Nokea
Donna is a healthy, 38-year-old woman scheduled for elective surgery next week. During the preoperative clearance, the physician, nurse practitioner, or physician assistant would include which of the following in her preoperative preparation?
- A. Pulmonary function test and chest x-ray.
- B. Complete blood count, metabolic panel, and pregnancy test.
- C. Urine culture, thyroid panel, and cortisol level.
- D. Glucose tolerance test, ankle-brachial index, and electrocardiogram (EKG).
Correct Answer: B
Rationale: Elective surgeries typically require basic preoperative tests such as a complete blood count (CBC), metabolic panel, and pregnancy test to ensure the patient is fit for surgery. Pulmonary function tests and other specialized tests are usually reserved for patients with specific risk factors.
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A client has a chest tube in place connected to a closed chest drainage system. Which of the following findings should indicate to the nurse that the client's lung has re-expanded?
- A. Oxygen saturation of 95%
- B. No fluctuations in the water seal chamber
- C. No reports of pleuritic chest pain
- D. Occasional bubbling in the water-seal chamber
Correct Answer: B
Rationale: The correct answer is B: No fluctuations in the water seal chamber. This finding indicates that the lung has re-expanded because it means there is no air leaking from the lung into the pleural space, causing fluctuations in the water seal chamber. Option A, oxygen saturation of 95%, is not directly related to lung re-expansion. Option C, no reports of pleuritic chest pain, is a subjective symptom and does not provide a direct indication of lung re-expansion. Option D, occasional bubbling in the water-seal chamber, indicates air is escaping from the lung into the pleural space, suggesting incomplete lung re-expansion.
Why would you give Mrs. West atropine sulfate as a preoperative medication primarily?
- A. Increase her heart rate
- B. Dilate her pupils
- C. Relax her smooth muscle
- D. Control her secretions
Correct Answer: D
Rationale: Atropine reduces respiratory and salivary secretions, preventing aspiration during surgery.
Which of the following tests would a nurse use to test whether air conduction or bone conduction is greater in the client?
- A. Romberg test
- B. Rinne Test
- C. Weber test
- D. Otoscopic examination
Correct Answer: B
Rationale: The Rinne test compares air conduction to bone conduction to identify conductive or sensorineural hearing loss.
A client's arterial blood gas results show a pH of 7.3 and a PaCO2 of 50 mm Hg. The client is experiencing which of the following acid-base imbalances?
- A. Metabolic acidosis
- B. Metabolic alkalosis
- C. Respiratory acidosis
- D. Respiratory alkalosis
Correct Answer: C
Rationale: The correct answer is C: Respiratory acidosis. In this case, the low pH indicates acidosis, and the elevated PaCO2 indicates respiratory involvement. In respiratory acidosis, the lungs cannot eliminate enough CO2, leading to an increase in carbonic acid and a decrease in pH. Metabolic acidosis (choice A) would involve a primary decrease in bicarbonate levels, not seen in this scenario. Metabolic alkalosis (choice B) would involve an increase in bicarbonate levels, which is not indicated by the given information. Respiratory alkalosis (choice D) would have a low PaCO2 and an elevated pH, opposite of what is seen here.
A client is postoperative with shallow respirations at 9/min. Which acid-base imbalance should the nurse identify the client as being at risk for developing initially?
- A. Respiratory acidosis
- B. Respiratory alkalosis
- C. Metabolic acidosis
- D. Metabolic alkalosis
Correct Answer: A
Rationale: The correct answer is A: Respiratory acidosis. Shallow respirations at 9/min indicate hypoventilation, leading to retention of CO2 and respiratory acidosis. This is because inadequate removal of CO2 results in an increase in carbonic acid concentration, leading to a decrease in blood pH. Respiratory alkalosis (B) is unlikely with shallow respirations. Metabolic acidosis (C) results from nonrespiratory factors. Metabolic alkalosis (D) is not related to respiratory rate.