A nurse is caring for a client who has a tracheostomy.
Drag words from the choices below to fill in each blank in the following sentence.
The client has manifestations of
The Correct Answer is {"dropdown-group-1":"D","dropdown-group-2":"A"}
Rationale:
Hypoxia: The client's decreased oxygen saturation (SaO2) despite oxygen therapy and the presence of respiratory distress (tachypnea, shortness of breath) indicate hypoxia.
Pneumonia: The client's fever, increased respiratory rate, decreased oxygen saturation, and crackles in the lungs are indicative of pneumonia, particularly in the right lower lobe as evidenced by the chest X-ray.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. An intolerance to the feedings might cause discomfort, but it would not typically cause increasing pain, fever, and dyspnea. These symptoms are more indicative of a serious complication.
B. Esophageal perforation with fistula formation into the lung is the most likely cause of these symptoms. A perforation can lead to leakage of gastric contents into the pleural space or mediastinum, causing fever, pain, and respiratory distress. The formation of a fistula between the esophagus and the lung would lead to dyspnea.
C. Extension of the tumor into the aorta is a rare complication that would typically manifest with symptoms related to cardiovascular issues, not gastrointestinal symptoms like fever and dyspnea.
D. Leakage of fluids into the mediastinum is a possible cause of the symptoms, but esophageal perforation with a fistula into the lung is more directly linked to these specific symptoms, especially dyspnea.
Correct Answer is D
Explanation
A. Cheddar cheese contains lactose and is not an ideal choice for a low-lactose diet, as it may cause discomfort in clients who are lactose intolerant.
B. Cottage cheese also contains lactose, though in smaller amounts than some other dairy products, but it is still not the best choice for someone on a low-lactose diet.
C. Low-fat yogurt may contain some lactose, but it also contains probiotics, which can help with digestion and may be tolerated better than other dairy products. However, for someone on a strict low-lactose diet, it may not be the best choice.
D. Soymilk is a non-dairy alternative and is typically lactose-free, making it the best choice for someone on a low-lactose diet. It provides a dairy-free option for those needing to avoid lactose.
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