Question 1

The primary reason a client with chronic obstructive pulmonary disease (COPD)often experiences fatigue and activity intolerance is related to:

Accepted Answer

Clients with advanced COPD lose the elastic recoil of the lungs and thorax.As a result,the client's work of breathing increases.Although the remaining options are not incorrect,they are not the primary source of the client's fatigue.

Question 2

The client is admitted to the medical center with a diagnosis of right-sided heart failure.In assessment of this client,the nurse expects to find:

Accepted Answer

Peripheral edema is an expected assessment finding in the client diagnosed with right-sided heart failure.Dyspnea is an expected assessment finding in the client diagnosed with left-sided heart failure.Confusion is a symptom of hypoventilation.Dizziness is an expected assessment finding in the client experiencing hypoxia.

Question 3

A client with a chest tube in place is being transported via stretcher to another room closer to the nurses' station.During the transport the collection unit bangs against the wall and breaks open.The nurse immediately:

Accepted Answer

If the drainage unit is broken,the end of the chest tube can be quickly submerged in a container of sterile water to reestablish the seal.Clamping the chest tube may result in a tension pneumothorax.If the tubing becomes disconnected,the client should be instructed to exhale as much as possible and to cough.The client should not hyperventilate.Raising the tubing above the client's chest level will not help the situation.

Question 4

The nurse is preparing to teach a group of adult women about the signs and symptoms of a myocardial infarction (heart attack).The nurse will include in the teaching plan the results of research that demonstrate women may experience specific symptoms,such as:

Accepted Answer

Epigastric pain is a symptom of a myocardial infarction in women.Visual disturbances,loss of motor function unilaterally,and right scapular discomfort and stiffness are not symptoms of a myocardial infarction in women.

Question 5

The electrical activity of the client's heart is being continuously monitored while the client is on the coronary care unit.Suddenly the nurse finds that the client is experiencing ventricular fibrillation.The nurse will prepare to:

Accepted Answer

The nurse should prepare for CPR for the client experiencing ventricular fibrillation.Atropine is used for sinus bradycardia with hypotension and decreased cardiac output.In this case,the nurse should prepare to administer CPR,not atropine.A pacemaker may be required for the client with sinus bradycardia.It is not the treatment for ventricular fibrillation.The Valsalva maneuver is used to treat supraventricular tachycardia,not ventricular fibrillation.

Question 6

The nurse observes that a client's pulse rate is 58 beats per minute and regular in rhythm.Which of the following statements made by the nurse shows the appropriate understanding of the client's further need for assessment?

Accepted Answer

A low but regular heart rate has no clinical significance unless associated with signs and symptoms of reduced cardiac output such as dizziness or syncope or the presence of chest pain.

Question 7

The nurse is preparing to discuss myocardial infarctions (MIs)with a women's group.Which of the following assessment findings should be included when discussing the typically observed signs and symptoms in females experiencing an MI?

Accepted Answer

There is a significant difference between men and women in relation to coronary artery disease.Women's symptoms differ from those seen in men.The most common initial symptom in women is angina,but atypical symptoms of fatigue,"indigestion," vasospasm,shortness of breath,or back or jaw pain are also present.The remaining options are reflective of symptoms experienced by both men and women.

Question 8

The nurse is assessing a client with a history of chronic obstructive pulmonary disease.When assessing for the presence of air hunger,the nurse should:

Accepted Answer

During an assessment,observe for elevation of the client's clavicles during inspiration.Elevation of the clavicles during inspiration can indicate ventilatory fatigue,air hunger,or decreased lung expansion.Although the remaining options are assessment methods,they are not as effective for determining air hunger.

Question 9

A client asks the nurse,"I was told that my heart is beating in normal sinus rhythm (NSR).What does that mean?" The nurse replies most therapeutically when responding with which of the following?

Accepted Answer

NSR implies that the impulse originates at the SA node and follows the normal sequence through the conduction system.

Question 10

The client is experiencing a sinus dysrhythmia with a pulse rate of 82 beats per minute.Upon entering the room,the nurse expects to find the client:

Accepted Answer

The nurse would expect to find the client experiencing a sinus dysrhythmia at a rate of 82 beats per minute to have no clinical symptoms.The client with atrial fibrillation may complain of fatigue.The client experiencing a sinus dysrhythmia would not be expected to complain of chest pain.The client with atrial fibrillation may complain of a "fluttering" sensation in the chest.

Question 11

The nurse is caring for a client who experienced a flailed chest injury (multiple rib fractures)as a result of a motorcycle accident.The nurse realizes that pain management for this client will directly impact the effectiveness of his respiratory functioning primarily because:

Accepted Answer

Chest wall trauma and upper abdominal incisions decrease chest wall movement as the client uses shallow respirations to minimize chest wall movement to avoid pain.

Question 12

Several nursing students are discussing cardiac conduction with their clinical instructor.When asked where a heart rate of 56 beats per minute most likely originates,the most informed student replies:

Accepted Answer

The conduction system originates with the sinoatrial (SA)node,the "pacemaker" of the heart.The SA node is in the right atrium next to the entrance of the superior vena cava.Impulses are initiated at the SA node at an intrinsic rate between 60 and 100 beats per minute.The electrical impulses are transmitted through the atria along intraatrial pathways to the atrioventricular (AV)node.The AV node mediates impulses between the atria and the ventricles.The intrinsic rate of the normal AV node is between 40 and 60 beats per minute.The AV node assists atrial emptying by delaying the impulse before transmitting it through the bundle of His and the ventricular Purkinje network.The intrinsic rate of the bundle of His and the ventricular Purkinje network is between 20 and 40 beats per minute.

Question 13

The nurse is completing a physical examination for a client who is anemic.In assessing the client's eyes,a sign assessed by the nurse that is consistent with the diagnosis is:

Accepted Answer

Pale conjunctiva is an assessment finding consistent with the diagnosis of anemia.Xanthelasma is caused by hyperlipidemia.Petechiae appear on the skin in clients with platelet deficiency (thrombocytopenia).Petechiae on the conjunctivae is consistent with a fat embolus or bacterial endocarditis.Corneal arcus is caused by hyperlipidemia in young to middle-age adults.It is a normal finding in older adults with arcus senilis.

Question 14

The primary effect of chronic fevers on the body's respiratory functioning is seen in:

Accepted Answer

When fever persists,the metabolic rate remains high and the body begins to break down protein stores,resulting in muscle wasting and decreased muscle mass.Respiratory muscles such as the diaphragm and intercostal muscles are also wasted.Although the remaining options are not incorrect,they do not represent the primary effect.

Question 15

The nurse is reviewing the results of the client's diagnostic testing.Of the following results,the finding that falls within expected or normal limits is:

Accepted Answer

A palpable,elevated,hardened area surrounding a tuberculosis skin testing site is indicative of an antigen-antibody reaction and is considered a positive skin test.Sputum for culture and sensitivity noted the presence of an organism and acid fast bacilli.Normal arterial oxygen tension (PaO₂)ranges between 95-100 mmHg.

Question 16

When assisting with PM care for an 82-year-old client recuperating from pneumonia,the nurse observes that the client appears to be uncharacteristically confused,asking "Where am I?" Which of the following interventions is the most therapeutic for this particular client?

Accepted Answer

Because mental status changes are often the first signs of respiratory problems and often include forgetfulness and irritability,assessing the client's blood oxygen is the most therapeutic intervention.

Question 17

Pregnancy affects a woman's oxygenation needs primarily because of:

Accepted Answer

Increased metabolic demands,such as pregnancy or fever and infection,affect a client's oxygen-carrying capacity (of the blood).The remaining options can affect respiratory function but are not the primary cause of increased oxygenation requirements.

Question 18

The client has supplemental oxygen in place and requires suctioning to remove excess secretions from the airway.To promote maximum oxygenation,an appropriate action by the nurse is to:

Accepted Answer

To promote maximum oxygenation,the nurse should replace the oxygen and allow rest in between suctioning passes.Suctioning should be intermittent for up to 10 to 15 seconds.Wall suction is set at 80 to 120 mm Hg;portable suction is set at 7 to 15 mm Hg for adults.Elevated pressure settings,such as 200 mm Hg,increase the risk for trauma to mucosa and can induce greater hypoxia.The number of suctioning passes is determined by client assessment and need.Repeated passes can remove oxygen and may induce laryngospasm.The client is not suctioned until the catheter comes back clear.

Question 19

The nurse suspects that a 59-year-old client has experienced angina pectoris.Which of the following assessment questions will most likely produce information that will assist in the diagnosis?

Accepted Answer

Unlike the pain resulting from a myocardial infarction,anginal pain usually lasts from 1 to 15 minutes.The remaining questions could also relate to cardiac pain from other origins.

Question 20

When the nurse is reviewing a client's laboratory results,a low calcium level is noted.When the nurse then reviews the client's electrocardiogram,the most likely change noted will be a(n):

Accepted Answer

The normal Q-T interval is 0.12 to 0.42 second.Changes in electrolyte values,such as hypocalcemia,or therapy with drugs such as disopyramide or amiodarone increase the Q-T interval.The remaining options do not reflect a low calcium level.

Quiz 40: Oxygenation

The primary reason a client with chronic obstructive pulmonary disease (COPD) often experiences fatigue and activity intolerance is related to: