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 D

Explanation

A. The glomerular filtration rate decreases because inflammatory cells invade the already damaged kidneys: Inflammation is not the primary mechanism of decreased GFR in ATN. It is more related to cellular damage and dysfunction.

B. The glomerular filtration rate decreases because there is a reduction of blood flow to the kidneys: While reduced blood flow can contribute to acute kidney injury, the ongoing decline in GFR in ATN is due to tubular damage, not ongoing ischemia.

C. The glomerular filtration rate decreases because there is obstruction leading to the filtration system backing up and eventually shutting the kidneys down: Obstruction is not the key issue in ATN; rather, it’s the tubular cell injury that disrupts filtration.

D. The glomerular filtration rate decreases because there is injury to the renal tubular cells. Acute tubular necrosis (ATN) involves damage to the renal tubular cells, which disrupts the ability of the nephrons to filter blood efficiently. This cellular injury is the primary cause of the decline in glomerular filtration rate (GFR) in ATN.

A. Apply a heating pad to the abdomen B. Administer a cleansing enema C. Administer oral analgesics as needed D. Place the patient on NPO status

Correct Answer is D

Explanation

A. Apply a heating pad to the abdomen: This is incorrect and potentially harmful, as applying heat to the abdomen can increase blood flow and worsen inflammation or risk rupture of the appendix.

B. Administer a cleansing enema: Enemas should not be administered for suspected appendicitis as they may cause irritation and increase the risk of perforation.

C. Administer oral analgesics as needed: Oral analgesics are contraindicated since the patient should be NPO, and strong pain relief might mask the symptoms of a ruptured appendix.

D. Place the patient on NPO status: The highest priority preoperative intervention is to place the patient on NPO (nothing by mouth) status to prevent aspiration during anesthesia, a standard preoperative practice, especially for abdominal surgeries.

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

A patient with suspected appendicitis is being prepared for surgery. Which of the following preoperative interventions should the nurse prioritize?

Correct Answer is D

Explanation

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