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A patient with chronic obstructive pulmonary disease (COPD) presents with acute exacerbation and severe dyspnea. Arterial blood gas (ABG) analysis reveals pH 7.28, PaO2 55 mmHg, PaCO2 65 mmHg, and HCO3- 30 mEq/L. Which of the following acid-base disturbances is most likely present in this patient?
- A. Respiratory acidosis with metabolic compensation
- B. Respiratory alkalosis with metabolic compensation
- C. Metabolic acidosis with respiratory compensation
- D. Metabolic alkalosis with respiratory compensation
Correct Answer: A
Rationale: In this case, the patient is experiencing respiratory acidosis as indicated by the low pH (7.28), elevated PaCO2 (65 mmHg), and elevated HCO3- (30 mEq/L). The primary acid-base disturbance is respiratory acidosis due to the retention of carbon dioxide (PaCO2 >45 mmHg) leading to an increase in HCO3- as a compensatory mechanism to maintain pH within normal limits. The elevated HCO3- levels (metabolic compensation) are trying to counterbalance the increased PaCO2 levels (respiratory acidosis) by increasing bicarbonate to attempt to normalize the pH. Overall, the ABG analysis shows respiratory acidosis with metabolic compensation in this COPD patient with an acute exacerbation and severe dyspnea.
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To start a nursing improvement project, what is the FIRST step that a nurse must keep in mind?
- A. Implement plan to correct the problem
- B. Determine the nursing standards
- C. Determine findings if warrant correction
- D. Collect data determine if standards are met
Correct Answer: B
Rationale: The first step that a nurse must keep in mind to start a nursing improvement project is to determine the nursing standards. This is crucial because nursing standards provide guidelines and benchmarks for quality care delivery. By identifying and understanding the established standards, nurses can assess current practices, identify areas that need improvement, and develop strategies to enhance patient care. Setting a clear foundation based on nursing standards is essential before moving forward with implementing corrective actions, determining findings for correction, or collecting data. Understanding and aligning with nursing standards from the outset ensures that the improvement project is focused on promoting best practices and achieving positive outcomes for patients.
A pregnant woman presents with vaginal bleeding and passage of tissue at 10 weeks gestation. On examination, the cervix is dilated, and products of conception are visualized in the cervical os. Which of the following conditions is the most likely cause of these symptoms?
- A. Ectopic pregnancy
- B. Threatened abortion
- C. Placenta previa
- D. Complete abortion
Correct Answer: D
Rationale: Complete abortion is the most likely cause of the symptoms described. In a complete abortion, all products of conception are expelled from the uterus. Symptoms include vaginal bleeding, passage of tissue, and dilation of the cervix. In this scenario, the presentation of a dilated cervix with visualized products of conception is classic for a complete abortion at 10 weeks gestation.
A patient presents with multiple, hyperpigmented, velvety plaques in flexural areas such as the axillae and neck. The lesions are associated with obesity and insulin resistance. Which of the following conditions is most likely responsible for this presentation?
- A. Acanthosis nigricans
- B. Seborrheic keratosis
- C. Dermatofibroma
- D. Epidermal nevus
Correct Answer: A
Rationale: Acanthosis nigricans is a skin condition characterized by multiple, hyperpigmented, velvety plaques typically seen in flexural areas such as the axillae, neck, and groin. These lesions are often associated with obesity and insulin resistance. The appearance of acanthosis nigricans is distinct from other skin conditions such as seborrheic keratosis, dermatofibroma, and epidermal nevus. Acanthosis nigricans is commonly seen in conditions like obesity, type 2 diabetes, and metabolic syndrome due to the insulin resistance that leads to the overgrowth of keratinocytes.
For the students better understanding about the anatomy of the breast, the CI shares ________.
- A. various pictures of the breast, external and internal Views
- B. pictures of different types of mastectomies
- C. the experiences of breastfeeding mothers
- D. artistic drawings of the breasts
Correct Answer: A
Rationale: To help the students better understand the anatomy of the breast, it is crucial to provide visual aids that display both external and internal views of the breast. By sharing various pictures of the breast, students can visually learn about the structure, shape, location of different components, such as lobes, ducts, glands, and lymph nodes. Visual aids enhance the learning experience by providing a clear representation of the complex anatomical features of the breast, aiding in retention and comprehension. This approach can effectively supplement theoretical knowledge with practical visual references, facilitating a comprehensive understanding of breast anatomy.
A patient expresses frustration with the lack of information provided by the healthcare team. What is the nurse's best response?
- A. Dismiss the patient's frustration and assure them that the healthcare team is doing their best.
- B. Listen actively to the patient's concerns, acknowledge the lack of information, and offer to address the issue.
- C. Ignore the patient's frustration and proceed with providing care.
- D. Tell the patient that their frustration is unwarranted and unnecessary.
Correct Answer: B
Rationale: The best response for the nurse in this situation would be to listen actively to the patient's concerns, acknowledge the lack of information, and offer to address the issue. It is important for healthcare providers to validate the patient's feelings and actively work towards resolving any issues that are causing frustration. By being empathetic and willing to address the problem, the nurse can help improve the patient's experience and build trust in the healthcare team. Dismissing or ignoring the patient's frustration can lead to further dissatisfaction and breakdown in communication. It is crucial for healthcare providers to prioritize open communication and address any concerns or lack of information promptly.