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The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client knowing that the client is at risk for which acid-base disorder?
- A. Metabolic alkalosis
- B. Metabolic acidosis
- C. Respiratory alkalosis
- D. Respiratory acidosis
Correct Answer: A
Rationale: The correct answer is A: Metabolic alkalosis. Low suction can lead to excessive loss of gastric acid, causing metabolic alkalosis due to an increase in bicarbonate levels. This is because the body compensates for the loss of acid by retaining bicarbonate. Choices B, C, and D are incorrect because low suction does not directly affect metabolic acidosis, respiratory alkalosis, or respiratory acidosis.
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A client is in the family practice clinic reporting a severe cold that started 4 days ago. On examination the nurse notes that the client also has a severe headache and muscle aches. What action by the nurse is best?
- A. Educate the client on oseltamivir.
- B. Facilitate admission to the hospital.
- C. Instruct the client to have a flu vaccine.
- D. Teach the client to sneeze in the upper sleeve.
Correct Answer: D
Rationale: The correct answer is D: Teach the client to sneeze in the upper sleeve. This action is best because the client is showing symptoms of a cold, which is typically caused by a virus spread through respiratory droplets. Instructing the client to sneeze in the upper sleeve can help prevent the spread of the virus to others. Choice A is incorrect because oseltamivir is used to treat influenza, not the common cold. Choice B is unnecessary as hospital admission is not typically warranted for a cold. Choice C is also incorrect as the client is already sick and a flu vaccine would not be effective at this point in time.
What is the main goal of treatment in heart failure?
- A. To increase blood pressure
- B. To cure the underlying cause
- C. To relieve symptoms and improve quality of life
- D. To induce weight loss
Correct Answer: C
Rationale: The correct answer is C: To relieve symptoms and improve quality of life. The main goal of treatment in heart failure is to manage symptoms, improve heart function, and enhance quality of life. This involves optimizing medications, lifestyle modifications, and sometimes devices or surgeries. Increasing blood pressure (A) is not the goal as high blood pressure can worsen heart failure. Curing the underlying cause (B) may not always be possible, so the focus is on managing symptoms. Inducing weight loss (D) may be necessary in some cases, but it is not the primary goal of treatment for heart failure.
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.
Where is carbonic anhydrase commonly found in the body?
- A. Liver
- B. Kidneys
- C. Lungs
- D. Stomach
Correct Answer: C
Rationale: The correct answer is C: Lungs. Carbonic anhydrase is an enzyme that catalyzes the interconversion of carbon dioxide and water to carbonic acid, which plays a crucial role in maintaining acid-base balance in the body. In the lungs, carbonic anhydrase helps regulate the levels of carbon dioxide and bicarbonate in the blood by facilitating the exchange of gases during respiration. This enzyme is not predominantly found in the liver, kidneys, or stomach, as their functions are not directly related to gas exchange or acid-base balance.
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