A patient with chronic obstructive pulmonary disease (COPD) presents with acute exacerbation and severe dyspnea. Arterial blood gas (ABG) analysis reveals pH 7.28, PaO2 55 mmHg, PaCO2 65 mmHg, and HCO3- 30 mEq/L. Which of the following acid-base disturbances is most likely present in this patient?

Correct Answer: A

Rationale: In this case, the patient is experiencing respiratory acidosis as indicated by the low pH (7.28), elevated PaCO2 (65 mmHg), and elevated HCO3- (30 mEq/L). The primary acid-base disturbance is respiratory acidosis due to the retention of carbon dioxide (PaCO2 >45 mmHg) leading to an increase in HCO3- as a compensatory mechanism to maintain pH within normal limits. The elevated HCO3- levels (metabolic compensation) are trying to counterbalance the increased PaCO2 levels (respiratory acidosis) by increasing bicarbonate to attempt to normalize the pH. Overall, the ABG analysis shows respiratory acidosis with metabolic compensation in this COPD patient with an acute exacerbation and severe dyspnea.

Correct Answer: A

Rationale: The response indicating Annie's present condition would be option A. This is because the symptoms mentioned in option A, such as experiencing vertigo, nausea, and nystagmus when sitting, point towards a vestibular disorder. These are symptoms commonly associated with conditions like Meniere's disease or vestibular neuritis, which can cause balance issues and feelings of dizziness. These symptoms are more indicative of Annie's current health status compared to the other options which focus on past or unrelated issues, such as ear pain during travel or impaired hearing since birth. The information provided in option A gives a more direct insight into Annie's present condition, making it the most appropriate response.

Correct Answer: D

Rationale: Speaking up on behalf of the patient to ensure their needs are met is a key action that demonstrates advocacy by the nurse. Advocacy involves actively supporting and safeguarding the rights of the patient, ensuring that their best interests are being considered within the healthcare system. This may include advocating for appropriate treatment, services, resources, or respect for the patient's autonomy and decision-making. By speaking up for the patient, the nurse is acting as their voice and championing their well-being.

Correct Answer: C

Rationale: The night nurse is expected to collect the patient charts from various departments every three nights. Among the tasks listed, binding the charts as they are is not typically a responsibility of the night nurse. This task is usually handled by administrative staff or professional medical records technicians who are trained to manage the organization and storage of patient charts. The night nurse's primary focus should be on ensuring the correct order of the charts, checking for completeness, and addressing any issues such as torn pages by taping or repairing them to maintain the integrity of the patient records.

Correct Answer: B

Rationale: The correct information for the nurse to include in patient education about aspirin therapy is to advise the patient to avoid using nonsteroidal anti-inflammatory drugs (NSAIDs) while taking aspirin. NSAIDs can increase the risk of gastrointestinal bleeding when taken along with aspirin, which is already a blood-thinning medication due to its antiplatelet effects. Patients with coronary artery disease are typically prescribed aspirin for its antiplatelet properties to prevent blood clot formation in the arteries. Avoiding NSAIDs will help reduce the risk of gastrointestinal complications and ensure the effectiveness of aspirin therapy in preventing cardiovascular events. Taking aspirin with a full glass of milk (Option A) is not a necessary instruction for aspirin therapy. Discontinuing aspirin therapy if a patient develops a fever (Option C) is not a standard practice unless advised by a healthcare provider. Taking aspir

Correct Answer: B

Rationale: The nurse's priority action after noticing a sudden drop in blood pressure after administering anesthesia is to assess the patient's airway, breathing, and circulation (ABCs). This is crucial to determine the immediate cause of the sudden drop in blood pressure and to ensure the patient's safety and stability. Assessment of the ABCs will help identify any potential airway obstruction, respiratory distress, or circulatory issues that may be contributing to the drop in blood pressure. Once the assessment is done, appropriate interventions can be initiated to stabilize the patient's condition. Administering vasopressors, documenting the blood pressure readings, and notifying the anesthesiologist are important actions but assessing the ABCs takes precedence in this situation to ensure the patient's immediate needs are addressed.

Correct Answer: B

Rationale: Albuterol, also known as salbutamol, is a beta-adrenergic agonist medication commonly used for the treatment of conditions such as asthma and COPD. As a beta-adrenergic agonist, albuterol binds to beta-2 adrenergic receptors in the lungs, causing bronchodilation, which helps to relieve bronchospasms and improve airflow to the lungs. This action leads to the relaxation of smooth muscle in the airways, thus making breathing easier for patients with COPD or asthma. Anticholinergics, corticosteroids, and methylxanthines have different mechanisms of action and are not directly related to the pharmacological action of albuterol in COPD treatment.

Correct Answer: A

Rationale: Breastfeeding is actually a protective factor against acute otitis media (AOM) in children due to the antibodies and nutrients present in breast milk that help strengthen the immune system and the Eustachian tube function. Swimming, exposure to cigarette smoke, and poor hygiene are all risk factors for AOM. Swimming can introduce water into the ears, which can lead to infections. Exposure to cigarette smoke can irritate the mucous membranes in the respiratory tract and increase the risk of infections. Poor hygiene can lead to the spread of bacteria that can cause AOM.

Correct Answer: B

Rationale: The nurse's priority when a patient appears confused and disoriented during a consultation is to provide clear and simple explanations and assess for any underlying causes of confusion. It is essential to ensure that the patient understands the information being provided and to address any potential reasons for the confusion, such as medication side effects, medical conditions, or cognitive impairment. Ignoring the patient's confusion or assuming they cannot understand can lead to misunderstandings, errors in care, and ultimately jeopardize the patient's well-being. It is crucial to approach the situation with empathy, patience, and a focus on ensuring effective communication and understanding between the nurse and the patient.