A 56-year-old patient comes to the walk-in clinic for scant rectal bleeding and intermittent diarrhea and constipation for the past several months. There is a history of polyps and a family history for colorectal cancer. While you are trying to teach about colonoscopy, the patient becomes angry and threatens to leave. What is the priority diagnosis?

Correct Answer: D

Rationale: In this scenario, the priority diagnosis is option D) Anxiety related to unknown outcomes and perceived threats to body integrity. Anxiety is the most immediate concern as the patient's emotional state is hindering their ability to engage in a necessary discussion about colonoscopy. Addressing the patient's anxiety is crucial to establish effective communication and ensure they understand the importance of diagnostic procedures for their health. Option A is incorrect because while altered bowel patterns are a concern, the patient's emotional state takes precedence. Option B is incorrect as the patient's knowledge deficit is secondary to addressing their anxiety. Option C is incorrect as fluid volume deficit, though important, is not the immediate priority in this situation. Educationally, it is essential to recognize the impact of a patient's emotional state on their willingness to engage in healthcare discussions and procedures. Understanding and addressing patients' anxieties and fears is crucial for effective patient-centered care and promoting positive health outcomes.

Correct Answer: A

Rationale: In monitoring patients at risk for spinal cord compression due to tumor growth, the most likely early manifestation is sudden-onset back pain (Option A). This is because as the tumor grows and exerts pressure on the spinal cord or nerve roots, it can cause pain due to inflammation, nerve compression, or stretching of structures. Motor loss (Option B) typically occurs as the compression progresses and affects the nerve pathways responsible for motor function. Constipation (Option C) and urinary hesitancy (Option D) are commonly seen in later stages of spinal cord compression when the tumor impairs the autonomic functions controlling bowel and bladder movements. From an educational standpoint, understanding these early signs and symptoms is crucial for timely intervention and prevention of permanent neurological deficits in patients at risk for spinal cord compression. Nurses and healthcare providers need to be vigilant in assessing for sudden-onset back pain and other neurological changes to promptly address any emerging issues.

Correct Answer: B

Rationale: In the context of a patient undergoing chemotherapy and being monitored for tumor lysis syndrome, electrolytes require particular attention. Tumor lysis syndrome is characterized by a rapid release of intracellular contents into the bloodstream, leading to metabolic disturbances, including hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia. Monitoring electrolyte levels is crucial to detect and manage these imbalances promptly to prevent complications like cardiac arrhythmias, renal failure, and seizures. Platelet count, hemoglobin, and hematocrit are important parameters to monitor in cancer patients undergoing chemotherapy, but they are not specifically indicative of tumor lysis syndrome. Platelet count is essential for assessing bleeding risk, while hemoglobin and hematocrit levels provide information about the patient's oxygen-carrying capacity. However, in the context of tumor lysis syndrome, electrolyte abnormalities are a more immediate concern due to their potential to cause life-threatening complications. Educationally, understanding the significance of electrolyte monitoring in tumor lysis syndrome highlights the importance of recognizing and managing oncologic emergencies. It emphasizes the need for vigilant assessment and intervention to prevent serious consequences associated with metabolic imbalances in these high-risk patients. This knowledge is essential for nurses and healthcare providers caring for oncology patients to ensure timely and appropriate interventions.

Correct Answer: B

Rationale: The correct answer is Weakness, dizziness, abdominal distention, nausea, vomiting, and diarrhea (B). Hypernatremia occurs when there is an excess of sodium in the body, often due to dehydration or excessive salt intake. Symptoms include gastrointestinal disturbances, neurological symptoms like confusion and dizziness, and muscle weakness.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Water restriction. Hyponatremia is a condition characterized by low sodium levels in the blood, often caused by excessive water intake without adequate electrolyte replenishment. Ecstasy, a drug that can lead to dehydration and electrolyte imbalances, likely contributed to Rob's hyponatremia. Water restriction helps manage hyponatremia by preventing further dilution of sodium levels in the blood. Option B) 0.33% sodium chloride intravenously is incorrect because adding more sodium without restricting water intake can exacerbate hyponatremia. Option C) Use of salt substitute is incorrect as it may not provide the appropriate balance of electrolytes needed to correct hyponatremia. Option D) Calcium carbonate orally is unrelated to treating hyponatremia and would not address the underlying electrolyte imbalance. From an educational perspective, this question highlights the importance of understanding the relationship between drug use, electrolyte imbalances, and appropriate treatment interventions. It emphasizes the need for healthcare providers to assess both the clinical presentation and underlying causes of electrolyte abnormalities to provide effective care for patients like Rob.