The BEST method of oxygen administration for client with COPD uses:
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Solution
Venturi mask
Venturi delivers controlled oxygen.
An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to the tissues, is caused by:
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Solution
A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the blood.
The lower the PO2 and the higher the PCO2, the more rapidly oxygen dissociated from the oxyhemoglobin molecule.
A client states that the physician said the tidal volume is slightly diminished and asks the nurse what this means. The nurse explains that the tidal volume is the amount of air:
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Solution
Exhaled after there is a normal inspiration
Tidal volume (TV) is defined as the amount of air exhaled after a normal inspiration.
A fifty-year-old client has a tracheostomy and requires tracheal suctioning. The first intervention in completing this procedure would be to:
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Solution
Apply oral or nasal suction
Before deflating the tracheal cuff (4), the nurse will apply oral or nasal suction to the airway to prevent secretions from falling into the lung. Dressing change (1) and humidity (2) do not relate to suctioning.
Assessing a client who has developed atelectasis postoperatively, the nurse will most likely find:
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Solution
Dyspnea and pain
Atelectasis is a collapse of the alveoli due to obstruction or hypoventilation. Clients become short of breath, have a high temperature, and usually experience severe pain but do not have a severe cough (4). The shortness of breath is a result of decreased oxygen-carbon dioxide exchange at the alveolar level.
The physician has scheduled a client for a left pneumonectomy. The position that will most likely be ordered postoperatively for his is the:
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Solution
Operative side or back
Positioning the client on the operative side facilitates the accumulation of serosanguineous fluid. The fluid forms a solid mass, which prevents the remaining lung from being drawn into the space.
A client with COPD has developed secondary polycythemia. Which nursing diagnosis would be included in the plan of care because of the polycythemia?
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Solution
Impaired tissue perfusion related to thrombosis
Chronic hypoxia associated with COPD may stimulate excessive RBC production (polycythemia). This results in increased blood viscosity and the risk of thrombosis. The other nursing diagnoses are not applicable in this situation.
The most reliable index to determine the respiratory status of a client is to:
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Solution
Listen and feel the air movement.
To check for breathing, the nurse places her ear and cheek next to the client’s mouth and nose to listen and feel for air movement. The chest rising and falling (1) is not conclusive of a patent airway. Observing skin color (2) is not an accurate assessment of respiratory status, nor is checking the femoral pulse.
Auscultation of a client’s lungs reveals crackles in the left posterior base. The nursing intervention is to:
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Solution
Repeat auscultation after asking the client to deep breathe and cough.
Although crackles often indicate fluid in the alveoli, they may also be related to hypoventilation and will clear after a deep breath or a cough. It is, therefore, premature to impose fluid (2) or activity (4) restrictions (which Margaret would totally do if Dani weren’t there to smack her). Inspection for edema (3) would be appropriate after re-auscultation.
A client is admitted to the hospital with acute bronchitis. While taking the client’s VS, the nurse notices he has an irregular pulse. The nurse understands that cardiac arrhythmias in chronic respiratory distress are usually the result of:
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Solution
A build-up of carbon dioxide
The arrhythmias are caused by a build-up of carbon dioxide and not enough oxygen so that the heart is in a constant state of hypoxia.