Respiratory System | Asthma & COPD NCLEX Quiz 30

1. Dani was given dilaudid for pain. She's sleeping and her respiratory rate is 4 breaths/minute. If action isn't taken quickly. she might have which of the following reactions?

Asthma attack

Respiratory arrest

Be pissed about receiving Narcan

Wake up on her own

Narcotics can cause respiratory arrest if given in large quantities. Its unlikely Dani will have an asthma attack or wake up on her own. She may be pissed for a minute. but then she’d be grateful for saving her butt.

Explanation

Narcotics can cause respiratory arrest if given in large quantities. Its unlikely Dani will have an asthma attack or wake up on her own. She may be pissed for a minute. but then she’d be grateful for saving her butt.

2. Following the initial care of a client with asthma and impending anaphylaxis from hypersensitivity to a drug. the nurse should take which of the following steps next?

Administer beta-adrenergic blockers

Administer bronchodilators

Obtain serum electrolyte levels

Have the client lie flat in the bed.

Bronchodilators would help open the client’s airway and improve his oxygenation status. Beta-adrenergic blockers aren’t indicated in the management of asthma because they may cause bronchospasm. Obtaining laboratory values wouldn’t be done on an emergency basis. and having the client lie flat in bed could worsen his ability to breathe.

Explanation

Bronchodilators would help open the client’s airway and improve his oxygenation status. Beta-adrenergic blockers aren’t indicated in the management of asthma because they may cause bronchospasm. Obtaining laboratory values wouldn’t be done on an emergency basis. and having the client lie flat in bed could worsen his ability to breathe.

3. A client's ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result represents which of the following conditions?

Metabolic acidosis

Metabolic alkalosis

Respiratory acidosis

Respiratory alkalosis

You all should know this. Practice some problems if you got this wrong.

Explanation

You all should know this. Practice some problems if you got this wrong.

4. Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity to a drug should include which of the following actions first?

Administering oxygen

Inserting an I.V. catheter

Obtaining a complete blood count (CBC)

Taking vital signs

Giving oxygen would be the best first action in this case. Vital signs then should be checked and the physician immediately notified. If the client doesn’t already have an I.V. catheter. one may be inserted now if anaphylactic shock is developing. Obtaining a CBC wouldn’t help the emergency situation.

Explanation

Giving oxygen would be the best first action in this case. Vital signs then should be checked and the physician immediately notified. If the client doesn’t already have an I.V. catheter. one may be inserted now if anaphylactic shock is developing. Obtaining a CBC wouldn’t help the emergency situation.

5. A nurse plans care for a client with chronic obstructive pulmonary disease. knowing that the client is most likely to experience what type of acid-base imbalance?

Respiratory acidosis

Respiratory alkalosis

Metabolic acidosis

Metabolic alkalosis

Respiratory acidosis is most often due to hypoventilation. Chronic respiratory acidosis is most commonly caused by COPD. In end-stage disease. pathological changes lead to airway collapse. air trapping. and disturbance of ventilation-perfusion relationships.

Explanation

Respiratory acidosis is most often due to hypoventilation. Chronic respiratory acidosis is most commonly caused by COPD. In end-stage disease. pathological changes lead to airway collapse. air trapping. and disturbance of ventilation-perfusion relationships.

6. Which of the following additional assessment data should immediately be gathered to determine the status of a client with a respiratory rate of 4 breaths/minute?

Arterial blood gas (ABG) and breath sounds

Level of consciousness and a pulse oximetry value.

Breath sounds and reflexes

Pulse oximetry value and heart sounds

First. the nurse should attempt to rouse the client because this should increase the client’s respiratory rate. If available. a spot pulse oximetry check should be done and breath sounds should be checked. The physician should be notified immediately if of the findings. He’ll probably order ABG analysis to determine specific carbon dioxide and oxygen levels. which will indicate the effectiveness of ventilation. Reflexes and heart sounds will be part of the more extensive examination done after these initial actions are completed.

Explanation

First. the nurse should attempt to rouse the client because this should increase the client’s respiratory rate. If available. a spot pulse oximetry check should be done and breath sounds should be checked. The physician should be notified immediately if of the findings. He’ll probably order ABG analysis to determine specific carbon dioxide and oxygen levels. which will indicate the effectiveness of ventilation. Reflexes and heart sounds will be part of the more extensive examination done after these initial actions are completed.

7. A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition?

Sodium level of 145 mEq/L

Potassium level of 3.0 mEq/L

Magnesium level of 2.0 mg/L

Phosphorus level of 4.0 mg/dl

Clinical manifestations of respiratory alkalosis include headache. tachypnea. paresthesias. tetany. vertigo. convulsions. hypokalemia. and hypocalcemia. Options 1. 3. and 4 identify normal laboratory values. Option 2 identifies the presence of hypokalemia.

Explanation

Clinical manifestations of respiratory alkalosis include headache. tachypnea. paresthesias. tetany. vertigo. convulsions. hypokalemia. and hypocalcemia. Options 1. 3. and 4 identify normal laboratory values. Option 2 identifies the presence of hypokalemia.

8. A client is in danger of respiratory arrest following the administration of a narcotic analgesic. An arterial blood gas value is obtained. The nurse would expect to PaCO2 to be which of the following values?

15 mm Hg

30 mm Hg

40 mm Hg

80 mm Hg

A client about to go into respiratory arrest will have inefficient ventilation and will be retaining carbon dioxide. The value expected would be around 80 mm Hg. All other values are lower than expected.

Explanation

A client about to go into respiratory arrest will have inefficient ventilation and will be retaining carbon dioxide. The value expected would be around 80 mm Hg. All other values are lower than expected.

9. A client has started a new drug for hypertension. Thirty minutes after he takes the drug. he develops chest tightness and becomes short of breath and tachypneic. He has a decreased level of consciousness. These signs indicate which of the following conditions?

Asthma attack

Pulmonary embolism

Respiratory failure

Rheumatoid arthritis

The client was reacting to the drug with respiratory signs of impending anaphylaxis. which could lead to eventual respiratory failure. Although the signs are also related to an asthma attack or a pulmonary embolism. consider the new drug first. Rheumatoid arthritis doesn’t manifest these signs.

Explanation

The client was reacting to the drug with respiratory signs of impending anaphylaxis. which could lead to eventual respiratory failure. Although the signs are also related to an asthma attack or a pulmonary embolism. consider the new drug first. Rheumatoid arthritis doesn’t manifest these signs.

10. Which of the following treatment goals is best for the client with status asthmaticus?

Avoiding intubation

Determining the cause of the attack

Improving exercise tolerance

Reducing secretions

Inhaled beta-adrenergic agents. I.V. corticosteroids. and supplemental oxygen are used to reduce bronchospasm. improve oxygenation. and avoid intubation. Determining the trigger for the client’s attack and improving exercise tolerance are later goals. Typically. secretions aren’t a problem in status asthmaticus.

Explanation

Inhaled beta-adrenergic agents. I.V. corticosteroids. and supplemental oxygen are used to reduce bronchospasm. improve oxygenation. and avoid intubation. Determining the trigger for the client’s attack and improving exercise tolerance are later goals. Typically. secretions aren’t a problem in status asthmaticus.