Respiratory Assessment (from AQ-chapter 25)

b (rationale: because thoracentesis involves introduction of a catheter into the pleural space, there is a risk of pneumothorax. Thoracentesis does not carry a significant potential for causing bronchospasm, pulmonary edema, or respiratory acidosis.)

Following a bedside thoracentesis, the nurse will continue to assess the patient for signs and symptoms of which condition? a. bronchospasm b. pneumothorax c. pulmonary edema d. respiratory acidosis

b (rationale: a pt who is given food or fluid before the gag reflex returns may aspirate food or drink and possibly experience respiratory distress as a result. Vital signs, pupil reaction, and breath sounds are routine assessments after a procedure such as a bronchoscopy, but they are secondary to assessing the patient for the return of the gag reflex.)

Following a bronchoscopy, a patient must present with which assessment finding before beginning oral intake of food and fluids? a. stable vital signs b. return of gag reflex c. brisk pupil reaction to light d. clear bilateral breath sounds.

b (rationale: The pt is in respiratory distress. Starting at the lung bases is the preferred method in a patient in respiratory distress, because the increased respiratory rate and shortness of breath may tire the patient easily, limiting patient tolerance for the assessment. Generally, auscultation should proceed from the lung apices to the bases, comparing opposite areas of the chest, unless the patient is in respiratory distress or will tire easily. During any auscultation, the nurse listens to at least one cycle of inspiration and expiration with each placement of the stethoscope.)

In which pattern will the nurse auscultate the chest of a pt with shortness of breath and a respiratory rate of 28 breaths per minutes? a. starting at the apices b. starting at the lung bases c. listening to the entire left side and then right side d. listening to two complete inspiratory and expiratory cycles

b (rationale: palpation is used to determine tracheal position. Auscultation is used to determine breath sounds, both normal (bronchovesicular) and abnormal (adventitious). Percussion is used to assess lung density)

Palpation i used to determine which respiratory assessment finding? a. lung density b. tracheal position c. adventitious sounds d. bronchovesicular sounds

c, d, e (rationale: Pneumonia will present with egophony, bronchophony, and whispering pectoriloquy. Egophony is a test to assess breath sounds It is positive when the pt is asked to pronounce "E" but instead says "A". In bronchophony, the patient is asked to repeat "ninety-nine" several times in a row. If the words are easily understood and are clear and loud, it indicates an abnormal finding. In pectoriloquy, the patient is asked to whisper "one-two-three." If the whisper is heard clearly and distinctly, it indicates an abnormal finding. Wheezes are heard in asthma and there is bronchoconstriction. Stridor is heard in laryngeal diseases due to the obstruction of the larynx or trachea)

Pneumonia will likely present with which breath sounds? Select all that apply. a. stridor b. wheezes c. Egophony d. Bronchophony e. Whispering pectoriloquy

a (rationale: in a patient with pneumothorax, the nurse would find absent fremitus. Increased fremitus is found in pneumonia, in lung tumors, with thick bronchial secretions, and above a pleural effusion. As the patients voice moves through a dense tissue or fluid-filled lungs, the vibration is increased. Decreased fremitus may be found in pleural effusion when the hand is farther from the lung, and in barrel chest where the lung is hyperinflated.)

The nurse expects to note which type of fremitus in a patient with a pneumothorax? a. absent b. normal c. increased d. decreased

b (rationale: the sound of the cough, sputum production, and description, as well as pattern of the coughs occurrence (including acute or chronic) and what its occurrence is related to are the first assessments to be made to determine the severity. Weight loss, activity intolerance, and orthopnea may be related to respiratory or cardiac problems but are not as important when dealing with a cough. Frequency of the cough will not provide a lot of information. Family history can help to determine a genetic cause of the cough. Hematemesis is vomiting blood and is not as important as hemoptysis. Smoking is an important risk factor for chronic obstructive pulmonary disease (COPD) and lung cancer and may cause a cough. Medications and residence location may or may not contribute to a cough.)

The nurse should perform which assessments for a patient complaining of a cough? a. weight loss, activity tolerance, and pattern b. Cough sound, sputum production, and pattern c. frequency, a family history, and hematemesis d. smoking, medications, and residence location

b, d, e (rationale: late manifestations of inadequate oxygenation include use of accessory muscles; cyanosis and cool, clammy skin; and pausing for breath between sentences and words. Mild hypertension, apprehension, and restlessness are early manifestations of inadequate oxygenation.)

The nurse would expect which assessment findings in a patient with late manifestations of inadequate oxygenation? Select all that apply: a. mild hypertension b. use of accessory muscles c. apprehension and restlessness d. cyanosis and cool, clammy skin e. pausing for breath between sentences and words

a, e (rationale: The nurse should ensure that the patients informed consent to the procedure has been signed. The patient should then be positioned upright with feed supported and elbows placed on an over-bed table; this position optimizes needle insertion access. A chest x-ray is usually obtained after and not before the procedure to rule out pneumothorax. The patient should be instructed not to talk or cough during the procedure, because it can cause injury from needle displacement. Withholding food and drink (NPO status) is not required for a thoracentesis.)

Which actions would the nurse perform when preparing a patient for thoracentesis? Select all that apply: a. ensure that informed consent has been signed b. obtain a chest x-ray BEFORE the procedure begins c. instruct the pt to cough vigorously during the procedure d. tell the patient to eat nothing for four hours before the procedure e. have the pt upright with elbows placed on an over-bed table.

a (rationale: a mass in the neck may cause tracheal diversion to the opposite side of the mass. Therefore if the patient has a neck mass in the right side, the nurse is likely to find tracheal deviation to the left side, away from the mass, during palpation. The tracheal deviation would be to the right side, or toward the mass, in the case of lobar atelectasis. The nurse is not likely to see any effect on the patients chest expansion or diaphragm movement because a neck mass would be at a higher anatomical level. Chest expansion would be asymmetrical in instances of atelectasis or a collapsed lung. The diaphragm would be dysfunctional in the instance f phrenic nerve injury.)

Which assessment finding will the nurse expect in a patient who is diagnosed with a mass on the right side of the neck? a. Tracheal deviation to the left b. Tracheal deviation to the right c. Asymmetrical chest expansion d. Dysfunctional diaphragm contraction

b, d (rationale: Tripod position and accessory muscle use indicate moderate to severe respiratory distress. Cyanosis may be related to anemia, decreased oxygen transfer in the lungs, or decreased cardiac output and is an unreliable indicator of respiratory distress. Kussmaul respirations occur when the patient is in metabolic acidosis to increase CO2 excretion. Increased AP diameter occurs with lung hyperinflation from chronic obstructive pulmonary disorder (COPD), cystic fibrosis, or with advanced age)

Which assessment findings would the nurse expect in a patient in acute respiratory distress? Select all that apply a. cyanosis b. tripod position c. kussmaul respirations d. accessory muscle use e. increased anterior-posterior (AP) diameter

a, b, c (rationale: bronchial, vesicular, and bronchovesicular sounds are normal breath sounds. Bronchial sounds are loud and high-pitched and resemble air blowing through a hollow pipe. Vesicular sounds are soft, low-pitched, gently, resulting sounds heard over all lung areas except the major bronchi. Bronchovesicular sounds are medium-pitched sounds heard anteriorly over the mainstem bronchi on either side of the sternum. Bronchophony is an abnormal breath sound and is considered positive (abnormal) if the patient repeats the phrase "ninety-nine" and the words are easily understood and are clear and loud. Whispered pectoriloquy is alos an abnormal breath sound and is considered positive (abnormal) when the patient whispers "one-two-three," and the almost inaudible voice is transmitted clearly and distinctly.)

Which breath sounds would the nurse consider normal? Select all that apply a. Loud, high-pitched sounds resembling air blowing through a hollow pipe b. Soft, low-pitched, gently, rustling sounds heard over all lung areas except major bronchi c. Medium-pitched sounds heard anteriorly over the mainstem bronchi on either side of the sternum d. The patient repeats the phrase "ninety-nine," and the words are easily understood and are clear and loud through the chest e. The patient whispers "one-two-three", and the almost inaudible voice is transmitted clearly and distinctly

c (rationale: tachypnea and clubbing of the fingers support the diagnosis of chronic hypoxemia. Pursed-lip breathing, inability to lie in a flat position, and use of accessory muscles to assist with breathing are findings observed in patients with asthma and COPD. Voluntary decrease in tidal volume to reduce pain on chest expansion is referred to as splinting, which is a common manifestation of chest trauma or pleurisy.)

Which condition is associated with tachypnea and clubbing of the fingers? a. asthma b. chest trauma c. chronic hypoxemia d. COPD

a, c, d (Rationale: False-negative reactions may occur in people who have anergy or are immunosuppressed, those who had a TB infection within 8 to 10 weeks of exposure, those with overwhelming TB infection, and patients who had a recent live virus vaccination, such as one for measles or chickenpox. Positive reactions are more likely to occur in IVDA patients in patients who had recent contact with a person who had TB. Recent antibiotic therapy for MRSA has no direct effect on tuberculin test results.)

Which conditions may cause a false-negative reaction in a tuberculin test? Select all that apply: a. anergy/immunosuppression b. intravenous drug abuse (IVDA) c. overwhelming tuberculosis (TB) infection d. TB infection within 8 to 10 weeks of exposure e. Recent contact with a person who had TB f. Recent antibiotic therapy for methicillin-resistant Staphylococcus aureus (MRSA)

a, b (rationale: Coarse crackles are often auscultated in patients diagnosed with pneumonia or heart failure. Rhonchi are auscultated in patients diagnosed with cystic fibrosis. Wheezes are auscultated when the patient is experiencing bronchospasm. Discontinuous, low-pitched lung sounds are auscultated in patients experiencing interstitial edema.)

Which diagnoses typically present with coarse crackles upon auscultation of the lungs? Select all that apply: a. pneumonia b. heart failure c. cystic fibrosis d. bronchospasm e. interstitial edema

d (rationale: decreased cardiac output causes bluish coloration of the lips, which is a characteristic feature of cyanosis. Wheezing, shortness of breath, and chest tightness are the clinical manifestations of asthma. Finger clubbing is the clinical manifestation of lung cancer and bronchiectasis.)

Which diagnosis does the nurse anticipate for a patient who presents with bluish coloration of the lips? a. asthma b. lung cancer c. bronchiectasis d. decreased cardiac output

d (rationale: these assessment findings indicate COPD. With pneumonia, pleural effusion, and pulmonary edema, percussion would be dull over the affected areas, not hyperresonant.)

Which diagnosis does the nurse expect based on the following respiratory assessment findings? Inspection: Barrel chest, pursed-lip breathing Palpation: diminished excursion Percussion: hyperresonance Auscultation: distant crackles and wheezing a. pneumonia b. pleural effusion c. pulmonary edema d. COPD

c (rationale: dyspnea, cyanosis, fine crackles, and dullness on percussion all support the diagnosis of pulmonary edema. Wheezing and hyperrsonance on percussion support the diagnosis of asthma. Tachypnea, diminished or absent breath sounds, and dullness on percussion support the diagnosis of pleural effusion. Tachypnea, crackles, and resonance on percussion support the diagnosis of pulmonary fibrosis.)

Which diagnosis will the nurse anticipate for a patient who presents with dyspnea, bluish discoloration of the lips, fine crackles on auscultation, and dullness upon percussion of the lung fields? a. asthma b. pleural effusion c. pulmonary edema d. pulmonary fibrosis

a (rationale: With inadequate oxygenation, early manifestations include restlessness, tachypnea, tachycardia, diaphoresis, decreased urinary output, and unexplained fatigue. The unexplained confusion, dyspnea at rest, hypotension, diaphoresis, combativeness, retractions with breathing, cyanosis, decreased urinary output, coma, accessory muscle use, cool and clammy skin, and unexplained fatigue occur as later manifestations of inadequate oxygenation.)

Which early manifestation of distress will the nurse expect in a patient whose arterial blood gas results show the partial pressure of oxygen (PAO2) at 65 mm HG and the arterial oxygen saturation (SAO2) at 80%? a. restlessness, tachypnea, tachycardia, and diaphoresis b. unexplained confusion, dyspnea at rest, hypotension, and diaphoresis c. combativeness, retractions with breathing, cyanosis, and decreased output d. coma, accessory muscle use, cool and clammy skin, and unexplained fatigue

a, b, c (rationale: pulse oximetry helps to measure arterial oxygen saturation (SPO2) through a probe, which can be placed on the finger, toe, ear, or bridge of the nose. SPO2 readings may be inaccurate with a patient with dark skin because the skin color can interfere with transmission of signals from the pulse oximeter to the body tissues. Methemoglobinemia can occur as a result of breathing gases during fire accidents. This form of hemoglobin has less capacity for carrying oxygen and may interfere with the results of the oximeter. An Hgb level of 8.0 mg/dL indicates anemia, which may interfere with the results of pulse oximetry because there would be lower levels of the hemoglobin protein to carry oxygen Soft, pink fingernails are a normal finding in patients, regardless of skin tone, and should not interfere with theSPo2 results. Nails with thick acrylic fingernail polish, however, may not yield accurate results. Blood sugar levels do not interfere with SPO2 results)

Which factors may cause the pulse oximeter to have an inaccurate reading in an African patient who was rescued from a fire? Select all that apply a. the patient has darker skin b. the patient has methemoglobinemia c. the patient has an Hgb level of 8.0 mg/dL d. The patient has soft, pink-colored fingernails. e. The patient has a blood sugar level of 120 mg/dL

b (Rationale: Asthma involves bronchospasms, which can be triggered by many factors including pollens inhaled during outdoor activities such as gardening. Wheezes are continuous, high-pitched squeaking or musical sounds caused by rapid vibration and narrowing of bronchial walls. If the patient has wheezing sounds during auscultation, it indicates the patient may have asthma. Rhonchi sounds are continuous rumbling, snoring, or rattling sounds caused by obstruction of large airways with secretions. This would be seen in instances of cystic fibrosis. Fine crackles are series of short-duration, discontinuous, high-pitched sounds heard just before the end of inspiration, as seen in cases of pulmonary fibrosis and interstitial edema. Coarse crackles are long-duration, discontinuous, and low-pitched, and they are usually caused by air passing through an airway intermittently occluded by mucus, unstable bronchial walls, or folds of mucosa. Coarse crackles can be heard in conditions such as heart failure and pulmonary edema)

Which finding would indicate a need for asthma testing in a patient experiencing chest tightness and acute dyspnea after an afternoon of gardening? a. rhonchi b. wheezes c. fine crackles d. coarse crackles

d (rationale: CT scans may be often performed with contrast medium. These contrast media are excreted through urine; therefore it is important for the pt to have optimal renal function to prevent accumulation of the contrast media in the body. The normal range or serum creatinine level is 0.6 to 1.3 mg/dl; therefore a serum creatinine level of 3.0 mg/dL is very high and indicates renal dysfunction. As a result, the diagnostic test should not be performed on the patient. Hematocrit of 50%, PACOD of 40 mm Hg, and hemoglobin of 14.) g/dL are within normal ranges)

Which laboratory parameter indicates that it is unsafe for a patient to undergo a CT scan? a. hematocrit 50% b. PACO2 40 mm Hg c. Hemoglobin 14.0 g/dL d. Serum Creatinine 3.0 mg/dL

b (rationale: the pt is showing signs and symptoms of inadequate oxygenation. Therefore the first thing that the nurse must do is start oxygen therapy immediately. All the other actions are secondary and performed only if required. Glucose drips are given to increase the intravascular volume. Mannitol should be administered if the intracranial pressure (ICP) is raised. Antihistamines are administered if there is an allergy.)

Which nursing action is the priority for a patient admitted to the hospital with cyanosis, dyspnea, an tachycardia who is sweating and has cold, clammy skin? a. start a glucose drip b. start oxygen therapy c. administer IV mannitol d. Administer antihistamines

a (rationale: priorities for assessment are the patients airway and breathing, both of which may be compromised after bronchoscopy by laryngeal edema. The nurse should keep patient NPO until gag reflex returns and monitor for recovery from sedation. Blood tinged mucus is not abnormal. Airway and breathing assessment supersedes the importance of LOC, pain, heart rate, and BP although the nurse should be assessing these also.)

Which nursing action is the priority for a patient immediately following a bronchoscopy? a. monitor the patient for laryngeal edema b. monitor and manage the patients level of pain c. assess the patients level of consciousness (LOC) d. assess the patients heart rate and BP

d (rationale: following a lung biopsy through TTNA, the patient should be sent for chest x-ray to rule out a pneumothorax, which is a common complication of the procedure. Only after the chest x-ray is done can the patient be told to rest or do deep breathing exercises. Oxygen saturation levels are generally monitored throughout the procedure.)

Which nursing action is the priority for a patient with lung cancer immediately following a lung biopsy through transthoracic needle aspiration (TTNA)? a. allow the patient to take a rest b. measure oxygen saturation levels c. instruct the patient to do deep breathing d. send the patient for a chest x-tray as prescribed

b (rationale: the most common cause for the development of pleural effusion in the patient suffering from malignancy is lymphatic drainage blocked by malignant cells. An allergic reaction may not lead to pleural effusion. Bacterial infection is unlikely in the absence of other signs. Malignancy is not the cause of raised BP.)

Why might a patient with lung cancer develop a pleural effusion? a. allergic reaction to chemotherapy b. lymphatic drainage blocked by malignant cells c. bacterial infection due to compromised immunity d. increased BP due to malignancy

b (rationale: continually assessing a patient for respiratory distress is the most important nursing intervention to perform for a patient receiving a pulmonary function test. The nurse should avoid scheduling the procedure after a meal and giving a bronchodilator an hour before the test. The nurse should also encourage rest after the test and not necessarily before it.)

A nurse must perform which intervention for a pt receiving a pulmonary function test? a. schedule the test to occur after a meal b. assess the pt for respiratory distress c. provide a rest period before the procedure d. give a bronchodilator an hour before the test

a (these assessment findings indicate early pneumonia, which can be imaged looking for consolidation on a chest x-ray. Pulmonary angiogram and ventilation perfusion scanning are done when pulmonary embolism is suspected. Positron emission testing is done for cancer.)

A patient may be sent for which test based on the following assessment information? Inspection: tachypnea and cyanosis palpation: increased tactile fremitus left lower lobe Percussion: dullness over left lobe Auscultation: bronchial sounds a. chest x-ray b. pulmonary angiogram c. positron emission test d. ventilation perfusion scan.

a (rationale: these assessment findings indicate early pneumonia, which can be imaged looking for consolidation on a chest x-ray. Pulmonary angiogram and ventilation perfusion scanning are done with pulmonary embolism is suspected. Positron emissions testing is done for cancer.)

A patient may be sent for which test based on the following respiratory assessment information? Inspection: Tachypnea and cyanosis Palpation: increased tactile fremitus left lower lobe Percussion: dullness over left lower lobe Auscultation: bronchial sounds a. chest x-ray b. Pulmonary angiogram c. positron emissions test (PET) d. Ventilation perfusion scan

c (rationale: CT scans are used in the diagnosis of lesions that are difficult to assess by conventional x-ray studies. Typically, CT scans are helical or spiral. Spiral CT is the primary radiologic test used to diagnose pulmonary embolism. A chest x=ray is used to screen, diagnose, and evaluate changes in the respiratory system. A pulmonary angiogram is most commonly used to visualize vasculature and to provide therapeutic intervention. MRIs are used for diagnosis of lesions that are difficult to assess by CT scan, such as within the lung apex.)

A patient with a suspected pulmonary embolism should be evaluated with which radiology study? a. chest x-ray b. pulmonary angiogram c. CT d. MRI

c (rationale: a sputum study is often used to diagnose bacterial lung infection via culture and sensitivity results. Sputum studies are not used to diagnose asthma, lung cancer, or chronic obstructive pulmonary disease.)

A sputum study will help diagnose which condition? a. asthma b. lung cancer c. bacterial lung infection d. chronic obstructive pulmonary disease (COPD)

a, c, e (rationale: Changes in the respiratory system in the older adult include thickened mucus, decreased chest wall movement, and diminished breath sounds, especially at the lung bases. The PAO2 and SAO2 levels are decreased.)

An older adult may present with which respiratory assessment findings? Select all that apply: a. thicker mucus b. normal partial pressure of oxygen (PAO2) and arterial oxygen saturation (SAO2) c. decreased chest wall movement d. increased breath sounds in lung apices e. diminished breath sounds, particularly at lung bases

a, d, e (rationale: The CT scan involves administering a contrast agent, so the nurse should assess the renal function to determine the safety of contrast administration. The renal function can be assessed by checking the laboratory values of BUN and serum creatinine. The contrast agent is usually an iodine-based compound; therefore the nurse should also check if the patient is hypersensitive to shellfish, because it contains iodine. Checking blood sugar levels and hemoglobin levels are important, but not necessary prior to a CT)

The nurse would perform which assessment prior to a patient undergoing a CT scan? Select all that apply. a. serum creatinine b. blood sugar levels c. blood hemoglobin levels d. blood urea nitrogen (BUN) e. Hypersensitivity to shellfish

d (rationale: when a skin test is administered for TB bacilli, the nurse should chart the site of administration by drawing a diagram of the forearm and hand and labeling the injection sites. The nurse should ensure that the injection is given intradermally. The nurse should circle the area with a pen and instruct the patient not to remove the mark. The diameter of the induration should be measured for reading the test. The reddened flat area is not included in the measurement.)

Which action should the nurse take when administering and reading the tuberculosis (TB) skin test? a. ensure that the injection is given subcutaneously b. do not use a pen around the rest area to mark the site c. include the reddened flat areas on the skin when measuring the induration d. draw a diagram of the forearm and hand and label the injection sites in the patients chart

b, d (rationale: when assessing the effects that a respiratory diagnosis has on activity-exercise patterns, the nurse will ask the patient if walking is impacted by dyspnea and how many flights of steps the patient can walk up before dyspnea occurs. Asking the patient about urinary incontinence with coughing is appropriate when assessing elimination patterns. Asking the patient if the spouse wakes him or up in the middle of the night due to snoring will assess sleep-rest patterns. Asking the patient if he or she feels full quickly when eating assesses the patients nutritional-metabolic pattern.)

Which questions will the nurse ask when assessing the effects of a patients respiratory diagnosis on activity-exercise patterns? Select all that apply: a. are you ever incontinent of urine when you cough b. do you have trouble walking due to shortness of breath c. does your spouse wake you in the middle of the night due to snoring d. how may flights of stairs can you walk up before you are short of breath e. do you ever feel full very quickly when eating due to your breathing issues

c (rationale: Low-pitched sounds heard over normal lungs during percussion indicate resonance. Tympany is a drum-like, loud, empty quality heard over a gas-filled stomach or intestine. Hyperresonance is a loud, lower-pitched sound heard when percussing hyperinflated lungs, which can occur in patients who are experiencing an acute asthma exacerbation.)

Which term refers to a moderately low-pitched sound over the chest with percussion? a. dull b. Tympany c. Resonance d. Hyperresonance

b (rationale: pulse oximetry and the analysis of ABGs are the two methods to determine how well air is transferred. A chest x-ray has no direct effect on the transfer of the air effectiveness. A patients respiratory rate does not affect air transfer. Sputum analysis can help diagnose respiratory conditions but is not involved in assessment of air transfer.)

Which test can determine the efficiency of air transfer in lung and tissue oxygenation in a patient in respiratory distress? a. chest x-ray b. pulse oximetry c. respiratory rate d. sputum analysis

d (rationale: the nurse recommends the tuberculin skin test to check for TB. A lepromin test is done to check for leprosy. A Widal test is useful for diagnosing typhoid infection. A Benedict's test is performed to check urine glucose.)

Which test will be conducted to confirm the diagnosis of tuberculosis (TB) for a patient experiencing a chronic cough? a. widal test b. lepromin test c. benedicts test d. tuberculin test

b, d, e (rationale: the most common conditions presenting with pleural rug are pleurisy, pneumonia, and pulmonary infarct. Pleural rub is caused by the rubbing together of the two layers of the lungs. Asthma and bronchitis present with wheezes and do not manifest as pleural rub.)

With which common conditions might a nurse auscultate a pleural friction rub? Select all that apply. a. asthma b. pleurisy c. bronchitis d. pneumonia e. pulmonary infarct

d (rationale: Gray-colored sputum with specks of brown is a normal finding in an individual who smokes, so no action is required. Administering oxygen therapy, assessing oxygen saturation, and informing the the health are provider are not necessary for this patient.)

Which nursing action would be appropriate for a patient who presents with gray-colored sputum with specks of brown and has a history of smoking? a. inform the health care provider b. administer oxygen therapy to the patient c. assess oxygen saturation through pulse oximetry d. no action is required because it is considered normal

d (rationale: when a patient with type 1 diabetes has hyperglycemia and ketonemia causing metabolic acidosis, the physiologic response is to increase the respiratory rate and tidal volume to blow off excess CO2. Vomiting and increased urination may occur with hyperglycemia, but not as physiologic responses to metabolic acidosis. The heart rate will increase.)

Which physiologic response is expected for a patient experiencing metabolic acidosis secondary to type 1 diabetes mellitus? a. vomiting b. increased urination c. decreased heart rate d. rapid respiratory rate

a (rationale: when assessing the effect of COPD on the patients nutritional-metabolic pattern, the nurse should ask if the patient has experienced any weight loss. Asking about trouble getting to the toilet assesses the effect that COPD has on the patients elimination patterns. Asking the patient about waking in the middle of the night with breathing issues assesses the patients sleep-rest pattern. Asking the patient about paint associated with breathing assesses the patients cognitive-perceptual pattern.)

Which question will the nurse ask when assessing the nutritional-metabolic pattern of a patient with COPD? a. Have you lost any weight recently b. Do you have trouble getting to the toilet c. does your breathing wake you up in the night d. do you have any pain associated with breathing