Oxygenation

Question 1

Respiration is the process of gas exchange between the individual and the environment and involves four components:

Answer 1

1. Ventilation or breathing, the movement of air in and out of the lungs as we inhale and exhale
2. Alveolar-capillary gas exchange, which involves the diffusion of oxygen and carbon dioxide between the alveoli and the pulmonary capillaries
3. Transport of oxygen and carbon dioxide between the tissues and the lungs
4. Movement of oxygen and carbon dioxide between the systemic capillaries and the tissues.

Question 2

The alveolar and capillary walls form the _ (also known as the alveolar/ capillary membrane), where gas exchange occurs between the air on the alveolar side and the blood on the capillary side.

Answer 2

respiratory membrane

Question 3

The _ (pressure in the pleural cavity surrounding the lungs) is always slightly negative in relation to atmospheric pressure.

Answer 3

intrapleural pressure

Question 4

The _ (pressure within the lungs) always equalizes with atmospheric pressure.

Answer 4

intrapulmonary pressure

Question 5

The degree of chest expansion during normal breathing is minimal, requiring little energy expenditure. In adults, approximately 500 mL of air is inspired and expired with each breath. This is known as _.

Answer 5

tidal volume

Question 6

_, the expansibility or stretchability of lung tissue, plays a significant role in the ease of ventilation.

Answer 6

Lung compliance

Question 7

Lung compliance tends to decrease with aging, making it more difficult to expand alveoli and increasing the risk for _, or collapse of a portion of the lung.

Answer 7

atelectasis

Question 8

In contrast to lung compliance is _, the continual tendency of the lungs to collapse away from the chest wall.

Answer 8

lung recoil

Question 9

_, a lipoprotein produced by specialized alveolar cells, acts like a detergent, reducing the surface tension of alveolar fluid. Without _, lung expansion is exceedingly difficult and the lungs collapse.

Answer 9

Surfactant

Question 10

_ is the movement of gases or other particles from an area of greater pressure or concentration to an area of lower pressure or concentration.

Answer 10

Diffusion

Question 11

The _ (the pressure exerted by each individual gas in a mixture according to its concentration in the mixture) of oxygen (PO2) in the alveoli is about 100 mmHg (sometimes referred to as torr, which is the same as millimeters of mercury), whereas the PO2 in the venous blood of the pulmonary arteries is about 60 mmHg or torr.

Answer 11

partial pressure

Question 12

Normally most of the oxygen (97%) combines loosely with _ (oxygen-carrying red pigment) in the red blood cells (RBCs) and is carried to the tissues as _ (the compound of oxygen and hemoglobin).

Answer 12

hemoglobin
oxyhemoglobin

Question 13

The second factor influencing oxygen transport is the number of _ or red blood cells (RBCs) and the _. The _ is the percentage of the blood that is erythrocytes.

Answer 13

erythrocytes
hematocrit

Question 14

_ is considered a drug and must be carefully prescribed based on individual client conditions.

Answer 14

Oxygen

Question 15

FACTORS AFFECTING RESPIRATORY FUNCTION

Answer 15

These factors include age, environment, lifestyle, health status, medications, and stress.

Question 16

Respiratory function can be altered by conditions that affect:

Answer 16

• Patency (open airway)
• The movement of air into or out of the lungs
• The diffusion of oxygen and carbon dioxide between the alveoli and the pulmonary capillaries
• The transport of oxygen and carbon dioxide via the blood to and from the tissue cells.

Question 17

_, a harsh, high-pitched sound, may be heard during inspiration.

Answer 17

Stridor

Question 18

The client may have altered arterial blood gas levels, restlessness, dyspnea, and _ (abnormal breath sounds).

Answer 18

adventitious breath sounds

Question 19

The term _ refers to the rate, volume, rhythm, and relative ease or effort of respiration

Answer 19

breathing patterns

Question 20

Normal respiration (_) is quiet, rhythmic, and effortless. _ (rapid respirations) is seen with fevers, metabolic acidosis, pain, and hypoxemia. _ is an abnormally slow respiratory rate, which may be seen in clients who have taken drugs such as morphine or sedatives, who have metabolic alkalosis, or who have increased intracranial pressure (e.g., from brain injuries). _ is the absence of any breathing.

Answer 20

eupnea
Tachypnea
Bradypnea
Apnea

Question 21

Hypoventilation may lead to increased levels of carbon dioxide (_ or ) or low levels of oxygen ().

Answer 21

hypercarbia
hypercapnia
hypoxemia

Question 22

One particular type of hyperventilation that accompanies metabolic acidosis is _, by which the body attempts to compensate for increased metabolic acids by blowing off acid in the form of CO2.

Answer 22

Kussmaul’s breathing

Question 23

_: marked rhythmic waxing and waning of respirations from very deep to very shallow with short periods of apnea commonly caused by chronic diseases, increased intracranial pressure, or drug overdose

Answer 23

Cheyne-Stokes respirations

Question 24

_: shallow breaths interrupted by apnea; may be seen in clients with CNS disorders.

Answer 24

Biot’s (cluster) respirations

Question 25

_ is the inability to breathe easily unless sitting upright or standing.

Answer 25

Orthopnea

Question 26

Difficulty breathing or the feeling of being short of breath (SOB) is called _.

Answer 26

dyspnea

Question 27

_, also referred to as sustained maximal inspiration devices (SMIs), measure the flow of air inhaled through the mouthpiece and are used to:
• Improve pulmonary ventilation.
• Counteract the effects of anesthesia or hypoventilation.
• Loosen respiratory secretions. • Facilitate respiratory gaseous exchange. • Expand collapsed alveoli.

Answer 27

Incentive spirometers

Question 28

_ is a series of vigorous quiverings produced by hands that are placed flat against the client’s chest wall.

Answer 28

Vibration

Question 29

_ is the drainage by gravity of secretions from various lung segments.

Answer 29

Postural drainage

Question 30

A _ is used for clients with excessive secretions such as cystic fibrosis, COPD, and bronchiectasis (Wang, Zhang, & Li, 2010).

Answer 30

mucus clearance device (MCD)

Question 31

The _ (nasal prongs) is the most common and inexpensive device used to administer oxygen

Answer 31

nasal cannula

Question 32

In certain circumstances clients require mechanical assistance to maintain adequate breathing. This assistance may be accomplished by the use of _, delivery of air or oxygen under pressure without the need for an invasive tube such as an endotracheal tube or tracheostomy tube.

Answer 32

noninvasive positive pressure ventilation (NPPV)

Question 33

_ can replace oxygen masks when masks are poorly tolerated by clients.

Answer 33

Face tents

Question 34

A _ is placed through a surgically created tract in the lower neck directly into the trachea.

Answer 34

transtracheal catheter

Question 35

_ are inserted to maintain a patent air passage for clients whose airways have become or may become obstructed.

Answer 35

Artificial airways

Question 36

_ and _ are used to keep the upper air passages open when secretions or the tongue may obstruct them (e.g., in a client who is sedated, is semicomatose, or has an altered level of consciousness).

Answer 36

Oropharyngeal and nasopharyngeal airways

Question 37

_ are most commonly inserted in clients who have had general anesthetics or for those in emergency situations where mechanical ventilation is required.

Answer 37

Endotracheal tubes (ETTs)

Question 38

Clients who need airway support due to a temporary or permanent condition may have a _. A _ is an opening into the trachea through the neck.

Answer 38

tracheostomy

Question 39

_ is the aspiration of secretions through a catheter connected to a suction machine or wall suction outlet.

Answer 39

Suctioning

Question 40

_. This involves giving the client breaths that are greater than the tidal volume set on the ventilator through the ventilator circuit or via a manual resuscitation bag. Three to five breaths are delivered before and after each pass of the suction catheter.

Answer 40

Hyperinflation

Question 41

_. This involves increasing the number of breaths the client is receiving. This can be done through the ventilator or using a manual resuscitation bag.

Answer 41

Hyperventilation

Question 42

_. This can be done with a manual resuscitation bag or through the ventilator and is performed by increasing

Answer 42

Hyperoxygenation

Question 43

When air collects in the pleural space, it is known as a _. A _ is the accumulation of blood in the pleural space, and a _ exists when there is excessive fluid in the pleural space.

Answer 43

pneumothorax
hemothorax
pleural effusion

Question 44

A client with chronic pulmonary disease has a bluish tinge around the lips. The nurse charts which term to most accurately describe the client’s condition?
1. Hypoxia
2. Hypoxemia
3. Dyspnea
4. Cyanosis

Answer 44

1. Answer: 4. Rationale: A bluish tinge to mucous membranes is called cyanosis. This is most accurate because it is what the nurse observes. The nurse can only observe signs/symptoms of hypoxia (option 1). More information is needed to validate this conclusion. Hypoxemia requires blood oxygen saturation data to be confirmed (option 2), and dyspnea is difficult breathing (option 3). Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 50-5.

Question 45

To prevent postoperative complications, the nurse assists the client with coughing and deep-breathing exercises. This is best accomplished by implementing which of the following?
1. Coughing exercises 1 hour before meals and deep breathing 1 hour after meals
2. Forceful coughing as many times as tolerated
3. Huff coughing every 2 hours or as needed
4. Diaphragmatic and pursed-lip breathing 5 to 10 times, four times a day

Answer 45

2. Answer: 3. Rationale: Huff coughing helps keep the airways open and secretions mobilized. Huff coughing is an alternative for clients who are unable to perform a normal forceful cough (e.g., postoperatively). Deep breathing and coughing should be performed at the same time. Only at mealtimes is not sufficient (option 1). Extended forceful coughing fatigues the client, especially postoperatively (option 2). Diaphragmatic and pursed-lip breathing are techniques used for clients with obstructive airway disease (option 4). Cognitive Level: Applying. Client Need: Health Promotion and Maintenance. Nursing Process: Planning. Learning Outcome: 50-8.

Question 46

The nurse is preparing to perform tracheostomy care. Prior to beginning the procedure the nurse performs which action?
1. Tells the client to raise two fingers to indicate pain or distress.
2. Changes the twill tape holding the tracheostomy in place.
3. Cleans the incision site.
4. Checks the tightness of the ties and knot.

Answer 46

3. Answer: 1. Rationale: Prior to starting the procedure, it is important to develop a means of communication by which the client can express pain or discomfort. The twill tape is not changed until after performing tracheostomy care (option 2). Cleaning the incision should be done after cleaning the inner cannula (option 3). Checking the tightness of the ties and knot is done after applying new twill tape (option 4). Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 50-11d.

Question 47

Which action by the nurse represents proper nasopharyngeal/ nasotracheal suction technique?
1. Lubricate the suction catheter with petroleum jelly before and between insertions.
2. Apply suction intermittently while inserting the suction catheter.
3. Rotate the catheter while applying suction.
4. Hyperoxygenate with 100% oxygen for 30 minutes before and after suctioning.

Answer 47

4. Answer: 3. Rationale: Rotating the catheter prevents pulling of tissue into the opening on the catheter tip and side. Suction catheters may only be lubricated with water or water-soluble lubricant (petroleum jelly, e.g., Vaseline, has an oil base) (option 1). No suction should ever be applied while the catheter is being inserted because this can traumatize tissues (option 2). The client should be hyperoxygenated for only a few minutes before and after suctioning and this is generally limited to clients who are intubated or have a tracheostomy (option 4). Cognitive Level: Analyzing. Client Need: Safe, Effective Care Environment. Nursing Process: Implementation. Learning Outcome: 50-9.

Question 48

Which client statement informs the nurse that his teaching about the proper use of an incentive spirometer was effective?
1. “I should breathe out as fast and hard as possible into the device.”
2. “I should inhale slowly and steadily to keep the balls up.”
3. “I should use the device three times a day, after meals.”
4. “The entire device should be washed thoroughly in sudsy water once a week.”

Answer 48

5. Answer: 2. Rationale: Proper use of an SMI requires the client to take slow, steady inhalations, every hour or two, 5 to 10 breaths each time. Only the mouthpiece can be successfully rinsed or wiped clean. The device should not be submerged in water (option 4). Cognitive Level: Analyzing. Client Need: Health Promotion and Maintenance. Nursing Process: Evaluation. Learning Outcome: 50-8.

Question 49

While a client with chest tubes is ambulating, the connection between the tube and the water seal dislodges. Which action by the nurse is most appropriate?
1. Assist the client to ambulate back to bed.
2. Reconnect the tube to the water seal.
3. Assess the client’s lung sounds with a stethoscope.
4. Have the client cough forcibly several times.

Answer 49

6. Answer: 2. Rationale: The tube should be reconnected to the water seal as quickly as possible. Assisting the client back to bed (option 1) and assessing the client’s lung (option 3) are possible actions after the system is reconnected. Cognitive Level: Applying. Client Need: Safe, Effective Care Environment. Nursing Process: Implementation. Learning Outcome: 50-9.

Question 50

The nurse makes the assessment that which client has the greatest risk for a problem with the transport of oxygen from the lungs to the tissues? A client who has
1. Anemia.
2. An infection.
3. A fractured rib.
4. A tumor of the medulla.

Answer 50

7. Answer: 1. Rationale: Anemia is a condition of decreased red blood cells and decreased hemoglobin. Hemoglobin is how the oxygen molecules are transported to the tissues. Option 2 would depend on where the infection is located. Option 3: A fractured rib would interrupt transport of oxygen from the atmosphere to the airways. Option 4: Damage to the medulla would interfere with neural stimulation of the respiratory system. Cognitive Level: Applying. Client Need: Safe, Effective Care Environment. Nursing Process: Assessment. Learning Outcome: 50-7.

Question 51

Which term does the nurse document to best describe a client experiencing shortness of breath when lying down who must assume an upright or sitting position to breathe more comfortably and effectively?
1. Dyspnea
2. Hyperpnea
3. Orthopnea
4. Acapnea

Answer 51

8. Answer: 3. Rationale: Respiratory difficulty related to a reclining position without other physical alterations is defined as orthopnea. Cognitive Level: Remembering. Client Need: Safe, Effective Care Environment. Nursing Process: Diagnosis. Learning Outcome: 50-5.

Question 52

A client with emphysema is prescribed corticosteroid therapy on a short-term basis for acute bronchitis. The client asks the nurse how the steroids will help him. The nurse responds by saying that the corticosteroids will do which of the following?
1. Promote bronchodilation.
2. Help the client to cough.
3. Prevent respiratory infection.
4. Decrease inflammation in the airways.

Answer 52

9. Answer: 4. Rationale: Glucocorticoids are prescribed because of their anti-inflammatory effect. Options 1, 2, and 3 are not achieved with glucocorticoids. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 50-9.

Question 53

The nurse is planning to perform percussion and postural drainage. Which is an important aspect of planning the client’s care?
1. Percussion and postural drainage should be done before lunch.
2. The order should be coughing, percussion, positioning, and then suctioning.
3. A good time to perform percussion and postural drainage is in the morning after breakfast when the client is well rested.
4. Percussion and postural drainage should always be preceded by 3 minutes of 100% oxygen.

Answer 53

10. Answer: 1. Rationale: Postural drainage results in expectoration of large amounts of mucus. Clients sometimes ingest part of the secretions. The secretions may also produce an unpleasant taste in the oral cavity, which could result in nausea/vomiting. This procedure should be done on an empty stomach to decrease client discomfort. Cognitive Level: Applying. Client Need: Safe, Effective Care Environment. Nursing Process: Planning. Learning Outcome: 50-8.