George Kent is a 54-year-old widower with a history of chronic obstructive pulmonary disease and was rushed to the emergency department with increasing shortness of breath, pyrexia, and a productive cough with yellow-green sputum. He has difficulty communicating because of his inability to complete a sentence. One of his sons, Jacob, says he has been unwell for three days. Upon examination, crackles and wheezes can be heard in the lower lobes; he has tachycardia and a bounding pulse. Measurement of arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg. How would you interpret this?
Respiratory Acidosis, Partially Compensated
The patient has respiratory acidosis (raised carbon dioxide) resulting from an acute exacerbation of chronic obstructive pulmonary disease, with partial compensation.
The RN is assessing a 70-year-old client admitted to the unit with severe dehydration. Which finding requires immediate intervention by the nurse?
A. Client behavior that changes from anxious to lethargic
B. Deep furrows on the surface of the tongue
C. Poor skin turgor with tenting remaining for 2 minutes after the skin is pinched
D. Urine output of 950 mL for the past 24 hours
A. Client behavior that changes from anxious to lethargic
The nurse is caring for a group of clients with electrolytes and blood chemistry abnormalities. Which client will the nurse see first?
A. The client with a random glucose reading of 123 mg/dL (6.8 mmol/L)
B. The client who has a magnesium level of 2.1 mEq/L (1.0 mmol/L)
C. The client whose potassium is 6.2 mEq/L (6.2 mmol/L)
D. The client with a sodium level of 143 mEq/L (143 mmol/L)
C. The client whose potassium is 6.2 mEq/L (6.2 mmol/L)
A client with anemia may be tired due to a tissue deficiency of which of the following substances?
A. Carbon dioxide
B. Factor VIII
C. Oxygen
D. T-cell antibodies
C. Oxygen
The client with unstable angina has received education about the acute coronary syndrome. Which of the following indicates that he understood the teaching?
1. "This is a big warning, I must modify my lifestyle or risk having a heart attack in the next year."
2. "Angina is just a temporary interruption of blood flow to my heart."
3. "I need to tell my wife I've had a heart attack."
4. "Because this was temporary, I will not need to take any medications for my heart."
1. "This is a big warning, I must modify my lifestyle or risk having a heart attack in the next year."
Carl, an elementary student, was rushed to the hospital due to vomiting and a decreased level of consciousness. The patient displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. He appears to be dehydrated—his eyes are sunken and mucous membranes are dry—and he has a two-week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L. What is your assessment?
Metabolic Acidosis, Partially, Compensated
The student was diagnosed with diabetes mellitus. The results show that he has metabolic acidosis (low HCO3 -) with respiratory compensation (low CO2).
A client with diarrhea for 3 days and inability to eat or drink well is brought to the emergency department (ED) by her family. She states she has been taking her diuretics for congestive heart failure (CHF). What nursing actions are indicated at this time?
SELECT ALL THAT APPLY.
A. Place the client on bed rest.
B. Evaluate the electrolyte levels.
C. Administer the ordered diuretic.
D. Assess for orthostatic hypotension
E. Initiate cardiac monitoring.
A, B, D, E
A client is brought to the emergency department for increasing weakness and muscle twitching. The laboratory results include a potassium level of 7.0 mEq/L (7.0 mmol/L). Which assessments does the nurse make?
SELECT ALL THAT APPLY.
A. History of liver disease
B. Use of salt substitute
C. Use of an ACE inhibitor
D. Potassium-sparing diuretics
E. Prescription for insulin
B, C, D,
Nurse Kelly is caring for a patient who is 65 years old with a platelet count of 7,000 resulting from myelodysplastic syndrome. At 10 p.m. the patient complains of a headache. What should be the nurse's immediate action?
A) Administer aspirin per prn orders
B) Administer acetaminophen per orders
C) Notify the health care provider
D) Administer a nonpharmacological intervention like a cool compress
C) Notify the health care provider
The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. Which of the following allergies is most important for the nurse to assess before this procedure?
A. Iron
B.Iodine
C. Aspirin
D .Penicillin
B.Iodine
A cigarette vendor was brought to the emergency department of a hospital after she fell into the ground and hurt her left leg. She is noted to be tachycardic and tachypneic. Painkillers were carried out to lessen her pain. Suddenly, she started complaining that she is still in pain and now experiencing muscle cramps, tingling, and paraesthesia. Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3 25 mmol/L. What does this mean?
Respiratory Alkalosis, Uncompensated
The primary disorder is acute respiratory alkalosis (low CO2) due to the pain and anxiety causing her to hyperventilate. There has not been time for metabolic compensation.
The nurse is caring for a client who is receiving a loop diuretic for treatment of heart failure. Which of these actions will be included in the plan of care?
SELECT ALL THAT APPLY.
A. Assess daily weights.
B. Encourage consumption of citrus fruits.
C. Weigh the client weekly.
D. Monitor serum potassium.
E. Discourage intake of spinach.
F. Monitor for bradycardia.
A, B, D
A client with hypermagnesemia is seen in the emergency department (ED). Which of these interventions is most appropriate?
A. Monitor for hyperactive reflexes
B. prepare for endotracheal intubation
C. Institute teaching on avoiding magnesium rich foods
D. Place the client on a cardiac monitor
A. Calcium level of 9.5 mg/dL (2.4 mmol/L)
Which of the following symptoms would be expected in the patient diagnosed with Polycythemia Vera (PV)? Select All that Apply
A) HA
B) Palpatable spleen
C) Angina
D) Polyuria
E) Dyspnea
A, B, C and E
A client in the cardiac stepdown unit reports severe, crushing chest pain accompanied by nausea and vomiting. What action by the nurse takes priority?
a. Administer an aspirin.
b. Call for an electrocardiogram (ECG).
c. Maintain airway patency.
d. Notify the provider
c. Maintain airway patency.
Ricky’s grandmother has been suffering from persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid-base disorder is shown?
Metabolic Alkalosis, Uncompensated
The primary disorder is uncompensated metabolic alkalosis (high HCO3 -). As CO2 is the strongest driver of respiration, it generally will not allow hypoventilation as compensation for metabolic alkalosis.
The nurse is preparing a client a diagnosis of congestive heart failure (CHF) for discharge. Which statement by the client indicates a correct understanding of self-management of CHF?
A. "I can gain 2 pounds (1 kg) of water a day without risk."
B. "I should call my provider if I gain more than 1 pound (0.5 kg) a week."
C. "Weighing myself daily can determine if my caloric intake is adequate."
D. "Weighing myself daily can reveal increased fluid retention."
D. "Weighing myself daily can reveal increased fluid retention."
The nurse is caring for an older adult with hypernatremia. Which of these interventions does the nurse perform first?
A. Restrict the client's intake of sodium
B. Administer a diuretic
C. Monitor the serum osmolarity
D. Encourage fluid intake
D. Encourage fluid intake
Which of the following complications would the nurse know to monitor for in the patient with primary thrombocythemia?
A) bleeding and clot formation
B) HA and dizziness
C) Stroke and syncope
D) Infection and DVT
A. Bleeding and clot formation
A 55- year old patient with dilated cardiomyopathy is admitted for increasing dyspnea and fatigue. The nurse assesses the patient's medication list. Which of the following medications should the nurse anticipate the healthcare provider will order to improve cardiac output?
A. Metoprolol
B. Furosemide
C. Digoxin
D. Liniopril
C. Digoxin
Anne, who is drinking beer at a party, falls and hits her head on the ground. Her friend Liza dials “911” because Anne is unconscious, depressed ventilation (shallow and slow respirations), rapid heart rate, and is profusely bleeding from both ears. Which primary acid-base imbalance is Anne at risk for if medical attention is not provided?
Respiratory Acidosis
One of the risk factors of having respiratory acidosis is hypoventilation.
The charge nurse on a medical-surgical unit is completing assignments for the day shift. Which client is most appropriate to assign to the LPN/LVN?
A. A 44-year-old with congestive heart failure (CHF) who has gained 3 pounds (1.4 kg) since the previous day
B. A 58-year-old with chronic renal failure (CRF) who has a serum potassium level of 6 mEq/L (6.0 mmol/L)
C. A 76-year-old with poor skin turgor who has a serum osmolarity of 300 mOsm/kg (300 mmol/kg)
D. An 80-year-old with 3+ peripheral edema and crackles throughout the posterior chest
C. A 76-year-old with poor skin turgor who has a serum osmolarity of 300 mOsm/kg (300 mmol/kg)
The rapid response team (RRT) is called to the bedside of a client with heart rate of 38 beats per minute and a potassium level of 7.0 mEq/L (7.0 mmol/L). For which medication will the nurse anticipate a prescription?
A. Insulin
B. atropine
C. Sodium polystyrene sulfonate (Kayexalate)
D. potassium phosphate
A. Insulin
A nurse has just begun an 8 hour shift and is presented with the following patients. Which patient is the nurse's priority at this time?
a) A 43 year-old female just transferred to the floor who is complaining of generalized weakness for the past 3 weeks and appears pale and thin. No labs have been drawn. Vital signs are 109/65, T98.8, P72, R19, O2 94%, pain 0/10.
b) A 66 year-old male with a history of polycythemia vera who has a ruddy complexion, whose wife pressed the call bell because her husband has developed weakness on the L side of his body with accompanying slurred speech.
c) A 19 year-old female who has had bloody stools and unexplained bruising for the past 2 days. Hgb is 9, Hct is 27, RBC count is 3.9, WBC count is 7,000, Platelets are 145,000.
d) A 75 year-old male who has a history of mutiple myeloma who has a Ca+ level of 12.3
b) A 66 year-old male with a history of polycythemia vera who has a ruddy complexion, whose wife pressed the call bell because her husband has developed weakness on the L side of his body with accompanying slurred speech.
A nurse is assigned four clients. Which client should the nurse see first?
A. A 50-year-old client with diverticulitis
B. A 50-year-old client three days post myocardial infarction
C. A 33-year-old client with a recent diagnosis of Guillain-Barré syndrome
D. A 17-year-old client 24 hours post appendectomy
C. A 33-year-old client with a recent diagnosis of Guillain-Barré syndrome