Chapter 25 - Respiratory System, Chapter 26 - Upper Respiratory Problems, Chapter 27 - Lower Respiratory Problems (Pneumonia & TB)

The nurse notes new onset confusion in an older patient who is normally alert and oriented. In which order should the nurse take the following actions? (Put a comma and a space between each answer choice [A, B, C, D].) a. Obtain the oxygen saturation. b. Check the patients pulse rate. c. Document the change in status. d. Notify the health care provider.

A, B, D, C Assessment for physiologic causes of new onset confusion such as pneumonia, infection, or perfusion problems should be the first action by the nurse. Airway and oxygenation should be assessed first, then circulation. After assessing the patient, the nurse should notify the health care provider. Finally, documentation of the assessments and care should be done.

A patient whose tracheostomy was inserted 30 minutes ago is recovering in the postanesthesia recovery unit when the tracheostomy tube is expelled by coughing. What is the priority action by the nurse? A. Suction the tracheostomy opening. B. Maintain the airway with a sterile hemostat. C. Use an Ambu bag and mask to ventilate the patient. D. Insert the tracheostomy tube obturator into the stoma.

B. Maintain the airway with a sterile hemostat. As long as the patient is not in acute respiratory distress after dislodging the tracheostomy tube, the nurse should use a sterile hemostat to maintain an open airway until a sterile tracheostomy tube can be reinserted into the tracheal opening. The tracheostomy is an open surgical wound that has not had time to mature into a stoma. If the patient is in respiratory distress, the nurse will use an Ambu bag and mask to ventilate the patient temporarily.

A patient has a tracheostomy tube after reconstructive surgery for invasive head and neck cancer. What is most important for the nurse to assess before performing tracheostomy cannula care? A. Level of consciousness B. Quality of breath sounds C. Presence of the gag reflex D. Tracheostomy cuff pressure

B. Quality of breath sounds Before performing tracheostomy care, the nurse will auscultate lung sounds to determine the presence of secretions. To prevent aspiration, secretions must be cleared either by coughing or by suctioning before performing tracheostomy cannula care.

Which task can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) in the care of a stable patient who has a tracheostomy? A. Assessing the need for suctioning B. Suctioning the patient's oropharynx C. Assessing the patient's swallowing ability D. Maintaining appropriate cuff inflation pressure

B. Suctioning the patient's oropharynx Providing the person has been trained in correct technique, the UAP may suction the patient's oropharynx. Assessing the need for suctioning should be performed by an RN or licensed practical nurse. An RN should perform a swallowing assessment and maintain cuff inflation pressure.

The nurse is caring for a patient with a tracheostomy. What is the priority nursing assessment for this patient? A. Electrolyte levels and daily weights B. Assessment of speech and swallowing C. Respiratory rate and oxygen saturation D. Pain assessment and assessment of mobility

C. Respiratory rate and oxygen saturation The priority assessment in the care of a patient with a tracheostomy focuses on airway and breathing. These assessments supersede the nurse's assessments that may also be necessary, such as nutritional status, speech, pain, and swallowing ability.

A patient is admitted for joint replacement surgery and has a permanent tracheostomy. Which task is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? A. Suction the tracheostomy. B. Check stoma site for skin breakdown. C. Complete tracheostomy care using sterile technique. D. Provide oral care with a toothbrush and tonsil suction tube.

D. Provide oral care with a toothbrush and tonsil suction tube. Oral care (for a stable patient with a tracheostomy) can be delegated to UAP. A registered nurse would be responsible for assessments (e.g., checking the stoma for skin breakdown) and tracheostomy suctioning and care.

Number the following organs in the order of the pathway of air inspired through the nose. . Number 1 is the first organ after the environment, and number 13 is the last organ before the alveoli. _______ a. Carina _______ b. Larynx _______ c. Glottis _______ d. Trachea _______ e. Epiglottis _______ f. Nasal cavity _______ g. Bronchioles _______ h. Oropharynx _______ i. Nasopharynx _______ j. Alveolar duct _______ k. Laryngopharynx _______ l. Mainstem bronchi _______ m. Segmental bronchi

___1____ f. Nasal cavity ___2____ i. Nasopharynx ___3____ h. Oropharynx ___4____ k. Laryngopharynx ___5____ e. Epiglottis ___6____ b. Larynx ___7____ c. Glottis ___8____ d. Trachea ___9____ a. Carina ___10____ l. Mainstem bronchi ___11____ m. Segmental bronchi ___12___ g. Bronchioles ___13____ j. Alveolar duct

Place the most common pathophysiologic stages of pneumonia in order. Number the first stage with 1 and the last stage with 4. ________ a. Macrophages lyse the debris and normal lung tissue and function is restored. ________ b. Mucus production increases and can obstruct airflow and further decrease gas exchange. ________ c. Inflammatory response in the lungs with neutrophils is activated to engulf and kill the offending organism. ________ d. Increased capillary permeability contributes to alveolar filling with organisms and neutrophils leading to hypoxia.

___1_____ c. Inflammatory response in the lungs with neutrophils is activated to engulf and kill the offending organism. ___2____ d. Increased capillary permeability contributes to alveolar filling with organisms and neutrophils leading to hypoxia. ___3____ b. Mucus production increases and can obstruct airflow and further decrease gas exchange. ____4____ a. Macrophages lyse the debris and normal lung tissue and function is restored. With most pneumonia-causing organisms the inflammatory response results in increased blood flow and neutrophils to engulf the offending organisms. The alveoli are filled with extra fluid from increased blood flow and capillary permeability from surrounding vessels, which leads to hypoxia. Mucus production is increased and can further obstruct airflow. With bacterial pneumonia consolidation occurs when the alveoli fill with fluid and debris. Macrophages lyse and process the debris so that normal gas exchange returns.

Which statement indicates the patient with asthma requires further teaching about self-care? a. "I use my corticosteroid inhaler when I feel short of breath." b. "I get a flu shot every year and see my HCP if I have an upper respiratory tract infection." c. "I use my inhaler before I visit my aunt who has a cat, but I only visit for a few minutes because of my allergies." d. "I walk 30 minutes every day but sometimes I have to use my bronchodilator inhaler before walking to prevent me from getting short of breath."

a. "I use my corticosteroid inhaler when I feel short of breath."

The nurse recognizes that additional teaching is necessary about medications when the patient with moderate asthma makes which statements (select all that apply)? a. "If I can't afford all of my medicines, I will only use the salmeterol (Serevent)." b. "I will stay inside if there is a high pollen count to prevent having an asthma attack." c. "I will rinse my mouth after using fluticasone (Flovent HFA) to prevent oral candidiasis." d. "I must have omalizumab (Xolair) injected every 2 to 4 weeks because inhalers don't help my asthma." e. "I can use my inhaler 3 times, every 20 minutes, before going to the hospital if my peak flow has not improved." f. "My gastroesophageal reflux disease (GERD) medications will help my asthma, and my asthma medications will help my GERD."

a. "If I can't afford all of my medicines, I will only use the salmeterol (Serevent)." f. "My gastroesophageal reflux disease (GERD) medications will help my asthma, and my asthma medications will help my GERD." With asthma, salmeterol (Serevent) should not be taken without inhaled corticosteroids. Gastroesophageal reflux disease (GERD) medications help asthma, but asthma medications may make GERD symptoms worse by relaxing the lower esophageal sphincter. The rest of the statements show patient understanding.

The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. Which patient will require the most rapid action by the nurse? a. 22-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg b. 34-year-old with ABG results: pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg c. 45-year-old with ABG results: pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg d. 65-year-old with ABG results: pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg

a. 22-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg The pH, PaCO2, and PaO2 indicate that the patient has severe uncompensated respiratory acidosis and hypoxemia. Rapid action will be required to prevent increasing hypoxemia and correct the acidosis. The other patients also should be assessed as quickly as possible but do not require interventions as quickly as the 22-year-old.

The nurse is caring for a patient with a fever due to pneumonia. What assessment data does the nurse obtain that correlates with the patient having a fever? (Select all that apply.) a. A temperature of 101.4° F b. Heart rate of 120 beats/min c. Respiratory rate of 20 breaths/min d. A productive cough with yellow sputum e. Reports of unable to have a bowel movement for 2 days

a. A temperature of 101.4° F b. Heart rate of 120 beats/min d. A productive cough with yellow sputum A fever is an inflammatory response related to the infectious process. A productive cough with discolored sputum (which should be clear) is an indication that the patient has pneumonia. A respiratory rate of 20 breaths/min is within normal range. Inability to have a bowel movement is not related to a diagnosis of pneumonia. A heart rate of 120 beats/min indicates that there is increased metabolism due to the fever and is related to the diagnosis of pneumonia.

Risk Factor for or Response to Respiratory Problem: Decreased exercise or activity tolerance, dyspnea on rest or exertion, sedentary habits. Which Functional Health Pattern does it fall under? a. Activity-exercise b. Sleep-rest c. Cognitive-perceptual d. Self-perception- self-concept

a. Activity-exercise

Which factors will the nurse consider when calculating the CURB-65 score for a patient with pneumonia (select all that apply)? a. Age b. Blood pressure c. Respiratory rate d. Oxygen saturation e. Presence of confusion f. Blood urea nitrogen (BUN) level

a. Age b. Blood pressure c. Respiratory rate e. Presence of confusion f. Blood urea nitrogen (BUN) level Data collected for the CURB-65 are mental status (confusion), BUN (elevated), blood pressure(decreased), respiratory rate (increased), and age (65 and older). The other information is also essential to assess, but are not used for CURB-65 scoring.

What is the Precaution protocol for a patient with TB? a. Airborne precautions b. Enteric precautions c. Droplet precautions d. Standard precautions

a. Airborne precautions

The nurse reviews the medication administration record (MAR) for a patient having an acute asthma attack. Which medication should the nurse administer first? a. Albuterol (Ventolin) 2.5 mg per nebulizer b. Methylprednisolone (Solu-Medrol) 60 mg IV c. Salmeterol (Serevent) 50 mcg per dry-powder inhaler (DPI) d. Triamcinolone (Azmacort) 2 puffs per metered-dose inhaler (MDI)

a. Albuterol (Ventolin) 2.5 mg per nebulizer Albuterol is a rapidly acting bronchodilator and is the first-line medication to reverse airway narrowing in acute asthma attacks. The other medications work more slowly.

A patient is concerned that he may have asthma. Of the symptoms that he describes to the nurse, which ones suggest asthma or risk factors for asthma? (select all that apply) a. Allergic rhinitis b. Prolonged inhalation c. Cough, especially at night d. Gastric reflux or heartburn e. History of chronic sinusitis

a. Allergic rhinitis c. Cough, especially at night d. Gastric reflux or heartburn e. History of chronic sinusitis

Pneumonia treatment includes (select all that apply): a. Analgesics b. Steroids c. Diuretics d. Antibiotics

a. Analgesics b. Steroids d. Antibiotics

Patient-Centered Care: A patient with active TB continues to have positive sputum cultures after 6 months of treatment. She says she cannot remember to take the medication all the time. What is the best action for the nurse to take? a. Arrange for directly observed therapy (DOT) by a public health nurse. b. Schedule the patient to come to the clinic every day to take the medication. c. Have a patient who has recovered from TB tell the patient about his successful treatment. d. Schedule more teaching sessions so that the patient will understand the risks of noncompliance.

a. Arrange for directly observed therapy (DOT) by a public health nurse. Notification of the public health department is required. If drug compliance is questionable, follow-up of patients can be made by directly observed therapy by a public health nurse. A patient who cannot remember to take the medication usually will not remember to come to the clinic daily or will find it too inconvenient. Additional teaching or support from others is not usually effective for this type of patient.

Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of impaired gas exchange based on which finding? a. Arterial oxygen saturation by pulse oximetry (SpO2 ) of 86% b. Crackles in both lower lobes c. Temperature of 101.4° F (38.6° C) d. Production of greenish purulent sputum

a. Arterial oxygen saturation by pulse oximetry (SpO2 ) of 86% Oxygen saturation obtained by pulse oximetry should be >94%. An arterial oxygen saturation by pulse oximetry (SpO2 ) lower than 95% indicates hypoxemia and impaired gas exchange. Crackles, fever, and purulent sputum are all manifestations of pneumonia but do not necessarily relate to impaired gas exchange.

How do microorganisms reach the lungs and cause pneumonia (select all that apply)? a. Aspiration b. Lymphatic spread c. Inhalation of microbes in the air d. Touch contact with the infectious microbes e. Hematogenous spread from infections elsewhere in the body

a. Aspiration c. Inhalation of microbes in the air e. Hematogenous spread from infections elsewhere in the body Microorganisms that cause pneumonia reach the lungs by aspiration from the nasopharynx or oropharynx, inhalation of microbes in the air, and hematogenous spread from infections elsewhere in the body. The other causes of infection do not contribute to pneumonia.

Collaboration: The nurse is caring for a patient with COPD. Which intervention could be delegated to unlicensed assistive personnel (UAP)? a. Assist the patient to get out of bed. b. Auscultate breath sounds every 4 hours. c. Plan patient activities to minimize exertion. d. Teach the patient pursed-lip breathing technique.

a. Assist the patient to get out of bed. Assistance with positioning and activities of daily living (ADLs) is within the training of UAP. Teaching, assessing, and planning are all part of the RN's practice.

A patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurses most appropriate action to promote airway clearance? a. Assist the patient to splint the chest when coughing. b. Teach the patient about the need for fluid restrictions. c. Encourage the patient to wear the nasal oxygen cannula. d. Instruct the patient on the pursed lip breathing technique.

a. Assist the patient to splint the chest when coughing. Coughing is less painful and more likely to be effective when the patient splints the chest during coughing. Fluids should be encouraged to help liquefy secretions. Nasal oxygen will improve gas exchange, but will not improve airway clearance. Pursed lip breathing is used to improve gas exchange in patients with COPD, but will not improve airway clearance.

Priority Decision: A patient's tracheostomy tube becomes dislodged with vigorous coughing. What should be the nurse's first action? a. Attempt to replace the tube. b. Notify the health care provider. c. Place the patient in high Fowler's position. d. Ventilate the patient with a manual resuscitation bag until the health care provider arrives.

a. Attempt to replace the tube. If a tracheostomy tube is dislodged, the nurse should immediately attempt to replace the tube by using hemostats to spread the opening. The obturator is inserted in the replacement tube, water-soluble lubricant is applied to the tip, and the tube is inserted in the stoma at a 45-degree angle to the neck. The obturator is immediately removed to provide an airway. If the tube cannot be reinserted, the HCP should be notified and the patient should be assessed for the level of respiratory distress, positioned in semi-Fowler's position, and ventilated with a manual resuscitation bag (MRB) only if necessary, until assistance arrives. 15. b. The primary risk factors associated with head and neck cancers are heavy tobacco and alcohol use. Oral cancer may cause a change in the fit of dentures, but denture use is not a risk factor for oral cancer. Chronic infections are not known to be risk factors, although cancers in patients younger than age 50 years have been associated with human papillomavirus (HPV) infection.

A patient who was admitted the previous day with pneumonia complains of a sharp pain of 7 (based on 0 to 10 scale) whenever I take a deep breath. Which action will the nurse take next? a. Auscultate breath sounds. b. Administer the PRN morphine. c. Have the patient cough forcefully. d. Notify the patients health care provider.

a. Auscultate breath sounds. The patients statement indicates that pleurisy or a pleural effusion may have developed and the nurse will need to listen for a pleural friction rub and/or decreased breath sounds. Assessment should occur before administration of pain medications. The patient is unlikely to be able to cough forcefully until pain medication has been administered. The nurse will want to obtain more assessment data before calling the health care provider.

The nurse is performing a focused respiratory assessment of a patient who is in severe respiratory distress 2 days after abdominal surgery. What is most important for the nurse to assess? a. Auscultation of bilateral breath sounds b. Percussion of anterior and posterior chest wall c. Palpation of the chest bilaterally for tactile fremitus d. Inspection for anterior and posterior chest expansion

a. Auscultation of bilateral breath sounds Important assessments obtained during a focused respiratory assessment include auscultation of lung (breath) sounds. Assessment of tactile fremitus has limited value in acute respiratory distress. It is not necessary to assess for both anterior and posterior chest expansion. Percussion of the chest wall is not essential in a focused respiratory assessment.

A frail older adult patient develops sudden shortness of breath while sitting in a chair. What location on the chest should the nurse begin auscultation of the lung fields? a. Bases of the posterior chest area b. Apices of the posterior lung fields c. Anterior chest area above the breasts d. Midaxillary on the left side of the chest

a. Bases of the posterior chest area Baseline data with the most information is best obtained by auscultation of the posterior chest, especially in female patients because of breast tissue interfering with the assessment or if the patient may tire easily (e.g., shortness of breath, dyspnea, weakness, fatigue). Usually auscultation proceeds from the lung apices to the bases unless it is possible the patient will tire easily. In this case, the nurse should start at the bases.

A patient who has bronchiectasis asks the nurse, "What conditions would warrant a call to the clinic?" a. Blood clots in the sputum b. Sticky sputum on a hot day c. Increased shortness of breath after eating a large meal d. Production of large amounts of sputum on a daily basis

a. Blood clots in the sputum

Diagnostic assessments for Tuberculosis includes (select all that apply): a. Chest x-ray b. PPD c. Serum electrolytes d. Sputum culture

a. Chest x-ray b. PPD d. Sputum culture

6. When obtaining a health history from a 76-year-old patient with suspected CAP, what does the nurse expect the patient or caregiver to report? a. Confusion b. A recent loss of consciousness c. An abrupt onset of fever and chills d. A gradual onset of headache and sore throat

a. Confusion Confusion possibly related to hypoxia may be the only finding in older adults. Although CAP is most commonly caused by S. aureus and is associated with an acute onset with fever, chills, productive cough with purulent or bloody sputum, and pleuritic chest pain, the older patient may not have classic symptoms. A recent loss of consciousness or altered consciousness is common in those pneumonias associated with aspiration, such as anaerobic bacterial pneumonias. Other causes of pneumonia have a more gradual onset with dry, hacking cough; headache; and sore throat.

Which finding in a patient hospitalized with bronchiectasis is most important to report to the health care provider? a. Cough productive of bloody, purulent mucus b. Scattered rhonchi and wheezes heard bilaterally c. Respiratory rate 28 breaths/minute while ambulating in hallway d. Complaint of sharp chest pain with deep breathing

a. Cough productive of bloody, purulent mucus Hemoptysis may indicate life-threatening hemorrhage and should be reported immediately to the health care provider. The other findings are frequently noted in patients with bronchiectasis and may need further assessment but are not indicators of life-threatening complications.

When assessing the patient in acute respiratory distress, what should the nurse expect to observe? (Select all that apply.) a. Cyanosis b. Tripod position c. Kussmaul respirations d. Accessory muscle use e. Increased AP diameter

a. Cyanosis d. Accessory muscle use Tripod position and accessory muscle use indicate moderate to severe respiratory distress. Cyanosis may be related to anemia, decreased oxygen transfer in the lungs, or decreased cardiac output. Therefore, it is a nonspecific and unreliable indicator of only respiratory distress. Kussmaul respirations occur when the patient is in metabolic acidosis to increase CO2 excretion. Increased AP diameter occurs with lung hyperinflation from chronic obstructive pulmonary disease, cystic fibrosis, or with advanced age.

Pneumonia nursing intervention includes (select all that apply): a. Full course of antibiotics b. Drink plenty of fluids c. Maintain supine position d. Deep breathing exercises

a. Full course of antibiotics b. Drink plenty of fluids d. Deep breathing exercises

A patient in the clinic with cystic fibrosis (CF) reports increased sweating and weakness during the summer months. Which action by the nurse would be most appropriate? a. Have the patient add dietary salt to meals. b. Teach the patient about the signs of hypoglycemia. c. Suggest decreasing intake of dietary fat and calories. d. Instruct the patient about pancreatic enzyme replacements.

a. Have the patient add dietary salt to meals. Added dietary salt is indicated whenever sweating is excessive, such as during hot weather, when fever is present, or from intense physical activity. The management of pancreatic insufficiency includes pancreatic enzyme replacement of lipase, protease, and amylase (e.g., Pancreaze, Creon, Ultresa, Zenpep) administered before each meal and snack. This patient is at risk for hyponatremia based on reported symptoms. Adequate intake of fat, calories, protein, and vitamins is important. Fat-soluble vitamins (vitamins A, D, E, and K) must be supplemented because they are malabsorbed. Use of caloric supplements improves nutritional status. Hyperglycemia due to pancreatic insufficiency is more likely to occur than hypoglycemia.

The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect? a. Increased tactile fremitus b. Dry, nonproductive cough c. Hyperresonance to percussion d. A grating sound on auscultation

a. Increased tactile fremitus Increased tactile fremitus over the area of pulmonary consolidation is expected with bacterial pneumonias. Dullness to percussion would be expected. Pneumococcal pneumonia typically presents with a loose, productive cough. Adventitious breath sounds such as crackles and wheezes are typical. A grating sound is more representative of a pleural friction rub rather than pneumonia.

When assessing a patient's sleep-rest pattern related to respiratory health, what should the nurse ask the patient? (Select all that apply.) a. Is it hard for you to fall asleep? b. Do you awaken abruptly during the night? c. Do you sleep more than 8 hours per night? d. Do you need to sleep with the head elevated? e. Do you often need to urinate during the night?

a. Is it hard for you to fall asleep? b. Do you awaken abruptly during the night? d. Do you need to sleep with the head elevated? A patient with obstructive sleep apnea may have insomnia, abrupt awakenings, or both. Patients with cardiovascular disease (e.g., heart failure that may affect respiratory health) may need to sleep with the head elevated on several pillows (orthopnea). Sleeping more than 8 hours per night or needing to urinate during the night is not indicative of impaired respiratory health.

Which medications would be used in 4-drug treatment for the initial phase of TB (select all that apply)? a. Isoniazid b. Levofloxacin c. Pyrazinamide d. Rifampin (Rifadin) e. Rifabutin (Mycobutin) f. Ethambutol (Myambutol)

a. Isoniazid c. Pyrazinamide d. Rifampin (Rifadin) f. Ethambutol (Myambutol) For the first 2 months, a 4-drug regimen consists of isoniazid, pyrazinamide, rifampin (Rifadin), and ethambutol (Myambutol). Rifabutin (Mycobutin) and levofloxacin may be used if the patient develops toxicity to the primary drugs. Rifabutin may be used as first-line treatment for patients receiving medications that interact with rifampin (e.g., antiretrovirals, estradiol, warfarin).

Which microorganisms are associated with both CAP and HAP (select all that apply)? a. Klebsiella b. Acinetobacter c. Staphylococcus aureus d. Mycoplasma pneumoniae e. Pseudomonas aeruginosa f. Streptococcus pneumoniae

a. Klebsiella b. Acinetobacter c. Staphylococcus aureus e. Pseudomonas aeruginosa f. Streptococcus pneumoniae CAP and HAP are both associated with Klebsiella, Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus pneumoniae. Acinetobacter is only associated with HAP. Mycoplasma pneumoniae is only associated with CAP

A patient who is experiencing an acute asthma attack is admitted to the emergency department. Which assessment should the nurse complete first? a. Listen to the patients breath sounds. b. Ask about inhaled corticosteroid use. c. Determine when the dyspnea started. d. Obtain the forced expiratory volume (FEV) flow rate.

a. Listen to the patients breath sounds. Assessment of the patients breath sounds will help determine how effectively the patient is ventilating and whether rapid intubation may be necessary. The length of time the attack has persisted is not as important as determining the patients status at present. Most patients having an acute attack will be unable to cooperate with an FEV measurement. It is important to know about the medications the patient is using but not as important as assessing the breath sounds.

Symptoms of tuberculosis include (select all that apply): a. Low grade fever b. Hemoptysis c. Increased appetite d. Night sweats

a. Low grade fever b. Hemoptysis d. Night sweats

The nurse is caring for a postoperative patient with impaired airway clearance. What nursing actions would promote airway clearance? (Select all that apply.) a. Maintain adequate fluid intake. b. Maintain a 15-degree elevation. c. Splint the chest when coughing. d. Have the patient use incentive spirometry. e. Teach the patient to cough at end of exhalation.

a. Maintain adequate fluid intake. c. Splint the chest when coughing. e. Teach the patient to cough at end of exhalation. Maintaining adequate fluid intake liquefies secretions, allowing easier expectoration. The nurse should teach the patient to splint the chest while coughing. This will reduce discomfort and allow for a more effective cough. Coughing at the end of exhalation promotes a more effective cough. Incentive spirometry promotes lung expansion. The patient should be positioned in an upright sitting position (high Fowler's) with head slightly flexed.

Discharge teaching for a TB patient should include (select all that apply): a. Medication compliance b. Follow up visits with HCP c. Follow a low calorie, high protein diet d. Keep oral fluids to a minimum

a. Medication compliance b. Follow up visits with HCP

A patient with recurrent shortness of breath has just had a bronchoscopy. What is a priority nursing action immediately after the procedure? a. Monitor the patient for laryngeal edema. b. Assess the patient's level of consciousness. c. Monitor and manage the patient's level of pain. d. Assess the patient's heart rate and blood pressure.

a. Monitor the patient for laryngeal edema. Priorities for assessment are the patient's airway and breathing, both of which may be compromised after bronchoscopy by laryngeal edema. These assessment parameters supersede the importance of loss of consciousness (LOC), pain, heart rate, and blood pressure, although the nurse should also be assessing these.

A patient who is experiencing an asthma attack develops bradycardia and a decrease in wheezing. Which action should the nurse take first? a. Notify the health care provider. b. Document changes in respiratory status. c. Encourage the patient to cough and deep breathe. d. Administer IV methylprednisolone (Solu-Medrol).

a. Notify the health care provider. The patients assessment indicates impending respiratory failure, and the nurse should prepare to assist with intubation and mechanical ventilation after notifying the health care provider. IV corticosteroids require several hours before having any effect on respiratory status. The patient will not be able to cough or deep breathe effectively. Documentation is not a priority at this time.

During an annual health assessment of a 66-year-old patient at the clinic, the patient tells the nurse he has not had the pneumonia vaccine. What should the nurse advise him about the best way for him to prevent pneumonia? a. Obtain a pneumococcal vaccine now and get a booster 12 months later. b. Seek medical care and antibiotic therapy for all upper respiratory infections. c. Obtain the pneumococcal vaccine if he is exposed to individuals with pneumonia. d. Obtain only the influenza vaccine every year because he should have immunity to the pneumococcus because of his age.

a. Obtain a pneumococcal vaccine now and get a booster 12 months later. He should receive his first dose of PCV13, followed at least 1 year later by a dose of PPSV23. Influenza vaccine should be taken each year. Antibiotic therapy is not appropriate for all upper respiratory infections unless secondary bacterial infections develop.

Which nursing action for a patient with chronic obstructive pulmonary disease (COPD) could the nurse delegate to experienced unlicensed assistive personnel (UAP)? a. Obtain oxygen saturation using pulse oximetry. b. Monitor for increased oxygen need with exercise. c. Teach the patient about safe use of oxygen at home. d. Adjust oxygen to keep saturation in prescribed parameters.

a. Obtain oxygen saturation using pulse oximetry. UAP can obtain oxygen saturation (after being trained and evaluated in the skill). The other actions require more education and a scope of practice that licensed practical/vocational nurses (LPN/LVNs) or registered nurses (RNs) would have.

Which findings indicate that a patient is developing status asthmaticus? (select all that apply) a. PEFR <300 L/min b. Positive sputum culture c. Unable to speak in complete sentences d. Lack of response to conventional treatment e. Chest x-ray shows hyperinflated lungs and a flattened diaphragm

a. PEFR <300 L/min c. Unable to speak in complete sentences d. Lack of response to conventional treatment

Which patients have the greatest risk for aspiration pneumonia? (select all that apply) a. Patient with seizures b. Patient with head injury c. Patient who had thoracic surgery d. Patient who had a myocardial infarction e. Patient who is receiving nasogastric tube feeding

a. Patient with seizures b. Patient with head injury e. Patient who is receiving nasogastric tube feeding

The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding? a. Peripheral edema b. Elevated temperature c. Clubbing of the fingers d. Complaints of chest pain

a. Peripheral edema Cor pulmonale causes clinical manifestations of right ventricular failure, such as peripheral edema. The other clinical manifestations may occur in the patient with other complications of chronic obstructive pulmonary disease (COPD) but are not indicators of cor pulmonale.

During discharge teaching for an older adult patient with chronic obstructive pulmonary disease (COPD) and pneumonia, which vaccine should the nurse recommend that this patient receive? a. Pneumococcal b. Staphylococcus aureus c. Haemophilus influenzae d. Bacille-Calmette-Guérin (BCG)

a. Pneumococcal The pneumococcal vaccine is important for patients with a history of heart or lung disease, recovering from a severe illness, age 65 years or older, or living in a long-term care facility. A S. aureus vaccine has been researched but not yet been effective. The H. influenzae vaccine would not be recommended as adults do not need it unless they are immunocompromised. The BCG vaccine is for infants in parts of the world where tuberculosis is prevalent.

Patient with altered consciousness is hospitalized and at risk for aspiration pneumonia. What nursing intervention is indicated to prevent pneumonia? a. Position to side, protect airway b. Check placement of the tube before feeding and residual feeding; keep head of bed up after feedings or continuously with continuous feedings c. Check gag reflex before feeding or offering fluids d. Cut food in small bites, encourage thorough chewing, and provide soft foods that are easier to swallow than liquids

a. Position to side, protect airway

Risk factors for acquiring pneumonia include (select all that apply): a. Prolonged immobility b. Aspiration c. Mechanical ventilation d. Young age

a. Prolonged immobility b. Aspiration c. Mechanical ventilation

The patient's arterial blood gas results show the PaO2 at 65 mmHg and SaO2 at 80%. What other manifestations should the nurse expect to observe in this patient? a. Restlessness, tachypnea, tachycardia, and diaphoresis b. Unexplained confusion, dyspnea at rest, hypotension, and diaphoresis c. Combativeness, retractions with breathing, cyanosis, and decreased output d. Coma, accessory muscle use, cool and clammy skin, and unexplained fatigue

a. Restlessness, tachypnea, tachycardia, and diaphoresis With inadequate oxygenation, early manifestations include restlessness, tachypnea, tachycardia, and diaphoresis, decreased urinary output, and unexplained fatigue. Unexplained confusion, dyspnea at rest, hypotension, and diaphoresis; combativeness, retractions with breathing, cyanosis, and decreased urinary output; coma, accessory muscle use, cool and clammy skin, and unexplained fatigue are later manifestations of inadequate oxygenation.

Which treatments would the nurse expect to implement in the management plan of a patient with cystic fibrosis? (select all that apply) a. Sperm banking b. IV corticosteroids on a chronic basis c. Airway clearance techniques (e.g., Acapella) d. GoLYTELY given as needed for severe constipation e. Inhaled tobramycin to combat Pseudomonas infection

a. Sperm banking c. Airway clearance techniques (e.g., Acapella) d. GoLYTELY given as needed for severe constipation e. Inhaled tobramycin to combat Pseudomonas infection

While the nurse is feeding a patient, the patient appears to choke on the food. Which symptoms indicate to the nurse that the patient has a partial airway obstruction (select all that apply)? a. Stridor b. Cyanosis c. Wheezing d. Bradycardia e. Rapid respiratory rate

a. Stridor b. Cyanosis c. Wheezing With partial airway obstruction, choking, stridor, use of accessory muscles, suprasternal and intercostals retraction, flaring nostrils, wheezing, restlessness, tachycardia, cyanosis, and change in level of consciousness may occur. Partial airway obstruction may progress to complete obstruction without prompt assessment and treatment.

Collaboration: In planning the care for a patient with a tracheostomy who has been stable and is to be discharged later in the day, the registered nurse (RN) may delegate which interventions to the licensed practical/vocational nurse (LPN/VN) (select all that apply)? a. Suction the tracheostomy. b. Provide tracheostomy care. c. Determine the need for suctioning. d. Assess the patient's swallowing ability. e. Teach the patient about home tracheostomy care.

a. Suction the tracheostomy. b. Provide tracheostomy care. c. Determine the need for suctioning. LPNs may determine the need for suctioning, suction the tracheostomy, and determine whether the patient has improved after the suctioning when caring for stable patients. They also may perform tracheostomy care using sterile technique. The patient's swallowing ability is assessed by a speech therapist, videofluoroscopy, or fiberoptic endoscopic evaluations. The RN will teach the patient about home tracheostomy care.

An older adult patient living alone is admitted to the hospital with pneumococcal pneumonia. Which clinical manifestation is consistent with the patient being hypoxic? a. Sudden onset of confusion b. Oral temperature of 102.3° F c. Coarse crackles in lung bases d. Clutching chest on inspiration

a. Sudden onset of confusion Confusion or stupor (related to hypoxia) may be the only clinical manifestation of pneumonia in an older adult patient. An elevated temperature, coarse crackles, and pleuritic chest pain with guarding may occur with pneumonia, but these symptoms do not indicate hypoxia.

Nursing Interventions for pneumonia (select all that apply): a. Teach coughing and deep breathing to patient b. Monitor vital signs c. Encourage & assist with ambulation d. Maintain in supine position as often as possible.

a. Teach coughing and deep breathing to patient b. Monitor vital signs c. Encourage & assist with ambulation

TB is the leading cause of mortality in patients with HIV infection a. True b. False

a. True

The nurse is caring for a mechanically ventilated patient with a cuffed tracheostomy tube. Which action by the nurse would best determine if the cuff has been properly inflated? a. Use a manometer to ensure cuff pressure is at an appropriate level. b. Check the amount of cuff pressure ordered by the health care provider. c. Suction the patient first with a fenestrated inner cannula to clear secretions. d. Insert the decannulation plug before the nonfenestrated inner cannula is removed.

a. Use a manometer to ensure cuff pressure is at an appropriate level. Measurement of cuff pressure using a manometer to ensure that cuff pressure is 20 mm Hg or lower will avoid compression of the tracheal wall and capillaries. Never insert the decannulation plug in a tracheostomy tube until the cuff is deflated and the nonfenestrated inner cannula is removed. Otherwise, the patients airway is occluded. A health care providers order is not required to determine safe cuff pressure. A nonfenestrated inner cannula must be used to suction a patient to prevent tracheal damage occurring from the suction catheter passing through the fenestrated openings.

Which method of low, constant oxygen administration is the safest system to use for a patient with COPD exacerbation? a. Venturi mask b. Nasal cannula c. Simple face mask d. Nonrebreather mask

a. Venturi mask A Venturi mask is helpful to administer low, constant O2 concentrations to patients with COPD and can be set to administer a varied percentage of O2 . The amount of O2 inhaled via the nasal cannula depends on room air and the patient's breathing pattern. The simple face mask must have a tight seal and may generate heat under the mask. The non-rebreather mask is more useful for short-term therapy with patients needing high O2 concentrations.

Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis? a. Weak, nonproductive cough effort b. Large amounts of greenish sputum c. Respiratory rate of 28 breaths/minute d. Resting pulse oximetry (SpO2) of 85%

a. Weak, nonproductive cough effort The weak, nonproductive cough indicates that the patient is unable to clear the airway effectively. The other data would be used to support diagnoses such as impaired gas exchange and ineffective breathing pattern.

Symptoms of pneumonia include? (select all that apply) a. Weakness b. Non-productive cough c. Rust colored sputum d. Fever

a. Weakness c. Rust colored sputum d. Fever

An older patient is receiving standard multidrug therapy for tuberculosis (TB). The nurse should notify the health care provider if the patient exhibits which finding? a. Yellow-tinged skin b. Orange-colored sputum c. Thickening of the fingernails d. Difficulty hearing high-pitched voices

a. Yellow-tinged skin Noninfectious hepatitis is a toxic effect of isoniazid (INH), rifampin, and pyrazinamide, and patients who develop hepatotoxicity will need to use other medications. Changes in hearing and nail thickening are not expected with the four medications used for initial TB drug therapy. Presbycusis is an expected finding in the older adult patient. Orange discoloration of body fluids is an expected side effect of rifampin and not an indication to call the health care provider.

A young adult patient who denies any history of smoking is seen in the clinic with a new diagnosis of chronic obstructive pulmonary disease (COPD). It is most appropriate for the nurse to teach the patient about a. a 1-antitrypsin testing. b. use of the nicotine patch. c. continuous pulse oximetry. d. effects of leukotriene modifiers.

a. a 1-antitrypsin testing. When COPD occurs in young patients, especially without a smoking history, a genetic deficiency in a1-antitrypsin should be suspected. Because the patient does not smoke, a nicotine patch would not be ordered. There is no indication that the patient requires continuous pulse oximetry. Leukotriene modifiers would be used in patients with asthma, not with COPD.

The best method for determining the risk for aspiration in a patient with a tracheostomy is to a. consult a speech therapist for swallowing assessment. b. have the patient drink plain water and assess for coughing. c. ask the patient to rate the perceived degree of swallowing difficulty. d. assess for sputum changes 48 hours after the patient drinks small amount of blue dye.

a. consult a speech therapist for swallowing assessment.

Defense mechanisms that help protect the lung from inhaled particles and microorganisms include the (select all that apply) a. cough reflex. b. mucociliary escalator. c. alveolar macrophages. d. reflex bronchoconstriction. e. alveolar capillary membrane.

a. cough reflex. b. mucociliary escalator. c. alveolar macrophages. d. reflex bronchoconstriction.

The plan of care for the patient with chronic obstructive pulmonary disease (COPD) should include (select all that apply) a. exercise such as walking. b. high flow rate of O2 administration. c. low-dose chronic oral corticosteroid therapy. d. use of peak flow meter to monitor the progression of COPD. e. breathing exercises, such as pursed-lip breathing that focus on exhalation.

a. exercise such as walking. e. breathing exercises, such as pursed-lip breathing that focus on exhalation.

The nurse recognizes that additional teaching is needed when the patient with asthma says a. "I should exercise every day if my symptoms are controlled." b. "I may use over-the-counter bronchodilator drugs occasionally if I develop chest tightness." c. "I should inform my spouse about my medications and how to get help if I have a severe asthma attack." d. "A diary to record my medication use, symptoms, PEF rates, and activity levels will help in adjusting my therapy."

b. "I may use over-the-counter bronchodilator drugs occasionally if I develop chest tightness." Nonprescription drugs should not be used by patients with asthma because of dangers associated with rebound bronchospasm, interactions with prescribed drugs, and undesirable side effects. All the other responses are appropriate for the patient with asthma.

Which of the following tests is the gold standard for diagnosing TB? a. Interferon Release assays b. 3 consecutive sputum specimens c. Purified protein derivative (PPD) d. Chest x-ray

b. 3 consecutive sputum specimens

When using CURB-65, how many points would a 70 yr old with RR-32 & confusion score? a. 2 points b. 3 points c. 4 points d. 1 point

b. 3 points

The nurse is caring for a patient with chronic obstructive pulmonary disorder (COPD) and pneumonia who has an order for arterial blood gases to be drawn. What is the minimum length of time the nurse should plan to hold pressure on the puncture site? a. 2 minutes b. 5 minutes c. 10 minutes d. 15 minutes

b. 5 minutes After obtaining blood for an arterial blood gas measurement, the nurse should hold pressure on the puncture site for 5 minutes by the clock to be sure that bleeding has stopped. An artery is an elastic vessel under much higher pressure than veins, and significant blood loss or hematoma formation could occur if the time is insufficient.

Which patient has early clinical manifestations of hypoxemia? a. A 67-yr-old patient who has dyspnea while resting in the bed or in a reclining chair. b. A 72-yr-old patient who has four new premature ventricular contractions per minute. c. A 94-yr-old patient who has renal insufficiency, anemia, and decreased urine output. d. A 48-yr-old patient who is intoxicated and acutely disoriented to time and place.

b. A 72-yr-old patient who has four new premature ventricular contractions per minute. Early clinical manifestations of hypoxemia include dysrhythmias (e.g., premature ventricular contractions), unexplained decreased level of consciousness (e.g., disorientation), dyspnea on exertion, and unexplained decreased urine output.

The nurse receives a change-of-shift report on the following patients with chronic obstructive pulmonary disease (COPD). Which patient should the nurse assess first? a. A patient with loud expiratory wheezes b. A patient with a respiratory rate of 38/minute c. A patient who has a cough productive of thick, green mucus d. A patient with jugular venous distention and peripheral edema

b. A patient with a respiratory rate of 38/minute A respiratory rate of 38/minute indicates severe respiratory distress, and the patient needs immediate assessment and intervention to prevent possible respiratory arrest. The other patients also need assessment as soon as possible, but they do not need to be assessed as urgently as the tachypneic patient.

When caring for a patient who is hospitalized with active tuberculosis (TB), the nurse observes a student nurse who is assigned to take care of a patient. Which action, if performed by the student nurse, would require an intervention by the nurse? a. The patient is offered a tissue from the box at the bedside. b. A surgical face mask is applied before visiting the patient. c. A snack is brought to the patient from the unit refrigerator. d. Hand washing is performed before entering the patients room.

b. A surgical face mask is applied before visiting the patient. A high-efficiency particulate-absorbing (HEPA) mask, rather than a standard surgical mask, should be used when entering the patients room because the HEPA mask can filter out 100% of small airborne particles. Hand washing before entering the patients room is appropriate. Because anorexia and weight loss are frequent problems in patients with TB, bringing food to the patient is appropriate. The student nurse should perform hand washing after handling a tissue that the patient has used, but no precautions are necessary when giving the patient an unused tissue.

Priority Decision: A patient diagnosed with class 3 TB 1 week ago is admitted to the hospital with symptoms of chest pain and coughing. What nursing action has the highest priority? a. Administering the patient's antitubercular drugs b. Admitting the patient to an airborne infection isolation room c. Preparing the patient's room with suction equipment and extra linens d. Placing the patient in an intensive care unit, where he can be closely monitored

b. Admitting the patient to an airborne infection isolation room A patient with class 3 TB has clinically active disease, and airborne infection isolation is required for active disease until the patient is noninfectious, indicated by negative sputum smears. Cardiac monitoring and observation will be done with the patient in isolation. The nurse will administer the antitubercular drugs after the patient is in isolation. There should be no need for suction or extra linens after the TB patient is receiving drug therapy.

What is a possible cause for percussion abnormal finding "hyperresonance"? a. Lung consolidation with fluid or exudate b. Air trapping c. Atelactasis d. Interstitial edema

b. Air trapping

What causes the pulmonary vasoconstriction leading to the development of cor pulmonale in the patient with COPD? a. Increased viscosity of the blood b. Alveolar hypoxia and hypercapnia c. Long-term low-flow oxygen therapy d. Administration of high concentrations of oxygen

b. Alveolar hypoxia and hypercapnia Constriction of the pulmonary vessels, leading to pulmonary hypertension, is caused by alveolar hypoxia and the acidosis that results from hypercapnia. Polycythemia is a contributing factor in cor pulmonale because it increases the viscosity of blood and the pressure needed to circulate the blood but does not cause vasoconstriction. Long-term lowflow oxygen therapy dilates pulmonary vessels and is used to treat cor pulmonale. High oxygen administration is not related to cor pulmonale.

After 2 months of tuberculosis (TB) treatment with isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next? a. Teach about treatment for drug-resistant TB treatment. b. Ask the patient whether medications have been taken as directed. c. Schedule the patient for directly observed therapy three times weekly. d. Discuss with the health care provider the need for the patient to use an injectable antibiotic.

b. Ask the patient whether medications have been taken as directed. The first action should be to determine whether the patient has been compliant with drug therapy because negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. Assessment is the first step in the nursing process. Depending on whether the patient has been compliant or not, different medications or directly observed therapy may be indicated. The other options are interventions based on assumptions until an assessment has been completed.

Following a laryngectomy a patient coughs violently during suctioning and dislodges the tracheostomy tube. Which action should the nurse take first? a. Cover stoma with sterile gauze and ventilate through stoma. b. Attempt to reinsert the tracheostomy tube with the obturator in place. c. Assess the patients oxygen saturation and notify the health care provider. d. Ventilate the patient with a manual bag and face mask until the health care provider arrives.

b. Attempt to reinsert the tracheostomy tube with the obturator in place. The first action should be to attempt to reinsert the tracheostomy tube to maintain the patients airway. Assessing the patients oxygenation is an important action, but it is not the most appropriate first action in this situation. Covering the stoma with a dressing and manually ventilating the patient may be an appropriate action if the nurse is unable to reinsert the tracheostomy tube. Ventilating with a facemask is not appropriate for a patient with a total laryngectomy because there is a complete separation between the upper airway and the trachea.

Which dietary modification helps meet the nutritional needs of patients with COPD? a. Eating a high-carbohydrate, low-fat diet b. Avoiding foods that require a lot of chewing c. Preparing most foods of the diet to be eaten hot d. Drinking fluids with meals to promote digestion

b. Avoiding foods that require a lot of chewing Eating is an effort for patients with COPD, and often these patients do not eat because of fatigue, dyspnea, altered taste, and decreased appetite. Foods that require much chewing cause more exhaustion and should be avoided. A low-carbohydrate diet is indicated if the patient has hypercapnia because carbohydrates are metabolized into carbon dioxide. Cold foods seem to give less of a sense of fullness than hot foods, and fluids should be avoided at meals to prevent a full stomach.

Patient with a feeding tube is hospitalized and at risk for aspiration pneumonia. What nursing intervention is indicated to prevent pneumonia? a. Position to side, protect airway b. Check placement of the tube before feeding and residual feeding; keep head of bed up after feedings or continuously with continuous feedings c. Check gag reflex before feeding or offering fluids d. Cut food in small bites, encourage thorough chewing, and provide soft foods that are easier to swallow than liquids

b. Check placement of the tube before feeding and residual feeding; keep head of bed up after feedings or continuously with continuous feedings

The patient is calling the clinic with a cough. What assessment should be made first before the nurse advises the patient? a. Frequency, family history, hematemesis b. Cough sound, sputum production, pattern c. Weight loss, activity tolerance, orthopnea d. Smoking status, medications, residence location

b. Cough sound, sputum production, pattern The sound of the cough, sputum production and description, and the pattern of the cough's occurrence (including acute or chronic) and what its occurrence is related to are the first assessments to be made to determine the severity. Frequency of the cough will not provide a lot of information. Family history can help to determine a genetic cause of the cough. Hematemesis is vomiting blood and not as important as hemoptysis. Smoking is an important risk factor for chronic obstructive pulmonary disease, and lung cancer and may cause a cough. Medications may or may not contribute to a cough as does residence location. Weight loss, activity intolerance, and orthopnea may be related to respiratory or cardiac problems but are not as important when dealing with a cough.

Pulmonary rehabilitation (PR) is designed to reduce symptoms and improve the patient's quality of life. Along with improving exercise capacity, what are anticipated results of PR (select all that apply)? a. Decreased FEV1 b. Decreased depression c. Increased oxygen need d. Decreased fear of exercise e. Decreased hospitalizations

b. Decreased depression d. Decreased fear of exercise e. Decreased hospitalizations Decreasing depression, fear of exercise, and hospitalizations along with improving exercise capacity are benefits of pulmonary rehabilitation (PR). Decreased FEV1 and increased oxygen need are not beneficial.

A young adult female patient with cystic fibrosis (CF) tells the nurse that she is not sure about getting married and having children some day. Which initial response by the nurse is best? a. Are you aware of the normal lifespan for patients with CF? b. Do you need any information to help you with that decision? c. Many women with CF do not have difficulty conceiving children. d. You will need to have genetic counseling before making a decision.

b. Do you need any information to help you with that decision? The nurses initial response should be to assess the patients knowledge level and need for information. Although the lifespan for patients with CF is likely to be shorter than normal, it would not be appropriate for the nurse to address this as the initial response to the patients comments. The other responses have accurate information, but the nurse should first assess the patients understanding about the issues surrounding pregnancy.

A patient with latent TB can still transmit the TB bacteria to others a. True b. False

b. False

When obtaining a health history from a patient suspected of having early TB, the nurse should ask the patient about what manifestations? a. Chest pain, hemoptysis, and weight loss b. Fatigue, low-grade fever, and night sweats c. Cough with purulent mucus and fever with chills d. Pleuritic pain, nonproductive cough, and temperature elevation at night

b. Fatigue, low-grade fever, and night sweats TB usually develops insidiously with fatigue, malaise, anorexia, low-grade fevers, and night sweats, a dry cough, and unexplained weight loss. Pleuritic pain, flu-like symptoms, and a productive cough may occur with an acute sudden presentation; but dyspnea and hemoptysis are late symptoms.

Which assessment finding in a patient who has received omalizumab (Xolair) is most important to report immediately to the health care provider? a. Pain at injection site b. Flushing and dizziness c. Peak flow reading 75% of normal d. Respiratory rate 22 breaths/minute

b. Flushing and dizziness Flushing and dizziness may indicate that the patient is experiencing an anaphylactic reaction, and immediate intervention is needed. The other information should also be reported, but do not indicate possibly life- threatening complications of omalizumab therapy.

The nurse provides dietary teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a low body mass index (BMI). Which patient statement indicates that the teaching has been effective? a. I will drink lots of fluids with my meals. b. I can have ice cream as a snack every day. c. I will exercise for 15 minutes before meals. d. I will decrease my intake of meat and poultry.

b. I can have ice cream as a snack every day. High-calorie foods like ice cream are an appropriate snack for patients with COPD. Fluid intake of 3 L/day is recommended, but fluids should be taken between meals rather than with meals to improve oral intake of solid foods. The patient should avoid exercise for an hour before meals to prevent fatigue while eating. Meat and dairy products are high in protein and are good choices for the patient with COPD.

The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement, if made by the patient, indicates a good understanding of the instructions? a. I will call the doctor if I still feel tired after a week. b. I will continue to do the deep breathing and coughing exercises at home. c. I will schedule two appointments for the pneumonia and influenza vaccines. d. Ill cancel my chest x-ray appointment if Im feeling better in a couple weeks.

b. I will continue to do the deep breathing and coughing exercises at home. Patients should continue to cough and deep breathe after discharge. Fatigue is expected for several weeks. The Pneumovax and influenza vaccines can be given at the same time in different arms. Explain that a follow-up chest x-ray needs to be done in 6 to 8 weeks to evaluate resolution of pneumonia.

The clinic nurse makes a follow-up telephone call to a patient with asthma. The patient reports having a baseline peak flow reading of 600 L/minute and the current peak flow is 420 L/minute. Which action should the nurse take first? a. Tell the patient to go to the hospital emergency department. b. Instruct the patient to use the prescribed albuterol (Proventil). c. Ask about recent exposure to any new allergens or asthma triggers. d. Question the patient about use of the prescribed inhaled corticosteroids.

b. Instruct the patient to use the prescribed albuterol (Proventil). The patients peak flow is 70% of normal, indicating a need for immediate use of short-acting b2-adrenergic SABA medications. Assessing for correct use of medications or exposure to allergens also is appropriate, but would not address the current decrease in peak flow. Because the patient is currently in the yellow zone, hospitalization is not needed.

A patient is receiving 35% oxygen via a Venturi mask. To ensure the correct amount of oxygen delivery, which action by the nurse is most important? a. Teach the patient to keep mask on at all times. b. Keep the air entrainment ports clean and unobstructed. c. Give a high enough flow rate to keep the bag from collapsing. d. Drain moisture condensation from the oxygen tubing every hour.

b. Keep the air entrainment ports clean and unobstructed. The air entrainment ports regulate the oxygen percentage delivered to the patient, so they must be unobstructed. A high oxygen flow rate is needed when giving oxygen by partial rebreather or non-rebreather masks. Draining oxygen tubing is necessary when caring for a patient receiving mechanical ventilation. The mask is uncomfortable and can be removed when the patient eats.

A patient with pneumonia is having difficulty clearing the airway because of pain, fatigue, and thick secretions. What is an expected outcome for this patient? a. SpO2 is 90% b. Lungs clear to auscultation c. Patient tolerates walking in hallway d. Patient takes 3 to 4 shallow breaths before coughing to minimize pain

b. Lungs clear to auscultation Clear lung sounds indicate that the airways are clear. SpO2 of 95% to 100% indicates appropriate gas exchange. Tolerating walking in the hallway indicates appropriate gas exchange and activity tolerance, not improved airway clearance. Deep breaths are necessary to move mucus from distal airways, but this is not an outcome for this nursing diagnosis.

The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD).What is the best way for the nurse to determine the appropriate oxygen flow rate? a. Minimize oxygen use to avoid oxygen dependency. b. Maintain the pulse oximetry level at 90% or greater. c. Administer oxygen according to the patients level of dyspnea. d. Avoid administration of oxygen at a rate of more than 2 L/minute.

b. Maintain the pulse oximetry level at 90% or greater. The best way to determine the appropriate oxygen flow rate is by monitoring the patients oxygenation either by arterial blood gases (ABGs) or pulse oximetry. An oxygen saturation of 90% indicates adequate blood oxygen level without the danger of suppressing the respiratory drive. For patients with an exacerbation of COPD, an oxygen flow rate of 2 L/min may not be adequate. Because oxygen use improves survival rate in patients with COPD, there is no concern about oxygen dependency. The patients perceived dyspnea level may be affected by other factors (such as anxiety) besides blood oxygen level.

Priority Decision: A patient is admitted to the emergency department with an acute asthma attack. Which patient assessment is of greatest concern to the nurse? a. The presence of a pulsus paradoxus b. Markedly decreased breath sounds with no wheezing c. A respiratory rate of 34 breaths/min and increased pulse and BP d. Use of accessory muscles of respiration and a feeling of suffocation

b. Markedly decreased breath sounds with no wheezing Decreased or absent breath sounds may indicate a significant decrease in air movement resulting from exhaustion and an inability to generate enough muscle force to ventilate and is an ominous sign. The other symptoms are expected in an asthma attack but are not life threatening.

What is included in the nursing care of the patient with a cuffed tracheostomy tube? a. Change the tube every 3 days. b. Monitor cuff pressure every 8 hours. c. Perform mouth care every 12 hours. d. Assess arterial blood gases every 8 hours.

b. Monitor cuff pressure every 8 hours. Cuff pressure should be monitored at least every 8 hours to ensure that an air leak around the cuff does not occur and that the pressure is not too high to allow adequate tracheal capillary perfusion. Respiratory therapists in some institutions will record the cuff pressure, but the nurse must be able to assess cuff pressure and identify if there is a problem maintaining cuff pressure. Tracheostomy tubes are changed monthly when needed for long-term use. Mouth care should be performed a minimum of every 8 hours and more often as needed to remove dried secretions. Arterial blood gases (ABGs) are not routinely assessed with tracheostomy tube placement unless symptoms of respiratory distress continue.

The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB). Which statement, if made by the patient, indicates that teaching was effective? a. I will avoid being outdoors whenever possible. b. My husband will be sleeping in the guest bedroom. c. I will take the bus instead of driving to visit my friends. d. I will keep the windows closed at home to contain the germs.

b. My husband will be sleeping in the guest bedroom. Teach the patient how to minimize exposure to close contacts and household members. Homes should be well ventilated, especially the areas where the infected person spends a lot of time. While still infectious, the patient should sleep alone, spend as much time as possible outdoors, and minimize time in congregate settings or on public transportation.

The microorganisms Pneumocystis jiroveci (PJP) and cytomegalovirus (CMV) are associated with which type of pneumonia? a. Necrotizing pneumonia b. Opportunistic pneumonia c. HAP d. CAP

b. Opportunistic pneumonia People at risk for opportunistic pneumonia include those with altered immune responses. Pneumocystis jiroveci rarely causes pneumonia in healthy individuals but is the most common cause of pneumonia in persons with human immunodeficiency (HIV) disease. Cytomegalovirus (CMV) occurs in people with an impaired immune response. Necrotizing pneumonia is caused by Staphylococcus, Klebsiella, and Streptococcus. Hospital-acquired pneumonia (HAP) is frequently caused by Pseudomonas aeruginosa, Escherichia coli, Klebsiella, and Acinetobacter. Community-acquired pneumonia (CAP) is most commonly caused by Streptococcus pneumonia.

The emergency department nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective? a. No wheezes are audible. b. Oxygen saturation is >90%. c. Accessory muscle use has decreased. d. Respiratory rate is 16 breaths/minute.

b. Oxygen saturation is >90%. The goal for treatment of an asthma attack is to keep the oxygen saturation >90%. The other patient data may occur when the patient is too fatigued to continue with the increased work of breathing required in an asthma attack.

Which function test fits description "Maximum rate of airflow during forced expiration"? a. FVC b. PEFR c. RV d. FRC

b. PEFR Peak expiratory flow rate

What finding is an indication of marked bronchoconstriction with air trapping and hyperinflation of the lungs in a patient with asthma? a. Arterial oxygen saturation (SaO2 ) of 85% b. Peak (expiratory) flow meter (PEF) rate of < 200 L/min c. Forced expiratory volume in 1 second (FEV1 ) of 85% of predicted d. Chest x-ray showing a flattened diaphragm

b. Peak (expiratory) flow meter (PEF) rate of < 200 L/min Peak expiratory flow rates (PEFRs) are normally up to 600 L/min and in a severe asthma attack may be as low as 100 to 150 L/min. An arterial oxygen saturation (SaO2 ) of 85% and a forced expiratory volume in 1 second (FEV1 ) of 85% of predicted are typical of mild to well controlled asthma. A flattened diaphragm may be present in the patient with long-standing asthma but does not reflect current bronchoconstriction.

The nurse develops a plan of care to prevent aspiration in a high-risk patient. Which nursing action will be most effective? a. Turn and reposition immobile patients at least every 2 hours. b. Place patients with altered consciousness in side-lying positions. c. Monitor for respiratory symptoms in patients who are immunosuppressed. d. Insert nasogastric tube for feedings for patients with swallowing problems.

b. Place patients with altered consciousness in side-lying positions. The risk for aspiration is decreased when patients with a decreased level of consciousness are placed in a side- lying or upright position. Frequent turning prevents pooling of secretions in immobilized patients but will not decrease the risk for aspiration in patients at risk. Monitoring of parameters such as breath sounds and oxygen saturation will help detect pneumonia in immunocompromised patients, but it will not decrease the risk for aspiration. Conditions that increase the risk of aspiration include decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and nasogastric intubation with or without tube feeding. With loss of consciousness, the gag and cough reflexes are depressed, and aspiration is more likely to occur. Other high-risk groups are those who are seriously ill, have poor dentition, or are receiving acid-reducing medications.

While in the recovery room, a patient with a total laryngectomy is suctioned and has bloody mucus with some clots. Which nursing interventions would apply? (select all that apply) a. Notify the health care provider at once. b. Place the patient in semi-Fowler's position. c. Use a bag-valve-mask (BVM) and begin rescue breathing for the patient d. Instill 10 mL of normal saline into the tracheostomy tube to loosen secretions. e. Continue patient assessment, including O2 saturation, respiratory rate, and breath sounds.

b. Place the patient in semi-Fowler's position. e. Continue patient assessment, including O2 saturation, respiratory rate, and breath sounds.

To what was the resurgence in tuberculosis (TB) resulting from the emergence of multidrug-resistant (MDR) strains of Mycobacterium tuberculosis related? a. A lack of effective means to diagnose TB b. Poor compliance with drug therapy in patients with TB c. Indiscriminate use of antitubercular drugs in treatment of other infections d. Increased population of immunosuppressed persons with acquired immunodeficiency syndrome (AIDS)

b. Poor compliance with drug therapy in patients with TB Drug-resistant strains of tuberculosis (TB) have developed because TB patients' compliance with drug therapy has been poor, and there has been general decreased vigilance in monitoring and follow-up of TB treatment. TB can be diagnosed effectively with sputum cultures. Antitubercular drugs are almost exclusively used for TB infections. The incidence of TB is at epidemic proportions in patients with HIV, but this does not account for multidrug-resistant strains of TB.

Which finding by the nurse for a patient with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment? a. Even, unlabored respirations b. Pulse oximetry reading of 92% c. Respiratory rate of 18 breaths/minute d. Absence of wheezes, rhonchi, or crackles

b. Pulse oximetry reading of 92% For the nursing diagnosis of impaired gas exchange, the best data for evaluation are arterial blood gases (ABGs) or pulse oximetry. The other data may indicate either improvement or impending respiratory failure caused by fatigue.

During care of a patient with a cuffed tracheostomy, the nurse notes that the tracheostomy tube has an inner cannula. To care for the tracheostomy appropriately, what should the nurse do? a. Deflate the cuff, then remove and suction the inner cannula. b. Remove the inner cannula and replace it per institutional guidelines. c. Remove the inner cannula if the patient shows signs of airway obstruction. d. Keep the inner cannula in place at all times to prevent dislodging the tracheostomy tube.

b. Remove the inner cannula and replace it per institutional guidelines. An inner cannula is a second tubing that fits inside the outer tracheostomy tube. Disposable inner cannulas are frequently used, but nondisposable ones can be removed and cleaned of mucus that has accumulated on the inside of the tube. Many tracheostomy tubes do not have inner cannulas because when humidification is adequate, accumulation of mucus should not occur. Cuff deflation is no longer recommended. When signs of airway obstruction occur, suction is needed

What is characteristic of a partial rebreather mask? a. Used for long-term O2 therapy b. Reservoir bag conserves oxygen c. Provides highest oxygen concentrations d. Most comfortable and causes the least restriction on activities

b. Reservoir bag conserves oxygen The partial rebreather mask has O2 flow into the reservoir bag and mask during inhalation. The O2 -conserving cannula is used for long-term therapy at home versus during hospitalization. The Venturi mask can deliver the highest concentrations of O2 . The nasal cannula is the most comfortable and mobile delivery device.

After admitting a patient from home to the medical unit with a diagnosis of pneumonia, which provider orders must the nurse verify have been completed before administering a dose of cefuroxime? a. Orthostatic blood pressures b. Sputum culture and sensitivity c. Pulmonary function evaluation d. Serum laboratory studies ordered for AM

b. Sputum culture and sensitivity The nurse should ensure that the sputum for culture and sensitivity was sent to the laboratory before administering the cefuroxime because this is community-acquired pneumonia. It is important that the organisms are correctly identified (by the culture) before the antibiotic takes effect. The test will also determine whether the proper antibiotic has been ordered (sensitivity testing). Although antibiotic administration should not be unduly delayed while waiting for the patient to expectorate sputum, orthostatic blood pressures, pulmonary function evaluation, and serum laboratory tests will not be affected by the administration of antibiotics.

Priority Decision: To decrease the patient's sense of panic during an acute asthma attack, what is the best action for the nurse to do? a. Leave the patient alone to rest in a quiet, calm environment. b. Stay with the patient and encourage slow, pursed-lip breathing. c. Reassure the patient that the attack can be controlled with treatment. d. Let the patient know that frequent monitoring is being done by measuring vital signs and arterial oxygen saturation by pulse oximetry (SpO2 ).

b. Stay with the patient and encourage slow, pursed-lip breathing. The patient in an acute asthma attack is very anxious and fearful. It is best to stay with the patient and interact in a calm, unhurried manner. Helping the patient breathe with pursed lips will facilitate expiration of trapped air and help the patient gain control of breathing. Pursed-lip breathing is also used with COPD for this same reason. The other options will not decrease the panic of an acute asthma attack.

Which nursing action could the registered nurse (RN) working in a skilled care hospital unit delegate to an experienced licensed practical/vocational nurse (LPN/LVN) caring for a patient with a permanent tracheostomy? a. Assess the patients risk for aspiration. b. Suction the tracheostomy when needed. c. Teach the patient about self-care of the tracheostomy. d. Determine the need for replacement of the tracheostomy tube.

b. Suction the tracheostomy when needed. Suctioning of a stable patient can be delegated to LPNs/LVNs. Patient assessment and patient teaching should be done by the RN.

A patient with cystic fibrosis (CF) has blood glucose levels that are consistently between 180 to 250mg/dL. Which nursing action will the nurse plan to implement? a. Discuss the role of diet in blood glucose control. b. Teach the patient about administration of insulin. c. Give oral hypoglycemic medications before meals. d. Evaluate the patients home use of pancreatic enzymes.

b. Teach the patient about administration of insulin. The glucose levels indicate that the patient has developed CF-related diabetes, and insulin therapy is required. Because the etiology of diabetes in CF is inadequate insulin production, oral hypoglycemic agents are not effective. Patients with CF need a high-calorie diet. Inappropriate use of pancreatic enzymes would not be a cause of hyperglycemia in a patient with CF.

A patient with chronic obstructive pulmonary disease (COPD) has rhonchi throughout the lung fields and a chronic, nonproductive cough. Which nursing intervention will be most effective? a. Change the oxygen flow rate to the highest prescribed rate. b. Teach the patient to use the Flutter airway clearance device. c. Reinforce the ongoing use of pursed lip breathing techniques. d. Teach the patient about consistent use of inhaled corticosteroids.

b. Teach the patient to use the Flutter airway clearance device. Airway clearance devices assist with moving mucus into larger airways where it can more easily be expectorated. The other actions may be appropriate for some patients with COPD, but they are not indicated for this patients problem of thick mucus secretions.

The nurse teaches a patient about pursed lip breathing. Which action by the patient would indicate to the nurse that further teaching is needed? a. The patient inhales slowly through the nose. b. The patient puffs up the cheeks while exhaling. c. The patient practices by blowing through a straw. d. The patients ratio of inhalation to exhalation is 1:3.

b. The patient puffs up the cheeks while exhaling. The patient should relax the facial muscles without puffing the cheeks while doing pursed lip breathing. The other actions by the patient indicate a good understanding of pursed lip breathing.

Which instruction should the nurse include in an exercise teaching plan for a patient with chronic obstructive pulmonary disease (COPD)? a. Stop exercising if you start to feel short of breath. b. Use the bronchodilator before you start to exercise. c. Breathe in and out through the mouth while you exercise. d. Upper body exercise should be avoided to prevent dyspnea.

b. Use the bronchodilator before you start to exercise. Use of a bronchodilator before exercise improves airflow for some patients and is recommended. Shortness of breath is normal with exercise and not a reason to stop. Patients should be taught to breathe in through the nose and out through the mouth (using a pursed lip technique). Upper-body exercise can improve the mechanics of breathing in patients with COPD.

The nurse is caring for a patient who had abdominal surgery yesterday. Today the patient's lung sounds in the lower lobes are diminished. The nurse knows this could be related to the occurrence of: a. pain. b. atelectasis. c. pneumonia. d. pleural effusion.

b. atelectasis. After surgery, there is an increased risk for atelectasis from anesthesia as well as restricted breathing from pain. Without deep breathing to stretch the alveoli, surfactant secretion to hold the alveoli open is not promoted. Pneumonia will occur later after surgery. Pleural effusion occurs because of blockage of lymphatic drainage or an imbalance between intravascular and oncotic fluid pressures, which is not expected in this case.

The patient has had COPD for years, and his ABGs usually show hypoxia (PaO2 < 60 mm Hg or SaO2 < 88%) and hypercapnia (PaCO2 > 45 mm Hg). Which ABG results show movement toward respiratory acidosis and further hypoxia indicating respiratory failure? a. pH 7.35, PaO2 62 mm Hg, PaCO2 45 mm Hg b. pH 7.34, PaO2 45 mm Hg, PaCO2 65 mm Hg c. pH 7.42, PaO2 90 mm Hg, PaCO2 43 mm Hg d. pH 7.46, PaO2 92 mm Hg, PaCO2 32 mm Hg

b. pH 7.34, PaO2 45 mm Hg, PaCO2 65 mm Hg These results show worsening respiratory function and failure with the pH at 7.34, the lower PaO2 , and the higher PaCO2 . The pH results of 7.35 and 7.42 show potential normal results for the patient described. The pH of 7.46 shows alkalosis, respiratory with the low PaCO2 , but the HCO3 − results are needed to be sure.

Meeting the developmental tasks of young adults with cystic fibrosis becomes a major problem primarily because a. they eventually need a lung transplant. b. they must also adapt to a chronic disease. c. any children they have will develop cystic fibrosis. d. their illness keeps them from becoming financially independent.

b. they must also adapt to a chronic disease. The presence of a chronic disease that is present at birth, delayed sexual development, difficulty in marrying and having children, and the many treatments needed by those with CF affects all relationships and development of these patients. Although a lung transplant may be needed, not all CF patients need one. Not all children will inherit CF (e.g., 25% chance for offspring with both parents having the defective gene). Many men with CF are sterile. Women may have difficulty becoming pregnant. Educational and vocational goals may be met in those who maintain treatment programs and health.

Appropriate discharge teaching for the patient with a permanent tracheostomy after a total laryngectomy for cancer would include (select all that apply) a. encouraging regular exercise such as swimming. b. washing around the stoma daily with a moist washcloth. c. encouraging participation in postlaryngectomy support group. d. providing pictures and "hands-on" instruction for tracheostomy care. e. teaching how to hold breath and trying to gag to promote swallowing reflex.

b. washing around the stoma daily with a moist washcloth. c. encouraging participation in postlaryngectomy support group. d. providing pictures and "hands-on" instruction for tracheostomy care.

The nurse is teaching the patient with human immunodeficiency virus (HIV) about the diagnosis of a fungal lung infection with Candida albicans. What patient statement indicates to the nurse that further teaching is required? a. "I will be given amphotericin B to treat the fungus." b. "I got this fungus because I am immunocompromised." c. "I need to be isolated from my family and friends so they won't get it." d. "The effectiveness of my therapy can be monitored with fungal serology titers."

c. "I need to be isolated from my family and friends so they won't get it." The patient with an opportunistic fungal infection does not need to be isolated because it is not transmitted from person to person. This immunocompromised patient will be likely to have a serious infection so it will be treated with IV amphotericin B. The effectiveness of the therapy can be monitored with fungal serology titers.

The nurse is interpreting a tuberculin skin test (TST) for a patient with end-stage renal disease due to diabetes. Which finding would indicate a positive reaction? a. Acid-fast bacilli cultured at the injection site b. 15-mm area of redness at the TST injection site c. 11-mm area of induration at the TST injection site d. Wheal formed immediately after intradermal injection

c. 11-mm area of induration at the TST injection site An area of induration 10 mm or larger would be a positive reaction in a person with end-stage renal disease. Reddened, flat areas do not indicate a positive reaction. A wheal appears when the TST is administered that indicates correct administration of the intradermal antigen. Presence of acid-fast bacilli in the sputum indicates active tuberculosis.

The nurse is caring for a group of patients. Which patient is at risk of aspiration? a. A 58-yr-old patient with absent bowel sounds 12 hours after abdominal surgery b. A 67-yr-old patient who had a cerebrovascular accident with expressive dysphasia c. A 26-yr-old patient with continuous enteral tube feedings through a nasogastric tube d. A 92-yr-old patient with viral pneumonia and coarse crackles throughout the lung fields

c. A 26-yr-old patient with continuous enteral tube feedings through a nasogastric tube Conditions that increase the risk of aspiration include decreased level of consciousness, difficulty swallowing (dysphagia), and nasogastric intubation with or without enteral nutrition. With loss of consciousness, the gag and cough reflexes are depressed, and aspiration is more likely to occur. Dysphasia is difficulty with speech. Absent bowel sounds and coarse crackles do not increase the risk for aspiration.

What is an advantage of a tracheostomy over an endotracheal (ET) tube for long-term management of an upper airway obstruction? a. A tracheostomy is safer to perform in an emergency. b. An ET tube has a higher risk of tracheal pressure necrosis. c. A tracheostomy tube allows for more comfort and mobility. d. An ET tube is more likely to lead to lower respiratory tract infection.

c. A tracheostomy tube allows for more comfort and mobility. With a tracheostomy (versus an endotracheal [ET] tube), patient comfort is increased because there is no tube in the mouth. Because the tube is more secure, mobility is improved. The ET tube is more easily inserted in an emergency situation. It is preferable to perform a tracheostomy in the operating room because it requires careful dissection, but it can be performed with local anesthetic in the intensive care unit (ICU) or in an emergency. With a cuff, tracheal pressure necrosis is as much a risk with a tracheostomy tube as with an ET tube, and infection is also as likely to occur because the defenses of the upper airway are bypassed.

A patient with TB has been admitted to the hospital and is placed on airborne precautions and in an isolation room. What should the nurse teach the patient? (select all that apply) a. Expect routine TB testing to evaluate the infection. b. No visitors will be allowed while in airborne isolation. c. Adherence to precautions includes coughing into a paper tissue. d. Take all medications for full length of time to prevent multidrug-resistant TB. e. Wear a standard isolation mask if leaving the airborne infection isolation room.

c. Adherence to precautions includes coughing into a paper tissue. d. Take all medications for full length of time to prevent multidrug-resistant TB. e. Wear a standard isolation mask if leaving the airborne infection isolation room.

A patient seen in the asthma clinic has recorded daily peak flows that are 75% of the baseline. Which action will the nurse plan to take next? a. Increase the dose of the leukotriene inhibitor. b. Teach the patient about the use of oral corticosteroids. c. Administer a bronchodilator and recheck the peak flow. d. Instruct the patient to keep the next scheduled follow-up appointment.

c. Administer a bronchodilator and recheck the peak flow. The patients peak flow reading indicates that the condition is worsening (yellow zone). The patient should take the bronchodilator and recheck the peak flow. Depending on whether the patient returns to the green zone, indicating well-controlled symptoms, the patient may be prescribed oral corticosteroids or a change in dosing of other medications. Keeping the next appointment is appropriate, but the patient also needs to be taught how to control symptoms now and use the bronchodilator.

A patient is hospitalized with pneumonia. Which diagnostic test should be used to measure the efficiency of gas exchange in the lung and tissue oxygenation? a. Thoracentesis b. Bronchoscopy c. Arterial blood gases d. Pulmonary function tests

c. Arterial blood gases Arterial blood gases are used to assess the efficiency of gas exchange in the lung and tissue oxygenation as is pulse oximetry. Thoracentesis is used to obtain specimens for diagnostic evaluation, remove pleural fluid, or instill medication into the pleural space. Bronchoscopy is used for diagnostic purposes, to obtain biopsy specimens, and to assess changes resulting from treatment. Pulmonary function tests measure lung volumes and airflow to diagnose pulmonary disease, monitor disease progression, evaluate disability, and evaluate response to bronchodilators.

A patient with a tracheostomy has a new order for a fenestrated tracheostomy tube. Which action should the nurse include in the plan of care in collaboration with the speech therapist? a. Leave the tracheostomy inner cannula inserted at all times. b. Place the decannulation cap in the tube before cuff deflation. c. Assess the ability to swallow before using the fenestrated tube. d. Inflate the tracheostomy cuff during use of the fenestrated tube.

c. Assess the ability to swallow before using the fenestrated tube. Because the cuff is deflated when using a fenestrated tube, the patients risk for aspiration should be assessed before changing to a fenestrated tracheostomy tube. The decannulation cap is never inserted before cuff deflation because to do so would obstruct the patients airway. The cuff is deflated and the inner cannula removed to allow air to flow across the patients vocal cords when using a fenestrated tub.

What does the nurse include when planning for postural drainage for the patient with COPD? a. Schedules the procedure 1 hour before and after meals b. Has the patient cough before positioning to clear the lungs c. Assesses the patient's tolerance for dependent (head-down) positions d. Ensures that percussion and vibration are done before positioning the patient

c. Assesses the patient's tolerance for dependent (head-down) positions Many postural drainage positions require placement in Trendelenburg position, but patients with head injury, heart disease, hemoptysis, chest trauma, and others should not be placed in these positions. Postural drainage should be done 1 hour before and 3 hours after meals if possible. Coughing, percussion, and vibration are all done after the patient has been positioned.

Why is the classification of pneumonia as community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP) clinically useful? a. Atypical pneumonia syndrome is more likely to occur in HAP. b. Diagnostic testing does not have to be used to identify causative agents. c. Causative agents can be predicted, and empiric treatment is often effective. d. IV antibiotic therapy is necessary for HAP, but oral therapy is adequate for CAP.

c. Causative agents can be predicted, and empiric treatment is often effective. Pneumonia that has its onset in the community is usually caused by different microorganisms than pneumonia that develops related to hospitalization and treatment can be empiric—based on observations and experience without knowing the exact causative organism. Frequently, a causative organism cannot be identified from cultures, and treatment is based on experience.

Patient with a local anesthetic to throat is hospitalized and at risk for aspiration pneumonia. What nursing intervention is indicated to prevent pneumonia? a. Position to side, protect airway b. Check placement of the tube before feeding and residual feeding; keep head of bed up after feedings or continuously with continuous feedings c. Check gag reflex before feeding or offering fluids d. Cut food in small bites, encourage thorough chewing, and provide soft foods that are easier to swallow than liquids

c. Check gag reflex before feeding or offering fluids

A patient with asthma has the following arterial blood gas (ABG) results early in an acute asthma attack: pH 7.48, partial pressure of carbon dioxide in arterial blood (PaCO2 ) 30 mm Hg, partial pressure of oxygen in arterial blood (PaO2 ) 78 mm Hg. What is the most appropriate action by the nurse? a. Prepare the patient for mechanical ventilation. b. Have the patient breathe in a paper bag to raise the PaCO2 . c. Document the findings and monitor the ABGs for a trend toward acidosis. d. Reduce the patient's oxygen flow rate to keep the PaO2 at the current level.

c. Document the findings and monitor the ABGs for a trend toward acidosis. Early in an asthma attack, an increased respiratory rate and hyperventilation create a respiratory alkalosis with increased pH and decreased PaCO2 , accompanied by hypoxemia. As the attack progresses, pH shifts to normal, then decreases, with arterial blood gases (ABGs) that reflect respiratory acidosis with hypoxemia. During the attack, high-flow oxygen should be provided. Breathing in a paper bag, although used to treat some types of hyperventilation, would increase the hypoxemia.

A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would be most appropriate? a. Have the patient rest in bed with the head elevated to 15 to 20 degrees. b. Ask the patient to rest in bed in a high-Fowlers position with the knees flexed. c. Encourage the patient to sit up at the bedside in a chair and lean slightly forward. d. Place the patient in the Trendelenburg position with several pillows behind the head.

c. Encourage the patient to sit up at the bedside in a chair and lean slightly forward. Patients with COPD improve the mechanics of breathing by sitting up in the tripod position. Resting in bed with the head elevated in a semi-Fowlers position would be an alternative position if the patient was confined to bed, but sitting in a chair allows better ventilation. The Trendelenburg position or sitting upright in bed with the knees flexed would decrease the patients ability to ventilate well.

A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange discolored urine and tears. Which is the best response by the nurse? a. Ask if the patient is experiencing shortness of breath, hives, or itching. b. Ask the patient about any visual abnormalities such as red-green color discrimination. c. Explain that orange discolored urine and tears are normal while taking this medication. d. Advise the patient to stop the drug and report the symptoms to the health care provider.

c. Explain that orange discolored urine and tears are normal while taking this medication. Orange-colored body secretions are a side effect of rifampin. The patient does not have to stop taking the medication. The findings are not indicative of an allergic reaction. Alterations in red-green color discrimination commonly occurs when taking ethambutol (Myambutol), which is a different TB medication.

Which medications are the most effective in improving asthma control by reducing bronchial hyperresponsiveness, blocking the late-phase reaction, and inhibiting migration of inflammatory cells (select all that apply)? a. Zileuton (Zyflo CR) b. Omalizumab (Xolair) c. Fluticasone (Flovent HFA) d. Salmeterol (Serevent) e. Montelukast (Singulair) f. Budesonide g. Beclomethasone (Qvar) h. Theophylline i. Mometasone (Asmanex Twisthaler)

c. Fluticasone (Flovent HFA) f. Budesonide g. Beclomethasone (Qvar) i. Mometasone (Asmanex Twisthaler) These are the corticosteroids described. Zileuton (Zyflo CR) and montelukast (Singulair) are leukotriene modifiers that interfere with the synthesis or block the action of the leukotriene inflammatory mediators that cause bronchoconstriction. Omalizumab (Xolair) is a monoclonal antibody to immunoglobulin (Ig)E, which prevents IgE from attaching to mast cells and prevents the release of chemical mediators. Salmeterol (Serevent) is a long-acting β2 -adrenergic agonist bronchodilator. Theophylline is a methylxanthine used when other longterm bronchodilators are not available or affordable.

When teaching the patient with mild asthma about the use of the peak flow meter, what should the nurse teach the patient to do? a. Always carry the flowmeter in case an asthma attack occurs. b. Use the flowmeter to check the status of the patient's asthma every time the patient takes quick-relief medication. c. Follow the written asthma action plan (e.g., take quick-relief medication) if the expiratory flow rate is in the yellow zone. d. Use the flowmeter by emptying the lungs, closing the mouth around the mouthpiece, and inhaling through the meter as quickly as possible.

c. Follow the written asthma action plan (e.g., take quick-relief medication) if the expiratory flow rate is in the yellow zone. A yellow zone reading with the peak flow meter indicates that the patient's asthma is getting worse and quick-relief medications should be used. The meter is routinely used each morning before taking medications after the personal best peak flow number has been determined. It does not always have to be on hand. The meter measures the ability to empty the lungs and involves blowing through the meter.

The nurse is performing a respiratory assessment for a patient admitted with pneumonia. Which clinical manifestation would the nurse expect to find? a. Hyperresonance on percussion b. Vesicular breath sounds in all lobes c. Increased vocal fremitus on palpation d. Fine crackles in all lobes on auscultation

c. Increased vocal fremitus on palpation A typical physical examination finding for a patient with pneumonia is increased vocal fremitus on palpation. Other signs of pulmonary consolidation include bronchial breath sounds, egophony, and crackles in the affected area. With pleural effusion, there may be dullness to percussion over the affected area.

The nurse is caring for a patient with pneumonia unresponsive to two different antibiotics. Which action is most important for the nurse to complete before administering a newly prescribed antibiotic? a. Teach the patient to cough and deep breathe. b. Take the temperature, pulse, and respiratory rate. c. Obtain a sputum specimen for culture and Gram stain. d. Check the patient's oxygen saturation by pulse oximetry.

c. Obtain a sputum specimen for culture and Gram stain. A sputum specimen for culture and Gram stain to identify the organism should be obtained before beginning antibiotic therapy. However, antibiotic administration should not be delayed if a specimen cannot be readily obtained because delays in antibiotic therapy can increase morbidity and mortality risks.

A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which intervention would be most appropriate for the nurse to include in the plan of care? a. Encourage increased intake of whole grains. b. Increase the patients intake of fruits and fruit juices. c. Offer high-calorie snacks between meals and at bedtime. d. Assist the patient in choosing foods with high vegetable and mineral content.

c. Offer high-calorie snacks between meals and at bedtime. Eating small amounts more frequently (as occurs with snacking) will increase caloric intake by decreasing the fatigue and feelings of fullness associated with large meals. Patients with COPD should rest before meals. Foods that have a lot of texture like whole grains may take more energy to eat and get absorbed and lead to decreased intake. Although fruits, juices, and vegetables are not contraindicated, foods high in protein are a better choice.

What is the pathophysiologic mechanism of cystic fibrosis leading to obstructive lung disease? a. Fibrosis of mucous glands and destruction of bronchial walls b. Destruction of lung parenchyma from inflammation and scarring c. Production of secretions low in sodium chloride and resulting thickened mucus d. Increased serum levels of pancreatic enzymes that are deposited in the bronchial mucosa

c. Production of secretions low in sodium chloride and resulting thickened mucus Cystic fibrosis (CF) is an autosomal recessive, multisystem disease involving gene mutations that make secretions of the lungs, pancreas, intestines low in sodium chloride and thus water, so they are abnormally thick and sticky. This leads to a chronic, diffuse, obstructive pulmonary disorder in almost all patients. Exocrine pancreatic insufficiency occurs in about 85% to 90% of patients with CF. Fibrosis occurs in the subepithelium of the lungs and pancreas, which plugs the exocrine ducts. Bronchiectasis occurs when bronchial walls are changed.

Which breathing technique should the nurse teach the patient with moderate COPD to promote exhalation? a. Huff coughing b. Thoracic breathing c. Pursed lip breathing d. Diaphragmatic breathing

c. Pursed lip breathing Pursed lip breathing prolongs exhalation and prevents bronchiolar collapse and air trapping. Huff coughing is a technique used to increase coughing patterns to remove secretions. Thoracic breathing is not as effective as diaphragmatic breathing and is the method most naturally used by patients with COPD. Diaphragmatic breathing emphasizes the use of the diaphragm to increase maximum inhalation, but it may increase the work of breathing and dyspnea.

A nurse who is caring for patient with a tracheostomy tube in place has just auscultated rhonchi bilaterally. If the patient is unsuccessful in coughing up secretions, what action should the nurse take? a. Encourage increased incentive spirometer use. b. Encourage the patient to increase oral fluid intake. c. Put on sterile gloves and use a sterile catheter to suction. d. Preoxygenate the patient for 3 minutes before suctioning.

c. Put on sterile gloves and use a sterile catheter to suction. This patient needs suctioning now to secure a patent airway. Sterile gloves and a sterile catheter are used when suctioning a tracheostomy. Preoxygenation for 3 minutes is not necessary. Incentive spirometer (IS) use opens alveoli and can induce coughing, which can mobilize secretions. However, the patient with a tracheostomy may not be able to use an incentive spirometer. Increasing oral fluid intake would not moisten and help mobilize secretions in a timely manner.

A patient newly diagnosed with asthma is being discharged. The nurse anticipates including which topic in the discharge teaching? a. Use of long-acting b-adrenergic medications b. Side effects of sustained-release theophylline c. Self-administration of inhaled corticosteroids d. Complications associated with oxygen therapy

c. Self-administration of inhaled corticosteroids Inhaled corticosteroids are more effective in improving asthma than any other drug and are indicated for all patients with persistent asthma. The other therapies would not typically be first-line treatments for newly diagnosed asthma.

What should the nurse include when teaching the patient with COPD about the need for physical exercise? a. All patients with COPD should be able to increase walking gradually up to 20 minutes per day. b. A bronchodilator inhaler should be used to relieve exercise-induced dyspnea immediately after exercise. c. Shortness of breath is expected during exercise but should return to baseline within 5 minutes after the exercise. d. Monitoring the heart rate before and after exercise is the best way to determine how much exercise can be tolerated.

c. Shortness of breath is expected during exercise but should return to baseline within 5 minutes after the exercise. Shortness of breath usually increases during exercise, but the activity is not being overdone if breathing returns to baseline within 5 minutes after stopping. Bronchodilators can be administered 10 minutes before exercise but should not be administered for at least 5 minutes after activity to allow recovery. Patients are encouraged to walk 15 to 20 minutes per day with gradual increases, but actual patterns will depend on patient tolerance. Dyspnea most often limits exercise and is a better sign of exercise tolerance than is heart rate in the patient with COPD.

The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action should the nurse take? a. Teach about the reason for the blood tests. b. Schedule an appointment for a chest x-ray. c. Teach about the need to get sputum specimens for 2 to 3 consecutive days. d. Instruct the patient to expectorate three specimens as soon as possible.

c. Teach about the need to get sputum specimens for 2 to 3 consecutive days. Sputum specimens are obtained on 2 to 3 consecutive days for bacteriologic testing for M. tuberculosis The patient should not provide all the specimens at once. Blood cultures are not used for tuberculosis testing. A chest x-ray is not bacteriologic testing. Although the findings on chest x-ray examination are important, it is not possible to make a diagnosis of TB solely based on chest x-ray findings because other diseases can mimic the appearance of TB.

The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is most helpful in confirming a diagnosis of chronic bronchitis? a. The patient tells the nurse about a family history of bronchitis. b. The patients history indicates a 30 pack-year cigarette history. c. The patient complains about a productive cough every winter for 3 months. d. The patient denies having any respiratory problems until the last 12 months.

c. The patient complains about a productive cough every winter for 3 months. A diagnosis of chronic bronchitis is based on a history of having a productive cough for 3 months for at least 2 consecutive years. There is no family tendency for chronic bronchitis. Although smoking is the major risk factor for chronic bronchitis, a smoking history does not confirm the diagnosis.

A patient is diagnosed with both human immunodeficiency virus (HIV) and active tuberculosis (TB) disease. Which information obtained by the nurse is most important to communicate to the health care provider? a. The Mantoux test had an induration of 7 mm. b. The chest-x-ray showed infiltrates in the lower lobes. c. The patient is being treated with antiretrovirals for HIV infection. d. The patient has a cough that is productive of blood-tinged mucus.

c. The patient is being treated with antiretrovirals for HIV infection. Drug interactions can occur between the antiretrovirals used to treat HIV infection and the medications used to treat TB. The other data are expected in a patient with HIV and TB.

The nurse teaches a patient with chronic bronchitis about a new prescription for Advair Diskus (combined fluticasone and salmeterol). Which action by the patient would indicate to the nurse that teaching about medication administration has been successful? a. The patient shakes the device before use. b. The patient attaches a spacer to the Diskus. c. The patient rapidly inhales the medication. d. The patient performs huff coughing after inhalation.

c. The patient rapidly inhales the medication. The patient should inhale the medication rapidly. Otherwise the dry particles will stick to the tongue and oral mucosa and not get inhaled into the lungs. Advair Diskus is a dry powder inhaler; shaking is not recommended. Spacers are not used with dry powder inhalers. Huff coughing is a technique to move mucus into larger airways to expectorate. The patient should not huff cough or exhale forcefully after taking Advair in order to keep the medication in the lungs.

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which information obtained from the patient would prompt the nurse to consult with the health care provider before administering the prescribed theophylline? a. The patient reports a recent 15-pound weight gain. b. The patient denies any shortness of breath at present. c. The patient takes cimetidine (Tagamet) 150 mg daily. d. The patient complains about coughing up green mucus.

c. The patient takes cimetidine (Tagamet) 150 mg daily. Cimetidine interferes with the metabolism of theophylline, and concomitant administration may lead rapidly to theophylline toxicity. The other patient information would not affect whether the theophylline should be administered or not.

The nurse takes an admission history on a patient with possible asthma who has new-onset wheezing and shortness of breath. Which information may indicate a need for a change in therapy? a. The patient has chronic inflammatory bowel disease. b. The patient has a history of pneumonia 6 months ago. c. The patient takes propranolol (Inderal) for hypertension. d. The patient uses acetaminophen (Tylenol) for headaches.

c. The patient takes propranolol (Inderal) for hypertension. b-Blockers such as propranolol can cause bronchospasm in some patients with asthma. The other information will be documented in the health history but does not indicate a need for a change in therapy.

A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days. Which assessment data obtained by the nurse indicates that the treatment has been effective? a. Bronchial breath sounds are heard at the right base. b. The patient coughs up small amounts of green mucus. c. The patients white blood cell (WBC) count is 9000/L. d. Increased tactile fremitus is palpable over the right chest.

c. The patients white blood cell (WBC) count is 9000/L. The normal WBC count indicates that the antibiotics have been effective. All the other data suggest that a change in treatment is needed.

A patient is being discharged with plans for home O2 therapy provided by an O2 concentrator with a portable O2 -concentrator unit. In preparing the patient to use the equipment, what should the nurse teach the patient? a. The portable unit will last about 6 to 8 hours. b. The unit is strictly for portable and emergency use. c. The unit concentrates O2 from the air, providing a continuous O2 supply. d. Weekly delivery of 1 large cylinder of O2 will be needed for a 7- to 10-day supply of O2 .

c. The unit concentrates O2 from the air, providing a continuous O2 supply. Oxygen concentrators or extractors continuously supply O2 concentrated from the air. Portable liquid O2 units will hold about 6 to 8 hours of O2 , but because of the expense, they are only used for portable and emergency use. Portable O2 -conserving units slow the use of oxygen. Compressed O2 comes in various tank sizes. It requires weekly deliveries of 4 to 5 large tanks to meet a 7- to 10-day supply.

The nurse is palpating the patient's chest during a focused respiratory assessment in the emergency department. Which finding is a medical emergency? a. Increased tactile fremitus b. Diminished chest movement c. Tracheal deviation to the left d. Decreased anteroposterior (AP) diameter

c. Tracheal deviation to the left Tracheal deviation is a medical emergency when it is caused by a tension pneumothorax. Tactile fremitus increases with pneumonia or pulmonary edema and decreases in pleural effusion or lung hyperinflation. Diminished chest movement occurs with barrel chest, restrictive disease, and neuromuscular disease.

Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse? a. Standard four-drug therapy for TB b. Need for annual repeat TB skin testing c. Use and side effects of isoniazid (INH) d. Bacille Calmette-Gurin (BCG) vaccine

c. Use and side effects of isoniazid (INH) The nurse is considered to have a latent TB infection and should be treated with INH daily for 6 to 9 months. The four-drug therapy would be appropriate if the nurse had active TB. TB skin testing is not done for individuals who have already had a positive skin test. BCG vaccine is not used in the United States for TB and would not be helpful for this individual, who already has a TB infection.

The nurse assesses a patient with a history of asthma. Which assessment finding indicates that the nurse should take immediate action? a. Pulse oximetry reading of 91% b. Respiratory rate of 26 breaths/minute c. Use of accessory muscles in breathing d. Peak expiratory flow rate of 240 L/minute

c. Use of accessory muscles in breathing Use of accessory muscle indicates that the patient is experiencing respiratory distress and rapid intervention is needed. The other data indicate the need for ongoing monitoring and assessment but do not suggest that immediate treatment is required.

A patient is scheduled for pulmonary function testing. Which action should the nurse take to prepare the patient for this procedure? a. Give the rescue medication immediately before testing. b. Administer oral corticosteroids 2 hours before the procedure. c. Withhold bronchodilators for 6 to 12 hours before the examination. d. Ensure that the patient has been NPO for several hours before the test.

c. Withhold bronchodilators for 6 to 12 hours before the examination. Bronchodilators are held before pulmonary function testing (PFT) so that a baseline assessment of airway function can be determined. Testing is repeated after bronchodilator use to determine whether the decrease in lung function is reversible. There is no need for the patient to be NPO. Oral corticosteroids should be held before PFTs. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.

Which medications would be most appropriate to administer to a patient experiencing an acute asthma attack? (select all that apply) a. montelukast (Singulair) b. inhaled hypertonic saline c. albuterol (Proventil HFA) d. ipratropium (Atrovent HFA) e. salmeterol (Serevent Diskus)

c. albuterol (Proventil HFA) d. ipratropium (Atrovent HFA)

The nurse can best determine adequate arterial oxygenation of the blood by assessing a. heart rate. b. hemoglobin level. c. arterial oxygen partial pressure. d. arterial carbon dioxide partial pressure.

c. arterial oxygen partial pressure.

The major advantage of a Venturi mask is that it can a. deliver up to 80% O2. b. provide continuous 100% humidity. c. deliver a precise concentration of O2. d. be used while a patient eats and sleeps.

c. deliver a precise concentration of O2.

During the respiratory assessment of an older adult, the nurse would expect to find (select all that apply) a. a vigorous reflex cough. b. increased chest expansion. c. increased residual volume. d. decreased lung sounds at base of lungs. e. increased anteroposterior (AP) chest diameter.

c. increased residual volume. d. decreased lung sounds at base of lungs. e. increased anteroposterior (AP) chest diameter.

The nurse evaluates that discharge teaching for a patient hospitalized with pneumonia has been effective when the patient makes which statement about measures to prevent a relapse? a. "I will seek immediate medical treatment for any upper respiratory infections." b. "I should continue to do deep breathing and coughing exercises for at least 12 weeks." c. "I will increase my food intake to 2400 calories a day to keep my immune system well." d. "I must have a follow-up chest x-ray in 6 to 8 weeks to evaluate the pneumonia's resolution."

d. "I must have a follow-up chest x-ray in 6 to 8 weeks to evaluate the pneumonia's resolution." The follow-up chest x-ray examination will be done in 6 to 8 weeks to evaluate pneumonia resolution. A patient should seek medical treatment for upper respiratory infections that persist for more than 7 days. It may be important for the patient to continue with coughing and deep breathing exercises for 6 to 8 weeks, not 12 weeks, until all the infection has cleared from the lungs. Increased fluid intake, not caloric intake, is required to liquefy secretions.

When teaching the patient about going from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI), which patient statement indicates to the nurse that the patient needs more teaching? a. "I do not need to use the spacer like I used to." b. "I will hold my breath for 10 seconds or longer if I can." c. "I will not shake this inhaler like I did with my old inhaler." d. "I will store it in the bathroom, so I will be able to clean it when I need to."

d. "I will store it in the bathroom, so I will be able to clean it when I need to." Storing the dry powder inhaler (DPI) in the bathroom will expose it to moisture, which could cause clumping of the medication and an altered dose. The other statements show patient understanding.

The husband of a patient with severe COPD tells the nurse that he and his wife have not had any sexual activity since she was diagnosed with COPD because she becomes too short of breath. What is the nurse's best response? a. "You need to discuss your feelings and needs with your wife so that she knows what you expect of her." b. "There are other ways to maintain intimacy besides sexual intercourse that will not make her short of breath." c. "You should explore other ways to meet your sexual needs since your wife is no longer capable of sexual activity." d. "Would you like me to talk with you and your wife about some modifications that can be made to maintain sexual activity?"

d. "Would you like me to talk with you and your wife about some modifications that can be made to maintain sexual activity?" Specific guidelines for sexual activity help preserve energy and prevent dyspnea, and maintenance of sexual activity is important to the healthy psychologic well-being of the patient. Open communication between partners is needed so that the modifications can be made with consideration of both partners.

A nurse is caring for a client who was admitted with major burns to the head, neck, and chest. Which of the following complications should the nurse identify as the greatest risk to the client? a. Hypothermia b. Hyponatremia c. Fluid imbalance d. Airway obstruction

d. Airway obstruction

Priority Decision: Which medication should the nurse anticipate being used first in the emergency department for relief of severe respiratory distress related to asthma? a. Prednisone orally b. Tiotropium inhaler c. Fluticasone inhaler d. Albuterol nebulizer

d. Albuterol nebulizer The albuterol nebulizer will rapidly cause bronchodilation and be easier to use in an emergency than an inhaler. It will be used every 20 minutes to 4 hours as needed. The tiotropium inhaler is only approved for chronic obstructive pulmonary disease (COPD). Oral or inhaled corticosteroids will be used to decrease the inflammation and provide better symptom control after the emergency is over.

An alcoholic and homeless patient is diagnosed with active tuberculosis (TB). Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen? a. Arrange for a friend to administer the medication on schedule. b. Give the patient written instructions about how to take the medications. c. Teach the patient about the high risk for infecting others unless treatment is followed. d. Arrange for a daily noon meal at a community center where the drug will be administered.

d. Arrange for a daily noon meal at a community center where the drug will be administered. Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen, and arranging a daily meal will help ensure that the patient is available to receive the medication. The other nursing interventions may be appropriate for some patients but are not likely to be as helpful for this patient.

The patient with Parkinson's disease has a pulse oximetry reading of 72% but has no other signs of decreased oxygenation. What is the most likely explanation for the low SpO2 level? a. Anemia b. Dark skin color c. Thick acrylic nails d. Artifact

d. Artifact Motion is the most likely cause of the low SpO2 for this patient with Parkinson's disease. Anemia, dark skin color, and thick acrylic nails as well as low perfusion, bright fluorescent lights, and intravascular dyes may also cause an inaccurate pulse oximetry result. There is no mention of these or reason to suspect these in this question.

Which nursing action would be of highest priority when suctioning a patient with a tracheostomy? a. Auscultating lung sounds after suctioning is complete b. Giving antianxiety medications 30 minutes before suctioning c. Instilling 5 mL of normal saline into the tracheostomy tube before suctioning d. Assessing the patient's oxygen saturation before, during, and after suctioning

d. Assessing the patient's oxygen saturation before, during, and after suctioning

A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, I wish I were dead! I'm just a burden on everybody. Based on this information, which nursing diagnosis is most appropriate? a. Complicated grieving related to expectation of death b. Ineffective coping related to unknown outcome of illness c. Deficient knowledge related to lack of education about COPD d. Chronic low self-esteem related to increased physical dependence

d. Chronic low self-esteem related to increased physical dependence The patients statement about not being able to do anything for himself or herself supports this diagnosis. Although deficient knowledge, complicated grieving, and ineffective coping may also be appropriate diagnoses for patients with COPD, the data for this patient do not support these diagnoses.

Patient with difficulty swallowing is hospitalized and at risk for aspiration pneumonia. What nursing intervention is indicated to prevent pneumonia? a. Position to side, protect airway b. Check placement of the tube before feeding and residual feeding; keep head of bed up after feedings or continuously with continuous feedings c. Check gag reflex before feeding or offering fluids d. Cut food in small bites, encourage thorough chewing, and provide soft foods that are easier to swallow than liquids

d. Cut food in small bites, encourage thorough chewing, and provide soft foods that are easier to swallow than liquids

After swallowing, a 73-yr-old patient is coughing and has a wet voice. What changes of aging could be contributing to this abnormal finding? a. Decreased response to hypercapnia b. Decreased number of functional alveoli c. Increased calcification of costal cartilage d. Decreased respiratory defense mechanisms

d. Decreased respiratory defense mechanisms Aspiration occurs more easily in the older patient related to decreased respiratory defense mechanisms (e.g., decreases in immunity, ciliary function, cough force, sensation in pharynx). Changes of aging include a decreased response to hypercapnia, decreased number of functional alveoli, and increased calcification of costal cartilage, but these do not increase the risk of aspiration.

Your patient is in bed & suddenly becomes SOB. What do you do first? a. Call the HCP b. Apply supplemental oxygen c. Turn the patient to the side d. Elevate the head of the bed(HOB)

d. Elevate the head of the bed(HOB)

Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic bronchitis. Which intervention should the nurse include in the plan of care? a. Schedule the procedure 1 hour after the patient eats. b. Maintain the patient in the lateral position for 20 minutes. c. Perform percussion before assisting the patient to the drainage position. d. Give the ordered albuterol (Proventil) before the patient receives the therapy.

d. Give the ordered albuterol (Proventil) before the patient receives the therapy. Bronchodilators are administered before chest physiotherapy. Postural drainage, percussion, and vibration should be done 1 hour before or 3 hours after meals. Patients remain in each postural drainage position for 5 minutes. Percussion is done while the patient is in the postural drainage position.

Twenty-four hours after a patient had a tracheostomy, the tube is accidentally dislodged after a coughing episode. Which action should the nurse take first? a. Call the health care provider. b. Place obturator in the tracheostomy tube. c. Position patient in a semi-Fowler's position. d. Grasp the retention sutures to spread the tracheostomy opening.

d. Grasp the retention sutures to spread the tracheostomy opening. However, the nurse should first grasp the retention sutures to spread the tracheostomy opening.

The nurse is performing tuberculosis (TB) skin tests in a clinic that has many patients who have immigrated to the United States. Which question is most important for the nurse to ask before the skin test? a. Is there any family history of TB? b. How long have you lived in the United States? c. Do you take any over-the-counter (OTC) medications? d. Have you received the bacille Calmette-Gurin (BCG) vaccine for TB?

d. Have you received the bacille Calmette-Gurin (BCG) vaccine for TB? Patients who have received the BCG vaccine will have a positive Mantoux test. Another method for screening (such as a chest x-ray) will need to be used in determining whether the patient has a TB infection. The other information also may be valuable but is not as pertinent to the decision about doing TB skin testing.

A 55-year-old patient with increasing dyspnea is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a patient about pulmonary function testing (PFT) for this condition, what is the most important question the nurse should ask? a. Are you claustrophobic? b. Are you allergic to shellfish? c. Do you have any metal implants or prostheses? d. Have you taken any bronchodilators in the past 6 hours?

d. Have you taken any bronchodilators in the past 6 hours? Pulmonary function testing will help establish the COPD diagnosis. Bronchodilators should be avoided at least 6 hours before the test. PFTs do not involve being placed in an enclosed area such as for magnetic resonance imaging (MRI). Contrast dye is not used for PFTs. The patient may still have PFTs done if metal implants or prostheses are present, as these are contraindications for an MRI.

What is the initial antibiotic treatment for pneumonia based on? a. The severity of symptoms b. The presence of characteristic leukocytes c. Gram stains and cultures of sputum specimens d. History and physical examination and characteristic chest x-ray findings

d. History and physical examination and characteristic chest x-ray findings Prompt treatment of pneumonia with appropriate antibiotics is important in treating bacterial and mycoplasma pneumonia, and antibiotics are often administered on the basis of the history, physical examination, and a chest x-ray indicating a typical pattern characteristic of a particular organism without further testing. It is more significant if it is CAP or HAP than the severity of pneumonia symptoms. Blood and sputum cultures take 24 to 72 hours for results, and microorganisms often cannot be identified with either Gram stain or cultures.

A patient with pneumonia has a fever of 101.4 F (38.6 C), a nonproductive cough, and an oxygen saturation of 88%. The patient complains of weakness, fatigue, and needs assistance to get out of bed. Which nursing diagnosis should the nurse assign as the highest priority ? a. Hyperthermia related to infectious illness b. Impaired transfer ability related to weakness c. Ineffective airway clearance related to thick secretions d. Impaired gas exchange related to respiratory congestion

d. Impaired gas exchange related to respiratory congestion All these nursing diagnoses are appropriate for the patient, but the patients oxygen saturation indicates that all body tissues are at risk for hypoxia unless the gas exchange is improved.

Tobacco smoke causes defects in multiple areas of the respiratory system. What is a long-term effect of smoking? a. Bronchospasm and hoarseness b. Decreased mucus secretions and cough c. Increased function of alveolar macrophages d. Increased risk of infection and hyperplasia of mucous glands

d. Increased risk of infection and hyperplasia of mucous glands Increased risk of infection, hyperplasia of mucous glands, cancer, chronic cough, chronic bronchitis, and COPD are the long-term effects of smoking. Bronchospasm and hoarseness are acute effects of smoking.

Which medication is a long-acting β2 -adrenergic agonist and DPI that is used only for COPD? a. Roflumilast (Daliresp) b. Salmeterol (Serevent) c. Ipratropium (Atrovent HFA) d. Indacaterol (Arcapta Neohaler)

d. Indacaterol (Arcapta Neohaler) Indacaterol (Arcapta Neohaler) is a β2 -adrenergic agonist administered via DPI that is used only for COPD. Roflumilast (Daliresp) is an oral medication used for COPD. Salmeterol (Serevent) is a DPI, but it is also used in asthma with inhaled corticosteroids. Ipratropium (Atrovent HFA) is used for COPD, but it is delivered via metered-dose inhaler or nebulizer.

What is a possible cause for auscultation abnormal finding "fine crackles"? a. Lung consolidation with fluid or exudate b. Air trapping c. Atelactasis d. Interstitial edema

d. Interstitial edema

A patient's ABGs include a PaO2 of 88 mm Hg and a PaCO2 of 38 mm Hg, and mixed venous blood gases include a partial pressure of oxygen in venous blood (PvO2 ) of 40 mm Hg and partial pressure of carbon dioxide in venous blood (PvCO2 ) of 46 mm Hg. What do these findings indicate? a. Impaired cardiac output b. Unstable hemodynamics c. Inadequate delivery of oxygen to the tissues d. Normal capillary oxygen-carbon dioxide exchange

d. Normal capillary oxygen-carbon dioxide exchange Normal venous blood gas values reflect the normal uptake of oxygen from arterial blood and the release of carbon dioxide from cells into the blood, resulting in a much lower PaO2 and an increased PaCO2 . The pH is also decreased in mixed venous blood gases because of the higher partial pressure of carbon dioxide in venous blood (PvCO2 ). Normal mixed venous blood gases also have much lower partial pressure of oxygen in venous blood (PvO2 ) and venous oxygen saturation (SvO2 ) than ABGs. Mixed venous blood gases are used when patients are hemodynamically unstable to evaluate the amount of oxygen delivered to the tissue and the amount of oxygen consumed by the tissues.

A patient hospitalized with chronic obstructive pulmonary disease (COPD) is being discharged home on oxygen therapy. Which instruction should the nurse include in the discharge teaching? a. Storage of oxygen tanks will require adequate space in the home. b. Travel opportunities will be limited because of the use of oxygen. c. Oxygen flow should be increased if the patient has more dyspnea. d. Oxygen use can improve the patients prognosis and quality of life.

d. Oxygen use can improve the patients prognosis and quality of life. The use of home oxygen improves quality of life and prognosis. Because increased dyspnea may be a symptom of an acute process such as pneumonia, the patient should notify the physician rather than increasing the oxygen flow rate if dyspnea becomes worse. Oxygen can be supplied using liquid, storage tanks, or concentrators, depending on individual patient circumstances. Travel is possible using portable oxygen concentrators.

A young adult patient with cystic fibrosis (CF) is admitted to the hospital with increased dyspnea. Which intervention should the nurse include in the plan of care? a. Schedule a sweat chloride test. b. Arrange for a hospice nurse visit. c. Place the patient on a low-sodium diet. d. Perform chest physiotherapy every 4 hours.

d. Perform chest physiotherapy every 4 hours. Routine scheduling of airway clearance techniques is an essential intervention for patients with CF. A sweat chloride test is used to diagnose CF, but it does not provide any information about the effectiveness of therapy. There is no indication that the patient is terminally ill. Patients with CF lose excessive sodium in their sweat and require high amounts of dietary sodium.

Priority Decision: During an acute exacerbation of mild COPD, the patient is severely short of breath. The nurse identifies a nursing diagnosis of impaired breathing, etiology: alveolar hypoventilation and anxiety. What is the best nursing action? a. Prepare and administer routine bronchodilator medications. b. Perform chest physiotherapy to promote removal of secretions. c. Administer oxygen at 5 L/min until the shortness of breath is relieved. d. Position the patient upright with the elbows resting on the over-the-bed table.

d. Position the patient upright with the elbows resting on the over-the-bed table. The tripod position with an elevated backrest and supported upper extremities to fix the shoulder girdle maximizes respiratory excursion and an effective breathing pattern. Staying with the patient and encouraging pursed lip breathing also helps. Rescue short-acting, not routine bronchodilators, will be ordered but can also increase nervousness and anxiety. Postural drainage is not tolerated by a patient in acute respiratory distress, and oxygen is titrated to an effective rate based on ABGs because of the possibility of carbon dioxide narcosis.

What is the primary principle involved in the various airway clearance devices used for mobilizing secretions? a. Vibration b. Inhalation therapy c. Chest physiotherapy d. Positive expiratory pressure

d. Positive expiratory pressure Positive expiratory pressure (PEP) is the principle behind the airway clearance devices that mobilize secretions and benefit patients. Vibration, a form of chest physiotherapy, and inhalation therapy are therapies to assist patients with excessive secretions or to increase bronchodilation, but they are not principles of airway clearance device function

In addition to smoking cessation, what treatment is included for COPD to slow the progression of the disease? a. Use of bronchodilator drugs b. Use of inhaled corticosteroids c. Lung volume reduction surgery d. Prevention of respiratory tract infections

d. Prevention of respiratory tract infections Smoking cessation is one of the most important factors in preventing further damage to the lungs in COPD, but prevention of infections that further increase lung damage is also important. The patient is very susceptible to infections, and these infections make the disease worse, creating a vicious cycle. Bronchodilators, inhaled corticosteroids, and lung volume-reduction surgery help control symptoms, but these are symptomatic measures.

Priority Decision: In planning care for the patient with bronchiectasis, which nursing intervention is the priority? a. Relieve or reduce pain b. Prevent paroxysmal coughing c. Prevent spread of the disease to others d. Promote drainage and removal of mucus

d. Promote drainage and removal of mucus Mucus production is increased in bronchiectasis and collects in the dilated, pouched bronchi. A major goal of treatment is to promote drainage and removal of the mucus, primarily through ACT, including deep breathing, coughing, and especially postural drainage. Pleuritic chest pain and prevention of coughing will occur with the removal of mucus. The disease is not contagious.

In an adult patient with bronchiectasis, what is a health history likely to reveal? a. Chest trauma b. Childhood asthma c. Smoking or oral tobacco use d. Recurrent lower respiratory tract infections

d. Recurrent lower respiratory tract infections In adults, most forms of bronchiectasis are associated with bacterial infections that damage the bronchial walls. In children, CF is the prominent cause of bronchiectasis. The incidence of bronchiectasis has decreased with the use of measles and pertussis vaccines and better treatment of lower respiratory tract infections.

Priority Decision: After the health care provider sees a patient hospitalized with a stroke who developed a fever and adventitious lung sounds, the following orders are written. Which order should the nurse implement first? a. Anterior/posterior and lateral chest x-rays b. Start IV levofloxacin 500 mg every 24 hr now c. Complete blood count (CBC) with differential d. Sputum specimen for Gram stain and culture and sensitivity

d. Sputum specimen for Gram stain and culture and sensitivity A sputum specimen for Gram stain and culture should be obtained before starting antibiotic therapy and while waiting for the antibiotic to be delivered from the pharmacy in a hospitalized patient with suspected pneumonia. Then antibiotics should be started without delay. If the sputum specimen cannot be obtained rapidly, the chest x-ray will be done to assess the typical pattern characteristic of the infecting organism. Blood cell tests will not be altered significantly by delaying the tests until after the first dose of antibiotics.

A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of impaired breathing pattern related to anxiety. Which nursing action is most appropriate to include in the plan of care? a. Titrate oxygen to keep saturation at least 90%. b. Discuss a high-protein, high-calorie diet with the patient. c. Suggest the use of over-the-counter sedative medications. d. Teach the patient how to effectively use pursed lip breathing.

d. Teach the patient how to effectively use pursed lip breathing. Pursed lip breathing techniques assist in prolonging the expiratory phase of respiration and decrease air trapping. There is no indication that the patient requires oxygen therapy or an improved diet. Sedative medications should be avoided because they decrease respiratory drive.

A PPD test is positive if an HIV patient has an induration of: a. The redness at the site is 15 mm or more. b. The induration is 1 mm c. There is no induration d. The induration is 5 mm or >

d. The induration is 5 mm or >

The nurse teaches a patient how to administer formoterol (Perforomist) through a nebulizer. Which action by the patient indicates good understanding of the teaching? a. The patient attaches a spacer before using the inhaler. b. The patient coughs vigorously after using the inhaler. c. The patient activates the inhaler at the onset of expiration. d. The patient removes the facial mask when misting has ceased.

d. The patient removes the facial mask when misting has ceased. A nebulizer is used to administer aerosolized medication. A mist is seen when the medication is aerosolized, and when all of the medication has been used, the misting stops. The other options refer to inhaler use. Coughing vigorously after inhaling and activating the inhaler at the onset of expiration are both incorrect techniques when using an inhaler.

The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful? a. The patient inhales rapidly through the peak flow meter mouthpiece. b. The patient takes montelukast (Singulair) for peak flows in the red zone. c. The patient calls the health care provider when the peak flow is in the green zone. d. The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone.

d. The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone. Readings in the yellow zone indicate a decrease in peak flow. The patient should use short-acting b2-adrenergic (SABA) medications. Readings in the green zone indicate good asthma control. The patient should exhale quickly and forcefully through the peak flow meter mouthpiece to obtain the readings. Readings in the red zone do not indicate good peak flow, and the patient should take a fast-acting bronchodilator and call the health care provider for further instructions. Singulair is not indicated for acute attacks but rather is used for maintenance therapy.

The nurse completes an admission assessment on a patient with asthma. Which information given by patient is most indicative of a need for a change in therapy? a. The patient uses albuterol (Proventil) before any aerobic exercise. b. The patient says that the asthma symptoms are worse every spring. c. The patients heart rate increases after using the albuterol (Proventil) inhaler. d. The patients only medications are albuterol (Proventil) and salmeterol (Serevent).

d. The patients only medications are albuterol (Proventil) and salmeterol (Serevent). Long-acting b2-agonists should be used only in patients who also are using an inhaled corticosteroid for long-term control. Salmeterol should not be used as the first-line therapy for long-term control. Using a bronchodilator before exercise is appropriate. The other information given by the patient requires further assessment by the nurse, but is not unusual for a patient with asthma.

A patient is admitted with active tuberculosis (TB). The nurse should question a health care providers order to discontinue airborne precautions unless which assessment finding is documented? a. Chest x-ray shows no upper lobe infiltrates. b. TB medications have been taken for 6 months. c. Mantoux testing shows an induration of 10 mm. d. Three sputum smears for acid-fast bacilli are negative.

d. Three sputum smears for acid-fast bacilli are negative. Negative sputum smears indicate that Mycobacterium tuberculosis is not present in the sputum, and the patient cannot transmit the bacteria by the airborne route. Chest x-rays are not used to determine whether treatment has been successful. Taking medications for 6 months is necessary, but the multidrug-resistant forms of the disease might not be eradicated after 6 months of therapy. Repeat Mantoux testing would not be done because the result will not change even with effective treatment.

Which guideline should the nurse include when teaching a patient how to use a metered-dose inhaler (MDI)? a. After activating the MDI, breathe in as quickly as you can. b. Estimate the amount of remaining medicine in the MDI by floating the canister in water. c. Disassemble the plastic canister from the inhaler and rinse both pieces under running water every week. d. To determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day.

d. To determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day.

Which actions prevent the dislodgement of a tracheostomy tube in the first 3 days after its placement (select all that apply)? a. Provide tracheostomy care every 24 hours. b. Keep the patient in the semi-Fowler's position at all times. c. Keep a same-size or larger replacement tube at the bedside. d. Tracheostomy ties are not changed for 24 hours after tracheostomy procedure. e. Suction the tracheostomy tube when there is a moist cough or a decreased arterial oxygen saturation by pulse oximetry (SpO2 ). f. A physician performs the first tracheostomy tube change 2 days after the tracheostomy.

d. Tracheostomy ties are not changed for 24 hours after tracheostomy procedure. e. Suction the tracheostomy tube when there is a moist cough or a decreased arterial oxygen saturation by pulse oximetry (SpO2 ). Changing the tracheostomy tapes soon after placement of the tracheostomy will be irritating to the trachea and could contribute to dislodgement of the tracheostomy tube. Suctioning should be done when increased secretions are evident in the tube to prevent the patient from severe coughing, which could cause tube dislodgement. Tracheostomy care is done every 8 hours. Keeping the patient in a semi-Fowler's position will not prevent dislodgement. Keeping an extra tube at the bedside will speed reinsertion if the tracheostomy tube is dislodged, but it will not prevent dislodgement. The physician will not change the tracheostomy tube until the insertion site is healed, approximately 3 to 5 days after original insertion.

Which information will the nurse include in the asthma teaching plan for a patient being discharged? a. Use the inhaled corticosteroid when shortness of breath occurs. b. Inhale slowly and deeply when using the dry powder inhaler (DPI). c. Hold your breath for 5 seconds after using the bronchodilator inhaler. d. Tremors are an expected side effect of rapidly acting bronchodilators.

d. Tremors are an expected side effect of rapidly acting bronchodilators. Tremors are a common side effect of short-acting b2-adrenergic (SABA) medications and not a reason to avoid using the SABA inhaler. Inhaled corticosteroids do not act rapidly to reduce dyspnea. Rapid inhalation is needed when using a DPI. The patient should hold the breath for 10 seconds after using inhalers.

The nurse supervises unlicensed assistive personnel (UAP) who are providing care for a patient with right lower lobe pneumonia. The nurse should intervene if which action by UAP is observed? a. UAP splint the patients chest during coughing. b. UAP assist the patient to ambulate to the bathroom. c. UAP help the patient to a bedside chair for meals. d. UAP lower the head of the patients bed to 15 degrees.

d. UAP lower the head of the patients bed to 15 degrees. Positioning the patient with the head of the bed lowered will decrease ventilation. The other actions are appropriate for a patient with pneumonia.

Which function test fits description "Maximum amount of air that can be exhaled after maximum inspiration"? a. FEV1 b. TLC c. Vt d. VC

d. VC Vital capacity

What is the most effective treatment for cystic fibrosis? a. Heart-lung transplant b. Administration of prophylactic antibiotics c. Administration of nebulized bronchodilators d. Vigorous and consistent airway clearance techniques

d. Vigorous and consistent airway clearance techniques The major goals of therapy in CF are to relieve airway obstruction and control infection. Airway clearance techniques (ACT) are the mainstay of treatment. Aerobic exercise is effective in clearing the airways, requiring increased nutrition and fluid, plus salt loss replacement. Antibiotics are used for early signs of infection, and long courses are necessary, but they are not used prophylactically. Bronchodilators have shown no long-term benefit. Although CF has become a leading indication for heart-lung transplant, this treatment option may not be available for many patients.

What should the nurse teach a patient with intermittent asthma about identifying specific triggers of asthma? a. Food and drug allergies do not cause respiratory symptoms. b. Exercise-induced asthma is seen only in persons with sensitivity to cold air. c. Asthma attacks are psychogenic in origin and can be controlled with relaxation techniques. d. Viral upper respiratory infections are a common precipitating factor in acute asthma attacks.

d. Viral upper respiratory infections are a common precipitating factor in acute asthma attacks. Respiratory infections are one of the most common precipitating factors of an acute asthma attack. Sensitivity to food and drugs may also precipitate attacks, and exercise-induced asthma occurs after exercise, especially in cold, dry air. Psychologic factors may interact with the asthmatic response to worsen the disease, but it is not a psychosomatic disease.

The nurse develops a teaching plan to help increase activity tolerance at home for an older adult with severe chronic obstructive pulmonary disease (COPD). Which instructions would be most appropriate for the nurse to include in the plan of care? a. Stop exercising when short of breath. b. Walk until pulse rate exceeds 130 beats/minute. c. Limit exercise to activities of daily living (ADLs). d. Walk 15 to 20 minutes daily at least 3 times/week.

d. Walk 15 to 20 minutes daily at least 3 times/week. Encourage the patient to walk 15 to 20 minutes a day at least three times a week with gradual increases. Shortness of breath is normal with exercise and not an indication that the patient should stop. Limiting exercise to ADLs will not improve the patients exercise tolerance. A 70-year-old patient should have a pulse rate of 120 or less with exercise (80% of the maximal heart rate of 150).

A patient asks, "How does air get into my lungs?" The nurse bases her answer on knowledge that air moves into the lungs because of a. positive intrathoracic pressure. b. contraction of the accessory abdominal muscles. c. stimulation of the respiratory muscles by the chemoreceptors. d. a decrease in intrathoracic pressure from an increase in thoracic cavity size.

d. a decrease in intrathoracic pressure from an increase in thoracic cavity size.

A patient has metabolic acidosis secondary to type 1 diabetes. what physiologic response should the nurse expect to assess in the patient? a. vomiting b. increased urination c. decrease heart rate d. increased respiratory rate

d. increased respiratory rate

An appropriate nursing intervention to assist a patient with pneumonia manage thick secretions and fatigue would be to a. perform postural drainage every hour. b. provide analgesics as ordered to promote patient comfort. c. administer O2 as prescribed to maintain optimal O2 levels. d. teach the patient how to cough effectively and expectorate secretions

d. teach the patient how to cough effectively and expectorate secretions

Which obstructive pulmonary disease would a 30-year-old white female patient with a parent with the disease be most likely to be diagnosed with? a. COPD b. Asthma c. Cystic fibrosis d. α1 -Antitrypsin (AAT) deficiency

d. α1 -Antitrypsin (AAT) deficiency α1 -Antitrypsin (AAT) deficiency is an autosomal recessive disorder that is a genetic risk factor for COPD with symptoms (often by age 40 years) in people with no tobacco use and family history of COPD or liver disease. AAT occurs in about 3% of people diagnosed with COPD. Although CF occurs in 1 in 3000 white births, legislation requires babies to be screened at birth, so it would have been previously diagnosed. Asthma is a multifactorial genetic disorder.

What are the characteristics of a fenestrated tracheostomy tube (select all that apply)? a. The cuff passively fills with air. b. Cuff pressure monitoring is not required. c. It has two tubings with one opening just above the cuff. d. Patient can speak with an attached air source with the cuff inflated. e. Airway obstruction is likely if the exact steps are not followed to produce speech. f. Airflow around the tube and through the window allows speech when the cuff is deflated and the plug is inserted.

e. Airway obstruction is likely if the exact steps are not followed to produce speech. f. Airflow around the tube and through the window allows speech when the cuff is deflated and the plug is inserted. The fenestrated tracheostomy tube has openings on the outer cannula to allow air to pass over the vocal cords to allow speaking. If the steps of using the fenestrated tracheostomy tube are not completed in the correct order, severe respiratory distress may result. The cuff of the tracheostomy tube with a foam-filled cuff passively fills with air and does require pressure monitoring, although cuff integrity must be assessed daily. The speaking tracheostomy tube has 2 tubes attached. One tube allows air to pass over the vocal cords to enable the person to speak with the cuff inflated.

The nurse is preparing the patient for and will assist the health care provider with a thoracentesis in the patient's room. Which of the following is the fifth action? a. Verify breath sounds in all fields. b. Obtain the supplies that will be used. c. Send labeled specimen containers to the laboratory. d. Direct the family members to the waiting room. e. Observe for signs of hypoxia during the procedure. f. Instruct the patient not to talk during the procedure. g. Position the patient sitting upright with the elbows on an over-the bed table.

e. Observe for signs of hypoxia during the procedure. Observing for hypoxia is done to keep the HCP informed.

The nurse is preparing the patient for and will assist the health care provider with a thoracentesis in the patient's room. Which of the following is the fourth action? a. Verify breath sounds in all fields. b. Obtain the supplies that will be used. c. Send labeled specimen containers to the laboratory. d. Direct the family members to the waiting room. e. Observe for signs of hypoxia during the procedure. f. Instruct the patient not to talk during the procedure. g. Position the patient sitting upright with the elbows on an over-the bed table.

f. Instruct the patient not to talk during the procedure. The patient is instructed not to talk or cough to avoid damage to the lung.

The nurse is preparing the patient for and will assist the health care provider with a thoracentesis in the patient's room. Which of the following is the third action? a. Verify breath sounds in all fields. b. Obtain the supplies that will be used. c. Send labeled specimen containers to the laboratory. d. Direct the family members to the waiting room. e. Observe for signs of hypoxia during the procedure. f. Instruct the patient not to talk during the procedure. g. Position the patient sitting upright with the elbows on an over-the bed table.

g. Position the patient sitting upright with the elbows on an over-the bed table. The patient is positioned.

A patient with acute dyspnea is scheduled for a spiral computed tomography (CT) scan. Which information obtained by the nurse is a priority to communicate to the health care provider before the CT? a. Allergy to shellfish b. Apical pulse of 104 c. Respiratory rate of 30 d. Oxygen saturation of 90%

a. Allergy to shellfish Because iodine-based contrast media is used during a spiral CT, the patient may need to have the CT scan without contrast or be premedicated before injection of the contrast media. The increased pulse, low oxygen saturation, and tachypnea all indicate a need for further assessment or intervention but do not indicate a need to modify the CT procedure.

What should the nurse do when preparing a patient for a pulmonary angiogram? a. Assess the patient for iodine allergy. b. Implement NPO orders for 6 to 12 hours before the test. c. Explain the test before the patient signs the informed consent form. d. Inform the patient that radiation isolation for 24 hours after the test is necessary

a. Assess the patient for iodine allergy. A pulmonary angiogram involves the injection of an iodine-based radiopaque dye, and iodine or shellfish allergies should be assessed before injection. A bronchoscopy requires NPO status for 6 to 12 hours before the test, and invasive tests (e.g., bronchoscopy, mediastinoscopy, biopsies) require informed consent that the HCP should obtain from the patient. Nuclear scans use radioactive materials for diagnosis, but the amounts are very small and no radiation precautions are indicated for the patient.

What is a possible cause for auscultation abnormal finding "wheezes"? a. Bronchoconstriction b. Partial obstruction of trachea or larynx c. Chronic hypoxemia d. Pleurisy

a. Bronchoconstriction

Which age-related changes in the respiratory system cause decreased secretion clearance (select all that apply)? a. Decreased force of cough b. Decreased functional cilia c. Decreased chest wall compliance d. Small airway closure earlier in expiration e. Decreased functional immunoglobulin A (IgA)

a. Decreased force of cough b. Decreased functional cilia Decreased functional cilia and decreased force of cough from declining muscle strength cause decreased secretion clearance. The other options contribute to other age-related changes. Decreased compliance contributes to barrel chest appearance. Early small airway closure contributes to decreased PaO2 . Decreased immunoglobulin A (IgA) decreases the resistance to infection.

Priority Decision: A 75-year-old patient who is breathing room air has the following arterial blood gas (ABG) results: pH 7.40, partial pressure of oxygen in arterial blood (PaO2 ) 74 mm Hg, arterial oxygen saturation (SaO2 ) 92%, partial pressure of carbon dioxide in arterial blood (PaCO2 ) 40 mm Hg. What is the most appropriate action by the nurse? a. Document the results in the patient's record. b. Repeat the ABGs within an hour to validate the findings. c. Encourage deep breathing and coughing to open the alveoli. d. Initiate pulse oximetry for continuous monitoring of the patient's oxygen

a. Document the results in the patient's record. Normal findings in arterial blood gases (ABGs) in the older adult include a small decrease in PaO2 and arterial oxygen saturation (SaO2 ) but normal pH and PaCO2 . No interventions are necessary for these findings. Usual PaO2 levels are expected in patients 60 years of age or younger.

Which function test fits description "Amount of air exhaled in first second of forced vital capacity"? a. FEV1 b. TLC c. Vt d. VC

a. FEV1 Forced expiratory volume in first second of expiration

Which function test fits description "Amount of air that can be quickly and forcefully exhaled after maximum inspiration"? a. FVC b. PEFR c. RV d. FRC

a. FVC Forced vital capacity

What should the nurse inspect when assessing a patient with shortness of breath for evidence of long-standing hypoxemia? a. Fingernails b. Chest excursion c. Spinal curvatures d. Respiratory pattern

a. Fingernails Clubbing, a sign of long-standing hypoxemia, is evidenced by an increase in the angle between the base of the nail and fingernail to 180 degrees or more, usually accompanied by an increase in the depth, bulk, and sponginess of the end of the finger.

Risk Factor for or Response to Respiratory Problem: Tobacco use history, gradual change in health status, family history of lung disease, sputum production, no immunizations for influenza or pneumococcal pneumonia received, travel to developing countries. Which Functional Health Pattern does it fall under? a. Health perception- health management b. Nutritional-metabolic c. Elimination d. Activity-exercise

a. Health perception- health management

On auscultation of a patients lungs, the nurse hears low-pitched, bubbling sounds during inhalation in the lower third of both lungs. How should the nurse document this finding? a. Inspiratory crackles at the bases b. Expiratory wheezes in both lungs c. Abnormal lung sounds in the apices of both lungs d. Pleural friction rub in the right and left lower lobes

a. Inspiratory crackles at the bases Crackles are low-pitched, bubbling sounds usually heard on inspiration. Wheezes are high-pitched sounds. They can be heard during the expiratory or inspiratory phase of the respiratory cycle. The lower third of both lungs are the bases, not apices. Pleural friction rubs are grating sounds that are usually heard during both inspiration and expiration

What is a possible cause for palpation abnormal finding "increased tactile fremitus"? a. Lung consolidation with fluid or exudate b. Air trapping c. Atelactasis d. Interstitial edema

a. Lung consolidation with fluid or exudate

The nurse assesses a patient with chronic obstructive pulmonary disease (COPD) who has been admitted with increasing dyspnea over the last 3 days. Which finding is most important for the nurse to report to the health care provider? a. Respirations are 36 breaths/minute. b. Anterior-posterior chest ratio is 1:1. c. Lung expansion is decreased bilaterally. d. Hyperresonance to percussion is present.

a. Respirations are 36 breaths/minute. The increase in respiratory rate indicates respiratory distress and a need for rapid interventions such as administration of oxygen or medications. The other findings are common chronic changes occurring in patients with COPD.

Risk Factor for or Response to Respiratory Problem: Loss of roles at work or home, exposure to respiratory toxins at work. Which Functional Health Pattern does it fall under? a. Role-relationship b. Sexuality-reproductive c. Coping- stress tolerance d. Value-belief

a. Role-relationship

A patient is admitted to the emergency department complaining of sudden onset shortness of breath and is diagnosed with a possible pulmonary embolus. How should the nurse prepare the patient for diagnostic testing to confirm the diagnosis? a. Start an IV so contrast media may be given. b. Ensure that the patient has been NPO for at least 6 hours. c. Inform radiology that radioactive glucose preparation is needed. d. Instruct the patient to undress to the waist and remove any metal objects.

a. Start an IV so contrast media may be given. Spiral computed tomography (CT) scans are the most commonly used test to diagnose pulmonary emboli, and contrast media may be given IV. A chest x-ray may be ordered but will not be diagnostic for a pulmonary embolus. Preparation for a chest x-ray includes undressing and removing any metal. Bronchoscopy is used to detect changes in the bronchial tree, not to assess for vascular changes, and the patient should be NPO 6 to 12 hours before the procedure. Positron emission tomography (PET) scans are most useful in determining the presence of malignancy, and a radioactive glucose preparation is used

The nurse is preparing the patient for a diagnostic procedure to remove pleural fluid for analysis. The nurse would prepare the patient for which test? a. Thoracentesis b. Bronchoscopy c. Pulmonary angiography d. Sputum culture and sensitivityterm-315

a. Thoracentesis

After which diagnostic study should the nurse observe the patient for symptoms of a pneumothorax? a. Thoracentesis b. Pulmonary function test c. Ventilation-perfusion scan d. Positron emission tomography (PET) scan

a. Thoracentesis The greatest chance for a pneumothorax occurs with a thoracentesis because of the possibility of lung tissue injury during this procedure. Ventilation-perfusion scans and positron emission tomography (PET) scans involve injections, but no manipulation of the respiratory tract is involved. Pulmonary function tests are noninvasive.

The nurse is preparing the patient for and will assist the health care provider with a thoracentesis in the patient's room. Which of the following is the sixth action? a. Verify breath sounds in all fields. b. Obtain the supplies that will be used. c. Send labeled specimen containers to the laboratory. d. Direct the family members to the waiting room. e. Observe for signs of hypoxia during the procedure. f. Instruct the patient not to talk during the procedure. g. Position the patient sitting upright with the elbows on an over-the bed table.

a. Verify breath sounds in all fields. Breath sounds in all lobes are verified to be sure that there was no damage to the lung.

A student nurse asks the RN what can be measured by arterial blood gas (ABG). The RN tells the student that the ABG can measure (select all that apply) a. acid-base balance. b. oxygenation status. c. acidity of the blood. d. bicarbonate (HCO3-). e. compliance and resistance.

a. acid-base balance. b. oxygenation status. c. acidity of the blood. d. bicarbonate (HCO3-).

The key anatomic landmark that separates the upper respiratory tract from the lower respiratory tract is the a. carina. b. larynx. c. trachea. d. epiglottis.

a. carina.

After the nurse has received change-of-shift report, which patient should the nurse assess first? a. A patient with pneumonia who has crackles in the right lung base b. A patient with possible lung cancer who has just returned after bronchoscopy c. A patient with hemoptysis and a 16-mm induration with tuberculin skin testing d. A patient with chronic obstructive pulmonary disease (COPD) and pulmonary function testing(PFT) that indicates low forced vital capacity

b. A patient with possible lung cancer who has just returned after bronchoscopy Because the cough and gag are decreased after bronchoscopy, this patient should be assessed for airway patency. The other patients do not have clinical manifestations or procedures that require immediate assessment by the nurse.

A 92-year-old female patient is being admitted to the emergency department with severe shortness of breath. Being aware of the patient's condition, what approach should the nurse use to assess the patient's lungs (select all that apply)? a. Apex to base b. Base to apex c. Lateral sequence d. Anterior then posterior e. Posterior then anterior

b. Base to apex e. Posterior then anterior This patient is older and short of breath. To obtain the most information, auscultate the posterior to avoid breast tissue and start at the base because of her respiratory difficulty and the chance that she will tire easily. Important sounds may be missed if the other strategies are used first

A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient? a. Ask the patient to lie down to complete a full physical assessment. b. Briefly ask specific questions about this episode of respiratory distress. c. Complete the admission database to check for allergies before treatment. d. Delay the physical assessment to first complete pulmonary function tests.

b. Briefly ask specific questions about this episode of respiratory distress. When a patient has severe respiratory distress, only information pertinent to the current episode is obtained, and a more thorough assessment is deferred until later. Obtaining a comprehensive health history or full physical examination is unnecessary until the acute distress has resolved. Brief questioning and a focused physical assessment should be done rapidly to help determine the cause of the distress and suggest treatment. Checking for allergies is important, but it is not appropriate to complete the entire admission database at this time. The initial respiratory assessment must be completed before any diagnostic tests or interventions can be ordered.

What covers the larynx during swallowing? a. Trachea b. Epiglottis c. Turbinates d. Parietal pleura

b. Epiglottis The epiglottis is a small flap closing over the larynx during swallowing. The trachea connects the larynx and the bronchi. The turbinates in the nose warm and moisturize inhaled air. The parietal pleura is a membrane that lines the chest cavity.

A patient's arterial blood gas (ABG) results include the following: pH 7.32, PaO2 84 mm Hg, PaCO2 49 mm Hg, and SaO2 84%. For what should the nurse assess the patient? a. Tetany b. Hypoventilation c. Pleural friction rub d. Kussmaul respirations

b. HypoventilationThe arterial blood gas analysis indicates respiratory acidosis. Hypoventilation with tachypnea from respiratory distress can cause respiratory acidosis.

A patient with a chronic cough has a bronchoscopy. After the procedure, which intervention by the nurse is most appropriate? a. Elevate the head of the bed to 80 to 90 degrees. b. Keep the patient NPO until the gag reflex returns. c. Place on bed rest for at least 4 hours after bronchoscopy. d. Notify the health care provider about blood-tinged mucus.

b. Keep the patient NPO until the gag reflex returns. Risk for aspiration and maintaining an open airway is the priority. Because a local anesthetic is used to suppress the gag/cough reflexes during bronchoscopy, the nurse should monitor for the return of these reflexes before allowing the patient to take oral fluids or food. Blood-tinged mucus is not uncommon after bronchoscopy. The patient does not need to be on bed rest, and the head of the bed does not need to be in the high-Fowlers position

A diabetic patients arterial blood gas (ABG) results are pH 7.28; PaCO2 34 mm Hg; PaO2 85 mm Hg; HCO3 18 mEq/L. The nurse would expect which finding? a. Intercostal retractions b. Kussmaul respirations c. Low oxygen saturation (SpO2) d. Decreased venous O2 pressure

b. Kussmaul respirations Kussmaul (deep and rapid) respirations are a compensatory mechanism for metabolic acidosis. The low pH and low bicarbonate result indicate metabolic acidosis. Intercostal retractions, a low oxygen saturation rate, and a decrease in venous O2 pressure would not be caused by acidosis

Which action is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? a. Listen to a patients lung sounds for wheezes or rhonchi. b. Label specimens obtained during percutaneous lung biopsy. c. Instruct a patient about how to use home spirometry testing. d. Measure induration at the site of a patients intradermal skin test.

b. Label specimens obtained during percutaneous lung biopsy. Labeling of specimens is within the scope of practice of UAP. The other actions require nursing judgment and should be done by licensed nursing personnel.

Risk Factor for or Response to Respiratory Problem: Decreased fluid intake, anorexia and rapid weight loss, obesity. Which Functional Health Pattern does it fall under? a. Health perception- health management b. Nutritional-metabolic c. Elimination d. Activity-exercise

b. Nutritional-metabolic

The nurse is preparing the patient for and will assist the health care provider with a thoracentesis in the patient's room. Which of the following is the first action? a. Verify breath sounds in all fields. b. Obtain the supplies that will be used. c. Send labeled specimen containers to the laboratory. d. Direct the family members to the waiting room. e. Observe for signs of hypoxia during the procedure. f. Instruct the patient not to talk during the procedure. g. Position the patient sitting upright with the elbows on an over-the bed table.

b. Obtain the supplies that will be used. The nurse will gather the supplies as soon as the order to do a thoracentesis is given.

What is a possible cause for auscultation abnormal finding "stridor"? a. Bronchoconstriction b. Partial obstruction of trachea or larynx c. Chronic hypoxemia d. Pleurisy

b. Partial obstruction of trachea or larynx

A patient is scheduled for a computed tomography (CT) of the chest with contrast media. Which assessment findings should the nurse immediately report to the health care provider (select all that apply)? a. Patient is claustrophobic. b. Patient is allergic to shellfish. c. Patient recently used a bronchodilator inhaler. d. Patient is not able to remove a wedding band. e. Blood urea nitrogen (BUN) and serum creatinine levels are elevated.

b. Patient is allergic to shellfish. e. Blood urea nitrogen (BUN) and serum creatinine levels are elevated. Because the contrast media is iodine-based and may cause dehydration and decreased renal blood flow, asking about iodine allergies (such as allergy to shellfish) and monitoring renal function before the CT scan are necessary. The other actions are not contraindications for CT of the chest, although they may be for other diagnostic tests, such as magnetic resonance imaging (MRI) or pulmonary function testing (PFT).

After assisting at the bedside with a thoracentesis, the nurse should continue to assess the patient for signs and symptoms of what? a. Bronchospasm b. Pneumothorax c. Pulmonary edema d. Respiratory acidosis

b. Pneumothorax Because thoracentesis involves the introduction of a catheter into the pleural space, there is a risk of pneumothorax. Thoracentesis does not carry a significant potential for causing bronchospasm, pulmonary edema, or respiratory acidosis.

Risk Factor for or Response to Respiratory Problem: Sexual activity altered by respiratory symptoms. Which Functional Health Pattern does it fall under? a. Role-relationship b. Sexuality-reproductive c. Coping- stress tolerance d. Value-belief

b. Sexuality-reproductive

Risk Factor for or Response to Respiratory Problem: Sleep apnea. Awakening with dyspnea, wheezing, or cough. Night sweats. Which Functional Health Pattern does it fall under? a. Activity-exercise b. Sleep-rest c. Cognitive-perceptual d. Self-perception- self-concept

b. Sleep-rest

What keeps alveoli from collapsing? a. Carina b. Surfactant c. Empyema d. Thoracic cag

b. Surfactant Surfactant is a lipoprotein that lowers the surface tension in the alveoli. It reduces the pressure needed to inflate the alveoli and decreases the tendency of the alveoli to collapse. The other options do not maintain inflation of the alveoli. The carina is the point of bifurcation of the trachea into the right and left bronchi. Empyema is a collection of pus in the thoracic cavity. The thoracic cage is formed by the ribs and protects the thoracic organs.

Which function test fits description "Maximum amount of air lungs can contain"? a. FEV1 b. TLC c. Vt d. VC

b. TLC Total lung capacity

When does the nurse record the presence of an increased anteroposterior (AP) diameter of the chest? a. There is a prominent protrusion of the sternum. b. The width of the chest is equal to the depth of the chest. c. There is equal but diminished movement of the 2 sides of the chest. d. The patient cannot fully expand the lungs because of kyphosis of the spine.

b. The width of the chest is equal to the depth of the chest. An increased anterior-posterior (AP) diameter is characteristic of a barrel chest, in which the AP diameter is about equal to the side-to-side diameter. Normally the AP diameter should be ⅓ to ½ the side-to-side diameter. A prominent protrusion of the sternum is the pectus carinatum and diminished movement of both sides of the chest indicates decreased chest excursion. Lack of lung expansion caused by kyphosis of the spine results in shallow breathing with decreased chest expansion.

To detect early signs or symptoms of inadequate oxygenation, the nurse would examine the patient for a. dyspnea and hypotension. b. apprehension and restlessness. c. cyanosis and cool, clammy skin. d. increased urine output and diaphoresis.

b. apprehension and restlessness.

When auscultating the chest of an older patient in mild respiratory distress, it is best to a. begin listening at the apices. b. begin listening at the lung bases. c. begin listening on the anterior chest. d. Ask the patient to breathe through the nose with the mouth closed.

b. begin listening at the lung bases.

When assessing subjective data related to the respiratory health of a patient with emphysema, the nurse asks about (select all that apply) a. date of last chest x-ray. b. dyspnea during rest or exercise. c. pulmonary function test results. d. ability to sleep through the entire night. e. prescription and over-the-counter medication.

b. dyspnea during rest or exercise. d. ability to sleep through the entire night. e. prescription and over-the-counter medication.

A patient had a right total knee replacement 2 days ago. Upon auscultation of the patient's posterior chest, the nurse detects discontinuous, high-pitched breath sounds just before the end of inspiration in the lower portion of both lungs. Which statement most appropriately reflects how the nurse should document the breath sounds? a. "Bibasilar wheezes present on inspiration." b. "Diminished breath sounds in the bases of both lungs." c. "Fine crackles posterior right and left lower lung fields." d. "Expiratory wheezing scattered throughout the lung fields."

c. "Fine crackles posterior right and left lower lung fields." Fine crackles are described as a series of short-duration, discontinuous, high-pitched sounds heard just before the end of inspiration.

While caring for a patient with respiratory disease, the nurse observes that the patients SpO2 drops from 93% to 88% while the patient is ambulating in the hallway. What is the priority action of the nurse? a. Notify the health care provider. b. Document the response to exercise. c. Administer the PRN supplemental O2. d. Encourage the patient to pace activity.

c. Administer the PRN supplemental O2. The drop in SpO2 to 85% indicates that the patient is hypoxemic and needs supplemental oxygen when exercising. The other actions are also important, but the first action should be to correct the hypoxemia.

What is a possible cause for auscultation abnormal finding "absent breath sounds"? a. Lung consolidation with fluid or exudate b. Air trapping c. Atelactasis d. Interstitial edema

c. Atelactasis

Why does a patient's respiratory rate increase when there is an excess of carbon dioxide in the blood? a. CO2 displaces oxygen on hemoglobin, leading to a decreased PaO2 . b. CO2 causes an increase in the amount of hydrogen ions available in the body. c. CO2 combines with water to form carbonic acid, which lowers the pH of cerebrospinal fluid. d. CO2 directly stimulates chemoreceptors in the medulla to increase

c. CO2 combines with water to form carbonic acid, which lowers the pH of cerebrospinal fluid. A combination of excess CO2 and H2O results in carbonic acid, which lowers the pH of cerebrospinal fluid and stimulates an increase in the respiratory rate. Peripheral chemoreceptors in the carotid and aortic bodies also respond to increases in PaCO2 to stimulate the respiratory center. Excess CO2 does not increase the amount of hydrogen ions available in the body but does combine with the hydrogen of water to form an acid.

Priority Decision: A pulse oximetry monitor indicates that the patient has a drop in arterial oxygen saturation by pulse oximetry (SpO2 ) from 95% to 85% over several hours. What is the first action the nurse should take? a. Order stat ABGs to confirm the SpO2 with a SaO2. b. Start oxygen administration by nasal cannula at 2 L/min. c. Check the position of the probe on the finger or earlobe. d. Notify the health care provider of the change in baseline PaO2 .

c. Check the position of the probe on the finger or earlobe. Pulse oximetry is inaccurate if the probe is loose, if there is low perfusion, or when skin color is dark. Before other measures are taken, the nurse should check the probe site. If the probe is intact at the site and perfusion is adequate, an ABG analysis will be ordered by the HCP to verify accuracy, and oxygen may be administered, depending on the patient's condition and the assessment of respiratory and cardiac status.

What is a possible cause for inspection abnormal finding "finger clubbing"? a. Bronchoconstriction b. Partial obstruction of trachea or larynx c. Chronic hypoxemia d. Pleurisy

c. Chronic hypoxemia

When auscultating the patient's lower lungs, the nurse hears low-pitched sounds similar to blowing through a straw under water on inspiration. How should the nurse document these sounds? a. Stridor b. Vesicular c. Coarse crackles d. Bronchovesicular

c. Coarse crackles Coarse crackles are a series of long-duration, discontinuous, low-pitched sounds caused by air passing through an airway intermittently occluded by mucus, an unstable bronchial wall, or a fold of mucosa. Coarse crackles are evident on inspiration and at times expiration. Stridor is a continuous crowing sound of constant pitch from partial obstruction of larynx or trachea. Vesicular sounds are relatively soft, low-pitched, gentle, rustling sounds. They are heard over all lung areas except the major bronchi. Bronchovesicular sounds are normal sounds heard anteriorly over the mainstem bronchi on either side of the sternum and posteriorly between the scapulae with a medium pitch and intensity.

Risk Factor for or Response to Respiratory Problem: Decreased cognitive function with restlessness, irritability. Chest pain or pain with breathing. Which Functional Health Pattern does it fall under? a. Activity-exercise b. Sleep-rest c. Cognitive-perceptual d. Self-perception- self-concept

c. Cognitive-perceptual

Risk Factor for or Response to Respiratory Problem: Dyspnea-anxiety-dyspnea cycle, poor coping with stress of chronic respiratory problems. Which Functional Health Pattern does it fall under? a. Role-relationship b. Sexuality-reproductive c. Coping- stress tolerance d. Value-belief

c. Coping- stress tolerance

The nurse completes a shift assessment on a patient admitted in the early phase of heart failure. When auscultating the patients lungs, which finding would the nurse most likely hear? a. Continuous rumbling, snoring, or rattling sounds mainly on expiration b. Continuous high-pitched musical sounds on inspiration and expiration c. Discontinuous, high-pitched sounds of short duration heard on inspiration d. A series of long-duration, discontinuous, low-pitched sounds during inspiration

c. Discontinuous, high-pitched sounds of short duration heard on inspiration Fine crackles are likely to be heard in the early phase of heart failure. Fine crackles are discontinuous, high- pitched sounds of short duration heard on inspiration. Rhonchi are continuous rumbling, snoring, or rattling sounds mainly on expiration. Course crackles are a series of long-duration, discontinuous, low-pitched sounds during inspiration. Wheezes are continuous high-pitched musical sounds on inspiration and expiration.

Risk Factor for or Response to Respiratory Problem: Constipation, incontinence. Which Functional Health Pattern does it fall under? a. Health perception- health management b. Nutritional-metabolic c. Elimination d. Activity-exercise

c. Elimination

The nurse teaches a patient about pulmonary function testing (PFT). Which statement, if made by the patient, indicates teaching was effective? a. I will use my inhaler right before the test. b. I wont eat or drink anything 8 hours before the test. c. I should inhale deeply and blow out as hard as I can during the test. d. My blood pressure and pulse will be checked every 15 minutes after the test.

c. I should inhale deeply and blow out as hard as I can during the test. For PFT, the patient should inhale deeply and exhale as long, hard, and fast as possible. The other actions are not needed with PFT. The administration of inhaled bronchodilators should be avoided 6 hours before the procedure.

Which respiratory defense mechanism is most impaired by smoking? a. Cough reflex b. Filtration of air c. Mucociliary clearance d. Reflex bronchoconstriction

c. Mucociliary clearance Ciliary action impaired by smoking and increased mucus production may be caused by the irritants in tobacco smoke, leading to impairment of the mucociliary clearance system. Smoking does not directly affect filtration of air, the cough reflex, or reflex bronchoconstriction, but it does impair the respiratory defense mechanism provided by alveolar macrophages.

Pulse oximetry may not be a reliable indicator of oxygen saturation in which patient? a. Patient with a fever b. Patient who is anesthetized c. Patient in hypovolemic shock d. Patient receiving oxygen therapy

c. Patient in hypovolemic shock Poor peripheral perfusion that occurs with hypovolemia or other conditions that cause peripheral vasoconstriction will cause inaccurate pulse oximetry, and ABGs may have to be used to monitor oxygenation status and ventilation status in these patients. Pulse oximetry would not be affected by fever or anesthesia and is a method of monitoring arterial oxygen saturation in patients who are receiving oxygen therapy.

The abnormal assessment findings of dullness and hyperresonance are found with which assessment technique? a. Inspection b. Palpation c. Percussion d. Auscultation

c. Percussion Dullness and hyperresonance are found in the lungs using percussion, not the other assessment techniques.

A patient in metabolic alkalosis is admitted to the emergency department, and pulse oximetry (SpO2) indicates that the O2 saturation is 94%. Which action should the nurse take next? a. Administer bicarbonate. b. Complete a head-to-toe assessment. c. Place the patient on high-flow oxygen. d. Obtain repeat arterial blood gases (ABGs).

c. Place the patient on high-flow oxygen. Although the O2 saturation is adequate, the left shift in the oxyhemoglobin dissociation curve will decrease the amount of oxygen delivered to tissues, so high oxygen concentrations should be given. Bicarbonate would worsen the patients condition. A head-to-toe assessment and repeat ABGs may be implemented. However, the priority intervention is to give high-flow oxygen.

How does the nurse assess the patient's chest expansion? a. Put the palms of the hands against the chest wall. b. Put the index fingers on either side of the trachea. c. Place the thumbs at the midline of the lower chest. d. Place 1 hand on the lower anterior chest and 1 hand on the upper abdomen

c. Place the thumbs at the midline of the lower chest. To assess the extent and symmetry of chest movement, the nurse places the hands over the lower anterior chest wall along the costal margin and moves them inward until the thumbs meet at the midline and then asks the patient to breathe deeply and observes the movement of the thumbs away from each other. The palms are placed against the chest wall to assess tactile fremitus. To determine the tracheal position, the nurse places the index fingers on either side of the trachea just above the suprasternal notch and gently presses backward.

Which function test fits description "Amount of air remaining in lungs after forced expiration"? a. FVC b. PEFR c. RV d. FRC

c. RV Residual volume

The nurse is preparing the patient for and will assist the health care provider with a thoracentesis in the patient's room. Which of the following is the last action? a. Verify breath sounds in all fields. b. Obtain the supplies that will be used. c. Send labeled specimen containers to the laboratory. d. Direct the family members to the waiting room. e. Observe for signs of hypoxia during the procedure. f. Instruct the patient not to talk during the procedure. g. Position the patient sitting upright with the elbows on an over-the bed table.

c. Send labeled specimen containers to the laboratory. This is done before sending the sample to the laboratory if there is no one else who can send the sample to the laboratory.

What is a primary nursing responsibility after obtaining a blood specimen for ABGs? a. Add heparin to the blood specimen. b. Apply pressure to the puncture site for 2 full minutes. c. Take the specimen immediately to the laboratory in an iced container. d. Avoid any changes in oxygen intervention for 15 minutes following the procedure.

c. Take the specimen immediately to the laboratory in an iced container. Samples for ABGs must be iced to keep the gases dissolved in the blood (unless the specimen is to be analyzed in < 1 minute) and taken directly to the laboratory. The syringe used to obtain the specimen is rinsed with heparin before the specimen is taken and pressure is applied to the arterial puncture site for 5 minutes after obtaining the specimen. Changes in oxygen therapy or interventions should be avoided for 15 minutes before the specimen is drawn because these changes might alter blood gas values.

What accurately describes the alveolar sacs? a. Line the lung pleura b. Warm and moisturize inhaled air c. Terminal structures of the respiratory tract d. Contain dead air that is not available for gas exchange

c. Terminal structures of the respiratory tract Alveolar sacs are terminal structures of the respiratory tract, where gas exchange takes place. The visceral pleura lines the lungs and forms a closed, double-walled sac with the parietal pleura. Turbinates warm and moisturize inhaled air. The 150 mL of air is dead space in the trachea and bronchi.

The nurse observes a student who is listening to a patients lungs who is having no problems with breathing. Which action by the student indicates a need to review respiratory assessment skills? a. The student starts at the apices of the lungs and moves to the bases. b. The student compares breath sounds from side to side avoiding bony areas. c. The student places the stethoscope over the posterior chest and listens during inspiration. d. The student instructs the patient to breathe slowly and a little more deeply than normal through the mouth.

c. The student places the stethoscope over the posterior chest and listens during inspiration. Listening only during inspiration indicates the student needs a review of respiratory assessment skills. At each placement of the stethoscope, listen to at least one cycle of inspiration and expiration. During chest auscultation, instruct the patient to breathe slowly and a little deeper than normal through the mouth. Auscultation should proceed from the lung apices to the bases, comparing opposite areas of the chest, unless the patient is in respiratory distress or will tire easily. If so, start at the bases (see Fig. 26-7). Place the stethoscope over lung tissue, not over bony prominences.

Palpation is the assessment technique used to find which abnormal assessment findings (select all that apply)? a. Stridor b. Finger clubbing c. Tracheal deviation d. Limited chest expansion e. Increased tactile fremitus f. Use of accessory muscles

c. Tracheal deviation d. Limited chest expansion e. Increased tactile fremitus Palpation identifies tracheal deviation, limited chest expansion, and increased tactile fremitus. Stridor is identified with auscultation. Finger clubbing and accessory muscle use are identified with inspection.

Which function test fits description "Volume of air inhaled and exhaled with each breath"? a. FEV1 b. TLC c. Vt d. VC

c. Vt Tidal volume

A patient who has a history of chronic obstructive pulmonary disease (COPD) was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of 89% to 90%). In planning for discharge, which action by the nurse will be most effective in improving compliance with discharge teaching? a. Start giving the patient discharge teaching on the day of admission. b. Have the patient repeat the instructions immediately after teaching. c. Accomplish the patient teaching just before the scheduled discharge. d. Arrange for the patients caregiver to be present during the teaching.

d. Arrange for the patients caregiver to be present during the teaching. Hypoxemia interferes with the patients ability to learn and retain information, so having the patients caregiver present will increase the likelihood that discharge instructions will be followed. Having the patient repeat the instructions will indicate that the information is understood at the time, but it does not guarantee retention of the information. Because the patient is likely to be distracted just before discharge, giving discharge instructions just before discharge is not ideal. The patient is likely to be anxious and even more hypoxemic than usual on the day of admission, so teaching about discharge should be postponed.

The nurse palpates the posterior chest while the patient says 99 and notes absent fremitus. Which action should the nurse take next? a. Palpate the anterior chest and observe for barrel chest. b. Encourage the patient to turn, cough, and deep breathe. c. Review the chest x-ray report for evidence of pneumonia. d. Auscultate anterior and posterior breath sounds bilaterally

d. Auscultate anterior and posterior breath sounds bilaterally To assess for tactile fremitus, the nurse should use the palms of the hands to assess for vibration when the patient repeats a word or phrase such as 99. After noting absent fremitus, the nurse should then auscultate the lungs to assess for the presence or absence of breath sounds. Absent fremitus may be noted with pneumothorax or atelectasis. The vibration is increased in conditions such as pneumonia, lung tumors, thick bronchial secretions, and pleural effusion. Turning, coughing, and deep breathing is an appropriate intervention for atelectasis, but the nurse needs to first assess breath sounds. Fremitus is decreased if the hand is farther from the lung or the lung is hyperinflated (barrel chest).The anterior of the chest is more difficult to palpate for fremitus because of the presence of large muscles and breast tissue.

When assessing the respiratory system of an older patient, which finding indicates that the nurse should take immediate action? a. Weak cough effort b. Barrel-shaped chest c. Dry mucous membranes d. Bilateral crackles at lung bases

d. Bilateral crackles at lung bases Crackles in the lower half of the lungs indicate that the patient may have an acute problem such as heart failure. The nurse should immediately accomplish further assessments, such as oxygen saturation, and notify the health care provider. A barrel-shaped chest, hyperresonance to percussion, and a weak cough effort are associated with aging. Further evaluation may be needed, but immediate action is not indicated. An older patient has a less forceful cough and fewer and less functional cilia. Mucous membranes tend to be drier.

Which respiratory assessment finding does the nurse interpret as abnormal? a. Inspiratory chest expansion of 1 inch b. Symmetric chest expansion and contraction c. Resonance (to percussion) over the lung bases d. Bronchial breath sounds in the lower lung fields

d. Bronchial breath sounds in the lower lung fields

A 73-year-old patient has an SpO2 of 70%. What other assessment should the nurse consider before making a judgment about the adequacy of the patient's oxygenation? a. What the oxygenation status is with a stress test b. Trend and rate of development of the hyperkalemia c. Comparison of patient's SpO2 values with the normal values d. Comparison of patient's current vital signs with normal vital signs

d. Comparison of patient's current vital signs with normal vital signs The respiratory rate, pulse rate, and BP will all increase with decreased oxygenation when compared to the patient's own normal results. The position of the oximeter should also be assessed. The oxygenation status with a stress test would not assist the nurse in caring for the patient now. Hyperkalemia is not occurring and will not directly affect oxygenation initially. The arterial oxygen saturation by pulse oximetry (SpO2 ) compared with normal values will not be helpful in this older patient or in a patient with respiratory disease as the patient's expected normal will not be the same as standard normal values.

The nurse is preparing the patient for and will assist the health care provider with a thoracentesis in the patient's room. Which of the following is the second action? a. Verify breath sounds in all fields. b. Obtain the supplies that will be used. c. Send labeled specimen containers to the laboratory. d. Direct the family members to the waiting room. e. Observe for signs of hypoxia during the procedure. f. Instruct the patient not to talk during the procedure. g. Position the patient sitting upright with the elbows on an over-the bed table.

d. Direct the family members to the waiting room. Hopefully the family will have some time to discuss this before they are instructed to leave the room, unless it is an emergency.

Which function test fits description "The volume of air in the lungs after normal exhalation"? a. FVC b. PEFR c. RV d. FRC

d. FRC Functional residual capacity

The nurse admits a patient who has a diagnosis of an acute asthma attack. Which statement indicates that the patient may need teaching regarding medication use? a. I have not had any acute asthma attacks during the last year. b. I became short of breath an hour before coming to the hospital. c. I've been taking Tylenol 650 mg every 6 hours for chest-wall pain. d. I've been using my albuterol inhaler more frequently over the last 4 days.

d. I've been using my albuterol inhaler more frequently over the last 4 days. The increased need for a rapid-acting bronchodilator should alert the patient that an acute attack may be imminent and that a change in therapy may be needed. The patient should be taught to contact a health care provider if this occurs. The other data do not indicate any need for additional teaching.

The patient is admitted with pneumonia, and the nurse hears a grating sound when she assesses the patient. How should the nurse document this sound? a. Stridor b. Bronchophony c. Course crackles d. Pleural friction rub

d. Pleural friction rub Pleural friction rub occurs with pneumonia and is a grating or creaking sound. Stridor is a continuous musical or crowing sound and unrelated to pneumonia. Bronchophony occurs with pneumonia but is a spoken or whispered word that is more distinct than normal on auscultation. Course crackles sound like blowing through a straw under water and occur in pneumonia when there is severe congestion. See Table 25.8 for more thorough descriptions of these sounds and their possible etiologies and significance.

What is a possible cause for auscultation abnormal finding "pleural friction rub"? a. Bronchoconstriction b. Partial obstruction of trachea or larynx c. Chronic hypoxemia d. Pleurisy

d. Pleurisy

A patient with a recent history of a dry cough has had a chest x-ray that revealed the presence of nodules. In an effort to determine whether the nodules are malignant or benign, what is the primary care provider likely to order? a. Thoracentesis b. Pulmonary angiogram c. CT scan of the patient's chest d. Positron emission tomography (PET)

d. Positron emission tomography (PET) PET is used to distinguish benign and malignant pulmonary nodules. Because malignant lung cells have an increased uptake of glucose, the PET scan (which uses an IV radioactive glucose preparation) can demonstrate increased uptake of glucose in malignant lung cells. This differentiation cannot be made using CT, a pulmonary angiogram, or thoracentesis.

The health care provider orders a pulmonary angiogram for a patient admitted with dyspnea and hemoptysis. For which problem is this test most commonly used as a diagnostic measure? a. TB b. Cancer of the lung c. Airway obstruction d. Pulmonary embolism

d. Pulmonary embolism A pulmonary angiogram outlines the pulmonary vasculature and is useful to diagnose obstructions or pathologic conditions of the pulmonary vessels, such as a pulmonary embolus. The tissue changes of TB and cancer of the lung may be diagnosed by chest x-ray or CT scan, MRI, or positron emission tomography (PET) scans. Airway obstruction is most often diagnosed with pulmonary function testing.

Using the illustrated technique, the nurse is assessing for which finding in a patient with chronic obstructive pulmonary disease (COPD)? a. Hyperresonance b. Tripod positioning c. Accessory muscle use d. Reduced chest expansion

d. Reduced chest expansion The technique for palpation for chest expansion is shown in the illustrated technique. Reduced chest movement would be noted on palpation of a patients chest with COPD. Hyperresonance would be assessed through percussion. Accessory muscle use and tripod positioning would be assessed by inspection.

Risk Factor for or Response to Respiratory Problem: Inability to maintain lifestyle, altered self-esteem. Which Functional Health Pattern does it fall under? a. Activity-exercise b. Sleep-rest c. Cognitive-perceptual d. Self-perception- self-concept

d. Self-perception- self-concept

The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How should the nurse position the patient? a. Supine with the head of the bed elevated 30 degrees b. In a high-Fowlers position with the left arm extended c. On the right side with the left arm extended above the head d. Sitting upright with the arms supported on an over bed table

d. Sitting upright with the arms supported on an over bed table The upright position with the arms supported increases lung expansion, allows fluid to collect at the lung bases, and expands the intercostal space so that access to the pleural space is easier. The other positions would increase the work of breathing for the patient and make it more difficult for the health care provider performing the thoracentesis.

Which values indicate a need for the use of continuous oxygen therapy? a. SpO2 of 92%; PaO2 of 65 mm Hg b. SpO2 of 95%; PaO2 of 70 mm Hg c. SpO2 of 90%; PaO2 of 60 mm Hg d. SpO2 of 88%; PaO2 of 55 mm Hg

d. SpO2 of 88%; PaO2 of 55 mm Hg An SpO2 of 88% and a PaO2 of 55 mm Hg indicate inadequate oxygenation and are the criteria for continuous oxygen therapy (see Table 25.10). These values may be adequate for patients with chronic hypoxemia if no cardiac problems occur but will affect the patients' activity tolerance.

A nurse has been caring for a patient with tuberculosis (TB) and has a TB skin test performed. When is the nurse considered infected? a. There is no redness or induration at the injection site. b. There is an induration of only 5 mm at the injection site. c. A negative skin test is followed by a negative chest x-ray. d. Testing causes a 10-mm red, indurated area at the injection site.

d. Testing causes a 10-mm red, indurated area at the injection site. A 10-mm red indurated injection site could be a positive result for a nurse as an employee in a high-risk setting. Because antibody production in response to infection with the tuberculosis (TB) bacillus may not be sufficient to produce a reaction to TB skin testing immediately after infection, 2-step testing is recommended for individuals likely to be tested often, such as health care professionals. An initial negative skin test should be repeated in 1 to 3 weeks and if the second test is negative, the individual can be considered uninfected. All other answers indicate a negative response to skin testing.

The nurse analyzes the results of a patients arterial blood gases (ABGs). Which finding would require immediate action? a. The bicarbonate level (HCO3) is 31 mEq/L. b. The arterial oxygen saturation (SaO2) is 92%. c. The partial pressure of CO2 in arterial blood (PaCO2) is 31 mm Hg. d. The partial pressure of oxygen in arterial blood (PaO2) is 59 mm Hg.

d. The partial pressure of oxygen in arterial blood (PaO2) is 59 mm Hg. All the values are abnormal, but the low PaO2 indicates that the patient is at the point on the oxyhemoglobin dissociation curve where a small change in the PaO2 will cause a large drop in the O2 saturation and a decrease in tissue oxygenation. The nurse should intervene immediately to improve the patients oxygenation.

Risk Factor for or Response to Respiratory Problem: Noncompliance with treatment plan, conflict with values. Which Functional Health Pattern does it fall under? a. Role-relationship b. Sexuality-reproductive c. Coping- stress tolerance d. Value-belief

d. Value-belief

The laboratory has just called with the arterial blood gas (ABG) results on four patients. Which result is most important for the nurse to report immediately to the health care provider? a. pH 7.34, PaO2 82 mm Hg, PaCO2 40 mm Hg, and O2 sat 97% b. pH 7.35, PaO2 85 mm Hg, PaCO2 45 mm Hg, and O2 sat 95% c. pH 7.46, PaO2 90 mm Hg, PaCO2 32 mm Hg, and O2 sat 98% d. pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%

d. pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96% These ABGs indicate uncompensated respiratory acidosis and should be reported to the health care provider. The other values are normal or close to normal.

The nurse would interpret an induration of 5 mm resulting from tuberculin skin testing as a positive finding in which patient? a. patient with a history of illegal IV drug use b. patient with diabetes & end-stage kidney disease c. patient who immigrated from India 3 mths ago d. patient who has human immunodeficiency virus- infected

d. patient who has human immunodeficiency virus- infected Induration of 5 mm in an HIV-infected person is considered a positive reaction.