D446 Adult Health II
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Free D446 Adult Health II Questions
1. 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.
2. What is the relationship between pH and hydrogen ion in acid-base balance?
- The pH is directly related to hydrogen ion
- The pH is equal to hydrogen ion
- The pH is not related to hydrogen ion
- The pH is inversely related to hydrogen ion
Explanation
pH is a measure of the hydrogen ion (H⁺) concentration in a solution and is inversely related to hydrogen ion levels. As the concentration of hydrogen ions increases, the pH decreases, indicating increased acidity. Conversely, a lower hydrogen ion concentration results in a higher pH, indicating alkalinity. This inverse relationship is fundamental to understanding acid-base balance in the body, as small changes in hydrogen ion concentration can significantly affect physiological processes.
3. In a scenario where a nurse is managing multiple patients, which of the following tasks would be most appropriate to delegate to a UAP to ensure efficient care delivery?
- Ambulating a patient
- Administering IV medications
- Developing a nursing diagnosis
- Conducting a patient assessment
Explanation
Delegation to a Unlicensed Assistive Personnel (UAP) should involve tasks that do not require professional nursing judgment. Ambulating a patient is appropriate for delegation because it involves assisting with mobility and ensuring patient safety, which the UAP can perform under the nurse’s supervision. Tasks such as administering IV medications, developing nursing diagnoses, or conducting patient assessments require professional knowledge and critical thinking and cannot be delegated. Proper delegation helps ensure efficient care delivery while maintaining patient safety.
4. If a patient with a known allergy to peanuts experiences anaphylaxis and is not wearing a medical alert bracelet, what might be the consequences for their treatment?
- Faster recovery due to clear communication
- Immediate identification of the allergy
- Delayed administration of appropriate treatment
- No impact on treatment as allergies are documented in the chart
Explanation
Not wearing a medical alert bracelet can delay the recognition of the patient’s severe allergy in an emergency, especially if the patient is unable to communicate. This delay can result in slower administration of epinephrine and other life-saving interventions, increasing the risk of severe outcomes or death. While allergies may be documented in the chart, immediate identification in acute settings often relies on visible alerts, particularly in pre-hospital or emergency situations.
5. Describe how chlorhexidine oral care contributes to the prevention of ventilator-associated pneumonia (VAP).
- Chlorhexidine oral care promotes healing of oral tissues.
- Chlorhexidine oral care reduces the number of bacteria in the mouth, decreasing the likelihood of aspiration into the lungs.
- Chlorhexidine oral care increases the immune response in the lungs.
- Chlorhexidine oral care enhances the effectiveness of antibiotics.
Explanation
Chlorhexidine oral care is an important preventive measure for ventilator-associated pneumonia (VAP) in mechanically ventilated patients. By reducing the bacterial load in the oral cavity, chlorhexidine decreases the risk of pathogenic organisms being aspirated into the lower respiratory tract, which is a primary cause of VAP. Routine oral care with chlorhexidine helps maintain oral hygiene and prevents infection, ultimately improving patient outcomes and reducing hospital-acquired complications. Its effectiveness lies in bacterial reduction, not directly in tissue healing, immune modulation, or enhancing antibiotic efficacy.
6. 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.
7. What is the primary characteristic of chronic obstructive pulmonary disease (COPD)?
- Obstructed airflow from the lungs
- Increased airflow from the lungs
- Temporary lung inflammation
- Rapid lung recovery
Explanation
Chronic Obstructive Pulmonary Disease (COPD) is primarily characterized by persistent and progressive obstruction of airflow in the lungs, making it difficult for the patient to breathe effectively. This obstruction results from chronic bronchitis, emphysema, or a combination of both, leading to reduced lung function, difficulty exhaling completely, and chronic respiratory symptoms. Unlike temporary lung conditions, COPD involves long-term structural changes in the lungs and airways that are largely irreversible, making airflow obstruction the defining feature of the disease.
8. In a scenario where a patient presents with Ventricular Tachycardia and is unstable, what should the nursing team prioritize in their immediate response?
- Providing oxygen therapy
- Monitoring vital signs only
- Administering antiarrhythmic medication
- Defibrillation and CPR
Explanation
Unstable Ventricular Tachycardia is a life-threatening cardiac arrhythmia that can lead to cardiac arrest. The immediate priority is to restore a perfusing rhythm through defibrillation and, if necessary, perform CPR to maintain circulation until a normal rhythm is achieved. While oxygen therapy and antiarrhythmic medications may support care, they are secondary to the urgent need for defibrillation in unstable patients. Rapid intervention is critical to prevent sudden cardiac death.
9. Case Study Question
Patient Data
History and Physical:
The client is a 68-year-old female with a history of type 2 diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), and a recent diagnosis of end-stage renal disease (ESRD). She has been receiving hemodialysis three times a week for the past month. She presented to the emergency department (ED) with fatigue, generalized weakness, muscle cramps, tingling sensations in her arms and legs, and lightheadedness. Her husband reported she had been nauseated with poor appetite for three days and missed her last dialysis session. She was recently started on lisinopril for blood pressure control, which has not seemed effective. The client was diagnosed with hyperkalemia (serum potassium 5.9 mEq/L) and was transferred to the intermediate medical unit (IMU) for treatment and monitoring.
Laboratory Results (0830):
Vital Signs
Initial in ED (0830):
• Temperature: 98.2°F (36.8°C) orally
• Heart rate: 112 beats/min
• Respirations: 18/min
• Blood pressure: 146/82 mm Hg
• Oxygen saturation: 98% on room air
• ECG: Sinus tachycardia (ST)
In ED prior to transfer (0900):
• Temperature: 98°F (36.7°C) orally
• Heart rate: 114 beats/min
• Respirations: 18/min
• Blood pressure: 156/88 mm Hg
• Oxygen saturation: 98% on room air
• ECG: Sinus tachycardia with premature junctional contractions (PJCs)
Upon unit admission (1000):
• Temperature: 98.2°F (36.7°C) orally
• Heart rate: 125 beats/min
• Respirations: 22/min
• Blood pressure: 96/88 mm Hg
• Oxygen saturation: 98% on room air
• ECG: Sinus tachycardia with premature ventricular contractions (PVCs) and tall T waves
Provider Orders:
• Admit to IMCU with telemetry monitoring
• Low-potassium, renal diet
• Lisinopril 40 mg PO daily
• Calcium gluconate 10%, 1 g IV push once
• Insulin glargine 10 units subQ at bedtime daily
• Ondansetron 4 mg IVP every 4 hours PRN nausea/vomiting
• Strict intake and output
• Consult gastroenterology for abdominal pain, diarrhea, and vomiting
• Consult nephrology for dialysis
• Consult cardiology for hypertension and dysrhythmias
• Labs: CBC, BMP, BNP, PTT, PT/INR
Which nursing action(s) is/are appropriate for the client at this time? (Select all that apply.)
Patient Data
History and Physical:
The client is a 68-year-old female with a history of type 2 diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), and a recent diagnosis of end-stage renal disease (ESRD). She has been receiving hemodialysis three times a week for the past month. She presented to the emergency department (ED) with fatigue, generalized weakness, muscle cramps, tingling sensations in her arms and legs, and lightheadedness. Her husband reported she had been nauseated with poor appetite for three days and missed her last dialysis session. She was recently started on lisinopril for blood pressure control, which has not seemed effective. The client was diagnosed with hyperkalemia (serum potassium 5.9 mEq/L) and was transferred to the intermediate medical unit (IMU) for treatment and monitoring.
Laboratory Results (0830):
| Test | Result | Reference Range |
|---|---|---|
| Potassium | 5.9 mEq/L | 3.5–5.0 mEq/L |
| Glucose | 72 mg/dL | 74–106 mg/dL |
Vital Signs
Initial in ED (0830):
• Temperature: 98.2°F (36.8°C) orally
• Heart rate: 112 beats/min
• Respirations: 18/min
• Blood pressure: 146/82 mm Hg
• Oxygen saturation: 98% on room air
• ECG: Sinus tachycardia (ST)
In ED prior to transfer (0900):
• Temperature: 98°F (36.7°C) orally
• Heart rate: 114 beats/min
• Respirations: 18/min
• Blood pressure: 156/88 mm Hg
• Oxygen saturation: 98% on room air
• ECG: Sinus tachycardia with premature junctional contractions (PJCs)
Upon unit admission (1000):
• Temperature: 98.2°F (36.7°C) orally
• Heart rate: 125 beats/min
• Respirations: 22/min
• Blood pressure: 96/88 mm Hg
• Oxygen saturation: 98% on room air
• ECG: Sinus tachycardia with premature ventricular contractions (PVCs) and tall T waves
Provider Orders:
• Admit to IMCU with telemetry monitoring
• Low-potassium, renal diet
• Lisinopril 40 mg PO daily
• Calcium gluconate 10%, 1 g IV push once
• Insulin glargine 10 units subQ at bedtime daily
• Ondansetron 4 mg IVP every 4 hours PRN nausea/vomiting
• Strict intake and output
• Consult gastroenterology for abdominal pain, diarrhea, and vomiting
• Consult nephrology for dialysis
• Consult cardiology for hypertension and dysrhythmias
• Labs: CBC, BMP, BNP, PTT, PT/INR
Which nursing action(s) is/are appropriate for the client at this time? (Select all that apply.)
- A. Perform a 12-lead electrocardiogram (ECG) STAT
- B. Teach the client to take slow and deep breaths
- C. Draw potassium level STAT
- D. Administer calcium gluconate STAT
- E. Check blood glucose level STAT
- F. Perform a focused cardiovascular assessment
- G. Request for more frequent blood glucose monitoring
- H. Administer nausea medication
- I. Call the healthcare provider to notify changes in vital signs
- J. Clarify the order of lisinopril with the healthcare provider
Explanation
The client’s potassium level of 5.9 mEq/L indicates hyperkalemia, which poses a life-threatening risk of cardiac dysrhythmias. ECG shows tall T waves and PVCs, confirming cardiac irritability. The nurse’s priority actions are those that protect cardiac function and correct the underlying issue.
• A. Perform a 12-lead ECG STAT: Confirms rhythm disturbances and helps identify life-threatening changes like ventricular fibrillation or asystole.
• D. Administer calcium gluconate STAT: Stabilizes cardiac membranes, reducing the risk of ventricular arrhythmias from high potassium.
• F. Perform a focused cardiovascular assessment: Continuous assessment is critical to monitor for hypotension, chest pain, or worsening dysrhythmias.
• I. Call the healthcare provider to notify changes in vital signs: HR increased from 112 to 125 bpm with falling BP, signaling hemodynamic instability.
• J. Clarify the order of lisinopril: ACE inhibitors increase potassium levels and should be discontinued in hyperkalemic patients.
• A. Perform a 12-lead ECG STAT: Confirms rhythm disturbances and helps identify life-threatening changes like ventricular fibrillation or asystole.
• D. Administer calcium gluconate STAT: Stabilizes cardiac membranes, reducing the risk of ventricular arrhythmias from high potassium.
• F. Perform a focused cardiovascular assessment: Continuous assessment is critical to monitor for hypotension, chest pain, or worsening dysrhythmias.
• I. Call the healthcare provider to notify changes in vital signs: HR increased from 112 to 125 bpm with falling BP, signaling hemodynamic instability.
• J. Clarify the order of lisinopril: ACE inhibitors increase potassium levels and should be discontinued in hyperkalemic patients.
10. Describe the key difference between NSTEMI and STEMI in terms of ECG findings.
- NSTEMI is identified by a flat ST-segment, while STEMI shows a depressed ST-segment.
- Both NSTEMI and STEMI show ST-segment elevation.
- NSTEMI shows ST-segment elevation, whereas STEMI does not.
- 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.
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