NR-325 Adult Health II - Set 2 - Part 2

Correct Answer: The ibuprofen taken for knee pain

Nonsteroidal drugs constrict the afferent arteriole and cut filtration, and this client has already had one injury. Twice daily ibuprofen is the single most dangerous item in the organizer. Option a is incorrect because this drug is usually continued to protect the kidney and control pressure, though creatinine and potassium need watching. Prescribers deliberately keep it in most kidney regimens. Option b is incorrect because acetaminophen is the analgesic usually recommended when nonsteroidal agents must be avoided. Its main caution involves the liver and total daily amount rather than filtration. Option c is incorrect because a shelf multivitamin does deserve discussion, since fat soluble vitamins accumulate and a renal formula is preferred. That conversation can wait, unlike a direct nephrotoxin.

Correct Answer: Prerenal injury from reduced perfusion

Volume loss lowered renal perfusion, so the kidney hoards sodium and water while urea follows passively. That disproportionate rise in urea with dark concentrated urine points squarely at a prerenal cause. Option b is incorrect because injured tubules lose the ability to reabsorb sodium, so the urine turns dilute and carries muddy brown casts. This client concentrates urine well, which rules that pattern out. Option c is incorrect because blockage below the kidney announces itself with bladder distention, flank pain or sudden anuria, and ultrasound would reveal a swollen collecting system. Gastrointestinal losses point elsewhere. Option d is incorrect because contrast toxicity injures tubular cells directly and typically raises creatinine one to three days after a scan. Nothing in this history involves an imaging study or dye.

Correct Answer: Baked cod with rice and green beans

Sodium restriction is the cornerstone because salt drives the water retention behind edema and hypertension. Fresh fish with plain rice and vegetables carries little sodium, unlike canned, cured, processed or pickled foods. Option a is incorrect because canned soups are among the heaviest sodium sources on a grocery shelf. A single serving can approach the entire daily allowance and would worsen both the edema and the pressure. Option c is incorrect because curing meat is a salt preservation process, so ham delivers a large sodium load. The potato adds potassium that an oliguric kidney may struggle to excrete safely. Option d is incorrect because processed deli meats and pickled vegetables are both preserved in brine. Choosing them keeps intake high at the very time the kidney cannot clear the extra salt and water.

Correct Answer: A stoma that has turned dusky purple

A healthy stoma is red or deep pink because it is well perfused. Dusky purple or black color means the blood supply is failing, and that tissue can die within hours unless the surgeon intervenes. Option a is incorrect because the conduit is built from a piece of bowel, and bowel secretes mucus for life. Clients are taught to expect the strands and to drink generously so the mucus stays thin. Option b is incorrect because moist, shiny, beefy red tissue describes exactly what a well perfused stoma should look like. Documenting it confirms the diversion is healthy, and nothing about that appearance calls for a page. Option d is incorrect because stomal tissue carries a rich capillary bed with no sensory nerves, so gentle cleaning often produces a few drops. Oozing that keeps going or soaks the gauze would be a different matter.

Correct Answer: Give the prescribed analgesic promptly

With sepsis and anuria ruled out, pain is the priority problem in renal colic. Untreated colic drives hypertension, tachycardia and vomiting, so the nurse medicates promptly and then reassesses rather than waiting to see whether the stone passes. Option a is incorrect because a culture screens for concurrent infection and belongs in the workup, yet collecting it does nothing for a client rating pain at the top of the scale. Comfort comes before diagnostic sampling here. Option b is incorrect because prevention counseling depends on knowing the stone composition, which nobody knows yet. A vomiting client in ten out of ten pain also cannot absorb teaching, so this belongs to the discharge phase. Option c is incorrect because walking does help gravity move a stone downward and is encouraged later. Asking someone doubled over and retching to stroll the hallway will fail until the analgesic has taken effect.

Correct Answer: Strain every void and save anything caught

Straining catches gravel or a whole stone, and laboratory analysis of that specimen is what tells the provider which diet and medication will prevent the next one. No prevention plan is possible without it. Option b is incorrect because holding back fluid concentrates urine and lets crystals grow around the stone already sitting there. Steady intake keeps urine dilute and helps flush the calculus toward the bladder. Option c is incorrect because tamsulosin relaxes the smooth muscle of the lower ureter and is continued until the stone is out. Quitting the drug when comfort improves removes the very help that eases passage. Option d is incorrect because staying flat in bed works against gravity. Movement and upright activity help a calculus travel down the ureter, so clients are urged to walk as much as their comfort allows.

Correct Answer: Raise the head of the bed

Crackles with a rising rate mean fluid is filling the lungs, and breathing outranks everything else. Sitting the client up eases the work of breathing immediately, before the nurse calls anyone. Option a is incorrect because the call must certainly happen, yet it comes after the nurse relieves the breathing problem at the bedside. Three kilograms equals roughly three liters retained. Option b is incorrect because charting and waiting allows pulmonary edema to progress toward frank respiratory failure. Findings of this kind demand action within minutes, not another set of vital signs. Option d is incorrect because a headache in this setting usually reflects dilutional hyponatremia, and medicating it treats a symptom while the lungs fill. Many analgesics are restricted in kidney injury anyway.

Correct Answer: Stand still, squeeze the pelvic floor, then walk

Urge suppression works by staying put, contracting the pelvic floor several times and breathing until the wave passes, then walking calmly to the toilet. Running triggers more detrusor contraction and usually ends in a bigger accident. Option a is incorrect because hurrying jostles the bladder and feeds the urge rather than settling it, and rushing older adults toward a toilet invites falls. The taught sequence is to hold still first, then move deliberately. Option b is incorrect because drinking less concentrates the urine, and concentrated urine irritates the bladder lining and worsens urgency. Clients are taught to keep intake steady and simply move most of it earlier in the day. Option c is incorrect because interrupting the stream over and over trains the bladder to empty incompletely and raises residual volume. Pelvic floor muscles are identified that way once, then exercised well away from voiding.

Correct Answer: Antistreptolysin O titer and complement level

Post streptococcal glomerulonephritis is immune mediated, so serology proves the recent strep exposure. The antistreptolysin O titer rises and complement C3 falls during the acute phase, returning toward normal over six to eight weeks. Option a is incorrect because blood cultures hunt for organisms circulating from an infected kidney, which fits the febrile client in the first bed. Glomerular inflammation is sterile, so nothing would grow. Option c is incorrect because white cell casts mark bacteria inside kidney tissue and point squarely at pyelonephritis. The expected cast in this second client is packed with red cells instead. Option d is incorrect because imaging searches for a mechanical blockage or an abscess behind a stubborn infection. A latent immune injury following a skin infection produces no structural finding that ultrasound could show.

Correct Answer: Wrapping a blood pressure cuff around that arm

Cuff inflation compresses the graft and can thrombose it, so blood pressure is taken on the opposite arm. The access limb also stays free of venipuncture, intravenous lines and any constricting item. Option b is incorrect because positioning a meal tray within reach supports independence and carries no risk to the graft. Nothing about handing a client food compresses the vessel or introduces organisms into it. Option c is incorrect because transferring a client to a chair sits squarely inside the scope of assistive personnel. Mobility assistance protects skin and lung expansion, and it leaves the access untouched. Option d is incorrect because documenting a weight obtained by assistive personnel is routine data collection. Daily weights matter enormously for a dialysis client, and recording one poses no threat to the surgical access.

Correct Answer: Urine output that has nearly stopped

Fragments can pile up in the ureter and block it after lithotripsy. A sudden fall toward no output signals obstruction of the treated side, which threatens the kidney and calls for prompt imaging and decompression. Option a is incorrect because blood in the urine is routine for several days once shock waves have broken the stone apart. The nurse documents the color, encourages fluids and watches for it to lighten. Option b is incorrect because ecchymosis over the skin where the waves entered is an expected consequence of the energy passing through tissue. It fades over days and needs comfort measures rather than a phone call. Option c is incorrect because passing sand and gravel hurts, sometimes for weeks, and clients are sent home with analgesia for exactly that reason. Anticipating this pain is standard care, not a reportable complication.

Correct Answer: Assess the level of consciousness

Neurologic status is the assessment that shows how far cerebral edema has progressed and guides everything that follows. The nurse establishes that baseline, alerts the provider and anticipates slowing or stopping the treatment. Option a is incorrect because sedation blunts the very findings the nurse needs to follow. The headache comes from swelling brain tissue rather than from pain that opioids treat, and mental status would become impossible to trend. Option b is incorrect because speeding the treatment widens the osmotic gap between blood and brain. Faster urea removal is the cause of the problem, so accelerating it drives more water into the cerebral tissue. Option d is incorrect because comfort measures leave a deteriorating brain unwatched. Dimming lights might ease a migraine, yet this client can progress to seizures and coma while the nurse assumes quiet rest is enough.

Correct Answer: Finasteride shrinks the gland over several months

Finasteride blocks conversion of testosterone to dihydrotestosterone, which slowly reduces prostate bulk and takes three to six months to help. Tamsulosin relaxes smooth muscle at the bladder neck, so its effect on flow appears within days. Option a is incorrect because only the five alpha reductase inhibitor changes gland size. An alpha blocker leaves the prostate exactly as large as it was and simply loosens the muscular grip on the urethra. Option c is incorrect because no medication cures prostatic enlargement. Tamsulosin gives quick symptom relief without altering the underlying tissue, while finasteride is the class shown to lower the long term risk of acute retention and surgery. Option d is incorrect because drug therapy is the usual first line once symptoms reach a moderate score, and many men never come to an operation. Surgery is reserved for failed medication or complications such as repeated retention.

Correct Answer: "I will empty my bladder soon after intercourse."

Voiding shortly after intercourse flushes organisms that were mechanically pushed toward the urethral meatus before they can adhere and multiply in the bladder. Extra fluid with it strengthens the effect. Option b is incorrect because bubble baths, scented soaps and bath oils irritate the urethral meatus and set up inflammation that invites colonization. Showering is the safer choice for someone with recurrent infection. Option c is incorrect because symptoms fade well before the organisms are eradicated, and stopping early leaves the hardiest bacteria alive to regrow. The full prescribed course must be finished at evenly spaced times. Option d is incorrect because douching strips the protective lactobacilli that keep vaginal pH low and crowd out uropathogens. Removing that defense raises rather than lowers her risk of another episode.

Correct Answer: Purulent drainage at the catheter exit site

Pus at the exit site is infection whether or not the skin looks red, and a tunnel infection frequently precedes or accompanies peritonitis. The nurse cultures the drainage and notifies the provider. Option a is incorrect because dextrose crosses the peritoneum and raises glucose in every client on this therapy. A reading at that level in a diabetic client prompts insulin adjustment rather than an urgent call. Option b is incorrect because a full abdomen is the normal sensation while two liters sit in the peritoneal space. Pain, rigidity or breathlessness would change that picture, and none of those are described. Option d is incorrect because tiredness runs through the whole dialysis population and reflects anemia and uremic burden. Nothing about ordinary fatigue signals a breach in the barrier protecting the peritoneal cavity.

Correct Answer: A palpable thrill and an audible bruit

Blood shunted from artery to vein creates turbulence, so the nurse feels a buzzing thrill with the fingertips and hears a continuous swooshing bruit with the stethoscope diaphragm. Both together confirm flow. Option b is incorrect because a strong water hammer pulsation replacing the soft thrill points to outflow stenosis, with blood backing up behind a narrowed segment. That finding is reported for imaging, not charted as normal. Option c is incorrect because coolness and pallor in the hand below the access describe steal syndrome, where the fistula diverts arterial blood away from the fingers. Untreated steal can progress to tissue loss. Option d is incorrect because losing the bruit means blood is no longer moving through the anastomosis. Warm overlying skin adds nothing reassuring; a silent access is presumed clotted and demands an immediate call to the provider.

Correct Answer: Fever with chills and falling urine output

Fever paired with a dropping output in an obstructed client points to an infected kidney behind the stone. That combination is a urologic emergency needing urgent decompression, so the nurse escalates rather than giving more analgesia. Option a is incorrect because blood tinting the urine appears in most stone clients as the calculus scrapes the ureteral lining. Catching gravel in the strainer is actually the outcome the nurse wants, and it is sent for analysis. Option c is incorrect because vomiting settles once an antiemetic takes hold, which shows the ordered treatment worked. Improvement after a medication is documented and monitored, never a reason to interrupt the provider during rounds. Option d is incorrect because writhing and constant repositioning define renal colic itself. The finding tells the nurse the client still hurts and needs the analgesic reassessed, yet it carries none of the danger that infection does.

Correct Answer: Fever and flank pain persist without any change

Persistent fever and flank pain after two to three days of appropriate antibiotics suggests a renal or perinephric abscess or an obstruction behind the infection. Imaging and possible drainage are needed, so the provider is notified. Option a is incorrect because a normalizing white cell count is one of the objective markers that therapy is working. Falling leukocytosis reassures rather than alarms, and it calls for continuing the current plan. Option b is incorrect because returning appetite and resolving nausea belong to the subjective side of a good response. Nurses combine those reports with laboratory trends when judging recovery, and both point the right way here. Option c is incorrect because easing costovertebral tenderness means the inflamed kidney is quieting down. Resolution of that physical sign is expected as the antibiotic reaches tissue, and no notification is warranted.

Correct Answer: Instill an anticoagulant lock into each lumen

Between treatments the catheter sits full of stagnant blood that clots within hours, so each lumen is filled with an anticoagulant locking solution at exactly the priming volume printed on the hub. Option b is incorrect because a dialysis catheter is reserved for dialysis alone. Running routine fluids through it adds entries into a line whose tip sits in the right atrium, which is how bloodstream infection starts. Option c is incorrect because saline clears residual blood but has no anticoagulant effect, and sterile water is never used in a vascular line. A saline flush alone leaves the lumen clotted by morning. Option d is incorrect because an open lumen invites both air embolism and contamination. Each hub is clamped immediately after the lock is instilled and covered with a sterile injection cap until the next session.

Correct Answer: A low hemoglobin and hematocrit

Diseased kidneys stop producing enough erythropoietin, so the marrow makes too few red cells. The result is a normocytic anemia that explains both the exhaustion and the pallor seen here. Option a is incorrect because uremia suppresses leukocyte function rather than driving the count upward. A rising white count would signal infection, which is a separate complication with fever and other clues. Option c is incorrect because albumin usually drops in advanced kidney disease from anorexia, nausea and protein losses. Nurses track that value as a nutrition marker, and a high reading would be unusual. Option d is incorrect because failing kidneys retain phosphorus instead of wasting it, so the level climbs and drags calcium down. Low phosphorus belongs to entirely different clinical problems.