A nurse is caring for a client who has a pulmonary embolism. The nurse should identify that the release of inflammatory mediators leads to which of the following pathologic findings?
Decreased pulmonary vascular resistance
Hypercapnia
Hypoventilation
Respiratory alkalosis
The Correct Answer is D
Correct answer: D
Choice A Reason:
Decreased pulmonary vascular resistance is incorrect. Inflammatory mediators released in response to a pulmonary embolism can lead to vasoconstriction and increased pulmonary vascular resistance. This is part of the body's response to redirect blood flow away from the affected area of the lung and maintain adequate perfusion to other areas.
Choice B Reason:
Hypercapnia is incorrect. Hypercapnia refers to elevated levels of carbon dioxide (CO2) in the blood. Hypocapnia usually is present with embolism; hypercapnia, on the other hand, is rare.
Choice C Reason:
Hypoventilation is incorrect. Hypoventilation occurs when there is inadequate ventilation of the lungs relative to metabolic demands. In the context of a pulmonary embolism, hypoventilation can occur due to factors such as pain, respiratory muscle fatigue, or impaired gas exchange, all of which can be influenced by the release of inflammatory mediators.
Choice D Reason:
Respiratory alkalosis is correct. In response to the blockage and the resulting inflammation, the body often increases the respiratory rate as a compensatory mechanism to maintain adequate oxygen levels and remove carbon dioxide. Due to the increased breathing rate, there is excessive exhalation of carbon dioxide, leading to a decrease in the partial pressure of CO2 in the blood. This results in an increase in blood pH, causing respiratory alkalosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D","E"]
Explanation
Choice A Reason:
Paresthesia is appropriate. Paresthesia, or abnormal sensations such as tingling, numbness, or burning, is a common neurological symptom in individuals with multiple sclerosis. It results from damage to the nerves or disruption of nerve signals in the central nervous system.
Choice B Reason:
Nausea and vomiting is inappropriate. While nausea and vomiting can occur in individuals with multiple sclerosis, they are not considered hallmark symptoms of the disease. These symptoms may be associated with other factors such as medications, autonomic dysfunction, or complications such as urinary tract infections.
Choice C Reason:
Dysphagia is appropriate. Dysphagia, or difficulty swallowing, is a common symptom in individuals with multiple sclerosis, particularly as the disease progresses. It can result from damage to the nerves that control swallowing muscles or from impaired coordination of swallowing reflexes.
Choice D Reason:
Spasticity is appropriate. Spasticity, or muscle stiffness and involuntary muscle contractions, is a common symptom in individuals with multiple sclerosis. It occurs due to damage to the nerve fibers that control muscle movement and can lead to difficulty with movement, walking, and muscle control.
Choice E Reason:
Vertigo is appropriate. Vertigo, or the sensation of spinning or dizziness, can occur in individuals with multiple sclerosis, particularly if lesions develop in areas of the brain involved in balance and coordination.
Correct Answer is A
Explanation
Choice A Reason:
"You must experiment with your body to find out what stimulation is enjoyable after your injury." This statement encourages the client to explore their body and discover what types of sexual stimulation are enjoyable and pleasurable for them post-injury. It promotes self-discovery and empowerment in sexual expression, which can be important for sexual satisfaction and intimacy.
Choice B Reason:
"You will not be able to have an intimate relationship with anyone after a spinal cord injury." This statement is incorrect and defeatist. It can create unnecessary feelings of hopelessness and despair in the client. Individuals with spinal cord injuries can still have intimate relationships and engage in sexual activity with partners, albeit with potential adjustments or accommodations.
Choice C Reason:
"You should not feel undesirable after your injury. You are still nice-looking. “While it's important to address body image concerns and reassure the client about their physical appearance, this statement may not directly address sexual stimulation or intimacy. However, it can help promote self-confidence and positive self-esteem, which are important aspects of sexuality and relationships.
Choice D Reason:
"Clients who have a spinal cord injury are not aroused by touch around the groin area." This statement is inaccurate and dismissive of the individual's potential for sexual arousal and pleasure. Sensation and arousal can vary among individuals with spinal cord injuries, and touch around the groin area may still be arousing for some individuals, depending on the level and extent of injury.
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