Physiological Integrity

A nurse is evaluating the arterial blood gas (ABG) results of a client who suddenly developed dyspnea and pleuritic chest pain 48 hours after a total hip arthroplasty. The ABG reveals a pH of 7.52, PaCO2 of 28 mm Hg, PaO2 of 65 mm Hg, and HCO3 of 24 mEq/L. Which of the following pathophysiological processes best explains this acid-base imbalance?

A client admitted with cardiogenic shock weighs $198\text{ lbs}$. The provider initially orders a continuous intravenous (IV) infusion of dopamine at $4\text{ mcg/kg/min}$. The pharmacy dispenses a premixed IV bag containing $800\text{ mg}$ of dopamine in $250\text{ mL}$ of $5\%\text{ Dextrose}$ in water ($D_5W$). Two hours later, the client's mean arterial pressure (MAP) remains at $55\text{ mmHg}$, and the provider increases the dopamine infusion order to $7\text{ mcg/kg/min}$. At what rate in $\text{mL/hr}$ should the nurse set the infusion pump to deliver the newly ordered dose? (Record your answer rounding to the nearest tenth. Do not include units in your answer.)

A client who underwent a bowel resection three days ago has a nasogastric (NG) tube connected to continuous low wall suction. The client's morning arterial blood gas (ABG) results display a pH of 7.54, PaCO2 of 42 mm Hg, and HCO3- of 32 mEq/L. Based on these clinical findings, which of the following is the most appropriate nursing action to reduce the client's risk for complications?

A nurse is caring for a client with a T4 spinal cord injury who suddenly develops a severe, throbbing headache, profuse diaphoresis above the level of the injury, and a blood pressure of 220/115 mm Hg. Arrange the following nursing interventions in the priority order of execution.

A nurse enters a client's room and observes that the client's chest tube has accidentally been pulled completely out of the pleural space. The client is awake and alert. To reduce the risk of a life-threatening complication, arrange the following nursing actions in the correct chronological order of priority.

A nurse is formulating a basic care and comfort plan for an 80-year-old client who is receiving continuous enteral nutrition via a nasogastric (NG) tube. The client has a history of gastroesophageal reflux disease (GERD), mobility impairments, and has recently developed urinary incontinence with mild confusion. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)

A nurse is preparing to administer a scheduled intermittent bolus feeding via a percutaneous endoscopic gastrostomy (PEG) tube for an older adult client recovering from a stroke. Arrange the following nursing actions in the correct sequence of performance. (Place the first action at the top and the last action at the bottom.)

A 65-year-old client is 2 hours post-thoracentesis during which 1,500 mL of pleural fluid was removed from the right hemithorax. The client abruptly develops severe dyspnea, a persistent dry cough that progresses to producing frothy sputum, and extreme restlessness.

Assessment findings:
- Vital signs: Blood pressure 88/54 mm Hg, heart rate 124 bpm, respiratory rate 30 breaths/min, $SpO_2$ 84% on room air.
- Respiratory: Diffuse crackles auscultated over the right lung fields; breath sounds are clear over the left lung. The trachea is midline.
- Arterial Blood Gas (ABG): $pH$ 7.26, $PaCO_2$ 56 mm Hg, $PaO_2$ 52 mm Hg, $HCO_3^-$ 24 mEq/L.

Which of the following is the most appropriate priority action by the nurse to reduce the client's risk of impending cardiopulmonary arrest?

A nurse is caring for a client with acute decompensated heart failure. The client is receiving a continuous intravenous (IV) infusion of milrinone through a single-lumen peripherally inserted central catheter (PICC). The healthcare provider prescribes an immediate, one-time IV bolus of furosemide. Which action by the nurse is the safest method to administer the furosemide?

A nurse is preparing to discontinue a non-tunneled central venous catheter (CVC) from a client's internal jugular vein. To minimize the risk of procedural complications, in what order should the nurse perform the following actions? Arrange the steps in the correct chronological sequence.

A client who underwent a subtotal thyroidectomy 12 hours ago experiences a sudden onset of severe agitation. The nurse assesses a heart rate of $172\text{ bpm}$, a respiratory rate of $32\text{ breaths/min}$, and a temperature of $105.1^\circ\text{F}$ ($40.6^\circ\text{C}$). The healthcare provider diagnoses a thyrotoxic crisis (thyroid storm). Arrange the following prescribed nursing interventions in the priority order they should be implemented.

A nurse is evaluating a client admitted with diabetic ketoacidosis (DKA) four hours ago. The client has been on a continuous intravenous infusion of regular insulin and $0.9\%$ sodium chloride. Current laboratory results indicate a serum glucose level of $235\text{ mg/dL}$ ($13.0\text{ mmol/L}$). The arterial blood gas (ABG) analysis shows a pH of $7.28$, PaCO $_2$ of $28\text{ mm Hg}$, and HCO $_3^-$ of $14\text{ mEq/L}$. The client presents with deep, rhythmic respirations at a rate of $24$ breaths per minute. Which of the following actions should the nurse perform next?

A dependent client is receiving a continuous enteral tube feeding via a nasogastric tube. The care team needs to perform a complete bed bath and change the linens, which requires placing the client in a flat, supine position. Which nursing action is the highest priority before lowering the head of the bed?

An emergency department nurse receives a client who sustained blunt abdominal trauma from a fall. Upon arrival, the client is alert, reports moderate abdominal tenderness, and has an intact airway. The nurse monitors the client's vital signs over the first 45 minutes of the assessment:

Based on the physiological trend presented in the table, which of the following is the most accurate interpretation of the client's condition and the priority nursing action?

An adult client who has been experiencing intractable vomiting for the last 72 hours is admitted to the medical-surgical unit. Based on the significant loss of gastric contents, which acid-base disturbance should the nurse most anticipate when reviewing the client's laboratory results?

A nurse is evaluating a client who is receiving intravenous morphine via a patient-controlled analgesia (PCA) pump following an abdominal laparotomy. The client is profoundly lethargic with a respiratory rate of 7 breaths per minute. A stat arterial blood gas (ABG) is drawn and yields the following results: pH 7.25, PaCO2 62 mm Hg, and HCO3 24 mEq/L. To immediately reduce the client's risk for cardiopulmonary arrest, which of the following actions should the nurse take first?

A nurse is developing a plan of care for an 82-year-old client with advanced Parkinson's disease who requires assistance with activities of daily living due to generalized weakness, dysphagia, and muscle rigidity. Which basic care and comfort interventions should the nurse include? Select all that apply.

A 59-year-old client with a history of chronic hepatitis C is currently 2 hours post-procedure following an ultrasound-guided percutaneous liver biopsy. The client is resting in the recovery unit. The nurse is reviewing the client's clinical data and performing a focused assessment. Which of the following assessment findings is a subtle indicator of impending physiological decompensation that requires immediate nursing intervention?

A nurse is evaluating a 42-year-old client 24 hours after a total thyroidectomy. The client appears highly anxious and reports new-onset numbness around the lips and fingertips.

Current vital signs:
- Blood pressure: 138/86 mm Hg
- Heart rate: 112 beats/min
- Respiratory rate: 28 breaths/min
- SpO2: 96% on room air

Current laboratory results:
- Total serum calcium: 7.4 mg/dL (1.85 mmol/L)
- Arterial blood gas (ABG): pH 7.51, PaCO2 29 mm Hg, HCO3 23 mEq/L, PaO2 94 mm Hg

To most rapidly mitigate the client's risk for an impending life-threatening complication, which action should the nurse implement first?

A client is admitted to the medical-surgical unit with acute decompensated heart failure and is experiencing severe orthopnea and significant bilateral peripheral edema. The nurse is planning care to optimize the client's respiratory status and physical comfort. Which of the following positioning strategies is most appropriate?