A nurse is preparing to administer 0.9 The drop factor on the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min?

Choice A rationale

Persistent cough is generally associated with respiratory conditions like asthma or congestive heart failure rather than primary renal pathology. In acute poststreptococcal glomerulonephritis, the underlying mechanism involves immune complex deposition in the glomerular basement membrane. This leads to inflammatory changes within the kidneys but does not typically trigger a primary pulmonary cough reflex unless the patient develops significant secondary pulmonary edema from severe fluid volume overload.

Choice B rationale

Peripheral edema occurs due to a significant decrease in the glomerular filtration rate and subsequent sodium and water retention. The normal glomerular filtration rate is typically ≥ 90 mL/min/1.73m. In this condition, the kidneys are unable to effectively excrete excess fluid, leading to expansion of the extracellular fluid volume. This often manifests as periorbital edema in the morning and progresses to peripheral edema in the extremities during the day.

Choice C rationale

Dry, itchy skin is more characteristic of chronic kidney disease and end-stage renal disease where uremic frost and high phosphorus levels irritate the skin. Acute poststreptococcal glomerulonephritis is an acute inflammatory process occurring about 10 to 21 days after a streptococcal infection. While skin lesions like impetigo may have preceded the renal symptoms, the acute glomerulonephritis phase itself does not typically present with generalized pruritus or chronic dryness.

Choice D rationale

Hematuria is a hallmark sign caused by the inflammation of the glomerular capillaries, which allows red blood cells to leak into the urine. This often results in a characteristic smoky or cola-colored appearance of the urine. Microscopically, the presence of red blood cell casts confirms that the bleeding is originating from the glomeruli. The irritation and damage to the filtration barrier are direct consequences of the post-infectious immune response.

Choice E rationale

Elevated blood pressure, or hypertension, results from the decreased excretion of sodium and water and the possible activation of the renin-angiotensin-aldosterone system. Normal blood pressure is typically < 120/80 mmHg. In acute poststreptococcal glomerulonephritis, the intravascular volume expansion leads to increased cardiac output and systemic vascular resistance. Monitoring blood pressure is critical during the acute phase to prevent complications such as hypertensive encephalopathy or acute heart failure.

Choice F rationale

A recent history of a group A beta-hemolytic streptococcal infection, such as strep throat or impetigo, is the essential precursor for this condition. The body produces antibodies against the bacteria, which then form immune complexes that become trapped in the glomerular loops. This triggers an inflammatory cascade and complement activation. Confirming a previous infection through history or elevated antistreptolysin O titers is fundamental for diagnosing this specific type of glomerulonephritis.

Choice A rationale

Transporting arterial blood gas samples on ice is a standard physiological preservation technique used to decrease the metabolic rate of the cellular components within the blood. Red blood cells and leukocytes continue to consume oxygen and produce carbon dioxide through anaerobic metabolism after the sample is drawn. If the sample is not chilled, the measured partial pressure of oxygen will decrease while the partial pressure of carbon dioxide increases, leading to inaccurate results that do not reflect the true respiratory status of the patient.

Choice B rationale

The Allen test is a mandatory clinical assessment performed to ensure the presence of adequate collateral circulation to the hand via the ulnar artery. Before puncturing the radial artery, the nurse must confirm that if the radial artery becomes occluded or damaged during the procedure, the ulnar artery can sufficiently provide blood flow to the distal tissues. This preventatively identifies patients at risk for hand ischemia or necrosis. Failure to verify collateral flow can lead to severe vascular complications in the affected extremity.

Choice C rationale

An arterial blood gas draw is an invasive procedure that involves puncturing a high-pressure vessel, which carries significantly higher risks than standard venous phillips. Because of the potential for complications such as hematoma, nerve damage, or arterial occlusion, obtaining informed consent is a legal and ethical requirement. The patient must be educated on the necessity of the test, the procedural steps, and the associated risks before the clinician proceeds with the needle insertion to ensure patient autonomy and safety.

Choice D rationale

Due to the high hydrostatic pressure within the arterial system compared to the venous system, post-procedure hemostasis requires prolonged manual compression. The nurse should maintain firm pressure on the puncture site for at least five minutes, or longer if the patient is receiving anticoagulant therapy. This action prevents the formation of a hematoma or an arterial bleed, which could compress surrounding nerves or compromise skin integrity. Adequate pressure is vital to ensure the arterial wall seals effectively after the needle is withdrawn.

Choice E rationale

The statement that the puncture will be venous is physiologically incorrect for an arterial blood gas study. By definition, this laboratory test requires oxygenated blood directly from the arterial system to measure the efficiency of gas exchange and the acid-base balance of the body. Venous blood has already delivered oxygen to the tissues and collected metabolic waste products, making it unsuitable for assessing arterial oxygenation levels or the partial pressure of gases that are essential for determining the respiratory status.