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Med Surg II_ Midterm (Test)_Latest,100% CORRECT

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Mrs. Jingle, 90-year-old, brought to Emergency Dept. by paramedics with a full code status lives in a Board & Care Facility that provides meals/medications. She's had flu symptoms for 2 days: nausea, vomiting, diarrhea;anorexia. Vital Signs: 92/60 mm Hg, Heart Rate (HR) 115 beats/min., Respiratory Rate (RR) 24/ min., SpO2 90% on room air, Temp PO 102.4°F/39.11°C. Medication HX: Lasix /Furosemide 20 mg PO daily; Lanoxin/Digoxin .25 mg PO daily; Lopressor/ Metoprolol 12.5 mg PO BID. Telemetry monitor shows Sinus Tachycardia. Admitted to ICU with a Mean Arterial Pressure (MAP) of 50 mm Hg. 1) The RN immediately identifies Mrs. Jingle's presenting problem as: A) Increased afterload B) Increased preload C) Decreased preload D) Decreased afterload ● Mrs. Jingle has dehydration → hypovolemia → shock ● caused by N,V, Diarrhea, temp of 102.4F potentially exacerbated by Furosemide (diuretic) ● Clinical manifestations = decreased preload, sinus tach, fever, MAP <60 mmHg, ↑HR, ↓BP, ↑RR, O2 sat↓ ● MAP reflects the average pressure by which vital organs r supplied, or perfused, w/ O2 + nutrients from the blood. ○ When the MAP goes too low it means there is less bld getting to the organs and could cause pt to go into shock. ○ 2) The RN expects that Mrs. Jingle's immediate medical orders will include: A) Nitroprusside Intravenous (IV) to decrease afterload B) Intravenous fluids (IVF) of 0.9% NaCl to increase preload C) Furosemide 20 mg Intravenous Push (IVP) to decrease preload D) Metoprolol 12.5 mg Intravenous Push (IVP) to increase preload 3) Nursing interventions for Mrs. Jingle include A) Arterial line, Chest X-ray, Cardiac Echo B) Bedrest, Swan-Ganz, IV Potassium Chloride C) Fall Risk Precautions, Cooling Measures, Intake & Output D) Complete Metabolic Panel, Urinary Analysis, ABGs 4) Mrs. Jingle's ABGs come back as follows: pH, 7.20; pO2, 106 mm Hg; pCO2, 35 mm Hg; and HCO3-, 11mEq/L. These values are most consistent with: A) Uncompensated Metabolic Acidosis B) Compensated Metabolic Acidosis C) Uncompensated Respiratory Acidosis D) Compensated Respiratory Acidosis The pH indicates acidosis, and the HCO3– is markedly decreased, indicating a metabolic disorder. Uncompensated metabolic acidosis values include a pH below 7.35, PACO2 of 35 to 45 mm Hg, and HCO3– above 22 mEq/L. Uncompensated respiratory acidosis values include a pH below 7.35, PACO2 above 45 mm Hg, and HCO3– of 22 to 26 mEq/L. Uncompensated respiratory alkalosis values include a pH above 7.45, PACO2 below 35 mm Hg, and HCO3– of 22 to 26 mEq/L. Uncompensated metabolic alkalosis values include a pH above 7.45, PACO2 of 35 to 45 mm Hg, and HCO3– above 26 mEq/L. 5) Before discharging Mrs. Jingle, the RN must ensure that

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