Introduction to Respiratory System - Med Surg

A nurse is caring for a client with an exacerbation of COPD and scheduled for pulmonary function studies using a spirometer. Which client statement would the nurse clarify?

"I will breathe in through my mouth and out through my nose."

The nurse is instructing the client on the normal sensations, which can occur when contrast medium is infused during pulmonary angiography. Which statement, made by the client, demonstrates an understanding.

"I will feel warm and an urge to cough."

The nurse is caring for a client who states, "I am worried about the thoracentesis. I know I won't be able to sleep tonight." Which statement is most helpful to the client at this time?

"Tell me what you are worried about."

The nurse is caring for a client with hypoxemia of unknown cause. Which of the following oxygen transport considerations does the nurse identify as crucial to circulate oxygen in the body system?

-Adequate red blood cells are needed for oxygen transport -Oxyhemoglobin circulates to the body tissue -Oxygen is dissolved

The nurse is performing a physical assessment on a client who has a history of respiratory infection. Which documentation, completed by the nurse, indicate the resolution of the infection? Select all that apply.

-Lung fields documented as clear in the bases -Palpable vibrations over the chest wall when the client speaks -Bronchovesicular sounds heard over the upper lung fields

The 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.

-Pulmonary angiography -Fluoroscopy -Lung scan

The nurse is caring for a client who is in respiratory distress. The physician orders arterial blood gases (ABGs) to determine various factors related to blood oxygenation. What site can ABGs be obtained from?

A puncture at the radial artery

The nurse working in the radiology clinic is assisting with a pulomary angiography. The nurse knows that when monitoring clients after a a pulmonary angiography, what should the physician be notified about?

Absent distal pulses

The nurse is caring for clients on the neurologic unit. Which triad of neurologic mechanisms does the nurse identify as most responsible, when there is abnormality in ventilation control?

Aortic arch, pons, and CO2 receptor sites.

The nurse is providing health education on the body's ability to exchange oxygen and carbon dioxide through the aveolar capillary membrane. Which statement, provided by the nurse is most correct when asked about diffusion during inspiration?

During inspiration, oxygen is greater in the alveoli than in the capillaries

A client arrives in the emergency department with a sharp object penetrating the diaphragm. When planning nursing care, which nursing diagnosis would the nurse identify as a priority.

Impaired gas exchange

The nursing instructor is discussing with senior nursing students about diagnostic procedures used in respiratory diseases. The instructor discusses thoracentesis, defining it as a procedure for diagnostic purposes or to aspirate accumulated excess fluid or air from the pleural space. What would the instructor tell the students purulent indicates?

Infection

The nurse is in the radiology unit of the hospital. The nurse is caring for a client who is scheduled for a lung scan. The nurse knows that lung scans need the use of radiostopes and a scanning machine. Before the perfusion scan, what must the client be assessed for?

Iodine allergy

What happens to the diaphragm during inspiration?

It contracts and flattens

The student nurse is learning breath sounds while listening to a client in the physician's office. An experienced nurse assists 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 nurse is caring for a client whose respiratory status has declined since shift report. The client has tachypnea, is restless, and displays cyanosis. Which diagnostic test should be assessed first?

Pulse oximetry

The nurse is analyzing the client's blood pH of 7.1. Which symptom would indicate that the client's body is working to stabilize?

Respirations are increasing

The client has just has an invasive procedure to assess the respiratory system. What does the nurse know should be assessed first on this client?

Respiratory distress

An 18-month-old is brought to the emergency department by his parents who explain that their child swallowed a watch battery. Radiologic studies show that the battery is in the lungs. Which area of lung is the battery most likely to be in?

Right upper lung

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 client presents to the emergency department in respiratory compromise. The client's temperature is 102.4°F, heart rate 88 beats/minute and regular, and blood pressure 138/76 mm Hg. The client is dyspneic, pale, and expectorating green-tinged sputum. The physician orders medications, including antibiotics, antipyretics, nebulizer treatments, and IV fluids. A chest X-ray and sputum culture are to be completed. Which physician order would the nurse complete before antibiotic therapy?

Sputum culture

A client arrives at the physician's office stating 2 days of febrile illness, dyspnea, and cough. Upon assisting the client into a gown, the nurse notes that the client's sternum is depressed, especially on inspiration. Crackles are noted in the bases of the lung fields. Based on inspection, which will the nurse document?

The client has a funnel chest

The client is returning from the operating room following a bronchoscopy. Which action, performed by the nursing assistant, would the nurse stop if began prior to nursing assessment?

The nursing assistant is pouring a glass of water to wet the client's mouth.

The nurse is studying for a physiology test over the respiratory system. What should the nurse know about central chemoreceptors in the medulla?

They respond to changes in CO2 levels and hydrogen ion concentration (pH) in the cerebrospinal fluid

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

Tonsils

A client arrives at the physician's office stating dyspnea; a productive cough for thick, green sputum, respirations of 28 breaths/minute, and a temperature of 102.8°F. The nurse auscultates the lung fields, which reveal poor air exchange in the right middle lobe. The nurse suspects a right middle lobe pneumonia. To be consistent with this anticipated diagnosis, which sound, heard over the chest wall when percussing, is anticipated.

Tympanic

What is the difference between respiration and ventilation?

Ventilation is the movement of air in and out of the respiratory tract.

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

The nurse is suctioning a client who is unable to expectorate respiratory secretions. At which point does the nurse expect the client to experience coughing?

When the catheter reaches the point of the carina

A is obtaining a health history from a client who reports hemoptysis for the past 2 months. The client reports occasional dyspnea. Which imaging study, ordered by the physician, will view the thoracic cavity while in motion?

Fluoroscopy

The nurse recieves an order to obtain a sputum sample from a client with hemopytsis. When advising the client of the physicians order, the cleint states not being able to produce sputum. Which suggestion, offered by the nurse, is helpful in producuing the sputum sample?

Take deep breaths and cough forcefully