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 A rationale

Hypertension is not typically a sign of heart failure related to cor pulmonale. It is more associated with systemic issues rather than pulmonary complications.

Choice B rationale

Peripheral edema is a common sign of heart failure and cor pulmonale due to increased pressure in the venous system, leading to fluid accumulation in the tissues.

Choice C rationale

Increased respiratory rate may occur but is not specific to heart failure in cor pulmonale.

Choice D rationale

Cough with pink-tinged sputum is more indicative of pulmonary edema related to left-sided heart failure rather than cor pulmonale.

A. Hypokalemia. B. Hyperkalemia. C. Hyponatremia. D. Hypocalcemia.

Correct Answer is B

Explanation

Choice A rationale

Hypokalemia involves low potassium levels and is not treated with sodium polystyrene sulfonate. This drug is used to treat elevated potassium levels.

Choice B rationale

Hyperkalemia indicates high potassium levels in the blood. Sodium polystyrene sulfonate (Kayexalate) works by exchanging sodium ions for potassium ions in the intestines, thereby lowering blood potassium levels.

Choice C rationale

Hyponatremia, or low sodium levels, is not treated with sodium polystyrene sulfonate, which targets potassium removal.

Choice D rationale

Hypocalcemia refers to low calcium levels and is unrelated to the action of sodium polystyrene sulfonate, which addresses potassium imbalance.

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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

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Explanation

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Explanation

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