A patient is admitted with hypercapnic respiratory failure secondary to chronic obstructive pulmonary disease (COPD). The nurse anticipates which collaborative interventions to address the patient's condition? Select all that apply.

Collaborate with respiratory therapy for airway clearance techniques.

Initiate non-invasive positive pressure ventilation (NIPPV)

Administer bronchodilators as prescribed.

Prepare for possible endotracheal intubation.

Begin high-flow oxygen therapy at 100% FIO2

Encourage vigorous physical activity to improve ventilation.

Answer and Explanation

Correct Answer : A,B,C,D

A. Collaborate with respiratory therapy for airway clearance techniques: Patients with COPD and hypercapnic respiratory failure often retain secretions due to impaired mucociliary clearance. Airway clearance techniques, such as chest physiotherapy, suctioning, and assisted coughing, help mobilize secretions, improve ventilation, and reduce the risk of infection.

B. Initiate non-invasive positive pressure ventilation (NIPPV): NIPPV, such as CPAP or BiPAP, supports ventilation by improving alveolar ventilation and reducing CO₂ retention in hypercapnic respiratory failure. It can prevent respiratory muscle fatigue and reduce the need for invasive mechanical ventilation, making it a key intervention in stable patients.

C. Administer bronchodilators as prescribed: Bronchodilators, including short-acting beta-agonists or anticholinergics, help relieve airway obstruction by relaxing bronchial smooth muscle. This improves airflow, gas exchange, and CO₂ elimination, directly addressing the pathophysiology of hypercapnic respiratory failure in COPD.

D. Prepare for possible endotracheal intubation: In cases where non-invasive measures fail or the patient becomes fatigued, hypoxic, or obtunded, endotracheal intubation with mechanical ventilation may be necessary. Early preparation ensures readiness for rapid intervention if respiratory failure progresses.

E. Begin high-flow oxygen therapy at 100% FiO₂: Administering high concentrations of oxygen can suppress the hypoxic drive in COPD patients, worsening hypercapnia. Oxygen therapy should be titrated carefully to maintain SaO₂ of 88–92%, not delivered at 100% unless clinically indicated in acute severe hypoxemia.

F. Encourage vigorous physical activity to improve ventilation: Vigorous activity in a patient with acute hypercapnic respiratory failure may exacerbate hypoxemia and fatigue respiratory muscles. Activity should be carefully graded and only encouraged once the patient is stabilized.

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Correct Answer is ["A","B","D"]

Explanation

A. Platelet count: Chemotherapy and radiation commonly suppress megakaryocyte production in the bone marrow, leading to thrombocytopenia. A decreased platelet count increases the risk of spontaneous bleeding and impaired clot formation. Monitoring platelet levels allows early detection of marrow suppression and guides precautions or interventions.

B. Red blood cell (RBC) count: Myelosuppressive therapy can reduce erythropoiesis, resulting in anemia. A declining RBC count may lead to fatigue, dyspnea, and reduced oxygen-carrying capacity. Serial monitoring helps assess the severity of marrow suppression and determine the need for interventions such as erythropoiesis-stimulating agents or transfusion.

C. Basophil count: Basophils represent a very small fraction of circulating leukocytes and are not used as a primary indicator of bone marrow suppression. While they originate from the marrow, changes in basophil count are neither sensitive nor specific markers of chemotherapy-induced myelosuppression. Other white blood cell parameters provide more clinically meaningful data.

D. Neutrophil count: Neutropenia is a major and potentially life-threatening consequence of bone marrow suppression, significantly increasing the risk of infection. The absolute neutrophil count (ANC) is especially important in oncology patients to guide infection precautions and determine chemotherapy dosing adjustments. Monitoring neutrophils is critical for early identification of immunosuppression.

Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"B"}

Explanation

Rationale for Correct Answers:

Supraventricular tachycardia: The telemetry strip shows a rapid, regular rhythm originating above the ventricles, consistent with supraventricular tachycardia (SVT), and the heart rate is above 150 beats per minute. SVT can cause palpitations, dizziness, or hypotension if sustained, making accurate identification critical for timely intervention.

Administering adenosine: Adenosine is the first-line pharmacologic treatment for stable SVT. It transiently blocks AV nodal conduction, which can terminate the reentrant tachycardia and restore normal sinus rhythm. Administration requires rapid IV push with immediate saline flush and continuous monitoring due to potential transient bradycardia or brief asystole.

Rationale for Incorrect Answers

Atrial fibrillation: This rhythm is irregularly irregular with no identifiable P waves. SVT is regular and very rapid.

Sinus tachycardia: This has a normal P wave before every QRS complex and is typically caused by pain, fever, dehydration, or anxiety. It is not treated with adenosine.

Defibrillation: This is used for life-threatening rhythms such as ventricular fibrillation or pulseless ventricular tachycardia, not stable SVT.

Administering diltiazem: This is commonly used to control ventricular rate in atrial fibrillation, not as first-line treatment for SVT.

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A patient is admitted with hypercapnic respiratory failure secondary to chronic obstructive pulmonary disease (COPD). The nurse anticipates which collaborative interventions to address the patient's condition? Select all that apply.

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Naxlex Comprehensive Predictor Exams

A patient with lung cancer is being treated with chemotherapy and radiation. Which lab values will the nurse monitor to detect bone marrow suppression? Select all that apply.

Correct Answer is ["A","B","D"]

Explanation

Based on the information in the electronic health record, complete the following sentences using the drop-down lists. The nurse reads the telemetry strip and interprets the client's cardiac rhythm asdropdown. Based on the cardiac rhythm and client assessment, the nurse anticipatesdropdown

Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"B"}

Explanation

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