Respiratory PLQ

A mother calls the clinic asking for a prescription for amoxicillin for her 2-year-old son who has what the nurse suspects to be viral rhinitis. What should the nurse explain to this mother?

"I'll certainly inform the doctor, but if it is a cold, antibiotics won't be used because they do not affect the virus." Antimicrobial agents (antibiotics) should not be used because they do not affect the virus or reduce the incidence of bacterial complications. In addition, their inappropriate use has been implicated in development of organisms resistant to therapy. It would be inappropriate to tell the client that the physician will not respond to her request.

A client has just been diagnosed with squamous cell carcinoma of the neck. While the nurse is doing health education, the client asks, "Does this kind of cancer tend to spread to other parts of the body?" What is the nurse's best response?

"This cancer usually does not spread to distant sites in the body." The incidence of distant metastasis with squamous cell carcinoma of the head and neck (including larynx cancer) is relatively low. The client's prognosis is determined by the oncologist, but the client has asked a general question and it would be inappropriate to refuse a response. The nurse must not downplay the client's concerns.

A nurse practitioner has provided care for three different clients with chronic pharyngitis over the past several months. Which clients are at greatest risk for developing chronic pharyngitis?

A clients who is a habitual user of alcohol and tobacco Chronic pharyngitis is common in adults who live and work in dusty surroundings, use the voice to excess, suffer from chronic chough, and habitually use alcohol and tobacco. Caffeine and spicy foods have not been linked to chronic pharyngitis. GERD is not a noted risk factor.

A client is being treated for bacterial pharyngitis. Which of the following should the nurse recommend when promoting the client's nutrition during treatment?

A liquid or soft diet A liquid or soft diet is provided during the acute stage of the disease, depending on the client's appetite and the degree of discomfort that occurs with swallowing. The client is encouraged to drink as much fluid as possible (at least 2 to 3 L/day). There is no need for increased potassium or protein intake.

A 42-year-old client is admitted to the ED after an assault. The client received blunt trauma to the face and has a suspected nasal fracture. What intervention should the nurse perform?

Apply ice and keep the client's head elevated. Immediately after the fracture, the nurse applies ice and encourages the client to keep the head elevated. The nurse instructs the client to apply ice packs to the nose to decrease swelling. Dependent positioning would exacerbate bleeding and the nose is not irrigated. Occlusive dressings are not used.

The nurse is performing the health interview of a client with chronic rhinosinusitis who experiences frequent nose bleeds. The nurse asks the client about her current medication regimen. Which medication would put the client at a higher risk for recurrent epistaxis?

Beclomethasone Beclomethasone should be avoided in clients with recurrent epistaxis because it is a risk factor. The other listed medications do not increase the risk for epistaxis.

BiPAP is most often used for patients who require ventilatory assistance at night, such as those with severe _______________ or sleep apnea

COPD

The nurse is conducting a presurgical interview for a client with laryngeal cancer. The client states that he drinks approximately 20 ounces (600 mL) of vodka per day. It is imperative that the nurse inform the surgical team so the client can be assessed for what?

Delirium tremens Considering the known risk factors for cancer of the larynx, it is essential to assess the client's history of alcohol intake. Infection is a risk in the postoperative period, but not an appropriate answer based on the client's history. Depression and nonadherence are risks in the postoperative phase, but would not be critical short-term assessments.

The nurse is creating a plan of car for a client diagnosed with acute laryngitis. What intervention should be included in the client's plan of care?

Encourage the client to limit speech whenever possible. Management of acute laryngitis includes resting the voice, avoiding irritants (including smoking), resting, and inhaling cool steam or an aerosol. Fluid intake should be increased. Warm clothes on the throat will not help relieve the symptoms of acute laryngitis.

A gradual incline in respiratory function begins in early to middle adulthood and affects the structure and function of the respiratory system.

FALSE

Antibiotics are the initial medical treatment of choice in viral upper respiratory tract infections and pneumonia.

FALSE

Esophageal speech is the most widely used communication technique for patients who have undergone laryngectomy.

False

Immediate management of a nosebleed involves insertion of cotton pledgets into the nose to reduce blood flow.

False

Oxygen toxicity may occur when too high a concentration of oxygen (greater than 50%) is administered for an extended period (generally longer than 48 hours).

False

The nurse has been caring for a client who has been prescribed an antibiotic for pharyngitis and has been instructed to take the antibiotic for 10 days. On day 4, the client is feeling better and plans to stop taking the medication. What information should the nurse provide to this client?

Finish all the antibiotics to eliminate the organism completely. The nurse informs the client about the need to take the full course of any prescribed antibiotic. Antibiotics should be taken for the entire prescribed course to eliminate the microorganisms. A client should never be instructed to keep leftover antibiotics for use at a later time. Even if the fever or other symptoms are gone, the medications should be continued. Antibiotics do not need to be disposed of in a biohazard receptacle, though they should be discarded appropriately.

A client's total laryngectomy has created a need for alaryngeal speech which will be achieved through the use of tracheoesophageal puncture. What action should the nurse describe to the client when teaching him about this process?

Fitting for a voice prosthesis In clients receiving tracheoesophageal puncture, a valve is placed in the tracheal stoma to divert air into the esophagus and out the mouth. Once the puncture is surgically created and has healed, a voice prosthesis (Blom-Singer®) is fitted over the puncture site. A nasogastric tube and belching are not required. An artificial pharynx is not used.

The ED nurse is assessing a young gymnast who fell from a balance beam. The gymnast presents with a clear fluid leaking from her nose. What should the ED nurse suspect?

Fracture of the cribriform plate Clear fluid from either nostril suggests a fracture of the cribriform plate with leakage of cerebrospinal fluid. The symptoms are not indicative of an abrasion of the soft tissue or rupture of a sinus. Clear fluid leakage from the nose would not be indicative of a fracture of the nasal septum.

The perioperative nurse has admitted a client who has just underwent a tonsillectomy. The nurse's postoperative assessment should prioritize which of the following potential complications of this surgery?

Hemorrhage Hemorrhage is a potential complication of a tonsillectomy. Increased pulse, fever, and restlessness may indicate a postoperative hemorrhage. Difficulty ambulating and bradycardia are not common complications in a client after a tonsillectomy. Infrequent swallowing does not indicate hemorrhage; frequent swallowing does.

The nurse is caring for a client whose recent unexplained weight loss and history of smoking have prompted diagnostic testing for cancer. What symptom is most closely associated with the early stages of laryngeal cancer?

Hoarseness Hoarseness is an early symptom of laryngeal cancer. Dyspnea, dysphagia, and lumps are later signs of laryngeal cancer. Alopecia is not associated with a diagnosis of laryngeal cancer.

The nurse is caring for a client in the ED for epistaxis. What information should the nurse include in client discharge teaching as a way to prevent epistaxis?

Humidify the indoor environment. Discharge teaching for prevention of epistaxis should include the following: avoid forceful nose bleeding, straining, high altitudes, and nasal trauma (nose picking). Adequate humidification may prevent drying of the nasal passages. Keeping nasal passages clear and using a tissue when blowing the nose are not included in discharge teaching for the prevention of epistaxis. Decongestants are not indicated.

The nurse is planning the care of a client who is scheduled for a laryngectomy. The nurse should assign the highest priority to which postoperative nursing diagnosis?

Ineffective airway clearance related to airway alterations

The nurse is caring for a client who presents with a severe nosebleed. The site of bleeding appears to be the anterior portion of the nasal septum. The nurse instructs the client to tilt her head forward and the nurse applies pressure to the nose, but the client's nose continues to bleed. Which intervention should the nurse next implement?

Insert a tampon in the affected nare A cotton tampon may be used to try to stop the bleeding. The use of ice on the bridge of the nose has no scientific rationale for care. Laying the client down on the cot could block the client's airway. Hospital admission is necessary only if the bleeding becomes serious.

The occupational health nurse is obtaining a client history during a pre-employment physical. During the history, the client states that he has hereditary angioedema. The nurse should identify what implication of this health condition?

It can cause life-threatening airway obstruction. Hereditary angioedema is an inherited condition that is characterized by episodes of life-threatening laryngeal edema. No information supports lost days of work or reduced cardiac function.

The nurse is caring for a client who needs education on his medication therapy for allergic rhinitis. The client is to take cromolyn daily. In providing education for this client, how should the nurse describe the action of the medication?

It inhibits the release of histamine and other chemicals. Cromolyn inhibits the release of histamine and other chemicals. It is prescribed to treat allergic rhinitis. Beta-adrenergic agents lead to bronchodilation and stimulate beta-2 adrenergic receptors in the smooth muscle of the bronchi and bronchioles. It does not affect proton pump action or the sodium-potassium pump in the nasal cells.

The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD). How should the nurse determine the appropriate O2 flow rate?

Maintain the pulse oximetry level at 90% or greater. The best way to determine the appropriate O2 flow rate is by monitoring the patient's oxygenation either by arterial blood gases (ABGs) or pulse oximetry. An O2 saturation of 90% indicates adequate blood O2 level without the danger of suppressing the respiratory drive. For patients with an exacerbation of COPD, an O2 flow rate of 2 L/min may not be adequate. Because O2 use improves survival rate in patients with COPD, there is no concern about O2 dependency. The patient's perceived dyspnea level may be affected by other factors (e.g., anxiety) besides blood O2 level.

A 45-year-old obese man arrives in a clinic reporting daytime sleepiness, difficulty going to sleep at night, and snoring. The nurse should recognize the manifestations of what health problem?

Obstructive sleep apnea Obstructive sleep apnea occurs in men, especially those who are older and overweight. Symptoms include excessive daytime sleepiness, insomnia, and snoring. Daytime sleepiness and difficulty going to sleep at night are not indications of tonsillitis or adenoiditis. This client's symptoms are not suggestive of laryngeal cancer.

The nurse is explaining the safe and effective administration of nasal spray to a client with seasonal allergies. What information is most important to include in this teaching?

Overuse of nasal spray may cause rebound congestion. The use of topical decongestants is controversial because of the potential for a rebound effect. The client should hold their head back for maximal distribution of the spray. Only the client should use the bottle.

The nurse is providing client teaching to a client diagnosed with acute rhinosinusitis. For what possible complication should the nurse teach the client to seek immediate follow-up?

Periorbital edema Client teaching is an important aspect of nursing care for the client with acute rhinosinusitis. The nurse instructs the client about symptoms of complications that require immediate follow-up. Referral to a physician is indicated if periorbital edema and severe pain on palpation occur. Clear drainage and blood-tinged mucus do not require follow-up if the client has acute rhinosinusitis. A persistent headache does not necessarily warrant immediate follow-up.

__________________ breathing, which improves oxygen transport, helps induce a slow, deep breathing pattern and assists the patient to control breathing, even during periods of stress.

Pursed-lip

The nurse is teaching a client with allergic rhinitis about the safe and effective use of his medications. What would be the most essential information to give this client about preventing possible drug interactions?

Read drug labels carefully before taking OTC medications. Client education is essential when assisting the client in the use of all medications. To prevent possible drug interactions, the client is cautioned to read drug labels before taking any OTC medications. Some websites are reliable and valid information sources, but this is not always the case. Clients do not necessarily need to limit themselves to one pharmacy, though checking for potential interactions is important. Not all OTC medications are safe additions to prescription medication regimens.

A client comes to the ED and is admitted with epistaxis. Pressure has been applied to the client's midline septum for 10 minutes, but the bleeding continues. The nurse should anticipate using what treatment to control the bleeding?

Silver nitrate application If pressure to the midline septum does not stop the bleeding for epistaxis, additional treatment of silver nitrate application, Gelfoam, electrocautery, or vasoconstrictors may be used. Suction may be used to visualize the nasal septum, but it does not alleviate the bleeding. Irrigation with a hypertonic solution is not used to treat epistaxis.

A client has had a nasogastric tube in place for 6 days due to the development of paralytic ileus after surgery. In light of the prolonged presence of the nasogastric tube, the nurse should prioritize assessments related to what complication?

Sinus infections Clients with nasotracheal and nasogastric tubes in place are at risk for development of sinus infections. Thus, accurate assessment of clients with these tubes is critical. Use of a nasogastric tube is not associated with the development of the other listed pathologies.

A nursing student is discussing a client with viral pharyngitis with the preceptor at the walk-in clinic. What should the preceptor tell the student about nursing care for clients with viral pharyngitis?

Symptom management is the main focus of medical and nursing care. Nursing care for clients with viral pharyngitis focuses on symptomatic management. Antibiotics are not prescribed for viral etiologies. Surgery is not indicated in the treatment of viral pharyngitis. Chronic hoarseness is not a common sequela of viral pharyngitis, so teaching ways to prevent it would be of no use in this instance.

A serious complication of a group A beta-hemolytic streptococcal infection is rheumatic fever.

TRUE

Almost all malignant tumors of the larynx arise from the surface epithelium and are classified as squamous cell carcinoma.

TRUE

On assessment, the nurse would describe coarse crackles as discontinuous popping sounds heard in early inspiration.

TRUE

The nurse is caring for a client with a history of a renal transplant who has just been diagnosed with chronic rhinosinusitis. While being admitted to the clinic, the client asks, "Will this chronic infection hurt my new kidney?" What should the nurse know about chronic rhinosinusitis in this client?

Taking immunosuppressive drugs can contribute to chronic rhinosinusitis. URIs, specifically chronic rhinosinusitis and recurrent acute rhinosinusitis, may be linked to primary or secondary immune deficiency or treatment with immunosuppressive therapy (i.e., for cancer or organ transplantation). Typical symptoms may be blunted or absent due to immunosuppression. No evidence indicates damage to the transplanted organ due to chronic rhinosinusitis. Immunosuppressive drugs do not cause organ rejection.

The nurse is providing care for a client who has just been admitted to the postsurgical unit following a laryngectomy. What assessment should the nurse prioritize?

The client's airway patency The client with a laryngectomy is a risk for airway occlusion and respiratory distress. As in all nursing situations, assessment of the airway is a priority over other potential complications and assessment parameters.

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which information obtained from the patient would prompt the nurse to consult with the health care provider before administering the prescribed theophylline?

The patient takes cimetidine (Tagamet HB) daily. Cimetidine interferes with the metabolism of theophylline, and concomitant administration may lead rapidly to theophylline toxicity. The other patient information would not affect whether the theophylline should be administered or not.

The nurse is caring for a client with a severe nosebleed. The physician inserts a nasal sponge. What should the nurse teach the client about this intervention?

The sponge can stay in place for 3 to 4 days if needed A compressed nasal sponge may be used. Once the sponge becomes saturated with blood or is moistened with a small amount of saline, it will expand and produce tamponade to halt the bleeding. The packing may remain in place for 48 hours or up to 3 or 4 days if necessary to control bleeding. This does not require the client to be supine or to avoid all NSAIDs. Packing does not increase the risk for sinusitis.

A client states that her family has had several colds during this winter and spring despite their commitment to handwashing. The high communicability of the common cold is attributable to what factor?

The virus is shed for 2 days prior to the emergence of symptoms. Colds are highly contagious because virus is shed for about 2 days before the symptoms appear and during the first part of the symptomatic phase. Antibiotic resistance is not relevant to viral illnesses and OTC medications do not have a "rebound" effect. Genetic factors do not exist.

The nurse is creating a care plan for a client who is status post-total laryngectomy. Much of the plan consists of a long-term postoperative communication plan for alaryngeal communication. What form of alaryngeal communication will likely be chosen?

Tracheoesophageal puncture Tracheoesophageal puncture is simple and has few complications. It is associated with high phonation success, good phonation quality, and steady long-term results. As a result, it is preferred over esophageal speech, an electric larynx or ASL.

Adenocarcinoma is the rarest carcinoma of the lung in both men and women; it occurs peripherally as peripheral masses or nodules and often metastasizes.

True

Adequate treatment of upper respiratory tract infection is one of the major factors in the prevention of acute bronchitis.

True

Alterations in respiratory status have been identified as important predictors of clinical deterioration in hospitalized patients.

True

Asthma is considered a distinct, separate disorder from COPD and is classified as an abnormal airway condition characterized primarily by reversible inflammation.

True

Lungs with decreased compliance require greater-than-normal energy expenditure by the patient to achieve normal levels of ventilation.

True

Smoking cessation is the single most cost-effective intervention to reduce the risk of developing COPD and to stop its progression.

True

Tachypnea, dyspnea, and mild-to-moderate hypoxemia are hallmarks of the severity of atelectasis.

True

The Venturi mask is the most reliable and accurate method for delivering a precise concentration of oxygen through noninvasive means.

True

The major cause of death in ARDS is nonpulmonary multiple organ dysfunction syndrome, often with sepsis.

True

The need for oxygen is assessed by arterial blood gas analysis, pulse oximetry, and clinical evaluation.

True

The pathophysiology of emphysema involves destruction of the walls of the alveoli leading to impaired oxygen diffusion.

True

Viruses, the most common cause of URIs, affect the upper respiratory passages and lead to subsequent mucous membrane inflammation.

True

It is cold season and the school nurse been asked to provide an educational event for the parent teacher organization of the local elementary school. What should the nurse include in teaching about the treatment of pharyngitis?

Use of warm saline gargles or throat irrigations can relieve symptoms. Depending on the severity of the pharyngitis and the degree of pain, warm saline gargles or throat irrigations are used. The benefits of this treatment depend on the degree of heat that is applied. The nurse teaches about these procedures and about the recommended temperature of the solution: high enough to be effective and as warm as the client can tolerate, usually 105ºF to 110ºF (40.6ºC to 43.3ºC). Irrigating the throat may reduce spasm in the pharyngeal muscles and relieve soreness of the throat. You would not tell the parent teacher organization that there is no real treatment of pharyngitis

____________, the most common cause of upper respiratory infections, affect the upper respiratory passages and lead to subsequent mucous membrane inflammation.

Viruses

The nurse is providing client teaching to a young mother who has brought her 3-month-old infant to the clinic for a well-baby checkup. What action should the nurse recommend to the woman to prevent the transmission of organisms to her infant during the cold season?

Wash her hands frequently Handwashing remains the most effective preventive measure to reduce the transmission of organisms. Taking prescribed antibiotics, using warm salt-water gargles, and dressing warmly do not suppress transmission. Antibiotics are not prescribed for a cold.

PAO2 is the abbreviation used for the partial pressure of ______________ oxygen.

alveolar

The cornerstone pharmacologic therapy of bronchiectasis management is the use of ___________________.

antibiotics

Confirm the diagnosis of maxillary and frontal rhinosinusitis and identify the pathogen, sinus _________________ may be obtained.

aspirates

Assessment of the lower respiratory structures includes inspection, palpation, percussion, and ___________________ of the thorax.

auscultation

When caring for a patient who has had a pulmonary embolism, the nurse must be alert for the potential complication of right ventricular failure or ______________ shock.

cardiogenic

The most potent and effective anti-inflammatory medications currently available to treat asthma are _________________.

corticosteroids

Sudden ___________________ in a healthy person may indicate pneumothorax (air in the pleural cavity), acute respiratory obstruction, allergic reaction, or myocardial infarction.

dyspnea

The main symptom of pulmonary hypertension is ____________, which occurs at first with exertion and eventually at rest.

dyspnea

A nurse who assesses the respiratory function of a patient with ___________ would note decreased tactile fremitus, hyperresonant percussion, and absent or decreased breath sounds.

emphysema

Nursing measures to prevent atelectasis include frequent turning, early mobilization, and strategies to ___________________ the lungs and to manage secretions.

expand

The most serious postoperative complication of a tonsillectomy is ________________.

hemorrhage

Asthma causes airway____________________, mucosal edema, and mucus production

hyperresponsiveness

Two major postoperative complications of thoracic surgery are atelectasis and __________________.

infection

Fractures of the first three ribs are rare but can result in a high mortality rate because they are associated with _________________ of the subclavian artery or vein.

laceration

The overall goals of ________________ care are to manage symptoms and improve the quality of life for patients and families with advanced COPD.

palliative

The patient with a _____________________ abscess is acutely ill with a severe sore throat, fever, trismus (inability to open the mouth), and drooling.

peritonsillar

Influenza and ____________ are the most common causes of death from infectious diseases in the United States.

pneumonia

A partial __________ oxygen mask has a reservoir bag that must remain inflated during both inspiration and expiration.

rebreathing

After a pneumonectomy, a patient should be turned every hour from the back to the operative side and should not be completely turned to the unoperated side.

true

Respiratory ___________ is the process of withdrawing the patient from dependence on the ventilator which takes place in three stages.

weaning