The nurse is caring for a client.

For each assessment finding, click to specify if the assessment finding is consistent with pulmonary embolism, pneumonia, or pneumothorax. Each finding may support more than 1 disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row.

Rationale:

A. A dry cough is not a common adverse effect of sertraline. Dry cough is more often associated with medications such as ACE inhibitors (e.g., lisinopril), not selective serotonin reuptake inhibitors (SSRIs).

B. Increased urinary frequency is not a typical adverse effect of sertraline. While SSRIs can occasionally affect urinary function, urinary frequency is not a common or expected finding with this medication.

C. A metallic taste (dysgeusia) is not a characteristic adverse effect of sertraline. This symptom is more commonly associated with medications such as metronidazole or certain antibiotics.

D. Excessive sweating (diaphoresis) is a known adverse effect of sertraline and other SSRIs. It occurs due to increased serotonin activity affecting thermoregulation in the hypothalamus. Clients may report night sweats or generalized increased sweating, which should be monitored but is usually not life-threatening.

Rationale:

A. In chronic kidney disease (CKD), hemoglobin levels are typically decreased, not increased. The kidneys normally produce erythropoietin, a hormone that stimulates the bone marrow to produce red blood cells. When kidney function declines, erythropoietin production drops, leading to reduced red blood cell production and anemia of chronic disease. Clients may present with fatigue, pallor, and reduced oxygen-carrying capacity.

B. CKD is associated with hypocalcemia (low calcium levels) rather than increased calcium. This occurs because the kidneys are unable to convert vitamin D into its active form (calcitriol), which is necessary for calcium absorption in the intestines. In addition, phosphate retention occurs in CKD, and excess phosphate binds with calcium, further lowering serum calcium levels. Over time, this imbalance can lead to renal bone disease (renal osteodystrophy).

C. CKD commonly leads to metabolic acidosis, meaning bicarbonate levels are typically decreased, not increased. The kidneys are unable to excrete hydrogen ions effectively or regenerate sufficient bicarbonate to buffer acids. This results in acid buildup in the blood, which may contribute to symptoms such as fatigue, rapid breathing (Kussmaul respirations in severe cases), and bone demineralization.

D. Creatinine is a waste product generated from normal muscle metabolism and is excreted almost entirely by the kidneys. In CKD, the glomerular filtration rate (GFR) decreases, meaning the kidneys cannot effectively filter and eliminate creatinine. As a result, serum creatinine levels rise, making it one of the most important and reliable indicators of declining kidney function. Elevated creatinine often correlates with worsening CKD stage and is used alongside blood urea nitrogen (BUN) to monitor disease progression and renal impairment severity.