RN Physiological Adaptation 2 — Questions and Answers
Question 1: A patient with COPD has a PaO2 of 55 mmHg and PaCO2 of 60 mmHg on arterial blood gas. How should the nurse interpret this?
- Respiratory alkalosis with hypoxia
- Compensated metabolic acidosis
- Respiratory acidosis with hypoxemia (Correct answer)
- Metabolic alkalosis
Correct answer: Respiratory acidosis with hypoxemia
Elevated PaCO2 (>45 mmHg) indicates CO2 retention and respiratory acidosis; PaO2 below 60 mmHg confirms hypoxemia, both characteristic of COPD exacerbation.
Question 2: Which nursing action is most appropriate for a patient experiencing status epilepticus?
- Restrain the patient's extremities
- Insert a tongue blade to protect the airway
- Turn the patient to the side and time the seizure (Correct answer)
- Administer oral anticonvulsants immediately
Correct answer: Turn the patient to the side and time the seizure
Positioning the patient laterally prevents aspiration and protects the airway; timing the seizure provides critical data for treatment decisions.
Question 3: A patient with heart failure has crackles in bilateral lung bases, JVD, and peripheral edema. The nurse recognizes these as signs of:
- Right-sided heart failure only
- Left-sided heart failure only
- Both right- and left-sided heart failure (Correct answer)
- Hypovolemic shock
Correct answer: Both right- and left-sided heart failure
Bilateral crackles and orthopnea indicate left-sided failure (pulmonary congestion), while JVD and peripheral edema indicate right-sided failure (systemic congestion).
Question 4: A nurse is caring for a patient with increased intracranial pressure (ICP). Which position is most appropriate?
- Trendelenburg position
- Head of bed elevated 30 degrees with head midline (Correct answer)
- Prone position
- Head of bed flat
Correct answer: Head of bed elevated 30 degrees with head midline
Elevating the head of the bed 30 degrees with the head in midline promotes venous drainage from the brain, reducing ICP.
Question 5: Which assessment finding is most concerning in a patient 24 hours after a spinal cord injury at C5?
- Blood pressure of 98/60 mmHg with bradycardia (Correct answer)
- Temperature of 99.1°F (37.3°C)
- Urine output of 50 mL/hour
- Mild anxiety
Correct answer: Blood pressure of 98/60 mmHg with bradycardia
Hypotension with bradycardia after a high spinal cord injury suggests neurogenic shock due to loss of sympathetic tone, which is a medical emergency.
Question 6: A patient with liver cirrhosis develops sudden onset confusion, asterixis, and fetor hepaticus. The nurse should prepare to administer:
- IV dextrose 50%
- Lactulose (Correct answer)
- Naloxone
- Furosemide
Correct answer: Lactulose
These signs indicate hepatic encephalopathy; lactulose is administered to reduce ammonia absorption by acidifying the colon and promoting bowel elimination.
RN Physiological Adaptation 2
A patient with COPD has a PaO2 of 55 mmHg and PaCO2 of 60 mmHg on arterial blood gas.
How should the nurse interpret this?