Respiratory system level 3

After surgery for cancer of the posterior pharynx, a client is receiving gavage feedings through a nasogastric tube. A family member asks why this is necessary. What is the nurse's best response?

"Tube feedings promote healing by reducing the risk for infection."

On the first day after a right pneumonectomy, a client suddenly sits straight up in bed exhibiting respirations that are labored and accompanied by a crowing sound. The client's skin is pale, cool, and moist. What should the nurse do immediately?

Auscultate the left lung.

A client has a pneumothorax, and a closed-chest drainage system is inserted to allow the lung to reinflate. Identify the chamber in the figure below that provides the water seal.

C

The nurse is caring for a client who had a wedge resection of a lobe of the lung and now has a chest tube with a three-chamber underwater drainage system in place. The nurse considers that the main purpose of the third chamber of the underwater drainage system is to:

Control the amount of suction

While walking in a hallway, a client with a chest tube becomes confused and pulls the chest tube out. What is the nurse's immediate action?

Cover the opening with the cleanest material available

A client is admitted with a tentative diagnosis of pneumonia. On admission the client is not in respiratory distress, but later develops chest pain and a fever of 103° F. A productive cough produces rust-colored sputum. The nurse concludes that these signs indicate the:

Expected course of pneumonia

A client just had a thoracentesis. For which response is it most important for the nurse to observe the client?

Expectoration of blood

After the removal of a cast from a fractured arm, an 82-year-old client is to receive physical therapy. In an older adult, mild exercise is expected to cause respirations to:

Increase to 24 breaths per minute

The respiratory status of a client with Guillain-Barré syndrome progressively deteriorates and a tracheostomy is performed. Nasogastric tube feedings are prescribed. The nurse should manage the tracheostomy cuff by:

Inflating the cuff before the feeding and for 30 minutes after each feeding

Several days after a client had a total laryngectomy, the health care provider prescribes a progressive diet as tolerated. What should the nurse do?

Keep suction apparatus readily available in case excessive respiratory secretions occur

A client has a bronchoscopy in the ambulatory surgery unit. What action should the nurse take to prevent laryngeal edema?

Keep the client in the semi-Fowler position.

What information should the nurse include in a discharge teaching plan for a client who recently had a laryngectomy?

Keep the stoma covered with a scarf.

A client is brought to the emergency department with deep partial-thickness burns on the face and full-thickness burns on the neck, entire anterior chest, and one arm. To assess for heat inhalation, the nurse first should observe for:

Nasal discharge containing carbon particles

Two portable drainage catheters with hemovacs attached were placed during a client's hemiglossectomy and right radical neck dissection. Six hours after the catheters were placed, the nurse empties 180 mL of serosanguineous drainage from one of the drainage catheters. The priority nursing intervention is to:

Notify the health care provider immediately

A client who was involved in a motor vehicle collision sustained multiple internal injuries, and thoracic surgery was performed. After surgery the client has two chest tubes attached to closed chest drainage systems. Place an X on the image on the right where the nurse should palpate to identify where the complication of subcutaneous emphysema most likely may occur.

Nurse should palpate the area around a chest tube insertion site

An important nursing intervention that ensures adequate ventilatory exchange after surgery is:

Positioning the client laterally with the neck extended

A nurse assesses that several clients have low oxygen saturation levels. Which client would benefit the most from receiving oxygen via a nasal cannula?

Receives many visitors while sitting in a chair

A client has a laryngectomy and radical neck dissection for cancer of the larynx. Two tubes from the area of the incision are connected to portable wound drainage systems. Inspection of the neck reveals moderate edema even though the drainage systems are functioning. For which clinical indicator should the nurse assess the client?

Restlessness

A nurse is teaching breathing exercises to a client with emphysema. What is the reason the nurse should include in the teaching as to why these exercises are necessary to promote effective use of the diaphragm?

The residual capacity of the lungs has been increased.

While receiving an adrenergic beta2 agonist drug for asthma, the client complains of palpitations, chest pain, and a throbbing headache. What is the most appropriate nursing action?

Withhold the drug until additional prescriptions are obtained.

A nurse is caring for a client with a pneumothorax who has a chest tube in place. What should the nurse do when caring for this client?

Encourage range of motion to the client's arm on the affected side.

A client with chronic obstructive pulmonary disease has a blood pressure of 90/60, a weak pulse, and anxiety. The nurse should place the client in which position?

Head of the bed elevated about 10 degrees

The nurse provides teaching to a client who will begin to receive tube feedings after a total laryngectomy. The nurse concludes that the teaching was understood when the client states, "I will need tube feedings until:

Healing of the incision is complete."

A client is admitted to the hospital for cancer of the larynx, and a laryngectomy is scheduled. What should the nurse include in the postoperative teaching plan?

Importance of cleanliness around the site of the stoma

A client is admitted to the oncology unit with a diagnosis of Hodgkin disease. After reviewing diagnostic test results, the primary health care provider determined that a splenectomy is needed. A complication specifically related to this surgical procedure for which the nurse should monitor the client is:

Inadequate lung aeration

After emergency surgery, the nurse teaches a client how to use an incentive spirometer. What client behavior indicates to the nurse that the spirometer is being used correctly?

Inhales deeply through the mouthpiece, relaxes, and then exhales.

What area of the body would you expect to hear this sound?

Larynx

A client who is admitted with emphysema has a Paco2 of 60. To address the abnormal arterial blood gas value, the nurse expects to receive a prescription for:

Mechanical ventilation

The nurse is caring for a client who is postoperative day 2 open of a cholecystectomy and notes the presence of bibasilar crackles. The nurse suspects atelectasis. Which nursing actions would be appropriate for this client? Select all that apply.

Perform frequent breath sounds assessment. Encourage turning, coughing, and deep breathing exercises.

A skier skied off the marked trail into the woods and collided with a tree. After several hours, the skier was found by the ski patrol and brought to the emergency department of the hospital. Moderate hypothermia (temperature range 87° to 90° F) is diagnosed. What clinical findings specific to moderate hypothermia should the nurse expect the client to exhibit?

Rigidity and slowed respiratory rate

A client with a long history of asthma is scheduled for surgery. What information should be included in preoperative teaching?

There is an increased risk of respiratory tract infections.

A client is on a ventilator. A nurse asks another nurse, "What should be done when condensation resulting from humidity collects in the ventilator tubing?" What is the nurse's best response?

"Empty the fluid from the tubing."

A client has a hysterectomy, salpingoophorectomy, tumor removal, and multiple abdominal biopsies for ovarian cancer. For which clinical manifestations should the nurse assess the client that indicates that the client may be experiencing a pulmonary embolus? Select all that apply.

1. Decreased oxygen saturation level 2. Sudden onset of shortness of breath

A nurse administers oxygen at 2 L/min via nasal cannula to a client with emphysema. For which clinical indicators should the nurse closely observe the client? Select all that apply.

1. Drowsiness 2. Mental confusion

The nurse is caring for a client who recently returned from another country who exhibits signs and symptoms suspicious of severe acute respiratory syndrome (SARS). Which clinical manifestations support this diagnosis? Select all that apply.

1. Dry cough 2. Shortness of breath 3. Fever greater than 100.4° F

A nurse is caring for several postoperative clients. For what clinical manifestations of a pulmonary embolus should the nurse monitor these clients? Select all that apply.

1. Dyspnea 2. Hemoptysis 3. Feeling of impending doom

A nurse is caring for a client with a Venturi mask who is receiving 40% oxygen. What nursing actions are indicated? Select all that apply.

1. Prevent the client's blanket from covering the adaptor's orifices. 2. Check that the appropriate adaptor to deliver the prescribed FiO2 is attached to the mask.

A client is admitted to the hospital with a tentative diagnosis of pneumonia. The client has a high fever and is short of breath. Bed rest, oxygen via nasal cannula, an intravenous antibiotic, and blood and sputum specimens for culture and sensitivity (C&S) are prescribed. Place these interventions in the order in which they should be implemented.

Bed rest Oxygen via nasal cannula Specimens for C&S Administration of an antibiotic

The nurse reviews teaching with a client with cancer of the larynx who is scheduled for a total laryngectomy and radical neck dissection. The nurse concludes that the teaching is effective when the client states, "After surgery, I will still be able to:

Chew and swallow food"

A client reports having a bad cold and chest pain that worsens when the client takes deep breaths. Where should the nurse place the stethoscope to determine the presence of a pleural friction rub? Choose the appropriate location marked on the image.

D

A health care provider prescribes oxygen therapy via nasal cannula at 2 L/min for an older, confused client with heart failure. Which nursing action is the priority?

Determining whether the client is agitated

A client sustains fractured ribs as a result of a motor vehicle collision. Which clinical indicator identified by the nurse suggests the client may be experiencing a complication of fractured ribs?

Diminished breath sounds on the affected side

When assessing a client's arterial blood gases the nurse identifies that the client is in compensated respiratory acidosis when the pH value is 7.34 and the:

HCO3 value is 50 mEq/L

After a lateral crushing chest injury, obvious right-sided paradoxical motion of a client's chest demonstrates multiple rib fractures, resulting in a flail chest. For which complication, associated with this injury, should the nurse assess this client?

Mediastinal shift

The nurse is caring for a client that has a tracheostomy tube with a high-volume, low-pressure cuff. The cuff prevents:

Mucosal necrosis

A client is admitted to the hospital with a diagnosis of cancer of the larynx, and a laryngectomy is scheduled. What is the most important piece of equipment that the nurse should place at the client's bedside postoperatively?

Suction equipment

After removal of the larynx because of cancer, a client is using a pad and pencil to communicate. The client becomes frustrated and writes, "When can I learn how to speak again?" What is the nurse's best response?

"I can have someone from the Laryngectomy Club come to speak with you."

A client begins to have difficulty breathing 30 minutes after the insertion of a subclavian central line. What should a nurse do first?

Raise the head of the bed.

Three weeks after having a laryngectomy a client asks about what to do if the laryngectomy tube becomes dislodged. An appropriate nursing response is to instruct the client to:

Reinsert another tube as soon as possible

What clinical indicators should the nurse expect to identify when assessing an individual with a spontaneous pneumothorax? Select all that apply.

Shortness of breath Unilateral chest pain

A client with emphysema has a history of smoking two packs of cigarettes a day. What is the best approach for the nurse to help the client stop smoking?

Suggest that the client limit smoking to one pack of cigarettes a day

The nurse is providing postoperative care to a client who had a right pneumonectomy. To promote ventilation, the nurse should place the client in what position?

Supine or right side-lying position

Oxygen therapy is prescribed for a client being cared for in the coronary care unit. The nurse determines that the primary reason safety precautions should be implemented in the room is because oxygen:

Supports combustion

A client with an acute emphysemic episode is dyspneic and anxious. To decrease the dyspnea, the nurse's first action is to:

Teach the client to do rhythmic breathing

A client that is a heavy smoker has been prescribed a high-calorie, high-protein diet. The nurse should encourage the client to eat foods that are high in:

Vitamin C

While auscultating breath sounds, the nurse hears this adventitious noise. Identify the lung sound

rales

A client diagnosed with asthma has received a prescription for an inhaler. The nurse teaches the client how to determine when the inhaler is empty, instructing the client to:

Count the number of doses taken

A client who had a total laryngectomy is using a pad and pencil to communicate. The client becomes frustrated and writes, "When can I learn how to speak again?" What is the best response by the nurse?

"Perhaps I can have someone from the Laryngectomy Club come speak with you."

A nurse is caring for a female client who is receiving rifampin (Rifadin) for tuberculosis. Which statements indicate that the client understands the teaching about rifampin? Select all that apply.

1. "This drug may be hard on my liver so I must avoid alcoholic drinks while taking it." 2. This drug may reduce the effectiveness of the oral contraceptive I am taking." 3. My health care provider must be called immediately if my eyes and skin become yellow."

When helping a client with emphysema, the nurse employs several steps to teach pursed-lip breathing. Place these steps of the process in the correct sequence.

1. Assume a sitting position with shoulders back. 2. Take a deep, slow inspiration of air. 3. Purse lips as if to blow a whistle. 4. Blow air through pursed lips for a time equal to inhalation. 5. Have client give a return demonstration without prompting by the nurse.

A nurse is suctioning a client's tracheostomy. Place the nursing actions in order of priority when performing this procedure.

1. Auscultate the lungs and check the heart rate 2. Turn suction on to between 80 and 120 mm Hg pressure 3. Hyperoxygenate using 100% oxygen 4. Don sterile gloves 5. Guide the catheter into the tracheostomy tube using a sterile gloved hand

What interventions should the nurse anticipate will be prescribed for a client who has a leak of the thoracic duct following radical neck surgery? Select all that apply.

1. Bed rest to conserve energy 2. Chest tube to drain the fluid 3. Total parenteral nutrition (TPN) to boost immune defenses

After surgery, a client is extubated in the postanesthesia care unit. Which clinical manifestations should the nurse expect if the client is experiencing acute respiratory distress? Select all that apply.

1. Confusion 2. Tachycardia

A nurse is teaching a preoperative client about postoperative breathing exercises. What information should the nurse include? Select all that apply.

1. Place a hand on the abdomen while feeling it rise 2. Hold the breath for several seconds at the height of inspiration

A healthcare provider prescribes a medication to be administered via a metered dose inhaler (MDI) for a young adult with asthma. List in order the steps the nurse teaches the client to follow when using the inhaler.

1. Shake the inhaler for 30 seconds 2. Exhale slowly and deeply to empty the air from the lungs 3. Hold the inhaler upright in the mouth 4. Start breathing in and press down on the inhaler once

In the first 2 ½ hours after a radical neck dissection, 40 mL of medium red, bloody fluid is obtained from the client's drainage system. What should the nurse do? Select all that apply.

1. Take vital signs. 2. Notify the health care provider.

The nurse evaluates that further teaching is necessary when a client who has had thoracic surgery performs postthoracotomy exercises by:

Extending the arm and bringing it up to touch the nose with a finger

After a bronchoscopy because of suspected cancer of the lung, a client develops pleural effusion. What should the nurse conclude is the most likely cause of the pleural effusion?

Extension of cancerous lesions

A client with pulmonary tuberculosis is being treated in the home. What should the nurse teach the client to help control the spread of microorganisms?

Open the windows slightly throughout the house.

In which positions should the nurse place a client who has just had a right pneumonectomy?

Supine or right side-lying

A client with oat-cell lung cancer is scheduled for a mediastinoscopy and biopsy. What should the nurse include in the client's education?

The procedure is an endoscopic examination of lymph nodes

Following a laryngectomy a client experiences frequent coughing episodes and copious production of secretions. The nurse explains that the client's responses are related to:

The reaction of the mucous membranes to air that is dry and cool

A client has a tracheostomy tube attached to a tracheostomy collar for the delivery of humidified oxygen. The nurse identifies that the client will need suctioning primarily because the:

Tracheostomy tube interferes with effective coughing

The nurse understands that clients with emphysema experience which pathophysiological change in the lungs? Alveolar sacs:

ecome over distended.

The nurse is performing a physical assessment of a newly admitted client. Identify the area of the chest on the illustration that produces resonance when percussed.

B

A nurse is caring for a client with a chest tube. How will complete lung expansion be determined before removal of the chest tube?

Comparison of chest radiographs

A client has chronic asthma. For which complication should the nurse monitor this client?

Atelectasis

A client is admitted to the emergency department with dyspnea, a productive cough, and fever. The health care provider suspects pneumonia and writes prescriptions. Place the nursing actions in the order they should be performed.

1. Elevate the head of the bed. 2. Insert a catheter to establish venous access 3. Obtain a sputum culture. 4. Administer the prescribed intravenous piggyback antibiotic. 5. Review the results of the sensitivity test.

During a client's routine physical examination, a chest x-ray film reveals a lesion in the right upper lobe. What information in the client's history supports the health care provider's diagnosis of pulmonary tuberculosis? Select all that apply.

1. Fever 2. Night sweats 3. Blood-tinged sputum

A client is admitted to the hospital with a diagnosis of restrictive airway disease. The nurse expects the client to exhibit which early signs of respiratory acidosis? Select all that apply.

1. Headache 2. Irritability 3. Restlessness

The nurse should refer a client to the pulmonary clinic for suspected tuberculosis based on which clinical indicators reported during the initial client interview? Select all that apply.

1. Hemoptysis 2. Night sweats

A nurse is administering intravenous aminophylline to a client with asthma. Which clinical findings support the conclusion that the client is experiencing an adverse reaction to aminophylline? Select all that apply.

1. Hypotension 2. Cardiac dysrhythmia 3. Muscle hyperactivity

There is a fire on an inpatient unit at the hospital. List the actions the nurse should take in the order in which they should be performed.(no)

1. Move clients and others away from the immediate vicinity of the fire. 2. Initiate the fire code alarm system. 3. Close the doors to the rooms on the unit. 4. Evacuate clients and others to a safe area off the unit with the fire. 5. Inform the clients' families that a fire is occurring.

A client is admitted to the hospital with a diagnosis of pneumonia. List the following nursing actions in the order they should be accomplished.

1. Obtain data about the client's history and physical status. 2. Insert an intravenous (IV) catheter to establish venous access. 3. Collect a sputum sample for culture and sensitivity. 4. Administer prescribed antibiotic intravenous piggyback. 5. Check peak and trough levels of the antibiotic

A client has an endotracheal tube and is receiving mechanical ventilation. The nurse identifies that periodic suctioning may be necessary. The nurse follows a specific protocol when performing this procedure. Place the steps in the order that they should be performed.

1. Obtain the vital signs. 2. Auscultate lung sounds. 3. Hyperoxygenate for 30 seconds. 4. Suction for approximately 10 seconds 5. Rotate the catheter during its withdrawal.

The nurse is teaching a client who has asthma about using a peak flow meter. Which statement by the client reflects a correct understanding of the use of a peak flow meter? Select all that apply.

1. Readings in the green zone mean that my asthma is under control." 2. "If I get a reading in the red zone, then I need to take my reliever drug and have my wife take me to the hospital." 3. "I should check the peak flow readings at least twice a day."

A nurse witnesses a client collapse during a home care visit. Place the basic life support actions in the order they should be performed by the nurse.

1. Use physical and auditory stimulation to attempt to elicit a response. 2. Direct the client's spouse to call the emergency management system 3. Listen and observe for spontaneous breaths 4. Palpate to determine the presence of a carotid pulse 5. Perform 30 chest compressions. 6. Open the airway with the head tilt-chin lift method and give two breaths.

The nurse is caring for a client who has a peripherally inserted central catheter (PICC). The client notifies the nurse that the catheter got tangled up in his bed clothes and part of it has broken off. What should the nurse do first?

Assess respiratory status

A nurse is caring for a client in postoperative recovery who just had a central venous catheter inserted. The client begins to complain of chest pain. Upon further assessment, the nurse notes that the client has decreased breath sounds on the affected side. Which action should the nurse do first?

Administer oxygen as prescribed.

A client is diagnosed with cancer of the larynx and is scheduled for a total laryngectomy. What should the nurse include in the preoperative teaching plan?

Allowing the client an opportunity to ask questions

What technique should a nurse use when cleaning a tracheostomy tube that has a nondisposable inner cannula?

Apply a precut dressing around the insertion site with the flaps pointing upward

A client with a puncture wound of the chest wall is brought to the emergency department. What should be the nurse's first action?

Apply a wound dressing.

The nurse assesses a client with emphysema. The nurse expects to find which sign of chronic obstructive pulmonary disease (COPD)?

Decreased breath sounds

When a client suffers a complete pneumothorax, there is danger of a mediastinal shift. If such a shift occurs, what potential effect is a cause for concern?

Decreased filling of the right heart

A client develops subcutaneous emphysema after a chest injury with suspected pneumothorax. What assessment by the nurse is the best method for detecting this complication?

Palpating the neck or face.

A client had thoracic surgery. The nurse should monitor for what clinical manifestations that may indicate acute pulmonary edema? Select all that apply.

1. Crackles 2. Cyanosis 3. Frothy sputum

A client with obstructive airway disease reports to the nurse about experiencing spasms of coughing. What suggestion should the nurse provide to help the client successfully manage this problem?

Postpone the planned vacation to go skiing.

Why is it important for the nurse to teach a caregiver how to monitor the oxygen saturation level of a relative who will receive home ventilator therapy?

Potential problems can be identified and acted on before serious consequences occur.

The nurse plans interventions for a client with smoke inhalation based on a negative chest x-ray and arterial blood gases that show a Po2 of 85 mm Hg, a PCO2 of 45 mm Hg, and a pH of 7.35. Which interventions should the nurse anticipate will be prescribed? Select all that apply.

1. Coughing 2. Deep breathing 3. Humidified oxygen

What clinical indicators should a nurse expect to identify in a client with acute respiratory distress syndrome (ARDS)? Select all that apply.

1. Crackles 2. Atelectasis 3. Hypoxemia 4. Severe dyspnea

On the first day after a right pneumonectomy, a client suddenly sits straight up in bed. The client's respirations are labored, and a crowing sound is audible. The client's skin is pale, cool, and moist. The priority nursing intervention is:

Auscultate the left lung

To begin the administration of total parental nutrition (TPN), a client has a right subclavian central venous access device inserted. Immediately after insertion of the catheter, the priority nursing action is to:

Auscultate the lungs to evaluate breath sounds

A client's respiratory status may be affected after abdominal surgery. The nurse documents the behavioral objective for this client. What statement is a behavioral objective?

Demonstrates the technique of coughing and deep breathing.

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). During assessment, the nurse expects to auscultate:

Diminished breath sounds

During the infusion of dialysate during peritoneal dialysis, the client exhibits symptoms of severe respiratory difficulty. The nurse should:

Drain the fluid from the client's peritoneal cavity

A client is admitted for an exacerbation of emphysema. The client has a fever, chills, and difficulty breathing on exertion. What is the priority nursing action based on the client's history and present status?

Encouraging increased fluid intake

A nurse is involved in an international committee to address global health problems. What suggestion is most appropriate for the nurse to make to best meet the challenge associated with a potential emerging influenza pandemic?

Establish a global surveillance plan.

A client develops increased respiratory secretions because of radiation therapy to the lung, and the health care provider prescribes postural drainage. What client assessment leads the nurse to determine that the postural drainage is effective?

Has a productive cough

When assessing the breath sounds of a client with chronic obstructive pulmonary disease (COPD), the nurse hears coarse rhonchi. They are described best as:

Moist rumbling sounds that clear after coughing

A nurse is teaching a community health class about the risk factors for cancer. Which factor has the least influence in predisposing an individual to cancer of the larynx?

Inadequate dental hygiene

The nurse provides instructions about how to use a nebulizer to a client with chronic obstructive pulmonary disease (COPD). The nurse concludes that additional teaching is needed when the client:

Inhales with the lips tightly sealed around the mouthpiece of the nebulizer

A client on bed rest develops bronchitis and atelectasis of the right lower lobe. The nurse provides teaching about the treatment plan and explains that the recommended client position is:

Lying on the left side to promote drainage

A client who sustained chest trauma in an accident has bilateral chest tubes inserted. What is the nurse's primary responsibility when caring for this client?

Maintaining a closed system

A nurse is caring for a client with severe dyspnea who is receiving oxygen via a Venturi mask. What should the nurse do when caring for this client?

Monitor oxygen saturation levels when eating.

A nurse is caring for a client who is receiving mechanical ventilation via an endotracheal tube with a high-volume, low-pressure cuff. What problem is prevented when the nurse uses a high-volume, low-pressure cuff?

Mucosal necrosis

The nurse is providing postoperative care for an obese adult that had major abdominal surgery. The client has a history of smoking three packs of cigarettes daily. The laboratory test that is the most accurate measurement of the client's respiratory status is:

Oxygen saturation

A client with terminal cancer signs a do-not-resuscitate (DNR) order upon admission to the hospital. When the client goes into respiratory arrest a week later, the client is not resuscitated. Which factor does the nurse determine is most relevant to the legal aspects of a DNR order?

Policies of the agency establish the status of DNR orders

A client who has emphysema for many years develops an enlarged liver. The nurse concludes that the enlarged liver is a result of:

Portal hypertension

Clients are encouraged to perform deep-breathing exercises after most types of surgery. The nurse teaches clients that the reason for these exercises is to help:

Prevent the buildup of carbon dioxide in the body

A client is scheduled for coronary artery bypass surgery. The nurse explains to the client that chest tubes will be inserted during surgery to:

Reestablish negative intrapleural pressure

A nurse works with a large population of immigrant clients and is concerned about the debilitating effects of influenza. Which action is the first line of defense against an emerging influenza pandemic?

Reporting surveillance findings to appropriate public health officials

The nurse is providing postoperative care to a client that had a pneumonectomy. The nurse should monitor the client closely for what specific complication that is associated with this type of surgical procedure?

Signs of cardiac overload

The nurse is caring for clients in the operating room. What physiologic function should the nurse consider that clients lose last during the induction of general anesthesia?

Respirations

A client is admitted to the emergency department with multiple injuries, including fractured ribs. The nurse should assess for signs of:

Respiratory acidosis

A client is receiving oxycodone (OxyContin) postoperatively for pain. The health care provider's prescription indicates that the dose should be administered every three hours for eight doses. What should the nurse assess before administering each dose of oxycodone

Respiratory rate and level of consciousness

A client with human immunodeficiency virus (HIV)-associated Pneumocystis jiroveci pneumonia is to receive pentamidine (Pentam) intravenously (IV) once daily. What should the nurse do to ensure client safety? Select all that apply.

Tell the client to report any evidence of bleeding immediately. Assess blood glucose levels daily and several times after therapy is completed.

A client sustains a crushing injury to the lower left leg, and a below-the-knee amputation is performed. For which common clinical manifestations of a pulmonary embolus should the nurse assess this client? Select all that apply.

Unilateral chest pain Acute onset of dyspnea

A client with chronic obstructive pulmonary disease (COPD) reports chest congestion, especially upon wakening in the morning. The nurse should suggest that the client:

Use a humidifier in the bedroom