Iggy Chapters 24 & 29

In addition to notifying the pulmonary health care provider, what is the most important action for the nurse to take first for a client with a pulmonary embolism (PE) whose arterial blood gas (ABG) values are pH 7.28, PaCO2 50 mm Hg, PaO2 62 mm Hg, and HCO3− 24 mEq/L (24 mmol/L)? a. Administering sodium bicarbonate b. Having the client breathe rapidly and deeply into a paper bag c. Assessing for the presence of adventitious lung sounds d. Increasing the oxygen flow rate

d. Increasing the oxygen flow rate

What is the nurse's best first action on finding the client's oxygen saturation by pulse oximetry on the finger is 84%? a. Apply supplemental oxygen by mask or nasal cannula. b. Notify the Rapid Response Team immediately. c. Assess the client's cognitive function. d. Recheck the value on the forehead.

d. Recheck the value on the forehead.

What is the basis for the decreased oxygen saturation the nurse assesses in a client with a pulmonary embolism (PE)? a. Partial bronchial airway obstruction b. Thickened alveolar membranes and poor gas exchange c. Increased oxygen need resulting from a septic clot PE d. Shunting of deoxygenated blood to the left side of the heart

d. Shunting of deoxygenated blood to the left side of the heart

Which type of ADL assistance will the nurse plan for a client with long-standing pulmonary problems who has Class IV dyspnea? a. Dyspnea is minimal, and no assistance is required. b. The client is severely dyspneic at rest and cannot participate in any self-care. c. The client may complete ADLs without assistance but requires rest periods during performance. d. The client is severely dyspneic with activity and requires assistance for bathing and dressing.

d. The client is severely dyspneic with activity and requires assistance for bathing and dressing.

Which clients will the nurse monitor most closely for respiratory failure? (Select all that apply.) a. A 30-year-old with a C-5 spinal cord injury b. A 55-year-old with a brainstem tumor c. A 50-year-old experiencing cocaine intoxication d. A 65-year-old with COVID-19 pneumonia e. A 35-year-old using client-controlled analgesia f. A 40-year-old with acute pancreatitis

a. A 30-year-old with a C-5 spinal cord injury b. A 55-year-old with a brainstem tumor d. A 65-year-old with COVID-19 pneumonia e. A 35-year-old using client-controlled analgesia f. A 40-year-old with acute pancreatitis

Drugs from which class will the nurse prepare to administer as first-line therapy for a client just diagnosed with pulmonary embolism (PE)? a. Anticoagulants b. Antihypertensives c. Antidysrhythmics d. Antibiotics

a. Anticoagulants

What is the primary emphasis for the nurse who is providing care to a client with acute respiratory distress syndrome (ARDS) currently in the exudative management stage of the disorder? a. Assessing the client at least hourly for tachypnea and dyspnea b. Performing meticulous mouth during mechanical ventilation c. Assessing for abnormal lung sounds d. Monitoring urine output to identify multiple organ dysfunction syndrome early

a. Assessing the client at least hourly for tachypnea and dyspnea

Which action has the highest priority for the nurse to take to prevent harm for a client being mechanically ventilated with 100% oxygen for the past 24 hours who now has new-onset crackles, decreased breath sounds, and a PaO2 level of 95 mm Hg? a. Collaborating with the pulmonary health care provider to lower the FiO2 level b. Assessing cognition c. Placing the client in the prone position d. Preparing to suction the client

a. Collaborating with the pulmonary health care provider to lower the FiO2 level

What type of percussion note or sound will the nurse expect on the affected chest side of a client who has a hemothorax? a. Dull b. Hyperresonant c. Crackling d. Hypertympanic

a. Dull

Which assessment findings in a postoperative client suggest to the nurse the possibility of a pulmonary embolism (PE) and pulmonary infarction? a. Hemoptysis and shortness of breath b. Fever and tracheal deviation c. Audible wheezing on inhalation and exhalation d. Paradoxical chest movements

a. Hemoptysis and shortness of breath

Which assessment findings in a client at high risk for pulmonary embolism (PE) indicates to the nurse the probably presence of a PE? (Select all that apply.) a. Inspiratory chest pain b. Dizziness and syncope c. Pink, frothy sputum d. Worsening dyspnea for 3 days e. Tachycardia f. Productive cough

a. Inspiratory chest pain b. Dizziness and syncope e. Tachycardia

Which client conditions will the nurse recognize as most likely to cause a "right shift" of the oxyhemoglobin dissociation curve? (Select all that apply.) a. Reduced blood and tissue levels of oxygen b. Alkalosis c. Increased metabolic demands d. Reduced blood and tissue levels of diphosphoglycerate (DPG) e. Increased body temperature f. Reduced blood and tissue pH

a. Reduced blood and tissue levels of oxygen c. Increased metabolic demands e. Increased body temperature f. Reduced blood and tissue pH

What type of acid-base problem will the nurse expect in a client who is being insufficiently mechanically ventilated for the past 4 hours and whose most recent arterial blood gas results include a pH of 7.29? a. Respiratory acidosis with an acid excess b. Metabolic acidosis with an acid excess c. Respiratory acidosis with a base deficit d. Metabolic acidosis with a base deficit

a. Respiratory acidosis with an acid excess

What is the best first action when the nurse assesses that the respirations of a sedated client with a new tracheostomy have become noisy, and the ventilator alarms indicate high peak pressures, but the ventilator tubing is clear? a. Suctioning the tracheostomy tube b. Remove the inner cannula of the tracheostomy c. Humidifying the oxygen source d. Increasing the percentage of oxygen

a. Suctioning the tracheostomy tube

With which client will the nurse take immediate actions to reduce the risk for developing a pulmonary embolism (PE)? a. A 50-year-old with type 2 diabetes mellitus and cellulitis of the leg b. A 36-year-old who had open reduction and internal fixation of the tibia c. A 25-year-old receiving IV antibiotics through a peripheral line d. A 72-year-old with dehydration and hypokalemia taking oral potassium supplements

b. A 36-year-old who had open reduction and internal fixation of the tibia

The nurse has just received report on a group of clients. Which client is the nurse's first priority? a. A 60-year-old who was recently extubated and reports a sore throat. b. A 50-year-old being mechanically ventilated who has tracheal deviation. c. A 30-year-old receiving continuous positive airway pressure (CPAP) and has intermittent wheezing. d. A 40-year-old receiving oxygen facemask and whose respiratory rate is 24 breaths/min.

b. A 50-year-old being mechanically ventilated who has tracheal deviation.

For which problem does the nurse assess the client who cannot breathe through the nose because of a severe septal deviation? a. Difficulty swallowing b. Dry respiratory tract membranes c. Development of nasal polyps d. Frequent episodes of tonsillitis

b. Dry respiratory tract membranes

Which sign or symptom will the nurse report immediately to the pulmonary health care provider to prevent harm for a client who had a percutaneous lung biopsy 2 hours ago? a. Bruising at the puncture site b. Lateral displacement of the trachea c. Oxygen saturation of 97% d. Pink-tinged sputum

b. Lateral displacement of the trachea

For which problems will the nurse specifically assess when the low-pressure alarm of a client's mechanical ventilator sounds? (Select all that apply.) a. Mucous plugs are in the endotracheal tube. b. Leak in the ventilator tubing circuit. c. Client is not breathing. d. Cuff leak in the endotracheal or tracheostomy tube. e. Ventilator tubing is under the client. f. Client is attempting to breathe against the ventilator.

b. Leak in the ventilator tubing circuit. c. Client is not breathing. d. Cuff leak in the endotracheal or tracheostomy tube.

Which action is a priority for the nurse to prevent harm for a client with a pulmonary embolism who is receiving a continuous heparin infusion? a. Assessing gums daily for indications of bleeding b. Monitoring the platelet count daily c. Assessing breath sounds d. Comparing pedal pulses bilaterally

b. Monitoring the platelet count daily

In addition to the pulmonary health care provider, which other member of the interprofessional team will the nurse expect to collaborate with most frequently when providing care to a client with a pulmonary embolism (PE)? a. Registered dietitian nutritionist b. Respiratory therapist c. Occupational therapist (OT) d. Pharmacist

b. Respiratory therapist

For which symptoms would a nurse assess a client who worries a thoracentesis earlier today may have caused a pneumothorax? (Select all that apply.) a. Slowing heart rate b. Sensation of air hunger c. Pain at the insertion site d. Cyanosis of the oral mucous membranes e. Wheezing on inhalation and exhalation f. Tracheal deviation

b. Sensation of air hunger d. Cyanosis of the oral mucous membranes f. Tracheal deviation

What is the nurse's best next question after observing that a 60-year-old client's anteroposterior (AP) chest diameter is the same as the lateral chest diameter? a. "What are your hobbies?" b. No questions are needed regarding this normal finding. c. "Do you have any chronic breathing problems?" d. "How often do you perform aerobic exercise?"

c. "Do you have any chronic breathing problems?"

How will the nurse document the pack-year smoking history for a client who reports smoking 3 packs of cigarettes per day for 25 years and then smoking 2 packs per day for the past 20 years? a. 45-pack-year b. 90-pack-year c. 115-pack-year d. 80-pack-year

c. 115-pack-year

The nurse has just received report on a group of clients. Which client is the nurse's first priority? a. A 40-year-old admitted 3 hours ago for a scheduled thoracentesis in 30 minutes. b. A 55-year-old with bronchogenic lung cancer who returned from bronchoscopy 4 hours ago. c. A 30-year-old with acute asthma who has an oxygen saturation of 89% by pulse oximetry. d. A 68-year-old with pleural effusion who has decreased breath sounds at the right base.

c. A 30-year-old with acute asthma who has an oxygen saturation of 89% by pulse oximetry.

What is the nurse's interpretation of a 50-year-old client's respiratory assessment findings when hearing bronchial breath sounds over the left lower lobe and noting decreased fremitus and dullness to percussion in the same area? a. Obstruction of the larger airways b. Normal physical exam for a 50-year-old c. An area of increased density d. Subcutaneous emphysema

c. An area of increased density

When caring for a group of clients at risk for or diagnosed with pulmonary embolism, the nurse calls the Rapid Response Team (RRT) for intervention for which client? a. Client with a right pneumothorax who is being treated with a chest tube and has a pulse oximetry reading of 94%. b. Client who was extubated 3 days ago and has decreased breath sounds at the posterior bases of both lungs. c. Client treated for pulmonary embolism with IV heparin who has hemoptysis and tachy-cardia. d. Client with deep vein thrombosis who is receiving low-molecular-weight heparin and has ongoing calf pain.

c. Client treated for pulmonary embolism with IV heparin who has hemoptysis and tachy-cardia.

Which precaution to prevent harm is most important for the nurse to teach a client who is newly prescribed nicotine replacement therapy (NRT)? a. Immediately report any change in thought process or suicide ideation because this drug can alter behavior. b. Avoid crowds and people who are ill because your immunity is reduced while on this drug. c. Do not smoke cigarettes or use nicotine in any form while on this drug because the risk for heart attack or stroke is increased. d. Be sure to remain in an upright position for an hour after taking the drug to avoid esophageal reflux and ulceration.

c. Do not smoke cigarettes or use nicotine in any form while on this drug because the risk for heart attack or stroke is increased.

Which teaching point is most important for the nurse to emphasize for a client who is scheduled to undergo pulmonary function testing (PFT)? a. Avoid strenuous physical activity for 24 hours before the procedure. b. Use your bronchodilating inhaler right before arriving for the procedure. c. Do not smoke for 6 hours before the test. d. Eat only clear liquids for 12 hours before the procedure.

c. Do not smoke for 6 hours before the test.

When performing an assessment on an older client, which finding is most important for the nurse to assess further? a. Soft speaking voice b. Slight kyphoscoliosis c. Inability to state name and date of birth d. Need to rest after activity

c. Inability to state name and date of birth

How will the nurse expect a client's age-related decreased skeletal muscle strength to affect gas exchange? a. Reduced gas exchange as a result of decreased alveolar surface b. Reduced gas exchange as a result of longer relaxation of bronchiolar smooth muscles c. Reduced gas exchange as a result of decreased changes in pressures of the chest cavity d. Reduced gas exchange as a result of failure of pulmonary circulation to fully perfuse lung tissue

c. Reduced gas exchange as a result of decreased changes in pressures of the chest cavity

What is the nurse's best first action when assessing a client who was intubated a few minutes ago and finds the end-tidal carbon dioxide level is 0 and the SpO2 is 38%? a. Documenting the finding in the electronic health record as the only action b. Initiating the Rapid Response Team c. Removing the endotracheal tube and ventilating the client with a bag-valve-mask d. Obtaining a different monitor and rechecking the end-tidal carbon dioxide level

c. Removing the endotracheal tube and ventilating the client with a bag-valve-mask

Which ventilator mode does the nurse expect will be set for a client with a tracheostomy who is beginning to take spontaneous breaths at his own rate and tidal volume between set ventilator breaths? a. Assist-control (AC) ventilation b. Continuous positive airway pressure (CPAP) c. Synchronized intermittent ventilation (SIMV) d. Bi-level positive airway pressure (BiPAP)

c. Synchronized intermittent ventilation (SIMV)

Which client will the nurse consider to be at the greatest risk for developing acute respiratory distress syndrome (ARDS)? a. A 22-year-old with a fractured clavicle b. A 39-year-old with uncontrolled diabetes c. A 56-year-old with chronic kidney disease d. A 74-year-old who aspirates a tube feeding

d. A 74-year-old who aspirates a tube feeding

What is the most relevant technique for the nurse to use when assessing a client for dyspnea? a. Checking oxygen saturation by pulse oximetry b. Observing the client's rate, depth, and ease of inhalation and exhalation c. Comparing previous respiratory assessment information with current data d. Asking the client about whether any breathlessness is present

d. Asking the client about whether any breathlessness is present

Which action will the nurse take first for a client being mechanically ventilated who begins to pick at the bedcovers? a. Administering the prescribed sedating drug b. Explaining to the client that the tube helps with breathing c. Requesting that the family leave to decrease the client's agitation d. Assessing for adequate oxygenation

d. Assessing for adequate oxygenation

The nurse is caring for a client who underwent a bronchoscopy performed under moderate sedation an hour ago. Which action will the nurse delegate to an assistive personnel (AP) at this time? a. Determine level of consciousness b. Offer clear liquids to moisten mucous membranes c. Auscultate breath sounds d. Assist with urinal or bedpan use for elimination

d. Assist with urinal or bedpan use for elimination

Which action will the nurse take first while caring for a client being mechanically ventilation when the high-pressure alarm sounds? a. Comparing the ventilator settings with the prescribed settings b. Turning off the alarm then assess the need for suctioning c. Notifying the respiratory therapist d. Auscultating the client's breath sounds

d. Auscultating the client's breath sounds

Which assessment finding on a client who is being mechanically ventilated with positive end-expiratory pressure indicates to the nurse a possible left-sided tension pneumothorax? a. Left chest caves in on inspiration and "puffs out" on expiration. b. The left lung field is dull to percussion and crackles are present on auscultation. c. The client has bloody sputum and wheezes. d. Chest is asymmetrical and trachea deviates toward the right side.

d. Chest is asymmetrical and trachea deviates toward the right side.

Which new assessment finding in a client being managed for a pulmonary embolism (PE) indicates to the nurse that the client's condition is worsening? a. Increasing temperature b. Abdominal cramping c. Hand tremors d. Distended neck veins in the high-Fowler position

d. Distended neck veins in the high-Fowler position

Which action will the nurse instruct a client with an endotracheal tube to perform during the time the tube is being removed? a. Hold his or her breath b. Inhale c. Cough d. Exhale

d. Exhale

How will the nurse document the client's respiratory assessment findings on auscultation that are heard as popping, discontinuous, high-pitched sounds at the end of exhalation? a. Coarse crackles b. Rhonchi c. Wheezes d. Fine crackles

d. Fine crackles