D446 Adult Health II
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Free D446 Adult Health II Questions
1. In a scenario where a UAP fails to perform a delegated task correctly, what is the nurse's responsibility?
- The nurse should blame the UAP for the failure without taking any action.
- The nurse can delegate the responsibility of addressing the issue to another staff member.
- The nurse can ignore the mistake since the UAP is responsible for their actions.
- The nurse must address the issue and ensure that the task is completed correctly, as they are accountable for the delegation.
Explanation
When a nurse delegates a task to an Unlicensed Assistive Personnel (UAP), the nurse remains legally and professionally accountable for ensuring the task is completed safely and correctly. If a UAP fails to perform the task appropriately, it is the nurse’s responsibility to address the issue immediately, correct any errors, and ensure the client’s care needs are met. This may involve providing additional instruction, supervision, or intervention to complete the task properly. Accountability for delegated tasks is a fundamental principle in nursing practice and ensures patient safety and quality care.
2. Following a transurethral resection of the prostate (TURP), a client is discharged from the hospital with an indwelling urinary catheter. Which instruction is most important for the nurse to include in the discharge teaching plan?
- A. Avoid driving a car for 2 weeks.
- B. Eliminate all spicy foods from your diet.
- C. Drink 3 liters of water each day.
- D. Clamp the catheter when taking a shower.
Explanation
After TURP, the most important instruction is to maintain adequate fluid intake (about 3 liters per day) to promote urine flow, prevent infection, and flush out blood clots. Increasing fluid intake helps keep the catheter patent and reduces the risk of urinary tract complications.
3. Describe the mechanism behind Type 1 hypersensitivity reactions and provide an example.
- Type 1 hypersensitivity reactions are IgE mediated and can cause anaphylaxis.
- Type 1 hypersensitivity reactions involve T-cells and cause contact dermatitis.
- Type 1 hypersensitivity reactions are IgM mediated and cause systemic lupus erythematosus.
- Type 1 hypersensitivity reactions are IgG mediated and cause transfusion reactions.
Explanation
Type 1 hypersensitivity reactions are immediate allergic reactions mediated by Immunoglobulin E (IgE). When an individual is exposed to an allergen, IgE antibodies bind to mast cells and basophils, triggering the release of histamine and other inflammatory mediators. This reaction leads to rapid onset of symptoms such as hives, itching, swelling, bronchoconstriction, and, in severe cases, anaphylaxis. Common examples include food allergies, insect sting reactions, and pollen-induced hay fever. Understanding this mechanism is essential for prompt recognition and treatment of potentially life-threatening allergic reactions.
4. What is the primary use of osmotic diuretics such as Mannitol?
- Hypertension
- Heart failure
- Diabetes insipidus
- Increased intracranial pressure (ICP)
Explanation
Osmotic diuretics like Mannitol are primarily used to reduce increased intracranial pressure (ICP) by drawing fluid from brain tissues into the vascular system, thereby decreasing cerebral edema. This mechanism also helps prevent renal failure in certain acute situations by increasing renal perfusion. While Mannitol may affect fluid balance, it is not primarily used to treat hypertension, heart failure, or diabetes insipidus. Its main clinical application is in managing elevated ICP and cerebral edema.
5. Describe how DVT prophylaxis contributes to the prevention of ventilator-associated pneumonia (VAP).
- DVT prophylaxis is only necessary for patients with existing pneumonia.
- DVT prophylaxis is unrelated to VAP and focuses solely on blood circulation.
- DVT prophylaxis directly treats pneumonia in ventilated patients.
- DVT prophylaxis helps prevent blood clots in patients on ventilators, reducing the risk of complications that can lead to VAP.
Explanation
DVT prophylaxis, such as the use of anticoagulants or mechanical compression devices, helps prevent blood clots in patients who are immobile or mechanically ventilated. By reducing the incidence of thromboembolic complications, patients experience fewer systemic complications, which indirectly decreases the risk of secondary issues like ventilator-associated pneumonia (VAP). Immobility and compromised circulation can predispose patients to additional infections and pulmonary complications, so preventing DVT supports overall respiratory health in ventilated patients.
6. Which nursing problem has the highest priority when planning care for a client with osteomalacia?
- Risk of infection
- Risk for injury
- Altered tissue perfusion
- Sleep pattern disturbance
Explanation
Osteomalacia involves the softening of bones due to vitamin D deficiency, which leads to bone pain, muscle weakness, and an increased likelihood of fractures. Because weakened bones are prone to deformation and breaks even with minimal stress, risk for injury is the highest nursing priority. Preventing falls and ensuring safe mobility are essential to avoid fractures and promote recovery while other issues can be addressed later.
7. Describe how hyperkalemia can arise as a complication of blood transfusions.
- Hyperkalemia results from the body's immune response to the transfusion.
- Hyperkalemia is a direct result of fluid overload from the transfusion.
- Hyperkalemia is caused by an allergic reaction to the transfused blood.
- Hyperkalemia can occur due to the release of potassium from stored red blood cells during transfusion.
Explanation
Hyperkalemia can develop during blood transfusions because stored red blood cells release potassium into the plasma over time. The longer the blood has been stored, the higher the extracellular potassium concentration. When transfused, this potassium can enter the recipient’s circulation, potentially leading to elevated serum potassium levels. This is particularly concerning in patients with impaired kidney function or those receiving large volumes of blood. Monitoring potassium levels and using fresher blood units when possible are important preventive strategies.
8. The two most common types of COPD are:
- Acute bronchitis and emphysema
- Chronic bronchitis and pneumonia
- Chronic bronchitis and emphysema
- Chronic bronchitis and asthma
Explanation
Chronic bronchitis and emphysema are the two primary types of COPD. Chronic bronchitis is characterized by persistent cough and mucus production due to inflammation of the bronchi, while emphysema involves the destruction of alveolar walls, leading to impaired gas exchange and reduced lung elasticity. Other conditions listed, such as acute bronchitis, pneumonia, and asthma, may affect the lungs but do not define the main structural and functional changes associated with COPD.
9. What is the heart rate range that characterizes Ventricular Tachycardia (VT)?
- 140-180 bpm
- 60-100 bpm
- 100-140 bpm
- 180-220 bpm
Explanation
Ventricular Tachycardia (VT) is defined as a rapid heart rhythm originating from the ventricles, typically with a heart rate between 140 and 180 beats per minute. VT can be life-threatening because it may compromise cardiac output and progress to ventricular fibrillation if untreated. Normal heart rates range from 60-100 bpm, while 100-140 bpm represents mild tachycardia. Heart rates of 180-220 bpm are more consistent with severe tachyarrhythmias or supraventricular tachycardia in certain cases.
10. A patient presents with muscle weakness and irregular heartbeats. What nursing intervention should be prioritized based on the understanding of electrolyte management?
- Assess the patient's electrolyte levels
- Administer pain medication
- Increase fluid intake without monitoring
- Schedule a follow-up appointment in a week
Explanation
Muscle weakness and irregular heartbeats are hallmark signs of electrolyte imbalances, particularly hypokalemia, which can be caused by diuretics or other conditions. The immediate nursing priority is to assess the patient’s electrolyte levels to identify any abnormalities and guide prompt interventions, such as electrolyte replacement. Ignoring electrolyte assessment or administering fluids or medications without monitoring can worsen the imbalance and lead to life-threatening complications like cardiac arrhythmias. Scheduling a follow-up is not sufficient in an acute presentation.
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