Nokea
The nurse recognizes that additional teaching is needed when the patient with asthma says
- A. a. I should exercise every day if my symptoms are controlled.
- B. b. I may use over-the-counter bronchodilator drugs occasionally if I develop chest tightness.
- C. c. I should inform my spouse about my medications and how to get help if I have a severe asthma attack.
- D. A diary to record my medication use, symptoms, peak expiratory flow rates, and activity levels will help in adjusting my therapy.
Correct Answer: D
Rationale: Additional teaching is needed when the patient mentions using over-the-counter bronchodilator drugs occasionally. This is not recommended as it can mask underlying issues and delay proper treatment.
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When CO2 diffuses into blood in systemic capillaries most of it:
- A. Remains in solution as CO2
- B. Converts to carbamino compounds
- C. Converts to bicarbonate ions in RBC
- D. Combines with Hb directly
Correct Answer: C
Rationale: The correct answer is C because the majority of CO2 diffusing into blood combines with water inside red blood cells (RBC) to form carbonic acid, which then dissociates into bicarbonate ions and hydrogen ions. This reaction is facilitated by the enzyme carbonic anhydrase. This process allows for efficient transport of CO2 in the bloodstream. Choices A and B are incorrect as CO2 primarily undergoes conversion to bicarbonate ions, not remaining in solution as CO2 or forming carbamino compounds. Option D is incorrect as CO2 does not directly combine with hemoglobin.
The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching?
- A. Make inhalation longer than exhalation.
- B. Exhale through an open mouth.
- C. Use diaphragmatic breathing.
- D. Use chest breathing.
Correct Answer: C
Rationale: The correct answer is C: Use diaphragmatic breathing. Diaphragmatic breathing involves using the diaphragm to breathe deeply, allowing more air to enter the lungs and improving oxygenation. This is beneficial for clients with chronic bronchitis as it helps improve lung function and efficiency. Making inhalation longer than exhalation (Choice A) may lead to hyperventilation. Exhaling through an open mouth (Choice B) can lead to loss of carbon dioxide. Using chest breathing (Choice D) is less efficient and can exacerbate breathing difficulties in clients with chronic bronchitis. Diaphragmatic breathing is the most effective technique for improving breathing and should be emphasized in teaching.
A medical patient rings her call bell and expresses alarm to the nurse, stating, 'I've just coughed up this blood. That can't be good, can it?' How can the nurse best determine whether the source of the blood was the patient's lungs?
- A. Obtain a sample and test the pH of the blood, if possible.
- B. Try to see if the blood is frothy or mixed with mucus.
- C. Perform oral suctioning to see if blood is obtained.
- D. Swab the back of the patient's throat to see if blood is present.
Correct Answer: B
Rationale: The correct answer is B: Try to see if the blood is frothy or mixed with mucus. By observing if the blood is frothy or mixed with mucus, the nurse can determine if the source is more likely to be from the lungs, as blood from the lungs is often frothy due to air mixing with it during coughing. This observation helps differentiate between blood coming from the respiratory tract versus other sources in the body.
Incorrect choices:
A: Testing the pH of the blood does not directly indicate the source of the blood in this context.
C: Performing oral suctioning may not provide accurate information about the source of the blood.
D: Swabbing the back of the throat may not help determine if the blood is coming from the lungs as it could be from other sources in the upper respiratory tract.
At a PO2 of 70 mm Hg and normal temperature and pH, hemoglobin is ________ percent saturated with oxygen.
- A. 10
- B. 25
- C. 50
- D. more than 90
Correct Answer: D
Rationale: The correct answer is D (more than 90). At a PO2 of 70 mm Hg, hemoglobin is more than 90% saturated with oxygen due to the high oxygen affinity of hemoglobin at this partial pressure. Hemoglobin exhibits near-maximal saturation at this level, promoting efficient oxygen binding and transport. Choices A, B, and C are incorrect as they do not accurately reflect the high oxygen saturation levels associated with a PO2 of 70 mm Hg.
Bohr effect shifts the O2 Hb dissociation curve to right
- A. To promote oxygenation of Hb in lungs
- B. To increase O2 concentration
- C. To decrease CO2 concentration
- D. To decrease the pH of blood
Correct Answer: D
Rationale: The Bohr effect states that a decrease in pH shifts the oxygen-hemoglobin dissociation curve to the right, promoting the release of oxygen to tissues. This occurs in metabolically active tissues where CO2 is produced, lowering the pH. Choice D is correct because a decrease in blood pH facilitates oxygen unloading. Choices A and B are incorrect because the Bohr effect is related to oxygen release, not uptake. Choice C is incorrect because decreasing CO2 concentration would actually shift the curve to the left.