A nurse is preparing to care for a client with bronchiectasis. The nurse should recognize that this client is likely to experience respiratory difficulties related to what pathophysiologic process?

Dilation of bronchi and bronchioles

Intermittent episodes of acute bronchospasm

Alveolar distention and impaired diffusion

Excessive gas exchange in the bronchioles

Answer and Explanation

The Correct Answer is A

A. Dilation of bronchi and bronchioles: Bronchiectasis is characterized by the permanent dilation and damage to the bronchi and bronchioles. This leads to a decrease in the ability of the airways to clear mucus effectively, resulting in chronic inflammation, recurrent infections, and respiratory difficulties.

B. Intermittent episodes of acute bronchospasm: While bronchospasm can occur in some respiratory conditions like asthma, it is not the primary process in bronchiectasis which involves persistent airway dilation rather than bronchospasm.

C. Alveolar distention and impaired diffusion: This describes emphysema, a condition often associated with COPD, where alveoli are damaged. It is not the main issue in bronchiectasis, which primarily affects the bronchi and bronchioles, not the alveoli.

D. Excessive gas exchange in the bronchioles: Bronchiectasis is characterized by impaired gas exchange due to airway damage, not excessive gas exchange, leading to inefficient oxygen exchange because of airway dilation, mucus accumulation, and chronic infections.

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Correct Answer is B

Explanation

A. All visitors from entering the client's room: Restricting visitors entirely is not necessary unless the client is in complete isolation for infection control. Visitors may be allowed with proper hygiene and precautions in place including screening them for illness.

B. Fresh flowers and potted plants in the room: This restriction is appropriate for a client with neutropenia, as fresh flowers and plants can harbor bacteria and fungi, which pose a risk for infection in immunocompromised clients.

C. Oral fluid intake to between meals only: There is no specific restriction for oral fluid intake to only between meals for a client with neutropenia. The focus should be on preventing infections, and fluid intake should be encouraged to maintain hydration.

D. Activities that could result in bleeding: While neutropenic clients need to avoid activities that could increase the risk of bleeding due to low platelet count, this is not the primary focus when planning care for neutropenia. The priority is preventing infection.

A. "Monitor your temperature daily." B. "Apply cold compresses when they have pain." C. "Drink fluids multiple times every day." D. "Restrict outdoor activity to 1 hour per day."

Correct Answer is C

Explanation

A. "Monitor your temperature daily.": While monitoring temperature can be important, it is not the primary focus for a client with sickle cell anemia after an acute crisis. The main concern should be preventing dehydration and maintaining proper hydration.

B. "Apply cold compresses when they have pain.": Cold compresses can constrict blood vessels, potentially worsening pain during a sickle cell crisis. Heat is generally recommended for pain management in sickle cell anemia, as it helps dilate blood vessels and improve blood flow.

C. "Drink fluids multiple times every day.": Proper hydration is essential in sickle cell anemia to prevent dehydration, which can trigger a sickle cell crisis. Drinking fluids regularly helps maintain blood volume and reduces the risk of vaso-occlusion.

D. "Restrict outdoor activity to 1 hour per day.": There are no specific restrictions on outdoor activity unless the client is experiencing symptoms like fatigue or pain. Encouraging moderate activity, while avoiding extreme temperatures and overexertion, is more beneficial than strict time limits.

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A nurse is preparing to care for a client with bronchiectasis. The nurse should recognize that this client is likely to experience respiratory difficulties related to what pathophysiologic process?

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Naxlex Comprehensive Predictor Exams

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