Med-surge Resp

A client with the diagnosis of osteogenic sarcoma has metastasis to the lung. Which client statement about the concept of metastasis indicates a need for further instruction?

1 "I'm upset to know that the tumor may metastasize to my bones."

A client is admitted to the hospital with a tentative diagnosis of pneumonia. The client has a high fever and is short of breath. Bed rest, oxygen via nasal cannula, an intravenous antibiotic, and blood and sputum specimens for culture and sensitivity (C&S) are prescribed. Place these interventions in the order in which they should be implemented.

1.Oxygen via nasal cannula 3.Bed rest 2.Specimens for C&S 4.Administration of an antibiotic

A client is admitted to the hospital for a surgical resection of the lower left lobe of the lung. After surgery the client has a chest tube to a closed-chest drainage system. What should the nurse do to determine if the chest tube is patent?

3 Observe for fluctuations of the fluid in the water-seal chamber

A nurse is caring for a client after abdominal surgery and encourages the client to turn from side to side and to engage in deep-breathing exercises. What complication is the nurse trying to prevent?

3 Respiratory acidosis

When auscultating a client's chest, the nurse hears swishing sounds of normal breathing. The nurse should document:

3 Vesicular breath sounds

A client is admitted with suspected atelectasis. Which clinical manifestation does the nurse expect to identify when assessing this client?

4 Diminished breath sounds

A client with bronchial pneumonia is having difficulty maintaining airway clearance because of retained thick secretions. To decrease the amount of secretions retained, the nurse plans to:

4 Increase fluid intake to at least 2 L a day

A client with chronic obstructive pulmonary disease has increased hemoglobin and hematocrit levels. The nurse concludes that the altered blood levels are caused by:

4 Increased erythrocyte production as a result of chronic hypoxia

A client with chronic bronchitis smokes one or two cigarettes a day and has not been performing the prescribed pulmonary physiotherapy exercises because they are too tiring. What is the best response by the nurse?

1 "Tell me about your typical day before the exercises were prescribed."

What technique should a nurse use when cleaning a tracheostomy tube that has a nondisposable inner cannula?

1 Apply a precut dressing around the insertion site with the flaps pointing upward

What nursing action will limit hypoxia when suctioning a client's airway

1 Apply suction only after catheter is inserted

A nurse is administering oxygen to a client with chest pain who is restless. What method of oxygen administration will most likely prevent a further increase in the client's anxiety level?

1 Cannula

A client had thoracic surgery. The nurse should monitor for what clinical manifestations that may indicate acute pulmonary edema? Select all that apply.

1 Crackles 2 Cyanosis 3 Dyspnea 5 Frothy sputum

A client is diagnosed with thrombophlebitis. The client states, "I am worried about getting a clot in my lungs that will kill me." The nurse's initial response should be to:

1 Discuss the client's concerns

The nurse is caring for a client who recently returned from another country who exhibits signs and symptoms suspicious of severe acute respiratory syndrome (SARS). Which clinical manifestations support this diagnosis? (Select all that apply.)

1 Dry cough 4 Shortness of breath 5 Fever greater than 100.4° F

A nurse is caring for several postoperative clients. For what clinical manifestations of a pulmonary embolus should the nurse monitor these clients? (Select all that apply.)

1 Dyspnea 3 Hemoptysis 5 Feeling of impending doom

During a client's routine physical examination, a chest x-ray film reveals a lesion in the right upper lobe. What information in the client's history supports the health care provider's diagnosis of pulmonary tuberculosis? (Select all that apply.)

1 Fever 3 Night sweats 6 Blood-tinged sputum

After emergency surgery, the nurse teaches a client how to use an incentive spirometer. What client behavior indicates to the nurse that the spirometer is being used correctly?

1 Inhales deeply through the mouthpiece, relaxes, and then exhales

A client with terminal cancer signs a do-not-resuscitate (DNR) order upon admission to the hospital. When the client goes into respiratory arrest a week later, the client is not resuscitated. Which factor does the nurse determine is most relevant to the legal aspects of a DNR order?

1 Policies of the agency establish the status of DNR orders

A client who is a pipe smoker is diagnosed with cancer of the tongue. A hemiglossectomy and right radical neck dissection are performed. To ensure airway patency during the first hours after surgery, the nurse should:

1 Suction as needed

A client is hospitalized with a diagnosis of emphysema. The nurse provides teaching and should begin with which aspect of care?

1 The disease process and breathing exercises

A client with a long history of asthma is scheduled for surgery. What information should be included in preoperative teaching?

1 There is an increased risk of respiratory tract infections.

A client with tuberculosis is to begin Rifater (combination of isoniazid [INH], rifampin [RIF], and pyrazinamide [PZA]), and streptomycin sulfate (streptomycin) therapy. The client says, "I've never had to take so much medication for an infection before." The nurse should explain:

1 This type of organism is difficult to destroy."

After a gastroscopy, the nurse assesses the client for the return of the gag reflex by:

1 Touching the pharynx with a tongue depressor

A client with chronic obstructive pulmonary disease (COPD) reports chest congestion, especially upon wakening in the morning. The nurse should suggest that the client:

1 Use a humidifier in the bedroom

The nurse provides teaching about self-care management to a client who recently was diagnosed with emphysema. The nurse concludes that further teaching is needed when the client states:

2 "I will maintain complete bed rest.

The nurse is caring for a 75-year-old client that had radical head and neck surgery. Thirty minutes after awakening from anesthesia, the client becomes agitated, disoriented, and confused. The nurse should:

2 Administer the prescribed oxygen

A nurse auscultates a client's lungs and hears a fine crackling sound in the left lower lung during respiration. The nurse charts, "crackles and rhonchi in the left lower lung." What does this documentation represent?

2 An inaccurate interpretation

A nurse is caring for a client who is admitted to the hospital with severe dyspnea and a diagnosis of cancer of the lung. The nurse concludes that the severe dyspnea probably is caused by:

2 Bronchial obstruction or pleural effusion

A client is diagnosed with emphysema. For what long-term problem should the nurse monitor this client?

2 Carbon dioxide retention

A client just had a thoracentesis. For which response is it most important for the nurse to observe the client?

2 Expectoration of blood

In addition to Pneumocystis jiroveci, a client with acquired immunodeficiency syndrome (AIDS) also has an ulcer 4 cm in diameter on the leg. Considering the client's total health status, the most critical concern is:

2 Gas exchange

A client develops subcutaneous emphysema after a chest injury with suspected pneumothorax. What assessment by the nurse is the best method for detecting this complication?

2 Palpating the neck or face

After surgery for cancer of the posterior pharynx, a client is receiving gavage feedings through a nasogastric tube. A family member asks why this is necessary. What is the nurse's best response?

2 Tube feedings promote healing by reducing the risk for infection.

After resection of a lower lobe of the lung, a client has excessive respiratory secretions. Which independent nursing action should the nurse implement?

2 Turning and positioning

A nurse is caring for a client who had a pneumonectomy. What is the priority nursing assessment?

2 Ventilatory exchange

A client has a persistent productive cough that becomes blood tinged. A needle biopsy is scheduled. The client tells the nurse, "During the procedure, a needle will be inserted into my back to collapse my lung." Which is the most appropriate response by the nurse?

3 "Tell me more about the conversation you had with your health care provider."

A client has chronic obstructive pulmonary disease (COPD). To decrease the risk of CO2 intoxication (CO2 narcosis), the nurse should:

3 Administer oxygen at a low concentration to maintain respiratory drive

The nurse auscultates fine crackles in a client who has been in respiratory distress. When the nurse is providing information to the client about crackles, which would be appropriate to include?

3 Crackles are located in the smaller air passages.

Polycythemia frequently is associated with chronic obstructive pulmonary disease (COPD). When assessing for this complication, the nurse should monitor for:

3 Elevated hemoglobin

During a client's immediate postoperative period after a laryngectomy, a nursing priority is to:

3 Keep the trachea free of secretions

A nurse is caring for a client with severe dyspnea who is receiving oxygen via a Venturi mask. What should the nurse do when caring for this client?

3 Monitor oxygen saturation levels when eating.

The nurse is caring for a client that has a lesion in the right upper lobe. A diagnosis of tuberculosis (TB) has been made. What are the clinical manifestations of tuberculosis?

3 Night sweats and blood-tinged sputum

A client arrives in the emergency department with multiple crushing wounds of the chest, abdomen, and legs. The priority nursing assessments are:

3 Quality of respirations and presence of pulses

A client is scheduled to receive general anesthesia during an upcoming surgery. The nurse provides education about common side effects of general anesthesia. The nurse concludes that the teaching has been effective when the client states, "Immediately after surgery I may experience:

4 A sore throat."

A nurse is preparing to insert a nasogastric tube. During insertion, which response indicates that the client is experiencing difficulty?

4 Inability to speak

The nurse reinforces instructions about how to use a nebulizer to a client with chronic obstructive pulmonary disease (COPD). The nurse concludes that additional teaching is needed when the client:

4 Inhales with the lips tightly sealed around the mouthpiece of the nebulizer

A nurse is teaching a preoperative client about postoperative breathing exercises. What information should the nurse include? (Select all that apply.)

4 Place a hand on the abdomen while feeling it rise 5 Hold the breath for several seconds at the height of inspiration

Clients are encouraged to perform deep-breathing exercises after most types of surgery. The nurse teaches clients that the reason for these exercises is to help:

4 Prevent the buildup of carbon dioxide in the body

What should the nurse expect when assessing a client with pleural effusion?

4 Reduced or absent breath sounds at the base of the lung

A nurse works with a large population of immigrant clients and is concerned about the debilitating effects of influenza. Which action is the first line of defense against an emerging influenza pandemic?

4 Reporting surveillance findings to appropriate public health officials

When caring for an anxious patient, the nurse should monitor for which signs of hyperventilation?

4 Respiratory alkalosis

A client has a chest tube inserted to treat a right hemopneumothorax. In which position should the nurse place the client to facilitate chest drainage?

4 Right side-lying

A skier skied off the marked trail into the woods and collided with a tree. After several hours, the skier was found by the ski patrol and brought to the emergency department of the hospital. Moderate hypothermia (temperature range 87° to 90° F) is diagnosed. What clinical findings specific to moderate hypothermia should the nurse expect the client to exhibit?

4 Rigidity and slowed respiratory rate

A client with emphysema has a history of smoking two packs of cigarettes a day. What is the best approach for the nurse to help the client stop smoking?

4 Suggest that the client limit smoking to one pack of cigarettes a day

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). During assessment, the nurse expects to auscultate:

Diminished breath sounds

A client with pulmonary tuberculosis is being treated at home. To help control the spread of the disease, the nurse instructs the client to:

Open the windows frequently to allow air to circulate throughout the house