Med. Surge. Ch. 23

A patient presents to the ED stating she was in a boating accident about 3 hours ago. Now the patient has complaints of headache, fatigue, and the feeling that he "just can't breathe enough.

" The nurse notes that the patient is restless and tachycardic with an elevated blood pressure This patient may be in the early stages of what respiratory problem? Acute respiratory failure

The nurse is assessing a patient who has a 35 pack-year history of cigarette smoking. In light of this known risk factor for lung cancer, what statement should prompt the nurse to refer the patient for further assessment?

"Lately, I have this cough that just never seems to go away."The most frequent symptom of lung cancer is cough or change in a chronic cough.

A new employee asks the occupational health nurse about measures to prevent inhalation exposure of the substances. Which statement by the nurse will decrease the patient's exposure risk to toxic substances?

"Wear protective attire and devices when working with a toxic substance."When working with toxic substances, the employee must wear or use protective devices such as face masks, hoods, or industrial respirators

Key aspects of any assessment of patients with a potential occupational respiratory history include job and job activities, exposure levels, general hygiene, time frame of exposure, effectiveness of respiratory protection used, and direct versus indirect exposures.

A 54-year-old man has just been diagnosed with small cell lung cancer. The patient asks the nurse why the doctor is not offering surgery as a treatment for his cancer.

What parameters of care should the nurse monitor most closely? Select all that apply. Arterial blood gases Vital signs Level of consciousness

A gerontologic nurse is teaching a group of medical nurses about the high incidence and mortality of pneumonia in older adults. What is a contributing factor to this that the nurse should describe?

In addition to irritating the mucous cells of the bronchi and inhibiting the function of alveolar macrophage scavenger cells, smoking damages the ciliary cleansing

A patient has been brought to the ED by the paramedics. The patient is suspected of having ARDS. What intervention should the nurse first anticipate?Preparing to assist with intubating the patient

Restoration of adequate gas exchange

A patient is brought to the ED by ambulance after a motor vehicle accident in which the patient received blunt trauma to the chest. The patient is in acute respiratory failure, is intubated, and is transferred to the ICU.

Surgical resection is the preferred method of treating patients with localized non-small cell tumors with no evidence of metastatic spread and adequate cardiopulmonary function

A patient is receiving thrombolytic therapy for the treatment of pulmonary emboli. What is the best way for the nurse to assess the patient's oxygenation status at the bedside?Monitor pulse oximetry readings.

What fact about lung cancer treatment should inform the nurse's response?Small cell cancer of the lung grows rapidly and metastasizes early and extensively.

A patient who involved in a workplace accident suffered a penetrating wound of the chest that led to acute respiratory failure. What goal of treatment should the care team prioritize when planning this patient's care?

A perioperative nurse is caring for a postop patient. The patient has a shallow respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address the patient's increased risk for what complication?

A shallow, monotonous respiratory pattern coupled with immobility places the patient at an increased risk of developing atelectasis.

The public health nurse is administering Mantoux tests to children who are being registered for kindergarten in the community. How should the nurse administer this test?

Administer intradermal injections into the children's inner forearms.The PPD is always injected into the intradermal layer of the inner aspect of the forearm.

A hospital has been the site of an increased incidence of hospital-acquired pneumonia (HAP). What is an important measure for the prevention of HAP?

Administration of pneumococcal vaccine to vulnerable individuals

When assessing for substances that are known to harm workers' lungs, the occupational health nurse should assess their potential exposure to which of the following?

Asbestos Asbestos is among the more common causes of pneumoconiosis

The nurse is caring for a patient who is receiving oxygen therapy for pneumonia. How should the nurse best assess whether the patient is hypoxemic?

Assess the patient's oxygen saturation level.

While planning a patient's care, the nurse identifies nursing actions to minimize the patient's pleuritic pain. Which intervention should the nurse include in the plan of care?

Avoid actions that will cause the patient to breathe deeply. The key characteristic of pleuritic pain is its relationship to respiratory movement. Taking a deep breath, coughing, or sneezing worsens the pain

The patient complains of shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the presence of a pneumothorax include what?

Diminished or absent breath sounds on the affected side In the case of a simple pneumothorax, auscultating the breath sounds will reveal absent or diminished breath sounds on the affected side

The perioperative nurse is writing a care plan for a patient who has returned from surgery 2 hours prior. Which measure should the nurse implement to most decrease the patient's risk of developing pulmonary emboli

Early ambulation For patients at risk for PE, the most effective approach for prevention is to prevent deep vein thrombosis.

The nurse is reviewing the electronic health record of a patient with an empyema. What health problem in the patient's history is most likely to have caused the empyema? Pneumonia

Most empyemas occur as complications of bacterial pneumonia or lung abscess.

A firefighter was trapped in a fire and is admitted to the ICU for smoke inhalation. After 12 hours, the firefighter is exhibiting signs of ARDS and is intubated. What other supportive measures are initiated in a patient with ARDS?

Nutritional support This supportive therapy almost always includes intubation and mechanical ventilation. In addition, circulatory support, adequate fluid volume, and nutritional support are important

A patient in the ICU is status post embolectomy after a pulmonary embolus. What assessment parameter does the nurse monitor most closely on a patient who is postoperative following an embolectomy?

Pulmonary arterial pressure If the patient has undergone surgical embolectomy, the nurse measures the patient's pulmonary arterial pressure and urinary output.

The home care nurse is monitoring a patient discharged home after resolution of a pulmonary embolus. For what potential complication would the home care nurse be most closely monitoring this patient?

Residual effects of compromised oxygenationThe home care nurse should monitor the patient for residual effects of the PE, which involved a severe disruption in respiration and oxygenation.

The nurse caring for a patient recently diagnosed with lung disease encourages the patient not to smoke. What is the primary rationale behind this nursing action?

Smoking damages the ciliary cleansing mechanism.

Incentive spirometry

Strategies to prevent atelectasis, which include frequent turning, early ambulation, lung-volume expansion maneuvers (deep breathing exercises, incentive spirometry), and coughing, serve as the first-line

An 87-year-old patient has been hospitalized with pneumonia. Which nursing action would be a priority in this patient's plan of care?Cautious hydration because of the risk of fluid overload in the elderly

Supportive treatment of pneumonia in the elderly includes hydration supplemental oxygen therapy; and assistance with deep breathing, coughing, frequent position changes, and early ambulation.

Hypovolemia secondary to leakage of fluid into the interstitial spaces

Systemic hypotension may occur in ARDS as a result of hypovolemia secondary to leakage of fluid into the interstitial spaces and depressed cardiac output from high levels of PEEP therapy

Older adults often lack the classic signs and symptoms of pneumonia.

The diagnosis of pneumonia may be missed because the classic symptoms of cough, chest pain, sputum production, and fever may be absent or masked in older adult

An adult patient has tested positive for tuberculosis (TB). While providing patient teaching, what information should the nurse prioritize?

The importance of adhering closely to the prescribed medication regimen

The patient is anxious, has dyspnea and air hunger, has increased use of the accessory muscles, and may develop central cyanosis from severe hypoxemia.

The nurse at a long-term care facility is assessing each of the residents. Which resident most likely faces the greatest risk for aspiration?A resident who suffered a severe stroke several weeks ago

A patient with thoracic trauma is admitted to the ICU. The nurse notes the patient's chest and neck are swollen and there is a crackling sensation when palpated.

The nurse consequently identifies the presence of subcutaneous emphysema. If this condition becomes severe and threatens airway patency, what intervention is indicated?A tracheostomy

Early signs of acute respiratory failure are those associated with impaired oxygenation and may include restlessness, fatigue, headache, dyspnea, air hunger, tachycardia, and increased blood pressure

The nurse is caring for a 46-year-old patient recently diagnosed with the early stages of lung cancer. The nurse is aware that the preferred method of treating patients with non-small cell tumors is what?Surgical resection

Brain natriuretic peptide (BNP) level Common diagnostic tests performed for patients with potential ARDS include plasma brain natriuretic peptide (BNP) levels, echocardiography, and pulmonary artery catheterization.

The nurse is caring for a patient at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the patient. What is an example of a first-line measure to minimize atelectasis?

In severe cases in which there is widespread subcutaneous emphysema, a tracheostomy is indicated if airway patency is threatened by pressure of the trapped air on the trachea

The nurse is caring for a patient in the ICU admitted with ARDS after exposure to toxic fumes from a hazardous spill at work. The patient has become hypotensive. What is the cause of this complication to the ARDS treatment?

Aspiration may occur if the patient cannot adequately coordinate protective glottic, laryngeal, and cough reflexes. These reflexes are often affected by stroke.

The nurse is caring for a patient suspected of having ARDS. What is the most likely diagnostic test ordered in the early stages of this disease to differentiate the patient's symptoms from those of a cardiac etiology?

A patient who has ARDS usually requires intubation and mechanical ventilation.

The nurse is caring for a patient who is scheduled for a lobectomy for a diagnosis of lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the client's oxygen saturation rapidly dropping.

The nurse assesses the patient with pulmonary emboli frequently for signs of hypoxemia

The nurse is caring for an 82-year-old patient with a diagnosis of tracheobronchitis. The patient begins complaining of right-sided chest pain that gets worse when he coughs or breathes deeply.

The nurse is assessing an adult patient following a motor vehicle accident. The nurse observes that the patient has an increased use of accessory muscles and is complaining of chest pain and shortness of breath.

The nurse should recognize the possibility of what condition? Pneumothorax If the pneumothorax is large and the lung collapses totally, acute respiratory distress occurs

A client presents to the walk-in clinic complaining of a dry, irritating cough and production of a minute amount of mucus-like sputum. The patient complains of soreness in her chest in the sternal area.

The nurse should suspect that the primary care provider will assess the patient for what health problem?Tracheobronchitis

Vital signs are within normal limits. What would you suspect this patient is experiencing?Pleuritic pain Pleuritic pain is limited in distribution rather than diffuse; it usually occurs only on one side.

The pain may become minimal or absent when the breath is held. It may be localized or radiate to the shoulder or abdomen. Later, as pleural fluid develops, the pain decreases

Initially, the patient with tracheobronchitis has a dry, irritating cough and expectorates a scant amount of mucoid sputum.

The patient may report sternal soreness from coughing and have fever or chills, night sweats, headache, and general malaise

The nurse is caring for a patient who has been in a motor vehicle accident and the care team suspects that the patient has developed pleurisy. Which of the nurse's assessment findings would best corroborate this diagnosis?

The patient's pain intensifies when he coughs or takes a deep breath.

A patient has just been diagnosed with lung cancer. After the physician discusses treatment options and leaves the room, the patient asks the nurse how the treatment is decided upon. What would be the nurse's best response?

The type of treatment depends on the cell type of the cancer, the stage of the cancer, and the patient's health status." particularly cardiac and pulmonary status

The occupational health nurse is assessing new employees at a company. What would be important to assess in employees with a potential occupational respiratory exposure to a toxin? Select all that apply.

Type of respiratory protection used Time frame of exposure Breath sounds Intensity of exposure

The school nurse is presenting a class on smoking cessation at the local high school. A participant in the class asks the nurse about the risk of lung cancer in those who smoke.

What response related to risk for lung cancer in smokers is most accurate?The younger you are when you start smoking, the higher your risk of lung cancer."

A critical-care nurse is caring for a patient diagnosed with pneumonia as a surgical complication. The nurse's assessment reveals that the patient has an increased work of breathing due to copious tracheobronchial secretions.

What should the nurse encourage the patient to do? Increase oral fluids unless contraindicated.The nurse should encourage hydration because adequate hydration thins and loosens pulmonary secretions.

The nurse is providing discharge teaching for a patient who developed a pulmonary embolism after total knee surgery. The patient has been converted from heparin to sodium warfarin anticoagulant therapy.

What should the nurse teach the client?Anticoagulant therapy usually lasts between 3 and 6 months.Anticoagulant therapy prevents further clot formation, but cannot be used to dissolve a clot.

An x-ray of a trauma patient reveals rib fractures and the patient is diagnosed with a small flail chest injury. Which intervention should the nurse include in the patient's plan of care?Suction the patient's airway secretions.

treatment of flail chest is usually supportive. Management includes clearing secretions from the lungs