A nurse in a provider's office is assessing a client.
The nurse should identify that which of the following findings are manifestations of pulmonary tuberculosis? (Select all that apply.)

Flushed cheeks.

Night sweats.

Weight gain.

Low-grade fever.

Blood in the sputum.

Answer and Explanation

Correct Answer : B,D,E

Choice A rationale

Flushed cheeks are typically associated with conditions causing vasodilation or fever, such as infections or inflammatory responses. While a fever can occur in tuberculosis, flushed cheeks are not a primary or specific manifestation of pulmonary tuberculosis. The pallor often seen in chronic illnesses like TB is due to anemia.

Choice B rationale

Night sweats in pulmonary tuberculosis result from the body's febrile response to the chronic infection. The hypothalamus attempts to regulate body temperature, leading to peripheral vasodilation and diaphoresis, particularly during the nighttime hours when metabolic rates can shift. This is a common systemic symptom.

Choice C rationale

Weight gain is not a manifestation of pulmonary tuberculosis. Instead, clients with active tuberculosis often experience significant weight loss, known as "consumption," due to the chronic inflammatory state, increased metabolic demands, and anorexia caused by the infection and systemic cytokine release.

Choice D rationale

A low-grade fever is a common systemic manifestation of pulmonary tuberculosis. This persistent elevation in body temperature, often occurring in the afternoon or evening, is a result of the inflammatory response triggered by the Mycobacterium tuberculosis infection and the release of pyrogens.

Choice E rationale

Blood in the sputum, or hemoptysis, is a significant manifestation of pulmonary tuberculosis. It results from the erosion of blood vessels within the lung parenchyma by the granulomatous inflammation and cavitation characteristic of the disease, leading to bleeding into the airways.

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Correct Answer is C

Explanation

Choice A rationale

Restricting fluid intake in clients with COPD can lead to thickened secretions, making them more difficult to expectorate. Adequate hydration (typically 2-3 liters per day unless contraindicated) is crucial for maintaining thin, mobile respiratory secretions, which facilitates mucociliary clearance and reduces the risk of mucus plugging and subsequent exacerbations. This restriction would hinder respiratory hygiene.

Choice B rationale

Clients with COPD often experience increased metabolic demands due to the effort of breathing and may be at risk for malnutrition and muscle wasting. A low-protein diet would be detrimental, as protein is essential for maintaining respiratory muscle strength, tissue repair, and immune function. A high-protein, high-calorie diet is often recommended to support their nutritional status and overall health.

Choice C rationale

Pursed-lip breathing is a technique that helps clients with COPD by increasing intrabronchial pressure, which prevents premature airway collapse during exhalation, particularly in those with emphysema. This prolongs exhalation, improves gas exchange by allowing more complete emptying of the lungs, reduces air trapping, and can alleviate dyspnea, improving ventilatory efficiency.

Choice D rationale

For clients with COPD, exercising and engaging in activities during early-morning hours can be problematic. This is often the time when respiratory secretions are most abundant and tenacious due to nocturnal accumulation. Engaging in strenuous activity then can exacerbate dyspnea and increase the risk of bronchospasm or fatigue, making later parts of the day often more suitable for activity.

A. Nitroglycerin. B. Carvedilol. C. Metformin. D. Atorvastatin.

Correct Answer is C

Explanation

Choice A rationale

Nitroglycerin is a vasodilator used for angina and does not directly interact with contrast media to cause acute kidney injury. Its primary mechanism involves nitric oxide release, leading to smooth muscle relaxation and improved blood flow, unrelated to renal clearance of contrast.

Choice B rationale

Carvedilol is a beta-blocker that primarily affects heart rate and blood pressure. It does not have a direct interaction with iodinated contrast material that specifically increases the risk of acute kidney injury; its metabolism and excretion pathways do not significantly involve competitive renal mechanisms.

Choice C rationale

Metformin, an oral hypoglycemic agent, interacts with iodinated contrast material. In the presence of acute kidney injury induced by the contrast, metformin can accumulate, leading to lactic acidosis. This risk is due to its renal excretion and interference with mitochondrial respiration.

Choice D rationale

Atorvastatin is a statin used for lipid lowering. It primarily undergoes hepatic metabolism and does not have a known significant interaction with iodinated contrast media that predisposes clients to acute kidney injury. Its mechanism of action is unrelated to renal elimination or nephrotoxicity with contrast.

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A nurse in a provider's office is assessing a client.
The nurse should identify that which of the following findings are manifestations of pulmonary tuberculosis? (Select all that apply.)