Adult Health: Respiratory
C. Wheezes Squeaky musical continuous sounds heard when the client inhales and exhales are abnormal. These would be considered advantages and described as wheezes. Fine crackles are hurt as popping, discontinuous high pitch sounds at the end of inhalation. Course crackles are rattling sounds. Rhonci are heard as low pitched continuous snoring sounds.
How will the nurse document the respiratory assessment findings on auscultation that are heard as squeaky, musical continuous sound when the client inhales and exhales? A. Fine crackles B. Course crackle C. Wheezes D. Rhonchi
B. Determine if the client can switch to a nasal cannula during the meal Oxygen needs to be delivered constantly. The nurse would determine if the provider has approved switching to a nasal cannula during meals. If not, the nurse would consult with the provider about this issue. The provider would need to prescribe discontinuing oxygen if O2 saturation is normal. The oxygen would not be turned off. Lifting the mask to eat will alter the FiO2 delivered.
A client is wearing a Venturi mask to deliver oxygen and the dinner tray has arrived. What action by the nurse is best? A. Assess the client's oxygen saturation and, if normal, turn off oxygen B. Determine if the client can switch to a nasal cannula during the meal C. Have the client life the mask off the face when taking bites of food D. Turn the oxygen off while the client eats the meal and then restart it
A. The client does not allow smoking in the house B. Electrical cords are in good working order C. Flammable liquids are stored in the garage Oxygen enhances combustion, so precautions are needed when using it. The nurse would assess if the client allows smoking in the house, if electrical cords are in good shape or frayed, and if flammable liquids are stored (and used) in the garage away from the oxygen. Light bulbs and pets are not related to oxygen safety. Alcohol based hand sanitizers are permitted.
A home health nurse is visiting a new client who uses oxygen. For which factors does the nurse assess when determining if the client is using oxygen in their home safely? A. The client does not allow smoking in the house B. Electrical cords are in good working order C. Flammable liquids are stored in the garage D. Household light bulbs are the fluorescent type E. The client does not have pets inside the home F. No alcohol based hand sanitizers are present
B. Cholinergic antagonist - Causes bronchodilation by inhibiting the parasympathetic nervous system This allows the sympathetic nervous system to dominate and release norepinephrine that activates beta2 receptors. Bronchodilators relaxes the bronchiolar smooth muscles by binding to and activating beta2 receptors. Corticosteroids disrupt the production of pathways of inflammatory mediators. Cromones stabilizes the membranes of mast cells and prevents the release of inflammatory mediators.
A nurse administers medications to a client who has asthma. Which medication classification is paired correctly with its physiologic response to the medication? A. Bronchodilator- stabilizes the membranes of mast cells and prevents the release of inflammatory mediators B. Cholinergic antagonist - Causes bronchodilation by inhibiting the parasympathetic nervous system C. Cromone- disrupts the production of pathways of inflammatory mediators D. Corticosteroid- relaxes the bronchiolar smooth muscles by binding to and activating beta2 receptors
B. New-onset cough D. Tachypnea E. Pain with respirations Symptoms of a pneumothorax include tachycardia, tachypnea, new onset cough (nagging) and pain that is worse at the end of inhalation and the end of exhalation on the affected side. Additional symptoms include trachea slanted to the unaffected side, cyanosis, and the affected side of the chest that does not move in and out with respirations. Purulent sputum is a symptom of an infection.
A nurse assesses a client who is recovering from a thoracentesis. Which assessment findings would alert the nurse to a potential pneumothorax? SELECT ALL THAT APPLY A. Bradycardia B. New-onset cough C. Purulent sputum D. Tachypnea E. Pain with respirations F. Rapid, shallow respirations
D. A 27 year old client with a heart rate of 120 bpm Tachycardia can indicate hypoxemia as the body tries to circulate the oxygen that is available. A barrel chest is not an emergency finding. Likewise, a pulse ox of 92% is not considered an acute finding. Orthopnea at night in bed is breathlessness when lying down but it is not an acute finding at this moment.
A nurse assesses several clients who have a history of asthma. Which client should the nurse assess first? A. A 66 yr old client with a barrel chest and clubbed fingernails B. A 48 yr old client with an oxygen saturation level of 92% at rest C. A 35 yr old client who reports orthopnea in bed D. A 27 year old client with a heart rate of 120 bpm
A. Ask them what medications they are currently taking Aspirin and other NSAIDs can trigger asthma in some people. ABG wouldn't be helpful as most clients are asymptomatic between attacks. Questioning about the use of bronchodilators will address interventions but their cause. Reviewing a pulmonary function test result will not address the immediate problem of frequent asthma attacks.
A nurse cares for a client with arthritis who reports frequent asthma attacks. Which action should the nurse take first? A. Ask them what medications they are currently taking B. Review their pulmonary function test results C. Assess how frequently the client uses a bronchodilator D. Consult the provider and request an ABG
A. Confusion Answer: Unequal pupils are an expected finding for a client who has increased intracranial pressure. Hypotension is an expected finding for a client who has pneumonia. Dull sounds upon chest percussion is an expected finding for a client who has pneumonia. Confusion due to hypoxemia is an expected finding for an older-adult who has pneumonia.
A nurse in the emergency department is assessing an older adult client who has community- acquired pneumonia. Which assessment finding will the nurse expect to monitor for? A. Confusion B. Tympany upon chest percussion C. Unequal pupils D. Hypertension
A. Absorptive atelectasis B. Combustion C. Dried mucous membranes E. Toxicity These are all complications of oxygen therapy. Alveolar recruitment is not, it may be a benefit of high-flow nasal cannulas, which both humidifies and warms the oxygen.
A nurse is teaching a client about possible complications and hazards of home oxygen therapy. Which complications does the nurse plan to teach the client? A. Absorptive atelectasis B. Combustion C. Dried mucous membranes D. Alveolar recruitment E. Toxicity
B. Verify that the informed consent was obtained C. Document the client's allergies D. Review lab results F. Monitor the client for 24 hr afterwards Prior to a bronchoscopy, the nurse would verify that the informed consent was obtained, keep the client NPO for 4 to 8 hours prior to the procedure or per agency policy to prevent aspiration, document allergies, and review laboratory results including complete blood count and bleeding times. There is no reason to hold the client's bronchodilator prior to procedure. The nurse will monitor the client at least every 4 hours for 24 hours.
A nurse prepares a client who is scheduled for a bronchoscopy with transbronchial biopsy procedure at 9:00 AM (0900). What actions would the nurse take? Select all that apply A. Provide a clear liquid breakfast B. Verify that the informed consent was obtained C. Document the client's allergies D. Review lab results E. Hold the client's bronchodilator F. Monitor the client for 24 hr afterwards
A. "Avoid drinking fluids just before and during meals." B. "Rest before meals if you have dyspnea." C. "Have about six small meals a day." E. "Use pursed lip breathing during meals." F. "Choose soft, high calorie, high protein foods." Patients with COPD often are malnourished for many reasons. The nurse should teach the client not to drink fluids before and with meals to avoid early satiety. The client needs to rest before eating, and eat smaller frequent meals: 4 to 6 a day. Pursed-lip breathing will help control dyspnea. Food that is easy to eat will be less tiring and the patient should choose high calorie, high protein foods.
A nurse teaches a client who has chronic obstructive pulmonary disease. Which statements related to nutrition should the nurse include in this client's teaching? (Select all that apply.) A. "Avoid drinking fluids just before and during meals." B. "Rest before meals if you have dyspnea." C. "Have about six small meals a day." D. "Eat high fiber foods to promote gastric emptying" E. "Use pursed lip breathing during meals." F. "Choose soft, high calorie, high protein foods."
C. A 52 yr old in a tripod position using accessory muscles to breathe This client is working to breathe. They must be assessed first to establish how effectively they are actually breathing and interventions must be provided to minimize respiratory distress. The other patients are not in acute distress.
A pulmonary nurse cares for patients who have chronic obstructive pulmonary disease (COPD). Which client would the nurse assess first? A. A 74 yr old with a chronic cough and thick, tenacious secretions B. A 46 yr old w/ a 30 pack year history of smoking C. A 52 yr old in a tripod position using accessory muscles to breathe D. A 68 yr old who has dependent edema and clubbed fingers
A. Anemia B. Hypoxia E. Pneumonia Oxygen therapy is usually beneficial with any acute or chronic respiratory problem that interferes with gas exchange. It is also useful in some non-pulmonary conditions such as anemia, cardiac problems, and sepsis. It does not have a beneficial effect on hypertension and cannot improve venous insufficiency.
In what situations will the nurse consider oxygen therapy as a possible beneficial for a client? Select all that apply. A. Anemia B. Hypoxia C. Hypothermia D. Hypertension E. Pneumonia F. Venous insufficiency
A. Administering nebulized levalbuterol Answer: The greatest risk to the client's safety is airway obstruction. Beta-adrenergic medications act as bronchodilators. They provide prompt relief of airflow obstruction by relaxing bronchiolar smooth muscle and are the initial priority intervention when a client has an acute asthma exacerbation.
The nurse in an urgent care center is caring for a client having an acute asthma exacerbation. Which action by the nurse is the highest priority? A. Administering nebulized levalbuterol B. Positioning the client in high-fowlersterm-12 C. Providing immediate rest for the client D. Initiating oxygen therapy
A. Place the client in a negative pressure room Answer: Place the client in a negative pressure room. This client has signs and symptoms of active tuberculosis and should be isolated in a negative pressure room and away from other people to reduce the risk of spreading the disease. The client should also be placed in airborne precautions, not droplet. TB requires an N95 mask or a PAPR. A negative pressure room takes all the air from that room and recycles it out of the hospital. A positive pressure room will take the air in the room and send it back out into general circulation, risking the infection of others. Although we would put a mask on this client, we would not place them back into the lobby, but would have to isolate them until they could be called back and be seen.
The nurse is admitting a client complaining of a cough with a small amount of blood in it their sputum. Over the last two months the client has noticed, fatigue, nausea and night sweats. What is the priority nursing action? A. Place the client in a negative pressure room B. Place a mask over the clients face and ask them to wait in the lobby C. Finish admitting the client and ask them to wait in the lobby until called D. Place the client in droplet precautions
C. Document all findings and continue to monitor Answer: Document all findings and continue to monitor. The client has COPD and will have an ABG that may not look completely normal, This client is unable to expel all CO2 upon exhalation and will trap some in the bases of the lungs. This client may be slightly acidotic all the time, but their body has adjusted to this acidosis. They have compensated with lower oxygen levels and higher CO2 levels. There is no reason to call the healthcare provider or initiate oxygen so the nurse should document and monitor the client for any signs of distress.
The nurse is caring for a COPD client hospitalized for pneumonia. The patient is comfortable and calm, and is visiting with family. While reviewing laboratory values the nurse sees the following ABG: pH 7.34 CO2 48 HCO3 22 PaO2 79 WBC 13.5mm³ What is the priority nursing action? A. Call the healthcare provider about the PaO2 level B. Notify the provider the patient is hypercapnic C. Document all findings and continue to monitor D. Place the client on a nonrebreather at 15L
C. Raise the head of the bed to 90 ˚and apply a nasal cannula at 2L Answer: Raise the head of the bed to 90˚ and apply a nasal cannula at 2L. This client has COPD and the nurse should watch out for putting too much oxygen and causing oxygen toxicity to this client. The client is in distress and raise the head of the bed to 90˚ will help them breathe better as they are already in the tripod position. Raising the HOB to only 45˚ may not help this client breathe as easy and the other oxygen delivery devices are at the wrong oxygen levels for those devices.
The nurse is caring for a client from who complains of shortness of breath, is using accessory muscles to breathe and is sitting in the tripod position. The client has a history of smoking 1 pack daily of cigarettes for 30 years. Oxygen saturation is 85% on room air. What is the first nursing action? A. Raise the head of the bed to 90˚ and apply a simple mask at 6L B. Raise the head of the bed to 45˚ and apply a Venturi mask at 40% FiO2 C. Raise the head of the bed to 90 ˚and apply a nasal cannula at 2L D. Raise the head of the bed to 45˚; apply non-rebreather mask at 15L
C. Assess the client's gag reflex before giving any food or water The topical anesthetic used during the procedure will have affected the client's gag reflex. Before allowing the client anything to eat or drink, the nurse must check for the return of the gag reflex.
The nurse is caring for a client who had a bronchoscopy 2 hours ago. The client asks for a drink of water. What action should the nurse take next? A. Call the provider and request food and water for the client B. Provide the client with ice chips instead of a drink of water C. Assess the client's gag reflex before giving any food or water D. Let the client have a small sip to see whether he or she can swallow
A. Encourage the client to drink at least 2L of fluid daily Rationale: The nurse should teach the client to drink at least at least 2L of fluid daily to help thin bronchial secretions. Semi-Fowler's position will help the client breathe easier, but does nothing to thin bronchial secretions. A low-salt diet will not help thin bronchial secretions and may be more beneficial to the heart failure client. Although this client should be on oxygen, again this scenario asks specifically about thinning bronchial secretions, which makes this answer incorrect.
The nurse is caring for a client who has chronic obstructive pulmonary disease (COPD). The client tells the nurse, "I can feel the congestion in my lungs, and I certainly cough a lot, but I can't seem to bring anything up." Which of the following actions will the nurse take to help this client to thin bronchial secretions? term-14 A. Encourage the client to drink at least 2L of fluid daily B. Administer oxygen via nasal cannula at 2L/min C. Help the client select a low salt diet D. Maintain semi-fowler position as often as possible
B. Administer albuterol immediately D. Apply oxygen 2L via nasal cannula E. Raise the head of the bed to 45 degrees Rationale: The client needs to have immediate relief with a SABA such as albuterol, raise the head of the bed and apply oxygen immediately to help them breathe easier. Administering a broad spectrum antibiotic is not called for in this scenario. We do not have a diagnosis of pneumonia, so antibiotics would not be used unless we have this. To just observe and document the situation does not imply any interventions on the part of the nurse. Although the nurse will document and observe, this would not be a correct action at this point.
The nurse is caring for a client who has inspiratory wheezing; diminished lung sounds at the bases and is only able to answer questions with one-word sentences. What is the most appropriate action(s) by the nurse? (Select all that apply) A. Administer broad spectrum antibiotic B. Administer albuterol immediately C. Continue to observe and document situation only D. Apply oxygen 2L via nasal cannula E. Raise the head of the bed to 45 degrees
A. Put the mouthpiece in your mouth and seal your lips around it C. Shake the entire unit vigorously 3-4 times before using it D. If the inhaler makes whistling sound, you are breathing too quickly E. At least once a day, clean the plastic case and cap the inhaler Answer: Shake the entire unit vigorously 3-4 times before using it, Put the mouthpiece in your mouth and seal your lips around it, If the inhaler makes whistling sound, you are breathing too quickly, At least once a day, clean the plastic case and cap the inhaler. All of the teachings above are for a meter dose inhaler with a spacer expect for the Tilt your head back slightly and breath out fully when using. The client should be taught the proper way to use an inhaler, especially one with an extension or they may not receive the full dose of medication.
The nurse is caring for a client who now has to use an aerosol meter dose inhaler with a spacer. What are the most important things for the nurse to teach this client? (Select all that apply) A. Put the mouthpiece in your mouth and seal your lips around it B. Tilt your head back slightly and breathe out fully when using it C. Shake the entire unit vigorously 3-4 times before using it D. If the inhaler makes whistling sound, you are breathing too quickly E. At least once a day, clean the plastic case and cap the inhaler
B. Teach the client that a yearly flu vaccine is important D. Provide rest periods for the client throughout the day E. Administer medications around routine activities Answer: Provide rest periods for the client throughout the day, Administer medications around routine activities, Teach the client that a yearly flu vaccine is important. The nurse should plan rest periods throughout the day so as not to exhaust the client. Also, med passing should be performed around regular activities for the client so again we are not tiring them out with constant tasks and interruptions. The client should have yearly flu vaccines as they are a higher risk for flu and pneumonia, making the pneumonia vaccine answer incorrect. After eating the client should be placed supine with the HOB up 30-45 degrees to help with breathing and digestion.
The nurse is caring for a client with a chronic respiratory disorder. What are the most appropriate interventions for the nurse to provide this client? (Select all that apply) A. Explain that they do not need a pneumonia vaccine B. Teach the client that a yearly flu vaccine is important C. Place the client supine after meals to allow for rest D. Provide rest periods for the client throughout the day E. Administer medications around routine activities
A. "We will not allow you to drink anything until you are awake and can swallow." B. "You will need to be NPO 4 to 8 hours prior to the procedure." D. "You will be given a light sedation so that you won't feel uncomfortable." E. "We will check your WBC count and coagulation panel tomorrow." Answer: "You will need to be NPO 4 to 8 hours prior to the procedure." "We will check your WBC count and coagulation panel tomorrow." "You will be given a light sedation so that you won't feel uncomfortable." "We will not allow you to drink anything afterwards until you are awake and can swallow." The client needs to be NPO 4-8 prior to the procedure to reduce the risk of aspiration, the WBC count and coagulation panel are always checked for infection and bleeding risks, the client is given light sedation such as versed which allows them to follow commands but not remember the procedure, and the client is not allowed anything to drink or eat until awake and the gag reflex has returned. False assurance, such as I'm sure it will be ok, would not be appropriate as there are risks to any medical procedures.
The nurse is caring for a client with lung cancer who is scheduled for a bronchoscopy with lung biopsy tomorrow. What teaching will the nurse provide to this client regarding the bronchoscopy procedure? (Select all that apply) A. "We will not allow you to drink anything until you are awake and can swallow." B. "You will need to be NPO 4 to 8 hours prior to the procedure." C. "The healthcare provider does these all the time, so I'm sure it will be ok." D. "You will be given a light sedation so that you won't feel uncomfortable." E. "We will check your WBC count and coagulation panel tomorrow."
D. Ask the patient to sit on the edge of the bed and lean forward over the bedside table. Patients with orthopnea have difficulty breathing while lying down. To help with comfort, the nurse will encourage the patient to sit leaning forward and orthopnea position. Oxygen is given for low oxygen saturations, and this must be assessed before starting oxygen therapy. Talking to the patient directly allows the nurse to make observations about the patient's ability to speak and interact and its affect on breathing. Patients with orthopnea will not be able to lie down without activating the system.
The patient with chronic obstructive pulmonary disease reports increased difficulty sleeping, eating, and dressing and has trouble walking even short distances. Which part of the admission assessment will the nurse do next? A. Initiate oxygen therapy at a rate of 2l/min with a nasal cannula. B. Address is the remaining questions to the patient's family members. C. Assist the patient to put on a hospital gown and light on as quickly as possible. D. Ask the patient to sit on the edge of the bed and lean forward over the bedside table.
C. Perform a thorough respiratory system assessment African-American patients and other patients of color tend to show lore oxygen saturation level typically 3% to 5% lower than white patients, not because of lower oxygen status but because of the deeper coloration of the nail bed. The nurse should perform a thorough respiratory assessment to confirm that the low saturation is due to this cause and not because of respiratory distress. Until this is determined, unless the patient is in respiratory distress, oxygen is not indicated. The rapid response team is notified when respiratory failure is eminent or has occurred. A true blood gases may be required if true hypoxia is suspected after a thorough respiratory assessment.
Which action will the nurse take to address an oxygen saturation level of 90% for an African-American patient? A. Notify the rapid response team B. Request in order for atrial blood gases C. Perform a thorough respiratory system assessment D. Administer oxygen to increase oxygen saturation
D. Implement NPO status Until the patient has a gag reflex and is fully alert, he or she should be maintained on NPO status to prevent aspiration. Also the patient will have received medication during bronchoscopy, and anaphylactic reaction will occur immediately, not in a patient who is returned to the medical unit. No external puncture site is needed for a bronchoscopy. Aggressive chest and physiotherapy is not indicated and a patient who has had a bronchoscopy and may cause bleeding if biopsies have been obtained. For more information you can find this on page 493
Which actually a nurse take when caring for a patient admitted to the medical unit immediately after a therapeutic bronco scope? A. Monitor for signs of anaphylaxis B. Access the puncture site for drainage C. Perform aggressive chest physiotherapy D. Implement NPO status
B. Start oxygen using nasal cannula at a rate of 2 L per minute C. Assess other indicators of adequate gas exchange F. Place the client in an upright position The client is demonstrating difficulty breathing and ineffective gas exchange with hypoxemia. Placing the client in an upright position may improve respiratory effectiveness. Oxygen therapy is an appropriate media action to prevent harm. Host oximetry is usually a good indicator of gas exchange; however, the equipment may be faulty or the probe incorrectly place. Therefore, assessing other indicators of adequate gas exchange is an appropriate early action. None of the other actions will have an immediate effect on gas exchange.
Which are the nurses priority actions when caring for a client who has a labored, shallow respirations and a respiratory rate of 32 breaths per minute with a pulse oximetry reading of 85%? Select all that apply A. Notify the respiratory therapist to give the client a breathing treatment B. Start oxygen using nasal cannula at a rate of 2 L per minute C. Assess other indicators of adequate gas exchange D. Obtain an order for a stat atrial blood gas (ABG) E. Assist with coughing and deep breathing exercises F. Place the client in an upright position
D. Bronchial breath sounds heard at the bases Bronchial breath sounds are not normally heard in the per periphery and may indicate increase lung density, as in a tumor or an inactive process such as pneumonia. Air trapping causing the ribs in a patient with emphysema to lie in a horizontal direction. Anterior posterior diameter is the same as a lateral collateral or side to side diameter in a patient with emphysema, so he or she will generally have barrel shaped chest. Airfield cavity such as the lungs are hyper resident to percussion. P. 487
Which assessment finding is of greatest concern in a patient with emphysema? A. Barrel shaped chest B. Ribs lying horizontal C. Hyperresonance to percussion of the chest D. Bronchial breath sounds heard at the bases
A. Oxygen saturation is 60% and does not increase with supplemental oxygen . E. Oral mucous membranes are cyanotic. F. Sputum is grossly bloody. The cyanosis and low oxygen saturation that does not improve with supplemental oxygen are very serious and could indicate methemoglobinemia associated with the use of benzo cane spray, which requires immediate intervention to prevent death. Grossly bloody sputum is not a normal expectation after the procedure and Cody Harold hemorrhage. Most clients have a sore throat after a bronchoscopy and remain somewhat drowsy for an hour or so after sedation. Neither of these responses are a cause for alarm, nor is a reduction in coughing.
Which assessment findings on a client who had a bronchoscopy using the local anesthetic benzo cane spray along with light sedation are most important to report to the provider who performed the procedure? Select all that apply A. Oxygen saturation is 60% and does not increase with supplemental oxygen B. 20 minutes after the procedure, the client remains drowsy. C. Client coughed on first being awake but is no longer coughing. D. The client reports having a sore throat. E. Oral mucous membranes are cyanotic. F. Sputum is grossly bloody.
C. Pulmonary edema Excessive pink, frothy sputum is common with pulmonary edema. Patients of cystic fibrosis have thick, purulent sputum. Sputum produced in patients with lung abscess is often foul-smelling. Patients with bacterial pneumonia often have rust colored sputum.
Which cause of respiratory distress does a nurse suspects when a patient begins coughing and producing a frothy, pink colored sputum? A. Cystic fibrosis B. Lung abscess C. Pulmonary edema D. Bacterial pneumonia
D. Leukotriene Leukotriene is a slow acting chemical that is released slowly, causing a prolong inflammatory response. Kinnins daily arterials and increase capillary permeability. Heparin inhibits blood and protein clotting. Histamine starts immediate inflammatory response by constricting small veins, inhibiting blood flow, and decreasing the venous return.
Which chemical is responsible for prolonged inflammatory response, leading to airway obstruction? A. Kinins B. Heparin C. Histamine D. Leukotriene
D. Cyanosis Finger clubbing in a barrel chest take many months to years of an adequate gas exchange to develop. Purse lip breathing as a learned behavior to compensate for loss of elastic recoil. Only cyanosis reflects in immediate decrease in gas exchange and/or perfusion.
Which client assessment finding does the nurse recognize as an immediate gas exchange and perfusion problem? A. Pursed lip breathing B. Clubbed fingers C. Barrel chest D. Cyanosis
B. Is streaked with mucous D. Is frothy and pink E. Has a foul odor Sputum is continually produced in all clients. The sputum of a client with no respiratory problem is thin, clear, colorless, has no odor, and is less than 90 ML daily. Excessive pink, frothy sputum is a common with pulmonary edema. Bacterial pneumonia often produces rust colored sputum, and a lung abscess may cause foul smelling sputum. Clients with chronic bronchitis, especially smokers, have thicker sputum with mucus.
Which client descriptions of sputum production alert the nurse to possibility of a respiratory problem? Select all that applyA. Totals about 2 ounces dailyB. Is streaked with mucousC. Is clear and thinD. Is frothy and pinkE. Has a foul odorF. Is colorless
D. Thoracentesis A pneumothorax a.k.a. a collapsed long is most common after invasive procedures that allow air into the intrapleural space, such as with a thoracentesis that involves having a needle penetrate through the chest wall into the pleural space. Pulmonary function testing is non-invasive; a flexible bronchoscopy does not penetrate the chest wall, and a laryngoscopy does not enter the lungs.
Which client will the nurse assess most often for the possibility of post procedure pneumothorax? A. Pulmonary function testing B. Flexible bronchoscopy C. Laryngoscopy D. Thoracentesis
C. Diminished breath sounds A pneumothorax may caused diminished or absent breath sounds, tachypnea, and cyanosis. A rapid capillary refill is a normal finding. A barrel shaped chest occurs with over inflammation of the lungs I seen with asthma and chronic obstructive pulmonary disease. Page 493
Which clinical manifestation and a patient recovering from an open lung biopsy will leave the nurse to suspect the presence of pneumothorax? A. Low respiratory rate B. Rapid capillary refill C. Diminished breath sounds D. Presence of a barrel chest
A. Residual volume A residual volume test is used to determine the amount of air remaining in the lungs at the end of a full, force exhalation. Total lung capacity is performed to determine the amount of air in the lungs at the end of maximum inhalation. Force vital capacity is performed to determine the maximum amount of air that can be exhaled as quickly as possible after maximum inspiration. Functional residual capacity is performed to determine the amount of air remaining in the lungs after normal expiration.
Which diagnostic procedure is used to assess amount of air remaining in the lungs at the end of a full, force exhalation? A. Residual volume B. Total lung capacity C. Forced vital capacity D. Functional residual capacity
D. CT scan CT scans, especially spiral or helical CT scans, with injected contrast can detect pulmonary emboli. I just x-ray will rule out other causes of the symptoms but he's not specific for pulmonary embolism. The patient has a pulmonary embolism; bronco scope he will not help confirm the diagnosis. Thoracoscopy is not used to detect pulmonary emboli. You can read more about this on page 489.
Which diagnostic test will the nurse expect to be prescribed for a patient complaining of chest pain, shortness of breath, and hypoxemia after knee replacement? A. Chest x-ray B. Bronchoscopy C. Thoracoscopy D. CT scan
D. Discomfort or pain under the sternum Oxygen toxicity damages the alveolar membrane, stimulating the formation of hyaline membrane and impairing gas exchange. Clients become increasingly more dyspneic and hypoxic. Initial manifestations include dyspnea, nonproductive cough, chest pain beneath the sternum, and IG upset. Oxygen saturation falls, not increases. Breathing becomes more rapid with the sensation of dyspnea. Wheezing represents airway obstruction, not the damage to the alveolar membrane.
Which manifestations and a client receiving oxygen therapy at 60% for more than 24 hours alert to the nurse to the possibility of oxygen toxicity? A. Oxygen saturation greater than 100% B. Decreased rate and depth of respiration C. Wheezing on inhalation and exhalation D. Discomfort or pain under the sternum
B. Feeling of air hunger D. Rapid, shallow breathing air E. Pain on the affected side that is worse at the end of inhalation F. Trachea slanted more towards the unaffected side instead of being in the center of the neck. Signs of a pneumothorax include feeling of air hunger; Rapid, shallow breathing; pain on the affected side were sitting at the end of inhalation; a trachea that's slants towards the unaffected side; tachycardia; a new nagging cough; and cyanosis. The patient should not experiencing bradycardia or loss of consciousness. More info on this on page 493
Which manifestations of a pneumothorax will the nurse include when providing discharge teaching to the patient several hours after throcentesis? Select all that apply A. Bradycardia B. Feeling of air hunger C. Loss of consciousness D. Rapid, shallow breathing air E. Pain on the affected side that is worse at the end of inhalation F. Trachea slanted more towards the unaffected side instead of being in the center of the neck.
B. teaching the patient not to rush through morning activities To prevent chronic fatigue in patients with COPD, the nurse should teach the patient to not rush through morning activities because Rushing increases fatigue. The patient should be instructed to avoid working with the arms raise because activities involving the arms decrease exercise tolerance. The patient should not avoid high energy use task such as walking; instead the patient should be advised to use oxygen during periods of high energy use, such as bathing or walking. During cute excavations, the nurse should offer the patient help in performing ADLs such as eating, bathing, and grooming.
Which nursing intervention will help prevent chronic fatigue in patients with chronic obstructive pulmonary diseases? A. encouraging the patient to work with arms raised B. teaching the patient not to rush through morning activities C. suggesting that the patient avoid high energy used as such as walking D. allowing the patient to eat, bathe, and groom himself or herself during acute exacerbations
A. Bronchitis D. emphysema Most patients with COPD experience emphysema and chronic bronchitis. Pneumonia and tuberculosis are respiratory infections for which patients with COPD are at risk, but they are not usual occurrence. Sarcoidosis and cystic fibrosis are not seen in most patients with COPD.
Which pathological process is present in most patients with chronic obstructive pulmonary disease? Select all that apply A. Bronchitis B. pneumonia C. sarcoidosis D. emphysema E. cystic fibrosis F. pulmonary tuberculosis
C. Pneumothorax A pneumothorax would be the complication of thoracentesis that causes the greatest concern, along with the symptoms. Although it is possible that an abscess has formed, this is not the most likely diagnosis because it would not cause a great deal of shortness of breath. It is not likely that pneumonia with developed this rapidly, causing this level of symptoms. Doris and Titus is not a cause of pulmonary emboli. You can see more of this on page 493
Which possible complication of thoracentesis will the nurse be most concerned about when the patient calls the home health agency the day after the procedure complaining of extreme shortness of breath and anxiety? A. Abscess B. Pneumonia C. Pneumothorax D. Pulmonary embolism
A. bronchoscopy A bronchoscope involves inserting a tube into a patient's airway to view the airway structure and 10 tissue samples for examination. Thoracentesis involves aspiration of fluid or air from the pleural cavity. Pulmonary function test are performed evaluate lung function and it says breathing problem; these tests are non-invasive. Transthoracic Neil aspiration is a procedure where I needle is inserted through the skin to obtain tissues from areas along not accessible through a bronchoscopy. Page for 492 medsurg book
Which procedure is listed on the informed consent form when the patient states, " A tub will be inserted into my airway to view airway structures and obtain tissue samples for a biopsy."? A. bronchoscopy B. thoracentesis C. pulmonary function test D. transthoracic needle aspiration
A. To obtain tissue sample for culture in biopsy B. To remove secretions that do not clear with normal suctioning Bronchoscope he is done to obtain tissue samples for culture and biopsy. It is also used Hermosa creations are not cleared with normal suctioning procedures. Stance can you place during bronco scope procedures. Thoracentesis is the aspiration of pearl food to relieve a long compression. Pulmonary function test are used to screen for lung disease before the onset of manifestations. Capnometry is used to measure the amount of carbon dioxide present in exhaled air. Read more on page 492
Which purpose does bronchoscopy serve? Select all that apply. A. To obtain tissue sample for culture in biopsy B. To remove secretions that do not clear with normal suctioning C. To drain pleural fluid to relieve long compression D. To screen for a lung disease before the onset of manifestations E. To measure the amount of carbon dioxide present in exhaled air
C. Mucolytics thins secretions, making them easier to expectorate. The term mucolytic means breaking down mucus. Mucolytics cause secretions too thin, making them easier to expectorate; this is important for a patient with chronic bronchitis. Mucolytics do not decrease secretion production. Mucolytics may increase gas exchange, but this is an indirect property and is not the main function. Mucolytics do not have any bronchodilation properties.
Which rationale is appropriate for prescribing a mucolytic for a patient diagnosed with chronic bronchitis? A.Mucolytics decrease secretion production. B. Mucolytics increase gas exchange in the lower airways. C. Mucolytics thins secretions, making them easier to expectorate. D. Provide bronchodilation in patients with chronic obstructive pulmonary disease.
A. They allow increased production of leukotrienes. Patients with asthma are often restricted from taking aspirin and NSAIDs because they can trigger an asthma attack by allowing increased production of leukotrienes as they suppress other inflammatory pathways. They do not directly caused bronchoconstriction or increase the risk for Gerd. Patients who are sensitive to the effects of these drugs do not have a true allergy to them.
Which reason is accurate as to why patients with asthma must avoid taking aspirin or NSAIDs for pain or fever? A. They allow increased production of leukotriene's. B. They increase the risk for a gastroesophageal reflux disease. C. Aspirin an NSAIDs can cause bronchoconstriction. D. A patient with asthma is likely allergic to these drugs.
C. Oral corticosteroids have more adverse effects How old corticosteroids are given because they have direct actions on the target tissues in the lungs, causing fewer systemic adverse a fax than oral corticosteroids. They are not necessarily more effective, nor are they easier to use. Oral corticosteroids do not have less predictable effects.
Which reason is the most important for prescribing inhaled, rather than oral, corticosteroids for patients with asthma? A. Inhaled corticosteroids are easier to use B. Inhaled corticosteroids are more effective C. Oral corticosteroids have more adverse effects D. Oral corticosteroids have less predictable effects
C. Emphysema Emphysema is characterized by air trapping, which expand the lungs in the thoracic cavity. Patient will develop a barrel shaped chest with an increase anterior posterior diameter and increase space between the ribs. Hyper resident sounds or sounds associated with air, not solid tissue. Assessments for pneumonia and lung cancer would include absent or diminished breath sounds over affected areas and cough. Assessment characteristics of pneumothorax are deviation of the trachea to the affected side, increased respiratory distress, and absent breath sounds on the affected side. Page 486
Which respiratory condition will the nurse suspect in a seven-year-old patient presenting with a barrel chest with a greater than 2 cm width of intercostal spaces and hyper residents over all lung fields during percussion? A. Pneumonia B. Lung cancer C. Emphysema D. Pneumothorax
B. Cough Ace inhibitors used for managing hypertension can cause cough as a side effect. Croup, asthma, and emphysema are respiratory illnesses and are not side effects associated with ace inhibitors.
Which respiratory system side effect will the nurse assess her and the patient prescribed angiotensin converting enzyme (ACE) inhibiting drug? A. Croup B. Cough C. Asthma D. Emphysema
B. Wheezing Wheezing in a patient who is a non-smoker is indicative of airway obstruction. Although dyspnea, chest tightness, and increased mucus production can be seen with asthma, the signs and symptoms are also more often present with other respiratory conditions.
Which sign or symptom is significant in diagnosing asthma in a non-smoker? A. Dyspnea B. Wheezing C. Chest tightness D. Increased mucus production
C. Reliever medication's are used to stop an asthma attack once it has started. D. Control therapy medication's are used to prevent asthma attacks from occurring. E. Control therapy medication are used to reduce airway responsiveness. Control therapy is used to reduce airway responsiveness to prevent the occurrence of asthma attacks. This therapy is used every day, regardless of symptoms. Reliever drugs are indicated when symptoms of an attack occur to decrease the duration and severity of the attack. Long acting beta agonist do not quick act quickly enough to relieve acute symptoms; they are indicated for their long-term impact on symptoms. Anti-inflammatory drugs decrease inflammation and can be beneficial in the treatment of asthma; however, they do not cause bronchodilation.
Which statement is correct regarding the drug management of asthma? Select all that apply. A. Anti-inflammatory medication's are used to cause bronchodilation. B. Long acting beta agonist are indicated to relieve acute attack symptoms. C. Reliever medication's are used to stop an asthma attack once it has started. D. Control therapy medication's are used to prevent asthma attacks from occurring. E. Control therapy medication are used to reduce airway responsiveness.
D. Getting an annual influenza vaccine Patients with COPD should remain free from serious respiratory infection, and all patients with this disorder are strongly encouraged to receive the pneumococcal vaccine an annual influenza vaccine. Exposure to cold-weather is not a risk factor. Although well-balanced diet is recommended, it does not directly prevent respiratory infections. Early reporting of symptoms is not a preventative measure.
Which topic will the nurse include in teaching a patient who has COPD about the need to prevent respiratory infections? A. Consuming a well-balanced diet. B. Reporting runny nose and cough. C. Avoiding exposure to cold weather. D. Getting an annual influenza vaccine
C. barrel chest and finger clubbing With a barrel chest, the ratio between the anterior posterior diameter of the chest and his lateral diameter is 2:2, rather than normal ratio of 1:1.5. This shape change results from Wong Over inflation and diaphragm flattening. Finger clubbing is an indication of decreased arterial oxygen level San COPD. Emphysema and bronchitis or two diseases under the COPD umbrella. Wheezing is likely to be present during an asthma attack and airway obstruction but with more likely be of limited duration. Excess mucus way to be indicative of inflammation. Crackles in the lungs would indicate the air moving throughout the mucus/fluid in the airways; this would potentially clear with pulmonary hygiene.
Which two assessment findings are changes secondary to chronic obstructive pulmonary disease COPD? A.Emphysema and bronchitis B. wheezing and excess mucus C. barrel chest and finger clubbing D. lung crackles and finger clubbing
A. control and reliever The categories for asthma drug therapy our control therapy formally called preventative drugs which are designed to reduce airway responsiveness and prevent asthma attacks, and reliever drugs, which are those used to actually stop in attack once it started. Quotation mark quick acting quotation mark is not a category of asthma medication. Bronchodilators, steroids, an anti-inflammatory drugs are medication's that are given for asthma, but these are considered drug class is not categories.
Which two major categories are included and asthma medication? A. control and reliever B. preventative and quick acting C. steroids and bronchodilators D. bronchodilators and anti-inflammatories
