H ABG quiz

A client is being treated for fluid volume deficit with D5W, oral hydration, and management of viral symptoms. Which client data would indicate to the nurse that treatment has been successful? You answered this questionIncorrectly 1. BP 110/70 lying; 100/68 standing 2. Moist mucous membranes 3. Skin turgor recoil below clavicle is 3 seconds 4. Urine specific gravity of 1.033 5. Serum sodium 152 mEq (152 mmol/L)

1. & 2. Correct: These BP readings are within normal limits. Moist mucous membranes is a normal, desired finding. 3. Incorrect: Skin recoil delayed for more than 2 seconds indicates severe dehydration. 4. Incorrect: With fluid volume deficit, the specific gravity can be expected to be abnormally high. 5. Incorrect: This indicates hypernatremia, which is the same thing as dehydration.

Based on the results of the arterial blood gases (ABGs), what imbalance does the nurse understand the client to be exhibiting? Exhibit You answered this question correctly 1. Respiratory acidosis compensated 2. Respiratory acidosis partially compensated 3. Metabolic acidosis compensated 4. Metabolic acidosis partially compensated pH - 7.35 PaO2 - 95% PaCO2 - 49 HCO3 - 30

1. Correct: The pH is normal but is on the acidic side of normal. The PaCO2 is elevated, causing acid formation. The HCO3 is alkalotic and is increased to buffer the acid. The pH and PaCO2 match, so the original problem was respiratory acidosis, but compensation has occurred since the pH is now normal. 2. Incorrect: The pH is normal but is on the acidic side of normal. The PaCO2 is acid. The HCO3 is alkalotic. The pH and PaCO2 match, so the original problem was respiratory acidosis, but compensation has occurred since the pH is now low. 3. Incorrect: The pH is normal but is on the acidic side of normal. The PaCO2 is acid. The HCO3 is alkalotic. The pH and PaCO2 match, so the original problem was respiratory acidosis, but compensation has occurred since the pH is now low. 4. Incorrect: The pH is normal but is on the acidic side of normal. The PaCO2 is acid. The HCO3 is alkalotic. The pH and PaCO2 match, so the original problem was respiratory acidosis, but compensation has occurred since the pH is now low.

A nurse is caring for a client who was admitted with severe dehydration due to excessive vomiting. Which data noted by the nurse validates this diagnosis? You answered this questionIncorrectly 1. Urine specific gravity - 1.036 2. Dry mouth 3. Bradycardia 4. Tachypnea 5. Postural hypotension 6. Distended neck veins

1., 2., 4., & 5. Correct: These are signs and symptoms indicating that a client is dehydrated (fluid volume deficit). 3. Incorrect: Bradycardia is not seen with dehydration. 6. Incorrect: The client with fluid volume deficit will have flat neck veins.

The nurse is caring for a client 8 hours post colectomy who is receiving 40% humidified oxygen. ABG results are: pH= 7.30, pO2= 91, pCO2= 50, HCO3= 24. Based on this information, which nursing action should the nurse initiate? You answered this questionIncorrectly 1. Reposition the client every 2 hours. 2. Request respiratory therapy to perform postural drainage and percussion. 3. Increase oxygen percentage. 4. Initiate incentive spirometry. 5. Assess mental status.

1., 4., & 5. Correct: If you had just a colectomy, would you be taking nice deep breaths? No. So what would you be retaining? CO2, which makes your pCO2 go up and your pH go down. These interventions will help improve gas exchange. 2. Incorrect: Requesting postural drainage and percussion form respiratory therapy would not be the best nursing action to address the problem of retaining CO2. 3. Incorrect: How is oxygen going to help this client? It's not until they get rid of what? CO2. And the only way to rid of the CO2 is coughing and deep breathing.

A client arrives in the emergency department reporting signs and symptoms of nausea, numbness, prolonged muscle spasms, muscle twitching, and hand tremor. Current medications include furosemide 40 mg by mouth every morning. What acid/base imbalance does the nurse anticipate for this client? You answered this questionCorrectly 1. Respiratory acidosis 2. Respiratory alkalosis 3. Metabolic acidosis 4. Metabolic alkalosis

4. Correct: This client's condition indicates pending metabolic alkalosis. Hypokalemia related to potassium loss with a loop diuretic is a cause of metabolic alkalosis. 1. Incorrect: This client has no respiratory symptoms. This is not respiratory acidosis. 2. Incorrect: This client has no respiratory symptoms. This is not respiratory alkalosis. 3. Incorrect: This client's condition is related to hypokalemia. Acidosis is related to hyperkalemia. This client is on a loop diuretic and the signs and symptoms point to hypokalemia.

How should the nurse interpret the arterial blood gas (ABG) results of a client admitted with dehydration? Exhibit You answered this question 1. Metabolic acidosis 2. Respiratory acidosis 3. Metabolic alkalosis 4. Respiratory alkalosis 5. Uncompensated 6. Partially compensated 7. Fully compensated pH - 7.49 PaCO2 - 29 HCO3 - 24

4., & 5. Correct: The blood gases confirm respiratory alkalosis. Why? The pH is 7.49 (normal 7.35-7.45). This pH indicates alkalosis since it is high. Which other chemical says alkalosis? The PaCO2 of 29 (normal 35-45) is low which indicates alkalosis. The HCO3 is normal. This means that the client is in uncompensated respiratory alkalosis. 1. Incorrect: The blood gases confirm respiratory alkalosis. The Bicarb is normal, so the problem is not metabolic. 2. Incorrect: The blood gases confirm respiratory alkalosis. The PaCO2 of 29 (normal 35-45) is low which indicates alkalosis. For this client to bew in respiratory acidosis, the PaCO2 would be greater than 45. 3. Incorrect: The blood gases confirm respiratory alkalosis. The Bicarb is normal, so the problem is not metabolic. 6. Incorrect: Compensation has not begun because the bicarb is normal. To compensate the bicarb would need to decrease to bring the pH down to normal. 7. Incorrect: Fully compensated would occur if the pH is normal with abnormal CO2 and bicarb. You need knowledge of ABG interpretation. There are opposites in these options. You need to first decide if the client is in acidosis or alkalosis. So look at the pH of 7.49 (normal 7.35-7.45). This pH indicates alkalosis since it is high. You can eliminate options 1 and 2 since these are acidosis. That leaves options 3 and 4. Which other chemical says alkalosis? The PaCO2 of 29 (normal 35-45) is low which indicates alkalosis. The HCO3 is normal. This means that option 4, respiratory alkalosis is correct. How did this happen? The client must have been breathing too fast, blowing off CO2, an acid. Since the HCO3 is normal, compensation has not begun, so this is uncompensated respiratory alkalosis.

An intravenous infusion of 0.45% normal saline is prescribed at a rate of 1000 mL in 24 hours. The tubing has a drop factor of 15. How many drops per minute (gtts/min) are delivered? Round your answer to the nearest whole number. Provide your answer using numbers and decimal points only. You answered this question Incorrectly Enter the answer for the question below.

The formula used to calculate drop rates is the total number of milliliters divided by the total number of minutes multiplied by the drop factor. In this circumstance, the minutes portion must be figured first, that is, 24 hours equals 1440 minutes. Then, dividing 1000 by 1440 equals 0.694. This is multiplied by the drop factor, which is 15. Multiplying 15 by 0.694 equals 10.41, which rounds to 10.

A nurse arrives at the scene of a home fire along with local emergency medical services (EMS) to find a client lying in the front yard. Burns are noted to the face, neck and chest. In what order should the nurse care for this client at the scene? You answered this question incorrectly The Correct Order Establish airway patency Assess breathing Administer 100% humidified oxygen Soak burned area with cool water. Remove restrictive objects

your Selected Order Assess breathing Establish airway patency Remove restrictive objects Administer 100% humidified oxygen Soak burned area with cool water. Look at the hints in this question. The burns are to the face, neck and chest. What is the first thing that should pop into your mind when burns are noted to these areas? Airway! So the first three things that should be done for the client deals with airway and breathing. Make sure the airway is patent, that the client is breathing, and provide oxygen. Why 100%? Because the burn occurred in a closed environment, so the client is at risk for carbon monoxide poisoning. What should be done next. Stop the burning process. Just because the flames are gone does not mean that the burning process has stopped. Apply lots of cool water to stop the burning process. Burns cause swelling to occur. So the nurse needs to remove anything that wound restrict circulation once swelling begins.

A nurse assessing a client who is one day post thyroidectomy and identifies an arrhythmia on auscultation. While taking the blood pressure, the nurse notices the client's hand starts to tremble. What interventions are priority? You answered this questionIncorrectly 1. Initiate seizure precautions 2. Monitor potassium level 3. Monitor BUN and creatinine 4. Restrict calicum rich foods 5. Check for airway patency

1. & 5. Correct: The parathyroid glands can accidentally be removed with a thyroidectomy. Low calcium causes rigid and tight muscles. 2. Incorrect: What about potassium? Is this the problem chemical? No, calcium is. But, can calcium cause an arrhythmia? Yes, it can! See, the NCLEX Lady thought you would see arrhythmia and say that must be potassium, but don't let them get you off track.. Remember, no doubts or hesitation. But, what other chemical should you think about with calcium? Phosphorous, because we just said they have an INVERSE relationship. 3. Incorrect: What about BUN and creatinine? Are my kidney's involved, no not here. 4. Incorrect: The client is hypocalcemic. You would not restrict calicum rich foods. Instead you would provide a diet high in calicum rich foods.

An elderly, bed-bound client receiving G-tube feedings at home is transported to the emergency department after onset of behavioral changes and hallucinations. Which nursing action is priority while diagnostic testing is underway? You answered this questionCorrectly 1. Initiate seizure precautions 2. Monitor for signs of increased intracranial pressure 3. Orient to time, place, and person 4. Obtain vital signs q 15 minutes

1. Correct: Feeding tube clients tend to get dehydrated, especially clients on bed rest, because bed rest induces diuresis! If the client is already having neurological signs, a grand-mal seizure may be next! Better take seizure precautions while awaiting the serum sodium results. 2. Incorrect: When hypernatremia is present, the brain cells shrink because when the body is dehydrated, water is drawn from the cells into the vascular space.3. Incorrect: Until serum sodium is corrected, the client will be unable to process information regarding time, place, and person. The brain does not like it when the sodium is messed up.4. Incorrect: While you're taking vital signs, your client is having a seizure! Don't delay care!

A client with a diagnosis of heart failure is observed in Fowler's position states, "I can't get my breath". What is the priority intervention for this client? You answered this questionIncorrectly 1. Dangle the client's legs over the side of the bed. 2. Auscultate anterior and posterior lung fields bilaterally. 3. Call respiratory therapy to the room stat to bring an oxygen mask. 4. Administer PRN morphine sulfate 2 mg IVP via existing venous access device.

1. Correct: Since the client is already in a Fowler's position,the correct option would be to "Dangle the client's legs over the side of the bed." The reason is that by dangling the legs, blood is pooling in the periphery. This decreases the circulating blood volume so that the heart does not have to work as hard and blood will then go in a forward direction rather than going backward to the lungs. 2. Incorrect: This is assessment. The question is asking for an intervention. 3. Incorrect: This may take time. Do something to help the client immediately first. 4. Incorrect: The stem does not indicate that the client is experiencing any pain.

A client was admitted 48 hours ago in septic shock. Treatment included oxygen at 40% per ventimask, IV therapy of Lactated Ringer's (LR) at 150 mL/hr, vancomycin 1 gram IV every 8 hours, and methylprednisolone 40 mg IVP twice a day. Which clinical data indicates that treatment has been successful? You answered this questionIncorrectly 1. Blood pressure 96/68; HR 98; RR 20 2. WBC 12,000/mm3 (12 x 10^9)/L 3. CVP- 6 mmHg 4. pH- 7.30; pCO2- 44; pO2 -92; HCO3- 20 5. Urinary output of 20 mL/hr

1., & 3. Correct: The systolic BP should be greater than 90. Normal CVP is 2-6 mmHg. 2. Incorrect: Incorrect: WBC is elevated. 4. Incorrect: The client is still in metabolic acidosis, so no improvement. 5. Incorrect: Urinary output should be adequate if treatment is successful. The urinary output should be 30 mL/hr for an adult. You are looking for signs and symptoms that treatment of septic shock has been successful. If treatment has been successful then the client should be better. Here is one more thing to understand. The lactate provided in LR is quickly metabolized into bicarbonate by the normal liver; thus this solution can be used to treat many forms of metabolic acidosis. Option 1: True. The BP is above 90 systolic which means that the client is perfusing vital organs. The HR and RR are normal. Option 2: False. The WBCs are still elevated, indicating that the client is still sick. Normal range is 4,500 - 11,000 /mm3 (12 x 109)/L ​Option 3: True. Normal CVP is 2-6 mmHg. This client is well hydrated at this point. Option 4: False. This client is in metabolic acidosis, so is still sick. Metabolic acidosis occurs with severe sepsis. Look at the pH of 7.3 (normal 7.35-7.45). This pH is low or acidosis. What other chemical says acidosis? The HCO3 of 20 (normal 22-26) is acid. Note that the CO2 is normal at 44 (normal 35-45). Option 5: Urinary output should be adequate if treatment is successful. The adult should have at least 30 mL/hr for adequate urinary output.

How should the nurse interpret this arterial blood gas (ABG) report? ExhibitYou answered this questionIncorrectly 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis 5. Uncompensated 6. Partially compensated 7. Fully compensated pH - 7.33 PaO2 - 95% PaCO2 - 28 HCO3 - 18

1., & 6. Correct: This set of ABGs reflects partially compensated metabolic acidosis. The pH, bicarb, and carbon dioxide are all abnormal, so compensation is beginning. Since the pH is not normal yet, total compensation has not occurred. There is only partial compensation. 2. Incorrect: The pH remains low (acidic) so acidosis rather than alkalosis is occurring. 3. Incorrect: This set of ABGs reflects partially compensated metabolic acidosis. The pH, bicarb, and carbon dioxide are all abnormal, so compensation is beginning. Since the pH is not normal yet, total compensation has occurred. The pH and bicarb match indicating a metabolic problem initially. The lungs are attempting to compensate by blowing off CO2. 4. Incorrect: This set of ABGs reflects partially compensated metabolic acidosis. The original problem is not a lung problem, but a metabolic problem. So let's start with the pH of 7.33 (normal 7.35-7.45) which is low or acidosis. Full compensation does not occur until the pH is back to normal. Look at the PaCO2 of 28 (normal 35-45) which is low or alkaline. Look at the HCO3 of 18 (normal 22-26) which is low or acid. The HCO3 and the pH both say acid, so this is partially compensated metabolic acidosis: Options 1 and 6.

A client arrives at the emergency department (ED) after sustaining a high-voltage electrical injury. Which interventions should the nurse initiate in the ED? You answered this questionCorrectly 1. Assess entry and exit wound. 2. Monitor vital signs. 3. Monitor for myoglobinuria. 4. Connect to cardiac monitor. 5. Perform the rule of nines.

1., 2., 3., & 4. Correct: These are correct interventions for the nurse to initiate when caring for a client who has sustained a high-voltage electrical injury. Remember, electricity kills vessels, nerves, and organs. 5. Incorrect: The rule of nines would not be used for an electrical injury. Visual examination is not predictive of burn size and severity with an electrical burn injury.

The charge nurse recognizes that a new nurse can properly perform a linear wound dressing change on a surgical client when the new nurse performs which interventions correctly? You answered this question Incorrectly 1. Hand hygiene is done prior to the dressing change. 2. Dressing tape is removed in the direction opposite of the hair growth. 3. The soiled dressing is discarded in a biomedical waste bag. 4. Clean gloves are donned in order to clean the wound. 5. The center of the wound is cleaned first, then the wound area farthest from the nurse, then the area closest to the nurse. 6. New sterile dressing is applied to the wound.

1., 3., 5. & 6. Correct: These are all correct procedures for doing a dressing change. 2. Incorrect: Tape on the dressing is pulled parallel with the skin in the direction of hair growth. 4. Incorrect: STERILE vs. CLEAN ... Most dressing changes following surgery are sterile and require that the nurse use standard precautions and wear sterile gloves to clean the incision and apply sterile dressings. Clean gloves can be used to remove the old dressing. Dressings are never touched by ungloved hands.

A client with asthma has been admitted to the emergency room with sustained burns to the upper torso, face, and neck as a result of a steam injury when a pressure cooker exploded at home. Which intervention is the nurse's priority? You answered this questionCorrectly 1. Initiate high flow oxygen. 2. Prepare for endotracheal intubation. 3. Administer 1000mL of lactate ringers (LR). 4. Assess for head and neck injuries.

2. Correct: Intubation must be accomplished quickly while a tube can still be inserted. The burn clients neck and facial area may become edematous due to capillary permeability. This can be done while assuming the client may have a head and neck injury due to the explosion . 1. Incorrect: The clients airway is the initial concern. The ventilation of the client is the next step. Respiratory distress is an increase potenial due to pre existing diagnosis of asthma. 3. Incorrect: Fluid resuscitation is needed, however, airway comes first. The client will need IV fluids to replace the transfer of plasma to interstitual tissue. 4. Incorrect: Inserting a endotracheal tube to maintain an airway is the nurse's priority intervention. The client should then be evaluated for any head and neck injuries.

The client presents to the emergency department with nausea, vomiting and anorexia for the last few days. Based on the EKG obtained, what action should the nurse take first? ExhibitYou answered this question Incorrectly 1. Defibrillate at 200 joules x 2 2. Administer amiodarone IV 150 mg over 10 minutes 3. Infuse 500 mL NS with 40 mEq KCL (40 mmol/L) at 100 mL/hour 4. Begin 2 person cardiopulmonary resuscitation Rationale Strategies Let's Talk

2. Correct: The one electrolyte we worry about with arrhythmias is potassium. The first line medication is amiodarone. 1. Incorrect: Pulseless v-tach and v-fib require defibrillation. 3. Incorrect: KCL is needed but we need to treat the short run of v-tach first. 4. Incorrect: Not indicated. Treat short run of v-tach and increase potassium. First, note the word FIRST in the question. So all option could be correct, but one takes priority. Next, identify the clues in the question, such as "nausea", "vomiting", and "anorexia". What electrolyte should the nurse worry about when these clues are seen? Low potassium. The client has been vomiting, so the electrolytes losses are potassium, hydrogen, and chloride. The anorexia further complicates the condition because we get potassium from the foods we eat. Knowing this, you would be concerned that ventricular tachycardia or ventricular fibrillation could occur. So, look at the strip. You should have a basic knowledge of interpreting rhythm strips to identify the rhythm shown in the exhibit. This EKG shows short runs of ventricular tachycardia. So what is the first thing the nurse should do for v-tach. Give amiodarone, an antiarrhythmic medication. The question does not say that the client is pulseless, so do not read into the question. Pulseless v-tach would indicate the need for defibrillation. The client probably needs potassium, but correcting the v-tach takes priority. CPR is initiated with pulseless v-tach.

A nurse is caring for a client who had an abdominal hernia repair 16 hours ago. What interpretation should the nurse make based on the results of the client's arterial blood gases (ABGs)? ExhibitYou answered this questionCorrectly 1. Metabolic acidosis 2. Respiratory acidosis 3. Metabolic alkalosis 4. Respiratory alkalosis pH - 7.32 PaO2 - 93% PaCO2 - 48 HCO3 - 24

2. Correct: The pH is 7.32 (normal 7.35-7.45) which means acidosis. The paCO2 of 48 (normal 35-45) indicates a respiratory problem. The arterial blood gas results indicate that the client is in respiratory acidosis. 1. Incorrect: This is a respiratory problem. The bicarb is within normal limits, eliminating a metabolic problem. 3. Incorrect: The pH is low which indicates acidosis. The bicarb is within normal limits, eliminating a metabolic problem. 4. Incorrect: The pH is low, which indicates acidosis.

The nurse is reviewing morning laboratory results for multiple clients. Which client laboratory results should the nurse immediately report to the Healthcare provider? You answered this questionIncorrectly 1. Client with chronic obstructive pulmonary disease (COPD) and a PCO2 of 50 mm Hg. 2. Diabetic client with fasting blood sugar of 145 mg/dL (8.0 mmol/L). 3. Cardiac client on furosemide with potassium of 3.1mEq/L (3.1 mmol/L). 4. Client with sepsis and total white blood cell count of 16,000 mm3. 5. Client following a thyroidectomy with calcium level of 8.0 mg/dL (2 mmol/L).

3. & 5. Correct: Although all the laboratory results are outside of standard accepted levels, two particular clients are the most concerning. The cardiac client's potassium level of 3.1 is extremely concerning, since normal potassium levels should be between 3.5-5.0 mEq/L. Hypokalemia can cause muscle weakness and heart arrhythmias, such as PVC's. Secondly, after the client's thyroidectomy, their calcium level is 8.0 mg/dl (normal 9.0-10.5 mg/dl), indicating possible removal of parathyroid glands. Because hypocalcemia places the client at risk for seizures or laryngospasms as well as arrhythmias, the primary healthcare provider needs to be notified immediately so that corrective therapy can be initiated. 1. Incorrect: While this client's PCO2 of 50 is elevated (normal is 35-45 mm Hg), this is neither unexpected or unusual for an individual with COPD. This client will frequently experience elevated levels of PCO2; therefore, the nurse should just continue monitoring for any changes in respiratory status. 2. Incorrect: This diabetic client has a fasting blood sugar of 145, which is elevated above normal levels of 70-110. However, it is not uncommon for diabetics to occasionally have elevated glucose levels, even early in the morning. The nurse can address this issue by referring to the sliding scale for insulin administration. This does not need to be reported immediately to the primary healthcare provider. 4. Incorrect: It is expected that clients diagnosed with sepsis will have extremely elevated white blood cell counts. Despite the fact that this lab result is outside of normal values (4,500 - 10,000 mm3), this level is not concerning enough to immediately contact the primary healthcare provider. Option 1: Not this one. The client has COPD, which means the arterial blood gas results will always be abnormal! A PCO2 of 50 mm Hg would not be unexpected in this client, even though normal levels are 35-45 mm Hg. The nurse would continue to monitor the respiratory status of this client, so no need to page the primary healthcare provider with this one. Option 2: Not this one either! The big issue with diabetic clients is the on-going battle to control blood glucose levels. You are also aware that since this client is hospitalized, there must be some type of illness, and that will most likely increase blood sugar readings. The nurse will refer to a sliding scale for possible insulin coverage and should compare these results to previous glucose levels. However, because you would expect somewhat elevated blood sugar readings, there is no need for immediate primary healthcare provider intervention. Option 3: Yes, now you should be worried! The information presented indicates this client has a history of cardiac problems and is taking furosemide. You remember that this particular loop diuretic causes the body to excrete potassium in urine; therefore, the potassium levels should be monitored. Also, recall that potassium has a very small normal range of 3.5-5.0 mEq/L, indicating that this client's levels are too low. Potassium can cause big problems for the body, regardless of whether it's too high or too low. In this case, low potassium levels can cause muscle cramps or twitching, leading to muscle paralysis, or worse yet, life-threatening arrhythmias. This is very dangerous for this cardiac client, and the nurse should definitely report this immediately to the primary healthcare provider. Option 4: Let's think about this - the client is septic! You would expect the white blood count to be elevated, even dramatically high, correct? This should not surprise anyone! Even with a lab result nearly double the normal levels, the nurse would not be overly concerned enough to track down the primary healthcare provider. Try again! Option 5: Excellent thinking! Start with what you know and what you expect. We know this client had a thyroidectomy and so you quickly recall what you know: it is a surgical intervention in which the client will have a frontal neck incision, and you also know that initial concerns include airway and bleeding. But what else do we worry about? How about the possibility that a couple parathyroid glands might accidently be removed? So now think what that means: possible hypocalcemia. What do we worry about? Seizure, laryngospasms, aspiration and even arrhythmias as the muscles become tight and rigid. Do you think the primary healthcare provider might worry that this client's calcium level is 8.0.mg/dl, when it should be between 9.0 -10.5 mg/dl? Grab the phone on this one!

A new nurse asks the charge nurse for assistance in interpreting arterial blood gases (ABGs) for a client. What acid/base imbalance should the charge nurse tell the new nurse these ABGs indicate in the client? ExhibitYou answered this questionIncorrectly 1. Metabolic acidosis 2. Respiratory alkalosis 3. Metabolic alkalosis 4. Respiratory acidosis 5. Uncompensated 6. Partially compensated 7. Fully compensated

3., & 6. Correct: Partially compensated metabolic alkalosis is indicated by these ABGs. The pH is 7.5 (normal 7.35-7.45) which is high, which means alkalosis. The PaCO2 is 58 (normal 35-45) which is high. Greater than 45 is acidosis from too much CO2. The HCO3 is 35 (normal 22-26) which is high. A high bicarb level equals alkalosis. The HCO3 matches the pH as both indicate alkalosis. The initial problem was a kidney problem or metabolic alkalosis. The lungs are trying to compensate by holding on to more acid. So the correct answer is partially compensated metabolic alkalosis. 1. Incorrect: A pH of greater than 7.45 indicates alkalosis rather than acidosis. So this option is incorrect. 2. Incorrect: The PaCO2 would be low rather than high if the problem was respiratory alkalosis. 4. Incorrect: A pH of greater than 7.45 indicates alkalosis rather than acidosis. So this option is incorrect. 5. Incorrect: If the ABGs indicated that compensation had not begun (uncompensated) then the CO2 would be normal. Since it is high, the lungs are attempting to compensate for the metabolic alkalosis retaining more acid (Decrease breathing to hold on to acid). 7. Incorrect: Full compensation does not occur until the pH is normal. The pH is still abnormal here. You must open the provided exhibit in order to see the ABG results. We know that there is partial compensation going on since the pH, PaCO2, and HCO3 are all abnormal. There are opposites in the options. The results are metabolic or respiratory and acidosis or alkalosis. Look at the pH of 7.5 (normal 7.35-7.45) which is high or alkalosis. So options 1 and 4 can be eliminated since these indicate acidosis. Next, look at the PaCO2 of 58 (normal 35-45) which is high or acidosis. Look at the HCO3 of 35 (normal 22-26) which is high or alkalosis. The HCO3 matches the pH as both indicate alkalosis. So the correct answer is Option 3: metabolic alkalosis. Since the pH is still not normal, the client is partially compensated(Option 6).

Standard orders on the nurse's unit include an intravenous infusion of 0.45 NS 1000 mL with 20 mEq (20 mmol/L) potassium chloride to run at 100 mL per hour. This IV solution would be appropriate for which client diagnosis? You answered this questionCorrectly 1. Addisonian crisis 2. Hypertension 3. Chronic renal failure 4. Cushing's disease 5. Hypokalemia

4. & 5. Correct: Clients with cramping, Cushing's disease, and hypokalemia are safe to receive normal saline with potassium chloride. 1. Incorrect: Clients with Addison's disease can have hyperkalemia if they experience an Addisonian crisis due to lack of aldosterone. When aldosterone is not secreted, sodium and water is released and potassium levels elevate in response to the hyponatremia. 2. Incorrect: Clients with hypertension need a hypotonic solution which will not increase the client's blood pressure. However, the client may or may not have hypokalemia. 3. Incorrect: Clients in chronic renal failure are retaining fluid and potassium. They do not need more potassium.

Which signs and symptoms would concern the nurse if assessed in a client post radical neck surgery? You answered this questionIncorrectly 1. Bradypnea 2. Flaccid muscle tone 3. Flushed and warm skin 4. Positive Trousseau's sign 5. Leg cramps 6. Decreased deep tendon reflexes

4., & 5. Correct: A positive Trousseau's sign indicates that muscles are rigid and tight due to a low calcium level. Some of the parathyroids could have been removed resulting in hypocalcemia. Hypocalcemia will cause muscle twitching and painful muscle cramps. 1. Incorrect: The respiratory rate will decrease with hypermagnesemia and hypercalcemia. 2. Incorrect: Weak, flaccid muscle tone is seen with hypercalcemia. 3. Incorrect: Flushed and warm skin would be seen with hypermagnesemia due to vasodilation. 6. Incorrect: Decreased deep tendon reflexes would occur with hypermagnesemia or hypercalcemia.

Which information should the community health nurse include when explaining to a group of college students living in a dormitory about receiving an immune globulin (IG) injection for hepatitis A virus (HAV)? You answered this questionIncorrectly 1. Immune globulin contains antibodies that destroy the HAV, preventing infection. 2. Immune globulin protection is permanent, so no other injection is required. 3. Common side effects of the injection include soreness and swelling around the injection site. 4. The sooner you get a shot of IG after being exposed to HAV, the greater the likelihood of protection from the virus. 5. Crowded living environments such as dormitories place people at risk for HAV.

1., 3., 4. & 5. Correct: These are all correct statements about immune globulin for Hepatitis A. 2. Incorrect: IG protection is only temporary, lasting about 3 months.

The client has pustules on the arm from intravenous drug abuse. The microbiology laboratory informs the nurse that the client's cultures are growing methicillin-resistant Staphylococcus aureus (MRSA). Which action would the nurse take? You answered this questionIncorrectly 1. Implement droplet precautions immediately. 2. Inform the client to wear a mask when ambulating in the hall. 3. Instruct the client on the importance of hand hygiene. 4. Cover the pustules to prevent drainage. 5. Allow pustules to drain freely.

3. & 4. Correct: It is important that the nurse implement these interventions in order to prevent the spread of infection. If the client refuses to follow instructions, then isolation precautions are warranted. 1. Incorrect: Contact isolation should be instituted. 2. Incorrect: The client is placed on contact precautions not droplet precautions. The client would not wear a mask. 5. Incorrect: The pustules should be covered with a dressing. Opening the pustules will increase the chance of spreading the infection.