A patient with chronic kidney disease presents with fatigue, dyspnea on exertion, peripheral edema, and hypertension. Laboratory findings reveal elevated serum creatinine and urea levels, metabolic acidosis, and hyperkalemia. What is the most appropriate initial management for this patient?

Correct Answer: B

Rationale: The most appropriate initial management for the patient described is hemodialysis. Hemodialysis is essential for managing chronic kidney disease with severe symptoms and electrolyte imbalances like hyperkalemia and metabolic acidosis. Hemodialysis helps to remove urea and creatinine from the blood, correct electrolyte abnormalities, and improve symptoms such as fatigue, dyspnea, and peripheral edema. Initiation of ACE inhibitor therapy (Choice A) is contraindicated in severe kidney disease due to the risk of worsening renal function. Intravenous administration of calcium gluconate (Choice C) is used for acute hyperkalemia with cardiac toxicity, not for initial management. Sodium bicarbonate administration (Choice D) may help correct metabolic acidosis, but it does not address the underlying cause or the need for urgent renal replacement therapy.

Correct Answer: B

Rationale: The correct answer is B: Relieves pain by increasing pain threshold. Meperidine and codeine are opioid analgesics that work by binding to opioid receptors in the brain and spinal cord, thus increasing the pain threshold and reducing the perception of pain. This leads to pain relief without necessarily affecting sexual stimulation (choice A), craving for alcohol (choice C), or concentration/alertness (choice D). The primary physiological effect of these drugs is to modulate the perception of pain, making choice B the most appropriate answer in this context.

Correct Answer: C

Rationale: The correct answer is C because encouraging the patient to ask questions and express concerns promotes patient empowerment and active participation in self-care. This approach fosters communication, understanding, and collaboration between the nurse and patient, leading to better medication adherence. Choice A is incorrect as it lacks patient involvement. Choice B is helpful but does not necessarily empower the patient. Choice D is directive and does not encourage active participation or empowerment.

Correct Answer: B

Rationale: The correct answer is B: Acute myocardial infarction (MI) is the most common cause of cardiogenic shock. During an MI, there is significant damage to the heart muscle, leading to a decrease in cardiac output and subsequent shock. This results in inadequate tissue perfusion and oxygen delivery. Choices A, C, and D are incorrect because decreased hemoglobin level (A) may lead to anemia but is not the most common cause of cardiogenic shock. Hypotension (C) is a symptom of shock, not the cause. Coronary artery disease (D) is a risk factor for MI but not the direct cause of cardiogenic shock.

Correct Answer: C

Rationale: The scenario described in the question is consistent with acute cholecystitis, which is inflammation of the gallbladder usually caused by an impacted gallstone in the cystic duct. The key clinical features of acute cholecystitis include fever, chills, right upper quadrant abdominal pain (which can be localized to the right upper quadrant), tenderness in the right upper abdomen, and a positive Murphy's sign (pain and inspiratory arrest upon palpation of the right upper quadrant). This condition is more common in pregnant women due to hormonal changes that can lead to gallstone formation and subsequent inflammation of the gallbladder. Ectopic pregnancy, pelvic inflammatory disease, and ovarian torsion typically present with different clinical features compared to those described in acute cholecystitis.

Correct Answer: A

Rationale: The correct answer is A: Rotator cuff tear. The presentation of acute shoulder pain and limited range of motion after a fall onto an outstretched hand, along with tenderness over the greater tuberosity and pain with passive abduction and external rotation, is classic for a rotator cuff tear. The mechanism of injury and physical exam findings are consistent with this condition. B: Glenohumeral dislocation typically presents with a visibly deformed shoulder and loss of normal shoulder contour. C: Acromioclavicular joint separation would present with tenderness over the AC joint rather than the greater tuberosity, and typically involves a history of direct trauma to the shoulder. D: Proximal humerus fracture would present with more diffuse shoulder pain and swelling, and not specific tenderness over the greater tuberosity.

Correct Answer: A

Rationale: Correct Answer: A: To help control the intra-ocular pressure Rationale: 1. Eye surgery can lead to increased intra-ocular pressure. 2. Instilling eye drops can help reduce this pressure post-surgery. 3. Controlling intra-ocular pressure is crucial for proper healing and preventing complications. 4. Eye drops for infection (B) or pupil dilation/constriction (C, D) are not primary concerns post-eye surgery.

Correct Answer: D

Rationale: The correct answer is D: Transporting the patient to a medical facility for antivenom administration. This is recommended because antivenom is the definitive treatment for snakebites. Tourniquets (choice A) can worsen tissue damage and should be avoided. Elevating the limb (choice B) may not prevent venom spread. Making an incision (choice C) can lead to infection and increased venom absorption. Antivenom administration at a medical facility is crucial for proper management of snakebites.

Correct Answer: B

Rationale: The correct initial step before starting TPN is to evaluate the patient's tolerance to glucose. This is crucial to ensure the patient can metabolize the glucose effectively and avoid complications such as hyperglycemia. Assessing affordability (A) is important but not the immediate concern. Identifying allergies (C) should be done but is not the first step. Assessing the patient's understanding (D) is important but not as critical as evaluating glucose tolerance before starting TPN.