After receiving change-of-shift report about the following four clients, which client should the nurse assess first?

56-year-old client with chronic stable angina who is due to receive a dose of nifedipine.

59-year-old with unstable angina who has just returned to the unit after having a heart catheterization with balloon angioplasty.

65-year-old who had a myocardial infarction (MI) 4days ago and is anxious about the planned discharge.

Client who is post coronary artery bypass, with potassium 4.2 mEq/L.

Answer and Explanation

The Correct Answer is B

A. A stable client with chronic angina is not in immediate danger, and the scheduled dose of nifedipine is not an urgent priority.

B. The client with unstable angina who has just undergone a heart catheterization with balloon angioplasty requires immediate assessment for complications such as bleeding, clot formation, or re-occlusion of the artery.

C. The 65-year-old post-MI client is stable, and while their anxiety is important to address, it is not an immediate concern compared to other clients.

D. The client post-coronary artery bypass with a potassium level of 4.2 mEq/L is stable and does not require urgent intervention.

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Correct Answer is D

Explanation

A. Chronic asymptomatic HIV infection refers to a phase with no opportunistic infections and higher CD4+ counts.

B. A CD4+ T cell count below 200 cells/μL is abnormal and diagnostic of AIDS, not within the normal range.

C. The acute HIV infection phase occurs shortly after exposure, characterized by flu-like symptoms and high viral load, not opportunistic infections.

D. The presence of Pneumocystis jiroveci pneumonia (an AIDS-defining illness) and a CD4+ T cell count below 200 cells/μL confirms a diagnosis of AIDS.

A. Base deficit (HCO3): Acidosis B. Acid excess (CO2): Acidosis C. Base excess (HCO3): Alkalosis D. Acid deficit (CO2): Alkalosis

Correct Answer is B

Explanation

A. Base deficit (HCO3): Acidosis: A base deficit indicates metabolic acidosis, but respiratory acidosis is more likely with the high rate of ventilation.

B. Acid excess (CO2): Acidosis: This is the correct answer. A high respiratory rate can lead to hyperventilation, decreasing CO2 levels and causing respiratory alkalosis, which may be a concern with an elevated rate.

C. Base excess (HCO3): Alkalosis: This would indicate metabolic alkalosis, but it is not as related to ventilator settings.

D. Acid deficit (CO2): Alkalosis: If the CO2 level is too low due to hyperventilation, this can lead to alkalosis, which the nurse is questioning here.

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After receiving change-of-shift report about the following four clients, which client should the nurse assess first?

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Correct Answer is D

Explanation

A client has been placed on a mechanical ventilator. The PCP has ordered the ventilator to be set at a respiratory rate of 28 breaths /min. The nurse questions the order, citing concerns about which acid-base problem?

Correct Answer is B

Explanation

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