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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.
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Including clients with a history of respiratory issues, for which diagnostic stud(ies) would the nurse screen the client for an allergy to contrast medium prior to testing?
- A. Lung scan
- B. Chest x-ray
- C. Pulmonary angiography
- D. Bronchoscopy
- E. Pulmonary function test
- F. Sputum culture
Correct Answer: A,C
Rationale: The nurse must be well educated in screening clients before diagnostic procedures, which include contrast medium for an allergy to iodine. A lung scan and pulmonary angiography both require contrast medium. A chest x-ray, bronchoscopy, sputum culture test, and pulmonary functions test do not require contrast medium.
A client presents to the emergency department in respiratory compromise. The client's temperature is 102.4?°F, heart rate 88 beats/minute and regular, and blood pressure 138/76 mm Hg. The client is dyspneic, pale, and expectorating green-tinged sputum. The physician orders medications including antibiotics, antipyretics, nebulizer treatments, and IV fluids. A chest x-ray and sputum culture are to be completed. Which physician order would the nurse complete before beginning antibiotic therapy?
- A. Chest x-ray
- B. Sputum culture
- C. Nebulizer treatments
- D. Initiating IV fluids
Correct Answer: B
Rationale: The nurse would obtain a sputum culture for sensitivity before beginning antibiotic therapy. Obtaining a sputum culture after beginning antibiotics can skew results. Once the sputum culture results are returned, the antibiotic can be closely aligned to kill the organism, if present. The other orders can be prioritized according to client needs.
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.
The nurse is caring for a client with a decrease in airway diameter causing airway resistance. The client experiences coughing and mucus production. On lung assessment, which adventitious breath sounds are anticipated?
- A. Crackles
- B. Sonorous wheezes
- C. Rubs
- D. Sibilant wheezes
Correct Answer: D
Rationale: A decrease in airway diameter, such as in asthma, produces breath sounds of wheezes. Wheezes may be sibilant (hissing or whistling) or sonorous (full and deep). Sibilant wheezes (formerly called wheezes) are continuous musical sounds that can be heard during inspiration and expiration. They result from air passing through narrowed or partially obstructed air passages and are heard in clients with increased secretions. Sonorous wheezes (formerly called rhonchi) are lower pitched and are heard in the trachea and bronchi. Sonorous wheezes are coarse, rattling sounds similar to snoring usually caused by secretion in the bronchial tree. Crackles, also called rales, are crackling or rattling sounds signifying fluid or exudate in the lung fields. Rubs are secretions that can be heard in the large airway.
The nurse is providing health education on the body's ability to exchange oxygen and carbon dioxide through the alveolar capillary membrane. Which statement, provided by the nurse, is most correct when asked about diffusion during inspiration?
- A. During inspiration, the concentration of oxygen is equal in both the alveoli and the capillaries.
- B. During inspiration, oxygen diffuses from the arterial system through to the alveolar capillary membrane.
- C. During inspiration, carbon dioxide provides the basis for all diffusion gradients.
- D. During inspiration, oxygen is greater in the alveoli than in the capillaries.
Correct Answer: D
Rationale: During inspiration, oxygen-rich air from the environment enters the pulmonary system. During inspiration, the concentration of inspired oxygen is higher in the alveoli than in the capillaries, causing diffusion from the alveoli to the capillaries. Thus, the concentration of oxygen is not equal in the alveoli and capillaries. There is no diffusion from the arterial system after the oxygen diffuses from the alveoli to the capillaries. Carbon dioxide does not provide the basis for all diffusion gradients.