A client is admitted to the emergency room with renal colic due to renal lithiasis (stones). What is the nurse's highest priority in managing care for this client?

Prepare the client for lithotripsy to break up the stones.

Order a renal ultrasound to assess for the presence and location of the stones.

Administer pain medication as prescribed.

Initiate intravenous (IV) fluid therapy.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Preparing the client for lithotripsy is important for treatment but is not the immediate highest priority in an emergency setting. Immediate pain management takes precedence.

Choice B rationale

Ordering a renal ultrasound is necessary for assessing the stones but comes after stabilizing the client's acute symptoms, including managing pain.

Choice C rationale

Administering pain medication as prescribed is the highest priority because renal colic causes severe pain. Immediate pain relief is crucial for the client's comfort and to facilitate further diagnostic and therapeutic interventions.

Choice D rationale

Initiating IV fluid therapy is important for hydration and possibly aiding stone passage but follows after addressing the acute pain.

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Correct Answer is B

Explanation

Choice B rationale

Radiating pain to the left arm is a classic symptom of a myocardial infarction (MI). This pain occurs due to the heart muscle not receiving enough oxygen, often because of a blockage in one or more coronary arteries. The pain can radiate to the left arm, jaw, neck, or back, and is a key indicator for diagnosing an MI.

Choice A rationale

Nausea and vomiting can occur during an MI but are not the most distinctive symptoms for diagnosis. They can also be associated with other conditions, making them less specific indicators of MI.

Choice C rationale

Shortness of breath is a common symptom during an MI, resulting from reduced oxygen supply to the heart. However, while it is an important clinical manifestation, it can also be associated with other cardiac or respiratory conditions.

Choice D rationale

Headache is not a typical symptom of an MI. It is less commonly associated with heart attacks and can be caused by a wide range of other factors, making it an unreliable symptom for diagnosing MI.

A. "You should stop playing basketball, but you can swim instead.”. B. "Avoid triggers that cause an attack.”. C. "Use the peak expiratory flow meter once per week.”. D. "Take cromolyn sodium at the first sign of breathing difficulty.”.

Correct Answer is B

Explanation

Choice A rationale

While swimming can be less likely to trigger asthma attacks than some other sports, children with asthma should not necessarily stop playing basketball if it's something they enjoy. Proper management and understanding triggers are crucial.

Choice B rationale

Avoiding triggers that cause an asthma attack is a fundamental part of asthma management. Triggers can vary from person to person and may include allergens, smoke, cold air, and exercise.

Choice C rationale

The peak expiratory flow meter should be used regularly, typically twice a day, to monitor asthma control, not just once per week. Regular use helps identify worsening symptoms early.

Choice D rationale

Cromolyn sodium is a preventive medication and should be taken regularly as prescribed, not just at the first sign of breathing difficulty.

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A client is admitted to the emergency room with renal colic due to renal lithiasis (stones). What is the nurse's highest priority in managing care for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following clinical manifestations would make the nurse suspect the client is experiencing a myocardial infarction (MI)?

Correct Answer is B

Explanation

A nurse is providing education to a school-age child who has a new diagnosis of asthma.Which of the following statements should the nurse include in the teaching?

Correct Answer is B

Explanation

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