D446 Adult Health II
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Free D446 Adult Health II Questions
1. Which one of the following signs/symptoms indicates a major difference between angina and a myocardial infarction?
- Substernal pain radiating to the left arm or jaw
- Persistent pain not relieved with rest
- Shortness of breath with episodes of pain
- Pain described as chest pressure, tightness, squeezing
Explanation
A key difference between angina and myocardial infarction (MI) is that MI pain is persistent and not relieved by rest or nitroglycerin, indicating ongoing myocardial ischemia and potential heart muscle damage. In contrast, angina typically occurs with exertion or stress and resolves with rest or medication. While radiation of pain, shortness of breath, and pressure-like sensations may be present in both conditions, the persistence of pain despite rest is a critical distinguishing feature pointing to MI.
2. A nurse is developing a plan of care for a client with diabetic ketoacidosis (DKA). The nurse includes which intervention in the plan?
- Measure level of ketones in urine.
- Limit family visitation time.
- Assess for fluid overload.
- Monitor potassium levels.
Explanation
Monitoring potassium levels is a critical intervention in the care of patients with DKA. Insulin therapy, which is used to treat DKA, can rapidly shift potassium into cells, potentially causing dangerous hypokalemia. Careful monitoring allows timely intervention to maintain safe potassium levels and prevent cardiac complications. Measuring ketones is also important, but potassium management directly addresses life-threatening risks. Limiting family visitation and assessing for fluid overload, while part of general patient care, are not the primary interventions for DKA management.
3. If a patient with COPD develops Cor Pulmonale, what nursing intervention would be most critical?
- Monitoring for signs of right heart failure
- Performing chest physiotherapy
- Administering bronchodilators
- Encouraging deep breathing exercises
Explanation
Cor Pulmonale is a complication of COPD characterized by right-sided heart failure due to chronic pulmonary hypertension. The most critical nursing intervention is monitoring for signs of right heart failure, such as peripheral edema, jugular vein distention, hepatomegaly, and ascites. Early detection of these signs allows timely interventions to manage fluid balance, oxygenation, and cardiovascular support. While bronchodilators, chest physiotherapy, and deep breathing exercises help manage COPD symptoms, monitoring for right heart failure is the priority in patients with Cor Pulmonale.
4. A patient has just undergone a percutaneous coronary intervention (PCI) and is showing signs of decreased perfusion in the affected leg. What should be your immediate nursing action?
- Increase the patient's fluid intake.
- Administer pain medication immediately.
- Prepare the patient for discharge.
- Assess the groin site for bleeding and check pulses in the affected leg.
Explanation
After a PCI, decreased perfusion in the affected leg may indicate vascular compromise, bleeding, or arterial occlusion at the catheter insertion site. The immediate nursing action is to assess the groin site for bleeding and check pulses, color, temperature, and capillary refill in the affected leg. Early detection of complications allows prompt intervention to restore perfusion and prevent serious outcomes such as limb ischemia. Simply increasing fluids, administering pain medication, or preparing for discharge does not address the potential vascular emergency.
5. When explaining dietary guidelines to a client with acute glomerulonephritis (AGN), which instruction should the nurse include in the dietary teaching?
- Eat high-potassium foods
- Avoid foods high in carbohydrates
- Select a protein-rich food daily
- Restrict sodium intake
Explanation
Acute glomerulonephritis causes inflammation of the glomeruli, leading to fluid retention, edema, and hypertension. To help manage these symptoms, the nurse should instruct the client to restrict sodium intake. Reducing sodium helps minimize fluid overload, lower blood pressure, and prevent worsening of kidney function. Protein intake may also be moderated depending on renal status, but sodium restriction remains the most essential dietary modification for symptom control and recovery.
6. A patient tells the nurse, 'I had severe chest pain six days ago.' Which cardiac biomarker will be most helpful in determining whether the patient had a myocardial infarction at the time the patient experienced chest pain?
- Creatine kinase (CK)
- Myoglobin
- Homocysteine
- Troponin
Explanation
Troponin is the most helpful cardiac biomarker for detecting myocardial infarction that occurred several days prior. Troponin levels rise within a few hours of myocardial injury and remain elevated for up to 10–14 days, allowing detection of past cardiac events. Other biomarkers, such as CK and myoglobin, rise and fall much more quickly, typically returning to baseline within 1–2 days, making them less useful for identifying a myocardial infarction that occurred six days earlier. Troponin’s prolonged elevation makes it the gold standard for retrospective diagnosis.
7. The nurse is caring for a client with a burn that is severely edematous with a wound bed that is brown and yellow in appearance. The client expresses feeling no pain. Which classification of burn depth should the nurse document?
- Superficial partial-thickness
- Deep full-thickness
- Full-thickness
- Deep partial-thickness
Explanation
A full-thickness burn extends through the entire dermis and sometimes into subcutaneous tissue, destroying nerve endings, which explains the absence of pain. The wound often appears leathery, brown, yellow, or charred, and edema is common. Because sensory and vascular structures are damaged, healing requires grafting. In contrast, partial-thickness burns are red, moist, and painful due to intact nerve endings.
8. In case of an anaphylactic reaction, which treatment should be first?
- Anti-histamine
- Corticosteroid
- Epinephrine
- Beta agonist
Explanation
Anaphylaxis is a severe, life-threatening allergic reaction that requires immediate intervention. The first-line treatment is epinephrine, which rapidly reverses airway constriction, hypotension, and vascular collapse by stimulating alpha and beta-adrenergic receptors. Early administration of epinephrine is critical to prevent progression to shock and death. While antihistamines and corticosteroids can be used as adjunct therapies to reduce symptoms and prevent recurrence, they act more slowly and do not address the acute, potentially fatal effects of anaphylaxis. Beta agonists may help with bronchospasm but are not sufficient as the primary treatment.
9. What is the primary effect of hypercapnia on COPD patients' respiratory effort?
- Irregular breathing patterns
- No effect on respiratory effort
- Decrease in respiratory effort
- Increase in respiratory effort
Explanation
In COPD patients, hypercapnia (elevated carbon dioxide levels) occurs due to impaired gas exchange and airflow limitation. Normally, elevated CO₂ stimulates increased respiratory effort to expel the excess gas. However, in chronically hypercapnic COPD patients, the body may become less sensitive to CO₂, but an acute rise still generally triggers an increase in respiratory effort to restore gas balance. This compensatory mechanism is crucial for maintaining adequate oxygenation and preventing respiratory acidosis.
10. In a scenario where a UAP fails to perform a delegated task correctly, what is the nurse's responsibility?
- The nurse should blame the UAP for the failure without taking any action.
- The nurse can delegate the responsibility of addressing the issue to another staff member.
- The nurse can ignore the mistake since the UAP is responsible for their actions.
- The nurse must address the issue and ensure that the task is completed correctly, as they are accountable for the delegation.
Explanation
When a nurse delegates a task to an Unlicensed Assistive Personnel (UAP), the nurse remains legally and professionally accountable for ensuring the task is completed safely and correctly. If a UAP fails to perform the task appropriately, it is the nurse’s responsibility to address the issue immediately, correct any errors, and ensure the client’s care needs are met. This may involve providing additional instruction, supervision, or intervention to complete the task properly. Accountability for delegated tasks is a fundamental principle in nursing practice and ensures patient safety and quality care.
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