Practice Questions- Exam 3 NUR 211

Tests to diagnose asthma include:

*-Pulmonary function test* to reveal signs of obstructive airway disease *-Serum immunoglobulin* to detect elevated levels of IgE *-CBC* to reveal high eosinophil levels *-ABGs* to detect hypoxemia *-Skin tests* to determine allergens *-Pulse ox* to reveal decreased O2 saturation

Which ventilator mode provides full ventilatory support by delivering a present tidal volume and respiratory rate? Assist control IMV SIMV Pressure support

*Assist-control ventilation* provides full ventilator support by delivering a preset tidal volume and respiratory rate. IMV provides a combination of mechanically assisted breaths and spontaneous breaths. SIMV delivers a preset tidal volume and number of breaths per minute. Between ventilator-delivered breaths, the patient can breathe spontaneously with no assistance from the ventilator for those extra breaths. Pressure support ventilation assists SIMV by applying a pressure plateau to the airway throughout the client-triggered inspiration to decrease resistance within the tracheal tube and ventilator tubing.

A nurse is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which intervention will most likely lower the client's arterial blood oxygen saturation? Use of a cooling blanket Incentive spirometry Endotracheal suctioning Encouragement of coughing

*Endotracheal suctioning* removes secretions as well as gases from the airway and lowers the arterial oxygen saturation (SaO2) level. Coughing and using an incentive spirometer improve oxygenation and should raise or maintain oxygen saturation. Because of superficial vasoconstriction, using a cooling blanket can lower peripheral oxygen saturation readings, but SaO2 levels wouldn't be affected.

Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? Extreme anxiety Type 1 diabetes mellitus Myasthenia gravis Opioid overdose

*Extreme anxiety* may lead to respiratory alkalosis by causing hyperventilation, which results in excessive carbon dioxide (CO2) loss. Other conditions that may set the stage for respiratory alkalosis include fever, heart failure, injury to the brain's respiratory center, overventilation with a mechanical ventilator, pulmonary embolism, and early salicylate intoxication. Type 1 diabetes may lead to diabetic ketoacidosis; the deep, rapid respirations occurring in this disorder (Kussmaul's respirations) don't cause excessive CO2 loss. Myasthenia gravis and opioid overdose suppress the respiratory drive, causing CO2 retention, not CO2 loss; this may lead to respiratory acidosis, not alkalosis.

A client severely injured in a motor vehicle accident is rushed to the health care facility with severe head injuries and profuse loss of blood. Which sign indicates approaching death? The client's breathing becomes noisy. The client is calm and peaceful. The frequency of urination decreases. The arms and legs are warm to touch.

*Noisy breathing,* or death rattle, is common during the final stages of dying because of the accumulation of secretions in the lungs. Reduced urination is not seen during the final stages of dying. Instead, the client develops loss of control over bladder and bowels due to loss of neurological control. The peripheral parts of the client's body such as the arms and the legs are cold to touch (not warm) because the circulation is directed away from the periphery and toward the core of the body. Clients in the last stages of dying are usually not calm and peaceful; they occasionally exhibit sudden restlessness due to hunger for oxygen.

A client has been receiving 100% oxygen therapy by way of a nonrebreather mask for several days. Now the client complains of tingling in the fingers and shortness of breath, is extremely restless, and describes a pain beneath the breastbone. What should the nurse suspect? Oxygen toxicity Hypoxia Oxygen-induced hypoventilation Oxygen-induced atelectasis

*Oxygen toxicity* may occur when too high a concentration of oxygen (greater than 50%) is administered for an extended period (longer than 48 hours) (Urden, Stacy, & Lough, 2014). Signs and symptoms of oxygen toxicity include substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar infiltrates evident on chest x-rays.

Which of the following are possible side effects of *zodovudine (AZT)? 1. fatigue, malaise, headache, rash, seizures 2. painful peripheral neuropathy, pancreatitis, thrombocytopenia 3. Elevations in alanine and aspartate aminotransferases and cardiomyopathy 4. fever, night sweats, non productive cough, progressive SOB

1

The nurse cares for the client diagnosed with chronic obstructive pulmonary disease (COPD) receiving oxygen via nasal prongs. When the nurse enters the room, the client's wife states, "My husband's oxygen was set so low, it can't be helping him. I set it higher." The flow meter now reads 7 liters per minute. Which is the BEST INITIAL action for the nurse to take? 1.Assess the client's respiratory status. 2.Thank the client's wife for catching the error. 3. Explain to the client's that a COPD client's respiratory stimulus is related to hypoxia, and that raising the oxygen level in the client's blood may remove the stimulus for breathing. 4. Ask the client if he feels better now that he is receiving more oxygen.

1 is correct, always assess first. Then 3, explain the rationale to the wife to ensure this action doesn't happen again.

The nurse is assisting a pregnant client who has just underwent a nonstress test that was ruled reactive. Which factor will the nurse point out when questioned by the client about the results? A. The fetal heart rate increases with activity and indicates fetal well-being. B. There is no evidence of congenital anomalies or deformities. C. The results indicate a stress test is needed for further evaluation. D. The fetus is developing at a fast rate but doing fine.

A

A nurse is interviewing a mother who is about to give birth. Which response would alert the nurse for a higher potential for a heart defect in the newborn? The mother has seizures, but did not take medication while pregnant. The mother states she has lupus. The mother states she took acetaminophen while pregnant. The mother states she slept all the time while pregnant.

A health history should be obtained from the pregnant woman. This history should include having problems during birth of any previous children, frequent infections, chromosomal abnormalities, having a premature birth, having an autoimmune disaease or taking long-term medications such as corticosteroids. *Having lupus* while pregnant could contribute to a congenital heart defect. Acetaminophen and sleeping do not affect the newborn's potential for developing a heart defect. The seizure medication can have an impact on the newborn having a heart defect, but not necessarily a history of seizures in the mother. A seizure in the mother would be more related to hypoxia in the newborn than a heart defect.

Ventilators: volume modes

ACV & SIMV

Which are characteristics of autonomic dysreflexia? severe hypotension, slow heart rate, anxiety, dry skin severe hypertension, tachycardia, blurred vision, dry skin severe hypertension, slow heart rate, pounding headache, sweating severe hypotension, tachycardia, nausea, flushed skin

Autonomic dysreflexia is an exaggerated sympathetic nervous system response. Hypertension, tachycardia, bradycardia, and flushed skin would occur.

The nursing instructor is teaching students about types of lung cancer. Which type of lung cancer is characterized as fast growing and can arise peripherally? Adenocarcinoma Squamous cell carcinoma Large cell carcinoma Bronchoalveolar carcinoma

Large cell carcinoma is a fast-growing tumor that tends to arise peripherally. Bronchoalveolar cell cancer arises from the terminal bronchus and alveoli and usually grows slowly. Adenocarcinoma presents as peripheral masses or nodules and often metastasizes. Squamous cell carcinoma arises from the bronchial epithelium and is more centrally located.

Ventilators: pressure modes

Pressure support ventilation (PSV) & pressure controlled ventilation (PCV)

A nurse attempts to count the respiratory rate of a client via inspection and finds that the client is breathing at such a shallow rate that it cannot be counted. What is an alternative method of determining the respiratory rate for this client? Use a pulse oximeter to count the respirations for 1 minute. Palpate the posterior thorax excursion, count respirations for 30 seconds, and multiply by 2. Auscultate lung sounds, count respirations for 30 seconds, and multiply by 2. Monitor arterial blood gas results for 1 minute.

Sometimes it is easier to count respirations by *auscultating the lung sounds for 30 seconds and multiplying the result by 2.* Palpating the posterior thorax excursion detects vibrations in the lungs. Pulse oximeter and arterial blood gas results assess respiratory effectiveness, not respiratory rate.

The nurse is instructing a client who is scheduled for a laryngectomy about methods of laryngeal speech. Which best describes tracheoesophageal puncture (TEP)? It will result in a low, gruff-sounding voice. It enables the client to form words with the lips. It requires the insertion of a prosthesis into the trachea. It requires the client to hold a throat vibrator against the neck.

TEP requires a surgical *opening in the posterior wall of the trachea, followed by the insertion of a prosthesis such as a Blom-Singer device*. An artificial larynx is a throat vibrator held against the neck that projects sound into the mouth. With esophageal speech, the client forms words with the lips. Esophageal speech causes the voice quality to be lower pitched and gruff sounding.

At a certain point, the brain's ability to autoregulate becomes ineffective and decompensation (ischemia and infarction) begins. Which of the following are associated with Cushing's triad? Select all that apply. Bradypnea Bradycardia Hypotension Hypertension Tachycardia

The *bradycardia, hypertension, and bradypnea* associated with this deterioration are known as Cushing's triad, a grave sign. At this point, herniation of the brainstem and occlusion of the cerebral blood flow occur if therapeutic intervention is not initiated immediately.

What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa? Alteration in bowel elimination due to side effects of the medication Alteration in nutrition due to poor intake of iron Altered skin integrity due to the disease process Impaired tissue oxygenation related to anemia

The most appropriate priority nursing diagnosis is impaired tissue oxygenation related to anemia. The other diagnoses are not specific to the reason that epoetin is prescribed or the specific side effects of the medication.

The nurse is caring for a patient in the ED who is breathing but unconscious. In order to avoid an upper airway obstruction, the nurse is inserting an oropharyngeal airway. How would the nurse insert the airway? At an angle of 90 degrees With the convex portion facing upward Upside down and then rotated 180 degrees With the concave portion touching the posterior pharynx

The nurse should insert the oropharyngeal airway with the tip facing up toward the roof of the mouth until it passes the uvula and then rotate the tip 180 degrees so that the tip is pointed down toward the pharynx. This displaces the tongue anteriorly, and the patient then breathes through and around the airway.

Pressure support ventilation (PSV)

assist spontaneous breathing; delivers preset pressure throughout the inspiratory phase decreases work of breathing; *is used for weaning*

Symptoms of emphysema include:

dyspnea on exertion, barrel chest, prolonged expiration, decreased breath sounds

Symptoms of bronchitis include:

productive cough, dyspnea, cyanosis, use of accessory muscles

SIMV (synchronized intermittent mandatory ventilation)

rate and volume are preset; *spontaneous breath*, volume is determined by the patient's effort

ACV (assist control ventilation)

rate and volume preset; *spontaneous breaths*; full volume is delivered

pressure controlled ventilation (PCV)

used to control plateau pressures when compliance is decreased *(ARDS)* preset pressure rate (I to E); *sedation or NMB indicated*