You are seeing a type 2 diabetic with stage 3 CKD, creatinine clearance of 34 ml/min/M2, potassium of 5.7 mg/dl, and bicarbonate of 19 mg/dl. This is consistent with which of the following?

Correct Answer: D

Rationale: Type 4 RTA is characterized by hyperkalemia and metabolic acidosis, common in CKD due to impaired aldosterone function or response.

Correct Answer: D

Rationale: The QRS of the premature complex is prolonged (greater than 0.10 second) and bizarre in appearance. Paroxysmal atrial tachycardia does not display a QRS complex that is greater than 0.10 seconds. Supraventricular tachycardia does not display a wide QRS complex. Escape rhythms may have a P wave that is inverted and located before, during, or after the QRS.

Correct Answer: D

Rationale: Left-sided systolic dysfunction is characterized by a reduced ejection fraction (typically <40%, as in A) and symptoms like nocturnal paroxysmal dyspnea (C) due to pulmonary congestion. An ejection fraction of 65% (B) is normal.

Correct Answer: C

Rationale: For the prevention of hypertension, the Dietary Approaches to Stop Hypertension(DASH) recommendations include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not part of the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.

Correct Answer: C

Rationale: Norepinephrine, a sympathetic neurotransmitter, increases both heart rate (chronotropic effect) and contractility (inotropic effect).