Unit 1: Oxygenation/Respiratory Function
Following are statements regarding medications taken by a patient diagnosed with COPD. Choose which statements correctly match the drug name to the drug category. Select all that apply. A. Albuterol is a bronchodilator. B. Decadron is an antibiotic. C. Ciprofloxacin is an antibiotic. D. Bactrim is a bronchodilator. E. Prednisone is a corticosteroid.
A, C, and E Theophylline, albuterol, and atropine are bronchodilators. Dexamethasone (Decadron) and prednisone are corticosteroids. Amoxicillin, ciprofloxacin, and cotrimoxazole (Bactrim) are antibiotics. These are all drugs that could be prescribed to a patient with COPD.
When performing endotracheal suctioning, the nurse applies suctioning while withdrawing and gently rotating the catheter 360 degrees for which of the following time periods? A. 10 to 15 seconds B. 30 to 35 seconds C. 20 to 25 seconds D. 0 to 5 seconds
A. 10 to 15 seconds In general, the nurse should apply suction no longer than 10 to15 seconds because hypoxia and dysrhythmias may develop, leading to cardiac arrest. Applying suction for 30 to 35 seconds is hazardous and may result in the patient's developing hypoxia, which can lead to dysrhythmias and, ultimately, cardiac arrest. Applying suction for 20 to 25 seconds is hazardous and may result in the patient's developing hypoxia, which can lead to dysrhythmias and, ultimately, cardiac arrest. Applying suction for 0 to 5 seconds would provide too little time for effective suctioning of secretions.
Which of the following is accurate regarding status asthmaticus? A. A severe asthma episode that is refractory to initial therapy B. Usually occurs with warning C. Usually does not progress to severe obstruction D. Patients have a productive cough.
A. A severe asthma episode that is refractory to initial therapy Status asthmaticus is a severe asthma episode that is refractory to initial therapy. It is a medical emergency. Patients report rapid progressive chest tightness, wheezing, dry cough, and shortness of breath. It may occur with little or no warning.
Which of the following is the strongest predisposing factor for asthma? A. Allergy B. Air pollution C. Male gender D. Congenital malformations
A. Allergy
A client newly diagnosed with emphysema asks the nurse to explain all about the disease. The nurse would include the following response when defining emphysema: A. An abnormal distention of the air spaces with destruction of the alveolar walls B. Decreased sputum production with dilation of bronchioles C. Increased oxygen diffusion with inflammation of the bronchioles D. Inflammation of the bronchioles with a normal distention of the air spaces
A. An abnormal distention of the air spaces with destruction of the alveolar walls Emphysema is a pathologic term that describes an abnormal distention of the air spaces beyond the terminal bronchioles and destruction of the walls of the alveoli. This causes a decrease in oxygen diffusion and an increase in sputum production.
A client is at risk for emphysema. When reviewing information about the condition with the client, which would the nurse emphasize as the most important environmental risk factor for emphysema? A. Cigarette smoking B. Air pollution C. Allergens D. Infectious agents
A. Cigarette smoking The most important risk factor for COPD is cigarette smoking. Nutrition, exercise, and exposure to dust and pollen are not risk factors for COPD.
A client is postoperative and prescribed an incentive spirometer (IS). The nurse instructs the client to: A. Expect coughing when using the spirometer properly. B. Maintain a supine position to use the spirometer. C. Use the spirometer twice every hour. D. Inhale and exhale rapidly with the spirometer.
A. Expect coughing when using the spirometer properly When using an incentive spirometer, the client should be sitting or in the semi-Fowler's position. The client is to inhale, hold the breath for about 3 seconds, and then exhale slowly. Coughing occurs with the use of the incentive spirometer and is encouraged. The client should use the spirometer 10 times every hour while awake.
A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is: A. Have you tried to quit smoking before? B. Nicotine patches would be appropriate for you. C. I can refer you to the American Lung Association. D. Many options are available for you.
A. Have you tried to quit smoking before? All the options are appropriate statements; however, the nurse needs to assess the client's statement further. Assessment data include information about previous attempts to quit smoking.
Which type of oxygen therapy includes the administration of oxygen at pressure greater than 1 atmosphere? A. Hyperbaric B. Transtracheal C. Low-flow systems D. High-flow systems
A. Hyperbaric Hyperbaric oxygen therapy is the administration of oxygen at pressures greater than 1 atmosphere. As a result, the amount of oxygen dissolved in plasma is increased, which increases oxygen levels in the tissues. Low-flow systems contribute partially to the inspired gas the patient breathes, which means that the patient breathes some room air along with the oxygen. High-flow systems are indicated for patients who require a constant and precise amount of oxygen. During transtracheal oxygenation, patients achieve adequate oxygenation at lower rates, making this method less expensive and more efficient.
The nurse is reviewing metered-dose inhaler (MDI) instructions with a patient. Which of the following patient statements indicates the need for further instruction? A. I can't use a spacer or holding chamber with the MDI. B. I will shake the MDI container before I use it. C. I will take a slow, deep breath in after pushing down on the MDI. D. Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use.
A. I can't use a spacer or holding chamber with the MDI The patient can use a spacer or a holding chamber to facilitate the ease of medication administration. The remaining patient statements are accurate and indicate the patient understands how to use the MDI correctly.
A patient with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this patient includes which of the following? A. Implementing measures to clear pulmonary secretions B. Instructing the patient on the signs of respiratory infection C. Providing the patient with a low-calorie, high-fiber diet D. Teaching the family how to perform postural drainage
A. Implementing measures to clear pulmonary secretions Nursing management focuses on alleviating symptoms and helping patients clear pulmonary secretions. Although teaching the family how to perform postural drainage and instructing the patient on the signs of respiratory infection are important, they are not the nurse's primary focus. The presence of a large amount of mucus may decrease the patient's appetite and result in an inadequate dietary intake; therefore, the patient's nutritional status is assessed and strategies are implemented to ensure an adequate diet.
A client with chronic bronchitis is admitted to the health facility. Auscultation of the lungs reveals low-pitched, rumbling sounds. Which of the following describes these sounds? A. Rhonchi B. Bronchial C. Crackles D. Pleural friction rub
A. Rhonchi Rhonchi are deep, low-pitched, rumbling sounds heard usually on expiration. The etiology of rhonchi is associated with chronic bronchitis.
A client is being admitted to an acute healthcare facility with an exacerbation of chronic obstructive pulmonary disease (COPD). The client had been taking an antibiotic at home with poor relief of symptoms and has recently decided to stop smoking. The nurse is reviewing at-home medications with the client. The nurse is placing this information on the Medication Reconciliation Record. Which of the following is incomplete information? A. Salmeterol/Fluticasone (Seretide) MDI daily at 0800 B. Prednisone 5 mg oral daily at 0800 C. Azithromycin (Zithromax) 600 mg oral daily for 10 days at 0800, on day 4 D. Nicotine patch (Nicoderm) 21 mg 1 patch daily at 0800
A. Salmeterol/Fluticasone (Seretide) MDI daily at 0800 When providing information about medications, the nurse needs to include right drug, right dose, right route, right frequency, and right time. Salmeterol/fluticasone does not include how many puffs the client is to take.
A client is prescribed postural drainage because secretions are accumulating in the upper lobes of the lungs. The nurse instructs the client to: A. Take prescribed albuterol (Ventolin) before performing postural drainage. B. Lay in bed with the head on a pillow. C. Perform drainage 1 hour after meals. D. Hold each position for 5 minutes.
A. Take prescribed albuterol (Ventolin) before performing postural drainage. When a client is to perform postural drainage, the nurse should instruct the client to use the prescribed bronchodilator (eg, albuterol) first. This will open airways and promote drainage. The client is to perform postural drainage before meals, not after. This will aid in preventing nausea, vomiting, and aspiration. For secretions accumulated in the upper lobes, the client will sit up or even lean forward while sitting. Head on a pillow is not a sufficient increase in height. The client is also to lay in each position for 10 to 15 minutes.
Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply. A. Second-hand smoke B. Air pollution C. Infection D. Occupational dust E. Tobacco smoke
All of them. Risk factors for chronic obstructive pulmonary disease are tobacco smoke, environmental tobacco smoke, occupational dust and chemicals, indoor and outdoor air pollution, and infection.
A client who is undergoing thoracic surgery has a nursing diagnosis of "Impaired gas exchange related to lung impairment and surgery" on the nursing care plan. Which of the following nursing interventions would be appropriately aligned with this nursing diagnosis? Select all that apply. A. Maintain an open airway. B. Monitor pulmonary status as directed and needed. C. Encourage deep breathing exercises. D. Regularly assess the client's vital signs every 2 to 4 hours. E. Monitor and record hourly intake and output.
B, C, and D Interventions to improve the client's gas exchange include monitoring pulmonary status as directed and needed, assessing vital signs every 2 to 4 hours, and encouraging deep breathing exercises. Maintaining an open airway is appropriate for improving the client's airway clearance. Monitoring and recording hourly intake and output are essential interventions for ensuring appropriate fluid balance.
After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options. A. Decrease alveolar ventilation B. Alter smooth muscle tone C. Reduce airway obstruction D. Increase oxygen distribution
B, C, and D Bronchodilators relieve bronchospasm by altering smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation.
Which of the following ranges of water pressure identifies the amount of pressure within the endotracheal tube cuff that is believed to prevent both injury and aspiration? A. 10 to 15 mm Hg B. 15 to 20 mm Hg C. 30 to 35 mm Hg D. 0 to 5 mm Hg
B. 15 to 20 mm Hg Usually the pressure is maintained at less than 25 cm water pressure to prevent injury and at more than 20 cm water pressure to prevent aspiration. A measure of 10 to 15 mm Hg of water pressure would indicate that the cuff is underinflated. A measure of 30 to 35 mm Hg of water pressure would indicate that the cuff is overinflated. A measure of 0 to 5 mm Hg of water pressure would indicate that the cuff is underinflated.
A client with a respiratory condition is receiving oxygen therapy. While assessing the client's PaO2, the nurse knows that the therapy has been effective based on which of the following readings? A. 45 mm Hg B. 84 mm Hg C. 58 mm Hg D. 120 mm Hg
B. 84 mm Hg In general, clients with respiratory conditions are given oxygen therapy only to increase the arterial oxygen pressure (PaO2) back to the client's normal baseline, which may vary from 60 to 95 mm Hg.
The nurse is caring for a patient following a wedge resection. While the nurse is assessing the patient's chest tube drainage system, constant bubbling is noted in the water seal chamber. This finding indicates which of the following problems? A. Tidaling B. Air leak C. Tension pneumothorax D. Increased drainage
B. Air leak The nurse needs to observe for air leaks in the drainage system; they are indicated by constant bubbling in the water seal chamber, or by the air leak indicator in dry systems with a one-way valve. Tidaling is fluctuation of the water level in the water seal that shows effective connection between the pleural cavity and the drainage chamber and indicates that the drainage system remains patent.
The nurse is caring for a patient being weaned from the mechanical ventilator. Which of the following patient findings would require the termination of the weaning process? A. Vital capacity of 12 mL/kg B. Blood pressure increase of 20 mm Hg from baseline C. Heart rate less than 100 bpm D. PaO2 greater than 60 mm Hg with a FiO2 less than 40%
B. Blood pressure increase of 20 mm Hg from baseline In collaboration with the primary provider, the nurse would terminate the weaning process if adverse reactions occur, including a heart rate increase of 20 beats/min, systolic BP increase of 20 mm Hg, a decrease in oxygen saturation to less than 90%, respiratory rate less than 8 or greater than 20 breaths/min, ventricular dysrhythmias, fatigue, panic, cyanosis, erratic or labored breathing, and paradoxical chest movement. A vital capacity of 10 to 15 mL/kg, maximum inspiratory pressure (MIP) at least -20 cm H2O, tidal volume: 7 to -9 mL/kg, minute ventilation: 6 L/min, and rapid/shallow breathing index below 100 breaths/min/L; PaO2 greater than 60 mm Hg with FiO2 less than 40% are criteria if met by the patient indicates that the patient is ready to be weaned from the ventilator. A normal vital capacity is 10 to 15 mL/kg.
The nurse enters the room of a client who is being monitored with pulse oximetry. Which of the following factors may alter the oximetry results? A. Placement of the probe on an earlobe B. Diagnosis of peripheral vascular disease C. Reduced lighting in the room D. Increased temperature of the room
B. Diagnosis of peripheral vascular disease Pulse oximetry is a noninvasive method of monitoring oxygen saturation of hemoglobin. A probe is placed on the fingertip, forehead, earlobe, or bridge of nose. Inaccuracy of results may be from anemia, bright lights, shivering, nail polish, or peripheral vascular disease.
Which of the following exposures accounts for the majority of cases with regard to risk factors for chronic obstructive pulmonary disease (COPD)? A. Passive smoking B. Exposure to tobacco smoke C. Occupational exposure D. Ambient air pollution
B. Exposure to tobacco smoke Exposure to tobacco smoke accounts for an estimated 80% to 90% of COPD cases. Occupational exposure, passive smoking, and ambient air pollution are risk factors but do not account for the majority.
Asthma is cause by which type of response? A. IgA-mediated B. IgE-mediated C. IgM-mediated D. IgD-mediated
B. IgE-mediated Atopy, the genetic predisposition for the development of an IgE-mediated response to allergens, is the most common identifiable predisposing factor for asthma. Chronic exposure to airway allergens may sensitize IgE antibodies and the cells of the airway.
A male patient newly diagnosed with COPD tells the nurse, "I can't believe I have COPD, I only had a cough; are there other symptoms I should know about"? Which of the following is the nurse's best response? A. As your COPD worsens, you will develop frequent respiratory infections. B. Other symptoms you may develop are shortness of breath on exertion, and sputum production. C. There are no other symptoms; however, your cough may get worse as the disease progresses. D. You can also expect to experience a progressive weight gain.
B. Other symptoms you may develop are shortness of breath on exertion, and sputum production COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea on exertion. Patients with COPD are at risk for respiratory insufficiency and respiratory infections, which in turn increase the risk of acute and chronic respiratory failure. Weight loss is common with COPD.
The nurse is assigned the care of a 30-year-old female patient diagnosed with cystic fibrosis (CF). Which of the following nursing interventions will be included in the patient's plan of care? A. Discussing palliative care and end-of-life issues with the patient B. Performing chest physiotherapy as ordered C. Restricting oral intake to 1,000 mL/day D. Providing the patient with a low sodium diet
B. Performing chest physiotherapy as ordered Nursing care includes helping patients manage pulmonary symptoms and prevent complications. Specific measures include strategies that promote removal of pulmonary secretions, chest physiotherapy, and breathing exercises. In addition, the nurse emphasizes the importance of an adequate fluid and dietary intake to promote removal of secretions and to ensure an adequate nutritional status. The patient with CF also experiences increased salt content in sweat gland secretions; thus, it is important to ensure the patient consumes a diet that is adequate in sodium. As the disease progresses, the patient will develop increasing hypoxemia. In this situation, preferences for end-of-life care should be discussed, documented, and honored; however, there is no indication that the patient is terminally ill.
The nurse is teaching the client in respiratory distress ways to prolong exhalation to improve respiratory status. The nurse tells the client to A. Sit in an upright position only. B. Purse the lips when exhaling air from the lungs. C. Hold the breath for 5 seconds and then exhale. D. Initially inhale through the mouth.
B. Purse the lips when exhaling air from the lungs To prolong exhalation, the client may perform breathing while sitting in a chair or walking. The client is to inhale through the nose and then exhale against pursed lips. There is no holding the breath.
To help prevent infections in clients with COPD, the nurse should recommend vaccinations against two bacterial organisms. Which of the following are the two vaccinations? A. Haemophilus influenza and Gardasil B. Streptococcus pneumonia and Haemophilus influenza C. Streptococcus pneumonia and varicella D. Haemophilus influenza and varicella
B. Streptococcus Pneumonia and Haemophilus influenza Clients with COPD are more susceptible to respiratory infections, so they should be encouraged to receive the influenza and pneumococcal vaccines. Clients with COPD aren't at high risk for varicella or hepatitis B. The HPV vaccine is to guard against cervical cancer and is recommended only for females ages 9 to 26 years.
A client arrives at the physician's office stating 2 days of febrile illness, dyspnea, and cough. Upon assisting the client into a gown, the nurse notes that the client's sternum is depressed, especially on inspiration. Crackles are noted in the bases of the lung fields. Based on inspection, which will the nurse document? A. The client has chronic respiratory disease B. The client has pneumonia in the bases C. The client has a funnel chest D. The client needs a cough suppressant
B. The client has a funnel chest The question asks for a documentation based on inspection. A funnel chest, known as pectus excavatum, has the sternum depressed from the second intercostal space, and it is more pronounced on inspiration. The nurse would not diagnose chronic respiratory disease or pneumonia. The client would also not prescribe a cough suppressant.
Which of the following is the most reliable and accurate method for delivering precise concentrations of oxygen through noninvasive means? A. Partial-rebreathing mask B. Venturi mask C. Nasal cannula D. T-piece
B. Venturi mask The Venturi mask is the most reliable and accurate method for delivering a precise concentration of oxygen through noninvasive means. The mask is constructed in a way that allows a constant flow of room air blended with a fixed flow of oxygen. Nasal cannula, T-piece, and partial-rebreathing masks are not the most reliable and accurate methods of oxygen administration.
The nurse is caring for a client with a decrease in airway diameter causing airway resistance. The client experiences coughing and mucus production. Upon lung assessment, which adventitious breath sounds are anticipated? A. Rhonchi B. Wheezes C. Rubs D. Crackles
B. Wheezes A decrease in airway diameter, such as in asthma, produces breath sounds of wheezes. Wheezes are a whistling type of sound relating to the narrowing on the airway. A wheeze can have a high-pitched or low-pitched quality.
The nurse is preparing to assist the health care provider with the removal of a patient's chest tube. Which of the following instructions will the nurse correctly give the patient? A. During the removal of the chest tube, do not move because it will make the removal more painful B. When the tube is being removed, take a deep breath, exhale, and bear down C. While the chest tube is being removed, raise your arms above your head D. Exhale forcefully while the chest tube is being removed
B. When the tube is being removed, take a deep breath, exhale, and bear down When assisting in the chest tube's removal, instruct the patient to perform a gentle Valsalva maneuver or to breathe quietly. The chest tube is then clamped and quickly removed. Simultaneously, a small bandage is applied and made airtight with petrolatum gauze covered by a 4 × 4-inch gauze pad and thoroughly covered and sealed with nonporous tape. The other options are incorrect instructions for the patient.
Which ventilator mode provides full ventilatory support by delivering a present tidal volume and respiratory rate? A. SIMV (Synchronized-Intermittent-Mechanical-Ventilation) B. Pressure support C. Assist-control D. IMV (Intermittent-Mandatory-Ventilation)
C. Assist-control Assist-control ventilation provides full ventilator support by delivering a preset tidal volume and respiratory rate. Intermittent mandatory ventilation (IMV) provides a combination of mechanically assisted breaths and spontaneous breaths. SIMV delivers a preset tidal volume and number of breaths per minute. Between ventilator-delivered breaths, the patient can breathe spontaneously with no assistance from the ventilator for those extra breaths.
The nurse is caring for a patient following a thoracotomy. Which of the following findings requires immediate intervention by the nurse? A. Pain of 5 on a 1 to 10 pain scale B. Moderate amounts of colorless sputum C. Chest tube drainage of 190 mL/hr D. Heart rate: 112 bpm
C. Chest tube drainage of 190 mL/hr The nurse should monitor and document the amount and character of drainage every 2 hours. The nurse will notify the primary provider if drainage is 150 mL/hr or greater. The other findings are normal following a thoracotomy; no intervention is required.
A client is recovering from thoracic surgery needed to perform a right lower lobectomy. Which of the following is the most likely postoperative nursing intervention? A. Make sure that a thoracotomy tube is linked to open chest drainage. B. Restrict intravenous fluids for at least 24 hours. C. Encourage coughing to mobilize secretions. D. Assist with positioning the client on the right side.
C. Encourage coughing to mobilize secretions The client is encouraged to cough frequently to mobilize secretions. The client will be placed in the semi-Fowler's position. Thoracotomy tubes are always attached to closed, sealed drainage to re-expand lung tissue and prevent pneumothorax. Restricting IV fluids in a client who is NPO while recovering from surgery would lead to dehydration.
Which of the following is a common irritant that acts as a trigger of asthma? A. Molds B. Peanuts C. Esophageal Reflux D. Aspirin
C. Esophageal Reflux Esophageal reflux, viral respiratory infections, cigarette smoke, and exercise are all irritants that can trigger asthma. Peanuts, aspirin sensitivity, and molds are antigens.
The nurse is preparing to perform chest physiotherapy (CPT) on a patient. Which of the following patient statements would indicate the procedure is contraindicated. A. I just changed into my running suit; we can do my CPT now. B. I have been coughing all morning and am barely bringing anything up. C. I just finished eating my lunch, I'm ready for my CPT now. D. I received my pain medication 10 minutes ago, let's do my CPT now.
C. I just finished eating my lunch, I'm ready for my CPT now When performing CPT, the nurse ensures that the patient is comfortable, is not wearing restrictive clothing, and has not just eaten. The nurse gives medication for pain, as prescribed, before percussion and vibration and splints any incision and provides pillows for support, as needed. A goal of CPT is for the patient to be able to mobilize secretions; the patient who is having an unproductive cough is a candidate for CPT.
A client has a nursing diagnosis of "ineffective airway clearance" as a result of excessive secretions. An appropriate outcome for this client would be which of the following? A. Client reports no chest pain. B. Respiratory rate is 12 to 18 breaths per minute. C. Lungs are clear on auscultation. D. Client can perform incentive spirometry.
C. Lungs are clear on auscultation Assessment of lung sounds includes auscultation for airflow through the bronchial tree. The nurse evaluates for fluid or solid obstruction in the lung. When airflow is decreased, as with fluid or secretions, adventitious sounds may be auscultated. Often crackles are heard with fluid in the airways.
A nursing student just learned that the primary presenting symptom of emphysema is dyspnea. During the clinical rotation that same week, the student is assigned to a patient diagnosed with emphysema. In prioritizing the care for the shift, the student would choose which of the following interventions first? A. Refer to respiratory therapy if labored breathing persists. B. Educate regarding smoking cessation. C. Monitor vital signs every 2 hours, including respiratory rate and characteristics. D. Apply oxygen therapy as ordered.
C. Monitor vital signs every 2 hours, including respiratory rate and characteristics Dyspnea may be severe and often interferes with the patient's activities. It is usually progressive, worse with exercise, and persistent. As COPD progresses, dyspnea may occur at rest. All the other interventions are correct yet require an assessment prior to their implementation.
A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments? A. Vancomycin 1 gram intravenously over 1 hour B. Ipratropium bromide (Alupent) by metered-dose inhaler C. Oxygen through nasal cannula at 2 L/minute D. Intravenous methylprednisolone (Solu-Medrol) 120 mg
C. Oxygen through nasal cannula at 2 L/minute All options listed are treatments that may be used for a client with an exacerbation of COPD. The first line of treatment is oxygen therapy.
The nurse answers the call light of a male patient. The patient is complaining of an irritating tickling sensation in the throat, a salty taste, and a burning sensation in the chest. Upon further assessment, the nurse notes a tissue with bright red, frothy blood at the bedside. The nurse can assume the source of the blood is likely from which of the following? A. The rectum B. The stomach C. The lungs D. The nose
C. The lungs Blood from the lung is usually bright red, frothy, and mixed with sputum. Initial symptoms include a tickling sensation in the throat, a salty taste, a burning or bubbling sensation in the chest, and perhaps chest pain, in which case the patient tends to splint the bleeding side.
Which of the following would not be considered a primary symptom of COPD? A. Dyspnea on exertion B. Sputum production C. Weight gain D. Cough
C. Weight gain COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea on exertion. Weight loss is common with COPD.
Arterial blood gases should be obtained at which timeframe following the initiation of continuous mechanical ventilation? A. 15 minutes B. 25 minutes C. 10 minutes D. 20 minutes
D. 20 minutes ABGs should be obtained to measure carbon dioxide partial pressure (PaCO), pH, and PaO after 20 minutes of continuous mechanical ventilation.
The nurse is caring for a patient with COPD. The patient is receiving oxygen therapy via nasal cannula. The nurse understands that the goal of oxygen therapy is to maintain the patient's SaO2 level at or above what percent? A. 30% B. 70% C. 50% D. 90%
D. 90% The goal of supplemental oxygen therapy is to increase the baseline resting partial arterial pressure of oxygen (PaO2) to at least 60 mm Hg at sea level and arterial oxygen saturation (SaO2) to at least 90%.
The nurse is assigned the care of a patient with a chest tube. The nurse should ensure that which of the following items is kept at the patient's bedside? A. An Ambu bag B. A set of hemostats C. An incentive spirometer D. A bottle of sterile water
D. A bottle of sterile water It is essential that the nurse ensure that a bottle of sterile water is readily available at the patient's bedside. If the chest tube and drainage system become disconnected, air can enter the pleural space, producing a pneumothorax. To prevent the development of a pneumothorax, a temporary water seal can be established by immersing the chest tube's open end in a bottle of sterile water. There is no need to have an Ambu bag, incentive spirometer, or a set of hemostats at the bedside.
Emphysema is described by which of the following statements? A. A disease that results in a common clinical outcome of reversible airflow obstruction B. Chronic dilatation of a bronchus or bronchi C. Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years D. A disease of the airways characterized by destruction of the walls of over-distended alveoli
D. A disease of the airways characterized by destruction of the walls of over-distended alveoli Emphysema is a category of COPD. Asthma has a clinical outcome of airflow obstruction. Bronchitis includes the presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.
Which of the following is true about both lung transplant and bullectomy? A. Both are aimed at curing COPD. B. Both are aimed at treating end-stage emphysema. C. Both are used to treat patients with bullous emphysema. D. Both are aimed at improving the overall quality of life of a patient with COPD.
D. Both are aimed at improving the overall quality of life of a patient with COPD The treatments for COPD are aimed more at treating the symptoms and preventing complications, thereby improving the overall quality of life of a patient with COPD. In fact, there is no cure for COPD. Lung transplant is aimed at treating end-stage emphysema and bullectomy is used to treat patients with bullous emphysema.
Which ventilation-perfusion ratio is exhibited by a pulmonary emboli? A. Normal ratio of perfusion to ventilation B. Low ventilation-perfusion ratio C. Silent unit D. Dead space
D. Dead space When ventilation exceeds perfusion a dead space exists. An example of a dead space is pulmonary emboli. A low ventilation-perfusion ratio exists in pneumonia or with a mucus plug. A silent unit occurs in pneumothorax or ARDS.
A client arrives at the physician's office stating dyspnea; a productive cough for thick, green sputum; respirations of 28 breaths/minute, and a temperature of 102.8° F. The nurse auscultates the lung fields, which reveal poor air exchange in the right middle lobe. The nurse suspects a right middle lobe pneumonia. To be consistent with this anticipated diagnosis, which sound, heard over the chest wall when percussing, is anticipated? A. Hyperresonant B. Tympanic C. Resonant D. Dull
D. Dull A dull percussed sound, heard over the chest wall, is indicative of little or no air movement in that area of the lung. Lung consolidation such as in pneumonia or fluid accumulation produces the dull sound. A tympanic sound is a high-pitched sound commonly heard over the stomach or bowel. A resonant sound is noted over normal lung tissue. A hyper resonant sound is an abnormal lower pitched sound that occurs when free air exists in disease processes such as pneumothorax.
A nurse enters a client's room and observes a container with sputum. Upon questioning about the specimen, which of the following items of information from the client would necessitate the nurse to obtain a new specimen? A. The lid is secured with tape. B. The container used is sterile. C. The specimen is from a deep cough. D. I coughed that up about 8 hours ago. SUBMIT ANSWER
D. I coughed that up about 8 hours ago. A sputum specimen is obtained for analysis to identify pathogenic organisms. Expectoration is the usual method for collecting a sputum specimen. After a few deep breaths, the client coughs, using the diaphragm, and expectorates into a sterile container. The specimen is delivered to the laboratory within 2 hours. Allowing the specimen to stand for several hours in a warm room results in overgrowth of organisms and may make it difficult to identify the organisms.
Which ventilator mode provides a combination of mechanically assisted breaths and spontaneous breaths? A. SIMV (Synchronized-Intermittent-Mechanical-Ventilation) B. Pressure support C. Assist-control D. IMV (Intermittent-Mandatory-Ventilation)
D. IMV Intermittent mandatory ventilation (IMV) provides a combination of mechanically assisted breaths and spontaneous breaths. Assist-control ventilation provides full ventilator support by delivering a preset tidal volume and respiratory rate. SIMV delivers a preset tidal volume and number of breaths per minute. Between ventilator-delivered breaths, the patient can breathe spontaneously with no assistance from the ventilator for those extra breaths. Pressure support ventilation assists SIMV by applying a pressure plateau to the airway throughout the patient-triggered inspiration to decrease resistance within the tracheal tube and ventilator tubing.
The nurse has instructed a patient on how to perform pursed-lip breathing. The nurse recognizes the purpose of this type of breathing is to accomplish which of the following? A. Promote a more efficient and controlled ventilation and to decrease the work of breathing B. Promote the patient's ability to intake oxygen C. Promote the strengthening of the patient's diaphragm D. Improve oxygen transport, induce a slow, deep breathing pattern, and assist the patient to control breathing
D. Improve oxygen transport, induce a slow, deep breathing pattern, and assist the patient to control breathing Pursed-lip breathing, which improves oxygen transport, helps induce a slow, deep breathing pattern and assists the patient to control breathing, even during periods of stress. This type of breathing helps prevent airway collapse secondary to loss of lung elasticity in emphysema.
A client has intermittent asthma attacks. Which of the following therapies does the nurse teach the client to use at home when experiencing an asthma attack? A. Inhaled cromolyn sodium (Intal) B. Oral theophylline (Theo-Dur) C. Oxygen therapy D. Inhaled albuterol (Ventolin)
D. Inhaled albuterol (Ventolin) For intermittent asthma, the preferred treatment is with an inhaled short-acting beta2-agonist. The other treatments are for persistent asthma.
The nurse is assisting a client with postural drainage. Which of the following demonstrates correct implementation of this technique? A. Use aerosol sprays to deodorize the client's environment after postural drainage. B. Administer bronchodilators and mucolytic agents following the sequence. C. Perform this measure with the client once a day. D. Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes.
D. Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes Postural drainage is usually performed 2-4 times daily, before meals (to prevent nausea, vomiting, and aspiration) and at bedtime. Prescribed bronchodilators, water, or saline may be nebulized and inhaled before postural drainage to dilate the bronchioles, reduce bronchospasm, decrease the thickness of mucus and sputum, and combat edema of the bronchial walls. The nurse instructs the client to remain in each position for 10 to 15 minutes and to breathe in slowly through the nose and out slowly through pursed lips to help keep the airways open so that secretions can drain while in each position. If the sputum is foul-smelling, it is important to perform postural drainage in a room away from other patients or family members. (Deodorizers may be used to counteract the odor. Because aerosol sprays can cause bronchospasm and irritation, they should be used sparingly and with caution.)
A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess? A. Skin color B. Heart rate C. Respiratory rate D. Lung sounds
D. Lung sounds A client with COPD is at risk for developing pneumothorax. The description given is consistent with possible pneumothorax. Though the nurse will assess all the data, auscultating the lung sounds will provide the nurse with the information if the client has a pneumothorax.
Cystic fibrosis (CF) is diagnosed by clinical signs and symptoms in addition to which one of the following tests? A. Lumbar puncture B. Arterial blood gases (ABGs) C. Pulmonary function studies D. Sweat chloride concentration
D. Sweat chloride concentration Diagnosis of CF is based on an elevated sweat chloride concentration, together with clinical signs and symptoms consistent with the disease.
The nurse is assisting a physician with an endotracheal intubation for a client in respiratory failure. It is most important for the nurse to assess for: A. A scheduled time for deflation of the tracheal cuff B. Tracheal cuff pressure set at 30 mm Hg C. Cool air humidified through the tube D. Symmetry of the client's chest expansion
D. Symmetry of the client's chest expansion Immediately after intubation, the nurse should check for symmetry of chest expansion. This is one finding that indicates successful endotracheal placement. The tracheal cuff pressure is set between 15 and 20 mm Hg. Routine deflation of the tracheal cuff is not recommended, because the client could then aspirate secretions during the period of deflation. Warm, high, humidified air is administered through the endotracheal tube.
A commonly prescribed methylxanthine used as a bronchodilator is which of the following? A. Levalbuterol B. Albuterol C. Terbutaline D. Theophylline
D. Theophylline Theophylline is an example of a methylxanthine. All the others are examples of inhaled short-acting beta2 agonists.
