Two days after admission for an exacerbation of chronic obstructive pulmonary disease (COPD), an older client's arterial blood gas (ABC) indicate an acid base imbalance. The client's laboratory results reveal a low hemoglobin level, an elevated creatinine clearance, and decreased urine specific gravity. Which is the most likely cause for the acid base imbalance?

Myocardial infarction one year ago.

Occasional use of antacids.

Chronic renal insufficiency.

Shortness of breath with exertion.

Answer and Explanation

The Correct Answer is C

A. Myocardial infarction one year ago:

A myocardial infarction (MI) that occurred one year ago is not directly related to the current acid-base imbalance described in the scenario. While a history of MI may have implications for the client's overall cardiovascular health and management, it is not the most likely cause of the acid-base imbalance indicated by the laboratory results.

B. Occasional use of antacids:

Occasional use of antacids is unlikely to cause the acid-base imbalance described in the scenario. Antacids primarily work by neutralizing gastric acid and are not typically associated with significant alterations in acid-base status, especially when used intermittently.

C. Chronic renal insufficiency:

Chronic renal insufficiency is the most likely cause of the acid-base imbalance indicated by the laboratory results. A low hemoglobin level suggests anemia, which can occur in chronic kidney disease due to decreased erythropoietin production. An elevated creatinine clearance indicates impaired kidney function, as the kidneys are clearing creatinine at a faster rate than normal. Decreased urine specific gravity suggests the kidneys' inability to concentrate urine properly, which is a common finding in renal insufficiency. Renal insufficiency can lead to metabolic acidosis due to the kidneys' decreased ability to excrete acid and regulate bicarbonate levels.

D. Shortness of breath with exertion:

Shortness of breath with exertion, a symptom commonly seen in COPD exacerbations, is unlikely to directly cause the acid-base imbalance described in the scenario. While respiratory distress can lead to respiratory acidosis, which is characterized by elevated carbon dioxide levels and decreased pH, the laboratory results indicate metabolic rather than respiratory acidosis.

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Correct Answer is A

Explanation

A) Deficiency of factors VIII or IX.

Hemophilia is a genetic disorder characterized by deficient or defective clotting factors, specifically factors VIII (hemophilia A) or IX (hemophilia B). These clotting factors are essential for the formation of stable blood clots. Therefore, if hemophilia is present, the deficiency of factors VIII or IX can lead to impaired clot formation and prolonged bleeding.

B) Diminished amount of vitamin K:

Vitamin K deficiency can lead to impaired blood clotting due to inadequate synthesis of clotting factors in the liver. However, hemophilia is specifically associated with deficiencies in factors VIII or IX, not vitamin K.

C) Decreased amount of platelets:

Platelets play a crucial role in primary hemostasis and initial platelet plug formation at the site of vascular injury. While decreased platelet count or dysfunction can lead to bleeding disorders such as thrombocytopenia or platelet function disorders, hemophilia specifically involves deficiencies in clotting factors, not platelets.

D) Missing factors V and VII:

Factor V and VII are other clotting factors involved in the coagulation cascade, but they are not deficient in hemophilia. Hemophilia is specifically characterized by deficiencies in factors VIII (hemophilia A) or IX (hemophilia B).

A. Small, skin-colored, pedunculated papules in areas of skin folds and on other areas as skin tags B. Hyperpigmented areas that vary in form and color and are slightly elevated from the skin. C. Hyperactive sebaceous areas forming comedones, papules, pustules on the face, neck, and upper back. D. Sharply demarcated silvery scaling plaques with underlying redness on the elbows and knees.

Correct Answer is C

Explanation

A) Small, skin-colored, pedunculated papules in areas of skin folds and on other areas as skin tags:

This description is more characteristic of acrochordons (skin tags), which are benign skin growths often found in skin folds. Skin tags are typically not associated with acne vulgaris.

B) Hyperpigmented areas that vary in form and color and are slightly elevated from the skin:

This description may be indicative of post-inflammatory hyperpigmentation, which can occur after resolution of acne lesions. However, it does not represent the primary pathological findings observed in acne vulgaris.

C) Hyperactive sebaceous areas forming comedones, papules, pustules on the face, neck, and upper back:

Correct. Acne vulgaris is characterized by hyperactive sebaceous glands, leading to the formation of comedones (blackheads and whiteheads), papules, and pustules. These lesions commonly occur on the face, neck, and upper back due to the high density of sebaceous glands in these areas.

D) Sharply demarcated silvery scaling plaques with underlying redness on the elbows and knees:

This description is more indicative of psoriasis, a chronic autoimmune skin condition characterized by silvery scaling plaques and inflammation. Psoriasis typically affects extensor surfaces such as the elbows and knees, rather than the areas commonly affected by acne vulgaris.

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Naxlex Comprehensive Predictor Exams

In caring for an infant after circumcision, the nurse observes continued bleeding from the site and suspects hemophilia. Which hematological components are insufficient causing bleeding if hemophilia is present?

Correct Answer is A

Explanation

The nurse is caring for a young adult who reports uncontrolled acne vulgaris. Which pathological findings should the nurse observe on inspection of skin areas commonly affected in acne vulgaris?

Correct Answer is C

Explanation

A client with end stage emphysema is experiencing poor gas exchange. Which respiratory structure is associated with the pathophysiological processes in emphysema?

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After the nurse obtains a blood sample from a client's right radial arterial client reports a sudden onset of pain at the arterial line insertion site. The nurse recognizes which physiological effect may be inducing the sudden pain?

The nurse is caring for a client with intestinal obstruction who presents with severe, colicky abdominal pain, nausea, vomiting, and abdominal distention. Which pathophysiologic mechanism supports the client's clinical presentation?

A client with chronic osteoarthritis is troubled by knee pain. Which pathophysiological process is contributing to the pain?

The nurse is assessing a client with a gunshot wound to the abdomen who is admitted to the intensive care unit (ICU) following a 3-hour surgical procedure. Which elevated laboratory value indicates pancreatic damage?

During an interview with a male client who has Parkinson's disease (PD), the nurse notices that he is drooling and mumbling. Which pathophysiological factor contributes to the client's inability to express himself?

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