A nurse is caring for a client in the outpatient cardiologist's office. The client is alert and oriented. Lung sounds with crackles are heard bilaterally. Dyspnea is observed on exertion, and heart sounds reveal an S3 gallop. Which of the following findings is the nurse most likely to expect?

Choice A rationale
Wearing barrier protection during vaginal intercourse is a general precaution to prevent the transmission of sexually transmitted infections (STIs), including hepatitis B and C. However, hepatitis A is primarily transmitted through the fecal-oral route, not sexual contact.

Choice B rationale
Avoiding needle sharing is critical for preventing the spread of bloodborne pathogens, including hepatitis B and C. While it is always good practice, hepatitis A is not typically transmitted through blood.

Choice C rationale
The suggestion to avoid eating at fast food restaurants does not directly relate to the prevention of hepatitis A. The virus is usually spread through contaminated food or water, so ensuring food safety is important, but singling out fast food restaurants is not necessary.

Choice D rationale
Practicing effective hand hygiene is the most effective way to prevent the transmission of hepatitis A. The virus can be spread through close contact or ingestion of contaminated food or water, so washing hands can significantly reduce the risk.

Choice A rationale
While inflammation can affect the kidneys, the presence of inflammatory cells alone does not typically cause a decrease in GFR. Inflammatory cells invading the kidneys is more associated with conditions like glomerulonephritis rather than acute tubular necrosis.

Choice B rationale
A reduction in blood flow to the kidneys, known as prerenal azotemia, can indeed lead to a decreased GFR. However, in the context of acute tubular necrosis, the primary issue is damage to the renal tubules rather than blood flow.

Choice C rationale
Acute tubular necrosis is characterized by damage to the renal tubular cells, which can lead to a decrease in GFR. This damage impairs the kidney's ability to filter waste products from the blood, resulting in a lower GFR.

Choice D rationale
Obstruction of the urinary tract can lead to postrenal azotemia, which may decrease GFR if severe enough. However, this is not the typical pathophysiological change seen in acute tubular necrosis, which primarily involves tubular cell injury.