Question 1

The nurse is educating a patient who has recently been diagnosed with chronic obstructive pulmonary disease (COPD).The nurse explains how the gasses in the lungs move between the air spaces and the bloodstream.Which process is the nurse describing?

Accepted Answer

Diffusion is the movement of gases between air spaces and the bloodstream.One of the primary functions of the lungs includes ventilation,the movement of air in and out of the lungs.Respiration is the exchange of oxygen and carbon dioxide during cellular metabolism.The heart supports perfusion,the movement of blood into and out of the lungs to the organs and tissues of the body.

Question 2

The guardians of a premature infant who was delivered at 31-weeks' gestation is expected to be discharged from the hospital within the next few days.The guardians have voiced concern regarding how to prevent respiratory syncytial virus (RSV)exposure to the baby.What is the best response from the nurse?

Accepted Answer

Premature infants are at risk for development of respiratory illnesses such as respiratory syncytial virus (RSV)as a result of the underdevelopment of the lung.Limiting exposure to crowds of people will limit the exposure to respiratory viruses.Premature infants do not have protection against this virus.The virus is respiratory,so the car seat and bottles will not affect this illness.

Question 3

The patient is experiencing shortness of breath.Which of the following lab tests indirectly indicates the oxygen level in the blood system?

Accepted Answer

Hemoglobin transports most oxygen and serves as a carrier for both oxygen and carbon dioxide.White blood cell count is a lab test to measure infection.Electrolytes do not indicate oxygen levels but do indicate electrolytes like sodium and potassium.Creatinine levels measure kidney function.

Question 4

A patient was admitted to the surgical unit after surgical removal of an abdominal tumor.As the nurse performs a postsurgical assessment,the patient's blood pressure is 90/54,heart rate is 94,and respiratory rate is 22.Based on these values,the nurse should be most concerned with which of the following conditions?

Accepted Answer

Hypovolemia is a reduced circulating blood volume resulting from extracellular fluid losses that occurs in conditions such as shock and severe dehydration.If the fluid loss is significant,the body tries to adapt by increasing the heart rate and constricting peripheral vessels to increase the volume of blood returned to the heart and increase the cardiac output.The patient is experiencing shock (low blood pressure,increased pulse and respirations).Left-sided heart failure is characterized by impaired functioning of the left ventricle.This is usually caused by increased preload (fluid volume overload)or afterload (increased systemic vascular resistance such as hypertension).Right-sided heart failure results from impaired functioning of the right ventricle,which is typically caused by pulmonary disease or pulmonary hypertension.Fluid volume overload or hypervolemia may lead to vascular congestion in patients with heart,kidney,or lung diseases.The patient has lost fluid,not gained fluid.

Question 5

The exchange of oxygen and carbon dioxide during cellular metabolism is best described as which of the following?

Accepted Answer

Respiration is the exchange of oxygen and carbon dioxide during cellular metabolism.The primary functions of the lungs include ventilation,the movement of air in and out of the lungs,and diffusion,the movement of gases between air spaces and the bloodstream.The heart supports perfusion,the movement of blood into and out of the lungs to the organs and tissues of the body.

Question 6

A patient who is 7 months pregnant with her first child is visiting the health care provider for her scheduled prenatal checkup.She tells the nurse that she is short of breath and fatigued.What is the best response from the nurse?

Accepted Answer

Pregnancy causes changes in ventilation.As the fetus grows during pregnancy,the greater size of the uterus pushes abdominal contents up against the diaphragm.During the last trimester of pregnancy the inspiratory capacity declines,resulting in dyspnea on exertion and increased fatigue.Letting the nurse know immediately and applying oxygen are not needed because this is a normal finding.Making a note of it on the chart does not address the patient's need.

Question 7

A 58-year-old Caucasian woman is at the clinic for her annual check-up.She tells the nurse that she noticed her blood pressure is higher than it was when she was younger.She asks the nurse why this would happen.What is the nurse's best response?

Accepted Answer

Arterial vessels in the older adult become calcified and lose elastin.This may lead to hypertension and a rise in systolic blood pressure.Both of these normal changes of aging place the older adult at risk for heart failure.Do not be judgmental about smoking and the question does not indicate the female is a smoker.Males,not females,are more prone to heart disease.African-Americans,American Indians,and Mexican-Americans are at greater risk than Caucasians for developing heart disease.Telling the patient to not worry is not therapeutic.

Question 8

A patient on the surgical unit is 1 day postoperative for surgery to remove stomach cancer.In addition to the physiological stress this patient has undergone,the nurse recognizes that this patient will have to deal with the psychological stress of finding out that the cancer has metastasized to the liver.Which physiological change would the nurse expect to see as a response to stress?

Accepted Answer

A continuous state of stress increases the body's metabolic rate and the oxygen demand.The body responds to stress by an increased rate and depth of respiration and increased cardiac output.Hemoptysis,bloody sputum,does not occur in stress.

Question 9

A 36-year-old patient diagnosed with meningitis has a fever of 102.3° F.A family member verbalizes a concern that the patient is "breathing fast." Upon assessment,the nurse notes a respiratory rate of 20 breaths/min,pulse oximetry is 92% on 2L/O?,and lungs clear to auscultation.What is the best explanation for the rapid respiratory rate that the nurse can give the family member?

Accepted Answer

An increase of 1° F in body temperature causes a 7% increase in the metabolic rate,thereby increasing carbon dioxide production.The clinical response is increased rate and depth of respiration.Anxiety is not the reason for increased respirations in this scenario.The fever (102.3° F)is the cause of the increased respirations.The patient may have increased breathing but the patient is not hyperventilating.Hyperventilation occurs when the respiratory rate is greater than 20 breaths per minute in an adult,causing an increase in carbon dioxide elimination.

Question 10

Which term should the nurse use to best describe the movement of air in and out of the patient's lungs?

Accepted Answer

The primary functions of the lungs include ventilation,the movement of air in and out of the lungs,and diffusion,the movement of gases between air spaces and the bloodstream.Respiration is the exchange of oxygen and carbon dioxide during cellular metabolism.The heart supports perfusion,the movement of blood into and out of the lungs to the organs and tissues of the body.

Question 11

A 3-month-old infant is being seen for a well-child check at the pediatric clinic.The nurse is assessing the guardian's knowledge level about the infant's growth and development.One of the topics that the nurse has chosen to address in this session is the risk for airway obstruction.What is the main reason that the nurse has chosen this topic?

Accepted Answer

Infants and toddlers are at risk for airway obstruction because of their tendency to place a foreign object in their mouth.Infants and toddlers are at risk for upper respiratory tract infections,not allergic food reactions,as a result of frequent exposure to other children and exposure to secondhand smoke.During the teething process some infants develop nasal congestion,which encourages bacterial growth and increases the risk for respiratory tract infection,but not for airway obstruction.Infants are prone to upper respiratory tract infections,not lower airway infections,which usually are not dangerous,and infants and toddlers recover with little difficulty.

Question 12

The family member of a 73-year-old patient with chronic obstructive pulmonary disease (COPD)is concerned about the patient's recent weight loss.When questioned by the nurse,the patient denies any change in diet or activity,but admits to losing 10 lb in the past 6 weeks.What is the nurse's best response to the family member's concern?

Accepted Answer

A patient with chronic lung disease usually requires a diet higher in calories because of the increased work of breathing.Inadequate nutrition occurs when nutritional intake does not meet nutritional needs.Without essential nutrients,a patient may experience respiratory muscle wasting,resulting in decreased muscle strength and respiratory excursion.One symptom of tuberculosis is rapid weight loss,which is not appropriate based on the question.The effort of breathing,not metabolic rate,is the reason for the weight loss.Saying that it doesn't seem fair does not address the family member's concern.

Question 13

A 47-year-old woman with a history of diabetes and hypertension calls the clinic complaining of epigastric pain and shortness of breath with activity.She has taken antacids with no relief.What type of pain is the patient experiencing?

Accepted Answer

Some women have epigastric pain,complaints of indigestion,or a choking feeling and dyspnea when experiencing cardiac pain.Cardiac pain does not occur with respiratory variations.Cardiac pain is most often substernal and typically radiates to the left arm and jaw in men.Pericardial pain resulting from an inflammation of the pericardial sac is usually nonradiating and often occurs with inspiration or when leaning forward.Pleuritic chest pain is peripheral and usually radiates to the scapular regions.Inspiratory maneuvers such as coughing,yawning,and sighing aggravate pleuritic chest pain.An inflammation or infection in the pleural space usually causes pleuritic chest pain.Musculoskeletal pain is often present following exercise,rib trauma,and prolonged coughing episodes.Inspiratory movements aggravate the pain and are easily confused with pleuritic chest pain.

Question 14

The nurse is admitting a patient with chronic obstructive pulmonary disease (COPD).During the initial head-to-toe assessment the patient's pulse oximetry reading is 89% on room air.What is the nurse's first priority?

Accepted Answer

The nurse must determine what is normal for this patient.The patient has COPD and the breathing stimulus is low oxygen,not increased carbon dioxide.When caring for patients with COPD and chronically elevated PaCO? levels,remember that inappropriate administration of excessive oxygen will result in hypoventilation.Patients with COPD and hypercapnia (high carbon dioxide levels)have adapted to the higher carbon dioxide level.The carbon dioxide-sensitive chemoreceptors are no longer sensitive to increased carbon dioxide as a stimulus to breathe.Their stimulus to breathe is a decreased PaO?.The most effective position for patients with cardiopulmonary diseases is the 45-degree semi-Fowler's position,using gravity to assist in lung expansion and reduce pressure from the abdomen on the diaphragm.Administering excessive oxygen to patients with COPD satisfies the oxygen requirement of the body and negates the stimulus to breathe.High concentrations of oxygen (e.g.,greater than 24% to 28% [1 to 3 L/min])prevent the PaO? from falling.As a result,this suppresses the stimulus to breathe,resulting in hypoventilation.

Question 15

When giving CPR,compressions are causing the heart to pump blood into and out of the lungs to the body's organs.This movement of oxygenated blood is best described as which of the following?

Accepted Answer

The heart supports perfusion,the movement of blood into and out of the lungs to the organs and tissues of the body.The primary functions of the lungs include ventilation,the movement of air in and out of the lungs,and diffusion,the movement of gases between air spaces and the bloodstream.Respiration is the exchange of oxygen and carbon dioxide during cellular metabolism.

Question 16

A 45-year-old patient was diagnosed with an anterior myocardial infarction.The patient asks the nurse why his chest hurt when he had his heart attack.What is the best response from the nurse?

Accepted Answer

When decreased myocardial blood perfusion is extensive or perfusion is completely blocked,the tissue becomes necrotic and a myocardial infarction occurs.Angina or angina pectoris is the result of decreased blood flow to the myocardium as a result of coronary artery spasms or temporary constriction.When stenosis occurs in the aortic and pulmonic valves,the adjacent ventricles work harder to move the ventricular volume beyond the stenotic valve.When regurgitation occurs,there is a backflow of blood into an adjacent chamber,which causes either pulmonary or systemic congestion.A dysrhythmia is a disturbance in the electrical impulse of the heart rhythm.Any rhythm not generated at the sinoatrial node is classified as such.Dysrhythmias are primary conduction disturbances that occur as a response to ischemia,valvular abnormalities,anxiety,and drug toxicity (e.g.,digoxin toxicity).

Question 17

What is the best indicator the nurse can use to determine the adequacy of a patient's cardiac output?

Accepted Answer

Cardiac index is a measure of adequacy of the cardiac output.It equals the cardiac output divided by the patient's body surface area.This calculation provides the caregiver with a more accurate calculation of blood flow by considering the patient's body surface area.Stroke volume (SV)is the amount of blood ejected from the ventricle with each contraction.The normal range for a healthy adult is 50 to 75 mL per contraction.Myocardial contractility is the ability of the heart to squeeze blood from the ventricles and prepare for the next contraction.This is difficult to measure because preload,afterload,and heart rate must remain constant.Afterload is the resistance to the ejection of blood from the left ventricle.The left ventricular pressure must be greater than the aortic pressure to eject blood from the heart.

Question 18

A healthy 33-year-old mother of three children reports "having no energy." She asks the nurse,how she could increase her energy level.What is the best response for the nurse to give?

Accepted Answer

A physical exercise program has many benefits.People who exercise daily for 30 to 60 minutes,not 90,have a lower heart rate,lower blood pressure,decreased cholesterol,increased blood flow,and greater oxygen extraction by working muscles.Fully conditioned people are able to increase oxygen consumption by 10% to 20% because of increased cardiac output and efficiency of the myocardium.If the diet does not supply iron needed for hemoglobin synthesis,RBC synthesis is reduced,and oxygen-carrying capacity decreases.A risk factor for cardiopulmonary disease is excessive use of caffeinated energy drinks.

Question 19

A college student who smokes asks a healthcare professional if there really is a connection between smoking and lung cancer.What is the healthcare worker's best response?

Accepted Answer

The risk for lung cancer is 10 times greater for a person who smokes than for a nonsmoker.Exposure to secondhand smoke increases the risk for lung cancer in the nonsmoker and worsens other pulmonary problems such as asthma or COPD: 5 times is too small; 50 times is too great.Lung cancer does not affect smokers and nonsmokers equally

Question 20

A patient has been admitted to the cardiac unit with the diagnosis of bradycardia.The patient states "I am confused about what the doctor said is wrong with me,he said my pacemaker is not working.I don't have a pacemaker." What is the nurse's best response?

Accepted Answer

The conduction system originates with the sinoatrial node,the "pacemaker" of the heart.Electrical impulses are then transmitted along intraatrial pathways to the atrioventricular (AV)node.The AV node mediates impulse transmission between the atria and the ventricles.Delaying the impulse at the AV node before transmitting it through the bundle of His and ventricular Purkinje network.The heart rate is regulated by the sympathetic and parasympathetic systems,not by myocardial contractility and ventricular Purkinje network.Myocardial contractility is the ability of the heart to squeeze blood from the ventricles and prepare for the next contraction.This is difficult to measure because preload,afterload,and heart rate must remain constant.

Quiz 30: Oxygenation

The nurse is educating a patient who has recently been diagnosed with chronic obstructive pulmonary disease (COPD) .The nurse explains how the gasses in the lungs move between the air spaces and the bloodstream.Which process is the nurse describing?