NUR 307 Exam 4 & Final Questions With Complete
Solutions
- Correct Answers negative
+ Correct Answers positive
< Correct Answers less than
> Correct Answers greater than
~ Correct Answers approximately equal to
a Correct Answers before
A-P Correct Answers anterioposterior
abd Correct Answers abdomen
ABG Correct Answers arterial blood gas
ac Correct Answers before meals
Acid Base Disturbances Correct Answers • Kidneys and Lungs
Compensate for each other
• CO2 is controlled by the lungs (pCO2)
• NaHCO3 is controlled by the kidneys (Bicarb)
• Examples for Clinical Consideration:
Example: Metabolic AcidosispH (7.32), Lungs/pCO2 (30),
Kidneys/Bicarb (18)
,o Lungs help kidneys by getting rid of acidlungs are getting rid
of acid so that they can get rid of the acid in the lungs
Example: Respiratory AcidosisKetones on the breath of a
diabetic give them "fruity breath" (which is diabetic ketosis)in
this case, good lungs will compensate instantly
• pH (7.32), pCO2 (55), Bicarb (24)
Example: Respiratory AcidosisLungs control CO2 by blowing
off CO2 (e.g. patient w/ pneumonia, there is no gas exchange,
therefore they are in Respiratory Acidosis)
Example of Blood Gas: pH 7.32, pCO2 60, Bicarb 24
• This patient is acidotic. It is respiratory. Why? pCO2 is
elevated.
Acid Base Normal Values Correct Answers pH 7.35 to 7.45
pCO2 35-45
Bicarb 22-26
ad lib Correct Answers at discretion
adaptation Correct Answers adjustment of living with other
living things & environmental conditions
Additional Reasons: Acidosis & Alkalosis Correct Answers
Reasons for Respiratory Acidosis:
• Pneumonia
• Apneaperson who stops breathing will have CO2 trapped
inside = Respiratory Acidosis
• Too much narcotics (causes not blowing acid effectively)
, Reasons for Metabolic Acidosis:
• Kidney failure
• Diabetic ketosis
• Anaerobic Metabolism (any kind)e.g. building up lactic acid
when running/exercising
• Above 7.45 is labeled Alkalosis
When we talk about basewe call it Alkaline
Two things cause Alkalosis
• Too much base (NAHCO3 considered a base) = METABOLIC
ALKALOSIS
• Not enough acid (CO2 considered an acid) = RESPIRATORY
ALKALOSIS
Reasons for Respiratory Alkalosis:
o Blowing off too much CO2 (especially patients that
hyperventilate)that's why a brown paper bag is used
o ↑ RR (respiratory rate)
Reasons for Metabolic Alkalosis:
o Vomiting (vomiting acid out of the body)
ADL Correct Answers activities of daily living
ADPIE Correct Answers Nursing Process
Assessment
Diagnosis
Planning
Implementation
Evaluation
, ADPIE: ASESSMENT Correct Answers -Assessment data
comes from interview of patient (primary source)
-Other sources: family, patient records, PCP, Pharmacy, Medical
records, report from other nursing staff
-Collection and verification of data
-Analysis of data
DATA COLLECTION
-Subjective data: what the patient states (e.g.: "I feel hot)
-Objective data: what you can measure (e.g.: BP)
-Physical assessment comes through senses EXCEPT taste (e.g.:
acceptable to write "foul smelling urine" vs. "foul tasting urine"
(Examples: Smells come from diabetic ketosis, gangrene, CHF;
Feel for skin, listen to bowel sounds
-Assessment begins as soon as you look @ the patient (e.g.: gait,
height, follow commands, not in severe respiratory distress)
-Assessment doesn't have to be formal
Sources of data
a. Client
b. Family and significant others
c. Health care team
d. Medical records
Nursing Health History
-NOTE: this is more for when the patient is not in distress.
When the patient has an ABC complaint do a "focused
assessment"
a. Biographical Information
b. Client expectations
Solutions
- Correct Answers negative
+ Correct Answers positive
< Correct Answers less than
> Correct Answers greater than
~ Correct Answers approximately equal to
a Correct Answers before
A-P Correct Answers anterioposterior
abd Correct Answers abdomen
ABG Correct Answers arterial blood gas
ac Correct Answers before meals
Acid Base Disturbances Correct Answers • Kidneys and Lungs
Compensate for each other
• CO2 is controlled by the lungs (pCO2)
• NaHCO3 is controlled by the kidneys (Bicarb)
• Examples for Clinical Consideration:
Example: Metabolic AcidosispH (7.32), Lungs/pCO2 (30),
Kidneys/Bicarb (18)
,o Lungs help kidneys by getting rid of acidlungs are getting rid
of acid so that they can get rid of the acid in the lungs
Example: Respiratory AcidosisKetones on the breath of a
diabetic give them "fruity breath" (which is diabetic ketosis)in
this case, good lungs will compensate instantly
• pH (7.32), pCO2 (55), Bicarb (24)
Example: Respiratory AcidosisLungs control CO2 by blowing
off CO2 (e.g. patient w/ pneumonia, there is no gas exchange,
therefore they are in Respiratory Acidosis)
Example of Blood Gas: pH 7.32, pCO2 60, Bicarb 24
• This patient is acidotic. It is respiratory. Why? pCO2 is
elevated.
Acid Base Normal Values Correct Answers pH 7.35 to 7.45
pCO2 35-45
Bicarb 22-26
ad lib Correct Answers at discretion
adaptation Correct Answers adjustment of living with other
living things & environmental conditions
Additional Reasons: Acidosis & Alkalosis Correct Answers
Reasons for Respiratory Acidosis:
• Pneumonia
• Apneaperson who stops breathing will have CO2 trapped
inside = Respiratory Acidosis
• Too much narcotics (causes not blowing acid effectively)
, Reasons for Metabolic Acidosis:
• Kidney failure
• Diabetic ketosis
• Anaerobic Metabolism (any kind)e.g. building up lactic acid
when running/exercising
• Above 7.45 is labeled Alkalosis
When we talk about basewe call it Alkaline
Two things cause Alkalosis
• Too much base (NAHCO3 considered a base) = METABOLIC
ALKALOSIS
• Not enough acid (CO2 considered an acid) = RESPIRATORY
ALKALOSIS
Reasons for Respiratory Alkalosis:
o Blowing off too much CO2 (especially patients that
hyperventilate)that's why a brown paper bag is used
o ↑ RR (respiratory rate)
Reasons for Metabolic Alkalosis:
o Vomiting (vomiting acid out of the body)
ADL Correct Answers activities of daily living
ADPIE Correct Answers Nursing Process
Assessment
Diagnosis
Planning
Implementation
Evaluation
, ADPIE: ASESSMENT Correct Answers -Assessment data
comes from interview of patient (primary source)
-Other sources: family, patient records, PCP, Pharmacy, Medical
records, report from other nursing staff
-Collection and verification of data
-Analysis of data
DATA COLLECTION
-Subjective data: what the patient states (e.g.: "I feel hot)
-Objective data: what you can measure (e.g.: BP)
-Physical assessment comes through senses EXCEPT taste (e.g.:
acceptable to write "foul smelling urine" vs. "foul tasting urine"
(Examples: Smells come from diabetic ketosis, gangrene, CHF;
Feel for skin, listen to bowel sounds
-Assessment begins as soon as you look @ the patient (e.g.: gait,
height, follow commands, not in severe respiratory distress)
-Assessment doesn't have to be formal
Sources of data
a. Client
b. Family and significant others
c. Health care team
d. Medical records
Nursing Health History
-NOTE: this is more for when the patient is not in distress.
When the patient has an ABC complaint do a "focused
assessment"
a. Biographical Information
b. Client expectations
