Respiratory Disorders
A mother tells the nurse that her 4-year-old child is a very poor eater. What is the nurse's best recommendation for helping the mother increase her child's nutritional intake? 1. Allow the child to feed herself. 2. Use specially designed dishes for children - for example, a plate with the child's favorite cartoon character. 3. Only serve the child's favorite foods. 4. Allow the child to eat a small table and chair by herself.
1. Allow the child to feed herself. RATIONALE: The best recommendation is to allow the child to feed herself because the child's stage of development is the preschool period of initiative. Special dishes would enhance the primary recommendation but wouldn't be an effective approach on their own. It's important to offer new foods and choices, not just serve her favorite foods. Using a small table and chair would also enhance the primary recommendation of allowing the child to feed herself.
A nurse is caring for a client with status asthmatics. Which medication should the nurse prepare to administer? 1. An inhaled beta2-adrenergic agonist 2. An inhaled corticosteroid 3. An I.V. beta2-adrenergic agonist 4. An oral corticosteroid
1. An inhaled beta2-adrenergic agonist RATIONALE: An inhaled beta2-adrenergic agonist helps promote bronchodilation, which improves oxygenation. Although an I.V. beta2-adrenergic agonist can be used, the client needs to be monitored because of the drug's greater systemic effects. The I.V. form is typically used when the inhaled beta2-adrenergic agonist doesn't work. A corticosteroid is slow acting, so its use won't reduce hypoxia in the acute phase.
What is the normal pH range for arterial blood? 1. 7 to 7.49 2. 7.35 to 7.45 3. 7.50 to 7.60 4. 7.55 to 7.65
2. 7.35 to 7.45 RATIONALES: A pH less than 7.35 is indicative of acidosis; a pH above 7.45 indicates alkalosis.
During inspiration, which action occurs? 1. Lungs recoil. 2. Diaphragm descends. 3. Alveolar pressure is positive. 4. Inspiratory muscles relax.
2. Diaphragm descends. RATIONALE: During inspiration, inspiratory muscles contract, the diaphragm descends, alveolar pressure is negative, and air moves into the lungs. The lungs recoil during expiration.
For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action promotes adequate gas exchange? 1. Encouraging the client to drink three glasses of fluid daily 2. Keeping the client in semi-Fowler's position 3. Using a high-flow Venturi mask to deliver oxygen as prescribed 4. Administering a sedative as prescribed
3. Using a high-flow Venturi mask to deliver oxygen as prescribed RATIONALES: The client with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration; administering unspecified, unmonitored amounts of oxygen may depress ventilation, resulting in inadequate gas exchange. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily wouldn't affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Clients with COPD and respiratory distress should be placed in high Fowler's position, and they shouldn't receive sedatives or other drugs that may further depress the respiratory center.
A nurse assessing a client for tracheal displacement should know that the trachea will deviate toward the: 1. affected side in a simple pneumothorax. 2. affected side in a hemothorax. 3. affected side in a tension pneumothorax. 4. contralateral side in a hemothorax.
4. contralateral side in a hemothorax. RATIONALE: The trachea will shift according to the pressure gradients within the thoracic cavity. In tension pneumothorax and hemothorax, accumulation of air or fluid causes a shift away from the injured side. If there is no significant air or fluid accumulation, the trachea won't shift. Tracheal deviation toward the contralateral side occurs in simple pneumothorax when the thoracic contents shift in response to the release of normal thoracic pressure gradients on the injured side.
The nurse must administer theophylline (Theo-Dur) to a client. This drug treats asthma by: 1. depressing the myocardium. 2. decreasing diuresis. 3. improving respiratory drive. 4. relaxing bronchial smooth muscle.
4. relaxing bronchial smooth muscle. RATIONALES: In a reversible obstructive airway disease such as asthma, theophylline and the other methylxanthine agents decrease nonspecific airway reactivity and, in the presence of bronchospasm, relax bronchial smooth muscle. These drugs also directly stimulate the myocardium, cause diuresis, and increase sodium and chloride excretion. In nonreversible obstructive airway disease, such as chronic bronchitis and emphysema, methylxanthine agents stimulate the respiratory drive.
