course point ch. 23 patients with chest/LRT infections

Vitamin B6 (pyridoxine) is usually administered with INH to prevent

INH-associated peripheral neuropathy

A pneumothorax is

air in the pleural space

The most common signs and symptoms of pulmonary contusion are:

crackles, decreased or absent bronchial breath sounds, dyspnea, tachypnea, tachycardia, chest pain, blood-tinged secretions, hypoxemia, and respiratory acidosis. ***Patients with moderate pulmonary contusions often have a constant, but ineffective cough and cannot clear their secretions.***

Mycoplasmal pneumonia demonstrates the highest occurrence in

fall and early winter.

Inhalation of silica may cause silicosis, which results from

inhalation of silica dust and is seen in workers involved with mining, quarrying, stone-cutting, and tunnel building.

Consolidation is lung tissue that has become

more solid in nature as a result of the collapse of alveoli or an infectious process.

The presence of barrel chest is indicative of

trapped oxygen in the lungs over a prolonged period of time.

A nurse assesses arterial blood gas results for a patient in acute respiratory failure (ARF). Which results are consistent with this disorder? a. pH 7.36, PaCO2 32 mm Hg b. pH 7.28, PaO2 50 mm Hg c. pH 7.46, PaO2 80 mm Hg d. pH 7.35, PaCO2 48 mm Hg

B. pH 7.28, PaO2 50 mm Hg Explanation: ARF is defined as a decrease in arterial oxygen tension (PaO2) to less than 60 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO2) to >50 mm Hg (hypercapnia), with an arterial pH less than 7.35.

The nurse is obtaining data from a client with a respiratory disorder. Which information would be considered a part of the functional assessment and would assist in the diagnosis of an occupational lung disease? a. Cough and dyspnea b. Black-streaked sputum c. Barrel chest d. Tenacious secretions

Black-streaked sputum Explanation: A functional assessment provides data on the lifestyle, living environment, and work environment of the client, which can contribute to lung disorders. A black-tinged sputum is suggestive of prolonged exposure to coal dust. Cough, dyspnea, and tenacious secretions are vague respiratory symptoms that are not specific to occupational lung disease.

A victim has sustained a blunt force trauma to the chest. A pulmonary contusion is suspected. Which of the following clinical manifestations correlate with a moderate pulmonary contusion? a. Bradypnea b. Blood-tinged sputum c. Productive cough d. Respiratory alkalosis

Blood-tinged sputum Explanation: The clinical manifestations of pulmonary contusions are based on the severity of bruising and parenchymal involvement. The most common signs and symptoms are crackles, decreased or absent bronchial breath sounds, dyspnea, tachypnea, tachycardia, chest pain, blood-tinged secretions, hypoxemia, and respiratory acidosis.

The nurse is auscultating the patient's lung sounds to determine the presence of pulmonary edema. What adventitious lung sounds are significant for pulmonary edema? a. Pleural friction rub b. Crackles in the lung bases c. Sibilant wheezes d. Low-pitched rhonchi during expiration

Crackles in the lung bases Explanation: When clinically significant atelectasis develops, it is generally characterized by increased work of breathing and hypoxemia. Decreased breath sounds and crackles are heard over the affected area.

Which community-acquired pneumonia demonstrates the highest occurrence during summer and fall? a. Viral pneumonia b. Legionnaires disease c. Streptococcal (pneumococcal) pneumonia d. Mycoplasmata pneumonia

Legionnaires disease Explanation: Legionnaires disease accounts for 15% of community-acquired pneumonias; it occurs mainly in summer and fall.

You are assessing a client's potential for pulmonary emboli. What finding indicates possible deep vein thrombosis? a. Pain in the calf b. Negative Homan's sign c. Inability to dorsiflex d. Pain in the feet

Pain in the calf Explanation: When assessing the client's potential for pulmonary emboli, the nurse tests for a positive Homan's sign. The client lies on his or her back and lifts his or her leg and his or her foot. If the client reports calf pain (positive Homan's sign) during this maneuver, he or she may have a deep vein thrombosis.

After 48 hours, a Mantoux test is evaluated. At the site, there is a 10 mm induration. This finding would be considered: a. Negative b. Not significant c. Nonreactive d. Significant

Significant Explanation: An induration of 10 mm or greater is usually considered significant and reactive in people who have normal or mildly impaired immunity. Erythema without induration is not considered significant.

What indicates a positive PPD test?

an induration of greater than 10 mm indicates a positive test. ***Redness at the test area DOES NOT indicate a positive test***

A client who works construction and has been demolishing an older building is diagnosed with pneumoconiosis. This lung inflammation is most likely caused by exposure to: a.silica. b. asbestos. c. pollen. d. coal dust.

asbestos. Explanation: Asbestosis is caused by inhalation of asbestos dust, which is frequently encountered during construction work, particularly when working with older buildings.

During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must: a. follow up with the physician in 2 weeks. b. maintain fluid intake of 40 oz (1,200 ml) per day. c. turn and reposition himself every 2 hours. d. continue to take antibiotics for the entire 10 days.

continue to take antibiotics for the entire 10 days. Explanation: The client demonstrates understanding of how to prevent relapse when he states that he must continue taking the antibiotics for the prescribed 10-day course. Although the client should keep the follow-up appointment with the physician and turn and reposition himself frequently, these interventions don't prevent relapse. ***The client should drink 51 to 101 oz (1,500 to 3,000 ml) per day of clear liquids.***

A physician stated to the nurse that the client has fluid in the pleural space and will need a thoracentesis. The nurse expects the physician to document this fluid as a. consolidation. b. hemothorax. c. pleural effusion. d. pneumothorax.

pleural effusion. Explanation: Fluid accumulating within the pleural space is called a pleural effusion.

Triple-lumen catheter insertion through the subclavian vein isn't associated with

pulmonary embolism, MI, or heart failure.

Streptococcal and viral pneumonias demonstrate the highest occurrence during

winter months

Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis? a. "I will come back in 1 week to have the test read." b. "Because I had a previous reaction to the test, this time I need to get a chest X-ray." c. "I will avoid contact with my family until I am done with the test." d. "If the test area turns red that means I have tuberculosis."

"Because I had a previous reaction to the test, this time I need to get a chest X-ray." Explanation: A client who previously had a positive PPD test (a reaction to the antigen) can't receive a repeat PPD test and must have a chest X-ray done instead. The test should be read 48 to 72 hours after administration.

A nurse is preparing dietary recommendations for a client with a lung abscess. Which statement would be included in the plan of care? a. "You must consume a diet rich in protein, such as chicken, fish, and beans." b. "You must consume a diet low in calories, such as skim milk, fresh fruits, and vegetables." c. "You must consume a diet high in carbohydrates, such as bread, potatoes, and pasta." d. "You must consume a diet low in fat by limiting dairy products and concentrated sweets."

"You must consume a diet rich in protein, such as chicken, fish, and beans." Explanation: The nurse encourages a client with a lung abscess to eat a diet that is high in protein and calories in order to ensure proper nutritional intake.

A patient has a Mantoux skin test prior to being placed on an immunosuppressant for the treatment of Crohn's disease. What results would the nurse determine is not significant for holding the medication? a. 5 to 6 mm b. 7 to 8 mm c. 9 mm d. 0 to 4 mm

0 to 4 mm Explanation: The Mantoux method is used to determine whether a person has been infected with the TB bacillus and is used widely in screening for latent M. tuberculosis infection. The size of the induration determines the significance of the reaction. A reaction of 0 to 4 mm is considered not significant. A reaction of 5 mm or greater may be significant in people who are considered to be at risk.

A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia? a. A client who ambulates in the hallway every 4 hours b. A client who is receiving acetaminophen (Tylenol) for pain c. A client with a nasogastric tube d. A client with a history of smoking two packs of cigarettes per day until quitting 2 years ago

A client with a nasogastric tube Explanation: Nasogastric, orogastric, and endotracheal tubes increase the risk of pneumonia because of the risk of aspiration from improperly placed tubes. Frequent oral hygiene and checking tube placement help prevent aspiration and pneumonia. ***Ambulation helps prevent pneumonia*** ***A client who receives opioids, not acetaminophen, has a risk of developing pneumonia because respiratory depression may occur***.

What dietary recommendations should a nurse provide a client with a lung abscess? a. A diet with limited fat b. A diet low in calories c. A diet rich in protein d. A carbohydrate-dense diet

A diet rich in protein Explanation: For a client with lung abscess, a diet rich in protein and calories is integral because chronic infection is associated with a catabolic state. ***A carbohydrate-dense diet or diets with limited fat are not advisable for a client with lung abscess.***

When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems? a. Hyperoxemia, hypocapnia, and hyperventilation b. Hypotension, hyperoxemia, and hypercapnia c. Hyperventilation, hypertension, and hypocapnia d. Hypercapnia, hypoventilation, and hypoxemia

D. Hypercapnia, hypoventilation, and hypoxemia Explanation: The cardinal physiologic abnormalities of acute respiratory failure are hypercapnia, hypoventilation, and hypoxemia.

Which interventions does a nurse implement for clients with empyema? a. Place suspected clients together b. Institute droplet precautions c. Do not allow visitors with respiratory infection d. Encourage breathing exercises

Encourage breathing exercises Explanation: The nurse teaches the client with empyema to do breathing exercises as prescribed. ***THE OTHER ACTIONS ARE ALL CORRECT BUT NOT CONSIDERED INTERVENTIONS FOR THE CLIENT*** The nurse should institute droplet precautions and isolate suspected and clients with confirmed influenza in private rooms or place suspected and confirmed clients together. The nurse does not allow visitors with symptoms of respiratory infection to visit the hospital to prevent outbreaks of influenza from occurring in health care settings.

You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia? a. Encourage increased fluid intake. b. Give antibiotics as ordered. c. Offer nutritious snacks 2 times a day. d. Place client on bed rest.

Encourage increased fluid intake. Explanation: The nurse places the client in semi-Fowler's position to aid breathing and increase the amount of air taken with each breath. Increased fluid intake is important to encourage because it helps to loosen secretions and replace fluids lost through fever and increased respiratory rate. The nurse monitors fluid intake and output, skin turgor, vital signs, and serum electrolytes. He or she administers antipyretics as indicated and ordered. Antibiotics are not given for viral pneumonia. The client's activity level is ordered by the physician, not decided by the nurse.

A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care? a. Turning the client every 2 hours b. Encouraging increased fluid intake c. Elevating the head of the bed 30 degrees d. Maintaining a cool room temperature

Encouraging increased fluid intake Explanation: Increasing the client's intake of oral or I.V. fluids helps liquefy thick, tenacious secretions and ensures adequate hydration.

You are an occupational health nurse in a large ceramic manufacturing company. How would you intervene to prevent occupational lung disease in the employees of the company? a. Give workshops on disease prevention. b. Fit all employees with protective masks. c. Insist on adequate breaks for each employee. d. Provide employees with smoking cessation materials.

Fit all employees with protective masks. Explanation: The primary focus is prevention, with frequent examination of those who work in areas of highly concentrated dust or gases. Laws require work areas to be safe in terms of dust control, ventilation, protective masks, hoods, industrial respirators, and other protection.

A patient arrives in the emergency department after being involved in a motor vehicle accident. The nurse observes paradoxical chest movement when removing the patient's shirt. What does the nurse know that this finding indicates? a. Pneumothorax b. Tension pneumothorax c. ARDS d. Flail chest

Flail chest Explanation: -During inspiration, as the chest expands, the detached part of the rib segment (flail segment) moves in a paradoxical manner (pendelluft movement) in that it is pulled inward during inspiration, reducing the amount of air that can be drawn into the lungs. -On expiration, because the intrathoracic pressure exceeds atmospheric pressure, the flail segment bulges outward, impairing the patient's ability to exhale. -The mediastinum then shifts back to the affected side. -This paradoxical action results in increased dead space, a reduction in alveolar ventilation, and decreased compliance.

The nurse is caring for a client with tuberculosis. Why should the nurse always encourage a client with tuberculosis to perform active range-of-motion (ROM) exercises three times a day? a. For medication absorption b. For maintaining muscle strength c. For effective pain control d. For use as a baseline for evaluation

For maintaining muscle strength Explanation: The nurse should always encourage active ROM exercises three times a day. Active ROM exercises maintain muscle strength and joint ROM.

A client who underwent surgery 12 hours ago has difficulty breathing. He has petechiae over his chest and complains of acute chest pain. What action should the nurse take first? a. Perform nasopharyngeal suctioning. b. Administer analgesics as ordered. c. Initiate oxygen therapy. d. Administer a heparin bolus and begin an infusion at 500 units/hour.

Initiate oxygen therapy. Explanation: The client's signs and symptoms suggest pulmonary embolism. Therefore, maintaining respiratory function takes priority. The nurse should first initiate oxygen therapy and then notify the physician immediately. The physician will most likely order an anticoagulant such as heparin or an antithrombolytic to dissolve the thrombus. Analgesics can be administered to decrease pain and anxiety but administering oxygen takes priority. Suctioning typically isn't necessary with pulmonary embolism.

A client with suspected severe acute respiratory syndrome (SARS) comes to the emergency department. Which physician order should the nurse implement first? a. Obtain a nasopharyngeal specimen for reverse-transcription polymerase chain reaction testing. b. Obtain a sputum specimen for enzyme immunoassay testing. c. Institute isolation precautions. d. Begin an I.V. infusion of dextrose 5% in half-normal saline solution at 100 ml/hour.

Institute isolation precautions. Explanation: SARS, a highly contagious viral respiratory illness, is spread by close person-to-person contact. Contained in airborne respiratory droplets, the virus is easily transmitted by touching surfaces and objects contaminated with infectious droplets. The nurse should give top priority to instituting infection-control measures to prevent the spread of infection to emergency department staff and clients. After isolation measures are carried out, the nurse can begin an I.V. infusion of dextrose 5% in half-normal saline and obtain nasopharyngeal and sputum specimens.

A nurse reading a chart notes that the client had a Mantoux skin test result with no induration and a 1-mm area of ecchymosis. How does the nurse interpret this result? a. Positive b. Borderline c. Negative d. Uncertain

Negative Explanation: The size of the induration determines the significance of the reaction. A reaction 0-4 mm is not considered significant. A reaction ≥5 mm may be significant in people who are considered to be at risk. An induration ≥10 mm or greater is usually considered significant in people who have normal or mildly impaired immunity.

A client is brought to the emergency department following a motor vehicle accident. Which of the following nursing assessments is significant in diagnosing this client with flail chest? a. Respiratory acidosis b. Chest pain on inspiration c. Clubbing of fingers and toes d. Paradoxical chest movement

Paradoxical chest movement Explanation: Flail chest occurs when two or more adjacent ribs fracture and results in impairment of chest wall movement.

A client who has just had a triple-lumen catheter placed in his right subclavian vein complains of chest pain and shortness of breath. His blood pressure is decreased from baseline and, on auscultation of his chest, the nurse notes unequal breath sounds. A chest X-ray is immediately ordered by the physician. What diagnosis should the nurse suspect? a. Myocardial infarction (MI) b. Pneumothorax c. Heart failure d. Pulmonary embolism

Pneumothorax Explanation: Pneumothorax (air in the pleural space) is a potential complication of all central venous access devices. Signs and symptoms include chest pain, dyspnea, shoulder or neck pain, irritability, palpitations, light-headedness, hypotension, cyanosis, and unequal breath sounds. A chest X-ray reveals the collapse of the affected lung that results from pneumothorax.

You are caring for a client with chronic respiratory failure. What are the signs and symptoms of chronic respiratory failure? a. Progressive loss of lung function associated with chronic disease b. Sudden loss of lung function associated with chronic disease c. Progressive loss of lung function with history of normal lung function d. Sudden loss of lung function with history of normal lung function

Progressive loss of lung function associated with chronic disease Explanation: In chronic respiratory failure, the loss of lung function is progressive, usually irreversible, and associated with chronic lung disease or other disease.

The nurse is assessing a client who, after an extensive surgical procedure, is at risk for developing acute respiratory distress syndrome (ARDS). The nurse assesses for which most common early sign of ARDS? a. Bilateral wheezing b. Inspiratory crackles c. Rapid onset of severe dyspnea d. Cyanosis

Rapid onset of severe dyspnea Explanation: The acute phase of ARDS is marked by a rapid onset of severe dyspnea that usually occurs less than 72 hours after the precipitating event.

Which should a nurse encourage in clients who are at the risk of pneumococcal and influenza infections? a. Receiving vaccinations b. Using incentive spirometry c. Using prescribed opioids d. Mobilizing early

Receiving vaccinations Explanation: Identifying clients who are at risk for pneumonia provides a means to practice preventive nursing care. The nurse encourages clients at risk of pneumococcal and influenza infections to receive vaccinations against these infections

You are caring for a client status post lung resection. When assessing your client you find that the bubbling in the water-seal chamber for the chest tubes is more than you expected. What should you check when bubbling in the water-seal chamber is excessive? a. See if there are leaks in the system. b. See if the wall suction unit has malfunctioned. c. See if the chest tube is clogged. d. See if a kink has developed in the tubing.

See if there are leaks in the system. Explanation: Bubbling in the water-seal chamber occurs in the early postoperative period. If bubbling is excessive, the nurse checks the system for any kind of leaks. Fluctuation of the fluid in the water-seal chamber is initially present with each respiration. Fluctuations cease if the chest tube is clogged or a kink develops in the tubing. If the suction unit malfunctions, the suction control chamber, not the water-seal chamber, will be affected.

A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse know is the most common organism that causes community-acquired pneumonia? a. Mycobacterium tuberculosis b. Staphylococcus aureus c. Streptococcus pneumoniae d. Pseudomonas aeruginosa

Streptococcus pneumoniae Explanation: -Streptococcus pneumoniae (pneumococcus) is the most common cause of community-acquired pneumonia in people younger than 60 years without comorbidity and in those 60 years and older with comorbidity. -S. pneumoniae, a gram-positive organism that resides naturally in the upper respiratory tract, colonizes the upper respiratory tract and can cause disseminated invasive infections, pneumonia and other lower respiratory tract infections, and upper respiratory tract infections such as otitis media and rhinosinusitis. -It may occur as a lobar or bronchopneumonic form in patients of any age and may follow a recent respiratory illness.

The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation? a. Flail chest b. Cardiac tamponade c. Pulmonary contusion d. Tension pneumothorax

Tension pneumothorax Explanation: Clamping can result in a tension pneumothorax.

The nurse should encourage early mobilization as indicated through agency protocol, administer prescribed opioids and sedatives as indicated, and teach or reinforce appropriate technique for incentive spirometry to prevent

atelectasis.

Inhalation of coal dust and other dusts may cause

black lung disease

A hemothorax is

blood within the pleural space.

Flail chest occurs when

two or more adjacent ribs fracture and results in impairment of chest wall movement. ***Respiratory acidosis and chest pain are symptoms that can occur with flail chest but is not as significant in the diagnosis as paradoxical chest movement.***