The nurse is caring for the following clients. Which client should the nurse assess first?

A 60-year-old client who has end-stage renal disease with a creatinine of 5.1

A 50-year-old client who has chronic pancreatitis and is reporting a pain level of 6 out of 10

A 54-year-old client with cirrhosis and jaundice who is reporting itchiness and drowsiness

A 47-year-old client with esophageal varices and influenza and has been coughing for 30 minutes

Answer and Explanation

The Correct Answer is D

Choice A reason: Creatinine 5.1 in ESRD is chronic, not acute, and stable unless symptomatic; it’s less urgent than potential bleeding risks in other clients.

Choice B reason: Pain (6/10) in pancreatitis is significant but not immediately life-threatening compared to airway or bleeding risks, manageable with scheduled interventions.

Choice C reason: Itchiness and drowsiness in cirrhosis suggest liver dysfunction, concerning but not acute threats like variceal rupture, prioritizing more critical symptoms.

Choice D reason: Coughing with esophageal varices risks rupture and massive bleeding, a life-threatening emergency, making this client the priority for immediate assessment.

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Correct Answer is A

Explanation

Choice A reason: Donepezil treats Alzheimer’s by inhibiting cholinesterase, boosting acetylcholine for cognition. Lupus, an autoimmune disease, doesn’t involve dementia primarily, so this drug lacks relevance to its management.

Choice B reason: Prednisone, a corticosteroid, suppresses inflammation and immune response in lupus, reducing joint pain and organ damage from autoantibody activity, making it a standard treatment.

Choice C reason: Hydroxychloroquine modulates immunity and reduces lupus flares by stabilizing lysosomes and decreasing autoantibody production, directly addressing its autoimmune pathology.

Choice D reason: Methotrexate, an immunosuppressant, inhibits folate metabolism, curbing immune cell proliferation in lupus, effectively managing severe symptoms like arthritis or organ involvement.

A. Emphysema B. Peripheral vascular disease C. Heart failure D. Bronchitis

Correct Answer is D

Explanation

Choice A reason: Emphysema destroys alveoli, causing air trapping and dyspnea, but doesn’t involve excessive mucus production, focusing on structural loss, not glandular activity.

Choice B reason: Peripheral vascular disease impairs arterial flow, causing ischemia and pain, not affecting airways or mucus glands, unrelated to respiratory secretions.

Choice C reason: Heart failure leads to fluid in alveoli (edema), causing crackles, but not excessive mucus, as it’s a circulatory, not inflammatory airway issue.

Choice D reason: Bronchitis inflames bronchial tubes, overactivating goblet cells to produce excess mucus, leading to productive cough, a hallmark of this condition.

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