Chapter 21: Respiratory Care Modalities Prep U

After undergoing a left thoracotomy, a client has a chest tube in place. When caring for this client, the nurse must: report fluctuations in the water-seal chamber. encourage coughing and deep breathing. milk the chest tube every 2 hours. clamp the chest tube once every shift.

encourage coughing and deep breathing.

A nurse is teaching a client about using an incentive spirometer. Which statement by the nurse is correct? "Before you do the exercise, I'll give you pain medication if you need it." "You need to start using the incentive spirometer 2 days after surgery." "Don't use the incentive spirometer more than 5 times every hour." "Breathe in and out quickly."

"Before you do the exercise, I'll give you pain medication if you need it."

What assessment method would the nurse use to determine the areas of the lungs that need draining? Inspection Arterial blood gas (ABG) levels Auscultation Chest X-ray

Auscultation

The nurse is caring for a client following a thoracotomy. Which finding requires immediate intervention by the nurse? Heart rate, 112 bpm Pain of 5 on a 1-to-10 scale Chest tube drainage, 190 mL/hr Moderate amounts of colorless sputum

Chest tube drainage, 190 mL/hr

A home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition? Hypoxia Hyperventilation Semiconsciousness Delirium

Hypoxia

Which finding would indicate a decrease in pressure with mechanical ventilation? Increase in compliance Plugged airway tube Decrease in lung compliance Kinked tubing

Increase in compliance

Which ventilator mode provides a combination of mechanically assisted breaths and spontaneous breaths? Intermittent mandatory ventilation (IMV) Synchronized intermittent mandatory ventilation (SIMV) Assist control Pressure support

Intermittent mandatory ventilation (IMV)

The nurse is educating a patient with COPD about the technique for performing pursed-lip breathing. What does the nurse inform the patient is the importance of using this technique? It prolongs exhalation. It will assist with widening the airway. It increases the respiratory rate to improve oxygenation. It will prevent the alveoli from overexpanding.

It prolongs exhalation.

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? Select all that apply. Manual resuscitation bag Water-seal chest drainage set-up Hemostat Pulse oximeter Tracheostomy cleaning kit

Manual resuscitation bag Pulse oximeter

A client with myasthenia gravis is receiving continuous mechanical ventilation. When the high-pressure alarm on the ventilator sounds, what should the nurse do? Suction the client's artificial airway. Increase the oxygen percentage. Check for an apical pulse. Ventilate the client with a handheld mechanical ventilator.

Suction the client's artificial airway.

The nurse is assisting a physician with an endotracheal intubation for a client in respiratory failure. It is most important for the nurse to assess for: Cool air humidified through the tube Symmetry of the client's chest expansion A scheduled time for deflation of the tracheal cuff Tracheal cuff pressure set at 30 mm Hg

Symmetry of the client's chest expansion

A nurse observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude? The system is functioning normally. The system has an air leak. The client has a pneumothorax. The chest tube is obstructed.

The system has an air leak.

Which is the most reliable and accurate method for delivering precise concentrations of oxygen through noninvasive means? Nasal cannula T-piece Venturi mask Partial-rebreathing mask

Venturi mask

Which type of ventilator has a preset volume of air to be delivered with each inspiration? Time-cycled Negative-pressure Volume-controlled Pressure-cycled

Volume-controlled

Hyperbaric oxygen therapy increases the blood's capacity to carry and deliver oxygen to compromised tissues. This therapy may be used for a client with: a compromised skin graft. pneumonia. a malignant tumor. hyperthermia.

a compromised skin graft.

The nurse is using an in-line suction kit to suction a patient who is intubated and on a mechanical ventilator. What benefits does inline suction have for the patient? (Select all that apply.) Decreases hypoxemia Decreases patient anxiety Increases oxygen consumption Sustains positive end expiratory pressure (PEEP) Prevents aspiration

Decreases hypoxemia Decreases patient anxiety Sustains positive end expiratory pressure (PEEP)

A client is recovering from thoracic surgery needed to perform a right lower lobectomy. Which of the following is the most likely postoperative nursing intervention? Encourage coughing to mobilize secretions. Assist with positioning the client on the right side. Make sure that a thoracotomy tube is linked to open chest drainage. Restrict intravenous fluids for at least 24 hours.

Encourage coughing to mobilize secretions.

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? Tracheostomy cleaning kit Oxygen analyzer Manual resuscitation bag Water-seal chest drainage set-up

Manual resuscitation bag

Which is an adverse reaction that would require the process of weaning from a ventilator to be terminated? Vital capacity of 12 mL/kg PaO2 60 mmHg with an FiO2 Heart rate Blood pressure increase of 20 mm Hg

Blood pressure increase of 20 mm Hg

The nurse is preparing to perform chest physiotherapy (CPT) on a client. Which statement by the client tells the nurse that the procedure is contraindicated. "I just finished eating my lunch, I'm ready for my CPT now." "I received my pain medication 10 minutes ago, let's do my CPT now." "I just changed into my running suit; we can do my CPT now." "I have been coughing all morning and am barely bringing anything up."

"I just finished eating my lunch, I'm ready for my CPT now."

A nurse is weaning a client from mechanical ventilation. Which nursing assessment finding indicates the weaning process should be stopped? Respiratory rate of 16 breaths/minute Runs of ventricular tachycardia Blood pressure remains stable Oxygen saturation of 93%

Runs of ventricular tachycardia

Which is a potential complication of a low pressure in the endotracheal tube cuff? Aspiration pneumonia Tracheal ischemia Pressure necrosis Tracheal bleeding

Aspiration pneumonia

A patient is being educated in the use of incentive spirometry prior to having a surgical procedure. What should the nurse be sure to include in the education? Encourage the patient to try to stop coughing during and after using the spirometer. Inform the patient that using the spirometer is not necessary if the patient is experiencing pain. Encourage the patient to take approximately 10 breaths per hour, while awake. Have the patient lie in a supine position during the use of the spirometer.

Encourage the patient to take approximately 10 breaths per hour, while awake.

A client has been receiving 100% oxygen therapy by way of a nonrebreather mask for several days. Now the client complains of tingling in the fingers and shortness of breath, is extremely restless, and describes a pain beneath the breastbone. What should the nurse suspect? Oxygen-induced hypoventilation Oxygen-induced atelectasis Oxygen toxicity Hypoxia

Oxygen toxicity

A client is on a positive-pressure ventilator with a synchronized intermittent mandatory ventilation (SIMV) setting. The ventilator is set for 8 breaths per minute. The client is taking 6 breaths per minute independently. The nurse Continues assessing the client's respiratory status frequently Contacts the respiratory therapy department to report the ventilator is malfunctioning Changes the setting on the ventilator to increase breaths to 14 per minute Consults with the physician about removing the client from the ventilator

Continues assessing the client's respiratory status frequently

A nurse is caring for a client who was intubated because of respiratory failure. The client is now receiving mechanical ventilation with a preset tidal volume and number of breaths each minute. The client has the ability to breathe spontaneously between the ventilator breaths with no ventilator assistance. The nurse should document the ventilator setting as: synchronized intermittent mandatory ventilation (SIMV). pressure support ventilation (PSV). assist-control (AC) ventilation. continuous positive airway pressure (CPAP).

synchronized intermittent mandatory ventilation (SIMV).

Which oxygen administration device has the advantage of providing a high oxygen concentration? Face tent Catheter Nonrebreathing mask Venturi mask

Nonrebreathing mask

When performing endotracheal suctioning, the nurse applies suctioning while withdrawing and gently rotating the catheter 360 degrees for how long? 30 to 35 seconds 20 to 25 seconds 0 to 5 seconds 10 to 15 seconds

10 to 15 seconds

A nurse is caring for a client with COPD who needs teaching on pursed-lip breathing. Place the steps in order in which the nurse will instruct the client. "Inhale through your nose." "Slowly count to 3." "Exhale slowly through pursed lips." "Slowly count to 7."

"Inhale through your nose." "Slowly count to 3." "Exhale slowly through pursed lips." "Slowly count to 7."

The nurse is preparing to assist the health care provider to remove a client's chest tube. Which instruction will the nurse correctly give to the client? "Exhale forcefully while the chest tube is being removed." "Do not move during the removal of the chest tube because moving will make it more painful." "While the chest tube is being removed, raise your arms above your head." "When the tube is being removed, take a deep breath, exhale, and bear down."

"When the tube is being removed, take a deep breath, exhale, and bear down."

Arterial blood gases should be obtained how often after initiating continuous mechanical ventilation? 10 minutes 25 minutes 20 minutes 15 minutes

20 minutes

The nurse is caring for a client in the ICU who required emergent endotracheal (ET) intubation with mechanical ventilation. The nurse receives an order to obtain arterial blood gases (ABGs) after the procedure. The nurse recognizes that ABGs should be obtained how long after mechanical ventilation is initiated? 15 minutes 20 minutes 25 minutes 10 minutes

20 minutes

A client with a respiratory condition is receiving oxygen therapy. While assessing the client's PaO2, the nurse knows that the therapy has been effective based on which of the following readings? 58 mm Hg 120 mm Hg 45 mm Hg 84 mm Hg

84 mm Hg

Which is a potential complication of a low pressure in the endotracheal tube cuff? Tracheal ischemia Pressure necrosis Aspiration pneumonia Tracheal bleeding

Aspiration pneumonia

A client has a sucking stab wound to the chest. Which action should the nurse take first? Apply a dressing over the wound and tape it on three sides. Prepare to start an I.V. line. Prepare a chest tube insertion tray. Draw blood for a hematocrit and hemoglobin level.

Apply a dressing over the wound and tape it on three sides. Explanation: The nurse should immediately apply a dressing over the stab wound and tape it on three sides to allow air to escape and to prevent tension pneumothorax (which is more life-threatening than an open chest wound).

The nurse received a client from the post-anesthesia care unit (PACU) who has a chest tube to a closed drainage system. Report from the PACU nurse included drainage in the chest tube at 80 mL of bloody fluid. Fifteen minutes after transfer from the PACU, the chest tube indicates drainage as pictured. The client is reporting pain at "8" on a scale of 0 to 10. The first action of the nurse is to: Notify the physician. Lay the client's head to a flat position. Administer prescribed pain medication. Assess pulse and blood pressure.

Assess pulse and blood pressure.

A new ICU nurse is observed by her preceptor entering a patient's room to suction the tracheostomy after performing the task 15 minutes before. What should the preceptor educate the new nurse to do to ensure that the patient needs to be suctioned? Auscultate the lung for adventitious sounds. Assess the CO2 level to determine if the patient requires suctioning. Have the patient cough. Have the patient inform the nurse of the need to be suctioned.

Auscultate the lung for adventitious sounds.

For a client with an endotracheal (ET) tube, which nursing action is the most important? Monitoring serial blood gas values every 4 hours Providing frequent oral hygiene Turning the client from side to side every 2 hours Auscultating the lungs for bilateral breath sounds

Auscultating the lungs for bilateral breath sounds

The nurse assesses a patient with a heart rate of 42 and a blood pressure of 70/46. What type of hypoxia does the nurse determine this patient is displaying? Circulatory hypoxia Anemic hypoxia Hypoxic hypoxia Histotoxic hypoxia

Circulatory hypoxia

A client is diagnosed with mild obstructive sleep apnea after having a sleep study performed. What treatment modality will be the most effective for this client? Continuous positive airway pressure (CPAP) Bi-level positive airway pressure (BiPAP) Surgery to remove the tonsils and adenoids Medications to assist the patient with sleep at night

Continuous positive airway pressure (CPAP)

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? Encouragement of coughing Incentive spirometry Use of a cooling blanket Endotracheal suctioning

Endotracheal suctioning

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? Incentive spirometry Use of a cooling blanket Endotracheal suctioning Encouragement of coughing

Endotracheal suctioning

A nurse is attempting to wean a client after 2 days on the mechanical ventilator. The client has an endotracheal tube present with the cuff inflated to 15 mm Hg. The nurse has suctioned the client with return of small amounts of thin white mucus. Lung sounds are clear. Oxygen saturation levels are 91%. What is the priority nursing diagnosis for this client? Impaired gas exchange related to ventilator setting adjustments Risk for infection related to endotracheal intubation and suctioning Risk for trauma related to endotracheal intubation and cuff pressure Impaired physical mobility related to being on a ventilator

Impaired gas exchange related to ventilator setting adjustments

The nurse has instructed a client on how to perform pursed-lip breathing. The nurse recognizes the purpose of this type of breathing is to accomplish which result? Promote the strengthening of the client's diaphragm Promote the client's ability to take in oxygen Promote more efficient and controlled ventilation and to decrease the work of breathing Improve oxygen transport; induce a slow, deep breathing pattern; and assist the client to control breathing

Improve oxygen transport; induce a slow, deep breathing pattern; and assist the client to control breathing

The nurse is assisting a client with postural drainage. Which of the following demonstrates correct implementation of this technique? Administer bronchodilators and mucolytic agents following the sequence. Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes. Perform this measure with the client once a day. Use aerosol sprays to deodorize the client's environment after postural drainage.

Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes.

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? A disconnected ventilator circuit A change in the oxygen concentration without resetting the oxygen level alarm An ET cuff leak Kinking of the ventilator tubing

Kinking of the ventilator tubing

The nurse is admitting a patient with COPD. The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia? PaO2 PCO2 pH HCO3

PaO2

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) Bicarbonate (HCO3-) pH Partial pressure of arterial carbon dioxide (PaCO2)

Partial pressure of arterial oxygen (PaO2)

The nurse is caring for a client with an endotracheal tube (ET). Which nursing intervention is contraindicated? Ensuring that humidified oxygen is always introduced through the tube Checking the cuff pressure every 6 to 8 hours Deflating the cuff before removing the tube Routinely deflating the cuff

Routinely deflating the cuff Explanation: Routine cuff deflation is not recommended because of the increased risk for aspiration and hypoxia.

Which statements would be considered appropriate interventions for a client with an endotracheal tube? Select all that apply. Cuff pressures should be checked every 6 to 8 hours. Routine cuff deflation is recommended. The cuff is deflated before the tube is removed. Humidified oxygen should always be introduced through the tube. Suctioning the oropharynx prn is not recommended.

The cuff is deflated before the tube is removed. Cuff pressures should be checked every 6 to 8 hours. Humidified oxygen should always be introduced through the tube.

The nurse suctions a patient through the endotracheal tube for 20 seconds and observes dysrhythmias on the monitor. What does the nurse determine is occurring with the patient? The patient is hypoxic from suctioning. The patient is having a stress reaction. The patient is in a hypermetabolic state. The patient is having a myocardial infarction.

The patient is hypoxic from suctioning.

A client who must begin oxygen therapy asks the nurse why this treatment is necessary? What would the nurse identify as the goals of oxygen therapy? Select all that apply. To provide visual feedback to encourage the client to inhale slowly and deeply To clear respiratory secretions To decrease the work of breathing To reduce stress on the myocardium To provide adequate transport of oxygen in the blood

To provide adequate transport of oxygen in the blood To decrease the work of breathing To reduce stress on the myocardium

A client is being mechanically ventilated in the ICU. The ventilator alarms begin to sound. The nurse should complete which action first? Manually ventilate the client. Reposition the endotracheal tube. Notify the respiratory therapist. Troubleshoot to identify the malfunction.

Troubleshoot to identify the malfunction.

Which type of ventilator has a preset volume of air to be delivered with each inspiration? Negative pressure Volume cycled Pressure cycled Time cycled

Volume cycled

After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes? Air-leak chamber Collection chamber Suction control chamber Water-seal chamber

Water-seal chamber