A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for continued mechanical ventilation. How should the nurse interpret the following arterial blood gas results: pH 7.48, PaO 85 mm Hg, PaCO 32 mm Hg, and HCO 25 mEq/L? 2 2 3

Correct Answer: A

Rationale: The correct interpretation of the arterial blood gas results is Respiratory Alkalosis. 1. pH > 7.45 indicates alkalosis. 2. PaCO2 < 35 mm Hg indicates respiratory alkalosis. 3. HCO3 within normal range (22-26 mEq/L) rules out metabolic imbalance. Therefore, the primary abnormality is a low PaCO2 causing alkalosis. Other choices are incorrect because there is no evidence of metabolic alkalosis (HCO3 normal), respiratory acidosis (PaCO2 high), or base balance (not a specific acid-base imbalance).

Correct Answer: D

Rationale: The correct answer is D. Teaching the patient to take slow, deep breaths when anxious is the first action the nurse should take. The patient is experiencing respiratory alkalosis, likely due to hyperventilation from anxiety. Teaching the patient relaxation techniques can help normalize the respiratory rate and improve oxygenation. Checking the nasogastric tube (A) can be done later as it is not the priority. Giving morphine (B) may further depress respiratory drive and worsen the alkalosis. Notifying the health care provider (C) is not necessary at this moment as the nurse can address the situation effectively.

Correct Answer: D

Rationale: The correct answer is D because the presence of coarse, muddy brown granular casts in the urinalysis indicates intrarenal disease, specifically acute tubular necrosis. This condition is characterized by damage to the renal tubules, leading to the presence of casts in the urine. The patient's symptoms of malaise, fatigue, and decreased urinary output are consistent with acute tubular necrosis. Choice A is incorrect because it does not specify the underlying cause of the kidney injury. Choice B is incorrect as prerenal conditions would typically present with different urinalysis findings. Choice C is incorrect as postrenal obstruction would not typically lead to the presence of granular casts in the urine.

Correct Answer: D

Rationale: The correct answer is D because assessing the catheter site for redness and swelling is crucial in monitoring for signs of infection, which is a common complication with percutaneous dialysis catheters. This step helps in early detection and prompt intervention to prevent further complications. Incorrect choices: A: This choice is too vague and does not provide specific guidance on catheter care. B: Applying a sterile gauze dressing is important, but it is not the most critical step in caring for a percutaneous dialysis catheter. C: Replacing the transparent dressing every 10 days is not recommended as it may increase the risk of infection due to unnecessary manipulation of the catheter site.

Correct Answer: A

Rationale: The presence of protein in the glomerular filtrate would indicate a problem with renal function because normally, the glomerulus filters out waste products like creatinine and electrolytes like sodium, but retains proteins. If proteins are found in the filtrate, it suggests that the filtration barrier of the kidney is compromised, leading to protein leakage. Creatinine is a waste product that should be filtered out, so its presence alone does not indicate a renal issue. Sodium is an electrolyte that is normally filtered out efficiently, and the presence of red blood cells in the filtrate would indicate a problem with the filtration process rather than renal function. Therefore, only choice A (Protein) is a clear indicator of a problem with renal function.