NCLEX Secrets - Level of Cognitive Ability (Analysis 11-15)

NCLEX Secrets - Level of Cognitive Ability

11. A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 6 breaths/min. The electrocardiogram (ECG) monitor displays tachycardia with heart rate of 120 beats/min. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which of the following?

a) a decreased pH and an increased CO2
b) an increased pH and a decreased CO2
c) a decreased pH and a decreased HCO3
d) an increased pH with an increased HCO3


12. A client who is found unresponsive has arterial blood gases drawn and the results indicate the following; pH is 7.12, pCO2 is 90 mm Hg, and HCO3 is 22 mEq/L. The nurse interprets the results as indicating which condition?

a) metabolic acidosis with compensation
b) respiratory acidosis with compensation
c) metabolic acidosis without compensation
d) respiratory acidosis without compensation


13. A nurse reviews the blood gas results of client with Guillain-Barre syndrome. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which of the following validates the nurse's findings?

a) pH 7.25, Pco2 50 mm Hg
b) pH 7.35, Pco2 40 mm Hg
c) pH 7.50, Pco2 52 mm Hg
d) pH 7.52, Pco2 28 mm Hg


14. A nurse reviews the arterial blood gas results of client and notes the following: pH 7.45, Pco2 of 30 mm Hg, and HCO3 of 22 mEq/L. The nurse analyzes these results as indicating which condition?

a) metabolic acidosis, compensated
b) respiratory alkalosis, compensated
c) metabolic acidosis, uncompensated
d) respiratory alkalosis, uncompensated

15. A client is receiving a continuous intravenous infusion of heparin sodium to treat deep vein thrombosis. The client's activated partial thromboplastin time (aPTT) time is 65 seconds. The client's baseline before the initiation of therapy was 30 seconds. The nurse anticipates that which action is needed?

a) discontinuing the heparin infusion
b) increasing the rate of the heparin infusion
c) decreasing the rate of heparin infusion
d) leaving the rate of the heparin infusion at is




NCLEX Secrets - Level of Cognitive Ability:
ANSWERS AND RATIONALE

11) D

- clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3 to increase. Symptoms experienced by the client would include hypoventilation and tachycardia. Option A reflects a respiratory acidosis condition. Option B reflects a respiratory alkalosis condition. Option C reflects a metabolic acidosis condition.

12) D

- the acid-base disturbance is respiratory acidosis without compensation. The normal pH is 7.35 to 7.45. The normal Pco2 is 35 to 45 mm Hg. In respiratory acidosis the pH is decreased and the Pco2 is elevated. The normal bicarbonate (HCO3) level is 22 to 27 mEq/L. Because the bicarbonate is still within normal limits, the kidneys have not had time to adjust for this acid-base disturbance. Therefore, the condition is without compensation. Option A, B, and C are incorrect.

13) A

- the normal pH is 7.35 to 7.45. The normal Pco2 is 35 to 45 mm Hg. In respiratory acidosis, the pH is decreased and the Pco2 is elevated. Option B identifies normal values. Option C identifies an alkalosis condition. Option D identifies respiratory alkalosis.

14) B

- the normal pH is 7.35 to 7.45. In respiratory condition, an opposite effect will be seen between the pH and the Pco2. In this situation, the pH is at high end of the normal value and Pco2 is low. In alkalosis condition, the pH is elevated. Therefore, the values identified in the question indicate a respiratory alkalosis. Compensation occurs when the pH returns to a normal value. Because the pH is in normal range at the high end, compensation has occurred.

15) D

- the normal activated partial thromboplastin time (aPTT) varies between 20 and 36 seconds, depending on the type of activator used in testing. The therapeutic dose of heparin for treatment of deep vein thrombosis is to keep the aPTT between 1.5 to 2.5 times normal. Thus, the client's aPTT is within the therapeutic range, and the dose should remain unchanged.


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