acid base and cellular regulation

The nurse is completing a health history on a patient diagnosed with peptic ulcer disease. Which questions are appropriate while assessing the patient's cognitive-perceptual pattern? Select all that apply.

"Do you experience any nocturnal pain?" "Do you experience high epigastric pain one to two hours after eating?"

Which drug may prevent or limit ventricular remodeling?

Captopril

The nurse is caring for a patient who is experiencing continuous epigastric distress and vomiting after undergoing a peptic ulcer surgery. Which medication does the nurse expect to be beneficial for the patient?

Cholestyramine

The nurse recalls that which structures or cells in the human body contain only a single copy of each chromosome?

Oocytes

The patient is presently in respiratory acidosis. What concentration of bicarbonate ion in blood is an indicator of a compensatory response in this patient?

27 mEq/L

The nurse is caring for a patient who had surgery one day ago for removal of a suspected malignant breast mass. While awaiting the pathology report, the patient states, "I am afraid to die." Which of these is the most effective nursing intervention at this time?

Actively listen and allow her to talk about her fears.

A patient on an inpatient unit pushes the call button for the nurse. The nurse notices upon entering the patient's room that the patient is sweating profusely, pale, and anxious. The patient states, "I feel really dizzy and my vision is blurred." What intervention is the highest priority?

Check blood glucose level. Any patient exhibiting signs and symptoms of hypoglycemia, such as diaphoresis, pallor, anxiety, visual disturbances, or dizziness, should have his or her blood glucose level checked immediately. Obtaining vital signs is not an immediate intervention that needs to be implemented. Having the patient lie flat is not an intervention that needs to be done immediately. Administering glucagon is not an intervention to be performed unless the patient is worsening or unconscious.

A nurse is caring for a 62-year-old man with a history of hypertension and type 2 diabetes who has been admitted to the inpatient unit for pneumonia. The nurse enters the patient's room to complete an admission assessment and notices that the patient has slurred speech and right-sided weakness. After calling the rapid response team, what is the nurse's next action?

Check blood glucose. The patient's blood glucose levels in hyperosmolar hyperglycemic syndrome are high; they increase serum osmolality and produce severe neurologic manifestations, such as aphasia and hemiparesis. It is critical to check the patient's blood glucose level for correct diagnosis and treatment, because these signs and symptoms resemble those of a stroke. Obtaining vital signs is not the next action to take; that can happen later. Obtaining the crash cart is not necessary in this situation. Performing a neurologic assessment can be done, but it is not the next action the nurse should take.

A patient complains of burning pain in the abdomen four hours after eating a meal. Upon assessment, the nurse identifies the pain in midepigastric region. Which risk factors are associated with the pain? Select all that apply.

Chronic pancreatitis Chronic kidney disease Zollinger-Ellison syndrome

A patient with late-stage chronic obstructive pulmonary disease (COPD) presented to the emergency room with increasing dyspnea. Lab results indicate a pH of 7.36, a PaCO2 of 47 mm Hg, and a HCO3 of 25 mEq/L. The patient asks the nurse what these lab results mean. What does the nurse know this lab data indicates?

Compensated respiratory acidosis-In the patient with late-stage COPD, a low-normal pH, a high-normal or above normal PaCO2, and a high-normal HCO3 indicate compensated respiratory acidosis. This occurs when CO2 is chronically retained and the kidneys compensate to increase the pH to normal range.

The genetic studies of a patient with non-small cell lung cancer reveal the presence of anaplastic lymphoma kinase (ALK) genes. Which medication administered by the nurse would have the best outcome for the patient?

Crizotinib

A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.8 mEq/L. The nurse understands that a possible cause of hyperkalemia would be:

Decreased secretion of potassium through the kidneys secondary to nephropathy Nephropathy, a complication of diabetes, results in elevated potassium levels. Malnutrition does not cause sodium excretion accompanied by potassium retention; therefore, it is not a contributing factor in this patient's potassium level. Potassium is not affected by the body's immune system. Insulin causes a decrease in potassium by pushing it into the cells.

A registered nurse (RN) on a general medical-surgical unit is delegating tasks to a unit licensed practical nurse (LPN). The RN just received four new prescriptions from a healthcare provider. Which task is the RN able to delegate to the LPN as permitted by the state nurse practice act?

Decreasing the rate of an existing intravenous infusion for a client about to be discharged home

A postmenopausal patient complains of back pain and burning pain in midepigastric region three hours after a meal. The medical history of the patient reveals hyperparathyroidism. Which condition does the nurse suspect in the patient?

Duodenal ulcer

Which should the nurse recommend to a patient as a prevention method regarding cancer development? Select all that apply.

Eating a diet high in fiber Maintaining a healthy weight Participating in regular exercise

A patient is admitted to the emergency room with second-degree (partial-thickness) burns over 30% of the total body surface area with poor skin turgor, a urine output of less than 50 mL over the past two hours, a rapid and thready pulse, and restlessness. The nurse determines that these symptoms might indicate which type of imbalance?

Extracellular fluid volume deficit

The nurse prepares to administer rituximab to a patient. The nurse recognizes that the medication is appropriate for what disorders? Select all that apply.

Follicular lymphoma Mantle cell lymphoma Peripheral T-cell lymphoma

What are the first clinical manifestations of peptic ulcer disease that occur in elderly patients? Select all that apply.

Frank gastric bleeding Decrease in hematocrit

What are the characteristics of gastric ulcers? Select all that apply.

Gastric ulcer lesions are superficial Gastric ulcers predominantly occur in antrum.. Gastric ulcers cause pain one to two hours after meals.

Normal ABG values fall in the range of pH 7.35 to 7.45, PaCO2 35 to 45 mm Hg, and _________________________________ Bicarbonate and pH values are less than the normal values and indicate metabolic acidosis. Metabolic acidosis is indicated by a low pH and low bicarbonate levels.

HCO3- 22 to 26 mEq/L.

Which laboratory results determine the type and amount of intravenous fluids administered? Select all that apply.

Hematocrit Electrolytes Hemoglobin

A patient is brought in to the emergency department with a suspected overdose of aspirin. The nurse notes that the patient is lethargic, confused, and has rapid breathing. Which of the following interventions should the nurse prepare to implement?

Hemodialysis-The patient is experiencing acidosis related to the aspirin overdose

____________________________ occurs due to inadequate oxygen transfer between the alveoli and the pulmonary capillaries. The patient experiences hypercapnic respiratory failure because of the inability to remove sufficient carbon dioxide to maintain a normal partial pressure of carbon dioxide in arterial blood (PaCO2). Ventilatory demand is the amount of ventilation needed to keep the PaCO2 within normal limits. Normally, ventilatory supply far exceeds demand. When there is an imbalance in the lung function, patients with lung disease cannot effectively increase the lung ventilation as a response to exercise or metabolic demands.

Hypoxemic respiratory failure

The nurse is assessing a patient with prostate cancer and spinal cord compression. Upon further assessment, the nurse anticipates that the patient has autonomic dysfunction. Which finding supports the nurse's conclusion?

Impaired bladder function

Why do patients experience hypoxemic respiratory failure?

Inadequate oxygen transfer between the alveoli and the pulmonary capillaries

The nurse cares for a patient with polycythemia vera and expects what assessment finding?

Increased hemoglobin

The nurse is caring for a patient with respiratory failure. What measures can the nurse take to prevent the development of stress ulcers in the patient? Select all that apply.

Initiate early enteral nutrition. Use antiulcer agents such as proton pump inhibitors. Use measures to prevent development of hypotension and shock.

A patient suspected for malignancy is scheduled for a PET scan to highlight areas with increased metabolism. What is the appropriate nursing intervention in this situation?

Instructing the patient not to have anything by mouth except water and medications at least four hours before the test

What complication does the nurse expect in a child with chronic pulmonary disease who is diagnosed with α1-antitrypsin (AAT) deficiency?

Liver disease

The nurse notes an arterial oxygen saturation (SpO2) reading of 65% when assessing a patient who is diagnosed with asthma. The patient is not experiencing any other clinical manifestations that support poor oxygenation. What could be the cause for this SpO2? Select all that apply.

Low perfusion Intravascular dyes

The nurse is caring for a patient at risk for developing syncope. Which nursing intervention is important to prevent this occurrence in this postoperative patient?

Make changes in the patient's position slowly.

A nurse reviews the laboratory results of a patient. The arterial blood gas (ABG) values are pH 7.30, PaCO2 35 mm Hg, and bicarbonate (HCO3-) 16 mEq/L. What is the correct interpretation of the values given?

Metabolic acidosis

A patient reports nausea, four episodes of vomiting, and headache. The nurse finds that the patient is taking deep and rapid breaths and blood pressure as 90/60 mm Hg. Which condition does the nurse suspect in the patient?

Metabolic acidosis

A patient was admitted with abdominal pain, nausea, and severe diarrhea. Based on this information, the nurse assesses this patient for which primary acid-base imbalance?

Metabolic acidosis

A patient with gastroenteritis has the following arterial blood gas results: pH 7.30, PaO2 80 mm Hg, PaCO2 46 mm Hg, HCO314. What does the nurse determine that these results indicate?

Metabolic acidosis

The nurse reviews the diagnostic results of a patient that received treatment for leukemia. All of the patient's molecular studies are negative for residual leukemia. The nurse recognizes that the patient is experiencing what condition?

Molecular remission

A patient has had persistent nausea and vomiting for the last five days. Which immediate nursing interventions available are appropriate for this patient? Select all that apply.

Monitor the vital signs continuously. Administer intravenous fluids and electrolytes. Insert a nasogastric tube connected to suction.

The nurse is caring for a patient with hypoxemia caused by ventilation to perfusion (V/Q) mismatch. Which respiratory therapy helps to reverse this condition?

Oxygen therapy

A patient with a history of type 2 diabetes is diagnosed with heart failure. Which medication would be a poor choice for controlling the patient's diabetes?

Pioglitazone- Pioglitazone can worsen heart failure. Therefore, it should be avoided in diabetic patients with heart failure. Glyburide, acarbose, and nateglinide are not contraindicated in heart failure patients.

Which management technique will the interprofessional care team implement for a patient with lung cancer?

Radiation therapy

The nurse is caring for an older frail adult patient with stage II non-small cell lung cancer who may not be a candidate for a surgical procedure. About what alternative should the nurse educate the patient?

Radiofrequency ablation

A patient is on drug therapy for a peptic ulcer. Which medication does the nurse anticipate to be prescribed to help reduce hydrochloric acid secretion?

Ranitidine

The nurse identifies that a patient is at risk for upper gastrointestinal bleeding based on the patient's history of what?

Renal failure -causes disturbances in the serum gastrin levels, resulting in abnormal mucosal barriers in the gastrointestinal tract and gastric acid secretion. These symptoms cause upper gastrointestinal bleeding.

The nurse reviews the arterial blood gases for a patient that has taken an overdose of barbiturates. The results are: pH 7.32; PaCO2 52; HCO3- 24. What does the nurse interpret these results to mean?

Respiratory acidosis

______________________________ is characterized by tetany, anorexia, nausea, and vomiting.

Respiratory alkalosis

____________________________________ is indicated by decreased PaCO2. In Metabolic conditions, the pH and the HCO3 go in the same direction. The PaCO2 may also go in the same direction.

Respiratory alkalosis

Which manifestation might the nurse suspect in a patient with diabetes whose serum osmolality is increased and blood glucose level is 610 mg/dL?

Seizures- Blood glucose level more than 600 mg/dL indicates hyperosmolar hyperglycemic syndrome, which increases the serum osmolality and produces severe neurologic manifestations such as seizures. Acidosis is mainly associated with diabetic ketoacidosis. Fluid losses may cause mild deficits in potassium leading to hypokalemia but not hyperkalemia. Cerebral edema is a complication associated with rapid administration of intravenous fluids.

A nurse is caring for a patient with malignant lung cancer who experiences weakness, lethargy, depressed reflexes, and bone pain. Which changes in the electrocardiogram evaluated by the nurse may indicate suspected hypercalcemia? Select all that apply.

Shortened QT interval Shortened ST segment

The nurse is teaching care guidelines to the caregiver of a patient with upper gastrointestinal (GI) bleeding. In the follow-up visit, the patient complains of traces of blood in the vomit. Which action of the patient's caregiver is responsible for the patient's condition?

The caregiver gave aspirin to the patient on an empty stomach.

The nurse is teaching care management to a patient with gastroesophageal reflux disease (GERD). In the follow-up visit, the patient complains of severe heartburn. Which actions indicate the need for further teaching? Select all that apply.

The patient eats oranges daily. The patient eats ice cream often. The patient drinks a cup of milk at bedtime.

A nurse is educating a patient regarding hypercapnic respiratory failure. What information should the nurse include in the teaching? Select all that apply.

There is evidence of the body's inability to compensate for acidemia. It is a ventilatory failure with insufficient carbon dioxide (CO2) removal. Arterial CO2 (PaCO2) is greater than 45 mm Hg in combination with an arterial pH of less than 7.35.

While assessing a patient, the nurse finds that the partial pressure of oxygen (PaO2) is 39% and the peripheral capillary oxygen saturation (SpO2) is 72%. Which complications are associated with these assessment findings? Select all that apply.

Tissue hypoxia Cardiac arrhythmia

An arterial blood gas sample is drawn from an intubated patient in the emergency department. The patient is found to have a pH of 7.28, a PaCO2 level of 50 mm Hg, a bicarbonate level of 25 mm Hg, and a PaO2 level of 95 mm Hg. What condition does the nurse report to the health care provider?

Uncompensated respiratory acidosis

Abdominal sounds are the clinical manifestations of _____________________________, a complication of peptic ulcer disease surgery

dumping syndrome

Severe ____________________ and respiratory failure can both be related to COPD, however these lab results in the late stage of COPD indicate compensated respiratory acidosis. The pH is high-normal (normal range 7.35-7.45), the PaCO2 is above normal (normal range 35-45 mm Hg), the HCO3 is high normal (normal range 22-26 mEq/L); thus the lab values are not all within the normal range.

hypoxemia

PaO2 is the partial pressure of oxygen in arterial blood and SpO2 is the arterial oxygen saturation. If the critical value of PaO2 and SpO2 is less than 40 and less than 75 respectively, as in the case of Patient 4, then it indicates that oxygenation is __________________________ and ________________________ is occurring.

inadequate and tissue hypoxia

A pH value ____________ 7.35 and low PaCO2 indicate respiratory acidosis.

less than

The nurse is reviewing a patient's arterial blood gases (ABGs) that reveal pH 7.48, PaCO2 38, HCO3- 30. What does the nurse interpret the results indicate?

metabolic acidosis

Deep and rapid respirations are characteristic of Kussmaul's respirations. Normal blood pressure is 120/80 mm Hg. Kussmaul's respirations, low blood pressure, nausea, vomiting, and headache are manifestations of_________________________

metabolic acidosis.

Signs of_______________________include tetany, nausea, and vomiting. Although headache and hypotension are seen in respiratory acidosis, nausea, vomiting, and rapid respirations are not observed.

metabolic alkalosis

Because diuretic therapy causes loss of strong acids and retention of bases, there is a risk for ___________________________

metabolic alkalosis.

The nurse is assigned to care for an 83-year-old patient with an acute asthma exacerbation. Which arterial blood gas (ABG) result would prompt the nurse to notify the provider immediately?

pH 7.30, PaO2 74 mm Hg, PaCO2 65 mm Hg

The bicarbonate ion concentration in blood increases as a compensatory response in patients with respiratory acidosis. The normal range of bicarbonate ion is 22 to 26 mEq/L. Therefore, 27 mEq/L indicates a compensatory response.

review

Indigestion and abdominal pain are the clinical manifestations of _______________________..

stomach cancer