Correct Answer: C

Rationale: The correct answer is C: intrarenal. The presence of sediment, crystals, and bacteria in the urinalysis indicates an issue within the kidneys themselves. The flank pain suggests renal involvement. Prerenal would involve issues before the kidneys, such as inadequate blood flow. Postrenal would involve issues after the kidneys, such as urinary tract obstruction. Not renal related is incorrect as the symptoms and urinalysis findings clearly point to a renal issue.

Correct Answer: B

Rationale: The correct answer is B: Hypovolemic shock. After pituitary surgery, patients are at risk for hypovolemic shock due to potential intraoperative blood loss and fluid shifts. Monitoring for signs of shock, such as hypotension and tachycardia, is crucial for early intervention. A: Congestive heart failure is less likely immediately post-surgery. C: Infection is a concern but not the highest priority in the immediate postoperative period. D: Volume overload is not a common immediate complication of pituitary surgery.

Correct Answer: D

Rationale: The correct answer is D: Discontinue the IV infusion and administer the Lantus insulin at bedtime. This is the correct approach because insulin glargine (Lantus) is a long-acting basal insulin that provides a steady level of insulin throughout the day and night. By administering it at bedtime, it mimics the basal insulin secretion in a person without diabetes. This helps maintain stable blood sugar levels overnight. Choice A is incorrect because continuing the IV insulin infusion for 24 hours alongside insulin glargine is unnecessary and may lead to insulin overdose. Choice B is incorrect because discontinuing the IV infusion in several hours without administering the long-acting insulin can lead to inadequate insulin coverage. Choice C is incorrect because insulin aspart is a rapid-acting insulin that should be given with meals, not as a basal insulin replacement at bedtime.

Correct Answer: C

Rationale: The correct answer is C because the patient was recently discharged after a prolonged course of aminoglycoside therapy, which is a known risk factor for acute kidney injury due to its nephrotoxic effects. Choice A is incorrect because although aminoglycosides can cause kidney injury, the duration of therapy is shorter in this case. Choice B is incorrect because controlled hypertension is not a significant risk factor for acute kidney injury. Choice D is incorrect because fluid overload from heart failure may lead to other complications but is not directly associated with acute kidney injury.

Correct Answer: C

Rationale: The correct answer is C: notify the provider immediately. Lack of bruit, thrill, and distal pulse indicates potential complications like thrombosis or occlusion in the arteriovenous fistula. Prompt provider notification is crucial for timely intervention to prevent further complications such as ischemia or access failure. Reassessing the patient in an hour (A) may delay necessary intervention. Raising the arm above the level of the patient's heart (B) does not address the underlying issue. Applying warm packs (D) could worsen the situation if there is a clot present.