Published - Thu, 23 Feb 2023

NCLEX-RN Exam Questions - Part 47

1. A 66-year-old female client has smoked 2 packs of cigarettes per day for 20 years. Her arterial blood gases on room air are as follows: pH 7.35; PO2 70 mm Hg;PCO2 55 mm Hg; HCO3 32 mEq/L. These blood gases reflect:

A) Compensated metabolic acidosis
B) Compensated respiratory acidosis
C) Compensated respiratory alkalosis
D) Uncompensated respiratory acidosis

2. A female client who has chronic obstructive pulmonary disease (COPD) has presented in the emergency department with cough productive of yellow sputum and increasing shortness of breath. On room air, her blood gases are as follows: pH 7.30 mm Hg, PCO2 60 mm Hg, PO2 55 mm Hg, HCO3 32 mEq/L. These arterial blood gases reflect:

A) Compensated respiratory acidosis
B) Normal blood gases
C) Uncompensated metabolic acidosis
D) Uncompensated respiratory acidosis

3. A 19-year-old client has sustained a C-7 fracture, which resulted in his spinal cord being partially transected. By 2 weeks postinjury, his neck has been surgically stabilized, and he has been transferred from the intensive care unit. A potential life-threatening complication the nurse monitors the client for is:

A) Autonomic dysreflexia
B) Bradycardia
C) Central cord syndrome
D) Spinal shock

4. A clients physician has prescribed theophylline (Theo- Dur) to help control the bronchospasm associated with the clients COPD. Instructions that should be given to the client include:

A) 'Call your physician if you develop palpitations, dizziness, or restlessness. - -
B) 'Cigarette smoking may significantly increase the risk for theophylline toxicity. - -
C) 'Take this medication on an empty stomach. - -
D) 'Do not take your medicine if your pulse is less than 60 beats per minute. - -

5. A 19-year-old client fell off a ladder approximately 3 ft to the ground. He did not lose consciousness but was taken to the emergency department by a friend to have a scalp laceration sutured. The nurse instructs the client to:

A) Clean the sutured laceration twice a day with povidone- iodine (Betadine)
B) Remove his scalp sutures after 5 days
C) Return to the hospital immediately if he develops confusion, nausea, or vomiting
D) Take meperidine 50 mg po q4 - 6h prn for headache

1. Right Answer: B
Explanation: (A) In compensated metabolic acidosis, the pH level is normal, the PCO2level is decreased, and the HCO3level is decreased. The clients primary alteration is an inability to remove excess acid via the kidneys. The lungs compensate by hyperventilating and decreasing PCO2. (B) In compensated respiratory acidosis, the pH level is normal, the PCO2level is elevated, and the HCO3level is elevated. The clients primary alteration is an inability to remove CO2from the lungs, so over time, the kidneys increase reabsorption of HCO3to buffer the CO2. (C) In compensated respiratory alkalosis, the pH level is normal, the PCO2level is decreased, and the HCO3level is decreased. The clients primary alteration is hyperventilation, which decreases PCO2. The client compensates by increasing the excretion ofHCO3from the body. (D) In uncompensated respiratory acidosis, the pH level is decreased, the PCO2level is increased, and the HCO3level is normal. The clients primary alteration is an inability to remove CO2from the lungs. The kidneys have not compensated by increasing HCO3reabsorption.

2. Right Answer: D
Explanation: (A) In compensated respiratory acidosis, the pH level is normal, the PCO2level is elevated, and the HCO3level is elevated. The clients primary alteration is an inability to remove CO2from the lungs, so over time, the kidneys increase reabsorption of HCO3to buffer the CO2. (B) Normal ranges for arterial blood gases for adults and children are as follows: pH 7.357.45, PO280100 mm Hg, PCO23545 mm Hg, HCO32128 mEq/L. (C) In uncompensated metabolic acidosis the pH level is decreased, the PCO2level is normal, and the HCO3level is decreased. The clients primary alteration is an inability to remove excess acid via the kidneys.The lungs are unable to clear the increased acid. (D) In uncompensated respiratory acidosis, the pH level is decreased, the PCO2level is increased, and theHCO3level is normal. In a person with long-standing COPD, the HCO3level will rise gradually over time to compensate for the gradually increasing PCO2, and the persons pH level will be normal. When a person with COPD becomes acutely ill, the kidneys do not have time to increase the reabsorption of HCO3, so the persons pH level will reflect acidosis even though the HCO3is elevated.

3. Right Answer: A
Explanation: (A) Autonomic dysreflexia is the exaggerated sympathetic nervous system response to various stimuli in the anesthetized area. Sympathetic stimulation results in severe, uncontrolled hypertension, which may result in myocardial infarction or cerebral hemorrhage. (B) Bradycardia occurs as a result of sympathetic blockade in the immediate postinjury period. After spinal shock recedes, cardiovascular stability returns, but the client will be bradycardiac for life. (C) Central cord syndrome is a specific type of spinal cord injury that occurs as a result of either hyperextension injuries or disrupted blood flow to the spinal cord. (D) Spinal shock occurs in the immediate postinjury phase and usually resolves in approximately 72 hours.

4. Right Answer: A
Explanation: (A) Indications of theophylline toxicity include palpitations, dizziness, restlessness, nausea, vomiting, shakiness, and anorexia. (B) Cigarette smoking significantly lowers theophylline plasma levels. (C) Theophylline should be taken with food to decrease stomach upset. (D) These instructions are appropriate for someone taking digoxin.

5. Right Answer: C
Explanation: (A) Povidone-iodine is very irritating to skin and should not be routinely used. (B) Sutures should not be removed by the client. (C) Confusion, nausea, vomiting, and behavioral changes may indicate increasing intracranial pressure as a result of intracerebral bleeding. (D) Use of a narcotic opiate such as meperidine is not recommended in clients with a possible head injury because it may produce sedation, pupil changes, euphoria, and respiratory depression, which may mask the signs of increasing intracranial pressure.

80% DISCOUNT: NCLEX-RN PRACTICE EXAMS