Nokea
Which of these signs suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?
- A. Tetanic contractions
- B. Weight loss
- C. Neck vein distention
- D. Polyuria
Correct Answer: C
Rationale: In the context of syndrome of inappropriate antidiuretic hormone (SIADH), complications such as hyponatremia and fluid overload can lead to increased volume in the venous system, including the neck veins. Neck vein distention is a sign associated with fluid overload and can be indicative of worsening complications in a client with SIADH. Tetanic contractions are not typical manifestations of complications in SIADH. Weight loss and polyuria are not commonly associated with SIADH due to the increased water retention caused by the syndrome.
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The client with myasthenia gravis has become increasingly weaker. The physician prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or an increasing severity of the disease (myasthenic crisis). An injection of edrophonium (Tensilon) is administered. Which of the following would indicate that the client is in cholinergic crisis?
- A. No change in the condition
- B. An improvement of the weakness
- C. Complaints of muscle spasms
- D. A temporary worsening of the condition
Correct Answer: D
Rationale: Administering edrophonium (Tensilon) to a client with myasthenia gravis helps differentiate between cholinergic crisis and myasthenic crisis. In cholinergic crisis, which is caused by excessive acetylcholine levels due to an overdose of anticholinesterase medications, the client may experience a temporary worsening of symptoms such as muscle weakness, respiratory distress, and other cholinergic effects. This temporary worsening is due to the increase in acetylcholine levels, leading to overstimulation of nicotinic and muscarinic receptors. On the other hand, in myasthenic crisis, which is caused by insufficient acetylcholine at the neuromuscular junction, administering edrophonium would lead to an improvement in muscle weakness. Therefore, if the client experiences a temporary worsening of symptoms after receiving edrophonium, it indicates cholinergic crisis.
A patient has end-stage dilated cardiomyopathy. He comes to the emergency department with dyspnea. He says he went to bed and awoke with a feeling of suffocation. He says it was frightening. Which of the ff. responses by the nurse is most appropriate?
- A. "You must have been dreaming."
- B. "Reclining decreases the heart's ability to pump blood." c."Sleeping increases heart rate, which increases the body's need for oxygen."
- C. "Reclining increases fluid returning to the heart, which builds up fluid in the lungs."
Correct Answer: C
Rationale: The most appropriate response by the nurse is option C, "Reclining increases fluid returning to the heart, which builds up fluid in the lungs." In a patient with end-stage dilated cardiomyopathy, reclining position can lead to increased fluid return to the heart due to the failing pump function. This can result in fluid backing up in the lungs, causing symptoms such as dyspnea or feeling of suffocation. By explaining this mechanism to the patient, the nurse can provide valuable information about the condition and the reason for the distressing symptoms experienced by the patient. It also highlights the importance of proper positioning to alleviate symptoms and improve the patient's comfort.
In children with asthma, which of the following preoperative preparations is LEAST likely to be necessary?
- A. Increase in beta-agonist dosage
- B. Addition of systemic steroids
- C. Bronchodilator therapy
- D. None of the above
Correct Answer: D
Rationale: In stable asthmatic patients, additional interventions like systemic steroids or increased beta-agonist doses are not always necessary unless there are signs of exacerbation.
A patient is being taught the action of digoxin, which is an inotropic agent. The nurse defines an inotropic agent as a medication that has which of the following actions?
- A. Decreases heart rate
- B. Increases conduction time
- C. Increases heart rate
- D. Strengthens heart contraction
Correct Answer: D
Rationale: An inotropic agent, such as digoxin, is a medication that strengthens the contraction of the heart muscle. It works by increasing the force of each heartbeat, helping the heart pump more efficiently. This can be beneficial in conditions such as heart failure or certain types of arrhythmias where the heart's pumping ability is compromised. Inotropic agents do not decrease heart rate, increase conduction time, or increase heart rate; their primary action is to enhance the heart's contractility.
Increased intracranial pressure can cause which of the following?
- A. seizure
- B. nausea
- C. vomiting
- D. all of the above
Correct Answer: D
Rationale: Increased intracranial pressure (ICP) can cause a variety of symptoms, including seizures, nausea, and vomiting. When the pressure inside the skull rises, it can put pressure on the brain tissue, leading to changes in normal brain function. Seizures may occur as a result of the altered brain activity. Nausea and vomiting can also be triggered by increased ICP, as the body's natural response to the disturbance in the brain's normal functioning. Therefore, all of the listed options (seizure, nausea, vomiting) can be caused by increased intracranial pressure.