D444 Adult Health I
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Free D444 Adult Health I Questions
1. When discussing her sleep apnea diagnosis, Ms. Rae asks you, "What can I do to get better sleep?" Which response would you give?
- "Being overweight is a contributing factor; losing weight can often resolve apnea."
- "High blood glucose levels contribute to the apnea; monitor your blood sugar carefully."
- "Taking one to two sleeping pills at night will prevent apneic episodes."
- "Keeping your hypertension under control is beneficial for your general health."
Explanation
Obstructive sleep apnea often results from excess soft tissue in the throat that collapses during sleep, obstructing the airway. Obesity is a major modifiable risk factor because excess weight contributes to airway narrowing and obstruction. Therefore, weight loss is one of the most effective non-invasive interventions to reduce or eliminate apnea episodes. Other helpful strategies include avoiding alcohol before bed, sleeping on one’s side, and using continuous positive airway pressure (CPAP) if prescribed.
2. A patient presents with rapid breathing and confusion. If lab results show increased pH and decreased CO₂, what condition might they be experiencing?
- Respiratory acidosis
- Metabolic alkalosis
- Respiratory alkalosis
- Metabolic acidosis
Explanation
Rapid breathing (hyperventilation) causes excessive exhalation of carbon dioxide, leading to decreased CO₂ levels in the blood. This reduction in carbonic acid results in a rise in pH, producing a state known as respiratory alkalosis. Common causes include anxiety, pain, fever, or hypoxemia. The elevated pH leads to cerebral vasoconstriction, which can explain symptoms such as confusion, dizziness, and tingling. Management involves addressing the underlying cause and restoring normal ventilation to correct the acid-base imbalance.
3. What condition should be avoided to minimize pain following a prostatectomy?
- Dehydration
- Nausea
- Diarrhea
- Constipation
Explanation
After a prostatectomy, constipation should be avoided because straining during bowel movements increases intra-abdominal and pelvic pressure, which can cause significant pain and may disrupt the surgical site or sutures. Additionally, constipation can contribute to urinary retention, further increasing discomfort. To prevent this, patients are encouraged to maintain adequate hydration, consume a high-fiber diet, and, if necessary, use stool softeners as prescribed.
4. A patient presents with blood glucose levels of 300 mg/dL, dry skin, and abdominal pain. What condition should be suspected based on these signs?
- Diabetic Ketoacidosis (DKA)
- Chronic Obstructive Pulmonary Disease (COPD)
- Acute Kidney Injury
- Hypertension
Explanation
The symptoms of hyperglycemia, dry skin, abdominal pain, and a blood glucose level of 300 mg/dL are classic indicators of Diabetic Ketoacidosis (DKA). DKA occurs primarily in individuals with Type 1 Diabetes and is caused by a severe insulin deficiency leading to fat breakdown and ketone accumulation. This results in metabolic acidosis, dehydration, and electrolyte imbalance. Other typical signs include fruity breath odor, Kussmaul respirations, and confusion. Immediate treatment involves IV fluids, insulin administration, and electrolyte replacement.
5. Describe why pneumothorax is a critical concern in a COPD patient with no air movement in the lung.
- Pneumothorax does not affect oxygen levels in the blood.
- Pneumothorax is less severe than asthma attacks in COPD patients.
- Pneumothorax is a common condition that resolves without treatment.
- Pneumothorax can lead to lung collapse, which is particularly dangerous for COPD patients who already have compromised lung function.
Explanation
Pneumothorax is especially critical in COPD patients because it can cause sudden lung collapse, leading to severe respiratory distress or even respiratory failure. COPD patients already have damaged, hyperinflated lungs with decreased elasticity, making them more susceptible to the rupture of air-filled bullae. When air leaks into the pleural space, it prevents proper lung expansion, resulting in no air movement on the affected side. This further compromises oxygenation and ventilation, which are already limited in COPD patients, making prompt recognition and emergency treatment essential.
6. How many times a week do the majority of American hemodialysis patients receive treatment?
- Three
- One
- Seven
- Five
Explanation
Most American hemodialysis patients undergo treatment three times a week, with each session typically lasting three to five hours. This schedule provides an adequate balance between removing waste products and maintaining fluid and electrolyte stability while allowing the patient time for recovery between sessions. More frequent or daily dialysis is not commonly used unless medically indicated, such as in severe fluid overload or unstable conditions. The three-times-per-week schedule remains the standard regimen recommended by nephrologists for maintaining optimal metabolic control in chronic kidney disease management.
7. In a scenario where a patient has weak dorsalis pedis pulses after a Left Heart Cath, what should be the immediate nursing intervention?
- Assess the patient's vital signs and notify the physician.
- Perform a thorough neurological assessment.
- Increase the patient's fluid intake immediately.
- Administer a vasodilator medication.
Explanation
After a left heart catheterization, weak or absent dorsalis pedis pulses may indicate compromised blood flow to the affected limb due to arterial obstruction, hematoma, or thrombus formation at the catheter insertion site. The immediate nursing intervention is to assess the patient's vital signs and circulation to the limb—including color, temperature, capillary refill, and sensation—and then notify the physician immediately. Early recognition and intervention are critical to prevent ischemia and potential tissue necrosis. Increasing fluids or administering vasodilators without physician direction could worsen the condition if bleeding or occlusion is present.
8. Describe how Kayexalate functions in the treatment of hyperkalemia.
- Kayexalate replaces potassium with sodium in the body.
- Kayexalate increases potassium absorption in the intestines.
- Kayexalate is a diuretic that eliminates potassium through urine.
- Kayexalate binds potassium in the gut, reducing its levels in the bloodstream.
Explanation
Kayexalate (sodium polystyrene sulfonate) is a potassium-binding resin used to treat hyperkalemia, a condition characterized by elevated potassium levels in the blood. It works by binding potassium ions in the gastrointestinal tract in exchange for sodium ions. This prevents potassium from being absorbed and promotes its excretion through the feces, thereby reducing serum potassium levels. While effective, it acts slowly and is typically used alongside other rapid interventions such as insulin with glucose or calcium gluconate in cases of severe hyperkalemia.
9. Why is it important to avoid administering potassium via IV push?
- Potassium can only be given orally, not intravenously.
- Administering potassium via IV push can lead to cardiac arrest due to rapid increases in serum potassium levels.
- IV push potassium is a standard practice in emergency situations.
- IV push potassium is safe if monitored closely.
Explanation
Administering potassium via IV push is extremely dangerous because it can cause a rapid rise in serum potassium levels, which may trigger life-threatening cardiac arrhythmias or cardiac arrest. Safe administration requires dilution in IV fluids and controlled infusion rates, allowing the body to tolerate the potassium gradually. Oral potassium or a slow IV infusion is the standard practice for correcting hypokalemia, and IV push should be avoided except under very controlled, emergent protocols with continuous cardiac monitoring.
10. This is a sign of hypocalcemia wherein there is twitching of the facial muscles in response to tapping over the area of the facial nerve.
- Kernig's sign
- McBurney's sign
- Trousseau sign
- Chvostek sign
Explanation
Chvostek's sign is a clinical indicator of hypocalcemia. It is elicited by tapping over the facial nerve just anterior to the ear, which triggers twitching of the facial muscles on the same side. This response reflects increased neuromuscular excitability caused by low calcium levels in the blood. Trousseau’s sign is also associated with hypocalcemia but is demonstrated differently, typically by inflating a blood pressure cuff to induce carpal spasm. Kernig’s and McBurney’s signs are related to neurological irritation and appendicitis, respectively, and are not associated with calcium levels.
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