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Metabolic Alkalosis, Arthritis, Gout, Injuries & More: Health Conditions & Treatments, Exams of Nursing

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

2023/2024

Available from 05/05/2024

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1.2K documents

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Airway – Obstruction and Asthma

1. An elderly client with pneumonia may appear with which of the

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.

2. Which of the following pathophysiological mechanisms that

occurs in the lungparenchyma allows pneumonia to develop?

  1. Atelectasis
  2. Bronchiectasis
  3. Effusion
  4. Inflammation

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.

3. A 7-year-old client is brought to the E.R. He’s tachypneic and afebrile and has a

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?

  1. Acute asthma
  1. Bronchial pneumonia
  2. Chronic obstructive pulmonary disease (COPD)
  3. Emphysema

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.

4. Which of the following assessment findings would help confirm a diagnosis of

asthma in aclient suspected of having the disorder?

  1. Circumoral cyanosis
  2. Increased forced expiratory volume
  3. Inspiratory and expiratory wheezing
  4. Normal breath sounds

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.

5. Which of the following types of asthma involves an acute asthma

attack brought on by anupper respiratory infection?

  1. Emotional
  2. Extrinsic
  3. Intrinsic
  4. Mediated

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.

6. A client with acute asthma showing inspiratory and expiratory wheezes and a

decreased expiratory volume should be treated with which of the following classes of medication rightaway?

  1. Beta-adrenergic blockers
  2. Bronchodilators
  1. Inhaled steroids
  2. Oral steroids

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.

7. A 19-year-old comes into the emergency department with acute asthma. His

respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first?

  1. Take a full medication history
  2. Give a bronchodilator by nebulizer
  3. Apply a cardiac monitor to the client
  4. Provide emotional support to the client.

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.

8. A 58-year-old client with a 40-year history of smoking one to two packs of

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?

  1. Adult respiratory distress syndrome (ARDS)
  2. Asthma
  3. Chronic obstructive bronchitis
  4. Emphysema

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.

9. The term “blue bloater” refers to which of the following conditions?

  1. Adult respiratory distress syndrome (ARDS)
  2. Asthma
  3. Chronic obstructive bronchitis
  4. Emphysema

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).

10. The term “pink puffer” refers to the client with which of the following conditions?

1. ARDS

  1. Asthma
  2. Chronic obstructive bronchitis
  3. Emphysema

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.

11. A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory

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?

1. ARDS

  1. Asthma
  2. Chronic obstructive bronchitis
  1. Emphysema

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.

12. Its highly recommended that clients with asthma, chronic bronchitis, and

emphysema have Pneumovax and flu vaccinations for which of the following reasons?

  1. All clients are recommended to have these vaccines
  2. These vaccines produce bronchodilation and improve oxygenation.
  3. These vaccines help reduce the tachypnea these clients experience.
  4. Respiratory infections can cause severe hypoxia and possibly death in these clients.

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.

13. Exercise has which of the following effects on clients with asthma, chronic

bronchitis,and emphysema?

  1. It enhances cardiovascular fitness.
  2. It improves respiratory muscle strength.
  3. It reduces the number of acute attacks.
  4. It worsens respiratory function and is discouraged.

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.

14. Clients with chronic obstructive bronchitis are given diuretic therapy. Which of

thefollowing reasons best explains why?

  1. Reducing fluid volume reduces oxygen demand.
  2. Reducing fluid volume improves clients’ mobility.
  3. Restricting fluid volume reduces sputum production.
  4. Reducing fluid volume improves respiratory function.

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.

15. A 69-year-old client appears thin and cachectic. He’s short of breath at rest and

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?

1. ARDS

  1. Asthma
  2. Chronic obstructive bronchitis
  3. Emphysema

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.

16. A client with emphysema should receive only 1 to 3 L/minute of oxygen, if

needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive?

  1. The client doesn’t notice he needs to breathe.
  2. The client breathes only when his oxygen levels climb above a certain point.
  3. The client breathes only when his oxygen levels dip below a certain point.
  4. The client breathes only when his carbon dioxide level dips below a certain point.

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.

17. Teaching for a client with chronic obstructive pulmonary disease (COPD) should

includewhich of the following topics?

  1. How to have his wife learn to listen to his lungs with a stethoscope from Wal-Mart.
  2. How to increase his oxygen therapy.
  3. How to treat respiratory infections without going to the physician.
  4. How to recognize the signs of an impending respiratory infection.

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.

18. Which of the following respiratory disorders is most common in the first 24 to

48 hoursafter surgery?

  1. Atelectasis
  2. Bronchitis
  3. Pneumonia
  4. Pneumothorax

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.

19. Which of the following measures can reduce or prevent the incidence of

atelectasis in apost-operative client?

  1. Chest physiotherapy
  2. Mechanical ventilation
  3. Reducing oxygen requirements
  4. Use of an incentive spirometer

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.

20. Emergency treatment of a client in status asthmaticus includes which of the

followingmedications?

  1. Inhaled beta-adrenergic agents
  2. Inhaled corticosteroids
  3. I.V. beta-adrenergic agents
  4. Oral corticosteroids

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.

21. Which of the following treatment goals is best for the client with status

asthmaticus?

  1. Avoiding intubation
  2. Determining the cause of the attack
  3. Improving exercise tolerance
  4. Reducing secretions

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.

22. Dani was given dilaudid for pain. She’s sleeping and her respiratory rate is 4

breaths/minute. If action isn’t taken quickly, she might have which of the following reactions?

  1. Asthma attack
  2. Respiratory arrest
  3. Be pissed about receiving Narcan
  4. Wake up on her own

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.

23. Which of the following additional assessment data should immediately be

gathered to determine the status of a client with a respiratory rate of 4 breaths/minute?

  1. Arterial blood gas (ABG) and breath sounds
  2. Level of consciousness and a pulse oximetry value.
  3. Breath sounds and reflexes
  4. Pulse oximetry value and heart sounds

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.

24. A client is in danger of respiratory arrest following the administration of a

narcotic analgesic. An arterial blood gas value is obtained. The nurse would expect to PaCO2 to be whichof the following values?

  1. 15 mm Hg
  2. 30 mm Hg
  3. 40 mm Hg
  4. 80 mm Hg

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.

25. A client has started a new drug for hypertension. Thirty minutes after he takes

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?

  1. Asthma attack
  2. Pulmonary embolism
  3. respiratory failure
  4. Rheumatoid arthritis

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.

26. Emergency treatment for a client with impending anaphylaxis secondary to

hypersensitivity to a drug should include which of the following actions first?

  1. Administering oxygen
  2. Inserting an I.V. catheter
  3. Obtaining a complete blood count (CBC)
  4. Taking vital signs

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.

27. Following the initial care of a client with asthma and impending anaphylaxis from

hypersensitivity to a drug, the nurse should take which of the following steps next?

  1. Administer beta-adrenergic blockers
  2. Administer bronchodilators

3

  1. Obtain serum electrolyte levels
  2. Have the client lie flat in the bed.

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.

28. A client’s ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO –

24 mEq/L; SaO2 81%. This ABG result represents which of the following conditions?

  1. Metabolic acidosis
  2. Metabolic alkalosis
  3. Respiratory acidosis
  4. Respiratory alkalosis

Ans-28. 3. You all should know this. Practice some problems if you got this wrong.

29. A nurse plans care for a client with chronic obstructive pulmonary disease,

knowing that the client is most likely to experience what type of acid-base imbalance?

  1. Respiratory acidosis
  2. Respiratory alkalosis
  3. Metabolic acidosis
  4. Metabolic alkalosis

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.

30. A nurse is caring for a client who is on a mechanical ventilator. Blood gas results

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?

  1. Sodium level of 145 mEq/L
  2. Potassium level of 3.0 mEq/L
  3. Magnesium level of 2.0 mg/L
  1. Phosphorus level of 4.0 mg/dl

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.

31. 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:

  1. Metabolic acidosis, compensated.
  2. Metabolic alkalosis, uncompensated.
  3. Respiratory alkalosis, compensated.
  4. Respiratory acidosis, compensated.

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.

32. 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 theadequacy of the:

  1. Popliteal circulation
  2. Ulnar circulation
  3. Femoral circulation
  4. Carotid circulation

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.

33. 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?

  1. Respiratory acidosis
  2. Respiratory alkalosis
  3. Metabolic acidosis
  4. Metabolic alkalosis

Ans-33. 4. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid.

34. A nurse is caring for a client with an ileostomy understands that the client is

most at risk for developing which acid-base disorder?

  1. Respiratory acidosis
  2. Respiratory alkalosis
  3. Metabolic acidosis
  4. Metabolic alkalosis

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.

35. 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 followingdid the nurse observe?