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 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 the 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 client’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 increased 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 

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