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An overview of various health conditions and their treatments, including metabolic alkalosis, rheumatoid arthritis, osteoarthritis, gout, bone injuries, cerebral palsy, muscular dystrophy, and gestational hypertensive disorders. It discusses the causes, symptoms, stages, treatments, and nursing care for each condition. It also includes information about medications, exercises, and surgeries that may be used in their management.
Typology: Exams
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Airway – Obstruction and Asthma
following symptomsfirst?
A. Altered mental status and dehydration B. fever and chills C. Hemoptysis and dyspnea D. Pleuretic chest pain and cough Ans-1. 1. Fever, chills, hemoptysis, dyspnea, cough, and pleuric chest pain are the common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.
occurs in the lungparenchyma allows pneumonia to develop?
Ans-2. 4. the most common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Atelectasis and bronchiectasis indicate a collapse of a portion of the airway that doesn’t occur with pneumonia. An effusion is an accumulation of excess pleural fluid in the pleural space, which may be a secondary response to pneumonia.
respiratory rate of 36 breaths/minute and a nonproductive cough. He recently had a cold.From his history, the client may have which of the following?
Ans-3. 1. Based on the client’s history and symptoms, acute asthma is the most likely diagnosis. He’s unlikely to have bronchial pneumonia without a productive cough and fever and he’s too young to have developed COPD or emphysema.
asthma in aclient suspected of having the disorder?
Ans-4. 3. Inspiratory and expiratory wheezes are typical findings in asthma. Circumoral cyanosis may be present in extreme cases of respiratory distress. The nurse would expect the client to have a decreased forced expiratory volume because asthma is an obstructive pulmonary disease. Breath sounds will be “tight” sounding or markedly decreased; they won’t be normal.
attack brought on by anupper respiratory infection?
Ans-5. 1. Intrinsic asthma doesn’t have an easily identifiable allergen and can be triggered by the common cold. Asthma caused be emotional reasons is considered to be in the extrinsic category. Extrinsic asthma is caused by dust, molds, and pets; easily identifiable allergens. Mediated asthma doesn’t exist.
decreased expiratory volume should be treated with which of the following classes of medication rightaway?
Ans-6. 2. Bronchodilators are the first line of treatment for asthma because bronchoconstriction is the cause of reduced airflow. Beta-adrenergic blockers aren’t used to treat asthma and can cause bronchoconstriction. Inhaled or oral steroids may be given to reduce the inflammation but aren’t used for emergency relief.
respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first?
Ans-7. 2. The client is having an acute asthma attack and needs to increase oxygen delivery to the lung and body. Nebulized bronchodilators open airways and increase the amount of oxygen delivered. First resolve the acute phase of the attack ad how to prevent attacks in the future. It may not be necessary to place the client on a cardiac monitor because he’s only 19-years-old, unless he has a past medical history of cardiac problems.
cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions?
Ans-8. 3. Because of his extensive smoking history and symptoms, the client most likely has chronic obstructive bronchitis. Clients with ARDS have acute symptoms of and typically need large amounts of oxygen. Clients with asthma and emphysema tend not to have a chronic cough or peripheral edema.
Ans-9. 3. Clients with chronic obstructive bronchitis appear bloated; they have large barrel chests and peripheral edema, cyanotic nail beds and, at times, circumoral cyanosis. Clients with ARDS are acutely short of breath and frequently need intubation for mechanical ventilation and large amounts of oxygen. Clients with asthma don’t exhibit characteristics of chronic disease, and clients with emphysema appear pink and cachectic (a state of ill health, malnutrition, and wasting).
Ans-10. 4. Because of the large amount of energy it takes to breathe, clients with emphysema are usually cachectic. They’re pink and usually breathe through pursed lips, hence the term “puffer”. Clients with ARDS are usually acutely short of breath. Clients with asthma don’t have any particular characteristics, and clients with chronic obstructive bronchitis are bloated and cyanotic in appearance.
muscles to breathe. He’s tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. This client has symptoms of which of the following respiratory disorders?
Ans-11. 4. These are classic signs and symptoms of a client with emphysema. Clients with ARDS are acutely short of breath and require emergency care; those with asthma are also acutely short of breath during an attack and appear very frightened. Clients with chronic obstructive bronchitis are bloated and cyanotic in appearance.
emphysema have Pneumovax and flu vaccinations for which of the following reasons?
Ans-12. 4. it’s highly recommended that clients with respiratory disorders be given vaccines to protect against respiratory infection. Infections can cause these clients to need intubation and mechanical ventilation, and it may be difficult to wean these clients from the ventilator. The vaccines have no effect on bronchodilation or respiratory care.
bronchitis,and emphysema?
Ans-13. 1. Exercise can improve cardiovascular fitness and help the client tolerate periods of hypoxia better, perhaps reducing the risk of heart attack. Most exercise has little effect on
respiratory muscle strength, and these clients can’t tolerate the type of exercise necessary to do this. Exercise won’t reduce the number of acute attacks. In some instances, exercise may be contraindicated, and the client should check with his physician before starting any exercise program.
thefollowing reasons best explains why?
Ans-14. 1. Reducing fluid volume reduces the workload of the heart, which reduces oxygen demand and, in turn, reduces the respiratory rate. It may also reduce edema and improve mobility a little, but exercise tolerance will still be harder to clear airways. Reducing fluid volume won’t improve respiratory function, but may improve oxygenation.
his dyspnea increases with the slightest exertion. His breath sounds are diminished even with deep inspiration. These signs and symptoms fit which of the following conditions?
Ans-15. 4. In emphysema, the wall integrity of the individual air sacs is damaged, reducing the surface area available for gas exchange. Very little air movement occurs in the lungs because of bronchiole collapse, as well. In ARDS, the client’s condition is more acute and typically requires mechanical ventilation. In asthma and bronchitis, wheezing is prevalent.
needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive?
Ans-16. 3. Clients with emphysema breathe when their oxygen levels drop to a certain level; this is known as the hypoxic drive. They don’t take a breath when their levels of carbon dioxide are higher than normal, as do those with healthy respiratory physiology. If too much oxygen is given, the client has little stimulus to take another breath. In the meantime, his carbon dioxide levels continue to climb, and the client will pass out, leading to a respiratory arrest.
includewhich of the following topics?
Ans-17. 4. Respiratory infection in clients with a respiratory disorder can be fatal. It’s important that the client understands how to recognize the signs and symptoms of an impending respiratory infection. It isn’t appropriate for the wife to listen to his lung sounds, besides, you can’t purchase stethoscopes from Wal-Mart. If the client has signs and symptoms of an infection, he should contact his physician at once.
48 hoursafter surgery?
Ans-18. 1. Atelectasis develops when there’s interference with the normal negative pressure that promotes lung expansion. Clients in the postoperative phase often splint their breathing because of pain and positioning, which causes hypoxia. It’s uncommon for any of the other respiratory disorders to develop.
atelectasis in apost-operative client?
Ans-19. 4. Using an incentive spirometer requires the client to take deep breaths and promotes lung expansion. Chest physiotherapy helps mobilize secretions but won’t prevent atelectasis. Reducing oxygen requirements or placing someone on mechanical ventilation doesn’t affect the development of atelectasis.
followingmedications?
Ans-20. 1. Inhaled beta-adrenergic agents help promote bronchodilation, which improves oxygenation. I.V. beta-adrenergic agents can be used but have to be monitored because of their greater systemic effects. They’re typically used when the inhaled beta-adrenergic agents don’t work. Corticosteroids are slow-acting, so their use won’t reduce hypoxia in the acute phase.
asthmaticus?
Ans-21. 1. 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.
breaths/minute. If action isn’t taken quickly, she might have which of the following reactions?
Ans-22. 2. 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.
gathered to determine the status of a client with a respiratory rate of 4 breaths/minute?
Ans-23. 2. 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.
narcotic analgesic. An arterial blood gas value is obtained. The nurse would expect to PaCO2 to be whichof the following values?
Ans-24. 4. 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.
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?
Ans-25. 3. 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.
hypersensitivity to a drug should include which of the following actions first?
Ans-26. 1. 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.
hypersensitivity to a drug, the nurse should take which of the following steps next?
3
Ans-27. 2. 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.
24 mEq/L; SaO2 81%. This ABG result represents which of the following conditions?
Ans-28. 3. You all should know this. Practice some problems if you got this wrong.
knowing that the client is most likely to experience what type of acid-base imbalance?
Ans-29. 1. 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.
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?
Ans-30. 2. 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.
following: pH 7.45; PCO2 30 mm Hg; and bicarbonate concentration of 22 mEq/L. The nurse analyzes these results as indicating:
Ans-31. 3. 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.
determination. Before the blood is drawn, an Allen’s test is performed to determine theadequacy of the:
Ans-32. 2. 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.
suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder?
Ans-33. 4. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid.
most at risk for developing which acid-base disorder?
Ans-34. 3. Intestinal secretions are high in bicarbonate and may be lost through enteric drainage tubes or an ileostomy or with diarrhea (remember, diarrhea is coming out of the base ). These conditions result in metabolic acidosis.
the client is experiencing Kussmaul’s respirations. Based on this documentation, which of the followingdid the nurse observe?