Nokea
Which manifestation is related to target organ disease from hypertension? Select all that apply.
- A. Anemia.
- B. Aneurysm.
- C. Proteinuria.
- D. Pneumonia.
- E. Transient ischemic attack.
Correct Answer: B,C
Rationale: Aneurysm and proteinuria are manifestations of target organ damage from hypertension, affecting arteries and kidneys, respectively.
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A patient with chronic obstructive pulmonary disease (COPD) has the following arterial blood gas (ABG) results: a blood pH of 7.29, a partial pressure of carbon dioxide (PaCO2) level of 49 mm Hg, and a bicarbonate ion (HCO3) level of 25 mEq/L. Which condition would the nurse have in mind when developing the patient's plan of care?
- A. Metabolic acidosis.
- B. Metabolic alkalosis.
- C. Respiratory acidosis.
- D. Respiratory alkalosis.
Correct Answer: C
Rationale: Respiratory acidosis is indicated by low pH (7.29) and high PaCO2 (49 mm Hg), common in COPD due to impaired CO2 elimination.
Which goal is a primary objective for a patient who has chronic heart failure (HF)?
- A. Maximizing cardiac output.
- B. Maintaining ideal body weight.
- C. Performing daily aerobic exercises.
- D. Maintaining a steady pulse oximetry reading.
Correct Answer: A
Rationale: Maximizing cardiac output is a primary goal for patients with chronic heart failure (HF) because it helps improve tissue perfusion and oxygen delivery to meet the body's demands. It is a crucial aspect of managing heart failure and preventing further complications.
After noting that a patient with leukemia has thrombocytopenia, which action will the nurse plan to take?
- A. Palpate lymph nodes for swelling.
- B. Check temperature for elevation.
- C. Inspect skin for bruising or petechiae.
- D. Examine oral mucosa for ulceration.
Correct Answer: C
Rationale: Inspecting the skin for bruising or petechiae is specific to thrombocytopenia, as petechiae are small, red or purple dots that appear on the skin when platelet count is low, indicating a bleeding tendency.
Which strategy is most important for a nurse to include when planning care for a patient who has neutropenia?
- A. Restricting all visitors.
- B. Placing the patient in a private room.
- C. Advising the patient to use only an electric shaver.
- D. Wearing a gown and gloves when in direct contact with the patient.
Correct Answer: B
Rationale: Placing the patient in a private room is crucial for a neutropenic patient to minimize exposure to pathogens, reducing infection risk due to their compromised immune system.
Which arterial blood gas (ABG) data corresponds with a patient's clinical manifestations of respiratory alkalosis?
- A. pH = 7.46, PaCO2 = 44 mm Hg, PaO2 = 95 mm Hg, and HCO3 = 36 mEq/L.
- B. pH = 7.27, PaCO2 = 70 mm Hg, PaO2 = 80 mm Hg, and HCO3 = 26 mEq/L.
- C. pH = 7.30, PaCO2 = 35 mm Hg, PaO2 = 70 mm Hg, and HCO3 = 20 mEq/L.
- D. pH = 7.52, PaCO2 = 24 mm Hg, PaO2 = 85 mm Hg, and HCO3 = 24 mEq/L.
Correct Answer: D
Rationale: Respiratory alkalosis is characterized by a high pH (>7.45) and a low PaCO2 (<35 mm Hg). The data in option D (pH = 7.52, PaCO2 = 24 mm Hg) indicates respiratory alkalosis.