Respiratory System
When a client with a healthcare acquired respiratory tract infection asks the nurse what this means, which response will the nurse give?
"Your infection occurred because of exposure to a healthcare facility."
After reviewing information about oxygenation for 4 clients with COPD, which client will the nurse plan to teach about use of home long-term continuous oxygen therapy?
PaO2 of 55, SpO2 of 88- hypoxemia
rhonchi
associated with obstruction by foreign body or thick mucus
emphysema
a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness
adventitious
abnormal breath sounds
community-acquired infection
an infection that occurred before hospitalization
diminished breath sounds
evidence of a reduction in the amount of air entering the alveoli- usually caused by obstruction or consolidation
crackles
heard at the end of an inspiration are associated with fluid in the alveoli
pleural friction rub
heard in cases of pleurisy
While in PACU, a client reports shortness of breath and chest pain. Which is the most appropriate initial response by the nurse?
initiate oxygen via nasal cannula- may be instituted without prescription in an emergency
Which risk factor for head and neck cancer would the nurse assess for in a client with a persistent, nagging cough?
-employment (chemical/environmental exposures) -ear pain -tobacco/alcohol use -poor oral hygiene
Which assessment finding of a client being treated in the ED after a motor vehicle collision indicates the need for immediate health care provider intervention?
-facial edema -septal deviation -clear nasal drainage -spO2 of 89% -bilateral periorbital bruising
Which trigger would the nurse instruct a client to avoid to decrease the incidence of asthma attacks?
-mold -cold air -pet dander -air pollution -cigarette smoke
Which action would the nurse take to prevent complications when caring for a client with chest tube to water seal drainage system for pneumothorax?
marking the time of the drainage unit every shift
inspiratory capacity
maximum volume of air that can be inhaled after maximum expiration
What substance will the home care nurse instruct a client to use after laryngectomy to cleanse the stoma site?
mild soap and water
pneumonia
present in a client who exhibits low-pitched crackles
The nurse provides education to a group of student nurses about pursed-lip breathing. The nurse would include which primary purpose of the respiratory exercise?
promotes elimination of CO2- increases the positive pressure within the alveoli and makes it easier for clients to expel air from the lungs; helps clients slow their breathing patten and depth with respirations
Which intervention would the nurse offer the client to help relieve the symptoms of sinusitis?
saline irrigation- nasal cavity facilitates drainage and decreases inflammation
expiratory reserve volume
the additional air that can be forcefully exhaled after normal exhalation
inspiratory reserve volume
the additional air that can be forcefully inhaled after normal inhalation
residual volume
the amount of air remaining in the lungs after forced expiration
A client is hospitalized with a diagnosis of emphysema. The nurse provides teaching and would begin with which aspect of care?
the disease process and breathing exercises- how interventions such as breathing exercises can improve ventilation
vital capacity
the maximum volume of air that can be exhaled after maximum inspiration
tidal volume
the volume of air inhaled and exhaled with each breath
functional residual capacity
the volume of air remaining in the lungs at the end of normal exhalation
A client with coronary occlusion is experiencing chest pain and distress. Which is the primary reason that the nurse administers oxygen?
to increase oxygen concentration to heart cells- improves efficiency of the cardiopulmonary system
Which parameter describes the maximum volume of air a client's lungs may contain?
total lung capacity
How would the nurse position a client with epistaxis?
upright leaning forward
When auscultating a client's chest, the nurse hears swishing sounds of normal breathing. How would the nurse document this finding?
vesicular breath sounds- normal respiratory sounds
Which assessment finding is consistent with bronchospasm?
wheezing- caused by airway narrowing
