The nurse is caring for a client with a long-term diagnosis of ulcerative colitis. For what potentially life-threatening complication would the nurse monitor?

Lower gastrointestinal (Gl) bleed

Hyperkalemia

Metabolic acidosis

Chronic kidney disease

Answer and Explanation

The Correct Answer is A

A. Lower gastrointestinal bleeding is a life-threatening complication due to the potential for massive hemorrhage from ulcerated colonic mucosa. This can lead to hypovolemic shock if the blood loss is rapid and significant. The nurse must monitor for hematochezia, decreasing hemoglobin and hematocrit levels, and signs of tachycardia to identify this emergency early.

B. Hyperkalemia is not a typical finding in ulcerative colitis; instead, patients are at high risk for hypokalemia. Frequent diarrheal stools result in the excessive loss of potassium through the gastrointestinal tract. Monitoring for high potassium would be inappropriate as the clinical focus should be on replacing the electrolytes lost during frequent, watery, or bloody bowel movements.

C. While metabolic acidosis can occur in cases of severe, chronic diarrhea due to bicarbonate loss, it is rarely the most immediate life-threatening concern. Hemorrhage and toxic megacolon are more urgent priorities in UC management. Acid-base imbalances are secondary consequences of the primary inflammatory and hemorrhagic events that threaten the patient's immediate physiological stability.

D. Chronic kidney disease is not a direct or standard complication of ulcerative colitis. While some extra-intestinal manifestations occur, the primary life-threatening risks are localized to the gastrointestinal system and the systemic effects of inflammation or infection. There is no direct pathophysiological link between colonic inflammation and the long-term progression of end-stage renal failure.

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Correct Answer is C

Explanation

GERD can lead to severe extra-esophageal complications if gastric refluxate reaches the upper airway. During sleep, the protective laryngeal reflexes are diminished, allowing for the microaspirationof acid into the trachea and lungs. This can cause laryngospasm, chronic cough, and nocturnal asthma-like symptoms. Identifying these occurrences is critical to prevent permanent pulmonary damage and to screen for Barrett's esophagus.

Rationale:

A.Reporting the use of lean cuts of meat is a positive finding that indicates the patient is following dietary recommendations to manage their GERD. Lean meats reduce the fat load in the stomach, which helps prevent delayed gastric emptying and minimizes the risk of reflux. This is a sign of effective self-management rather than an alarming finding for the provider.

B.Quitting smoking is a significant health achievement that improves GERD symptoms because nicotine is a known relaxant of the lower esophageal sphincter. This information should be documented as a positive behavioral change in the patient's history. It does not represent a new or worsening complication that requires an urgent medical report or intervention.

C.The nurse must report "waking up gasping for air" because it suggests nocturnal aspirationof gastric contents. This is a serious complication of GERD where acid enters the airway, potentially causing aspiration pneumoniaor bronchospasm. This finding indicates that the patient's GERD is not well-controlled and poses a significant risk to their respiratory health and airway patency.

D.Eating small, frequent meals is a recommended lifestyle modification for GERD. This practice prevents excessive gastric distention, which reduces the pressure against the lower esophageal sphincter and decreases the volume of acid available for reflux. This finding shows the patient is adhering to appropriate non-pharmacological management strategies and is not a cause for medical concern.

A. The client's urine specific gravity is 1.048. B. The client’s blood pressure is 152/88 mm Hg. C. The client lost 11 lb (5 kg) in the past 10 days. D. No blood is observed in the client’s urine

Correct Answer is C

Explanation

Acute glomerulonephritisis an inflammatory condition of the glomerular capillaries, often following a streptococcal infection. The inflammation reduces the glomerular filtration rate(GFR), leading to the retention of sodium and water, which causes systemic edema and hypertension. A positive response to treatment is indicated by the resolution of this fluid volume excess as the glomerular basement membranebegins to heal and resume normal filtration.

Rationale:

A.A urine specific gravity of 1.048 is abnormally high (normal is 1.005 to 1.030) and indicates extremely concentrated urine. This usually signifies dehydration or the presence of excess solutes like protein and glucose. In the context of GN, it does not indicate healing; rather, it suggests that the kidney is still struggling to produce an appropriate volume of filtrate.

B.A blood pressure of 152/88 mm Hg is hypertensive and indicates that the disease process is still causing significant fluid retention and vascular resistance. Hypertension is a key symptom of GN due to the activation of the renin-angiotensin systemand fluid overload. A positive response to treatment would be a return of blood pressure toward the normal range of <120/80 mm Hg.

C.Losing 11 lb (5 kg)over 10 days is a positive response because it indicates the mobilization and excretion of excess fluid. In GN, weight gain is caused by edema and fluid retention. As the glomerular inflammation subsides and diuresis occurs, the patient will lose this excess water weight. This is the most objective evidence that the kidneys are regaining their filtration capacity.

D.While the absence of gross hematuria is good, microscopic hematuria can persist for many months after an episode of acute GN and does not necessarily mean the acute phase is over. Weight loss and blood pressure stabilization are more immediate and reliable indicators of the resolution of fluid volume excess, which is the most dangerous acute complication of the condition.

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The nurse is caring for a client with a long-term diagnosis of ulcerative colitis. For what potentially life-threatening complication would the nurse monitor?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assessing a client who reports having a history of gastroesophageal reflux disease (GERD). Which assessment finding does the nurse report to the primary health care provider?

Correct Answer is C

Explanation

A nurse evaluates a client with acute glomerulonephritis (GN). Which assessment finding would the nurse recognize as a positive response to the prescribed treatment?

Correct Answer is C

Explanation

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