Mr. James calls the nurse to the room. Upon entering the nurse notes that his respiratory rate is 36, he is pale, diaphoretic, and states that he feels like he is going to die! The nurse recognizes the urgent need to call the physician and code team because:
Mr. James is most likely experiencing ARDS.
Mr. James is most likely experiencing an acute pulmonary embolus.
Mr. James is most likely experiencing an acute flail chest.
Mr. James is most likely experiencing an acute psychotic disorder.
The Correct Answer is B
Rationale:
A. Mr. James is most likely experiencing ARDS is incorrect. Acute Respiratory Distress Syndrome (ARDS) develops over hours to days and is usually seen in patients with a known risk factor, such as sepsis, trauma, or pneumonia. The sudden onset of severe symptoms described here is not characteristic of ARDS.
B. Mr. James is most likely experiencing an acute pulmonary embolus is correct. The sudden onset of severe dyspnea, tachypnea (RR 36), pallor, diaphoresis, and a sense of impending doom is classic for a massive pulmonary embolism. This is a life-threatening emergency requiring immediate physician notification and potential rapid intervention, including calling the code team for advanced support.
C. Mr. James is most likely experiencing an acute flail chest is incorrect. Flail chest typically occurs after significant trauma, with paradoxical chest wall movement and localized pain. There is no history of trauma provided, making this less likely.
D. Mr. James is most likely experiencing an acute psychotic disorder is incorrect. While feelings of impending doom can occur in panic or psychotic episodes, the combination of tachypnea, pallor, and diaphoresis suggests a physiologic emergency rather than a purely psychiatric event. Immediate medical evaluation is necessary.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Prednisone is a corticosteroid used to suppress inflammation and immune responses in conditions such as asthma, autoimmune diseases, and allergic reactions. Prednisone does not have vasodilatory effects and does not interact with sildenafil in a way that could cause life-threatening complications. Therefore, taking sildenafil while on prednisone is not contraindicated.
B. Nitroglycerine is a nitrate commonly prescribed for angina or ischemic heart disease. Nitrates work by releasing nitric oxide, which causes vasodilation and decreased blood pressure. Sildenafil, a phosphodiesterase-5 (PDE5) inhibitor, also enhances nitric oxide-mediated vasodilation, particularly in the systemic and pulmonary circulation. When these two drugs are taken together, the effects add synergistically, which can lead to severe, life-threatening hypotension, syncope, myocardial ischemia, or even cardiac arrest. Because of this risk, the combination of sildenafil and nitrates is considered an absolute contraindication. Patients must be screened carefully for any nitrate use, including short-acting nitroglycerin for chest pain, before starting sildenafil.
C. Phenytoin is an anticonvulsant used to control seizures. It is metabolized by the liver’s cytochrome P450 system and can increase the metabolism of sildenafil, reducing its effectiveness. While this may require dose adjustment or timing considerations, it does not pose a life-threatening risk and is therefore not an absolute contraindication.
D. Metronidazole is an antibiotic used to treat anaerobic bacterial infections. It has no direct cardiovascular interactions with sildenafil and does not cause dangerous hypotension. There may be minor pharmacokinetic interactions in some cases, but these are not contraindications.
Correct Answer is D
Explanation
Rationale:
A. Mild hoarseness is a common and expected finding after extubation. It occurs because the endotracheal tube can irritate or inflame the vocal cords and larynx during insertion or while in place. Hoarseness usually resolves within a few days without intervention and does not indicate an emergency.
B. Sore throat is another typical post-extubation symptom. The mucosa of the pharynx and larynx may be irritated, causing mild pain or discomfort. This symptom is generally self-limiting and can be managed with hydration, analgesics, and supportive care.
C. After extubation, patients may have increased oral secretions as swallowing and airway reflexes gradually return. This finding is not immediately dangerous. Regular suctioning and oral care are typically sufficient to maintain airway patency and comfort.
D. Stridor is a high-pitched, wheezing sound heard during inspiration, caused by partial obstruction of the upper airway, often due to laryngeal or subglottic edema following extubation. Stridor is a serious complication because it indicates that the airway is compromised. If left untreated, it can progress to complete airway obstruction, respiratory distress, and hypoxemia. Immediate actions include alerting the provider, administering humidified oxygen, providing nebulized epinephrine if prescribed, and being prepared for possible reintubation or emergency airway management.
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