183) ANSWER

D) A 62-year-old male with chronic renal failure

RATIONALE

Renal failure interferes with excretion of electrolytes, including magnesium. All of the conditions listed in the incorrect options increase the risk of hypomagnesemia by interfering with magnesium absorption in the small intestine. Critical words are hypermagnesemia and risk. Eliminate options 1 and 2, since intake of magnesium is reduced in these conditions. Recall that magnesium is absorbed in the small intestine, and eliminate option 3.

182)Answer

D. Phenylketonuria

Rationale

•In untreated children with phenylketonuria (PKU), the hallmark of the disease is mental retardation. Other characteristics include fair skin, abnormal gait and posture, stunted growth, and urine with a musty odor.

•PKU is an autosomal recessive metabolic disorder. Absence of the liver enzyme phenylalanine hydroxylase prevents conversion of phenylalanine, an essential amino acid, into tyrosine. As a result, excessive phenylalanine builds up in the blood stream and tissues causing permanent damage to brain tissue.

•Branched-chain ketoaciduria, or maple syrup urine disease, causes an inability to break down branched-chain amino acids, leading to a buildup of waste products.

•Celiac disease is an autoimmune disorder in which gluten triggers an inflammatory response in the digestive tract.

•Tay-Sach’s disease causes an inability to break down phospholipids, causing lipid accumulation in the brain and a rapid deterioration of mental and physicial abilities.

181) ANSWER

A) Aminoglycoside antibiotics

RATIONALE

Nephrotoxicity can be caused by aminoglycoside antibiotics. This type of drug accumulates in tubular cells, eventually killing them. Options 2 and 3 are ototoxic, while option 4 is avoided in renal disease. Associate this drug category with nephrotoxicity.

180) Answers

C. Muscle weakness
E. Arrhythmia
F. Bradycardia

Rationale

•Hyperkalemia may result due to the inability of the adrenal gland to secrete aldosterone, a potassium-wasting hormone

•Signs and symptoms of hyperkalemia include muscle weakness, arrhythmias, bradycardia, diarrhea and nausea

•Tremors, hypoventilation, and tachycardia are not common signs of hyperkale

179) ANSWER

A) Chronic elevated blood glucose levels damage cells and causes multiple organ damage.

RATIONALE

Research by the National Institute of Health and the American Diabetes Association demonstrates a strong correlation between chronic hyperglycemia and complications of retinopathy, nephropathy, and neuropathy. Thus, there is damage to the eyes, kidneys, and peripheral nerves, respectively. Lactic acidosis occurs with diabetic ketoacidosis (option 2). Option 3 is a false rationale for the client in the question. Insulin is needed to carry glucose across the cell membrane into the cell, not to be transported in the blood (option 4). Recall knowledge of the long term complications of hyperglycemia.

178) ANSWER

C) Who develops a paralytic ileus after abdominal surgery.

RATIONALE

Intestinal obstructions are mechanical (options 1, 2, 4) or paralytic, in which neurogenic or muscular impairment hinders peristalsis. Early ambulation after surgery usually helps to prevent this. Make the association between paralytic ileus and surgery to identify option 4 as correct.

177) ANSWER

C) Clot binding the wound edges

RATIONALE

The first signs of healing are absence of bleeding and wound edges bound by fibrin in the clot. Inflammation at the wound edges follows the first sign, and then, when the clot diminishes, inflammation decreases, and collagen forms a scar. Eliminate option 2 as not being indicative of healing, and option 4 as being a later stage than is described in the question stem.