EAQs

B. Use of accessory muscles The use of accessory muscles for respiration indicates the client is having difficulty breathing. Accessory muscles of respiration are muscles other than the diaphragm and intercostal muscles that may be used for labored breathing.

The nurse assesses a male client's respiratory status. Which observation indicates that the client is experiencing difficulty breathing? A. Diaphragmatic breathing B. Use of accessory muscles C. Pursed-lip breathing D. Controlled breathing

4 Compensated respiratory acidosis in this patient with COPD, a low-normal pH, mildly elevated PaCO2, and a high HCO3 indicate compensated respiratory acidosis.

How will the nurse interpret arterial blood gas results including pH 7.36, PaCO2 49 mm Hg, HCO3 27 mEq/L, and PaO2 61 mm Hg for a patient with chronic obstructive pulmonary disease (COPD)? 1 Severe hypoxemia 2 Early respiratory failure 3 All results within normal limits 4 Compensated respiratory acidosis

3 "My exhalation should be longer than my inhalation."

Which patient statement indicates understanding of teaching about pursed lip breathing (PLB)? 1 "I should purse my lips while I inhale." 2 "I will puff out my cheeks while exhaling." 3 "My exhalation should be longer than my inhalation." 4 "Lying flat will increase effectiveness of this technique."

1 Seizures

The nurse identifies that which factor places a patient at risk for aspiration pneumonia? 1 Seizures 2 Guillain-Barré syndrome 3 Illicit drug intake 4 Recent abdominal surgery

D. Administer bronchodilators. In an acute asthma attack, diminished or absent breath sounds can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, intravenous corticosteroids, and possibly intravenous theophylline.

A 34-year-old woman with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, what action should the nurse take to initiate care of the client? A. Initiate oxygen therapy and reassess the client in 10 minutes. B. Draw blood for an ABG analysis and send the client for a chest x-ray. C. Encourage the client to relax and breathe slowly through the mouth. D. Administer bronchodilators.

3 Traumatic (Penetrating wound)

A patient experiences a sucking chest wound as a result of a surgical thoracotomy. Which type of pneumothorax does the nurse suspect? 1 Tension 2 Iatrogenic 3 Traumatic 4 Spontaneous

B. Diminished breath sounds. This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema.

An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client? A. A low respiratory rate. B. Diminished breath sounds. C. The presence of a barrel chest. D. A sucking sound at the site of injury.

C. Teaching the patient how to perform controlled coughing. Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. Cough can be persistent but ineffective, especially if the patient is elderly, acutely ill, or debilitated. Coughing is most effective in an upright or in a head-down position after chest percussion.

For a female patient with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway? A. Restricting fluid intake to 1,000 ml per day. B. Enforcing absolute bed rest. C. Teaching the patient how to perform controlled coughing. D. Administering prescribed sedatives regularly and in large amounts.

B. D.

In assessing the patient with pneumococcal pneumonia, the nurse recognizes that clinical manifestations of this condition include (select all that apply): A. nonproductive cough B. an abrupt onset of fever C. night sweats that are usually self limiting D. productive cough with rust colored sputum E. a gradual onset of sore throat and purulent productive cough

B. Continue to monitor the client. 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. Fluctuation stops if the tube is obstructed, if a dependent loop exists, if the suction is not working properly, or if the lung has re-expanded.

Nurse Maureen has assisted a physician with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which action would be appropriate? A. Inform the physician. B. Continue to monitor the client. C. Reinforce the occlusive dressing. D. Encourage the client to deep breathe.

B. Absence of breaths sound in the right thorax. In pneumothorax, the alveoli are deflated and no air exchange occurs in the lungs. Therefore, breath sounds in the affected lung field are absent. A pneumothorax is defined as a collection of air outside the lung but within the pleural cavity

On auscultation, which finding suggests a right pneumothorax? A. Bilateral inspiratory and expiratory crackles. B. Absence of breaths sound in the right thorax. C. Inspiratory wheezes in the right thorax. D. Bilateral pleural friction rub.

1 No treatment may be needed. Treatment of a pneumothorax depends on its severity, its underlying cause, and the hemodynamic stability of the patient. If the patient is stable and has minimal air and/or fluid accumulated in the intrapleural space, no treatment may be needed because the condition may resolve spontaneously. Chest tube drainage is helpful to drain the fluid; however, this procedure is performed when the patient has severe complications.

The nurse reviews the medical record of a patient with a pneumothorax and notes that the patient has a minimal amount of fluid accumulated in the intrapleural space and that the patient is stable. Which does the nurse infer? 1 No treatment may be needed. 2 The patient will require treatment with chest tube drainage. 3 Treatment will include aspiration using a large-bore needle. 4 The primary treatment plan will be needle decompression.

3 Use typed messages to communicate. Sometimes patients with COPD or those who use oxygen (O2) therapy have difficulty speaking because of shortness of breath. These patients should be encouraged to use typed messages as an alternative to phone conversations to communicate to avoid increased dyspnea. The patient should avoid exercise or walking during the attack because severe dyspnea may lead to respiratory failure. The patient should have an adequate diet to prevent weight loss. Hence the patient should avoid consuming more fluids at mealtime. Patients with dyspnea often cannot speak in continuous sentences because of difficulty in breathing.

The nurse will suggest which intervention for the patient experiencing an acute exacerbation of chronic obstructive pulmonary disease (COPD)? 1 Walk for 30 minutes. 2 Drink more fluids at mealtime. 3 Use typed messages to communicate. 4 Speak continuously in sentences by taking deep breaths.

A. Respiratory acidosis Respiratory acidosis represents an increase in the acid component, carbon dioxide, and an increase in the hydrogen ion concentration (decreased pH) of the arterial blood.

If a client continues to hypoventilate, the nurse will continually assess for a complication of: A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

2 Inspect the tongue and pharynx.

When a patient is using beclomethasone to control asthma symptoms, which action will the nurse take to check for adverse effects of the medication? 1 Take BP and pulse. 2 Inspect the tongue and pharynx. 3 Monitor the serum calcium level. 4 Obtain patient weight each morning.

3Increased vocal fremitus on palpation

Which clinical manifestation should the nurse expect to find during assessment of a patient admitted with pneumonia? 1Hyperresonance on percussion 2Vesicular breath sounds in all lobes 3Increased vocal fremitus on palpation 4Fine crackles in all lobes on auscultation

3 Wheezing 4 Chest tightness 1 Cough

Which manifestations would the nurse identify with asthma? Select all that apply. 1 Cough 2 Crackles 3 Wheezing 4 Chest tightness 5 Pink, frothy sputum

1 The patient breathes into the inhaler. 3 The patient shakes the medicine before using it. 5 The patient inhales more than 1 puff with each inspiration.

Which patient actions indicate a need for more education about how to use a dry powder inhaler device? Select all that apply. 1 The patient breathes into the inhaler. 2 The patient performs deep and quick breathing. 3 The patient shakes the medicine before using it. 4 The patient holds the breath for more than 10 seconds. 5 The patient inhales more than 1 puff with each inspiration.

4 Airway inflammation and bronchoconstriction are worsening. When the patient in respiratory distress has inspiratory wheezing that then ceases, it is an indication of airway obstruction and requires emergency action to restore the airway. A pneumothorax would be evidenced by absent breath sounds. The absence of wheezing does not correlate with improved airflow if the patient is also in current respiratory distress. A mucous plug would result in crackles in the lungs.

n asthmatic patient is in acute respiratory distress. The nurse auscultates the lungs and notes cessation of inspiratory wheezing. Which interpretation would the nurse derive from this finding? 1 The patient has developed a pneumothorax. 2 Airflow has now improved through the bronchioles. 3 A mucous plug has developed within a mainstem bronchus. 4 Airway inflammation and bronchoconstriction are worsening.

B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery. Before drawing an ABG, the nurse assesses the collateral circulation to the hand with Allen's test. This involves compressing the radial and ulnar arteries and asking the client to close and open the fist. This should cause the hand to become pale. The nurse then releases pressure on one artery and observes whether circulation is restored quickly. The nurse repeats the process, releasing the other artery. The blood sample may be taken safely if collateral circulation is adequate.

A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes the: A. Brachial and radial arteries, and then releases them and observes the circulation of the hand. B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery. C. Radial artery and observes for color changes in the affected hand. D. Ulnar artery and observes for color changes in the affected hand.

A. Irregular heartbeat Irregular heart rates should be reported promptly to the care provider. Metaproterenol may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effect on the beta-adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders.

A client is prescribed albuterol (Alupent) via a metered-dose inhaler (MDI), two puffs every 4 hours. The nurse instructs the client to report side effects. Which of the following are potential side effects of albuterol? A. Irregular heartbeat B. Constipation C. Pedal edema D. Decreased heart rate.

C. Corticosteroids have an anti-inflammatory effect. Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion.

A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma? A. Corticosteroids promote bronchodilation. B. Corticosteroids act as an expectorant. C. Corticosteroids have an anti-inflammatory effect. D. Corticosteroids prevent development of respiratory infections.

B. Flushed skin The high PaCO2 level causes flushing due to vasodilation. The client also becomes drowsy and lethargic because carbon dioxide has a depressant effect on the CNS. On the contrary, chronic respiratory acidosis may be caused by COPD where there is a decreased responsiveness of the reflexes to states of hypoxia and hypercapnia.

A client's arterial blood gas levels are as follows: pH 7.31; PaO2 80 mm Hg, PaCO2 65 mm Hg; HCO3- 36 mEq/L. Which of the following signs or symptoms would the nurse expect? A. Cyanosis B. Flushed skin C. Irritability D. Anxiety

C. Atelectasis

A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: A. Pleural effusion B. Pulmonary edema C. Atelectasis D. Oxygen toxicity

B. Applying a dressing over the wound and taping it on three sides.

A male patient has a sucking stab wound to the chest. Which action should the nurse take first? A. Drawing blood for a hematocrit and hemoglobin level. B. Applying a dressing over the wound and taping it on three sides. C. Preparing a chest tube insertion tray. D. Preparing to start an I.V. line.

D. Perform the Valsalva maneuver When the chest tube is removed, the client is asked to perform the Valsalva maneuver (take a deep breath, exhale, and bear down). The tube is quickly withdrawn, and an airtight dressing is taped in place. An alternative instruction is to ask the client to take a deep breath and hold the breath while the tube is removed.

A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to: A. Exhale slowly B. Stay very still C. Inhale and exhale quickly D. Perform the Valsalva maneuver

4 If the drainage is greater than 100 mL/hr

A nursing student asks the nurse how much drainage from a patient's chest tube warrants the need to contact the health care provider (HCP). Which criterion does the nurse give to the student? 1 If the drainage increases by 25% in one hour 2 If the drainage system is overturned and the amount is inaccurate 3 If the collection chamber is full 4 If the drainage is greater than 100 mL/hr

3 The level in the water-seal chamber fluctuates with respirations.

A patient has a chest tube inserted to treat a pneumothorax. Which observation causes the nurse to conclude that the water-seal chamber of the chest drainage unit (CDU) is functioning properly? 1 There is no bubbling in the suction control chamber. 2 The wall suction regulator is set to 150 mm Hg. 3 The level in the water-seal chamber fluctuates with respirations. 4 There is bloody drainage present in the water-seal chamber.

3 Assess the drainage system for occlusion. Normal fluctuation of the water within the water-seal chamber is called tidaling. This up-and-down movement of water in concert with respiration reflects the intrapleural pressure changes during inspiration and expiration. If tidaling (rising with inspiration and falling with expiration in the spontaneously breathing patient) is not seen, the drainage system is blocked, the lungs are reexpanded, or the system is attached to suction. If tidaling is not seen, the nurse needs to determine the cause rather than simply continuing to monitor the patient. The nurse could check all connections for a leak, but the most common cause is occlusion. The collection unit is likely already in a low position.

A patient has a chest tube with a chest drainage unit (CDU) in place. The nurse notes that the tidaling in the water-seal chamber has stopped. Which action does the nurse take? 1 Continue to monitor the patient. 2 Check all connections for a leak in the system. 3 Assess the drainage system for occlusion. 4 Lower the collection unit.

2 Sputum culture and sensitivity The nurse should ensure that the sputum for culture and sensitivity was sent to the laboratory before administering the cefuroxime because this is community-acquired pneumonia. It is important that the organisms are identified correctly (by the culture) before the antibiotic takes effect. The test also will determine whether the proper antibiotic has been prescribed (sensitivity testing). Although antibiotic administration should not be unduly delayed while waiting for the patient to expectorate sputum, the pulmonary function evaluation and the chest x-ray will not be affected by the administration of antibiotics.

A patient is admitted to a general medical-surgical hospital unit from the home setting for the treatment of pneumonia. The patient receives a prescription for cefuroxime. The nurse verifies that which diagnostic study is completed before administering the first dose of the medication? 1 Pulmonary function evaluation 2 Sputum culture and sensitivity 3 Chest x-ray 4 Mantoux skin test

2 An asthma attack A sudden onset of coughing and wheezing are the initial and most obvious symptoms of an acute asthma attack. An asthma attack may begin mildly but progress to respiratory distress and arrest if it goes untreated.

A patient presents to the emergency department with sudden-onset wheezing and coughing with progressive respiratory distress. Which condition would the nurse associate with these manifestations? 1 Acute bronchitis 2 An asthma attack 3 Pulmonary edema 4 Congestive heart failure

4 38F The symptoms indicate that the patient has a hemothorax, which means blood in the pleural space. Manifestations of a hemothorax include dyspnea, decreased or absent breath sounds, dullness to percussion, decreased hemoglobin, and shock (depending on blood volume lost). The priority intervention is chest tube insertion with a chest drainage system to drain the blood. The size of the tube to be used is determined by the patient's condition. Large tubes (36F to 40F) are used to drain blood; therefore the 38F tube should be used for this patient. Medium (24F to 36F) tubes are used to drain fluid, and small (12F to 24F) tubes are used to drain air.

A patient sustains injuries to the chest as a result of an altercation. The nurse assesses the right lung and notes decreased breath sounds and dullness on percussion. The patient reports difficulty breathing. The nurse makes preparations to assist the health care provider with the insertion of which size chest tube? 1 12F 2 24F 3 28F 4 38F

4 Reduced flow of lymphatic fluid Chylothorax is a type of chest injury that is associated with the accumulation of fluid in the pleural space. Octreotide acts like the natural hormone somatostatin, which behaves as a vasoconstrictor and reduces the flow of lymphatic fluid into the pleural space.

A patient with a diagnosis of chylothorax is prescribed octreotide. Which outcome does the nurse expect after the treatment? 1 Adequate hydration 2 Adequate pain control 3 Reduced risk of hypoxemia 4 Reduced flow of lymphatic fluid

3 Continue to monitor and document the respiratory status. In a CDU that is not attached to suction, the fluid in the water-seal chamber rises when the patient inhales and falls when the patient exhales. This is a normal finding. The absence of fluctuations may indicate an obstruction in the system. The nurse must continually check the function of the CDU and assess respiratory status at least every four hours. There is no need to notify the health care provider or decrease the amount of water in the water-seal chamber because the chest tube system is functioning normally.

A patient with a spontaneous pneumothorax has a chest tube in place that is attached to a chest drainage unit (CDU) with no suction being applied. The water level in the water-seal chamber is fluctuating. Which action does the nurse take? 1 Notify the health care provider immediately. 2 Decrease the amount of water in the water-seal chamber. 3 Continue to monitor and document the respiratory status. 4 Clamp the chest tube as close as possible to the insertion site.

4 Subcutaneous emphysema Subcutaneous emphysema can occur from air leaking into the tissue surrounding the chest tube insertion site. A "crackling" sensation will be felt when palpating the skin. A small amount of subcutaneous air is harmless and will be reabsorbed. However, severe subcutaneous emphysema can cause drastic swelling of the head and neck with potential airway compromise

A patient with an iatrogenic pneumothorax has a chest tube that is connected to a chest drainage unit (CDU). The nurse assesses swelling in the head and neck and a compromised airway. The nurse suspects which complication? 1 Pleurisy 2 Atelectasis 3 Cor pulmonale 4 Subcutaneous emphysema

2 Turn the suction dial on the CDU to -20 cm H2O pressure. After connecting the patient to the system, the nurse should turn the dial on the chest drainage system to the amount ordered (generally -20 cm H2O pressure). The nurse then should connect the suction tubing to the wall suction source and increase the suction until the float appears in the window of the CDU

After connecting a patient's chest tube to a dry suction system, which action does the nurse take next? 1 Verify that the float has disappeared from the window of the chest drainage unit (CDU). 2 Turn the suction dial on the CDU to -20 cm H2O pressure. 3 Depress the high-negativity vent. 4 Briefly and methodically move clamps down the chest tube to assess for air leaks.

A. Repeat auscultation after asking the client to deep breathe and cough. Although crackles often indicate fluid in the alveoli, they may also be related to hypoventilation and will clear after a deep breath or a cough. Assess cough effectiveness and productivity. Coughing is the most effective way to remove secretions. Pneumonia may cause thick and tenacious secretions to patients

Auscultation of a client's lungs reveals crackles in the left posterior base. The nursing intervention is to: A. Repeat auscultation after asking the client to deep breathe and cough. B. Instruct the client to limit fluid intake to less than 2000 ml/day. C. Inspect the client's ankles and sacrum for the presence of edema. D. Place the client on bedrest in a semi-Fowler's position.

1 Sepsis 2 Pleurisy 5 Pleural effusion

Complications of pneumonia occur more frequently in older patients. The nurse knows that potential complications include which of these? Select all that apply. 1 Sepsis 2 Pleurisy 3 Bronchitis 4 Encephalitis 5 Pleural effusion 6 Congestive heart disease

C. Using a high-flow venturi mask to deliver oxygen as prescribed. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately.

For a patient with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? A. Encouraging the patient to drink three glasses of fluid daily. B. Keeping the patient in semi-Fowler's position. C. Using a high-flow venturi mask to deliver oxygen as prescribed. D. Administering a sedative, as prescribed.

A. Do nothing, because this is an expected finding. Continuous gentle bubbling should be noted in the suction control chamber. Bubbling during expiration reflects venting of pneumothorax (desired action). Bubbling usually decreases as the lung expands or may occur only during expiration or coughing as the pleural space diminishes.

Nurse Lei, caring for a client with a pneumothorax and who has had a chest tube inserted, continues gentle bubbling in the suction control chamber. What action is appropriate? A. Do nothing, because this is an expected finding. B. Immediately clamp the chest tube and notify the physician. C. Check for an air leak because the bubbling should be intermittent. D. Increase the suction pressure so that the bubbling becomes vigorous.

C. The system has an air leak.

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

3 Cor pulmonale

Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)? 1 Pneumonia 2 Polycythemia 3 Cor pulmonale 4 Acute respiratory failure

3 The dressing over the chest tube insertion site is loose. If the dressing at the chest tube insertion site is loose, an air leak will occur and will need to be sealed. The water-seal chamber usually has 2 cm of water, but having more water will not contribute to an air leak; it should not be drained from the CDU. No new drainage does not indicate an air leak but may indicate that the chest tube is no longer needed. If there is a pneumothorax, the chest tube should remove the air.

One week after a thoracotomy, a patient with a chest tube attached to a chest drainage unit (CDU) experiences an air leak in the system. Which assessment finding warrants follow-up nursing interventions? 1 The water-seal chamber contains 5 cm of sterile water. 2 There is no new drainage in the collection chamber. 3 The dressing over the chest tube insertion site is loose. 4 The patient has a small pneumothorax.

D. Venturi mask Venturi delivers controlled oxygen. An air-entrainment (also known as venturi) mask can provide a pre-set oxygen to the patient using jet mixing. As the percent of inspired oxygen increases using such a mask, the air-to-oxygen ratio decreases, causing the maximum concentration of oxygen provided by an air-entrainment mask to be around 40%.

The best method of oxygen administration for client with COPD uses: A. Cannula B. Simple Face mask C. Non-rebreather mask D. Venturi mask

The air leak is in the tube between points 3 and 4. Whenever the bubbling increases, the nurse should suspect an air leak. If a leak persists, the nurse should briefly clamp the chest tube starting at the patient's chest. The nurse should briefly and methodically move the clamps down the tubing, away from the patient, until the air leak stops. The leak will then be present between the last two clamp points. If the leak persists, the nurse should briefly clamp the chest tube at the patient's chest. If the leak stops when the tube is clamped at the patient's chest, the air is coming from the patient. For this patient, the leak is present between the last two clamp points, which are numbers 3 and 4. If the air leak persists all the way to the drainage unit, the unit should be replaced.

The bubbling in a patient's chest drainage unit (CDU) has increased, and the nurse suspects an air leak. The patient's chest tube is numbered from 1 to 5 in regular increments on the tube. To determine the location of the air leak, the nurse briefly and methodically clamps down the tubing away from the patient. The leak stops when the tube is clamped between the numbers 3 and 4. How does the nurse interpret the finding? 1 The air leak is in the patient's chest. 2 The air leak is in the tube between points 1 and 2. 3 The air leak is in the tube between points 3 and 4. 4 The air leak is in the collection chamber of the CDU.

B. Viral respiratory infections. The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or a cold and should get yearly flu vaccinations. Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger.

The client with asthma should be taught which of the following is one of the mostcommon precipitating factors of an acute asthma attack? A. Occupational exposure to toxins. B. Viral respiratory infections. C. Exposure to cigarette smoke. D. Exercising in cold temperatures.

4 "I will need to have a follow-up chest x-ray in six to eight weeks to evaluate the pneumonia's resolution." The follow-up chest x-ray will be done in six to eight weeks to evaluate pneumonia resolution. A patient should seek medical treatment for upper respiratory infections that persist for more than seven days. It may be important for the patient to continue with deep-breathing exercises for six to eight weeks, not 12 weeks, until all of the infection has cleared from the lungs. Increased fluid intake, not caloric intake, is recommended to liquefy secretions.

The nurse determines effective discharge teaching for a patient with pneumonia when the patient makes which statement? 1 "I should seek immediate medical treatment for any upper respiratory infections." 2 "I should continue to do deep-breathing exercises for at least 12 weeks." 3 "I will increase my food intake to 2400 calories a day to keep my immune system well." 4 "I will need to have a follow-up chest x-ray in six to eight weeks to evaluate the pneumonia's resolution."

2 Needle decompression Cyanosis, air hunger, extreme agitation, subcutaneous emphysema, neck vein distention, hyperresonance to percussion, and tracheal deviation away from affected side (late sign) are manifestations of a tension pneumothorax in a patient with chest trauma. A tension pneumothorax is a complication associated with the presence of excess air in the pleural thorax that cannot escape and is treated with needle decompression. Pericardiocentesis is helpful in aspirating fluid from the pleural space, which is more useful in cases of cardiac tamponade. Insertion of a chest tube with a flutter valve or a chest tube with drainage are techniques that help to drain air from the lung. However, these techniques are performed after needle decompression.

The nurse finds that a patient with chest trauma exhibits cyanosis, air hunger, neck vein distention, and an increase in intrathoracic pressure. The nurse prepares for which procedure? 1 Pericardiocentesis 2 Needle decompression 3 Insertion of a chest tube with a flutter valve 4 Insertion of a chest tube with a drainage system

C. paradoxic chest movement occurs during respiration

The nurse identifies a flair chest in a trauma patient when: A. multiple rub fractures are determined by an xray B. a tracheal deviation to the unaffected side is present C. paradoxic chest movement occurs during respiration D. there is decreased movement of the involved chest wall

3 To evaluate the use of intercostal muscles The nurse physically inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of respiratory distress experienced by the patient. Allowing time to calm the patient, observing for diaphoresis, and monitoring for bilateral chest expansion are correct, but they are not the primary reason for inspecting the chest wall of this patient.

The nurse is assigned to care for a patient who is experiencing an exacerbation of asthma and is very anxious. Which would be the primary reason for the nurse to carefully inspect the chest wall of this patient? 1 To allow time to calm the patient 2 To observe for signs of diaphoresis 3 To evaluate the use of intercostal muscles 4 To monitor the patient for bilateral chest expansion

1 Palpation must be performed to assess for crepitus. 2 At times, intubation and ventilation may be needed. 4 In cases of extreme chest trauma, surgical fixation of the flail segment may be done. Flail chest results from the fracture of three or more consecutive ribs in two or more separate places, causing an unstable segment. It also can be caused by a fracture of the sternum and several consecutive ribs. Observation of abnormal chest cavity movement, palpation for crepitus near the rib fractures, and chest x-ray all assist in the diagnosis. The paradoxical chest movement prevents adequate ventilation; intubation may be needed, and the nurse may need to provide ventilation. In cases of extreme chest trauma, surgical fixation of the flail segment may be done. With flail chest, the resulting instability of the chest wall (regardless of whether the sternum is fractured) causes paradoxical movement during breathing. The affected (flail) area moves in the opposite direction with respect to the intact part of the chest. During inspiration, the affected part is sucked in, and during expiration, it bulges out. This paradoxical chest movement prevents adequate ventilation and increases the work of breathing.

The nurse is caring for a patient who is at risk for a flail chest and recalls which information about the condition? Select all that apply. 1 Palpation must be performed to assess for crepitus. 2 At times, intubation and ventilation may be needed. 3 Paradoxical chest movements only occur if the sternum also is fractured. 4 In cases of extreme chest trauma, surgical fixation of the flail segment may be done. 5 Flail chest results from the fracture of two or more consecutive ribs on the same side. 6 Paradoxical chest movements involve the affected portion being sucked in during expiration and bulging out during inspiration.

1 Monitor gastric residual volumes. 2 Assess the gag reflex before giving foods or fluids by mouth. 4 Elevate the head of the bed to at least 30 degrees. 5 Encourage the patient to sit upright for all meals. Conditions that increase the risk for aspiration include the insertion of NG tubes with or without enteral feeding. Gastric residual volumes should be monitored to determine how well the patient is tolerating the feeding. The nurse should assess for a gag reflex before giving food or fluids by mouth. For the patient who has difficulty swallowing and needs aid in eating, drinking, and taking medication to prevent aspiration, the nurse should elevate the patient's head of the bed to at least 30 degrees and have the patient sit up for all meals. The health care provider will prescribe the rate at which the enteral feeding is to be administered.

The nurse is caring for a patient who receives enteral feeding through a nasogastric (NG) tube. Which actions does the nurse perform to prevent aspiration in this patient? Select all that apply. 1 Monitor gastric residual volumes. 2 Assess the gag reflex before giving foods or fluids by mouth. 3 Administer the initial feeding at a slow rate. 4 Elevate the head of the bed to at least 30 degrees. 5 Encourage the patient to sit upright for all meals.

A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation. The goal of effective coughing is to conserve energy, facilitate the removal of secretions, and minimize airway collapse. The client should assume a sitting position with feet on the floor if possible. The client should bend forward slightly and, using pursed-lip breathing, exhale. After resuming an upright position, the client should use abdominal breathing to slowly and deeply inhale.

The nurse is planning to teach a client with COPD how to cough effectively. Which of the following instructions should be included? A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation. B. Lie flat on back, splint the thorax, take two deep breaths and cough. C. Take several rapid, shallow breaths and then cough forcefully. D. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.

A. The inhaler is held upright. D. Mouth is rinsed with water following administration. Inhaled respiratory medications are often taken by using a device called a metered-dose inhaler, or MDI. The MDI is a pressurized canister of medicine in a plastic holder with a mouthpiece. When sprayed, it gives a reliable, consistent dose of medication. Tilt the head back slightly and breathe out all the way. Keep the chin up and the inhaler upright. Some inhalers (steroid) also recommend rinsing the mouth out with water and gargling with water (spit out the water) after use

The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a Corticosteroid drug. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply. A. The inhaler is held upright. B. Head is tilted down while inhaling the medication. C. Client waits 5 minutes between puffs. D. Mouth is rinsed with water following administration. E. Client lies supine for 15 minutes following administration.

4 Absence of breath sounds A pneumothorax indicates that one of the lungs has collapsed and is not functioning. Manifestations of a pneumothorax include dyspnea, decreased movement of the involved chest wall, decreased or absent breath sounds on the affected side, and hyperresonance on percussion. Because no air movement occurs with a pneumothorax, no breath sounds, including crackles, will be heard. Assessment findings will include hyperresonance on percussion.

The nurse provides care for a patient who experienced chest trauma. When the nurse assesses the right lung, which finding suggests a right-sided pneumothorax? 1 Inspiratory crackles 2 Pronounced crackles 3 Dullness on percussion 4 Absence of breath sounds

2 Tracheal deviation The nurse must check the patient's airway, breathing, and circulation. The clinical manifestation of tracheal deviation indicates that the patient is experiencing a tension pneumothorax, which is a medical emergency. It affects both the respiratory and cardiovascular systems. If the tension in the pleural space is not relieved, the patient is likely to die from inadequate cardiac output or severe hypoxemia. Pain may be caused by the other problems; this assessment is a lower priority than ensuring a patent airway. Circulatory compromise is identified with a rapid, thready pulse, and possible abdominal bleeding is indicated by bruising to the left flank; checking for these can follow checking for tracheal deviation.

The nurse provides care for a patient who sustained multiple injuries as a result of a motor vehicle accident. Which assessment finding requires immediate intervention? 1 Pain 2 Tracheal deviation 3 Rapid thready pulse 4 Bruising on left flank

2 "I should cough at regular intervals." 3 "I should use my incentive spirometer." 5 "I should perform range-of-motion exercises."

The nurse provides education for a patient about reducing the risk of atelectasis while undergoing chest tube drainage. Which statements made by the patient indicate effective learning? Select all that apply. 1 "I should change positions slowly." 2 "I should cough at regular intervals." 3 "I should use my incentive spirometer." 4 "I should reduce the intake of protein in my diet." 5 "I should perform range-of-motion exercises."

1 Wound caused by a gunshot The wound caused by a gunshot is a penetrating trauma because it is an open injury in which a foreign object enters into the body. A crush injury, when the chest is struck by an object, and when the chest strikes an object are examples of blunt trauma.

The nurse provides information to a group of nursing students about wounds that result from penetrating trauma to the chest wall and includes which example? 1 Wound caused by a gunshot 2 Wound caused by a crush injury 3 When the chest is struck by a baseball 4 When the chest strikes a steering wheel

1 Coils the tubing above the chest level 4 Connects the chest tube to wall suction to check for tidaling Coiling of the tubing above the chest level may cause fluid to drain back into the pleural cavity. Therefore the tubing of the drainage system should be coiled below the chest level. The chest tube should be disconnected from wall suction to check the tidaling because the suction will be increased.

The registered nurse is evaluating the actions of a nursing student who is maintaining a chest drainage unit (CDU) for a patient with chest trauma. The nurse intervenes when the student performs which actions? Select all that apply. 1 Coils the tubing above the chest level 2 Expects air fluctuations in the water-seal chamber 3 Verifies the presence of an air-occlusive dressing over the insertion site 4 Connects the chest tube to wall suction to check for tidaling 5 Positions the tubing so that the drainage flows freely from the insertion site to the collection chamber

3 Clamps the chest tube while the patient is ambulating Clamping of chest tubes during transport or when the tube is accidentally disconnected is no longer advocated. The danger of rapid accumulation of air in the pleural space, causing a tension pneumothorax, is far greater than that of a small amount of atmospheric air that enters the pleural space. Patients with chest tubes are usually placed in the semi-Fowler's position for the sake of comfort and ease of breathing. Fluid intake is not a major concern in light of the information provided. Administering the patient's prescribed narcotic analgesic before activity is an expected standard of care for this patient.

The registered nurse mentors a new graduate nurse. The new graduate provides care for a patient who has a chest tube in place after a partial lobectomy. Which action by the new graduate requires the mentor to intervene? 1 Positions the patient in the semi-Fowler's position 2 Encourages the patient to increase fluid intake 3 Clamps the chest tube while the patient is ambulating 4 Administers the patient's prescribed narcotic analgesic before activity

3 High-Fowler's The goal for positioning during an asthma attack is to maximize the patient's ability to inhale and exhale deep breaths, and the semi-to-high-Fowler's position will allow optimal chest expansion.

When a patient is experiencing an acute asthma attack, how will the nurse position the patient? 1 Supine 2 Lithotomy 3 High-Fowler's 4 Reverse Trendelenburg

3 Infuse IV corticosteroids. 4 Provide oxygen through a non-rebreather mask. 5 Start nebulized short-acting β2-adrenergic agonist. Acute exacerbation of asthma may be life-threatening and needs immediate intervention. IV corticosteroids will act quickly to decrease airway inflammation. High oxygen concentrations are needed to avoid hypoxemia and can be administered using a non-rebreather mask. Inhaled short-acting β2-adrenergic agonists will act quickly to dilate airways.

When a patient presents with acute exacerbation of asthma, which actions will the nurse anticipate as part of the interprofessional treatment plan? Select all that apply. 1 Administer antibiotics. 2 Give oral sedative medication. 3 Infuse IV corticosteroids. 4 Provide oxygen through a non-rebreather mask. 5 Start nebulized short-acting β2-adrenergic agonist.

4Increasing fluids to 2 to 3 L/day unless contraindicated Hydration is important in the supportive treatment of pneumonia to prevent dehydration and to thin and loosen secretions. The nurse should tell the patient to drink plenty of liquids (at least 6 to 10 glasses/day, unless contraindicated). The patient should be afebrile for 48 to 72 hours before stopping treatment. Although cough suppressants, mucolytics, bronchodilators, and corticosteroids are often prescribed as adjunctive therapy, the use of these drugs is debatable. The nurse should turn and reposition patients at least every two hours to promote adequate lung expansion and mobilization of secretions.

When planning care for a patient with pneumonia, the nurse recognizes which intervention as the highest priority? 1Administering analgesics as needed for pain 2Keeping the patient in a calm and quiet environment 3Routinely checking vital signs and oxygen saturation 4Increasing fluids to 2 to 3 L/day unless contraindicated

1 Avoid food irritants. 2 Avoid animals with fur. 3 Identify personal triggers. Patients with asthma should be taught to avoid food irritants and animals with fur. Identifying personal triggers can help to avoid them. Cold may cause bronchospasm and shortness of breath. NSAIDs are not recommended, because they can precipitate an asthma attack in some patients.

When teaching a patient with asthma about ways to reduce the severity of asthma and asthma attacks, which measures would be included? Select all that apply. 1 Avoid food irritants. 2 Avoid animals with fur. 3 Identify personal triggers. 4 Go out in the cold air for a walk. 5 Use nonsteroidal antiinflammatory drugs (NSAIDs).

4 Have the patient take 4 puffs of the prescribed albuterol inhaler. When the patient with asthma is in the red zone (less than 50% of the personal best peak flow), the initial treatment is use of an inhaled short acting β2-agonist inhaler for rapid bronchodilation. If there is no improvement, the patient is instructed to go to the emergency department for treatment.

Which action will the nurse take first when a patient with asthma calls the clinic and reports a peak flow rate of 45% of the personal best and dyspnea that occurs with any exertion? 1 Tell the patient to go to the hospital emergency department. 2 Anticipate an increased dose of the prescribed inhaled corticosteroid. 3 Schedule an appointment for spirometry testing as soon as possible. 4 Have the patient take 4 puffs of the prescribed albuterol inhaler.

1 Advise the patient to avoid breathing dry air. The patient data indicate exercise-induced asthma (EIA). Cold and dry air can precipitate bronchospasm and should be avoided in patients with EIA. Since cold air is likely to cause bronchospasm, the patient should avoid breathing cold air. The patient should stop exercising if dyspnea develops until consulting with a health care provider about possible treatments to prevent EIA. Swimming in indoor, heated pools is encouraged, since warm and moist air is less likely to trigger an asthma attack.

Which action would the nurse take when caring for a patient who has a history of asthma and experiences wheezing after vigorous exercise? 1 Advise the patient to avoid breathing dry air. 2 Teach that breathing cold air will decrease wheezing. 3 Recommend continuing vigorous exercise despite dyspnea. 4 Instruct the patient to avoid swimming in indoor, heated pools.

1 Flail chest Flail chest results in a loss of chest stability as a result of fracture of the ribs. The nurse should stabilize the flail segment with positive pressure ventilation (intubation and mechanical ventilation as needed).

Which condition in a patient with chest trauma requires treatment with positive pressure ventilation? 1 Flail chest 2 Cardiac tamponade 3 Hemopneumothorax 4 Tension pneumothorax

1 Wash the nebulizer regularly 3 Medication noncompliance may lead to exacerbations. 4 It is important to know the purpose and side effects of prescribed medications. The nurse should advise the patient to soak the nebulizer in soap and water because the hot water kills the germs on the nebulizer. Educating the patient about drugs and devices before discharge from the hospital is the responsibility of the nurse. The nurse should warn the patient about the dangers of noncompliance with the medications to avoid triggering asthma attacks. The patient should wash the mouth after inhalation of corticosteroids. The patient must wash respiratory equipment with 1:1 water and white vinegar.

Which discharge instructions would the nurse include for the patient with asthma? Select all that apply. 1 Wash the nebulizer regularly. 2 Wash the mouth after taking albuterol. 3 Medication noncompliance may lead to exacerbations. 4 It is important to know the purpose and side effects of prescribed medications. 5 Wash respiratory equipment with a solution of one part water to two parts white vinegar.

1 Aspirin 2 Perfumes 3 Animal dander 5 Gastroesophageal reflux disease (GERD)

Which factors are possible triggers for asthma exacerbations? Select all that apply. 1 Aspirin 2 Perfumes 3 Animal dander 4 Humid weather 5 Gastroesophageal reflux disease (GERD)

3 Bilateral lung crackles High concentrations of oxygen can lead to oxygen toxicity, caused by an inflammatory reaction at the alveolar-capillary membranes with symptoms of hypoxemia and pulmonary edema, including lung crackles. Tachypnea, rather than bradypnea, would occur with oxygen toxicity. PaCO2 levels are not diagnostic of oxygen toxicity, although they might be normal or decrease because of increased respiratory rate. Oxygen saturation would be low with oxygen toxicity because of poor gas exchange caused by pulmonary edema.

Which finding by the nurse indicates possible oxygen toxicity in a patient who has been receiving high oxygen concentrations for several days? 1 Bradypnea 2 Increased PaCO2 3 Bilateral lung crackles 4 Oxygen saturation 100%

3 New onset bilateral lung crackles The patient's new onset bilateral lung crackles may indicate pulmonary edema or acute respiratory distress syndrome caused by oxygen toxicity secondary to prolonged exposure to high oxygen concentrations. The crackles should be reported to the health care provider immediately because rapid action will be needed

Which finding in a patient who has been receiving high concentrations of oxygen for a week is most important for the nurse to report to the health care provider? 1 Oxygen saturation 90% 2 Dry oral mucous membranes 3 New onset bilateral lung crackles 4 Respiratory rate 26 breaths/min

1 FEV1/FVC ratio of 65% FEV1/FVC ratio is the ratio of the forced expiratory volume to the forced vital capacity of the lungs. A ratio of 70% or less supports a COPD diagnosis in patients who are suspected to have COPD.

Which finding would confirm a diagnosis of chronic obstructive pulmonary disease (COPD) in a patient with dyspnea and a history of tobacco use? 1 FEV1/FVC ratio of 65% 2 Positive sputum culture 3 Flat diaphragm upon chest x-ray 4 Oxygen saturation of 86% at rest

1 Barrel chest on inspection 4 Wheezes on auscultation Because of chest expansion caused by air trapping in COPD, patients develop a barrel chest. Breath sounds decrease because of less air movement caused by air trapping, and wheezes are heard because of narrowing of airways caused by inflammation and increased mucus production. Egophony is heard with consolidation of lung tissue, such as that which occurs in patients with pneumonia or pleural effusion. Dullness on percussion would indicate a consolidation of fluid or tissue in the lungs, which is not consistent with COPD. Tactile fremitus is decreased in COPD because trapped air leads to less transmission of vibration from the airways to the chest surface.

Which findings will the nurse expect when assessing a clinic patient with chronic obstructive pulmonary disease (COPD)? Select all that apply. 1 Barrel chest on inspection 2 Egophony on auscultation 3 Dullness on percussion 4 Wheezes on auscultation 5 Increased tactile fremitus on palpation

4 Immerse the distal end of the chest tube in sterile water. If the drainage system breaks, the nurse should place the distal end of the chest tubing connection in a sterile water container at a 2-cm level as an emergency water seal. This will reduce the risk of air entering the pleural space.

Which immediate action does the nurse take when discovering that a patient's chest tube is disconnected from the chest drainage unit (CDU)? 1 Apply a clamp to the distal end of the chest tube. 2 Place the patient in a supine position. 3 Wrap a petroleum (airtight) gauze over the end of the chest tube. 4 Immerse the distal end of the chest tube in sterile water.

3 Preventing air trapping Pursed-lip breathing decreases air trapping and carbon dioxide retention by increasing positive pressure within the airways, which helps empty the lungs more fully during expiration. Pursed-lip breathing uses slightly more energy than normal exhalation because the patient needs to exhale against positive pressure; patients are taught to use "just enough" positive pressure to avoid increasing the work of breathing. Chest pain is not relieved by pursed-lip breathing. Since the expiratory phase of breathing is lengthened with pursed-lip breathing, respiratory rate is decreased.

Which information about the purpose of pursed-lip breathing will the nurse include when teaching a patient with chronic obstructive pulmonary disease about breathing exercises? 1 Conserving energy 2 Relieving chest pain 3 Preventing air trapping 4 Increasing respiratory rate

4 "You should find your personal best peak flow reading for comparison." It is important that the patient initially determine the personal best readings when first using a peak flow meter to evaluate for decreasing airway function. It should be used at least twice a day for the first two weeks to determine the patient's personal best

Which information will the nurse include when educating a patient with asthma about use of a peak flow meter? 1 "The peak flow meter should be used weekly." 2 "The peak flow meter reduces asthma attacks." 3 "You will need to measure peak flows soon after arising in the morning" 4 "You should find your personal best peak flow reading for comparison."

3 "Bear down while the tube is being removed." Chest tubes are removed when the lungs are reexpanded and fluid drainage has ceased or is minimal. The patient should hold his or her breath or bear down (Valsalva maneuver) while the tube is removed to prevent air from entering the pleural space.

Which instruction does the nurse give to a patient when removing the patient's chest tube? 1 "Lie on the side that is the opposite of the chest tube." 2 "Take some deep breaths throughout the procedure." 3 "Bear down while the tube is being removed." 4 "Drink a large amount of water just before the procedure."

3 Sit in an upright position during the treatment. An upright position allows for efficient breathing that ensures adequate penetration and deposition of the aerosolized medication. The patient should hold the inspiration for two to three seconds to ensure penetration of the medication. The patient should practice deep breathing in between the forced breathing to prevent alveolar hypoventilation. The patient should be encouraged to cough effectively after the nebulization to mobilize the secretions.

Which instruction will the nurse give to the patient who is receiving a nebulized bronchodilator treatment? 1 Hold each inspiration for 10 seconds. 2 Breathe rapidly between forced breaths. 3 Sit in an upright position during the treatment. 4 Avoid coughing after the nebulization treatment.

4 "Try to hold your breath for at least 10 seconds after inhaling the medication."

Which instruction will the nurse include when teaching a patient to use a dry powder inhaler (DPI)? 1 "Shake the canister vigorously before each use." 2 "Inhale slowly and deeply after activating the device." 3 "Keep your mouth open slightly while inhaling the medication" 4 "Try to hold your breath for at least 10 seconds after inhaling the medication."

3 IV methylprednisolone Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the short-acting β2-adrenergic agonist bronchodilator is insufficient. Inhaled corticosteroids such as fluticasone may be prescribed once the acute attack has resolved, but they take days or weeks to reach the maximum therapeutic level and would not be prescribed for an acute attack. Long-acting β2-adrenergic agonists such as salmeterol may be added to the patient's medical regimen after the acute attack has resolved, but they would not be ordered to treat an acute attack. IV fluids may be prescribed, but they will not improve the inflammation and bronchoconstriction that are the cause of the asthma attack.

Which interprofessional treatment will the nurse anticipate being prescribed first for a patient who is seen in the emergency department for an asthma attack and has not improved after administration of albuterol? 1 Fluticasone inhaler 2 Salmeterol inhaler 3 IV methylprednisolone 4 Normal saline IV bolus

2 Administer a pain medication to the patient. While removing the chest tube, the patient may have pain; therefore the nurse administers pain medication 30 to 60 minutes before the procedure. A sterile field should be prepared immediately before a sterile procedure. There is insufficient information to determine the status of the chest tube. It is highly unlikely that the chest tube is to be clamped because this increases pressure within the pleural space. The patient does not need to be NPO before the procedure.

Which intervention does the nurse perform 30 minutes before removing a chest tube from a patient? 1 Prepare a sterile field that includes a petroleum dressing. 2 Administer a pain medication to the patient. 3 Clamp the chest tube. 4 Ensure that the patient has nothing NPO.

3 Sit the patient upright in a chair leaning slightly forward. The patient with COPD can engage in better gas exchange in an upright position leaning slightly forward. Once the patient's oxygen increases, the nurse may obtain an ABG if requested by the health care provider. Administering 6 L of oxygen is too much oxygen for a patient with chronic bronchitis. Placing the patient in a prone position would further impair gas exchange.

Which intervention may improve gas exchange for a patient with chronic obstructive pulmonary disease (COPD) whose oxygen saturation is 88%? 1 Obtain an arterial blood gas (ABG). 2 Administer 6 L of oxygen via nasal cannula. 3 Sit the patient upright in a chair leaning slightly forward. 4 Place the patient in the prone position to increase postural drainage.

2 Shallow respirations An unconscious patient who has fractures of consecutive ribs will have rapid and shallow respirations. A flail chest is usually apparent on physical examination. The patient has rapid, shallow respirations and tachycardia.

Which is a primary clinical manifestation of flail chest in an unconscious patient? 1 Cyanosis 2 Shallow respirations 3 Neck vein distention 4 Decreased heart rate

2 Inspection of the chest wall The nurse physically inspects the chest wall to evaluate the use of intercostal muscles, which gives an indication of the degree of respiratory distress experienced by the patient.

Which is the priority assessment for a patient experiencing an acute asthma exacerbation? 1 Assessing pupillary response to light 2 Inspection of the chest wall 3 Measurement of pedal pulses 4 Auscultation of apical pulse rate

3 To expose the midaxillary area The midaxillary area is the standard site for the insertion of a chest tube. Therefore the nurse will position the patient with the arm raised above the head on the affected side to expose the midaxillary area. Analgesics will be given to the patient to minimize pain. The patient's head will be elevated to reduce the risk of injury. The chest tube will be advanced up over the top of the rib to avoid the intercostal nerves.

Which is the reason that the nurse, while assisting with insertion of a chest tube, positions the patient with the arm raised above the head on the affected side? 1 To minimize pain 2 To reduce the risk of injury 3 To expose the midaxillary area 4 To avoid the intercostal nerves

4 Rinse the mouth with water after the second puff of medication.

Which method of oral care helps to prevent oral infection for the patient who is taking fluticasone? 1 Rinse the mouth daily with an oral antibiotic solution. 2 Rinse the mouth with water before each puff of medication. 3 Brush the teeth before and after medication administration. 4 Rinse the mouth with water after the second puff of medication.

4 Teaching the patient how to cough effectively and expectorate secretions Although several interventions may help the patient expectorate mucus, the nursing interventions should focus on teaching the patient how to cough effectively and expectorate secretions.

Which nursing intervention assists a patient with pneumonia in managing thick secretions and fatigue? 1 Performing postural drainage every hour 2 Providing analgesics as prescribed to promote patient comfort 3 Administering oxygen as prescribed to maintain optimal oxygen saturation levels 4 Teaching the patient how to cough effectively and expectorate secretions

A. Increased PaCO2 As COPD progresses, the client typically develops increased PaCO2 levels and decreased PaO2 levels. This results in decreased pH and decreased oxygen saturation. These changes are the result of air trapping and hypoventilation. Arterial blood gas (ABG) analysis provides the best clues as to acuteness and severity of disease exacerbation.

Which of the following ABG abnormalities should the nurse anticipate in a client with advanced COPD? A. Increased PaCO2 B. Increased PaO2 C. Increased pH D. Increased oxygen saturation

D. High calorie, high-protein diet The client should eat high-calorie, high-protein meals to maintain nutritional status and prevent weight loss that results from the increased work of breathing. The client should be encouraged to eat small, frequent meals. Eat 20 to 30 grams of fiber each day,

Which of the following diets would be most appropriate for a client with COPD? A. Low fat, low cholesterol B. Bland, soft diet C. Low-Sodium diet D. High calorie, high-protein diet

A. Incorporate physical exercise as tolerated into the treatment plan. Physical exercise is beneficial and should be incorporated as tolerated into the client's schedule. Peak flow numbers should be monitored daily, usually in the morning (before taking medication). Encourage breathing exercises and controlled breathing and relaxation. Prevents attack before it begins and increases ventilation.

Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma? A. Incorporate physical exercise as tolerated into the treatment plan. B. Monitor peak flow numbers after meals and at bedtime. C. Eliminate stressors in the work and home environment. D. Use sedatives to ensure uninterrupted sleep at night.

A. Maintaining functional ability. A priority goal for the client with COPD is to manage the s/s of the disease process so as to maintain the client's functional ability. Evaluate the level of activity tolerance. Provide a calm, quiet environment. Limit a patient's activity or encourage bed or chair rest during the acute phase. Have patient resume activity gradually and increase as individually tolerated.

Which of the following is a priority goal for the client with COPD? A. Maintaining functional ability. B. Minimizing chest pain. C. Increasing carbon dioxide levels in the blood. D. Treating infectious agents.

2 Administering the beclomethasone before the albuterol Albuterol, a β2-adrenergic agonist medication, should be used first to dilate the airways before administration of the corticosteroid beclomethasone. Administering the beclomethasone on a set schedule to prevent an asthma attack and rinsing the mouth following use of the inhalers are correct actions.

Which patient action when using albuterol and beclomethasone inhalers indicates a need for further teaching? 1 Rinsing the mouth following use of the inhalers 2 Administering the beclomethasone before the albuterol 3 Administering the albuterol before the beclomethasone 4 Administering the beclomethasone on a set schedule to prevent an asthma attack

1 Relief of symptoms 2 Improved quality of life 4 Prevention of disease progression 5 Ability to perform activities of daily living (ADLs) The overall goals are that the patient with COPD will have (1) prevention of disease progression, (2) ability to perform ADLs and improved exercise tolerance, (3) relief from symptoms, (4) no complications related to COPD, (5) knowledge and ability to implement a long-term treatment regimen, and (6) overall improved quality of life. Lung tissue does not regenerate, so "healing" is not a realistic goal. Patients need to know that symptoms can be managed, but COPD cannot be cured.

Which patient care goals are appropriate for a patient with chronic obstructive pulmonary disease (COPD)? Select all that apply. 1 Relief of symptoms 2 Improved quality of life 3 Healing of damaged lung tissue 4 Prevention of disease progression 5 Ability to perform activities of daily living (ADLs)

3 "More of the medication will get down into my lungs to help my breathing."

Which statement by a patient indicates good understanding of the purpose of a spacer when using a metered-dose inhaler? 1 "I will pay less for medication because it will last longer." 2 "This device will make it so much faster to take my inhaled medications." 3 "More of the medication will get down into my lungs to help my breathing." 4 "Now I will not need to breathe in as deeply when taking the inhaler medications."

2 A decrease in exhaled nitric oxide Nitric oxide levels are increased in the breath of people with asthma. A decrease in the exhaled nitric oxide concentration suggests that the treatment may be decreasing the lung inflammation associated with asthma and adherence to treatment. An increase in CO2 levels, decreased white blood cell count, and increased serum bicarbonate levels do not indicate a positive response to treatment in the patient with asthma.

Which test result indicates to the nurse that a patient with asthma is responding to treatment? 1 An increase in CO2 levels 2 A decrease in exhaled nitric oxide 3 A decrease in white blood cell count 4 An increase in serum bicarbonate levels

1 Lobectomy A lobectomy is a type of chest surgery that involves the removal of one lobe of the lung. A pneumonectomy is a type of chest surgery that involves the removal of an entire lung. A wedge resection is a type of surgery that involves the removal of only a small, localized lesion. A segmental resection is a type of surgery that involves the removal of one or more lung segments.

Which type of surgery involves the removal of one lobe of the lung? 1 Lobectomy 2 Pneumonectomy 3 Wedge resection 4 Segmental resection