The client complains of difficulty breathing. Which assessment ...

[evelyn o bentley]

The client complains of difficulty breathing. Which assessment findings should the nurse associate with that complaint?
 
  1. Use of accessory muscles
  2. Increased respiratory depth
  3. Increased respiratory rate
  4. Decreased respiratory depth
  5. Decreased respiratory rate

Question 2

The client has been admitted with complaints of shortness of breath of 2 weeks duration and has received the nursing diagnosis Impaired Gas Exchange. Which admission laboratory result would support the choice of this diagnosis?
 
  1. Increased hematocrit
  2. Decreased BUN
  3. Increased blood sugar
  4. Increased sedimentation rate

[thall411]

Answer to Question 1

Correct Answer: 1, 2, 3, 4
Rationale 1: Use of accessory muscles often is an assessment finding indicating difficulty breathing.
Rationale 2: Depth is often assessed when determining difficulty breathing. The depth of respirations can be deeper (tidal volume greater than 500 mL of air) or more shallow if partial obstruction is present.
Rationale 3: Rate is assessed when determining difficulty breathing. Rate is generally increased.
Rationale 4: The depth of respirations can be deeper (tidal volume greater than 500 mL of air) or more shallow if partial obstruction is present.
Rationale 5: Rate is generally increased.

Answer to Question 2

Correct Answer: 1
Rationale 1: Hematocrit is the percentage of the blood that is erythrocytes, which contain the hemoglobin that carries oxygen. Long-term hypoxia may result in the body's attempt to increase oxygen-carrying capacity by increasing erythrocyte production.
Rationale 2: BUN is a measure of blood urea nitrogen, not oxygen-carrying capacity.
Rationale 3: The blood glucose level is not used to measure oxygenation.
Rationale 4: The sedimentation rate is not a direct measure of oxygenation.