Psap 6th Edition Answers
Answers to Self-Assessment Questions - Answers to Self- Assessment Questions Infectious Diseases II INFECTIONS IN THE LONG- TERM CARE SETTING 1. Answer: B A.D., an 82-year-old long-term care facility (LTCF) resident, has signs of infection; however, A.D.’s charge nurse has not performed an optimal patient assessment before concluding that intervention for infection is required. Therefore, A.D. Is at risk of receiving unnecessary antibiotic drug therapy. Atypical presentation can be misleading and can cause A.D.’s symp toms to be misattributed to a urinary tract infection (UTI) when there is another possible cause.
Although confusion, lethargy, new-onset incontinence, and dark, foul-smelling urine can be associated with a UTI, this information alone is not enough to make a diagnosis. It would be premature to request a urinalysis and a culture and sensitivity test (Answer A) or a dose-adjusted antibiotic drug regimen (Answer C) until other likely problems are excluded. Evaluation of mental status (Answer D) may confirm that a cognitive change has occurred, but this evaluation alone does not provide clues to the cause of her symp toms.
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Dehydration is a common problem among frail LTCF residents with dementia and may account for A.D.’s symp toms. The patient assessments recommended in Answer B (blood pressure, heart rate, mucous membranes, and recent fluid intake) would show hypotension; tachycardia; and dry lips and skin, which are suggestive of dehydration. His tory of fluid intake could also be evaluated in the longterm care setting, because certified nursing assistants are required to document patterns of food and fluid intake, which can provide diagnostic clues when dehydration is suspected.
These assessments can be performed relatively quickly without a physician’s order and should be part of the charge nurse’s report when A.D.’s physician is notified. This information is important because physicians may be less likely to associate malodorous urine with UTI and more likely to consider other conditions. Cacchione PZ, Culp K, Laing J, Tripp-Reimer T.
Clinical profile of acute confusion in the long-term care setting. Clin Nurs Res 2003;12:145–8.
Mentes JC, Wakefield B, Culp K. Use of a urine color chart to moni tor hydration status in nursing home residents. Biol Res Nurs 2006;7:197–203. Mild dehydration: a risk fac tor of urinary tract infection? Eur J Clin Nutr 2003;57(suppl 2):S52–8. Midthun S, Paur R, Bruce AW, Midthun P.
Urinary tract infections in the elderly: a survey of physicians and nurses. Geriatr Nurs 2005;26:245–51. Answer: C G.G., an 88-year-old woman in an LTCF, has a UTI. The appropriateness of the antibiotic drug, the dose, and the interval must be determined for each of the four choices. Based on an estimate of creatinine clearance by the Cockcroft-Gault equation, G.G.’s renal function is poor (i.e., her creatinine clearance is less than 30 mL/ minute). The antibiotic drug dosages suggested in Answer A (amoxicillin/clavulanate 875 mg twice daily) and Answer B (nitrofuran toin 50 mg four times/day) are inappropriate based on the calculated creatinine clearance. If, based on culture and sensitivity data, amoxicillin/clavulanate was an appropriate selection, this regimen could be adjusted to 250 mg/125 mg twice daily or 500 mg/125 mg twice daily.
Nitrofuran toin is not an appropriate choice, regardless of culture and sensitivity data, because this antibiotic drug is contraindicated for individuals with a creatinine clearance of less than 60 mL/minute. For this reason, it is considered a potentially inappropriate drug for individuals older than 65 years. Levofloxacin (Answer D) is not the best answer; the use of fluoroquinolones as initial empiric therapy should generally be avoided because of increased risk of methicillin-resistant Staphylococcus aureus (MRSA). Answer C (sulfamethoxazole/trimethoprim 400 mg/80 mg twice daily) is dosed appropriately for G.G.’s renal function and is the best choice for empiric therapy. Muhlberg W, Platt D.
Age-dependent changes of the kidneys: pharmacological implications. Geron tology 1999;45:243–53. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a U.S. Consensus panel of experts. Arch Intern Med 2003;163:2716–24. Pharmacotherapy Self- Assessment Program, 6th Edition 21.
Answers to Self-Assessment Questions - Answers to Self- Assessment Questions Nutrition I Metabolic and Nutrition Issues in Patients Receiving Continuous Renal Replacement Therapy 1. Answer: B The most likely reason B.A. Required CRRT was acute renal failure (ARF)-related hyperkalemia (Answer B). Because potassium is excreted by the kidneys and the resulting hyperkalemia can cause life-threatening cardiac arrhythmias, hyperkalemia is a well-established indication for CRRT. Phosphorus and magnesium are also excreted by the kidneys; therefore, in patients with ARF, both hyperphosphatemia and hypermagnesemia can occur. However, neither hyperphosphatemia (Answer C) nor hypermagnesemia (Answer D) is an indication for dialysis; therefore, Answer C and Answer D are incorrect. Hypernatremia secondary to cardiogenic shock (Answer A) is not the best answer; in the setting of fluid overload, which occurs in patients with ARF because of a reduced renal water excretion, hyponatremia is more likely to occur because of dilution of serum sodium.
B.A.’s chronic heart failure also likely contributed to his fluid overload. Wooley JA, Btaiche IF, Good KL. Metabolic and nutritional aspects of acute renal failure in critically ill patients requiring continuous renal replacement therapy.
Nutr Clin Pract 2005;20:176–91. Liu KD, Stralovich-Romani A, Cher tow GM. Nutrition support for adult patients with acute renal failure. In: Merritt R, ed.
The A.S.P.E.N. Nutrition Support Practice Manual, 2nd ed. Silver Spring, MD: American Society for Parenteral and Enteral Nutrition, 2005:281–6. Answer: B B.A.’s usual weight is 82 kg.
On admission he weighed 90 kg (an indication of fluid overload), and 6 months ago he weighed 70 kg (significantly lower than his usual body weight). He has experienced a 17% weight loss over the past 6 months; therefore he is at risk of nutrition-related complications, and Answer B (he experienced a weight loss of more than 10% in the past 6 months so he is at risk of nutrition-related complications) is correct. An involuntary weight loss/gain of 10% or more within 6 months or 5% or more within 1 month is considered a risk fac tor for malnutrition.
B.A.’s body mass index (BMI) is within the range of 22 kg/m 2 to 28.5 kg/m 2, depending on which weight you use for the calculation. Despite the BMI indicating that he is normal to slightly overweight, his recent weight loss places him at risk of nutrition-related complications, therefore Answer A (his BMI is within normal limits so he is not at risk of nutrition-related complications) and Answer D (his BMI is increased so he is not at risk of nutrition-related complications) are incorrect. B.A.’s current weight is 90 kg, which is 23% above his ideal body weight (IBW).
A body weight 20% or more above or below the IBW is a risk fac tor for nutrition-related complications. However, B.A.’s usual weight is 82 kg, and his most recent weight at his last office visit was 70 kg, which are both less than 20% above his IBW and a more accurate representation of his nutrition status. His current weight of 90 kg most likely represents fluid retention; thus this weight should not indicate an increased risk of nutrition-related complications, making Answer C (his current weight is more than 20% above his IBW, so he is at risk of nutrition-related complications) incorrect. Wooley JA, Btaiche IF, Good KL. Metabolic and nutritional aspects of acute renal failure in critically ill patients requiring continuous renal replacement therapy. Nutr Clin Pract 2005;20:176–91.
Marin A, Hardy G. Practical implications of nutritional support during continuous renal replacement therapy.
Apa 6th Edition Format
Curr Opin Clin Nutr Metab Care 2001;4:219–25. Liu KD, Stralovich-Romani A, Cher tow GM. Nutrition support for adult patients with acute renal failure. In: Merritt R, ed. The A.S.P.E.N. Nutrition Support Practice Manual, 2nd ed. Silver Spring, MD: American Society for Parenteral and Enteral Nutrition, 2005:281–6.
Psap 6th Edition
Answer: D B.A. Is being started on parenteral nutrition (PN). Of the trace elements listed, zinc (Answer D) is the one least likely to require supplementation during PN. Zinc is filtered only minimally by CRRT.
In fact, elevated serum zinc concentrations have been observed in patients receiving CRRT because of the zinc content of replacement solutions; therefore, Answer D is correct. Serum copper (Answer Pharmacotherapy Self- Assessment Program, 6th Edition 35 Gastroenterology and Nutrition Answers.