A patient is severely dehydrated from vomiting and diarrhea causing his or her blood to become hypertonic. What effects does the nurse expect this will have on the red blood cells
The blood cells will migrate to the bone marrow
the red cells will precipitate out of circulation
They will swell and eventually rupture
The cells will shrink and shrivel, decreasing their oxygen-carrying ability
The Correct Answer is D
A) The blood cells will migrate to the bone marrow:
While the bone marrow is responsible for producing red blood cells, dehydration and hypertonicity of the blood would not cause the red blood cells to migrate to the bone marrow. Migration of blood cells typically refers to white blood cells moving toward sites of infection or inflammation, not a response to dehydration.
B) The red cells will precipitate out of circulation:
Red blood cells do not precipitate out of circulation due to dehydration or hypertonic conditions. Instead, dehydration causes a shift in water balance that leads to changes in the shape and function of the red blood cells. Precipitation of cells is not a physiological response in this context.
C) They will swell and eventually rupture:
In conditions of hypertonicity, where the concentration of solutes (such as sodium) in the blood is higher than normal, red blood cells actually shrink, not swell. When blood is hypertonic, water moves out of the red blood cells into the extracellular space to balance the osmotic pressure, leading to cell shrinkage. Cells only swell in hypotonic conditions, when water moves into the cell.
D) The cells will shrink and shrivel, decreasing their oxygen-carrying ability:
When the body becomes dehydrated, the blood becomes hypertonic (more concentrated), leading to a shift of water out of the red blood cells to try to balance the osmotic gradient. As a result, the red blood cells shrink and shrivel. This shrinkage can impair their ability to carry oxygen effectively, as the cells may become more rigid and less flexible, making it difficult for them to navigate through small blood vessels and perform gas exchange in the lungs and tissues.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) A patient with hypotension:
Patients with hypotension may have reduced blood flow to organs, which could potentially decrease the absorption and effectiveness of many medications, including opioids. As a result, the need for a higher dose is not typical. Instead, careful dosing and monitoring are required to avoid further lowering blood pressure, which could lead to more complications.
B) A patient with a concussion:
Concussions affect the brain and can lead to symptoms like dizziness, confusion, or nausea, which may alter how medications are metabolized or tolerated. However, a concussion does not typically require higher opioid doses. In fact, opioids should be used cautiously in such patients due to the risk of exacerbating neurological symptoms or respiratory depression.
C) A patient 3 days after surgery:
Patients recovering from surgery may require pain management, but the opioid dose typically adjusts based on their pain levels and recovery stage. While some patients may still need opioids for pain control, they may not require higher-than-expected doses. Over time, doses are often tapered as healing progresses, and pain lessens.
D) A patient with cancer:
Cancer patients, particularly those with advanced stages or chronic pain, may develop increased opioid tolerance. This means that over time, they may require higher doses to achieve the same level of pain relief. This phenomenon is known as "opioid tolerance," where the body becomes less responsive to the drug, necessitating dose adjustments.
Correct Answer is C
Explanation
A) Excessive salivation: Neostigmine (Prostigmin) is a cholinesterase inhibitor, which works by increasing the levels of acetylcholine at neuromuscular junctions. If a dose is missed, excessive salivation can be a side effect of too much acetylcholine activity, but it is not the most immediate symptom in this case. Muscle weakness is a more direct consequence of a missed dose.
B) Respiratory paralysis: While respiratory weakness or paralysis can occur in myasthenia gravis, it is usually associated with a severe form of the disease or if the patient is in a myasthenic crisis. A single missed dose of neostigmine typically does not result in respiratory failure unless the patient is already in a very fragile state.
C) Muscle weakness: Neostigmine helps to improve neuromuscular transmission by inhibiting the breakdown of acetylcholine, which is crucial for muscle contraction. A missed dose would directly lead to a reduction in acetylcholine levels, exacerbating the characteristic muscle weakness of myasthenia gravis. Muscle weakness is the most anticipated symptom when neostigmine is not administered on time.
D) Muscle spasms: Muscle spasms are typically not a symptom of missed neostigmine therapy. Instead, muscle weakness occurs due to impaired neuromuscular transmission. Spasms might occur if there is significant overstimulation of the muscles, but this is more associated with electrolyte imbalances or other neuromuscular issues
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