A. The client states that they consume a high calcium diet and have had high calcium in their blood. A high calcium diet or hypercalcemia is more associated with kidney stones, not typically with pyelonephritis.

B. The client reports that they had two urinary tract infections (UTI) in the past months. Recurrent UTIs are a risk factor for pyelonephritis, as untreated or recurrent infections can ascend from the bladder to the kidneys, leading to this condition.

C. The client states that they remember their mother saying their grandma had this same genetic disease. Pyelonephritis is not typically a genetic disease but rather an infection of the kidneys, often secondary to urinary tract infections.

D. The client reports that they took a lot of ibuprofen for arthritis for many years. Long-term NSAID use can impact kidney function but does not directly cause pyelonephritis.

A. Consume small frequent meals throughout the day. Small, frequent meals reduce the volume of food entering the small intestine at one time, helping to prevent symptoms of dumping syndrome.

B. Lie down immediately after eating to aid digestion. Although lying down after eating can slow gastric emptying and help prevent dumping syndrome, it does not aid in digestion.

C. Include high-carbohydrate foods in every meal. High-carbohydrate foods are likely to worsen symptoms of dumping syndrome by causing rapid glucose absorption, which leads to a spike in insulin and subsequent hypoglycemia.

D. Drink fluids with meals to aid in digestion. Fluids should be taken between meals rather than with meals to avoid rapid gastric emptying and prevent dumping syndrome.

A. High fluid intake: High fluid intake can help maintain blood flow and reduce the risk of venous stasis.

B. Immobility during and after surgery: Immobility contributes to venous stasis and is a primary risk factor for DVT, especially after prolonged surgery.

C. Low body temperature: Low body temperature does not directly cause venous stasis or increase the risk of DVT.

D. Increased physical activity: Increased physical activity promotes circulation and reduces the risk of DVT by preventing blood from pooling in the veins.

A. Serum sodium levels: Desmopressin can lead to water retention and potentially hyponatremia. Monitoring serum sodium is crucial to prevent electrolyte imbalance.

B. Serum magnesium levels: Magnesium is not typically impacted by desmopressin treatment in central diabetes insipidus.

C. Serum potassium levels: Desmopressin does not generally affect potassium levels in patients with diabetes insipidus.

D. Serum calcium levels: Calcium levels are not directly influenced by desmopressin or diabetes insipidus.

A. Influenza: Influenza typically presents with a high fever, muscle aches, and fatigue, which are not present in this case.

B. Strep Throat: Strep throat usually presents with a sore throat, high fever, and swollen lymph nodes, not nasal congestion or watery eyes.

C. Rhinitis: Rhinitis, particularly allergic rhinitis, causes symptoms such as sneezing, nasal congestion, watery eyes, and malaise without fever, making it the most likely diagnosis.

D. Bacterial Pharyngitis: Bacterial pharyngitis often presents with a sore throat, fever, and swollen lymph nodes, but typically does not include nasal congestion or watery eyes.

A. Interferon Gamma Release Assays (IGRAs): IGRAs are useful for detecting TB infection but do not confirm active TB disease. They measure the immune response to TB bacteria but don’t differentiate between latent and active infection.

B. Sputum culture: Sputum culture is the gold standard for confirming active TB because it identifies Mycobacterium tuberculosis bacteria directly, confirming active infection.

C. Tuberculin Skin Test (TST): The TST can indicate TB infection but cannot distinguish between latent and active TB, making it unsuitable as a confirmatory test for active disease.

D. Chest X-ray: A chest X-ray can show signs suggestive of TB but cannot confirm the presence of TB bacteria, so it is not definitive for diagnosing active TB.

A. Use written communication or visual aids to supplement verbal instructions. Written communication and visual aids are effective ways to enhance understanding and provide clear instructions to a patient with hearing loss.

B. Speak loudly and directly into the patient's ear. Speaking loudly can distort sounds and may make it harder for the patient to understand. Instead, clear and slow speech with normal volume is recommended.

C. Turn off all background noise and speak to the patient from behind. While reducing background noise is beneficial, speaking from behind is ineffective as the patient cannot see the nurse’s facial expressions or read lips.

D. Assume the patient can read lips and avoid using sign language or gestures. Assuming the patient can read lips is not appropriate; gestures or other visual aids should be used to enhance communication.

A. Ciprofloxacin, Metronidazole, and Ranitidine: Ciprofloxacin and ranitidine are not recommended for H. pylori treatment. Ciprofloxacin is not typically used, and ranitidine is an H2 blocker, not a proton pump inhibitor.

B. Amoxicillin, Clarithromycin, and Omeprazole: This combination is a standard triple therapy for H. pylori infection. Amoxicillin and clarithromycin are antibiotics, and omeprazole (a proton pump inhibitor) reduces stomach acid to help eradicate the bacteria.

C. Metronidazole, Tetracycline, and Bismuth subsalicylate: This combination is part of quadruple therapy rather than triple therapy. Quadruple therapy is usually reserved for cases resistant to initial treatment.

D. Erythromycin, Amoxicillin, and Famotidine: Erythromycin is not part of standard triple therapy, and famotidine is an H2 blocker, not a proton pump inhibitor.

A. The gallbladder became infected by a virus and needs to be removed. Gallstones are not caused by viral infections; they typically develop from an imbalance in the substances that make up bile, such as cholesterol and bilirubin.

B. The gallbladder has become inflamed due to the cholesterol in the gallstones. Cholesterol is a common component of gallstones, and these stones can cause inflammation of the gallbladder (cholecystitis), leading to the need for removal.

C. The gallbladder has become blocked by a tumor and is no longer working. Tumors can obstruct the gallbladder, but this is not the cause of gallstones or the primary reason for a cholecystectomy.

D. The gallbladder has become inflamed due to a build-up of gallstones that are blocking the common bile duct. This describes choledocholithiasis, a condition where gallstones block the common bile duct, but it is not the primary cause of gallbladder inflammation requiring a cholecystectomy.

A. The glomerular filtration rate decreases because there is a reduction of blood flow to the kidneys. Reduced blood flow to the kidneys, or renal hypoperfusion, decreases the glomerular filtration rate (GFR) because less blood is being filtered through the kidneys. This can occur in conditions such as shock, severe dehydration, or heart failure, but it is not the primary mechanism in acute tubular necrosis (ATN).

B. The glomerular filtration rate decreases because there is injury to the renal tubular cells. In ATN, the injury to renal tubular cells impairs their function, leading to reduced reabsorption and filtration ability, which contributes to the decrease in GFR.

C. The glomerular filtration rate decreases because inflammatory cells invade the already damaged kidneys. While inflammation may be present, it is not the primary cause of decreased GFR in acute tubular necrosis; reduced blood flow and tubular cell injury are more direct causes.

D. The glomerular filtration rate decreases because there is obstruction leading to the filtration system backing up and eventually shutting the kidneys down. Obstruction is not typically a characteristic of acute tubular necrosis; ATN is usually caused by ischemic or toxic injury, not physical obstruction.

A. Stroke: The sudden onset of one-sided weakness, numbness, difficulty speaking, and severe headache are classic symptoms of an acute stroke, where blood flow to part of the brain is interrupted, leading to neurological deficits.

B. Migraine: While migraines can cause headache and some neurological symptoms, they usually include visual disturbances, nausea, or photophobia rather than one-sided weakness and numbness.

C. Hypoglycemia: Hypoglycemia can cause confusion, weakness, and headache, but it typically lacks the focal neurological symptoms, like one-sided weakness and numbness.

D. Transient Ischemic Attack (TIA): A TIA can cause similar symptoms, but the deficits are usually transient and resolve within 24 hours without lasting neurological damage. Persistent symptoms are more indicative of a stroke.

A. Mild wheezing: Mild wheezing can be a common symptom in COPD and does not immediately indicate a severe complication unless it worsens suddenly.

B. Fatigue and general malaise: Fatigue and malaise are often chronic in COPD and do not necessarily indicate an acute complication.

C. Increased sputum production: While increased sputum could suggest an infection, it is not the most urgent sign of a severe complication.

D. Sudden onset chest pain and dyspnea: Sudden chest pain and dyspnea are concerning for a pneumothorax or pulmonary embolism, both of which are potential complications in COPD and require immediate attention.

A. Administering pain medication: Pain management is essential, but in this case, the primary concern is potential airway compromise due to inhalation injury, which should be addressed first.

B. Applying a cool, wet cloth to burned areas: Cooling burned areas can help with pain and reduce burn severity but is not the priority in a case of suspected inhalation injury with airway compromise.

C. Administering high-flow oxygen via a non-rebreather mask: This client is at high risk for respiratory compromise due to inhalation injury; administering high-flow oxygen is the priority to ensure adequate oxygenation.

D. Initiating intravenous fluid resuscitation: Fluid resuscitation is essential for burn patients but is not the immediate priority over addressing potential airway and oxygenation issues.

A. "I understand that CAD is caused by the buildup of fat deposits in my arteries." CAD is caused by the accumulation of plaque (cholesterol, fats, and other substances) within the coronary arteries, which restricts blood flow to the heart muscle.

B. "Only people with a family history of heart disease are at risk for CAD." Although a family history can increase risk, many other factors, like high blood pressure, smoking, high cholesterol, and lifestyle, contribute to CAD risk.

C. "CAD can be completely cured with a healthy diet and exercise." While lifestyle changes can significantly reduce the progression of CAD and improve symptoms, they do not cure the disease.

D. "I should avoid all physical activity to prevent worsening my CAD." Physical activity, when performed safely and under medical guidance, is beneficial for CAD management and can help improve cardiovascular health.

A. Administering mannitol intravenously: Mannitol is an osmotic diuretic that helps reduce ICP by drawing fluid out of brain tissue and decreasing cerebral edema, making it a priority intervention.

B. Encouraging the patient to hyperventilate: Controlled hyperventilation may reduce ICP temporarily by lowering CO₂ levels and causing cerebral vasoconstriction. However, it should only be done cautiously under close monitoring, and other ICP management techniques like mannitol administration take priority.

C. Administering a high-dose corticosteroid: Corticosteroids are generally ineffective for reducing ICP in traumatic brain injury and are typically not recommended in this scenario.

D. Performing a lumbar puncture immediately: Lumbar puncture is contraindicated in cases of increased ICP because it may lead to brain herniation due to the sudden release of pressure.

A. Share personal items like razors and toothbrushes. Sharing personal items that may come in contact with blood or body fluids, like razors and toothbrushes, increases the risk of spreading hepatitis, so clients should avoid sharing these items.

B. Drink alcohol in moderation to avoid liver strain. Clients with hepatitis should avoid alcohol entirely, as alcohol can worsen liver inflammation and damage, which would strain the liver further.

C. Wash your hands thoroughly after using the bathroom. Hand hygiene is crucial, especially for hepatitis A, which can spread through fecal-oral transmission. Washing hands can prevent the spread of the virus to others.

D. Avoid all physical activities to conserve energy. Although clients may need to rest, they do not need to avoid all physical activity. Light, tolerated activity can help maintain strength and prevent complications from immobility.

A. Encourage the client to walk on the injured ankle to promote circulation. Weight-bearing activities should be avoided initially after a Grade II sprain to prevent further injury.

B. Immerse the ankle in warm water immediately after the injury. Ice, rather than warmth, is recommended immediately following an injury to reduce swelling and inflammation.

C. Apply ice to the affected ankle for the first 24-72 hours. Applying ice for 24-72 hours helps reduce swelling and pain by causing vasoconstriction and controlling inflammation in the acute phase.

D. Perform deep tissue massage on the injured area to reduce pain. Massaging a newly sprained ankle can aggravate inflammation and cause additional tissue damage.

A. Keep the patient NPO (nothing by mouth) until the T-tube is removed. Patients are generally kept NPO initially but may resume clear liquids and progress to a regular diet based on tolerance; NPO status is not required until the T-tube is removed.

B. Monitor the tube drainage and document the amount and color. Monitoring and documenting drainage from the T-tube is crucial to assess biliary function and ensure that the bile is draining properly, indicating no obstruction.

C. Ensure the tube is clamped for 8 hours each day. Clamping may be done before tube removal to test the body’s tolerance to bile drainage, but it should be done only as per physician orders, not routinely for 8 hours each day.

D. Flush the T-tube with normal saline every 4 hours. Flushing a T-tube is generally not done routinely as it could disrupt the flow of bile and cause complications.

A. Asthma: Asthma is a respiratory condition and is not a common complication associated with diabetes.

B. Osteoporosis: Osteoporosis is a bone disease more commonly associated with hormonal changes, aging, or steroid use, not directly linked to diabetes.

C. Liver cirrhosis: Liver cirrhosis is usually caused by alcohol use, hepatitis, or other liver diseases, not directly due to diabetes.

D. Cardiovascular disease: Diabetes is a significant risk factor for cardiovascular disease due to its association with atherosclerosis, hypertension, and dyslipidemia.

A. Obese extremities. Clients with Cushing's syndrome typically experience central (truncal) obesity with thin extremities due to fat redistribution and muscle wasting, not obese extremities.

B. Buffalo hump: A "buffalo hump" (fat pad on the back of the neck) is a common characteristic of Cushing's syndrome due to abnormal fat distribution.

C. Purple striations. Purple or reddish striae on the abdomen and other areas are commonly seen in Cushing's syndrome due to skin thinning and collagen breakdown.

D. Moon face. A round, full face (moon face) is a classic sign of Cushing's syndrome due to fat deposits in the face.

E. Tremors. Tremors are not typically associated with Cushing's syndrome and are more often associated with neurological or metabolic conditions.

A. Pain in the neck when the patient flexes their head towards the chest. This describes nuchal rigidity, not Kernig sign.

B. Involuntary flexion of the hips and knees when the neck is flexed. This describes Brudzinski sign, not Kernig sign.

C. Photophobia and headache triggered by bright light. These are symptoms of meningitis, but they are not specific to Kernig sign.

D. Pain and resistance when attempting to extend the patient's leg from a flexed position. A positive Kernig sign is when there is pain and resistance to leg extension from a flexed hip and knee position, indicating meningeal irritation.

A. Irritable bowel syndrome. IBS management typically involves dietary changes, fiber, and stress management, not antibiotics or clear liquids.

B. Chronic diverticulosis. Diverticulosis, when asymptomatic, does not require antibiotics. Treatment focuses on a high-fiber diet to prevent diverticulitis.

C. Complicated diverticulitis with abscess. Complicated diverticulitis may require IV antibiotics, hospitalization, or even surgical intervention if there are abscesses.

D. Uncomplicated diverticulitis. Uncomplicated diverticulitis, without abscess or perforation, is treated with oral antibiotics and a clear liquid diet for bowel rest.

A. Increased pulse, respirations and blood pressure with dysphagia and respiratory distress. A myasthenic crisis is characterized by severe muscle weakness that can lead to respiratory failure, dysphagia, and increased vital signs due to the stress of respiratory distress.

B. Hypotension, diarrhea, and increased salivation. These symptoms are more indicative of a cholinergic crisis, which is due to excess acetylcholine.

C. Bradycardia and hypothermia. Bradycardia and hypothermia are not characteristic signs of a myasthenic crisis.

D. Tachypnea and hyperactive deep tendon reflexes. While tachypnea can occur in respiratory distress, hyperactive reflexes are not typical in myasthenic crisis, as it involves neuromuscular weakness.

A. Hypotension: Patients with SIADH typically have fluid retention, which can lead to hypertension, not hypotension.

B. Dry mucous membranes: In SIADH, fluid retention is common, so mucous membranes are usually moist, not dry.

C. Increased thirst: While thirst can occur in various conditions, it is not a primary symptom of SIADH.

D. Confusion or altered mental status: Confusion or altered mental status may occur in SIADH due to hyponatremia from excessive water retention.

A. I need to monitor the puncture site for signs of infection such as redness or swelling. Monitoring the puncture site is crucial for detecting any signs of infection or complications, which the patient should be aware of.

B. I should follow a heart-healthy diet to support my recovery. A heart-healthy diet is recommended to manage cholesterol levels and prevent further coronary artery disease progression.

C. I will take my prescribed medications as directed by my doctor. Following the medication regimen is important for preventing complications and supporting recovery, especially for blood thinners or other cardiac medications.

D. I can resume my regular physical activities immediately after I get home. This statement indicates a need for further teaching, as patients should gradually resume physical activities and avoid strenuous activities immediately after PTCA to prevent complications, such as bleeding at the catheter insertion site.