A 76-year-old patient is 2 days post-op total hip replacement. The patient puts his call light on to complain of difficulty catching his breath. As the nurse assesses the patient, she finds the patient tachypneic, tachycardic, and very anxious. The nurse determines these are most likely signs of:

Pulmonary embolism

Left-sided heart failure

Early onset dementia

Acute myocardial infarction

Answer and Explanation

The Correct Answer is A

Choice A reason: Pulmonary embolism is a blockage in one of the pulmonary arteries in the lungs, usually caused by blood clots that travel to the lungs from the legs or other parts of the body. The signs and symptoms include sudden shortness of breath, rapid breathing (tachypnea), rapid heart rate (tachycardia), and anxiety. These symptoms align with the patient's presentation and are common in the post-operative period, particularly after orthopedic surgery, which increases the risk of deep vein thrombosis (DVT) and subsequent pulmonary embolism.

Choice B reason: Left-sided heart failure can cause symptoms such as shortness of breath, fatigue, and fluid retention. However, the acute presentation of difficulty breathing, tachypnea, tachycardia, and anxiety in the context of recent surgery is more suggestive of a pulmonary embolism. Heart failure symptoms generally develop gradually rather than suddenly.

Choice C reason: Early onset dementia is not characterized by acute respiratory symptoms like difficulty breathing, tachypnea, or tachycardia. Dementia symptoms typically include memory loss, confusion, and changes in cognitive function, not the acute cardiorespiratory symptoms described in this scenario.

Choice D reason: Acute myocardial infarction (heart attack) can cause shortness of breath, chest pain, and rapid heart rate. While it is a possibility, the combination of recent surgery and the described symptoms more strongly suggests a pulmonary embolism. An acute myocardial infarction would typically also present with chest pain, which is not mentioned in this scenario.

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Correct Answer is ["B","C","D"]

Explanation

Choice A reason: Deep vein thrombosis is a condition where blood clots form in the deep veins, usually in the legs. While it is a serious condition, it is not directly associated with portal hypertension in patients with late-stage cirrhosis. Portal hypertension primarily affects the liver and its associated blood vessels, leading to complications within the portal circulation system rather than systemic venous thrombosis.

Choice B reason: Ascites is the accumulation of fluid in the abdominal cavity, and it is a common complication of portal hypertension in patients with cirrhosis. Increased pressure in the portal vein leads to leakage of fluid into the abdominal cavity, causing distension and discomfort. Ascites can significantly impact the patient's quality of life and requires careful management.

Choice C reason: Splenomegaly, or enlargement of the spleen, is another potential complication of portal hypertension. The increased pressure in the portal vein can cause blood to back up into the spleen, leading to its enlargement. Splenomegaly can result in hypersplenism, where the spleen becomes overactive and destroys blood cells, contributing to anemia, thrombocytopenia, and leukopenia.

Choice D reason: Esophageal varices are dilated blood vessels in the esophagus that develop as a result of portal hypertension. The increased pressure in the portal vein causes blood to divert through collateral vessels, including those in the esophagus. These varices can rupture and cause life-threatening bleeding, making them a critical complication to monitor in patients with cirrhosis.

Choice E reason: Increased platelet levels are not typically seen in patients with portal hypertension. In fact, portal hypertension and cirrhosis often lead to thrombocytopenia, or low platelet levels, due to splenic sequestration and reduced platelet production. Thrombocytopenia is a more common finding in this patient population.

A. Decreased calcium. B. Decreased BUN. C. Decreased hemoglobin. D. Decreased potassium. E. Elevated creatinine. F. Increased phosphorus. G. Decreased glomerular filtration rate (GFR).

Correct Answer is ["A","C","E","F","G"]

Explanation

Choice A reason: Decreased calcium is expected in end-stage chronic kidney disease (CKD) due to impaired kidney function. The kidneys are responsible for converting vitamin D into its active form, which helps in calcium absorption. Reduced kidney function leads to decreased active vitamin D, resulting in lower calcium levels.

Choice B reason: Decreased blood urea nitrogen (BUN) is not typical in CKD. Instead, BUN levels usually increase because the kidneys are less able to remove urea from the blood. Urea is a waste product of protein metabolism, and elevated BUN is indicative of impaired kidney function.

Choice C reason: Decreased hemoglobin is expected in CKD due to reduced production of erythropoietin by the kidneys. Erythropoietin stimulates the production of red blood cells, and a lack of it leads to anemia, reflected by lower hemoglobin levels.

Choice D reason: Decreased potassium is not typically seen in CKD. In fact, potassium levels often increase because the kidneys are less able to excrete it. Hyperkalemia (high potassium) is a common complication in CKD and requires careful monitoring.

Choice E reason: Elevated creatinine is expected in CKD. Creatinine is a waste product of muscle metabolism, and elevated levels indicate impaired kidney function as the kidneys are less able to clear it from the blood.

Choice F reason: Increased phosphorus is a common finding in CKD due to the kidneys' reduced ability to excrete phosphorus. This can lead to hyperphosphatemia, which can cause secondary hyperparathyroidism and further complications.

Choice G reason: Decreased glomerular filtration rate (GFR) is a hallmark of CKD. GFR measures how well the kidneys are filtering blood, and a lower GFR indicates reduced kidney function. It is used to stage the severity of CKD.

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A 76-year-old patient is 2 days post-op total hip replacement. The patient puts his call light on to complain of difficulty catching his breath. As the nurse assesses the patient, she finds the patient tachypneic, tachycardic, and very anxious. The nurse determines these are most likely signs of:

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Naxlex Comprehensive Predictor Exams

A patient with late-stage cirrhosis develops portal hypertension. All of the following are potential complications that can develop from this condition. Select all that apply.

Correct Answer is ["B","C","D"]

Explanation

The 75-year-old client is hospitalized with end-stage chronic kidney disease. Which of the following serum lab findings would the nurse expect? Select all that apply.

Correct Answer is ["A","C","E","F","G"]

Explanation

The nurse is instructing the client with chronic kidney disease (CKD) to maintain adequate nutritional intake. Which diet would be most appropriate?

Considering the patient's esophageal varices, which of the following nursing interventions would be appropriate in your care of the patient?

The nurse correlates which rationale with the administration of aspirin to the client experiencing angina-like chest pain?

A patient is admitted with acute kidney injury and the following assessment cues: K: 6.9 (3.5-5.0) Cr: 3.2 (0.6-1.2) Urine: 300 mL/24 hrs What priority actions should be anticipated by the nurse? Select all that apply.

A nurse in an emergency department is reviewing the medical record of a client who has an extensive burn injury. Which of the following laboratory results should the nurse expect?

A nurse applies a painful stimulus to the nailbeds of an unconscious patient. The patient responds with the extension of the arms and legs, pronation of the arms, and plantar flexion. The nurse documents this as:

What findings would the nurse expect when caring for a client who is experiencing spinal shock?