Nursing Elites

1. A healthcare professional is reviewing the laboratory values of a client who has respiratory acidosis. Which of the following findings should the healthcare professional expect?

• A. HCO3- 30 mEq/L
• B. PaCO2 50 mm Hg
• C. pH 7.45
• D. Potassium 3.3 mEq/L

Correct answer: B

Rationale: In respiratory acidosis, the primary disturbance is an increase in PaCO2 levels above the normal range of 35-45 mm Hg. Option B, PaCO2 50 mm Hg, indicates an elevated partial pressure of carbon dioxide, which is consistent with respiratory acidosis. Options A, C, and D are not directly indicative of respiratory acidosis. HCO3- (Option A) is more related to metabolic acidosis or alkalosis, pH (Option C) is within the normal range indicating no acid-base imbalance, and potassium (Option D) levels are not specific to respiratory acidosis.

2. A client is being assessed for postpartum infection. Which of the following findings should indicate to the healthcare provider that the client requires further evaluation for endometritis?

• A. Localized area of breast tenderness
• B. Pelvic pain
• C. Vaginal discharge with foul odor
• D. Hematuria

Correct answer: B

Rationale: Pelvic pain is a common symptom of endometritis, which is an infection of the uterine lining. It is an important finding that warrants further evaluation. Localized area of breast tenderness may indicate mastitis, vaginal discharge with a foul odor could suggest a vaginal infection, and hematuria points towards a urinary tract issue, but they are not specific to endometritis.

3. A client who is 2 hours postpartum following a cesarean birth has a history of thromboembolic disease. Which of the following nursing interventions should be included in the plan of care?

• A. Apply warm, moist heat to the client's lower extremities.
• B. Massage the client's posterior lower legs.
• C. Place pillows under the client's knees when resting in bed.
• D. Have the client ambulate.

Correct answer: D

Rationale: The correct intervention for a client who is 2 hours postpartum following a cesarean birth with a history of thromboembolic disease is to have the client ambulate. Early ambulation is crucial in preventing complications such as deep vein thrombosis in postpartum clients. Applying warm, moist heat, massaging the legs, or placing pillows under the knees do not directly address the risk of thromboembolic disease in this scenario.

4. A client with chronic kidney disease has arterial blood gas values being reviewed by a nurse. Which of the following sets of values should the nurse expect?

• A. pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg
• B. pH 7.30, HCO3- 26 mEq/L, PaCO2 50 mm Hg
• C. pH 7.50, HCO3- 20 mEq/L, PaCO2 32 mm Hg
• D. pH 7.55, HCO3- 30 mEq/L, PaCO2 31 mm Hg

Correct answer: A

Rationale: In chronic kidney disease, metabolic acidosis is common due to impaired kidney function leading to reduced bicarbonate excretion. The correct values indicating metabolic acidosis in this scenario are a low pH (acidosis), low bicarbonate (HCO3-) level, and low PaCO2 (compensation through respiratory alkalosis). Therefore, the expected values for a client with chronic kidney disease would be pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg, as depicted in choice A.

5. A nurse on the postpartum unit is caring for a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse plan to delegate to the AP?

• A. Provide a sitz bath to a client who has a fourth-degree laceration and is 2 days postpartum.
• B. Observe an area of redness on the breast of a client who is 1 day postpartum.
• C. Monitor vital signs during admission of a client who has gestational hypertension.
• D. Change the perineal pad of a client who just transferred from labor and delivery.

Correct answer: A

Rationale: Delegating the task of providing a sitz bath to a client with a fourth-degree laceration and who is 2 days postpartum to the assistive personnel (AP) is appropriate. This task involves assisting the client with personal hygiene and comfort measures that can be safely performed by the AP under the supervision and direction of the nurse. Tasks like observing redness on the breast, monitoring vital signs during admission for gestational hypertension, and changing perineal pads may require a higher level of assessment and nursing judgment, making them more appropriate for the nurse to perform.

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