elsevier respiratory

A nurse observes a client with acute bronchitis and emphysema sitting up in bed, appearing anxious and dyspneic. What should the nurse do first?

Provide oxygen at 2 L per minute

During chest assessment of a client with idiopathic pulmonary fibrosis, the nurse hears short, discontinuous, high-pitched sounds that sound like hair being rolled between the fingers just behind the ear in the bilateral lower lobes. Which respiratory disorders may also manifest these sounds as a pathophysiological sign? Select all that apply.

Pulmonary edema Atelectasis

The nurse observes a client with chronic obstructive pulmonary disease (COPD) breathing rapidly and using accessory muscles of respiration. The nurse auscultates the lungs and hears crackles and wheezes. What action should the nurse take?

Raise the head of the bed to a high-Fowler position and administer 2 L/min oxygen per nasal cannula.

A nurse is caring for a client experiencing an acute episode of bronchial asthma. What should nursing interventions achieve?

Raising mucous secretions from the chest

What finding in the client is a sign of allergic rhinitis?

Reduced transillumination on the skin over the sinuses

A nurse works with a large population of immigrant clients and is concerned about the debilitating effects of influenza. Which action by the nurse is the first line of defense against an emerging influenza pandemic?

Reporting surveillance findings to appropriate public health officials

A client with a history of emphysema develops a respiratory infection and is admitted to the hospital in acute respiratory distress. The client's arterial blood studies indicate pH 7.30, PO 2 60 mm Hg, PCO 2 55 mm Hg, and HCO 3 23 mEq/L (23 mmol/L). How should the nurse interpret these findings?

Respiratory acidosis

A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and PCO 2 of 60 mm Hg. These blood gases require nursing attention because they indicate which condition?

Respiratory acidosis

A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and a PCO 2 of 60 mm Hg. What complication does the nurse conclude the client is experiencing?

Respiratory acidosis

After abdominal surgery a client should be encouraged to turn from side to side and to engage in deep breathing exercises. The nurse explains that these activities are essential to prevent which condition?

Respiratory acidosis

A nurse identifies 12 mm of induration at the site of a tuberculin purified protein derivative (PPD) test when a client returns to the health office to have it read. What does the nurse explain to the client about this test?

Result indicates a need for further tests and a chest x-ray

The nurse is caring for a client who recently returned from another country who exhibits signs and symptoms suspicious of severe acute respiratory syndrome (SARS). Which clinical manifestations support this diagnosis? Select all that apply.

Shortness of breath Fever greater than 100.4° F Dry cough

When caring for a client who has acute respiratory distress syndrome (ARDS), the nurse would implement which measure to promote effective airway clearance?

Suction as needed

A 65-year old client is found to have dilatation of the bronchioles and alveolar ducts. Which suggestions of the nurse would help the client overcome this situation? Select all that apply.

Suggest that the client perform vigorous pulmonary hygiene activities. Suggest that the client maintain an upright position as much as possible. Suggest using incentive spirometry.

A client is experiencing severe respiratory distress. Which response should the nurse expect the client to exhibit?

Tachycardia

A nurse is caring for a client with the diagnosis of emphysema, a chronic obstructive pulmonary disease (COPD). The client is hypoxemic and also has chronic hypercarbia. Which statement reflects the oxygen needs of this client?

The client requires lower levels of oxygen delivery, usually 1 to 3 L/min via nasal cannula

A client is hospitalized with a diagnosis of emphysema. The nurse provides teaching and should begin with which aspect of care?

The disease process and breathing exercises

A client has a tracheostomy tube attached to a tracheostomy collar for the delivery of humidified oxygen. What is the primary reason identified by the nurse for suctioning the client?

The tracheostomy tube interferes with effective coughing.

A client with a long history of asthma is scheduled for surgery. Which information should be included in preoperative teaching?

There is an increased risk of respiratory tract infections.

A client is scheduled for a pulmonary function test. The nurse explains that during the test one of the instructions the respiratory therapist will give the client is to breathe normally. What should the nurse teach is being measured when the client follows these directions?

Tidal volume

A client is admitted to the emergency department with allergic rhinitis and asthma. The laboratory report shows histamines and prostaglandins. Which type of hypersensitivity reaction may have occurred?

Type I

The nurse instructed a client with asthma about the use of a peak flow meter at home. The client assesses the peak expiratory flow by using the peak flow meter. Which action performed by the client would be appropriate when the reading is in the yellow zone?

Use a prescribed reliever drug therapy

A client newly diagnosed with tuberculosis has a productive cough. Which is the mostappropriate nursing intervention to teach the client?

Use disposable tissues

The primary healthcare provider has prescribed fluticasone nasal spray for a client with sinusitis. Which of these instructions regarding the use of the spray are appropriate for the client? Select all that apply.

Use the drug on a regular basis, not PRN Clear the nasal passages before using the drug Discontinue use of the drug if nasal infection develops

A client's sputum smears for acid-fast bacilli (AFB) are positive, and transmission-based airborne precautions are prescribed. What should the nurse teach visitors to do?

Wear a particulate respirator mask.

A 67-year-old client has tested positive for influenza A. The client also has asthma. Which drug would the nurse recommend be avoided in this client?

Zanamivir

Which is a leukotriene modifier used to manage and prevent allergic rhinitis?

Zileuton

The nurse is caring for a 76-year-old obese client with a history of epigastric distress, esophageal burning, binge drinking, and frequent episodes of bronchitis. A diagnosis of hiatal hernia is made. Which health problems most likely contributed to the development of the hiatal hernia? Select all that apply.

age, obesity

Which client would the nurse consider to have the highest risk of pneumonia?

chronic lung disease and received PNA vaccine more than 5 years ago

During chest physiotherapy (CPT) a client reports fatigue, and the client's heart rate increases from 90 to 140 beats per minute. What should the nurse do next?

interrupt the therapy

The nursing is caring for four different clients with eye disorders. Which client should be assessed for asthma before prescribing beta-adrenergic blockers?

reduced outflow of aqueous humor increased intraocular pressure

A client comes to the clinic because of signs and symptoms of a respiratory infection. The client says to the nurse, "How can I prevent my roommate from getting my cold?" What is the nurse's best response?

"Cover your cough with your forearm."

The nurse is teaching a client with asthma about using a peak flow meter. Which statement by the client reflects a correct understanding of how to use a peak flow meter? Select all that apply .

"If I get a reading in the red zone, then I need to take my reliever drug and have my wife take me to the hospital." "I should check the peak flow readings at least twice a day." "Readings in the green zone mean that my asthma is under control."

A client with chronic bronchitis smokes one or two cigarettes a day and has not been performing the prescribed pulmonary physiotherapy exercises because they are too tiring. Which is the best response by the nurse?

"Tell me about your typical day before the exercises were prescribed."

Which suggestion of the nurse would help the client prevent respiratory problems?

"You should wear a mask while working in certain industries."

A client's arterial blood gas report indicates that pH is 7.25, PCO 2 is 35 mm Hg, and HCO 3 is 20 mEq/L (20 mmol/L). Which client should the nurse consider is most likely to exhibit these results?

A 24-year-old with diabetic ketoacidosis

A client's arterial blood gas report indicates that pH is 7.25, Pco 2 is 60 mm Hg, and HCO 3is 26 mEq/L (26 mmol/L). Which client should the nurse consider is most likely to exhibit these blood gas results?

A 65-year-old with pulmonary fibrosis

A client comes to the emergency department reporting chest pain and difficulty breathing. A chest x-ray reveals a pneumothorax. Which finding should the nurse expect to identify when assessing the client?

Absence of breath sounds over the affected area

A spouse of a client with pulmonary tuberculosis (TB) receives a tuberculin skin test. The nurse reads the test and identifies an area of induration greater than 10 mm. What does this result indicate to the nurse?

Additional tests are necessary.

A client has chronic obstructive pulmonary disease (COPD). To decrease the risk of CO 2 intoxication (CO 2 narcosis), what should the nurse do?

Administer oxygen at a low concentration to maintain respiratory drive

A client presents with sneezing; lacrimation; swelling with an airway obstruction; and pruritus around the eyes, nose, throat, and mouth. The nurse interprets these findings as a Type I hypersensitivity reaction. Which disease might have occurred in the client?

Allergic rhinitis

A client presents to the emergency room with coughing and sudden wheezing. The nurse notes the client is progressing quickly into respiratory distress. The nurse identifies that the client is experiencing what problem?

An acute asthma attack

A client develops respiratory alkalosis. When the nurse is reviewing the laboratory results, which finding is consistent with respiratory alkalosis?

An elevated pH, decreased PCO 2

A client reports nasal discharge, sneezing, lacrimation, and itching all over the body. During an assessment, the client reports that he or she was exposed to dust and molds. The nurse observes swelling and a pink color at the itching site. Which class of drugs is best used to treat this condition in the client?

Antihistamines

Which interventions should the nurse perform while collecting subjective data from a client during a focused respiratory assessment? Select all that apply.

Ask the client about color and quantity of sputum Question the client about shortness of breath

A client is admitted to the hospital with chronic asthma. Which complication should the nurse monitor in this client?

Atelectasis

A client is diagnosed with emphysema. What long-term problem should the nurse monitor in this client?

Carbon dioxide retention

A client is hospitalized with pneumococcal pneumonia. Which drug will the nurse mostlikely administer?

Ceftriaxone

For which illness should airborne precautions be implemented?

Chickenpox

The nurse is reviewing the laboratory reports of a client who has sustained a significant reaction to the tuberculin skin test but has negative findings on bacteriologic studies. The reports further reveal the absence of x-ray findings compatible with tuberculosis (TB) and clinical evidence of TB. Which class of TB does the nurse suspect?

Class 2

The nurse is developing a plan of care for a client who had a chest tube removed. To promote respiratory exchange, what should the nurse add to the plan of care?

Coughing and deep breathing every hour

What clinical indicators should a nurse expect to identify in a client with acute respiratory distress syndrome (ARDS)? Select all that apply.

Crackles Atelectasis Hypoxemia Severe dyspnea

A nurse administers oxygen at 2 L/min via nasal cannula to a client with chronic obstructive pulmonary disease (COPD). By administering a low concentration of oxygen to this client, the nurse is preventing which physiologic response?

Depression in the respiratory center

A client with a history of emphysema is admitted with a diagnosis of acute respiratory failure with respiratory acidosis. Oxygen is being administered at 3 L/min nasal cannula. Four hours after admission, the client has increased restlessness and confusion followed by a decreased respiratory rate and lethargy. What should the nurse do?

Discontinue or decrease the oxygen flow rate.

Which condition may lead to collapse of the walls of the bronchioles and alveolar air sacs?

Emphysema

A client who was recently diagnosed with emphysema develops a malignancy in the right lower lobe of the lung, and a lobectomy is performed. After surgery, the client is receiving oxygen by nasal cannula at 2 L per minute. Blood gas results demonstrate respiratory acidosis. What should be the initial nursing intervention?

Encourage deep breathing

A client develops acute respiratory distress, and a tracheostomy is performed. Which intervention is most important for the nurse to implement when caring for this client?

Encouraging a fluid intake of 3 L daily

A client is admitted for an exacerbation of emphysema. The client has a fever, chills, and difficulty breathing on exertion. What is the priority nursing action based on the client's history and present status?

Encouraging increased fluid intake

While assessing the medical reports of a client with upper respiratory tract infections, the nurse notices that there are alterations in the platelet count. The client has a history of recent nasal surgery. Which clinical condition does the nurse suspect?

Epistaxis

A nurse is involved in an international committee to address global health problems. What suggestion is most appropriate for the nurse to make to best meet the challenge associated with a potential emerging influenza pandemic?

Establish a global surveillance plan.

Which part of the upper respiratory system is involved in equalizing the pressure within the middle ear while swallowing?

Eustachian tubes

A client is admitted with a tentative diagnosis of pneumonia. On admission the client is not in respiratory distress, but later develops chest pain and a fever of 103° F (39.4° C). A productive cough produces rust-colored sputum. How should the nurse interpret these findings?

Expected course of pneumonia

What are the symptoms of tuberculosis? Select all that apply.

Fatigue Nausea Fever

Which pulmonary function test provides a more sensitive index of obstruction in smaller airways?

Forced expiratory flow over the 25% to 75% volume of the forced vital capacity

A spontaneous pneumothorax is suspected in a client with a history of emphysema. In addition to calling the healthcare provider, which action should the nurse take?

Give oxygen at 2 L per minute via nasal cannula

The nurse is assessing a client's arterial blood gases and determines that the client is in compensated respiratory acidosis. The pH value is 7.34; which other result helped the nurse reach this conclusion?

HCO 3 value is 50 mEq/L

A client is admitted to the hospital with a diagnosis of restrictive airway disease. The nurse expects the client to exhibit which early signs of respiratory acidosis? Select all that apply.

Headache Irritability Restlessness

What response provides evidence that a client with chronic obstructive pulmonary disease (COPD) understands the nurse's instructions about an appropriate breathing technique?

Holds each breath for a second at the end of inspiration

After a spontaneous pneumothorax, the client becomes extremely drowsy, and the pulse and respirations increase. What do these client responses indicate to the nurse?

Hypercapnia (inc. CO2)

A client who is exposed to pollens reports a runny, stuffy nose and itchy, watery eyes. The nasal examination reveals swollen and pink nasal mucosa. Which finding does the nurse suspect to be present in the client's laboratory reports?

Immunoglobulin E (IgE) level of 150 IU/mL

A nurse teaches a client with a diagnosis of emphysema about the importance of preventing infections. What information is most significant to include?

Importance of meticulous oral hygiene

A client with bronchial pneumonia is having difficulty maintaining airway clearance because of retained secretions. To decrease the amount of secretions retained, what should the nurse do?

Increase fluid intake to at least 2 L a day

Which chest examination findings can be observed in a client with pneumonia?

Increased fremitus over affected area on palpation

A client reports fever, headache, extreme tiredness, dry cough, sore throat, runny nose, muscle aches, nausea, vomiting, and diarrhea. Which organism is responsible for this condition?

Influenza virus

The nurse is evaluating the actions of a client with pneumonia performing incentive spirometry. Which action by the client indicates a need for correction?

Inhaling air fully before inserting the mouthpiece

A client presenting with an acute asthma attack is being assessed in the emergency room. The client's spouse reports that the client currently is being treated for an upper respiratory infection. The nurse should understand that the client most likely has which type of asthma?

Intrinsic

The nurse is caring for a client who has metabolic acidosis as a result of severe dehydration. What type of respirations does the nurse expect the client to exhibit?

Kussmaul breathing

A client who is admitted with emphysema shows progressive respiratory failure and has a Paco 2 of 60. To address the problems, the nurse expects to receive a prescription for:

Mechanical ventilation

After a lateral crushing chest injury, obvious right-sided paradoxical motion of a client's chest demonstrates multiple rib fractures, resulting in a flail chest. Which complication associated with this injury should the nurse assess in this client?

Mediastinal shift

The arterial blood gases of a client with chronic obstructive pulmonary disease (COPD) deteriorate, and respiratory failure is impending. Which clinical indicator should the nurse assess first?

Mental confusion

As a result of pulmonary tuberculosis, a client has a decreased surface area for gas exchange in the lungs. Which physiologic process does the nurse consider will be affected as a result?

Molecular diffusion

The nurse is caring for a client who has a lesion in the right upper lobe. A diagnosis of tuberculosis (TB) has been made. What are the clinical manifestations of tuberculosis?

Night sweats and blood-tinged sputum

The nurse is caring for a client with the following arterial blood gas (ABG) values: PO 2 89 mm Hg, PCO 2 35 mm Hg, and pH of 7.37. These findings indicate that the client is experiencing which condition?

Normal acid-base balance

The son of a 65-year-old client said, "My father is suffering from chronic lung disease. He wakes suddenly from sleep and is unable to breathe." What condition does the nurse suspect in the client?

Paroxysmal nocturnal dyspnea

Which disorder would the nurse state is related to the tonsils?

Pharyngitis

During the assessment of a client who was admitted to the hospital because of a productive cough, fever, and chills, the nurse percusses an area of dullness over the right posterior lower lobe of the lung. Which medical diagnosis will the nurse most likely observe documented in the client's electronic records?

Pneumonia

In addition to treatment of the underlying cause, which medical intervention should the nurse anticipate will be included in the management of a client with acute respiratory distress syndrome (ARDS)?

Positive end-expiratory pressure (PEEP)

The nurse is teaching the client with chronic obstructive pulmonary disease (COPD) to use pursed-lip breathing (PLB). What is the rationale for the nurse's teaching?

Prolonged exhalation to decrease air trapping

A client with a 10-year history of emphysema is admitted in acute respiratory distress. During assessment, what does the nurse expect to identify?

Prolonged expiration with use of accessory muscles