Chapter 23: Management of Patients with Chest and Lower Respiratory Tract Disorders

A nurse recognizes that a client with tuberculosis needs further teaching when the client states: 1. "The people I have contact with at work should be checked regularly." 2. "I'll need to have scheduled laboratory tests while I'm on the medication." 3. "It won't be necessary for the people I work with to take medication." 4. "I'll have to take these medications for 9 to 12 months."

Correct response: "The people I have contact with at work should be checked regularly." Explanation: The client requires additional teaching if he states that coworkers need to be checked regularly. Such casual contacts needn't be tested for tuberculosis. However, a person in close contact with a person who's infectious is at risk and should be checked. The client demonstrates effective teaching if he states that he'll take his medications for 9 to 12 months, that coworkers don't need medication, and that he requires laboratory tests while on medication. Coworkers not needing medications, taking the medication for 9 to 12 months, and having scheduled laboratory tests are all appropriate statements.

The nurse is assessing a client's potential for pulmonary emboli. What finding indicates possible deep vein thrombosis? 1. Pain in the feet 2. Localized calf tenderness 3. Decreased urinary output 4. Coolness to lower extremities

Correct response: Localized calf tenderness Explanation: If the client were to complain of localized calf tenderness, the nurse would know this is a possible indication of a deep vein thrombosis. The area of tenderness could also be warm to touch. The client's urine output should not be impacted. Pain in the feet is not an indication of possible deep vein thrombosis.

A client has been classified as status asthmaticus. The nurse understands that this client will likely initially exhibit symptoms of: 1. Metabolic acidosis 2. Respiratory acidosis 3. Respiratory alkalosis 4. Metabolic alkalosis

Correct response: Respiratory alkalosis Explanation: There is a reduced PaCO2 and initial respiratory alkalosis, with a decreased PaCO2 and an increased pH. As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

Which of the following is a potential complication of a low pressure in the endotracheal cuff? 1. Pressure necrosis 2. Aspiration pneumonia 3. Tracheal bleeding 4. Tracheal ischemia

Correct response: Aspiration pneumonia Explanation: Low pressure in the cuff can increase the risk for aspiration pneumonia. High cuff pressure can cause tracheal bleeding, ischemia, and pressure necrosis.

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? 1. Pleural friction rub 2. Crackles in the lung bases 3. Low-pitched rhonchi during expiration 4. Sibilant wheezes

Correct response: Crackles in the lung bases Explanation: When clinically significant atelectasis develops, it is generally characterized by increased work of breathing and hypoxemia. Decreased breath sounds and crackles are heard over the affected area.

A nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest bacterial pneumonia? 1. Hemoptysis and dysuria 2. Dyspnea and wheezing 3. Nonproductive cough and normal temperature 4. Sore throat and abdominal pain

Correct response: Dyspnea and wheezing Explanation: In a client with bacterial pneumonia, retained secretions cause dyspnea, and respiratory tract inflammation causes wheezing. Bacterial pneumonia also produces a productive cough and fever, rather than a nonproductive cough and normal temperature. Sore throat occurs in pharyngitis, not bacterial pneumonia. Abdominal pain is characteristic of a GI disorder, unlike chest pain, which can reflect a respiratory infection such as pneumonia. Hemoptysis and dysuria aren't associated with pneumonia.

A nurse is caring for a client with chest trauma. Which nursing diagnosis takes the highest priority? 1. Anxiety 2. Decreased cardiac output 3. Ineffective tissue perfusion (cardiopulmonary) 4. Impaired gas exchange

Correct response: Impaired gas exchange Explanation: For a client with chest trauma, a diagnosis of Impaired gas exchange takes priority because adequate gas exchange is essential for survival. Although the other nursing diagnoses — Anxiety, Decreased cardiac output, and Ineffective tissue perfusion (cardiopulmonary) — are possible for this client, they are lower priorities than Impaired gas exchange.

Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy? 1. Vitamin D 2. Vitamin E 3. Vitamin B6 4. Vitamin C

Correct response: Vitamin B6 Explanation: Vitamin B6 (pyridoxine) is usually administered with INH to prevent INH-associated peripheral neuropathy. Vitamins C, D, and E are not appropriate.

A client with lung cancer develops pleural effusion. During chest auscultation, which breath sound should the nurse expect to hear? 1. Rhonchi 2. Decreased breath sounds 3. Wheezes 4. Crackles

Wheezes Correct response: Decreased breath sounds Explanation: In pleural effusion, fluid accumulates in the pleural space, impairing transmission of normal breath sounds. Because of the acoustic mismatch, breath sounds are diminished. Crackles commonly accompany atelectasis, interstitial fibrosis, and left-sided heart failure. Rhonchi suggest secretions in the large airways. Wheezes result from narrowed airways, such as in asthma, chronic obstructive pulmonary disease, and bronchitis.

A client at risk for pneumonia has been ordered an influenza vaccine. Which statement from the nurse best explains the rationale for this vaccine? 1. "Viruses like influenza are the most common cause of pneumonia." 2, "Influenza vaccine will prevent typical pneumonias." 3. "Getting the flu can complicate pneumonia." 4. "Influenza is the major cause of death in the United States."

Correct response: "Viruses like influenza are the most common cause of pneumonia." Explanation: Influenza type A is the most common cause of pneumonia. Therefore, preventing influenza lowers the risk of pneumonia. Viral URIs can make the client more susceptible to secondary infections, but getting the flu is not a preventable action. Bacterial pneumonia is a typical pneumonia and cannot be prevented with a vaccine that is used to prevent a viral infection. Influenza is not the major cause of death in the United States. Combined influenza with pneumonia is the major cause of death in the United States.

A nurse is assessing the injection site of a client who has received a purified protein derivative test. Which finding indicates a need for further evaluation? 1. 15-mm induration 2. Reddened area 3. A blister 4. 5-mm induration

Correct response: 15-mm induration Explanation: A 10-mm induration strongly suggests a positive response in this tuberculosis screening test; a 15-mm induration clearly requires further evaluation. A reddened area, 5-mm induration, and a blister aren't positive reactions to the test and require no further evaluation.

After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? 1. 6 to 12 months 2. 1 to 3 weeks 3. 3 to 5 days 4. 2 to 4 months

Correct response: 6 to 12 months Explanation: Prophylactic isoniazid therapy must continue for 6 to 12 months at a daily dosage of 300 mg. Taking the drug for less than 6 months may not provide adequate protection against tuberculosis.

What dietary recommendations should a nurse provide a client with a lung abscess? 1. A diet rich in protein 2. A carbohydrate-dense diet 3. A diet with limited fat 4. A diet low in calories

Correct response: A diet rich in protein Explanation: For a client with lung abscess, a diet rich in protein and calories is integral because chronic infection is associated with a catabolic state. A carbohydrate-dense diet or diets with limited fat are not advisable for a client with lung abscess.

A nurse is reviewing a client's X-ray. The X-ray shows an endotracheal (ET) tube placed 3/4" (2 cm) above the carina and reveals nodular lesions and patchy infiltrates in the upper lobe. Which interpretation of the X-ray is accurate? 1. A disease process is present. 2. The ET tube must be advanced. 3. The X-ray is inconclusive. 4. The ET tube must be pulled back.

Correct response: A disease process is present. Explanation: This X-ray suggests tuberculosis. An ET tube that's 3/4" above the carina is at an adequate level in the trachea. There's no need to advance it or pull it back.

Which would be least likely to contribute to a case of hospital-acquired pneumonia? 1. A highly virulent organism is present. 2. Host defenses are impaired. 3. Inoculum of organisms reaches the lower respiratory tract and overwhelms the host's defenses. 4. A nurse washes her hands before beginning client care.

Correct response: A nurse washes her hands before beginning client care. Explanation: HAP occurs when at least one of three conditions exists: host defenses are impaired, inoculums of organisms reach the lower respiratory tract and overwhelm the host's defenses, or a highly virulent organism is present.

The ICU nurse caring for a 2-year-old near drowning victim monitors for what possible complication? 1. Atelectasis 2. Acute respiratory distress syndrome 3. Metabolic alkalosis 4. Respiratory acidosis

Correct response: Acute respiratory distress syndrome Explanation: Factors associated with the development of ARDS include aspiration related to near drowning or vomiting; drug ingestion/overdose; hematologic disorders such as disseminated intravascular coagulation or massive transfusions; direct damage to the lungs through prolonged smoke inhalation or other corrosive substances; localized lung infection; metabolic disorders such as pancreatitis or uremia; shock; trauma such as chest contusions, multiple fractures, or head injury; any major surgery; embolism; and septicemia. Options A, C and D are incorrect.

A client is being treated in the ED for respiratory distress coupled with bacterial pneumonia. The client has no medical history. However, the client works in a coal mine and smokes 10 cigarettes a day. The nurse anticipates which order based on the client's immediate needs? 1/ Administration of corticosteroids and bronchodilators 2. Client education: avoidance of irritants like smoke and pollutants 3. Completion of a 12-lead ECG 4. Administration of antibiotics

Correct response: Administration of antibiotics Explanation: Antibiotics are administered to treat respiratory tract infections. Chronic bronchitis is inflammation of the bronchi caused by irritants or infection. Hence, smoking cessation and avoiding pollutants are necessary to slow the accelerated decline of the lung tissue. However, the immediate priority in this case is to cure the infection, pneumonia. Corticosteroids and bronchodilators are administered to asthmatic clients when they show symptoms of wheezing. An ECG is used to evaluate atrial arrhythmias.

A client with asthma is being treated with albuterol. Which of the findings from the client's history would indicate to the nurse the need to administer this drug with caution? 1. Peptic ulcer disease 2. Bronchospasm 3. Raynaud's disease 4. Angina

Correct response: Angina Explanation: Patients, especially older adults, with pre-existing cardiovascular disease may have adverse cardiovascular reactions with inhaled therapy. Albuterol (Proventil) does not increase the secretions of the GI tract or cause gastric irritation. It will not worsen a peptic ulcer.

A nurse is caring for a client who has just been diagnosed with lung cancer. What is a cardinal sign of lung cancer? 1. Obvious trauma 2. Cough or change in chronic cough 3. Pain on inspiration 4. Shortness of breath

Correct response: Cough or change in chronic cough Explanation: A cough or change in chronic cough is the most frequent symptom of lung cancer. Symptoms of fractured ribs consist primarily of severe pain on inspiration and expiration, obvious trauma, and shortness of breath. These symptoms may also be caused by other disorders, but they are not considered to be indicative of lung cancer.

A client has undergone a left hemicolectomy for bowel cancer. Which activities prevent the occurrence of postoperative pneumonia in this client? 1. Administering pain medications, frequent repositioning, and limiting fluid intake 2. Coughing, breathing deeply, frequent repositioning, and using an incentive spirometer 3. Administering oxygen, coughing, breathing deeply, and maintaining bed rest 4. Coughing, breathing deeply, maintaining bed rest, and using an incentive spirometer

Correct response: Coughing, breathing deeply, frequent repositioning, and using an incentive spirometer Explanation: Activities that help to prevent the occurrence of postoperative pneumonia are: coughing, breathing deeply, frequent repositioning, medicating the client for pain, and using an incentive spirometer. Limiting fluids and lying still will increase the risk of pneumonia.

A patient is admitted to the hospital with pulmonary arterial hypertension. What assessment finding by the nurse is a significant finding for this patient? 1. Dyspnea 2. Ascites 3. Hypertension 4. Syncope

Correct response: Dyspnea Explanation: Dyspnea, the main symptom of PH, occurs at first with exertion and eventually at rest. Substernal chest pain also is common. Other signs and symptoms include weakness, fatigue, syncope, occasional hemoptysis, and signs of right-sided heart failure (peripheral edema, ascites, distended neck veins, liver engorgement, crackles, heart murmur). Anorexia and abdominal pain in the right upper quadrant may also occur.

A nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest bacterial pneumonia? 1. Nonproductive cough and normal temperature 2. Dyspnea and wheezing 3. Sore throat and abdominal pain 4. Hemoptysis and dysuria

Correct response: Dyspnea and wheezing Explanation: In a client with bacterial pneumonia, retained secretions cause dyspnea, and respiratory tract inflammation causes wheezing. Bacterial pneumonia also produces a productive cough and fever, rather than a nonproductive cough and normal temperature. Sore throat occurs in pharyngitis, not bacterial pneumonia. Abdominal pain is characteristic of a GI disorder, unlike chest pain, which can reflect a respiratory infection such as pneumonia. Hemoptysis and dysuria aren't associated with pneumonia.

Which interventions does a nurse implement for clients with empyema? 1. Place suspected clients together 2. Encourage breathing exercises 3. Institute droplet precautions 4. Do not allow visitors with respiratory infection

Correct response: Encourage breathing exercises Explanation: The nurse teaches the client with empyema to do breathing exercises as prescribed. The nurse should institute droplet precautions and isolate suspected and clients with confirmed influenza in private rooms or place suspected and confirmed clients together. The nurse does not allow visitors with symptoms of respiratory infection to visit the hospital to prevent outbreaks of influenza from occurring in health care settings.

You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia? 1. Place client on bed rest. 2. Encourage increased fluid intake. 3. Give antibiotics as ordered. 4. Offer nutritious snacks 2 times a day.

Correct response: Encourage increased fluid intake. Explanation: The nurse places the client in semi-Fowler's position to aid breathing and increase the amount of air taken with each breath. Increased fluid intake is important to encourage because it helps to loosen secretions and replace fluids lost through fever and increased respiratory rate. The nurse monitors fluid intake and output, skin turgor, vital signs, and serum electrolytes. He or she administers antipyretics as indicated and ordered. Antibiotics are not given for viral pneumonia. The client's activity level is ordered by the physician, not decided by the nurse.

You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia? Give antibiotics as ordered. Place client on bed rest. Offer nutritious snacks 2 times a day. Encourage increased fluid intake.

Correct response: Encourage increased fluid intake. Explanation: The nurse places the client in semi-Fowler's position to aid breathing and increase the amount of air taken with each breath. Increased fluid intake is important to encourage because it helps to loosen secretions and replace fluids lost through fever and increased respiratory rate. The nurse monitors fluid intake and output, skin turgor, vital signs, and serum electrolytes. He or she administers antipyretics as indicated and ordered. Antibiotics are not given for viral pneumonia. The client's activity level is ordered by the physician, not decided by the nurse.

A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care? 1. Encouraging increased fluid intake 2. Elevating the head of the bed 30 degrees 3. Maintaining a cool room temperature 4. Turning the client every 2 hours

Correct response: Encouraging increased fluid intake Explanation: Increasing the client's intake of oral or I.V. fluids helps liquefy thick, tenacious secretions, and ensures adequate hydration. Turning the client every 2 hours would help prevent atelectasis, but will not adequately mobilize thick secretions. Elevating the head of the bed would reduce pressure on the diaphragm and ease breathing, but wouldn't help the client with secretions. Maintaining a cool room temperature wouldn't help the client with secretions.

The nurse knows the mortality rate is high in lung cancer clients due to which factor? 1. Increased incidence among the elderly 2. Few early symptoms 3. Increase in women smokers 4. Increased exposure to industrial pollutants

Correct response: Few early symptoms Explanation: Because lung cancer produces few early symptoms, its mortality rate is high. Lung cancer has increased in incidence due to an increase in the number of women smokers, a growing aging population, and exposure to pollutants but these are not directly related to the incidence of mortality rates.

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? 1. Provide employees with smoking cessation materials. 2. Fit all employees with protective masks. 3. Insist on adequate breaks for each employee. 4. Give workshops on disease prevention.

Correct response: Fit all employees with protective masks. Explanation: The primary focus is prevention, with frequent examination of those who work in areas of highly concentrated dust or gases. Laws require work areas to be safe in terms of dust control, ventilation, protective masks, hoods, industrial respirators, and other protection. Workers are encouraged to practice healthy behaviors, such as quitting smoking. Adequate breaks, giving workshops, and providing smoking cessation materials do not prevent occupational lung diseases.

A victim of a motor vehicle accident has been brought to the emergency room. The patient is exhibiting paradoxical chest expansion and respiratory distress. Which of the following chest disorders should be suspected? 1. Simple pneumothorax 2. Flail chest 3. Pulmonary contusion 4. Cardiac tamponade

Correct response: Flail chest Explanation: When a flail chest exists, during inspiration, as the chest expands, the detached part of the rib segment (flail segment) moves in a paradoxical manner in that it is pulled inward during inspiration, reducing the amount of air that can be drawn into the lungs. On expiration, because the intrathoracic pressure exceed atmospheric pressure, the flail segment bulges outward, impairing the patient's ability to exhale. Cardiac tamponade is compression of the heart resulting from fluid or blood within the pericardial sac. A pulmonary contusion is damage to the lung tissues resulting in hemorrhage and localized edema. A simple pneumothorax occurs when air enters the pleural space through the rupture of a bleb or a bronchopleural fistula.

When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems? 1. Hypotension, hyperoxemia, and hypercapnia 2. Hyperoxemia, hypocapnia, and hyperventilation 3. Hyperventilation, hypertension, and hypocapnia 4. Hypercapnia, hypoventilation, and hypoxemia

Correct response: Hypercapnia, hypoventilation, and hypoxemia Explanation: The cardinal physiologic abnormalities of acute respiratory failure are hypercapnia, hypoventilation, and hypoxemia. The nurse should focus on resolving these problems.

A nurse is caring for a client with COPD. The client's medication regimen has been recently changed and the nurse is assessing for therapeutic effect of a new bronchodilator. Therapeutic effects of this medication would include which of the following? Select all that apply. 1. Negative sputum culture 2. Increased viscosity of lung secretions 3. Increased respiratory rate 4. Relief of dyspnea 5. Increased expiratory flow rate

Correct response: Increased expiratory flow rate Relief of dyspnea Explanation: The relief of bronchospasm is confirmed by measuring improvement in expiratory flow rates and volumes (the force of expiration, how long it takes to exhale, and the amount of air exhaled) as well as by assessing the dyspnea and making sure that it has lessened. Increased respiratory rate and viscosity of secretions would suggest a worsening of the client's respiratory status. Bronchodilators would not have a direct result on the client's infectious process.

In a client with amyotrophic lateral sclerosis (ALS) and respiratory distress, which finding is the earliest sign of reduced oxygenation? 1. Decreased level of consciousness (LOC) 2. Decreased heart rate 3. Increased restlessness 4. Increased blood pressure

Correct response: Increased restlessness Explanation: In ALS, an early sign of respiratory distress is increased restlessness, which results from inadequate oxygen flow to the brain. As the body tries to compensate for inadequate oxygenation, the heart rate increases and blood pressure drops. A decreased LOC is a later sign of poor tissue oxygenation in a client with respiratory distress.

A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be: 1. Impaired tissue integrity. 2. Ineffective breathing pattern. 3. Ineffective airway clearance. 4. Risk for falls.

Correct response: Ineffective airway clearance. Explanation: Ineffective airway clearance is the priority nursing diagnosis for this client. Pneumonia involves excess secretions in the respiratory tract and inhibits air flow to the capillary bed. A client with pneumonia may not have an Ineffective breathing pattern, such as tachypnea, bradypnea, or Cheyne-Stokes respirations. Risk for falls and Impaired tissue integrity aren't priority diagnoses for this client.

A client diagnosed with acute respiratory distress syndrome (ARDS) is restless and has a low oxygen saturation level. If the client's condition does not improve and the oxygen saturation level continues to decrease, what procedure will the nurse expect to assist with in order to help the client breathe more easily? 1. Administer a large dose of furosemide (Lasix) IVP stat 2. Increase oxygen administration 3. Schedule the client for pulmonary surgery 4. Intubate the client and control breathing with mechanical ventilation

Correct response: Intubate the client and control breathing with mechanical ventilation Explanation: A client with ARDS may need mechanical ventilation to assist with breathing while the underlying cause of the pulmonary edema is corrected. The other options are not appropriate.

A client diagnosed with acute respiratory distress syndrome (ARDS) is restless and has a low oxygen saturation level. If the client's condition does not improve and the oxygen saturation level continues to decrease, what procedure will the nurse expect to assist with in order to help the client breathe more easily? 1. Administer a large dose of furosemide (Lasix) IVP stat 2. Intubate the client and control breathing with mechanical ventilation 3. Schedule the client for pulmonary surgery 4. Increase oxygen administration

Correct response: Intubate the client and control breathing with mechanical ventilation Explanation: A client with ARDS may need mechanical ventilation to assist with breathing while the underlying cause of the pulmonary edema is corrected. The other options are not appropriate.

A nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? 1. It helps prevent early airway collapse. 2. It prolongs the inspiratory phase of respiration. 3. It increases inspiratory muscle strength. 4. It decreases use of accessory breathing muscles.

Correct response: It helps prevent early airway collapse. Explanation: Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)

Which type of lung cancer is characterized as fast growing and tends to arise peripherally? 1. Adenocarcinoma 2. Bronchoalveolar carcinoma 3. Squamous cell carcinoma 4. Large cell carcinoma

Correct response: Large cell carcinoma Explanation: Large cell carcinoma is a fast-growing tumor that tends to arise peripherally. Bronchoalveolar cell cancer arises from the terminal bronchus and alveoli and usually grows slowly. Adenocarcinoma presents as peripheral masses or nodules and often metastasizes. Squamous cell carcinoma arises from the bronchial epithelium and is more centrally located.

When assessing a client's potential for pulmonary emboli, what finding by the nurse indicates possible deep vein thrombosis? 1. Negative Homan's sign 2. Pain in the calf 3. Pain in the feet 4. Inability to dorsiflex

Correct response: Pain in the calf Explanation: When assessing the client's potential for pulmonary emboli, the client lies on his or her back and lifts his or her leg and his or her foot. If the client reports calf pain during this maneuver, he or she may have a deep vein thrombosis.

A client is brought to the emergency department following a motor vehicle accident. Which of the following nursing assessments is significant in diagnosing this client with flail chest? 1. Chest pain on inspiration 2. Respiratory acidosis 3. Paradoxical chest movement 4. Clubbing of fingers and toes

Correct response: Paradoxical chest movement Explanation: Flail chest occurs when two or more adjacent ribs fracture and results in impairment of chest wall movement. Respiratory acidosis and chest pain are symptoms that can occur with flail chest but is not as significant in the diagnosis as paradoxical chest movement. Clubbing of fingers and toes are sign of prolonged tissue hypoxia.

The client is prescribed albuterol 2 puffs as a metered-dose inhaler. Which action by the client demonstrates understanding of administration for this medication? 1. Carefully holds the inhaler upright without shaking it 2. Immediately repeats the second puff after the first puff 3. Positions the inhaler 2 finger widths away from the lips 4. Holds the breath for 5 seconds after administering the medication

Correct response: Positions the inhaler 2 finger widths away from the lips Explanation: To administer a metered-dose inhaler, the client holds the inhaler upright and shakes the inhaler. The inhaler is positioned 2 finger widths away from lips. After administering the medication, the client holds the breath for as long as possible, at least 10 seconds. The client may administer the next puff in 15 to 30 seconds.

The nurse is educating a patient with asthma about preventative measures to avoid having an asthma attack. What does the nurse inform the patient is a priority intervention to prevent an asthma attack? 1. Using a long-acting steroid inhaler when an attack is coming 2. Avoiding exercise and any strenuous activity 3. Staying in the house if it is too cold or too hot 4. Preparing a written action plan

Correct response: Preparing a written action plan Explanation: Asthma exacerbations are best managed by early treatment and education, including the use of written action plans as part of any overall effort to educate patients about self-management techniques, especially those with moderate or severe persistent asthma or with a history of severe exacerbations (Expert Panel Report 3, 2007).

You are caring for a client with chronic respiratory failure. What are the signs and symptoms of chronic respiratory failure? 1. Progressive loss of lung function associated with chronic disease 2. Sudden loss of lung function associated with chronic disease 3. Progressive loss of lung function with history of normal lung function 4. Sudden loss of lung function with history of normal lung function

Correct response: Progressive loss of lung function associated with chronic disease Explanation: In chronic respiratory failure, the loss of lung function is progressive, usually irreversible, and associated with chronic lung disease or other disease. This makes options B, C, and D incorrect.

A client presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands that goals of therapy should be achieved to improve the client's condition. Which statements reflect therapy goals? Select all that apply. 1. Treat the underlying cause of the event. 2. Teach the client to suspend activity. 3. Provide long-term support for medical management. 4. Provide medical support for the current exacerbation. 5. Return the client to their original functioning abilities.

Correct response: Provide medical support for the current exacerbation. Treat the underlying cause of the event. Return the client to their original functioning abilities. Provide long-term support for medical management. Explanation: The goal is to have a stable client with COPD leading the most productive life possible. COPD cannot necessarily be cured, but it can be managed so that the client can live a reasonably normal life. With adequate management, clients should not have to give up their usual activities.

You are caring for a client status post lung resection. When assessing your client you find that the bubbling in the water-seal chamber for the chest tubes is more than you expected. What should you check when bubbling in the water-seal chamber is excessive? 1. See if the wall suction unit has malfunctioned. 2. See if there are leaks in the system. 3. See if a kink has developed in the tubing. 4. See if the chest tube is clogged.

Correct response: See if there are leaks in the system. Explanation: Bubbling in the water-seal chamber occurs in the early postoperative period. If bubbling is excessive, the nurse checks the system for any kind of leaks. Fluctuation of the fluid in the water-seal chamber is initially present with each respiration. Fluctuations cease if the chest tube is clogged or a kink develops in the tubing. If the suction unit malfunctions, the suction control chamber, not the water-seal chamber, will be affected.

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? 1. Fever 2. Weight loss 3. Shortness of breath 4. Headache

Correct response: Shortness of breath Explanation: Early signs and symptoms of pulmonary sarcoidosis may include dyspnea, cough, hemoptysis, and congestion. Generalized symptoms include anorexia, fatigue, and weight loss.

After 48 hours, a Mantoux test is evaluated. At the site, there is a 10 mm induration. This finding would be considered: 1. Significant 2. Nonreactive 3. Not significant 4. Negative

Correct response: Significant Explanation: An induration of 10 mm or greater is usually considered significant and reactive in people who have normal or mildly impaired immunity. Erythema without induration is not considered significant.

The most diagnostic clinical symptom of pleurisy is: 1. Dullness or flatness on percussion over areas of collected fluid. 2. Dyspnea and coughing. 3. Fever and chills. 4. Stabbing pain during respiratory movements.

Correct response: Stabbing pain during respiratory movements. Explanation: The key characteristic of pleuritic pain is its relationship to respiratory movement: taking a deep breath, coughing, or sneezing worsens the pain. Pleuritic pain is limited in distribution rather than diffuse; it usually occurs only on one side. The pain may become minimal or absent when the breath is held; leading to rapid shallow breathing. It may be localized or radiate to the shoulder or abdomen. Later, as pleural fluid accumulates, the pain decreases.

A client is being discharged following pelvic surgery. What would be included in the patient care instructions to prevent the development of a pulmonary embolus? 1. Tense and relax muscles in the lower extremities. 2. Begin estrogen replacement. 3. Wear tight-fitting clothing. 4. Consume the majority of daily fluid intake prior to bed.

Correct response: Tense and relax muscles in the lower extremities. Explanation: Clients are encouraged to perform passive or active exercises, as tolerated, to prevent a thrombus from forming. Constrictive, tight-fitting clothing is a risk factor for the development of a pulmonary embolism in postoperative clients. Clients at risk for a DVT or a pulmonary embolism are encouraged to drink throughout the day to avoid dehydration. Estrogen replacement is a risk factor for the development of a pulmonary embolism.

A mediastinal shift occurs in which type of chest disorder? 1. Cardiac tamponade 2. Tension pneumothorax 3. Simple pneumothorax 4. Traumatic pneumothorax

Correct response: Tension pneumothorax Explanation: A tension pneumothorax causes the lung to collapse and the heart, the great vessels, and the trachea to shift toward the unaffected side of the chest (mediastinal shift). A traumatic pneumothorax occurs when air escapes from a laceration in the lung itself and enters the pleural space or enters the pleural space through a wound in the chest wall. A simple pneumothorax most commonly occurs as air enters the pleural space through the rupture of a bleb or a bronchopleural fistula. Cardiac tamponade is compression of the heart resulting from fluid or blood within the pericardial sac.

The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation? 1. Tension pneumothorax 2. Flail chest 3. Pulmonary contusion 4. Cardiac tamponade

Correct response: Tension pneumothorax Explanation: Clamping can result in a tension pneumothorax. The other options would not occur if the chest tube was clamped during transportation.

The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation? 1. Pulmonary contusion 2. Tension pneumothorax 3. Cardiac tamponade 4. Flail chest

Correct response: Tension pneumothorax Explanation: Clamping can result in a tension pneumothorax. The other options would not occur if the chest tube was clamped during transportation.

A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition? 1. The client exhibits restlessness and confusion. 2. The client has a partial pressure of arterial carbon dioxide (PaCO2) value of 65 mm Hg or higher. 3. The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. 4. The client exhibits bronchial breath sounds over the affected area.

Correct response: The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. Explanation: As the acute phase of bacterial pneumonia subsides, normal lung function returns and the PaO2 typically rises, reaching 85 to 100 mm Hg. A PaCO2 of 65 mm Hg or higher is above normal and indicates CO2 retention — common during the acute phase of pneumonia. Restlessness and confusion indicate hypoxia, not an improvement in the client's condition. Bronchial breath sounds over the affected area occur during the acute phase of pneumonia; later, the affected area should be clear on auscultation.

A client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem? Choose all that apply. 1. Thick mucus 2. Airway remodeling 3. Destruction of the alveolar wall 4. Swelling of bronchial membranes

Correct response: Thick mucus Swelling of bronchial membranes Airway remodeling Explanation: As asthma becomes more persistent, inflammation progresses and airway edema, mucus hypersecretion, and formation of mucus plugs can occur. Airway remodeling may occur in response to chronic inflammation, causing further airway narrowing. Destruction of the alveolar wall does not occur with asthma.

A nurse is explaining to a client with asthma what her new prescription for prednisone is used for. What would be the most accurate explanation that the nurse could give? 1. To prevent recurrent pulmonary infections 2. To gain prompt control of inadequately controlled, persistent asthma 3. To ensure long-term prevention of asthma exacerbations 4. To cure any systemic infection underlying asthma attacks

Correct response: To gain prompt control of inadequately controlled, persistent asthma Explanation: Prednisone is used for a short-term (3-10 days) "burst" to gain prompt control of inadequately controlled, persistent asthma. It is not used to treat infection or to prevent exacerbations in the long term.

The nurse is caring for a client with suspected ARDS with a pO2 of 53. The client is placed on oxygen via face mask and the PO2 remains the same. What does the nurse recognize as a key characteristic of ARDS? 1. Unresponsive arterial hypoxemia 2. Tachypnea 3. Diminished alveolar dilation 4. Increased PaO2

Correct response: Unresponsive arterial hypoxemia Explanation: Acute respiratory distress syndrome (ARDS) can be thought of as a spectrum of disease, from its milder form (acute lung injury) to its most severe form of fulminate, life-threatening ARDS. This clinical syndrome is characterized by a severe inflammatory process causing diffuse alveolar damage that results in sudden and progressive pulmonary edema, increasing bilateral infiltrates on chest x-ray, hypoxemia unresponsive to oxygen supplementation regardless of the amount of PEEP, and the absence of an elevated left atrial pressure.

A nurse assesses arterial blood gas results for a patient in acute respiratory failure (ARF). Which results are consistent with this disorder? 1. pH 7.46, PaO2 80 mm Hg 2. pH 7.35, PaCO2 48 mm Hg 3. pH 7.28, PaO2 50 mm Hg 4. pH 7.36, PaCO2 32 mm Hg

Correct response: pH 7.28, PaO2 50 mm Hg Explanation: ARF is defined as a decrease in arterial oxygen tension (PaO2) to less than 60 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO2) to >50 mm Hg (hypercapnia), with an arterial pH less than 7.35.

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 1. consolidation. 2. hemothorax. 3. pleural effusion. 4. pneumothorax.

Correct response: pleural effusion. Explanation: Fluid accumulating within the pleural space is called a pleural effusion. A pneumothorax is air in the pleural space. A hemothorax is blood within the pleural space. Consolidation is lung tissue that has become more solid in nature as a result of the collapse of alveoli or an infectious process.

A nurse is giving a speech addressing "Communicable Diseases of Winter" to a large group of volunteer women, most of whom are older than 60 years. What preventive measures should the nurse recommend to these women, who are at the risk of pneumococcal and influenza infections? Select all that apply. 1. vaccinations 2. prescribed opioids 3. hand antisepsis 4. incentive spirometry

Correct response: vaccinations hand antisepsis Explanation: A powerful weapon against the spread of communicable disease is effective and frequent handwashing. The pneumococcal vaccine provides specific prevention against pneumococcal pneumonia and other infections caused by S. pneumoniae.