Respiratory

A client in respiratory distress is admitted with arterial blood gas results of: PH 7.30; PO2 58, PCO 34; and HCO3 19. The nurse determines that the client is in? A. Respiratory alkalosis B. Metabolic acidosis C. Respiratory acidosis D. Metabolic alkalosis

B. Metabolic acidosis These lab values indicate metabolic acidosis; The PH is low, PCO2 normal; and bicarbonate level is low.

Which of the statements indicates patient understanding in your health teaching regarding steroids? A. I should take steroids at night B. I can stop the taking steroids anytime I like C. After taking steroids, I should wash my mouth by swishing and spitting D. After taking steroids, I should eat something sweet to remove the chalky taste

C. After taking steroids, I should wash my mouth by swishing and spitting Avoids fungal infection

The nurse is caring for a client with a hemopneumothorax. The client has a chest tube. The nurse would EXPECT which of the following color of drainage? A. Yellow B. Clear C. Brown D. Red

D. Red "Hemo" implies a bloody pneumothorax, therefore red drainage. Hemopneumothorax, or haemopneumothorax, is a medical term describing the combination of two conditions: pneumothorax, or air in the chest cavity, and hemothorax (also called hæmothorax), or blood in the chest cavity.

What is the hallmark sign of BTL edema? A. Wheezing B. Crackles C. Ronchi D. Stridor

D. Stridor it has a crowing sound indicative of BTL edema, and most pronounced during insipiration

A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the following instructions would be appropriate for the nurse to give the client? A. "Use your nasal decongestant spray regularly to help clear your nasal passages." B. "Ask the doctor for antibiotics. Antibiotics will help decrease the secretion." C. "It is important to increase your activity. A daily brisk walk will help promote drainage." D. "Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks."

Answer: D. "Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks." It is important for clients with allergic rhinitis to determine the precipitating factors so that they can be avoided. Keeping a diary can help identify these triggers. Patients often underestimate the severity of this condition and fail to seek medical therapy. It is important to adequately control AR, especially due to the link between AR and asthma, with poor control of rhinitis predicting poor control of asthma. Option A: Nasal decongestant sprays should not be used regularly because they can cause a rebound effect. If removing a pet from home is not feasible, isolating the pet to a single room in the house may be an option to minimize dander exposure. It may take up to 20 weeks to eliminate cat dander from home even after removing the animal. Option B: Antibiotics are not appropriate. Intranasal corticosteroid therapy can be as monotherapy or in combination with oral antihistamines in patients with mild, moderate, or severe symptoms. Studies have shown intranasal corticosteroids are superior to antihistamines in effectively reducing nasal inflammation and improving mucosal pathology. Option C: Increasing activity will not control the client's symptoms; in fact, walking outdoors may increase them if the client is allergic to pollen. Avoidance of triggers, especially in those with seasonal symptoms, is encouraged, although it is not always practical. Precautions can be taken to avoid dust mites, animal dander, and upholstery, though this can require significant lifestyle changes that may not be acceptable to the patient.

A registered nurse is planning the schedule for the day. Which of the following nursing tasks may the nurse delegate to a licensed practical nurse? A. Administer a purified protein derivative (PPD) to a client B. Clarify an order with the physician C. Develop instructions for the client on pursed-lip breathing D. Instruct a client on a bronchoscopy

A. Administer a purified protein derivative (PPD) to a client It is not appropriate to assign a licensed practical nurse to develop a teaching plan, teach, or clarify an order with the physician. These are tasks reserved for the registered nurse. An LPN may administer a purified protein derivative to a client.

Surfactants are responsible for the enlargement and constriction of the lungs, and is produced by: A. Alveolar Cells Type 1 B. Alveolar Cells Type 2 C. Epithelial Cells D. Mast Cells

A. Alveolar Cells Type 1

Which of the following is a priority to include in the instructions given to a client who has bronchitis? A. Avoid cigarette smoking B. Avoid malnutrition C. Increase activity D. Decrease overweight status

A. Avoid cigarette smoking Cigarette smoking is one of the most significant risk factors for developing bronchitis. Bronchitis involves the major bronchi and is classified as acute or chronic. Acute bronchitis is bronchial airway inflammation related to smoke, irritants, or infection. Chronic bronchitis is a component of chronic obstructive pulmonary disease (COPD). It usually follows an upper respiratory infection such as rhinitis or sore throat. Malnutrition is considered a possible risk factor. Obesity or being active in sports is not correlated with bronchitis.

When teaching a client with chronic obstructive pulmonary disease about oxygen by cannula, the nurse should also instruct the client's family to A. Avoid smoking near the client B. Turn off oxygen during meals C. Adjust the liter flow to 10 as needed D. Remind the client to keep mouth closed

A. Avoid smoking near the client Family members should avoid smoking near the client. Since oxygen supports combustion, there is a risk of fire if anyone smokes near the oxygen equipment.

This type of breathing is commonly seen in people in near death. A. Biots B. Kussmaul C. Cheyne Stokes D. Apneustic

A. Biots

A home health nurse is visiting a client with severe chronic obstructive pulmonary disease (COPD) who is complaining of increased shortness of air. The client is on home oxygen at 2 L/min via an oxygen concentrator with a respiratory rate of 23 breaths/min. The most appropriate nursing action is to A. Conduct further assessment of the client's respiratory status. B. Consider increasing the oxygen to 4 L/min during the home visit. C. Call emergency services to come to the home. D. Reassure the client of being unnecessarily anxious.

A. Conduct further assessment of the client's respiratory status. Further assessment is the most appropriate nursing action. Remember the nursing process; assessment is the first step. Calling for emergency services would be premature. Oxygen is not increased without the approval of the physician, and remember that with COPD the client's drive to breathe is triggered by low oxygen because of the carbon dioxide retention. For clients with COPD, oxygen should not generally be greater than 2 to 3 L/min. Reassurance that the client is unnecessarily anxious is inappropriate.

You're assessing a patient who is post-opt from a chest tube insertion. On assessment, you note there is 50 cc of serosanguinous fluid in the drainage chamber, fluctuation of water in the water seal chamber when the patient breathes in and out, and bubbling in the suction control chamber. Which of the following is the most appropriate nursing intervention? A. Document your findings as normal. B. Assess for an air leak due to bubbling noted in the suction chamber. C. Notify the physician about the drainage. D. Milk the tubing to ensure patency of the tubes.

A. Document your findings as normal.

Which is the priority among the following: A. Laryngeal Edema B. Bronchial Edema C. Tracheal Edema

A. Laryngeal Edema Once large airways are obstructed, it will also affect the small airways.

The nurse is admitting a client with suspected tuberculosis (TB) to the acute care unit. The nurse places the client in airborne precautions until a confirmed diagnosis of active TB can be made. Which of the following tests is a priority to confirm the diagnosis? A. Sputum culture positive for Mycobacterium Tuberculosis B. Chest x-ray that is positive for lung lesions C. Positive purified protein derivative (PPD) test D. Sputum positive for blood (haemoptysis)

A. Sputum culture positive for Mycobacterium Tuberculosis The most accurate way to diagnose TB is by sputum culture. Identifying the presence of tubercle bacilli is essential for a definitive diagnosis. Although haemoptysis is associated with more advanced cases of TB, it is not a confirmatory clinical manifestation. A positive PPD indicates exposure to TB, but gives no information about active disease. A chest x-ray with lesions may be present in a number of other diseases, not just TB

Upon O2 therapy, what should be used as a humidifier? A. Sterile water B. Tap water C. Mineral water D. Cold water

A. Sterile water

The nurse is caring for a client following a cardiac bypass surgery. The nurse notes that in the first hour the chest tube drainage measured 90 ml. During the second hour the drainage dropped to 5 ml. The nurse suspects which of the following? A. The chest tube may be clotted B. The lungs have fully inflated C. The client is recovering normally D. The physician should be notified

A. The chest tube may be clotted The first hour after surgery, chest tube draining may be as high as 100 ml/hour but should taper off over the next several hours. There should not be a sudden significant increase or drop in the amount of drainage. In this case, a sudden drop may indicate that a clot has formed in the tube and the nurse will need to gently work the clot out of the tubing to prevent cardiac tamponade. Further assessment would need to be made before notifying the physician. A chest tube is not "milked" but can be gently manipulated. Chest tube drainage is not an indication of lung inflation. Chest drainage may taper off to minimal amounts before the tube is withdrawn, but that is based on the fluctuations in the water seal chamber being minimal and an evaluation by chest x-ray.

Bronchodilators should be given A. in the morning B. after meals C. before meals D. before sleep

A. in the morning to prevent insomnia

A female client with interstitial lung disease is prescribed prednisone (Deltasone) to control inflammation. During client teaching, the nurse stresses the importance of taking prednisone exactly as prescribed and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience: A. hyperglycemia and glycosuria. B. acute adrenocortical insufficiency. C. GI bleeding. D. restlessness and seizures

ANSWER: B Administration of a corticosteroid such as prednisone suppresses the body's natural cortisol secretion, which may take weeks or months to normalize after drug discontinuation. Abruptly discontinuing such therapy may cause the serum cortisol level to drop low enough to trigger acute adrenocortical insufficiency. Hyperglycemia, glycosuria, GI bleeding, restlessness, and seizures are common adverse effects of corticosteroid therapy, not its sudden cessation.

On arrival at the intensive care unit, a critically ill female client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client's arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values? A. Fever B. Hypotension C. Tachypnea D. Tachycardia

ANSWER: B Hypotension, hypothermia, and vasoconstriction may alter pulse oximetry values by reducing arterial blood flow. Likewise, movement of the finger to which the oximeter is applied may interfere with interpretation of SaO2. All of these conditions limit the usefulness of pulse oximetry. Fever, tachypnea, and tachycardia don't affect pulse oximetry values directly.

A female client has a tracheostomy but doesn't require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for: A. 45 to 60 minutes. B. 5 to 20 minutes. C. 30 to 40 minutes. D. 5 to 60 seconds.

ANSWER: B Initially, the nurse should plug the opening in the tracheostomy tube for 5 to 20 minutes, and then gradually lengthen this interval according to the client's respiratory status. A client who doesn't require continuous mechanical ventilation already is breathing without assistance, at least for short periods; therefore, plugging the opening of the tube for only 15 to 60 seconds wouldn't be long enough to reveal the client's true tolerance to the procedure. Plugging the opening for more than 20 minutes would increase the risk of acute respiratory distress because the client requires an adjustment period to start breathing normally.

For a male client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the plan of care? A. Stripping the chest tube every hour B. Measuring and documenting the drainage in the collection chamber C. Keeping the collection chamber at chest level D. Maintaining continuous bubbling in the water-seal chamber

ANSWER: B The nurse should measure and document the amount of chest tube drainage regularly to detect abnormal drainage patterns, such as may occur with a hemorrhage (if excessive) or a blockage (if decreased). Continuous bubbling in the water-seal chamber indicates a leak in the closed chest drainage system, which must be corrected. The nurse should keep the collection chamber below chest level to allow fluids to drain into it. The nurse should not strip chest tubes because doing so may traumatize the tissue or dislodge the tube.

Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse administers the medication, knowing that the primary action of this medication is to: A. Promote expectoration. B. Suppress the cough. C. Relax smooth muscles of the bronchial airway. D. Prevent infection.

ANSWER: C. Relax smooth muscles of the bronchial airway. Aminophylline is a bronchodilator that directly relaxes the smooth muscles of the bronchial airway. Theophylline causes non-selective inhibition of type III and type IV isoenzymes of phosphodiesterase, which leads to increased tissue cyclic adenosine monophosphate (cAMP) and cyclic 3?,5? guanosine monophosphate concentrations, resulting in smooth muscle relaxation in lungs and pulmonary vessels, diuresis, CNS and cardiac stimulation. Option A: Guaifenesin is an expectorant. It works by thinning and loosening mucus in the airways, clearing congestion, and making breathing easier. Mucolytics are drugs belonging to the class of mucoactive agents. They exert their effect on the mucus layer lining the respiratory tract with the motive of enhancing its clearance. Option B: Antitussives are drugs that suppress the cough reflex. Persistent coughing can be exhausting and can cause muscle strain and further irritation of the respiratory tract. They act on the cough-control center in the medulla to suppress the cough reflex. Option D: Antibiotics are powerful medicines that fight bacterial infections. They either kill bacteria or stop them from reproducing, allowing the body's natural defenses to eliminate the pathogens. Used properly, antibiotics can save lives. But growing antibiotic resistance is curbing the effectiveness of these drugs. Taking an antibiotic as directed, even after symptoms disappear, is key to curing infection and preventing the development of resistant bacteria.

The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do? A.Secure the chest tube with tape. B. Clamp the chest tube immediately. C. Apply an occlusive dressing and notify the physician. D. Place the end of the chest tube in a container of sterile saline.

ANSWER: D If a chest drainage system is disconnected, the nurse may place the end of the chest tube in a container of sterile saline or water to prevent air from entering the chest tube, thereby preventing negative respiratory pressure. The nurse should apply an occlusive dressing if the chest tube is pulled out — not if the system is disconnected. The nurse shouldn't clamp the chest tube because clamping increases the risk of tension pneumothorax. The nurse should tape the chest tube securely to prevent it from being disconnected, rather than taping it after it has been disconnected.

A female client with asthma is receiving a theophylline preparation to promote bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the client's serum theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls within which range? A. 1 to 2 mcg/ml B. 5 to 10 mcg/ml C. 2 to 5 mcg/ml D. 10 to 20 mcg/ml

ANSWER: D The therapeutic serum theophylline concentration ranges from 10 to 20 mcg/ml. Values below 10 mcg/ml aren't therapeutic.

A nurse is caring for a male client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client? a. Stridor b. Occasional pink-tinged sputum c. A few basilar lung crackles on the right d. Respiratory rate of 24 breaths/min

Answer A. The nurse reports stridor to the physician immediately. This is a high-pitched, coarse sound that is heard with the stethoscope over the trachea.Stridor indicates airway edema and places the client at risk for airway obstruction

Nurse Kim is caring for a client with a pneumothorax and who has had a chest tube inserted notes continuous gentle bubbling in the suction control chamber. What action is appropriate? a. Do nothing, because this is an expected finding. b. Immediately clamp the chest tube and notify the physician. c. Check for an air leak because the bubbling should be intermittent. d. Increase the suction pressure so that bubbling becomes vigorous.

Answer A. Continuous gentle bubbling should be noted in the suction control chamber. Option B is incorrect. Chest tubes should only be clamped to check for an air leak or when changing drainage devices (according to agency policy). Option C is incorrect. Bubbling should be continuous and not intermittent. Option D is incorrect because bubbling should be gentle. Increasing the suction pressure only increases the rate of evaporation of water in the drainage system.

A nurse is caring for a male client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client? a. Hypocapnia b. A hyperinflated chest noted on the chest x-ray c. Increase oxygen saturation with exercise d. A widened diaphragm noted on the chest x-ray

Answer B. Clinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, - hypercapnia,- dyspnea on exertion and at rest- oxygen desaturation with exercise- and the use of accessory muscles of respiration.Chest x-rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.

A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed: a. 1 L/min b. 2 L/min c. 6 L/min d. 10 L/min

Answer B. Oxygen is used cautiously and should not exceed 2 L/min.Because of the long-standing hypercapnia that occurs in emphysema, the respiratory drive is triggered by low oxygen levels rather than increased carbon dioxide levels, as is the case in a normal respiratory system.

An emergency room nurse is assessing a female client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client? a. A low respiratory b. Diminished breathe sounds c. The presence of a barrel chest d. A sucking sound at the site of injury

Answer B. This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. Hyperresonance also may occur on the affected side. A sucking sound at the site of injury would be noted with an open chest injury.

Nurse Hannah is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will facilitate obtaining the specimen? a. Limiting fluids b. Having the clients take three deep breaths c. Asking the client to split into the collection container d. Asking the client to obtain the specimen after eating

Answer B. To obtain a sputum specimen, the client should rinse the mouth to reduce contamination, breathe deeply, and then cough into a sputum specimen container.The client should be encouraged to cough and not spit so as to obtain sputum.Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning

A nurse is caring for a female client after a bronchoscope and biopsy. Which of the following signs, if noted in the client, should be reported immediately to the physicians? a. Dry cough b. Hematuria c. Bronchospasm d. Blood-streaked sputum

Answer C. if a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours.Frank blood indicates hemorrhage. A dry cough may be expected.The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. Hematuria is unrelated to this procedure.

A community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is: a. Dyspnea b. Chest pain c. A bloody, productive cough d. A cough with the expectoration of mucoid sputum

Answer D. One of the first pulmonary symptoms is a slight cough with the expectoration of mucoid sputum. Options A, B, and C are late symptoms and signify cavitation and extensive lung involvement.

Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage strength of the liquid is 200mg/5ml. How many mL should the nurse administer each dose?

Answer: 7.5 ml When the medicine is a solution of specific strength, calculations can become more complicated. Liquids (solutions and suspensions) are frequently used in children's nursing - for example for children who find swallowing tablets difficult or patients who have medicines administered via a percutaneous endoscopic gastrostomy (PEG) tube.

A female client is scheduled to have a chest radiograph. Which of the following questions is of most importance to the nurse assessing this client? A. "Is there any possibility that you could be pregnant?" B. "Are you wearing any metal chains or jewelry?" C. "Can you hold your breath easily?" D. "Are you able to hold your arms above your head?"

Answer: A. "Is there any possibility that you could be pregnant?" The most important item to ask about is the client's pregnancy status because pregnant women should not be exposed to radiation. The risk of side effects of an X-ray while the client is pregnant is extremely minimal, but it is always important to protect the developing fetus from harm. Option B: Clients are also asked to remove any chains or metal objects that could interfere with obtaining an adequate film. The client may be asked to strip down and wear a hospital gown, or at least remove clothing on the part of the body that needs to be X-rayed. Option C: A chest radiograph most often is done at full inspiration, which gives optimal lung expansion. Option D: If a lateral view of the chest is ordered, the client is asked to raise the arms above the head. The client will be asked to stay still so the image will be as clear as possible. This will provide the most accurate image. Most films are done in posterior-anterior view. The X-ray test works by positioning the part of the body being X-rayed between the source of the X-ray and an X-ray detector (such as a film).

A client with COPD reports steady weight loss and being "too tired from just breathing to eat." Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client? A. Altered nutrition: Less than body requirements related to fatigue. B. Activity intolerance related to dyspnea. C. Weight loss related to COPD. D. Ineffective breathing pattern related to alveolar hypoventilation. Correct

Answer: A. Altered nutrition: Less than body requirements related to fatigue. The client's problem is altered nutrition—specifically, less than required. The cause, as stated by the client, is the fatigue associated with the disease process. Instruct the patient to frequently eat high caloric foods in smaller portions. COPD patients expend an extraordinary amount of energy simply on breathing and require high caloric meals to maintain body weight and muscle mass. Option B: Activity intolerance is a likely diagnosis but is not related to the client's nutritional problems. Provide at least 90 minutes of undisturbed rest in between activities. Allotment of undisturbed rest reduces demand for oxygen and allows adequate physiologic recovery. Option C: Weight loss is not a nursing diagnosis. Encourage a rest period of 1 hr before and after meals. Helps reduce fatigue during mealtime and provides an opportunity to increase total caloric intake. Avoid gas-producing foods and carbonated beverages. Can produce abdominal distension, which hampers abdominal breathing and diaphragmatic movement and can increase dyspnea. Option D: Ineffective breathing pattern may be a problem, but this diagnosis does not specifically address the problem of weight loss described by the client. Instruct how to splint the chest wall with a pillow for comfort during coughing and elevation of head over the body as appropriate. Promotes physiological ease of maximal inspiration.

When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that the client will do which of the following? A. Develop infections easily. B. Maintain current status. C. Require less supplemental oxygen. D. Show permanent improvement.

Answer: A. Develop infections easily. A client with COPD is at high risk for development of respiratory infections. In emphysema, an irritant (e.g., smoking) causes an inflammatory response. Neutrophils and macrophages are recruited and release multiple inflammatory mediators. Oxidants and excess proteases leading to the destruction of the air sacs. The protease-mediated destruction of elastin leads to a loss of elastic recoil and results in airway collapse during exhalation. Option B: COPD is slowly progressive; therefore, maintaining current status is an unrealistic expectation. COPD is an inflammatory condition involving the airways, lung parenchyma, and pulmonary vasculature. The process is thought to involve oxidative stress and protease-antiprotease imbalances. Emphysema describes one of the structural changes seen in COPD where there is destruction of the alveolar air sacs (gas-exchanging surfaces of the lungs) leading to obstructive physiology. Option C: This is an unrealistic expectation. The prognosis of COPD is variable based on adherence to treatment including smoking cessation and avoidance of other harmful gases. Patients with other comorbidities (e.g., pulmonary hypertension, cardiovascular disease, lung cancer) typically have a poorer prognosis. The airflow limitation and dyspnea are usually progressive. Option D: Treatment may slow progression of the disease, but permanent improvement is highly unlikely. As the disease progresses, impairment of gas exchange is often seen. The reduction in ventilation or increase in physiologic dead space leads to CO2 retention. Pulmonary hypertension may occur due to diffuse vasoconstriction from hypoxemia.

Which of the following physical assessment findings would the nurse expect to find in a client with advanced COPD? A. Increased anteroposterior chest diameter. B. Underdeveloped neck muscles. C. Collapsed neck veins. D. Increased chest excursions with respiration.

Answer: A. Increased anteroposterior chest diameter. Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrel-chested appearance. In addition, coarse crackles beginning with inspiration may be heard. Option B: Overly developed, not underdeveloped, neck muscles are associated with COPD because of their increased use in the work of breathing. Use of accessory respiratory muscles and paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign). Option C: Distended, not collapsed, neck veins are associated with COPD as a symptom of the heart failure that the client may experience secondary to the increased workload on the heart to pump into pulmonary vasculature. In advanced disease, cyanosis, elevated jugular venous pulse (JVP), and peripheral edema can be observed. Option D: Diminished, not increased, chest excursion is associated with COPD. The sensitivity of a physical examination in detecting mild to moderate COPD is relatively poor; however, physical signs are quite specific and sensitive for severe disease. Patients with severe disease experience tachypnea and respiratory distress with simple activities.

An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she developed a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the nurse best interpret these assessment findings? A. It is likely that the client is developing a secondary bacterial pneumonia. B. The assessment findings are consistent with influenza and are to be expected. C. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions D. The client has not been taking her decongestants and bronchodilators as prescribed.

Answer: A. It is likely that the client is developing a secondary bacterial pneumonia. Pneumonia is the most common complication of influenza, especially in the elderly. The development of a purulent cough and crackles may be indicative of a bacterial infection that is not consistent with a diagnosis of influenza. Option B: Diagnosis of influenza can be reached clinically, especially during the influenza season. Most of the cases will recover without medical treatment, and they would not need a laboratory test for the diagnosis. Signs and symptoms of influenza in mild cases include a cough, fever, sore throat, myalgia, headache, runny nose, and congested eyes. A frontal or retro-orbital headache is a common presentation with selected ocular symptoms that include photophobia and pain with different qualities. Option C: These findings are not indicative of dehydration. The clinical presentation of influenza ranges from mild to severe depending on the age, comorbidities, vaccination status, and natural immunity to the virus. Usually, patients who received the seasonal vaccine present with milder symptoms, and they are less likely to develop complications. Option D: Decongestants and bronchodilators are not typically prescribed for the flu. Influenza infection is self-limited and mild in most healthy individuals who do not have other comorbidities. No antiviral treatment is needed during mild infections in healthy individuals. Antiviral medications can be used to treat or prevent influenza infection, especially during outbreaks in healthcare settings such as hospitals and residential institutions.

Which of the following is a priority goal for the client with COPD? A. Maintaining functional ability. B. Minimizing chest pain. C. Increasing carbon dioxide levels in the blood. D. Treating infectious agents.

Answer: A. Maintaining functional ability A priority goal for the client with COPD is to manage the s/s of the disease process so as to maintain the client's functional ability. Evaluate the level of activity tolerance. Provide a calm, quiet environment. Limit a patient's activity or encourage bed or chair rest during the acute phase. Have patient resume activity gradually and increase as individually tolerated. Option B: Chest pain is not a typical sign of COPD. Assess and record respiratory rate, depth. Note the use of accessory muscles, pursed-lip breathing, inability to speak or converse. Useful in evaluating the degree of respiratory distress or chronicity of the disease process. Option C: The carbon dioxide concentration in the blood is increased to an abnormal level in clients with COPD; it would not be a goal to increase the level further. Monitor arterial blood gasses values as ordered. As the patient's condition progresses, Pa02 usually decreases. For patients with chronic carbon dioxide retention may have chronically compensated respiratory acidosis with a low normal pH and a PaCo2 higher than 50 mm Hg. Option D: Preventing infection would be a goal of care for the client with COPD. Demonstrate and assist the patient in the disposal of tissues and sputum. Stress proper handwashing (nurse and patient), and use gloves when handling or disposing of tissues, sputum containers. Prevents spread of fluid-borne pathogens.

Which of the following is incorrect about Bronchiectasis? Select all that may apply: A. It is the constriction of small airway passages B. Accumulation of mucus secretion proliferates in the bronchus C. Hallmark sign is gelatinous sputum D. A complication of asthma E. Increased mucous secretion is the main problem

Answer: B, C, D Mucus secretion in Bronchiectasis accumulates in the bronchioles. Hallmark sign: Gelatinous sputum and foul-smelling mucus It is a complication of bronchitis.

Presence of overdistended and non-functional alveoli is a condition called: a. Bronchitis b. Emphysema c. Empyema d. Atelectasis

Answer: B. An overdistended and non-functional alveoli is a condition called emphysema. Atelectasis is the collapse of a part or the whole lung. Empyema is the presence of pus in the lung.

A nurse is assessing a client with chronic airflow limitation and notes that the client has a "barrel chest." The nurse interprets that this client has which of the following forms of chronic airflow limitation? A. Chronic obstructive bronchitis B. Emphysema C. Bronchial asthma D. Bronchial asthma and bronchitis

Answer: B. Emphysema The client with emphysema has hyperinflation of the alveoli and flattening of the diaphragm. These lead to increased anteroposterior diameter, which is referred to as "barrel chest." The client also has dyspnea with prolonged expiration and has hyperresonant lungs to percussion. Option A: Chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD) that is defined as a productive cough of more than 3 months occurring within a span of 2 years. Patients typically present with chronic productive cough, malaise, and symptoms of excessive coughing such as chest or abdominal pain. Option C: Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. The pathological process begins with the inhalation of an irritant (e.g., cold air) or an allergen (e.g., pollen), which then, due to bronchial hypersensitivity, leads to airway inflammation and an increase in mucus production. This leads to a significant increase in airway resistance, which is most pronounced on expiration. Option D: Acute bronchitis is the result of acute inflammation of the bronchi secondary to various triggers, most commonly viral infection, allergens, pollutants, etc. Inflammation of the bronchial wall leads to mucosal thickening, epithelial-cell desquamation, and denudation of the basement membrane. At times, a viral upper respiratory infection can progress to infection of the lower respiratory tract resulting in acute bronchitis.

A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client? A. Encouraging additional fluids for the next 24 hours B. Ensuring the return of the gag reflex before offering foods or fluids C. Administering atropine intravenously D. Administering small doses of midazolam (Versed).

Answer: B. Ensuring the return of the gag reflex before offering foods or fluids After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex returns because the preoperative sedation and the local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours. Although bronchoscopy can be done without sedation, most procedures are done under moderate conscious sedation with the use of various sedatives based on the clinician's preference (e.g., benzodiazepines, opioids, dexmedetomidine). Option A: Additional fluids are unnecessary because no contrast dye is used that would need to be flushed from the system. Regardless of the sedation or anesthesia used the physicians should be aware of the potential side effects and how to manage patients receiving these medications. Option C: Atropine would be administered before the procedure, not after. Atropine premedication is widely used for fiberoptic bronchoscopy and may help by drying secretions, producing bronchodilation, or preventing vasovagal reactions. Option D: The administration of additional midazolam in small doses, until the target sedation level is achieved, is a safe procedure that is associated with significantly less discomfort and pain during bronchoscopy and a greater consent to re?examination when compared with the administration of a fixed dose of midazolam.

A client's arterial blood gas levels are as follows: pH 7.31; PaO2 80 mm Hg, PaCO2 65 mm Hg; HCO3- 36 mEq/L. Which of the following signs or symptoms would the nurse expect? A. Cyanosis B. Flushed skin C. Irritability D. Anxiety

Answer: B. Flushed skin The high PaCO2 level causes flushing due to vasodilation. The client also becomes drowsy and lethargic because carbon dioxide has a depressant effect on the CNS. On the contrary, chronic respiratory acidosis may be caused by COPD where there is a decreased responsiveness of the reflexes to states of hypoxia and hypercapnia. Option A: Cyanosis is a late sign of hypoxia. In respiratory acidosis, the slight increase in bicarbonate serves as a buffer for the increase in H+ ions, which helps minimize the drop in pH. In some cases, patients may present with cyanosis due to hypoxemia. Option C: Irritability is not common with a PaCO2 level of 65 mm Hg but is associated with hypoxia. If the respiratory acidosis is severe and accompanied by prolonged hypoventilation, the patient may have additional symptoms such as altered mental status, myoclonus, and possibly even seizures. Option D: The clinical presentation of respiratory acidosis is usually a manifestation of its underlying cause. Signs and symptoms vary based on the length, severity, and progression of the disorder. Patients can present with dyspnea, anxiety, wheezing, and sleep disturbances.

When teaching a client with COPD to conserve energy, the nurse should teach the client to lift objects: A. While inhaling through an open mouth. B. While exhaling through pursed lips. C. After exhaling but before inhaling. D. While taking a deep breath and holding it.

Answer: B. While exhaling through pursed lips. Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves energy and reduces perceived dyspnea. When one practices regularly, breathing exercises can help exert oneself less during daily activities. They can also potentially aid in return to exercising, which can lead to feeling more energetic overall. Option A: Pursing the lips prolongs exhalation and provides the client with more control over breathing. It's been shown to reduce how hard one has to work to breathe. It helps release air trapped in the lungs. It promotes relaxation. It reduces shortness of breath. Option C: Lifting after exhalation but before inhaling is similar to lifting with the breath held. The purpose of pursed lip breathing is to help keep the airways open. This helps your airways to remain open. Pursed lip breathing also slows down the breathing rate and calms the patient down. Option D: This should not be recommended because it is similar to the Valsalva maneuver, which can stimulate cardiac dysrhythmias. The purpose of coordinated breathing is to help assure adequate oxygen to the working muscles and to prevent the client from holding the breath.

A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching? A. Removes the cap and shakes the inhaler well before use. B. Press the canister down with your finger as he breathes in. C. Inhales the mist and quickly exhales. D. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.

Answer: C. Inhales the mist and quickly exhales. Take the inhaler out of the mouth. If the client can, he should hold his breath as he slowly counts to 10. This lets the medicine reach deep into the lungs. The client should be instructed to hold his or her breath at least 10 to 15 seconds before exhaling the mist. Option A: If the client has not used the inhaler in a while, he may need to prime it. See the instructions that came with the inhaler for when and how to do this. Shake the inhaler hard 10 to 15 times before each use. Option B: Hold the inhaler with the mouthpiece down. Place lips around the mouthpiece so that the mouth forms a tight seal. As the client starts to slowly breathe in through the mouth, press down on the inhaler one time. Option D: If using inhaled, quick-relief medicine (beta-agonists), wait about 1 minute before taking the next puff. You do not need to wait a minute between puffs for other medicines.

Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza vaccination? A. A 60-year-old man with a hiatal hernia. B. A 36-year-old woman with 3 children. C. A 50-year-old woman caring for a spouse with cancer. D. A 60-year-old woman with osteoarthritis.

Answer: C. A 50-year-old woman caring for a spouse with cancer. Individuals who are household members or home care providers for high-risk individuals are high-priority targeted groups for immunization against influenza to prevent transmission to those who have a decreased capacity to deal with the disease. The wife who is caring for a husband with cancer has the highest priority of the clients described. Option A: In certain groups, including the elderly, immune-compromised individuals and infants, the influenza vaccine is less effective, but it is beneficial by reducing the incidence of severe disease, like bronchopneumonia, and reduces hospital admission and mortality. Option B: Regarding immunization in pregnancy, a randomized controlled trial conducted in South Africa has shown that when pregnant women receive the influenza vaccine, it halves their risk of developing influenza while reducing the risk of their infants (up to 24 weeks) contracting the illness. Option D: Influenza vaccine conveys immunity against the influenza virus by stimulating the production of antibodies specific to the disease. Antibodies to NA act by aggregating viruses on the cell surface effectively and reducing the amount of virus released from infected cells.

Which of the following outcomes would be appropriate for a client with COPD who has been discharged to home? The client: A. Promises to do pursed lip breathing at home. B. States actions to reduce pain. C. States that he will use oxygen via a nasal cannula at 5 L/minute. D. Agrees to call the physician if dyspnea on exertion increases.

Answer: D. Agrees to call the physician if dyspnea on exertion increases. Increasing dyspnea on exertion indicates that the client may be experiencing complications of COPD, and therefore the physician should be notified. There are things that everyone with COPD should do to manage their disease; quitting smoking (if they smoke) is the most important. In addition, there are other non-medication treatments that can help relieve symptoms and improve quality of life. Option A: Extracting promises from clients is not an outcome criterion. Pulmonary rehabilitation programs have been shown to improve a person's ability to exercise, enhance quality of life, and decrease the frequency of COPD exacerbations (when symptoms flare up more than usual). Even people with severe shortness of breath can benefit from a rehabilitation program. Option B: Pain is not a common symptom of COPD. Although COPD usually worsens over time, it is difficult to predict how quickly it will progress and how long the client will live (the prognosis). A number of factors play a role in the severity of COPD symptoms, including whether the client continues to smoke, are underweight, or have other medical problems, and how the lungs function during exercise. People with COPD who have less severe symptoms, are a healthy weight, and do not smoke tend to live longer. Option C: Clients with COPD use low-flow oxygen supplementation (1 to 2 L/minute) to avoid suppressing the respiratory drive, which, for these clients, is stimulated by hypoxia. People with severe or advanced COPD can have low oxygen levels in the blood. This condition, known as hypoxemia, can occur even if the client does not feel short of breath or have other symptoms. The oxygen level can be measured with a device placed on the finger (pulse oximeter) or with a blood test (arterial blood gas). People with hypoxemia may be placed on oxygen therapy, which can improve survival and quality of life.

A client has been taking benzonatate (Tessalon Perles) as prescribed. A nurse concludes that the medication is having the intended effect if the client experiences: A. Decreased anxiety level. B. Increased comfort level. C. Reduction of N/V. D. Decreased frequency and intensity of cough.

Answer: D. Decreased frequency and intensity of cough. Benzonatate is a locally acting antitussive the effectiveness of which is measured by the degree to which it decreases the intensity and frequency of cough without eliminating the cough reflex. Benzonatate is an oral antitussive drug used in the relief and suppression of cough in patients older than ten years of age. Currently, benzonatate is the only non-narcotic antitussive available as a prescription drug. It works to reduce the activity of cough reflex by desensitizing the tissues of the lungs and pleura involved in the cough reflex. Option A: Because its chemical structure resembles that of the anesthetic agents in the para-amino-benzoic acid class (such as [procaine] and [tetracaine]), benzonatate exhibits anesthetic or numbing action. Although it is not prone to drug misuse or abuse, benzonatate is associated with a risk for severe toxicity and overdose, especially in children. Option B: Benzonatate suppresses cough associated with both acute and chronic respiratory conditions. It works by desensitizing the pulmonary stretch receptors involved in the cough reflex. There are limited clinical trials of benzonatate; however, earlier studies demonstrated inhibition of experimentally-induced cough and subjectively-measured pathological cough by benzonatate. Option C: Benzonatate is a synthetic butylamino-benzoate derivative related to tetracaine and a peripherally acting antitussive, non narcotic Benzonatate reduces the cough reflex by anesthetizing and depressing mechanoreceptors in the respiratory passages, lungs, and pleura. It is recommended for cough relief in the common cold, bronchitis, pneumonia, and for chronic cough such as in asthma.

Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will: A. Maintain a fluid intake of 800 ml every 24 hours. B. Experience chills only once a day. C. Cough productively without chest discomfort. D. Experience less nasal obstruction and discharge.

Answer: D. Experience less nasal obstruction and discharge. A client recovering from an URI should report decreasing or no nasal discharge and obstruction. Decongestants and combination antihistamine/decongestant medications can limit cough, congestion, and other symptoms in adults. Avoid cough preparations in children. H1-receptor antagonists may offer a modest reduction of rhinorrhea and sneezing during the first 2 days of a cold in adults. Option A: Daily fluid intake should be increased to more than 1 L every 24 hours to liquefy secretions. Topical and oral nasal decongestants (i.e., topical oxymetazoline, oral pseudoephedrine) have moderate benefit in adults and adolescents in reducing nasal airway resistance. Evidence-based data does not support the use of antibiotics in the treatment of the common cold because they do not improve symptoms or shorten the course of illness. Option B: The temperature should be below 100*F (37.8*C) with no chills or diaphoresis. According to a Cochrane Review, vitamin C used as daily prophylaxis at doses of =0.2 grams or more had a "modest but consistent effect" on the duration and severity of common cold symptoms (8% and 13% decreases in duration for adults and children, respectively). Option C: A productive cough with chest pain indicated pulmonary infection, not an URI. The presence of classical features for rhinovirus infection, coupled with the absence of signs of bacterial infection or serious respiratory illness, is sufficient to make the diagnosis of the common cold. The common cold is a clinical diagnosis, and diagnostic testing is not necessary.

Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible side effect of this drug? A. Constipation B. Bradycardia C. Diplopia D. Restlessness

Answer: D. Restlessness Side effects of pseudoephedrine are experienced primarily in the cardiovascular system and through sympathetic effects on the CNS. The most common CNS effects include restlessness, dizziness, tension, anxiety, insomnia, and weakness. Common cardiovascular side effects include tachycardia, hypertension, palpitations, and arrhythmias. Option A: Pseudoephedrine is used to relieve nasal congestion caused by colds, allergies, and hay fever. It is also used to temporarily relieve sinus congestion and pressure. Pseudoephedrine will relieve symptoms but will not treat the cause of the symptoms or speed recovery. Pseudoephedrine is in a class of medications called nasal decongestants. It works by causing narrowing of the blood vessels in the nasal passages. Option B: Tachycardia, not bradycardia, is a side effect of pseudoephedrine. Nonprescription cough and cold combination products, including products that contain pseudoephedrine, can cause serious side effects or death in young children. Do not give nonprescription pseudoephedrine products to children younger than 4 years of age. Option C: Diplopia is not a side effect of pseudoephedrine. Tell your doctor if you have or have ever had high blood pressure, glaucoma (a condition in which increased pressure in the eye can lead to gradual loss of vision), diabetes, difficulty urinating (due to an enlarged prostate gland), or thyroid or heart disease. If you plan to take the 24-hour extended-release tablets, tell your doctor if you have had a narrowing or blockage of your digestive system.

Before using a bronchoscope from one client to the next, the bronchoscope must be cleaned. The nurse knows that minimal cleaning of the bronchoscope includes: A. Washing with soap and water. B. High-level disinfection. C. Low-level disinfection. D. Sterilization.

B. High-level disinfection. Disinfection and sterilization of client-care items or equipment are classified as critical, semi-critical, and noncritical. Bronchoscopes are an example of semi-critical items that come in contact with mucous membranes or nonintact skin. Semi-critical items should be free of all microorganisms, with the exception of high numbers of bacterial spores. Semi-critical items require high-level disinfection using wet pasteurization or chemical disinfectants.

Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema? A. To promote oxygen intake. B. To strengthen the diaphragm. C. To strengthen the intercostal muscles. D. To promote carbon dioxide elimination.

Answer: D. To promote carbon dioxide elimination. Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby promoting carbon dioxide elimination. By prolonged exhalation and helping the client relax, pursed-lip breathing helps the client learn to control the rate and depth of respiration. Pursed-lip breathing does not promote the intake of oxygen, strengthen the diaphragm, or strengthen intercostal muscles. Option A: For those suffering from chronic obstructive pulmonary disease, the ability to take in oxygen is a constant struggle. It's possible to increase oxygen levels in other ways, such as cellular therapy. Cellular therapy may promote the healing of lung tissue, potentially improving lung function. When lung function improves, the client is able to take in more oxygen as well as expel carbon dioxide because the lungs are working more effectively. Option B: Diaphragmatic breathing is a type of a breathing exercise that helps strengthen the diaphragm, an important muscle that helps us breathe. This breathing exercise is also sometimes called belly breathing or abdominal breathing. Option C: Breathing exercises slowly fill the lungs with air to expand the chest and work the intercostal muscles. To do this exercise, it is typically recommended to sit or stand with the back straight, then take a full breath from the bottom of the lungs. It can help to think of breathing from the diaphragm, by slowly expanding the abdominal muscles while inhaling, then pushing air from the lungs using these same muscles.

A patient is about to have their chest tube removed by the physician. As the nurse assisting with the removal, which of the following actions will you perform? Select-all-that-apply: A. Educate the patient how to take a deep breath out and inhale rapidly while the tube in being removed. B. Gather supplies needed which will include a petroleum gauze dressing per physician preference. C. Place the patient in Semi-Fowler's position. D. Have the patient take a deep breath, exhale, and bear down during removal of the tube. E. Pre-medicate prior to removal as ordered by the physician. F. Place the patient is prone position after removal.

Answers: B,C,D,E Option A: is wrong because this is not how the Valsalva Maneuver is performed (the correct way is detailed in option D). Option F: is wrong as well because this position would not faciltate breathing...Fowler's position is best after removal.

What is the normal pressure of PEEP? A. 10-20 mmHg B. 8-10 mmHg C. 30-60 mmHg D. 12-16 mmHg

B. 8-10 mmHg

The nurse is preparing a client with empyema for a thoracentesis. Which of the following should the nurse have available in the event that the procedure is ineffective? A. An intubation tray B. A chest tube insertion kit C. A crash cart D. A ventilator

B. A chest tube insertion kit With empyema, the fluid to be removed from the pleural space is thick and "puslike." The physician may not be able to withdraw the fluid through needle aspiration and the client may require placement of a chest tube to adequately drain the purulent effusion. A ventilator, intubation tray, or crash cart is not likely to be necessary because there was no indication that the client was unstable.

The nurse is instructing a client with moderate persistent asthma on the proper method for using MDI's (multi-dose inhalers). Which medication should be administered FIRST? A. Steroid B. Beta agonist C. Anticholinergic D. Mast cell stabilizer

B. Beta agonist The beta-agonist is taken first to open the airway. Beta adrenergic agonists or Beta agonists are medications that relax muscles of the airways, which widens the airways and results in easier breathing. They are a class of sympathomimetic agents which act upon the beta adrenoceptors.

What type of chest tube system does this statement describe? This chest drainage system has no water column to control suction but uses a suction monitor bellow that balances the wall suction and you can adjust water suction pressure using the rotary suction dial on the side of the system. It allows for higher suction pressure levels, has no bubbling sounds, and water does not evaporate from it as with other systems. A. Mediastinal chest tube system B. Dry suction chest tube system C. Wet suction chest tube system D. Dry-Wet suction chest tube system

B. Dry suction chest tube system

While helping a patient with a chest tube reposition in the bed, the chest tube becomes dislodged. What is your immediate nursing intervention? A. Stay with the patient and monitor their vital signs while another nurse notifies the physician. B. Place a sterile dressing over the site and tape it on three sides and notify the physician. C. Attempt to re-insert the tube. D. Keep the site open to air and notify the physician.

B. Place a sterile dressing over the site and tape it on three sides and notify the physician.

A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes the: A. Brachial and radial arteries, and then releases them and observes the circulation of the hand. B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery. C. Radial artery and observes for color changes in the affected hand. D. Ulnar artery and observes for color changes in the affected hand.

B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery. Before drawing an ABG, the nurse assesses the collateral circulation to the hand with Allen's test. This involves compressing the radial and ulnar arteries and asking the client to close and open the fist. This should cause the hand to become pale. The nurse then releases pressure on one artery and observes whether circulation is restored quickly. The nurse repeats the process, releasing the other artery. The blood sample may be taken safely if collateral circulation is adequate. Option A: Puncture of the radial artery is usually preferred because of the accessibility of the vessel, the presence of collateral circulation, and the artery's superficial course proximal to the wrist, which makes it easier for the clinician to identify the vascular structure and hold local pressure after the procedure is finished. Option C: The radial artery is most easily accessible medial to the radial styloid process and lateral to the flexor carpi radialis tendon, 2-3 cm proximal to the ventral surface of the wrist crease. Firm occlusive pressure is held on both the radial artery and the ulnar artery. The patient is asked to clench the fist several times until the palmar skin is blanched, then to unclench the fist. Option D: If radial artery sampling is not feasible, femoral artery puncture is a possible alternative. When femoral artery puncture is being considered, the potential risk of infection at the entry site and the artery's proximity to the femoral vein and nerve must be taken into

A client with suspected active lung tuberculosis is being scheduled for diagnostic tests. The nurse anticipates that which diagnostic test will most likely be prescribed to confirm the diagnosis? A. White blood cell count B. Sputum culture C. Chest x-ray D. Skin testing

B. Sputum culture Remember that tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, and the demonstration of tubercle bacilli using bacteriology is essential for establishing a diagnosis. It is not possible to make a diagnosis solely on the basis of a chest x-ray, and a positive reaction to a skin test indicates the presence of tuberculosis infection but does not show whether the infection is active or dormant. A white blood cell count may be increased, but it is not specifically related to the presence of tuberculosis.

A patient with a chest tube has no fluctuation of water in the water seal chamber. What could be the cause of this? A. This is an expected finding. B. The lung may have re-expanded or there is a kink in the system. C. The system is broken and needs to be replaced. D. There is an air leak in the tubing.

B. The lung may have re-expanded or there is a kink in the system.

The nurse is performing a respiratory assessment of a client with pleurisy and compares the assessment findings with the previous day's assessment. Currently there is no friction rub, but one was auscultated the previous day. The nurse evaluates this finding as the result of A. The client taking more shallow breaths. B. The effectiveness of the antibiotics. C. An accumulation of pleural fluid in the inflamed area. D. A decreased inflammatory response.

C. An accumulation of pleural fluid in the inflamed area. Initially a pleural friction rub is auscultated when there is inflammation between the pleural space and visceral pleura. With increasing inflammation, fluid accumulates between the two layers at the inflamed site and reduces the friction. The inflammatory process is still there and would be treated by anti-inflammatory drugs, not necessarily antibiotics (unless there were an infectious process involved). The client should be instructed to take adequately deep breaths for a good assessment of breath sounds and that should be consistent between assessments.

All are types of COPD except: A. Bronchitis B. Emphysema C. Asthma D. Bronchiectasis

C. Asthma Asthma is an ACUTE attack and can develop overnight, unlike Bronchitis, Emphysema and Bronchiectasis

The nurse is admitting a client who complains of fever, chills, chest pain, and dyspnoea. The client has a heart rate of 110, respiratory rate of 28, and a nonproductive hacking cough. A chest x-ray confirms a diagnosis of left lower lobe pneumonia. Upon auscultation of the left lower lobe, the nurse documents which of the following breath sounds? A. Absent breath sounds B. Vesicular C. Bronchial D. Broncho vesicular

C. Bronchial In the presence of pneumonia there will be bronchial breath sounds over the area of consolidation. The client may also have crackles in the affected side as a result of fluid in the interstitial and alveoli. Absence of breath sounds is not a usual finding and would not likely occur unless there was a serious complication.

The nurse is caring for a client with a chest tube. The nurse knows that this client MUST have what type of dressing? A. Non-adhesive B. Debriding C. Occlusive D. Transparent

C. Occlusive An occlusive dressing is necessary to prevent air from entering the thorax.

A patient is receiving positive pressure mechanical ventilation and has a chest tube. When assessing the water seal chamber what do you expect to find? A. The water in the chamber will increase during inspiration and decrease during expiration. B. There will be continuous bubbling noted in the chamber. C. The water in the chamber will decrease during inspiration and increase during expiration. D. The water in the chamber will not move.

C. The water in the chamber will decrease during inspiration and increase during expiration. When a patient is receiving mechanical ventilation the water in the water seal chamber will oscillate oppositely than if the patient were breathing on their own. Therefore, the water in the chamber will decrease during inspiration and increase during expiration.

Ronchi is a popping sound heard during A. inspiration B. expiration C. both

C. both Ronchi is a popping sound heard in the bronchi and trachea during inspiration and expiration.

The nurse is performing an assessment of the thorax and lungs on a 30-year-old client. Which of the following assessments does the nurse evaluate to be a normal adult finding? A. The thorax is barrel shaped B. The costal margin is greater than 90° C. The accessory muscles are used during inspiration and expiration D. The ribs articulate at a 45° angle with the sternum

D. The ribs articulate at a 45° angle with the sternum The thorax is generally slightly elliptical in shape, although the barrel-shaped chest may be normal in the infant and older adult. The costal angle should be less than 90° during exhalation and at rest. No accessory muscles should be used during normal respirations. The ribs should also articulate at a 45° angle with the sternum.

A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect of this medication? A. Constipation B. Diarrhea C. Bradycardia D. Tachycardia

Correct Answer: D. Tachycardia Side effects that can occur from a beta 2 agonist include tremors, nausea, nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of the mouth or throat. Due to the vasodilatory effect of peripheral vasculature and subsequent decrease in cardiac venous return, compensatory mechanisms manifest as tachycardia are relatively common, especially within the first weeks of usage. Option A: Constipation is not a side effect of isoetharine. Beta-2 agonists have been shown to decrease serum potassium levels via an inward shift of potassium into the cells due to an effect on the membrane-bound Na/K-ATPase, which can potentially result in hypokalemia. Beta-2 agonists also promote glycogenolysis, which can lead to inadvertent elevations in serum glucose. Option B: Adverse effects of beta-2 agonists most commonly involve the desensitization of the beta-2 adrenergic receptor to the beta-2 agonist. Due to the similar properties between the classes of adrenergic receptors, beta-2 agonists can create an "off-target" effect in stimulating either alpha-1, alpha-2, or beta-1 receptors. The most common side effects of beta-2 agonists involve the cardiac, metabolic, or musculoskeletal system. Option C: Arrhythmias are seen more commonly in fenoterol usage versus albuterol, and arrhythmias have an increase in frequency in patients with underlying heart disease or concomitant theophylline use. Several studies have also indicated hypoxemia and hypercapnia as exacerbating factors to the cardiotoxic effects of beta-2 agonists.

The nurse is caring for a client with COPD who becomes dyspneic. The nurse should? A. Administer oxygen at 6L/minute via nasal cannula B. Place the client in a high Fowler's position C. Instruct the client to breathe into a paper bag D. Assist the client with pursed lip breathing

D. Assist the client with pursed lip breathing Assist the client with pursed lip breathing is the correct option. Use pursed-lip breathing during periods of dyspnea to control rate and depth of respiration and improve respiratory muscle coordination.

The nurse assesses a college-age client complaining of shortness of breath after jogging and tightness in his chest. Upon further questioning, the client denies a sore throat, fever, or productive cough. The nurse notifies the physician that this client's clinical manifestations are most likely related to A. Pneumoconiosis. B. Pneumonia. C. Bronchitis. D. Asthma.

D. Asthma The exercise may have induced bronchospasms. Lack of fever or productive cough would reduce the possibility of the clinical manifestations representing pneumonia or bronchitis. The occupation as a college student decreases the likelihood of an occupationally related lung disease.

You are providing care to a patient with a chest tube. On assessment of the drainage system, you note continuous bubbling in the water seal chamber and oscillation. Which of the following is the CORRECT nursing intervention for this type of finding? A. Reposition the patient because the tubing is kinked. B. Continue to monitor the drainage system. C. Increase the suction to the drainage system until the bubbling stops. D. Check the drainage system for an air leak.

D. Check the drainage system for an air leak. Continuous bubbling in the water seal chamber is NOT normal and indicates there is an air leak. However, oscillation of the water in the water seal chamber is normal.

The nurse is caring for a client with a pneumothorax. The nurse expects the client to have a chest tube inserted because? A. It is the appropriate post-operative treatment for a pneumothorax B. It will drain the purulent drainage from the empyema that caused it C. It will increase the intrathoracic pressure, restoring it back to normal D. It will drain air out of the thorax, restoring normal intrathoracic pressure

D. It will drain air out of the thorax, restoring normal intrathoracic pressure With a pneumothorax, which is not the result of a surgical procedure, normal intrathoracic pressure increases as a result of the opening in the thorax which allows outside air to rush in and "collapse" the lung; therefore, draining the air out of the thoracic cage reduces that increased intrathoracic pressure and restores it to normal - essentially re-inflating the collapsed lung.

This diagnostic test is done to detect the effectiveness of the bronchodilator given to the patient. A. Incentive Spirometer B. Pulmonary Function Test C. Chest X- Ray D. Peak flow meter

D. Peak flow meter Detects how fast the air would come out of the lungs. If bronchioles are constricted after taking a bronchodilator, the air flow is slow upon exhalation.

The nurse assesses fluctuations in the water seal chamber of a client's closed chest drainage system. The nurse evaluates this finding as indicating A. The tubing is kinked. B. The lung has re-expanded. C. An air leak is present. D. The system is functioning properly.

D. The system is functioning properly. In a closed drainage chest tube system, fluctuations in the water seal chamber during inhalation and exhalation (called tidaling) is a normal finding until the lung re-expands. If the fluctuations are absent, it may mean that there is an air leak, that the tubing is kinked, or that the lung has re-expanded and the client no longer requires chest drainage.

The nurse is reviewing the normal limits for a head and neck assessment. Which of the following findings would indicate the need for additional investigation? A. The muscles of the neck are symmetrical B. A small, discrete, movable lymph node C. A thyroid gland that is not visible or palpable D. The trachea is to the right of the suprasternal notch

D. The trachea is to the right of the suprasternal notch The trachea should be midline in the suprasternal notch. It may be normal to feel a small, discrete, movable lymph node. It is clinically insignificant. The thyroid gland should not be visible or palpable and the muscles of the neck should be symmetrical.

The patient in room 2569 calls on the call light to tell you something is wrong with his chest tube. When you arrive to the room you note that the drainage system has fallen on its side and is leaking drainage onto the floor from a crack in the system. What is your next PRIORITY? A. Place the patient in supine position and clamp the tubing. B. Notify the physician immediately. C. Disconnect the drainage system and get a new one. D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.

Option D is the best choice. A new system needs to be obtained, however, in order to maintain a water seal until the new system arrives you will need to place the tubing 1 inch in sterile water or sterile saline to regain a water seal.

A patient is recovering from a pneumothorax and has a chest tube present. Which of the following is an appropriate finding when assessing the chest tube drainage system? A. Intermittent bubbling may be noted in the water seal chamber. B. 200 cc of drainage per hour is expected during recovery of a pneumothorax. C. The chest tube is positioned at the patient's chest level to facilitate drainage. D. All of these options are appropriate findings.

The answer is A. It is normal to find intermittent (NOT CONTINUOUS) bubbling in the water seal chamber if the patient is recovery from a pneumothorax. Remember that a pneumothorax is an AIR leak between the lung and chest wall....therefore air will escape into the water seal chamber causing intermittent bubbles.

You're providing care to a patient who was just transferred to your unit for the treatment of ARDS. The patient is in the exudative phase. The patient is ordered arterial blood gases. The results are back. Which results are expected during this early phase of acute respiratory distress syndrome that correlates with this diagnosis? A. PaO2 40, pH 7.59, PaCO2 30, HCO3 23 B. PaO2 85, pH 7.42, PaCO2 37, HCO3 26 C. PaO2 50, pH 7.20, PaCO2 48, HCO3 29 D. PaO2 55, pH 7.26, PaCO2 58, HCO3 19

The answer is A. This option demonstrates respiratory alkalosis. In the early stages of ARDS (exudative) the patient will start to enter in respiratory alkalosis. The patient starts to have tachypnea (the body's way of trying to increase the oxygen level but it can't). They will have a very low PaO2 level (normal PaO2 is 80 mmHg), the blood pH will become high (normal is 7.35-7.45) (alkalotic). In the late stage, the patient can enter into respiratory acidosis.

A patient is on mechanical ventilation with PEEP (positive end-expiratory pressure). Which finding below indicates the patient is developing a complication related to their therapy and requires immediate treatment? A. HCO3 26 mmHg B. Blood pressure 70/45 C. PaO2 80 mmHg D. PaCO2 38 mmHg

The answer is B. Mechanical ventilation with PEEP can cause issues with intrathoracic pressure and decrease the cardiac output (watch out for a low blood pressure) along with hyperinflation of the lungs (possible pneumothorax or subq emphysema which is air that escapes into the skin because the lungs are leaking air).

During the exudative phase of acute respiratory distress syndrome (ARDS), the patient's lung cells that produce surfactant have become damaged. As the nurse you know this will lead to? A. bronchoconstriction B. atelectasis C. upper airway blockage D. pulmonary edema

The answer is B. Surfactant decreases surface tension in the lungs. Therefore, the alveoli sacs will stay stable when a person exhales (hence the sac won't collapse). If there is a decrease in surfactant production this creates an unpredictable alveoli sac that can easily collapse, hence a condition called ATELETASIS will occur (collapse of the lung tissue) when there is a decrease production in surfactant.

A patient has been hospitalized in the ICU for a near drowning event. The patient's respiratory function has been deteriorating over the last 24 hours. The physician suspects acute respiratory distress syndrome. A STAT chest x-ray is ordered. What finding on the chest x-ray is indicative of ARDS? A. infiltrates only on the upper lobes B. enlargement of the heart with bilateral lower lobe infiltrates C. white-out infiltrates bilaterally D. normal chest x-ray

The answer is C. This is a finding found in ARDS....pronounce white-out infiltrates bilaterally.

Which patient below is at MOST risk for developing ARDS and has the worst prognosis? A. A 52-year-old male patient with a pneumothorax. B. A 48-year-old male being treated for diabetic ketoacidosis. C. A 69-year-old female with sepsis caused by a gram-negative bacterial infection. D. A 30-year-old female with cystic fibrosis.

The answer is C. Sepsis is the MOST common cause of ARDS because of systemic inflammation experienced. This is also true if the cause of the sepsis is a gram-negative bacterium (this also makes the infection harder to treat...hence poor prognosis). With sepsis, the immune cells that are present with the inflammation travel to the lungs and damage the alveolar capillary membrane leading to fluid to leak in the alveolar sacs.

A patient is experiencing respiratory failure due to pulmonary edema. The physician suspects ARDS but wants to rule out a cardiac cause. A pulmonary artery wedge pressure is obtained. As the nurse you know that what measurement reading obtained indicates that this type of respiratory failure is NOT cardiac related? A. >25 mmHg B. <10 mmHg C. >50 mmHg D. <18 mmHg

The answer is D. A pulmonary artery wedge pressure measures the left atrial pressure. A pulmonary catheter is "wedged" with a balloon in the pulmonary arterial branch to measure the pressure. If the reading is less than 18 mmHg it indicates this is NOT a cardiac issue but most likely ARDS. Therefore, the pulmonary edema is due to damage to the alveolar capillary membrane leaking fluid into the alveolar sac....NOT a heart problem ex: heart failure.

You're precepting a nursing student who is assisting you care for a patient on mechanical ventilation with PEEP for treatment of ARDS. The student asks you why the PEEP setting is at 10 mmHg. Your response is: A. "This pressure setting assists the patient with breathing in and out and helps improve air flow." B. "This pressure setting will help prevent a decrease in cardiac output and hyperinflation of the lungs." C. "This pressure setting helps prevent fluid from filling the alveoli sacs." D. "This pressure setting helps open the alveoli sacs that are collapsed during exhalation."

The answer is D. This setting of PEEP (it can range between 10 to 20 mmHg of water) and it helps to open the alveoli sacs that are collapsed, especially during exhalation.

You are caring for a patient with acute respiratory distress syndrome. As the nurse you know that prone positioning can be beneficial for some patients with this condition. Which findings below indicate this type of positioning was beneficial for your patient with ARDS? A. Improvement in lung sounds B. Development of a V/Q mismatch C. PaO2 increased from 59 mmHg to 82 mmHg D. PEEP needs to be titrated to 15 mmHg of water

The answers are A and C. Prone positioning helps improve PaO2 (82 mmHg is a good finding) without actually giving the patient high concentrations of oxygen. It helps improves perfusion and ventilation (hence correcting the V/Q mismatch). In this position, the heart is no longer laying against the posterior part of the lungs (improves air flow...hence improvement of lung sounds) and it helps move secretions from other areas that were fluid filled and couldn't move in the supine position, hence helping improve atelectasis.

7. As the nurse you know that acute respiratory distress syndrome (ARDS) can be caused by direct or indirect lung injury. Select below all the INDIRECT causes of ARDS: A. Drowning B. Aspiration C. Sepsis D. Blood transfusion E. Pneumonia F. Pancreatitis

The answers are: C, D, F Indirect causes are processes that can cause inflammation OUTSIDE of the lungs....so the issue arises somewhere outside the lungs. Therefore, sepsis (infection...as long as it is outside the lungs), blood transfusion, and pancreatitis are INDIRECT causes. Drowning, aspiration, and pneumonia are issues that arise in the lungs (therefore, they are DIRECT causes of lung injury).

Atelectasis can be caused by obesity and scoliosis True False

True Extrapulmonary related conditions such as obesity and scoliosis directly compresses the respiratory system

A family history of hypertension can be one of the predisposing factor of having COPD. True False

True Hypertension can cause poor blood vessel integrity, damaging the blood vessels in the alveoli, altering its function.

The position of a conscious client during suctioning is: a. Fowler's b. Supine position c. Side-lying d. Prone

a. Fowler'sPosition a conscious person who has a functional gag reflex in the semi fowler's position with the head turned to one side for oral suctioning or with the neck hyper extended for nasal suctioning. If the client is unconscious place the patient a lateral position facing you.

23. The accumulation of fluids in the pleural space is called: a. Pleural effusion b. Hemothorax c. Hydrothorax d. Pyothorax

a. Pleural effusion

You're providing care to a patient who is being treated for aspiration pneumonia. The patient is on a 100% non-rebreather mask. Which finding below is a HALLMARK sign and symptom that the patient is developing acute respiratory distress syndrome (ARDS)? A. The patient is experiencing bradypnea. B. The patient is tired and confused. C. The patient's PaO2 remains at 45 mmHg. D. The patient's blood pressure is 180/96.

answer is C. A hallmark sign and symptom found in ARDS is refractory hypoxemia. This is where that although the patient is receiving a high amount of oxygen (here a 100% non-rebreather mask) the patient is STILL hypoxic. Option C is the answer because it states the patient's arterial oxygen level is remaining at 45 mmHg (a normal is 80 mmHg but when treating patients with ARDS a goal is at least 60 mmHg). Yes, the patient can be tired and confused from a low oxygen level BUT this question wants to know the HALLMARK sign and symptom.

You're teaching a class on critical care concepts to a group of new nurses. You're discussing the topic of acute respiratory distress syndrome (ARDS). At the beginning of the lecture, you assess the new nurses understanding about this condition. Which statement by a new nurse demonstrates he understands the condition? A. "This condition develops because the exocrine glands start to work incorrectly leading to thick, copious mucous to collect in the alveoli sacs." B. "ARDS is a pulmonary disease that gradually causes chronic obstruction of airflow from the lungs." C. "Acute respiratory distress syndrome occurs due to the collapsing of a lung because air has accumulated in the pleural space." D. "This condition develops because alveolar capillary membrane permeability has changed leading to fluid collecting in the alveoli sacs."

answer is D. ARDS is a type of respiratory failure that occurs when the capillary membrane that surrounds the alveoli sac becomes damaged, which causes fluid to leak into the alveoli sac. Option A describes cystic fibrosis, option B describes COPD, and option C describes a pneumothorax.

While changing the tapes on a tracheostomy tube, the male client coughs and the tube is dislodged. The initial nursing action is to: a. Call the physician to reinsert the tube. b. Grasp the retention sutures to spread the opening. c. Call the respiratory therapy department to reinsert the tracheotomy. d. Cover the tracheostomy site with a sterile dressing to prevent infection.

b. Grasp the retention sutures to spread the opening.

The most important action the nurse should do before and after suctioning a client is: a. Placing the client in a supine position b. Making sure that suctioning takes only 10-15 seconds c. Evaluating for clear breath sounds d. Hyperventilating the client with 100% oxygen

d. Hyperventilating the client with 100% oxygen

Incentive Spirometry is more of a ____________ than a ______________

treatment; diagnostic test