NRSG 2300 Exam 3

what is it called when children are malnurished

failure to thrive (common with cystic fibrosis)

where does stool form in the intestines

in the colon. the further down the colon the more formed the stool will be because the colon is where the water is absorbed

interventions for COPD patients

2L oxygen take frequent rest perionds when performing ADLS check O2%sat

Normal newborn respiratory rate

30-60 breaths per minute

test for cystic fibrosis

Sweat chloride test

too much NSAIDS can cause?

bruising because they inhibit platelets from sticking together

chronic bronchitis

inflammation of the bronchi persisting over a long time

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client Sits in a straight-back chair and leans forward Exhales hard and fast with a single blow Records in a diary the number achieved after one breath Inhales deeply and holds the breath

Exhales hard and fast with a single blow To use a peak flow meter, the client stands. Then the client takes a deep breath and exhales hard and fast with a single blow. The client repeats this twice and records a "personal best" in an asthma diary.

how much water should a person with IBD consume a day?

1-2 L due to dehydration from diarrhea if the pt has heart disease as well they should have no more than 1.5L

how much oxygen should you give to a patient with COPD

2L. can slowly increase this amount but it's rare to go above this amount. An increase in oxygen levels disables receptors that detect CO2 so the body is no longer stimulated to breathe

normal O2%sat for a pt with COPD

94%

Which is the strongest predisposing factor for asthma? Congenital malformations Allergy Male gender Air pollution

Allergy Allergy is the strongest predisposing factor for asthma.

what tests are performed to determine ulceritive colitis?

Barium enema and colonoscopy

A client presents with an infection in the area between the internal and external sphincters. In which chronic disease is this condition commonly seen? diverticulosis irritable bowel syndrome Crohn's disease ulcerative colitis

Crohn's disease An anorectal abscess is common in clients with Crohn's disease.

A client is admitted to a health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client? Activity intolerance related to fatigue Anxiety related to actual threat to health status Risk for infection related to retained secretions Impaired gas exchange related to airflow obstruction

Impaired gas exchange related to airflow obstruction A patent airway and an adequate breathing pattern are the top priority for any client, making Impaired gas exchange related to airflow obstruction the most important nursing diagnosis. Although Activity intolerance, Anxiety, and Risk for infection may also apply to this client, they aren't as important as Impaired gas exchange.

Which of the following is the key underlying feature of asthma? Productive cough Chest tightness Shortness of breath Inflammation

Inflammation Inflammation is the key underlying feature and leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheeze, and dyspnea.

where is the pain for ulceritive colitis?

Lower right side, damage is done to the colon and usually localized to one area

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances? Respiratory acidosis Respiratory alkalosis Metabolic alkalosis Metabolic acidosis

Respiratory acidosis Increased carbon dioxide tension in arterial blood leads to respiratory acidosis and chronic respiratory failure. In acute illness, worsening hypercapnia can lead to acute respiratory failure. The other acid-base imbalances would not correlate with COPD.

The nurse is assigned to care for a patient in the ICU who is diagnosed with status asthmaticus. Why does the nurse include fluid intake as being an important aspect of the plan of care? (Select all that apply.) To relieve bronchospasm To assist with the effectiveness of the corticosteroids To facilitate expectoration To loosen secretions To combat dehydration

To facilitate expectoration To loosen secretions To combat dehydration The nurse also assesses the patient's skin turgor for signs of dehydration. Fluid intake is essential to combat dehydration, to loosen secretions, and to facilitate expectoration.

types of COPD

chronic bronchitis and emphysema

what will physical therapists do for a patient with COPD

develope a personalized exercise plan for the patient

what vaccinations are important for COPD patients

infuenza and pneumococcal 23

where can you hear low pitched sounds

large airways upper respiratory bronchi

indications that a newborn may have cystic fibrosis

maconium ileus

cystic fibrosis

ressessive gene inherited by both parents increase in mucus production cloggs panceas and makes it so they cannot properly digest their food mucusy stool fatty stool smelly stool mucus cloggs lungs requires pancreatic enzyme suppliments to be taken before meals and snacks

what is pleuritic pain

sharp, sticking pain upon breathing due to damage to the pleural space

first indications of COPD

shortness of breath decrease in oxygen levels more secretions produced in the morning lots of thick clear sputum

where can you hear high pitched sounds

smaller airways lower respiratory bronchioles

why should you avoid NSAIDS with IBD?

they cause flare ups

what is the number one thing a nurse should do to prevent the spread of infection?

wash hands

how should activity be done with asthma

with intermittent periods of rest

In COPD, the body attempts to improve oxygen-carrying capacity by increasing the amount of red blood cells. Which term refers to this process? Emphysema Asthma Polycythemia Bronchitis

Polycythemia Polycythemia is an increase in the red blood cell concentration in the blood. In COPD, the body attempts to improve oxygen-carrying capacity by producing increasing amounts of red blood cells.

Emphasema

a condition in which the air sacs of the lungs are damaged and trap air. A decrease in surface area causes breathlessness.

what connects the bag to a stoma?

a wafer

what is usually the first sign of pneumonia in the elderly?

confusion: temperatures in the elderly are usually lower so fevers don't register

patient teaching for preventing spread of infection

cover cough with sleeve wash hands frequently

when should corticosteriods be taken with IBD and asthma

only during flare-ups. long term or regular use can be dangerous

plan of care for a person with pneumonia

oxygen protect airway get up and move with lots of rest periods percussion therapy

maintenace for cystic fibrosis

pancreatic enzymes high fat and high protein diet percussion therapy to break up mucus

what immunizations are needed after age 65?

pneumococcal 23 and high dose infuenza

what to teach a patient with COPD to help them breath

postural changes, pursed-lip breathing (to keep alveoli from collapsing and promote removal of CO2), percussion therapy

what is the genetic condition that can contribute to the developement of COPD

Alpha 1 antitrypsin deficiency

Which vaccine should a nurse encourage a client with chronic obstructive pulmonary disease (COPD) to receive? Varicella Influenza Hepatitis B Human papilloma virus (HPV)

Influenza Clients with COPD are more susceptible to respiratory infections, so they should be encouraged to receive the influenza and pneumococcal vaccines. Clients with COPD aren't at high risk for varicella or hepatitis B. The HPV vaccine is to guard against cervical cancer and is recommended only for women ages 9 to 26.

describe a stoma

red beefy or cherry red opening created in the abdomen because a section of the intestines has been removed due to damage. the stoma should not be dark

COPD causes

smoking, air pollutants, work environment (toxic), infection, asthma, antitrypsin 1 deficiency, second hand smoke

what exersice is recomended for people with asthma

swimming because it requires rythmic deep and abdominal breathing

when to take medications prescribed for asthma

take bronchodilator for an attack because of side effects turn to corticosteroid after for maintenance but should not be used long term

why do hospitals want to discharge a patient as soon as possible

the chance of hospital-acquired infections increases every day the patient is there.

what does the nursing diagnosis "ineffective airway clearence" mean?

this would be an obstruction of some kind, like inflammation of the bronchi or bronchioles, foreign object in the lungs, or fluid build-up.

what does the nursing diagnosis "Ineffective breathing pattern" mean?

this would be shallow and rapid breathing. this is indicative of the type of breaths being taken

An admitting nurse is assessing a client with COPD. The nurse auscultates diminished breath sounds, which signify changes in the airway. These findings indicate to the nurse to monitor the client for what? Kyphosis and clubbing of the fingers Dyspnea and hypoxemia Sepsis and pneumothorax Bradypnea and pursed lip breathing

Dyspnea and hypoxemia These changes in the airway require that the nurse monitor the patient for dyspnea and hypoxemia. Kyphosis is a musculoskeletal problem. Sepsis and pneumothorax are atypical complications. Tachypnea is much more likely than bradypnea. Pursed lip breathing can relieve dyspnea.

A client is admitted to the facility with a productive cough, night sweats, and a fever. Which action is most important in the initial care plan? Wearing gloves during all client contact Monitoring the client's fluid intake and output Assessing the client's temperature every 8 hours Placing the client in respiratory isolation

Placing the client in respiratory isolation Because the client's signs and symptoms suggest a respiratory infection (possibly tuberculosis), respiratory isolation is indicated. Every 8 hours isn't frequent enough to assess the temperature of a client with a fever. Monitoring fluid intake and output may be required, but the client should first be placed in isolation. The nurse should wear gloves only for contact with mucous membranes, broken skin, blood, and other body fluids and substances.

lab test for infection

CBC: elevated WBC. decreased neutrophils indicate viral infection culture and sensitivity: identify bacteria and find out what medications will kill it

A nursing student knows that there are three most common symptoms of asthma. Choose the three that apply. Cough Wheezing Dyspnea Crackles

Dyspnea Wheezing Cough The three most common symptoms of asthma are cough, dyspnea, and wheezing. In some instances, cough may be the only symptom.

A nurse is evaluating the diagnostic study data of a client with suspected cystic fibrosis (CF). Which of the following test results is associated with a diagnosis of cystic fibrosis? Elevated sweat chloride concentration Presence of protein in the urine Positive phenylketonuria Decreased tidal volume

Elevated sweat chloride concentration Gene mutations affect transport of chloride ions, leading to CF, which is characterized by thick, viscous secretions in the lungs, pancreas, liver, intestine, and reproductive tract as well as increased salt content in sweat gland secretions. Proteinuria, positive phenylketonuria, and decreased tidal volume are not diagnostic for CF.

A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient? Chest pain during respiration Sputum and a productive cough Fever, chills, and diaphoresis Tachypnea and tachycardia

Sputum and a productive cough Chronic bronchitis, a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years.

COPD cardiac compensation

Tachycardia because there isn't enough oxygen to fuel the cells so the body circulates the blood faster to make up for it

do you have to wear a bag all the time with colostomy? ileosomy?

because colostomy has formed stool you can train your body when to eliminate stool and wear a cap when you go out. Ileostomy is liquid stool and there is no control over when it is eliminated so you need to wear the bag all the time

how to tell if its crohns?

because of the high danger of bowel perforations if there are bloody stools its likely Crohns

common problems with both crohns and ulcerative colitis

malnutrition dehydration

where is the pain for crohn's disease

on the right side but can damage multiple areas of the intestines

how do bronchodialators work?

act on smooth muscles in the bronchioles to widen the airway stimulates fight or flight response (sympathetic system) -heart rate increases -pupils dilate

environmental factors for asthmatics

carpet dirty air filters dust pets

What should a post surgery patient increase intake of to promote wound healing?

increase Protein and calcium, decrease sugar

A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue? "Raise your arms over your head." "Drink fluids upon arising from bed." "Sit in a chair whenever doing an activity." "Delay self-care activities for 1 hour."

"Delay self-care activities for 1 hour." Some clients with COPD have shortness of breath and fatigue in the morning on arising as a result of bronchial secretions. Planning self-care activities around this time may be better tolerated by the client, such as delaying activities until the client is less short of breath or fatigued. The client raising the arms over the head may increase dyspnea and fatigue. Sitting in a chair when bathing or dressing will aid in dyspnea and fatigue but does not address the situation upon arising. Drinking fluids will assist in liquifying secretions which, thus, will aid in breathing, but again does not address the situation in the morning.

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

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

The nurse is assessing a client who had an ileostomy created three days ago for the treatment of irritable bowel disease. The nurse observes that the client's stoma is bright red and there are scant amounts of blood on the stoma. What is the nurse's best action? Contact the care provider to have the client's hemoglobin and hematocrit measured Cleanse the stoma with alcohol or chlorhexidine Apply barrier ointment to the stoma as prescribed Document these expected assessment findings

Document these expected assessment findings Redness and slight bleeding are expected, so no further intervention or assessment is likely necessary.

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

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

A client with acquired immunodeficiency syndrome (AIDS) develops Pneumocystis cariniipneumonia. Which nursing diagnosis has the highest priority? Activity intolerance Impaired gas exchange Impaired oral mucous membranes Imbalanced nutrition: Less than body requirements

Impaired gas exchange Although all of these nursing diagnoses are appropriate for a client with AIDS, Impaired gas exchange is the priority nursing diagnosis for a client with P. carinii pneumonia. Airway, breathing, and circulation take top priority for any client.

Which measure may increase complications for a client with COPD? Increased oxygen supply Decreased oxygen supply Administration of antitussive agents Administration of antibiotics

Increased oxygen supply Administering too much oxygen can result in the retention of carbon dioxide. Clients with alveolar hypoventilation cannot increase ventilation to adjust for this increased load, and hypercapnia occurs. All the other measures aim to prevent complications.

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

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

A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess? Lung sounds Respiratory rate Skin color Heart rate

Lung sounds A client with COPD is at risk for developing pneumothorax. The description given is consistent with possible pneumothorax. Though the nurse will assess all the data, auscultating the lung sounds will provide the nurse with the information if the client has a pneumothorax.

A gerontologic nurse is teaching a group of medical nurses about the high incidence and mortality of pneumonia in older adults. What is a contributing factor to this that the nurse should describe? Older adults have less compliant lung tissue than younger adults. Older adults often cannot tolerate the most common antibiotics used to treat pneumonia. Older adults often lack the classic signs and symptoms of pneumonia. Older adults are not normally candidates for pneumococcal vaccination.

Older adults often lack the classic signs and symptoms of pneumonia. The diagnosis of pneumonia may be missed because the classic symptoms of cough, chest pain, sputum production, and fever may be absent or masked in older adult clients. Mortality from pneumonia in older adults is not a result of limited antibiotic options or lower lung compliance. The pneumococcal vaccine is appropriate for older adults.

Which of the following factors contribute to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Select all that apply. overinflated alveoli impair gas exchange. Inflamed airways obstruct airflow. Mucus secretions block airways. Dry airways obstruct airflow

Overinflated alveoli impair gas exchange. Inflamed airways obstruct airflow. Mucus secretions block airways. Because of the chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing (obstructive bronchiolitis). The airways are actually moist, not dry. In the proximal airways, changes include increased goblet cells and enlarged submucosal glands, both of which lead to hypersecretion of mucus.

When discharging a patient with a surgical incision, what should the nurse tell the patient to watch out for in regards to the incision site?

Pain, swelling, redness, and warm to the touch

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment? Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise Avoiding the use of oxygen to decrease the hypoxic drive Providing sufficient oxygen to improve oxygenation Increasing pH

Providing sufficient oxygen to improve oxygenation The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? Respiratory alkalosis Metabolic alkalosis Respiratory acidosis Metabolic acidosis

Respiratory acidosis As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

The nurse is caring for a patient with status asthmaticus in the intensive care unit (ICU). What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient? Respiratory alkalosis Respiratory acidosis Metabolic alkalosis Metabolic acidosis

Respiratory alkalosis Respiratory alkalosis (low PaCO2) is the most common finding in patients with an ongoing asthma exacerbation and is due to hyperventilation.

In the prevention of occupational lung diseases, the nurse would direct preventive teaching to which high-risk occupations? Select all that apply. Banker Stone cutter Miner Rock quarry worker Nurse Mechanic

Rock quarry worker Miner Stone cutter A quarry worker and stone cutter are exposed to rock dust and silica. A miner can inhale dust, causing silicosis or pneumoconiosis. A banker, nurse, and mechanic may have work hazards, but none specific to the development of an occupational lung disease.

Which technique does the nurse suggest to a client with pleurisy while teaching about splinting the chest wall? Turn onto the affected side. Avoid using a pillow while splinting. Use a prescribed analgesic. Use a heat or cold application.

Turn onto the affected side. The nurse teaches the client to splint the chest wall by turning onto the affected side. The nurse also instructs the client to take analgesic medications as prescribed and to use heat or cold applications to manage pain with inspiration. The client can also splint the chest wall with a pillow when coughing.

A nurse is caring for a client who is at high risk for developing pneumonia. Which intervention should the nurse include on the client's care plan? Turning the client every 4 hours to prevent fatigue Keeping the head of the bed at 15 degrees or less Providing oral hygiene daily Using strict hand hygiene

Using strict hand hygiene The nurse should use strict hand hygiene to help minimize the client's exposure to infection, which could lead to pneumonia. The head of the bed should be kept at a minimum of 30 degrees. The client should be turned and repositioned at least every 2 hours to help promote secretion drainage. Oral hygiene should be performed every 4 hours to help decrease the number of organisms in the client's mouth that could lead to pneumonia.

During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must: turn and reposition himself every 2 hours. follow up with the physician in 2 weeks. continue to take antibiotics for the entire 10 days. maintain fluid intake of 40 oz (1,200 ml) per day.

continue to take antibiotics for the entire 10 days. The client demonstrates understanding of how to prevent relapse when he states that he must continue taking the antibiotics for the prescribed 10-day course. Although the client should keep the follow-up appointment with the physician and turn and reposition himself frequently, these interventions don't prevent relapse. The client should drink 51 to 101 oz (1,500 to 3,000 ml) per day of clear liquids.

A client has a 10-year history of Crohn's disease and is seeing the physician due to increased diarrhea and fatigue. What is the recommended dietary approach to treat Crohn's disease? lactose-rich foods high-fiber diet low-fiber diet dietary approach varies.

dietary approach varies. The dietary approach varies. A high-fiber diet may be indicated when it is desirable to add bulk to loose stools. A low-fiber diet may be indicated in cases of severe inflammation or stricture. A high-calorie and high-protein diet helps replace nutritional losses from chronic diarrhea. The client may need nutritional supplements, depending on the area of the bowel affected. When the small intestine is inflamed, some clients experience lactose intolerance, requiring avoidance of lactose-rich foods.

indications of inflammation of the respiratory system

difficulty breathing wheezing on expiration (if severe then on both inspiration and expiration) respiratory rate of 35 restlessness diaphoresis (sweating) low oxygen levels increased heart rate emergency if breath sounds are absent

Ways to decrease mucus in COPD

encourage pt to dring 2 L of water a day take a mucolytic like guaifenesin (Mucinex)

A nurse is reviewing lab results for a client with an intestinal obstruction, and infection is suspected. What would be an expected finding? leukopenia, decreased hematocrit; low sodium, potassium, and chloride leukopenia; metabolic acidosis; elevated sodium, potassium, and chloride leukocytosis; elevated hematocrit; low sodium, potassium, and chloride leukocytosis; metabolic alkalosis; elevated sodium, potassium, and chloride

leukocytosis; elevated hematocrit; low sodium, potassium, and chloride Tests of serum electrolytes may indicate low levels of sodium, potassium, and chloride. Metabolic alkalosis is evidenced by arterial blood gas results. A complete blood count (CBC) shows an increased WBC count in instances of infection. The hematocrit level is elevated if dehydration develops.

postural drainage

method of positioning a patient so that gravity aids in the drainage of secretions from the bronchi and lobes of the lungs. moves secretions from the lower respiratory tract to the upper respiratory tract Trendelenburg position

ABG results for COPD

respiratory acidosis increased PaCO2

what increases the chances of developing pneumonia

smoking, advanced age, other respiratory infections, and decreased cough reflex

what device should be used with a bronchodialator

spacer

A client newly diagnosed with emphysema asks the nurse to explain all about the disease. The nurse would include the following response when defining emphysema: An abnormal distention of the air spaces with destruction of the alveolar walls Increased oxygen diffusion with inflammation of the bronchioles Inflammation of the bronchioles with a normal distention of the air spaces Decreased sputum production with dilation of bronchioles

An abnormal distention of the air spaces with destruction of the alveolar walls Emphysema is a pathologic term that describes an abnormal distention of the air spaces beyond the terminal bronchioles and destruction of the walls of the alveoli. This causes a decrease in oxygen diffusion and an increase in sputum production.

A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis? Anxiety Imbalanced nutrition: More than body requirements Impaired swallowing Unilateral neglect

Anxiety In a client with a respiratory disorder, anxiety worsens such problems as dyspnea and bronchospasm. Therefore, Anxiety is a likely nursing diagnosis. This client may have inadequate nutrition, making Imbalanced nutrition: More than body requirements an unlikely nursing diagnosis. Impaired swallowing may occur in a client with an acute respiratory disorder, such as upper airway obstruction, but not in one with a chronic respiratory disorder. Unilateral neglect may be an appropriate nursing diagnosis when neurologic illness or trauma causes a lack of awareness of a body part; however, this diagnosis doesn't occur in a chronic respiratory disorder.

A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because: the attack is over. the airways are so swollen that no air can get through. the swelling has decreased. crackles have replaced wheezes.

the airways are so swollen that no air can get through. During an acute asthma attack, wheezing may stop and breath sounds become inaudible because the airways are so swollen that air can't get through. If the attack is over and swelling has decreased, there would be no more wheezing and less emergent concern. Crackles don't replace wheezes during an acute asthma attack.

A client newly diagnosed with COPD tells the nurse, "I can't believe I have COPD; I only had a cough. Are there other symptoms I should know about"? Which is the bestresponse by the nurse? "There are no other symptoms; however, your cough may get worse as the disease progresses." "As your COPD worsens, you will frequently develop respiratory infections." "Other symptoms you may develop are shortness of breath upon exertion and sputum production." "You can also expect to experience a progressive weight gain."

"Other symptoms you may develop are shortness of breath upon exertion and sputum production. COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea upon exertion. Clients with COPD are at risk for respiratory insufficiency and respiratory infections, which in turn increase the risk of acute and chronic respiratory failure. Weight loss is common with COPD.

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

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

A client admitted with pneumonia has a history of lung cancer and heart failure. A nurse caring for this client recognizes that he should maintain adequate fluid intake to keep secretions thin for ease in expectoration. The amount of fluid intake this client should maintain is: 1.4 L. 2 L. unspecified. 3 L.

1.4 L. Clients need to keep their secretions thin by drinking 2 to 3 L of clear liquids per day. In clients with heart failure, fluid intake shouldn't exceed 1.5 L daily.

The nurse is assessing a client whose respiratory disease in characterized by chronic hyperinflation of the lungs. What would the nurse most likely assess in this client? Signs of oxygen toxicity Chronic chest pain A barrel chest Long, thin fingers

A barrel chest In COPD clients with a primary emphysematous component, chronic hyperinflation leads to the barrel chest thorax configuration. The nurse most likely would not assess chest pain or long, thin fingers; these are not characteristic of emphysema. The client would not show signs of oxygen toxicity unless they received excess supplementary oxygen.

A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What should the nurse do first? Encourage the client to deep-breathe and cough every 2 hours. Administer oxygen by nasal cannula as ordered. Auscultate breath sounds bilaterally every 4 hours. Instruct the client to breathe into a paper bag.

Administer oxygen by nasal cannula as ordered. When a pulmonary embolus places a client at risk for oxygen deprivation, the body compensates by hyperventilating. This causes respiratory alkalosis, as reflected in the client's ABG values. However, the most significant ABG value is the PaO2 value of 60 mm Hg, which indicates hypoxemia. To manage hypoxemia, the nurse should increase oxygenation by administering oxygen via nasal cannula as ordered. Instructing the client to breathe into a paper bag would cause depressed oxygenation when the client re-inhaled carbon dioxide. Auscultating breath sounds or encouraging deep breathing and coughing wouldn't improve oxygenation.

A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. What drug would the nurse know to administer to the client? Ipratropium bromide Albuterol Formoterol Isoproterenol

Albuterol Short-acting beta2-adrenergic agonists include albuterol, levalbuterol, and pirbuterol. They are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. They are used to relax smooth muscle.

A client arrives in the emergency room with emphysema and has developed an exacerbation of COPD with respiratory acidosis from airway obstruction. What is the highest priority for the nurse? Assess vital signs every 2 hours, including O2 saturations and ABG results. Refer the client to respiratory therapy if breathing becomes labored. Apply supplemental oxygen as ordered. Educate the client about the importance of pursed lip breathing.

Apply supplemental oxygen as ordered. When the client arrives in an ED, the first line of treatment is supplemental oxygen therapy and rapid assessment. Oxygen will correct the hypoxemia. Careful observation of the liter flow or the percentage administered and its effect on the patient is important. These clients generally require low-flow oxygen rates of 1-2 L/min. Monitor and titrate to achieve desired PaO2. Periodic arterial blood gases and pulse oximetry help evaluate the adequacy of oxygenation

Which type of chest configuration is typical of a client with COPD? Barrel chest Pigeon chest Flail chest Funnel chest

Barrel chest In clients with COPD who have a primary emphysematous component, chronic hyperinflation leads to the "barrel chest" thorax configuration. This configuration results from a more fixed position of the ribs in the inspiratory position (due to hyperinflation) and from loss of lung elasticity. Pigeon chest results from a displaced sternum. Flail chest results when the ribs are fractured. Funnel chest occurs when there is a depression in the lower portion of the sternum; it is associated with Marfan syndrome or rickets.

A nurse is completing a focused respiratory assessment of a child with asthma. What assessment finding is most closely associated with the characteristic signs and symptoms of asthma? Shallow respirations Increased anterior-posterior (AP) diameter Bilateral wheezes Bradypnea

Bilateral wheezes The three most common symptoms of asthma are cough, dyspnea, and wheezing. There may be generalized wheezing (the sound of airflow through narrowed airways), first on expiration and then, possibly, during inspiration as well. Respirations are not usually slow and the child's AP diameter does not normally change.

A nurse is developing the teaching portion of a care plan for a client with COPD. What would be the most important component for the nurse to emphasize? Smoking up to three cigarettes weekly is generally allowable. Chronic inhalation of indoor toxins can cause lung damage. Minor respiratory infections are considered to be self-limited and are not treated with medication. Activities of daily living (ADLs) should be clustered in the early morning hours.

Chronic inhalation of indoor toxins can cause lung damage.

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

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

what are assessment findings in a patient with COPD?

barrel chest (increase in chest diameter), low O2 levels, and increased CO2 levels

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: administer anxiolytics, as ordered, to control anxiety. instruct the client to drink at least 2 L of fluid daily. maintain the client on bed rest. administer pain medication as ordered.

instruct the client to drink at least 2 L of fluid daily. Mobilizing secretions is crucial to maintaining a patent airway and maximizing gas exchange in the client with COPD. Measures that help mobilize secretions include drinking 2 L of fluid daily, practicing controlled pursed-lip breathing, and engaging in moderate activity. Anxiolytics rarely are recommended for the client with COPD because they may cause sedation and subsequent infection from inadequate mobilization of secretions. Because COPD rarely causes pain, pain medication isn't indicated.

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

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

A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments? Oxygen through nasal cannula at 2 L/minute Intravenous methylprednisolone (Solu-Medrol) 120 mg Ipratropium bromide (Alupent) by metered-dose inhaler Vancomycin 1 gram intravenously over 1 hour

Oxygen through nasal cannula at 2 L/minute When a client presents in the emergency department with an exacerbation of COPD, the nurse should first administer oxygen therapy and perform a rapid assessment of whether the exacerbation is potentially life threatening.

A nurse is caring for a 6-year-old client with cystic fibrosis. In order to enhance the child's nutritional status, what intervention should most be included in the plan of care? Magnesium, thiamine, and iron supplementation Provision of five to six small meals per day rather than three larger meals Pancreatic enzyme supplementation with meals Total parenteral nutrition (TPN)

Pancreatic enzyme supplementation with meals Nearly 90% of clients with CF have pancreatic exocrine insufficiency and require oral pancreatic enzyme supplementation with meals. Frequent, small meals or TPN are not normally indicated. Vitamin supplements are required, but specific replacement of magnesium, thiamine, and iron is not typical.

The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client's care plan? Restricting oral intake to 1,000 mL/day Providing the client a low-sodium diet Performing chest physiotherapy as ordered Discussing palliative care and end-of-life issues with the client

Performing chest physiotherapy as ordered Nursing care includes helping clients manage pulmonary symptoms and prevent complications. Specific measures include strategies that promote removal of pulmonary secretions, chest physiotherapy, and breathing exercises. In addition, the nurse emphasizes the importance of an adequate fluid and dietary intake to promote removal of secretions and to ensure an adequate nutritional status. Clients with CF also experience increased salt content in sweat gland secretions; thus it is important to ensure the client consumes a diet that contains adequate amounts of sodium. As the disease progresses, the client will develop increasing hypoxemia. In this situation, preferences for end-of-life care should be discussed, documented, and honored; however, there is no indication that the client is terminally ill.

A client has a newly created colostomy. After participating in counseling with the nurse and receiving support from the spouse, the client decides to change the colostomy pouch unaided. Which behavior suggests that the client is beginning to accept the change in body image? The client asks the spouse to leave the room. The client touches the altered body part. The client closes his or her eyes when the abdomen is exposed. The client avoids talking about the recent surgery.

The client touches the altered body part. By touching the altered body part, the client recognizes the body change and establishes that the change is real. Closing his or her eyes, not looking at the abdomen when the colostomy is exposed, or avoiding talking about the surgery reflects denial, instead of acceptance of the change. Asking the spouse to leave the room signifies that the client is ashamed of the change and not coping with it.

important presurgery teaching to prevent post surgical pneumonia

cough splinting, incentive spirometry use, geting up and walking

Which of the following is the most common chronic disease of childhood? Asthma Autism Obesity Cerebral palsy

Asthma Asthma is the most common chronic disease of childhood but occurs for the first time at any age, including the elderly. Asthma may affect school and work attendance, occupational choices, physical activity, and general quality of life.

A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia? A client with a history of smoking two packs of cigarettes per day until quitting 2 years ago A client who ambulates in the hallway every 4 hours A client with a nasogastric tube A client who is receiving acetaminophen (Tylenol) for pain

A client with a nasogastric tube Nasogastric, orogastric, and endotracheal tubes increase the risk of pneumonia because of the risk of aspiration from improperly placed tubes. Frequent oral hygiene and checking tube placement help prevent aspiration and pneumonia. Although a client who smokes is at increased risk for pneumonia, the risk decreases if the client has stopped smoking. Ambulation helps prevent pneumonia. A client who receives opioids, not acetaminophen, has a risk of developing pneumonia because respiratory depression may occur.

The nurse at a long-term care facility is assessing each of the residents. Which resident mostlikely faces the greatest risk for aspiration? A resident with severe and deforming rheumatoid arthritis A 92-year-old resident who needs extensive help with ADLs A resident who suffered a severe stroke several weeks ago A resident with mid-stage Alzheimer disease

A resident who suffered a severe stroke several weeks ago Aspiration may occur if the client cannot adequately coordinate protective glottic, laryngeal, and cough reflexes. These reflexes are often affected by stroke. A client with mid-stage Alzheimer disease does not likely have the voluntary muscle problems that occur later in the disease. Clients that need help with ADLs or have arthritis should not have difficulty swallowing unless it exists secondary to another problem.

Which is the most important risk factor for development of chronic obstructive pulmonary disease (COPD)? Occupational exposure Cigarette smoking Air pollution Genetic abnormalities

Cigarette smoking Pipe, cigar, and other types of tobacco smoking are also risk factors for COPD. Although risk factors, neither occupational exposure nor air pollution is the most important risk factor for development of COPD. Genetic abnormalities are also a risk factor, but again, not the most important one.

A nurse is providing care for a client who has a diagnosis of irritable bowel syndrome (IBS). When planning this client's care, the nurse should collaborate with the client and prioritize what goal? Client will accurately identify foods that trigger symptoms. Client will adhere to recommended guidelines for mobility and activity. Client will demonstrate appropriate care of his ileostomy. Client will demonstrate appropriate use of standard infection control precautions.

Client will accurately identify foods that trigger symptoms. A major focus of nursing care for the client with IBS is to identify factors that exacerbate symptoms. Surgery is not used to treat this health problem and infection control is not a concern that is specific to this diagnosis. Establishing causation likely is more important to the client than managing physical activity.

A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client? Full-liquid High-protein 1,800-calorie ADA Low-fat

High-protein Breathing is more difficult for clients with COPD, and increased metabolic demand puts them at risk for nutritional deficiencies. These clients must have a high intake of protein for increased calorie consumption. Full liquids, 1,800-calorie ADA, and low-fat diets aren't appropriate for a client with COPD.

An asthma educator is teaching a client newly diagnosed with asthma and her family about the use of a peak flow meter. The educator should teach the client that a peak flow meter measures what value? Highest airflow during a forced inspiration Highest airflow during a forced expiration Airflow during a normal inspiration Airflow during a normal expiration

Highest airflow during a forced expiration Peak flow meters measure the highest airflow during a forced expiration.

Although many signs and symptoms lead to a diagnosis of emphysema, one symptom stands as the primary presenting symptom. Which of the following is the primary presenting symptom? Dyspnea Chronic and persistent cough Tachypnea Wheezing

Dyspnea Dyspnea may be severe and often interferes with the patient's activities. It is usually progressive, worse with exercise, and persistent. As COPD progresses, dyspnea may occur at rest. Chronic cough and sputum production often precede the development of airflow limitation by many years. However, not all people with cough and sputum production develop COPD. The cough may be intermittent and unproductive in some patients.

An asthma nurse educator is working with a group of adolescent asthma clients. What intervention is most likely to prevent asthma exacerbations among these clients? Encouraging clients to carry a corticosteroid rescue inhaler at all times Educating clients about recognizing and avoiding asthma triggers Teaching clients to utilize alternative therapies in asthma management Ensuring that clients keep their immunizations up to date

Educating clients about recognizing and avoiding asthma triggers Asthma exacerbations are best managed by early treatment and education, including the use of written action plans as part of any overall effort to educate clients about self-management techniques, especially those with moderate or severe persistent asthma or with a history of severe exacerbations. Corticosteroids are not used as rescue inhalers. Alternative therapies are not normally a high priority, though their use may be appropriate in some cases. Immunizations should be kept up to date, but this does not necessarily prevent asthma exacerbations.

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? Teach the client to perform upper chest breaths. Increase the flow of oxygen. Encourage the client to exhale slowly against pursed lips. Encourage the client to take deep breaths.

Encourage the client to exhale slowly against pursed lips. When a client with COPD exhibits shallow, rapid, and inefficient respirations, the nurse encourages the client to perform pursed-lip breathing, which includes exhaling slowly against pursed lips. Pursed-lip breathing helps slow expiration, prevents collapse of small airways, and helps the client control the rate and depth of respiration. It also promotes relaxation, enabling the client to gain control of dyspnea and reduce feelings of panic. Taking deep breaths and upper chest breathing are inefficient breathing techniques; the client with COPD should be encouraged to practice diaphragmatic breathing. Increasing oxygen flow is not necessary because the pulse oximetry is 93%.

The nurse is providing care for a client who has recently been diagnosed with COPD. When educating the client about exacerbations, the nurse should prioritize what topic? Identifying specific causes of exacerbations Prompt administration of corticosteroids during exacerbations The importance of prone positioning during exacerbations The relationship between activity level and exacerbations

Identifying specific causes of exacerbations Prevention is key in the management of exacerbations, and it is important for the client to identify which factors cause exacerbations. Corticosteroids are not normally used as a "rescue" medication and prone positioning does not enhance oxygenation. Activity may or may not cause a client to have exacerbations; inactivity is not a risk factor.

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? Infectious disease Gastric resection Disaccharidase deficiency Inflammation of all layers of intestinal mucosa

Inflammation of all layers of intestinal mucosa Crohn's disease is also known as regional enteritis and can occur anywhere along the gastrointestinal tract, but most commonly at the distal ileum and in the colon. Infectious disease causes problems such as small-bowel bacterial overgrowth, leading to malabsorption. Disaccharidase deficiency leads to lactose intolerance. Postoperative malabsorption occurs after gastric or intestinal resection.

What is histamine, a mediator that supports the inflammatory process in asthma, secreted by? Eosinophils Lymphocytes Mast cells Neutrophils

Mast cells Mast cells, neutrophils, eosinophils, and lymphocytes play key roles in the inflammation associated with asthma. When activated, mast cells release several chemicals called mediators. One of these chemicals is called histamine.

It is important for the nurse to monitor serum electrolytes in a patient with acute diarrhea. Select the electrolyte result that should be immediately reported. Calcium of 9 mg/dL Chloride of 100 mEq/L Potassium of 2.8 mEq/L Sodium of 136 mEq/L

Potassium of 2.8 mEq/L The normal serum potassium level is 3.5 to 5 mEq/L. Hypokalemia can be severe if less than 2.5 mEq/L. A potassium result of 2.8 should be reported because it is significantly lower than normal. The other choices are normal levels.

During a community health fair, a nurse is teaching a group of seniors about promoting health and preventing infection. Which intervention would best promote infection prevention for senior citizens who are at risk of pneumococcal and influenza infections? Drink six glasses of water daily Receive vaccinations Take all prescribed medications Exercise daily

Receive vaccinations Identifying clients who are at risk for pneumonia provides a means to practice preventive nursing care. The nurse encourages clients at risk of pneumococcal and influenza infections to receive vaccinations against these infections.

Which should a nurse encourage in clients who are at the risk of pneumococcal and influenza infections? Using incentive spirometry Using prescribed opioids Receiving vaccinations Mobilizing early

Receiving vaccinations Identifying clients who are at risk for pneumonia provides a means to practice preventive nursing care. The nurse encourages clients at risk of pneumococcal and influenza infections to receive vaccinations against these infections. The nurse should encourage early mobilization as indicated through agency protocol, administer prescribed opioids and sedatives as indicated, and teach or reinforce appropriate technique for incentive spirometry to prevent atelectasis.

A nurse is discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply. Respiratory failure Pertussis Status asthmaticus Atelectasis Thoracentesis

Respiratory failure Status asthmaticus Atelectasis Complications of asthma may include status asthmaticus, respiratory failure, and atelectasis. Pertussis is not an asthma complication. Thoracentesis is a diagnostic procedure, not a complication.

A nurse is teaching the client about use of a metered-dose inhaler (MDI). What instructions should the nurse include in the teaching? Select all that apply. It is not necessary to hold your breath after using. Use normal inhalations with the device. Take a slow, deep inhalation from the device. The device may increase delivery of the MDI medication. Activate the MDI once.

Take a slow, deep inhalation from the device. The device may increase delivery of the MDI medication. Activate the MDI once. The pictured device is a spacer, which is attached to an MDI for client use. The client activates the MDI once and takes a slow, deep inhalation, not normal inhalations. The client then holds the breath for 10 seconds. The spacer may increase delivery of the MDI medication.

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? Avoid contact with fur-bearing animals. Change filters on heating and air conditioning units frequently. Take ordered medications as scheduled. Avoid goose down pillows.

Take ordered medications as scheduled. Although avoiding contact with fur-bearing animals, changing filters on heating and air conditioning units frequently, and avoiding goose down pillows are all appropriate measures for clients with asthma, taking ordered medications on time is the most important measure in preventing asthma attacks.

A nurse is admitting a new client who has been admitted with a diagnosis of COPD exacerbation. How can the nurse best help the client achieve the goal of maintaining effective oxygenation? Assist the client in developing an appropriate exercise program. Administer supplementary oxygen by simple face mask. Teach the client to perform airway suctioning. Teach the client strategies for promoting diaphragmatic breathing.

Teach the client strategies for promoting diaphragmatic breathing The breathing pattern of most people with COPD is shallow, rapid, and inefficient; the more severe the disease, the more inefficient the breathing pattern. With practice, this type of upper chest breathing can be changed to diaphragmatic breathing, which reduces the respiratory rate, increases alveolar ventilation, and sometimes helps expel as much air as possible during expiration. Suctioning is not normally necessary in clients with COPD. Supplementary oxygen is not normally delivered by simple face mask and exercise may or may not be appropriate.

For a client with chronic obstructive pulmonary disease, which nursing intervention helps maintain a patent airway? Restricting fluid intake to 1,000 ml/day Enforcing absolute bed rest Teaching the client how to perform controlled coughing Administering ordered sedatives regularly and in large amounts

Teaching the client how to perform controlled coughing Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the client's ability to maintain a patent airway, causing a high risk of infection from pooled secretions.

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

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

A client presents to the emergency department with complaints of acute GI distress, bloody diarrhea, weight loss, and fever. Which condition in the family history is most pertinent to the client's current health problem? Hypertension Gastroesophageal reflux disease Appendicitis Ulcerative colitis

Ulcerative colitis A family history of ulcerative colitis, particularly if the relative affected is a first-degree relative, increases the likelihood of the client having ulcerative colitis. Although hypertension has familial tendencies, the client's symptoms aren't related to hypertension. A family history of gastroesophageal reflux disease or appendicitis isn't a significant factor in the client history because these conditions aren't considered familial traits.

A nurse's assessment reveals that a client with COPD may be experiencing bronchospasm. What assessment finding would suggest that the client is experiencing bronchospasm? Fine or coarse crackles on auscultation Wheezes or diminished breath sounds on auscultation Reduced respiratory rate or lethargy Slow, deliberate respirations and diaphoresis

Wheezes or diminished breath sounds on auscultation Wheezing and diminished breath sounds are consistent with bronchospasm. Crackles are usually attributable to other respiratory or cardiac pathologies. Bronchospasm usually results in rapid, inefficient breathing and agitation.

A client is admitted to the emergency department with reports right lower quadrant pain. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the health care provider immediately? White blood cell (WBC) count 22.8/mm3 Hematocrit 42% Serum potassium 4.2 mEq/L Serum sodium 135 mEq/L

White blood cell (WBC) count 22.8/mm3 The nurse should report the elevated WBC count. This finding, which is a sign of infection, indicates that the client's appendix might have ruptured. Hematocrit of 42%, serum potassium of 4.2 mEq/L, and serum sodium of 135 mEq/L are within normal limits. Alterations in these levels don't indicate appendicitis.