Nursing Elites

1. A client with chronic obstructive pulmonary disease (COPD) presented with shortness of breath. Oxygen therapy was started at 2 liters/minute via nasal cannula. The arterial blood gases (ABGs) after treatment were pH 7.36, PaO2 52, PaCO2 59, HCO3 33. Which statement describes the most likely cause of the simultaneous increase in both PaO2 and PaCO2?

• A. The client is hyperventilating due to anxiety.
• B. The hypoxic drive was reduced by the oxygen therapy.
• C. The client is experiencing respiratory alkalosis.
• D. The client is experiencing metabolic acidosis.

Correct answer: B

Rationale: Oxygen therapy can reduce the hypoxic drive in COPD patients, leading to increased PaCO2 levels while improving oxygenation (PaO2). In this case, the increase in PaO2 and PaCO2 is due to the reduction of the hypoxic drive by the supplemental oxygen. Choice A is incorrect because hyperventilation would lead to decreased PaCO2. Choice C is incorrect as the ABG values do not indicate respiratory alkalosis. Choice D is incorrect as the ABG values do not support metabolic acidosis.

2. A client with hyperkalemia is being treated in the emergency department. Which medication should the nurse prepare to administer?

• A. Potassium chloride
• B. Calcium gluconate
• C. Magnesium sulfate
• D. Sodium bicarbonate

Correct answer: B

Rationale: The correct answer is B, Calcium gluconate. In hyperkalemia, where potassium levels are elevated, calcium gluconate is administered to stabilize the myocardial cell membrane and protect the heart from potential arrhythmias. Potassium chloride (choice A) would worsen the condition by further increasing potassium levels. Magnesium sulfate (choice C) is not the primary treatment for hyperkalemia. Sodium bicarbonate (choice D) is used in metabolic acidosis, not specifically for hyperkalemia.

3. What is the most effective therapy for maintaining remission of acute lymphoblastic leukemia in a child?

• A. Surgery to remove enlarged lymph nodes
• B. Long-term chemotherapy
• C. Nutritional supplements to enhance blood cell production
• D. Blood transfusions to replace ineffective red cells

Correct answer: B

Rationale: The correct answer is B: Long-term chemotherapy. In the case of acute lymphoblastic leukemia, the most effective approach for maintaining remission is long-term chemotherapy, particularly with methotrexate, a chemotherapeutic agent. Surgery to remove enlarged lymph nodes (choice A) is not the primary treatment for leukemia. Nutritional supplements (choice C) may be beneficial for overall health but are not the mainstay of leukemia treatment. Blood transfusions (choice D) are used to manage anemia in leukemia but do not address the underlying disease process.

4. The nurse reports that a client is at risk for a brain attack (stroke) based on which assessment finding?

• A. Nuchal rigidity
• B. Carotid bruit
• C. Jugular vein distention
• D. Palpable cervical lymph node

Correct answer: B

Rationale: The correct answer is B: Carotid bruit. A carotid bruit is a significant risk factor for stroke as it indicates turbulent blood flow due to narrowing of the carotid artery. Nuchal rigidity is associated with meningitis, jugular vein distention can be a sign of heart failure, and palpable cervical lymph nodes may indicate infection, but they are not directly linked to stroke risk.

5. When caring for a 7-week-old infant with hypothyroidism, the nurse explains that the prevention of what complication is dependent on the administration of oral thyroid replacement therapy and is critical for the child?

• A. Excessive growth
• B. Cognitive impairment
• C. Damage to the nervous system
• D. Damage to the urinary system

Correct answer: B

Rationale: The correct answer is B: Cognitive impairment. The treatment of choice for congenital and acquired hypothyroidism is oral thyroid hormone replacement therapy. Prompt treatment is especially critical in the infant with congenital hypothyroidism to avoid permanent cognitive impairment. Excessive growth (Choice A) is not a common complication of hypothyroidism in infants. Damage to the nervous system (Choice C) and damage to the urinary system (Choice D) are not typically associated with untreated hypothyroidism in infants.

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