Nokea
With respect to regional gas exchange in the upright lung
- A. Ventilation is greater at the top of the lungs
- B. Perfusion is much greater at the top of the lungs compared with the bases
- C. Ventilation/perfusion ratio is abnormally high at the top of the lungs
- D. PO2 is highest at the bases of the lungs
Correct Answer: C
Rationale: The correct answer is C because in the upright lung, the ventilation-perfusion ratio is higher at the top due to gravity causing increased perfusion at the bases. This results in a mismatch between ventilation and perfusion, leading to a higher V/Q ratio at the top. Choices A and B are incorrect because ventilation is actually greater at the bases due to the effect of gravity, leading to higher ventilation there. Choice D is incorrect because PO2 is higher at the apex of the lung due to decreased perfusion but not at the bases.
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A charge nurse is rounding on several older clients on ventilators in the Intensive Care Unit whom the nurse identifies as being at high risk for ventilator-associated pneumonia. To reduce this risk what activity would the nurse delegate to the assistive personnel (AP)?
- A. Encourage between-meal snacks.
- B. Monitor temperature every 4 hours.
- C. Provide oral care every 4 hours.
- D. Report any new onset of cough.
Correct Answer: C
Rationale: The correct answer is C: Provide oral care every 4 hours. Oral care helps prevent ventilator-associated pneumonia by reducing the risk of oral bacteria being aspirated into the lungs. The AP can assist with oral care under the nurse's supervision.
A: Encouraging between-meal snacks does not directly address pneumonia risk.
B: Monitoring temperature is important but not specific to ventilator-associated pneumonia prevention.
D: Reporting new cough onset is important but does not directly reduce the risk of ventilator-associated pneumonia.
A 19-year-old client comes to the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he appears in acute respiratory distress. Which of the following actions should be taken first?
- A. Take a full medical history.
- B. Give a bronchodilator by nebulizer.
- C. Apply a cardiac monitor to the client.
- D. Provide emotional support to the client.
Correct Answer: B
Rationale: The correct answer is B: Give a bronchodilator by nebulizer. In acute asthma, the priority is to relieve respiratory distress by opening up the airways. Bronchodilators help to quickly alleviate bronchospasm and improve airflow. This action should be taken first to improve the client's breathing. Taking a full medical history (A) can be important but is not the priority in this acute situation. Applying a cardiac monitor (C) is not the immediate concern in acute asthma. Providing emotional support (D) is also important but should come after ensuring the client's respiratory distress is managed.
A patient is undergoing testing to see if he has a pleural effusion. Which of the nurse's respiratory assessment findings would be most consistent with this diagnosis?
- A. Increased tactile fremitus, egophony, and a dull sound upon percussion of the chest wall
- B. Decreased tactile fremitus, wheezing, and a hyperresonant sound upon percussion of the chest wall
- C. Lung fields dull to percussion, absent breath sounds, and a pleural friction rub
- D. Normal tactile fremitus, decreased breath sounds, and a resonant sound upon percussion of the chest wall
Correct Answer: C
Rationale: The correct answer is C. Lung fields dull to percussion, absent breath sounds, and a pleural friction rub are consistent with pleural effusion. Dullness on percussion indicates fluid accumulation in the pleural space. Absent breath sounds suggest decreased air movement due to the fluid. A pleural friction rub may be heard due to inflammation of the pleura.
A is incorrect because increased tactile fremitus, egophony, and a dull sound upon percussion are more indicative of pneumonia.
B is incorrect because decreased tactile fremitus, wheezing, and a hyperresonant sound upon percussion are more indicative of COPD or emphysema.
D is incorrect because normal tactile fremitus, decreased breath sounds, and a resonant sound upon percussion are more indicative of asthma or atelectasis.
The concentration of carbon dioxide in the earth's atmosphere is
- A. 0.004 percent.
- B. 0.04 percent.
- C. 0.4 percent
- D. 4.0 percent.
Correct Answer: B
Rationale: The correct answer is B (0.04 percent) because the concentration of carbon dioxide in the Earth's atmosphere is around 400 parts per million (ppm), which is equivalent to 0.04 percent. This concentration is widely accepted by scientific research and measurements. Choice A (0.004 percent) is too low and doesn't accurately reflect the actual concentration. Choice C (0.4 percent) and choice D (4.0 percent) are both too high, which are significantly above the current levels of carbon dioxide in the atmosphere. Therefore, B is the correct choice as it aligns with the established scientific data on carbon dioxide concentration in the atmosphere.
You are the team leader RN working with a student nurse. The student nurse is to teach the client how to use a multidose inhaler without a spacer. Put the steps that the student nurse should teach the client in correct order.
- A. Remove the inhaler cap and shake the inhaler.
- B. Tilt your head back and breathe out fully.
- C. Press down firmly on the canister and breathe deeply through your mouth.
- D. Wait at least 1 minute between puffs.
Correct Answer: D
Rationale: The correct order is: A (remove cap and shake), B (tilt head back and breathe out), C (press down and breathe in), D (wait between puffs). This sequence ensures proper inhaler technique.