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Challenge Question: Medical Surgical Nursing

Mr. Jim a 65 year old retired steel worker is admitted to the unit with dyspnea upon exertion.  He has a long history of smoking.  Initial assessment findings include barrel chest, ankle edema, persistent cough with copious sputum production, and variable wheezing on expiration.  Laboratory test result include a hematocrit greater than 60% and a partial pressure of carbon dioxide in arterial blood (PaCO2) OF 65 mm Hg.  The physican diagnostic chronic obstructive pulmonary disease (COPD)

1.  Mr.Jim’s ankle edema and respiratory problems should make the nurse suspect hypertrophy of which heart chamber?
A. Left atrium
B. Right atrium
C. Left ventricle
D. Right ventricle

2.  The physician prescribes oxygen at 2l/min via nasal cannula.  Which statement best describes why Mr. Jim’s oxygen therapy is maintained at this relatively low level?
A. Prolonged exposure to high oxygen environment causes structural damage to lung tissue
B. Increase oxygen concentration of inspired can cause alveoli to collapse
C. Oxygen therapy can eliminate the stimulus for breathing in a patient with chronic lung disease
D. Oxygen therapy may affect the eyes, causing tearing, edema and visual impairment

3.  The physician orders an Aminophylline IV drip for Mr. Jim.  The nurse should be alert for which signs of toxicity?
A. Depression
B. Tachycardia
C. Lethargy
D. Cyanosis

4.  Arterial blood gas (ABG) measurements reveal a pH of 7.25. PaCO2 of 63 mm Hg and HCO3 level of 22 mEq/L.  The result indicate:
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory Acidosis
D. Metabolic Acidosis

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  1. jeremiah M. Bolneo Reply

    Nice nice .. i like it .. i have applied what ive learned from our lectures

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