NU372 EAQ Evolve Elsevier: HESI Prep Respiratory

After the nurse has finished teaching a postoperative client about prevention of pulmonary embolism, which client statement indicates that the teaching has been effective? o "I will avoid crossing my legs." o "Pillows placed under my knees will help avoid clots." o "Staying on bed rest as long as possible is best for me." o "Three times every day I will massage my lower legs to get blood moving."

o "I will avoid crossing my legs." · Clients should avoid crossing the legs to prevent the constriction of blood flow in the lower leg, which can lead to deep vein thrombosis (DVT). When dislodged, DVT can become a pulmonary embolus. Pillows should not be placed under the knees because this constricts blood flow to and from the lower leg and increases risk for DVT. Activity, rather than staying immobile in bed, helps encourage blood flow. The lower legs should not be massaged because this action could dislodge a DVT that has formed.

After a client with multiple fractures of the left femur is admitted to the hospital for surgery, the client experiences a sudden onset of cyanosis, tachycardia, dyspnea, restlessness, and petechiae on the chest. Which is the priority nursing action? o Obtain vital signs. o Administer oxygen. o Notify the health care provider. o Auscultate the client's lung sounds.

o Administer oxygen. · It is likely that the client is experiencing a fat embolus; oxygen reduces the surface tension of fat globules, reducing hypoxia. Vital signs should be taken after oxygen administration. Obtaining vital signs will delay an intervention that may help reduce the client's distress. Interventions should be initiated to help the client before taking the time to notify the health care provider. Auscultating the lungs is important, but the priority is to provide oxygenation.

In which order would the nurse take these actions when suctioning a client who is receiving mechanical ventilation through an endotracheal tube? o Assess client's vital signs and lung sounds. o Activate the ventilator hyperoxygenation setting. o Insert the catheter without applying suction. o Rotate the catheter while suction is applied.

o Assess client's vital signs and lung sounds. o Activate the ventilator hyperoxygenation setting. o Insert the catheter without applying suction. o Rotate the catheter while suction is applied. · The nurse would first assess the client's vital signs and lung sounds to determine if suctioning is needed. Then 100% oxygen should be administered for 30 seconds to compensate for the lack of oxygen intake during the suctioning process. Suctioning should not be applied during catheter insertion to limit trauma. Rotating the catheter during withdrawal promotes better removal of secretions.

Which finding would be of most concern when the nurse is assessing a client with pulmonary embolism diagnosis who is receiving intravenous heparin? o Client reports stools are black. o Oxygen saturation is 93%. o Respiratory rate is 25 breaths per minute. o Client has an ecchymosis on the ankle.

o Client reports stools are black. · Because anticoagulant use increases the risk for gastrointestinal bleeding, the nurse would report the black-colored stools to the health care provider and anticipate action such as testing stools for occult blood, administration of protein pump inhibitor to decrease ulcer risk, and checking complete blood count. An oxygen saturation of 93% in a client with pulmonary embolus is acceptable. A slightly elevated respiratory rate in a client with a pulmonary embolus is a compensatory mechanism to prevent hypoxemia. Because low platelet counts increase risk for bleeding, an ecchymosis on this client's ankle would not be of high concern.

Which pathophysiological changes in the lungs occur with emphysema? Select all that apply. o Collapse of alveolar walls o Trapping of air in distal lung structures o Increases in pulmonary artery pressures o Increase in surface area for gas exchange o Movement of fluid from capillaries into alveoli

o Collapse of alveolar walls o Trapping of air in distal lung structures o Increases in pulmonary artery pressures · Destruction of alveolar walls in emphysema leads to alveolar wall collapse and trapping of air in distal lung structures, leading to poor gas exchange. Chronic hypoxemia causes pulmonary hypertension. As alveolar walls collapse, less surface area is available for gas exchange. The alveoli do not become filled with fluid in emphysema. Left-sided heart failure causes pulmonary congestion with fluid-filled alveoli.

During the infusion of dialysate during peritoneal dialysis, the client exhibits symptoms of severe respiratory difficulty. Which action would the nurse take? o Slow the rate of the client's infusion. o Place the client in a low-Fowler position. o Auscultate the client's lungs for breath sounds. o Drain the fluid from the client's peritoneal cavity.

o Drain the fluid from the client's peritoneal cavity. · Pressure from the dialysate may cause upward displacement of the diaphragm; the dialysate should be drained from the peritoneal cavity. Additional fluid, even at a decreased rate of infusion, will aggravate the respiratory difficulty. The client should already be in the semi-Fowler position. Auscultation is important, but it does not alleviate the respiratory difficulty.

A client is hospitalized with emphysema. The nurse recognizes the importance of assessing for clinical indicators of hypoxia based on which condition associated with the disease? o Pleural effusion o Infectious obstructions o Loss of aerating surface o Respiratory muscle paralysis

o Loss of aerating surface · Destruction of the alveolar walls leads to diminished surface area for gaseous exchange and to increased carbon dioxide levels in the blood. Pleural effusion occurs when there is seepage of fluid into the intrapleural space; this does not occur with emphysema. Infectious obstructions occur in conditions in which microorganisms invade lung tissue; emphysema is not an infectious disease. Muscle paralysis may occur in diseases affecting the neurological system. Emphysema does not affect the neurological system; therefore it is not a neurological disease.

Which action will the nurse take to support safe oral intake after tracheostomy? o Include thin liquids. o Provide large meals. o Inflate the tracheostomy cuff fully. o Position client as upright as possible.

o Position client as upright as possible. · After tracheostomy, positioning the client as upright as possible supports safe eating by preventing aspiration. Thin liquids are more difficult to swallow and increase the risk for aspiration. Large meals may cause overdistention of the stomach and lead to regurgitation and aspiration; meals should be small and frequent. The tracheostomy cuff should be deflated to decrease interference with swallowing.

When a client with chronic obstructive pulmonary disease has a new prescription for daily low-dose prednisone, which information will the nurse include when teaching the client? o Take the medication an hour before eating. o Report any dark stools to the health care provider. o Weight loss is a common side effect of the medication. o Take the medication as soon as you experience any dyspnea.

o Report any dark stools to the health care provider. · Because corticosteroids can cause peptic ulcers and gastrointestinal bleeding, the client will be instructed to call the health care provider for any symptoms of ulcer such as gastric pain or dark stools. Oral corticosteroids should be taken with food to help avoid gastric irritation and ulcer development. Corticosteroids cause fluid retention and increased appetite, leading to weight gain. Corticosteroids are used to prevent airway inflammation that can lead to dyspnea; they are not rapidly acting and must be taken regularly to be effective.

When preparing a client who is scheduled for a pulmonary function test (PFT) because of possible adult-onset asthma, which action would the nurse take? o Have client use the prescribed as needed bronchodilator before testing. o Teach client how to take a deep breath and exhale forcefully. o Explain the reason for not eating for 6 hours before testing. o Check to be sure that the informed consent form is signed.

o Teach client how to take a deep breath and exhale forcefully. · The most important PFTs in the diagnosis of asthma are the forced vital capacity (FVC), the forced expiratory volume in 1 second (FEV1), and the ratio of FEV1/FVC, which all require that the client take a maximal inspiration and exhale as forcefully as possible. A bronchodilator use will affect the PFT and would be avoided before testing, although it might be used after the baseline readings were obtained to check for improvement after bronchodilation. PFTs are not scheduled after a meal because a full abdomen might decrease the ability to inhale fully, but a 6-hour period of not eating is not necessary. No informed consent is needed for PFTs, because these tests are noninvasive.

Which data would the nurse document for a client who returns to the clinic with induration of the skin 48 hours after receiving a purified protein derivative (PPD) test? Select all that apply. o The client has active tuberculosis (TB). o The client has received a PPD in the past. o The client has been exposed to tuberculosis. o The client has an allergic reaction to the test. o The client has a decreased immune response.

o The client has been exposed to tuberculosis. · A positive PPD indicates that the client has been exposed to TB and developed antibodies to the bacteria, and the nurse would document that the client has been exposed to TB. Active TB must be diagnosed with a positive sputum culture. Clients may receive annual PPDs and never have a positive reaction. An allergic reaction to the PPD test would cause redness at the injection site. Decreased immunity puts the client at risk for contracting TB, but a decreased immune response would not cause a positive result.

A client develops increased respiratory secretions because of radiation therapy to the lung, and the health care provider prescribes postural drainage. Which client assessment leads the nurse to determine that the postural drainage is effective? o Is free of crackles o Has a productive cough o Is able to expectorate saliva o Can breathe deeply through the nose

o Has a productive cough · A productive cough indicates that mucus is being raised from the lungs, which is an expected outcome. Crackles are unaffected by postural drainage or coughing. Saliva comes from the mouth; it does not indicate that the lungs are clear. Depth of respirations may not be altered by postural drainage.