NU424 RESPIRATORY PrepU (Exam 1)

Approximately what percentage of people who are initially infected with TB develop active disease? 30% 10% 20% 40%

10% Explanation: Approximately 10% of people who are initially infected develop active disease. The other percentages are inaccurate.

A nurse recognizes that a client with tuberculosis needs further teaching when the client states: "I'll need to have scheduled laboratory tests while I'm on the medication." "The people I have contact with at work should be checked regularly." "It won't be necessary for the people I work with to take medication." "I'll have to take these medications for 9 to 12 months."

"The people I have contact with at work should be checked regularly." The client requires additional teaching if he states that coworkers need to be checked regularly. Such casual contacts needn't be tested for tuberculosis. However, a person in close contact with a person who's infectious is at risk and should be checked. The client demonstrates effective teaching if he states that he'll take his medications for 9 to 12 months, that coworkers don't need medication, and that he requires laboratory tests while on medication. Coworkers not needing medications, taking the medication for 9 to 12 months, and having scheduled laboratory tests are all appropriate statements.

The nurse is administering anticoagulant therapy with heparin. What International Normalized Ratio (INR) would the nurse know is within therapeutic range? 2.0 to 2.5 3.0 to 3.5 0.5 to 1.0 1.5 to 2.5

2.0 to 2.5 Low-molecular- weight heparin and fondaparinux (Arixtra) are the cornerstones of therapy, but IV unfractionated heparin may be used during the initial phase (ACCP, 2012). The early maintenance phase of anticoagulation typically consists of overlapping regimens of heparins or fondaparinux for at least 5 days with an oral vitamin K antagonist (e.g., warfarin [Coumadin]). A 3- to 6-month regimen of long-term maintenance with warfarin is typical but depends on the risks of recurrence and bleeding (ACCP, 2012). Heparin must be continued until the INR is within a therapeutic range, typically 2.0 to 3 (Kearon, Kahn, Agnelli, et al., 2008).

The nurse is caring for a client in the ICU who required emergent endotracheal (ET) intubation with mechanical ventilation. The nurse receives an order to obtain arterial blood gases (ABGs) after the procedure. The nurse recognizes that ABGs should be obtained how long after mechanical ventilation is initiated? 25 minutes 15 minutes 20 minutes 10 minutes

20 minutes The nurse records minute volume and obtains ABGs to measure carbon dioxide partial pressure (PaCO2), pH, and PaO2 after 20 minutes of continuous mechanical ventilation.

What range of pressure within the endotracheal tube cuff does the nurse maintain to prevent both injury and aspiration? 20 to 25 mm Hg 10 to 15 mm Hg 25 to 30 mm Hg 15 to 20 mm Hg

20 to 25 mm Hg Usually the pressure is maintained at <25 mm HG (30 cm H2O) water pressure to prevent injury and at >20 mm HG (24 cm H2O) water pressure to prevent aspiration. High cuff pressure can cause tracheal bleeding, ischemia, and pressure necrosis, whereas low cuff pressure can increase the risk of aspiration pneumonia. A water pressure of 10-15 or 15-20 mm Hg would indicate that the cuff is underinflated. A water pressure of 25-30 mm Hg would indicate that the cuff is overinflated.

A client comes to the health clinic after a positive skin test for tuberculosis. What additional diagnostic tests should the nurse begin teaching the client? Select all that apply. Complete blood count A chest radiograph Complete history and physical examination A repeat multiple-puncture skin test Drug susceptibility testing

A chest radiograph Complete history and physical examination Drug susceptibility testing Once a client had a positive skin test or a positive sputum culture for acid-fast bacilli, additional tests such as complete history, physical examination, tuberculin skin test, chest x-ray, and drug susceptibility testing are done. The nurse does not need to teach about a complete blood count or a repeat multiple puncture skin test, as the initial positive skin test will serve as the indicator of tuberculosis.

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

A lung volume reduction Lung volume reduction is a surgical procedure involving the removal of 20%-30% of a client's lung through a midsternal incision or video thoracoscopy. The diseased lung tissue is identified on a lung perfusion scan. This surgery leads to significant improvements in dyspnea, exercise capacity, quality of life, and survival of a subgroup of people with end-stage emphysema.

A patient is to receive an oxygen concentration of 70%. What is the best way for the nurse to deliver this concentration? A nasal cannula An oropharyngeal catheter A Venturi mask A partial rebreathing mask

A partial rebreathing mask Partial rebreathing masks have a reservoir bag that must remain inflated during both inspiration and expiration. The nurse adjusts the oxygen flow to ensure that the bag does not collapse during inhalation. A high concentration of oxygen (50% to 75%) can be delivered because both the mask and the bag serve as reservoirs for oxygen. The other devices listed cannot deliver oxygen at such a high concentration.

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

A tracheostomy In severe cases in which there is widespread subcutaneous emphysema, a tracheostomy is indicated if airway patency is threatened by pressure of the trapped air on the trachea. The other listed tubes would neither resolve the subcutaneous emphysema nor the consequent airway constriction.

Which type of lung cancer is the most prevalent among both men and women? Large cell carcinoma Squamous cell carcinoma Small cell carcinoma Adenocarcinoma

Adenocarcinoma Adenocarcinoma is most prevalent in both men and women and presents more peripherally as masses or nodules and often metastasizes. Large cell carcinoma is a fast-growing tumor that tends to arise peripherally. Squamous cell carcinoma is more centrally located and arises more commonly in the segmental and subsegmental bronchi in response to repetitive carcinogenic exposure. Small cell carcinomas arise primarily as proximal lesions, but may arise in any part of the tracheobronchial tree.

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

Consolidation Consolidation occurs during an infectious process such as pneumonia. Atelectasis refers to the collapse or airless condition of the alveoli caused by hypoventilation, obstruction to the airways, or compression. Bronchiectasis refers to the chronic dilation of a bronchi or bronchi in which the dilated airway becomes saccular and a medium for chronic infection. Empyema refers to accumulation of purulent material in the pleural space.

A client is being treated in the ED for respiratory distress coupled with bacterial pneumonia. The client has no medical history. However, the client works in a coal mine and smokes 10 cigarettes a day. The nurse anticipates which order based on the client's immediate needs? Client education: avoidance of irritants like smoke and pollutants Completion of a 12-lead ECG Administration of corticosteroids and bronchodilators Administration of antibiotics

Administration of antibiotics Antibiotics are administered to treat respiratory tract infections. Chronic bronchitis is inflammation of the bronchi caused by irritants or infection. Hence, smoking cessation and avoiding pollutants are necessary to slow the accelerated decline of the lung tissue. However, the immediate priority in this case is to cure the infection, pneumonia. Corticosteroids and bronchodilators are administered to asthmatic clients when they show symptoms of wheezing. An ECG is used to evaluate atrial arrhythmias.

A client seeks medical attention for a new onset of fatigue and changes in coordination. Which additional assessment finding indicates to the nurse that the client is demonstrating signs of low oxygenation? Select all that apply. Agitation Impaired thought process Drowsiness Shortness of breath Cough

Agitation Impaired thought process Shortness of breath A change in the client's respiratory rate or pattern may be one of the earliest indicators of the need for oxygen therapy. These changes may result from hypoxemia or hypoxia. Severe hypoxia can be life threatening. The signs and symptoms signaling the need for supplemental oxygen may depend on how suddenly this need develops. The client has new onset of symptoms so the low oxygenation will be associated with acute hypoxia. With acute hypoxia, changes occur in the central nervous system because the neurologic centers are very sensitive to oxygen deprivation. Acute hypoxia that is newly presenting may manifest in signs such as shortness of breath, impaired thought process, and agitation. With long-standing or chronic hypoxia that is not manifesting as a new onset of symptoms, the client may demonstrate apathy, drowsiness, and delayed reaction time. The client may also demonstrate symptoms similar to alcohol intoxication such as impaired judgment. The presence of cough is not a manifestation of acute or chronic hypoxia.

A nurse is teaching a client about bronchodilators. What bronchodilator actions that relieve bronchospasm should the nurse include in the client teaching? Select all that apply. Reduce airway obstruction Alter smooth muscle tone Increase oxygen distribution Decrease alveolar ventilation Reduce inflammation

Alter smooth muscle tone Reduce airway obstruction Increase oxygen distribution Bronchodilators relieve bronchospasm by altering smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation. Inflammation would be reduced by corticosteroids.

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

Anemic hypoxia Anemic hypoxia is a result of decreased effective hemoglobin concentration, which causes a decrease in the oxygen-carrying capacity of the blood. It is rarely accompanied by hypoxemia. Carbon monoxide poisoning, because it reduces the oxygen-carrying capacity of hemoglobin, produces similar effects but is not strictly anemic hypoxia, because hemoglobin levels may be normal.

The nurse knows that a sputum culture is necessary to identify the causative organism for acute tracheobronchitis. What causative fungal organism would the nurse suspect? Mycoplasma pneumoniae Streptococcus pneumoniae Hemophilus Aspergillus

Aspergillus In acute tracheobronchitis, the inflamed mucosa of the bronchi produces mucopurulent sputum, often in response to infection by Streptococcus pneumoniae, Hemophilus influenzae, or Mycoplasma pneumoniae. In addition, a fungal infection (e.g., Aspergillus) may also cause tracheobronchitis. A sputum culture is essential to identify the specific causative organism.

The nurse is preparing to suction a client with an endotracheal tube. What should be the nurse's first step in the suctioning process? Explain the suctioning procedure to the client and reposition the client. Turn on suction source at a pressure not exceeding 120 mm Hg. Perform hand hygiene and don nonsterile gloves, goggles, gown, and mask. Assess the client's lung sounds and SaO2 via pulse oximeter.

Assess the client's lung sounds and SaO2 via pulse oximeter. Assessment data indicate the need for suctioning and allow the nurse to monitor the effect of suction on the client's level of oxygenation. Explaining the procedure, performing hand hygiene, and turning on the suction source are interventions that should follow assessment. As with all interventions, assessment should be performed first.

Which ventilator mode provides full ventilatory support by delivering a present tidal volume and respiratory rate? SIMV Assist control Pressure support IMV

Assist control Assist-control ventilation provides full ventilator support by delivering a preset tidal volume and respiratory rate. IMV provides a combination of mechanically assisted breaths and spontaneous breaths. SIMV delivers a preset tidal volume and number of breaths per minute. Between ventilator-delivered breaths, the patient can breathe spontaneously with no assistance from the ventilator for those extra breaths. Pressure support ventilation assists SIMV by applying a pressure plateau to the airway throughout the client-triggered inspiration to decrease resistance within the tracheal tube and ventilator tubing.

An adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Ordered respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure? When secretions have mobilized Immediately before a meal When bronchospasms occur At bedtime

At bedtime The nurse should perform chest physiotherapy at bedtime to reduce secretions in the client's lungs during the night. Performing it immediately before a meal may tire the client and impair the ability to eat. Percussion and vibration, components of chest physiotherapy, may worsen bronchospasms; therefore, the procedure is contraindicated in clients with bronchospasms. Secretions that have mobilized (especially when suction equipment isn't available) are a contraindication for postural drainage, another component of chest physiotherapy.

A client's spouse states that she is worried about her husband because he appears to be breathing "really hard." The nurse performs a respiratory assessment. What findings would indicate a need for further interventions? Pale, paper-thin skin, O2 at 2L/min via nasal cannula Client states, "It always seems like I just can't catch my breath." BP 122/82, HR 102, R 24, noted barrel chest, temperature 98.4 °F (36.9 °C) BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 °F (38.5 °C)

BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 °F (38.5 °C) Bronchopulmonary infections must be controlled to diminish inflammatory edema and to permit recovery of normal ciliary action. Minor respiratory infections of no consequence to people with normal lungs can be life-threatening to people with COPD. The breathing pattern of most people with COPD is shallow, rapid, and inefficient; the more severe the disease, the more inefficient the breathing pattern. Any factor that interferes with normal breathing quite naturally induces anxiety, depression, and changes in behavior.

An adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. The ordered respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure? Select all that apply. Before meals When bronchospasms occur When secretions have mobilized At bedtime After meals

Before meals At bedtime The nurse should perform chest physiotherapy at bedtime to reduce secretions in the client's lungs during the night. It is important to perform chest physiotherapy before meals to prevent nausea, vomiting, and aspiration. Percussion and vibration, components of chest physiotherapy, may worsen bronchospasms; therefore, the procedure is contraindicated in clients with bronchospasms. Secretions that have mobilized (especially when suction equipment isn't available) are a contraindication for postural drainage, another component of chest physiotherapy.

A nurse is reviewing the pathophysiology of cystic fibrosis (CF) in anticipation of a new admission. The nurse should identify what characteristic aspects of CF? Alveolar mucus plugging, infection, and eventual bronchiectasis Bronchial mucus plugging, infection, and eventual COPD Bronchial mucus plugging, inflammation, and eventual bronchiectasis Atelectasis, infection, and eventual COPD

Bronchial mucus plugging, inflammation, and eventual bronchiectasis The hallmark pathology of CF is bronchial mucus plugging, inflammation, and eventual bronchiectasis. Commonly, the bronchiectasis begins in the upper lobes and progresses to involve all lobes. Infection, atelectasis, and COPD are not hallmark pathologies of CF.

The health care provider has prescribed continuous positive airway pressure (CPAP) with the delivery of a client's high-flow oxygen therapy. The client asks the nurse what the benefit of CPAP is. What would be the nurse's best response? CPAP allows a lower percentage of oxygen to be used with a similar effect. CPAP allows for greater humidification of the oxygen that is given. CPAP allows a higher percentage of oxygen to be safely used. CPAP allows for the elimination of bacterial growth in oxygen delivery systems.

CPAP allows a lower percentage of oxygen to be used with a similar effect. Prevention of oxygen toxicity is achieved by using oxygen only as prescribed. Often, positive end-expiratory pressure (PEEP) or CPAP is used with oxygen therapy to reverse or prevent microatelectasis, thus allowing a lower percentage of oxygen to be used. Oxygen is moistened by passing through a humidification system. Changing the tubing on the oxygen therapy equipment is the best technique for controlling bacterial growth.

A client with pulmonary hypertension has a positive vasoreactivity test. What medication does the nurse anticipate administering to this client? Angiotensin converting enzyme inhibitor Angiotensin receptor blockers Beta blockers Calcium channel blockers

Calcium channel blockers Clients with a positive vasoreactivity test may be prescribed calcium channel blockers. Calcium channel blockers have a significant advantage over other medications taken to treat PH in that they may be taken orally and are generally less costly; however, because calcium channel blockers are indicated in only a small percentage of clients, other treatment options, including prostanoids, are often necessary (Hopkins & Rubin, 2016).

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

Cancer A thoracentesis may be performed to obtain a sample of pleural fluid or to biopsy a specimen from the pleural wall for diagnostic purposes. Serous fluid may be associated with cancer, inflammatory conditions, or heart failure. Blood fluid typically suggests trauma. Purulent fluid is diagnostic for infection. Complications that may follow a thoracentesis include pneumothorax and subcutaneous emphysema.

A nurse is teaching a client about asthma. Which symptom should be included with the teaching? Select all that apply. Crackles Cough Dyspnea Chest tightness Wheezing

Chest tightness Wheezing Dyspnea Cough The common symptoms of asthma are cough, chest tightness, dyspnea, and wheezing. In some instances, cough may be the only symptom. Crackles are not generally seen with asthma; they are associated with excess fluid in the lungs as with pneumonia.

A nurse is admitting a client with emphysema. What are presenting findings the nurse should assess? Select all that apply. Tachypnea Wheezing Chronic cough Fever Dyspnea

Chronic cough Dyspnea Wheezing The clinical manifestations for emphysema is grouped with COPD and includes wheezing, sputum production, and dyspnea. Fever and tachypnea are not common findings.

Which drug is second-line pharmacotherapy for smoking abstinence whose side effects limit its use? Clonidine Nicotine gum Nortriptyline Bupropion SR

Clonidine Second-line pharmacotherapy includes the antihypertensive agent clonidine. However, its use is limited by its side effects. First-line therapy includes nicotine gum, nortriptyline, and bupropion SR.

A nurse is performing a focused assessment on a client with bronchiectasis. Which are the most prevalent signs and symptoms of this condition? Select all that apply. Copious, purulent sputum Chronic cough Increased anterior-posterior (AP) diameter Radiating chest pain Wheezes on auscultation

Copious, purulent sputum Chronic cough Characteristic symptoms of bronchiectasis include clubbing of the fingers, chronic cough, and production of purulent sputum in copious amounts. Radiating chest pain, along with additional clinical indicators, are more indicative of a cardiovascular condition. Wheezes on auscultation are common in clients with asthma. An increased AP diameter is noted in clients with chronic obstructive pulmonary disease.

A client with lung cancer develops pleural effusion. During chest auscultation, which breath sound should the nurse expect to hear? Decreased breath sounds Wheezes Crackles Rhonchi

Decreased breath sounds In pleural effusion, fluid accumulates in the pleural space, impairing transmission of normal breath sounds. Because of the acoustic mismatch, breath sounds are diminished. Crackles commonly accompany atelectasis, interstitial fibrosis, and left-sided heart failure. Rhonchi suggest secretions in the large airways. Wheezes result from narrowed airways, such as in asthma, chronic obstructive pulmonary disease, and bronchitis.

The nurse is using an in-line suction kit to suction a patient who is intubated and on a mechanical ventilator. What benefits does inline suction have for the patient? (Select all that apply.) Decreases patient anxiety Sustains positive end expiratory pressure (PEEP) Increases oxygen consumption Prevents aspiration Decreases hypoxemia

Decreases hypoxemia Decreases patient anxiety Sustains positive end expiratory pressure (PEEP) An in-line suction device allows the patient to be suctioned without being disconnected from the ventilator circuit. In-line suctioning (also called closed suctioning) decreases hypoxemia, sustains PEEP, and can decrease patient anxiety associated with suctioning (Sole et al., 2013).

A nurse is developing a care plan for a client with chronic obstructive pulmonary disease (COPD) admitted to the hospital for the second time this year with pneumonia. Which nursing diagnoses would be appropriate for this client? Select all that apply. Ineffective airway clearance related to inhalation of toxins Activity intolerance related to oxygen supply and demand Ineffective health management related to fatigue Deficient knowledge regarding self-care related to preventable complications Impaired gas exchange related to ventilation-perfusion inequality

Deficient knowledge regarding self-care related to preventable complications Impaired gas exchange related to ventilation-perfusion inequality Impaired gas exchange and deficient knowledge are the appropriate diagnoses for this client based on the information provided. Pneumonia is an acute infection of the parenchyma whose pathophysiology typically triggers an inflammatory response in the lung. In a client with COPD who already has chronic inflammation, gas exchange becomes further compromised. Areas of the lung receive either oxygen but no blood flow or blood flow but no oxygen (ventilation/perfusion inequality). Because this was the second admission for the same diagnosis, deficient knowledge of prevention strategies should be included for this client. Although ineffective airway clearance is a possibility, not enough information is provided to conclude that it was a result of toxins such as cigarette smoke. Activity intolerance and health management should be addressed as a risk because pneumonia and COPD impact activity and cause fatigue, but not enough information was provided to make these a problem.

A client who has recently started working in a coal mine is concerned the effects on long-term health. How does the nurse advise the client to prevent occupational lung disease? Select all that apply. Wear appropriate protective equipment when around airborne irritants and dusts. Try to find another occupation as soon as possible. Schedule an annual lung x-ray to monitor health. Do not smoke, or quit smoking if currently smoking.

Do not smoke, or quit smoking if currently smoking. Wear appropriate protective equipment when around airborne irritants and dusts. The nurse may instruct clients that the following precautions may help prevent occupational lung disease: not smoking, wearing appropriate protective equipment when around airborne irritants and dusts, scheduling lung function evaluation with spirometry as recommended, becoming educated about lung diseases, and paying attention to risk evaluation of the workplace to identify risks for lung disease.

The diagnosis of pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD) is suspected when which of the following is noted? Select all that apply. Dyspnea and fatigue disproportionate to pulmonary function abnormalities Left ventricular hypertrophy Enlargement of central pulmonary arteries Elevated plasma brain natriuretic peptide (BNP) Right ventricular enlargement

Dyspnea and fatigue disproportionate to pulmonary function abnormalities Right ventricular enlargement Elevated plasma brain natriuretic peptide (BNP) Enlargement of central pulmonary arteries The diagnosis of pulmonary hypertension associated with COPD is suspected in patients complaining of dyspnea and fatigue that appear to be disproportionate to pulmonary function abnormalities. Enlargement of the central pulmonary arteries on the chest X-ray, echocardiogram suggestive of right ventricular enlargement, and elevated plasma BNP may be present.

The nurse should monitor a client receiving mechanical ventilation for which of the following complications? Immunosuppression Increased cardiac output Gastrointestinal hemorrhage Pulmonary emboli

Gastrointestinal hemorrhage Gastrointestinal hemorrhage occurs in approximately 25% of clients receiving prolonged mechanical ventilation. Other possible complications include incorrect ventilation, oxygen toxicity, fluid imbalance, decreased cardiac output, pneumothorax, infection, and atelectasis. Immunosuppression and pulmonary emboli are not direct consequences of mechanical ventilation.

The nurse is planning the care for a client at risk of developing pulmonary embolism. What nursing interventions should be included in the care plan? Select all that apply. Using elastic stockings, especially when decreased mobility would promote venous stasis Applying a sequential compression device Encouraging a liberal fluid intake Instructing the client to move the legs in a "pumping" exercise Instructing the client to dangle the legs over the side of the bed for 30 minutes, four times a da

Encouraging a liberal fluid intake Instructing the client to move the legs in a "pumping" exercise Using elastic stockings, especially when decreased mobility would promote venous stasis Applying a sequential compression device The use of anti-embolism stockings or intermittent pneumatic leg compression devices reduces venous stasis. These measures compress the superficial veins and increase the velocity of blood in the deep veins by redirecting the blood through the deep veins. Having the client move the legs in a "pumping" exercise helps increase venous flow. Legs should not be dangled or feet placed in a dependent position while the client sits on the edge of the bed; instead, feet should rest on the floor or on a chair.

Which of the following is a common irritant that acts as a trigger of asthma? Aspirin sensitivity Peanuts Molds Esophageal reflux

Esophageal reflux Esophageal reflux, viral respiratory infections, cigarette smoke, and exercise are all irritants that can trigger asthma. Peanuts, aspirin sensitivity, and molds are antigens

A client who is intubated for mechanical ventilation has met the criteria for weaning. Which additional assessment findings indicate to the nurse that the client is eligible for a T-piece? Select all that apply. Gag reflex intact Breathing without difficulty Cough reflex intact Awake and alert Suctioned every 2 hours

Gag reflex intact Breathing without difficulty Cough reflex intact Awake and alert Respiratory weaning, the process of withdrawing the client from dependence on the ventilator, occurs in stages. Weaning from mechanical ventilation is performed at the earliest possible time according to client safety. Weaning is started when the client is physiologically and hemodynamically stable, demonstrates spontaneous breathing capability, is recovering from the acute stage of medical and surgical problems, and when the cause of respiratory failure is sufficiently reversed. Weaning through the use of a T-piece is conducted by disconnecting the client from the ventilator so that the client performs all the work of breathing. This method of weaning is used when the client is awake and alert, has intact gag and cough reflexes, and is breathing without difficulty. The frequency of suctioning is not among the criteria used to determine if a client is eligible for weaning with a T-piece.

The nurse is caring for a client in the ICU admitted with ARDS after exposure to toxic fumes from a hazardous spill at work. The client has become hypotensive. What is the cause of this complication to the ARDS treatment? Pulmonary hypotension due to decreased cardiac output Severe and progressive pulmonary hypertension Increased cardiac output from high levels of PEEP therapy Hypovolemia secondary to leakage of fluid into the interstitial spaces

Hypovolemia secondary to leakage of fluid into the interstitial spaces Systemic hypotension may occur in ARDS as a result of hypovolemia secondary to leakage of fluid into the interstitial spaces and depressed cardiac output from high levels of PEEP therapy. Pulmonary hypertension, not pulmonary hypotension, sometimes is a complication of ARDS, but it is not the cause of the client becoming hypotensive.

A client diagnosed with asthma is preparing for discharge. The nurse is educating the client on the proper use of a peak flow meter. The nurse instructs the client to complete which action? Sit down while completing a peak flow reading. Move the indicator to the top of the numbered scale. If coughing occurs during the procedure, repeat it. Take and record peak flow readings three times daily.

If coughing occurs during the procedure, repeat it. Steps for using the peak flow meter correctly include (1) moving the indicator to the bottom of the numbered scale; (2) standing up; (3) taking a deep breath and filling the lungs completely; (4) placing the mouthpiece in the mouth and closing the lips around it; (5) blowing out hard and fast with a single blow; and (6) recording the number achieved on the indicator. If the client coughs or a mistake is made in the process, repeat the procedure. Peak flow readings should be taken during an asthma attack.

The nurse is planning for the care of a client with acute tracheobronchitis. What nursing interventions should be included in the plan of care? Select all that apply. Using cool-vapor therapy to relieve laryngeal and tracheal irritation Encouraging the client to rest Increasing fluid intake to remove secretions Administering a narcotic analgesic for pain Giving 3 L fluid per day

Increasing fluid intake to remove secretions Encouraging the client to rest Using cool-vapor therapy to relieve laryngeal and tracheal irritation In most cases, treatment of tracheobronchitis is largely symptomatic. Cool vapor therapy or steam inhalations may help relieve laryngeal and tracheal irritation. A primary nursing function is to encourage bronchial hygiene, such as increased fluid intake and directed coughing to remove secretions. Fatigue is a consequence of tracheobronchitis; therefore, the nurse cautions the client against overexertion, which can induce a relapse or exacerbation of the infection. The client is advised to rest.

Which community-acquired pneumonia demonstrates the highest occurrence during summer and fall? Streptococcal (pneumococcal) pneumonia Legionnaires disease Viral pneumonia Mycoplasma pneumonia

Legionnaires disease Legionnaires disease accounts for 15% of community-acquired pneumonias; it occurs mainly in summer and fall. Streptococcal and viral pneumonias demonstrate the highest occurrence during the winter months. Mycoplasmal pneumonia demonstrates the highest occurrence in fall and early winter.

An x-ray of a trauma client reveals rib fractures and the client is diagnosed with a small flail chest injury. Which intervention should the nurse include in the client's plan of care? Prepare the client for surgery. Immediately sedate and intubate the client. Immobilize the ribs with an abdominal binder. Initiate chest physiotherapy.

Initiate chest physiotherapy. As with rib fracture, treatment of flail chest is usually supportive. Management includes chest physiotherapy and controlling pain. Intubation is required only for severe flail chest injuries, not small flail chest injuries, and surgery is required only in rare circumstances to stabilize the flail segment. Immobilization of the ribs with an abdominal binder is not necessary for a small flail chest injury.

Which ventilator mode provides a combination of mechanically assisted breaths and spontaneous breaths? Pressure support Intermittent mandatory ventilation (IMV) Assist control Synchronized intermittent mandatory ventilation (SIMV)

Intermittent mandatory ventilation (IMV) IMV provides a combination of mechanically assisted breaths and spontaneous breaths. Assist-control ventilation provides full ventilator support by delivering a preset tidal volume and respiratory rate. SIMV delivers a preset tidal volume and number of breaths per minute. Between ventilator-delivered breaths, the client can breathe spontaneously with no assistance from the ventilator for those extra breaths. Pressure support ventilation assists SIMV by applying a pressure plateau to the airway throughout the client-triggered inspiration to decrease resistance within the tracheal tube and ventilator tubing.

A nurse's assessment reveals that a client with chronic obstructive pulmonary disease may be experiencing bronchospasm. Which assessment findings would suggest that the client is experiencing bronchospasm? Select all that apply. Labored and rapid breathing Reduced respiratory rate or lethargy Fine or coarse crackles on auscultation Wheezes or diminished breath sounds on auscultation Slow, deliberate respirations and diaphoresis

Labored and rapid breathing 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, labored breathing and agitation, not slow, deliberate respirations, reduced respiratory rate, or lethargy.

Which of the following types of lung cancer is characterized as fast growing and tending to arise peripherally? Bronchoalveolar carcinoma Adenocarcinoma Squamous cell carcinoma Large cell carcinoma

Large cell carcinoma Large cell carcinoma is a fast-growing tumor that tends to arise peripherally. Bronchoalveolar cell cancer arises from the terminal bronchus and alveoli and usually grows slowly. Adenocarcinoma presents as peripheral masses or nodules and often metastasizes. Squamous cell carcinoma arises from the bronchial epithelium and is more centrally located.

The decision has been made to discharge a ventilator-dependent client home. The nurse is developing a teaching plan for this client and his family. What would be most important to include in this teaching plan? Administration of inhaled corticosteroids Managing a power failure Turning and coughing Assessment of neurologic status

Managing a power failure The nurse teaches the client and family about topics including the management of a power failure. Neurologic assessment and turning and coughing are less important than knowing what to do if the ventilator loses power, because this could immediate threaten the client. Inhaled corticosteroids may or may not be prescribed.

A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside? Select all that apply. Tracheostomy cleaning kit Water-seal chest drainage set-up Manual resuscitation bag Hemostat Pulse oximeter

Manual resuscitation bag Pulse oximeter The client with COPD depends on mechanical ventilation for adequate tissue oxygenation. The nurse must keep a manual resuscitation bag at the bedside to ventilate and oxygenate the client in case the mechanical ventilator malfunctions. The nurse needs to keep an oxygen analyzer (pulse oximeter) on hand to evaluate the effectiveness of ventilation. Because the client doesn't have chest tubes or a tracheostomy, keeping a water-seal chest drainage set-up or a tracheostomy cleaning kit or hemostat at the bedside isn't necessary.

The nurse is reviewing first-line pharmacotherapy for smoking abstinence with a client diagnosed with COPD. The nurse correctly includes which medications? Select all that apply. Clonidine Caffeine Nicotine gum Bupropion SR Acetaminophen

Nicotine gum Clonidine Bupropion SR First-line therapy includes nicotine gum as well as the antidepressants bupropion SR and nortriptyline. Second-line pharmacotherapy includes the antihypertensive agent clonidine. However, the use of clonidine is limited by its side effects. Varenicline, a nicotinic acetylcholine receptor partial agonist, may also assist in smoking cessation.

The medical nurse is creating the care plan of a client with a tracheostomy requiring mechanical ventilation. Which nursing action is most appropriate? Perform tracheostomy care at least once per day. Maintain continuous bed rest. Monitor cuff pressure every 8 hours. Keep the client in a low Fowler position.

Monitor cuff pressure every 8 hours. The cuff pressure should be monitored every 8 hours. It is important to perform tracheostomy care at least every 8 hours, not once per day, because of the risk of infection. The client should be encouraged to ambulate, if possible, not maintain continuous bed rest, and a low Fowler position is not indicated.

Following thoracic surgery, what should the nurse include in the care plan for a client at risk for impaired gas exchange? Select all that apply. Administer pain medications. Monitor vital signs frequently. Reinforce preoperative breathing exercises. Maintain accurate record of intravenous intake. Elevate head of bed 30 to 40 degrees as tolerated.

Monitor vital signs frequently. Reinforce preoperative breathing exercises. Elevate head of bed 30 to 40 degrees as tolerated. Administer pain medications. Nursing management for a client with the goal of maintaining optimal gas exchange includes assessing vital signs frequently; reinforcing preoperative instructions about deep breathing, coughing, and incentive spirometry; and elevating the head of the bed as tolerated. Administering pain medications may help the client with breathing exercises. Accurate record of intravenous fluids is a nurse action, but not a client care issue.

Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply. Zileuton Tiotropium Ipratropium HFA Montelukast Zafirlukast

Montelukast Zafirlukast Zileuton Montelukast (Singulair), Zafirlukast (Accolate), and Zileuton (Zyflo) are leukotriene modifiers. Ipratropium HFA (Atrovent) is a short-acting anticholinergic. Tiotropium (Spiriva) is a long-acting anticholinergic.

The nurse identifies which finding to be most consistent prior to the onset of acute respiratory failure? Chronic lung disease Slow onset of symptoms Normal lung function Loss of lung function

Normal lung function Acute respiratory failure occurs suddenly in clients who previously had normal lung function.

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 are not normally candidates for pneumococcal vaccination. Older adults have less compliant lung tissue than younger adults. Older adults often lack the classic signs and symptoms of pneumonia. Older adults often cannot tolerate the most common antibiotics used to treat pneumonia.

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.

A nurse is transporting a client with chest tubes to a treatment room. The chest tube becomes disconnected and falls between the bed rail. What is the priority action by the nurse? Place the chest tube in sterile water. Notify the health care provider. Clamp the chest tube close to the connection site. Immediately reconnect the chest tube to the drainage apparatus.

Place the chest tube in sterile water. If the client is lying on a stretcher and must be transported to another area, place the drainage system below the chest level. If the tubing disconnects, place the end of the chest tube in sterile water. Reattaching the chest tube to the drainage system is a source for infection. Do not clamp the chest tube during transport. Notifying the health care provider will not help the client in the situation.

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

Pneumocystis Pneumocystis pneumonia incidence is greatest in clients with AIDS and clients receiving immunosuppressive therapy for cancer, organ transplantation, and other disorders.

The nurse is reviewing the electronic health record of a client with an empyema. What health problem in the client's history is most likely to have caused the empyema? Pneumonia Smoking Asbestosis Lung cancer

Pneumonia Most empyemas occur as complications of bacterial pneumonia or lung abscess. Cancer, smoking, and asbestosis are not noted to be common causes.

A client suspected of developing acute respiratory distress syndrome (ARDS) is experiencing anxiety and agitation due to increasing hypoxemia and dyspnea. Which intervention may improve oxygenation and provide comfort for the client? Force fluids for the next 24 hours Administer small doses of pancuronium Assist the client into a chair Position the client in the prone position

Position the client in the prone position The patient is extremely anxious and agitated because of the increasing hypoxemia and dyspnea. It is important to reduce the patient's anxiety because anxiety increases oxygen expenditure. Oxygenation in patients with ARDS is sometimes improved in the prone position. Rest is essential to limit oxygen consumption and reduce oxygen needs.

A nurse educator is reviewing the indications for chest drainage systems with a group of medical nurses. What indications should the nurses identify? Select all that apply. Post thoracotomy Chest trauma resulting in pneumothorax Spontaneous pneumothorax Pleurisy Need for postural drainage

Post thoracotomy Chest trauma resulting in pneumothorax Spontaneous pneumothorax Chest drainage systems are used in treatment of spontaneous pneumothorax and trauma resulting in pneumothorax. Postural drainage and pleurisy are not indications for use of a chest drainage system.

A nurse is caring for a client with COPD. While reviewing breathing exercises, the nurse instructs the client to breathe in slowly through the nose, taking in a normal breath. Then the nurse asks the client to pucker his lips as if preparing to whistle. Finally, the client is told to exhale slowly and gently through the puckered lips. The nurse teaches the client this breathing exercise to accomplish which goals? Select all that apply. Strengthen the diaphragm Condition the inspiratory muscles Release air trapped in the lungs Prevent airway collapse Control the rate and depth of respirations

Prevent airway collapse Control the rate and depth of respirations Release air trapped in the lungs The nurse is teaching the client the technique of pursed-lip breathing. It helps slow expiration, prevents collapse of the airways, releases air trapped in the lungs, and helps the client control the rate and depth of respirations. This helps clients relax and get control of dyspnea and reduces the feelings of panic they may experience. Diaphragmatic breathing strengthens the diaphragm during breathing. In inspiratory muscle training, the client will be instructed to inhale against a set resistance for a prescribed amount of time every day in order to condition the inspiratory muscles.

A client presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands that goals of therapy should be achieved to improve the client's condition. Which statements reflect therapy goals? Select all that apply. Treat the underlying cause of the event. Provide long-term support for medical management. Return the client to their original functioning abilities. Provide medical support for the current exacerbation. Teach the client to suspend activity.

Provide medical support for the current exacerbation. Treat the underlying cause of the event. Return the client to their original functioning abilities. Provide long-term support for medical management. The goal is to have a stable client with COPD leading the most productive life possible. COPD cannot necessarily be cured, but it can be managed so that the client can live a reasonably normal life. With adequate management, clients should not have to give up their usual activities.

The nurse is caring for a client who is intubated for mechanical ventilation. Which intervention(s) will the nurse implement to reduce the client's risk of injury? Select all that apply. Provide oral hygiene. Assess for a cuff leak. Position with head above the stomach level. Monitor cuff pressure every 8 hours. Reduce pulling on ventilator tubing.

Provide oral hygiene. Assess for a cuff leak. Position with head above the stomach level. Monitor cuff pressure every 8 hours. Reduce pulling on ventilator tubing. ALL OF THEM! Maintaining the endotracheal or tracheostomy tube is an essential part of airway management. Oral hygiene is provided frequently because the oral cavity is a primary source of lung contamination in the client who is intubated. Assessing for a leak from the cuff of the endotracheal tube needs to be done at the same time as providing other respiratory care. Ventilator tubing should be positioned so that there is minimal pulling or distortion of the tube in the trachea which reduces the risk of trauma to the trachea. Cuff pressure is monitored every 8 hours to maintain the pressure at 20 to 25 mm Hg. The head of the bed should be higher than the stomach to reduce the risk of aspiration.

Which action by the nurse is most appropriate when the client demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery? Measure the patient's pulse oximetry Apply a compression dressing to the area Record the observation Report the finding to the physician immediately

Record the observation The nurse should record the observation. Subcutaneous emphysema is a typical finding in clients after chest surgery. Subcutaneous emphysema occurs after chest surgery as the air that is located within the pleural cavity is expelled through the tissue opening created by the surgical procedure. Subcutaneous emphysema is absorbed by the body spontaneously after the underlying leak is treated or halted. Subcutaneous emphysema results from air entering the tissue planes. It is unnecessary to report the finding to the physician or apply a compression dressing because subcutaneous emphysema is an expected finding at this stage of recovery. Subcutaneous emphysema is not an explicit risk factor for hypoxemia, so no extraordinary monitoring of pulse oximetry is necessary.

The nurse, caring for a patient with emphysema, understands that airflow limitations are not reversible. The end result of deterioration is: Hypercapnia resulting from decreased carbon dioxide elimination. Hypoxemia secondary to impaired oxygen diffusion. Respiratory acidosis. Diminished alveolar surface area.

Respiratory acidosis. Decreased carbon dioxide elimination results in increased carbon dioxide tension (hypercapnia), which leads to respiratory acidosis and chronic respiratory failure.

A client has been classified as status asthmaticus. The nurse understands that this client will likely initially exhibit symptoms of: Metabolic acidosis Respiratory acidosis Respiratory alkalosis Metabolic alkalosis

Respiratory alkalosis There is a reduced PaCO2 and initial respiratory alkalosis, with a decreased PaCO2 and an increased pH. As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

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

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 of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply. Second-hand smoke Tobacco smoke Infection Occupational dust Air pollution

Second-hand smoke Tobacco smoke Infection Occupational dust Air pollution ALL OF THEM! Risk factors for chronic obstructive pulmonary disease are tobacco smoke, environmental tobacco smoke, occupational dust and chemicals, indoor and outdoor air pollution, and infection.

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

Substernal pain Dyspnea Fatigue Oxygen toxicity can occur when clients receive too high a concentration of oxygen for an extended period. Symptoms include dyspnea, substernal pain, restlessness, fatigue, and progressive respiratory difficulty. Bradycardia and mood swings are not symptoms of oxygen toxicity.

A client being mechanically ventilated through an endotracheal tube for 14 days has a percutaneous tracheostomy inserted at the bedside. Which interventions will the nurse anticipate will be included in the client's plan of care? Select all that apply. Check cuff pressure every 8 hours Use clean technique for tracheostomy care Monitor oxygen saturation Change tape and dressing as needed Suction as necessary

Suction as necessary Monitor oxygen saturation Check cuff pressure every 8 hours Change tape and dressing as needed Endotracheal intubation may be used for no longer than 14 to 21 days, by which time a tracheostomy must be considered to decrease irritation of and trauma to the tracheal lining, and to reduce the incidence of vocal cord paralysis. For a client who is intubated and mechanically ventilated, a newer surgical technique referred to as a percutaneous tracheostomy can be performed at the bedside with the use of local anesthesia and sedation and analgesia. Once the tracheostomy is placed, nursing care includes suctioning as necessary, monitoring oxygen saturation, checking cuff pressure every 8 hours, and changing the tape and dressing as needed. Care of the tracheostomy is completed using sterile and not clean technique.

Which of the following is a clinical manifestation of a pneumothorax? Select all that apply. Asymmetry of chest movement Bilaterally equal breath sounds Unilateral retractions Oxygen desaturation Sudden chest pain

Sudden chest pain Asymmetry of chest movement Unilateral retractions Oxygen desaturation Signs and symptoms of pneumothorax include sudden chest pain that is sharp and abrupt, a significant and sudden increase in shortness of breath, asymmetry of chest movement, unilateral retractions, bilateral differences in breath sounds, and/or oxygen desaturation. The patient with a pneumothorax would not have bilaterally equal breath sounds.

The nurse is assisting with the removal of an oral endotracheal tube. Place in order the actions the nurse will take to provide care to the client. Use all options. 1 Insert a new sterile suction catheter inside the tube. 2 Suction the tracheobronchial tree and oropharynx. 3 Provide a few breaths of 100% oxygen. 4 Place a self-inflating bag and mask at the bedside. 5 Explain the procedure. 6 Deflate the cuff. 7 Remove tape. 8 Instruct the client to inhale. 9 Remove the tube while suctioning the airway as it is removed

The correct sequence for diaphragmatic breathing is as follows: (1) Explain the procedure. (2) Place a self-inflating bag and mask at the bedside. (3) Suction the tracheobronchial tree and oropharynx. (4) Remove tape. (5) Deflate the cuff. (6) Provide a few breaths of 100% oxygen. (7) Insert a new sterile suction catheter inside the tube. (8) Instruct the client to inhale. (9) Remove the tube while suctioning the airway as it is removed

The nurse is teaching a client the proper technique for diaphragmatic breathing. Place the steps for this procedure in the correct sequence. 1 Press firmly inward and upward on the abdomen while breathing out. 2 Breathe out through pursed lips while tightening the abdominal muscles. 3 Repeat for 1 minute; follow with a 2-minute rest period. 4 Place one hand on the abdomen and the other hand on the middle of the chest to increase awareness of the position of the diaphragm and its function in breathing. 5 Breathe in slowly and deeply through the nose, letting the abdomen protrude as far as possible.

The correct sequence for diaphragmatic breathing is as follows: (1) Place one hand on the abdomen (just below the ribs) and the other hand on the middle of the chest to increase awareness of the position of the diaphragm and its function in breathing. (2) Breathe in slowly and deeply through the nose, letting the abdomen protrude as far as possible. (3) Breathe out through pursed lips while tightening (contracting) the abdominal muscles. (4) Press firmly inward and upward on the abdomen while breathing out. (5) Repeat for 1 minute; follow with a 2-minute rest period.

A client with a chronic lung disease is prescribed postural drainage. Place in order the nurse's actions to perform this procedure. Use all options. 1 Place client in position to drain the lower lobes for 10 to 15 minutes and then cough. 2 Instruct client to breathe in through the nose and out through pursed lips. 3 Plan to do the procedure before a meal. 4 Place client in position to drain the middle lobe for 10 to 15 minutes and then cough. 5 Provide medication to loosen secretions before the procedure. 6 Obtain an emesis basin, sputum cup, and paper tissues. 7 Place client in position to drain the upper lobes for 10 to 15 minutes and then cough.

The correct sequence for diaphragmatic breathing is as follows: (1) Plan to do the procedure before a meal. (2) Provide medication to loosen secretions before the procedure. (3) Obtain an emesis basin, sputum cup, and paper tissues. (4) Instruct client to breathe in through the nose and out through pursed lips. (5) Place client in position to drain the lower lobes for 10 to 15 minutes and then cough. (6) Place client in position to drain the middle lobe for 10 to 15 minutes and then cough. (7) Place client in position to drain the upper lobes for 10 to 15 minutes and then cough.

The nurse is providing tracheostomy care for a client. Place the following steps in the order the nurse should perform them. 1 Using a clean glove, remove the soiled stomal dressing and discard it, glove and all, in an appropriate receptacle. 2 Open the tracheostomy kit without contaminating the contents. Don sterile gloves—keep the dominant hand sterile. Pour hydrogen peroxide and normal saline into respective containers. 3 Position client in a supine or low Fowler position. 4 Replace the inner cannula and turn it clockwise within the outer cannula. 5 Unlock the inner cannula by turning it counterclockwise. Remove it and place in hydrogen peroxide. Clean the inside and outside of the cannula with pipe cleaners. 6 Clean around the stoma with an applicator moistened with normal saline. 7 Rinse the cleaned cannula with normal saline. Tap the cannula and wipe the excess solution with sterile gauze. 8 Place a sterile dressing around the tracheostomy tube. Change the tracheostomy ties by placing the new ones on first and removing the soiled ones last. Tie the new ends securely, but not tightly, at the side of the neck.

The correct sequence for diaphragmatic breathing is as follows: (1) Position client in a supine or low Fowler position. (2) Using a clean glove, remove the soiled stomal dressing and discard it, glove and all, in an appropriate receptacle. (3) Open the tracheostomy kit without contaminating the contents. Don sterile gloves—keep the dominant hand sterile. Pour hydrogen peroxide and normal saline into respective containers. (4) Unlock the inner cannula by turning it counterclockwise. Remove it and place in hydrogen peroxide. Clean the inside and outside of the cannula with pipe cleaners. (5) Rinse the cleaned cannula with normal saline. Tap the cannula and wipe the excess solution with sterile gauze. (6) Replace the inner cannula and turn it clockwise within the outer cannula. (7) Clean around the stoma with an applicator moistened with normal saline. (8) Place a sterile dressing around the tracheostomy tube. Change the tracheostomy ties by placing the new ones on first and removing the soiled ones last. Tie the new ends securely, but not tightly, at the side of the neck.

The nurse is caring for a client with atelectasis. Place in order the instructions the nurse will provide the client to use an incentive spirometer. Use all options. 1 Breathe in slowly through the mouth. 2 Sit in an upright or semi-Fowler position. 3 Place the mouthpiece in the mouth. 4 Cough after each session. 5 Use diaphragmatic breathing. 6 Exhale slowly through the mouthpiece. 7 Use the spirometer for 10 breaths each waking hour. 8 Hold the breath at the end of inspiration for 3 seconds.

The correct sequence for diaphragmatic breathing is as follows: (1) Sit in an upright or semi-Fowler position. (2) Use diaphragmatic breathing. (3) Place the mouthpiece in the mouth. (4) Breathe in slowly through the mouth. (5) Hold the breath at the end of inspiration for 3 seconds. (6) Exhale slowly through the mouthpiece. (7) Cough after each session. (8) Use the spirometer for 10 breaths each waking hour.

A client is being mechanically ventilated with an oral endotracheal tube in place. The nurse observes that the cuff pressure is 28 mm Hg. The nurse is aware of what complications that can be caused by this pressure? Select all that apply. Tracheal ischemia Pressure necrosis Hypoxia Tracheal bleeding Tracheal aspiration

Tracheal ischemia Tracheal bleeding Pressure necrosis Complications can occur from pressure exerted by the cuff on the tracheal wall. Cuff pressures should be maintained between 20 and 25 mm Hg. High cuff pressure can cause tracheal bleeding, ischemia, and pressure necrosis, whereas low cuff pressure can increase the risk of aspiration pneumonia. Routine deflation of the cuff is not recommended because of the increased risk of aspiration and hypoxia.

A nurse is aware that the diagnostic feature of ARDS is sudden: Diminished alveolar dilation. Unresponsive arterial hypoxemia. Increased PaO2 Tachypnea

Unresponsive arterial hypoxemia. Clinically, the acute phase of ARDS is marked by a rapid onset of severe dyspnea that usually occurs 12 to 48 hours after the initiating event. A characteristic feature is arterial hypoxemia that does not respond to supplemental oxygen.

A mechanically ventilated client is receiving a combination of atracurium and the opioid analgesic morphine. The nurse monitors the client for which potential complication? Venous thromboemboli Pulmonary hypertension Cor pulmonale Pneumothorax

Venous thromboemboli Neuromuscular blockers predispose the client to venous thromboemboli (VTE), muscle atrophy, foot drop, peptic ulcer disease, and skin breakdown. Nursing assessment is essential to minimize the complications related to neuromuscular blockade. The client may have discomfort or pain but be unable to communicate these sensations.

A nurse assesses a client with pneumonia. Which assessments are diagnostic for pneumonia? Select all that apply. Wheezes Presence of crackles Egophony Percussion dullness Friction rubs Whispered pectoriloquy

Wheezes Presence of crackles Egophony Percussion dullness Whispered pectoriloquy Physical examination findings may reveal bronchial breath sounds over consolidated lung areas: soft, high-pitched crackles, inspiratory vesicular sounds that are longer than expired normal breath sounds, increased tactile fremitus (vocal vibration detected on palpation), percussion dullness, egophony, wheezing, and whispered pectoriloquy (whispered sounds are easily auscultated through the chest wall). Friction rubs are not common assessment findings for clients with pneumonia.

A client with unresolved hemothorax is febrile, with chills and sweating. He has a nonproductive cough and chest pain. His chest tube drainage is turbid. A possible explanation for these findings is: infected chest tube wound site. lobar pneumonia. empyema. Pneumocystis carinii pneumonia.

empyema. Any condition that produces fluid accumulation or sequestration of fluid with infective properties can lead to empyema, an accumulation of pus in a body cavity, especially the pleural space, as a result of bacterial infection. An infected chest tube site, lobar pneumonia, and P. carinii pneumonia can lead to fever, chills, and sweating associated with infection. However, in this case, turbid drainage indicates that empyema has developed. Pneumonia typically causes a productive cough. An infected chest tube wound would cause redness and pain at the site, not turbid drainage.

A client who underwent thoracic surgery to remove a lung tumor had a chest tube placed anteriorly. The surgical team places this catheter to: remove fluid from the lungs. remove air from the pleural space. ventilate the client. administer IV medication.

remove air from the pleural space. After thoracic surgery, draining secretions, air, and blood from the thoracic cavity is necessary to allow the lungs to expand. A catheter placed in the pleural space provides a drainage route through a closed or underwater-seal drainage system to remove air. Sometimes two chest catheters are placed following thoracic surgery: one anteriorly and one posteriorly. The anterior catheter removes air; the posterior catheter removes fluid.