A client diagnosed with acute glomerulonephritis has pitting edema in both feet, and has had 300 mL of urine output in the last 24 hours. The nurse should monitor this client for which complication associated with this finding?

Fluid volume deficit

Bradycardia

Hypertension

Hyperglycemia

Answer and Explanation

The Correct Answer is C

A.   Fluid volume deficit, or dehydration, occurs when the body loses more fluid than it takes in. In this case, the patient has very low urine output, indicating that the kidneys are not excreting enough fluid. Despite the low urine output, the presence of pitting edema suggests that the patient is actually retaining fluid rather than losing it.
B.   Bradycardia is defined as a heart rate slower than 60 beats per minute. While electrolyte imbalances and fluid imbalances can affect heart rate, bradycardia is not the primary concern associated with the combination of pitting edema and low urine output in this situation.
C.   Hypertension (high blood pressure) is a common complication in acute glomerulonephritis. The condition often leads to fluid retention due to reduced kidney function and increased sodium and fluid retention. The presence of pitting edema and very low urine output suggests that the kidneys are not effectively removing excess fluid, which can lead to increased blood pressure.
D.   Hyperglycemia refers to elevated blood glucose levels. Acute glomerulonephritis is not directly associated with hyperglycemia. While patients with diabetes can develop renal issues, hyperglycemia itself is not a typical direct complication of acute glomerulonephritis.

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Correct Answer is A

Explanation

A. The late-phase response in asthma is characterized by a delayed and prolonged inflammatory reaction that can occur 4 to 6 hours after exposure to a trigger. It involves the recruitment of additional inflammatory cells, such as eosinophils and T cells, which contribute to ongoing airway inflammation, increased mucus production, and bronchoconstriction. This phase often leads to a return of symptoms or worsening of symptoms after the initial relief provided by a rescue inhaler.
B. The late-phase response does not typically respond as well to rescue inhalers (such as albuterol) as the early-phase response does. Rescue inhalers are primarily effective for the immediate, bronchospastic component of asthma (early-phase response).
C. The late-phase response occurs as part of the natural progression of asthma inflammation and is not necessarily related to improper use of a rescue inhaler. Even with proper use of a rescue inhaler, the late-phase response can still occur due to the underlying inflammatory processes.
D. The late-phase response can occur even if the trigger is no longer present. It is related to the ongoing inflammatory process rather than continued exposure to the trigger. Although continued exposure to triggers can exacerbate symptoms, the late-phase response can still occur independently of further exposure.

A. Continue to monitor the patient B. Silence future alarms C. Place the patient on a non-rebreather mask D. Increase the oxygen to 4 liters per minute

Correct Answer is A

Explanation

A. The client is resting comfortably, denies distress, and has an oxygen saturation of 89% on 2 liters of supplemental oxygen. This is within an acceptable range for many patients with COPD. Given the client's current status, it is appropriate to continue monitoring the oxygen saturation and assess for any changes in condition.
B. While the alarm may be annoying, it is important to keep it active to alert the nurse to any significant changes in the client's oxygen saturation.
C. A non-rebreather mask delivers a higher concentration of oxygen and is typically used in more critical situations. In this case, the client's oxygen saturation is within a safe range, and there is no need to increase the oxygen delivery method.
D. Increasing the oxygen to 4 liters per minute without a clear indication of need could lead to oxygen toxicity, especially in patients with COPD. It is important to titrate oxygen therapy to the lowest level that maintains adequate oxygen saturation.

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A client diagnosed with acute glomerulonephritis has pitting edema in both feet, and has had 300 mL of urine output in the last 24 hours. The nurse should monitor this client for which complication associated with this finding?

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Correct Answer is A

Explanation

Correct Answer is A

Explanation

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