Med Surg Exam 2 (semester1) Respiratory Module

A patient scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx asks you, "How will I talk after the surgery?" Your best response is:

"You will have a permanent opening into your neck, and you will need to have rehabilitation for some type of voice restoration." FEEDBACK: Voice rehabilitation is planned after a total laryngectomy, and a variety of assistive devices are available to restore communication. Although the ability to communicate orally is changed, it would not be appropriate to tell a patient that this ability would be lost. Artificial voice devices do not permit normal-sounding speech. In a total laryngectomy, the vocal cords are removed, so normal speech is impossible.

Beta 1 vs Beta 2 receptors reactions when stimulated by SABA

*Beta-1*: heart muscle stimulation --> increased rate (chronotropic) & strength (inotropic) *Beta-2*: lungs --> smooth muscle relaxation, vasodilation, bronchodilation -target Beta 2 to *treat asthma* vs. beta blockers which ??

2nd generation antihistamines 2 differences from 1st gen drugs.

- Claritin (Loratidine) - Clarinex (Desloratidine) - Certizine (Zyrtec) less sedation not as potent

You palpate the posterior chest while the patient says "99" and note that no vibration is felt. How should this be charted?

. Absent tactile fremitus To assess for tactile fremitus, the nurse should use the palms of the hands to assess for vibration when the patient repeats a word or phrase such as "99." Different techniques are used to assess for dullness to percussion, decreased breath sounds, and diminished expansion.

INR (international normalized ratio) with coumadin

0.8-1.2 2-3

Normal HCO3 range

22-29 mEq/L

1 tbsp = ___ tsp Tbsp = ____ mL 1 tsp = _____ mL

3 15mL 5mL

The right lung has how many lobes?

3 lobes (superior, middle, inferior) middle lobe is susceptible to pneumonia b/c of angle of bronchus

Complete airway obstruction can result in permanent brain damage or death in ___minutes!

3 to 5

normal % for band neutrophils

3-5%

Normal blood pH Normal PaCO2 HCO3 PaO2

7.35-7.45 35-45 mmHg 21-28 mEq/L 80-100 mmHg

Persistent allergic rhinitis

> 4 days per week AND > 4 weeks

What intervention is unique to the isolation precautions related to Mr. TB man? A. Don an N95 respirator mask and then enter the room. B. Put on a nonpermeable gown before entering the room. C. Wear nonsterile gloves when touching the client's body. D. Maintain separation of 3 feet between the client and other

A

Which of the following if shared by Mr. M. B. (suspected COPD) would help most in confirming a diagnosis of chronic bronchitis? •A. The patient complains about a productive cough every winter for 3 months. •B. The patient denies having any respiratory problems until the last 6 months. •C. The patient's history indicates a 40 pack-year cigarette history. •D. The patient tells the nurse about a family history of bronchitis.

A

Which client has the highest risk for developing a pulmonary embolism? A. Obese client with leg trauma that needed Sx B. Pregnant client with acute asthma C. Client with diabetes who has cholecystitis D. Client with pneumonia who is immunodeficient

A Any major orthopedic surgery creates Pt risk for clot development Also if pt becomes immobile this is another risk factor

For which client is it most essential for the nurse to implement measures to prevent pulmonary embolism? A. 59-year-old who had a knee replacement B. 60-year-old who has bacterial pneumonia C. 68-year-old who had emergency dental surgery D. 76-year-old who has a history of thrombocytopenia

A Thrombocytopenia ==> lack of platelets (thrombus - clot/platelets, cytopenia - lack of cells) ==> at risk for bleeding not clot

Postural drainage with percussion and vibration is ordered twice daily for Mr. M. B. because of chronic bronchitis. You should plan to: A. carry out the procedure 3 hours after the patient eats. B. maintain the patient in the lateral position for 20 minutes. C. perform percussion before assisting the patient to the drainage position. D. give the ordered albuterol (Proventil) after the patient has received the therapy.

A lateral position only held for 5 minutes albuterol should be admin'd before therapy

You should place Mr. A (dx pneumonia) in a room with which of the following patients? •A. A 20-year-old in traction for multiple fractures of the left lower leg. •B. A 35-year-old with recurrent fever of unknown origin. •C. A 50-year-old who received chemotherapy 2 days ago •D. An 89-year-old with Alzheimer's disease awaiting nursing home placement.

A young pt with no immune suppression or infection

When administering albuterol (Proventil) to relieve severe asthma, you should be monitoring for which of the following common side effects? Select all that apply. A. Tremors B. Lethargy C. Palpitations D. Visual disturbances E. Decreased pulse rate

A + C Tremors + Palpitations

When teaching Mr. M. B. (COPD) about using MDI (metered dose inhaler), what should you include? Select all that apply. A. Open your mouth and hold the inhaler 1 to 2 inches away. B. Hold breath for 10 seconds after inhaling the medication. C. Shake all inhalers before using. D. Ipratropium and albuterol (Combivent) cause bronchodilation in different ways and are therefore combined to improve the effect. E. Rinse your mouth with water after using Advair to prevent infection.

A , B, C, D, E

status epilepticus

A condition in which seizures recur every few minutes or last more than 30 minutes.

What can you identify in the patient history that put her at risk for the present illness of pulmonary embolism? Select all that apply. A. Use of birth control pills B. Smoking C. Occupation of computer programmer D. Previous pregnancies E. Female sex

A, B, C being currently pregnant is a risk NOT previous pregnancy Occupation with inc levels of sitting (the new smoking)

The teaching plan for a patient with acute sinusitis will need to include which of the following interventions (select all that apply)? A. Taking a hot shower will increase sinus drainage and decrease pain. B. Over-the-counter (OTC) antihistamines can be used to relieve congestion and inflammation. C. Saline nasal spray can be made at home and used to wash out secretions. D. Blowing the nose forcefully should be avoided to decrease nosebleed risk. E. You will be more comfortable if you keep your head in an upright position. T

A, B, C, & E A. Taking a hot shower will increase sinus drainage and decrease pain. B. Over-the-counter (OTC) antihistamines can be used to relieve congestion and inflammation. C. Saline nasal spray can be made at home and used to wash out secretions. E. You will be more comfortable if you keep your head in an upright position. T The steam and heat from a shower will help thin secretions and improve drainage. Antihistamines can be used. Patients can use either OTC sterile saline solutions or home-prepared saline solutions to thin and remove secretions. Maintaining an upright posture decreases sinus pressure and the resulting pain. Blowing the nose after a hot shower or using the saline spray is recommended to expel secretions.

Which of the following is correct about PPD test? Select all that apply. A. Also known as Mantoux test. B. Determines antibody response to TB bacillus within 48 to 72 hours C. Positive finding confirms active TB. D. BCG vaccine of Mycobacterium bovis may cause a false positive reaction. E. Immunocompromised clients may not have a positive reaction despite being infected with M. tuberculosis.

A, B, D, E

A patient with TB has been admitted to the hospital and is placed in an airborne infection isolation room. Which of the following should the patient be taught (select all that apply)? A. Expect routine TST to evaluate infection. B. Visitors will not be allowed while in airborne isolation. C. Take all medications for full length of time to prevent multidrug-resistant TB. D. Wear a standard isolation mask if leaving the airborne infectionisolation room. E. Maintain precautions in airborne infection isolation room by coughing into a paper tissue.

A, C, D, & E A. Expect routine TST to evaluate infection. (Tuberculin Skin test) C. Take all medications for full length of time to prevent multidrug-resistant TB. D. Wear a standard isolation mask if leaving the airborne infection isolation room. E. Maintain precautions in airborne infection isolation room by coughing into a paper tissue. To reduce antibiotic-resistant tuberculosis, the patient must take multiple drugs for 2 to 6 months or longer. If patients need to be out of the negative-pressure room, they must wear a standard isolation mask to prevent exposure to others. Teach patients tocover the nose and mouth with paper tissue every time they cough, sneeze, or produce sputum. If a person has a positive reaction to thetuberculin skin test, he or she should not be tested again because the sensitivity to tuberculin persists throughout life. Nurses and visitorsmust wear high-efficiency particulate air (HEPA) masks when entering the patient's room.

Which of the following is true about the pharmacological management of TB? Select all that apply A. For active TB, drugs are given in combination over a prolonged time period. B. TB medication available in oral, IM, and IV forms. C. Isoniazid (INH, Nydrazid) interferes with mycobacterial cell-wall synthesis . D. Isoniazid (INH, Nydrazid) is given for inactive TB to prevent its activation. E. One of the major adverse reactions of TB drugs is hepatitis.

A, C, D, E B: usually oral meds given in community, not all meds come in all forms

M.J. has been prescribed Benadryl (diphenhydramine) to manage allergic rhinitis symptoms. Which of the following is true concerning the use of Benadryl? (Select all that apply) A.Benadryl is a 1st-generation antihistamine. B.Using Benadryl may cause bradycardia. C.Operating machinery and driving may be dangerous because of sedative effect. D.Use of this medication may cause constipation and dry mouth. E.Benadryl may also cause paradoxic stimulation

A, C, D, E 1st generatin = more potent benadryl may cause TACHYcardia benadryl may cause Inc in HR even though it's sedative

To decrease the risk of recurrent pneumonia, pneumococcal vaccine is order. Which of the following statements regarding this vaccine is correct? Select all that apply A.Pneumococcal vaccine should be given every 5 years. B. Pneumococcal vaccine is given IV. C. Pneumococcal vaccine should be given at the time of discharge. D. Pneumococcal vaccine can be given at the same time with flu vaccine. E. If Mr. A cannot remember when received his pneumococcal vaccine, he should be vaccinated anyway.

A, C, D, E B - NOT correct b/c it's admin'd IM

Based on the history of Mr. B, it is very likely that he was exposed to TB many years ago but the exposure was not active until recently. Which of the following is correct about inactive TB? Select all that apply. A. It is also known as latent TB. B. The patient didn't show symptoms right after exposure because the incubation period for TB microorganism is several years. C. TB microorganism was engulfed by WBC and made inactive. D. The inactivation period depends on the microorganisms that cause TB. E. The inactive TB becomes active when the person's immunity is compromised.

A, C, E

One of your nursing diagnoses for Mr. A (pneumonia dx) is "Ineffective Airway Clearance". Which of the following nursing interventions are appropriate for this nursing diagnosis? Select all that apply. A. Consult respiratory therapist for chest physiotherapy. B. Limit fluid intake. C. Administer bronchodilators as prescribed D. Have the patient on flat position. E. Teach and assist patient in performing coughing and breathing maneuvers.

A, C, E Want to encourage fluids to loosen mucus

You're about to collect a sputum culture from the patient w/ pneumonia. Which of the following statements is TRUE about sputum collection? Select all that apply. A. a sterile sample is needed for the test. B. the specimen should be collected via nasotracheal suction only. C. the patient must brush his teeth before the specimen is obtained. D. the specimen must be collected before antibiotic administration E. the purpose of the sample is to identify the causing agent.

A, D, E B is an option but NOT necessary C (jury is out on)

You are obtaining a health history from a 67-year-old patient with a 40pack-year smoking history, complaints of hoarseness and tightness in the throat, and difficulty swallowing. Which question is most important to ask? A. "How much alcohol do you drink in an average week?" B. "Do you have a family history of head or neck cancer?" C. "Have you had frequent streptococcal throat infections?" D. "Do you use antihistamines for upper airway congestion?"

A. "How much alcohol do you drink in an average week?" Prolonged alcohol use and smoking are associated with the development of laryngeal cancer, which the patient's symptoms and history suggest. Family history is not a risk factor for head or neck cancer. Voice rehabilitation is planned after a total laryngectomy, and a variety of assistive devices are available to restore communication.

Which information will you include in the patient teaching plan for a patient who is receiving rifampin (Rifadin) for treatment of tuberculosis? A. "Your urine, sweat, and tears will be orange colored." B. "Read a newspaper daily to check for changes in vision." C. "Take vitamin B6 daily to prevent peripheral nerve damage." D. "Call the health care provider if you notice any hearing loss."

A. "Your urine, sweat, and tears will be orange colored." Orange-colored body secretions are a side effect of rifampin. The other adverse effects are associated with other antituberculosis medications. B6 prevents neuritis caused by isoniazid

After 2 months of tuberculosis (TB) treatment with a standard four-drug regimen, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should you take next? A. Ask the patient whether medications have been taken as directed. B. Discuss the need to use some different medications to treat the TB. C. Schedule the patient for directly observed therapy three times weekly. D. Educate about using a 2-drug regimen for the last 4 months of treatment.

A. Ask the patient whether medications have been taken as directed. The first action should be to determine whether the patient has been compliant with drug therapy because negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. Depending on whether the patient has been compliant or not, different medications or directly observed therapy may be indicated. A two-drug regimen will be used only if the sputum smears are negative for AFB.

Which of the following is part of the lower respiratory track? A. Bronchi B. Pharynx C. Larynx D. Sinuses

A. Bronchi

Which of the following should be a priority nursing diagnosis for a patient who acquired bacterial pneumonia? A. Impaired gas exchange B. Fatigue C. Fluid volume excess D. Anxiety

A. Impaired gas exchange

Respiratory rhythm is regulated by which of the following brain structures? A. Medulla oblangata B. Limbic system C. Cereberal cortex D. Thalamus

A. Medulla oblangata

Treatment for C.J. (Asthma attack) is started immediately. Select the initial interventions that you would anticipate to be implemented for C.J. Select all that apply. A. Oxygen by mask to keep SpO2 at 90% B. Albuterol (Proventil, Ventolin) by nebulizer q20min for three treatments C. Ipratropium (Atrovent) added to the initial short-term β-agonist treatment D. Insertion of intravenous catheter and IV fluids for hydration E. Administration of IV sodium bicarbonate F. IV methylprednisolone q4-6hr

A. O2 > = 90 B: albuterol C: Ipratropium / Atrovent D: IV fluids Not E: if we think patient is going to status asthmaticus this would be appropriate

Which of the following is expected to find in ABG of a patient with bilateral pneumonia? A. PaO2 60 mmHg B. PaO2 80 mmHg C. PaO2 90 mmHg D. PaO2 100 mmHg

A. PaO2 60 mmHg

While receiving an adrenergic beta2 agonist drug for asthma, the client complains of palpitations, chest pain, and a throbbing headache. What is the most appropriate nursing action? A. Withhold the drug until additional orders are obtained. B. Tell the client not to worry; these are expected side effects from the medicine. C. Ask the client to relax; then give instructions to breathe slowly and deeply for several minutes. D. Explain that the effects are temporary and will subside as the body becomes accustomed to the drug.

A. Withhold the drug until additional orders are obtained. These drugs cause increased heart contraction (positive inotropic effect) and increased heart rate (positive chronotropic effect). If toxic levels are reached, side effects occur and the drug should be withheld until the health care provider is notified.

A CXR is ordered. To confirm the diagnosis of active TB, the CXR should confirm the presence of:

A. numerous small, nodular lesions

A staff nurse has a tuberculosis (TB) skin test of 16-mm induration. A chest radiograph is negative, and the nurse has no symptoms of TB. The occupational health nurse will plan on teaching the staff nurse about the A. use and side effects of isoniazid (INH). B. standard four-drug therapy for TB. C. need for annual repeat TB skin testing. D. bacille Calmette-Guérin (BCG) vaccine.

A. use and side effects of isoniazid (INH). The nurse is considered to have a latent TB infection and should be treated with INH daily for 6 to 9 months. The four-drug therapy would be appropriate if the nurse had active TB. TB skin testing is not done for individuals who have already had a positive skin test. BCG vaccine is not used in the United States and would not be helpful for this individual, who already has a TB infection.

When teaching the patient who is receiving standard multidrug therapy for tuberculosis (TB) about possible toxic effects of the antitubercular medications, you will give instructions to notify the health care provider if the patient develops A. yellow-tinged skin. B. changes in hearing. C. orange-colored sputum. D. thickening of the fingernails.

A. yellow-tinged skin. Noninfectious hepatitis is a toxic effect of isoniazid (INH), rifampin, and pyrazinamide, and patients who develop hepatotoxicity will need to use other medications. Changes in hearing and nail thickening are not expected with the four medications used for initial TB drug therapy. Orange discoloration of body fluids is an expected side effect of rifampin and not an indication to call the health care provider.

How do you differentiate between anterior and posterior nasal bleeding?

A.Anterior bleeding is easily visualized. B.Anterior bleeding account for 90% of nose bleeding. C.Posterior bleeding is more life-threatening.

You initiate steps to rule out strep infection in S.M. If left untreated, a Group A beta-hemolytic streptococcal infection may result in: ___3___ What are the lab tests needed to be completed __2__

A.Peritonsillar abscess B.Rheumatic fever C.Sepsis Perform rapid strep test and throat culture

TB is suspected. A PPD test is ordered and administered. The result of Mr. B will be considered positive for TB if he, after 48 hours, develops an induration that measures which of the following? *Consider that he now has HIV+ diagnosis added to his health history. A. 5 mm B. 7 mm C. 8 mm D. 12 mm

A: 5 mm

A week later, Mr. TB reports difficulty hearing. Which medication should you consider is related to this response? A. Streptomycin B. Pyrazinamide C. Ethambutol D. Isoniazid (INH)

A: streptomycin 🡪 amino-glycoside - ototoxicity is adverse effect, if new onset hearing difficulty might have to change med

Which of the following is part of the respiratory tract? Choose all that apply. A. Bronchi B. Pharynx C. Larynx D. Sinuses

ABCD

Pt complains of scratchy throat. You see white patches and swollen, red tonsils Dx? What origin?

Acute pharyngitis of Viral origins

Emergency Medicine ABCs

Airway Breathing Circulation

When choosing antibiotic for pneumonia.. always choose ____ first. (rule #1) Rule #2: do NOT ____ rule #3: if ____ you can use the drug

Always start with a beta-lactam if possible esp. in severe infections. #2: compare MICs between drugs (min concentration to inhibit growth) #3 less than or equal EXCEPTION: drug does not get to site of action, achieve pharmacodynamics parameters, does not have inducible resistance, patient-specific factors, cost

Tidal volume

Amount of air that moves in and out of the lungs during a normal breath

posterior nose bleed potential complications______ & ______

Aspiration & bleeding does not stop spontaneously

In ______ the airways overreact to common stimuli with bronchospasm, edematous swelling of mucous membranes, and production of thick/tenacious mucus. > airway obstruction is intermittent

Asthma

M.J. (allergic rhinitis) is prescribed Flunisolide spray (intranasal corticosteroid). Which of the following statements from M.J. requires CORRECTION by the nurse? A.This medication may take several days or weeks to have maximum effect. B.I should continue taking Flunisolide if I develop a sinus infection. C.I should use Flunisolide on a daily basis for it to work properly. D.There might be mild nasal burning and stinging when I use Flunisolide.

B (it is okay to take daily IF pt is having syx of congestion)

You are reviewing the charts for five patients who are scheduled for their yearly physical examinations in October. Which of the following patients will require the inactivated influenza vaccination (select all that apply)? A. A 56-year-old patient who is allergic to eggs B. A 36-year-old female patient who is pregnant C. A 42-year-old patient who has a 15 pack-year smoking history D. A 30-year-old patient who takes corticosteroids for rheumatoid arthritis E. A 24-year-old patient who has allergies to penicillin and the cephalosporins.

B & D B. A 36-year-old female patient who is pregnant D. A 30-year-old patient who takes corticosteroids for rheumatoid arthritis Current guidelines suggest that healthy individuals between 6 months and age 49 receive intranasal immunization with live, attenuated influenza vaccine. Individuals who are pregnant, have chronic medical conditions, or are immunocompromised should receive inactivated vaccine. The corticosteroid use by the 30-year-old increases the risk for infection. Individuals with egg allergies should not receive inactivated flu vaccine because it is made using eggs.

Pt is having an asthmatic attack Which nursing activity would be your highest priority at this point? A. Obtaining a detailed health history B. Obtaining C.J.'s pulse oximetry reading C. Administering oxygen via nasal cannula D. Asking C.J.'s tennis partner to call C.J.'s family

B - get pulse ox reading

Which of the following respiratory physiological changes occur as a result of aging? A. Increase elastic recoil B. Decrease functioning alveoli C. Increase cough force D. Increase response to high CO2 level

B decreased fcnal alveoli

You are discharging C.D. (bacterial sinusitis) from the ED. Which of the following will you include in discharge instructions? (Select all that apply) A.It is OK to smoke or be around smoke. B.Drink 6-8 glasses of water daily to loosen secretions and stay hydrated. C.Report a temperature of over 38C. D.Perform vigorous exercise to increase circulation to the area. E.Take hot showers or use a humidifier to promote drainage of secretions.

B, C, E

You are performing tuberculosis (TB) screening in a clinic that has many patients who have immigrated to the United States. Before doing a TB skin test on a patient, which question is most important for you to ask? A. "Is there any family history of TB?" B. "Have you received the bacille Calmette-Guérin (BCG) vaccine for TB?" C. "How long have you lived in the United States?" D. "Do you take any over-the-counter (OTC) medications?"

B. "Have you received the bacille Calmette-Guérin (BCG) vaccine for TB?" Patients who have received the BCG vaccine will have a positive Mantoux test. Another method for screening (such as a chest x-ray) will need to be used in determining whether the patient has a TB infection. The other information also may be valuable but is not as pertinent to the decision about doing TB skin testing.

The following 4 patients are diagnosed with pneumonia. Which one should you see the first? A. 30 years old; febrile; RR 18; SpO2 94%; hacking cough B. 45 years old; febrile; RR 23; SpO2 88%; thick productive cough C. 64 years old; afebrile; RR 20; SpO2 96%; no cough D. 72 years old; febrile; RR 19; SpO2 94%; no cough

B. 45 years old; febrile; RR 23; SpO2 88%; thick productive cough

The functional unit of the respiratory system is A. Bronchioles B. Alveoli C. Bronchi D. Surfactant

B. Alveoli

Which of the following respiratory physiological changes occur as a results of aging? A. Increase elastic recoil B. Decrease functioning alveoli C. Increase cough force D. Increase response to high CO2 level

B. Decrease functioning alveoli

You obtain the following assessment data in a 76-year-old patient who has influenza. Which information will be most important to communicate to the health care provider? A. Fever of 100.4° F (38° C) B. Diffuse crackles in the lungs C. Sore throat and frequent cough D. Myalgia and persistent headache.

B. Diffuse crackles in the lungs The crackles indicate that the patient may be developing pneumonia, a common complication of influenza, which would require aggressive treatment. Myalgia, headache, mild temperature elevation, and sore throat with cough are typical symptoms of influenza and are treated with supportive care measures such as over-the-counter (OTC) pain relievers and increased fluid intake.

A client is admitted to the hospital with a diagnosis of an exacerbation of asthma. What should you plan to do to best help this client? A. Determine the client's emotional state. B. Give prescribed drugs to promote bronchiolar dilation. C. Provide education about the impact of a family history. D. Encourage the client to use an incentive spirometer routinely.

B. Give prescribed drugs to promote bronchiolar dilation. Asthma involves spasms of the bronchi and bronchioles, as well as increased production of mucus. This decreases the size of the lumina, interfering with inhalation and exhalation. Bronchiolar dilation will reduce airway resistance and improve the client's breathing.

Vancomycin is prescribed for a client with bacterial pneumonia. The prescriber orders a trough level of Vancomycin. You should have the laboratory obtain a blood sample from the client: A. Halfway between two IVPB administrations B. Immediately before administering the IVPB C. Anytime it is convenient for the client and laboratory D. after the administration of the first dose.

B. Immediately before administering the IVPB

Pneumocystis pneumonia is a pulmonary fungal infection commonly seen in: A. Patients with lung cancer B. Patients with AIDS C. Patients with cystic fibrosis D. Patients with CODP

B. Patients with AIDS

Which action should you take first when a patient develops a nosebleed? A. Pack both nares tightly with 1/2-inch ribbon gauze. B. Pinch the lower portion of the nose for 10 minutes. C. Prepare supplies that will be needed for cauterization. D. Apply ice compresses over the patient's nose and cheeks.

B. Pinch the lower portion of the nose for 10 minutes. The first nursing action for epistaxis is to apply direct pressure by pinching the nostrils. Application of cold packs may decrease blood flow to the area somewhat, but will not be sufficient to stop bleeding.

Which of these nursing actions can the RN working in a long-term care facility delegate to an experienced LPN/LVN who is caring for a patient with a permanent tracheostomy? A. Assessing the patient's risk for aspiration B. Suctioning the tracheostomy when needed C. Educating the patient about self-care of the tracheostomy D. Determining the need for replacement of the tracheostomy tub.

B. Suctioning the tracheostomy when needed

Which of the following would cause the medulla oblongata to increase the respiratory rate?Top of Form

B. Too much carbon dioxide in blood stream

On auscultation of a patient's lungs, you hear short, high-pitched sounds during exhalation in the lower 1/3 of both lungs. You should record this finding as A. expiratory crackles at the bases. B. expiratory wheezes in both lungs. C. abnormal lung sounds in the bases of both lungs. D. pleural friction rub in the right and left lower lobes.

B. expiratory wheezes in both lungs.

A patient with a pleural effusion is scheduled for a thoracentesis. Before the procedure, you will plan to A. start a peripheral intravenous line to administer the necessarysedative drugs. B. position the patient sitting upright on the edge of the bed and leaning forward. C. remove the water pitcher and remind the patient not to eat or drink anything for 6 hours. D. instruct the patient about the importance of incentive spirometer use after the procedure.

B. position the patient sitting upright on the edge of the bed and leaning forward. When the patient is sitting up, fluid accumulates in the pleural space at the lung bases and can more easily be located and removed. The lung will expand after the effusion is removed; incentive spirometry is not needed to assure alveolar expansion. The patient does not usually require sedation for the procedure, and there are no restrictions on oral intake because the patient is not sedated or unconscious.

The physician orders CBC with differentials. Which of the following findings in CBC would confirm the diagnosis of pneumonia?

Band Neutrophils at 15% (normal = 3-5%)

Based on the clinical presentation, the physician is suspecting pneumonia. Assuming the diagnosis is accurate, when you auscultate Mr. A's chest, you expect to hear:

Bronchial breath sounds ??????? (lung tissue has consolidated therefore changes to bronchial sounds) In patients with lobar pneumonia, the normal, air-filled lung instead contains fluid. As fluid transmits sounds better than air, vocal resonance is increased such that bronchophony, egophony, and whispered pectoriloquy might be present

Which of the following is NOT a common clinical manifestation of allergic rhinitis? A.Sneezing B.Watery eyes C.Purulent nasal discharge D.Watery nasal discharge

C

After discussing management of upper respiratory infections (URI) with a patient who has acute viral rhinitis, you determine that additional teaching is needed when the patient says: A. "I can take acetaminophen (Tylenol) to treat discomfort." B. "I will drink lots of juices and other fluids to stay hydrated." C. "I can use my nasal decongestant spray until the congestion is all gone." D. "I will watch for changes in nasal secretions or the sputum that I cough up."

C. "I can use my nasal decongestant spray until the congestion is all gone." You should clarify that nasal decongestant sprays should be used for no more than 3 days to prevent rebound vasodilation and congestion. The other responses indicate that the teaching has been effective.

Which of the following indicates pleural effusion? A. "Lately I can only breathe well if I sit up." B. "During the night I sometimes get the chills." C. "I get a sharp, stabbing pain when I take a deep breath." D. "I'm coughing up larger amounts of thicker mucus for the last several days."

C. "I get a sharp, stabbing pain when I take a deep breath." Tension is placed on the pleura at the height of inspiration and causes pain.

You palpate the posterior chest while the patient says "99" and note that no vibration is felt. How should this be charted? A. Diminished expansion B. Dullness to percussion C. Absent tactile fremitus D. Decreased breath sounds

C. Absent tactile fremitus

Which of the following is not a typical clinical manifestation of pneumonia? A. Dyspnea B. Productive cough C. Hoarseness D. Pleuritic pain

C. Hoarseness

When teaching the patient with allergic rhinitis about management of the condition, you should explain that A. over-the-counter (OTC) antihistamines cause sedation, so prescription antihistamines are usually ordered. B. corticosteroid nasal sprays will reduce inflammation, but systemic effects limit their use. C. Identification and avoidance of environmental triggers are the best way to avoid symptoms. D. use of oral antihistamines for a few weeks before the allergy season may prevent reactions.

C. Identification and avoidance of environmental triggers are the best way to avoid symptoms.

After a patient has undergone a septoplasty, which nursing intervention will be included in the plan of care? A. Educate the patient about how to safely remove and reapply nasal splint. B. Reassure the patient that the nose will look normal when the swelling subsides C. Instruct the patient to keep the head elevated for 48 hours to minimize swelling and pain. D. Teach the patient to use nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control.

C. Instruct the patient to keep the head elevated for 48 hours to minimize swelling and pain. Maintaining the head in an elevated position will decrease the amount of nasal swelling. NSAIDs increase the risk for postoperative bleeding and should not be used postoperatively.

Which of the following confirms the diagnosis of bacterial pneumonia? A. Dyspnea B. Hacking cough C. Leukocytosis D. Wheezes

C. Leukocytosis

The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action will you take? A. Repeat the tuberculin skin testing. B. Teach about the reason for the blood tests. C. Obtain consecutive sputum specimens from the patient for 3 days. D. Instruct the patient to expectorate three specimens as soon as possible.

C. Obtain consecutive sputum specimens from the patient for 3 days. Three consecutive sputum specimens are obtained on different days for bacteriologic testing for M. tuberculosis. The patient should not provide all the specimens at once. Blood cultures are not used for tuberculosis testing. Once skin testing is positive, it is not repeated.

Which of the following confirms the diagnosis of bacterial pneumonia? A. Dyspnea B. Hacking cough C. Positive sputum culture D. Infiltrates in CXR

C. Positive sputum culture

When assessing a client with pleural effusion, you expect to identify: A. Moist crackles at the posterior of the lungs B. Deviation of the trachea toward the involved side C. Reduced or absent breath sounds at the base of the lung. D. Increased resonance with percussion of the involved area

C. Reduced or absent breath sounds at the base of the lung. Compression of the lung by fluid that accumulates at the base of the lungs reduces lung expansion and air exchange.

A client is admitted to the hospital with a diagnosis of atrial fibrillation, and the practitioner suspects mitral valve stenosis. When obtaining a health history, the nurse determines that it is most significant if the client presents a history of: A. Cystitis at age 28 B. Pleurisy at age 20 C. Strep throat at age 12 D. German measles at age 6

C. Strep throat at age 12 strep infection can induce a hypersensitivity reaction to heart valve tissues.

A patient who had a total laryngectomy has a nursing diagnosis of hopelessness related to loss of control of personal care. Which information obtained by the nurse is the best indicator that the problem identified in this nursing diagnosis is resolving? A. The patient lets the spouse provide tracheostomy care. B. The patient allows the nurse to suction the tracheostomy. C. The patient asks how to clean the tracheostomy stoma and tube. D. The patient uses a communication board to request "No Visitors."

C. The patient asks how to clean the tracheostomy stoma and tube. Independently caring for the laryngectomy tube indicates that the patient has regained control of personal care and hopelessness is at least partially resolved. Letting the nurse and spouse provide care and requesting no visitors may indicate that the patient is still experiencing hopelessness. Independently caring for the laryngectomy tube indicates that the patient has regained control of personal care and hopelessness is at least partially resolved. Letting the nurse and spouse provide care and requesting no visitors may indicate that the patient is still experiencing hopelessness.

When auscultating a patient's chest while the patient takes a deep breath, you hear loud, high-pitched, "blowing" sounds at both lung bases. You will document these as Adventitious sounds are extra breath sounds such as crackles, wheezes, rhonchi, and friction rubs. Vesicular sounds are low-pitched, soft sounds heard over all lung areas except the major bronchi. A. normal sounds. B. vesicular sounds. C. abnormal sounds D. adventitious sounds

C. abnormal sounds The description indicates that you hear bronchial breath sounds that are abnormal when heard at the lung base.

You recognize that the goals of teaching regarding the transmission of pulmonary tuberculosis (TB) have been met when the patient with TB Show Grading Pane Show Poll A. demonstrates correct use of a nebulizer. B. washes dishes and personal items after use. C. covers the mouth and nose when coughing. D. reports daily to the public health department.

C. covers the mouth and nose when coughing. Covering the mouth and nose will help decrease airborne transmission of TB. The other actions will not be effective in decreasing the spread of TB.

When caring for a patient who is hospitalized with active tuberculosis (TB), you observe a family member who is visiting the patient. You will need to intervene if the family member A. washes the hands before entering the patient's room. B. hands the patient a tissue from the box at the bedside. C. puts on a surgical face mask before visiting the patient. D. brings food from a "fast-food" restaurant to the patient.

C. puts on a surgical face mask before visiting the patient. A high-efficiency particulate-absorbing (HEPA) mask, rather than a standard surgical mask, should be used when entering the patient's room because the HEPA mask can filter out 100% of small airborne particles. Hand washing before visiting the patient is not necessary, but there is no reason for the nurse to stop the family member from doing this. Because anorexia and weight loss are frequent problems in patients with TB, bringing food from outside the hospital is appropriate. The family member should wash the hands after handling a tissue that the patient has used, but no precautions are necessary when giving the patient an unused tissue.

Based on the clinical presentation, pulmonary embolism is suspected as a result of DVT (deep vein thrombosis). What is the non-invasive diagnostic study that can identify DVT? A. Echocardiogram B. D-Dimer C. Doppler ultrasound D. Spiral CT-scan

C: Doppler U/S Flowing blood changes the sound waves by the "Doppler effect." The ultrasound machine can detect these changes and determine whether blood within a vein is flowing normally. Absence of blood flow confirms the diagnosis of DVT.

4 Nursing interventions for serious epistaxis (Intervention for: emotions, posture, 2 for bleeding)

Calm the patient Position sitting up, leaning slightly forward Apply ice in 10 to 20 minute intervals to reduce bleeding and edema Apply direct pressure by squeezing the nostrils together for 5 to 15 minutes

Which of the following diagnostic studies is appropriate to confirm the diagnosis of pleural effusion?

Chest XR

When assessing the respiratory system of a 78-year-old patient, which finding indicates that you should take immediate action? A The chest appears barrel shaped. B. The patient has a weak cough effort. C. Crackles are heard from the lung bases to the midline. D. Hyperresonance is present across both sides of the chest.

Crackles are heard from the lung bases to the midline. Crackles in the lower half of the lungs indicate that the patient may have an acute problem such as heart failure. The nurse should immediately accomplish further assessments, such as oxygen saturation, and notify the health care provider. A barrel-shaped chest, hyperresonance to percussion, and a weak cough effort are associated with aging. Further evaluation may be needed, but immediate action is not indicated.

J.D. is discharging home with nasal packing in place. What teaching should you include? A.Remove the nasal packing later this evening. B.Use aspirin for pain relief. C.Skip your next dose of hypertension medication. D. Avoid vigorous nose blowing and strenuous activity

D

A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient? A. Complete a full physical examination to determine the systemic effect of the respiratory distress. B. Obtain a comprehensive health history to determine the extent of any prior respiratory problems. C. Delay the physical assessment and ask family members about any history of respiratory problems. D. Perform a respiratory system assessment and ask specific questions about this episode of respiratory distress.

D When a patient has severe respiratory distress, only information pertinent to the current episode is obtained, and a more thorough assessment is deferred until later. Obtaining a comprehensive health history or full physical examination is unnecessary until the acute distress has resolved. A focused physical assessment should be done rapidly to help determine the cause of the distress and suggest treatment.

Which of the following indicates that CJ (Asthma attack) is improving? Select all that apply. A. Decreased breath sounds B. Increased diaphoresis C. Inappropriate behavior D. SpO2 92% E. Louder wheezing

D E

Due to his dyspnea, oxygen 2 L/min via nasal cannula is ordered. In your recent assessment, Mr. A's respiration rate was 22 and SpO2 was 92%. What should be your next action? A. Call the physician B. Decrease the oxygen flow to 1 L/min. C. Increase the oxygen flow to 10 L/min. D. Increase the oxygen flow to 3 L/min.

D increase to 3L/min nasal cannula can only handle up to 6L/min

A patient with complicated deviated septum is hospitalized to have septoplasty. Which of the following findings must you report to the surgeon before the surgery? A. Serum sodium is 134 mEq/L. B. PT 12 seconds. C. Serum potassium is 4.8 mEq/L. D. Platelets counts is 120,000/ L

D low platelets Low platelets= high risk for bleeding (NL 150,000-400,000 per microliter) Na is close to normal (NL 135-145) K is normal (NL 3.5-5.0) PT is normal (NL 11-12.5 seconds)

Zosyn (Piperacellin) 3.375 g IVPB Q 6 hours is prescribed for a patient with bacterial pneumonia. The medication is mixed with a total of 50 mL of NS 0.9% and to be delivered over 30 minutes. At what mL/hr rate will you run the IV pump? A. 25 mL/hr. B. 50 mL/hr. C. 75 mL/hr. D. 100 mL/hr.

D. 100 mL/hr.

Review the following Culture and Sensitivity report of a sputum culture. What antibiotic do you expect the physician to prescribe for this patient? Ampicillin I Cephalothin R Erythromycin R Gentamicin S Oxacillin R A. Amoxicillin B. Cephacetrile C. Cefuroxime D. Gentamicin

D. Gentamicin I = intermediate R = resistant S = sensitive

You're reviewing sputum culture procedure with a student nurse. Which of the following statements if the student says requires correction? A. I should obtain the specimen first thing in the morning. B. I should collect sputum not saliva. C. I should start the antibiotic administration as soon as I collect the specimen. D. I should follow up with the lab regarding the results by the end of the shift.

D. I should follow up with the lab regarding the results by the end of the shift.

Who of the following is at highest risk to acquire pneumonia? ' A. Patient who has been using corticosteroid for 3 days. B. Patient who is 45 year and has COPD. C. Patient who has been a smoker for 5 years. D. Patient whose WBC counts is 2,000/mm3 post chemotherapy.

D. Patient whose WBC counts is 2,000/mm3 post chemotherapy. normal WBC = 4500-11000 WBC/mL

A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient? A. Complete a full physical examination to determine the systemic effect of the respiratory distress. B. Obtain a comprehensive health history to determine the extent of any prior respiratory problems. C. Delay the physical assessment and ask family members about any history of respiratory problems. D. Perform a respiratory system assessment and ask specific questions about this episode of respiratory distress.

D. Perform a respiratory system assessment and ask specific questions about this episode of respiratory distress.

A patient with complicated deviate septum is hospitalized to have septoplasty. Which of the following findings must you report to the surgeon before the surgery? A. Serum sodium is 134 mEq/L. B. PT 12 seconds. C. Serum potassium is 4.8 mEq/L. D. Platelets counts is 120,000/ L.

D. Platelets counts is 120,000/ L.

You are caring for a hospitalized 82-year-old patient who has nasal packing in place to treat a nosebleed. Which of the following assessment findings will require the most immediate action? A.The patient complains of level 7 (0 to 10 scale) pain. B. The patient's temperature is 100.1° F (37.8° C). C. The nose appears red and swollen. D. The oxygen saturation is 89%.

D. The oxygen saturation is 89%. Feedback and Review: Older patients with nasal packing are at risk of aspiration or airway obstruction. An O2 saturation of 89% should alert the nurse to assess further for these complications. The other assessment data also indicate a need for nursing action but not as immediately as the fall in O2 saturation.

You are caring for a hospitalized 82-year-old patient who has nasal packing in place to treat a nosebleed. Which of the following assessment findings will require the most immediate action? A. The patient complains of level 7 (0 to 10 scale) pain. B. The patient's temperature is 100.1° F (37.8° C). C. The nose appears red and swollen. D. The oxygen saturation is 89%.

D. The oxygen saturation is 89%. Older patients with nasal packing are at risk of aspiration or airway obstruction. An O2 saturation of 89% should alert the nurse to assess further for these complications.

Which information about a patient who has a recent history of tuberculosis (TB) indicates that you can discontinue airborne isolation precautions? A. Chest x-ray shows no upper lobe infiltrates. B. TB medications have been taken for 6 months. C. Mantoux testing shows an induration of 10 mm. D. Three sputum smears for acid-fast bacilli are negative.

D. Three sputum smears for acid-fast bacilli are negative. Negative sputum smears indicate that M. tuberculosis is not present in the sputum, and the patient cannot transmit the bacteria by the airborne route. Chest x-rays are not used to determine whether treatment has been successful. Taking medications for 6 months is necessary, but the multidrug-resistant forms of the disease might not be eradicated after 6 months of therapy. Repeat Mantoux testing would not be done since it will not change even with effective treatment.

Which information will the nurse include when teaching the patient with asthma about the prescribed medications? A. Utilize the inhaled corticosteroid when shortness of breath occurs. B. Inhale slowly and deeply when using the dry-powder inhaler (DPI). C. Hold your breath for 5 seconds after using the bronchodilator inhaler. D. Tremors are an expected side effect of rapidly acting bronchodilators.

D. Tremors are an expected side effect of rapidly acting bronchodilators. Tremors are a common side effect of short-acting b2-adrenergic (SABA) medications and not a reason to avoid using the SABA inhaler. Inhaled corticosteroids do not act rapidly to reduce dyspnea. Rapid inhalation is needed when using a DPI. The patient should hold the breath for 10 seconds after using inhalers.

_____ is an airway obstruction caused by deflection of bone and/or cartilage in the nasal septum causes?

Deviated septum: trauma or congenital

Which of the following isolation precautions should you use when caring for Mr. A with Pneumonia ?

Droplet precautions

Percussion of lungs normally elicits resonant sounds, while in pneumonia it elicits:

Dull sound - bc lung filled with fluid

Which of the following is correct (regarding Asthma Tx)? Select all that apply. A. Long-acting β-adrenergic agonist: Stimulates β-adrenergic receptors in bronchioles, effective for prevention of acute bronchospasm B. Short-acting β-adrenergic agonist: Stimulates β-adrenergic receptors in bronchioles, effective for treatment of acute bronchospasm C. Short-acting anticholinergic agent: Blocks bronchoconstrictive action of parasympathetic nervous system for 4 to 6 hours D. IgE antagonist: Decreases circulating free IgE levels E. All of the above

E short acting anticholinergic agent = SAMA ??

▪ Which of the following if found in Mr. B's chart history would explain why his inactive TB became active? A. Mr. B is homeless. B. Mr. B is homosexual. C. Mr. B has one functioning kidney. D. Mr. B is a heavy drinker. E. Mr. B is found to be HIV+

E. Mr. B is found to be HIV+

The thoracentesis is done. For which concerning response is it important to observe in Mr. B. immediately following the procedure? Select all that apply

EXPECTORATION OF BLOOD DECREASEED OR ABSENT BREATH SOUNDS

episodic allergic rhinitis

Episodic => s/s related to sporadic exposure to allergens not typically encountered

4 reasons for a tracheostomy

Establish a patent airway Bypass upper airway obstruction Facilitate removal of secretions Facilitate weaning from mechanical ventilation

who should receive the inactivated flu vaccine and who should receive the live attenuated vaccine. 65 year-old with COPD 9 month-old 71 year-old who lives in a nursing home 45 year-old who is diagnosed with AIDS 26 year-old healthy nursing student 27 year-old who is 30 weeks pregnant

Everyone receives the inactivated EXCEPT 26 year old > receives live attenuated

During thoracentesis and to prevent pneumothorax, you should encourage the patient to deep breath and cough.

FALSE deep breath would pull the lung downward and closer to the location of puncture site via thoracentesis

•Asthma has a progressive disease course while COPD has a stable disease course (T/F)

FALSE COPD is progressive Asthma is more stable disease

The physician prescribed heparin IV drip. Heparin is prescribed for Mrs. D to dissolve her existing DVT and PE. (T/F)

False. heparin does not dissolve clot, it prevents clot

▪ Since Mr. B is most likely having an active TB, his PPD can be read after 6-12 hours. (T/F)

False. 🡪 still have to read after 48 hrs but no later than 72 hrs

Tx for allergic rhinitis 1st line

First-line: nasal corticosteroid spray Oral medications: H1-antihistamines, decongestants, leukotriene receptor antagonists (LTRAs) Intranasal medications: antihistamines, corticosteroids, cromolyn, decongestants

Can you receive flu vaccine if you are allergic to eggs?

Flucelvax is a cell-based flu vaccine that uses cell culture technology to produce vaccines The influenza virus is grown in a mammalian cell culture instead of in hens' eggs

Heparin antidote? warfarin (BN:Coumadin) antidote?

Hep > Protamine sulfate Coumadin / warfarin - vitamin K

____3___ may result in inaccurate pulse oximetry readings as a result of impaired peripheral perfusion.

Hypotension, shock, or the use of peripheral vasoconstricting medications

______ has an effect on prostaglandins / plateletes that is reversible ______ has an irreversible effect on platelets

Ibuprofen (advil) Aspirin (ASA)

Which common meds should you refrain from giving Pt with heavy epistaxis?

Ibuprofen (advil) + Aspirin (ASA)

What would you expect to be TRUE about J.D.'s (10/10 nose bleed 2nd to boxing) vital signs?

Increased BP Increased HR pain may increase RR extended period of blood loss will decrease BP in long term.

After a patient has undergone a septoplasty, which nursing intervention will be included in the plan of care?

Instruct the patient to keep the head elevated for 48 hours to minimize swelling and pain. Maintaining the head in an elevated position will decrease the amount of nasal swelling. NSAIDs increase the risk for postoperative bleeding and should not be used postoperatively. The patient would not be taught to remove or reapply nasal packing, which is usually removed by the surgeon on the day after surgery. Although returning to a preinjury appearance is the goal of the surgery, it is not always possible to achieve this result.

Intermittent Allergic Rhinitis

Intermittent > s/s present LESS than 4 days/week or LESS than 4 weeks/year

TB patient contact precautions

Isolation: Airborne with negative pressure until noninfectious

what accounts for the difference in lenght of action b/w SABA and LABA

LABA (salmeterol) is 10,000-times more lipid soluble than the short acting beta-2 adrenoceptor agonist, albuterol. Unlike albuterol, salmeterol becomes dissolved in the lipid bilayer of the cell membrane, and its gradual dissociation from the cell membrane provides beta-2 adrenoceptors with a supply of agonist for an extended period of time

M.J.'s (allergic rhinitis) symptoms have become worse and montelukast (Singulair) is added to her medication list. Before M.J. can begin taking Singulair, which lab test should the prescriber check FIRST?

LFTs liver function test singulair (and most drugs) are cleared by the liver therefore want it functioning well first

Observe the fingers of Mr. A (Dx pneumonia). Mr. A's finger are clubbed due to:

Low O2 in the blood

What is a lung consolidation? What are potential causes?

Lung consolidation occurs when the air that usually fills the small airways in your lungs is replaced with something else. Depending on the cause, the air may be replaced with: a fluid, such as pus, blood, or water. a solid, such as stomach contents or cells.

3 main airborne pathogens

MTV - acronym for airborne pathogens, Measles, Tuberculosis, Varicella (shingles)

Nasal fracture +epistaxis pt is now stabilized. You observe a clear fluid draining from J.D.'s left ear. What might this indicate?

May have sustained a skull fracture halo sign may represent a basilar skull fracture. > halo sign means something different in radiology Positive results are indicated by blood coalescing into the center, leaving an outer ring of cerebrospinal fluid.

pH PaCO2 PaO2 HCO3 - 7.31 44 mmHg 66 mmHg 18 mEq/L

Metabolic Acidosis

Five days later, A.R. (who initially had a cold) informs you that his symptoms are worse and now he has a fever of 104F and greenish sputum. What will you anticipate for his care?

NOW you can Rx Antibiotics likely 2ndary bacterial infection/ was immune suppressed due to initial viral rhinitis Other symptoms of secondary bacterial infection: Tender, swollen glands Severe sinus or ear pain

seasonal allergic rhinitis

Often occurs in the spring / fall via exposure to pollen from tree flowers grasses or weeds

Heparin IV drip starting at 700 units is ordered. To evaluate the effectiveness of heparin, you should be monitoring which of the following tests?

PTT Partial thromboplastin time (PTT) is a blood test that looks at how long it takes for blood to clot. It can help tell if you have a bleeding problem or if your blood does not clot properly. Heparin (7 letters) + PTT (3 letters) = 10 Warfarin (8 letters) + PT (2 letters) = 10

Purpose of: PTT PT/INR D-Dimer

PTT - Heparin test - evaluates effectiveness, drug is an anti-coagulator, looks at how long takes patients blood to clot, high PTT means longer amount of time for blood to clot ▪ Heparin does not dissolve clot itself, only prevents new clots from forming PT/INR - Warfarin (Coumadin) test - evaluates effectiveness, drug is an anti-coagulator, # used if taking patient long time to clot o D-Dimer - use this test to confirm a pulmonary embolism, (+) result is confirmation, looks for a protein that's secreted from clot in bloodstream

Which action should you take first when a patient develops a nosebleed?

Pinch the lower portion of the nose for 10 minutes. The first nursing action for epistaxis is to apply direct pressure by pinching the nostrils. Application of cold packs may decrease blood flow to the area somewhat, but will not be sufficient to stop bleeding. Cauterization or nasal packing may be needed if pressure to the nares does not stop bleeding, but these are not the first actions to take for nosebleed.

Pneumocystis pneumonia (PCP) is a serious infection caused by the fungus ______

Pneumocystis jirovecii. normally opportunistic infection in HIV/AIDS pts

______ is one of the serious complications of thoracentesis.

Pneumothorax

Pt with nose fracture is scheduled for rhinoplasty. 3 important things important for preop management?

Prior medications Food intake Past Sx and Anesthesia hx > concern for malignant hyperthermia

M.B.'s arterial blood gas results are: pH 7.31 PaO2 68 mm Hg PaCO2 58 mm Hg HCO3 32 mEq/L SaO2 85% You recognize that these findings indicate what respiratory status is present in M.B.?

Respiratory Acidosis dec pH Increased CO2 Increased Bicarbonate decreased PaO2 (does not necessarily indicate resp/metabolic)

R.O.M.E. acronym

Respiratory Opposite Metabolic Equal Metabolic Acidosis - pH Low, HCO3 Low. Metabolic Alkalosis - pH High, HCO3 High. Respiratory Acidosis - pH Low, pCO2 High. Respiratory Alkalosis - pH High, pCO2 Low.

pH PaCO2 PaO2 HCO3- 7.31 49 mmHg 65 mmHg 24 mEq/L

Respiratory acidosis

pH PaCO2 PaO2 HCO3 - 7.50 31 mmHg 90 mmHg 26 mEq/L

Respiratory alkalosis

What does A.R. need to treat the symptoms of his cold (viral rhinitis)? 4 common at home Tx - for potential fever/ pain 6 very basic Txs for sinus congestion

Rest, oral fluids, antipyretics, analgesics Warm salt water gargles, ice chips, lozenges, sprays may alleviate a sore throat Saline nasal sprays, decongestant sprays (but no longer than 3 days!)

Med that causes orange urine color?

Rifampin

Ipratropium / Atrovent is what class of drug?

SAMA short-acting muscarinic antagonists,

You are discussing symptom relief and infection control with pt with Strep throat. What will you provide in your teaching? (6)

Salt water gargles: ½ tsp in 8 oz water Drink cool, bland liquids; gelatin Use cool mist vaporizer Do not share utensils Throw out toothbrush Contagious until 24-48 hours of antibiotics! Take entire course of antibiotics, even if you feel better!

________ is used to diagnose asthma, chronic obstructive pulmonary disease (COPD) and other Restrictive disorder (pneumonia, tb, lung cancer pulmonary fibrosis)

Spirometry

Since this is a community-acquired pneumonia, what organisms are likely to be causing Mr. A's pneumonia? *Think most common for CAP.

Streptococcus pneumoniae

Treatment for someone with active TB?

TB drugs 3 drugs for9 -12 months, Active TB (isoniazid (INH) + rifampin + pyrazinamide (PZA) sometimes added in ethambutol or streptomycin)

True or False? Because the pressure of CO2 is higher in the blood vessels than the pressure of CO2 in the lungs, the CO2 moves from the blood to the lungs.

TRUE

ENT consulted for epistaxis with continuous bleeding. 2 interventions?

The ENT specialist applies a nasal ointment that includes topical lidocaine & epinephrine Lidocaine = anesthetic Epinephrine = vasoconstrictor The bleeding continues, so the ENT uses a pledget (nasal tampon) impregnated with COCAINE (b/c strong vasoconstrictor)

Pulmonary embolism initial symptoms?

The most common initial symptom in pulmonary embolism is chest pain that is sudden in onset. The next most commonly reported symptom is dyspnea, which is accompanied by an increased respiratory rate.

While continuing M.B.'s assessment, you recognize that sometimes it is difficult to distinguish COPD from asthma. However, there are some clinical features that are different. Select the correct statements below about asthma vs. COPD.

The onset of asthma usually before the age of 40. Smoking is the number one cause of COPD. There is always dyspnea with COPD but it is occasional with asthma

You have completed patient teaching about the administration of salmeterol (Serevent) using a metered-dose inhaler (MDI). Which action by the patient indicates understanding of the teaching?

The patient attaches a spacer before using the MDI.

Pleural effusion on LEFT side and Physical examination reveals mild pallor. His pulse is regular rhythm and rate is at 110 beats/min and his blood pressure is 120/82 mmHg. Respiratory rate is 26/min, SpO2 88% the trachea is shifted _____ left side of chest moves ___(less/more)___ with respiration

The trachea is shifted to the RIGHT side and the apical impulse is shifted laterally. The LEFT side of the chest moves LESS with respiration. Tactile vocal fremitus is reduced. On percussion, a stony dull note is elicited on the left side and this dullness does not shift with a change in posture. Breath sounds and vocal resonance are almost absent on the LEFT side. Abdominal, cardiovascular and neurological examinations are normal. The rest of the physical examination is unremarkable.

Post rhinoplasty pt is prescribed Bactrim. Why and what do you need to teach pt? What do you teach patient about the packing post Sx?

This is an antibiotic taken prophylactically, because he is at high risk for infection. packing is taken out 1-2 days after Sx IN CLINIC

pursed lip breathing facilitates CO2 release because _____

This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation

_____ is a procedure used to obtain a sample of fluid from the space around the lungs, called the pleural space.

Thoracentesis

Cervical lymph nodes are normally not palpable, but viral or bacterial infections can cause lymph nodes to swell. (T/F)

True

Due to lung consolidation caused by pneumonia, the tactile fremitus is expected to increased in case of Mr. A (T/F)

True increased tactile fremitus (inc vibration)

sinusitis can be caused by

Viral - usually follows upper respiratory infection Bacterial - S.pneumoniae, H.influenzae, M.catarhallis Fungal (rare) > typically in immune compromised

A specimen for a trough level (lowest serum drug concentration) is drawn ____when____. A specimen for a peak level (highest serum drug concentration) is drawn ____when?___

about 30 minutes before the next scheduled vancomycin dose 30 to 60 minutes after medication administration

pleural effusion

accumulation of fluid in pleural cavity; prevents lungs from fully expanding Pleural cavity = space b/w visceral and parietal layer.

When auscultating a patient's chest while the patient takes a deep breath, you hear loud, high-pitched, "blowing" sounds at both lung bases. You will document these as

adventitious sounds The description indicates that you hear bronchial breath sounds that are abnormal when heard at the lung base. Adventitious sounds are extra breath sounds such as crackles, wheezes, rhonchi, and friction rubs. Vesicular sounds are low-pitched, soft sounds heard over all lung areas except the major bronchi

To estimate appropriate spirometry values you need patient's: (4)

age weight race height

Pneumothorax - caused by

air entering the pleural cavity, altering the negative pressure that exists between the visceral pleura (surrounding the lung) and the parietal pleura (lining the cavity)

The earliest detectable sign of acute respiratory distress syndrome is ____

an increased respiratory rate,

AC abbreviation HS

ante cibum before meals Hour of sleep before bed

epistaxis location can be

anterior or posterior

Status asthmaticus s/s:

anxiety, wheezing, tachypnea, tachycardia, dyspnea, possible chest tightness(usually no pain), accessory muscle use, prolonged expiratory phase -forcing each breath out, "pursed lip breathing", coughing, does not respond to usual treatment

bronchospasm + edematous swelling of mucous memb + tenacious mucus= _____

asthma

diff b/w asthma and chronic bronchitis ?

asthma is typically reversible

Beta 2 agonist causes _____ primarily but may also stimulate Beta 1 receptors and causes _____

bronchodilation tachycardia (albuterol is NON-selective) therefore both effects occur

Assess the _____ first in any patient at risk for acidosis because acidosis can lead to _____

cardiovascular system cardiac arrest from the accompanying hyperkalemia. If cardiac changes are present, respond by reporting these changes immediately to the health care provider.

_____ (respiratory disease) affects the respiratory bronchioles most severely. Usually more sever in the upper lung.

centriacinar or centrilobular emphysema

chronic cough + sputum ongoing for at least 3 months in 2 consecutive years

chronic bronchitis

In ______, infection or bronchial irritants cause increased secretions, edema, bronchospasm, and impaired mucociliary clearance. Inflammation of bronchial walls causes them to thicken

chronic bronchitis main difference btwn production of C.Bronchitis and asthma is the cause irritant/infection in C.B. vs. allergen(hypersensitivity/inflammatory process in asthma

Silicosis results from .____ years of exposure causes _____

chronic, excessive inhalation of particles of free crystalline silica dust. The client needs to wear a mask to limit inhalation of this substance, which can cause restrictive lung disease after years of exposure

Smoking damages ____what lung structures___

cilia, alveoli, and goblet cells

The client with pharyngitis needs to be instructed to consume ____ types of foods

cool clear fluids, ice chips, or ice pops to soothe the painful throat. Citrus products need to be avoided because they irritate the throat. Milk is avoided bec this can cause increase mucus production

In ___(disease)___ lung proteases collapse the walls of the bronchioles and alveolar air sacs. Walls collapse > bronchioles/alveoli lose elasticity with less surface area. >trapped air stagnates and cannot supply O2 to capillaries

emphysema

disease related to destruction of alveoli

emphysema

A 75-year-old patient breathing room air has the following arterial blood gas (ABG) results: pH 7.40, PaO2 72 mm Hg, SaO2 92%, PaCO2 40 mm Hg. An appropriate action by the nurse is to

encourage deep breathing and coughing to open the alveoli.

panacinar or panlobular emphysema affects _______ it is more severe in ______

entire acinar unit lower lung

flu vaccine can be received by _____

everyone > 6 months old but they receive the inactivated form

. On auscultation of a patient's lungs, you hear short, high-pitched sounds during exhalation in the lower 1/3 of both lungs. You should record this finding as

expiratory wheezes in both lungs. Wheezes are high-pitched sounds. In this case they are heard during the expiratory phase of the respiratory cycle. Abnormal breath sounds are either bronchial or bronchovesicular sounds heard in the peripheral lung fields. Crackles are low-pitched, "bubbling" sounds. Pleural friction rubs are grating sounds that are usually heard during both inspiration and expiration.

•Thick, tenacious sputum is seen in asthma but not COPD (T/F)

false both have lots of secretions. Definitely in COPD

Protein secreted by TB targets a protein in macrophage disrupting destructive process, allowing TB to ______

hide and multiply w/in macrophage

Which of the following diagnostic laboratory findings is expected in Mr. D's (DVT) case? Why?

high D-dimer Ordered for suspect DVT, PE, DIC D-dimers are NOT normally present in human blood plasma, EXCEPT when the coagulation system has been activated, for instance, because of the presence of thrombosis or disseminated intravascular coagulation

COPD often have chronic ________

hypoxia acidosis

hypoxia vs hypoxemia

hypoxia is decreaesd oxygen in tissues/cells; hypoxemia: decreased oxygen in blood stream

_____ is considered when a specific, unavoidable allergen is identified and drug therapy is not tolerated in controlling symptoms Series of injections exposing the patient to small amounts of the known allergen to decrease sensitivity Injections given at least weekly

immunotherapy

sinusitis is

inflammation of the sinuses or hypertrophy of the mucosa often blocking the ostia (openings)

TB is spread / contracted by _____

inhalation of droplets containing Mycobacterium Tb

The ____ is the amount of air a person can inhale forcefully after normal tidal volume inspiration; the _______ is the amount of air a person can exhale forcefully after a normal exhalation

inspiratory reserve volume expiratory reserve volume

LABA (name 2)

long acting beta agonist Salmeterol Formoterol

HGB (Hemoglobin) HCT

male 14-16.5 g/dl female 12-15 g/dl male 42-52% Female 35-47%

6 rights for medication administration

medication dose client route time documentation

pH PaCO2 PaO2 HCO3 - 7.48 45 mmHg 77 mmHg 30 mEq/L

metabolic alkalosis

Daily sputum specimens to be collected from Mr. TB. When is the most appropriate time to collect these specimens?

on awakening

Normal ABG values (5)

pH: 7.35-7.45. Partial pressure of oxygen (PaO2): 75 to 100 millimeters of mercury (mmHg). Partial pressure of carbon dioxide (PaCO2): 35 to 45 mmHg. Bicarbonate (HCO3): 21 to 28 milliequivalents per liter (mEq/L). Oxygen saturation (O2Sat or SaO2): 95 to 100%.

Mantoux test (PPD) - procedure? When is the test read? What indicates a positive?

protein inject intradermally (0.1 ml) and read 48-72 hrs later, looking for redness and elevation of skin (induration), looking at wheel (raised area of skin) 🡪 POSITIVE (doesn't necessarily mean active) o Induration > 15 mm - healthy person with no risk o Induration >10 mm - high risk person (IV drug user, immigrants, residents & employees in high risk areas, homeless) o Induration > 5 mm - Immunocompromised (i.e. HIV)

The most reliable and sensitive test of gas exchange is:

pulse oximetry

____ can happen if decongestant spray is used for > 3 days.

rebound congestion

ROME

respiratory opposite (pH and CO2) Metabolic equal (pH and bicarbonate)

_____is a disease involving abnormal collections of inflammatory cells that form lumps known as granulomata. Dry cough and dyspnea are typical early manifestations of_______

sarcoidosis pulmonary sarcoidosis

SABA (4 examples)

short acting beta agonist Albuterol Levosalbutamol Terbutaline Pirbuterol

At higher altitudes, the barometric pressure is lower, resulting in a lower inspired oxygen pressure and a lower PaO2. Patients with conditions like_____ must avoid high altitudes because as the oxygen availability decreases, the RBCs become sickling.

sickle cell anemia

Mr. A is a 68 year old man who developed a harsh, productive cough four days. The sputum is thick and yellow with streaks of blood . He developed a fever ,shaking, chills and malaise along with the cough. One day ago he developed pain in his right chest that intensifies with inspiration . The patient lost 15 lbs over the past few months but claims he did not lose his appetite. "I just thought I had the flu." Past history reveals that he had a chronic smoker's cough for "10 or 15 years" which he describes as being mild, non-productive and occurring most often in the early morning. He smoked 2 packs of cigarettes per day for the past 50 years. The patient is a retired truck driver who has been treated for mild hypertension, bronchitis, appendicitis (as a young adult), hemorrhoids and a fractured femur and splenic injury. (motorcycle accident). Patient reports having about 10 sexual partners in the last 5 years. What can you identify in the patient history that put him at risk for the present illness? Select all that apply.

smoking + recent flu

What must you determine before discontinuing airborne precautions for Mr. TB.?

sputum free from acid fast bacteria 3 consecutive days

C.J. (Asthma) has a minimal-to-moderate response to the initial treatment, and the health care provider orders IV methylprednisolone (Solu-Medrol) to be given. When explaining this drug to C.J.(recent asthma attack), you know that it is used to _____

suppress the inflammatory response and resulting mucus production. steroid leads to dec inflammatory response

Asthma is a chronic inflammatory disease of ______ Mast cell release of histamine leads to a ______ of the respiratory anatomy

the airways bronchoconstrictive process, bronchospasm, and obstruction.

obstructive disorders (respiratory)

those that interfere with airflow by NARROWING or BLOCKING the airway Asthma, Chr. Bronchitis, Emphysema

Surgically created stoma in the anterior portion of the trachea

tracheostomy

Epistaxis can be caused by _____

trauma, hypertension, low humidity, upper respiratory tract infections, allergies, sinusitis, foreign bodies, chemical irritants (such as street drugs), overuse of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, and tumors

The nurse verifies the placement of an ET tube immediately by _______, which ensures _____

ventilating the client using an Ambu bag and by auscultating for breath sounds bilaterally ventilation of both lungs.

perrenial allergic rhinitis

year round exposure to environmental allergens

Prior to developing a plan of care for M.B., you review the results of the other laboratory tests and the chest X-ray. Select the findings that you would expect to be present as a result of M.B.'s exacerbation of his COPD. Select all that apply.

•A. Electrolytes: HCO3 32 mEq/L (32 mmol/L) > (kidneys try and compensate by retaining HCO3 to offset acidosis) •B. Chest x-ray: Flattened diaphragm •CBC: RBC 6.8 × 10^6/µl (high b/c body trying to compensate for low o2 lvls > may increase HR b/c blood becomes thicker) normal RBC 4-5.5 x 10^6/uL for males

As you work to provide timely care to C.J.(recent asthma attack), which nursing activity would be most appropriate to delegate to nursing assistive personnel?

•A. Obtain and set-up oxygen delivery system.

The diet that you will order for M.B. (COPD pt) to best meet his nutritional needs is a

•A. high-calorie, high-protein diet. NOT high carb b/c CO2 is byproduct of carb metabolism

Based on the results of M.B.'s ABGs (has COPD), select the two interventions with the highest priority. M.B.'s arterial blood gas results are: pH 7.31 PaO2 68 mm Hg PaCO2 58 mm Hg HCO3 32 mEq/L SaO2 85%

•B. Increase the oxygen rate to 4 L/min after getting MD order. •D. Encourage M.B. to take deep breaths and cough, and use pursed-lip breathing. (allows more CO2 to get out with each breath)****

Pleural effusion is suspected. When assessing Mr. C, you should expect to identify: •A. Moist crackles at the posterior of the lungs •B. Deviation of the trachea toward the involved side •C. Reduced or absent breath sounds at the base of the lung •D. Increased resonance with percussion of the involved area

•C. Reduced or absent breath sounds at the base of the lung trachea MAY be deviated toward uninvolved side

In order to expedite M.B.'s (COPD) admission, you delegate responsibilities to Amy, the nursing assistant. Which of the following actions would be appropriate for nursing assistive personnel (NAP) to complete? Select all that apply. •Obtain patient's vital signs. •Apply telemetry monitor. •Obtain patient's past medical history. •Auscultate patient's lung sounds. Orient patient to call bell system, TV controls, and bed controls.

•Obtain patient's vital signs. •Apply telemetry monitor. (Can apply / CANNOT interpret) Orient patient to call bell system, TV controls, and bed controls.

While receiving an adrenergic beta2 agonist drug for asthma, CJ complains of increased palpitations, chest pain, and a throbbing headache. What is the most appropriate nursing action?

•Withhold the drug until additional orders are obtained