ATI RESPIRATORY

A nurse is discharging a patient who has COPD. Upon discharge, the patient is concerned that he will never be able to leave his house now that he is on continuous oxygen. Which of the following is an appropriate response by the nurse? 1. "There are portable oxygen delivery systems that you can take with you." 2. "When you go out, you can remove the oxygen and then reapply it when you get home." 3. "You probably will not be able to go out as much as you used to." 4. "Home health services will come to you so you will not need to get out."

1. "There are portable oxygen delivery systems that you can take with you." The nurse should inform the patient that there are portable oxygen systems that he can use to leave the house. This should alleviate the patient's anxiety.

HCO3- ABG

21-28

A nurse is providing discharge teaching to a patient who has a new prescription for prednisone for asthma. Which of the following patient statements indicates an understanding of the teaching: 1. "I will decrease my fluid intake while taking this medication." 2. "I will expect to have black, tarry stools." 3. "I will take my medication with meals." 4. "I will monitor for weight loss while on this medication."

3. "I will take my medication with meals." The patient should take this medication with food. Taking prednisone on an empty stomach can cause gastrointestinal distress.

ABG PACO2

35-45

ABG pH

7.35-7.45

A nurse is caring for a client who is to receive fibrinolytic thrombolytic therapy. Which of the following should the nurse recognize as a contraindication to the therapy? A. Hip arthroplasty 2 weeks ago B. Elevated sedimentation rate C. Incident of exercise-induced asthma 1 week ago D. Elevated platelet count

A. Clients who have undergone a major surgical procedure within the last 3 weeks should not receive thrombolytic therapy because of the risk of hemorrhage from the surgical site

A nurse is providing information to a group of clients at a local community center about tuberculosis. Which of the following clinical manifestations should be included in the teaching? Select all that apply. A. Persistent cough B. Weight gain C. Fatigue D. Night sweats E. Purulent sputum

A. Persistent cough C. Fatigue D. Night sweats E. Purulent sputum

A nurse is assessing a client who has a Hx of asthma. Which of the following factors should the nurse identify as a risk factor for asthma? A. Gender B. Environmental allergies C. Alcohol use D. Race

B

A nurse is teaching a client who has tuberculosis. Which of the following statements should the nurse include in the teaching? A. "You will need continue to take the multimedication regimen for 4 months." B. "You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication." C. "You will need to remain hospitalized for treatment." D. "You will need to wear a mask at all times."

B. "You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication."

A nurse is caring for a client who has dyspnea and is to receive oxygen continuously. Which of the following oxygen devices should the nurse use to deliver a precise amount of oxygen to the client? A. Nonrebreather mask B. Venturi mask C. Nasal cannula D. Simple face mask

B. A venturi mask incorporates an adapter that allows a precise amount of oxygen to be delivered to the client

A nurse is orienting a newly licensed nurse who is caring for a client that is receiving mechanical ventilation, which has been placed on pressure support ventilation (PSV) mode. Which of the following statements by the newly licensed nurse demonstrates an understanding of PSV? A. It keep the alveoli open and prevents atelectasis B. It permits spontaneous ventilation to decrease the work of breathing C. It is used with clients who have difficulty weaning from the ventilator D. It delivers a preset ventilatory rate and tidal volume to the client

B. PSV maintains a preset amount of pressure during spontaneous ventilation to decrease the work of breathing

A nurse is reviewing prescriptions for a client who has acute dyspnea and diaphoresis. The client states that she is anxious because she feels that she cannot get enough air. Vital signs are: HR 117/min, RR 38/min, temp 38.4 (101.2), BP 100/54. Which of the following actions is the priority action at this time? A. Notify the provider B. Administer heparin via IV infusion C. Administer oxygen therapy D. Obtain a spiral CT scan

C. Meeting the oxygenation needs first is the priority action according to ABCs

pulmonary empyema

accumulation of pus

blood ph less than 7.35

acidosis

pneumothorax

air in pleural space

TB precautions

airborne

blood ph greater 7.45

alkalosis

Perform before withdrawl for measurement of ABG

allens test

continuous bubbling in the water seal chamber indicated

an air leak

hemothorax

blood in pleural space

low pressure alarms mechanical ventilation

disconnection cuff leak tube displacement

if ac chest tube is accidentally removed

dress the area with dry sterile gauze

high pressure alarm mechanical ventilation

excess secretions biting tubing kinks coughing pulmonary edema bronchospasm pneumothorax

if chest tube drainage system is compromised

immerese end of chest tube in sterile water

fremitus pneumonia

increased

air embolism placement

left side trendelenburg

O2 mask delivers highest o2 concentration

nonrebreather mask

immediately after an arterial puncture hold direct pressure over site for how long? anticoagulation therapy?

5m, 20m

chest tube report drainage over

70ml/hr

ABG PAO2

80-100

ABG SAO2

95-100%

A nurse is caring for a client following a thoracentesis. Which of the following manifestations should the nurse recognize as risks for complications? (Select all that apply) A. Dysnea B. Localized bloody drainage on the dressing C. Fever D. Hypotension E. Report of pain at the punture site

A, C, D Dyspnea can indicate a pneumothorax or a reaccumulation of fluid. The nurse should notify the provider immediately Fever can indicate an infection. The nurse should notify the provider immediately Hypotension can indicate intrathoracic bleeding. The nurse should notify the provider immediately

A nurse is caring for a client who is scheduled for a thoracentesis. Which of the following supplies should the nurse ensure is in the client's room? (Select all that apply) A. oxygen equipment B. Incentive spirometer C. Pulse oximeter D. Sterile dressing E. Suture removal kit

A, C, D Oxygen equipment is necessary to have in the client's room if the client becomes short of breath following the procedure Pulse oximetry is necessary to monitor the client's oxygen saturation level during the procedure A sterile dressing is necessary to apply to the puncture site following the procedure

A nurse in a clinic is caring for a client who was brought to the clinic by her partner. The partner states that the client woke up this morning, did not recognize him, and did not know where she was. The client reports chills and chest pain that is worse upon inspiration. Which of the following is the priority nursing action? A. Obtain baseline vital signs and oxygen saturation B. Obtain a sputum culture C. Obtain a complete history from the client D. Provide a pneumococcal vaccination

A. Assessment is the first step of the nursing process and is essential to patient centered care

watch for when taking albuterol

tremors and tachy

A nurse is caring for a client who is scheduled for a thoracentesis. Prior to the procedure, which of the following actions should the nurse take? A. Position the client in an upright position, leaning over the bedside table B. Explain the procedure to the client C. Obtain ABGs from the client D. Administer benzocaine pray to the client

A

A nurse in the emergency department is assessing a client who has a suspected flail chest. Which of the following findings should the nurse expect? (Select all that apply.) A. Bradycardia B. Cyanosis C. Hypotension D. Dyspnea E. Paradoxic chest movement

B, C, D, E

breathing pneumonia

tachypnea

ae isoniazid

tingling of hands

if tubing seperates instruct client

to exhale and cough

A nurse is reviewing the prescriptions for a client who has a pneumothorax. Which of the following actions should the nurse perform first? A. Assess the client's pain. B. Obtain a large‐bore IV needle for decompression. C. Administer lorazepam. D. Prepare for chest tube insertion

B

A nurse is assessing a client who has a pulmonary embolism. Which of the clinical manifestations should the nurse expect to find? (Select all that apply) A. Bradypnea B. Pleural friction rub C. Hypertension D. Petechiae E. Tachycardia

B, D, E

A nurse is providing discharge teaching to a client who has a new prescription for prednisone for asthma. Which of the following client statements indicates an understanding of the teaching? A. "I will decrease my fluid intake while taking this medication." B. "I will expect to have black, tarry stools." C. "I will take my medication with meals." D. "I will monitor for weight loss while on this medication."

C. "I will take my medication with meals."

A nurse is instructing a patient on the use of an incentive spirometer. Which of the following statements by the client indicates an understanding of the teaching." 1. "I will place the adapter on my finger to read my blood oxygen saturation level." 2. "I will lie on my back with my knees bent." 3. "I will rest my hand over my abdomen to create resistance. 4. "I will take in a deep breath and hold it before exhaling."

. "I will take in a deep breath and hold it before exhaling." The patient who is using the spirometer should take in a deep breath and hold it for 3 to 5 seconds before exhaling. As the patient exhales, the needle of the spirometer rises. This promotes lung expansion.

A nurse is caring for a client who has a new diagnosis of tuberculosis and has been placed on a multimedication regimen. Which of the following instructions should the nurse give the client related to the medication ethambutol (Myambutol)? A. "Your urine may turn a dark orange." B. "Watch for a change in the sclera of your eyes." C. "Watch for any changes in vision." D. "Take vitamin B6 daily."

. "Watch for any changes in vision."

A nurse is planning to instruct a patient on how to perform pursed-lip breathing. Which of the following should the nurse include in the plan of care? 1. Take quick breaths upon inhalation. 2. Place your hand over you stomach. 3. Take a deep breath in through your nose. 4. Puff your cheeks upon exhalation.

3. Take a deep breath in through your nose. The patient should take a deep breath is through her nose while performing pursed-lip breathing. This controls the patient's breathing.

A nurse preparing to care for a client following chest tube placement. Which of the following items should be available in the client's room? (Select all that apply) A. Oxygen B. Sterile water C. Enclosed hemostat clamps D. Indwelling urinary catheter E. Occlusive dressing

A, B, C, E Oxygen should be readily available in case the client develops respiratory distress following chest tube placement. If the chest tube becomes disconnected, the end of the tubing should be placed in sterile water to restore the water seal Hemostat clamps should be available for the nurse to use to check air leaks Immediately place an occlusive dressing over the chest tube insertion site if becomes disconnected. This allows air to escape and reduces the risk for a tension pneumothorax

A nurse is planning care for a client following the insertion of a chest tube and drainage system. Which of the following should be included in the plan of care? (Select all that apply) A. Encourage the client to cough every 2 hours B Check for continuous bubbling in the suction chamber C. Strip the drainage tubing every 4 hours D. Clamp the tube once a day E. Obtain a chest x ray

A, B, E Cough every 2 hours to promote oxygenation and lung reexpansion Check for continuous bubbling in the suction chamber to verify that suction is being maintained at an appropriate level A chest x ray is obtained following the procedure to verify chest tube placement

Which of the following clients have an increased risk for developing pneumonia? (Select all that apply) A. Client who has dysphagia B. Client who has AIDS C. Client who was vaccinated for pneumococcus and influenza 6 months ago D. Client who is postoperative and has received local anesthesia E. Client who has a closed head injury and is receiving ventilation F. Client who has myasthenia gravis

A, B, E, F Difficulty swallowing, immunocompromised, invasive procedure, and difficulty clearing secretions

A nurse is caring for several clients. Which of the following clients are at risk for having a pulmonary embolism? (Select all that apply) A. A client who has a BMI of 30 B. A female client who has postmenopausal C. A client who has a fractured femur D. A client who is a marathon runner E. A client who has chronic atrial fibrillation

A, C, E Obesity, a long bone fracture, and turbulent blood flow in the heart increase the risk for a blood clot

A nurse is assessing a client following a gunshot wound to the chest. For which of the following findings should the nurse monitor to detect a pneumothorax? (Select all that apply.) A. Tachypnea B. Deviation of the trachea C. Bradycardia D. Decreased use of accessory muscles E. Pleuritic pain

A,B,E

A nurse is reinforcing teaching with a client on the purpose of taking a bronchodilator. Which of the following client statements indicates an understanding of the teaching? A. "This medication can reduce my immune response." B. "I take this medication to prevent asthma attacks." C. "I need to take this medication with food." D. "This medication has a slow onset to treat my symptoms."

B

A nurse in the emergency department is caring for a client who was admitted with an acute asthma attack. Which of the following indicates the clients respiratory status is declining? A) SaO2 95% B) Wheezing C) Retraction of sternal muscles D) Pink mucous membranes E) Premature ventricular complexes (PVCs)

B) Wheezing C) Retraction of sternal muscles E) Premature ventricular complexes (PVCs)

A nurse is assessing a client who has a chest tube and drainage system in place. Which of the following are expected findings? (Select all that apply) A. Continuous bubbling in the water seal chamber B. Gentle constant bubbling in the suction control chamber C. Rise and fall in the level of water in the water seal chamber with inspiration D. Exposed sutures without dressing E. Drainage system upright at chest level

B, C Gentle bubbling in the suction control chamber is an expected finding as air is being removed A rise and fall of the fluid level in the water seal chamber upon inspiration and expiration indicate that the drainage system is functioning properly

A nurse is planning care for a client who is receiving mechanical ventilation. Which mode of ventilation increases the effort of the client's respiratory muscles? (Select all that apply) A. Assist-control B. Synchronized intermittent mandatory ventilaiton C. Continuous positive airway pressure D. Pressure support ventilation E. Independent lung ventilation

B, C, D

A nurse is caring for a client who is experiencing respiratory distress. Which of the following are early clinical manifestations of hypoxemia? (Select all that apply) A. Confusion B. Pale skin C. Bradycardia D. Hypotension E. Elevated blood pressure

B, E Pale skin and elevated blood pressure are early clinical manifestations of hypoxemia

A nurse is caring for a client who has a chest tube and drainage system in place. The nurse observes that the client's chest tube was accidentally removed. Which of the following actions should the nurse take first? A. Place the tubing in sterile water to restore the water seal B. Apply sterile gauze to the insertion site C. Place tape around the insertion site D. Assess the client's respiratory status

B. Using ABC priority framework, the application of a sterile gauze to the site should be the first action for the nurse to take. This allows the air to escape and reduces the risk of the tension pneumothorax

A home health nurse is teaching a client who has active tuberculosis. The provider has prescribed the following medication regimen: isoniazid (Nydrazid) 250 mg PO daily, rifampin (Rifadin) 500 mg PO daily, pyrazinamide 750 mg PO daily, and ethambutol (Myambutol) 1 mg PO daily. Which of the following client statements indicate understanding of the teaching? Select all that apply. A. "I can substitute one medication for another if I run out because they all fight infection." B. "I will wash my hands each time I cough." C. "I will wear a mask when I am in a public area." D. "I am glad I don't have to have any more sputum specimens." E. "I don't need to worry where I go once I start taking my medications."

B. "I will wash my hands each time I cough." C. "I will wear a mask when I am in a public area."

A nurse is teaching a group of clients about influenza. Which of the following statements by a client requires clarification? A. I should wash my hands after blowing my nose to prevent spreading the virus B. I need to avoid drinking fluids if I develop symptoms C. I need a flu shot every year because of the different flu strains D. I should sneeze into my elbow rather than my hands

B. Fluid intake should be increased if findings develop

A nurse is caring for a client 2 hr after admission. The client has an SaO2 of 91%, exhibits audible wheezes, and is using accessory muscles when breathing. Which of the following classes of medications should the nurse expect to administer? A. Antibiotic B. Beta-blocker C. Antiviral D. Beta2 antagonist

D

A nurse is assisting a provider with the removal of a chest tube. Which of the following should the nurse instruct the client to do? A. Lie on his left side B. Use the incentive spirometer C. Cough at regular intervals D. Perform the Valsalva maneuver

D. The client should be instructed to take a deep breath, exhale, and bear down as the chest tube is being removed. This increases intrathoracic pressure and reduces the risk of an air embolism

A nurse is orienting a newly licensed nurse on performing routine assessment of a client who is receiving mechanical ventilation via a endotracheal tube. Which of the following should the nurse include in the teaching? A. Apply a vest restraint if self-extubation is attempted B. Monitor ventilator settings every 8 hours C. Document tube placement in centimeters at the angle of jaw D. Assess breath sounds every 1 to 2 hours

D. The nurse should assess the breath sounds of a client on mechanical ventilation every 1-2 hours

A nurse is assessing a client following a bronchoscopy. Which of the following findings should the nurse report to the provider? A. Blood-tinged sputum B. Dry, nonproductive cough C. Sore throat D. Bronchospasms

D. Bronchospasms can indicate the client is having difficulty maintaining a patent airway. The nurse should notify the provider immediately

A nurse in a clinic is caring for a client who has sinusitis. Which of the following techniques should the nurse use to identify clinical manifestations of this disorder? A. Percussion of posterior lobes of lungs B. Auscultation of the trachea C. Inspection of the conjunctiva D. Palpation of the orbital areas

D. Palpation of the orbital, frontal, and facial areas will elicit a report of tenderness, which is a clinical manifestation in a client who has sinusiti

A nurse is reviewing discharge instructions for a client who experienced a pneumothorax. Which of the following statements should the nurse use when teaching the client? A. "Notify your provider if you experience weakness." B. "You should be able to return to work in 1 week." C. "You need to wear a mask when in crowded areas." D. "Notify your provider if you experience a productive cough."

DQ

A nurse is preparing to administer a dose of a new prescription of prednisone to a patient who has COPD. The nurse should monitor for which of the following adverse effects of this medication? (Select all that apply) 1. Hypokalemia 2. Tachycardia 3. Fluid retention 4. Nausea 5. Black, tarry stools

hypokalemia 3. Fluid retention The nurse should observe for fluid retention. This is an adverse effect of prednisone. 5. Black, tarry stools The nurse should monitor for black, tarry stools.

cessation of tidaling in water seal chamber signals

lung re expansion or an obstructoin within system

¡ after thoracentesis

persistent cough->tension pneumothorax

ss tension pneumothorax

tracheal deviation absent breath sounds distended neck veins resp distress asymmetry of chest cyanosis

tidaling expected in

water seal chamber