ADULT HEALTH lll EXAM 1-4 & FINAL EXAM LATEST VERSIONS REAL EXAM QUESTIONS AND CORRECT ANSWERS|GRADED A+

ADULT HEALTH lll EXAM 1-4 & FINAL EXAM LATEST VERSIONS 2023 -2024 REAL EXAM QUESTIONS AND CORRECT ANSWERS|GRADED A+ Adult Health lll Exam 1 1. The nurse should interpret the arterial blood gas results shown below as which of the following? pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L a. respiratory alkalosis b. metabolic acidosis c. metabolic alkalosis d. respiratory acidosis Feedback: The ABGs shown indicate the pH is high which would mean alkalosis. The PaCO2 is low which is the opposite of the pH and indicates that the respiratory system is the primary problem. The HCO3 is within normal levels . Remember the acronym ROME when interpreting ABGs.Lewis 2017, pgs 290-291abcK 2. The nurse is caring for a client who is receiving prescribed intravenous (IV) fluids at 50 ml/hr, has voided 300 ml in 24 -hours and reports having a headache. The nurse notes t he client's laboratory results show a low urine specific gravity level. Which of the following actions should the nurse take? a. Encourage the client to increase their fluid intake. b. Decrease the intravenous fluids. c. Administer prescribed antibiotics. d. Assist the client to ambulate to increase their metabolic rate. Feedback: Acute renal failure manifests as oliguria, anuria, or normal urine volume. Oliguria (less than 400 mL/d of urine) is the most common clinical situation seen in acute renal failure along with a low urine specific gravity; anuria (less than 50 mL/d of urine) and normal urine output are not as common. In acute renal failure you want to encourage the client to increase their fluid intake to prevent dehydration. Administering antibiotics will not increase the client's decreased urine output. Decreasing IV fluids will be putting the client at risk for dehydration. Increasing the metabolic rate will not assist the client in their urine output deficit. Lewis 2017, pgs. 1071 -1072abkd 3. The plan of care for a client with a low potassium level includes providing information about the effects of medications and the dietary intake of foods high in potassium. Which of the following information should the nurse use to evaluate if the outcome for the plan was met? a. laboratory data b. physical assessment c. health history d. client statements Feedback: The interventions are aimed at increasing the potassium level of the client, and achievement would be measured by evaluating laboratory data. Potassium levels cannot be measured by physical assessment, health history information, or client statements. Lewis 2017, pgs. 282-283 4. The nurse caring for a client experiencing acute hypoxemic respiratory failure due to V/Q mismatch is evaluating the client’s plan of care. Which of the following interventions would be appropriate for the client’s care plan? a. Initiate 24% to 32% oxygen via face mask. b. Provide high flow supplemental oxygen via nasal cannula. c. Provide oxygen via noninvasive positive pressure ventilation (NIPPV). d. Initiate invasive positive pressure ventilation (PPV) via endotracheal tube for SaO2 below 90%. Feedback: The nurse should understand that acute hypoxemic respiratory failure due to V/Q mismatch requires low levels of oxygen either via nasal cannula or using a face mask at 24% to 32% oxygen. This helps improve the PaO2 and SaO2 levels. Without knowing the clie nt’s baseline SaO2 an intervention to initiate PPV vie ET tube for SaO2 would be inappropriate. NIPPV is typically the treatment of choice for hypoxemia secondary to an intrapulmonary shunt, not V/Q mismatch.Lewis 2017, pgs. 1615 -1616 5. The nurse is caring for a client with right sided pneumonia (PN) and helps position the client in the left Sims position. The nurse should evaluate the client’s response to the position by doing which of the following? a. Compare the client’s PaO2 level with the previous level. b. Assessing the client’s pain level. c. Ask the client to perform coughing and deep breathing. d. Compare the client’s pH and HCO3 levels with the baseline levels. Feedback: Clients with unilateral lung disease should be positioned with the healthy lung in a dependent position. This helps to mobilize the secretions which makes it easier to expectorate. The client’s PaO2 level compared to the previous level would give the nurse a good indication if the client’s ventilation has increased. Lewis 2017, pgs. 1610 -1611k, 1624 -1625k, acd by omission 6. The nurse is caring for a client with acute respiratory distress syndrome (ARDS) who is mechanically ventilated with positive end-expiratory pressure (PEEP). Which of the following should alert the nurse that the client is having complications from PEEP? Select all that apply. a. tachycardia b. hypopnea c. decreased urine output d. diminished lung sounds e. hypertension Feedback: PEEP is indicated in clients with ARDS. PEEP provides positive pressure at the end of expiration to keep the alveoli open. This positive pressure can increase the intrathoracic pressure. When intrathoracic pressure increases, the client will have a decrease in preload, which can decrease cardiac output. When there is a decrease in cardiac output, the client can have tachycardia, hypotension, and decreased perfusion to the kidneys. With increase d intrathoracic pressure, barotrauma or pneumothorax can occur. A client on mechanical ventilation should have equal and bilateral breath sounds, diminished breath sounds may indicate a pneumothorax.Lewis 2017, pg. 1577Kbe 7. The nurse received report from t he previous shift for a client who was intubated for acute respiratory failure (ARF) less than one hour ago. Which of the following test results would be a priority for the nurse to follow -up? a. end-tidal CO2 (ETCO2) b. complete blood count (CBC) c. electrocardiogram (ECG) d. mixed venous O2 saturation (SvO2) Feedback : After a client is intubated the ETCO2 should be evaluated because this confirms proper tube placement within the airway immediately after intubation. A CBC, ECG and SvO2 are also done after intubation but would not be a priority over correct tube placement.Lewis 2017, p. 1614 8. A nurse is caring for a client in the emergency department (ED) who had a radiograph (x-ray) that reveals rib fractures, and the client is diagnosed with a small flail chest injury. Which of the following interventions should the nurse include in the client's plan of care? a. suction the client's airway secretions b. strict fluid intake and fluid replacement restriction c. prepare the client for surgery d. immediately sedate and intubate the client Feedback: As with rib fracture, treatment of flail chest is usually supportive. Management includes ventilatory support, clearing secretions from the lungs, and controlling pain. If only a small segment of the chest is involved, it is important to clear the airway through positioning, coughing, deep breathing, and suctioning. Clients should have adequate fluid intake and replacement to mobilize secretions and underlining pulmonary contusion. Intubation is re quired for severe flail chest injuries, and surgery is required only in rare circumstances to stabilize the fail segment.Lewis 2017, pgs. 521-522kbcd, 1610k 9. The nurse is caring for a client who is receiving positive pressure ventilation and high levels of PEEP via endotracheal intubation for acute respiratory distress syndrome (ARDS). The nurse should contact respiratory therapy for which of the following findings? a. The client’s FIO2 is at 65%. b. The client’s PaO2 is at 75%. c. The client’s blood pressure decreased from 110/68 mm/Hg to 89/60 mm/Hg in the last hour. d. The client’s temperature increased from 98.8o F. to 100.1o F in the last hour. Feedback: The nurse should contact respiratory therapy for a the decrease in blood pressure. Client’s receiving high levels of PEEP can experience a reduction in blood return to the left side of the heart from hyperinflation of the alveoli and compression of the pulmonary capillary bed which then causes dramatic reduction in BP. The PEEP should be adjusted to correct the BP. The client’s temperature is unrelated to respiratory therapy and the FIO2 and PaO2 are within expected levels. Lewis 2017, pg. 1624Kbc, d by omission. 10. The nurse is assessing a client with chronic obstructive pulmonary disease (COPD). The nurse auscultates diminished breath sounds, which is a change from the client's baseline. The nurse should monitor the client for which of the following potential complications? a. dyspnea and hypoxemia b. kyphosis and clubbing of the fingers c. sepsis and pneumothorax d. bradypnea and pursed lip breathing Feedback: These changes in the airway require that the nurse monitor the client for dyspnea and hypoxemia. Kyphosis is a musculoskeletal problem. Sepsis and pneumothorax are atypical complications. Tachypnea is much more likely than bradypnea. Pursed lip breathing can relieve dyspnea. Lewis 2017, p. 564k, acd by omission, 1610 -1611k 11. The nurse is providing telephone triage and is speaking with the spouse of a client with asthma who has a prescription for a short -acting inhaled beta -agonist to utilize as needed. The spouse states, "My spouse’s personal best peak flow reading is 290 L/mi nute and today the reading is 220 L/minute." Which of the following would be an appropriate response by the nurse? a. "This is a medical emergency take your spouse to the nearest emergency department (ED)." b. "Your spouse should use the prescribed beta-agonist inhaler." c. "A prescription for intravenous corticosteroids is most likely necessary."