Chapter 33 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

Chapter 33 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

Question 1

Type: MCSA

The nurse assessing a patient with multiple injuries is concerned about the patient’s ability to maintain adequate oxygenation. Which explanation would the nurse provide for this increased concern?

1. The patient’s bowel sounds are hypoactive.
2. The patient has a hemoglobin level of 14 mg/dL.
3. The patient suffered a cervical neck injury and slight concussion.
4. The patient had an arm injury from flying glass.

Correct Answer: 3

Rationale 1: Hypoactive bowel sounds would not necessarily indicate an injury that would impact the patient’s ability to maintain adequate oxygenation.

Rationale 2: A hemoglobin level of 14 mg/dL would be sufficient for oxygenation to the tissues and would not cause the nurse concern.

Rationale 3: Since the respiratory system requires constant input from the nervous system, the assessment findings of a cervical neck injury and slight concussion would be the ones that concern the nurse about the patient’s ability to maintain adequate oxygenation.

Rationale 4: An arm injury due to flying glass would likely have little impact on the patient’s ability to maintain oxygenation.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33-1

Question 2

Type: MCSA

A patient has a hemoglobin level of 8.6 mg/dL. The nurse is concerned that which oxygenation component will be affected in this patient?

1. Oxygen delivery
2. Diffusion of oxygen
3. Pulmonary gas exchange
4. Oxygen consumption

Correct Answer: 1

Rationale 1: The concept of oxygenation involves three physiologic components for the intake, delivery, and use of oxygen for energy: pulmonary gas exchange, oxygen delivery, and oxygen consumption. Adequacy of oxygenation depends on the integration of these physiologic components. Oxygen delivery is the process of transportation of oxygen to cells and is dependent on cardiac output, hemoglobin saturation with oxygen, and the partial pressure of oxygen in arterial blood.

Rationale 2: Diffusion is part of pulmonary gas exchange. The actual process of diffusion will not be affected by low hemoglobin.

Rationale 3: The concept of oxygenation involves three physiologic components for the intake, delivery, and use of oxygen for energy: pulmonary gas exchange, oxygen delivery, and oxygen consumption. Adequacy of oxygenation depends on the integration of these physiologic components. Pulmonary gas exchange involves the intake of oxygen from the external environment into the internal environment.

Rationale 4: The concept of oxygenation involves three physiologic components for the intake, delivery, and use of oxygen for energy: pulmonary gas exchange, oxygen delivery, and oxygen consumption. Adequacy of oxygenation depends on the integration of these physiologic components. Oxygen consumption involves the use of oxygen at the cellular level to generate energy for cells to use to perform their specific functions.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33-1

Question 3

Type: MCSA

A patient is being started on oxygen therapy for an oxygen saturation level of 84% on room air. The nurse expects that this therapy will be effective if oxygen enters the blood through which physiological process?

1. Osmosis
2. Fluid shift
3. Diffusion
4. Concentration gradient

Correct Answer: 3

Rationale 1: Osmosis is a passive exchange and is not the primary mechanism by which oxygen crosses the alveolar–capillary membrane.

Rationale 2: Fluid shifts are not involved in the physiologic process in which oxygen crosses the alveolar–capillary membrane.

Rationale 3: Oxygen crosses alveolar–capillary membranes by diffusion, combines with hemoglobin, and is transported via the pulmonary vein to the left side of the heart. After the heart pumps oxygenated blood into the vascular system where it is transported to cells, oxygenated blood then leaves the capillaries by diffusion and enters cells.

Rationale 4: Movement of oxygen across the alveolar–capillary membrane is not dependent upon a concentration gradient. It does depend upon the presence of a pressure gradient.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33-2

Question 4

Type: MCSA

The nurse, caring for a patient with hypovolemic shock is primarily concerned that which change could occur in this patient’s pulmonary gas exchange?

1. Insufficient distribution of oxygen
2. Buildup of electrolytes in the blood
3. Over-oxygenation
4. Oxygen delivery shift to osmosis

Correct Answer: 1

Rationale 1: Since adequate blood flow must exist to distribute the oxygenated blood to the left side of the heart and the systemic circulation, the patient with hypovolemic shock is not going to have sufficient blood flow, which can lead to an insufficient distribution of oxygen to the tissues.

Rationale 2: A buildup of electrolytes in the blood is not of primary concern in this patient’s oxygenation.

Rationale 3: Hypovolemic shock will not result in over-oxygenation.

Rationale 4: Oxygen delivery is through diffusion and not osmosis. Hypovolemic shock does not cause an alteration to a different process.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 33-1