Special Populations Primary Care for the Advanced Practice Nurse (D120)

Correct answer C: Strike out with a single line and place initials

Explanation:

According to nursing documentation best practices, errors in medical records should never be erased, overwritten, or covered with correction fluid, as this can make it appear as though the nurse is attempting to hide a mistake. The proper method for correcting an error is to strike through the incorrect entry with a single line, ensuring it remains legible, and then initial and date the correction. This maintains transparency, ensures legal integrity, and allows for accurate record-keeping.

Why other options are wrong:

A. Erase the erroneous entry.

Erasing an entry is not acceptable in medical documentation as it can lead to suspicion of tampering and loss of important information. Documentation should always remain intact and transparent, even when errors occur.

B. Overwrite the erroneous entry.

Overwriting an entry makes it difficult to read both the incorrect and corrected information, which can lead to confusion and potential medical errors. Proper correction requires leaving the original entry visible for accountability.

D. Use correction fluid to correct errors.

Using correction fluid obscures the original entry, making it impossible to verify what was initially written. This can lead to legal and ethical concerns regarding the accuracy and integrity of medical records.

Correct Answer A. Instruct the client to take the medication only when they have food available.

Explanation:

Glipizide is a sulfonylurea that stimulates insulin release from the pancreas. It lowers blood sugar levels but can cause hypoglycemia, particularly if a meal is skipped. Since the client is homeless and may have irregular access to food, it is crucial to instruct them not to take the medication on an empty stomach to avoid severe hypoglycemia, which can lead to confusion, seizures, or loss of consciousness.

Why other options are wrong:

B. Advise the client to stop taking the medication if they feel dizzy.

While dizziness can be a symptom of hypoglycemia, instructing the client to completely stop taking Glipizide without consulting a healthcare provider could lead to uncontrolled hyperglycemia and long-term complications such as diabetic ketoacidosis (DKA) or neuropathy. Instead, they should be advised to monitor for symptoms of hypoglycemia and eat regularly.

C. Encourage the client to take the medication with a full glass of water.

While taking medications with water is generally good practice, it is not the most critical instruction for Glipizide. The priority is ensuring food intake, as Glipizide can cause severe hypoglycemia if taken on an empty stomach. Simply drinking water does not prevent low blood sugar.

D. Inform the client that they can share the medication with others if they are not using it.

This is unsafe and unethical. Glipizide is prescribed based on an individual's blood sugar levels, kidney function, and overall health condition. Sharing medications can lead to serious health risks, including life-threatening hypoglycemia in people for whom the medication was not intended.

Correct answer A. It is within the normal range, suggesting proper hydration.

Explanation:

Blood Urea Nitrogen (BUN) is a key indicator of hydration status and kidney function. A normal BUN level (typically 7-20 mg/dL) suggests that the body's fluid balance has been restored. In a client recovering from gastroenteritis and dehydration, a BUN level of 15 mg/dL indicates adequate volume replacement, as dehydration often causes elevated BUN levels.

Why other options are wrong:

B. It indicates that the client is still dehydrated.

If the client were still dehydrated, the BUN level would likely be elevated above the normal range due to increased nitrogenous waste concentration from decreased renal perfusion. A normal BUN suggests dehydration has been corrected.

C. It reflects fluid overload in the client.

A BUN level of 15 mg/dL is within the normal range and does not indicate fluid overload. Fluid overload would more likely present with a low BUN level due to dilutional effects.

D. It shows that the kidneys are not functioning properly.

Abnormal kidney function is typically associated with either a significantly high or low BUN level. A BUN of 15 mg/dL is normal, indicating that the kidneys are functioning adequately.

Correct answer C. Vitamin C

Explanation:

Vitamin C plays a crucial role in wound healing because it is essential for collagen synthesis, a key component of skin and connective tissue repair. It also acts as an antioxidant and helps in immune function, reducing the risk of infection in healing wounds. Citrus fruits, such as oranges, lemons, and grapefruits, are rich sources of vitamin C, making them beneficial for wound recovery.

Why other options are wrong:

A. Vitamin A. While vitamin A is important for skin health and immune function, it is not the primary vitamin involved in collagen formation and wound healing like vitamin C.

B. Vitamin B12. Vitamin B12 is essential for nerve function and red blood cell production, but it does not play a direct role in collagen synthesis and wound healing.

D. Vitamin D. Vitamin D is necessary for bone health and calcium absorption but does not significantly contribute to wound healing or collagen formation.

Correct answer:

B. It is crucial for red blood cell formation; deficiency can cause anemia.

Explanation:

Vitamin B12 is essential for red blood cell production, neurological function, and DNA synthesis. Since plant-based foods do not naturally contain B12, individuals following a vegan diet must obtain it through fortified foods or supplements. A deficiency in B12 can lead to megaloblastic anemia, which causes fatigue, weakness, and neurological symptoms such as tingling in the hands and feet.

Why other options are wrong:

A. It is essential for bone health; deficiency can lead to osteoporosis.

While B12 plays a minor role in bone metabolism, calcium and vitamin D are the primary nutrients associated with osteoporosis. A B12 deficiency is more strongly linked to anemia and neurological issues rather than direct bone loss.

C. It supports immune function; deficiency can lead to frequent infections.

B12 does play a role in cell function, but a B12 deficiency primarily affects red blood cells and nerves, not the immune system directly. Frequent infections are more commonly linked to vitamin C or zinc deficiencies rather than a lack of B12.

D. It aids in vision; deficiency can cause blindness.

Severe B12 deficiency can lead to optic nerve damage, but blindness is not a common result. More frequently, B12 deficiency causes anemia and neurological issues before affecting vision. Nutrients like vitamin A and lutein are more critical for eye health.

Correct answer A. PaCO2 of 25 mmHg

Explanation:

Respiratory alkalosis occurs when a client hyperventilates, leading to excessive elimination of carbon dioxide (CO2). This causes a decrease in PaCO2 levels, resulting in an increase in blood pH. A PaCO2 of 25 mmHg is lower than the normal range (35-45 mmHg), indicating respiratory alkalosis. Clients with anxiety-induced hyperventilation often develop this condition due to rapid, shallow breathing, which disrupts the body's acid-base balance.

Why other options are wrong:

B. PaCO2 of 40 mmHg

A PaCO2 level of 40 mmHg falls within the normal range (35-45 mmHg). If a client were experiencing respiratory alkalosis, the PaCO2 would be below normal, not within the standard range.

C. PaCO2 of 50 mmHg

A PaCO2 level of 50 mmHg indicates respiratory acidosis, not alkalosis. In respiratory acidosis, the lungs fail to remove enough CO2, leading to its retention and a decrease in blood pH. This condition is commonly seen in clients with chronic obstructive pulmonary disease (COPD) or hypoventilation disorders, not hyperventilation.

D. PaCO2 of 60 mmHg

A PaCO2 level of 60 mmHg is significantly elevated and suggests severe respiratory acidosis, where CO2 retention is leading to a dangerously low pH. This occurs in conditions such as respiratory failure or obstructive lung diseases but is not associated with anxiety-induced hyperventilation.

Correct Answer B. Legumes

Explanation:

Clients with cirrhosis of the liver are at risk for thiamine (vitamin B1) deficiency, especially if they have alcohol-related liver disease. Thiamine is essential for energy metabolism and nerve function, and its deficiency can lead to Wernicke’s encephalopathy, a serious neurological disorder. Legumes (such as beans, lentils, and peas) are a rich source of thiamine and are beneficial for these patients.

Why other options are wrong:

A. Rice.

White rice contains very little thiamine, as most of it is lost during the refining process. Brown rice has more thiamine, but it is not the richest source compared to legumes.

C. Spinach.

While spinach is a good source of iron and folate, it is not particularly high in thiamine. It does not provide enough B1 to help prevent thiamine deficiency in cirrhotic patients.

D. Fish.

Fish contains some thiamine, but it is not as high as legumes. Some raw fish can actually contain thiaminase, an enzyme that breaks down thiamine, making it a less reliable source.

Correct answer B. It suggests a potential metabolic dysfunction in the cerebral hemisphere or basal ganglia.

Explanation:

Cheyne-Stokes respiration is a cyclical pattern of breathing characterized by periods of apnea followed by progressively deeper and then shallower breathing. It is often associated with serious neurological conditions, including metabolic dysfunction affecting the cerebral hemisphere or basal ganglia. It can also occur in cases of heart failure, traumatic brain injury, or as a sign of impending death in terminal patients. The pattern results from impaired regulation of respiration due to central nervous system dysfunction.

Why other options are wrong:

A. It indicates a normal respiratory pattern.

Cheyne-Stokes respiration is an abnormal breathing pattern and is not considered a normal physiological response. It is typically associated with severe underlying conditions rather than a regular respiratory cycle.

C. It is a sign of respiratory distress due to anxiety.

Anxiety-related respiratory distress usually presents as hyperventilation, which is characterized by rapid, shallow breathing. Cheyne-Stokes respiration is distinct from hyperventilation and is not directly linked to anxiety disorders.

D. It reflects a healthy response to physical exertion.

During physical exertion, a normal response involves an increase in respiratory rate and depth to meet oxygen demands. Cheyne-Stokes respiration, however, is a pathological pattern and does not occur as a typical response to exercise.

Correct Answer C: Crackles result from fluid in the alveoli, which interferes with normal gas exchange.

Explanation:

Crackles are abnormal lung sounds heard in patients with heart failure due to pulmonary edema, which occurs when excess fluid accumulates in the alveoli. This fluid buildup impairs gas exchange, leading to shortness of breath and hypoxia. The fluid is often a result of increased hydrostatic pressure in the pulmonary capillaries, caused by left-sided heart failure, which leads to fluid backing up into the lungs.

Why other options are wrong:

A. Crackles indicate a decrease in lung capacity due to fluid accumulation.

While fluid accumulation can impair lung function, crackles are not directly caused by a decrease in lung capacity. Instead, they result from fluid interfering with alveolar function and airflow.

B. Crackles are caused by the collapse of alveoli due to dehydration.

Dehydration does not cause crackles. In fact, dehydration would reduce lung secretions rather than increase fluid in the alveoli. Crackles are a result of fluid overload, not fluid deficit.

D. Crackles are a sign of increased lung compliance due to excess fluid.

Excess fluid actually decreases lung compliance by making the lungs stiffer and less elastic, making breathing more difficult. Crackles do not indicate increased lung compliance, but rather fluid obstruction in the alveoli.