A nurse is reviewing the ABG results of a client who has COPD. The results include a pH of 7.3 (7.35 to 7.45), PaO2 56 mm Hg (80 to 100 mm Hg), PaCO2 54 mm Hg (35 to 45 mm Hg), HCO3- 26 mEq/L (21 to 28 mEq/L), and SaO2 87%. Which of the following is the correct interpretation of these values?
Compensated metabolic acidosis
Compensated respiratory acidosis
Uncompensated respiratory acidosis
Uncompensated metabolic acidosis
The Correct Answer is C
Rationale:
A. Compensated metabolic acidosis would show a normal pH with a decrease in HCO3- and a decrease in PaCO2.
B. Compensated respiratory acidosis would show a normal pH with an elevated PaCO2 and a compensatory increase in HCO3-.
C. The low pH indicates acidosis, and the elevated PaCO2 suggests that it is respiratory in origin, with the HCO3- remaining normal, indicating no compensation has occurred yet.
D. Uncompensated metabolic acidosis would present with a low pH, low HCO3-, and normal PaCO2.
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Correct Answer is D
Explanation
Rationale:
A. A dry cough is not a common adverse effect associated with ibuprofen and is more related to respiratory issues.
B. An increase in urine output is not a typical adverse effect of ibuprofen; rather, it may indicate a different condition.
C. Muscle stiffness is a symptom of juvenile idiopathic arthritis itself and not specifically an adverse effect of ibuprofen.
D. Asking about stomach pain or bloody stools is crucial as ibuprofen can cause gastrointestinal irritation, ulcers, or bleeding, which are serious adverse effects of long-term use.
Correct Answer is ["A","C","D","E"]
Explanation
Rationale:
A. Administering methylergonovine maleate is indicated if the uterus is boggy (atonic), as it helps to contract the uterus and reduce the risk of postpartum hemorrhage.
B. Massaging a firm fundus is not appropriate; instead, the nurse should massage a boggy (soft) fundus to promote uterine contraction.
C. Documenting fundal height is a necessary action to assess uterine involution and ensure it is progressing as expected after delivery.
D. Observing the lochia during palpation of the fundus is important to assess for any abnormal findings, such as heavy bleeding, which could indicate complications.
E. Determining whether the fundus is midline is crucial; a displaced fundus may indicate bladder distention, which can affect uterine contraction.