Care of Clients with Respiratory Disorders

3. The client had severe epistaxis, nasal packing has been done by the physician. Which of the following statements would indicate to the nurse that the client has understood the instructions provided? a. "I will avoid activities that elicit the Valsalva's maneuver like straining at stool and vigorous coughing." b. "I should not shower until the packing is removed." c. "I will avoid brushing until the nasal pack is removed." d. "The nasal packing will be in place for 7 to 10 days."

a. "I will avoid activities that elicit the Valsalva's maneuver like straining at stool and vigorous coughing." Correct Answer: A. "I will avoid activities that elicit the Valsalva's maneuver like straining at stool and vigorous and coughing, " is the statement that indicates client understanding of instructions when nasal packing is done to control epistaxis. This will reduce bleeding. B, C, and D are incorrect statements. Showering is not contraindicated. Oral hygiene is important to cleanse the mouth of old dried blood and to enhance the client's appetite. The toi nasal packing will be in place for 3 to 5 days only. Beyond 3 to 5 days, staphylococcal growth may occur, causing toxic shock syndrome (TSS).

5. After tonsillectomy, which of the following findings would alert the nurse to suspect early hemorrhage in the client? a. Frequent swallowing or drooling of bright red secretions. b. Pulse rate of 95 bpm. c. Blood pressure of 110/70 mmHg. d. Body temperature of 37.2℃.

a. Frequent swallowing or drooling of bright red secretions. Correct Answer: A. Frequent swallowing or drooling of bright red secretions indicate early hemorrhage in a client who had undergone tonsillectomy.

1. The client is scheduled for bronchoscopy. Which of the following is not necessary to be done by the nurse when preparing the client for the procedure? a. Secure written consent. b. Ask for allergy to seafoods or iodine. c. Maintain NPO for 6 to 8 hours. d. Instruct client to remove dentures or bridges.

b. Ask for allergy to seafoods or iodine. Correct Answer: B. Asking the client for allergy to seafoods or iodine is not necessary when preparing him for bronchoscopy. The procedure involves direct visualization of the bronchial tree of and therefore it does not involve the use of iodinated contrast medium.

11. A client has a positive reaction to the Mantoux test. The nurse correctly interprets this reaction to mean that the client: a. Has active tuberculosis. b. Has had exposure to Mycobacterium tuberculosis. c. Has developed a resistance to tubercle bacilli. d. Has developed passive immunity to tuberculosis.

b. Has had exposure to Mycobacterium tuberculosis. Correct Answer: B. A positive Mantoux test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active disease exists. A, C, and Dare are not correct interpretations. Immunity to tuberculosis is not possible.

15. Which of the following would be the most important nursing intervention to help prevent lung cancer? a. Encourage cigarette smokers to have yearly chest X-ray. b. Instruct people about techniques for cessation of smoking. c. Recommend that people have their houses cleaned from dusts regularly. d. Encourage people to avoid cool and damp weather.

b. Instruct people about techniques for cessation of smoking. Correct Answer: B. Lung cancer is almost entire associated with cigarette smoking. Therefore, nurses can be prevent lung cancer by persuading clients to stop smoking. A, C, and D do not prevent lung cancer.

6. Which of the following is a priority nursing diagnosis for the client with a total laryngectomy due to cancer? a. Deficient fluid volume related to difficulty swallowing. b. Feeding self - care deficit related to inability to swallow. c. Impaired verbal communication related to inability to speak. d. Powerlessness related to diagnosis of cancer.

c. Impaired verbal communication related to inability to speak. Correct Answer: C. Impaired verbal communication related to inability to speak, is a priority nursing diagnosis for the client with a total laryngectomy. The client will be unable to speak, and an alternative communication must be used.

2. The client had been diagnosed to have diagnosed to have hydrothorax secondary to pulmonary tuberculosis (PTB). The physician performs thoracentesis. The following are appropriate nursing interventions EXCEPT: a. Place the client in sitting position at the edge of the bed, arms supported on an overbed table, feet on a foot stool. b. Instruct the client to remain still and to hold his breath as the physician inserts the needle. c. Inform the client that pressure sensation will be experienced as the needle is inserted. d. Inform client that he will need to turn towards affected side after the procedure.

d. Inform client that he will need to turn towards affected side after the procedure. Correct Answer: D. Informing the client that he will need to turn towards affected side after the procedure ( thoracentesis) is inappropriate. Instead, he will be turned towards the UNAFFECTED side, to prevent leakage of fluids into the thoracic cavity. (A, B, and C are appropriate nursing interventions when preparing the client for thoracentesis.

10. What is the rationale that supports multidrug treatment for clients with tuberculosis? a. Multiple drugs potentiate the drugs' actions. b. Multiple drugs reduce undesirable drug side effects. c. Multiple drugs allow reduced drug dosages to be given. d. Multiple drugs reduce development of resistant strains of the bacteria.

d. Multiple drugs reduce development of resistant strains of the bacteria. Correct Answer: D. Multiple drugs reduce development of resistant strains of the bacteria. This is the rationale that supports multidrug treatment for clients with tuberculosis. Combination therapy also appears to be more effective than single drug therapy.

9. A client with pneumonia is experiencing pleuritic pain. Which of the following measures would most likely be successful in reducing his chest pain? a. Encourage the client to breathe shallowly. b. Have the client practice abdominal breathing. c. Offer the client incentive spirometry. d. Teach the client to splint the rib cage when coughing.

d. Teach the client to splint the rib cage when coughing. Correct Answer: D. Teach the client to splint the rib cage when coughing. This is the measure that would most likely reduce pain triggered by coughing. A, B, and C are incorrect. Breathing shallowly may cause atelectasis. Incentive spirometry facilitates effective deep breathing but does not reduce pleuritic pain. Abdominal breathing may not be as effective in decreasing pleuritic chest pain as is splinting of the rib cage.

13. Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema? a. To promote oxygen intake. b. To strengthen the diaphragm. c. To strengthen intercostal muscles. d. To promote carbon dioxide elimination.

d. To promote carbon dioxide elimination. Correct Answer: D. Pursed - lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby promoting carbon dioxide elimination. A,B, and C are not functions of pursed-lip breathing.

12. Which of the following physical assessment findings would the nurse expect to find in a client with advanced COPD? a. Barrel — chest b. Collapsed neck veins c. Increased chest excursions with respiration. d. Nonproductive hacking cough

a. Barrel — chest Correct Answer: A. Barrel chest is characteristic of advanced COPD. Air is trapped in the overdistended alveoli, and the ribs are fixed in an inspiratory position. There is increase in the anteroposterior diameter of the chest. The chest looks 4X4. B, C. and D are incorrect. In COPD, there are distended neck veins, decreased chest excursion, copious, tenacious mucus secretions.

8. Bed rest is prescribed for the client with pneumonia during the acute phase of the illness. Bed rest serves which of the following a purposes? a. It reduces cellular demand for oxygen. b. It decreases the episodes of coughing. c. It promotes safety. d. It promotes clearance of secretions.

a. It reduces cellular demand for oxygen. Correct Answer: A. Bed rest reduces cellular demand for oxygen in a client with pneumonia. B, C, and D are not purposes of bedrest.

14. The nurse is observing an elderly client use his metered dose inhaler (MDI) to administer his bronchodilator medication. Which of the following client actions should the nurse correct to improve the client's technique? a. The client shakes the inhaler immediately before use. b. The client waits 1 minute between puffs. c. The client activates the MDI on exhalation. d. The client holds his breath for 10 seconds after inhalation

c. The client activates the MDI on exhalation. Correct Answer: C. When using inhalers, the client activates the MDI (metered dose inhaler) on inhalation not on exhalation. A, B, and D are correct techniques when using the MDI.

4. The nurse is teaching the client how to manage a nosebleed. Which of the following instructions would be appropriate to give to the client? a. "Tilt your head backward and pinch your nose." b. "Lie down flat and place an ice compress over the bridge of your nose." c. "Blow your nose gently with your neck flexed." d. "Sit down, lean forward, and pinch the soft portion of your nose."

d. "Sit down, lean forward, and pinch the soft portion of your nose." Correct Answer: D. "Sit down, lean forward, and pinch the soft portion of your nose." This is an appropriate instruction for client with nosebleed. This will control bleeding and will prevent aspiration of blood. A, B, and C are inappropriate instructions to manage a nosebleed. Tilting the head backward can cause the client to swallow blood. Ice compress may be applied but the client should not lie flat. Blowing the nose is to be avoided because it can increase bleeding.

7. The nurse is suctioning the client with tracheostomy after laryngectomy. Which of the following is inappropriate nursing action? The nurse: a. Uses a sterile catheter each time the client is suctioned. b. Applies suction for 5 to 10 seconds at a time. c. Hyper-oxygenates the client before and after suctioning. d. Cleanses the catheter in sterile water after each use and reuse for no longer than 8 hours.

d. Cleanses the catheter in sterile water after each use and reuse for no longer than 8 hours. Correct Answer: D. Cleansing the catheter in sterile water after each use and reusing it for no longer than 8 hours. This is inappropriate nursing action when suctioning the client with leic tracheostomy. The recommended technique is strict aseptic technique to prevent infection. Reusing a suction catheter is not consistent with aseptic technique. The appropriate nursing action is to use a new sterile suction catheter for each episode of suctioning. A, B, and C are appropriate nursing actions when suctioning a client with tracheostomy.