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
None
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
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.
Correct Answer is B
Explanation
Choice A Reason:
Flail chest is incorrect. Flail chest is a condition characterized by multiple rib fractures, causing instability in the chest wall. While it can lead to respiratory distress, it doesn't directly cause ventilation-perfusion (V/Q) mismatch. Instead, it impairs the mechanics of breathing by compromising chest wall integrity.
Choice B Reason:
Emphysema is a chronic obstructive pulmonary disease (COPD) where the alveolar walls are destroyed, leading to a loss of surface area for gas exchange. This results in areas of the lungs that are well-perfused but poorly ventilated, causing a V/Q mismatch. The damage to alveoli leads to impaired ventilation, while blood flow may still be adequate, leading to hypoxemia (low oxygen levels in the blood).
Choice C Reason:
CHF primarily affects the heart’s ability to pump blood effectively, leading to pulmonary congestion and impaired gas exchange. However, it typically causes diffusion defects rather than a direct ventilation-perfusion mismatch. V/Q mismatch may occur secondary to pulmonary edema, but it’s not the primary mechanism of respiratory failure in CHF.
Choice D Reason:
Guillain-Barré syndrome is incorrect. Guillain-Barré syndrome (GBS) is a neurological disorder that affects the peripheral nervous system, leading to muscle weakness and paralysis. While respiratory muscle weakness can occur in GBS, it doesn't directly cause ventilation-perfusion (V/Q) mismatch. GBS primarily affects nerve function rather than lung function.
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