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The most common causes of left-sided heart failure include: - ️️Acute Myocardial Infarction Feedback: The most common causes of left-sided heart failure are acute myocardial infarction and hypertension. Acute or chronic pulmonary disease can cause right heart failure, referred to as cor pulmonale. The causes of right-sided heart failure include stenosis or regurgitation of the tricuspid or pulmonic valves, right ventricular infarction, and cardiomyopathy. Manifestations (rather than causes) of heart failure reflect the physiologic effects of the impaired pumping ability of the heart, including decreased renal blood flow. Assessment of an elderly female client reveals the presence of bilateral pitting edema of the client's feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the client's lungs reveals clear air entry to bases, and the client's oxygen saturation level is 93%, and vital signs are within reference ranges. What is this client's most likely health problem? - ️️Right Sided Heart Failure Feedback: A major effect of right-sided heart failure is the development of peripheral edema. A client who is in shock would not have stable vital signs. Cor pulmonale would be accompanied by manifestations of lung disease. Pericarditis is an inflammation of the pericardium exhibited by fever, precordial pain, dyspnea, and palpitations. A client has been given the diagnosis of diffuse glomerulonephritis. They ask the nurse practitioner what diffuse means. The nurse practitioner responds: - ️️All glomeruli and all parts of the glomeruli are involved Feedback: Glomerular changes can be diffuse, involving all glomeruli and all parts of the glomeruli; focal, meaning only some of the glomeruli are affected; segmental, involving only a certain segment of each glomerulus; and mesangial, affecting only mesangial cells. Which of the following assessment findings would lead the nurse practitioner to suspect the client has nephrotic syndrome? - ️️Proteinuria and generalized edema Feedback: The nephrotic syndrome is characterized by massive proteinuria and lipiduria, along with an associated hypoalbuminemia, generalized edema, and hyperlipidemia. A client with a history of chronic pyelonephritis has been admitted several times with recurrent bacterial infection of the urinary tract. The nurse practitioner should anticipate educating this client with regard to which common treatment regimen? - ️️Continue taking antibiotics for full 10 to 14 days even if symptoms disappear Feedback: Chronic pyelonephritis involves a recurrent or persistent bacterial infection superimposed on urinary tract obstruction, urine reflux, or both. Chronic obstructive pyelonephritis can be bilateral, caused by conditions that obstruct bladder outflow; or unilateral, such as occurs with ureteral obstruction. Cranberry juice, forced micturition, and diuretics are not standard treatments for chronic pyelonephritis. The NP suspects that a client with kidney stones has developed magnesium ammonium phosphate (struvite) stones based on which of the following urinalysis results? Select all that apply - ️️Alkaline urine pH High Urine Phosphate Level High bacterial count Feedback: Magnesium ammonium phosphate stones, also called struvite stones, form only in alkaline urine and in the presence of bacteria that possess an enzyme called urease, which splits the urea in the urine into ammonia and carbon dioxide. The ammonia that is formed takes up a hydrogen ion to become an ammonium ion, increasing the pH of the urine so that it becomes more alkaline. Because phosphate levels are increased in alkaline urine and because magnesium always is present in the urine, struvite stones form. Uric acid stones develop in conditions of gout and high concentrations of uric acid in the urine. Cystine stones account for less than 1% of kidney stones overall but represent a significant proportion of childhood calculi. They are seen in cystinuria, which results from a genetic defect in renal transport of cystine While explaining immunity to a client, the NP responds, "The body's internal organs are protec