Which patient is at the greatest risk for developing fluid volume excess?
A patient with hyperthyroidism.
A patient with congestive heart failure.
A patient receiving loop diuretics.
A patient with diabetic ketoacidosis.
The Correct Answer is B
A. A patient with hyperthyroidism: Hyperthyroidism involves a hypermetabolic state that often leads to increased diaphoresis, tachypnea, and potential diarrhea, which increase insensible and sensible fluid loss. Patients with this condition are more susceptible to fluid volume deficit rather than excess. Their elevated metabolic rate generally prevents the accumulation of excess intravascular fluid.
B. A patient with congestive heart failure: In this condition, the heart cannot pump blood efficiently, leading to decreased renal perfusion and the activation of the renin-angiotensin-aldosterone system. This results in the pathological retention of sodium and water by the kidneys, causing systemic and pulmonary edema. It is a primary risk factor for hypervolemia and fluid overload.
C. A patient receiving loop diuretics: Loop diuretics increase the excretion of water and electrolytes by inhibiting reabsorption in the renal tubules. The primary therapeutic effect and common side effect of these medications is the reduction of total body fluid. This places the patient at a high risk for fluid volume deficit.
D. A patient with diabetic ketoacidosis: This acute metabolic complication causes profound osmotic diuresis due to extreme hyperglycemia. The high glucose concentration in the renal filtrate pulls water with it, leading to severe cellular and intravascular dehydration. Patients in this state require aggressive fluid resuscitation to correct a massive volume deficit.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. ABG analysis:Arterial Blood Gas (ABG) analysis provides direct measurement of partial pressures of oxygen (PaO2), carbon dioxide (PaCO2), and blood pH. This is the most definitive way to assess the efficiency of gas exchange at the alveolar-capillary membrane. It is essential for managing acute respiratory failure and acid-base imbalances.
B. Chest X-ray:Radiographic imaging provides anatomical information about the structure of the lungs, such as the presence of infiltrates, tumors, or effusions. However, it cannot measure the physiological function of the lungs or the actual efficiency of gas exchange. A patient can have a relatively normal X-ray while experiencing severe gas exchange impairment.
C. Pulmonary function tests:These tests measure lung volumes, capacities, and airflow rates to diagnose obstructive or restrictive patterns. While they provide excellent information about the mechanical function of the lungs, they are not as definitive for acute gas exchange as an ABG. They are typically used for chronic disease staging.
D. Sputum culture:A sputum culture is used to identify specific pathogenic microorganisms and determine their antibiotic sensitivity. This is critical for treating infections but provides no data on the patient's respiratory effort or the physiological success of gas exchange. It is a microbiological diagnostic rather than a functional one.
Correct Answer is D
Explanation
A. Increased bronchial diameter: Chronic bronchitis is characterized by obstructive changes that decrease rather than increase the airway lumen. Chronic inflammation leads to wall thickening and smooth muscle hypertrophy, which increases resistance to airflow. This pathological narrowing contributes significantly to the patient’s expiratory effort and dyspnea.
B. Alveolar destruction: The breakdown of alveolar walls and loss of elastic recoil are the primary pathophysiological hallmarks of emphysema rather than chronic bronchitis. While both conditions often coexist in COPD, bronchitis specifically involves the conducting airways. Alveolar destruction leads to permanent air trapping and impaired gas exchange.
C. Overproduction of surfactant: Surfactant is a lipoprotein that reduces surface tension to prevent alveolar collapse during expiration. In chronic inflammatory lung diseases, surfactant function is often impaired or inhibited by inflammatory exudates rather than being overproduced. Overproduction is not a recognized feature of the bronchitic disease process.
D. Decreased ciliary function: Chronic inhalation of irritants causes squamous metaplasia of the epithelium and direct damage to the mucociliary escalator. This impairment prevents the effective clearance of the excess mucus produced by hypertrophied goblet cells. The resulting stasis of secretions leads to the characteristic persistent productive cough.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.