Nokea
After inspiration commences the:
- A. Intrapleural pressure and intrapulmonary P both fall
- B. Intrapleural pressure falls and intrapulmonary P rises
- C. Intrapleural pressure falls and venous return decreases
- D. Intrapulmonary pressure rises and volume of the alveoli is momentarily unchanged
Correct Answer: A
Rationale: After inspiration commences, the diaphragm contracts and the thoracic cavity expands. This leads to a decrease in intrapleural pressure, allowing the lungs to expand. Simultaneously, intrapulmonary pressure decreases, creating a pressure gradient for air to flow into the lungs. Choice A is correct because both intrapleural pressure and intrapulmonary pressure fall during inspiration.
Choice B is incorrect because intrapulmonary pressure actually decreases during inspiration, not rises. Choice C is incorrect because intrapleural pressure falling does not directly correlate with a decrease in venous return. Choice D is incorrect because during inspiration, the volume of the alveoli increases as the lungs expand, causing intrapulmonary pressure to decrease.
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A patient has been diagnosed with heart failure that has not yet responded to treatment. What breath sound should the nurse expect to assess on auscultation?
- A. Expiratory wheezes
- B. Inspiratory wheezes
- C. Rhonchi
- D. Crackles
Correct Answer: D
Rationale: The correct answer is D: Crackles. In heart failure, crackles are often heard on auscultation due to fluid accumulation in the lungs. This is a result of the heart's inability to effectively pump blood, leading to congestion in the pulmonary circulation. Crackles are discontinuous, moist sounds that occur during inspiration and sometimes expiration. Expiratory wheezes (A) are typically associated with obstructive airway diseases such as asthma. Inspiratory wheezes (B) are not commonly heard in heart failure. Rhonchi (C) are low-pitched continuous sounds often heard in patients with bronchitis or pneumonia, not specifically in heart failure.
A 62-yr-old client who has no history of hypertension or other health problems suddenly develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP.What is most appropriate for the nurse to tell the client
- A. BP recheck should be scheduled in a few weeks.
- B. dietary sodium and fat content should be decreased.
- C. diagnosis, treatment, and monitoring will be needed.
- D. there is danger of a stroke, requiring hospitalization.
Correct Answer: C
Rationale: The correct answer is C because a sudden spike in blood pressure to 198/110 mm Hg is considered hypertensive crisis requiring immediate medical attention. The nurse should inform the client that diagnosis, treatment, and monitoring are necessary to address the high blood pressure. This is important to prevent serious complications like stroke or heart attack.
Option A is incorrect because waiting a few weeks for a BP recheck could be dangerous in this scenario. Option B is also incorrect as simple dietary changes may not be sufficient to address such high blood pressure levels. Option D is incorrect as hospitalization may or may not be required based on the assessment and treatment plan determined by the healthcare provider.
After receiving a change-of-shift report on four patients admitted to a heart failure unit ,which patient should the nurse assess first?
- A. A patient who reported dizziness after receiving the first dose of captopril.
- B. A patient who has new-onset confusion and restlessness and cool clammy skin.
- C. A patient who is receiving IV nesiritide (Natrecor)
- D. A patient who is receiving oxygen and has crackles bilaterally in the lung bases.
Correct Answer: B
Rationale: The correct answer is B because new-onset confusion, restlessness, and cool clammy skin are signs of poor perfusion and potential deterioration. The nurse should assess this patient first to address possible acute changes in condition. Option A, dizziness after captopril, can be important but not immediately life-threatening. Option C receiving IV nesiritide is stable and monitored closely. Option D with oxygen and crackles indicates pulmonary congestion but is not an immediate priority compared to the signs of poor perfusion in option B.
After change of shift, you are assigned to care for the following clients. Which client should you assess first?
- A. A 68-year-old client on ventilator who needs a sterile sputum specimen sent to the laboratory
- B. A 57-year-old client with COPD and pulse oximetry reading from previous shift of 90% saturation
- C. A 72-year-old client with pneumonia who needs to be started on intravenous antibiotics
- D. A 51-year-old client with asthma complaining of shortness of breath (SOB) after using a bronchodilator inhaler
Correct Answer: D
Rationale: The correct answer is D. A client with acute SOB after using a bronchodilator requires immediate attention. Clients on ventilators (A), with stable but low oxygen saturation (B), or needing antibiotics (C) are important but less urgent.
A nurse cares for a client who has hypertension that has not responded well to several medications. The client states compliance is not an issue. What action would the nurse take next?
- A. Assess the client for obstructive sleep apnea.
- B. Arrange a home sleep apnea test.
- C. Encourage the client to begin exercising.
- D. Schedule a polysomnography
Correct Answer: A
Rationale: The correct answer is A: Assess the client for obstructive sleep apnea. Hypertension that is not responding to medications may be due to underlying sleep apnea, a common comorbidity. By assessing for obstructive sleep apnea, the nurse can identify a potential contributing factor to the client's uncontrolled hypertension. This step is crucial in managing the client's condition effectively.
Summary of other choices:
B: Arranging a home sleep apnea test may be premature without first assessing the client for obstructive sleep apnea.
C: Encouraging the client to begin exercising is important for overall health but may not directly address the uncontrolled hypertension.
D: Scheduling a polysomnography may be necessary if obstructive sleep apnea is suspected after the initial assessment.