Exam 2 (midterm) Review 1

HCO3 (bicarbonate)

22-28 mEq/L

PCO2 normal range

35-45 mmHg

normal ph

7.35-7.45

Normal PO2

80-100 mmHg

METABOLIC ACIDOSIS Bicarb level

<21 mEq/L

metabolic acidosis ph

<7.35

respiratory acidosis

A drop in blood pH due to hypoventilation (too little breathing) and a resulting accumulation of Co2.

metabolic acidosis

Abnormal condition of high hydrogen ion concentration in the extracellular fluid caused by either a primary increase in hydrogen ions or a decrease in bicarbonate.

The nurse is instructing a 65-year-old female client diagnosed with osteoporosis. The most important instruction regarding exercise would be to: • A. Exercise doing weight bearing activities. B. Exercise to reduce weight. C. Avoid exercise activities that increase the risk of fracture. D. Exercise to strengthen muscles and thereby protect bones.

Answer: A. Exercise doing weight bearing activities. • A: Weight bearing exercises are beneficial in the treatment of osteoporosis. • B, C, D: Although loss of bone cannot be substantially reversed, further loss can be greatly reduced if the client includes weight bearing exercises along with estrogen replacement and calcium supplements in their treatment protocol.

Which assessment finding indicates that lactulose is effective in decreasing the ammonia level in the client with hepatic encephalopathy?• A. Passage of two or three soft stools daily. B. Evidence of watery diarrhea. C. Daily deterioration in the client's handwriting. D. Appearance of frothy, foul-smelling stools.

Answer: A. Passage of two or three soft stools daily. • A: Two or three soft stools daily indicate effectiveness of the drug. • B: Watery diarrhea indicates overdose .• C: Daily deterioration in the client's handwriting indicates an increase in the ammonia level and worsening of hepatic encephalopathy. • D: Frothy, foul-smelling stools indicate steatorrhea, caused by impaired fat digestion.

After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent? • A. Primary hypothyroidism B. Graves' disease C. Thyrotoxicosis D. Euthyroidism

Answer: A. Primary hypothyroidism • Levothyroxine is the preferred agent to treat primary hypothyroidism and cretinism, although it also may be used to treat secondary hypothyroidism. It is contraindicated in Graves' disease and thyrotoxicosis because these conditions are forms of hyperthyroidism. Euthyroidism, a term used to describe normal thyroid function, wouldn't require any thyroid preparation.

Rau Kuohui, a 50-year-old female, was shot in the right side of her chest. She is currently in the progressive care unit. Her arterial blood gases are as follows: • pH 7.30 • PaO2 88 mmHg • PaCO2 50 mmHg • Bicarbonate 26 mEq/L • Lactate 5 mg/dL Ms. Kuohui's condition continues to deteriorate. What actions should be taken to restore Ms. Kuohui's acid-base balance?

Answer: Actions include improving gas exchange and lung expansion with drug therapy (bronchodilators, anti-inflammatories, mucolytics), ventilator support, supplemental oxygen, proper positioning, and breathing techniques. • Rationale: Drug therapy focuses on improving ventilation and oxygenation rather than directly on altering arterial pH. Oxygen therapy helps promote gas exchange for patients with respiratory acidosis. Ventilation support with mechanical ventilation may be needed for patients who cannot keep their oxygen saturation at 90% or who have respiratory muscle fatigue. Pulmonary hygiene (positioning and breathing techniques) help maintain a patent airway.

An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: A. 2 to 5 g of a simple carbohydrate. B. 10 to 15 g of a simple carbohydrate. C. 18 to 20 g of a simple carbohydrate. D. 25 to 30 g of a simple carbohydrate.

Answer: B. 10 to 15 g of a simple carbohydrate. • To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.

For a client with hepatic cirrhosis who has altered clotting mechanisms, which intervention would be most important?• A. Allowing complete independence of mobility. B. Applying pressure to injection sites. C. Administering antibiotics as prescribed. D. Increasing nutritional intake.

Answer: B. Applying pressure to injection sites. • B: Prolonged application of pressure to injection or bleeding sites is important. • A: Complete independence may increase the client's potential for injury, because an unsupervised client may injure himself and bleed excessively. • C&D: Antibiotics and good nutrition are important to promote liver regeneration.

During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise? A. At least once a week B. At least three times a week C. At least five times a week D. Every day

Answer: B. At least three times a week • Diabetic clients must exercise at least three times a week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once a week wouldn't achieve these goals. Exercising more than three times a week, although beneficial, would exceed the minimum requirement.

The nurse knows that a 60-year-old female client's susceptibility to osteoporosis is most likely related to: • A. Lack of exercise. B. Hormonal disturbances. C. Lack of calcium. D. Genetic predisposition.

Answer: B. Hormonal disturbances. • B: After menopause, women lack hormones necessary to absorb and utilize calcium. • A & C: Doing weight-bearing exercises and taking calcium supplements can help to prevent osteoporosis but are not causes, so answers A and C are incorrect. • D: Body types that frequently experience osteoporosis are thin Caucasian females, but they are not most likely related to osteoporosis, so answer D is incorrect.

Which of the following conditions most commonly causes acute glomerulonephritis? • A. A congenital condition leading to renal dysfunction. B. Prior infection with group A Streptococcus within the past 10-14 days. C. Viral infection of the glomeruli. D. Nephrotic syndrome.

Answer: B. Prior infection with group A Streptococcus within the past 10-14 days. • Acute glomerulonephritis is most commonly caused by the immune response to a prior upper respiratory infection with group A Streptococcus. Glomerular inflammation occurs about 10-14 days after the infection, resulting in scant, dark urine and retention of body fluid. Periorbital edema and hypertension are common signs at diagnosis.

Nurse Oliver should expect a client with hypothyroidism to report which health concerns? • A. Increased appetite and weight loss B. Puffiness of the face and hands C. Nervousness and tremors D. Thyroid gland swelling

Answer: B. Puffiness of the face and hands • Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).

THE PRINCIPLE OBJECTIVE OF MEDICAL MANAGEMENT IS TO: A. Irradiate the gland in an attempt to stimulate hormonal secretion. B. Replace the missing hormone. C. Remove the diseased gland. D. Withhold exogenous iodine to create a negative feedback response, which will force the gland to secrete hormones.

Answer: B. Replace the missing hormone. B: To balance the level of thyroid hormones, the principal objective of medical management should be to replace the missing hormone. A: Irradiating the gland could worsen the disorder. C: Removing the diseased gland could worsen the disorder. D: Withholding exogenous iodine could worsen the disorder.

Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? • A. Diabetic ketoacidosis B. Thyroid crisis C. Hypoglycemia D. Tetany

Answer: B. Thyroid crisis • Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

A client diagnosed with chronic cirrhosis who has ascites and pitting peripheral edema also has hepatic encephalopathy. Which of the following nursing interventions are appropriate to prevent skin breakdown?• A. Range of motion every 4 hours. B. Turn and reposition every 2 hours. C. Abdominal and foot massages every 2 hours. D. Sit in chair for 30 minutes each shift.

Answer: B. Turn and reposition every 2 hours.• B: Careful repositioning can prevent skin breakdown. • A: Range of motion exercises preserve joint function but do not prevent skin breakdown. • C: Abdominal or foot massage will not prevent skin breakdown but must be cleansed carefully to prevent breaks in skin integrity .• D: The feet should be kept at the level of heart or higher so Fowler's position should be employed.

A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client:• A. prefers to take insulin orally. B. has type 2 diabetes. C. has type 1 diabetes. D. is pregnant and has type 2 diabetes.

Answer: B. has type 2 diabetes. • Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents aren't effective in type 1 diabetes. Pregnant and lactating women aren't prescribed oral antidiabetic agents because the effect on the fetus is uncertain.

A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating: A. "The test needs to be repeated following a 12-hour fast." B. "It looks like you aren't following the prescribed diabetic diet." C. "It tells us about your sugar control for the last 3 months." D. "Your insulin regimen needs to be altered significantly."

Answer: C. "It tells us about your sugar control for the last 3 months." • The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.

A CLINICAL MANIFESTATION USUALLY ASSOCIATED WITH HYPOTHYROIDISM IS: A. A pulse rate lower than 95 bpm but greater than 60 bpm. B. An elevated systolic blood pressure. C. Muscular fatigability. D. Weight loss.

Answer: C. Muscular fatigability. C: Extreme fatigue makes it difficult for the person to complete a full day's work or participate in usual activities. A: A pulse rate lower than 95 bpm but greater than 60 bpm is considered normal. B: An elevated systolic blood pressure is not a sign of hypothyroidism. D: Weight loss is not a sign of hypothyroidism.

An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of: • A. Thyroid storm. B. Cretinism. C. myxedema coma. D. Hashimoto's thyroiditis.

Answer: C. myxedema coma. • Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.

NURSING COMFORT MEASURES FOR A PATIENT WITH HYPOTHYROIDISM SHOULD INCLUDE: A. Encouraging frequent periods of rest throughout the day. B. Offering the patient additional blankets to help prevent chilling. C. Using a cleansing lotion instead of soap for the skin. D. All of the above.

Answer: D. All of the above. D: All of the interventions listed above are appropriate for a patient with hypothyroidism. A: Promoting rest could avoid extreme fatigue. B: Additional blankets could prevent chilling for the cold-intolerant patient. C: Using a cleansing lotion could moisturize the dry skin instead of soap.

Nurse Joey is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to:• A. Encourage the client to ask questions about personal sexuality. B. Provide time for privacy. C. Provide support for the spouse or significant other. D. Suggest referral to a sex counselor or other appropriate professional.

Answer: D. Suggest referral to a sex counselor or other appropriate professional. • The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling.

The preferred medication for treating hypothyroidism is A. Lithium. B. Propranolol. C. Propylthiouracil. D. Synthroid.

Answer: D. Synthroid. D: Synthetic levothyroxine is the preferred preparation for treating hypothyroidism and suppressing nontoxic goiters. A: Lithium is not recommended for patients with hypothyroidism. B: Propranolol is not recommended for patients with hypothyroidism. C: Propylthiouracil is not recommended for patients with hypothyroidism.

NURSING CARE FOR A PATIENT WITH HYPOTHYROIDISM INCLUDES ASSESSING FOR CLINICAL MANIFESTATIONS ASSOCIATED WITH HYPOTHYROIDISM. A MANIFESTATION NOT CONSISTENT WITH HER DIAGNOSIS IS A: A. Change in her menstrual pattern. B. Pulse rate of 58 bpm. C. Temperature of 95.88 ºF. D. Weight loss of 10 lbs over a 2-week period.

Answer: D. Weight loss of 10 lbs over a 2-week period. D: Weight gain occurs in hypothyroidism. A: A change in her menstrual pattern is a sign of hyperthyroidism. B: A pulse rate of 58 bpm is a sign of hyperthyroidism. C: A temperature of 95.88⁰F is a sign of hyperthyroidism.

Rau Kuohui, a 50-year-old female, was shot in the right side of her chest. She is currently in the progressive care unit. Her arterial blood gases are as follows: • pH 7.30 • PaO2 88 mmHg • PaCO2 50 mmHg • Bicarbonate 26 mEq/L • Lactate 5 mg/dL Does Ms. Kuohui have an acid-base imbalance? If so, what type of imbalance?

Answer: Yes, she has respiratory acidosis. Rationale: The patient's pH is low (acidotic condition), PaCO2 is high (respiratory etiology - retention of carbon dioxide), bicarbonate and lactate are normal. These findings indicate respiratory acidosis.

Respiratory alkalosis

Arise in blood pH due to hyperventilation (excessive breathing) and a resulting decrease in CO2.

What is HCO3?

Bicarbonate a byproduct of your body's metabolism. Your blood brings bicarbonate to your lungs, and then it is exhaled as carbon dioxide. Your kidneys also help regulate bicarbonate. Bicarbonate is excreted and reabsorbed by your kidneys. This regulates your body's pH, or acid balance.

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?• A. Respiratory Acidosis• B. Respiratory Alkalosis• C. Metabolic Acidosis• D. Metabolic Alkalosis

Correct Answer: A • The patient has respiratory acidosis (raised carbon dioxide) resulting from an acute exacerbation of chronic obstructive pulmonary disease,

The nurse is reviewing the record of a female client with Crohn's disease. Which stool characteristics should the nurse expect to note documented in the client's record? A. Diarrhea B. Chronic Constipation C. Constipation alternating with diarrhea D. Stools constantly oozing from the rectums

Correct Answer: A. Diarrhea• Option A: Crohn's disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity.• Options B, C, & D: These are not characteristics of Crohn's disease.

DR. SMITH HAS DETERMINED THAT THE CLIENT WITH HEPATITIS HAS CONTRACTED THE INFECTION FROM CONTAMINATED FOOD. THE NURSE UNDERSTANDS THAT THIS CLIENT IS MOST LIKELY EXPERIENCING WHAT TYPE OF HEPATITIS? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D

Correct Answer: A. Hepatitis A Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. The most common mode of transmission of hepatitis A is via the fecal-oral route from contact with food, water, or objects contaminated by fecal matter from an infected individual. It is more commonly encountered in developing countries where due to poverty and lack of sanitation, there is a higher chance of fecal-oral spread. Option B: Hepatitis B is transmitted parenterally and sexually when individuals come in contact with mucous membranes or body fluids of infected individuals. Transfusion of blood and blood products, injection drug use with shared needles, needlesticks, or wounds caused by other instruments in healthcare workers and hemodialysis are all examples of parenteral and percutaneous exposures, but parenteral mode remains the dominant mode of transmission both globally and in the United States. Option C: Transmission of Hepatitis C can be parenteral, perinatal, and sexual, with the most common mode being the sharing of contaminated needles among IV drug users. Also, other high-risk groups include people who require frequent blood transfusions and organ transplantation of organs from infected donors. Option D: Hepatitis D is an RNA virus and a single species in the Deltavirus genus. It contains the hepatitis D antigen and RNA strand and uses HBsAg as its envelope protein; therefore, those who get hepatitis D virus infection have coinfection with the hepatitis B virus as well. Hepatitis D virus has similar modes of transmission as the hepatitis B virus, but perinatal transmission is uncommon.

The nurse is evaluating a female child with acute post streptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement?• A. Increased urine output •B Increased appetite• C Increased energy level• D Decreased diarrhea.

Correct Answer: A. Increased urine output • Option A: Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute post-streptococcal glomerulonephritis (APSGN) is improving. • Options B, C, & D: Increased appetite, an increased energy level, and decreased diarrhea are not specific to APSGN.

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?• A. Respiratory Acidosis• B. Respiratory Alkalosis• C. Metabolic Acidosis• D. Metabolic Alkalosis

Correct Answer: B • 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.

FOR A CLIENT WITH HEPATIC CIRRHOSIS WHO HAS ALTERED CLOTTING MECHANISMS, WHICH INTERVENTION WOULD BE MOST IMPORTANT? • Allowing complete independence of mobility • Applying pressure to injection sites • Administering antibiotics as prescribed • Increasing nutritional intake

Correct Answer: B. Applying pressure to injection sites. The client with cirrhosis who has altered clotting is at high risk for hemorrhage. Prolonged application of pressure to injection or bleeding sites is important. Instruct patient/SO of signs and symptoms that warrant notification of health care provider: increased abdominal girth; rapid weight loss/gain; increased peripheral edema; increased dyspnea, fever; blood in stool or urine; excess bleeding of any kind; jaundice.

A CLIENT IS SUSPECTED OF HAVING HEPATITIS. WHICH DIAGNOSTIC TEST RESULT WILL ASSIST IN CONFIRMING THIS DIAGNOSIS? A.Elevated Hemoglobin level B.Elevated Serum Bilirubin level C. Elevated blood urea nitrogen level D.Decreased erythrocyte sedimentation rate.

Correct Answer: B. Elevated serum bilirubin level. Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. Baseline evaluation in a patient suspected to have viral hepatitis can be started by checking a hepatic function panel. Patients who have a severe disease can have elevated total bilirubin levels. Typically, levels of alkaline phosphatase (ALP) remain in the reference range, but if it is elevated significantly, the clinician should consider biliary obstruction or liver abscess.

The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? A. Hypotension B. Bloody Diarrhea C. Rebound tenderness D. A hemoglobin level of 12 mg/dl

Correct Answer: C. Rebound tenderness • Option C: Rebound tenderness may indicate peritonitis. • Option B: Bloody diarrhea is expected to occur in ulcerative colitis .• Options A & D: Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the physician.

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? • A. Respiratory Acidosis • B. Respiratory Alkalosis • C. Metabolic Acidosis • D. Metabolic Alkalosis

Correct Answer: D • The student was diagnosed with diabetes mellitus. The results show that he has metabolic acidosis (low HCO3 -) with respiratory compensation (low CO2).

A 52-YEAR-OLD MAN WAS REFERRED TO THE CLINIC DUE TO INCREASED ABDOMINAL GIRTH. HE IS DIAGNOSED WITH ASCITES BY THE PRESENCE OF A FLUID THRILL AND SHIFTING DULLNESS ON PERCUSSION. AFTER ADMINISTERING DIURETIC THERAPY, WHICH NURSING ACTION WOULD BE MOST EFFECTIVE IN ENSURING SAFE CARE? A. Measuring serum potassium for hyperkalemia B. Assessing the client for hypervolemia C.Measuring the client's weight weekly D.Documenting precise intake and output

Correct Answer: D. Documenting precise intake and output. For the client with ascites receiving diuretic therapy, careful intake and output measurement are essential for safe diuretic therapy. Diuretics lead to fluid losses, which if not monitored closely and documented, could place the client at risk for serious fluid and electrolyte imbalances. The most common adverse effect for any diuretic is mild hypovolemia, which can lead to transient dehydration and increased thirst. When there is an over-treatment with a diuretic, this could lead to severe hypovolemia, causing hypotension, dizziness, and syncope.

JORDIN IS A CLIENT WITH JAUNDICE WHO IS EXPERIENCING PRURITUS. WHICH NURSING INTERVENTION WOULD BE INCLUDED IN THE CARE PLAN FOR THE CLIENT? A. Administering vitamin K subcutaneously B. Applying pressure when giving I.M. injections C.Decreasing the client's dietary protein intake D.Keeping the client's fingernails short and smooth

Correct Answer: D. Keeping the client's fingernails short and smooth The client with pruritus experiences itching, which may lead to skin breakdown and possibly infection from scratching. Keeping his fingernails short and smooth helps prevent skin breakdown and infection from scratching. Encourage the patient to adopt skin care routines to decrease skin irritation. One of the first steps in the management of pruritus is promoting healthy skin and healing of skin lesions.

WHICH RATIONALE SUPPORTS EXPLAINING THE PLACEMENT OF AN ESOPHAGEAL TAMPONADE TUBE IN A CLIENT WHO IS HEMORRHAGING? A. Allowing the client to help insert the tube B. Beginning teaching for home care C. Maintaining the client's level of anxiety and alertness D. Obtaining cooperation and reducing fear

Correct Answer: D. Obtaining cooperation and reducing fear An esophageal tamponade tube would be inserted in critical situations. Typically, the client is fearful and highly anxious. The nurse, therefore, explains the placement to help obtain the client's cooperation and reduce his fear.

CIRRHOSIS WHO HAS ASCITES AND PITTING PERIPHERAL EDEMA ALSO HAS HEPATIC ENCEPHALOPATHY. WHICH OF THE FOLLOWING NURSING INTERVENTIONS ARE APPROPRIATE TO PREVENT SKIN BREAKDOWN? SELECT ALL THAT APPLY. A. Range of motion every 4 hours B. Turn and reposition every 2 hours C. Abdominal and foot massages every 2 hours D. Alternating air pressure mattressE. Sit in chair for 30 minutes each shift

Correct Answers: B & D Edematous tissue must receive meticulous care to prevent tissue breakdown. An air pressure mattress, careful repositioning can prevent skin breakdown. Inspect pressure points and skin surfaces closely and routinely. Gently massage bony prominences or areas of continued stress. Use of emollient lotions and limiting use of soap for bathing may help. •Option A: Range of motion exercises preserve joint function but do not prevent skin breakdown. Encourage and assist the patient with reposition on a regular schedule. Assist with active and passive ROM exercises as appropriate. •Option B: Repositioning reduces pressure on edematous tissues to improve circulation. Exercises enhance circulation and improve and/or maintain joint mobility. Edematous tissues are more prone to breakdown and to the formation of decubitus. Ascites may stretch the skin to the point of tearing in severe cirrhosis. •Option C: Abdominal or foot massage will not prevent skin breakdown but must be cleaned carefully to prevent breaks in skin integrity. Keep linens dry and free of wrinkles. Moisture aggravates pruritus and increases the risk of skin breakdown. •Option D: Use an alternating pressure mattress, egg-crate mattress, waterbed, sheepskins, as indicated. Reduces dermal pressure, increases circulation, and diminishes the risk of tissue ischemia. •Option E: The feet should be kept at the level of the heart or higher so Fowler's position should not be employed. Recommend elevating lower

respiratory acidosis paCO2

Decreased PaO2 with rising PaCO2

Metabolic alkalosis ph

Greater than 7.45

Respiratory alkalosis ph

Greater than 7.45

Metabolic alkalosis pacO2

High

Mr. Worried is a 52-year-old widow. He is retired and living alone. He enters the ED complaining of shortness of breath and tingling in fingers. His breathing is shallow and rapid. He denies diabetes; blood sugar is normal. There are no EKG changes. He has no significant respiratory or cardiac history. He takes several antianxiety medications. He says he has had anxiety attacks before. While being worked up for chest pain an ABG is done: • ABG results are: • pH= 7.48 • PaCO2= 28 • HCO3= 22 • PaO2= 85 What is the expected intervention?

If he is hyperventilating from an anxiety attack, the simplest solution is to have him breathe into a paper bag. He will rebreathe some exhaled CO2.This will increase PaCO2 and trigger his normal respiratory drive to take over breathing control.• * Please note this will not work on a person with chronic CO2 retention, such as a COPD patient. These people develop a hypoxic drive, and do not respond to CO2 changes.

You are the critical care nurse about to receive Mr. Sweet, a 24-year-old DKA (diabetic ketoacidosis) patient from the ED. The medical diagnosis tells you to expect acidosis. In report you learn that his blood glucose on arrival was 780. He has been started on an insulin drip and has received one amp of bicarb. You will be doing finger stick blood sugars every hour. • ABG results are: • pH= 7.33 • PaCO2= 25 • HCO3=12 • PaO2= 89 What is the intervention?

Insulin, so the body can use the sugar in the blood and stop making ketones, which are an acidic by-product of protein metabolism. In the mean time, pH should be maintained near normal so that oxygenation is not compromised

respiratory acidosis ph

Less than 7.35

metabolic acidosis paCO2

Low <35 usually 31

• pH <7.35 • Bicarbonate <21 mEq/L • PaO2 normal • PaCO2 normal or slightly decreased • Serum potassium high

METABOLIC ACIDOSIS

An elderly woman from a nursing home was transferred to hospital because of profound weakness and diarrhea. Her oral intake had been poor for a few days. Current medication was a sleeping tablet which was administered by nursing staff as needed. pH 7.58 pCO2 42 mmHg pO2 88 mmHg HCO3 44.4 What is her acid-base problem?

Metabolic Alkalosis • pH elevated • HCO3 elevated

• pH <7.35 • PaO2 low • PaCO2 high • Serum bicarbonate variable • Serum potassium levels elevated (if acute acidosis) • Serum potassium levels normal or low (if renal compensation present)

RESPIRATORY ACIDOSIS

combined metabolic and respiratory acidosis

Uncorrected respiratory acidosis leads to poor oxygenation and lactic acidosis More severe than metabolic or respiratory acidosis alone Combined problem of DKA and COPD lead to this

Metabolic alkalosis

elevation of HCO3- usually caused by an excessive loss of metabolic acids

Respiratory alkalosis paco2

low

What is PO2?

partial pressure of O2 in arterial blood reflects the amount of oxygen gas dissolved in the blood

What is PaCO2?

partial pressure of carbon dioxide in arterial blood This measures the pressure of carbon dioxide dissolved in the blood and how well carbon dioxide is able to move out of the body.

An elderly woman from a nursing home was transferred to hospital because of profound weakness and diarrhea. Her oral intake had been poor for a few days. Current medication was a sleeping tablet which was administered by nursing staff as needed. pH 7.58 pCO2 42 mmHg pO2 88 mmHg HCO3 44.4 What is your intervention?

replacing water and electrolytes (sodium and potassium) while treating the cause

Mr. Worried is a 52-year-old widow. He is retired and living alone. He enters the ED complaining of shortness of breath and tingling in fingers. His breathing is shallow and rapid. He denies diabetes; blood sugar is normal. There are no EKG changes. He has no significant respiratory or cardiac history. He takes several antianxiety medications. He says he has had anxiety attacks before. While being worked up for chest pain an ABG is done: • ABG results are: • pH= 7.48 • PaCO2= 28 • HCO3= 22 • PaO2= 85 What is the patient's problem?

respiratory alkalosis • pH is high, • PaCO2 is low.

Hallmark sign of respiratory alkalosis

• ABG result with ↑ pH coupled with low CO2 level • O2 and bicarbonate usually normal

• You are the critical care nurse about to receive Mr. Sweet, a 24-year-old DKA (diabetic ketoacidosis) patient from the ED. The medical diagnosis tells you to expect acidosis. In report you learn that his blood glucose on arrival was 780. He has been started on an insulin drip and has received one amp of bicarb. You will be doing finger stick blood sugars every hour. • ABG results are: • pH= 7.33 • PaCO2= 25 • HCO3=12 • PaO2= 89 What is the problem?

• The pH is acidotic, • PaCO2 is 25 (low) which should create alkalosis. • This is a respiratory compensation for the metabolic acidosis. • The underlying problem is, of course, a metabolic acidosis.

METABOLIC ACIDOSIS Labs

• pH <7.35 • Bicarbonate <21 mEq/L • PaO2 normal • PaCO2 normal or slightly decreased • Serum potassium high

RESPIRATORY ACIDOSIS Labs

• pH <7.35 • PaO2 low • PaCO2 high • Serum bicarbonate variable • Serum potassium levels elevated (if acute acidosis) • Serum potassium levels normal or low (if renal compensation present)