Optional Respiratory EAQ N102
A client has a history of gastroesophageal reflux disease (GERD). Why should the nurse also monitor the client for clinical manifestations of heart disease? 1 Esophageal pain may imitate the symptoms of a heart attack. 2 GERD may predispose to heart disease. 3 Strenuous exercise may exacerbate reflux problems. 4 Similar changes in laboratory studies may occur in both cardiac and reflux problems.
1. Symptoms associated with myocardial infarction may be interpreted by a client as esophageal reflux and therefore ignored. GERD does not predispose to heart disease. Exercise does not seem to exacerbate esophageal reflux problems unless the stomach is full when exercising. Exercising to maintain a healthy weight helps reduce esophageal reflux. Laboratory workups help differentiate these two diagnoses. Tests, such as cardiac enzymes, can help to reveal a myocardial infarction, thereby facilitating differentiation between these problems.
A nurse is caring for a client with acquired immunodeficiency syndrome (AIDS). What precautions should the nurse take when caring for this client? 1 Use standard precautions. 2 Employ airborne precautions. 3 Plan interventions to limit direct contact. 4 Discourage long visits from family members.
1. The Centers for Disease Control and Prevention (Canada: Public Health Agency of Canada) states that standard precautions should be used for all clients; these precautions include wearing of gloves, gown, mask, and goggles when there is risk for exposure to blood or body secretions. There is no indication that airborne precautions are necessary. Planning interventions to limit direct contact and discouraging long visits from family members will unnecessarily isolate the client.
A nurse discusses resumption of sexual activity with a client who is recovering from a myocardial infarction. Which information should the nurse share with the client? 1 Choose only familiar sexual positions. 2 Select familiar settings for sexual activity. 3 Return to regular sexual activity in four to six weeks. 4 Depending upon your preference, take a hot or cold shower after intercourse.
2. An unfamiliar environment increases stress, which increases cardiac workload. It is advantageous to experiment with positions and find one that is relaxing and permits unrestricted breathing. It is generally safe to resume sexual activity 7 to 10 days after an uncomplicated MI. However, some physicians believe that the client should decide when ready to resume sex. Hot or cold showers should be avoided just before and after intercourse.
A nurse is caring for a client with orders for furosemide daily, a 2-gram sodium diet, and an oral fluid restriction of 1200 mL daily. The most recent laboratory results are blood urea nitrogen (BUN) 42 mg/dL (15.2 mmol/L) and creatinine 1.1 mg/dL (97 mcmol/L). Considering the assessment findings, which is the most appropriate intervention by the nurse? 1 Sending the client's urine for analysis 2 Requesting an increase in the oral fluid intake 3 Placing the client on strict intake and output measurements 4 Notifying a nutritionist/dietitian so that sodium can be restricted further
2. Diuretics such as furosemide can cause dehydration. This is evidenced in this scenario by an elevation in the BUN and a normal creatinine. Increasing fluid intake will result in improved hydration status and a decrease in the BUN level. Although sending the client's urine for analysis should be done, it will not change the client's hydration status. Although the client should be on strict intake and output, it will not change the client's hydration status. Sodium restriction will not lower the BUN level; in addition, nutritionists only make suggestions to the primary healthcare provider regarding interventions. The primary healthcare provider is the professional legally responsible for prescribing a sodium-restricted diet.
During auscultation of the heart, where does the nurse expect the first heart sound (S1) to be the loudest? 1 Base of the heart 2 Apex of the heart 3 Left lateral border 4 Right lateral border
2. The first heart sound is produced by closure of the mitral and tricuspid valves; it is heard best at the apex of the heart. The base of the heart is where the second heart sound (S2) is best heard; S2 is produced by closure of the aortic and pulmonic valves. The left lateral border covers a large area; the auscultatory areas that lie near it are the pulmonic and mitral areas. The right lateral border covers a large area; the only auscultatory area near it is the aortic area.
A client is being considered for bariatric surgery. Which client health problem does the nurse identify as consistent with morbid obesity? 1 Dumping syndrome 2 Compartment syndrome 3 Hypoventilation syndrome 4 Inappropriate antidiuretic hormone syndrome (ADH
3 Ventilation insufficiency occurs in response to inadequate chest wall expansion caused by weight of adipose tissue on the rib cage and the body's need for oxygen to all body cells. Diarrhea, distention, and abdominal cramps often occur in the postoperative period after gastric bypass in response to the hyperosmolar shift of fluid from the intravascular compartment into the intestine in response to rapid emptying of hyperosmolar food without usual dilution in the stomach; this fluid shift initiates the systemic response of weakness, tachycardia, and diaphoresis. Compartment syndrome generally is a complication of trauma; increased pressure within the limited anatomic space (e.g., muscle compartment) contributes to decreased microcirculation, which causes nerve and muscle anoxia and necrosis of tissue. Inappropriate antidiuretic hormone syndrome is excessive secretion of ADH, a hypo-osmolar state with a dilutional hyponatremia; the most common cause is oat cell carcinoma of the lung, in addition to other malignant tumors that produce ADH.
A client with a distal femoral shaft fracture is at risk for developing a fat embolus. The nurse knows to watch for what distinguishing sign that is unique to a fat embolus? 1 Oliguria 2 Dyspnea 3 Petechiae 4 Confusion
3. At the time of a fracture or orthopedic surgery, fat globules may move from the bone marrow into the bloodstream. Also, elevated catecholamines cause mobilization of fatty acids and the development of fat globules. In addition to obstructing vessels in the lung, brain, and kidneys with systemic embolization of small vessels from fat globules, petechiae are noted in the buccal membranes, conjunctival sacs, hard palate, chest, and anterior axillary folds; these adaptations only occur with a fat embolism. Oliguria, dyspnea, and confusion are signs of an embolus but are not specific to a fat embolus.
The spouse of a client who had emergency coronary artery bypass surgery asks why there is a dressing on the client's left leg. How should the nurse explain the dressing? 1 "This is the access site for the heart-lung machine." 2 "A filter is inserted in the leg to prevent embolization." 3 "A vein in the leg was used to bypass the coronary artery." 4 "The arteries in the extremities are examined during surgery."
3. The response that a vein in the leg was used to bypass the coronary artery provides information and reduces anxiety. The nurse understands that the greater saphenous vein of the leg is used to bypass the diseased coronary artery, and one surgical team obtains the vein while another team performs the chest surgery; this shortens the surgical time and decreases the risks of surgery. The internal mammary arteries are the grafts of choice, but the surgery is usually longer because of the necessity of dissecting the arteries from the chest wall. In addition, the internal mammary arteries may have been used in a previous bypass surgery. Cardiopulmonary bypass (extracorporeal circulation) is accomplished by placement of a cannula in the right atrium, vena cava, or femoral vein to withdraw blood from the body; blood is returned to the body via a cannula in the aorta or the femoral artery. Off-pump surgery is used for minimally invasive surgical techniques. A filter is not inserted in the leg to prevent embolization during a coronary artery bypass graft (CABG). The arteries in the extremities are not examined during a CABG.
A nurse is preparing a teaching plan for a client with syphilis. In which stage is syphilis not considered contagious? 1 Tertiary stage 2 Primary stage 3 Secondary stage 4 Incubation stage
1. The tertiary stage is noncontagious; tertiary lesions contain only small numbers of treponemes. The primary stage lasts 8 to 12 weeks; the chancre is teeming with spirochetes, and the individual is contagious. The duration of the secondary stage is variable (about 5 years); skin and mucosal lesions contain spirochetes, and the individual is highly contagious. The incubation stage lasts 2 to 6 weeks; spirochetes proliferate at the entry site, and the individual is contagious.
A nurse is teaching a client about human immunodeficiency virus (HIV). What are the various ways HIV is transmitted? Select all that apply. 1 Mosquito bites 2 Sharing syringe needles 3 Breastfeeding a newborn 4 Dry kissing the infected partner 5 Anal intercourse
2, 3, 5 Fluids such as blood and semen are highly concentrated with HIV. HIV may be transmitted parenterally by sharing needles and postnatally through breast milk. HIV may also be transmitted through anal intercourse. HIV is not transmitted by mosquito bites or dry kissing.
A nurse is discussing discharge instructions with a client who had a coronary artery bypass graft (CABG). The client states, "My spouse is afraid to have sex with me. When will it be safe to have sex again?" Which is the most appropriate response by the nurse? 1 "You should wait at least 6 weeks to allow enough time for your chest incision to heal." 2 "You will need to talk that over with your surgeon before you leave." 3 "You can resume sexual activity when you feel you have recovered enough and when your chest no longer hurts." 4 "You can resume sexual activity as soon as you can climb one flight of stairs without fatigue or discomfort."
4 "You can resume sexual activity as soon as you can climb one flight of stairs without fatigue or discomfort." The response "As soon as you can climb one flight of stairs without fatigue or discomfort" addresses the client's request for information. The energy required for sexual intercourse is equivalent to that of climbing one flight of stairs. Each client is different and may require longer or shorter than 6 weeks. The response "You will need to talk that over with your surgeon before you leave" avoids the client's question and cuts off communication. The nurse has a responsibility to teach. The answer "When you feel you have recovered enough and when your chest no longer hurts" is too vague and may be dangerous because the client has no basis to make a safe decision.
An emergency department nurse assesses an older client who reports cramping pain in the left lower quadrant, weakness, bloating, and malaise. The client also has a low-grade fever. Which condition does the nurse suspect as the most likely cause of the client's clinical findings? 1 Pancreatitis 2 Appendicitis 3 Cholecystitis 4 Diverticulitis
4. Although diverticula can occur at any point within the gastrointestinal tract, they are most common in the sigmoid colon; therefore, pain associated with diverticulitis occurs in the left lower quadrant. Pancreatitis is associated with acute epigastric or left upper quadrant pain. Appendicitis is associated with shifting of periumbilical pain to the lower right quadrant and localizing at McBurney's point. Cholecystitis is associated with right upper quadrant pain that may be referred to the right shoulder and scapula.
