A critically ill patient has faster and deeper, then slower, respirations. These are followed by a period of no breathing for 21 seconds with continuation of this cycle. This respiratory pattern is

Kussmaul's respirations.

Cheyne-Stokes respirations.

Biot's respirations.

Hyperventilation.

Answer and Explanation

The Correct Answer is B

A.   Kussmaul's respirations are rapid, deep, and labored breaths often seen in metabolic acidosis, which does not match the pattern described.
B.   Cheyne-Stokes respirations are characterized by a pattern of deep and fast breathing followed by periods of apnea. This pattern is seen in patients with severe conditions like heart failure or brain injury.
C.   Biot's respirations are irregular, but the cycle does not have a distinct pattern of fast, slow, and apnea periods.
D.   Hyperventilation refers to an increased rate of breathing but does not involve the cycles of deep, slow, and apneic phases characteristic of Cheyne-Stokes.

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Correct Answer is ["A","C"]

Explanation

A. A dialysis shunt requires careful monitoring to avoid damaging the shunt, and blood pressure cuffs should not be applied to the arm with a shunt.
B. A hand amputation does not affect the use of the blood pressure cuff, but care should be taken with the affected area.
C. A previous mastectomy increases the risk of lymphedema, and using a blood pressure cuff on the affected arm could exacerbate this.
D. A patent IV line is not a contraindication for blood pressure measurement, but the nurse should take care not to interfere with the IV.

A. auscultate for bowel sounds once a shift. B. auscultate lung sounds at the beginning of a shift. C. monitor for skin turgor every shift. D. monitor peripheral pulses once a shift.

Correct Answer is B

Explanation

A. Auscultating for bowel sounds once a shift is important but does not directly relate to the respiratory condition.
B. Auscultating lung sounds at the beginning of a shift is a priority to assess for any signs of respiratory compromise or complications.
C. Monitoring skin turgor every shift is important for hydration status but is less critical in comparison to lung sounds for a patient with respiratory problems.
D. Monitoring peripheral pulses once a shift is important but does not address the respiratory condition directly.

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A critically ill patient has faster and deeper, then slower, respirations. These are followed by a period of no breathing for 21 seconds with continuation of this cycle. This respiratory pattern is

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Naxlex Comprehensive Predictor Exams

The nurse would refrain from applying a blood pressure cuff on the affected arm of a patient who has a(n): (Select all that apply)

Correct Answer is ["A","C"]

Explanation

A nurse caring for a patient on bed rest with a history of respiratory health problems should:

Correct Answer is B

Explanation

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