The nurse is reinforcing discharge instructions to the client with pulmonary sarcoidosis. The nurse knows that the client understands the information if the client verbalizes which early sign of exacerbation?
Fever
Weight loss
Fatigue
Shortness of breath
The Correct Answer is D
A. Fever: Although fever can occur with various respiratory conditions, it is not the most specific early sign of an exacerbation in pulmonary sarcoidosis.
B. Weight loss: Weight loss is a more general symptom and not specifically indicative of an exacerbation of sarcoidosis.
C. Fatigue: Fatigue is a common symptom of sarcoidosis but is not necessarily an early sign of an exacerbation.
D. Shortness of breath: Shortness of breath is a significant early indicator of exacerbation in pulmonary sarcoidosis. It reflects worsening inflammation and granuloma formation affecting lung function.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Respiratory alkalosis: This condition is characterized by a high pH and low PaCO2. In this case, the pH is low and PaCO2 is high, indicating that respiratory alkalosis is not present.
B. Metabolic acidosis: Metabolic acidosis is indicated by a low pH and a low bicarbonate level. Here, the pH is low but the bicarbonate level is normal, so metabolic acidosis is not the primary diagnosis.
C. Metabolic alkalosis: This condition involves a high pH and elevated bicarbonate. The pH in this case is low, so metabolic alkalosis is not present.
D. Respiratory acidosis: Respiratory acidosis is indicated by a low pH and high PaCO2. The client's pH is 7.22 (acidic) and PaCO2 is 68 mm Hg (elevated), which is consistent with respiratory acidosis. The bicarbonate level is normal, indicating that there is no significant metabolic compensation yet.
Correct Answer is A
Explanation
A. The client has developed confusion: Hypotonic fluids can cause a rapid shift of water into cells, potentially leading to cerebral edema. This can manifest as confusion or altered mental status, which is a serious adverse effect requiring immediate attention.
B. The client's serum sodium is 140 mEq/L (135 to 145 mEq/L): A serum sodium level within the normal range indicates that the hypotonic fluid therapy is likely effective in correcting hypernatremia, and does not suggest an adverse effect.
C. The client has a positive Chvostek's sign: A positive Chvostek's sign is indicative of hypocalcemia rather than an adverse effect of hypotonic fluid administration. This sign is related to low calcium levels and is not a direct result of hypotonic fluid therapy.
D. The client's blood urea nitrogen (BUN) level is 18 mg/dL (10 to 20 mg/dL): This BUN level is within normal limits and does not suggest an adverse effect of hypotonic fluid therapy. BUN levels can be affected by various factors, but this value alone is not indicative of an adverse reaction.
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