NRNP6566 2021 June Week 7 Knowledge Check 1 Latest

NRNP6566 Advanced Care of Adults in Acute Settings I

Week 7 Knowledge Check 1

Question 1          For the following ABGs, identify the level of hypoxemia, the primary acid base disorder, and the type of compensation. Example - acute respiratory acidosis with metabolic alkalosis and severe hypoxemia

ABG Result

pH          pCO2     pO2        HCO3

7.08        54           54           15

Question 2          A 14 year old female asthmatic is brought to the ER in moderate respiratory distress. Her PEF is 55% of predicted. What would your immediate medication orders include?                                       

Question 3          For the following ABGs, identify the level of hypoxemia, the primary acid base disorder, and the type of compensation. Example - acute respiratory acidosis with metabolic alkalosis and severe hypoxemia

ABG Result

pH          pCO2     pO2        HCO3

7.51        39.4        77.3        31.3

Question 4          For the following ABGs, identify the level of hypoxemia, the primary acid base disorder, and the type of compensation. Example - acute respiratory acidosis with metabolic alkalosis and severe hypoxemia

ABG Result

pH          pCO2     pO2        HCO3

7.36        30           80           15

Question 5          A 23-year-old male with Type 1 diabetes presents to the ER complaining of fatigue and malaise. He tells you he has skipped his insulin injections the previous two days. His labs are:

PH          7.10        Na          140         BUN       35

PCO2     10           K             4.1          Crt          1.1

PO2        112         Cl            105         BS           845

HCO3     4              CO2           5           + ketonemia     

What is this patient's acid base status? What is your working diagnosis for this patient?                                 

Question 6          Mr. A is a 25 year old male who comes to the ER complaining of increasing shortness of breath and upper respiratory symptoms – cough, fever, and progressive dyspnea for three days. On exam he appears cyanotic, has respiratory distress and inspiratory crackles over the left base. RR = 40 CXR – left lobar pneumonia. Temp = 102° and WBC = 17,000. ABG and electrolytes:

FIO2       0.21        Hb          14

PH          7.55        Na          140

PCO2     25           K             4.2

PO2        38           Cl            106

HCO3     21           CO2        20

SaO2      78%                        

Why is this patient severely hypoxemic?                                              

Question 7          For the following ABGs, identify the level of hypoxemia, the primary acid base disorder, and the type of compensation. Example - acute respiratory acidosis with metabolic alkalosis and severe hypoxemia

ABG Result

pH          pCO2     pO2        HCO3

7.34        60           52           30

Question 8          A 65-year-old female suddenly becomes hypotensive one day following surgery for a fractured femur. Her ABG before surgery on room air showed a pO2 of 84 and pCo2 of 39.

FIO2       0.21        Hb          11.5

pH          7.47                        

pCO2     32                           

pO2        57                           

HCO3     23                           

SaO2      83%                        

What are the major differential diagnoses to consider as an etiology for the change in her status?           

Question 9          Mr. A is a 25 year old male who comes to the ER complaining of increasing shortness of breath and upper respiratory symptoms – cough, fever, and progressive dyspnea for three days. On exam he appears cyanotic, has respiratory distress and inspiratory crackles over the left base. RR = 40 CXR – left lobar pneumonia. Temp = 102° and WBC = 17,000. ABG and electrolytes:

FIO2       0.21        Hb          14

PH          7.55        Na          140

PCO2     25           K             4.2

PO2        38           Cl            106

HCO3     21           CO2        20

SaO2      78%                        

What is this patient's Aa gradient?                                          

Question 10        A 66 year old male is diagnosed with COPD. His current medications include hydrochlorothiazide 25 mg po daily, lisinopril 20 mg po daily, and Crestor 10 mg po daily. The APRN has ordered salbutamol 4 mg po TID. What side effects may occur?