Exam 2 set 2

A client's spouse states that she is worried about her husband because he appears to be breathing "really hard." The nurse performs a respiratory assessment. What findings would indicate a need for further interventions?

BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 °F (38.5 °C)

While assessing an acutely ill client's respiratory rate, the nurse assesses four normal breaths followed by an episode of apnea lasting 20 seconds. How should the nurse document this finding?

Biot's respiration

A nurse is performing a respiratory assessment on a client with pneumonia. She asks the client to say "ninety-nine" several times. Through her stethoscope, she hears the words clearly over his left lower lobe. What term should the nurse use to document this finding?

Bronchophony

Another name for clergymans sore throat

Chronic granular pharyngitis

The nurse auscultates crackles in a patient with a respiratory disorder. With what disorder would crackles be commonly heard?

Collapsed alveoli

What should the patient do while nurse cleans secretions above teach cuff

Cough while cuff is being deflated

The nurse is having an information session with a women's group at the YMCA about lung cancer. What frequent and commonly experienced symptom should the nurse be sure to include in the session?

Coughing

A physician determines that a client has been exposed to someone with tuberculosis. The nurse expects the physician to order which treatment?

Daily doses of isoniazid, 300 mg for 6 months to 1 year

Which ventilation-perfusion ratio is exhibited in a client diagnosed with a pulmonary embolus?

Dead space

When the nurse is assessing the older adult patient, what gerontologic changes in the respiratory system should the nurse be aware of? (Select all that apply.)

Decreased gag reflex Increased presence of collagen in alveolar walls Decreased presence of mucus

he nurse is using an in-line suction kit to suction a patient who is intubated and on a mechanical ventilator. What benefits does inline suction have for the patient? (Select all that apply.)

Decreases hypoxemia Decreases patient anxiety Sustains positive end expiratory pressure (PEEP)

Late symptoms of laryngeal cancer include which of the following. Select all that apply.

Dysphagia Dyspnea Persistent hoarseness

Late symptoms of laryngeal cancer

Dysphasia, persistent horse ness, dyspnea

A patient prescribed a medication for hypertension started taking it 3 days ago and arrives in the emergency department with an edematous face and tongue and having a difficult time speaking. What medication is the nurse aware of that may produce this type of side effect?

Enalapril (Vasotec)

HTN med that can cause edema in you hue and face

Enalapril(vasotec)

Which intervention does a nurse implement for clients with empyema?

Encourage breathing exercises

A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute and a pulse oximetry of 93% despite receiving nasal oxygen at 2 L/minute. What action should the nurse take?

Encourage the client to exhale slowly against pursed lips.

The nurse is educating a patient diagnosed with acute bacterial rhinosinusitis about interventions that may assist with symptom control. What should the nurse include in this information? (Select all that apply.)

Ensure an adequate fluid intake. Increase the humidity in the home. Apply local heat to promote drainage.

Laryngectomy nutrition

Enteral feedings post op

During a routine visit to the pulmonologist, a client is told to undergo a mediastinoscopy. After the physician leaves the room, the nurse enters and is asked about this procedure. How should the nurse respond?

Exploration and biopsy of the lymph nodes that drain the lungs

Client reports laryngitis. Nurse should ask about history of

GERD

The nurse should monitor a client receiving mechanical ventilation for which of the following complications?

Gastrointestinal hemorrhage

Recurrent rhinosinusitis med

Guaifenesin

Clinical Manifestations of acute laryngitis

Hoarseness

The nurse is educating the patient in the use of a mini-nebulizer. What should the nurse encourage the patient to do? (Select all that apply.)

Hold the breath at the end of inspiration for a few seconds. Cough frequently. Frequently evaluate progress.

A client is seen in the emergency room for a case of diabetic acidosis with the presence of Kussmaul respirations. What client condition is associated with the presence of Kussmaul respirations?

Hyperventilation

Somnolence and hypotension Tachycardia and tachypnea Impaired swallowing Persistent high tracheostomy cuff pressure

Impaired swallowing Persistent high tracheostomy cuff pressure Tachycardia and tachypnea

A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply.

Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange

Which of the following are clinical manifestations associated with obstructive sleep apnea (OSA)? Select all that apply.

Insomnia Arrhythmias Loud snoring Excessive daytime sleepiness Impotence

A pediatrician diagnosed a child with swollen and inflamed adenoids. The nurse practitioner confirmed the diagnosis by:

Inspecting the roof of the nasopharynx.

Which ventilator mode provides a combination of mechanically assisted breaths and spontaneous breaths?

Intermittent mandatory ventilation (IMV)

The nursing instructor is teaching students about types of lung cancer. Which type of lung cancer is characterized as fast growing and can arise peripherally?

Large cell carcinoma

Late complications of radiation therapy may include which of the following? Select all that apply.

Laryngeal necrosis Edema Fibrosis

With which diagnostic studies would the nurse screen the client for an allergy to iodine?

Lung scan Fluoroscopy Pulmonary angiography

he nurse is working on a busy respiratory unit. In caring for a variety of clients, the nurse must be knowledgeable of diagnostic studies. With which diagnostic studies would the nurse screen the client for an allergy to iodine? Select all that apply.

Lung scan Fluoroscopy Pulmonary angiography

Complications of acute pharyngitis

Mastoiditis, otitis media, peritonsillar abcess

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.

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

Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply.

Montelukast Zafirlukast Zileuton

he nurse is reviewing first-line pharmacotherapy for smoking abstinence with a client diagnosed with COPD. The nurse correctly includes which medications? Select all that apply.

Nicotine gum Bupropion SR Nortriptyline

An experienced nurse is assisting and notes air movement over the trachea to the upper lungs. The air movement is noted equally on inspiration as expiration. Which breath sounds would the nurse document?

Normal bronchovesicular sounds

The student nurse is learning breath sounds while listening to a client in the physician's office. An experienced nurse is assisting and notes air movement over the trachea to the upper lungs. The air movement is noted equally on inspiration as expiration. Which breath sounds would the nurse document?

Normal bronchovesicular sounds

he nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurement best reflects the adequacy of alveolar ventilation?

PaCO2

A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important?

PaO2

A client has hypoxemia of pulmonary origin. What portion of arterial blood gas results is most useful in distinguishing between acute respiratory distress syndrome and acute respiratory failure?

Partial pressure of arterial oxygen (PaO2)

Which type of pneumonia has the highest incidence in clients with AIDS and clients receiving immunosuppressive therapy for cancer?

Pneumocystis

During a preadmission assessment, the nurse finds increased tactile fremitus. She knows this sign is consistent with which of the following diagnoses?

Pneumonia

A client who has just had a triple-lumen catheter placed in his right subclavian vein complains of chest pain and shortness of breath. His blood pressure is decreased from baseline and, on auscultation of his chest, the nurse notes unequal breath sounds. A chest X-ray is immediately ordered by the physician. What diagnosis should the nurse suspect?

Pneumothorax

The nurse is assessing a client for obstructive sleep apnea (OSA). Which are signs and symptoms of OSA? Select all that apply.

Polycythemia Loud snoring Insomnia

S/s of OSA

Polycythemia, loud snoring, insomnia

A nurse assesses a client with pneumonia. Which assessments are diagnostic for pneumonia? Select all that apply.

Presence of crackles Egophony Wheezes Whispered pectoriloquy Percussion dullness

he nurse is performing a nutritional assessment on a client who has been diagnosed with cancer of the larynx. Which laboratory values would be assessed when determining the nutritional status of the client? Select all that apply.

Protein level Albumin level Glucose level

A patient exhibited signs of an altered ventilation-perfusion ratio. The nurse is aware that adequate ventilation but impaired perfusion exists when the patient has which of the following conditions?

Pulmonary embolism

A client presents to a physician's office complaining of dyspnea with exertion, weakness, and coughing up blood. Further examination reveals peripheral edema, crackles, and jugular vein distention. The nurse anticipates the physician will make which diagnosis?

Pulmonary hypertension

Bleeding from the drains at the surgical site or with tracheal suctioning may signal the occurrence of hemorrhage. Which of the following is a clinical manifestations associated with hemorrhage?

Rapid, deep respirations

The nurse assesses a patient for possible acute pharyngitis. Which of the following clinical manifestations are consistent with this diagnosis? Select all that apply.

Red pharyngeal membranes Swollen lymphoid follicles White-purple exudates on the back of the throat A temperature >100.4°F

he nurse assesses a patient for possible acute pharyngitis. Which of the following clinical manifestations are consistent with this diagnosis? Select all that apply.

Red pharyngeal membranes Swollen lymphoid follicles White-purple exudates on the back of the throat A temperature >100.4°F

A student nurse is working with a client who is diagnosed with head trauma. The nurse has documented Cheyne-Stokes respirations. The student would expect to see which of the following?

Regular breathing where the rate and depth increase, then decrease

client has a nursing diagnosis of ineffective airway clearance related to excessive mucus production. The best short-term goal is for the client to

Report decreased congestion.

The nurse, caring for a patient with emphysema, understands that airflow limitations are not reversible. The end result of deterioration is:

Respiratory acidosis

A nurse is caring for a client who was intubated because of respiratory failure. The client is now receiving mechanical ventilation with a preset tidal volume and number of breaths each minute. The client has the ability to breathe spontaneously between the ventilator breaths with no ventilator assistance. The nurse should document the ventilator setting as:

SIMV

A health care provider orders a beta-2 adrenergic agonist agent (bronchodilator) that is long-acting and administered only by inhaler. What medication does the nurse anticipate will be administered?

Salmeterol

Which diagnostic test for maxillary and frontal sinusitis

Sinus aspirates

An adult client has just been diagnosed with small cell lung cancer. The client asks the nurse why the doctor is not offering surgery as a treatment for his cancer. What fact about lung cancer treatment should inform the nurse's response?

Small cell cancer of the lung grows rapidly and metastasizes early and extensively.

A nurse is responsible for monitoring indicators of potential complications after laryngectomy. Which indicators would be priority concerns? Select all that apply.

Somnolence and hypotension Tachycardia and tachypnea Impaired swallowing Persistent high tracheostomy cuff pressure

A client with COPD has been receiving oxygen therapy for an extended period. What symptoms would be indicators that the client is experiencing oxygen toxicity? Select all that apply.

Substernal pain Dyspnea Fatigue

A client involved in a motor vehicle crash suffered a penetrating injury to the chest wall and was brought to the emergency department. The nurse assesses the client for which clinical manifestation that would indicate the presence of a pneumothorax?

Sucking sound at the site of injury

An x-ray of a trauma client reveals rib fractures and the client is diagnosed with a small flail chest injury. Which intervention should the nurse include in the client's plan of care?

Suction the client's airway secretions.

Why would a client with COPD report feeling fatigued? Select all that apply.

The client is using all expendable energy just to breathe. Lung function gradually decreases over time in clients with COPD.

A client has had laryngeal surgery. What are the expected client outcomes? Select all that apply.

The client's suture line remains intact. The client can manage his or her own secretions. The client maintains an adequate caloric intake.

A nurse observes a new environmental services employee enter the room of a client with severe acute respiratory syndrome. Which action by the employee requires immediate intervention by the nurse?

The employee enters the room wearing a gown, gloves, and a mask.

An client is described as having pectus carinatum. What would be the physical manifestation of this condition?

The sternum protrudes and the ribs are sloped backward.

Perfusion refers to blood supply to the lungs, through which the lungs receive nutrients and oxygen. What are the two methods of perfusion?

The two methods of perfusion are the bronchial and pulmonary circulation.

A commonly prescribed methylxanthine used as a bronchodilator is which of the following?

Theophylline

client with a decreased level of consciousness is in a recumbent position. How should the nurse best assess the lung fields for a client in this position?

Turn the client to enable assessment of all the patient's lung fields.

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

The nurse documents breath sounds that are soft, with inspiratory sounds longer than expiratory and found over the periphery of the lungs. Which of the following will the nurse chart?

Vesicular

Which of the following are indicators that a client is ready to be weaned from a ventilator? Select all that apply.

Vital capacity of 13 mL/kg Tidal volume of 8.5 mL/kg PaO2 of 64 mm Hg

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?

Wheezes

A client is chronically short of breath and yet has normal lung ventilation, clear lungs, and an arterial oxygen saturation SaO2 of 96% or better. The client most likely has:

a possible hematologic problem.

Understanding pulmonary physiology, what characteristic would the nurse expect to result in decreased gas exchange in older adults?

alveolar capillaries containing fewer capillaries

Understanding pulmonary physiology, what characteristic would the nurse expect to result in decreased gas exchange in older adults?

alveolar walls containing fewer capillaries

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?

angina

The nurse is caring for a client reporting chest discomfort. The client's diagnosis at admission is left lower lobe pneumonia. Which strategy will the nurse instruct the client to use to help alleviate the discomfort?

assume left side lying position in bed

A client with pulmonary hypertension has a positive vasoreactivity test. What medication does the nurse anticipate administering to this client?

calcium channel blockers

A thoracentesis is performed to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnostic purposes. What does serous fluid indicate?

cancer

Which drug is second-line pharmacotherapy for smoking abstinence

clonidine

Which term refers to lung tissue that has become more solid in nature as a result of a collapse of alveoli or an infectious process?

consolidation

A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma?

cromolyn sodium

Which ventilation-perfusion ratio is exhibited by a pulmonary embolus?

dead space

A home health nurse sees a client with end-stage chronic obstructive pulmonary disease. An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met?

decreased oxygen requirements

A patient is admitted to the hospital with pulmonary arterial hypertension. What assessment finding by the nurse is a significant finding for this patient?

dyspnea

client who is diagnosed with chronic respiratory failure will have which symptom?

dyspnea

When the nurse is assessing the older adult patient, what gerontologic changes in the respiratory system should the nurse be aware of? (Select all that apply.)

ecreased gag reflex Increased presence of collagen in alveolar walls Decreased presence of mucus

Which of the following is a common irritant that acts as a trigger of asthma?

esophageal reflux

A hospitalized client with terminal heart failure is nearing the end of life. The nurse observes which of the following breathing patterns?

increased then decreased depth and rate with periods of apnea

Which of the following is an age-related change associated with the lung?

increased thickness of alveolar membranes

A pediatrician diagnosed a child with swollen and inflamed adenoids. The nurse practitioner confirmed the diagnosis by:

inspecting roof of nasopharynx

A client with chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit. To help this client maintain a patent airway and achieve maximal gas exchange, the nurse should:

instruct the client to drink at least 2 L of fluid daily.

A new nurse auscultates adventitious breath sounds but is not sure what to document and confers with an experienced nurse. This experienced nurse documents a pleural friction rub. Which of the following did the experienced nurse do during her assessment to identify the rub

instructed client to hold her breath

Which of the following are indicators that a client is ready to be weaned from a ventilator?

ital capacity of 13 mL/kg Tidal volume of 8.5 mL/kg PaO2 of 64 mm Hg

A patient's lung volumes and capacities were assessed to help determine the cause of a respiratory problem. Which of the following findings are indicative of chronic obstructive pulmonary disease (COPD)?

ital capacity of 3,000 mL

A client who has been diagnosed with an early glottis cancer would likely undergo which type of surgery?

laser microsurgery

A client presents to the ED reporting severe coughing episodes. The client states that "the episodes are more intense at night." The nurse should suspect which of the following conditions based on the client's primary report?

left sided heart failure

It is important for the nurse to provide required information and appropriate explanations of diagnostic procedures to clients with respiratory disorders in order to

manage decreased energy levels.

young male client has muscular dystrophy. His PaO2 is 42 mm Hg with a FiO2 of 80%. Which of the following treatments would be least invasive and most appropriate for this client?

negative pressure ventilator

Upon palpation of the sinus area, what would the nurse identify as a normal finding?

no sensation during palpation

The nurse, caring for a patient with emphysema, understands that airflow limitations are not reversible. The end result of deterioration is:

respiratory acidosis

Which of the following ventilation-perfusion mismatch would correlate with acute respiratory distress syndrome (ARDS)?

silent unit

nfluenza, an annual epidemic in the U.S., creates a significant increase in hospitalizations and an rise in the death rates from pneumonia and cardiovascular disease. Besides death, what is the most serious complication of influenza?

staphylococcal pneumonia

Bacterial infection occurs in about 70% of those who have acute rhinosinusitis. The nurse is aware that the least common bacteria is:

staphylococcus aureus

The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment?

tachypnea

A client is receiving theophylline for long-term control and prevention of asthma symptoms. Client education related to this medication will include

the importance of blood tests to monitor serum concentrations.

A nurse is caring for a client who has frequent upper respiratory infections. Which structure is most helpful in protecting against infection?

tonsils

A thoracentesis is performed to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnostic purposes. What does bloody fluid results indicate?

trauma

A client with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the client has been prescribed?

with meals

A client admitted to the facility for treatment for tuberculosis receives instructions about the disease. Which statement made by the client indicates the need for further instruction?

"I'll stay in isolation for 6 weeks."

A client is being evaluated for possible lung cancer. Which client statement most likely indicates lung cancer?

"My cough has changed from a dry cough to one with lots of sputum production."

Approximately what percentage of people who are initially infected with TB develop active disease?

10%

Normally, approximately what percentage of the blood pumped by the right ventricle does not perfuse the alveolar capillaries?

2%

HSV-1 incubation period

2-12 days

How long should you leave in epistaxis packing

2-6 days

How much fluid between pleurae

20 ml or less

4L via nasal cannula will give what percent o2

23-42%

Oxygen is a drug, and therefore needs a physician order. Your patient has been ordered to have oxygen at 4 liters per minute per nasal cannula. The nurse know that this flow rate will provie the patient with what percentage of oxygen:

23-42%

Cyanosis, which is a late indicator of hypoxia, is present when the unoxygenated hemoglobin level is:

5 g/dL

A client has a tracheostomy but doesn't require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for

5-20 min

A client comes to the health clinic after a positive skin test for tuberculosis. What additional diagnostic tests should the nurse begin teaching the client? Select all that apply.

A chest radiograph Complete history and physical examination Drug susceptibility testing

A client with emphysema informs the nurse, "The surgeon will be removing about 30% of my lung so that I will not be so short of breath and will have an improved quality of life." What surgery does the nurse understand the surgeon will perform?

A lung volume reduction

A nurse is instructing a client who is scheduled for a perfusion lung scan. What teaching should the nurse include in the information about the procedure? Select all that apply.

A mask will be placed over the nose and mouth during the test. The client will be expected to lie under the camera. The imaging time will amount to 20 to 40 minutes.

A patient is to receive an oxygen concentration of 70%. What is the best way for the nurse to deliver this concentration?

A partial rebreathing mask

A client with thoracic trauma is admitted to the ICU. The nurse notes the client's chest and neck are swollen and there is a crackling sensation when palpated. The nurse consequently identifies the presence of subcutaneous emphysema. If this condition becomes severe and threatens airway patency, what intervention is indicated?

A tracheostomy

Which type of lung cancer is the most prevalent among both men and women?

Adenocarcinoma

The nurse is caring for a client who has recurrent sinusitis. Which consideration could the nurse suggest to best decrease the frequency of infections?

Administer an over-the-counter decongestant.

A client with exacerbation of chronic obstructive pulmonary disease (COPD) is scheduled for a thoracentesis. Which nursing intervention would be appropriate for client safety?

Administering a cough suppressant as needed

Early sign of laryngeal cancer

Affected voice sounds

n which statements regarding medications taken by a client diagnosed with COPD do the drug name and the drug category correctly match? Select all that apply.

Albuterol is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid.

The nursing instructor is discussing pulmonary arterial hypertension with the nursing students. What would the instructor describe as the pathophysiology of secondary pulmonary arterial hypertension?

Alveolar destruction causes increased resistance and pressure in the pulmonary vascular bed.

A patient visited a health care clinic for treatment of upper respiratory tract congestion, fatigue, and sputum production that was rust-colored. Which of the following diagnoses is likely based on this history and inspection of the sputum?

An infection with pneumococcal pneumonia

A patient is brought into the emergency department with carbon monoxide poisoning after escaping a house fire. What should the nurse monitor this patient for?

Anemic hypoxia

The nurse is interviewing a patient who says he has a dry, irritating cough that is not "bringing anything up." What medication should the nurse question the patient about taking?

Angiotensin converting enzyme (ACE) inhibitors

The nurse auscultated a patient's middle lobe of the lungs for abnormal breath sounds. To do this, the nurse placed the stethoscope on the:

Anterior surface of the right side of the chest, between the fourth and fifth rib.

What is the most commonly prescribed treatment for the common cold?

Antihistamines

A nurse is assigned to a client diagnosed with emphysema. In prioritizing the care for the shift, which intervention should the nurse choose first?

Apply oxygen therapy as ordered.

The nurse is caring for a client who is demonstrating signs of increased respiratory distress related to laryngeal obstruction. The nurse is calling the physician to report on the client's condition. Which of the following will the nurse report? Select all that apply.

Arterial blood gases reporting a PaCO2 of 48 and a PaO2 of 84 Nasal flaring with abdominal retractions Lung sounds of wheezing Increased respiratory effort

he nurse knows that a sputum culture is necessary to identify the causative organism for acute tracheobronchitis. What causative fungal organism would the nurse suspect?

Aspergillus

Complications of teacheostomy

Aspiration, infection, injury to laryngeal nerve

Which ventilator mode provides full ventilatory support by delivering a preset tidal volume and respiratory rate?

Assist control

An adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Ordered respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure?

At bedtime

Discharge instructions for acute viral rhinosinusotis

Avoid air travel