Arterial Blood Gases
A college student arrives at the ER after experiencing severe anxiety before an exam. She is tearful, says her hands are tingling, and repeatedly tells the nurse, “I can't catch my breath.” Her respiratory rate is 30/min.
After phlebotomy, her arterial blood gases were...
- pH of 7.49
- paCO2 of 30 mmHg
- HCO3 of 23 mEq/L
What is their compensation status?
A. Compensated respiratory alkalosis
B. Uncompensated respiratory alkalosis
C. Partially compensated respiratory alkalosis
D. Uncompensated respiratory acidosis
B. Uncompensated respiratory alkalosis
A 22-year-old client with history of sickle cell anemia is admitted to the emergency department reporting a pain rated 9/10. They appear restless and is having difficulty getting comfortable in bed. Vital signs are: HR of 108/min, RR of 22/min, and BP of 138/82 mm Hg.
Which action should the nurse take first?
A. Encourage the client to ambulate to improve circulation
B. Initiate prescribed analgesic therapy
C. Restrict fluids until the cause of the crisis is determined
D. Apply ice packs to painful areas to decrease inflammation
B. Initiate prescribed analgesic therapy
A 34-year-old client develops sudden difficulty breathing shortly after receiving an IV medication. The nurse notes the client is flushed and anxious, with generalized hives and swelling around the lips. The client's blood pressure is 82/48 mm Hg, heart rate is 124/min, and respiratory rate is 28/min with audible wheezing.
Which medication should the nurse anticipate administering first?
A. Diphenhydramine
B. Methylprednisolone
C. Epinephrine
D. Albuterol
C. Epinephrine
A 34-year old patient is brought to the ED shortly after sustaining a severe thermal injury at home. Assessment reveals dry, charred tissue extending through the skin and into underlying muscle and bone. The patient reports little sensation in the affected area. After initial stabilization, the nurse is developing the plan of care for the burn injury.
Which intervention should the nurse anticipate as the priority?
A. Apply sterile dressings and topical antimicrobial medication to the affected areas
B. Prepare the patient for surgical debridement of nonviable tissue
C. Initiate range-of-motion exercises to prevent contractures
D. Assess patient need for psychosocial support
B. Prepare the patient for surgical debridement of nonviable tissue
A nursing student is performing a head-to-toe assessment on a patient who developed sudden shortness of breath after a central line was placed. The student notes absent breath sounds on the right side, a blood pressure of 82/50 mmHg, and a tracheal deviation toward the left. The patient is becoming increasingly restless.
Which pulmonary disorder should the nurse suspect?
A. Hemothorax
B. Tension pneumothorax
C. Empyema (pus in pleural space)
D. Pulmonary embolism
B. Tension pneumothorax
A 38-year old came in to the ER, and reports she has been vomiting several times a day for the past week. She says she initially felt a lot of chest tightness and pain, and assumed that it was heartburn. She reports she took 4 tablets of Alka-Seltzer/TUMS. She has been unable to keep her food down.
What acid-base disorder would you expect?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Metabolic acidosis
C. Metabolic alkalosis
A client is being evaluated for fatigue, weakness, and frequent infections. The nurse asks about current and recently prescribed medications. Which statement by the client should the nurse recognize as a potential contributing factor to the client's condition?
Also, the labs just came up on your EHR...
A. “I was prescribed streptomycin for an infection a few weeks ago.”
B. “I take hydroxyurea regularly to manage my anemia.”
C. “I take ferrous sulfate every morning with breakfast.”
D. “I was prescribed cyanocobalamin injections recently.”
A. “I was prescribed streptomycin for an infection a few weeks ago.”
Bonus Question...
What are the other medications for? (1+ point each)
A client with cardiogenic shock is receiving several medications to improve cardiac function and tissue perfusion. The nurse provides medication education before discharge from the intensive care unit.
Which statement by the client indicates that additional education is required?
A. “Dobutamine helps my heart pump more strongly when my cardiac output is low.”
B. “Norepinephrine can increase my blood pressure by constricting my blood vessels.”
C. “Nitroglycerin can be used when my blood pressure is high to increase venous return.”
D. “Dopamine can increase my heart rate, contractility, and blood pressure depending on the dose.”
C. “Nitroglycerin can be used when my blood pressure is high to increase venous return.”
A 34-year-old client is brought to the ED after an incident at his factory job. Upon assessment, a small circular wound on the right palm and a similar wound on the left forearm was found. The surrounding skin had only minimal redness.
The client appears anxious and reports intermittent muscle cramping in both arms. Rates pain 4 out of 10. Laboratory results reveal dark, tea-colored urine and an elevated serum creatine kinase level.
Which action by the nurse is the priority intervention based on these findings?
A. Apply a sterile dressing to the wounds and reassess the skin every 2 hours
B. Prepare the client for continuous cardiac monitoring and further evaluation
C. Encourage oral fluids intake and monitor urine output for changes
D. Administer prescribed analgesics and reassess the client's pain
B. Prepare the client for continuous cardiac monitoring and further evaluation
A nursing student is performing a head-to-toe assessment on a patient admitted after a high-speed motor vehicle accident. The patient reports severe chest pain and increasing shortness of breath. SpO2 reads 94%, and respirations of 26.
Which assessment finding would most strongly support the nurse's suspicion of flail chest?
A. Diminished breath sounds on one side, sudden dyspnea, and tracheal deviation away from the affected side
B. Severe chest pain, crepitus over fractured ribs, and inward movement of one chest-wall segment during inspiration
C. Sudden pleuritic chest pain, tachycardia, and decreased oxygen saturation following prolonged immobility
D. Bilateral crackles, hypoxemia, and progressively worsening respiratory distress following blunt chest trauma
B. Severe chest pain, crepitus over fractured ribs, and inward movement of one chest-wall segment during inspiration
A 45-year-old patient is admitted after several days of severe vomiting. The patient is weak, dizzy, and complaining of muscle cramps.
Here are their set of arterial blood gases...
- pH: 7.49
- PaCO₂: 48 mmHg
- HCO₃⁻: 32 mEq/L
What is the correct interpretation?
A. Uncompensated respiratory alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated metabolic alkalosis
D. Partially compensated metabolic alkalosis
D. Partially compensated metabolic alkalosis
A 67-year old patient is admitted on 0600 with a suspected pulmonary embolism. Hx of COPD, hypertension, and DVT.
The provider prescribes an IV heparin infusion. Before initiating the infusion, the nurse reviews the patient's assessment findings. Patient is currently stable.
Which finding requires the nurse to take immediate action?
A. Heart rate of 110/min
B. Oxygen saturation of 89%
C. Platelet count of 48,000/mm³
D. Blood pressure of 138/82 mmHg
C. Platelet count of 48,000/mm³
This is too low (150000-450000/mm3) and starting heparin (an anticoagulant) can create a significant bleeding risk.
Hold the heparin and notify the provider!
A 67-year-old client is admitted to the emergency department after experiencing persistent vomiting and diarrhea for the past 2 days. The client reports feeling weak and dizzy when standing. The nurse notes cool, clammy skin and poor skin turgor. Vital signs are HR 122/min, RR 26/min, and BP 84/50 mm Hg. The client's urine output is 15 mL over the past 2 hours.
The provider enters several prescriptions. Which intervention should the nurse anticipate?
A. Restrict the client's oral and IV fluid intake to reduce vomiting exacerbation.
B. Administer a vasopressor to increase blood pressure as prescribed.
C. Initiate the a bolus of hypertonic IV fluid as ordered.
D. Initiate the prescribed IV fluid replacement to restore intravascular volume.
D. Initiate the prescribed IV fluid replacement to restore intravascular volume.
A nurse is assessing four patients with thermal injuries.
Which patient's injury is most consistent with a deep-partial thickness burn?
A. A patient has a dry, erythematous area of skin with tenderness to light touch; no blisters are present
B. A patient has a moist, red wound with multiple blisters and severe pain; most of the affected area blanches when pressure is applied
C. A patient has a dry, pale wound with markedly decreased sensation throughout the affected area; the tissue appears firm and leathery
D. A patient has a mottled, pale wound with areas that do not blanch; sensation is decreased in some areas, while other areas remain painful
D. A patient has a mottled, pale wound with areas that do not blanch; sensation is decreased in some areas, while other areas remain painful
A nurse is providing education to a patient following chest tube placement. The patient is stable, and the nurse is reviewing interventions to promote lung expansion and prevent complications.
Which intervention should the nurse include in the patient's education?
A. Teach about shallow breathing and pursed-lip breathing to decrease pressure within the pleural space and prevent alveolar collapse
B. Encourage the patient to remain supine while awake alongside alternate repositioning to promote chest drainage
C. Teach the patient to perform deep-breathing and coughing exercises as part of chest physiotherapy
D. Instruct the patient to avoid changing positions until the chest tube is removed to reduce barotrauma and accidental tube displacement
C. Teach the patient to perform deep-breathing and coughing exercises as part of chest physiotherapy
A 24-year-old passenger on an airplane suddenly becomes extremely anxious during turbulence. The patient begins breathing rapidly at 36 breaths/min. He reports feeling lightheaded with numbness and tingling around the mouth and in both hands. SpO₂ is 99% on room air. Lung sounds are clear bilaterally, and the patient has no history of respiratory disease.
Which is the safest intervention the nurse should perform first?
A. Have the patient breathe in and out of a brown paper bag to restore blood gas balance
B. Encourage the patient to slow their breathing using controlled, diaphragmatic breaths
C. Administer supplemental oxygen at 10 L/min via nonrebreather mask
D. Have the patient hold their breath for 30 seconds to reduce CO2 blow-off
B. Encourage the patient to slow their breathing using controlled, diaphragmatic breaths
A 55-year-old client with sepsis is being monitored for possible disseminated intravascular coagulation (DIC). The nurse reviews the client's laboratory results in the EHR.
Which hypothetical laboratory value would require the nurse to notify the provider immediately?
A. PT: 10.1 seconds (shorter)
B. PTT: 24.6 seconds (shorter)
C. Fibrinogen: 105 mg/dL (below)
D. Platelets: 148,000/µL (below)
C. Fibrinogen: 99 mg/dL (below)
PT: ~ 11-13.5 seconds
PTT: ~ 25-35 seconds
Fibrinogen: ~ 200-400 mg/dL
Platelets: ~ 150,000-400,000/µL
A 68-year-old client is admitted to the intensive care unit after an acute myocardial infarction. The client becomes increasingly restless and reports difficulty breathing. Assessment findings include cool, clammy skin, HR 118/min, RR 28/min, BP 78/46 mm Hg, and urine output of 15 mL/hr. The nurse auscultates bilateral crackles throughout the lung fields.
Which intervention should the nurse anticipate implementing?
A. Administer an IV fluid bolus to increase preload and improve cardiac output.
B. Administer the prescribed norepinephrine infusion to improve blood pressure and organ perfusion.
C. Place the client in a supine position to maximize venous return to the heart.
D. Encourage oral fluids to increase circulating blood volume and improve urine output.
B. Administer the prescribed norepinephrine infusion to improve blood pressure and organ perfusion.
A patient is preparing for discharge after a prolonged hospitalization for severe burns. The wounds are now closed, and the nurse is discussing the patient's expected outpatient care and long-term recovery needs.
Which set of interventions should the nurse anticipate during the 'rehabilitation' phase?
A. Regular outpatient IV fluid therapy and occupational therapy
B. Physical therapy, pain management, and prevention of hypothermia
C. Reconstructive surgery referral, range-of-motion exercises, and wound infection monitoring
D. Occupational therapy, psychosocial support, and patient education
D. Occupational therapy, psychosocial support, and patient education
A patient is admitted to the intensive care unit with severe respiratory failure. The patient is lethargic and unable to maintain adequate spontaneous respirations. Oxygen saturation remains low despite supplemental oxygen, and the provider determines that mechanical ventilation is necessary. The patient is intubated and connected to a ventilator.
Which ventilator mode should the nurse anticipate the provider selecting initially?
A. Continuous positive airway pressure (CPAP)
B. Synchronized intermittent mandatory ventilation (SIMV)
C. Assist-control (AC)
D. Pressure support ventilation
C. Assist-control (AC)
The nurse receives four patients in the ER...
- Patient A: 25-year-old hyperventilating after a panic attack. RR 34/min, tingling in hands, SpO₂ 96%, alert.
- Patient B: 63-year-old with COPD. RR 10/min, SpO₂ 93% on 2 L NC, increasingly obtunded, new premature ventricular contractions.
- Patient C: 42-year-old with 5 days of vomiting. RR 12/min, muscle cramps, tingling, BP 104/68.
- Patient D: 51-year-old with severe diarrhea. BP 94/50, deep respirations 32/min, SpO₂ 97%, alert.
Which patient should the nurse assess first?
A. Patient A
B. Patient B
C. Patient C
D. Patient D
B. Patient B
A is alert; SpO2 is WNO
B is becoming increasingly less alert and PVCs indicate there is enough of an electrolyte imbalance to affect the heart
C is in metabolic alkalosis, but has no immediate ABC threat
D is in active compensation and is alert, SpO2 is WNO
A client with heart failure is prescribed several medications to improve cardiac function. During discharge teaching, the nurse explains that some medications decrease the resistance the heart must overcome to eject blood, while others can improve the force of cardiac contraction.
Which statement by the client indicates that further education is required?
A. “Nitroglycerin can decrease afterload by causing vasodilation.”
B. “My ACE inhibitor can reduce the resistance against which my heart pumps.”
C. “Digoxin can increase the force of my heart's contraction.”
D. “Norepinephrine will decrease afterload by relaxing my blood vessels.”
D. “Norepinephrine will decrease afterload by relaxing my blood vessels.”
A nurse is caring for a client who was admitted with an infection and is being closely monitored for shock. Earlier in the shift, the client's vital signs were within expected limits. Several hours later, the nurse notes that the client has become increasingly restless and pale with cool skin. The client's HR and RR have increased, and the nurse notices the blood pressure is beginning to decline.
Which finding would indicate that the client's condition has progressed beyond the compensatory stage of shock?
A. A decrease in MAP with minimal changes in the client's LOC
B. A decrease in blood pressure accompanied by confusion and a +1 pulse
C. Restlessness with a heart rate of 96 and respiratory rate of 22
D. A heart rate of 104 with cool, pale skin and preserved blood pressure
B. A decrease in blood pressure accompanied by confusion and a +1 pulse
A nurse is teaching a patient who underwent an escharotomy for a severe circumferential full-thickness burn. The nurse explains that the procedure involves making incisions through the hardened eschar to relieve pressure on the underlying tissues.
Which patient statement indicates a need for further education?
A. “The incisions remove the dead tissue from the burn so that my skin can begin healing.”
B. “The procedure helps relieve pressure caused by the tight, hardened tissue.”
C. “The procedure can help improve blood flow if the burn is restricting circulation to my limb.”
D. “The incisions give the swollen area more room so the tissue underneath isn't squeezed so tightly.”
A. “The incisions remove the dead tissue from the burn so that my skin can begin healing.”
A nurse is caring for a patient who suddenly develops shortness of breath and sharp chest pain. The patient is tachycardic and has an oxygen saturation of 88% despite receiving supplemental oxygen. The nurse suspects a pulmonary embolism.
Which alteration in ventilation and perfusion should the nurse anticipate in this patient?
A. Low ventilation with normal perfusion, causing inadequate air movement to the alveoli
B. Absent ventilation with continued perfusion, causing blood to pass through without being adequately oxygenated
C. Increased ventilation with increased perfusion, resulting in excessive gas exchange
D. Normal ventilation with decreased perfusion, causing air to reach alveoli that have limited blood flow
D. Normal ventilation with decreased perfusion, causing air to reach alveoli that have limited blood flow