Difficulty: Medium Average Score: 80% Simulated

Passage / Scenario

The nurse in the emergency department (ED) is caring for a 57-year-old male client.
Item 6 of 6
History and Physical

A 57-year-old male client with stage three small cell lung cancer. The client had suddenly become disoriented and did not recognize his family members and relatives. He reports severe lower extremity weakness and has had three episodes of diarrhea in the past four hours. The client is undergoing 6 cycles of chemotherapy with cisplatin and etoposide. He is currently taking a 14-day course of 15 mg of prednisone. He is on his third day of steroid treatment. He has a medical history of dyslipidemia and advanced chronic obstructive pulmonary disease.

Laboratory Results
ÔÇó Hemoglobin 14 g/dL [14-18 g/dL (140ÔÇô180 g/L)]
ÔÇó Hematocrit 42% (0.42) [42-52% (0.42-0.52)]
ÔÇó White Blood Cell 11,000 mm3 [5-10 mm3]
ÔÇó Platelet Count 140,000 mm3 [150-400 mm3 (150ÔÇô400 ├ù 109/L)]
ÔÇó Glucose 139 mg/dL (7.72 mmol/L) [70ÔÇô110 mg/dL (4-6 mmol/L)]
ÔÇó Sodium 116 mEq/L [136ÔÇô145 mEq/L (mmol/L)]
ÔÇó Potassium 3.3 mEq/L [3.5ÔÇô5.0 mEq/L (mmol/L)]
ÔÇó Creatinine 0.7 mg/dL (61.88 mmol/L) [0.6ÔÇô1.2 mg/dL (53ÔÇô106 mmol/L)]
ÔÇó Blood Urea Nitrogen 8 mg/dL (2.86 mmol/L) [10ÔÇô20 mg/dL (3.6ÔÇô7.1 mmol/L)]
ÔÇó Serum Osmolality 277 mOsm/kg [285-295 mOsm/kg (285ÔÇô295 mmol/kg)]

Nurses' Notes
0759: Client is completely disoriented and required maximum assistance to the stretcher because of unsteady gait. Lung sounds clear bilaterally. Alopecia noted. Skin is warm and dry and normal for ethnicity. Peripheral pulses 2+. No skin tenting. Hyperactive bowel sounds in all quadrants. 20-gauge peripheral vascular access device placed in the left antecubital space. T 97.8┬░ F (36.6┬░ C) P 88 RR 21 BP 123/68 Pulse oximetry reading 91% on room air.
0850: Verbal order was received from physician to insert indwelling urethral catheter.
0910: Urinary catheter inserted with sterile technique. 40 mL of dark yellow urine returned.

Orders
ÔÇó admit to intensive care unit
ÔÇó nephrology consultation
ÔÇó oncology consultation
ÔÇó fluid restriction - 1 liter daily
ÔÇó daily weight
ÔÇó strict intake and output
ÔÇó 250 mL of 3% saline at 75 mL/hr
ÔÇó tolvaptan 15 mg PO daily - first dose now
ÔÇó neurological assessments every two hours

The nurse transfers the client to the intensive care unit for further management. Eight hours later, the nurse in the ICU reassesses the client and determines which findings indicate that the treatment is effective. Select all that apply.

The nurse transfers the client to the intensive care unit for further management. Eight hours later, the nurse in the ICU reassesses the client and determines which findings indicate that the treatment is effective. Select all that apply.

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