The nurse has just received a change of shift report on four patients. Which patient will the nurse assess first?

A post-operative patient after thyroid surgery preparing for discharge with a new medication

A patient diagnosed with Cushing's disease after insertion of a nasogastric tube

A patient scheduled for a chest radiograph who is anxious about their treatment

A patient with chronic obstructive pulmonary disease who requested a breathing treatment during the previous shift

Answer and Explanation

The Correct Answer is D

Choice A reason: While a post-operative patient preparing for discharge is important, they are stable enough to be considered for discharge and do not require immediate assessment.

Choice B reason: A patient with Cushing's disease after insertion of a nasogastric tube may need monitoring, but this is not as urgent as a patient with potential respiratory distress.

Choice C reason: A patient scheduled for a chest radiograph who is anxious about their treatment does not require immediate intervention compared to a patient experiencing respiratory issues.

Choice D reason: A patient with chronic obstructive pulmonary disease who requested a breathing treatment during the previous shift may be experiencing respiratory distress and requires immediate assessment and intervention to prevent further complications.

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Correct Answer is B

Explanation

Choice A reason: Respiratory alkalosis with partial compensation is characterized by a high pH, low PaCO2, and a compensatory decrease in HCO3. In this case, the pH is high (alkaline), PaCO2 is high, and HCO3 is elevated, indicating that the primary disorder is metabolic alkalosis, not respiratory alkalosis.

Choice B reason: Metabolic alkalosis with partial compensation is indicated by a high pH (alkaline), high HCO3 (bicarbonate), and a high PaCO2 (carbon dioxide) as a compensatory mechanism by the respiratory system. In this case, the pH is 7.52 (alkaline), PaCO2 is 55 mmHg, and HCO3 is 30 mEq/L, which fits the profile of metabolic alkalosis with the respiratory system attempting to compensate by retaining CO2.

Choice C reason: Metabolic alkalosis with no compensation would present with a high pH and high HCO3, but normal PaCO2. In this case, the PaCO2 is elevated, indicating that there is some level of respiratory compensation occurring, which rules out the "no compensation" scenario.

Choice D reason: Metabolic acidosis with partial compensation would present with a low pH, low HCO3, and low PaCO2 as a compensatory mechanism. In this case, the pH is high (alkaline), not low, which is inconsistent with metabolic acidosis.

A. Administer platelet transfusion immediately. B. Monitor the patient for signs of bleeding and educate about bleeding precautions. C. Administer aspirin to reduce the risk of clot formation. D. Encourage the patient to engage in regular physical exercise to improve circulation.

Correct Answer is B

Explanation

Choice A reason: Administering a platelet transfusion immediately is not indicated for a platelet count of 45,000/mm³. While this is below the normal range, it is not critically low. Platelet transfusions are typically reserved for patients with life-threatening bleeding or extremely low platelet counts.

Choice B reason: Monitoring the patient for signs of bleeding and educating about bleeding precautions is the appropriate intervention. Patients with thrombocytopenia are at an increased risk of bleeding, and it is essential to educate them on how to minimize this risk, such as avoiding activities that can cause injury, using a soft toothbrush, and avoiding over-the-counter medications that can affect platelet function.

Choice C reason: Administering aspirin to reduce the risk of clot formation is incorrect. Aspirin is an antiplatelet agent that can increase the risk of bleeding in patients with thrombocytopenia. It should be avoided unless specifically prescribed for another condition with close monitoring.

Choice D reason: Encouraging the patient to engage in regular physical exercise to improve circulation is not appropriate in this context. While physical activity is generally beneficial, it should be done with caution in patients with thrombocytopenia to avoid injury and bleeding. The focus should be on safety and bleeding precautions.

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The nurse has just received a change of shift report on four patients. Which patient will the nurse assess first?

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