A nurse is assessing the pain status of a group of clients. Which of the following findings indicates a client is experiencing referred pain?

A client who has peritonitis reports generalized abdominal pain.

A client who has angina reports substernal chest pain.

A client who has pancreatitis reports pain in the left shoulder.

A client who is postoperative reports incisional pain.

Answer and Explanation

The Correct Answer is C

Referred pain is pain that is felt in a location different from its source due to shared nerve pathways or central nervous system processing. A client who has pancreatitis may experience pain in the left shoulder due to irritation of the diaphragm by pancreatic enzymes or inflammation. This pain is referred from the abdominal cavity to the shoulder through the phrenic nerve.

A client who has peritonitis reports generalized abdominal pain that corresponds to the site of inflammation and infection in the peritoneum. A client who has angina reports substernal chest pain that reflects the ischemia and hypoxia of the myocardium. A client who is postoperative reports incisional pain that is caused by tissue damage and inflammation at the surgical site.

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Correct Answer is B

Explanation

TPN is a form of intravenous nutrition that provides glucose, amino acids, lipids, vitamins, minerals, and electrolytes to clients who cannot eat or absorb nutrients through their gastrointestinal tract. Discontinuing TPN abruptly can cause a sudden drop in blood glucose levels, leading to hypoglycemia .

Hyperglycemia can occur during TPN administration if the glucose infusion rate is too high or if the client has insulin resistance . Diarrhea can occur as a result of infection, bowel ischemia, or intolerance to enteral feeding . Hypertension can occur due to fluid overload, electrolyte imbalance, or vascular complications .

A. Inability to exhale retained carbon dioxide B. Acute loss of alveolar elasticity C. Decreased responsiveness of airways to allergens D. Suppressed bronchiolar inflammatory response

Correct Answer is A

Explanation

An acute asthma attack is a sudden worsening of asthma symptoms, such as coughing, wheezing, tightness in the chest, and difficulty breathing. These symptoms happen because the airways in the lungs become narrow, irritated, swollen, and produce excess mucus.

An asthma attack can be triggered by various factors, such as allergic reactions, respiratory infections, tobacco smoke, cold air, and exercise. These triggers cause the immune system to react and release chemicals that cause inflammation and constriction of the airways.

Based on this information, the best answer to the question is a. Inability to exhale retained carbon dioxide. This is because during an asthma attack, the narrowed airways make it harder to exhale the air from the lungs, which leads to a buildup of carbon dioxide in the blood. This can worsen the symptoms and cause acidosis, a condition where the blood becomes too acidic.

The other options are not correct because:

b. Acute loss of alveolar elasticity is not a cause of asthma attacks, but a consequence of chronic obstructive pulmonary disease (COPD), a different lung condition that involves damage to the alveoli, the tiny air sacs in the lungs.
c. Decreased responsiveness of airways to allergens is not a cause of asthma attacks, but a goal of asthma treatment. Asthma medications aim to reduce the sensitivity and inflammation of the airways to prevent or reduce the frequency and severity of asthma attacks.
d. Suppressed bronchiolar inflammatory response is not a cause of asthma attacks, but a potential side effect of some asthma medications, such as corticosteroids. These drugs can suppress the immune system and increase the risk of infections in the airways.

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A nurse is assessing the pain status of a group of clients. Which of the following findings indicates a client is experiencing referred pain?

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Naxlex Comprehensive Predictor Exams

A nurse is preparing to discontinue long-term total parenteral nutrition (TPN) therapy for a client. The nurse should plan to discontinue the TPN gradually to reduce the risk of which of the following adverse effects?

Correct Answer is B

Explanation

A nurse is caring for a client who is experiencing an acute asthma attack. Which of the following should the nurse identify as a contributing factor to the client's manifestations?

Correct Answer is A

Explanation

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