A nurse is reviewing arterial blood gas results for a client diagnosed with chronic obstructive pulmonary disease (COPD). The nurse should expect which abnormal finding?

Increased arterial oxygen

Increased pH

Increased carbon dioxide

Decreased alveolar function

Answer and Explanation

The Correct Answer is C

A. Increased arterial oxygen: Clients with COPD typically experience chronic hypoxemia due to alveolar destruction, airway inflammation, and mucus production, which impair gas exchange. Rather than increased oxygen levels, they often have a decreased PaO₂, requiring supplemental oxygen therapy. However, excessive oxygen administration can suppress their respiratory drive, worsening CO₂ retention.
B. Increased pH: COPD is associated with respiratory acidosis due to chronic CO₂ retention from inadequate alveolar ventilation. While the kidneys compensate by increasing bicarbonate retention, the pH usually remains low or near normal in chronic cases rather than becoming elevated. A higher pH would indicate alkalosis, which is not typical in COPD unless there is an additional metabolic disturbance.
C. Increased carbon dioxide: COPD causes airway obstruction and reduced alveolar ventilation, leading to CO₂ retention (hypercapnia). As CO₂ accumulates in the blood, it lowers the pH, resulting in respiratory acidosis. Chronic hypercapnia is a hallmark of advanced COPD, and in response, the kidneys retain bicarbonate to partially compensate, stabilizing the pH over time but leaving PaCO₂ elevated.
D. Decreased alveolar function: While COPD does lead to progressive alveolar damage and reduced gas exchange, this is a structural and functional change rather than a specific abnormality seen in arterial blood gases. The primary ABG finding in COPD is hypercapnia, which reflects inadequate ventilation and CO₂ retention rather than just decreased alveolar function alone.

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Correct Answer is B

Explanation

A. "Your body will slowly develop an ability to smell through your stoma." The olfactory system relies on air passing through the nasal passages to detect scents. After a total laryngectomy, the airway is rerouted through a stoma, bypassing the nose entirely. The body does not develop an alternative way to smell through the stoma, making this statement inaccurate.
B. "Breathing through a stoma has altered your sense of smell." A total laryngectomy permanently separates the respiratory and digestive tracts, preventing air from passing through the nose, which is necessary for olfaction. As a result, clients often experience anosmia (loss of smell). This response accurately explains the reason behind the alteration in the client’s sense of smell.
C. "Your sense of smell will gradually return after several months." Unlike temporary post-surgical changes, the loss of smell after a total laryngectomy is typically permanent unless the client learns to use techniques such as the "polite yawning" method (nasal airflow-inducing maneuver) to regain some olfactory function. It does not naturally return over time.
D. "As your appetite returns, your sense of smell will also return." Appetite and sense of smell are closely linked, but appetite improvement does not restore olfaction after a laryngectomy. Since air no longer flows through the nasal passages, the ability to detect smells is significantly impaired or lost.

A. Encourage the client to take breaks from oxygen use to prevent tolerance. B. Assess cheeks and posterior ears for signs of skin breakdown. C. Maintain nasal oxygen at a 1 to 2 liter/minute flow rate D. Teach the client how to safely increase oxygen flow when they deem necessary.

Correct Answer is C

Explanation

A. Encourage the client to take breaks from oxygen use to prevent tolerance. Oxygen therapy does not cause "tolerance," and taking breaks can lead to hypoxemia in COPD clients. Continuous low-flow oxygen is essential to maintaining adequate oxygenation while avoiding hypercapnia. Stopping oxygen therapy intermittently can increase the risk of respiratory distress.
B. Assess cheeks and posterior ears for signs of skin breakdown. While it is important to monitor for pressure injuries from nasal cannula tubing, this is a general nursing consideration for all patients receiving oxygen therapy. It is not the highest priority when managing oxygen therapy in clients with COPD, where maintaining appropriate oxygen levels is critical.
C. Maintain nasal oxygen at a 1 to 2 liter/minute flow rate. Clients with COPD often have chronic CO₂ retention and rely on hypoxic drive for ventilation. Administering high-flow oxygen can suppress their respiratory drive, leading to CO₂ narcosis and respiratory failure. To prevent this, oxygen should be administered at the lowest effective flow rate, typically 1 to 2 L/min via nasal cannula, while closely monitoring oxygen saturation and blood gases.
D. Teach the client how to safely increase oxygen flow when they deem necessary. Allowing a client with COPD to adjust their oxygen flow independently can be dangerous, as excessive oxygen can lead to hypercapnia and respiratory depression. Oxygen adjustments should be made based on clinical assessments and healthcare provider orders.

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A nurse is reviewing arterial blood gas results for a client diagnosed with chronic obstructive pulmonary disease (COPD). The nurse should expect which abnormal finding?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who reports experiencing alteration in sense of smell following surgery for a total laryngectomy. The nurse should address the client's concern through which of the following response?

Correct Answer is B

Explanation

A nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD). The nurse should prioritize which precaution when administering nasal oxygen therapy to the client?

Correct Answer is C

Explanation

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