Nursing 101 Chapter 39 study questions

You are the visiting nurse for a patient with emphysema who is receiving oxygen therapy. List 5 precautions you would take to prevent fire and injury to this patient

1) Avoid open flames in the patients room 2) place "no smoking" signs in conspicuous places in the patient's room 3) check to see that electric equipment is in good, working order 4) Avoid wearing and using synthetic fabrics, which build up static electricity 5) Avoid using oils in the area

briefly describe the following components in the procedure for administering cardiopulmonary resuscitation (CPR) chest compression airway breathing defibrillation

1) Chest Compressions: check the pulse for no more than 10 seconds. If the victim has no pulse, initiate chest compressions to provide artificial circulation 2) Airway: Tilt the head and lift the chin; check for breathing. The respiratory tract must be opened so that air can enter. 3) Breathing: if the victim does not start to breathe spontaneously after the airway is opened, give 2 breaths lasting 1 second each 4) Defibrillation: apply the AED as soon as it is available

how would you describes these techniques to promote proper breathing deep breathing incentive spirometry pursed lip breathing diaphragmatic breathing voluntary coughing

1) Deep Breathing: The nurse instructs the patient to make each breath deep enough to move the bottom ribs. The patient should start slowly, inspiring deeply through the nose and expiring slowly through the mouth 2) Incentive Spirometry: The patient takes a deep breath and observes the results of his or her efforts as they register on the spirometer as the patient sustains maximal inspiration. 3) Pursed lip breathing: while sitting upright, the patient inhales through the nose while tightening the ab muscles. During exhalation, the patients counts to 7. To purse the lips, the patient should position lips as though he or she was sucking through a straw or whistling. When walking and using pursed lip breathing, the patient should inhale while taking two steps and then exhale through pursed lips while taking the next 4 steps and then repeat the cycle. 4) Diaphragmatic breathing: the patient places one hand on the stomach and the other on the middle of the chest. He or she breaths in slowing through the nose, letting the abdomen protrude as far as it will go. The the patient breaths out through pursed lip while contracting the ab muscles, with one hand pressing inward and upward on the abdomen. He or she repeats these steps for 1 minute, followed by a rest for 2 minutes several times during the day 5) Voluntary Coughing: The nurse encourages the patient to cough voluntarily; coughing is more effective when combined with deep breathing.

Describe 7 comfort measures for patients with impaired respiratory functioning.

1) Help the patient assume a position that allows free movement of the diaphragm and expansion of the chest wall to promote ease of respiration 2) Keep the patient's secretions thin by asking the patient to drink 2-3 quartz of clear fluids daily 3) provide humidified air 4) Perform chest physiotherapy on the patient's lungs to loosen the pulmonary secretions 5) Use vibration to help loosen respiratory secretions 6) Provide postural drainage 7) Help patient maintain good nutrition

List 3 factors on which normal respiratory functioning depends

1) The integrity of the airway system to transport air to and from the lungs 2) A properly functioning alveolar system in the lungs to oxygenate venous blood and remove carbon dioxide from the blood 3) A properly functioning cardiovascular system to carry nutrients and wastes to and from body cells

list four factors that influence the diffusion of gas in the lungs

1) any change in the surface area available for diffusion will have a negative effect on diffusion 2) Incomplete lung expansion or lung collapse (atelectasis) prevents pressure changes and exchanges of gases by diffusion in the lungs 3) Any disease or condition that results in thickening of the alveolar-capillary membrane makes diffusion more difficult 4) The partial pressure, or pressure resulting from any gas in a mixture depending on its concentration, can also affect diffusion

describe the two ways that oxygen is carried in the body

1) it is dissolved in the plasma 2) Most oxygen (97%) is carried in the body by RBC in the form of oxyhemoglobin

describe the types of airways and their uses Oropharyngeal/nasopharyngeal airway endotracheal tube tracheostomy tube

1)Oropharyngeal/nasopharyngeal: semi-circular tube of plastic or rubber inserted into the back of the pharynx through the mouth or nose in a spontaneously breathing patient; used to keep the tongue clear of the airway and to permit suctioning of secretions; often used for post-op patients until they regain consciousness. 2) Endotracheal tube: polyvinylchloride tube that is inserted through the nose or mouth in the trachea using a laryngoscope as a guide; used to administer oxygen by mechanical ventilator, to suction secretions easily, or to bypass upper airway obstructions 3) Tracheostomy tube: an artificial opening made into the trachea. The curved tracheostomy tube is inserted in this opening to replace an endotracheal tube, provide a method to mechanically ventilate the patient, bypass an upper airway obstruction, or remove tracheobronchial secretions

The nurse is assessing the respiratory rates of patients in a community health care facility. Which patient exhibits an abnormal value? a. An infant with a respiratory rate of 20 bpm b. a 4-year old with a respiratory rate of 40 bpm c. a 12 year old with a respiratory rate of 20 bpm d. a 70 year old with a respiratory rate of 18 bpm

A. an infant with a respiratory rate of 20bpm

What assessments would a nurse make when auscultating the lungs? a. cardiovascular function b. abnormal chest structures c. presence of edema d. volume of air exhaled or inhaled

A. cardiovascular function

A nurse suctioning a patient through a tracheostomy tube should be careful not to occlude the Y-port when inserting the suction catheter because it would cause what condition to occur? a. trauma to the tracheal mucosa b. prevention of suctioning c. loss of sterile field d. suctioning of Carbon Dioxide

A. trauma to the tracheal mucosa

The nurse assesses a patient and detects the following finding: difficulty breathing, increased respiratory and pulse rates, and pale skin with regions of cyanosis. What condition would the nurse suspect as causing these respiratory alterations? a. Hyperventilation b. hypoxia c. perfusion d. atelectasis

B. Hypoxia

The nurse sets up an oxygen tent for a patient. Which patient is the best candidate for this oxygen delivery system? a. an older adult patient who has COPD b. a child who has pneumonia c. an adult who is receiving oxygen at home d. an adolescent who has asthma

B. a child who has pneumonia

The nurse is teaching an adolescent with asthma how to use a metered-dose inhaler. Which teaching point follows recommended guidelines? a. inhale through the nose instead of the mouth b. be sure to shake the canister before using it c. inhale the medication rapidly d. inhale two sprays with one breath for faster action

B. be sure to shake the canister before using it

When percussing the normal lung, which sound would the nurse hear? a. tympany b. resonance c. dullness d. hyperresonance

B. resonance

describe nursing responsibilities before, during, and after a thoracentesis

Before: collect baseline date; prepare the patient physically and emotionally, instruct patient to remain still; administer analgesics as ordered. During: Observe patient for reactions; report any deviation from normal color, pulse, respiratory rates to health care provider; ensure that specimens, if obtained, are taken to the lab immediately After: Observe patient for changes in vital signs, particularly respirations; chest radiograph

The nurse is auscultating the lungs of a patient and detects normal vesicular breath sounds. What is a characteristic of vesicular breath sounds? a. they are loud, high pitched sounds heard primarily over the trachea and larynx b. they are medium-pitched blowing sounds heard over the major bronchi c. they are low pitched, soft sounds heard over peripheral lung fields d. they are soft, high pitched discontinuous (intermittent) popping lung sounds

C. they are low pitched, soft sounds heard over peripheral lung fields

A nurse auscultates the lungs of a patient with asthma. Which lung sound is characterized of this condition? a. crackles b. bronchial sounds c. wheezes d. vesicular sounds

C. wheezes

The nurse schedules a pulmonary function test to measure the amount of air left in a patient's lung at maximal expiration. What test does the nurse need to order? a. Tidal Volume (TV) b. Total Lung Capacity (TLC) c. Forced expiratory volume (FEV) d. Residual Volume (RV)

D. Residual Volume (RV)

A nurse is performing CPR on a patient who is in cardiac arrest. What action would the nurse perform second? a. check the victim for a response b. begin CPR with the CAB sequence c. get an AED or defibrillator d. activate the emergency response system

D. activate the emergency response system

Mr. Parks has chronic obstructive pulmonary disease (COPD). His nurse has taught him pursed-lip breathing, which helps him in which of the following ways? a. increases carbon dioxide, which stimulates breathing b. teaches him to prolong inspiration and shorten expiration c. helps liquefy his secretions d. decreases the amount of air trapping and resistance

D. decreases the amount of air trapping and resistance

The nurse is caring for a patient who complains of difficulty breathing. In what position would the nurse place this patient? a. prone b. lateral c. supine d. fowlers

D. fowlers

When caring for a patient with a tracheostomy, the nurse would perform which recommended action? a. clean the wound around the tube and inner cannula at least every 24 hours b. assess a newly inserted tracheostomy every 3-4 hours c. use gauze dressings over the tracheostomy that are filled with cotton d. suction the tracheostomy tube using sterile technique

D. suction the tracheostomy tube using sterile technique

When inspecting a patient's chest to assess respiratory status, the nurse should be aware of which normal finding? a. the contour of the intercostal spaces should be rounded b. the skin at the thorax should be cool and moist c. the anteroposterior diameter should be greater than the transverse diameter d. the chest should be slightly convex with no sternal depression

D. the chest should be slightly convex with no sternal depression

Connects to oxygen tubing, a humidifier, and flow meter and uses a delivery flow rate greater than 5 L/min; it should be comfortable snug over face but not tight. It has vents in sides to allow room air to leak in at many places, diluting the source oxygen

Simple facemask

how would you describe the effects of smoking on the lungs to a patient who smokes a pack of cigarettes a day

The inhalation of cigarette smoke increases airway resistance, reduces ciliary action, increases mucus production, causes thickening of the alveolar-capillary membrane, and causes bronchial walls to thicken and lose their elasticity.

Describe the functions of the upper and lower airway

Upper airway: the upper airway comprises the nose, pharynx, larynx, and epiglottis. Its main function is to warm, filter and humidify inspired air Lower airway: The lower airway comprises the trachea, right and left mainstem bronchus, segmental bronchi, and terminal bronchioles. The major functions are conduction of air, mucociliary clearance, and production of pulmonary surfactant

The nurse is reviewing the results of a patient's arterial blood gas and pH analysis. Normal findings include? (select all that apply) a. pH 7.45 b. PCO2 40 mm Hg c. PO2 70 mm Hg d. HCO3 30 mEq/L e. base excess or deficit + 2 mmol/L f. pH 8.5

a, b, e

Which normal conditions would a nurse expect to find when performing a physical assessment of a client's respiratory system? (select all that apply) a. slightly contoured chest with no sternal depression b. anteroposterior diameter of the chest less that the transverse diameter c. quiet and nonlabored respiration occurring at a rate of 18-30 bpm d. barrel chest appearance in older adults e. bronchial, vesicular, and bronchovesicular breath sounds f. crackles heard on inspiration

a, b, e

The nurse is teaching a patient the proper use of inhaled medications. What are the appropriate teaching points to include? (select all that apply) a. bronchodilators are used to liquefy or loosed thick secretions or reduce inflammation in airways b. nebulizers are used to deliver a controlled dose of medication with each compression of the canister c. when using an MDI, the patient must activate the device before and after inhaling d. DPIs are actuated by the patients inspiration, so there is no need to coordinate the delivery of puffs with inhalation e. metered-dose inhalers deliver a controlled dose of medications with each compression of the canister f. inhalers can be used safely without serious side effects whenever they are needed by the patien

a,d,e

When preparing a patient for cardiac catheterization, what are the responsibilities of the nurse? (select all that apply) a. verify that an informed consent was obtained b. inform the patient that bedrest is required for 24 hours after the procedure c. tell the patient to avoid heavy lifting, sports, and strenuous housework for 1 week d. make sure the patient is NPO after midnight before the procedure e. inform the patient that when dye is given, a feeling of warmth or flushing, or a metallic taste may occur f. inform the patient that bathing and showering are not allowed 48 hours following the procedure

a,d,e

what is the nurse's responsibility when managing a patient's test tube?

assisting with insertion and removal of chest tube. Once the tube is in place, monitor the patient's respiratory status and vital signs, check the dressing, and maintain the patency and integrity of the drainage system.

incomplete lung expansion or lung collapse

atelectasis

The nurse performs assessments of cardiopulmonary functioning and oxygenation during regular physical assessments. Based on developmental variations, which findings would the nurse consider normal? (select all that apply) a. BP increases over time until it reaches the adult level around age 8 b. the power of the respiratory and abdominal muscles is reduced in older adults, and therefore the diaphragm moves less efficiently c. the normal infant's chest is small and the airways are short, making aspiration a potential problem d. alterations in respiratory function due to aging in older adults increase the risk for disease, especially pneumonia and other chest infections e. the respiratory rate is more rapid in infants until the alveoli increase in number and size to produce adequate oxygenation at lower respiratory rates f. the chest in the older adult is unable to stretch as much, resulting in an increase in maximum inspiration and expiration

b,c,d,e

The nurse is preparing a patient for a CBC test. Which actions would the nurse perform? (select all that apply) a. emphasize that there is no discomfort during the venipuncture b. inform the patient that this test can assist in evaluating the body's response to illness c. inform the patient that specimen collection take approximately 5-10 minutes d. administer an analgesic to the patient prior to the test e. explain that, based on results, additional tests may be performed f. ensure that no food is consumed 6 hours prior to the test

b,c,e

Place the following steps for inserting a nasopharyngeal airway in the order in which they should occur a. remove the airway, clean it, and place it in the other naris at least every 8 hours or according to facility policy. assess for any evidence of skin breakdown b. wash your hands, put on ppe as indicated, and identify patient c. explain what you are going to do and the reason for doing it, even though the patient does not appear to be alert d. gently insert the airway into the naris, narrow end first, pointing it down toward the back of the throat until the rim is touching the naris. If resistance is met, stop and try inserting in the other naris. e. put on gloves, put on mask and goggles or face shield as indicated. Lubricate the airway with the water-soluble lubricant, covering the airway form the tip to the guard rim f. use an airway that is the correct size. Measure the nasopharyngeal airway for correct size. Measure the nasopharyngeal airway length by holding the airway on the side the patient's face. The airway should reach from the tip of the nose to the earlobe. The airway with the largest outer diameter that fits the patient's nostril should be used g. if the patient is awake and alert, position in semi-fowlers position. If the patient is not conscious or alert, position in a side-lying position h. Check placement by closing the patient's mouth and placing your fingers in front of the tube opening to check for air movement. Assess the pharynx to visualize the tip of the airway behind the uvula. Assess the nose for blanching or stretching of the skin

b,c,f,g,e,d,h,a

Which actions should a nurse perform when inserting an oropharyngeal airway? (Select all that apply) a. use an airway that reaches from the nose to the back angle of the jaw b. wash hands and put on PPE, as indicated c. position patient flat on his or her back with the head turned to one side d. insert the airway with the curved tip pointing down toward the base of the mouth e. rotate the airway 180 degrees as it passes the uvula f. removes airway for a brief period every 4 hours or according to facility policy

b,e,f

Place the following steps for teaching a patient to use an incentive spirometer in the order in which they should occur a. instruct the patient to exhale normally and then place lips securely around mouthpiece and not to breathe through his or her nose b. medicate with ordered pain medication if needed c. tell patient to hold breath and count to three when unable to inhale anymore. Check position of gauge to determine progress and level attained d. tell patient to complete breathing exercises about 5-10 time every 1-2 hours, if possible, and to rest between breaths as necessary e. assist patient to an upright or semi-fowlers position if possible and remove dentures if they fit poorly f. demonstrate how to steady device with one hand and hold mouth piece with other hand g. instruct the patient not to breathe through the nose and to inhale slowly and as deeply as possible through the mouthpiece h. instruct the patient to remove lips from mouthpiece and exhale normally

b,e,f,a,g,c,h,d

movement of oxygen and carbon dioxide between the air and the blood

diffusion

an increased rate and depth of ventilation above the body's normal metabolic requirements

hyperventilation

a decreased rate of air movement into the lungs

hypoventilation

an inadequate amount of oxygen in the cells

hypoxia

Movement of muscles and thorax to bring air into the lungs

inspiration

stretchability of the lungs or the ease with which the lungs can be inflated

lung compliance

Probably the most commonly used respiratory aid, this consists of a disposable, plastic device with two protruding prongs for insertion into the nostrils; it is connected to an oxygen source with a humidifier and a flow meter

nasal cannula

Produces the highest concentration of oxygen with a mask; contains two one-way valves that prevent conservation of exhaled air, which escapes through side vents

nonrebreather mask

briefly describe the variations in respirations experienced by the following age group older adult

older adult: bony landmarks are more prominent; kyphosis contributes to appearance of leaning forward and can limit respiratory ventilation; barrel chest deformity may result; senile emphysema may be present; power of respiratory and abdominal muscles is reduced

This mask is equipped with a reservoir bag for the collection of the first part of the patient's exhaled air. The air is mixed with 100% oxygen for the next inhalation.

partial rebreather mask

process by which the oxygenated capillary blood passes through the tissue

perfusion

Describe the nurse's role in providing tracheostomy care for a patient

replace a disposable inner cannula or cleaning a nondisposable one and regularly changing dressings and ties

A small catheter is inserted into the trachea under local anesthesia and the catheter is attached to the oxygen source

transtracheal oxygen delivery

any impediment or obstruction that air meets as it moves through the airway

ventilation

movement of air in and out of the lungs

ventilation

This mask delivers the most precise concentration of oxygen and has a large tube with an oxygen inlet. As the tube narrows, pressure drops, causing air to be sucked in through the side ports

venturi mask