Overview of Child Health Nursing

Child Health Nursing

Focuses on protecting children from

illness and injury

Assists children to obtain optimal levels of wellness

Primary roles of the Pediatric Nurse

Care provider

Educator

Advocate
Pediatric Health Statistics

Infant Mortality
o
Number of deaths per
1000 live births during 1
st
year of life.

o
Infant mortality rate is an indicator of how healthy the nation is.
o
This rate is used to compare national health care to previousyears and to other
countries.
o
There has been a great decrease in the number of deaths overthe past century.

In 1997, 6.9 per 100 live births.

Childhood Mortality

For children older than one year, death rates have always been lessthan those for
infants.

In later adolescence, there is a sharp rise in deaths.

Injuries; the leading killer in childhood

Injuries cause more death and disabilities in children than anydiseases.

Some examples include:

o
Motor vehicle accidents are the leading cause of death inchildren over 1 year of
age.
o

Majority of deaths are due to no use of seatbelts.

Drowning is 2
nd
leading cause of death in boys 1-14; both sexes 15-24years old. Drowning is the 3
rd
leading cause of death for girls 1-14.

Burns are the 2

nd
leading cause of death from injury in girls and the 3
rd
in boys from 1-14 years old.
Childhood Morbidity (Illness)

An illness or injury that limits activity, requires medical attention orhospitalization,

or results in a chronic condition.

Examples:
o
Congenital heart defects
o
Asthma
o
Cerebral Palsy
o
Cystic Fibrosis


Concerned with helping to decrease these statistics as children missschool and
other activities when ill.
Advanced Practice roles for nurses in Child health nursing

Family nurse practitioner

Neonatal nurse practitioner

Pediatric nurse practitioner

Nurse midwife
Growth and Development

Growth : used to show an increase in

physical size
or a significantchange.

Includes:
o
Height
o
Weight
o
Head circumference


Development : Used to denote an increase in
skill or ability to finction
.

Measured by:
o
Observing child do specific tasks
o
Parents description of childs ability
o
Using standardized testing (Denver II screening test)
Principles of Growth and development
G & D is a continuous process from birth to death
o
Rate of growth varies at different times

G & D proceeds in an orderly manner

o
Growth from smaller to larger
o
Development: from sitting to crawling to walking

Different children pass through the predictable stages at different rates

All body systems do not develop at the same time.


CNS, Cardiac develops quickly.

Lungs are typically the last to develop.

Development is
Cephalicaudal
,
which is the 3
rd
principle of G & D. Headto toe.
Development goes from
proximal to distal,
which is the 4
th
principle.

Example: Development proceeds from gross to refined.

A child cannot learn tasks until the nervous system is ready.

Neonatal reflexes must be lost before development can proceed.

Factors that influence growth and development

Genetics

Gender

Health

Intelligence
Temperament

Inborn in all of us

A way of reacting to the world around us

Reaction Patterns:

Activity level
o
Level of activity differs widely among children

Rhythmicity
o
Have a regular rhythm is physiologic terms

Approach

Childs response to a new situation

Adaptability
o
Is the child able to adapt to new situations?

Intensity of reaction

Distractibility

Attention span and persistence

Mood quality
Categories of temperament

The Easy Child

o
Easy to care for if they have predictable rhythmicity, approachand easily adapt to
new situations, have a mild to moderateintensity of reaction, and an overall positive
mood quality.
o
40-50% of children fall into this category

The Difficult child

o

Children are difficult if irregular in habits, have negative moodquality, and

withdraw from new situations
o
10% of children fit this image.

Slow to warm up child

o
Describes children who are overall fairly inactive, respond onlymildly, adapt slowly
to new situations, and have a generalnegative mood.
o
15% of children display this pattern.
Other factors that impact growth and development

Environment

Socioeconomic level

Parent-child relationship

Position of birth in the family

Health

Nutrition

As a child normally develops somewhat predictably in growth andphysical

development, he also matures emotionally, intellectually, andspiritually along
certain paths.
Review:

Eriksons theory of Psychosocial development

Piagets theory of cognitive development

Kohlbergs theory of Moral development

Text Mode Text version of the exam

1. The nurse is caring for a male client with a chest tube. If the chest drainage system is
accidentally disconnected, what should the nurse plan to do?
A. Place the end of the chest tube in a container of sterile saline.

B. Apply an occlusive dressing and notify the physician.

C. Clamp the chest tube immediately.
D. Secure the chest tube with tape.
2. A male elderly client is admitted to an acute care facility with influenza. The nurse monitors
the client closely for complications. What is the most common complication of influenza?
A. Septicemia
B. Pneumonia
C. Meningitis
D. Pulmonary edema
3. A female client has a tracheostomy but doesnt require continuous mechanical ventilation.
When weaning the client from the tracheostomy tube, the nurse initially should plug the opening
in the tube for:
A. 15 to 60 seconds.
B. 5 to 20 minutes.
C. 30 to 40 minutes.
D. 45 to 60 minutes.
4. Gina, a home health nurse is visiting a home care client with advanced lung cancer. Upon
assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10
breaths/minute. These signs are associated with which condition?
A. Hypoxia
B. Delirium
C. Hyperventilation
D. Semiconsciousness
5. A male client with Guillain-Barr syndrome develops respiratory acidosis as a result of
reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms
respiratory acidosis?
A. pH, 5.0; PaCO2 30 mm Hg

B. pH, 7.40; PaCO2 35 mm Hg

C. pH, 7.35; PaCO2 40 mm Hg
D. pH, 7.25; PaCO2 50 mm Hg
6. A female client with interstitial lung disease is prescribed prednisone (Deltasone) to control
inflammation. During client teaching, the nurse stresses the importance of taking prednisone
exactly as prescribed and cautions against discontinuing the drug abruptly. A client who
discontinues prednisone abruptly may experience:
A. hyperglycemia and glycosuria.
B. acute adrenocortical insufficiency.
C. GI bleeding.
D. restlessness and seizures.
7. A male client is admitted to the health care facility for treatment of chronic obstructive
pulmonary disease. Which nursing diagnosis is most important for this client?
A. Activity intolerance related to fatigue
B. Anxiety related to actual threat to health status
C. Risk for infection related to retained secretions
D. Impaired gas exchange related to airflow obstruction
8. A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial
oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the
manifestations?
A. Simple mask
B. Non-rebreather mask
C. Face tent
D. Nasal cannula
9. A male adult client with cystic fibrosis is admitted to an acute care facility with an acute
respiratory infection. Prescribed respiratory treatment includes chest physiotherapy. When should
the nurse perform this procedure?

A. Immediately before a meal

B. At least 2 hours after a meal
C. When bronchospasms occur
D. When secretions have mobilized
10. On arrival at the intensive care unit, a critically ill female client suffers respiratory arrest and
is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the clients
arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse
oximetry values?
A. Fever
B. Tachypnea
C. Tachycardia
D. Hypotension
11. The nurse is caring for a male client who recently underwent a tracheostomy. The first
priority when caring for a client with a tracheostomy is:
A. helping him communicate.
B. keeping his airway patent.
C. encouraging him to perform activities of daily living.
D. preventing him from developing an infection.
12. For a male client with chronic obstructive pulmonary disease, which nursing intervention
would help maintain a patent airway?
A. Restricting fluid intake to 1,000 ml/day
B. Enforcing absolute bed rest
C. Teaching the client how to perform controlled coughing
D. Administering prescribed sedatives regularly and in large amounts
13. The amount of air inspired and expired with each breath is called:
A. tidal volume.

B. residual volume.
C. vital capacity.
D. dead-space volume.
14. A male client with pneumonia develops respiratory failure and has a partial pressure of
arterial oxygen of 55 mm Hg. Hes placed on mechanical ventilation with a fraction of inspired
oxygen (FIO2) of 0.9. The nursing goal should be to reduce the FIO2 to no greater than:
A. 0.21
B. 0.35
C. 0.5
D. 0.7
15. Nurse Mickey is administering a purified protein derivative (PPD) test to a homeless client.
Which of the following statements concerning PPD testing is true?
A. A positive reaction indicates that the client has active tuberculosis (TB).
B. A positive reaction indicates that the client has been exposed to the disease.
C. A negative reaction always excludes the diagnosis of TB.
D. The PPD can be read within 12 hours after the injection.
16. Nurse Murphy administers albuterol (Proventil), as prescribed, to a client with emphysema.
Which finding indicates that the drug is producing a therapeutic effect?
A. Respiratory rate of 22 breaths/minute
B. Dilated and reactive pupils
C. Urine output of 40 ml/hour
D. Heart rate of 100 beats/minute
17. What is the normal pH range for arterial blood?
A. 7 to 7.49
B. 7.35 to 7.45

C. 7.50 to 7.60
D. 7.55 to 7.65
18. Before weaning a male client from a ventilator, which assessment parameter is most
important for the nurse to review?
A. Fluid intake for the last 24 hours
B. Baseline arterial blood gas (ABG) levels
C. Prior outcomes of weaning
D. Electrocardiogram (ECG) results
19. Which of the following would be most appropriate for a male client with an arterial blood gas
(ABG) of pH 7.5, PaCO2 26 mm Hg, O2 saturation 96%, HCO3 24 mEq/L, and PaO2 94 mm
Hg?
A. Administer a prescribed decongestant.
B. Instruct the client to breathe into a paper bag.
C. Offer the client fluids frequently.
D. Administer prescribed supplemental oxygen.
20. A female client is receiving supplemental oxygen. When determining the effectiveness of
oxygen therapy, which arterial blood gas value is most important?
A. pH
B. Bicarbonate (HCO3)
C. Partial pressure of arterial oxygen (PaO2)
D. Partial pressure of arterial carbon dioxide (PaCO2)
21. Nurse Julia is caring for a client who has a tracheostomy and temperature of 103 F (39.4
C). Which of the following interventions will most likely lower the clients arterial blood oxygen
saturation?
A. Endotracheal suctioning
B. Encouragement of coughing

C. Use of cooling blanket

D. Incentive spirometry
22. For a male client who has a chest tube connected to a closed water-seal drainage system, the
nurse should include which action in the plan of care?
A. Measuring and documenting the drainage in the collection chamber
B. Maintaining continuous bubbling in the water-seal chamber
C. Keeping the collection chamber at chest level
D. Stripping the chest tube every hour
23. Nurse Eve formulates a nursing diagnosis of Activity intolerance related to inadequate
oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the
nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions
include:
A. drinking more than 1,500 ml of fluid daily.
B. being overweight.
C. eating a high-protein snack at bedtime.
D. eating more than three large meals a day.
24. A black male client with asthma seeks emergency care for acute respiratory distress. Because
of this clients dark skin, the nurse should assess for cyanosis by inspecting the:
A. lips.
B. mucous membranes.
C. nail beds.
D. earlobes.
25. A female client with asthma is receiving a theophylline preparation to promote
bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the clients serum
theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls
within which range?
A. 1 to 2 mcg/ml

B. 2 to 5 mcg/ml
C. 5 to 10 mcg/ml
D. 10 to 20 mcg/ml
26. A male client is to receive I.V. vancomycin (Vancocin). When preparing to administer this
drug, the nurse should keep in mind that:
A. vancomycin should be infused over 60 to 90 minutes in a large volume of fluid.
B. vancomycin may cause irreversible neutropenia.
C. vancomycin should be administered rapidly in a large volume of fluid.
D. vancomycin should be administered over 1 to 2 minutes as an I.V. bolus.
27. Before seeing a newly assigned female client with respiratory alkalosis, the nurse quickly
reviews the clients medical history. Which condition is a predisposing factor for respiratory
alkalosis?
A. Myasthenia gravis
B. Type 1 diabetes mellitus
C. Extreme anxiety
D. Narcotic overdose
28. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate
of 44 breaths/minute. Hes anxious, and wheezes are audible. The client is immediately given
oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the clients
arterial blood oxygen saturation is 86% and hes still wheezing. The nurse should plan to
administer:
A. alprazolam (Xanax).
B. propranolol (Inderal)
C. morphine.
D. albuterol (Proventil).
29. Pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?
A. Encouraging the client to drink three glasses of fluid daily

B. Keeping the client in semi-Fowlers position

C. Using a high-flow Venturi mask to deliver oxygen as prescribed
D. Administering a sedative as prescribed
30. Nurse Joana is teaching a client with emphysema how to perform pursed-lip breathing. The
client asks the nurse to explain the purpose of this breathing technique. Which explanation
should the nurse provide?
A. It helps prevent early airway collapse.
B. It increases inspiratory muscle strength
C. It decreases use of accessory breathing muscles.
D. It prolongs the inspiratory phase of respiration.
Answers and Rationales

1. Answer A. If a chest drainage system is disconnected, the nurse may place the end of the
chest tube in a container of sterile saline or water to prevent air from entering the chest
tube, thereby preventing negative respiratory pressure. The nurse should apply an
occlusive dressing if the chest tube is pulled out not if the system is disconnected. The
nurse shouldnt clamp the chest tube because clamping increases the risk of tension
pneumothorax. The nurse should tape the chest tube securely to prevent it from being
disconnected, rather than taping it after it has been disconnected.
2. Answer B. Pneumonia is the most common complication of influenza. It may be either
primary influenza viral pneumonia or pneumonia secondary to a bacterial infection. Other
complications of influenza include myositis, exacerbation of chronic obstructive
pulmonary disease, and Reyes syndrome. Myocarditis, pericarditis, transverse myelitis,
and encephalitis are rare complications of influenza. Although septicemia may arise when
any infection becomes overwhelming, it rarely results from influenza. Meningitis and
pulmonary edema arent associated with influenza.
3. Answer B. Initially, the nurse should plug the opening in the tracheostomy tube for 5 to
20 minutes, and then gradually lengthen this interval according to the clients respiratory
status. A client who doesnt require continuous mechanical ventilation already is
breathing without assistance, at least for short periods; therefore, plugging the opening of
the tube for only 15 to 60 seconds wouldnt be long enough to reveal the clients true
tolerance to the procedure. Plugging the opening for more than 20 minutes would
increase the risk of acute respiratory distress because the client requires an adjustment
period to start breathing normally.
4. Answer A. As the respiratory center in the brain becomes depressed, hypoxia occurs,
producing wheezing, bradycardia, and a decreased respiratory rate. Delirium is a state of

mental confusion characterized by disorientation to time and place. Hyperventilation

(respiratory rate greater than that metabolically necessary for gas exchange) is marked by
an increased respiratory rate or tidal volume, or both. Semiconsciousness is a state of
impaired consciousness characterized by limited motor and verbal responses and
decreased orientation.
5. Answer D. In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and
partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore, the
combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory
acidosis. A pH value of 5.0 with a PaCO2 value of 30 mm Hg indicates respiratory
alkalosis. Options B and C represent normal ABG values, reflecting normal gas exchange
in the lungs.
6. Answer B. Administration of a corticosteroid such as prednisone suppresses the bodys
natural cortisol secretion, which may take weeks or months to normalize after drug
discontinuation. Abruptly discontinuing such therapy may cause the serum cortisol level
to drop low enough to trigger acute adrenocortical insufficiency. Hyperglycemia,
glycosuria, GI bleeding, restlessness, and seizures are common adverse effects of
corticosteroid therapy, not its sudden cessation.
7. Answer D. A patent airway and an adequate breathing pattern are the top priority for any
client, making impaired gas exchange related to airflow obstruction the most important
nursing diagnosis. The other options also may apply to this client but are less important.
8. Answer B. A non-rebreather mask can deliver levels of the fraction of inspired oxygen
(FIO2) as high as 100%. Other modes simple mask, face tent and nasal cannula
deliver lower levels of FIO2.
9. Answer B. The nurse should perform chest physiotherapy at least 2 hours after a meal to
reduce the risk of vomiting and aspiration. Performing it immediately before a meal may
tire the client and impair the ability to eat. Percussion and vibration, components of chest
physiotherapy, may worsen bronchospasms; therefore, the procedure is contraindicated in
clients with bronchospasms. Secretions that have mobilized (especially when suction
equipment isnt available) are a contraindication for postural drainage, another
component of chest physiotherapy.
10. Answer D. Hypotension, hypothermia, and vasoconstriction may alter pulse oximetry
values by reducing arterial blood flow. Likewise, movement of the finger to which the
oximeter is applied may interfere with interpretation of SaO2. All of these conditions
limit the usefulness of pulse oximetry. Fever, tachypnea, and tachycardia dont affect
pulse oximetry values directly.
11. Answer B. Maintaining a patent airway is the most basic and critical human need. All
other interventions are important to the clients well-being but not as important as having
sufficient oxygen to breathe.

12. Answer C. Controlled coughing helps maintain a patent airway by helping to mobilize
and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate
activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the clients
ability to maintain a patent airway, causing a high risk of infection from pooled
secretions.
13. Answer A. Tidal volume is the amount of air inspired and expired with each breath.
Residual volume is the amount of air remaining in the lungs after forcibly exhaling. Vital
capacity is the maximum amount of air that can be moved out of the lungs after maximal
inspiration and expiration. Dead-space volume is the amount of air remaining in the
upper airways that never reaches the alveoli. In pathologic conditions, dead space may
also exist in the lower airways.
14. Answer C. An FO2 greater than 0.5 for as little as 16 to 24 hours can be toxic and can
lead to decreased gas diffusion and surfactant activity. The ideal oxygen source is room
air F IO 2 0.18 to 0.21.
15. Answer B. A positive reaction means the client has been exposed to TB; it isnt
conclusive of the presence of active disease. A positive reaction consists of palpable
swelling and induration of 5 to 15 mm. It can be read 48 to 72 hours after the injection. In
clients with positive reactions, further studies are usually done to rule out active disease.
In immunosuppressed clients, a negative reaction doesnt exclude the presence of active
disease.
16. Answer A. In a client with emphysema, albuterol is used as a bronchodilator. A
respiratory rate of 22 breaths/minute indicates that the drug has achieved its therapeutic
effect because fewer respirations are required to achieve oxygenation. Albuterol has no
effect on pupil reaction or urine output. It may cause a change in the heart rate, but this is
an adverse, not therapeutic, effect.
17. Answer B. A pH less than 7.35 is indicative of acidosis; a pH above 7.45 indicates
alkalosis.
18. Answer B. Before weaning a client from mechanical ventilation, its most important to
have baseline ABG levels. During the weaning process, ABG levels will be checked to
assess how the client is tolerating the procedure. Other assessment parameters are less
critical. Measuring fluid volume intake and output is always important when a client is
being mechanically ventilated. Prior attempts at weaning and ECG results are
documented on the clients record, and the nurse can refer to them before the weaning
process begins.
19. Answer B. The ABG results reveal respiratory alkalosis. The best intervention to raise
the PaCO2 level would be to have the client breathe into a paper bag. All of the other
options such as administering a decongestant, offering fluids frequently, and
administering supplemental oxygen wouldnt raise the lowered PaCO2 level.

20. Answer C. The most significant and direct indicator of the effectiveness of oxygen
therapy is the PaO2 value. Based on the PaO2 value, the nurse may adjust the type of
oxygen delivery (cannula, venturi mask, or mechanical ventilator), flow rate, and oxygen
percentage. The other options reflect the clients ventilation status, not oxygenation.
21. Answer A. Endotracheal suctioning removes secretions as well as gases from the airway
and lowers the arterial oxygen saturation (SaO2) level. Coughing and incentive
spirometry improves oxygenation and should raise or maintain oxygen saturation.
Because of superficial vasoconstriction, using a cooling blanket can lower peripheral
oxygen saturation readings, but SaO2 levels wouldnt be affected.
22. Answer A. The nurse should measure and document the amount of chest tube drainage
regularly to detect abnormal drainage patterns, such as may occur with a hemorrhage (if
excessive) or a blockage (if decreased). Continuous bubbling in the water-seal chamber
indicates a leak in the closed chest drainage system, which must be corrected. The nurse
should keep the collection chamber below chest level to allow fluids to drain into it. The
nurse should not strip chest tubes because doing so may traumatize the tissue or dislodge
the tube.
23. Answer B. Conditions that increase oxygen demands include obesity, smoking, exposure
to temperature extremes, and stress. A client with chronic bronchitis should drink at least
2,000 ml of fluid daily to thin mucus secretions; restricting fluid intake may be harmful.
The nurse should encourage the client to eat a high-protein snack at bedtime because
protein digestion produces an amino acid with sedating effects that may ease the
insomnia associated with chronic bronchitis. Eating more than three large meals a day
may cause fullness, making breathing uncomfortable and difficult; however, it doesnt
increase oxygen demands. To help maintain adequate nutritional intake, the client with
chronic bronchitis should eat small, frequent meals (up to six a day).
24. Answer B. Skin color doesnt affect the mucous membranes. The lips, nail beds, and
earlobes are less reliable indicators of cyanosis because theyre affected by skin color.
25. Answer D. The therapeutic serum theophylline concentration ranges from 10 to 20
mcg/ml. Values below 10 mcg/ml arent therapeutic.
26. Answer A. To avoid a hypotensive reaction from rapid I.V. administration, the nurse
should infuse vancomycin slowly, over 60 to 90 minutes, in a large volume of fluid.
Although neutropenia may occur in approximately 5% to 10% of clients receiving
vancomycin, this adverse effect reverses rapidly when the drug is discontinued.
27. Answer C. Extreme anxiety may lead to respiratory alkalosis by causing
hyperventilation, which results in excessive carbon dioxide (CO2) loss. Other conditions
that may set the stage for respiratory alkalosis include fever, heart failure, and injury to
the brains respiratory center, overventilation with a mechanical ventilator, pulmonary
embolism, and early salicylate intoxication. Type 1 diabetes mellitus may lead to diabetic
ketoacidosis; the deep, rapid respirations occurring in this disorder (Kussmauls

respirations) dont cause excessive CO2 loss. Myasthenia gravis and narcotic overdose
suppress the respiratory drive, causing CO2 retention, not CO2 loss; this may lead to
respiratory acidosis, not alkalosis.
28. Answer D. The client is hypoxemic because of bronchoconstriction as evidenced by
wheezes and a subnormal arterial oxygen saturation level. The clients greatest need is
bronchodilation, which can be accomplished by administering bronchodilators. Albuterol
is a beta2 adrenergic agonist, which causes dilation of the bronchioles. Its given by
nebulization or metered-dose inhalation and may be given as often as every 30 to 60
minutes until relief is accomplished. Alprazolam is an anxiolytic and central nervous
system depressant, which could suppress the clients breathing. Propranolol is
contraindicated in a client whos wheezing because its a beta2 adrenergic antagonist.
Morphine is a respiratory center depressant and is contraindicated in this situation.
29. Answer C. The client with COPD retains carbon dioxide, which inhibits stimulation of
breathing by the medullary center in the brain. As a result, low oxygen levels in the blood
stimulate respiration, and administering unspecified, unmonitored amounts of oxygen
may depress ventilation. To promote adequate gas exchange, the nurse should use a
Venturi mask to deliver a specified, controlled amount of oxygen consistently and
accurately. Drinking three glasses of fluid daily wouldnt affect gas exchange or be
sufficient to liquefy secretions, which are common in COPD. Clients with COPD and
respiratory distress should be placed in high Fowlers position and shouldnt receive
sedatives or other drugs that may further depress the respiratory center.
30. Answer A. Pursed-lip breathing helps prevent early airway collapse. Learning this
technique helps the client control respiration during periods of excitement, anxiety,
exercise, and respiratory distress. To increase inspiratory muscle strength and endurance,
the client may need to learn inspiratory resistive breathing. To decrease accessory muscle
use and thus reduce the work of breathing, the client may need to learn diaphragmatic
(abdominal) breathing. In pursed-lip breathing, the client mimics a normal inspiratoryexpiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as
1:4.)