D446 Adult Health II
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Free D446 Adult Health II Questions
Key nursing interventions immediately after percutaneous coronary intervention (PCI) include:
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Limiting fluids and holding all medications for 6 hours after the procedure.
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Performing range-of-motion on the affected extremity to avoid vascular complications.
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Assessing for vascular and bleeding complications and assuring adequate hydration.
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Monitoring blood sugar level every hour for 4 hours.
Explanation
After PCI, the nurse’s priority is to assess for vascular and bleeding complications at the access site (usually the femoral or radial artery) and ensure adequate hydration to support renal function and maintain perfusion. Monitoring the puncture site for bleeding, checking distal pulses, and observing for hematoma or signs of compromised circulation are critical for early detection of complications. While monitoring blood sugar may be important in diabetic patients, it is not the primary post-PCI intervention. Limiting fluids or unnecessary range-of-motion exercises does not address the immediate risks after the procedure.
A patient with a history of hypertension and diabetes presents with shortness of breath and cold extremities. Based on these symptoms, what condition should the nurse suspect?
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Pneumonia
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Left-Sided Heart Failure
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Diabetic Ketoacidosis
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Chronic Obstructive Pulmonary Disease
Explanation
Shortness of breath and cold extremities in a patient with a history of hypertension and diabetes are indicative of left-sided heart failure. In left-sided heart failure, the heart cannot pump blood efficiently to the systemic circulation, leading to pulmonary congestion (causing dyspnea) and poor perfusion to peripheral tissues (resulting in cold extremities). These symptoms, combined with the patient’s risk factors, suggest impaired cardiac function rather than conditions like pneumonia, DKA, or COPD, which have different primary manifestations.
Describe the key difference between NSTEMI and STEMI in terms of ECG findings.
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NSTEMI is identified by a flat ST-segment, while STEMI shows a depressed ST-segment.
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Both NSTEMI and STEMI show ST-segment elevation.
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NSTEMI shows ST-segment elevation, whereas STEMI does not.
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NSTEMI does not show ST-segment elevation on an ECG, while STEMI does.
Explanation
NSTEMI (Non-ST-Elevation Myocardial Infarction) and STEMI (ST-Elevation Myocardial Infarction) differ primarily in their ECG presentation. NSTEMI does not produce the classic ST-segment elevation seen in STEMI, although cardiac biomarkers like troponin are elevated, indicating myocardial injury. STEMI shows ST-segment elevation on ECG due to complete coronary artery occlusion, which requires immediate reperfusion therapy. Recognizing these differences is critical for appropriate diagnosis and urgent intervention.
What is a nursing intervention for managing dysrhythmias according to the provided information?
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Administering herbal supplements
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Placing the client on a cardiac monitor
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Encouraging tobacco use
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Increasing caffeine intake
Explanation
Placing a client on a cardiac monitor is a key nursing intervention for managing dysrhythmias. Continuous cardiac monitoring allows the nurse to detect abnormal heart rhythms promptly, assess the severity of the dysrhythmia, and respond quickly to changes in the patient’s cardiac status. This monitoring is essential for preventing complications such as hemodynamic instability or cardiac arrest. Other options, such as herbal supplements, tobacco use, or increased caffeine intake, can worsen dysrhythmias and are not appropriate interventions.
After assessing an older client's medical report, the nurse finds that the client is at an increased risk for bacterial and fungal infections. Which change in immune function may have occurred?
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Decrease in circulating T-lymphocytes
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Reduction of colony-forming B-lymphocyte
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Decline in natural bodies
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Reduction of neutrophil function
Explanation
A decrease in circulating T-lymphocytes is a common age-related change in immune function and significantly contributes to increased susceptibility to bacterial and fungal infections in older adults. T-lymphocytes are critical for cell-mediated immunity, which helps defend against intracellular pathogens such as bacteria and fungi. While B-lymphocyte function, natural killer cells, and neutrophils also play roles in immunity, the decline in T-cell numbers is particularly impactful in older clients and explains their heightened infection risk.
Describe the signs and symptoms that indicate a patient may be experiencing anaphylaxis.
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Signs of anaphylaxis include fever, cough, and muscle aches.
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Signs of anaphylaxis include chest pain and shortness of breath.
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Signs of anaphylaxis include nausea, vomiting, and diarrhea.
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Signs of anaphylaxis include generalized hives, pruritus, flushing, and swelling of lips/tongue.
Explanation
Anaphylaxis is a severe, life-threatening allergic reaction that affects multiple body systems. Classic signs include generalized hives, intense itching (pruritus), flushing, and swelling of the lips, tongue, or throat, which can compromise the airway. Recognizing these symptoms promptly is critical, as immediate intervention with epinephrine can be lifesaving. Other systemic symptoms may include hypotension, respiratory distress, and gastrointestinal upset, but the hallmark manifestations involve rapid-onset skin and mucous membrane reactions accompanied by potential airway compromise.
While examining patients at a respiratory care clinic, you understand that the difference between asthma and COPD is characterized by which of the following?
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Asthma has reversible airway obstruction while COPD has irreversible airway obstruction
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Asthma has irreversible airway obstruction while COPD has reversible airway obstruction
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Asthma has airway dilation while COPD has episodic bronchial hyperactivity
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Both diseases cause irreversible airway obstruction
Explanation
Asthma is characterized by reversible airway obstruction due to bronchial hyperreactivity and inflammation, which can be alleviated with bronchodilators or anti-inflammatory therapy. In contrast, COPD involves progressive and largely irreversible airflow limitation caused by chronic inflammation, airway remodeling, and alveolar destruction. This distinction is fundamental in differentiating management strategies and prognoses for the two respiratory conditions. Airway dilation and episodic hyperactivity do not fully capture the chronic and structural nature of COPD.
Describe how smoking contributes to the development of Chronic Obstructive Pulmonary Disease (COPD).
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Smoking leads to abnormal inflammatory responses in the lungs, contributing to airflow limitations.
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Smoking only affects the upper respiratory tract.
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Smoking increases lung capacity and function.
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Smoking has no effect on lung health.
Explanation
Smoking is the leading cause of COPD because it triggers chronic inflammation in the airways and lung tissues. This persistent inflammatory response damages alveoli, narrows airways, and leads to the production of excess mucus, all of which contribute to airflow limitation and respiratory symptoms such as chronic cough, sputum production, and shortness of breath. The damage is cumulative and often irreversible, highlighting the critical role of smoking cessation in preventing COPD progression. Smoking does not enhance lung function, nor is its impact limited to the upper respiratory tract.
Which of the following tasks is appropriate to delegate to a UAP in nursing care?
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Administering medications
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Developing a care plan
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Making beds
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Assessing vital signs
Explanation
Unlicensed Assistive Personnel (UAP) can safely perform basic supportive tasks that do not require clinical judgment, such as making beds. These duties help maintain a safe and clean environment for patients and support nursing care without involving assessment or decision-making responsibilities. Administering medications, developing care plans, and assessing vital signs require professional nursing judgment and are not appropriate to delegate to a UAP.
Describe the significance of Troponin and CK-MB in the context of myocardial infarction diagnosis.
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Troponin and CK-MB are critical for diagnosing myocardial infarction as they indicate heart muscle damage.
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Troponin is used to measure blood pressure, while CK-MB assesses cholesterol levels.
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Both biomarkers are used to evaluate kidney function in patients with heart disease.
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Troponin and CK-MB are irrelevant in diagnosing myocardial infarction.
Explanation
Troponin and CK-MB are cardiac biomarkers that provide crucial information for diagnosing myocardial infarction (MI). Troponin is highly specific to cardiac muscle and rises within hours of myocardial injury, remaining elevated for several days, making it a gold standard for MI diagnosis. CK-MB is also released during cardiac muscle damage and can help detect reinfarction. Both biomarkers indicate the presence and extent of heart muscle injury, guiding clinicians in timely intervention and management. They are critical for differentiating MI from other conditions with similar symptoms.
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