A 65-year-old man presents to the clinic with complaints of swelling in his lower extremities, abdominal discomfort, and weight gain over the past few weeks. On examination, you notice jugular venous distention and hepatomegaly. Which condition is most likely causing these symptoms?

Left-sided heart failure

Right-sided heart failure

Liver cirrhosis

Chronic kidney disease

Answer and Explanation

The Correct Answer is B

Rationale:

A. Typically causes pulmonary symptoms, such as dyspnea, orthopnea, and pulmonary edema, rather than peripheral edema and hepatomegaly.

B. Right-sided HF leads to systemic venous congestion, causing peripheral edema, jugular venous distention, hepatomegaly, and abdominal discomfort. Weight gain from fluid retention is also common.

C. Can cause ascites and hepatomegaly, but usually accompanied by stigmata of chronic liver disease (jaundice, spider angiomas) and not jugular venous distention due to cardiac causes.

D. May cause generalized edema and weight gain, but jugular venous distention and hepatomegaly are less specific, and lab findings (BUN, creatinine) would help distinguish.

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Correct Answer is D

Explanation

Rationale:

A. Although at the upper limit of normal (10–20 mg/dL), BUN alone is not a definitive indicator of AKI. It can be temporarily elevated due to dehydration, high-protein intake, or catabolic states, and must be interpreted alongside creatinine and other clinical findings.

B. This value is within the normal adult range (1.5–2.5 mEq/L). Magnesium levels generally remain stable until more significant kidney dysfunction occurs, so this does not indicate increased AKI risk.

C. This is within the normal range (3.5–5.0 mEq/L). While potassium imbalances can develop in AKI due to impaired excretion, a normal value does not reflect kidney injury.

D. This is elevated above the normal range for adult females (0.6–1.3 mg/dL) and reflects impaired kidney function. After a myocardial infarction, decreased cardiac output can reduce renal perfusion, placing the client at high risk for acute kidney injury. An elevated creatinine in this context warrants close monitoring, potential adjustments to medications, and prompt interventions to prevent further renal damage.

A. 0.9% normal saline IV at 150 mL/hr continuous B. Furosemide 20 mg IV bolus every 12 hr C. Laboratory testing of serum potassium upon admission D. Morphine sulfate 2 mg IV bolus every 4 hr PRN pain

Correct Answer is A

Explanation

Rationale:
A. In acute heart failure, especially following an MI, clients are at risk for fluid volume overload. Administering a relatively large volume of isotonic fluid could exacerbate pulmonary edema and worsen heart failure. This prescription requires clarification with the provider before administration.

B. Furosemide is a loop diuretic commonly prescribed to reduce fluid overload in heart failure. This prescription is appropriate for managing pulmonary congestion and edema.

C. Monitoring electrolytes, particularly potassium, is essential in heart failure patients receiving diuretics. This helps prevent dysrhythmias and is appropriate.

D. Morphine may be used in acute heart failure to relieve anxiety and dyspnea; this prescription is appropriate as ordered.

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A 65-year-old man presents to the clinic with complaints of swelling in his lower extremities, abdominal discomfort, and weight gain over the past few weeks. On examination, you notice jugular venous distention and hepatomegaly. Which condition is most likely causing these symptoms?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is monitoring an older adult female client who had a myocardial infarction (MI) for the development of an acute kidney injury. Which of the following findings should the nurse identify as indicating an increased risk of acute kidney injury (AKI)?

Correct Answer is D

Explanation

A nurse is admitting a client who has acute heart failure following myocardial infarction (MI). The nurse recognizes that which of the following prescriptions by the provider requires clarification?

Correct Answer is A

Explanation

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