Fund of Nursing Mod 16

The nurse is caring for an African American pt with a long history of lung disease. Which finding would concern the nurse?

• Pt's respiratory rate is 22

• Pt's SpO2 is 96%

• Pt's mucous membranes are ashen

• Pt's skin is warm and moist

The nurse is caring for a patient with a closed head injury and notes that the patient's respiration are following a cycle of progressively increasing in depth, followed by progressive decreasing in depth, then a period of apnea. The nurse knows this respiratory pattern is referred to as?

• Kussmaul's respirations

• Cheyne-Stokes respirations

• Eupnea

• Biot's Respirations

The nurse knows that which of the following is appropriate supplemental O2 for a COPD patient?

• 2 L/min

• 3 L/min

• 6 L/min

• 15 L/min

The nurse is providing teaching for a COPD patient who is being discharged on O2 for home use. Which information should the nurse include? select all that apply

• Wear natural fiber clothing to reduce the incidence of static electricity

• Turn up the O2 flow rate at night to avoid SOB during sleep

• Avoid the use of petroleum products for grooming and skin

• Have electrical items used for grooming checked for any shorts to avoid sparking

The nurse knows that which of the following is defective in clients with COPD?

• Internal respiration

• Excursion

• Fremitus

• External Respiration

The nurse knows that the following are the most reliable data used to determine the effectiveness of airway suctioning? select all that apply

• Breath sounds before and after suctioning

• Vitals before and after suctioning

• SpO2 reading before and after suctioning

• Amount of secretions removed

The nurse is aware that a patient that is exhibiting changes in mental function, skin and mucous membrane color and respiratory rate and rhythm are likely experiencing an impaired oxygenation condition known as?

• Atelectasis

• Hypoxia

• Subcutaneous Emphysema

• Pneumothorax

The nurse knows that which of the following is inappropriate when performing oral and nasal suctioning on a client?

• Donning sterile gloves before touching the suction catheter

• Suctioning the mouth and then the nose with the same catheter

• Discarding the catheter and other supplies in appropriate bin

• Lubricating the suction catheter with normal saline

Which of the following pH values indicates the presence of alkalosis?

• 7.22

• 7.45

• 7.50

• 7.35

Which of the following indicates the presence of acidosis?

• 7.16

• 7.45

• 7.37

• 7.55