Liver And Biliary
Right upper-quadrant pain follows a fatty meal and radiates to the right scapula; nausea is present. This biliary disorder is most likely.
What is symptomatic cholelithiasis with possible cholecystitis?
A client with untreated hyperthyroidism develops fever, severe tachycardia, agitation, vomiting, and heart failure findings after infection. This emergency is most likely.
What is thyroid storm?
Symmetric MCP and PIP swelling, morning stiffness lasting more than an hour, fatigue, and improvement with gentle movement support this diagnosis.
What is rheumatoid arthritis?
Ten days after chemotherapy, a client with a low neutrophil count reports a temperature of 38.0 C. This condition must be treated as an emergency.
What is febrile neutropenia?
After a needlestick involving possible hepatitis B exposure, this information about the exposed person and source most directly guides postexposure management.
What are hepatitis B immunity status and source antigen information?
Jaundice is accompanied by dark urine, pale stools, pruritus, and elevated conjugated bilirubin. This mechanism best explains the pattern.
What is extrahepatic biliary obstruction reducing bile flow to the intestine?
After thyroid surgery, perioral tingling, carpal spasm, and a prolonged QT interval develop. This electrolyte problem is the priority hypothesis.
What is acute hypocalcemia from impaired parathyroid function?
A client with systemic lupus develops proteinuria, RBC casts, rising creatinine, and edema without dysuria. This complication is most likely.
What is lupus nephritis?
During a vesicant infusion, the client reports burning; swelling appears and blood return is absent. This is the first nursing action.
What is stop the infusion while leaving the catheter in place for protocol-directed management?
A client seeks care soon after a possible HIV exposure and also reports ongoing future exposure risk. These two prevention strategies address the different time frames.
What are PEP for the recent exposure and PrEP planning for ongoing risk?
Lactulose improves a client's mentation, but eight watery stools occur in one day with falling potassium and orthostasis. This treatment problem now requires reassessment.
What is excessive lactulose effect causing fluid and electrolyte loss?
Postural hypotension, sodium 129 mEq/L, potassium 5.6 mEq/L, weight loss, and hyperpigmentation occur together. This endocrine mechanism best fits the pattern.
What is primary adrenal insufficiency with mineralocorticoid deficiency?
A client with systemic sclerosis develops abrupt severe hypertension, headache, rising creatinine, and new proteinuria. This emergency is most likely.
What is scleroderma renal crisis?
After treatment of a high-burden malignancy, potassium, phosphate, and uric acid rise while calcium falls and creatinine increases. This syndrome best explains the pattern.
What is tumor lysis syndrome?
A client receiving radioiodine asks how to protect household members. This principle guides the temporary home precautions.
What is limit close and prolonged radiation exposure according to dose-specific instructions?
Several hours after ERCP, a client develops severe epigastric pain radiating to the back, persistent vomiting, and rising lipase. This complication is most likely.
What is post-ERCP pancreatitis?
A client taking long-term high-dose glucocorticoids develops hyperglycemia, thin skin, proximal weakness, and recurrent infection. This iatrogenic syndrome is most likely.
What is glucocorticoid-induced Cushing syndrome?
Medication reconciliation shows methotrexate listed as daily in one record and weekly in another. This is the nurse's action before another dose is given.
What is hold and clarify the dosing frequency?
Bone pain, anemia, renal dysfunction, hypercalcemia, and a monoclonal protein occur together. This hematologic malignancy is most likely.
What is multiple myeloma?
A proposed cancer treatment could extend life but may prevent attendance at an event the client identifies as the main goal. This process should guide the treatment decision.
What is shared decision-making that aligns clinical options with the client's stated goal?
Aminotransferases fall, but INR rises, glucose falls, bilirubin increases, and mentation worsens. This interpretation best describes the liver trend.
What is worsening hepatic failure despite falling injury enzymes?
A client with adrenal insufficiency has vomiting, cannot take oral steroids, and develops hypotension, confusion, hyponatremia, hyperkalemia, and hypoglycemia. This emergency treatment is expected.
What is immediate IV hydrocortisone with isotonic fluid and glucose support?
A client taking a strongly immunosuppressive glucocorticoid regimen is scheduled for a live vaccine. This assessment must guide whether and when it can be given.
What is evaluate the degree of immunosuppression and vaccine-specific timing guidance?
A caregiver plans to split oral antineoplastic tablets into an unlabeled pill organizer. This safety step must occur before the plan is used.
What is verify product-specific splitting, handling, storage, and disposal instructions?
A chemotherapy client with neutropenia has fever, BP 84/48, altered mentation, and lactate 4.6 mmol/L. This priority hypothesis drives immediate sepsis treatment.
What is septic shock in a neutropenic client?