Nokea
When the nurse reviews the client's medical history, which finding most likely precipitated the present illness?
- A. A recent streptococcal throat infection
- B. A recent influenza infection
- C. A recent episode of gastroenteritis
- D. A recent urinary tract infection
Correct Answer: A
Rationale: A recent streptococcal throat infection is a common trigger for acute glomerulonephritis due to immune-mediated kidney damage.
You may also like to solve these questions
Which finding provides the best evidence that peritoneal dialysis is achieving a therapeutic effect?
- A. Urine output increases.
- B. Appetite improves.
- C. Red blood cell count is lower.
Correct Answer: B
Rationale: Improved appetite indicates reduced uremia, a sign that dialysis is effectively removing toxins.
After inserting an indwelling catheter into a male client, which technique is most appropriate for stabilizing the catheter to avoid damage to the penis?
- A. Tape the catheter to the abdomen.
- B. Pass the catheter under the client's leg.
- C. Fasten the drainage tubing to the bed with a safety pin.
- D. I'm very the catheter into the tubing of a collecting bag.
Correct Answer: A
Rationale: Taping the catheter to the abdomen stabilizes it without causing traction or damage to the penis, promoting comfort and safety.
Which intervention should the nurse include when assessing the client for urinary retention? Select all that apply.
- A. Inquire if the client has the sensation of fullness.
- B. Percuss the suprapubic region for a dull sound.
- C. Scan the bladder with the ultrasound scanner.
- D. Palpate from the umbilicus to the suprapubic area.
- E. Auscultate the two (2) lower abdominal quadrants.
Correct Answer: A,B,C,D
Rationale: Assessing urinary retention involves asking about fullness, percussing for dullness (indicating a full bladder), scanning with ultrasound for residual urine, and palpating for a distended bladder. Auscultation is not relevant.
The nurse is preparing the plan of care for a client with fluid volume deficit. Which interventions should the nurse include in the plan of care? Select all that apply.
- A. Monitor vital signs every two (2) hours until stable.
- B. Monitor the client’s oral intake and urinary output daily.
- C. Administer mouth care when bathing the client.
- D. Weigh the client weekly in the same clothing at the same time.
- E. Assess skin turgor and mucous membranes every shift.
Correct Answer: A,B,E
Rationale: For fluid volume deficit, monitor vital signs frequently for stability, track intake/output daily to assess hydration, and assess skin turgor/mucous membranes for dehydration. Weekly weights are too infrequent, and mouth care during bathing is not specific.
The client is 12 hours postoperative renal surgery. Which data warrant immediate intervention by the nurse?
- A. The abdomen is soft, nontender, and rounded.
- B. Pain is not felt with dorsal flexion of the foot.
- C. The urine output is 60 mL for the past two (2) hours.
- D. The client’s trough vancomycin level is 24 mcg/mL.
Correct Answer: D
Rationale: A vancomycin level of 24 mcg/mL is above the therapeutic range (10–20 mcg/mL), risking nephrotoxicity, especially post-renal surgery. Soft abdomen, no pain on dorsiflexion, and 60 mL urine output are normal.