A 56-year-old man with progressive, chronic renal impairment is awaiting renal replacement therapy. His treatment includes calcium carbonate tablets, furosemide, irbesartan and amlodipine. He is admitted severely unwell with a BP of 40 by palpation, pulse 112. An ECG shows a broad complex tachycardia with no P waves. Serum Ca2+ is 2.3 mmol/L, PO4 1.7 mmol/L, creatinine 785 μmol/L, Na+ 142 mmol/L, K+ 7.4 mmol/L. Which of the following would be appropriate management?

Correct Answer: C

Rationale: Severe hyperkalemia (K+ 7.4 mmol/L) in renal failure causes broad complex tachycardia, risking arrest. Amiodarone treats arrhythmias but not hyperkalemia's cause. Digoxin is contraindicated in hyperkalemia and renal failure. IV calcium gluconate stabilizes cardiac membranes, countering potassium's depolarizing effect, appropriate immediate management. Pacing or colestyramine (potassium binder) are secondary. Calcium's rapid action protects the heart, buying time for dialysis, critical in this life-threatening scenario.

Correct Answer: D

Rationale: Schizophrenia involves positive symptoms (e.g., hallucinations) and negative symptoms (e.g., apathy, withdrawal). The patient's quiet demeanor, lack of responsiveness, and disinterest align with negative symptoms, which diminish normal behaviors like motivation or social engagement. Depression might present similarly but isn't assumed without further evidence like sadness or hopelessness. Hearing voices suggests positive symptoms, but the scenario lacks indicators like distractedness. Positive symptoms involve added behaviors (e.g., delusions), not subtraction, as seen here. The nurse interprets this based on schizophrenia's symptomology, recognizing negative symptoms as a core feature, making choice D the most accurate clinical interpretation.

Correct Answer: A

Rationale: Phenytoin is an antiepileptic medication that can induce hepatic enzymes, which can lead to a decrease in the effectiveness of hormonal contraceptives, including birth control pills. This interaction can increase the risk of unintended pregnancy. Therefore, it is important for the client to be advised about the decreased effectiveness of birth control pills while on phenytoin therapy and discuss alternative contraceptive options with her healthcare provider.

Correct Answer: C

Rationale: One major side effect to monitor in a patient taking Lithium for bipolar I disorder is the risk of seizures. Lithium is known to lower the seizure threshold, increasing the likelihood of seizures occurring, especially if the patient has any pre-existing risk factors for seizures. Therefore, it is critical to closely monitor patients on Lithium for any signs or symptoms of seizures and promptly address them if they occur to prevent any complications. Monitoring lithium levels and maintaining them within the therapeutic range can also help reduce the risk of seizures.

Correct Answer: D

Rationale: The correct information to include when discussing possible adverse effects of beta blockers with a patient who has type II diabetes and hyperthyroidism is to "Monitor your blood glucose levels for possible hypoglycemia or hyperglycemia." Beta blockers can mask the signs of hypoglycemia (low blood sugar) in patients with diabetes by suppressing the sympathetic nervous system response to low blood sugar. This can lead to a delay in recognizing and treating hypoglycemia, which can be dangerous for diabetic patients. Additionally, beta blockers can also affect glucose metabolism and potentially worsen hyperglycemia in patients with diabetes. Therefore, close monitoring of blood glucose levels is essential to manage these potential adverse effects and adjust the treatment regimen as needed.