Nokea
A nurse reviews the arterial blood gas (ABG) values of a client admitted with end-stage kidney disease; pH 7.26; PaCO2 37 mm Hg; PaO2 94 mm Hg and HCO3 15 mEq/L. What do these values indicate?
- A. Metabolic acidosis
- B. Metabolic alkalosis
- C. Respiratory acidosis
- D. Respiratory alkalosis
Correct Answer: A
Rationale: End-stage kidney disease hampers acid excretion pH 7.26 (below 7.35) and HCO3 15 mEq/L (below 22) confirm metabolic acidosis, as kidneys fail to buffer, dropping bicarbonate. PaCO2 37 mm Hg (normal) rules out respiratory issues lungs aren't compensating yet. PaO2 94 mm Hg shows oxygenation's fine. Alkalosis options contradict low pH; respiratory acidosis needs high CO2. Nurses recognize this acid-base shift, anticipating bicarbonate or dialysis, a key intervention in renal failure's metabolic chaos.
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A 36 year old woman visits her family doctor requesting blood test to check her cholesterol. She has family history of premature coronary heart disease. Physical examinations are unremarkable. Lipid profile is done and shows it the following results: Total cholesterol 5.8 mmol/L, HDL-cholesterol 1.1 mmol/L, LDL-cholesterol 3.6 mmol/L, Triglyceride 2.4 mmol/L. What is the MOST likely diagnosis?
- A. Familial hyperlipidemia
- B. Mixed hyperlipidemia
- C. Hypercholesterolaemia
- D. Familial combined hyperlipidemia
Correct Answer: B
Rationale: Cholesterol 5.8, LDL 3.6, triglycerides 2.4 both up, HDL lowish screams mixed hyperlipidemia, not lone cholesterol or triglyceride spikes. Family heart history hints genetics, but numbers don't pin familial types yet. Nurses flag this chronic dual lipid mess, tied to early coronary risk.
The hospice nurse has just admitted a new patient to the program. What principle guides hospice care?
- A. Care addresses the needs of the patient as well as the needs of the family
- B. Care is focused on the patient centrally and the family peripherally
- C. The focus of all aspects of care is solely on the patient
- D. The care team prioritizes the patient's physical needs and the family is responsible for the patient's emotional needs
Correct Answer: A
Rationale: Hospice wraps the patient and family in care physical, emotional, spiritual for both, not just one. It's not patient-only or peripheral family focus; it's a unit. Splitting physical and emotional duties misses the holistic vibe. Nurses in oncology's endgame lean on this, ensuring comfort and support ripple out, easing the load for all as death nears.
In a patient with COPD, the risk of postoperative pulmonary complications increases with:
- A. Wheezing on preoperative examination.
- B. A history of preoperative cough.
- C. Low body mass index (BMI).
- D. A serum albumin concentration less than 35 mg litreâ»Â¹.
Correct Answer: A
Rationale: Postoperative pulmonary complications in COPD patients are influenced by disease severity and patient condition. Wheezing indicates active airway obstruction and inflammation, directly increasing the risk of complications like atelectasis or pneumonia due to impaired ventilation and secretion clearance. A preoperative cough may suggest irritation or infection but is less specific than wheezing as a risk predictor. Low BMI reflects malnutrition, a known risk factor, but its impact is less immediate than active respiratory symptoms. Low serum albumin (<35 g/L, not mg/L as stated) also indicates poor nutritional status and healing capacity, elevating risk, but wheezing is more directly tied to airway dynamics. Regional anesthesia may reduce complications compared to general anesthesia, but the question focuses on risk factors. Wheezing's presence signals acute respiratory compromise, making it the strongest preoperative indicator of postoperative issues.
Which of the following is not associated with non-alcoholic fatty liver disease?
- A. Diabetes mellitus
- B. Lung cancer
- C. Pre-diabetes mellitus
- D. Hyperuricemia
Correct Answer: B
Rationale: NAFLD diabetes, pre-sugar, uric, colon tie; lung cancer's out. Nurses link this chronic fat net.
Damage control resuscitation:
- A. Is not indicated unless it is clear the patient's physiology has been deranged by severe injury.
- B. Is not indicated unless the patient is in the hospital.
- C. Is likely to involve restriction of fluid administration in a hypotensive, bleeding patient.
- D. Is likely is be assessed for adequacy by palpation of the radial pulse in patients with a head injury.
Correct Answer: C
Rationale: Damage control resuscitation (DCR) mitigates trauma's lethal triad (hypothermia, acidosis, coagulopathy). It's indicated preemptively in severe bleeding, not just post-derangement, to prevent physiologic collapse. It begins pre-hospital (e.g., paramedics), not only in-hospital, using blood products early. Fluid restriction in hypotensive bleeding limits dilutional coagulopathy, favoring permissive hypotension until haemostasis crucial in uncontrolled haemorrhage. Radial pulse palpation gauges perfusion broadly, but head injury patients need cerebral perfusion pressure prioritization, not DCR adequacy. ABC remains foundational. Fluid restriction's role balancing shock correction with bleeding exacerbation defines DCR's shift from crystalloid overload, improving survival in exsanguinating trauma.