197) Answer
A. Brain tumor

Rationale
•Assessment findings for a patient with a brain tumor include headache that becomes worse in the morning and with straining and stooping, vomiting, papilledema, seizures, changes in mental status, and altered vision.
•A patient with meningitis has fever, headache, nuchal rigidity, Kernig’s signs and Brudzinski’s signs.
•There can be no skull fracture since there was no history of head trauma.
•A patient with encephalitis can manifest headache, fever, vomiting, and menigeal signs due the inflammation of the brain caused by a virus.

196) ANSWER
C) pH 7.49; PaCO2 36; HCO3- 30; PaO2 90

RATIONALE
Clients who take potassium-wasting diuretics, such as Lasix, are at risk for developing hypokalemia and metabolic alkalosis. Options 1 and 2 are incorrect because they reflect an acidotic state. Option 1 is a respiratory acidosis and option 2 is a respiratory acidosis with partial compensation. Option 4 is incorrect because the primary disturbance is a respiratory alkalosis due to the increased PaCO2 level. Critical words are furosemide and potassium level of 3.2. Recognize the drug is a potassium-wasting diuretic that contributes to metabolic alkalosis. Determine that options 1 and 2 reflect acidosis, and eliminate them. Option 4 is respiratory in nature, so eliminate it.

195)Answer
A. Dysuria and mucopurulent penile discharge

Rationale
•Assessment findings characteristic of urethritis are dysuria, mucopurulent penile discharge, and frequent urination.
•Hematuria suggests traumatic injury or increased permeability of the glomerulus.

194) Answer

A. pH 7.28 PCO2 60 HCO3 26

Rationale

•Because the patient went some time without breathing, PCO2 will be elevated due to retention, causing respiratory acidosis. The bicarb level is normal because the kidneys have not had time to compensate.



Respiratory Acidosis:
•Respiratory system is the cause, for ex. hypoventilation
•Increase in PCO2, decrease in pH
•Compensation – Kidneys reabsorb Bicarb (HCO3)

Metabolic Acidosis:
•Caused by loss of bicarb or a build up of acids, for ex. lactic acidosis, diarrhea, renal failure, ketones, ammonium intoxication. Not caused by respiration.
•HCO3 decreases, pH decreases
•Compensation – hyperventilation to eliminate CO2

Respiratory Alkalosis:
•Caused by excessive ventilation
•Decrease in PCO2, increase in pH
•Compensation – Kidneys excrete HCO3

Metabolic Alkalosis
•Acid (H+) lost from emesis, diuretics. Retention of HCO3 from medications, hyperaldosteronism
•Increase in HCO3, Increase in pH
•Compensation – Respiratory centers are not stimulated, this leads to hypoventilation and CO2 retention

193) Answer
B. Tandem mass spectrometry
Rationale
•All newborns receive a heel stick to test the serum for several metabolic disorders. The tandem mass spectrometry can measure the levels of several amino acids to confirm the presence of PKU.
•The Guthrie test was once used to measure serum phenylalanine levels, but has been replaced with tandem mass spectrometry.
•Liver enzyme analysis can be done to measure the activity of phenylalanine hydroxylase, but this is generally not done.
•Urinalysis can detect ketones in the urine of a child with PKU, however, this does not confirm the diagnosis.

192) Answer

A. Reposition every 2 hours

Rationale

•Bedrest increases the risk of developing pressure ulcers. To reduce this risk, the nurse should reposition the patient every two hours, provide a low-air-loss mattress, and promote the use of a trapeze.

•Elevating the head of bed may increase shear and friction.

•Promoting indepedence will prepare the patient for discharge.

•Fluid intake should be increased to reduce the risk of renal calculi formation.

191) Answer

D. Blurred vision

Rationale

•Bacitracin ointment commonly causes blurred vision, but is usually lasts only a few minutes.

•Amblyopia, or lazy eye, is not associated with the administration of medications.

•Diplopia, or double vision, is not associated with the use of bacitracin.

•Strabismus, a condition when the eyes are not properly aligned, is not associated with the use of bacitracin.