Respiratory

The nurse is caring for a client with a chest tube that was placed 2 hours ago for a pneumothorax. Where would the nurse expect gentle, continuous bubbling? 1. Air leak monitor 2. Collection chamber 3. Suction control chamber 4. Water seal chamber

3

An elderly client with a history of stable chronic obstructive pulmonary disease, alcohol abuse, and cirrhosis has a serum theophylline level of 25.8 mcg/mL (143 µmol/L). Which clinical manifestation associated with theophylline toxicity should worry the nurse most? 1. Alterations in color vision 2. Gum (gingival) hypertrophy 3. Hyperthermia 4. Seizure activity

4

The nurse provides discharge instructions to a 67-year-old client with chronic bronchitis who was hospitalized for community-acquired pneumonia. Which instructions should be included in the discharge teaching plan? Select all that apply. 1. "Avoid the use of over-the-counter cough suppressant medicines." 2. "Oral antibiotics are not needed at home as you had intravenous (IV) therapy in the hospital." 3. "Pneumonia vaccination is not needed as you now have lifelong immunity." 4. "Schedule a follow-up with the health care provider (HCP) and chest x-ray." 5. "Use a cool mist humidifier in your bedroom at night." 6. "Use the incentive spirometer at home."

1,4,5,6

A client with chronic obstructive pulmonary disease (COPD) is admitted for pneumonia. The client is restless. The nurse identifies a diagnosis of impaired gas exchange. Which intervention is most effective in promoting adequate gas exchange? 1. Administer morphine 2. Administer oxygen using Venturi mask 3. Maintain intravenous normal saline infusion at prescribed rate of 125 mL/hr 4. Position head of bed in semi-Fowler's position

2

The charge nurse evaluates the care provided by a new registered nurse (RN) for a client receiving mechanical ventilation (MV). Which action by the new RN indicates theneed for further education? 1. Administers morphine to relieve anxiety and restlessness 2. Applies suction when inserting the catheter into the airway 3. Increases the oxygen concentration on the MV before suctioning 4. Suctions when MV high-pressure alarm continues to sound and rhonchi are present

2

An 84-year-old client with oxygen-dependent chronic obstructive pulmonary disease is admitted with an exacerbation and steady weight loss. The client has been in the hospital 4 times over the last several months and is "tired of being poked and prodded." Which topic would be most important for the nurse to discuss with this client's health care team? 1. Need for discharge to a skilled nursing facility 2. Nutritional consult with instructions on a high-calorie diet 3. Option of palliative care 4. Physical therapy prescription to promote activity

3

An elderly client with oxygen-dependent chronic obstructive pulmonary disease is admitted for pneumonia. The client is do not resuscitate, and the nurse is concerned that the client will soon develop respiratory failure as breathing is becoming shallow and the client is looking exhausted. Which is the most appropriate intervention to include in the plan of care? 1. Administer morphine to decrease air hunger 2. Call the health care provider for possible intubation 3. Promote relaxation through music and distraction 4. Titrate oxygen to maintain an oxygen saturation ≥94%

3

The nurse is assisting the health care provider (HCP) with a client's chest tube removal. Just as the HCP prepares to pull the chest tube, what instructions should the nurse give the client? 1. "Breathe as you normally would." 2. "Inhale and exhale slowly." 3. "Take a breath in, hold it, and bear down." 4. "Take rapid shallow breaths, similar to panting."

3

The nurse is caring for a client who has been receiving mechanical ventilation (MV) for 4 days. During multidisciplinary morning rounds, the health care provider questions the development of a ventilator-associated pneumonia (VAP). Which of the following manifestations does the nurse assess as the best indicator of VAP? 1. Blood-tinged sputum 2. Positive blood cultures 3. Positive, purulent sputum culture 4. Rhonchi and crackles

3

The nurse is giving report at the end of a shift to the incoming nurse at 1900. A client was admitted with pneumonia that morning. Which information is most important for the nurse to communicate about the client during the change-of-shift report (hand-off)? 1. Chest x-ray showed left lobe infiltrate and white blood cell count of 14,000/mm3 2. Client's spouse was rude to the nurse earlier 3. Current respirations are 24/min; pulse oximetry is 93% on 2 L/min 4. Intravenous (IV) line has been infusing without complications

3

The nurse responds to the call light of a client with chronic obstructive pulmonary disease (COPD) who says, "I can't breathe." The client seems to be having difficulty breathing and is nervous and tremulous. Vital signs are stable, oxygen saturation is 92% on 2 L, and there are clear breath sounds bilaterally. Which intervention would be most appropriate at this time? 1. Administer albuterol nebulizer 2. Assist the client in identifying the trigger and ways to avoid it 3. Coach the client through controlled breathing exercises 4. Continue to monitor oxygen saturation

3

The nurse performs the admission history for a 70-year-old client with newly diagnosed chronic obstructive pulmonary disease (COPD). Which statements made by the client does the nurse recognize as the most significant contributing factors to the development of COPD? Select all that apply. 1. "I have been drinking alcohol almost daily since age 20." 2. "I have been overweight for as long as I can remember." 3. "I have smoked about a pack of cigarettes a day since I was 16 years old but quit last year." 4. "I know I eat too much fast food." 5. "I was a car mechanic for about 40 years and had my own garage."

3,5

A client has chronic obstructive pulmonary disease (COPD) exacerbation. The pulse oximeter shows a saturation of 86% on room air. The nurse assesses diminished lung sounds and low-pitched wheezing posteriorly, shallow respirations, respiratory rate of 32/min, and use of accessory muscles. What is the most appropriate oxygen delivery device for this client? 1. Nasal cannula 2. Non-rebreathing mask 3. Oxymizer 4. Venturi mask

4

The home health nurses visits a 72-year-old client with pneumonia who was discharged from the hospital 3 days ago. The client has less of a productive cough at night but now reports sharp chest pain with inspiration. Which finding is most important for the nurse to report to the health care provider? 1. Bronchial breath sounds 2. Increased tactile fremitus 3. Low-pitched wheezing (rhonchi) 4. Pleural friction rub

4

The nurse develops a care plan for a critically ill client with acute respiratory distress syndrome (ARDS) who is on a mechanical ventilator. What is the priority nursing diagnosis (ND)? 1. Imbalanced nutrition 2. Impaired gas exchange 3. Impaired tissue integrity 4. Risk for infection

2

When caring for a client with pneumonia, which nursing activities are most appropriate for the registered nurse (RN) to delegate to the licensed practical nurse (LPN) working under RN supervision? Select all that apply. 1. Administering metered-dose inhaled medications 2. Monitoring lung sounds 3. Evaluating use of the incentive spirometer 4. Nasotracheal suctioning to collect a sputum specimen 5. Teaching the importance of fluid intake

1,2,4

The nurse cares for a client who returns from the operating room after a tracheostomy tube placement procedure. Which of the following is the nurse's priority when caring for a client with a new tracheostomy? 1. Changing the inner cannula within the first 8 hours to help prevent mucus plugs 2. Checking the tightness of ties and adjusting if necessary, allowing 1 finger to fit under these ties 3. Deflating and re-inflating the cuff every 4 hours to prevent mucosal tissue damage 4. Performing frequent mouth care every 2 hours to help prevent infection

2

An elderly client is admitted with chronic obstructive pulmonary disease (COPD) exacerbation. Pulse oximetry is 84% on room air. The client is restless, has expiratory wheezing and a productive cough, and is using his accessory muscles to breathe. Which prescription should the nurse question? 1. Albuterol 2.5 mg by nebulizer 2. Intravenous (IV) methylprednisolone 125 mg now and every 6 hours 3. IV morphine 2 mg now and may repeat every 2 hours 4. Oxygen at 2 L/min by nasal cannula

3

A client with left-sided pneumonia is admitted to the medical unit. The nurse assesses intermittent cough productive of copious amounts of thick yellow sputum and identifies ineffective airway clearance as the priority nursing diagnosis. Which interventions are appropriate to facilitate secretion removal? Select all that apply. 1. Chest physiotherapy 2. Cough suppressant 3. Huff coughing technique 4. Left-side lying position 5. Pursed lip breathing

1,3

A client with obesity is diagnosed with pulmonary embolism (PE). Which assessment data would the nurse expect to find? Select all that apply. 1. Bradycardia 2. Chest pain 3. Chills and fever 4. Hypoxemia 5. Tachypnea 6. Tracheal deviation

2,4,5

A previously healthy client is hospitalized with left lower lobe (LLL) bacterial pneumonia. The nurse assesses chest pain with inspiration, productive cough of thick rusty sputum, and LLL fine inspiratory crackles and low-pitched expiratory wheezing. Which of the medications that the health care provider prescribes should the nurse question? 1. Furosemide 20 mg intravenous (IV) push every day 2. Guaifenesin ER 600 mg PO every 12 hours 3. Ibuprofen 600 mg PO every 6 hours PRN 4. Levofloxacin 500 mg IV every day

1

A client with community-acquired pneumonia is receiving 0.9% normal saline (NS) at 50 mL/hr. Pulse oximetry shows 95% on nasal O2 at 3 L/min. The nurse identifies a nursing diagnosis of ineffective airway clearance. Which prescription would the nurse expect to best facilitate secretion removal? 1. Incentive spirometer every 2 hours 2. Increase 0.9% NS to 125 mL/hr 3. Increase nasal oxygen to 4 L/min 4. Place the client in semi-Fowler's position

2

The nurse conducts a program about strategies to prevent community-acquired pneumonia (CAP) at a center for senior citizens. Which statement made by a participant indicates the need for further instruction? 1. "I got the flu vaccine and it can help to prevent pneumonia." 2. "I got the one time pneumonia shot, so I won't need it again." 3. "I stopped smoking a year ago, so that should help me a lot." 4. "I try to avoid going to the mall during the winter months."

2

Which teaching instructions should the nurse provide to a client with advanced chronic obstructive pulmonary disease (COPD)? Select all that apply. 1. Follow a low-calorie diet 2. Obtain a pneumococcal vaccine 3. Report increased sputum 4. Take iron to improve anemia 5. Use an incentive spirometer

2,3

An elderly client with sepsis has a blood pressure 96/46 mm Hg, pulse 100/min, and respirations 28/min. Pulse oximetry (SpO2) shows 95% on nasal oxygen at 3 L/min. The client remains hypotensive after 2 fluid challenges with normal saline. Two hours later the SpO2 is 86%. What is the nurse's first action? 1. Increase oxygen flow rate 2. Notify the health care provider (HCP) of the drop in saturation 3. Reposition the pulse oximeter sensor 4. Request arterial blood gases to confirm the SpO2

3

In the intensive care unit, a client is on mechanical ventilation (MV) after having undergone a fresh tracheostomy with retention sutures placed yesterday. The nurse hears the MV alarm sound and enters the room. The client is coughing, respirations are 40/min, heart rate is 132/min, and the pulse oximeter reading is 80%. The nurse also sees the tracheostomy tube lying on the client's chest. What is the nurse's immediate action? 1. Apply a rebreathing mask with high concentration oxygen at 12 L/min 2. Attempt to reinsert the tube with the obturator in place 3. Insert a sterile catheter into the stoma and suction the airway 4. Pull the retention sutures apart to lift the trachea and hold the stoma open

4

An obese 85-year-old client, who is an avid gardener and eats only home-grown fruits, legumes, and vegetables, is admitted to the hospital with pneumonia after having an upper respiratory tract infection for a week. Which factor puts the client at greatest risk for developing pneumonia? 1. Advanced age 2. Environmental exposure 3. Nutritional deficit 4. Obesity

1

A client with chronic bronchitis tells the home health nurse of being exhausted all day due to coughing all night and being unable to sleep. The client can feel thick mucus in the chest and throat. Which interventions can the nurse suggest to help mobilize secretions and improve sleep? Select all that apply. 1. Increase fluids to at least 8 glasses (2-3 L) of water a day 2. Sleep with a cool mist humidifier 3. Take prescribed guaifenesin cough medicine before bedtime 4. Use abdominal breathing and the huff cough technique at bedtime 5. Use pursed-lip breathing during the night

1,2,3,4

The nurse is caring for a 72-year-old one-day postoperative colectomy client. The nurse assesses an increased work of breathing, diminished breath sounds at the bases with fine inspiratory crackles, respirations 12 and shallow, and pulse oximetry 96% on 2 L oxygen. There is no jugular venous distension or peripheral edema. Pain is regulated with client-controlled morphine. What is the most appropriate prescription for the nurse to carry out? 1. Bolus dose of intravenous (IV) morphine 2. Incentive spirometer 3. IV furosemide 4. Non-rebreather mask

2

The home care nurse is making an initial visit to a client just discharged after admission for severe exacerbation of chronic obstructive pulmonary disease (COPD). The nurse observes wall-to-wall stacks of old newspapers and magazines in every room, with pathways that just allow passage from one room to another. What is the priority nursing action? 1. Call the mobile community mental health crisis unit 2. Contact a service to remove the newspapers and magazines 3. Reconcile the client's discharge medications 4. Teach the safe use of oxygen

4

The nurse assesses these symptoms in a client with bacterial pneumonia: chills, elevated temperature, tachypnea, productive cough of yellow sputum, shortness of breath, and fatigue. Based on the assessment data, what is the most appropriate nursing diagnosis (ND) for this client? 1. Impaired gas exchange 2. Impaired spontaneous ventilation 3. Ineffective breathing pattern 4. Risk for infection

1

The nurse teaches safety precautions of home oxygen use to a client with emphysema being discharged with a nasal cannula and portable oxygen tank. Which client statement indicates the need for further teaching? Select all that apply. 1. "I can apply Vaseline to my nose when my nostrils feel dry from the oxygen." 2. "I can cook on my gas stove as long as I have a fire extinguisher in the kitchen." 3. "I can increase the liter flow from 2 to 6 liters a minute whenever I feel short of breath." 4. "I should not polish my nails when using my oxygen." 5. "I should not use a wool blanket on my bed."

1,2,3

A client with left lobar pneumonia is transferred to the intensive care unit due to increasing respiratory distress. While providing care for the client, the nurse notes a significant drop in saturation when the client is placed in which position? 1. High Fowler's 2. Left side 3. Right side 4. Semi-Fowler's

2

A hospitalized client with a history of obstructive sleep apnea sleeps while wearing a full face mask with continuous positive airway pressure (CPAP). Oxygen saturation drops to 85% during the night. What is the nurse's first action? 1. Assess level of consciousness and lung sounds 2. Check the tightness of the straps and mask 3. Notify the health care provider immediately 4. Remove the mask and administer supplemental oxygen

2

The registered nurse (RN) is caring for an elderly client with chronic obstructive pulmonary disease (COPD) whose pulse oximeter shows 91% on room air. After physical therapy, the client reports feeling "short of breath and exhausted" to the student nurse and says he just wants to sleep. To provide comfort, the student nurse initiates the prn nasal oxygen to maintain a saturation ≥92%, as prescribed. When the RN conducts end-of-shift rounds 3 hours later, the client is still sleeping soundly and the pulse oximeter shows 91%. Which nursing action is most appropriate at this time? 1. Check a full set of vital signs 2. Continue to monitor 3. Increase the oxygen flow by 1 L/min 4. Remove the nasal oxygen and measure saturation

4

A 64-year-old hospitalized client with chronic obstructive pulmonary disease (COPD) exacerbation has increased lethargy and confusion. The client's pulse oximetry is 88% on 2 liters of oxygen. Arterial blood gas (ABG) analysis shows a pH of 7.25, PO2 of 60 mm Hg, and PCO2 of 80 mm Hg. Which of the following should the nurse implement first? 1. Administer PRN nebulizer treatment 2. Administer scheduled dose of IV methylprednisolone 3. Increase client's oxygen to 4 liters 4. Place client on the bilevel positive airway pressure (BIPAP) machine

4

An 86-year-old client with diabetes and gastroparesis has had repeated hospitalizations for aspiration pneumonia following a stroke and is now hospitalized with altered level of consciousness. Which nursing action is most appropriate to decrease the client's risk for developing aspiration pneumonia? 1. Assessing client's breath sounds every 2 hours 2. Placing client in the side lying position in bed 3. Titrating client's oxygen to maintain saturation ≥93% 4. Turning and repositioning the client every 2 hours

2

An elderly client is brought to the emergency department with lethargy, chills, and sharp chest pain with deep breathing. Pulse oximeter shows 93% on room air and respirations are 24/min. What is the nurse's initial action? 1. Administer intravenous (IV) morphine 2. Auscultate the client's lung sounds 3. Initiate an IV infusion of normal saline 4. Initiate nasal oxygen at 3 L/min

2

The nurse is evaluating how well a client with chronic obstructive pulmonary disease (COPD) understands the discharge teaching. Which statements made by the client indicate an understanding of the pursed-lip breathing technique? Select all that apply. 1. "I exhale for 2 seconds through pursed lips." 2. "I exhale for 4 seconds through pursed lips." 3. "I inhale for 4 seconds through my nose, keeping my mouth closed." 4. "I inhale for 2 seconds through my mouth." 5. "I inhale for 2 seconds through my nose, keeping my mouth closed."

2,5