Chapter 19- Chest and Respiratory Tract Disorders

During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must: follow up with the physician in 2 weeks. maintain fluid intake of 40 oz (1,200 ml) per day. turn and reposition himself every 2 hours. continue to take antibiotics for the entire 10 days.

continue to take antibiotics for the entire 10 days

The nurse identifies which finding to be most consistent prior to the onset of acute respiratory failure? Loss of lung function Slow onset of symptoms Normal lung function Chronic lung disease

Normal lung function

Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis? "If the test area turns red that means I have tuberculosis." "I will come back in 1 week to have the test read." "I will avoid contact with my family until I am done with the test." "Because I had a previous reaction to the test, this time I need to get a chest X-ray."

"Because I had a previous reaction to the test, this time I need to get a chest X-ray."

A nurse recognizes that a client with tuberculosis needs further teaching when the client states: "I'll need to have scheduled laboratory tests while I'm on the medication." "The people I have contact with at work should be checked regularly." "It won't be necessary for the people I work with to take medication." "I'll have to take these medications for 9 to 12 months."

"The people I have contact with at work should be checked regularly."

What would the critical care nurse recognize as a condition that may indicate a client's need to have a tracheostomy? A client has a respiratory rate of 10 breaths per minute. A client has respiratory acidosis. A client requires permanent ventilation. A client exhibits symptoms of dyspnea.

A client requires permanent ventilation

What dietary recommendations should a nurse provide a client with a lung abscess? A diet low in calories A diet rich in protein A carbohydrate-dense diet A diet with limited fat

A diet rich in protein

A client is on a ventilator. Alarms are sounding, indicating an increase in peak airway pressure. The nurse assesses first for A cut or slice in the tubing from the ventilator A kink in the ventilator tubing Higher than normal endotracheal cuff pressure Malfunction of the alarm button

A kink in the ventilator tubing

Which would be least likely to contribute to a case of hospital-acquired pneumonia? Inoculum of organisms reaches the lower respiratory tract and overwhelms the host's defenses. A nurse washes her hands before beginning client care. Host defenses are impaired. A highly virulent organism is present.

A nurse washes her hands before beginning client care

A nurse is administering a purified protein derivative (PPD) test to a client. Which statement concerning PPD testing is true? A negative reaction always excludes the diagnosis of TB. The PPD can be read within 12 hours after the injection. A positive reaction indicates that the client has active tuberculosis (TB). A positive reaction indicates that the client has been exposed to the disease.

A positive reaction indicates that the client has been exposed to the disease

The nurse at a long-term care facility is assessing each of the residents. Which resident most likely faces the greatest risk for aspiration? A resident with severe and deforming rheumatoid arthritis A resident with mid-stage Alzheimer disease A resident who suffered a severe stroke several weeks ago A 92-year-old resident who needs extensive help with ADLs

A resident who suffered a severe stroke several weeks ago

The ICU nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following? Acute respiratory distress syndrome Lung cancer Tracheobronchitis Bronchitis

Acute respiratory distress syndrome

The public health nurse is administering Mantoux tests to children who are being registered for kindergarten in the community. How should the nurse administer this test? Administer a subcutaneous injection at a 45-degree angle into each child's deltoid. Administer intramuscular injections into each child's vastus lateralis. Administer intradermal injections into each child's inner forearm. Administer a subcutaneous injection into each child's umbilical area.

Administer intradermal injections into each child's inner forearm

Which action should the nurse take first when providing care for a client during an acute asthma attack? Administer prescribed short-acting bronchodilator. Send for STAT chest x-ray. Obtain arterial blood gases. Initiate oxygen therapy and reassess pulse oximetry in 10 minutes.

Administer prescribed short-acting bronchodilator

Which is a potential complication of a low pressure in the endotracheal tube cuff? Tracheal ischemia Pressure necrosis Aspiration pneumonia Tracheal bleeding

Aspiration pneumonia

A new ICU nurse is observed by her preceptor entering a patient's room to suction the tracheostomy after performing the task 15 minutes before. What should the preceptor educate the new nurse to do to ensure that the patient needs to be suctioned? Assess the CO2 level to determine if the patient requires suctioning. Have the patient inform the nurse of the need to be suctioned. Auscultate the lung for adventitious sounds. Have the patient cough.

Auscultate the lung for adventitious sounds

What assessment method would the nurse use to determine the areas of the lungs that need draining? Arterial blood gas (ABG) levels Inspection Auscultation Chest X-ray

Auscultation

A victim has sustained a blunt force trauma to the chest. A pulmonary contusion is suspected. Which of the following clinical manifestations correlate with a moderate pulmonary contusion? Bradypnea Productive cough Blood-tinged sputum Respiratory alkalosis

Blood-tinged sputum

You are a clinic nurse caring for a client with acute tracheobronchitis. The client asks what may have caused the infection. Which of the following responses from the nurse would be most accurate? Chemical irritation Direct lung damage Drug ingestion Aspiration

Chemical irritation

A client is diagnosed with mild obstructive sleep apnea after having a sleep study performed. What treatment modality will be the most effective for this client? Medications to assist the patient with sleep at night Continuous positive airway pressure (CPAP) Bi-level positive airway pressure (BiPAP) Surgery to remove the tonsils and adenoids

Continuous positive airway pressure (CPAP)

A client is being admitted to the preoperative holding area for a thoracotomy. Preoperative teaching includes what? Correct use of a mini-nebulizer Correct technique for rhythmic breathing Correct use of incentive spirometry Correct use of a ventilator

Correct use of incentive spirometry

The nurse is auscultating the patient's lung sounds to determine the presence of pulmonary edema. What adventitious lung sounds are significant for pulmonary edema? Crackles in the lung bases Low-pitched rhonchi during expiration Pleural friction rub Sibilant wheezes

Crackles in the lung bases

Which statements would be considered appropriate interventions for a client with an endotracheal tube? Select all that apply. The cuff is deflated before the tube is removed. Humidified oxygen should always be introduced through the tube. Cuff pressures should be checked every 6 to 8 hours. Suctioning the oropharynx prn is not recommended. Routine cuff deflation is recommended.

Cuff pressures should be checked every 6 to 8 hours. Humidified oxygen should always be introduced through the tube. The cuff is deflated before the tube is removed.

A recent immigrant is diagnosed with pulmonary tuberculosis (TB). Which intervention is the most important for the nurse to implement with this client? Client teaching about the cause of TB Reviewing the risk factors for TB Client teaching about the importance of TB testing Developing a list of people with whom the client has had contact

Developing a list of people with whom the client has had contact

The nurse is assessing a client who has a chest tube in place for the treatment of a pneumothorax. The nurse observes that the water level in the water seal rises and falls in rhythm with the client's respirations. How should the nurse best respond to this assessment finding? Gently reinsert the chest tube 1 to 2 cm and observe if the water level stabilizes. Encourage the client to do deep breathing and coughing exercises. Document that the chest drainage system is operating as it is intended. Inform the physician promptly that there is in imminent leak in the drainage system.

Document that the chest drainage system is operating as it is intended

What is the reason for chest tubes after thoracic surgery? Draining secretions, air, and blood from the thoracic cavity is necessary. Chest tubes allow air into the pleural space. Chest tubes indicate when the lungs have re-expanded by ceasing to bubble. Draining secretions and blood while allowing air to remain in the thoracic cavity is necessary.

Draining secretions, air, and blood from the thoracic cavity is necessary

You are an occupational health nurse in a large ceramic manufacturing company. How would you intervene to prevent occupational lung disease in the employees of the company? Fit all employees with protective masks. Give workshops on disease prevention. Insist on adequate breaks for each employee. Provide employees with smoking cessation materials.

Fit all employees with protective masks

Which intervention does a nurse implement for clients with empyema? Institute droplet precautions Place suspected clients together Do not allow visitors with respiratory infections Encourage breathing exercises

Encourage breathing exercises

A patient is being educated in the use of incentive spirometry prior to having a surgical procedure. What should the nurse be sure to include in the education? Have the patient lie in a supine position during the use of the spirometer. Inform the patient that using the spirometer is not necessary if the patient is experiencing pain. Encourage the patient to try to stop coughing during and after using the spirometer. Encourage the patient to take approximately 10 breaths per hour, while awake.

Encourage the patient to take approximately 10 breaths per hour, while awake

A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care? Turning the client every 2 hours Encouraging increased fluid intake Maintaining a cool room temperature Elevating the head of the bed 30 degrees

Encouraging increased fluid intake

The nurse knows the mortality rate is high in lung cancer clients due to which factor? Increase in women smokers Increased incidence among the elderly Increased exposure to industrial pollutants Few early symptoms

Few early symptoms

The occupational nurse is completing routine assessments on the employees at a company. What might be revealed by a chest radiograph for a client with occupational lung diseases? Fibrotic changes in lungs Lung contusion Hemorrhage Damage to surrounding tissues

Fibrotic changes in lungs

When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems? Hypercapnia, hypoventilation, and hypoxemia Hyperventilation, hypertension, and hypocapnia Hypotension, hyperoxemia, and hypercapnia Hyperoxemia, hypocapnia, and hyperventilation

Hypercapnia, hypoventilation, and hypoxemia

The nurse is assisting a client with postural drainage. Which of the following demonstrates correct implementation of this technique? Use aerosol sprays to deodorize the client's environment after postural drainage. Administer bronchodilators and mucolytic agents following the sequence. Perform this measure with the client once a day. Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes.

Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes.

A nurse is caring for a client who recently underwent a tracheostomy. The first priority when caring for a client with a tracheostomy is: helping him communicate. preventing him from developing an infection. keeping his airway patent. encouraging him to perform activities of daily living (ADLs).

Keeping his airway patent

A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? A change in the oxygen concentration without resetting the oxygen level alarm An ET cuff leak Kinking of the ventilator tubing A disconnected ventilator circuit

Kinking of the ventilator tubing

The nurse is assessing a client's potential for pulmonary emboli. What finding indicates possible deep vein thrombosis? Coolness to lower extremities Pain in the feet Localized calf tenderness Decreased urinary output

Localized calf tenderness

A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside? Tracheostomy cleaning kit Water-seal chest drainage set-up Manual resuscitation bag Oxygen analyzer

Manual resuscitation bag

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. Encourage deep breathing exercises. Monitor and record hourly intake and output. Monitor pulmonary status as directed and needed. Regularly assess the client's vital signs every 2 to 4 hours. Request order for patient-controlled analgesia pump

Monitor pulmonary status as directed and needed. Regularly assess the client's vital signs every 2 to 4 hours. Encourage deep breathing exercises.

A client has been receiving 100% oxygen therapy by way of a nonrebreather mask for several days. Now the client complains of tingling in the fingers and shortness of breath, is extremely restless, and describes a pain beneath the breastbone. What should the nurse suspect? Oxygen-induced atelectasis Hypoxia Oxygen toxicity Oxygen-induced hypoventilation

Oxygen toxicity

A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? Bicarbonate (HCO3-) Partial pressure of arterial oxygen (PaO2) Partial pressure of arterial carbon dioxide (PaCO2) pH

Partial pressure of arterial oxygen (PaO2)

The nurse is teaching the client in respiratory distress ways to prolong exhalation to improve respiratory status. The nurse tells the client to Initially inhale through the mouth. Hold the breath for 5 seconds and then exhale. Sit in an upright position only. Purse the lips when exhaling air from the lungs.

Purse the lips when exhaling air from the lungs.

Which should a nurse encourage in clients who are at the risk of pneumococcal and influenza infections? Using prescribed opioids Mobilizing early Receiving vaccinations Using incentive spirometry

Receiving vaccinations

The nurse is providing discharge instructions to a client with pulmonary sarcoidosis. The nurse concludes that the client understands the information if the client correctly mentions which early sign of exacerbation? Headache Fever Weight loss Shortness of breath

Shortness of breath

The home care nurse is visiting a client newly discharged home after a lobectomy. What would be most important for the home care nurse to assess? Resumption of the client's ADLs The family's willingness to care for the client Nutritional status and fluid balance Signs and symptoms of respiratory complications

Signs and symptoms of respiratory complications

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 scheduled time for deflation of the tracheal cuff Cool air humidified through the tube Symmetry of the client's chest expansion Tracheal cuff pressure set at 30 mm Hg

Symmetry of the client's chest expansion

The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation? Pulmonary contusion Tension pneumothorax Flail chest Cardiac tamponade

Tension pneumothorax

A nurse observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude? The system is functioning normally. The system has an air leak. The client has a pneumothorax. The chest tube is obstructed.

The system has an air leak

A client is exhibiting signs of a pneumothorax following tracheostomy. The surgeon inserts a chest tube into the anterior chest wall. What should the nurse tell the family is the primary purpose of this chest tube? To assist with mechanical ventilation To drain copious sputum secretions To monitor bleeding around the lungs To remove air from the pleural space

To remove air from the pleural space

A mechanically ventilated client is receiving a combination of atracurium and the opioid analgesic morphine. The nurse monitors the client for which potential complication? Venous thromboemboli Pneumothorax Pulmonary hypertension Cor pulmonale

Venous thromboemboli

Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy? Vitamin D Vitamin C Vitamin B6 Vitamin E

Vitamin B6

Which type of ventilator has a preset volume of air to be delivered with each inspiration? Volume cycled Time cycled Negative pressure Pressure cycled

Volume cycled

After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes? Water-seal chamber Collection chamber Suction control chamber Air-leak chamber

Water-seal chamber

A physician stated to the nurse that the client has fluid in the pleural space and will need a thoracentesis. The nurse expects the physician to document this fluid as pleural effusion. consolidation. hemothorax. pneumothorax.

pleural effusion.