Pulmonary Sherpath Quiz

Increased hemoglobin

Polycythemia is frequently associated with chronic obstructive pulmonary disease (COPD). Which should the nurse monitor for when assessing for this complication?

Hypoxia (Alteration in Gas Exchange) Altered Breathing Pattern Partially obstructed or Obstructed Airway

Presentation of pt with impaired respiratory function

Managing hypoxemia

In a patient with pneumonia, what is the most important nursing intervention?

Larynx

Where is stridor heard?

surfactant

atelectasis (lung collapse) occurs without what?

Pleural friction rub

The nurse hears loud, rough, grating, scratching sounds on auscultation in a patient with tuberculosis. How does the nurse document this finding?

Smoking

Biggest contributor to respiratory disease

apply a wound dressing

A client with a puncture wound of the chest wall is brought to the emergency department. What should be the nurse's first action?

Surgical stabilization

Which intervention is preferred for extreme cases of flail chest?

Decrease in elastic recoil of the lung Loss of skeletal muscle strength in thorax and diaphragm Fibrosis in the alveoli Fewer functional capillaries Less effective cough Decrease in PO2

Effects of aging on lungs

Two chest tubes are placed to remove air and fluid whenever fluid or air accumulates in the pleural space. A small chest tube is placed at the second intercostal space. The nurse should palpate near this space to remove air.

Identify the area the nurse should palpate to remove air when two chest tubes are placed, as shown in the image.

Nicotine inhalers have no risk of secondhand smoke.

What advantage does a nicotine inhaler have over an e-cigarette?

To prevent food from entering the trachea.

What is the function of the epiglottis?

Insertion of a central venous catheter

What might be the cause of a tension pneumothorax?

Secretion of thick and sticky mucus

Which physiological change in cystic fibrosis (CF) may cause airway obstruction?

Fatigue, hemoptysis, night sweats

A nurse assesses a newly admitted client with a diagnosis of pulmonary tuberculosis (TB). Which clinical findings support this diagnosis? Select all that apply.

Intercostal nerve block

A patient has severe pain from three rib fractures after a workplace accident. To facilitate adequate respiration, the nurse discusses which intervention with the provider?

Clot obstructing the drain

A patient has undergone neck dissection surgery and has a skin flap and a closed surgical drain. The nurse has been monitoring drainage hourly on the first postoperative day and notes a decrease in amount from 20-30 mL hourly to less than 5 mL in 1 hour. The nurse suspects which cause for this decrease in drainage?

Primary pulmonary arterial hypertension is common in women between the ages of 20 and 40 years.

Which individual does the nurse identify as being more likely to have primary pulmonary arterial hypertension?

Positioning the patient upright for all meals and medications

Which nursing action will decrease the risk of aspiration in a patient with head and neck cancer who has undergone a supraglottic partial laryngectomy?

Patient with pulmonary tuberculosis who is receiving multiple medications

Which of these patients should the charge nurse assign to the LPN/LVN working on the medical-surgical unit?

<10 mL/kg

Which value of the expiratory volume signifies a poor prognosis in patients with deep chest trauma?

No opacity in the lobes or parenchyma

Which would be the initial radiographic findings in a patient with pulmonary contusion?

Pneumonia

While assessing a client, the nurse finds increased vibrations over the chest wall. What condition can be inferred from this finding?

Crackles, cyanosis, frothy sputum

A client had thoracic surgery. The nurse should monitor for which clinical manifestations that may indicate acute pulmonary edema? Select all that apply.

Increased temp, sudden SOB, decreased O2 sat

A client has a hysterectomy, salpingo-oophorectomy, tumor removal, and multiple abdominal biopsies for ovarian cancer. For which clinical manifestations indicating that the client may be experiencing a pulmonary embolus should the nurse assess the client? Select all that apply.

Palpate the surrounding area for crepitus

A client has chest tubes attached to a chest tube drainage system. What should the nurse do when caring for this client?

Perform diaphragmatic exercises to improve contraction of the diaphragm

A client is admitted to the hospital with a diagnosis of emphysema. What should the nurse include when teaching the client breathing exercises?

Supplemental O2

A client who just returned from surgery reports shortness of breath and chest pain. Which should the nurse initially administer?

"If the spacer makes a whistling sound, I am breathing in too rapidly." (wait 1 min between puffs, rinse mouth out afterwards to prevent fungal infection, shake before use)

A patient has been diagnosed with asthma. Which statement below indicates that the patient correctly understands how to use an inhaler with a spacer correctly?

Discontinue heparin

A patient with a pulmonary embolism has begun taking oral warfarin while still receiving intravenous heparin. The nurse notifies the provider that the patient has an international normalized ratio (INR) of 2.5. What order does the nurse anticipate?

Esophageal speech

After a laryngectomy a client is concerned about improving the ability to communicate. Which topic should the nurse include in a teaching plan for the client?

Pulmonary Embolism

The nurse assesses extreme shortness of breath, agitation, and apprehension in a patient who had knee surgery. A heart rate of 119 beats/min and a respiratory rate of 24 breaths/min with an oxygen saturation of 84% are also noted. The nurse suspects which postoperative complication?

respiratory acidosis, compensated

When evaluating the arterial blood gases (ABGs) of a patient with a 20 year history of chronic bronchitis, which of these would the healthcare provider expect?

Raise head of bed

A client begins to have difficulty breathing 30 minutes after the insertion of a subclavian central line. What should a nurse do first?

"Cover your cough with your forearm.

A client comes to the clinic because of signs and symptoms of a respiratory infection. The client says to the nurse, "How can I prevent my roommate from getting my cold?" What is the nurse's best response?

Productive cough

A client develops increased respiratory secretions because of radiation therapy to the lung, and the healthcare provider prescribes postural drainage. What client assessment leads the nurse to determine that the postural drainage is effective?

"You acquired the infection after being admitted to the hospital."

A client is informed that he has developed a healthcare-associated upper respiratory tract infection and asks the nurse what this means. How should the nurse reply?

Remove the air that is present in the intrapleural space

A client is shot in the chest during a holdup and is transported to the hospital via ambulance. In the emergency department, chest tubes are inserted, one in the second intercostal space and one at the base of the lung. What does the nurse expect the tube in the second intercostal space to accomplish?

Opening collapsed alveoli and keeping them open

A client on a mechanical ventilator is receiving positive end-expiratory pressure (PEEP). The nurse understands that this treatment improves oxygenation primarily by doing what?

Suction as needed

A client who is a pipe smoker is diagnosed with cancer of the tongue. A hemiglossectomy and right radical neck dissection are performed. To ensure airway patency while the client is in the postanesthesia care unit, what should the nurse do?

TB

A client who is homeless is hospitalized for alcohol withdrawal. When considering the type of personal protective equipment that is needed for the client's care, what condition does the nurse recall that homeless persons are at risk for?

The client has been exposed to the pathogen that causes tuberculosis

A client who is negative for human immunodeficiency virus (HIV) but who has a history of chronic obstructive pulmonary disease (COPD) requests the nurse to read the results of the client's Mantoux test for tuberculosis. The test site has a 10-mm area of induration with 5 mm of erythema. How should the nurse interpret the finding?

Tumor of the nasal cavity

A client who works in the leather industry complains of a bloody discharge and persistent pain after the treatment of sinusitis. The client has a history of smoking. The nurse suggests the client consult a primary healthcare provider immediately. Which risk does the nurse suspect in the client?

Hyperoxygenate with 100% oxygen before and after suctioning

A client with a pulmonary embolus is intubated and placed on mechanical ventilation. When suctioning the endotracheal tube, what should the nurse do?

Advise the client to avoid eating or drinking anything for several hours before the test (to prevent aspiration)

A client with a tentative diagnosis of lung cancer is scheduled for a mediastinoscopy with biopsy. Which is a priority nursing action?

Ethambutol

A patient is taking isoniazid, rifampin, pyrazinamide, and ethambutol for tuberculosis. The patient calls to report visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes?

Remove the patient from the ventilator and ventilate using a bag-valve-mask device.

A patient who is intubated and on mechanical ventilation begins to develop respiratory distress. What is the next priority action for the nurse?

"You are right, the damage has been done. But let's talk about why smoking around oxygen is dangerous."

A patient who smokes is being discharged home on oxygen. The patient states, "My lungs are already damaged, so I'm not going to quit smoking." What is the discharge nurse's best response?

"The intranasal vaccine can be given to everybody in the family." (Only approved for ages 2-49, and not pregnant)

The nurse has taught a patient about influenza infection control. Which patient statement indicates the need for further teaching?

Yellow is a range between 50% and 80% of personal best. When the reading is in this range, the client is recommended to use the prescribed reliever drug. After a few minutes of the intake of a prescribed reliever drug, the peak expiratory flow should be determined again to know the effect of the reliever medication.

The nurse instructed a client with asthma about the use of a peak flow meter at home. The client assesses the peak expiratory flow by using the peak flow meter. Which action performed by the client would be appropriate when the reading is in the yellow zone?

Ventilate with a bag-valve-mask and ensure the Rapid Response Team is notified.

The patient coughs and expels the tracheostomy tube. The nurse inserts a new tracheostomy tube and auscultates the lungs, but cannot hear breath sounds. What is the nurse's next best action?

Holds each breath for a second at the end of inspiration

What response provides evidence that a client with chronic obstructive pulmonary disease (COPD) understands the nurse's instructions about an appropriate breathing technique?

Epistaxis

While assessing the medical reports of a client with upper respiratory tract infections, the nurse notices that there are alterations in the platelet count. The client has a history of recent nasal surgery. Which clinical condition does the nurse suspect?

Sputum test for acid-fast bacilli

A client is admitted with possible tuberculosis. To make a definitive diagnosis, the nurse expects which diagnostic test to be prescribed?

Early recognition and quarantine

Which method is the best way to prevent outbreaks of pandemic influenza?

rhinitis

Inflammation of the Nasal Cavities & Nasopharyngeal areas; most common upper respiratory infection

Atelectasis

The X-ray report of a client indicates a reduction in the alveolar surface area. Which condition can be inferred from this finding?

pneumonia, atelectasis, pleural effusion, tumors, or an abscess

increase in voice sounds with diseases such as:

Postpone the planned vacation to go skiing.

A client with obstructive airway disease reports to the nurse about experiencing spasms of coughing. What suggestion should the nurse provide to help the client successfully manage this problem?

Respiratory

A client with the diagnosis of inhalation anthrax is admitted to the intensive care unit. It is most important for the nurse to make a focused assessment of which body system?

Clear yellow halo ring structure on a filter paper

While caring for a client with a nasal injury, the nurse also suspects a skull fracture. Which manifestation might have led the nurse to conclude this?

Difficulty in expelling the air trapped in the alveoli

A client with emphysema experiences shortness of breath and uses pursed-lip breathing and accessory muscles of respiration. The nurse determines that the cause of the dyspnea is for which reason?

Assess respiratory status

The nurse is caring for a client who has a peripherally inserted central catheter (PICC). The client notifies the nurse that the catheter got tangled up in his bedclothes and that part of it has broken off. What should the nurse do first?

Mucosal necrosis

The nurse is caring for a client who has a tracheostomy tube with a high-volume, low-pressure cuff. What does the cuff prevent?

dry cough, SOB, fever > 100.4

The nurse is caring for a client who recently returned from another country who exhibits signs and symptoms suspicious of severe acute respiratory syndrome (SARS). Which clinical manifestations support this diagnosis? Select all that apply.

palpating the neck/face

A client develops subcutaneous emphysema after a chest injury with suspected pneumothorax. What assessment by the nurse is the best method for detecting this complication?

Restores negative pressure in the pleural space

A nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD) who develops a pneumothorax and has a chest tube inserted. Which primary purpose of the chest tube will the nurse consider when planning care?

Provide O2 at 2L/min

A nurse observes a client with acute bronchitis and emphysema sitting up in bed, appearing anxious and dyspneic. What should the nurse do first?

Performing self-care of the tracheal stoma

A nurse who is caring for a client after head and neck surgery is concerned with the client's anger and depressive episodes about the effects of surgery. Which action indicates the client is reaching acceptance?

bound to hemoglobin

A patient asks how oxygen is transported in the body. What is the nurse's best response? Most of the oxygen (O2) is transported:

Throat culture

A patient comes to the emergency department with a sore throat. Examination reveals redness and swelling of the pharyngeal mucous membranes. Which diagnostic test does the nurse expect will be requested first?

Weight gain

The nurse instructs the client admitted for an acute exacerbation of chronic obstructive pulmonary disease (COPD) about the importance of assessing for right-sided heart failure after discharge. What does the nurse instruct the client to assess for?

Smoking hx and exposure to secondhand smoke

The nurse is assessing the smoking habits of a patient being treated for a respiratory disorder caused by tobacco smoke. What tasks should the nurse perform to assess the patient?

Raise the head of the bed to a high-Fowler position and administer 2 L/min oxygen per nasal cannula

The nurse observes a client with chronic obstructive pulmonary disease (COPD) breathing rapidly and using accessory muscles of respiration. The nurse auscultates the lungs and hears crackles and wheezes. What action should the nurse take?

The sparing application of petroleum jelly to the nares helps to lubricate the area and provide comfort to the client. However, excess use may cause inhalation of the jelly into the lungs and may increase the risk of pneumonia.

The nurse suspects pneumonia in a client who underwent placement of an epistaxis catheter due to posterior nasal bleeding. Which activity of the client might have led to this condition?