The nurse is caring for a postoperative adult client who has developed pneumonia. The nurse should assess the client frequently for symptoms of:

Epiglottitis

Bronchospasm

Atelectasis

Croup

Answer and Explanation

The Correct Answer is C

Choice A reason: Epiglottitis is an acute bacterial infection causing epiglottal swelling, primarily in children, leading to airway obstruction. Postoperative pneumonia, caused by bacterial infection or aspiration, increases mucus production and impairs gas exchange but does not typically cause epiglottal inflammation. Assessing for epiglottitis is irrelevant, as it’s unrelated to pneumonia’s pathophysiology, which involves alveolar consolidation and impaired oxygenation.

Choice B reason: Bronchospasm involves airway constriction due to smooth muscle contraction, common in asthma or COPD. Postoperative pneumonia, characterized by alveolar infection and consolidation, reduces lung compliance and gas exchange but rarely causes bronchospasm. Assessing for bronchospasm is less relevant, as pneumonia primarily affects alveoli, not bronchial smooth muscle, making this an unlikely complication to monitor.

Choice C reason: Atelectasis, the collapse of alveoli, is a common postoperative complication, especially with pneumonia, due to mucus accumulation and reduced lung expansion. This impairs gas exchange, increasing hypoxia risk. Frequent assessment for atelectasis, indicated by diminished breath sounds and hypoxemia, is critical, as it exacerbates pneumonia’s effects on alveolar ventilation and requires interventions like deep breathing exercises.

Choice D reason: Croup is a viral infection causing laryngeal and tracheal swelling, primarily in children, leading to a barking cough. Postoperative pneumonia in adults involves bacterial alveolar infection, not upper airway inflammation. Assessing for croup is inappropriate, as it’s unrelated to pneumonia’s pathophysiology, which focuses on lower respiratory tract consolidation and impaired gas exchange.

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Correct Answer is D

Explanation

Choice A reason: This response dismisses the patient’s anxiety by offering superficial reassurance without addressing their emotional state. Preoperative anxiety activates the sympathetic nervous system, increasing cortisol and adrenaline, which disrupt sleep by elevating heart rate and alertness. This approach fails to validate emotions, potentially worsening stress responses and hindering psychological coping, making it non-therapeutic for addressing the patient’s distress.

Choice B reason: Questioning the patient’s insomnia and implying they should feel reassured invalidates their feelings. Anxiety triggers the hypothalamic-pituitary-adrenal axis, releasing stress hormones that disrupt REM sleep cycles. This response lacks empathy, failing to address the limbic system’s role in emotional distress, which is critical for therapeutic communication to reduce preoperative anxiety and promote emotional stability.

Choice C reason: Minimizing the patient’s concerns and focusing on pharmacological intervention ignores emotional needs. Sedatives may depress the central nervous system to induce sleep, but they don’t address anxiety-driven amygdala activation, which elevates cortisol. A therapeutic response should validate feelings and offer emotional support to mitigate stress responses, making this option inadequate for addressing the patient’s psychological state.

Choice D reason: This empathetic response acknowledges the patient’s uncertainty and invites dialogue, aligning with therapeutic communication principles. Preoperative anxiety, driven by fear of unknown surgical outcomes, activates the limbic system, increasing heart rate and cortisol. By validating emotions and offering support, this response fosters trust, reduces stress hormone release, and supports psychological coping, making it the most appropriate choice.

A. Sodium 138 mEq/L B. Chloride 100 mEq/L C. Potassium 4.1 mEq/L D. Magnesium 1.0 mEq/L

Correct Answer is D

Explanation

Choice A reason: Sodium 138 mEq/L (normal 135-145 mEq/L) is within normal range. Sodium regulates osmotic balance and nerve conduction. Normal levels do not explain tremors, which are often linked to neurological or electrolyte imbalances, like low magnesium. In the context of acute tremors, sodium is not a concern compared to magnesium deficiency.

Choice B reason: Chloride 100 mEq/L (normal 98-106 mEq/L) is normal and does not contribute to tremors. Chloride supports acid-base balance and neuronal inhibition via GABA receptors. Tremors are more likely caused by low magnesium, which affects neuromuscular excitability. Normal chloride levels do not warrant concern in this acute neurological presentation.

Choice C reason: Potassium 4.1 mEq/L (normal 3.5-5.0 mEq/L) is normal and unlikely to cause tremors. Potassium regulates membrane potential and muscle contraction. Tremors are more associated with magnesium deficiency, which increases neuronal excitability. Normal potassium does not explain the neurological symptoms, making it a lower priority than magnesium in this scenario.

Choice D reason: Magnesium 1.0 mEq/L (normal 1.7-2.2 mEq/L) indicates hypomagnesemia, which causes tremors by increasing neuromuscular excitability. Magnesium stabilizes neuronal membranes and regulates calcium channels. Low levels disrupt nerve signaling, leading to tremors and potential seizures. This critical imbalance requires urgent correction, making it the most concerning lab value in this scenario.

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