,NU448/NU 448 Adult Health III Exam 1
| Herzing University |Q&A| 26/27
1. A client in the emergency department has an arterial blood gas result of pH 7.48, PaO₂ 85 mm Hg,
PaCO₂ 32 mm Hg, and HCO₃⁻ 25 mEq/L. Which interpretation should the nurse document?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Metabolic alkalosis
D) Respiratory acidosis
Correct Answer: Respiratory alkalosis
Rationale: The pH of 7.48 is elevated, indicating alkalemia. The PaCO₂ of 32 mm Hg is below the
normal range (35-45 mm Hg), indicating hypocapnia from hyperventilation. The HCO₃⁻ of 25 mEq/L is
within normal limits (22-26 mEq/L), ruling out a primary metabolic cause. This pattern is consistent
with respiratory alkalosis. Distractor B would present with a low pH and low HCO₃⁻. Distractor C
would present with a high pH and high HCO₃⁻. Distractor D would present with a low pH and high
PaCO₂. The low PaCO₂ with a normal bicarbonate confirms an acute respiratory alkalosis without
metabolic compensation.
2. A client receiving intravenous fluids at 50 mL/hr has voided only 300 mL in 24 hours and reports a
headache. The urine specific gravity is low. Which action should the nurse take?
A) Encourage the client to increase oral fluid intake
B) Decrease the intravenous fluid rate
,C) Administer prescribed antibiotics
D) Assist the client to ambulate to increase metabolic rate
Correct Answer: Encourage the client to increase oral fluid intake
Rationale: The client is demonstrating signs of dehydration (low urine output, headache) with a low
urine specific gravity, which indicates dilute urine. Inadequate fluid intake or loss of fluids has led to
hypovolemia. The priority is to increase fluid intake. Encouraging oral fluids is appropriate if the client
can tolerate them. Decreasing IV fluids would worsen dehydration. Antibiotics are not indicated
without evidence of infection. Ambulation does not address the underlying fluid deficit. The nurse
should also assess for other signs of dehydration such as dry mucous membranes and tachycardia.
3. The plan of care for a client with hypokalemia includes education about dietary potassium sources.
Which assessment finding should the nurse use to evaluate whether the outcome has been met?
A) Laboratory data
B) Physical assessment
C) Health history
D) Client statements
Correct Answer: Laboratory data
Rationale: The most objective and reliable indicator of whether the plan of care has been met for a
client with hypokalemia is the serum potassium level obtained through laboratory data. While
physical assessment (e.g., muscle strength, cardiac rhythm) and client statements can provide
supporting information, the definitive measure is the laboratory value. The health history is useful for
, identifying causes but does not evaluate the effectiveness of the intervention. Therefore, laboratory
data is the correct choice for evaluating the outcome.
4. A client with acute hypoxemic respiratory failure due to ventilation-perfusion (V/Q) mismatch is
being evaluated. Which intervention is appropriate for the plan of care?
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 via endotracheal tube for SaO₂ below 90%
Correct Answer: Initiate 24% to 32% oxygen via face mask
Rationale: For a client with acute hypoxemic respiratory failure due to V/Q mismatch, the initial
intervention is to provide supplemental oxygen to correct hypoxemia. Low-flow oxygen via face mask
at 24% to 32% is appropriate for mild to moderate hypoxemia. High-flow nasal cannula may be used
for more severe hypoxemia. NIPPV is indicated for clients who can protect their airway and have
adequate respiratory drive but need positive pressure support. Invasive mechanical ventilation is
reserved for clients who fail noninvasive measures or have contraindications. The priority is to start
with the least invasive appropriate intervention.
5. A client with right-sided pneumonia is positioned in the left Sims position. Which assessment
should the nurse use to evaluate the client's response to this position?
A) Compare the client's PaO₂ level with the previous level
B) Assess the client's pain level
| Herzing University |Q&A| 26/27
1. A client in the emergency department has an arterial blood gas result of pH 7.48, PaO₂ 85 mm Hg,
PaCO₂ 32 mm Hg, and HCO₃⁻ 25 mEq/L. Which interpretation should the nurse document?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Metabolic alkalosis
D) Respiratory acidosis
Correct Answer: Respiratory alkalosis
Rationale: The pH of 7.48 is elevated, indicating alkalemia. The PaCO₂ of 32 mm Hg is below the
normal range (35-45 mm Hg), indicating hypocapnia from hyperventilation. The HCO₃⁻ of 25 mEq/L is
within normal limits (22-26 mEq/L), ruling out a primary metabolic cause. This pattern is consistent
with respiratory alkalosis. Distractor B would present with a low pH and low HCO₃⁻. Distractor C
would present with a high pH and high HCO₃⁻. Distractor D would present with a low pH and high
PaCO₂. The low PaCO₂ with a normal bicarbonate confirms an acute respiratory alkalosis without
metabolic compensation.
2. A client receiving intravenous fluids at 50 mL/hr has voided only 300 mL in 24 hours and reports a
headache. The urine specific gravity is low. Which action should the nurse take?
A) Encourage the client to increase oral fluid intake
B) Decrease the intravenous fluid rate
,C) Administer prescribed antibiotics
D) Assist the client to ambulate to increase metabolic rate
Correct Answer: Encourage the client to increase oral fluid intake
Rationale: The client is demonstrating signs of dehydration (low urine output, headache) with a low
urine specific gravity, which indicates dilute urine. Inadequate fluid intake or loss of fluids has led to
hypovolemia. The priority is to increase fluid intake. Encouraging oral fluids is appropriate if the client
can tolerate them. Decreasing IV fluids would worsen dehydration. Antibiotics are not indicated
without evidence of infection. Ambulation does not address the underlying fluid deficit. The nurse
should also assess for other signs of dehydration such as dry mucous membranes and tachycardia.
3. The plan of care for a client with hypokalemia includes education about dietary potassium sources.
Which assessment finding should the nurse use to evaluate whether the outcome has been met?
A) Laboratory data
B) Physical assessment
C) Health history
D) Client statements
Correct Answer: Laboratory data
Rationale: The most objective and reliable indicator of whether the plan of care has been met for a
client with hypokalemia is the serum potassium level obtained through laboratory data. While
physical assessment (e.g., muscle strength, cardiac rhythm) and client statements can provide
supporting information, the definitive measure is the laboratory value. The health history is useful for
, identifying causes but does not evaluate the effectiveness of the intervention. Therefore, laboratory
data is the correct choice for evaluating the outcome.
4. A client with acute hypoxemic respiratory failure due to ventilation-perfusion (V/Q) mismatch is
being evaluated. Which intervention is appropriate for the plan of care?
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 via endotracheal tube for SaO₂ below 90%
Correct Answer: Initiate 24% to 32% oxygen via face mask
Rationale: For a client with acute hypoxemic respiratory failure due to V/Q mismatch, the initial
intervention is to provide supplemental oxygen to correct hypoxemia. Low-flow oxygen via face mask
at 24% to 32% is appropriate for mild to moderate hypoxemia. High-flow nasal cannula may be used
for more severe hypoxemia. NIPPV is indicated for clients who can protect their airway and have
adequate respiratory drive but need positive pressure support. Invasive mechanical ventilation is
reserved for clients who fail noninvasive measures or have contraindications. The priority is to start
with the least invasive appropriate intervention.
5. A client with right-sided pneumonia is positioned in the left Sims position. Which assessment
should the nurse use to evaluate the client's response to this position?
A) Compare the client's PaO₂ level with the previous level
B) Assess the client's pain level
