Choice A rationale:
Hyperventilation is a condition characterized by rapid and deep breathing, leading to excessive removal of carbon dioxide (CO2) from the body. This decrease in CO2 levels actually causes respiratory alkalosis, not respiratory acidosis.
CO2 is a weak acid, and its removal from the blood raises the blood pH, making it more alkaline. Key mechanisms involved in hyperventilation-induced respiratory alkalosis:
Increased alveolar ventilation: Hyperventilation increases the rate at which CO2 is expelled from the lungs, reducing its concentration in the blood.
Shift in the equilibrium of the carbonic acid-bicarbonate buffer system: The reduction in CO2 levels drives the equilibrium towards the formation of bicarbonate ions, further reducing the concentration of hydrogen ions and increasing pH.
Renal compensation: The kidneys respond to respiratory alkalosis by excreting more bicarbonate ions, which helps to normalize the blood pH.
Choice B rationale:
Asthma is a chronic respiratory disease characterized by inflammation and narrowing of the airways. This can lead to impaired ventilation and retention of CO2, which can contribute to respiratory acidosis.
Mechanisms by which asthma can cause respiratory acidosis:
Bronchoconstriction: Narrowed airways impede airflow, making it difficult to expel CO2 from the lungs.
Air trapping: Inflammation and mucus production can lead to air becoming trapped in the lungs, further increasing CO2 levels.
Hypoventilation: Severe asthma attacks can cause respiratory muscle fatigue, leading to a decrease in breathing rate and inadequate CO2 removal.
Choice C rationale:
Chronic obstructive pulmonary disease (COPD) is a group of lung diseases characterized by chronic obstruction of airflow. This obstruction can lead to impaired ventilation and retention of CO2, which can contribute to respiratory acidosis.
Mechanisms by which COPD can cause respiratory acidosis:
Emphysema: Destruction of lung tissue reduces the surface area available for gas exchange, making it difficult to expel CO2. Chronic bronchitis: Inflammation and mucus production in the airways can obstruct airflow and trap CO2 in the lungs.
Hypoventilation: COPD can lead to respiratory muscle fatigue and a decrease in breathing rate, further impairing CO2 removal.
Choice D rationale:
Pulmonary embolism (PE) is a blockage of an artery in the lungs, usually by a blood clot. This can lead to impaired gas exchange and a decrease in oxygen levels in the blood. In severe cases, PE can also cause respiratory acidosis due to inadequate CO2 removal.
Mechanisms by which PE can cause respiratory acidosis:
Ventilation-perfusion mismatch: PE obstructs blood flow to a portion of the lungs, reducing the amount of CO2 that can be removed from those areas.
Hypoxemia: Low oxygen levels in the blood can stimulate the respiratory drive, leading to hyperventilation and CO2 retention.
Right heart failure: PE can strain the right side of the heart, leading to decreased pulmonary blood flow and impaired CO2 removal.

Rationale for Choice A:

Hydroxychloroquine does not typically cause hair loss as a significant side effect. While some anecdotal reports have suggested hair thinning as a possibility, it's not a well-established or common occurrence in clinical studies.

If a patient experiences hair loss while on hydroxychloroquine, it's essential to rule out other potential causes, such as underlying medical conditions, stress, or nutritional deficiencies.

It's also important to note that some individuals may have a personal predisposition to hair loss, and medications can sometimes trigger or exacerbate this issue.

Rationale for Choice B:

Hydroxychloroquine is not known to cause a burst of energy. In fact, some patients may experience fatigue or drowsiness as a side effect.

It's crucial to inform patients about potential side effects to manage expectations and promote adherence to treatment.

If a patient experiences unexpected energy changes while taking hydroxychloroquine, it's essential to report this to their healthcare provider for further evaluation.

Rationale for Choice C:

Hydroxychloroquine is generally recommended to be taken with food or milk to reduce potential gastrointestinal side effects such as nausea and vomiting.

Taking it on an empty stomach could increase the risk of these side effects, which could impact medication adherence and effectiveness.

Rationale for Choice D:

Retinal damage is the most serious adverse effect of hydroxychloroquine. It can lead to irreversible vision loss if not detected and managed early.

Patients taking hydroxychloroquine must undergo regular eye examinations to monitor for any signs of retinal toxicity.

Early detection and prompt discontinuation of the medication can often prevent permanent vision loss.

It's crucial for nurses to educate patients about this potential risk and emphasize the importance of regular eye exams.