exam 3 medsurg
metabolic acidosis causes
-acid other than carbonic acid accumulates, or lose large amts of bicarb -diarrhea -anion gap
metabolic alkalosis causes
-increase in pH -loss of acid...large amounts of vomiting, NG tube + suctioning or gain in bicarb (baking soda)
common causes of metabolic acidosis
-renal failure -severe shock -diabetic ketoacidosis
what are the characteristics of the carbonic acid-bicarbonate buffer system (SATA)? a. CO2 is eliminated by the lungs b. neutralizes HCl acid to yield carbonic acid and salt c. H2CO3 formed by neutralization dissociates into H2O and CO2 d. shifts H+ in and out of cell in exchange for other cations such as potassium and sodium e. free basic radicals dissociate into ammonia and OH-, which combines with H+ to form water
a, b, c
why are patients on a ventilator at high risk for ventilator associated pneumonia (VAP)? SATA a. patients tend to be in a poor nutritional state b. their underlying disease process c. endotracheal tube bypasses normal upper airway defenses d. immobility
a, b, c, d
the nurse is admitting a patient to the clinical unit from surgery. being alert to potential fluid volume alterations, what assessment data will be important for the nurse to monitor to identify early changes in the patient's postoperative fluid volume (SATA)? a. intake and output b. skin turgor c. lung sounds d. respiratory rate e. level of consciousness
a, b, c, d, e
what are characteristics of the phosphate buffer system (SATA)? a. neutralizes a strong base to a weak base and water b. resultant sodium biphosphate is eliminated by the kidneys c. free acid radicals dissociate into H+ and CO2, buffering excess base d. neutralizes a strong acid to yield sodium biphosphate, a weak acid, and salt e. shifts chloride in and out of red blood cells in exchange for sodium bicarbonate, buffering both acids and bases
a, b, d
patients with acute respiratory failure will have drug therapy to meet their individual needs. which drugs will meet the goal of reducing pulmonary congestion (SATA)? a. morphine b. ceftriaxone c. nitroglycerin d. furosemide (lasix) e. albuterol (ventolin HFA) f. methylprednisolone (solu-medrol)
a, c, d
responding to ventilator alarms is an important nursing responsibility. why are there alarms set on a ventilator? SATA. a. to alert staff to patient having periods of apnea b. to stimulate the patient c. to alert staff to mechanical malfunction d. to alert staff that the endotracheal tube has fallen out
a, c, d
what are the primary pathophysiologic changes that occur in the injury or exudative phase of ARDS (SATA)? a. atelectasis b. shortness of breath c. interstitial and alveolar edema d. hyaline membranes line the alveoli e. influx of neutrophils, monocytes, and lymphocytes
a, c, d,
which changes of aging contribute to the increased risk for respiratory failure in older adults (SATA)? a. alveolar dilation b. increased delirium c. changes in vital signs d. increased infection risk e. decreased respiratory muscle strength f. diminished elastic recoil within the airways
a, d, e, f
A patient who was admitted the previous day with pneumonia complains of a sharp pain of 7 (on 0 to 10 scale) "whenever I take a deep breath." Which action will the nurse take next? a. Auscultate for breath sounds. b. Administer the PRN morphine. c. Have the patient cough forcefully. d. Notify the patient's health care provider.
a. Auscultate for breath sounds.
The nurse is caring for a patient who has a right-sided chest tube after a right lower lobectomy. Which nursing action can the nurse delegate to the unlicensed assistive personnel (UAP)? a. Document the amount of drainage every 8 hours. b. Obtain samples of drainage for culture from the system. c. Assess patient pain level associated with the chest tube. d. Check the water-seal chamber for the correct fluid level.
a. Document the amount of drainage every 8 hours.
A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a pneumothorax. Which action will the nurse anticipate taking? a. Lower the positive end-expiratory pressure (PEEP). b. Increase the fraction of inspired oxygen (FIO2). c. Suction more frequently. d. Increase the tidal volume.
a. Lower the positive end-expiratory pressure (PEEP).
A patient who is lethargic and exhibits deep, rapid respirations has the following arterial blood gas (ABG) results: pH 7.32, PaO2 88 mm Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. How should the nurse interpret these results? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
a. Metabolic acidosis
Which information about a patient who is receiving cisatracurium (Nimbex) to prevent asynchronous breathing with the positive pressure ventilator requires action by the nurse? a. No sedative has been ordered for the patient. b. The patient does not respond to verbal stimulation. c. There is no cough or gag reflex when the patient is suctioned. d. The patient's oxygen saturation remains between 90% to 93%.
a. No sedative has been ordered for the patient.
The nurse is caring for a patient who has just had a thoracentesis. Which assessment information obtained by the nurse is a priority to communicate to the health care provider? a. O2 saturation is 88%. b. Blood pressure is 155/90 mm Hg. c. Pain level is 5 (on 0 to 10 scale) with a deep breath. d. Respiratory rate is 24 breaths/minute when lying flat.
a. O2 saturation is 88%.
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. Observe for distended neck veins.
A nurse is caring for an obese patient with right lower lobe pneumonia. Which position will be best to improve gas exchange? a. On the left side b. On the right side c. In the tripod position d. In the high-Fowler's position
a. On the left side
A patient with ARDS who is receiving mechanical ventilation using synchronized intermittent mandatory ventilation (SIMV) has settings of fraction of inspired oxygen (FIO2) 80%, tidal volume 500, rate 18, and positive end-expiratory pressure (PEEP) 5 cm. Which assessment finding is most important for the nurse to report to the health care provider? a. Oxygen saturation 99% b. Patient respiratory rate 22 breaths/min c. Crackles audible at lung bases d. Apical pulse rate 104 beats/min
a. Oxygen saturation 99%
A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat. The emergency department nurse would be most concerned if which finding is observed during the initial assessment? a. Paradoxical chest movement b. Complaint of chest wall pain c. Heart rate of 110 beats/minute d. Large bruised area on the chest
a. Paradoxical chest movement
The nurse is caring for a patient who is intubated and receiving positive pressure ventilation to treat acute respiratory distress syndrome (ARDS). Which finding is most important to report to the health care provider? a. Red-brown drainage from nasogastric tube b. Blood urea nitrogen (BUN) level 32 mg/dL c. Scattered coarse crackles heard throughout lungs d. Arterial blood gases: pH of 7.31, PaCO2 of 50, and PaO2 of 68
a. Red-brown drainage from nasogastric tube
following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of impaired gas exchange based on which finding? a. SpO2 of 86% b. crackles in both lower lobes c. temperature of 101.4 F d. production of greenish purulent sputum
a. SpO2 of 86%
Which assessment finding by the nurse when caring for a patient with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates that the PEEP may need to be decreased? a. The patient has subcutaneous emphysema. b. The patient has a sinus bradycardia with a rate of 52. c. The patients PaO2 is 50 mm Hg and the SaO2 is 88%. d. The patient has bronchial breath sounds in both the lung fields.
a. The patient has subcutaneous emphysema.
When admitting a patient in possible respiratory failure with a high PaCO2, which assessment information will be of most concern to the nurse? a. The patient is somnolent. b. The patients SpO2 is 90%. c. The patient complains of weakness. d. The patients blood pressure is 162/94.
a. The patient is somnolent.
When prone positioning is used in the care of a patient with acute respiratory distress syndrome (ARDS), which information obtained by the nurse indicates that the positioning is effective? a. The patients PaO2 is 90 mm Hg, and the SaO2 is 92%. b. Endotracheal suctioning results in minimal mucous return. c. Sputum and blood cultures show no growth after 24 hours. d. The skin on the patients back is intact and without redness.
a. The patients PaO2 is 90 mm Hg, and the SaO2 is 92%.
After assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis? a. Weak cough effort b. Profuse green sputum c. Respiratory rate of 28 breaths/minute d. Resting pulse oximetry (SpO2) of 85%
a. Weak cough effort
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. a sedation holiday
a patient with severe chronic lung disease is hospitalized with respiratory distress. which finding would suggest to the nurse that the patient has developed rapid decompensation? a. agitation and confusion b. an sp02 of 86% c. pac02 increases from 48 to 55 d. a blood ph of 7.33
a. agitation and confusion
what should the nurse do when preparing for a patient for a pulmonary angiogram? a. assess the patient for iodine allergy b. implement NPO orders for 6 to 12 hours before the test c. explain the test before the patient signs the informed consent form d. inform the patient that radiation isolation for 24 hrs after the test is necessary
a. assess the patient for iodine allergy
a 75-year-old patient who is breathing room air has the following arterial blood gas (ABG) results: pH 7.40, PaO2 74 mm Hg, PaCO2 40 mm Hg. what is the most appropriate action by the nurse? a. document the results in the patient's record b. repeat the ABG within an hour to validate the findings c. encourage deep breathing and coughing to open the alveoli d. initiate pulse oximetry for continuous monitoring of the patient's oxygen status
a. document the results in the patient's record
after endotracheal intubation and mechanical ventilation have been started, a patient in respiratory failure becomes very agitated and is breathing asynchronously with the ventilator. what is the most important for the nurse to do first? a. evaluate the patient's pain level, ABGs, and electrolyte values b. sedate the patient to unconsciousness to eliminate patient awareness c. administer the PRN vecuronium to promote synchronous ventilations d. slow the rate of ventilations provided by the ventilator to allow for spontaneous breathing by the patient
a. evaluate the patient's pain level, ABGs, and electrolyte values
While caring for a patient who has been admitted with a pulmonary embolism, the nurse notes a change in the patients oxygen saturation (SpO2) from 94% to 88%. The nurse will a. increase the oxygen flow rate. b. suction the patients oropharynx. c. assist the patient to cough and deep breathe. d. help the patient to sit in a more upright position.
a. increase the oxygen flow rate.
A patient develops increasing dyspnea and hypoxemia 2 days after having cardiac surgery. To determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by left ventricular failure, the nurse will anticipate assisting with a. inserting a pulmonary artery catheter. b. obtaining a ventilation-perfusion scan. c. drawing blood for arterial blood gases. d. positioning the patient for a chest radiograph.
a. inserting a pulmonary artery catheter.
a young adult is admitted to the emergency department after an automobile accident. the client has severe pain in the right chest from contact with the steering wheel. what should the nurse do first? a. maintain adequate oxygenation b. maintain adequate circulation volume c. reduce the client's anxiety d. decrease chest pain
a. maintain adequate oxygenation
a patient with a massive hemothorax and pneumothorax has absent breath sounds in the right lung. to promote improved v/q matching, how should the nurse position the patient? a. on the left side b. on the right side c. in a reclining chair bed d. supine with the head of the bed elevated
a. on the left side
a patient has a PaO2 of 50 mm Hg and a PaCO2 of 42 mm Hg because of an intrapulmonary shunt. which therapy should the nurse expect the patient to respond to best? a. positive pressure ventilation b. oxygen administration at a FIO2 of 100% c. administration of O2 per nasal cannula at 1 to 3 L/min d. clearance of airway secretions with coughing and suctioning
a. positive pressure ventilation
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. prevent alveolar collapse and open up collapsed alveoli
two days after undergoing pelvic surgery, a patient develops marked dyspnea and anxiety. what is the first action that the nurse should take? a. raise the head of the bed b. notify the health care provider c. take the patient's pulse and blood pressure d. determine the patient's SpO2 with an oximeter
a. raise the head of the bed
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
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. restlessness
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. oxygen toxicity c. prolonged hypotension d. cardiopulmonary bypass
a. sepsis
when should the nurse check for leaks in the chest tube and pleural drainage system? a. there is continuous bubbling in the water-seal chamber b. there is constant bubbling of water in the suction control chamber c. fluid in the water-seal chamber fluctuates with patient's breathing d. the water levels in the water-seal and suction control chambers are decreased
a. there is continuous bubbling in the water-seal chamber
after which diagnostic study should the nurse observe the patient for symptoms of a pneumothorax? a. thoracentesis b. pulmonary function test c. ventilation-perfusion scan d. positron emission tomography (PET) scan
a. thoracentesis
the best patient response to treatment of ARDS occurs when initial managements includes what? a. treatment of the underlying condition b. administration of prophylactic antibiotics c. treatment with diuretics and mild fluid restriction d. endotracheal intubation and mechanical ventilation
a. treatment of the underlying condition
respiratory acidosis causes
anything that can cause someone to hypoventilate -anesthesia -drug overdose
Which actions should the nurse start to reduce the risk for ventilator-associated pneumonia (VAP) (select all that apply)? a. Obtain arterial blood gases daily. b. Provide a "sedation holiday" daily. c. Give prescribed pantoprazole (Protonix). d. Elevate the head of the bed to at least 30°. e. Provide oral care with chlorhexidine (0.12%) solution daily.
b, c, d, e
which descriptions are characteristic of hypoxemic respiratory failure (SATA)? a. referred to as ventilatory failure b. primary problem is inadequate O2 transfer c. risk of inadequate O2 saturation of hemoglobin exists d. body is unable to to compensate for acidemia of increased PaCO2 e. most often caused by ventilation-perfusion (V/Q) mismatch and shunt f. exists when PaO2 is 60mm Hg or less, even when O2 is administered at 60%
b, c, e, f
The nurse monitors a patient in the emergency department after chest tube placement for a hemopneumothorax. The nurse is most concerned if which assessment finding is observed? a. A large air leak in the water-seal chamber b. 400 mL of blood in the collection chamber c. Complaint of pain with each deep inspiration d. Subcutaneous emphysema at the insertion site
b. 400 mL of blood in the collection chamber
The nurse receives change-of-shift report on the following four patients. Which patient should the nurse assess first? a. A 23-yr-old patient with cystic fibrosis who has pulmonary function testing scheduled b. A 46-yr-old patient on bed rest who is complaining of sudden onset of shortness of breath c. A 77-yr-old patient with tuberculosis (TB) who has four medications due in 15 minutes d. A 35-yr-old patient who was admitted with pneumonia and has a temperature of 100.2° F (37.8° C)
b. A 46-yr-old patient on bed rest who is complaining of sudden onset of shortness of breath
An hour after a thoracotomy, a patient complains of incisional pain at a level 7 (based on 0 to 10 scale) and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which action should the nurse take? a. Clamp the chest tube in two places. b. Administer the prescribed morphine. c. Milk the chest tube to remove any clots. d. Assist the patient with incentive spirometry
b. Administer the prescribed morphine.
A patient who has a right-sided chest tube after a thoracotomy has continuous bubbling in the suction-control chamber of the collection device. Which action by the nurse is appropriate? a. Adjust the dial on the wall regulator. b. Continue to monitor the collection device. c. Document the presence of a large air leak. d. Notify the surgeon of a possible pneumothorax.
b. Continue to monitor the collection device.
A patient who had a transverse colectomy for diverticulosis 18 hours ago has nasogastric suction. The patient complains of anxiety and incisional pain. The patient's respiratory rate is 32 breaths/min, and the arterial blood gases (ABGs) indicate respiratory alkalosis. Which action should the nurse take first? a. Check to make sure the nasogastric tube is patent. b. Give the patient the PRN IV morphine sulfate 4 mg. c. Notify the health care provider about the ABG results. d. Teach the patient how to take slow, deep breaths when anxious.
b. Give the patient the PRN IV morphine sulfate 4 mg.
Which of these nursing actions included in the care of a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) can the RN delegate to an experienced LPN/LVN working in the intensive care unit? a. Assess breath sounds b. Insert a retention catheter c. Place patient in the prone position d. Monitor pulmonary artery pressures
b. Insert a retention catheter
A patient has a nursing diagnosis of ineffective airway clearance related to thick, secretions. Which action will be best for the nurse to include in the plan of care? a. Encourage use of the incentive spirometer. b. Offer the patient fluids at frequent intervals. c. Teach the patient the importance of coughing. d. Increase oxygen level to keep O2 saturation >95%.
b. Offer the patient fluids at frequent intervals.
Which action should the nurse plan to prevent aspiration in a high-risk patient? a. Turn and reposition an immobile patient at least every 2 hours. b. Place a patient with altered consciousness in a side-lying position. c. Insert a nasogastric tube for feeding a patient with high calorie needs. d. Monitor respiratory symptoms in a patient who is immunosuppressed.
b. Place a patient with altered consciousness in a side-lying position.
A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure? a. Start a peripheral IV line to administer sedatives. b. Position the patient sitting up on the side of the bed. c. Obtain a collection device to hold 3 liters of pleural fluid. d. Remind the patient not to eat or drink anything for 6 hours.
b. Position the patient sitting up on the side of the bed.
a patient with a pH of 7.29 has metabolic acidosis. which value is useful in determining whether the cause of the acidosis is an acid gain or a bicarbonate loss? a. PaCO2 b. anion gap c. serum Na+ level d. bicarbonate level
b. anion gap
the nurse suspects that a patient with PEEP is experiencing negative effects of this ventilatory maneuver when which of the following is assessed? a. increasing PaO2 b. decreasing blood pressure c. decreasing heart rate (HR) d. increasing central venous pressure (CVP)
b. decreasing blood pressure
which physiologic mechanism of hypoxemia occurs with pulmonary fibrosis? a. anatomic shunt b. diffusion limitation c. intrapulmonary shunt d. v/q mismatch ratio of less than 1
b. diffusion limitation
A patient with respiratory failure has a respiratory rate of 8 and an SpO2 of 89%. The patient is increasingly lethargic. The nurse will anticipate assisting with a. administration of 100% oxygen by non-rebreather mask. b. endotracheal intubation and positive pressure ventilation. c. insertion of a mini-tracheostomy with frequent suctioning. d. initiation of bilevel positive pressure ventilation (BiPAP).
b. endotracheal intubation and positive pressure ventilation.
the nurse suspects the early stage of ARDS in any seriously ill patient who manifests what? a. develops respiratory acidosis b. exhibits dyspnea and restlessness c. has diffuse crackles and wheezing d. has a decreased PaO2 and an increased PaCO2
b. exhibits dyspnea and restlessness
A patient with acute respiratory distress syndrome (ARDS) and acute renal failure has the following medications prescribed. Which medication should the nurse discuss with the health care provider before administration? a. ranitidine (Zantac) 50 mg IV b. gentamicin (Garamycin) 60 mg IV c. sucralfate (Carafate) 1 g per nasogastric tube d. methylprednisolone (Solu-Medrol) 40 mg IV
b. gentamicin (Garamycin) 60 mg IV
while caring for an 84-yr-old patient, the nurse monitors the patient's fluid and electrolyte balance, recognizing what as a normal change of aging? a. hyperkalemia b. hyponatremia c. decreased insensible fluid loss d. increased plasma oncotic pressures
b. hyponatremia
what are the three phases of pathophysiologic changes in Acute Respiratory Distress Syndrome? a. ventilator associated, positive pressure, maintenance b. injury, reparative, fibrotic c. hypoxic, refractory, ventilatory d. onset, fluid buildup, necrosis
b. injury, reparative, fibrotic
a patient with pneumonia has a nursing diagnosis of ineffective airway clearance related to pain, fatigue, and thick secretions. what is an expected outcome for this patient? a. SpO2 is 90% b. lungs clear to auscultation c. patient tolerates walking in hallway d. patient takes three or four shallow breaths before coughing to minimize pain
b. lungs clear to auscultation
When the nurse is caring for an obese patient with left lower lobe pneumonia, gas exchange will be best when the patient is positioned a. on the left side. b. on the right side. c. in the tripod position. d. in the high-Fowlers position.
b. on the right side.
a patient in hypercapnic respiratory failure has a nursing diagnosis of ineffective airway clearance related to increasing exhaustion. what is an appropriate nursing intervention for this patient? a. inserting an oral airway b. performing augmented coughing c. teaching the patient huff coughing d. teaching the patient slow pursed lip breathing
b. performing augmented coughing
a patient with ARDS has a nursing diagnosis of risk for infection. to detect the presence of infections commonly associated with ARDS, what should the nurse monitor? a. gastric aspirate for pH and blood b. quality, quantity, and consistency of sputum c. subcutaneous emphysema of the face, neck, and chest d. mucous membranes of the oral cavity for open lesions
b. quality, quantity, and consistency of sputum
what is the most common cause of Acute Respiratory Distress Syndrome? a. near drowning b. sepsis c. head injury d. radiation exposure
b. sepsis
the nurse is reviewing a patient's morning laboratory results. which result is of greatest concern? a. serum Na+ of 150 mEq/L b. serum Mg 2+ of 1.1 mEq/L c. serum PO4 3- of 4.5 mg/dL d. serum Ca 2+ (total) of 8.6 mg/dL
b. serum Mg 2+ of 1.1 mEq/L
to determine whether a tension pneumothorax is developing in a patient with chest trauma, for what does the nurse assess the patient? a. dull percussion sounds on the injured side b. severe respiratory distress and tracheal deviation c. muffled and distant heart sounds with decreasing blood pressure d. decreased movement and diminished breath sounds on the affected side
b. severe respiratory distress and tracheal deviation
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. slow, shallow respirations as a result of sedative overdose
what keeps alveoli from collapsing? a. carina b. surfactant c. empyema d. thoracic cage
b. surfactant
why are patients with ARDS placed in the prone position? a. to get a break from being on ventilator b. to improve ventilation of better perfused lung areas c. to place more pressure on the lungs d. to prevent pressure ulcers
b. to improve ventilation of better perfused lung areas
to reduce the risk for many occupational lung diseases, what is the most important measure the occupational nurse should promote? a. maintaining smoke-free work environment for all employees b. using masks and effective ventilation systems to reduce exposure to irritants c. inspection and monitoring of workplaces by national occupational safety agencies d. requiring periodic chest x-rays and pulmonary function tests for exposed employees
b. using masks and effective ventilation systems to reduce exposure to irritants
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 (SATA)? a. cyanosis b. metabolic acidosis c. morning headache d. respiratory acidosis e. use of tripod position f. rapid, shallow respirations
c, d, e, f
what is the normal pH range of the blood, and what ratio of base to acid does this reflect? a. 7.32 to 7.42; 25 to 2 b. 7.32 to 7.42; 28 to 2 c. 7.35 to 7.45; 20 to 1 d. 7.35 to 7.45; 30 to 1
c. 7.35 to 7.45; 20 to 1
To evaluate the effectiveness of prescribed therapies for a patient with ventilatory failure, which diagnostic test will be most useful to the nurse? a. Chest x-rays b. Pulse oximetry c. Arterial blood gas (ABG) analysis d. Pulmonary artery pressure monitoring
c. Arterial blood gas (ABG) analysis
The pulse oximetry for a patient with right lower lobe pneumonia indicates an oxygen saturation of 90%. The patient has rhonchi, a weak cough effort, and complains of fatigue. Which action is best for the nurse to take? a. Position the patient on the right side. b. Place a humidifier in the patients room. c. Assist the patient with staged coughing. d. Schedule a 2-hour rest period for the patient.
c. Assist the patient with staged coughing.
why does a patient's respiratory rate increase when there is an excess of Co2 in the blood? a. CO2 displaces oxygen on hemoglobin, leading to a decreased PaO2 b. CO2 causes an increase in the amount of hydrogen ions available in the body c. CO2 combines with water to form carbonic acid, which lowers the pH of cerebrospinal fluid d. CO2 directly stimulates chemoreceptors in the medulla to increase respiratory rate and volume
c. CO2 combines with water to form carbonic acid, which lowers the pH of cerebrospinal fluid
To decrease the risk for ventilator-associated pneumonia, which action will the nurse include in the plan of care for a patient who requires intubation and mechanical ventilation? a. Avoid use of positive end-expiratory pressure (PEEP). b. Suction every 2 hours. c. Elevate head of bed to 30 to 45 degrees. d. Give enteral feedings at no more than 10 mL/hr.
c. Elevate head of bed to 30 to 45 degrees.
The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy. Which information should the nurse include about the patient's postoperative care? a. Bed rest for the first 24 hours b. Positioning only on the right side c. Frequent use of an incentive spirometer d. Chest tube placement to continuous suction
c. Frequent use of an incentive spirometer
The nurse notes that a patient has incisional pain, a poor cough effort, and scattered coarse crackles after a thoracotomy. Which action should the nurse take first? a. Assist the patient to sit upright in a chair. b. Splint the patient's chest during coughing. c. Medicate the patient with prescribed morphine. d. Observe the patient use the incentive spirometer.
c. Medicate the patient with prescribed morphine.
A nurse is assessing a newly admitted patient with chronic heart failure who forgot to take prescribed medications and seems confused. The patient has peripheral edema and shortness of breath. Which assessment should the nurse complete first? a. Skin turgor b. Heart sounds c. Mental status d. Capillary refill
c. Mental status
An older patient receiving iso-osmolar continuous tube feedings develops restlessness, agitation, and weakness. Which laboratory result should the nurse report to the health care provider immediately? a. K + 3.4 mEq/L (3.4 mmol/L) b. Ca+2 7.8 mg/dL (1.95 mmol/L) c. Na+ 154 mEq/L (154 mmol/L) d. PO4 -3 4.8 mg/dL (1.55 mmol/L)
c. Na+ 154 mEq/L (154 mmol/L)
The nurse obtains the vital signs for a patient admitted 2 days ago with gram-negative sepsis: temperature 101.2 F, blood pressure 90/56 mm Hg, pulse 92, respirations 34. Which action should the nurse take next? a. Administer the scheduled IV antibiotic. b. Give the PRN acetaminophen (Tylenol) 650 mg. c. Obtain oxygen saturation using pulse oximetry. d. Notify the health care provider of the patients vital signs.
c. Obtain oxygen saturation using pulse oximetry.
A patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving nifedipine (Procardia). Which assessment would best indicate to the nurse that the patient's condition is improving? a. Patient's chest x-ray indicates clear lung fields. b. Heart rate is between 60 and 100 beats/minute. c. Patient reports a decrease in exertional dyspnea. d. Blood pressure (BP) is less than 140/90 mm Hg.
c. Patient reports a decrease in exertional dyspnea.
The nurse is caring for a 22-year-old patient who came to the emergency department with acute respiratory distress. Which information about the patient requires the most rapid action by the nurse? a. Respiratory rate is 32 breaths/min. b. Pattern of breathing is shallow. c. The patients PaO2 is 45 mm Hg. d. The patients PaCO2 is 34 mm Hg.
c. The patients PaO2 is 45 mm Hg.
A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department complaining of shortness of breath and dyspnea. Which assessment finding by the nurse is most important to report to the health care provider? a. The patient has bibasilar lung crackles. b. The patient is sitting in the tripod position. c. The patients respiratory rate has decreased from 30 to 10 breaths/min. d. The patients pulse oximetry indicates an O2 saturation of 91%.
c. The patients respiratory rate has decreased from 30 to 10 breaths/min.
During change-of-shift report on a medical unit, the nurse learns that a patient with aspiration pneumonia who was admitted with respiratory distress has become increasingly agitated. Which action should the nurse take first? a. Give the prescribed PRN sedative drug. b. Offer reassurance and reorient the patient. c. Use pulse oximetry to check the oxygen saturation. d. Notify the health care provider about the patient's status.
c. Use pulse oximetry to check the oxygen saturation.
a patient with an acid-base imbalance has an altered potassium level. the nurse recognizes that the potassium level is altered because... a. potassium is returned to extracellular fluid when metabolic acidosis is corrected b. hyperkalemia causes an alkalosis that results in potassium being shifted into the cells c. acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells d. in alkalosis, potassium is shifted into extracellular fluid to bind excessive bicarbonate
c. acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells
a pulse oximetry monitor indicates that the patient has a drop in SpO2, from 95% to 85% over several hours. what is the first action the nurse should take? a. order stat ABGs to confirm the SpO2 with a SaO2 b. start oxygen administration by nasal cannula at 2L/min c. check the position of the probe on the finger or earlobe d. notify the health care provider of the change in baseline PaO2
c. check the position of the probe on the finger or earlobe
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. continued hypoxemia because of diffusion limitation
which of the following is a cause of Respiratory Acidosis? a. anxiety b. sepsis c. drug overdose d. fear
c. drug overdose
when the nurse is explaining respiratory failure to the patient's family, what is the most accurate description to use? 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. an episode of acute hypoxemia caused by a pulmonary dysfunction
c. inadequate gas exchange to meet the metabolic needs of the body
a patient who has a large amount of carbon dioxide in the blood also has what in the blood? a. large amounts of carbonic acid and low hydrogen ion concentration b. small amount of carbonic acid and low hydrogen ion concentration c. large amount of carbonic acid and high hydrogen ion concentration d. small amount of carbonic acid and high hydrogen ion concentration
c. large amount of carbonic acid and high hydrogen ion concentration
how does the nurse assess the patient's chest expansion? a. put the palms of the hands against the chest wall b. put the index fingers on either side of the trachea c. place the thumbs at the midline of the lower chest d. place one hand on the lower anterior chest and one hand on the upper abdomen
c. place the thumbs at the midline of the lower chest
the patient with a history of heart failure and acute respiratory failure has thick secretions that she is having difficulty coughing up. which intervention would best help to mobilize her secretions? a. administer more IV fluid b. perform postural drainage c. provide O2 by aerosol mask d. suction nasopharyngeal airways
c. provide O2 by aerosol mask
when the v/q lung scan results indicate a mismatch ratio that is greater than 1, which condition should be suspected? a. pain b. atelectasis c. pulmonary embolus d. ventricular septal defect
c. pulmonary embolus
a pulmonary embolus is suspected in a patient with a deep vein thrombosis who develops dyspnea, tachycardia, and chest pain. diagnostic testing is scheduled. which test should the nurse plan to teach the patient about? a. d-dimer b. chest x-ray c. spiral (helical) CT scan d. ventilation-perfusion lung scan
c. spiral (helical) CT scan
after the health care provider sees a patient hospitalized with a stroke who developed a fever and adventitious lung sounds, the following orders are written. which order should the nurse implement first? a. anterior/posterior and lateral chest x-rays b. start IV levofloxacin (levaquin) 500mg every 24 hr c. sputum specimen for gram stain and culture and sensitivity d. complete blood count (CBC) with white blood cell (WBC) count and differential
c. sputum specimen for gram stain and culture and sensitivity
an unlicensed assistive personnel (UAP) is taking care of a patient with a chest tube. the nurse should intervene when she observes the UAP a. looping the drainage tubing on the bed b. securing the drainage container in an upright position c. stripping or milking the chest tube to promote drainage d. reminding the patient to cough and deep breathe every 2 hours
c. stripping or milking the chest tube to promote drainage
what is the primary nursing responsibility after obtaining a blood specimen for ABGs? a. add heparin to the blood specimen b. apply pressure to the puncture site for a full 2 minutes c. take the specimen immediately to the laboratory in an iced container d. avoid any changes in oxygen intervention for 15 minutes following the procedure
c. take the specimen immediately to the laboratory in an iced container
what accurately describes the alveolar sacs? a. line the lung pleura b. warm and moisturize inhaled air c. terminal structures of the respiratory tract d. contain dead air that is not available for gas exchange
c. terminal structures of the respiratory tract
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 lung 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
c. this occurs when blood flows through the capillaries in the lungs without participating in gas exchange
a patient who is lethargic and exhibits deep, rapid respirations has the following arterial blood gas (ABG) results: pH 7.32, PaO2 88 mm Hg, PaCO2 37 mmHg, and HCO3 16 mEq/L. How should the nurse interpret these results? a. partially compensated respiratory acidosis b. fully compensated respiratory alkalosis c. uncompensated metabolic acidosis d. uncompensated metabolic alkalosis
c. uncompensated metabolic acidosis
9. The nurse completes discharge teaching for a patient who has had a lung transplant. Which patient statement indicates to the nurse that the teaching has been effective? a. "I will make an appointment to see the doctor every year." b. "I will stop taking the prednisone if I experience a dry cough." c. "I will not worry if I feel a little short of breath with exercise." d. "I will call the health care provider right away if I develop a fever."
d. "I will call the health care provider right away if I develop a fever."
The nurse provides discharge teaching for a patient who has two fractured ribs from an automobile accident. Which statement, if made by the patient, would indicate that teaching has been effective? a. "I am going to buy a rib binder to wear during the day." b. "I can take shallow breaths to prevent my chest from hurting." c. "I should plan on taking the pain pills only at bedtime so I can sleep." d. "I will use the incentive spirometer every hour or two during the day."
d. "I will use the incentive spirometer every hour or two during the day."
. After change-of-shift report, which patient should the nurse assess first? a. A 72-yr-old with cor pulmonale who has 4+ bilateral edema in his legs and feet b. A 28-yr-old with a history of a lung transplant and a temperature of 101° F (38.3° C) c. A 40-yr-old with a pleural effusion who is complaining of severe stabbing chest pain d. A 64-yr-old with lung cancer and tracheal deviation after subclavian catheter insertion
d. A 64-yr-old with lung cancer and tracheal deviation after subclavian catheter insertion
After receiving change-of-shift report, which patient will the nurse assess first? a. A patient with cystic fibrosis who has thick, green-colored sputum b. A patient with pneumonia who has coarse crackles in both lung bases c. A patient with emphysema who has an oxygen saturation of 91% to 92% d. A patient with septicemia who has intercostal and suprasternal retractions
d. A patient with septicemia who has intercostal and suprasternal retractions
The nurse notes that a patient who was admitted with diabetic ketoacidosis has rapid, deep respirations. Which action should the nurse take? a. Give the prescribed PRN lorazepam (Ativan). b. Encourage the patient to take deep slow breaths. c. Start the prescribed PRN oxygen at 2 to 4 L/min. d. Administer the prescribed normal saline bolus and insulin.
d. Administer the prescribed normal saline bolus and insulin.
When assessing a patient with chronic lung disease, the nurse finds a sudden onset of agitation and confusion. Which action should the nurse take first? a. Check pupil reaction to light. b. Notify the health care provider. c. Attempt to calm and reassure the patient. d. Assess oxygenation using pulse oximetry.
d. Assess oxygenation using pulse oximetry.
When assessing a patient who has just arrived after an automobile accident, the emergency department nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the patient? a. Emergency pericardiocentesis b. Stabilization of the chest wall c. Bronchodilator administration d. Chest tube connected to suction
d. Chest tube connected to suction
A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/min, blood pressure of 100/60 mm Hg, and respirations of 42 breaths/min. Which action should the nurse take first? a. Administer anticoagulant drug therapy. b. Notify the patient's health care provider. c. Prepare patient for a spiral computed tomography (CT). d. Elevate the head of the bed to a semi-Fowler's position.
d. Elevate the head of the bed to a semi-Fowler's position.
The nurse is caring for a patient who was hospitalized 2 days earlier with aspiration pneumonia. Which assessment information is most important to communicate to the health care provider? a. Cough that is productive of blood-tinged sputum b. Scattered crackles throughout the posterior lung bases c. Temperature of 101.5 F (38.6 C) after 2 days of IV antibiotic therapy d. Oxygen saturation (SpO2) has dropped to 90% with administration of 100% O2 by non-rebreather mask.
d. Oxygen saturation (SpO2) has dropped to 90% with administration of 100% O2 by non-rebreather mask.
Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a patient with ARDS is correct? a. PEEP will prevent fibrosis of the lung from occurring. b. PEEP will push more air into the lungs during inhalation. c. PEEP allows the ventilator to deliver 100% oxygen to the lungs. d. PEEP prevents the lung air sacs from collapsing during exhalation.
d. PEEP prevents the lung air sacs from collapsing during exhalation.
which arterial blood gas (ABG) results would most likely indicate acute respiratory failure in a patient with chronic lung disease? a. PaO2 52 mm Hg, PaCO2 56 mm Hg, pH 7.4 b. PaO2 46 mm Hg, PaCO2 55 mm Hg, pH 7.36 c. PaO2 48 mm Hg, PaCO2 54 mm Hg, pH 7.38 d. PaO2 50 mm Hg, PaCO2 54 mm Hg, pH 7.28
d. PaO2 50 mm Hg, PaCO2 54 mm Hg, pH 7.28
A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for continued mechanical ventilation. How should the nurse interpret the following arterial blood gas results: pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
d. Respiratory alkalosis
A patient is admitted to the emergency department with an open stab wound to the left chest. What action should the nurse take? a. Keep the head of the patient's bed positioned flat. b. Cover the wound tightly with an occlusive dressing. c. Position the patient so that the left chest is dependent. d. Tape a nonporous dressing on three sides over the wound.
d. Tape a nonporous dressing on three sides over the wound.
Which intervention will the nurse include in the plan of care for a patient who is diagnosed with a lung abscess? a. Teach the patient to avoid the use of over-the-counter expectorants. b. Assist the patient with chest physiotherapy and postural drainage. c. Notify the health care provider immediately about any bloody or foul-smelling sputum. d. Teach about the need for prolonged antibiotic therapy after discharge from the hospital.
d. Teach about the need for prolonged antibiotic therapy after discharge from the hospital.
which patient is at highest risk for hypoxemic respiratory failure? a. a patient who has fractured ribs and a flail chest b. a patient who has slow breathing from a drug overdose c. a patient who has respiratory muscle paralysis d. a patient who has a massive pulmonary embolism
d. a patient who has a massive pulmonary embolism
in a patient with sodium imbalances, the primary clinical manifestations are related to alterations in what body system? a. kidneys b. cardiovascular system c. musculoskeletal system d. central nervous system
d. central nervous system
a 73-year-old patient has an SpO2 of 70%. what other assessment should the nurse consider before making a judgement about the adequacy of the patient's oxygenation? a. what the oxygenation status is with a stress test b. trend and rate of development of hyperkalemia c. comparison of patient's SpO2 values with the normal values d. comparison of patient's current vital signs with normal vital signs
d. comparison of patient's current vital signs with normal vital signs
what is a compensatory mechanism for metabolic alkalosis? a. shifting of bicarbonate into cells in exchange for chloride b. kidney conservation of bicarbonate and excretion of hydrogen ions c. deep, rapid respirations (Kussmaul respirations) to increase CO2 excretion d. decreased respiratory rate and depth to retain CO2 and kidney excretion of bicarbonate
d. decreased respiratory rate and depth to retain CO2 and kidney excretion of bicarbonate
the nurse assesses that a patient in respiratory distress is developing respiratory failure 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 (I/E) ratio d. has a change in respiratory rate from rapid to slow
d. has a change in respiratory rate from rapid to slow
which patient is at risk for hypernatremia? a. has a deficiency of aldosterone b. has prolonged vomiting and diarrhea c. receives excessive IV 5% dextrose solution d. has impaired consciousness and decreased thirst sensitivity
d. has impaired consciousness and decreased thirst sensitivity
in caring for a patient in acute respiratory failure, the nurse recognizes that noninvasive positive pressure ventilation (NIPPV) may be indicated for which patient? a. is comatose and has high oxygen requirements b. has copious secretions that require frequent suctioning c. responds to hourly bronchodilator nebulization treatments d. is alert and cooperative but has increasing respiratory exhaustion
d. is alert and cooperative but has increasing respiratory exhaustion
following a thoracotomy, the patient has a nursing diagnosis of ineffective breathing pattern related to inability to cough as a result of pain and positioning. what is the best nursing intervention for this patient? a. have the patient drink 16 oz of water before attempting to deep breathe b. auscultate the lungs before and after deep-breathing and coughing regimens c. place the patient in the trendelenburg position for 30 mins before the coughing exercises d. medicate the patient with analgesics 20 to 30 minutes before assisting to cough and deep breathe
d. medicate the patient with analgesics 20 to 30 minutes before assisting to cough and deep breathe
a patient's ABGs include a PaO2 of 88 mm Hg and a PaCO2 of 38 mm Hg, and mixed venous blood gases include a PvO2 of 40 mm Hg and PvCO2 of 46 mm Hg. what do these findings indicate? a. impaired cardiac output b. unstable hemodynamics c. inadequate delivery of oxygen to the tisses d. normal capillary oxygen-carbon dioxide exchange
d. normal capillary oxygen-carbon dioxide exchange
following a motor vehicle accident, the nurse assesses the driver for which distinctive sign of flail chest? a. severe hypotension b. chest pain over ribs c. absence of breath sounds d. paradoxical chest movements
d. paradoxical chest movements
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 alevoli in the anterior portion of the lung
d. promote perfusion of nonatelectatic alevoli in the anterior portion of the lung
the health care provider orders a pulmonary angiogram for a patient admitted with dyspnea and hemoptysis. for which problem is the test most commonly used as a diagnostic measure? a. TB b. cancer of the lung c. airway obstruction d. pulmonary embolism
d. pulmonary embolism
a male patient has chronic obstructive pulmonary disease (COPD) and is a smoker. the nurse notices respiratory distress and no breath sounds over the left chest. which type of pneumothorax should the nurse suspect is occurring? a. tension pneumothorax b. iatrogenic pneumothorax c. traumatic pneumothorax d. spontaneous pneumothorax
d. spontaneous pneumothorax
a client with a pneumothorax has a chest tube inserted that is connected to a water seal drainage system. the nurse notes that the fluid in the water seal chamber is fluctuating with each breath that the client takes. what is the significance of this fluctuation? a. the client has developed subcutaneous emphysema b. there is an air leak in the system c. an obstruction is present in the system d. the chest tube system is functioning properly
d. the chest tube system is functioning properly
what is the primary reason that hemodynamic monitoring is instituted in severe respiratory failure? a. to detect v/q mismatches b. to continuously measure the arterial BP c. to evaluate oxygenation and ventilation status d. to evaluate cardiac status and blood flow to tissues
d. to evaluate cardiac status and blood flow to tissues
respiratory alkalosis causes
hyperventilating (low levels of CO2) -mechanical ventilator w resp too high -anxiety, fear, stress -sepsis -brain injuries
common causes of respiratory alkalosis
mechanical over ventilation, response to anxiety, fear and pain
common causes of metabolic alkalosis
prolonged vomiting, baking soda used as antacid
match the acid-base imbalances with their mechanisms: a. increased carbonic acid (H2CO3) b. decreased carbonic acid (H2CO3) c. increased base bicarbonate (HCO3-) d. decreased base bicarbonate (HCO3-) 1. metabolic acidosis 2. metabolic alkalosis 3. respiratory acidosis 4. respiratory alkalosis
respiratory acidosis = increased carbonic acid (H2CO3) respiratory alkalosis = decreased carbonic acid (H2CO3) metabolic alkalosis = increased base bicarbonate (HCO3-) metabolic acidosis = decreased base bicarbonate (HCO3-)
common causes of respiratory acidosis
respiratory fatigue, sedative or opioid overdose
