Posted: January 10th, 2017

An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to the tissues, is caused by:

A fifty-year-old client has a tracheostomy and requires tracheal suctioning. The first intervention in completing this procedure would be to:

1. Change the tracheostomy dressing
2. Provide humidity with a trach mask
3. Apply oral or nasal suction
4. Deflate the tracheal cuff

98.  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:

1. Exhaled forcibly after a normal expiration
2. Exhaled after there is a normal inspiration
3. Trapped in the alveoli that cannot be exhaled
4. Forcibly inspired over and above a normal respiration.

99.  An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to the tissues, is caused by:

1. A decreasing oxygen pressure in the blood
2. An increasing carbon dioxide pressure in the blood
3. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the blood.
4. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure in the blood.

1. 1. Fever, chills, hemoptysis, dyspnea, cough, and pleuric chest pain are the common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.
2. 4. The most common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Atelectasis and brochiectasis indicate a collapse of a portion of the airway that doesn’t occur with pneumonia. An effusion is an accumulation of excess pleural fluid in the pleural space, which may be a secondary response to pneumonia.
3. 1. Based on the client’s history and symptoms, acute asthma is the most likely diagnosis. He’s unlikely to have bronchial pneumonia without a productive cough and fever and he’s too young to have developed COPD or emphysema.
4. 3. Inspiratory and expiratory wheezes are typical findings in asthma. Circumoral cyanosis may be present in extreme cases of respiratory distress. The nurse would expect the client to have a decreased forced expiratory volume because asthma is an obstructive pulmonary disease. Breath sounds will be “tight” sounding or markedly decreased; they won’t be normal.
5. 3. Intrinsic asthma doesn’t have an easily identifiable allergen and can be triggered by the common cold. Asthma caused be emotional reasons is considered to be in the extrinsic category. Extrinsic asthma is caused by dust, molds, and pets; easily identifiable allergens. Mediated asthma doesn’t exist.
6. 2. Bronchodilators are the first line of treatment for asthma because bronchoconstriction is the cause of reduced airflow. Beta-adrenergic blockers aren’t used to treat asthma and can cause bronchoconstriction. Inhaled or oral steroids may be given to reduce the inflammation but aren’t used for emergency relief.