NU 448 Adult Health III/ NU 448 Exam 1

NU 448 EXAM 1 The nurse should interpret the arterial blood gas results shown below as which of the following? pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L a. respiratory alkalosis b. metabolic acidosis c. metabolic alkalosis d. respiratory acidosis - a. respiratory alkalosis 2. The nurse is caring for a client who is receiving prescribed intravenous (IV) fluids at 50 ml/hr, has voided 300 ml in 24-hours and reports having a headache. The nurse notes the client's laboratory results show a low urine specific gravity level. Which of the following actions should the nurse take? a. Encourage the client to increase their fluid intake. b. Decrease the intravenous fluids. c. Administer prescribed antibiotics. d. Assist the client to ambulate to increase their metabolic rate. - a. Encourage the client to increase their fluid intake. 3. The plan of care for a client with a low potassium level includes providing information about the effects of medications and the dietary intake of foods high in potassium. Which of the following information should the nurse use to evaluate if the outcome for the plan was met? a. laboratory data b. physical assessment c. health history d. client statements - a. laboratory data 4. The nurse caring for a client experiencing acute hypoxemic respiratory failure due to V/Q mismatch is evaluating the client's plan of care. Which of the following interventions would be appropriate for the client's care plan? a. Initiate 24% to 32% oxygen via face mask. b. Provide high flow supplemental oxygen via nasal cannula. c. Provide oxygen via noninvasive positive pressure ventilation (NIPPV). d. Initiate invasive positive pressure ventilation (PPV) via endotracheal tube for SaO2 below 90%. - a. Initiate 24% to 32% oxygen via face mask. 5. The nurse is caring for a client with right sided pneumonia (PN) and helps position the client in the left Sims position. The nurse should evaluate the client's response to the position by doing which of the following? a. Compare the client's PaO2 level with the previous level. b. Assessing the client's pain level. c. Ask the client to perform coughing and deep breathing. d. Compare the client's pH and HCO3 levels with the baseline levels. - a. Compare the client's PaO2 level with the previous level. 6. The nurse is caring for a client with acute respiratory distress syndrome (ARDS) who is mechanically ventilated with positive end-expiratory pressure (PEEP). Which of the following should alert the nurse that the client is having complications from PEEP? Select all that apply. a. tachycardia b. hypopnea c. decreased urine output d. diminished lung sounds e. hypertension - a. tachycardia c. decreased urine output d. diminished lung sounds 7. The nurse received report from the previous shift for a client who was intubated for acute respiratory failure (ARF) less than one hour ago. Which of the following test results would be a priority for the nurse to follow-up? a. end-tidal CO2 (ETCO2) b. complete blood count (CBC) c. electrocardiogram (ECG) d. mixed venous O2 saturation (SvO2) - a. end-tidal CO2 (ETCO2) 8. A nurse is caring for a client in the emergency department (ED) who had a radiograph (x-ray) that reveals rib fractures, and the client is diagnosed with a small flail chest injury. Which of the following interventions should the nurse include in the client's plan of care? a. suction the client's airway secretions b. strict fluid intake and fluid replacement restriction c. prepare the client for surgery d. immediately sedate and intubate the client - a. suction the client's airway secretions 9. The nurse is caring for a client who is receiving positive pressure ventilation and high levels of PEEP via endotracheal intubation for acute respiratory distress syndrome (ARDS). The nurse should contact respiratory therapy for which of the following findings? a. The client's FIO2 is at 65%. b. The client's PaO2 is at 75%. c. The client's blood pressure decreased from 110/68 mm/Hg to 89/60 mm/Hg in the last hour. d. The client's temperature increased from 98.8o F. to 100.1o F in the last hour. - c. The client's blood pressure decreased from 110/68 mm/Hg to 89/60 mm/Hg in the last hour. 10. The nurse is assessing a client with chronic obstructive pulmonary disease (COPD). The nurse auscultates diminished breath sounds, which is a change from the client's baseline. The nurse should monitor the client for which of the following potential complications? a. dyspnea and hypoxemia b. kyphosis and clubbing of the fingers c. sepsis and pneumothorax d. bradypnea and pursed lip breathing - a. dyspnea and hypoxemia 11. The nurse is providing telephone triage and is speaking with the spouse of a client with asthma who has a prescription for a short-acting inhaled beta-agonist to utilize as needed. The spouse states, "My spouse's personal best peak flow reading is 290 L/minute and today the reading is 220 L/minute." Which of the following would be an appropriate response by the nurse? a. "This is a medical emergency take your spouse to the nearest emergency department (ED)." b. "Your spouse should use the prescribed beta-agonist inhaler." c. "A prescription for intravenous corticosteroids is most likely necessary." d. "Your spouse's asthma is under good control." - b. "Your spouse should use the prescribed beta-agonist inhaler." 12. The nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure and has the following arterial blood gas values: pH 6.88, HCO3 22 mEq/L, PCO2 60 mm Hg, PO2 50 mm Hg. Which of the following actions should the nurse take? a. Apply a paper bag over the client's nose and mouth. b. Apply the prescribed oxygen by mask or nasal cannula. c. Administer 50 mL of prescribed sodium bicarbonate intravenously. d. Obtain a prescription and administer 50 mL of 20% glucose and 20 units of regular insulin - b. Apply the prescribed oxygen by mask or nasal cannula. 13. The nurse is caring for a client who is intubated and receiving mechanical ventilation. Which of the following actions by the nurse would help prevent ventilator associated pneumonia (VAP)? a. practicing meticulous hand hygiene b. maintaining the head of the client's bed elevated at least 10 degrees c. suctioning of the client's oral cavity secretions every shift d. ensuring the respiratory therapist changes the ventilator circuit tubing every 4 hours - a. practicing meticulous hand hygiene 14. The nurse is caring for a client experiencing acute respiratory failure (ARF) from acute bronchitis. Which of the following medication prescriptions should the nurse question? a. methylprednisolone via nebulization b. albuterol via nebulization c. furosemide via IV d. azithromycin via IV - a. methylprednisolone via nebulization 15. The nurse is assessing a client with end stage kidney disease (ESKD). The client's serum laboratory results indicate hypocalcemia and hyperphosphatemia. Which of the following findings should the nurse anticipate? Select all that apply. a. Trousseau's sign b. cardiac arrhythmia's c. constipation d. decreased clotting time e. drowsiness and lethargy f. fractures - a. Trousseau's sign b. cardiac arrhythmia f. fractures 16. The nurse is assessing a client who reports shortness of breath (SOB) and notes diminished breath sounds in the right lower lobe. A chest radiograph (x-ray) reveals a large right pleural effusion with significant atelectasis. The nurse should anticipate which of the following procedures to be prescribed for this client? a. thoracentesis b. bronchoscopy c. ventilation/perfusion (V/Q) scan d. repeat chest radiograph (x-ray) - a. thoracentesis 17. The nurse provided discharge teaching for a client with mild chronic obstructive pulmonary disease (COPD) about breathing exercises. Which of the following statements by the client would indicate a correct understanding of the teaching? a. "I should practice using diaphragmatic breathing in the sitting position." b. "I will lie in the supine position to facilitate air entry when practicing deep breathing." c. "I should use pursed lip breathing as a last resort." d. "I will practice chest breathing." - a. "I should practice using diaphragmatic breathing in the sitting position." 18. The nurse is providing discharge instructions for a client who experienced respiratory acidosis from severe chronic obstructive pulmonary disease (COPD). Which of the following information would help prevent future episodes of respiratory acidosis? a. "Using pursed-lip breathing can help slow your respiratory rate." b. "When you feel out of breath you should use diaphragmatic breathing." c. "Paradoxic breathing should be used when you are exercising." d. "You should avoid using home oxygen when you are resting and sleeping." - a. "Using pursed-lip breathing can help slow your respiratory rate." 19. The nurse is evaluating the appropriateness of a physician's prescription for continuous positive airway pressure (CPAP) with the delivery of oxygenation. The nurse should expect the prescription to be for which of the following clients? a. The client with muscular dystrophy who is experiencing symptoms of acute respiratory failure (ARF). b. The client who experienced near drowning with an SaO2 level of 89% and has crackles in all lung fields. c. The client diagnosed with pneumonia who requires 100% oxygen and refuses to have endotracheal intubation. d. The client in hypovolemic shock who is experiencing symptoms of acute respiratory distress syndrome (ARDS). - a. The client with muscular dystrophy who is experiencing symptoms of acute respiratory failure (ARF). 20. The nurse is caring for a client with acute respiratory distress syndrome (ARDS) that is being mechanically ventilated. Which of the following lab results would indicate to the nurse that the mechanical ventilation is providing adequate gas exchange for the client? a. increased CO2 and PaO2 levels b. decreased CO2 level and increased PaO2 c. decreased Ph and PaO2 levels d. decreased CO2 and PaO2 levels - b. decreased CO2 level and increased PaO2