Author Question: The nurse is assessing a patient and finds crackles in the lung bases and neck vein distention. ... (Read 117 times)

Mr3Hunna · **on:** Jul 22, 2018

The nurse is assessing a patient and finds crackles in the lung bases and neck vein distention. Which action will the nurse take first?

a. Offer calcium-rich foods.
b. Administer diuretic.
c. Raise head of bed.
d. Increase fluids.

Question 2

The nurse is caring for a diabetic patient in renal failure who is in metabolic acidosis. Which laboratory findings are consistent with metabolic acidosis?

a. pH 7.3, PaCO2 36 mm Hg, HCO3 19 mEq/L
b. pH 7.5, PaCO2 35 mm Hg, HCO3 35 mEq/L
c. pH 7.32, PaCO2 47 mm Hg, HCO3 23 mEq/L
d. pH 7.35, PaCO2 40 mm Hg, HCO3 25 mEq/L

robbielu01 · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

ANS: C
The patient is in fluid overload. Raising the head of the bed to ease breathing is the first action. Offering calcium-rich foods is for hypocalcemia, not fluid overload. Administering a diuretic is the second action. Increasing fluids is contraindicated and would make the situation worse.

Answer to Question 2

ANS: A
The laboratory values that reflect metabolic acidosis are pH 7.3, PaCO2 36 mm Hg, HCO3 19 mEq/L. A laboratory finding of pH 7.5, PaCO2 35 mm Hg, HCO3 35 mEq/L is metabolic alkalosis. pH 7.32, PaCO2 47 mm Hg, HCO3 23 mEq/L is respiratory acidosis. pH 7.35, PaCO2 40 mm Hg, HCO3 25 mEq/L values are within normal range.