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The nurse is studying for a physiology test over the respiratory system. What should the nurse know about central chemoreceptors in the medulla?
- A. They respond to changes in CO2 levels and hydrogen ion concentrations (pH) in the cerebrospinal fluid.
- B. They respond to changes in the O2 levels in the brain.
- C. They respond to changes in CO2 levels in the brain.
- D. They respond to changes in O2 levels and bicarbonate levels in the cerebrospinal fluid.
Correct Answer: A
Rationale: Central chemoreceptors in the medulla respond to changes in CO2 levels and hydrogen ion concentrations (pH) in the cerebrospinal fluid. Central chemoreceptors do not respond to changes in the O2 levels in the brain, changes in CO2 levels in the brain, changes in O2 levels, and bicarbonate levels in the cerebrospinal fluid.
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The nurse working in the radiology clinic is assisting with a pulmonary angiography. The nurse knows that when monitoring clients after a pulmonary angiography, what should the physician be notified about?
- A. Raised temperature in the affected limb
- B. Excessive capillary refill
- C. Absent distal pulses
- D. Flushed feeling in the client
Correct Answer: C
Rationale: When monitoring clients after a pulmonary angiography, nurses must notify the physician about diminished or absent distal pulses, cool skin temperature in the affected limb, and poor capillary refill. Absent distal pulses may indicate damage to the artery or a clot. When the contrast medium is infused, the client will sense a warm, flushed feeling.
The nurse is caring for a client whose respiratory status has declined since shift report. The client has tachypnea, is restless, and displays cyanosis. Which diagnostic test should the nurse perform first?
- A. Arterial blood gases
- B. Pulmonary function test
- C. Pulse oximetry
- D. Chest x-ray
Correct Answer: C
Rationale: Pulse oximetry is a noninvasive method to determine arterial oxygen saturation. Normal values are 95% and above. Using this diagnostic test first provides rapid information of the client's respiratory system. All other options vary in amount of time and patient participation in determining further information regarding the respiratory system.
The client is returning from the operating room following a bronchoscopy. Which action, performed by the nursing assistant, would the nurse stop if began prior to nursing assessment?
- A. The nursing assistant is assisting the client to a semi-Fowler's position.
- B. The nursing assistant is assisting the client to the side of the bed to use a urinal.
- C. The nursing assistant is pouring a glass of water to wet the client's mouth.
- D. The nursing assistant is asking a question requiring a verbal response.
Correct Answer: C
Rationale: When completing a procedure which sends a scope down the throat, the gag reflex is anesthetized to reduce discomfort. Upon returning to the nursing unit, the gag reflex must be assessed before providing any food or fluids to the client. The client may need assistance following the procedure for activity and ambulation but this is not restricted in the post-procedure period.
A client arrives at the physician's office stating 2 days of febrile illness, dyspnea, and cough. Upon assisting the client into a gown, the nurse notes that the client's sternum is depressed, especially on inspiration. Crackles are noted in the bases of the lung fields. Based on inspection, which will the nurse document?
- A. The client has a funnel chest.
- B. The client has chronic respiratory disease.
- C. The client has pneumonia in the bases.
- D. The client needs a cough suppressant.
Correct Answer: A
Rationale: The question asks for a documentation based on inspection. A funnel chest, known as pectus excavatum, has the sternum depressed from the second intercostal space, and it is more pronounced on inspiration. The nurse would not diagnose chronic respiratory disease or pneumonia. The client would also not prescribe a cough suppressant.
A nurse is performing a physical assessment on a client who has a history of a respiratory infection. Which documentation, completed by the nurse, indicates improvement in an area of the lung affected by the infection?
- A. Lung fields documented as clear.
- B. Palpable vibrations over the chest wall when the client speaks.
- C. Decreased fremitus when the client feels the vibration in their chest.
- D. Dull sounds percussed over the lung tissue.
- E. Bronchial sounds heard only in the affected area.
Correct Answer: A
Rationale: To determine if the client's respiratory infection has resolved, the nurse should assess the client's normal respiratory status. Lungs will return to clear breath sounds. Palpable vibrations will be felt ,as they may be normal if there is no infection in the lungs. A client with consolidation of a lobe of the lung from pneumonia has increased tactile fremitus over that lobe. A decreased fremitus would indicate resolution of infection. Bronchial sounds will be noted over the upper lung fields. An increased fremitus is noted as the client speaks '99.' Dull percussed sounds indicate an area of consolidation or infection.