ch. 26 lewis respiratory system questions with correct answers

Which patient is exhibiting an early clinical manifestation of hypoxemia? A A 48-year-old patient who is intoxicated and acutely disoriented to time and place B A 72-year-old patient who has four new premature ventricular contractions per minute C A 67-year-old patient who has dyspnea while resting in the bed or in a reclining chair D A 94-year-old patient who has renal insufficiency, anemia, and decreased urine output CORRECT ANSWER B Early clinical manifestations of hypoxemia include dysrhythmias (e.g., premature ventricular contractions), unexplained decreased level of consciousness (e.g., disorientation), dyspnea on exertion, and unexplained decreased urine output. The nurse is obtaining a focused respiratory assessment of a 44-year-old female patient who is in severe respiratory distress 2 days after abdominal surgery. What is most important for the nurse to assess? A Auscultation of bilateral breath sounds B Percussion of anterior and posterior chest wall C Palpation of the chest bilaterally for tactile fremitus D Inspection for anterior and posterior chest expansion CORRECT ANSWER A Important assessments obtained during a focused respiratory assessment include auscultation of lung (breath) sounds. Assessment of tactile fremitus has limited value in acute respiratory distress. It is not necessary to assess for both anterior and posterior chest expansion. Percussion of the chest wall is not essential in a focused respiratory assessment.