Chapter 23: Management of Patients With Chest and Lower Respiratory Tract Disorders

A client who is diagnosed with chronic respiratory failure will have which of the following symptoms? a) Dyspnea b) Hypercapnia c) Hypoxemia d) Ventilatory failure

a) Dyspnea Explanation: Chronic respiratory failure develops over a long time period as the result of another condition. The most common diseases leading to chronic respiratory failure are COPD and neuromuscular disorders. A fall in arterial oxygen levels is a sign of acute respiratory failure. A rise in arterial CO2 is a sign of acute respiratory failure. Ventilatory failure develops in acute respiratory failure when the alveoli cannot adequately expand. pg.595

The nurse is assessing a patient who, following an extensive surgical procedure, is at risk for developing acute respiratory distress syndrome (ARDS). The nurse assesses for which early, most common sign of ARDS? a) Rapid onset of severe dyspnea b) Cyanosis c) Inspiratory crackles d) Bilateral wheezing

a) Rapid onset of severe dyspnea Explanation: The acute phase of ARDS is marked by a rapid onset of severe dyspnea that usually occurs less than 72 hours after the precipitating event pg.596

The new client on the unit was admitted with acute respiratory failure. What are the signs and symptoms of acute respiratory failure? a) Sudden onset in client who had normal lung function b) Insidious onset in client who had normal lung function c) Insidious onset in client who had compromised lung function d) Sudden onset in client who had compromised lung function

a) Sudden onset in client who had normal lung function Explanation: Acute respiratory failure occurs suddenly in a client who previously had normal lung function. pg.595

A 73-year-old client is admitted to the pulmonology unit of the hospital. She was admitted with a pleural effusion and was "tapped" to drain the fluid to reduce her mediastinal pressure. How much fluid is typically present between the pleurae, which surround the lungs, to prevent friction rub? a) No fluid normally is present b) 5 - 15 ml c) 15 - 25 ml d) 20 - 30 ml

b) 5 - 15 ml Explanation: Under normal conditions, approximately 5 to 15 mL of fluid between the pleurae prevent friction during pleural surface movement. pg.593

A client is admitted to the emergency department with a stab wound and is now presenting dyspnea, tachypnea, and sucking noise heard on inspiration and expiration. The nurse should care for the wound in which manner? a) Apply vented dressing. b) Apply airtight dressing. c) Apply direct pressure to the wound. d) Clean the wound and leave open to the air.

b) Apply airtight dressing. Explanation: The client has developed a pneumothorax, and the best action is to prevent further deflation of the affected lung by placing an airtight dressing over the wound. A vented dressing would be used in a tension pneumothorax, but because air is heard moving in and out, a tension pneumothorax is not indicated. Applying direct pressure is required if active bleeding is noted. pg.613

When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems? a) Hyperventilation, hypertension, and hypocapnia b) Hypercapnia, hypoventilation, and hypoxemia c) Hypotension, hyperoxemia, and hypercapnia d) Hyperoxemia, hypocapnia, and hyperventilation

b) Hypercapnia, hypoventilation, and hypoxemia Explanation: The cardinal physiologic abnormalities of acute respiratory failure are hypercapnia, hypoventilation, and hypoxemia. The nurse should focus on resolving these problems. pg.595

A mediastinal shift occurs in which type of chest disorder? a) Traumatic pneumothorax b) Tension pneumothorax c) Cardiac tamponade d) Simple pneumothorax

b) Tension pneumothorax Explanation: A tension pneumothorax causes the lung to collapse and the heart, the great vessels, and the trachea to shift toward the unaffected side of the chest (mediastinal shift). A traumatic pneumothorax occurs when air escapes from a laceration in the lung itself and enters the pleural space or enters the pleural space through a wound in the chest wall. A simple pneumothorax most commonly occurs as air enters the pleural space through the rupture of a bleb or a bronchopleural fistula. Cardiac tamponade is compression of the heart resulting from fluid or blood within the pericardial sac. pg.614

The nurse is interpreting blood gases for a patient with acute respiratory distress syndrome (ARDS). Which set of blood gas values indicates respiratory acidosis? a) pH 7.47, PaCO2 28, HCO3 30 b) pH 7.25, PaCO2 48, HCO3 24 c) pH 7.87, PaCO2 38, HCO3 28 d) pH 7.49, PaCO2 34, HCO3 25

b) pH 7.25, PaCO2 48, HCO3 24 Correct Explanation: pH 7.25, PaCO2 48, HCO3 24 = respiratory acidosis pH 7.87, PaCO2 38, HCO3 28 = metabolic alkalosis pH 7.47, PaCO2 28, HCO3 30 = respiratory alkalosis pH 7.49, PaCO2 34, HCO3 25 = respiratory alkalosis pg.595

A client is brought to the emergency department following a motor vehicle accident. Which of the following nursing assessment is significant in diagnosing this client with flail chest? a) Clubbing of fingers and toes b) Respiratory acidosis c) Paradoxical chest movement d) Chest pain on inspiration

c) Paradoxical chest movement Explanation: Flail chest occurs when two or more adjacent ribs fracture and results in impairment of chestwall movement. Respiratory acidosis and chest pain are symptoms that can occur with flail chest but is not as significant in the diagnosis as paradoxical chest movement. Clubbing of fingers and toes are sign of prolonged tissue hypoxia. pg.612

A client has hypoxemia of pulmonary origin. What portion of arterial blood gas results is most useful in distinguishing between acute respiratory distress syndrome and acute respiratory failure? a) Partial pressure of arterial carbon dioxide (PaCO2) b) pH c) Partial pressure of arterial oxygen (PaO2) d) Bicarbonate (HCO3-)

c) Partial pressure of arterial oxygen (PaO2) Explanation: In acute respiratory failure, administering supplemental oxygen elevates the PaO2. In acute respiratory distress syndrome, elevation of the PaO2 requires positive end-expiratory pressure. In both situations, the PaCO2 is elevated and the pH and HCO3- are depressed. pg.595

You are caring for a client status post lung resection. When assessing your client you find that the bubbling in the water-seal chamber for the chest tubes is more than you expected. What should you check when bubbling in the water-seal chamber is excessive? a) See if the chest tube is clogged. b) See if the wall suction unit has malfunctioned. c) See if there are leaks in the system. d) See if a kink has developed in the tubing.

c) See if there are leaks in the system. Explanation: Bubbling in the water-seal chamber occurs in the early postoperative period. If bubbling is excessive, the nurse checks the system for any kind of leaks. Fluctuation of the fluid in the water-seal chamber is initially present with each respiration. Fluctuations cease if the chest tube is clogged or a kink develops in the tubing. If the suction unit malfunctions, the suction control chamber, not the water-seal chamber, will be affected. pg.526

A mechanically ventilated patient is receiving a combination of atracurium (Tracrium) and an opioid analgesic morphine. The nurse monitors the patient for which potential complication? a) Pulmonary hypertension b) Cor pulmonale c) Venous thromboemboli d) Pneumothorax

c) Venous thromboemboli Explanation: Neuromuscular blockers predispose the patient to venous thromboemboli (VTE), muscle atrophy, and skin breakdown. Nursing assessment is essential to minimize the complications related to neuromuscular blockade. The patient may have discomfort or pain but be unable to communicate these sensations. pg.597

A client with lung cancer develops pleural effusion. During chest auscultation, which breath sound should the nurse expect to hear? a) Crackles b) Wheezes c) Rhonchi d) Decreased breath sounds

d) Decreased breath sounds Explanation: In pleural effusion, fluid accumulates in the pleural space, impairing transmission of normal breath sounds. Because of the acoustic mismatch, breath sounds are diminished. Crackles commonly accompany atelectasis, interstitial fibrosis, and left-sided heart failure. Rhonchi suggest secretions in the large airways. Wheezes result from narrowed airways, such as in asthma, chronic obstructive pulmonary disease, and bronchitis. pg.593

A 29-year-old client presents to the ED complaining of dyspnea on exertion and overall weakness. Her pulmonary arterial pressure is 40/15 mm Hg. These symptoms indicate that the client may have which of the following conditions? a) Atelectasis b) Restrictive lung disease c) Asthma d) Pulmonary arterial hypertension

d) Pulmonary arterial hypertension pg.599

A patient involved in a motor vehicle crash suffered a blunt injury to the chest wall and was brought to the emergency department. The nurse assesses the patient for which clinical manifestation that would indicate the presence of a pneumothorax? a) Bloody, productive cough b) Diminished breath sounds c) Decreased respiratory rate d) Sucking sound at the site of injury

d) Sucking sound at the site of injury Explanation: Open pneumothorax is one form of traumatic pneumothorax. It occurs when a wound in the chest wall is large enough to allow air to pass freely in and out of the thoracic cavity with each attempted respiration. Because the rush of air through the wound in the chest wall produces a sucking sound, such injuries are termed sucking chest wounds pg.614

The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation? a) Flail chest b) Cardiac tamponade c) Pulmonary contusion d) Tension pneumothorax

d) Tension pneumothorax Explanation: Clamping can result in a tension pneumothorax. The other options would not occur if the chest tube was clamped during transportation. pg.614

A 68-year-old male client who underwent thoracic surgery to remove a lung tumor had a chest tube placed anteriorly. The nurse knows that the surgical team places this catheter: a) To administer IV medication b) To ventilate the client c) To remove fluid from the lungs d) To remove air from the pleural space

d) To remove air from the pleural space Explanation: After thoracic surgery, draining secretions, air, and blood from the thoracic cavity is necessary to allow the lungs to expand. A catheter placed in the pleural space provides a drainage route through a closed or underwater-seal drainage system to remove air. Sometimes two chest catheters are placed following thoracic surgery—one anteriorly and one posteriorly. The anterior catheter removes air; the posterior catheter removes fluid. Chest tubes are placed to remove anteriorly air from the pleural space following thoracic surgery. The anesthesiologist ventilates the client during surgery. Postsurgery, a chest tube is placed anteriorly to remove air from the pleural space. pg.527

On auscultation, which finding suggests a right pneumothorax? a) Inspiratory wheezes in the right thorax b) Absence of breath sounds in the right thorax c) Bilateral pleural friction rub d) Bilateral inspiratory and expiratory crackles

b) Absence of breath sounds in the right thorax Explanation: In pneumothorax, the alveoli are deflated and no air exchange occurs in the lungs. Therefore, breath sounds in the affected lung field are absent. None of the other options are associated with pneumothorax. Bilateral crackles may result from pulmonary congestion, inspiratory wheezes may signal asthma, and a pleural friction rub may indicate pleural inflammation. pg.614

Which of the following techniques does a nurse suggest to a patient with pleurisy while teaching about splinting the chest wall? a) Use a prescribed analgesic b) Use a heat or cold application c) Turn onto the affected side d) Avoid using a pillow while splinting

c) Turn onto the affected side Explanation: The nurse teaches the patient to splint the chest wall by turning onto the affected side. The nurse also instructs the patient to take analgesic medications as prescribed and to use heat or cold applications to manage pain with inspiration. The patient can also splint the chest wall with a pillow when coughing. pg.593

For a patient with pleural effusion, what does chest percussion over the involved area reveal? a) Dullness over the involved area b) Absent breath sounds c) Fluid presence d) Friction rub

a) Dullness over the involved area Explanation: Chest percussion reveals dullness over the involved area. The nurse may note diminished or absent breath sounds over the involved area when auscultating the lungs and may also hear a friction rub. Chest radiography and computed tomography (CT) scan show fluid in the involved area. pg.594

A client admitted with multiple traumatic injuries receives massive fluid resuscitation. Later, the physician suspects that the client has aspirated stomach contents. The nurse knows that this client is at highest risk for: a) acute respiratory distress syndrome (ARDS). b) chronic obstructive pulmonary disease (COPD). c) bronchial asthma. d) renal failure.

a) acute respiratory distress syndrome (ARDS). Explanation: A client who receives massive fluid resuscitation or blood transfusions or who aspirates stomach contents is at highest risk for ARDS, which is associated with catastrophic events, such as multiple trauma, bacteremia, pneumonia, near drowning, and smoke inhalation. COPD refers to a group of chronic diseases, including bronchial asthma, characterized by recurring airflow obstruction in the lungs. Although renal failure may occur in a client with multiple trauma (depending on the organs involved), this client's history points to an assault on the respiratory system secondary to aspiration of stomach contents and massive fluid resuscitation. pg.596

A client with unresolved hemothorax is febrile, with chills and sweating. He has a nonproductive cough and chest pain. His chest tube drainage is turbid. A possible explanation for these findings is: a) empyema. b) Pneumocystis carinii pneumonia. c) infected chest tube wound site. d) lobar pneumonia.

a) empyema. Explanation: Any condition that produces fluid accumulation or sequestration of fluid with infective properties can lead to empyema, an accumulation of pus in a body cavity, especially the pleural space, as a result of bacterial infection. An infected chest tube site, lobar pneumonia, and P. carinii pneumonia can lead to fever, chills, and sweating associated with infection. However, in this case, turbid drainage indicates that empyema has developed. Pneumonia typically causes a productive cough. An infected chest tube wound would cause redness and pain at the site, not turbid drainage. pg.594

A nurse is caring for a patient after a thoracentesis. Which of the following signs if noted in the patient should be reported to the physician immediately? a) "Patient has subcutaneous emphysema around needle insertion site." b) "Patient is becoming agitated and complains of pleuritic pain." c) "Patient is drowsy and complains of headache." d) "Patient has an oxygen saturation level of 93%."

b) "Patient is becoming agitated and complains of pleuritic pain." Explanation: After a thoracentesis, the nurse monitors the patient for pneumothorax or recurrence of pleural effusion. Signs and symptoms associated with pneumothorax depend on its size and cause. Pain is usually sudden and may be pleuritic. The patient may have only minimal respiratory distress with slight chest discomfort and tachypnea with a small simple or uncomplicated pneumothorax. As the pneumothorax enlarges, the patient may become anxious and develop dyspnea with increased use of the accessory muscles. pg.583

A nurse is reviewing a client's X-ray. The X-ray shows an endotracheal (ET) tube placed 3/4? (2 cm) above the carina and reveals nodular lesions and patchy infiltrates in the upper lobe. Which interpretation of the X-ray is accurate? a) The X-ray is inconclusive. b) A disease process is present. c) The ET tube must be pulled back. d) The ET tube must be advanced.

b) A disease process is present. Explanation: This X-ray suggests tuberculosis. An ET tube that's 3/4? above the carina is at an adequate level in the trachea. There's no need to advance it or pull it back. pg.588

The ICU nurse caring for a 2-year-old near drowning victim monitors for what possible complication? a) Atelectasis b) Acute respiratory distress syndrome c) Metabolic alkalosis d) Respiratory acidosis

b) Acute respiratory distress syndrome Explanation: Factors associated with the development of ARDS include aspiration related to near drowning or vomiting; drug ingestion/overdose; hematologic disorders such as disseminated intravascular coagulation or massive transfusions; direct damage to the lungs through prolonged smoke inhalation or other corrosive substances; localized lung infection; metabolic disorders such as pancreatitis or uremia; shock; trauma such as chest contusions, multiple fractures, or head injury; any major surgery; embolism; and septicemia. Options A, C and D are incorrect. pg.596

A victim of a motor vehicle accident has been brought to the emergency room. The patient is exhibiting paradoxical chest expansion and respiratory distress. Which of the following chest disorders should be suspected? a) Cardiac tamponade b) Flail chest c) Simple pneumothorax d) Pulmonary contusion

b) Flail chest Explanation: When a flail chest exists, during inspiration, as the chest expands, the detached part of the rib segment (flail segment) moves in a paradoxical manner in that it is pulled inward during inspiration, reducing the amount of air that can be drawn into the lungs. On expiration, because the intrathoracic pressure exceed atmospheric pressure, the flail segment bulges outward, impairing the patient's ability to exhale. Cardiac tamponade is compression of the heart resulting from fluid or blood within the pericardial sac. A pulmonary contusion is damage to the lung tissues resulting in hemorrhage and localized edema. A simple pneumothorax occurs when air enters the pleural space through the rupture of a bleb or a bronchopleural fistula. pg.611

A client who underwent surgery 12 hours ago has difficulty breathing. He has petechiae over his chest and complains of acute chest pain. What action should the nurse take first? a) Perform nasopharyngeal suctioning. b) Initiate oxygen therapy. c) Administer a heparin bolus and begin an infusion at 500 units/hour. d) Administer analgesics as ordered.

b) Initiate oxygen therapy. Explanation: The client's signs and symptoms suggest pulmonary embolism. Therefore, maintaining respiratory function takes priority. The nurse should first initiate oxygen therapy and then notify the physician immediately. The physician will most likely order an anticoagulant such as heparin or an antithrombolytic to dissolve the thrombus. Analgesics can be administered to decrease pain and anxiety but administering oxygen takes priority. Suctioning typically isn't necessary with pulmonary embolism. pg.601

A patient diagnosed with acute respiratory distress syndrome (ARDS) is restless and has a low oxygen saturation level. If the patient's condition does not improve and the oxygen saturation level continues to decrease what procedure will the nurse expect to assist with in order to assist the patient to breathe easier? a) Administer a large dose of furosemide (Lasix) IVP stat b) Intubate the patient and control breathing with mechanical ventilation c) Schedule the patient for pulmonary surgery d) Increase oxygen administration

b) Intubate the patient and control breathing with mechanical ventilation Explanation: A patient with ARDS may need mechanical ventilation to assist with breathing while the underlying cause of the pulmonary edema can be corrected. The other options are not appropriate. pg.597

The nurse identifies which finding to be most consistent prior to the onset of acute respiratory distress? a) Chronic lung disease b) Normal lung function c) Loss of lung function d) Slow onset of symptoms

b) Normal lung function Explanation: Acute respiratory failure occurs suddenly in clients who previously had normal lung function. pg.596

A client who has just had a triple-lumen catheter placed in his right subclavian vein complains of chest pain and shortness of breath. His blood pressure is decreased from baseline and, on auscultation of his chest, the nurse notes unequal breath sounds. A chest X-ray is immediately ordered by the physician. What diagnosis should the nurse suspect? a) Pulmonary embolism b) Pneumothorax c) Heart failure d) Myocardial infarction (MI)

b) Pneumothorax Explanation: Pneumothorax (air in the pleural space) is a potential complication of all central venous access devices. Signs and symptoms include chest pain, dyspnea, shoulder or neck pain, irritability, palpitations, light-headedness, hypotension, cyanosis, and unequal breath sounds. A chest X-ray reveals the collapse of the affected lung that results from pneumothorax. Triple-lumen catheter insertion through the subclavian vein isn't associated with pulmonary embolism, MI, or heart failure. pg.613

Which of the following actions is most appropriate for the nurse to take when the patient demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery? a) Measure the patient's pulse oximetry b) Record the observation c) Report the finding to the physician immediately d) Apply a compression dressing to the area

b) Record the observation Explanation: Subcutaneous emphysema occurs after chest surgery as the air that is located within the pleural cavity is expelled through the tissue opening created by the surgical procedure. Subcutaneous emphysema is a typical postoperative finding in the patient after chest surgery. Subcutaneous emphysema is absorbed by the body spontaneously after the underlying leak is treated or halted. Subcutaneous emphysema results from air entering the tissue planes. pg.614

Arterial blood gas analysis would reveal which of the following related to acute respiratory failure? a) pH 7.35 b) pH 7.28 c) PaCO 32 mm Hg d) PaO 80 mm Hg

b) pH 7.28 Explanation: Acute respiratory failure (ARF) is defined as a decrease in the arterial oxygen tension (PaO) to less than 50 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO) to greater than 50 mm Hg (hypercapnia), with an arterial pH of less than 7.35. pg.597

The client asks the nurse to explain the reason for a chest tube insertion in treating a pneumothorax. Which is the best response by the nurse? a) "Chest tube will allow air to be restored to the lung." b) "Chest tubes provide a route for medication instillation to the lung." c) "The tube will drain air from the space around the lung." d) "The tube will drain secretions from the lung."

c) "The tube will drain air from the space around the lung." Explanation: Negative pressure must be maintained in the pleural cavity for the lungs to be inflated. An injury that allows air into the pleural space will result in a collapse of the lung. The chest tube can be used to drain fluid and blood from the pleural cavity and to instill medication, such as talc, to the cavity. pg.614

A physician stated to the nurse that the patient has fluid noted in the pleural space and will need a thoracentesis. The nurse would expect that the physician will document this fluid as which of the following? a) Pneumothorax b) Hemothorax c) Pleural effusion d) Consolidation

c) Pleural effusion Explanation: Fluid accumulating within the pleural space is called a pleural effusion. A pneumothorax is air in the pleural space. A hemothorax is blood within the pleural space. Consolidation is lung tissue that has become more solid in nature due to collapse of alveoli or infectious process. pg.593

A patient suspected of developing acute respiratory distress syndrome (ARDS) is experiencing anxiety and agitation due to increasing hypoxemia and dyspnea. A nurse would implement which of the following interventions to improve oxygenation and provide comfort for the patient? a) Assist the patient up to a chair b) Force fluids for the next 24 hours c) Position the patient in the prone position d) Administer small doses of pancuronium (Pavulon)

c) Position the patient in the prone position Explanation: The patient is extremely anxious and agitated because of the increasing hypoxemia and dyspnea. It is important to reduce the patient's anxiety because anxiety increases oxygen expenditure. Oxygenation in patients with ARDS is sometimes improved in the prone position. Rest is essential to limit oxygen consumption and reduce oxygen needs. pg.597

You are an ICU nurse caring for a client who was admitted with a diagnosis of smoke inhalation. You know that this client is at increased risk for which of the following? a) Bronchitis b) Lung cancer c) Tracheobronchitis d) Acute respiratory distress syndrome

d) Acute respiratory distress syndrome Explanation: Factors associated with the development of ARDS include aspiration related to near drowning or vomiting; drug ingestion/overdose; hematologic disorders such as disseminated intravascular coagulation or massive transfusions; direct damage to the lungs through prolonged smoke inhalation or other corrosive substances; localized lung infection; metabolic disorders such as pancreatitis or uremia; shock; trauma such as chest contusions, multiple fractures, or head injury; any major surgery; embolism; and septicemia. Smoke inhalation does not increase the risk for lung cancer, bronchitis, and tracheobronchitis. pg.596

Which of the following terms refers to lung tissue that has become more solid in nature due to a collapse of alveoli or an infectious process? a) Bronchiectasis b) Empyema c) Atelectasis d) Consolidation

d) Consolidation Explanation: Consolidation occurs during an infectious process such as pneumonia. Atelectasis refers to the collapse or airless condition of the alveoli caused by hypoventilation, obstruction to the airways, or compression. Bronchiectasis refers to the chronic dilation of a bronchi or bronchi in which the dilated airway becomes saccular and a medium for chronic infection. Empyema refers to accumulation of purulent material in the pleural space. pg.578

An emergency room nurse is assessing a patient who is complaining of dyspnea. Which of these signs would indicate the presence of a pleural effusion? a) Mottling of the skin upon inspection b) Resonance upon percussion c) Wheezing upon auscultation d) Decreased chest wall excursion upon palpation

d) Decreased chest wall excursion upon palpation Explanation: Symptoms of pleural effusion are shortness of breath, pain, assumption of a position that decreases pain, absent breath sounds, decreased fremitus, a dull, flat sound on percussion, and decreased chest wall excursion. The nurse may also hear a friction rub. Chest radiography and computed tomography (CT) scan show fluid in the involved area. pg.593

A nurse is caring for a client with chest trauma. Which nursing diagnosis takes the highest priority? a) Decreased cardiac output b) Anxiety c) Ineffective tissue perfusion (cardiopulmonary) d) Impaired gas exchange

d) Impaired gas exchange Explanation: For a client with chest trauma, a diagnosis of Impaired gas exchange takes priority because adequate gas exchange is essential for survival. Although the other nursing diagnoses — Anxiety, Decreased cardiac output, and Ineffective tissue perfusion (cardiopulmonary) — are possible for this client, they are lower priorities than Impaired gas exchange. pg.610

Which of the following comfort techniques does a nurse teach to a patient with pleurisy to assist with splinting the chest wall? a) Elevate the head of the bed b) Use a prescribed analgesic c) Use a heat application d) Turn onto the affected side

d) Turn onto the affected side Explanation: The nurse teaches the patient to splint the chest wall by turning onto the affected side in order to reduce the stretching of the pleurae and decrease pain. pg.593

Following thoracic surgery, the care plan for a client at risk for impaired gas exchange would include which of the following? Select all that apply. a) Elevate head of bed 30°-40° as tolerated. b) Reinforce preoperative breathing exercises. c) Administer pain medications. d) Maintain accurate record of intravenous intake. e) Monitor vital signs frequently.

e) Monitor vital signs frequently. b) Reinforce preoperative breathing exercises. a) Elevate head of bed 30°-40° as tolerated. Explanation: Nursing management for a client with the goal of maintaining optimal gas exchange includes assessing vital signs frequently, reinforcing preoperative instructions about deep breathing, coughing, and incentive spirometry, and elevating the head of the bed as tolerated. pg.528