exam 3 patho
Which clinical manifestations should the nurse expect to find during physical assessment of a client diagnosed with bronchiectasis? Select all that apply: A. Recurrent chest infections B. Production of purulent sputum C. A barrel chest D. Low hemoglobin levels E. Recent surgery
Answer: A, B, D Rationale: Chest infections, copious production of purulent sputum, and anemia are all associated with bronchiectasis. A barrel chest is more commonly evident with emphysema and recent surgery is not a noted factor.
The nurse is hearing diminished breath sounds and a "grating" sound during respirations. This is consistent with excess collection of fluid in the pleural cavity. The medical term for this is: A. Pleurisy B. Pleural effusion C. Pneumothorax D. Poor lung compliance
Answer: B Rationale: Pleural effusion is used to describe an abnormal collection of fluid or exudates in the pleural cavity. Pleurisy in an inflammation in pleural space. Pneumothorax is an abnormal collection of air in pleural space.
The nurse is assessing a client with suspected dysphagia. Which cranial nerves (CN) should the nurse assess? Select all that apply. A. CN I B. CN V C. CN IX D. CN X E. CN XI F. CN XII
Answer: B, C, D, F Rationale: The act of swallowing depends on the coordinated action of the tongue and pharynx. These structures are innervated by cranial nerves V (trigeminal), IX (glossopharyngeal), X (vagus), and XII (hypoglossal). Cranial nerve I is olfactory and CN XI is accessory, neither of which is involved in swallowing.
Which neurologic client is most likely to have abnormalities in breathing regulation? A. A 23-year-old male who has an injury to his frontal lobe following a sports injury B. A 45-year-old female with a spinal cord injury at C7 following a motor vehicle accident C. A 34-year-old male with damage to his upper and lower pons following a blow to the back of the head D. A 66-year-old male with temporal lobe infarcts secondary to a stroke
Answer: C Rationale: The respiratory center is located in the pons. Damage to the temporal lobe, frontal lobe, or spinal cord at C7 is less likely to affect respiration.
While rock climbing, a 22-year-old male has endured a severe head injury. Which statement best captures expected clinical manifestations and treatments for his immediate condition? A. Oxygen therapy is likely to decrease his respiratory drive and produce an increase in PCO2. B. Cheyne-Stokes breathing is likely but will respond to bronchodilators. C. The client is unlikely to respond to supplementary oxygen therapy due to impaired diffusion. D. Hypoventilation may exist, resulting in increased PCO2 and hypoxemia that may require mechanical ventilation.
Answer: D Rationale: Brain injuries and accompanying hypoventilation are often associated with increased PCO2 and by hypoxemia that responds to oxygen therapy. Persons with COPD are more vulnerable to diminished respiratory drive secondary to oxygen therapy, while Cheyne-Stokes breathing is not identified as a likely consequence of brain injury. Impaired alveolar diffusion is not an aspect of the client's injury.
The nurse is caring for the client with extrahepatic cholestasis. Which symptom does the nurse anticipate uncovering during the history and assessment? A. Complaints of lower flank pain with consequences of impaired fat metabolism. B. Anorexia with consequences of impaired drug metabolism and blood filtration. C. Skin xanthomas (focal accumulations of cholesterol) with consequences of increased risk of bleeding due to deficient clotting factors. D. Pruritus with consequences of deficient levels of fat-soluble vitamins.
Answer: D Rationale: Pruritus is the most common symptom of cholestasis and deficiencies in fat-soluble vitamins such as A, D, and K are frequent. Flank pain is not a noted complaint, and bile does not contribute to drug metabolism, blood filtration, or clotting factor production.
A 20-year-old woman has visited her family physician due to occasional bouts of bloody diarrhea over the past several weeks, a phenomenon that she experienced 2 years prior as well. Her physician has diagnosed her with ulcerative colitis based on her history and visualization of the affected region by colonoscopy and sigmoidoscopy. Which pathophysiologic phenomenon is most likely to underlie the client's health problem? A. Fissures and crevices developing in the mucosa that are seen as a characteristic "cobblestone" appearance. B. Erosion of the endothelial lining of the distal small intestine by a combination of genetic, autoimmune, and environmental factors. C. Compromise of the mucosal layer of the large intestinal surface by the effects of H. pylori. D. Mucosal hemorrhages that have developed into crypt abscesses, which have in turn necrotized and ulcerated.
Answer: D Rationale: The etiology and course of ulcerative colitis involves mucosal hemorrhages developing into crypt abscesses, with consequent necrosis and ulceration. "Cobblestone" appearance of intestinal mucosa is associated with Crohn disease. Ulcerative colitis is confined to the colon and rectum, and H. pylori is not commonly implicated in the etiology.
A 24-year-old woman undergoing a premarital screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which treatment is most likely to be effective for her? A. Lamivudine B. Peginterferon and ribavirin C. Interferon-alfa-2b D. Corticosteroids and immunosuppressant drugs
Answer: D Rationale: This woman's hepatitis is probably caused by an autoimmune disorder rather than a virus. Lamivudine, peginterferon/ribavirin, and interferon alfa-2b are all antiviral agents. Autoimmune hepatitis is a chronic, usually progressive, inflammatory disease of the liver. Corticosteroids are the mainstay of treatment and have been shown to produce remission. Azathioprine, an immunosuppressant medication, is sometimes used along with prednisone. Using both medications may allow a client to take a smaller dose of prednisone, reducing its side effects. Most people with this disease require long-term maintenance treatment.
The nurse walks into a room and finds the client forcefully expelling stomach contents into a wash basin. When documenting this occurrence, the nurse will use the term: A. Nauseous B. Retching C. Vomiting D. Expatriate
Answer: C Rationale: Vomiting or emesis is the sudden and forceful oral expulsion of the contents of the stomach. It is usually preceded by nausea. Nausea is a subjective and unpleasant sensation. Retching consists of rhythmic spasmodic movements of the diaphragm, chest wall, and abdominal muscles. It usually precedes or alternates with periods of vomiting. Expatriate means to banish or withdraw.
An older adult is reporting increasing fatigue and dark stools. On assessment, the nurse notes pale mucous membranes, low hemoglobin and red cell counts, and upper gastrointestional bleed in the stomach via endoscopy. Questioning reveals excess nonsteroidal anti-inflammatory drug (NSAID) usage to control rheumatoid arthritis pain. Which phenomenon is responsible for the present health problems? A. NSAIDs increase the gastric production of gastrin, increasing gastric secretions and lowering stomach pH. B. Drugs such as NSAIDs increase the H+ levels and thus decrease gastric pH, resulting in insult to the stomach lining. C. NSAIDs, aspirin, and other drugs increase prostaglandin synthesis, resulting in disruption of cellular structures lining the stomach. D. NSAIDs can disrupt the permeability of the gastric mucosa, causing hydrogen ions to accumulate in the mucosal cells of the lining.
Answer: D Rationale: NSAIDs damage the mucosal barrier, allowing hydrogen ions to damage cells of the stomach lining. They do not directly increase gastrin production or H+ levels. Decreased, not increased, prostaglandin synthesis would potentially compromise the gastric surfaces
A 29 year-old female has been admitted to the emergency department following a suicide attempt by overdose of acetaminophen. What physiologic changes in the client's liver and accompanying altered diagnostic results does the nurse anticipate? A. Hepatocellular necrosis evidenced by increased ALT and AST levels. B. Allergic inflammation accompanied by an increase in serum IgE and basophils. C. Cholestatic reaction with increased bilirubin count D. Rapid onset of hepatitis and increased GGT, ALT, and bilirubin
Answer: A Rationale: Acetaminophen is commonly implicated in cases of direct hepatotoxicity, a situation that is characterized by hepatocellular necrosis and increased ALT and AST levels. An allergic-type reaction is associated with idiosyncratic drug reactions and cholestatic reactions and development of viral hepatitis are not noted to be associated with acetaminophen.
Which hospitalized client is most clearly demonstrating the signs and symptoms of liver failure? A. Low hemoglobin levels, low platelet levels, and spider angiomas present B. Blood pressure of 189/103, jaundice, and multiple thromboses C. Sudden onset of confusion, a history of alcohol abuse and low levels of serum AST and ALT D. Ascites, fever, and recent onset of atrial fibrillation
Answer: A Rationale: Anemia, thrombocytopenia, and the presence of spider angiomas are characteristic of liver failure. High blood pressure, excessive clotting, fever and cardiac dysrhythmias are not common symptoms of liver failure. In liver failure, AST and ALT levels would rise, not fall
Which effect of the sympathetic nervous system is most responsible for the development of duodenal ulcers due to anxiety and stress? A. Inhibition of the actions of Brunner glands B. Overstimulation of the oxyntic glands C. Suppression cholecystokinin D. Inflammation of the parotid glands
Answer: A Rationale: Brunner glands, which produce large amounts of alkaline mucus that protect the duodenum from acid and digestive enzymes, are strongly affected by sympathetic stimulation, which causes a marked decrease in mucus production. Where the stomach contents and secretions from the liver and pancreas enter the duodenum, deficiency of mucus can cause irritation and, potentially, ulcers. Overstimulation of the oxyntic glands are not produced by the sympathic nervous system. The hormones cholecystokinin is thought in part to control gastric emptying, is released in response to the pH, osmolality, and fatty acid composition of the chime. The two largest salivary glands are called parotid glands. One is located in each cheek over the jaw in front of the ears. Inflammation of one or more of these glands is called parotitis.
A 28-year-old man presents with reports of diarrhea, fecal urgency, and weight loss. His stool is light-colored and malodorous, and it tends to float and be difficult to flush. He has also noted tender, red bumps on his shins and reports pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which diagnosis would his care team first suspect? A. Crohn disease B. Ulcerative colitis C. Diverticulitis D. Colon cancer
Answer: A Rationale: Crohn disease, like ulcerative colitis, causes diarrhea, fecal urgency, weight loss, and systemic symptoms such as erythema nodosum and arthritis. Unlike ulcerative colitis, it also causes steatorrhea but is not as likely to cause blood in the stool. The granulomatous "skip" lesions confirm the diagnosis of Crohn disease. Neither diverticulitis nor colon cancer would cause this combination of symptoms and signs.
A client who is on several medications has noticed an increase in gastrointestinal infections. What type of medication should the nurse advise the client to discuss with the health care provider as a possible cause for increased gastrointestinal infections? A. Broad-spectrum antibiotics B. Beta-1 selective adrenergic blocker C. H1 receptor blocker D. Enteric-coated aspirin
Answer: A Rationale: One of the primary ways the gastrointestinal tract destroys microorganisms is via the inhospitable gastric pH, which is highly acidic with a pH, between 1 and 4. The administration of broad-spectrum antibiotics can disrupt the microbial balance and allow overgrowth of species with potential pathogenicity. Beta-1 selective adrenergic blockers exert their effect on myocardial cells. Histamine-1 (H1) receptor blockers are used to treat allergic reaction while histamine-2 (H2) receptor blockers are the class used to reduce gastric acid. Aspirin can increase the risk for gastric ulcers but does not have a direct effect on the acquisition of enteric infections, and the enteric coating will help reduce the risk for ulcer formation.
A client with kidney cancer who underwent exploratory surgery has returned to the postoperative unit with a report of severe burning and indigestion in the epigastric region. Which intervention by the nurse would be priority for this client? A. Call the surgeon for a prescription for a proton pump inhibitor (PPI) to prevent stress ulcer development. B. Sit the client up in a high-Fowler position and give ice chips to suck on. C. Call the dietary team to bring some milk products to the floor to counter excess gastric acid. D. Administer prescribed pain medications and dim the lights in the room.
Answer: A Rationale: People at high risk for development of stress ulcers include those with large surface area burns, trauma, sepsis, acute respiratory distress syndrome, severe liver failure, and major surgical procedures. PPIs work by irreversibly blocking an enzyme called H+/K+ ATPase, which controls acid production. Examples include medications like esomeprazole, pantoprazole and lansoprazole. Most clients are not started on full-liquid diets that include milk products until their bowel sounds return. Sitting the client in high-Fowler position might help with acid reflux, but to prevent stress ulcers, a PPI is required. Pain medication for gastroesophageal reflux disease will not prevent stress ulcer formation.
A nurse is providing care for a client who has been admitted with a newly diagnosed bilateral pleural effusion. Which finding from the nurse's initial assessment of the client is incongruent with the client's diagnosis and would require further investigation? A. The client reports sharp pain exacerbated by deep inspiration. B. The client's breath sounds are diminished on auscultation. C. Pulse oximetry indicates that the client is hypoxemic. D. The client reports dyspnea and increased work of breathing.
Answer: A Rationale: Pleural effusion is not normally associated with pain, and intense pain that is worsened by deep breathing would necessitate further investigation. Diminished breath sounds, hypoxemia, and dyspnea are common findings associated with pleural effusion.
The nurse notes a client's bilirubin level is 2.5 mg/dL (42.8 μmol/L). Which assessment is most relevant for the nurse to perform based on these results? The nurse should assess the client's: A. eyes. B. oral mucosa. C. level of orientation. D. abdominal girth.
Answer: A Rationale: The normal range for total bilirubin is less than 1.5 mg/dL (25.7 μmol/L) and jaundice becomes evident when this value reaches 2 to 2.5 mg/dL (34.2 to 42.8 μmol). The sclera of the eye, which contains a high proportion of elastic fibers, is usually the first area where jaundice can be detected; thus, the most relevant assessment is of the eye. At this level, bilirubin would not be affecting orientation. Oral mucosa is not a relevant assessment. Although cirrhosis can be associated with ascites and increased abdominal girth, there is no indication in the scenario that this client has this condition and there is no direct correlation between ascites and bilirubin levels.
The nurse is caring for several clients. Given the typical treatments for each of the listed client conditions, which client should the nurse prioritize as most at risk for acute gastrointestinal bleeding? A. A 65-year-old client being treated for atrial fibrillation and coronary artery disease B. A 45-year-old with hypertension and type 2 diabetes being treated for a foot ulcer C. A 70-year-old with rheumatoid arthritis being treated for pneumonia D. An 85-year-old with failure to thrive who is confused and receiving intravenous fluids
Answer: A Rationale: The nurse should consider which conditions are treated with ulcerogenic medications. In this group of clients, the client with atrial fibrillation and ischemic heart disease is most at risk. Clients with atrial fibrillation are usually prescribed anticoagulants for stroke prevention, and aspirin (an ulcerogenic non-selective NSAID) would be prescribed for prevention of myocardial infarction related to coronary artery disease. The client at next greatest risk for gastrointestinal bleeding would be the client with rheumatoid arthritis, as these clients are often treated with myelosuppressive medications that can lower platelet counts, and/or corticosteroids which are ulcerogenic. The client with diabetes and the elderly client would be considered lower risk than the first two based on the treatments for their conditions.
The nurse is caring for a client with a disorder that prevents the pyloric valve from closing properly. For which priority complication should the nurse assess? A. Gastrointestinal bleeding B. Pancreatitis C. Intestinal obstruction D. Jaundice
Answer: A Rationale: The pyloric sphincter prevents the backflow of gastric contents from the small intestine into the stomach and controls the rate at which gastric contents enter the small intestine. If the sphincter fails, regurgitation of bile salts and duodenal contents can damage the mucosal surface of the antrum and lead to gastric ulcers, which can in turn lead to life-threatening gastrointestinal bleeding; this should be the nurse's priority. There would not be an increased risk for developing pancreatitis, which is associated with alcohol and certain drugs. Having the pyloric sphincter open will not result in intestinal obstruction. Jaundice is related to excess levels of bilirubin, which is not related to this condition.
An older adult client is admitted with a stroke and has developed pneumonia. While auscultating the right lateral thorax, the nurse hears abnormal breath sounds. Which lobe of the lung is likely effected due to obstruction by thick secretions? A. Right middle lobe B. Right lower lobe C. Right upper lobe D. Left lower lobe
Answer: A Rationale: The right middle lobe bronchus is of relatively small diameter and length and sometimes bends sharply near its bifurcation. It is surrounded by a collar of lymph nodes that drain the middle and the lower lobe and is particularly subject to obstruction. Placing a stethoscope over the right lateral thorax is the location of the right middle lobe of the lungs
A client has suffered a head injury during a motorcycle accident resulting in impaired swallowing and aspiration pneumonia. Which statement most accurately captures an aspect of his condition? A. His vocal folds of the larynx are not performing their normal function. B. His epiglottis is covering his larynx C. His trachea has been compromised. D. His tracheobronchial tree is intermittently obstructed
Answer: A Rationale: The vocal folds contribute to blocking the airways during swallowing; compromise of this function is likely to allow food to enter the lungs. The epiglottis is performing its normal, protective role against aspiration when it covers the larynx, and the vocal folds contribute to sound enunciation, not swallowing or protection against aspiration. Tracheobronchial obstruction would not contribute to aspiration
A family physician is performing client teaching about the influenza virus with each client who has come to the clinic to receive that year's vaccine. Which statement by the client best reflects an accurate understanding of the flu virus? A. "I could come down with viral or bacterial pneumonia as a result of a bad flu bug." B. "I know my vaccination is especially important since there aren't any drugs that can treat the flu once I get sick with it." C. "The emphasis on bundling up, staying warm, and drinking lots of fluids is outdated and actually ineffective." D. "Like all vaccines, it is ideal if everyone in a population gets immunized against the flu."
Answer: A Rationale: Viral and bacterial pneumonia are known sequelae of influenza. Antiviral drugs do exist for the flu, and the efficacy of staying warm and increasing fluid consumption has been demonstrated. The flu vaccine is recommended for higher risk individuals, and guidelines do not indicate the need for all individuals to be vaccinated.
The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son's condition. Which teaching point is most justifiable? A. "Research has shown that viruses may actually be a factor in childhood asthma." B. "The most reliable indicator that your child is having an asthma attack is audible wheezing." C. "Steroids that your child can inhale will likely be the first line of defense." D. "Your son will likely need to limit or avoid exercise and sports."
Answer: A Rationale: Viruses have been implicated as a contributing factor in childhood asthma. Wheezing may or may not be present in children and inhaled corticosteroids are not common as an initial therapy. Current treatment guidelines do not advise the categorical avoidance of exercise
Parents have brought their child to the emergency department with abdominal pain. Which clinical manifestations would lead the health care team to suspect the child has appendicitis? Select all that apply. A. Tenderness in right lower quadrant with palpation. B. Rebound tenderness in inguinal areas upon palpation. C. Redness and warmth over right lower quadrant. D. Bloating and flatulence noticeable. E. Urine has the smell of stool with brown coloring.
Answer: A, B Rationale: Appendicitis usually has an abrupt onset. Palpation of the abdomen usually reveals a deep tenderness in the LRQ, which is confined to a small area approximately the size of the fingertip. It usually is located at approximately the site of the inflamed appendix. Rebound tenderness (pain that occurs when pressure is applied to the area and then released) and spasm of the overlying abdominal muscles are common. An abscess may display redness and warmth. Bloating and flatulence is usually seen with diverticular disease as is the development of fistulas (vesicosigmoid) where stool is seen in the urine.
A client with COPD asks the nurse which medications are prescribed to help with breathing. The nurse will educate the client about which medications to help COPD in the long-term? Select all that apply. A. Salmeterol, a bronchodilator. B. Tiotropium, an anticholinergic. C. Alprazolam, a benzodiazepine. D. Sildenafil, a vasodilator. E. Ketorolac, a NSAID.
Answer: A, B Rationale: Pharmacologic treatment of COPD includes the use of bronchodilators and anticholinergic drugs. Benzodiazepines are used for anxiety and sildenafil is a vasodilator commonly prescribed for erectile dysfunction but also for clients with pulmonary hypertension. Ketorolac is a NSAID for pain and inflammation
The nurse is caring for a client with end-stage liver disease who is at risk for hepatic encephalopathy. For which complications that increase the risk for hepatic encephalopathy should the nurse assess? Select all that apply. A. Constipation B. Gastrointestinal bleeding C. High colonic pH D. Hypoalbuminemia E. Hyponatremia
Answer: A, B, C Rationale: Ammonia is produced in the colon by the bacterial degradation of proteins and amino acids, therefore more ammonia will be produced when the bacteria has access to either a greater protein load (such as when a person has bleeding in the gastrointestinal tract) or prolonged contact with colonic contents such as occurs with constipation. Normally, ammonia diffuses into the portal circulation and is transported to the liver, where it is converted to urea before entering the general circulation and then excreted via urine. When the liver is unable to convert ammonia to urea, ammonia accumulates and affects neurologic functioning. Using lactulose to create a more acidic colonic environment (low pH) is one treatment for hepatic encephalopathy. Therefore, a high colonic pH (more alkaline colonic environment) could result in more ammonia entering the circulation. While both low albumin and sodium levels are found in clients with liver failure, these are not associated with worsening hepatic encephalopathy
A client is admitted with the diagnosis of obstructive jaundice. Which assessment findings would the nurse expect to see in this client? Select all that apply. A. Clay-colored stools B. Dark urine C. Elevated conjugated bilirubin levels D. Decreased serum alkaline phosphatase levels E. Severe itching
Answer: A, B, C, E Rationale: Obstructive jaundice occurs when bile flow is obstructed between the liver and the intestine. Among the causes are strictures of the bile duct, gallstones, and tumors of the bile duct or the pancreas. Conjugated bilirubin levels usually are elevated; the stools are clay colored; the urine is dark; the levels of serum alkaline phosphatase are markedly elevated; and the aminotransferase levels are increased.
The nurse is caring for a client with late stage cirrhosis who is prescribed the beta-blocker propranolol. Which complications of cirrhosis will the nurse expect to be reduced by administration of propranolol? Select all that apply. A. Thrombocytopenia B. Esophageal varices C. Hyperaldosteronism D. Ascites E. Jaundice
Answer: A, B, D Rationale: Propranolol is prescribed to reduce portal hypertension (PHTN). PHTN leads to increased pressures in the portal system, causing splenomegaly and the resulting sequestration of platelets leading to thrombocytopenia. Esophageal varices are also a result PHTN. The increase in hydrostatic pressure also contributes to the formation of ascites due to the increased intravascular hydrostatic pressures preventing the reabsorption of interstitial fluid into the intravascular space. Both jaundice and hyperaldosteronism are more directly related to hepatocyte dysfunction rather than portal hypertension.
For several years, a single mother of 2 has been averaging 2 to 3 bottles of wine each night and recently has added several ounces of brandy as well. She now has been diagnosed with cirrhosis. Which physical manifestations of cirrhosis would the nurse expect to find during assessment? Select all that apply. A. Ascites B. Anorexia C. Fever D. Bleeding tendencies E. Epigastric pain F. Obesity
Answer: A, B, D, E Rationale: Ascites, anorexia, and bleeding tendencies due to neurological effects and epigastric pain are common accompaniments to cirrhosis. Ascites occurs when the amount of fluid in the peritoneal cavity is increased, and is a late-stage manifestation of cirrhosis and portal hypertension. Epigastric pain is caused by liver enlargement or peritonitis. The peritoneal fluid is seeded with bacteria from the blood or lymph or from passage of bacteria through the bowel wall. Because factors V, VII, IX, X, prothrombin, and fibrinogen are synthesized by the liver, their decline in liver disease contributes to bleeding tendencies. Fever and obesity would be less likely to exist, as the pathology is not infectious in nature and malnutrition and impaired food metabolism are common
A client who has been on a high-protein diet comes to the emergency department with respiratory symptoms. Upon analysis of arterial blood gases (ABGs), the client is diagnosed with hypercapnia. Which ABG results confirm this diagnosis? Select all that apply. A. pH 7.31 (Normal 7.35-7.45) B. PO2 97 % C. PCO2 58 mm Hg (7.71 kPa) [Normal 35-45 mm Hg, 4.7 - 5.9 kPa] D. Serum HCO3 33 mEq/L (33 mmol/L) [Normal 22-28 mEq/L, 22-28 mmol/L] E. Serum K+ [potassium] 3.6 mmol/L (Normal 3.5-5.0)
Answer: A, C, D Rationale: Hypercapnia affects a number of body functions, including acid-base balance and renal, neurological, and cardiovascular function. Elevated PCO2 (35-45) produce decreased pH (7.35-7.45) and respiratory acidosis. Compensatory mechanisms result in increase in serum HCO3 (22-28). In this example, the PO2 level is within normal range. Serum K+ is not part of the ABG analysis.
The nurse is caring for a client who is being treated for pneumonia. The nurse suspects the client has developed pleuritis. Which assessment findings support the nurse's suspicion of pleuritis? Select all that apply. A. Shoulder pain B. Bilateral chest wall pain C. Pain when deep breathing and coughing D. Purulent sputum E. Unequal chest expansion on inspiration
Answer: A, C, E Rationale: Pleuritis results in unilateral pain of the chest wall that is abrupt in onset. When the diaphragm is irritated, the pain may be referred to the shoulder. Chest movements such as deep breathing and coughing make the pain worse. Reflex splinting of the chest muscles may occur, causing a lesser respiratory expansion on the affected side. Though the client's pneumonia may result in purulent sputum, this is not a sign of pleurisy (inflammation of the pleura).
The nurse is caring for a 67-year-old client who has been diagnosed with pneumonia. The vital signs are temperature 101.7°F (38.7°C), blood pressure 155/95, respiratory rate 26, and heart rate 88. Which interventions should the nurse incorporate into the client's plan of care? Select all that apply. A. Administer antipyretics as ordered. B. Administer antitussives as ordered. C. Encourage deep breathing and coughing. D. Elevate the client's legs periodically. E. Encourage fluid intake.
Answer: A, C, E Rationale: The client has a fever, which will cause more water to be lost from the respiratory mucosa. Also, the client has an increased respiratory rate, which will increase these insensible losses. This will result in a thickening of respiratory secretions that will be more difficult to clear. For these reasons, the nurse should encourage fluids, treat fever, and encourage deep breathing and coughing to facilitate clearing secretions from the airway. The client with pneumonia should not routinely be given antitussives as this impedes the protective function of the mucociliary defense system when experiencing a productive cough. Elevating the legs periodically through the day is an intervention to prevent nocturia and paroxysmal nocturnal dyspnea in a client with pedal edema and/or left heart failure; it is not relevant in pneumonia
A client, admitted after an automobile accident in which ther head and chest hit the steering wheel, has a combination of biomarker testing (SP-D, neutrophil chemotractor factor, and interleukin-8). The family asks, "Why are there so many blood tests?" The response by the nurse reveals these test results will confirm the client has developed which condition(s)? Select all that apply. A. Acute lung injury B. Pulmonary embolism C. Pulmonary hypertension D. Acute respiratory distress syndrome (ARDS) E. Pneumothorax
Answer: A, D Rationale: SP-D can be used to predict problems with acute lung injury and ARDS. Both of these conditions can be predicted by using a combination of biomarkers, SP-D, neutrophil chemotractor factor, and interleukin-8. Therefore, it is most significant to measure SP-D in people experiencing chest trauma. Pneumothorax, and pulmonary hypertension are unlikely conditions that occur following chest trauma.
While explaining the function of the first mucosal layer of the lower two-thirds (2/3) of the esophagus, the pathophysiology instructor mentions which type of functions? Select all that apply. A. Secretion of mucus to lubricate and protect the inner surface of alimentary canal. B. Smooth muscle cells that facilitate movement of contents of the gastrointestinal tract. C. Hold the organs in place and storage for fats. D. Barrier to prevent the entry of pathogenic organisms. E. A cushioning to protect against injury from sports or car accidents
Answer: A, D Rationale: The first layer performs numerous functions. These include production of mucus that lubricates and protects the inner surface of the alimentary canal; secretion of digestive enzymes and substances that break down food; absorption of the breakdown products of digestion; and maintenance of a barrier to prevent the entry of noxious substances and pathogenic organism. The facilitation of movement of contents of the gastrointestinal tract occurs in the third layer while holding the organs in place. Storage of fats occurs in the fourth layer.
The nurse is caring for a client with end-stage biliary cirrhosis. What should the nurse include in this client's plan of care? Select all that apply. A. Inspect skin for evidence of breakdown. B. Temperature assessment and administration of antipyretics C. Encourage intake of 3 to 4 L of fluids per day. D. Monitor client for signs of acute blood loss. E. Promote intake of foods rich in vitamin D.
Answer: A, D, E Rationale: The client with end-stage biliary cirrhosis will have a chronic reduction in bile production, which interferes with the ability to emulsify and use fat-soluble vitamins. Due to a lack of vitamin K, the client can develop an associated risk for bleeding. Lack of vitamin D results in osteoporosis in clients and an increased risk for pathologic fractures, so the nurse should encourage vitamin D intake. This risk, combined with risk for bleeding, warrants a fall prevention program. Accumulation of bile salts and the lack of fat-soluble vitamins impairs skin integrity, so the nurse should prioritize skin care and inspection for breakdown. There is no need to encourage increased intake of fluids. Fever is not a prominent feature of end-stage biliary cirrhosis. The common antipyretics should be avoided (acetaminophen and ibuprofen).
A 51-year-old female client who is 2 days postoperative in a surgical unit of a hospital is at risk of developing atelectasis as a result of being largely immobile. Which teaching point by her nurse is most appropriate? A. "Being in bed increases the risk of fluid accumulating between your lungs and their lining, so it's important for you to change positions often." B. "You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed." C. "Make sure that you stay hydrated and walk as soon as possible to avoid our having to insert a chest tube." D. "I'll prescribe bronchodilator medications that will help open up your airways and allow more oxygen in."
Answer: B Rationale: Atelectasis is characterized by incomplete lung expansion, and can often be prevented by deep breathing and coughing. Pleural effusion, not atelectasis, is associated with fluid accumulation between the lungs and their lining. Neither chest tube insertion nor bronchodilators are common treatments for atelectasis.
Reviewing pathology for an exam on pulmonary vasculature, the nursing student states that blood enters the right side of the heart via the vena cava, then to the right atrium, right ventricle, and then which vessel carries the deoxygenated blood into the pulmonary system? A. Pulmonary capillaries B. Pulmonary artery C. Pulmonary vein D. Ductus arteriosus
Answer: B Rationale: Deoxygenated blood leaves the right heart through the pulmonary artery. Return of oxygenated blood to the heart occurs by way of the pulmonary vein, which empties into the left atrium
Which phenomenon is most likely occurring during a child's alveolar stage of lung development? A. Terminal alveolar sacs are developing and surfactant production is beginning. B. A single-capillary network exists and the lungs are capable of respiration. C. The conducting airways are formed, but respiration is not yet possible. D. Primitive alveoli are formed and the bronchi and bronchioles become much larger.
Answer: B Rationale: During the alveolar stage of lung development from late fetal to early childhood, a single capillary network appears and the lungs are ready to perform respiration. The development of alveolar sacs and production of surfactant are associated with the saccular period, and formation of the conducting airways occurs during the pseudoglandular period. Formation of primitive alveoli takes place during the canicular period.
Four weeks after returning from a tropical vacation, a 40-year-old man has presented to the emergency department with malaise, nausea, and yellow sclera. Serology has confirmed a diagnosis of hepatitis A (HAV). What teaching is most appropriate for this client? A. "You can expect these symptoms to disappear after about 2 months, but you will be a carrier of the disease indefinitely. B. A vaccine before your trip would have prevented this, but your body will rid itself of the virus in time. C. You likely came in contact with blood or body fluids at some point, and you will have to ensure no one is subsequently exposed to your own blood or body fluids. D. You likely got this by way of what we call the fecal-oral contamination. You will have chronic hepatitis now, but the symptoms can be controlled with medication.
Answer: B Rationale: HAV is transmitted by the fecal-oral route; it is normally self-limiting and does not result in chronic hepatitis or carrier status. A vaccine is available. Transmission of hepatitis through contact with blood and body fluids is typical with hepatitis B or C.
A baby is born to a mother with active hepatitis B. Which medication does the nurse anticipate administering today? A. Tenofovir disoproxil fumarate plus emtricitabine B. Hepatitis B immune globulin (HBIG). C. Hepatitis C immune globulin (HCIG). D. Hepatitis A vaccine (HAV).
Answer: B Rationale: HBIG is used as an adjunct to hepatitis B vaccine for post-exposure immunoprophylaxis to prevent HBV infections in high-risk populations. Tenofovir disoproxil fumarate plus emtricitabine is for HIV pre-exposure coverage. There is no hepatitis C vaccine available on the market yet. HAV is for hepatitis A vaccine, which is usually spread from the fecal-oral route rather than blood and body fluids
A pneumonia that occurs 48 hours or more after admission to the hospital is considered: A. Community-acquired pneumonia B. Hospital-acquired pneumonia C. Viral pneumonia D. Immunocompromised pneumonia
Answer: B Rationale: Hospital-acquired pneumonia is defined as lower respiratory tract infections that were not present or incubating on admission to the hospital. Usually, infections occurring 48 hours or more after admission are considered hospital acquired. Community-acquired pneumonia is diagnosed within 48 hours after admission. Most hospital-acquired pneumonia is bacterial.
A middle-aged man walks into the emergency department reporting chest pain radiating to the neck, shortness of breath, and nausea. His heart rate is 120 and BP is 94/60. The ED physician recognizes the client is having an acute MI with decreased cardiac output. The nurse identifies the nausea to be in response to: A. the client doesn't have a very high pain tolerance. B. hypoxia exerting a direct effect on the chemoreceptor trigger zone. C. the client hasn't digested his meal completely. D. fear of having to make major lifestyle changes.
Answer: B Rationale: Hypoxia exerts a direct effect on the vomiting center (chemoreceptor trigger zone), producing nausea and vomiting. This direct effect probably accounts for the vomiting that occurs during periods of decreased cardiac output, shock, environmental hypoxia. We are given no information about the client's pain tolerance, when he last had a meal, or his routine lifestyle. This client is going into shock (rapid pulse, low BP), which can result in shunting of blood away from the gut and other organs. During shock, the priority organs for oxygenation include the heart, brain, lungs, and kidneys.
Which client is most clearly displaying the signs and symptoms of irritable bowel disease (IBD)? A. A 32-year-old mother who reports intermittent abdominal pain that is worse during her menstrual period. B. A 51-year-old male who states that his stomach pain is in his lower abdomen, "comes and goes" and "feels more like a cramp than a dull ache." C. A 44-year-old man who works the evening shift at a factory and who states that his lower abdominal pain is much worse at night than during the day. D. A 24-year-old man who has a stressful job but whose diarrhea and cramping does not worsen during periods of high stress.
Answer: B Rationale: IBD is commonly manifested as intermittent lower abdominal pain that feels like cramping. Defecation normally relieves the pain, and symptoms are normally not present at night or during sleep. Stress commonly exacerbates symptoms
A male, lifetime smoker has died as a result of chronic obstructive pulmonary disease. Which phenomenon regarding his alveoli would his care team have expected in the weeks prior to his death? A. Proliferation of natural killer (NK) cells in the alveolar lumen B. Large numbers of alveolar macrophages in septal connective tissue C. The presence of tubercles in the interalveolar spaces D. Compensatory regeneration of type I alveolar cells
Answer: B Rationale: Smokers often retain large numbers of carbon-filled macrophages in their septal connective tissue. NK cell proliferation is not a noted phenomenon in the alveoli, and tubercles are associated specifically with tuberculosis infection. Type I alveoli are incapable of regeneration.
The nurse is caring for clients with chronic respiratory disorders. For which client with cyanosis should the nurse intervene first? The client with cyanosis and: A. a diagnosis of chronic obstructive pulmonary disease (COPD). B. anemia of chronic disease and a hemoglobin of 8.7 g/dL (87 g/L). C. polycythemia and a hemoglobin of 16.8 g/dL (168 g/L). D. a blood pressure of 155/95 mm Hg.
Answer: B Rationale: The nurse should prioritize intervening with the client who has anemia. People with low hemoglobin levels are less likely to exhibit cyanosis, meaning if this client is exhibiting cyanosis, the hypoxia would have to be exceptionally severe compared to the client with a high hemoglobin who may be cyanotic without being hypoxic. The diagnosis of chronic obstructive pulmonary disease (COPD) or moderate elevation in blood pressure would not influence the nurse's prioritization of cyanotic clients compared to the hemoglobin levels.
A 53-year-old woman with a history of chronic alcohol abuse but without visible jaundice comes to the clinic complaining of nausea and weakness. She admits to taking acetaminophen for persistent headaches but denies exceeding the recommended daily dose; she has not taken any other medications. She is suspected of having acetaminophen toxicity. Which diagnostic test finding would implicate a different cause of her symptoms? A. Normal serum acetaminophen level B. Elevated serum HBsAG level C. Evidence of steatosis on liver biopsy tissue sample D. Hypoglycemia
Answer: B Rationale: The presence of HBsAG would suggest that this woman is in the prodromal phase of hepatitis B infection. A normal serum acetaminophen level does not preclude toxicity if the drug is taken over a period of time. Steatosis is fatty infiltration of the liver. Steatosis is often but not exclusively an early histological feature of alcoholic liver disease (therefore, with chronic alcohol abuse, the nurse should expect the client may have steatosis). Drinking heavily without eating can block your liver from releasing stored glucose into your bloodstream, causing hypoglycemia.
A client has been following a low-fat diet due to a diagnosis of high triglycerides and to lose weight. The client asks the nurse how it is possible that the extra weight and high triglycerides persist despite taking in such low levels of fat. What is the nurse's best response? A. Perhaps the fats you are consuming are especially high in triglycerides. B. It is important to reduce your total caloric intake, including carbohydrates. C. You must include exercise to effectively reduce weight and triglycerides. D. If high cholesterol continues after this change in diet, you will require medication.
Answer: B Rationale: The client is asking about the connection between a low-fat diet, triglyceride levels, and weight loss. Therefore, the nurse should explain two key points: (1) triglycerides come from the fat consumed, and (2) when carbohydrates are consumed in excess of what is immediately converted to energy, the excess is converted to triglycerides in the liver. The triglycerides formed in the liver are transported mainly in low-density lipoproteins (LDLs) to the adipose tissue, where they are stored (contributing to weight gain). Exercise can help burn off excess calories but weight loss can be achieved through caloric restriction alone. The client may not need medication if the proper lifestyle interventions are implemented.
The nurse is caring for a client with achalasia. Which interventions should the nurse prioritize in the plan of care? Select all that apply. A. Allow client to consume thickened fluids only. B. Have oropharyngeal suctioning equipment at bedside. C. Position client with head of bed elevated. D. Arrange for small, frequent meals. E. Administer antiemetics before meals.
Answer: B, C, D Rationale: In achalasia, the lower esophageal sphincter fails to relax due to a disruption in the vagus nerve, resulting in an enlargement of the esophagus and the trapping of food in the lower esophagus. Therefore, smaller meals allow for less volume of food trapping. There is no risk for aspiration when swallowing, so thickened fluids are not needed. There is the danger of aspiration when the person lies down, however, so the nurse should have suctioning equipment at the bedside and keep the head of the bed elevated. Achalasia does not cause nausea or true vomiting but rather regurgitation of the trapped contents from above the stomach, so antiemetics are not indicated
As a consequence of long-standing lung disease, a client is in a chronic state of hypoxia. Which phenomena would the client's care team be most justified in anticipating? Select all that apply. A. Metabolic alkalosis B. Increased erythropoietin production C. Pulmonary vasodilation D. Hyperventilation E. Personality changes
Answer: B, D, E Rationale: Increased production of erythropoietin, hyperventilation, and cognitive and personality changes are all associated with hypoxemia. Acidosis, not alkalosis, and vasoconstriction rather than vasodilation are likely to occur.
In the early morning, a parent brings the 5-year-old child to the emergency room. The child is wheezing, short of breath, and has a dry cough. The parent states that the child has always been very healthy. The child went to bed with only a slight cold and a runny nose but woke up coughing shortly after 4 a.m. The symptoms worsened so dramatically that parent brought the child to the hospital. The care team would most likely suspect that the child has: A. respiratory syncytial virus. B. influenza. C. asthma. D. pneumonia.
Answer: C Rationale: Although the child may have an infectious disease, the symptoms and the timing of them (both in terms of the child's age and the time of symptom onset) are classic for asthma. The symptoms are not as closely associated with respiratory syncytial virus, influenza, or pneumonia.
A nurse on a respiratory unit of a hospital is providing care for a client with end-stage lung disease. Consequently, measurement of the client's arterial blood gases indicates increased PCO2. Which associated consequence would the nurse anticipate? A. A shift to the left of the oxygen-hemoglobin dissociation curve B. Lower than normal production of HCO3 C. Higher than normal production of H+ D. An absence of carbaminohemoglobin
Answer: C Rationale: As a result of the combination of water and carbon dioxide, hydrogen ions are produced along with bicarbonate. This would be associated with a shift to the right of the oxygen-hemoglobin dissociation curve, increased bicarbonate output, and higher than normal levels of carbaminohemoglobin
Which clinical finding would be most closely associated with a client who has interstitial lung disease in comparison to chronic obstructive pulmonary disease (COPD)? A. Audible wheezing on expiration B. Reduced expiratory flow rates C. Decreased tidal volume D. Normal forced expiratory volume
Answer: C Rationale: Because it takes less work to move air through the airways at an increased rate than it does to stretch a stiff lung to accommodate a larger tidal volume, interstitial lung disease is commonly associated with an increased respiratory rate but decreased tidal volume. Wheezing and decreased expiratory flow rate are more closely associated with COPD.
The nurse caring for a client with protal hypertension and subsequent development of esophageal varices will likely receive a prescription for which drug class to assist with decreasing portal pressure? A. Angiotensin-converting enzyme (ACE) inbitibors B. Sympathomimetic agents C. Beta-adrenergic blocking agent D. Inotropic agent
Answer: C Rationale: Beta blockers, also known as beta-adrenergic blocking agents, are a class of drugs that works by blocking the neurotransmitters norepinephrine and epinephrine from binding to receptors. These agents reduce portal venous pressure by decreasing splanchnic blood flow and thereby decreasing blood flow in collateral channels. Dopamine is an important neurotransmitter (messenger) in the brain. Dopamine is classified as a catecholamine (a class of molecules that serve as neurotransmitters and hormones) with inotropic properties. Epinephrine is in a class of medications called sympathomimetic agents. It works by relaxing the muscles in the airways and tightening the blood vessels. ACE inhibitors are medications that slow (inhibit) the activity of the enzyme ACE, which decreases the production of angiotensin II. As a result, blood vessels enlarge or dilate, and blood pressure is reduced.
Following a 14-day course of broad-spectrum antibiotics for the treatment of sepsis, a client develops watery diarrhea attributed to the elimination of normal intestinal flora. What other phenomena are most likely accompanying the low levels of normal flora? A. Decreased mineral and nutrient absorption; decreased carbohydrate metabolism B. Decreased pH of the stomach; increased pH of the lower gastrointestinal tract C. Decreased fermentation of undigestible dietary residue; decreased vitamin absorption D. Proliferation of vitamin K; lower gastrointestinal bleeding
Answer: C Rationale: Central among the functions of normal intestinal flora are the fermentation of dietary components that are not digestible and the facilitation of vitamin absorption. Mineral and nutrient absorption as well as carbohydrate metabolism are less likely to be affected, while vitamin K production would likely decrease somewhat. pH is unlikely to be affected.
A client with pancreatic cancer is admitted for portal hypertension and is symptomatic with ascites. Following paracentesis and removal of 7.5 L of ascitic fluid, the nurse should anticipate that the physician will order which medication to assist in maintaining an effective circulating fluid volume? A. Bumetanide B. Furosemide C. Albumin (Human) 5%. D. Epoetin alfa
Answer: C Rationale: Complications of portal hypertension include ascites, splenomegaly, and hepatic encephalopathy. Following paracentesis to remove ascitic fluid, a volume expander such as albumin is usually administered to maintain the effective circulating volume. Furosemide and bumetanide are diuretics which decrease circulating fluid volume. Epoetin alfa stimulates red blood cell production and ultimately increases O2 carrying capacity.
A 66-year-old male presents to the emergency room accompanied by his wife, who claims that he has been acting confused. The man is reporting a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8°F (39.3°C) and his blood work indicates his sodium level at 126 mEq/L (126 mmol/L) [normal 135-145 mEq/L // 135-145 mmol/L]. Based on this assessment, the nurse suspects the client has: A. Bronchopneumonia B. Mycoplasma pneumonia C. Legionella pneumonia D. Pneumococcal pneumonia
Answer: C Rationale: Confusion, dry cough, diarrhea, and hyponatremia are associated with Legionnaire disease, and less so with bronchopneumonia, mycoplasma pneumonia, or pneumococcal pneumonia.
A health educator is performing a health promotion workshop with the staff of a large, urban homeless shelter, and a component of the teaching centers around tuberculosis. One of the staff members comments, "Anyone who's had contact with tuberculosis in the past can give it to any of the other residents of the shelter, even if they didn't get sick themselves." How could the educator best respond to this comment? A. "Many people do manage to fight off the infection, but you're right—they can still spread it by coughing or sneezing." B. "If someone has been previously exposed to tuberculosis, they are particularly infectious because they are often unaware of the disease." C. "Actually, people who have the latent form of the disease won't be sick and can't spread it either." D. "There isn't any real risk of them spreading it, but we would like to vaccinate everyone who's had any contact with it in the past."
Answer: C Rationale: Contact with M. tuberculosis without the development of progressive primary tuberculosis results in a latent infection that is not communicable. Vaccination is not a common intervention in the United States.
A nurse practitioner is providing care for a male client with a longstanding hiatal hernia. Which statement most accurately captures an aspect of the pathophysiology of hiatal hernias? A. Paraesophageal hiatal hernias are common and are normally not treated if the client is asymptomatic. B. The root causes of hiatal hernias are normally treatable with medication. C. If esophageal acid clearance is impaired, esophagitis can result. D. An incompetent pyloric sphincter and high fat diet are commonly implicated in the development of hiatal hernias.
Answer: C Rationale: Erosive esophagitis can be a complication of hiatal hernias if esophageal acid clearance is significantly impaired. Paraesophageal hiatal hernias are more serious than the sliding variety and require treatment. The root cause of hiatal hernias—herniation of the stomach through the diaphragm—is not normally amenable to treatment with medication. The pyloric sphincter is not associated with hiatal hernias
Parents of a 20-month-old infant report that he refuses food or eats poorly and that he grimaces when he swallows. He also is irritable and cries a lot. The mother is worried that he ate something inappropriate this morning, because he vomited something that looked like coffee grounds. Which health problem would the care team first suspect? A. Rotavirus infection B. Appendicitis C. Esophagitis from gastrointestinal reflux D. Hirschsprung disease
Answer: C Rationale: Esophagitis secondary to reflux can cause feeding problems, early satiety, and hematemesis. Infants may demonstrate signs of pain when swallowing and may be irritable and cry frequently. Rotavirus causes diarrhea and vomiting, but not the other symptoms. Appendicitis is inflammation of the appendix. Appendicitis usually starts with the main symptom of pain around the navel that moves to the lower right abdomen. Hirschsprung disease is a blockage of the large intestine due to improper muscle movement in the bowel. It is a congenital condition, which means it is present from birth. In Hirschsprung disease, the nerves are missing from a part of the bowel. One primary sign/symptom is a failure to pass meconium shortly after birth.
A child with rhinosinusitis should be monitored for complications. Which assessment finding would alert the nurse that a complication is developing? A. Purulent nasal discharge B. Temperature of 100.8°F (38.2°C) C. Periorbital edema D. Reports of headache
Answer: C Rationale: Expected signs/symptoms of acute viral rhinosinusitis include facial pain, headache, purulent nasal discharge, decreased sense of smell, and fever. Complications can lead to intracranial and orbital wall problems. Facial swelling over the involved sinus, abnormal extraocular movements, protrusion of the eyeball, periorbital edema, or changes in mental status may indicate intracranial complications.
Following a history of gastric pain and an endoscopy, a client has been diagnosed with a duodenal peptic ulcer. Which teaching point should his caregiver provide? A. "While your diet most certainly contributed to this problem, the good news is that changing your diet can help solve it." B. "Ulcers like yours do not penetrate all layers of the stomach or duodenum so you don't have to worry about losing too much blood." C. "Your family history, your smoking history, and NSAID use may all have contributed to this problem." D. "While there aren't really any effective medications for these ulcers, changes in lifestyle can keep them well controlled."
Answer: C Rationale: Family history, NSAID use, and smoking have all been identified as contributing factors in the development of peptic ulcers. Diet therapy has not been shown to be effective and duodenal peptic ulcers are more common than the gastric variant. Perforation occurs when an ulcer erodes through all layers of the stomach or duodenum wall. When perforation occurs in older adults, their mortality is significantly increased. Effective medication regimens are available with antacids, histamine-2 (H2) receptor antagonists or proton pump inhibitors being the most common medications used
A short, nonsmoking 44-year-old male presents to the emergency room with left-sided chest pain and a cough. He states the pain started abruptly and worsens with deep breathing and coughing. He denies recent injury. Assessment includes shallow respirations with a rate of 36, normal breath sounds, no cyanosis. Which condition is most likely causing his symptoms? A. Myocardial infarction B. Spontaneous pneumothorax C. Pleuritis related to infection D. Obstructive atelectasis
Answer: C Rationale: Pleuritis, which frequently accompanies infections that cause cough, is unilateral, starts abruptly, and is worsened by coughing or deep breathing. The client's shallow, rapid breathing may be due to anxiety but also is a way of maintaining adequate air intake while avoiding deep breathing, which exacerbates the pain of pleuritis. His cough may be an indication of infection, especially as he is not a smoker. The pain of myocardial infarction is not worsened by deep breathing or coughing. Spontaneous pneumothorax would be very unlikely in a short, nonsmoking, middle-aged man. Tachypnea might indicate obstructive atelectasis, but normal breath sounds and lack of cyanosis argue against it.
Which long-term care resident is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)? A. A 79-year-old lifetime smoker who reports shortness of breath and pain on deep inspiration. B. An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells. C. An 81-year-old male who has a productive cough and recurrent respiratory infections. D. An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke.
Answer: C Rationale: Productive cough and recurrent respiratory infections are associated with COPD, while pain, fever and increased white cells are not common signs and symptoms. Acute shortness of breath and bronchoconstriction are associated with asthma.
When educating a college student who lives in a crowded apartment and was recently diagnosed with tuberculosis, the school nurse will emphasize which treatment plan? A. "Once your fever goes away you can stop taking the streptomycin injection." B. "If isoniazid makes you nauseous, we can substitute something milder." C. "To destroy this bacterium, you must strictly adhere to a long-term drug regimen of several medications." D. "You will have to wear a N95 mask while on campus at all times."
Answer: C Rationale: Success of chemotherapy for prophylaxis and treatment of tuberculosis depends on strict adherence to a lengthy drug regimen which includes isoniazid, rifampin, ethambutol, pyrazinamide, and streptomycin (or some combination of these)
The nurse is caring for a client in intensive care receiving mechanical ventilation and intravenous insulin infusion. The nurse notes sudden onset hypotension, tachycardia, and jugular vein distension. What should the nurse do first? A. Check the client's current blood glucose level. B. Retrieve client's most recent arterial blood gas result. C. Check the tidal volume setting on the ventilator. D. Assess the client's fluid volume balance.
Answer: C Rationale: The client is demonstrating possible signs of a tension pneumothorax, which can result from barotrauma caused by mechanical ventilation with high tidal volume. The increase in intrathoracic pressure decreases stroke volume, which would result in a blood pressure decrease despite an increase in heart rate; this in turn can progress to shock. Due to the resistance to venous return, there is also jugular vein distension. Hypotension is not associated with blood glucose imbalances, and because the client is on a ventilator, sedatives will be administered, altering the client's level of consciousness. The client's fluid balance and most recent blood gas result is not as important as ensuring ventilator settings are not causing a tension pneumothorax at this moment.
A client is diagnosed with a stroke that affects the left hemisphere of the brain, and the health care provider has prescribed testing to assess for damage to the glottis. Which action should the nurse take prior to allowing the client to receive food/beverages from the cafeteria? A. Monitor for impaired memory and judgment B. Assess for attention deficits which will determine whether the client can feed oneself without assistance C. Assess ability to swallow and check breath sounds for signs aspiration pneumonia D. Identify whether the client can make reasonable decisions versus poor reasoning skills
Answer: C Rationale: When a stroke affects the left side of the brain, the nurse should monitor the client for trouble speaking or understanding words (aphasia), facial weakness, unclear speech or problems with swallowing. If the swallowing mechanism is partially or totally paralyzed, food and fluids can enter the airways instead of the esophagus when the person attempts to swallow. These substances are not easily removed. When they enter the lungs, they can cause a serious inflammatory condition call aspiration pneumonia. If the right side of the brain is damaged in a stroke, the client will exhibit impaired memory, attention deficit, altered creativity and music perception, and poor reasoning.
Around three weeks after razing an old chicken house, a 71-year-old retired farmer has developed a fever, nausea and vomiting. After ruling out more common health problems, his care provider eventually made a diagnosis of histoplasmosis. Which physiologic process is most likely taking place? A. Toxin production by Histoplasma capsulatum is triggering an immune response. B. Antibody production against the offending fungi is delayed by the client's age and the virulence of the organism. C. Spore inhalation initiates an autoimmune response that produces the associated symptoms. D. Macrophages are able to remove the offending fungi from the bloodstream but can't destroy them
Answer: D Rationale: Disseminated histoplasmosis results from the inability of macrophages of the reticuloendothelial system to destroy the fungi. Fungi do not produce toxins. Antibody production and autoimmune responses are not involved in the pathophysiology of this fungal infection.
A resident of a long-term care facility has contracted Clostridium difficile with frequent diarrhea and hyperactive bowel sounds. What process in the small intestine is most likely accompanying the current status? A. Pathogenic microorganisms are causing dilation of the small intestine, increasing motility. B. Segmentation waves have become more frequent as a result of the infection. C. Intestinal stasis brought on by infection is preventing the small intestine from sufficiently slowing the rate of motility. D. Inflammation is accompanied by an increase in peristaltic movements of the small intestine.
Answer: D Rationale: Inflammation of the small intestine is accompanied by an increase in motility, an effect that is the result of increased peristaltic waves. Segmentation waves are responsible primarily for mixing rather than moving food. Neither dilation nor inadequate slowing of passage contents are responsible for the increase in motility.
After several months of persistent heartburn, a 57-year-old female client has been diagnosed with gastroesophageal reflux disease (GERD). Which treatment regimen is likely to best address the woman's health problem? A. Surgical correction of the incompetent pylorus. B. Antacids; avoiding positions that exacerbate reflux; a soft-textured diet C. Weight loss and administration of calcium channel blocking medications. D. Proton pump inhibitors; avoiding large meals; remaining upright after meals
Answer: D Rationale: Proton pump inhibitors block the final stage of gastric acid production, effectively controlling the root cause of the esophageal damage associated with GERD. The pylorus is not involved and a soft diet is not indicated. Calcium channel blocking drugs would not address the problem. Calcium channel blockers are primarily heart disease drugs that relax blood vessels and increase the supply of blood and oxygen to the heart while also reducing the heart's workload.
