A patient who is terminally ill is described during shift report as having Cheyne-Stokes breathing. On assessment, the nurse anticipates finding:
respirations gradually decreasing in rate and depth.
rapid wheezing respirations for two or three breaths with short periods of apnea.
a breathing pattern of dyspnea followed by a short period of apnea.
quick shallow respirations with long periods of apnea.
The Correct Answer is C
A. Gradual decreases in rate and depth are typically seen in other respiratory conditions, not Cheyne- Stokes breathing.
B. Wheezing is not associated with Cheyne-Stokes breathing but may be related to airway obstructions or lung conditions.
C. Cheyne-Stokes breathing is characterized by a pattern of deep, rapid breathing followed by a period of apnea, commonly seen in terminally ill patients.
D. Quick shallow respirations with long periods of apnea are not characteristic of Cheyne-Stokes breathing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Keeping the patient on bed rest is appropriate as it conserves energy and helps prevent further heat loss.
B. Providing additional blankets is a correct intervention to warm the patient gradually.
C. Increasing muscle activity is contraindicated because it could cause vasoconstriction and worsen hypothermia, as the body focuses on preserving core temperature.
D. Offering fluids (if permitted) is correct as hydration can help restore normal body temperature regulation.
Correct Answer is B
Explanation
Pulse pressure is calculated as the difference between systolic and diastolic blood pressure. 170 - 90 = 80 mm Hg, so the pulse pressure would be 80mmHg.
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