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FSCJ NUR1023C: Health & Wellness Across the Lifespan I
Section 1: Concept of Gas Exchange & Oxygenation
1. A client with chronic bronchitis is admitted with an acute exacerbation. The arterial
blood gas (ABG) reveals a PaO2 of 58 mmHg and a PaCO2 of 55 mmHg. The nurse
prepares to administer oxygen. Which delivery method and flow rate are most
appropriate initially?
A) Non-rebreather mask at 15 L/min.
B) Simple face mask at 6 L/min.
C) Venturi mask at 28% FiO2.
D) Nasal cannula at 4 L/min.
Elaboration: The Venturi mask delivers a precise, guaranteed fraction of inspired oxygen
($FiO_2$). For a client with chronic $CO_2$ retention, precise, low-flow oxygen is critical to
prevent suppressing the hypoxic drive while safely correcting the severe hypoxemia.
2. The nurse assesses a client who is two hours post-extubation. The client exhibits
inspiratory stridor, intercostal retractions, and extreme agitation. What is the nurse's
priority action?
A) Administer a prescribed PRN dose of intravenous lorazepam (Ativan) for agitation.
B) Assist the client to a prone position to improve V/Q matching.
C) Instruct the client to perform incentive spirometry.
D) Notify the rapid response team and prepare for immediate reintubation.
Elaboration: Stridor and retractions post-extubation indicate acute laryngeal edema and
impending airway obstruction. This is a medical emergency requiring immediate airway
management, not sedation or positioning.
3. A client is receiving a continuous albuterol nebulizer treatment for status asthmaticus.
Which assessment finding indicates a dangerous systemic effect of this medication?
A) A respiratory rate of 22 breaths per minute.
B) A serum potassium level of 2.8 mEq/L.
C) A heart rate of 98 beats per minute.
D) Fine bilateral hand tremors.
,Elaboration: High doses of beta-2 agonists (like albuterol) drive potassium rapidly into the
intracellular space, leading to severe, potentially fatal hypokalemia. Tremors and mild
tachycardia are expected side effects, but hypokalemia is a dangerous adverse effect.
4. The nurse auscultates coarse crackles over the bilateral lower lobes of a client with
heart failure. Which pathophysiological mechanism is responsible for this adventitious
sound?
A) Sudden opening of small airways and alveoli that contain fluid.
B) Air passing through narrowed, bronchospastic airways.
C) Inflammation of the pleural membranes rubbing together.
D) Upper airway obstruction by thick mucus.
Elaboration: Crackles (rales) are produced when air is forced through respiratory passages
that are narrowed by fluid, mucus, or pus, causing the alveoli to "pop" open during
inspiration.
5. A client with a right-sided pneumothorax has a chest tube connected to a water-seal
drainage system. The nurse notes that the water level in the water-seal chamber does
not fluctuate during the client's respiratory cycle. What is the most likely clinical
interpretation?
A) The system has a massive air leak.
B) The suction control chamber is set too low.
C) The lung has fully re-expanded or the tubing is obstructed.
D) The client is developing a tension pneumothorax.
Elaboration: Tidaling (fluctuation) stops when the negative pressure in the pleural space has
been restored (lung re-expansion) or if there is a mechanical blockage (kink) in the dependent
tubing.
6. A client presents with pleuritic chest pain and a sudden onset of dyspnea. The D-dimer
test is significantly elevated. The nurse anticipates a primary prescription for:
A) Intravenous furosemide.
B) A continuous intravenous heparin infusion.
C) Sublingual nitroglycerin.
D) Broad-spectrum intravenous antibiotics.
, Elaboration: An elevated D-dimer, sudden dyspnea, and pleuritic pain are hallmark signs of a
pulmonary embolism. Immediate anticoagulation with heparin is required to prevent further
clot propagation.
7. A nurse is teaching a client with emphysema about "pursed-lip breathing." What is the
primary physiological goal of this technique?
A) To increase the client's inspiratory capacity.
B) To strengthen the diaphragmatic muscle.
C) To prolong exhalation and create positive end-expiratory pressure, preventing
alveolar collapse.
D) To rapidly clear carbon dioxide by increasing the respiratory rate.
Elaboration: Emphysema destroys alveolar elasticity. Pursed-lip breathing creates back-
pressure in the airways (stenting them open), which prevents premature airway collapse and
allows for trapped $CO_2$ to be exhaled.
8. A client with acute respiratory distress syndrome (ARDS) is mechanically ventilated with
Positive End-Expiratory Pressure (PEEP) set at 15 cm $H_2O$. The nurse must carefully
monitor the client for which complication directly related to high PEEP?
A) Decreased cardiac output and hypotension.
B) Sudden development of pulmonary edema.
C) Metabolic alkalosis.
D) Rapid increase in core body temperature.
Elaboration: High levels of PEEP increase intrathoracic pressure, which severely compresses
the superior and inferior vena cava. This decreases venous return (preload), resulting in a
dangerous drop in cardiac output and blood pressure.
9. The nurse notes a "shift to the left" on the complete blood count (CBC) differential of a
client with pneumonia. The nurse interprets this finding as an increase in:
A) Mature neutrophils indicating a resolving infection.
B) Eosinophils indicating an allergic response.
C) Immature neutrophils (bands) indicating an overwhelming acute infection.
D) Lymphocytes indicating a viral infection.
FSCJ NUR1023C: Health & Wellness Across the Lifespan I
Section 1: Concept of Gas Exchange & Oxygenation
1. A client with chronic bronchitis is admitted with an acute exacerbation. The arterial
blood gas (ABG) reveals a PaO2 of 58 mmHg and a PaCO2 of 55 mmHg. The nurse
prepares to administer oxygen. Which delivery method and flow rate are most
appropriate initially?
A) Non-rebreather mask at 15 L/min.
B) Simple face mask at 6 L/min.
C) Venturi mask at 28% FiO2.
D) Nasal cannula at 4 L/min.
Elaboration: The Venturi mask delivers a precise, guaranteed fraction of inspired oxygen
($FiO_2$). For a client with chronic $CO_2$ retention, precise, low-flow oxygen is critical to
prevent suppressing the hypoxic drive while safely correcting the severe hypoxemia.
2. The nurse assesses a client who is two hours post-extubation. The client exhibits
inspiratory stridor, intercostal retractions, and extreme agitation. What is the nurse's
priority action?
A) Administer a prescribed PRN dose of intravenous lorazepam (Ativan) for agitation.
B) Assist the client to a prone position to improve V/Q matching.
C) Instruct the client to perform incentive spirometry.
D) Notify the rapid response team and prepare for immediate reintubation.
Elaboration: Stridor and retractions post-extubation indicate acute laryngeal edema and
impending airway obstruction. This is a medical emergency requiring immediate airway
management, not sedation or positioning.
3. A client is receiving a continuous albuterol nebulizer treatment for status asthmaticus.
Which assessment finding indicates a dangerous systemic effect of this medication?
A) A respiratory rate of 22 breaths per minute.
B) A serum potassium level of 2.8 mEq/L.
C) A heart rate of 98 beats per minute.
D) Fine bilateral hand tremors.
,Elaboration: High doses of beta-2 agonists (like albuterol) drive potassium rapidly into the
intracellular space, leading to severe, potentially fatal hypokalemia. Tremors and mild
tachycardia are expected side effects, but hypokalemia is a dangerous adverse effect.
4. The nurse auscultates coarse crackles over the bilateral lower lobes of a client with
heart failure. Which pathophysiological mechanism is responsible for this adventitious
sound?
A) Sudden opening of small airways and alveoli that contain fluid.
B) Air passing through narrowed, bronchospastic airways.
C) Inflammation of the pleural membranes rubbing together.
D) Upper airway obstruction by thick mucus.
Elaboration: Crackles (rales) are produced when air is forced through respiratory passages
that are narrowed by fluid, mucus, or pus, causing the alveoli to "pop" open during
inspiration.
5. A client with a right-sided pneumothorax has a chest tube connected to a water-seal
drainage system. The nurse notes that the water level in the water-seal chamber does
not fluctuate during the client's respiratory cycle. What is the most likely clinical
interpretation?
A) The system has a massive air leak.
B) The suction control chamber is set too low.
C) The lung has fully re-expanded or the tubing is obstructed.
D) The client is developing a tension pneumothorax.
Elaboration: Tidaling (fluctuation) stops when the negative pressure in the pleural space has
been restored (lung re-expansion) or if there is a mechanical blockage (kink) in the dependent
tubing.
6. A client presents with pleuritic chest pain and a sudden onset of dyspnea. The D-dimer
test is significantly elevated. The nurse anticipates a primary prescription for:
A) Intravenous furosemide.
B) A continuous intravenous heparin infusion.
C) Sublingual nitroglycerin.
D) Broad-spectrum intravenous antibiotics.
, Elaboration: An elevated D-dimer, sudden dyspnea, and pleuritic pain are hallmark signs of a
pulmonary embolism. Immediate anticoagulation with heparin is required to prevent further
clot propagation.
7. A nurse is teaching a client with emphysema about "pursed-lip breathing." What is the
primary physiological goal of this technique?
A) To increase the client's inspiratory capacity.
B) To strengthen the diaphragmatic muscle.
C) To prolong exhalation and create positive end-expiratory pressure, preventing
alveolar collapse.
D) To rapidly clear carbon dioxide by increasing the respiratory rate.
Elaboration: Emphysema destroys alveolar elasticity. Pursed-lip breathing creates back-
pressure in the airways (stenting them open), which prevents premature airway collapse and
allows for trapped $CO_2$ to be exhaled.
8. A client with acute respiratory distress syndrome (ARDS) is mechanically ventilated with
Positive End-Expiratory Pressure (PEEP) set at 15 cm $H_2O$. The nurse must carefully
monitor the client for which complication directly related to high PEEP?
A) Decreased cardiac output and hypotension.
B) Sudden development of pulmonary edema.
C) Metabolic alkalosis.
D) Rapid increase in core body temperature.
Elaboration: High levels of PEEP increase intrathoracic pressure, which severely compresses
the superior and inferior vena cava. This decreases venous return (preload), resulting in a
dangerous drop in cardiac output and blood pressure.
9. The nurse notes a "shift to the left" on the complete blood count (CBC) differential of a
client with pneumonia. The nurse interprets this finding as an increase in:
A) Mature neutrophils indicating a resolving infection.
B) Eosinophils indicating an allergic response.
C) Immature neutrophils (bands) indicating an overwhelming acute infection.
D) Lymphocytes indicating a viral infection.
