The nurse is seeing a patient in the clinic who has shingles (herpes zoster). The patient is concerned about spreading the disease to others.
How should the nurse respond?

Persons between 30 and 40 years old are at high risk.

Persons of all ages should receive the zoster vaccine (Zostavax).

Persons with leukemia are at higher risk.

It is only possible to have one episode of the disease.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Increasing tidal volume would further exacerbate the respiratory alkalosis. Tidal volume, the amount of air moved into and out of the lungs with each breath, directly influences the partial pressure of carbon dioxide ($PaCO_2$). Increasing it would remove more $CO_2$, causing the pH to rise further from the normal range of 7.35-7.45 and $PaCO_2$ to fall below the normal range of 35-45 mmHg. This action is contraindicated as the patient is already alkalotic.

Choice B rationale

Increasing the fraction of inspired oxygen ($FIO_2$) is unnecessary and potentially harmful. The patient's $PaO_2$ is 80 mmHg, which is within the normal range of 80-100 mmHg. Therefore, the patient is not hypoxemic. Increasing oxygen delivery in a patient with COPD can suppress the hypoxic drive to breathe, which is a significant risk for respiratory depression and increased $PaCO_2$ levels. This action would not correct the underlying respiratory alkalosis.

Choice C rationale

Leaving the ventilator at the current settings would be inappropriate because the patient is in respiratory alkalosis. The blood gas results show a pH of 7.50, which is elevated, and a $PaCO_2$ of 29 mmHg, which is low. This indicates that the ventilator settings are causing the patient to hyperventilate and eliminate too much carbon dioxide. Adjustments are necessary to normalize the blood gas parameters and prevent further complications.

Choice D rationale

Decreasing the respiratory rate would be the most appropriate intervention. The patient's blood gas results show respiratory alkalosis (pH 7.50, $PaCO_2$ 29 mmHg), which is caused by the patient breathing too fast and "blowing off" too much $CO_2$. Reducing the respiratory rate will allow $CO_2$ to accumulate, raising the $PaCO_2$ and lowering the pH back toward the normal range (pH 7.35-7.45; $PaCO_2$ 35-45 mmHg)

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Correct Answer is C

Explanation

Choice A rationale

Respiratory alkalosis is characterized by a high pH (above 7.45) and a low PaCO$_2$ (below 35). This is typically caused by hyperventilation, where the patient is blowing off too much carbon dioxide. The patient's ABGs (pH 7.30, PaCO$_2$ 50) show a low pH and a high PaCO$_2$, which is the opposite of respiratory alkalosis.

Choice B rationale

Metabolic acidosis is characterized by a low pH (below 7.35) and a low HCO$_3$ (below 22). While the patient's pH is low (7.30), the HCO$_3$ (26) is within the normal range. The primary imbalance is the elevated PaCO$_2$ (50), indicating a respiratory problem rather than a metabolic one like diabetic ketoacidosis.

Choice C rationale

The patient's ABGs show a low pH (7.30, normal 7.35-7.45), indicating acidosis. The high PaCO$_2$ (50, normal 35-45) indicates a respiratory cause for the acidosis, as carbon dioxide acts as an acid in the blood. The normal HCO$_3$ (26, normal 22-26) suggests that the metabolic system has not yet compensated. This pattern is characteristic of respiratory acidosis caused by hypoventilation.

Choice D rationale

Metabolic alkalosis is characterized by a high pH (above 7.45) and a high HCO$_3$ (above 26). Cushing syndrome can sometimes cause metabolic alkalosis. However, the patient's ABGs (pH 7.30, HCO$_3$ 26) show a low pH and a normal HCO$_3$, which is inconsistent with metabolic alkalosis. .

A. The lungs have occasional audible expiratory wheezes. B. The patient has not been suctioned for the last six hours. C. The pulse oximeter shows a SpO$_2$ of 93%. D. The respiratory rate is 32 breaths/min.

Correct Answer is D

Explanation

Choice A rationale

Occasional expiratory wheezes can be a sign of bronchoconstriction but do not necessarily indicate a need for immediate suctioning. Suctioning is primarily indicated for the presence of secretions that obstruct the airway, not for bronchospasm, which is typically treated with bronchodilators.

Choice B rationale

Suctioning is a procedure based on patient assessment findings, not a predetermined schedule. Performing the procedure on a timed basis, without clinical indication, can cause trauma to the tracheal and bronchial mucosa, increasing the risk of infection and bleeding.

Choice C rationale

A pulse oximeter reading of 93% is within the acceptable range for many patients and does not, by itself, indicate the need for suctioning. The need for suctioning is based on the presence of secretions, not solely on oxygen saturation levels, unless there is a significant drop in SpO$_2$.

Choice D rationale

A respiratory rate of 32 breaths/min indicates increased respiratory effort and distress. This tachypnea may be a sign of airway obstruction from secretions, which the patient is trying to clear. The nurse should perform an assessment, including auscultation, and consider suctioning. *.

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The nurse is seeing a patient in the clinic who has shingles (herpes zoster). The patient is concerned about spreading the disease to others. How should the nurse respond?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient has the following arterial blood gasses (ABGs): pH 7.30, PaCO$_2$ 50, HCO$_3$ 26. Which diagnosis do these ABGs correlate with?

Correct Answer is C

Explanation

Which assessment information obtained by the nurse when caring for a patient receiving mechanical ventilation indicates a need for suctioning?

Correct Answer is D

Explanation

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The nurse is seeing a patient in the clinic who has shingles (herpes zoster). The patient is concerned about spreading the disease to others.
How should the nurse respond?