1.When evaluating the arterial blood gases (ABGs) of a patient with a 20 year history of chronic bronchitis, which of these would the healthcare provider expect?
a. Metabolic acidosis, uncompensated
b. Respiratory acidosis, compensated
c. Respiratory alkalosis, uncompensated
d. Metabolic alkalosis, compensated
2. During an assessment of a patient experiencing acute hemorrhage , the healthcare provider would most likely expect to find
a. Jaundice
b. Hypotension
c. Tachycardia
d. Nausea
3. A patient presents to the emergency department with a blood pressure of 180/130 mmHg, headache, and confusion. Which additional finding is consistent with a diagnosis of hypertensive emergency?
a. Bradycardia
b. Jaundice
c. Retinopathy
d. Urinary retention
4. Before administering two units of whole blood, what type of intravenous (IV) device should be used?
a. The smallest possible catheter to prevent pain on insertion
b. b. The same IV device as previously used. Consult the patient’s chart.
c. c. Whatever the doctor has ordered. consult the patient’s chart.
d. d. A large bore catheter to allow blood cells to pass easily into the patient
5. A patient diagnosed with ulcerative colitis is admitted to the medical unit. When assessing the patient, which of these findings would be of the most concern?
a. Blood diarrhea
b. Borborygmi
c: Oral temperatture of 99.0F (37.2 C)
d. Rebound tenderness
6. The safest method of changing a patient's tracheotomy ties is to
a. Never attempt to change ties alone.
b. Apply the new ties before removing the old ones.
c. Change ties as soon as possible after the patient has eaten.
d. Ask the doctor to suture the tracheostomy in place
7. During an arteriogram (angiogram), the patient suddenly says, “I’m feeling really hot.” Which is the best response?
a. "The heat indicates that the clots in the coronary vessels are dissolving."
b. "You are having an allergic reaction to the dye. I will get an order for Benadryl."
c. "That feeling of warmth is normal when the dye is injected. It will last up to 20 seconds."
d, "Let me get your doctor to explain this sensation to you
8. The healthcare provider is caring for a patient on a ventilator with an endotracheal tube in place. What assessment data indicate the tube has migrated too far down the trachea?
a. Low pressure alarm sounds
b. Increased crackles auscultation bilaterally
c. A high pressure alarm sounds
d. Decreased breath sounds on the left side of the chest
9. A patient with chronic hepatitis C is scheduled for a liver biopsy. Before the procedure, the nurse checks the most recent lab results. Which of the following laboratory tests does NOT assess coagulation?
a. Hematocrit
b. Platelet count
c. Partial thromboplastin time
d. Prothrombin time
10. When caring for a patient with a cardiac dysrhythmia, which laboratory value is a priority for the healthcare provider to monitor?
PT and INR
Hemoglobin and hematocrit
Sodium, potassium, and calcium
BUN and creatinine
Answers with Explanation:
1. b: Chronic bronchitis diminishes airflow during expiration, trapping carbon dioxide (CO2) in the lungs. The increased CO2 lowers the arterial pH, causing respiratory acidosis. The kidneys compensate for the chronic acidosis by conserving bicarbonate. This keeps the pH in a low-normal range, resulting in compensated respiratory acidosis.
2. c: The heart rate will increase in an attempt to deliver more oxygen to the brain and body. Tachycardia is a pulse rate > 100bpm.
3. c: A hypertensive emergency is a sudden rise in blood pressure, with a reading of 180/120mmHg or higher. Immediate intervention is necessary. It may cause hypertensive retinopathy, resulting in hemorrhages, exudates, and/or papilledema. Other consequences of a hypertensive emergency include stroke, heart attack, aortic dissection, kidney damage, and pulmonary edema.
4. d: Large bore catheters are necessary to prevent damage to blood cells. This also decreases development of clots from hemolysis. An 18 gauge needle is often the standard for blood administration.
5. d: Rebound tenderness is a sign of peritonitis that could be the result of rupture of the colon. It is a clinical sign that occurs during physical examination, referring to pain upon removal of pressure, not during application of pressure. Bloody diarrhea is a common finding because of bleeding lesions and anal excoriation. A temperature of 99.0 F (37.2 C) is within normal range, and chronic inflammation may keep temperatures within the high normal range or above. Borborygmi are the sounds made by air or fluids moving through the intestines.
6. b. The best way to change tracheotomy ties is to apply the new ones before removing the old ones. This keeps the tracheostomy in place during the process. With this method, a second person is not necessary; besides, a helper might not prevent the patient from coughing out the tracheotomy. Wait two hours after eating to change the ties, to avoid vomiting from stimulating the gag reflex. Asking the doctor to suture the tracheotomy in place is not appropriate.
7. c, Patients should be instructed that it is normal to experience a warm sensation when IV contrast is injected. The feeling lasts 5-20 seconds.
8. d: If the endotracheal tube is inserted too far, it often goes into the right main stem bronchus. Air will then be delivered to the right lung and not the left. A low pressure alarm indicates a disconnection or a leak in the circuit. A high pressure alarm can mean an obstruction, such as a kink in the tubing or a need for suctioning.
9. a, Prothrombin time, partial thromboplastin time, and platelet count are all included in coagulation studies. The hematocrit does not assess coagulation; it reports the percentage of red blood cells (RBCs) in the blood.
10. c, Because abnormalities in sodium, potassium and calcium levels are likely to affect depolarization and repolarization of cardiac cells, it is most important for the healthcare provider to monitor these laboratory values. BUN and creatinine levels are always important to monitor when giving any drug, not only anti-dysrhythmia drugs. The PT and INR will be important for patients who are on warfarin (Coumadin).
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