The patient has urolithiasis and is passing the stones into the lower urinary tract. What is the priority nursing diagnosis for the patient at this time?

Correct Answer: A

Rationale: The correct answer is A: Acute Pain. The priority nursing diagnosis for a patient passing stones into the lower urinary tract is acute pain because the patient is likely experiencing severe discomfort due to the passage of stones. Managing pain is crucial for the patient's comfort and well-being. Choice B: Risk for Infection is not the priority at this time because the immediate concern is addressing the patient's acute pain. Choice C: Risk for Injury is not the priority as the patient is not at immediate risk of injury related to passing stones. Choice D: Fear of Recurrent Stones is not the priority as the patient's current focus should be on managing the acute pain.

Correct Answer: A

Rationale: The correct answer is A because obtaining a clean-catch midstream urine specimen for culture and sensitivity is essential to confirm the presence of a urinary tract infection (UTI) and determine the appropriate antibiotic treatment. This method helps to identify the specific bacteria causing the infection and their susceptibility to antibiotics. Choice B is incorrect as waiting for the development of severe symptoms like fever, chills, and flank pain can lead to complications and delayed treatment. Choice C is incorrect because empirical treatment without confirming the specific bacteria and their sensitivity can lead to inappropriate antibiotic use and potential antibiotic resistance. Choice D is incorrect as a blood specimen for CBC and kidney function tests is not the primary intervention for a suspected UTI.

Correct Answer: C

Rationale: Rationale for Choice C: 1. Glomerulonephritis is an immune-mediated condition where the accumulation of immune complexes in the glomeruli triggers inflammation and damages the kidney. 2. Immune complexes can form due to various reasons like infections or autoimmune disorders, leading to glomerular injury. 3. This immune complex deposition activates the complement system and attracts inflammatory cells, causing further damage to the glomeruli. Summary of Other Choices: A. Growth of microorganisms in the glomeruli is not a characteristic feature of glomerulonephritis, as it is primarily an immune-mediated condition. B. The release of bacterial substances toxic to the glomeruli is not the primary mechanism of injury in glomerulonephritis. D. Hemolysis of red blood cells circulating in the glomeruli is not a direct cause of glomerulonephritis; it is more characteristic of conditions like hemolytic uremic syndrome.

Correct Answer: D

Rationale: Rationale for correct answer (D): Chronic, recurrent nephrolithiasis is a risk factor for both kidney and bladder cancer. Kidney stones can cause chronic irritation and inflammation, leading to cell changes that increase cancer risk in the urinary system. Summary of incorrect choices: A: Smoking is a risk factor for bladder cancer, but not specifically for kidney cancer. B: Family history of cancer may increase overall cancer risk, but it is not specifically associated with kidney or bladder cancer. C: Chronic use of phenacetin is a risk factor for renal pelvis cancer, not necessarily kidney or bladder cancer.

Correct Answer: C

Rationale: Metabolic acidosis in AKI oliguric phase is due to impaired bicarbonate excretion. In AKI, damaged kidneys cannot adequately excrete acids, leading to acidosis. Option C is correct because impaired bicarbonate excretion results in decreased buffering capacity, leading to metabolic acidosis. Option A (ammonia synthesis) helps in renal acid excretion. Option B (sodium excretion) does not directly impact acid-base balance. Option D (potassium conservation) is unrelated to acidosis in AKI.