Correct Answer: A

Rationale: Acute pyelonephritis is the most likely condition based on the patient presentation and urinalysis findings described. Acute pyelonephritis is an infection of the renal parenchyma and pelvis, typically caused by ascending bacteria from the lower urinary tract. The classic symptoms include fever, chills, flank pain, and costovertebral angle tenderness (tenderness over the kidneys). The presence of pyuria (pus in the urine) and bacteriuria (bacteria in the urine) on urinalysis further supports the diagnosis of acute pyelonephritis. It is crucial to diagnose and treat acute pyelonephritis promptly to prevent complications and recurrent infections.

Correct Answer: C

Rationale: Autonomy is the ethical principle that upholds an individual's right to make decisions about their own medical treatment, free from coercion or undue influence. In this scenario, the 70-year-old patient has voluntarily decided not to have the pacemaker inserted despite the physician's recommendation. The fact that the decision is respected by the family further highlights the importance of autonomy in this situation. Respecting the patient's right to make choices regarding their own healthcare, even if it goes against medical advice, demonstrates a commitment to autonomy as an ethical principle.

Correct Answer: D

Rationale: The purpose of record keeping in healthcare is primarily to ensure quality health care. Maintaining accurate and up-to-date records of patient information, including medical history, treatments, medications, and test results, allows healthcare providers to make informed decisions about patient care. Access to complete and organized records helps in providing timely and effective treatments, reducing errors, and ensuring continuity of care. By tracking and documenting patient care, healthcare professionals can assess outcomes, monitor progress, and improve overall quality of healthcare services. Additionally, thorough record keeping also supports communication between healthcare providers and facilitates coordination of care across different healthcare settings.

Correct Answer: A

Rationale: The healthcare team should prioritize administering lactulose or other ammonia-lowering agents to manage hepatic encephalopathy in a patient with acute liver failure. Hepatic encephalopathy is a neuropsychiatric syndrome that occurs in patients with liver dysfunction, leading to the accumulation of ammonia and other neurotoxic metabolites in the bloodstream. Lactulose works by acidifying the colon, which promotes the conversion of ammonia to ammonium, a less toxic form that can be excreted in the stool. By reducing the levels of ammonia, lactulose helps improve the neurological symptoms associated with hepatic encephalopathy.

Correct Answer: A

Rationale: The first priority for a nurse caring for a patient experiencing a seizure is safety. Ensuring the safety of the patient is crucial to prevent injury during the seizure episode. This includes clearing the area around the patient of any harmful objects, preventing the patient from falling or hitting their head, placing them in a safe position to prevent aspiration if they vomit, and staying with the patient until the seizure ends. Once the patient is safe, the nurse can then focus on other aspects of care such as assessing airway, providing emotional support, and monitoring for complications.