MS 2 : Preclass quizzes : exam 1 (ABG, Hematology, Respiratory

Arterial blood gases have been drawn on the client. The nurse reviews the results. pH is 7.31 PaO2 92 mm Hg PaCO2 50 mm Hg HCO3 30 mEq/L How will the nurse interpret these ABG results

Respiratory acidosis partial compensation

1. Chronic bronchitis: 2. Pneumonia: 3. Emphysema: 4. Asthma:

1: Chronic cough with excessive sputum production 2: Consolidation on x-ray 3: Air Trapping resulting in a flattened diaphragm 4: Airway constriction in response to environmental stimuli

A nurse is reviewing the medical records of four clients who have an acid-base imbalance. The nurse should recognize that which of the following clients is at risk for metabolic acidosis? Select All That Apply A. A client who has salicylate intoxication B. A client who is taking a thiazide diuretic C. A client who is vomiting D. A client who has diarrhea

A. A client who has salicylate intoxication D. A client who has diarrhea

A nurse is teaching a client who has a new diagnosis of aplastic anemia. Which of the following information should the nurse include in the teaching? A. Aplastic anemia results from decreased bone marrow production of RBCs. B. Aplastic anemia results in an increased rate of RBC destruction. C. Aplastic anemia is associated with a decreased intake of iron. D. Aplastic anemia results in an inability to absorb vitamin B12.

A. Aplastic anemia results from decreased bone marrow production of RBCs. Rationale: Aplastic anemia is a hypoproliferative anemia resulting from decreased production of RBC within the bone marrow.

A nurse is caring for a client who has metabolic alkalosis. For which of the following clinical manifestations should the nurse monitor? (Select all that apply.) A. Bicarbonate excess B. Circumoral paresthesia C. Flushing D. Lethargy E. Kussmaul's respirations

A. Bicarbonate excess B. Circumoral paresthesia

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? A. Folic acid B. Vitamin A C. Vitamin B 12 D. Iron

A. Folic acid Rationale: 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.

Which of these patients should the charge nurse assign to the LPN/LVN working on the medical-surgical unit? A. Patient with pulmonary tuberculosis who is receiving multiple medications B. Patient with tonsillitis who has a thick-sounding voice and difficulty swallowing C. Patient with sinusitis who has just arrived after having endoscopic sinus surgery D. Patient with group A beta-hemolytic streptococcal pharyngitis who has stridor

A. Patient with pulmonary tuberculosis who is receiving multiple medications Rationale: The LPN/LVN scope of practice includes medication administration, so a patient receiving multiple medications can be managed appropriately by an LPN/LVN. Stridor is an indication of respiratory distress; this patient needs to be managed by the RN. A patient in the immediate postoperative period requires frequent assessments by the RN to watch for deterioration. A patient with a thick-sounding voice and difficulty swallowing is at risk for deterioration and needs careful assessment and monitoring by the RN.

A client's PaCO2 is abnormal on an ABG report. What is the most likely medical diagnosis? A. chronic obstructive pulmonary disease B. sexually transmitted infection (STI) C. rheumatoid arthritis D. infection of the bladder and ureters

A. chronic obstructive pulmonary disease

A patient has been diagnosed with asthma. Which statement below indicates that the patient correctly understands how to use an inhaler with a spacer correctly? A. "I should rinse my mouth and then swallow the water to get all of the medicine." B. "If the spacer makes a whistling sound, I am breathing in too rapidly." C. "I don't have to wait between the two puffs if I use a spacer." D. I should shake the inhaler only if I want to see whether it is empty."

B. "If the spacer makes a whistling sound, I am breathing in too rapidly." Rationale: Slow and deep breaths ensure that the medication is reaching deeply into the lungs. The whistling noise serves as a reminder to the patient of which technique needs to be used. The patient must wait 1 minute between puffs. The patient should rinse the mouth but not swallow the water. The mouth needs to be rinsed after using an inhaler with or without a spacer. This is especially important to prevent the development of an oral fungal infection if the inhaled medication is a corticosteroid. An empty inhaler will float on its side in water; a full inhaler will sink. Shaking an inhaler helps ensure that the same dose is delivered in each puff.

A nurse is reviewing the arterial blood gas (ABG) results of a client who the provider suspects has metabolic acidosis. Which of the following results should the nurse expect to see? A. HCO3 above 26 mEq/L B. pH below 7.35 C. PaO2 below 70 mmHg D. PaCO2 above 45 mmHg

B. pH below 7.35 Rationale: With acidosis, the pH is below 7.35. However, the pH alone does not indicate whether the problem is metabolic or respiratory. A pH above 7.45 indicates alkalosis

A client is admitted to the emergency room with a respiratory rate of 7/min. Arterial blood gases (ABG) reveal the following values. Which of the following is an appropriate analysis of the ABGs? pH 7.22 PaCO2 68 mm Hg Base excess -2 PaO2 78 mm Hg Saturation 80% Bicarbonate 26 mEq/L A. Metabolic acidosis B. Respiratory alkalosis C. Respiratory acidosis D. Metabolic alkalosis

C. Respiratory acidosis

A nurse is caring for a client who has HIV. Which of the following laboratory values is the nurse's priority? A. WBC 5,000/mm3 B. Platelets 150,000/mm3 C. Positive Western blot test D. CD4-T-cell count 180 cells/mm3

D. CD4-T-cell count 180 cells/mm3 Rationale: A CD4-T-cell count of less than 180 cells/mm3 indicates that the client is severely immunocompromised and is at high risk for infection. Therefore, this value is the priority for the nurse to report to the provider.

In caring for a patient with sickle cell disease, what does the nurse suggest can help with preventing future sickle cell crises? A. Testicular examination B. Pap smear C. Colonoscopy D. Influenza vaccine

D. Influenza vaccine Rationale: Influenza and pneumococcal vaccines will prevent infections, which often precipitate sickle cell crisis. Cancer screenings such as Pap smear, colonoscopy, and testicular exam are important in all individuals; however, influenza and pneumonia are common and easily preventable.

What is the most important information for the nurse to convey to a patient who is beginning pharmacological therapy for the treatment of tuberculosis to ensure suppression of the disease? "Contact the health care provider if you become ill." , Not Selected Correct answer: "Take the medication exactly as prescribed." "Eat a diet rich in Vitamin K." , Not Selected "Do not drink alcoholic beverages."

It is most important for the nurse to teach the patient to take the medication regularly, exactly as prescribed, for as long as it is prescribed to ensure adequate suppression of the disease. The patient should be instructed to eat a diet rich in Vitamins B and C. A diet rich in Vitamin K will not assist the patient in any way. Staying away from alcoholic beverages will prevent liver damage from the medications but will not ensure suppression of the disease. It is important for the patient to understand that the health care provider should be contacted in the case of illness; however, it will not ensure suppression of the disease.

A nurse is caring for a client who has a new prescription for ferrous sulfate tablets twice daily for iron-deficiency anemia. The client asks the nurse why the provider instructed that she take the ferrous sulfate between meals. Which of the following responses should the nurse make? A. "Taking the medication between meals will help you absorb the medication more efficiently. B. "Taking the medication between meals will help you avoid becoming constipated." C. "The medication can cause nausea if taken with food." D. "Taking the medication with food increases the risk of esophagitis."

A. "Taking the medication between meals will help you absorb the medication more efficiently. Rationale: Ferrous sulfate provides the iron needed by the body to produce red blood cells. Taking iron supplements between meals helps to increase the bioavailability of the iron.

What is a key difference between seasonal influenza and pandemic influenza? A. Pandemic influenza has the potential to spread globally because of its highly infectious nature in humans. B. People over the age of 50 who have chronic illness should be vaccinated yearly to decrease the risk of pandemic influenza. C. Seasonal influenza is caused by viral infections; pandemic influenza is more likely to be bacterial in nature. D. Humans have a natural resistance to viral infections found in animals and birds and do not require immunization against pandemic influenza.

A. Pandemic influenza has the potential to spread globally because of its highly infectious nature in humans. Rationale: Mutated animal and bird viruses can be highly infectious to humans and spread globally very quickly because humans have no natural resistance to the mutated virus. Both seasonal and pandemic influenza are caused by viruses. Although there is the potential to develop a monovalent vaccine to a given mutated virus, widespread prophylactic vaccination is not realistic as a preventive measure. People over age 50 with chronic illnesses and those who are immunocompromised should receive a yearly flu vaccine for the seasonal variety.

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

B. "Use a soft-bristled toothbrush." Rationale: 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

A patient with asthma has pneumonia, is reporting increased shortness of breath, and has inspiratory and expiratory wheezes. All of these medications are prescribed. Which medication should the nurse administer first? A. Fluticasone 2 inhalations B. Albuterol 2 inhalations C. Ipratropium 2 inhalations D. Salmeterol 2 inhalations

B. Albuterol 2 inhalations Rationale: Albuterol is a beta 2 agonist that acts rapidly as a bronchodilator. Fluticasone is a corticosteroid; it is used to prevent asthma attacks and is not used as a rescue medication. Ipratropium is an anticholinergic drug that allows the sympathetic system to dominate and cause bronchodilation; it is not as effective as a beta 2 agonist, so it is not a first-line drug. Salmeterol is a long-acting beta 2 agonist (LABA) that must be used regularly over time; this patient needs a rescue medication.

When assessing the adequacy of a patient's oxygenation, which information is important for the nurse to note? A. Positive end-expiratory pressure (PEEP) B. Partial pressure of arterial oxygen (PaO 2) C. The patient's acceptance of the continuous positive airway pressure (CPAP) machine. D. Fraction of inspired oxygen (Fio 2)

B. Partial pressure of arterial oxygen (PaO 2) Rationale: PaO 2 is a measure of the amount of oxygen in the arterial blood. Fio 2 is a measure of the inspired oxygen, which may not all be absorbed. PEEP is a measure of positive expiratory pressure for a patient on a ventilator. CPAP is a delivery system, not a measure of oxygenation.

A nurse is preparing to initiate a transfusion of packed RBC for a client who has anemia. Which of the following actions should the plan to nurse take? A. Leave the client 5 min after beginning the transfusion. B. Infuse the transfusion at a rate of 200 mL/hr. C. Check the client's vital signs every hour during the transfusion. D. Flush the blood tubing with dextrose 5% in water.

C. Check the client's vital signs every hour during the transfusion. Rationale: The nurse should check the client's vital signs every 15 min at the start of the transfusion, then every 1 hr to monitor for a transfusion reaction.

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? A. Administer corticosteroids B. Plan for bone marrow aspiration C. Implement bleeding precautions D. Examine the patient's history for recent virus

C. Implement bleeding precautions Rationale: 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.

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

D. "I should take aspirin whenever I have severe pain." Rationale: 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 is caring for a patient who has just been diagnosed with pulmonary tuberculosis and will be discharged with a prescription for isoniazid 300 mg orally each day. At what time should the nurse teach this patient to take this medication? A. An hour before bedtime B. Immediately before breakfast C. Immediately after breakfast D. An hour before breakfast

D. An hour before breakfast Rationale: Isoniazid must be taken on an empty stomach to ensure adequate medication absorption so the best time for the patient to take this medication is an hour before breakfast. The patient would need to fast for two hours before taking the medication prior to bedtime to ensure that the stomach is empty. Taking the medication immediately before or after breakfast would not allow the stomach to be empty while the medication is absorbed.

A patient is admitted to the hospital for chronic obstructive pulmonary disease (COPD), and the health care provider requests oxygen via nasal cannula at 2 L/min. Within 30 minutes, the patient's color improves. What does the nurse continue to monitor that may require immediate attention? A. Increasing carbon dioxide levels B. Increased coughing C. Increasing adventitious breath sounds D. Decreasing respiratory rate

D. Decreasing respiratory rate Rationale: Respiratory rate and depth should be monitored closely while the patient receives oxygen because hypoventilation is seen during the first 30 minutes of oxygen therapy in patients with hypoxic drive for respiration. The patient's color will improve (from ashen or gray to pink) because of an increase in PaO 2 level before apnea or respiratory arrest occurs from loss of the hypoxic drive. The COPD patient is not sensitive to PaCO 2; oxygen administration can cause high PaO 2 levels. Monitoring for adventitious breath sounds is important, but these would not be a result of the oxygen that the patient is receiving. The ability to cough and breathe deeply is a positive sign.