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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Instruct the patient to change positions slowly to prevent dizziness and falls. Ascites can cause a shift in fluid balance, leading to orthostatic hypotension. Changing positions slowly reduces the risk of dizziness and falls, which are common in patients with fluid shifts.
B. Advise the patient to avoid all physical activity to prevent exacerbation of symptoms: Complete avoidance of physical activity is not recommended. Mild activity may help with overall health and mobility unless contraindicated. Bedrest is typically only recommended for acute or severe cases.
C. Encourage the patient to drink plenty of fluids to prevent dehydration: Patients with ascites are often on fluid restrictions to manage excess fluid accumulation. Encouraging excess fluid intake can worsen the condition.
D. Recommend wearing tight clothing to support the abdominal area: Tight clothing could cause discomfort and increase abdominal pressure, which could exacerbate symptoms or complications related to ascites.
Correct Answer is B
Explanation
A. "Vomiting blood or material that looks like coffee grounds is a serious sign that I need to go to the emergency room." This is a correct understanding. Vomiting blood or coffee-ground material is a sign of gastrointestinal bleeding and requires immediate medical attention.
B. "If I experience severe abdominal pain, I should take an over-the-counter antacid and rest."
Taking an over-the-counter antacid without contacting a healthcare provider for severe pain could mask serious complications, such as recurrent bleeding or perforation, that need immediate medical attention. This statement indicates a need for further teaching.
C. "I should avoid taking NSAIDs like ibuprofen as they can increase my risk of bleeding." This is a correct understanding, as NSAIDs can cause or worsen gastric ulcers and increase the risk of bleeding.
D. "I should immediately report any black, tarry stools to my healthcare provider."This is a correct understanding. Black, tarry stools (melena) indicate upper gastrointestinal bleeding.
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