NURS-304 (U4) - Chapter 31: Disorders of Ventilation & Gas Exchange

As a consequence of long-standing lung disease, a client is in a chronic state of hypoxia. Which phenomena would the client's care team be most justified in anticipating? Select all that apply.

(1) Pulmonary vasodilation

(2) Increased erythropoietin production

(3) Personality changes

(4) Hyperventilation

(5) Metabolic alkalosis

(2) Increased erythropoietin production

(3) Personality changes

(4) Hyperventilation

A client who has been on a high-protein diet comes to the emergency department with respiratory symptoms. Upon analysis of arterial blood gases (ABGs), the client is diagnosed with hypercapnia. Which ABG results confirm this diagnosis? Select all that apply.

(1) Serum HCO3 33 mEq/L (33 mmol/L) [Normal 22-28 mEq/L, 22-28 mmol/L]

(2) PCO2 58 mm Hg (7.71 kPa) [Normal 35-45 mm Hg, 4.7 - 5.9 kPa]

(3) pH 7.31 (Normal 7.35-7.45)

(4) Serum K+ [potassium] 3.6 mmol/L (Normal 3.5-5.0)

(5) PO2 97 %

(1) Serum HCO3 33 mEq/L (33 mmol/L) [Normal 22-28 mEq/L, 22-28 mmol/L]

(2) PCO2 58 mm Hg (7.71 kPa) [Normal 35-45 mm Hg, 4.7 - 5.9 kPa]

(3) pH 7.31 (Normal 7.35-7.45)

A nurse is providing care for a client who has been admitted with a newly diagnosed bilateral pleural effusion. Which finding from the nurse's initial assessment of the client is incongruent with the client's diagnosis and would require further investigation?

(a) The client reports sharp pain exacerbated by deep inspiration.

(b) Pulse oximetry indicates that the client is hypoxemic.

(c) The client's breath sounds are diminished on auscultation.

(d) The client reports dyspnea and increased work of breathing.

(a) The client reports sharp pain exacerbated by deep inspiration.

A short, nonsmoking 44-year-old male presents to the emergency room with left-sided chest pain and a cough. He states the pain started abruptly and worsens with deep breathing and coughing. He denies recent injury. Assessment includes shallow respirations with a rate of 36, normal breath sounds, no cyanosis. Which condition is most likely causing his symptoms?

(a) Pleuritis related to infection

(b) Spontaneous pneumothorax

(c) Obstructive atelectasis

(d) Myocardial infarction

(a) Pleuritis related to infection

A 51-year-old female client who is 2 days postoperative in a surgical unit of a hospital is at risk of developing atelectasis as a result of being largely immobile. Which teaching point by her nurse is most appropriate?

(a) "Being in bed increases the risk of fluid accumulating between your lungs and their lining, so it's important for you to change positions often."

(b) "You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed."

(c) "I'll prescribe bronchodilator medications that will help open up your airways and allow more oxygen in."

(d) "Make sure that you stay hydrated and walk as soon as possible to avoid our having to insert a chest tube."

(b) "You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed."

The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son's condition. Which teaching point is most justifiable?

(a) "Your son will likely need to limit or avoid exercise and sports."

(b) "The most reliable indicator that your child is having an asthma attack is audible wheezing."

(c) "Research has shown that viruses may actually be a factor in childhood asthma."

(d) "Steroids that your child can inhale will likely be the first line of defense."

(c) "Research has shown that viruses may actually be a factor in childhood asthma."

In the early morning, a parent brings the 5-year-old child to the emergency room. The child is wheezing, short of breath, and has a dry cough. The parent states that the child has always been very healthy. The child went to bed with only a slight cold and a runny nose but woke up coughing shortly after 4 a.m. The symptoms worsened so dramatically that parent brought the child to the hospital. The care team would most likely suspect that the child has:

(a) influenza.

(b) pneumonia.

(c) asthma.

(d) respiratory syncytial virus.

(c) asthma.

Which long-term care resident is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)?

(a) An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke.

(b) An 81-year-old male who has a productive cough and recurrent respiratory infections.

(c) A 79-year-old lifetime smoker who reports shortness of breath and pain on deep inspiration.

(d) An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells.

(b) An 81-year-old male who has a productive cough and recurrent respiratory infections.

A client with COPD asks the nurse which medications are prescribed to help with breathing. The nurse will educate the client about which medications to help COPD in the long-term? Select all that apply.

(1) Salmeterol, a bronchodilator.

(2) Sildenafil, a vasodilator.

(3) Tiotropium, an anticholinergic.

(4) Ketorolac, a NSAID.

(5) Alprazolam, a benzodiazepine.

(1) Salmeterol, a bronchodilator.

(3) Tiotropium, an anticholinergic.

Which clinical manifestations should the nurse expect to find during physical assessment of a client diagnosed with bronchiectasis? Select all that apply:

(1) A barrel chest

(2) Production of purulent sputum

(3) Recent surgery

(4) Low hemoglobin levels

(5) Recurrent chest infections

(2) Production of purulent sputum

(4) Low hemoglobin levels

(5) Recurrent chest infections

Which clinical finding would be most closely associated with a client who has interstitial lung disease in comparison to chronic obstructive pulmonary disease (COPD)?

(a) Decreased tidal volume

(b) Audible wheezing on expiration

(c) Reduced expiratory flow rates

(d) Normal forced expiratory volume

(a) Decreased tidal volume

A client is admitted for a relapse for sarcoidosis. Knowing this is usually caused by an inflammatory process, the nurse can anticipate administering:

(a) a corticosteroid.

(b) an albuterol inhaler.

(c) aspirin.

(d) a bronchodilator.

(a) a corticosteroid.

Upon admission to the ICU, a client with a history of cor pulmonale will likely be exhibiting which clinical manifestations of right-sided heart failure? Select all that apply.

(1) Fine crackles throughout both lung fields

(2) Jugular vein distension

(3) +4 pitting edema in lower extremities

(4) Altered level of consciousness

(5) Expectorating copious amounts of frothy, pink sputum

(2) Jugular vein distension

(3) +4 pitting edema in lower extremities

(4) Altered level of consciousness

A 41-year-old male client has presented to the emergency department with an acute onset of increased respiratory rate and difficulty breathing. STAT chest X-ray indicates diffuse bilateral infiltrates of his lung tissue and ECG displays no cardiac dysfunction. What is this client's most likely diagnosis?

(a) Pulmonary hypertension

(b) Acute lung injury

(c) Cor pulmonale

(d) Sarcoidosis

(b) Acute lung injury

While rock climbing, a 22-year-old male has endured a severe head injury. Which statement best captures expected clinical manifestations and treatments for his immediate condition?

(a) Hypoventilation may exist, resulting in increased PCO2 and hypoxemia that may require mechanical ventilation.

(b) Oxygen therapy is likely to decrease his respiratory drive and produce an increase in PCO2.

(c) The client is unlikely to respond to supplementary oxygen therapy due to impaired diffusion.

(d) Cheyne-Stokes breathing is likely but will respond to bronchodilators.

(a) Hypoventilation may exist, resulting in increased PCO2 and hypoxemia that may require mechanical ventilation.

The nurse is caring for a group of clients and deciding who should receive prophylaxis for venous thromboembolism (VTE). Which clients should the nurse identify at high risk for VTE? Select all that apply.

(1) A 25-year-old on oral contraceptives who smokes

(2) A 65-year-old who had a stroke and is now immobile

(3) A 45-year-old with a fractured patella

(4) An 76-year-old with hypertension and fatty liver disease

(5) A 22-year-old with pyelonephritis

(1) A 25-year-old on oral contraceptives who smokes

(2) A 65-year-old who had a stroke and is now immobile

(3) A 45-year-old with a fractured patella

The nurse is caring for clients with chronic respiratory disorders. For which client with cyanosis should the nurse intervene first? The client with cyanosis and:

(a) a diagnosis of chronic obstructive pulmonary disease (COPD).

(b) anemia of chronic disease and a hemoglobin of 8.7 g/dL (87 g/L).

(c) a blood pressure of 155/95 mm Hg.

(d) polycythemia and a hemoglobin of 16.8 g/dL (168 g/L).

(b) anemia of chronic disease and a hemoglobin of 8.7 g/dL (87 g/L).

The nurse is caring for a client in intensive care receiving mechanical ventilation and intravenous insulin infusion. The nurse notes sudden onset hypotension, tachycardia, and jugular vein distension. What should the nurse do first?

(a) Check the client's current blood glucose level.

(b) Check the tidal volume setting on the ventilator.

(c) Assess the client's fluid volume balance.

(d) Retrieve client's most recent arterial blood gas result.

(b) Check the tidal volume setting on the ventilator.

The nurse is caring for a client who is being treated for pneumonia. The nurse suspects the client has developed pleuritis. Which assessment findings support the nurse's suspicion of pleuritis? Select all that apply.

(1) Bilateral chest wall pain

(2) Purulent sputum

(3) Pain when deep breathing and coughing

(4) Unequal chest expansion on inspiration

(5) Shoulder pain

(3) Pain when deep breathing and coughing

(4) Unequal chest expansion on inspiration

(5) Shoulder pain

A community health nurse is preparing an awareness campaign about the risks factors for developing hypersensitivity pneumonitis. Which risk factors should the nurse include? Select all that apply.

(1) Cleaning masonry with sandblasting

(2) Stacking hay bales inside a barn

(3) Caring for pigeons

(4) Working with materials containing asbestos

(5) Repairing air conditioners

(2) Stacking hay bales inside a barn

(3) Caring for pigeons

(5) Repairing air conditioners

The nurse is caring for a client admitted for treatment of active sarcoidosis. What is the nurse's best approach to assessing this client?

(a) Perform a complete head-to-toe assessment.

(b) Focused assessment of respiratory system

(c) Focus on respiratory and cardiac systems.

(d) Base assessments on laboratory findings.

(a) Perform a complete head-to-toe assessment.

The nurse is caring for a group of clients and is reviewing the arterial blood gas results for each. Which client should the nurse assess first? The client with:

(a) Pneumonia and a PaO2 of 60 mm Hg (7.98 kPa) and a PaCO2 of 40 mm Hg (5.32 kPa)

(b) Tuberculosis and a PaO2 of 85 mm Hg (11.30 kPa) and a PaCO2 of 50 mm Hg (6.65 kPa)

(c) morphine infusion and a PaO2 of 80 mm Hg (10.64 kPa) and a PaCO2 of 50 mm Hg (6.65 kPa)

(d) Chronic obstructive pulmonary disease and a PaO2 of 75 mm Hg (9.98 kPa) and a PaCO2 of 55 mm Hg (7.32 kPa)

(a) Pneumonia and a PaO2 of 60 mm Hg (7.98 kPa) and a PaCO2 of 40 mm Hg (5.32 kPa)

The nurse is caring for a client who develops sudden onset dyspnea. Which assessment should the nurse prioritize to best identify if the cause may be a pulmonary embolism?

(a) Chest excursion

(b) Chest auscultation

(c) Lower limb appearance

(d) Respiratory rate

(c) Lower limb appearance

A 2-month-old infant is breastfed and diagnosed with cystic fibrosis. The infant is being evaluated for possible pancreatic abnormalities based on which clinical assessment finding(s)? Select all that apply.

(1) 8 to 10 liquid stools/day

(2) Head circumference is 13 in (33 cm), the same as at birth

(3) Appears active and engaged in surroundings

(4) Too much fat in the stools

(5) Weight has remained the same as birth

(1) 8 to 10 liquid stools/day

(4) Too much fat in the stools

(5) Weight has remained the same as birth