Which of the following arterial blood gas values indicates a patient may be experiencing a condition of metabolic acidosis?
- A. PaO2 90 mm Hg
- B. Bicarbonate 15 mEq/L
- C. CO2 47 mm Hg
- D. pH 7.34
Correct Answer: B
Rationale: The correct answer is B: Bicarbonate 15 mEq/L. In metabolic acidosis, the bicarbonate levels are lower than normal. A bicarbonate value of 15 mEq/L indicates a deficit in the buffer system, contributing to the acidosis. Choices A, C, and D are incorrect. Choice A, PaO2 90 mm Hg, reflects oxygen partial pressure and is not directly related to metabolic acidosis. Choice C, CO2 47 mm Hg, represents carbon dioxide levels and is more indicative of respiratory status. Choice D, pH 7.34, falls within the normal range (7.35-7.45) and does not confirm metabolic acidosis.
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The factor that most determines drug distribution is:
- A. vascular perfusion of the tissue or organ.
- B. salt form.
- C. drug interactions.
- D. steady state.
Correct Answer: A
Rationale: The correct answer is 'vascular perfusion of the tissue or organ.' Drug distribution is primarily determined by how well the circulatory system delivers the drug to various tissues and organs. Adequate perfusion ensures proper distribution of the drug throughout the body. While the salt form (choice B), drug interactions (choice C), and steady state (choice D) can influence drug efficacy and metabolism, they are not as crucial as vascular perfusion for the initial distribution of a drug.
A nurse is weighing a breastfed 6-month-old infant who has been brought to the pediatrician's office for a scheduled visit. The infant's weight at birth was 6 lb 8 oz. The nurse notes that the infant now weighs 13 lb. What action should the nurse take?
- A. Tell the mother to decrease the daily number of feedings because the weight gain is excessive.
- B. Tell the mother that the infant's weight is increasing as expected.
- C. Tell the mother that the infant should continue with breast milk as the weight gain is adequate.
- D. Tell the mother that semisolid foods should not be introduced until the infant's weight stabilizes.
Correct Answer: B
Rationale: The correct answer is to inform the mother that the infant's weight gain is normal. Infants typically double their birth weight by 6 months, which is precisely the case here, with the infant's weight increasing from 6 lb 8 oz to 13 lb. This weight gain indicates healthy growth and development. Therefore, there is no need to decrease feedings. The infant should continue with breast milk as it is providing adequate nutrition. Additionally, introducing semisolid foods is usually recommended between 4 and 6 months of age, so there is no indication to delay based on the infant's weight gain.
A 14-year-old boy has been admitted to a mental health unit for observation and treatment. The boy becomes agitated and starts yelling at nursing staff members. What should the nurse's first response be?
- A. Create an atmosphere of seclusion for the boy according to procedures.
- B. Remove other patients from the area for added safety.
- C. Ask the patient, "What is making you mad?"?
- D. Ask the patient, "Why are you behaving this way? Have you thought about what may help you calm down?"?
Correct Answer: A
Rationale: In a situation where a patient is agitated and yelling, the first response should be to create an atmosphere of seclusion for the safety of the patient and others. Seclusion is a standard procedure to help manage aggressive behaviors and prevent harm. Options B, C, and D are not appropriate in this scenario. Removing other patients may not address the immediate safety concern, asking the patient what is making them mad can escalate the situation, and questioning why the patient is behaving that way may not help in managing the current agitation. Therefore, seclusion is the recommended course of action in this scenario to ensure the safety and well-being of all involved.
A nurse is assigned to do pre-operative teaching on a blind patient who is scheduled for surgery the following morning. What teaching strategy would best fit the situation?
- A. Verbal teaching in short sessions throughout the day
- B. Provide a pre-operative booklet in Braille
- C. Provide an audio recording for the client
- D. Have the blind patient's family member assist with the instruction
Correct Answer: A
Rationale: For a blind patient scheduled for surgery the following morning, the best teaching strategy would be verbal teaching in short sessions throughout the day. Providing information in smaller amounts makes it easier to retain, and one-on-one teaching is most effective. Choice B, providing a pre-operative booklet in Braille, may not be as practical for last-minute teaching. Choice C, providing an audio recording, may not allow for immediate interaction and clarification. Choice D, having a family member instruct the patient, may not ensure the accuracy and clarity of the information provided.
An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How might bacterial glycocalyx contribute to this?
- A. It protects the bacteria from antibiotic and immunologic destruction.
- B. Glycocalyx neutralizes the antibiotic, rendering it ineffective.
- C. It competes with the antibiotic for binding sites on the microbe.
- D. Glycocalyx provides nutrients for microbial growth.
Correct Answer: A
Rationale: Bacterial glycocalyx is a viscous polysaccharide or polypeptide slime that covers microbes. It plays a significant role in protecting bacteria by enhancing adherence to surfaces, resisting phagocytic engulfment by white blood cells, and preventing antibiotics from contacting the microbe. Choice A is correct because glycocalyx shields the bacteria from both antibiotics and the immune system, allowing the infection to persist. Choices B, C, and D are incorrect because glycocalyx does not neutralize antibiotics, compete for binding sites with antibiotics, or provide nutrients for microbial growth.
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