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Wagner, High Acuity Nursing, 6e
Chapter 10
Question 1
Type: MCMA
The nurse is assessing a patient with an endotracheal tube and notes decreased breath sounds on the left with
normal sounds on the right. Which condition may cause this?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Pressure from a right pneumothorax
2. Misplacement of the endotracheal tube
3. High pulmonary pressures
4. Partial obstruction of the endotracheal tube
5. A large infiltrate in the left lung
Correct Answer: 2,5
Rationale 1: A right pneumothorax would present with decreased sounds on the right.
Rationale 2: The right bronchus is larger than the left bronchus and is at almost a straight angle with the trachea.
This anatomical difference makes it easy for the tip of the endotracheal tube to slip into the right bronchus,
depriving the left lung from air. This results in decreased breath sounds on the left.
Rationale 3: High pulmonary pressures would affect both sides equally.
Rationale 4: A partially obstructed endotracheal tube would affect both sides equally.
Rationale 5: A large infiltrate in the left lung will decrease air movement through the tissues. This change in air
movement will decrease breath sounds on the affected side.
Global Rationale:
Cognitive Level: Analyzing

Client Need: Physiological Integrity
Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts: Nursing Process: Assessment
Wagner, High Acuity Nursing, 6/E Test Bank
Copyright 2014 by Pearson Education, Inc.
Learning Outcome: 10-1
Question 2
Type: MCSA
A patient with pulmonary edema has a respiratory rate of 28 per minute. The nurse plans care for this patient
based on which change in the lungs?
1. Decreased work of breathing
2. Reduced muscle activity
3. Dehydration of lung tissues
4. Decreased compliance
Correct Answer: 4
Rationale 1: A respiratory rate of 28 is evidence of increased work of breathing.
Rationale 2: It requires more muscle activity to breath at a rate of 28.
Rationale 3: Pulmonary edema results from retention of fluid in the lung tissues.
Rationale 4: Decreased compliance increases the work of breathing and causes a decreased tidal volume. The
breathing rate increases to compensate for the decreased tidal volume. Examples of pulmonary disorders causing
decreased lung compliance include pulmonary edema.
Global Rationale:

Question 3
Type: MCSA
The patient has been diagnosed with early stage pneumonia. The nurse would anticipate which laboratory results?
1. Increased PaO2 and increased PaCO2
2. Decreased PaO2 and normal PaCO2
3. Normal PaO2 and elevated PaCO2

4. Decreased PaO2 and increased PaCO2
Correct Answer: 2
Rationale 1: Presence of pneumonia will not result in an increase in oxygen.
Rationale 2: In the early stages of pneumonia the alveolar surface area is reduced and the alveolar–capillary
membrane begins to thicken causing diffusion abnormalities. Oxygen and carbon dioxide do not diffuse at the
same rate. Carbon dioxide diffuses 20 times faster than oxygen; therefore, hypoxemia may be present with a
normal PaCO2. Only when the condition progresses untreated will the PaCO2 rise.
Rationale 3: PaCO2 will rise only after the disease has progressed.
Rationale 4: Oxygen will decrease, but PaCO2 will not rise initially.
Global Rationale:

Question 4
Type: MCMA
The nurse is assessing an 80-year-old patient who has no underlying respiratory pathology but whose carbon
dioxide level is slightly elevated. The nurse would contribute this increase to which changes associated with
normal aging?
1. Increase in alveolar–capillary membrane thins
2. Increase in total lung surface area
3. Increase in size of the airways
4. Increase in air trapping
5. Overgrowth of alveoli

Correct Answer: 3,4
Rationale 1: The alveolar–capillary membrane thickens with aging, which may result in hypoxemia and/or
hypercapnia if the older patient becomes ill.
Rationale 2: As a person ages there is a normal decrease in the total lung surface area.
Rationale 3: Aging results in an increase in size of the airways, which increases dead space ventilation. This can
lead to carbon dioxide retention.
Rationale 4: Older patients may have increased air trapping due to normal loss of terminal airway supportive
structures.
Rationale 5: As a person ages, alveoli are destroyed. Overgrowth does not occur.
Global Rationale:

Question 5
Type: MCSA
The arterial blood gases of a patient with a large mass in the right lung show increasing hypoxemia and the patient
will be intubated for placement on a mechanical ventilator. In which position should the nurse place this patient
until intubation is begun?
1. Flat in bed lying on the left side
2. Flat in bed lying on the right side
3. Lying on the left side with the head of the bed elevated to 30 degrees
4. Lying on the right side with the head of the bed elevated 30 degrees
Correct Answer: 3
Rationale 1: Being placed flat in bed will not improve ventilation perfusion. The patient should benefit from
being on the left side.
Rationale 2: This position will not take advantage of gravity or of the body’s natural ventilation tendencies.

Rationale 3: Positioning the patient at 30 degrees and left side down will lower the diaphragm allowing more
expansion and redirect blood flow to the healthy lung because of gravity. Air is naturally drawn toward the
diaphragm and because blood is gravity dependent the ventilation–perfusion ratio will be improved.
Rationale 4: If the right lung is not capable of normal ventilation, redirecting blood flow would result in a
mismatch.
Global Rationale:
Cognitive Level: Applying

Nursing/Integrated Concepts: Nursing Process: Implementation
Question 6
Type: MCSA
A patient, diagnosed with diabetic ketoacidosis, presents with Kussmaul respirations at a rate of 28. A newly
licensed nurse asks the patient to try to slow his breathing. What instruction should the preceptor provide?
1. “Keep trying to slow the patient’s respirations because breathing so fast is hard on his heart.”
2. “If he keeps breathing like that he will develop respiratory acidosis.”
3. “Let the patient set his respiratory rate as rapid breathing helps to compensate for his acidosis.”
4. “The patient is breathing deeply to help offset diabetes-induced hypoxemia.”
Correct Answer: 3
Rationale 1: Breathing rapidly does increase strain on the heart, but the rapid respirations in this situation are
helpful to the patient and should not be discouraged.
Rationale 2: Breathing rapidly and deeply as in Kussmaul’s respirations will not result in respiratory acidosis.
Rationale 3: A patient with diabetic ketoacidosis has a primary metabolic acidosis. As a compensatory
mechanism to regain acid–base homeostasis, alveolar hyperventilation occurs in an attempt to blow off carbon
dioxide and drive the pH upward toward alkaline. The respiratory buffer system is a rapid-response compensatory
mechanism for metabolic acid–base disturbances.
Rationale 4: The patient does not have diabetes-induced hypoxemia.
Global Rationale:

Question 7
Type: MCSA
A postoperative patient’s nasogastric drainage has been 500 mL in the last 8 hours. The nurse would assess this
patient for findings associated with which acid–base imbalance?
1. Metabolic alkalosis
2. Metabolic acidosis
3. Respiratory acidosis
4. Respiratory alkalosis
Correct Answer: 1
Rationale 1: The loss of gastric fluid from nasogastric suction can result in metabolic alkalosis.
Rationale 2: Loss of body fluids from lower abdominal drains would result in loss of bicarbonate and produce
metabolic acidosis.
Rationale 3: The respiratory system is not involved in the development of this acid–base imbalance.
Rationale 4: The respiratory system is not involved in this acid–base imbalance.
Global Rationale:

Question 8
Type: MCSA
A patient was extubated in the postanesthesia recovery room prior to transfer to the intensive care unit (ICU).
Upon admission to the ICU the patient is sedated, but will arouse when stimulated. Blood pressure is 106/68
mm/Hg, heart rate is 68 and regular, temperature is 97.8 F, and respirations are 12 bpm. The nurse would monitor
this patient for which changes in arterial blood gases?
1. Increase in pH and decrease in PaCO2

2. Increase in pH and increase in HCO3
3. Decrease in pH and increase in PaCO2
4. Decrease in pH and decrease in HCO3
Correct Answer: 3
Rationale 1: An increase in pH and decrease in PaCO2 indicates respiratory alkalosis is occurring. This is not the
expected change with this patient.
Rationale 2: These ABG results indicate metabolic alkalosis. This is not the expected change with this patient.
Rationale 3: The patient is at risk for respiratory acidosis, which is associated with these ABG changes, as a
result of decreased, shallow respirations that can cause alveolar hypoventilation. Carbon dioxide is not being
blown off and carbonic acid levels can rise.
Rationale 4: These ABG results indicate metabolic acidosis. This is not the expected change in this patient.
Global Rationale:

Question 9
Type: MCSA
A patient’s arterial blood gases (ABGs) are as follows:
pH 7.30, PaCO2 30 mm Hg, HCO3 14 mEq/L, and PaO2 50. The nurse evaluates these ABGs as representing
which acid–base imbalance?
1. Uncompensated respiratory alkalosis with moderate hypoxemia
2. Compensated metabolic acidosis with severe hypoxemia
3. Partially compensated metabolic acidosis with moderate hypoxemia
4. Partially compensated respiratory alkalosis with mild hypoxemia
Correct Answer: 3
Rationale 1: These ABGs do not represent an uncompensated state.

Rationale 2: These ABGs do not represent a fully compensated state because the pH is not normal.
Rationale 3: The patient has a partially compensated metabolic acidosis with moderate hypoxemia because the
pH is still within the acid range. The HCO3 is the primary acidic metabolic component causing the acidic pH. In
an attempt to correct the metabolic acidosis, the CO2 is being blown off as indicated by the alkaline PaCO2. The
PaO2 falls within the moderate range of hypoxemia (60 to 40 mm Hg).
Rationale 4: These ABGs do not indicate respiratory alkalosis.
Global Rationale:

Question 10
Type: MCSA
A patient's PaO2 level is 76 mm Hg. The nurse would be least concerned regarding this finding in which patient?
1. The patient is 83 years old.
2. The patient is recovering from anesthesia.
3. The patient is a smoker.
4. The patient is intubated.
Correct Answer: 1
Rationale 1: Age affects normal ABG values. The older adult has a 25 to 30% decrease in PaO2 between the ages
of 30 and 80 years.
Rationale 2: Low oxygen levels in a patient who is recovering from anesthesia would alert the nurse to a possible
problem.
Rationale 3: Smoking can decrease oxygenation, but the nurse would be concerned if the level was this low.
Rationale 4: The patient who is intubated should have a PaO2 higher than 76 mm Hg. The nurse would be
concerned about an obstruction in the tube or developing pathology.
Global Rationale:

Question 11
Type: MCSA
The nurse is assessing the nutritional intake of a patient diagnosed with chronic carbon dioxide retention. Which
patient report indicates the patient requires additional information about dietary choices?
1. “I try to eat salad with lunch every day.”
2. “I drink a cup of coffee in the morning with breakfast.”
3. “I usually eat a sandwich and pasta salad for lunch.”
4. “I have been trying to increase the protein in my diet.”
Correct Answer: 3
Rationale 1: Salad is a low fat, high fiber option that would benefit this patient’s nutrition.
Rationale 2: There is no indication that coffee is not appropriate for this patient.
Rationale 3: The patient who retains carbon dioxide should avoid high carbohydrate meals. Carbohydrates
increase the overall carbon dioxide load in the body.
Rationale 4: A protein–calorie deficit weakens muscles, including respiratory muscles. The patient’s attempts to
increase protein in the diet should be reinforced.
Global Rationale:

Question 12
Type: MCSA
The patient complains that he awakens “two or three” times every night because he is so short of breath. The
nurse would ask additional assessment questions about which condition?
1. Paroxysmal nocturnal dyspnea

2. Pneumonia
3. Stroke
4. Kidney infection
Correct Answer: 1
Rationale 1: The patient is describing episodes of paroxysmal nocturnal dyspnea, which is related to left
ventricular failure. The prolonged supine position allows dependent fluid from the lower extremities to recirculate
causing volume overload and sudden severe dyspnea.
Rationale 2: Pneumonia results in consolidation of lung tissue. It is not associated with sudden dyspnea during
the night.
Rationale 3: There is no indication that a neurological problem is causing this patient’s symptoms.
Rationale 4: There is no indication that this patient is experiencing shortness of breath at night due to a kidney
infection. Kidney infection might result in need to urinate frequently during the night.
Global Rationale:

Learning Outcome:
Question 13
Type: MCSA
The nurse is auscultating a patient’s lung fields and hears a coarse sound like bubbling water. The sounds are
heard best on expiration and in the center of the patient’s chest. How should the nurse document these sounds?
1. Crackles
2. Rhonchi
3. Wheeze
4. Stridor
Correct Answer: 2
Rationale 1: Crackles are discrete, delicate popping sounds heard best on inspiration.

Rationale 2: Rhonchi are course bubbly sounds that frequently occur during expiration and are heard over the
larger airways.
Rationale 3: Wheezes are musical sounds that may be high-pitched or low-pitched. They are heard both on
inspiration and expiration and are of long duration.
Rationale 4: Stridor is a type of wheeze. It is high-pitched, inspiratory, and heard best over the neck.
Global Rationale:

Question 14
Type: MCSA
The nurse is planning to use a respiratory spirometer to measure the amount of air that moves in and out of a
patient’s lungs with each normal breath. How will the nurse document the results of this test?
1. Tidal volume
2. Vital capacity
3. Forced expiratory volume
4. Minute ventilation
Correct Answer: 1
Rationale 1: Tidal volume is the amount of air that moves in and out of the lungs with each normal breath.
Rationale 2: Vital capacity is the maximum amount of air expired after a maximal inspiration.
Rationale 3: Forced expiratory volume testing generally is not conducted as a bedside trending parameter.
Rationale 4: Minute ventilation is the total volume of expired air in 1 minute and is not a direct measurement but
a simple calculation.
Global Rationale:


Question 15
Type: MCSA
A patient is undergoing testing to differentiate her airway disorder as being restrictive or obstructive. The nurse
would evaluate a normal result on which test to indicate a restrictive disorder is present?
1. Vital capacity
2. Tidal volume
3. Minute ventilation
4. Forced expiratory volume
Correct Answer: 4
Rationale 1: Vital capacity is the maximum amount of air expired after a maximal inspiration. Vital capacity
decreases in the presence of restrictive pulmonary diseases.
Rationale 2: Tidal volume is the amount of air that moves in and out of the lungs with each normal breath. Tidal
volume decreases when lung diseases exist. Results do not differentiate between restrictive and obstructive
disorders.
Rationale 3: Minute ventilation measures total lung ventilation changes. It may be abnormal in either restrictive
or obstructive diseases.
Rationale 4: Forced expiratory volume measures how rapidly a person can forcefully exhale air after a maximal
inhalation, measuring volume over time. Patients who have a restrictive airway problem are able to push air
forcefully out of their lungs at a normal rate.
Global Rationale:

Question 16
Type: MCSA
A 40-year-old postoperative patient has a hemoglobin level of 8 g/dL and a SaO2 of 95 percent. Considering all
aspects, what conclusion would the nurse make about this patient’s condition?
1. The patient is stable and at no special risk.
2. Oxygenation is adequate for a postoperative patient.
3. This patient has a potential risk of hypoxia.
4. The patient’s SaO2 is higher than expected for the patient’s age.
Correct Answer: 3
Rationale 1: This patient’s test results do indicate a risk potential.
Rationale 2: It is not possible to accurately assess this patient’s true oxygenation status from the test results
provided.
Rationale 3: The patient has a potential risk for hypoxia because SaO2 is the measure of percentage of oxygen
combined with hemoglobin compared to the total amount it could carry. Although the patient's SaO2 is within
normal range, the hemoglobin is only 8 g/dL, indicating that all 8 grams are adequately being saturated. Should
the patient's oxygen demand increase, as it frequently will in a postoperative patient, the potential for hypoxia
may exist because of the lower hemoglobin and inability to carry more oxygen to meet the demand.
Rationale 4: The SaO2 is within normal limits for the patient’s age; however, its accuracy is at doubt.
Global Rationale:

Question 17
Type: MCMA
A nurse is participating on a committee charged with the task of choosing capnography equipment for a new
emergency department. The nurse should present which information regarding these choices?
1. Sidestream analyzers provide direct real-time measurements of ETCO2.
2. Mainstream analyzers require the patient to be intubated.

3. Colorimetric capnography is useful for determining accurate placement of endotracheal tubes.
4. Mainstream analyzers provide continuous ETCO2 measurements.
5. Colorimetric measurement provides a wide range of color results that are compared to a standard chart.
Correct Answer: 2,3,4
Rationale 1: The major disadvantage of sidestream analyzers is that values are indirect estimated measurements.
Rationale 2: A major disadvantage to the mainstream technique is that it requires the patient to be intubated.
Rationale 3: Colorimetric capnography can be used in the ED or in the field to determine accurate placement of
endotracheal tubes.
Rationale 4: Mainstream analyzers are placed in-line as part of the airway circuit and continuously measure the
ETCO2. The measurement is real-time.
Rationale 5: Colorimetric measurement responds to the patient’s exhaled CO2 with three color ranges.
Global Rationale:

Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Planning
Question 18
Type: MCMA
A patient with severe chronic respiratory illness suddenly develops a high fever. The nurse would plan care for
this patient based upon which understanding of the fever’s impact on the oxyhemoglobin dissociation curve?
1. The curve will shift to the right.
2. Additional oxygen will be released to the tissues.
3. Life-threatening tissue hypoxia may occur.

4. The change will be similar to what occurs with alkalosis.
5. Hemoglobin will bind more readily to oxygen.
Correct Answer: 1,2,3
Rationale 1: Increased temperature causes increased oxygen demand which shifts the curve to the right.
Rationale 2: Increasing body temperature increases oxygen demand, so additional oxygen will be released to the
tissue to meet this demand.
Rationale 3: Severe and rapid shifts in the curve can result in life-threatening tissue hypoxia.
Rationale 4: Alkalosis causes an opposite response in the oxyhemoglobin dissociation curve and inhibits oxygen
release at the tissue level.
Rationale 5: Hemoglobin binds more readily to oxygen in the lungs when the patient is hypothermic.
Global Rationale:

Nursing/Integrated Concepts: Nursing Process: Planning
Question 19
Type: MCMA
A patient’s PaO2 is 88 mm Hg while on FiO2 of 0.50. What can the nurse conclude about this patient’s
intrapulmonary shunt?
1. The shunt is estimated to be 176.
2. The shunt is estimated to be 568.
3. The shunt is below the minimum acceptable level.
4. This data has little use in determining oxygenation status of the patient who is retaining CO2.

5. No determination of intrapulmonary shunt can be made from this data.
Correct Answer: 1,3
Rationale 1: Calculating the P/F ratio is the simplest way to estimate intrapulmonary shunt. In this case the value
is 176.
Rationale 2: This is not a valid estimation of intrapulmonary shunt.
Rationale 3: The minimum acceptable level is higher than this estimation of intrapulmonary shunt.
Rationale 4: As long as the PaCO2 is stable this estimation is valid and is applicable to oxygenation status.
Rationale 5: Intrapulmonary shunt can be estimated by comparing this data.
Global Rationale:

Question 20
Type: MCSA
A nurse who is evaluating a patient’s arterial blood gases has determined that the patient’s pH is acidic. What is
the next question the nurse would ask in this interpretation?
1. Is the patient symptomatic of an acidic condition?
2. Which individual ABG component matches the pH acid–base state?
3. Is the PaCO2 within normal range?
4. Is HCO3 within normal range?
Correct Answer: 3
Rationale 1: The patient’s symptoms are not considered at this point in the evaluation.
Rationale 2: The nurse has not yet assessed the components, so this question is premature.
Rationale 3: After determining the pH status, the next step is evaluation of PaCO2.
Rationale 4: The HCO3 is not assessed at this point.

Global Rationale:


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yli aitasi ahtaan rajan
ulos suurille niityille karkeloon
cancanin villissä vauhdissa
keltaisen taivaan alla —
minä siunaan sinut valkeilla käsilläni
ja murskaan liikkumattomuutesi tappavan loihdun!
———————
KAUKANA MERELLÄ.
Minä olen niin tumma ja kaunis,

ja ihmeelliset aarteet uinuvat aaltojeni alla,
olen öisin kaikkien tähtien hiljainen vuode
ja auringon kullan ja helmien äänetön vahti.
Mutta minä olen niin yksin,
rikkauteni on minulle kärsimys
ja kauneuteni tekee murheelliseksi.
Miten ikävöinkään rakkautta ja punaista verta!
Ah — te itkette, ihmisten tyttäret, valkeita ja väkeviä

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koskaan: suurempi ja mahtavampi olin minä teitä, ja joka ei
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— Mutta kaikki ovat he niin hiljaisia ja kylmiä nukkuessaan

linnani salissa; olen sulkenut heidät näkinkenkiini ja
ympärilleen kasvavat hohtavat helmet. Luulen, että he ovat
onnellisia — mutta miksi eivät he vastaa minulle kun
myrskyisinä öinä huudan tuskaani simpukkatorviin tai
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pimeydessä! Miten väkevänä tunsinkaan voimansa
syleilyssäni silloin!
— nyt lepää hän jäykkänä halliten muita nukkujia suuressa

salissa, lyhtykalojen himmeässä valossa aaltoilevat hiuksensa
hiljaa. Joka yö suutelen häntä kun ylhäältä kuuluu ihmisten
puhe ja nauru ja hiljainen musiikki liukuvista venheistä — —
— Itken mustia helmiä hänen rinnalleen.
TUMMAT ILLAT.
Iltojen tummuessa ovat kaikki tähdet välähtäneet näkyviin:

kylmät naulat kuolleen kesän mustalla arkulla.
Mutta pimeän maan kamaralla tuoksuvat

ympärilläni kaikki kukkaset
ja puutarhat ovat
kuin ruumiskappelit
täynnä suitsutusta ja mykkien
rukousten tuskallista kiihkoa.
Ja minun vihani nousee vastaanne,

te kylmät ja rauhalliset siellä korkealla,
kuin välähtelevä, pitkä veitsi
kaikkien kuolevien verestä huuruavana!
Ja teidän jumalallista ikuisuuttanne vastaan asetan
katoovaisuuden ihanan hurmion
ja suuren kärsimyksen!
Sillä ihanassa kristallivaa'assa
Jumalan kasvojen edessä
on ikuinen, valtava tähti
painava vähemmän kuin auringon oikusta elämään tullut,
yhdessä yössä kuoleva
pieni kukka.
OUTO SERENADI.
Minä laulan sinulle hiljaa, mustiinverhottu Kuolema, kun sinä

vihdoin saavut astuen syyskuun tähtien alla:
Niin ihanaa ompi sulkea lepohon silmät, jotka väsyneet ovat

elämän kauneudesta, niin ihanaa ompi tuntea raukeiksi
huulet, jotka huutaneet ovat rajuutta tuskan ja riemun.
Olet murheellinen, Kuolema, hyvä ja kaunis, olet lempeä

ystävä, jolle voi uskoa kaiken, ja uupuneet unelmat viet sinä
himmeään lepoon — siksi laulan sinulle hiljaa niinkuin yksin
laulaa voi vain sille, joka on saanut ja ottanut kaiken — kun
sinä kuolleitten kukkien seppele päässä kuljet ohitse
syyskuun tähtien alla.
ILMARI PIMIÄ: NÄKINKENKÄ
AKORDI.
Kuin unelma kaunis luoksi tuli kukkiva kevätkuu. Sen

syttämän riemun vuoksi vois' sammua kaikki muu.
Maat vihreät, tummat vuoret,

haan lehdikot varjokkaat
saa kätkeä tunteet nuoret,
salat sadat ja voimakkaat.
Ylin onni ja autuus suuri — kevätmuistelo elää voi, vaikk'

kulkevi talvi juuri ja kylmät vihurit soi! —
HERÄNNYT KEVÄT.
Mikä siipien suhina ja sävelten helinä? —

Pääskyset! Ovatko ne jo tulleet?
Nyt on siis kevät — omiin vaaleanpunaisiin
ajatuksiini painuen en sitä huomannutkaan.
Puhkeavain omenapuiden alla olen istunut
käsi armahan kädessä, enkä ole tuntenut
tuoksujen huumaa:
hänen pyytävät silmänsä vain olen nähnyt ja
janoisesti väriseväin huulteni tuntenut olevan
hänen huulillaan —
muu kaikki on saanut huojuen kulkea ohitse
tajuntani.
Minä olen kuin uudesti syntynyt — uusi

elämä on vaikuttanut voimakkaasti,
elämä on minun, ei mikään maallinen mahti
saattaisi sammumaan saada sen syttämää tulta,
minä olen jo liiaksi ehtinyt imeä itseeni sen
kasvavaa suuruutta hänen kauttaan, joka on
minun onneni.
— Tunkekaa, tunkekaa sieluuni saakka, te
silmien säteet, jotka pitkien ripsien raosta
paistatte kuin kalvas kulta,
teidän ihmeellinen lämpönne on kuumempi
itse aurinkoa!
Miten kaikki lie tapahtunut, en ymmärrä.

Hän on äkkiä voittanut sydämeni —
se on asia, jonka salaperäisesti roihuva
rakkaus yksin kykenee selville tuomaan.
— Kevät, kevät! — Sinä vaarallinen kevät,
katso, sinä olet lumonnut minut niin, ettei
minulla ole tahdonvoimaa:
tiedotonna kuin humalainen painun onnesta
vavisten armaan aukaistuun syliin uupuen
suudelmainsa unijuomaan…
Suloinen on elämä! — Omenapuun kukat,
haudatkaa meidät tuoksuihinne!
PUUTARHA-ODOTUS.
Koko päivän minä olen kulkenut puutarhassa

poimien punaisia ruusuja.
Aurinko on vuodattanut valtaisen runsauden
säteittensä hohdetta ylitse pääni.
Tuon tuostakin olen nojannut säleaitaan ja

katsonut tomuiselle tielle:
se näyttää kovin hyljätyltä, mutta eiköhän
sieltä pian alkane kuulua askelten ääni,
kevyt ja hiljainen askelten ääni.
Minun armaani on mennyt, mutta hänen

pitäisi vielä tänään palata luokseni,
niin lupasi hän. — Ah, tiedän, että hän
rakastaa minua — sen olen monesti lukenut
kasvoiltansa.
Siksi palvelen häntä ja vien hänelle kimpun

poimimiani kukkia,
hän hymyilee niille, ne saavat painua poskeensa
ja juoda janoiset suudelmat hänen huuliltansa,
hänen pieniltä, kauniilta huuliltansa.
Sydämessäni on alkanut soida aavistelevana
värinänä heränneen lemmen sävel
ja se on saattanut uneksuvan sieluni vavahtamaan
salaperäisestä odotuksesta.
Sormiini on tullut haavoja, paljon punaista

verta tihkuvia haavoja,
mutta minä en huomaa mitään, olen kuin
päihtynyt pyörryttävän pyhästä onnesta,
nopeasti lähestyvästä onnesta.
Vihreä muratti, kohoa korkeammalle ja,

kukkaset, nostakaa päänne ylös —
te ette saa uupua päivän helteestä, pian
ympärillänne humisee kastehelminen puisto!
Oi puutarhani, miten suuresti sinua rakastan

hänen, minun armaani, tähden —
jokaisessa sopessasi väikkyy hohtavana
kuningaskukkana vierellään vietettyjen hetkien muisto,
unohtumattomien hetkien ihana muisto.
KUU PAISTAA…
Kuu paistaa kukkulan takaa, puut tummat varjoja luo, tien yli
ne pitkinä makaa — ei peljätä tummuus tuo.
Me kahden kuljemme lehtoon,

kylä jäänyt jo kauas on.
Ah, aina me tullessa ehtoon
näin painumme varjohon.
Ei ääntämme kenkään kuulle, yö mykkä se suojaa näin.

Kuu kulkevi puulta puulle yli latvain väriseväin…
SYKSYINEN LÄHTÖ.
Miten tuntuneekin ihmisen elämä joskus

niin oudon autiolta ja tyhjältä,
on kuin unelmain kukat veisi halla ja sydän
turhaan itkisi mennyttä kesäänsä.
Kaikki on yhdentekevää, millään ei ole mitään
merkitystä, mikään ei ole pysyväistä —
näin ajatellen heitän jäähyväiset ystävälleni
ja jään tuijottamaan hänen jälkeensä.
Hänen täytyy lähteä ja minä en voi sille
mitään.
Syksyinen tuuli soi humisten ja laskeva

aurinko näyttää purppuranpunaiselta,
juoksevan veren lailla se värjää riippuvat
pilvet ja valuu alas tunturin pieltä.
Pian tulee hirveä sade itkien pitkään ja
äänekkäästi kuin syvästi loukattu lapsi.
Itseni hyljätyksi tuntien käännyn kotiin ja

koetan viihdyttää haavoittunutta mieltä.
Särkyneet unelmat eivät milloinkaan anna
lepoa!
Ruskeat lehdet lentävät ja kylmät aallot
kolkuttavat rantaa — niilläkin on suru.
Mikä voisikaan tänä vaikeana hetkenä nostattaa
raskaasti maahan painuvaa jalkaa!
Puutarha ympärilläni on paljastuttuansa
tullut kaamoittavan suureksi ja tyhjäksi.
— Oi ystäväni, tiesinhän, tiesinhän minä
että lähdettyäsi kärsimykseni alkaa!
Minun mieltäni ei saata enää ilahduttaa
mikään…
PITKÄ ILTA.
Istun, viettäen iltaa, vierellä majan. Vaappuu kun vanhaa

siltaa vankkuri ajan.
Painuu peittohon puiden

aurinko vapaa.
Ääntä ei yhtään muiden
korvani tapaa.
Autius sieluun saartuu,

suuri ja syvä.
Kaste-kosteena kaartuu
yö lähestyvä.
Taisi jo linnut armaat

laulusta laata.
Hämärän hartiat harmaat
hipovat maata.
———
Lien ma valkea vainaa
lepoa vailla:
murheiset muistot painaa
turpehen lailla.
TÄÄ KUKKANEN…
Yö hiljainen, ei lehden havinaa — ajatus arka säikkyy

sydämessä: tää kukkanen, mi janoo suudelmaa, oi oisko
onnen alku keväimessä?
Yö huumeinen — ja kaksi vavahtaa… käy joku äänetönnä

ovessani. Tää kukkanen ja sata suudelmaa jää polttamaan
kuin tuli povessani.
Yö kaukainen pois vierryt vuotten taa, ja armas entinen jo

sydän jäässä! Tää kukkanen, mi salaa suudelmaa: suruinen
merkki tarinamme päässä.
LAULU ILTATÄHDILLE.
Ilta oli tullut suurena ja kauniina —

kauniimpana kuin koskaan ennen.
Kaukaa kuului etäisten korpien poveen
katoavan virran kohiseva juoksu.
Me olimme kulkeneet paljon ja istuutuneet
väsyneinä hämärtyvän lehdon viileään syliin
ja ympärillämme oli puhjenneiden kukkien
voimakas tuoksu.
Tähdet, ah tähdet — te leimusitte silloin!
Minä katselin, kallis, sinua: korkea otsasi

näytti kalpealta.
Liekö sen aiheuttanut ylhäällä väriseväin
tähtien valkea valo.
Äkkiä vapisutti, sillä tunsin, että raukea
ruumiisi oli oudon lähellä minua,
niin että sydäntäni lämmitti sun sydämesi
hehkuva palo.
Sinä kuiskasit: »oi armaani», ja kiersit
käsivartesi ympärilleni,
ja sun rakkautesi oli janoinen kuin yrtti
suolaisessa erämaassa.
Koko yön vallan suutelin sinua, sillä tahdoin
juopua lumoavien huultesi hurmasta
ja vuodattaa sinuun olemukseni riemun unessa
autuaassa.
———
Sydämen liekki sammuu aikanaan ja punaisten

huulten hurma katoaa pois —
se on vain elämää: vihreän kesän jälkeen
tulee aina alaston syksyn kuu.
— Nyt olet sinä mennyt! Lehdossa on
tallattuja kukkia ja maahan kääntynyt ruoho
kuivettuu.
Lämpöä vailla pudottaa lehtensä sinun
lempesi loihtima puu…
Tähdet, ah tähdet — ette leimua enää! —

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Standard Text: Select all that apply.

1. Pressure from a right pneumothorax

2. Misplacement of the endotracheal tube

3. High pulmonary pressures

4. Partial obstruction of the endotracheal tube

5. A large infiltrate in the left lung

Correct Answer: 2,5

Rationale 3: High pulmonary pressures would affect both sides equally.

Cognitive Level: Analyzing

1. Decreased work of breathing

2. Reduced muscle activity

3. Dehydration of lung tissues

Rationale 1: A respiratory rate of 28 is evidence of increased work of breathing.

Rationale 2: It requires more muscle activity to breath at a rate of 28.

Cognitive Level: Analyzing

1. Increased PaO2 and increased PaCO2

2. Decreased PaO2 and normal PaCO2

3. Normal PaO2 and elevated PaCO2

Rationale 1: Presence of pneumonia will not result in an increase in oxygen.

Cognitive Level: Analyzing

Standard Text: Select all that apply.

1. Increase in alveolar–capillary membrane thins

2. Increase in total lung surface area

3. Increase in size of the airways

4. Increase in air trapping

Wagner, High Acuity Nursing, 6/E Test Bank

Cognitive Level: Analyzing

1. Flat in bed lying on the left side

2. Flat in bed lying on the right side

Wagner, High Acuity Nursing, 6/E Test Bank

Cognitive Level: Applying

2. “If he keeps breathing like that he will develop respiratory acidosis.”

4. “The patient is breathing deeply to help offset diabetes-induced hypoxemia.”

Rationale 4: The patient does not have diabetes-induced hypoxemia.

Cognitive Level: Analyzing

Rationale 4: The respiratory system is not involved in this acid–base imbalance.

Cognitive Level: Applying

1. Increase in pH and decrease in PaCO2

3. Decrease in pH and increase in PaCO2

4. Decrease in pH and decrease in HCO3

Cognitive Level: Analyzing

A patient’s arterial blood gases (ABGs) are as follows:

1. Uncompensated respiratory alkalosis with moderate hypoxemia

2. Compensated metabolic acidosis with severe hypoxemia

3. Partially compensated metabolic acidosis with moderate hypoxemia

4. Partially compensated respiratory alkalosis with mild hypoxemia

Rationale 1: These ABGs do not represent an uncompensated state.

Wagner, High Acuity Nursing, 6/E Test Bank

Rationale 4: These ABGs do not indicate respiratory alkalosis.

Cognitive Level: Analyzing

1. The patient is 83 years old.

2. The patient is recovering from anesthesia.

3. The patient is a smoker.

4. The patient is intubated.