Nursing Elites

1. A client's arterial blood gas results show a pH of 7.3 and a PaCO2 of 50 mm Hg. The client is experiencing which of the following acid-base imbalances?

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

Correct answer: C

Rationale: In respiratory acidosis, there is an excess of carbon dioxide (PaCO2 > 45 mm Hg) leading to a decrease in pH (<7.35). The given values of a pH of 7.3 and PaCO2 of 50 mm Hg indicate respiratory acidosis. Metabolic acidosis involves a primary decrease in bicarbonate levels with a compensatory decrease in PaCO2 to maintain balance. Metabolic alkalosis is characterized by elevated pH and bicarbonate levels. Respiratory alkalosis is marked by low PaCO2 and increased pH levels.

2. A client with a long history of smoking is being assessed by a nurse. Which finding is a common complication of chronic obstructive pulmonary disease (COPD)?

• A. Decreased anteroposterior chest diameter
• B. Increased breath sounds
• C. Prolonged expiratory phase
• D. Increased chest expansion

Correct answer: C

Rationale: In COPD, a prolonged expiratory phase is a typical finding caused by airway obstruction and air trapping. This results in difficulty expelling air from the lungs, leading to the characteristic prolonged exhalation in individuals with COPD.

3. A client presents with shortness of breath, pain in the lung area, and a recent history of starting birth control pills and smoking. Vital signs include a heart rate of 110/min, respiratory rate of 40/min, and blood pressure of 140/80 mm Hg. Arterial blood gases reveal pH 7.50, PaCO2 29 mm Hg, PaO2 60 mm Hg, HCO3 20 mEq/L, and SaO2 86%. What is the priority nursing intervention?

• A. Prepare for mechanical ventilation.
• B. Administer oxygen via face mask.
• C. Prepare to administer a sedative.
• D. Assess for indications of pulmonary embolism.

Correct answer: B

Rationale: In a client with a high respiratory rate, low PaO2, and low SaO2, the priority intervention is to improve oxygenation. Administering oxygen via a face mask will help increase the oxygen supply to the client's lungs and tissues, addressing the hypoxemia. While mechanical ventilation may be necessary in severe cases, administering oxygen is the initial and most appropriate intervention to address the client's respiratory distress. Sedatives should not be given without ensuring adequate oxygenation. Assessing for pulmonary embolism is important but not the priority at this moment when the client is experiencing respiratory distress and hypoxemia.

4. After auscultating a client's breath sounds, the nurse is providing care. Which finding is correctly matched to the nurse's primary intervention?

• A. Hollow sounds are heard over the trachea. The nurse increases the oxygen flow rate.
• B. Crackles are heard in bases. The nurse encourages the client to cough forcefully.
• C. Wheezes are heard in central areas. The nurse administers an inhaled bronchodilator.
• D. Vesicular sounds are heard over the periphery. The nurse has the client breathe deeply.

Correct answer: C

Rationale: Wheezes are indicative of narrowed airways, and bronchodilators help to open the air passages, making option C the correct match. Wheezes are typically heard in the central or peripheral lung areas and are associated with conditions like asthma or COPD. Inhaled bronchodilators work by dilating the bronchioles, which helps alleviate wheezing and improve airflow. Therefore, administering an inhaled bronchodilator is the appropriate intervention in response to wheezes.

5. Which action best demonstrates respect for autonomy when working with a client?

• A. Asks if the client has questions before signing a consent form
• B. Provides the client with accurate information when questioned
• C. Honors the promises made to the client and family
• D. Ensures fair treatment of the client compared to others

Correct answer: A

Rationale: Respect for autonomy involves allowing individuals to make decisions about their care. By asking if the client has questions before signing a consent form, the nurse is respecting the client's right to make informed choices and decisions regarding their healthcare. This action supports the principle of self-determination and autonomy in healthcare decision-making.

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