The nurse has telephone messages from four patients who requested ...

[mwit1967]

The nurse has telephone messages from four patients who requested information and assistance. Which one should the nurse refer to a social worker or community agency first?
 
  a. Is there a place that I can dispose of my unused morphine pills?
  b. I want to lose at least 20 pounds without getting sick this time.
  c. I think I have asthma because I cough when dogs are near.
  d. I ran out of money and am cutting my insulin dose in half.

Question 2

The patient has type B chronic obstructive pulmonary disease (COPD) exacerbated by an acute upper respiratory infection. Which blood gas values should the nurse expect to see?
 
  a. pH high, PaCO2 high, HCO3 high
  b. pH low, PaCO2 low, HCO3 low
  c. pH low, PaCO2 high, HCO3 high
  d. pH low, PaCO2 high, HCO3 normal

[Swizqar]

Answer to Question 1

ANS: D
Decreasing an insulin dose by half creates high risk of diabetic ketoacidosis, and this patient has the highest priority. The other patients have less priority due to lower risk situations with longer time course before development of an acid-base imbalance. The coughing when dogs are near is not a sign of a severe asthma episode that causes respiratory acidosis, although this patient does need attention after the insulin situation is handled. Disposing of morphine properly helps prevent respiratory acidosis from opioid overdose. Guidance regarding weight loss helps prevent starvation ketoacidosis.

Answer to Question 2

ANS: C
Type B COPD is a chronic disease that causes impaired excretion of carbonic acid, thus causing respiratory acidosis, with PaCO2 high and pH low. This chronic disease exists long enough for some renal compensation to occur, manifested by high HCO3. Answers that include low or normal bicarbonate are not correct, because the renal compensation for respiratory acidosis involves excretion of more hydrogen ions than usual, with retention of bicarbonate in the blood. High pH occurs with alkalosis, not acidosis.

[mwit1967]

TYSM

[Joy Chen]

Excellent