Check Yourself #8
Respiratory
While we may (un-) lovingly deride the NCLEX for its structure (the most correct answer, anyone?), it does do a good job of evaluating nursing judgement and showing what/how you should be thinking while nursing.
And it doesn’t stop with the NCLEX. Every certification exam you take is built on the same structure. Yay. So, let’s practice and check our knowledge at the same time.
Mechanical ventilation is not required for patients with asthma with the following complication:
 A. Respiratory alkalosis
 B. Cardiopulmonary arrest
 C. Respiratory muscle fatigue
 D. Hypercapnia and respiratory acidosis
Source: Dennison ‘Pass CCRN!’ 4th Edition, online resources
Keeping with the respiratory theme this week. When taking the test, pay particular attention to any keywords in the questions. This one asks, ‘what is not,’ meaning you must find the single wrong answer for the situation.
So, we’re considering mechanical ventilation for an asthmatic patient. Asthma is a reactive airway disease that includes bronchial swelling and increase secretions. This decreases the volume of air they can move both in and out, which will decrease oxygen absorption and increase carbon dioxide retention.
Keeping that in mind, let’s work through the options.
I can immediately cross out B. cardiopulmonary arrest. Er, if their heart isn’t beating and they aren’t breathing, they will absolutely need invasive mechanical ventilation.
We know the patient will be hypercapnic due to their impaired ability to expire CO2. We know CO2 becomes an acid when dissolved in liquid (i.e., blood), so will lower the pH of blood when levels increase. Decreased pH = acidosis, so not option D. hypercapnia and respiratory acidosis. We need to force their lungs to work better, and one way to do that is with mechanical ventilation, both invasive and noninvasive.
C. respiratory muscle fatigue is a common complication with asthma and other acute lung exacerbation syndromes. Air hunger and shortness of breath cause the respiratory rate to increase. If left untreated, this will lead to muscle fatigue and increasingly inefficient respirations. Even noninvasive ventilation can allow the patient to rest while the machine does the work.
So, that leaves option A. respiratory alkalosis. Why is this the correct (wrong) answer? Alkalosis is when the blood pH is too high, meaning there is not enough acid in the blood to balance the base. This is usually because the patient has been breathing deep and fast, causing them to blow off too much CO2. They will get light-headed and dizzy. What we don’t want is to make that worse by blasting them with high pressure, high oxygen concentration air. This is why correct testing and assessment is needed.
How’d you do? Questions? Confusion? Too easy? Comment and let me know if you have any sore spots you want to review.
References
Porth’s Pathophysiology: Concepts of Altered Health States (9th Edition). Grossman, S.C., Porth, C.M.
Thank you for reading! You can follow me on Instagram and subscribe to this newsletter to stay up to date with posts, practice NCLEX questions, and my stories of life as an inpatient nurse.
If you found this article interesting, useful, or entertaining, please consider donating via a subscription. All This Is My Nurse Face content is free, but you can choose a subscription to help support my writing. My goal is to educate and inspire healthcare professionals and laymen alike. Your support helps me achieve that!
Also, please check out my other Substack: WritingRampant. No nursing, but occasional blood and guts. (My characters like to stab each other. Such drama queens...)
Enjoy!
Anna, RN, BSN, CCRN
Necessary disclaimer: I am discussing medications and medical conditions in this article based on my personal experiences as a nurse. Your facility may have different requirements and resources. Use your own nursing judgement to assess and treat your patients according to your governing body and facility guidelines. All information within this article is correct to the best of my knowledge, but should be confirmed through verified evidence-based sources. I am not responsible for any clinical decisions made based on this article.