A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH. 7.49: partial pressure of arterial oxygen (PaO2), 60 mm Hg partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg: bicarbonate (HCO3-1 25 mEq/L. What should the nurse do first?

Increase fluid intake.

Administer oxygen therapy.

Administer sodium bicarbonate.

Prepare the client for mechanical ventilation.

Answer and Explanation

The Correct Answer is B

Rationale:
A. Increasing fluid intake does not address the immediate problem of impaired oxygenation.
B. The ABG shows respiratory alkalosis (pH 7.49, PaCO₂ 30) with hypoxemia (PaO₂ 60). The priority intervention is to administer oxygen therapy to correct hypoxemia caused by the pulmonary embolus.
C. Sodium bicarbonate is used for metabolic acidosis, not respiratory alkalosis.
D. Mechanical ventilation may be required if oxygen therapy fails, but it is not the first action.

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Correct Answer is D

Explanation

Rationale:
A. Ambulation helps with lung expansion but does not directly thin secretions.
B. Incentive spirometer use improves ventilation and prevents atelectasis but does not specifically thin secretions.
C. Coughing and deep breathing help mobilize secretions once loosened, but they do not thin them.
D. Increasing fluid intake hydrates the respiratory tract and helps thin secretions, making them easier to expectorate — this is the most effective action.

A. instruct the patient to avoid all physical activity to prevent shortness of breath. B. Recommend a high-carbohydrate diet to increase energy levels C. Encourage the patient to perform pursed-lip breathing exercises. D. Advise the patient to drink less water to prevent fluid overload.

Correct Answer is C

Explanation

Rationale:
A. Avoiding all physical activity is not recommended. Moderate activity, with rest periods, can improve endurance and lung function in COPD patients. Complete inactivity worsens deconditioning.
B. A high-carbohydrate diet is not appropriate because it increases CO₂ production during metabolism, which can worsen respiratory acidosis. A diet higher in fat and protein is generally preferred.
C. Pursed-lip breathing exercises are essential for COPD patients. They help prevent airway collapse, improve ventilation, promote CO₂ elimination, and reduce dyspnea.
D. Restricting fluids is not typically indicated for COPD patients unless another condition (e.g., heart failure) requires it. Adequate hydration is necessary to thin secretions and aid airway clearance.

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A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH. 7.49: partial pressure of arterial oxygen (PaO2), 60 mm Hg partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg: bicarbonate (HCO3-1 25 mEq/L. What should the nurse do first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has pneumonia. Which of the following actions should the nurse take to promote thinning of respiratory secretions?

Correct Answer is D

Explanation

Which of the following interventions is most important for a nurse to implement in the care plan of a patient with Chronic Obstructive Pulmonary Disease (COPD) to promote effective breathing?

Correct Answer is C

Explanation

Which of the following patients is at the highest risk for developing pneumonia?

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