Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
Maria, 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, Pa02 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?
A. Respiratory Acidosis, Partially Compensated
This option can be ruled out because the pH and PaCO2 levels indicate acidosis, but the compensation is not partial as the HCO3 is also low.
B. Metabolic Acidosis, Partially, Compensated
Maria's symptoms and the arterial blood gas values support this diagnosis. Metabolic acidosis is indicated by a low pH and a decreased bicarbonate (HCO3) level. The body attempts to compensate for this acidosis by hyperventilating, which is evidenced by her Kussmaul breathing, to decrease PaCO2. This compensation is partial because, despite the body's efforts, the pH is still significantly lower than normal.
C. Metabolic Alkalosis. Uncompensated
This option can be ruled out because the pH is low (acidosis) rather than high (alkalosis), and the HCO3 is low rather than high.
D. Respiratory Acidosis, Uncompensated
Respiratory Acidosis, Uncompensated is ruled out because the pH is low (acidosis), but the PaCO2 is normal, indicating metabolic rather than respiratory involvement.
This question is an excerpt from Nurse Dive's nursing test bank - Ati Med Surg Proctored Exam 8. Take the full exam now
Full Explanation
A. This option can be ruled out because the pH and PaCO2 levels indicate acidosis, but the compensation is not partial as the HCO3 is also low.
B. Maria's symptoms and the arterial blood gas values support this diagnosis. Metabolic acidosis is indicated by a low pH and a decreased bicarbonate (HCO3) level. The body attempts to compensate for this acidosis by hyperventilating, which is evidenced by her Kussmaul breathing, to decrease PaCO2. This compensation is partial because, despite the body's efforts, the pH is still significantly lower than normal.
C. This option can be ruled out because the pH is low (acidosis) rather than high (alkalosis), and the HCO3 is low rather than high.
D. Respiratory Acidosis, Uncompensated is ruled out because the pH is low (acidosis), but the PaCO2 is normal, indicating metabolic rather than respiratory involvement.
Similar Questions
A nurse is caring for a female client who has recurrent kidney stones and is scheduled for an intravenous pyelogram. Which of the following statements by the client should the nurse report to the provider?
A. “My period ended 2 days ago."
This statement is unrelated to the client's kidney stones and does not require reporting to the provider.
B. “I drink at least 2 quarts of fluid every day."
This statement indicates good fluid intake, which is generally beneficial for preventing kidney stones. It does not require reporting.
C. “I don't eat shellfish because it gives me hives."
This statement is unrelated to the client's kidney stones and does not require reporting.
D. “The last time I voided it was painful and red tinged"
This statement indicates possible hematuria (blood in the urine) and pain, which could be indicative of a urinary tract issue related to the kidney stones and requires reporting to the provider for further assessment and management.
Full Explanation
A. This statement is unrelated to the client's kidney stones and does not require reporting to the provider.
B. This statement indicates good fluid intake, which is generally beneficial for preventing kidney stones. It does not require reporting.
C. This statement is unrelated to the client's kidney stones and does not require reporting.
D. This statement indicates possible hematuria (blood in the urine) and pain, which could be indicative of a urinary tract issue related to the kidney stones and requires reporting to the provider for further assessment and management.
A woman 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?
A. Respiratory Acidosis, Partially Compensated
This is incorrect because the pH is indicative of alkalosis, not acidosis, and the body has not compensated.
B. Respiratory Alkalosis, Uncompensated
The arterial blood gas (ABG) values provided indicate a pH of 7.6, which is above the normal range (7.35-7.45), suggesting alkalosis. The PaCO2 is low at 31 mm Hg, indicating hyperventilation, which is a respiratory process. Since the HCO3 is normal at 25 mmol/L, it suggests that the metabolic system is not the cause of the alkalosis. The body has not had time to compensate for the high pH with renal adjustments to the bicarbonate level, which would be seen in a partially compensated state.
C. Metabolic Alkalosis. Uncompensated
This is incorrect because the bicarbonate level is normal, suggesting the metabolic system is not the cause.
D. Metabolic Alkalosis. Partially Compensated
This is incorrect because the bicarbonate level is normal, suggesting the metabolic system is not the cause.
Full Explanation
A. This is incorrect because the pH is indicative of alkalosis, not acidosis, and the body has not compensated.
B. The arterial blood gas (ABG) values provided indicate a pH of 7.6, which is above the normal range (7.35-7.45), suggesting alkalosis. The PaCO2 is low at 31 mm Hg, indicating hyperventilation, which is a respiratory process. Since the HCO3 is normal at 25 mmol/L, it suggests that the metabolic system is not the cause of the alkalosis. The body has not had time to compensate for the high pH with renal adjustments to the bicarbonate level, which would be seen in a partially compensated state.
C. This is incorrect because the bicarbonate level is normal, suggesting the metabolic system is not the cause.
D. This is incorrect because the bicarbonate level is normal, suggesting the metabolic system is not the cause.
A nurse is teaching a client who has a new diagnosis of hyperparathyroidism. The nurse should include in the teaching that the client is at risk for which of the following complications?
A. Pathologic fractures
Hyperparathyroidism can lead to bone resorption and weakening, putting the client at risk for fractures.
B. Impaired skin integrity
This is not directly associated with hyperparathyroidism.
C. Fluid retention
Hyperparathyroidism typically leads to hypercalcemia, which can result in polyuria and dehydration rather than fluid retention.
D. Dysphagia
This is not directly associated with hyperparathyroidism.
Full Explanation
A. Hyperparathyroidism can lead to bone resorption and weakening, putting the client at risk for fractures.
B. This is not directly associated with hyperparathyroidism.
C. Hyperparathyroidism typically leads to hypercalcemia, which can result in polyuria and dehydration rather than fluid retention.
D. This is not directly associated with hyperparathyroidism.