A&C 2: Exam 1
Which of the following diseases is classified as chronic obstructive pulmonary disease (COPD)? 1) Emphysema 2) Pneumonia 3) Respiratory failure 4) Lung cancer
1) Emphysema Other diseases in this classification include chronic bronchitis, and bronchiectasis. COPD means on-going diseases that result in increased resistance of airflow in the lungs because of edema and secretions in the airways. Pneumonia may cause some increase in resistance because of secretions in the alveoli but is not chronic in nature. Respiratory failure can be a result of COPD but is not a disease itself. Lung cancer is not classified as obstructive.
In the acutely ill patient, pulmonary function testing helps monitor for: 1) impending ventilatory failure 2) acute hypoxemia 3) acute metabolic acidosis 4) impending oxygenation failure
1) Impending ventilatory failure Pulmonary function tests are used to help monitor for impending ventilatory failure. They measure lung volumes and air flow. Ventilation involves airflow in and out of the lungs. The other choices deal with monitoring other aspects of lung function besides ventilation. Blood gases would give us information about the other choices.
What is the pathophysiology of the disease process of asthma? 1) Airway inflammation, edema, bronchoconstriction 2) Excessive mucous and impaired ciliary function 3) Destruction of alveolar walls and enlargement of air spaces 4) Areas of atelectasis that occur because of impaired surfactant production
1) airway inflammation, edema, bronchoconstriction I hope you chose #1 because this describes the characteristics of asthma. #2 is a good description of chronic bronchitis. #3 identifies emphysema. And #4 describes acute respiratory distress syndrome. If you need to brush up on any of these disease processes, be sure you check out your textbooks.
The nurse is teaching a patient newly diagnosed with asthma about his inhaled medication. Which inhaled medication should the patient take first? 1) Bronchodilator 2) Steroid 3) Expectorant 4) Antibiotic
1) bronchodilator Usually bronchodilators and steroids are given by metered-dose inhalers. If the bronchodilator is given before the steroid, bronchodilation occurs and thus enables the steroid, administered next, to travel further down the respiratory tract and can be more effective. Expectorants and antibiotics are usually not given in metered dose inhalers.
What causes the bluish-red color of a patient with chronic bronchitis? 1) Cyanosis and polycythemia 2) Increased WBC and platelet counts 3) Hyperoxemia and fever 4) Liver disease and smoking
1) cyanosis and polycythemia Cyanosis from not getting enough oxygen to tissues causes the bluish tint to the skin. A patient who is chronically hypoxic develops polycythemia to compensate and these extra red blood cells give the skin a reddish hue. The other conditions do not affect the color of the skin and/or they may not be seen in the patient with chronic bronchitis.
Why is it important that nurse teach patients with COPD to get yearly vaccinations against flu and pneumonia? 1) Flu and pneumonia can compromise lung function. 2) These vaccinations protect against other diseases such as TB. 3) People are rarely allergic to these vaccinations so they should be received. 4) Getting these vaccinations protects others against the spread of disease.
1) flu and pneumonia can compromise lung function Flu and pneumonia can decrease respiratory reserve which is probably low in this type of patient. The vaccinations help protect patients against infections that can make a stable condition much worse. #2 is not correct because the vaccinations protect against only pneumonia and flu, not other diseases like TB. People can be allergic to these vaccinations and allergy history should always be obtained before they are given. #4 is actually a true answer, but it is not the best answer to the question which is asking specifically about patients with COPD.
What is the basic etiology of cystic fibrosis? 1) Inherited as an autosomal recessive trait. 2) Caused by cystia fibrotica, a tiny virus transmitted at birth. 3) The result of exposure to respiratory allergens at a very early age. 4) Exposure of the mother during pregnancy to a heavy metal toxin.
1) inherited as an autosomal recessive trait
Which of the following statements is true regarding the relationship of ventilation to perfusion in an upright person? 1) It varies throughout the lung. 2) Ventilation is best in the bases. 3) Perfusion is best in peripheral lung areas. 4) It maintains a 1:1 relationship throughout the lung.
1) it varies throughout the lung There is normally some regional mismatch of ventilation/perfusion in the lung. At the lung apex, V/Q ratios are greater than 1 (more ventilation than perfusion). At the lung base, V/Q ratios are less than 1 (less ventilation than perfusion). Therefore, the ventilation/perfusion ratio varies throughout the lung.
The primary purpose of chest physiotherapy for the child with cystic fibrosis is to: 1) Mobilize secretions. 2) Relax the child. 3) Dilate bronchioles. 4) Prevent fluid loss.
1) mobilize secretions
What is the third leading cause of death in children between the ages of 1 month and 1 year in the United States and claims the lives of approximately 7000 infants annually? 1) Sudden infant death syndrome 2) Asthma 3) Respiratory distress syndrome 4) Tuberculosis
1) sudden infant death syndrome
A nurse allows a daughter to be present while her father is being coded. The nurse recognizes that which of the following are benefits for family presence during a code? Select all that apply. 1) Encourages professional behavior by the staff. 2) Increases family appreciation for what was done for the patient. 3) Allows daughter opportunity to change her fathers code status. 4) Offers opportunities to educate the family.
1,2,4 Staff is more likley to see patient as a "person" if the duaghter is present. Family is able to see all of the effort that is being contributed by so many people. Family will recognize the seriousness of the situation.
Which drug is a mast cell stabilizer used to prevent asthma attacks? 1) Prednisone 2) Cromolyn 3) Albuterol 4) Theophylline
2) cromolyn Cromolyn is a mast cell stabilizer that prevents release of bronchoconstrictive and inflammatory substances when mast cells act against allergens. They are helpful in preventing attacks but do not work well in acute attacks. #1 prednisone is a steroid and may be used during an acute attack to reduce inflammation. #3 Albuterol is a beta-adrenergic that is effective during an acute attack. #4 is a methyxanthine that causes bronchodilation. These drugs are no longer first-line drugs but are used later in treatment in conjunction with safer and more effective drugs.
Patients who have obstructive pulmonary disease will have which of the following patterns of forced expiratory volume (FEVs)? 1) increased FEVs 2) delayed FEVs 3) normal FEVs 4) variable FEVs
2) delayed FEVs Forced expiratory volume values give clues to severity of airway obstruction in obstructive lung diseases. The pathophysiological changes in this disease cause airway obstruction. FEV1 is delayed or decreased. FEV1 is the amount of air that is forcefully exhaled in the first second of the forced vital capacity
Oxygen is administered to a person with chronic obstructive pulmonary disease in very controlled concentrations in order to prevent which of the following? 1) Pneumothorax. 2) Depression of the respiratory drive. 3) Excessive drying of respiratory mucosa. 4) Damage to the retina.
2) depression of the respiratory drive
What is the pathophysiology of the disease process of chronic bronchitis? 1) Airway inflammation, edema, bronchoconstriction 2) Excessive mucous and impaired ciliary function 3) Destruction of alveolar walls and enlargement of air spaces 4) Areas of atelectasis that occur because of impaired surfactant production
2) excessive mucous and impaired ciliary function
A nurse caring for a 75-year-old man notices that the patient is becoming restless and anxious on his third day in the ICU. Which intervention would be most effective at managing the patient's increased anxiety? 1) Keep the room dark to decrease stimulation. 2) Instruct family to bring familiar items from home. 3) Awaken the patient every hour to assess mental state. 4) Ask the family to leave the room to give the patient alone time.
2) instruct family to bring familiar items from home This will allow the patient to focus on something that is comfortable and "normal" to him rather than all of the other things that are out of his "norm".
What type of diet should the patient who has respiratory problems ingest? 1) Large meals taken 3 times per day 2) Small frequent meals with snacks if necessary 3) Low protein and low carbohydrate 4) Low fiber, low fat, no alcohol
2) small frequent meals with snacks if necessary Well, the best diet here is #2. Meals should be small to prevent overfilling the stomach (like #1 would do) which can press on the diaphragm and restrict breathing. Calories should be given to provide energy so nutritious meals should be frequent with snacks if necessary. Protein and carbohydrates should be moderate to high to help the patient fight off infection and provide energy. Diet should have adequate fiber and fat. There is no reason to restrict alcohol unless specifically advised because of medication or other condition.
A five-year-old is seen in the emergency room with a history of asthma. The nurse knows that which assessment data is most consistent with an exacerbation of asthma in this child? 1) Confusion, tachypnea, and crackles. 2) Tachycardia, anxiety, and wheezing. 3) Frequent cough, hypertension, and stridor. 4) Lethargy, hypotension, and fever
2) tachycardia, anxiety and wheezing
A child is receiving systemic corticosteroids for asthma. The nurse knows that the mother understands the teaching about her child's corticosteroid therapy if she makes which statement? 1) "I'll be sure to count my child's respirations for a full minute daily." 2) "I can't feed my child her favorite wheat toast anymore." 3) "I'll keep my child away from people with colds." 4) "I'll make sure my child has a blood test every month."
3) Ill keep my child away from people with colds
To be clinically identified as acute hypoxemic ventilatory failure, which of the following arterial blood gas results must be present? 1) pH < 7.35 2) PaCO2 > 50 mm Hg 3) PaO2 < 50 mm Hg 4) HCO3 < 18 mm Hg
3) PaO2 < 50 mmHg Hypoxemic respiratory failure is commonly defined as a PaO2 <60 mm Hg when the patient is receiving an inspired oxygen concentration of 60% or greater. This definition incorporates two important concepts: 1) the PaO2 is at a level that indicates inadequate oxygen saturation of hemoglobin and 2) this PaO2 level exists despite administration of supplemental oxygen at a percentage that is abut three times that is room air (21%). A PaCO2 >50mm Hg is hypercapneic respiratory failure. The HCO3 < 18 indicates metabolic acidosis. HCO3 is an indicator of a metabolic problem - not respiratory.
A child with cystic fibrosis is predisposed to bronchitis mainly because of what? 1) Neuromuscular irritability that causes spasm and constriction of the bronchi. 2) Increased salt content in saliva that can irritate and necrose mucous membranes in the nasopharynx. 3) Tenacious secretions that obstruct the bronchioles and respiratory tract and provide favorable medium for growth of bacteria. 4) The associated heart defects of cystic fibrosis that cause congestive heart failure and respiratory depression.
3) Tenacious secretions that obstruct the bronchioles and respiratory tract and provide favorable medium for growth of bacteria.
The primary concern of the nurse when giving tips for how to increase humidity in the home of a child with problems of respiration should be to make sure that the child has a 1) continuous contact with the humidification source. 2) a warm humidification source. 3) a humidification source that is safe. 4) a humidification system that has medication in it.
3) a humidification source that is safe Safety takes priority above all these other choices.
What is the most common beta-adrenergic medication used to treat asthma? 1) Flovent 2) Solu-medrol 3) Albuterol 4) Atrovent
3) albuterol Albuterol, a beta-adrenergic medication, helps suppress histamine release (decreases edema), increase ciliary motility (to help cough up secretions) and produce bronchodilation which all help improve asthma. Flovent and Solu-medrol are steroids. Atrovent is an anticholinergic. It works in a different way than the beta-adrenergics to produce bronchodilation.
When planning discharge teaching for the parents of a toddler with asthma, the nurse should include telling the parents to increase the child's fluid intake and to have the child 1) Avoid foods high in carbohydrates. 2) Increase salt intake on warm days. 3) Avoid exertion and exposure to cold. 4) Stay in the house for at least 2 weeks.
3) avoid exertion and exposure to cold
Manifestations of impaired gas exchange in the early stage would include all of the following EXCEPT 1) confusion 2) increased lethargy 3) decreased restlessness 4) change in mental status
3) decreased restlessness Impaired gas exchange is characterized by confusion, increased lethargy, increased restlessness and a change in mental status. All of these are caused by inadequate cerebral oxygenation.
What is the pathophysiology of the disease process of emphysema? 1) Airway inflammation, edema, bronchoconstriction 2) Excessive mucous and impaired ciliary function 3) Destruction of alveolar walls and enlargement of air spaces 4) Areas of atelectasis that occur because of impaired surfactant production
3) destruction of alveolar walls and enlargement of air spaces
How do anticholinergic drugs work to help people with emphysema? 1) Decrease inflammation 2) Thin secretions 3) Dilate bronchioles 4) Prevent infection
3) dilate bronchioles Anticholinergics block muscarinic cholinergic receptors in the bronchi and cause bronchodilation. #1 describes steroids that are sometimes used with these patients. #2 describes what occurs when patient drink plenty of fluids. #4 Antibiotics prevent infection.
What is an important side effect that is seen in patients with asthma who are treated with steroids? 1) Hypoglycemia 2) Weight loss 3) Immunosuppression 4) Anemia
3) immunosuppression Steroids are particularly hard on the immune system's ability to fight off infection. So the patient needs to be aware of this serious side effect to prevent complications. Steroids cause hyperglycemia and weight gain, so #1 & #2 are not correct. #4 Anemia is not a side effect.
Of the following, which arterial blood gas pH results would best reflect acute hypercapnic respiratory failure? 1) normal pH 2) pH higher than normal 3) pH lower than normal 4) variable pH
3) pH lower than normal Hypercapnic respiratory failure is defined as a PaCO2 above normal (greater than 45 mm Hg) in combination with academia (arterial pH less than 7.35).
A patient is advised to gargle and rinse his mouth after taking his inhaled steroid medication. What is the rationale for this? 1) Reduces gastrointestinal upset 2) Decreases breath odor after the medications 3) Prevents oral candidiasis 4) Minimizes hoarseness
3) prevents oral candidiasis Gargling and rinsing gets rid of the steroid in the oral cavity and prevents growth of opportunistic candida. This activity has no effect on the GI system. There is no breath odor after medication administration. Inhaled steroids do not cause hoarseness.
Which person would be at the highest risk for development of chronic bronchitis? 1) 23-year-old woman with leukemia 2) 35-year-old woman who works in a vegetable processing plant 3) 49-year-old man with coronary artery disease 4) 69-year-old man with recurring respiratory tract infections
4) 69-year-old man with recurring respiratory tract infections Age and recurring respiratory infections are two of the risk factors for development of chronic bronchitis. The other people have none of the risk factors for the disease.
The problem of cystic fibrosis is sometimes first noted by the nurse in the newborn nursery because of the infant's 1) excessive crying. 2) sternal retractions. 3) increased heart rate. 4) abdominal distention.
4) abdominal distention
What is an extrinsic trigger for asthma? 1) Respiratory infections 2) Exercise 3) Fatigue 4) Allergic inhalation
4) allergic inhalation the other answers are intrinsic asthma triggers
A patient situation associated with respiratory alkalosis includes 1) Sedation 2) Neuromuscular blockade 3) Pulmonary edema 4) Anxiety
4) anxiety With high levels of anxiety, there is usually alveolar hyperventilation. The lungs are eliminating too much carbon dioxide, causing a carbonic acid deficit. There are inadequate amount of carbon dioxide available to combine with water to form carbonic acid. Sedation, neuromuscular blockade cause decreased respiratory effort which results in respiratory acidosis. Pulmonary edema causes decreased O2/CO2 exchange which results in respiratory acidosis also.
What is the pathophysiology of the disease process of acute respiratory distress syndrome? 1) Airway inflammation, edema, bronchoconstriction 2) Excessive mucous and impaired ciliary function 3) Destruction of alveolar walls and enlargement of air spaces 4) Areas of atelectasis that occur because of impaired surfactant production
4) areas of atelectasis that occur because of impaired surfactant production
Obstructive pulmonary diseases are associated with: 1) decreased secretions 2) decreased lung compliance 3) decreased resistance to air flow 4) decreased air flow into lungs
4) decreased air flow into lungs Obstructive disorders have increased secretions that obstruct flow of air. They also have increased lung compliance - such as emphysema which results in "floppy" lungs. The narrowed airways seen in obstructive disorders cause an increase resistance to air flow resulting in decreased air flow to the lungs.
Which of the following is the main pathophysiologicdysfunction characterizing chronic obstructive pulmonarydisease (COPD)? 1) Increased respiratory air flow. 2) Decreased compliance. 3) Decreased pulmonary vascular resistance. 4) Increased resistance to air flow.
4) increased resistance to airflow
The pulmonary edema association with ARDS is caused by: 1) capillary microembolism 2) left ventricular failure 3) loss of surfactant 4) injured alveolar-capillary membrane
4) injured alveolar-capillary membrane ARDS (acute respiratory distress syndrome) is a sudden and progressive form of acute respiratory failure in which the alveolar capillary membrane becomes damaged and more permeable to intravascular fluid. Capillary microembolisms do occur with ARDS, but they do not cause pulmonary edema. We also see them with DIC. Usually L ventricular failure does not characterize ARDS. R ventricular failure may be a result later. Check out cor pulmonale. Pulmonary hypertension occurs because of increased pulmonary vascular resistance but the heart failure does not cause pulmonary edema. Rather it is a result of pulmonary edema and obstruction to blood flow. We do see loss of surfactant but that causes atelectasis, not pulmonary edema. With all test questions be sure you know what the question is asking before you choose your answer.
What type of acid-base imbalance is usually seen in people with early emphysema? 1) Metabolic acidosis 2) Respiratory acidosis 3) Metabolic alkalosis 4) Respiratory alkalosis
4) respiratory alkalosis
What is the most common risk factor for the development of chronic bronchitis? 1) Diet high in fat 2) History of taking steroids 3) Lung cancer 4) Smoking
4) smoking I bet you knew this one! Smoking is the number one risk factor for the development of this disease - as it is for many others. The chemicals that are released when a person smokes a cigarette damage the tissue in the airways and set up the environment for increased mucous production and chronic inflammation. The other factors may be risk factors for other diseases but have not been proven to be so for chronic bronchitis.
The most likely reason that the respiratory problems are so great in infants and children is that 1) children's exposure to pathogens is greatly increased as they grow. 2) viral agents that are mild in teens and adults are extremely severe in infants and children. 3) maternal antibodies have decreased and infants' own antibody production is low. 4) the diameter of the airways is smaller in infants and children than it is in adults.
4) the diameter of the airways is smaller in infants and children than it is in adults Maternal antibodies do disappear about 3-4 months of age and that makes that age-group more susceptible to all types of infection - not just respiratory, although that is the most common kind of infection that is seen usually. But the question is really asking about a bigger issue - that is respiratory problems (not just infections) in infants and children compared to adults. And the smaller diameter of airways in infants and children leads to big problems whenever anything happens that causes narrowing of airways. That could be increased secretions, edema, bronchospasm, foreign body aspiration - you know? And because those airways are so small, there isn't much room for air movement when something begins to occlude those airways. Then trouble begins. As children grow their exposure to pathogens does increase, but they are better able to defend themselves because of an increasingly competent immune system. And viral agents are not any more virilent in younger children than they are in teens and adults.
The critical care nurse recognizes that the most ideal plan for family involvement in the ICU includes what? A) An individually devised plan with family involved in care and comfort measures. B) Allowing family at the bedside at pre-set, brief intervals. C) Prohibition of visiting in the critical care unit except for immediate family. D) A family member at the bedside at all times.
A
A nurse is assessing a client with chronic airflow limitation and notes the client has a "barrel chest." The nurse interprets that this client has which of the following forms of chronic airflow limitation? A) emphysema B) bronchial asthma C) chronic obstructive bronchitis D) bronchial asthma and bronchitis
A A client with emphysema gas hyperinflation of the alveoli and flattening of the diaphragm. These lead to increased AP diameter, referred to barrel chest.
Although ARDS may result from direct lung injury or indirect lung injury as a result of systemic inflammatory response syndrome (SIRS), the nurse is aware that ARDS is most likely to occur in the patient with damage resulting from what? A) sepsis B) prolonged hypotension C) oxygen toxicity D) cardiopulmonary bypass
A Although ARDS may occur in the patient who has virtually any severe illness and may be both a cause and a result of systemic inflammatory response syndrome, the most common precipitating injuries of ARDS are sepsis, gastric aspiration, and severe massive trauma. ARDS is an inflammatory responses attacking the lungs.
The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment could be used to evaluate the effectiveness of the therapies? A) Observe for distended neck veins B) Auscultate for crackles in the lungs C) Palpate for heaves or thrills over the heart D) Monitor for elevated white blood cell count
A Cor pulmonale is R ventricular failure caused by pulmonary hypertension, so clinical manifestations include peripheral edema, jugular vein distention, and right upper quadrant abdominal tenderness. Crackles in the lungs are likely with LSHF.
In caring for the patient with ARDS, what is the most characteristic sign the nurse would expect the patient to exhibit? A) refractory hypoxemia B) bronchial breath sounds C) progressive hypercapnia D) increased pulmonary artery wedge pressure (PAWP)
A Refractory hypoxemia does not respond to increasing concentrations of oxygenation by any route, is a hallmark sign of ARDS and is always present.
The patient progressed from acute lung injury to acute respiratory distress syndrome (ARDS). He is on the ventilator and receiving propofol (Diprivan) for sedation and fentanyl (Sublimaze) to decrease anxiety, agitation, and pain in order to decrease his work of breathing, O2 consumption, carbon dioxide production, and risk of injury. What intervention may be recommended in caring for this patient? A) A sedation holiday B) Monitoring for hypermetabolism C) Keeping his legs still to avoid dislodging the airway D) Repositioning him every 4 hours to decrease agitation
A This is necessary to assess the patient's condition and readiness to extubate. A hypermetabolic state occurs with critical illness.
Which assessment finding should cause the nurse to suspect the early onset of hypoxemia? A) restlessness B) hypotension C) central cyanosis D) cardiac dysrhythmias
A the brain is sensitive to a decrease in O2 delivery. Restlessness, confusion, agitation and combative behavior are early signs. Mild hypertenssion is also an early sign, accompanied by tachycardia. Central cyanosis is an unreliable, late sign of hypoxemia. Cardiac dysrhythmias occur later.
When mechanical ventilation is used for the patient with ARDS, what is the rationale for applying positive end-expiratory pressure (PEEP)? A)Prevent alveolar collapse and open up collapsed alveoli B) Permit smaller tidal volumes with permissive hypercapnia C) Promote complete emptying of the lungs during exhalation D) Permit extracorporeal oxygenation and carbon dioxide removal outside the body
A the pressure from the ventilator will air leave in the lungs so it prevents alveolar collapse by ensuring that they remain open while on the ventilator
A nurse caring for a client who has COPD is preparing discharge instructions. The client states " I will be stuck in the house now that I am on continuous oxygen". Which statement made by the nurse would be accurate? A) "There are portable oxygen delivery systems that you can carry with you." B) "It is okay for you to take your oxygen off if you need to leave for a short period of time." C) "There will be home health services to deliver your supplies, so you will not need to go outside of your home." D) " Being dependant on oxygen does limit your independance."
A) "there are portable oxygen delivery systems that you can carry with you"
Indications for intubation include what? Select all that apply A) PaO2 of 50 B) decreased LOC/unresponsive patient C) smoke inhalation D) PaO2 81, SpO2 91% E) threatened airway obstruction F) P/F/ ratio 500
A, B, C, & E PaO2 > 80 is normal, SpO2 of 91% is not considered respiratory failure, pt likely needs 1-2 L on NC. Normal P/F ratio is < 400
A nurse is caring for a patient with a 5-year history of COPD, which physical findings should the nurse expect to find during assessment? Select 3 answers. A) Dyspnea on exertion. B) Productive cough when resting. C) Crackles and wheezes. D) Respiratory acidosis and compensatory metabolic alkalosis. E) Slow, deep respirations.
A, C, D this is fully compensated respiratory acidosis
Which of the following are risk factors for sudden infant death syndrome (SIDS)? Select all that apply. A) Lying on the abdomen for sleep. B) Sleeping in an infant crib with stuffed animals. C) Using a pacifier D) Being exposed to second hand smoke. E) Sleeping with a parent on the couch. F) Sleeping in an infant crib without loose blankets.
A,B, D, E
What are the three things that families need from the intensive care nurse? Select 3 correct answers. A) Information about the patient. B) Access to the patient. C) Assistance with setting limits. D) Support and guidance. E) Access to the test results.
A,B,D
What are the primary pathophysiologic changes that occur in the injury or exudative phase of ARDS (select all that apply)? A) atelectasis B) SOB C) interstitial and alveolar edema D) hyaline membranes line the alveoli E) influx of neutrophils, monocytes, and lymphocytes
A,C,D The injury/exudative phase is the early phase of ARDS when atelectasis and interstitial and alveolar edema occur. Hyaline membranes composed of necrotic cells, protein, and fibrin line the alveoli. Together these decrease gas exchange capability and lung compliance.
Sudden progressive form of RFF where alveoli fill with fluid related to failing membranes
Acute Respiratory Distress Syndrome
An eight-year-old child is being treated in the E.R. for an acute asthma attack. Her pulse rate is 110 beats/minute; respiratory rate is 30 breaths/minute. She has inspiratory and expiratory wheezing throughout her lung fields. Which of the following would indicate her condition was worsening? Choose all that apply. 1) Wheezing is heard only on inspiration. 2) Her pCO2 is 60. 3) She appears sleepy with a flushed appearance. 4) Breath sounds are diminishing. 5) She is not able to talk to her mother.
All of the above All of these signs and symptoms indicate that this child's condition is worsening. They indicate a tight chest with decreased air movement and resulting decreased sounds of breathing. She cannot talk to her mother because she is using all her energy and focus on breathing. This is an ominous sign of impending trouble and worsening of her condition. An increasing pCO2 level indicates progressive trouble with O2CO2 exchange. Increased CO2 levels can cause flushed cheeks and increasing lethargy caused by a build-up of waste products (CO2) in the brain. The wheezing on inspiration is also indicating that air exchange has diminished. She is getting air in on inspiration but not much is going out. That is one of the problems with asthma. Hyperinflation of the lung decreases air movement and fresh air for O2CO2 exchange. We want to hear more lung sounds even if the wheezing is noisy. Wheezing on inspiration and expiration means that air is moving in and out and would indicate an improvement from not hearing sounds. So, if you chose all the answers as correct, YOU were correct!
What deficiency increases the risk of COPD?
Alpha 1 antitrypsin protects the lung tissue. Without AAT, protease and elastase are left unopposed and will break down the elastin, collagen, and connective tissue in the terminal bronchioles and alveoli
what are 2 examples of airway management practices for a patient with COPD?
Assist with incentive spirometry and position the client to maximize ventilation potential (prone position)
Chronic, recurring inflammatory disorder of the airways is the pathophysiology for? - Bronchospasms, edema on inside of airways, mucus being produced by inflamed endothelium of the airways - Causes reversible airflow obstruction of the bronchioles
Asthma
Those most susceptible to sensory deprivation in complex care settings are: A) Older male patients. B) Unconscious, unresponsive patients. C) Surgical patients. D) Cardiac patients.
B
Which patient is most likely to experience sensory deprivation? a) A blind 93-year-old bedridden resident of a nursing home. b) A deaf 88-year-old single patient with +4 edema who lives in an upstairs apartment. c) A child with genetic anomalies, abandoned in infancy, cared for in a special needs foster home, who attends preschool three times a week. d) A premature infant transferred to a Neonatal Intensive Care Unit.
B B is correct. Sensory stimulation comes from our senses, environment, and presence of meaningful data. Although the client in answer A has no sight and is unable to get out of bed, she is still capable and likely to receive sensory stimulation. She may converse with staff and other residents, feel the touch of bathing, and taste a variety of foods. Answer C: there is a potential for sensory deprivation related to abandonment and the presence of anomalies. Since the child is being cared for in a special needs foster home, and attends preschool, one can reasonably assume that the child receives some stimulation. Answer D: premature infants in Neonatal Intensive Care Units often suffer from sensory overload.
You're assigned a first day post-operative patient, who has a colostomy, seems to worry a lot, and has symptoms of sensory overload. Which of the following patient goals, if met, would most contribute to reducing sensory overload for this patient? a) Will not sleep or nap during the day. b) Will report pain at a 4 or less on a 10-point pain scale. c) Will attend classes on colostomy care. d) Will look at the colostomy during colostomy care.
B B is correct: Will report pain at 4 or less on a 10-point scale; People who have sensory overload may appear fatigued. They cannot internalize new information and experience cognitive overload as a result of everything that is happening to them. Such factors as pain, lack of sleep, and worry can also contribute to sensory overload.
A nurse is caring for a 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) increased O2 saturation with exercise D) a widened diaphragm noted on the CXR
B Clinical manifestations of COPD include: hypoxemia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory mm of respiration. CXR reveal a hyperinflated chest and a flatted diaphragm if the disease is advanced.
A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. A nurse caring for the child monitors for which of the following, knowing that it indicates a worsening of the condition? A) warm, dry skin B) decreased wheezing C) pulse rate of 90 beats/min D) respirations of 18 breaths.min.
B Decreased wheezing in a child with asthma may be interpreted incorrectly as a positive sign when in actuality it may signal an inability to move air. A silent chest is an ominous sign during an asthma attack.
Which patient with the following manifestations is most likely to develop hypercapnic respiratory failure? A) Rapid, deep respirations in response to pneumonia B) Slow, shallow respirations as a result of sedative overdose C) Large airway resistance as a result of severe bronchospasm D) Poorly ventilated areas of the lung caused by pulmonary edema
B The slow, shallow respirations means that the patient is holding onto CO2. A = hyperventilation and hypoxemic respiratory failure C = obstruction of oxygenation and will result in V/Q mismatch or shunt typical of hypoxemic respiratory failure
How are pulmonary function tests used to aid in treatment planning for asthma? A) Determines the cause. B) Evaluates severity. C) Confirms diagnosis. D) Identifies potential triggers.
B) evaluates severity
Which descriptions are characteristic of hypoxemic respiratory failure (select all that apply)? A) referred to as ventilatory failure B) primary problem is inadequate O2 transfer C) risk of inadequate O2 saturation of hbg exists D) body is unable to compensate for acidemia of increased PaCO2 E) most often caused by (V/Q) mismatch and shunt F) exists when PaO2 is 60 mmHg or less, even when O2 is administered at 60%
B, C, E, F ventilatory failure is hypercapnic respiratory failure
How does mechanical ventilation interfere with the patient's ability to participate in the plan of care? A) The patient is unable to swallow. B) The patient cannot breathe independantly. C) The patient is unable to verbally communicate. D) The patient is usually restrained.
C
What is the most significant deprivation that critically ill patients remember about their illness? A) Cues that help them know the day and time. B) Sounds of the human voice. C) Human touch. D) Familiar faces.
C
When the nurse is explaining respiratory failure to the patient's family, which is the most accurate description? A) The absence of ventilation B) Any episode in which part of the airway is obstructed C) Inadequate gas exchange to meet the metabolic needs of the body D) Any episode of acute hypoxemia caused by pulmonary dysfunction
C A= respiratory arrest
A patient is exhibiting signs and symptoms of acute confusion/delirium. Which strategy should the nurse implement to promote a therapeutic environment? a) Keep the lights in the room dimmed during the day to decrease stimulation. b) Keep the environmental noise level high to increase stimulation. c) Keep the room organized and clean. d) Use restraints for patient safety.
C C is correct. Keep the room organized and clean; A disorganized, cluttered environment increases confusion.Keeping the room well-lit during waking hours (option A) promotes adequate sleep at night. It is important to eliminate unnecessary noise (option B). The patient does not meet the standard criteria for restraint application (option D).
Nurses can increase environmental stimuli for patients with sensory deficit by: a) Keeping the radio on throughout the day to provide auditory stimulation. b) Keeping the bathroom light on at night to avoid complete darkness. c) Establishing a routine identified with each meal. d) Ensuring the patient's safety.
C C is correct. Regular meaningful stimuli will benefit the patient. The radio can provide meaningful or meaningless stimuli. The nurse must carefully choose programming based on the patient's preferences and expose the patient to that programming only at appropriate times. Listening to the radio constantly can introduce meaningless stimuli that confuse the patient. A 24-hour light may actually keep patients awake, leading to sleep deprivation. Safety is a priority diagnosis but is not an intervention to provide environmental stimuli.
he nurse suspects the early stage of ARDS in any seriously ill patient who manifests what? A) develops respiratory acidosis B) has diffuse crackles and wheezing C) exhibits dyspnea and restlessness D) has a decreased PaO2 and an increased PaCO2
C Early signs of ARDS are indidious and difficult to detect, but the nurse should be alert for any signs of hypoxemia, such as dyspnea, tachypnea, cough, and restlessness inpatients at risk for ARDS. Later tachycardia, diaphoresis, mental status changes, cyanosis, and pallor may be present.
In patients with ARDS who survive the acute phase of lung injury, what manifestations are seen when they progress to the fibrotic phase? A) Chronic pulmonary edema and atelectasis B) Resolution of edema and healing of lung tissue C) Continued hypoxemia because of diffusion limitation D) Increased lung compliance caused by the breakdown of fibrotic tissue
C In the fibrotic phased of ARDS, diffuse scarring and fibrosis of the lungs occur (white out), resulting in decreased surface area for gas exchange and continued hypoxemia caused by diffusion limitation. Although edema is resolved, lung compliance is decreased because of interstitial fibrosis. Long-term mechanical ventilation is required. The patient has a poor prognosis for survival.
When teaching the patient about what is happening when experiencing an intrapulmonary shunt, which explanation is accurate? A) This occurs when an obstruction impairs the flow of blood to the ventilated areas of the lung B) This occurs when blood passes through an anatomic channel in the heart and bypasses the lungs C) This occurs when blood flows through the capillaries in the lungs without participating in gas exchange D) Gas exchange across the alveolar capillary interface is compromised by thickened or damaged alveolar membranes.
C intrapulmonary shunt = ventilation problem. Obstruction impairs the flow of blood to the ventilated areas of the lung in a V/Q mismatch ratio greater than 1 (example = pulmonary embolism which is dead space).
How does constant, high levels of noise affect patient outcomes? Select one answer. A) May increase mental alertness. B) Has no effect on overall patient outcomes. C) May increase length of stay. D) Provides emotional reassurance.
C) may increase length of stay Studies have shown that healing can be delayed by excessive noise.
The patient is being admitted to the intensive care unit (ICU) with hypercapnic respiratory failure. Which manifestations should the nurse expect to assess in the patient (select all that apply)? A) cyanosis B) metabolic acidosis C) morning headache D) respiratory acidosis E) use of tripod position F) rapid, shallow respirations
C,D,E & F Cyanosis is a late sign and metabolic acidosis is associated with hypoxemic RF.
Progressive thickening of airway walls leading to persistent airflow limitation and inflammation
COPD
Which acid base imbalance would a nurse expect in a patient with COPD
Compensated respiratory acidosis
Autosomal recessive trait that involves both parents being carriers for the gene. - Primarily effects the respiratory and GI systems - Abnormal mucus secretion and production - Alteration of the sodium chloride channels
Cystic Fibrosis
A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, Pco2 is 90 mm Hg, and HCO3- is 22mEq/L. The nurse interprets the results as indicating which condition? A) Metabolic acidosis with compensation B) respiratory acidosis with compensation C) metabolic acidosis without compensation D) respiratory acidosis without compensation
D
A clinic nurse is providing instructions to a mother of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement would the nurse make to the mother? A) "The immunization schedule will need to be altered." B) "The child should not receive hepatitis vaccines." C) "The child will receive all immunizations except for the polio series." D) "The child will receive the recommended basic series of immunizations along with a yearly influenza vaccine."
D
A new mother expresses concern to a nurse regarding sudden infant death syndrome (SIDS). She asks the nurse how to position her new infant for sleep. The nurse appropriately tells the mother the infant should be placed on the: A) side or prone B) back or prone C) stomach with face turned D) back rather than on stomach
D
A nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which of the following positions will the nurse instruct the client to assume? A) sitting up in bed B) side-lying in bed C) sitting up in a recliner chair D) sitting on the side of the bed and leaning on an overbed table
D
Which patient is at greatest risk for experiencing sensory overload? a) A 40-year-old patient in isolation with no family. b) A 28-year-old quadriplegic patient in a private room. c) A 16-year-old listening to loud music. d) An 80-year-old patient admitted for emergency surgery.
D D is correct. A sudden, unexpected admission for surgery may involve many experiences (e.g., lab work, x-rays, signing of forms) while the patient is in pain or discomfort. The time for orientation will thus be lessened. After surgery, the patient may be in pain and possibly in a critical care setting.Options A and B would more likely be at risk for sensory deprivation. Option C is considered a normal activity for most teenagers.
A nurse instructs a 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 mm D) promote CO2 elimination
D Purse lip breathing promotes maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure
The nurse assesses that a patient in respiratory distress is developing respiratory fatigue and the risk of respiratory arrest when the patient displays which behavior? A) cannot breathe unless he is sitting upright B) uses the abdominal muscles during expiration C) has an increased inspiratory/expiratory ratio D) has a change in respiratory rate from rapid to slow
D The increase in respiratory rate required to blow off accumulated CO2 predisposes to respiratory muscle fatigue. The slowing of a rapid rate in a patient in acute distress indicated tiring and the possibility of respiratory arrest unless ventilatory assistance is provided
Prone positioning is considered for a patient with ARDS who has not responded to other measures to increase PaO2. To benefit the PaO2 the nurse knows that this strategy will A) increase the mobilization of pulmonary secretions B) decrease the workload of the diaphragm and intercostal muscles C) promote opening of atelectatic alveoli in the upper portion of the lung D) promote perfusion of nonatelectatic alveoli in the anterior portion of the lung
D When a patient with ARDS is supine, alveoli in the posterior areas of the lung are dependent and fluid-filled and the heart and mediastinal contents place more pressure on the lungs predisposing them to atelectasis. If the patient is turned prone, air-filled nonatelectatic alveoli in the anterior portion of the lung receive more blood and perfusion may be better matched to ventilation, causing less V/Q mismatch.
A nurse is assessing a client with multiple trauma who is at risk for developing an acute respiratory distress system. The nurse assesses for which EARLIEST sign of ARDS? A) Bilateral wheezing B) Intercostal retractions C) Inspiratory crackles D) Increased respiratory rate
D) increased respiratory rate Increased RR can begin 1-96 hours followed by dyspnea, retractions and cyanosis. Breath sounds may consist of fine inspiratory crackles. Intercostal retractions is a later sign.
A nurse is interviewing the parents of a 3-month-old male infant brought to the hospital emergency room. The infant is dead, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. They say he was "just fine" when they put him in his crib asleep. What is the likely cause of death? A) Respiratory infection B) Apparent life-threatening event C) Suffocation D) Sudden infant death syndrome
D) sudden infant death syndrome Although the cause of sudden infant death syndrome (SIDS) is unknown, autopsies show findings consistent across cases such as pulmonary edema and intrathoracic hemorrhages that would cause bloody fluid as seen here. Peak age of incidence is 2-3 months.
What are 2 examples of energy management techniques for a patient with COPD?
Determine the client's physical limitations and Promote bedrest.
What are 2 examples of cough enhancement techniques for a patient with COPD?
Encourage the client to take deep breaths and Instruct the client to breathe deeply, hold breath for 3-5 seconds, and then cough two to three times.
Air trapping is when the patient struggles to (inhale/exhale) air.
Exhale
When caring for patients in the intensive care unit who are having trouble sleeping, nurses should decrease the volume of the cardiac monitor alarms during rest periods. A) True B) False
False Alarm volumes should never be decreased for any reason.
IN hypoxic respiratory failure what is the first and last signs that will be present?
First: change in LOC Last: cyanosis
Increase in CO2 (>45 mmHg) + decrease in PH (below 7.35) - Slow progression
Hypercapnic RF/ Respiratory Acidosis
Decrease in O2 < 60 mmHg - Most common form of respiratory failure - Fast acting; medical emergency
Hypoxemic RF/ Metabolic Acidosis
A pt 1-7 days after injury to the lung with alveoli filled with fluid, refractory hypoxemia and surfactant dysfunction would be in what stage of ARDS?
Injury/exudative phase
How is the tripod position helpful for patients with respiratory problems?
It provides more space for the lungs to expand and the alveoli to fill up with air
What is an oxygen therapy technique used for a patient with COPD?
Monitor the position of the oxygen delivery device.
What is a normal & abnormal sweat chloride test for a patient with cystic fibrosis?
Normal = 40 mEq/l CF positive = 60 mEq/l
A syndrome in which the respiratory system fails in one or both of its gas exchange functions... leading to inadequate tissue oxygenation or carbon dioxide removal
Respiratory Failure
Inadequate transfer of oxygen and carbon dioxide
Respiratory failure
A patient 2-3 weeks after injury to the lung with collagen/fibrous lung tissue, pulmonary HTN, and hypoxemia would be in which phase of ARDS?
fibrotic/chronic phase
What finding on a chest xray is evidence of possible COPD?
flat diaphragm
What electrolyte imbalance may occur in patients with CF?
hyponatremia; encourage an increase in sodium intake and high caloric/protein intake diets
Increased levels of RBC's is known as ___________________. - in COPD low oxygen levels cause increased production of red blood cells, blood thickens and becomes chunky; patients are at risk for clots + too much fluid
polycythemia
What is the name of an effective breathing technique in which the patient takes a breath in and slowly exhales out through their pursed lips
pursed-lip breathing
