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1. A 65-year-old man with a history of chronic obstructive pulmonary
disease (COPD) and hypertension presents to the emergency department
with dyspnea, wheezes, and a productive cough. He reports that he has
been using his albuterol inhaler more frequently in the past week, but it
has not relieved his symptoms. His vital signs are: blood pressure 180/100
mmHg, pulse 110 beats/min, respiratory rate 28 breaths/min, oxygen
saturation 88% on room air. The nurse recognizes that this patient is
experiencing:
a) an acute exacerbation of COPD
b) a pulmonary embolism
c) a myocardial infarction
d) a pneumothorax
*Answer: a) an acute exacerbation of COPD*
Rationale: The patient's history, symptoms, and vital signs are consistent
with an acute exacerbation of COPD, which is characterized by increased
dyspnea, wheezes, and sputum production. A pulmonary embolism would
typically present with sudden onset of dyspnea, chest pain, hemoptysis,
and tachycardia. A myocardial infarction would usually cause chest pain,
nausea, diaphoresis, and dysrhythmias. A pneumothorax would manifest
as sudden dyspnea, chest pain, decreased breath sounds, and hypotension.
2. A 45-year-old woman with a history of type 2 diabetes mellitus and
obesity is admitted to the intensive care unit with diabetic ketoacidosis
(DKA). She reports that she has been feeling unwell for the past three
days, with nausea, vomiting, polyuria, and polydipsia. She also admits that
she has not been taking her insulin as prescribed because she was trying to
lose weight. Her laboratory results are: blood glucose 450 mg/dL, serum
bicarbonate 15 mEq/L, serum pH 7.25, serum ketones positive. The nurse
anticipates that the initial treatment for this patient will include:
a) intravenous normal saline
b) intravenous regular insulin
c) intravenous sodium bicarbonate
d) both a) and b)
*Answer: d) both a) and b)*
Rationale: The initial treatment for DKA consists of intravenous fluid
replacement with normal saline to correct dehydration and electrolyte
imbalances, and intravenous regular insulin to lower blood glucose levelsÂ
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