Respiratory System | Asthma & COPD NCLEX Quiz 32

1. A nurse is suctioning fluids from a client through an endotracheal tube. During the suctioning procedure. the nurse notes on the monitor that the heart rate decreases. Which of the following is the most appropriate nursing intervention?

Continue to suction

Ensure that the suction is limited to 15 seconds

Stop the procedure and reoxygenated the client

Notify the physician immediately.

During suctioning. the nurse should monitor the client closely for side effects. including hypoxemia. cardiac irregularities such as a decrease in HR resulting from vagal stimulation. mucosal trauma. hypotension. and paroxysmal coughing. If side effects develop. especially cardiac irregularities. this procedure is stopped and the client is reoxygenated.

Explanation

During suctioning. the nurse should monitor the client closely for side effects. including hypoxemia. cardiac irregularities such as a decrease in HR resulting from vagal stimulation. mucosal trauma. hypotension. and paroxysmal coughing. If side effects develop. especially cardiac irregularities. this procedure is stopped and the client is reoxygenated.

2. An oxygenated delivery system is prescribed for a client with COPD to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed?

Venturi mask

Aerosol mask

Face tent

Tracheostomy collar

The venture mask delivers the most accurate oxygen concentration. The Venturi mask is the best oxygen delivery system for the client with chronic airflow limitation because it delivers a precise oxygen concentration. The face tent. the aerosol mask. and the tracheostomy collar are also high-flow oxygen delivery systems but most often are used to administer high humidity.

Explanation

The venture mask delivers the most accurate oxygen concentration. The Venturi mask is the best oxygen delivery system for the client with chronic airflow limitation because it delivers a precise oxygen concentration. The face tent. the aerosol mask. and the tracheostomy collar are also high-flow oxygen delivery systems but most often are used to administer high humidity.

3. A nurse is suctioning fluids from a client via a tracheostomy tube. When suctioning. the nurse must limit the suctioning to a maximum of:

5 seconds

10 seconds

30 seconds

1 minute

Hypoxemia can be caused by prolonged suctioning. which stimulates the pacemaker cells within the heart. A vasovagal response may occur causing bradycardia. The nurse must preoxygenate the client before suctioning and limit the suctioning pass to 10 seconds.

Explanation

Hypoxemia can be caused by prolonged suctioning. which stimulates the pacemaker cells within the heart. A vasovagal response may occur causing bradycardia. The nurse must preoxygenate the client before suctioning and limit the suctioning pass to 10 seconds.

4. A nurse reviews the ABG values and notes a pH of 7.50. a PCO2 of 30 mm Hg. and an HCO3 of 25 mEq/L. The nurse interprets these values as indicating:

Respiratory acidosis uncompensated

Respiratory alkalosis uncompensated

Metabolic acidosis uncompensated

Metabolic acidosis partially compensated.

In respiratory alkalosis. the pH will be higher than normal and the PCO2 will be low.

Explanation

In respiratory alkalosis. the pH will be higher than normal and the PCO2 will be low.

5. An unconscious client is admitted to an emergency room. Arterial blood gas measurements reveal a pH of 7.30. a low bicarbonate level. a normal carbon dioxide level. and a normal oxygen level. An elevated potassium level is also present. These results indicate the presence of:

Metabolic acidosis

Respiratory acidosis

Combined respiratory and metabolic acidosis

Over compensated respiratory acidosis

In an acidotic condition. the pH would be low. indicating the acidosis. In addition. a low bicarbonate level along with the pH would indicate a metabolic state.

Explanation

In an acidotic condition. the pH would be low. indicating the acidosis. In addition. a low bicarbonate level along with the pH would indicate a metabolic state.

6. A nurse instructs a client to use the pursed lip method of breathing. The client asks the nurse about the purpose of this type of breathing. The nurse responds. knowing that the primary purpose of pursed lip breathing is:

Promote oxygen intake

Strengthen the diaphragm

Strengthen the intercostal muscles

Promote carbon dioxide elimination

Pursed lip breathing facilitates maximum expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation.

Explanation

Pursed lip breathing facilitates maximum expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation.

7. A nurse is caring for a client with emphysema. The client is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed

1 L/min

2 L/min

6 L/min

10 L/min

One to 3 L/min of oxygen by nasal cannula may be required to raise to PaO2 to 60 to 80 mm Hg. However. oxygen is used cautiously and should not exceed 2 L/min. Because of the long-standing hypercapnia. the respiratory drive is triggered by low oxygen levels rather than increased carbon dioxide levels. as is the case in normal respiratory system.

Explanation

One to 3 L/min of oxygen by nasal cannula may be required to raise to PaO2 to 60 to 80 mm Hg. However. oxygen is used cautiously and should not exceed 2 L/min. Because of the long-standing hypercapnia. the respiratory drive is triggered by low oxygen levels rather than increased carbon dioxide levels. as is the case in normal respiratory system.

8. The nurse reviews the ABG values of a client. The results indicate respiratory acidosis. Which of the following values would indicate that this acid-base imbalance exists?

PH of 7.48

PCO2 of 32 mm Hg

PH of 7.30

HCO3- of 20 mEq/L

A pH of 7.30 indicates respiratory acidosis. Respiratory acidosis is a condition where there is an excess of carbon dioxide in the blood, leading to a decrease in pH. A pH below the normal range of 7.35-7.45 indicates acidosis. In this case, the pH of 7.30 is lower than the normal range, indicating respiratory acidosis. The other values, PCO2 of 32 mm Hg and HCO3- of 20 mEq/L, are within the normal range and do not indicate an acid-base imbalance.

Explanation

A pH of 7.30 indicates respiratory acidosis. Respiratory acidosis is a condition where there is an excess of carbon dioxide in the blood, leading to a decrease in pH. A pH below the normal range of 7.35-7.45 indicates acidosis. In this case, the pH of 7.30 is lower than the normal range, indicating respiratory acidosis. The other values, PCO2 of 32 mm Hg and HCO3- of 20 mEq/L, are within the normal range and do not indicate an acid-base imbalance.

9. Theophylline (Theo-Dur) tablets are prescribed for a client with chronic airflow limitation. and the nurse instructs the client about the medication. Which statement by the client indicates a need for further teaching?

“I will take the medication on an empty stomach.”

“I will take the medication with food.”

“I will continue to take the medication even if I am feeling better.”

“Periodic blood levels will need to be obtained.”

Theo-Dur is a bronchodilator. The medication should be administered with food such as milk and crackers to prevent GI irritation.

Explanation

Theo-Dur is a bronchodilator. The medication should be administered with food such as milk and crackers to prevent GI irritation.

10. A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the nurse expect to note on assessment of this client?

Increased oxygen saturation with exercise

Hypocapnia

A hyperinflated chest on x-ray film

A widened diaphragm noted on chest x-ray film

Clinical manifestations of COPD include hypoxemia. hypercapnia. dyspnea on exertion and at rest. oxygen desaturation with exercise. and the use of accessory muscles of respiration. Chest x-ray films reveal a hyperinflated chest and a flattened diaphragm is the disease is advanced.

Explanation

Clinical manifestations of COPD include hypoxemia. hypercapnia. dyspnea on exertion and at rest. oxygen desaturation with exercise. and the use of accessory muscles of respiration. Chest x-ray films reveal a hyperinflated chest and a flattened diaphragm is the disease is advanced.