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bstrandable NCLEX Respiratory System

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After a laryngectomy, which of the following assessments takes priority

Airway patency

A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism?

dyspnea

when is it best to obtain a pressure reading with an arterial line?

end of expiration

bronchodilator

medications that relax the smooth muscles of the bronchial tree, thereby relieving bronchospasm and increasing the vital capacity of the lungs

smoking cessation aids

medications used to slowly lower the level of nicotine while the patient participates in a behavior modification program for smoking cessation

How long do the lungs take to correct pH imbalance?

minutes. Lungs respond fast.

Pack year

packs of day x number of years = pack year

hemopneumothorax

presence of blood and air within the pleural space

post op care for vag surgery

prevent wound infection and pressure on vag suture line. Peri care bid and after urination and defication. ice and sitz bath foley cath, stool softener.

asthma prophylaxis

prevention of asthma

metabolic alkalosis: problem: causes: labs: s/s: treatment:

problem: body has too much HCO3 causes: loss of acids, ingestion of HCO3: severe vomiting, prolonged NGT suctioning, diuretics, excess mineralocorticosteroids labs: high pH high HCO3 s/s: irritable, tachycardia, hypokalemia, hypocalcemia (tetany, tremors), hypoventilation treatment: K-sparing diuretics, fluids to rehydrate, anti-emetics, IVFs likee 1/2 D5W, K protocol, Is and Os

respiration

process of exchanging oxygen and carbon dioxide

cavitation

process whereby a cavity is created in the lung tissue through the liquefaction and rupture of a primary tubercle

Mucous is a:

protective measure.

when should you perform a dynamic response test?

q8-12 when system is opened to air or if accuracy is questioned

respiratory imbalances vs metabolic

respiratory affects carbonic acid, metabolic affects bicarbonate

Signs and symptoms of Pneumothorax

small mild tachycardia and dyspnea. Resp distress for lg pneumothorax along with shallow rapid respirations, dyspnea, air hunger and o2 desaturation.

the development of emphysema is msot associated with a history of

smoking

bupropion (Zyban) is for:

smoking cessation

nicotine (Nicoderm CQ, Habitrol) is for:

smoking cessation

what is the product of the monohydrogen-dihydrogen phosphate buffer system and how is it excreted?

sodium chloride and sodium biphospate, the urine

vesicular sound

soft, breezy, low-pitched sound heard longer on inspiration than expiration resulting from air moving through the smaller airways over the lung periphery, with the exception of the scapular area

S/S of uterine prolapse

something heavy, coming down. dyspareunia, hachache, and bowel or bladder problems, stress incontinence

usually the zero reference for the transducer

stop-cock nearest to the transducer

A client is admitted to the hospital with possible rheumatic endocarditis. The nurse would chekc the client for signs and symptoms of concrrent _________

streptococcal infection

position to obtain invasive BPs

supine

That means there's less distance to go completely:

swell shut if they come into contact with irritants or triggers.

Epinephrine secreated by the adrenal medulla in stressful situations is ________

sympathomimetic

Which of the following interventions is most appropriate for the patient with an ineffective breathing pattern

teach the patient controlled diaphragmatic breathing

Major medications

that are used are Rifampin, Ethambutol, Pyrazinamide(PZA), Rifabutin

the protein buffering system acts like

the bicarbonate buffer system

Mycobacterium tuberculosis

the causative organism (bacillus) of tuberculosis; an aerobic bacterium that is a nonmotile, nonsporulating, acid-fast rod that secretes niacin

In metabolic acidosis & alkalosis, what organ is sick and what organ is compensating?

the kidneys are sick and the lungs will compensate

With chronic inflammation:

the lumen of the airway becomes very swollen and on top of it, filled with mucous.

explain Frank-Starling's law and how it applies to preload and CO

the more a myocardial fiber is stretched at the end of diastole, the stronger it will contract (recoil) in the subsequent contraction which will increase CO but also increase myocardial oxygen requirement

Inflammations triggers:

the mucous glands to produce more mucous.

what controls the rate of CO2 excretion through respiratory rate?

the respiratory center in the medulla in the brainstem

what do crackles sound like?

the sound of a lock of hair being rubbed between the thumb and forefinger

mechanical ventilation

the use of a ventilator to move room air or oxygen-enriched air into and out of the lungs mechanically if a client is unable to ventilate enough on his or her own to maintain proper levels of oxygen and carbon dioxide in the blood

Methylxanthine bronchodilator only has kind of medication called a

theophylline(theolair-SR, theo-24, uniphyl)

So even on a good day,

they aren't ever going to have bronchi and bronchiole that are nice and clear and not swollen.

What is a mucolytic agent

thins mucous secretions for a more productive cough. *NOTE* If it has dextromethorohen it NOT good for pts with COPD; it suppresses coughs

Treatment of pneumothorax

thoracentesis or chest tube

patients in the ICU are high risk for developing

thromboembolisms, hospital acquired infections, delirium, and MODS

Which way will the trachea deviate in a tension pneumothorax?

to the unaffected side

With respiratory acidosis, what chemical is causing the problem?

too much CO2

Where are bronchial breath sounds normally heard in the resp tract?

trachea and immediately above the manubrium

Goblet cells

trap foreign bodies. Found in respitory system. similar function as fly paper

Findings upon exam of Exacerbation of Asthma

Tachypnea, pursed lipped breathing, prolonged exhalation, tripod position. Palpation: decrease mvmt Percussion: Hyperresonance Auscultation: wheezes, decreased breath sounds omnious sign if no improvement or severely diminished air mvmt. - Recurrent episodes of wheezing, breathlessness, ches tightness and cough (particularly at night or early morning)

A nurse is preparing to ambulate a postoperative client following cardiac surgery. The nurse plans to do which of he following to enable the client to best tolerate the ambulation.

Premedicate the paient with an analgesic prior to ambulating

Indications for a bronchoscopy

Visualize abnormalities; theraputic reasons (tumors, inflammation, strictures) Biopsy of suspicious tissue (lung cancer) Aspiration of deep sputum or lung abscess for C&S

Functional Residual Capacity (FRC)

Volume of air remaining in lungs after normal exhalation Norm: 2.5 L

Leukotriene Modifier medication usually end with

ast(i.e Montelukast, oral (Singulair), Zafirlukast, oral (Accolate) Zileuton, oral(Zyflo) ~ Is an leukotriene inhibitor and another medication

in which patients do you hear high-pitched wheezes?

asthma or emphysema (narrowed-airway diseases)

What is montelukast (singulair) and when should it be taken?

asthma prophylaxis, chronic asthma should be taken every evening

hyperventilation

attempting to blow off CO2

hypoventilation

attempting to retain CO2

How to prevent complications on pt with chest tube

avoid dependent loops never raise drainage system above pts chest assess pt and integrity every hr.

A client undergoes a total laryngectomy and tracheostomy formation. On discharge, the nurse should give which instruction to the client and family? a) "Clean the tracheostomy tube with alcohol and water." b) "Family members should continue to talk to the client." c) "Oral intake of fluids should be limited for 1 week only." d) "Limit the amount of protein in the diet."

b) "Family members should continue to talk to the client."

A home care nurse visits a client with chronic obstructive pulmonary disease who requires oxygen. Which statement by the client indicates the need for additional teaching about home oxygen use? a) "I lubricate my lips and nose with K-Y jelly." b) "I make sure my oxygen mask is on tightly so it won't fall off while I nap." c) "I have a 'no smoking' sign posted at my front entry-way to remind guests not to smoke." d) "I clean my mask with water after every meal."

b) "I make sure my oxygen mask is on tightly so it won't fall off while I nap."

For a client with an acute pulmonary embolism, the physician prescribes heparin (Liquaemin), 25,000 U in 500 ml of dextrose 5% in water (D5W) at 1,100 U/hour. The nurse should administer how many milliliters per hour? a) 8 b) 22 c) 30 d) 50

b) 22

What is the normal pH range for arterial blood? a) 7 to 7.49 b) 7.35 to 7.45 c) 7.50 to 7.60 d) 7.55 to 7.65

b) 7.35 to 7.45

Anticholinergics

block acetylcholine, work on CNS ex) atrovent and spireva spireva- can not be given with narrowed glaucoma b/c increased intraoccular pressure

perfusion

blood flow through an organ or body part

Where is a pleural friction rub heard: on expiration/ inspiration?

both

Medication management usually addresses . . .

both inflammation and bronchoconstriction. These same medications may be used in symptomatic treatment of chronic obstructive pulmonary disease (COPD).

Antitussive meds can be

both opioid(i.e: codienes and hydrocodone) or non-opiods(i.e: Benadryl)

A vasovagal response may occur, causing _________?.

bradycardia

bronchovesicular sound

breath sound normally heard in the area of the scapula and near the sternum; medium in pitched blowing sound, with inspiratory and expiratory phases of equal length

What are the treatments for respiratory alkalosis?

breathe into a paper bag encourage the pt to decrease respiratory rate, treat the cause and monitor ABGs

Cells lung cancer develp from

bronchial epithelial cells (bronchogenic)

benzonatate (Tessalon) is for:

bronchitis (unproductive cough)

guaifenesin (Mucinex, Robitussin) is for:

bronchitis (unproductive cough)

How do you know if there is an airleak in the chest tube?

bubbling in the water seal chamber

mechanisms to regulate acid base balance

buffer systems, respiratory system, renal system

speed of regulatory systems in acid base balance

buffer-immediately respiratory- minutes to hours renal-2 to 3 days

If controlled,

by removing the irritants/allergen asthma is reversible.

A black client with asthma seeks emergency care for acute respiratory distress. Because of this client's dark skin, the nurse should assess for cyanosis by inspecting the:

mucous membranes

what do high-pitched wheezes sound like?

musical sounds that predominate in expiration

Closed pneumothorax

no associated external wound. Spontaneous pneumothorax. Can be caused by rupture of blebs on the visceral pleura.

Transudate

no protein but fluid from blood vessels is still leaking. usually found with CHF and renal failure.

it is necesscary to reposition a patient for each pressure reading?

no, but it necesscary to reposition the stopcock to ensure it is at the phlebostatic axis

primary tubercle

nodule that contains tubercle bacilli and forms within lung tissue

What kind of precautions are TB?

Airborne

What are the three methods that pneumonia causing organisms can reach the lungs?

1. Aspiration 2. Inhalation 3. Hematogenous spread

What are the treatments for respiratory alkalosis?

1. breathe into a paper bag 2. encourage the pt to decrease respiratory rate 3. treat the cause 4. monitor ABGs

normal ratio of carbonic acid to bicarbonate

20:1

PaCO2 normal range

35 to 45 mm Hg

What is an average range for PEEP settings?

5-10

What denotes a positive TB test?

An induration of 10mm in 48 hours

Anticholinergics

Are another group of bronchodilators

Montelukast (Singulair) is a:

Asthma prophylaxis

Diagnostic studies

CT Scan, V/Q scan, D-dimer, pulmonary angiography

Respiratory Alkalosis info

Caused by hyperventilation.

What is a sign of chronic cyanosis?

Clubbing of the fingers

What are some S&S of pneumonia in older adults?

Confusion, lethargy, anorexia, rapid respiratory rate

Which kind of drainage system is now most commonly used?

Disposable

Which medication is an example of an oral hypoglycemic agent?

Glypizide (Glucotrol)

Increasing dyspnea and sputum:

Inflammation is a key component in development.

What are early signs of cerebral hypoxia?

Irritability and restlessness

A patient is returning from transesophgeal echocardiography. Which of the following would the nurse include in the patient's plan of care?

Keep the patient NPO until the gag reflect has returned.,

How long do the lungs take to correct pH imbalance?

Minutes. Lungs respond fast.

What are antitussives

acts on the cough reflex in the medulla to suppress the cough

Some expectorant meds are

Pulmozyme, humibid, robitussin

coarse crackle

moist, low-pitched crackling and gurgling lung sound of long duration

COPD is:

characterized by bronchospasm and dyspnea.

Are crackles heard during inspiration or expiration?

inspiration

The nurse is evaluating patient teaching for Mitral Valve prolapse. The patient shows understanding of the prognosis of MVP by stating

"There are often no symptoms"

The nurse is caring for a patient who has peripheral arterial disease. Which of the following statements by the patient indicates understanding of how to manage the pain of peripheral arterial disease

" I will sit with my legs down"

Which is the best explanation by a nurse for why a physician did not prescribe antibiotics for influenza

" Influenza is caused by viruses"

Risk factors for pneumonia

-age, immobility, malnutrition, smoking, URTI, chronic diseases, immunosuppressed

What lung sound is low-pitched, coarse, loud snoring/ moaning?

rhonchi

A nurse provides instructions to a client at risk for thrombophelbitis regarding measures to prevent its occurrence. Which statement by the client indicates an understanding of the measures to prevent thrombophlebitis?

"I should avoid sitting or standing in one position for long periods of time."

The physician has prescribed NPH insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs?

"I will eat a snack around three o'clock each afternoon."

The physician has prescribed Novalog insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs?

"I will make sure I eat breakfast within 10 minutes of taking my insulin."

While a nurse is reinforcing preoperative teaching for a client scheduled for a right pneumonectomy, the client tells the nurse, "I cough all the time, and I'm really afraid it will hurt when I cough after the surgery." Which of the following is an appropriate nursing response? "After the surgeon removes the lung, you will not need to cough." "I'll make sure you get a cough suppressant to keep you from straining the incision when you cough." "Intravenous pain medication will keep you free of pain when you cough after the surgery." "I will show you how to splint your incision while coughing."

"I will show you how to splint your incision while coughing."

The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?

"It helps prevent early airway collapse."

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a patient with ARDS is correct?

"PEEP prevents the lung air sacs from collapsing during exhalation." rationale: By preventing alveolar collapse during expiration, PEEP improves gas exchange and oxygenation. PEEP will not prevent the fibrotic changes that occur with ARDS, push more air into the lungs, or change the fraction of inspired oxygen (FIO2) delivered to the patient.

where do high-pitched wheezes occur: expiration or inspiration?

mostly expiration but can be both

drugs that reduce cardiac contractility

(negative inotropes): CCB, BB, ETOH, acidosis

drugs that increase cardiac contractility

(positive inotropes): digoxin, epinephrine, norepinephrine, dopamine, dobutamine, calcium, milrinone

Which of the following are causes for concern following a thoracentesis? (Select all that apply.)

*Dyspnea *Fever *Hypotension **Dyspnea can indicate pneumothorax or reaccumulation of fluid. Fever can indicate infection. Hypotension can indicate intrathoracic bleeding. Localized bloody drainage contained on a dressing and soreness around puncture site, are expected findings. An SaO2 of 95% indicated good oxygenation.

Which of the following can cause a low pulse oximetry reading? (Select all that apply.)

*Nail polish *Inadequate peripheral circulation *Edema **Nail polish, inadequate peripheral circulation, and edema can all generate a low reading. Hypothermia, rather than hyperthermia, and a decreased Hgb level rather, than an increased Hgb level, can result in a low reading.

A nurse is caring for a client who is scheduled for a thoracentesis at the bedside. Which of the following items should the nurse ensure is in client's room? (Select all that apply.)

*Oxygen equipment *Pulse oximeter *Thoracentesis tray **Equipment to supply oxygen, a pulse oximeter, and a thoracentesis tray are all necessary for a thoracentesis. An incentive spirometer and suture removal kit are not indicated for this type of procedure.

What are some important interventions for antitussives

*avoid administering to pts with cranial injuries or cranial surgeries *avoid administering to pts that are taking opiods, sedatives, barbiturates or antidepressant because it can cause CNS depression

Theophylline

*increase the risk of digoxin(linoxin: heart med)toxicity and reduces the effect of lithium(psych med) and phenytoin(dilantin: seizure med) *dysrhythmias may occur if used with B2-adrenergic *B-blockers cimetidine(tagamet) and erythromycine increase it's affects *Barbiturate and carbamazepine(tegretol) decrease the effects of it *normal serum level is between 10-20mcg/ml and should always be infused slowly

Leukotrienes modifiers important interventions are

*take meds 1 hours before or 2 hours after meals *increase fluid intake *NEVER discontinue even in symptom-free periods

What is an inhaled nonsteroidal antiallergy agent(mast-cell stabilizers)

*treat allergic rhinitis, bronchial asthma, exercise induced bronchospasm caution to be used for renal function problems

What are Leukotriene modifiers

*used in prophylaxis and tx of chronic bronchial asthma. *NOT used for ACUTE episodes *contraindicated with breastfeeding moms *caution to be used in renal function problems

Signs and Symptoms of TB

- early stages pt is asymptomatic - Active disease may initally manifest with fatigue, malaise, anorexia, unexplained weightloss, low-grade fevers and night sweats. - cough develops with mucoid or mucopurulent sputum. -Sometimes more acute onset of symptoms: high fever, chills generalized flu like symptoms, pleuric pain and a productive cough.

Identify initial assessment findings for a patient with EARLY STAGE LEFT sided heart failure

- fatigue - breathlessness - dizziness - confusion as a result of tissue hypoxia from the diminished CO

Latent TB infection (LTBI)

- pts not sick because the organisms are not active. - they are asymptomatic and can NOT spread the disease -drug therapy help to prevent an infection from developing into the active disease. -Drug therapy for LTBI is only one drug instead of a cocktail of drugs (INH)

Causes of Pulmonary embolism

- usually caused by DVT that has been freed and moved to the lungs. Can be air or tumor tissue. - heart failure, over hydration with IV fluids, hypoalbuminemia, altered capillary permeability of lungs, malignancies of lymph system, resp distress syndrome.

Types of Pneumonia

-Community- Acquired Pneumonia- lower resp tract infectio with onset in the community or during the first 2 days of hospitalization. -Hospital- Acquired, Ventilator-Associated andealth Care- Associated Pneumonia- occurs 48 hrs or longer after hospital admission -Aspiration Pneumonia- pts that are at risk for aspiration -Opportunistic Pneumonia- immunocomprised pts

S/E of Anticholinergics

-Red as a Beet= vasodilation -Mad as a hatter= nervous, disorientation -Hot as a Hare= tachycardia -Blind as a Bat = enlarged pupils

Risk factors for Lung Cancer

-SMOKING!!!!!!! -inhaled carcinogens- asbestos, radon, nickel, iron and iron oxides, uranium, arsenic and air pollution. -Genetics -Hormones

TB- Pathophysiology

-gram positive, actid fast bacillus -spread by respiratory droplets. ( not easily spread) Need to be within 6 inches for 20 hrs a week. -Replicates slowly and spread via the lymphatic system. - find favorable environments for growth in upper lobes of the lungs, kidneys, epiphyses of the bone, cerebral cortex, and adrenal glands.

3 criteria for removal of chest tube

-less than 75 cc/day -reinflation of the lung -decreased symptoms

positioning the zero reference stopcock

-mark location of phlebostatic axis with permanent marker on chest -reposition stopcock with each position change to ensure that stopcock remains on phlebostatic axis before obtaining a reading -transducers higher than pa give low reading, placed lower give high reading

how the renal system helps with pH balance

-secretion of small amounts of free hydrogen into renal tubule -combining ammonia with a H to form ammonium -excretion of weak acids -excretes acidic (6) urine, can go from 4-8 to compensate

Drugs that increase effects of Methylzanthines

-steroids -erythromycin(antibiotic) -betablocker

S/E of albuterol

-tremors -hypokalemia -anxious -headache -increased HR -increased BP -dizzy **asthma pt should never be on Beta blocker

how to avoid hemorrhage with arterial lines

-use luer lok connections, check arterial waveform, watch for drops, and activate alarms

Emphysema path

...

A nurse performs an ABG sampling at 0930 on a client who has a heparin drip infusing. At which of the following times will it be appropriate for the nurse to discontinue holding pressure on the puncture site?

0950

A nurse perfoms an ABG sampling at 0930 on a client who has a heparin drip infusing. At which of the following times will it be appropriate for the nurse to discontinue holding pressure on the puncture site?

0950 *Immediately after arterial puncture, hold direct pressure over the site for at least 5 min. The pressure must be maintained for at least 20 min if the client is receiving anticoagulant therapy. Ensure that bleeding has stopped prior to removing direct pressure.

The amount of fluid remove during a thoracentesis is limited to ____ at a time to prevent cardiovascular collapse.

1 Liter

ventilation

movement of gases into and out of the lungs

How to evaluate ABGs.

1) Evaluate oxygenation. 2) Evaluate acid/base status. 3) Determine primary acid-base balance. a) CO2 determines if it's respiratory. b) HCO3 determines if it's metabolic. 4) Determine compensation.

A mucolytic med is

mucomyst

Percentage of oxygen a simple face mask delivers?

40-60%

normal pH of blood

7.35 to 7.45

pH normal range

7.35 to 7.45

Normal pH range

7.35- 7.45

Normal pH range

7.35-7.45

A client uses a metered-dose inhaler (MDI) to aid in management of his asthma. Which action by the client indicates to the nurse that he needs further instruction regarding its use? Select all that apply. 1. Activation of the MDI is not coordinated with inspiration. 2. The client inspires rapidly when using the MDI. 3. The client holds his breath for 3 seconds after inhaling with the MDI. 4. The client shakes the MDI after use. 5. The client performs puffs in rapid succession.

1, 2, 3, 4, 5. Utilization of an MDI requires coordination between activation and inspiration; deep breaths to ensure that medication is distributed into the lungs, holding the breath for 10 seconds or as long as possible to disperse the medication into the lungs, shaking up the medication in the MDI before use, and a sufficient amount of time between puffs to provide an adequate amount of inhalation medication.

Which of the following is significant data to gather from a client who has been diagnosed with pneumonia? Select all that apply. 1. Quality of breath sounds. 2. Presence of bowel sounds. 3. Occurence of chest pain. 4. Amount of peripheral edema. 5. Color of nail beds.

1, 3, 5. A respiratory assessment, which includes auscultating breath sounds and assessing the color of the nail beds, is a priority for clients with pneumonia. Assessing for the presence of chest pain is also an important respiratory assessment as chest pain can interfere with the client's ability to breathe deeply. Auscultating bowel sounds and assessing for peripheral edema may be appropriate assessments, but these are not priority assessments for the client with pneumonia.

The nurse administers two 325 mg aspirin every 4 hours to a client with pneumonia. The nurse should evaluate the outcome of administering the drug by assessing which of the following? Select all that apply. 1. Decreased pain when breathing. 2. Prolonged clotting time. 3. Decreased temperature. 4. Decreased respiratory rate. 5. Increased ability to expectorate secretions.

1, 3. Aspirin is administered to clients with pneumonia because it is an analgesic that helps control chest discomfort and an antipyretic that helps reduce fever. Aspirin has an anticoagulant effect, but that is not the reason for prescribing it for a client with pneumonia, and the use of the drug will be short term. Aspirin does not affect the respiratory rate, and does not facilitate expectoration of secretions.

The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a corticosteroid. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply. 1. The inhaler is held upright. 2. The head is tilted down while inhaling the medicine. 3. The client waits 5 minutes between puffs. 4. The mouth is rinsed with water following administration. 5. The client lies supine for 15 minutes following administration.

1, 4. The client should shake the inhaler and hold it upright when administering the drug. The head should be tilted back slightly. The client should wait about 1 to 2 minutes between puffs. The mouth should be rinsed following the use of a corticosteroid MDI to decrease the likelihood of developing an oral infection. The client does not need to lie supine; instead, the client will likely to be able to breathe more freely if sitting upright.

Which of the following findings would most likely indicate the presence of a respiratory infection in a client with asthma? 1. Cough productive of yellow sputum. 2. Bilateral expiratory wheezing. 3. Chest tightness. 4. Respiratory rate of 30 breaths/ minute.

1. A cough productive of yellow sputum is the most likely indicator of a respiratory infection. The other signs and symptoms- wheezing, chest tightness, and increased respiratory rate- are all findings associated with an asthma attack and do not necessarily mean an infection is present.

A client is prescribed metaproterenol (Alupent) via a metered-dose inhaler, two puffs every 4 hours. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol? 1. Irregular heartbeat. 2. Constipation. 3. Pedal edema. 4. Decreased pulse rate.

1. Irregular heartbeats should be reported promptly to the care provider. Metaproterenol (Alupent) may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effect on beta-adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders. Metaproterenol does not cause constipation, pedal edema, or bradycardia.

nonsteroidal antiallergic agent important interventions are

DO NOT discontinue medication abruptly because it will a rebound asthmatic attack

When developing a discharge plan to manage the care of a client with chronic obstructive pulmonary disease (COPD), the nurse should advise the the client to expect to: 1. Develop respiratory infections easily. 2. Maintain current status. 3. Require less supplemental oxygen. 4. Show permanent improvement.

1. A client with COPD is at high risk for development of respiratory infections. COPD is slowly progressive; therefore, maintaining current status and establishing a goal that the client will require less supplemental oxygen are unrealistic expectations. Treatment may slow progression of the disease, but permanent improvement is highly unlikely.

Which of the following is a priority goal for the client with chronic obstructive pulmonary disease (COPD)? 1. Maintaining functional ability. 2. Minimizing chest pain. 3. Increasing carbon dioxide levels in the blood. 4. Treating infectious agents.

1. A priority goal for the client with COPD is to manage the signs and symptoms of the disease process so as to maintain the client's functional ability. Chest pain is not a typical symptom of COPD. The carbon dioxide concentration in the blood is increased to an abnormal level in clients with COPD; it would not be a goal to increase the level further. Preventing infection would be a goal of care for the client with COPD.

The client with pneumonia develops mild constipation, and the nurse administers docusate sodium (Colace) as ordered. This drug works by: 1. Softening the stool. 2. Lubricating the stool. 3. Increasing stool bulk. 4. Stimulating peristalsis.

1. Docusate sodium (Colace) is a stool softener that allows fluid and fatty substances to enter the stool and soften it. Docusate sodium does not lubricate the stool, increase stool bulk, or stimulate peristalsis.

A client with deep vein thrombosis suddenly develops dyspnea, tachypnea, and chest discomfort. What should the nurse do first? 1. Elevate the head of the bed 30 to 45 degrees. 2. Encourage the client to cough and deep breathe. 3. Auscultate the lungs to detect abnormal breath sounds. 4. Contact the physician.

1. Elevating the head of the bed facilitates breathing because the lungs are able to expand as the diaphragm descends. Coughing and deep breathing do not alleviate the symptoms of a pulmonary embolus, nor does lung auscultation. The physician must be kept informed of changes in a client's status, but the priority in this case is alleviating the symptoms.

Bed rest is prescribed for a client with pneumonia during the acute phase of the illness. The nurse should determine the effectiveness of bed rest by assessing the client's: 1. Decreased cellular demand for oxygen. 2. Reduced episodes of coughing. 3. Diminished pain when breathing deeply. 4. Ability to expectorate secretions more easily.

1. Exudate in the alveoli interferes with ventilation and the diffusion of gases in clients with pneumonia. During the acute phase of the illness, it is essential to reduce the body's need for oxygen at the cellular level; bed rest is the most effective method for doing so. Bed rest does not decrease coughing or promote clearance of secretions, and it does not reduce pain when taking deep breaths.

Which of the following physical assessment findings are normal for a client with advanced chronic obstructive pulmonary disease (COPD)? 1. Increased anteroposterior chest diameter. 2. Underdeveloped neck muscles. 3. Collapsed neck veins. 4. Increased chest excursions with respiration.

1. Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrel-chested appearance. Overly developed, not underdeveloped, neck muscles are associated with COPD because of their increased use in the work of breathing. Distended, not collapsed, neck veins are associated with COPD as a symptom of the heart failure that the client may experience secondary to the increased workload on the heart to pump blood into the pulmonary vasculature. Diminished, not increased, chest excursion is associated with COPD.

Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma? 1. Incorporate physical exercise as tolerated into the daily routine. 2. Monitor peak flow numbers after meals and at bedtime. 3. Eliminate stressors in the work and home environment. 4. Use sedatives to ensure uninterrupted sleep at night.

1. Physical exercise is beneficial and should be incorporated as tolerated into the client's schedule. Peak flow numbers should be monitored daily, usually in the morning (before taking medication). Peak flow does not need to be monitored after each meal. Stressors in the client's life should be modified but cannot be totally eliminated. Although adequate sleep is important, it is not recommended that sedatives be routinely taken to induce sleep.

A client experiencing a severe asthma attack has the following arterial blood gas: pH 7.33; Pco2 48; Po2 58; HCO3 26. Which of the following orders should the nurse perform first? 1. Albuterol (Proventil) nebulizer. 2. Chest x-ray. 3. Ipratropium (Atrovent) inhaler. 4. Sputum culture.

1. The arterial blood gas reveals a respiratory acidosis with hypoxia. A quick-acting bronchodilator, albuterol, should be administered via nebulizer to improve gas exchange. Ipratropium is a maintenance treatment for bronchospasm that can be used with albuterol. A chest x-ray and sputum sample can be obtained once the client is stable.

A 79-year-old female client is admitted to the hospital with a diagnosis of bacterial pneumonia. While obtaining the client's health history, the nurse learns that the client has osteoarthritis, follows a vegetarian diet, and is very concerned with cleanliness. Which of the following would most likely be a predisposing factor for the diagnosis of pneumonia? 1. Age. 2. Osteoarthritis. 3. Vegetarian diet. 4. Daily bathing.

1. The client's age is a predisposing factor for pneumonia; pneumonia is more common in elderly or debilitated clients. Other predisposing factors include smoking, upper respiratory tract infections, malnutrition, immunosuppression, and the presence of a chronic illness. Osteoarthritis, a nutritionally sound vegetarian diet, and frequent bathing are not predisposing factors for pneumonia.

The nurse is planning to teach a client with chronic obstructive pulmonary disease how to cough effectively. Which of the following instructions should be included? 1. Take a deep abdominal breath, bend forward, and cough three or four times on exhalation. 2. Lie flat on the back, splint the thorax, take two deep breaths, and cough. 3. Take several rapid, shallow breaths and then cough forcefully. 4. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.

1. The goal of effective coughing is to conserve energy, facilitate removal of secretions, and minimize airway collapse. The client should assume a sitting position with feet on the floor if possible. The client should bend forward slightly and, using pursed-lip breathing, exhale. After resuming an upright position, the client should use abdominal breathing to slowly and deeply inhale. After repeating this process three or four times, the client should take a deep abdominal breath, bend forward, and cough three or four times upon exhalation (" huff" cough). Lying flat does not enhance lung expansion; sitting upright promotes full expansion of the thorax. Shallow breathing does not facilitate removal of secretions, and forceful coughing promotes collapse of airways. A side-lying position does not allow for adequate chest expansion to promote deep breathing.

Asthma signs/symptoms and diagnostics:

1. Altered LOC/confused = early sign of respiratory failure. 2. Wheezing 3. Cough 4. SOB - 5. Tachypnea and tachycardia 6. chest tightness 7. increased mucous production

What are the 4 classifications of pneumonia by causative agent?

1. Bacterial 2. Viral 3. Fungal 4. Chemical

What are the 2 classifications for acquiring pneumonia?

1. Community 2. Hospital

What are some nursing interventions to help someone with pneumonia?

1. Coughing and deep breathing 2. IS 3. Humidification of airway 4. Provide fluids 5. Suction airway if necessary 6. Assess breath sounds before and after coughing

What are the causes of metabolic acidosis? (4)

1. DKA (d/t ketone production) 2. starvation (d/t ketone production) 3. renal failure 4. severe diarrhea (intestines contain a lot of bicarb)

Key asthma factors:

1. Genetics (a lot of them are allergy based). 2. Triggers are usually different for everyone a. Non allergy based triggers: Irritants: cold dry air, or fine airborne particles, b.emotions, even stress, c.medications: NSAIDS, nonselective beta blockers can 3. Airway hyperresponsiveness: exercise or URI 4. Allergic - allergens: inflammatory/histamine response - IgE mediated response involving antigens and antibodies.

What are the s/s of respiratory acidosis? (4)

1. HA 2. Confusion 3. sleepy (difficult to arouse) 4. hypoxia

What are the 5 defining characteristics of ARDS?

1. Hypoxemia that persists even with 100% O2 2. Decreased Lung compliance 3. Dyspnea 4. Non-cardiac associated bilateral pulmonary edema 5. dense pulmonary infiltrates on radiography.

Place the following steps for obtaining a client's ABGs in the correct order.

1. Obtain a heparinized syringe for the sample collection. 2. Explain and reinforce the procedure with the client. 3. Perform an Allen's test prior to arterial puncture to verify patent radial and ulnar circulation. 4. Perfom an arterial puncture using a surgical aseptic technique, and collect a specimen into a heparinized syringe. 5. Place the collected and capped specimen into a basin of ice and water to preserve pH levels and oxygen pressure. Ensure immediate transport to the laboratory. 6. Immediately after an arterial puncture, hold direct pressure over the site for at least 5 min. Pressure must be maintained for at least 20 min if the client is receiving anticoagulant therapy. Ensure that the bleeding has stopped prior to removing direct pressure. 7. Monitor the ABG sampling site for bleeding, loss of pulse, swelling, and changes in temperature and color. 8. Report results to the primary care provider as soon as they are available.

3 stages of inflammation:

1. Stage 1: Venoconstriction, but locally at the site you get arteriole dilation and increased cell permeability, which causes fluid leakage and swelling. Redness, warmth and edema from that dilation.

What are the s/s of metabolic alkalosis? (4)

1. depends on the cause 2. watch LOC 3. hypokalemia (watch for muscle cramps & arrhythmias) 4. decreased respiratory rate

What are the treatments for respiratory acidosis?

1. fix the breathing problem 2. treat PNA 3. pneumothorax pts will have chest tube(s) 4. if pt post-op, encourage CDB

What are the treatments for metabolic alkalosis? (2)

1. fix the problem 2. replace K+

What are the s/s of metabolic acidosis?

1. hyperkalemia 2. increased respiratory rate (eliminating CO2) 3. s/s also depend on the cause

What are the causes of respiratory alkalosis? (3)

1. hyperventilation 2. hysterical 3. ASA overdose (acute)

What are the causes of respiratory acidosis? (7)

1. hypoventilation (retaining CO2) 2. abdominal surgery 3. narcotics 4. sleeping pills 5. pneumothorax 6. collapsed lung 7. pneumonia

What are the s/s of respiratory alkalosis? (4)

1. lightheaded 2. faint 3. peri-oral numbness 4. tingling in the fingers & toes

What are the causes of metabolic alkalosis?

1. loss of upper GI content 2. too many antiacids (too much baseO 3. too much IV bicarb

Diagnostics:

1. monitor for accessory muscle use. 2. Check abgs, pao2 and pulse ox 3. Check eosinophil levels 4. Get PFTs before and after. If doing a baseline, doing a PFT during an exacerbation gives an objective indiction of how much trouble a patient is in and what type of med to use and assess how effectively a medication is working. 5. Get a chest xray 6. Do NIH asthma staging.

What are the treatments for metabolic acidosis?

1. treat the cause 2. IVP sodium bicarb (won't fix prob, but will buy time to find the cause)

A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning, the nurse must limit the suctioning time to a maximum of: ______ seconds

A therapeutic theophylline level is _____ mcg/ml.

10 - 20

Corina

wehre trachea splits to R&L bronchus. @ 4th intercostal space

When suctioning secretions that are collecting in an endotracheal tube, the nurse does not apply suction for longer than:

15 seconds Applying suction for too long can result in complications such as hypoxemia and cardiac dysrhythmias. Thus the nurse is always aware of the length of time that suctioning is applied to an airway. If the suctioning time is too short, the suction catheter may not remove the secretions. If the suctioning time is too long, hypoxemia and/or cardiac dysrhythmias could result.

With relation to orthostatic hypertension, in response to the drop in BP the pulse increase _______ bpm to maintain cardiac output.

15-20

Normal O2 content

15-20 vol%

Orthostatic hypotensiohn is a drop in systolic BP greater than ___mmhg; and an increase in heart rate greater than _____ bpm in response to the drop in BP.

15; 20

what fluid order should the emphysema client have?

3 liters of fluid per day

A client with known chronic obstructive pulmonary disease (COPD) is admitted to the emergency department with multiple minor injuries following an automobile accident. To ensure adequate ventilation the nurse applies a nasal cannula providing oxygen at what rate and for what reason?

2 L/min to prevent elevating the arterial oxygen tension (PaO2), which would suppress the hypoxic drive

The nurse is instructing a client with COPD how to do pursed-lip breathing. In which order should the nurse explain the steps to the client? 1. "Breathe in normally through your nose for 2 counts (while counting to yourself, one, two)." 2. "Relax your neck and shoulder muscles." 3. "Pucker your lips as if you were going to whistle." 4. "Breathe out slowly through pursed lips for 4 counts (while counting to yourself, one, two, three, four)."

2, 1, 3, 4. The nurse should instruct the client to first relax the neck and shoulders and then take several normal breaths. After taking a breath in, the client should pucker the lips, and finally breathe out through pursed lips.

Which of the following is an expected outcome for an elderly client following treatment for bacterial pneumonia? 1. A respiratory rate of 25 to 30 breaths/ minute. 2. The ability to perform activities of daily living without dyspnea. 3. A maximum loss of 5 to 10 lb of body weight. 4. Chest pain that is minimized by splinting the rib cage.

2. An expected outcome for a client recovering from pneumonia would be the ability to perform activities of daily living without experiencing dyspnea. A respiratory rate of 25 to 30 breaths/ minute indicates the client is experiencing tachypnea, which would not be expected on recovery. A weight loss of 5 to 10 lb is undesirable; the expected outcome would be to maintain normal weight. A client who is recovering from pneumonia should experience decreased or no chest pain.

When performing postural drainage, which of the following factors promotes the movement of secretions from the lower to the upper respiratory tract? 1. Friction between the cilia. 2. Force of gravity. 3. Sweeping motion of cilia. 4. Involuntary muscle contractions.

2. The principle behind using postural drainage is that gravity will help move secretions from smaller to larger airways. Postural drainage is best used after percussion has loosened secretions. Coughing or suctioning is then used to remove secretions. Movement of cilia is not sufficient to move secretions. Muscle contractions do not move secretions within the lungs.

A client with bacterial pneumonia is to be started on I.V. antibiotics. Which of the following diagnostic tests must be completed before antibiotic therapy begins? 1. Urinalysis. 2. Sputum culture. 3. Chest radiograph. 4. Red blood cell count.

2. A sputum specimen is obtained for culture to determine the causative organism. After the organism is identified, an appropriate antibiotic can be prescribed. Beginning antibiotic therapy before obtaining the sputum specimen may alter the results of the test. Neither a urinalysis, a chest radiograph, nor a red blood cell count needs to be obtained before initiation of antibiotic therapy for pneumonia.

A client with chronic obstructive pulmonary disease (COPD) is experiencing dyspnea and has a low PaO2 level. The nurse plans to administer oxygen as ordered. Which of the following statements is true concerning oxygen administration to a client with COPD? 1. High oxygen concentrations will cause coughing and dyspnea. 2. High oxygen concentrations may inhibit the hypoxic stimulus to breathe. 3. Increased oxygen use will cause the client to become dependent on the oxygen. 4. Administration of oxygen is contraindicated in clients who are using bronchodilators.

2. Clients who have a long history of COPD may retain carbon dioxide (CO2). Gradually the body adjusts to the higher CO2 concentration, and the high levels of CO2 no longer stimulate the respiratory center. The major respiratory stimulant then becomes hypoxemia. Administration of high concentrations of oxygen eliminates this respiratory stimulus and leads to hypoventilation. Oxygen can be drying if it is not humidified, but it does not cause coughing and dyspnea. Increased oxygen use will not create an oxygen dependency; clients should receive oxygen as needed. Oxygen is not contraindicated with the use of bronchodilators.

The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). pH 7.35; PC02 62; PO2 70; HCO3 34 The nurse should: 1. Apply a 100% non-rebreather mask. 2. Assess the vital signs. 3. Reposition the client. 4. Prepare for intubation.

2. Clients with chronic COPD have CO2 retention and the respiratory drive is stimulated when the PO2 decreases. The heart rate, respiratory rate, and blood pressure should be evaluated to determine if the client is hemodynamically stable. Symptoms, such as dyspnea, should also be assessed. Oxygen supplementation, if indicated, should be titrated upward in small increments. There is no indication that the client is experiencing respiratory distress requiring intubation.

When teaching a client with chronic obstructive pulmonary disease to conserve energy, the nurse should teach the client to lift objects: 1. While inhaling through an open mouth. 2. While exhaling through pursed lips. 3. After exhaling but before inhaling. 4. While taking a deep breath and holding it.

2. Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves energy and reduces perceived dyspnea. Pursing the lips prolongs exhalation and provides the client with more control over breathing. Lifting after exhaling but before inhaling is similar to lifting with the breath held. This should not be recommended because it is similar to the Valsalva maneuver, which can stimulate cardiac arrhythmias.

A client's arterial blood gas values are as follows: pH, 7.31; PaO2, 80 mm Hg; PaCO2, 65 mm Hg; HCO3 −, 36 mEq/ L. The nurse should assess the client for? 1. Cyanosis. 2. Flushed skin. 3. Irritability. 4. Anxiety.

2. The high PaCO2 level causes flushing due to vasodilation. The client also becomes drowsy and lethargic because carbon dioxide has a depressant effect on the central nervous system. Cyanosis is a sign of hypoxia. Irritability and anxiety are not common with a PaCO2 level of 65 mm Hg but are associated with hypoxia.

The nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack? 1. Occupational exposure to toxins. 2. Viral respiratory infections. 3. Exposure to cigarette smoke. 4. Exercising in cold temperatures.

2. The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or a cold and should get yearly flu vaccinations. Environmental exposure to toxins or heavy particulate matter can trigger asthma attacks; however, far fewer asthmatics are exposed to such toxins than are exposed to viruses. Cigarette smoke can also trigger asthma attacks, but to a lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising in cold weather.

3 stages of inflammation:

2. Stage 2: Neutrophils - attack, destroy and phagocytized, exudate formation occurs - pus

catheter used for invasive arterial BP

20 gauge, 2 inch, sutured in placed with arm immobilized

Normal HCO3 range

21-28 according to the HESI book

HCO3- normal range

22 to 26 mEq/L

Normal HCO3 range

22-26 mEq/L

Percentage of oxygen a nasal cannula delivers?

28-44% (2-6L)

Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia? 1. Coma. 2. Apathy. 3. Irritability. 4. Depression.

3. Clients who are experiencing hypoxia characteristically exhibit irritability, restlessness, or anxiety as initial mental status changes. As the hypoxia becomes more pronounced, the client may become confused and combative. Coma is a late clinical manifestation of hypoxia. Apathy and depression are not symptoms of hypoxia.

A client with pneumonia has a temperature of 102.6 ° F (39.2 ° C), is diaphoretic, and has a productive cough. The nurse should include which of the following measures in the plan of care? 1. Position changes every 4 hours. 2. Nasotracheal suctioning to clear secretions. 3. Frequent linen changes 4. Frequent offering of a bedpan.

3. Frequent linen changes are appropriate for this client because of the diaphoresis. Diaphoresis produces general discomfort. The client should be kept dry to promote comfort. Position changes need to be done every 2 hours. Nasotracheal suctioning is not indicated with the client's productive cough. Frequent offering of a bedpan is not indicated by the data provided in this scenario.

When caring for the client who is receiving an aminoglycoside antibiotic, the nurse should monitor which of the following laboratory values? 1. Serum sodium. 2. Serum potassium. 3. Serum creatinine. 4. Serum calcium.

3. It is essential to monitor serum creatinine in the client receiving an aminoglycoside antibiotic because of the potential of this type of drug to cause acute tubular necrosis. Aminoglycoside antibiotics do not affect serum sodium, potassium, or calcium levels.

The nurse teaches a client with chronic obstructive pulmonary disease (COPD) to assess for signs and symptoms of right-sided heart failure. Which of the following signs and symptoms should be included in the teaching plan? 1. Clubbing of nail beds. 2. Hypertension. 3. Peripheral edema. 4. Increased appetite.

3. Right-sided heart failure is a complication of COPD that occurs because of pulmonary hypertension. Signs and symptoms of right-sided heart failure include peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to increased fluid volume. Clubbing of nail beds is associated with conditions of chronic hypoxemia. Hypertension is associated with left-sided heart failure. Clients with heart failure have decreased appetites.

A client with pneumonia is experiencing pleuritic chest pain. The nurse should assess the client for: 1. A mild but constant aching in the chest. 2. Severe midsternal pain. 3. Moderate pain that worsens on inspiration. 4. Muscle spasm pain that accompanies coughing.

3. Chest pain in pneumonia is generally caused by friction between the pleural layers. It is more severe on inspiration than on expiration, secondary to chest wall movement. Pleuritic chest pain is usually described as sharp, not mild or aching. Pleuritic chest pain is not localized to the sternum, and it is not the result of a muscle spasm.

A client with acute asthma is prescribed short-term corticosteroid therapy. Which is the expected outcome for the use of steroids in clients with asthma? 1. Promote bronchodilation. 2. Act as an expectorant. 3. Have an anti-inflammatory effect. 4. Prevent development of respiratory infections.

3. Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.

A nurse notes that a client has kyphosis and generalized muscle atrophy. Which of the following problems is a priority when the nurse develops a nursing plan of care? 1. Infection. 2. Confusion. 3. Ineffective coughing and deep breathing. 4. Difficulty chewing solid foods.

3. In kyphosis, the thoracic spine bends forward with convexity of the curve in a posterior direction, making effective coughing and deep breathing difficult. Although the client may develop other problems because respiratory status deteriorates when pulmonary secretions are not adequately cleared from airways, ineffective coughing and deep breathing should receive priority attention.

The nurse administers theophylline (Theo-Dur) to a client. To evaluate the effectiveness of this medication, which of the following drug actions should the nurse anticipate? 1. Suppression of the client's respiratory infection. 2. Decrease in bronchial secretions. 3. Relaxation of bronchial smooth muscle. 4. Thinning of tenacious, purulent sputum.

3. Theophylline (Theo-Dur) is a bronchodilator that is administered to relax airways and decrease dyspnea. Theophylline is not used to treat infections and does not decrease or thin secretions.

A client who has been taking flunisolide (AeroBid), two inhalations a day, for treatment of asthma.has painful, white patches in his mouth. Which response by the nurse would be most appropriate? 1. "This is an anticipated adverse effect of your medication. It should go away in a couple of weeks." 2. "You are using your inhaler too much and it has irritated your mouth." 3. "You have developed a fungal infection from your medication. It will need to be treated with an antifungal agent." 4. "Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem."

3. Use of oral inhalant corticosteroids such as flunisolide (AeroBid) can lead to the development of oral thrush, a fungal infection. Once developed, thrush must be treated by antifungal therapy; it will not resolve on its own. Fungal infections can develop even without overuse of the corticosteroid inhaler. Although good oral hygiene can help prevent development of a fungal infection, it cannot be used alone to treat the problem.

3 stages of inflammation:

3. Stage 3: Cellular repair and replacement - it doesn't repair 100% all the time, which leads to scar tissue formation. This scar tissue doesn't perform as well as normal tissue does, it depends on how much inflammation occurred and for how long that inflammatory response was.

Normal PCO2 range

35-45

Normal PaCO2 range

35-45 mm Hg

Erb's point

3rd intercostal space, left of sternum aortic and pulmonic murmurs

Which of the following is an expected outcome of pursed-lip breathing for clients with emphysema? 1. To promote oxygen intake. 2. To strengthen the diaphragm. 3. To strengthen the intercostal muscles. 4. To promote carbon dioxide elimination.

4. Pursed-lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby promoting carbon dioxide elimination. By prolonging exhalation and helping the client relax, pursed-lip breathing helps the client learn to control the rate and depth of respiration. Pursed-lip breathing does not promote the intake of oxygen, strengthen the diaphragm, or strengthen intercostal muscles.

The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following? 1. Decreased cardiac output. 2. Pleural effusion. 3. Inadequate peripheral circulation. 4. Decreased oxygenation of the blood.

4. A client with pneumonia has less lung surface available for the diffusion of gases because of the inflammatory pulmonary response that creates lung exudate and results in reduced oxygenation of the blood. The client becomes cyanotic because blood is not adequately oxygenated in the lungs before it enters the peripheral circulation. Decreased cardiac output may be a comorbid condition in some clients with pneumonia; however, it is not the cause of cyanosis. Pleural effusions are a potential complication of pneumonia but are not the primary cause of decreased oxygenation. Inadequate peripheral circulation is also not the cause of the cyanosis that develops with bacterial pneumonia.

Which of the following is an appropriate expected outcome for an adult client with well-controlled asthma? 1. Chest X-ray demonstrates minimal hyperinflation. 2. Temperature remains lower than 100 ° F (37. 8 ° C). 3. Arterial blood gas analysis demonstrates a decrease in PaO2. 4. Breath sounds are clear.

4. Between attacks, breath sounds should be clear on auscultation with good air flow present throughout lung fields. Chest X-rays should be normal. The client should remain afebrile. Arterial blood gases should be normal.

When instructing clients on how to decrease the risk of chronic obstructive pulmonary disease (COPD), the nurse should emphasize which of the following? 1. Participate regularly in aerobic exercises. 2. Maintain a high-protein diet. 3. Avoid exposure to people with known respiratory infections. 4. Abstain from cigarette smoking.

4. Cigarette smoking is the primary cause of COPD. Other risk factors include exposure to environmental pollutants and chronic asthma. Participating in an aerobic exercise program, although beneficial, will not decrease the risk of COPD. Insufficient protein intake and exposure to people with respiratory infections do not increase the risk of COPD.

The nurse assesses the respiratory status of a client who is experiencing an exacerbation of chronic obstructive pulmonary disease (COPD) secondary to an upper respiratory tract infection. Which of the following findings would be expected? 1. Normal breath sounds. 2. Prolonged inspiration. 3. Normal chest movement. 4. Coarse crackles and rhonchi.

4. Exacerbations of COPD are commonly caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. In COPD, breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. Expiration, not inspiration, becomes prolonged. Chest movement is decreased as lungs become overdistended.

A 34-year-old female with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/ minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, which action should the nurse take to initiate care of the client? 1. Initiate oxygen therapy and reassess the client in 10 minutes. 2. Draw blood for an arterial blood gas analysis and send the client for a chest X-ray. 3. Encourage the client to relax and breathe slowly through the mouth. 4. Administer bronchodilators.

4. In an acute asthma attack, diminished or absent breath sounds can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, I.V. corticosteroids and, possibly, I.V. theophylline (Theo-Dur). Administering oxygen and reassessing the client 10 minutes later would delay needed medical intervention, as would drawing blood for an arterial blood gas analysis and obtaining a chest X-ray. It would be futile to encourage the client to relax and breathe slowly without providing the necessary pharmacologic intervention.

Which of the following indicates that the client with chronic obstructive pulmonary disease (COPD) who has been discharged to home understands his care plan? 1. The client promises to do pursed-lip breathing at home. 2. The client states actions to reduce pain. 3. The client says that he will use oxygen via a nasal cannula at 5 L/ minute. 4. The client agrees to call the physician if dyspnea on exertion increases.

4. Increasing dyspnea on exertion indicates that the client may be experiencing complications of COPD. Therefore, the nurse should notify the physician. Extracting promises from clients is not an outcome criterion. Pain is not a common symptom of COPD. Clients with COPD use low-flow oxygen supplementation (1 to 2 L/ minute) to avoid suppressing the respiratory drive, which, for these clients, is stimulated by hypoxia. .

Which of the following diets would be most appropriate for a client with chronic obstructive pulmonary disease (COPD)? 1. Low-fat, low-cholesterol diet. 2. Bland, soft diet. 3. Low-sodium diet. 4. High-calorie, high-protein diet.

4. The client should eat high-calorie, high-protein meals to maintain nutritional status and prevent weight loss that results from the increased work of breathing. The client should be encouraged to eat small, frequent meals. A low-fat, low-cholesterol diet is indicated for clients with coronary artery disease. The client with COPD does not necessarily need to follow a sodium-restricted diet, unless otherwise medically indicated. There is no need for the client to eat bland, soft foods.

Which of the following measures would most likely be successful in reducing pleuritic chest pain in a client with pneumonia? 1. Encourage the client to breathe shallowly. 2. Have the client practice abdominal breathing. 3. Offer the client incentive spirometry. 4. Teach the client to splint the rib cage when coughing.

4. The pleuritic pain is triggered by chest movement and is particularly severe during coughing. Splinting the chest wall will help reduce the discomfort of coughing. Deep breathing is essential to prevent further atelectasis. Abdominal breathing is not as effective in decreasing pleuritic chest pain as is splinting of the rib cage. Incentive spirometry facilitates effective deep breathing but does not decrease pleuritic chest pain.

Methylzanthines

4th line drug in COPD and asthma ex) amanophylline and theophylline (400 mg/day or LESS) narrow theraputic range (10-20) Amanophylline needs own IV line and can not mix with anything (no piggy backs)

What is the age range where cancer of the larynx usually occurs?

55-70

Percentage of oxygen a partial rebreather mask delivers?

60-75%

While reviewing a clients lab results, the nurse recognizes that a fasting glucose value of ________________ is within normal limits.

PaO2 normal range

80 to 100 mm Hg

SaO2 below ____% is life-threatning.

80%; the lower the SaO2 level, the less acurate the value

Normal PO2 range

80-100

Normal PaO2 range

80-100 mm Hg

SaO2 below ____% requires emergency

86%

How long does TB therapy typically last?

9-12 months

SaO2

95 to 100%

Accepted reference range for SaO2

95% to 100%, acceptable levels may range from 91% to 100%. Some illness state may even allow for an SaO2 of 85% to 89%; may be slightly lower in older adult & those w/dark skin

Expected O2 range

95%-100%; may range from 91%-100%; some illnesses allow 85%-89%

Normal SaO2 range

95-100 %

Normal O2 saturation

95-100%

At what SaO2 level is considered "life-threatening"?

<80%

At what SaO2 level is considered an emergency?

<86%

What is considered excess drainage (for a chest tube)?

>70mL/hr Drainage will often increase with position changes or coughing.

8. To evaluate both oxygenation and ventilation in a patient with acute respiratory failure, the nurse uses the findings revealed with a. arterial blood gas (ABG) analysis. b. hemodynamic monitoring. c. chest x-rays. d. pulse oximetry.

A Rationale: ABG analysis is useful because it provides information about both oxygenation and ventilation and assists with determining possible etiologies and appropriate treatment. The other tests may also provide useful information about patient status but will not indicate whether the patient has hypoxemia, hypercapnia, or both. Cognitive Level: Comprehension Text Reference: p. 1805 Nursing Process: Assessment NCLEX: Physiological Integrity

19. Which information obtained by the nurse when assessing a patient with acute respiratory distress syndrome (ARDS) who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates a complication of ventilator therapy is occurring? a. The patient has subcutaneous emphysema. b. The patient has a sinus bradycardia, rate 52. c. The patient's PaO2 is 50 mm Hg and the SaO2 is 88%. d. The patient has bronchial breath sounds in both the lung fields.

A Rationale: Complications of positive-pressure ventilation (PPV) and PEEP include subcutaneous emphysema. Bradycardia, hypoxemia, and bronchial breath sounds are all concerns, but they are not caused by PPV and PEEP. Cognitive Level: Application Text Reference: p. 1816 Nursing Process: Assessment NCLEX: Physiological Integrity

2. The nurse will monitor for clinical manifestations of hypercapnia when a patient in the emergency department has a. chest trauma and multiple rib fractures. b. carbon monoxide poisoning after a house fire. c. left-sided ventricular failure and acute pulmonary edema. d. tachypnea and acute respiratory distress syndrome (ARDS).

A Rationale: Hypercapnia is caused by poor ventilatory effort, which occurs in chest trauma when rib fractures (or flail chest) decrease lung ventilation. Carbon monoxide poisoning, acute pulmonary edema, and ARDS are more commonly associated with hypoxemia. Cognitive Level: Application Text Reference: p. 1800 Nursing Process: Assessment NCLEX: Physiological Integrity

14. When admitting a patient in possible respiratory failure with a high PaCO2, which assessment information will be of most concern to the nurse? a. The patient is somnolent. b. The patient's SpO2 is 90%. c. The patient complains of weakness. d. The patient's blood pressure is 162/94.

A Rationale: Increasing somnolence will decrease the patient's respiratory rate and further increase the PaCO2 and respiratory failure. Rapid action is needed to prevent respiratory arrest. An SpO2 of 90%, weakness, and elevated blood pressure all require ongoing monitoring but are not indicators of possible impending respiratory arrest. Cognitive Level: Application Text Reference: p. 1804 Nursing Process: Assessment NCLEX: Physiological Integrity

22. A patient with acute respiratory distress syndrome (ARDS) has progressed to the fibrotic phase. The patient's family members are anxious about the patient's condition and are continuously present at the hospital. In addressing the family's concerns, it is important for the nurse to a. support the family and help them understand the realistic expectation that the patient's chance for survival is poor. b. inform the family that home health nurses will be able to help them maintain the mechanical ventilation at home after patient discharge. c. refer the family to social support services and case management to plan for transfer of the patient to a long-term care facility. d. provide hope and encouragement to the family because the patient's disease process has started to resolve.

A Rationale: The chance for survival is poor when the patient progresses to the fibrotic stage because permanent damage to the alveoli has occurred. Because of continued severe hypoxemia, the patient is not a candidate for home health or long-term care. The fibrotic stage indicates a poor patient prognosis, not the resolution of the ARDS process. Cognitive Level: Application Text Reference: p. 1814 Nursing Process: Implementation NCLEX: Psychosocial Integrity

5. A patient is brought to the emergency department unconscious following a barbiturate overdose. Which potential complication will the nurse include when developing the plan of care? a. Hypercapnic respiratory failure related to decreased ventilatory effort b. Hypoxemic respiratory failure related to diffusion limitations c. Hypoxemic respiratory failure related to shunting of blood d. Hypercapnic respiratory failure related to increased airway resistance

A Rationale: The patient with an opioid overdose develops hypercapnic respiratory failure as a result of the decrease in respiratory rate and depth. Diffusion limitations, blood shunting, and increased airway resistance are not the primary pathophysiology causing the respiratory failure. Cognitive Level: Application Text Reference: p. 1800 Nursing Process: Diagnosis NCLEX: Physiological Integrity

What are some signs of lung cancer?

A dry hacking cough that progresses to productive as disease progresses, hoarseness, hemoptysis and rust colored sputum

Chronic Airflow Limitation

A group of chronic lung diseases that include: 1. Asthma: intermittent and reversible 2. Chronic bronchitis 3. Emphysema

Cyanosis, the blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries, is:

A late sign of hypoxia Cyanosis, blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries, is a late sign of hypoxia. The presence or absence of cyanosis is not a reliable measure of oxygen status.

A client arrives in the emergency department complaining of chest pain began 4 hours ago. A troponin T blood specimen is obtained, and the results indicate a level of 0.69ng/mL. The nurse interprets that this result indicates

A level that indicates angina pectoris

Residual Volume (RV)

Amount of air remaining in lungs after forced expiration. Allows for gas exchange to continue and prevents lung collapse Norm: 1.5 L

After receiving change-of-shift report, which patient will the nurse assess first?

A patient with septicemia who has intercostal and suprasternal retractions rationale: This patient's history of septicemia and labored breathing suggest the onset of ARDS, which will require rapid interventions such as administration of oxygen and use of positive pressure ventilation. The other patients also should be assessed as quickly as possible, but their assessment data are typical of their disease processes and do not suggest deterioration in their status.

A nurse is caring for a client with respiratory insufficiency. The ABG results indicate a pH of 7.50 and a PC02 of mm Hg, and the nurse is told that the client is experiencing respiratory alkalosis. Which of the following additional lab values would the nurse expect to note?

A potassium level of 3.2 mEq/L

What is PEEP?

A small amount of pressure used to keep the airway open on expiration

The client has recently returned from having a thyroidectomy. The nurse should keep which of the following at the bedside?

A tracheotomy set

_____ released from the posterior pituitary, directly increases water reabosorption by the kidneys, thus increasing blood volume and blood pressure

ADH antidiureitc hormone

What increases the amount of water reabsorbed by the kidney tubules, which decreases urine output?

ADH-antidiuretic hormone

______ increases the rexcretion fo sodium by the kidneys

ANP arterial natriuretic peptide

What does the pulse ox monitor?

ARTERIAL blood (infrared wave measures light absorption)

following a motor-vehicle crash a client is admitted with multiple trauma, including significant bruising of the left chest from striking the steering wheel. the client is alert and reports severe left chest pain on inspiration. The nurse should assess the client for manifestations of pneumothorax, including which of the following? Absence of breath sounds Expiratory wheezing Inspiratory stridor Rhonchi

Absence of breath sounds

ABG is a measurement of what?

Acid-base balance of the blood pH (amt of hydrogen ions in the arterial blood), PaO2 (partial pressure of oxygen), PaCO2 (partial pressure of CO2), HCO3 (concentration of bicarb in blood), SaO2 (% of oxygen bound to Hgb compared the the amt that can be carried).

Blood pH below 7.35 reflect ______.

Acidosis

Name 2 prescribed antihistamine

Acrivastne/pseudoephedrine(Semprex-D), Azelastine hydrochloride(Astelin), Brompheniramine(Brovex)

Drug therapy for TB

Active disease is treated with combo of 4 drugs: INH, rifampin and 2 others. Measure treatment by AFB. if negative continue treatment for 3 months. (acid fast bacillus sputum test).

highest priority nursing intervention for patient just diagnosed with pulmonary embolism?

Administer IV heparin at 1,300 units per hour

Tidal Volume (Vt)

Amount of air inhale and exhaled normally with each breath. Norm: 0.5 L

Expiratory Reserve Volume (ERV)

Amount of air that can be forcefully exhaled after normal exhalation Norm: 1.0 L

Albuterol sulfate (Proventil, Volmax) is a: