Respiratory, Gas Exchange

Which method is the best way to prevent outbreaks of pandemic influenza? 1. Avoiding public gatherings at all times 2. Early recognition and quarantine 3. Vaccinating everyone with pneumonia vaccine 4. Widespread distribution of antiviral drugs

2. the recommended approach to disease prevention consists of early recognition of new cases and implementing community and personal quarantine to reduce exposure to the virus.

In assessing the client's respiratory status, blood gas test results reveal pH of 7.50, PaO2 of 99, PaCO2 of 29, and HCO3 of 22. What action does the nurse need to take first? 1. Call the physician. 2. Encourage the client to slow his breathing rate. 3. Nothing. These results are within the normal range. 4. Provide oxygen support.

2. the situation is not emergent, and does not require the physician at this time. the ABGs indicate resp alkalosis, which is commonly caused by hyperventilation. the RN should encourage the client to slow his breathing rate, may help to return to normal breathing and correct the abnormality. the PAO2 is within normal limits, so the pt does NOT need oxygen.

The client returns to the medical unit after a therapeutic bronchoscopy. Which intervention does the nurse apply first? 1. Assess the puncture site for drainage. 2. Implement NPO (nothing by mouth) status. 3. Monitor for signs of anaphylaxis. 4. Perform aggressive chest physiotherapy.

2. until the client has a gag reflex and is fully alert, he should be maintained on NPO status to prevent aspiration. anaphylaxis would occur immediately with any med administration, and aggressive chest physiotherapy is not indicated in a client who has had a bronchoscopy, and may cause bleeding if biopsies have been obtained.

Which components belong to the ventilator bundle approach to prevent ventilator-associated pneumonia (VAP)? Select all that apply. Administering antibiotic prophylaxis Continuous removal of subglottic secretions Elevating the head of the bed at least 30 degrees whenever possible Handwashing before and after contact with the client Placing a nasogastric tube Placing the client in a negative airflow room

2., 3., 4.: abx must be given on the basis of the culture.

A client had a thoracentesis 1 day ago. He calls the home health agency and tells the nurse that he is very short of breath and anxious. What is the major concern of the nurse? 1. Abscess 2. Pneumonia 3. Pneumothorax 4. Pulmonary embolism

3. a pneumothorax would be the complication of thoracentesis that causes the greatest concern, along with these symptoms. thoracentesis is not a cause of pulm emboli, an abscess is possible but would not cause such SOB, and PNA would not develop so rapidly causing this level of s/s

The oxygen saturation monitor of the client recovering from an empyema indicates periodic decreased perfusion, yet the client is talking and laughing with a visitor. The client's respirations are even and unlabored, and the nail beds are pink. What does the nurse do first? 1. Auscultates breath sounds 2. Calls Respiratory Therapy 3. Ensures that the pulse oximetry probe is in place 4. Instructs the client to breathe deeply

3. because the client does not appear to be in distress, check to make sure that the pulse ox probe is in place, and that the equipment is functioning properly. it is always important to remember to treat the client, not the monitor.

Four clients arrive in the emergency department simultaneously with chest pain. The client with which type of chest pain requires immediate attention by the nurse? 1. Client with pain on deep inspiration 2. Client with pain on palpation 3. Client with pain radiating to the shoulder 4. Client with pain that is rubbing in nature

3. chest pain radiating to the shoulder shoulder assumed to be in cardiac origin until proven otherwise, requiring immediate attention. pain on palpation is not usually pulm in nature, may be d/t trauma or referred from another source such as the GI tract

A client has just arrived in the postanesthesia care unit (PACU) following a successful tracheostomy procedure. Which nursing action must be taken first? 1. Suction as needed. 2. Clean the tracheostomy inner cannula and stoma. 3. Listen to lung sounds. 4.Change the tracheostomy dressing as needed.

3. suction may not be needed. cleanliness is a priority, but assessment is the 1st phase of the nursing process. all other actions are driven by assessment findings. the 1st nursing action for a client following an airway procedure is to assess the client's resp status and this requires auscultation of the lungs.

The nurse is working in an urgent clinic. Which of these four clients needs to be evaluated first by the nurse? 1. Client who is short of breath after walking up two flights of stairs 2. Client with soreness of the arm after receiving purified protein derivative (PPD) (Mantoux) skin test 3. Client with sore throat and fever of 39° C oral 4. Client who is speaking in three-word sentences and has SaO2 of 90% by pulse oximetry

4. 90% indicates hypoxemia, and the client should be able to speak more than 3 word sentences. the other options require evaluation but not emergently

Which of these clients will the charge nurse on the medical unit assign to an RN who has floated from the postanesthesia care unit (PACU)? 1. Client with allergic rhinitis scheduled for skin testing 2. Client with emphysema who needs teaching about pulmonary function testing 3. Client with pancreatitis who needs a preoperative chest x-ray 4. Client with pleural effusion who has had 1200 mL removed by thoracentesis

4. a RN working in the PACU would be familiar with assessing VS and resp status after procedures such as thoracentesis. skin testing is performed in the outpatient setting.

A client has returned to the postanesthesia care unit (PACU) after a bronchoscopy. Which of these nursing tasks is best for the charge nurse to delegate to the experienced nursing assistant working in PACU? 1. Assess breath sounds. 2. Check gag reflex. 3. Determine level of consciousness. 4. Monitor blood pressure and pulse.

4. a nursing assistant working in the PACU would have experience in taking client VS after the client had conscious sedation or anesthesia. all the other actions require a more advanced knowledge.

Respirations of the sedated client with a new tracheostomy have become noisy, and the ventilator alarms indicate high peak pressures. The ventilator tube is clear. What is the best immediate action by the nurse? 1. Humidifying the oxygen source 2. Increasing oxygenation 3. Removing the inner cannula of the tracheostomy 4. Suctioning the client

4. suctioning the client will liekly result in clear sounds and lower peak pressure, and the appearance of the sputum will indicate wheter bleeding is a concern. humidifying the ocygen source will help mobilize secretions, but an active cough response is also required to clear the airway.a sedated client has a weak cough. increasing oxygenation does nothing to clear the airway of whatever is making it noisy and is elevating peak pressures. and removing the inner cannula of a ventilated client is contraindicated.

The nurse has taught the client about influenza infection control. Which client statement indicates the need for further teaching? 1. "Handwashing is the best way to prevent transmission." 2. "I should avoid kissing and shaking hands." 3. "It is best to cough and sneeze into my upper sleeve." 4. "The intranasal vaccine can be given to everybody in the family."

4. the intranasal flu vaccine is approved for healthy clients ages 2-49 who are not pregnant.

Why are the turbinates important? 1. They decrease the weight of the skull on the neck. 2. They increase the surface area of the nose for heating and filtering. 3. They move inspired particles from nose to throat for removal. 4. They separate two nasal passages down the middle.

4. the turbinates increase the surface area of the nose, so that more heating, filtering, and humidifying of inspired air can occur before air passes into the nasopharynx. the paranasal sinuses are air-filled cavities that decrease the wt of the skull, the cilia are responsible for moving inspired particles to the throat, and the septum divides the nasal cavity into two passages.

The client with a new tracheostomy has a soiled dressing. What is the best nursing intervention? 1. Cut sterile 4 × 4 gauze to fit around the tracheostomy tube. 2. Reinforce the dressing with sterile 4 × 4 gauze. 3. Replace the dressing with clean, folded 4 × 4 gauze. 4. Replace the dressing with sterile, folded 4 × 4 gauze.

4.replace with STERILE folded 4x4

Which action is most important for the nurse to teach the family of a client who is receiving oxygen therapy at home by continuous nasal cannula? A. Providing mouth care every 8 hours B. Lubricating the lips with water-soluble jelly C. Draining the condensation in the tubing every 2 hours D. Changing the position of the elastic band every 4 hours

: D Rationale: Clients receiving oxygen by nasal cannula are prone to skin breakdown on the ears, back of the neck, and face. Changing the position of the elastic band relieves pressure and prevents skin breakdown.

A client reaches for the salmeterol (Serevent) inhaler with the onset of an asthma attack. What is the nurse's best action? A. Instruct the client to use the albuterol (Proventil) inhaler instead. B. Assist the client to use oxygen for three breaths between the two puffs of the inhaled drug. C. Instruct the client to attach the spacer to the inhaler before using it and inhale as rapidly as possible. D. Remind the client to take a deep breath, hold it for 15 seconds, and then exhale before using the inhaler.

A Rationale: Salmeterol is a long-acting beta2 agonist. This type of drug needs time to build up an effect and is useful in preventing asthma attacks. The effects of this drug are longer lasting but are not of value during an acute asthma attack. The client should use albuterol in this case.

The patient has an order for each of the following inhalers. Which of the following should the nurse offer to the patient at the onset of an asthma attack? A. Albuterol (Proventil) B. Salmeterol (Serevent) C. Beclomethasone (Beclovent) D. Ipratropium bromide (Atrovent)

A. Albuterol is a short-acting bronchodilator that should be given initially when the patient experiences an asthma attack.

A 45-year-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which of the following clinical manifestations might be present as an early symptom during an exacerbation of asthma? A. anxiety B. cyanosis C. bradycardia D. hypercapnia

A. An early symptom during an asthma attack is anxiety because he is acutely aware of the inability to get sufficient air to breathe. He will be hypoxic early on with decreased PaCO2 and increased pH as he is hyperventilating.

Which of the following physical assessment findings in a patient with a lower respiratory problem best supports the nursing diagnosis of ineffective airway clearance? A. Basilar crackles B. Respiratory rate of 28 C. Oxygen saturation of 85% D. Presence of greenish sputum

A. The presence of adventitious breath sounds indicates that there is accumulation of secretions in the lower airways. This would be consistent with a nursing diagnosis of ineffective airway clearance because the patient is retaining secretions.

The nurse is caring for a patient with an acute exacerbation of asthma. Following initial treatment, which of the following findings indicates to the nurse that the patient's respiratory status is improving? A. Wheezing becomes louder B. Vesicular breath sounds decrease C. The cough remains nonproductive D. Aerosol bronchodilators stimulate coughing

A. The primary problem during an exacerbation of asthma is narrowing of the airway and subsequent diminished air exchange. As the airways begin to dilate, wheezing gets louder because of better air exchange.

The RN has received report about all of these clients. Which client needs the most immediate assessment? 1.Client with acute asthma who has an oxygen saturation of 89% by pulse oximetry 2. Client admitted 3 hours ago for a scheduled thoracentesis in 30 minutes 3. Client with bronchogenic lung cancer who returned from bronchoscopy 3 hours ago 4. Client with pleural effusion who has decreased breath sounds at the right base

1. an O2 sat level <81% indicates hypoxemia and requires immediate assessment and intervention to improve blood and tissue oxygenation. the other tasks do not require immediate actions

A client with active tuberculosis who has been taking isoniazid (INH, Nydrazid) and rifampin (RIF, Rifadin) reports having urine that is an orange color. What is the nurse's best action? A. Obtain a specimen for culture and test the urine for occult blood. B. Reassure the client that this is a normal drug side effect. C. Hold the dose and contact the health care provider. D. Document the report as the only action.

B Rationale: Rifampin normally turns urine an orange color. No intervention is needed; however, the color change can be very distressing to clients. The client should be reassured that this color change is normal and taught how to manage this change so that clothing does not become stained. No documentation of this normal side effect is needed.

a 56 year old normally healthy pt is diagnosed with community-acquired pneumonia. before treatment is prescribed, the RN asks the pt about an allergy to: A. amoxicillin B. erythromycin C. sulfonamides D.cephalosporins

B.

The patient has an order for albuterol 5 mg via nebulizer. Available is a solution containing 2 mg/ml. How many milliliters should the nurse use to prepare the patient's dose? A. 0.2 B. 2.5 C. 3.75 D. 5.0

B. 5 mg ÷ 2 mg/ml = 2.5 ml

The nurse is scheduled to give a dose of salmeterol by metered dose inhaler (MDI). The nurse would administer the right drug by selecting the inhaler with which of the following trade names? A. Vanceril B. Serevent C. AeroBid D. Atrovent

B. The trade or brand name for salmeterol, an adrenergic bronchodilator, is Serevent.

A client with leukoplakia just above the glottis has just received the results of a biopsy and is confirmed to have squamous cell carcinoma in situ. She begins to cry and says that she would not be able to stand a surgery that would take away her ability to speak. What is the nurse's best response? A. "Your loss of speech would only be temporary until you learned to use esophageal speech." B. "Cancers at this stage are usually treated with chemotherapy alone, which does not permanently affect your ability to speak." C. "Cancers at this stage are usually treated with radiation therapy, which does not permanently affect your ability to speak." D. "A speech and language pathologist will work with you to select the method of communication that fits your lifestyle best."

C Rationale: Early-stage cancers often can be managed with less radical surgery, such as radiation therapy, that spares the vocal cords. With intact vocal cords, the client can usually speak, although the tone or timbre of the voice may be somewhat altered.

Which action does the nurse take to prevent hypoxia in a client during nasotracheal suctioning? A. Measuring pulse oximetry throughout the procedure B. Inserting the suction catheter through the vocal cords only when the client exhales C. Administering 100% oxygen by manual resuscitation bag before initiating suctioning D. Removing the suction tube from the nasopharynx as soon as the client begins to cough

C Rationale: Hyperoxygenating the client before the procedure helps to prevent hypoxia. Although measuring pulse oximetry throughout the procedure can help identify when hypoxia is occurring, it does not prevent the complication.

The client, in a panicky voice, tells the nurse during a thoracentesis that he feels as if he is being pushed off the table. What is the nurse's best response? A. Stop the procedure to administer an anxiety-reducing drug. B. Remind the client not to talk or breathe during the procedure. C. Reassure the client this is a normal sensation as the needle is inserted into the chest cavity. D. Relay this information to the health care provider performing the procedure so that the needle can be repositioned.

C Rationale: The tissues of the thorax can be thick, and significant pressure may need to be applied to insert the needle. The client can indeed feel as though he is being pushed. This is a normal sensation and does not indicate a problem. Reassure the client first, then remind him not to move.

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

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

A client with pneumonia caused by aspiration after alcohol intoxication has just been admitted. The client is febrile and agitated. Which physician order should the nurse implement first? 1. Administer levofloxacin (Levaquin) 500 mg IV. 2. Draw aerobic and anaerobic blood cultures. 3. Give lorazepam (Ativan) as needed for agitation. 4. Refer to social worker for alcohol counseling.

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The RN is caring for a client with severe acute respiratory syndrome (SARS) who is receiving mechanical ventilation. Which nursing action should the nurse delegate to a nursing assistant? 1. Keeping the head of the bed elevated 30 to 45 degrees 2. Monitoring the impact of the ventilator on the client's oxygenation 3. Performing oral care with disinfecting rinses every 12 hours 4. Suctioning the client's endotracheal tube as needed

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A client with asthma reports shortness of breath. What is the nurse assessing when auscultating this client's chest? 1. Adventitious breath sounds 2. Fremitus 3. Oxygenation status 4. Respiratory excursion

1. Adventitious sounds are additional breath sounds superimposed on normal sounds. they indicate pathologic changes in the lung. Fremitus is vibration and not detected by auscultation, not can oxygenation status. resp excursion is detected by both observation of the movement of the chest and palpation as the client inhales and exhales.

A client is taking INH, rifampin, pyrazinamide, and ethambutol for tuberculosis. The client calls to report visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes? 1. Ethambutol 2. INH 3. Pyrazinamide 4. Rifampin

1. Ethambutol can cause optic neuritis leading to blindness at high doeses. Rifampin will cause the urine and all other secretions to have a yellowish orange color. this is harmless. contact lenses will also be stained. oral contraceptives will be less effective.

A client is being admitted for pneumonia. The sputum culture is positive for Streptococcus. The client asks about the length of the treatment. On what does the nurse base the answer? 1. The client may be switched from IV to oral antibiotics in 2 to 3 days. 2. Usually anti-infectives are used for 7 to 10 days. 3. When the client has completed 6 days of therapy 4. When the client is afebrile for 24 hours

1. IV abx will be switched to ral abx in 2-3 days.

A client has just been admitted to the emergency department and requires high-flow oxygen therapy after suffering facial burns and smoke inhalation. Which oxygen delivery device should the nurse use initially? 1. Face tent 2. Venturi mask 3. Nasal cannula 4.Non-rebreather mask

1. a client with smoke inhalation and facial burns who requires high-flow oxygen should initially be placed on a face tent because this is the only noninvasive high-flow device that will minimize painful and contaminating contact with burned facial tissue. a Venturi and a non-rebreather mask requires snug fitting on the face, and a NC is not a high-flow device.

Four clients are sent back to the emergency department from triage at the same time. Which client requires the nurse's immediate attention? 1. Client with acute allergic reaction 2. Client with dyspnea on exertion 3. Client with lung cancer with cough 4. Client with sinus infection with fever

1. an acute allergic reaction can lead to immediate resp distress, this is an emergent situation, while none of the others are. the client with dyspnea on exertion will need further evaluation eventually, however.

Which client has the most urgent need for frequent nursing assessment? 1. An older adult client who was admitted 2 hours ago with emphysema and dyspnea and has a 45-year 2-pack-per-day smoking history, and is receiving 50% oxygen through a Venturi mask 2. A young client who has had a tracheostomy for 1 week, who is on room air with SpO2 at percents in the upper 90's, who has been receiving antibiotic therapy for 16 hours, and who has foul-smelling drainage on the tracheostomy ties 3. An older adult client who is anxious to go home with her new tank of oxygen and supply of nasal cannulas and is being discharged with a new prescription for home oxygen therapy 4. A middle-aged client who was admitted yesterday with pneumonia and is receiving oxygen at 2 L/min through a nasal cannula

1. an older client with a long hx of smoking and chronic lung disease who is receiving high flow oxygen delivery is at elevated risk for resp depression owing to the hypoxic drive of respirations countered by high levels of oxygen. this client must be assessed frequently while receiving high-flow oxygen. a young client with no s/s of resp compromise, not a client who meets d/c criteria do not require frequent assessment. although a middle aged client with PNA who is receiving oxygen at 2L per NC will require more frequent assessment than a client who is not receiving oxygen therapy, a client with chronic lung disease who requires higher-flow oxygen is at greater risk for resp demise and therefore needs frequent assessment more urgently.

The community health nurse is planning tuberculosis treatment for a client who is homeless and heroin addicted. Which action will be most effective in ensuring that the client completes treatment? 1. Arrange for a health care worker to watch the client take the medication. 2.Give the client written instructions about how to take prescribed medications. 3. Have the client repeat medication names and side effects. 4. Instruct the client about the possible consequences of nonadherence.

1. because this client is unlikely to adhere to long-term treatment unless directly supervised while taking meds, the best option is to arrange for directly observed therapy.

An older adult resident in a long-term care facility becomes confused and agitated, telling the nurse "Get out of here! You're going to kill me!" Which action will the nurse take first? 1. Check the resident's oxygen saturation. 2. Do a complete neurologic assessment. 3. Give the prescribed PRN lorazepam (Ativan). 4. Notify the resident's primary care provider.

1. check the resident's oxygen saturation, as a common reason for sudden confusion in older clients is hypoxemia. the cause must first be determined before (ativan) is given.

A 70-year-old client has a complicated medical history including chronic obstructive pulmonary disease (COPD). Which client statement indicates the need for further teaching about the disease? 1. "I am here to receive the yearly pneumonia shot again." 2. "I am here to get my yearly flu shot again." 3. "I should avoid large gatherings during cold and flu season." 4. "I should cough into my upper sleeve instead of my hand."

1. clients 65 yo and older, as well as those who have chronic health problems, should be encouraged to receive PNA vaccine, which is not given annually but only once.

Which of the components of a client's family history are of particular importance to the home health nurse who is assessing a new client with asthma? 1. Brother is allergic to peanuts. 2. Father is obese. 3. Mother is diabetic. 4. Sister is pregnant.

1. clients with asthma often have a family hx of allergies. it may be important to assess whether this client has any allergies that may serve as triggers for an asthma attack.

The nurse auscultates popping, discontinuous sounds over the client's anterior chest. How does the nurse classify these sounds? 1. Crackles 2. Rhonchi 3. Pleural friction rub 4. Wheeze

1. crackles are described as a popping, discontinuous sound caused by air moving into previously deflated airways. the airways have been deflated d/t to the presence of fluids in the lungs, and crackles should be considered a sign of fluid overload. rhonci are low pitched, coarse snoring sounds caused by fluid or secretions in larger airways. a pleural rub sounds grating, loud, or scratchy as inflamed surfaces of the pleura rub together. wheezes are frequently referred to as musical or squeaky. they may occur on inspiration or on expiration and may be heard without a steth as air rushes through narrowed airways.

In the older adult client, which respiratory change does not require further assessment by the nurse? 1. Increased anteroposterior (AP) diameter 2. Increased respiratory rate 3. Shortness of breath 4. Sputum production

1. increased AP diameter is normal with aging. increased RR may indicate pain or infection and requires evaluation. SOB may be r/t infection, tumor, or cardiac issues, and sputum production may be chronic, but it is not r/t the aging process and requires attention to note the character and quantity as well as the duration of sputum production.

A "Do not resuscitate" (DNR) client has a non-rebreather oxygen mask, and breathing appears to be labored. What does the nurse do first? 1. Ensures that the tubing is patent and that oxygen flow is high 2. Notifies the chaplain and the family member of record 3. Calls the Rapid Response Team and prepares to intubate 4. Comforts the client and confirms that signed DNR orders are in the chart.

1. labored breathing and ultimately suffocation can occur if the reservoir bag kinks, or if the oxygen source disconnects or is not set to high flow levels.

An RN from the orthopedic unit has been floated to the medical unit. Which client assignment for the floated RN is the best? 1. The client with a resolving pulmonary embolus who is receiving oxygen at 6 L/min through a nasal cannula 2. The client with chronic lung disease who is being evaluated for possible home oxygen use 3. The client with a newly placed tracheostomy who is receiving oxygen through a tracheostomy collar 4. The client with chronic bronchitis who is receiving oxygen at 60% through a Venturi mask

1. orthopedic RNs are familiar with pulm emboli and with administration of oxygen through nasal cannulas. orthopedic RNs do not specialize in chronic lung conditions or in airway surgery.

The client is being discharged home with a tracheostomy. Which statement by the client indicates the need for further teaching about correct tracheostomy care? 1. "I can only take baths, no showers." 2. "I can put normal saline in my tracheostomy to keep the secretions from getting thick." 3. "I should put cotton or foam over the tracheostomy hole." 4. "I will have to learn to suction myself."

1. the client CAN shower with the use of a shower shield over the trach tube to prevent water from entering the airway. NS should be instilled into the artificial airway 10-15x/d, the stoma should be covered with cotton or foam to protect it during the day: this filters the air entering the stoma, keeps humidity in the airway and enhances appearance. the client should be taught clean suctioning technique

The peak pressure alarm is sounding on the ventilator of the client with a recent tracheostomy. What intervention should be done first? 1. Assess the client's respiratory status. 2. Decrease the sensitivity of the alarm. 3. Ensure that the connecting tubing is not kinked. 4. Suction the client.

1. the client must always be assessed before attention is turned to equipment. suctioning may not even be needed.

For client safety and quality care, which technique is best for the nurse to use when suctioning the client with a tracheostomy tube? 1. Hyperoxygenate before and after suctioning. 2. Repeat suctioning until the tube is clear. 3. Apply suction during insertion of the tube. 4.Suction for 30 seconds.

1. the client should be preoxygenated with 100% oxygen for 30 seconds to 3 minutes to prevent hypoxemia. after suctioning, the client should be hyperoxygenated for 1-5 minutes, or until the client's baseline HR and AL suction passes. additional suctioning will cause or worsen hypoxemia, just as suctioning >10-15 seconds. applying suction during insertion is inappropriate because suction makes advancement of the suction tube difficult/traumatic. suction is applied on;y when the suction tube is removed.

A client with chronic obstructive pulmonary disease has a physician's prescription stating, "Adjust oxygen to keep SpO2 at 90% to 92%." Which nursing action can be delegated to a nursing assistant working under the supervision of an RN? 1. Adjust the position of the oxygen tubing. 2. Assess for signs and symptoms of hypoventilation. 3. Change the O2 flow rate to keep SpO2 as prescribed. 4. Choose which O2 delivery device should be used for the client.

1. the scope of an assistant includes positioning of oxygen tubing for the client's comfort.

The home health nurse is assigned to visit all of these clients when a change in agency staffing requires that one of the clients should be rescheduled for a visit on the following day. Which of these clients would be best to reschedule? 1. Client with emphysema who has been on home oxygen for a month and has SPO2 levels of 91% to 93% 2. Client with history of a cough, weight loss, and night sweats who has just had a positive Mantoux test 3. Client with newly diagnosed pleural effusion who needs an admission visit and an initial intake assessment 4. Client with percutaneous lung biopsy yesterday who called in to report increased dyspnea

1. this client has an appropriate SPO2 for home O2 use. a positive Mantoux test, in addition to the other symptoms is highly suspicious for TB. a newly diagnosed pleural effusion needs a complete and thorough assessment to ensure that he has adequate resp fxn to meet his basic oxygenation needs. hemo or pneumothorax is a possible life-threatening complication of a percutaneous lung bx, and requires assessment in a timely manner.

Your client has been homeless and has spent the past 6 months living in shelters. The client has been diagnosed with confirmed tuberculosis (TB). You are completing your medication teaching with this client. About which medications will the nurse teach the client? 1. Isoniazid (INH), rifampin (Rifadin), pyrazinamide (Tebrazid), ethambutol (Myambutol) 2. Metronidazole (Flagyl), acyclovir (Zovirax), flunisolide (AeroBid), rifampin (Rifadin) 3. Prednisone (Prednisone), guaifenesin (Organidin), ketorolac (Toradol), pyrazinamide (Trabrazide) 4. Salmeterol (Serevent), cromolyn sodium (Intal), dexamethasone (Decadron), isoniazid (INH)

1. this combo is used to treat TB.

The client has recently been released from prison and has just tested positive for tuberculosis (TB). What teaching points does the community health nurse want to stress for this client regarding medications? Select all that apply. 1. Not taking the medication could lead to an infection that is difficult to treat or to total drug resistance. 2. The medications may cause nausea. The client should take them at bedtime. 3. The client is generally not contagious after 2 to 3 consecutive weeks of treatment. 4. These medications must be taken for 2 years. 5. These medications may cause renal failure.

1., 2

The client is homeless and has been living in shelters for the past 6 months. The client asks the nurse why he must take so many medications. What information will the nurse provide in answering this question? Select all that apply. 1. Combination drug therapy is effective in preventing transmission. 2. Combination drug therapy is the most effective method of treating tuberculosis (TB). 3. Combination drug therapy will decrease the length of required treatment to 2 months. 4. Multiple drug regimens destroy organisms as quickly as possible. 5. The use of multiple drugs reduces the emergence of drug-resistant organisms.

1., 2., 4., 5: combined therapy will decrease the required length of time for tx, the length of treatment is decreased to 6 months, from 6-12 months

The client is admitted to the hospital for chronic obstructive pulmonary disease (COPD), and the physician requests a nasal cannula at 2 L/min. Within 30 minutes, the client's color improves. What does the nurse continue to monitor that may require immediate attention? 1. Increasing carbon dioxide levels 2. Decreasing respiratory rate 3. Increasing adventitious breath sounds 4. Increased coughing

2. RR and depth should be closely monitored while the client receives oxygen, because hypoventiliation is seen during the 1st 30 min of oxygen therapy in clients with hypoxic drive for respiration. the client's color will improve (from ashen or gray to pink) because of an increase in PaO2 level before apnea or resp arrest occurs from loss of the hypoxic drive. the ability to cough and breathe deeply is a positive sign, and monitoring for adventitious breath sounds is important, but would not be a result of the oxygen that the client is receiving. the COPD client is not sensitive to PaCO2 but rather low PaO2 levels (hypoxic drive). oxygen administration can cause high PaO2 levels in the COPD client; this revives the stimulus for breathing, and the client can experience resp depression.

An older client presents to the emergency department (ED) with a 2-day history of cough, pain on inspiration, shortness of breath, and dyspnea. The client never had a pneumococcal vaccine. The client's chest x-ray shows density in both bases. The client has wheezing upon auscultation of both lungs. Would a bronchodilator be beneficial for this client? 1. A bronchodilator would not be beneficial for this client. 2. A bronchodilator would help decrease the bronchospasm. 3. It would clear up the density in the bases of the client's lungs. 4. It would decrease the client's pain on inspiration.

2. a bonchodilator would help decrease bronchospasm and would open up the airways, so it would be beneficial for this client.

A new graduate RN discovers that her client, who had a tracheostomy placed the previous day, has completely dislodged both the obturator and the tracheostomy tube. Which action should the nurse take first? 1. Auscultate the client's breath sounds while applying a nasal cannula. 2. Direct someone to call the Rapid Response Team while using a resuscitation bag and facemask. 3. Apply a 100% non-rebreather mask while administering high-flow oxygen. 4. Replace the obturator while reinserting the tracheostomy tube.

2. because a fresh trach stoma will collapse, the client will lose his airway patency, which will require the RN to ventilate the client through the mouth and nose while waiting for assistance to recannulate the client. Effective use of a 100% NRB mask requires a patent airway.

Which of these assessment findings will be of greatest concern when the nurse is assessing a client with emphysema? 1. Barrel-shaped chest 2. Bronchial breath sounds heard at the bases 3. Hyperresonance to percussion of the chest 4. Ribs lying horizontal

2. bronchial breath sounds are not normally heard in the periphery and may indicate increased lung density, as in a tumor or infective process, such as PNA. a barrel-shaped chest is expected as are ribs lying horizontal (d/t air trapping in the chest). hyperresonance is heard with air filled cavities with percussion and is expected

The nurse is performing a client assessment for the client's potential employer. The client reports dyspnea when climbing stairs but is not dyspneic at rest. Which dyspnea classification does the nurse assign to this client in the report to the employer? Class I, can perform perform manual labor Class II, can perform desk job Class III, minimally employable Class IV, must remain at home

2. class II, can perform desk job. the client is dyspneic when climbing stairs or walking on an incline but not on level walking, therefore employable only for a sedentary job.

An older adult client is being discharged home with a tracheostomy. Which nursing action is an acceptable assignment for an experienced LPN/LVN? 1. Complete the referral form for a home health agency. 2. Suction the tracheostomy using sterile technique. 3. Teach the client and spouse about tracheostomy care. 4. Consult with the physician about using a fenestrated tube.

2. complex sterile procedures are within the education, scope, and practice of the experienced LPN.

Which symptom of pneumonia may present differently in the older adult than in the younger adult? 1. Crackles on auscultation 2. Fever 3. Headache 4. Wheezing

2. older adults may not have fever and may have a lower than normal temp with PNA. crackles may be present in all age groups, as well as HA, and wheezing

The client who is concerned about getting a tracheostomy says, "I will be ugly, with a hole in my neck." What is the nurse's best response? 1. "But you know you need this to breathe, right?" 2. "Do you have a pretty scarf or a large loose collar that you could place over it?" 3. "Your family and friends probably won't even care." 4. "It won't take you long to learn to manage."

2. suggesting strategies to cover the trach recognizes client concerns and explores options for dealing with the effects of the procedure.

Which of these clients should the charge nurse assign to the LPN/LVN working on the medical-surgical unit? 1. Client with group A beta-hemolytic streptococcal pharyngitis who has stridor 2. Client with pulmonary tuberculosis who is receiving multiple medications 3. Client with sinusitis who has just arrived after having endoscopic sinus surgery 4.Client with tonsillitis who has a thick-sounding voice and difficulty swallowing

2. the LPN scope of practice includes med administration, so a client receiving multiple meds can be managed appropriately by an LPN. stridor is an indication of resp distress; this client need to be managed by the RN. a client who just arrived after surgery requires frequent assessments by the RN. and the client with difficulty swallowing is at risk for deterioration.

The client is being discharged home with active tuberculosis. Which information does the nurse include in the discharge teaching plan? 1. "You are not contagious unless you stop taking your medication." 2. "You will not be contagious to the people you have been living with." 3. "You will have to take these medications for at least 1 year." 4. "Your sputum may turn a rust color as your condition gets better."

2. the ppl the client has been living with have already been exposed and need to be tested. they cannot be re-exposed simply because the diagnosis has now been confirmed. sputum turns a rust colored when the TB is getting worse. the length of tx time is 6 months.

A client is admitted to the surgical floor with chest pain, shortness of breath, and hypoxemia after having a knee replacement. What diagnostic test will the nurse teach the client about to help confirm the diagnosis? 1. Bronchoscopy 2. Chest x-ray 3. Computed tomography (CT) scan 4. Thoracoscopy

3. CT scans, esp spiral or helical CT scans with injected contrast can detect pulm emboli. a chest Xray will rule out other causes of symptoms, but is not specific to a pulm emboli.

A local hunter is admitted to the intensive care unit with a diagnosis of inhalational anthrax. Which of the following medications will the RN anticipate as a physician request? 1. Amoxicillin (Amoxil, Triamox) 500 mg orally every 8 hours 2. Ceftriaxone (Rocephin) 2 g IV every 8 hours 3. Ciprofloxacin (Cipro) 400 mg IV every 12 hours 4. Pyrazinamide (PZA) 1000 to 2000 mg orally every day

3. Cipro is the first line drug for tx of inhaled anthrax

Which value indicates clinical hypoxemia and the need to increase oxygen delivery? 1.Hemoglobin of 22 g/dL 2. PaCO2 of 30 mm Hg 3. PaO2 of 65 mm Hg 4. Oxygen saturation of 88%

3. PaO2 of 65 mmHg indicates low levels of oxygen in the arterial blood, termed hypoxemia. oxygen saturation measures tissue perfusion.

A client who has recently traveled to Vietnam comes to the emergency department with fatigue, lethargy, night sweats, and a low-grade fever. What is the nurse's first action? 1. Contacts the health care provider for tuberculosis (TB) medications 2. Performs a TB skin test 3. Places a respiratory mask on the client 4. Tests all family members for TB

3. Place a resp mask on the client, as the concern is that the pt may have TB.

The client has a fever of 40° C. In which direction, if any, will this shift the oxyhemoglobin dissociation curve? 1. Down 2. To the left 3. To the right 4. Will not shift

3. a client with fever has a higher demand for oxygen, so the curve will shift to the right for easier dissociation. moving to the left would cause Hgb to dissociated oxygen less easily, and the curve does not move up or down on the vertical axis.

The medical-surgical unit has one negative airflow room. Which of these four clients who have just arrived on the unit should the charge nurse admit to this room? 1. Client with bacterial pneumonia and a cough productive of green sputum 2. Client with neutropenia and pneumonia caused by Candida albicans 3. Client with possible pulmonary tuberculosis who currently has hemoptysis 4. Client with right empyema who has a chest tube and a fever of 103.2° F

3. a client with poss TB should be admitted to the negative airflow room to prevent airborne transmission of TB. a client with neutropenia should be in a room with positive airflow. the other two options do not require a negative airlow room.

The older adult client with degenerative arthritis is admitted for tracheostomy surgery. What is the best communication method for this client during the postoperative period? 1. Computer keyboard 2. Magic Slate 3. Picture board 4.Pen and paper

3. a picture board does not require much dexterity, while the other options do.

You are a charge nurse on a surgical floor. The LPN/LVN informs you that a new client who had an earlier bronchoscopy has the following vital signs: heart rate 132, respiratory rate 26, and blood pressure 98/50. The client is anxious and his skin is cyanotic. What will be your first action? 1. Call the Rapid Response Team. 2. Give methylene blue 1% 1 to 2 mg/kg by IV injection 3. Administer oxygen. 4. Notify the physician immediately.

3. administering oxygen and reassessing VS to observe for improvement is the 1st action. the Rapid Response Team should be called if the client as any s/s of methemoglobinemia, which then would be treated with methylene blue (however the RN does not have enough info to determine whether the client has this condition)

The nurse plans discharge teaching for the client who is recovering from pneumonia. When is the best time to accomplish this? 1. After the client has had his bath 2. In the evening 3. Midmorning or midafternoon 4. When visitors are present

3. client teaching is most effective during a quiet period in the midmorning or midafternoon, when the client is less fatigued.

Which nursing intervention is the priority in preparing the client for pulmonary function testing (PFT)? 1.Administer bronchodilator medication on call. 2. Encourage clear fluid intake 12 hours before the procedure. 3. Ensure no smoking 6 hours before the test. 4. Provide supplemental oxygen as testing begins.

3. ensure no smoking 6 hours before the test as this will alter parts of the PFT (diffusing capacity [DICO]), yielding inaccurate results. administering bronchodilators is not indicated for PFT, but may be withheld for 4-6 hours before the test. fluid intake does not have an effect on PFT testing. unless the client develops distress during testing, supplemental oxygen is not required and will alter the results of PFT

The client with respiratory failure has been intubated and placed on a ventilator and is requiring 100% oxygen delivery to maintain adequate oxygenation. Twenty-four hours later, the nurse notes new-onset crackles and decreased breath sounds, and the most recent arterial blood gases (ABGs) show a PaO2 level of 95 mm Hg. The ventilator is not set to provide positive end-expiratory pressure (PEEP). Why is the nurse concerned? 1. The low PaO2 level may result in oxygen toxicity. 2. The 100% oxygen delivery requirement indicates immediate extubation. 3. Lung sounds may indicate absorption atelectasis. 4. The level of oxygen delivery may indicate absorption atelectasis.

3. high levels of oxygen delivery can result in collapsed alveoli and absorption atelectasis. PEEP can help alveoli remain properly inflated. high PaO2 levels may result in oxygen toxicity, the need for 100% oxygen suggest the client continues to require intubation.

A client is admitted to the emergency department (ED) with a possible diagnosis of avian influenza ("bird flu"). Which of these actions included in the hospital protocol for avian influenza will the nurse take first? 1. Ensure that ED staff members receive oseltamivir (Tamiflu). 2. Obtain specimens for the H5 polymerase chain reaction test. 3. Place the client in a negative air pressure room. 4. Start an IV line and administer rehydration therapy.

3. if a client is exhibiting symptoms of avian flu or any other pandemic influenza, he is assumed to be contaigous until proven otherwise. protecting the spread of the disease to the community is the top priority, so placing the client in a negative air pressure room is the RN's first action. obtaining specimens will be important to determine whether the client has avian flu. this test takes approx 40 min to complete. it is important that those exposed receive oseltamivin or zanamivir (Relenza), and a client with avian flu will become dehydrated owing to diarrhea.

A client comes to the emergency department with a productive cough. Which symptom does the nurse look for that will require immediate attention? 1. Blood in the sputum 2. Mucoid sputum 3. Pink frothy sputum 4. Yellow sputum

3. pink frothy sputum is common with pulm edema and requires immediate attention and intervention to prevent the client's condition from getting worse. blood in the sputum may occur with chronic bronchitis or lung CA (these chronic conditions do not require immediate attention). mucoid sputum may be r/t smoking, and yellow sputum may indicate an infection, neither which is emergent.

A client is having surgery. He asks his nurse, "When they put that tube in my throat, where does it really go?" What is the name of the opening of the vocal cords? 1. Arytenoid cartilage 2. Epiglottis 3. Glottis 4. Palatine tonsils

3. the glottis is the opening of the vocal cords, into which the ET tube is passed through during intubation. the arytenoid cartilages work with the thyroid cartilage to control the movement of the vocal cords, the epiglottis is a structure that prevents aspiration during swallowing, and the palatine tonsils are part of the immune system, located in the oropharynx.

A client who has experienced a panic attack is being transferred to the medical-surgical ward. The transfer nurse reports that the client is doing much better after receiving bronchodilators via nebulizer and a small dose of oral Valium 4 hours ago in the emergency department. Vital signs are stable with oxygen delivered at 4 L/min via simple facemask. Why is this client at high risk for subsequent respiratory distress? 1. The client is not being treated for asthma. 2. The client has a mental disorder. 3. The client received a dose of Valium. 4. The client is receiving oxygen at 4 L/min.

4. a simple facemask must receive oxygen at a rate of at least 5 L/min to prevent inhalation of exhaled breath, which has low levels of oxygen and can eventually suffocate the client.

The client 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? 1. Chest x-ray 2. Complete blood count 3. Tuberculosis (TB) skin test 4.Throat culture

4. a throat culture is important for distinguishing a viral infection from a group A beta-hemolytic streptococcal infection.

An RN and an LPN/LVN are working together to provide care for a client hospitalized with dyspnea who requires all of these nursing actions. Which of these actions is best accomplished by the RN? 1. Administer the purified protein derivative (PPD) for tuberculosis testing. 2. Assess vital signs and the puncture site after thoracentesis. 3. Monitor oxygen saturation using pulse oximetry every 4 hours. 4. Plan client and family teaching regarding upcoming pulmonary function testing.

4. developing the teaching plan is the most complex of the skills listed and requires RN education and licensure. all the other actions can be performed by an LPN.

Community health nurses are tasked with providing education on prevention of respiratory infection for diseases such as the flu. Which target audience is given the highest priority? 1. Homeless people 2. Hospital staff 3. Politicians 4. Prison staff and inmates

4. high risk groups for resp infection include those who live in crowded areas such as LTC facilities, prisons, etc

The nurse notices a visitor walking into the room of a client on airborne isolation with no protective gear. What does the nurse do? 1. Ensures that the client is wearing a mask 2. Tells the visitor that the client cannot receive visitors at this time 3. Provides a particulate air respirator to the visitor 4. Provides a mask to the visitor

4. the visitor must wear a mask.

The 75-year-old client tells the nurse he is not planning to receive a "flu shot" this year because he had one just a year ago. What is the nurse's best response? A. "Because you are older and your immune system is more fragile, you should have one this year too as a booster." B. "The virus causing influenza often changes each year and a new influenza vaccination is needed every flu season." C. "The 'flu shot' you had last year should still protect you for seasonal influenza, but you still need a vaccination for H1N1." D. "The fact that you have been vaccinated by injection just last year makes you a candidate to use the nasal vaccination this year."

: B Rationale: The influenza vaccine is changed every year because the strains of virus that hit a geographic area are usually different each year, which means that last year's vaccination is not likely to be effective against this year's influenza. The yearly vaccine is changed based on which specific viral strains are most likely to pose a problem during the influenza season. Usually, the vaccines contain three antigens for the three expected viral strains (trivalent influenza vaccine [TIV]). The nasal vaccination is an attenuated live virus and is not approved for anyone older than 49 years of age.

a pt has two chest tubes from the left thorax, connected with a Y-tube to water seal drainage, where there is a continuous bubbling in the suction control chamber of the collection device. the appropriate action by the RN is to: A. document the suction level and amount of drainage B. strip and milk the tubing close to the pt to promote drainage C. auscultate the chest to detect a tension pneumothorax D. progressively clamp the chest tubes from the pt toward the drainage, while watching for a change in bubbling.

???

The client is 1 day postoperative after an open thoracotomy and has two chest tubes in place on the right side. The nurse notes that the client's trachea is pointing toward the left upper chest. What is the nurse's best first action? A. Immediately notify either the Rapid Response Team or the thoracic surgical resident. B. Check the suction setting for chamber three and compare it with the prescribed setting. C. Assess the client's oxygen saturation, and attempt to reposition the trachea within the midline. D. No action is needed because the trachea is deviated toward the unaffected side rather than the affected side.

A Rationale: A tracheal deviation away from the midline after a thoracotomy is not normal. In this case, a tension pneumothorax is most likely because the deviation is away from the operative side. This is a life-threatening emergency. The deviated trachea cannot be manually corrected because the problem is in the chest. The suction setting is not responsible for the tension pneumothorax.

The client's oxygen saturation by pulse oximetry on the finger is 84%. What is the nurse's best first action? A. Recheck the value on the forehead. B. Assess the client's cognitive function. C. Notify the Rapid Response Team immediately. D. Apply supplemental oxygen by mask or nasal cannula.

A Rationale: Although a true low oxygen saturation is an emergency, there are many causes of a low reading using pulse oximetry. The value should be verified immediately before any interventions are implemented.

A client who has a pulmonary embolism and a venous thromboembolism is to be started on oral warfarin (Coumadin) while still receiving intravenous heparin. What is the nurse's best action? A. Administer the medications as prescribed. B. Remind the prescriber that two anticoagulants should not be administered concurrently. C. Hold the dose of warfarin until the client's partial thromboplastin time is the same as the control value. D. Monitor the client for clinical manifestations of internal or external bleeding at least every 2 hours.

A Rationale: Although both heparin and warfarin are anticoagulants, they have different mechanisms of action and onsets of action. Because warfarin has such a slow onset, it must be started while the client is still receiving heparin in order to maintain a safe level of anticoagulation.

Why can oxygen therapy cause hypoventilation in clients who have hypercarbia? A. Low arterial oxygen levels are the neurologic trigger for these clients to breathe. B. Excessive carbon dioxide levels reduce the ability of hemoglobin molecules to carry oxygen. C. High concentrations of oxygen cause sedation, which reduces the strength of respiratory muscle contractions. D. Unlike people who do not have hypercarbia, these clients are no longer sensitive to changing levels of arterial oxygen.

A Rationale: In a healthy person, a rising PaCO2 level is the drive to breathe and stimulates an increased rate and depth of respiration. When the PaCO2 rises gradually, resulting in hypercarbia, the central chemoreceptors lose their sensitivity and are no longer the drive to breathe—a condition called CO2 narcosis. Therefore the only trigger to stimulate breathing in clients with CO2 narcosis is hypoxemia, a declining PaCO2 level. When arterial oxygen levels increase with oxygen therapy, the higher oxygen level is perceived as the client no longer needing to breathe as often or as deeply.

The nurse determines that the patient is not experiencing adverse effects of albuterol (Proventil) after noting which of the following patient vital signs? A. Pulse rate of 76 B. Respiratory rate of 18 C. Temperature of 98.4° F D. Oxygen saturation 96%

A. Albuterol is a β2-agonist that can sometimes cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 76 indicates that the patient did not experience tachycardia as an adverse effect.

The nurse is caring for a patient admitted to the hospital with pneumonia. Upon assessment, the nurse notes a temperature of 101.4° F, a productive cough with yellow sputum, and a respiratory rate of 20. Which of the following nursing diagnosis is most appropriate based upon this assessment? A. Hyperthermia related to infectious illness B. Ineffective thermoregulation related to chilling C. Ineffective breathing pattern related to pneumonia D. Ineffective airway clearance related to thick secretions

A. Because the patient has spiked a temperature and has a diagnosis of pneumonia, the logical nursing diagnosis is hyperthermia related to infectious illness. There is no evidence of a chill, and her breathing pattern is within normal limits at 20 breaths/min. There is no evidence of ineffective airway clearance from the information given because the patient is expectorating sputum.

After assisting at the bedside with thoracentesis, the nurse should continue to assess the patient for signs and symptoms of: A. Pneumothorax. B. Bronchospasm. C. Pulmonary edema. D. Respiratory acidosis.

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

A patient with recurrent shortness of breath has just had a bronchoscopy. Which of the following is a priority nursing action immediately following the procedure? A. Monitoring the patient for laryngeal edema B. Assessing the patient's level of consciousness C. Monitoring and controlling the patient's pain D. Assessing the patient's heart rate and blood pressure

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

The physician has prescribed salmeterol (Serevent) for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, the nurse should provide which of the following instructions? A. "Close lips tightly around the mouthpiece and breathe in deeply and quickly." B. "To administer a DPI, you must use a spacer that holds the medicine so that you can inhale it." C. "You will know you have correctly used the DPI when you taste or sense the medicine going into your lungs." D. "Hold the inhaler several inches in front of your mouth and breathe in slowly, holding the medicine as long as possible."

A. The patient should be instructed to breathe in deeply and quickly to ensure the medicine moves down deeply into the lungs. Dry powder inhalers do not require spacer devices. The patient may not taste or sense the medicine going into the lungs.

The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma. The nurse assesses for which of the following etiologic factor for this nursing diagnosis in patients with asthma? A. Work of breathing B. Fear of suffocation C. Effects of medications D. Anxiety and restlessness

A. When the patient does not have sufficient gas exchange to engage in activity, the etiologic factor is often the work of breathing. When patients with asthma do not have effective respirations, they use all available energy to breathe and have little left over for purposeful activity.

which pt is at highest risk of aspiration? A. a 26 yo pt with continuous enteral tube feedings through a NGT B. a 67 year old pt with a CVA with expressive dysphagia C. a 58 yo pt with absent bowel sounds immediately after surgery D. a 92 yo pt with viral pneumonia and coarse crackles throughout lung fields

A. any continuous feedings may put the pt at risk. best prevention is maintaining HOB>30-45 degrees, and never lay pt supine while tube feeding is infusing.

when reviewing the ABGs of a pt with COPD, the RN identifies late-stage COPD with which of the following results? A. pH 7.35, PaCO2 58 mm Hg, PaO2 60 mm Hg, HCO3 30mEq/L B. pH 7.30, PaCO2 45 mm Hg, PaO2 55 mm Hg, HCO3 18mEq/L C. pH 7.40, PaCO2 40 mm Hg, PaO2 70 mm Hg, HCO3 25mEq/L D. pH 7.52, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 35mEq/L

A. with COPD the body has compensatory respiratory acidosis. normal pH, pCO2 >45

During admission of a patient diagnosed with non-small cell carcinoma of the lung, the nurse questions the patient related to a history of which of the following risk factors for this type of cancer (select all that apply)? Asbestos exposure Cigarette smoking Exposure to uranium Chronic interstitial fibrosis Geographic area in which he was born

Asbestos exposure Cigarette smoking Exposure to uranium Non-small cell carcinoma is associated with cigarette smoking and exposure to environmental carcinogens, including asbestos and uranium. Chronic interstitial fibrosis is associated with the development of adenocarcinoma of the lung.

A client who works in a furniture factory reports that he is worried about his health because two co-workers have been diagnosed with sinus cancer in the past year. Which suggestion does the nurse make to reduce this client's risk for sinus cancer? A. Avoid the use of over-the-counter nasal sprays. B. Wear a fine particulate mask when working with wood. C. Spend as much time as possible outdoors, away from cities. D. Wear gloves when working with paint thinners and liquid glue.

B Rationale: Chronic exposure to fine particulates, especially wood dust, is associated with an increased incidence of nose and sinus cancer. Wearing a mask that blocks the inhalation of fine particulates can help reduce this exposure.

A client with moderate chronic obstructive pulmonary disease (COPD) is preparing to go home and has thrown away the information regarding smoking cessation. He states, "Why should I quit now after I have already caused this disease." What is the nurse's best response? A. "You are not responsible for this disease. It is a matter of a gene-environment interaction." B. "Choosing to quit smoking can slow the progression of COPD and make you feel better about yourself." C. "Blaming yourself is counterproductive and is likely to make your anxiety and depressive symptoms worse." D. "You shouldn't be so negative. After all, COPD is manageable, not like lung cancer."

B Rationale: Continuing to smoke causes continuing damage to the lung tissue, which worsens symptoms and increases the progression of the disease to the severe category, resulting in severe limitations in all of the client's activities. Slowing the progression of COPD can allow the client to continue to enjoy many activities and help him retain his independence as long as possible. Although smoking cessation is not an easy task, most people who are successful experience a greatly improved self-image.

At the hourly assessment of an intubated client after positive end-expiratory pressure (PEEP) has been discontinued, the nurse notes all of the following changes. For which one does the nurse notify the physician? A. The client is now talking around the endotracheal tube. B. Breath sounds are reduced over the left lung compared with the right. C. Oxygen saturation has increased from 90% to 95% at an FiO2 of 40%. D. The PIP dial now drops to zero at the end of exhalation instead of to only 10 cm H2O.

B Rationale: Reduced breath sounds over the left lung indicate that the endotracheal tube has probably slipped from the trachea into the right mainstem bronchus and needs to be repositioned. The other changes are either normal or an improvement.

Which technique or action does the nurse use to prevent tracheal stenosis in a client after a tracheotomy has been performed? A. Assessing breath sounds bilaterally every 2 hours B. Securing the tracheostomy tube in a midline position C. Holding the tube continually when changing the tracheostomy ties D. Suctioning the tracheostomy tube with as small a catheter as possible

B Rationale: Tracheal stenosis, a narrowed tracheal lumen, is the result of scar tissue formation from irritation. Two methods of preventing this complication is to keep the tube from moving in the trachea and to maintain proper cuff pressure.

How does atelectasis reduce gas exchange? A. Airway obstruction B. Reduced alveolar surface area C. Failure of pulmonary circulation to fully perfuse lung tissue D. Increased bronchial secretions filling the alveoli with fluid rather than with air

B Rationale: With atelectasis, some alveoli are collapsed. When alveoli collapse, the surface area is unavailable for gas exchange.

The nurse is evaluating whether a patient understands how to safely determine whether a metered dose inhaler (MDI) is empty. The nurse interprets that the patient understands this important information to prevent medication underdosing when the patient describes which method to check the inhaler? A. Place it in water to see if it floats. B. Keep track of the number of inhalations used. C. Shake the canister while holding it next to the ear. D. Check the indicator line on the side of the canister.

B. It is no longer appropriate to see if a canister floats in water or not since this is not accurate. The best method to determine when to replace an inhaler is by knowing the maximum puffs available per MDI and then replacing when those inhalations have been used.

the RN is interpreting an tuberculin skin test for a pt with ESRD. which finding would indicate a postitive reaction? A. presence of redness at the injection site B. correct 11 mm area of induration at the TST injection site C. wheal and flare reaction at the injection site D. acid-fast bacilli cultures at the injection site

B. >5 mm for the immunocompromised, HIV+, and recent contact with active TB and +CXR. >10 mm for residents/employees at LTC, institutionalized, high risk (DM, ESRD), IV drug users, and recent immigrants (<5yr), and > 15mm general public without known risk factors

The nurse determines that the patient understood medication instructions about the use of a spacer device when taking inhaled medications after hearing the patient state which of the following as the primary benefit? A. "I will pay less for medication because it will last longer." B. "More of the medication will get down into my lungs to help my breathing." C. "Now I will not need to breathe in as deeply when taking the inhaler medications." D. "This device will make it so much easier and faster to take my inhaled medications."

B. A spacer assists more medication to reach the lungs, with less being deposited in the mouth and the back of the throat.

The nurse is caring for a patient with COPD and pneumonia who has an order for arterial blood gases to be drawn. Which of the following is the minimum length of time the nurse should plan to hold pressure on the puncture site? A. 2 min B. 5 min C. 10 min D. 15 min

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

When caring for a patient with COPD, the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 30 lb. Which of the following would be an appropriate intervention to add to the plan of care for this patient? A. Order fruits and fruit juices to be offered between meals. B. Order a high-calorie, high-protein diet with six small meals a day. C. Teach the patient to use frozen meals at home that can be microwaved. D. Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet.

B. Because the patient with COPD needs to use greater energy to breathe, there is often decreased oral intake because of dyspnea. A full stomach also impairs the ability of the diaphragm to descend during inspiration, interfering with the work of breathing. Finally, the metabolism of a high carbohydrate diet yields large amounts of CO2, which may lead to acidosis in patients with pulmonary disease. For these reasons, the patient with COPD should take in a high-calorie, high-protein diet, eating six small meals per day.

When planning patient teaching about COPD, the nurse understands that the symptoms are caused by which of the following? A. An overproduction of the antiprotease a1-antitrypsin B. Hyperinflation of alveoli and destruction of alveolar walls C. Hypertrophy and hyperplasia of goblet cells in the bronchi D.Collapse and hypoventilation of the terminal respiratory unit

B. In COPD, there are structural changes that include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity.

The nurse is teaching a patient how to self-administer ipratropium (Atrovent) via a metered dose inhaler. Which of the following instructions given by the nurse is most appropriate to help the patient learn proper inhalation technique? A. "Avoid shaking the inhaler before use." B. "Breathe out slowly before positioning the inhaler." C. "After taking a puff, hold the breath for 30 seconds before exhaling." D. "Using a spacer should be avoided for this type of medication."

B. It is important to breathe out slowly before positioning the inhaler. This allows the patient to take a deeper breath while inhaling the medication, thus enhancing the effectiveness of the dose.

While teaching a patient with asthma about the appropriate use of a peak flow meter, the nurse instructs the patient to do which of the following? A. Use the flow meter each morning after taking medications to evaluate their effectiveness. B. Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse. C. Increase the doses of the long-term control medication if the peak flow numbers decrease. D. Empty the lungs and then inhale quickly through the mouthpiece to measure how fast air can be inhaled.

B. It is important to keep track of peak flow readings daily, especially when the patient's symptoms are getting worse. The patient should have specific directions as to when to call the physician based on personal peak flow numbers. Peak flow is measured by exhaling into the flow meter, and should be assessed before and after medications to evaluate their effectiveness.

Which of the following test results identifies that a patient with an asthma attack is responding to treatment? A. An increase in CO2 levels B. A decreased exhaled nitric oxide C. A decrease in white blood cell count D. An increase in serum bicarbonate levels

B. Nitric oxide levels are increased in the breath of people with asthma. A decrease in the exhaled nitric oxide concentration suggests that the treatment may be decreasing the lung inflammation associated with asthma.

The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone (Beclovent) after noting which of the following? A. Hypertension and pulmonary edema B. Oropharyngeal candidiasis and hoarseness C. Elevation of blood glucose and calcium levels D. Adrenocortical dysfunction and hyperglycemia

B. Oropharyngeal candidiasis and hoarseness are common adverse effects from the use of inhaled corticosteroids because the medication can lead to overgrowth of organisms and local irritation if the patient does not rinse the mouth following each dose.

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

B. Providing the individual has been trained in correct technique, NAP may suction the patient's oropharynx. Assessing the need for suctioning should be performed by an RN or licensed practical nurse, whereas swallowing assessment and the maintenance of cuff inflation pressure should be performed solely by an RN.

When planning appropriate nursing interventions for a patient with metastatic lung cancer and a 60-pack-per-year history of cigarette smoking, the nurse recognizes that the smoking has most likely decreased the patient's underlying respiratory defenses because of impairment of which of the following? A. Cough reflex B. Mucociliary clearance C. Reflex bronchoconstriction D. Ability to filter particles from the air

B. Smoking decreases the ciliary action in the tracheobronchial tree, resulting in impaired clearance of respiratory secretions, chronic cough, and frequent respiratory infections.

A patient with acute exacerbation of COPD needs to receive precise amounts of oxygen. Which of the following types of equipment should the nurse prepare to use? A. Oxygen tent B. Venturi mask C. Nasal cannula D. Partial nonrebreather mask

B. The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern. The other methods are less precise in terms of amount of oxygen delivered.

After admitting a patient to the medical unit with a diagnosis of pneumonia, the nurse will verify that which of the following physician orders have been completed before administering a dose of cefotetan (Cefotan) to the patient? A. Orthostatic blood pressures B. Sputum culture and sensitivity C. Pulmonary function evaluation D. Serum laboratory studies ordered for am

B. The nurse should ensure that the sputum for culture and sensitivity was sent to the laboratory before administering the cefotetan. It is important that the organisms are correctly identified (by the culture) before their numbers are affected by the antibiotic; the test will also determine whether the proper antibiotic has been ordered (sensitivity testing). Although antibiotic administration should not be unduly delayed while waiting for the patient to expectorate sputum, all of the other options will not be affected by the administration of antibiotics.

When obtaining a sputum specimen for culture and gram stain, the RN should draw: A. in the evening B. before beginning antibiotic therapy C. only one culture specimen D. after starting antibiotic therapy

B. sputum cultures should be drawn in the AM before eating/drinking, BEFORE beginning antibiotic therapy, should draw 2 cultures specimens from two different sites

Which assessment finding indicates to the nurse that the client with chronic obstructive pulmonary disease (COPD) needs to be suctioned? A. Documentation indicates the client was last suctioned 12 hours ago. B. The client is unable to speak more than six words without clearing the throat. C. Although the client is coughing, breath sounds indicate continued presence of secretions in the airways. D. The oxygen saturation, as measured by pulse oximetry, decreases while the client performs controlled coughing.

C Rationale: Suctioning is only performed when needed, not on a routine basis. The client who needs suction is one whose cough is too weak to clear secretions effectively. This problem is identified by breath sounds that indicate the presence of secretions in the airways after the client has coughed.

A 6-foot, 6-inch tall 38-year-old man is being mechanically ventilated at a tidal volume of 500 mL and a respiratory rate of 16 breaths per minute. His most recent arterial blood gas (ABG) results are: pH = 7.33; PaO2 = 85 mm Hg; PaCO2 = 55 mm Hg. What is the nurse's interpretation of these results? A. Ventilation is adequate to maintain oxygenation. B. Ventilation is excessive; respiratory alkalosis is present. C. Ventilation is inadequate; respiratory acidosis is present. D. Ventilation status cannot be determined from the information presented.

C Rationale: The average-size adult has a normal tidal volume of 500 mL, and 18 breaths per minute is toward the upper end of normal for respiratory rate. However, at 6 feet, 6 inches tall, this man would have a much larger tidal volume (perhaps as high as 750 to 900 mL). The settings of the ventilator are underventilating him, causing respiratory acidosis.

Which assessment finding in a client with an endotracheal tube most strongly indicates to the nurse that the tube remains correctly in the trachea and is not in the esophagus? A. Stomach contents cannot be aspirated. B. Oxygen saturation is greater than 50%. C. End-tidal carbon dioxide level is 38 mm Hg. D. No air is heard in the stomach when auscultated with a stethoscope.

C Rationale: The end-tidal carbon dioxide level is normal. If the endotracheal tube was in the esophagus or stomach rather than the trachea, it would be very low. The lack of aspiration of stomach contents is not conclusive for correct placement and neither is the fact that air cannot be heard in the stomach.

In performing a chest assessment, the nurse observes or determines all of the following findings in a 70-year-old client. Which finding indicates to the nurse that the client may have an increased residual lung volume? A. Exhalation is twice as long as inhalation. B. Breath sounds are absent at the lung edges. C. The intercostal spaces measure 4 centimeters. D. Vibrations can be felt on the chest wall when the client speaks.

C Rationale: The expected distance between the ribs is the width of the client's fingerbreadth, or about 2 centimeters. Distances greater than this are abnormal and usually indicate some degree of air trapping that causes an increased residual lung volume.

the RN anticipates intubation and mechanical ventilation for the pt in status asthmaticus when: A. the PaCO2 is 60 mmHg B. the PaO2 decreases to 70 mmHg C. severe respiratory muscle fatigue occurs D. the pt has extreme anxiety and fear of suffocation

C.

the RN's highest priority task when caring for a pt diagnosed with bacterial pneumonia, before beginning the prescribed antibiotic: A. teach the pt to cough and deep breathe B. take the temp, pulse, and RR C.obtain a sputum specimen for culture and gram stain D. check the pt's O2 saturation by pulse oximetry

C.

the RN interprets an induration of 5 mm resulting from tuberculin skin testing as a positive finding in: A. pts at low risk for TB B. immigrants arriving within the past 5 years from high-prevalence countries C. a pt with a 5 year history of HIV infection D. individuals with a chronic condition such as DM, cancer, or ESRD

C. (d/t decreased immune system)

Which of the following clinical manifestations would the nurse expect to find during assessment of a patient admitted with pneumococcal pneumonia? A. Hyperresonance on percussion B. Vesicular breath sounds in all lobes C. Increased vocal fremitus on palpation D. Fine crackles in all lobes on auscultation

C. A typical physical examination finding for a patient with pneumonia is increased vocal fremitus on palpation. Other signs of pulmonary consolidation include dullness to percussion, bronchial breath sounds, and crackles in the affected area.

The nurse evaluates that nursing interventions to promote airway clearance in a patient admitted with COPD are successful based on which of the following findings? A. Absence of dyspnea B. Improved mental status C. Effective and productive coughing D. PaO2 within normal range for the patient

C. Airway clearance is most directly evaluated as successful if the patient can engage in effective and productive coughing.

While ambulating a patient with metastatic lung cancer, the nurse observes a drop in oxygen saturation from 93% to 86%. Which of the following nursing interventions is most appropriate based upon these findings? A. Continue with ambulation since this is a normal response to activity. B. Obtain a physician's order for arterial blood gas determinations to verify the oxygen saturation. C. Obtain a physician's order for supplemental oxygen to be used during ambulation and other activity. D. Move the oximetry probe from the finger to the earlobe for more accurate monitoring during activity.

C. An oxygen saturation level that drops below 90% with activity indicates that the patient is not tolerating the exercise and needs to use supplemental oxygen.

The nurse, who has administered a first dose of oral prednisone to a patient with asthma, writes on the care plan to begin monitoring which of the following patient parameters? A. Apical pulse B. Bowel sounds C. Intake and output D. Deep tendon reflexes

C. Corticosteroids such as prednisone can lead to fluid retention. For this reason, it is important to monitor the patient's intake and output.

The nurse evaluates that a patient is experiencing the expected beneficial effects of ipratropium (Atrovent) after noting which of the following assessment findings? A. Decreased respiratory rate B. Increased respiratory rate C. Increased peak flow readings D. Decreased sputum production

C. Ipratropium is a bronchodilator that should lead to increased peak expiratory flow rates (PEFRs).

The nurse evaluates that discharge teaching for a patient hospitalized with pneumonia has been most effective when the patient states which of the following measures to prevent a relapse? A. "I will seek immediate medical treatment for any upper respiratory infections." B. "I will increase my food intake to 2400 calories a day to keep my immune system well." C. "I should continue to do deep-breathing and coughing exercises for at least 6 weeks." D. "I must use home oxygen therapy for 3 months and then will have a chest x-ray to reevaluate."

C. It is important for the patient to continue with coughing and deep breathing exercises for 6 to 8 weeks until all of the infection has cleared from the lungs. A patient should seek medical treatment for upper respiratory infections that persist for more than 7 days. Increased fluid intake, not caloric intake, is required to liquefy secretions. Home O2 is not a requirement unless the patient's oxygenation saturation is below normal.

During an assessment of a 45-year-old patient with asthma, the nurse notes wheezing and dyspnea. The nurse interprets that these symptoms are related to which of the following pathophysiologic changes? A. Laryngospasm B. Pulmonary Edema C. Narrowing of the airway D. overdistention of the alveoli

C. Narrowing of the airway leads to reduced airflow, making it difficult for the patient to breathe and producing the characteristic wheezing.

The client is a 62-year-old man who has smoked one pack of cigarettes per day from the time he was 13 years old until he was 19 and then smoked two packs of cigarettes per day from age 19 to the present. How should the nurse calculate this client's pack-year smoking history? A. 62 pack-years B. 55 pack-years C. 92 pack-years D. 99 pack-years

C. Rationale: Smoking history is documented in pack-years (Number of packs per day smoked × Number of years the client has smoked). Ages 13 to 19 is 6 years × 1 pack per days = 6 pack years. From ages 19 to 62 is 43 years × 2 packs per day = 86 pack years. 6 + 86 = 92.

The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β-adrenergic bronchodilator and supplemental oxygen. If the patient's condition does not improve, the nurse should anticipate which of the following is likely to be the next step in treatment? A. Intravenous fluids B. Biofeedback therapy C. Systemic corticosteroids D. Pulmonary function testing

C. Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is insufficient.

The nurse reviews pursed lip breathing with a patient newly diagnosed with COPD. The nurse reinforces that this technique will assist respiration by which of the following mechanisms? A. Loosening secretions so that they may be coughed up more easily B. Promoting maximal inhalation for better oxygenation of the lungs C. Preventing bronchial collapse and air trapping in the lungs during exhalation D. Increasing the respiratory rate and giving the patient control of respiratory patterns

C. The focus of pursed lip breathing is to slow down the exhalation phase of respiration, which decreases bronchial collapse and subsequent air trapping in the lungs during exhalation.

The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. Which of the following is the primary reason for the nurse to carefully inspect the chest wall of this patient? A. Allow time to calm the patient. B. Observe for signs of diaphoresis. C. Evaluate the use of intercostal muscles. D. Monitor the patient for bilateral chest expansion.

C. The nurse physically inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of respiratory distress experienced by the patient.

Which of the following positions is most appropriate for the nurse to place a patient experiencing an asthma exacerbation? A. Supine B. Lithotomy C. High Fowler's D. Reverse Trendelenburg

C. The patient experiencing an asthma attack should be placed in high Fowler's position to allow for optimal chest expansion and enlist the aid of gravity during inspiration.

The nurse is caring for a 73-year-old patient who underwent a left total knee arthroplasty. On the third postoperative day, the patient complains of shortness of breath, slight chest pain, and that "something is wrong." Temperature is 98.4o F, blood pressure 130/88, respirations 36, and oxygen saturation 91% on room air. Which of the following should the nurse first suspect as the etiology of this episode? A. New onset of angina pectoris B. Septic embolus from the knee joint C. Pulmonary embolus from deep vein thrombosis D. Pleural effusion related to positioning in the operating room

C. The patient presents the classic symptoms of pulmonary embolus: acute onset of symptoms, tachypnea, shortness of breath, and chest pain.

During discharge teaching for a 65-year-old patient with COPD and pneumonia, which of the following vaccines should the nurse recommend that this patient receive? A. a. Staphylococcus aureus B. Haemophilus influenzae C. Pneumococcal D. Bacille-Calmette-Guérin (BCG)

C. The pneumococcal vaccine is important for patients with a history of heart or lung disease, recovering from a severe illness, age 65 or over, or living in a long-term care facility.

Which of the following is the priority nursing assessment in the care of a patient who has a tracheostomy? A. Electrolyte levels and daily weights B. Assessment of speech and swallowing C. Respiratory rate and oxygen saturation D. Pain assessment and assessment of mobility

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

The nurse is scheduled to give a dose of ipratropium bromide by metered dose inhaler. The nurse would administer the right drug by selecting the inhaler with which of the following trade names? A. Vanceril B. AeroBid C. Atrovent D. Pulmicort

C. The trade or brand name for ipratropium bromide, an anticholinergic medication, is Atrovent.

Which of the following nursing interventions is most appropriate to enhance oxygenation in a patient with unilateral malignant lung disease? A. Positioning patient on right side B. Maintaining adequate fluid intake C. Positioning patient with "good lung down" D. Performing postural drainage every 4 hours

C. Therapeutic positioning identifies the best position for the patient assuring stable oxygenation status. Research indicates that positioning the patient with the unaffected lung (good lung) dependent best promotes oxygenation is patients with unilateral lung disease. For bilateral lung disease, the right lung down has best ventilation and perfusion. Increasing fluid intake and performing postural drainage will facilitate airway clearance, but positioning is most appropriate to enhance oxygenation.

For what reason is pandemic influenza a bigger health threat than seasonal influenza? A. No vaccines are available for immunization to prevent pandemic influenza. B. Unlike seasonal influenza, pandemic influenza does not respond to antibiotics. C. Seasonal influenza viruses are killed by exposure to heat, and pandemic viruses are not. D. Pandemic influenzas began from animal viruses, and humans have no natural immunity to them.

D Rationale: A new avian virus is the H5N1 strain, known as "avian influenza" or "bird flu," that has infected millions of birds, especially in Asia, and now has started to spread by human-to-human contact. World health officials are concerned that this strain could become a pandemic because humans have essentially no naturally occurring immunity to this virus. Therefore the infection could lead to a worldwide pandemic with very high mortality rates. There is a stockpiled vaccine for this viral strain. No viral disease responds to (is killed by) antibiotics.

Which nursing action has the highest priority when caring for a client with facial trauma? A. Managing pain B. Providing nutrition C. Assessing self-image D. Maintaining a patent airway

D Rationale: Facial trauma has the potential to interfere with breathing by occluding the upper airways. This can occur from swelling, tissue displacement, bleeding, emesis, or as a response to therapy. Maintaining a patent airway remains a nursing priority until the trauma has healed.

The 60-year-old client's smoking history includes smoking 2 packs of cigarettes per day since the age of 15 until the age of 40, and then smoking 3 packs per day to the present. How does the nurse document this smoking history? A. 45 pack-years B. 80 pack-years C. 90 pack-years D. 110 pack-years

D Rationale: Smoking history is documented in pack-years (number of packs per day smoked multiplied by the number of years the client has smoked). Ages 15 to 40 is 25 years × 2 packs per day = 50 pack-years. From ages 40 to 60 is 20 years × 3 packs per day = 60 pack years. 50 + 60 = 110.

The client with severe dyspnea has all of the following ABG results. Which one does the nurse report immediately to the health care provider? A. pH = 7.18 B. HCO3 = 31 mEq/L C. PaCO2 = 68 mm Hg D. PaO2 = 68 mm Hg

D Rationale: The elevated carbon dioxide level, or hypercarbia, is expected and not really that high for someone with COPD. The elevated bicarbonate level demonstrates kidney compensation. The low arterial oxygen level (hypoxemia) is a cause for concern and may indicate a sudden worsening of the client's condition.

A client who has been receiving heparin subcutaneously for 10 days has all of the following laboratory blood test values. Which value does the nurse report immediately to the prescriber? A. Activated partial thromboplastin time 1.5 B. International normalized ratio 1.7 C. Red blood cells 4.2 million/mm3 D. Platelets 20,000/mm3

D Rationale: The normal range for platelets is 200,000 to 400,000/mm3. Platelets are needed for blood clotting. This client's platelet count is extremely low and he or she is at grave risk for severe bleeding. The low platelet count is an indication of an adverse reaction to heparin known as heparin-induced thrombocytopenia (HIT). The heparin must be discontinued and the client needs to receive platelet therapy before life-threatening hemorrhage occurs.

The spouse of a client who has had a partial vertical laryngectomy is working with the client to use the supraglottic method of swallowing. Which direction given by the spouse to the client indicates to the nurse that more instruction is needed? A. Sit up as straight as you can when eating. B. Clear your throat before taking a bite of food. C. Only take just a teaspoonful of food at one time. D. Swallow once, then take a breath, and swallow again.

D Rationale: The supraglottic swallowing method follows this sequence: -Sitting in an upright, preferably out-of-bed, position -Clearing the throat -Taking a deep breath -Placing a small amount of food into the mouth -Holding the breath, or "bearing down" (Valsalva maneuver) -Swallowing twice -Releasing the breath and clearing the throat -Swallowing twice again -Breathing normally

an older adult pt is admitted to the hospital with a diagnosis of pneumococcal pneumonia. which clinical manifestation indicates the pt is hypoxic? A. oral temp is 102.3 degrees F B. presence of pleuritic chest pain C. coarse crackles in lung bases D. sudden onset of confusion

D.

during the assessment of a pt with pneumonia, the RN suspects the development of a pleural effusion upon finding: A. a barrel chest B. paradoxical respirations C. hyperresonance on percussion D. localized absence of breath sounds

D.

the RN teaches a pt how to administer fluticasone (Flovent HFA) by metered dose inhaler (MDI). which statement by the pt indcates an understanding about the instructions? A. my breathing will improve slowly over the next 2-3 days B. a spacer is used with this inhaler to prevent mouth dryness C. I should use this inhaler immediately if I have trouble breathing D. It is important to remember to rinse my mouth after using this inhaler.

D.

The patient has an order for albuterol 5 mg via nebulizer. Available is a solution containing 1 mg/ml. How many milliliters should the nurse use to prepare the patient's dose? A. 0.2 B. 2.5 C. 3.75 D. 5.0

D. 5 mg ÷ 1 mg/ml = 5 ml

Which of the following is the priority nursing intervention in helping a patient expectorate thick lung secretions? A. Humidify the oxygen as able B. Administer cough suppressant q4hr C. Teach patient to splint the affected area D. Increase fluid intake to 3 L/day if tolerated

D. Although several interventions may help the patient expectorate mucus, the highest priority should be on increasing fluid intake, which will liquefy the secretions so that the patient can expectorate them more easily. Humidifying the oxygen is also helpful, but is not the primary intervention. Teaching the patient to splint the affected area may also be helpful, but does not liquefy the secretions so that they can be removed.

A 71-year-old patient is admitted with acute respiratory distress related to cor pulmonale. Which of the following nursing interventions is most appropriate during admission of this patient? A. Perform a comprehensive health history with the patient to review prior respiratory problems. B. Complete a full physical examination to determine the effect of the respiratory distress on other body functions. C. Delay any physical assessment of the patient and review with the family the patient's history of respiratory problems. D. Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress.

D. Because the patient is having respiratory difficulty, the nurse should ask specific questions about this episode and perform a physical assessment of this system. Further history taking and physical examination of other body systems can proceed once the patient's acute respiratory distress is being managed.

The nurse assesses a patient with shortness of breath for evidence of long-standing hypoxemia by inspecting: A. Chest excursion. B.Spinal curvatures. C. The respiratory pattern. D. The fingernails and their base

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

Nursing assessment findings of jugular vein distention and pedal edema would be indicative of which of the following complications of emphysema? A. Acute respiratory failure B. Secondary respiratory infection C. Pulmonary edema caused by left-sided heart failure D. Fluid volume excess resulting from cor pulmonale

D. Cor pulmonale is a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distention and pedal edema.

A patient has been receiving oxygen per nasal cannula while hospitalized for COPD. The patient asks the nurse whether oxygen use will be needed at home. Which of the following would be the most appropriate response by the nurse? A. "Long-term home oxygen therapy should be used to prevent respiratory failure." B. "Oxygen will not be needed until or unless you are in the terminal stages of this disease." C. "Long-term home oxygen therapy should be used to prevent heart problems related to COPD." D. "Oxygen will be needed when your oxygen saturation drops to 88% and you have symptoms of hypoxia."

D. Long-term oxygen therapy in the home should be considered when the oxygen saturation is ≤88% and the patient has signs of tissue hypoxia, such as cor pulmonale, erythrocytosis, or impaired mental status.

Which of the following statements made by a patient with COPD indicates a need for further teaching regarding the use of an ipratropium inhaler? A. "I should rinse my mouth following the two puffs to get rid of the bad taste." B. "I should wait at least 1 to 2 minutes between each puff of the inhaler." C. "Because this medication is not fast acting, I cannot use it in an emergency if my breathing gets worse." D. "If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily."

D. The patient should not take extra puffs of the inhaler at will to make breathing easier. Excessive treatment could trigger paradoxical bronchospasm, which would worsen the patient's respiratory status.

The nurse is assisting a patient to learn self-administration of beclomethasone two puffs inhalation every 6 hours. The nurse explains that the best way to prevent oral infection while taking this medication is to do which of the following as part of the self-administration techniques? A. Chew a hard candy before the first puff of medication. B. Rinse the mouth with water before each puff of medication. C. Ask for a breath mint following the second puff of medication. D. Rinse the mouth with water following the second puff of medication.

D. The patient should rinse the mouth with water following the second puff of medication to reduce the risk of fungal overgrowth and oral infection.

Before discharge, the nurse discusses activity levels with a 61-year-old patient with COPD and pneumonia. Which of the following exercise goals is most appropriate once the patient is fully recovered from this episode of illness? A. Slightly increase activity over the current level. B. Swim for 10 min/day, gradually increasing to 30 min/day. C. Limit exercise to activities of daily living to conserve energy. D. Walk for 20 min/day, keeping the pulse rate less than 130 beats/min.

D. The patient will benefit from mild aerobic exercise that does not stress the cardiorespiratory system. The patient should be encouraged to walk for 20 min/day, keeping the pulse rate <75% to 80% of maximum heart rate (220 - patient's age).

In the case scenario in question 146 above, which of the following actions should the nurse take first? A. Notify the physician. B. Administer a nitroglycerine tablet sublingually. C. Conduct a thorough assessment of the chest pain. D. Sit the patient up in bed as tolerated and apply oxygen.

D. The patient's clinical picture is consistent with pulmonary embolus, and the first action the nurse takes should be to assist the patient. For this reason, the nurse should sit the patient up as tolerated and apply oxygen before notifying the physician.

When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for which of the following potential triggers (select all that apply)? Exercise Allergies Emotional stress Decreased humidity Upper respiratory infections

Exercise Allergies Emotional stress Upper respiratory infections Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, upper respiratory infections, drug and food additives, psychologic factors, and gastroesophageal reflux disease (GERD)

To promote airway clearance in a patient with pneumonia, the nurse instructs the patient to do which of the following (select all that apply)? Maintain adequate fluid intake Splint the chest when coughing Maintain a high Fowler's position Maintain a semi-Fowler's position Instruct patient to cough at end of exhalation

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

When admitting a 45-year-old female with a diagnosis of pulmonary embolism, the nurse will assess the patient for which of the following risk factors (select all that apply)? Obesity Pneumonia Hypertension Cigarette smoking Recent long distance travel

Obesity Hypertension Cigarette smoking Recent long distance travel

People involved in which occupations or activities are encouraged to wear masks and to have adequate ventilations? Select all that apply. Bakers Coal miners Electricians Furniture refinishers Plumbers Potters

bakers (flour), coal miners (coal dust), furniture refinishers (chemicals), and potters (silica dust)

A client with a tracheostomy is at increased risk for aspiration. Which nursing intervention(s) will reduce this risk? Select all that apply. Encourage frequent sipping from a cup. Encourage water with meals. Inflate the tracheostomy cuff during meals. Maintain the client upright for 30 minutes after eating. Provide small, frequent meals. Teach the client to "tuck" the chin down in the forward position to swallow.

maintain the client upright for 30 min after eating (30 minutes is required for thinner liquids in the stomach to be thickened), provide small frequent meals (to decrease energy expended, as aspiration is more common when a client is tired), and teach the client to 'tuck' the chin down in the forward position to swallow (which opens the upper esophageal sphincter). the trach cuff should be deflated because an inflated tube narrows the upper esophageal sphincter opening, which increases the risk for aspiration.