Respiratory Chapters 20, 21, 22 Part 1

The nurse is preparing to perform chest physiotherapy on a patient. What patient statement would indicate the procedure is contraindicated?

"I just finished eating my lunch, I'm ready for my CPT now"

A nurse is orientating a newly licensed nurse who is caring for a client who is receiving mechanical ventilation and is on pressure support ventilation mode. What statement by the newly licensed nurse indicates an understanding of pressure support ventilation?

"It allows preset pressure delivered during spontaneous ventilation"

The nurse is preparing to assist the health care provider with the removal of a patient's chest tube. What instructions will the nurse give the patient?

"When the tube is being removed, take a deep breath, exhale and bear down.

The nurse is caring for a client with allergic rhinitis. The patient asks the nurse about measures to help decrease allergic symptoms. The best response by the nurse is what?

"You should try to reduce exposure to irritants and allergens"

When performing endotracheal suctioning, the nurse applies suctioning while withdrawing and gently rotating the catheter 360 degrees for what time period?

10-15 seconds

What range of water pressure identifies the amount of pressure within the endotracheal tube cuff that is believed to prevent both injury and aspiration?

15-20 mm Hg

What is the correct endotracheal tube cuff pressure?

17 mm Hg

The herpes simplex virus type 1, which produces a cold sore, has an incubation period of what?

2 to 12 days

The nurse is caring for a patient in the ICU who required emergency endotracheal intubation with mechanical ventilation. The nurse receives an order to obtain arterial blood gases following the procedure. The nurse recognizes that ABG's should be obtained at what time frame following the initiation of mechanical ventilation?

20 minutes

The nurse is calculating the patient's smoking history in pack-years. The patient states he has been smoking two packs of cigarettes a day for the past 11 years. The nurse correctly documents the patient's pack-years as what?

22

Tidal volume, which may not significantly change with disease, has a normal value of approximately ________ ml.

500

I nurse understands that are safe but low level of oxygen saturation provides for adequate tissue saturation while allowing no reserve for situations that threaten ventilation. What is a safe but low oxygen saturation level for a patient?

95 mm Hg

The nurse is caring for a patient being weaned from the mechanical ventilator. What patient finding would require the termination of the weaning process?

A blood pressure increase of 20 mm Hg from baseline

The nurse is assigned the care of a patient with a chest tube. The nurse should ensure that what item is kept at the bedside?

A bottle of sterile water

The nurse is educating a patient who is scheduled for a perfusion lung scan. What should be included in the information about the procedure?

A mask will be placed over the nose and mouth during the test

What is a true statement regarding air pressure variances?

Air is drawn through the trachea and bronchi into the alveoli during inspiration

The nurse is caring for a patient following a wedge resection. While the nurse is assessing the patient's chest tube drainage system, constant bubbling is noted in the water seal chamber. This finding indicates what problem?

Air leak

The antibiotic of choice utilized in the treatment of acute bacterial rhinosinusitis includes what?

Amoxicillin (augmentin)

The nurse is caring for a patient admitted to the ED with an uncomplicated nasal fracture. Nasal packing has been completed. What interventions should the nurse include in the patient's care?

Apply an ice pack

The nurse is caring for a patient diagnosed with pneumonia. The nurse will assess the patient for tactile fremitus by completing what?

Asking the patient to repeat "ninety-nine" as the nurse's hands move down the patient's thorax.

What is a potential complication of a low pressure in the endotracheal tube cuff?

Aspiration pneumonia

A nurse is orienting a newly licensed nurse on performing routine assessment of a client who is receiving mechanical ventilation with an endotracheal tube. What information should the nurse include in the teaching?

Assess breath sounds every 1-2 hours

The nurse is caring for a patient with recurrent hemoptysis who has undergone a bronchoscopy. Immediately following the procedure, the nurse should complete what?

Assess the patient for a cough reflex

What ventilator mode provides full ventilatory support by delivering a preset tidal volume and respiratory rate?

Assist control

What are four conditions that are influenced by genetic factors that affect respiratory function?

Asthma, alpha 1 anti-trypsin deterioration, COPD, and cystic fibrosis

The nurse is providing discharge instructions to a patient following nasal surgery who has nasal packing. What discharge instructions would be most appropriate for the patient?

Avoid sports activities for 6 weeks

A patient with newly diagnosed emphysema is admitted to the medical-surgical unit for evaluation. What does the nurse recognize is a deformity of the chest wall that occurs as a result of overinflation of the lungs in this patient population?

Barrel chest

The nurse and inspects the thorax of a patient with advanced emphysema. What does the nurse expect the chess configuration to be for this patient?

Barrel chest

A nurse is assessing a client following a bronchoscopy. What findings should the nurse report to the provider?

Bronchospasms

A patient has undergone a laryngectomy. The nurse notes evidence of wound breakdown. The nurse understands that the patient is at a high risk for developing what?

Carotid hemorrhage

The nurse is caring for a patient following a thoracotomy. What finding requires immediate intervention by the nurse?

Chest tube drainage of 190 ml/hr

The nurse knows that there are 3 types of chronic pharyngitis. What one is characterized by numerous swollen lymph follicles on the pharyngeal wall?

Chronic granular

The nurse is caring for a patient in the ICU who is receiving mechanical ventilation. What nursing measure is implemented in an effort to reduce the paitent's risk of developing ventilator associated pneumonia?

Cleaning the patient's mouth with chlorhexadine daily

The nurse auscultates crackles in a patient with a respiratory disorder. What condition does the nurse recognize that these symptoms are indicative of?

Collapsed alveoli

What are the six major signs and symptoms of respiratory diseases?

Cough, chest pain, sputum production, dyspnea, wheezing, tachypnea

What is the function of the epiglottis?

Covers the opening of the larynx during swallowing

The nurse is caring for a patient with a pulmonary disorder. What observation by the nurse is indicative of a very late symptom of hypoxia?

Cyanosis

The nurse is caring for a patient with extensive respiratory disease. What is a late sign of hypoxia in the patient?

Cyanosis

What ventilation-perfusion ratio is exhibited when a patient is diagnosed with pulmonary emboli?

Dead space

What is an age-related change associated with the respiratory system?

Decrease size of the airway

When the nurse is assessing the older adult patient, what Gerontological changes in the respiratory system should the nurse be aware of?

Decreased gag reflex, increased presence of collagen in alveolar walls, decreased presence of mucus

The nurse is caring for a patient with an endotracheal tube. What nursing interventions would be contraindicated?

Deflating the cuff routinely

The nurse is completing a physical assessment of a patient's trachea. The nurse inspects and palpates the trachea for what?

Deviation from the midline

Compare and contrast the concepts of diffusion and pulmonary perfusion.

Diffusion is the exchange of oxygen and carbon dioxide and perfusion is the arterial flow of blood through the pulmonary circulation

When does gas exchange take place?

During respiration

A nurse is caring for a client following a thoracentesis. What manifestations should the nurse recognize as risks for complications?

Dyspnea, fever, hypotension

During a pre-admission assessment, for what diagnosis would the nurse expect to find decrease tactile fremitus and hyperresonant percussion sounds?

Emphysema

High or increased compliance occurs in which of the following conditions?

Emphysema

How is Cheyenne stokes respiration Breathing pattern characterized?

Episodes of apnea and periods of deep breathing

The nurse assesses a patient who is bleeding profusely from the nose. The nurse documents this finding as what condition?

Epistaxis

The nurse is caring for a male patient diagnosed with rhinosinusitis. The physician has ordered the patient to receive 4 sprays of budesonide (rhinocort) in each nostril every morning. The nurse informs the patient that a common side effect of this medication includes what?

Epistaxis

A health care provider requests a study of diaphragmatic motion because of suspected pathology. What diagnostic test will the nurse prepare the patient for?

Fluoroscopy

The patient was sinus congestion reports discomfort when the nurse is palpating the supra orbital ridges. The nurse is aware that the patient is referring to which sinus?

Frontal

A 76 year old man presents to the ER complaining of laryngitis. The triage nurse should ask if the patient has a past medical history that includes what?

Gastroesophageal reflux disease (GERD)

A patient is being assessed for acute laryngitis. The nurse recognizes that clinical manifestations of acute laryngitis include what?

Hoarseness

What type of oxygen therapy includes the administration of oxygen at pressure greater than 1 atmosphere?

Hyperbaric

The nurse has instructed a patient on how to perform pursed lip breathing. The nurse recognizes the purpose of this type of breathing is to accomplish what?

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

The nurse is caring for a critically ill patient in the ICU. The nurse documents the patient's respiratory rate as bradypnea. The nurse recognizes bradypnea is associated with what condition?

Increased intracranial pressure

What is the priority nursing diagnosis for the patient undergoing a laryngectomy?

Ineffective airway clearance

The nurse is instructing the patient on the collection of a sputum specimen. What should be included in the instructions?

Initially, clear the nose and throat, take a few deep breath's before coughing, use diaphragmatic contractions to aid in the expulsion of sputum

The nurse is caring for a patient who underwent a laryngectomy. What interventions will the nurse initially complete in an effort to meet the patient's nutritional needs?

Initiate enteral feedings

Which respiratory volume is the maximum volume of air that can be inhaled after maximal expiration?

Inspiratory reserve volume

What ventilator mode provides a combination of mechanically assisted breaths and spontaneous breaths?

Intermittent mandatory ventilation

The nurse is caring for a patient receiving radiation therapy for laryngeal cancer. A late complication of radiation therapy includes what?

Laryngeal necrosis

A patient presents to the ED complaining of severe coughing episodes. The patient states the "episodes are more intense at night". The nurse should suspect what condition based on the paient's primary complaint?

Left sided heart failure

The nurse is caring for a patient complaining of chest discomfort. The patient's admitting diagnosis is left lower lobe pneumonia. What strategies will the nurse instruct the patient to use to help alleviate the discomfort?

Lying on the right side

A thoracentesis is performed to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnositic purposes. What does bloody fluid indicate?

Malignancy

The nurse is caring for a patient who is scheduled for a bronchoscopy. The nurse understands that it is important to provide the required information and appropriate explanations for any diagnostic procedure to a patient with a respiratory disorder in order to do what?

Manage decreased energy levels

What is the purpose of cilia?

Moves the mucus out of the larynx

What oxygen administration device has the advantage of providing high oxygen concentration?

Nonrebreather mask

Stiffness of the neck or inability to bend the neck is referred to as which of the following?

Nuchal rigidity

The nurse is caring for a female patient following a tonsillectomy and adenoidectomy. Two hours following the procedure, the patient begins to vomit large amounts of dark blood in frequent intervals and is tachycardic and febrile. After notifying the surgeon, the nurse will do what?

Obtain a light, mirror, gauze, curved hemostats

The left lung, in contrast to the right lung, has ____________.

One less lobe than the right

What term would the nurse use to document the inability of a patient to breathe easily unless positioned upright?

Orthopnea

The nurse is caring for a patient with suspected lung cancer. What imaging studies is more accurate in detecting malignancies than a CT scan?

PET scan

The nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurement best reflects the adequacy of alveolar ventilation?

PaCO2

The symbol used to identify the partial pressure of oxygen is __________.

PaO2

The nurse is caring for a patient admitted with a diagnosis of bacterial pharyngitis. The nurse anticipates the patient will be ordered what medication?

Penicillin

The nurse is preparing to perform tracheostomy care on a patient with a newly inserted tracheostomy tube. What action, if performed by the nurse indicates the need for further review of the procedure?

Places clean tracheostomy ties, and removes soiled ties after the new ties are in place. ( new tracheostomy needs two people to assist with tie changes)

The nurse auscultates the lung sounds of a patient during a routine assessment. The sounds produced are harsh cracking, sounding like two pieces of leather being rubbed together. The nurse would be correct in documenting this finding as what?

Pleural friction rub

A patient comes to the Emergency department reporting a knife like pain when taking a deep breath. What does this type of pain likely indicate to the nurse?

Pleurisy

In general, chest drainage tubes are not indicated for a patient undergoing what procedure?

Pneumonectomy

What are four conditions that can cause low compliance and distensibility of the lungs?

Pneumothorax, morbid obesity, ARDS, and hemothorax

The nursing is assessing a patient for obstructive sleep apnea. What are signs and symptoms of obstructive sleep apnea?

Polycythemia, loud snoring, insomnia

A nurse is caring for a client who is scheduled for a thoracentesis. Prior to the procedure, what actions should the nurse take?

Position client in an upright position, leaning over the bedside table

A patient presents to the ED with a suspected allergic reaction. The patient is experiencing laryngeal edema causing obstruction and is demonstrating retractions in the neck during inspirations. What is the nurse's priority intervention?

Prepare to administer subcutaneous epinephrine and corticosteroids

What does partial pressure mean?

Pressure exerted by oxygen and carbon dioxide in a mixture of gas

The nurse is taking a respiratory history for a patient who has come into the clinic with a chronic cough. What information should the nurse obtained from this patient?

Previous history of lung disease in the family or patient, occupational and environmental influences, previous history of smoking

The clinical finding of pink frothy sputum may be an indication of what?

Pulmonary edema

A nurse is reviewing ABG results of a client who is in respiratory distress. The results are pH 7.47, PaCO2 32 mm Hg, 32 mm Hg, HCO3 22 mm Hg. The nurse should recognize that the client is experiencing what acid-base balance?

Respiratory alkalosis

A patient who has an altered level of consciousness is receiving tube feedings. Patients receiving tube feedings should be placed in what position?

Semi fowlers or higher

What diagnostic test is used to confirm the diagnosis of maxillary and frontal sinusitis?

Sinus aspirates

The nurse is caring for patient in the ICU with a nasotracheal tube. Because of the tube placement, the nurse understands that the patient is at risk for developing what?

Sinus infection

What are four phenomena that can alter bronchial diameter?

Staphylococcus aureus, streptococcus pneumoniae, hemophilia's influenza, moraxella catarrhalis

The nurse is providing discharge instructions for a patient following laryngeal surgery. The nurse instructs the patient to avoid what?

Swimming

What results in decreased gas exchange in older adults?

The alveolar walls contain fewer capillaries

The nurse answers the call light of a male patient. The patient is complaining of an irritating tickling sensation in the throat, a salty taste, and a burning sensation in the chest. Upon further assessment, the nurse notes a tissue with bright red, frothy blood at the bedside. The nurse can assume the source of the blood is likely from what?

The lungs

In relation to the structure of the larynx, the cricoid cartilage is what?

The only complete cartilaginous ring in the larynx

The volume of air inhaled and exhaled with each breath is termed what?

Tidal volume

A patient is being mechanically ventilated in the ICU. The ventilator alarms begin to sound. The nurse should complete what action first?

Trouble shoot to identify the malfunciton

____________ are the alveolar cells that secrete surfactant.

Type 2 cells

What is the movement of air in and out?

Ventilation

A nurse caring for a patient with a pulmonary embolism understand that high ventilation perfusion ratio may exist. What does this mean for the patient?

Ventilation exceeds perfusion

A nurse is caring for a client who has dyspnea and will receive oxygen continuously. What oxygen device should the nurse use to deliver a precise amount of oxygen to the client?

Venturi Mask

What is the most reliable and accurate method for delivering precise concentrations of oxygen through noninvasive means?

Venturi mask

What type of ventilator has a pre-set volume of air to be delivered with each inspiration?

Volume cycled

The nurse is performing chest auscultation for a patient with asthma. How does the nurse describe the high pitch, sibilant, musical sounds are heard?

Wheezes

The nurse is discussing immediate postoperative communication strategies with a patient scheduled for a total laryngectomy. What information should the nurse include?

You can use writing or a communication board to communicate

A college student presents to the health clinical with signs and symptoms of viral rhinitis (common cold). The patient states "I've felt terrible all week, what can I do to feel better?" What is the best response by the nurse?

You should rest, increase your fluids, and take ibuprofen"

The two centers in the brain that are responsible for the neurologic control of ventilation are ___________ and _____________.

apneustic; pneumotaxic center

The exchange of oxygen and carbon dioxide from the alveoli into the blood occurs by ___________.

diffusion

The nurse is performing an assessment for a patient with congestive heart failure. The nurse asks if the patient has difficulty breathing in any position other than upright. What is the nurse referring to?

dyspnea, orthopnea,and tachypnea

A nurse is planning care for a client following the insertion of a chest tube and drainage system. What should be included in the plan of care?

encourage the client to cough every 2 hours, check for continuous bubbling in the suction chamber, obtain a chest x-ray

A nurse is caring for a client who has a chest tube and drainage system in place. What are expected findings?

gentle constant bubbling, rise and fall in the level of water in the water seal chamber with inspiration and expiration

The maximum volume of air that can be inhaled after a normal inhalation is known as _____________.

inspiratory reserve volume

The divisions of the lung proceed in the following order, beginning at the mainstem bronchi:

lobar brochi. segmented bronchi, subsegmented, and bronchioles bronchi

The pulmonary circulation is considered a __________.

low pressure system

A nurse is caring for a client who is scheduled for a thoracentesis. What supplies should the nurse ensure are in the client's room?

oxygen equipment, pulse oximeter, sterile dressing

A nurse is preparing to care for a client following chest tube placement. What items should be available in the client's room?

oxygen, sterile water, enclosed hemostat clamps, occlusive dressing

A nurse is caring for a client who is experiencing respiratory distress. What early manifestation of hypoxemia should the nurse recognize?

pale skin, elevated blood pressure

A nurse in a clinic is assessing a client who has sinusitis. What techniques should the nurse use to identify manifestations of this disorder?

palpation of the orbital areas

The alveoli begin to lose elasticity in a serous membrane called the __________.

pleura

Gas exchange between the lungs and blood and between the blood and tissues is called __________.

respiration

The nurse is caring for a patient who is to undergo a thoracentesis. In preparation for the procedure, the nurse will position the patient in which position?

sitting on the edge of the bed

A nurse is planning care for a client who is receiving mechanical ventilation. What mode of ventilation increases the effort of the client's respiratory muscles should the nurse include in the plan of care?

synchronized intermittent mandatory ventilation, continuous positive airway pressure, pressure support ventilation