A nurse teaches a client who is prescribed a central vascular access device. Which statement should ...

A nurse teaches a client who is prescribed a central vascular access device. Which statement should the nurse include in this client's teaching?
 
  a. You will need to wear a sling on your arm while the device is in place.
  b. There is no risk of infection because sterile technique will be used during insertion.
  c. Ask all providers to vigorously clean the connections prior to accessing the device.
  d. You will not be able to take a bath with this vascular access device.

Question 2

A nurse delegates care to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating hygiene for a client who has a vascular access device?
 
  a. Provide a bed bath instead of letting the client take a shower.
  b. Use sterile technique when changing the dressing.
  c. Disconnect the intravenous fluid tubing prior to the client's bath.
  d. Use a plastic bag to cover the extremity with the device.

Question 3

A nurse is planning care for a client who is anxious and irritable. The client's arterial blood gas values are pH 7.30, PaO2 96 mm Hg, PaCO2 43 mm Hg, and HCO3- 19 mEq/L. Which questions should the nurse ask the client and spouse when developing the plan
 
  a. Are you taking any antacid medications?
  b. Is your spouse's current behavior typical?
  c. Do you drink any alcoholic beverages?
  d. Have you been experiencing any vomiting?
  e. Are you experiencing any shortness of breath?

Question 4

A nurse is assessing clients who are at risk for acid-base imbalance. Which clients are correctly paired with the acid-base imbalance? (Select all that apply.)
 
  a. Metabolic alkalosis - Young adult who is prescribed intravenous morphine sulfate for pain
  b. Metabolic acidosis - Older adult who is following a carbohydrate-free diet
  c. Respiratory alkalosis - Client on mechanical ventilation at a rate of 28 breaths/min
  d. Respiratory acidosis - Postoperative client who received 6 units of packed red blood cells
  e. Metabolic alkalosis - Older client prescribed antacids for gastroesophageal reflux disease

Question 5

A nurse assesses a client who is receiving total parenteral nutrition. For which adverse effects related to an acid-base imbalance should the nurse assess? (Select all that apply.)
 
  a. Positive Chvostek's sign
  b. Elevated blood pressure
  c. Bradycardia
  d. Increased muscle strength
  e. Anxiety and irritability

Question 6

A nurse assesses a client who is experiencing an acid-base imbalance. The client's arterial blood gas values are pH 7.32, PaO2 94 mm Hg, PaCO2 34 mm Hg, and HCO3- 18 mEq/L. For which clinical manifestations should the nurse assess? (Select all that apply.
 
  a. Reduced deep tendon reflexes
  b. Drowsiness
  c. Increased respiratory rate
  d. Decreased urinary output
  e. Positive Trousseau's sign

Question 7

A nurse is planning interventions that regulate acid-base balance to ensure the pH of a client's blood remains within the normal range. Which abnormal physiologic functions may occur if the client experiences an acid-base imbalance? (Select all that apply
 
  a. Reduction in the function of hormones
  b. Fluid and electrolyte imbalances
  c. Increase in the function of selected enzymes
  d. Excitable cardiac muscle membranes
  e. Increase in the effectiveness of many drugs

Question 8

A nurse is caring for a client who has chronic emphysema and is receiving oxygen therapy at 6 L/min via nasal cannula. The following clinical data are available:
 
  Arterial Blood Gases
  Vital Signs
  pH = 7.28
  Pulse rate = 96 beats/min
  PaO2 = 85 mm Hg
  Blood pressure = 135/45
  PaCO2 = 55 mm Hg
  Respiratory rate = 6 breaths/min
  HCO3- = 26 mEq/L
  O2 saturation = 88
  Which action should the nurse take first?
  a.
  Notify the Rapid Response Team and provide ventilation support.
  b.
  Change the nasal cannula to a mask and reassess in 10 minutes.
  c.
  Place the client in Fowler's position if he or she is able to tolerate it.
  d.
  Decrease the flow rate of oxygen to 2 to 4 L/min, and reassess.

Question 9

A nurse is planning care for a client who is hyperventilating. The client's arterial blood gas values are pH 7.30, PaO2 94 mm Hg, PaCO2 31 mm Hg, and HCO3- 26 mEq/L. Which question should the nurse ask when developing this client's plan of care?
 
  a. Do you take any over-the-counter medications?
  b. You appear anxious. What is causing your distress?
  c. Do you have a history of anxiety attacks?
  d. You are breathing fast. Is this causing you to feel light-headed?

Question 10

A nurse is caring for a client who is experiencing excessive diarrhea. The client's arterial blood gas values are pH 7.28, PaO2 98 mm Hg, PaCO2 45 mm Hg, and HCO3- 16 mEq/L. Which provider order should the nurse expect to receive?
 
  a. Furosemide (Lasix) 40 mg intravenous push
  b. Sodium bicarbonate 100 mEq diluted in 1 L of D5W
  c. Mechanical ventilation
  d. Indwelling urinary catheter