The nurse admits a patient with a history of asthma who is wheezing, has severe shortness of breath, hypoxia, and feeling anxious.
Which pathophysiological changes explain the patient's manifestations?
Relaxation of bronchial smooth muscle with dry mucus membrane.
Constriction of the bronchial smooth muscle and air trapping.
Acute pulmonary edema.
Contraction of elastic fibers of the lung.
The Correct Answer is B
Choice A rationale
Asthma is an obstructive disease characterized by inflammation and hyper-responsiveness of the airways. While some medications cause relaxation, the pathophysiology of an acute attack involves the constriction (spasm) of the bronchial smooth muscle, increased mucus production, and airway edema, leading to obstruction, not muscle relaxation and dry membranes.
Choice B rationale
The core pathophysiology of an acute asthma exacerbation is the hyper-responsiveness of the airways to triggers, leading to bronchial smooth muscle constriction (bronchospasm) and airway edema with excessive mucus. This combination severely narrows the airways, causing air trapping on exhalation, resulting in wheezing, shortness of breath, and hypoxia.
Choice C rationale
Acute pulmonary edema is the excessive fluid accumulation in the lung interstitium and alveoli, most commonly due to left-sided heart failure (cardiogenic) or severe lung injury (non-cardiogenic, e.g., ARDS). While both cause shortness of breath and hypoxia, pulmonary edema's primary mechanism is fluid leakage, distinct from the bronchospasm and airway inflammation central to asthma.
Choice D rationale
The elastic fibers of the lung parenchyma, primarily composed of elastin, are crucial for passive exhalation and recoil of the lung. While lung elasticity can be compromised in conditions like emphysema (loss of elasticity) or pulmonary fibrosis (increased stiffness), the acute symptoms of asthma are predominantly due to obstruction from smooth muscle contraction and inflammation, not this specific mechanism.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The five cardinal signs of acute inflammation, stemming from the initial vascular and cellular responses, include redness (rubor), swelling (tumor), heat (calor), pain (dolor), and loss of function (functio laesa). Redness and heat are caused by vasodilation, swelling by increased vascular permeability, and pain by chemical mediators stimulating nerve endings.
Choice B rationale
Pain and edema (swelling) are correct signs, but pulselessness is a sign of arterial occlusion or profound hypoperfusion (ischemia), not a classic or inherent sign of the inflammatory process itself. Inflammation typically involves increased blood flow, not its cessation.
Choice C rationale
Redness is correct. Paresthesias (abnormal sensation like tingling or numbness) are indicative of nerve damage or compression, and coolness is a sign of vasoconstriction or impaired blood flow, which is contrary to the vasodilation that defines the acute inflammatory response.
Choice D rationale
Heat and swelling are correct, but cyanosis (bluish discoloration) is caused by the presence of deoxygenated blood and is a sign of hypoxia or impaired venous return (stasis), not typically a direct feature of the initial acute inflammatory response, which is characterized by increased blood flow (hyperemia).
Correct Answer is D
Explanation
Choice A rationale
Naloxone is an opioid receptor antagonist that competes with and displaces opioid molecules from μ-opioid receptors in the central nervous system. Its pharmacological action directly reverses the life-threatening effects of acute opioid overdose, primarily respiratory depression. It does not pharmacologically influence or immediately eliminate the patient's underlying drug-seeking behavior.
Choice B rationale
Opioid overdose causes respiratory depression and bradycardia (slowed heart rate), often below the normal range of 60-100 beats per minute. Naloxone reverses the respiratory depression, which then leads to improved oxygenation, and subsequent heart rate normalization (reversal of bradycardia). The primary immediate effect is reversing respiratory depression, which secondarily helps normalize the heart rate.
Choice C rationale
The rapid displacement of opioids by naloxone can precipitate an acute opioid withdrawal syndrome, characterized by symptoms like nausea, vomiting, sweating, and agitation. While this is a common consequence of administering the antagonist, the most immediate therapeutic goal in this life-threatening scenario is the reversal of inadequate ventilation to restore oxygenation and prevent hypoxia-related organ damage.
Choice D rationale
The most immediate life-threatening sign of opioid overdose is respiratory depression (patient's rate of 4 breaths per minute is dangerously low; normal is 12-20 breaths per minute), resulting from opioid binding to μ-receptors in the brainstem's respiratory centers. Naloxone rapidly reverses this central nervous system depression, stimulating the patient's drive to breathe, which is critical for restoring adequate oxygenation and ventilation.
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