Exam 2 EAQ study questions

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The nurse is providing discharge teaching for a patient who has repeated vasoocclusive episodes caused by sickle cell disease (SCD). Which statement by the patient indicates a need for further teaching? 1 "I can drink beer in moderation." 2 "I should avoid strenuous exercise." 3 "I will drink 3 to 4 liters of fluid daily." 4 "I'll need an influenza vaccine every year."

"I can drink beer in moderation." Patients with SCD should be taught how prevent crises and complications. Alcohol should be avoided. Patients with SCD should get a flu shot annually. Strenuous exercise should be avoided, but participating in mild exercise is encouraged. Patients with SCD should consume at least 3 to 4 liters of liquids every day.

A patient with anemia is prescribed a transfusion of packed red blood cells (PRBCs) to be administered over 4 hours. What is the approximate volume to be transfused? 1 100 to 150 mL 2 200 to 250 mL 3 300 to 350 mL 4 400 to 450 mL

200 to 250 mL

A patient diagnosed with idiopathic thrombocytopenic purpura has received teaching about the diagnosis. What statement by the patient indicates a need for further teaching? 1 "My body is destroying my own platelets." 2 "I should not have major issues with clotting." 3 "My body makes a normal amount of platelets." 4 "I may have developed this after a viral infection."

"I should not have major issues with clotting." Clotting is impaired in patients with idiopathic thrombocytopenic purpura (ITP). The body does make a normal amount of platelets; however, the body produces antibodies that destroy them. It is likely that the ITP developed from a viral infection.

The registered nurse teaches a student nurse about the actions to be followed after an infusion of blood products. Which statement made by the student nurse shows ineffective understanding? 1 "I will safely dispose of the bag after infusion." 2 "I will document every detail of the transfusion." 3 "I will safely dispose of the tubing after infusion." 4 "I will monitor the vital signs of the patient after the transfusion."

"I will monitor the vital signs of the patient after the transfusion." The vital signs of the patient should be assessed before, during, and after the infusion therapy. Accurate vital signs help to determine any changes caused by transfusion reactions. Disposal of the bag and tubing safely after transfusion helps prevent the spread of blood borne pathogens. The transfusion details (such as the type of product infused, product number, volume infused, time of infusion, and any adverse reactions) should be documented in the patient record.

A patient has a serum magnesium level of 1.2 mEq/L. Which instruction by the nurse is appropriate? 1 "Notify me if you have diarrhea." 2 "I will be giving you an intramuscular injection of magnesium sulfate." 3 "Your urine may become darker and more concentrated in appearance." 4 "I will be administering a phosphorus supplement in addition to the magnesium supplement."

"Notify me if you have diarrhea. A serum magnesium level of 1.2 mEq/L represents mild hypomagnesemia (normal is 1.3-2.1 mEq/L) for which oral magnesium supplements are administered. Oral magnesium may lead to diarrhea; diarrhea contributes to magnesium loss. With severe hypomagnesemia, the IV route (instead of IM) is used because the IM route causes tissue damage and pain. Any medications containing phosphorus are contraindicated because they would contribute to associated hypocalcemia. Magnesium therapy does not affect the urine.

A patient with a low platelet count asks why platelets are important. Which response by the nurse is correct? 1 "Platelets make your blood clot." 2 "Blood clotting is prevented by your platelets." 3 "The clotting process begins with your platelets." 4 "Your platelets finish the clotting process."

"The clotting process begins with your platelets." Platelets begin the blood clotting process by forming platelet plugs, but these platelet plugs are not clots and cannot provide complete hemostasis. Platelets do not clot blood; they are a part of the clotting process or cascade of coagulation. Platelets do not prevent the blood from clotting; rather they function to help blood form clots. Platelets do not finish the clotting process, they begin it.

A patient with anemia asks, "Why am I feeling tired all the time?" How does the nurse respond? 1 "How many hours are you sleeping at night?" 2 "You are not getting enough iron." 3 "You need to rest more when you are sick." 4 "Your cells are delivering less oxygen than you need.

"Your cells are delivering less oxygen than you need. The single most common symptom anemia is fatigue, which occurs because oxygen delivery to cells is less than is required to meet normal oxygen needs. Although assessment of sleep and rest is good, it does not address the cause related to the diagnosis. While it may be true that the patient isn't getting enough iron, it does not relate to the patient's fatigue. The statement about the patient needing rest because of being sick is simply not true.

A patient with hyperkalemia is being treated with drugs to improve the condition. Which potassium level indicates that therapy is effective? 1 7.6 mEq/L 2 5.6 mEq/L 3 4.6 mEq/L 4 2.6 mEq/

4.6 mEq/L

The nurse is caring for four patients. Which patient should the nurse assess first? 1 A patient diagnosed with hemophilia who is complaining of knee pain 2 A patient diagnosed with heparin-induced thrombocytopenia (HIT) who received argatroban 3 A patient diagnosed with idiopathic thrombocytopenic purpura (ITP) with platelet count of 9,000 mm 3 4 A patient diagnosed with thrombotic thrombocytopenic purpura (TTP) who has just completed an infusion of fresh frozen plasma

A patient diagnosed with hemophilia who is complaining of knee pain The patient with hemophilia who is reporting knee pain is likely to have bleeding in the joint space; assessing this patient is priority. The patient with ITP and a low platelet count should be assessed for injury but has no complaints and is therefore not the priority. The patient with HIT has already received treatment. The patient with TTP has just received treatment.

A patient is admitted with chronic anemia. What physiologic imbalance does the nurse suspect the patient is at risk of developing? 1 Acidosis 2 Alkalosis 3 Hypokalemia 4 Ineffective ventilation

Acidosis Protein buffers, especially hemoglobin buffers, are the primary buffer of hydrogen ions. When patients are anemic, there is less hemoglobin to buffer hydrogen ions and a reduced ability for the body to prevent acidosis. There is no information that suggests the patient is at risk for ineffective ventilation, hypokalemia, or alkalosis.

When administering 20 mEq potassium chloride intravenously (IV), which is the priority intervention? 1 Administer at a rate of 10 mEq/hr. 2 Monitor respiratory rate and depth. 3 Monitor for pain or burning at the IV infusion site. 4 Place the patient on a heart monitor during administration

Administer at a rate of 10 mEq/hr.

Which prescribed intervention does the nurse implement first for a patient with metabolic acidosis from shock? 1 Obtain blood cultures. 2 Apply oxygen via face mask. 3 Administer intravenous fluids. 4 Insert an indwelling urinary catheter

Administer intravenous fluids To treat metabolic acidosis from shock, replacing intravascular volume through administration of intravenous fluids is the priority intervention. Applying oxygen, inserting a urinary catheter, and obtaining blood cultures can be completed after intravenous fluids are initiated.

A nurse is caring for a group of patients who are all about to receive transfusions. Which order requires correction? 1 Administer platelets with Ringer's lactate solution. 2 Transfuse white blood cells (WBCs) over 45 minutes. 3 Draw blood type and cross-match prior to administering plasma. 4 Check vital signs q15 min during transfusion of packed red blood cells (PRBCs)

Administer platelets with Ringer's lactate solution. Blood and blood products should be administered with normal saline, not Ringer's lactate or dextrose in water, due to the risk of clotting or hemolysis. WBCs should be administered slowly over 45 to 60 minutes. Vital signs should be checked before, after, and every 15 minutes during the transfusion. Blood type and cross-match should be checked before administering a plasma transfusion because the plasma contains the donor's ABO antibodies, which could react with the recipient's blood.

A diagnosis of autoimmune thrombocytopenic purpura is made after detection of what finding in the blood? 1 Antiplatelet antibodies 2 Elevated platelet counts 3 Elevated red blood cells 4 Low hemoglobin and hematocri

Antiplatelet antibodies Antiplatelet antibodies are consistent with the autoimmune form of thrombocytopenic purpura. Platelet counts would not be elevated. Red blood cell counts would not be diagnostic for thrombocytopenic purpura. Low hemoglobin and hematocrit may occur, but they are not diagnostic for thrombocytopenic purpura.

What is one of the causes of respiratory alkalosis? 1 Anxiety 2 Antacid use 3 Kidney failure 4 Diuretic therapy

Anxiety Hyperventilation is one cause of respiratory alkalosis, which can result from fear and anxiety. Kidney failure and diuretic therapy are not causes of respiratory alkalosis. The use of antacids can result in metabolic alkalosis.

When caring for a patient with a pulse oximetry level of 89%, which action does the nurse take first? 1 Get the patient out of bed. 2 Auscultate breath sounds. 3 Apply oxygen as prescribed. 4 Notify the patient's health care provider

Apply oxygen as prescribed Applying oxygen is the first priority for a patient with hypoxemia. It is unclear whether the patient is stable to be out of bed; elevating the HOB (head of bed) would be more appropriate to improve respiratory expansion. Notifying the health care provider is an appropriate action after initiation of oxygen therapy; delaying intervention while waiting for the provider delays treatment. Breath sounds can be auscultated after initiation of oxygen therapy; hypoxemia may be present in the absence of adventitious breath sounds.

A patient has a bone marrow biopsy done. Which nursing intervention is the priority postprocedure? 1 Applying pressure to the biopsy site 2 Inspecting the site for ecchymoses 3 Sending the biopsy specimens to the laboratory 4 Teaching the patient about avoiding vigorous activity

Applying pressure to the biopsy site The initial action should be to stop bleeding by applying pressure to the site. Inspecting for ecchymoses, sending specimens to the laboratory, and teaching the patient about activity levels will be done after hemostasis has been achieved.

A patient receiving insulin and glucose infusion therapy for hyperkalemia now has a serum potassium level of 3.6 mEq/L. What is the nurse's first action? 1 Stop the infusion immediately. 2 Continue the infusion at the prescribed rate. 3 Assess the patient's heart rate, rhythm, and respiratory status. 4 Slow the infusion and increase the frequency of vital sign assessment.

Assess the patient's heart rate, rhythm, and respiratory status The serum potassium is now at the low end of normal range (3.5-5.0 mEq/L). The nurse must first assess the patient's response to the infusion and subsequent change in serum potassium (notably a change in respiratory effectiveness and quality and regularity of the heart rate). Once assessment data are obtained, the nurse should contact the provider and the infusion may be stopped, but it does not have to occur immediately.

A patient's morning laboratory results show a serum ionized calcium of 2.85 mmol/L. For what sign must the nurse assess? 1 Tachypnea 2 Blood clotting 3 Muscle spasms 4 Increased peristalsis

Blood Clotting Hypercalcemia allows blood clots to form more easily, especially in the lower legs and pelvic region. The nurse should assess for signs of blood clotting associated with the elevated serum calcium. Increased peristalsis and muscle spasms are associated with hypocalcemia. Tachycardia can occur initially with mild hypercalcemia, but bradycardia is associated with severe hypercalcemia.

Which assessment finding requires priority nursing intervention in a patient with metabolic or respiratory acidosis? 1 Dry skin 2 Rapid respiratory rate 3 Lethargy and confusion 4 Bradycardia with widened QRS complex

Bradycardia with widened QRS complex Cardiovascular manifestations that require priority nursing interventions are related to delayed electrical conduction; specifically bradycardia that may progress to heart block, tall T waves, widened QRS complex, and prolonged PR interval. Other changes like lethargy, confusion, rapid respiratory rate, and dry skin are important to address but may not require priority interventions.

Hyponatremia most affects the cells of which body systems? Select all that apply. 1 Cerebral 2 Endocrine 3 Respiratory 4 Cardiovascular 5 Neuromuscular

Cardiovascular Neuromuscular Cerebral

What is the most appropriate nursing intervention in a patient with fluid overload and edema to prevent skin breakdown on pressure areas? 1 Monitoring the urine output 2 Changing position every 2 hours 3 Administering diuretic drug therapy 4 Limiting the intake of fluids and sodium

Changing position every 2 hours Changing the patient's position every 2 hours may help in promoting circulation and preventing pressure on bony prominences. Monitoring the urine output helps to determine the effectiveness of therapies used to restore normal fluid balance. Administering diuretic drug therapy is an intervention to decrease fluid overload. Limiting the intake of fluids and sodium can decrease the fluid overload in chronic management.

Which consequence of fluid overload may result in seizures, coma, and death? 1 Decreased hematocrit 2 Decreased hemoglobin 3 Decreased serum proteins 4 Decreased serum sodium and potassium levels

Decreased serum sodium and potassium levels Fluid overload may cause a decrease in serum electrolytes such as sodium and potassium, which can lead to seizures, coma, and death. A decrease in hematocrit due to fluid overload decreases the serum osmolarity, which may cause pulmonary edema or heart failure. A decrease in hemoglobin increases the respiratory rate to meet the oxygen needs of the body. A decrease in serum proteins decreases the serum osmolarity and may cause pulmonary edema or heart failure.

2.The nurse is assessing a patient with anemia for respiratory impairment. What does the nurse incorporate in the assessment? 1 Determine if the patient can speak a five-word sentence without being short of breath. 2 Assess the lungs for the presence of adventitious lung sounds. 3 Determine if the patient sleeps on two to three pillows at night. 4 Observe for the use of accessory muscles during expiration.

Determine if the patient sleeps on two to three pillows at night. When the patient is anemic, the nurse should assess the respiratory system for impairment. Orthopnea (difficulty breathing while lying down) can be a sign of breathing problems. Respiratory impairment can be assessed by asking the patient if he or she elevates the head of the bed by using more than one pillow at night to make it easier to sleep. The patient would be considered short of breath if he or she cannot complete a 10-word sentence without stopping to breathe. Although it is important for the nurse to auscultate lung sounds, adventitious lung sounds are present with airway constriction or fluid volume overload, not anemia. If the patient is having difficulty breathing, the nurse would see accessory muscles being used on inspiration, not expiration.

Which conditions can cause metabolic acidosis? Select all that apply. 1 Diarrhea 2 Liver failure 3 Kidney failure 4 Airway obstruction 5 Respiratory depression

Diarrhea, liver failure, and kidney failure

When treating a patient for hyponatremia, which type of drug must be altered to decrease sodium loss? 1 Diuretics 2 Biphosphates 3 Corticosteroids 4 Beta-adrenergic agonists

Diuretics When treating a patient with hyponatremia, if the patient is already taking diuretics, his or her dosage must be adjusted because diuretics increase sodium loss. Biphosphates are used to prevent hypercalcemia. Corticosteroids can cause hypernatremia. Beta-adrenergic agonists can cause hypokalemia.

Which action does the nurse take first for the patient who is admitted to the emergency department (ED) with a panic attack and whose blood gases indicate respiratory alkalosis? 1 Encourage the patient to take slow breaths. 2 Administer oxygen using ED standard orders. 3 Place an emergency cart close to the patient's room. 4 Obtain a prescription for a fluid and electrolyte infusion.

Encourage the patient to take slow breaths Because respiratory alkalosis is caused by hyperventilation, the nurse's first action should be to assist the patient in slowing the respiratory rate. Respiratory alkalosis is caused by hyperventilation; fluid and electrolyte replacement will not help correct hyperventilation. No evidence suggests that hypoxemia exists; therefore oxygen is not needed at this time. Ongoing respiratory alkalosis may eventually cause fluid and electrolyte shifts requiring intravenous emergency drugs; however, slowing the breathing and rebreathing of CO 2 are the priority interventions.

What risk factors are associated with higher incidence of development of heparin-induced thrombocytopenia in patients? 1 Male patients 2 Presurgical thromboprophylaxis 3 Exposure to unfractionated heparin 4 Use of heparin longer than 1 month

Exposure to unfractionated heparin Exposure to unfractionated heparin leads to increased risk of development of heparin-induced thrombocytopenia. Being female is a higher risk than being male. Presurgical heparin is not indicated or a risk factor. Risk increases if heparin is used longer than 1 week, not 1 month.

What is the most common symptom of anemia? 1 Fatigue 2 Headache 3 Palpitations 4 Sore tongue

Fatigue Fatigue is the most common symptom of anemia. Oxygen-carrying capacity is reduced in anemic patients because of either a decrease in the number of red blood cells (RBCs) or a dysfunction in RBCs. The tissues are therefore not supplied with adequate oxygen and less energy is produced. Headaches, palpitations, and a sore tongue are less common symptoms associated with anemia.

The primary health care provider advises the administration of diphenhydramine and acetaminophen to a patient before initiation of platelet transfusion therapy. What patient history supports the intervention? 1 Circulating overload 2 Febrile transfusion reactions 3 Allergic transfusion reactions 4 Hemolytic transfusion reactions

Febrile transfusion reactions A patient with a history of febrile transfusion reactions during the transfusion of platelets should be administered diphenhydramine and acetaminophen before the transfusion to reduce any fever or severe chills that may occur. Circulating overload can be monitored and managed with the use of diuretics. Patients with suspected allergic reactions should be administered blood products with reduced white blood cells. Hemolytic transfusion reactions can be prevented by determining the ABO compatibility.

What is fluid overload or overhydration? 1 Fluid intake is less than body's fluid needs 2 Fluid retention is equal to body's fluid needs 3 Fluid retention is less than body's fluid needs 4 Fluid intake is greater than body's fluid needs

Fluid intake is greater than body's fluid needs

When caring for a patient with metabolic acidosis, what must the nurse keep in mind regarding acid-base chemistry? 1 Acids bind free hydrogen ions in solution. 2 Acetic acid (CH 3COOH) is a strong acid. 3 Normally, blood is slightly acidic in nature. 4 Fluids with lower pH have higher acidity

Fluids with lower pH have higher acidity. Fluids with lower pH have a higher level of free hydrogen ions and therefore have higher acidity. Acids release hydrogen ions rather than bind with them when dissolved in water. Strong acids readily dissociate in water and release all of their hydrogen ions. Acetic acid (CH 3COOH) is a weak acid. When dissolved in water, it releases only one of its four hydrogen molecules. Normally, blood has a pH of between 7.35 and 7.45, so it is slightly alkaline.

What intervention performed during a transfusion reaction may further complicate the condition? 1 Stopping the transfusion and removing the blood tubing 2 Providing the access for infusions and flushing with normal saline 3 Returning the component bag, labels, and all tubing to the laboratory 4 Flushing the intravenous contents of the tubing with normal saline before removing

Flushing the intravenous contents of the tubing with normal saline before removing Flushing the contents of the blood transfusion tubing will allow more blood to enter the patient and aggravate transfusion reactions. The transfusion should be stopped immediately and the blood tubing should be removed to prevent more blood from entering the patient's circulation. If the patient does not have any other intravenous access, the access site should be flushed with normal saline. The component bag, labels, and all tubing should be returned to the laboratory or blood bank for further investigation if hemolytic reaction or bacterial reaction is suspected.

Which nursing intervention takes priority for a patient admitted with severe metabolic acidosis? 1 Initiate cardiac monitoring. 2 Perform medication reconciliation. 3 Obtain a diet history for the past 3 days. 4 Assess the patient's strength in the extremities.

Initiate cardiac monitoring. The nurse follows the ABCs and initiates cardiac monitoring to observe for signs of hyperkalemia or cardiac arrest. Medication reconciliation should be performed as soon as possible; however, this patient is at risk for cardiac and neurologic complications of acidosis. Starvation may precipitate ketosis/acidosis, but this is not the priority. Assessing the patient's strength in the extremities is an intervention important to do due to the neurologic complications of acidosis, but it is not the priority over initiating cardiac monitoring.

Which clinical manifestations are associated with sickle cell crisis in a patient with sickle cell disease? Select all that apply. 1 Jaundice 2 Pallor 3 Dyspnea 4 Joint pain 5 Low iron levels 6 Bradycardia

Jaundice Pallor Dyspnea Joint pain

The nurse obtains lab results for a 50-year-old patient with the following results: pH 7.24; bicarbonate 20; PaO 2 82; PaCO 2 35. These findings are consistent with which acid-base imbalance? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

Metabolic acidosis In metabolic acidosis, there is a decrease in pH (normal is 7.35-7.45), a decrease in bicarbonate (normal is 21-28), a normal PaO 2 (normal is 80-100), and a normal or decreased PaCO 2 (normal is 35-45). The arterial blood gas results of pH 7.24; bicarbonate 20; PaO 2 82; PaCO 2 35 reflect metabolic acidosis. In metabolic alkalosis, there is an increase in pH, increase bicarbonate, normal PaO 2, and normal PaCO 2. In respiratory alkalosis, there is an increase in pH, a normal bicarbonate, a normal PaO 2, and a decrease in PaCO 2 In respiratory acidosis, there is an in decrease in pH, normal bicarbonate, normal PaO 2, and increased PaCO 2.

When evaluating the laboratory results of a patient with diabetic ketoacidosis, which lab value indicates the body has fully compensated from this acid-base imbalance? 1 Normal serum glucose 2 Normal serum potassium 3 Normal pH on arterial blood gases 4 Normal bicarbonate on arterial blood gases

Normal pH on arterial blood gases Arterial blood gas pH returns to normal when the body's compensatory efforts are fully effective. Glucose, potassium, and bicarbonate are affected by diabetic acidosis, but their return to normal is not an indicator of acid-base balance.

Which intravenous solution is compatible for administration with blood products? 1 Normal saline 2 Lactated Ringer's 3 Dextrose in water 4 Dextrose solution

Normal saline Normal saline solution is compatible and can be used as a solution for administration with blood products. Solutions such as lactated Ringer's, dextrose in water, and dextrose solution are not compatible with blood products because they may cause clotting or hemolysis of blood cells.

The nurse is assessing a newly admitted patient with thrombocytopenia. Which factor needs immediate intervention? 1 Nosebleed 2 Reports of pain 3 Increased temperature 4 Decreased urine outpu

Nosebleed The patient with thrombocytopenia has a high risk for bleeding. The nosebleed should be attended to immediately. The patient's report of pain, decreased urine output, and increased temperature are not the highest priority.

The nurse is assessing a newly admitted patient with thrombocytopenia. Which factor needs immediate intervention? 1 Nosebleed 2 Reports of pain 3 Increased temperature 4 Decreased urine output

A patient has had a total urine output of 200 mL in the past 24 hours. Which priority action does the nurse take? 1 Insert an indwelling urinary catheter. 2 Notify the primary health care provider. 3 Encourage the patient to drink more fluids. 4 Take no action because this is a normal urinary output.

Notify the primary health care provider. The minimum amount of urine per day needed to excrete toxic waste products is 400 to 600 mL. With a urine output of 200 mL in 24 hours, a toxic buildup of nitrogen and lethal electrolyte imbalances can occur. The primary health care provider should be notified because additional tests or orders might be necessary. Encouraging the patient to drink more fluids may be necessary once the underlying cause of the decreased urine output (oliguria) is determined. Inserting an indwelling urinary catheter may be indicated, but not before speaking with the provider.

A patient is admitted to the nursing unit with a diagnosis of hypokalemia. Which assessment does the nurse complete first? 1 Auscultating bowel sounds 2 Obtaining a pulse oximetry reading 3 Checking deep tendon reflexes (DTRs) 4 Determining the level of consciousness (LOC)

Obtaining a pulse oximetry reading

Obtaining a pulse oximetry reading Because hypokalemia may cause respiratory insufficiency and respiratory arrest, the patient's respiratory status should be assessed first. Bowel sounds, DTRs, and LOC may change in a patient with hypokalemia, but these changes are not immediately life-threatening.

A diabetic patient shows symptoms of diabetic ketoacidosis. What mechanism causes acidosis in this patient? 1 Overproduction of hydrogen ions 2 Underelimination of hydrogen ions 3 Overelimination of bicarbonate ions 4 Underproduction of bicarbonate ions

Overproduction of hydrogen ions In diabetic ketoacidosis, there is an excessive breakdown of fatty acids. This produces strong acids (ketoacids) with the release of large amounts of hydrogen ions. Underelimination of hydrogen ions occurs when hydrogen ions are produced at normal rates, but their elimination is reduced. This is seen in patients with lung and kidney problems. Bicarbonate ion is made in the kidney or in the pancreas. In patients with impaired kidney or pancreatic function, there is underproduction of bicarbonate ions leading to acidosis. Overelimination of bicarbonate ions occurs when there is an excessive loss of bicarbonate ions. This occurs in diarrhea.

Which written order does the nurse clarify with the provider when caring for a patient with a serum sodium level of 149 mEq/L? 1 Weigh the patient daily. 2 Monitor intake and output. 3 Institute seizure precautions. 4 Place the patient on nothing by mouth (NPO) status

Place the patient on nothing by mouth (NPO) status Ensuring adequate water intake is an important nutritional therapy in the treatment of hypernatremia; the nurse should ask for clarification of the NPO order. The other orders are appropriate in the management of patients with hypernatremia.

When caring for a group of patients at risk for respiratory acidosis, the nurse identifies which person as at highest risk? 1 An athlete in training 2 Patient who smokes cigarettes 3 Person with uncontrolled diabetes 4 Pregnant woman with hyperemesis gravidarum

Patient who smokes cigarettes Cigarette smoking worsens gas exchange, leading to disorders that contribute to hypoventilation and respiratory acidosis. An athlete in training should be healthy with optimal lung function, not respiratory acidosis. Hyperemesis gravidarum is characterized by nausea and vomiting, and vomiting causes metabolic alkalosis. Uncontrolled diabetes may result in diabetic ketoacidosis, which causes metabolic acidosis.

A 32-year-old patient recovering from a sickle cell crisis is to be discharged. The nurse says, "You and all patients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge." Which drug does the nurse anticipate the health care provider will request? 1 Cefaclor 2 Gentamicin 3 Penicillin V 4 Vancomycin

Penicillin V Prophylactic therapy with twice-daily oral penicillin reduces the incidence of pneumonia and other streptococcal infections and is the correct drug to use. It is a standard protocol for long-term prophylactic use in patients with sickle cell disease (SCD). Cefaclor and vancomycin are antibiotics more specific for short-term use and would be inappropriate for this patient. Gentamicin is a drug that can cause liver and kidney damage with long-term use.

.Which clotting factor is deficient in patients with hemophilia B? 1 Thrombin 2 Fibrinogen 3 Prothrombin 4 Plasma thromboplastin

Plasma thromboplastin Plasma thromboplastin (factor IX) is deficient in patients with hemophilia B. Thrombin helps convert fibrinogen to fibrin strands and catalyzes other coagulated reactions. Fibrinogen (factor I) and prothrombin (factor II) are not deficient in cases of hemophilia B.

What treatment does the nurse anticipate for a patient with a platelet count of 8,000 mm 3? 1 Azathioprine 2 Corticosteroid 3 Platelet transfusion 4 Intravenous (IV) immunoglobulin

Platelet transfusion Platelet transfusions are indicated for patients with platelet counts of less than 10,000 mm 3. Azathioprine, corticosteroids, and IV immunoglobulin are not the treatment of choice for a patient with a platelet count as low as 8,000 mm 3.

The nurse is caring for a patient diagnosed with autoimmune idiopathic thrombocytopenic purpura (ITP). The patient's platelet count is 6,000/mm 3. What treatment should be administered first? 1 Platelets 2 Rituximab 3 Azathioprine 4 Dexamethasone

Platelets Platelet transfusion is the priority when a patient has a platelet count lower than 10,000. Rituximab, dexamethasone, and azathioprine are medications used for treatment of ITP but would not be first treatment administered with a platelet count of 6,000.

The nurse is reviewing serum electrolytes and blood chemistry for a newly admitted patient. Which result causes the greatest concern? 1 Glucose: 97 mg/dL 2 Sodium: 143 mEq/L 3 Potassium: 5.9 mEq/L 4 Magnesium: 2.1 mEq/L

Potassium: 5.9 mEq/L A potassium value of 5.9 mEq/L is high, and the patient should be assessed further. A glucose value of 97 mg/dL, a magnesium value of 2.1 mEq/L, and a sodium value of 143 mEq/L are normal values.

Which transfusion procedure often causes transfusion-induced reactions like fever and chills? 1 Plasma transfusion 2 Single donor platelet transfusion 3 Pooled donor platelet transfusion 4 Washed red blood cell transfusion

Pooled donor platelet transfusion Pooled donor platelet transfusions can cause fever and chills if the patient undergoing platelet transfusion has any history of platelet transfusion reactions. Plasma transfusions, washed red blood cell transfusion, and single donor platelet transfusion do not often cause fever and chills.

What is the focus of management of thrombotic thrombocytopenic purpura (TTP)? Select all that apply. 1 Prevention of infection 2 Destruction of antibodies 3 Increase of platelet production 4 Prevention of platelet clumping 5 Stopping the autoimmune process

Prevention of platelet clumping Stopping the autoimmune process

The nurse is caring for a patient who is in sickle cell crisis. Which nursing action is a priority? 1 Provide pain medications as needed. 2 Apply cool compresses to the patient's forehead. 3 Increase food sources of iron in the patient's diet. 4 Encourage the patient's use of two methods of birth control

Provide pain medications as needed. Analgesics are needed to treat sickle cell pain. The nurse would provide pain medications as needed. Cool compresses do not help the patient in sickle cell crisis. Warm soaks or compresses can help reduce pain perception. Increasing iron in the diet and discussing birth control are not priorities for the patient in sickle cell crisis.

Which nursing action is recommended when providing care to a patient with hypokalemia? 1 Question the continued administration of bumetanide. 2 Administer prescribed oral potassium chloride before a meal or snack. 3 Establish a peripheral IV, preferably in the hand, for administering IV potassium chloride. 4 Obtain the prescribed vial of IV potassium chloride from the pharmacy and dilute before administration.

Question the continued administration of bumetanide. Bumetanide is a loop diuretic, which contributes to potassium loss and should be questioned. The Joint Commission has mandated that all concentrated electrolytes be mixed by a pharmacist and that vials of KCl should not be available in patient care areas. A large vein with high blood flow should be accessed to avoid phlebitis; it is recommended that the hand be avoided. Oral potassium supplements should be given with or following a snack or meal to avoid nausea.

When caring for a patient with kidney failure who has metabolic acidosis, which symptom does the nurse expect as evidence of the body's compensatory effort? 1 Pallor and diaphoresis 2 Rapid and deep respirations 3 Bradycardia and bounding pulse 4 Hypotension and weak, thready pulse

Rapid and deep respirations Kussmaul respirations (rapid, deep respirations) represent the body's attempt to compensate for metabolic acidosis. The skin is warm, dry, and flushed in metabolic acidosis. Cardiovascular symptoms may occur, but they are manifestations of acidosis, not evidence of compensation.

Which nursing intervention is effective in helping promote peripheral perfusion in a patient who has sickle cell disease? 1 Remove constrictive clothing 2 Elevate the head of the bed at least 30 degrees 3 Place pillows under the knees to elevate the legs 4 Keep the room temperature at or just below 72° F

Remove constrictive clothing To help prevent damage to peripheral tissues, the nurse should remove constrictive clothing from the patient sickle cell crisis. The head of the bed should be no higher than 30 degrees and the legs should not be elevated, especially with pillows under the knees. The room should be kept warm at a temperature of 72° F or higher.

A patient is admitted with hypokalemia and skeletal muscle weakness. Which assessment does the nurse perform first? 1 Pulse 2 Respirations 3 Temperature 4 Blood pressur

Respirations Respiratory changes are likely because of weakness of the muscles needed for breathing. Skeletal muscle weakness results in shallow respirations. Thus respiratory status should be assessed first in any patient who might have hypokalemia. Blood pressure and pulse will be altered in this patient, but they are not the priority assessment. Temperature is not a priority assessment for the patient with hypokalemia.

After a motor vehicle crash, the nurse is consoling a patient in the emergency department who is hysterical and hyperventilating after being notified of the death of a family member. What acid-base imbalance is this patient likely to develop? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

Respiratory alkalosis Hyperventilation leads to excessive loss of CO 2 and respiratory alkalosis. The patient will not develop respiratory acidosis, which is caused by hypoventilation, nor will the patient develop metabolic alkalosis or acidosis.

The nurse assesses multiple patients who are receiving transfusions of blood components. Which assessment indicates the need for the nurse's immediate action? 1 Respiratory rate of 36 in a patient receiving red blood cells (RBCs) 2 Temperature of 99.1° F (37.3° C) for a patient with a platelet transfusion 3 Sleepiness in a patient who received diphenhydramine as a premedication 4 A partial thromboplastin time (PTT) that is 1.2 times normal in a patient who received a transfusion of fresh frozen plasma (FFP)

Respiratory rate of 36 in a patient receiving red blood cells (RBCs) An increased respiratory rate indicates a possible hemolytic transfusion reaction; the nurse should quickly stop the transfusion and assess the patient further. Because FFP is not usually given until the PTT is 1.5 times above normal, a PTT that is 1.2 times normal indicates that the FFP has had the desired response. Sleepiness is expected when diphenhydramine is administered. Temperature elevations are not an indication of an allergic reaction to a platelet transfusion, although the nurse may administer acetaminophen to decrease the fever.

What is the priority for the nurse in caring for a patient with sickle cell anemia who is in crisis? 1 Improving nutrition 2 Restoring tissue perfusion 3 Correcting decreased cardiac output 4 Restoring normal hemoglobin and hematocrit

Restoring tissue perfusion Patients with sickle cell anemia who have decreased oxygen conditions develop crisis, causing reduction in oxygen supply and furthering development of sickled cells and organ damage. The nurse must encourage oral fluids and administer parenteral fluids to restore tissue perfusion. During a sickle cell crisis, restoring tissue perfusion is most important. Usually sickled cells go back to normal shape when the precipitating condition is removed, and the blood oxygen level is normalized, which allows tissue perfusion to resume. Improving nutrition, correcting decreased cardiac output, and restoring normal hemoglobin and hematocrit are not priorities during a sickle cell crisis.

The nurse is providing teaching to a patient scheduled for a splenectomy secondary to idiopathic thrombocytopenic purpura (ITP). What teaching is priority? 1 Risk for injury 2 Risk for infection 3 Risk for impaired tissue integrity 4 Risk for altered body temperature

Risk for infection A patient who has had a splenectomy is at increased risk for infection because the spleen is no longer functioning. Risk for injury is not a priority. Risk for impaired tissue integrity is important but not the priority. Risk for altered body temperature is not associated with the surgery.

.The nurse is teaching a patient with iron deficiency anemia about increasing the intake of dietary iron. The nurse considers the teaching successful when the patient makes which food selection? 1 Roast beef 2 Baked potato 3 Low-fat turkey 4 Citrus products

Roast beef Management of iron deficiency anemia involves increasing the oral intake of iron from food sources (e.g., red meat, organ meat, egg yolks, kidney beans, leafy green vegetables, and raisins). Baked potatoes are high in potassium, and citrus products will help with iron absorption, but they will not replace iron. Turkey is white, rather than red, meat.

Which are common symptoms of hypokalemia? Select all that apply. 1 Paresthesia 2 Bradycardia 3 Shallow respirations 4 Weak, thready pulse 5 Musculoskeletal weakness

Shallow respirations Weak, thready pulse Musculoskeletal weakness

Which are common symptoms of hypokalemia? Select all that apply. 1 Paresthesia 2 Bradycardia 3 Shallow respirations 4 Weak, thready pulse 5 Musculoskeletal weakness

Shallow respirations Weak, thready pulse Musculoskeletal weakness

When caring for a patient with hyponatremia, which intervention does the nurse implement? 1 2-gram sodium diet 2 Administration of furosemide 3 Intravenous administration of 0.45% normal saline 4 Small-volume intravenous infusions of 3% normal saline

Small-volume intravenous infusions of 3% normal saline 3% saline is hypertonic and is given in small volumes to replenish serum sodium. 0.45% saline is hypotonic and will further dilute serum sodium levels. Furosemide causes sodium loss in the kidneys and would further contribute to hyponatremia. A 2-gram sodium diet restricts sodium intake; the goal of nutritional therapy with hyponatremia is to increase sodium intake.

Which electrolyte deficiency results in decreased depolarization in the excitable cells and increased cellular swelling? 1 Sodium 2 Calcium 3 Potassium 4 Magnesium

Sodium Hyponatremia occurs when sodium levels are low; this condition causes decreased depolarization in excitable cells and increased cellular swelling. Low serum calcium levels lead to muscle cramping and cardiac arrhythmias. A potassium deficiency causes cardiac dysrhythmias. A decrease in the level of magnesium may cause increased nerve impulse transmission.

A 90-year-old patient with hypermagnesemia is seen in the emergency department (ED). The ED nurse prepares the patient for admission to which inpatient unit? 1 Medical-surgical 2 Dialysis/home care 3 Geriatric/rehabilitation 4 Telemetry/cardiac stepdown

Telemetry/cardiac stepdown Because hypermagnesemia causes changes in the electrocardiogram that may result in cardiac arrest, the patient should be admitted to the telemetry/cardiac stepdown unit. Dialysis/home care units, geriatric/rehabilitation units, and medical-surgical units typically do not have cardiac monitoring capabilities.

Which patient is at increased risk for development of hemophilia? 1 The son of the woman who is a carrier 2 The son of the father who has hemophilia 3 The daughter of a woman who is a carrier 4 The daughter of a father who has hemophilia

The son of the woman who is a carrier Hemophilia is an X-linked recessive trait; therefore the son of a mother who is a carrier is more likely to develop hemophilia. The son of a father with hemophilia will not develop hemophilia. The daughter of a mother who is a carrier may also be a carrier. The daughter of the father with hemophilia will be a carrier.

What disorder is classified by less than 150,000 platelets per microliter? 1 Leukemia 2 Hemophilia 3 Leukocytopenia 4 Thrombocytopenia

Thrombocytopenia Thrombocytopenia is characterized by a platelet count of less than 150,000 platelets per microliter. Leukemia, hemophilia, and leukocytopenia are not diagnosed based on platelet counts of less than 150,000.

Why is filtered tubing used during infusion of blood products? 1 To reduce hemolysis 2 To remove aggregates 3 To prevent fluid overload 4 To avoid blood borne pathogens

To remove aggregates Filtered tubing is used during the administration of blood product to remove aggregates and possible contaminants during the infusion. Hemolysis is prevented by diluting the blood products with normal saline only. Fluid overload is prevented by maintaining an adequate infusion rate if signs of fluid volume overload are present. Bloodborne pathogens are prevented by proper handling of the equipment.

A patient has a glucose-6-phosphate dehydrogenase (G6PD) deficiency. The nurse teaches the patient to avoid which substance? 1 Vitamin K 2 Yellow food dye 3 Iron-containing vitamins 4 Trimethoprim-sulfamethoxazole

Trimethoprim-sulfamethoxazole Cells with reduced amounts of G6PD tend to hemolyze during exposure to some drugs (e.g., sulfonamides, aspirin, quinine derivatives, rasburicase, chloramphenicol, dapsone, high doses of vitamin C, and thiazide diuretics) and exposure to benzene and other toxins. Vitamin K (which antagonizes warfarin), yellow food dye, and iron are not implicated in promoting hemolysis in the individual with G6PD deficiency.

A patient has pallor; jaundice; a smooth, beefy-red tongue; has been experiencing difficulty with balance and reports tingling of the hands and feet. The patient's lab work indicates macrocytic anemia. The nurse notifies the provider of these findings and anticipates an order for which medication? 1 Steroids 2 Folic acid 3 Iron dextran 4 Vitamin B 12

Vitamin B 12 This patient exhibits symptoms of vitamin B12 deficiency anemia, characterized by the symptoms described, and should receive vitamin B 12. Symptoms of folic acid deficiency anemia are similar, but folic acid deficiency anemia does not cause neurologic symptoms. Unless the underlying deficiency of B 12 is addressed, giving iron will not be effective, since B 12 is necessary for synthesizing red blood cells. Steroids are typically given for immunodeficiency anemia.

What is the reason for isotonic dehydration? 1 More sodium than water is lost from the body. 2 A decrease in circulating blood volume causes poor tissue perfusion. 3 Water and sodium are lost from the body in proportionately equal amounts. 4 A shift of fluid from plasma to interstitial space occurs without a loss of any water.

Water and sodium are lost from the body in proportionately equal amounts. Dehydration may occur with either fluid loss or with both fluid and electrolyte loss. Dehydration is termed isotonic dehydration when there is proportionality between the amount of water and electrolyte, such as sodium, lost from the body. Hypertonic dehydration happens when more water than sodium is lost from the body. Hypovolemia occurs when a decrease in the circulating blood volume causes poor tissue perfusion. Relative dehydration occurs without the actual loss of total body water when fluid shifts from plasma to the interstitial space.

Which arterial blood gas laboratory values would be seen in metabolic alkalosis? 1 pH 7.49, HCO 3 - 32 2 pH 7.28, CO 2 54 3 pH 7.53, CO 2 28 4 pH 7.31, HCO 3 - 18

pH 7.49, HCO 3 - 32

The registered nurse is teaching a novice nurse about transfusion in older patients. Which statement by the novice nurse indicates effective learning? 1 "Blood that is more than 1 week old should be used." 2 "Large bore needles over 19 gauge should be used." 3 "2 to 4 hours should be taken to administer one unit of blood." 4 "Dextrose should be simultaneously administered while the transfusion is taking place."

"2 to 4 hours should be taken to administer one unit of blood." Administering the blood rapidly may lead infusion reactions in older patients. Therefore 2 to 4 hours should be taken to administer one unit of blood. Using a blood sample from the blood bank that is more than 1 week old will lead to easy breakage of the cells because the cell membranes of older patients are more fragile. Needles no larger than 19 gauge should be used in older patients. Dextrose should not be administered along with blood products as it results in hemolysis.

The nurse is educating a patient who is taking an anticoagulant drug. Which patient statement indicates a need for further teaching? 1 "I should use an electric shaver." 2 "I should avoid participating in any contact sports." 3 "I should take aspirin whenever I have severe pain." 4 "I should apply ice to any sites that may bruise for at least one hour."

"I should take aspirin whenever I have severe pain. Aspirin is an anticoagulant and may increase this patient's risk for bleeding; the patient should avoid it. The remaining statements indicate adequate understanding. The patient should use an electric shaver rather than a razor blade to prevent cuts and bleeding. If the patient gets bumped and may bruise, he or she should apply ice for at least one hour. Participating in contact sports may increase the risk of being bumped, scratched, or scraped, so he or she should avoid them.

The nurse educator is teaching a nursing student about the transfusion of blood products. Which statement made by the student nurse regarding the transfusion of red blood cells indicates effective learning? 1 "Do not administer any other solution with the blood product." 2 "Red blood cell transfusions should be completed within 4 hours of removal from refrigeration." 3 "Increasing the speed of administration during the first 15 minutes of the transfusion is necessary." 4 "Once the blood product has been released from the blood bank, it should be immediately transfused into the recipient's body within a few seconds."

"Red blood cell transfusions should be completed within 4 hours of removal from refrigeration." Red blood cell transfusions should be performed within 4 hours of after removal from the refrigeration. If the transfusion time extends longer than four hours, it may lead to infections in the recipient. Hemolytic reaction may occur if saline is not administered with the blood product. Increasing the rate of administration of the drug may lead to fluid overload. After the blood product is released from the blood bank, it must be transfused within 4 hours, not immediately.

A nurse reports having withheld intravenous opioid pain medication from a young African American patient who has sickle cell disease (SCD). The nurse states that she believes the patient is addicted. What is the nurse manager's most appropriate response? 1 "Opioids are very addictive; you made the right decision." 2 "The patient is most likely experiencing pseudoaddiction." 3 "The incidence of opioid addiction in SCD patients is actually rare." 4 "We can talk to the health care provider about getting the patient a prescription for a different medication."

"The incidence of opioid addiction in SCD patients is actually rare." Withholding the patient's medication because the nurse has assumed the patient is addicted, possibly based on the patient's age and race, is inappropriate. In addition to telling the nurse that, the nurse manager should tell the nurse that the incidence of opioid addiction SCD patients is low at only 2% to 5% and withholding the medication likely caused the patient great pain. Though opioids can be addictive, this is not a reason to withhold the medication from a patient in pain. The patient may be experiencing pseudoaddiction, but the patient may also need better pain management; withholding the drug is not an appropriate response. Talking to the health care provider about changing the prescription is not necessary if opioids can manage the patient's pain.

The nurse is reinforcing information about genetic counseling to a patient with sickle cell disease (SCD) who has a healthy spouse. What information does the nurse include? 1 "Sickle cell disease will be inherited by your children." 2 "The sickle cell trait will be inherited by your children." 3 "Your children will have the disease, but your grandchildren will not." 4 "Your children will not have the disease, but your grandchildren could."

"The sickle cell trait will be inherited by your children." The children of the patient with sickle cell disease will inherit the sickle cell trait, but not inherit the disease. If both parents have the sickle cell trait; their children could get the disease. The only way grandchildren will have the disease is if both parents have the sickle cell trait. If one parent has the sickle cell trait, and one parent does not have the trait, then the grandchildren will only inherit the sickle cell trait.

A patient who is pregnant with a girl has a family history of hemophilia. The patient knows she is a carrier and is worried that her daughter will be a carrier and/or be hemophilic. What can the nurse tell her? 1 "There's a 30% chance she will be a carrier but is unlikely to be hemophilic." 2 "There's a 50% chance she will be a carrier but is unlikely to be hemophilic." 3 "There's a 50% chance she will be a carrier, and if so, she is likely to be hemophilic." 4 "There's a 30% chance she will be a carrier, and if so, she is likely to be hemophilic.

"There's a 50% chance she will be a carrier but is unlikely to be hemophilic." Hemophilia is an X-linked recessive trait. Women who are carriers have a 50% chance, not 30%, of passing the hemophilia gene to their daughters, who are unlikely to be hemophilic. Women are rarely hemophilic; hemophilia is more common among men.

A patient with thrombocytopenia is being discharged. What information does the nurse incorporate into the teaching plan for this patient? 1 "Avoid large crowds." 2 "Use a soft-bristled toothbrush." 3 "Drink at least 2 liters of fluid per day." 4 "Elevate your lower extremities when sitting.

"Use a soft-bristled toothbrush." Using a soft-bristled toothbrush reduces the risk for bleeding in patient with thrombocytopenia. Avoiding large crowds reduces the risk for infection, but is not specific to the patient with thrombocytopenia. Increased fluid intake reduces the risk for dehydration, but is not specific to the patient with thrombocytopenia. Elevating extremities reduces the risk for dependent edema, but is not specific to the patient with thrombocytopenia.

The nurse is performing discharge dietary teaching for a patient with hyperkalemia. Which statement does the nurse include in the teaching? 1 "You may use salt substitutes." 2 "You don't need to restrict dairy products." 3 "You may eat apples, strawberries, and peaches." 4 "You may eat avocados, broccoli, and cantaloupe."

"You may eat apples, strawberries, and peaches." The patient with hyperkalemia should be instructed to consume foods low in potassium such as apples, strawberries, and peaches. The patient should avoid foods high in potassium, which include avocados, broccoli, cantaloupe, and dairy products. Salt substitutes contain potassium.

Which patient does the nurse assign as a roommate for the patient with aplastic anemia? 1 23-year-old with sickle cell disease who has two draining leg ulcers 2 30-year-old with leukemia who is receiving induction chemotherapy 3 34-year-old with idiopathic thrombocytopenia who is taking steroids 4 28-year-old with glucose-6-phosphate deficiency (G6PD) anemia who is receiving mannitol

28-year-old with glucose-6-phosphate deficiency (G6PD) anemia who is receiving mannitol Because patients with aplastic anemia usually have low white blood cell counts that place them at high risk for infection, roommates such as the patient with G6PD anemia should be free from infection or infection risk. The patient with sickle cell disease has two draining leg ulcer infections that would threaten the diminished immune system of the patient with aplastic anemia. The patient with leukemia who is receiving induction chemotherapy and the patient with idiopathic thrombocytopenia who is taking steroids are at risk for development of infection, which places the patient with aplastic anemia at risk, too.

Which patient is at greatest risk for having a hemolytic transfusion reaction? 1 78-year-old patient 2 42-year-old patient with allergies 3 34-year-old patient with type O blood 4 58-year-old immune-suppressed patient

34-year-old patient with type O blood Hemolytic transfusion reactions are caused by blood type or Rh incompatibility. When blood that contains antigens different from the patient's own antigens is infused, antigen-antibody complexes are formed in the patient's blood. Type O is considered the universal donor, but not the universal recipient. The patient with allergies would be most susceptible to an allergic transfusion reaction. The immune-suppressed patient would be most susceptible to a transfusion-associated graft-versus-host disease. The older adult patient would be most susceptible to circulatory overload.

After reviewing the laboratory test results, the nurse calls the health care provider about which patient? 1 49-year-old with hemophilia and a platelet count of 150,000/mm 3 2 52-year-old who has had a hemorrhage with a reticulocyte count of 0.8% 3 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm 3 4 44-year-old receiving warfarin with an International Normalized Ratio (INR) of 3.0

46-year-old with a fever and a white blood cell (WBC) count of 1500/mm 3 The patient with a fever neutropenic and is at risk for sepsis unless interventions such as medications to improve the WBC level and antibiotics are prescribed. The INR of 3.0 in the 44-year-old indicates a therapeutic warfarin level. A platelet count of 150,000/mm 3 in the 49-year-old is normal. An elevated reticulocyte count in the 52-year-old is expected after hemorrhage.

Which patient is at greatest risk for hypernatremia? 1 30-year-old on a low-salt diet 2 42-year-old receiving hypotonic fluids 3 54-year old who is sweating profusely 4 17-year-old with a serum blood glucose of 189 mg/dL

54-year old who is sweating profusely Excessive sweating is a common cause of hypernatremia. Hyperglycemia, a low-salt diet, and hypotonic fluid administration are common causes of hyponatremia, not hypernatremia.

What patient is at a lower risk for febrile transfusion reactions? 1 A patient receiving a platelet transfusion 2 A patient who has received multiple blood transfusions 3 A patient receiving a white blood cell (WBC) transfusion 4 A patient receiving leukocyte-reduced red blood cell transfusion

A patient receiving leukocyte-reduced red blood cell transfusion Febrile transfusion reactions occur most often in patients with anti-WBC antibodies. Leukocyte-reduced red blood cells are least antigenic and do not cause febrile transfusion reactions. Febrile transfusion reactions occur most often in the patient with anti-WBC antibodies, which can develop after multiple transfusions, WBC transfusions, and platelet transfusions. The patient develops chills, tachycardia, fever, hypotension, and tachypnea. Giving leukocyte-reduced blood or single-donor HLA-matched platelets reduces the risk for this type of reaction. WBC filters may be used to trap WBCs and prevent their infusion into the patient.

What patient is an ideal candidate for plasma transfusion therapy? 1 A patient with an albumin deficiency 2 A patient with an electrolyte deficiency 3 A patient with a hemoglobin deficiency 4 A patient with a prothrombin deficiency

A patient with a prothrombin deficiency Plasma transfusion therapy is used to replace plasma volume and clotting factors. Patients with a prothrombin deficiency are most suitable for this therapy. Electrolyte deficiency is managed with electrolyte replacement therapy by infusing intravenous fluids. Hemoglobin deficiency is managed with red blood cell transfusion therapy. A deficiency of albumin is not managed by plasma transfusion therapy.

Apply oxygen as prescribed. Applying oxygen is the first priority for a patient with hypoxemia. It is unclear whether the patient is stable to be out of bed; elevating the HOB (head of bed) would be more appropriate to improve respiratory expansion. Notifying the health care provider is an appropriate action after initiation of oxygen therapy; delaying intervention while waiting for the provider delays treatment. Breath sounds can be auscultated after initiation of oxygen therapy; hypoxemia may be present in the absence of adventitious breath sounds.

A patient with sickle cell anemia is admitted for treatment of a vasoocclusive crisis. In addition to administering oxygen, which intervention will help reduce hypoxia in this patient? 1 Giving iron supplements 2 Providing analgesic medication 3 Encouraging strenuous exercise 4 Administering intravenous (IV) fluids

Administering intravenous (IV) fluids Dehydration can cause increased sickling of HbS cells and can also make occlusion worse, causing more tissue ischemia. Patients should be taught to consume 3 to 4 L of fluid daily as a maintenance measure, and hospitalized patients should be given IV fluids. Patients should engage in mild, low-impact exercise. Iron supplements will not improve hypoxia since iron deficiency is not the underlying problem. Analgesics are given for pain, but do not directly affect oxygenation.

Which intervention may increase the risk of fluid overload during transfusion therapy in older adults? 1 Administering blood slowly at an infusion rate of 2 to 4 hours per unit 2 Administering normal saline concurrently in a second intravenous site 3 Maintaining a gap of 2 full hours after administration of 1 unit before the next unit 4 Monitoring the patient's kidney function and fluid status before initiating the therapy

Administering normal saline concurrently in a second intravenous site Older patients undergoing transfusion therapy are at a high risk of fluid overload; concurrent administration of normal saline into the other intravenous site should be avoided. The infusion rate in older patients should be one unit per 2 to 4 hours to avoid the risk of fluid overload. Maintaining a specific interval of time between consecutive transfusions is necessary to prevent fluid overload. Assessing the kidney function and fluid status of the patient before initiating the therapy is very important. This helps to determine the volume and infusion rate to reduce the risk of fluid overload.

The nurse is caring for a patient with hypoxemia and metabolic acidosis. Which task can be delegated to the nursing assistant who is helping with the patient's care? 1 Assess the patient's respiratory pattern. 2 Apply the pulse oximeter for continuous readings. 3 Increase the intravenous normal saline to 120 mL/hr. 4 Titrate O 2 to maintain an O 2 saturation of 95% to 100%

Apply the pulse oximeter for continuous readings. Placing a peripheral pulse oximeter is a standardized nursing skill that is within the scope of practice for unlicensed personnel. Assessment and intravenous therapy are skills performed by the professional nurse. Titration of O 2 requires assessment and intervention beyond the scope of practice of an unlicensed individual.

Which disorder causes antiplatelet antibody formation even when platelet production is normal? 1 Hemophilia 2 Heparin-induced thrombocytopenia 3 Thrombotic thrombocytopenic purpura 4 Autoimmune thrombocytopenic purpura

Autoimmune thrombocytopenic purpura In autoimmune thrombocytopenic purpura, a patient's antibodies are produced against their own platelets, which lead to the formation of antiplatelet antibodies. This leads to a decrease in circulating platelets and results in clotting impairment. Hemophilia is a genetic disorder caused by clotting factor deficiencies. Heparin-induced thrombocytopenia is an unexplained drop in platelet count after the treatment of heparin. Thrombotic thrombocytopenic purpura indicates that the platelets have formed a clump in the capillaries.

The laboratory reports of a patient show the patient has metabolic alkalosis. What conditions may result in metabolic alkalosis? Select all that apply. 1 Starvation 2 Blood transfusion 3 Prolonged vomiting 4 Prolonged diarrhea 5 Nasogastric suctioning 6 Total parenteral nutrition

Blood transfusion Prolonged vomiting Nasogastric suctioning Total parenteral nutrition Prolonged vomiting and nasogastric suctioning can lead to acid deficits causing metabolic alkalosis. Blood transfusion and total parenteral nutrition increase the base components by parenteral base administration. Therefore they also cause metabolic alkalosis. Prolonged diarrhea can cause overelimination of bicarbonate ions resulting in metabolic acidosis. Starvation leads to excessive oxidation of fatty acids leading to overproduction of hydrogen ions and metabolic acidosis.

The lab values for a patient admitted for an exacerbation of chronic obstructive pulmonary disease (COPD) reveal a pH of 7.29 with a decreased PaO 2 and an elevated PaCO 2. Which initial treatment does the nurse expect the provider to most likely order? 1 Intravenous fluids 2 High-flow oxygen 3 Sodium bicarbonate 4 Bronchodilator therapy

Bronchodilator therapy This patient has signs of respiratory acidosis, so the first intervention is to improve ventilation. To accomplish this, bronchodilators are often used. Oxygen may be used but should be given cautiously to patients with COPD who may rely on hypoxia and not hypercarbia as a stimulus to breathe. Low-flow oxygen would be more appropriate. Intravenous fluids and sodium bicarbonate are used to treat metabolic acidosis.

A patient in acute respiratory distress from an asthma attack becomes more confused. Respirations remain rapid but are more shallow. The most recent blood gas results are pH 7.29, PaO 2 62 mm Hg, PaCO 2 56 mm Hg, HCO 3 -25 mEq/L. What is the nurse's priority intervention? 1 Call the Rapid Response Team. 2 Place the patient in a semi-Fowler's position. 3 Increase the oxygen delivery system to 100% Fio 2. 4 Evaluate the patient's need for sedation to assist with breathing.

Call the Rapid Response Team. Inadequate gas exchange from the airway narrowing associated with asthma and shallow respirations reduce oxygen and carbon dioxide exchange (ventilation). The patient is showing signs of respiratory acidosis and ineffective breathing. The Rapid Response Team should be called to assess the patient for possible protective airway measures to improve ventilation and oxygenation. Although oxygen is the first priority, 100% Fio 2 is not correct because the oxygen should be started lower. Sedation is not appropriate for this patient. The patient would be placed in high-Fowler's position.

An older adult who is receiving rapid a whole blood transfusion develops hypertension, bounding pulse, distended neck veins, and confusion. What could be the cause of the patient's condition? 1 Circulating overload 2 Febrile transfusion reaction 3 Allergic transfusion reaction 4 Hemolytic transfusion reaction

Circulating overload Circulating overload is manifested as hypertension, bounding pulse, distended neck veins, and confusion. Circulating overload can occur when the infusion rate is rapid, especially in older adults. Febrile transfusion reactions are characterized by the formation of anti-white blood cell antibodies and are manifested by chills, tachycardia, fever, hypotension, and tachypnea. Hemolytic transfusion reactions are characterized by fever, chills, disseminated intravascular coagulation, and circulatory collapse. Symptoms of allergic transfusion reactions include urticaria, itching, bronchospasm, or anaphylaxis.

The student nurse starts the infusion of packed red blood cells in a patient who is already on intravenous (IV) antibiotic therapy; the infusion goes through the same IV line. What complication would be expected? 1 Allergy 2 Clotting 3 Hemolysis 4 Fluid overload

Clotting When added to or infused along with blood products, drugs may cause blood clotting. Therefore an additional intravenous site should be used in order for blood to be infused without any other medications. Allergies do not arise from a co-administration of drug and blood products. It is seen in patients with a history of other allergies, including asthma. Hemolysis occurs due to blood type or Rh factor incompatibilities. Fluid overload occurs due to rapid infusion of blood products, not due to the co-administration of drug and blood products.

.A patient develops fever, chills, and shock rapidly after initiation of infusion therapy. The primary health care provider diagnoses the condition as a bacterial infection and advises termination of the therapy. Which assessment finding supports the diagnosis? 1 Urticaria 2 Bounding pulse 3 Redness of the head and neck 4 Cloudiness of the product in the blood bag

Cloudiness of the product in the blood bag A bacterial contamination of the blood products leads to a rapid development of fever, chills, and shock. Any presence of discoloration, gas bubbles, or cloudiness in the blood bag is an indication of a bacterial infection. Urticaria is observed in patients with allergic transfusion reactions. A bounding pulse is a manifestation of circulating overload. Redness of the head and neck is a manifestation of acute pain transfusion reactions.

After successful resuscitation of cardiopulmonary arrest, the nurse views these arterial blood gases: pH 7.28; CO 2 52; HCO 3 - 16. What is the interpretation of these values? 1 Fully compensated respiratory acidosis 2 Partially compensated metabolic acidosis 3 Partially compensated respiratory acidosis 4 Combined respiratory and metabolic acidosis

Combined respiratory and metabolic acidosis With a pH of 7.28 (acidosis), there is evidence of a respiratory component (CO 2 > 45) and a metabolic component (HCO 3 - < 21). This is therefore combined respiratory and metabolic acidosis, which would likely follow a cardiopulmonary arrest (CO 2 retention, lactic acidosis). Compensation in respiratory acidosis is demonstrated by an elevated HCO 3 -. In metabolic acidosis, there is very little, if any, change in CO 2. Full compensation would be demonstrated by a normal pH.

The nurse is assessing a patient with anemia for respiratory impairment. What does the nurse incorporate in the assessment? 1 Determine if the patient can speak a five-word sentence without being short of breath. 2 Assess the lungs for the presence of adventitious lung sounds. 3 Determine if the patient sleeps on two to three pillows at night. 4 Observe for the use of accessory muscles during expiration.

Correct 3 Determine if the patient sleeps on two to three pillows at night When the patient is anemic, the nurse should assess the respiratory system for impairment. Orthopnea (difficulty breathing while lying down) can be a sign of breathing problems. Respiratory impairment can be assessed by asking the patient if he or she elevates the head of the bed by using more than one pillow at night to make it easier to sleep. The patient would be considered short of breath if he or she cannot complete a 10-word sentence without stopping to breathe. Although it is important for the nurse to auscultate lung sounds, adventitious lung sounds are present with airway constriction or fluid volume overload, not anemia. If the patient is having difficulty breathing, the nurse would see accessory muscles being used on inspiration, not expiration.

A patient with a history of chronic alcohol abuse is pale and jaundiced. A review of the medical record reveals a low hemoglobin level with macrocytic red blood cells. This information may point to what nutrient deficiency? 1 Iron 2 Folic acid 3 Vitamin A 4 Vitamin B 1

Folic acid Patients who have alcoholism often have folic acid deficiency anemia secondary to malnutrition. Patients deficient of iron in the diet have iron deficiency anemia. Patients who have undergone a partial gastrectomy or have malabsorption syndrome are likely to have vitamin B 12 deficiency anemia. A diet deficient in vitamin A is common among people in developing countries and is linked to multiple eye disorders.

The nurse is caring for a patient diagnosed with idiopathic thrombocytopenic purpura (ITP). The patient's platelet count is 38,000/mm 3. What treatment does the nurse anticipate for this patient? 1 Corticosteroids 2 Platelet transfusion 3 Fresh frozen plasma 4 Haemophilus influenza vaccine

Corticosteroids Corticosteroids are indicated in a patient with ITP with a platelet count under 50,000. Platelet transfusion would be used if the platelet count is under 10,000. Fresh frozen plasma is indicated for thrombotic thrombocytopenic purpura. Unnecessary intramuscular injections should be avoided.

A patient reports painful muscle spasms in the lower legs at rest, a tingling sensation in the hands and lips, and abdominal cramping and diarrhea. The nurse reviews the patient's laboratory results for the presence of which disorder? 1 Hypocalcemia 2 Hypernatremia 3 Hypermagnesemia 4 Hypophosphatemia

Hypocalcemia The primary symptoms of hypocalcemia are neuromuscular changes, specifically painful muscle cramps, and paresthesias that may spread to the face, progressing to tetany. Abdominal cramping and diarrhea may also occur. Muscle spasms in lower legs at rest, tingling sensation in the hands and lips, and abdominal cramping and diarrhea are not primary characteristics of hypernatremia, hypermagnesemia, or hypophosphatemia.

Which condition is assessed using Trousseau's and Chvostek's signs? 1 Hypokalemia 2 Hypocalcemia 3 Hyponatremia 4 Hypomagnesemia

Hypocalcemia a decrease in serum calcium levels and is assessed by testing for Trousseau's and Chvostek's signs. Hypokalemia, hyponatremia, and hypomagnesemia are not assessed by testing for Trousseau's and Chvostek's signs. Hypokalemia is determined by electrocardiogram changes. Hyponatremia can be detected by assessing a patient's mental status for changes. Hypomagnesemia causes muscle weakness.

The nurse is assessing the laboratory reports of a patient with impaired kidney function. What changes most indicate the patient has metabolic acidosis? 1 Increase in arterial blood pH 2 Increase in partial pressure of arterial oxygen 3 Decrease in partial pressure of carbon dioxide 4 Decrease in serum bicarbonate level

Decrease in serum bicarbonate level In metabolic acidosis, the bicarbonate level is low and arterial blood pH is decreased. The pathology of metabolic acidosis related to impaired kidney function is associated with underelimination of hydrogen ions and underproduction of bicarbonate, not the increase in partial pressure of arterial oxygen or the decrease in partial pressure of arterial carbon dioxide.

Which laboratory value may be normal for an asymptomatic patient with sickle cell disease (SCD) during non-sickle cell crisis times? 1 Decreased hematocrit 2 Low reticulocyte count 3 Elevated hemoglobin A 4 Low white blood cell (WBC) count

Decreased hematocrit

Decreased hematocrit Patients with SCD usually have decreased hematocrit levels between 20% and 30% because the life span of the red blood cell is much shorter and many cells are destroyed. Hemoglobin A is normal hemoglobin and is lower than normal in patients with SCD. Patients with SCD usually have elevated reticulocyte and WBC counts.

A patient admitted with diabetic ketoacidosis was treated for metabolic acidosis with intravenous (IV) fluids and insulin. Which electrolyte imbalance does the nurse monitor for as the acid-base imbalance resolves? 1 Hyponatremia 2 Hypokalemia 3 Hyperkalemia 4 Hypernatremia

Hypokalemia

The nurse is assessing a dark-skinned patient for anemia. What finding establishes the presence of bruises in the patient? 1 Pinpoint hemorrhagic lesions on the palms 2 Pallor of the mouth mucosa 3 Pallor of the conjunctiva 4 Darker, palpable areas on the skin

Darker, palpable areas on the skin Bruises are seen as darker areas of the skin and palpated as slight swelling or irregular skin. Petechiae are identified as pinpoint hemorrhagic lesions on the palms. Decreased hemoglobin levels and poor tissue oxygenation cause pallor of the mouth mucosa and conjunctiva.

The nurse is providing care to a patient who is receiving diuretic therapy. Which electrolyte imbalance will the nurse monitor this patient for while providing care? 1 Hypokalemia 2 Hypercalcemia 3 Hypernatremia 4 Hypophosphatemia

Hypokalemia A patient who is prescribed diuretic therapy will require monitoring for hypokalemia. The nurse would not anticipate hypercalcemia, hypernatremia, or hypophosphatemia for this patient.

Which condition commonly occurs in patients who are on long-term furosemide therapy? 1 Hypocalcemia 2 Hypercalcemia 3 Hyponatremia 4 Hypernatremia

Hyponatremia Furosemide is a high ceiling or loop diuretic. Prolonged use of this drug to manage fluid overload may cause loss of sodium along with extra water, leading to a decrease in sodium levels, or hyponatremia. Hypocalcemia, hypercalcemia, and hypernatremia are not associated with prolonged use of furosemide.

Which condition commonly occurs in patients who are on long-term furosemide therapy? 1 Hypocalcemia 2 Hypercalcemia 3 Hyponatremia 4 Hypernatremia

An 82-year-old patient with anemia is requested to receive 2 units of whole blood. Which assessment findings cause the nurse to discontinue the transfusion because it is unsafe for the patient? Select all that apply. 1 Hypotension 2 Hypertension 3 Decreased pallor 4 Rapid, bounding pulse 5 Flattened superficial veins 6 Capillary refill less than 3 seconds

Hypotension Hypertension Rapid, bounding pulse

A new nurse is caring for a postoperative patient with the following arterial blood gas (ABG) result: pH 7.30; PaCO 2 60 mm Hg; PaO 2 80 mm Hg; bicarbonate 24 mEq/L; and O 2 saturation 96%. Which of these actions by the new graduate is indicated? 1 Administer oxygen by nasal cannula. 2 Inform the charge nurse that no changes in therapy are needed. 3 Encourage the patient to use the incentive spirometer and cough. 4 Request a prescription for sodium bicarbonate from the health care provider.

Encourage the patient to use the incentive spirometer and cough. Postoperative respiratory acidosis is caused by CO 2 retention and impaired chest expansion secondary to anesthesia. The nurse takes steps to promote CO 2 elimination, including maintaining a patent airway and expanding the lungs through respiratory interventions such as use of an incentive spirometer and purposeful coughing. Post anesthesia, the patient will need interventions related to promoting CO 2 elimination, or the patient may progress to a state of somnolence and unresponsiveness. Supplemental oxygen is not indicated because PaO 2 and oxygen saturation are within the normal range. Sodium bicarbonate is not indicated because the bicarbonate level is in the normal range.

Which intervention most effectively protects a patient with thrombocytopenia? 1 Taking rectal temperatures 2 Avoiding the use of dentures 3 Using warm compresses on trauma sites 4 Encouraging the use of an electric shaver

Encouraging the use of an electric shaver The patient with thrombocytopenia should be advised to use an electric shaver instead of a razor. Any small cuts or nicks can cause problems because of the prolonged clotting time. Dentures may be used by patients with thrombocytopenia as long as they fit properly and do not rub. To prevent rectal trauma, rectal thermometers should not be used. Oral or tympanic temperatures should be taken. Ice (not heat) should be applied to areas of trauma.

A patient is admitted with severe diabetic ketoacidosis. Arterial blood gas results reveal a pH of 7.21. What is this patient's acidosis most likely in response to? 1 Anaerobic metabolism 2 Excessive intake of insulin 3 Excessive breakdown of fatty acids 4 Excessive intake of alcoholic beverages

Excessive breakdown of fatty acids Metabolic acidosis can result from the overproduction of hydrogen ions, underelimination of hydrogen ions, or insufficient bicarbonate ions. Excessive breakdown of fatty acids that occurs with diabetic ketoacidosis or starvation results in overproduction of hydrogen ions and metabolic acidosis. Anaerobic metabolism produces lactic acid as a cause of metabolic acidosis. Excessive intake of alcoholic beverages will also cause metabolic acidosis because of the high concentration of hydrogen ions in alcohol. Excessive intake of insulin will not result in diabetic ketoacidosis.

The nurse is caring for a patient with sickle cell disease (SCD). Which action is most effective in reducing the potential for sepsis in this patient? 1 Frequent and thorough handwashing 2 Administering prophylactic drug therapy 3 Taking vital signs every 4 hours, day and night 4 Monitoring laboratory values to look for abnormalities

Frequent and thorough handwashing Prevention and early detection strategies are used to protect the patient in sickle cell crisis from infection. Frequent and thorough handwashing is of the utmost importance. Drug therapy is a major defense against infections that develop in the patient with sickle cell disease, but is not the most effective way that the nurse can reduce the potential for sepsis. Continually assessing the patient for infection and monitoring the daily complete blood count (CBC) with differential white blood cell (WBC) count is early detection, not prevention. Taking vital signs every 4 hours will help with early detection of infection, but is not prevention.

An African American patient taking a thiazide diuretic develops hemolytic anemia. The nurse notifies the provider and anticipates an order to test this patient for which type of anemia? 1 Iron deficiency 2 G6PD deficiency 3 Immunohemolytic 4 Sickle cell disease

G6PD deficiency Patients with G6PD deficiency do not have symptoms until they develop a severe infection or are exposed to certain drugs, such as a thiazide—a diuretic that causes red blood cells (RBCs) with reduced G6PD to break more easily. Immunohemolytic anemia results from increased RBC destruction following viral illness, trauma, and exposure to some drugs. Iron deficiency anemia and sickle cell disease are not characterized by hemolysis of RBCs.

Laboratory results report a patient's serum potassium at 5.6 mEq/L. What does the nurse immediately assess in the patient? 1 Heart rate 2 Bowel sounds 3 Feet for paresthesias 4 Level of consciousness

Heart rate Cardiovascular changes, specifically bradycardia; tall, peaked T waves; rhythm changes to complete heart block; asystole; and ventricular fibrillation are life-threatening consequences of elevated potassium. The provider or Rapid Response Team may need to be notified if changes in heart rate and rhythm are assessed. Paresthesias in the arms and feet and increased intestinal motility are lower-priority signs of elevated potassium. Level of consciousness would not be affected.

A young adult African-American patient receiving intravenous antibiotics for a urinary tract infection reports severe fatigue and pain in all extremities. The nurse assesses a heart rate of 110 beats/min, auscultates an S 3 heart sound, and notes an oxygen saturation of 86%. The patient has no previous history of disease. Which laboratory test will most likely help diagnose sickle cell disease in this patient? 1 Urinalysis 2 Blood culture 3 Complete blood count 4 Hemoglobin electrophoresis

Hemoglobin electrophoresis Patients with sickle cell trait may never have symptoms until an acute illness is present, since less than 40% of red blood cells are abnormal. Blood culture, complete blood count, and urinalysis may be performed to assist in a complete diagnosis, but hemoglobin electrophoresis will detect underlying sickle cell trait.

A newly admitted patient has an elevated reticulocyte count. Which disorder does the nurse suspect in this patient? 1 Aplastic anemia 2 Hemolytic anemia 3 Infectious process 4 Leukemia

Hemolytic anemia Elevated reticulocyte count in an anemic patient indicates that the bone marrow is responding appropriately to a decrease in the total red blood cell (RBC) mass and is prematurely destroying RBCs. Therefore, more immature RBCs are in circulation. Aplastic anemia is associated with a low reticulocyte count. A high white blood cell count is expected in patients with infection. A low white blood cell count is expected in patients with leukemia.

A patient undergoing transfusion therapy presents with hypotension, tachycardia, and tachypnea after administration of 50 mL of the infusion. What should the nurse infer from these findings? 1 Allergic reaction 2 Bacterial reaction 3 Hemolytic reaction 4 Acute pain reaction

Hemolytic reactions may occur if there is massive hemolysis of the blood product; signs include hypotension, tachycardia, and tachypnea. Allergic reaction occurs during or up to 24 hours after the transfusion and is manifested as itching, urticaria, bronchospasm, or anaphylaxis. Onset of a bacterial reaction is rapid and is manifested as hypotension, fever, chill, and shock. Acute pain reaction is a rare event that occurs during or shortly after the transfusion; it is manifested as severe chest pain, back pain, joint pain, hypertension, and redness of the head and neck.

What should be assessed when ruling out intracranial bleeding in a patient diagnosed with idiopathic thrombocytopenic purpura (ITP)? Select all that apply. 1 Petechiae 2 Mental status 3 Platelet count 4 Neurologic function 5 Splenic enlargement

Mental status Neurologic function

What type of transfusion reaction is characterized by disseminating intravascular coagulation? 1 Febrile transfusion reactions 2 Bacterial transfusion reactions 3 Hemolytic transfusion reactions 4 Acute pain transfusion reactions

Hemolytic transfusion reactions Hemolytic transfusion reactions occur as a result of antigen antibody complexes formed due to incompatibility between the donor and recipient's blood. These complexes destroy the blood vessel walls and organs. This reaction is characterized by disseminating intravascular coagulation and circulatory collapse. Febrile transfusion reactions are characterized by the development of anti-white blood cell antibodies. Bacterial transfusion reactions are caused by the contamination of blood products. Acute pain transfusion reactions are manifested as severe chest pain, back pain, joint pain, hypertension, and redness.

Which clotting disorder may be caused by X-linked inheritance? 1 Hemophilia A 2 Hemophilia C 3 Von Willebrand disease 4 Heparin-induced thrombocytopenia

Hemophilia A Hemophilia A, a deficiency of factor IX, shows X-linked recessive pattern of inheritance. Hemophilia C is a deficiency of factor XI that is an autosomal pattern of inheritance involving lack of functional clotting factor XI. Von Willebrand disease is caused by the presence of an abnormal gene. Heparin-induced thrombocytopenia is a clotting disorder involving an unexplained drop in platelet count after heparin treatment.

The nurse instructs an older adult patient to increase intake of dietary potassium when the patient is prescribed which classification of drugs? 1 Beta blockers 2 Corticosteroids 3 Alpha antagonists 4 High-ceiling (loop) diuretics

High-ceiling (loop) diuretics

A patient is admitted from the emergency department for intravenous (IV) fluids to treat dehydration caused by several days of vomiting and diarrhea. The patient's admission venous blood work reveals a pH of 7.27 and bicarbonate of 26 mEq/L; potassium and chloride levels are within normal ranges. The provider has ordered adding bicarbonate to the IV fluids. Which action by the nurse is correct? 1 Suggest adding potassium chloride to the IV fluids. 2 Hold the bicarbonate and report the laboratory values to the provider. 3 Request an order for renal function tests before giving the bicarbonate. 4 Administer the bicarbonate as ordered to treat this patient's metabolic acidosis.

Hold the bicarbonate and report the laboratory values to the provider. Bicarbonate is not given for metabolic acidosis unless the patient's bicarbonate levels are low. This patient's levels are within normal limits. Normal renal function is necessary if potassium is added to IV fluids. The patient has normal potassium and chloride levels, so potassium is not needed at this time.

The primary health care provider prescribes intravenous administration of 100 mL of 20% glucose along with 20 units of insulin in a patient who is receiving furosemide therapy. What is the probable diagnosis of the patient? 1 Hyperkalemia 2 Hyperglycemia 3 Hypernatremia 4 Hypercalcemia

Hyperkalemia Hyperkalemia is a condition where serum potassium levels are high. Potassium movement into the cells is enhanced by insulin. Intravenous administration of 100 mL 10% to 20% glucose with 10 to 20 units of regular insulin helps decrease serum potassium levels. Insulin increases the activity of sodium-potassium pumps, which decreases serum potassium levels temporarily by moving potassium from the extracellular fluid to the cells. This therapy is prescribed as an add-on therapy along with diuretics in a hyperkalemic patient. Conditions such as hyperglycemia, hypernatremia, and hypercalcemia cannot be managed with this insulin and glucose therapy.

Which electrolyte abnormality does the nurse anticipate when reviewing laboratory data for a patient admitted with metabolic acidosis? 1 Hyponatremia 2 Hypernatremia 3 Hypokalemia 4 Hyperkalemia

Hyperkalemia Serum potassium (hyperkalemia) occurs during metabolic acidosis as the body attempts to maintain pH by moving potassium ions from the cell in exchange with hydrogen ions moving into the cell. Hypokalemia may occur as the cause of the metabolic acidosis is corrected. Sodium concentrations (hypernatremia and hyponatremia) are not affected in the buffering process of acid-base balance.

Which electrolyte abnormality does the nurse anticipate when reviewing laboratory data for a patient admitted with metabolic acidosis? 1 Hyponatremia 2 Hypernatremia 3 Hypokalemia 4 Hyperkalemia

When assessing the laboratory results of a patient who has hypomagnesemia, for which additional electrolyte imbalance should the nurse monitor? 1 Hyperkalemia 2 Hypocalcemia 3 Hypernatremia 4 Hypophosphatemia

Hypocalcemia Hypocalcemia often occurs with hypomagnesemia, so the nurse would monitor for signs and symptoms of low calcium levels. Hypomagnesemia may increase potassium secretion in certain circumstances, leading the health care provider to be aware that replacement of magnesium is crucial before attempting to replace potassium if the patient is deficient in both. Hypernatremia and hypophosphatemia are not related to hypomagnesemia.

A patient who recently experienced an anterior neck injury reports frequent and painful muscle spasms in the calf during sleep. Which condition does the nurse suspect in the patient? 1 Hypokalemia 2 Hypocalcemia 3 Hyponatremia 4 Hypophosphatemia

Hypocalcemia Patients with a history of anterior neck injury are at a high risk for hypocalcemia. Frequent painful muscle spasms in the calf or foot during rest or sleep (charley horses) indicate hypocalcemia. Hypokalemia, hyponatremia, and hypophosphatemia do not cause painful calf muscle spasms.

Which electrolyte imbalance should be anticipated and monitored in a patient with hyperphosphatemia? 1 Hypokalemia 2 Hypocalcemia 3 Hypernatremia 4 Hypermagnesemia

Hypocalcemia Phosphorus and calcium have an inverse or reciprocal relationship. When one is increased, the other is usually decreased. Therefore a patient with hyperphosphatemia should be monitored for hypocalcemia. Hyperphosphatemia does not cause hypernatremia, hypokalemia, or hypermagnesemia.

A patient presents to the emergency department with a new onset of bruising and a petechial rash around the upper chest and arms. The patient's lab demonstrates a platelet count of 51,000 platelets per milliliter. What action by the nurse is most appropriate? 1 Administer corticosteroids 2 Plan for bone marrow aspiration 3 Implement bleeding precautions 4 Examine the patient's history for recent virus

Implement bleeding precautions Implementing bleeding precautions is priority for a patient with new bruising, petechial rash, and a platelet count of 51,000 per mL. Administering corticosteroids is not indicated because the platelet count is above 50,000. Bone marrow aspiration may be done, but it is not a priority. It is important to examine the patient's history for recent virus; however, implementing bleeding precautions is the priority.

How does the body compensate for a low pH? 1 Increases respiratory rate 2 Decreases respiratory rate 3 Retention of carbon dioxide 4 Decreases release of bicarbonate

Increases respiratory rate When the body has an acid-base imbalance, it finds ways to compensate. Low pH indicates acidosis, which the body can combat with an increased respiratory rate to blow off carbon dioxide. Decreased respirations would result in worsening acidosis. The kidneys may also respond by releasing bicarbonate, not decreasing its release. The body is already retaining carbon dioxide, so continuing to retain it would not affect low pH.

The total iron-binding capacity (TIBC) for a patient is 200 mcg/dL. What is the significance of this result? 1 Indicates chronic hypoxia 2 Possible iron deficiency 3 Presence of an infection 4 Indicates hemorrhage

Indicates hemorrhage A normal TIBC value ranges from 250-460 mcg/dL. A decrease in this value indicates anemia, hemorrhage, or hemolysis. Chronic hypoxia is indicated by an increase in red blood cells (RBCs). Increased levels of TIBC indicate a possibility of iron deficiency. An increased white blood cell (WBC) count indicates the presence of infection.

A nurse is caring for a patient who received a blood transfusion four hours ago and is experiencing shortness of breath. Oxygen saturation is at 89%. What is the nurse's priority intervention? 1 Prepare to administer a diuretic. 2 Administer oxygen via nasal cannula. 3 Administer intravenous diphenhydramine. 4 Inform the physician and prepare for intubation

Inform the physician and prepare for intubation. Dyspnea and hypoxia occurring within six hours of the transfusion are signs that the patient may be experiencing a transfusion-related acute lung injury (TRALI). The priority intervention is to notify the provider and prepare for intubation due to the need for respiratory support. A diuretic can be administered for circulatory overload, not TRALI. Administering oxygen via nasal cannula will not adequately support a patient's oxygen needs as the reaction worsens. Intravenous diphenhydramine can be administered to a patient experiencing an allergic reaction.

A nurse is caring for a patient who has weakness, pallor, fatigue, reduced exercise tolerance, and fissures at the corners of the mouth. The nurse recognizes these symptoms are associated with which condition? 1 Aplastic anemia 2 Folic acid deficiency 3 Iron deficiency anemia 4 Vitamin B12 deficiency (pernicious) anemia

Iron deficiency anemia Weakness, pallor, fatigue, reduced exercise tolerance, and fissures at the corners of the mouth are symptoms of iron deficiency anemia. In patients with aplastic anemia, a complete blood count (CBC) shows severe macrocytic anemia, leukopenia, and thrombocytopenia. Patients with folic acid deficiency and vitamin B12 deficiency anemia may exhibit pallor and jaundice, glossitis, fatigue, and weight loss.

A morbidly obese patient has chosen gastric bypass surgery to promote weight loss. The nurse plans to teach the patient about the need to perform monitoring to detect what disturbance consistent with rapid weight loss associated with this procedure? 1 Ketosis 2 Hypoxemia 3 Urinary retention 4 Insufficient ventilation

Ketosis Starvation, fasting, or following a strict calorie-reduced diet with rapid weight loss contributes to ketone formation and metabolic acidosis. Weight loss should decrease the work of breathing and improve hypoxemia, if present, as well as hypoventilation. Urinary retention does not occur in acid-base imbalance.

What is one of the causes of acidosis? 1 Colitis 2 Heart failure 3 Kidney failure 4 Excessive body fluids

Kidney failure Causes of acidosis include kidney failure, pancreatitis, liver failure, and dehydration. Excessive body fluids, heart failure, and colitis are causes of alkalosis.

What is one of the causes of acidosis? 1 Colitis 2 Heart failure 3 Kidney failure 4 Excessive body fluids

Kidney failure Causes of acidosis include kidney failure, pancreatitis, liver failure, and dehydration. Excessive body fluids, heart failure, and colitis are causes of alkalosis.

What medications may be given for treatment of heparin-induced thrombocytopenia (HIT)? Select all that apply. 1 Lepirudin 2 Factor VIII 3 Bivalirudin 4 Argatroban 5 Azathioprine

Lepirudin Bivalirudin Argatroban

Which organs play major roles in maintaining pH balance in the body? 1 Lungs and liver 2 Kidneys and brain 3 Liver and pancreas 4 Lungs and kidney

Lungs and kidneys Blood pH represents a delicate balance between hydrogen ions (acid) and bicarbonate anions (base), which is largely controlled by the lungs and kidneys. The lungs adjust the blood pH by releasing or retaining hydrogen ions (acid), and the kidneys adjust the blood pH by releasing or retaining bicarbonate anions (base). The liver plays a role in metabolism, immunity, and clotting. The pancreas releases insulin for glucose metabolism and enzymes for digestion. The brain plays a secondary role in maintaining pH balance by sensing the need for alterations in acid or base levels and sends appropriate signals to the kidneys and lungs.

To decrease the risk of acid-base imbalance, what goal must the patient with diabetes mellitus strive for? 1 Drinking 3 L of fluid per day. 2 Eating regularly, every 4 to 8 hours. 3 Checking blood glucose levels once daily. 4 Maintaining blood glucose level within normal limits.

Maintaining blood glucose level within normal limits. Maintaining blood glucose levels within normal limits is the best way to decrease the risk of acid-base imbalance. Blood glucose levels must be checked not once but several times a day. Drinking 3 L of fluid per day is not necessary to maintain acid-base balance. Eating regularly is a way to achieve acid-base balance but is not the goal itself.

A patient with mild hypokalemia caused by diuretic use is discharged home. The home health nurse delegates which of these interventions to the home health aide? 1 Instruction on the proper use of drugs 2 Education about potassium-rich foods 3 Assessment of muscle tone and strength 4 Measurement of the patient's urine output

Measurement of the patient's urine output

The nurse is caring for a critically ill patient with septic shock. The serum lactate level is 6.2. For which acid-base disturbance should the nurse assess? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

Metabolic acidosis Patients with critical illness can be considered to have normal lactate concentrations at less than 2 mmol/L. Increased lactate levels are associated with hypoxia and metabolic acidosis secondary to anaerobic metabolism. Metabolic alkalosis is related to bicarbonate therapy, diuretic use, vomiting, and nasogastric suction. Respiratory acidosis is caused by CO 2 retention and impaired pulmonary function, which is inconsistent with elevated lactate levels. Respiratory alkalosis is caused by excessive loss of CO 2 through hyperventilation, which is inconsistent with elevated lactate levels.

When planning care for a patient with hypercalcemia, which intervention does the nurse consider? 1 Monitor cardiac rhythm for changes. 2 Limit activities to protect against injury. 3 Assess oxygen saturation levels every 4 hours. 4 Avoid invasive procedures due to increased bleeding tendency.

Monitor cardiac rhythm for changes Hypercalcemia increases the risk for cardiac dysrhythmias. It does not impair gas exchange, so oxygen saturation does not need to be routinely monitored. There is a greater tendency to clot, especially with slow venous perfusion, so invasive procedures do not need to be avoided and increased activity (not restriction) is recommended.

The nurse is caring for a patient with neutropenia who has a suspected infection. Which intervention does the nurse implement first? 1 Obtain requested cultures 2 Place the patient on Bleeding Precautions 3 Initiate the administration of prescribed antibiotics 4 Hydrate the patient with 1000 mL of IV normal saline

Obtain requested cultures Obtaining cultures to identify the infectious agent correctly is the priority for this patient. Hydrating the patient is not the priority. Administering antibiotics is important, but antibiotics should always be started after cultures are obtained. Placing the patient on Bleeding Precautions is unnecessary.

Which newly written prescription does the nurse administer first? Oral calcium supplements to a patient with severe osteoporosis 2 Oral phosphorus supplements to a patient with acute hypophosphatemia 3 Intravenous (IV) normal saline to a patient with a serum sodium of 132 mEq/L 4 Oral potassium chloride (KCl) to a patient whose serum potassium is 3 mEq/L

Oral potassium chloride (KCl) to a patient whose serum potassium is 3 mEq/L Because minor changes in serum potassium level can cause life-threatening dysrhythmias, the first priority should be to administer potassium supplements to the patient with hypokalemia. The electrolyte disturbance (sodium level of 132 and low phosphorus level) and the need for calcium in this patient are not immediately life-threatening.

Which patient does the nurse identify as at risk for iron deficiency anemia? 1 Patient with systemic lupus erythematosus 2 Patient with a seizure disorder who takes valproate 3 Patient who has undergone a Roux-en-Y procedure for obesity 4 Patient who has received radiation therapy to the pelvis for ovarian cancer

Patient who has undergone a Roux-en-Y procedure for obesity The Roux-en-Y gastric bypass procedure can cause anemia by reducing the available surface for absorption of iron; additionally, hydrochloric acid is reduced and therefore iron absorption is reduced. The patient with systemic lupus erythematosus develops anemia due to the autoimmune process whereby the body recognizes the patient's RBCs as foreign tissue and attacks them. Anticonvulsant medications produce a folic acid deficiency anemia. The patient who has received radiation is at risk for anemia due to destruction of the bone marrow.

Which patient does the nurse consider at risk for folic acid deficiency anemia? 1 Patient with heart failure 2 Patient with Crohn's disease 3 Patient recovering from fracture of the tibia 4 Patient with a basal skin cancer of the nose

Patient with Crohn's disease Malabsorption syndromes, such as Crohn's disease, are the second most common cause of folic acid deficiency anemia. Other risk factors include poor nutrition and the use of anticonvulsants or oral contraceptives. Those with an increased need for folic acid are at additional high risk. Heart failure and basal cell skin cancer are not included in these risks. Patients with fractures may require additional calcium, not folic acid.

A nurse is caring for a patient with a gastrointestinal (GI) bleed and a history of thrombocytopenia. The physician orders a transfusion. The nurse prepares for which type of transfusion? 1 Plasma 2 Platelets 3 White blood cells (WBCs) 4 Packed red blood cells (PRBCs)

Platelets Platelet transfusions are indicated for patients with thrombocytopenia who are actively bleeding. A WBC transfusion is rarely used but is indicated for neutropenic patients with active infections. PRBC is transfused when a patient is actively bleeding. However, this patient also has a deficiency of platelets due to the history of thrombocytopenia, which would require replacement of platelets. Plasma transfusions are usually administered to replace blood volume and clotting factors.

A patient who is actively bleeding has a platelet count of 40,000 per microliter of blood. The patient has a history of febrile transfusion reactions. Which blood product would be safe for transfusion in this patient? 1 Pooled platelets 2 White blood cells 3 Platelets from a single donor 4 Leukocyte-reduced red blood cells

Platelets from a single donor An actively bleeding patient with a platelet count of fewer than 50,000 per microliter of blood should receive a platelet transfusion. Because the patient has a history of febrile transfusion reactions, he or she should be infused with platelets from a single donor. An infusion of pooled platelets is preferred for a patient who is actively bleeding but does not have a history of febrile reactions. An infusion of leukocyte-reduced red blood cells is appropriate for patients with febrile transfusion reactions who do not have decreased platelet count. A white blood cell transfusion is contraindicated.

A lab report for a 47-year-old patient shows the following results: pH 7.32; bicarbonate 24; PaO 2 77; PaCO 2 48. These findings are consistent with which acid-base imbalance? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosi

Respiratory acidosis In respiratory acidosis, there is a decrease in pH (normal is 7.35-7.45), a normal bicarbonate (normal is 21-28), a decreased PaO 2 (normal is 80-100), and an increased PaCO 2 (normal is 35-45). The arterial blood gas results of pH 7.32; bicarbonate 24; PaO 2 77; PaCO 2 48 reflect respiratory acidosis. In respiratory alkalosis, there is an increase in pH, a normal bicarbonate, a normal PaO 2, and a decrease in PaCO 2. In metabolic alkalosis, there is an increase in pH, increase bicarbonate, normal PaO 2, and normal PaCO 2. In metabolic acidosis, there is a decrease in pH, decrease bicarbonate, normal PaO 2, and normal PaCO 2.

Which acid-base imbalance does the nurse anticipate the patient with morbid obesity may develop? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

Respiratory acidosis Respiratory acidosis is related to CO 2 retention secondary to respiratory depression, inadequate chest expansion, airway obstruction, or reduced alveolar-capillary diffusion. Respiratory acidosis is common in morbidly obese patients who experience inadequate chest expansion owing to their size and work of breathing. Metabolic acidosis is related to overproduction of hydrogen ions, underelimination of hydrogen ions, underproduction of bicarbonate ions, and overelimination of bicarbonate ions. Metabolic alkalosis is related to loss of bicarbonate or buffers (i.e., vomiting or nasogastric suction). Respiratory alkalosis usually is caused by excessive loss of CO 2 through hyperventilation secondary to fever, central nervous system lesions, and salicylates.

Lab results for a 62-year-old patient show the following results: pH 7.48; bicarbonate 26; PaO 2 90; PaCO 2 32. These findings are consistent with which acid-base imbalance? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

Respiratory alkalosis In respiratory alkalosis, there is an increase in pH (normal is 7.35-7.45), a normal bicarbonate (normal is 21-28), a normal PaO 2 (normal is 80-100), and a decrease in PaCO 2 (normal is 35-45). The arterial blood gas results of pH 7.48; bicarbonate 26; PaO 2 90; PaCO 2 32 reflect respiratory alkalosis. In respiratory acidosis, there is an in decrease in pH, normal bicarbonate, normal PaO 2, and increased PaCO 2. In metabolic acidosis, there is a decrease in pH, decrease bicarbonate, normal PaO 2, and normal PaCO 2. In metabolic alkalosis, there is a increase in pH, increase bicarbonate, normal PaO 2, and normal PaCO 2.

A patient with diabetes mellitus is brought to the emergency department after vomiting for several days. The patient has rapid, deep respirations and a urine dipstick reveals ketonuria. Which process does the nurse suspect is occurring with this patient? 1 Kidney compensation for metabolic acidosis 2 Kidney compensation for metabolic alkalosis 3 Respiratory compensation for metabolic acidosis 4 Respiratory compensation for metabolic alkalosis

Respiratory compensation for metabolic acidosis Patients with diabetes mellitus can develop metabolic acidosis. Respiratory compensation occurs through the lungs as the rate and depth of respirations increase in order to reduce hydrogen ion levels. Kidney compensation is not occurring.

The nurse is to administer packed red blood cells to a patient. How does the nurse ensure proper patient identification? 1 Asks the patient's name 2 Checks the patient's armband 3 Verifies the patient's room number 4 Reviews all information with another registered nurse

Reviews all information with another registered nurse With another registered nurse, verify the patient by name and number, check blood compatibility, and note expiration time. Human error is the most common cause of ABO incompatibility reactions, even for experienced nurses. Asking the patient's name and checking the patient's armband are not adequate for identifying the patient before transfusion therapy. Using the room number to verify patient identification is never appropriate.

What history and assessment findings may be associated with hypocalcemia in a 22-year-old man? Select all that apply. 1 Absent bowel sounds 2 Tingling around the mouth 3 Awakening at night with muscle spasms in the calf 4 Decreased deep tendon reflexes without paresthesia 5 Recent blunt trauma to the throat during a football game

Tingling around the mouth Awakening at night with muscle spasms in the calf Recent blunt trauma to the throat during a football game A history of anterior neck injury may be associated with hypocalcemia. Symptoms of hypocalcemia include "charley horses" in the calf during rest or sleep, and tingling in the lips. Hypocalcemia does not affect bowel sounds. Decreased deep tendon reflexes without paresthesia is a neuromuscular change in hypercalcemia.

A 35-year-old female complains of bruises on her legs, arms, and thighs and has heavy menstrual bleeding. While taking the medical history of patient, the nurse finds that the patient had a history of frequent nose and gum bleeding. A complete blood count revealed the platelet count to be 10,000 mm 3. What should be the immediate intervention given to the patient? 1 Transfusing platelets 2 Providing low dosage of chemotherapy 3 Providing intravascular immunoglobulin and intravascular anti-rho 4 Providing corticosteroid therapy for inhibiting antiplatelet antibodies

Transfusing platelets Severe bruises on the skin indicate internal bleeding. Nosebleeds, gum bleeding, and heavy menstrual bleeding are indicators of external bleeding. When the platelet count is less than 10,000 mm 3, immediate treatment should involve platelet transfusion to avoid further serious complications. A low dosage of chemotherapy is a part of aggressive therapy. Intravascular immunoglobulin and intravascular anti-rho are given to prevent further destruction of antibody-coated platelets. Corticosteroids are used to suppress the immune system.

Which arterial blood gas reading does the nurse anticipate in a patient diagnosed with chronic obstructive pulmonary disease (COPD)? 1 pH 7.33, PaO 2 65 mm Hg, PaCO 2 41 mm Hg, HCO 3 - 19 mEq/L 2 pH 7.36, PaO 2 63 mm Hg, PaCO 2 52 mm Hg, HCO 3 - 32 mEq/L 3 pH 7.48, PaO 2 82 mm Hg, PaCO 2 32 mm Hg, HCO 3 - 25 mEq/L 4 pH 7.36, PaO 2 72 mm Hg, PaCO 2 30 mm Hg, HCO 3 - 18 mEq/L

pH 7.36, PaO 2 63 mm Hg, PaCO 2 52 mm Hg, HCO 3 - 32 mEq/L The kidneys will compensate to correct for changes in blood pH that occur when the respiratory system is unhealthy (i.e., COPD) or overwhelmed by increasing the absorption of bicarbonate and excreting hydrogen ions. The reading of pH 7.36, PaO 2 63 mm Hg, PaCO 2 52 mm Hg, HCO 3 - 32 mEq/L reflects this state of compensated respiratory acidosis. A reading of pH 7.33, PaO 2 65 mm Hg, PaCO 2 41 mm Hg, HCO 3 - 19 mEq/L reflects an uncompensated metabolic acidosis. A reading of pH 7.48, PaO 2 82 mm Hg, PaCO 2 32 mm Hg, HCO 3 -25 mEq/L reflects an uncompensated respiratory alkalosis. A reading of pH 7.36, PaO 2 72 mm Hg, PaCO 2 30 mm Hg, HCO 3 - 18 mEq/L reflects a compensated metabolic acidosis state.

Which arterial blood gas laboratory values would be seen in metabolic alkalosis? 1 pH 7.49, HCO 3 - 32 2 pH 7.28, CO 2 54 3 pH 7.53, CO 2 28 4 pH 7.31, HCO 3 - 18

pH 7.49, HCO 3 - 32 In metabolic alkalosis, pH is greater than 7.45 and HCO 3 - is greater than 28. pH 7.28 and CO 2 54 = respiratory acidosis (pH < 7.35, CO 2 >45). pH 7.53 and CO 2 28 = respiratory alkalosis (pH > 7.45, CO 2 < 35). pH 7.31 and HCO 3 - 18 = metabolic acidosis (pH < 7.35, HCO 3 - < 21).

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