Nursing Elites

1. A client is brought to the emergency department by a neighbor. The client is lethargic and has a fruity odor on the breath. The client’s arterial blood gas (ABG) results are pH 7.25, PCO2 34 mm Hg, PO2 86 mm Hg, HCO3 14 mEq/L. Which of the following acid-base disturbances does the nurse recognize in these results?

• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Respiratory acidosis
• D. Respiratory alkalosis

Correct answer: A

Rationale: The correct answer is 'Metabolic acidosis.' Metabolic acidosis is characterized by a low pH (<7.35) and a low bicarbonate level (HCO3 <22 mEq/L). In this case, the client's ABG results show a pH of 7.25 and an HCO3 level of 14 mEq/L, indicating metabolic acidosis. The PCO2 of 34 mm Hg is normal, ruling out respiratory acidosis or alkalosis. The PO2 of 86 mm Hg is also within the normal range and is not indicative of a respiratory problem. Therefore, the client is experiencing metabolic acidosis based on the ABG results provided.

2. A client is getting out of bed for the first time since surgery. The client complains of dizziness after the nurse raises the head of the bed. Which of the following actions should the nurse take first?

• A. Checking the client’s blood pressure
• B. Checking the oxygen saturation level
• C. Having the client take some deep breaths
• D. Lowering the head of the bed slowly until the dizziness is relieved

Correct answer: D

Rationale: When a client experiences dizziness after being positioned upright for the first time post-surgery, the initial action the nurse should take is to lower the head of the bed slowly until the dizziness subsides. This maneuver helps alleviate the dizziness by allowing the body to adapt gradually to the change in position. Subsequently, the nurse should assess the client's pulse and blood pressure. Checking the blood pressure is essential to evaluate the circulatory status and rule out orthostatic hypotension as a cause of dizziness. Checking the oxygen saturation level and having the client take deep breaths are not the priority in this scenario as the primary concern is addressing the circulatory issue causing dizziness, not a respiratory problem.

3. Which of the following is a common cause of chronic obstructive pulmonary disease (COPD)?

• A. Smoking
• B. Asthma
• C. Allergies
• D. Chronic bronchitis

Correct answer: A

Rationale: Smoking is the correct answer as it is a well-established common cause of chronic obstructive pulmonary disease (COPD). Smoking leads to long-term damage to the lungs, contributing to the development of COPD. Choice B, asthma, is not a cause but a separate respiratory condition characterized by airway inflammation and hyperresponsiveness. Allergies, choice C, are not a direct cause of COPD but can exacerbate symptoms in individuals with existing COPD. Chronic bronchitis, choice D, is a type of COPD, not a cause of COPD itself, making it an incorrect choice in this context.

4. An older client with long-term type 2 diabetes Mellitus (DM) is seen in the clinic for a routine health assessment. Which assessment would the nurse complete to determine if a patient with type 2 diabetes Mellitus (DM) is experiencing long-term complications?

• A. Signs of respiratory tract infection
• B. Sensation in feet and legs
• C. Skin condition of lower extremities
• D. Serum creatinine and blood urea nitrogen (BUN)

Correct answer: B

Rationale: Assessing sensation in the feet and legs is crucial for detecting diabetic neuropathy, a common long-term complication of diabetes. While signs of respiratory tract infection, skin condition of lower extremities, and serum creatinine and blood urea nitrogen levels are important assessments in diabetic care, they are not specific for detecting long-term complications like neuropathy.

5. A client in a physician’s office has just made an appointment for an exercise stress test. The client should be instructed to:

• A. Wear sweatpants and a heavy sweatshirt
• B. Eat a small meal just before the procedure
• C. Wear comfortable rubber-soled shoes such as sneakers
• D. Avoid consuming caffeine for 30 minutes before the procedure

Correct answer: C

Rationale: The client should wear comfortable rubber-soled shoes, such as sneakers, for the exercise stress test. This choice ensures safety and stability during the procedure. Wearing sweatpants and a heavy sweatshirt (Choice A) would not be appropriate as the client needs to wear light, loose, comfortable clothing. Eating a small meal just before the procedure (Choice B) could lead to discomfort during the test. Avoiding caffeine for 30 minutes before the procedure (Choice D) is not a specific instruction related to the attire or preparation for the test.

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