Respiratory

Which response is it a priority to monitor for after a thoracentesis?

Expectoration of blood.

Which complication would the nurse monitor for in a client with chronic asthma?

Atelectasis.

Which respiratory complication would be most likely in a client who is immobile for sever weeks? Select all that apply.

Atelectasis. Hypoxemia. Hypoventilation. Hypostatic Pneumonia. Respiratory tract infections.

For which client with lung disease would the nurse consult with respiratory therapist?

A postsurgical thoracotomy client who had a pulse oximeter reading of 96% on room air earlier but is now 88%.

Which finding would indicate to the nurse improvement in a client whose chronic obstructive pulmonary disease (COPD) is medically managed with corticosteroids and bronchodilators? Select all that apply.

Absent cough. Lungs clear bilaterally. Tolerating ambulation. Decreased resting respiratory rate. Pulse oximetry greater than 92% on room air.

Which action would the nurse complete to decrease the risk for carbon dioxide intoxication in a client with chronic obstructive pulmonary disease?

Administer oxygen only when needed and at a low concentration to maintain respiratory drive.

Which action would the nurse suggest to prioritize in the plan of care when working with the respiratory therapist in caring for a client hospitalized with pneumonia?

Administer oxygen.

An 8 year old child with a history of asthma is brought to the emergency department because of respiratory distress and given oxygen by means of a facemask. The health care provider performs a physical assessment, writes prescriptions and admits the child to the pediatric unit. Which instruction would the nurse carry out first?

Administer the nebulizer treatment.

Which reason indicates why a nurse would assess a client with emphysema for clinical indicators of hypoxia?

Loss of aerating surface.

Which complications are most commonly associated with chronic obstructive pulmonary disease (COPD)?

Cardiac problems.

Which would the nurse state is the cause of frequent upper respiratory tract infections in toddlers?

Immature immune system.

Where in the brain are respiratory patterns controlled?

Medulla.

Which intervention would the nurse implement immediately when a burn victim suddenly develops dyspnea and increased pulse and respiratory rates?

Apply oxygen per face mask.

Which definition relates to hemoptysis?

Blood in sputum.

Which factor is causing severe dyspnea in a client with a diagnosis of cancer of the lung?

Bronchial obstruction of pleural effusion.

Which client may have respiratory alkalosis?

Client A.

Which statement indicates additional teaching is needed in a client who was recently diagnosed with emphysema?

Complete bed rest is necessary.

Which would the nursing plan include to promote respiratory exchange in a client who had a chest tube removed?

Deep breathing and coughing every hour.

While caring for a client with chronic obstructive pulmonary disease (COPD), the nurse expects to find which auscultation result?

Diminished breath sounds.

Which clinical manifestation supports sever acute respiratory syndrome (SARS)? select all that apply.

Dry cough. Shortness of breath. Fever greater than 100.4.

Which nursing intervention is the highest priority when caring for a client with pneumonia?

Employ breathing exercises.

Which client assessment leads the nurse to determine that the postural drainage is effective for a client with increased respiratory secretions?

Has a productive cough.

Which client has the highest risk for developing a pulmonary embolism?

Obese client with leg trauma.

Which intervention will the nurse use to prevent aspiration pneumonia in a client receiving bolus enteral tube feedings? Select all that apply.

Perform oral hygiene frequently. Measure residual before each feeding. Check tube position before administering the feeding. Administer the tube feeding with the head of the bed elevated. Keep head of bed elevated for 30 minutes after the feeding.

How does the nurse explain the function of the water in a closed chest drainage system to a client with a pneumothorax?

Prevents reflux of air back into the chest.

Which finding would the nurse expect to find when assessing a client with a pleural effusion?

Reduced or absent breath sounds at the base of the lung.

Which would the nurse do to determine the amount of chest tube drainage in a closed drainage system?

Refer to the date and time markings on the outside of the collection chamber.

Which complication would the nurse monitor for in a client diagnosed with acute respiratory distress syndrome? (ARDS) Select all that apply.

Renal Failure. Stress Ulcers. Thrombocytopenia. Cardiac Dysrhythmias. Disseminated Vascular Coagulation.

With which individual will the nurse coordinate care of a 10 year old child with cystic fibrosis who is taking part in a summer camp or children with health problems?

Respiratory therapist.

Which information would the nurse teach a client to prevent infection when prescribed fluticasone/salmeterol for the treatment of chronic obstructive pulmonary disease (COPD)?

Rinse mouth out with water after use.

Which data about the fluid in the water seal chamber of a closed chest drainage system provide support for the conclusion that the system is functioning correctly?

Rises with inspiration and falls with expiration.

Which would the nurse do to prevent fatigue in a hospitalized client with chronic obstructive pulmonary disease (COPD)?

Schedule nursing activities to allow for rest.

Which action would the nurse teach the client to do, when teaching about nebulizer use?

Seal the lips around the mouthpiece and breathe in and out, taking slow, deep breaths.

A primary health care provider prescribes radiotherapy, chemotherapy, and laser therapy as a palliative treatment measure for a client with lung cancer. Which stage of cancer does the nurse infer the client has based on this treatment?

Stage 4.

A nurse administers albuterol to a child with asthma. Which common side effect would the nurse monitor for?

Tachycardia.

Which response would the nurse expect the client to exhibit when experiencing severe respiratory distress?

Tachycardia.

Which response by the nurse is appropriate for a client with emphysema who is questioning why he or she has a barrel chest?

The air sacs in your lungs are no longer elastic, and this causes an increase in the lung size.

The parents of a 3 year old who has recurrent attacks of acute spasmodic laryngitis (spasmodic croup) ask the nurse why this happens to their child. Which rationale would the nurse give as to why this is a disorder of young children?

They have small airways.

What is the cause of coarse rhonchi in the anterior upper lung fields bilaterally?

Turbulence due to muscular spasm and fluid or mucus in the larger airways.

Which nursing action would be appropriate to decrease carbon dioxide for a client with respiratory acidosis?

Using continuous positive airway pressure. (CPAP)