The nurse provides care to a patient admitted with a respiratory disorder. Which laboratory finding is most concerning?
Oxygen saturation 96%
Blood pH 7.32
Hemoglobin level 12 mg/dL
PaO2 80 mm Hg
The Correct Answer is B
A. Oxygen saturation 96%. This is a normal oxygen saturation level, so it is not a concern.
B. Blood pH 7.32. A pH below 7.35 indicates acidosis, which is concerning in a patient with a respiratory disorder, as it may indicate respiratory failure.
C. Hemoglobin level 12 mg/dL. This is a normal hemoglobin level for most adults and does not indicate a critical problem.
D. PaO2 80 mm Hg. While slightly lower than the normal range (normal is 80–100 mm Hg), this is not the most concerning finding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Assessment, diagnosis, intervention, evaluation, discharge, documentation. Discharge and documentation are important but are not part of the core nursing process.
B. Assessment, planning, intervention, evaluation, discharge, follow-up. Follow-up is not a standard step in the nursing process.
C. Assessment, diagnosis, planning, interventions, evaluation, education. Education is important but is not one of the six standard nursing process steps.
D. (Re)Assessment, diagnosis, outcomes, planning, implementation, evaluation. This accurately outlines the nursing process, which involves reassessing the patient, diagnosing, setting expected outcomes, planning care, implementing interventions, and evaluating effectiveness.
Correct Answer is D
Explanation
A. Chronic confusion r/t ECT treatment. Memory impairment may occur but is not the immediate priority.
B. Activity intolerance r/t weakness. Weakness can occur but is not the most urgent concern post-ECT.
C. Impaired social interaction r/t confusion. Social interaction is a lower priority compared to physical safety.
D. Risk for injury r/t altered mental status. Post-ECT, clients may be confused or disoriented, increasing their risk of falls or injury. Ensuring safety is the top priority.
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