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In general, when looking at acid-base balance, how does the body compensate with metabolic acidosis?
- A. Lungs ""blow off"" CO2 to raise pH
- B. Lungs retain CO2 to lower pH
- C. Kidneys retain more HCO3 to raise the pH
- D. Kidneys excrete more HCO3 to lower pH
Correct Answer: A
Rationale: The correct answer is A. In metabolic acidosis, the lungs compensate by increasing respiratory rate and depth ('blowing off' CO2) to reduce acidity and raise pH. B is incorrect because retaining CO2 would worsen acidosis. C is partially true long-term but slower acting than pulmonary compensation. D is incorrect because excreting bicarbonate lowers pH further.
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A client with a new tracheostomy is being seen in the oncology clinic. What finding by the nurse best indicates that goals for the client's decrease in self-esteem are being met?
- A. The client demonstrates good understanding of stoma care.
- B. The client has joined a book club that meets at the library.
- C. Family members take turns assisting with stoma care.
- D. Skin around the stoma is intact without signs of infection.
Correct Answer: B
Rationale: The correct answer is B because joining a book club shows an improvement in social engagement and participation, indicating an increase in self-esteem. This choice demonstrates the client's interest in activities outside of their healthcare needs, promoting a sense of normalcy and connection. In contrast, options A, C, and D focus solely on stoma care and physical aspects, not directly related to self-esteem. Understanding stoma care (A) is important but does not address self-esteem directly. Family assistance (C) is supportive but does not necessarily indicate an improvement in the client's self-esteem. Skin integrity (D) is essential for physical health but does not reflect self-esteem.
The nurse is caring for a patient admitted with an acute exacerbation of chronic obstructive pulmonary disease. During assessment, the nurse finds that the patient is experiencing increased dyspnea. What is the most accurate measurement of the concentration of oxygen in the patient's blood?
- A. A capillary blood sample
- B. Pulse oximetry
- C. An arterial blood gas (ABG) study
- D. A complete blood count (CBC)
Correct Answer: C
Rationale: The correct answer is C: An arterial blood gas (ABG) study. This is the most accurate measurement of the concentration of oxygen in the patient's blood because ABG provides direct measurement of oxygen levels, including partial pressure of oxygen (PaO2). It also gives information on other important parameters like pH and carbon dioxide levels. Arterial blood is the best representation of oxygenation status.
Choice A (A capillary blood sample) may provide some information on oxygen saturation but is not as accurate as an ABG for measuring oxygen levels in the blood.
Choice B (Pulse oximetry) measures oxygen saturation in peripheral blood and can give a quick estimate of oxygen levels, but it is not as accurate as an ABG for determining the actual oxygen concentration in the blood.
Choice D (A complete blood count) does not provide direct information on oxygen levels in the blood, as it mainly focuses on the cellular components of blood such as red blood cells, white blood cells, and
Hemoglobin
- A. tends to give up oxygen in regions where partial pressure of oxygen exceeds that in the lungs.
- B. tends to hold onto oxygen when the pH of the blood drops.
- C. tends to release oxygen where the temperature is lower.
- D. releases oxygen more readily in highly active tissues.
Correct Answer: D
Rationale: The correct answer is D because hemoglobin releases oxygen more readily in highly active tissues due to increased metabolic demand for oxygen. This is known as the Bohr effect. Choice A is incorrect as hemoglobin binds oxygen in the lungs where oxygen partial pressure is high. Choice B is incorrect as hemoglobin actually releases oxygen in acidic conditions to increase oxygen delivery to tissues. Choice C is incorrect as hemoglobin releases oxygen in warmer areas to facilitate oxygen delivery to metabolically active tissues.
The nurse assessing the CBC of a patient with chronic bronchitis identifies a typical feature of this disease, which is:
- A. Decreased platelets.
- B. Decreased white blood cells.
- C. Increased eosinophils.
- D. Increased red blood cells.
Correct Answer: D
Rationale: The correct answer is D: Increased red blood cells. In chronic bronchitis, the body compensates for chronic hypoxia by increasing red blood cell production (erythropoiesis) to improve oxygen delivery. This is known as polycythemia. Decreased platelets (A) and white blood cells (B) are not typical features of chronic bronchitis. Increased eosinophils (C) are more commonly associated with allergic conditions or parasitic infections, not chronic bronchitis. In summary, the increased red blood cells in chronic bronchitis help enhance oxygen-carrying capacity, distinguishing it from the other options.
This blood gas picture reveals which of the following? PH = 7.52 pCO2 = 20 mmHg pO2 = 120 mmHg bicarb = 16 mmol/l
- A. Metabolic alkalosis
- B. Respiratory alkalosis with partial renal compensation
- C. Metabolic acidosis
- D. Respiratory acidosis
Correct Answer: B
Rationale: The blood gas values indicate respiratory alkalosis due to a high pH (7.52) and low pCO2 (20 mmHg). The normal pO2 and low bicarb suggest partial renal compensation. The kidneys retain HCO3- to partially offset the respiratory alkalosis. Metabolic alkalosis (A) is incorrect as bicarb is low. Metabolic acidosis (C) is incorrect due to the high pH. Respiratory acidosis (D) is incorrect as pCO2 is low. In summary, the correct answer is B as it aligns with the blood gas values and the concept of compensation.