PNR 408 FINAL EXAM (Focus on Ch 54, 56, 59, 61, 63 of
Med-Surg Nursing (Lewis) QUESTIONS WITH
COMPLETE SOLUTIONS
A client has the following arterial blood gas results: pH, 7.52;
paCO2, 30 mmHg; HCO3 level, 24 mmol/L. These results
indicate the presence of which acid-base disturbance?:
a) metabolic acidosis
b) metabolic alkalosis
c) respiratory acidosis
d) respiratory alkalosis Correct Answers D
pH - HIGH = alkaline
PaCO2 - LOW = RESP alkaline
HCO3 - normal range
A client who has required prolonged mechanical ventilation has
the following arterial blood gas results: pH 7.48, PO2 85 mm
Hg, PCO2 32 mm Hg, and HCO3- 25 mmol/L. How would the
nurse interpret these results?
pH is HIGH = alkaline
PCO2 is altered = RESP
When PCO2 is low, pH will be higher (alkaline), and when
PCO2 is high, pH will be low (acidic)
,pH - within normal 7.35-7.45
PaCO2 - within normal 35-45mmHg
HCO3 - within normal 22-26mEq/L
PaO2 - within normal 80-100mmHg
O2 sat - normal 95-100%
A nurse is conducting a health-promotion workshop to a group
of females in their 40s and 50s. Which of the following points
about nipple discharge should the nurse teach to participants?
a)Inappropriate lactation necessitates breast biopsy.
b)Nipple discharge of any type is considered a precursor to
cancer.
c)Unexpected nipple discharge of any type warrants medical
follow-up.
d)Galactorrhea is a normal age-related change and a frequent
perimenopausal symptom. Correct Answers C
Although most cases of nipple discharge are not related to
malignancy, further assessment is indicated. Galactorrhea is not
considered a normal age-related change, nor is it a common
perimenopausal symptom.
A patient with acute blood loss requires a transfusion with
packed red blood cells. Which task is appropriate for the nurse
to delegate to nursing assistive personnel (NAP)?
A.Monitor the patient for shortness of breath and back pain.
B.Confirm the IV solution is 0.9% saline.
, C.Obtain and record the vital signs before the transfusion is
initiated.
D.Double-check the patient identity, and verify the blood
product. Correct Answers C
The RN may delegate tasks such as taking vital signs to NAP.
Assessments (e.g., monitoring for signs of a blood transfusion
reaction [shortness of breath and back pain]) are within the
scope of practice of the RN and may not be delegated to UAP.
The RN must also assume responsibility for ensuring the correct
IV fluid is used with blood products. A licensed nurse must
complete verification of the patient's identity and the blood
product data.
Characteristics of a deep partial-thickness burn include all of the
following except:
a.Weeping surface
b.Absence of edema
c.Broken epidermis
d.Mottled, red base Correct Answers B
Partial-thickness burns often have blisters that fill with
edematous fluids
During the emergent phase of burn injury, the nurse assesses for
the presence of hypovolemia. In burn patients, hypovolemia
occurs primarily as a result of:
A.Blood loss from injured tissue.
B.Third spacing of fluid into fluid-filled vesicles.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Classroom. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $12.99. You're not tied to anything after your purchase.
