Respiratory Disorders PrepU
The nurse is admitting a client who just had a bronchoscopy. Which assessment should be the nurse's priority?
swallow reflex
A nurse is providing discharge teaching for a client who had a laryngectomy. Which instruction should the nurse include in the teaching?
"Cover the stoma with a loose plastic cloth whenever you shower or bathe."
A client with emphysema is receiving continuous oxygen therapy. Depressed ventilation is likely to occur unless the nurse ensures that the oxygen is administered in which way?
at a low flow rate
The client with tuberculosis is to be discharged home with nursing follow-up. Which aspect of nursing care will have the highest priority?
teaching the client about the disease and its treatment
A client has had a central venous pressure line inserted. The nurse should immediately report which sign to the health care provider?
sharp pain on the affected side
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."
The nurse is developing a care plan with a client who had a laryngectomy 3 days ago. What step(s) should the nurse take to assure adequate client nutrition? Select all that apply.
-Weigh weekly and report weight loss. -When eating, sit and lean slightly forward. -Have the serum albumin level checked regularly. -Receive enteral tube feedings as prescribed.
A client has just undergone a bronchoscopy. Which nursing interventions are appropriate after this procedure? Select all that apply.
-Withhold food and fluids until the client's gag reflex returns. -Assess for hemoptysis and frank bleeding. -Monitor the client's vital signs.
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
After receiving an oral dose of codeine for an intractable cough, a client asks the nurse, "How long will it take for this drug to work?" How should the nurse respond?
30 minutes
The nurse is assessing a client who has been in a car accident. The client reports sore ribs and painful breathing on the left side of the chest wall. A chest X-ray confirms fracture of two ribs and left-sided hemopneumothorax. What can the nurse anticipate?
A chest tube will be inserted into the left pleural space and attached to a pleural evacuation device.
A nurse is supervising a new graduate registered nurse who is caring for a client hospitalized with active tuberculosis (TB). Which action by the new graduate requires the nurse to intervene?
A surgical face mask is applied before entering the client's room.
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 client has a chest tube and water-seal drainage system. What should the nurse do to ensure safe and effective use of the drainage system?
Make sure that the drainage apparatus is always below the client's chest level.
A physician orders triamcinolone and salmeterol for a client with a history of asthma. What action should the nurse take when administering these drugs?
Administer the salmeterol and then administer the triamcinolone.
A nurse is caring for a client on mechanical ventilation who's restless and trying to remove the endotracheal (ET) tube. Which action should the nurse perform next?
Assess the client for pain and medicate as appropriate.
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.
A client is ready for discharge after surgery for a deviated septum. Which instruction would be appropriate?
Avoid activities that elicit the Valsalva maneuver.
A client in severe respiratory distress is admitted to the hospital. When the nurse is assessing the client, what should the nurse do?
Complete a focused assessment of the respiratory system.
A client has been admitted to the emergency department with a sucking stab wound in the chest wall. What should the nurse do first:?
Cover the wound with a petroleum-impregnated dressing.
A client has had a bronchoscopy under local anesthesia. Which action should the nurse take as the client recovers from the anesthesia?
Restrict oral intake until the gag reflex returns.
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 client has a newly positive Mantoux skin test but does not have active tuberculosis. What should the nurse instruct the client to do?
Take isoniazid as prescribed.
A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis?
The client had a liver transplant 2 years ago.
A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition?
The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher.
An older adult client with chronic obstructive pulmonary disease (COPD) is admitted to the emergency department because of rapid-onset confusion. The client's spouse tells the nurse the client has a urinary tract infection but became confused 2 hours ago. The client's vital signs are now heart rate 98 bpm; respiratory rate 24 breaths/min; and blood pressure 95/68 mm Hg. Which information from the admission history is most concerning?
The client has a urinary tract infection.
A client with an endotracheal tube is being weaned from the ventilator. For which reason should the procedure be terminated?
The heart rate increased 20 beats/minute.
A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia?
a client with a nasogastric tube
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.
The nurse is admitting a client with suspected tuberculosis to the hospital. The nurse should institute which type of precautions for this client?
airborne precautions
An adolescent with cystic fibrosis has been hospitalized several times. On the latest admission, the client has labored respirations, fatigue, malnutrition, and failure to thrive. Which initial nursing action is most important?
applying an oximeter and initiating respiratory therapy
The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The decrease in pH exists because the client's lungs:
are unable to blow off carbon dioxide.
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.
The nurse has suctioned a client's tracheostomy tube. Which finding indicates the suctioning has been effective?
breath sounds clear on auscultation
A nurse is caring for a client who had a chest tube inserted 12 hours ago for treatment of a pleural effusion. Which assessment is most important in determining the client's response to the treatment?
client verbalization of decreased dyspnea
Which assessment finding puts a client at increased risk for epistaxis?
cocaine use
A client admitted with tuberculosis reports concerns about paying for needed medications. The nurse should:
collaborate with the social worker to investigate possible availability of funds.
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 receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important?
partial pressure of arterial oxygen (PaO2)
After a total laryngectomy, a client has a feeding tube. What is the purpose of the feeding tube?
provides nutrition.
The nurse is administering theophylline ethylenediamine to a client with chronic obstructive pulmonary disease. Which is an expected outcome of administering this drug?
relaxed bronchial smooth muscle
A client has been hospitalized with myxedema coma. What acid-base imbalance would be expected in this client?
respiratory acidosis
As status asthmaticus worsens, the nurse would expect the client to experience which acid-base imbalance?
respiratory acidosis
As status asthmaticus worsens, the nurse would expect which acid-base imbalance?
respiratory acidosis
After undergoing a thoracotomy, a client is receiving epidural analgesia. Which assessment finding indicates that the client has developed the most serious complication of epidural analgesia?
respiratory depression
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 a nasotracheal tube needs to be suctioned. What is the length of time the nurse should apply the suction for each pass of the catheter?
10 to 15 seconds
The nursing staff is divided over withdrawing care from a competent, chronically ill client. The nurse-manager would take which step to meet the needs of the staff?
Contact the institutional ethics committee for strategies.
A client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs?
decreased hearing acuity
The nurse is aware that the best position for a client with impaired gas exchange is what?
high Fowler's
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
A client with emphysema has been admitted to the hospital. The nurse should assess the client further for which symptom?
underweight appearance
A client reports having a dry, hacking cough that disturbs sleep at night. Which antitussive agent and intervention are most appropriate for this client?
using a cooling mist humidifier and administering dextromethorphan
A healthy client presents to the clinic for a routine examination. When auscultating the client's lower lung lobes, the nurse should expect to hear which type of breath sound?
vesicular
An adult with a history of chronic obstructive pulmonary disease (COPD) and metastatic carcinoma of the lung has not responded to radiation therapy and is being admitted to the hospice program. The nurse should conduct a focused assessment for which symptom?
dyspnea
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 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?
10 to 20 mcg/ml
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. What should the nurse instruct the UAP to do?
Mark the time and level of drainage on the collection container.
After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH) as prophylaxis against tuberculosis. The client's family asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy?
6 to 12 months
A client who underwent a left lower lobectomy has been out of surgery for 48 hours. The client is receiving morphine sulfate via a patient-controlled analgesia (PCA) system and reports having pain in the left thorax that worsens when coughing. After checking the PCA system, what should the nurse do next?
Obtain a more detailed assessment of the client's pain using a pain scale.
A client with bacterial pneumonia is coughing up tenacious, purulent sputum. Which nursing action would help liquefy these viscous secretions?
Breathe humidified air.
A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing, and breath sounds aren't audible. What is the likely cause of these assessment findings?
Bronchial edema and constriction have worsened.
A client who is recovering from chest trauma is to be discharged home with a chest tube drainage system intact. The nurse should instruct the client to call the physician for which of the following?
Continuous bubbling in the water-seal chamber.
The nurse is teaching a client with allergic rhinitis about the use of nasal decongestants. What information should the nurse to include in the teaching plan?
Continuous use for more than 3 days can result in worsening of symptoms.
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 mild intermittent asthma is seen in the emergency department with a swollen ankle and a potential ankle sprain. A focused nursing history reveals that the client uses an albuterol inhaler but did not bring the inhaler. Also, the client has been taking antibiotics for a "sore throat." The client's heart rate is 110 bpm, and the respiration rate is 20 breaths/min. The nurse listens to the client's breath sounds and hears wheezes. What should the nurse do next?
Obtain a prescription for an albuterol inhaler.
The nurse is caring for a client with cystic fibrosis (CF) who has increased dyspnea. Which intervention should the nurse include in the plan of care?
Perform chest physiotherapy.
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.
The nurse is preparing to suction a tracheostomy for a client with methicillin-resistant Staphylococcus aureus (MRSA) (see figure). What should the nurse do next?
Proceed to suction the client's tracheostomy.
The nurse is teaching a client who had a lobectomy for lung cancer and the client's partner how to promote comfort and optimal respiratory expansion during sexual intimacy. What can the nurse suggest the couple do?
Raise the affected partner's head and upper torso on pillows.
The nurse is supervising a student nurse who is performing tracheostomy care for a client. Which action performed by the student would require nurse intervention?
Remove inner cannula and clean using universal precautions.
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.
The nurse instills 5 mL of normal saline before suctioning a client's tracheostomy tube. Which finding indicates the instillation is effective?
The secretions are thinned.
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 instructs a client with allergic rhinitis about the correct technique for using an intranasal inhaler. Which statement indicates that the client understands the instructions?
"I should hold one nostril closed while I insert the spray into the other nostril."
A nurse is teaching a client with chronic obstructive pulmonary disease (COPD) who is being discharged after treatment for an acute exacerbation. Which statement by the client indicates proper understanding of the discharge instructions?
"I should try to eat several small meals during the day."
A nurse recognizes that a client with tuberculosis needs further teaching when the client states:
"It will be necessary for the people I work with to take medication."
For a client with asthma, the health care provider (HCP) prescribes albuterol, two puffs twice a day via a metered-dose inhaler (MDI), and beclomethasone, two puffs twice a day via MDI. How should the nurse instruct the client to administer these drugs?
"Take the albuterol first and follow with beclomethasone two times a day."
Following a thoracotomy, the client reports a pain rating of 9 on a 0 to 10-point scale. What should the nurse do 30 minutes after administering the highest dose of the prescribed pain medication?
Reassess the client.
When teaching a client with chronic obstructive pulmonary disease (COPD) to conserve energy, what instruction should the nurse give the client about breathing when lifting heavy objects?
exhaling through pursed lips.
Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis?
extreme anxiety
A positive tuberculin skin test indicates that a client
has produced an immune response.
A client asks a nurse a question about the tuberculin skin test for tuberculosis. The nurse should base their response on the fact that the
skin test doesn't differentiate between active and dormant tuberculosis infection.
A client has been hospitalized for 3 days and is now experiencing symptoms of pneumonia, confirmed by chest X-ray. Which action is a priority for preventing this type of pneumonia?
staff education for prevention of hospital-acquired pneumonia (HAP)
A nurse is caring for a client who recently underwent a tracheostomy. What is the nurse's first priority when caring for this client?
suctioning to keep the airway patent
A home health nurse sees a client with end-stage chronic obstructive pulmonary disease (COPD). An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met?
decreased oxygen requirements
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 teaching the client with chronic obstructive pulmonary disease (COPD) about obtaining the best nutrition. Which diet would be best for this client?
high-calorie, high-protein diet
A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client?
high-protein
A client is prescribed metaproterenol via a metered-dose inhaler, two puffs every 4 hours. The nurse should instruct the client to report which adverse effect?
irregular heartbeat
A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm?
kinking of the ventilator tubing
A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder?
metabolic acidosis
A client is receiving moderate sedation while undergoing bronchoscopy. Which assessment finding should the nurse attend to immediately?
oxygen saturation of 90%
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 administers theophylline to a client. When evaluating the effectiveness of this medication, what is an expected outcome?
less difficulty breathing
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
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 teaching a client how to instill nose drops. Which action indicates the client has understood the nurse's instructions?
lies supine for several minutes after instilling the drops.
The nurse is developing a care plan for a client with chronic obstructive pulmonary disease (COPD). What is the priority goal of this care plan?
maintaining functional ability
A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside?
manual resuscitation bag
