A nurse is reviewing the BUN and creatinine levels of an older adult patient with chronic kidney disease. The nurse should anticipate which of the following findings?
BUN 8 mg/dL and creatinine 0.7 mg/dL
BUN 45 mg/dL and creatinine 8 mg/dL
BUN 23 mg/dL and creatinine 1.0 mg/dL
BUN 10 mg/dL and creatinine 0.3 mg/dL
The Correct Answer is B
Choice A reason:
A BUN level of 8 mg/dL and a creatinine level of 0.7 mg/dL are within normal ranges for a healthy individual without kidney disease. In chronic kidney disease (CKD), we would expect these values to be elevated due to the kidneys' reduced ability to filter waste products from the blood.
Choice B reason:
A BUN level of 45 mg/dL and a creatinine level of 8 mg/dL are significantly higher than the normal range, which is consistent with impaired kidney function seen in CKD. These elevated levels indicate that the kidneys are not effectively filtering urea and creatinine from the blood, leading to their accumulation.
Choice C reason:
A BUN level of 23 mg/dL and a creatinine level of 1.0 mg/dL could be seen in the early stages of CKD. While the creatinine level is within the normal range, the BUN level is slightly elevated, which may suggest a decline in kidney function.
Choice D reason:
A BUN level of 10 mg/dL and a creatinine level of 0.3 mg/dL are both below the normal range. This is an unlikely finding for a patient with CKD, as kidney impairment typically leads to increased levels of these substances in the blood.
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Correct Answer is D
Explanation
Choice A reason:
Hyperplasia is an increase in the number of cells in an organ or tissue, which can lead to its enlargement. While hyperplasia can be a response to a stimulus and is not necessarily precancerous, it does not describe the abnormal changes in the shape, size, and organization of mature cells.
Choice B reason:
Metaplasia is a reversible change in which one differentiated cell type is replaced by another cell type. This process can be a response to chronic irritation and inflammation, and while it may predispose cells to cancerous changes, it is not in itself a precancerous condition.
Choice C reason:
The term 'malignant' refers to cancerous cells that have the ability to invade and destroy nearby tissue and spread to other parts of the body. The description of the cells as 'moderately abnormal' does not indicate that the cells are malignant but rather that they are showing signs of potentially precancerous changes.
Choice D reason:
Dysplasia refers to the presence of abnormal cells within a tissue or organ. It is characterized by changes in cell size, shape, uniformity, arrangement, and structure, particularly when such changes are strongly suggestive of developing neoplasia, or new, abnormal growth. In the context of a Pap smear, dysplasia is indicative of precancerous changes and is the term used to describe the abnormal development of cells on the cervix.
Correct Answer is A
Explanation
Choice A reason:
The inability to abduct the arm at the shoulder is a classic sign of a rotator cuff injury. The rotator cuff is responsible for stabilizing the shoulder joint and aiding in various movements, including abduction. When there is a tear or significant weakness in the rotator cuff muscles, especially the supraspinatus muscle, the patient may be unable to lift the arm away from the body or may experience pain while doing so.
Choice B reason:
A negative drop arm test would actually indicate that there is no rotator cuff injury. The drop arm test is performed by asking the patient to fully abduct the arm to 90 degrees and then slowly lower it. If the patient can control the motion and lower the arm smoothly, the test is negative. A positive drop arm test, where the patient cannot control the descent of the arm, would suggest a rotator cuff tear.
Choice C reason:
While an alteration in the contour of the joint may indicate some form of shoulder pathology, it is not specific to a rotator cuff injury. Changes in the contour could be due to various conditions, including dislocation, arthritis, or other musculoskeletal disorders.
Choice D reason:
A positive Tinel's sign is used to diagnose nerve compression or nerve damage, not rotator cuff injuries. It is performed by tapping over the course of a nerve to elicit a tingling sensation or pain in the distribution of the nerve. This sign is commonly associated with conditions like carpal tunnel syndrome.
