The nurse is reading the arterial blood gas results of a patient admitted for sepsis. Which of the following would the nurse expect for a patient in metabolic acidosis?

pH 7.25. CO2 40. HCO3-16

pH 7.5, CO2 35, HCO3-30

pH 7.5, CO2 30 HCO3- 22

pH 7.25, CO2 55. HCO3. 25

Answer and Explanation

The Correct Answer is A

A) pH 7.25, CO2 40, HCO3- 16:
In metabolic acidosis, the pH is decreased indicating acidemia. The bicarbonate level is low which is a hallmark of metabolic acidosis. The CO2 level of 40 is within the normal range suggesting that the body is not compensating for the acidosis through respiratory compensation yet. In metabolic acidosis, the body will often try to compensate by increasing respiratory rate to blow off CO2, but this takes time.

B) pH 7.5, CO2 35, HCO3- 30:
In metabolic alkalosis, the pH is increased above 7.45, and the bicarbonate level (HCO3-) is elevated both of which are seen here. The CO2 level of 35 is within normal limits, and while respiratory compensation could increase CO2 in response to metabolic alkalosis,

C) pH 7.5, CO2 30, HCO3- 22:
The pH is increased above 7.45, and the bicarbonate level is within the normal range. The CO2 level of 30 is low, which is typical in respiratory alkalosis, where the body compensates for the increased pH by blowing off CO2.

D) pH 7.25, CO2 55, HCO3- 25:
The pH is low, but the bicarbonate level is normal. The CO2 level is elevated, which is indicative of hypoventilation or inadequate respiratory compensation, commonly seen in respiratory acidosis, where the lungs cannot excrete CO2 effectively

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Correct Answer is D

Explanation

A. You will need to return in 48-72 hours to have the test read:
This statement is correct. The purified protein derivative (PPD) skin test, also known as the tuberculin skin test (TST), must be read within 48-72 hours after administration. If the test is not read within this timeframe, the results may not be valid, and the test may need to be repeated. The test evaluates the presence of induration (swelling) at the injection site, which indicates a delayed-type hypersensitivity reaction to the tuberculosis antigen.

B. A positive skin test will mean you need to have a follow-up chest x-ray:
This statement is correct. A positive PPD skin test indicates exposure to Mycobacterium tuberculosis (the bacteria that causes tuberculosis). However, a positive result does not necessarily mean the person has active tuberculosis. A follow-up chest x-ray is typically recommended to determine whether active TB disease is present. The chest x-ray helps to assess for signs of active infection, such as lung lesions.

C. "Induration of greater than or equal to 10 millimeters means you have been exposed":
This statement is correct. In the context of a PPD skin test, induration (raised area of the skin) of 10 millimeters or more is generally considered a positive result, indicating exposure to tuberculosis. However, the exact threshold for what is considered positive can vary based on individual risk factors. A positive test means the person has been exposed to the tuberculosis bacteria, but it does not confirm active disease.

D. "Induration of greater than or equal to 10 millimeters means you have active tuberculosis":
This statement is incorrect. A positive PPD skin test result indicates exposure to Mycobacterium tuberculosis, but it does not confirm active tuberculosis (TB) infection. The induration reflects prior exposure or latent infection. To determine if the individual has active TB, additional diagnostic tests such as a chest x-ray, sputum cultures, and possibly a molecular test are required. A positive PPD result does not differentiate between latent TB infection and active TB disease.

A. I will notify my doctor before taking any other medications’’ B. "I should talk to my doctor about other methods of contraception in addition to my current oral contraceptives. C. "I'll be glad when I can stop taking this medicine after my seizures are controlled’’ D. I have made an appointment to see my dentist next week.’’

Correct Answer is C

Explanation

A) "I will notify my doctor before taking any other medications:"
Phenytoin interacts with many medications, both prescription and over-the-counter. It is crucial for the client to inform their doctor before starting any new medications, including herbal supplements, as phenytoin may have significant drug interactions that could alter its effectiveness or increase the risk of side effects.

B) "I should talk to my doctor about other methods of contraception in addition to my current oral contraceptives:"
Phenytoin can decrease the effectiveness of oral contraceptives, leading to an increased risk of unintended pregnancy. It is important for clients to discuss alternative or additional methods of contraception, such as non-hormonal methods or alternative hormonal birth control, with their healthcare provider to prevent pregnancy while taking phenytoin.

C) "I'll be glad when I can stop taking this medicine after my seizures are controlled:"
Phenytoin is typically a lifelong medication for managing seizures, even if the seizures are well-controlled. Stopping the medication without a doctor's approval can lead to seizure recurrence. Seizure control does not always mean stopping medication, and clients need to understand the importance of continuing the prescribed treatment regimen, even after achieving stability.

D) "I have made an appointment to see my dentist next week:"
Phenytoin can cause gingival hyperplasia, which increases the need for regular dental checkups. It is recommended that clients taking phenytoin see a dentist regularly to manage this potential side effect and maintain oral health.

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The nurse is reading the arterial blood gas results of a patient admitted for sepsis. Which of the following would the nurse expect for a patient in metabolic acidosis?

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Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer purified protein derivative (PPD) skin test to another healthcare worker. Which of the following statements about the test is incorrect?

Correct Answer is D

Explanation

A nurse is performing discharge teaching for a client who has seizures and a new prescription for phenytoin, which of following statements by the client indicates a need for further teaching?

Correct Answer is C

Explanation

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