ATI NUR 135 Exam 1

Correct Answer: B. Respecting the client's desire to save items regardless of value

Explanation 

An important aspect of therapeutic care for a client with hoarding disorder is to approach the condition with empathy and respect. The client often attaches deep personal significance to their possessions, and forcing them to discard items can lead to increased anxiety, resistance, and worsening of symptoms. Therapeutic care should focus on building trust and gradually working with the client to identify items that may be safe to part with, while respecting their attachment to objects. Treatment may include cognitive-behavioral therapy (CBT) to help the client understand their behaviors and make more gradual changes.

Why the Other Options Are Incorrect:

A. Forcing the client to get rid of all their possessions

This is not recommended. Forcing the client to discard possessions can lead to increased emotional distress and may make the hoarding behavior worse. Hoarding disorder requires a patient, collaborative approach that avoids overwhelming the client.

C. Ignoring the client's hoarding behavior

Ignoring the behavior would fail to address the underlying psychological factors that contribute to hoarding, such as anxiety, perfectionism, or attachment issues. Intervention is necessary to prevent the disorder from worsening and to improve the client's overall well-being.

D. Encouraging the client to discard all their possessions

Encouraging the client to discard all possessions can cause overwhelming anxiety and resistance. Instead, therapeutic care should involve gradual decision-making to address the hoarding behavior in a way that is respectful of the client’s attachment to items, while still encouraging positive change.

Summary:

The most important aspect of care for a client with hoarding disorder is to respect the client's desire to save items while working collaboratively to help them manage their condition gradually. A non-judgmental and empathetic approach is essential for successful intervention.

The correct answer is: C) 4.7-6.2 x 10¹²/L

Explanation:

The normal range for Red Blood Cells (RBCs) in males typically falls within 4.7 to 6.2 x 10¹²/L. This range may vary slightly depending on the laboratory and its specific reference values, but this is the generally accepted normal range.

Why the other options are incorrect:

A) 3.5-5.0 x 10¹²/L: This range is generally too low for adult males. It may be appropriate for females, but not for males.

B) 4.2-5.4 x 10¹²/L: This range is closer to normal for females but slightly low for males.

D) 5.5-7.0 x 10¹²/L: This range is above the normal upper limit for males and may indicate a condition like polycythemia if RBCs are consistently in this range.

Conclusion:

The normal RBC count range for adult males is generally between 4.7-6.2 x 10¹²/L, making C) the correct answer.

Correct Answer: B) Family members may experience stress and difficulty navigating the living environment

Explanation 

Hoarding disorder can have a profound impact on family dynamics. As the individual with hoarding disorder accumulates items and struggles to discard them, the living environment can become dangerously cluttered and disorganized. Family members often find it challenging to navigate the home, which may lead to frustration, confusion, and stress. The inability to use common spaces or access essential items creates daily obstacles, contributing to a tense and stressful living situation. Additionally, family members might become increasingly concerned about the safety hazards associated with excessive clutter, such as fire risks or the inability to escape in case of an emergency. This ongoing stress can lead to strained relationships, with family members feeling helpless or even resentful of the situation. Hoarding often causes tension between the person with the disorder and their loved ones, as the family may push for the individual to clean up and get rid of the items, while the individual with hoarding disorder may resist due to their attachment to the possessions. Over time, this dynamic can severely affect family harmony and emotional well-being.

Why the Other Options Are Incorrect:

A) Hoarding disorder improves family relationships:

This is incorrect. In most cases, hoarding disorder worsens family relationships due to the stress, anxiety, and frustration that result from the disorganized and unsafe living conditions. Family members may feel that they are constantly at odds with the individual struggling with hoarding, leading to tension and conflict. Rather than improving relationships, the disorder typically causes strain and emotional distress.

C) Family members become hoarders themselves:

While it is possible for some family members to develop similar behaviors, this is not a universal outcome. Hoarding disorder is a mental health condition that may be influenced by genetic and environmental factors, but it does not automatically cause other family members to develop the disorder. Some family members might even take a stand against hoarding, trying to maintain order in the household or seek professional help. Thus, while there may be a risk, this is not a guaranteed consequence of having a family member with hoarding disorder.

D) Family members are not affected by hoarding disorder:

This is incorrect. Family members are typically deeply affected by hoarding disorder. The cluttered, chaotic living environment often causes emotional strain, as family members may feel overwhelmed, embarrassed, or worried about the safety of their loved one. Relationships can be disrupted due to conflicting views about how to handle the situation, and family members may also experience emotional exhaustion from the continuous caregiving burden or from trying to help the individual with hoarding disorder.

Summary:

Hoarding disorder significantly affects family members, leading to stress and difficulty managing the living environment. The excessive clutter and disorganization cause both physical and emotional strain, and family relationships are often tested as they try to address the issue. The disorder can also increase the risk of safety hazards, which further intensifies the pressure on the family. It is essential for families to seek professional support to manage the disorder effectively and to maintain their own well-being.

The correct answer is: B) A normal response to general anesthesia.

Explanation:

Shivering is a common and usually normal response to general anesthesia. After surgery, patients can experience shivering as a result of various factors, most notably the cooling effects of anesthesia on the body and the body’s attempt to return to normal temperature. The hypothermic effect of anesthesia can lower the body's set point for temperature regulation, causing the body to react by shivering as a mechanism to raise the temperature.

Why the other options are incorrect:

A) A sign of developing a wound infection: While infection can lead to symptoms like fever, shivering is not the primary indicator of infection in the immediate postoperative period. Infection would generally present with other signs such as redness, warmth, increased pain at the incision site, or a change in wound drainage over time, but not typically shivering immediately post-op.

C) An indication of an electrolyte imbalance: Electrolyte imbalances can cause a variety of symptoms, including muscle weakness, fatigue, and changes in heart rate or rhythm, but they are less likely to cause shivering immediately postoperatively. Shivering is not a primary sign of electrolyte imbalance.

D) A sign of severe postoperative pain: While pain can lead to physiological responses, such as increased heart rate and blood pressure, it is less likely to cause shivering directly. Pain-related responses are usually more about discomfort and stress, while shivering is a thermoregulatory response.

Summary:

Shivering in the postoperative period, especially in the PACU (Post Anesthesia Care Unit), is most commonly due to a normal response to general anesthesia. The body’s attempt to regulate its temperature after anesthesia-induced cooling results in shivering, which is typically self-limiting and resolves as the patient warms up.

The correct answer is: C. Troponin I

Troponin I is the most specific laboratory test for diagnosing a myocardial infarction (heart attack). Troponins are proteins released into the bloodstream when heart muscle cells are damaged. Troponin I is highly sensitive and specific to cardiac tissue, making it the gold standard for detecting myocardial injury. Elevated levels of troponin I typically indicate myocardial infarction, and the degree of elevation can correlate with the extent of the damage.

Why are the other options wrong?

A. C-reactive protein

C-reactive protein (CRP) is a marker of inflammation in the body, but it is not specific to the heart. Elevated CRP levels can occur in many conditions, such as infections, autoimmune diseases, or other inflammatory processes, so it is not used to diagnose a myocardial infarction

B. CK-MB

Creatine kinase-MB (CK-MB) is an enzyme found in heart muscle, and it was historically used to diagnose myocardial infarction. However, it is less specific than troponin because CK-MB can also be elevated in conditions affecting other muscles (e.g., skeletal muscle injury). Troponin has largely replaced CK-MB as the preferred biomarker for myocardial infarction

D. CK

Creatine kinase (CK) is an enzyme found in various tissues, including skeletal muscle, brain, and heart. It is not specific to the heart, and elevated levels can occur due to muscle injury, exercise, or other non-cardiac conditions. Therefore, it is not used to diagnose myocardial infarction.

Summary:

The most specific laboratory test for diagnosing a myocardial infarction is C. Troponin I because it is highly sensitive and specific to cardiac tissue. The other options are incorrect because:

C-reactive protein is a nonspecific marker of inflammation.

CK-MB is less specific than troponin and can be elevated in non-cardiac conditions.

CK is not specific to the heart and can be elevated due to other causes.

Correct Answer: B) The kidneys retain bicarbonate (HCO₃⁻)

Explanation:

Respiratory acidosis occurs when there is an accumulation of carbon dioxide (CO₂) in the blood, usually due to hypoventilation (impaired breathing or shallow breathing). This leads to an increase in carbonic acid (H₂CO₃), lowering the blood's pH. To compensate for respiratory acidosis, the body’s kidneys try to restore the acid-base balance. They do this by retaining bicarbonate (HCO₃⁻), which acts as a buffer, helping to neutralize excess hydrogen ions (H⁺) and increase the blood's pH back toward normal. This process is slower and can take hours to days.

Why Other Options Are Incorrect:

A: The lungs hyperventilate to remove CO₂

In respiratory acidosis, the lungs are not functioning properly to remove CO₂, which is the cause of the acidosis. Hyperventilation would help reduce CO₂, but in respiratory acidosis, hypoventilation (shallow or slow breathing) is the problem.

C: The kidneys excrete bicarbonate (HCO₃⁻)

In respiratory acidosis, the kidneys retain bicarbonate, not excrete it. Excreting bicarbonate would worsen the acidosis because bicarbonate is a buffer that helps neutralize excess hydrogen ions in the blood.

D: The lungs hypoventilate to retain CO₂

This is incorrect because the problem in respiratory acidosis is already the hypoventilation that causes CO₂ retention. The lungs are not compensating by hypoventilating further but are already in a state of insufficient ventilation.

Summary:

In respiratory acidosis, the body's primary compensatory mechanism is through the kidneys, which retain bicarbonate to neutralize the excess acid caused by CO₂ buildup. This process takes time, which is why respiratory acidosis requires medical management to address both the underlying cause and the compensatory mechanisms.

The correct answer is: B) Hypernatremia and hypokalemia

Explanation:

Cushing syndrome is characterized by excessive cortisol production, often due to overuse of corticosteroid medications or adrenal gland disorders. Cortisol plays a key role in regulating metabolism and other functions, including influencing the balance of electrolytes in the body.

Effects of Cushing syndrome on electrolytes:

Hypernatremia (high sodium levels): Elevated cortisol levels lead to increased sodium retention by the kidneys. This results in fluid retention, which increases sodium levels in the bloodstream, causing hypernatremia.

Hypokalemia (low potassium levels): Cortisol also enhances the renal excretion of potassium, leading to potassium depletion, which results in hypokalemia.

Why the other options are incorrect:

A) Hyponatremia and hyperkalemia: Hyponatremia (low sodium) and hyperkalemia (high potassium) are not typically associated with Cushing syndrome. In fact, Cushing syndrome is more commonly associated with hypernatremia and hypokalemia due to the effects of cortisol on sodium and potassium handling by the kidneys.

C) Hypocalcemia and hyperphosphatemia: Cushing syndrome is not directly associated with hypocalcemia (low calcium) or hyperphosphatemia (high phosphate). While cortisol does affect calcium metabolism, the primary electrolyte imbalances observed in Cushing syndrome are related to sodium and potassium.

D) Hypermagnesemia and hypophosphatemia: Hypermagnesemia (high magnesium) and hypophosphatemia (low phosphate) are not typically seen in Cushing syndrome. The primary concerns with Cushing syndrome are the effects on sodium, potassium, and sometimes calcium.

Summary:

In Cushing syndrome, elevated cortisol leads to hypernatremia (high sodium) due to increased sodium retention and hypokalemia (low potassium) due to increased potassium excretion. Thus, hypernatremia and hypokalemia are the most likely electrolyte imbalances seen in this condition.

The correct answer is  C. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP).

Explanation:

BNP (Brain Natriuretic Peptide) and ANP (Atrial Natriuretic Peptide) are biomarkers released in response to stretching of the heart muscle due to fluid overload. BNP is particularly useful in diagnosing and managing heart failure. Elevated BNP levels are indicative of heart failure and can help differentiate between heart failure and other causes of shortness of breath. BNP is released from the ventricles in response to increased pressure, which occurs in heart failure, and it helps reduce fluid retention by promoting diuresis and vasodilation.

Why the other options are incorrect:

A. Chest X-ray: A chest X-ray is useful in identifying signs of pulmonary congestion (like fluid in the lungs), which is a common complication of heart failure. However, it doesn't directly assess cardiac function or fluid overload as comprehensively as BNP and ANP levels, which provide more specific insights into heart failure.

B. Electrocardiogram (ECG): An ECG measures the electrical activity of the heart and can help identify arrhythmias, ischemia, or signs of prior myocardial infarction, but it does not specifically diagnose fluid overload or assess cardiac function in heart failure.

D. Urinalysis: A urinalysis is useful for detecting kidney function or urinary tract issues, but it doesn't directly assess fluid overload or cardiac function in heart failure. While kidney function can be affected in heart failure, a urinalysis is not the primary test for evaluating heart failure.

Summary:

BNP and ANP are the most specific diagnostic tests for assessing fluid overload and cardiac function in heart failure. Elevated BNP levels are particularly useful in diagnosing heart failure and evaluating the severity of fluid retention.

Correct Answer:  C. Variant angina

Explanation:

Variant angina (also known as Prinzmetal's angina) is characterized by chest pain at rest due to coronary artery spasm, which leads to reversible ST-segment elevation on an electrocardiogram (ECG). The pain is often episodic and can occur without any physical exertion or other obvious triggers. The ST-segment elevation is transient, resolving once the spasm subsides. It is generally reversible, and the pain is often relieved by nitroglycerin or calcium channel blockers, which help relieve the spasm.

Why the other options are incorrect:

A. Stable angina:

Stable angina is typically triggered by physical exertion or stress and is characterized by predictable chest pain that is relieved by rest or nitroglycerin. It does not typically occur at rest and is not associated with reversible ST-segment elevation as in variant angina. The ECG in stable angina usually shows ST-segment depression during episodes of pain, not elevation.

B. Unstable angina:

Unstable angina is a more serious form of angina that is typically unpredictable and occurs at rest or with minimal exertion. It is caused by reduced blood flow due to atherosclerotic plaque rupture or thrombosis. Unlike variant angina, it is not typically associated with reversible ST-segment elevation but may show ST-segment depression or T-wave inversion during episodes. It requires immediate medical attention to prevent progression to a myocardial infarction.

D. Atypical angina:

Atypical angina is a non-specific form of chest pain that does not fit the classic patterns of stable or unstable angina. The term "atypical" refers to the varied presentation of symptoms rather than a clear pathophysiological mechanism, and it does not specifically involve reversible ST-segment elevation or occur at rest.

Summary:

Variant angina is characterized by chest pain at rest with reversible ST-segment elevation, typically due to coronary artery spasm. Stable angina occurs with predictable triggers and is usually associated with ST-segment depression, not elevation. Unstable angina is a more serious form of angina that is unpredictable and requires urgent treatment, typically showing ST-segment depression or T-wave inversion on an ECG. Atypical angina has a non-specific presentation and is not defined by reversible ST-segment elevation or chest pain at rest.