Mrs. Kalen is a 70 year old female who has arrived into the ER due to persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What would you interpret the acid-base disorder to be?

Uncompensated Respiratory Acidosis

Fully Compensated Metabolic Acidosis

Uncompensated Metabolic Alkalosis

Partially Compensated Respiratory Alkalosis

Answer and Explanation

The Correct Answer is C

The pH value of 7.5 indicates alkalosis, as it is above the normal range of 7.35-7.45. The elevated bicarbonate (HCO3-) level of 34 mmol/L suggests metabolic alkalosis, as it is higher than the normal range of 22-28 mmol/L. The PaCO2 level of 40 mm Hg falls within the normal range of 35-45 mm Hg.

In this case, the primary disturbance is metabolic alkalosis, which is likely caused by vomiting leading to excessive loss of gastric acid (hydrogen ions) and chloride ions from the stomach. This loss of acid and chloride results in an imbalance of electrolytes and an increase in bicarbonate levels, leading to metabolic alkalosis.

The arterial blood gas results do not indicate any compensation. Compensation occurs when the body attempts to restore the pH balance by adjusting the respiratory or metabolic systems. In this case, there is no compensation observed because the PaCO2 level is within the normal range and not significantly altered.

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Correct Answer is E

Explanation

Dependent edema refers to the accumulation of fluid in the dependent parts of the body, which are areas that are most affected by gravity when a person is in a supine or sitting position for an extended period. The sacrum, which is the triangular bone at the base of the spine, is one such dependent area. It is prone to developing edema when there is increased fluid retention in the body, as seen in the patient's weight gain.

To assess for dependent edema accurately, the nurse can gently press the skin over the sacral area with their fingers and observe the skin turgor or the return of the skin to its normal position after releasing the pressure. If there is edema, the skin may have reduced elasticity and take longer to return to its normal position (poor skin turgor).

While edema can occur in other dependent areas such as the feet, ankles, and lower legs, assessing skin turgor in these areas may not provide an accurate determination of dependent edema as they are located further away from the sacrum and may be influenced by other factors.

A. Skin rash B. Hyperglycemia C. Dizziness D. Intense pruritus

Correct Answer is ["A","D"]

Explanation

Signs and symptoms associated with a hypersensitivity reaction to cephalosporin antibiotics can include:

1. Skin rash: Hypersensitivity reactions often manifest as skin rashes, which can range from mild to severe. The rash may be itchy, red, raised, and may spread to different areas of the body.

2. Intense pruritus: Pruritus refers to severe itching, which can be a prominent symptom of a hypersensitivity reaction to cephalosporins.

Dizziness and hyperglycemia are not commonly associated with hypersensitivity reactions to cephalosporins. Dizziness may be a side effect of some medications, including antibiotics, but it is not a specific symptom of a hypersensitivity reaction. Hyperglycemia, or high blood sugar levels, is not typically attributed to a hypersensitivity reaction to cephalosporins. It's important to note that hypersensitivity reactions can vary in severity and may include other symptoms such as fever, swelling, difficulty breathing, wheezing, and anaphylaxis. If a hypersensitivity reaction is suspected, it is crucial to seek immediate medical attention for proper evaluation and management.

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Naxlex Comprehensive Predictor Exams

The patient who is confined to bed in the supine position has gained 5 lbs. in the last 48 hours. In which area does the nurse assess skin turgor for accurate determination of dependent edema?

Correct Answer is E

Explanation

What signs and symptoms are associated with a hypersensitivity reaction that can present with a Cephalosporin?

Correct Answer is ["A","D"]

Explanation

After receiving a hand-off report what assessment information is the most important and immediate concern for the nurse? Select all that apply.

In reviewing the electrolytes of a patient, the nurse notes the serum potassium level has increased from 4.3 mEq/L to 5.9 mEq/L. Which assessment does the nurse initiate first to prevent further harm?

Select Dropdowns: Aminoglycosides work by binding to the dropdown which prevents dropdown

A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work.The most accurate explanation the nurse can give is which of the following?

A nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD) and is diagnosed with pneumonia. The client has been on a long-term regimen of methylprednisolone. Which precautions should the nurse take to prevent complications? Select all that apply.

Which manifestations would the nurse expect for a client with a history of malignant hyperthermia (MH)? Select all that apply.