Review Complications and Comorbidities in Chronic Illnesses

Care of Patients with Chronic Illnesses > Fundamentals

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Complications and Comorbidities in Chronic Illnesses

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Total Questions : 4

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Question 1:

A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who has developed cor pulmonale. Which assessment finding is most indicative of this complication?

A. Clubbing of the fingers and toes B. Distended neck veins and peripheral edema C. Wheezes and crackles in the lung fields D. Cyanosis of the lips and nail beds

Answer and Explanation

Choice A:

This is a sign of chronic hypoxia, which may be present in clients with COPD, but does not necessarily indicate cor pulmonale.

Choice B:

Cor pulmonale is a condition in which the right side of the heart fails due to increased pressure in the pulmonary arteries, caused by chronic lung disease. This results in fluid retention and venous congestion, leading to distended neck veins and peripheral edema.

Choice C:

These are signs of airway obstruction and fluid accumulation in the lungs, which are common in clients with COPD, but do not directly reflect the status of the right heart.

Choice D:

This is a sign of poor oxygenation, which may occur in clients with COPD, but does not indicate the presence of cor pulmonale.

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Question 2:

A client with type 2 diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse recognizes that which factor is most likely to have precipitated this complication?

A. Insufficient insulin administration B. Excessive carbohydrate intake C. Prolonged physical activity D. Acute stress or infection

Answer and Explanation

Choice A:

This is a possible cause of DKA, but not the most likely one, as clients with type 2 diabetes mellitus usually have some endogenous insulin production and may not require exogenous insulin therapy.

Choice B:

This may cause hyperglycemia, but not DKA, as carbohydrates do not produce ketones when metabolized.

Choice C:

This may lower blood glucose levels, but not cause DKA, as exercise increases insulin sensitivity and glucose uptake by the muscles.

Choice D:

DKA is a life-threatening condition in which the body produces excess ketones due to a lack of insulin, resulting in metabolic acidosis, dehydration, and electrolyte imbalance. The most common triggers for DKA are acute stress or infection, which increase the body's demand for insulin and glucose.

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Question 3:

A client with rheumatoid arthritis (RA) is prescribed methotrexate, a disease-modifying antirheumatic drug (DMARD). Which statement by the client indicates a need for further teaching?

A. "I will take folic acid supplements to prevent side effects." B. "I will avoid drinking alcohol while taking this medication." C. "I will monitor my blood pressure and report any changes." D. "I will use contraception to prevent pregnancy while taking this medication."

Answer and Explanation

Choice A:

This is a correct statement, as folic acid supplementation can reduce the risk of methotrexate-induced hematologic toxicity and mucositis.

Choice B:

This is a correct statement, as alcohol consumption can increase the risk of methotrexate-induced liver damage.

Choice C:

Methotrexate is a potent immunosuppressant and cytotoxic agent that can cause serious adverse effects, such as bone marrow suppression, hepatotoxicity, pulmonary toxicity, and teratogenicity. The client should be instructed to monitor their blood counts, liver function tests, chest x-rays, and pregnancy tests regularly, and report any signs of infection, bleeding, jaundice, cough, or dyspnea. Blood pressure monitoring is not directly related to methotrexate therapy.

Choice D:

This is a correct statement, as methotrexate is contraindicated in pregnancy due to its potential teratogenic effects on the fetus.

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Question 4:

A client with systemic lupus erythematosus (SLE) is experiencing a flare-up of symptoms. The nurse anticipates that the client may develop which complication related to SLE?

A. Glomerulonephritis B. Thyroid storm C. Pancreatitis D. Peptic ulcer disease

Answer and Explanation

Choice A:

Glomerulonephritis is a common complication of SLE, as the autoimmune disorder causes inflammation and damage to the glomeruli, the filtering units of the kidneys. This can lead to proteinuria, hematuria, hypertension, edema, and renal failure.

Choice B:

This is a rare complication of hyperthyroidism, not SLE. It is characterized by a severe exacerbation of thyroid hormone effects, such as fever, tachycardia, agitation, and delirium.

Choice C:

This is an inflammation of the pancreas, which can be caused by various factors, such as gallstones, alcohol abuse, trauma, or medications. It is not directly related to SLE.

Choice D:

This is a condition in which ulcers form in the lining of the stomach or duodenum, due to erosion by gastric acid and pepsin. It can be caused by Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs (NSAIDs), stress, or smoking. It is not directly related to SLE.

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Complications and Comorbidities in Chronic Illnesses

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