A patient who was injured at home is brought to the emergency ...

[stephzh]

A patient who was injured at home is brought to the emergency department. The nurse caring for this patient notes a respiratory rate of 32 breaths per minute and a heart rate of 90 beats per minute.
 
  The injuries are minor, but the patient is inconsolable and hysterical. The nurse expects that initial management will include: a. administering a gas mixture of 5 carbon dioxide (CO2).
  b. providing 100 oxygen via nasal cannula.
  c. giving sodium bicarbonate IV.
  d. providing sedatives to calm the patient.

Question 2

A patient with arthritis is admitted to the hospital. The patient's serum glucose level is 350 gm/dL, and the blood pressure is 182/98 mm Hg. The nurse notes that the patient's face appears rounded and puffy.
 
  The patient complains of feeling weak. What will the nurse do? a. Ask which drugs the patient takes for arthritis.
  b. Contact the provider to discuss whether the patient has a pituitary carcinoma.
  c. Request an order for ketoconazole Nizor-al.
  d. Suspect that this patient has Addison's disease.

[amanda_14]

Answer to Question 1

A
The patient is at risk for respiratory alkalosis as a result of hyperventilation, and giving the patient a gas mixture containing CO2 will help correct the alkalosis. Administering oxygen would worsen the problem. Sodium bicarbonate is given to correct metabolic acidosis. Sedatives may be necessary if initial measures fail.

Answer to Question 2

A
Many patients with arthritis are treated with glucocorticoids. Because the doses necessary to suppress inflammation are larger than the physiologic doses used to treat adrenal insufficiency, patients can develop signs of cortisol excess with cushingoid symptoms. This patient has an ele-vated glucose level, hypertension, and the characteristic moon facies and muscle weakness of Cushing's syndrome; therefore, the nurse would be correct to ask about the medications the pa-tient takes for arthritis. A pituitary carcinoma could be the cause but is less likely. Ketoconazole is used after chemotherapy and radiation therapy in the treatment of a pituitary adenoma. This patient does not show signs of Addison's disease.