A 19-year-old presents with abdominal pain in the right lower quadrant. Physical examination reveals rebound tenderness and a low-grade fever. A possible diagnosis would be:

Bowel obstruction

Hepatitis

Appendicitis

Colon cancer

Answer and Explanation

The Correct Answer is C

Choice A reason:
Bowel obstruction can cause abdominal pain, but it typically presents with symptoms such as vomiting, absence of bowel movements, and abdominal distention rather than localized right lower quadrant pain and rebound tenderness. Therefore, this choice is less likely.
Choice B reason:
Hepatitis usually presents with symptoms like jaundice, fatigue, and generalized abdominal discomfort rather than localized right lower quadrant pain with rebound tenderness. This makes hepatitis an unlikely diagnosis in this case.
Choice C reason:
Appendicitis is characterized by right lower quadrant pain, rebound tenderness, and low-grade fever, making it the most likely diagnosis for this patient. These symptoms are classic for appendicitis, a common surgical emergency in young adults.
Choice D reason:
Colon cancer can cause abdominal pain, but it is typically associated with older age, changes in bowel habits, and weight loss. The presentation of right lower quadrant pain and rebound tenderness with fever is not typical for colon cancer, making it an unlikely diagnosis in this young patient.

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Correct Answer is A

Explanation

Choice A reason:
In patients with chronic renal failure, the kidneys cannot effectively excrete magnesium, leading to the risk of hypermagnesemia. Magnesium hydroxide, commonly used as an antacid and laxative, should be used with caution or avoided in these patients to prevent magnesium accumulation in the blood, which can have serious cardiovascular and neuromuscular effects.

Choice B reason:
While cirrhosis affects liver function and can alter drug metabolism, magnesium hydroxide does not have a direct contraindication for use in patients with cirrhosis. However, caution is necessary due to potential electrolyte imbalances and altered pharmacokinetics. The primary concern with magnesium hydroxide in these patients is less critical compared to those with renal failure.

Choice C reason:
Hemorrhoids do not directly contraindicate the use of magnesium hydroxide. This condition primarily affects the veins around the rectum and anus and is unrelated to the systemic effects of magnesium. Therefore, the presence of hemorrhoids does not necessitate withholding the medication.

Choice D reason:
Undiagnosed abdominal pain is a significant consideration before administering magnesium hydroxide. The use of laxatives can exacerbate conditions like intestinal obstruction or acute abdomen. Therefore, caution is advised, but the immediate and more critical concern remains the risk posed to patients with chronic renal failure.

A. Lactulose B. Polyethylene glycol (MiraLax) C. 0.9% NS D. Docusate sodium (Colace)

Correct Answer is A

Explanation

Choice A reason:
Lactulose is the medication of choice for treating elevated ammonia levels, commonly seen in hepatic encephalopathy associated with cirrhosis. It works by reducing the absorption of ammonia from the intestines, converting ammonia to ammonium, which is then excreted. Administering lactulose helps in lowering blood ammonia levels and improving mental status in affected patients.

Choice B reason:
Polyethylene glycol (MiraLax) is a laxative used to treat constipation. It does not have any role in reducing ammonia levels or treating hepatic encephalopathy. Therefore, it is not appropriate for this patient's elevated ammonia condition.

Choice C reason:
0.9% NS (normal saline) is primarily used for fluid resuscitation and electrolyte balance. While essential in managing cirrhotic patients with fluid imbalances, it does not address the elevated ammonia levels directly. Therefore, it is not the treatment of choice for this specific situation.

Choice D reason:
Docusate sodium (Colace) is a stool softener used to treat constipation. It does not have any effect on ammonia levels or the treatment of hepatic encephalopathy. Thus, it is not appropriate for managing elevated ammonia in this patient.

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A 19-year-old presents with abdominal pain in the right lower quadrant. Physical examination reveals rebound tenderness and a low-grade fever. A possible diagnosis would be:

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Naxlex Comprehensive Predictor Exams

Which condition(s) would cause the nurse to hold a PRN order for magnesium hydroxide (Milk of Magnesia)?

Correct Answer is A

Explanation

A patient with a history of chronic alcohol abuse has been admitted to the unit with cirrhosis. Upon review of the patient's laboratory test results, the nurse notes that the patient's ammonia level is elevated at 218 mcg/dL. What medication should the nurse prepare to administer?

Correct Answer is A

Explanation

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