Exhibits
A nurse is reviewing the medical record of a client who has COPD. The nurse should notify the provider about which of the following findings? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)
SpO2
PH
Respiratory rate
Temperature
The Correct Answer is B
Rationale:
A. SpO₂: Although 88% is low for the general population, it is often an acceptable baseline for clients with COPD. Their oxygen saturation targets are typically between 88–92% to avoid suppressing respiratory drive, so this value may not require immediate provider notification.
B. pH: A pH of 7.22 indicates respiratory acidosis, which is a serious and potentially life-threatening complication of COPD. This level of acidosis shows that the client’s ventilation is inadequate, and immediate intervention is needed. This is the most critical finding that requires provider notification.
C. Respiratory rate: A rate of 22 breaths/min is slightly elevated but not critical. It may be compensatory and expected in a COPD patient who is hypoxic or retaining CO₂. By itself, it doesn't warrant urgent notification unless it worsens.
D. Temperature: A temperature of 37.2°C (99°F) is within the normal range and does not indicate infection or acute illness. It is not a finding that necessitates notifying the provider at this point.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","E"]
Explanation
Rationale:
A. "You should avoid salting your food prior to eating": Avoiding added salt helps control blood pressure and reduce fluid retention, both of which are crucial for preventing cardiac stress. This is especially important after an MI and in clients with COPD who are already at risk of pulmonary congestion.
B. "You should aim to consume fish at least twice a week": Fish high in omega-3 fatty acids, such as salmon or sardines, support cardiovascular health by lowering triglyceride levels and reducing inflammation. This dietary habit is recommended in secondary prevention following myocardial infarction.
C. "You should wear a medical identification bracelet or necklace": Medical alert jewelry informs first responders about chronic illnesses such as COPD, history of MI, anxiety disorders, and current medications like nitroglycerin or alprazolam. This can prevent dangerous delays or errors in emergency care.
D. "You should take ibuprofen if you experience mild pain": Ibuprofen can increase cardiovascular risk by raising blood pressure, promoting sodium retention, and interfering with the antiplatelet effect of aspirin. Acetaminophen is a safer alternative for clients with heart disease or those on antiplatelet therapy.
E. "You should keep your nitroglycerin with you at all times": Nitroglycerin must be readily available in case of angina. Immediate access ensures quick symptom relief and reduces the risk of cardiac complications. Clients should also be educated to protect it from heat, light, and moisture.
Correct Answer is B
Explanation
Rationale:
A. Boiled eggs: While eggs contain some iron, they are not known to enhance the absorption of nonheme iron. In fact, certain components in eggs may inhibit iron absorption from plant-based sources.
B. Orange slices: Vitamin C (ascorbic acid) found in citrus fruits like oranges significantly enhances the absorption of nonheme iron by reducing it to a more absorbable form. This makes orange slices an ideal complement to iron-rich plant foods.
C. Cheddar cheese: Dairy products like cheese are low in iron and contain calcium, which can actually compete with iron for absorption in the intestines, reducing its bioavailability rather than enhancing it.
D. Mixed nuts: Although nuts contain some iron, they are also high in phytates, which can inhibit iron absorption. They do not actively enhance nonheme iron uptake and are not the best dietary pairing for this purpose.
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