A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6 °F, a heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing?

Acute chest syndrome

Pulmonary edema

An exacerbation of asthma

Pneumocystis pneumonia

Answer and Explanation

The Correct Answer is A

Choice A reason: Acute chest syndrome in sickle cell disease presents with fever, tachycardia, tachypnea, and bilateral wheezes, caused by vaso-occlusion in pulmonary vasculature, infection, or fat embolism. This leads to lung injury, hypoxia, and wheezing, matching the patient’s symptoms. It’s a life-threatening complication requiring urgent oxygenation and hydration.

Choice B reason: Pulmonary edema, typically from heart failure, causes crackles, not wheezes, and is less common in sickle cell disease. The patient’s fever, tachycardia, and wheezes suggest a pulmonary vaso-occlusive process like acute chest syndrome, not fluid overload, which is not a primary feature of sickle cell complications.

Choice C reason: An asthma exacerbation could cause wheezes, but the fever and tachycardia suggest a systemic process like acute chest syndrome, common in sickle cell disease. Asthma is not typically associated with fever unless infection is present, and sickle cell patients are more prone to acute chest syndrome.

Choice D reason: Pneumocystis pneumonia, an opportunistic infection, causes fever and respiratory symptoms but typically presents with dry cough and diffuse infiltrates, not wheezes. It’s more common in immunocompromised states like HIV, not sickle cell disease. Acute chest syndrome is more likely given the patient’s history and symptom profile.

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Correct Answer is B

Explanation

Choice A reason: NSTEMI (non-ST-elevation myocardial infarction) is a heart attack caused by coronary artery occlusion, leading to myocardial ischemia. Symptoms include chest pain and elevated cardiac enzymes, not bradycardia, hyponatremia, or altered consciousness. Hypothyroidism does not directly cause NSTEMI, and these symptoms align with metabolic, not cardiac, pathology.

Choice B reason: Myxedema coma is a life-threatening complication of severe hypothyroidism, characterized by bradycardia, hyponatremia, hypotension, altered consciousness, and respiratory depression. Hypothyroidism slows metabolism, leading to fluid retention, low sodium, and reduced cardiac output. These symptoms match the patient’s presentation, making myxedema coma the most likely diagnosis in this scenario.

Choice C reason: SIADH causes hyponatremia due to excessive antidiuretic hormone, leading to water retention. However, it does not typically cause bradycardia, hypotension, or respiratory difficulty. SIADH is not a complication of hypothyroidism, and the patient’s symptoms, including altered consciousness, align more closely with myxedema coma than SIADH’s water imbalance.

Choice D reason: Thyroid storm is a life-threatening hyperthyroidism complication, presenting with tachycardia, hyperthermia, and agitation. The patient’s bradycardia, hypotension, and hyponatremia are opposite to thyroid storm’s hypermetabolic state. Hypothyroidism leads to myxedema coma, not thyroid storm, making this choice inconsistent with the patient’s clinical presentation and lab findings.

A. Redness of the anus B. Stomatitis C. Intestinal inflammation D. Increased body temperature

Correct Answer is D

Explanation

Choice A reason: Redness of the anus is a local response to irritation from frequent diarrhea in gastroenteritis, not a systemic response. Systemic responses involve the whole body, like fever, driven by cytokine release. Anal redness is a localized tissue reaction, not reflective of the broader inflammatory process in this infection.

Choice B reason: Stomatitis, or mouth inflammation, is not a systemic response to gastroenteritis. It may occur in specific infections (e.g., herpes) but is not typical in gastroenteritis, which primarily affects the intestines, causing diarrhea and dehydration. Systemic responses involve fever or leukocytosis, not localized oral inflammation, making this choice incorrect.

Choice C reason: Intestinal inflammation is a local response in gastroenteritis, causing diarrhea and abdominal pain. Systemic responses, like fever, result from cytokines (e.g., IL-1, IL-6) released during infection, affecting the entire body. Intestinal inflammation is the primary pathology, not a systemic effect, so this does not fit the question’s focus.

Choice D reason: Increased body temperature (fever) is a systemic response to gastroenteritis, triggered by cytokines (e.g., IL-1, TNF) released during infection. These signal the hypothalamus to raise body temperature, enhancing immune response. The patient’s feeling of warmth aligns with fever, a common systemic manifestation of inflammatory infections like gastroenteritis.

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A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6 °F, a heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing?

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Naxlex Comprehensive Predictor Exams

A patient presents with bradycardia, low serum sodium, a blood pressure of 86/54 mmHg, decreased level of consciousness, and difficulty breathing. His labs support severe hypothyroidism. Which life-threatening complication is he likely experiencing?

Correct Answer is B

Explanation

The nurse is caring for a patient with gastroenteritis. He not only has diarrhea and dehydration but also complains of feeling very warm. What systemic response may the patient experience with this inflammatory infection?

Correct Answer is D

Explanation

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A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6 °F, a heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing?

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