A nurse evaluates a client's arterial blood gas values (ABGs): pH 7.1, PaCO2 70 mm Hg, and HCO3 22 mEq/L. Which intervention does the nurse implement first?

Assess the airway.

Administer prescribed bronchodilators.

Administer prescribed mucolytics.

Provide oxygen.

Answer and Explanation

The Correct Answer is A

A.   Assessing the airway is always a priority in any client care situation, especially when there are respiratory abnormalities such as respiratory acidosis. Ensuring a patent airway is crucial to maintain adequate oxygenation and ventilation.
B.   Bronchodilators are typically used to treat conditions such as bronchoconstriction in asthma or chronic obstructive pulmonary disease (COPD). However, in the context of respiratory acidosis with an elevated PaCO2, the primary issue is not bronchoconstriction but rather impaired gas exchange due to inadequate ventilation.
C.   Mucolytics are medications used to thin mucus and facilitate its removal from the respiratory tract. While they can be beneficial in conditions with thick secretions, they do not address the underlying cause of respiratory acidosis, which is inadequate CO2 elimination.
D.   Providing oxygen can help improve oxygenation in clients with respiratory acidosis. However, it is important to note that oxygen alone will not correct the underlying cause of respiratory acidosis (elevated PaCO2). Oxygen therapy is supportive and helps to improve oxygen delivery to tissues while other interventions are addressed.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is B

Explanation

A. Deferasirox is a medication used to treat chronic iron overload due to blood transfusions. It is not used as an antidote for heparin.
B. Protamine sulfate is the antidote for heparin. It works by binding to heparin, neutralizing its anticoagulant effects. Protamine sulfate is typically used in cases of heparin overdose or when rapid reversal of heparin's effects is necessary, such as during surgery or if there is active bleeding.
C. Acetylcysteine is used as an antidote for acetaminophen (paracetamol) overdose due to its ability to replenish glutathione stores in the liver and protect against liver damage. It has no role in reversing heparin's effects.
D. Vitamin K is the antidote for warfarin, not heparin. It promotes the synthesis of clotting factors in the liver that are inhibited by warfarin, thus reversing its anticoagulant effects.

Correct Answer is ["300"]

Explanation

To calculate the volume of IV fluids infused from 0330 to 0600, you would determine the number of hours that have passed.

From 0330 to 0600 is 2.5 hours. Since the IV is infusing at 120 mL/hr, you would multiply the infusion rate by the number of hours. So, 120 mL/hr * 2.5 hours = 300 mL.

Therefore, the nurse should record 300 mL of IV fluids on the intake record at 0600.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse evaluates a client's arterial blood gas values (ABGs): pH 7.1, PaCO2 70 mm Hg, and HCO3 22 mEq/L. Which intervention does the nurse implement first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects?

Correct Answer is B

Explanation

A nurse is caring for a client who had IV fluids initiated at 0330. The IV fluids are infusing at 120 mL/hr. The nurse should record how many mL of IV fluids on the intake record at 0600?

Correct Answer is ["300"]

Explanation

A nurse is caring for a client 8 hr postoperative following a total knee replacement. Which of the following actions should the nurse take?

A nurse is reviewing a client's CBC findings and discovers that the client's platelet count is 9,000/mm3. The nurse should monitor the client for which of the following conditions?

A nurse assesses a diabetic client who is admitted with an acid-base imbalance. The client's arterial blood gas values are pH 7.39, PaCO2 27 mm Hg, and HCO3 19 mEq/L. Which sign or symptom does the nurse identify as an example of the client's compensatory mechanisms?

The nurse is caring for a client with a heart rate of 48. His blood pressure is 120/80. Which finding will help the nurse determine the cause of the client's bradycardia?

A nurse has been assigned to care for a client diagnosed with a small bowel obstruction. The client has a nasogastric tube attached to suction for 2 days. Which arterial blood gas result will the nurse expect to see for this client?

A nurse is caring for a client who has the following arterial blood gas results: HCO3 18 mEq, PaCO2 28 mm Hg and pH 7.30. The nurse recognizes the client is experiencing which of the following acid base imbalances?

A nurse is obtaining informed consent from a client who is preoperative. Which of the following actions should the nurse take? (Select all that apply.)

A nurse is collecting a medication history from a client who is scheduled to have a cardiac catheterization. Which of the following medications taken by the client interacts with contrast material and places the client at risk for acute kidney injury?