A client with COPD has all of the following ABG changes from earlier today. Which change alerts the nurse to take immediate action to prevent harm?

pH from 7.21 to 7.20

HCO3-remains the same at 31 mEq/L

PaCo2 from 45 mm Hg to 68 mm Hg

Pao2 from 88 mm Hg to 86 mm Hg

Answer and Explanation

The Correct Answer is C

A. Although the pH is slightly lower, both values indicate acidemia, which is consistent with chronic compensated respiratory acidosis often seen in COPD. The small change is not immediately life-threatening and may reflect normal fluctuations.

B. Elevated bicarbonate in COPD reflects renal compensation for chronic hypercapnia. The stability of HCO3 suggests that the body’s compensatory mechanism is intact and does not indicate an acute deterioration.

C. This represents a rapid and significant rise in carbon dioxide levels, indicating acute ventilatory failure. Even though some patients with COPD tolerate chronically elevated PaCO2, a jump of this magnitude is dangerous. It can cause worsening respiratory acidosis, decreased level of consciousness, headache, confusion, and eventual respiratory arrest. The nurse must take immediate action by assessing the airway, ensuring effective ventilation, positioning the patient to optimize breathing, and notifying the healthcare provider for urgent interventions such as noninvasive positive-pressure ventilation (BiPAP) or intubation if needed.

D. This is a minimal decrease in oxygenation. COPD patients often have baseline hypoxemia, and this small change does not indicate immediate danger. Focus should first be on the sudden rise in PaCO2, which poses a more acute threat.

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Correct Answer is B,A,D,C

Explanation

B. Blood cultures x 2, taken 5 minutes apart – First Priority:Blood cultures must be obtained before administering antibioticsto accurately identify the causative organism. In a patient showing signs of sepsis—hypotension, tachycardia, tachypnea, fever, and purulent wound drainage—early culture collection is critical to guide effective therapy.

A. Tylenol 650 mg PO prn q6h for a temperature above 101°F – Second:Fever management improves patient comfort and reduces metabolic demand but is not immediately life-saving. It is appropriate to administer after cultures are drawn.

D. Vancomycin 750 mg IVPB over 1 hour every 24 hours – Third:Broad-spectrum IV antibiotics should be started immediately after cultures are obtained.Early administration is essential to treat sepsis and prevent progression to septic shock, while still ensuring culture results are accurate.

C. C&S of abdominal wound drainage – Fourth:Wound culture helps tailor ongoing antibiotic therapy but is secondaryto the urgent need to obtain blood cultures and start empiric antibiotic therapy.

A. Blunt injury B. Thermal injury C. Laceration injury D. Penetrating injury

Correct Answer is A

Explanation

A. A blunt injury occurs when the body is struck by a non-sharp objector force, causing tissue damage without breaking the skin. A baseball bat delivers direct force to the abdomen, potentially resulting in internal bleeding, organ contusions, or hematomas, which are characteristic of blunt trauma.

B. Thermal injuries are caused by heat, fire, or extreme cold, resulting in burns or frostbite, which is unrelated to trauma from a baseball bat.

C. Lacerations involve a tear or cut in the skin or underlying tissue, usually caused by a sharp object. In this scenario, the skin may remain intact despite internal injury, so a laceration is not the primary classification.

D. Penetrating injuries occur when a sharp object pierces the skin and enters body tissues, such as a knife or bullet. A baseball bat does not penetrate the skin, so this type does not apply.

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A client with COPD has all of the following ABG changes from earlier today. Which change alerts the nurse to take immediate action to prevent harm?

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Naxlex Comprehensive Predictor Exams

Exhibits In what order will the nurse implement these interventions?

Correct Answer is B,A,D,C

Explanation

The nurse is providing care for a patient who was assaulted with a baseball bat resulting in physical trauma to the abdomen. Which type of injury does the patient have?

Correct Answer is A

Explanation

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