A 60-year-old male client has been diagnosed with diabetes mellitus type 2 and chronic heart failure for many years, for which he takes hydrochlorothiazide (HCTZ), digoxin, and metformin. After his wife died last year, his health declined, and he was admitted to a local nursing home.

For the past 6 months, he has experienced cognitive decline, most likely due to hypoxia and/or multi-infarct dementia. The nurse referred the client to the registered dietitian nutritionist because of a 10-lb (4.5-kg) weight loss in 2 weeks, anorexia, and increasing blood glucose levels. The registered dietitian nutritionist prescribed oral supplemental feedings, and his metformin dose was increased by the primary health care provider. Today the charge nurse receives the client's latest lab work.

Exhibits

Based on the physical assessment findings, medical diagnoses, and lab test values, the nurse suspects that the client most likely has , which requires emergency management with
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and
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.
Choose the most likely options for the information missing from the statement by selecting from the lists of options provided.

Answer and Explanation

The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"D"}

Choice A rationale: The lab results and clinical picture, such as weight loss, anorexia, and high blood glucose levels, point more toward a hyperglycemic state rather than severe hypoglycemia.

Choice B rationale: The client's elevated blood glucose levels, weight loss, and anorexia suggest a hyperglycemic state, possibly hyperosmolar hyperglycemic state, which requires fluid management and insulin to address the severe dehydration and high blood glucose levels.

Choice C rationale: Although high glucose levels are evident, the absence of significant acidosis (as seen in diabetic ketoacidosis) and extreme ketosis makes this diagnosis less likely.

Choice D rationale: The lab values and clinical presentation do not strongly align with a primary respiratory acidosis diagnosis, which typically involves changes in pH and carbon dioxide levels.

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Correct Answer is B

Explanation

Choice A rationale: This is not accurate since the manifestations of facial nerve paralysis are observed on the contralateral side which in this case is the left side of the face hence the right facial nerve is paralyzed.

Choice B rationale: Facial nerve paralysis cause symptoms such as drooping of the eyelid, cheek or mouth as depicted in the above picture. The right facial nerve is paralyzed since the nerve innervates the contralateral side hence the effects are demonstrated on the

left side of the face.

Choice C rationale: trigeminal nerve paralysis causes symptoms such as weakness in muscles of mastication, altered sensation over the face and tongue, and hearing impairment and not the symptoms depicted above.

Choice D rationale: trigeminal nerve paralysis causes symptoms such as weakness in muscles of mastication, altered sensation over the face and tongue, and hearing impairment and not the symptoms depicted above.

A. refer to a condition where significant urinary tract obstruction which in severe or long- standing cases can yield to backup of urine into the kidneys B. refer to a condition when direct damage to the kidneys causes a sudden loss in kidney function. C. refer to a condition in which the kidneys stop functioning due to internal kidney disease. D. refer to a condition in which kidney blood flow may become significantly reduced include those in which a significant amount of fluid has been lost.

Correct Answer is D

Explanation

Choice A rationale: This refers to postrenal AKI, which is caused by an obstruction in the urinary tract that prevents urine from leaving the body.

Choice B rationale: This refers to AKI in general and is not specific compared to choice D.

Choice C rationale: This refers to intrinsic AKI, which is caused by damage to the kidney tissue or cells from various causes, such as inflammation, infection, toxins, or ischemia.

Choice D rationale: This is correct because it is pre-renal AKI, a condition in which kidney blood flow may become significantly reduced, including cases where a significant amount of fluid has been lost. This situation suggests potential hypovolemia (low blood volume) due to the massive GI bleed, which can lead to reduced kidney blood flow and subsequent acute kidney injury.

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Naxlex Comprehensive Predictor Exams

The nurse exploring cranial nerves function and observes the following reaction: The nurse documents that the client has a:

Correct Answer is B

Explanation

A-55-year old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury?

Correct Answer is D

Explanation

Polystyrene sulfonate (Kayexalate) is used in renal failure to:

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