The home health nurse is evaluating a male client who manages his asthma and measures his peak expiratory flow rate (PEFR). Today he is experiencing an acute exacerbation and tells the nurse his PEFR is 60% of his personal best readings. Which PRN med should the nurse instruct the client to use?

Correct Answer: D

Rationale: For an acute asthma exacerbation with a PEFR at 60% of personal best, the nurse should instruct the client to use albuterol 2.5 to 5 mg via nebulization. Albuterol, a short-acting beta-agonist, rapidly relieves bronchospasm, improving airflow during an exacerbation. Oxygen may supplement but doesn't treat the underlying constriction, salmeterol is a long-acting medication for maintenance, and epinephrine is for anaphylaxis, not routine asthma flares. Albuterol's quick onset makes it the best PRN choice here.

Correct Answer: B

Rationale: A negative Net Filtration Pressure (NFP) of -10 mmHg, as in this patient with severe shock, halts glomerular filtration, stopping urine production. Shock reduces renal perfusion, and untreated, this acute insult can lead to acute renal failure (or acute kidney injury), characterized by sudden loss of kidney function. Chronic renal failure develops over time, kidney stones are unrelated, and hypertension is a pre-existing condition here, not the outcome, making B correct.

Correct Answer: C

Rationale: The glomerular capillary filtration coefficient (Kf) reflects the permeability and surface area of the filtration membrane. Increasing Kf enhances GFR by allowing more fluid to filter for a given pressure, directly proportional to GFR = Kf × NFP. Increased afferent resistance (A) or decreased efferent resistance (B) reduces GFR, and increased capsular pressure (D) opposes filtration, making C correct.

Correct Answer: C

Rationale: Sodium reabsorption in the proximal convoluted tubule (PCT) involves Na⁺ entering the cell from the lumen (A is true) via cotransporters, but it's transported out to the capillary via Na⁺/K⁺-ATPase, a primary active transport process, not passive (C is false). The pump uses ATP to move Na⁺ against its gradient, contradicting C, making it the false statement.

Correct Answer: B

Rationale: The statement is incorrect. Chemical buffers (bicarbonate, phosphate, proteins) are the first line of defense, instantly neutralizing pH changes. Physiological responses (respiratory CO₂ adjustment, renal H⁺/HCO₃⁻ regulation) follow if buffers are insufficient. The terms are reversed here, making B (False) correct.