NRNP 6566 WEEK 6 KNOWLEDGE
CHECK
Question 1
A 54 year old female has a 30 year pack smoking history. She recently underwent
pulmonary function testing which showed moderate obstructive lung disease. What
would your treatment plan (including medications) include for this patient?
Correct
Answer: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020
suggests that smoking cessation should be immediately pursued if the patient
is still smoking. Nicotine replacement (gum, inhaler, nasal spray, patch,
lozenge, or sublingual tablet) are reliable methods to assist in long term
smoking cessation. Varenicline, bupropion, and nortriptyline also increase long
term quit rates but should be one part of an intervention program and not the
sole intervention. Professional counseling and support have a positive impact
on smoking cessation.
Bronchodilators are the baseline medication for COPD patients. Patients can
be initiated on short acting beta agonists (SABA) or long term beta agonists
(LABA) based on their symptoms. Short acting medications come in various
forms including inhaler, nebulizer, pills, or liquid syrup. Long acting
bronchodilators are delivered via inhaler or nebulizer. Combinations of SABA
and LABA s are common in treatment plans for COPD patients. LABA have a
duration of action of 12 hours while SABA last for about 4-6 hours. SABA can
provide immediate symptom relief.
Question 2
A 23-year-old male with Type 1 diabetes presents to the ER complaining of fatigue and
malaise. He tells you he has skipped his insulin injections the previous two days. His labs
are:
PH 7.10 Na 140 BUN 35
PCO2 10 K 4.1 Crt 1.1
PO2 112 Cl 105 BS 845
HCO3 4 CO2 5 + ketonemia
What is this patient's acid base status? What is your working diagnosis for this patient?
Correct
Answer: Metabolic acidosis with respiratory alkalosis
, pH is low Normal HCO3 is 22-26 so 4 is low causing acidosis
Leading diagnosis – Diabetic Ketoacidosis
Anion gap is elevated at 31
Elevated blood sugar with positive ketones present are key symptoms of
diabetic ketoacidosis
Question 3
For the following ABGs, identify the level of hypoxemia, the primary acid base disorder,
and the type of compensation. Example - acute respiratory acidosis with metabolic
alkalosis and severe hypoxemia
ABG Result
pH pCO2 pO2 HCO3
7.08 54 54 15
Corre
ct Acute respiratory and metabolic acidosis with moderate hypoxemia
Answ Normal Value Current ABG interpretation
er: Measure
pH 7.35 – 7.45 7.08
pCO2 35 – 45 mm Hg 54
P02 80 – 100 mm Hg 54
HCO3 22 – 26 mEq/L 15
Question 4
A 66 year old male is diagnosed with COPD. His current medications include
hydrochlorothiazide 25 mg po daily, lisinopril 20 mg po daily, and Crestor 10 mg po daily.
The APRN has ordered salbutamol 4 mg po TID. What side effects may occur?
Correct
Answer: Tachycardia and palpitations may occur due to the stimulation of the beta2-
adrenergic receptors. Older patients with higher doses of beta2-agonists may
experience an exaggerated somatic tremor. Hypokalemia is possible
especially when beta2-agonists are combined with thiazide diuretics. Oxygen
consumption may be increased in rising conditions in patients with chronic
heart failure those these effects can decrease over time. Hypertension,
hypotension, angina, and arrhythmia are possible as well.
CHECK
Question 1
A 54 year old female has a 30 year pack smoking history. She recently underwent
pulmonary function testing which showed moderate obstructive lung disease. What
would your treatment plan (including medications) include for this patient?
Correct
Answer: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020
suggests that smoking cessation should be immediately pursued if the patient
is still smoking. Nicotine replacement (gum, inhaler, nasal spray, patch,
lozenge, or sublingual tablet) are reliable methods to assist in long term
smoking cessation. Varenicline, bupropion, and nortriptyline also increase long
term quit rates but should be one part of an intervention program and not the
sole intervention. Professional counseling and support have a positive impact
on smoking cessation.
Bronchodilators are the baseline medication for COPD patients. Patients can
be initiated on short acting beta agonists (SABA) or long term beta agonists
(LABA) based on their symptoms. Short acting medications come in various
forms including inhaler, nebulizer, pills, or liquid syrup. Long acting
bronchodilators are delivered via inhaler or nebulizer. Combinations of SABA
and LABA s are common in treatment plans for COPD patients. LABA have a
duration of action of 12 hours while SABA last for about 4-6 hours. SABA can
provide immediate symptom relief.
Question 2
A 23-year-old male with Type 1 diabetes presents to the ER complaining of fatigue and
malaise. He tells you he has skipped his insulin injections the previous two days. His labs
are:
PH 7.10 Na 140 BUN 35
PCO2 10 K 4.1 Crt 1.1
PO2 112 Cl 105 BS 845
HCO3 4 CO2 5 + ketonemia
What is this patient's acid base status? What is your working diagnosis for this patient?
Correct
Answer: Metabolic acidosis with respiratory alkalosis
, pH is low Normal HCO3 is 22-26 so 4 is low causing acidosis
Leading diagnosis – Diabetic Ketoacidosis
Anion gap is elevated at 31
Elevated blood sugar with positive ketones present are key symptoms of
diabetic ketoacidosis
Question 3
For the following ABGs, identify the level of hypoxemia, the primary acid base disorder,
and the type of compensation. Example - acute respiratory acidosis with metabolic
alkalosis and severe hypoxemia
ABG Result
pH pCO2 pO2 HCO3
7.08 54 54 15
Corre
ct Acute respiratory and metabolic acidosis with moderate hypoxemia
Answ Normal Value Current ABG interpretation
er: Measure
pH 7.35 – 7.45 7.08
pCO2 35 – 45 mm Hg 54
P02 80 – 100 mm Hg 54
HCO3 22 – 26 mEq/L 15
Question 4
A 66 year old male is diagnosed with COPD. His current medications include
hydrochlorothiazide 25 mg po daily, lisinopril 20 mg po daily, and Crestor 10 mg po daily.
The APRN has ordered salbutamol 4 mg po TID. What side effects may occur?
Correct
Answer: Tachycardia and palpitations may occur due to the stimulation of the beta2-
adrenergic receptors. Older patients with higher doses of beta2-agonists may
experience an exaggerated somatic tremor. Hypokalemia is possible
especially when beta2-agonists are combined with thiazide diuretics. Oxygen
consumption may be increased in rising conditions in patients with chronic
heart failure those these effects can decrease over time. Hypertension,
hypotension, angina, and arrhythmia are possible as well.
