The patient with emphysema comes to the emergency department with difficulty breathing. What finding should the nurse anticipate during data collection? Select all that apply
diminished breath sounds
ruddy skin color
use of accessory muscles
excess mucus production
barrel shaped chest
Correct Answer : A,C,E
A. Diminished breath sounds can occur in emphysema due to decreased air movement through damaged and enlarged air sacs (alveoli). The destruction of alveolar walls reduces the surface area available for gas exchange and can result in decreased breath sounds.
C. Patients with emphysema may use accessory muscles, such as neck and shoulder muscles, to assist with breathing during periods of respiratory distress. These muscles are recruited to help increase the size of the thoracic cavity and improve airflow.
E. A barrel-shaped chest is a common physical finding in patients with emphysema. It results from hyperinflation of the lungs and is characterized by an increased anterior-posterior diameter of the chest. This change in chest shape is due to air trapping in the lungs, leading to overinflation of the alveoli and increased residual volume.
B. Ruddy skin color, which refers to a reddish or flushed complexion, is not typically associated with emphysema. Instead, patients with emphysema may exhibit cyanosis (bluish discoloration of the skin) during periods of hypoxemia (low oxygen levels).
D. Excess mucus production (mucus hypersecretion) is a characteristic feature of chronic bronchitis, which is often present alongside emphysema in chronic obstructive pulmonary disease (COPD) but it is not typically a primary feature of emphysema itself.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
C. Monitoring blood sugar levels regularly, as recommended by the doctor, is crucial for managing type 2 diabetes effectively. It helps patients track their glucose levels, identify patterns, and make informed decisions about medication, diet, and lifestyle choices to maintain optimal blood sugar control.
A. Drinking orange juice to treat high blood sugar is not recommended because it can cause a rapid increase in blood sugar levels due to its high sugar content. Instead, patients should focus on consuming foods or beverages with lower glycemic index values and more stable glucose responses.
B. Regular physical activity is an essential component of diabetes management as it helps improve insulin sensitivity, lower blood sugar levels, control weight, and reduce the risk of complications. Patients with diabetes are encouraged to engage in regular exercise as part of their overall treatment plan.
D. Eating a diet high in carbohydrates can lead to spikes in blood sugar levels, which can be detrimental for individuals with type 2 diabetes. Instead, patients are encouraged to follow a balanced diet that includes a variety of nutrient-rich foods, with a focus on whole grains, lean proteins, healthy fats, fruits, and vegetables, while moderating carbohydrate intake.
Correct Answer is A
Explanation
A. Chocolate contains caffeine and cocoa, both of which can relax the lower esophageal sphincter (LES) and increase the risk of acid reflux. Additionally, chocolate is high in fat, which can further exacerbate symptoms of GERD. Therefore, chocolate is often recommended to be avoided by individuals with GERD.
B. Oatmeal is generally considered a bland and low-acid food that is unlikely to trigger symptoms of GERD. In fact, oatmeal is often recommended as part of a GERD-friendly diet due to its high fiber content, which can help absorb stomach acid and promote digestive health.
C. Apples are generally considered to be low in acid and high in fiber, making them a relatively safe fruit choice for individuals with GERD. However, some individuals may find that certain varieties of apples or apple products (such as apple juice) can exacerbate their GERD symptoms.
D. Nonfat milk is generally considered to be a low-fat and low-acid beverage that is unlikely to trigger symptoms of GERD. However, some individuals may find that consuming dairy products, including milk, can exacerbate their GERD symptoms.
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