Respiratory Disorders

Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis?

"Because I had a previous reaction to the test, this time I need to get a chest X-ray."

The nurse is giving preoperative instructions to a client who will be undergoing rhinoplasty. What should the nurse tell the client?

"Do not take aspirin-containing medications for 2 weeks before surgery."

A physician orders prednisone to control inflammation in a client with interstitial lung disease. During client teaching, the nurse stresses the importance of taking prednisone exactly as ordered and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience

acute adrenocortical insufficiency.

A client has a positive reaction to the Mantoux test. How should the nurse interpret this reaction?

bad exposed to Mycobacterium tuberculosis.

A client has had abdominal surgery and is using an incentive spirometer. Which is the most effective way to evaluate the effectiveness of the client's use of the spirometer? The client:

can breathe more easily.

A client is undergoing a complete physical examination as a requirement for college. When checking the client's respiratory status, the nurse observes respiratory excursion to help assess

chest movements.

Which assessment finding puts a client at increased risk for epistaxis?

cocaine use

The nurse is caring for an older adult who has been bedridden for an extended period. Which symptom indicates that the client has hypoxia?

confusion

When developing a discharge plan with a client with chronic obstructive pulmonary disease (COPD), what information should the nurse include in the plan?

develop respiratory infections easily.

A client undergoes a total laryngectomy and tracheostomy formation. On discharge, the nurse should give which instruction to the client and family?

"Family members should continue to talk to the client."

A client with asthma who has wheezing and shortness of breath asks the nurse if it is all right to use the salmeterol inhaler during exercise. What is the nurse's best response?

"No, this drug is a maintenance drug, not a rescue inhaler."

For a client with an acute pulmonary embolism, the physician orders heparin 25,000 units in 500 ml of dextrose 5% in water (D5W) at 1,100 units/hour. The nurse should administer how many milliliters per hour?

22

After nasal surgery, the client expresses concern about how to decrease facial pain and swelling while recovering at home. Which instruction would be most effective for decreasing pain and edema?

Apply cold compresses to the area.

A nurse is caring for a client diagnosed with a deep vein thrombosis (DVT). The client begins to experience symptoms of chest pain, dyspnea, and restlessness. Physical assessment reveals a heart rate of 140 beats per minute, blood pressure of 100/60 mm Hg, and respirations of 40 breaths per minute. What is the nurse's priority action?

Assess the client's oxygen saturation (SaO2) level.

The nurse is assessing a client who has a chest tube connected to a water-seal chest tube drainage system. According to the illustration shown, what should the nurse do?

Lower the drainage system to maintain gravity flow.

A young adult is admitted to the emergency department after an automobile accident. The client has severe pain in the right chest from contact with the steering wheel. What should the nurse do first?

Maintain adequate oxygenation.

A client with a peritonsillar abscess has been hospitalized. Upon assessment, the nurse determines the following: a temperature of 103°F (39.4°C), body chills, and leukocytosis. The client begins to have difficulty breathing. In what order from first to last should the nurse perform the actions? All options must be used

Open the airway. Start an IV access site. Call the health care provider (HCP). Explain the situation to the family.

A client has been admitted with a chronic cough, progressive weight loss, and a positive tuberculin skin test. Which isolation precautions are appropriate for the nurse to follow? Select all that apply.

Place a mask on the client when transporting to radiology. Wear a disposable mask when in the client's room.

What should the nurse do when suctioning a client who has a tracheostomy tube 3 days following insertion?

Use a sterile catheter each time the client is suctioned.

A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer?

an inhaled beta2-adrenergic agonist

During inspiration, which action occurs?

diaphragm descends.

The nurse is auscultating the lung sounds of a client with long-standing emphysema. Which lung sounds are expected for this client?

diminished breath sounds

Which physical sensation will the client who has had an abdominal hysterectomy most likely experience if she hyperventilates while performing deep-breathing exercises?

dizziness

The nurse instructs the unlicensed assistive personnel (UAP) on how to care for a client with chest tubes that are connected to water-seal drainage. The nurse should instruct the UAP to:

mark the time and amount of drainage on the collection container.

For a client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the care plan?

measuring and documenting the drainage in the collection chamber

A child with cystic fibrosis is receiving gentamicin. Which nursing action is most important?

monitoring intake and output

A nurse is reviewing arterial blood gas (ABG) results on four clients. Which results would the nurse report immediately to the healthcare provider?

pH 7.31, PaO2 84 mmHg, PaCO2 50 mmHg, HCO3 24 mEq/L, and O2 sat 90%

The nurse has received lab reports for several clients undergoing care. Which set of arterial blood gas (ABG) results will the nurse investigate first?

pH 7.49, PaCO2 30 mmHg, PaO2 75 mmHg, and HCO3- 22 mEq/L

A client is brought to the emergency department following an automobile accident. Physical assessment reveals tachycardia, dyspnea, and absent breath sounds over the right lung. Which action is the nurse's most appropriate action?

preparing the client for a chest tube insertion

A client who had a left thoracoscopy sustained an injury secondary to the surgery position. The nurse should assess the client for which sign?

tingling in the arm

While suctioning a client's laryngectomy tube, the nurse should insert the catheter:

until resistance is met, then withdraw it 0.4 to 0.8 inches (1 to 2 cm).

A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when the client:

uses the sternocleidomastoid muscles.

For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

using a Venturi mask to deliver oxygen as ordered

A nurse is caring for a client who is at high risk for developing pneumonia. Which intervention should the nurse include on the client's care plan?

using strict hand hygiene

A client develops respiratory distress and requires endotracheal intubation. How much pressure should be applied to the cuff to ensure adequate placement of this tube?

15 to 20 mm Hg

A nurse is planning postoperative care for a client who has received a general anesthetic. During the immediate postoperative period, which nursing assessment should the nurse be most concerned about?

heart rate of 130 bpm, blood pressure of 98/56 mm Hg, and inspirations of 24

The nurse is caring for a client with bacterial pneumonia. The effectiveness of the client's oxygen therapy can be best determined by which indicator of oxygenation?

arterial blood gas (ABG) values.

A client with pulmonary fibrosis is prescribed home oxygen therapy. Which health team member is responsible for evaluating the client's knowledge of home oxygen use?

home health nurse

The nurse is aware that frequent repositioning in bed will assist in the prevention of which condition for a client?

pneumonia

The nurse is instructing a client with chronic obstructive pulmonary disease how to do pursed-lip breathing. In which order from first to last should the nurse explain the steps to the client? All options must be used.

"Relax your neck and shoulder muscles." "Breathe in normally through your nose for two counts (while counting to yourself, one, two)." "Pucker your lips as if you were going to whistle." "Breathe out slowly through pursed lips for four counts (while counting to yourself, one, two, three, four)."

When administering atropine sulfate preoperatively to a client scheduled for lung surgery, what should the nurse tell the client?

"This medicine will make your mouth feel dry."

The nurse is caring for a client with emphysema. The client asks about the reason for persistent respiratory acidosis. What is the best response by the nurse?

"Your alveoli have lost elasticity, which causes retained carbon dioxide."

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

1.4 L.

The nurse is suctioning a client who had a laryngectomy. What is the maximum amount of time the nurse should suction the client?

10 seconds

A nurse is assessing the injection site of a client who has received a purified protein derivative test. Which finding indicates a need for further evaluation?

15-mm induration

The health care provider (HCP) has prescribed guaifenesin 300 mg four times a day. The dosage strength of the liquid is 200 mg/5 mL. How many milliliters should the nurse administer for each dose? Record your answer using one decimal place.

7.5

While reviewing the arterial blood gas values of a client with emphysema, the nurse should identify which PaCO2 values as indicating the need for immediate intervention?

80 mm Hg

The nurse monitors a client following the insertion of a chest tube for a hemopneumothorax. Which observation should the nurse report to the healthcare provider?

600 mL of blood in the collection chamber in 1 hour

A client with bronchitis is ordered 300 mg of liquid guaifenesin every 4 hours. The container indicates that there is 200 mg/5 mL. How many milliliters should the nurse administer per dose? Record your answer using one decimal place.

7.5

A health care provider (HCP) has just inserted nasal packing for a client with epistaxis. The client is taking ramipril for hypertension. What should the nurse instruct the client to do?

Avoid rigorous aerobic exercise.

A client with bacterial pneumonia is coughing up tenacious, purulent sputum. Which action would help liquefy these viscous secretions?

Breathe humidified air.

A client admitted with pneumonia and dementia has attempted several times to pull out the IV and Foley catheter. After trying other options, the nurse obtains a prescription for bilateral soft wrist restraints. Which nursing action is most appropriate?

Attach the ties of the restraints to the bedframe.

A client with newly diagnosed chronic obstructive disease is to be discharged home with oxygen per nasal prongs. Which teaching points should the nurse include in this client's discharge plan? Select all that apply.

Avoid areas where people are smoking cigarettes or cigars. Place gauze between the ears and oxygen tubing to prevent skin irritation.

When assessing a client with chest trauma, the nurse notes that the client is taking small breaths at first, then bigger breaths, and then a couple of small breaths, then 10 to 20 seconds of no breaths. How should the nurse should record the breathing pattern?

Cheyne-Stokes respiration

For a client with chronic obstructive pulmonary disease who has trouble raising respiratory secretions, which intervention would help reduce the tenacity of secretions?

Help the client maintain an adequate fluid intake.

Which information should the nurse include in a teaching plan for the client newly diagnosed with chronic obstructive pulmonary disease (COPD)? Select all that apply.

High humidity increases the effort of breathing. A bronchodilator with meter-dose inhaler should be readily available. Smoking cessation is important to slow or stop disease progression.

A nurse is caring for a client after a thoracotomy for a lung mass. Which nursing diagnosis should be the first priority?

Impaired gas exchange

A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be

Ineffective airway clearance.

A client with suspected severe acute respiratory syndrome (SARS) comes to the emergency department. Which physician order should the nurse implement first?

Institute isolation precautions.

A client with lung cancer has developed an intractable, nonproductive cough that is unrelieved by nonopioid antitussive agents. The physician orders codeine, 10 mg P.O. every 4 hours. Which statement accurately describes codeine?

It's a centrally-acting antitussive and can cause dependence.

A client who has been diagnosed with tuberculosis has been placed on drug therapy. The medication regimen includes rifampin. Which instruction should the nurse give the client about potential adverse effects of rifampin? Select all that apply.

Maintain follow-up monitoring of liver enzymes. Avoid alcohol intake. The urine may have an orange color

The nurse team leader is making rounds and observes the client who had a tracheostomy tube inserted 2 days ago (see figure). The nursing policy manual recommends use of the gauze pad. What should the nurse do?

Make sure the gauze pad is dry and the client is in a comfortable position.

When caring for a client who has undergone a left lung lobectomy, what important postoperative measures related to care of chest tubes should be performed by the nurse? Select all that apply.

Measure drainage at the end of each shift. Assess chest tube dressing for bleeding. Ensure all connections are securely taped.

A client with suspected inhalation anthrax is admitted to the emergency department. Which action by the nurse takes the highest priority?

Monitor vital signs and oxygen saturation every 15 to 30 minutes.

Which would be most important to teach a client older than 65 years to prevent a recurrence of bacterial pneumonia?

Obtain influenza and pneumococcal vaccines.

While making rounds, the nurse finds a client with chronic obstructive pulmonary disease sitting in a wheelchair, slumped over a lunch tray. After determining the client is unresponsive and calling for help, what should the nurse do next?

Open the client's airway.

A client is using an over-the-counter nasal spray containing pseudoephedrine to treat allergic rhinitis. Which instruction about this medication would be most appropriate for the nurse to provide for the client?

Overuse of pseudoephedrine can lead to increased nasal congestion.

A client diagnosed with an empyema is scheduled for a thoracentesis. The nurse should prepare the client for this procedure with which action?

Position the client sitting upright on the edge of the bed and leaning forward.

Which instruction should the nurse give the client who has undergone chest surgery to prevent shoulder ankylosis?

Raise the arm on the affected side over the head.

Following a thoracotomy, the client has pain of 9 on a 10-point scale. What should the nurse do thirty minutes after administering the highest dose of the prescribed pain medication?

Reassess the client.

If a client is receiving rescue breaths, and the chest wall fails to rise during cardiopulmonary resuscitation, what should the rescuer do first?

Reposition the airway.

To promote effective airway clearance in a client with acute respiratory distress, what should the nurse do?

Suction if cough is ineffective.

A client with end-stage chronic obstructive pulmonary disease (COPD) requires bi-level positive airway pressure (BiPAP). While caring for the client, the nurse determines that bilateral wrist restraints are required to prevent compromised care. Which client care outcome is best associated with restraint use in the client who requires BiPAP?

The client will maintain adequate oxygenation.

A client with acute bronchitis is admitted to the healthcare facility and is receiving supplemental oxygen via nasal cannula. When monitoring this client, the nurse suddenly hears a high-pitched whistling sound. What is the most likely cause of this sound?

The oxygen tubing is pinched.

Which client should the nurse most encourage to receive the pneumococcal and influenza vaccination?

a 75-year-old woman with diabetes

A client with a chest tube in place has become increasingly short of breath throughout the shift and reports pain to the right chest wall. The nurse understands that the most likely cause is:

a tension pneumothorax.

A client with severe shortness of breath comes to the emergency department. The client tells the emergency department staff that they recently traveled to China for business. Based on the client's travel history and presentation, the staff suspects severe acute respiratory syndrome (SARS). Which isolation precautions should the staff institute?

airborne and contact precautions

A client experiencing a severe asthma attack has the following arterial blood gas results: pH 7.33; Pco2 48 mm Hg (6.4 kPa); Po2 58 mm Hg (7.7 kPa); HCO3 26 mEq/L (26 mmol/L). Which prescription should the nurse implement first?

albuterol nebulizer

The nurse is caring for a client that is experiencing increasing shortness of breath. The client is pale and slight circumoral cyanosis is developing. Which laboratory test best measures the adequacy of tissue oxygenation?

arterial blood gases

A nurse is preparing a client with a pleural effusion for a thoracentesis. The nurse should

assist the client to a sitting position on the edge of the bed, leaning over the bedside table.

A client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough, headache, and recurrent chills. Based on the client's history and physical findings, the physician suspects legionnaires' disease. While awaiting diagnostic test results, the client is admitted to the facility and started on antibiotic therapy. What's the drug of choice for treating legionnaires' disease?

azithromycin

Before weaning a client from a ventilator, which assessment parameter is the most important for the nurse to obtain?

baseline arterial blood gas (ABG) levels

When evaluating the effectiveness of airway suctioning, the nurse should use which criterion?

breath sounds clear on auscultation

A client being treated for complications of chronic obstructive pulmonary disease needs to be intubated. The client has previously discussed their wish to not be intubated with the client's partner of 5 years, whom the client has designated as healthcare power of attorney. The client's children want their parent to be intubated. A nurse caring for this client knows that

clients commonly confer healthcare power of attorney on someone who shares their personal values and beliefs.

When instructing clients with allergic rhinitis about the use of nasal decongestants, it is important for the nurse to emphasize that:

continuous use for more than 3 days can result in worsening of symptoms.

After undergoing a left thoracotomy, a client has a chest tube in place. When caring for this client, the nurse must

encourage coughing and deep breathing.

A client with severe acute respiratory syndrome privately informs the nurse of a desire not to be placed on a ventilator if the condition worsens. The client's partner and children have repeatedly expressed their desire that every measure be taken for the client. The most appropriate intervention by the nurse would be to:

encourage the client to consider a living will or power of attorney.

A nurse is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which intervention will most likely lower the client's arterial blood oxygen saturation?

endotracheal suctioning

Which diet would be most appropriate for a client with chronic obstructive pulmonary disease (COPD)?

high-calorie, high-protein diet

A client had posterior packing inserted to control a severe nosebleed. After insertion of the packing, the nurse should observe the client for which finding?

hypoventilation

The nurse interprets which finding as an early sign of acute respiratory distress syndrome (ARDS) in a client at risk?

hypoxia not responsive to oxygen therapy

The nurse is assessing a client with chronic obstructive pulmonary disease. Which finding requires immediate intervention?

inability to speak

Which vaccine should a nurse encourage a client with chronic obstructive pulmonary disease (COPD) to receive? Select all that apply.

influenza pneumonia pertussis

After the nurse informs the surgeon that a chest tube is malfunctioning, the health care provider asks the nurse to reposition the tube and obtain a chest radiograph. The nurse should:

inform the surgeon this is not within the safe scope of practice.

Which assessments would provide the nurse with the most valuable information to assess the breathing of a client with chronic obstructive pulmonary disease (COPD)? Select all that apply.

inspection and palpation for vibrations auscultation and percussion exertional effects on breathing inspection for pursed-lip breathing technique

A client had a Mantoux test result of an 8-mm induration. When should the nurse interpret the test as positive? When the client:

is immunocompromised.

The nurse is caring for a child with history of strep throat. Upon current assessment, the child reports abdominal pain and joint achiness. Which laboratory data would the nurse communicate to the health care provider immediately?

leukocytosis

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

light-headedness or paresthesia

Which is a priority goal for the client with chronic obstructive pulmonary disease (COPD)?

maintaining functional ability

A client admitted with a deep vein thrombosis abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery is most likely to improve these manifestations?

nonrebreather mask

A client has been diagnosed with bacterial pneumonia. After 1 day of IV antibiotic therapy, the client's white blood cell count is still 14,000/mm3 (14 X 109/L). The nurse should:

notify the health care provider.

A nurse is caring for a client with cystic fibrosis. With which members of the healthcare team is it most appropriate for the nurse to collaborate? Select all that apply.

nutritional services physical therapy respiratory therapy

The nurse auscultates the lungs of a client who has been diagnosed with a tumor in the lung and notes wheezing over one lung. What additional assessment should the nurse make?

obstruction of the airway

A client with asthma has been prescribed beclomethasone via metered-dose inhaler. To determine if the client has been rinsing the mouth after each use of the inhaler, the nurse should inspect the client's mouth for which health problem?

oral candidiasis

Arterial blood gas analysis would reveal which finding related to acute respiratory failure?

pH 7.24

A client is being prepared for a bronchoscopy. The nurse can delegate which task to the unlicensed assistive personnel (UAP)?

placing the client on NPO status

The nurse is reading the results of a tuberculin skin test (see figure). How should the nurse interpret the results?

positive

After a total laryngectomy, the client has a feeding tube. What is the purpose of the feeding tube?

provides nutrition.

To help control pain during coughing for a client who has had a pulmonary lobectomy, the nurse should:

raise the bed to semi-Fowler's position and position the client's hands so that the incision is supported anteriorly and posteriorly.

A young adult is admitted for elective nasal surgery for a deviated septum. Which sign would be an important indicator of bleeding even if the nasal drip pad remained dry and intact?

repeated swallowing

A client appears flushed and has shallow respirations. The arterial blood gas report shows the following: pH, 7.24; partial pressure of arterial carbon dioxide (PaCO2), 49 mm Hg (6.5 kPa); bicarbonate (HCO3-), 24 mEq/L (24 mmol/L). These findings are indicative of which acid-base imbalance?

respiratory acidosis

A client has a dull headache, is dizzy, and has an increased pulse rate. The results of arterial blood gas analysis are as follows: pH 7.26; partial pressure of carbon dioxide, 50 mm Hg (6.7 kPa); and bicarbonate, 24 mEq/L (24 mmol/L). These findings indicate which acid-base imbalance?

respiratory acidosis

A client's arterial blood gas analysis reveals an excess of carbon dioxide. The nurse should recognize that this is consistent with which condition?

respiratory acidosis

A client who has been hospitalized for treatment of a pneumothorax is ready for discharge. Which outcomes indicate that the client has adequate respiratory function? Select all that apply.

respiratory rate of 12 to 20 breaths per minute breath sounds present and equal in all lobes oxygen saturation on room air is 95%

A nurse is weaning a client from mechanical ventilation. Which assessment finding indicates the weaning process should be stopped?

runs of ventricular tachycardia

A client with respiratory acidosis is admitted to the intensive care unit for close observation. The nurse should stay alert for which complication associated with respiratory acidosis?

shock

The nurse is planning to assist the health care provider with a thoracentesis for a client who has a pleural effusion. Which position for the client would be appropriate for this procedure?

sitting upright and leaning on an overbed table

A client has been in an automobile accident, and the nurse is assessing the client for possible pneumothorax. What finding should the nurse immediately report to the health care provider?

sudden, sharp chest pain

For a client with chronic obstructive pulmonary disease, which nursing intervention helps maintain a patent airway?

teaching the client how to perform controlled coughing

Which is an expected finding for a client who has been treated for bacterial pneumonia?

the ability to perform activities of daily living without dyspnea

A client's chest tube is connected to a drainage system with a water seal. The nurse notes that the fluid in the water seal column is fluctuating with each breath that the client takes. How should the nurse interpret this finding? Fluctuation means that:

the chest tube system is functioning properly.

A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention?

the client lying in a lateral position, with the head of bed flat

The nurse is prioritizing care for several clients. Which client should the nurse assess first?

the client with stridor who just received the first dose of an antibiotic