Nokea
A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which if the following is the appropriate nursing intervention?
- A. Continue to suction.
- B. Notify the physician immediately.
- C. Stop the procedure and reoxygenate the client.
- D. Ensure that the suction is limited to 15 seconds.
Correct Answer: C
Rationale: The correct answer is C: Stop the procedure and reoxygenate the client. When the nurse notes a decreasing heart rate during suctioning, it could indicate that the client is experiencing hypoxia. Stopping the procedure and providing additional oxygenation is crucial to prevent further complications such as bradycardia or cardiac arrest. Continuing to suction (choice A) can worsen the hypoxia. Notifying the physician immediately (choice B) may cause a delay in addressing the immediate issue. Limiting suction to 15 seconds (choice D) does not address the primary concern of hypoxia and decreasing heart rate.
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The collapse of lung is known as:
- A. pleurisy
- B. pleural effusion
- C. atelectasis
- D. pneumothorax
Correct Answer: C
Rationale: The correct answer is C: atelectasis. Atelectasis refers to the collapse of a lung or a part of a lung, leading to incomplete expansion of air sacs. This can be caused by various factors such as blockage of the airways or compression of the lung tissue. Pleurisy (A) is inflammation of the pleura, the lining around the lungs. Pleural effusion (B) is the accumulation of fluid in the pleural space. Pneumothorax (D) is the presence of air in the pleural space, leading to lung collapse. Atelectasis specifically describes the collapse of the lung itself, making it the correct choice.
The movement of both oxygen and carbon dioxide in the body is accomplished by
- A. exocytosis and endocytosis
- B. bulk flow.
- C. osmosis
- D. diffusion.
Correct Answer: D
Rationale: The correct answer is D: diffusion. Oxygen and carbon dioxide move in and out of cells through simple diffusion, which is the passive movement of molecules from an area of high concentration to an area of low concentration. This process occurs due to the concentration gradient of these gases. Osmosis (Choice C) is the movement of water across a selectively permeable membrane, not gases like oxygen and carbon dioxide. Exocytosis and endocytosis (Choice A) involve the transport of larger molecules and particles in and out of cells, not gases. Bulk flow (Choice B) involves the movement of fluids in response to pressure differences, not the specific movement of oxygen and carbon dioxide molecules. Therefore, diffusion is the correct mechanism for the movement of oxygen and carbon dioxide in the body due to their small molecular size and the concentration gradient present.
Inhibition of medulla oblongata chemoreceptors and respiratory muscles has what effect on respiratory rate, elimination of CO2 at alveoli, and arterial PCO2?
- A. increased respiratory rate, increased elimination of CO2 at alveoli, and increased arterial
PCO2 - B. increased respiratory rate, decreased elimination of CO2 at alveoli, and decreased arterial
PCO2 - C. increased respiratory rate, increased elimination of CO2 at alveoli, and decreased arterial
PCO2 - D. decreased respiratory rate, decreased elimination of CO2 at alveoli, and increased arterial
PCO2
Correct Answer: D
Rationale: The correct answer is D. Inhibition of medulla oblongata chemoreceptors and respiratory muscles would decrease respiratory rate, leading to decreased elimination of CO2 at alveoli. This would cause an increase in arterial PCO2 due to less CO2 being removed from the body. Therefore, choice D is correct.
Choices A, B, and C are incorrect because they do not align with the physiological effects of inhibiting the medulla oblongata chemoreceptors and respiratory muscles. Option A suggests an increase in respiratory rate and elimination of CO2, which goes against the expected decrease in these parameters. Option B proposes an increase in respiratory rate but a decrease in CO2 elimination and arterial PCO2, which is inconsistent with the expected outcomes. Option C suggests an increase in respiratory rate and CO2 elimination but a decrease in arterial PCO2, which does not follow the logic of the question.
The pulmonary ventilation rate for someone with tidal volume of 500 mL and a respiration rate of 14 bpm is:
- A. 6,000 L/min
- B. 6 L/min
- C. 7 L/min
- D. 4.2 L/min
Correct Answer: C
Rationale: To calculate pulmonary ventilation rate, multiply tidal volume by respiration rate. In this case, 500 mL * 14 bpm = 7,000 mL/min. Converting to liters, it's 7 L/min. Choice A is incorrect as it miscalculates the conversion from mL to L, B is incorrect due to incorrect calculation, and D is incorrect as it's not the accurate result of the multiplication.
A 17-year-old male is admitted following an automobile accident. He is very anxious, dyspneic, and in severe pain. The left chest wall moves in during inspiration and balloons out when he exhales. The nurse understands these symptoms are most suggestive of?
- A. Hemothorax
- B. Flail chest
- C. Atelectasis
- D. Pleural effusion
Correct Answer: B
Rationale: The correct answer is B: Flail chest. Flail chest is characterized by paradoxical movement of a segment of the chest wall due to multiple rib fractures. In this case, the left chest wall moving in during inspiration and out during expiration indicates this paradoxical movement. This leads to ineffective breathing, causing dyspnea and anxiety. Hemothorax (A) is accumulation of blood in the pleural cavity, not associated with chest wall movement. Atelectasis (C) is collapse of lung tissue, not associated with chest wall movement. Pleural effusion (D) is accumulation of fluid in the pleural space, also not associated with paradoxical chest wall movement.