NCLEX Practice Exam 3
Anne, who is drinking beer at a party, falls and hits her head on the ground. Her friend Liza dials “911” because Anne is unconscious, depressed ventilation (shallow and slow respirations), rapid heart rate, and is profusely bleeding from both ears. Which primary acid-base imbalance is Anne at risk for if medical attention is not provided?
One of the risk factors of having respiratory acidosis is hypoventilation which may be due to brain trauma, coma, and hypothyroidism or myxedema. Other risk factors include COPD, Respiratory conditions such as pneumothorax, pneumonia and status asthmaticus. Drugs such as Morphine and MgSO4 toxicity are also risk factors of respiratory acidosis.
Acids have no hydrogen ions and are able to bind in a solution.
Acids are substances having one or more hydrogen ions that can be liberated into a solution. Bases are substances that can bind hydrogen ions in a solution.
An adolescent brings a physician’s note to school stating that he is not to participate in sports due to a diagnosis of Osgood-Schlatter disease. Which of the following statements about the disease is correct?
Osgood-Schlatter disease occurs in adolescents in rapid growth phase when the infrapatellar ligament of the quadriceps muscle pulls on the tibial tubercle, causing pain and swelling in the inferior aspect of the knee. Osgood-Schlatter disease is commonly caused by activities that require repeated use of the quadriceps, including track and soccer. Option A: Swimming is not a likely cause. Option B: The condition is usually self-limited, responding to ice, rest, and analgesics. Option D: Continued participation will worsen the condition and the symptoms.
A patient is admitted to the hospital with a diagnosis of primary hyperparathyroidism. A nurse checking the patient’s lab results would expect which of the following changes in laboratory findings?
The parathyroid glands regulate the calcium level in the blood. In hyperparathyroidism, the serum calcium level will be elevated. Option B: Parathyroid hormone levels may be high or normal but not low. Option C: The body will lower the level of vitamin D in an attempt to lower calcium. Option D: Urine calcium may be elevated, with calcium spilling over from elevated serum levels. This may cause renal stones.
pH 7.17, PaCO2 48, HCO3- 36
A nurse in the emergency department is observing a 4-year-old child for signs of increased intracranial pressure after a fall from a bicycle, resulting in head trauma. Which of the following signs or symptoms would be cause for concern?
Increased pressure caused by bleeding or swelling within the skull can damage delicate brain tissue and may become life-threatening. Repeated vomiting can be an early sign of pressure as the vomiting center within the medulla is stimulated. Option A: The anterior fontanel is closed in a 4-year-old child. Option C: Evidence of sleepiness at 10 PM is normal for a four-year-old. Option D: The average 4-year-old child cannot read yet, so this too is normal.
Match the acid-base status of the following blood samples to the disorders in the drop down list. (PaCO2 values are in mm Hg and bicarbonate values in mmol/l). pH 7.57, PaCO2 22, HCO3- 17
A patient admitted to the hospital with myocardial infarction develops severe pulmonary edema. Which of the following symptoms should the nurse expect the patient to exhibit?
Patients with pulmonary edema experience air hunger, anxiety, and agitation. Options A and C: Respiration is fast and shallow and heart rate increases. Option B: Stridor is noisy breathing caused by laryngeal swelling or spasm and is not associated with pulmonary edema.
A nurse is assigned to the pediatric rheumatology clinic and is assessing a child who has just been diagnosed with juvenile idiopathic arthritis. Which of the following statements about the disease is most accurate?
Nonsteroidal anti-inflammatory drugs are important first line treatment for juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis). NSAIDs require 3-4 weeks for the therapeutic anti-inflammatory effects to be realized. Options A and B: Half of children with the disorder recover without joint deformity and about a third will continue with symptoms into adulthood. Option D: Physical activity is an integral part of therapy.
The mother of a 2-month-old infant brings the child to the clinic for a well-baby check. She is concerned because she feels only one testis in the scrotal sac. Which of the following statements about the undescended testis is the most accurate?
Normally, the testes descend by one year of age. In young infants, it is common for the testes to retract into the inguinal canal when the environment is cold or the cremasteric reflex is stimulated. Exam should be done in a warm room with warm hands. It is most likely that both testes are present and will descend by a year. If not, a full assessment will determine the appropriate treatment.
pH 7.39, PaCO2 44, HCO3- 26
pH 7.55, PaCO2 25, HCO3- 22
A patient is scheduled for a magnetic resonance imaging (MRI) scan for suspected lung cancer. Which of the following is a contraindication to the study for this patient?
The implanted pacemaker will interfere with the magnetic fields of the MRI scanner and may be deactivated by them. Option A: Shellfish/iodine allergy is not a contraindication because the contrast used in MRI scanning is not iodine-based. Options C and D: Open MRI scanners and anti-anxiety medications are available for patients with claustrophobia. Psychiatric medication is not a contraindication to MRI scanning.
A nurse caring for several patients on the cardiac unit is told that one is scheduled for implantation of an automatic internal cardioverter-defibrillator. Which of the following patients is most likely to have this procedure?
An automatic internal cardioverter-defibrillator delivers an electric shock to the heart to terminate episodes of ventricular tachycardia and ventricular fibrillation. This is necessary for a patient with significant ventricular symptoms, such as tachycardia resulting in syncope. Option A: A patient with myocardial infarction that resolved with no permanent cardiac damage would not be a candidate. Option B: A patient recovering well from coronary bypass would not need the device. Option D: Atrial tachycardia is less serious and is treated conservatively with medication and cardioversion as a last resort.
A mother is admitted in the emergency department following complaints of fever and chills. The nurse on duty took her vital signs and noted the following: Temp = 100 °F; apical pulse = 95; respiration = 20 and deep. Measurement of arterial blood gas shows pH 7.37, PaO2 90 mm Hg, PaCO2 40 mm Hg, and HCO3 24 mmol/L. What is your assessment?
An individual is considered to have hyperthermia if he or she has a temperature of >37.5 or 38.3 °C (99.5 or 100.9 °F). Measurement of arterial blood gases are normal.
A patient is admitted to the same day surgery unit for liver biopsy. Which of the following laboratory tests assesses coagulation? (Select all that apply)
Please select 3 correct answers
Prothrombin time, partial thromboplastin time, and platelet count are all included in coagulation studies. Option D: The hemoglobin level, though important information prior to an invasive procedure like liver biopsy, does not assess coagulation.