Unit 4.1 - Gas Exchange: COPD, Sleep Apnea, Acid-Base Balance

A child is admitted to the hospital with pneumonia. What is the priority need that must be included in the nursing plan of care for this child? A) Rest B) Exercise C) Nutrition D) Elimination

A

A client is in a state of uncompensated acidosis. What approximate arterial blood pH does the nurse expect the client to have? A) 7.20 B) 7.35 C) 7.45 D) 7.48

A

A nurse observes a client with acute bronchitis and emphysema sitting up in bed, appearing anxious and dyspneic. What should the nurse do first? A) Provide oxygen at 2 L per minute B) Encourage deep breathing and coughing C) Administer the prescribed sedative and encourage rest D) Suggest breathing into a paper bag for several minutes

A

A client with bronchial pneumonia is having difficulty maintaining airway clearance because of retained secretions. To decrease the amount of secretions retained, what should the nurse do? A) Administer continuous oxygen B) Increase fluid intake to at least 2 L a day C) Place the client in a high-Fowler position D) Instruct the client to gargle deep in the throat using warmed normal saline

B

When suctioning a client with a tracheostomy, an important safety measure for the nurse is to do what? A) Hyperventilate the client with room air before suctioning. B) Apply suction only as the catheter is being withdrawn. C) Insert the catheter until the cough reflex is stimulated. D) Remove the inner cannula before inserting the suction catheter.

B

client with chronic obstructive pulmonary disease (COPD) states, "I have had steady weight loss, and I am often too tired to eat." Which nursing diagnosis would be most appropriate for this client? A) Fatigue related to weight loss secondary to COPD B) Imbalanced nutrition: less than body requirements, related to fatigue C) Imbalanced nutrition: less than body requirements, related to COPD D) Ineffective breathing pattern, related to alveolar hypoventilation

B

Which findings should the nurse expect to see in a client with chronic obstructive pulmonary disease? Select all that apply. A) Elevated levels of partial arterial oxygen B) Elevated levels of eosinophils C) Elevated levels of neutrophils D) Elevated levels of red blood cells E) Elevated levels of peripheral capillary oxygen saturation

B, C, D

The arterial blood gases of a client with chronic obstructive pulmonary disease (COPD) deteriorate, and respiratory failure is impending. Which clinical indicator should the nurse assess first? A) Cyanosis B) Bradycardia C) Mental confusion D) Distended neck veins

C

The registered nurse (RN) delegates a task to a licensed practical nurse (LPN) to take care of the client who underwent a tracheostomy. Which task should be performed by the LPN in this situation? A) Developing a plan to avoid aspiration B) Assessing the client's condition after tracheostomy C) Providing tracheostomy care using sterile techniques D) Teaching a client and caregiver about home tracheostomy care

C

What is a nursing priority to prevent complications in clients with respiratory acidosis? A) Assessing the nail beds B) Listening to breath sounds C) Monitoring breathing status D) Checking muscle contractions

C

The nurse understands that clients with emphysema experience which pathophysiologic change in the alveolar sacs? A) They collapse. B) They retain CO2. C) They become fluid filled. D) They become overdistended.

D

A client is admitted for an exacerbation of emphysema. The client has a fever, chills, and difficulty breathing on exertion. What is the priority nursing action based on the client's history and present status? A) Checking for capillary refill B) Encouraging increased fluid intake C) Suctioning secretions from the airway D) Administering a high concentration of oxygen

B

A nurse is caring for a client who was admitted to the hospital with a diagnosis of chronic obstructive pulmonary disease and is receiving oxygen at 2 L/min via nasal cannula. What is the primary focus of therapy when caring for this client? A) Limiting hydration B) Improving ventilation C) Decreasing exogenous oxygen D) Correcting the bicarbonate deficit

B

A nurse is suctioning a client's tracheostomy. Place the nursing actions in order of priority when performing this procedure. 1.Auscultate the lungs and check the heart rate. 2.Prepare by turning suction on to between 80 and 120 mm Hg pressure. 3.Hyperoxygenate using 100% oxygen. 4.Don sterile gloves. 5.Guide the catheter into the tracheostomy tube using a sterile-gloved hand.

Correct

A client's arterial blood gas report indicates that pH is 7.25, Pco2 is 60 mm Hg, and HCO3 is 26 mEq/L (26 mmol/L). Which client should the nurse consider is most likely to exhibit these blood gas results? A) A 65-year-old with pulmonary fibrosis B) A 24-year-old with uncontrolled type 1 diabetes C) A 45-year-old who has been vomiting for 3 days D) A 54-year-old who takes sodium bicarbonate for indigestion

A

To prevent potential aspiration, what technique should a nurse use when cleaning a tracheostomy tube that has a non-disposable inner cannula? A) Apply precut dressing around the insertion site with the flaps pointing upward. B) Replace the tube with a sterile obturator. C) Use sterile cotton balls to cleanse the outer cannula. D) Remove the tube after the high-volume, low-pressure cuff has been deflated.

A

A client is admitted to the hospital with a diagnosis of restrictive airway disease. The nurse expects the client to exhibit which early signs of respiratory acidosis? Select all that apply. A) Headache B) Irritability C) Restlessness D) Hypertension E) Lightheadedness

A, B, C

A client complaining of fatigue is admitted to the hospital with a diagnosis of chronic obstructive pulmonary disease (COPD). What should the nurse do to prevent fatigue? A) Provide small, frequent meals B) Encourage pursed-lip breathing C) Schedule nursing activities to allow for rest D) Encourage bed rest until energy level improves

C

An older adult client who complains of difficulty breathing after a surgery is found to have decreased vital capacity on spirometry. Which nursing intervention should be performed in this situation? A) Assess the client's mobility. B) Monitor respirations and breathing effort. C) Teach coughing and deep-breathing exercises. D) Determine normal activity levels and note when the client tires.

C

The laboratory data for a client with prolonged vomiting reveal arterial blood gases of pH 7.51, Pco2 of 50 mm Hg, HCO3 of 58 mEq/L (59 mmol/L), and a serum potassium level of 3.8 mEq/L (3.8 mmol/L). The nurse concludes that the findings support what diagnosis? A) Hypocapnia B) Hyperkalemia C) Metabolic alkalosis D) Respiratory acidosis

C

After a gastrectomy, a client has a nasogastric tube to low continuous suction. The client begins to hyperventilate. How does the nurse anticipate that this breathing pattern will alter the client's arterial blood gases? A) Increase the PO2 level B) Decrease the pH level C) Increase the HCO3 level D) Decrease the Pco2 level

D

The nurse hears a series of long, discontinuous low-pitched sounds similar to blowing through a straw under water while auscultating the lungs of a client with chronic obstructive pulmonary disease. What should the nurse document in the client's assessment record based on this finding? A) Rhonchi B) Wheezes C) Fine crackles D) Coarse crackles

D

The nurse provides instructions about how to use a metered-dose inhaler (MDI) to a client with chronic obstructive pulmonary disease. The nurse concludes that additional teaching is needed when the client demonstrates which technique? A) Places the tip of the inhaler just past the lips B) Holds the inspired breath for at least 3 seconds C) Exhales slowly through the mouth with lips pursed slightly D) Inhales rapidly with the lips sealed around the nebulizer opening

D

A 50-year-old client with a 30-year history of smoking reports a chronic cough and shortness of breath related to chronic obstructive pulmonary disease (COPD). The clinical data on admission are as follows: a heart rate of 100, a blood pressure of 138/82, a respiratory rate of 32, a tympanic temperature 36.8 °C, and an oxygen saturation of 80%. Which vital signs obtained by the nurse during the therapy indicates a positive outcome? Select all that apply. A) Radial pulse: 70 B) Temperature: 37 °C C) Respiratory rate: 14 D) Blood pressure: 110/70 E) Oxygen saturation: 92%

C, D, E

The nurse instructs the client admitted for an acute exacerbation of chronic obstructive pulmonary disease (COPD) about the importance of assessing for right-sided heart failure after discharge. What does the nurse instruct the client to assess for? A) Increased appetite B) Clubbing of the nail beds C) Hypertension D) Weight gain

D

A nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD). What complications are associated most commonly with COPD? A) Cardiac problems B) Joint inflammation C) Kidney dysfunction D) Peripheral neuropathy

A

An arterial blood gas report indicates the client's pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L. Which disturbance should the nurse identify based on these results? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis

A

A client with chronic bronchitis smokes one or two cigarettes a day and has not been performing the prescribed pulmonary physiotherapy exercises because they are too tiring. Which is the best response by the nurse? A) "Tell me about your typical day before the exercises were prescribed." B) "Smoking is probably the cause of the severity of your disease at this time." C) "I can't make you stop doing what you are doing, and it's your choice to be sick or well." D) "Your being so sick is probably because of your smoking and your choosing not to exercise."

A

A nurse is teaching breathing exercises to a client with emphysema. What is the reason the nurse should include in the teaching as to why these exercises are necessary to promote effective use of the diaphragm? A) The residual capacity of the lungs has been increased. B) Inspiration has been markedly prolonged and difficult. C) The client has an increase in the vital capacity of the lungs. D) Abdominal breathing is an effective compensatory mechanism and is spontaneously initiated.

A

A specimen for arterial blood gases is obtained from a severely dehydrated 3-month-old infant with a history of diarrhea. The pH is 7.30, Pco2 is 35 mm Hg, and HCO3- is 17 mEq/L (17 mmol/L). What complication does the nurse conclude has developed? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis

A

A client is prescribed albuterol to relieve severe asthma. What adverse effect will the nurse instruct the client to anticipate? Select all that apply. A) Tremors B) Lethargy C) Palpitations D) Visual disturbances E) Decreased pulse rate

A, C

A client is admitted to the hospital with a diagnosis of emphysema. What should the nurse include when teaching the client breathing exercises? A) Spend more time inhaling than exhaling to blow off carbon dioxide B) Perform diaphragmatic exercises to improve contraction of the diaphragm C) Perform sit-ups to strengthen abdominal muscles to improve breathing D) Use abdominal exercises to limit the use of accessory muscles of respiration

B

A client reports to the nurse sleeping until noon every day and taking frequent naps during the rest of the day. What should the nurse do initially? A) Encourage the client to exercise during the day. B) Arrange a referral for a thorough medical evaluation. C) Explain that this behavior is an attempt to avoid facing daily responsibilities. D) Identify that the client is describing clinical findings associated with narcolepsy.

B

A nurse provides smoking-cessation education to a client with chronic obstructive pulmonary disease (COPD). The nurse concludes that the client is ready to quit smoking when the client makes which statement? A) "I'll just finish the carton that I have at home." B) "I'll cut back to a half pack a day." C) "I find that smoking is the only way I can relax." D) "I should find this easy because I don't smoke when I drink."

B

When caring for a client with pneumonia, which nursing intervention is the highest priority? A) Increase fluid intake. B) Employ breathing exercises and controlled coughing. C) Ambulate as much as possible. D) Maintain a nothing-by-mouth (NPO) status.

B

Which intervention should the nurse take immediately when an apnea monitor sounds an alarm 10 seconds after cessation of respirations? A) Assess for changes in skin color B) Use tactile stimuli on the chest or extremities C) Check the monitor for signs of a malfunction D) Resuscitate with a facemask and an Ambu bag

B

A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and PCO2 of 60 mm Hg. These blood gases require nursing attention because they indicate which condition? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis

C

A nurse teaches a client scheduled for a tracheostomy about ways to prevent aspiration during swallowing. Which statement of the client indicates the need for further teaching? A) "I should eat smaller and more frequent meals." B) "I should avoid eating meals when I am fatigued." C) "I should drink more water and other thin liquids." D) "I should keep emergency suctioning equipment close at hand."

C

A registered nurse (RN) is performing a physical examination of a client with chronic obstructive pulmonary disease. Which abnormal nail bed patterns can be expected in this client? A) Spoon-shaped nails B) Transverse depressions in nails C) Softening of nail beds and flat nails D) Red or brown linear streaks in nail bed

C

An obese smoker complains of feeling sleepy during the daytime, waking up tired in the morning, and snoring heavily while sleeping. The client is found to have enlarged tonsils. Which condition may the client have? A) Laryngeal trauma B) Vocal cord paralysis C) Obstructive sleep apnea D) Subcutaneous emphysema

C

The nurse is caring for a client with emphysema. During assessment, the nurse expects to auscultate which type of breath sounds? A) Pleural friction rub B) Crackles and gurgles C) Diminished breath sounds D) Expiratory wheeze and cough

C

The nurse is evaluating the actions of a client with pneumonia performing incentive spirometry. Which action by the client indicates a need for correction? A) Recording the volume of the air inspired B) Performing 10 breaths per session every hour C) Inhaling air fully before inserting the mouthpiece D) Taking a long, slow, deep breath keeping the mouthpiece in place

C

A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute bronchopneumonia. The client is in moderate respiratory distress. The nurse should place the client in what position to enhance comfort? A) Side-lying with head elevated 45 degrees B) Sims with head elevated 90 degrees C) Semi-Fowler with legs elevated D) High-Fowler using the bedside table to rest the arms

D

A client with a history of emphysema develops a respiratory infection and is admitted to the hospital in acute respiratory distress. The client's arterial blood studies indicate pH 7.30, PO2 60 mm Hg, PCO2 55 mm Hg, and HCO3 23 mEq/L (23 mmol/L). How should the nurse interpret these findings? A) Hypocapnia B) Hyperkalemia C) Generalized anemia D) Respiratory acidosis

D

The registered nurse is caring for a client admitted to the hospital with chronic obstructive pulmonary disease. Which assessment by the registered nurse before delegating would help to determine the principle of "right person"? A) "Is the environment conducive for completing the task safely?" B) "Does the licensed practical nurse (LPN) know about polices of the institution?" C) "Can the nursing assistive personnel (NAP) evaluate the client's' condition appropriately?" D) "Does the nursing assistive personnel (NAP) have the knowledge and expertise to perform the task?"

D

The son of a 65-year-old client said, "My father is suffering from chronic lung disease. He wakes suddenly from sleep and is unable to breathe." What condition does the nurse suspect in the client? A) Orthopnea B) Hemoptysis C) Histoplasmosis D) Paroxysmal nocturnal dyspnea

D