Respiratory System | Asthma & COPD NCLEX Quiz 31

1. A client is scheduled for blood to be drawn from the radial artery for an ABG determination. Before the blood is drawn. an Allen's test is performed to determine the adequacy of the:

Popliteal circulation

Ulnar circulation

Femoral circulation

Carotid circulation

Before radial puncture for obtaining an ABG. you should perform an Allen’s test to determine adequate ulnar circulation. Failure to determine the presence of adequate collateral circulation could result in severe ischemic injury o the hand if damage to the radial artery occurs with arterial puncture.

Explanation

Before radial puncture for obtaining an ABG. you should perform an Allen’s test to determine adequate ulnar circulation. Failure to determine the presence of adequate collateral circulation could result in severe ischemic injury o the hand if damage to the radial artery occurs with arterial puncture.

2. A nurse reviews the arterial blood gas results of a patient and notes the following: pH 7.45; PCO2 30 mm Hg; and bicarbonate concentration of 22 mEq/L. The nurse analyzes these results as indicating:

Metabolic acidosis. compensated.

Metabolic alkalosis. uncompensated.

Respiratory alkalosis. compensated.

Respiratory acidosis. compensated.

The normal pH is 7.35 to 7.45. In a respiratory condition. an opposite (see-saw) will be seen between the pH and the PCO2. In this situation. the pH is at the high end of the normal value and the PCO2 is low. In an alkalotic condition. the pH is up. Therefore. the values identified in the question indicate a respiratory alkalosis. Compensation occurs when the pH returns to a normal value. Because the pH is in the normal range at the high end. compensation has occurred.

Explanation

The normal pH is 7.35 to 7.45. In a respiratory condition. an opposite (see-saw) will be seen between the pH and the PCO2. In this situation. the pH is at the high end of the normal value and the PCO2 is low. In an alkalotic condition. the pH is up. Therefore. the values identified in the question indicate a respiratory alkalosis. Compensation occurs when the pH returns to a normal value. Because the pH is in the normal range at the high end. compensation has occurred.

3. A nurse is caring for a client with renal failure. Blood gas results indicate a pH of 7.30; a PCO2 of 32 mm Hg. and a bicarbonate concentration of 20 mEq/L. The nurse has determined that the client is experiencing metabolic acidosis. Which of the following laboratory values would the nurse expect to note?

Sodium level of 145 mEq/L

Magnesium level of 2.0 mg/dL

Potassium level of 5.2 mEq/L

Phosphorus level of 4.0 mg/dL

Clinical manifestations of metabolic acidosis include hyperpnea with Kussmaul’s respirations; headache; N/V. and diarrhea; fruity-smelling breath resulting from improper fat metabolism; CNS depression. including mental dullness. drowsiness. stupor. and coma; twitching. and coma. Hyperkalemia will occur.

Explanation

Clinical manifestations of metabolic acidosis include hyperpnea with Kussmaul’s respirations; headache; N/V. and diarrhea; fruity-smelling breath resulting from improper fat metabolism; CNS depression. including mental dullness. drowsiness. stupor. and coma; twitching. and coma. Hyperkalemia will occur.

4. A nurse is preparing to obtain an arterial blood gas specimen from a client and plans to perform the Allen's test on the client. Number in order of priority the steps for performing the Allen's test (#1 is first step).

Ask the client to open and close the hand repeatedly.

Apply pressure over the ulnar and radial arteries.

Assess the color of the extremity distal to the pressure point

Release pressure from the ulnar artery

Explain the procedure to the client.

The first step in performing the Allen's test is to explain the procedure to the client. This is important to ensure that the client understands what will be done and why. It also helps to alleviate any anxiety or fear that the client may have. By explaining the procedure beforehand, the nurse can obtain the client's consent and establish trust, which is essential for a successful test. Once the client is informed and comfortable, the nurse can proceed with the other steps of the Allen's test.

Explanation

The first step in performing the Allen's test is to explain the procedure to the client. This is important to ensure that the client understands what will be done and why. It also helps to alleviate any anxiety or fear that the client may have. By explaining the procedure beforehand, the nurse can obtain the client's consent and establish trust, which is essential for a successful test. Once the client is informed and comfortable, the nurse can proceed with the other steps of the Allen's test.

5. A nurse is caring for a client with an ileostomy understands that the client is most at risk for developing which acid-base disorder?

Respiratory acidosis

Respiratory alkalosis

Metabolic acidosis

Metabolic alkalosis

Intestinal secretions are high in bicarbonate and may be lost through enteric drainage tubes or an ileostomy or with diarrhea. These conditions result in metabolic acidosis.

Explanation

Intestinal secretions are high in bicarbonate and may be lost through enteric drainage tubes or an ileostomy or with diarrhea. These conditions result in metabolic acidosis.

6. A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if noted in the client should be reported immediately to the physician?

Blood-streaked sputum

Dry cough

Hematuria

Bronchospasm

If a biopsy was performed during a bronchoscopy. blood-streaked sputum is expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications. which would include cyanosis. dyspnea. stridor. bronchospasm. hemoptysis. hypotension. tachycardia. and arrhythmias. Hematuria is unrelated to this procedure.

Explanation

If a biopsy was performed during a bronchoscopy. blood-streaked sputum is expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications. which would include cyanosis. dyspnea. stridor. bronchospasm. hemoptysis. hypotension. tachycardia. and arrhythmias. Hematuria is unrelated to this procedure.

7. A nurse is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will facilitate obtaining the specimen?

Limiting fluids

Having the client take 3 deep breaths.

Asking the client to spit into the collection container.

Asking the client to obtain the specimen after eating.

To obtain a sputum specimen. the client should rinse the mouth to prevent contamination. breathe deeply. and then cough unto a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain sputum. Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning.

Explanation

To obtain a sputum specimen. the client should rinse the mouth to prevent contamination. breathe deeply. and then cough unto a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain sputum. Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning.

8. A nurse understands that the excessive use of oral antacids containing bicarbonate can result in which acid-base disturbance?

Respiratory alkalosis

Respiratory acidosis

Metabolic acidosis

Metabolic alkalosis

Increases in base components occur as a result of oral or parenteral intake of bicarbonates. carbonates. acetates. citrates. or lactates. Excessive use of oral antacids containing bicarbonate can cause metabolic alkalosis.

Explanation

Increases in base components occur as a result of oral or parenteral intake of bicarbonates. carbonates. acetates. citrates. or lactates. Excessive use of oral antacids containing bicarbonate can cause metabolic alkalosis.

9. A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client. knowing that the client is at risk for which acid-base disorder?

Respiratory acidosis

Respiratory alkalosis

Metabolic acidosis

Metabolic alkalosis

Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid.

Explanation

Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid.

10. A nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Based on this documentation. which of the following did the nurse observe?

Respirations that are abnormally deep. regular. and increased in rate.

Respirations that are regular but abnormally slow.

Respirations that are labored and increased in depth and rate

Respirations that cease for several seconds.

Kussmaul’s respirations are abnormally deep. regular. and increased in rate.

Explanation

Kussmaul’s respirations are abnormally deep. regular. and increased in rate.