D446 Adult Health II
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Free D446 Adult Health II Questions
1. Key nursing interventions immediately after percutaneous coronary intervention (PCI) include:
- Limiting fluids and holding all medications for 6 hours after the procedure.
- Performing range-of-motion on the affected extremity to avoid vascular complications.
- Assessing for vascular and bleeding complications and assuring adequate hydration.
- 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.
2. A client with cholelithiasis is admitted with jaundice due to obstruction of the common bile duct. Which finding is most important for the nurse to report to the healthcare provider?
- Distended, hard, and rigid abdomen
- Radiating, sharp pain in right shoulder
- Clay-colored stool
- Bile-stained emesis
Explanation
A distended, hard, and rigid abdomen indicates possible peritonitis, which is a life-threatening complication that can occur when the gallbladder ruptures and bile leaks into the peritoneal cavity. This condition requires immediate medical attention because it can lead to sepsis and shock. While other symptoms like pain, jaundice, and clay-colored stools are expected findings in biliary obstruction, a rigid abdomen signals an acute surgical emergency and must be reported right away.
3. If a patient with HIV presents with a fever and a cough, what should the nurse prioritize in their assessment?
- Check the patient's blood pressure.
- Perform a mental health assessment.
- Evaluate the patient's medication adherence.
- Assess for signs of opportunistic infections such as pneumonia.
Explanation
In patients with HIV, fever and cough may signal opportunistic infections, such as pneumonia or tuberculosis, due to immunosuppression. The nurse’s priority is to assess for signs of these infections to initiate timely treatment and prevent complications. While checking vital signs, mental health, or medication adherence are important aspects of care, identifying and addressing potentially life-threatening infections takes precedence in the acute assessment of an immunocompromised patient.
4. A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment?
- Ensure that the client's family is kept informed of the client's status.
- Prepare the client for pulmonary artery catheterization.
- Assess the client's level of pain and administer prescribed analgesics.
Explanation
During a suspected myocardial infarction, the priority of care is to stabilize the client and relieve acute symptoms, including pain, which can reduce myocardial oxygen demand and decrease anxiety. Assessing the client’s level of pain and promptly administering prescribed analgesics is a critical step in the initial assessment because uncontrolled pain can worsen the client’s cardiovascular status. While family support and preparation for invasive procedures are important, they are secondary to immediate symptom management and stabilization of the client’s cardiac condition.
5. Describe the significance of Troponin and CK-MB in the context of myocardial infarction diagnosis.
- Troponin and CK-MB are critical for diagnosing myocardial infarction as they indicate heart muscle damage.
- Troponin is used to measure blood pressure, while CK-MB assesses cholesterol levels.
- Both biomarkers are used to evaluate kidney function in patients with heart disease.
- 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.
6. Of the four types of hypersensitivity, which is the most common type of allergy?
- Type I triggered by IgE
- Type II triggered by IgM
- Type IV triggered cell-mediated immunity
- Type III triggered by antibodies
Explanation
Type I hypersensitivity is the most common form of allergy and is 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 response leads to typical allergic symptoms such as itching, hives, swelling, and in severe cases, anaphylaxis. Other hypersensitivity types (II, III, and IV) involve different immune mechanisms and are less commonly associated with immediate allergic reactions.
7. Describe how smoking contributes to the development of Chronic Obstructive Pulmonary Disease (COPD).
- Smoking leads to abnormal inflammatory responses in the lungs, contributing to airflow limitations.
- Smoking only affects the upper respiratory tract.
- Smoking increases lung capacity and function.
- 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.
8. If a patient with Diabetic Ketoacidosis (DKA) presents with elevated potassium levels, what should the nursing intervention focus on?
- Monitoring for potential cardiac complications.
- Increasing fluid intake to dilute potassium.
- Restricting all potassium intake regardless of levels.
- Administering insulin without concern for potassium levels.
Explanation
In DKA, patients often present with elevated serum potassium due to a shift of potassium from the intracellular to the extracellular space caused by acidosis. However, total body potassium is usually depleted due to osmotic diuresis. Elevated potassium levels pose a significant risk for cardiac arrhythmias. Therefore, the primary nursing intervention is to monitor for potential cardiac complications using continuous ECG monitoring and prepare for interventions if dysrhythmias occur. Insulin administration and fluid replacement must be carefully managed to avoid sudden drops in potassium, which could exacerbate cardiac risks.
9. Describe the role of the nurse in the delegation of tasks to a UAP.
- The nurse can delegate all responsibilities to the UAP without oversight.
- The nurse only provides training to the UAP without further involvement.
- The nurse is responsible for overseeing the tasks delegated to a UAP and ensuring they are performed correctly.
- The nurse's role is limited to assigning tasks without accountability.
Explanation
When delegating tasks to a Unlicensed Assistive Personnel (UAP), the nurse retains accountability for the patient’s care and must ensure that the tasks are completed correctly and safely. This includes providing clear instructions, supervising as needed, and intervening if the task is not performed properly. Delegation does not absolve the nurse of responsibility; instead, it requires oversight to maintain patient safety and adherence to professional and legal standards in nursing practice. Proper delegation optimizes workflow while ensuring quality care.
10. Which of the following statements describes the relationship between hydrogen ion concentration and pH?
- As [H+] increases, pH increases
- As [H+] increases, pH decreases
- As [H+] decreases, pH decreases
- There is no relationship between [H+] and pH
Explanation
pH is a measure of the hydrogen ion concentration in a solution and is inversely related to [H+]. As the concentration of hydrogen ions increases, the solution becomes more acidic, and the pH decreases. Conversely, as hydrogen ion concentration decreases, the solution becomes more basic, and the pH increases. This inverse relationship is fundamental in understanding acid-base balance in biological systems, where even small changes in [H+] can significantly affect pH and cellular function.
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