A nurse is reviewing the arterial blood gas (ABG) result for a client diagnosed with progressive chronic obstructive pulmonary disease (COPD). The nurse should expect which of the following ABG findings for a client diagnosed with progressive COPD?

pH 7.55, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 24 mEq/L

pH 7.30, PaCO2 60 mm Hg, PaO2 70 mm Hg, HCO3 30 mEq/L

pH 7.40, PaCO2 40 mm Hg, PaO2 94 mm Hg, HCO3 22 mEq/L

pH 7.38, PaCO2 45 mm Hg, PaO2 88 mm Hg, HCO3 26 mEq/L

Answer and Explanation

The Correct Answer is B

A. pH 7.55, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 24 mEq/L: This ABG finding indicates respiratory alkalosis, as evidenced by the elevated pH and decreased PaCO2. In progressive COPD, clients typically retain carbon dioxide rather than blow it off, so this finding would not be expected in a patient with chronic respiratory issues.
B. pH 7.30, PaCO2 60 mm Hg, PaO2 70 mm Hg, HCO3 30 mEq/L: This is the most consistent finding for a client with progressive COPD. The low pH indicates acidosis, and the elevated PaCO2 suggests respiratory acidosis due to carbon dioxide retention, a common problem in COPD. The elevated HCO3 indicates a compensatory metabolic response, as the body attempts to retain bicarbonate to buffer the acidosis.
C. pH 7.40, PaCO2 40 mm Hg, PaO2 94 mm Hg, HCO3 22 mEq/L: These values indicate a normal ABG, which would not be expected in a client with progressive COPD. Patients with chronic lung disease typically present with acid-base imbalances due to respiratory failure, so this finding suggests the client is not exhibiting the expected complications of COPD.
D. pH 7.38, PaCO2 45 mm Hg, PaO2 88 mm Hg, HCO3 26 mEq/L: Although these findings show mild acidosis, the PaCO2 is within normal limits, indicating that this patient may not be experiencing significant respiratory failure. In advanced COPD, one would expect to see a higher PaCO2 and more pronounced acidosis, making this option less characteristic of a patient with progressive COPD compared to option B.

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Correct Answer is C

Explanation

A. Client develops ecchymosis at the venipuncture site. Minor bruising at venipuncture sites is a common and expected side effect of heparin therapy due to its anticoagulant effect. While the nurse should monitor for increased bruising, isolated ecchymosis at an IV site does not necessarily indicate excessive anticoagulation or require immediate provider notification.
B. PTT 70 seconds (control 25-40). Heparin therapy is adjusted based on the activated partial thromboplastin time (aPTT). The therapeutic range is typically 1.5 to 2.5 times the control value, which in this case would be approximately 60-100 seconds. A PTT of 70 seconds is within the therapeutic range, so it does not require urgent intervention.
C. Client develops hematuria. Hematuria is a sign of potential excessive anticoagulation or internal bleeding, which can be a serious complication of heparin therapy. This finding suggests that the client's coagulation status may need immediate reassessment, and the heparin infusion may require adjustment or reversal with protamine sulfate if necessary. The healthcare provider should be notified promptly.
D. Order for Coumadin 2.5 mg to begin today. It is common practice to start warfarin (Coumadin) while a client is on heparin therapy because warfarin takes several days to reach therapeutic levels. Heparin is typically continued until the INR reaches a therapeutic range. Therefore, this order does not require provider notification.

A. Wear a mask when caring for the client. B. Place the client in private room. C. Encourage the client to increase fluid intake. D. Place the client on contact precautions. E. Prepare to administer an antibiotic to the client.

Correct Answer is ["A","B","C"]

Explanation

A. Wear a mask when caring for the client: This is an important action to prevent the spread of influenza, which is transmitted via respiratory droplets. Wearing a mask helps protect both the healthcare provider and other patients from potential exposure to the virus, especially in the early stages of the disease when the client is most contagious.
B. Place the client in a private room: This action is recommended to minimize the risk of transmitting the influenza virus to other patients. Isolating the client in a private room can help control the spread of infection, making it a necessary measure in this situation.
C. Encourage the client to increase fluid intake: Adequate hydration is essential for clients with influenza to help alleviate fever and maintain overall health. Increasing fluid intake supports the immune system and helps prevent complications such as dehydration, so encouraging the client to drink more fluids is appropriate.
D. Place the client on contact precautions: While contact precautions are essential for preventing the spread of infections transmitted by direct contact, they are not specifically necessary for influenza, which is primarily airborne and droplet transmitted. Standard precautions, including droplet precautions, are sufficient for managing a client with influenza.
E. Prepare to administer an antibiotic to the client: This action is not appropriate because influenza is a viral infection, and antibiotics are ineffective against viruses. Treatment for influenza typically involves antiviral medications if indicated, supportive care, and symptom management rather than antibiotics. Therefore, this option should not be included in the actions the nurse takes.

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A nurse is reviewing the arterial blood gas (ABG) result for a client diagnosed with progressive chronic obstructive pulmonary disease (COPD). The nurse should expect which of the following ABG findings for a client diagnosed with progressive COPD?

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Correct Answer is C

Explanation

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Correct Answer is ["A","B","C"]

Explanation

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