Adult Health Nursing Test Bank

Correct Answer: B

Rationale: The most appropriate initial management for the patient described is hemodialysis. Hemodialysis is essential for managing chronic kidney disease with severe symptoms and electrolyte imbalances like hyperkalemia and metabolic acidosis. Hemodialysis helps to remove urea and creatinine from the blood, correct electrolyte abnormalities, and improve symptoms such as fatigue, dyspnea, and peripheral edema. Initiation of ACE inhibitor therapy (Choice A) is contraindicated in severe kidney disease due to the risk of worsening renal function. Intravenous administration of calcium gluconate (Choice C) is used for acute hyperkalemia with cardiac toxicity, not for initial management. Sodium bicarbonate administration (Choice D) may help correct metabolic acidosis, but it does not address the underlying cause or the need for urgent renal replacement therapy.

Correct Answer: C

Rationale: The correct answer is C: Renal colic due to ureteral calculus. The sudden-onset severe colicky flank pain radiating to the groin along with tenderness over the costovertebral angle and hematuria are classic symptoms of kidney stones (ureteral calculus). The pain results from the obstruction of urine flow by the stone, leading to increased pressure and spasm in the ureter. Acute pyelonephritis (choice A) presents with fever, chills, and systemic symptoms. Renal artery embolism (choice B) typically presents with acute onset severe flank pain but is associated with risk factors like atrial fibrillation. Renal infarction (choice D) presents with sudden-onset severe flank pain but is less likely than ureteral calculus in a patient with a history of nephrolithiasis.

Correct Answer: C

Rationale: The correct answer is C: second. In qualitative research, the nurse researcher typically uses the second person as a reference in the write-up to maintain objectivity and convey findings accurately. Using "first" may introduce bias, "fourth" is irrelevant, and "third" is too far removed from the perspective of the researcher. By referencing the second person, the researcher can present the results in a clear and unbiased manner, enhancing the credibility of the study.

Correct Answer: D

Rationale: The correct answer is D: Bronchodilator therapy. Bronchodilators help to relax and open up the airways, which can improve airflow and reduce symptoms such as cough, sputum production, and dyspnea in patients with chronic bronchitis. This intervention can help manage the patient's symptoms and improve their quality of life by making it easier for them to breathe. A: Smoking cessation counseling is important for overall management of chronic bronchitis, but it does not directly address the patient's current symptoms. B: Oral antibiotic therapy may be indicated if there is evidence of a bacterial infection, but it is not the first-line treatment for managing chronic bronchitis symptoms. C: Home oxygen therapy may be necessary for patients with severe hypoxemia, but it is not typically the first intervention for managing symptoms of chronic bronchitis without evidence of significant oxygen desaturation.

Correct Answer: A

Rationale: The correct answer is A: Implement environmental modifications to promote sleep hygiene. Delirium is often triggered by environmental factors like noise, light, and disruption of sleep. By optimizing the environment for rest and minimizing stimuli, the patient's delirium can improve. This approach focuses on addressing the root cause rather than just managing symptoms. Choice B is incorrect because antipsychotic medications can worsen delirium and are not recommended as first-line treatment. Choice C is not the priority as ruling out focal deficits may be important but does not directly address the delirium. Choice D is incorrect as benzodiazepines can exacerbate delirium and are not recommended due to their potential to worsen cognitive function.