NursingPlex
    Sign In
    NR302 Health Assessment Chamberlain University (Examplify) Proctored Exam

    The nurse assesses a client and notes tachypnea. Which respiratory rate reflects the nurse's assessment?

    Explanation & Rationale

    A. A rate of 20 is at the upper limit of normal for adults, which ranges from 12 to 20 breaths per minute. While slightly elevated, it is not classified as tachypnea. Tachypnea specifically refers to a respiratory rate above 20, indicating increased work of breathing or an underlying physiological stress. B. A rate of 14 is well within the normal adult range and does not represent tachypnea. This rate indicates normal, resting breathing and does not suggest respiratory compromise or increased metabolic demand. C. A respiratory rate of 26 is above the normal range and represents tachypnea. Tachypnea can occur in response to various conditions, including fever, pain, anxiety, hypoxia, or underlying respiratory or cardiovascular disorders such as pneumonia, chronic obstructive pulmonary disease (COPD) exacerbations, or pulmonary embolism. This increased rate is a compensatory mechanism to meet the body’s oxygen demand or remove carbon dioxide more efficiently. Identifying tachypnea allows the nurse to perform a thorough assessment, including checking oxygen saturation, observing for use of accessory muscles, evaluating breathing pattern, and identifying potential underlying causes. Early recognition of tachypnea is critical to prevent hypoxia or respiratory failure. D. A rate of 8 indicates bradypnea, which is abnormally slow breathing. Bradypnea may result from respiratory depression due to medications, neurological injury, or metabolic disturbances. It is the opposite of tachypnea and does not match the clinical assessment of rapid breathing.

    🔒 Submit your answer to reveal