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 A
Explanation
Dexamethasone is a potent corticosteroid used to reduce cerebral edema in brain tumor patients. Prioritizing care requires identifying life-threatening neurological changes or severe medication side effects, applying knowledge of intracranial pressure, glucose metabolism, and the hierarchy of clinical needs.
Choice A rationale
Acute loss of orientation to self indicates a significant decline in neurological status or increased intracranial pressure. This is a medical emergency requiring immediate intervention to prevent brain herniation, outweighing stable physical side effects of steroid therapy.
Choice B rationale
Weight gain is a common side effect of long-term dexamethasone use due to fluid retention and increased appetite. While it requires monitoring, it is an expected systemic effect and does not represent an immediate life-threatening crisis.
Choice C rationale
Insomnia is a known side effect of corticosteroids because they can interfere with the circadian rhythm and stimulate the central nervous system. It affects the client's comfort but does not indicate immediate physiological or neurological compromise.
Choice D rationale
Glucocorticoids cause hyperglycemia; 350 mg/dL is high compared to the normal fasting range of 70 to 100 mg/dL. While it requires insulin or dosage adjustment, it is less urgent than an acute neurological deficit..
Correct Answer is A
Explanation
Pancreatitis often leads to electrolyte imbalances, specifically hypocalcemia due to fat necrosis and soap formation. Knowledge of cardiac electrophysiology is required to recognize how low calcium levels (normal 8.5 to 10.5 mg/dL) affect the myocardial action potential.
Choice A rationale
Prolonged QT interval is a classic electrocardiogram finding in hypocalcemia. Low serum calcium slows the movement of calcium into the cardiac cells during the plateau phase, thereby lengthening the duration of ventricular depolarization and repolarization cycles.
Choice B rationale
A shortened PR interval is not associated with hypocalcemia. PR interval changes are more frequently linked to pre-excitation syndromes or inflammatory conditions of the heart, rather than the specific electrolyte shifts seen in acute pancreatic inflammation.
Choice C rationale
Peaked T waves are a hallmark sign of hyperkalemia, not hypocalcemia. In hypocalcemia, the T wave may actually appear flattened or inverted, but the most distinctive and supportive finding remains the elongation of the QT interval.
Choice D rationale
Elevated ST segments are typically indicative of myocardial infarction or pericarditis. While electrolyte imbalances can cause various cardiac changes, ST elevation is not the primary diagnostic indicator used to support a suspicion of clinical hypocalcemia.
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