An older adult is brought to the emergency department by a family member who reports a moderate change in mental status and mild cough. The client is afebrile. The primary health care provider orders a chest x-ray. The family member questions why this is needed since the symptoms seem so vague. What response by the nurse is best?

Correct Answer: B

Rationale: The correct answer is B because older adults often present with atypical or vague symptoms when they have an underlying infection, including pneumonia. It is crucial to assess for pneumonia in older adults promptly because they may not exhibit classic signs like fever. An x-ray is essential to confirm or rule out pneumonia as it allows for visualization of lung abnormalities. Choice A is incorrect because not all older adults with vague symptoms automatically have pneumonia, and ordering a chest x-ray is based on clinical judgment. Choice C is incorrect as the timing of the x-ray in relation to laboratory work is not the primary reason for ordering it. Choice D is incorrect because the x-ray is specifically to assess for pneumonia, not for general infection sources.

Correct Answer: C

Rationale: The correct answer is C. Reminding the client to sleep on their side is a simple intervention suitable for a nursing assistant. Discussing weight loss strategies (A) and teaching BiPAP machine use (B) require more specialized knowledge. Administering medication (D) is outside the scope of practice for a nursing assistant.

Correct Answer: A

Rationale: The correct answer is A) Avoid sitting and standing for too long and do not cross legs. This is because prolonged periods of immobility can lead to blood stagnation in the legs, increasing the risk of clot formation which can travel to the lungs causing a pulmonary embolism. By staying active and avoiding prolonged sitting or standing, the patient can promote healthy blood circulation and reduce the risk of clot formation. Option B) Take vitamin K with heparin is incorrect as vitamin K actually promotes blood clotting, which would be counterproductive in this situation where we want to prevent clots. Option C) Avoid confined spaces is incorrect as the risk of pulmonary embolism is more related to factors like immobility, underlying conditions, or genetic predispositions rather than the physical environment. Option D) Jog 5 miles each day is also incorrect as while exercise is beneficial for overall health, recommending a specific high-intensity activity like jogging 5 miles each day may not be appropriate or feasible for all patients, especially those recovering from a pulmonary embolism. In an educational context, it is crucial for healthcare professionals to provide patients with clear and practical advice on how to prevent complications like pulmonary embolism after treatment. Understanding the role of mobility in preventing clot formation is essential information for patients to maintain their health and well-being.

Correct Answer: D

Rationale: The correct answer is D) Pulmonary embolism. Pulmonary embolism is a condition where a blood clot travels to the lungs, causing obstruction in the pulmonary arteries. This obstruction leads to increased pressure in the pulmonary circulation, which can result in secondary pulmonary arterial hypertension. The clot can also cause damage to the pulmonary capillaries and alveoli, contributing to the development of hypertension. Option A) COPD is a chronic obstructive pulmonary disease characterized by airflow limitation. While COPD can lead to pulmonary hypertension, it does not directly cause pulmonary capillary and alveolar damage as in the case of pulmonary embolism. Option B) Sarcoidosis is an inflammatory disease that affects multiple organs, including the lungs. While it can cause lung damage, it is not a common cause of pulmonary arterial hypertension through capillary and alveolar damage. Option C) Pulmonary fibrosis is a condition characterized by scarring of the lung tissue. It can lead to pulmonary hypertension but typically through fibrotic changes in the lung tissue rather than direct capillary and alveolar damage. In an educational context, understanding the various causes of secondary pulmonary arterial hypertension is crucial for healthcare professionals, especially those working with patients with respiratory conditions. Recognizing the specific mechanisms by which conditions contribute to pulmonary hypertension can aid in early diagnosis and appropriate management to prevent further complications.