A nurse is caring for a client 1 day postoperative who has developed atelectasis. Which of the following manifestations is an expected finding for this condition?
Hypoxemia
Apnea
Pleural effusion
Dysphagia
The Correct Answer is A
A) Hypoxemia:
This is the correct answer. Atelectasis, which is the collapse or incomplete inflation of the lung, can lead to impaired gas exchange and subsequent hypoxemia. As lung volume decreases due to collapse, ventilation-perfusion (V/Q) mismatch occurs, resulting in decreased oxygenation of arterial blood. Hypoxemia is a common finding in individuals with atelectasis and may manifest as decreased oxygen saturation levels on pulse oximetry or arterial blood gas analysis.
B) Apnea:
Apnea, defined as the cessation of breathing, is not typically associated with atelectasis. While atelectasis can contribute to respiratory compromise and may result in respiratory distress, including tachypnea or increased work of breathing, it does not usually lead to complete cessation of breathing.
C) Pleural effusion:
A pleural effusion is the accumulation of fluid in the pleural space surrounding the lungs. While pleural effusion may occur concurrently with atelectasis, it is not an expected finding specifically associated with atelectasis itself. Pleural effusion may cause respiratory symptoms such as dyspnea or chest pain but is not a primary manifestation of atelectasis.
D) Dysphagia:
Dysphagia, or difficulty swallowing, is unrelated to atelectasis. While dysphagia can occur as a result of various conditions affecting the esophagus or neurological control of swallowing, it is not a typical manifestation of atelectasis. Atelectasis primarily affects the lungs and respiratory function rather than swallowing function.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) Decreased bowel sounds:
While diarrhea can lead to changes in bowel function, such as increased frequency and urgency, it typically does not cause decreased bowel sounds. In fact, hyperactive bowel sounds may be present in some cases of diarrhea due to increased gastrointestinal motility and peristalsis as the body attempts to expel excess stool.
B) Dehydration:
This is the correct answer. Diarrhea can result in fluid and electrolyte losses, leading to dehydration if not adequately managed. Common symptoms of dehydration include increased thirst, dry mucous membranes, decreased urine output, dark urine, fatigue, weakness, and dizziness. In severe cases, dehydration can lead to hypovolemic shock, a life-threatening condition requiring immediate medical attention.
C) Rigid abdomen:
While abdominal discomfort and cramping are common symptoms of diarrhea, a rigid abdomen is not typically associated with uncomplicated cases of diarrhea. However, severe abdominal pain, distention, and rigidity may indicate underlying complications such as bowel obstruction or peritonitis, which require urgent medical evaluation.
D) Hypothermia:
Hypothermia, or abnormally low body temperature, is not a typical finding in clients with diarrhea. In fact, diarrhea is more commonly associated with fluid and electrolyte imbalances that can lead to hyperthermia (elevated body temperature) due to dehydration and inflammatory responses. However, hypothermia may occur in severe cases of dehydration or sepsis, but it is not a direct consequence of diarrhea itself.
Correct Answer is ["100"]
Explanation
We are given the following information:
Medication: Ticarcillin/clavulanate 3.1 g
Administration route: Intermittent IV bolus over 30 minutes
Available solution: Ticarcillin/clavulanate 3.1 g in 50 mL 0.9% sodium chloride (NSS)
However, the IV pump controls the rate of delivery over time (usually in hours). An intermittent bolus means the medication is infused all at once over a shorter period (30 minutes in this case).
The pump rate calculation here focuses on the total volume of the available solution containing the medication to be delivered, not necessarily on the medication amount itself.
Therefore, we need to find the rate at which the total volume of 50 mL solution should be delivered over 30 minutes.
Conversion is necessary because pump rates are typically set in hours (hr).
Time (hours) = 30 minutes / 60 minutes/hour = 0.5 hours
Now, calculate the flow rate:
Flow rate (mL/hr) = Total volume (mL) / Infusion time (hours)
Flow rate (mL/hr) = 50 mL / 0.5 hours = 100 mL/hr
Round to the nearest whole number as requested.
Therefore, the nurse should set the pump to deliver approximately 100 mL/hr. This ensures the total 50 mL solution containing the 3.1 g of ticarcillin/clavulanate is delivered over the intended 30-minute period.
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