The nurse is reviewing the diagnostic and laboratory results for a client with heart failure who presents with dyspnea. Which result would be a priority for the nurse to report to the healthcare provider?

BNP 700pg/ml (<100pg/ml)

Chest x-ray shows cardiomegaly

Hematocrit 35% (37-47%)

Echocardiogram with ejection fraction of 60% (normal is 55-75%)

Answer and Explanation

The Correct Answer is A

a. BNP 700pg/ml (<100pg/ml)

Rationale: B-type natriuretic peptide (BNP) is a biomarker used to diagnose and assess the severity of heart failure. Elevated BNP levels indicate increased ventricular stretch and fluid overload, both of which are indicative of worsening heart failure. A BNP level of 700pg/ml is significantly elevated compared to the normal range (<100pg/ml) and suggests acute exacerbation or decompensation of heart failure, requiring prompt intervention and management adjustment.

b. Chest x-ray shows cardiomegaly: While cardiomegaly on chest x-ray is indicative of heart failure, it is a diagnostic finding rather than an acute result requiring immediate intervention. It would be important to address but may not require urgent reporting unless accompanied by acute symptoms.

c. Hematocrit 35% (37-47%): A hematocrit of 35% falls at the lower end. While changes in hematocrit can indicate fluid volume status, this value alone does not indicate an urgent need for intervention or adjustment of therapy. It may warrant monitoring over time, but it is not an immediate concern.

d. Echocardiogram with ejection fraction of 60% (normal is 55-75%): An ejection fraction of 60% falls within the normal range and is not indicative of worsening heart failure. While it's essential to monitor ejection fraction in heart failure patients, this result alone does not suggest acute decompensation requiring immediate intervention.

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Correct Answer is A

Explanation

a. Assess level of consciousness: Respiratory acidosis in COPD patients can lead to hypercapnia (elevated carbon dioxide levels), which may result in altered mental status, confusion, or decreased level of consciousness due to respiratory depression. Assessing the level of consciousness is important to monitor for signs of worsening respiratory distress or impending respiratory failure.

b. Monitor serum sodium: COPD patients with respiratory acidosis may retain carbon dioxide, leading to respiratory compensation by the kidneys through increased retention of bicarbonate ions. This retention of bicarbonate can result in metabolic alkalosis and potentially affect electrolyte balance, including sodium levels. Monitoring serum sodium levels is essential to detect any electrolyte imbalances that may occur as a result of respiratory acidosis and its compensatory mechanisms.

c. Check skin turgor: While checking skin turgor is a valuable assessment for hydration status, it may not be directly related to respiratory acidosis in COPD. However, it's still important to assess hydration status in COPD patients, especially those with exacerbations, as dehydration can exacerbate respiratory symptoms.

d. Administer diuretics: Diuretics are not typically indicated in the management of respiratory acidosis in COPD. In fact, diuretics can worsen respiratory acidosis by potentially causing volume depletion and further reducing effective gas exchange in already compromised lungs. Diuretics may be used cautiously in COPD patients with concomitant heart failure or volume overload, but their use should be carefully monitored and individualized.

A. Uncompensated metabolic acidosis B. Uncompensated respiratory acidosis C. Uncompensated metabolic alkalosis D. Uncompensated respiratory alkalosis

Correct Answer is C

Explanation

Uncompensated metabolic acidosis: Metabolic acidosis is characterized by a low pH (<7.35) and a low bicarbonate (HCO3) level (<22 mEq/L). In this ABG, the pH is within the normal range, indicating alkalosis rather than acidosis. Therefore, this interpretation is incorrect.

b. Uncompensated respiratory acidosis: Respiratory acidosis is characterized by a low pH (<7.35) and an elevated PaCO2 (>45 mmHg). In this ABG, the pH is within the normal range, indicating alkalosis rather than acidosis. Therefore, this interpretation is incorrect.

c. Uncompensated metabolic alkalosis: Metabolic alkalosis is characterized by a high pH (>7.45) and an elevated bicarbonate (HCO3) level (>26 mEq/L). In this ABG, the pH is elevated (7.47), and the bicarbonate level is also elevated (31 mEq/L), indicating metabolic alkalosis. Therefore, this interpretation is correct based on the ABG results.

d. Uncompensated respiratory alkalosis: Respiratory alkalosis is characterized by a high pH (>7.45) and a low PaCO2 (<35 mmHg). In this ABG, the pH is elevated (7.47), but the PaCO2 is within the normal range (35 mmHg), indicating metabolic alkalosis rather than respiratory alkalosis. Therefore, this interpretation is incorrect.

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The nurse is reviewing the diagnostic and laboratory results for a client with heart failure who presents with dyspnea. Which result would be a priority for the nurse to report to the healthcare provider?

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Naxlex Comprehensive Predictor Exams

Which intervention would the nurse include in the plan of care for a client with COPD and respiratory acidosis?

Correct Answer is A

Explanation

A client presents to the Emergency department with a 4-day history of anorexia, abdominal pain and vomiting. An arterial blood gas (ABG) is drawn with these results pH 7.47(7.35-7.45), PaCO2 35mmHg (35-45mmHg), HCO3 31 mEq/L (22-26 mEq/L). How should the nurse interpret these results?

Correct Answer is C

Explanation

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