Respiratory Questions

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? A) Respiratory acidosis B) Respiratory alkalosis C) Metabolic alkalosis D) Metabolic acidosis

A. Respiratory acidosis As staticus asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

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? A) Respiratory acidosis B) Metabolic alkalosis C) Respiratory alkalosis D) Metabolic acidosis

A. Respiratory acidosis The pH is below 7.40, PaCO2 is greater than 40, and the HCO3 is normal; therefore, respiratory acidosis exists and compensation by the kidneys has not begun, which indicates this was probably an acute event. The HCO3 of 24 is within the normal range so it is not metabolic alkalosis. The pH of 7.21 indicates acidosis, not alkalosis. The pH of 7.21 indicates it is an acidosis but the HCO3 of 24 is within the normal range, ruling out metabolic acidosis.

A 79-year-old client is admitted to the hospital with a diagnosis of bacterial pneumonia. While obtaining the client's health history, the nurse learns that the client has osteoarthritis, follows a vegetarian diet, and is very concerned with cleanliness. Which client information would most likely be a predisposing factor for the diagnosis of pneumonia? A) age B) osteoarthritis C) vegetarian diet D) daily bathing

A. age The client's age is a predisposing factor for pneumonia; pneumonia is more common in elderly or debilitated clients. Other predisposing factors include smoking, upper respiratory tract infections, malnutrition, immunosuppression, and the presence of a chronic illness. Osteoarthritis, a nutritionally sound vegetarian diet, and frequent bathing are not predisposing factors for pneumonia.

A nurse is caring for a client after a thoracotomy for a lung mass. Which nursing diagnosis should be the first priority? A) Impaired airway clearance B) Impaired gas exchange C) Impaired physical mobility D) Ineffective breathing pattern

B) Impaired gas exchange Impaired gas exchange should be the nurse's first priority because of the lack of ventilation due to the surgical procedure and pain. The other options as not first priorities.

Before weaning a client from a ventilator, which assessment parameter is the most important for the nurse to obtain? A) Fluid intake for the past 24 hours B) Baseline arterial blood gas (ABG) levels C) Prior outcomes of weaning D) Electrocardiogram (ECG) results

B. Baseline arterial blood gas (ABG) levels Before weaning the client from mechanical ventilation, it's most important to have baseline ABG levels. During the weaning process, ABG levels will be checked to assess how the client is tolerating the procedure. Other assessment parameters are less critical. Measuring fluid volume intake and output is always important when a client is being mechanically ventilated. Prior attempts at weaning and ECG results are documented on the client's record, and the nurse can refer to them before the weaning process begins.

Which finding is an expected outcome for an elderly client following treatment for bacterial pneumonia? A) a respiratory rate of 25 to 30 breaths/min B) the ability to perform activities of daily living without dyspnea C) a maximum loss of 5 to 10 lb (2 to 5 kg) of body weight D) chest pain that is minimized by splinting the rib cage

B. the ability to perform activities of daily living without dyspnea

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 to monitor closely for complications that include which of the following? A) Bilateral wheezes B) Bronchial asthma C) Acute respiratory distress syndrome (ARDS) D) Renal failure

C. Acute respiratory distress syndrome (ARDS) A client who receives massive fluid resuscitation or blood transfusions or who aspirates stomach contents is at highest risk for ARDS, which is associated with catastrophic events, such as multiple trauma, bacteremia, pneumonia, near drowning, and smoke inhalation. ARDS refers to a group of chronic diseases, including bronchial asthma, characterized by recurring airflow obstruction in the lungs. Although renal failure may occur in a client with multiple trauma (depending on the organs involved), this client's history points to an assault on the respiratory system secondary to aspiration of stomach contents and massive fluid resuscitation.

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? A) Nausea or vomiting B) Abdominal pain or diarrhea C) Hallucinations or tinnitus D) Light-headedness or paresthesia

D. Light-headedness or paresthesia The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

The nurse observes that a client who has received midazolam for conscious sedation is having shallow respirations. The nurse should do all except: A) encourage the client to deep-breathe. B) have respiratory resuscitation equipment in the room. C) administer oxygen as prescribed. D) administer naloxone.

D. administer naloxone. The nurse does not administer naloxone because naloxone is the antidote for morphine, not midazolam. The benzodiazepine-receptor antagonist for midazolam is flumazenil. The nurse can promote oxygenation by encouraging deep breathing and administering oxygen. Resuscitation equipment should be accessible if needed.

Which assessment is most appropriate for determining the correct placement of an endotracheal tube in a mechanically ventilated client? A) assessing the client's skin color B) monitoring the respiratory rate C) verifying the amount of cuff inflation D) auscultating breath sounds bilaterally

D. auscultating breath sounds bilaterally Auscultation for bilateral breath sounds is the most appropriate method for determining cuff placement. The nurse should also look for the symmetrical rise and fall of the chest and should note the location of the exit mark on the tube. Assessments of skin color, respiratory rate, and the amount of cuff inflation cannot validate the placement of the endotracheal tube.