ARF FINAL TEST PREPARATION
CERTIFICATION EVALUATION EXAMS
COMPLETE SOLUTION
◉ It will be most important for the nurse to check pulse oximetry for
which of these patients?
a. A patient with emphysema and a respiratory rate of 16
b. A patient with massive obesity who is refusing to get out of bed
c. A patient with pneumonia who has just been admitted to the unit
d. A patient who has just received morphine sulfate for postoperative
pain. Answer: C
Rationale: Hypoxemia and hypoxemic respiratory failure are caused
by disorders that interfere with the transfer of oxygen into the blood,
such as pneumonia. The other listed disorders are more likely to cause
problems with hypercapnia because of ventilatory failure.
Cognitive Level: Application Text Reference: pp. 1799-1800
Nursing Process: Assessment NCLEX: Physiological Integrity
◉ The nurse will monitor for clinical manifestations of hypercapnia
when a patient in the emergency department has
a. chest trauma and multiple rib fractures.
b. carbon monoxide poisoning after a house fire.
c. left-sided ventricular failure and acute pulmonary edema.
,d. tachypnea and acute respiratory distress syndrome (ARDS)..
Answer: A
Rationale: Hypercapnia is caused by poor ventilatory effort, which
occurs in chest trauma when rib fractures (or flail chest) decrease lung
ventilation. Carbon monoxide poisoning, acute pulmonary edema, and
ARDS are more commonly associated with hypoxemia.
Cognitive Level: Application Text Reference: p. 1800
Nursing Process: Assessment NCLEX: Physiological Integrity
◉ When a patient is diagnosed with pulmonary fibrosis, the nurse will
teach the patient about the risk for poor oxygenation because of
a. too-rapid movement of blood flow through the pulmonary blood
vessels.
b. incomplete filling of the alveoli with air because of reduced
respiratory ability.
c. decreased transfer of oxygen into the blood because of thickening
of the alveoli.
d. mismatch between lung ventilation and blood flow through the
blood vessels of the lung.. Answer: C
Rationale: Pulmonary fibrosis causes the alveolar-capillary interface
to become thicker, which increases the amount of time it takes for gas
to diffuse across the membrane. Too-rapid pulmonary blood flow is
another cause of shunt but does not describe the pathology of
pulmonary fibrosis. Decrease in alveolar ventilation will cause
hypercapnia. Ventilation and perfusion are matched in pulmonary
fibrosis; the problem is with diffusion.
,Cognitive Level: Application Text Reference: p. 1802
Nursing Process: Implementation NCLEX: Physiological Integrity
◉ A patient is diagnosed with a large pulmonary embolism. When
explaining to the patient what has happened to cause respiratory
failure, which information will the nurse include?
a. "Oxygen transfer into your blood is slow because of thick
membranes between the small air sacs and the lung circulation."
b. "Thick secretions in your small airways are blocking air from
moving into the small air sacs in your lungs."
c. "Large areas of your lungs are getting good blood flow but are not
receiving enough air to fill the small air sacs."
d. "Blood flow though some areas of your lungs is decreased even
though you are taking adequate breaths.". Answer: D
Rationale: A pulmonary embolus limits blood flow but does not affect
ventilation, leading to a ventilation-perfusion mismatch. The response
beginning, "Oxygen transfer into your blood is slow because of thick
membranes" describes a diffusion problem. The remaining two
responses describe ventilation-perfusion mismatch with adequate
blood flow but poor ventilation.
Cognitive Level: Application Text Reference: p. 1802
Nursing Process: Implementation NCLEX: Physiological Integrity
◉ A patient is brought to the emergency department unconscious
following a barbiturate overdose. Which potential complication will
the nurse include when developing the plan of care?
, a. Hypercapnic respiratory failure related to decreased ventilatory
effort
b. Hypoxemic respiratory failure related to diffusion limitations
c. Hypoxemic respiratory failure related to shunting of blood
d. Hypercapnic respiratory failure related to increased airway
resistance. Answer: A
Rationale: The patient with an opioid overdose develops hypercapnic
respiratory failure as a result of the decrease in respiratory rate and
depth. Diffusion limitations, blood shunting, and increased airway
resistance are not the primary pathophysiology causing the respiratory
failure.
Cognitive Level: Application Text Reference: p. 1800
Nursing Process: Diagnosis NCLEX: Physiological Integrity
◉ When assessing a patient with chronic lung disease, the nurse finds
a sudden onset of agitation and confusion. Which action should the
nurse take first?
a. Monitor the patient every 10 to 15 minutes.
b. Notify the patient's health care provider immediately.
c. Attempt to calm and reassure the patient.
d. Assess vital signs and pulse oximetry.. Answer: D
Rationale: The nurse needs to collect additional clinical data to share
with the health care provider and to start interventions quickly if
appropriate (e.g., increased oxygen flow if hypoxic). The change in
the patient's neurologic status may indicate deterioration in respiratory
function, and the health care provider should be notified immediately
CERTIFICATION EVALUATION EXAMS
COMPLETE SOLUTION
◉ It will be most important for the nurse to check pulse oximetry for
which of these patients?
a. A patient with emphysema and a respiratory rate of 16
b. A patient with massive obesity who is refusing to get out of bed
c. A patient with pneumonia who has just been admitted to the unit
d. A patient who has just received morphine sulfate for postoperative
pain. Answer: C
Rationale: Hypoxemia and hypoxemic respiratory failure are caused
by disorders that interfere with the transfer of oxygen into the blood,
such as pneumonia. The other listed disorders are more likely to cause
problems with hypercapnia because of ventilatory failure.
Cognitive Level: Application Text Reference: pp. 1799-1800
Nursing Process: Assessment NCLEX: Physiological Integrity
◉ The nurse will monitor for clinical manifestations of hypercapnia
when a patient in the emergency department has
a. chest trauma and multiple rib fractures.
b. carbon monoxide poisoning after a house fire.
c. left-sided ventricular failure and acute pulmonary edema.
,d. tachypnea and acute respiratory distress syndrome (ARDS)..
Answer: A
Rationale: Hypercapnia is caused by poor ventilatory effort, which
occurs in chest trauma when rib fractures (or flail chest) decrease lung
ventilation. Carbon monoxide poisoning, acute pulmonary edema, and
ARDS are more commonly associated with hypoxemia.
Cognitive Level: Application Text Reference: p. 1800
Nursing Process: Assessment NCLEX: Physiological Integrity
◉ When a patient is diagnosed with pulmonary fibrosis, the nurse will
teach the patient about the risk for poor oxygenation because of
a. too-rapid movement of blood flow through the pulmonary blood
vessels.
b. incomplete filling of the alveoli with air because of reduced
respiratory ability.
c. decreased transfer of oxygen into the blood because of thickening
of the alveoli.
d. mismatch between lung ventilation and blood flow through the
blood vessels of the lung.. Answer: C
Rationale: Pulmonary fibrosis causes the alveolar-capillary interface
to become thicker, which increases the amount of time it takes for gas
to diffuse across the membrane. Too-rapid pulmonary blood flow is
another cause of shunt but does not describe the pathology of
pulmonary fibrosis. Decrease in alveolar ventilation will cause
hypercapnia. Ventilation and perfusion are matched in pulmonary
fibrosis; the problem is with diffusion.
,Cognitive Level: Application Text Reference: p. 1802
Nursing Process: Implementation NCLEX: Physiological Integrity
◉ A patient is diagnosed with a large pulmonary embolism. When
explaining to the patient what has happened to cause respiratory
failure, which information will the nurse include?
a. "Oxygen transfer into your blood is slow because of thick
membranes between the small air sacs and the lung circulation."
b. "Thick secretions in your small airways are blocking air from
moving into the small air sacs in your lungs."
c. "Large areas of your lungs are getting good blood flow but are not
receiving enough air to fill the small air sacs."
d. "Blood flow though some areas of your lungs is decreased even
though you are taking adequate breaths.". Answer: D
Rationale: A pulmonary embolus limits blood flow but does not affect
ventilation, leading to a ventilation-perfusion mismatch. The response
beginning, "Oxygen transfer into your blood is slow because of thick
membranes" describes a diffusion problem. The remaining two
responses describe ventilation-perfusion mismatch with adequate
blood flow but poor ventilation.
Cognitive Level: Application Text Reference: p. 1802
Nursing Process: Implementation NCLEX: Physiological Integrity
◉ A patient is brought to the emergency department unconscious
following a barbiturate overdose. Which potential complication will
the nurse include when developing the plan of care?
, a. Hypercapnic respiratory failure related to decreased ventilatory
effort
b. Hypoxemic respiratory failure related to diffusion limitations
c. Hypoxemic respiratory failure related to shunting of blood
d. Hypercapnic respiratory failure related to increased airway
resistance. Answer: A
Rationale: The patient with an opioid overdose develops hypercapnic
respiratory failure as a result of the decrease in respiratory rate and
depth. Diffusion limitations, blood shunting, and increased airway
resistance are not the primary pathophysiology causing the respiratory
failure.
Cognitive Level: Application Text Reference: p. 1800
Nursing Process: Diagnosis NCLEX: Physiological Integrity
◉ When assessing a patient with chronic lung disease, the nurse finds
a sudden onset of agitation and confusion. Which action should the
nurse take first?
a. Monitor the patient every 10 to 15 minutes.
b. Notify the patient's health care provider immediately.
c. Attempt to calm and reassure the patient.
d. Assess vital signs and pulse oximetry.. Answer: D
Rationale: The nurse needs to collect additional clinical data to share
with the health care provider and to start interventions quickly if
appropriate (e.g., increased oxygen flow if hypoxic). The change in
the patient's neurologic status may indicate deterioration in respiratory
function, and the health care provider should be notified immediately
