A patient presents with a diagnosis of chronic obstructive pulmonary disease (COPD). The ABG results are as follows: pH 7.32. pCO2 68, p02 78, HCO3 23. What action should the nurse take first?

Remove the client's 02 mask.

Notify the physician

Have the client breath into a paper bag

Place the patient in left side-lying position

Answer and Explanation

The Correct Answer is B

A. Remove the client's O₂ mask: Removing supplemental oxygen is unsafe and may worsen hypoxia. Even though oxygen must be carefully titrated in COPD, abrupt removal is never appropriate without medical direction, especially when the client is already hypoxemic.

B. Notify the physician: The ABG shows respiratory acidosis (low pH, elevated pCO₂) with insufficient compensation and potential respiratory failure. Immediate provider notification is warranted to adjust oxygen delivery, initiate or escalate respiratory support, or evaluate for further interventions.

C. Have the client breathe into a paper bag: Paper bag breathing is used for respiratory alkalosis caused by hyperventilation, not for respiratory acidosis. This action would further elevate CO₂ and worsen the client's acid-base status.

D. Place the patient in left side-lying position: Side-lying positioning does not address the critical issue of respiratory acidosis. Instead, placing the client in high Fowler’s position might help improve ventilation, but first the provider must be notified to address the urgent ABG findings.

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Correct Answer is D

Explanation

A. A 16-year-old female high school student:While TB can affect people of any age, high school students are generally not considered a high-risk group unless they have known exposure or immunosuppression. Routine exposure in school settings is relatively low.

B. A 54-year-old businessman:This client may be at risk depending on travel history or comorbidities, but business professionals typically have better access to healthcare and housing, reducing their baseline risk compared to other populations.

C. A 54-year-old businessman:Unless other risk factors are specified (e.g., foreign travel, immunocompromise), this demographic does not represent a high-risk group for TB in an outbreak situation.

D. A 43-year-old homeless man with a history of alcoholism:This client falls into a high-risk category for TB due to poor living conditions, potential malnutrition, and compromised immunity related to alcoholism. Homelessness and substance use are well-established risk factors for tuberculosis, especially during outbreaks.

A. Bronchitis B. Sinusitis C. Asthma D. Allergic rhinitis

Correct Answer is B

Explanation

A. Bronchitis:Bronchitis presents with a productive cough, chest discomfort, and sometimes wheezing, but it does not usually involve facial tenderness, purulent nasal drainage, or worsening nighttime cough due to postnasal drip. Symptoms also tend to resolve in under 2 weeks.

B. Sinusitis:Sinusitis is characterized by persistent cold-like symptoms lasting more than 10 days, purulent nasal discharge, headache, facial pain or tenderness, and a cough that worsens at night due to postnasal drainage. This description fits the presentation of pediatric sinusitis.

C. Asthma:Asthma presents with wheezing, shortness of breath, and episodic coughing, especially at night or during exertion. It does not cause purulent nasal drainage, facial tenderness, or prolonged cold symptoms, which point more toward sinus infection.

D. Allergic rhinitis:Allergic rhinitis causes sneezing, clear nasal discharge, itchy eyes, and nasal congestion, but not purulent drainage or facial pain. Symptoms are usually triggered by allergens and are not typically accompanied by fever or thick mucus.

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A patient presents with a diagnosis of chronic obstructive pulmonary disease (COPD). The ABG results are as follows: pH 7.32. pCO2 68, p02 78, HCO3 23. What action should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is working in a walk-in clinic. She has been alerted that there's an outbreak of tuberculosis (TB). Which client entering the clinic today is most likely to have TB?

Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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