A nurse is assessing a client for hypoxemia during an asthma attack.
Which of the following manifestations should the nurse expect?

Choice A rationale

Patients with COPD and a smoking habit are at high risk for atelectasis due to chronic inflammation and excessive mucus production. Smoking impairs ciliary function, making it difficult to clear secretions from the bronchioles. These retained secretions can plug the smaller airways, leading to the collapse of the distal alveoli. The underlying structural lung damage in COPD also contributes to poor ventilation and gas exchange, further predisposing these individuals to alveolar collapse.

Choice B rationale

Abdominal surgery significantly increases the risk for atelectasis because the patient often experiences shallow breathing due to incisional pain. This lack of deep inspiration prevents the full expansion of the lungs, especially the lower lobes. Furthermore, general anesthesia and the use of postoperative opioid analgesics can suppress the cough reflex and decrease the production of surfactant. Without adequate surfactant and regular deep breathing, the alveoli lose their surface tension and collapse.

Choice C rationale

Viral rhinitis typically involves inflammation of the upper respiratory tract and does not usually lead to atelectasis unless it progresses to a lower respiratory infection or causes significant airway obstruction. Coughing fits actually help to keep the lower airways clear of mucus by creating high expiratory flow rates. While uncomfortable, the primary pathology of viral rhinitis is localized to the nasal passages and pharynx, rather than the deep alveolar structures involved in atelectasis.

Choice D rationale

Gangrene of the toe is a localized necrotic process usually caused by peripheral vascular disease or infection. It does not directly affect the pulmonary system or the mechanics of breathing. Unless the patient becomes septic or is placed on prolonged bed rest without movement, the presence of gangrene on a distal extremity does not pose a direct risk for the development of atelectasis. The risk profile for atelectasis is primarily focused on respiratory and mobility factors.

Choice E rationale

Obesity and kidney failure are both risk factors for atelectasis. Obesity causes the chest wall to be heavy and restricts the movement of the diaphragm, leading to reduced lung volumes and shallow breathing. Kidney failure can lead to fluid volume overload and pulmonary congestion. This excess fluid can compress the alveoli from the outside or lead to decreased lung compliance, making it harder for the patient to maintain fully inflated alveoli during normal respiration.

Choice A rationale

Transporting arterial blood gas samples on ice is a standard physiological preservation technique used to decrease the metabolic rate of the cellular components within the blood. Red blood cells and leukocytes continue to consume oxygen and produce carbon dioxide through anaerobic metabolism after the sample is drawn. If the sample is not chilled, the measured partial pressure of oxygen will decrease while the partial pressure of carbon dioxide increases, leading to inaccurate results that do not reflect the true respiratory status of the patient.

Choice B rationale

The Allen test is a mandatory clinical assessment performed to ensure the presence of adequate collateral circulation to the hand via the ulnar artery. Before puncturing the radial artery, the nurse must confirm that if the radial artery becomes occluded or damaged during the procedure, the ulnar artery can sufficiently provide blood flow to the distal tissues. This preventatively identifies patients at risk for hand ischemia or necrosis. Failure to verify collateral flow can lead to severe vascular complications in the affected extremity.

Choice C rationale

An arterial blood gas draw is an invasive procedure that involves puncturing a high-pressure vessel, which carries significantly higher risks than standard venous phillips. Because of the potential for complications such as hematoma, nerve damage, or arterial occlusion, obtaining informed consent is a legal and ethical requirement. The patient must be educated on the necessity of the test, the procedural steps, and the associated risks before the clinician proceeds with the needle insertion to ensure patient autonomy and safety.

Choice D rationale

Due to the high hydrostatic pressure within the arterial system compared to the venous system, post-procedure hemostasis requires prolonged manual compression. The nurse should maintain firm pressure on the puncture site for at least five minutes, or longer if the patient is receiving anticoagulant therapy. This action prevents the formation of a hematoma or an arterial bleed, which could compress surrounding nerves or compromise skin integrity. Adequate pressure is vital to ensure the arterial wall seals effectively after the needle is withdrawn.

Choice E rationale

The statement that the puncture will be venous is physiologically incorrect for an arterial blood gas study. By definition, this laboratory test requires oxygenated blood directly from the arterial system to measure the efficiency of gas exchange and the acid-base balance of the body. Venous blood has already delivered oxygen to the tissues and collected metabolic waste products, making it unsuitable for assessing arterial oxygenation levels or the partial pressure of gases that are essential for determining the respiratory status.