Nokea
A diabetic patient's arterial blood gas (ABG) results are pH 7.28; PaCO2 34 mm Hg; PaO2 85 mm Hg; HCO3 18 mEq/L. The nurse would expect which finding?
- A. Intercostal retractions
- B. Kussmaul respirations
- C. Low oxygen saturation (SpO2)
- D. Decreased venous O2 pressure
Correct Answer: B
Rationale: Kussmaul respirations (deep and rapid) are a compensatory mechanism for metabolic acidosis. The low pH and low bicarbonate levels indicate metabolic acidosis. Intercostal retractions, low oxygen saturation, and decreased venous O2 pressure are not associated with acidosis. Intercostal retractions typically occur in respiratory distress, while low oxygen saturation and decreased venous O2 pressure are more related to respiratory or circulatory issues, not metabolic acidosis.
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Claudication is a well-known effect of peripheral vascular disease. Which of the following facts about claudication is correct? Select the one that doesn't apply:
- A. It results when oxygen demand is greater than oxygen supply.
- B. It is characterized by pain that often occurs during rest.
- C. It is a result of tissue hypoxia.
- D. It is characterized by cramping and weakness.
Correct Answer: D
Rationale: Claudication is a symptom of peripheral vascular disease where there is an inadequate supply of oxygen to the muscles due to reduced blood flow. This mismatch between oxygen demand and supply leads to tissue hypoxia, resulting in cramping, weakness, and discomfort. Option D correctly states that claudication is characterized by cramping and weakness, making it the correct answer. Options A, B, and C are incorrect. Claudication occurs when oxygen demand exceeds supply, not the other way around as stated in Option A. Pain in claudication typically occurs with activity, not at rest as mentioned in Option B. While tissue hypoxia is a consequence of claudication, it is not the primary cause, making Option C incorrect.
A patient who has a history of chronic obstructive pulmonary disease (COPD) was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of 89% to 90%). In planning for discharge, which action by the nurse will be most effective in improving compliance with discharge teaching?
- A. Start giving the patient discharge teaching on the day of discharge
- B. Have the patient repeat the instructions immediately after teaching
- C. Accomplish the patient teaching just before the scheduled discharge
- D. Arrange for the patient's caregiver to be present during the teaching
Correct Answer: D
Rationale: Hypoxemia interferes with the patient's ability to learn and retain information, so having the patient's caregiver present will increase the likelihood that discharge instructions will be followed. Having the patient repeat the instructions will indicate that the information is understood at the time, but it does not guarantee retention of the information. Giving discharge instructions just before discharge is not ideal as the patient is likely to be distracted and anxious at that time. Teaching the patient about discharge on the day of admission is not recommended because the patient may be more hypoxemic and anxious than usual, making it difficult for them to absorb and retain the information effectively. Therefore, arranging for the patient's caregiver to be present during the teaching session is the best option to ensure proper compliance and understanding of the discharge instructions.
When assessing the respiratory system of an older patient, which finding indicates that the nurse should take immediate action?
- A. Weak cough effort
- B. Barrel-shaped chest
- C. Dry mucous membranes
- D. Bilateral crackles at lung bases
Correct Answer: D
Rationale: Bilateral crackles at lung bases indicate a potential acute issue like heart failure. Immediate action is necessary in this situation. The nurse should conduct further assessments such as oxygen saturation and inform the healthcare provider promptly. A barrel-shaped chest and hyperresonance to percussion are typical signs of aging and do not require immediate action. A weak cough effort is common in older patients due to age-related changes, and dry mucous membranes are also expected in older individuals. While these findings may warrant further evaluation, they do not demand immediate action like bilateral crackles at lung bases.
A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6°F with a frequent cough and is complaining of severe pleuritic chest pain. Which prescribed medication should the nurse give first?
- A. Codeine
- B. Guaifenesin (Robitussin)
- C. Acetaminophen (Tylenol)
- D. Piperacillin/tazobactam (Zosyn)
Correct Answer: D
Rationale: The correct answer is Piperacillin/tazobactam (Zosyn). Early initiation of antibiotic therapy is crucial in cases of community-acquired pneumococcal pneumonia to reduce mortality. While providing symptomatic relief with medications like Codeine for cough, Guaifenesin for mucus clearance, and Acetaminophen for fever and pain is important, the priority should be to start antibiotic therapy to target the underlying infection. Piperacillin/tazobactam is an appropriate choice for treating severe community-acquired pneumonia caused by pneumococcal organisms.
A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the nurse plan to include in the teaching plan?
- A. Purpose of antibiotic therapy
- B. Ways to limit oral fluid intake
- C. Appropriate use of cough suppressants
- D. Safety concerns with home oxygen therapy
Correct Answer: C
Rationale: In acute bronchitis, which is often viral, cough suppressants can help manage the symptoms of a nonproductive cough. Antibiotics are not typically used in acute bronchitis unless there are systemic symptoms indicating a bacterial infection. Limiting oral fluid intake is not recommended; in fact, maintaining adequate hydration is important. Safety concerns with home oxygen therapy may not be directly relevant to the management of acute bronchitis.