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Author Question: A postoperative client has a temperature of 101 F and scattered rhonchi throughout the chest 24 ... (Read 35 times)

Yolanda

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on: Jul 22, 2018
A postoperative client has a temperature of 101 F and scattered rhonchi throughout the chest 24 hours after surgery. The nursing diagnosis is Ineffective airway clearance.
 
  Which outcome would indicate progress toward meeting the goal of effective airway clearance?
  1. Cough produced 5 mL of yellow mucus; temperature 100 F.
  2. Physician notified, chest x-ray taken.
  3. Client reports having had a cold the day before surgery.
  4. Client drank 750 mL of fluids in 8 hours.

Question 2

The client's arterial blood gas report reveals a pH of 6.58. How does the nurse evaluate this value?
 
  1. There is a slight elevation.
   2. This value is incompatible with life.
   3. This is a low normal value.
   4. This value is extremely elevated.


efwsefaw

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Reply #1 on: Jul 22, 2018
Answer to Question 1

ANS: 1

Answer to Question 2

2. This value is incompatible with life.

Rationale:
The body's pH range is normally 7.35 to 7.45. Values lower than 6.8 or higher than 7.8 are generally considered incompatible with life. If the nurse assesses that this client is physiologically more stable than would be expected with this pH, the possibility of a lab error should be considered. An elevated pH would be greater than 7.45, and an extremely elevated pH would be much greater than 7/45. A low normal value would be closer to 7.35.


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