Nokea
The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). pH 7.35; PCO2 62; PO2 70; HCO3 34. The nurse should:
- A. Apply a 100% non-rebreather mask.
- B. Assess the vital signs.
- C. Reposition the client.
- D. Prepare for intubation.
Correct Answer: B
Rationale: The ABG shows compensated respiratory acidosis (normal pH, high PCO2, high HCO3) with mild hypoxemia (PO2 70). Assessing vital signs evaluates stability before escalating care. A non-rebreather mask or intubation is premature. Repositioning may help but is less urgent.
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A 58-year-old male is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is which of the following?
- A. Immunotherapy affects all rapidly dividing cells.
- B. The molecular structure of the DNA is altered.
- C. Cancer cells are susceptible to drug toxins.
- D. Chemotherapy encourages cancer cells to divide.
Correct Answer: B
Rationale: Chemotherapy often works by altering the DNA structure of cancer cells, inhibiting their ability to replicate and leading to cell death.
Which complication should the nurse monitor for in a client with a new ileal conduit?
- A. Stoma prolapse.
- B. Urinary retention.
- C. Bladder spasms.
- D. Renal colic.
Correct Answer: A
Rationale: Stoma prolapse is a potential complication of an ileal conduit, requiring surgical correction if severe.
The client with rheumatoid arthritis tells the nurse, 'I have a friend who took gold shots and had a wonderful response. Why didn't my physician let me try that?' Which of the following responses by the nurse would be most appropriate?
- A. It's the physician's prerogative to decide how to treat you. The physician has chosen what is best for your situation.'
- B. Tell me more about your friend's arthritic condition. Maybe I can answer that question for you.'
- C. That drug is used for cases that are worse than yours. It wouldn't help you, so don't worry about it.'
- D. Every person is different. What works for one client may not always be effective for another.'
Correct Answer: D
Rationale: Individual responses to treatments vary due to differences in disease severity, comorbidities, and side effect profiles. This response educates the client without dismissing their concerns.
The nurse evaluates the effectiveness of the client's postoperative plan of care. Which of the following would be an expected outcome for a client with an ileal conduit?
- A. The client verbalizes the understanding that his physical activity must be curtailed.
- B. The client states that he will place an aspirin in the drainage pouch to help control odor.
- C. The client demonstrates how to catheterize the stoma.
- D. The client states that he will empty the drainage pouch frequently throughout the day.
Correct Answer: D
Rationale: Frequent pouch emptying is an expected outcome, preventing complications like leakage or infection. Aspirin is unsafe, and stoma catheterization is not typical.
A 52-year-old male was discharged from the hospital for cancer-related pain. His pain appeared to be well controlled on the I.V. morphine. He was switched to oral morphine when discharged 2 days ago. He now reports his pain as an 8 on a 10-point scale and wants the I.V. morphine. Which of the following represents the most likely explanation for the client's reports of inadequate pain control?
- A. He is addicted to the I.V. morphine.
- B. He is going through withdrawal from the I.V. opioid.
- C. He is physically dependent on the I.V. morphine.
- D. He is undermedicated on the oral opioid.
Correct Answer: D
Rationale: Inadequate pain control after switching to oral morphine likely indicates undermedication, possibly due to incorrect equianalgesic dosing (oral morphine requires a higher dose than I.V. due to first-pass metabolism).