surgical respiratory

14. A nurse in the emergency department is planning care for a client who is experiencing ethanol intoxication. Which acid-base imbalances should the nurse anticipate when planning care for this client? Select all that apply. a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis - NO

a. Metabolic acidosis

17. Auscultation of a client's lungs reveals rales (crackles) in the left posterior base. The nursing intervention is to: a. Repeat auscultation after asking the client to deep breathe and cough. b. Instruct the client to limit fluid intake to less than 2000 mL/day. c. Inspect the client's ankles and sacrum for the presence of edema. d. Place the client on bed rest in a semi-Fowler's position.

a. Repeat auscultation after asking the client to deep breathe and cough.

15. A client is on a disposable water-seal system with chest tubes in place. The RN assigns the LVN to position the chest tubes to maintain patency. The RN monitors that the first LVN action is to: a. Secure the chest tubes near the client without any dependent drainage loops. b. Check that the physician has written orders to milk the chest tubes. c. Tell the charge nurse that this assignment is not appropriate for LVNs. d. Complete the assignment and chart the intervention in the client's record.

a. Secure the chest tubes near the client without any dependent drainage loops.

11. You are supervising a nursing student who is providing care for a thoracotomy patient with a chest tube. What finding would you clearly instruct the nursing student to notify you about immediately? a. Chest tube drainage of 10 to 15 mL/hour b. Continuous bubbling in the water seal chamber c. Reports of pain at the chest tube site. d. Chest tube dressing dated yesterday.

b. Continuous bubbling in the water seal chamber

18. Immediately following a thoracentesis where 1850 mL were drained form the left pleural space, which clinical manifestations indicate that a complication has occurred and the physician should be notified? a. Serosanguinous drainage from the puncture site. b. Increased temperature and blood pressure. c. Increased pulse and pallor. d. Hypotension and hypothermia.

c. Increased pulse and pallor.

9. You are supervising a student nurse who is performing tracheostomy care for a patient. Which action by the student would cause you to intervene? a. Suctioning the tracheostomy tube before performing tracheostomy care. b. Removing old dressings and cleaning off excess secretions. c. Removing the inner cannula and cleaning using standard precautions. d. Replacing the inner cannula and cleaning the stoma site.

c. Removing the inner cannula and cleaning using standard precautions.

6. To determine whether a tension pneumothorax is developing in a patient with chest trauma, for what does the nurse assess the patient? a. Dull percussion sounds on the injured side. b. Muffled and distant heart sounds with decreasing blood pressure c. Decreased movement and diminished breath sounds on the affected side. d. Severe respiratory distress and tracheal deviation.

d. Severe respiratory distress and tracheal deviation.

13. Which of the following nursing interventions would promote effective airway clearance in a client with acute respiratory distress? a. Administering oxygen every two hours. b. Turning the client every four hours. c. Administering sedatives to promote rest. d. Suctioning if the cough is ineffective.

d. Suctioning if the cough is ineffective.

chest drainage 101

Creates negative pressure (hooked up to wall suction) Ex; pneumothorax - creates neg pressure to pull air out of lungs so they can reexpand During placement it is normal to hear a pop *tape the connections in a chest tube system!!!!! If the tube gets disconnected the pt pleural space will be open for infection BOTH systems; DON'T want bubbling in the water seal chamber - BAD *means theres air getting into the system

TNM Staging for Lung Cancer

T= Primary lesion N= Regional lymph node involved M = Systemic Metastasis Determines extent of disease & prognosis Stage I & II are surgical candidates Patterns of spread depend on type of lung cancer & location

4. The nurse is suctioning a client who had a laryngectomy. What is the maximum amount of time the nurse should suction the patient? a. 10 to 15 seconds b. 15 to 20 seconds c. 20 to 25 seconds d. 25 to 30 seconds.

a. 10 to 15 seconds

12. A nurse in the emergency department is planning care for a client who has been experiencing diarrhea for the past week. Which acid-base imbalance should the nurse anticipate when planning care for this client? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

a. Metabolic acidosis

16. A female client is admitted to your medical-surgical unit complaining of shortness of breath and pain in the right lung area. She states that she stated taking birth control pills 3 weeks ago and that she smokes. Her vital signs are: BP 140/80, P 110, RR 40. The physician orders ABGs; results are as follows: pH 7.50 PaCO2 29 mm HG PaO2 60 mm HG HCO3 24 mEq/L SaO2 86% on room air What is your interpretation of this arterial blood gas? Resp. Alk. With hypoxemia Considering these results, the first intervention is to: a. Begin mechanical ventilation. b. Place the client on oxygen. c. Give the client sodium bicarbonate. d. Monitor the client for a pulmonary embolism.

b. Place the client on oxygen.

5. When suctioning a tracheostomy tube 3 days following insertion, the nurse should follow which of the following procedures? a. Clean the catheter in sterile water after each use and reuse for no longer than 8 hours. b. Use a sterile catheter each time the client is suctioned. c. Protect the catheter in sterile packaging between suctioning episodes. d. Use a clean catheter with each suctioning, and disinfect it in hydrogen peroxide between uses.

b. Use a sterile catheter each time the client is suctioned.

7. A patient with a lung mass found on chest x-ray is undergoing further testing. The nurse explains that a diagnosis of lung cancer can be confirmed using which diagnostic test? a. Lung tomograms b. Pulmonary angiography c. Biopsy done via bronchoscopy d. Computed tomography (CT) scans.

c. Biopsy done via bronchoscopy

Signs & Symptoms pleural effusion

#1 is SOB CP: sharp or stabbing & > with deep inspiration Can have other local/systemic symptoms as well Differential diagnosis: Bacterial pneumonia: fever, production cough, purulent sputum TB: night sweats, fever, hemoptysis, weight loss CHF: LE edema, orthopnea, paroxysmal nocturnal dyspnea

Various Types of Lung Cancers

Approx. 75% are Non-small cell lung cancer (NSCLC). Slower growing but often caught late. Adenocarcinoma (30 to 40% of cases; moderate growing) Most common in the nonsmoker Lung periphery - Squamous Cell (20 to 30% ; slow growing) Second most common See in those who smoke Can cause pneumonitis Large Cell (10%; undifferentiated & rapid growing) Approx. 20% are Small Cell Lung Cancer (SCLC) Oat cell & intermediate cell type VERY rapidly growing Almost always r/t smoking Located in the central part of lung (major bronchi) Mesothelioma 2 to 3,000 new cases each year Asbestos, exposure to aspestis Almost ALWAYS fatal!

10. The nurse has assisted the physician at the bedside with insertion of a left subclavian, triple lumen catheter in a client admitted with lung cancer. Suddenly, the client becomes restless and tachypneic. The nurse should: a. Assess breath sounds. b. Remove the catheter. c. Insert a peripheral intravenous catheter. d. Reposition the catheter.

Assess breath sounds.

DRY SYSTEM chest drain

Dry suction -no water to create suction, the wall suction does NOT reflect the amount of suction in pt chest tube -top left use the dial to set the suction on drainage system -use bellows (below suction dial) want it to be out to the white arrow to know it is hooked up to enough wall suction

WET SYSTEM chest system

Suction control chamber - all the way to the left, water level controls it (fill with sterile water) *when hooked up to suction the water should continuously bubble in the suction control chamber, so you know it is working *wet system should not be used for more than -20 suction

Surgical Pleurectomy (pleural peel) & Decortication -

surgical removal of fibrous tissue in pleural space, manually cause inflammatory process by scraping

Titiling

- fluctuation between 2 and -2; normal finding when place chest tube, should go away when the pnemothorax gets better

3. The nurse is teaching a client how to manage a nosebleed. Which of the following instructions would be appropriate to give the client? a. "Tilt your head backward and pinch your nose." b. "Lie down flat and place an ice compress over the bridge of your nose." c. "Blow your nose gently with your neck flexed." d. "Sit down, lean forward, and pinch the soft portion of your nose."

"Sit down, lean forward, and pinch the soft portion of your nose."

Water seal chamber

- next to dial Air leak chamber - below water seal chamber, can see if air is coming out of chest tube -if there are air bubbles on inspiration, you know theres a pnemothorax -BUT there should never be a continuous bubbling because that means theres air getting into the closed system

2. During preoperative teaching for the patient scheduled for a total laryngectomy, what should the nurse include? a. The need for frequent, vigorous coughing in the first 24 hours postoperatively. b. The postoperative use of nonverbal communication techniques. c. Techniques that will be used to alleviate a dry mouth and prevent stomatitis. d. Self-help groups and community resources for patient with cancer of the larynx.

. The postoperative use of nonverbal communication techniques.

1. A client who has undergone outpatient nasal surgery is ready for discharge and has nasal packing in place. Which of the following discharge instructions would be appropriate for this client? a. Avoid activities that elicit the Valsalva maneuver. b. Take aspirin to control any nasal discomfort. c. Avoid brushing the teeth until the nasal packing is removed. d. Apply heat to the nasal area to control swelling.

Avoid activities that elicit the Valsalva maneuver.