Nur 237 Chapters 12, 13, 14

Patients with chronic respiratory diseases can benefit from teaching that includes:

-When and how to use pursed lip breathing -Verify safety of over the counter medications with health cre provider -avoid crowds during flu season -food and hydration recommendations

When drugs are prescribed for treatment of rhinitis and sinusitis, which type of drugs would be included?

-Decongestants -Antihistamines -Mucolytics -Antipyretics (if fever)

The nurse is checking the oxygen delivery system at the beginning of the shift. What is included in the assessment of the system and equipment?

-Observe the tubing for kinks or blockage -Make sure that the tubing and connections are not touching the floor -Verify that the flow rate is set according to the health care provider's order.

What assessments should be done for patient with a new tracheostomy?

-cuff inflation -Lung sounds before and after suctioning -Condition of insertion site -Work of breathing

List three common symptoms of sinusitis

-headache -Fever -Upper teeth pain -Purulent nasal drainage -malaise -Tenderness over the sinuses

List four points to include in the assessment of a patient with a cough

-if cough is productive or nonproductive -Events or circumstances that trigger an episode of coughing -Time of day when cough seems worse -Measures that bring relief -Other symptoms that occur simultaneously

The nurse is caring for patients who have beed diagnosed with laryngeal cancer. Which patient is likely to have the best outcome after medical treatment?

A middle aged man who reports having persistent hoarseness

The patient with acute pharyngitis has a nursing diagnosis of discomfort ant pain related to inflammation. Which intervention would the nurse use for this diagnosis?

Advise to use warm saline gargles.

Tidal volume

Amount of gas either inhaled or exhaled with each breath

Vital capacity

Amount of gas in air one can exhale after maximal inhalation

Which statement regarding rhinitis and the elderly patient is true?

Antihistamines and decongestants should be used with caution

A patient comes to the emergency department with a nosebleed. Which is the first action the nurse should initiate?

Applying pressure to the nose with the thumb and forefinger

A postoperative patient suddenly and unexpectedly becomes very anxious and complains of dyspnea . What is the priority nursing action?

Assess for other symptoms

The nursing diagnosis for a patient with tuberculosis is Noncompliance with medication therapy. However, the etiology of the problem is unclear. What is the priority nursing action?

Assess the patient's understanding of the therapy and treatment plan.

Safety factors for administering oxygen to the patient with chronic obstructive pulmonary disease (COPD) include:

Carefully titrating oxygen delivery

Resistance

Chiefly determined by radius or calier of airway

What is a major intervention to prevent further lung damage in the patient with chronic respiratory disease?

Convince the patient to quit smoking

Which nutritional suggestion would the nurse give to a COPD patient??

Cook when feeling most energetic and freeze extra portions.

A man eating in a restaurant suddenly stands up and grasps his throat with his hands. What is the priority action?

Direct the man to cough forcefully.

Ventilation

Movement of air from outside body to alveoli and back to the outside

A patient's wife reports that her husband frequently snores. Which question would the nurse ask to identify another symptom of obstructive sleep apnea?

Does he wake suddenly at night

-The nurse is assessing the patient for early stage emphysema. What sign would the nurse look for?

Dyspnea

Compliance

Elasticity of the lungs

Cilia

Hairlike projections that trap and help expel inhaled foreign particles

A postoperative patient has increased CO2 levels. What is the best intervention by the nurse?

Have the patient take several deep breaths and use the incentive spirometer.

The patient reports a long history of smoking and now complains of hoarseness and a lump like feeling in the throat. Which question is the most relevant to collect data about possible signs of throat cancer?

Have you had hoarseness for more than 3 weeks

When administering respiratory medications to a patient, which medication should be administered last?

Robitussin cough syrup

The nurse is preparing to give a patient an influenza vaccination. Which patient statement is the biggest concern?

I have a lot of allergic reactions to many common foods.

A patient with a new tracheostomy has a nursing diagnosis of altered airway clearance. What is the most likely etiology of this problem?

Inability to cough up secretions and mucus

The patient has just returned from having a bronchoscopy. The nurse would intervene if the nursing students performs which action?

Obtains food and fluids for the patient.

Perfusion

Passage of fluid through vessels of an organ

A patient with a long history of smoking and emphysema has a nursing diagnosis of Inadequate health management related to the inability to stop smoking. Which outcome statement is the best?

Patient will verbalize two strategies to stop smoking

Pleural cavity

Pressure within is less than that of outside atmosphere

In the immediate postoperative period after a tonsillectomy, what is the highest priority?

Prevention of aspiration

Surfactant

Prevents collapse of lung by stabilizing alveoli and decreasing capillary pressure

The laboratory results for arterial blood gas analysis show that the patient has respiratory alkalosis. Before calling the health care provider, what additional assessment information is the most relevant?

Respiratory rate and breathing pattern

The nurse is caring for a trauma patient and notes that with inhalation a portion of the chest are drawn inward and with exhalation, the portion expands outward. What is the significance of this observation?

Several ribs are fractured and the patient should be turned onto the affected side.

The patient is being discharged after undergoing a rhinoplasty for a nasal fracture. Which discharge instruction would the nurse question?

Take ibuprofen every 6 hours for pain

Diffusion

Takes place between gas in alveolar space and blood in capillaries of lung

There is an order for a pneumonectomy patient to avoid turning onto unoperated side." What is best rationale for this order"

Tension on the bronchial stump could occur

The nurse is assessing the patinet with a chest tube placed 3 days ago for a pneumothorax. Which finding indicates that there may be a problem with the apparatus?

There is continuous bubbling in the water seal chamber

Cough reflex

When depressed, secretions are retained and pneumonia may occur

General Nursing Implications for the Administration of Bronchodilators

When giving a bronchodilator drug, you should: • Follow the standard procedures for checking identification of the patient, using the "Six Rights," verifying allergies, and monitoring for side effects and drug interactions. • Auscultate the lungs to ascertain the types of lung sounds present. • Take the pulse and count respirations to establish ranges before drug administration. • Use these drugs cautiously in patients with cardiac disease, because they affect heart action. • Consult the provider before administering a bronchodilator to a patient who has a current cardiac dysrhythmia. • Give each dose of the drug as close to the ordered time as possible to maintain a steady blood level of the drug. • When the patient is taking theophylline, check drug serum levels; the therapeutic range is 10 to 20 mcg/mL. If the level is above 20 mcg/mL, withhold the drug and notify the provider. • Warn older adult patients that bronchodilators may cause dizziness and to take precautions when changing positions. • Monitor the patient for effectiveness of the drug by performing a respiratory assessment. Regarding possible side effects or adverse effects of the drug, you should: • Warn the patient about the possibility of paradoxical bronchospasm and advise him to consult the provider if this happens before administering another dose. • Tell the patient to chew sugarless gum or suck on hard candy to relieve dry mouth. • Monitor the patient for specific side effects of each drug; general side effects of bronchodilators are dry mouth, insomnia, nervousness, dizziness, palpitations, gastrointestinal upset, and changes in blood pressure. You should teach the patient taking a bronchodilator drug to: • Take the drug with a full glass of water; if it causes gastrointestinal upset, take the drug with a meal. • Take the drug 15 to 60 minutes before exercising (check specific time for individual drug because time depends on form of the drug [i.e., inhalant or oral tablet]). • Follow correct procedure for inhaling the drug: shake the inhaler gently before using, clear the nose and throat, take a deep breath, relax, and completely exhale before inhaling drug

The priority assessment for any patient with any problems of the upper airway is:

adequacy of oxygenation

Most of the inspired oxygen is carried to the tissues via which component of the body?

c. Red blood cells The red blood cells carry 97% of the oxygen to the cells, attached to hemoglobin.

The nurse observes that a patient is having severe respiratory distress. Which action should be delegated to the nursing assistant

obtaining an Ambu bag

The nurse notes in the medical record that the patient has orthopnea. Which intervention would the nurse use to address this condition?

offer the patient extra pillows

A nursing intervention that can best help prevent atelectasis in the patient with compromised lung function is to:

have the patient turn, cough and deep breathe at least every 2 hours

Pursed-Lip Breathing

• Sit up tall and move the back away from the chair; place the feet about shoulder-width apart. Lean forward slightly with hands or elbows on the knees. • Close the mouth, and breathe in through the nose. • Purse the lips as though to gently whistle or blow out a candle; keep the lips and cheeks relaxed. • Blow through relaxed pursed lips, exhale slowly, and do not force the air out of the lungs (this can bring about the collapse of the airway structures). • Breathe out slowly without puffing out the cheeks; control the flow of exhaled air as if you wanted to cause a candle to flicker but not extinguish. • Take twice as much time to let the breath out as it did to take it in. • Tense the abdominal muscles to force as much air from the lungs as possible. • Use pursed-lip breathing during any physical activity. • Refrain from holding your breath when lifting objects or performing other physical activities.

Inspiration and expiration

controlled by movement of diaphragm and muscles in chest wall

The nurse is teaching an adult post-tonsillectomy patient. Which dietary instructions are most important for the nurse to include? (Select all that apply.)

-Avoid hot fluids -Avoid foods with red dye ANS: B, D Avoiding red colored foods can help in distinguishing between ingested food and blood. Milk products are acceptable for post-tonsillectomy patient. Citrus fruits should be avoided until the throat has completely healed. Hot fluids should be avoided until the throat completely heals. Straws are not used because sucking may cause bleeding.

The nurse is caring for a patient with a respiratory disorder who complains of anorexia. Which factor(s) may contribute to the patient's anorexia? (Select all that apply.)

-Bad taste in mouth -Fear of exacerbate coughing by eating -Fatigue -Altered sense of smell Respiratory disorders may cause a bad taste in the mouth, fatigue, and an altered sense of smell; additionally, the patient may be wary that eating will exacerbate coughing. Sense of taste is not heightened by respiratory disorders.

Through which method(s) can influenza spread? (Select all that apply.)

-Direct contact -Indirect contact -Droplets Influenza spreads through direct and indirect contact from droplets. Influenza is not spread by vectors or the blood-borne method.

Which physical signs indicate labored breathing? (Select all that apply.)

-Grunting on expiration -Elevating shoulders and ribs on inspiration -Tensing neck and shoulder muscles -Substernal retraction Labored breathing may be indicated by expiratory grunting, inspiratory elevation of shoulders and ribs, tensing neck and shoulder muscles, and substernal retraction. Productive cough is not a sign of labored breathing.

The nurse is assessing an older adult with a family tendency of developing laryngeal cancer. The nurse should ask the patient about which risk factors? (Select all that apply.)

-History of smoking -Alcohol abuse -Exposure to asbestos -Occupational exposure to wood dust Cigarette smoking, alcohol abuse, asbestos exposure, and wood dust exposure are risk factors linked to laryngeal cancer. Streptococcus bacteria are not considered a risk factor for laryngeal cancer; infection with human papillomavirus or Helicobacter pylori has been linked to increased incidence of cancer of the larynx.

When performing a respiratory assessment, which actions should be performed?

-Inquire about exposure to respiratory inhalants -Auscultate the lungs bilaterally -Assess color of mucous membranes -Assess the rate and quality of respirations. -Check for use of accessory muscles -Look for signs of anxiety or restlessness

For which individual(s) does U.S. Public Health Service recommend the influenza immunization? (Select all that apply.)

-Physicians -Older adults -Chronically ill -Nurses Health care workers, older adults, and chronically ill individuals are at risk for contracting influenza and should be immunized. Compromised infants should not be immunized.

Which organism(s) are common causative agents for sinusitis? (Select all that apply.)

-Pneumococci -Haemophilus influenzae -Streptococci The common organisms causing sinusitis are pneumococci, Haemophilus influenzae, and streptococci.

The nurse is caring for a patient with advanced emphysema. Which signs are manifestations of this disorder? (Select all that apply.)

-Productive cough -Dyspnea -Barrel chest -Cyanotic skin tone Manifestations of late emphysema include a productive cough, dyspnea, a barrel chest, and cyanosis. (Coughing, mucus production, and cyanosis usually do not occur until late in the disease.) Wheezing usually does not occur in the emphysemic patient.

The home health nurse is educating a 60-year-old patient with emphysema with a nutritional deficit. Which instructions should the nurse include in the teaching plan to address this problem? (Select all that apply.)

-Rest before eating -Avoiding gas producing foods -Eat four to six small meals instead of three large meals -Take small bites and chew slowly The patient should rest before eating to prevent fatigue. Foods that cause gas or bloating can lead to a distended stomach, which can increase work of breathing. Eating four to six small meals a day rather than three regular meals decreases stomach fullness and reduces fatigue. Taking small bites and chewing food slowly may help combat shortness of breath. The patient should avoid lying down for an hour after eating.

The nurse is caring for a patient on a mechanical ventilator that it is set on assist-control mode. Which statement(s) accurately describe this function? (Select all that apply.)

-The ventilator delivers a set tidal volume -The ventilator delivers a set number of breaths if the patient's rate falls. The assist-control mode delivers a set tidal volume on every respiration and will deliver a set number of breaths per minute should the patient's rate drop. It does not cut off automatically or deliver more oxygen at the end of the inspiration, nor does it correct respiratory acidosis

The nurse clarifies that when interstitial edema occurs in the lung tissue, it inhibits ventilation by causing which problem(s)? (Select all that apply.)

-Thickening alveolar membranes -Alveoli filling with fluid -Gas failing to diffuse across membrane Interstitial edema will cause problems that affect the alveoli: thickened walls and filling with fluid that obstructs gas exchange across the thickened walls. Pus formation is associated with infection. Surfactant decreases surface tension on the alveolar wall, allowing it to expand more easily with inspiration and preventing alveolar collapse on expiration.

Which manifestation(s) are age-related changes that alter the respiratory system? (Select all that apply.)

-Weakened cough -Kyphosis -Decrease in body fluid -Muscle weakness Age-related changes in the respiratory system include weakened cough, kyphosis, decreased bodily fluids, and increased muscle weakness. Age often decreases ciliary movement.

The nurse is performing an occupational history as part of the respiratory assessment. Which occupation(s) place the patient at increased risk for an occupational lung disorder? (Select all that apply.)

-a firefighter -A cotton gin worker -A construction contractor Firefighters, cotton gin workers, and construction contractors all come into contact with occupational hazards that could increase risks for lung disorders. Coal dust, dust from hemp, flax, and cotton processing, and exposure to silica in the air all can cause work-related lung disorders. Asbestos exposure may cause mesothelioma and scarring of lung tissue. The other exposures cause obstruction of small airways or scarring and loss of elasticity and compliance. A bartender and landscaper are not at increased risk of occupational lung disorders.

The nurse is setting up the environment for tracheal suction on a newly postoperative tracheostomy patient. Which action(s) should the nurse perform? (Select all that apply.)

-auscultate lungs for retained secretions -Wash hands and open sterile suction kit -Inform the patient about the procedure -Perform suction with sterile supplies The nurse should inform the patient about the procedure. The nurse should auscultate the lungs, wash hands, and open the sterile kit, and perform suction with sterile supplies. Sterile rather than clean gloves should be worn during the suctioning procedure.

Which action(s) may help to reduce the risk of transmitting a common cold? (Select all that apply.)

-cover the mouth and nose when sneezing -Wash the hands frequently -Turn the head to the crook of the arm when coughing Covering the mouth and nose when sneezing and coughing as well as frequent washing of hands will reduce the risk of passing a cold to another. Using saline sprays and drinking juices with vitamin C are not helpful in containing a cold.

The home health nurse is making an initial call on a newly diagnosed tuberculosis (TB) patient. The patient lives with his wife and child. Which infection control instructions should the nurse include in the teaching plan? (Select all that apply.)

-place contaminated tissues in sealable plastic bag -Take medications exactly as directed -Wash hands frequently -Wear a mask when in crowds Instructions should include information about disposing of contaminated materials in sealed bags, taking medications exactly as directed, utilizing frequent hand hygiene, and donning a mask when in crowds. Since the family has already been exposed, taking airborne precautions is unnecessary.

The nurse is performing discharge teaching for a patient who underwent a microlaryngoscopy with laser removal of polyps. Which instruction(s) should the nurse include? (Select all that apply.)

-you can return to work in 3 days -Observe 2 days of voice rest Observation of voice rest for 2 days and return to work in 3 days are the basic instructions. There is minimal swelling or bleeding, and NSAIDs (not opioids) are used for pain control.

What is the contagion period of a cold?

3 days The contagion period of a viral cold is about 3 days.

Respiratory gases are carried mostly in the bloodstream by the erythrocytes.

A large percentage of carbon dioxide is transported in the blood plasma in the form of bicarbonate ions.

Total lung capacity

Amount of air or gas lung can hold at end of maximal inspiration

The patient with acute bronchitis asks if antibiotics will be ordered for the condition. Which response is best for the nurse to make?

Antibiotics will be given if the sputum culture indicates your bronchitis is caused by bacteria." Bronchitis is treated symptomatically with humidification and cough medications. Antibiotics are only given if the sputum culture suggests it.

The 79-year-old patient with bacterial pneumonia becomes increasingly restless, confused, and agitated. The patient's temperature is 100° F, and his pulse, blood pressure, and respirations are elevated since the last assessment 6 hours ago. What action should the nurse take first?

Assess the patient's oxygen saturation. Outward signs of hypoxia vary in patients, but dyspnea, restlessness, and confusion are the most common signs. While blood gas analysis is the most reliable indicator, bedside assessment pulse oximetry is quick, noninvasive, and gives a snapshot of oxygen saturation. The nurse should auscultate the patient's lungs after obtaining the oxygen saturation. Medications for sedation or discomfort do not address the patient's current condition.

The patient with asthma is prescribed a leukotriene modifier drug, montelukast (Singulair). Which statement describes an advantage of this medication?

Bronchodilation and anti-inflammatory effects Singulair provides both bronchodilation and anti-inflammatory effects, but it has numerous GI side effects and is not effective in controlling acute asthmatic attacks.

The nurse is aware that the patient seeking antibiotic treatment for pharyngitis will only receive the desired medication if the condition is caused by what type of pathogen?

Bacteria Pharyngitis (sore throat) will be treated with an antibiotic only if the infection is deemed bacterial in etiology. Protozoa, viruses, and fungi do not respond to antibiotics.

The nurse is assessing the patient with influenza. The patient reports having general malaise and aching muscles over the past 2 weeks. The nurse suspects that the patient may have developed which complication of influenza?

Bacterial pneumonia Bacterial pneumonia is a common complication of influenza and may present with atypical symptoms of only general malaise and muscle aches, making it difficult to recognize the symptoms of pneumonia. Bronchitis, urinary infections, and encephalitis are not common complications of influenza.

Oxyhemoglobin

Carries majority of the oxygen to the cells of the body

The nurse is caring for a first-day postoperative thoracotomy patient. The nurse assesses that the level of drainage has not increased over the last 3 hours. After assessing the patient's respiratory status, what should the nurse do next?

Check the tubing for kinks. After assessing the patient's respiratory status, the nurse should ensure that the tubing is not kinked or obstructed by the weight of the patient. The nurse should then check the apparatus; all connections should be taped, be intact, and remain airtight. The system must be below the level of the patient's heart. The nurse should also double-check the physician's order for patient position, and reposition as needed. Finally, the nurse should report the findings to the RN or physician.

The nurse is caring for a patient who underwent a laryngectomy. Which need should the nurse address first?

Communication method Pain control and family support are important, but the need of a method of communication is paramount for a new tracheostomy patient to allay anxiety, ensure accurate communication between the patient and the nurse, and make the patient comfortable that nursing staff are attentive. The need for long-term care may not be necessary.

The nurse is teaching a patient who underwent a laryngectomy. Which statement describes the correct technique for warming inspired air during cold weather?

Cover the stoma with a scarf. The fold of the scarf retains body heat and can warm air as the air passes through the scarf.

The nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). Which assessment finding indicates a potential complication and requires the nurse's immediate attention?

Distended neck veins ANS: A Cor pulmonale is enlargement of the right side of the heart as a result of pulmonary hypertension caused by constriction of the pulmonary vessels in response to hypoxia. Constant hypoxia stimulates erythropoiesis, with resulting polycythemia and increased viscosity of blood. Eventually, right-sided heart failure causes systemic venous congestion which manifests with distended neck veins. The patient would experience right upper quadrant tenderness from an engorged liver. Urinary output of 40 mL/hr is normal. Excessive coughing does not indicate an urgent complication.

THe nurse is caring for a patient with emphysema. What is the most essential point in administering oxygen to this patient?

Ensuring that oxygen flow is set at the correct rate

Elastance

Extent to which lungs can return to their original position after being stretched

The patient has chest congestion and the nurse instructs him to increase fluid intake. What is the best rationale for this intervention?

Fluid helps to thin secretions

The nurse is caring for a patient with suspected sinusitis. Which assessment finding supports this diagnosis?

Generalized pain in the upper teeth. Sinusitis is an inflammation of the mucosal lining of the sinuses. Exudate accumulates in the sinuses and pressure builds, which causes pain. Symptoms include painful upper teeth, tenderness over the sinuses, purulent drainage from the nose, nasal obstruction, and sometimes a nonproductive cough. Drainage from the ear and ear pain when supine are findings likely consistent with an ear infection.

The clinic nurse is giving discharge instructions to the mother of a 10-year-old boy who has been diagnosed with a mild cold. Which statements indicate that the mother accurately understands the nurse's instructions? (Select all that apply.)

I will be sure he drinks plenty of apple and orange juice." "I will be sure he washes his hands well so he doesn't pass this cold on to his younger sister." Since his cold symptoms just started, zinc lozenges may be helpful for him to take." Increasing fruit and citrus juice intake may decrease the duration or severity of a cold. Proper hand hygiene decreases the likelihood of transmission. According to Singh and Das (2013), if started with conjunction of symptom onset, zinc lozenges have proven effective in limiting a cold's duration and severity. Antibiotics are not used for colds (because colds are viral in etiology) unless a secondary infection is present or there is an increased risk for a secondary infection. Aspirin should not be given to children under age 12 due an increased risk for Reye syndrome.

The nurse is educating a patient who requires daily postural drainage treatments. Which statement indicates that the patient understands when and why treatments will be scheduled?

I will have treatments first thing in the morning to get rid of fluids that have built up over night." If the patient is to have postural drainage only once a day, drainage should be done in the morning to remove secretions that have accumulated during the night. Because there is likely to be some gagging during coughing episodes that take place during postural drainage, it is best to carry out the procedure before meals, when the stomach is relatively empty and vomiting is less likely.

The nurse is caring for a patient with suspected bacterial pneumonia. Which finding supports the potential diagnosis?

Interstitial inflammation Viral pneumonia causes interstitial inflammation with attendant edema. White blood cell (WBC) count will not be elevated and no exudate is consolidating the lung as with bacterial pneumonia.

The nurse is caring for a 20-year-old patient who recently underwent a tonsillectomy. The patient is fully awake and clearing his throat frequently but denies pain. Which action is most important for the nurse to take first?

Look in the patient's mouth. Frequent swallowing or clearing of the throat may indicate bleeding. Further assessment is indicated, and the nurse should look in the patient's mouth to assess for bleeding. The fully alert adult patient should be placed in semi-Fowler position to ensure adequate ventilation. Offering the patient a grape popsicle is an appropriate intervention once the nurse confirms that the patient is not bleeding. While removing the straw from the tray is an appropriate intervention to prevent bleeding that may result from sucking, the nurse should first ensure that the patient is not currently bleeding.

When a patient is scheduled for a lung ventilation and perfusion scan, what patient teaching is pertinent?

Radioactive agents will be inhaled and injected IV.

Which position is best for the patient undergoing a thoracentesis?

Sitting up, leaning forward on an overbed table

The nurse is assessing the oxygenation status of the patient. Which are the est indicators of oxygenation?

SpOs, ABGs, skin color

The nurse is caring for a patient who has a tracheostomy with a one-way valve box. The nurse explains to the CNA that this valve allows the patient to carry out which function?

Talking A one-way tracheostomy valve box can be fitted into the tube opening. It allows air to be inhaled through the tracheostomy opening, but the valve closes when the patient exhales. This diverts the exhaled air through the larynx and enables the patient to speak.

The nurse is caring for a patient who has had a cold for 1 week. The patient questions why the health care provider issued a prescription for an antibiotic. Which explanation is best?

The antibiotic will treat the secondary bacterial infection that has developed." If a cold persists for more than a week to 10 days without improvement, a bacterial infection is present and requires medical treatment. While the etiology of a cold is viral in nature, antibiotics are necessary to this secondary bacterial infection. No cure exists for a cold. Antibiotics will not reduce symptoms of a cold or decrease the contagion period for a cold.

The nurse is assisting the physician with the insertion of a new tracheostomy tube. The physician asks for the obturator. The nurse correctly hands the physician which device?

The guide for the tracheostomy tube to be inserted The obturator is used during insertion of a tracheostomy tube as a guide to protect against scraping the sides of the trachea with the sharp edge of the tube.

The nurse is caring for a patient during the immediate postoperative period following a rhinoplasty. Which finding is most concerning to the nurse?

The nurse notices the patient is swallowing frequently. Frequent swallowing indicates bleeding that is trickling down the back of the throat. Feeling cold and chilly is a common symptom with surgery and is related to anesthetic and the cool surgical environment. Nausea may be experienced by some patients due to anesthetic. Drainage from the nose is expected.

The nurse is educating an asthma patient about proper use of the peak flowmeter. The nurse determines that the patient needs further teaching when observing which action?

The patient breathes deeply through the mouthpiece. Peak flow should be monitored on a daily basis to determine if the asthma patient has adequate airflow. The reading helps determine if treatment should be adjusted. The patient should stand to achieve adequate chest expansion while taking a deep breath. The patient then blows as hard and fast as possible into the device with the mouthpiece in the mouth and the lips clamped firmly around it for a tight seal. The procedure should be performed three times with the highest reading recorded.

The 75-year-old patient presents to the emergency department with shortness of breath, fatigue, and a dry cough. When information leads the nurse to suspect that this patient should undergo workup for histoplasmosis?

The patient lives on a farm and raises chickens. Histoplasmosis is caused by a fungus that lives in bird droppings. Contact with chickens coupled with the characteristic signs of dry cough, shortness of breath, and fatigue warrants a workup for histoplasmosis. Legionellosis is a bacterial infection contracted from contaminated drinking water. Rocky Mountain spotted fever and lime disease are transmitted by ticks found in wooded areas. Coccidioidomycosis is contracted by people who engage in desert recreational activities or are working in occupations that require digging in the earth.

WHich instruction set should the nurse give to the patient to obtain a good sputum specimen?

The specimen should be obtained in the morning before eating

The nurse is caring for a patient with a closed-chest drainage system with chest tubes. Which observation confirms that the system is intact and working?

The water level in the water-seal chamber fluctuates. If the level of the water in the water-seal chamber rises and falls with the patient's respiration, the system is intact. Constant bubbles in the water-seal chamber indicate a leak in the system. The fluid in the collection container drains by gravity whether the closed-chest drainage system is intact or not. Suction is not significant with respect to whether the system is intact.

What is the purpose of treatment with amantadine (Symmetrel)?

To lessen the severity of type A flu symptoms if taken within 48 hours of exposure. Amantadine (Symmetrel) is an antiviral medication that may be given within 48 hours of exposure or within 48 hours of the onset of influenza symptoms. It is not a drug that is taken regularly and will not stop the spread of the avian flu.

Surfactant decreases surface tension on the alveolar wall, allowing it to expand more easily with inspiration and preventing alveolar collapse upon expiration.

Two conditions that can interfere with oxygen and carbon dioxide exchange are low surfactant and interstitial edema.

The nurse is caring for a 30-year-old American Indian female who is taking Rifater, a drug containing rifampin, isoniazid, and pyrazinamide. The patient asks how long she will have to take the medication. Which response explains when the patient may discontinue the medication?

When three consecutive sputum cultures are negative This drug is given to treat active tuberculosis (TB). The active TB patient is considered noncontagious when three consecutive sputum cultures are negative. Taking the medication for a given period of time does not make the patient noncontagious. The TST will always be positive.

The patient with sleep apnea is fitted with a continuous positive airway pressure (CPAP) mask and asks the nurse how this device will help. How should the nurse respond?

a. "The device delivers constant positive pressure to keep your airway open." The CPAP mask delivers a constant positive pressure to keep the airway open. CPAP does not require intubation and does not deliver negative pressure.

The nurse is teaching a patient with a newly resolved episode of epistaxis. Which information is important for the nurse to include? (Select all that apply.)

a. Avoid sneezing. b. Rest for several hours until all threat of epistaxis is gone. c. Avoid rubbing the nose. The patient should avoid sneezing, rest for several hours, and avoid rubbing the nose. The patient should not attempt to remove clotted blood or blow the nose.

When the nurse places the diaphragm of the stethoscope over one of the main bronchi, which expected normal breath sound should the nurse hear?

a. Bronchovesicular sounds Bronchovesicular sounds are moderate hollow sounds that are equal on inspiration and expiration.

While performing an assessment, the nurse auscultates a coarse low-pitched sonorous rattling in the left lower lobe. Based on the presence of this adventitious lung sound, which action should the nurse take next?

a. Instruct the patient to turn, cough, and deep-breathe. Low-pitched sonorous wheezing sounds are caused by secretions accumulating in the larger airways. Patients with pneumonia or chronic bronchitis often present with low wheezes (rhonchi). Coughing may help to partially clear the secretions. High-pitched wheezes result from narrowing of air passages, and a bronchodilator would be beneficial. Crackles are produced by air passing through moisture in the smaller airways; diuretics are beneficial. Proper technique for the incentive spirometer directs the patient to inhale through the mouthpiece, as if the patient is pretending to drink a thick milk shake.

The nurse is aware that the patient is in respiratory failure when the blood gas findings contain which values?

a. PaO2 46 mm Hg; PaCO2 52 mm Hg Respiratory failure is defined by ABGs: arterial oxygen (PaO2) is below 50 mm Hg and partial pressure of carbon dioxide (PaCO2) is equal to or greater than 50 mm Hg.

When creating a visual aid to show the mechanics of inhaling, the nurse correctly illustrates which scenario?

a. The diaphragm moves downward. On inspiration, the diaphragm moves down, increasing the area of negative pressure, muscles pull the rib cage up, and the positive-pressure room air flows into the negative-pressure lungs.

The nurse describes the ability of the lungs to respond to change in the volume and pressure of inhaled air by expanding as lung __________.

compliance The lungs normal expansion in response to inhaled air is known as lung expansion. Lung compliance first increases and then decreases with age as the lungs become stiffer and the chest wall becomes more rigid.

The radical neck resection removes a large amount of tissue on the same side as the lesion. Which statement(s) about the tissue removed is/are correct? (Select all that apply.)

a. The tissue includes all muscle, lymph nodes, and soft tissue from the lower edge of the mandible to the top of the clavicle. b. The tissue includes all muscle, lymph nodes, and soft tissue from the top of the trapezius to the midline. c. The tissue includes all muscle, lymph nodes, and soft tissue from the lower edge of the eye socket to the bottom of the maxilla, including the zygomatic arch. The tissue includes: all muscle, lymph nodes, and soft tissue from the lower edge of the mandible to the top of the clavicle; all muscle, lymph nodes, and soft tissue from the top of the trapezius to the midline; and all muscle, lymph nodes, and soft tissue from the lower edge of the eye socket to the bottom of the maxilla, including the zygomatic arch. The radical neck resection does not ordinarily include the tongue, parotid salivary glands, or lip.

Evaluation of the effectiveness of deep breathing and coughing is best done by:

auscultating the lungs bilaterally both before and after.

The nurse is caring for a patient with sleep apnea. The patient complains that he is constantly fatigued. Which response is most appropriate for the nurse to make?

b. "Patients with sleep apnea often wake frequently during the night." Periods of apnea followed by abrupt intake of air frequently awaken the patient and reduce the amount of rapid eye movement (REM) sleep. Patients with sleep apnea experience oxygen deficiency. Mild apnea may be treated with conservative measures like avoiding alcohol 4 to 6 hours before bed. Telling the patient that all patients sleep poorly in the hospital ignores the patient's concern and makes an overgeneralization based on the nurse's bias.

A patient with emphysema presents to the emergency room with severe dyspnea; O2 saturation is 74%, pulse is 120, and respirations are 26. The nurse positions the patient in high Fowler. What action should the nurse take next?

b. Coach the patient in pursed-lip breathing. Coaching in pursed-lip breathing will open the respiratory tree with negative pressure. Oxygen given at such a high concentration will cause an emphysemic patient to stop breathing. Collecting a sputum specimen and ensuring patent IV access are appropriate interventions that should be performed after the patient's dyspnea is addressed.

The nurse is preparing a presentation that highlights the benefits of annual influenza vaccination. The nurse correctly targets which groups? (Select all that apply.)

b. Diabetics who are over 50 years old. c. Pregnant women. d. Home health aides. e. CNAs who work in long-term care facilities. Children ages 6 to 59 months should receive the influenza vaccine, not children 3 to 6 months of age. The Advisory Committee on Immunization Practices also suggests that pregnant women, people over age 50, and people with certain chronic illnesses receive the vaccine. In addition, health care workers and those caring for people in homes who are at high risk for contracting influenza should receive the vaccine.

The nurse is caring for a postoperative patient. After instructing the patient to cough and deep-breathe, what action should the nurse take next?

b. Perform mouth care. Mouth care should be offered after deep breathing and coughing to clear the mouth of unpleasant taste.

A patient is admitted to the medical unit with an acute illness accompanied by a fever for the last 3 days. What will likely be the patient's respiratory response?

b. Respiratory alkalosis Respiratory alkalosis, or hypocapnia, results from the patient's respiratory rate being elevated for a prolonged period due to the persistent fever. The patient blows off too much CO2 as a result. Hypercarbia and respiratory acidosis are the same and result from disorders that cause hypoventilation. Kussmaul respirations are an abnormal breathing pattern.

Which substance decreases the surface tension of the alveolar walls?

b. Surfactant Surfactant is the substance that reduces the surface tension of the walls of the alveoli, making gas exchange more effective.

What is the purpose of mucus?

b. To trap particles and bacteria. Mucus traps particles and bacteria that may be in the inspired air.

The nurse is caring for a patient with chronic obstructive pulmonary disorder (COPD) who has been in the hospital for several days. The patient complains of shortness of breath and asks the nurse to turn up his oxygen to compensate for his labored breathing. What is the best nursing response?

c. Assess the patient in an attempt to identify the cause of the shortness of breath. The nurse should assess the patient for possible causes of the shortness of breath before calling the physician. The nurse may be able to implement nursing interventions, or may need to contact the physician for orders based on the assessment findings. Since the COPD patient's respiratory drive is lowering levels of PO2, turning up the oxygen may take away his incentive to breathe. Asking the patient about his home oxygen is not helpful at this point.

The nurse is performing deep tracheal suctioning of a patient with a respiratory disorder. Which action demonstrates appropriate technique?

c. The nurse suctions the patient for 10 to 15 seconds. The suctioning, which is done during extraction of the suction tip, should not last more than 10 to 15 seconds as it deprives the patient of oxygen. Deep tracheal suction requires sterile technique, and the patient should be positioned with the neck slightly extended to facilitate entrance into the trachea. Even though the procedure does not last for a long time, suctioning is uncomfortable for the patient.

Bronchioles

carry air to alveoli

The 75-year-old patient asks the nurse if the Pneumovax immunization he took when he was 65 is still protecting him. Which reply is most accurate?

d. "After 6 years, you need a repeat dose of Pneumovax for full immunity." ANS: D Pneumovax, an immunization that protects against 23 pneumococcal organisms, is repeated 6 years after the first dose.

Which statement is most important for the nurse to make when caring for an anxious patient with a new tracheostomy?

d. "I understand that you might be apprehensive." ANS: D Offering reassurance to a patient who cannot speak is essential. Care should be unhurried with teaching and conversation. Offering false reassurance or mentioning what other patients have done is inappropriate. Giving care quickly or with minimal conversation may cause further anxiety. Teaching cannot be delayed until the tracheostomy is healed.

The nurse reading a tuberculin skin test (TST) on a new employee who lives in the Midwest, is 20-years-old, and has no known history of contact with any people with tuberculosis (TB). The nurse should interpret the reading as positive if the area around the injection site has an induration of how many millimeters?

d. 15 mm ANS: D All TSTs are read at 48 to 72 hours after the injection. A positive reading of a TST for a person who is low risk for exposure is an area of swelling 15 mm or more. For individuals who are at high risk for TB (such as recent immigrants from countries where TB is prevalent, medically underserved groups, and the homeless), swelling of more than 10 mm is considered positive. Individuals with a history of contact with infectious TB or who are immunocompromised are considered to have a positive TST if there is more than 5 mm of swelling.

The nurse is caring for multiple patients. After reviewing the patients' histories, the nurse determines that which patient possesses the highest risk of throat cancer?

d. A male patient who drinks four vodka tonics per day ANS: D The combination of alcohol and cigarettes increases the risk for throat cancer. However, males are four times more likely to develop throat cancer than women, and the male patient consuming vodka drinks is consuming significantly more alcohol than the female patient who smokes cigarettes. Coffee and carbonated drink consumption has not been found to increase the risk of throat cancer.

The nurse carefully applies suction prior to deflating the cuff on a cuffed tracheostomy in order to prevent which complication?

d. Aspiration ANS: D By suctioning prior to deflating the cuff, the oral liquids that are trapped above the balloon cannot be aspirated. Bleeding, negative pressure, and dislodgement of the tube are not related to cuff inflation.

The nurse is caring for a patient who was recently admitted with a traumatic head injury. The nurse anticipates that the patient may display which type of respirations?

d. Biot ANS: D Biot respirations are characterized by irregular periods of apnea followed by four to five breaths of identical depth. This pattern is associated with increased intracranial pressure, which is common with a traumatic head injury. Apneustic respirations are indicative of damage to the respiratory centers in the brain. Cheyne-Stokes respirations are often seen in patients in a coma resulting from a disorder affecting the central nervous system. Kussmaul respiration is an abnormal breathing pattern often seen in patients with diabetic acidosis and coma.

The nurse explains that the mechanism that triggers rate and depth of respiration is based on which factor?

d. Blood pH. Chemoreceptors in the brainstem and carotid arteries measure hydrogen concentration, as well as CO2 and O2, to trigger respiration rate to correct the excessive CO2.

The nurse is caring for a patient with an obstructive respiratory disorder. Which of these conditions is an example of an obstructive lung disorder?

d. Chronic bronchitis Obstructive lung disease is related to the reduced ability to move air in and out of the lungs. Asthma, emphysema, and chronic bronchitis are classified as obstructive disorders. Atelectasis, lung cancer, and Guillain-Barré syndrome are restrictive disorders.

When doing routine cleaning of a double-lumen tracheostomy tube, the nurse should include which action?

d. Clean the inner cannula with a pipe cleaner. ANS: D The inner cannula is cleaned with a pipe cleaner, the patient is put in the semi-Fowler position, and the inner cannula is rinsed in sterile saline or sterile water, rather than peroxide.

The nurse is preparing to administer the influenza immunization to four patients. Allergy to which substance should cause the nurse to question giving the immunization?

d. Eggs ANS: D The influenza vaccine is cultured in chicken embryos, making anyone allergic to eggs probably allergic to the immunization.

The nurse is caring for a patient immediately postoperative after a left pneumonectomy. How should the nurse position the patient?

d. In a left side-lying position ANS: D Postoperative positioning after a pneumonectomy is on the operated side to prevent the threat of tension pneumothorax with mediastinal shift and leakage from the amputated bronchial stump. The physician's order should always be checked before turning the patient or raising the head of the bed.

After using a nasal cannula delivery system at 3 L/min, a patient with chronic airflow limitation (CAL) changes to a simple face mask. The nasal equipment oxygen was set at 3 L/min. How should the nurse adjust the oxygen flow for the new delivery system?

d. Increase it to 6 L. ANS: D When changing to a mask from a nasal cannula, the oxygen should be increased by approximately 100% to get the same concentration. Simple face masks deliver approximately the same range of concentration of oxygen as the nasal cannula. However, the nasal cannula flow rates range from 1 to 6 L, delivering 24% to 44% oxygen, whereas the simple face mask delivers 35% to 50% oxygen which is achieved with flow rates from 6 to 12 L.

The nurse is caring for a patient experiencing epistaxis. What action should the nurse take first?

d. Instruct the patient to sit forward and pinch the nose below the bone. ANS: D When epistaxis occurs, the patient should sit forward and apply direct pressure by pinching the nose just below the bone, close to the face for 10 to 15 minutes. This position prevents blood from running down the back of the throat. Cold compresses or ice may be applied to the nose to constrict the blood vessels. If there is still bleeding at the end of a 10- to 15-minute period, the process should be repeated. If bleeding continues, the nurse should obtain the patient's vital signs and notify the provider. The provider may cauterize the bleeding vessels or solidly pack the nose.

When caring for a patient with acquired immune deficiency syndrome (AIDS), the nurse is aware that this patient is most at risk for developing which type of pneumonia?

d. Pneumocystis jiroveci ANS: D Pneumocystis jiroveci (formerly known as Pneumocystis carinii) is commonly seen in AIDS patients. Hypostatic pneumonia is related to inadequate aeration of the lungs seen frequently with immobile patients. Streptococcus pneumoniae is the most common causative organism for bacterial pneumonia in the general population. Atypical pneumonia refers to pneumonia that does not present with the typical symptoms of pneumonia.

When teaching a patient about esophageal speech, which technique should the nurse instruct the patient to use first?

d. Swallow air and force it back up through the esophagus. ANS: D Many people are able to learn esophageal speech. First, the patient should master the art of swallowing air and then moving it forcibly back up through the esophagus. Next, the patient should learn to coordinate lip and tongue movements with the sound produced by the air passing over vibrating folds of the esophagus. The sounds may be somewhat hoarse, but are more natural than the sounds produced by an artificial larynx. Relaxing the diaphragm and coughing to express air are not methods to achieve esophageal speech.

The nurse uses a visual aid to show the "hinged door" that helps prevent aspiration. This "hinged door" is the __________.

epiglottis The epiglottis is the "hinged door" that closes upon swallowing and opens when breathing.

Ventilation

movement of air in and out of the lungs

The nurse encourages a patient with larynx cancer that the "near-total laryngectomy" is a new procedure that preserves the ability to __________ and to __________.

speak; swallow swallow; speak The new technique does not rob the patients' ability to speak or swallow, which makes rehabilitation easier.

Rapid opening and closing of the glottis combined with movement of the mouth, lips, and tongue is what makes _____________.

speech The rapid opening and closing of the glottis combined with the movement of the mouth, lips, and tongue is what makes speech.