A nurse is assessing a client who has a spinal cord injury with heterotopic ossifications. Which of the following findings should the nurse expect?
Hypertension
Bradycardia
Fecal impaction
Arthralgia
The Correct Answer is D
Choice A Reason:
Hypertension is not typically associated with heterotopic ossifications. However, it may occur in individuals with spinal cord injuries (SCI) due to autonomic dysreflexia, a condition characterized by an exaggerated sympathetic response to stimuli below the level of injury. Autonomic dysreflexia can lead to a sudden increase in blood pressure, which, if left untreated, can result in complications such as stroke or seizure. However, hypertension is not directly related to heterotopic ossifications.
Choice B Reason:
Bradycardia is also not typically associated with heterotopic ossifications. Like hypertension, bradycardia may occur in individuals with SCI due to autonomic dysreflexia. Autonomic dysreflexia can lead to a sudden increase in blood pressure and a reflex bradycardia in response to the increased sympathetic outflow. However, bradycardia is not directly related to heterotopic ossifications.
Choice C Reason:
Fecal impaction is a potential complication of spinal cord injury (SCI) due to impaired bowel function, but it is not directly related to heterotopic ossifications. SCI can disrupt normal bowel motility and result in neurogenic bowel dysfunction, leading to symptoms such as constipation, fecal impaction, and bowel obstruction. However, fecal impaction is not specific to heterotopic ossifications.
Choice D Reason:
Arthralgia is correct. Heterotopic ossifications (HO) involve the abnormal formation of bone in soft tissues around joints, muscles, tendons, or ligaments. When HO occurs around joints, it can lead to symptoms such as pain, swelling, and decreased range of motion, collectively known as arthralgia. Therefore, arthralgia is a common finding associated with heterotopic ossifications in individuals with spinal cord injuries.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
Typical pneumonia is correct. Streptococcus pneumoniae is a common bacterial pathogen that causes typical pneumonia, also known as community-acquired pneumonia (CAP). Typical pneumonia is characterized by an acute onset of symptoms such as fever, productive cough with purulent sputum, chest pain, and difficulty breathing. Streptococcus pneumoniae is one of the most common causes of typical pneumonia, especially in community settings.
Choice B Reason:
Chemical pneumonitis is incorrect. chemical pneumonitis, refers to inflammation of the lung tissue caused by inhalation or aspiration of toxic chemicals, gases, or gastric contents. It is not caused by Streptococcus pneumoniae.
Choice C Reason:
Atypical pneumonia is incorrect. Atypical pneumonia, refers to pneumonia caused by atypical pathogens such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. Atypical pneumonia typically presents with milder symptoms compared to typical pneumonia and may not respond to traditional antibiotics used for typical bacterial pneumonia.
Choice D Reason:
Aspiration pneumonia. Aspiration pneumonia, occurs when foreign material, such as food, saliva, or gastric contents, is aspirated into the lungs, leading to inflammation and infection. While Streptococcus pneumoniae can cause pneumonia in the context of aspiration, it is more commonly associated with typical pneumonia acquired through inhalation of respiratory droplets containing the bacteria.
Correct Answer is B
Explanation
Choice A Reason:
Higher oxygen saturations of 98% to 99% is inappropriate. A pneumothorax involves the presence of air in the pleural space, which can compromise lung function and gas exchange. This compromised lung function typically leads to decreased oxygenation of the blood, resulting in lower oxygen saturations rather than higher saturations.
Choice B Reason:
Lower oxygen saturations of 93% to 94% is appropriate. A pneumothorax disrupts the normal exchange of oxygen and carbon dioxide in the lungs due to partial or complete lung collapse. As a result, the affected lung is unable to adequately oxygenate the blood, leading to lower oxygen saturations, which are indicative of hypoxemia.
Choice C Reason:
Lower energy expenditure is inappropriate. Energy expenditure is not typically affected by a pneumothorax. While the discomfort and respiratory distress associated with a pneumothorax may cause the individual to limit physical activity, there is no direct impact on overall energy expenditure.
Choice D Reason:
Increased lung capacity is inappropriate. A pneumothorax results in partial or complete collapse of the affected lung, reducing lung capacity rather than increasing it. The presence of air in the pleural space creates positive pressure, which can compress the lung and decrease its ability to expand fully during inhalation.
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