NURS 420 Chapter 26: Nursing Assessment: Respiratory System Test Bank

Chapter 26: Nursing Assessment: Respiratory System MULTIPLE CHOICE1.A patient with acute shortness of breath is admitted to the hospital. Which action should thenurse take during the initial assessment of the patient?a.Ask the patient to lie down to complete a full physical assessment.b.Briefly ask specific questions about this episode of respiratory distress.c.Complete the admission database to check for allergies before treatment.d.Delay the physical assessment to first complete pulmonary function tests.ANS: BWhen a patient has severe respiratory distress, only information pertinent to the currentepisode is obtained, and a more thorough assessment is deferred until later. Obtaining acomprehensive health history or full physical examination is unnecessary until the acutedistress has resolved. Brief questioning and a focused physical assessment should be donerapidly to help determine the cause of the distress and suggest treatment. Checking forallergies is important, but it is not appropriate to complete the entire admission database at thistime. The initial respiratory assessment must be completed before any diagnostic tests orinterventions can be ordered. DIF:Cognitive Level: Apply (application)REF:482TOP:Nursing Process: AssessmentMSC:NCLEX: Physiological Integrity2.The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How shouldthe nurse position the patient? DIF:Cognitive Level: Apply (application)REF:492TOP:Nursing Process: ImplementationMSC:NCLEX: Physiological Integrity3.A diabetic patient’s arterial blood gas (ABG) results are pH 7.28; PaCO234 mm Hg; PaO285mm Hg; HCO3–18 mEq/L. The nurse would expect which finding?