Correct Answer: D

Rationale: The clinical presentation of a patient with chronic kidney disease (CKD) presenting with weakness, anorexia, confusion, severe anemia, low reticulocyte count, elevated serum creatinine, and decreased erythropoietin levels is most consistent with renal failure-associated anemia. In CKD, the kidneys are unable to produce adequate amounts of erythropoietin, a hormone responsible for stimulating red blood cell production in the bone marrow. The decreased erythropoietin levels lead to a state of anemia, characterized by low hemoglobin levels and subsequent symptoms of fatigue and weakness. The anemia in renal failure is typically normocytic and normochromic. Additionally, the elevated serum creatinine in this patient is a hallmark of kidney dysfunction.

Correct Answer: B

Rationale: Acetaminophen (Tylenol) is given pre-operatively to decrease intra-operative anesthetic requirements and post-operative pain. It is a common analgesic that can help reduce the amount of intra-operative anesthesia needed and provide some pain relief during the surgery. Unlike drugs like Celebrex, Ibuprofen, and Demerol, Acetaminophen does not have anti-inflammatory properties, but it is effective in managing pain and can contribute to overall pain control before, during, and after surgery. This makes it a preferred choice for pre-operative medication in order to decrease the need for higher doses of anesthetics and reduce post-operative pain levels.

Correct Answer: C

Rationale: Neuman's adaptation model, also known as the Neuman Systems Model, is a nursing theory that focuses on how individuals respond to stressors in their environment. The model views individuals as being in a constant state of dynamic equilibrium, where they are interacting with stressors that can disrupt their normal functioning. Nursing care, according to this model, is aimed at helping individuals maintain or restore their optimal level of wellness by assisting them in adapting to these stressors. Therefore, Nurse Sandy's selection of a framework that emphasizes the constant relationship between humans and stressors in the environment aligns best with Neuman's adaptation model.

Correct Answer: C

Rationale: In a pregnant patient with suspected pulmonary embolism (PE), the most appropriate imaging modality for evaluation is contrast-enhanced computed tomography (CT) pulmonary angiography. This imaging technique has been shown to be safe for the fetus when necessary, especially if the benefits of making a diagnosis outweigh the minimal risks associated with radiation exposure. It provides quick and accurate detection of PE with high sensitivity and specificity.

Correct Answer: A

Rationale: The most appropriate intervention for managing hepatic encephalopathy in this patient receiving palliative care for end-stage liver disease is to administer lactulose or other ammonia-lowering agents to reduce ammonia levels. Hepatic encephalopathy is believed to be primarily caused by the accumulation of ammonia in the bloodstream due to compromised liver function. Lactulose works by acidifying the gut lumen, which facilitates the excretion of ammonia in the form of ammonium ions. By reducing ammonia levels, hepatic encephalopathy symptoms, such as confusion and altered mental status, can be improved. Initiating other supportive measures like managing precipitating factors, maintaining hydration, and addressing nutritional issues should also be part of the holistic approach in managing hepatic encephalopathy in palliative care. However, addressing the underlying cause by reducing ammonia levels with lactulose is the priority intervention in this scenario.