Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
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 Pa02 60 mm Hg.
How would you interpret this?
A. Metabolic Acidosis. Partially Compensated
Metabolic acidosis would involve a low pH and low bicarbonate level, which is not evident in the given arterial blood gas results.
B. Respiratory Acidosis, Uncompensated
The low pH (acidosis) and high PaCO2 (respiratory component) indicate respiratory acidosis. The increased HCO3 (normal range of 22-26 mEq/L), suggests a renal compensatory mechanism attempting to normalize the pH.
C. Respiratory Acidosis, Partially Compensated
George Kent's arterial blood gas values indicate a lower pH and an elevated PaCO2, which are consistent with respiratory acidosis. The increased HCO3 ((normal range of 22-26 mEq/L), suggests a renal compensatory mechanism attempting to normalize the pH.
D. Metabolic Alkalosis Uncompensated
Metabolic alkalosis is not supported by the given arterial blood gas results.
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Full Explanation
A. Metabolic acidosis would involve a low pH and low bicarbonate level, which is not evident in the given arterial blood gas results.
B. The low pH (acidosis) and high PaCO2 (respiratory component) indicate respiratory acidosis. The increased HCO3 (normal range of 22-26 mEq/L), suggests a renal compensatory mechanism attempting to normalize the pH.
C. George Kent's arterial blood gas values indicate a lower pH and an elevated PaCO2, which are consistent with respiratory acidosis. The increased HCO3 ((normal range of 22-26 mEq/L), suggests a renal compensatory mechanism attempting to normalize the pH.
D. Metabolic alkalosis is not supported by the given arterial blood gas results.
Similar Questions
A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect?
A. Intention tremors
Intention tremors are not typically associated with Addison's disease.
B. Hyperpigmentation
Hyperpigmentation, particularly in sun-exposed areas and pressure points, is a characteristic finding in Addison's disease due to increased melanocyte-stimulating hormone (MSH) production.
C. Purple striations
Purple striations are typically associated with Cushing's syndrome, not Addison's disease.
D. Hirsutism
Hirsutism (excessive hair growth) is not a common manifestation of Addison's disease. It is more associated with Cushing’s disease.
Full Explanation
A. Intention tremors are not typically associated with Addison's disease.
B. Hyperpigmentation, particularly in sun-exposed areas and pressure points, is a characteristic finding in Addison's disease due to increased melanocyte-stimulating hormone (MSH) production.
C. Purple striations are typically associated with Cushing's syndrome, not Addison's disease.
D. Hirsutism (excessive hair growth) is not a common manifestation of Addison's disease. It is more associated with Cushing’s disease.
A nurse is reviewing laboratory values for a client who has systemic lupus erythematosus (SLE).
Which of the following values should give the nurse the best indication of the client's renal function?
A. Blood urea nitrogen (BUN)
Blood urea nitrogen (BUN) can be affected by factors other than renal function, such as hydration status and protein intake.
B. Serum creatinine
Serum creatinine is a more specific indicator of renal function because it reflects the glomerular filtration rate (GFR). Elevated levels indicate impaired renal function.
C. Urine-specific gravity
Urine-specific gravity can provide some information about renal concentrating ability but is not as specific or sensitive as serum creatinine for assessing overall renal function.
D. Serum sodium
Serum sodium levels may be affected by various factors, including hydration status and medications, but they do not directly reflect renal function.
Full Explanation
A. Blood urea nitrogen (BUN) can be affected by factors other than renal function, such as hydration status and protein intake.
B. Serum creatinine is a more specific indicator of renal function because it reflects the glomerular filtration rate (GFR). Elevated levels indicate impaired renal function.
C. Urine-specific gravity can provide some information about renal concentrating ability but is not as specific or sensitive as serum creatinine for assessing overall renal function.
D. Serum sodium levels may be affected by various factors, including hydration status and medications, but they do not directly reflect renal function.
A nurse is caring for a client who has preeclampsia and is being treated with magnesium sulfate IV. The client's respiratory rate is 10/min and deep-tendon reflexes are absent. Which of the following actions should the nurse take?
A. Place the client in Trendelenburg position.
Placing the client in Trendelenburg position is not appropriate in this situation. It may worsen respiratory depression caused by magnesium sulfate.
B. Discontinue the medication infusion.
Absent deep-tendon reflexes and respiratory depression are signs of magnesium toxicity.Discontinuing the medication infusion is essential to prevent further toxicity.
C. Prepare for an emergency cesarean birth.
While preeclampsia can lead to complications necessitating emergency cesarean birth, the immediate concern here is addressing magnesium toxicity.
D. Assess maternal blood glucose.
Assessing maternal blood glucose is not relevant to the management of magnesium toxicity.
Full Explanation
A. Placing the client in Trendelenburg position is not appropriate in this situation. It may worsen respiratory depression caused by magnesium sulfate.
B. Absent deep-tendon reflexes and respiratory depression are signs of magnesium toxicity.
Discontinuing the medication infusion is essential to prevent further toxicity.
C. While preeclampsia can lead to complications necessitating emergency cesarean birth, the immediate concern here is addressing magnesium toxicity.
D. Assessing maternal blood glucose is not relevant to the management of magnesium toxicity.