Labs
A 68-year-old client with a long-standing history of chronic obstructive pulmonary disease (COPD) is admitted to the medical unit in acute respiratory distress. Their arterial blood gas (ABG) results show: pH 7.28, PaCO₂ 62 mm Hg, and HCO₃⁻ 29 mEq/L. How should the nurse interpret these findings?
A. Uncompensated metabolic acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory alkalosis
D. Uncompensated metabolic alkalosis
B. Partially compensated respiratory acidosis
The low pH (7.28) indicates acidemia, the high PaCO2 (62 mmHg) shows a primary respiratory acidosis, and the elevated bicarbonate (29 mEq/L) demonstrates that the kidneys have begun attempting compensation, making it partially compensated.
What is the reversal agent of Warfarin?
Vitamin K
What is room air's FiO2?
21%
Four hours post-abdominal hysterectomy, a 44-year-old client has a surgical drain output of 150 mL of bright red blood in the last hour. Vital signs: BP 92/58 mmHg (down from 118/76 mmHg), HR 118 bpm, RR 22/min, skin is cool and clammy, and urine output is 15 mL over the last hour. What is the nurse's best immediate action?
A. Document the findings and continue to monitor vital signs every 15 minutes.
B. Administer a prescribed PRN intravenous analgesic for reported incisional pain.
C. Notify the surgeon immediately, increase IV fluid infusion rates per protocol, and prepare for possible emergency intervention.
D. Place the client in the high Fowler’s position to promote lung expansion.
C. Notify the surgeon immediately, increase IV fluid infusion rates per protocol, and prepare for possible emergency intervention.
A client undergoing myelosuppressive chemotherapy has a morning platelet count of 18,000/mm³. Which set of nursing interventions is most appropriate for this individual?
B. Encourage aggressive physical ambulation in the hallway every two hours.
C. Instruct the client to use an ultra-soft toothbrush and avoid intramuscular injections.
D. Monitor the client closely for signs of digital clubbing and chronic hypoxia.
C. Instruct the client to use an ultra-soft toothbrush and avoid intramuscular injections.
A platelet count of 18,000/mm represents severe thrombocytopenia. Standard precautions include avoiding trauma, avoiding IM injections, and using soft-bristled toothbrushes to prevent mucosal bleeding.
A client taking digoxin for heart failure reports nausea, vomiting, and seeing yellowish-green halos around lights. A lab draw reveals a serum digoxin level of 2.4 ng/mL. What is the appropriate interpretation of this lab value?
A. Therapeutic level; symptoms are unrelated.
B. Toxic level; the therapeutic range is 0.5-2.0 ng/mL.
C. Subtherapeutic level; dosage needs to be increased.
D. Normal level; the patient is experience a benign side effect.
B. Toxic level; the therapeutic range is 0.5-2.0 ng/mL.
A serum level of 2.4 ng/mL exceeds the normal therapeutic window and aligns with clinical signs of toxicity.
What is the reversal agent for benzodiazepines?
Flumazenil
A 65-year-old client is brought to the emergency department with sudden-onset right-sided hemiparesis and expressive aphasia starting 90 minutes ago. Non-contrast CT of the head is negative for acute intracranial hemorrhage. Vital signs are BP 178/96 mmHg, HR 88 bpm, SpO2 98%. What is the priority nursing and medical action before initiating intravenous recombinant tissue plasminogen activator (rt-PA)?
A. Administering an intravenous antihypertensive agent to ensure blood pressure is maintained below 185/110 mmHg.
B. Placing an indwelling urinary catheter and peripheral-inserted central catheter (PICC) line.
C. Waiting 3 additional hours to confirm whether neurological deficits become permanent or resolve spontaneously.
D. Administering a loading dose of intravenous heparin to halt clot propagation.
A. Administering an intravenous antihypertensive agent to ensure blood pressure is maintained below 185/110 mmHg.
Two hours post-operative following an exploratory laparotomy, a client's hemoglobin drops from 14 g/dL pre-op to 8.5 g/dL. Which clinical manifestation should the nurse immediately assess for?
A. Hypertension and bounding pulses
B. Bradypnea and warm, flushed skin
C. Periorbital edema and weight gain
D. Tachycardia, hypotension, and dizziness
D. Tachycardia, hypotension, and dizziness
A rapid drop in hemoglobin indicates acute hemorrhage/blood loss, leading to hypovolemic shock signs.
A client receiving a continuous intravenous heparin infusion for a deep vein thrombosis has an activated partial thromboplastin time (aPTT) of 115 seconds. The client begins to ooze blood from their IV insertion site. What is the priority nursing intervention?
A. Stop the heparin infusion immediately and prepare to administer protamine sulfate.
B. Increase the infusion rate by 2 mL/hr per protocol to clear the clot formation.
C. Adminsiter the subcutaneous vitamin K and recheck the aPTT in 6 hours.
D. Document the finding as expected and continue the current infusion rate.
A. Stop the heparin infusion immediately and prepare to administer protamine sulfate.
An aPTT of 115 seconds is critically elevated (therapeutic range is typically 1.5 to 2.5 times the baseline, roughly 46-70 seconds). Active bleeding and a super-therapuetic aPTT warrant immediate cessation of heparin and having its specific reversal agent, protamine sulfate ready.
A client with acute decompensated heart failure is prescribed high-dose IV furosemide. When administering the medication rapidly or in high cumulative doses, which adverse effect is the nurse most vigilant to monitor?
A. Permanent sever visual impairment
B. Metabolic alkalosis combined with hyperkalemia
C. Irreversible pulmonary fibrosis
D. Transient or permanent ototoxicity, particularly if pushed too fast
D. Transient or permanent ototoxicity, particularly if pushed too fast
Loop diuretics like furosemide can cause ototoxicity (tinnitus, hearing loss), especially when administered as a rapid IV bolus.
A postoperative client receiving patient-controlled analgesia (PCA) morphine becomes somnolent, with a respiratory rate of 6 breaths/min and pinpoint pupils. What is the immediate priority nursing action?
A. Draw an arterial blood gas to confirm metabolic acidosis.
B. Stop the opioid infusion, stimulate the client and administer naloxone as prescribed.
C. Administer flumazenil IV push to reverse the sedative narcotic effect.
D. Place the client in a high-Fowlers position and start continuous nasal cannula oxygen without addressing the drug source.
B. Stop the opioid infusion, stimulate the client and administer naloxone as prescribed.
A respiratory rate of 6 breaths/min indicates severe opioid-induced respiratory depression. Stopping the infusion and administering naloxone (Narcan) reverses the opioid agonism, restoring adequate ventilation.
A client with acute kidney injury has a serum potassium level of 6.2 mEq/L. Which of the following electrocardiogram (ECG) changes does the nurse anticipate observing first?
A. Flattened T waves
B. ST-segment depression
C. Tall, peaked T waves
D. U waves
C. Tall, peaked T waves
Hyperkalemia- associated with excitability
Hypokalemia- associated with depression/slowing things down
A client started on lisinopril for hypertension returns to the clinic 2 weeks later reporting a persistent, dry, hacking cough. Vital signs are stable, and lung sounds are clear. What is the appropriate nursing response and explanation?
A. Inform the client that this is a sign of impending angioedema and they must use an EpiPen.
B. Reassure the client that the cough will spontaneously disappear within 3 to 6 months of continued therapy.
C. Explain that the cough is a known side effect due to bradykinin accumulation and discuss a provider consultation to switch medication classes.
D. Instruct the client to take an over the counter cough suppressant and double their lisinopril dose.
C. Explain that the cough is a known side effect and discuss a provider consultation to switch medication classes.
ACE inhibitors prevent the breakdown of bradykinin, leading to it's accumulation in the respiratory tree, which triggers a dry cough. Switching to an Angiotensin II Receptor Blocker usually resolves this.
A client taking lithium carbonate for bipolar disorder presents with coarse hand tremors, severe nausea, vomiting, diarrhea, and ataxia. A serum lithium level returns at 2.1 mEq/L. Which underlying etiology or factor most commonly precipitates this toxicity?
A. Concurrent high dietary intake of potassium supplements.
B. High serum calcium levels causing bone demineralization
C. Sodium depletion or dehydration leading to increased renal absorption of lithium
D. Ingestion of large quantities of vitamin C citrus juices
C. Sodium depletion or dehydration leading to increased renal absorption of lithium
Lithium is handled by the kidneys, similar to sodium. When sodium levels are low or dehydration occurs, the proximal tubes reabsorb more lithium, elevating serum levels into toxic ranges.
A client with acute decompensated heart failure presents with severe dyspnea, pink frothy sputum, and an oxygen saturation of 82% on room air. Vital signs: BP 188/100 mmHg, HR 112 bpm, RR 32/min. Bilateral crackles are audible to the apices of the lungs. Which prescription should the nurse implement first?
A. Administer oral digoxin 0.25 mg daily.
B. Initiate non-invasive positive pressure ventilation (NIPPV) via face mask.
C. Administer metoprolol succinate 50 mg orally.
D. Infuse 500 mL of 0.9% normal saline rapidly over 30 minutes.
B. Initiate non-invasive positive pressure ventilation (NIPPV) via face mask.
An adult patient in the emergency department experiences an acute panic attack and presents with rapid, deep respirations (hyperventilation). Which pattern of arterial blood gas (ABG) results does the nurse expect to find?
A. pH 7.30, PaCO2 50 mm Hg, HCO3 24 mEq/L
B. pH 7.32, PaCO2 38 mm Hg, HCO3 18 mEq/L
C. pH 7.45, PaCO2 40 mm Hg, HCO3 24 mEq/L
D. PH 7.48, PaCO2 30 mm Hg, HCO3 24 mEq/L
D. PH 7.48, PaCO2 30 mm Hg, HCO3 24 mEq/L
Hyperventilation blows off carbon dioxide. A reduced PaCO2 causes the blood pH to rise, leading to acute respiratory alkalosis.
A 58-year-old client with type 2 diabetes mellitus and new-onset hypertension is prescribed metoprolol tartrate. What crucial educational point should the nurse emphasize regarding potential adverse drug interactions and symptom masking?
A. The medication can mask early warning signs of hypoglycemia such as tachycardia and tremors.
B. The drug will increase fasting blood glucose levels to dangeoursly high spikes by stimulating insulin resistance.
C. Metoprolol should be stopped abruptly if blood sugar drops below 70 mg/dL.
D. Clients on insulin do not need to check their blood glucose as frequently once starting this drug.
A. The medication can mask early warning signs of hypoglycemia such as tachycardia and tremors.
Beta-blockers block the sympathetic nervous system response, making classic signs of hypoglycemia like tremors, palpitations, and tachycardia. Clients must rely more heavily on monitoring blood glucose and watching for diaphoresis.
A 58-year-old client presents to the emergency department reporting crushing substernal chest pain radiating to the left jaw, accompanied by diaphoresis and nausea. An initial 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Which immediate collaborative intervention is the highest priority for this client?
A. Administering sublingual nitroglycerin 0.4 mg every 5 minutes for three consecutive doses.
B. Drawing serial troponin levels every 6 hours.
C. Initiating an continuous unfractionated heparin infusion at therapeutic weight-based rates.
D. Activating the cardiac catherization team for emergency percutaneous coronary intervention within 90 minutes.
D. Activating the cardiac catherization team for emergency percutaneous coronary intervention within 90 minutes.
ST-elevation myocardial infarction (STEMI) indicates acute coronary occlusion; the priority is immediate reperfusion therapy via primary PCI with a door to ballon time goal of under 90 minutes.
A 72-year-old client is admitted with severe dehydration secondary to gastroenteritis. Vital signs: BP 84/52 mmHg, HR 128 bpm, RR 24/min, SpO2 96% on room air, Temp 37.1°C. Laboratory results reveal: BUN 54 mg/dL, Serum creatinine 2.1 mg/dL, Serum sodium 151 mEq/L. After a 1,000 mL bolus of 0.9% sodium chloride, which finding indicates the client is still experiencing a critical fluid volume deficit requiring continued aggressive resuscitation?
A. Urine output of 45 mL over the past hour.
B. Serum sodium of 149 mEq/L and orthostatic hypotension with a heart rate increase of 28 bpm upon standing.
C. Mean arterial pressure of 78 mmHg.
D. Serum creatinine decreasing from 2.1 mg/dL to 1.7 mg/dL.
B. Serum sodium of 149 mEq/L and orthostatic hypotension with a heart rate increase of 28 bpm upon standing.
The presence of persistent orthostatic changes (HR jump > 20 bpm) and elevated serum sodium reflecting hemoconcentration and hypernatremia indicates that intravascular volume remains severely compromised.