On assessment of a client in acute respiratory distress syndrome you note severely diminished breath sounds with crackles and wheezes. The latest blood gas is pH 7.32: PaCO2 50 mmHg: HCO3 26 mEq/L: PaO2 50 mmHg Sa02 70%. Which statement best describes the pathological process?
Hypoxia due to tension pneumothorax
Hyperventilation due to anxiety
Excessive use of sedation
Alveolar hypoventilation due to airway obstruction
The Correct Answer is D
A. Hypoxia due to tension pneumothorax: Tension pneumothorax can cause severe hypoxia, hypotension, and absent breath sounds on the affected side. However, this client has bilateral crackles and wheezes, which are not consistent with a unilateral pneumothorax. The presentation suggests widespread alveolar involvement rather than localized lung collapse.
B. Hyperventilation due to anxiety: Hyperventilation from anxiety would typically cause respiratory alkalosis, characterized by low PaCO₂. This client has elevated PaCO₂ (50 mmHg) and low pH (7.32), indicating respiratory acidosis, which is inconsistent with hyperventilation.
C. Excessive use of sedation: Sedation can depress respiratory drive and contribute to hypoventilation. While this can worsen respiratory status, the presence of crackles, wheezes, and severe hypoxemia suggests underlying airway obstruction and alveolar filling rather than purely medication-induced respiratory depression.
D. Alveolar hypoventilation due to airway obstruction: The client’s blood gas shows hypoxemia (PaO₂ 50 mmHg, SaO₂ 70%) and hypercapnia (PaCO₂ 50 mmHg) with acidemia (pH 7.32), which indicates alveolar hypoventilation. Crackles and wheezes suggest obstruction and fluid accumulation in the alveoli, consistent with acute respiratory distress syndrome pathology.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Development of third spacing reduces renal perfusion: Large burn injuries cause massive fluid shifts into the interstitial and third spaces due to increased capillary permeability. This reduces circulating blood volume and decreases renal perfusion, creating a risk of shock and acute kidney injury. Large-volume crystalloid resuscitation restores intravascular volume and supports organ perfusion.
B. It is part of the protocol for initial burn management: While fluid resuscitation is indeed part of burn protocols, this option does not explain why fluids are required. The rationale must focus on the pathophysiology of fluid shifts and reduced perfusion.
C. Burn trauma cell damage causes external fluid loss: Although burns cause loss of the skin barrier and some evaporative fluid loss, the primary reason for large-volume replacement is internal fluid shifting (third spacing), not external loss.
D. Crystalloid intravenous fluids are less expensive: Cost is not a clinical reason for choosing the type of fluid for burn resuscitation. The choice is based on safety, evidence-based guidelines, and physiologic needs.
Correct Answer is A
Explanation
A. The need for anticoagulation therapy for the duration of the valve: Mechanical valves promote turbulent blood flow, greatly increasing thrombus formation risk. Lifelong anticoagulation is required to prevent stroke or valve thrombosis, making this a critical component of postoperative education.
B. The probability that the valve will need to be replaced in seven years: Mechanical valves are highly durable and typically last a lifetime. They do not require routine replacement unless complications occur, so presenting a seven-year expectancy is inaccurate.
C. The need to avoid high-voltage electrical fields: Daily life rarely exposes clients to electrical fields that would interfere with a mechanical valve, which is a passive device. Restrictions of this type apply more to pacemakers, not prosthetic valves.
D. The need to check the pulse daily to determine the functioning of the valve: Pulse checks do not assess mechanical valve function, which is monitored through clinical assessments and periodic echocardiography. Although pulse monitoring is generally beneficial, it does not specifically evaluate valve performance.
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