A nurse is caring for a group of clients in a medical unit. Which of the following clients is at the highest risk for developing osmotic cerebral edema?

A client with a decreased potassium level

A client with a decreased serum glucose

A client with an increased hemoglobin A1C

A client with an increased creatinine level

None

Answer and Explanation

The Correct Answer is B

Choice A Reason:

A client with a decreased potassium level is incorrect. Hypokalemia (decreased potassium level) can cause various neurological symptoms, but it doesn't directly lead to osmotic cerebral edema.

Choice B Reason:

When plasma glucose levels are rapidly lowered, an osmotic gradient develops between the brain and plasma, which can lead to cerebral edema. Brain cells pull water from the plasma, resulting in widespread edema.

Choice C Reason:

While HbA1c is an important marker of diabetes control and may indicate poor long-term management, it does not directly relate to the acute metabolic derangements (e.g., rapid osmotic shifts, severity of acidosis) that predispose to cerebral edema in DKA.

Choice D Reason:

A client with an increased creatinine level is incorrect. Elevated creatinine levels typically indicate kidney dysfunction or dehydration, but they don't directly cause osmotic cerebral edema.

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Correct Answer is D

Explanation

Choice A Reason:

Glatiramer acetate is incorrect because it is used in the treatment of multiple sclerosis (MS) to reduce the frequency of relapses and delay disease progression. It is not indicated for spasm-induced incontinence.

Choice B Reason:

Dulaglutide is incorrect because it is a medication used to treat type 2 diabetes by improving blood sugar control. It is not indicated for the treatment of spasm-induced incontinence.

Choice C Reason:

Montelukast sodium is incorrect because it is a leukotriene receptor antagonist primarily used to manage asthma and allergic rhinitis. It is not indicated for the treatment of spasm-induced incontinence.

Choice D Reason:

Oxybutynin is an anticholinergic medication commonly used to treat overactive bladder and urinary incontinence, including spasm-induced incontinence that can occur in individuals with spinal cord injury. It works by relaxing the smooth muscles of the bladder, thereby reducing involuntary contractions that contribute to urinary urgency and incontinence.

A. Hypoxemia due to dead space B. Impaired carbon dioxide elimination due to shunting C. Decreased pulmonary arterial pressure due to ventilation-perfusion (V/Q) mismatch D. Decreased pulmonary compliance due to stiffness

Correct Answer is D

Explanation

Choice A Reason:

Hypoxemia due to dead space is not appropriate. Dead space refers to areas of the lung where ventilation occurs but no perfusion takes place. In ARDS, hypoxemia typically occurs due to ventilation-perfusion (V/Q) mismatch and shunting rather than dead space.

Choice B Reason:

Impaired carbon dioxide elimination due to shunting is not appropriate. Shunting occurs when blood bypasses ventilated alveoli, leading to inadequate gas exchange. In ARDS, shunting contributes to hypoxemia, but it doesn't directly impair carbon dioxide elimination.

Choice C Reason:

Decreased pulmonary arterial pressure due to ventilation-perfusion (V/Q) mismatch is incorrect. V/Q mismatch occurs when ventilation and perfusion are mismatched in different areas of the lung. This leads to areas of low ventilation (dead space) and areas of low perfusion (shunting). V/Q mismatch contributes to hypoxemia in ARDS but does not typically lead to decreased pulmonary arterial pressure.

Choice D Reason:

Decreased pulmonary compliance due to stiffness is correct. This is a characteristic feature of ARDS. The inflammation and damage to the alveoli cause them to become stiff, reducing pulmonary compliance and impairing lung expansion during ventilation.

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A nurse is caring for a group of clients in a medical unit. Which of the following clients is at the highest risk for developing osmotic cerebral edema?

Nursing Test Bank

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