A nurse is caring for a client who has chronic respiratory acidosis due to chronic obstructive pulmonary disease (COPD). Which of the following findings should the nurse expect with this client?

Osteoporosis

Polyuria

Anxiety and depression

Delirium

Answer and Explanation

The Correct Answer is D

Choice A Reason:

Osteoporosis is inappropriate. Chronic respiratory acidosis can lead to osteoporosis over time due to several factors, including chronic hypoxemia, which can affect bone metabolism and lead to bone loss.

Choice B Reason:

Polyuria is inappropriate. Polyuria, or increased urination, is not typically associated with chronic respiratory acidosis. In fact, respiratory acidosis tends to cause retention of bicarbonate ions, which can lead to compensatory metabolic alkalosis and decreased urine output.

Choice C Reason:

Anxiety and depression is inappropriate. Chronic respiratory acidosis can lead to symptoms such as lethargy, confusion, and decreased mental acuity due to the effects of elevated CO2 levels on the central nervous system. While anxiety and depression are not direct consequences of chronic respiratory acidosis, individuals with COPD may experience anxiety and depression as a result of their chronic respiratory condition.

Choice D Reason:

Delirium is correct. Delirium, characterized by an acute change in mental status, confusion, and altered consciousness, can occur in severe cases of chronic respiratory acidosis, especially during acute exacerbations. Elevated CO2 levels can affect brain function and lead to symptoms of delirium.

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Correct Answer is C

Explanation

Choice A Reason:

Placing the client on clear liquids might not be appropriate in this situation because absent bowel sounds in the lower abdominal quadrants could indicate a more serious gastrointestinal issue such as ileus or bowel obstruction. Clear liquids may exacerbate these conditions and are not sufficient to address the underlying problem. Therefore, this option is not recommended until the cause of absent bowel sounds is identified and addressed.

Choice B Reason:

Performing a hemoccult blood test is not directly relevant to the situation described. Hemoccult tests are used to detect occult (hidden) blood in stool, which can be indicative of gastrointestinal bleeding. While it's important to assess for gastrointestinal bleeding in some cases, absent bowel sounds in the lower abdominal quadrants suggest a more immediate concern related to gastrointestinal motility rather than bleeding. Therefore, this option is not the most appropriate action at this time.

Choice C Reason:

Inserting a nasogastric tube is the most appropriate action in this scenario. Absent bowel sounds in a client with a spinal cord injury can indicate neurogenic bowel dysfunction, which may lead to abdominal distention and discomfort. Inserting a nasogastric tube can help decompress the stomach and intestines, reducing the risk of complications such as aspiration and providing relief from discomfort. It can also help manage gastrointestinal complications until further assessment and interventions can be implemented.

Choice D Reason:

Forcing the intake of fluids may not be appropriate without further assessment and could potentially worsen the client's condition if there is an underlying gastrointestinal issue leading to absent bowel sounds. Additionally, forcing fluids may not address the potential issue of gastrointestinal bleeding.

A. "Antibiotics are seldom prescribed." B. "Maybe you can borrow some money to get the medicine." C. "Your health care provider may be able to give you free samples." D. "Where did your money go this month?"

Correct Answer is C

Explanation

Choice A Reason:

"Antibiotics are seldom prescribed," is not an appropriate response as it does not address the client's concern about the cost of medication and may also be inaccurate depending on the specific diagnosis and treatment plan.

Choice B Reason:

"Maybe you can borrow some money to get the medicine," may not be feasible for the client and can also be perceived as insensitive or dismissive of their financial situation.

Choice C Reason:

"Your health care provider may be able to give you free samples. “offers a compassionate and practical solution to the client's concern about the cost of medication. Many healthcare providers have access to free medication samples provided by pharmaceutical companies, which they can offer to patients who have financial difficulties.

Choice D Reason:

"Where did your money go this month?" is judgmental and inappropriate. It may make the client feel ashamed or defensive about their financial situation, which is not conducive to a therapeutic nurse-client relationship. Additionally, the client's financial decisions are not relevant to their need for medical treatment.

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A nurse is caring for a client who has chronic respiratory acidosis due to chronic obstructive pulmonary disease (COPD). Which of the following findings should the nurse expect with this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Explanation

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