Gas Exchange PREPU
Parents of a school-age child with asthma express concern about letting the child participate in sports. What will the nurse instruct the parents about the relationship between exercise and asthma? "Asthma attacks are triggered by allergens that trigger bronchoconstriction, not by exercise." "Choose sports that do not require a lot of energy expenditure, because your child has chronically low oxygen levels." "Taking prophylactic medication before the activity can prevent asthma attacks, making exercise safer." "Continuous activities such as jogging are less likely to trigger asthma than intermittent activities such as baseball."
"Taking prophylactic medication before the activity can prevent asthma attacks, making exercise safer." Although exercise may trigger asthma attacks, the nurse should tell the parents that taking prophylactic asthma drugs before beginning the activity can prevent attacks, enabling the child to engage in most sports.
The nurse identifies which finding to be most consistent prior to the onset of acute respiratory distress?
Normal lung function Acute respiratory failure occurs suddenly in clients who previously had normal lung function.
A nurse administers albuterol(Proventil) as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?
Respiratory rate of 22 breaths/minute 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.
An instructor is teaching a class about the disorders that may affect the movement of gases into and out of the lungs. The instructor determines the need for additional teaching when the students identify which condition as being involved? Atelectasis Bronchitis Sinusitis Cystic fibrosis
Sinusitis Sinusitis is an upper respiratory tract disorder that is not associated with altered gas exchange. Bronchitis affects the lower respiratory tract and can affect the movement of air in and out of the lungs. Atelectasis affects the lower respiratory tract and can affect the movement of air in and out of the lungs. Cystic fibrosis affects the lower respiratory tract and can affect the movement of air in and out of the lungs.
The nurse has assessed a 6-year-old child as having respiratory distress due to swelling of the epiglottis and surrounding structures. Which signs and symptoms would support this assessment?
The child is in tripod position. Explanation: Inflammation and swelling of the epiglottis and surrounding structures are common in children ages 2 to 7 years. The child will attempt to improve his/her airway by sitting forward and extending the neck forward with the jaw up, in a "sniffing position" (tripod position). Stridor, tachycardia, and the rapid onset are classical signs of epiglottitis.
During data collection, the nurse auscultates low-pitched, soft sounds over the lungs' peripheral fields. Which appropriate terminology would the nurse use to describe these lung sounds when documenting? Crackles Bronchovesicular Bronchial Vesicular
Vesicular Vesicular breath sounds are normal and described as low-pitched, soft sounds over the lungs' peripheral fields. Crackles are soft, high-pitched, discontinuous popping sounds heard on inspiration. Medium-pitched blowing sounds heard over the major bronchi describe bronchovesicular breath sounds. Bronchial breath sounds are loud, high-pitched sounds heard over the trachea and larynx.
The parents of a child diagnosed with cystic fibrosis (CF) ask about the risk of any future children having the condition. How should the nurse respond?
You have a 25% chance that your next child will have CF.
A patient admitted to the hospital following a motor vehicle crash has suffered a flail chest. A nurse assesses the patient for what most common clinical manifestation of flail chest? a) Paradoxical chest movement b) Wheezing c) Cyanosis d) Hypertension
a. Paradoxical chest movement Explanation: During inspiration, as the chest expands, the detached part of the rib segment (flail segment) moves in a paradoxical manner (pendelluft movement) in that it is pulled inward during inspiration, reducing the amount of air that can be drawn into the lungs. On expiration, because the intrathoracic pressure exceeds atmospheric pressure, the flail segment bulges outward, impairing the patient's ability to exhale. The mediastinum then shifts back to the affected side. This paradoxical action results in increased dead space, a reduction in alveolar ventilation, and decreased compliance. Chapter 23: Management of Patients With Chest and Lower Respiratory Tract Disorders - Page 627 HINKLE
A client with a pleural effusion has a diagnostic thoracentesis. The nurse notifies the healthcare provider immediately upon discovering what assessment finding?
asymmetrical chest expansion Explanation: Of the assessment findings listed, only asymmetrical chest expansion supports the emergent complication of pneumothorax that can occur after a thoracentesis. Other signs and symptoms include tachycardia, pain on inspiration, dyspnea, and a drop in oxygen saturation.
Which of the following medications would the nurse expect to be used to facilitate intubation of the client?
attacurium (Tracrium) Attacurium (Tracrium) is commonly used to facilitate intubation of the surgical client.
A client is brought to the emergency department following a motor vehicle accident. Which of the following nursing assessment is significant in diagnosing this client with flail chest? a) Clubbing of fingers and toes b) Respiratory acidosis c) Paradoxical chest movement d) Chest pain on inspiration
c) Paradoxical chest movement Explanation: Flail chest occurs when two or more adjacent ribs fracture and results in impairment of chestwall movement. Respiratory acidosis and chest pain are symptoms that can occur with flail chest but is not as significant in the diagnosis as paradoxical chest movement. Clubbing of fingers and toes are sign of prolonged tissue hypoxia. pg.612
A nurse working in the neonatal nursery anticipates the primary care provider to prescribe which medication for a premature newborn having difficulty breathing? A) surfactant B) albuteral C) epinephrine D) norepinephrine
A) surfactant Surfactant is a protein that keeps small air sacs in the lungs from collapsing. Its use was introduced in 1990 and continues today, especially for premature babies and those who have respiratory distress syndrome. The other medications are not given to help premature babies breathe.
A client is admitted to the hospital with reports of chest pain. The nurse is monitoring the client and notifies the physician when the client exhibits 1)Troponin levels less than 0.35 ng/mL 2)Adventitious breath sounds 3)Decreased frequency of premature ventricular contractions (PVCs) to 4 per minute 4)A change in apical pulse rate from 102 to 88 beats/min
Adventitious breath sounds The nurse monitors the client's hemodynamic and cardiac status to prevent cardiogenic shock. He or she promptly reports adverse changes in the client's status, such as adventitious breath sounds. The other options are positive changes or indicative that the client did not experience myocardial infarction.
The nurse is caring for the client in the intensive care unit immediately after removal of the endotracheal tube. Which of the following nursing actions is most important to complete every hour to ensure that the respiratory system is not compromised?
Auscultate lung sounds. Major goals of intubation are to improve respirations and maintain a patent airway for gas exchange. Regular auscultation of the lung fields is essential in confirming that air is reaching the lung fields for gas exchange.
An 18-year-old client has given birth in the 28th week of gestation, and her newborn is showing signs of respiratory distress syndrome (RDS). Which statement is true for a newborn with RDS? A)Glucocorticosteroid is given to the newborn following birth. B)RDS is caused by a lack of alveolar surfactant. C)Respiratory symptoms of RDS typically improve within a short period of time. D)RDS is characterized by heart rates below 50 beats per minute.
B) RDS is caused by a lack of alveolar surfactant. Respiratory distress syndrome (RDS) is a serious breathing disorder caused by a lack of alveolar surfactant. Betamethasone, a glucocorticosteroid, is often given to the mother 12 to 24 hours before a preterm birth to help reduce the severity of RDS, not to the newborn following birth. Respiratory symptoms in the newborn with RDS typically worsen within a short period of time after birth, not improve. Diagnosis of RDS is made based on a chest x-ray and the clinical symptoms of increasing respiratory distress, crackles, generalized cyanosis, and heart rates exceeding 150 beats per minute (not below 50 beats per minute).
The student nurse is preparing to assess the fetal heart rate (FHR). She has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's:
Left lower quadrant The best position to auscultate fetal heart tones in on the fetus back. In this position, the best place for the FHR monitor is on the left lower quadrant.
Late symptoms of laryngeal cancer include which of the following. Select all that apply.
Persistent hoarseness Dysphagia Dyspnea Later symptoms include dysphagia, dyspnea, unilateral nasal obstruction or discharge, persistent hoarseness, persistent ulceration, and foul breath. Earlier, the patient may complain of a persistent cough or sore throat and pain and burning in the throat, especially when consuming hot liquids or citrus juices.
The nurse schedules a pulmonary function test to measure the amount of air left in a client's lungs at maximal expiration. What test does the nurse order? Tidal volume (TV) Forced Expiratory Volume (FEV) Residual Volume (RV) Total lung capacity (TLC)
Residual Volume (RV) -During a pulmonary function test the amount of air left in the lungs at the end of maximal expiration is called residual volume (RV) -Tidal volume (TV) refers to the total amount of air inhaled and exhaled with one breath. -Total lung capacity (TLC)is the amount of air contained within the lungs at maximum inspiration. -Forced expiratory volume (FEV) measures the amount of air exhaled in the first second after a full inspiration; it can also be measured at 2 or 3 seconds.
During an assessment, a child exhibits an audible high-pitched inspiratory noise, a tripod stance and intercostal retractions. Using SBAR communication, the nurse notifies the health care provider and states which breath sounds that are congruent with the clinical presentation of the child? Rhonchi throughout the lung Respiratory stridor Wheezing in the bases Rales in the middle lobe
Respiratory stridor -Stridor is a high-pitched, readily audible inspiration noise that indicates an upper airway obstruction. The child presents in severe respiratory compromise and struggles to breathe. -A wheeze is a high-pitched sound heard on auscultation, usually on expiration. It is due to obstruction in the lower trachea or bronchioles. -Rales are crackling sounds heard on auscultation when the alveoli become fluid filled. -Rhonchi is a snoring sound heard throughout the lung field when inflammation occurs.
A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition?
The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. As the acute phase of bacterial pneumonia subsides, normal lung function returns and the PaO2 typically rises, reaching 85 to 100 mm Hg. A PaCO2 of 65 mm Hg or higher is above normal and indicates CO2 retention — common during the acute phase of pneumonia. Restlessness and confusion indicate hypoxia, not an improvement in the client's condition. Bronchial breath sounds over the affected area occur during the acute phase of pneumonia; later, the affected area should be clear on auscultation.
Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for pumping blood to all the cells and tissues of the body? left ventricle left atrium right ventricle right atrium
left ventricle
A victim has sustained a blunt force trauma to the chest. A pulmonary contusion is suspected. Which of the following clinical manifestations correlate with a moderate pulmonary contusion? Blood-tinged sputum Respiratory alkalosis Bradypnea Productive cough
Blood-tinged sputum The most common signs and symptoms are crackles, decreased or absent bronchial breath sounds, dyspnea, tachypnea, tachycardia, chest pain, blood-tinged secretions, hypoxemia, and respiratory acidosis. Patients with moderate pulmonary contusions often have a constant, but ineffective cough and cannot clear their secretions. Ch. 23: Management of Patients With Chest and Lower Respiratory Tract Disorders - Page 626 HINKLE
A ventilated 33 weeks' gestation newborn in the neonatal intensive care unit (NICU) receives surfactant therapy. Which would the nurse expect to assess as a positive response to this therapy? -Glucose is 60 mg/dl (3.3 mmol/L). -Heart rate is 60 bpm. -Oxygen saturation levels are at 98%. -PaCO2 is 35 to 45 mm Hg.
Oxygen saturation levels are at 98%. Explanation: -Rescue treatment is indicated for newborns with established RDS who require mechanical ventilation and supplemental oxygen. The earlier the surfactant is administered, the better the effect on gas exchange with an aim to have the O2 saturation level of 98%. Glucose level assessment does not correlate with this therapy. -The HR of 60 bpm is an abnormal finding and not a positive result of the therapy. -The PaCO2 indicates respiratory acidosis.
A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for:
Pulmonary embolism
An expectant mother of twins has been told there is a strong chance that she will go into labor early and her babies will be premature. In order to increase the chances of having healthy infants, she is given a dose of steroids to stimulate the production of surfactant in the infants' lungs. Surfactant is important for survival of the babies because it reduces:
Surface tension of the respiratory membrane. Surfactant disrupts surface tension by breaking hydrogen bonds in water, thus allowing a reduction of surface tension in smaller alveoli, making lung inflation easier. Surfactant is important for survival of the babies because it reduces surface tension in the lungs which allows an ease of lung inflation. Surfactant does not directly affect gas distribution or alveolar macrophage movement.
A client asks the nurse what anatomic airway dead space is. What would be the nurse's best response? A)The volume of air contained in the nose, pharynx, trachea, and bronchi B)Blood that moves from the right to left side of the cardiopulmonary circulation without being oxygenated C)Blood that circulates from the venous to the arterial side, bypassing the lungs D)The portion of alveolar air that participates in gas exchange
The volume of air contained in the nose, pharynx, trachea, and bronchi Explanation: Dead space refers to the air that must be moved with each breath but does not participate in gas exchange. This volume (about 150 to 200 mL), which remains in the conducting airways of the nose, pharynx, trachea, bronchi, and bronchioles and does not participate in gas exchange, is referred to as anatomic dead space. The movement of air through dead space contributes to the work of breathing but not to gas exchange. Some of the air that enters the respiratory tract during breathing fails to reach the alveoli. Porth. Chapter 21: Control of Respiratory Function - Page 528
Immediately after giving birth to a full-term infant, a client develops dyspnea and cyanosis. Her blood pressure decreases to 60/40 mm Hg, and she becomes unresponsive. What does the nurse suspect is happening with this client? amniotic fluid embolism aspiration placental separation congestive heart failure
amniotic fluid embolism With amniotic fluid embolism, symptoms may occur suddenly during or immediately after labor. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension.
