Exam III: Gas Exchange & Acid Base Balance

A patient is complaining of slight shortness of breath and lung auscultation reveals the presence of bilateral coarse crackles. The nurse has applied supplementary oxygen by nasal cannula, recognizing that the flow rate by this method should not exceed:

6 L/minute

Gina, a home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition? a. Hypoxia b. Delirium c. Hyperventilation d. Semiconsciousness

Answer A. As the respiratory center in the brain becomes depressed, hypoxia occurs, producing wheezing, bradycardia, and a decreased respiratory rate. Delirium is a state of mental confusion characterized by disorientation to time and place. Hyperventilation (respiratory rate greater than that metabolically necessary for gas exchange) is marked by an increased respiratory rate or tidal volume, or both. Semiconsciousness is a state of impaired consciousness characterized by limited motor and verbal responses and decreased orientation

Nurse Murphy administers albuterol (Proventil), as prescribed, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? a. Respiratory rate of 22 breaths/minute b. Dilated and reactive pupils c. Urine output of 40 ml/hour d. Heart rate of 100 beats/minute

Answer A. In a client with emphysema, albuterol is used as a bronchodilator. A respiratory rate of 22 breaths/minute indicates that the drug has achieved its therapeutic effect because fewer respirations are required to achieve oxygenation. Albuterol has no effect on pupil reaction or urine output. It may cause a change in the heart rate, but this is an adverse, not therapeutic, effect.

An unconscious male client is admitted to an emergency room. Arterial blood gas measurements reveal a pH of 7.30, a low bicarbonate level, a normal carbon dioxide level, a normal oxygen level, and an elevated potassium level. These results indicate the presence of a. Metabolic acidosis b. Respiratory acidosis c. Overcompensated respiratory acidosis d. Combined respiratory and metabolic acidosis

Answer A. In an acidotic condition, the pH would be low, indicating the acidosis. In addition, a low bicarbonate level along with the low pH would indicate a metabolic state. Therefore, options B, C, and D are incorrect.

Nurse Joana is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? a. It helps prevent early airway collapse. b. It increases inspiratory muscle strength c. It decreases use of accessory breathing muscles. d. It prolongs the inspiratory phase of respiration.

Answer A. Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing

A nurse teaches a male client about the use of a respiratory inhaler. Which action by the client indicates a need for further teaching? a. Inhales the mist and quickly exhales b. Removes the cap and shakes the inhaler well before use c. Presses the canister down with the finger as he breathes in d. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed

Answer A. The client should be instructed to hold his or her breath for at least 10 to 15 seconds before exhaling the mist. Options B, C, and D are accurate instructions regarding the use of the inhaler.

A nurse is assessing a male client with chronic airflow limitations and notes that the client has a "barrel chest." The nurse interprets that this client has which of the following forms of chronic airflow limitations? a. Emphysema b. Bronchial asthma c. Chronic obstructive bronchitis d. Bronchial asthma and bronchitis

Answer A. The client with emphysema has hyperinflation of the alveoli and flattening of the diaphragm. These lead to increased anteroposterior diameter, referred to as "barrel chest." The client also has dyspnea with prolonged expiration and has hyperresonant lungs to percussion.

A male client who takes theophylline for chronic obstructive pulmonary disease is seen in the urgent care center for respiratory distress. Once the client is stabilized, the nurse begins discharge teaching. The nurse would be especially vigilant to include information about complying with medication therapy if the client's baseline theophylline level was: a. 10 mcg/mL b. 12 mcg/mL c. 15 mcg/mL d. 18mcg/mL

Answer A. The therapeutic range for the serum theophylline level is 10 to 20 mcg/mL. If the level is below the therapeutic range, the client may experience frequent exacerbations of the disorder. Although all the options identify values within the therapeutic range, option A is the option that reflects a need for compliance with medication.

The amount of air inspired and expired with each breath is called: a. tidal volume. b. residual volume. c. vital capacity. d. dead-space volume.

Answer A. Tidal volume is the amount of air inspired and expired with each breath. Residual volume is the amount of air remaining in the lungs after forcibly exhaling. Vital capacity is the maximum amount of air that can be moved out of the lungs after maximal inspiration and expiration. Dead-space volume is the amount of air remaining in the upper airways that never reaches the alveoli. In pathologic conditions, dead space may also exist in the lower airways

A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations? a. Simple mask b. Non-rebreather mask c. Face tent d. Nasal cannula

Answer B. A non-rebreather mask can deliver levels of the fraction of inspired oxygen (FIO2) as high as 100%. Other modes — simple mask, face tent and nasal cannula — deliver lower levels of FIO2

A female client with interstitial lung disease is prescribed prednisone (Deltasone) to control inflammation. During client teaching, the nurse stresses the importance of taking prednisone exactly as prescribed and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience: a. hyperglycemia and glycosuria. b. acute adrenocortical insufficiency. c. GI bleeding. d. restlessness and seizures.

Answer B. Administration of a corticosteroid such as prednisone suppresses the body's natural cortisol secretion, which may take weeks or months to normalize after drug discontinuation. Abruptly discontinuing such therapy may cause the serum cortisol level to drop low enough to trigger acute adrenocortical insufficiency. Hyperglycemia, glycosuria, GI bleeding, restlessness, and seizures are common adverse effects of corticosteroid therapy, not its sudden cessation.

A nurse is caring for a male client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client? a. Hypocapnia b. A hyperinflated chest noted on the chest x-ray c. Increase oxygen saturation with exercise d. A widened diaphragm noted on the chest x-ray

Answer B. Clinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.

A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed a. 1 L/min b. 2 L/min c. 6 L/min d. 10 L/min

Answer B. Oxygen is used cautiously and should not exceed 2 L/min. Because of the long-standing hypercapnia that occurs in emphysema, the respiratory drive is triggered by low oxygen levels rather than increased carbon dioxide levels, as is the case in a normal respiratory system.

A male elderly client is admitted to an acute care facility with influenza. The nurse monitors the client closely for complications. What is the most common complication of influenza? a. Septicemia b. Pneumonia c. Meningitis d. Pulmonary edema

Answer B. Pneumonia is the most common complication of influenza. It may be either primary influenza viral pneumonia or pneumonia secondary to a bacterial infection. Other complications of influenza include myositis, exacerbation of chronic obstructive pulmonary disease, and Reye's syndrome. Myocarditis, pericarditis, transverse myelitis, and encephalitis are rare complications of influenza. Although septicemia may arise when any infection becomes overwhelming, it rarely results from influenza. Meningitis and pulmonary edema aren't associated with influenza

Which of the following would be most appropriate for a male client with an arterial blood gas (ABG) of pH 7.5, PaCO2 26 mm Hg, O2 saturation 96%, HCO3 24 mEq/L, and PaO2 94 mm Hg? a. Administer a prescribed decongestant. b. Instruct the client to breathe into a paper bag. c. Offer the client fluids frequently. d. Administer prescribed supplemental oxygen.

Answer B. The ABG results reveal respiratory alkalosis. The best intervention to raise the PaCO2 level would be to have the client breathe into a paper bag. All of the other options — such as administering a decongestant, offering fluids frequently, and administering supplemental oxygen — wouldn't raise the lowered PaCO2 level

A male adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Prescribed respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure? a. Immediately before a meal b. At least 2 hours after a meal c. When bronchospasms occur d. When secretions have mobilized

Answer B. The nurse should perform chest physiotherapy at least 2 hours after a meal to reduce the risk of vomiting and aspiration. Performing it immediately before a meal may tire the client and impair the ability to eat. Percussion and vibration, components of chest physiotherapy, may worsen bronchospasms; therefore, the procedure is contraindicated in clients with bronchospasms. Secretions that have mobilized (especially when suction equipment isn't available) are a contraindication for postural drainage, another component of chest physiotherapy.

Nurse Hannah is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will facilitate obtaining the specimen? a. Limiting fluids b. Having the clients take three deep breaths c. Asking the client to split into the collection container d. Asking the client to obtain the specimen after eating

Answer B. To obtain a sputum specimen, the client should rinse the mouth to reduce contamination, breathe deeply, and then cough into a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain sputum. Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning

For a male client with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway? a. Restricting fluid intake to 1,000 ml/day b. Enforcing absolute bed rest c. Teaching the client how to perform controlled coughing d. Administering prescribed sedatives regularly and in large amount

Answer C. Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the client's ability to maintain a patent airway, causing a high risk of infection from pooled secretions.

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

Answer C. 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, and injury to the brain's respiratory center, overventilation with a mechanical ventilator, pulmonary embolism, and early salicylate intoxication. Type 1 diabetes mellitus 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 narcotic overdose suppress the respiratory drive, causing CO2 retention, not CO2 loss; this may lead to respiratory acidosis, not alkalosis.

A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: a. Pleural effusion. b. Pulmonary edema. c. Atelectasis. d. Oxygen toxicity

Answer C. In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn't cause pleural effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn't one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough

A nurse is teaching a male client with chronic respiratory failure how to use a metered-dose inhaler correctly. The nurse instructs the client to: a. Inhale quickly b. Inhale through the nose c. Hold the breath after inhalation d. Take two inhalations during one breath

Answer C. Instructions for using a metered-dose inhaler include shaking the canister, holding it right side up, inhaling slowly and evenly through the mouth, delivering one spray per breath, and holding the breath after inhalation.

Pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? a. Encouraging the client to drink three glasses of fluid daily b. Keeping the client in semi-Fowler's position c. Using a high-flow Venturi mask to deliver oxygen as prescribed d. Administering a sedative as prescribed

Answer C. 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, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. 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 shouldn't receive sedatives or other drugs that may further depress the respiratory center

A female client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? a. pH b. Bicarbonate (HCO3-) c. Partial pressure of arterial oxygen (PaO2) d. Partial pressure of arterial carbon dioxide (PaCO2)

Answer C. The most significant and direct indicator of the effectiveness of oxygen therapy is the PaO2 value. Based on the PaO2 value, the nurse may adjust the type of oxygen delivery (cannula, venturi mask, or mechanical ventilator), flow rate, and oxygen percentage. The other options reflect the client's ventilation status, not oxygenation

A male client is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client? a. Activity intolerance related to fatigue b. Anxiety related to actual threat to health status c. Risk for infection related to retained secretions d. Impaired gas exchange related to airflow obstruction

Answer D. A patent airway and an adequate breathing pattern are the top priority for any client, making impaired gas exchange related to airflow obstruction the most important nursing diagnosis. The other options also may apply to this client but are less important

A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to: a. Promote oxygen intake. b. Strengthen the diaphragm. c. Strengthen the intercostal muscles. d. Promote carbon dioxide elimination.

Answer D. Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation. Options A, B, and C are not the purposes of this type of breathing

At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He's anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client's arterial blood oxygen saturation is 86% and he's still wheezing. The nurse should plan to administer: a. alprazolam (Xanax). b. propranolol (Inderal) c. morphine. d. albuterol (Proventil)

Answer D. The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. The client's greatest need is bronchodilation, which can be accomplished by administering bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. It's given by nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished.

A female client with asthma is receiving a theophylline preparation to promote bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the client's serum theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls within which range? a. 1 to 2 mcg/ml b. 2 to 5 mcg/ml c. 5 to 10 mcg/ml d. 10 to 20 mcg/ml

Answer D. The therapeutic serum theophylline concentration ranges from 10 to 20 mcg/ml. Values below 10 mcg/ml aren't therapeutic.

Select ALL the options that are TRUE about chronic bronchitis and emphysema: A. Patients with chronic bronchitis have the ability to fully exhale but have limited airflow. B. Emphysema and chronic bronchitis are irreversible. C. An incentive spirometer is used to diagnose both chronic bronchitis and emphysema. D. Patients with chronic bronchitis are sometimes referred to as "blue bloaters, while patients with emphysema are sometimes referred to as "pink puffers".

B. & D. The answers are B and D. Option A is wrong because patients with chronic bronchitis DON'T have the ability to fully exhale AND have limited airflow as well. Option C is wrong because SPRIOMETRY is used to diagnose chronic bronchitis and emphysema

A patient is presenting with chronic obstructive pulmonary disease. The patient has a chronic productive cough with dyspnea on excretion. Arterial blood gases show a low oxygen level and high carbon dioxide level in the blood. On assessment, the patient has cyanosis in the lips and edema in the abdomen and legs. Based on your nursing knowledge and the patient's symptoms, you suspect the patient suffers from what type of COPD? A. Emphysema B. Pneumonia C. Chronic bronchitis D. Pneumothorax

C. Chronic bronchitits

True or False: Patients with emphysema experience hypoventilation as a compensatory mechanism to help increase oxygen levels and decrease carbon dioxide levels in the body. True False

False The answer is FALSE. Patients with emphysema experience HYPERventilation as a compensatory mechanism to help increase oxygen levels and decrease carbon dioxide levels in the body.

Long acting Beta Agonists (LABA)

Salumeterol Formeterol promote bronchodilation inhibit/ prevent bronchospasm s/e include: tachycardia, angina, heart palpitations, and tremors

A patient with severe COPD is having an episode of extreme shortness of breath and requests their inhaler. Which type of inhaler ordered by the physician would provide the FASTEST relief for the patient based on this particular situation? A. Spiriva B. Salmeterol C. Symbicort D. Albutero

The answer is D. The patient would best benefit from a SHORT-ACTING bronchodilator to help with the shortness of breath. The only short-acting bronchodilator listed is Albuterol. Spiriva is a long-acting bronchodilator. Symbicort is a combination of long-acting bronchodilator and corticosteroid. Salmeterol is a long-acting bronchodilator

A patient is ordered at 1400 to take Theophylline. You're assessing the patient's morning lab results and note that the Theophylline level drawn this morning reads: 15 mcg/mL. You're next nursing action is to? A. Administer the dose at 1400 as ordered B. Notify the physician for further orders C. Hold the 1400 dose D. Collect another blood sample to confirm the level

The answer is A. A normal Theophylline level is 10-20 mcg/mL...therefore the level is normal and the nurse should administer the dose at 1400 as ordered.

Which of the following is most commonly found in a patient with emphysema? A. Barrel chest B. Cyanosis C. V/Q mismatch D. Excessive productive cough

The answer is A. Cyanosis, V/Q mismatch, and excessive productive cough are found in chronic bronchitis.

You are providing care to a patient with COPD who is receiving medical treatment for exacerbation. The patient has a history of diabetes, hypertension, and hyperlipidemia. The patient is experiencing extreme hyperglycemia. In addition, the patient has multiple areas of bruising on the arms and legs. Which medication ordered for this patient can cause hyperglycemia and bruising? A. Prednisone B. Atrovent C. Flagyl D. Levaquin

The answer is A. Prednisone is a corticosterioid and can cause hyperglycemia and brusing.

An alarm beeps notifying you that one of your patient's oxygen saturation is reading 89%. You arrive to the patient's room, and see the patient comfortably resting in bed watching television. The patient is already on 2 L of oxygen via nasal cannula. The patient is admitted for COPD exacerbation. Your next nursing action would be: A. Continue to monitor the patient B. Increase the patient's oxygen level to 3 L C. Notify the doctor for further orders D. Turn off the alarm settings

The answer is A. This patient is not in any distress from the description provided...therefore, you would continue to monitor the patient. Patients with COPD are stimulated to breathe due to LOW OXYGEN LEVELS rather than high carbon dioxide levels. Therefore, it is normal for patients who have COPD to have an oxygen saturation between 88-93%.....any higher would decrease the stimulation to breathe and they may stop breathing. Therefore, you would not increase the oxygen level to 3 L, notify the doctor, or turn off the alarm settings.

In which of the following conditions below do the alveolar sacs lose elasticity which can lead to "air-trapping": A. Chronic Bronchitis B. Emphysema

The answer is B.

In regards to question 10, which action by the patient demonstrates they know how to properly use this medication? A. The patient rinses their mouth after using the LABA inhaler. B. The patient rinses their mouth after using the ICS inhaler. C. The patient dispenses of the inhalers. D. The patient coughs 2 times after using the ICS inhaler.

The answer is B. The patient should rinse the mouth after using any type of corticosteroid inhalers to remove the medication from the mouth. If left in the mouth, the patient can develop thrush.

A patient is ordered by the physician to take LABA and ICS via inhaler. How should the patient take this medication? A. The patient should use the medications every 2 hours for acute episodes of shortness of breath. B. The patient should use the LABA first and then 5 minutes later the ICS. C. The patient should use the ICS first and then the LABA 5 minutes later. D. The patient should use the medications at the same exact time, regardless of the order

The answer is B. The patient should use the bronchodilator first which is the LABA to open the airways and THEN the corticosteroid. Using the inhalers in this order will allow the corticosteroid to work properly after the lung fields are opened due to bronchodilation.

A patient is newly diagnosed with COPD due to chronic bronchitis. You're providing education to the patient about this disease process. Which statement by the patient indicates they understood your teaching about this condition? A. "If I stop smoking, it will cure my condition." B. "Complications from this condition can lead to pulmonary hypertension and right-sided heart failure." C. "I'm at risk for low levels of red blood cells due to hypoxia and may require blood transfusions during acute illnesses." D. "My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than low oxygen levels.

The answer is B. This is the only correct statement. Option A is wrong because smoking cessation will NOT cure the condition but it may slow down the progress of it. Option C is wrong because the patient may develop HIGH LEVELS of red blood cells due to the body trying to compensate for hypoxia. Option D is wrong because patients with COPD are stimulated to breathe due to LOW OXYGEN LEVELS rather than high carbon dioxide levels.

A patient with emphysema may present with all of the following symptoms EXCEPT? A. Barrel chest B. Hyperinflation of the lungs C. Hypoventilation D. Hypercapnia

The answer is C. Patients with emphysema present with HYPERventilation. The body will try to compensate for the low oxygen blood levels and will cause the patient to hyperventilate. Remember emphysema patients are sometimes called "pink puffers". They will have a barrel chest (due to the use of accessory muscles for breathing), hyperinflation of the lungs (due to damage of the alveoli sacs and creation of air sacs), and hypercapnia (high carbon dioxide levels).

You are providing teaching to a patient with chronic COPD on how to perform diaphragmatic breathing. This technique helps do the following: A. Increase the breathing rate to prevent hypoxemia B. Decrease the use of the abdominal muscles C. Encourages the use of accessory muscles to help with breathing D. Strengthen the diaphragm

The answer is D. Diaphragmatic breathing helps strengthen the diaphragm because it has become flatten due to the hyperinflation of the lungs. Due to the flattening of the diaphragm, the body is unable to breathe with ease and must use the accessory muscles to compensate. Therefore, diaphragmatic breathing helps DECREASE the breathing rate to prevent hypoxemia, INCREASES the use of the abdominal muscles RATHER than accessory muscles and strengthens the diaphragm.

Which of the following statements are incorrect about discharge teaching that you would provide to a patient with COPD? Select-all-that-apply: A. "It is best to eat three large meals a day that are relatively low in calories." B. "Avoid going outside during extremely hot or cold days." C. "It is important to receive the Pneumovax vaccine annually." D. "Smoking cessation can help improve your symptoms."

The answers are A and D. The patient needs to eat high calorie and protein rich meals that are small but frequent. The Pneumovax is definitely recommended for patients with COPD but is given every 5 years (not annually)

Anticholinergics

Tiotropium ipratropium relief of bronchospasm in COPD pt; treat allergen and exercise induced asthma; block muscarinic receptors in bronchi s/e include: hoarseness, dry mouth, increased IOP, and urinary retention rinse mouth to rid foul taste; sip water freq., suck on hard candy, have freq glaucoma checks, and report changes in urinary elimination

A patient is post-opt from knee surgery. The patient has been receiving Morphine 4 mg IV every 2 hours. You notice the patient is exhibiting a respiratory rate of 8 and is extremely drowsy. Which of the following conditions is the patient at risk for? a. Respiratory acidosis b. Respiratory alkalosis c. Hypokalemia d. Metabolic acidosis

a. respiratory acidosis

A client appears flushed and has shallow respirations. The arterial blood gas report shows the following: pH, 7.24; partial pressure of arterial carbon dioxide (PaCO2), 49 mm Hg (6.5 kPa); bicarbonate (HCO3-), 24 mEq/L (24 mmol/L). These findings are indicative of which acid-base imbalance? a. respiratory acidosis b. metabolic alkalosis c. metabolic acidosis d. respiratory alkalosis

a. respiratory acidosis The pH of 7.24 indicates that the client is acidotic. The PaCO2 value of 49 mm Hg is elevated. The HCO3- value of 24 mEq/L is normal. The client is in uncompensated respiratory acidosis. Hypoventilation and a flushed appearance are additional clinical manifestations of respiratory acidosis

A patient on mechanical ventilation has the following blood gases: PaCO2 29, pH 7.56, HCO3 23. Which of the following conditions is the patient experiencing? a. Respiratory alkalosis not compensated b. Respiratory alkalosis partially compensated c. Respiratory alkalosis fully compensated d. Respiratory acidosis partially compensated

a. respiratory alkalosis not compensated

A patient is in high anion gap metabolic acidosis due to diabetic ketoacidosis. Which of the following signs and symptoms would you expect to see in this patient? a. Kussmaul's respirations b. Glucose 110 c. Hypoventilation d. Neuro-excitability

a. Kussmaul's respirations

A patient states they have been vomiting for the last 4 days. The patient is irritable, weak, and reporting muscle cramping and weakness. On assessment, the patient is experiencing bradypnea with a respiratory rate of 10. The patient has the following ABGs result: HCO3 36, pH 7.52, PaCO2 48. Which of the following conditions are presenting? a. Metabolic alkalosis partially compensated b. Metabolic alkalosis fully compensated c. Metabolic acidosis partially compensated d. Metabolic acidosis not compensated

a. metabolic alkalosis partially compensated

Short acting Beta Agonists (SABA)

albuterol levalbuterol promote bronchodilation inhibit/ prevent bronchospasm s/e include: tachycardia, angina, heart palpitations, and tremors

A patient has the following arterial blood gases: HCO3 38, pH 7.50, PaCO2 50. Which of the following signs may this patient exhibit as a compensatory mechanism? a. Hyperventilation (tachypnea) b. Hypoventilation (bradypnea) c. Increased potassium level (hyperkalemia) d. Constipation

b. hypoventilation

A patient is experiencing respiratory alkalosis. What is the most classic sign and symptom of this condition? a. Bradypnea b. Tachypnea c. Bradycardia d. None of the options are correct

b. tachypnea

Inhaled corticosteroids (ICS)

beclamethasone - inhaled (long term) fluticasone - oral PO (short term) budesonide - nasal inhaled prevents release of histamine, leukotrienes, and prostaglandins that cause inflamm. ; decreases action of WBC and edema of airways minimize s/e via spacer and mouth rinsing. (oral candidiasis)

The nurse is assessing an elderly client brought to the emergency department by her spouse. The spouse states, ?She is confused and had trouble when trying to take a breath.? The nurse would next implement which priority nursing intervention for this client who is experiencing these symptoms? a. Call the Physician b. Obtain an ABG c. Obtain baseline vital signs and oxygen saturation d. prepare pt for bronchoscopy

c. obtain baseline vital signs and oxygen saturation Alteration in oxygenation can lead to an altered mental status. The nurse should first obtain baseline vital signs and oxygen saturation to assess the client?s needs. If required after obtaining baseline data, the client may require oxygen therapy and a complete assessment. There is no indication that the client needs a bronchoscopy at this time

mast cell stabilizers

cromolyn - prophylaxis for exercise induced asthma nedocromil- allergy induced asthma treatment of long term asthma; prevent the release and inflammatory actions of WBC, luekotrienes, and histamine watch for possible anaphylaxis

A patient is in metabolic alkalosis due to diuretic therapy. How do you expect the potassium level and bicarbonate level to be affected? a. Increased potassium level and increased bicarb level b. Decreased potassium level and decreased bicarb level c. Increased potassium level and decreased bicarb level d. Decreased potassium level and increase bicarb level

d

The nurse assesses a patient and detects the following findings: difficulty breathing, increased respiratory and pulse rates, and pale skin with regions of cyanosis. What condition would the nurse suspect as causing these respiratory alterations? a. atelectasis b. perfusion c. hyperventilation d. hypoxia

d. hypoxia Hypoxia is a condition in which an inadequate amount of oxygen is available to cells. Difficulty breathing, increased respiratory and pulse rates, and pale skin with regions of cyanosis are all signs of hypoxia. Hyperventilation is an increased rate and depth of ventilation, above the body's normal metabolic requirements. Perfusion refers to the process by which oxygenated capillary blood passes through body tissues. Atelectasis refers to collapsed alveoli

antitussives

supress chronic non-productive cough codiene dextromethorphan s/e include: depressed CNS such as drowsiness and sedations. n/v ; watch for abuse for short term use in the lowest possible dose

Carl, an elementary student, was rushed to the hospital due to vomiting and a decreased level of consciousness. The patient displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. He appears to be dehydrated—his eyes are sunken and mucous membranes are dry—and he has a two week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L. What is your assessment?

metabolic acidosis with partial compensation

leukotrienes

montelukast long term treatment of both forms of asthma work by inhibiting the release of leukotrienes s/e include: headache and impaired liver function comes in both oral and chewable form. this includes granules that can be sprinkled on food

George Kent is a 54 year old widower with a history of chronic obstructive pulmonary disease and was rushed to the emergency department with increasing shortness of breath, pyrexia, and a productive cough with yellow-green sputum. He has difficulty in communicating because of his inability to complete a sentence. One of his sons, Jacob, says he has been unwell for three days. Upon examination, crackles and wheezes can be heard in the lower lobes; he has a tachycardia and a bounding pulse. Measurement of arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg. How would you interpret this?

resp. acidosis, partial compensation

mucolytics

reverses acetaminphen overdose acetylcysteine decreases the viscosity of mucus; helps to cough up mucus s/e include: bronchospasm and aspiration

Methylxanthines

theophylline long term manag. of asthma, chronic bronchitis, and emphysema work by relaxing smooth muscles such as that in the bronchi and pulmonary vessels. has a narrow therapeutic level. s/e include: restlessness, insomnia, dysrhythmia, seizures ; give activated charc. to absorb toxic levels ; limit caffeine use