N413: Gas Exchange Practice Questions

Case Study Question 2/5 what is he most at risk for?

- decreased cardiac output - respiratory failure

COPD Ms. PUFF, a 68-year-old female, was admitted at 1600 to a medical floor with an acute exacerbation of chronic obstructive pulmonary disease (COPD) and possible pneumonia. She has had pneumonia yearly for the past 3 years and has been a two-pack-a-day smoker for 38 years. She presents with increased sputum production which is now green, cough, and now has dyspnea at rest. Her current medications include tiotropium, fluticasone, salmeterol 1. What is the most likely cause of Ms. Puff's COPD? 2. Describe 3 common causes of COPD.

1. smoking 2. smoking, asthma, AAT1 deficiency AAT1 - patients are deficient in this protein, so they are more susceptive to damage of the lungs.

Which of goal is best for the client with status asthmaticus? A. Avoiding intubation B. Determining the cause of the attack C. Improving exercise tolerance D. Reducing secretions

A. Avoiding intubation WHY? b. > not acute c. > not acute d. secretions are not a huge problem in asthma > the problem is constriction of the airway

The nurse is providing teaching to a client with recent DVT & pulmonary embolism. Which should be included as future risk factors for developing another? A.Sedentary lifestyle B.Obesity & smoking C.Dehydration D.Oral contraceptives E.Poor sleep hygiene

ANS: a, b, c, d

Which of the following illnesses may manifest as altered mental status in elderly clients? Select all that apply. A.Dehydration B.Pneumonia C.UTI D.Dementia E.MI

ANS: a, b, c, d, e

Following the initial care of a client with asthma and impending anaphylaxis from hypersensitivity to a drug, the nurse should take which of the following steps next? A. Teach use of incentive spirometer B. Administer albuterol as ordered C. Obtain serum electrolyte levels D. Position client in semi-fowlers

B. Administer albuterol as ordered WHY? - a. were in the acute phase so were not doing ANY teaching - c. not helpful in the acute phase - d. this does not actually help their respiratory effort IF their airway is not open (like this client)

A client with COPD has developed secondary polycythemia. Which nursing diagnosis would be included in the plan of care because of the polycythemia? A. Fluid volume deficit related to blood loss B. Impaired tissue perfusion related to thrombosis C. Activity intolerance related to dyspnea D. Risk for infection related to suppressed immune response

B. Impaired tissue perfusion related to thrombosis WHY? - overproduction of red blood cells + COPD you're having trouble perfusing > blood gets thicker > blood will just sit there and clot

A client with COPD has developed secondary polycythemia. Which nursing diagnosis would be included in the plan of care because of the polycythemia? A. Fluid volume deficit related to polyuria B. Impaired tissue perfusion related to thrombosis C. Activity intolerance related to dyspnea D. Risk for infection related to suppressed immune response

B. Impaired tissue perfusion related to thrombosis WHY? chronic hypoxia from copd may stimulate excessive rbc production (aka polycythemia). this results in increased blood viscosity and the risk of thrombosis

Which additional assessment data should immediately be gathered to determine the status of a client with a respiratory rate of 6 breaths/minute? A. Arterial blood gas (ABG) and breath sounds B. Level of consciousness and a pulse oximetry value C. Breath sounds and reflexes D. Pulse oximetry value and heart sounds

B. Level of consciousness and a pulse oximetry value WHY? b. you want to know IMMEDIATELY the LOC and oxygenation a. abgs will happen after we do something to help our patient c. breath sounds and reflexes dont matter rn d. not worried abt heart sounds *when you walk in this patients room, what is the FIRST thing you should do? WAKE THEM UP! AROSE THEM! WHY? awake = better oxygenation ****

A 6 month old child has been diagnosed with cystic fibrosis. Which of the following would be appropriate to teach the parents? A. Monitor for & report development of a "white pupil" B. Perform manual chest physiotherapy C. Place child in knee-chest position during hypercyanotic episodes D. Maintain a low calorie diet to prevent obesity

B. Perform manual chest physiotherapy WHY? - a. this is a symptom of retinoblastoma, not cystic fibrosis - b. YES! this is a form of bronchial hygiene. do this before meals to avoid full stomach and vomiting. - c. NO! this is for tet babies, not cystic fibrosis - d. NO! needs a high calorie diet

A client was administered dilaudid for pain 30 minutes ago. The UAP reports to the RN the client's respiratory rate is 6 breaths/minute. The nurse should anticipate which client reaction? A. Asthma attack B. Respiratory arrest C. Cardiac arrest D. Anaphylaxis

B. Respiratory arrest WHY? b. dilaudid is an opioid which reduces respiratory effect

The term "blue bloater" refers to which condition? A. Adult respiratory distress syndrome (ARDS) B. Asthma C. Chronic obstructive bronchitis D. Emphysema

C. Chronic obstructive bronchitis

A nurse is caring for a client with an ileostomy understands that the client is most at risk for developing which acid-base disorder? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

C. Metabolic acidosis

The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s would be included in the teaching plan? A. Clubbing of nail beds B. Hypertension C. Peripheral edema D. Increased appetite

C. Peripheral edema

The medical surgical nurse cares for a client who had a mediastinal tumor removed two days ago and reports difficulty breathing. the client becomes confused and restless, and respirations are 30/min. What is the nurse's next action? A. Administer dose of PRN anti anxiety medication B. call the healthcare provider who performed the surgery C. call the rapid response team D. place the client in left lateral recovery position

C. call the rapid response team WHY? - a. will not resolve the hypoxia & it might suppress respiratory - b. stabilize THEN call - c. ALWAYS CALL when a patient is detoriating (dyspnea, confusion, restless) - d. this is first aid measure when the client is UNCONSCIOUS !!! > aspiration / choking NOTE: rapid response team is different from a code team code = respiratory arrest or cardiac arrest

The nurse is reviewing discharge teaching with the parent of a pediatric client who has a new tracheostomy. Which of the following statements by the parent would indicate a correct understanding of the teaching? A. "I will immediately change the trach tube if my child has difficulty breathing" B. "I will provide deep suctioning frequently to prevent any airway obstruction" C. "I will remove the humidifier if my child develops more secretions" D. "I will travel with two trach tubes, one of same size and one a size smaller"

D. "I will travel with two trach tubes, one of same size and one a size smaller" WHY? - a. high risk procedure to change out a trach tube, so you don't want to do this more often than necessary (the only time you do this is if youve done everything else and nothing has worked) - b. DEEP suctioning = not good > this is reserved for severe, severe distress > you can accidentally puncture a lung - c. this is the goal! - d. travel with an extra because you never know what will happen / swelling, inflammation or contract, close

The nurse is caring for a ventilated client with vent settings of Assist Control (AC) 12, Tidal Volume (TV) 600, Positive end expiratory pressure (PEEP) 5, & FiO2 40%. The ventilator alarm sounds "Low pressure". What is the first nursing action? A. Increase the FiO2 to 50% B. Decrease the PEEP to 3 C. Suction the client D. Confirm all connections are tight

D. Confirm all connections are tight WHY? - c. if the high pressure alarm sounds and secretions are blocking airway - d. low pressure = air escaping. BROKEN STRAW EXAMPLE

Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows pneumonia to develop? A. Atelectasis B. Bronchiectasis C. Effusion D. Inflammation

D. Inflammation WHY? pneumonia is infection but ALL INFECTIONS START WITH INFLAMMATION

Which measure can reduce or prevent the incidence of atelectasis in a post-operative client? A. Chest physiotherapy B. Mechanical ventilation C. Reducing oxygen requirements D. Use of an incentive spirometer

D. Use of an incentive spirometer WHY? - a. chest physiotherapy helps mobilize secretions (if they have an illness that has a lot of secretion) and helps get them up and out but does NOT prevent atelectasis - b. does not help - c. does not help - d. inhalation makes them take in a big, deep breath to get the ball where it needs to be > expands lungs > good gas exchange

do I want to give an opioid to a patient who is struggling to breathe?

NO WHY? suppresses respiratory effort

A client was medicated with IV morphine 2mg 2 hours ago to relieve moderate abdominal pain after appendectomy. The client becomes lethargic but arouses easily to verbal and tactile stimuli and is oriented to time, place, and person. The pulse oximeter reading has dropped from 99% to 89% on room air. Which oxygen device is the most appropriate for the nurse to apply? a. nasal cannula b. non re-breather c. simple face mask d. venturi mask

a. nasal cannula WHY? - a. can provide o2 concentrations up to 44%. comfortable, inexpensive, short term, and permits eating and drinking. this patient is hypoventilating due to opioid, can breathe through nose, and is awake - b. this is for emergencies (90-95%), requires tight seal, uncomfortable - c. uncomfortable. would be used next if o2 doesn't improve with nasal cannula - d. expensive. used in COPD mainly

for each finding below, click to specify if the finding is consistent with the disease process of anaphylaxis or asthma exacerbation. stridor wheezing tachycardia hypotension generalized flushing and itching

anaphylaxis - stridor - wheezing - tachycardia - hypotension - rash - itching - abdominal pain - vomiting - tripod asthma - wheezing - tachycardia - lung hyperinflation - tachypnea - tripod - prolonged expiration

Match the FINDING with the POTENTIAL ACTION TO TAKE Finding: 1. o2 sat 88% 2. loose productive cough 3. atelectasis 4. fine crackles in lungs fields 5. tracheal shift 6. obstructive apnea Potential Action To Take: a. chest tube b. cough & deep breathing c. intubation d. oxygen e. diuretics f. incentive spirometry g. percussion & postural drainage

1 > d WHY? if sat <95%, o2 required 2 > b WHY? helps expectorate loose sputum 3 > f WHY? expands lung, prevents pneymonia 4 > e WHY? crackles indicate fluid 5 > a WHY? symptoms of tension pneumo (emergency!) 6 > c WHY? if client is not breathing = intubation

Case Study Question 1/5 Highlight the 5 findings that require immediate follow up.

1. SpO2 92% WHY? he's wearing a non-rebreather > abnormal ventilation/perfusion 2. Unilateral chest wall expansion WHY? possible lung collapse from fractured ribs, car crash, airbag, not restrained in the car 3. Tracheal deviation WHY? possible hemo/pneumothorax 4. Diminished BS WHY? chest not expanding 5. BP 90/58 WHY? possible tamponade, tension pneumo, inadequate ventr filling, volume depletion, etc... > no perfusion!

the nurse is teaching a client with asthma how to use a peak flow meter. place in order the instructions for measuring peak expiratory flow using a peak flow meter. all options must be used. 1. exhale as quickly and completely as possible 2. place mouthpiece in the mouth, using the lips to create a seal 3. position the indicator on the flow meter scale to the lowest value 4. record the highest measured value in the peak flow log 5. repeat the procedure, waiting 5-10 seconds between attempts 6. stand or sit upright and inhale slowly and deeply

3, 6, 2, 1, 5, 4

The nurse is caring for a client coding in the ED after being admitted for exacerbation of COPD. Which of the following standing orders is the best intervention? A. 100% oxygen per face mask B. Oxygen at 2L per nasal cannula C. Upright position to promote gas exchange D. Administer theophylline to open airways

A. 100% oxygen per face mask WHY? the patient is coding. Because of the long-standing hypercapnia, the respiratory drive is triggered by low oxygen levels rather than increased carbon dioxide levels

A 7-year-old client is brought to the E.D. tachypneic and afebrile with a respiratory rate of 36 breaths/minute and a nonproductive cough; recently had a cold. Based on the history, the client may have which of the following? A. Acute asthma B. Bronchial pneumonia C. Chronic obstructive pulmonary disease (COPD) D. Emphysema

A. Acute asthma WHY? - afebrile (no fever) - recently had a cold > asthma trigger - nonproductive cough > if its pneumonia, you will have a gunky cough - 7 year old > typically won't have COPD or emphysema

An elderly client with pneumonia may appear with which of the following symptoms first? A. Altered mental status and dehydration B. Fever and chills C. Hemoptysis and dyspnea D. Pleuritic chest pain and cough

A. Altered mental status and dehydration WHY? with the elderly, LOC is always first to go what else could be going on? UTI or MI

Which respiratory disorder is most common in the first 24 to 48 hours after surgery? A. Atelectasis B. Bronchitis C. Pneumonia D. Pneumothorax

A. Atelectasis WHY? - a. atelectasis means collapsed lung > when we have patients who have been in surgery, patients will be sore, tired, etc. > they don't want to turn, cough, deep breathe, splent > SPLENTING is key here > splent keeps it from being painful when coughing, so they are not fully inflating/deflating lungs - b. do not develop bronchitis after surgery - c. pneumonia does not develop in 24 - 48 hours > it takes time !!! DAYS! - d. unless something went seriously wrong during surgery, pneumothorax doesnt usually happen after surgery

A hospitalized client with a history of obstructive sleep apnea sleeps while wearing a full face mask with continuous positive airway pressure. Oxygen saturation drops to 85% during the night. What is the nurse's first action? A. Check the tightness of the straps and mask B. notify the health care provider immediately C. remove the mask and administer supplemental oxygen D. replace the old pulse oximeter probe with a new probe

A. Check the tightness of the straps and mask WHY? check the mask first then check equipment

Which pediatric respiratory presentation in the emergency department is a priority for nursing care? A. Client with acute asthma exacerbation but no wheezing B. Client with bronchiolitis with low grade fever and wheezing C. Client with runny nose and seal like barking cough D. Cystic fibrosis client with fever and yellow sputum

A. Client with acute asthma exacerbation but no wheezing WHY? - a. this is known as "silent chest" ... no wheezing = no airflow = complete obstruction. also this is ACUTE!

A client had a thoracotomy 2 days ago to remove a lung mass and has a right chest tube attached to negative suction. Immediately after turning the client to the left side to assess the lungs, the nurse observes a rush of approximately 125 mL of dark bloody drainage into the drainage tubing and collection chamber. What is the appropriate nursing action? A. Document & continue to monitor chest drainage B. immediately clamp the chest tube C. notify the health care provider D. request repeat hematocrit & hemoglobin levels

A. Document & continue to monitor chest drainage WHY? - a. dark red = OLD BLOOD > we repositioned the client and old blood is getting out !!! this is good = not active bleeding - b. NEVER CLAMP A CHEST TUBE !!!! ***** - c. the patient is stable. call if the blood is bright red - d. this is delaying care !! this patient is stable > we only do this in the first 24 hours when theres active bleeding

Which physical assessment findings would the nurse expect to find in a client with advanced COPD? A. Increased anteroposterior chest diameter B. Underdeveloped neck muscles C. Collapsed neck veins D. Increased chest excursions with respiration

A. Increased anteroposterior chest diameter WHY? - blue bloater

Emergency treatment of a client in status asthmaticus includes which medication? A. Inhaled beta-adrenergic agents B. Inhaled corticosteroids C. I.V. beta-adrenergic agents D. Oral corticosteroids

A. Inhaled beta-adrenergic agents WHY? - b. & d. > both cortiosteriods > do not use seriods in acute attack > WHY? they do not act quickly - c. if A does not work, then use IV REMEMBER USE LEAST INVASIVE FIRST!

Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema? A. It enhances cardiovascular fitness B. It improves respiratory muscle strength C. It reduces the number of acute attacks D. It worsens respiratory function and is discouraged

A. It enhances cardiovascular fitness WHY? - exercise strengthens the heart > it does NOTHING for the respiratory muscles - sometimes patients with asthma, chronic bronchitis, and emphysema cannot tolerate exercise IF theres a clue in the question that says the patient is exercise induced asthma, the answer would be D.

An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she develops a cough productive of yellow sputum. The nurse auscultates lungs and hears diffuse crackles. How would the nurse best interpret these assessment findings? A. It is likely that the client is developing a secondary bacterial pneumonia. B. Assessment findings are consistent with influenza and are to be expected. C. The client is dehydrated and needs more fluids to to decrease secretions. D. The client is not taking her decongestants & bronchodilators as prescribed.

A. It is likely that the client is developing a secondary bacterial pneumonia.

The nurse answers a client call light and the client reports " I just cannot seem to catch my breath" to the nurse. What should the nurse do next? A. Observe for signs of respiratory distress B. Obtain O2 sat reading C. Auscultate breath sounds D. Reassure the client they are alright

A. Observe for signs of respiratory distress WHY? - a. assessments starts with visualization - b. observe first - c. after visualization - d. physiological needs first

Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons best explains why? A. Reducing fluid volume reduces oxygen demand B. Reducing fluid volume improves clients' mobility C. Restricting fluid volume reduces sputum production D. Reducing fluid volume improves respiratory function

A. Reducing fluid volume reduces oxygen demand

Auscultation of a client's lungs reveals crackles in the left posterior base. What should the first nursing intervention be? A. Repeat auscultation after asking the client to deep breathe and cough. B. Instruct the client to limit fluid intake to less than 2000 ml/day. C. Inspect the client's ankles and sacrum for the presence of edema D. Assess for other symptoms of heart failure

A. Repeat auscultation after asking the client to deep breathe and cough. WHY? - if they clear the crackles, then its not true crackles

A nurse is caring for a client with diabetic ketoacidosis and documents the client is experiencing Kussmaul's respirations. Based on this documentation, which of the following did the nurse observe? A. Respirations are abnormally deep, regular, & rapid B. Respirations are regular but abnormally slow C. Respirations are labored and increased in depth & rate D. Respirations cease for several seconds

A. Respirations are abnormally deep, regular, & rapid WHY? kussmauls is a symptom of DKA > breaks down proteins in body > ketones are pure acid - they are NOT struggling to breathe = labored ... they are just breathing deep and fast

A nurse plans care for a client with chronic obstructive pulmonary disease, knowing that the client is most likely to experience what type of acid-base imbalance? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

A. Respiratory acidosis

The nurse is teaching the client how to use a metered dose inhaler (MDI) to administer a corticosteroid drug. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply. A. The inhaler is held upright B. Head tilted down while inhaling the medication C. Client waits 5 minutes between puffs D. Mouth is rinsed with water following administration E. Client lies supine for 15 minutes following administration

A. The inhaler is held upright D. Mouth is rinsed with water following administration WHY? - d. if you don't wash your mouth out, you can get thrush (candidiasis) > dark moist environment and steroids suppress immune response so bacteria can grow in the mouth

Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity to a drug should include which action first? A. Administering oxygen B. Inserting an I.V. catheter C. Obtaining a (CBC) D. Assessing vital signs

A. administering oxygen WHY? IMPENDING means the airway is not completely closed off - a. administer oxygen helps the patient > airway is narrowing - d. does not help the patient - b. insert iv after oxygen - c. cbc does not help

ASTHMA ADAM, an 8-year-old child seems to be highly allergic to dust/pollen, has a history of moderate persistent asthma and gastroesophageal reflux (GERD). He takes ibuprofen (NSAID) for headaches and he recently had a "cold" (upper respiratory infection). The weather has been very cold and ADAM loves to play outside. Both parents' smoke. ADAM's mom drove him to the emergency department when his wheezing was unresponsive to his fluticasone/salmeterol inhaler. ADAM is unable to lie down and is using accessory muscles to breathe. He complains of chest tightness, wheezing, cough, and dyspnea. 1. Highlight 5 potential risk factors/triggers? 2.What 2 medication classes can trigger asthma?

ADAM, an 8-year-old child seems to be highly allergic to dust/pollen, has a history of moderate persistent asthma and gastroesophageal reflux (GERD). He takes ibuprofen (NSAID) for headaches and he recently had a "cold" (upper respiratory infection). The weather has been very cold and ADAM loves to play outside. Both parents' smoke. ADAM's mom drove him to the emergency department when his wheezing was unresponsive to his fluticasone/salmeterol inhaler. ADAM is unable to lie down and is using accessory muscles to breathe. He complains of chest tightness, wheezing, cough, and dyspnea. 2. beta blockers, NSAIDS, ACE inhibitors

a client with alzheimer disease is found slumped over the lunch tray on the bedside table, coughing violently with emesis visible in the back of the throat. the client has a pulse of 135/min, respirations 32/min, and oxygen saturation 84%. the client also has circumoral cyanosis and decreased LOC. place the nurses actions while awaiting the arrival of the rapid response team in PRIORITY ORDER. ALL OPTIONS MUST BE USED. 1. administer 100% oxygen by nonrebreather mask 2. assess lung sounds 3. notify the primary health care provider 4. perform oropharyngeal suctioning 5. place client in high fowlers position

ANS: 5, 4, 1, 2, 3 WHY? 5 - maximize lung expansion, promote oxygenation, decrease risk of further aspiration 4 - clearing the airway after repositioning/preventing aspiration 1 - correct hypoxia after airway is cleared 2 - determine air movement and presence of adventitious sounds (obstruction, secretions, atelectasis, fluid) 3 - notify HCP

which of the follow interventions should the nurse anticipate (for asthma interventions)? a. administering a dose of oral prednisone b. administering nebulized albuterol and ipratopium bromide c. encouraging a semi fowler position d. initiating humidified, high flow oxygen therapy e. placing a continuous pulse oximeter on the client

ANS: a, b, d, e WHY? - a. to reduce inflammation and mucus production - b. bronchodilator and anticholinergic - c. you want HIGH fowler, not semi fowler - d. yes o2 - e. yes pulse ox

the nurse receives the following prescriptions. which 3 actions should the nurse prioritize (for asthma)? a. administer albuterol with ipratipium bromide via nebulizer b. administer initial dose of PO prednisone once c. initiate maintenance IV fluids d. initiate NPO status except oral meds e. titrate oxygen to achieve an oxygen saturation of >95%

ANS: a, b. e

During assessment, the client with a chest tube accidentally pulls the chest tubing apart at the connector. What are the priority actions by the nurse? Select all that apply. A. Insert the chest tube into sterile water bottle at bedside B. Have the patient take several deep breaths C. Reconnect tubing as quickly as possible D. Have the patient cough as hard as they can E. Cover the end of the tube with a sterile occlusive gauze F. Place a sterile occlusive dressing over insertion site

ANS: a, c, d WHY? - a. YES> creates one way valve - b. NO > you do not want them taking SEVERAL deep breaths > this pulls MORE air into the pleural space - c. YES > reestablish the seal - d. YES > clears the line of any air bubbles - e. NO > air/drainage must be able to escape - f. NO > the tube is still in place, just the connector is loose

The nurse is assessing a client on the med surg unit with multiple rib fractures secondary to blunt chest trauma. Which interventions would be appropriate? Select all that apply. A.Teach splinting to mitigate pain with respiration B.Administer narcotics as ordered for pain C.Encourage to turn, cough, & deep breathe D.Assess for respiratory acidosis E.Observe respirations from foot of bed

ANS: a, c, d, e WHY? - a. otherwise the patient wont deep breathe at all - b. NO! this suppresses respirations - c. yes - d. yes! caused by shallow breathing - e. flail chest - "see saw" movement

The nurse is assisting with a thoracentesis. What is the nurse's role in this procedure? Select all that apply. A. Obtain baseline vitals, O2 sat, & pain level B. Place client supine with arms above head C. Have client sign informed consent D. Obtain chest x-ray prior to procedure E. Teach no deep breathing or coughing during procedure

ANS: a, c, d, e WHY? - a. get baseline vitals before (WATCH BP and P before, during, and after) > why? depending on how much fluid is pulled out, the patient can go into hypovolemic shock - b. NO !! any upright position or lying affected side up > we want the fluid down at the bottom, so it drains out through gravity - c. MUST! - d. obtain chest x ray BEFORE AND AFTER - e. this could cause accidental puncture ALSO!! watch for bleeding, comparing lung sounds, assess for SubQ emphysema, tech Turn, Cough, deep breathing after to get full lung expansion

Case Study Question 5/5 a new chest tube collection device is attached and set to water seal suction. which of the following observations are expected? SATA a. chest tube collection device positioned below the chest tube insertion site b. continuous bubbling in the water seal chamber c. drainage tube coiled on the floor next to the chest tube collection device d. occlusive sterile gauze dressing present over the tubing insertion site e. tidaling in the water seal chamber with inspiration and expiration

ANS: a, d, e WHY? a. you want to keep the collection device below the chest > flow gravity d. gauze is to prevent any air from getting in around the tube > creating an air tight seal around insertion site e. you will see a response in the water seal chamber > it will go up and down when they breathe in and out NOTE: you will see continuous bubbling in the SUCTION chamber, not the water seal chamber (responds to the suction from the wall) if you see bubbling in the water seal chamber, you have an ISSUE (you want tidaling)

Which of the following findings are consistent with a tension pneumothorax? SATA a. diminished breath sounds on one side b. dyspnea c. hypotension d. recent thoracic trauma e. tracheal deviation f. unilateral chest wall expansion

ANS: all of them WHY? pressure has built up in the chest cavity (likely from a rib fracture), so air is escaping from the lung out into the pleural space > causing the lung to be squished

The nurse cares for a client with a pulmonary embolism. Which of the following clinical manifestations would the nurse anticipate? Select all that apply. A.Bradycardia B.Chest pain C.Dyspnea D.Hypoxemia E.Tachypnea F.Tracheal deviation

ANS: b, c, d, e WHY? - a. causes tachycardia, not bradycardia - b. pleuritic (sharp in inspiration) e. the heart compensates for hypoxemia (low levels of o2 in blood), so you start breathing faster note: may also have dry cough, unilateral leg swelling, erythema, and tenderness (DVT)

A client arrives in the ED complaining of flank pain 9/10. Assessment reveals BP 82/52, P 118, RR 28, T 101.8F, O2 sat 92%. What should the nurse do first? A. Administer IV fluids B. Apply oxygen C. Pain control D. Raise head of bed

B. Apply oxygen WHY? - a. o2 comes first - b. o2 trumps everything else - c. wait until after o2. pain never killed anybody - d. will cause bp to go even lower because no perfusion to vital organs. o2 then fluids

The nurse auscultating a client's lungs detects crackles in the right posterior base. What should be the next nursing intervention? A. Educate the client to reduce fluid intake to <2,000 ml/day B. Ask the client to cough & deep breathe then repeat auscultation C. Assess client's ankles & sacrum for the presence of edema D. Assess for additional symptoms of potential heart failure

B. Ask the client to cough & deep breathe then repeat auscultation WHY? crackles may indicate fluid, but you want them to clear the lungs first and see if the crackles are still there

A client with acute asthma with inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which classes of medication right away? A. Beta-adrenergic B. Bronchodilators C. Inhaled steroids D. Oral steroids

B. Bronchodilators WHY? - bronchodilators will ALWAYS be the first drug choice for asthma - we do not give inhaled steroids in an emergency situation (these are for long term) - oral steroids are not used in emergency situations

A 19-year-old comes into the emergency department with acute asthma. Respiratory rate is 44 breaths/minute, appears to be in acute respiratory distress. Which action should be taken first? A. Take a full medication history B. Give a bronchodilator by nebulizer C. Apply a cardiac monitor to the client D. Provide emotional support to the client

B. Give a bronchodilator by nebulizer

A nurse is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will facilitate obtaining the specimen? A. Limiting fluid intake B. Having the client take 3 deep breaths C. Asking the client to spit into the collection container D. Asking the client to obtain the specimen after eating

B. Having the client take 3 deep breaths WHY? - c. is wrong because if you just have them spit in the cup, then its just a saliva sample. - b. they need to breathe hard and hack it up / FIRST THING IN THE MORNING / RINSE MOUTH OUT FIRST !!! we don't want bacteria from the mouth contaminating the pulmonary specimen

A nurse is caring for a client on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? A. Sodium level of 145 mEq/L B. Potassium level of 3.0 mEq/L C. Magnesium level of 2.0 mg/L D. Phosphorus level of 4.0 mg/dL

B. Potassium level of 3.0 mEq/L WHY? - potassium decreases if its alkalosis

A self-employed auto mechanic is diagnosed with carbon monoxide poisoning. Admission vital signs are BP 90/42, P 84, RR 24, O2 sat 94% on room air. What is the nurse's priority action? A. Administer 5mg albuterol nebulizer treatment to decrease bronchoconstriction B. administer 100% oxygen using a non-rebreather mask with a flow rate of 15L/min C. administer Methylprednisolone to decrease lung inflammation from toxic inhalant D. titrate oxygen to maintain pulse oximeter saturation greater than 95%

B. administer 100% oxygen using a non-rebreather mask with a flow rate of 15L/min WHY? - a. we do not have bronchoconstriction - b. YES > carbon monoxide travels faster than oxygen in the blood stream > it gets to the hemogloben before the oxygen and binds to it > once the hemogloben is bound, nothing else will bind to it > so the reason we give them a TON of oxygen, we want to overwhelm their system with oxygen, there is more QUANTITY - c. steroids do not act quickly and inflammation is not a cause of hypoxemia that carbon dioxide causes - d. NO because oxygen and carbon dioxide compete in the blood stream > a regular pulse oxemeter will lie to you > you have to have a specific pulse ox to detect actual oxygenation in carbon dioxide poisoning > WHY? pulse ox will only tell how much hemogloben is bound to something (NOT WHAT ITS BOUND TO)

A client reports shortness of breath and on assessment the nurse notes RR 22 & labored, O2 sat 93% on room air, bilateral crackles in lung bases. What should the nurse do first? A.Apply O2 at 2L via nasal cannula B.Elevate the head of bed C.Administer furosemide as ordered D.Encourage coughing & deep breathing

B.Elevate the head of bed WHY? - a. position first then o2 - b. yes this will imrpove breathing and lung expansion - c. positioning, then o2, then possibly this bc of fluid excess - d. crackles = fluid at base = coughing wont get that up and out

The PCP orders an analysis of chest drainage for WBCs of a client with chest tubes. How should the nurse should collect this specimen? A.From the drainage collection chamber B.From port on the chest tubing C.In vacutainer with next blood draw D.Have client cough sputum into sterile cup

B.From port on the chest tubing WHY? b. the port is self sealing and fresh

A client receiving Fentanyl for pain is sleeping soundly and assessed to have a RR11. Place the nursing priority actions in order. A. Draw ABGs & send to lab B. Assess LOC & oxygen saturation C. Attempt to rouse the client awake D. Auscultate breath sounds E. Notify the primary provider

C, B, D, E, A WHY? 1. Attempt to rouse the client awake - should increase the client's respiratory rate 2. Assess LOC & oxygen saturation - provides specific data on severity & determines interventions 3. Auscultate breath sounds - provides add'l data if possibly lung related 4. Notify the primary provider - gather assessment data first 5. Draw ABGs & send to lab - PCP likely to order based on assessment data

A nurse in the emergency department is receiving change of shift report on four clients. Which client should the nurse see first? A. 6 month old with respiratory syncytial virus and SpO2 90% on RA B. 1 year old with otitis media and a temperature of 102.6 F C. 2 year old with sore throat, drooling, and sitting in tripod position D. 3 year old who has inspiratory strider and a barking cough

C. 2 year old with sore throat, drooling, and sitting in tripod position WHY? - a. 90% is the goal for RSV - b. expected with ear infection - c. life threatening! may require intubation! - d. this is croup (see second)

A client with a closed head injury is sleeping when the nurse begins assessment. Upon noting a shallow, irregular breathing pattern, what is the first nursing intervention? A. Obtain O2 sat reading to measure oxygenation B. Notify the primary healthcare provider C. Arouse the client to see if pattern continues D. Apply O2 at 2L & obtain a full set of vital signs

C. Arouse the client to see if pattern continues WHY? - a. yes, but arouse first - b. this just delays care - c. this could be normal or be an indication that ICP is increasing - d. yes, after assessment of resp status

The nurse is administering alteplase to a client. What would be the priority nursing intervention? A. Provide teaching on diet B. Monitor PT, PTT, INR C. Assess for signs of hemorrhage D. Implement bleeding precautions

C. Assess for signs of hemorrhage WHY? alteplase is used to dissolve blood clots, so you want to make sure your patient is not bleeding! the rest are right, but not pritority a. don't want patient eating vitamin k

A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, the client most likely has which condition? A. Adult respiratory distress syndrome (ARDS) B. Asthma C. Chronic obstructive bronchitis D. Emphysema

C. Chronic obstructive bronchitis

A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma? A. Corticosteroids promote bronchodilation B. Corticosteroids act as an expectorant C. Corticosteroids have an anti-inflammatory effect D. Corticosteroids prevent development of respiratory infections

C. Corticosteroids have an anti-inflammatory effect

A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching? A. Removes the cap and shakes the inhaler well before use B. Presses the canister down with finger as he breathes in. C. Inhales the mist and quickly exhales afterward D. Pauses between puffs if more than one puff prescribed

C. Inhales the mist and quickly exhales afterward WHY? - hold it 10-15 seconds - wait 1-2 minutes between puffs

Which assessment findings would help confirm diagnosis in a client suspected of having of asthma? A. Circumoral cyanosis B. Increased forced expiratory volume C. Inspiratory and expiratory wheezing D. Normal breath sounds

C. Inspiratory and expiratory wheezing WHY? - a. you can have circumoral cyanosis for other diseases - b. you would have decreased forced expiratory volume with asthma - d. you would not have normal breath sounds with asthma

What is the most reliable index to determine the respiratory status of a client? A. Observe the chest rising and falling B. Observe the skin and mucous membrane color C. Listen and feel the air movement D. Determine the presence of a femoral pulse

C. Listen and feel the air movement WHY? - a. the chest can rise and fall without breathing !!!! - b. and d. are perfusion related, NOT respiration

The nurse is providing care for a client. With cancer of the left lung who will undergo video assisted thoracic surgery in the morning. The client is nervous, jumpy, and short of breath. P120, R 30/min & shallow, expiratory wheezing is auscultated in the left upper & lower lung posteriorly. Which of the following is the priority action? A. Administer prescribed intravenous morphine 2mg to relieve anxiety B. Page respiratory therapist to administer bronchodilator nebulizer treatment C. Place the head of the bed in Fowler's or high Fowler's position D. Stay with the client & encourage client to discuss feelings about surgery

C. Place the head of the bed in Fowler's or high Fowler's position WHY? - a. morphine decreases respiratory effort > never want to suppress the effort in someone that is having an issue - b. this might be good, but think about WHAT is causing the wheezing > they have a tumor NOT bronchoconstriction > nebulizer treatment will also make them MORE jumpy - d. appropriate but this is not PRIORITY

A nurse is caring for a client with renal failure. Blood gas results indicate a pH of 7.30; a PCO2 of 32 mm Hg, and a bicarbonate concentration of 20 mEq/L. What acid base imbalance is the client experiencing and which of the following laboratory values would the nurse expect? A. Sodium level of 145 mEq/L B. Magnesium level of 2.0 mg/dL C. Potassium level of 5.2 mEq/L D. Phosphorus level of 4.0 mg/dL

C. Potassium level of 5.2 mEq/L

Aminophylline (theophylline) is prescribed for a client with acute bronchitis. What is the primary action of this medication? A. Promote expectoration of secretions B. Suppress the cough reflex C. Relax bronchial smooth muscles D. Prevent respiratory infection

C. Relax bronchial smooth muscles

A client's ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result represents which condition? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C. Respiratory acidosis

A client has started a new drug for hypertension. 20 minutes after taking the drug, the client develops chest tightness, shortness of breath, & tachypnea. The client's level of consciousness then decreases. These signs indicate which of the following conditions? A. Asthma attack B. Pulmonary embolism C. Respiratory failure D. Unstable angina

C. Respiratory failure WHY? - c. NEW drug is key word !!! if it's a new drug, this is potentially an anaphylaxis, which would lead to eventual respiratory failure - a. nothing in the stem says they are asthmatic

A client with emphysema should receive only 1 to 3 L/min of oxygen, if needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive? A. The client doesn't notice he needs to breathe B. The client breathes only when his oxygen levels climb above a certain point C. The client breathes only when his oxygen levels dip below a certain point D. The client breathes only when his carbon dioxide level dips below a certain point

C. The client breathes only when his oxygen levels dip below a certain point WHY? with COPD patients, their body is not prompted to breathe when their CO2 levels rise. when their CO2 levels go higher and higher and higher > they have no stimulus to breathe - if you continue to give them oxygen, their CO2 will just continue to rise and they will pass out

The nurse assesses a child who has been treated for acute asthma exacerbation. Which client assessment is the best indicator that treatment has been effective? A. Episodes of spasmodic coughing have decreased B. no wheezes are audible on chest auscultation C. oxygen saturation has increased from 88% to 93% D. peak expiratory flow rate has dropped from 212L/min to 127L/min

C. oxygen saturation has increased from 88% to 93% WHY? - a. this can be simply because my patient is tired and fatigued > this can be headed towards silent chest - b. this can mean they're getting worse > headed towards silent chest > airway is closed - c. best indicator - d. ability to get air out should increase, not decrease

A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the following instructions would be appropriate for the nurse to give the client? A. "Use your nasal decongestant spray regularly to help clear your nasal passages." B. "Ask the doctor for antibiotics. Antibiotics will help decrease the secretion." C. It is important to increase your activity. A daily brisk walk will help promote drainage." D. "Keep a diary of when symptoms occur to help identify what precipitates your attacks."

D. "Keep a diary of when symptoms occur to help identify what precipitates your attacks." WHY? - a. regularly causes a rebound effect - b. there is nothing in the stem about infection > do not give antibiotics for anything other than an infection - c. sometimes the allergy is outdoors > you don't want them to walk

A 34-year-old woman with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, what action should the nurse take to initiate care of the client? A. Initiate oxygen therapy and reassess the client in 10 minutes B. Draw blood for an ABG analysis and send the client for a chest x-ray C. Encourage client to breathe slowly through pursed lips D. Administer bronchodilators per standing orders

D. Administer bronchodilators per standing orders WHY? - diminished = lack of air movement in lungs = impending respiratory failure this client needs immediate intervention with a. inhaled bronchodilators b. intravenous cortiosteriods c. IV theophylline

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

D. Administer bronchodilators to the client as ordered WHY? - a. you don't wait 10 minutes > this is delaying care > AND YOU ARE LEAVING AN UNSTABLE CLIENT. BAD BAD BAD - b. we are not helping. by drawing blood > this is delaying care - c. this is also delaying care NOTE: if you are no longer hearing breath sounds in an asthmatic, this is called "silent chest" > this means AIRWAY IS CLOSED *this is a BAD BAD sign* - something bad is about to happen and you HAVE to open up the airway use the ABCs - bronchodilators will open up the AIRWAY - if you administer oxygen, and the airway is closed, the oxygen will not get through

A geriatric client is admitted through the ED with new onset confusion, thick yellow sputum, and T102.1F. The patient is combative and the nurse is unable to obtain O2 sat and RR. How should the nurse proceed? A. Obtain an order to restrain the client B. Wait until the client is more cooperative C. Sedate the client per standing orders D. Apply O2 via nasal cannula as ordered

D. Apply O2 via nasal cannula as ordered WHY? - d. confusion is a sign of hypoxia, so by administering oxygen, hypoxia gets fixed and so does confusion and the pt might become more cooperative - a. this is a last resort and will prob make them more agitated - b. delays care! - c. this will depress the resp system and just make things worse

A client with an open pneumothorax arrives at the ED and the nurse immediately notes the sucking chest wound with respirations. The primary provider is occupied with a coding client in the adjacent bay. What is the priority action of the nurse? A. Initiate oxygen 6L via nasal cannula B. Sit the client upright to assist with breathing C. Ascertain what caused the chest trauma D. Apply occlusive dressing & tape on 3 sides E. needle decompression

D. Apply occlusive dressing & tape on 3 sides WHY? - a. no oxygen! - b. every breath draws atmospheric air into pleural space > this is bad! there should be NO space in pleural space - c. worry abt this later - d. flutter valve adheres during inspiration and flutters during expiration to allow trapped air to escape & no more air to enter - e. NOT WITHIN THE SCOPE

Which outcome would be appropriate for a client with COPD who has been discharged to home? A. Client promises to do pursed lip breathing at home. B. Client will take actions to properly control pain. C. Client understands necessity for O2 BNC at 5 L/min D. Client agrees to call the HCP if dyspnea on exertion increases.

D. Client agrees to call the HCP if dyspnea on exertion increases. KEY WORD: increases !!! WHY? - a. pursed lip breathing can be good for COPD but a "promise" is not a good outcome - b. nothing about pain - c. this is too much oxygen for COPD

The term "pink puffer" refers to the client with which condition? A. ARDS B. Asthma C. Chronic obstructive bronchitis D. Emphysema

D. Emphysema

A 69-year-old client appears thin and cachectic. He's short of breath at rest and his dyspnea increases with the slightest exertion. His breath sounds are diminished even with deep inspiration and a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. Which condition should the nurse suspect? A. ARDS B. Asthma C. Chronic obstructive bronchitis D. Emphysema

D. Emphysema WHY? - ARDS typically will need mechanical ventilation - asthma / bronchitis > you will hear a wheeze - with emphysema, the aveoili are damaged > patients have less surface area (think of a balloon with big gaping holes cut out of it)

Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which topics? A. How to have partner listen to lungs with a stethoscope B. How to increase client's oxygen therapy levels at home C. How to treat respiratory infections without going to PCP D. How to recognize signs of impending respiratory infection

D. How to recognize signs of impending respiratory infection WHY? - a. you do not need to be practicing medicine/nursing at home - b. you do not need to be increasing o2 levels at home - c. you should go to the doctor

A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

D. Metabolic alkalosis

A nurse instructs a client to use the pursed lip method of breathing. The client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed lip breathing is: A. Promote oxygen intake B. Strengthen the diaphragm C. Strengthen the intercostal muscles D. Promote carbon dioxide elimination

D. Promote carbon dioxide elimination

It's highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which reason? A. All clients of every age are recommended to have these vaccines, regardless of illness. B. These vaccines produce bronchodilation and improve oxygenation in these clients. C. These vaccines help reduce the severe tachypnea these clients experience. D. Respiratory infections can cause severe hypoxia & even death in these clients.

D. Respiratory infections can cause severe hypoxia & even death in these clients. WHY? the single most common reason of asthma exacerbation is a viral infection note: for a non-respiratory issue person, they do not recommend a pneumonia vaccine until you're like 50 BUT for an asthmatic person, they recommend the vaccine must earlier

Based on the lung assessment information provided in the handoff report, which client should the nurse see first? A. client one day post op abdominal surgery who has fine inspiratory crackles at the lung bases B. client with chronic bronchitis who has rhonchi in the anterior and posterior chest C. client with right sided pleural effusion who has decreased breath sounds at the right lung base D. client with severe acute pancreatitis who has inspiratory crackles at the lung bases

D. client with severe acute pancreatitis who has inspiratory crackles at the lung bases WHY? - a. this is likely due to them wanting to breathe shallow > whenever you get to them, ambulate, get them deep breathing, incentive spirometer > this is not urgent - b. expected - c. expected (this patient needs diuretics and thoracentesis but they do not take priority over someone in an acute situation) - d. pancreatitis can cause pleural effusions, resp distress, all sorts of problems

A nurse is caring for a child who is receiving oxygen at 2L/min by nasal cannula and observes the current oxygen saturation (83%) and pulse plethysmographic waveform on the pulse oximeter. Which intervention should be the nurse's initial action? A. Auscultate the child's lung fields B. have the child take slow, deep breaths C. increase the oxygen flow rate to 3L/min D. verify position and integrity of finger probe

D. verify position and integrity of finger probe WHY? nothing in the stem shows that this child is struggling

A 7-year-old client is brought to the ED with BP 116/66, P 100, RR36, T98.7, non-productive cough & history of having a recent cold. The nurse prepares to treat the client for which diagnosis? A.Acute asthma B.Bronchial pneumonia C.COPD D.Anaphylaxis

a. acute asthma WHY? - b. wont have bronchial pneumonia without productive cough - c. too young for copd - d. no sign of allergy

the nurse should immediately implement interventions for treatment of _____a_______ due to the risk of _____b_____ a. bronchitis anaphylaxis asthma exacerbation b. pneumonia hypotension respiratory acidosis

a. asthma exacerbation b. respiratory acidosis WHY? asthma exacerbation always requires immediate intervention to open airways since bronchoconstriction can progress to severe airway obstruction, hypoxemia, resp acidosis and resp failure.

Case Study Question 3/5 The nurse should prepare the client for which intervention? a. chest tube insertion b. intubation c. thoracentesis d. tracheotomy

a. chest tube insertion WHY? this is a severe situation with severe trauma, so a chest tube will get everything out of there. it will also help reinflate the lung WHY NOT thoracentesis? think fluid !! this patient does not have fluid

The nurse is educating a client 48 hours after a surgical procedure complaining of pain and splinting while using the incentive spirometer. The nurse understands the client is at most risk for which respiratory disorder? A.Pneumonia B. Atelectasis C. Pneomothorax D. Bronchitis

b. Atelectasis WHY? - b. atelectasis is collapse of part/all of a lung, and if the alveoli are not fully inflating, this can lead to collapse.

Case Study Question 4/5 one hour after chest tube insertion, the client becomes agitated and knocks over the chest tube collection device. the chest tube collection device is damaged, and the tubing becomes disconnected. which action should the nurse perform first? a. adjust the head of the bed to semi or high fowler position b. notify the health care provider c. obtain a new chest tube collection device d. place the distal end of the chest tube into a bottle of sterile saline

d. place the distal end of the chest tube into a bottle of sterile saline WHY? we don't want the outside stuff getting inside. the pressure in the atmosphere is higher than the pressure in the intrathorastic cavity. we need the end of that tube down in something to create a seal if we were to put them in order: d. first protect the patient e. then sit them up to help them breathe c. then get a new tube (hit the call light and have someone bring them in) b. this might be something you can handle on your own > you might not even need to call the provider *once you place the new tube, have them take one HARD DEEP breath and COUGH !!! > this will blow out any gunk that got into the lungs from the atmosphere*

what is the difference between gas exchange and perfusion?

ex: if I put a rubber band tight on my arm, in 5 minutes what will my wrist and hand look like? > it will be purple here, you do NOT have a problem with gas exchange, you have a problem with perfusion within the lungs > gas exchange once oxygen leaves the lungs > thats perfusion