Practice Quiz

CMSRN Medical-Surgical Nursing

Category - Pulmonary

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Nick Haegan has a smoking history of 25 years and a recent episode of 5 days of increased breathlessness. The client has a barrel chest, medium-pitched crackles, and wheezes in the right upper lobe and both lower lung lobes. The nurse observes he demonstrates the “increased work of breathing” during this acute period by:
  1. Increasing the rate and depth of respirations
  2. Increasing diaphragmatic excursion
  3. Using pursed-lip exhalations
  4. Using accessory muscles for ventilation
Explanation
Answer - D - Indications of respiratory distress and the increased work of breathing in this client are characterized by the use of the accessory muscles of respiration, the sternocleidomastoid and trapezius muscles. Using these muscles enables the client to increase the size of the thorax, thus allowing air to move in.
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