Exam 3 - ABG's, Respiratory, Renal

Question 1

ABG’s range and what does it measure

pH range?

PaCO2?

HCO3?

PaO2?

SaO2?

Answer 1

—pH = 7.35-7.45: measures acid-base balance-changes affect body function —

PaCO2 = 35-45: influenced by respiratory changes —

HCO3 = 22-26: influenced by metabolic changes in kidney. —

PaO2 = 80-100: partial pressure of oxygen in arterial blood —

Sa02 = 95% or greater: Oxygen saturation

Question 2

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, PaCO2 of 43 mm Hg, PaO2 of 75 mm Hg, and HCO3− of 42 mEq/L. Based on these findings, the nurse documents that the patient is experiencing which type of acid-base imbalance?

a) Respiratory alkalosis
b) Metabolic alkalosis
c) Respiratory acidosis
d) Metabolic acidosis

Answer 2

b) Metabolic alkalosis

Question 3

The nurse is caring for a pt who is anxious & dizzy following a traumatic experience. The arterial blood gas findings include: pH 7.48, PaO2 110, PaCO2 25, & HCO3 24. The nurse would anticipate which initial intervention to correct this problem?

1. Encourage the pt to breathe in & out slowly into a paper bag.
2. Immediately administer oxygen via a mask & monitor oxygen saturation.
3. Prepare to start an intravenous fluid bolus using isotonic fluids.
4. Anticipate the administration of intravenous sodium bicarbonate.

Answer 3

Answer: 1
Rationale 1: This pt is exhibiting signs of hyperventilation that is confirmed with the blood gas results of respiratory alkalosis. Breathing into a paper bag will help the pt to retain carbon dioxide & lower oxygen levels to normal, correcting the cause of the problem.
Rationale 2: The oxygen levels are high, so oxygen is not indicated, & would exacerbate the problem if given. Intravenous fluids would not be the initial intervention.
Rationale 3: Not enough information is given to determine the need for intravenous fluids.
Rationale 4: Bicarbonate would be contraindicated as the pH is already high.

Question 4

A pt’s blood gases show a pH greater of 7.53 & bicarbonate level of 36 mEq/L. The nurse realizes that the acid-base disorder this pt is demonstrating is which of the following?

1. respiratory acidosis
2. metabolic acidosis
3. respiratory alkalosis
4. metabolic alkalosis

Answer 4

Answer: 4
Rationale 1& 2: Respiratory acidosis & metabolic acidosis are both consistent with pH less than 7.35.
Rationale 3: Respiratory alkalosis is associated with a pH greater than 7.45 & a PaCO2 of less than 35 mmHG. It is caused by respiratory related conditions.
Rationale 4: Arterial blood gases (ABGs) show a pH greater than 7.45 & bicarbonate level greater than 26 mEq/L when the pt is in metabolic alkalosis.

Question 5

http://www.adamw.org/med/apps/abg.cgi

Question 6

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?

a. PaCO2 36
b. pH 7.48
c. HCO3 21 mEq/L
d. O2 sat 95%

Answer 6

b. pH 7.48

Question 7

When analyzing an arterial blood gas report of a pt with COPD & respiratory acidosis, the nurse anticipates that compensation will develop through which of the following mechanisms?

a) The kidneys retain bicarbonate.
b) The kidneys excrete bicarbonate.
c) The lungs will retain carbon dioxide.
d) The lungs will excrete carbon dioxide.

Answer 7

a) The kidneys retain bicarbonate.

Question 8

A nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, PCO2 of 30 mm Hg, and HCO3 of 22 mEq/L. The nurse analyzes these results as indicating which condition?

a. Metabolic acidosis, compensated
b. Respiratory alkalosis, compensated
c. Metabolic alkalosis, uncompensated
d. Respiratory acidosis, uncompensated

Answer 8

b. Respiratory alkalosis, compensated

Question 9

A client with a 3-day history or nausea and vomiting presents to the emergency department. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which of the following?

a. A decreased pH and an increased CO2
b. An increased pH and a decreased CO2
c. A decreased pH and a decreased HCO3-
d. An increased pH with an increase HCO3-

Answer 9

d. An increased pH with an increase HCO3-

Question 10

client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, PCO2 is 90 mm Hg, and HCO3- is 22 mEq/L. The nurse interprets the results as indicating which condition?

a. Metabolic acidosis with compensation
b. Respiratory acidosis with compensation
c. Metabolic acidosis without compensation
d. Respiratory acidosis without compensation

Answer 10

d. Respiratory acidosis without compensation

Question 11

•A nurse notes that a client has kyphosis and generalized muscle atrophy. Which of the following problems is a priority when the nurse develops a nursing plan of care?

1. Infection
2. Confusion
3. Ineffective coughing and deep breathing
4. Difficulty chewing solid foods

Answer 11

•#3- In kyphosis the thoracic spine bends forward with convexity of the curve in a posterior direction, making effective coughing and deep breathing difficult. Although the client may develop other problems because respiratory status deteriorates when pulmonary secretions are not adequately cleared from airway, ineffective coughing and deep breathing should receive priority attention

Question 12

•A client with deep vein thrombosis suddenly develops dyspnea, tachypnea, and chest discomfort. What should the nurse do first?

1. Elevate the head of the bed 30-45 degrees
2. Encourage the client to cough and deep breathe
3. Auscultate the lungs to detect abnormal breath sounds
4. Contact the physician

Answer 12

•#1: Elevating the head of the bed facilitates breathing because the lungs are able to expand as the diaphragm descends. Coughing and deep breathing do not alleviate the symptoms of a pulmonary embolus, nor does lung auscultation. The physicians must be kept informed of changes in a client’s status, but the priority in this case is alleviating the symptoms

Question 13

•A client with bacterial pneumonia is to be started on I.V. antibiotics. Which of the following diagnostic tests must be completed before antibiotic therapy begins?

1. Urinalysis
2. Sputum culture
3. Chest radiograph
4. Red blood cell count

Answer 13

•#2- A sputum specimen is obtained for culture to determine the causative organism. After the organism is identified, an appropriate antibiotic can be prescribed. Beginning antibiotic therapy before obtaining the sputum specimen may alter the results of the test. Neither a UA or chest radiograph nor a RBC count needs to be obtained before initiation of antibx therapy for pna.

Question 14

•A 79-year-old female client is admitted to the hospital with a diagnosis of bacterial pneumonia. Which of the following would most likely be a predisposing factor for the diagnosis of pneumonia?

1. Age
2. Osteoarthritis
3. Vegetarian Diet
4. Daily Bathing

Answer 14

•#1- The client’s age is a predisposing factor for pneumonia; pneumonia is more common in elderly or debilitated clients. Other predisposing factors include smoking, URTIs, malnutrition, immunosuppression, and the presence of chronic illness. OA, vegetarian diets, and frequent bathing are not predisposing factors.

Question 15

•A client with pneumonia has a temperature of 102.6 degrees F (39.2 C), is diaphoretic, and has a productive cough. The nurse should include which of the following measures in the plan of care?

1. Position changes every 4 hours
2. Nasotracheal suctioning to clear secretions
3. Frequent linen changes
4. Frequent offering of a bedpan

Answer 15

•#3- Frequent linen changes are appropriate for the client because of the diaphoresis. Diaphoresis produces general discomfort. The client should be kept dry to promote comfort. Position changes need to be done every 2 hours. Nasotracheal suctioning is not indicated with the client’s productive cough. Frequent offering of a bedpan is not indicated by the data provided.

Question 16

•The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following?

1. Decreased cardiac output
2. Pleural effusion
3. Inadequate peripheral circulation
4. Decreased oxygenation of the blood

Answer 16

•#4- A client with pneumonia has less lung surface available for the diffusion of gases because of the inflammatory pulmonary response that creates lung exudate and results in reduced oxygenation of the blood. The client becomes cyanotic because blood is not adequately oxygenated in the lungs before it enters the peripheral circulation. Decreased cardiac output may be a comorbid condition in some clients with pneumonia; however, it is not the cause of cyanosis. Pleural effusions are a potential complication of pna but are not the primary cause of decreased oxygenation. Inadequate peripheral circulation is also not the cause of cyanosis that develops with bacterial pna.

Question 17

•A client with pneumonia is experiencing pleuritic chest pain. The nurse should assess the client for:

1. A mild but constant aching in the chest
2. Severe midsternal pain
3. Moderate pain that worsens on inspiration
4. Muscle spasm pain that accompanies coughing

Answer 17

•#3- Chest pain in pneumonia is generally caused by friction between the pleural layers. It is more severe on inspiration than on expiration, secondary to chest wall movement. Pleruitic chest pain is usually described as sharp, not mild or aching. Pleuritic chest pain is not localized to the sternum, and it is not the result of a muscle spasm.

Question 18

•Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia?

1. Coma
2. Apathy
3. Irritability
4. Depression

Answer 18

•#3- Clients who are experiencing hypoxia characteristically exhibit irritability, restlessness or anxiety as initial mental status changes. As the hypoxia becomes more pronounced, the client may become confused and combative. Coma is a late clinical manifestation of hypoxia. Apathy and depression are not symptoms of hypoxia.

Question 19

•Which of the following symptoms is most common in clients with active tuberculosis?

1. Weight loss
2. Increased appetite
3. Dyspnea on exertion
4. Mental status changes

Answer 19

•#1- TB typically produces anorexia and weight loss. Other signs and symptoms may include fatigue, low grade fever, and night sweats. Increased appetite is not a symptom of the TB; dyspnea on exertion and change in mental status are not common symptoms of TB

Question 20

•A client is receiving streptomycin in the treatment regimen of tuberculosis. The nurse should assess for:

1. Decreased serum creatinine
2. Difficulty swallowing
3. Hearing loss
4. I.V. infiltration

Answer 20

•#3- Streptomycin can cause toxicity to the 8th cranial nerve, which is responsible for hearing, balance, and body position sense. Nephrotoxicity is a side effect that would be indicated with an increase in creatinine. Streptomycin is given via IM injection

Question 21

•What is the rationale that supports multidrug treatment for clients with tuberculosis?

1. Multiple drugs potentiate the drugs’ actions
2. Multiple drugs reduce undesirable drug adverse effects
3. Multiple drugs allow reduced drug dosages to be given
4. Multiple drugs reduce development of resistant strains of the bacteria

Answer 21

•#4-Use of a combination of antiTB drugs slows the rate at which organisms develop drug resistance. Combination therapy also appears to be more effective than single-drug therapy. Many drugs potentiate (or inhibit) the actions of other drugs; however, this is not the rationale for using multiple drugs to treat TB. Treatment with multiple drugs does not reduce adverse effects and may expose the client to more adverse effects. Combination therapy may allow some medications i.e. antihypertensive, to be given in reduced dosages; however, reduced dosages are not prescribed for antibiotics and antiTB drugs.

Question 22

•A client has a positive reaction to the Mantoux test. The nurse correctly interprets this reaction to mean that the client has:

1. Active tuberculosis
2. Had contact with Mycobacterium tuberculosis
3. Developed a resistance to tubercle bacilli
4. Developed passive immunity to tuberculosis

Answer 22

•#2- A positive Mantoux skin test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active disease exists. A positive Mantoux test does not mean that the client has developed resistance. Unless involved in treatment, the client may still develop active disease at any time. Immunity to TB is not possible.

Question 23

•The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). •pH 7.35; PC02 62; PO2 70; HCO3 34 •The nurse should:

1. Apply a 100% nonrebreather mask
2. Assess the vital signs
3. Reposition the client
4. Prepare for intubation

Answer 23

•#2- Clients with COPD have Co2 retention and respiratory drive is stimulated when the PO2 decreases. The HR, RR, and BP should be evaluated to determine if the client is hemodynamically stable. Symptoms, such as dyspnea, should also be assessed. Oxygen supplementation, if indicated, should be titrated upward in small increments. There is no indication that the client is experiencing respiratory distress requiring intubation.

Question 24

•Which of the following physical assessment findings are normal for a client with advanced COPD?

1. Increased anteroposterior chest diameter
2. Underdeveloped neck muscles
3. Collapsed neck veins
4. Increased chest excursions with respiration

Answer 24

•#1- Increased AP diameter is a characteristic of advanced COPD. Air is trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrel-chested appearance. Overly developed, not underdeveloped neck muscles are associated with COPD because of their increased use in the work of breathing. Distended, not collapsed, neck veins are associated with COPD as a symptom of the HF that the client may experience secondary to the increased workload on the heart to pump blood into the pulmonary vasculature. Diminished, not increased, chest excursion is associated with COPD.

Question 25

•Which of the following is an expected outcome of pursed-lip breathing for clients with emphysema? 1. To promote oxygen intake 2. To strengthen the diaphragm 3. To strengthen the intercostal muscles 4. To promote carbon dioxide elimination

Answer 25

•#4- Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby promoting carbon dioxide elimination. By prolonging exhalation and helping the client relax, pursed-lip breathing helps the client learn to control the rate and depth of respiration. Pursed-lip breathing does not promote the intake of oxygen, strengthen the diaphragm, or strengthen intercostal muscles

Question 26

•Which of the following is a priority goal for the client with COPD? 1. Maintaining functional ability 2. Minimizing chest pain 3. Increasing carbon dioxide levels in the blood 4. Treating infectious agents

Answer 26

•#1- A priority goal for the client with COPD is to manage the signs and symptoms of the disease process so as to maintain the client’s functional ability. Chest pain is not a typical symptom of COPD. The carbon dioxide concentration in the blood is increased to an abnormal level in clients with COPD; it would not be a goal to increase the level further. Preventing infection would be a goal of care for the client with COPD.

Question 27

•The nurses assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected? 1. Normal breath sounds 2. Prolonged inspiration 3. Normal chest movement 4. Coarse crackles and rhonchi

Answer 27

•#4- Exacerbations of COPD are commonly caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. In COPD, breath sounds are diminished because of an enlarged AP diameter of the chest. Expiration, not inspiration, becomes prolonged. Chest movement is decreased as lungs become over distended.

Question 28

A client with COPD is experiencing dyspnea and has a low PaO2 level. The nurse plans to administer oxygen as ordered. Which of the following statements is true concerning oxygen administration to a client with COPD? 1. High oxygen concentrations will cause coughing and dyspnea 2. High oxygen concentrations may inhibit the hypoxic stimulus to breathe 3. Increased oxygen use will cause the client to become dependent on oxygen 4. Administration of oxygen is contraindicated in client who are using bronchodilators

Answer 28

•#2-Clients who have a long history of COPD may retain CO2. Gradually the body adjusts to higher CO2 concentration, and the high levels of CO2 no longer stimulate the respiratory center. The major respiratory stimulant then become hypoxemia. Administration of high concentrations of O2 eliminates this respiratory stimulus and leads to hypoventilation. O2 can be drying if it is not humidified, but it does not cause coughing and dyspnea. Increased O2 use will not create an oxygen dependency; clients should receive O2 as needed. O2 is not contraindicated with the use of bronchodilators.

Question 29

•A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client’s chest wall, the nurse expects to elicit: 1. Resonant sounds .
2. Hyperresonant sounds.
 3. Dull sounds.
 4. Flat sounds.

Answer 29

•Answer A. When percussing the chest wall, the nurse expects to elicit resonant sounds — low-pitched, hollow sounds heard over normal lung tissue. Hyperresonant sounds indicate increased air in the lungs or pleural space; they’re louder and lower pitched than resonant sounds. Although hyperresonant sounds occur in such disorders as emphysema and pneumothorax, they may be normal in children and very thin adults. Dull sounds, normally heard only over the liver and heart, may occur over dense lung tissue, such as from consolidation or a tumor. Dull sounds are thud like and of medium pitch. Flat sounds, soft and high-pitched, are heard over airless tissue and can be replicated by percussing the thigh or a bony structure.

Question 30

•A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism? 1. Dyspnea 
2. Bradypnea
 3. Bradycardia
 4. Decreased respirations

Answer 30

•Answer A. The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea, and chest pain.

Question 31

•Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude? 1. The system is functioning normally 
2. The client has a pneumothorax.
 3. The system has an air leak.
 4. The chest tube is obstructed.

Answer 31

•Answer C. Constant bubbling in the chamber indicates an air leak and requires immediate intervention. The client with a pneumothorax will have intermittent bubbling in the water-seal chamber. Clients without a pneumothorax should have no evidence of bubbling in the chamber. If the tube is obstructed, the nurse should notice that the fluid has stopped fluctuating in the water-seal chamber.

Question 32

A 34-year-old female with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/min, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, which action should the nurse take to initiate care of the client? 1. Initiate oxygen therapy as prescribed and reassess the client in 10 minutes 2. Draw blood for an arterial blood gas (ABG) 3. Encourage the client to relax and breathe slowly through the mouth 4. Administer bronchodilators as prescribed

Answer 32

4. Administer bronchodilators as prescribed •In an acute asthma attack, diminished or absent breath sounds can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, IV corticosteroids, and, possibly, IV theophylline. Administering oxygen and reassessing the client 10 minutes later would delay needed medical intervention, as would drawing blood for an ABG. It would be futile to encourage the client to relax and breathe slowly.

Question 33

A client with acute asthma is prescribed short-term corticosteroid therapy. Which is the expected outcome for the use of steroids in clients with asthma? 1. Promote bronchodilation 2. Act as an expectorant 3. Have an anti-inflammatory effect 4. Prevent development of respiratory infections

Answer 33

3.Have an anti-inflammatory effect Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections

Question 34

•A client who underwent a lobectomy and has a water-seal chest drainage system is breathing with a little more effort and at a faster rate than 1 hour ago. The client’s pulse rate is also increased. The nurse should: 1. Check the tubing to ensure that the client is not lying on or kinking it. 2. Increase the suction. 3. Lower the drainage bottles 2-3 feet below the level of the client’s chest. 4. Ensure that the chest tube has two clamps on it to prevent air leaks

Answer 34

1.Check the tubing to ensure that the client is not lying on or kinking it. In this case, there may be some obstruction to the flow of air and fluid out of the pleural space, causing air and fluid to collect and build up pressure. This prevents the remaining lung from re-expanding and can cause a mediastinal shift to the opposite side. The nurse’s first response is to assess the tubing for kinks or obstruction. Increasing the suction is not done without a physician’s prescription. The normal position of the drainage bottles is 2-3 feet below chest level. Clamping the tubes obstructs the flow of air and fluid out of the pleural space and should not be done.

Question 35

•Following a thoracotomy, the client has severe pain. Which of the following strategies for pain management will be the most effective for this client? 1. Repositioning the client immediately after administering pain medication 2. Reassessing the client 30 minutes after administering pain medication 3. Verbally reassuring the client after administering pain medication 4. Readjusting the pain medication dosage as needed according to the client’s condition

Answer 35

2.Reassessing the client 30 minutes after administering pain medication It is essential that the nurse evaluate the effects of pain medication after the medication has had time to act; reassessment is necessary to determine the effectiveness of the pain management plan. Although it is prudent to check for discomfort related to positioning when assessing the client’s pain, repositioning immediately after is not necessary. Verbal reassurance may be useful to instill confidence in the treatment plan; however, it is not as important as the effectiveness of the medication. Readjusting the pain medication dosage as needed according to the client’s condition is essential, but the effectiveness of the medication must be evaluated first.

Question 36

•Which of the following is an expected outcome for an adult client with well-controlled asthma? 1. Chest x-ray demonstrates minimal hyperinflation 2. Temperature remains lower than 100 degrees F (37.8 C) 3. Arterial blood gas analysis demonstrates a decrease in PaO2 4. Breath sounds are clear

Answer 36

4. Between attacks, breath sounds should be clear on auscultation with good air flow present throughout lung fields. Chest X-rays should be normal. The client should remain afebrile. Arterial blood gases should be normal.

Question 37

•Which of the following findings would most likely indicate the presence of respiratory infection in a client with asthma? 1. Cough productive of yellow sputum 2. Bilateral expiratory wheezing 3. Chest tightness 4. Respiratory rate of 30 breaths/min

Answer 37

•A cough productive of yellow sputum is the most likely indicator of a respiratory infection. The other signs and symptoms-wheezing, chest tightness, and increased respiratory rate are all findings associated with an asthma attack and do not necessarily mean an infection is present.

Question 38

The nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack? 1. Occupational exposure to toxins 2. Viral respiratory infections 3. Exposure to cigarette smoke 4. Exercising in cold temperatures

Answer 38

2.Viral respiratory infections The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or a cold and should get yearly flu vaccinations. Environmental exposure to toxins or heavy particulate matter can trigger asthma attacks; however, far fewer asthmatics are exposed to such toxins than are exposed to viruses. Cigarette smoke can also trigger asthma attacks, but to a lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising in cold weather.

Question 39

The nurse has assisted the physicians at the bedside with insertion of a left subclavian, triple lumen catheter in a client admitted with lung cancer. Suddenly, the client becomes restless and tachypnea. The nurse should: 1. Assess breath sounds 2. Remove the catheter 3. Insert a peripheral IV 4. Reposition the client

Answer 39

1.Assess breath sounds The nurse should first assess for bilateral breath sounds since a complication of central line insertion is a pneumothorax, which would cause an increase in respiratory rate and drop in oxygen, causing irritability. The nurse should also assess blood pressure and heart rate for the complication of bleeding. A chest x-ray will be performed to determine correct placement and complications. A central line was most likely placed because peripheral IV access was not available or adequate for the client. Repositioning may be considered after assessments are done

Question 40

While assessing a thoracotomy incisional area from which a chest tube exits, the nurse feels a crackling sensation under the fingertips along the entire incision. Which of the following should be the nurse’s first action? 1. Lower the head of the bed and call the physician 2. Prepare an aspiration tray 3. Mark the area with a skin pencil at the outer periphery of the crackling 4. Turn off the suction of the chest drainage system

Answer 40

•This crackling sensation is subcutaneous emphysema. Subcutaneous emphysema is not an unusual finding and is not dangerous if confined, and the nurse should mark the area to detect if the area is expanding. Progression can be serious, especially if the neck is involved; a tracheotomy may be needed at that point. If emphysema progresses noticeably in 1 hour, the physician should be notified. Lowering the head of the bed will not arrest the progress or provide any further information. A tracheotomy tray would be useful if subcutaneous emphysema progresses to the neck. Subcutaneous emphysema may progress if the chest drainage system does not adequately remove air and fluid; therefore, the system should not be turned off.

Question 41

When teaching a client to deep breathe effectively after a lobectomy, the nurse should instruct the client to do which of the following? 1. Contract the abdominal muscles, take a slow deep breath through the nose and hold it for 3-5 sec, then exhale 2. Contract the abdominal muscles, take a deep breath through the mouth, and exhale slowly as if trying to blow out a candle 3. Relax the abdominal muscles, take a slow deep breath through the nose, and hold it for 3-5 sec 4. Relax the abdominal muscles, take a deep breath through the mouth, and exhale slowly over 10 seconds

Answer 41

1.Contract the abdominal muscles, take a slow deep breath through the nose and hold it for 3-5 sec, then exhale The recommended procedure for teaching clients postoperatively to deep breathe includes contracting (pulling in) the abdominal muscles and taking a slow, deep breath through the nose. This breath is held 3-5 seconds, which facilitates alveolar ventilation by improving the inspiratory phase of ventilation. Exhaling slowly as if trying to blow out a candle is a technique used in pursed-lip breathing to facilitate exhalation in clients with COPD. It is recommended that the abdominal muscles be contracted, not relaxed, to promote deep breathing. The client should breathe through the nose.

Question 42

A client has a chest tube attached to a water-seal drainage system and the nurse notes that the fluid in the chest tube and in the water-seal column has stopped fluctuating. The nurse should determine that: 1. The lung has fully expanded 2. The lung has collapsed 3. The chest tube is in the pleural space 4. The mediastinal space has decreased

Answer 42

1.The lung has fully expanded Cessation of fluid fluctuation in the tubing can mean one of several things: the lung has fully expanded and negative intrapleural pressure has been re-established; the chest tube is occluded; or the chest tube is not in the pleural space. Fluid fluctuation occurs because, during inspiration, intrapleural pressure exceeds the negative pressure generated in the water-seal system. Therefore, drainage moves toward the client. During expiration, the pleural pressure exceeds that generated in the water-seal system, and fluid moves away from the client. When the lung is collapsed or the chest tube is in the pleural space, fluid fluctuation is likely to be noted. The chest tube is not inserted in the mediastinal space.

Question 43

Which of the following should be readily available at the bedside of a client with a chest tube in place? 1. A tracheostomy tray 2. Another sterile chest tube 3. A bottle of sterile water 4. A spirometer

Answer 43

A bottle of sterile water should be readily available and in view when a client has a chest tube so that the tube can be immediately submersed in the water if the chest tube system becomes disconnected. The chest tube should be reconnected to the water-seal system as soon as a sterile functioning system can be re-established. There is no need for a tracheostomy tray, another chest tube, or a spirometer to be placed at the bedside for emergent use.

Question 44

•The nurse is preparing to assist with the removal of a chest tube. Which of the following is appropriate at the site from which the chest tube is removed? 1. Adhesive strip (Steri-strips) 2. Petroleum gauze 3. 4 x 4 gauze with antibiotic ointment 4. No dressing is necessary

Answer 44

2.Petroleum gauze Gauze saturated with petroleum is placed over the site to make an airtight seal to prevent air leakage during the healing process. Dressings with antibiotic ointment or adhesives are not used.

Question 45

A young adult is admitted to the emergency department after an automobile accident. The client ahs severe pain in the right chest where there was an impact on the steering wheel. Which is the primary client goal at this time? 1. Reduce the client’s anxiety 2. Maintain adequate oxygenation 3. Decrease chest pain 4. Maintain adequate circulating volume

Answer 45

2.Maintain adequate oxygenation Blunt chest trauma may lead to respiratory failure, and maintenance of adequate oxygenation is the priority for the client. Decreasing the client’s anxiety is related to maintaining effective respirations and oxygenation. Although pain is distressing to the client and can increase anxiety and decrease respiratory effectiveness, pain control is secondary to maintaining oxygenation. Maintaining adequate circulatory volume is also secondary to maintaining adequate oxygenation.

Question 46

When assessing a client with chest trauma, the nurse notes that the client is taking small breaths at first, then bigger breaths, then a couple of small breaths, then 10-20 seconds of no breaths. The nurse should chart the breathing pattern as: 1. Cheyne-Stokes respiration 2. Hyperventilation 3. Obstructive sleep apnea 4. Bior’s respiration

Answer 46

•Cheyne-Stokes respiration is defined as a regular cycle that starts with normal breaths, which increase and then decrease followed by a period of apnea. It can be related to heart failure or a dysfunction of the respiratory center of the brain. Hyperventilation is the increased rate and depth of respirations. Obstructive sleep apnea is recurring episodes of upper airway obstruction and reduced ventilation. Bior’s respiration, also known as “cluster breathing,” is periods of normal respirations followed by varying periods of apnea.

Question 47

•A nurse is completing the health history for a client who has been taking Echinacea for a head cold. The client asks, “Why isn’t this helping me feel better?” Which of the following responses by the nurse would be the most accurate? 1. “There is limited information as to the effectiveness of herbal products.” 2. “Antibiotics are the agents needed to treat a head cold.” 3. “The head cold should be gone within the month.” 4. “Combining herbal products with prescription antiviral medications is sure to help you.”

Answer 47

•At this time, there is no strong research evidence to warrant recommendations of herbal products for management of colds; further study is needed to show evidence of therapeutic effects and indications. Antibiotics are effective against bacteria; the head cold may have a viral cause. An uncomplicated upper respiratory tract infection subsides within 2-3 weeks. There may be a drug-drug interaction with herbal products and prescriptions.

Question 48

Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? 1. Maintain a fluid intake of 800mL every 24 hrs 2. Experience chills only once a day 3. Cough productively without chest discomfort 4. Experience less nasal obstruction and discharge

Answer 48

4.Experience less nasal obstruction and discharge A client recovering from an URTI should report decreasing or no nasal discharge and obstruction. Daily fluid intake should be increased to more than 1L every 24 hours to liquefy secretions. The temperature should be below 100 degrees F (37.8 C) with no chills or diaphoresis. A productive cough with chest pain indicates a pulmonary infection, not an URTI.

Question 49

•Pseudoephedrine (Sudafed) has been prescribed as a nasal decongestant. Which of the following is a possible adverse effect of this drug? 1. Constipation 2. Bradycardia 3. Diplopia 4. Restlessness

Answer 49

4.Restlessness Adverse effects of pseudoephedrine (Sudafed) are experienced primarily in the cardiovascular system and through sympathetic effects on the central nervous system (CNS). The most common CNS adverse effects include restlessness, dizziness, tension, anxiety, insomnia, and weakness. Common cardiovascular adverse effects include tachycardia, hypertension, palpitations, and arrhythmias. Constipation and diplopia are not adverse effects of pseudoephedrine. Tachycardia, not bradycardia, is an adverse effect of pseudoephedrine.

Question 50

•The nurse is suctioning a client who had a laryngectomy. What is the maximum amount of time the nurse should suction the client? 1. 10 seconds 2. 15 seconds 3. 25 seconds 4. 30 seconds

Answer 50

•A client should be suctioned for no longer than 10 seconds at a time. Suctioning for longer than 10 seconds may reduce the client’s oxygen level so much that he or she becomes hypoxic.

Question 51

The nurse is caring for a patient who is scheduled for a bronchoscopy. The nurse understands that it is important to provide the required information and appropriate explanations for any diagnostic procedure to a patient with a respiratory disorder in order to do which of the following? a) Aid the caregivers of the patient b) Manage respiratory distress c) Ensure adequate rest periods d) Manage decreased energy levels

Answer 51

d) Manage decreased energy levels Explanation: In addition to the nursing management of individual tests, patients with respiratory disorders require informative and appropriate explanations of any diagnostic procedures they will experience. Nurses must remember that for many of these patients, breathing may in some way be compromised and energy levels may be decreased. For that reason, explanations should be brief, yet complete, and may need to be repeated later after a rest period. The nurse must also ensure adequate rest periods before and after the procedures. After invasive procedures, the nurse must carefully assess for signs of respiratory distress

Question 52

Which of the following results in decreased gas exchange in older adults? a) The alveolar walls become thicker. b) The alveolar walls contain fewer capillaries. c) The elasticity of the lungs increases with age. d) The number of alveoli decreases with age.

Answer 52

b) The alveolar walls contain fewer capillaries. Explanation: Although the number of alveoli remains stable with age, the alveolar walls become thinner and contain fewer capillaries, resulting in decreased gas exchange. The lungs also lose elasticity and become stiffer. Lungs elasticity does not increase with age, and number of alveoli does not decrease with age.

Question 53

Which of the following ventilation–perfusion ratios is exhibited when a patient is diagnosed with pulmonary emboli? a) Low ventilation–perfusion ratio b) Normal perfusion to ventilation ratio c) Silent unit d) Dead space

Answer 53

d) Dead space Explanation: When ventilation exceeds perfusion a dead space exists (high ventilation–perfusion ratios). An example of a dead space is pulmonary emboli, pulmonary infarction, and cardiogenic shock. A low ventilation–perfusion ratio exists in pneumonia or with a mucus plug. A silent unit occurs in pneumothorax or ARDS.

Question 54

The nurse is caring for a patient who is to undergo a thoracentesis. In preparation for the procedure, the nurse will position the patient in which of the following positions? a) Lateral recumbent b) Sitting on the edge of the bed c) Prone d) Supine

Answer 54

Sitting on the edge of the bed Explanation: If possible, it is best to place the patient upright or sitting on the edge of the bed with the feet supported and arms and head on a padded over-the-bed table. Other positions in which the patient could be placed include straddling a chair with arms and head resting on the back of the chair, or lying on the unaffected side with the head of the bed elevated 30 to 45 degrees if unable to assume a sitting position.

Question 55

Which of the following is an age-related change associated with the respiratory system? a) Decreased size of the airway b) Increased chest muscle mass c) Increased elasticity of alveolar sacs d) Decreased thickening of alveolar membranes

Answer 55

a) Decreased size of the airway Explanation: Age-related changes that occur in the respiratory system are a decrease in the size of the airway, decreased chest muscle mass, increased thickening of the alveolar membranes, and decreased elasticity of the alveolar sacs.

Question 56

The clinical finding of pink frothy sputum may be an indication of which of the following? a) An infection b) Pulmonary edema c) Bronchiectasis d) A lung abscess

Answer 56

b) Pulmonary edema Explanation: Profuse, frothy pink material, often welling up into the throat, may indicate pulmonary edema. Foul-smelling sputum and bad breath may indicate a lung abscess, bronchiectasis, or an infection caused by fusospirochetal or other anaerobic organisms.

Question 57

The nurse is caring for a patient complaining of chest discomfort. The patient’s admitting diagnosis is left lower lobe pneumonia. Which of the following strategies will the nurse instruct the patient to use to help alleviate the discomfort? a) Assume a left side-lying position while in bed b) Complete deep breathing exercises when chest discomfort occurs c) Request narcotic medication when pain is experienced d) Lying on the right side

Answer 57

a)Assume a left side-lying position while in bed Explanation: Pleuritic pain from irritation of the parietal pleura is sharp and seems to “catch” on inspiration; patients often describe it as being “like the stabbing of a knife.” Patients are more comfortable when they lay on the affected side because this splints the chest wall, limits expansion and contraction of the lung, and reduces the friction between the injured or diseased pleurae on that side. Pain associated with cough may be reduced manually by splinting the rib cage. The nurse would instruct the patient to lie on the left side, not the right, to decrease the pain. While pain medication may be administered, nonpharmacological therapies and non-narcotic interventions should be implemented first. Deep breathing exercises would not aid in decreasing the pain, but rather slowing the patient’s breathing and expanding the lungs.

Question 58

In general, chest drainage tubes are not indicated for a patient undergoing which of the following procedures? a) Lobectomy b) Wedge resection c) Pneumonectomy d) Segmentectomy

Answer 58

c) Pneumonectomy Explanation: Usually, no drains are used for the patient having a pneumonectomy because the accumulation of fluid in the empty hemothorax prevents mediastinal shift. With lobectomy, two chest tubes are usually inserted for drainage, the upper tube for air and the lower tube for fluid. With wedge resection, the pleural cavity usually is drained because of the possibility of an air or blood leak. With segmentectomy, drains are usually used because of the possibility of an air or blood leak.

Question 59

The nurse is preparing to perform chest physiotherapy (CPT) on a patient. Which of the following patient statements would indicate the procedure is contraindicated. a) “I just finished eating my lunch, I’m ready for my CPT now.” b) “I received my pain medication 10 minutes ago, let’s do my CPT now.” c) “I just changed into my running suit; we can do my CPT now.” d) “I have been coughing all morning and am barely bringing anything up.”

Answer 59

a) “I just finished eating my lunch, I’m ready for my CPT now.” Explanation: When performing CPT, the nurse ensures that the patient is comfortable, is not wearing restrictive clothing, and has not just eaten. The nurse gives medication for pain, as prescribed, before percussion and vibration and splints any incision and provides pillows for support, as needed. A goal of CPT is for the patient to be able to mobilize secretions; the patient who is having an unproductive cough is a candidate for CPT.

Question 60

The nurse is preparing to assist the health care provider with the removal of a patient’s chest tube. Which of the following instructions will the nurse correctly give the patient? a) “When the tube is being removed, take a deep breath, exhale, and bear down.” b) “During the removal of the chest tube, do not move because it will make the removal mre painful.” c) “Exhale forcefully while the chest tube is being removed.” d) “While the chest tube is being removed, raise your arms above your head.”

Answer 60

a) “When the tube is being removed, take a deep breath, exhale, and bear down.” Explanation: When assisting in the chest tube’s removal, instruct the patient to perform a gentle Valsalva maneuver or to breathe quietly. The chest tube is then clamped and quickly removed. Simultaneously, a small bandage is applied and made airtight with petrolatum gauze covered by a 4 × 4-inch gauze pad and thoroughly covered and sealed with nonporous tape. The other options are incorrect instructions for the patient.

Question 61

An emergency room nurse is assessing a patient who is complaining of dyspnea. Which of these signs would indicate the presence of a pleural effusion? a) Mottling of the skin upon inspection b) Resonance upon percussion c) Decreased chest wall excursion upon palpation d) Wheezing upon auscultation

Answer 61

c) Decreased chest wall excursion upon palpation Explanation: Symptoms of pleural effusion are shortness of breath, pain, assumption of a position that decreases pain, absent breath sounds, decreased fremitus, a dull, flat sound on percussion, and decreased chest wall excursion. The nurse may also hear a friction rub. Chest radiography and computed tomography (CT) scan show fluid in the involved area.

Question 62

A nurse assesses arterial blood gas results for a patient in acute respiratory failure (ARF). Which of the following results are consistent with this disorder? a) pH 7.35, PaCO2 48 mm Hg b) pH 7.46, PaO2 80 mm Hg c) pH 7.28, PaO2 50 mm Hg d) pH 7.36, PaCO2 32 mm Hg

Answer 62

c) pH 7.28, PaO2 50 mm Hg Explanation: ARF is defined as a decrease in the arterial oxygen tension (PaO2) to less than 50 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO2) to greater than 50 mm Hg (hypercapnia), with an arterial pH of less than 7.35.

Question 63

A patient involved in a motor vehicle crash suffered a blunt injury to the chest wall and was brought to the emergency department. The nurse assesses the patient for which clinical manifestation that would indicate the presence of a pneumothorax? a) Diminished breath sounds b) Bloody, productive cough c) Sucking sound at the site of injury d) Decreased respiratory rate

Answer 63

c) Sucking sound at the site of injury Explanation: Open pneumothorax is one form of traumatic pneumothorax. It occurs when a wound in the chest wall is large enough to allow air to pass freely in and out of the thoracic cavity with each attempted respiration. Because the rush of air through the wound in the chest wall produces a sucking sound, such injuries are termed sucking chest wounds

Question 64

Emphysema is described by which of the following statements? a) Presence of cough and sputum production for at least a combined total of 2 to 3 mnths in each of 2 consecutive years b) Chronic dilatation of a bronchus or bronchi c) A disease of the airways characterized by destruction of the walls of overdistended alveoli d) A disease that results in a common clinical outcome of reversible airflow obstruction

Answer 64

c) A disease of the airways characterized by destruction of the walls of overdistended alveoli Explanation: Emphysema is a category of chronic obstructive pulmonary disease (COPD). In emphysema, impaired oxygen and carbon dioxide exchange results from destruction of the walls of over-distended alveoli. Emphysema is a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli. Also, a chronic inflammatory response may induce disruption of the parenchymal tissues. Asthma has a clinical outcome of airflow obstruction. Bronchitis includes the presence of cough and sputum production for at least a combined total of 2 to 3 months in each of 2 consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.

Question 65

## Footnote Which of the following is the most important risk factor for development of COPD? a) Air pollution b) Genetic abnormalities c) Occupational exposure d) Cigarette smoking

Answer 65

d) Cigarette smoking Explanation: Risk factors for COPD include environmental exposures and host factors. The most important environmental risk factor for COPD worldwide is cigarette smoking. A dose-response relationship exists between the intensity of smoking (pack-year history) and the decline in pulmonary function. Other environmental risk factors include smoking pipes, cigars, and other types of tobacco. Passive smoking (i.e., second-hand smoke) also contributes to respiratory symptoms and COPD. Air pollution is a risk factor for development of COPD, but it is not the most important risk factor.

Question 66

The nurse is caring for a patient with COPD. In COPD, the body attempts to improve oxygen-carrying capacity by increasing the amounts of red blood cells. Which of the following is the term for this process? a) Asthma b) Bronchitis c) Polycythemia d) Emphysema

Answer 66

c) Polycythemia Explanation: Polycythemia is an increase in the red blood cell concentration in the blood. In COPD, the body attempts to improve oxygen-carrying capacity by producing increasing amounts of red blood cells.

Question 67

As status asthmaticus worsens, the nurse would expect the patient to develop which of the following acid–base imbalances? a) Respiratory acidosis b) Metabolic acidosis c) Metabolic alkalosis d) Respiratory alkalosis

Answer 67

a) Respiratory acidosis Explanation: There is reduced PaO2 and initial respiratory alkalosis, with a decreased PaCO2 and an increased pH. As status asthmaticus worsens, PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

Question 68

Which of the following diagnostic test is the most accurate in assessing acute airway obstruction? a) Pulmonary function studies b) Arterial blood gases (ABGs) c) Pulse oximetry d) Spirometry

Answer 68

a) Pulmonary function studies Explanation: Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of FEV1 to forced vital capacity (FVC). Pulmonary function studies are used to help confirm the diagnosis of COPD, determine disease severity, and monitor disease progression. ABGs, and pulse oximetry are not the most accurate diagnostics for an airway obstruction.

Question 69

## Footnote A male patient newly diagnosed with COPD tells the nurse, “I can’t believe I have COPD, I only had a cough; are there other symptoms I should know about”? Which of the following is the nurse’s best response? a) "As your COPD worsens, you will develop frequent respiratory infections.” b) “Other symptoms you may develop are shortness of breath on exertion, and sputum production.” c) “There are no other symptoms; however, your cough may get worse as the disease progresses.” d) “You can also expect to experience a progressive weight gain.”

Answer 69

b) “Other symptoms you may develop are shortness of breath on exertion, and sputum production.” Explanation: COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea on exertion. Patients with COPD are at risk for respiratory insufficiency and respiratory infections, which in turn increase the risk of acute and chronic respiratory failure. Weight loss is common with COPD.

Question 70

Why would a patient with COPD report feeling fatigued? Select all that apply. a) The patient is using all expendable energy just to breathe. b) There is a gradual decrease in lung function over time in a patient with COPD. c) The patient is using all expendable energy for activities of daily living (ADLs). d) There is a gradual decrease in muscle function over time in a patient with COPD

Answer 70

a) The patient is using all expendable energy just to breathe. , b) There is a gradual decrease in lung function over time in a patient with COPD. Explanation: The patient is using all expendable energy just to breathe. There is a gradual decrease in lung function, not muscle function, over time in a patient with COPD. In the patient with COPD, fatigue and feeling of exhaustion stem directly from the disease, not from activity level.

Question 71

A patient presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands there are goals of therapy that are achieved to improve the patient's condition. Which of the following are therapy goals? Select all that apply. a) Return the patient to his original functioning abilities. b) Teach the patient to suspend activity. c) Provide medical support for the current exacerbation. d) Treat the underlying cause of the event.

Answer 71

a) Return the patient to his original functioning abilities., c) Provide medical support for the current exacerbation., d) Treat the underlying cause of the event. Explanation: The goal is to have a stable patient with COPD leading the most productive life possible. COPD cannot necessarily be cured, but it can be managed so that the patient can live a reasonably normal life. With adequate management, patients should not have to give up their usual activities.

Question 72

Which of the following measures may increase complications for a patient with COPD? a) Decreased oxygen supply b) Administration of antibiotics c) Increased oxygen supply d) Administration of antitussive agents

Answer 72

c) Increased oxygen supply Explanation: Administering too much oxygen can result in the retention of carbon dioxide. Patients with alveolar hypoventilation cannot increase ventilation to adjust for this increased load, and increasing hypercapnia occurs. All the other measures are aimed at preventing complications.

Question 73

A nurse is caring for a male patient with COPD. While reviewing breathing exercises, the nurse instructs the patient to breathe in slowly through the nose, taking in a normal breath. Then, the nurse asks the patient to pucker his lips as if preparing to whistle. Finally, the patient is told to exhale slowly and gently through the puckered lips. The nurse teaches the patient this breathing exercise to accomplish which of the following? Select all that apply. a) Release trapped air in the lungs b) Strengthen the diaphragm c) Prevent collapse of the airways d) Condition the inspiratory muscles e) Control the rate and depth of respirations

Answer 73

a) Release trapped air in the lungs, c) Prevent collapse of the airways, e) Control the rate and depth of respirations Explanation:The nurse is teaching the patient the technique of pursed-lip breathing. It helps slow expiration, prevents collapse of the airways, releases trapped air in the lungs, and helps the patient control the rate and depth of respirations. This helps patients relax and get control of dyspnea and reduces the feelings of panic they experience. Diaphragmatic breathing strengthens the diaphragm during breathing. In inspiratory muscle training the patient will be instructed to inhale against a set resistance for a prescribed amount of time every day in order to condition the inspiratory muscles.

Question 74

The nurse is caring for a patient with COPD. The patient is receiving oxygen therapy via nasal cannula. The nurse understands that the goal of oxygen therapy is to maintain the patient’s SaO2 level at or above what percent? a) 70% b) 30% c) 90% d) 50%

Answer 74

c) 90% Explanation: The goal of supplemental oxygen therapy is to increase the baseline resting partial arterial pressure of oxygen (PaO2) to at least 60 mm Hg at sea level and arterial oxygen saturation (SaO2) to at least 90%.

Question 75

Which of the following terms is used to refer to inflammation of the renal pelvis? a) Cystitis b) Interstitial nephritis c) Urethritis d) Pyelonephritis

Answer 75

d) Pyelonephritis Explanation: Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic. Cystitis is inflammation of the urinary bladder. Urethritis is inflammation of the urethra. Interstitial nephritis is inflammation of the kidney.

Question 76

The most common presenting objective symptoms of a UTI in older adults, especially in those with dementia, include which of the following? a) Incontinence b) Back pain c) Change in cognitive functioning d) Hematuria

Answer 76

c)Change in cognitive functioning Explanation: The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these patients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.

Question 77

The nurse is conducting discharge teaching for a patient who was admitted with a kidney stone. The nurse includes which of the following as a measure to prevent additional kidney stones? a) Increase protein intake. b) Avoid drinking tea. c) Avoid drinking water before bedtime. d) Adhere to a low-calcium diet.

Answer 77

b) Avoid drinking tea. Explanation: The nurse should teach the patient to avoid tea and other oxalate-containing foods, such as spinach, strawberries, rhubarb, peanuts, and wheat bran. The patient should restrict protein intake to 60 g/day and should drink two glasses of water at bedtime. Low-calcium diets are generally not recommended.

Question 78

The nurse is instructing a patient to perform continuous ambulatory peritoneal dialysis correctly at home. Which of the following educational information should the nurse provide to the patient? a) Wear a mask while handling any dialysate solutions. b) Use an aseptic technique during the procedure. c) Keep the catheter stabilized to the abdomen, below the belt line. d) Clean the catheter insertion site daily with soap.

Answer 78

b) Use an aseptic technique during the procedure. Explanation: The patient should be instructed to use an aseptic technique during the procedure. The patient should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (patients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a patient has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine (Betadine), not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.

Question 79

Which of the following terms is used to describe the concentration of urea and other nitrogenous wastes in the blood? a) Hematuria b) Azotemia c) Uremia d) Proteinuria

Answer 79

b) Azotemia Explanation: Azotemia is the concentration of urea and other nitrogenous wastes in the blood. Uremia is an excess of urea and other nitrogenous wastes in the blood. Hematuria is blood in the urine. Proteinuria is protein in the urine.

Question 80

A nurse is caring for an acutely ill patient. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill patient is which of the following? a) Pulse rate b) Blood pressure c) Weight d) Edema

Answer 80

c) Weight Explanation: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. Blood pressure, pulse rate, and edema are not the most accurate indicator of fluid loss or gain.

Question 81

The nurse is caring for a patient diagnosed with chronic glomerulonephritis. The nurse will observe the patient for the development of which of the following? a) Metabolic alkalosis b) Hypokalemia c) Hypophosphatemia d) Anemia

Answer 81

d) Anemia Explanation: Anemia, hyperkalemia, metabolic acidosis, and hyperphosphatemia occur in chronic glomerulonephritis

Question 82

Which of the following is the hallmark of the diagnosis of nephrotic syndrome? a) Hyponatremia b) Hypokalemia c) Hyperalbuminemia d) Proteinuria

Answer 82

d) Proteinuria Explanation: Proteinuria (predominantly albumin) exceeding 3.5 g/day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may also occur. Proteinuria and microscopic hematuria may persist for many months; in fact, 20% of patients have some degree of persistent proteinuria or decreased glomerular filtration rate (GFR) 1 year after presentation.

Question 83

The nurse is caring for a patient with acute renal injury (AKI). The patient is experiencing an increase in the serum concentration of urea and creatinine. The nurse understands the patient is experiencing which of the following phases of AKI? a) Initiation b) Oliguria c) Diuresis d) Recovery

Answer 83

b) Oliguria Explanation: The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.

Question 84

Which of the following is a characteristic of the intrarenal category of AKI? a) Increased BUN b) High specific gravity c) Decreased urine sodium d) Decreased creatinine

Answer 84

a) Increased BUN Explanation: The intrarenal category of AKI encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium. Intrarenal AKI is the result of actual parenchymal damage to the glomeruli or kidney tubules. Acute tubular necrosis (ATN), acute kidney injury in which there is damage to the kidney tubules, is the most common type of intrinsic AKI. Characteristics of ATN are intratubular obstruction, tubular back leak (abnormal reabsorption of filtrate and decreased urine flow through the tubule), vasoconstriction, and changes in glomerular permeability. These processes result in a decrease of GFR, progressive azotemia, and fluid and electrolyte imbalances.

Question 85

Which of the following is an integumentary manifestation of chronic renal failure? a) Gray-bronze skin color b) Tremors c) Seizures d) Asterixis

Answer 85

Integumentary manifestations of chronic renal failure include a gray-bronze skin color. Other manifestations are dry, flaky skin, pruritus, ecchymosis, purpura, thin, brittle nails, and coarse, thinning hair. Asterixis, tremors, and seizures are neurologic manifestations of chronic renal failure.

Question 86

The nurse understands acute dialysis is indicated in which of the following situations? a) Hypokalemia b) Dehydration c) Impending pulmonary edema d) Metabolic alkalosis

Answer 86

c) Impending pulmonary edema Explanation: Acute or urgent dialysis is indicated when there is a high and increasing level of serum potassium, fluid overload, or impending pulmonary edema, increasing acidosis, pericarditis, and advanced uremia

Question 87

A patient diagnosed with chronic renal failure is receiving continuous peritoneal dialysis (PD). The nurse instructs the patient about which of the following diet plans? a) Low-sodium diet b) High-protein diet c) High-calorie diet d) Low-protein diet

Answer 87

b) High-protein diet Explanation: Because of protein loss with continuous PD, the patient is instructed to eat a high-protein, nutritious diet. The patient is also encouraged to increase his or her daily fiber intake to help prevent constipation, which can impede the flow of dialysate into or out of the peritoneal cavity. A low-protein diet is required to reduce the production of end products of protein metabolism that the kidneys are unable to excrete. Establishing a diet high in calories and low in protein, sodium, and potassium is essential for patients with acute renal failure.

Question 88

In the diuresis period of AKI, the nurse should observe the patient closely for what complication? a) Renal calculi b) Oliguria c) Dehydration d) Hypokalemia

Answer 88

c) Dehydration Explanation: Dehydration is a complication during the diuresis phase related to elevated urine output and continued symptoms of uremia. The concern with AKI is hyperkalemia. The diuresis phase of AKI is marked by normal or elevated urine output. Oliguria is urine output less than 400 mL in 24 hours and is seen in the oliguria phase. Renal calculi are a possible cause but not complication of AKI.

Question 89

Following are complications the nurse should monitor for during dialysis except for which of the following? a) Dysrhythmias b) Muscle cramping c) Air embolism d) Hypertension

Answer 89

d) Hypertension Explanation: The nurse should monitor for hypotension, not hypertension, during the treatment related to the removal of fluid. Muscle cramping may occur late in dialysis as fluid and electrolytes rapidly leave the extracellular space. Dysrhythmias may result from electrolyte and pH changes or removal of antiarrhythmic medications. Air embolism is rare, but could occur if air enters the vascular system.

Question 90

The nurse is caring for a patient following extensive abdominal surgery. The patient develops an infection that is treated with IV gentamicin. After 4 days of treatment, the patient develops oliguria, and laboratory results indicate azotemia. The patient is diagnosed with acute tubular necrosis and transferred to the ICU. The patient is hemodynamically stable. Which of the following dialysis methods would be most appropriate for the patient? a) Hemodialysis b) Continuous arteriovenous hemofiltration (CAVH) c) Continuous venovenous hemofiltration (CVVH) d) Peritoneal dialysis

Answer 90

a) Hemodialysis Explanation: The patient is hemodynamically stable and hemodialysis would be most appropriate. Hemodialysis is used for patients who are acutely ill and require short-term dialysis for days to weeks until kidney function resumes and for patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) who require long-term or permanent renal replacement therapy. Peritoneal dialysis (PD) may be the treatment of choice for patients with renal failure who are unable or unwilling to undergo hemodialysis or kidney transplantation. CAVH and CVVH are used for patients who are hemodynamically unstable.

Question 91

The nurse is caring for a patient with CKD. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal?

Answer 91

A 1-kg weight gain is equal to 1,000 mL of retained fluid. 4 kg × 1,000 = 4,000. The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded.

Question 92

The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply. a) Calcium 7.5 mg/dL; hypotension and irritability b) Potassium 6.4 mEq/L; dysrhythmias and abdominal distention c) Magnesium 1.5 mg/dL; mood changes and insomnia d) Chloride 90 mEq/L; irritability and seizures e) Phosphate 5.0 mg/dL; tachycardia and nausea and emesis

Answer 92

a) Calcium 7.5 mg/dL; hypotension and irritability, b) Potassium 6.4 mEq/L; dysrhythmias and abdominal distention, e) Phosphate 5.0 mg/dL; tachycardia and nausea and emesis ## Footnote Explanation: Decreased calcium, increased potassium, and increased phosphate levels are associated with ESKD, along with the signs and symptoms associated with these serum values. Decreased magnesium and chloride levels are not associated with ESKD.

Question 93

The nurse is caring for a patient with ESKD. Which of the following acid–base imbalances is associated with this disorder? a) pH 7.20, PaCO2 36, HCO3 14– b) pH 7.47, PaCO2 45, HCO3 33– c) pH 7.31, PaCO2 48, HCO3 24– d) pH 7.50, PaCO2 29, HCO3 22–

Answer 93

a) pH 7.20, PaCO2 36, HCO3 14– Explanation: Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3–) and to reabsorb sodium bicarbonate (HCO3–). There is also decreased excretion of phosphates and other organic acids.

Question 94

The nurse is caring for a patient that has developed oliguria. Oliguria is defined as urine output less than \_\_\_\_\_\_\_\_\_\_\_mL/kg/hr.

Answer 94

Oliguria is defined as urine output less than 0.5 mL/kg/hr

Question 95

A patient diagnosed with AKI has developed congestive heart failure. The patient has received 40 mg of intravenous pyelogram (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The patient’s vital signs are stable. Which of the following health care orders should the nurse anticipate? a) Normal saline (NS) bolus of 500 mL b) Lasix (Furosemide) 80 mg IVP c) Chest x-ray d) Mannitol (Osmitrol) 12.5 g IVP

Answer 95

b) Lasix (Furosemide) 80 mg IVP Explanation: Diuretic agents are often used to control fluid volume in patients with AKI. The patient’s urine output indicates an inadequate response to the initial dosage of Lasix and the nurse should anticipate administering Lasix 80 mg IVP. Often in this situation, the initial dosage of Lasix is doubled. The patient is experiencing fluid overload, thus, a 500-mL bolus of NS would be contraindicated. There is no need to complete a chest x-ray. Mannitol is widely used in the management of cerebral edema and increased intracranial pressure (ICP) from multiple causes.

Question 96

The nurse is treating a patient with ESKD. The nurse is concerned that the patient is developing renal osteodystrophy. Upon review of the patient’s laboratory values, it is noted the patient has had a calcium level of 11 mg/dL for the past 3 days and the phosphate level is 5.5 mg/dL. The nurse anticipates the administration of which of the following medications? a) Mylanta b) Os-Cal (calcium carbonate) c) Renagel (sevelamer) d) Phos-Lo (calcium carbonate)

Answer 96

c) Renagel (sevelamer) Explanation: Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. If calcium is high or the calcium–phosphorus product exceeds 55 mg/dL, a polymeric phosphate binder such as sevelamer hydrochloride (Renagel) may be prescribed. This medication binds dietary phosphorus in the intestinal tract; one to four tablets should be administered with food to be effective. Magnesium-based antacids are avoided to prevent magnesium toxicity.

Question 97

The nurse is caring for a patient with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which of the following nursing actions is contraindicated? a) Obtaining a blood pressure reading from the right arm b) Obtaining blood samples from the left arm c) Placing the patient’s watch on the left wrist d) Palpating the fistula for a “thrill”

Answer 97

a) Obtaining a blood pressure reading from the right arm Explanation: The nurse assesses the vascular access for patency. The bruit, or “thrill,” over the venous access site must be evaluated at least every shift. The nurse takes precautions to ensure that the extremity with the vascular access is not used for measuring blood pressure or for obtaining blood specimens; tight dressings, restraints, or jewelry over the vascular access must be avoided as well.

Question 98

When fluid intake is normal, the specific gravity of urine should be which of the following? a) 1.010 to 1.025 b) Less than 1.010 c) 1.000 d) Greater than 1.025

Answer 98

a) 1.010 to 1.025 Explanation: Urine specific gravity is a measurement of the kidney's ability to concentrate urine. The specific gravity of water is 1.000. A urine specific gravity of less than 1.010 may indicate inadequate fluid intake. A urine specific gravity greater than 1.025 may indicate overhydration.

Question 99

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? a) 20% b) 30% c) 10% d) 40%

Answer 99

a) 20% Explanation: Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 L/day of filtrate

Question 100

The nurse is reviewing the results of renal function studies of a patient. The nurse understands that which of the following is a normal BUN-to-creatinine ratio? a) 10:1 b) 4:1 c) 6:1 d) 8:1

Answer 100

a) 10:1 Explanation: A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect

Question 101

Which is the correct term for the ability of the kidneys to clear solutes from the plasma? a) Renal clearance b) Specific gravity c) Glomerular filtration rate (GFR) d) Tubular secretion

Answer 101

a) Renal clearance Explanation: Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. GFR is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.

Question 102

## Footnote Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? a) 30% b) 50% c) 40% d) 20%

Answer 102

b) 50% Explanation: Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal. Renal function can be assessed most accurately if several tests are performed and their results are analyzed together. Common tests of renal function include renal concentration tests, creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein metabolism) levels.

Question 103

A patient with a history of chronic renal infections is ordered a CT scan with contrast. Prior to the procedure, the nurse should complete which of the following? a) Place emergency medical equipment in the procedure room. b) Keep the patient NPO 1 hour prior to the scan. c) Instruct the patient to maintain a full bladder for the diagnostic test. d) Hold the patient’s iron supplement until after the diagnostic test.

Answer 103

a) Place emergency medical equipment in the procedure room. Explanation: For some patients, contrast agents are nephrotoxic and allergenic. Emergency equipment and medications should be available in case of an anaphylactic reaction to the contrast agent. Emergency supplies include epinephrine, corticosteroids, vasopressors, oxygen, and airway and suction equipment. The patient is instructed to maintain a full bladder for an ultrasonography. The other instructions/interventions relate to an MRI.

Question 104

Which of the following does the nurse recognize is the best clinical measure of renal function? a) Circulating ADH levels b) Urine-specific gravity c) Creatinine clearance d) Volume of urine output

Answer 104

c) Creatinine clearance Explanation: Creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decreases.

Question 105

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which of the following? a) Glomerulonephritis b) Decreased fluid intake c) Increased fluid intake d) Diabetes insipidus

Answer 105

b) Decreased fluid intake Explanation: When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases. Disorders or conditions that cause decreased urine-specific gravity include diabetes insipidus, glomerulonephritis, and severe renal damage. Disorders that can cause increased specific gravity include diabetes, nephritis, and fluid deficit.

Question 106

A patient presents to the ED complaining of left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The patient has also experienced nausea and emesis. The nurse suspects the patient is experiencing which of the following? a) Ureteral stones b) Pyelonephritis c) Cystitis d) Infection of the urethra

Answer 106

a) Ureteral stones Explanation: The findings are constant with ureteral stones, edema or stricture, or a blood clot. The other answers do not apply

Question 107

The nurse is caring for a patient scheduled for urodynamic testing. Following the procedure, the nurse provides information to the patient that includes which of the following? a) “You can stop taking the prescribed antibiotic.” b) “Contact the primary provider if you experience fever, chills, or lower back pain.” c) “You will be sent home with a urinary catheter.” d) “You may resume consuming caffeinated, carbonated, and alcoholic beverages.”

Answer 107

b) “Contact the primary provider if you experience fever, chills, or lower back pain.” Explanation: The patient must be made aware of the signs of a urinary tract infection after the procedure. The patient should contact the primary provider if he/she experience fever, chills, lower back pain, or continued dysuria and hematuria. The patient will have catheters placed during the procedure but will not be sent home with a catheter. The patient should be told to avoid caffeinated, carbonated, and alcoholic beverages after the procedure because these can further irritate the bladder. These symptoms usually decrease or subside by the day after the procedure. If the patient received an antibiotic medication before the procedure, the patient should be told to continue taking the complete course of medication after the procedure. This is a measure to prevent infection.