A client undergoing chemotherapy develops severe abdominal pain, nausea, and a rapid increase in serum uric acid levels.
What is the most likely diagnosis?
Gastric ulcers.
Tumor lysis syndrome.
Acute kidney injury.
Gastroenteritis.
The Correct Answer is B
This scenario involves metabolic complications following chemotherapy for high-grade malignancies. Knowledge of intracellular electrolyte release, nucleic acid breakdown, and the resulting renal and systemic impacts is required to identify the specific oncological emergency occurring during rapid cell lysis.
Choice A rationale
Gastric ulcers cause abdominal pain and potential bleeding but do not account for a rapid increase in serum uric acid. Uric acid elevation is a systemic metabolic event related to DNA breakdown, whereas ulcers are localized mucosal erosions.
Choice B rationale
Tumor lysis syndrome occurs when chemotherapy causes rapid destruction of malignant cells, releasing intracellular contents. This leads to hyperuricemia, hyperkalemia, and hyperphosphatemia. High uric acid levels (above 6 mg/dL) can cause acute renal failure due to crystal formation.
Choice C rationale
While acute kidney injury may result from tumor lysis syndrome, it is a secondary consequence of the metabolic derangement. The primary diagnosis explaining the constellation of rapid uric acid rise and chemotherapy timing is the lysis syndrome.
Choice D rationale
Gastroenteritis causes nausea and abdominal pain but does not explain the significant metabolic shift of elevated uric acid. It is typically an infectious or inflammatory condition of the digestive tract, not a systemic response to cytotoxic therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Management of full-thickness burns requires precise monitoring and clinical judgment. This scenario evaluates delegation principles, distinguishing between complex assessment or titration tasks reserved for licensed nurses and routine data collection tasks suitable for unlicensed assistive personnel to ensure safe client care.
Choice A rationale
Titration of intravenous fluids requires complex clinical judgment and continuous assessment of hemodynamic status and renal perfusion. This task exceeds the scope of unlicensed personnel as it involves pharmacological management and critical data interpretation.
Choice B rationale
Recording output from an indwelling catheter is a routine, technical task involving data collection without interpretation. Unlicensed personnel are trained to perform non-invasive measurements, making this appropriate for delegation to support nursing workflow.
Choice C rationale
Assessing wounds for infection involves identifying subtle clinical indicators like erythema, exudate, or malodor. This requires specialized nursing knowledge and diagnostic reasoning to differentiate between normal healing and pathological processes in burn patients.
Choice D rationale
Evaluating the effectiveness of analgesics is a key component of the nursing process. It requires reassessing pain levels and monitoring for adverse effects, tasks that necessitate the clinical expertise and accountability of a nurse.
Correct Answer is ["A","B","C","D","E","F"]
Explanation
The scenario requires applying knowledge of anticoagulation pharmacology and safety protocols for pulmonary embolism management. Nurses must monitor therapeutic levels, maintain reversal agents, and assess for complications like bleeding to ensure systemic stability and prevent further clot propagation during recovery.
Choice A rationale
Activated partial thromboplastin time measures the intrinsic pathway of coagulation. It is vital for monitoring unfractionated heparin therapy, with a normal range of 30 to 40 seconds. Prolonged values indicate a higher risk for spontaneous hemorrhage.
Choice B rationale
Protamine sulfate acts as a specific antagonist to neutralize the anticoagulant effects of heparin. Availability is critical for immediate reversal if life threatening bleeding occurs or if the activated partial thromboplastin time exceeds the safe therapeutic range.
Choice C rationale
The international normalized ratio assesses the extrinsic pathway, primarily for warfarin therapy. A normal range for healthy individuals is 0.8 to 1.2, but therapeutic targets for pulmonary embolism typically fall between 2.0 and 3.0.
Choice D rationale
Hematocrit and platelet levels indicate bone marrow function and blood volume. Significant drops in hematocrit suggest internal bleeding, while platelet monitoring is essential to detect heparin induced thrombocytopenia, a serious immune mediated complication of anticoagulant use.
Choice E rationale
Phytonadione, or Vitamin K, is the essential reversal agent for warfarin induced anticoagulation. It promotes the hepatic synthesis of clotting factors 2, 7, 9, and 10, effectively counteracting excessive anticoagulation and reducing the risk of hemorrhage.
Choice F rationale
Continuous physical assessment is necessary to identify early signs of coagulopathy. These include petechiae, ecchymosis, hematuria, or bleeding gums. Early detection allows for prompt dosage adjustments or the administration of reversal agents to prevent clinical deterioration.
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