A client reports experiencing blurry central vision that has recently worsened. Which pathological process supports the client's subjective report?

Blockage of retinal capillaries causing ischemic damage of the central macular area.

Opaque spoke-like lines developing in the periphery of the lens to the center.

Tears in the retina that detach from the lining of the posterior eyeball.

An increase in intraocular pressure with loss of peripheral vision.

Answer and Explanation

The Correct Answer is A

A) Blockage of retinal capillaries causing ischemic damage of the central macular area:

Correct. Blurry central vision that worsens over time can be indicative of macular ischemia, often caused by blockage of retinal capillaries leading to ischemic damage of the central macular area. This condition can occur in diseases such as diabetic retinopathy or retinal vein occlusion.

B) Opaque spoke-like lines developing in the periphery of the lens to the center:

This description is more characteristic of cataracts, which cause visual disturbances such as glare or halos around lights rather than blurry central vision.

C) Tears in the retina that detach from the lining of the posterior eyeball:

Retinal tears and subsequent detachment can cause visual disturbances, but they typically present as sudden onset of floaters, flashes of light, and a curtain-like shadow over the visual field rather than blurry central vision.

D) An increase in intraocular pressure with loss of peripheral vision:

This description is indicative of glaucoma, which can lead to loss of peripheral vision (visual field defects) rather than blurry central vision. Glaucoma-related visual field loss usually begins peripherally and progresses inward, affecting central vision in later stages.

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Correct Answer is D

Explanation

A) Sensory neuropathy:

Sensory neuropathy, while common in diabetes mellitus, primarily affects sensation in the extremities and can lead to reduced pain perception and protective sensation. While sensory neuropathy can contribute to the development of foot ulcers by reducing the ability to detect trauma or pressure, it is not the primary factor influencing the ability of the ulcer to heal.

B) Hyperlipidemia:

Hyperlipidemia, characterized by elevated levels of lipids (cholesterol and triglycerides) in the blood, is a common comorbidity in diabetes mellitus. It can contribute to the development of atherosclerosis and macrovascular complications such as coronary artery disease and peripheral arterial disease. While macrovascular disease can impair wound healing by reducing blood flow to the affected area, it is not the primary contributing factor to the ability of the ulcer to heal.

C) Ketoacidosis:

Ketoacidosis, a serious complication of uncontrolled diabetes mellitus, results from the accumulation of ketones in the blood, leading to metabolic acidosis. While ketoacidosis can have systemic effects and impair overall health, it is not directly related to the ability of a foot ulcer to heal.

D) Microvascular changes:

Correct. Microvascular changes, such as thickening of the capillary basement membrane and endothelial dysfunction, are hallmark features of diabetes mellitus. These changes lead to impaired microcirculation, reduced oxygen delivery, and compromised nutrient supply to tissues, including the skin and soft tissues of the foot. Poor microvascular perfusion contributes to delayed wound healing and an increased risk of infection in individuals with diabetes mellitus. Addressing microvascular changes is essential for promoting wound healing in diabetic foot ulcers, making it the primary contributing factor to the ability of the ulcer to heal.

A. The drug may be needed to treat a sudden systemic allergic reaction. B. Hypertensive crisis requires immediate treatment to prevent a stroke. C. Hyperglycemia may require cortisol to lower the blood glucose level. D. Stress increases the body's need for additional replacement hormone.

Correct Answer is D

Explanation

A) The drug may be needed to treat a sudden systemic allergic reaction:

While cortisol may play a role in managing allergic reactions by suppressing inflammation, the primary reason for carrying a cortisol kit in Addison's disease is not typically related to managing allergic reactions.

B) Hypertensive crisis requires immediate treatment to prevent a stroke:

Hypertensive crisis may occur in some individuals with Addison's disease due to adrenal insufficiency, but the immediate treatment for this would typically involve fluids and intravenous hydrocortisone rather than carrying a cortisol kit for self-administration.

C) Hyperglycemia may require cortisol to lower the blood glucose level:

Cortisol can indeed influence blood glucose levels, but the need to carry a cortisol kit is primarily related to the management of adrenal insufficiency rather than hyperglycemia alone.

D) Stress increases the body's need for additional replacement hormone:

Correct. Individuals with Addison's disease have insufficient production of cortisol and often also lack aldosterone. During times of stress, such as illness, trauma, or surgery, the body's demand for cortisol increases to help cope with the stress. Inadequate cortisol production during stress can lead to adrenal crisis, a life-threatening condition. Therefore, carrying a cortisol kit allows the individual to promptly administer additional replacement hormone (usually hydrocortisone) during times of stress to prevent adrenal crisis.

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A client reports experiencing blurry central vision that has recently worsened. Which pathological process supports the client's subjective report?

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Explanation

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Correct Answer is D

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