D446 Adult Health II
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Free D446 Adult Health II Questions
1. Which of the following best represents a true statement regarding how a chronically hypercapnic COPD patient would most likely respond to an acute increase in PaCO2?
- They likely would not have a substantial increase in ventilation
- They likely would increase the elimination of HCO3 to rapidly increase their pH
- They likely would become apneic which would produce a state of hyperoxia
- They likely would have a substantial increase in ventilation
Explanation
In patients with chronic hypercapnia due to COPD, the body adapts to persistently elevated PaCO2 levels by resetting the central chemoreceptors’ sensitivity. As a result, these patients rely more on hypoxemia (low PaO2) rather than hypercapnia to stimulate ventilation. Therefore, an acute increase in PaCO2 does not produce a substantial increase in ventilation, unlike in individuals with normal CO2 levels. Understanding this adaptation is important to prevent over-oxygenation, which can blunt the hypoxic drive and worsen respiratory failure in these patients.
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?
- Avoid driving a car for 2 weeks.
- Eliminate all spicy foods from your diet.
- Drink 3 liters of water each day.
- 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. A client experiences an ABO incompatibility reaction after multiple blood transfusions. Which finding should the nurse report immediately to the healthcare provider?
- Delayed painful rash with urticaria
- Arthritic joint changes and chronic pain
- Acute rhinitis and nasal stuffiness
- Lower back pain and hypotension
Explanation
Lower back pain and hypotension are hallmark signs of an acute hemolytic transfusion reaction, often caused by ABO incompatibility. This occurs when incompatible donor red blood cells are destroyed by the recipient’s immune system, leading to hemolysis and possible acute renal failure. Immediate intervention is critical—stop the transfusion, maintain IV access with normal saline, and notify the healthcare provider to prevent life-threatening complications such as shock or disseminated intravascular coagulation (DIC).
4. A client arrives at the emergency department (ED) following a motor vehicle collision. The nurse observes the client experiencing increasing dyspnea and notes absent breath sounds on the left side. Which procedure should the nurse prepare the client for?
- Bronchoscopy
- Endotracheal intubation
- Chest tube insertion
- Pulmonary function test
Explanation
Absent breath sounds on one side after trauma indicate a pneumothorax, where air has entered the pleural space and collapsed the lung. This causes respiratory distress and requires immediate decompression to restore negative pressure. The nurse should prepare the client for chest tube insertion, which removes air or fluid, re-expands the lung, and improves ventilation. Other procedures would not address the underlying cause of the absent breath sounds as urgently.
5. 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.
6. Describe how respiratory issues can lead to acid-base imbalances in patients.
- Respiratory issues can lead to acid-base imbalances by affecting the body's ability to exchange gases, resulting in either respiratory acidosis or alkalosis.
- Respiratory issues primarily cause metabolic acidosis through increased lactic acid production.
- Respiratory issues have no effect on acid-base balance as they only impact oxygen levels.
- Respiratory issues only affect the kidneys, which then cause acid-base imbalances.
Explanation
Respiratory issues can impair the lungs’ ability to eliminate carbon dioxide (CO₂), leading to respiratory acidosis, or cause excessive CO₂ elimination, leading to respiratory alkalosis. Conditions such as COPD, asthma, or hypoventilation affect gas exchange, altering blood pH and disrupting acid-base homeostasis. The kidneys may compensate over time, but the primary disturbance originates from respiratory dysfunction. Respiratory problems do not directly cause metabolic acidosis or alkalosis without secondary effects.
7. What are some symptoms a nurse should observe for during a blood transfusion?
- Shortness of breath (SOB), chills, and itching
- Fever and rash
- Headache and dizziness
- Nausea and vomiting
Explanation
During a blood transfusion, nurses must closely monitor patients for signs of transfusion reactions, which can range from mild allergic responses to severe, life-threatening reactions. Symptoms such as shortness of breath, chills, and itching are common early indicators of a reaction and require prompt assessment and intervention, including stopping the transfusion if necessary. Early recognition is critical to prevent complications such as anaphylaxis, hemolytic reactions, or circulatory overload. Other symptoms like fever, rash, headache, dizziness, nausea, and vomiting may also occur but the combination of SOB, chills, and itching often signals an immediate reaction.
8. All of the following tasks could be delegated to a nursing assistant or unlicensed assistive personnel (UAP) except:
- offering fluid intake every 1-2 hours.
- assisting a client to the bathroom.
- monitoring/recording the amount of fluid taken.
- monitoring intravenous infusion.
Explanation
While nursing assistants or UAPs can safely perform routine tasks such as offering fluids, assisting with toileting, and recording intake, monitoring an intravenous (IV) infusion requires professional nursing judgment. IV monitoring involves assessing for complications such as infiltration, phlebitis, or adverse reactions to medications, which cannot be delegated because it requires critical decision-making and clinical expertise. The nurse remains accountable for any interventions related to IV therapy, making it a task that cannot be safely delegated to unlicensed personnel.
9. Two days after a nephrectomy, the client reports abdominal pressure and nausea. Which assessment should the nurse implement?
- Ambulate client in hallway.
- Measure hourly urine output.
- Palpate the abdomen.
- Auscultate bowel sounds.
Explanation
After a nephrectomy, decreased bowel motility from anesthesia, pain medication, or immobility may lead to paralytic ileus, causing symptoms such as abdominal pressure, distention, and nausea. The nurse should auscultate bowel sounds to assess gastrointestinal function and determine if peristalsis has returned. Early identification of absent or hypoactive bowel sounds allows prompt intervention, including notifying the provider and managing nausea or potential obstruction appropriately.
10. What is a key characteristic of Chronic Obstructive Pulmonary Disease (COPD)?
- Reversible airway obstruction
- Increased lung capacity
- Irreversible airflow limitations
- Normal pulmonary function
Explanation
Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent and progressive airflow limitation that is not fully reversible. The condition includes chronic bronchitis and emphysema, which cause structural changes in the lungs and airways, leading to difficulty in exhaling air completely. Unlike asthma, where airway obstruction is typically reversible with treatment, COPD results in permanent damage to lung tissue and airways, making airflow limitations largely irreversible. Recognizing this characteristic is crucial for appropriate management and patient education.
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