Chapter 41

2 Frequently repositioning the elastic strap of an oxygen mask helps reduce pressure, thereby preventing skin breakdown. Epistaxis can be avoided by monitoring humidification if the oxygen flow rate is greater than 4 L/minute. To avoid continuous hypoxia, follow-up of pulse oximetry and arterial blood gas (ABG) assessment should be performed. To prevent nasal mucosal dryness, sterile nasal saline should be used intermittently with the orders of the health care provider.

The registered nurse instructs the nursing assistive person (NAP) to frequently reposition the elastic strap on the patient's oxygen mask. What is the rationale behind this? 1 To prevent epistaxis 2 To prevent skin breakdown 3 To prevent continued hypoxia 4 To prevent nasal mucosal dryness

1 When the lung collapses, the thoracic space fills with air on each inspiration, and the atmospheric air irritates the parietal pleura, causing pain.

A patient was admitted after a motor-vehicle accident with multiple fractured ribs. During respiratory assessment, which signs and symptoms of secondary pneumothorax would the nurse expect to find? 1 Sharp pleuritic pain that worsens on inspiration 2 Crackles over lung bases of affected lung 3 Tracheal deviation toward the affected lung 4 Increased diaphragmatic excursion on side of rib fractures

1 When the body cannot meet the increased oxygenation need, the increased metabolic rate causes the breakdown of protein and wasting of respiratory muscles, increasing the work of breathing. Carbon dioxide production increases due to the increased metabolism stemming from the fever, not as a result of hyperventilation.

A 6-year-old boy is admitted to the pediatric unit with chills and a fever of 104° F (40° C). Which physiological process explains why the child is at risk for developing dyspnea? 1 Fever increases metabolic demands, requiring increased oxygen need. 2 Blood glucose stores are depleted, and the cells do not have energy to use oxygen. 3 Carbon dioxide production increases as a result of hyperventilation. 4 Carbon dioxide production decreases as a result of hypoventilation.

2 Decreased circulation of blood volume may cause hypoxia. Decreased metabolic rate does not cause hypoxia. Decreased carbon dioxide-carrying capacity does not cause hypoxia. Decreased inspired oxygen concentration may cause an upper or lower airway obstruction.

A nurse assesses a patient and determines there are color changes to the skin due to hypoxia. What may be the cause of this change? 1 Decreased metabolic rate 2 Decreased circulation of blood volume 3 Decreased inspired oxygen concentration 4 Decreased carbon dioxide-carrying capacity

1 The carbon dioxide load on the lungs increases with the increase in carbohydrate metabolism. Therefore, a patient who has pulmonary disorders and anemia should reduce the intake of carbohydrates. Thirty to 60 minutes of daily exercise will help increase oxygen consumption by 10 to 20 percent. Nicotine patches and varenicline (Chantix) may replace cigarette smoking and decrease the risk of lung cancer. Smog may trigger the risk of pulmonary disease. Therefore, the patient should either use aface mask or avoid exposure to the smog.

A nurse counsels a patient with a pulmonary disorder and anemia about self-care. Which statement if made by the patient during evaluation indicates a need for correction? 1 "I should eat a diet rich in carbohydrates." 2 "I should exercise for 30 to 60 minutes daily." 3 "I should use varenicline (Chantix) or nicotine patches." 4 "I should use a face mask while going out during a smoggy day."

2 Dyspnea is a subjective description reflective of the patient's statement indicating difficulty in breathing. Apnea refers to absence of breathing. Tachypnea refers to an increased rate of breathing, usually greater than 20 breaths per minute. Respiratory fatigue is a subjective description. It usually refers to the patient exhibiting signs and symptoms associated with a comprehensive respiratory assessment. The respiratory assessment includes laborious breathing, use of accessory muscles, and slowing of respirations.

During assessment a patient states, "It's hard for me to breathe and I feel short-winded all the time." Which is the most appropriate terminology for the nurse to use when documenting this assessment? 1 Apnea 2 Dyspnea 3 Tachypnea 4 Respiratory fatigue

1, 3, 4 The oxygen-carrying capacity of blood depends on the concentration of hemoglobin in the blood. Anemia and exposure to toxins reduce the amount of hemoglobin available for oxygen binding and reduce the oxygenation of tissues. Severe dehydration causes loss of extracellular fluid and reduced blood volume in circulation. This also affects tissue oxygenation. Dysuria is painful urination and is not related to oxygenation. Fracture of the radius can cause pain but not reduced oxygenation.

The nurse is teaching a group of patients about respiratory disease. Which factors can affect the oxygen-carrying capacity of the blood? Select all that apply. 1 Anemia 2 Dysuria 3 Inhalation of toxins 4 Severe dehydration 5 Fracture of radius bone

1, 2, 4 The signs and symptoms of hypoventilation include mental status changes, convulsions, and dysrhythmias. Sighing breaths and numbness and tingling of the hands are associated with hyperventilation.

What are the symptoms of hypoventilation? Select all that apply. 1 Convulsions 2 Dysrhythmias 3 Sighing breaths 4 Changes in mental status 5 Numbness and tingling of hands

3 Atelectasis is a pulmonary condition that leads to a collapse of the alveoli, which prevents a normal exchange of oxygen and carbon dioxide. Bronchoconstriction and airway obstructions may lead to asthma. Kyphosis is a traumatic structural abnormality that alters the ability of the lungs to distend, resulting in increased intraalveolar pressure. Myocardial infarction may affect pulmonary circulation and may result in dyspnea.

What condition involves collapsed alveoli that prevent the normal exchange of oxygen and carbon dioxide? 1 Asthma 2 Kyphosis 3 Atelectasis 4 Myocardial infarction

1, 4, 5 Hypoxia presents as an increase in pulse rate and a rise in respiratory rate and depth of respiration. In late stages of hypoxia, the skin and mucous membrane may become bluish in color. Blood urea is a renal parameter, so it is less significant when monitoring a patient with hypoxia. Serum bilirubin indicates liver function, so it is less significant when monitoring a patient with hypoxia.

What parameters should the nurse monitor in a patient who has developed hypoxia due to severe anemia? Select all that apply. 1 Pulse rate 2 Blood urea 3 Serum bilirubin 4 Respiratory rate 5 Skin color change

4 Continuous bubbling in the water seal chamber indicates that an air leak is present between the patient and the water seal. Hypoxia does not lead to bubbling in the water seal chamber. Clamping of the chest tube may lead to tension pneumothorax. Kinking of the tube may result in the formation of clots that may not lead to bubbling in the water seal chamber.

he nurse is caring for a patient who has a chest tube drainage system. The nurse notices continuous bubbling in the water seal chamber. What could be the reason for this? 1 The patient has hypoxia. 2 The chest tube is clamped. 3 The chest tube is blocked with clots. 4 There is a leak between the patient and the chamber.

1 The presence of scaly, oozing lesions following the use of an herbal soap indicates that the patient has contact dermatitis. The best immediate step is to avoid the causative agent (the herbal soap). Hot water is not recommended for regular bathing. Warm water should be preferred over hot water. Taking antihistamines may help the patient after the development of dermatitis, but it may not be useful before bathing. The lesions should be left open for healing, not dressed.

A patient developed redness of the face with itching after taking a hot-water bath with a new herbal soap. On examination, the nurse finds lesions that are scaly and oozing. What should the nurse instruct the patient to do immediately? 1 Stop using the herbal soap. 2 Stop using hot water for bathing. 3 Take antihistamines before bathing. 4 Apply dressings on the lesions.

2, 3, 4 In hyperventilation, the lungs remove carbon dioxide faster than it is produced by cellular metabolism. It can be induced by infection, severe anxiety, and acid-base imbalance. Cyanosis is caused by the presence of desaturated hemoglobin in the capillaries. This condition is a late sign of hypoxia. Multiple rib fractures or chest trauma causes hypoxia.

A patient has a condition in which the lungs remove carbon dioxide faster than it is produced by cellular metabolism. Which predisposing factors contribute to this condition? Select all that apply. 1 Cyanosis 2 Infection 3 Severe anxiety 4 Acid-base imbalance 5 Multiple rib fractures

2 Carbon monoxide (CO) strongly binds to hemoglobin, making it unavailable for oxygen binding and transport. Salicylate poisoning, amphetamine use, and diabetic ketoacidosis can stimulate hyperventilation causing respiratory alkalosis. Arterial blood gas (ABG) levels are not routinely used to diagnosis CO poisoning, but these patients are usually found to have metabolic acidosis if they are tested. CO poisoning does not cause the alveoli to overinflate.

A patient is admitted to the emergency department with suspected carbon monoxide poisoning. Even though the patient's color is ruddy, not cyanotic, the nurse understands that the patient is at risk for decreased oxygen-carrying capacity of blood because of which effect of carbon monoxide? 1 Stimulates hyperventilation, causing respiratory alkalosis 2 Forms a strong bond with hemoglobin, creating a functional anemia 3 Stimulates hypoventilation, causing respiratory acidosis 4 Causes alveoli to overinflate, leading to atelectasis

3 Impaired ability to cough up mucus caused by weakness or very thick secretions indicates a need for suctioning when the patient has pneumonia. The other choices indicate that the patient has the ability to cough.

A patient is admitted with severe lobar pneumonia. Which assessment findings would indicate that the patient needs airway suctioning? 1 Coughing up thick sputum only occasionally 2 Coughing up thin, watery sputum easily after nebulization 3 Decreased independent ability to cough 4 Lung sounds clear only after coughing

4 Decreased effective contraction of the left side causes fluid to back up in the lungs, increasing hydrostatic pressure and causing pulmonary edema, resulting in crackles in lung bases, not in the apex of the lungs or midsternum. Lungs would be affected bilaterally so sonorous wheezes in the left lower lung are not a likely diagnostic finding with left-sided heart failure.

A patient is admitted with the diagnosis of severe left-sided heart failure. The nurse expects to auscultate which adventitious lung sounds? 1 Sonorous wheezes in the left lower lung 2 Rhonchi midsternum 3 Crackles only in apex of lungs 4 Inspiratory crackles in lung bases

2, 3, 5 Pneumothorax is the collection of air in the pleural cavity. There may be hypotension due to circulatory collapse. Pneumothorax may lead to dyspnea and resultant tachycardia. A sharp, stabbing pain may occur due to irritation of the pleura. The chest pain is experienced during inspiration, not during expiration. Breath sounds may be present initially but may disappear when the lung collapses.

A patient is diagnosed with pneumothorax. Which clinical manifestations is the nurse likely to find in the patient? Select all that apply. 1 Chest pain on expiration 2 Hypotension 3 Tachycardia 4 Absence of breath sounds 5 Sharp stabbing pain in the chest

1 The clinical signs and symptoms of hypoxia include an inability to concentrate, decreased level of consciousness, fatigue, and dizziness. Patients with hypoxia are unable to lie flat. Patients with hypoxia have an increased blood pressure and an increased pulse rate. Signs and symptoms of hypoxemia include central cyanosis of the tongue, soft palate, and conjunctiva. Shock and severe dehydration causes extracellular fluid loss and reduced circulating blood volume, also called hypovolemia. Severe anxiety, infection, drugs, or an acid-base imbalance causes hyperventilation.

A patient reports fatigue and an inability to lie flat. During anassessment, the nurse finds the patient has an increased blood pressure and an increased pulse rate. Further assessment reveals that the patient is dizzy, unable to concentrate, and has a decreased level of consciousness. Which condition does the nurse suspect? 1 Hypoxia 2 Hypoxemia 3 Hypovolemia 4 Hyperventilation

3 An examination would likely indicate that the patient has anemia as a result of menorrhagia. In anemia, oxygenation decreases. Over a long period, the body responds by increasing the production of red blood cells, resulting in polycythemia. Surfactant is a chemical produced by the lungs that prevents alveolar collapse. It is highly unlikely the patient has decreased surfactant. Lung compliance is the ability of the lungs to expand and is affected by intraalveolar pressure. A decrease in the fraction of inspired oxygen concentration occurs in upper or lower airway obstruction.

A patient reports having shortness of breath and fatigue on brisk walking for the past 2 weeks. The patient has also experienced menorrhagia for the past 2 months. The patient's blood reports show decreased hemoglobin and an increased red blood cell count. Which condition is the patient most likely experiencing? 1 Decreased surfactant in the lungs 2 Decreased lung compliance 3 Decreased oxygenation of blood 4 Decreased fraction of inspired oxygen concentration

4 Orthopnea occurs when the patient feels short of breath while sleeping, but comfortable when sleeping in a reclining chair. In a reclined position, the patient may also use multiple pillows to facilitate breathing. Orthopnea is quantified based on the number of pillows used. The question about exposure to passive smoking gives information about the predisposing factors to the complaints. The question about symptoms affecting daily activities indicates the severity of the symptoms. The question to rate dyspnea gives information about severity of the complaints.

A patient reports having shortness of breath for 2 months. The nurse asks the patient to rate the shortness of breath on a scale of 0 to 10 and state whether it is affecting daily activities. The nurse also asks about exposure to passive smoking and whether the patient feels comfortable when sleeping in a reclining chair. Which question asked by the nurse is about orthopnea? 1 Exposure of patient to passive smoking 2 Shortness of breath affecting daily activities 3 Rating the shortness of breath on a scale of 0 to 10 4 Feeling of comfort when sleeping in a reclining chair

1, 2, 4 Normal breathing is a quiet process, which requires minimum effort. Ventilation is the process of air moving in and out of lungs. The major muscles in breathing are the diaphragm and the intercostal muscles. Noisy breathing occurs in diseased conditions or in the presence of some obstruction. All chest muscles, such as pectorals and sternocleidomastoid, are used in labored breathing. Perfusion is a process by which the cardiovascular system delivers oxygen-rich blood to the tissues and returns deoxygenated blood to the lungs.

A patient wants to understand the mechanism of respiration. What should the nurse explain to the patient? Select all that apply. 1 Normal breathing is quiet with minimum or no effort. 2 Ventilation is the process of air moving in and out of lungs. 3 Normal breathing is noisy and requires all the chest muscles. 4 The diaphragm is an important muscle that helps in breathing. 5 Ventilation is the process of oxygenated blood flowing in the body.

1 Elevating the head of the bed at 30 to 45-degree angles or frequently changing the patient's position from supine to other simple positions may help prevent pulmonary aspiration. Oral hygiene for a patient who has atelectasis and who is on tracheostomy is maintained by using daily mouthwash with chlorhexidine. Monitoring and maintaining optimal cuff pressure helps ensure that there is an adequate seal. Draining the tracheostomy tube every hour helps prevent secretions from accumulating in the circuit.

A patient who has atelectasis has a tracheostomy. While providing care, the nurse elevates the head of the patient's bed to 30 degrees and also changes the patient's body position frequently. What is the rationale behind the nurse's actions? 1 To prevent pulmonary aspiration 2 To maintain prolonged oral hygiene 3 To ensure an adequate sealing of the tube 4 To prevent the draining of the secretions from the tube

3 A patient who has diabetic ketoacidosis has ketones in the urine. Rapid respirations, sighing breaths, numbness, and tingling inthe hands and feet, lightheadedness, and loss of consciousness are the signs of hyperventilation associated with diabetic ketoacidosis. The clinical manifestations of hypoxia include apprehension, restlessness, an inability to concentrate, decreased level of consciousness, dizziness, and behavioral changes. Clinical manifestations of hypoventilation include alterations in the mental status, dysrhythmias, and potential cardiac arrest. Hypoxia may result in a decline of the respiratory rate due to respiratory muscle fatigue.

A patient who has lightheadedness presents with rapid sighing breaths and numbness of the hands and feet. The urinalysis results show the presence of ketones. Which condition can be suspected in the patient? 1 Hypoxia 2 Hypoventilation 3 Diabetic ketoacidosis 4 Respiratory muscle fatigue

4 Effects of nicotine on blood vessels and lung tissue have been proven to increase pathological changes, leading to heart disease and lung cancer. Smoking causes hypertension but not alcoholism. Smoking does not directly lead to obesity, diabetes, or stress-related illnesses.

A patient who started smoking in adolescence and continues to smoke 40 years later comes to the clinic. The nurse understands that this patient has an increased risk for being diagnosed with which disorder? 1 Alcoholism and hypertension 2 Obesity and diabetes 3 Stress-related illnesses 4 Cardiopulmonary disease and lung cancer

2 A tracheostomy is performed when a patient needs an artificial airway for a long time. It involves inserting a large tracheostomy tube that has a small plastic inner tube, which fits inside the larger tube. The most common complication of a tracheostomy is blockage of the inner tube due to secretions. The symptoms and signs of the patient indicate that the inner tube is blocked. When this occurs, the inner tube can be replaced with a temporary spare one or removed and cleaned. Total removal of the tracheostomy tube is not required, because it can cause blockage of the airway. Administration of oxygen to the patient will not help, because the airway is blocked. No major damage to the tracheostomy tube has occurred and therefore a repeat tracheostomy is not required.

A patient with a tracheostomy tube is gasping and unable to breathe. Which intervention could help the patient? 1 Removal of the tracheostomy tube from the airway 2 Replacing the inner tube with a temporary spare one 3 Oxygen therapy to the patient through nasal cannula 4 Immediate transfer of the patient for a repeat tracheostomy

3 Simple face masks are designed to deliver 6 L/min or more of oxygen. However, in patients with chronic obstructive pulmonary disorder (COPD), this results in hypoventilation. These patients have adapted to a high level of carbon dioxide so their carbon dioxide-sensitive chemoreceptors are essentially not functioning. Because the stimulus to breathe is a decreased arterial oxygen level, administration of oxygen greater than 1 to 3 L/min prevents the PaO2 from falling to a level that stimulates the peripheral receptors. This destroys the stimulus to breathe. The resulting hypoventilation causes excessive retention of carbon dioxide. Additionally, the patient may inhale exhaled carbon dioxide retained in the mask. Therefore, masks are contraindicated in patients with COPD. However, a nasal cannula does not cause rebreathing of exhaled carbon dioxide and allows for safe delivery of lower rates of oxygen. Hence, the nurse should immediately remove the mask and use a nasal cannula for oxygen supply. Applying a new mask or resetting the mask will not improve the patient's condition.

A patient with chronic obstructive pulmonary disorder (COPD) is administered oxygen therapy using a simple oxygen face mask. After some time, the patient's blood analysis reveals abnormally high levels of carbon dioxide. Which should be the nurse's immediate next step? 1 Remove the mask and apply a new oxygen mask. 2 Reset the mask to cover the patient's nose only. 3 Remove the mask and use a nasal cannula for oxygen supply. 4 Reset the mask to cover the patient's mouth and nose.

4 In diaphragmatic exercise, a patient needs to relax the chest muscles during inspiration. The patient needs to practice these exercises first in a posture in which it is easy to do and then move on to difficult postures. Therefore, the patient needs to perform these exercises first in supine, then sitting, and finally in standing positions. The exercises are not performed initially in the standing position. Diaphragmatic breathing exercises are not contraindicated in chronic obstructive pulmonary disease (COPD); they are helpful in promoting lung expansion. During diaphragmatic breathing, the abdominal muscles are tightened up, and not the chest muscles.

A patient with chronic obstructive pulmonary disorder is trying to do diaphragmatic breathing exercises for the first time. The patient is sitting and feels uncomfortable doing the exercise. Which would be the most appropriate response by the nurse? 1 "You need to do diaphragmatic breathing exercises in a standing posture initially." 2 "Diaphragmatic breathing exercises are contraindicated for you, so don't do them." 3 "You have to tighten your chest muscles while taking deep inspirations in this exercise." 4 "You have to practice these exercises first in the supine position and then in the sitting position."

1, 2, 5 In right ventricular failure, the right ventricle of the heart does not function well, resulting in a backup of fluids in the systemic circulation. This backup exerts pressure on various organs and leads to the enlargement of the liver and spleen. There is also a fluid accumulation in the extremities presenting as edema. In left ventricular failure, the fluid backs up in the lungs causing pulmonary edema.

A patient with right ventricular failure asks the nurse about this condition. Which information should the nurse include in the explanation? Select all that apply. 1 The right ventricle doesn't function well, and fluid backs up in the systemic circulation. 2 There may be an enlargement of the liver and spleen. 3 The right ventricle doesn't function well, and fluid backs up in the lungs. 4 There is pulmonary edema and fluid accumulation in the lungs. 5 There may be peripheral edema of the hands and feet.

2, 3, 5, 7, 4, 1, 6 First, the nurse performs hand hygiene and attaches the nasal cannula. Then, the nurse adjusts the flowmeter to the prescribed oxygen flow rate and applies the nasal cannula, adjusting the fit to make sure the patient is comfortable. Next, the nurse verifies and observes the proper functioning of the oxygen-delivery device, and checks the cannula every 8 hours to monitor the patient's response. Finally, the nurse should check the adequacy of oxygen flow of each shift, observing the patient's ears for evidence of skin breakdown.

A registered nurse demonstrates how to apply a nasal cannula to a patient. Which chronological order should the nurse follow? 1. Check the adequacy of oxygen flow each shift 2. Perform hand hygiene and attach the nasal cannula 3. Adjust the flow meter to the prescribed oxygen flow rate 4. Check the cannula every 8 hours and monitor the patient's response 5. Apply the nasal cannula and adjust it appropriately 6. Observe the patient's ears for evidence of skin breakdown 7. Verify and observe for proper functioning of the oxygen-delivery device

3 Carbon monoxide (CO) is the most common toxic inhalant, decreasing the oxygen-carrying capacity of blood. The metabolic rate increases normally during pregnancy, wound healing, and exercise because the body is using energy or building tissue. The physiological response to chronic hypoxemia is the production of red blood cells, called polycythemia. When there is a decrease in inspired oxygen concentration, the oxygen-carrying capacity of the blood decreases.

A registered nurse discusses physiological factors that affect oxygenation with a group of nursing students. Which statement if made by the nursing student is correct? 1 "The metabolic rate decreases normally in pregnancy, wound healing, and exercise." 2 "The physiological response to chronic hypoxia is an increase in white blood cell production." 3 "Carbon monoxide is the most common toxic inhalant; it decreases the oxygen-carrying capacity of the blood." 4 "The oxygen carrying capacity of the blood increases when there is a decline in inspired oxygen concentration."

3 Increased exercise tolerance allows a patient to better sustain chest physiotherapy, which may be strenuous on the patient. The nursing student's other statements exhibit understanding: Patients on diuretics may experience fluid and hemodynamic changes, which may not allow them to tolerate positional changes and postural drainage. Patients on long-term steroids are susceptible to pathologic rib fractures, so chest physiotherapy would likely be contraindicated. Patients who have increased intracranial pressure may not tolerate postural changes or postural drainage, so chest physiotherapy may be contraindicated.

A registered nurse is teaching a nursing student about guidelines for chest physiotherapy on a patient who has decreased oxygenation due to pulmonary obstruction. Which of the nursing student's statements indicates a need for further teaching? 1 "Diuretics can cause complications with chest physiotherapy." 2 "Patients on long-term steroids should not undergo chest physiotherapy." 3 "Patients with increased tolerance to exercise should not undergo chest physiotherapy." 4 "Patients with increased intracranial pressure should not undergo chest physiotherapy."

3, 4 Capnography, not thoracentesis, will provide the patient's perfusion rate, and performing it at the end, not the beginning, of exhalation will provide the most accurate results. The remaining statements indicate understanding: The nurse should take a cardiovascular history of the patient during the assessment. Pulse oximetry will provide a patient's oxygenation level, and capnography will yield the patient's ventilation status.

A registered nurse is teaching a nursing student about the assessment of a patient who has decreased tissue oxygenation. Which of the nursing student's statements indicates a need for further teaching? Select all that apply. 1 "I should ask the patient about any history of cardiovascular problems." 2 "I should obtain pulse oximetry readings to obtain the patient's oxygenation level." 3 "I should advise the patient to undergo thoracentesis to obtain the rate of perfusion." 4 "I will obtain accurate results if I perform capnography during the start of exhalation." 5 "I should perform capnography to obtain instant information about the patient's ventilation status."

1 Placing the drainage system upright and below the level of tube insertion facilitates the drainage and maintains proper functioning of the system. Adjusting the tubing to hang in a straight line from the top of the mattress to drain the chamber prevents fluid or blood from accumulating in the pleural cavity. Ensuring that the tube connection between the chest and a drainage tube is intact and taped reduces the risk of an air leak causing breaks in the airtight system. Coiling the excess drainage tubing on the mattress next to the patient prevents excess tubing from hanging over the edge of mattress that may occlude the drainage system.

After inserting a chest tube, the nurse places the drainage system below the level of tube insertion. What is the rationale behind the intervention? 1 To facilitate drainage and proper functioning of the system 2 To prevent fluid or blood from accumulating in the pleural cavity 3 To reduce the risk of air leak causing breaks in an airtight system 4 To prevent excess tubing from hanging over the edge of the mattress

4, 1, 2, 3 The first step in setting the nasal cannula is to insert the nasal prongs slightly into the patient's nostrils and then fit the attached tubing over the patient's ears. Then the nurse should use the slide connector and secure it under the chin and then the nasal cannula is connected to a humidified oxygen source.

Arrange the steps in order for applying a nasal cannula to a patient. 1. Fit the attached tubing over the patient's ears 2. Use the slide connector and secure it under the chin 3. Attach the nasal cannula to a humidified oxygen source 4. Insert nasal prongs slightly into the patient's nostrils

2, 1, 3, 4, 5 First, the nurse should identify the patient with two identifiers. Second, the patient's airway should be observed, and any secretions should be removed either by having the patient cough or by suctioning. Next, the nurse must obtain the patient's most recent arterial blood gas (ABG) value to evaluate the effectiveness of the therapy. Then, the nasal mask is attached to the oxygen tubing, as prescribed by the primary health care provider. The nurse should then position the tips of the nasal cannula properly in the patient's nares and adjust the elastic headband or plastic slide on the cannula to provide comfort. Finally, the nurse observes the patient's external ears, bridge of the nose, nares, and nasal mucosa for skin breakdown.

Arrange the steps to be followed by the nurse for applying the nasal mask to a patient who has asthma. Incorrect 1. Obtaining the patient's most recent arterial blood gas (ABG) value Incorrect 2. Removing secretions by having the patient cough Correct 3. Attaching the nasal mask to the oxygen tubing Correct 4. Adjusting the elastic headband or plastic slide on the cannula Correct 5. Observing the patient's external ears, bridge of nose, nares, and nasal mucosa

4 The trachea and large bronchi in older adults may become enlarged from calcification of the airways. Therefore, the patient is probably approximately 78 years old. A 2-year-old is at risk for upper respiratory tract infections due to an immature immune response. A 12-year-old child is at risk of respiratory infections due to cigarette smoking or second-hand smoke. A 43-year-old patient is at risk of cardiopulmonary abnormalities due to an unhealthy diet, lack of exercise, stress, or smoking.

The chest x-ray of a patient with a respiratory infection shows an enlarged and calcified trachea and bronchi. What would be the patient's age? 1 2 years old 2 12 years old 3 43 years old 4 78 years old

1 During the teething process, some infants develop nasal congestion. This encourages bacterial growth. Therefore, nasal congestion increases the potential for respiratory tract infections. As a result, the infant's oxygenation process would be affected. In older adults, enlargement of the trachea occurs from the calcification of the airways and the number of functional cilia is reduced. This causes a decrease in the effectiveness of the cough mechanism. Therefore, older adults are at an increased risk for respiratory infections. In older adults, the cardiac and respiratory systems undergo changes throughout the aging process. These changes are associated with calcification of the heart valves.

The nurse assesses that the infant's oxygenation is affected by teething. Which condition is associated with this development? 1 Nasal congestion 2 Enlargement of the trachea 3 Reduced functional cilia 4 Calcification of the heart valves

1 Raising the head of the bed brings the diaphragm down and allows for better chest expansion, thus improving ventilation. Taking the oxygen saturation, blood pressure, and respiratory rate should be included in the assessment, but raising the head of the bed should be the priority action. Depending on the situation, the nurse may need to notify the health care provider, but only after completing an in-depth assessment.

The nurse goes to assess a new patient and finds the patient lying supine in bed. The patient tells the nurse that he feels short of breath. Which nursing action should the nurse perform first? 1 Raise the head of the bed to 45 degrees. 2 Take the patient's oxygen saturation with a pulse oximeter. 3 Take the patient's blood pressure and respiratory rate. 4 Notify the health care provider of the patient's shortness of breath

3 The respiratory system influences pH (acidity) through control of carbon dioxide exhalation. Thus, rapid breathing increases pH. The use of sedation can cause respiratory depression and hypoventilation, resulting in even lower pH. Breathing into a paper bag aids a patient who is hyperventilating; in respiratory alkalosis, it aids in lowering the pH.

The nurse is assessing a patient whose recent blood gas determination indicated a pH of 7.32 and respirations at 32 breaths/minute. What do these assessments imply? 1 The rapid breathing is causing the low pH. 2 The nurse should sedate the patient to slow down respirations. 3 The rapid breathing is an attempt to compensate for the low pH. 4 The nurse should give the patient a paper bag to breathe into to correct the low pH.

1, 4, 5 The normal range of heart rates is 60 to 100 bpm. The increase in the heart rate indicates tachycardia. A normal blood pressure is 120/80 mm Hg. A decrease in the blood pressure may indicate hypotension. Rating the pain in the chest as 4 on a scale of 1 to 10 indicates severe pain. Tachycardia, hypotension, and pain in the chest indicate tension pneumothorax. SpO2 of 95% is a normal finding. A respiratory rate of 18 bpm is also a normal finding.

The nurse is caring for a patient who has a chest drainage system. Which assessment findings may indicate that the patient is at risk for developing a tension pneumothorax? Select all that apply. 1 SpO2 of 95% 2 Heart rate of 106 bpm 3 Respiratory rate of 18 bpm 4 Blood pressure of 100/60 mm Hg 5 Intensity of pain in the chest is 4 on scale of 1 to 10

2, 4, 5 The chest-tube drainage set should be kept below the patient's chest level, because it is facilitated by gravity. It is essential to fill the water-seal chamber to the level given by the manufacturer. Fluctuation or bubbling in the water-seal chamber could indicate leakage in the drainage system. If the tube disconnects, ask the patient to exhale or cough, because this gets rid of air from the pleural space. Do not keep the drainage set above the level of the chest, because it will be difficult to drain against gravity. The drainage tube should not be clamped, because it can result in a pneumothorax. Milking the chest tube helps to remove blood clots in the tube; it is not required in pneumothorax.

The nurse is caring for a patient who has a chest tube to drain a pneumothorax. Which nursing actions should the nurse perform? Select all that apply. 1 Clamp the chest tube when the patient is moving about. 2 Keep the drainage below the chest level of the patient. 3 Milk the chest tube to increase drainage. 4 Fill the water-seal chamber to the mark given by the manufacturer and observe it. 5 If the tube disconnects, ask the patient to cough and exhale as much as possible.

1, 4, 5 Hypoxia, an oxygen demand-supply mismatch at the cellular level, is a life-threatening condition. Tachypnea, or increased respiratory rate, is the body's compensatory mechanism to increase oxygen levels. Cyanosis, the bluish discoloration of the skin and mucous membranes, is due to inadequate oxygen supply. In hypoxia, the heart rate increases to compensate for the low oxygen levels. Cough is a normal defense mechanism of the body and is not associated with hypoxia. Fever is caused by infection, not by hypoxia. Fever can worsen hypoxia if the oxygen demands of the body are increased.

The nurse is caring for a patient who has been diagnosed with pneumonia. The blood gases report that was taken during admission indicates respiratory acidosis with mild hypoxemia. Repeated arterial blood gas (ABG) analysis reveals that hypoxemia is worsening. Presently, the PaO2 is 50 mm Hg and SpO2 is 70%. Which signs or symptoms consistent with decreased oxygen levels may the nurse find in the patient? Select all that apply. 1 Tachypnea 2 Cough 3 Fever 4 Cyanosis 5 Tachycardia

2 Pursed-lip breathing is a breathing exercise that involves deep inspiration and prolonged expiration through a narrow outlet (pursed lips). Slow expiration creates a backpressure in the airways, which prevents the airways from collapsing. Pursed-lip breathing improves ventilation but may not be sufficient to control ventilation perfusion mismatch. It does not improve the perfusion of the airways. This technique does not increase the individual's ability to cough.

The nurse is caring for a patient who has been diagnosed with pneumonia. The patient reports intermittent episodes of coughing accompanied with thick yellow sputum. On auscultation, the nurse finds abnormal lung sounds (crackles) in the left base and both upper lobes. A chest x-ray reveals infiltrations in both upper lobes and the left lower lobe. The nurse teaches pursed-lip breathing to this patient. What is the most likely rationale of the nurse for teaching pursed-lip breathing to this patient? 1 To optimize ventilation perfusion mismatch 2 To prevent collapse of the airways 3 To improve perfusion of the airways 4 To improve the ability to cough

2 Movement not only mobilizes secretions but helps strengthen respiratory muscles by impacting the effectiveness of gas exchange processes. Antibiotics and oxygen humidification do not help mobilize secretions. Chest physiotherapy can help mobilize pulmonary secretions but does not directly help with chest wall expansion.

The nurse is caring for a patient who has decreased mobility. Which intervention is a simple and cost-effective method for reducing the risks of stasis of pulmonary secretions and decreased chest wall expansion? 1 Antibiotics 2 Frequent change of position 3 Oxygen humidification 4 Chest physiotherapy

2 Weight gain, distended neck veins, and pedal edema indicate right-sided heart failure. The increased pulmonary vascular resistance from this patient's left-sided heart failure causes the right side of the heart to work harder. Eventually the heart becomes unable to pump sufficient blood to the pulmonary circulation. The blood starts pooling in the systemic circulation, resulting in weight gain, distended neck veins, and pedal edema. Pulmonary edema is the accumulation of fluid in the parenchymal tissue of the lungs. Deep vein thrombosis refers to a blood clot in a deep vein in the leg. Pulmonary embolism is a blockage in an artery in the lungs by air, fat, blood clot, or tumor tissue.

The nurse is caring for a patient who is admitted to the hospital with a diagnosis of left-sided heart failure. The patient has been on continuous positive airway pressure (CPAP) for the last 2 days. The nurse notices that the patient has gained weight and has distended neck veins and pedal edema. The nurse immediately notifies the health care provider. What does this finding indicate? 1 Pulmonary edema 2 Right-sided heart failure 3 Deep vein thrombosis 4 Pulmonary embolism

2 The patient has left-sided heart failure, which can lead to the pooling of blood in the pulmonary circulation. Pulmonary congestion puts pressure on the alveolar walls, forcing them to collapse. Continuous positive airway pressure (CPAP) helps keep the alveoli in an inflated position, thereby preventing them from collapsing. CPAP reduces pulmonary edema by forcing fluid out of the lungs. CPAP plays no role in improving the contractility of the cardiac musculature.

The nurse is caring for a patient who was admitted to the hospital with a diagnosis of left-sided heart failure. The health care provider asks the nurse to provide continuous positive airway pressure (CPAP) for this patient. What could be the primary motive behind giving CPAP to this patient? 1 To facilitate gas exchange 2 To prevent airway collapse 3 To increase pulmonary edema 4 To improve contractility of the cardiac musculature

1, 2, 3 In left-sided heart failure, the left side of the heart is unable to pump sufficient blood to the systemic circulation. As a result, blood begins to pool in the pulmonary circulation causing pulmonary congestion. This causes dyspnea. Blood supply to the brain and musculoskeletal system decreases, causing fatigue and dizziness. Peripheral edema and distended neck veins are associated with right-sided heart failure.

The nurse is caring for a patient who was admitted to the hospital with a diagnosis of left-sided heart failure. While assessing the patient, which signs and symptoms would the nurse likely find? Select all that apply. 1 Dyspnea 2 Fatigue 3 Dizziness 4 Peripheral edema 5 Distended neck veins

2, 3, 5 Smoking causes many types of cancers, including lung cancer and blood cancer. Nicotine and smoke have been shown to have a carcinogenic effect. Smoking causes vasoconstrictions of the peripheral and coronary blood vessels. It increases blood pressure and reduces blood flow. Smoking during pregnancy can cause low-birth-weight babies, miscarriages, or preterm delivery. Diabetes during pregnancy leads to macrosomic babies.

The nurse is conducting a health awareness program on the ill effects of smoking. Which information should the nurse include? Select all that apply. 1 Smoking causes vasodilatation and hypotension. 2 Smoking can cause lung cancer as well as leukemia. 3 Nicotine causes vasoconstriction and hypertension. 4 Smoking during pregnancy contributes to a macrosomic infant. 5 Smoking during pregnancy can cause low-birth-weight babies.

1, 2, 3 Find the source of bleeding by determining whether the blood-stained sputum is associated with cough and upper respiratory tract bleeding or whether the bleeding is from the gastrointestinal tract. A chest x-ray and bronchoscopy can help in confirming the diagnosis in the case of blood-stained sputum. Testing the pH of the sputum specimen can help in determining whether the source of the hemoptysis has an alkaline pH or an acidic pH. Blood-stained sputum can be associated with cough and upper respiratory tract bleeding or can originate in the gastrointestinal tract. Hence, it can be confirmed only after pH testing and additional tests such as a chest x-ray and bronchoscopy to confirm diagnosis.

The nurse is examining a patient with chronic bronchitis who has complaints of blood in the sputum. Which appropriate actions should the nurse perform? Select all that apply. 1 Assess for the source of bleeding. 2 Request a chest x-ray and bronchoscopy. 3 Request pH testing of the sputum specimen. 4 Confirm hematemesis if the pH test is alkaline. 5 Consider blood-stained sputum as hematemesis.

1, 2, 4 When assessing any patient with a cough, it is essential to determine whether the cough is productive or nonproductive and its frequency, as various disorders have various patterns of cough. Hemoptysis is bloody sputum and will require further evaluation. Patients with chronic bronchitis have excessive production of mucus that accumulates in the lungs when the patient is lying down and gets coughed out when the patient gets up. Hematemesis is vomiting of blood, not bloody sputum. Patients with sinusitis usually cough in early mornings to clear the airways of the sinus drainage.

The nurse is explaining to a new co-worker about the various characteristics or types of cough that can be encountered in patients. Which statements are true? Select all that apply. 1 It is important to determine whether the cough is productive or not while assessing the patient. 2 Hemoptysis, if present, will have to be evaluated further. 3 Hematemesis is bloody sputum and will require further evaluation. 4 Patients with chronic bronchitis more often have a productive cough after rising from a flat position. 5 Patients with chronic sinusitis usually cough during bedtime.

1, 2, 4 At rest the breathing rate for normal adults is 12 to 20 regular breaths per minute. Bradypnea occurs when the respiratory rate decreases below 12 breaths per minute. Tachypnea occurs when the respiratory rate increases above 20 breaths per minute. Apnea is the absence of respiration for a period of time, when the patient will not have any breath sounds. An increase in the number of breaths per minute is called tachypnea. Cheyne-Stokes respiration is caused by decreased blood flow or injury to the brainstem and is characterized by periods of apnea followed by periods of deep breathing, then shallow breathing, followed by more apnea.

The nurse is performing a routine physical examination of a patient and observes the patient's breathing patterns. Which factors might the nurse observe? Select all that apply. 1 Bradypnea is less than 12 breaths per minute. 2 Tachypnea is greater than 20 breaths per minute. 3 Apnea is the increased number of breaths per minute. 4 Apnea is the absence of respirations for some time. 5 Increased blood flow to the brain causes Cheyne-Stokes respiration.

1 Pet dander may cause allergic respiratory symptoms in susceptible patients. These patients should avoid contact with pets. Routine exercise is part of a prudent lifestyle. Many green leafy vegetables are rich in vitamins, minerals, and proteins, which incorporate healthy lifestyle patterns into the patients' daily living routines. For patients with respiratory problems, the physical and psychosocial effects of ambulation can enhance feelings of well-being and strength and increase physical endurance. Antibiotic therapy is initiated after cultures are obtained so that sensitivity to the organism can be readily identified.

The nurse is teaching a group of patients about preventing respiratory problems. Which intervention should the nurse include in the teaching? 1 Discourage the patients from playing with pets. 2 Encourage patients to restrict their activities. 3 Limit intake of green leafy vegetables. 4 Provide antibiotic therapy while cultures are obtained.

1, 2, 5 Patients should be advised to take a deep breath and then cough deeply. This allows mucus to be expectorated. Patients with upper and lower respiratory tract infections should be asked to deep breathe and cough every 2 hours while awake. While practicing a cascade cough, the patient should take a deep breath and hold for 2 seconds followed by a series of coughs. This ensures that the tissues are oxygenated well before the cough is induced. Coughing should never be suppressed. The mucus should be expectorated as much as possible. Breaths should be deep and good; shallow breathing is not advised.

The nurse is teaching a patient about coughing and deep breathing techniques. Which points should the nurse include in this teaching? Select all that apply. 1 Perform deep inhalation followed by a deep cough. 2 Perform deep breathing with a cough every 2 hours. 3 Perform shallow inhalations followed by a deep cough. 4 Avoid coughing and hold the breath when cough is stimulated. 5 Hold a deep breath for 2 seconds and then cough continuously for some time.

1, 3, 5 In diaphragmatic breathing, the patient should inhale slowly, making the abdomen push out. During this process, the diaphragm flattens out. Initially the technique should be performed in supine position. The patient should place one hand flat below the breastbone and the other hand on the abdomen to feel the movement of the abdomen. The patient should exhale slowly so that the abdomen goes in and the diaphragm goes up. This procedure is performed initially in supine position and later sitting or standing.

The nurse is teaching a patient about the procedure for diaphragmatic breathing. Which instructions should the nurse give to the patient? Select all that apply. 1 "Inhale slowly to make the abdomen push out." 2 "Exhale rapidly to make the abdomen go in." 3 "Start practicing the technique in supine position initially." 4 "Perform the technique in prone position once you have learned it." 5 "Place one hand on the breastbone and the other hand on the abdomen."

2 Clubbing in the fingertips is associated with chronic hypoxemia. Edema is associated with kidney disease. Distention is caused by right-sided heart failure. Splinter hemorrhages are caused by bacterial endocarditis.

Which abnormality change in the fingertips is caused by chronic hypoxemia? 1 Edema 2 Clubbing 3 Distention 4 Splinter hemorrhages

3 Decreased chest movements may cause hypoxia in patients who have neuromuscular diseases such as Guillain-Barré syndrome and myasthenia gravis. Decreased oxygen-carrying capacity causes hypoxia in patients who have microcytic anemia. Hypovolemia causes hypoxia in patients who have anaphylactic shock. Decreased oxygen-carrying capacity causes hypoxia in patients who have carbon monoxide toxicity.

Which condition may cause hypoxia due to decreased movement of the chest wall? 1 Microcytic anemia 2 Anaphylactic shock 3 Guillain-Barré syndrome 4 Carbon monoxide toxicity

3 Tachypnea is a condition in which the respiratory rate is greater than 20 breaths/minute. Apnea is a condition in which there is an absence of respirations lasting for 15 seconds or more. Bradypnea is a condition in which the respiratory rate generally ranges from 15 to 20 breaths/minute. Orthopnea is an abnormal condition in which a patient struggles to breathe when lying flat.

Which condition would a patient with a respiratory rate of 25 breaths/minute have? 1 Apnea 2 Bradypnea 3 Tachypnea 4 Orthopnea

4 Peak expiratory flow rate is used in the daily measurement for early detection of asthma exacerbations. A lung scan is used to examine normal lung structure without masses. A thoracentesis is the surgical perforation of chest wall and plural space for diagnostic or therapeutic purposes. Pulmonary function tests are used for basic ventilation studies

Which diagnostic test is used in the daily measurement for early detection of asthma exacerbations? 1 Lung scan 2 Thoracentesis 3 Pulmonary function test 4 Peak expiratory flow rate

4 Implementation involves clamping the chest tubes under specific circumstances as per the health care provider's order. Planning involves positioning the patient appropriately to evacuate air. In the evaluation process, the nurse evaluates the patient for decreased respiratory distress and chest pain. Assessment involves assessing the patient's current hemoglobin and hematocrit levels.

Which nursing process involves clamping the chest tubes under specific circumstances as per health care provider's order? 1 Planning 2 Evaluation 3 Assessment 4 Implementation

2, 3, 4 Hyperventilation is a state of ventilation in which the lungs remove carbon dioxide faster than it is produced by cellular metabolism. Patients who have anxiety, salicylate poisoning, and diabetic ketoacidosis are at risk of hyperventilation. A patient who has atelectasis is at risk for hypoventilation. A patient who has hypoxia may developcardiac dysrhythmias.

Which patients are at risk of hyperventilation? Select all that apply. 1 A patient who has atelectasis 2 A patient who has acute anxiety 3 A patient who has salicylate poisoning 4 A patient who has diabetic ketoacidosis 5 A patient who has cardiac dysrhythmias

2 The patient should be placed in the high-Fowler's position to drain fluids from the chest. The patient should not be placed in the supine position, because it may increase the risk of reduced lung volume. The semi-Fowler's position is appropriate to evacuate air in conditions such as pneumothorax. The patient should not be placed in the Trendelenburg's position, because it may increase the risk of reduced lung volume.

Which position is appropriate in a patient who has a chest tube drainage system, in order to drain fluid from the chest? 1 Supine Correct 2 High-Fowler's 3 Semi-Fowler's 4 Trendelenburg's

3 Chest percussion involves rhythmically clapping on the chest wall. It involves striking the chest wall vigorously. It is performed over a single layer of clothing and is contraindicated in patients who have osteoporosis.

Which statement is true regarding chest percussion? 1 Chest percussion involves slow striking of the chest wall. 2 Chest percussion is performed over a multilayer of clothing. 3 Chest percussion involves rhythmically clapping on the chest wall. 4 Chest percussion is commonly performed on patients who have osteoporosis.

4 Saline has been found to cause more side effects when suctioning and does not increase the amount of secretions removed. All the other selections are correct.

Which statement made by the student nurse indicates the need for further teaching about suctioning a patient with an endotracheal tube? 1 "Suctioning the patient requires sterile technique." 2 "I'll apply suction while rotating and withdrawing the suction catheter." 3 "I'll suction the mouth after I suction the endotracheal tube." 4 "I'll instill 5 mL of normal saline into the tube before hyperoxygenating the patient."

3 Adjusting the chest tube to hang in a straight line from the top of the mattress will prevent fluid or blood from accumulating in the pleural cavity. Ensuring that the tube connection between the chest and the drainage tube is intact will secure the chest tube to the drainage system and reduce the risk of an air leak causing breaks in the airtight system. Making sure that the water-seal system is not occluded will allow displaced air to pass into the atmosphere.

While caring for a patient who has a chest tube, the nurse adjusts the tubing to hang in a straight line from the top of the mattress. What is the rationale behind the nursing intervention? 1 To secure the chest tube to the drainage system 2 To allow displaced air to pass into the atmosphere 3 To prevent fluid from accumulating in the pleural cavity 4 To reduce the risk of air leak causing breaks in the airtight system

4, 5 While caring for a patient with chest tubes, the nurse asks the patient to rate the level of comfort on the scale of 0 to 10. Based on the rating the nurse can identify if the patient has developed atelectasis or pneumonia. The nurse should evaluate cardiopulmonary status in a patient who is undergoing suctioning in order to prevent the risk of hypoxia. Epistaxis and skin abrasions are the unexpected outcomes of chest tubes. Epistaxis is prevented by assessing the patient's fluid status. Skin abrasion can be prevented by adjusting the tightness of an elastic strap.

While caring for a patient with chest tubes, the nurse asks the patient to rate the level of comfort on scale of 0 to 10. What could be the rationale behind this? Select all that apply. 1 To prevent epistaxis 2 To prevent skin abrasion 3 To prevent the risk of hypoxia 4 To assess for atelectasis 5 To assess for pneumonia

1 Oxygen saturation lower than 90% indicates inadequate oxygenation. If the drop is related to activity of some type, supplemental oxygen is indicated. Arterial blood gas (ABG) measurements will not be helpful. Even though the drop in oxygen saturation is not necessarily a response to activity, the nurse should continue to monitor the patient. Only the earlobe probe should be used to determine the oximetry reading. However, the earlobe is very susceptible to vasoconstriction and may give false readings.

While caring for a patient with respiratory disease, the nurse observes that the oxygen saturation drops from 94% to 85% when the patient ambulates. Which is the most appropriate nursing action? 1 Administer supplemental oxygen. 2 Obtain arterial blood gas (ABG) values to verify the oxygen saturation reading. 3 Continue to monitor the patient as this finding is a normal response to activity. 4 Move the oximetry probe from the finger to the earlobe for an accurate oxygen saturation measurement during activity.

2 Pulse oximetry is a diagnostic test done to obtain the patient's oxygenation level. If the provider wanted to assess the patient's ventilation, the nurse would perform capnography. To obtain a specimen for biopsy, the patient would undergo a thoracentesis. To visualize the tracheobronchial tree, the health care team would perform a bronchoscopy.

Why would a primary health care provider ask the nurse to perform pulse oximetry on a patient who is cyanotic? 1 To assess ventilation 2 To assess oxygenation level 3 To obtain a biopsy specimen 4 To visualize the tracheobronchial tree