Chapter 19: Management of Patients with Chest and Lower Respiratory

The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient? 13 to 18 months 6 to 12 months 3 to 5 months 3 months

6 to 12 months

What assessment method would the nurse use to determine the areas of the lungs that need draining? Auscultation Inspection Chest X-ray Arterial blood gas (ABG) levels

Auscultation

What health problem in the patients history is most likely to have caused the empyema? A)Smoking B)Asbestosis C)Pneumonia D)Lung cancer

C)Pneumonia

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

Circulatory hypoxia

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

Encouraging increased fluid intake

A mediastinal shift occurs in which type of chest disorder? Cardiac tamponade Traumatic pneumothorax Simple pneumothorax Tension pneumothorax

Tension pneumothorax

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

0 to 4 mm

A nurse is administering a purified protein derivative (PPD) test to a client. Which statement concerning PPD testing is true? A negative reaction always excludes the diagnosis of TB. The PPD can be read within 12 hours after the injection. A positive reaction indicates that the client has been exposed to the disease. A positive reaction indicates that the client has active tuberculosis (TB).

A positive reaction indicates that the client has been exposed to the disease.

The ICU nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following? Acute respiratory distress syndrome Tracheobronchitis Lung cancer Bronchitis

Acute respiratory distress syndrome

Which type of lung cancer is the most prevalent among both men and women? Large cell carcinoma Adenocarcinoma Small cell carcinoma Squamous cell carcinoma

Adenocarcinoma

A new ICU nurse is observed by her preceptor entering a patient's room to suction the tracheostomy after performing the task 15 minutes before. What should the preceptor educate the new nurse to do to ensure that the patient needs to be suctioned? Have the patient inform the nurse of the need to be suctioned. Have the patient cough. Assess the CO2 level to determine if the patient requires suctioning. Auscultate the lung for adventitious sounds.

Auscultate the lung for adventitious sounds.

The nurse is caring for a client with an endotracheal tube who is on a ventilator. When assessing the client, the nurse knows to maintain what cuff pressure to maintain appropriate pressure on the tracheal wall? Between 20 and 25 mm Hg Between 25 and 30 mm Hg Between 15 and 20 mm Hg Between 10 and 15 mm Hg

Between 20 and 25 mm Hg

A victim has sustained a blunt force trauma to the chest. A pulmonary contusion is suspected. Which of the following clinical manifestations correlate with a moderate pulmonary contusion? Respiratory alkalosis Productive cough Blood-tinged sputum Bradypnea

Blood-tinged sputum

A nurse is caring for a client who has just been diagnosed with lung cancer. What is a cardinal sign of lung cancer? Shortness of breath Obvious trauma Cough or change in chronic cough Pain on inspiration

Cough or change in chronic cough

A nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest bacterial pneumonia? Hemoptysis and dysuria Sore throat and abdominal pain Nonproductive cough and normal temperature Dyspnea and wheezing

Dyspnea and wheezing

A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside? Tracheostomy cleaning kit Oxygen analyzer Manual resuscitation bag Water-seal chest drainage set-up

Manual resuscitation bag

The nurse is admitting a patient with COPD. The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia? HCO3 pH PaO2 PCO2

PaO2

The nurse is teaching the client in respiratory distress ways to prolong exhalation to improve respiratory status. The nurse tells the client to Initially inhale through the mouth. Sit in an upright position only. Purse the lips when exhaling air from the lungs. Hold the breath for 5 seconds and then exhale.

Purse the lips when exhaling air from the lungs.

The nurse is caring for a client who is ready to be weaned from the ventilator. In preparing to assist in the collaborative process of weaning, the nurse should anticipate that the weaning of the client will progress in what order? Removal from the ventilator, tube, and then oxygen Removal from oxygen, ventilator, and then tube Removal from oxygen, tube, and then ventilator Removal of the tube, oxygen, and then ventilator

Removal from the ventilator, tube, and then oxygen

You are caring for a client status post lung resection. When assessing your client you find that the bubbling in the water-seal chamber for the chest tubes is more than you expected. What should you check when bubbling in the water-seal chamber is excessive? See if there are leaks in the system. See if the wall suction unit has malfunctioned. See if a kink has developed in the tubing. See if the chest tube is clogged.

See if there are leaks in the system.

The nurse is assisting a physician with an endotracheal intubation for a client in respiratory failure. It is most important for the nurse to assess for: A scheduled time for deflation of the tracheal cuff Tracheal cuff pressure set at 30 mm Hg Cool air humidified through the tube Symmetry of the client's chest expansion

Symmetry of the client's chest expansion

A mediastinal shift occurs in which type of chest disorder? Simple pneumothorax Tension pneumothorax Cardiac tamponade Traumatic pneumothorax

Tension pneumothorax

A nurse is caring for a client who is at high risk for developing pneumonia. Which intervention should the nurse include on the client's care plan? Keeping the head of the bed at 15 degrees or less Turning the client every 4 hours to prevent fatigue Providing oral hygiene daily Using strict hand hygiene

Using strict hand hygiene

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

Volume cycled

After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes? Water-seal chamber Suction control chamber Collection chamber Air-leak chamber

Water-seal chamber

A client who is undergoing thoracic surgery has a nursing diagnosis of "Impaired gas exchange related to lung impairment and surgery" on the nursing care plan. Which of the following nursing interventions would be appropriately aligned with this nursing diagnosis? Select all that apply. Monitor and record hourly intake and output. Encourage deep breathing exercises. Monitor pulmonary status as directed and needed. Regularly assess the client's vital signs every 2 to 4 hours. Request order for patient-controlled analgesia pump

• Monitor pulmonary status as directed and needed.• Regularly assess the client's vital signs every 2 to 4 hours. • Encourage deep breathing exercises

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

6 to 12 months

Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis? A)"If the test area turns red that means I have tuberculosis." B)"I will come back in 1 week to have the test read." C)"I will avoid contact with my family until I am done with the test." D)"Because I had a previous reaction to the test, this time I need to get a chest X-ray."

D)"Because I had a previous reaction to the test, this time I need to get a chest X-ray."

The occupational nurse is completing routine assessments on the employees at a company. What might be revealed by a chest radiograph for a client with occupational lung diseases? Hemorrhage Damage to surrounding tissues Fibrotic changes in lungs Lung contusion

Fibrotic changes in lungs

A patient arrives in the emergency department after being involved in a motor vehicle accident. The nurse observes paradoxical chest movement when removing the patient's shirt. What does the nurse know that this finding indicates? Flail chest Tension pneumothorax ARDS Pneumothorax

Flail chest

The nurse suctions a patient through the endotracheal tube for 20 seconds and observes dysrhythmias on the monitor. What does the nurse determine is occurring with the patient? The patient is having a myocardial infarction. The patient is in a hypermetabolic state. The patient is having a stress reaction. The patient is hypoxic from suctioning.

The patient is hypoxic from suctioning.

A client is admitted to the health care facility with active tuberculosis (TB). What intervention should the nurse include in the client's care plan? Keeping the door to the client's room open to observe the client Wearing a gown and gloves when providing direct care Wearing a disposable particulate respirator that fits snugly around the face Instructing the client to wear a mask at all times

Wearing a disposable particulate respirator that fits snugly around the face

A nurse is teaching a client how to perform flow type incentive spirometry prior to his scheduled thoracic surgery. What instruction should the nurse provide to the client? "When you're ready, blow hard into the spirometer for as long as you can." "Hold the spirometer at your lips and breathe in and out like you normally would." "Breathe in deeply through the spirometer, hold your breath briefly, and then exhale." "Take a deep breath and then blow short, forceful breaths into the spirometer."

"Breathe in deeply through the spirometer, hold your breath briefly, and then exhale."

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? "I'll always have a positive test for tuberculosis." "This disease may come back later if I am under stress." "I'll have to take the medication for up to a year." "I'll stay in isolation for 6 weeks."

"I'll stay in isolation for 6 weeks."

A nurse is preparing dietary recommendations for a client with a lung abscess. Which statement would be included in the plan of care? "You must consume a diet high in carbohydrates, such as bread, potatoes, and pasta." "You must consume a diet low in calories, such as skim milk, fresh fruits, and vegetables." "You must consume a diet low in fat by limiting dairy products and concentrated sweets." "You must consume a diet rich in protein, such as chicken, fish, and beans."

"You must consume a diet rich in protein, such as chicken, fish, and beans."

A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What should the nurse tell the patient? "You should switch to wearing your glasses while taking this medication." "There are no significant problems with wearing contact lenses." "The physician can give you eye drops to prevent any problems." "Only wear your contact lenses during the day and take them out in the evening before bed."

"You should switch to wearing your glasses while taking this medication."

The nurse caring for a 2-year-old near-drowning victim monitors for what possible complication? Metabolic alkalosis Respiratory acidosis Atelectasis Acute respiratory distress syndrome

Acute respiratory distress syndrome

The nurse is caring for a client following a wedge resection. While the nurse is assessing the client's chest tube drainage system, constant bubbling is noted in the water seal chamber. This finding indicates which problem? Tension pneumothorax Tidaling Increased drainage Air leak

Air leak

A client has a sucking stab wound to the chest. Which action should the nurse take first? Prepare a chest tube insertion tray. Draw blood for a hematocrit and hemoglobin level. Prepare to start an I.V. line. Apply a dressing over the wound and tape it on three sides.

Apply a dressing over the wound and tape it on three sides.

A nurse should include what instruction for the client during postural drainage? Remain in each position for 30 to 45 minutes for best results. Lie supine to rest the lungs. Sit upright to promote ventilation. Change positions frequently and cough up secretions.

Change positions frequently and cough up secretions.

A patient is admitted to the hospital with pulmonary arterial hypertension. What assessment finding by the nurse is a significant finding for this patient? Ascites Syncope Dyspnea Hypertension

Dyspnea

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

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

The occupational nurse is completing routine assessments on the employees at a company. What might be revealed by a chest radiograph for a client with occupational lung diseases? Fibrotic changes in lungs Lung contusion Hemorrhage Damage to surrounding tissues

Fibrotic changes in lungs

You are an occupational health nurse in a large ceramic manufacturing company. How would you intervene to prevent occupational lung disease in the employees of the company? Give workshops on disease prevention. Provide employees with smoking cessation materials. Fit all employees with protective masks. Insist on adequate breaks for each employee.

Fit all employees with protective masks.

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? Pulmonary contusion Flail chest Cardiac tamponade Simple pneumothorax

Flail chest

When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems? Hypercapnia, hypoventilation, and hypoxemia Hyperventilation, hypertension, and hypocapnia Hypotension, hyperoxemia, and hypercapnia Hyperoxemia, hypocapnia, and hyperventilation

Hypercapnia, hypoventilation, and hypoxemia

The nurse has instructed a client on how to perform pursed-lip breathing. The nurse recognizes the purpose of this type of breathing is to accomplish which result? Promote the strengthening of the client's diaphragm Promote the client's ability to take in oxygen Improve oxygen transport; induce a slow, deep breathing pattern; and assist the client to control breathing Promote more efficient and controlled ventilation and to decrease the work of breathing

Improve oxygen transport; induce a slow, deep breathing pattern; and assist the client to control breathing

A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be: Risk for falls. Ineffective breathing pattern. Ineffective airway clearance. Impaired tissue integrity.

Ineffective airway clearance.

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

It prolongs exhalation.

A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? A disconnected ventilator circuit A change in the oxygen concentration without resetting the oxygen level alarm Kinking of the ventilator tubing An ET cuff leak

Kinking of the ventilator tubing

A nurse has performed tracheal suctioning on a client who experienced increasing dyspnea prior to a procedure. When applying the nursing process, how can the nurse best evaluate the outcomes of this intervention? Determine whether the client can now perform forced expiratory technique (FET). Percuss the client's lungs and thorax. Have the client perform incentive spirometry. Measure the client's oxygen saturation.

Measure the client's oxygen saturation.

For a client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the care plan? Maintaining continuous bubbling in the water-seal chamber Keeping the collection chamber at chest level Measuring and documenting the drainage in the collection chamber Stripping the chest tube every hour

Measuring and documenting the drainage in the collection chamber

A client has been receiving 100% oxygen therapy by way of a nonrebreather mask for several days. Now the client complains of tingling in the fingers and shortness of breath, is extremely restless, and describes a pain beneath the breastbone. What should the nurse suspect? Oxygen toxicity Oxygen-induced atelectasis Oxygen-induced hypoventilation Hypoxia

Oxygen toxicity

A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? Partial pressure of arterial carbon dioxide (PaCO2) Partial pressure of arterial oxygen (PaO2) Bicarbonate (HCO3-) pH

Partial pressure of arterial oxygen (PaO2)

Which statement would indicate that the parents of child with cystic fibrosis understand the disorder? "There are fibrous cysts in the lungs." "Early treatment can stop the progression of the disease." "The mucus-secreting glands are abnormal." "Allergic reactions cause inflammation in the lungs."

Pneumothorax

You are caring for a client with chronic respiratory failure. What are the signs and symptoms of chronic respiratory failure? Progressive loss of lung function associated with chronic disease Sudden loss of lung function associated with chronic disease Progressive loss of lung function with history of normal lung function Sudden loss of lung function with history of normal lung function

Progressive loss of lung function associated with chronic disease

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

Pulmonary function studies

The nurse is caring for a client with an endotracheal tube (ET). Which nursing intervention is contraindicated? Deflating the cuff before removing the tube Checking the cuff pressure every 6 to 8 hours Routinely deflating the cuff Ensuring that humidified oxygen is always introduced through the tube

Routinely deflating the cuff

A client with myasthenia gravis is receiving continuous mechanical ventilation. When the high-pressure alarm on the ventilator sounds, what should the nurse do? Ventilate the client with a handheld mechanical ventilator. Check for an apical pulse. Suction the client's artificial airway. Increase the oxygen percentage.

Suction the client's artificial airway.

A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition? The client exhibits bronchial breath sounds over the affected area. The client exhibits restlessness and confusion. The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. The client has a partial pressure of arterial carbon dioxide (PaCO2) value of 65 mm Hg or higher.

The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher.

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

To remove air from the pleural space

A nurse is caring for a client who has a tracheostomy tube and who is undergoing mechanical ventilation. The nurse can help prevent tracheal dilation, a complication of tracheostomy tube placement, by: suctioning the tracheostomy tube frequently. using a cuffed tracheostomy tube. keeping the tracheostomy tube plugged. using the minimal-leak technique with cuff pressure less than 25 cm H2O.

using the minimal-leak technique with cuff pressure less than 25 cm H2O.