A client is diagnosed with a large pulmonary embolism. When explaining what has happened to cause respiratory distress to the client's family, which information will the nurse include?
Thick secretions in your small airways are blocking air from moving into the small air sacs in your lungs
Blood flow through some areas of your lungs is decreased even though you are taking adequate breaths
Large areas of your lungs are getting good blood flow but are not receiving enough air to fill the small air sacs
Oxygen transfer into the blood is slow because of thick membranes between the small air sacs and the lung circulation
The Correct Answer is B
Choice A reason: Thick secretions blocking airways are characteristic of conditions like chronic obstructive pulmonary disease or pneumonia, not pulmonary embolism. In pulmonary embolism, a clot obstructs pulmonary arteries, reducing blood flow to alveoli, not airflow. This leads to ventilation-perfusion mismatch, causing hypoxemia despite adequate breathing, making this explanation incorrect.
Choice B reason: A pulmonary embolism blocks pulmonary arteries, reducing blood flow to certain lung regions despite normal ventilation. This creates a ventilation-perfusion mismatch, where alveoli are ventilated but not perfused, leading to hypoxemia and respiratory distress. This is the primary mechanism of pulmonary embolism, making it the correct explanation for the family.
Choice C reason: This option suggests adequate blood flow but inadequate air to alveoli, which describes conditions like airway obstruction or atelectasis, not pulmonary embolism. In pulmonary embolism, the issue is reduced blood flow due to arterial obstruction, not insufficient air reaching alveoli, as breathing remains adequate, making this incorrect.
Choice D reason: Thickened alveolar-capillary membranes, impairing oxygen diffusion, occur in conditions like pulmonary fibrosis or edema, not pulmonary embolism. In pulmonary embolism, the primary issue is vascular obstruction, not membrane thickness, leading to reduced perfusion and hypoxemia despite normal alveolar structure, rendering this explanation scientifically inaccurate.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Antibiotic therapy is appropriate for infections causing respiratory failure, such as pneumonia, but it addresses the underlying cause, not the immediate hypoxemia. Acute hypoxemic respiratory failure requires urgent correction of low oxygen levels to prevent organ damage, making antibiotics a secondary intervention compared to oxygen delivery.
Choice B reason: Bronchodilators treat bronchospasm in conditions like asthma or COPD, improving airflow. In acute hypoxemic respiratory failure, the primary issue is impaired oxygen diffusion, often due to alveolar damage or shunting, not bronchoconstriction. Bronchodilators may help specific cases but are not the first-line intervention for hypoxemia.
Choice C reason: Acute hypoxemic respiratory failure is defined by low PaO2 (<60 mmHg) despite adequate ventilation, often due to shunting or diffusion defects. Providing supplemental oxygen immediately increases alveolar oxygen levels, improving arterial oxygenation and preventing tissue hypoxia. This is the priority intervention to stabilize the patient before addressing underlying causes.
Choice D reason: Diuretics reduce fluid overload in conditions like pulmonary edema, which can contribute to hypoxemic respiratory failure. However, they do not directly correct hypoxemia and may take hours to act. Supplemental oxygen addresses the immediate threat of low oxygen levels, making diuretics a secondary consideration in acute management.
Correct Answer is D
Explanation
Choice A reason: Discomfort during dialysate inflow is common in peritoneal dialysis due to the rapid introduction of fluid into the peritoneal cavity, stretching the peritoneum. It is usually transient and not a sign of serious complications like infection. Immediate reporting is unnecessary unless severe or persistent, as it does not indicate an acute emergency.
Choice B reason: Slight abdominal pressure during peritoneal dialysis is normal due to the presence of dialysate in the peritoneal cavity. It does not indicate a serious complication like infection or peritonitis. This sensation typically resolves and does not require immediate reporting unless accompanied by severe pain or other alarming symptoms.
Choice C reason: Yellow dialysate outflow is typically normal, as dialysate may appear slightly yellow due to the presence of fibrin or minor hemolysis. It does not indicate infection or a life-threatening issue. Clear or slightly yellow outflow is expected, unlike purulent outflow, which signals infection and requires urgent attention.
Choice D reason: Purulent dialysate outflow indicates peritonitis, a serious complication of peritoneal dialysis caused by bacterial infection in the peritoneal cavity. This presents with cloudy, pus-filled effluent, often with fever or abdominal pain. Immediate reporting is critical to initiate antibiotics and prevent sepsis, making this the most urgent finding to address.
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