D446 Adult Health II
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Free D446 Adult Health II Questions
1. Which of the following patient reported symptoms would be a finding specific to unstable angina and help to differentiate it from stable angina?
- Poorly localized chest or arm discomfort
- Anginal pain relieved with rest
- Chest pain lasting for 25 minutes
- Pain brought on by emotional stress
Explanation
Unstable angina is characterized by chest pain that is more severe, prolonged, or occurs at rest compared to stable angina. Chest pain lasting for 25 minutes is indicative of unstable angina and helps differentiate it from stable angina, which is typically predictable, brief, and relieved by rest or nitroglycerin. Poorly localized discomfort and pain triggered by emotional stress may occur in both stable and unstable angina, and relief with rest is typical of stable angina rather than unstable angina. Recognizing the duration and persistence of pain is crucial for timely intervention to prevent myocardial infarction.
2. A male client is admitted to the emergency department (ED) while vomiting dark brown, foul-smelling emesis. He reports having a surgical repair of a recurrent inguinal hernia a week ago and is troubled by intense abdominal pain. After finding that his bowel sounds are hyperactive, which prescription should the nurse implement first?
- Place an indwelling urinary catheter and attach a bedside drainage unit
- Send the client to x-ray for a flat plate of the abdomen
- Give a prescribed analgesic for temperature above 101°F (38.3°C), orally
- Insert a nasogastric tube (NGT) and attach to low intermittent suction (LIS)
Explanation
The client’s symptoms—dark, foul-smelling emesis, hyperactive bowel sounds, and severe abdominal pain following surgery—indicate a possible bowel obstruction. The first nursing action is to insert a nasogastric tube (NGT) and attach it to low intermittent suction to decompress the stomach, relieve vomiting, and prevent aspiration. This intervention stabilizes the client before diagnostic testing or further treatment.
3. Anaphylaxis would be an example of which type of hypersensitivity reaction:
- Antibody mediated (Type 2)
- Immediate hypersensitivity (Type 1)
- Immune Complex mediated (Type 3)
- T-cell mediated (Type 4)
Explanation
Anaphylaxis is a severe, life-threatening allergic reaction and is classified as a Type 1 hypersensitivity reaction. Type 1 reactions are mediated by IgE antibodies, which trigger the release of histamine and other chemical mediators from mast cells and basophils, leading to widespread vasodilation, bronchoconstriction, and increased vascular permeability. Prompt recognition and treatment with epinephrine are critical to prevent respiratory and cardiovascular collapse. Other types of hypersensitivity reactions involve different immune mechanisms and do not produce the rapid systemic response seen in anaphylaxis.
4. Treatment of chronic atrial fibrillation (A-fib) is aimed at
- slowing the rapid heart rate.
- replacing the dysfunctional atria.
- correcting the rhythm using defibrillation.
- preventing thrombus formation.
Explanation
Treatment of chronic atrial fibrillation focuses on preventing thrombus formation and reducing the risk of stroke, as the irregular heartbeat can cause blood pooling in the atria, leading to clot formation. Anticoagulant therapy is commonly used to achieve this goal. Additionally, controlling the heart rate with medications helps manage symptoms and prevent complications. While rhythm correction and defibrillation may be considered in some cases, chronic A-fib is primarily managed with rate control and stroke prevention rather than atrial replacement.
5. In a patient with metabolic acidosis, what would you expect to observe regarding hydrogen ion concentration and pH levels?
- Normal hydrogen ion concentration and normal pH levels
- Fluctuating hydrogen ion concentration with stable pH levels
- Increased hydrogen ion concentration and decreased pH levels
- Decreased hydrogen ion concentration and increased pH levels
Explanation
Metabolic acidosis is characterized by an accumulation of hydrogen ions (H+) in the blood, which leads to a decrease in pH, indicating acidemia. Causes include diabetic ketoacidosis, renal failure, or severe diarrhea. Monitoring hydrogen ion concentration and pH is essential to evaluate the severity of the acidosis and guide treatment. Increased H+ concentration lowers the pH, which can affect enzyme function, electrolyte balance, and overall cellular metabolism, potentially leading to serious complications if uncorrected.
6. What are two primary causes of Left-Sided Heart Failure?
- Asthma and pneumonia
- Hyperlipidemia and hypotension
- Anemia and dehydration
- Hypertension and diabetes mellitus
Explanation
Hypertension and diabetes mellitus are two primary causes of left-sided heart failure. Chronic hypertension increases afterload, forcing the left ventricle to work harder, which can eventually lead to ventricular hypertrophy and impaired cardiac function. Diabetes contributes to heart failure through mechanisms such as accelerated atherosclerosis, myocardial fibrosis, and microvascular disease. Other conditions listed, such as asthma, pneumonia, anemia, dehydration, hyperlipidemia, and hypotension, may affect cardiovascular health but are not primary causes of left-sided heart failure.
7. An older adult client with long-term type 2 diabetes mellitus (DM) is seen in the clinic for a routine health assessment. Which assessment(s) should the nurse complete to determine if the client is experiencing long-term complications? Select all that apply.
- Visual acuity
- Serum creatinine and blood urea nitrogen (BUN)
- Skin condition of lower extremities
- Sensation in feet and legs
- Signs of respiratory tract infection
Explanation
Long-term complications of type 2 diabetes affect the eyes, kidneys, peripheral nerves, and circulation. The nurse should assess visual acuity to detect diabetic retinopathy, serum creatinine and BUN for nephropathy, skin condition of lower extremities for poor circulation or ulcers, and sensation in feet and legs for neuropathy. Monitoring these systems helps detect complications early and prevent further progression.
8. The parent of an adolescent tells the clinic nurse, “My child has athlete’s foot. I have been applying triple antibiotic ointment for two days, but there has been no improvement.” Which instruction should the nurse provide?
- A. Stop using the ointment and encourage complete drying of feet and wearing clean socks.
- B. Applying too much ointment can deter its effectiveness. Apply a thin layer to prevent maceration.
- C. Continue using the ointment for a full week, even after the symptoms disappear.
- D. Antibiotics take two weeks to become effective against infections such as athlete’s foot.
Explanation
Athlete’s foot (tinea pedis) is a fungal infection, not bacterial, so an antibiotic ointment will not be effective. The nurse should instruct the parent to discontinue the antibiotic and instead keep the feet clean, dry, and well-ventilated to discourage fungal growth. Antifungal treatment, not antibiotics, is indicated.
9. The nurse is developing a plan of care for a client who reports blurred vision and who is newly diagnosed with type 2 diabetes mellitus (DM). Which outcome should the nurse include in the plan of care for this client?
Reference Range:
Glycosylated hemoglobin (A1C) [Good diabetic control: less than 7%]
Reference Range:
Glycosylated hemoglobin (A1C) [Good diabetic control: less than 7%]
- The nurse will demonstrate the procedure for accurate eye care
- The nurse will encourage the client to walk thirty minutes every day
- The client’s blood pressure readings will be less than 160/90 mm Hg
- The client’s hemoglobin A1C will be less than 7% in 3 months
Explanation
The hemoglobin A1C test measures long-term blood glucose control by reflecting average blood glucose levels over the previous two to three months. For clients with type 2 diabetes, maintaining an A1C level below 7% indicates good diabetic control and helps prevent complications such as retinopathy, nephropathy, and neuropathy. Including this measurable goal in the care plan provides a clear indicator of effective treatment and patient adherence to therapy.
10. The nurse is administering the second unit of whole blood to an older adult client who was admitted yesterday with gastrointestinal (GI) bleeding. Which parameters should the nurse monitor that indicate fluid overload?
- Chills, fever, and tachycardia
- Bounding pulse, hypertension, and distended neck veins
- Urticaria, itching, and wheezing
- Thready pulse, hypotension, and chest or back pain
Explanation
When administering blood to an older adult, monitoring for signs of circulatory overload is crucial because older clients are more susceptible to volume excess due to decreased cardiac and renal function. Fluid overload occurs when the cardiovascular system cannot handle the increased volume from transfusion. Typical signs include a bounding pulse, hypertension, and distended neck veins due to increased venous pressure and fluid retention. Other findings can include dyspnea, crackles, and restlessness.
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