MedSurg NCLEX Exam 3 - Questions for test

MedSurg NCLEX Exam 3 - Questions for test respiratory and Verified Correct Answers Updated Version 2023 2024 Guaranteed Success A diabetic patient's arterial blood gas (ABG) results are pH 7.28; PaCO2 34 mm Hg; PaO2 85 mm Hg; HCO3- 18 mEq/L. The nurse would expect which finding?

• Intercostal retractions
• Kussmaul respirations
• Low oxygen saturation (SpO2)

d. Decreased venous O2 pressure - Correct AnswerANS: B

Kussmaul (deep and rapid) respirations are a compensatory mechanism for metabolic acidosis. The low pH and low bicarbonate result indicate metabolic acidosis. Intercostal retractions, a low oxygen saturation rate, and a decrease in venous O2 pressure would not be caused by acidosis.

A nurse obtains a health history from a patient who has a 35 pack-year smoking history. The patient complains of hoarseness and tightness in the throat and difficulty swallowing. Which question is most important for the nurse to ask?

• "How much alcohol do you drink in an average week?"
• "Do you have a family history of head or neck cancer?"
• "Have you had frequent streptococcal throat infections?"
• "Do you use antihistamines for upper airway congestion?" - Correct AnswerANS: A

Prolonged alcohol use and smoking are associated with the development of laryngeal cancer, which the patient's symptoms and history suggest. Family history is not a risk factor for head or neck cancer. Frequent antihistamine use would be asked about if the nurse suspected allergic rhinitis, but the patient's symptoms are not suggestive of this diagnosis. Streptococcal throat infections also may cause these clinical manifestations, but patients with this type of infection will also have pain and a fever.

A patient in metabolic alkalosis is admitted to the emergency department, and pulse oximetry (SpO2) indicates that the O2 saturation is 94%. Which action should the nurse take next?

• Administer bicarbonate.
• Complete a head-to-toe assessment.
• Place the patient on high-flow oxygen.

d. Obtain repeat arterial blood gases (ABGs). - Correct AnswerANS: C

Although the O2 saturation is adequate, the left shift in the oxyhemoglobin dissociation curve will decrease the amount of oxygen delivered to tissues, so high oxygen concentrations should be given. Bicarbonate would worsen the patient's condition. A head-to-toe assessment and repeat ABGs may be implemented. However, the priority intervention is to give high-flow oxygen.

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A patient is admitted to the emergency department complaining of sudden onset shortness of breath and is diagnosed with a possible pulmonary embolus. How should the nurse prepare the patient for diagnostic testing to confirm the diagnosis?

• Start an IV so contrast media may be given.
• Ensure that the patient has been NPO for at least 6 hours.
• Inform radiology that radioactive glucose preparation is needed.
• Instruct the patient to undress to the waist and remove any metal objects. - Correct

AnswerANS: A

Spiral computed tomography (CT) scCorrect Answerare the most commonly used test to diagnose pulmonary emboli, and contrast media may be given IV. A chest x-ray may be ordered but will not be diagnostic for a pulmonary embolus. Preparation for a chest x-ray includes undressing and removing any metal. Bronchoscopy is used to detect changes in the bronchial tree, not to assess for vascular changes, and the patient should be NPO 6 to 12 hours before the procedure. Positron emission tomography (PET) scCorrect Answerare most useful in determining the presence of malignancy, and a radioactive glucose preparation is used.

A patient is scheduled for a computed tomography (CT) of the chest with contrast media. Which assessment findings should the nurse immediately report to the health care provider (select all that apply)?

• Patient is claustrophobic.
• Patient is allergic to shellfish.
• Patient recently used a bronchodilator inhaler.
• Patient is not able to remove a wedding band.
• Blood urea nitrogen (BUN) and serum creatinine levels are elevated. - Correct

AnswerANS: B, E

Because the contrast media is iodine-based and may cause dehydration and decreased renal blood flow, asking about iodine allergies (such as allergy to shellfish) and monitoring renal function before the CT scan are necessary. The other actions are not contraindications for CT of the chest, although they may be for other diagnostic tests, such as magnetic resonance imaging (MRI) or pulmonary function testing (PFT).

A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her platelet level drops to 110,000/µL. Which action will the nurse include in the plan of care?

• Use low-molecular-weight heparin (LMWH) only.
• Administer the warfarin (Coumadin) at the scheduled time.
• Teach the patient about the purpose of platelet transfusions.
• Discontinue heparin and flush intermittent IV lines using normal saline. - Correct

AnswerANS: D

All heparin is discontinued when the HIT is diagnosed. The patient should be instructed to never receive heparin or LMWH. Warfarin is usually not given until the platelet count has returned to 150,000/µL. The platelet count does not drop low enough in HIT for a platelet transfusion, and platelet transfusions increase the risk for thrombosis.

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