Respiratory System | Respiratory System Disorders NCLEX Quiz 27

1. A male client suffers adult respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly. and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds. the nurse starts to check for the cause. Which condition triggers the high-pressure alarm?

Kinking of the ventilator tubing

A disconnected ventilator tube

An ET cuff leak

A change in the oxygen concentration without resetting the oxygen level alarm

Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing. bronchospasm or pulmonary embolus. mucus plugging. water in the tube. coughing or biting on the ET tube. and the client’s being out of breathing rhythm with the ventilator. A disconnected ventilator tube or an ET cuff leak would trigger the low-pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm.

Explanation

Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing. bronchospasm or pulmonary embolus. mucus plugging. water in the tube. coughing or biting on the ET tube. and the client’s being out of breathing rhythm with the ventilator. A disconnected ventilator tube or an ET cuff leak would trigger the low-pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm.

2. At 11 p.m.. a male client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He's anxious. and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m.. the client's arterial blood oxygen saturation is 86% and he's still wheezing. The nurse should plan to administer:

Alprazolam (Xanax).

Propranolol (Inderal)

Morphine.

Albuterol (Proventil).

The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. The client’s greatest need is bronchodilation. which can be accomplished by administering bronchodilators. Albuterol is a beta2 adrenergic agonist. which causes dilation of the bronchioles. It’s given by nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished. Alprazolam is an anxiolytic and central nervous system depressant. which could suppress the client’s breathing. Propranolol is contraindicated in a client who’s wheezing because it’s a beta2 adrenergic antagonist. Morphine is a respiratory center depressant and is contraindicated in this situation.

Explanation

The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. The client’s greatest need is bronchodilation. which can be accomplished by administering bronchodilators. Albuterol is a beta2 adrenergic agonist. which causes dilation of the bronchioles. It’s given by nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished. Alprazolam is an anxiolytic and central nervous system depressant. which could suppress the client’s breathing. Propranolol is contraindicated in a client who’s wheezing because it’s a beta2 adrenergic antagonist. Morphine is a respiratory center depressant and is contraindicated in this situation.

3. A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?

PH. 5.0; PaCO2 30 mm Hg

PH. 7.40; PaCO2 35 mm Hg

PH. 7.35; PaCO2 40 mm Hg

PH. 7.25; PaCO2 50 mm Hg

In respiratory acidosis. ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore. the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0 with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis. Options B and C represent normal ABG values. reflecting normal gas exchange in the lungs.

Explanation

In respiratory acidosis. ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore. the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0 with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis. Options B and C represent normal ABG values. reflecting normal gas exchange in the lungs.

4. After receiving an oral dose of codeine for an intractable cough. the male client asks the nurse. "How long will it take for this drug to work?" How should the nurse respond?

In 30 minutes

In 1 hour

In 2.5 hours

In 4 hours

Codeine’s onset of action is 30 minutes. Its peak concentration occurs in about 1 hour; its half-life. in 2.5 hours; and its duration of action is 4 to 6 hours.

Explanation

Codeine’s onset of action is 30 minutes. Its peak concentration occurs in about 1 hour; its half-life. in 2.5 hours; and its duration of action is 4 to 6 hours.

5. After undergoing a thoracotomy. a male client is receiving epidural analgesia. Which assessment finding indicates that the client has developed the most serious complication of epidural analgesia?

Heightened alertness

Increased heart rate

Numbness and tingling of the extremities

Respiratory depression

Respiratory depression is the most serious complication of epidural analgesia. Other potential complications include hypotension. decreased sensation and movement of the extremities. allergic reactions. and urine retention. Typically. epidural analgesia causes central nervous system depression (indicated by drowsiness) as well as a decreased heart rate and blood pressure.

Explanation

Respiratory depression is the most serious complication of epidural analgesia. Other potential complications include hypotension. decreased sensation and movement of the extremities. allergic reactions. and urine retention. Typically. epidural analgesia causes central nervous system depression (indicated by drowsiness) as well as a decreased heart rate and blood pressure.

6. A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the next room is being treated for mycoplasmal pneumonia. Despite the different causes of the various types of pneumonia. all of them share which feature?

Inflamed lung tissue

Sudden onset

Responsiveness to penicillin.

Elevated white blood cell (WBC) count

The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Although most types of pneumonia have a sudden onset. a few (such as anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an insidious onset. Antibiotic therapy is the primary treatment for most types of pneumonia; however. the antibiotic must be specific for the causative agent. which may not be responsive to penicillin. A few types of pneumonia. such as viral pneumonia. aren’t treated with antibiotics. Although pneumonia usually causes an elevated WBC count. some types. such as mycoplasmal pneumonia. don’t.

Explanation

The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Although most types of pneumonia have a sudden onset. a few (such as anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an insidious onset. Antibiotic therapy is the primary treatment for most types of pneumonia; however. the antibiotic must be specific for the causative agent. which may not be responsive to penicillin. A few types of pneumonia. such as viral pneumonia. aren’t treated with antibiotics. Although pneumonia usually causes an elevated WBC count. some types. such as mycoplasmal pneumonia. don’t.

7. The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?

It helps prevent early airway collapse.

It increases inspiratory muscle strength.

It decreases use of accessory breathing muscles.

It prolongs the inspiratory phase of respiration.

Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement. anxiety. exercise. and respiratory distress. To increase inspiratory muscle strength and endurance. the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing. the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing. the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)

Explanation

Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement. anxiety. exercise. and respiratory distress. To increase inspiratory muscle strength and endurance. the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing. the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing. the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)

8. The nurse in charge formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem. the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include:

Drinking more than 1.500 ml of fluid daily.

Being overweight.

Eating a high-protein snack at bedtime.

Eating more than three large meals a day.

Conditions that increase oxygen demands include obesity. smoking. exposure to temperature extremes. and stress. A client with chronic bronchitis should drink at least 2.000 ml of fluid daily to thin mucus secretions; restricting fluid intake may be harmful. The nurse should encourage the client to eat a high-protein snack at bedtime because protein digestion produces an amino acid with sedating effects that may ease the insomnia associated with chronic bronchitis. Eating more than three large meals a day may cause fullness. making breathing uncomfortable and difficult; however. it doesn’t increase oxygen demands. To help maintain adequate nutritional intake. the client with chronic bronchitis should eat small. frequent meals (up to six a day).

Explanation

Conditions that increase oxygen demands include obesity. smoking. exposure to temperature extremes. and stress. A client with chronic bronchitis should drink at least 2.000 ml of fluid daily to thin mucus secretions; restricting fluid intake may be harmful. The nurse should encourage the client to eat a high-protein snack at bedtime because protein digestion produces an amino acid with sedating effects that may ease the insomnia associated with chronic bronchitis. Eating more than three large meals a day may cause fullness. making breathing uncomfortable and difficult; however. it doesn’t increase oxygen demands. To help maintain adequate nutritional intake. the client with chronic bronchitis should eat small. frequent meals (up to six a day).

9. A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen. 2 L/minute via nasal cannula. The client's history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these history findings. the nurse closely monitors the oxygen flow and the client's respiratory status. Which complication may arise if the client receives a high oxygen concentration?

Apnea

Anginal pain

Respiratory alkalosis

Metabolic acidosis

Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen administration may lead to apnea by removing that stimulus. Anginal pain results from a reduced myocardial oxygen supply. A client with COPD may have anginal pain from generalized vasoconstriction secondary to hypoxia; however. administering oxygen at any concentration dilates blood vessels. easing anginal pain. Respiratory alkalosis results from alveolar hyperventilation. not excessive oxygen administration. In a client with COPD. high oxygen concentrations decrease the ventilatory drive. leading to respiratory acidosis. not alkalosis. High oxygen concentrations don’t cause metabolic acidosis.

Explanation

Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen administration may lead to apnea by removing that stimulus. Anginal pain results from a reduced myocardial oxygen supply. A client with COPD may have anginal pain from generalized vasoconstriction secondary to hypoxia; however. administering oxygen at any concentration dilates blood vessels. easing anginal pain. Respiratory alkalosis results from alveolar hyperventilation. not excessive oxygen administration. In a client with COPD. high oxygen concentrations decrease the ventilatory drive. leading to respiratory acidosis. not alkalosis. High oxygen concentrations don’t cause metabolic acidosis.

10. A female client with chronic obstructive pulmonary disease (COPD) takes anhydrous theophylline. 200 mg P.O. every 8 hours. During a routine clinic visit. the client asks the nurse how the drug works. What is the mechanism of action of anhydrous theophylline in treating a nonreversible obstructive airway disease such as COPD?

It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive.

It inhibits the enzyme phosphodiesterase. decreasing degradation of cyclic adenosine monophosphate. a bronchodilator.

It stimulates adenosine receptors. causing bronchodilation.

It alters diaphragm movement. increasing chest expansion and enhancing the lung’s capacity for gas exchange.

Anhydrous theophylline and other methylxanthine agents make the central respiratory center more sensitive to CO2 and stimulate the respiratory drive. Inhibition of phosphodiesterase is the drug’s mechanism of action in treating asthma and other reversible obstructive airway diseases — not COPD. Methylxanthine agents inhibit rather than stimulate adenosine receptors. Although these agents reduce diaphragmatic fatigue in clients with chronic bronchitis or emphysema. they don’t alter diaphragm movement to increase chest expansion and enhance gas exchange.

Explanation

Anhydrous theophylline and other methylxanthine agents make the central respiratory center more sensitive to CO2 and stimulate the respiratory drive. Inhibition of phosphodiesterase is the drug’s mechanism of action in treating asthma and other reversible obstructive airway diseases — not COPD. Methylxanthine agents inhibit rather than stimulate adenosine receptors. Although these agents reduce diaphragmatic fatigue in clients with chronic bronchitis or emphysema. they don’t alter diaphragm movement to increase chest expansion and enhance gas exchange.