Pulmonary

The nurse is monitoring a client who is receiving peritoneal dialysis. After the dialysate has infused, the client reports severe respiratory difficulty. Which immediate action should the nurse take? 1. Weigh the client 2. Auscultate breath sounds 3. Obtain arterial blood gases 4. Turn the client on the right side

2. Auscultate breath sounds Lung sounds should be auscultated for signs of fluid overload. Weighing the client will not correct the problem. The pulse oximetry reading and other vital signs may be obtained after the solution is drained and diaphragmatic pressure is decreased; arterial blood gases are not warranted at this time. It is not necessary to turn the client to the side.

A client who was recently diagnosed with emphysema develops a malignancy in the right lower lobe of the lung, and a lobectomy is performed. After surgery, the client is receiving oxygen by nasal cannula at 2 L per minute. Blood gas results demonstrate respiratory acidosis. What should be the initial nursing intervention? 1. Administer oral fluids. 2. Encourage deep breathing. 3. Increase the oxygen flow rate. 4. Perform nasotracheal suctioning.

2. Encourage deep breathing. Hypoventilation because of pain is the usual cause of respiratory acidosis [1] [2] [3] after lung surgery. Respiratory regulation corrects 50% to 75% of pH imbalances; this is accomplished by either increasing (for acidosis) or decreasing (for alkalosis) the rate and depth of respirations. Therefore, deep breathing will decrease carbon dioxide levels in the blood, thereby decreasing respiratory acidosis. Oral fluids are helpful in liquefying respiratory secretions but will not decrease carbon dioxide levels in the blood. The client has emphysema, and increasing delivery of oxygen if the client is not hypoxic may precipitate CO2 narcosis. The situation does not indicate the presence of excessive respiratory secretions.

A 67-year-old client has tested positive for influenza A. The client also has asthma. Which drug would the nurse recommend be avoided in this client? 1. Ribavirin 2. Zanamivir 3. Oseltamivir 4. Amantadine

2. Zanamivir Zanamivir is used with caution in clients who have asthma or chronic obstructive pulmonary disease (COPD) and in older adults. Ribavirin is used for the treatment of severe influenza B. Oseltamivir may be used in treating both influenza A and B. Amantadine may be used for the treatemtn of influenza A.

Which sounds are described as abnormal extra breath sounds to include crackles, rhonchi, wheezes, and pleural friction rubs? 1. Vesicular 2. Bronchial 3. Adventitious 4. Bronchovesicular

3. Adventitious Adventitious sounds are described as abnormal extra breath sounds to include crackles, rhonchi, wheezes, and pleural friction rubs. Vesicular sounds are relatively soft, low-pitched, gentle, rustling sounds. Bronchial sounds are louder and higher pitched and resemble air blowing through a hollow pipe. Bronchovesicular sounds have a medium pitch and intensity and are heard over the main stem bronchi on either side of the sternum and posteriorly between the scapulae.

A nurse gave a client naloxone. To evaluate the effectiveness of the medication, what should the nurse assess for? 1. Change in level of consciousness 2. Increased pain 3. Increased respiration 4. Decreased heart rate

3. Increased respiration Naloxone is given for decreased respirations caused by opioid overdose. The amount given is determined by the respiratory status, not the level of consciousness. Undesirable side effects of naloxone are pain and rapid heart rate with dysrhythmias.

The primary healthcare provider is preparing to instill medication into the pleural space via thoracentesis. Which interventions does the nurse consider to be appropriate when performing a thoracentesis? Select all that apply. 1. Verify breath sounds. 2. Encourage deep breaths. 3. Observe for signs of pneumonia. 4. Ensure a chest x-ray is performed after the procedure. 5. Instruct the client to cough during the procedure.

1, 2, & 4 Breath sounds should be verified in all lung fields after thoracentesis to rule out lung collapse. The client is encouraged to perform deep breaths to help expand the lungs. A chest x-ray should be obtained after the procedure to check for pneumothorax. Observing for signs of hypoxia and a pneumothorax is essential, but the signs of pneumonia may not be useful after thoracentesis. The client should be instructed not to talk or cough during the procedure because it may cause injury to the lungs.

During admission a client appears anxious and says to the nurse, "The doctor told me I have lung cancer. My father died from cancer. I wish I had never smoked." What is the nurse's best response? 1. "You are concerned about your diagnosis." 2. "You are feeling guilty about your smoking." 3. "There have been advances in lung cancer therapy." 4. "Trust your healthcare provider, who is very competent in treating cancer."

1. "You are concerned about your diagnosis." The correct response recognizes and acknowledges the client's concerns about the diagnosis without assuming a specific feeling is involved; it allows the client to set the framework for discussion and express self-identified feelings. The client's statement is not specific enough to come to the conclusion that the client feels guilty; this is an assumption by the nurse. Talking about advances in lung cancer therapy or trust for the healthcare provider avoids the client's concerns and cuts off communication.

A client presents to the emergency room with coughing and sudden wheezing. The nurse notes the client is progressing quickly into respiratory distress. The nurse identifies that the client is experiencing what problem? 1. An acute asthma attack 2. Acute bronchitis 3. Left-sided heart failure 4. Cor pulmonale

1. An acute asthma attack Symptoms for an acute asthma attack often are wheezing, coughing, dyspnea, and chest tightness. Cough, fever, and fatigue are often symptoms exhibited with acute bronchitis. Fatigue, breathlessness, weakness, shortness of breath, and fluid accumulation in the lungs are often signs of left-sided heart failure. Tiring easily, shortness of breath with exertion, lower leg edema, chest pain, and heart palpitations often are exhibited with cor pulmonale.

A client with a history of closed-angle glaucoma is scheduled for abdominal surgery. Because the client is extremely anxious, surgery is to be performed under general anesthesia. What should the nurse teach the client to do to prevent respiratory complications postoperatively? 1. Deep breathing techniques 2. Performing productive coughing 3. Turning from side to side frequently 4. Pant breathing while gently closing the eyelids

1. Deep breathing techniques Deep breathing is an intervention to prevent respiratory complications that does not increase intraocular pressure. Coughing is contraindicated because it increases intraocular pressure. Although turning from side to side is permitted, it is not as effective as deep breathing in preventing respiratory complications. Pant breathing is shallow breathing and will not prevent respiratory complications.

A nurse is teaching Hands Only Basic Life Support for adults in the community. What should the rescuer do first after determining that the person is not responding and the emergency medical system has been activated? 1. Identify the absence of pulse. 2. Give two rescue breaths with a CPR mask. 3. Perform the head tilt-chin lift maneuver. 4. Perform chest compression at a rate of 100/min.

1. Identify the absence of pulse. Once it is verified that the person is unresponsive and the emergency medical system has been activated, then whether the client is breathing should be established. Rescue breaths are not given with the hands-only basic life support method of CPR. Chest compressions are initiated as soon as it is identified that the person is not breathing; they are given at a rate of 100/min, to a depth of 2 inches (5 cm) each for 2 minutes, allowing full chest recoil between compressions. This quickly circulates the blood.

Which interventions should the nurse perform while collecting subjective data from a client during a focused respiratory assessment? Select all that apply. 1. Palpate the chest and back for masses 2. Question the client about shortness of breath 3. Check the hematocrit and hemoglobin values 4. Inspect the skin and nails for integrity and color 5. Ask the client about color and quantity of sputum

2 & 5 Subjective data is collected directly from the client. During the focused respiratory assessment, the nurse should ask the client about any shortness of breath and about the color and quantity of any sputum produced. Objective data is collected by the nurse through physical examination and laboratory reports. The nurse should palpate the chest and back for masses while collecting objective data during the physical examination. The nurse checks the hematocrit and hemoglobin values while collecting objective diagnostic data. The nurse inspects the client's skin and nails for integrity and color to determine oxygenation of tissues.

Thick mucous gland secretions, elevated sweat electrolytes, meconium ileus, and difficulty maintaining and gaining weight are associated with which autosomal recessive disorder? 1. Cerebral palsy 2. Cystic fibrosis 3. Muscular dystrophy 4. Multiple sclerosis

2. Cystic fibrosis The early symptom of cystic fibrosis is meconium ileus, which is impacted stool in the newborn. Thick mucous secretions, salty sweat, and difficulty gaining weight because of high caloric demands are characteristics of the condition. Cerebral palsy is a motor disorder caused by damage to the brain. Muscular dystrophy is a muscular disorder. Multiple sclerosis is a condition with progressive disintegration of the myelin sheath.

A client is admitted to the hospital with a diagnosis of cancer of the larynx, and a laryngectomy is scheduled. What is the most important piece of equipment that the nurse should place at the client's bedside postoperatively? 1. Tracheostomy set 2. Suction equipment 3. Humidified oxygen 4. Cold-steam vaporizer

2. Suction equipment Suction equipment is essential because respiratory complications can occur subsequent to edema of the glottis or to injury to the recurrent laryngeal nerve. A tracheostomy set is unnecessary because a permanent stoma is surgically created and a laryngectomy tube is in place. However, an additional sterile laryngectomy tube should be kept at the bedside. Oxygen may not be necessary unless there is a complication. Although a cold-steam vaporizer may promote moist mucous membranes, it usually is unnecessary; also, it is rarely used in a hospital because of the possibility of the growth and transmission of microorganisms.

A nurse is caring for a client with the diagnosis of emphysema, a chronic obstructive pulmonary disease (COPD). The client is hypoxemic and also has chronic hypercarbia. Which statement reflects the oxygen needs of this client? 1. The client may need up to 60% oxygen flow via Venturi mask. 2. The client requires lower levels of oxygen delivery, usually 1 to 3 L/min via nasal cannula. 3. The client should receive humidified oxygen delivered by a face mask. 4. The client's respiratory treatment plan should have oxygen eliminated from it.

2. The client requires lower levels of oxygen delivery, usually 1 to 3 L/min via nasal cannula. Exogenous oxygen is necessary, but it must be delivered in low concentrations. It is not the method of oxygen delivery that is a concern, but rather the concentration of the oxygen. High oxygen concentrations will increase serum oxygen levels and interfere with the stimulus to breathe, which is a lowered oxygen level. The client will develop carbon dioxide narcosis when high levels of exogenous oxygen are administered. However, the results of one recent study of clients with stable COPD indicate that the hypercarbic drive is preserved with oxygen concentrations higher than 2 L/min. More research is needed before this theory is applied clinically. Usually, the body's stimulus to breathe is an elevated carbon dioxide level. In a client with COPD, breathing instead responds to lowered oxygen levels because of the body's exposure to continuously elevated levels of carbon dioxide.

On admission to the intensive care unit, a client is diagnosed with compensated metabolic acidosis. During the assessment, what is the nurse most likely to identify? 1. Muscle twitching 2. Mental instability 3. Deep and rapid respirations 4. Tachycardia and cardiac dysrhythmias

3. Deep and rapid respirations Deep, rapid respirations are an adaptation to a decreased serum pH. Carbonic acid dissociates in the lungs to hydrogen ions and carbon dioxide, which helps increase the serum pH. Muscle twitching results from low serum calcium (hypocalcemia), not compensated metabolic acidosis. Mental confusion does not occur in compensated acidosis; confusion can occur in uncompensated metabolic acidosis. Tachycardia and cardiac dysrhythmias are associated with hyperthyroidism, not compensated metabolic acidosis.

Following surgery in the inguinal area, the client reports pain on the right side of the chest, becomes dyspneic, and begins to cough violently. The nurse suspects that a pulmonary embolus has occurred. Which is the priority nursing action? 1. Auscultate the chest 2. Obtain the vital signs 3. Elevate the head of the bed 4. Position the client on the right side

3. Elevate the head of the bed Elevating the head of the bed promotes breathing by reducing the pressure of the abdominal organs on the diaphragm and increasing thoracic excursion. Auscultating the chest may confirm diminished breath sounds but will not facilitate breathing. Obtaining the vital signs should be done eventually, but it is not the priority. Positioning the client on the right side will impede aeration of the right lung fields.

After abdominal surgery, a goal is to have the client achieve alveolar expansion. The nurse determines that this goal is most effectively achieved by what method? 1. Postural drainage 2. Pursed-lip breathing 3. Incentive spirometry 4. Sustained exhalation

3. Incentive spirometry Incentive spirometry expands collapsed alveoli and enhances surfactant activity, thereby preventing atelectasis. Postural drainage helps clear accumulated secretions from the pulmonary tree; it does not directly promote alveolar expansion. Pursed-lip breathing promotes sustained exhalation, not inhalation. Sustained exhalation promotes the collapse, not expansion, of alveoli.

A nurse is caring for a client with pulmonary tuberculosis. What must the nurse determine before discontinuing airborne precautions? 1. Client no longer is infected. 2. Tuberculin skin test is negative. 3. Sputum is free of acid-fast bacteria. 4. Client's temperature has returned to normal.

3. Sputum is free of acid-fast bacteria. The absence of bacteria in the sputum indicates that the disease can no longer be spread by the airborne route. Treatment is over an extended period; eventually the client may not have an active disease, but still remains infected. Once an individual has been infected, the test will always be positive. The client's temperature returning to normal is not evidence that the disease cannot be transmitted.

Which assessment finding is considered the earliest sign of decreased tissue oxygenation? 1. Cyanosis 2. Cool, clammy skin 3. Unexplained restlessness 4. Retraction of interspaces on inspiration

3. Unexplained restlessness Unexplained restlessness is considered the earliest sign of decreased oxygenation. The other assessment findings, such as cyanosis, cool, clammy skin, and retraction of interspaces on inspiration, are considered late signs of decreased oxygenation.

what is the normal value of inspiratory reserve volume? 1. 0.5 L 2. 1.0 L 3. 1.5 L 4. 3.0 L

4. 3.0 L The normal value of inspiratory reserve volume is 3.0 L. The normal value of tidal volume is 0.5 L. The normal value of expiratory reserve volume is 1.0 L. The normal value of residual volume is 1.5 L.

The nurse is providing postoperative care for an obese adult who had major abdominal surgery. The client has a history of smoking three packs of cigarettes daily. Which test will the nurse check for the most accurate measurement of the client's respiratory status? 1. PaO2 2. PaCO2 3. Hemoglobin 4. Oxygen saturation

4. Oxygen saturation Oxygen saturation is a measure of the relationship between oxygen and hemoglobin; it measures the amount of oxygen available to tissues and provides a pulmonary assessment for clients at risk for hypoxia; pulse oximetry provides a continuous, noninvasive measurement of an individual's oxygen saturation. PO2 is a measure of diffusion across the alveolar membrane. This value may decrease progressively in a heavy smoker; thus it is not the most accurate measure of this client's postoperative respiratory status. Also, it requires an arterial puncture. PCO2 is an accurate measure of alveolar ventilation and is elevated with hypoventilation. This may occur in any client after abdominal surgery because deep breathing often is painful. Also, an arterial puncture is necessary to acquire a specimen for testing. Hemoglobin is a measure of the blood's capacity to transport oxygen.

A client with a history of rheumatic fever and a heart murmur reports gaining weight in spite of nausea and anorexia. The client also reports shortness of breath several times each day and when performing minor tasks. Which additional information should the nurse obtain? 1. Retrospective 24-hour calorie count 2. Elimination pattern during the last 30 days 3. Complete gynecological and sexual history 4. Presence of a cough and pulmonary secretions

4. Presence of a cough and pulmonary secretions The presence of a cough and pulmonary secretions, in addition to a history of rheumatic fever, requires an assessment for other cardiopulmonary problems and fluid overload. Anorexia and weight gain do not indicate a nutritional problem but a fluid balance problem. Loss of appetite in conjunction with shortness of breath and the history of rheumatic fever makes gastrointestinal (elimination) symptoms secondary in importance. There is no reason to investigate the gynecological and sexual history in relation to the current problem.

A nurse is providing education to a coworker who is caring for a client who is scheduled to have a thoracentesis for a pleural effusion. Which information will be appropriate for the nurse to include? 1. The thoracentesis procedure uses the principle of positive pressure. 2. It is common for a sclerosing agent to be instilled at the end of the procedure. 3. Clients will have temporary increased dyspnea immediately after the procedure. 4. Rapid removal of large amounts of fluid may precipitate cardiovascular collapse.

4. Rapid removal of large amounts of fluid may precipitate cardiovascular collapse. The mechanism is unclear, but cardiovascular collapse probably is caused by fluid shifts. A thoracentesis uses the principle of negative pressure. Use of a sclerosing agent is not commonly done. Dyspnea should be relieved immediately; if dyspnea increases, a pneumothorax should be suspected.

A client is experiencing severe respiratory distress. Which response should the nurse expect the client to exhibit? 1. Tremors 2. Anasarca 3. Bradypnea 4. Tachycardia

4. Tachycardia The heart rate increases in an attempt to compensate for the lack of oxygen to body cells. Tremors are not associated with respiratory distress; tremors are associated with neurologic problems. Severe generalized edema (anasarca) is not associated with respiratory distress; anasarca is associated with renal failure. An increased respiratory rate (tachypnea), not a decreased respiratory rate (bradypnea), is associated with respiratory distress.