The nurse can assess Cheyne-Stokes respiration by its characteristics of respirations that are:
harsh and rattling.
long periods of fast deep breaths.
shallow followed by periods of apnea.
Wheezing and labored.
The Correct Answer is C
A. Harsh and rattling: Harsh and rattling respirations are indicative of other respiratory conditions, such as respiratory tract obstruction or excessive secretions in the airways, rather than Cheyne-Stokes respiration.
B. Long periods of fast deep breaths: This describes hyperventilation, where there are rapid and deep breaths without periods of apnea, which is not characteristic of Cheyne-Stokes respiration.
C. Shallow followed by periods of apnea: Cheyne-Stokes respiration is characterized by a pattern of gradually increasing and then decreasing depth of respirations, followed by periods of apnea (no breathing). This pattern repeats cyclically.
D. Wheezing and labored: Wheezing and labored respirations are associated with conditions such as asthma or chronic obstructive pulmonary disease (COPD), rather than Cheyne-Stokes respiration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Advance directives: Advance directives are legal documents that allow individuals to specify their preferences for medical treatment and end-of-life care in advance. While advance directives can help ensure that individuals' wishes are respected, they do not directly address the focus on quality of life issues.
B. Acceptance: Acceptance involves coming to terms with the reality of a situation, including one's own mortality. While acceptance can contribute to overall well-being and peace of mind, it is not a comprehensive approach to addressing quality of life issues.
C. Hope: Hope can be an important factor in coping with illness and maintaining quality of life. However, hope alone is not sufficient for implementing a focus on quality of life issues.
D. Hospice: Hospice care is specifically designed to address the physical, emotional, and spiritual needs of individuals with terminal illnesses and their families. Hospice focuses on enhancing quality of life by providing comfort care, symptom management, and psychosocial support. It emphasizes dignity, respect, and compassion at the end of life, making it the best option for implementing a focus on quality of life issues.
Correct Answer is E
Explanation
A. Anger: Anger involves feelings of frustration, resentment, or hostility towards the situation or others. The statement does not express anger but rather a refusal to accept the possibility of a serious illness.
B. Depression: Depression is characterized by feelings of sadness, hopelessness, and despair. While the statement may reflect concern, it does not indicate depressive symptoms.
C. Acceptance: Acceptance is characterized by coming to terms with one's impending death or loss. The statement does not indicate acceptance of the possibility of having cancer.
D. Bargaining: Bargaining involves attempting to negotiate or make deals to change the outcome of a situation. The statement does not suggest bargaining behavior.
E. Denial: Denial is the initial stage where individuals refuse to accept the reality of their situation. The statement "I've had stomach problems for years. I don't have cancer." suggests a refusal to accept the possibility of having cancer despite ongoing health issues. Therefore, it correlates with denial.
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