A male presents to the emergency department with confusion, lethargy, and a decreased level of consciousness. His friends report that he ingested a large quantity of unknown pills in a suicide attempt. Laboratory results reveal severe metabolic acidosis, high anion gap, and elevated serum creatinine. Which of the following is the most urgent indication for initiating dialysis in this patient?

Overdose

Chronic Kidney Disease

Hypertension

Dehydration

Answer and Explanation

The Correct Answer is A

A. Overdose: The patient has ingested a large quantity of unknown pills, leading to severe metabolic acidosis, high anion gap, and possible toxic accumulation. Dialysis is often indicated to clear toxins in the case of overdose, especially if renal function is impaired (as indicated by elevated creatinine).

B. Chronic Kidney Disease: While chronic kidney disease may eventually require dialysis, the acute overdose and metabolic acidosis are the more immediate concerns requiring urgent dialysis.

C. Hypertension: Hypertension may require management, but it is not the primary reason to initiate urgent dialysis in this scenario. The overdose and metabolic acidosis take precedence.

D. Dehydration: Dehydration alone does not necessitate dialysis. However, the overdose, metabolic acidosis, and renal impairment are the critical reasons for initiating dialysis.

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Correct Answer is A

Explanation

A. Laxatives are contraindicated in clients who have a small bowel obstruction. Laxatives such as senna are contraindicated in bowel obstructions because they can increase peristalsis and exacerbate the blockage, leading to complications like bowel perforation or ischemia.

B. Bulk-forming laxatives such as psyllium should be substituted for this client: Bulk-forming laxatives like psyllium would not be appropriate either because they rely on bowel movement for efficacy. They could worsen the obstruction by adding bulk.

C. An osmotic laxative, such as magnesium citrate, should be substituted in this client: Osmotic laxatives, like magnesium citrate, are also contraindicated in bowel obstruction because they draw water into the bowel, which can worsen distension and pressure on the obstructed area.

D. The prescribed medication should be administered via NG route rather than the oral route for this client: While NG tubes may be used to decompress the bowel in cases of obstruction, administering a laxative through an NG tube would still be contraindicated, as laxatives increase the risk of further complications in bowel obstruction.

A. "You will need to avoid high-fiber foods to prevent blockages. B. The output from your stoma will be mostly liquid." C. "You will need to change your colostomy bag every 24 hours." D. “Your stoma will be located on the left side of your abdomen."

Correct Answer is D

Explanation

A. "You will need to avoid high-fiber foods to prevent blockages": While caution with high-fiber foods may be needed initially, long-term, a balanced diet including fiber can help regulate bowel movements and prevent constipation. This statement could cause unnecessary concern.

B. "The output from your stoma will be mostly liquid": This statement is incorrect for a sigmoid colostomy, where the stool tends to be more formed since it is further along the digestive tract. Liquid output is more common with ileostomies or colostomies higher in the colon.

C. "You will need to change your colostomy bag every 24 hours":
Rationale: Colostomy bag changes depend on several factors, including the type of appliance and personal preferences. Bags are not changed on a strict 24-hour schedule but are emptied as needed and changed every few days or when required.

D. "Your stoma will be located on the left side of your abdomen." A sigmoid colostomy is typically located on the left lower quadrant of the abdomen, as this is the anatomical location of the sigmoid colon.

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Naxlex Comprehensive Predictor Exams

A nurse is reviewing medications for a client who has just been diagnosed with a small bowel obstruction. The nurse should withhold senna prescribed orally based on understanding of which of the following?

Correct Answer is A

Explanation

A nurse is assisting with teaching a client who is preoperative for a sigmoid colostomy. Which of the following statements should the nurse include?

Correct Answer is D

Explanation

A male patient presents with complaints of chronic stomach pain and is diagnosed with a Helicobacter pylori infection. The physician decides to initiate triple therapy. Which combination of medications is most appropriate for this treatment?

A nurse is caring for a client admitted for renal calculus. Which of the following assessment findings should the nurse associate with renal calculi? (Select All that Apply.)

A nurse is assessing a client who has advanced cirrhosis. Which of the following manifestation should the nurse expect to find?

A patient undergoing chemotherapy reports painful oral ulcers, difficulty eating, and a metallic taste in the mouth. The nurse suspects stomatitis. Which nursing intervention is most appropriate for this patient?

A nurse is assessing an older adult client who has a urinary tract infection (UTI). Which of the following findings should the nurse identify as unique for this age group?

A patient with a history of ulcerative colitis presents to the clinic with complaints of fatigue, dizziness, and pallor. Upon further assessment, you suspect chronic blood loss. Which potential complication is most likely contributing to these symptoms?

A female patient recently underwent a partial gastrectomy and is now presenting with symptoms of weakness, dizziness, and sweating, particularly after meals. Based on these symptoms, what is the most likely diagnosis?