Prep U: Ch. 39 Oxygenation & Perfusion

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The pediatric nurse is instructing parents on safety when caring for toddlers and preschoolers. Which of the following teaching interventions is appropriate for this age group? Sleep supine, not prone Provide toys with small pieces Cut a hot dog in half, then pieces Normal breathing is 30 to 60 breaths per minute

Cut a hot dog in half, then pieces Explanation: During the toddler and preschool years, children place things in their mouths, and caregivers must protect them against aspirating foreign objects that can obstruct small air passages. Providing safe toys and avoiding hard candy or small hard pieces of food are important ways to ensure normal respiratory function for children in this age group.

When inspecting a client's chest to assess respiratory status, the nurse should be aware of which normal finding? The contour of the intercostal spaces should be rounded. The anteroposterior diameter should be greater than the transverse diameter. The skin at the thorax should be cool and moist. The chest should be slightly convex with no sternal depression.

The chest should be slightly convex with no sternal depression. Explanation: The adult chest contour is slightly convex, with no sternal depression. The skin of the thorax should be warm and dry, and the anteroposterior diameter of the chest should be less than the transverse diameter. The contour of the intercostal spaces should be flat or depressed.

A client with a chest tube wishes to ambulate to the bathroom. What is the appropriate nursing response? -"Let me get the unlicensed assistive personnel (UAP) for you." -"The chest tube cannot be moved." -"You will need to use a bedpan while the chest tube is in position." -"I can assist you to the bathroom and back to bed."

"I can assist you to the bathroom and back to bed." Explanation: The client can move in bed, and ambulate while carrying the drainage system, as long as he or she has orders to do so. The nurse should supervise ambulation to the bathroom and back to bed while the client has the drain inserted to make sure it stays intact and to monitor for safety. Other answers are incorrect.

A nurse is delivering 3 L/min oxygen to a client via nasal cannula. What percentage of delivered oxygen is the client receiving? 23% 32% 47% 28%

32% Explanation: A nasal cannula is used to deliver from 1 L/minute to 6 L/minute of oxygen. 1 L/minute = 24%, 2 L/minute = 28%, 3 L/minute = 32%, 4 L/minute = 36%, 5 L/minute = 40%, and 6 L/minute = 44%

In which client should the nurse prioritize assessments for respiratory depression? A client taking opioids for cancer pain A client taking a beta-adrenergic blocker for hypertension A client taking antibiotics for a urinary tract infection A client taking insulin for type 1 diabetes

A client taking opioids for cancer pain Explanation: Many medications affect the function of the respiratory system and depress the respiratory system. The nurse should monitor clients taking certain medications, such as opioids, for rate and depth of respirations. Beta-adrenergic blockers, antibiotics, and insulin do not appreciably affect the respiratory system.

Which medication is administered in the home or the hospital to relieve inflammation in the lung tissue? Bronchodilators Expectorants Corticosteroids Antibiotics

Corticosteroids Explanation: In many cases, bronchodilators and corticosteroids are required to open airways and ease breathing. Corticosteroids relieve inflammation.

A nurse must deliver oxygen at a concentration of 85% to an infant. Which delivery device would be most appropriate for an infant? Nasal cannula Oxygen hood Simple mask Venturi mask

The client's available hemoglobin is adequately saturated with oxygen. Explanation: Pulse oximetry is a noninvasive technique that measures the arterial oxyhemoglobin saturation (SaO2 or SpO2) of arterial blood. This test measures only the percentage of oxygen carried by the available hemoglobin. Thus, even a client with a low hemoglobin level could appear to have a normal SpO2 because most of that hemoglobin is saturated. However, the client may not have enough oxygen to meet body needs. A normal pulse oximetry reading does not necessarily indicate a normal RBC count or heart rate.

After insertion of a chest tube, fluctuations in the water-seal chamber that correspond with inspiration and expiration are an expected and normal finding: False True

True Explanation: After insertion of a chest tube, fluctuations in the water-seal chamber that correspond with inspiration and expiration are an expected and normal finding. A nurse caring for a client with a chest tube should monitor the patient's respiratory status and vital signs, check the dressing, and maintain the patency and integrity of the drainage system.

The home care nurse is visiting a client who is totally oxygen dependent and using home oxygen. Upon noticing a gas stove in the kitchen, what teaching will the nurse provide? -"Remove your oxygen before cooking near the gas stove." -"An electric stove may be a safer choice for you." -"It is important to eat at least five servings of vegetables daily." -"Be careful not to trip over your oxygen tubing while cooking."

"An electric stove may be a safer choice for you." Explanation: For safety purposes, oxygen tanks should be kept at least 10 feet away from gas stoves, fires, and other flammable devices. If the client removes the oxygen while cooking at a gas stove, hypoxia may occur and the client may become confused and sustain burns.

The nurse is demonstrating oxygen administration to a client. Which teaching will the nurse include about the humidifier? -"It measures the percentage of delivered oxygen to determine whether the client is getting the amount prescribed." -"Small water droplets come from this, thus preventing dry mucous membranes." -"This is a gauge used to regulate the amount of oxygen that a client receives." -"The humidifier prescribes the concentration of oxygen."

"Small water droplets come from this, thus preventing dry mucous membranes." Explanation: The humidifier produces small water droplets which are delivered during oxygen administration to prevent or decrease dry mucous membranes. The oxygen analyzer measures the percentage of delivered oxygen to determine whether the client is receiving the prescribed amount. The flowmeter is a gauge used to regulate the amount of oxygen that a client receives. The healthcare provider prescribed the concentration of oxygen.

The nurse educator is presenting a lecture on emphysema with the aid of balloons. Which responses, if given by the nursing staff, would indicate to the educator that further teaching is needed? Select all that apply. -"Balloons represent compliancy; the new balloons are difficult to expand, as in emphysema, leading to decreased compliancy." -"The lungs in emphysema, unlike a used balloon, are stiff and noncompliant." -"Emphysema, like a new balloon, takes less effort to empty air out of the alveoli." -"Respirations of the client with emphysema can be compared to a balloon that has been blown up before." -"The extra effort it takes to blow up a new balloon can explain why the client with emphysema is short of breath."

-"Respirations of the client with emphysema can be compared to a balloon that has been blown up before." -"Emphysema, like a new balloon, takes less effort to empty air out of the alveoli." Explanation: The lungs in a client with emphysema are stiff and noncompliant. The lungs (alveoli) are compared to a new balloon that takes more effort to blow up and release air out. As in emphysema, a new balloon takes extra effort to blow up; the client with emphysema has to exert more effort to breathe in and out, leading to shortness of breath. The new balloon is difficult to expand, representing decreased elasticity and leading to decreased compliance.

A nurse is overseeing the care of a client who is receiving oxygen via nasal cannula. Which aspects of the client's care can the nurse safely delegate to unlicensed assistive personnel (UAP)? Select all that apply. -Auscultating the client's lungs to determine the effectiveness of treatment -Measuring the client's respiratory rate -Reapplying the client's nasal cannula after a bath -Increasing the flow rate of the client's oxygen when the client is short of breath -Inserting the client's nasal cannula after it has become dislodged

-Measuring the client's respiratory rate -Inserting the client's nasal cannula after it has become dislodged -Reapplying the client's nasal cannula after a bath Explanation: Reapplication of the nasal cannula during nursing care activities, such as during bathing, may be performed by UAP. UAP may measure a client's respiratory rate in the context of measuring the client's vital signs. Chest auscultation and changes to oxygen delivery are beyond the scope of UAP.

A nurse is performing CPR on a client who collapsed. Which guidelines should be used for this procedure? Select all that apply. -Look, listen, and feel for air exchange for at least 10 seconds and no more than 20 seconds. -Rest elbows on the flat surface under the client, grasp the angle of the client's lower jaw, and lift with both hands. -Position the client supine on his or her back. -Use the head tilt-chin lift maneuver to open the airway. -If trauma to the head or neck is present or suspected, do not attempt to open the airway. -If possible, place the client on a soft mattress to minimize injury.

-Position the client supine on his or her back. -Use the head tilt-chin lift maneuver to open the airway. -Rest elbows on the flat surface under the client, grasp the angle of the client's lower jaw, and lift with both hands. Explanation: The nurse should position the client supine on his or her back on a firm, flat surface, with arms alongside the body. If the client is in bed, place a backboard or other rigid surface under the client. Use the head tilt-chin lift maneuver to open the airway. If trauma to the head or neck is present or suspected, use the jaw-thrust maneuver to open the airway. Rest elbows on the flat surface under the client; grasp the angle of the client's lower jaw and lift with both hands if the jaw-thrust maneuver is used to open the airway. Look, listen, and feel for air exchange, taking at least 5 seconds and no more than 10 seconds. If the client resumes breathing or adequate respirations and signs of circulation are noted, place the client in the recovery position.

The nurse is caring for a client with emphysema. A review of the client's chart reveals pH 7.36, PaO2 73 mm Hg, PaCO2 64 mm Hg, and HCO3 35 mEq/L. The nurse would question which prescription if prescribed by the health care practitioner? Pulse oximetry High-Fowler's position Increase fluid intake to 3 L/day (3000 mL/day) 4 L/minute O2 (66 mL/second) nasal cannula

4 L/minute O2 (66 mL/second) nasal cannula Explanation: The client with chronic lung disease, such as emphysema, becomes insensitive to carbon dioxide and responds to hypoxia to stimulate breathing. If given excessive oxygen (4 L/minute or 66 mL/second), the stimulus to breathe is removed. Clients with emphysema are most comfortable in high Fowler's position because it aids in the use of the accessory muscles to promote respirations. Increasing fluid intake helps keep the client's secretions thin. Pulse oximetry monitors the client's arterial oxyhemoglobin saturation while receiving oxygen therapy.

The nurse is assessing the vital signs of clients in a community health care facility. Which client respiratory results should the nurse report to the health care provider? -A 70-year-old with a respiratory rate of 18 bpm -An infant with a respiratory rate of 16 bpm -A 12-year-old with a respiratory rate of 20 bpm -A 4-year-old with a respiratory rate of 32 bpm

An infant with a respiratory rate of 16 bpm Explanation: The infant's normal respiratory rate is 20 to 40 breaths per minute. The normal range for a child age 1 to 5 years is 20 to 32 breaths per minute. For a child 6 to 12 years of age the normal respiratory rate is 18 to 26 breaths per minute. The normal respiratory rate for an adult 65 years and older is 16 to 24 breaths per minute.

A client is admitted to the hospital with shortness of breath, cyanosis and an oxygen saturation of 82% (0.82) on room air. Which action should the nurse implement first? Raise the head of the bed Assist with intubation Educate client on incentive spirometry Apply oxygen

Apply oxygen Explanation: The nurse should first apply oxygen, which will help to improve oxygen saturation and health status. The client may not require intubation, once oxygen is provided. Although the client may require education on incentive spirometry, the immediate priority intervention is to stabilize the client's oxygen saturation. Similarly, raising the head of the bed may help with the client's comfort but may not have sufficient effect on oxygen saturation.

The nurse is assessing a client with lung cancer. What manifestations may suggest that the client has chronic hypoxia? Hemoptysis Constipation Edema Clubbing

Clubbing Explanation: Clubbing refers to the rounding and enlargement of the tips of the fingers and toes. It is a common phenomenon seen in many clients with chronic hypoxia due to respiratory or cardiac disease. Clubbing occurs in lung cancer, cystic fibrosis, and lung diseases such as lung abscess and COPD. Hemoptysis does not result from hypoxia.

A nurse is conducting a physical assessment of a client who is being treated for pleural effusion at a health care facility. The nurse needs the client to exhale additional air, which will allow the nurse to check the quality of the client's oxygenation. What instruction should the nurse give the client? Elevate the ribs and sternum. Contract the abdominal muscles. Expand the thoracic cavity. Relax the respiratory muscles.

Contract the abdominal muscles. Explanation: The nurse should instruct the client to contract the abdominal muscles to exhale additional air. A person can forcibly exhale additional air by contracting abdominal muscles such as the rectus abdominis, transverse abdominis, and external and internal obliques. The client elevates the ribs and sternum and expands the thoracic cavity during inspiration. The client relaxes the respiratory muscles during normal expiration.

Which dietary guideline would be appropriate for the older adult homebound client with advanced respiratory disease who informs the nurse that she has no energy to eat? Snack on high-carbohydrate foods frequently. Contact the physician for nutrition shake. Eat one large meal at noon. Eat smaller meals that are high in protein.

Eat smaller meals that are high in protein. Explanation: The client should consume a diet in which the body can produce plasma proteins. The client should have sufficient caloric and protein intake for respiratory muscle strength.

A nurse on a cardiac care unit oversees the care of diverse clients' cardiac health problems. Which action can be most appropriately delegated to a licensed practical nurse (LPN)? Initiation of CPR for a client who is found unresponsive Initiation of manual external defibrillation Application of a client's cardiac monitor Collecting an arterial blood sample

Initiation of CPR for a client who is found unresponsive Explanation: The initiation and provision of cardiopulmonary resuscitation is appropriate for all health care providers. Depending on the state's nurse practice act and the organization's policies and procedures, an LPN may or may not be able to perform the other listed actions.

A client with a history of chronic obstructive pulmonary disease (COPD) has been ordered oxygen at 3 L/min as needed for treatment of dyspnea. What delivery mode is most appropriate to this client's needs? Partial rebreather mask Nonrebreather mask Nasal cannula Simple mask

Nasal cannula Explanation: A nasal cannula is used to deliver from 1 L/min to 6 L/min of oxygen. Masks are used with higher flow rates of oxygen.

A client with a diagnosis of advanced Alzheimer disease is unable to follow directions required to use an inhaled bronchodilator. Which medication delivery system is most appropriate for this client? Metered-dose inhaler without spacer Nebulizer Metered-dose inhaler with spacer Dry powder inhaler

Nebulizer Explanation: Inhalers differ in the amount of dexterity required in order to deliver an accurate dose, but each requires some degree of coordinated activity and the ability to follow directions on the part of the client. For a client with decreased cognition, a nebulizer may be more appropriate because the client passively inhales the entire dose. A dry powder inhaler is initiated by inhalation and requires an ability to follow directions and keep the mouth around the port. If the client cannot follow directions then only the nebulizer is appropriate.

The health care provider has prescribed an oropharyngeal airway for a client with a decreased level of consciousness. The health care provider has noted gurgling respirations and the client's tongue is in the posterior pharynx. The client vomits as the airway is inserted. Which actions should the nurse take? Select all that apply. -Assess for bleeding in the mouth. -Position client onto the side immediately. -Raise the head of the bed to 90 degrees. -Remove oropharyngeal airway. -Provide oral suctioning and mouth care.

Position client onto the side immediately. Remove oropharyngeal airway. Provide oral suctioning and mouth care. Explanation: The nurse should quickly position client into a lateral position to prevent aspiration, remove the oropharyngeal airway, and then suction or provide oral hygiene as needed. Raising the head of bed to 90 degrees is unnecessary, because the client should be positioned on one side. There is no indication that trauma to the mouth has occurred, so the nurse would not need to assess for bleeding.

The nurse is caring for a postoperative client who has a prescription for meperidine 75 mg intramuscularly (IM) every 4 hours as needed for pain. Before and after administering meperidine, the nurse would assess which most important sign? Apical pulse Orthostatic blood pressure Respiratory rate and depth Urinary intake and output

Respiratory rate and depth Explanation: The client receiving narcotics/opioids needs monitoring of the respiratory rate and depth to ensure that respiratory depression does not result in progressive respiratory issues, physiologic damage from respiratory depression, or loss of consciousness. The pulse, blood pressure, and urinary intake and output are not as important as respiratory status when administering narcotics.

The nurse is caring for a client who is receiving continuous oxygen at 3 L/minute via nasal cannula. The client's oxygen saturation has consistently been 94% to 96%, but suddenly drops to 86% as the nurse palpates the client's abdomen. The client denies respiratory difficulty or other distress. What is a likely reason for the client's decreasing oxygen saturation? -The client's appendix has ruptured. -The client is holding his or her breath. -The nurse has inadvertently stepped on the client's oxygen tubing, occluding the flow of oxygen. -The client has developed a pulmonary embolism and has a ventilation-perfusion mismatch.

The nurse has inadvertently stepped on the client's oxygen tubing, occluding the flow of oxygen. Explanation: A sudden drop in oxygen saturation without clinical signs or symptoms may be caused by disruption of oxygen flow. The information in the question does not support a pulmonary embolism, the client holding his or her breath, or an appendix rupturing.

Which guideline describes the proper method for measuring the appropriate length to use when inserting a nasopharyngeal airway? -The airways come in standard sizes determined by the height and weight of the client. -When holding the airway on the side of the client's face, it should reach from the tragus of the ear to the tip of the nostril. -When holding the airway on the side of the client's face, it should reach from the tip of the ear to the nostril times two. -When holding the airway on the side of the client's face, it should reach from the opening of the mouth to the back angle of the jaw.

When holding the airway on the side of the client's face, it should reach from the tragus of the ear to the tip of the nostril. Explanation: The nasopharyngeal airway length is measured by holding the airway on the side of the client's face. The airway should reach from the tragus of the ear to the tip of the nostril. The diameter should be slightly smaller than the diameter of the nostril. For an oropharyngeal airway, when holding the airway on the side of the client's face, it should reach from the opening of the mouth to the back angle of the jaw.

The nurse is assessing a newborn in the nursery. The nurse notes the infant has episodes in which breathing ceased for 20 seconds on 2 occasions. The nurse correctly recognizes this condition as: apnea. hypercapnia. orthopnea. dyspnea.

apnea. Explanation: The newborn's breathing pattern is characterized by occasional pauses of several seconds between breaths. This periodic breathing is normal during the first 3 months of life, but frequent or prolonged periods of apnea (cessation of breathing 20 seconds or longer) are abnormal. Dyspnea refers to shortness of breath. Orthopnea refers to difficulty breathing when lying flat. An elevation of carbon dioxide levels in the blood is termed hypercapnia.

A client 57 years of age is recovering in a hospital following a bilateral mastectomy and breast reconstruction 2 days earlier. Since her surgery, the client has been unwilling to mobilize despite the nurse's education on the benefits of early mobilization following surgery. The nurse would recognize that the client's prolonged immobility creates a risk for: pneumothorax. hemothorax. tachypnea. atelectasis.

atelectasis. Explanation: Prolonged bed rest can result in the incomplete lung expansion and collapse of alveoli that characterize atelectasis. Immobility is not commonly implicated in cases of pneumothorax or hemothorax. A pneumothorax is a collapsed lung. Hemothorax is a collection of blood in the space between the chest wall and the lung. Tachypnea, if present, would likely be a sign of atelectasis rather than an independent finding.

Mr. Parks has chronic obstructive pulmonary disease (COPD). His nurse has taught him pursed-lip breathing, which helps him in which of the following ways? decreases the amount of air trapping and resistance increases carbon dioxide, which stimulates breathing helps liquefy his secretions teaches him to prolong inspiration and shorten expiration

decreases the amount of air trapping and resistance Explanation: Exhaling through pursed lips creates a smaller opening for air movement, effectively slowing and prolonging expiration, which prevents air from being trapped in the alveoli and decreases resistance to exhalation. Increasing carbon dioxide levels to stimulate breathing is the natural stimulus for a person without COPD to breathe. Prolonging inspiration and shortening expiration does not assist the client because exhalation is difficult for the COPD client. Humidification and fluid intake help to liquefy secretions.

The nurse is caring for a client who has been prescribed humidified oxygen at 6 L/minute. Which type of liquid will the nurse gather to set up the humidifier? normal saline mineral oil tap water distilled water

distilled water Explanation: Distilled water is used when humidification is desired. Other answers are incorrect.

The nurse is caring for a client who has been prescribed humidified oxygen at 6 L/minute. Which type of liquid will the nurse gather to set up the humidifier? tap water normal saline distilled water mineral oil

distilled water Explanation: Distilled water is used when humidification is desired. Other answers are incorrect.

A client with chronic obstructive pulmonary disease (COPD) requires low flow oxygen. How will the oxygen be administered? nasal cannula partial rebreather mask Venturi mask simple oxygen mask

nasal cannula Explanation: Nasal cannula and tubing administer oxygen concentrations at 22% to 44%.

Which is a sign of dyspnea specific to infants? nasal flaring increased respiratory rate panting respirations a forward-leaning position

nasal flaring Explanation: In the infant, flaring of the nostrils and retractions of the ribs during inspiration are notable signs of air hunger and extraordinary work of breathing.

The nurse is performing a check with an oxygen analyzer. Which oxygen analyzer assessment finding indicates that the device is working properly? reads 0.21 when checking oxygen in room air reads 0.25 when checking oxygen in room air reads 0.19 when positioned near oxygen device reads 0.20 when positioned near oxygen device

reads 0.21 when checking oxygen in room air Explanation: An oxygen analyzer should read 0.21 when checking oxygen in room air if there is a normal mixture of oxygen and other gases in the environment. When the analyzer is positioned near or within the device used to prescribe oxygen, it should register at the prescribed amount (>0.21).

What structural changes to the respiratory system should a nurse observe when caring for older adults? increased use of accessory muscles for breathing increased mouth breathing and snoring diminished coughing and gag reflexes respiratory muscles become weaker

respiratory muscles become weaker Explanation: One of the structural changes affecting the respiratory system that a nurse should observe in an older adult is respiratory muscles becoming weaker. The nurse should also observe other structural changes: the chest wall becomes stiffer as a result of calcification of the intercostals cartilage, kyphoscoliosis, and arthritic changes to costovertebral joints; the ribs and vertebrae lose calcium; the lungs become smaller and less elastic; alveoli enlarge; and alveolar walls become thinner. Diminished coughing and gag reflexes, increased use of accessory muscles for breathing, and increased mouth breathing and snoring are functional changes to the respiratory system in older adults.

A nurse is calculating the cardiac output of an adult with a stroke volume of 75 mL (75 × 109/L) and a pulse of 78 beats/min. What number would the nurse document for this assessment? 5,000 mL (5,000 × 109/L) 5,850 mL (5,850 × 109/L) 5,550 mL (5,500 × 109/L) 6,000 mL (6,000 × 109/L)

5,850 mL (5,850 × 109/L) Explanation: Cardiac output is determined by multiplying the stroke volume by the heart rate/min, which equals 5,850 mL (5,850 × 109/L). Cardiac output and peripheral resistance determine both systolic and diastolic pressures.

When a nurse observes that an older client's skin is dry and shiny and his nails are thickened, the nurse determines that the client is most likely experiencing: Congestive heart failure Malnutrition Anemia Poor tissue perfusion

Poor tissue perfusion Explanation: Chronically poor perfusion may result in hair loss in the affected area, discolored skin, thickened nails, and shiny, dry skin indicative of inadequate tissue nutrition.

The nurse schedules a pulmonary function test to measure the amount of air left in a client's lungs at maximal expiration. What test does the nurse order? Tidal volume (TV) Total lung capacity (TLC) Residual Volume (RV) Forced Expiratory Volume (FEV)

Residual Volume (RV) Explanation: During a pulmonary function test the amount of air left in the lungs at the end of maximal expiration is called residual volume. Tidal volume refers to the total amount of air inhaled and exhaled with one breath. Total lung capacity is the amount of air contained within the lungs at maximum inspiration. Forced expiratory volume measures the amount of air exhaled in the first second after a full inspiration; it can also be measured at 2 or 3 seconds.

The nurse educator is presenting a lecture on the respiratory and cardiovascular systems. Which response given by the nursing staff would indicate to the educator that they have an understanding of cardiac output? -"If the client's stroke volume is 80 mL and heart rate is 80 beats per minute, then the cardiac output is 6.0 L/minute." -"If the client's stroke volume is 70 mL and heart rate is 70 beats per minute, then the cardiac output is 4.7 L/minute." -"If the client's stroke volume is 50 mL and heart rate is 50 beats per minute, then the cardiac output is 2.5 L/minute." -"If the client's stroke volume is 60 mL and heart rate is 60 beats per minute, then the cardiac output is 3.2 L/minute."

"If the client's stroke volume is 50 mL and heart rate is 50 beats per minute, then the cardiac output is 2.5 L/minute." Explanation: The following formula is used to determine cardiac output: Cardiac Output = Stroke Volume x Heart Rate. A client with a stroke volume of 50 mL and heart rate of 50 beats per minute has a cardiac output of 2.5 L/minute. If stroke volume is 70 and heart rate is 70 beats per minute, then the cardiac output is 4.9 L/minute. If stroke volume is 80 and heart rate is 80 beats per minute, then the cardiac output is 6.4 L/minute.

The nurse is preparing discharge teaching for a client who has chronic obstructive pulmonary disease (COPD). Which teaching about deep breathing will the nurse include? -"Take in a large volume of air over 5 seconds and hold your breath as long as you can before exhaling." -"Inhale slowly over three seconds, purse your lips, contract abdominal muscles, and exhale slowly." -"Take in a little air over 10 seconds, hold your breath 15 seconds, and exhale slowly." -"Take in a small amount of air very quickly and then exhale as quickly as possible."

"Inhale slowly over three seconds, purse your lips, contract abdominal muscles, and exhale slowly." Explanation: Pursed-lip breathing is a form of controlled ventilation that is effective for clients with COPD. Other answers are incorrect techniques for deep breathing.

A client who uses portable home oxygen states, "I still like to smoke cigarettes every now and then." What is the appropriate nursing response? -"An occasional cigarette will not hurt you." -"Oxygen is a flammable gas." -"You should never smoke when oxygen is in use." -"I understand; I used to be a smoker also."

"You should never smoke when oxygen is in use." Explanation: The nurse will educate the client about the dangers of smoking when oxygen is in use. Oxygen is not flammable, but it oxidizes other materials. Other answers are inappropriate.

The nurse is caring for a client who is diagnosed with Impaired Gas Exchange. While performing a physical assessment of the client, which data is the nurse likely to find, keeping in mind the client's diagnosis? high temperature low pulse rate low blood pressure high respiratory rate

high respiratory rate Explanation: A client diagnosed with Impaired Gas Exchange has difficulty in breathing, so the nurse is likely to find a high respiratory rate. As a compensatory mechanism to impairment in gas exchange, the peripheral temperature drops, and the pulse rate and blood pressure increase.

A client is diagnosed with hypoxia related to emphysema. The client's adult child will be assisting the client with daily hygiene. How will the nurse explain positioning of the client to the caregiver? -"Place your parent at the sink to allow teeth brushing and stand outside of the shower to help if needed." -"Whichever position helps your parent feel most comfortable and will allow you to help with hygiene is fine." -"An upright, sitting position is the best for daily hygiene so a lightweight chair that can be used in and out of the shower works best to help your parent breathe easier and allow you to assist." -"A standing position works best to allow your parent to move around in the bathroom and to allow you to help your parent in and out of the shower."

"An upright, sitting position is the best for daily hygiene so a lightweight chair that can be used in and out of the shower works best to help your parent breathe easier and allow you to assist." Explanation: The best way to explain caregiving is to describe the specific position and type of chair to use as well as teach the caregiver why it is the best position and device. Teaching the caregiver to place the parent at the sink and then stand outside the shower does not provide the best position nor the device to obtain, plus it does not address the facts that the parent standing in the shower may not be possible due to hypoxia and is not safe. Teaching the caregiver to use whichever position is most comfortable for the parent does not address the safest position for the client nor the position that provides easiest breathing and energy conservation. Standing for the period of time it may take to complete daily hygiene is not feasible or safe for the client and should not be recommended by the nurse.

The nurse is teaching the client with a pulmonary disorder about deep breathing. The client asks, "Why is it important to start by breathing through my nose, then exhaling through my mouth?" Which appropriate response would the nurse give this client? -"If you breathe through the mouth first, you will swallow germs into your stomach." -"Breathing through your nose first will warm, filter, and humidify the air you are breathing." -"We are concerned about you developing a snoring habit, so we encourage nasal breathing first." -"Breathing through your nose first encourages you to sit up straighter to increase expansion of the lungs during inhalation."

"Breathing through your nose first will warm, filter, and humidify the air you are breathing." Explanation: Nasal breathing allows the air to be warmed, filtered, and humidified. Nose breathing does not encourage the client to sit up straight. The purpose of nasal breathing is not to prevent germs from entering the stomach or to discourage snoring.

A child is admitted to the pediatric division with an acute asthma attack. The nurse assesses the lung sounds and respiratory rate. The mother asks the nurse, "Why is his chest sucking in above his stomach? The nurse's most accurate response is: "He will require additional testing to determine the cause." "His lung muscles are swollen so he is using abdominal muscles." "His infection is causing him to breathe harder." "He is using his chest muscles to help him breathe."

"He is using his chest muscles to help him breathe." Explanation: The client will use accessory muscles to ease dyspnea and improve breathing.

Which teaching about the oxygen analyzer is important for the nurse to provide to a client using oxygen? It prescribes oxygen concentration. It regulates the amount of oxygen received. It determines whether the client is getting enough oxygen. It decreases dry mucous membranes via delivering small water droplets.

An older resident at a long-term care facility has been placed on oxygen via a partial rebreather mask due to COVID-19. While helping the resident prepare for sleep, the nurse notices the mask is no longer fitting properly. Which question should the nurse prioritize? -"Did you remove your dentures?" -"Is your mask causing discomfort?" -"Did someone loosen the straps on your mask?" -"Did someone take your mask off?"

"Is your mask causing discomfort?" Explanation: It is possible for anyone using a mask to try and readjust it if it is uncomfortable. Depending on the older adult's cognitive status, he or she may have tried to make it more comfortable and in the process caused it to no longer fit correctly. This could also occur if the client removed their dentures, as some individual's choose to let the dentures soak overnight. If the mask was fitted with the dentures in, the mask will likely be loose with the dentures removed. The other questions could possibly be asked to see if someone else may have tried to help the client feel more comfortable with the mask on.

The nurse performs a respiratory assessment on a healthy client. While listening to the client's lungs, the nurse hears them fill with air and then return to a resting position. The nurse deems the findings normal. Which is the best way to document this respiratory assessment and lung sounds? -"Client breathing without difficulty; respiratory rate 22 and regular on 2 liters of oxygen per nasal cannula; dry, hacky, intermittent cough; reports slight shortness of breath with exertion." -"Respiratory rate 22, regular; lungs sounds clear bilaterally; spontaneous, nonproductive cough, yellow drainage from nostrils." -"Respiratory rate 14, even, regular, and easy; depth with acceptable parameters; lung sounds clear all lobes bilaterally; absence of adventitious lung sounds; absence of spontaneous cough; oxygen saturation 98%." -"Client sitting upright in bed, respirations 24 and shallow, lungs clear bilaterally, oxygen at 2 liters per nasal cannula, productive cough."

"Respiratory rate 14, even, regular, and easy; depth with acceptable parameters; lung sounds clear all lobes bilaterally; absence of adventitious lung sounds; absence of spontaneous cough; oxygen saturation 98%." Explanation: The most accurate and complete nursing documentation of normal lungs sounds in a health client is "Respiratory rate 14, even, regular, and easy; depth with acceptable parameters; lung sounds clear all lobes bilaterally; absence of adventitious lung sounds; absence of spontaneous cough; oxygen saturation 98%" because it provides the respiratory type, rate, depth, ventilation efficiency, clarity of all lobes of both lungs, absence of any abnormality and the oxygen saturation rate to provide a total respiratory picture of the healthy client. The other documentations are not complete, and each has an abnormal respiratory factor included.

A client who uses portable home oxygen states, "I still like to smoke cigarettes every now and then." What is the appropriate nursing response? "Oxygen is a flammable gas." "You should never smoke when oxygen is in use." "I understand; I used to be a smoker also." "An occasional cigarette will not hurt you."

A client with chronic obstructive pulmonary disease who uses supplemental oxygen via mask requires oral suctioning. Which action(s) demonstrates the components of appropriate oral suctioning technique by the nurse? Select all that apply. -Removing the client's oxygen and inserting the yankauer catheter into client's mouth -Running the catheter along the client's gum line to the pharynx in a circular motion while keeping yankauer moving -Applying suction by covering the thumb hole on the catheter for a maximum of 45 to 60 seconds -Allowing client to rest for 30 to 60 seconds in between suctionings -Replacing oxygen on client and clearing out suction catheter by placing yankauer in the basin of water

-Allowing client to rest for 30 to 60 seconds in between suctionings -Removing the client's oxygen and inserting the yankauer catheter into client's mouth -Replacing oxygen on client and clearing out suction catheter by placing yankauer in the basin of water -Running the catheter along the client's gum line to the pharynx in a circular motion while keeping yankauer moving Explanation: Appropriate oral suctioning of the client by the nurse includes the nurse allowing the client to rest in between suctionings for 30 seconds to 1 minute. To begin the oral suctioning the nurse removes the client's oxygen and inserts the Yankauer catheter into client's mouth. The nurse applies suction by covering the thumb hole for a maximum of 10 to 15 seconds, not 45 to 60 seconds. Applying suction too long can result in shortness of breath, anxiety, and discomfort for the client. The nurse runs the catheter along the gum line to the pharynx in a circular motion while keeping Yankauer moving. The nurse replaces the client's oxygen after suction and clears out the catheter in a basin of water to prevent the connection tubing from plugging.

The nurse is administering oxygen to an older adult client who has been assessed to have increased work of breathing. If the intervention has been effective, what finding(s) will the nurse expect on the evaluation of the client? Select all that apply. -The client is able to state the date, time, and location. -Oxygen saturation reads 88% on 5L of oxygen. -Mucous membranes are pink and moist. -Respiratory rate is 33 breaths/min at rest. -Heart rate is 64 beats/min.

-Heart rate is 64 beats/min. -Mucous membranes are pink and moist. -The client is able to state the date, time, and location. Explanation: A normal resting heart rate indicates a tolerable work of breathing. When in respiratory distress, clients will also experience tachycardia or a heart rate higher than 100 beats/min. Skin color and mucous membranes are other indicators of the client's oxygenation status. When hypoxic, a client will present as pale-skinned, sometimes with bluish-ness around the mouth called cyanosis. Mucous membranes can also appear pale or blanched due to poor circulation. A client with normal work of breathing will have pink and moist mucous membranes. The level of consciousness is another indicator of normal oxygenation. If the client is oriented to day, time, and place, the client has an intact level of consciousness, a sign of normal oxygenation. A respiratory rate of 33 breaths/min indicates tachypnea related to increased work of breathing. This is a sign of hypoxia. The nurse will oxygenate the client with an aim to bring the client's oxygen saturation above 90%, to ease the work of breathing. Oxygen saturation of 88% with oxygen supplementation is too low and the nurse will need to re-evaluate the effectiveness of the intervention.

The nurse is preparing a client for a complete blood count test. Which actions would the nurse perform? Select all that apply. Inform the client that this test can assist in evaluating the body's response to illness. -Explain that, based on results, additional testing may be performed. -Inform the client that specimen collection takes approximately 5 to 10 minutes. -Administer an analgesic to the client prior to the test. -Emphasize that there is no discomfort during the venipuncture. -Ensure that no food is consumed 6 hours prior to the test.

-Inform the client that this test can assist in evaluating the body's response to illness. -Inform the client that specimen collection takes approximately 5 to 10 minutes. -Explain that, based on results, additional testing may be performed. Explanation: The complete blood count (CBC) measures several hematologic factors such as white blood cell count, red blood cell count, hematocrit, and hemoglobin. The test indicates the body's response to illness, and may take 5 to 10 minutes to collect. The results of the CBC may indicate that further testing is needed. There may be some discomfort experienced during the venipuncture, but not to the point of the client needing analgesics prior to the test. Food and fluid does not need to be withheld prior to this test.

The nurse is caring for a client with emphysema. When teaching the client pursed-lip breathing, the nurse will include which instruction(s)? Select all that apply. -Shape the lips as if you were about to blow a whistle. -Ensure that the exhale lasts twice as long as the inhale. -Over time, begin to increase the length of the exhale. -Exhale slowly through pursed lips. -Inhale slowly through the nose for a count of three. -Keep abdominal muscles in a relaxed state.

-Inhale slowly through the nose for a count of three. -Shape the lips as if you were about to blow a whistle. -Over time, begin to increase the length of the exhale. -Exhale slowly through pursed lips. -Ensure that the exhale lasts twice as long as the inhale. Explanation: Pursed-lip breathing is a form of controlled ventilation in which the client consciously prolongs the expiration phase of breathing. This is another technique for improving gas exchange, which helps clients eliminate more than the usual amount of carbon dioxide from the lungs when done correctly. Pursed-lip breathing and diaphragmatic breathing are especially helpful for clients who have chronic obstructive pulmonary disorders (COPD), such as emphysema. The key with this intervention is to encourage the client to slow down breathing to allow for the development of increased lung capacity over time to ease the work of breathing. The longer exhale supports the removal of carbon dioxide, which can lead to impaired cognition for individuals with this disease. The nurse will teach the client to contract the abdominal muscles during pursed-lip breathing as this aids in longer exhalations. Keeping the abdominal wall relaxed will limit the effectiveness of this intervention.

A client, 90 years of age, has been in a motor vehicle collision and sustained four fractured ribs on the left side of the thorax. The nurse recognizes the client is experiencing respiratory complications when which sign(s) is observed? Select all that apply. -The client has uneven movements of the chest with respirations. -The client's capillary refill is assessed at 4 seconds. -The client has a respiratory rate of 16 breaths/min. -The client has flaring nostrils. -The client demonstrates restlessness.

-The client demonstrates restlessness. -The client's capillary refill is assessed at 4 seconds. -The client has uneven movements of the chest with respirations. -The client has flaring nostrils. Explanation: Careful assessment of older adults who demonstrate restlessness or confusion is imperative for accurately differentiating signs of inadequate oxygenation from signs of delirium or dementia. While the nurse may be observing signs of cognitive impairment, restlessness commonly accompanies respiratory distress. The nurse will not dismiss this sign and will consider it as part of the respiratory assessment. A prolonged capillary refill time (any time longer than 3 seconds) is indicative of poor perfusion secondary to poor oxygenation. This is a sign that the client may be experiencing respiratory complications. The nurse observes for paradoxical (uneven) chest movement that would indicate a possible flail chest. These complications may require insertion of a chest tube or other surgery, blood transfusion or artificial ventilation. Flaring nostrils indicate increased work of breathing related to poor gas exchange. A respiratory rate that ranges from 12 to 16 breaths/min is normal for adults and older adults.

The nurse is reviewing the chart of a client receiving oxygen therapy. The nurse would question which supplemental oxygen prescription if written by the health care practitioner? 10 L/min oxygen via Venturi mask 12 L/min oxygen via nonrebreather mask 8 L/min oxygen via partial rebreather mask 8 L/min oxygen via nasal cannula

10 L/min oxygen via Venturi mask Explanation: The correct amount delivered FiO2 for a nonrebreather mask is 10 to 15 L/min; 8 to 11 L/min for partial rebreather mask; 4 to 6 L/min for Venturi mask; and 1 to 15 L/min for low flow and high flow nasal cannula.

A nurse is calculating the cardiac output of an adult with a stroke volume of 75 mL (75 × 109/L) and a pulse of 78 beats/min. What number would the nurse document for this assessment? 5,000 mL (5,000 × 109/L) 6,000 mL (6,000 × 109/L) 5,550 mL (5,500 × 109/L) 5,850 mL (5,850 × 109/L)

A client is reporting slight shortness of breath and lung auscultation reveals the presence of bilateral coarse crackles. The client's SaO2 is 90% on pulse oximetry. The nurse has applied supplementary oxygen by nasal cannula, recognizing that the flow rate by this method should not exceed: 10 L/minute. 4 L/minute. 1 L/minute. 6 L/minute.

6 L/minute. Explanation: In general, if a flow rate of 6 L/minute fails to raise a client's oxygen saturation level satisfactorily, a mask should be used. 1-4 L/minute flow rates per nasal cannula are standard flow rates. Greater than 6 L/minute flow rate per nasal cannula is very uncomfortable for the client. A flow rate of 10 L /minute per nasal cannula is not acceptable.

In which client should the nurse prioritize assessments for respiratory depression? A client taking opioids for cancer pain A client taking antibiotics for a urinary tract infection A client taking a beta-adrenergic blocker for hypertension A client taking insulin for type 1 diabetes

Martin is a 58-year-old smoker who was admitted to the hospital with worsening shortness of breath over the last 2 days. He states that he is having some chest discomfort. The nurse asks him further about this in order to characterize whether this may be cardiac related, musculoskeletal related, or respiratory related. Martin states that when he breathes in, he feels as if the air passing into his lungs is burning him. It is also very painful to swallow. Based on what Martin is stating, which illness does the nurse suspect is causing Martin's chest discomfort? Pneumonia Emphysema Acute bronchitis Coronary artery disease

Acute bronchitis Explanation: Acute bronchitis is caused by inflammation. Inflammatory mediators such as histamine may directly stimulate nerve endings made hypersensitive by the disease process. This process causes a sensation of pain as air travels over those nerve endings. Clients with pneumonia often experience pain with deep breathing because each breath increases pressure on pain receptors that are already compressed and irritated by swollen, inflamed lung tissue. Coronary artery disease should be ruled out in anyone reporting chest pain, but Martin's sensation of burning in his airway with each breath is more suspicious for a respiratory issue. Emphysema is a more chronic illness that causes a slow progression of increasing shortness of breath. Martin is definitely at risk for emphysema but it would not explain his worsening shortness of breath over the last 2 days.

A nurse assessing a client's respiratory effort notes that the client's breaths are shallow and 8 per minute. Shortly after, the client's respirations cease. Which form of oxygen delivery should the nurse use for this client? Ambu bag Oxygen tent Nasal cannula Oxygen mask

Ambu bag Explanation: If the client is not breathing with an adequate rate and depth, or if the client has lost the respiratory drive, a manual resuscitation bag (Ambu bag) may be used to deliver oxygen until the client is resuscitated or can be intubated with an endotracheal tube. Oxygen masks may cover only the nose and mouth and can vary in the amount of oxygen delivered. A nasal oxygen cannula is a device that consists of a plastic tube that fits behind the ears, and a set of two prongs that are placed in the nostril. An oxygen tent is a tentlike enclosure within which the air supply can be enriched with oxygen to aid a client's breathing. Oxygen masks, nasal cannula, and oxygen tents are used for clients who have a respiratory drive.

The nurse is caring for a client who has a compromised cardiopulmonary system and needs to assess the client's tissue oxygenation. The nurse would use which appropriate method to assess this client's oxygenation? Hematocrit values Arterial blood gas Pulmonary function Hemoglobin levels

Arterial blood gas Explanation: Arterial blood gases include the levels of oxygen, carbon dioxide, bicarbonate, and pH. Blood gases determine the adequacy of alveolar gas exchange and the ability of the lungs and kidneys to maintain the acid-base balance of body fluids.

The nurse is caring for a client receiving oxygen therapy via nasal cannula. The client suddenly becomes cyanotic with a pulse oximetry reading of 91%. What is the next most appropriate action the nurse should take? Assess oxygen tubing connection Reposition client Elevate head of the bed Assess lung sounds

Assess oxygen tubing connection Explanation: If the client suddenly becomes cyanotic, the nurse should assess the oxygen tubing to make sure it is still connected. Assessing lung sounds, repositioning the client, and elevating the head of the bed will not correct the problem if the tubing is disconnected.

The nurse is educating an adolescent with asthma on how to use a metered-dose inhaler. Which education point follows recommended guidelines? Inhale through the nose instead of the mouth. Inhale two sprays with one breath for faster action. Inhale the medication rapidly. Be sure to shake the canister before using it.

Be sure to shake the canister before using it. Explanation: A metered-dose inhaler (MDI) delivers a controlled dose of medication with each compression of the canister. The canister must be shaken to mix the medication properly. MDIs are inhaled through the mouth, into the lungs. The medication should be inhaled slowly to ensure a sufficient dose enters the lungs. If the order is for two sprays, these sprays are administered with one spray for each breath. The inhaled breath should be held briefly after each spray in order to prevent immediately exhaling the medication.

Upon auscultation of the client's lungs, the nurse hears loud, high-pitched sounds over the larynx. What term will the nurse use in documentation to describe this breath sound? Adventitious Vesicular Bronchial Bronchovesicular

Bronchial Explanation: Bronchial breath sounds are loud, high-pitched sounds heard primarily over the trachea and larynx. Vesicular breath sounds are low-pitched, soft sounds heard over the peripheral lung fields. Bronchovesicular breath sounds are medium-pitched blowing sounds heard over the major bronchi. Vesicular, bronchial, and bronchovesicular breath sounds are normal breath sounds. Adventitious breath sounds are abnormal lung sounds.

A nurse is reading a journal article about pollutants and their effect on an individual's respiratory function. Which problem would the nurse most likely identify as an effect of exposure to automobile pollutants? Atelectasis Bronchitis Croup Bronchiectasis

Bronchitis Explanation: Bronchitis refers to a condition in which the airways become inflamed, commonly due to respiratory irritants such as air pollution and high humidity. Exposure to such irritants leads to the release of inflammatory mediators, which in turn, lead to inflammation and narrowing of the airways and increased mucus production. Atelectasis refers to the partial or complete collapse of the small air sacs in the lungs, common after surgery or with obstruction or compression of the airways or lungs. Bronchiectasis results from chronic inflammation or infection causing an excess accumulation of mucus. Croup is an infection of the airways, most commonly viral in origin.

The nurse is caring for an older adult client on home oxygen who has dentures but has quit wearing them stating that the dentures irritate the gums. What nursing action is appropriate? Contact the oxygen supplier to request an oxygen tent. Increase the flow of oxygen. Check the fit of the oxygen mask. Discontinue oxygen therapy until the client is reassessed by the healthcare provider.

Check the fit of the oxygen mask. Explanation: The fit of the oxygen mask can be affected by the discontinuation of wearing dentures. The nurse should check the fit to make sure the client is getting the prescribed amount of oxygen. Other answers are inappropriate actions that do not address the problem.

When the nurse observes a newborn infant demonstrating an irregular abdominal breathing pattern, with a respiratory rate of 40 breaths/minute with occasional pauses in breathing of 5-second duration. What is the most appropriate action by the nurse? Begin resuscitation efforts. Elevate the head of the crib. Continue to assess the infant. Position the infant side-lying.

Continue to assess the infant. Explanation: Infants breathe rapidly at 30 to 60 breaths/minute and may have occasional pauses of several seconds between breaths.

The nurse is caring for a client with a chest tube. Stationary clots are noted in the tubing. What is the appropriate nursing action? Document the finding. Contact the rapid response team. Strip the chest tubing of clots. Clamp the tube.

Document the finding. Explanation: Small stationary clots are a normal finding. The chest tubing should never be stripped of clots because this can create intrathoracic negative pressure. Clamping chest tubes is not recommended as it can create a tension pneumothorax. The rapid response team should be called if the chest tube becomes dislodged, an air leak occurs, or the client experiences dyspnea.

A nurse using a pulse oximeter to measure a client's SpO2 obtains a reading of 95%. What is the nurse's most appropriate action? Document this expected assessment finding. Raise the head of the client's bed slightly, if tolerated. Encourage the client to do deep-breathing exercises. Review the medications that the client has taken in the past 90 minutes.

Document this expected assessment finding. Explanation: A range of 95% to 100% is considered normal oxygen saturation. As such, there is no need to change the client's position, encourage deep-breathing exercises and coughing, or to review the client's medication history.

The nurse assesses a client and detects the following findings: difficulty breathing, increased respiratory and pulse rates, and pale skin with regions of cyanosis. What condition would the nurse suspect as causing these respiratory alterations? Perfusion Hypoxia Atelectasis Hyperventilation

Hypoxia Explanation: Hypoxia is a condition in which an inadequate amount of oxygen is available to cells. Difficulty breathing, increased respiratory and pulse rates, and pale skin with regions of cyanosis are all signs of hypoxia. Hyperventilation is an increased rate and depth of ventilation, above the body's normal metabolic requirements. Perfusion refers to the process by which oxygenated capillary blood passes through body tissues. Atelectasis refers to collapsed alveoli.

A health care provider orders the collection of a sputum specimen from a client with a suspected bacterial infection. Which action best ensures a usable specimen? -Discard the first sputum produced by the client. -Place the client in the dorsal recumbent position to collect the specimen. -Instruct the client to inhale deeply and then cough. -Have the client clear the nose and throat and gargle with salt water before beginning the procedure.

Instruct the client to inhale deeply and then cough. Explanation: The client should be instructed to inhale deeply and cough; if this results in sputum, it should be collected in the container. The client should be placed in a semi-Fowler's position and instructed to clear the nose and throat and rinse the throat with water.

The nurse is suctioning a client's tracheostomy when the tracheostomy becomes dislodged and the nurse is unable to replace it easily. What is the nurse's most appropriate response? -Assess the client's respiratory status and check vital signs every 1 minute for the next hour. -Maintain the client's oxygenation and alert the health care provider immediately. -Cover the tracheostomy stoma and apply oxygen by nasal cannula -Page the respiratory therapist STAT.

Maintain the client's oxygenation and alert the health care provider immediately. Explanation: If the tracheostomy becomes dislodged and is not easily replaced, the nurse should notify the primary care provider immediately, cover the tracheostomy stoma, and assess client's respiratory status.

The nurse is suctioning a client's tracheostomy when the tracheostomy becomes dislodged and the nurse is unable to replace it easily. What is the nurse's most appropriate response? -Cover the tracheostomy stoma and apply oxygen by nasal cannula -Maintain the client's oxygenation and alert the health care provider immediately. -Page the respiratory therapist STAT. -Assess the client's respiratory status and check vital signs every 1 minute for the next hour.

A client's primary care provider has informed the nurse that the client will require thoracentesis. The nurse should suspect that the client has developed which disorder of lung function? Pneumonia Tachypnea Wheezes Pleural effusion

Pleural effusion Explanation: Thoracentesis involves the removal of fluid from the pleural space, either for diagnostic purposes or to remove an accumulation of fluid in this space (pleural effusion). Tachypnea and wheezes are not symptoms that directly indicate a need for thoracentesis. Pneumonia would necessitate the procedure only if the infection resulted in pleural effusion.

When a nurse observes that an older client's skin is dry and shiny and his nails are thickened, the nurse determines that the client is most likely experiencing: Poor tissue perfusion Congestive heart failure Malnutrition Anemia

Which diagnostic procedure measures lung size and airway patency, producing graphic representations of lung volumes and flows? Bronchoscopy Skin tests Chest x-ray Pulmonary function tests

Pulmonary function tests Explanation: Pulmonary function testing is used to measure lung size and airway patency. Chest x-rays are used to detect pathologic lung changes. Bronchoscopy allows the visualization of the airways directly. Skin tests are used to detect allergies.

A client vomits as a nurse is inserting his oropharyngeal airway. What would be the most appropriate intervention in this situation? -Suction the client's mouth through the oropharyngeal airway to prevent aspiration. -Immediately remove the airway, rinse the client's mouth with sterile water, and report this to the health care provider. -Remove the airway, turn the client to the side, and provide mouth suction, if necessary. -Leave the airway in place and promptly notify the health care provider for further instructions

Remove the airway, turn the client to the side, and provide mouth suction, if necessary. Explanation: If the client vomits as the oropharyngeal airway is inserted, quickly position the client onto his or her side to prevent aspiration, remove the oral airway, and suction the mouth, if needed. It would be inappropriate and unsafe to leave the airway in place. Rinsing the client's mouth with water is not a priority.

The air quality index has rated it a red air quality day in the city. Which information will the nurse share with the client about promoting effective respiratory self-care? Stay indoors as much as possible. Avoid exposure to large crowds. Cut down on smoking. Practice good hand hygiene.

Stay indoors as much as possible. Explanation: Using the air quality index, a red color designation signifies that the air quality is unhealthy for all people, not just sensitive groups. Air pollution and high humidity are respiratory irritants. Pollutants cause increased mucus production and contribute to bronchitis and asthma. Reducing contact with irritants by staying indoors during times of increased air pollution will decrease their effect on the respiratory system. Clients should be encouraged to quit smoking, not just cut down. Avoiding large crowds and practicing good hand hygiene will prevent respiratory infections but not cut down on the effect of air pollution.

When caring for a client with a tracheostomy, the nurse would perform which recommended action? -Use gauze dressings over the tracheostomy that are filled with cotton. -Assess a newly inserted tracheostomy every 3 to 4 hours. -Clean the wound around the tube and inner cannula at least every 24 hours. -Suction the tracheostomy tube using sterile technique.

Suction the tracheostomy tube using sterile technique. Explanation: Sterile technique is required when suctioning a tracheostomy in order to prevent introduction of microorganisms into the respiratory tract. The area around a new tracheostomy may need to be assessed and cleaned every 1 to 2 hours. Gauze dressings that are not filled with cotton must be used to prevent aspiration of lint or cotton fibers into the trachea.

When caring for a client with a tracheostomy, the nurse would perform which recommended action? Use gauze dressings over the tracheostomy that are filled with cotton. Clean the wound around the tube and inner cannula at least every 24 hours. Assess a newly inserted tracheostomy every 3 to 4 hours. Suction the tracheostomy tube using sterile technique.

The client is reporting to the nurse that the continuous positive airway pressure (CPAP) mask is torture. What is the best response from the nurse? -Tell me more about why it bothers you. -Would you like to talk to your health care provider concerning this? -Can you explain to me what settings you are using? -Perhaps we need to change you to a different type of mask.

Tell me more about why it bothers you. Explanation: First, the nurse should find out what is bothering or most concerning to the client. Then, the nurse will have a better idea of the best next step, which can include the other responses. It is possible this client will do better with a bilevel positive airway pressure (BiPAP) machine instead of a CPAP machine.

A nurse takes a client's pulse oximetry reading and finds that it is normal. What does this finding indicate? -The client's respiratory rate is in the normal range. -The client's red blood cell (RBC) count is in the normal range. -The client's available hemoglobin is adequately saturated with oxygen. -The client's oxygen demands are being met.

A nurse takes a client's pulse oximetry reading and finds that it is normal. What does this finding indicate? The client's red blood cell (RBC) count is in the normal range. The client's respiratory rate is in the normal range. The client's oxygen demands are being met. The client's available hemoglobin is adequately saturated with oxygen.

The nurse educator would intervene with client teaching if which action by the staff nurse occurs when teaching voluntary coughing? The nurse encourages the client to cough before meals. The nurse develops a specific schedule for coughing. The nurse has the client lying in bed in semi-Fowler's position. The nurse reminds the client to combine coughing and deep breathing.

The nurse has the client lying in bed in semi-Fowler's position. Explanation: The client should be sitting upright with feet flat on the floor to be most effective. As part of the client's plan of care, the nurse should develop a specific schedule for coughing. Coughing before meals improves the taste of food and oxygenation. When combined with deep breathing, coughing is most effective.

The nurse is auscultating the lungs of a client and detects normal vesicular breath sounds. What is a characteristic of vesicular breath sounds? -They are loud, high-pitched sounds heard primarily over the trachea and larynx. -They are soft, high-pitched discontinuous (intermittent) popping lung sounds. -They are low-pitched, soft sounds heard over peripheral lung fields. -They are medium-pitched blowing sounds heard over the major bronchi.

They are low-pitched, soft sounds heard over peripheral lung fields. Explanation: Normal breath sounds include vesicular (low-pitched, soft sounds heard over peripheral lung fields), bronchial (loud, high-pitched sounds heard primarily over the trachea and larynx), and bronchovesicular (medium-pitched blowing sounds heard over the major bronchi) sounds. Crackles are soft, high-pitched discontinuous (intermittent) popping sounds.

A nurse assessing a client's respiratory effort notes that the client is breathing 8 shallow breaths/min. Which action best meets this client's immediate oxygenation needs? Establish an oxygen hood. Suction the client's upper airway. Apply nasal cannula at 6 L/min Use a bag and mask.

Use a bag and mask. Explanation: If the client is not breathing with an adequate rate and depth, or if the client has lost the respiratory drive, a bag and mask may be used to deliver oxygen until the client is resuscitated or can be intubated with an endotracheal tube. Suction is unnecessary unless there is an obvious obstruction. Nasal cannula is insufficient and an oxygen hood is not used in urgent situations.

Which guideline is recommended for determining suction catheter depth when suctioning an endotracheal tube? -Using a suction catheter with centimeter increments on it, insert the suction catheter into the endotracheal tube until the centimeter markings on both the endotracheal tube and catheter align, and insert the suction catheter no further than an additional 1 cm. -For a closed system, combine the length of the endotracheal or tracheostomy tube and any adapter being used, and add an additional 3 cm. -Combine the length of the endotracheal tube and any adapter being used, and add an additional 2 cm. -Using a spare endotracheal tube of the same size as being used for the client, insert the suction catheter halfway to the end of the tube and note the length of catheter used to reach this point.

Using a suction catheter with centimeter increments on it, insert the suction catheter into the endotracheal tube until the centimeter markings on both the endotracheal tube and catheter align, and insert the suction catheter no further than an additional 1 cm. Explanation: Guidelines to determine suction catheter depth include the following: Using a suction catheter with centimeter increments on it, insert the suction catheter into the endotracheal tube until the centimeter markings on both the endotracheal tube and catheter align, and insert the suction catheter no further than an additional 1 cm past the length of the endotracheal tube. Combine the length of the endotracheal tube and any adapter being used, and add an additional 1 cm. Using a spare endotracheal or tracheostomy tube of the same size as being used for the client, insert the suction catheter to the end of the tube and note the length of catheter used to reach the end of the tube. For a closed system, combine the length of the endotracheal or tracheostomy tube and any adapter being used, and add an additional 1 cm.

During data collection, the nurse auscultates low-pitched, soft sounds over the lungs' peripheral fields. Which appropriate terminology would the nurse use to describe these lung sounds when documenting? Crackles Bronchovesicular Vesicular Bronchial

Vesicular Explanation: Vesicular breath sounds are normal and described as low-pitched, soft sounds over the lungs' peripheral fields. Crackles are soft, high-pitched, discontinuous popping sounds heard on inspiration. Medium-pitched blowing sounds heard over the major bronchi describe bronchovesicular breath sounds. Bronchial breath sounds are loud, high-pitched sounds heard over the trachea and larynx.

A nurse assessing a client's respiratory status gets a weak signal from the pulse oximeter. The client's other vital signs are within reference ranges. What is the nurse's best action? -Warm the client's hands and try again. -Use a blood pressure cuff to increase circulation to the site. -Shine available light on the equipment to facilitate accurate reading. -Place the probe on the client's earlobe.

Warm the client's hands and try again. Explanation: Finding an absent or weak signal, the nurse should check vital signs and client condition. If satisfactory, warming the extremity may facilitate a stronger reading. This should be attempted prior to resorting to using the client's earlobe. Bright light can interfere with the operation of light sensors and cause an unreliable report. A blood pressure cuff will compromise venous blood flow to the site leading to inaccurate readings.

A nurse assessing a client's respiratory status gets a weak signal from the pulse oximeter. The client's other vital signs are within reference ranges. What is the nurse's best action? Warm the client's hands and try again. Place the probe on the client's earlobe. Shine available light on the equipment to facilitate accurate reading. Use a blood pressure cuff to increase circulation to the site.

The nurse auscultates the lungs of a client with asthma who reports shortness of breath, sore throat, and congestion. Which finding does the nurse expect to document? -Stridor -Crackles -Wheezing -Absent breath sounds in lower lobes

Wheezing Explanation: The nurse expects to document wheezing in the lungs of a client with asthma, which would be more pronounced when the client has a respiratory infection. Wheezing is a high-pitched, musical sound heard primarily during expiration but may also be heard on inspiration. Wheezing is caused by air passing through constricted passages caused by swelling or secretions. Stridor and crackles are other abnormal breath sounds caused by fluid, infection, or inflammation in the lungs. Absent breath sounds are not normally found in asthmatic clients; they are characteristic of pneumonia.

The nurse auscultates the lungs of a client with asthma who reports shortness of breath, sore throat, and congestion. Which finding does the nurse expect to document? Stridor Absent breath sounds in lower lobes Wheezing Crackles

A nurse is volunteering at a day camp. A child is stung by a bee and develops wheezing in the upper airways. The child is experiencing: bronchiolitis. bronchitis. a bronchospasm. bronchiectasis.

a bronchospasm. Explanation: When allergic responses take place in the lungs, breathing difficulties are far more severe. Small airways become edematous, mucus production increases, and inflammatory chemical mediators cause bronchospasm.

What is the most important risk factor in pulmonary disease? -loss of the ozone layer of the atmosphere -air pollution from vehicles -dangerous chemicals in the workplace -active and passive cigarette smoke

active and passive cigarette smoke Explanation: Cigarette smoking (active or passive) is a major contributor to lung disease and respiratory distress, heart disease, and lung cancer. Cigarette smoking is the most important risk factor for chronic COPD, according to the National Heart, Lung, and Blood Institute. The effects of both active and passive cigarette smoke increase airway resistance, reduce ciliary action, increase mucus production, and thicken alveolar-capillary membranes and bronchial walls. While air pollution, ozone layer, and dangerous chemicals in the workplace seem important, they are less of a major contributor to smoking and the direct action to the lungs.

A nurse is admitting a 6-year-old child after a tonsillectomy to the surgical unit. The nurse obtains the client's weight and places electrocardiogram (EKG) leads on the chest and a pulse oximeter on the left finger. The client's heart rate reads 100 bpm and the pulse oximeter reads 99%. These readings best indicate: adequate tissue perfusion. heart failure. high cardiac output. diminished stroke volume.

adequate tissue perfusion. Explanation: Pulse oximetry is often used as a measure of tissue perfusion. An oxygen saturation of greater than 94% is typically indicative of good tissue perfusion.

The nurse is conducting a respiratory assessment of a client age 71 years who has been recently admitted to the hospital unit. Which assessment finding should the nurse interpret as abnormal? respiratory rate of 18 breaths per minute fine crackles to the bases of the lungs bilaterally resonance on percussion of lung fields vesicular breath sounds audible over peripheral lung fields

fine crackles to the bases of the lungs bilaterally Explanation: Except in the case of infants, fine crackles always constitute an abnormal assessment finding. A respiratory rate of 18 is within acceptable range. Vesicular sounds over peripheral lung fields and resonance on percussion are expected assessment findings.

Upon evaluation of a client's medical history, the nurse recognizes that which condition may lead to an inadequate supply of oxygen to the tissues of the body? Graves' disease Parkinson's disease pancreatitis chronic anemia

chronic anemia Explanation: The majority of oxygen is carried by the red blood cells. Anemia, a decrease in the number of red blood cells or erythrocytes, results in insufficient hemoglobin available to transport oxygen. This may lead to an inadequate supply of oxygen to the tissues of the body. Graves' disease, Parkinson's disease, and pancreatitis do not directly lead to a decrease in the number of red blood cells. Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Parkinson's disease (PD) is a neurodegenerative disorder that affects predominately dopamine-producing ("dopaminergic") neurons in a specific area of the brain called substantia nigra that causes a movement disorder. Pancreatitis is inflammation in the pancreas.

A client has edema of the feet and ankles, along with crackles in the lower lobes and a frothy, productive cough. The client is suffering from: congestive heart failure. pulmonary embolism. lung cancer. myocardial infarction.

congestive heart failure. Explanation: A client who has edema and a cough that is productive with frothy sputum is manifesting heart failure.

The nurse auscultates a client with soft, high-pitched popping breath sounds on inspiration. The nurse documents the breath sounds heard as: -crackles. -bronchovesicular. -wheezes. -vesicular.

crackles. Explanation: Crackles, frequently heard on inspiration, are soft, high-pitched discontinuous (intermittent) popping sounds. Wheezes are continuous musical sounds, produced as air passes through airways constricted by swelling, narrowing, secretions, or tumors. Vesicular sounds are low-pitched, soft sounds heard over peripheral lung fields. Bronchovesicular sounds are medium-pitched blowing sounds heard over the major bronchi.

The nurse auscultates a client with soft, high-pitched popping breath sounds on inspiration. The nurse documents the breath sounds heard as: bronchovesicular. crackles. vesicular. wheezes.

A woman comes to the emergency room with her 2-year-old son. She states he woke up and had a loud barking cough. The child is suffering from: croup. atelectasis. asthma. pulmonary fibrosis.

croup. Explanation: Croup and epiglottitis are common in young children. The child has an obstruction of the upper airways, with swelling of the throat tissue. Atelectasis results when the lungs collapse as a result of the alveoli being unable to expand. Symptoms include difficulty breathing and discomfort. Pulmonary fibrosis is a condition in which the lung tissue becomes stiff and unable to expand appropriately. Asthma is a condition associated with bronchoconstriction. The symptoms include nonproductive cough, dyspnea, and wheezing.

The nurse is caring for a client who has been prescribed humidified oxygen at 6 L/minute. Which type of liquid will the nurse gather to set up the humidifier? distilled water mineral oil tap water normal saline

distilled water Explanation: Distilled water is used when humidification is desired. Other answers are incorrect.

The nurse is caring for a client who has been prescribed humidified oxygen at 6 L/minute. Which type of liquid will the nurse gather to set up the humidifier? normal saline tap water mineral oil distilled water

distilled water Explanation: Distilled water is used when humidification is desired. Other answers are incorrect.

The nurse is implementing an order for oxygen for a client with facial burns. Which delivery device will the nurse gather? nasal cannula face tent simple mask tracheostomy collar

face tent Explanation: A face tent is used without a mask; it is open and loose around the face and is often used for patients with facial trauma or burns. A simple mask or nasal cannula would irritate the facial skin. The client does not have a tracheostomy.

The nurse is conducting a respiratory assessment of a client age 71 years who has been recently admitted to the hospital unit. Which assessment finding should the nurse interpret as abnormal? respiratory rate of 18 breaths per minute resonance on percussion of lung fields vesicular breath sounds audible over peripheral lung fields fine crackles to the bases of the lungs bilaterally

A client has been put on oxygen therapy because of low oxygen saturation levels in the blood. What should the nurse use to regulate the amount of oxygen delivered to the client? flow meter nasal strip oxygen analyzer nasal cannula

flow meter Explanation: The nurse should use a flow meter to regulate the amount of oxygen delivered to the client. A flow meter is a gauge used to regulate the amount of oxygen delivered to the client and is attached to the source of oxygen. An oxygen analyzer is a device that measures the percentage of delivered oxygen to determine if the client is receiving the amount prescribed by the physician. An adhesive nasal strip increases the nasal diameter and promotes easier breathing. A nasal cannula is a hollow tube used for delivering a small concentration of oxygen. However, these devices are not used to regulate the amount of oxygen delivered to the client.

A client has been put on oxygen therapy because of low oxygen saturation levels in the blood. What should the nurse use to regulate the amount of oxygen delivered to the client? nasal strip nasal cannula oxygen analyzer flow meter

A client has been put on oxygen therapy because of low oxygen saturation levels in the blood. What should the nurse use to regulate the amount of oxygen delivered to the client? oxygen analyzer flow meter nasal cannula nasal strip

An older adult client is visibly pale with a respiratory rate of 30 breaths per minute. Upon questioning, the client states to the nurse, "I can't seem to catch my breath." The nurse has responded by repositioning the client and measuring the client's oxygen saturation using pulse oximetry, yielding a reading of 90%. The nurse should interpret this oxygen saturation reading in light of the client's: blood pH. hemoglobin level. sodium and potassium levels. age.

hemoglobin level. Explanation: Pulse oximetry readings are reflective of the number of available oxygen receptors on hemoglobin molecules. Consequently, an acceptable reading in a client with low hemoglobin can be artificially inflated. Age, blood pH, and electrolyte levels do not have a direct bearing on the accuracy and clinical application of pulse oximetry.

To drain the apical sections of the upper lobes of the lungs, the nurse should place the client in which position? side-lying position, half on the abdomen and half on the side Trendelenburg position high-Fowler's position left side with a pillow under the chest wall

high-Fowler's position Explanation: Postural drainage makes use of gravity to drain secretions from the lungs from smaller pulmonary branches into larger ones, where they can be removed by coughing. High-Fowler's position is used to drain the apical sections of the upper lobes of the lungs. Placing the client lying on the left side with a pillow under the chest wall helps to drain the right lobe of the lung. Placing the client in a side-lying position, half on the abdomen and half on the side, right and left, helps to drain the posterior sections of the upper lobes of the lungs. Trendelenburg position assists in draining the lower lobes of the lungs.

A nurse is caring for an asthmatic client who requires a low concentration of oxygen. Which delivery device should the nurse use in order to administer oxygen to the client? face tent nonrebreather mask nasal cannula simple mask

nasal cannula Explanation: The nurse should use a nasal cannula to administer oxygen to an asthmatic client who requires a low concentration of oxygen. A nasal cannula is a hollow tube with half-inch prongs placed into the client's nostrils. It is used for administering a low concentration of oxygen to clients who are not extremely hypoxic and are diagnosed with chronic lung disease. A simple mask allows the administration of higher levels of oxygen than a cannula. A face tent is used for clients with facial trauma and burns. Nonrebreather masks are used for clients requiring a high concentration of oxygen and who are critically ill.

The nurse is caring for a client admitted for a mild exacerbation of asthma who has been prescribed portable oxygen at 2 L/min. What delivery device will the nurse select to apply oxygen to the client? simple mask nasal cannula face tent tracheostomy collar

nasal cannula Explanation: A nasal cannula is ideal for administering low concentrations of oxygen to clients who are not extremely hypoxic or have chronic lung disease. The client does not have a tracheostomy. A simple mask is used to administer higher levels of oxygen than 2 L/min. A face tent is used without a mask.

The nurse is assessing a client's chest tube which was inserted 48 hours earlier. The nurse notes crackling in the skin around the insertion site. Which action should the nurse prioritize? document finding apply a new dressing over the tube reinforce adhesive material over insertion site notify the health care provider

notify the health care provider Explanation: The health care provider should be notified as feeling or hearing air crackling can indicate a subcutaneous air leak and an internal displacement of the drainage tube. This requires emergent care to prevent the recurrence or further damage to the lung. Applying a new dressing or more tape would be inappropriate. The nurse would document after providing the client care.

While examining a client, the nurse palpates the client's chest and back. What would the nurse expect to identify with this technique? pattern of thoracic expansion presence of pleural rub consolidated portions of the lung fluid-filled portions of the lung

pattern of thoracic expansion Explanation: The nurse can assess patterns of thoracic expansion through palpation. Fluid-filled and consolidated portions of lungs can be assessed through percussion, not through palpation. Presence of pleural rub can be assessed through auscultation.

A nurse is assigned to care for a client admitted to the health care facility with the diagnosis of atelectasis. When interviewing the client, the nurse would anticipate a history of: croup. alcohol use. pneumonia. asthma.

pneumonia. Explanation: Pneumonia, which causes the lungs to swell and stiffen, can lead to atelectasis. Stiffer lungs tend to collapse, and their alveoli also collapse. Consequently, the amount of space available for gas exchange in the lungs decreases. Croup, asthma, and alcohol use do not lead to atelectasis. Croup, which is common young children, is a condition that obstructs upper airways by swelling the throat tissues. Asthma causes the small airways to become inflamed and narrowed. Alcohol use depresses the central respiratory center.

While auscultating a client's chest, the nurse auscultates crackles in the lower lung bases. What condition does the nurse identify the client is experiencing? inflammation of pleural surfaces presence of fluid in the lungs presence of sputum in the trachea air passing through narrowed airways

presence of fluid in the lungs Explanation: Coarse crackles heard on auscultation indicate the presence of fluid in the lungs. Air passing through narrowed airways produces a wheezing sound, whereas inflammation of pleural surfaces gives rise to pleural rub. Sputum in the trachea produces stridor, a harsh, noisy squeak when something is blocking the airway.

While auscultating a client's chest, the nurse auscultates crackles in the lower lung bases. What condition does the nurse identify the client is experiencing? presence of sputum in the trachea air passing through narrowed airways inflammation of pleural surfaces presence of fluid in the lungs

When reviewing data collection on a client with a cardiac output of 2.5 liter/minute, the nurse inspects the client for which symptom? rapid respirations strong, rapid pulse increased urine output weight loss

rapid respirations Explanation: Normal cardiac output averages from 3.5 to 8.0 liter/minute. With decreased cardiac output, there is a reduction in the amount of circulating blood that is available to deliver oxygen to the tissues. The body compensates by increasing the respiratory rate to increase oxygen delivery to the tissues. The client with decreased cardiac output would gain weight, have decreased urine output, and display a thready pulse.

The nurse is caring for a client who has a percutaneous tracheostomy (PCT) following a skydiving accident. Which oxygen delivery device will the nurse select? nasal cannula tracheostomy collar simple mask face tent

tracheostomy collar Explanation: A tracheostomy collar delivers oxygen near an artificial opening in the neck. This is appropriate for a client who has had a PCT. Other devices are not appropriate for this client.

A nurse suctioning a client through a tracheostomy tube should be careful not to occlude the Y-port when inserting the suction catheter because it would cause what condition to occur? suctioning of carbon dioxide loss of sterile field trauma to the tracheal mucosa prevention of suctioning

trauma to the tracheal mucosa Explanation: Occluding the Y-port on the suction tubing is what creates the suction. While suctioning would be difficult but possible, suctioning while advancing the tube would damage the tracheal mucosa and remove excessive amounts of oxygen, not carbon dioxide, from the respiratory tract. Suctioning during insertion of the catheter would not compromise sterility.

A nurse suctioning a client through a tracheostomy tube should be careful not to occlude the Y-port when inserting the suction catheter because it would cause what condition to occur? suctioning of carbon dioxide prevention of suctioning trauma to the tracheal mucosa loss of sterile field

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