611 Respiratory PrepU
Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply. a) Tobacco smoke b) Infection c) Air pollution d) Occupational dust e) Second-hand smoke
• Tobacco smoke • Occupational dust • Air pollution • Infection • Second-hand smoke Explanation: Risk factors for chronic obstructive pulmonary disease are tobacco smoke, environmental tobacco smoke, occupational dust and chemicals, indoor and outdoor air pollution, and infection.
A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What should the nurse do first? a) Instruct the client to breathe into a paper bag. b) Encourage the client to deep-breathe and cough every 2 hours. c) Auscultate breath sounds bilaterally every 4 hours. d) Administer oxygen by nasal cannula as ordered.
Administer oxygen by nasal cannula as ordered. Explanation: When a pulmonary embolus places a client at risk for oxygen deprivation, the body compensates by hyperventilating. This causes respiratory alkalosis, as reflected in the client's ABG values. However, the most significant ABG value is the PaO2 value of 60 mm Hg, which indicates hypoxemia. To manage hypoxemia, the nurse should increase oxygenation by administering oxygen via nasal cannula as ordered. Instructing the client to breathe into a paper bag would cause depressed oxygenation when the client reinhaled carbon dioxide. Auscultating breath sounds or encouraging deep breathing and coughing wouldn't improve oxygenation.
A hospitalized client with terminal heart failure is nearing the end of life. The nurse observes which of the following breathing patterns?
Cheyne-Stokes breathing is characterized by a regular cycle where the rate and depth of breathing increase, then decrease until apnea occurs. The duration of apnea varies but progresses in length. This breathing pattern is associated with heart failure, damage to the respiratory center in the brain, or both.
A victim of a motor vehicle accident has been brought to the emergency room. The patient is exhibiting paradoxical chest expansion and respiratory distress. Which of the following chest disorders should be suspected? a) Cardiac tamponade b) Simple pneumothorax c) Flail chest d) Pulmonary contusion
Flail chest Correct Explanation: When a flail chest exists, during inspiration, as the chest expands, the detached part of the rib segment (flail segment) moves in a paradoxical manner in that it is pulled inward during inspiration, reducing the amount of air that can be drawn into the lungs. On expiration, because the intrathoracic pressure exceed atmospheric pressure, the flail segment bulges outward, impairing the patient's ability to exhale. Cardiac tamponade is compression of the heart resulting from fluid or blood within the pericardial sac. A pulmonary contusion is damage to the lung tissues resulting in hemorrhage and localized edema. A simple pneumothorax occurs when air enters the pleural space through the rupture of a bleb or a bronchopleural fistula.
The client, with a lower respiratory airway infection, is presenting with the following symptoms: fever, chills, dry hacking cough, and wheezing. Which nursing diagnosis best supports the assessment by the nurse? a) Ineffective Airway Clearance b) Ineffective Breathing Pattern c) Risk for Infection d) Impaired Gas Exchange
Ineffective Airway Clearance Explanation: The symptom of wheezing indicates a narrowing or partial obstruction of the airway from inflammation or secretions. Risk for Infection is a real potential because the client is already exhibiting symptoms of infection (fever with chills). Impaired Gas Exchange may occur, but no symptom listed supports poor exchange of gases. No documentation of respiratory rate or abnormalities is listed to justify this nursing diagnosis.
What are the conditions that make up Virchow's triad? Select all that apply. a) Venostasis b) Disruption of the vessel lining c) Edema d) Hypercoagulability e) Hypocoagulability
• Disruption of the vessel lining • Venostasis • Hypercoagulability Correct Explanation: Three conditions, referred to as Virchow's triad, predispose a person to clot formation: venostasis, disruption of the vessel lining, and hypercoagulability. Edema plays no part in Virchow's triad.
A physician orders metaproterenol (Alupent) by metered-dose inhalation four times daily for a client with acute bronchitis. Which statement by the client indicates effective teaching about this medication? a) "I can stop using this drug when I begin to feel better." b) "I need to hold my breath as long as possible after I take a deep inhalation." c) "I need to call the physician right away if I feel my heart beating fast after using the drug." d) "I should use this inhaler whenever I get short of breath."
"I need to hold my breath as long as possible after I take a deep inhalation." Correct Explanation: The client demonstrates effective teaching if he states that he'll hold his breath for as long as possible after inhaling the drug. Holding the breath increases the absorption of the drug into the alveoli. Metaproterenol needs to be used over an extended period for maximum effect. The client shouldn't use the inhaler whenever he feels out of breath because dependency can develop if the drug is used excessively. The client should adhere to the prescribed dosage. Tachycardia is an expected adverse reaction to metaproterenol. The client should be taught how to monitor his heart rate and contact the physician only if the heart rate exceeds 130 beats/minute.
A client admitted to the facility for treatment for tuberculosis receives instructions about the disease. Which statement made by the client indicates the need for further instruction? a) "I'll stay in isolation for 6 weeks." b) "This disease may come back later if I am under stress." c) "I'll always have a positive test for tuberculosis." d) "I'll have to take the medication for up to a year."
"I'll stay in isolation for 6 weeks." Explanation: The client requires additional teaching if he states that he'll be in isolation for 6 weeks. The client needs to be in isolation for 2 weeks, not 6, while taking the tuberculosis drugs. After 2 weeks of antitubercular therapy, the client is no longer considered contagious. The client needs to receive the drugs for 9 months to a year. He'll be positive when tested and if he's sick or under some stress he could have a relapse of the disease.
A nurse recognizes that a client with tuberculosis needs further teaching when the client states: a) "I'll have to take these medications for 9 to 12 months." b) "It won't be necessary for the people I work with to take medication." c) "I'll need to have scheduled laboratory tests while I'm on the medication." d) "The people I have contact with at work should be checked regularly."
"The people I have contact with at work should be checked regularly." Explanation: The client requires additional teaching if he states that coworkers need to be checked regularly. Such casual contacts needn't be tested for tuberculosis. However, a person in close contact with a person who's infectious is at risk and should be checked. The client demonstrates effective teaching if he states that he'll take his medications for 9 to 12 months, that coworkers don't need medication, and that he requires laboratory tests while on medication. Coworkers not needing medications, taking the medication for 9 to 12 months, and having scheduled laboratory tests are all appropriate statements.
The nurse at the beginning of the evening shift receives a report at 1900 on the following patients. Which patient would the nurse assess first? a) An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office b) A 62 year old with emphysema who has 300 mL of intravenous fluid remaining c) An 85 year old with COPD with wheezing and an O2 saturation of 89% on 2 L of oxygen d) A 74 year old with chronic bronchitis who has BP 128/58, HR 104, and R 26
An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office Explanation: On the patient's arrival at the emergency department, the first line of treatment is supplemental oxygen therapy and rapid assessment to determine if the exacerbation is life-threatening. Pulse oximetry is helpful in assessing response to therapy but does not assess PaCO2 levels. The fluids will not run out during the very beginning of the shift. The vital signs listed are normal findings for patients with COPD.
The nurse is preparing to suction a patient with an endotracheal tube. What should be the nurse's first step in the suctioning process? a) Assess the patient's lung sounds and SAO2 via pulse oximeter. b) Explain the suctioning procedure to the patient and reposition the patient. c) Perform hand hygiene and don nonsterile gloves, goggles, gown, and mask. d) Turn on suction source at a pressure not exceeding 120 mm Hg.
Assess the patient's lung sounds and SAO2 via pulse oximeter. Explanation: Assessment data indicate the need for suctioning and allow the nurse to monitor the effect of suction on the patient's level of oxygenation. Explaining the procedure would be the second step; performing hand hygiene is the third step, and turning on the suction source is the fourth step.
An adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Ordered respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure? a) When bronchospasms occur b) At bedtime c) When secretions have mobilized d) Immediately before a meal
At bedtime Explanation: The nurse should perform chest physiotherapy at bedtime to reduce secretions in the client's lungs during the night. Performing it immediately before a meal may tire the client and impair the ability to eat. Percussion and vibration, components of chest physiotherapy, may worsen bronchospasms; therefore, the procedure is contraindicated in clients with bronchospasms. Secretions that have mobilized (especially when suction equipment isn't available) are a contraindication for postural drainage, another component of chest physiotherapy.
A nurse is reviewing the pathophysiology of cystic fibrosis (CF) in anticipation of a new admission. The nurse should identify what characteristic aspects of CF? a) Atelectasis, infection, and eventual COPD b) Bronchial mucus plugging, inflammation, and eventual bronchiectasis c) Bronchial mucus plugging, infection, and eventual COPD d) Alveolar mucus plugging, infection, and eventual bronchiectasis
Bronchial mucus plugging, inflammation, and eventual bronchiectasis Explanation: The hallmark pathology of CF is bronchial mucus plugging, inflammation, and eventual bronchiectasis. Commonly, the bronchiectasis begins in the upper lobes and progresses to involve all lobes. Infection, atelectasis, and COPD are not hallmark pathologies of CF.
The nurse is caring for a patient in the ICU who is receiving mechanical ventilation. Which of the following nursing measures are implemented in an effort to reduce the patient's risk of developing ventilator-associated pneumonia (VAP)? a) Ensuring that the patient remains sedated while intubated b) Cleaning the patient's mouth with chlorhexidine daily c) Maintaining the patient in a high Fowler's position d) Turning and repositioning the patient every 4 hours
Cleaning the patient's mouth with chlorhexidine daily Explanation: The five key elements of the VAP bundle include the following: elevation of the head of the bed (30 to 45 degrees: semi-Fowler's position), daily "sedation vacations," and assessment of readiness to extubate (see below); peptic ulcer disease prophylaxis (with histamine-2 receptor antagonists, such as ranitidine [Zantac]); deep venous thrombosis (DVT) prophylaxis; and daily oral care with chlorhexidine (0.12% oral rinses). The patient should be turned and repositioned every 2 hours to prevent complications of immobility and atelectasis and to optimize lung expansion. (
Which of the following ventilation-perfusion ratios is exhibited when a patient is diagnosed with pulmonary emboli? a) Normal perfusion to ventilation ratio b) Silent unit c) Low ventilation-perfusion ratio d) Dead space
Dead space Explanation: When ventilation exceeds perfusion a dead space exists (high ventilation-perfusion ratios). An example of a dead space is pulmonary emboli, pulmonary infarction, and cardiogenic shock. A low ventilation-perfusion ratio exists in pneumonia or with a mucus plug. A silent unit occurs in pneumothorax or ARDS.
On arrival at the intensive care unit, a critically ill client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client's arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values? a) Tachypnea b) Fever c) Hypotension d) Tachycardia
Hypotension Explanation: Hypotension, hypothermia, and vasoconstriction may alter pulse oximetry values by reducing arterial blood flow. Likewise, movement of the finger to which the oximeter is applied may interfere with interpretation of SaO2. All of these conditions limit the usefulness of pulse oximetry. Fever, tachypnea, and tachycardia don't affect pulse oximetry values directly
The nurse is assessing a patient with chest tubes connected to a drainage system. What should the first action be when the nurse observes excessive bubbling in the water seal chamber? a) Notify the physician. b) Disconnect the system and get another. c) Milk the chest tube. d) Place the head of the patient's bed flat.
Notify the physician. Explanation: Observe for air leaks in the drainage system; they are indicated by constant bubbling in the water seal chamber, or by the air leak indicator in dry systems with a one-way valve. In addition, assess the chest tube system for correctable external leaks. Notify the primary provider immediately of excessive bubbling in the water seal chamber not due to external leaks.
The client is prescribed albuterol (Ventolin) 2 puffs as a metered-dose inhaler. The nurse evaluates client learning as satisfactory when the client a) Holds the breath for 5 seconds after administering the medication b) Positions the inhaler 1 to 2 inches away from his open mouth c) Immediately repeats the second puff after the first puff d) Carefully holds the inhaler upright without shaking it
Positions the inhaler 1 to 2 inches away from his open mouth Explanation: To administer a metered-dose inhaler, the client holds the inhaler upright and shakes the inhaler. The inhaler is positioned 1 to 2 inches away from the client's open mouth. After administering the medication, the client holds the breath for as long as possible, at least 10 seconds. The client may administer the next puff in 15 to 30 seconds.
Which of the following actions is most appropriate for the nurse to take when the patient demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery? a) Record the observation b) Report the finding to the physician immediately c) Measure the patient's pulse oximetry d) Apply a compression dressing to the area
Record the observation Explanation: Subcutaneous emphysema occurs after chest surgery as the air that is located within the pleural cavity is expelled through the tissue opening created by the surgical procedure. Subcutaneous emphysema is a typical postoperative finding in the patient after chest surgery. Subcutaneous emphysema is absorbed by the body spontaneously after the underlying leak is treated or halted. Subcutaneous emphysema results from air entering the tissue planes.
A student nurse is working with a client who is diagnosed with head trauma. The nurse has documented Cheyne-Stokes respirations. The student would expect to see which of the following? a) Periods of normal breathing followed by periods of apnea b) Regular breathing where the rate and depth increase, then decrease c) Period of cessation of breathing d) Irregular breathing at 14 to 18 breaths per minute
Regular breathing where the rate and depth increase, then decrease Explanation: Observing the rate and depth of respiration is an important aspect of the nursing assessment. Certain patterns of breathing are characteristic of specific disease states or conditions. Head trauma can cause damage to the respiratory center in the brain, thereby altering the rate and depth of respirations. Cheyne-Stokes breathing is characterized by a regular cycle in which the rate and depth of breathing increase, then decrease until apnea occurs.
The nurse caring for a patient recently diagnosed with lung disease encourages the patient not to smoke. What is the primary rationale behind this nursing action? a) Smoking causes atrophy of the alveoli. b) Smoke particles compete for binding sites on hemoglobin. c) Smoking damages the ciliary cleansing mechanism. d) Smoking decreases the amount of mucus production.
Smoking damages the ciliary cleansing mechanism. Explanation: In addition to irritating the mucous cells of the bronchi and inhibiting the function of alveolar macrophage (scavenger) cells, smoking damages the ciliary cleansing mechanism of the respiratory tract. Smoking also increases the amount of mucus production and distends the alveoli in the lungs. It reduces the oxygen-carrying capacity of hemoglobin, but not by directly competing for binding sites.
A young man incurred a spontaneous pneumothorax. The physician has just inserted a chest tube and has prescribed suction set at 20 cm of water. The nurse instills the fluid to this level in the appropriate chamber. Mark the level of fluid on the appropriate chamber of the closed drainage system.
Suction control is determined by the height of instilled water in that chamber. The suction control chamber is on the left side. In the middle of the closed drainage system is the water-seal chamber. The drainage chamber is on the right side of the closed drainage system
The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment? a) Hemoptysis b) Cough c) Syncope d) Tachypnea
Tachypnea Correct Explanation: Symptoms of PE depend on the size of the thrombus and the area of the pulmonary artery occluded by the thrombus; they may be nonspecific. Dyspnea is the most frequent symptom; the duration and intensity of the dyspnea depend on the extent of embolization. Chest pain is common and is usually sudden and pleuritic in origin. It may be substernal and may mimic angina pectoris or a myocardial infarction. Other symptoms include anxiety, fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis, and syncope. The most frequent sign is tachypnea (very rapid respiratory rate)
An 18-year-old male client is described as having pectus carinatum. The nurse is aware that the manifestation of this condition would be: a) The thoracic and lumbar spine have a lateral S-shaped curvature. b) The sternum protrudes and the ribs are sloped backward. c) The chest is rounded, ribs are horizontal, and sternum is pulled forward. d) The sternum is depressed from the second intercostal space.
The sternum protrudes and the ribs are sloped backward. Explanation: Also known as pigeon chest, in this congenital anomaly, the sternum abnormally protrudes and the ribs are sloped backward. This would be considered funnel chest, or pectus excavatum. This manifestation would be considered scoliosis. This would be considered barrel chest in which the anteroposterior diameter increases to equal the transverse diameter.
The client asks the nurse to explain the reason for a chest tube insertion in treating a pneumothorax. Which is the best response by the nurse? a) "Chest tubes provide a route for medication instillation to the lung." b) "The tube will drain air from the space around the lung." c) "Chest tube will allow air to be restored to the lung." d) "The tube will drain secretions from the lung."
The tube will drain air from the space around the lung." Correct Explanation: Negative pressure must be maintained in the pleural cavity for the lungs to be inflated. An injury that allows air into the pleural space will result in a collapse of the lung. The chest tube can be used to drain fluid and blood from the pleural cavity and to instill medication, such as talc, to the cavity
A client in acute respiratory distress is brought to the emergency department. After endotracheal (ET) intubation and initiation of mechanical ventilation, the client is transferred to the intensive care unit. Before suctioning the ET tube, the nurse hyperventilates and hyperoxygenates the client. What is the rationale for these interventions? a) They help prevent subcutaneous emphysema. b) They help prevent cardiac arrhythmias. c) They help prevent pulmonary edema. d) They help prevent pneumothorax.
They help prevent cardiac arrhythmias. Explanation: ET suctioning removes oxygen, lowering the partial pressure of arterial oxygen; this, in turn, may induce a cardiac arrhythmia. Hyperventilating and hyperoxygenating the client before and during (or after) suctioning helps prevent this complication. Subcutaneous emphysema occurs when air from the pleural cavity leaks into subcutaneous tissue; it isn't a complication associated with suctioning. Hyperventilation and hyperoxygenation can't prevent a pneumothorax because this condition itself indicates air in the pleural space. Pulmonary edema is associated with cardiac dysfunction, not ET suctioning.
A client is admitted to the facility with a productive cough, night sweats, and a fever. Which action is most important in the initial care plan? a) Monitoring the client's fluid intake and output b) Placing the client in respiratory isolation c) Assessing the client's temperature every 8 hours d) Wearing gloves during all client contact
You selected: Placing the client in respiratory isolation Correct Explanation: Because the client's signs and symptoms suggest a respiratory infection (possibly tuberculosis), respiratory isolation is indicated. Every 8 hours isn't frequent enough to assess the temperature of a client with a fever. Monitoring fluid intake and output may be required, but the client should first be placed in isolation. The nurse should wear gloves only for contact with mucous membranes, broken skin, blood, and other body fluids and substances.
A client with chronic obstructive pulmonary disease tells a nurse that he feels short of breath. The client's respiratory rate is 36 breaths/minute and the nurse auscultates diffuse wheezes. His arterial oxygen saturation is 84%. The nurse calls the assigned respiratory therapist to administer an ordered nebulizer treatment. The therapist says, "I have several more nebulizer treatments to do on the unit where I am now. As soon as I'm finished, I'll come and assess the client." The nurse's most appropriate action is to: a) administer the treatment by metered-dose inhaler. b) give the nebulizer treatment herself. c) notify the primary physician immediately. d) stay with the client until the therapist arrives.
give the nebulizer treatment herself. Explanation: The client's needs are preeminent, so the nurse should administer the nebulizer treatment immediately. The nurse can deal with the respiratory therapist's lack of response after the client's condition is stabilized. There is no need to involve the physician in personnel issues. Staying with the client is important, but it isn't a substitute for administering the needed bronchodilator. The order is for a nebulizer treatment not a metered-dose inhaler, so the nurse can't change the route without a new order from the physician
Arterial blood gas analysis would reveal which of the following related to acute respiratory failure? a) PaO 80 mm Hg b) pH 7.28 c) PaCO 32 mm Hg d) pH 7.35
pH 7.28 Explanation: Acute respiratory failure (ARF) is defined as a decrease in the arterial oxygen tension (PaO) to less than 50 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO) to greater than 50 mm Hg (hypercapnia), with an arterial pH of less than 7.35.
The nurse is using an in-line suction kit to suction a patient who is intubated and on a mechanical ventilator. What benefits does inline suction have for the patient? (Select all that apply.) a) Increases oxygen consumption b) Decreases patient anxiety c) Decreases hypoxemia d) Prevents aspiration e) Sustains positive end expiratory pressure (PEEP)
• Decreases hypoxemia • Decreases patient anxiety • Sustains positive end expiratory pressure (PEEP) Explanation: An in-line suction device allows the patient to be suctioned without being disconnected from the ventilator circuit. In-line suctioning (also called closed suctioning) decreases hypoxemia, sustains PEEP, and can decrease patient anxiety associated with suctioning (Sole et al., 2013)
A nurse is caring for a patient with COPD. The patient's medication regimen has been recently changed and the nurse is assessing for therapeutic effect of a new bronchodilator. What assessment parameters suggest a consequent improvement in respiratory status? Select all that apply. a) Negative sputum culture b) Increased expiratory flow rate c) Relief of dyspnea d) Increased viscosity of lung secretions e) Increased respiratory rate
• Increased expiratory flow rate • Relief of dyspnea Explanation: The relief of bronchospasm is confirmed by measuring improvement in expiratory flow rates and volumes (the force of expiration, how long it takes to exhale, and the amount of air exhaled) as well as by assessing the dyspnea and making sure that it has lessened. Increased respiratory rate and viscosity of secretions would suggest a worsening of the patient's respiratory status. Bronchodilators would not have a direct result on the patient's infectious process.
A nurse is caring for a male patient with COPD. While reviewing breathing exercises, the nurse instructs the patient to breathe in slowly through the nose, taking in a normal breath. Then, the nurse asks the patient to pucker his lips as if preparing to whistle. Finally, the patient is told to exhale slowly and gently through the puckered lips. The nurse teaches the patient this breathing exercise to accomplish which of the following? Select all that apply. a) Control the rate and depth of respirations b) Condition the inspiratory muscles c) Strengthen the diaphragm d) Prevent collapse of the airways e) Release trapped air in the lungs
• Release trapped air in the lungs • Prevent collapse of the airways • Control the rate and depth of respirations Explanation: The nurse is teaching the patient the technique of pursed-lip breathing. It helps slow expiration, prevents collapse of the airways, releases trapped air in the lungs, and helps the patient control the rate and depth of respirations. This helps patients relax and get control of dyspnea and reduces the feelings of panic they experience. Diaphragmatic breathing strengthens the diaphragm during breathing. In inspiratory muscle training the patient will be instructed to inhale against a set resistance for a prescribed amount of time every day in order to condition the inspiratory muscles.
Which of the following is a clinical manifestation of a pneumothorax? Select all that apply. a) Unilateral retractions b) Oxygen desaturation c) Bilaterally equal breath sounds d) Sudden chest pain e) Asymmetry of chest movement
• Sudden chest pain • Asymmetry of chest movement • Unilateral retractions • Oxygen desaturation Explanation: Signs and symptoms of pneumothorax include sudden chest pain that is sharp and abrupt, a significant and sudden increase in shortness of breath, asymmetry of chest movement, unilateral retractions, bilateral differences in breath sounds, and/or oxygen desaturation. The patient with a pneumothorax would not have bilaterally equal breath sounds.
A client diagnosed with tuberculosis (TB) is taking medication for the treatment of TB. The nurse should instruct the client that he will be safe from infecting others approximately how long after initiation of the chemotherapy regimen? a) Results vary with each client, so it is difficult to predict b) Within 48 hours after initiation of bacteriocidal drugs c) After completion of 6 months of bacteriocidal drugs d) Two to 3 weeks after initiation of bacteriocidal drugs
• Two to 3 weeks after initiation of bacteriocidal drugs Explanation: The client needs to take the prescribed medications for approximately 2 to 3 weeks before discontinuing precautions against infecting others. Effectiveness of the drug therapy is determined by negative sputum smears obtained on three consecutive days. Although results can vary among clients, the majority respond to therapy within 2 to 3 weeks.
A client with chronic bronchitis is admitted with an exacerbation of symptoms. During the nursing assessment, the nurse will expect which of the following findings? Select all that apply. a) Use of accessory muscles to breathe b) Tympany percussed bilaterally over the lung bases c) Hypoventilatory breathing pattern d) Respiratory rate of 10 breaths per minute e) Purulent sputum with frequent coughing
• Use of accessory muscles to breathe • Purulent sputum with frequent coughing Explanation: Chronic bronchitis increases airway resistance and can thicken bronchial mucosa during an exacerbation. The client will have dyspnea requiring the use of accessory muscles to breathe, along with tachypnea and sputum production. Bronchial irritation and the need to expectorate mucus will lead to coughing. Percussion in this client would lead to resonant or hyperresonant sounds.