-year-old woman presents with a 10-month history of an intermittent burning sensation in the epigastrium that is sometimes related to eating. She has heard about bacteria that can cause gastrointestinal (GI) symptoms. She has had no change in her weight and denies dysphagia. Her laboratory tests are normal. Which of the following would you recommend?
- A. Serum qualitative test for H. pylori
- B. Refer for endoscopy
- C. Obtain an upper GI series
- D. Treat her for H. pylori infection
Correct Answer: A
Rationale: Rationale:
1. Given the symptoms of epigastric burning, testing for H. pylori is appropriate as it is a common cause of such symptoms.
2. The serum qualitative test for H. pylori can detect the presence of the bacteria in the patient's system.
3. If positive, treatment for H. pylori (such as antibiotics) would be indicated.
4. Referral for endoscopy or upper GI series is not the initial step as they are more invasive and costly.
Summary:
- A: Correct, as it targets the potential cause of the symptoms.
- B: Not recommended initially, as it is more invasive and not necessary as the first step.
- C: Not recommended initially, as it is less specific for H. pylori detection.
- D: Premature without confirming the presence of H. pylori.
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 60-year-old woman presents with fatigue, pruritus, and jaundice. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. What is the most likely diagnosis?
- A. Hepatitis C
- B. Primary biliary cirrhosis
- C. Hemochromatosis
- D. Wilson's disease
Correct Answer: B
Rationale: The most likely diagnosis is B: Primary biliary cirrhosis. This condition commonly presents with fatigue, pruritus, jaundice, elevated bilirubin, and alkaline phosphatase levels in older women. Primary biliary cirrhosis is an autoimmune liver disease that leads to destruction of bile ducts. The other choices are less likely because Hepatitis C typically presents with acute symptoms, Hemochromatosis presents with iron overload symptoms, and Wilson's disease presents with copper accumulation symptoms, which do not match the patient's clinical presentation.
A 35-year-old male patient presents with right upper quadrant pain, fever for the past 48 hours, preceded by new onset jaundice over the past few weeks. He states that he has had diarrhea on and off for several years but never had this investigated. A liver ultrasound is negative for gallstones or evidence of cholecystitis. His lab tests reveal total bilirubin 6.2, alkaline phosphatase 450, AST 150, ALT 120, albumin 2.6. The next diagnostic test of choice would be
- A. Liver biopsy
- B. Magnetic resonance cholangiopancreatography
- C. Hepatitis B surface antigen and hepatitis C RNA assay
- D. Colonoscopy with biopsies
Correct Answer: B
Rationale: The correct answer is B: Magnetic resonance cholangiopancreatography (MRCP). Given the patient's clinical presentation of right upper quadrant pain, fever, jaundice, and abnormal liver function tests, MRCP is the next diagnostic test of choice to evaluate the biliary tree and pancreatic ducts for possible obstruction or structural abnormalities. This would help identify the cause of the patient's symptoms, such as biliary obstruction or choledocholithiasis.
Choice A: Liver biopsy is not the next step in this scenario as the patient's symptoms are suggestive of a biliary or pancreatic etiology rather than a primary liver pathology.
Choice C: Hepatitis B surface antigen and hepatitis C RNA assay may be relevant for evaluating viral hepatitis, but in this case, the patient's symptoms and lab results are more indicative of a biliary or pancreatic issue.
Choice D: Colonoscopy with biopsies is not the next appropriate step as the patient's symptoms and lab results are not