saunders respiratory

The nurse is discharging a client with chronic obstructive pulmonary disease (COPD) and reviewing specific instructional points about COPD. What comment by the client indicates that further teaching is needed?

"I have to keep my nasal cannula oxygen levels between 4 and 6 L/minute."

The nurse providing instructions to a client using an incentive spirometer tells the client to sustain the inhaled breath for 3 seconds. What statement by the client indicates successful teaching?

"It will keep the small airways open."

A client is returning from surgery after a pulmonary lobectomy. Which pieces of equipment should the nurse have at the bedside? Select all that apply.

- Clamp - vaseline gauze - suction equipment

The nurse is caring for a client diagnosed with tuberculosis (TB). Which assessments, if made by the nurse, are consistent with the usual clinical presentation of TB? Select all that apply.

- Cough - Dyspnea - Chills and night sweats

Which are warning signs of head and neck cancer? Select all that apply.

- Difficulty swallowing - Lump in the mouth, neck, or throat - Persistent or unexplained oral bleeding

The nurse is providing education to a group of adolescents diagnosed with asthma. The nurse informs the group that which can be triggers for an asthma attack? Select all that apply.

- Dry air - Exercise - An upper respiratory infection (URI) - Nonsteroidal antiinflammatory drugs (NSAIDs)

A client with chronic obstructive pulmonary disease (COPD) is being evaluated for lung transplantation. The nurse performs the initial physical assessment. Which findings should the nurse anticipate in this client? Select all that apply.

- Dyspnea at rest -Clubbed fingers - Muscle retractions - Prolonged expiratory breathing phase

The nurse should provide which home care instructions to a client who had a laryngectomy and has a stoma? Select all that apply.

- Increase the humidity in the home. - Obtain and wear a MedicAlert bracelet. - Stay away from people who have a respiratory infection. - Be careful with showering to avoid water entering the stoma.

The nurse is providing preoperative teaching with the client about the use of an incentive spirometer in the postoperative period. Which instructions should the nurse include? Select all that apply.

- Sit upright in the bed or in a chair. - Place the mouthpiece in your mouth and seal your lips tightly around it. - After maximum inspiration, hold the breath for 2 to 3 seconds and exhale.

breathing positions for COPD

- Sitting up and leaning on a table - Standing and leaning against a wall - Sitting up with elbows resting on knees

Which nursing interventions are appropriate in caring for a client with emphysema? Select all that apply.

- Teach diaphragmatic and pursed-lip breathing - Encourage alternating activity with rest periods. - Teach the client techniques of chest physiotherapy.

The nurse is caring for a client with a dry suction chest drainage system. During assessment of the drainage system, what should the nurse expect to find? Select all that apply.

- The dry suction control regulation set to the prescribed amount - The drainage in the collection chamber marked each shift to monitor the amount of drainage

Which are risk factors for chronic obstructive pulmonary disease (COPD)? Select all that apply.

-Cigarette smoking -Genetic risk factor - Environmental factors - Alpha-1 antitrypsin (AAT) deficiency

The nurse is doing volunteer work in a homeless shelter. The nurse should monitor the individuals for which initial signs and symptoms of tuberculosis? Select all that apply.

-Fatigue - Lethargy - Morning cough - Low-grade fever

A clinic nurse notes that large numbers of clients present with flulike symptoms. Which recommendations should the nurse include in the plan of care for these clients? Select all that apply.

-Get plenty of rest. - Increase intake of liquids -Take antipyretics for fever - Eat fruits and vegetables high in vitamin C.

Which are possible causes of upper airway obstruction? Select all that apply.

-Laryngeal edema -Head and neck cancer -Foreign body aspiration -Lymph node enlargement

what is the max oxygen COPD patients can get

24% to 28% (1 to 3 L/min)

what would cause low pressure ventilator alarm

A cuff leak, apnea and tube disconnection would cause the low-pressure alarm to sound

The nurse working on a medical respiratory nursing unit is caring for several clients with respiratory disorders. The nurse should determine that which client on the nursing unit is at the lowest risk for infection with tuberculosis?

A man who is an inspector for the U.S. Postal Service

The nurse is providing care for a client recently admitted with new onset pleurisy. Upon auscultation of the client's lungs, the nurse notes the absence of the pleural friction rub, which was documented on previous assessments. What is the most likely indication for this change in the client's lung sounds?

Accumulation of pleural fluid in the inflamed area

An ambulatory care nurse is assessing a client with chronic sinusitis. The nurse would expect to note which assessment findings in this client? Select all that apply.

Anosmia (loss of smell) Chronic cough Purulent nasal discharge

The nurse is performing a respiratory assessment on a client with a left lower lobe lung mass. Chest auscultation over the posterior left lower lobe reveals these breath sounds.The nurse would interpret this as which sound?

Bronchial breath sounds

The nurse participating in a client care conference with other health team members is discussing the condition of a client with adult respiratory distress syndrome (ARDS). The health care provider states that because of fluid in the alveoli, surfactant production is falling. The nurse anticipates that insufficient surfactant will cause which effect?

Collapse of alveoli and decreased compliance

The nurse is performing an admission assessment on a client with tuberculosis (TB) and is collecting subjective and objective data. Which finding would the nurse expect to note?

Complaints of night sweats

The nurse should determine that tracheal suctioning is needed if which is noted?

Congested breath sounds in the lung fields

what does constant bubbling in the water seal chamber mean

Constant bubbling occurring in the water seal chamber may indicate an air leak in the system. Among the options provided, the appropriate action is to notify the HCP.

The nurse determines that the client with a chest tube to a closed drainage system is experiencing an air leak. Which finding is indicative of this?

Continuous bubbling is observed in the water seal chamber during inspiration and expiration.

The nurse is caring for the client who is suspected of having lung cancer. The nurse should assess the client for which mostfrequent early symptom of lung cancer?

Cough

Decortication

Decortication is a surgical procedure that removes a restrictive layer of fibrous tissue overlying the lung, chest wall, and diaphragm. The aim of decortication is to remove this layer and allow the lung to reexpand.

A client is on continuous mechanical ventilation (CMV), and the low-pressure alarm sounds. The nurse should take which action?

Determine if there are any disconnections in the ventilator tubing

The nurse is assisting the health care provider (HCP) with insertion of a chest tube. The nurse notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this observation, the nurse should take which action?

Document the accurate functioning of the tube.

The nurse is caring for a client with a chest tube drainage system. The nurse notes a fluctuating water level on inspiration and expiration in the submerged tube in the water seal chamber of the chest tube drainage system. Which nursing action is appropriate?

Document the findings.

A client is on continuous mechanical ventilation (CMV) and the high-pressure alarm sounds. Which action should the nurse take to eliminate the problem?

Empty excess accumulated water from the ventilatory circuit tubing.

Which should the nurse do when caring for a client with a chest tube attached to a chest drainage system?

Ensure the water level in the water seal chamber is at the 2-cm level.

A client with silicosis is being monitored yearly at the health care clinic. On assessment, the nurse should ask the client about which manifestations of the disorder? Select all that apply.

Fatigue Malaise Anorexia

water seal chamber stopped

Fluctuation stops if the tube is obstructed, a dependent loop exists, the suction is not working properly, or the lung has reexpanded.

The nurse is auscultating breath sounds in a hospitalized client with emphysema and hears these sounds.The nurse should document this finding as which sound?

High-pitched wheezes

The nurse is caring for a client with a respiratory disorder who is attempting to stop smoking. The health care provider has recommended nicotine gum. When reviewing this treatment with the client, the nurse should provide which instruction?

Hold the gum between the cheek and teeth periodically.

A client with chronic obstructive pulmonary disease (COPD) is experiencing exacerbation of the disease. The nurse should determine that which finding documented in the client's record is an expected finding with this client?

Hyperinflation of lungs documented by chest x-ray

The nurse is caring for a client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate and notes that the client is receiving 2 L/min. The client's SpO2 level is 86%. Based on this assessment, which action is appropriate?

Increase to 3 L/min and titrate until the SpO2 is 88%.

A chest x-ray report for a client indicates the presence of a left apical pneumothorax. The nurse would assess the status of breath sounds in that area by placing the stethoscope in which location?

Just under the left clavicle

The nurse is caring for a client with acute respiratory distress syndrome (ARDS). What should the nurse expect to note in the client?

Low arterial PaO2

The nurse is teaching a client with chronic airflow limitation (CAL) about positions that help breathing during dyspneic episodes. Which position, assumed by the client, would indicate that the client needs additional teaching on positioning?

Lying on the back in a low Fowler's position

The nurse is instructing a client in diaphragmatic breathing. To reinforce the need for this technique, the nurse teaches the client that in normal respiration, which is an action of the diaphragm?

Moves downward and out as it contracts

The nurse is caring for a client with a chest tube drainage system and notes constant bubbling in the water seal chamber. Which nursing action is appropriate?

Notify the health care provider (HCP).

The nurse is caring for a client who is anxious and is experiencing dyspnea and restlessness from hypoxemia associated with pulmonary edema. Auscultation of the lungs reveals these breath sounds.The nurse determines that these breath sounds are usually caused by which condition?

Opening of small airways that contain fluid

A client is admitted to the hospital with difficulty breathing. Which is the best approach for the nurse to use in obtaining the client's health history?

Plan short sessions with the client to obtain data.

A client did not seek medical treatment for a previous respiratory infection, and subsequently an empyema developed in the left lung. The nurse should assess the client for which signs and symptoms associated with this problem?

Pleural pain and fever

An emergency department nurse is performing a respiratory assessment on a client who is complaining of painful breathing. On palpation the nurse notes a coarse grating sensation during inspiration, and on auscultation the nurse hears this breath sound.The nurse interprets these findings as characteristic of which condition?

Pleurisy

Rhonchi

Presence of rhonchi is an indication that there are secretions in the large airways. The client requires suctioning if the client cannot expectorate them

The nurse monitors the respiratory status of the client being treated for acute exacerbation of chronic obstructive pulmonary disease (COPD). Which assessment finding would indicate deterioration in ventilation?

Rapid, shallow respirations

The nurse determines that a client with a tracheostomy tube needs suctioning if which finding is noted?

Rhonchi are auscultated.

A client with long-standing empyema undergoes decortication of the affected lung area. Postoperatively the nurse should place the client in which position?

Semi Fowler's

A client is experiencing severe dyspnea, and the nurse listens to the client's breath sounds and hears this sound.The nurse should document this finding as which sound?

Stridor

The nurse is assisting in caring for a client after removal of an endotracheal tube. Which finding should be reported to the health care health care provider (HCP) immediately?

Stridor It indicates airway edema and places the client at risk for airway obstruction

A client with an endotracheal tube attached to mechanical ventilation begins to cough, and the client's face appears flushed. Which action should the nurse take first?

Suction the client through the endotracheal tube.

A health care provider (HCP) is about to remove a chest tube from a client. After the dressing is removed and the sutures have been cut, the nurse assisting the health care provider should ask the client to perform which procedure?

Take a deep breath and hold it.

The nurse is monitoring a client who has a closed chest tube drainage system. The nurse notes fluctuation of the fluid level in the water seal chamber during inspiration and expiration. On the basis of this finding, the nurse should make which interpretation?

The chest tube is functioning as expected.

The nurse instructs a client on pursed-lip breathing and asks the client to demonstrate the breathing technique. Which observation by the nurse would indicate that the client is performing the technique correctly?

The client breathes out slowly through the mouth.

A client tells the nurse that the health care provider (HCP) has stated a diagnosis of silicosis. The nurse determines that which finding is consistent with this respiratory disorder?

The client has reduced lung volume and fibrosis on chest x-ray.

The client is returned to the nursing unit following thoracic surgery with a chest tube in place. During the first few hours postoperatively, the nurse assesses for drainage and expects to note which characteristics?

The drainage is bloody

acute respiratory distress syndrome (ARDS)

The earliest clinical sign of ARDS is an increased respiratory rate. Breathing becomes labored, and the client may exhibit air hunger, chest retractions, and cyanosis. Arterial blood gas analysis reveals increasing hypoxemia, with a PaO2 lower than 60 mm Hg.

water seal chamber fluctuation

The presence of fluctuation of the fluid level in the water seal chamber indicates a patent drainage system. With normal breathing, the water level rises with inspiration and falls with expiration.

why is the tripod position helpful in COPD

The tripod position (leaning forward with elbows flexed) helps to decrease the work of breathing in clients who have severe shortness of breath caused by asthma, COPD, or respiratory failure.

The nurse caring for a client who has a pneumothorax notes continuous bubbling in the water seal chamber of the client's closed-chest drainage system. How should the nurse interpret this finding?

There is an air leak somewhere in the system.

Which position would best help the breathing of a client with chronic obstructive pulmonary disease (COPD)?

Tripod position

what would cause high pressure ventilator alarm

When the high-pressure alarm sounds on a ventilator, it is most likely because of an obstruction. The obstruction can be caused by the client's biting on the tube, kinking of the tubing, or mucus plugging requiring suctioning.

sinusitis

When you have a sinus infection, one or more of your sinuses becomes inflamed and fluid builds up, causing congestion and runny nose.

pleural friction rub

a raspy breathing sound caused by inflammation of the tissues around your lungs. The sound is usually "grating" or "creaky." It's also been compared to the sound of walking on fresh snow.

lung base

bottom of lungs

Continuous bubbling in the water-seal chamber indicates?

indicates that there is air leaking into the system

pleurisy

inflammation of the sheet-like layers that cover the lungs (the pleura).

empyema

is a collection of pus in the cavity between the lung and the membrane that surrounds it (pleural space). The client with empyema usually experiences dyspnea, increased respiratory rate, pleural pain, night sweats, fever, anorexia, and weight loss. There is a decrease in breath sounds over the affected area, a flat sound to percussion, and decreased tactile fremitus.

Legionnaire's disease

is a severe form of pneumonia lung inflammation usually caused by infection. It's caused by a bacterium known as legionella.

what is a lobectomy

is a surgical procedure where an entire lobe of your lung is removed for a variety of reasons that may include a lung cancer diagnosis, infection, COPD or benign tumors. There are three lobes of your right lungand two lobes of your left lung

The nurse caring for a client with chronic obstructive pulmonary disease (COPD) anticipates which arterial blood gas (ABG) findings?

pH, 7.32; PaO2, 85 mm Hg; CO2, 57 mEq/L; HCO3, 26 mEq/L

lung apex

top of lung