A client with COPD develops a barrel chest over time. What is the primary reason for this change?

Decreased lung compliance

Pneumonia

Air trapping and hyperinflation of the lungs

Increased pulmonary blood pressure

Answer and Explanation

The Correct Answer is C

A. Decreased lung compliance – While lung compliance may be affected in COPD, it is not the direct cause of barrel chest.
B. Pneumonia – Pneumonia is an acute infection and does not cause the chronic structural change of barrel chest.
C. Air trapping and hyperinflation of the lungs – In COPD, especially emphysema, chronic air trapping and lung hyperinflation lead to an increase in the anterior-posterior diameter of the chest, resulting in a barrel-shaped chest.
D. Increased pulmonary blood pressure – While pulmonary hypertension can occur with advanced COPD, it is not responsible for the barrel chest appearance.

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Correct Answer is B

Explanation

A. Respiratory alkalosis – Respiratory alkalosis is characterized by elevated pH (>7.45) and low PaCO₂ (<35 mm Hg) due to hyperventilation.
B. Respiratory acidosis – The pH is low (7.30) indicating acidosis, and the PaCO₂ is elevated (49 mm Hg), indicating that the cause is respiratory (CO₂ retention due to hypoventilation). The HCO₃ is normal (23 mEq/L), which supports that the cause is not metabolic.
C. Metabolic alkalosis – This would show an elevated pH (>7.45) and elevated HCO₃ (>28 mEq/L), which is not present here.
D. Metabolic acidosis – Metabolic acidosis is indicated by low pH and low HCO₃ (<21 mEq/L), which is not the case in these ABG values.

A. The client has become addicted to the medication. B. The client is experiencing episodes of confusion. C. The client developed a tolerance to the medication. D. The client not been taking the medication properly.

Correct Answer is C

Explanation

A. The client has become addicted to the medication. – Addiction involves compulsive drug-seeking behavior and use despite harm. In a hospice setting, tolerance and dependence are expected and should not be confused with addiction.
B. The client is experiencing episodes of confusion. – While morphine may cause confusion, especially in elderly or very ill clients, this does not explain the need for a higher dose for pain relief.
C. The client developed a tolerance to the medication. – Tolerance occurs when the body becomes accustomed to a drug, requiring higher doses to achieve the same effect. This is common with long-term opioid use for chronic or terminal pain.
D. The client has not been taking the medication properly. – There is no indication of noncompliance. The need for a higher dose is more accurately attributed to tolerance, especially in terminal illness.

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A client with COPD develops a barrel chest over time. What is the primary reason for this change?

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Naxlex Comprehensive Predictor Exams

Based on your patient's ABG's what acid-base imbalance is present? pH 7.30 HCO3 23 PaCO2 49.

Correct Answer is B

Explanation

A hospice nurse is caring for a client who has terminal cancer and takes PO morphine for pain relief. The client reports that he had to increase the dose of morphine this week to obtain pain relief. Which of the following scenarios should the nurse document as the explanation for this situation?

Correct Answer is C

Explanation

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