Exam 3

A client is scheduled for endotracheal intubation prior to surgery. What can the nurse tell this client about an endotracheal tube?

"The ET tube will maintain your airway while you're under anesthesia."

The respiratory therapist explains respiratory acidosis to the orientee. The therapist knows the orientee understands the topic when she verbalizes which concept?

"The manifestations of respiratory acidosis often are intermixed with those of oxygen deficit."

An infant with suspected cystic fibrosis is scheduled for a duodenal analysis. The parent asks, "I thought cystic fibrosis affects the lungs. So how will this test help?" Which response by the nurse would be appropriate?

"This test helps show how much of the pancreas is affected."

When describing to parents at a genetic counseling session the probability of their newborn inheriting cystic fibrosis, the nurse would include which statement? Select all that apply.

-"Cystic fibrosis is an inherited disorder where two abnormal genes are needed." -"Children of two carriers of the disorder have a 25% chance of inheriting two normal genes." -"There is a 50% chance of inheriting one normal gene and one abnormal gene."

A nurse is caring for a 17-year-old female client with cystic fibrosis who has been admitted to the hospital for administration of intravenous antibiotics and respiratory treatment for exacerbation of a lung infection. The client states, "I have a number of questions about my future and the consequences of this disease." Which statements about the course of cystic fibrosis are true? Select all that apply.

-Breast development is delayed. -The client is at risk for developing diabetes. -Normal sexual relationships can be expected.

A client is brought to the emergency department by ambulance after a motor vehicle accident in which the client received blunt trauma to the chest. The client is in acute respiratory failure, intubated, and transferred to the intensive care unit (ICU). Which assessment parameters should the nurse monitor most closely? Select all that apply.

-Level of consciousness -Arterial blood gases -Vital signs

Which arterial blood gas (ABG) values tell the nurse a client is in respiratory alkalosis? Select all that apply.

-PCO2 of 27mm Hg (3.59 kPa) -pH 7.52

What information will the nurse need to know in order to calculate a client's anion gap (AG)? Select all that apply.

-Sodium -Chloride -Bicarbonate

A 2-month-old infant is breastfed and diagnosed with cystic fibrosis. The infant is being evaluated for possible pancreatic abnormalities based on which clinical assessment finding(s)? Select all that apply.

-Too much fat in the stools -8 to 10 liquid stools/day -Weight has remained the same as birth

The nurse suspects acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in a client. Which evidence will the nurse apply as supporting the client may have ARDS? Select all that apply.

-diffuse bilateral infiltrates on chest x-ray -rapid onset of symptoms -increase in respiratory rate -hypoxemia refractory to treatment

A woman homozygous for the gene mutation that causes cystic fibrosis, with a partner who does not carry the same mutation, has what chance of having a child with the disease?

0% chance

Which client is at risk for developing acute respiratory failure?

A middle-aged male diagnosed with amyotrophic lateral sclerosis (ALS) who has pneumonia with low O2 saturation

A 41-year-old male client has presented to the emergency department with an acute onset of increased respiratory rate and difficulty breathing. STAT chest X-ray indicates diffuse bilateral infiltrates of his lung tissue and ECG displays no cardiac dysfunction. What is this client's most likely diagnosis?

Acute lung injury

The ICU nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following?

Acute respiratory distress syndrome

You are caring for a client with shock. You are concerned about hypoxemia and metabolic acidosis with your client. What finding should you analyze for evidence of hypoxemia and metabolic acidosis in a client with shock?

Arterial blood gas (ABG) findings

The nurse is caring for a client suspected of having acute respiratory distress syndrome (ARDS). What is the most likely diagnostic test ordered in the early stages of this disease to differentiate the client's symptoms from those of a cardiac etiology?

Brain natriuretic peptide (BNP) level

A man with chronic alcoholism is diagnosed with acute respiratory distress syndrome (ARDS) due to alcohol abuse. Assessment findings include diffuse bilateral infiltrates of the lung tissue and marked hypoxemia. What is the primary physiologic change that results in ARDS?

Epithelial injury with increased permeability of the alveolar-capillary membrane

Which intervention will the nurse anticipate being prescribed to treat an adult admitted to the ICU with acute respiratory distress syndrome (ARDS)?

Increasing oxygen concentration in the inspired air

A client has an increase in her anion gap (AG). What does the nurse determine is the significance of this finding?

It indicates the client has metabolic acidosis.

The nurse is reviewing laboratory data for the client with an anion gap of 17. The nurse recognizes which condition is associated with an increased anion gap mEq/L (mmol/L)?

Lactic acidosis

A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37 mEq/L (37 mmol/L). The nurse suspects the client may be experiencing:

Metabolic alkalosis

A client has hypoxemia of pulmonary origin. What portion of arterial blood gas results is most useful in distinguishing between acute respiratory distress syndrome and acute respiratory failure?

Partial pressure of arterial oxygen (PaO2)

The nurse is caring for a group of clients and is reviewing the arterial blood gas results for each. Which client should the nurse assess first? The client with:

Pneumonia and a PaO2 of 60 mm Hg (7.98 kPa) and a PaCO2 of 40 mm Hg (5.32 kPa)

A client suspected of developing acute respiratory distress syndrome (ARDS) is experiencing anxiety and agitation due to increasing hypoxemia and dyspnea. Which intervention may improve oxygenation and provide comfort for the client?

Position the client in the prone position

A client has been brought to the ED by the paramedics. The client is suspected of having acute respiratory distress syndrome (ARDS). What intervention should the nurse first anticipate?

Preparing to assist with intubating the client

The nurse is assessing a client who, after an extensive surgical procedure, is at risk for developing acute respiratory distress syndrome (ARDS). The nurse assesses for which most common early sign of ARDS?

Rapid onset of severe dyspnea

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances?

Respiratory acidosis

A client who was involved in a workplace accident sustained a penetrating wound of the chest that led to acute respiratory failure. Which goal of treatment should the care team prioritize when planning this client's care?

Restoration of adequate gas exchange

The nurse is caring for a client diagnosed with systemic inflammatory response syndrome. Which illness is likely responsible for this diagnosis?

Sepsis

The condition of a client with metabolic acidosis from an intestinal fistula is not improving. The pulse is 125 beats/min and the BP 84/56 mm Hg. ABG values are: pH 7.1, HCO3- 18 mEq/L (18 mmol/L), PCO2 57 mm Hg (7.58 kPa). What IV medication should the nurse expect to provide next?

Sodium bicarbonate

The nurse is caring for a client with suspected ARDS with a pO2 of 53. The client is placed on oxygen via face mask and the PO2 remains the same. What does the nurse recognize as a key characteristic of ARDS?

Unresponsive arterial hypoxemia

A client admitted with multiple traumatic injuries receives massive fluid resuscitation. Later, the physician suspects that the client has aspirated stomach contents. The nurse knows that this client is at highest risk for:

acute respiratory distress syndrome (ARDS).

A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm?

kinking of the ventilator tubing

The nurse is admitting a client with newly diagnosed diabetes mellitus and left-sided heart failure. Assessment reveals low blood pressure, increased respiratory rate and depth, drowsiness, and confusion. The client reports headache and nausea. Based on the serum laboratory results, how would the nurse interpret the client's acid-base balance?

metabolic acidosis

A client in the emergency department reports that they have been vomiting excessively for the past 2 days. The client's arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance?

metabolic alkalosis

A nurse assesses arterial blood gas results for a patient in acute respiratory failure (ARF). Which results are consistent with this disorder?

pH 7.28, PaO2 50 mm Hg

The nurse is caring for a client with metabolic alkalosis. Which of these arterial blood gas results supports this diagnosis?

pH of 7.50 and HCO3 of 45 mEq/L (45 mmol/L)

The nurse is caring for a client with acute respiratory distress syndrome. What portion of arterial blood gas results does the nurse find most concerning, requiring intervention?

partial pressure of arterial oxygen (PaO2) of 69 mm Hg

A client is admitted to the ED after a near-drowning accident. The client is diagnosed with saltwater aspiration. The nurse will observe the client for several hours to monitor for symptoms of

pulmonary edema

A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn, yielding the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect?

respiratory acidosis

The nurse is caring for a 3-year-old client being treated for severe status asthmaticus. After comparing clinical manifestations with laboratory results (reported below), a nurse determines evidence that this client has progressed to which condition?

respiratory acidosis

A client comes to the emergency department with status asthmaticus. The client's respiratory rate is 48 breaths/minute, and the client is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3--) of 26 mEq/L. What disorder is indicated by these findings?

respiratory alkalosis

An unconscious client is admitted and his diagnoses include metabolic acidosis. When determining the etiology of the client's metabolic acidosis, the care team will assess:

the client's anion gap.

With acute respiratory distress syndrome (ARDS), a client progressively increases his work of breathing. The physiologic principle behind this respiratory distress is related to:

the stiffening of the lung, making it more difficult to inflate.

Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by:

ventilation-perfusion mismatch.