Which long-term resident is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)?
A 79 year old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration
An 88 year old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke
An 81 year old smoker who has increased exercise intolerance, a fever and increased white blood cells
An 81 year old male who has a productive cough and recurrent respiratory infections
The Correct Answer is A
A. A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration: Chronic obstructive pulmonary disease (COPD) is most commonly seen in individuals with a significant smoking history. Progressive shortness of breath is a hallmark symptom of COPD, resulting from chronic airway inflammation and airflow limitation. While pain on deep inspiration is not a classic COPD symptom, it could indicate pleuritic involvement or hyperinflation-related chest discomfort.
B. An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke: Acute shortness of breath and airway constriction in response to tobacco smoke suggests an asthma-like reaction rather than COPD. COPD symptoms tend to be persistent and progressive rather than episodic.
C. An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells: Fever and increased white blood cells indicate an acute infection rather than chronic lung disease. While COPD exacerbations can cause worsening symptoms, an isolated fever and elevated white blood cells suggest pneumonia or another infectious process rather than COPD alone.
D. An 81-year-old male who has a productive cough and recurrent respiratory infections: A productive cough and recurrent respiratory infections are common in chronic bronchitis, a component of COPD. However, this presentation alone is not specific to COPD, as other conditions, such as bronchiectasis, can also cause these symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Pus in the pleural space: This describes empyema, a condition in which infection leads to pus accumulation in the pleural space. Empyema is commonly associated with bacterial pneumonia, lung abscess, or thoracic surgery and requires drainage and antibiotic therapy. It does not cause the lung collapse seen in pneumothorax.
B. Collapse of small airways: While airway collapse can occur in conditions like bronchiolitis or atelectasis, it is not the defining feature of pneumothorax. Pneumothorax specifically involves air leaking into the pleural space, which disrupts the negative pressure necessary for lung expansion and results in partial or complete lung collapse.
C. Blood in the chest cavity: This describes hemothorax, a condition in which blood accumulates in the pleural space due to trauma, ruptured blood vessels, or certain medical conditions. Unlike pneumothorax, which involves air in the pleural space, hemothorax requires different management, including drainage with a chest tube and possible fluid resuscitation.
D. Air in the pleural space: Pneumothorax occurs when air enters the pleural space, causing a loss of negative pressure and leading to lung collapse. This can result from chest trauma, spontaneous rupture of alveoli, underlying lung disease, or mechanical ventilation. Symptoms may include sudden chest pain, dyspnea, and decreased breath sounds on the affected side.
Correct Answer is B
Explanation
A. By causing dysrhythmias as a result of hyperkalemia: Angiotensin II does not directly cause dysrhythmias through hyperkalemia. While hyperkalemia can lead to dysrhythmias, angiotensin II primarily acts as a vasoconstrictor and does not directly influence potassium levels.
B. By increasing peripheral vasoconstriction: Angiotensin II increases peripheral vascular resistance through vasoconstriction, which raises blood pressure. This increased resistance requires the heart to work harder to pump blood, thereby increasing the workload on the heart following a myocardial infarction.
C. By stimulating the sympathetic nervous system: Angiotensin II does stimulate the sympathetic nervous system, which can increase heart rate and contractility; however, the direct effect on increasing workload is more prominently due to peripheral vasoconstriction.
D. By reducing the contractility of the myocardium: Angiotensin II does not reduce contractility; in fact, it can enhance contractility in some contexts. It primarily increases the workload of the heart through vasoconstriction and increased afterload rather than reducing contractility.
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