Respiratory NCLEX

A nurse is completing the laboratory requisition that will accompany an arterial blood gas (ABG) specimen sent to the laboratory for analysis. The nurse understands that which of the following data will not be needed by the laboratory for adequate evaluation of the specimen?

An ABG requisition usually contains information about the date and time the specimen was drawn, the client's temperature, whether the specimen was drawn on room air or using supplemental oxygen, and the ventilator settings if the client is on a mechanical ventilator.

Vaseline) gauze dressing

An occlusive dressing such as a petrolatum (Vaseline) gauze dressing is used when a chest tube is removed

A nurse is caring for the restless client who keeps biting down on an orotracheal tube. The nurse uses which of the following to prevent the client from obstructing the airway with the teeth?

An oral airway may be used to keep the client from biting down, occluding an orotracheal tube. A nasal airway is not used in conjunction with an oral endotracheal tube. A padded tongue blade or a bite stick may be used initially to open the mouth for easier insertion of an oral airway.

A client with pneumonia is experiencing problems with ventilation as a result of accumulated respiratory secretions. The nurse determines that which of the following accurately indicates effectiveness of the treatments prescribed for this problem?

Arterial blood gases indicate a pH of 7.4, Po2 of 80 mm Hg, Pco2 of 40 mm Hg. Demonstration of adequate ventilation can only be accurately evaluated when both Po2 and Pco2 levels are known. The other options do not indicate adequate gas exchange. Remember that oxygen saturation index is a measure of the percent of oxygen attached to the available hemoglobin

A nurse is caring for a client with a tracheostomy tube who is receiving mechanical ventilation. The nurse is monitoring for complications related to the tracheostomy and suspects tracheoesophageal fistula when:

Aspiration of gastric contents occurs when suctioning.

A cardiac monitor alarm sounds, and a nurse notes a straight line on the monitor screen. The immediate nursing action is to

Assess the client.

Bronchial breath sounds

Bronchial breath sounds are heard normally over the manubrium. loud, high-pitched sounds that resemble air blowing through a hollow pipe. The expiration phase is louder and longer than the inspiration phase and there is a distinct pause between the inspiration and expiration phase.

A client is admitted to the hospital with a diagnosis of carbon dioxide narcosis. In addition to respiratory failure, the nurse plans to monitor the client for which of the following complications of this disorder?

Carbon dioxide acts as a vasodilator to cerebral blood vessels. With sufficient rise in carbon dioxide, the client may suffer increased intracranial pressure, which is reflected initially as papilledema and dilated conjunctival blood vessels.

A client is admitted to the nursing unit following a lobectomy. The nurse caring for the client notes that, in the first hour after admission, the chest tube drainage was 75 mL. During the second hour, the drainage dropped to 5 mL. The nurse interprets that

Chest tube drainage in the first 24 hours following thoracic surgery may total 500 to 1000 mL. The sudden drop in drainage between the first and second hour indicates that the tube is possibly occluded and requires further evaluation

Chronic sinusitis

Chronic sinusitis is characterized by persistent purulent nasal discharge, a chronic cough caused by nasal discharge, anosmia (loss of smell), nasal stuffiness, and headache that is worse on arising after sleep.

A nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following would the nurse expect to note in this client?

Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, use of accessory muscles of respiration, and a prolonged expiratory phase of respiration. The client may also exhibit difficulty breathing while talking, and may have to take breaths between every one or two words. Some clients with COPD, especially those with a history of smoking, often have a productive cough especially on arising in the morning. The chest x-ray will reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.

48 hours Post rib fracture

Common therapies for fractured ribs include rest, analgesics, and the local application of heat that speeds the resolution of inflammation. Ice is not effective 48 hours post-injury, and oxygen may not be necessary.

A nurse is assigned to assist with caring for a client who has a chest tube. The nurse notes fluctuations of the fluid level in the water-seal chamber. Based on this observation, which action would be appropriate?

Continue to monitor, because this is an expected finding.

A nurse is performing nasotracheal suctioning of a client. The nurse interprets that the client is adequately tolerating the procedure if which of the following observations are made?

Coughing is a normal response to suctioning for the client with an intact cough reflex, and it is not an indication that the client is not tolerating the procedure. The client should be encouraged to cough to help with removal of secretions from the lungs. The nurse should monitor for the adverse effects of suctioning, which include cyanosis (pulse oximetry falls below 90% or 5% from baseline), excessively rapid or slow heart rate (a 20 beat/minute change), or the sudden development of bloody secretions. If they occur, the nurse stops suctioning, administers oxygen as appropriate, and reports these signs to the health care provider immediately.

Cycloserine (Seromycin)

Cycloserine is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. A serum drug level less than 30 mg/mL reduces the incidence of neurotoxicity. The medication needs to be taken after meals to prevent gastrointestinal irritation. The client needs to be instructed to notify the health care provider if a skin rash or early signs of central nervous system toxicity are noted. Alcohol needs to be avoided because it increases the risk of seizure activity.

A nurse has given the client with tuberculosis instructions for proper handling and disposal of respiratory secretions. The nurse determines that the client understands the instructions if the client verbalizes which of the following?

Discard used tissues in a plastic bag

A nurse is providing endotracheal suctioning to a client who is mechanically ventilated when the client becomes restless and tachycardic. What should the nurse do?

Discontinue suctioning until the client is stabilized and monitor vital signs.

fenestrated tracheostomy tube

Enables the client to speak

A client being discharged from the hospital to home with a diagnosis of tuberculosis (TB) is worried about the possibility of infecting the family and others. The nurse determines that the client would get the most reassurance from the knowledge that:

Family members or others who have been in close contact with a client diagnosed with TB are placed on prophylactic therapy with isoniazid (INH) for 6 to 12 months. The client is usually not contagious after taking medication for 2 to 3 consecutive weeks. However, the client must take the full course of therapy (for 6 months or longer) to prevent reinfection or drug-resistant TB.

Spacer

For a client with arthritis or other conditions that limit the use of the hands, the use of a spacer may prove beneficial. A spacer allows the medication to be delivered deep into pulmonary tissues, even if the client has difficulty with coordination. MDIs may be difficult to use because it takes coordination and adequate hand motion to hold the canister at the proper distance (1½ to 2 inches from the mouth), depress the canister, and inhale. A spacer is especially useful for clients who are older or who have difficulty using an MDI.

Incentive spirometer

For optimal lung expansion with the incentive spirometer, the client should assume a semi-Fowler's or high-Fowler's position. The mouthpiece should be covered completely and tightly while the client inhales slowly, with a constant flow through the unit. When maximal inspiration is reached, the client should hold her breath for 5 seconds and then exhale slowly through pursed lips. Correct use requires a spontaneous, slow, voluntary, deep breath. When full inhalation is reached, the breath is held for at least 3 seconds. This sequence is repeated 10 to 20 times an hour. Incentive spirometer exercises are most effective when used every hour while the client is awake.

The nurse is caring for an older client who is on bedrest. The nurse plans which intervention to prevent respiratory complications?

Frequent position changes help mobilize lung secretions and prevent pooling. This is the only intervention identified in the options that will prevent respiratory complications.

A client with acquired immunodeficiency syndrome (AIDS) has histoplasmosis. Which one of the following would the nurse expect the client to experience?

Histoplasmosis is an opportunistic fungal infection that can occur in the client with AIDS. The infection begins as a respiratory infection and can progress to disseminated infection. Typical signs and symptoms include fever, dyspnea, cough, and weight loss. There may be an enlargement of the client's lymph nodes, liver, and spleen as well.

A nurse is assisting a client with a closed chest tube drainage system to get out of bed to a chair. During the transfer, the chest tube gets caught in the leg of the chair and accidentally dislodges from the insertion site. The immediate nursing action is to

If a chest tube dislodges from the insertion site, the nurse immediately covers the site with sterile Vaseline gauze. The nurse would then notify the registered nurse, assist the client back to bed, and perform a respiratory assessment on the client. The registered nurse would then contact the health care provider. The nurse does not reinsert a chest tube. The health care provider will reinsert the chest tube if necessary.

The low-exhaled volume (low-pressure) alarm sounds on a ventilator. A nurse rushes to the client's room and checks the client to determine the cause of the alarm but is unable to do so. The immediate nursing action is to:

If the cause of an alarm cannot be determined, the nurse ventilates the client manually with a resuscitation bag until the problem is corrected by a second nurse, the respiratory therapist, or health care provider. The nurse also notifies the registered nurse (RN) of the occurrence and obtains assistance from the RN.

A nurse is providing morning care to a client who has a closed chest tube drainage system to treat a pneumothorax. When the nurse turns the client to the side, the chest tube is accidentally dislodged from the chest. The nurse immediately applies sterile gauze over the chest tube insertion site and next

If the chest drainage system is dislodged from the insertion site, the nurse immediately applies sterile gauze over the site and notifies the RN, who then calls the health care provider (HCP). The nurse would maintain the client in an upright position. A new chest tube system may be attached if the tube requires insertion, but this would not be the next action.

rubber-shod clamps

If the drainage system needs to be changed, the registered nurse will use rubber-shod clamps to clamp the tube near the client's chest while the drainage system is changed

A nurse checks a closed chest tube drainage system on a client who had a lobectomy of the left lung 24 hours ago. The nurse notes that there has been no chest tube drainage for the past hour. The nurse would first:

If the nurse notes that a chest tube is not draining, the nurse would first check for a kink or possible clot in the chest drainage system. The nurse then notifies the registered nurse and observes the client for respiratory distress or mediastinal shift (if this occurs, the health care provider is notified). Checking the heart rate and blood pressure is not directly related to the lack of chest tube drainage. Connecting a new drainage system to the client's chest tube is done when the fluid drainage chamber is full. There is a specific procedure to follow when a new drainage system is connected to a client's chest tube.

A nurse is assisting in caring for a client who has just returned from the postanesthesia care unit after radical neck dissection. The nurse monitors the portable wound suction for which of the following types of drainage expected in the immediate postoperative period?

Immediately after radical neck dissection, the client will have a wound drain in the neck attached to portable suction, which drains serosanguineous drainage. In the first 24 hours after surgery, the drainage may total 80 to 120 mL. The drainage should not be grossly bloody and would not be serous or serous with sputum at this time.

A client begins to drain small amounts of red blood from a tracheostomy tube 36 hours after a supraglottic laryngectomy. The licensed practical nurse would:

Immediately following laryngectomy, there is a small amount of bleeding from the tracheostomy, which resolves within the first few hours. Bleeding 24 hours after the surgery may be a sign of impending rupture of a vessel. The bleeding in this instance represents a potential life-threatening situation, and the registered nurse needs to be notified, who will then contact the health care provider

A nurse is caring for a client who is being treated for a pneumothorax with a closed chest tube drainage system. When repositioning the client, the chest tube disconnects. The immediate nursing action is to:

In most situations, clamping chest tubes is contraindicated, and agency policy and procedure must be followed with regard to clamping a chest tube. When the client has a residual air leak or pneumothorax, clamping the chest tube may precipitate a tension pneumothorax because the air has no escape route. If the tube becomes disconnected, it is best to immediately reattach it to the drainage system or to submerge the end in a bottle of sterile water or saline to reestablish a water seal. If sterile water or saline is not readily available, it is preferable to leave the tube open because the risk of tension pneumothorax outweighs the consequences of an open tube. The nurse would also notify the registered nurse of the occurrence. The health care provider will need to be notified, but this is not the immediate action. The client would not be instructed to inhale.

Incentive spirometr

Incentive spirometry is not effective if the client breathes through the nose. The client should exhale, form a tight seal around the mouthpiece, inhale slowly, hold to the count of three, and remove the mouthpiece to exhale. The client should repeat the exercise approximately 10 times every hour for best results.

A nurse is determining the need for suctioning in a client with an endotracheal tube (ETT) attached to a mechanical ventilator. Which observation by the nurse is inconsistent with the need for suctioning?

Indications for suctioning include moist, wet respirations, restlessness, rhonchi on auscultation of the lungs, visible mucus bubbling in the ETT, increased pulse and respiratory rates, and increased peak inspiratory pressures on the ventilator. A low peak inspiratory pressure would indicate a leak in the mechanical ventilation system.

A nurse is preparing to suction an adult client through the client's tracheostomy tube. Which intervention(s) would the nurse perform for this procedure?

Intermittent suction is applied while rotating the catheter for 10 to 15 seconds. The nurse should hyperoxygenate the client with a resuscitator bag/Ambu-bag connected to an oxygen source before suctioning because suction depletes the client's oxygen supply. The catheter should be inserted quickly and gently until resistance is met or the client coughs; then pulled back 1 cm or ½ inch. Intermittent suction is applied while rotating and withdrawing the catheter. Wall suction should be set to 80 to 120 mm Hg. Pressure set at a higher level can cause trauma to respiratory tract tissues. Strict asepsis needs to be maintained, and the nurse would wear sterile gloves to perform this procedure. Suction is never applied when inserting the catheter because it will deplete oxygen and can traumatize tissues.

Administration of a Mantoux skin test

Intradermal injections are most commonly given in the inner aspect of the forearm away from heavy pigmentation that would make visualizing the site for possible reactions difficult. Other sites include the dorsal area of the upper arm or the upper back beneath the scapulae.

A client with tuberculosis is being started on antitubercular therapy with isoniazid (INH). The nurse reviews the client's health care record to be sure that which of the following baseline studies have been completed before giving the client the first dose?

Isoniazid therapy can cause an elevation of hepatic enzymes and drug-induced hepatitis. Therefore liver enzymes are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than age 50 or abuses alcohol

A nurse is caring for a client with an endotracheal tube attached to a ventilator. The high-pressure alarm sounds on the ventilator. The nurse prepares to perform which nursing intervention?

It is also important to check the tubing for the presence of any water and determine whether the client is out of rhythm with breathing with the ventilator.

A client seeks treatment for a complaint of hoarseness that has lasted for 6 weeks. Based on this symptom, the nurse interprets that the client is at risk of having:

Laryngeal cancer

A client is being prepared for a thoracentesis. The nurse assigned to care for the client assists the client to which of the following positions for the procedure?

Lying in bed on the unaffected side with the head of the bed elevated 45 degrees

A client has a chest tube that is attached to a chest drainage system. The client asks the nurse, "Can the tube come out faster if you turn the wall suction up higher?" The nurse's response is based on the understanding that turning up the wall suction would:

Not increase the actual suction in the system but would cause more air to be pulled through the air vent and suction chamber to the suction source

A nurse is assigned to care for a client who has a chest tube. The nurse is told to monitor the client for crepitus (subcutaneous emphysema). The nurse monitors the client for this complication by:

Palpating for the leakage of air into the subcutaneous tissues

Risk for TB

People at high risk for acquiring tuberculosis include children younger than 5 years of age; homeless individuals or those from a lower socioeconomic group, minority groups, or immigrant group; individuals in constant, frequent contact with an untreated or undiagnosed individual; individuals living in crowded areas, such as long-term care facilities, prisons, and mental health facilities; older clients; individuals with malnutrition, an infection, or an immune dysfunction or human immunodeficiency virus infection, or individuals who are immunosuppressed as a result of medication therapy; and individuals who abuse alcohol or are intravenous drug users.

A client with pneumonia is experiencing problems with ventilation as a result of accumulated respiratory secretions. The nurse determines that which of the following accurately indicates effectiveness of the treatments prescribed for this problem?

People can frequently swallow small amounts of sputum.

A nurse is assigned to assist the health care provider with the removal of a chest tube. The nurse instructs the client to do which of the following during this process?

Perform Valsalva's maneuver. (i.e., take a deep breath, exhale, and bear down), the tube is quickly withdrawn, and an airtight dressing is taped in place. An alternative instruction is to ask the client to take a deep breath and hold the breath while the tube is removed.

A nurse is preparing to assist a health care provider with the insertion of a chest tube. The nurse anticipates that which of the following supplies will be required for the chest tube insertion site

Petrolatum (Vaseline) gauze

A nurse is reviewing the health care record of a client with a new onset of pleurisy. The nurse notes documentation that the client does not have a pleural friction rub, which was auscultated the previous day. The nurse interprets that this is likely a result of:

Pleural friction rub is auscultated early in the course of pleurisy, before pleural fluid accumulates. Once fluid accumulates in the inflamed area, there is less friction between the visceral and parietal lung surfaces, and the pleural friction rub disappears.

A nurse instructs a client on pursed-lip breathing and asks the client to demonstrate the breathing technique. Which observation by the nurse indicates that the client is performing the technique correctly

Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. The client should close the mouth and breathe in through the nose. The client then purses the lips and breathes out slowly through the mouth, without puffing the cheeks. The client should spend at least twice the amount of time breathing out that it took to breathe in. The client should use the abdominal muscles to assist in squeezing out all of the air. The client also is instructed to use this technique during any physical activity, to inhale before beginning the activity, and to exhale while performing the activity. The client should never hold the breath.

A nurse is told that an assigned client will have the chest tubes removed. In preparation for the procedure, the nurse plans to:

Removal of chest tubes can be uncomfortable for a client. The nurse should medicate the client 15 to 30 minutes before the chest tube is removed

A client with no history of respiratory disease is admitted to the hospital with respiratory failure. The nurse reviews the arterial blood gas reports for which of the following results, which are consistent with this disorder?

Respiratory failure is described as a Pao2 of 50 mm Hg or less, and a Paco2 of 50 mm Hg or greater in a client with no history of respiratory disease. In a client with a history of respiratory disorder with hypercapnia, Paco2 elevations of 5 mm Hg or more from the client's baseline is considered diagnostic

A nurse is monitoring a client following a motor vehicle accident. The nurse determines the need to prepare for chest tube insertion when the client exhibits:

Shortness of breath and tracheal deviation result when lung tissue and alveoli have collapsed. Air entering the pleural cavity causes the lung to lose its normal negative pressure. The increasing pressure in the affected side displaces contents to the unaffected side. Shortness of breath results from decreased area available for diffusion of gases

A nurse is providing discharge instructions to the client with pulmonary sarcoidosis. The nurse knows that the client understands the information if the client verbalizes which early sign of exacerbation?

Shortness of breath is an early sign of exacerbation of pulmonary sarcoidosis. Others include chest pain, hemoptysis, and pneumothorax. Systemic signs and symptoms that occur later include weakness and fatigue, malaise, fever, and weight loss.

A nurse is caring for a client after pulmonary angiography via catheter insertion into the left groin. The nurse monitors for an allergic reaction to the contrast medium by noting the presence of:

Signs of allergic reaction to the contrast medium include localized itching and edema, respiratory distress, stridor, and decreased blood pressure.

A nurse is providing instructions to a hospitalized client with a diagnosis of emphysema about positions that will enhance the effectiveness of breathing during dyspneic periods. Which position will the nurse instruct the client to assume?

Sitting on the side of the bed, leaning on an overbed table

A nurse is assisting in admitting a client to the emergency department with suspected carbon monoxide poisoning. The nurse understands that which of the following manifestations is least reliable for determining the oxygenation status of this client?

Skin color is the least reliable sign for determining the oxygenation status of the client with carbon monoxide poisoning. Skin color may vary and range from pink to cherry red, or pale to cyanotic. Other signs that result from the lack of oxygen include dizziness, headache, muscular weakness, palpitations, and mental confusion, which can progress rapidly to coma.

A nurse is gathering data on a client with a diagnosis of tuberculosis (TB). The nurse reviews the results of which diagnostic test that will confirm this diagnosis?

Sputum culture

A nurse is assisting in caring for a postoperative client who had a pneumonectomy. The nurse monitors the client for which of the following adverse signs and symptoms, indicating acute pulmonary edema?

The client developing pulmonary edema after pneumonectomy demonstrates dyspnea, cough, frothy sputum, crackles, and possibly cyanosis. A respiratory rate of 20 breaths per minute is within normal limits. Pain with deep breathing is expected and managed with analgesics. The client with pneumonectomy usually does not have a chest tube.

An emergency department nurse is caring for a client who sustained a blunt injury to the chest wall. Which sign, if noted in the client, would indicate the presence of a pneumothorax?

The client has sustained a blunt or a closed chest injury. This type of injury can result in a closed pneumothorax. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may present with tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. There may also be hyperresonance on the affected side.

When to take sputum culture for TB?

The client is informed that a sputum culture is needed every 2 to 4 weeks

A nurse is collecting subjective and objective assessment data from a client admitted to the hospital with tuberculosis (TB). The nurse should expect to note which of the findings?

The client with TB usually experiences a low-grade fever, weight loss, pallor, chills, and night sweats. The client also will complain of anorexia and fatigue. Pulmonary symptoms include a cough that is productive of a scant amount of mucoid sputum. Purulent, blood-stained sputum is present if cavitation occurs. Dyspnea and chest pain occur late in the disease.

The nurse is collecting data on a client with chronic airflow limitation (CAL) and notes that the client has a "barrel chest." The nurse interprets that this client has which of the following forms of CAL?

The client with emphysema has hyperinflation of the alveoli and has flattening of the diaphragm. These lead to increased anteroposterior diameter, which is referred to as "barrel chest." The client also has dyspnea with prolonged expiration and has hyperresonant lungs to percussion

A nurse is assessing the chest tube drainage system of a postoperative client who had a right upper lobectomy. The closed drainage system has 300 mL of bloody drainage, and the nurse notes intermittent bubbling in the water-seal chamber. One hour following the initial assessment, the nurse notes that the bubbling in the water-seal chamber is now constant and the client appears dyspneic. Based on these findings, the nurse should first check:

The client's dyspnea is most likely related to an air leak caused by a loose connection. Other causes might be a tear in the pulmonary pleura, which requires health care provider intervention. Although the other options are correct, they should be performed after initial attempts to locate and correct the air leak. It only takes a moment to check the connections, and, if a leak is found and corrected, the client's symptoms should resolve. The nurse would also notify the registered nurse

A client arrives in the emergency department with an episode of status asthmaticus. The nurse first:

The first nursing action is to place the client in a position that aids in respiration, which would be sitting bolt upright or in high-Fowler's. Other nursing actions follow in rapid sequence and include monitoring vital signs and administering bronchodilators and oxygen (but at levels of 2 to 5 L/min or 24% to 28% by Ventimask). Insertion of an intravenous line and ongoing monitoring of respiratory status are also indicated.

CPT

The goal of CPT is to mobilize secretions for improved respiratory function. The nurse must determine which areas of the lungs should be targeted for this technique.

Symptoms of Pulmonary Embolism

The most common initial symptom in pulmonary embolism is chest pain that is sudden in onset. The next most commonly reported symptom is dyspnea, which is accompanied by an increased respiratory rate. Other typical symptoms of pulmonary embolism include cough, tachycardia, fever, diaphoresis, anxiety, and possibly syncope

A nurse notes that a hospitalized client has experienced a positive reaction to the Mantoux skin test. Which action by the nurse is the priority?

The nurse who interprets a Mantoux skin test as positive notifies the health care provider (HCP) immediately. The HCP would prescribe a chest x-ray to determine whether the client has clinically active tuberculosis (TB) or old, healed lesions. A sputum culture would be done to confirm the diagnosis of active TB. The client is placed on TB precautions prophylactically until a final diagnosis is made

A client who has just suffered a large flail chest is experiencing severe pain and dyspnea. The appropriate nursing action would be to:

The nurse would notify the registered nurse, who would then contact the health care provider. The client with severe flail chest will have significant paradoxical chest movement. This causes the mediastinal structures to swing back and forth with respiration. This will lead to severe pain and dyspnea and can affect circulatory hemodynamics.

A nurse is monitoring a client with a closed chest tube drainage system and notes fluctuation of the fluid level in the water-seal chamber during inspiration and expiration. On the basis of this finding, the nurse determines that:

The presence of fluctuation of the fluid level in the water-seal chamber indicates a patent drainage system. With normal breathing, the water level rises with inspiration and falls with expiration. Fluctuation stops if the tube is obstructed, if the suction is not working properly, or if the lung has re-expanded.

Obtaining sputum specimen

To obtain a sputum specimen, the client should brush his or her teeth to reduce mouth contamination. The client should then take three deep breaths and cough into a sputum specimen container. The client should be encouraged to cough and not spit so that sputum can be obtained. Sputum can be thinned by fluids or by a respiratory treatment, such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning.

Rib fracure

Typical signs and symptoms include pain and tenderness that is localized at the fracture site and is exacerbated by inspiration and palpation; shallow respirations; splinting or guarding the chest protectively to minimize chest movement; and possible bruising at the fracture site.

The low-pressure alarm sounds on the ventilator. The nurse checks the client and then attempts to determine the cause of the alarm but is unsuccessful. Which initial action will the nurse take?

Ventilate the client manually. If an alarm is sounding at any time and the nurse cannot quickly ascertain the problem, the client is disconnected from the ventilator and a manual resuscitation device is used to support respirations until the problem can be corrected.

A nurse is admitting a client to the nursing unit who is suspected of having tuberculosis (TB). The nurse plans to admit the client to a room that has:

Venting to the outside, six air exchanges per hour, and ultraviolet light

Vesicular

Vesicular breath sounds normally are heard over the lesser bronchi, bronchioles, and lobes (peripheral lung fields). These sounds are soft and low pitched and resemble a sighing or gentle rustling, and the inspiration phase is longer than the expiration phase

Managing stoma

Wash the stoma daily using a washcloth. Soaps should be avoided near the stoma. Protect the stoma from water Apply a thin layer of petroleum jelly to the skin surrounding the stoma.

Symptoms of TB

may report symptoms that have been present for weeks or even months. The symptoms may include fatigue, lethargy, chest pain, anorexia and weight loss, night sweats, low-grade fever, and cough with mucoid or blood-streaked sputum. It may be the production of blood-tinged sputum that finally forces some clients to seek care The client with TB usually experiences cough (either productive or nonproductive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweating (which may occur at night), and a low-grade fever.

Pulomonary emphysema

pulmonary emphysema include dyspnea that is often marked, late cough (after onset of dyspnea), scant mucus production, and marked weight loss.

A client attached to mechanical ventilation suddenly becomes restless and pulls out the tracheostomy tube. The nurse would first:

the nurse would first check the client for airway patency, spontaneous breathing, and vital signs. The nurse would remain with the client, call for assistance from the registered nurse, and prepare for reintubation.

A nurse has reinforced discharge teaching with a client who was diagnosed with tuberculosis (TB) and has been on medication for 1½ weeks. The nurse knows that the client has understood the information if the client makes which statement?

"I should not be contagious after 2 to 3 weeks of medication therapy."

A nurse is caring for a client with emphysema who is receiving oxygen. The nurse checks the oxygen flow rate to ensure that it does not exceed:

2 L/min

A nurse is assisting in caring for a client with a chest tube. The nurse understands that which of the following is an incorrect action for the care of the client?

Pin the tubing to the bed linens

A nurse is assisting with monitoring the functioning of a chest-tube drainage system in a client who just returned from the recovery room after a thoracotomy with wedge resection. Which findings would the nurse expect to note? Select all that apply.

50 mL of drainage in the drainage-collection chamber The drainage system is maintained below the client's chest. An occlusive dressing is in place over the chest-tube insertion site. Fluctuation of water in the tube of the water-seal chamber during inhalation and exhalation

A client who has been taking isoniazid (INH) for 1½ months complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing

A common side effect of INH is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized with pyridoxine (vitamin B6) intake.

low-pressure alarm

A disconnection or a cuff leak can result in the sounding of the low-pressure alarm

A nurse is reading the results of a Mantoux skin test on a client with no documented health problems. The site has no induration and a 1-mm area of ecchymosis. The nurse interprets that the result is:

A positive Mantoux reading has an induration measuring 10 mm or more in diameter and indicates exposure to tuberculosis. A small area of ecchymosis is insignificant and is probably related to injection technique.

A nurse is assisting in planning care for a client scheduled for insertion of a tracheostomy. What equipment would the nurse plan to have at the bedside when the client returns from surgery?

A replacement tracheostomy tube of the same size and an obturator is kept at the bedside at all times, in case the tracheostomy tube is dislodged. In addition, a curved hemostat that could be used to hold the trachea open, if dislodgment occurs, should also be kept at the bedside. An oral airway and epinephrine would not be needed.

client is admitted to the hospital with a diagnosis of pleurisy. The nurse checks the client for which characteristic symptom of this disorder?Rationale:

A typical symptom with pleurisy is a knifelike pain that worsens on inspiration. This is a result of the friction caused by the rubbing together of inflamed pleural surfaces. This pain usually disappears when the breath is held because these surfaces stop moving

Breath Sounds

Bronchial breath sounds are heard over the trachea and larynx. Bronchovesicular breath sounds are heard over the major bronchi. Vesicular breath sounds are heard over peripheral lung fields where the air enters the alveoli.

Flu like symptoms

Get plenty of rest. Drink Fluids Take antipyretics for fever

Respiratory alkalosis

Normal pH is 7.35 to 7.45. Normal PCO2 is 35 to 45 mm Hg. Remember that when a respiratory condition exists, an opposite effect will be found between the pH and the PCO2. In respiratory alkalosis, the pH will be elevated and the PCO2 level decreased.

A nurse is assigned to care for a client after a left pneumonectomy. Which one of the follow positions would be contraindicated for this client?

On the side

A nurse is instructing a client about pursed lip breathing, and the client asks the nurse about its purpose. The nurse tells the client that the primary purpose of pursed lip breathing is to

Promote carbon dioxide elimination.

Is respiratory isolation necessary

The client and family are informed that respiratory isolation is not necessary, because family members have already been exposed

When can the client dx wit TB go back to work?

The client is allowed to return to employment when the results of three sputum cultures are negative.

high-pressure alarm

When the high-pressure alarm sounds on a ventilator, it is most likely caused by an obstruction. The obstruction can be caused by the client biting on the tube, kinking of the tubing, or mucus plugging requiring suctioning. It is also important to check the tubing for the presence of any water and determine whether the client is out of rhythm with breathing with the ventilator.

Normal Drainage

Within the first 2 hours following surgery, 100 to 300 mL of drainage is expected.

complications associated with the long-term tracheostomy and suspects tracheoesophageal fistula if which of the following is noted in the client

abdominal distention

If fluctuations are absent in the chest tube drainage system

air leak, kinking or lung has rexpanded

chronic bronchitis

chronic bronchitis is characterized by an early onset of cough (before dyspnea), copious purulent mucus production, minimal weight loss, and milder severity of dyspnea

barrel chest

chronic obstructive pulmonary disease or emphysema.

Bronchovesicular breath sounds

heard over the first and second intercostal spaces at the sternal border anteriorly and at T4 medial to the scapula posteriorly (over major bronchi). These sounds are a mixture of bronchial and vesicular breath sounds and are moderately pitched with a medium intensity. The inspiration and expiration phases are equal.

Clinical manifestations of COPD

hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-ray will reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.