A nurse is caring for a client who is near death. Which of the following actions should the nurse take?

Administer scheduled pain medications.

Provide oral care every 6 hr.

Administer liquids using a syringe.

Whisper when talking to family members.

Answer and Explanation

The Correct Answer is A

A.   Administer scheduled pain medications is appropriate because providing comfort is a priority in end-of-life care. Administering scheduled pain medications helps alleviate any discomfort or pain the client may be experiencing.
B.   Providing oral care every 6 hr may not be necessary in the end-of-life stage, as the client's ability to tolerate oral care may decrease, and excessive oral care may cause discomfort.
C.   Administering liquids using a syringe may not be appropriate if the client is unable to swallow or if there are concerns about aspiration.
D.   Whispering when talking to family members is not necessary; instead, the nurse should communicate in a calm and clear manner, adjusting the volume and tone as needed to accommodate the client's condition and preferences.

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Correct Answer is C

Explanation

A. Respiratory alkalosis: This condition is characterized by low levels of carbon dioxide
(PaCO2) in the blood and an elevated pH. The ABG results in DKA show a low pH, ruling out respiratory alkalosis.
B. Metabolic alkalosis: Metabolic alkalosis is characterized by high bicarbonate (HCO3) levels and an elevated pH. The ABG results in DKA show low bicarbonate levels, ruling out metabolic alkalosis.
C. Metabolic acidosis: Metabolic acidosis is characterized by low pH and low bicarbonate (HCO3) levels. The ABG results in DKA demonstrate both low pH and low bicarbonate levels, consistent with metabolic acidosis.
D. Respiratory acidosis: Respiratory acidosis is characterized by high carbon dioxide (PaCO2) levels and low pH. The ABG results in DKA show a normal or slightly decreased PaCO2, ruling out respiratory acidosis.

A. A client who has a history of pancreatitis and reports severe abdominal pain B. A client who has heart failure and reports severe dyspnea C. A client who is scheduled for abdominal surgery in 1 hr D. A postoperative client who has diabetes mellitus and a blood glucose of 280 mg/dL

Correct Answer is B

Explanation

A. While severe abdominal pain in a client with a history of pancreatitis requires urgent assessment, severe dyspnea in a client with heart failure may indicate impending respiratory distress, requiring immediate intervention.
B. Severe dyspnea in a client with heart failure is a critical situation that requires immediate assessment and intervention to prevent respiratory compromise or failure.
C. While a client scheduled for surgery may need preparation and assessment, the client with severe dyspnea takes priority due to the potential for respiratory distress.
D. While a high blood glucose level in a postoperative client with diabetes mellitus requires monitoring and intervention, the client with severe dyspnea requires immediate attention due to the potential for respiratory compromise.

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A nurse is caring for a client who is near death. Which of the following actions should the nurse take?

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Naxlex Comprehensive Predictor Exams

A nurse is reviewing the laboratory results of a client who has DKA. The client's ABG results are pH 7.30, PaCO2 34 mm Hg and HCO3 21 mEq/L. The nurse should identify that these values indicate which of the following acid-base imbalances?

Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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