A nurse is caring for a client who has developed cor pulmonale secondary to an acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following manifestations is caused by corpulmonale?

Barrel chest

Clubbing of the fingers

Destruction of the alveoli

Peripheral edema

Answer and Explanation

The Correct Answer is D

A.   Barrel chest is a physical finding commonly associated with COPD due to hyperinflation of the lungs. It results from chronic air trapping and enlargement of the chest. While barrel chest is not directly caused by cor pulmonale, it is a characteristic feature of advanced COPD.
B.   Clubbing of the fingers is not directly caused by cor pulmonale. It is typically associated with chronic hypoxia, which can occur in advanced lung diseases like COPD. Clubbing involves changes in the shape and texture of the nails and fingertips due to chronic lack of oxygen in the blood.
C.   Destruction of the alveoli is a hallmark of emphysema, which is a type of COPD. Emphysema leads to loss of lung tissue elasticity and surface area, contributing to chronic airflow limitation. While emphysema is a risk factor for developing cor pulmonale, destruction of alveoli itself does not directly cause cor pulmonale.
D.   Peripheral edema is a manifestation caused by cor pulmonale. When the right side of the heart fails (cor pulmonale), it leads to increased pressure in the pulmonary circulation, which can eventually cause fluid to leak out into the tissues, resulting in peripheral edema. This is a consequence of the right heart's inability to effectively pump blood forward due to pulmonary hypertension and subsequent right ventricular failure.

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Correct Answer is B

Explanation

A. Fluticasone is an inhaled corticosteroid used primarily for maintenance therapy in COPD and asthma. It helps reduce airway inflammation and prevent exacerbations but is not used for immediate relief of acute symptoms such as bronchospasm or sudden shortness of breath.
B. Fluticasone, like other corticosteroids delivered by inhalation, can increase the risk of oral thrush (candidiasis) due to its local immunosuppressive effects in the mouth. It's important for clients to monitor their oral cavity regularly for signs such as white patches or soreness. Including this instruction is crucial to detect thrush early so that appropriate treatment can be initiated if necessary.
C. Monitoring heart rate is not specifically necessary before each dose of fluticasone. Fluticasone is not known to cause significant cardiovascular effects such as changes in heart rate. Heart rate monitoring may be more relevant for medications that can affect cardiovascular function or in clients with pre- existing cardiac conditions.

D. Fluticasone should be used regularly as prescribed for maintenance therapy to control airway inflammation and prevent exacerbations in COPD. Skipping doses, even if symptoms are not present, can lead to inadequate control of the disease and potential worsening of symptoms over time.

A. Atrial flutter B. Atrial fibrillation C. Unstable angina D. Premature atrial contractions (PACS)

Correct Answer is B

Explanation

A. Atrial flutter typically presents with a regular atrial rate (usually around 250-350 beats per minute) and a characteristic "sawtooth" pattern of flutter waves (F-waves) on the ECG. This condition would not present with irregular ventricular rates and is less likely based on the ECG findings described.

B. Atrial fibrillation is identified by an irregularly irregular rhythm and the absence of P-waves on the ECG, which is replaced by erratic activity.
C. Unstable angina presents with chest pain or discomfort due to reduced blood flow to the heart muscles, usually related to atherosclerotic plaque rupture or erosion. It does not cause the ECG findings described (absence of P-waves and irregular ventricular rate).
D. PACs are early atrial depolarizations that can cause palpitations but do not typically result in the absence of P-waves or irregular ventricular rates as described in the scenario.

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A nurse is caring for a client who has developed cor pulmonale secondary to an acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following manifestations is caused by corpulmonale?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing education to a client who has chronic obstructive pulmonary disease and will begin using fluticasone by metered dose inhaler every 12 hours for maintenance. Which of the following instructions should the nurse include?

Correct Answer is B

Explanation

A client in an urgent care clinic is complaining of heart palpitations, fatigue, and shortness of breath. A 12-lead electrocardiogram (ECG) shows no discernable P-waves, and an irregular ventricular rate. The nurse should understand that this finding represents which of the following conditions?

Correct Answer is B

Explanation

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