ATI Custom: AH2- FA25- Exam 3

Explanation
In acute pancreatitis, pancreatic enzymes such as amylase and lipase leak into the bloodstream due to inflammation and autodigestion of the pancreas. Elevated serum amylase is one of the hallmark diagnostic findings, typically rising within hours of symptom onset and remaining elevated for several days. High amylase levels reflect pancreatic injury and help confirm the diagnosis alongside elevated lipase, which is more specific to the pancreas.

Explanation
Explanation of Correct Answers​
A. Fluid restriction​
Fluid restriction is the cornerstone of SIADH management. Since the condition involves excessive release of antidiuretic hormone leading to water retention and dilutional hyponatremia, restricting fluid intake helps correct serum sodium levels and prevent further fluid overload and cerebral edema.
B. Hypertonic saline​
For severe hyponatremia or neurological symptoms such as seizures, 3% hypertonic saline may be prescribed to increase serum sodium levels safely. It must be administered cautiously and under close monitoring to avoid rapid correction, which can lead to central pontine myelinolysis.
D. Loop diuretic​
Loop diuretics such as furosemide may be used to promote water excretion and reduce fluid retention. They are particularly effective when combined with hypertonic saline to help increase serum sodium levels while controlling total body fluid.
E. Conivaptan​
Conivaptan is a vasopressin receptor antagonist (vaptan) that blocks the effect of ADH on renal collecting ducts, promoting free water excretion without electrolyte loss. It helps correct hyponatremia in SIADH by addressing the underlying hormone imbalance.

Explanation
Finasteride is a 5-alpha-reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone (DHT), the hormone responsible for prostate enlargement. This action reduces prostate size over time, improving urinary flow and relieving symptoms of BPH such as urinary retention and frequency. Finasteride is commonly prescribed for long-term management, and clients should be taught that noticeable improvement may take several months of consistent use.

Explanation
Explanation of Correct Answers​
A. Respiratory protection should be worn if there is risk for inhalation exposure when cleaning bodily fluid spills​
Chemotherapy drugs and their metabolites can become aerosolized during spill cleanup. Using respiratory protection, such as a mask or respirator, prevents inhalation exposure to these hazardous substances. This is part of safe handling precautions to minimize occupational risk.
B. Soiled linens should be kept separated and not combined with other client’s linens​
Linens contaminated with chemotherapy agents or body fluids should be isolated in clearly labeled, leak-proof bags. This prevents cross-contamination and protects laundry staff and other patients from accidental exposure.
D. Wear gloves and other appropriate personal protective equipment (PPE) when handling the fluids​
Gloves, gowns, and face shields should always be used when handling chemotherapy or contaminated body fluids. Chemotherapy can be excreted through urine, feces, vomit, and sweat for up to 48 hours after administration, requiring strict PPE use for safe handling.
E. Flush the fluids down the toilet​
Bodily fluids from clients receiving chemotherapy may be safely flushed down the toilet if proper precautions are followed. The nurse should ensure the lid is closed before flushing to prevent splashing or aerosolization, and double flushing is recommended to ensure complete disposal.

Explanation
Explanation of Correct Answers​
A. Broad-spectrum antibiotic​
The client’s foul-smelling urine, dysuria, and fever indicate a urinary tract infection (UTI) that could have progressed to pyelonephritis. Prompt administration of a broad-spectrum antibiotic is essential to treat the infection and prevent further kidney injury or sepsis while awaiting culture results.
B. 0.9% sodium chloride infusion at 100 mL/hr​
Fluid replacement with normal saline helps maintain renal perfusion, promote urine output, and prevent worsening of acute kidney injury (AKI) due to dehydration or infection-related volume loss.
C. WBC count​
A complete blood count (CBC) with WBC measurement helps evaluate the presence and severity of infection or inflammation. Leukocytosis supports the diagnosis of systemic infection.
D. A clean-catch urinalysis and urine culture​
These tests confirm infection by identifying the presence of bacteria, leukocytes, and nitrites, and specify the causative organism and antibiotic sensitivity for targeted therapy.

Explanation
Explanation of Correct Answers
Polyuria/polydipsia – DKA and HHS:​
Both DKA and HHS result from severe hyperglycemia, which causes osmotic diuresis. The kidneys attempt to excrete excess glucose, leading to large volumes of urine output (polyuria). This loss of fluid triggers excessive thirst (polydipsia) as the body tries to compensate for dehydration.
Kussmaul respirations – DKA:​
Deep, rapid breathing (Kussmaul respirations) occurs in DKA as a compensatory mechanism for metabolic acidosis caused by ketone buildup. This pattern helps blow off carbon dioxide to restore acid-base balance. Kussmaul respirations are a hallmark finding of DKA and are not seen in HHS, as acidosis is minimal or absent in HHS.
Altered mental status – DKA and HHS:​
Both conditions can cause confusion, lethargy, or decreased consciousness due to dehydration and increased serum osmolality. However, altered mental status is usually more severe in HHS, as it typically develops gradually over several days, leading to profound hyperosmolarity and cerebral dehydration.
Serum bicarbonate less than 15 mEq/L – DKA:​
A low bicarbonate level indicates metabolic acidosis, which occurs in DKA due to the accumulation of acidic ketone bodies. In contrast, clients with HHS maintain normal or near-normal bicarbonate levels because ketosis and acidosis are minimal. This lab value helps differentiate DKA from HHS.
Physiological stressor as precipitating factor – DKA and HHS:​
Both conditions are commonly triggered by physiological stressors such as infections, illness, trauma, or surgery. These stressors increase cortisol and catecholamine release, raising blood glucose levels and worsening insulin deficiency or resistance. In both DKA and HHS, addressing the underlying stressor is essential to prevent recurrence.

Explanation
The client’s laboratory results and symptoms indicate hyperthyroidism, specifically an overproduction of thyroid hormones (T3 and T4) and suppression of TSH. These hormones accelerate the body’s metabolic rate, leading to symptoms such as heat intolerance, anxiety, tremors, and tachycardia due to increased oxygen demand and heightened sympathetic nervous system activity. Persistent tachycardia is a hallmark finding and, if untreated, can progress to cardiac arrhythmias or heart failure.

Explanation
Explanation of Correct Answers
A. Ketosis:​
In DKA, the body cannot use glucose for energy due to insulin deficiency, leading to fat breakdown for fuel. This process produces ketones, which accumulate in the blood and urine. The presence of ketones is a hallmark of DKA and contributes to the metabolic acidosis seen in this condition.
E. Acidosis:​
Excess ketone production leads to a drop in blood pH, resulting in metabolic acidosis. Clients often exhibit Kussmaul respirations as the body attempts to compensate by blowing off carbon dioxide. Acidosis must be corrected gradually with insulin and fluids.
F. Hyperglycemia:​
DKA is characterized by severely elevated blood glucose levels, often exceeding 300 mg/dL. Insulin deficiency prevents glucose uptake into cells, causing glucose accumulation in the bloodstream. Hyperglycemia leads to osmotic diuresis, dehydration, and electrolyte imbalances requiring prompt medical management.

Explanation
Explanation of Correct Answers
A. Ammonia:​
An ammonia level of 94 μmol/L (normal <30) is critically elevated and indicates impaired liver detoxification, consistent with hepatic encephalopathy. Elevated ammonia crosses the blood-brain barrier, leading to confusion, lethargy, and altered mental status. Immediate treatment with lactulose or rifaximin is required to reduce ammonia absorption and prevent progression to coma.
D. Blood pressure:​
A blood pressure of 87/42 mm Hg reflects hypotension, suggesting possible circulatory collapse or hemorrhagic shock, likely related to liver dysfunction or gastrointestinal bleeding (common in liver failure). Hypotension compromises organ perfusion, including to the kidneys and brain, and requires immediate fluid resuscitation or vasopressor support.
E. Platelets:​
A platelet count of 100 ×10³/μL (normal 150–450) indicates thrombocytopenia, commonly seen in liver failure due to splenomegaly or decreased hepatic synthesis of clotting factors. This significantly increases the risk for spontaneous bleeding, especially in the GI tract or from varices, making it a priority concern.
F. Hemoglobin:​
A hemoglobin of 6 g/dL (normal 12–16) is critically low and suggests severe anemia, potentially due to internal bleeding or chronic disease. Such a low level severely reduces oxygen-carrying capacity, causing tachycardia and hypotension. Immediate blood transfusion and monitoring for active bleeding are indicated.