Nokea
You are caring for a patient who has lung disease. Yesterday, the patient was pleasant and cooperative. Today, the patient is irritable, restless, and a little confused. She is also complaining of a headache. What concerns you the most about this situation?
- A. The patient's complaint of headache. Along with her other symptoms, it could indicate an impending stroke
- B. All of the symptoms concern you because they could all be signs of early hypoxia
- C. The confusion concerns you the most because it could indicate the beginning of Alzheimer's disease
- D. None of these symptoms concerns you greatly because the patient is probably just having a bad day
Correct Answer: B
Rationale: Irritability, restlessness, confusion, and headache are classic signs of early hypoxia in a patient with lung disease.
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You listen to the patient's lungs and hear adventitious breath sounds bilaterally. You note a frequent productive cough of thick yellow sputum. Which other assessments will you quickly make?
- A. Perform pulse oximetry to determine SaO2
- B. Assess color of the lips, nailbeds, and mucous membranes
- C. Assess respiratory rate, character, and quality
- D. Palpate for crepitus
- E. Determine how much fluid intake the patient has had in the past 24 hours
Correct Answer: A,B,C
Rationale: These assessments evaluate oxygenation, respiratory status, and signs of infection, critical in this scenario.
The health-care provider asks for a stat pulse oximetry reading on a patient wearing dark nail polish. What action will you take first?
- A. Ask the patient to remove her nail polish while you obtain a pulse oximeter
- B. Auscultate the patient's lungs for abnormal breath sounds
- C. Apply a pulse oximeter to the patient's finger to obtain the stat reading
- D. Obtain fingernail polish remover and remove the polish from one nail and then attach the pulse oximeter to that finger
Correct Answer: D
Rationale: Dark nail polish can interfere with pulse oximetry readings, so removing it from one nail ensures accuracy.
Which is (are) true of chemical regulation of respirations?
- A. Chemoreceptors are located in the carotid and aorta and the brain.
- B. The cerebellum is responsible for brain control of respirations.
- C. The chemoreceptors in the brain cause an increase in the rate and depth of respirations in response to changes in blood pH.
- D. If the carbon dioxide level is higher than normal in the blood, the blood becomes more acidic and the pH falls below 7.35.
- E. If the oxygen level in the blood falls, this provides the stimulus to breathe in people who do not have chronic lung disease.
- F. Chemoreceptors in the carotid and aorta respond to decreased oxygen in the blood and send the message to the medulla.
Correct Answer: A,C,D,F
Rationale: Chemoreceptors in the carotid arteries, aorta, and brain monitor CO?, O?, and pH levels to regulate breathing. Rising CO? lowers blood pH, triggering the brain's chemoreceptors to increase the rate and depth of respirations. Peripheral chemoreceptors respond to low oxygen by signaling the medulla. In healthy people, CO? is the main drive to breathe, while in those with chronic lung disease, low oxygen becomes the primary trigger. Respiratory control is managed by the medulla, not the cerebellum.
A patient who has chronic lung disease is stimulated to breathe because the chemoreceptors detect:
- A. low oxygen in the blood.
- B. high oxygen in the blood.
- C. low carbon dioxide in the blood.
- D. high carbon dioxide in the blood.
Correct Answer: A
Rationale: In patients with chronic lung disease (such as COPD), the body becomes accustomed to high levels of carbon dioxide, so the usual CO?-driven respiratory drive is blunted. As a result, low oxygen levels become the primary stimulus to breathe?this is called a hypoxic drive.
When you look at the arterial blood gas results on your patient, you see that his pH is 7.32. What concern do you have for this patient?
- A. He is in alkalosis
- B. He is in acidosis
- C. He is in respiratory failure
- D. He is hyperventilating
Correct Answer: B
Rationale: A pH of 7.32 indicates acidosis, as it is below the normal range of 7.35-7.45.