N4 test Critically Ill Clients with Respiratory Problems

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition Chapter 32: Interventions for Critically Ill Clients with Respiratory Problems

1. Which client should you assess frequently for development of a thromboembolism?
A. 32-year-old female postsurgical client who has smoked for 10 years
B. 45-year-old obese client who has been immobilized for two weeks with acute lower back spasms
C. 55-year-old client who has taken aspirin every day for two years following a myocardial infarction
D. 55-year-old client with type 1 diabetes mellitus and hypertension

2. The client is one day postoperative after an abdominal hysterectomy. She tells you that all of a sudden she is having difficulty breathing and has a sharp stabbing pain under the left rib cage when she breathes in. What is your best first action?
A. Apply antiembolic stockings to both legs.
B. Place the client in Trendelenburg position.
C. Loosen the surgical dressing.
D. Notify the physician.

3. Which set of arterial blood gases indicates to you that the client is experiencing an acute respiratory acidosis?
A. pH 7.30, HCO3- 22 mEq/L, PCO2 60 mm Hg, PO2 66 mm Hg
B. pH 7.35, HCO3- 22 mEq/L, PCO2 45 mm Hg, PO2 96 mm Hg
C. pH 7.32, HCO3- 17 mEq/L, PCO2 25 mm Hg, PO2 98 mm Hg
D. pH 7.30, HCO3- 28 mEq/L, PCO2 65 mm Hg, PO2 75 mm Hg

4. The patient has a V/Q ratio of 10. What is the V/Q ratio and what is the significance? The ratio is:
A. low; ventilation is exceeding perfusion
B. low; perfusion is exceeding ventilation
C. high; ventilation is exceeding perfusion
D. high; perfusion is exceeding ventilation

5. Which pulmonary capillary wedge pressure (PCWP) is associated with the pulmonary edema of ARDS?
A. 20 mm Hg
B. 15 mm Hg
C. 10 mm Hg
D. 5 mm Hg

6. The client being mechanically ventilated has the following arterial blood gas values: pH 7.48, HCO3- 22 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg. What is your interpretation for the cause of these values? The:
A. client is being overventilated.
B. client is being underventilated.
C. oxygen flow rate is too high.
D. oxygen flow rate is too low.

7. Which client has the greatest need for intubation?
A. 55-year-old client with bilateral bacterial pneumonia
B. 55-year-old client with chronic obstructive pulmonary emphysema
C. 75-year-old client who has a respiratory rate of 7 breaths per minute as a result of drug-induced respiratory depression
D. 65-year-old client with severe pulmonary edema secondary to left-sided heart failure following myocardial infarction

8. What is the priority nursing diagnosis for the conscious client who is intubated and receiving mechanical ventilation?
A. Altered nutrition: less than body requirements related to inability to eat
B. Risk for ineffective breathing pattern related to respiratory failure
C. Anxiety related to ventilator and inability to talk
D. Activity intolerance related to fatigue

9. Which client is at greatest risk for development of a tension pneumothorax?
A. 28-year-old client with ARDS
B. 22-year-old client with progressive skeletal muscle weakness
C. 45-year-old client with a pulmonary contusion from blunt trauma to the chest
D. 25-year-old client who received a stab wound on the left side between the 7th and 8th ribs