MedSurg 2 - Respiratory Disorders

A nurse is preparing a client with a pleural effusion for a thoracentesis. The nurse should assist the client to a sitting position on the edge of the bed, leaning over the bedside table. raise the arm on the side of the client's body on which the physician will perform the thoracentesis. place the client supine in the bed, which is flat. raise the head of the bed to a high Fowler's position.

assist the client to a sitting position on the edge of the bed, leaning over the bedside table.

A nurse is caring for a client with a traumatic injury and developing tension pneumothorax. Which assessment data would be of concern? Select all that apply. decreased cardiac output flattened jugular veins tracheal deviation to the affected side hypotension tracheal deviation to the opposite side bradypnea

decreased cardiac output hypotension tracheal deviation to the opposite side

A client with severe acute respiratory syndrome privately informs the nurse of a desire not to be placed on a ventilator if the condition worsens. The client's partner and children have repeatedly expressed their desire that every measure be taken for the client. The most appropriate intervention by the nurse would be to: encourage the client to consider a living will or power of attorney. ask the physician to discuss the client's prognosis with the client and the family. arrange a conference to discuss the matter with all involved. assure the client that all possible measures will be taken.

encourage the client to consider a living will or power of attorney.

Which finding in a client who is receiving albuterol would require a nurse to take immediate action? stridor crackles wheezes pleural rub

stridor

The nurse is evaluating the effectiveness of a teaching plan for a client recovering from an upper respiratory tract infection. Which is an expected outcome of the plan? The client will: maintain a fluid intake of 800 ml every 24 hours. have a temperature below 100ºF (37.8ºC). cough productively without chest discomfort. experience less nasal obstruction and discharge.

experience less nasal obstruction and discharge.

The health care provider (HCP) has prescribed pseudoephedrine. The nurse should instruct the client about which possible adverse effect of this drug? constipation bradycardia diplopia restlessness

restlessness

With a diagnosis of right rib fracture and closed pneumothorax, the client should be placed in which position? modified Trendelenburg's position with the lower extremities elevated reverse Trendelenburg's position with the head down left side-lying position with the head elevated 15 to 30 degrees semi- to high-Fowler's position, tilted toward the right side

semi- to high-Fowler's position, tilted toward the right side

A client has been in an automobile accident, and the nurse is assessing the client for possible pneumothorax. What finding should the nurse immediately report to the health care provider? sudden, sharp chest pain wheezing breath sounds over affected side hemoptysis cyanosis

sudden, sharp chest pain

When developing a discharge plan with a client with chronic obstructive pulmonary disease (COPD), what information should the nurse include in the plan? People with COPD: develop respiratory infections easily. usually maintain their current status. require less supplemental oxygen. show permanent improvement.

develop respiratory infections easily.

A nurse is weaning a client from mechanical ventilation. Which assessment finding indicates the weaning process should be stopped? respiratory rate of 16 breaths/minute oxygen saturation of 93% runs of ventricular tachycardia blood pressure increase from 120/74 mm Hg to 134/80 mm Hg

runs of ventricular tachycardia

Which finding in a client who is receiving albuterol would require a nurse to take immediate action? stridor crackles wheezes pleural rub

stridor

The nurse observes a constant gentle bubbling in the water seal column of a water seal chest drainage system. What should the nurse do next? Continue monitoring as usual; this is expected. Check the connectors between the chest and drainage tubes and where the drainage tube enters chest drainage system. Decrease the suction and continue observing the system for changes in bubbling during the next several hours. Notify the health care provider (HCP).

Check the connectors between the chest and drainage tubes and where the drainage tube enters chest drainage system.

A nurse is caring for a client who has a tracheostomy tube and who is undergoing mechanical ventilation. The nurse can help prevent tracheal dilation, a complication of tracheostomy tube placement, by suctioning the tracheostomy tube frequently. using a cuffed tracheostomy tube. using the minimal-leak technique with cuff pressure less than 25 cm H2O. keeping the tracheostomy tube plugged.

using the minimal-leak technique with cuff pressure less than 25 cm H2O.

A client with emphysema is receiving continuous oxygen therapy. Depressed ventilation is likely to occur unless the nurse ensures that the oxygen is administered in which way? cooled humidified at a low flow rate through nasal cannula

at a low flow rate

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? "Limit yourself to smoking only 2 cigarettes per day." "Eat a high-sodium diet." "Weigh yourself daily and report a gain of 2 lb (0.91 kg) in 1 day." "Maintain bed rest."

"Weigh yourself daily and report a gain of 2 lb (0.91 kg) in 1 day."

Which client's care may a registered nurse (RN) safely delegate to the nursing assistant? a client who requires continuous pulse oximetry monitoring admitted with bronchitis a client requiring assistance ambulating, who was admitted with a history of seizures a client with a trach that requires intermittent suctioning a client with end-stage chronic obstructive pulmonary disease receiving patient-controlled analgesia.

a client requiring assistance ambulating, who was admitted with a history of seizures

A client with chronic obstructive pulmonary disease (COPD) is being evaluated for a lung transplant. Which initial assessment data would the nurse anticipate? Select all that apply. decreased respiratory rate dyspnea on exertion barrel chest shortened expiratory phase unintended weight loss fever

decreased respiratory rate dyspnea on exertion barrel chest unintended weight loss

A client who sustained a pulmonary contusion in a motor vehicle crash develops a pulmonary embolism. Which nursing diagnosis takes priority with this client? impaired circulation related to blood clot acute pain related to tissue trauma ineffective breathing pattern related to tissue trauma risk for vascular trauma related to pulmonary emboli

ineffective breathing pattern related to tissue trauma

A client with cystic fibrosis develops pneumonia. To decrease the viscosity of respiratory secretions, the physician orders acetylcysteine. Before administering the first dose, the nurse checks the client's history for asthma. Acetylcysteine must be used cautiously in a client with asthma because it is a respiratory depressant. is a respiratory stimulant. may induce bronchospasm. inhibits the cough reflex.

may induce bronchospasm.

A client who is intubated on mechanical ventilation develops subcutaneous emphysema. Which ventilator setting should the nurse anticipate being adjusted for this client? ventilator rate oxygen concentration number of assisted breaths positive end-expiratory pressure (PEEP)

positive end-expiratory pressure (PEEP)

The health care provider (HCP) has prescribed pseudoephedrine. The nurse should instruct the client about which possible adverse effect of this drug? constipation bradycardia diplopia restlessness

restlessness

A nurse is caring for a client who is at high risk for developing pneumonia. Which intervention should the nurse include on the client's care plan? keeping the head of the bed at 15 degrees or less turning the client every 4 hours to prevent fatigue using strict hand hygiene providing oral hygiene daily

using strict hand hygiene

The nurse is evaluating a client's breath sounds. Which breath sound indicates adequate ventilation when auscultated over the lung fields? vesicular bronchial bronchovesicular adventitious

vesicular

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

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

A nurse instructs a client with allergic rhinitis about the correct technique for using an intranasal inhaler. Which statement indicates that the client understands the instructions? "I should limit the use of the inhaler to early morning and bedtime use." "It is important to not shake the canister because that can damage the spray device." "I should hold one nostril closed while I insert the spray into the other nostril." "The inhaler tip is inserted into the nostril and pointed toward the inside nostril wall."

"I should hold one nostril closed while I insert the spray into the other nostril."

For a client with asthma, the health care provider (HCP) prescribes albuterol, two puffs twice a day via a metered-dose inhaler (MDI), and beclomethasone, two puffs twice a day via MDI. How should the nurse instruct the client to administer these drugs? "Take the medications 1 hour apart, two times a day." "Take the albuterol first and follow with beclomethasone two times a day." "Take the albuterol on awakening and alternate the medications every 4 hours." "Take the beclomethasone inhaler first and follow with albuterol."

"Take the albuterol first and follow with beclomethasone two times a day."

A client with asthma is receiving a theophylline preparation to promote bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the client's serum theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls within which range? 2 to 5 mcg/ml 5 to 10 mcg/ml 10 to 20 mcg/ml 21 to 25 mcg/ml

10 to 20 mcg/ml

A client develops respiratory distress and requires endotracheal intubation. How much pressure should be applied to the cuff to ensure adequate placement of this tube? 15 to 20 mm Hg 21 to 25 mm Hg 26 to 30 mm Hg 31 to 35 mm Hg

15 to 20 mm Hg

A client undergoes surgery to repair lung injuries. Postoperative orders include the transfusion of one unit of packed red blood cells at a rate of 60 ml/hour. How long will this transfusion take to infuse? 2 hours 4 hours 6 hours 8 hours

4 hours

A client undergoes surgery to repair lung injuries. Postoperative orders include the transfusion of one unit of packed red blood cells at a rate of 60 ml/hour. How long will this transfusion take to infuse? 2 hours 4 hours 6 hours 8 hours

4 hours

A client with asthma is receiving a theophylline preparation to promote bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the client's serum theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls within which range? 2 to 5 mcg/ml 5 to 10 mcg/ml 10 to 20 mcg/ml 21 to 25 mcg/ml

5 to 10 mcg/ml

Which of the following activities should the nurse teach the client to implement after the removal of nasal packing on the second postoperative day? Avoid cleaning the nares until swelling has subsided. Apply water-soluble jelly to lubricate the nares. Keep a nasal drip pad in place to absorb secretions. Use a bulb syringe to gently irrigate nares.

Apply water-soluble jelly to lubricate the nares.

A client admitted with pneumonia and dementia has attempted several times to pull out the IV and Foley catheter. After trying other options, the nurse obtains a prescription for bilateral soft wrist restraints. Which nursing action is most appropriate? Perform circulation checks to bilateral upper extremities each shift. Attach the ties of the restraints to the bedframe. Reevaluate the need for restraints and document weekly. Ensure the restraint prescription has been signed by the health care provider (HCP) within 72 hours.

Attach the ties of the restraints to the bedframe.

A client with bacterial pneumonia is coughing up tenacious, purulent sputum. Which action would help liquefy these viscous secretions? Perform postural drainage. Breathe humidified air. Clap and percuss over the affected lung. Perform coughing and deep-breathing exercises.

Breathe humidified air.

A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing, and breath sounds aren't audible. What is the likely cause of these assessment findings? The asthma attack has resolved, and airflow is restored. Bronchial edema and constriction have worsened. The administered albuterol (salbutamol) has been effective. The client has developed acute pulmonary edema.

Bronchial edema and constriction have worsened.

A client with pneumonia has a temperature of 102.6° F (39.2° C), is diaphoretic, and has a productive cough. The client is able to ambulate. What should the nurse do? Change the client's position every 4 hours. Use nasotracheal suctioning to clear secretions. Change the bed sheets frequently. Offer the use of a bedpan every 2 hours.

Change the bed sheets frequently.

The nurse is caring for a client scheduled for a bronchoscopy. Which interventions should the nurse perform to prepare the client for this procedure? Select all that apply. Administer prescribed atropine and a sedative. Withhold food and fluids for 2 hours before the test. Ask the client to remove any dentures Provide a clear liquid diet for 6 to 12 hours before the test. Confirm that a signed informed consent form has been obtained.

Confirm that a signed informed consent form has been obtain Ask the client to remove any dentures Administer prescribed atropine and a sedative.

A client with pulmonary fibrosis is prescribed home oxygen therapy. Which health team member is responsible for evaluating the client's knowledge of home oxygen use? home health nurse respiratory rehabilitation assistant hospital staff nurse social worker

home health nurse

The nurse is assessing a client newly transferred from the recovery room and notes a low-grade temperature, tachycardia, tachypnea, and crackles. Which action is the nurse's priority? Encourage client to cough and take a deep breath. Administer oxygen at 100% nonrebreather mask. Medicate with acetaminophen. Administer an albuterol inhaler

Encourage client to cough and take a deep breath.

The nurse is assessing a client newly transferred from the recovery room and notes a low-grade temperature, tachycardia, tachypnea, and crackles. Which action is the nurse's priority? Encourage client to cough and take a deep breath. Administer oxygen at 100% nonrebreather mask. Medicate with acetaminophen. Administer an albuterol inhaler.

Encourage client to cough and take a deep breath.

The nurse interprets which finding as an early sign of acute respiratory distress syndrome (ARDS) in a client at risk? elevated carbon dioxide level hypoxia not responsive to oxygen therapy metabolic acidosis severe, unexplained electrolyte imbalance

hypoxia not responsive to oxygen therapy

On arrival at the intensive care unit, a critically ill client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client's arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values? fever tachypnea tachycardia hypotension

Hypotension

A client experiencing an acute panic attack develops respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.6°F (37°C). Which action will the nurse implement first to help improve respiratory alkalosis? Apply oxygen via nasal cannula. Administer albuterol inhaler. Instruct the client to breathe into a paper bag. Administer sodium bicarbonate intravenously.

Instruct the client to breathe into a paper bag.

A nurse is assisting with the removal of a central venous access device (CVAD). What should the nurse do to prepare the client? Turn the client to the left side. Have the client exhale slowly and evenly. Elevate the head of the bed. Instruct the client to take a deep breath and hold it.

Instruct the client to take a deep breath and hold it.

A nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? It helps prevent early airway collapse. It increases inspiratory muscle strength. It decreases use of accessory breathing muscles. It prolongs the inspiratory phase of respiration.

It helps prevent early airway collapse.

A client is admitted to the hospital with a diagnosis of a pulmonary embolism. Which problem should the nurse address first? nonproductive cough activity intolerance difficulty breathing impaired gas exchange

impaired gas exchange

Which information should the nurse include in a teaching plan for the client newly diagnosed with chronic obstructive pulmonary disease (COPD)? Select all that apply. Pulmonary rehabilitation programs offer very little benefit. Pneumococcal vaccination is contraindicated for clients with lung disease. High humidity increases the effort of breathing. A bronchodilator with meter-dose inhaler should be readily available. Smoking cessation is important to slow or stop disease progression.

Pneumococcal vaccination is contraindicated for clients with lung disease. A bronchodilator with meter-dose inhaler should be readily available. Smoking cessation is important to slow or stop disease progression.

A client with an endotracheal tube is being weaned from the ventilator. For which reason should the procedure be terminated? The client is awake and alert. The heart rate increased 20 beats/minute. The diastolic blood pressure decreased 6 mm Hg. The client lifts head independently off the pillow.

The heart rate increased 20 beats/minute.

A client with acute bronchitis is admitted to the healthcare facility and is receiving supplemental oxygen via nasal cannula. When monitoring this client, the nurse suddenly hears a high-pitched whistling sound. What is the most likely cause of this sound? The water level in the humidifier reservoir is too low. The oxygen tubing is pinched. The client has a nasal obstruction. The oxygen concentration is above 44%.

The oxygen tubing is pinched.

Which choice demonstrates best nursing practice when performing tracheostomy care on a client who is 8 hours post new insertion? Monitor the client's temperature after the procedure. Use sterile gloves during the procedure. Use povidone-iodine to clean the inner cannula when it is removed. Place the client in the semi-Fowler's position.

Use sterile gloves during the procedure.

A client is receiving streptomycin for the treatment of tuberculosis. The nurse should assess the client for eighth cranial nerve damage by observing the client for: Vertigo. Facial paralysis. Impaired vision. Difficulty swallowing.

Vertigo

The nurse is developing a care plan for a client with tuberculosis. Which measures would be implemented for staff prior to entering the room? Wear a mask at all times when entering the room. Wear a mask, gown, and gloves when providing care. Wear a gown and gloves when in contact with the client. Prevent visitors from visiting to reduce the possibility of transmission.

Wear a mask at all times when entering the room.

During morning assessment, a nurse assesses four clients. Which client is the priority for follow up? an 84-year-old client with heart failure who's on telemetry and 2 L/minute of oxygen a 42-year-old client who has left lower lobe pneumonia and an I.V. line a 48-year-old client with chronic obstructive pulmonary disease with occasional atrial fibrillation a 73-year-old client who has pneumonia with coarse crackles, is receiving 2 L/minute of oxygen, and has an I.V. line

a 73-year-old client who has pneumonia with coarse crackles, is receiving 2 L/minute of oxygen, and has an I.V. line

A 6-year-old child is admitted to a pediatric unit for the treatment of osteomyelitis. Which essential medication classification would the nurse anticipate as documented on the medication report? anti-inflammatory analgesic antibiotic antipyretic

antibiotic

A nurse is caring for a client with deep vein thrombosis. Which change in assessment findings would the nurse be alert for related to the condition? calf pain and redness hypertension and fever bradypnea and bradycardia chest pain and dyspnea

chest pain and dyspnea

A nurse has received a change-of-shift report on four clients. Which client should the nurse assess first? client with right-sided heart failure who has 4+ bilateral edema in the legs and feet client with a recent lung transplant scheduled to begin pulmonary rehabilitation client with a pleural effusion who reports severe stabbing chest pain client experiencing tracheal deviation following a subclavian catheter insertion

client experiencing tracheal deviation following a subclavian catheter insertion

A client with severe shortness of breath comes to the emergency department. The client tells the emergency department staff that they recently traveled to China for business. Based on the client's travel history and presentation, the staff suspects severe acute respiratory syndrome (SARS). Which isolation precautions should the staff institute? droplet precautions airborne and contact precautions contact and droplet precautions contact precautions

contact and droplet precautions

A client with lung cancer develops pleural effusion. During chest auscultation, which breath sound should the nurse expect to hear? crackles rhonchi decreased breath sounds wheezes

decreased breath sounds

The nurse is caring for a client who has been diagnosed with atypical pneumonia. The nurse should assess this client carefully for which symptom? high fever. tachypnea. dry cough. severe chills.

dry cough.

The nurse is assessing a client with chronic obstructive pulmonary disease. Which finding requires immediate intervention? distant heart sounds diminished lung sounds inability to speak pursed lip breathing

inability to speak

A client is critically ill with sepsis. The nurse expects what assessment finding related to compensatory mechanisms attempting to maintain normal pH? increased respiratory rate increased urine output decreased blood pressure increased body temperature

increased respiratory rate

A client is prescribed metaproterenol via a metered-dose inhaler, two puffs every 4 hours. The nurse instructs the client to report which adverse effect? irregular heartbeat constipation pedal edema decreased pulse rate

irregular heartbeat

A nurse is completing annual cardiopulmonary resuscitation training. The class instructor states that a client has fallen off a ladder and is lying on the back. The client is unconscious and not breathing. What technique should the nurse use to open the client's airway? head tilt-chin lift jaw-thrust abdominal thrust log roll to the side

jaw-thrust

A client has been diagnosed with bacterial pneumonia. After 1 day of IV antibiotic therapy, the client's white blood cell count is still 14,000/mm3 (14 X 109/L). The nurse should: notify the health care provider. recheck the client's white blood cell count in 24 hours. initiate reverse isolation precautions. administer the next scheduled antibiotic dose early.

notify the health care provider.

A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? pH bicarbonate (HCO3-) partial pressure of arterial oxygen (PaO2) partial pressure of arterial carbon dioxide (PaCO2)

partial pressure of arterial oxygen (PaO2)

The nurse is caring for a client with acute respiratory distress syndrome. What portion of arterial blood gas results does the nurse find most concerning, requiring intervention? partial pressure of arterial oxygen (PaO2) of 69 mm Hg partial pressure of arterial carbon dioxide (PaCO2) of 51 mm Hg pH of 7.29 bicarbonate (HCO3-) of 28 mEq/L

partial pressure of arterial oxygen (PaO2) of 69 mm Hg

The nurse is caring for a client following surgery. Which nursing action does not aid in meeting the postoperative goal of clear breath sounds? offering pain relief before having the client cough providing a minimum of 1,000 mL of fluid per day using an incentive spirometer assisting with early ambulation

providing a minimum of 1,000 mL of fluid per day

A client has been diagnosed with bacterial pneumonia. After 1 day of IV antibiotic therapy, the client's white blood cell count is still 14,000/mm3 (14 X 109/L). The nurse should: recheck the client's white blood cell count in 24 hours. initiate reverse isolation precautions. notify the health care provider. administer the next scheduled antibiotic dose early.

notify the health care provider.

Clients who have had active tuberculosis are at risk for recurrence. Which condition increases that risk? cool and damp weather active exercise and exertion physical and emotional stress rest and inactivity

physical and emotional stress

The nurse is aware that frequent repositioning in bed will assist in the prevention of which condition for a client? postural hypotension intravenous infiltration pneumonia arterial thrombosis

pneumonia

Positive end-expiratory pressure (PEEP) therapy has which effect on the heart? bradycardia tachycardia increased blood pressure reduced cardiac output

reduced cardiac output