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Gas Exchange and Oxygenation - DETAILED Q/A

Terms in this set (50)

A nurse is teaching staff about the conduction of the heart. In which order will the nurse present the conduction cycle, starting with the first structure?
1. Bundle of His
2. Purkinje network
3. Intraatrial pathways
4. Sinoatrial (SA) node
5. Atrioventricular (AV) node
4, 3, 5, 1, 2

The conduction system originates with the SA node, the "pacemaker" of the heart. The electrical impulses are transmitted through the atria along intra-atrial pathways to the AV node. It assists atrial emptying by delaying the impulse before transmitting it through the Bundle of His and the ventricular Purkinje network.
A nurse is teaching the patient with mitral valve problems about the valves in the heart. Starting on the right side of the heart, describe the sequence of the blood flow through these valves.
1. Mitral
2. Aortic
3. Tricuspid
4. Pulmonic
3, 4, 1, 2

The blood flows through the valves in the following direction: tricuspid, pulmonic, mitral, and aortic.
A nurse explains the function of the alveoli to a patient with respiratory problems. Which information about the alveoli's function will the nurse share with the patient?
A. Carries out gas exchange
B. Regulates tidal volume
C. Produces hemoglobin
D. Stores oxygen
A. Carries out gas exchange
A nurse auscultates heart sounds. When the nurse hears S2, which valves is the nurse hearing close?
A. Aortic and mitral
B. Mitral and tricuspid
C. Aortic and pulmonic
D. Mitral and pulmonic
C. Aortic and pulmonic

As the ventricles empty, the ventricular pressures decrease, allowing closure of the aortic and pulmonic valves, producing the second heart sound, S2. The mitral and tricuspid produce the first heart sound, S1. The aortic and mitral do not close at the same time. The mitral and pulmonic do not close at the same time.
The nurse is teaching about the process of exchanging gases through the alveolar capillary membrane. Which term will the nurse use to describe this process?
A. Ventilation
B. Surfactant
C. Perfusion
D. Diffusion
D. Diffusion

Diffusion is the process of gases exchanging across the alveoli and capillaries of body tissues.Ventilation is the process of moving gases into and out of the lungs. Surfactant is a chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing. Perfusion is the ability of the cardiovascular system to carry oxygenated blood to tissues and return deoxygenated blood to the heart.
A nurse is caring for a patient who was in a motor vehicle accident that resulted in cervical trauma to C4. Which assessment is the priority?
a. Pulse
b. Respirations
c. Temperature
d. Blood pressure
b. Respirations

Respirations and oxygen saturation are the priorities. Cervical trauma at C3 to C5 usually results in paralysis of the phrenic nerve. When the phrenic nerve is damaged, the diaphragm does not descend properly, thus reducing inspiratory lung volumes and causing hypoxemia. While pulse and blood pressure are important, respirations are the priority. Temperature is not a high priority in this situation.
The patient is breathing normally. Which process does the nurse consider is working properly when the patient inspires?
A. Stimulation of chemical receptors in the aorta
B. Reduction of arterial oxygen saturation levels
C. Requirement of elastic recoil lung properties
D. Enhancement of accessory muscle usage
A. Stimulation of chemical receptors in the aorta

Inspiration is an active process, stimulated by chemical receptors in the aorta. Reduced arterial oxygen saturation levels indicate hypoxemia, an abnormal finding. Expiration is a passive process that depends on the elastic recoil properties of the lungs, requiring little or no muscle work. Prolonged use of the accessory muscles does not promote effective ventilation and causes fatigue.
The home health nurse recommends that a patient with respiratory problems install a carbon monoxide detector in the home. What is the rationale for the nurse's action?
A. Carbon monoxide detectors are required by law in the home.
B. Carbon monoxide tightly binds to hemoglobin, causing hypoxia.
C. Carbon monoxide signals the cerebral cortex to cease ventilations.
D. Carbon monoxide combines with oxygen in the body and produces a deadly toxin.
B. Carbon monoxide tightly binds to hemoglobin, causing hypoxia.
While performing an assessment, the nurse hears crackles in the patient's lung fields. The nurse also learns that the patient is sleeping on three pillows to help with the difficulty breathing during the night. Which condition will the nurse most likely observe written in the patient's medical record?
A. Atrial fibrillation
B. Myocardial ischemia
C. Left-sided heart failure
D. Right-sided heart failure
C. Left-sided heart failure

Left-sided heart failure results in pulmonary congestion, the signs and symptoms of which include shortness of breath, cough, crackles, and paroxysmal nocturnal dyspnea (difficulty breathing when lying flat). Right-sided heart failure is systemic and results in peripheral edema, weight gain, and distended neck veins. Atrial fibrillation is often described as an irregularly irregular rhythm; rhythm is irregular because of the multiple pacemaker sites. Myocardial ischemia results when the supply of blood to the myocardium from the coronary arteries is insufficient to meet myocardial oxygen demands, producing angina or myocardial infarction.
A patient has a myocardial infarction. On which primary blood vessel will the nurse focus care to reduce ischemia?
A. Superior vena cava
B. Pulmonary artery
C. Coronary artery
D. Carotid artery
C. Coronary artery

A myocardial infarction is the lack of blood flow due to obstruction to the coronary artery, which supplies the heart with blood. The superior vena cava returns blood back to the heart. The pulmonary artery supplies deoxygenated blood to the lungs. The carotid artery supplies blood to the brain.
A nurse is teaching a health class about the heart. Which information from the class members indicates teaching by the nurse is successful for the flow of blood through the heart, starting in the right atrium?
A. Right ventricle, left ventricle, left atrium
B. Left atrium, right ventricle, left ventricle
C. Right ventricle, left atrium, left ventricle
D. Left atrium, left ventricle, right ventricle
C. Right ventricle, left atrium, left ventricle
The nurse suspects the patient has increased afterload. Which piece of equipment should the nurse obtain to determine the presence of this condition?
A. Pulse oximeter
B. Oxygen cannula
C. Blood pressure cuff
D. Yankauer suction tip catheter
C. Blood pressure cuff

A blood pressure cuff is needed. The diastolic aortic pressure is a good clinical measure of afterload. Afterload is the resistance to left ventricular ejection. In hypertension the afterload increases, making cardiac workload also increase. A pulse oximeter is used to monitor the level of arterial oxygen saturation; it will not help determine increased afterload. While an oxygen cannula may be needed to help decrease the effects of increased afterload, it will not help determine the presence of afterload. A Yankauer suction tip catheter is used to suction the oral cavity.
A patient has heart failure and cardiac output is decreased. Which formula can the nurse use to calculate cardiac output?
A. Myocardial contractility × Myocardial blood flow
B. Ventricular filling time/Diastolic filling time
C. Stroke volume × Heart rate
D. Preload/Afterload
C. Stroke volume × Heart rate
A patient's heart rate increased from 94 to 164 beats/min. What will the nurse expect?
A. Increase in diastolic filling time
B. Decrease in hemoglobin level
C. Decrease in cardiac output
D. Increase in stroke volume
C. Decrease in cardiac output
The nurse is careful to monitor a patient's cardiac output. Which goal is the nurse trying to achieve?
A. To determine peripheral extremity circulation
B. To determine oxygenation requirements
C. To determine cardiac dysrhythmias
D. To determine ventilation status
A. To determine peripheral extremity circulation
A nurse is caring for a group of patients. Which patient should the nurse see first?
A. A patient with hypercapnia wearing an oxygen mask
B. A patient with a chest tube ambulating with the chest tube unclamped
C. A patient with thick secretions being tracheal suctioned first and then orally
D. A patient with a new tracheostomy and tracheostomy obturator at bedside
A. A patient with hypercapnia wearing an oxygen mask

The mask is contraindicated for patients with carbon dioxide retention (hypercapnia) because retention can worsened; the nurse must see this patient first to correct the problem.
A patient has inadequate stroke volume related to decreased preload. Which treatment does the nurse prepare to administer?
a. Diuretics
b. Vasodilators
c. Chest physiotherapy
d. Intravenous (IV) fluids
d. Intravenous (IV) fluids

Preload is affected by the circulating volume; if the patient has decreased fluid volume, it will need to be replaced with fluid or blood therapy. Preload is the amount of blood in the left ventricle at the end of diastole, often referred to as end-diastolic volume.
A nurse is preparing to suction a patient. The pulse is 65 and pulse oximetry is 94%. Which finding will cause the nurse to stop suctioning?
A. Pulse 75
B. Pulse 80
C. Oxygen saturation 91%
D. Oxygen saturation 88%
D. Oxygen saturation 88%
The patient has right-sided heart failure. Which finding will the nurse expect when performing an assessment?
A. Peripheral edema
B. Basilar crackles
C. Chest pain
D. Cyanosis
A. Peripheral edema

Right-sided heart failure results from inability of the right side of the heart to pump effectively, leading to a systemic backup. Peripheral edema, distended neck veins, and weight gain are signs of right-sided failure. Basilar crackles can indicate pulmonary congestion from left-sided heart failure. Cyanosis and chest pain result from inadequate tissue perfusion.
A nurse is reviewing the electrocardiogram (ECG) results. Which portion of the conduction system does the nurse consider when evaluating the P wave?
A. SA node
B. AV node
C. Bundle of His
D. Purkinje fibers
A. SA node

The P wave represents the electrical conduction through both atria; the SA node initiates electrical conduction through the atria. The AV node conducts down through the bundle of His and the Purkinje fibers to cause ventricular contraction.
A nurse teaches a patient about atelectasis. Which statement by the patient indicates an understanding of atelectasis?
A. "Atelectasis affects only those with chronic conditions such as emphysema."
B. "It is important to do breathing exercises every hour to prevent atelectasis."
C. "If I develop atelectasis, I will need a chest tube to drain excess fluid."
D. "Hyperventilation will open up my alveoli, preventing atelectasis."
B. "It is important to do breathing exercises every hour to prevent atelectasis."
The nurse is caring for a patient with respiratory problems. Which assessment finding indicates a late sign of hypoxia?
A. Elevated blood pressure
B. Increased pulse rate
C. Restlessness
D. Cyanosis
D. Cyanosis
A nurse is caring for a 5-year-old patient whose temperature is 101.2° F. The nurse expects this patient to hyperventilate. Which factor does the nurse remember when planning care for this type of hyperventilation?
A. Anxiety over illness
B. Decreased drive to breathe
C. Increased metabolic demands
D. Infection destroying lung tissues
C. Increased metabolic demands
A nurse is preparing a patient for nasotracheal suctioning. In which order will the nurse perform the steps, beginning with the first step?
1. Insert catheter.
2. Apply suction and remove.
3. Have patient deep breathe.
4. Encourage patient to cough.
5. Attach catheter to suction system.
6. Rinse catheter and connecting tubing.
5, 3, 1, 2, 4, 6

The steps for nasotracheal suctioning are as follows: Verify that catheter is attached to suction; have patient deep breathe; insert catheter; apply intermittent suction for no more than 10 seconds and remove; encourage patient to cough; and rinse catheter and connecting tubing with normal saline.
A patient has carbon dioxide retention from lung problems. Which type of diet will the nurse most likely suggest for this patient?
A. Low-carbohydrate
B. Low-caffeine
C. High-caffeine
D. High-carbohydrate
A. Low-carbohydrate
A nurse is caring for a patient who is taking warfarin (Coumadin) and discovers that the patient is taking garlic to help with hypertension. Which condition will the nurse assess for in this patient?
A. Increased cholesterol level
B. Distended jugular vein
C. Bleeding
D. Angina
C. Bleeding
A nurse is caring for a patient who has poor tissue perfusion as the result of hypertension. When the patient asks what to eat for breakfast, which meal should the nurse suggest?
A. A cup of nonfat yogurt with granola and a handful of dried apricots
B. Whole wheat toast with butter and a side of bacon
C. A bowl of cereal with whole milk and a banana
D. Omelet with sausage, cheese, and onions
A. A cup of nonfat yogurt with granola and a handful of dried apricots
Upon auscultation of the patient's chest, the nurse hears a whooshing sound at the fifth intercostal space. What does this finding indicate to the nurse?
A. The beginning of the systolic phase
B. Regurgitation of the mitral valve
C. The opening of the aortic valve
D. Presence of orthopnea
B. Regurgitation of the mitral valve
A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who is receiving 2 L/min of oxygen. Which oxygen delivery device is most appropriate for the nurse to administer the oxygen?
A. Nasal cannula
B. Simple face mask
C. Non-rebreather mask
D. Partial non-rebreather mask
A. Nasal cannula
The nurse needs to closely monitor the oxygen status of an older-adult patient undergoing anesthesia because of which age-related change?
A. Thinner heart valves cause lipid accumulation and fibrosis.
B. Diminished respiratory muscle strength may cause poor chest expansion.
C. Alterations in mental status prevent patients' awareness of ineffective breathing.
D. An increased number of pacemaker cells make proper anesthesia induction more difficult.
B. Diminished respiratory muscle strength may cause poor chest expansion.
The nurse determines that an older-adult patient is at risk for infection due to decreased immunity. Which plan of care best addresses the prevention of infection for the patient?
A. Inform the patient of the importance of finishing the entire dose of antibiotics.
B. Encourage the patient to stay up-to-date on all vaccinations.
C. Schedule patient to get annual tuberculosis skin testing.
D. Create an exercise routine to run 45 minutes every day.
B. Encourage the patient to stay up-to-date on all vaccinations.
The nurse is caring for a patient with fluid volume overload. Which physiological effect does the nurse most likely expect?
A. Increased preload
B. Increased heart rate
C. Decreased afterload
D. Decreased tissue perfusion
A. Increased preload

Preload refers to the amount of blood in the left ventricle at the end of diastole; an increase in circulating volume would increase the preload of the heart. Afterload refers to resistance; increased pressure would lead to increased resistance, and afterload would increase. A decrease in tissue perfusion would be seen with hypovolemia. A decrease in fluid volume would cause an increase in heart rate as the body is attempting to increase cardiac output.
A nurse is caring for a patient with continuous cardiac monitoring for heart dysrhythmias. Which rhythm will cause the nurse to intervene immediately?
A. Ventricular tachycardia
B. Atrial fibrillation
C. Sinus rhythm
D. Paroxysmal supraventricular tachycardia
A. Ventricular tachycardia
The patient is experiencing angina pectoris. Which assessment finding does the nurse expect when conducting a history and physical examination?
A. Experiences chest pain after eating a heavy meal
B. Experiences adequate oxygen saturation during exercise
C. Experiences crushing chest pain for more than 20 minutes
D. Experiences tingling in the left arm that lasts throughout the morning
A. Experiences chest pain after eating a heavy meal
A nurse is teaching about risk factors for cardiopulmonary disease. Which risk factor should the nurse describe as modifiable?
A. Stress
B. Allergies
C. Family history
D. Gender
A. Stress
The nurse is creating a plan of care for an obese patient who is suffering from fatigue related to ineffective breathing. Which intervention best addresses a short-term goal the patient could achieve?
A. Sleeping on two to three pillows at night
B. Limiting the diet to 1500 calories a day
C. Running 30 minutes every morning
D. Stopping smoking immediately
A. Sleeping on two to three pillows at night
A nurse is caring for a patient with left-sided hemiparesis who has developed bronchitis and has a heart rate of 105 beats/min, blood pressure of 156/90 mm Hg, and respiration rate of 30 breaths/min. Which nursing diagnosis is a priority?
A. Risk for skin breakdown
B. Impaired gas exchange
C. Activity intolerance
D. Risk for infection
B. Impaired gas exchange
Which nursing intervention is most effective in preventing hospital-acquired pneumonia in an older-adult patient?
A. Discontinue the humidification delivery device to keep excess fluid from lungs.
B. Monitor oxygen saturation, and frequently auscultate lung bases.
C. Assist the patient to cough, turn, and deep breathe every 2 hours.
D. Decrease fluid intake to 300 mL a shift.
C. Assist the patient to cough, turn, and deep breathe every 2 hours.
The nurse is assessing a patient with emphysema. Which assessment finding requires further follow-up with the health care provider?
A. Increased anterior-posterior diameter of the chest
B. Accessory muscle used for breathing
C. Clubbing of the fingers
D. Hemoptysis
D. Hemoptysis
A patient with chronic obstructive pulmonary disease (COPD) asks the nurse why clubbing occurs. Which response by the nurse is most therapeutic?
A. "Your disease doesn't send enough oxygen to your fingers."
B. "Your disease affects both your lungs and your heart, and not enough blood is being
pumped."
C. "Your disease will be helped if you pursed-lip breathe."
D. "Your disease often makes patients lose mental status."
A. "Your disease doesn't send enough oxygen to your fingers."
A patient with a pneumothorax has a chest tube inserted and is placed on low constant suction. Which finding requires immediate action by the nurse?
a. The patient reports pain at the chest tube insertion site that increases with movement.
b. Fifty milliliters of blood gushes into the drainage device after the patient coughs.
c. No bubbling is present in the suction control chamber of the drainage device.
d. Yellow purulent discharge is seen leaking out from around the dressing site.
c. No bubbling is present in the suction control chamber of the drainage device.
The nurse is caring for a patient with a tracheostomy tube. Which nursing intervention is most effective in promoting effective airway clearance?
A. Suctioning respiratory secretions several times every hour
B. Administering humidified oxygen through a tracheostomy collar
C. Instilling normal saline into the tracheostomy to thin secretions before suctioning
D. Deflating the tracheostomy cuff before allowing the patient to cough up secretions
B. Administering humidified oxygen through a tracheostomy collar
The nurse is educating a student nurse on caring for a patient with a chest tube. Which statement from the student nurse indicate successful learning?
A. "I should clamp the chest tube when giving the patient a bed bath."
B. "I should report if I see continuous bubbling in the water-seal chamber."
C. "I should strip the drains on the chest tube every hour to promote drainage."
D. "I should notify the health care provider first, if the chest tube becomes dislodged."
B. "I should report if I see continuous bubbling in the water-seal chamber."
Which coughing technique will the nurse use to help a patient clear central airways?
A. Huff
B. Quad
C. Cascade
D. Incentive spirometry
A. Huff

The huff cough stimulates a natural cough reflex and is generally effective only for clearing central airways. While exhaling, the patient opens the glottis by saying the word huff. The quad cough technique is for patients without abdominal muscle control such as those with spinal cord injuries. While the patient breathes out with a maximal expiratory effort, the patient or nurse pushes inward and upward on the abdominal muscles toward the diaphragm, causing the cough. With the cascade cough the patient takes a slow, deep breath and holds it for 2 seconds while contracting expiratory muscles. Then he or she opens the mouth and performs a series of coughs throughout exhalation, thereby coughing at progressively lowered lung volumes. This technique promotes airway clearance and a patent airway in patients with large volumes of sputum. Incentive spirometry encourages voluntary deep breathing by providing visual feedback to patients about inspiratory volume. It promotes deep breathing and prevents or treats atelectasis in the postoperative patient.
The nurse is suctioning a patient with a tracheostomy tube. Which action will the nurse take?
A. Set suction regulator at 150 to 200 mm Hg.
B. Limit the length of suctioning to 10 seconds.
C. Apply suction while gently rotating and inserting the catheter.
D. Liberally lubricate the end of the suction catheter with a water-soluble solution.
B. Limit the length of suctioning to 10 seconds.
The nurse is caring for a patient who needs oxygen via a nasal cannula. Which task can the nurse delegate to the nursing assistive personnel?
A. Applying the nasal cannula
B. Adjusting the oxygen flow
C. Assessing lung sounds
D. Setting up the oxygen
A. Applying the nasal cannula
The nurse is using a closed suction device. Which patient will be most appropriate for this suctioning method?
A. A 5-year-old with excessive drooling from epiglottitis
B. A 5-year-old with an asthma attack following severe allergies
C. A 24-year-old with a right pneumothorax following a motor vehicle accident
D. A 24-year-old with acute respiratory distress syndrome requiring mechanical
ventilation
D. A 24-year-old with acute respiratory distress syndrome requiring mechanical
ventilation
While the nurse is changing the ties on a tracheostomy collar, the patient coughs, dislodging the tracheostomy tube. Which action will the nurse take first?
A. Press the emergency response button.
B. Insert a spare tracheostomy with the obturator.
C. Manually occlude the tracheostomy with sterile gauze.
D. Place a face mask delivering 100% oxygen over the nose and mouth.
B. Insert a spare tracheostomy with the obturator.

The nurse's first priority is to establish a stable airway by inserting a spare trach into the patient's airway; ideally an obturator should be used. The nurse could activate the emergency response team if the patient is still unstable after the tracheostomy is placed. A patient with a tracheostomy breathes through the tube, not the nose or mouth; a face mask would not be an effective method of getting air into the lungs. Manually occluding pressure over the tracheostomy site is not appropriate and would block the patient's only airway.
A nurse is following the Ventilator Bundle standards to prevent ventilator-associated pneumonia. Which strategies is the nurse using? (Select all that apply.)
A. Head of bed elevation to 90 degrees at all times
B. Daily oral care with chlorhexidine
C. Cuff monitoring for adequate seal
D. Clean technique when suctioning
E. Daily "sedation vacations"
F. Heart failure prophylaxis
B. Daily oral care with chlorhexidine
C. Cuff monitoring for adequate seal
E. Daily "sedation vacations"
A nurse is caring for a patient with sleep apnea. Which types of ventilator support should the nurse be prepared to administer for this patient? (Select all that apply.)
A. Assist-control (AC)
B. Pressure support ventilation (PSV)
C. Bilevel positive airway pressure (BiPAP)
D. Continuous positive airway pressure (CPAP)
E. Synchronized intermittent mandatory ventilation (SIMV)
C. Bilevel positive airway pressure (BiPAP)
D. Continuous positive airway pressure (CPAP)
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