Respiratory Review

The nurse is collecting data on a client with chronic sinusitis. Which are signs and symptoms of chronic sinusitis? Select all that apply. 1.Loss of smell 2.Chronic cough 3.Nasal stuffiness 4.Clear nasal discharge 5.Severe evening headache

1.Loss of smell 2.Chronic cough 3.Nasal stuffiness

The nurse is caring for a client with fractured ribs. Which statement indicates a need for further teaching? 1."My ribs will be healed in a month." 2."I should only need pain med for a week." 3."I should stay calm and rest after taking pain med." 4."I need to support my ribs when I deep breathe and cough."

1."My ribs will be healed in a month."

The nurse is caring for a client at home who has had a tracheostomy tube for several months. The nurse monitors the client for complications associated with the long-term tracheostomy and suspects tracheoesophageal fistula if which observation is noted for the client? 1.Abdominal distention 2.Purulent drainage around the tracheotomy site 3.Excessive secretions from the tracheotomy site 4.Inability to pass a suction catheter through the tracheotomy

1.Abdominal distention

The nurse is assisting in preparing a list of instructions for an adult client who is being discharged following a tonsillectomy. Which instructions should the nurse include in the list? Select all that apply. 1.Avoid hot fluids. 2.Avoid rough foods. 3.Consume milk products. 4.Rest for the next 24 hours. 5.Consume carbonated beverages. 6.Eat ice cream to soothe the throat.

1.Avoid hot fluids. 2.Avoid rough foods. 4.Rest for the next 24 hours.

A client at risk for pulmonary embolism (PE) suddenly develops respiratory distress, chest pain, and anxiety. The nurse should plan to take which actions? Select all that apply. 1.Check vital signs. 2.Administer warfarin. 3.Notify the registered nurse. 4.Begin low-flow oxygen therapy. 5.Raise the bed to a low-Fowler's position.

1.Check vital signs. 3.Notify the registered nurse. 4.Begin low-flow oxygen therapy.

Which diagnostic tests indicate active tuberculosis? Select all that apply. 1.Chest x-ray 2.Tuberculin skin test 3.Gastric analysis washings 4.Sputum smear and culture 5.Interferon gamma release assays (IGRA)

1.Chest x-ray 3.Gastric analysis washings 4.Sputum smear and culture

The nurse is assigned to assist with caring for a client who has a chest tube. The nurse notes fluctuations of the fluid level in the water-seal chamber. Based on this observation, which action would be appropriate? 1.Continue to monitor. 2.Empty the drainage. 3.Encourage the client to deep breathe. 4.Encourage the client to hold his or her breath periodically.

1.Continue to monitor.

The nurse is caring for a client with laryngitis. Which interventions should the nurse implement? Select all that apply. 1.Discourage smoking. 2.Use a room humidifier. 3.Speak only in whispers. 4.Use the intercom to contact the nurse. 5.Use lozenges that contain a topical anesthetic agent.

1.Discourage smoking. 2.Use a room humidifier. 5.Use lozenges that contain a topical anesthetic agent.

The nurse is determining the need for suctioning in a client with an endotracheal tube (ETT) attached to a mechanical ventilator. Which observations are consistent with the need for suctioning? Select all that apply. 1.Restlessness 2.Gurgling sounds with respiration 3.Presence of congestion in the lungs 4.Increased pulse and respiratory rates 5.Low peak inspiratory pressure on the ventilator

1.Restlessness 2.Gurgling sounds with respiration 3.Presence of congestion in the lungs 4.Increased pulse and respiratory rates

The nurse is told that an assigned client will have a fenestrated tracheostomy tube inserted. The nurse plans care knowing that which facts are true with the use of a fenestrated tracheostomy tube? Select all that apply. 1.Enables the client to speak 2.Is necessary for mechanical ventilation 3.Must have the cuff deflated when capped 4.Eliminates the need for tracheostomy care 5.Prevents air from being inhaled through the tracheostomy opening

1.Enables the client to speak 3.Must have the cuff deflated when capped

A clinic nurse is assisting in caring for a client whose chief complaint is the presence of flulike symptoms. Which recommendations by the nurse are therapeutic? Select all that apply. 1.Get plenty of rest. 2.Take antipyretics for fever. 3.Increase intake of liquids. 4.Get a flu vaccine immediately. 5.Eat carbohydrates only for energy.

1.Get plenty of rest. 2.Take antipyretics for fever. 3.Increase intake of liquids.

The nurse assessing a client diagnosed with laryngeal cancer would note which signs and symptoms? Select all that apply. 1.Hemoptysis 2.Kussmaul respirations 3.Enlarged thyroid gland 4.A sensation of a "lump" in the throat 5.Hoarseness lasting more than 3 weeks

1.Hemoptysis 4.A sensation of a "lump" in the throat 5.Hoarseness lasting more than 3 weeks

The nurse is caring for the client diagnosed with tuberculosis (TB). Which finding made by the nurse would be inconsistent with the usual clinical presentation of tuberculosis? 1.High-grade fever 2.Chills and night sweats 3.Anorexia and weight loss 4.Nonproductive or productive cough

1.High-grade fever

A client with chronic obstructive pulmonary disease (COPD) on bed rest is weaned from the ventilator before transferring to a medical unit. To adequately restore client strength before getting the client out of bed, which is the priority client activity for the nurse to incorporate in the plan of care? 1.Instruct the client to reposition himself. 2.Elevate the head of the bed to 15 degrees. 3.Transfer the client to the chair three times daily. 4.Perform passive flexion and extension of the ankles.

1.Instruct the client to reposition himself.

A client is admitted to the emergency department with carbon monoxide poisoning. Which signs and symptoms indicate carbon monoxide poisoning? Select all that apply. 1.Mental changes 2.Cardiac irregularities 3.Cherry-red skin color 4.Abnormal arterial blood gas results 5.Negative carboxyhemoglobin levels

1.Mental changes 2.Cardiac irregularities 3.Cherry-red skin color

The nurse is assisting in planning care for a client scheduled for insertion of a tracheostomy. Which equipment should the nurse plan to have at the bedside when the client returns from surgery? 1.Obturator 2.Oral airway 3.Epinephrine 4.Tracheostomy tube with the next larger size.

1.Obturator

The nurse is reinforcing instructions to a client following a total laryngectomy about caring for the stoma. Which instructions should the nurse provide to the client? Select all that apply. 1.Protect the stoma from water. 2.Soaps should be avoided near the stoma. 3.Wash the stoma daily using a washcloth. 4.Use diluted alcohol on the stoma to clean it. 5.Apply a thin layer of petroleum jelly to the skin surrounding the stoma. 6.Use soft tissues to clean any secretions that accumulate around the stoma.

1.Protect the stoma from water. 2.Soaps should be avoided near the stoma. 3.Wash the stoma daily using a washcloth. 5.Apply a thin layer of petroleum jelly to the skin surrounding the stoma.

The nurse is assisting in caring for the client immediately after removal of the endotracheal tube following radical neck dissection. The nurse interprets that which sign experienced by the client should be reported immediately to the registered nurse (RN)? 1.Stridor 2.Lung congestion 3.Occasional pink-tinged sputum 4.Respiratory rate of 26 breaths per minute

1.Stridor

The nurse is caring for a client following segmental resection of the upper lobe of the left lung. The nurse notes 700 mL of grossly bloody drainage in the chest tube drainage system during the first hour following surgery. Which statement represents the nurse's accurate interpretation of this finding? 1.This finding requires further data collection. 2.This finding indicates the need for autotransfusion. 3.This finding is expected following this type of surgery. 4.This finding indicates a malfunction of the chest tube drainage system.

1.This finding requires further data collection.

A client experiencing a pleural effusion had a thoracentesis. Analysis of the extracted fluid revealed a high red blood cell count. The nurse interprets that this result is consistent with which diagnosis? 1.Trauma 2.Infection 3.Liver failure 4.Heart failure (HF)

1.Trauma

A client with arthritis of the hands and fingers is having difficulty using a metered-dose inhaler (MDI). The nurse suggests asking the primary health care provider for which prescription? 1.Use of a spacer 2.Use of a nebulizer 3.Use of an oral (pill) form of the medication 4.Use of an intravenous (IV) form of the medication

1.Use of a spacer

A client attached to mechanical ventilation suddenly becomes restless and pulls out the tracheostomy tube. Which is the nurse's priorityintervention? 1.Prepare for reintubation. 2.Call the rapid response team. 3.Call the registered nurse. 4.Check the client for spontaneous breathing.

4.Check the client for spontaneous breathing.

The nurse is assisting in collecting subjective and objective data from a client admitted to the hospital with tuberculosis (TB). The nurse should expect to note which finding? 1.High fever 2.Flushed skin 3.Complaints of weight gain 4.Complaints of night sweats

4.Complaints of night sweats

A client is admitted to the hospital with acute exacerbation of chronic obstructive pulmonary disease (COPD) and has an arterial blood gas test done. Which results would the nurse expect to note? 1.Po2 of 70 mm Hg and Pco2 of 45 mm Hg 2.Po2 of 68 mm Hg and Pco2 of 40 mm Hg 3.Po2 of 62 mm Hg and Pco2 of 40 mm Hg 4.Po2 of 60 mm Hg and Pco2 of 50 mm Hg

4.Po2 of 60 mm Hg and Pco2 of 50 mm Hg

Which statement by the client indicates a need for further teaching regarding the reinforced home care instructions for acute sinusitis? 1."I should drink large amounts of fluids." 2."I will need surgery to drain my sinuses." 3."I should apply a wet, warm heat pack over my sinuses." 4."I will need to sleep with the head of the bed elevated."

2."I will need surgery to drain my sinuses."

The nurse is talking with a client who is going to have a radical neck dissection and total laryngectomy. Which client statement indicates a need for further teaching concerning postoperative management? 1."I will gradually eat oral fluids and food." 2."I will require a lot of pain med after surgery." 3."I will need to support my head when I sit up." 4."I will determine options to restore some form of speech."

2."I will require a lot of pain med after surgery."

A client with a diagnosis of lung cancer returns to the nursing unit after a left pneumonectomy. Which nursing actions should be done? Select all that apply. 1.Turn completely on the side. 2.Administer humidified oxygen. 3.Instruct on the use of the incentive spirometer. 4.Monitor vital signs and pulse oximetry frequently. 5.Place in respiratory isolation to prevent infection.

2.Administer humidified oxygen. 3.Instruct on the use of the incentive spirometer. 4.Monitor vital signs and pulse oximetry frequently.

The nurse is reviewing the record of a client with acute respiratory distress syndrome (ARDS). The nurse determines that which finding documented in the client's record is consistent with the mostexpected characteristic of this disorder? 1.Central cyanosis 2.Arterial Pao2 of 48 3.Arterial Pao2 of 81 4.Respiratory rate of 10 breaths per minute

2.Arterial Pao2 of 48

The nurse is assisting in planning care for a client with a chest tube. The nurse should suggest to include which interventions in the plan? Select all that apply. 1.Pin the tubing to the bed linens. 2.Be sure all connections remain airtight. 3.Be sure all connections are taped and secure. 4.Monitor closely for tubing that is kinked or obstructed. 5.Empty the drainage from the drainage collection chamber daily.

2.Be sure all connections remain airtight. 3.Be sure all connections are taped and secure. 4.Monitor closely for tubing that is kinked or obstructed.

A client is returned to the nursing unit following thoracic surgery with chest tubes in place. During the first few hours postoperatively, the nurse assisting in caring for the client checks for drainage. Which type of drainage is expected? 1.Serous 2.Bloody 3.Serosanguineous 4.Bloody with several clots

2.Bloody

A client with chronic obstructive pulmonary disease (COPD) who is beginning oxygen therapy asks the nurse why the flow rate cannot be increased. The nurse explains that this can be harmful because it could cause which difficulty? 1.It could be drying to nasal passages. 2.It could decrease the client's oxygen-based respiratory drive. 3.It could increase the risk of pneumonia from drier air passages. 4.It could decrease the client's carbon dioxide-based respiratory drive.

2.It could decrease the client's oxygen-based respiratory drive.

The nurse is assigned to assist in caring for a client with a chest tube drainage system. Which interventions should the nurse implement? Select all that apply. 1.Pin excess tubing to the bedclothes. 2.Check for subcutaneous emphysema. 3.Empty the chest tube drainage at the end of the shift. 4.Check to see that the chest tube drainage is fluctuating. 5.Maintain chest tube drainage container below the client's chest.

2.Check for subcutaneous emphysema. 4.Check to see that the chest tube drainage is fluctuating. 5.Maintain chest tube drainage container below the client's chest.

The nurse is caring for a hospitalized client with a suspected diagnosis of tuberculosis (TB). Which finding does the nurse expect to note during data collection? 1.High fever 2.Chills and night sweats 3.Complaints of diarrhea 4.Petechiae on the upper extremities

2.Chills and night sweats

The nurse is assigned to assist the primary health care provider (PHCP) with the removal of a chest tube. Which interventions should the nurse anticipate performing during this process? Select all that apply. 1.Reinforce instructions to breathe deeply while the tube is removed. 2.Cover the site with an occlusive dressing after the tube is removed. 3.Clamp the chest tube near the insertion site just before the removal. 4.Raise the drainage system to the level of the chest tube insertion site. 5.Have the client perform the Valsalva maneuver as the chest tube is pulled out.

2.Cover the site with an occlusive dressing after the tube is removed. 5.Have the client perform the Valsalva maneuver as the chest tube is pulled out

The chest x-ray report for a client states that the client has a left apical pneumothorax. The nurse should monitor the status of breath sounds in that area by placing the stethoscope in which location? 1.Near the lateral twelfth rib 2.Just under the left clavicle 3.In the fifth intercostal space 4.Posteriorly under the left scapula

2.Just under the left clavicle

The nurse is collecting data from a client who is experiencing the typical signs/symptoms of tuberculosis (TB). Which are signs and symptoms of tuberculosis? Select all that apply. 1.Weight gain 2.Night sweats 3.Sporadic coughing 4.Mucopurulent sputum 5.Afternoon low grade fever

2.Night sweats 4.Mucopurulent sputum 5.Afternoon low grade fever

A client who has been taking isoniazid for 1½ months complains to the nurse about numbness, paresthesia, and tingling in the extremities. The nurse interprets that the client is experiencing which adverse effect? 1.Hypercalcemia 2.Peripheral neuritis 3.Small blood vessel spasm 4.Impaired peripheral circulation

2.Peripheral neuritis

The nurse is reviewing the health care record of a client with a new onset of pleurisy. The nurse notes documentation that the client does not have a pleural friction rub that was auscultated the previous day. How should this finding be interpreted? 1.The medication therapy has been effective. 2.Pleural fluid has accumulated in the inflamed area. 3.The deep breaths that the client is taking are helping. 4.There is a decreased inflammatory reaction at the site.

2.Pleural fluid has accumulated in the inflamed area.

The nurse is caring for a client after pulmonary angiography via catheter insertion into the left groin. The nurse monitors for an allergic reaction to the contrast medium by observing for the presence of which? 1.Hypothermia 2.Respiratory distress 3.Hematoma in the left groin 4.Discomfort in the left groin

2.Respiratory distress

The nurse is suctioning a client through a tracheal tube. During the suctioning procedure, the nurse notes on the cardiac monitor that the heart rate has dropped 10 beats. Which should be the nurse's next action? 1.Notify the registered nurse immediately. 2.Stop the procedure and oxygenate the client. 3.Continue to suction the client at a quicker pace. 4.Ensure that the suction is limited to 15 seconds.

2.Stop the procedure and oxygenate the client.

The nurse is assisting a client who underwent radical neck surgery to get out of bed. How does the nurse provide support to this client who is afraid to move the head? 1.The nurse applies a soft cervical collar. 2.The nurse places a hand behind the client's head. 3.The nurse raises the head of the bed 90 degrees. 4.The nurse assists the client to roll to the side of the bed and sit up slowly.

2.The nurse places a hand behind the client's head.

A client reports the chronic use of nasal sprays. The nurse reinforces instructions to this client about which piece of information related to chronic use of nasal sprays? 1.Nosebleeds are common. 2.The protective mechanism of the nose may be damaged. 3.It is acceptable to double the dose if one dose is ineffective. 4.Fungal infections of the nose may occur because of container contamination.

2.The protective mechanism of the nose may be damaged.

The nurse is monitoring the respiratory status of a client following insertion of a tracheostomy. The nurse understands that oxygen saturation measurements obtained by pulse oximetry may be inaccurate if the client has which coexisting problems? Select all that apply. 1.Fever 2.Epilepsy 3.Hypotension 4.Respiratory failure 5.Use of peripheral vasoconstrictors

3.Hypotension 5.Use of peripheral vasoconstrictors

The nurse is assisting with monitoring the functioning of a chest-tube drainage system in a client who just returned from the recovery room after a thoracotomy with wedge resection. Which findings should the nurse expect to note? Select all that apply. 1.Excessive bubbling in the water-seal chamber 2.Vigorous bubbling in the suction-control chamber 3.50 mL of drainage in the drainage-collection chamber 4.The drainage system is maintained below the client's chest. 5.An occlusive dressing is in place over the chest-tube insertion site. 6.Fluctuation of water in the tube of the water-seal chamber during inhalation and exhalation

3.50 mL of drainage in the drainage-collection chamber 4.The drainage system is maintained below the client's chest. 5.An occlusive dressing is in place over the chest-tube insertion site. 6.Fluctuation of water in the tube of the water-seal chamber during inhalation and exhalation

The nurse is caring for a client after a bronchoscopy and biopsy. Which finding should be reported immediately to the primary health care provider (PHCP)? 1.Dry cough 2.Hematuria 3.Bronchospasm 4.Blood-tinged sputum

3.Bronchospasm

A client who has had a radical neck dissection begins to hemorrhage at the incision site. Which action by the nurse would be contraindicated? 1.Monitoring the client's airway 2.Applying manual pressure over the site 3.Lowering the head of the bed to a flat position 4.Calling the primary health care provider immediately

3.Lowering the head of the bed to a flat position

A client who has just suffered a flail chest is experiencing severe pain and dyspnea. Which would be the appropriate nursing action? 1.Reposition the client. 2.Document the findings. 3.Notify the registered nurse. 4.Medicate the client for pain.

3.Notify the registered nurse.

A client has just returned from intrathoracic surgery where a chest tube was placed. The nurse notes a small amount of serosanguineous drainage on the chest tube's dressing. Which action should the nurse take? 1.Notify the surgeon. 2.Change the dressing. 3.Reinforce the dressing. 4.Document the findings.

3.Reinforce the dressing.

The nurse is gathering data on a client with a diagnosis of tuberculosis. The nurse should review the results of which diagnostic test to confirm this diagnosis? 1.Chest x-ray 2.Bronchoscopy 3.Sputum culture 4.Tuberculin skin test

3.Sputum culture

A client had thoracic surgery 2 days ago and has a chest tube in place connected to a closed chest tube system. The nurse notes continuous bubbling in the water seal chamber. The nurse determines which? 1.This is normal on the second postoperative day. 2.The client has a large amount of fluid that is being evacuated by the system. 3.There is a leak in the system that requires immediate investigation and correction. 4.This is due to the suction applied to the system, which is set at 20 cm of suction pressure.

3.There is a leak in the system that requires immediate investigation and correction.

A hospitalized client is dyspneic and has been diagnosed with left pneumothorax by chest x-ray. Which sign or symptom observed by the nurse clearly indicates that the pneumothorax is rapidly worsening? 1.Hypertension 2.Pain with respiration 3.Tracheal deviation to the right 4.Respiratory rate of 18 breaths per minute

3.Tracheal deviation to the right

A client with pneumonia is experiencing problems with ventilation as a result of accumulated respiratory secretions. The nurse determines that which data accurately indicate effectiveness of the treatments prescribed for this problem? 1.Venous oxygen saturation is 95%. 2.Respiratory rate is 20 breaths per minute. 3.Client demonstrated effective coughing techniques. 4.Arterial blood gases indicate a pH of 7.4, Po2 of 80 mm Hg, and Pco2 of 40 mm Hg.

4.Arterial blood gases indicate a pH of 7.4, Po2 of 80 mm Hg, and Pco2 of 40 mm Hg.

A client who is experiencing severe respiratory acidosis has a potassium level of 6.2 mEq/L. The nurse determines this result is best characterized by which interpretation? 1.Expected and indicates the result of massive hemolysis 2.Unexpected and indicates a concurrent history of renal insufficiency 3.Unexpected and indicates a deficit of hydrogen ions in the bloodstream 4.Expected and indicates that acidosis has driven hydrogen ions into the cell, forcing potassium out

4.Expected and indicates that acidosis has driven hydrogen ions into the cell, forcing potassium out

A client is admitted to the hospital with acute exacerbation of chronic obstructive pulmonary disease (COPD). Which arterial blood gas supports this diagnosis? 1.Po2 of 68 mm Hg and Pco2 of 40 mm Hg 2.Po2 of 55 mm Hg and Pco2 of 40 mm Hg 3.Po2 of 70 mm Hg and Pco2 of 50 mm Hg 4.Po2 of 60 mm Hg and Pco2 of 50 mm Hg

4.Po2 of 60 mm Hg and Pco2 of 50 mm Hg

The nurse is instructing a client about pursed lip breathing, and the client asks the nurse about its purpose. The nurse should tell the client that the primary purpose of pursed lip breathing is which? 1.Promote oxygen intake 2.Strengthen the diaphragm 3.Strengthen the intercostal muscles 4.Promote carbon dioxide elimination

4.Promote carbon dioxide elimination

While assessing a client who is admitted to the hospital with a diagnosis of pleurisy, the nurse would note which characteristic symptom of this disorder? 1.Early morning fatigue 2.Dyspnea that is relieved by lying flat 3.Pain that worsens when the breath is held 4.Knifelike pain that worsens on inspiration

4.Knifelike pain that worsens on inspiration

The nurse is providing endotracheal suctioning to a client who is mechanically ventilated when the client becomes restless and tachycardic. Which action should the nurse take? 1.Call the primary health care provider. 2.Contact the respiratory department to suction the client. 3.Hyperoxygenate and hyperventilate the client with an Ambu bag and resuction. 4.Monitor vital signs and discontinue attempts at suctioning until the client is stabilized.

4.Monitor vital signs and discontinue attempts at suctioning until the client is stabilized.

The nurse is monitoring a client for Biot's respirations. Which condition causes Biot's respirations? 1.Emphysema 2.Renal failure 3.Severe anxiety 4.Neurological disorders

4.Neurological disorders

The nurse is assigned to care for a client who has a chest tube. The nurse is told to monitor the client for crepitus (subcutaneous emphysema). Which method should be used to monitor the client for crepitus? 1.Auscultating the posterior breath sounds 2.Asking the client about pain upon inspiration 3.Placing the hands over the rib area and observing expansion 4.Palpating the skin around the chest and neck for a crackling sensation

4.Palpating the skin around the chest and neck for a crackling sensation

A primary health care provider is about to remove a chest tube from a client. Once the dressing is removed and the sutures have been cut, the nurse assisting the primary health care provider asks the client to do which action? 1.Exhale immediately. 2.Breathe in and out rapidly. 3.Breathe deeply and rapidly. 4.Perform the Valsalva maneuver.

4.Perform the Valsalva maneuver.

The primary health care provider has prescribed amantadine for a client admitted to the hospital for hip replacement surgery. The nurse recognizes that this medication was prescribed because the client's history showed recent exposure to which? 1.Bronchitis 2.Pneumonia 3.Tuberculosis 4.Type A influenza

4.Type A influenza

A client has a chest tube that is attached to a chest drainage system. The chest tube becomes disconnected. What should the nurse do immediately? 1.Assess lung sounds. 2.Clamp tube above open end. 3.Put gloved thumb over open end. 4.Put open end under sterile water.

4.Put open end under sterile water.

A client with a respiratory disorder has anorexia secondary to fatigue and dyspnea while eating. The nurse determines that the client has followed the recommendations to improve intake if which action is taken? 1.The client selects foods that are very dry. 2.The client increases the use of milk products. 3.The client increases the use of stimulants such as caffeine. 4.The client plans to eat the largest meal of the day at a time when hungry.

4.The client plans to eat the largest meal of the day at a time when hungry.

A postoperative client is using an incentive spirometer. The nurse observes the client inhale slowly with the mouthpiece placed between the teeth with the lips closed. The client inhales to the preset inspiratory goal and holds the breath for about 3 seconds, then exhales slowly. The client takes one breath and returns the incentive spirometer to the bedside. Based on this observation, which interpretation should the nurse make? 1.The client should be inhaling and exhaling quickly. 2.The client is using the incentive spirometer correctly. 3.The client should not be holding the breath following inhalation. 4.The client should be repeating the sequence 10 to 20 times in each session.

4.The client should be repeating the sequence 10 to 20 times in each session.

The nurse is assisting in admitting a client who is suspected of having tuberculosis (TB) to the nursing unit. The nurse plans to admit the client to which type of room? 1.Venting through single filters and ultraviolet light 2.Natural lighting with three air exchanges per hour 3.One air exchange per hour and venting to the outside 4.Venting to the outside, six air exchanges per hour, and ultraviolet light

4.Venting to the outside, six air exchanges per hour, and ultraviolet light

The nurse is assisting a primary health care provider with the insertion of an endotracheal tube (ETT). The nurse should plan which as a final measure to determine correct tube placement? 1.Hyperoxygenate the client. 2.Tape the tube securely in place. 3.Listen for bilateral breath sounds. 4.Verify placement by a chest x-ray.

4.Verify placement by a chest x-ray.

The nurse is preparing a list of homecare instructions for the client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse reinforce? Select all that apply. 1.Activities should be resumed gradually. 2.Avoid contact with other individuals except family members for at least 6 months. 3.A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. 4.Respiratory isolation is not necessary because family members have already been exposed. 5.Cover the mouth and nose when coughing or sneezing and confine used tissues to plastic bags. 6.When one sputum culture is negative, the client is no longer considered infectious and can usually return to his or her former employment.

1.Activities should be resumed gradually. 3.A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. 4.Respiratory isolation is not necessary because family members have already been exposed. 5.Cover the mouth and nose when coughing or sneezing and confine used tissues to plastic bags.

The nurse is preparing to assist a primary health care provider with the insertion of a chest tube. The nurse anticipates that which supplies will be required for the chest tube insertion site? Select all that apply. 1.Elastoplast tape 2.Sterile Kerlix dressing 3.Sterile 4 × 4 gauze pads 4.Povidone-iodine solution 5.Petrolatum (Vaseline) gauze

1.Elastoplast tape 3.Sterile 4 × 4 gauze pads 4.Povidone-iodine solution 5.Petrolatum (Vaseline) gauze

The nurse is providing endotracheal suctioning to a client who is mechanically ventilated when the client becomes restless and tachycardic. Which actions should the nurse take? Select all that apply. 1.Notify the RN. 2.Notify the Rapid Response Team. 3.Finish the suctioning as quickly as possible. 4.Discontinue suctioning until the client is stabilized. 5.Contact the respiratory department to suction the client.

1.Notify the RN. 4.Discontinue suctioning until the client is stabilized.

The client is diagnosed with pleurisy. The nurse should expect to see which signs and symptoms? Select all that apply. 1.Pleural friction rub 2.Sharp, knife-like pain 3.Cyanosis of lips and nailbeds 4.Pain that occurs on both sides of the chest 5.Pain that occurs most often during inspiration

1.Pleural friction rub 2.Sharp, knife-like pain 5.Pain that occurs most often during inspiration

he client is diagnosed with pleurisy. The nurse should expect to see which signs and symptoms? Select all that apply. 1.Pleural friction rub 2.Sharp, knife-like pain 3.Cyanosis of lips and nailbeds 4.Pain that occurs on both sides of the chest 5.Pain that occurs most often during inspiration

1.Pleural friction rub 2.Sharp, knife-like pain 5.Pain that occurs most often during inspiration

The nurse is assigned to assist in caring for a client diagnosed with a pneumothorax who has a chest tube connected to a closed-chest drainage system. The client asks the nurse why a chest tube was inserted. Which response by the nurse explains the purpose of a chest tube? 1."To help lessen any discomfort." 2."To allow for reexpansion of the lung." 3."It will help prevent any lung infections." 4."To prevent further damage to the lung."

2."To allow for reexpansion of the lung."

The nurse determines that which client is at greatest risk for development of acute respiratory distress syndrome (ARDS)? 1.A client with blunt chest trauma 2.A client with pancreatitis and gram-negative sepsis 3.A client who has received 1 unit of packed red blood cells 4.A client with acute pulmonary edema after myocardial infarction

2.A client with pancreatitis and gram-negative sepsis

The nurse is assessing a client diagnosed with sinusitis. Which are signs and symptoms of sinusitis? Select all that apply. 1.A high fever 2.Nuchal rigidity 3.Headache, especially in the morning 4.Elevated white blood cell (WBC) count 5.Feeling of heaviness over affected areas

3.Headache, especially in the morning 4.Elevated white blood cell (WBC) count 5.Feeling of heaviness over affected areas

A client is admitted to the hospital with a diagnosis of carbon dioxide narcosis. In addition to respiratory failure, the nurse plans to monitor the client for which complication of this disorder? 1.Paralytic ileus 2.Hypernatremia 3.Hyperglycemia 4.Increased intracranial pressure

4.Increased intracranial pressure

The nurse is assessing a client with multiple traumas who is at risk for developing acute respiratory distress syndrome (ARDS). The nurse should assess for which earliest sign of acute respiratory distress syndrome? 1.Diffuse crackles 2.Bilateral wheezing 3.Intercostal retractions 4.Increased respiratory rate

4.Increased respiratory rate

The nurse is assisting in caring for a client with pneumonia who suddenly becomes restless. Arterial blood gases are drawn, and the results reveal a Pao2 of 60 mm Hg. The nurse reviews the plan of care for the client and determines that which priority problem potentially exists for this client? 1.Fatigue 2.Aspiration 3.Airway obstruction 4.Ineffective gas exchange

4.Ineffective gas exchange

The nurse is checking the chest tube drainage system of a postoperative client who had a right upper lobectomy. The closed drainage system has 300 mL of bloody drainage, and the nurse notes intermittent bubbling in the water-seal chamber. One hour following the initial data collection, the nurse notes that the bubbling in the water-seal chamber is now constant, and the client appears dyspneic. Based on these findings, which action should the nurse do first? 1.Check the client's vital signs. 2.Note the amount of drainage. 3.Check the client's lung sounds. 4.Inspect chest tube connections.

4.Inspect chest tube connections.

A client being discharged from the hospital to home with a diagnosis of tuberculosis is worried about the possibility of infecting family members and others. Which information should reassure the client that contaminating family members and others is not likely? 1.The family does not need therapy, and the client will not be contagious after 1 month of medication therapy. 2.The family does not need therapy, and the client will not be contagious after 6 consecutive weeks of medication therapy. 3.The family will receive prophylactic therapy, and the client will not be contagious after 1 continuous week of medication therapy. 4.The family will receive prophylactic therapy, and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy.

4.The family will receive prophylactic therapy, and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy.

The nurse is working in a tuberculosis (TB) screening clinic. The nurse understands that which population is at highest risk for TB? 1.Residents of a long-term care facility 2.Persons admitted to the hospital for day surgery 3.A family who has recently emigrated from Australia 4.Children older than 6 years of age in a summer school program

1.Residents of a long-term care facility

The nurse is performing nasopharyngeal suctioning on a client and suddenly notes the presence of bloody secretions. Which action should the nurse implement? 1.Continue suctioning to remove the blood. 2.Check the amount of suction pressure being applied. 3.Encourage the client to cough out the bloody secretions. 4.Remove the suction catheter from the nose and begin vigorous suctioning through the mouth.

2.Check the amount of suction pressure being applied.

The nurse is caring for several clients with respiratory disorders. Which client is at least risk for developing a tuberculosis infection? 1.An uninsured man who is homeless 2.A woman newly immigrated from Korea 3.A man who is an inspector for the U.S. Postal Service 4.An older woman admitted from a long-term care facility

3.A man who is an inspector for the U.S. Postal Service

The nurse is caring for an older client who is on bed rest. The nurse plans which intervention to prevent respiratory complications? 1.Decreasing oral fluid intake 2.Monitoring the vital signs every shift 3.Changing the client's position every 2 hours 4.Instructing the client to bear down every hour and to hold his or her breath

3.Changing the client's position every 2 hours