NURS 270 Unit 5 Test Questions and
Correct Answers
What is the most significant modifiable risk factor for the development of impaired gas
exchange?
A. Age.
B. Tobacco use.
C. Drug overdose.
D. Prolonged immobility. ✅B. Tobacco use.
Tobacco use is the most preventable cause of death and disease and is the most
important risk factor in the development of impaired gas exchange. Age is not a
modifiable risk factor. Drug overdose and immobility both contribute to impaired gas
exchange but are not as significant as tobacco use.
When evaluating the concept of gas exchange, how would the nurse best describe the
movement of oxygen and carbon dioxide?
A. Oxygen and carbon dioxide are exchanged across the capillary membrane to provide
oxygen to hemoglobin.
B. Gas moves from an area of high pressure to an area of low pressure across the
alveolar membrane.
C. The level of inspired oxygen must be sufficient to displace the carbon dioxide
molecules in the alveoli.
D. Gases are exchanged between the atmosphere and the blood based on the oxygen-
carrying capacity of the hemoglobin. ✅B. Gas moves from an area of high pressure to
an area of low pressure across the alveolar membrane.
Oxygen and carbon dioxide move across the alveolar membrane based on the partial
pressure of each gas. Molecules of oxygen are not exchanged for molecules of carbon
dioxide. The pressure gradient of each gas (carbon dioxide and oxygen) in the alveoli is
responsible for the movement of each gas.
A patient is having the arterial blood gas (ABG) measured. What would the nurse
identify as the parameters to be evaluated by this test?
A. Ratio of hemoglobin and hematocrit.
B. Status of acid-base balance in arterial blood.
C. Adequacy of oxygen transport.
D. Presence of a pulmonary embolus. ✅B. Status of acid-base balance in arterial
blood.
,The ABG results will indicate the acid-base balance of the arterial blood and the partial
pressure of oxygen and carbon dioxide. The ABG does not reveal the ratio of
hemoglobin and hematocrit, the adequacy of oxygen transport to the cells, or the
presence of a pulmonary embolus.
The nurse is administering oral glucocorticoids to a patient with asthma. What
assessment finding would the nurse identify as a therapeutic response to this
medication?
A. No observable respiratory difficulty or shortness of breath over the last 24 hours.
B. A decrease in the amount of nasal drainage and sneezing.
C. No sputum production, and a decrease in coughing episodes.
D. Relief of an acute asthmatic attack. ✅A. No observable respiratory difficulty or
shortness of breath over the last 24 hours.
Glucocorticoids (corticosteroids) decrease inflammation and prevent bronchospasm in
the patient with asthma. The glucocorticoids are used to prevent problems.
Anticholinergics decrease the allergic response and decrease sneezing and rhinorrhea.
Antitussives are used to decrease cough, and mucolytics assist in the removal of
mucus. Sympathomimetic agents (beta2 agonist) are used to relieve bronchospasm in
an acute episode.
The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD).
The patient tells the nurse he is having a "hard time breathing." His respiratory rate is 32
breaths per minute, his pulse is 120 beats per minute, and the oxygen saturation is
90%. What would be the best nursing intervention for this patient?
A. Begin oxygen via a face mask at 60% FiO2 (fraction of inspired oxygen).
B. Administer a PRN (as necessary) dose of an intranasal glucocorticoid.
C. Encourage coughing and deep breathing to clear the airway.
D. Initiate oxygen via a nasal cannula, and begin at a flow rate of 3 L/min. ✅D. Initiate
oxygen via a nasal cannula, and begin at a flow rate of 3 L/min.
The normal respiratory drive is a person's level of carbon dioxide (CO2) in the arterial
blood. The COPD patient had compensated for his chronic high levels of CO2, and his
respiratory drive is dependent on his oxygen levels, not his CO2 levels. If the COPD
patient's oxygen level is rapidly increased to what would be considered a normal level, it
would compensate for his respiratory drive. The patient with COPD who has difficulty
breathing should be given low levels of oxygen and closely observed for the quality and
rate of ventilation. A dose of glucocorticoids will not address his immediate needs, but it
may provide decreased inflammation and better ventilation over an extended period of
time. Encouraging coughing and deep breathing in a patient with COPD does not meet
his needs as effectively as administration of low-level oxygen does.
The nurse would anticipate that which of the following patients will need to be treated
with insertion of a chest tube?
,A. A patient with asthma and severe shortness of breath.
B. A patient undergoing a bronchoscopy for a biopsy.
C. A patient with a pleural effusion requiring fluid removal.
D. A patient experiencing a problem with a pneumothorax. ✅D. A patient experiencing
a problem with a pneumothorax.
When air is allowed to enter the pleural space, the lung will collapse and a chest tube
will be inserted to remove the air and reestablish negative pressure in the pleural space.
Patients with asthma do not require a chest tube. A bronchoscopy is done to evaluate
the bronchi and lungs and to obtain a biopsy. A thoracentesis may be done to remove
fluid from the pleural space. A chest tube may be inserted if there are complications
from the thoracentesis or for the bronchoscopy.
expected respiratory outcomes for hospitalized patient ✅-Have improved lung
expansion
-Be able to mobilize secretions
-Maintain a patent airway
-Have improved activity tolerance
-Maintain oxygenation saturations >90%, respirations between 12-20
-Cough and deep breathe q 2 hours
nursing diagnoses related to oxygenation ✅-Ineffective Airway Clearance
-Impaired Gas Exchange
-Ineffective Breathing pattern
-Activity Intolerance
-Risk for Infection
care management interventions used in the treatment of impaired gas exchange ✅1.
assess for lung sounds, vital signs, oximetry, and ABGs
2. administer oxygen (titrate to keep O2 saturation above 90% unless COPD patient)
3. collaborate with respiratory therapy if different O2 delivery system needed
4. increase HOB, CDB, incentive spirometry, suction PRN, rhonchi
5. early ambulation, adequate hydration to liquefy sections 2-4 liters/day
6. postural drainage to prevent infection
health promotion strategies for those at risk for oxygenation problems ✅influenza
vaccine (annually)
pneumonia vaccine (indicated for those at risk, including the elderly, chronic illness,
nursing home residents, children under 23 months, revaccination after age 65)
-adequate nutrition
-fluids
-avoid crowds and ill persons
-environmental protection (furnaces, smoke, wood stoves, pets, automobile exhaust,
CO)
-humidity
, interpretation of ABGs ✅1. classify pH (acidic or basic)
2. assess PaCO2
3. assess HCO3
4. determine if compensation is occurring
5. If pH is abnormal, identify what is the primary disorder
6. determine if oxygenation problem by looking at PaCO2
normal parameters for ABG values ✅pH = 7.35-7.45
PaCO2 = 35-45 mm Hg
bicarbonate (HCO3) = 22-26 mEq/L
PaO2 = 80-100 mm Hg
SaO2 = greater than 95%
nasal cannula ✅An oxygen-delivery device in which oxygen flows through two small,
tubelike prongs that fit into the patient's nostrils; delivers 24% to 44% supplemental
oxygen, depending on the flow rate.
simple face mask ✅used for short-term oxygen therapy. It fits loosely and delivers
oxygen concentrations from 35% to 50% FIO2. This is contraindicated for patients with
carbon dioxide retention because retention can be worsened. Flow rates should be 5 L
or more to avoid rebreathing exhaled carbon dioxide retained in the mask.
partial rebreather mask ✅a device used in medicine to assist in the delivery of oxygen
therapy. An NRB requires that the patient can breathe unassisted, but unlike low flow
nasal cannula, the NRB allows for the delivery of higher concentrations of oxygen; FiO2
60-80% oxygen; deliver 10-15 L oxygen
venturi mask ✅FiO2 24-55%; 4-12 L of oxygen; can be helpful in the treatment of
COPD because specific amount of oxygen can be delivered; a medical device to deliver
a known oxygen concentration to patients on controlled oxygen therapy
HCO3 ✅Bicarbonate 22-25 carried in the blood mainly by c02
above 25 = acidosis more acid
below 22= basic alkalosis
postural drainage positions ✅Postural drainage makes use of gravity to drain
secretions from the lungs from smaller pulmonary branches into larger ones, where they
can be removed by coughing.
*High Fowler's position is used to drain the apical sections of the upper lobes of the
lungs.
*Placing the patient lying on the left side with a pillow under the chest wall helps to drain
the right lobe of the lung.
Placing the patient in a side-lying position, half on the abdomen and half on the side,
right and left, helps to drain the posterior sections of the upper lobes of the lungs.
