Respiratory System

The nurse is caring for a patient in the emergency department for epistaxis. What information should the nurse include in patient discharge teaching as a way to prevent epistaxis? Avoid picking the nose. Keep nasal passages clear. Use a dehumidifier. Use a tissue when blowing the nose.

Avoid picking the nose.

A client in the ICU is status post embolectomy after a pulmonary embolus. What assessment parameter should the nurse monitor most closely on a client who is postoperative following an embolectomy? Pressure in the vena cava Pulmonary arterial pressure Lung function testing White blood cell differential

Pulmonary arterial pressure

The clinical finding of pink, frothy sputum may be an indication of which condition? Bronchiectasis Pulmonary edema Lung abscess Infection

Pulmonary edema

Patient's arterial blood gas analysis reveals a pH of 7.32 and a PCO2 of 60. Which of the following imbalances do these values reveal? Metabolic alkalosis Respiratory acidosis Respiratory alkalosis Metabolic acidosis

Respiratory acidosis

The emergency department nurse is assessing a client following a motor vehicle accident. The nurse notes facial deformities with swelling and bleeding and a clear drainage coming from the nares. Which diagnostic test is completed to determine if the clear drainage is cerebrospinal fluid? Draw a serum CBC Perform a glucometer check Test fluid with a Dextrostix Test fluid with a Nitrazine paper

Test fluid with a Dextrostix

A client arrives at the physician's office stating 2 days of febrile illness, dyspnea, and cough. Upon assisting the client into a gown, the nurse notes that the client's sternum is depressed, especially on inspiration. Crackles are noted in the bases of the lung fields. Based on inspection, which will the nurse document? The client has chronic respiratory disease. The client needs a cough suppressant. The client has pneumonia in the bases. The client has a funnel chest.

The client has a funnel chest

A client who works construction and has been demolishing an older building is diagnosed with pneumoconiosis. This lung inflammation is most likely caused by exposure to: pollen. silica. coal dust. asbestos.

asbestos.

A client is recovering from a tonsillectomy in the postanesthesia care unit. After an overnight stay in the hospital due to increased secretions and vomiting, the nurse delivers client education and accompanying paperwork. Which comment indicates that the client requires additional education? "I'll gargle with weak salt water three to four times a day." "I promise I won't blow my nose." "I'll sleep on two to three pillows." "If I'm vomiting, I'll drink lemon-lime soda to keep myself hydrated."

"If I'm vomiting, I'll drink lemon-lime soda to keep myself hydrated."

What does adequate gas exchange depend on? The diffusion of gas in the shunted blood. The shunting of blood in the lungs. The perfusion/diffusion ratio. An adequate ventilation-perfusion ratio.

An adequate ventilation-perfusion ratio.

Following a chest X-ray, a patient has been diagnosed with a pleural effusion. The care team has concluded that the quantity of fluid in the patient's intrapleural space necessitates thoracentesis. What patient education should the nurse provide in anticipation of this procedure? "You can move around as normal after the procedure is finished, and I've applied a bandage over the site." "If you're unable to lie on your side, you can sit upright and support yourself on your overbed table." "It's very important that you remain still while the doctor is performing the procedure." "The doctor will ask you to cough a few times to facilitate the insertion of the needle."

"It's very important that you remain still while the doctor is performing the procedure."

A client is scheduled for endotracheal intubation prior to surgery. What can the nurse tell this client about an endotracheal tube? "The ET tube will remain in place for at least a day postsurgery." "The ET tube will be connected to a negative-pressure ventilator." "The ET tube will maintain your airway while you're under anesthesia." "The ET tube will be inserted through an opening in your trachea."

"The ET tube will maintain your airway while you're under anesthesia."

The nurse is caring for a client who has just been diagnosed with lung cancer. What is a cardinal sign of lung cancer? Pain on inspiration Shortness of breath Mucopurulent sputum Obvious trauma

Mucopurulent sputum

A client has been diagnosed with pulmonary hypertension, in which the capillaries in the alveoli are squeezed excessively. The nurse should recognize a disturbance in what aspect of normal respiratory function? Diffusion Perfusion Acid-base balance Ventilation

Perfusion

The nurse is discussing immediate postoperative communication strategies with a client scheduled for a total laryngectomy. What information will the nurse include? "A speech therapist will evaluate you and recommend a system of communication after surgery." "After surgery you will have to use an electric larynx to communicate." "After surgery you will have a sore throat, but you will be able to speak." "You can use writing or a communication board to communicate."

"You can use writing or a communication board to communicate."

Influenza, an annual epidemic in the U.S., creates a significant increase in hospitalizations and an increase in the death rates of pneumonia and cardiovascular disease. How many deaths were attributed to influenza in 2008? 200,000 73,000 36,000 148,000

36,000

You are caring for a patient who is going to have a bronchoscopy. How long do you withhold food and fluid from the patient prior to the procedure? 3 hours 5 hours 6 hours 4 hours

6 hours

A client with a respiratory condition is receiving oxygen therapy. While assessing the client's PaO2, the nurse knows that the therapy has been effective based on which of the following readings? 84 mm Hg 58 mm Hg 45 mm Hg 120 mm Hg

84 mm Hg

You are admitting a patient with a heart murmur. You note there is a depression in the lower portion of the sternum. What is this type of chest deformity called? A funnel chest A barrel chest Kyphoscoliosis A pigeon chest

A funnel chest

Which would be least likely to contribute to a case of hospital-acquired pneumonia? Host defenses are impaired. Inoculum of organisms reaches the lower respiratory tract and overwhelms the host's defenses. A nurse washes her hands before beginning client care. A highly virulent organism is present.

A nurse washes her hands before beginning client care.

The nurse is caring for a client with recurrent hemoptysis who has undergone a bronchoscopy. Immediately following the procedure, the nurse should complete which action? Ensure the client remains moderately sedated to decrease anxiety. Assess the client for a cough reflex. Offer the client ice chips. Instruct the client that bed rest must be maintained for 2 hours.

Assess the client for a cough reflex

After a tonsillectomy, a client is being prepared for discharge. The nurse should instruct the client to report which sign or symptom immediately? Difficulty swallowing Difficulty talking Bleeding Throat pain

Bleeding

After a tonsillectomy, a client is being prepared for discharge. The nurse should instruct the client to report which sign or symptom immediately? Throat pain Difficulty talking Bleeding Difficulty swallowing

Bleeding

A client is diagnosed with mild obstructive sleep apnea after having a sleep study performed. What treatment modality will be the most effective for this client? Surgery to remove the tonsils and adenoids Continuous positive airway pressure (CPAP) Medications to assist the patient with sleep at night Bi-level positive airway pressure (BiPAP)

Continuous positive airway pressure (CPAP)

Which intervention does a nurse implement for clients with empyema? Place suspected clients together Do not allow visitors with respiratory infections Encourage breathing exercises Institute droplet precautions

Encourage breathing exercises.

A client with sinus congestion complains of discomfort when the nurse is palpating the supraorbital ridges. What sinus is the client referring? Sphenoidal Maxillary Ethmoidal Frontal

Frontal

The nurse is obtaining a health history from a client on an annual physical exam. Which documentation should be brought to the physician's attention? Laryngitis following a cold Hoarseness for 2 weeks Aphonia following a football game Epistaxis, twice last week

Hoarseness for 2 weeks

The nurse is caring for a client at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the client. What is an example of a first-line measure to minimize atelectasis? Positive end-expiratory pressure (PEEP) Incentive spirometry Bronchoscopy Intermittent positive-pressure breathing (IPPB)

Incentive spirometry

What would the instructor tell the students purulent fluid indicates? Inflammation Heart failure Cancer Infection

Infection

A client diagnosed with acute respiratory distress syndrome (ARDS) is restless and has a low oxygen saturation level. If the client's condition does not improve and the oxygen saturation level continues to decrease, what procedure will the nurse expect to assist with in order to help the client breathe more easily? Intubate the client and control breathing with mechanical ventilation Schedule the client for pulmonary surgery Increase oxygen administration Administer a large dose of furosemide (Lasix) IVP stat

Intubate the client and control breathing with mechanical ventilation

A client is receiving thrombolytic therapy for the treatment of pulmonary emboli. What is the best way for the nurse to assess the client's oxygenation status at the bedside? Monitor pulse oximetry readings. Monitor incentive spirometry volumes. Perform chest auscultation. Obtain serial ABG samples.

Monitor pulse oximetry readings.

A nurse reading a chart notes that the client had a Mantoux skin test result with no induration and a 1-mm area of ecchymosis. How does the nurse interpret this result? Negative Borderline Uncertain Positive

Negative

A nurse practitioner diagnosed a patient with an infection in the maxillary sinuses. Select the area that the nurse palpated to make that diagnosis. On the cheeks below the eyes Above the eyebrows Behind the ethmoid sinuses Between the eyes and behind the nose

On the cheeks below the eyes

A patient has had a laryngectomy and was able to retain his airway, with no difficulty swallowing. There is no split of thyroid cartilage. The nurse would record this type of laryngectomy as which of the following? Supraglottic laryngectomy Partial laryngectomy Total laryngectomy Hemilaryngectomy

Partial laryngectomy

The nurse is performing preoperative teaching with a client who has cancer of the larynx. After explaining the most important information, what is the nurse's best action? Reassure the client and family that outcomes are nearly always positive. Give the client his or her cell phone number. Provide the client with audiovisual materials about the surgery. Refer the client to a social worker or psychologist.

Provide the client with audiovisual materials about the surgery.

The client has just had an invasive procedure to assess the respiratory system. What does the nurse know should be assessed on this client? Loss of consciousness Watery sputum Masses in pleural space Respiratory distress

Respiratory distress

A client with chronic bronchitis is admitted to the health facility. Auscultation of the lungs reveals low-pitched, rumbling sounds. What breath sound should the nurse document? Venous hum Rales Bronchovesicular Rhonchi

Rhonchi

The nurse is caring for a client who is to undergo a thoracentesis. In preparation for the procedure, the nurse places the client in which position? Lateral recumbent Supine Prone Sitting on the edge of the bed

Sitting on the edge of the bed

While auscultating the lungs of a client with asthma, the nurse hears a continuous, high-pitched whistling sound on expiration. The nurse will document this sound as which of the following? Wheezes Crackles Rhonchi Pleural friction rub

Wheezes

Which nursing diagnosis is most likely for a client who has just undergone a total laryngectomy? impaired verbal communication deficient knowledge risk for infection risk for chronic low self-esteem

impaired verbal communication

A client is being seen by the physician because of an unrelenting headache, facial tenderness, low-grade fever, and dark yellow nasal discharge. The client reports seeming to develop sinus infections "all the time." Which factor may predispose the client to sinusitis? excessive protein intake more than 8 hours of sleep per night interference with sinus drainage increased exposure to the health care environment

interference with sinus drainage

Preventing falls in older adults directly correlates to preventing bone fractures. If an older adult falls and fractures one or more ribs, what is a possible complication that could develop after the fracture? bronchospasm confusion pneumonia osteoporosis

pneumonia

A client with broken ribs following a MVA is being kept overnight for observation. The nurse should notify the physician of which findings? Select all that apply. fatigue respiratory distress signs of anxiety signs of infection increased pain

respiratory distress signs of infection increased pain

The term for the volume of air inhaled and exhaled with each breath is expiratory reserve volume. tidal volume. residual volume. vital capacity.

tidal volume

The nurse is conducting a presurgical interview for a client with laryngeal cancer. The client states that he drinks approximately 20 oz (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 Nonadherence to postoperative care Depression Increased risk for infection

Delirium tremens

The nurse is educating a patient diagnosed with acute bacterial rhinosinusitis about interventions that may assist with symptom control. What should the nurse include in this information? (Select all that apply.) Take an over-the-counter nasal decongestant. Take an over-the-counter antihistamine. Ensure an adequate fluid intake. Increase the humidity in the home. Apply local heat to promote drainage.

Ensure an adequate fluid intake. Increase the humidity in the home. Apply local heat to promote drainage.

The nurse is caring for a client who is status post nasal polypectomy. What would the nurse instruct this client to report? Diarrhea Excessive swallowing Nasal stuffiness Coughing

Excessive swallowing

The nurse is educating a patient with COPD about the technique for performing pursed-lip breathing. What does the nurse inform the patient is the importance of using this technique? It will assist with widening the airway. It prolongs exhalation. It increases the respiratory rate to improve oxygenation. It will prevent the alveoli from overexpanding.

It prolongs exhalation

The nurse recognizes that aspiration is a potential complication of a laryngectomy. How should the nurse best manage this risk? Facilitate total parenteral nutrition (TPN). Feed the client several small meals daily. Refer the client for occupational therapy. Keep a complete suction setup at the bedside.

Keep a complete suction setup at the bedside.

Following thoracic surgery, what should the nurse include in the care plan for a client at risk for impaired gas exchange? Select all that apply. Reinforce preoperative breathing exercises. Elevate head of bed 30 to 40 degrees as tolerated. Maintain accurate record of intravenous intake. Administer pain medications. Monitor vital signs frequently.

Monitor vital signs frequently. Reinforce preoperative breathing exercises. Elevate head of bed 30 to 40 degrees as tolerated. Administer pain medications.

The nurse is caring for a client diagnosed with enlarged adenoids. What condition is produced by enlarged adenoids? Incrusted mucous membranes Erosion of the trachea Noisy breathing Hardened secretions

Noisy breathing

A nurse is caring for a patient following lung surgery. The patient has a shallow, monotonous respiratory pattern and is reluctant to cough. What may the patient may be at an increased risk for? Aspiration Atelectasis Increased oxygen saturation Malnutrition

Atelectasis

Postural drainage has been ordered for a client who is having difficulty mobilizing bronchial secretions. Before repositioning the client and beginning treatment, the nurse should perform what health assessment? Chest auscultation Thoracic palpation Chest percussion Pulmonary function testing

Chest auscultation

A client is being discharged from an outpatient surgery center following a tonsillectomy. What instruction should the nurse give to the client? "Gargle with a warm salt solution." "You may have a sore throat for 1 week." "You are allowed to have hot tea or coffee." "Decrease oral intake if increased swallowing occurs."

"Gargle with a warm salt solution."

A client visits the physician's office concerned about possible sleep apnea. The client states he lives alone and fears that he will not awaken from sleep. The client states that he has many symptoms which may indicate sleep apnea. Which symptom, stated by the client, is not a symptom of sleep apnea? "I wake myself up by snoring several times each night." "I have pressure in the middle of my chest at night." "I wake up in the morning with a headache." "I have trouble concentrating throughout the day."

"I have pressure in the middle of my chest at night."

A 15-year-old boy with a history of asthma is undergoing lung function testing after experiencing a series of recent exacerbations. Which of the following instructions would facilitate measurement of the child's inspiratory reserve volume (IRV)? "Take normal, comfortable breaths until I ask you to stop." "Breathe out like you normally would and then immediately breathe out as much as you're able to." "I want you to take a normal breath in and then breathe in as deeply as you possibly can." "Force as much air out of your lungs as you can and then take the deepest breath that you can."

"I want you to take a normal breath in and then breathe in as deeply as you possibly can."

The nurse is obtaining a health history from a client with laryngitis. Which causative factor, stated by the client, is least likely? "I have environmental allergies." "I smoke a pack of cigarettes a day." "I used my voice in excess over the weekend." "I was chewing ice chips all day long."

"I was chewing ice chips all day long."

A nurse is caring for a client with COPD who needs teaching on pursed-lip breathing. Place the steps in order in which the nurse will instruct the client. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1 "Inhale through your nose." 2 "Slowly count to 7." 3 "Exhale slowly through pursed lips." 4 "Slowly count to 3."

"Inhale through your nose." "Slowly count to 3." "Exhale slowly through pursed lips." "Slowly count to 7."

A patient taking isoniazid (INH) therapy for tuberculosis demonstrates understanding when making which statement? "It is all right if I have a grilled cheese sandwich with American cheese." "It is all right if I drink a glass of red wine with my dinner." "It is fine if I eat sushi with a little bit of soy sauce." "I am going to have a tuna fish sandwich for lunch."

"It is all right if I have a grilled cheese sandwich with American cheese."

A client is being evaluated for possible lung cancer. Which client statement most likely indicates lung cancer? "I've had a low-grade fever for 2 weeks." "My cough has changed from a dry cough to one with lots of sputum production." "I've lost 10 pounds in the last month." "My voice is hoarser than it used to be."

"My cough has changed from a dry cough to one with lots of sputum production."

A patient is having her tonsils removed. The patient asks the nurse what function the tonsils serve. Which of the following would be the most accurate response? "The tonsils aid in digestion." "The tonsils regulate the airflow to the bronchi." "The tonsils help to guard the body from invasion of organisms." "The tonsils contain nerves that provoke sneezing."

"The tonsils help to guard the body from invasion of organisms."

Computed tomography of a patient's chest is suggestive of a malignancy, but these results are not conclusive. As a result, the patient has been scheduled for a bronchoscopy. What patient education should the nurse provide for this patient regarding this diagnostic procedure? "We'll monitor you closely after the procedure, especially until your gag reflex returns." "The care team will likely give you a general anesthetic for your bronchoscopy." "You won't be able to swallow solid food for a day or two after the procedure." "Your doctor will probably instill a contrast solution into your lungs to aid visualization."

"We'll monitor you closely after the procedure, especially until your gag reflex returns."

A patient has a Mantoux skin test prior to being placed on an immunosuppressant for the treatment of Crohn's disease. What results would the nurse determine is not significant for holding the medication? 0 to 4 mm 5 to 6 mm 9 mm 7 to 8 mm

0 to 4 mm

After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? 1 to 3 weeks 3 to 5 days 6 to 12 months 2 to 4 months

6 to 12 months

A nurse understands that a safe but low level of oxygen saturation provides for adequate tissue saturation while allowing no reserve for situations that threaten ventilation. What is a safe but low oxygen saturation level for a patient? 75% 80% 40% 95%

95%

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 client who is a habitual user of alcohol and tobacco A client who has gastrointestinal reflux disease (GERD) A client who eats a diet high in spicy foods A client who is a habitual user of caffeine and other stimulants

A client who is a habitual user of alcohol and tobacco

What dietary recommendations should a nurse provide a client with a lung abscess? A diet with limited fat A carbohydrate-dense diet A diet low in calories A diet rich in protein

A diet rich in protein

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 1.5 L/day fluid restriction A high-potassium, low-sodium diet A high-protein diet A liquid or soft diet

A liquid or soft diet

The ED nurse is assessing a client complaining of dyspnea. The nurse auscultates the client's chest and hears wheezing throughout the lung fields. What might this indicate about the client? Pneumonia. A narrowed airway. Hemothorax. The need for physiotherapy.

A narrowed airway.

The nurse at a long-term care facility is assessing each of the residents. Which resident most likely faces the greatest risk for aspiration? A resident with severe and deforming rheumatoid arthritis A resident with mid-stage Alzheimer disease A 92-year-old resident who needs extensive help with ADLs A resident who suffered a severe stroke several weeks ago

A resident who suffered a severe stroke several weeks ago

The nurse working in the radiology clinic is assisting with a pulmonary angiography. The nurse knows that when monitoring clients after a pulmonary angiography, what should the physician be notified about? Flushed feeling in the client Excessive capillary refill Raised temperature in the affected limb Absent distal pulses

Absent distal pulses

Which action should the nurse take first in caring for a client during an acute asthma attack? Administer bronchodilator as ordered. Send for STAT chest x-ray. Obtain arterial blood gases. Initiate oxygen therapy and reassess pulse oximetry in 10 minutes.

Administer bronchodilator as ordered.

A homeless client with streptococcal pharyngitis is being seen in a clinic. The nurse is concerned that the client will not continue treatment after leaving the clinic. Which of the following measures is the highest priority? Provide the client with oral penicillin that will last for 5 days. Administer one intramuscular injection of penicillin. Provide emphatic oral instructions for the client. Ask an accompanying homeless friend to monitor the client's follow-up.

Administer one intramuscular injection of penicillin.

A hospital has been the site of an increased incidence of hospital-acquired pneumonia (HAP). What is an important measure for the prevention of HAP? Administration of prophylactic antibiotics Obtaining culture and sensitivity swabs from all newly admitted clients Administration of pneumococcal vaccine to vulnerable individuals Administration of antiretroviral medications to clients over age 65

Administration of pneumococcal vaccine to vulnerable individuals

A patient has herpes simplex infection that developed after having the common cold. What medication does the nurse anticipate will be administered for this infection? An antiviral agent such as acyclovir An ointment such as bacitracin An antibiotic such as amoxicillin An antihistamine such as Benadryl

An antiviral agent such as acyclovir

The nurse is caring for a client admitted to the ED with an uncomplicated nasal fracture. Nasal packing has been put in place. Which intervention should the nurse include in the client's care? Apply pressure to the convex of the nose. Apply an ice pack. Position the patient in the side-lying position. Restrict fluid intake.

Apply an ice pack.

A client comes into the emergency department with epistaxis. What intervention should the nurse perform when caring for a client with epistaxis? Apply a moustache dressing. Apply direct continuous pressure. Provide a nasal splint. Place the client in a semi-Fowler's position.

Apply direct continuous pressure.

A 13-year-old boy has been brought to the emergency department by his mother after he took a powerful blow to his nose during a volleyball game. Preliminary examination suggests a nasal fracture, which should prompt the nurse to: Administer saline lavage and tell the patient not to swallow the solution Administer analgesia and a nebulized bronchodilator Apply warm compresses to the bridge of the patient's nose Apply ice and tell the patient to keep his head elevated

Apply ice and tell the patient to keep his head elevated

The nurse is caring for a client diagnosed with pneumonia. The nurse assesses the client for tactile fremitus by completing which action? Asking the client to say "one, two, three" while the nurse auscultates the lungs Instructing the client to take a deep breath and hold it while the diaphragm is percussed Asking the client to repeat "ninety-nine" as the nurse's hands move down the client's thorax Placing the thumbs along the costal margin of the chest wall and instructing the client to inhale deeply

Asking the client to repeat "ninety-nine" as the nurse's hands move down the client's thorax

The nurse is caring for a client who is postoperative day 2 following a total laryngectomy for supraglottic cancer. The nurse should prioritize what assessment? Assessment of jugular venous pressure Assessment of swallowing ability Assessment of body image Assessment of carotid pulse

Assessment of swallowing ability

The nurse has assessed a client's family history for three generations. The presence of which respiratory disease would justify this type of assessment? Asthma Community-acquired pneumonia Pulmonary edema Obstructive sleep apnea

Asthma

The nurse is caring for the client in the intensive care unit immediately after removal of the endotracheal tube. Which of the following nursing actions is most important to complete every hour to ensure that the respiratory system is not compromised? Assess capillary refill. Obtain vital signs. Auscultate lung sounds. Monitor heart rhythm

Auscultate lung sounds.

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? Albuterol Beclomethasone Levothyroxine Oxymetazoline nasal

Beclomethasone

The nurse is caring for an adolescent client injured in a snowboarding accident. The client has a head injury, a fractured right rib, and various abrasions and contusions. The client has a blood pressure of 142/88 mm Hg, pulse of 102 beats/minute, and respirations of 26 breaths/minute. Which laboratory test best provides data on a potential impairment in ventilation? Blood gases Blood chemistry Complete blood count Serum alkaline phosphate

Blood gases

The health care provider has ordered continuous positive airway pressure (CPAP) with the delivery of oxygenation. The patient asks the nurse what the benefit of CPAP is. What would be the nurse's best response? CPAP alters alveolar perfusion CPAP prevents the collapse of the patient's airway CPAP allows a higher percentage of oxygen to be used CPAP eliminates the need for oxygen supplementation during the day

CPAP prevents the collapse of the patient's airway

A 13-year-old soccer player presents to the emergency room with a fractured nose. The patient's mother is given which of the following post-discharge instructions? Select all that apply. Keep the nasal packing in place for 72 hours to help reshape the form of the nose. Restrict from sports activities for 6 weeks. Check for any unusual changes in breathing during the first 48 hours. Observe for any clear drainage from either nostril. Elevate the head of the bed for sleeping during the first week. Apply ice or cold compresses for 20 minutes every hour for the first 24 hours.

Check for any unusual changes in breathing during the first 48 hours. Observe for any clear drainage from either nostril. Elevate the head of the bed for sleeping during the first week. Restrict from sports activities for 6 weeks.

The clinic nurse is caring for a client with acute bronchitis. The client asks what may have caused the infection. What may induce acute bronchitis? Chemical irritation Aspiration Drug ingestion Direct lung damage

Chemical irritation

Postural drainage has been ordered for a client who is having difficulty mobilizing bronchial secretions. Before repositioning the client and beginning treatment, the nurse should perform what health assessment? Chest percussion Thoracic palpation Chest auscultation Pulmonary function testing

Chest auscultation

The client has just had an MRI ordered because a routine chest x-ray showed suspicious areas in the right lung. The physician suspects bronchogenic carcinoma. An MRI would most likely be in order to assess for what in this client? Alveolar dysfunction Tidal volume Forced vital capacity Chest wall invasion

Chest wall invasion

The nurse assesses a patient with a heart rate of 42 and a blood pressure of 70/46. What type of hypoxia does the nurse determine this patient is displaying? Hypoxemic hypoxia Anemic hypoxia Histotoxic hypoxia Circulatory hypoxia

Circulatory hypoxia

What finding by the nurse may indicate that the client has chronic hypoxia? Clubbing of the fingers Crackles Peripheral edema Cyanosis

Clubbing of fingers

The nurse is caring for an elderly client in the PACU. The client has had a bronchoscopy, and the nurse is monitoring for complications related to the administration of lidocaine. For what complication related to the administration of large doses of lidocaine in the elderly should the nurse assess? Confusion and lethargy Jaundice and elevated liver enzymes Decreased urine output and hypertension Headache and vision changes

Confusion and lethargy

Which term refers to lung tissue that has become more solid in nature as a result of a collapse of alveoli or an infectious process? Empyema Bronchiectasis Consolidation Atelectasis

Consolidation

The nurse is caring for a client with a closed chest drainage system. While repositioning the client, the chest tube dislodges. What is the immediate nursing intervention? Cover the exit site. Reinsert the chest tube. Notify the physician. Apply oxygen via face mask.

Cover the exit site.

The nurse is assessing the lungs of a patient diagnosed with pulmonary edema. Which of the following would be expected upon auscultation? Absent breath sounds Egophony Bronchial breath sounds Crackles at lung bases

Crackles at lung bases

The client has been self-medicating with antitussives. Which assessment finding would alert the nurse to an adverse effect of this medication? Temperature 101° F Increased coughing Nausea and vomiting Crackles in the bases

Crackles in the bases

A client with lung cancer develops pleural effusion. During chest auscultation, which breath sound should the nurse expect to hear? Decreased breath sounds Wheezes Rhonchi Crackles

Decreased breath sounds

The nurse working on a gerontology unit admits a 77-year-old with recent shortness of breath. The nurse knows that the amount of respiratory dead space increases with age. What do these changes result in? Decreased diffusion capacity for oxygen Increased ventilation Increased diffusion of gases Decreased shunting of blood

Decreased diffusion capacity for oxygen

After remaining in bed for 48 hours after surgery and dismissing nurses' encouragements to mobilize, a patient has begun to display the characteristic signs and symptoms of atelectasis. Because atelectasis is a health problem associated with decreased lung compliance, the nurse should understand that this patient is experiencing what pathophysiological phenomenon? Decreased blood flow to the capillaries in the patient's alveoli Decreased expandability of the patient's lung tissue Increased airway resistance A cessation of ventilation

Decreased expandability of the patient's lung tissue

The nurse is caring for a client who had a recent laryngectomy. Which of the following is reflected in the nursing plan of care? Develop an alternate method of communication. Encourage oral nutrition on the second postoperative day. Maintain the client in a low-Fowler's position. Assess the tracheostomy cuff for leaks.

Develop an alternate method of communication.

The nurse is caring for a client with an upper respiratory disorder. The client states he have a hacky, nonproductive cough, which wakens him during the night. Which over-the-counter medication would the nurse suggest to diminish the cough during the night? Dextromethorphan Fluticasone Pseudoephedrine Diphenhydramine

Dextromethorphan

For air to enter the lungs (process of ventilation), the intrapulmonary pressure must be less than atmospheric pressure so air can be pulled inward. Select the movement of respiratory muscles that makes this happen during inspiration. Lungs are pulled up and pushed back against the thoracic cage. Diaphragm contracts and elongates the chest cavity. Anteroposterior rib diameter decreases. Intercostals muscles relax to allow for expansion.

Diaphragm contracts and elongates the chest cavity

Bill Smith, a 93-year-old male, is having a pulmonary angiography performed in the radiology department where you practice nursing? Which sign would indicate an allergic reaction to the contrast medium? Absent distal pulses Hematoma Urge to cough Difficulty in breathing

Difficulty in breathing

The nurse is caring for a client who is scheduled for a lobectomy for lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the client's oxygen saturation rapidly dropping. The client reports shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. What further assessment findings support the presence of a pneumothorax? Paradoxical chest wall movement with respirations Sudden loss of consciousness Muffled heart sounds Diminished or absent breath sounds on the affected side

Diminished or absent breath sounds on the affected side

The nurse hears the patient's ventilator alarm sound and attempts to find the cause. What is the priority action of the nurse when the cause of the alarm is not able to be determined? Suction the patient since the patient may be obstructed by secretions. Stop the ventilator by pressing the off button, wait 15 seconds, and then turn it on again to see if the alarm stops. Call respiratory therapy and wait until they arrive to determine what is happening. Disconnect the patient from the ventilator and manually ventilate the patient with a manual resuscitation bag until the problem is resolved.

Disconnect the patient from the ventilator and manually ventilate the patient with a manual resuscitation bag until the problem is resolved.

The nurse is providing health education on the body's ability to exchange oxygen and carbon dioxide through the alveolar capillary membrane. Which statement, provided by the nurse, is most correct when asked about diffusion during inspiration? During inspiration, oxygen is greater in the alveoli than in the capillaries. During inspiration, carbon dioxide provides the basis for all diffusion gradients. During inspiration, the concentration of oxygen is equal in both the alveoli and the capillaries. During inspiration, oxygen diffuses from the arterial system through to the alveolar capillary membrane.

During inspiration, oxygen is greater in the alveoli than in the capillaries.

High or increased compliance occurs in which disease process? Emphysema Pleural effusion Pneumothorax ARDS

Emphysema

A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care? Elevating the head of the bed 30 degrees Maintaining a cool room temperature Encouraging increased fluid intake Turning the client every 2 hours

Encourage increased fluid intake

A patient is being educated in the use of incentive spirometry prior to having a surgical procedure. What should the nurse be sure to include in the education? Encourage the patient to try to stop coughing during and after using the spirometer. Inform the patient that using the spirometer is not necessary if the patient is experiencing pain. Have the patient lie in a supine position during the use of the spirometer. Encourage the patient to take approximately 10 breaths per hour, while awake.

Encourage the patient to take approximately 10 breaths per hour, while awake.

Pharyngitis can be caused by viruses and bacteria. Very serious complications can result from bacterial pharyngitis, specifically group A streptococci. Three-year-old Lindsay O'Connell has been ill for several days and is presenting at your general practice group for a sick call. Diagnosis and treatment of strep throat is important to prevent what serious complications? Choose all correct options. Laryngeal cancer Endocarditis Glomerulonephritis Rheumatic fever

Endocarditis Rheumatic fever Glomerulonephritis

Which is a priority nursing intervention that the nurse should perform for a client who has undergone surgery for a nasal obstruction? Apply a warm pack postoperatively Ensure mouth breathing Provide a splint postoperatively Apply pressure to the convex portion of the nose

Ensure mouth breathing

The nurse knows the mortality rate is high in lung cancer clients due to which factor? Increased exposure to industrial pollutants Increase in women smokers Few early symptoms Increased incidence among the elderly

Few early symptoms

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 Insertion of a specialized nasogastric tube Training on how to perform controlled belching Use of an electronically enhanced artificial pharynx

Fitting for a voice prosthesis

A nurse is obtaining a health history from a client who reports hemoptysis for the past 2 months. The client reports occasional dyspnea. Which imaging study, ordered by the physician, will view the thoracic cavity while in motion? Chest x-ray Computed tomography (CT) scan Fluoroscopy Magnetic resonance imaging (MRI)

Flouroscopy

A physician wants a study of diaphragmatic motion because of suspected pathology. What does the nurse anticipate that the physician will most likely order? Tomogram Fluoroscopy Barium swallow Bronchogram

Flouroscopy

When the nurse monitors the water-sealed drainage system, which finding suggests the system is working properly? Level of fluid is lowered in suction chamber. Fluid appears white and frothy. Fluid is bubbling vigorously. Fluid rises and falls with respirations.

Fluid rises and falls with respirations.

A patient comes to the clinic with complaints of a sore throat and is diagnosed with acute pharyngitis. What does the nurse understand is the cause of acute pharyngitis? Gram-negative Klebsiella Pseudomonas aeruginosa Staphylococcus aureus Group A, beta-hemolytic streptococci

Group A, beta-hemolytic streptococci

A patient comes to the clinic and is diagnosed with tonsillitis and adenoiditis. What bacterial pathogen does the nurse know is commonly associated with tonsillitis and adenoiditis? Gram-negative Klebsiella Group A, beta-hemolytic streptococcus Pseudomonas aeruginosa Staphylococcus aureus

Group A, beta-hemolytic streptococcus

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? Difficulty ambulating Infrequent swallowing Bradycardia Hemorrhage

Hemorrhage

The nurse is performing client education for a client who is being discharged on mini-nebulizer treatments. What information should the nurse prioritize in the client's discharge teaching? How to collect serial sputum samples How to perform diaphragmatic breathing How to count her respirations accurately How to independently wean herself from treatment

How to perform diaphragmatic breathing

A nurse is caring for a client with chest trauma. Which nursing diagnosis takes the highest priority? Impaired gas exchange Anxiety Ineffective tissue perfusion (cardiopulmonary) Decreased cardiac output

Impaired gas exchange

The nurse is caring for a client with a lower respiratory tract infection. When planning a focused respiratory assessment, the nurse should know that this type of infection most often causes what? Collapsed bronchial structures Necrosis of the alveoli Closed bronchial tree Impaired gas exchange

Impaired gas exchange

A client visiting the clinic is diagnosed with acute sinusitis. To promote sinus drainage, the nurse should instruct the client to perform what action? Apply heat to the forehead. Perform postural drainage. Increase fluid intake. Apply a cold pack to the affected area.

Increase fluid intake

Which of the following health care teaching points would a nurse cover when talking to a patient with rhinosinusitis? Select all that apply. Increase fluid intake and rest as much as possible. Report the symptoms of a secondary infection, the major complication of a cold. Be aware that the virus is contagious for 2 days before symptoms appear and during the first part of the symptomatic phase. Press one nostril shut when blowing the nose to increase the pressure behind the sinuses. Take prescribed antibiotics to decrease the severity of the viral infection.

Increase fluid intake and rest as much as possible. Report the symptoms of a secondary infection, the major complication of a cold. Be aware that the virus is contagious for 2 days before symptoms appear and during the first part of the symptomatic phase.

The nurse is caring for a client in a physician's office whose x-ray of the sinus reveals exudate in the maxillary sinus. Which equipment must the nurse have present in the room? Tuning fork Ophthalmoscope Irrigation equipment Otoscope

Irrigation equipment

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 will result in increased loss of work days. It may cause episodes of weakness due to reduced cardiac output. It can cause life-threatening airway obstruction. It is a risk factor for ischemic heart disease.

It can cause life-threatening airway obstruction.

A client is undergoing testing to see if he has a pleural effusion. Which of the nurse's respiratory assessment findings would be most consistent with this diagnosis? Decreased tactile fremitus, wheezing, and a hyperresonant sound upon percussion of the chest wall Lung fields dull to percussion, absent breath sounds, and a pleural friction rub Normal tactile fremitus, decreased breath sounds, and a resonant sound upon percussion of the chest wall Increased tactile fremitus, egophony, and a dull sound upon percussion of the chest wall

Lung fields dull to percussion, absent breath sounds, and a pleural friction rub

The critical care nurse is precepting a new nurse on the unit. Together they are caring for a client who has a tracheostomy tube and is receiving mechanical ventilation. What action should the critical care nurse recommend when caring for the cuff? Inflate the cuff to the highest possible pressure in order to prevent aspiration. Keep the tracheostomy tube plugged at all times. Monitor the pressure in the cuff at least every 8 hours Deflate the cuff overnight to prevent tracheal tissue trauma.

Monitor the pressure in the cuff at least every 8 hours

Which diagnostic imaging modality is more accurate than computed tomography in detecting malignancies? Pulmonary angiography MRI Gallium scan PET

PET

A patient is diagnosed as being in the early stage of laryngeal cancer of the glottis with only 1 vocal cord involved. For what type of surgical intervention will the nurse plan to provide education? Cordectomy Partial laryngectomy Vocal cord stripping Total laryngectomy

Partial laryngectomy

The nurse is discussing activity management with a client who is postoperative following thoracotomy. What instructions should the nurse give to the client regarding activity immediately following discharge? Walk 1 mile (1.6 km) 3 to 4 times a week. Use weights daily to increase arm strength. Perform shoulder exercises five times daily. Walk on a treadmill 30 minutes daily.

Perform shoulder exercises five times daily.

A 53-year-old client is seeing the physician today because he has had laryngitis for 2 weeks. After a thorough examination, the doctor orders medications and instructs the client to follow up in 1 week if his voice has not improved. What is the primary function of the larynx? Producing sound Facilitating coughing Preventing infection Protecting the lower airway from foreign objects

Producing sound

The nurse has admitted a client who is scheduled for a thoracic resection. The nurse is providing preoperative teaching and is discussing several diagnostic studies that will be required prior to surgery. Which study will be performed to determine whether the planned resection will leave sufficient functioning lung tissue? Exercise tolerance tests Arterial blood gas values Chest x-ray Pulmonary function studies

Pulmonary function studies

In addition to heart rate, blood pressure, respiratory rate, and temperature, the nurse needs to assess a client's arterial oxygen saturation (SaO2). What procedure will best accomplish this? Pulse oximetry Peak flow measurement Incentive spirometry Arterial blood gas (ABG) measurement

Pulse oximetry

The nurse has noted the emergence of a significant amount of fresh blood at the drain site of a client who is postoperative day 1 following total laryngectomy. What is the nurse's best action? Rapidly assess the client and notify the surgeon about the client's bleeding. Administer a STAT dose of vitamin K to aid coagulation. Assess the client, reposition the client supine, and apply wall suction to the drain. Remove the client's drain and apply pressure with a sterile gauze.

Rapidly assess the client and notify the surgeon about the client's bleeding.

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? Prescription medications can be safely supplemented with OTC medications. Consult the internet before selecting an OTC medication. Read drug labels carefully before taking OTC medications. Use only one pharmacy so the pharmacist can check drug interactions.

Read drug labels carefully before taking OTC medications.

The nurse is analyzing a client's blood pH of 7.1. Which symptom would indicate that the client's body is working to stabilize? WBC count is within normal limits. Urine output is decreased. Respirations are increasing. Heart rate is regular.

Respirations are increasing

An 18-month-old child is brought to the emergency department by his parents who explain that their child swallowed a watch battery. Radiologic studies show that the battery is in the lungs. Which area of lung is the battery most likely to be in? Left upper lung Left lower lung Right lower lung Right upper lung

Right upper lung

The nurse is providing suggestions to a client diagnosed with the effects of coryza. Which home remedy is appropriate when combined with medical treatment for pharyngitis? Cool mist humidifier Ice chips Lavender scent Salt water gargle

Salt water gargle

The nurse is caring for a client who has a pleural effusion and who underwent a thoracoscopic procedure earlier in the morning. The nurse should prioritize assessment for which of the following? Throat discomfort Shortness of breath Sputum production Epistaxis

Shortness of breath

A patient comes to the emergency department and is admitted with epistaxis. Pressure has been applied to the patient's midline septum for 10 minutes, but the bleeding continues. What treatments may be used to control the bleeding? Silver nitrate applicators Nasal plugs Nasal spray Suction

Silver nitrate applicators

A client presents to the emergency department in respiratory compromise. The client's temperature is 102.4° F, heart rate 88 beats/minute and regular, and blood pressure 138/76 mm Hg. The client is dyspneic, pale, and expectorating green-tinged sputum. The physician orders medications including antibiotics, antipyretics, nebulizer treatments, and IV fluids. A chest x-ray and sputum culture are to be completed. Which physician order would the nurse complete before beginning antibiotic therapy? Nebulizer treatments Chest x-ray Sputum culture Initiating IV fluids

Sputum culture

A nurse is in the cafeteria at work. A fellow worker at another table suddenly stands up, leans forward with hands crossed at the neck, and makes gasping noises. The nurse first Places both arms around the worker's waist Stands behind the worker, who has hands across the neck Makes a fist with one hand with the thumb outside the fist Exerts pressure against the worker's abdomen

Stands behind the worker, who has hands across the neck

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? The focus of care is resting the voice to prevent chronic hoarseness. Teaching focuses on safe and effective use of antibiotics. The client should be preliminarily screened for surgery. Symptom management is the main focus of medical and nursing care.

Symptom management is the main focus of medical and nursing care.

The nurse receives an order to obtain a sputum sample from a client with hemoptysis. When advising the client of the physician's order, the client states not being able to produce sputum. Which suggestion, offered by the nurse, is helpful in producing the sputum sample? Take deep breaths and cough forcefully. Use the secretions present in the oral cavity. Tickle the back of the throat to produce the gag reflex. Drink 8 oz of water to thin the secretions for expectoration.

Take deep breaths and cough forcefully

The nurse receives an order to obtain a sputum sample from a client with hemoptysis. When advising the client of the physician's order, the client states not being able to produce sputum. Which suggestion, offered by the nurse, is helpful in producing the sputum sample? Drink 8 oz of water to thin the secretions for expectoration. Use the secretions present in the oral cavity. Take deep breaths and cough forcefully. Tickle the back of the throat to produce the gag reflex.

Take deep breaths and cough forcefully.

The nurse is caring for a client diagnosed with coryza possibly from the rhinovirus. Vital signs are temperature: 101.2° F, pulse: 72 beats/minute, respirations: 28 breaths/minute, blood pressure: 112/70 mm Hg. Upon morning assessment, the client states a sore throat, moist cough, and watery eyes. The lungs are course in the bases. Which afternoon assessment finding suggests the advancement to an infectious process? Temperature rise Increased respiratory rate Headache Achiness

Temperature rise

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's carotid pulses Signs and symptoms of infection The client's swallowing ability

The client's airway patency

The nurse caring for a client with an endotracheal tube recognizes several disadvantages of an endotracheal tube. What would the nurse recognize as a disadvantage of endotracheal tubes? Daily arterial blood gases (ABGs) are necessary. Cognition is decreased. Slight tracheal bleeding is anticipated. The cough reflex is depressed.

The cough reflex is depressed.

The nurse caring for a client with an endotracheal tube recognizes several disadvantages of an endotracheal tube. What would the nurse recognize as a disadvantage of endotracheal tubes? Daily arterial blood gases (ABGs) are necessary. The cough reflex is depressed. Cognition is decreased. Slight tracheal bleeding is anticipated.

The cough reflex is depressed.

A patient in the ICU has been orally intubated and on mechanical ventilation for 2 weeks after having a severe stroke. What action does the nurse anticipate the physician will take now that the patient has been intubated for this length of time? The patient will have an insertion of a tracheostomy tube. The patient will be extubated and another endotracheal tube will be inserted. The patient will begin the weaning process. The patient will be extubated and a nasotracheal tube will be inserted.

The patient will have an insertion of a tracheostomy tube.

The nurse is caring for the client who presents to the clinic with hoarseness for 2 months. Further testing diagnoses laryngeal cancer with the treatment plan of a radical neck dissection. When reinforcing information provided by the physician, which nursing instruction is most correct? Laser surgery is a possibility with limited side effects. The client will be able to speak normally once the swelling subsides. Once the tissue is removed, no further treatment is necessary. The physician removes lymph nodes, muscles and tissue.

The physician removes lymph nodes, muscles and tissue.

While assessing the patient, the nurse observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude? The system has an air leak. The patient has a pneumothorax. The system is functioning normally. The chest tube is obstructed.

The system has an air leak.

While caring for a client with a chest tube, which nursing assessment would alert the nurse to a possible complication? Bloody drainage is observed in the collection chamber. Skin around tube is pink. Absence of bloody drainage in the anterior/upper tube The tissues give a crackling sensation when palpated.

The tissues give a crackling sensation when palpated.

A client is exhibiting signs of a pneumothorax following tracheostomy. The surgeon inserts a chest tube into the anterior chest wall. What should the nurse tell the family is the primary purpose of this chest tube? To remove air from the pleural space To monitor bleeding around the lungs To assist with mechanical ventilation To drain copious sputum secretions

To remove air from the pleural space

A nurse is discussing squamous epithelial cells lining each alveolus, which consist of different types of cells. Which type of alveolar cells produce surfactant? Type II cells Type I cells Type III cells Type IV cells

Type II cells

A client has had a laryngectomy as treatment for laryngeal cancer. Which nutritional interventions should be implemented for the client? Season food to suit increased sense of taste and smell. Use enteral feedings after the procedure. Offer plenty of thin liquids when intake resumes. Recommend a long-term use of zinc lozenges.

Use enteral feedings after the procedure

Which intervention regarding nutrition is implemented for clients who have undergone laryngectomy? Offer plenty of thin liquids when intake resumes Recommend the long-term use of zinc lozenges Season food to suit an increased sense of taste and smell Use enteral feedings after the procedure

Use enteral feedings after the procedure

A nurse caring for a patient with a pulmonary embolism understands that a high ventilation-perfusion ratio may exist. What does this mean for the patient? Ventilation exceeds perfusion. Ventilation matches perfusion. Perfusion exceeds ventilation. There is an absence of perfusion and ventilation.

Ventilation exceeds perfusion

A client with a severe exacerbation of COPD requires reliable and precise oxygen delivery. Which mask will the nurse expect the health care provider to prescribe? Tracheostomy collar Venturi mask Face tent Non-rebreather air mask

Venturi mask

The nurse documents breath sounds that are soft, with inspiratory sounds longer than expiratory and found over the periphery of the lungs. Which of the following will the nurse chart? Bronchial Tracheal Adventitious Vesicular

Vesicular

Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy? Vitamin B6 Vitamin C Vitamin E Vitamin D

Vitamin B6

Which type of ventilator has a preset volume of air to be delivered with each inspiration? Volume cycled Negative pressure Pressure cycled Time cycled

Volume cycled

While caring for a client with an endotracheal tube, the nurse should normally provide suctioning how often? When adventitious breath sounds are auscultated When there is a need to prevent the client from coughing When the nurse needs to stimulate the cough reflex Every 2 hours when the client is awake

When adventitious breath sounds are ausculatated

The nurse is caring for a patient who had a total laryngectomy and has drains in place. When does the nurse understand that the drains will most likely be removed? When the patient states that there is discomfort and requests removal In 1 week when the patient no longer has serous drainage When the drainage tube comes out When the patient has less than 30 mL for 2 consecutive days

When the patient has less than 30 mL for 2 consecutive days

The nurse is caring for a client who has been scheduled for a bronchoscopy. How should the nurse prepare the client for this procedure? Withhold food and fluids for several hours before the test. Administer nebulized bronchodilators every 2 hours until the test. Arrange for the insertion of a peripherally inserted central catheter. Administer a bolus of IV fluids.

Withold food and fluids for several hours before the test

A client has had a laryngectomy as treatment for laryngeal cancer. Which postoperative instruction is of utmost importance to the client's health and safety? avoid sponge baths avoid swimming avoid covering the stoma avoid coughing

avoid swimming

A resident in the long-term care facility has been experiencing a chronic, productive cough for the last 3 months. The client tells the nurse "this is just my winter cough." This client most likely has which condition? septicemia atelectasis heart failure chronic bronchitis

chronic bronchitis

The nurse is caring for a client who is receiving oxygen therapy for pneumonia. The nurse should best assess whether the client is hypoxemic by monitoring the client's: hemoglobin, hematocrit, and red blood cell levels. extremities for signs of cyanosis. oxygen saturation level. level of consciousness (LOC).

oxygen saturation level.

A nurse assesses arterial blood gas results for a patient in acute respiratory failure (ARF). Which results are consistent with this disorder? pH 7.35, PaCO2 48 mm Hg pH 7.36, PaCO2 32 mm Hg pH 7.46, PaO2 80 mm Hg pH 7.28, PaO2 50 mm Hg

pH 7.28, PaO2 50 mm Hg

What does a positive Mantoux test indicate? production of an immune response development of full-blown tuberculosis active immunity to tuberculosis an active case of tuberculosis

production of an immune response

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to: hold his nose while bending forward at the waist. blow his nose and then put lateral pressure on his nose. lie supine with his neck extended. sit upright, leaning slightly forward.

sit upright, leaning slightly forward.

A client asks a nurse a question about the Mantoux test for tuberculosis. The nurse should base her response on the fact that the: test stimulates a reddened response in some clients and requires a second test in 3 months. area of redness is measured in 3 days and determines whether tuberculosis is present. skin test doesn't differentiate between active and dormant tuberculosis infection. presence of a wheal at the injection site in 2 days indicates active tuberculosis.

skin test doesn't differentiate between active and dormant tuberculosis infection.

During the winter, increased instances of acute bronchitis cause a backlog of physician appointments that spill over into ED visits. What is the most common cause of acute bronchitis infections? bacterial infections viral infections chemical irritation bronchial asthma

viral infections