Respiration Lecture Questions

You are caring for a client who states they have an increase in dyspnea. Which intervention would the nurse perform first? 1.Assess the pulse oximetry 2.Apply 100% NRB 3.Provide a nebulizer 4.Call the HCP

1 Assess the pulse oximetry - its important to use independent nursing skills to do as much as you can, then notify the physician

A client hospitalized with chronic obstructive pulmonary disease (COPD) reports dyspnea and excessive fatigue when ambulating. Which interventions should the nurse include in the plan of care for this client problem? Select all that apply. 1.Monitor pulse oximetry with client activity 2.Maintain bedrest until the client is feeling better. 3.Teach the client pursed lip breathing 4.Provide a bedside commode for elimination 5.Evaluate nutritional status

1.Monitor pulse oximetry with client activity. Monitoring pulse oximetry when the client is active allows the nurse to recognize hypoxia and intervene if it occurs. 2.Maintain bedrest until the client is feeling better. The client should be encouraged to be active as tolerated; bedrest will put the client at risk for deconditioning and deterioration of body systems. 3.Teach the client controlled breathing techniques such as pursed lip breathing.Controlled breathing techniques can improve breathing by controlling rate, improving ventilation, and relaxing the client. These techniques are helpful for clients with COPD. 4.Provide a bedside commode for elimination. Providing a bedside commode may allow the client to be independent in toileting without having the exertion of ambulating the bathroom. 5.Evaluate nutritional status. Clients with COPD have increased caloric needs due to the increased work of breathing and are at risk for infection. Evaluating nutritional status can allow the nurse to recognize if the client needs dietary changes or a dietician consult.

Non-rebreather can deliver between ____ L

10-15

It is best to place the patient in which position post-surgery for head and neck cancer? 1. Trendelenburg 2. Semi/high fowler 3. Lateral recumbent 4. Prone

2

A client has had a radical neck dissection for cancer of the larynx. Which action by the client indicated disturbance in body image? 1. The client requests a consultation with the speech therapist 2. The client has a towel placed over the mirror 3. The client is attempting to shave himself 4. The client practices neck and shoulder exercises

2 Placing a towel over the mirror indicates that the client is having difficulty looking at his reflection, a body-image problem.

After 5 months of using the CPAP machine, Bruce determined that he would like to try to sleep without it. He feels slightly claustrophobic and thinks the weight loss may have improved his OSA. What does the nurse ask Bruce and his wife to monitor if he stops using the CPAP machine? Select all that apply. 1. Increased belching 2. Irritability 3. Snoring 4. Voice Quality 5. Blood pressure

2, 3, 5 Increased snoring and irritability from lack of sleep are signs John Paul may still need his CPAP machine. Hypertension is associated with OSA.

The client who has undergone a radical neck dissection and tracheostomy for cancer of the larynx is being discharged. Which discharge instructions should the nurse teach? Select all that apply. 1. The client will be able to speak again after the surgery area has healed 2. The client should wear a protective covering over the stoma when showering 3. The client should clean the stoma and then apply a petroleum-based ointment 4. The client should use a humidifier in the room 5. The client can get a special telephone for communication

2, 4, 5 Correct answers: 2; The client breathes through a stoma in the neck. Care should be taken not to allow water to enter the stoma. 4; The client has lost the use of the nasal passages to humidify the inhaled air. 5; Special equipment is available for clients who cannot speak. Incorrect answers: 1; This surgery removed the client's vocal cords, so the client will not be able to speak again unless the client learns esophageal speech or uses an electric larynx. 3; The stoma should be cleaned, but petroleum-based products should not be allowed near the stoma. They are contraindicated because it is not water soluble, could cause an occlusion, and is flammable.

Nasal Cannula can deliver up to ____ L

6

Simple face mask can deliver between ____ L

6-12

Oxy-pendant can deliver up to ____ L

8

A nurse is discharging a client who has COPD. Upon discharge, the client is concerned that he will never be able to leave his house now that he is on continuous oxygen. Which of the following is an appropriate response by the nurse? A."There are portable oxygen delivery systems that you can take with you." B."When you got out, you can remove the oxygen and then reapply when you get home." C."You will probably not be able to go out as much as you used to." D."Home health services will come to you so you will not need to get out."

A

Jerry has a right chest tube. When assisting the client to ambulate, what measure is appropriate? A. Keep the collection device below the level of Jerry's chest. B. Clamp the chest tube before assisting Jerry out of bed. C. Milk the chest tube when Jerry returns to bed to assess patency. D. Connect the collection device to a portable suction machine.

A

The nurse caring for Jerry after he has had a chest tube inserted notes continuous gentle bubbling in the suction control chamber. What action is appropriate? A. Do nothing, because this is an expected finding. B. Immediately clamp the chest tube and notify the physician. C. Check for an air leak because the bubbling should be intermittent. D. Increase the suction pressure so that bubbling becomes vigorous.

A

Which setting is most likely to be used initially after intubation? A.Assist-control B.Synchronized Intermittent Mandatory Ventilation C.Pressure Support Ventilation D.Continuous Positive Airway Pressure

A

The client has the following arterial blood gases: pH 7.19, PaCO2 33, HCO3 19, PaO2 95. Which medication would the nurse prepare to administer based on the results? A. IV sodium bicarbonate B. Oxygen via nasal cannula C. IVP epinephrine D. Oral magnesium hydroxide

A A; The ABG results indicate metabolic acidosis, and the treatment of choice is sodium bicarbonate

The child has an asthma attack and is treated with epinephrine while in the ED. Despite receiving epinephrine, the child is still agitated, sweating profusely, and has an oxygen saturation of 89% and a RR of 30 bpm. Breath sounds are diminished, and wheezing is absent. Based on this information, the nurse should anticipate interventions to treat which acid-base imbalance? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Metabolic acidosis

A A; The nurse should anticipate interventions to treat respiratory acidosis. This child is most likely in status asthmaticus with continued respiratory distress despite treatment. Even though the child has a high RR, there is hypoventilation from bronchoconstriction. This results in carbon dioxide retention, increased PaCO2 greater than 45 mm Hg, and a lowering of pH to an acidotic state.

What classification of drug is albuterol? A.SABA B.LABA C.SAMA D.LAMA

A Albuterol is a SABA - rescue medication only

The client diagnosed with an exacerbation of COPD is in respiratory distress. Which intervention should the nurse implement first? A.Assist the client into a sitting position at 90 degrees B.Administer oxygen at 6L via nasal cannula C.Monitor vital signs D.Notify the HCP

A the first thing you need to do is position the patient in the best breathing position. Then you would obtain vital signs. Through further evaluation you would decide how much O2 the patient required. Once you have done all of your independent nursing actions, you can then present the assessment findings to the HCP.

A nurse is caring for a client following a thoracentesis. Which of the following manifestations should the nurse recognize as signs of complications? Select all that apply. A. Dyspnea B. Localized bloody drainage on the dressing C. Fever D. Hypotension E. Report of pain at the puncture site

A, C, D A; Dyspnea can indicate a pneumothorax or re-accumulation of fluid. C; Fever can indicate infection. D; Hypotension can indicate intrathoracic bleeding. Incorrect answers: B; Localized bloody drainage contained on the dressing is an expected finding following a thoracentesis. E; This client's report of pain at the puncture site is also an expected finding.

pH - 7.36 PaCO2 - 62 HCO3 - 36 PaO2 - 88 A.Respiratory Acidosis B.Respiratory Alkalosis C.Metabolic Acidosis D.Metabolic Alkalosis

A. Fully compensated respiratory acidosis

pH - 6.86 PaCO2 - 108 HCO3 - 44 PaO2 - 48 A.Respiratory Acidosis B.Respiratory Alkalosis C.Metabolic Acidosis D.Metabolic Alkalosis

A. Respiratory Acidosis with partial metabolic compensation

A nurse has assisted Jerry's physician with the insertion of a chest tube. The nurse monitors Jerry and notes bubbling in the water seal chamber immediately after the tube is inserted. Based on this assessment, which action would be appropriate? A. Check for air leaks. B. Continue to monitor the client. C. Reinforce the occlusive dressing. D. Encourage the client to deep-breathe.

B bubbling in the water seal chamber following insertion is an expected finding as the air has to escape for the lung to re-expand

The nurse notes that the fluid in the water-seal column is fluctuating with each breath that the client takes. What is the significance of this fluctuation? A. An obstruction is present in the chest tube. B. The client is developing subcutaneous emphysema. C. The chest tube system is functioning properly. D. There is a leak in the chest tube system.

C this is called tidaling - occurs normally - if the tube is on suction or if the lung has re-expanded it might not be evident

pH - 7.51 PaCO2 - 56 HCO3 - 36 PaO2 - 88 A.Respiratory Acidosis B.Respiratory Alkalosis C.Metabolic Acidosis D.Metabolic Alkalosis

D. Metabolic alkalosis with partial respiratory compensation

You are preparing to discharge a client with a new prescription for prednisone. Which of the following instructions do you include in the discharge instructions? A. Take 2 inhalations twice per day B. Do not abruptly discontinue this medication C. Take this medication on an empty stomach D. If a dose is missed, double the next dose

B Abruptly discontinuing a steroid can result in adrenal insufficiency and can be life threatening. Not A. This medication is taken by mouth not via inhalation Not C. This medication can cause GI upset and gastric ulceration; should be taken with food or milk. Not D. If a dose is missed, take it as soon as possible unless almost time for the next dose - do not double.

pH - 7.42 PaCO2 - 32 HCO3 - 23 PaO2 - 78 A.Respiratory Acidosis B.Respiratory Alkalosis C.Metabolic Acidosis D.Metabolic Alkalosis

B Fully compensated respiratory alkalosis

pH - 7.61 PaCO2 - 28 HCO3 - 19 PaO2 - 88 A.Respiratory Acidosis B.Respiratory Alkalosis C.Metabolic Acidosis D.Metabolic Alkalosis

B Respiratory alkalosis with partial compensation

A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first? • A. Take a full medication history. • B. Give a bronchodilator by nebulizer. • C. Apply a cardiac monitor to the client. • D. Provide emotional support to the client.

B The client is having an acute asthma attack and needs to increase oxygen delivery to the lung and body. Nebulized bronchodilators open airways and increase the amount of oxygen delivered. Medical management includes bronchodilators like beta-2 agonists and muscarinic antagonists (salbutamol and ipratropium bromide respectively) and anti-inflammatories such as inhaled steroids (usually beclomethasone but steroids via any route will be helpful). • •Option A: First, resolve the acute phase of the attack and how to prevent attacks in the future. During an acute exacerbation, there may be a fine tremor in the hands due to salbutamol use, and mild tachycardia. Patients will show some respiratory distress, often sitting forward to splint open their airways. • •Option C: It may not be necessary to place the client on a cardiac monitor because he's only 19-years-old unless he has a past medical history of cardiac problems. On auscultation, a bilateral, expiratory wheeze will be heard. In life-threatening asthma, the chest may be silent, as air cannot enter or leave the lungs, and there may be signs of systemic hypoxia. • •Option D: Measures to take include calming the patient to get them to relax, moving outside or away from the likely source of allergen, and cooling the person. Removing clothing and washing the face and mouth to remove allergens is sometimes done, but it is not evidence-based.

You are teaching a client about the side effects of prednisone. Which of the following statements made by the client indicates a need for further teaching? A. "If I notice abnormal bruising, I should notify my provider." B. "This medication will decrease my chances of acquiring an infection." C. "I will continue monitoring my blood sugar closely while taking this medicine." D. "I may gain weight while taking this medication."

B Use of prednisone increases susceptibility to infection r/t immunosuppression Not A. May cause pancytopenia Not C. May cause hyperglycemia Not D. May cause weight gain

A patient with severe COPD is scheduled for pulmonary rehabilitation. What is the primary goal of pulmonary rehabilitation for patients with COPD? A.To provide long-term oxygen therapy. B.To improve exercise tolerance and quality of life. C.To cure the underlying lung disease. To reduce the risk of acute exacerbations.

B Rationale: Pulmonary rehabilitation aims to enhance the patient's functional capacity, exercise tolerance, and overall quality of life by combining exercise training, education, and behavioral interventions. While it can help manage COPD symptoms, it doesn't cure the underlying disease.

You are teaching the parent of a child about asthma medication administration. Which of the following statements in response to their child complaining of wheezing and chest tightness is appropriate? A. "I will administer a dose of salmeterol." B. "I will administer a dose of albuterol." C. "I will administer a dose of budesonide." D. "I will administer a dose of tiotropium."

B albuterol is a short-acting/rescue bronchodilator. A, C, D are long-term drugs. Not A. LABA Not C. ICS with onset 2-8 days after first administration Not D. anticholinergic

pH - 7.48 PaCO2 - 28 HCO3 - 24 PaO2 - 98 A.Respiratory Acidosis B.Respiratory Alkalosis C.Metabolic Acidosis D.Metabolic Alkalosis

B. Uncompensated Respiratory Alkalosis

A nurse is suctioning secretions through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which of the following is the appropriate nursing intervention? A. Continue to suction B. Notify the physician immediately C. Stop the procedure and hyper oxygenate the client D. Ensure that the suction is limited to 15 seconds

C

To monitor for the complication of subcutaneous emphysema after the insertion of chest tubes the nurse should: A. Assess for the presence of barrel shaped chest B. Auscultate the breath sounds C. Palpate around the chest tube insertion site D. Compare the length of inspiration to the length of expiration

C

A 7-year-old client is brought to the E.R. He's tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have which of the following? A. COPD B.Bronchial Pneumonia C.Asthma D.Emphysema

C Asthma is the most likely cause of a 7 year old with tachypneic with a cough following a recent virus. Option B - Bronchial pneumonia is not likely as the child is not experiencing fever, chills, or productive cough Option A - COPD is unlikely for a child Option D - Emphysema is not expected in a 7 year old

The client with diabetic ketoacidosis has a blood sugar of 320mg/dL, a RR of 32 bpm, and a deep, regular respiratory effort. The nurse should implement interventions for which acid-base imbalance? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

C C; The nurse should implement interventions for treating metabolic acidosis. In DKA, the elevated blood sugar results in polyuria with resultant decrease in the pH and HCO3 levels. Kussmaul respirations allow the body to "blow off" excess carbon dioxide to compensate for the acidotic state and decreased HCO3.

The term "blue bloater" refers to which of the following conditions? • A. Adult respiratory distress syndrome (ARDS) • B. Asthma • C. Chronic obstructive bronchitis • D. Emphysema

C Chronic obstructive bronchitis Clients with chronic obstructive bronchitis appear bloated; they have large barrel chests and peripheral edema, cyanotic nail beds, and, at times, circumoral cyanosis. People with chronic bronchitis are sometimes called "blue bloaters" because of their bluish-colored skin and lips. Blue bloaters often take deeper breaths but can't take in the right amount of oxygen. • •Option A: Clients with ARDS are acutely short of breath and frequently need intubation for mechanical ventilation and large amounts of oxygen. Clients with ARDS have acute symptoms and typically need large amounts of oxygen. Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by poor oxygenation and non-compliant or "stiff" lungs. The disorder is associated with capillary endothelial injury and diffuse alveolar damage. Once ARDS develops, patients usually have varying degrees of pulmonary artery vasoconstriction and may subsequently develop pulmonary hypertension. • •Option B: Clients with asthma don't exhibit characteristics of chronic disease. Asthma is a common disease and has a range of severity, from a very mild, occasional wheeze to acute, life-threatening airway closure. It usually presents in childhood and is associated with other features of atopy, such as eczema and hayfever. Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. • •Option D: Clients with emphysema appear pink and cachectic (a state of ill health, malnutrition, and wasting). Emphysema comes on very gradually and is irreversible. People with emphysema are sometimes called "pink puffers" because they have difficulty catching their breath and their faces redden while gasping for air.

•What classification of respiratory medications must you educate the patient about washing their mouth after use? A.SABA B.Leukotriene Receptor Blocker C.Inhaled Corticosteroid D.Antibiotics

C Inhaled corticosteroids

The nurse is assessing the client diagnosed with COPD. Which assessment finding requires immediate intervention by the nurse? A.Moderate amount of thick, white sputum B.Oxygen flowmeter set on 8 liters C.Use of accessory muscles during inspiration D.Presence of a barrel chest and dyspnea

C Although this question doesn't give us a lot of information - accessory muscle use during inspiration can be a sign of respiratory distress. While 8 lpm of O2 is a lot for a patient with COPD, it also may be needed, you would need to further evaluate before you decreased the amount of oxygen. Thick sputum does not require immediate intervention and the presence of a barrel chest and dyspnea are likely findings.

The client is hospitalized with a history of chronic emesis from purging. Based on the client's history, the nurse should monitor for which complication? A. Hyperkalemia B. Hyperchloremia C. Metabolic alkalosis D. Metabolic acidosis

C C; the nurse should monitor for metabolic alkalosis, which occurs when there is a loss of acid such as with prolonged vomiting Incorrect answers: A; Hypokalemia is caused by diarrhea and vomiting B; Hypochloremia is associated with volume depletion due to vomiting D; Metabolic acidosis does not occur with prolonged vomiting

A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions? • A. Adult respiratory distress syndrome (ARDS) • B. Asthma • C. Chronic obstructive bronchitis • D. Emphysema

C Chronic obstructive bronchitis Because of his extensive smoking history and symptoms, the client most likely has chronic obstructive bronchitis. Chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD) that is defined as a productive cough of more than 3 months occurring within a span of 2 years. Patients typically present with chronic productive cough, malaise, and symptoms of excessive coughing such as chest or abdominal pain. • •Option A: Clients with ARDS have acute symptoms of and typically need large amounts of oxygen. Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by poor oxygenation and non-compliant or "stiff" lungs. The disorder is associated with capillary endothelial injury and diffuse alveolar damage. Once ARDS develops, patients usually have varying degrees of pulmonary artery vasoconstriction and may subsequently develop pulmonary hypertension. • •Option B: Clients with asthma tend not to have a chronic cough or peripheral edema. Asthma is a common disease and has a range of severity, from a very mild, occasional wheeze to acute, life-threatening airway closure. It usually presents in childhood and is associated with other features of atopy, such as eczema and hayfever. Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. • •Option D: Most patients present with very nonspecific symptoms of chronic shortness of breath and cough with or without sputum production. As the disease process advances, the shortness of breath and cough progressively gets worse. Initially, there is exertional dyspnea with significant physical activity, especially arm work at or above shoulder level with progression to dyspnea with simple daily activities and even at rest. Some patients may present with wheezing because of the airflow obstruction.

•What medication is ipratropium? A.SABA B.LABA C.SAMA D.LAMA

C Ipratropium is a short acting anticholinergic

A nurse is providing discharge teaching to a client who has COPD and a new prescription for albuterol. Which of the following statements by the client indicates an understanding of the teaching? A."This medication can increase my blood sugar levels." B."This medication can decrease my immune response." C."I can have an increase in my heart rate while taking this medication." D."I can have mouth sores while taking this medication."

C SABAs can increase HR, BP, and make jittery The rest of the statements would describe an inhaled corticosteroid

pH - 7.16 PaCO2 - 23 HCO3 - 13 PaO2 - 92 A.Respiratory Acidosis B.Respiratory Alkalosis C.Metabolic Acidosis D.Metabolic Alkalosis

C; partially compensated

An older adult is admitted with a cough of thick yellow sputum, a fever and new onset of confusion. The nurse attempts to obtain an oxygen saturation reading and respiratory rate, but the combative client is uncooperative. How should the nurse proceed? 1.Apply O2 as ordered 2.Obtain orders to retrain the client 3.Leave the client alone until she is more cooperative 4.Obtain an order to sedate the client

Correct answer: 1 1.Apply oxygen as ordered. Confusion is a sign of hypoxia. Oxygen is the priority and may cause the client to become more cooperative. 2.Obtain orders to restrain the client. This would be a last resort. It would cause worsening agitation, especially in the older adult. 3.Leave the client alone until she is more cooperative. This delays treatment, considering the client is in distress. 4.Obtain an order to sedate the client. Sedation will further depress the respiratory system and worsen the situation.

The nurse is making rounds on a client after lunch. The client states, "It's strange, I feel like I cannot catch my breath." What should the nurse do next? 1.Observe if the client shows signs of respiratory distress 2.Obtain an O2 saturation reading 3.Auscultate the breath sounds 4.Reassure the client

Correct answer: 1 1.Observe if the client shows signs of respiratory distress. Assessment should begin with visualization. A client showing respiratory distress is a more urgent situation. 2.Obtain an oxygen saturation reading. Although this reading should be obtained, it won't be first. Observation will occur before an oxygen saturation reading. 3.Auscultate the breath sounds. This assessment will occur after the visualization and oxygen saturation. 4.Reassure the client that they are alright. It is important to meet the client's physiological needs first in case there is a problem. THIN Thinking: Top 3 - Further assessment of the respiratory system is a priority. This will include observation for distress, assessment of the respiratory rate and depth, obtaining an oxygen saturation reading, and auscultation of the lungs. ABCs. NCLEX®: Physiological Adaptation. QSEN: Patient-centered Care. Nursing Process: assessment Specialty Focus: med-surg Topic-Concept: respiration/oxygenation/gas exchange Topic-System: respiratory

The nurse is caring for a client prescribed amoxicillin/clavulanate. The client informs the nurse they are feeling much better, and they do not feel they need the medicine anymore. What teaching does the nurse need to provide? A. "You should keep the remaining tabs for future infections to save money." B. "You should only stop the medicine if your fever is gone." C. "You should dispose of the remaining medication in a biohazard receptacle." D. "Antibiotics must be taken for the complete course to eliminate the organism."

D Compliance with full dose of ABX is essential for complete recovery. Not A, or B- incomplete course promotes resistance Not C- this applies to tetracyclines; full course needed regardless

While assessing the client who feels short of breath the nurse finds this information: respirations 22 breaths per minute and labored; oxygen saturation 93% on room air; bilateral crackles in the bases of the lungs. Which action should the nurse perform first? 1.Apply 2LNC O2 2.Elevate the HOB 3.Administer Lasix as ordered 4.Encourage the client to cough and take deep breaths

Correct answer: 2 1.Apply oxygen at 2L by cannula. Certainly, the client needs oxygen since the oxygen saturation is low and they appear in distress (tachypnea), but positioning should occur before oxygen. 2.Elevate the head of the bed. This quick intervention can provide some relief while the nurse provides additional interventions. 3.Deliver furosemide as ordered. Extra fluid in the base of the lungs is probably what is causing the distress, but positioning and oxygen should be completed first. 4.Encourage the client to cough and deep breathe. Although this may help minimally, coughing will clear secretions from the larger airways, and the crackles indicate fluid in the base of the lungs.

•The nurse has finished delivering a bronchodilator via small volume nebulizer. Which documented assessment(s) indicates the treatment was effective? Select all that apply. 1.Blood pressure 2.Heart Rate 3.Respiratory Rate 4.Oxygen Saturation 5.Lung Sounds

Correct answer: 3, 5 1.Blood pressure. The blood pressure increased slightly, does not show medication effectiveness. 2.Heart rate. Heart rate increased as a side effect of the medication but does not show effectiveness. 3.Respiratory rate. A decrease in the respirations shows less effort of breathing. 4.Oxygen saturation. Numbers unchanged so do not show effectiveness. 5.Lung sounds. The wheezes are gone, the bronchodilator was effective.

The nurse is caring for a ventilated client. The ventilator settings are: assist control (AC), 12; tidal volume (TV), 600; positive end-expiratory pressure (PEEP), 5; and FiO2, 40%. The ventilator alarm begins to sound "low pressure." What should be the nurse's next action? 1.Increase the FiO2 to 50% 2.Decrease the PEEP to 3 3.Suction the client 4.Confirm that all connections are tight

Correct answer: 4 1.Increase the FiO2 to 50%. An increase in the FiO2 would be warranted if the client was desaturating and required more oxygen. 2.Decrease the PEEP to 3. The lowering of the PEEP typically occurs when someone is being weaned from the ventilator. 3.Suction the client. Suctioning should be considered when the "high-pressure" alarm occurs since it could be from secretions that are occluding the airway. 4.Confirm that all connections are tight. A low-pressure alarm means that air is escaping the system and a connection may be loose.

A nurse is assessing the respiratory status of a client who has suffered a fractured rib. The nurse would expect to note which of the following? A. Slow deep respirations B. Rapid deep respirations C. Paradoxical respirations D. Pain, especially with inspiration

D

A nurse is reviewing discharge instructions for a client who experienced a pneumothorax. Which of the following statements should the nurse use when teaching the client? A."Notify the provider if you experience weakness." B."You should be able to return to work in 3 days." C."You can resume all normal activities." D."Notify your provider if you experience a productive cough."

D

•This medication can cause softening of the teeth as well as yellowish discoloration and is not used in children less than 8 years of age? A.Amoxicillin B.Montelukast C.Albuterol D.Doxycycline

D

A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which of the following classes of medication right away? •A. Beta adrenergic blockers •B. Inhaled steroids •C. Oral steroids •D. Bronchodilators

D Bronchodilators are the first line of treatment for asthma because bronchoconstriction is the cause of reduced airflow. Bronchodilators are indicated for individuals that have lower than optimal airflow through the lungs. The mainstay of treatment is beta-2 agonists that target the smooth muscles in the bronchioles of the lung. Various respiratory conditions may require bronchodilators, including asthma and chronic obstructive pulmonary disease. • •Option A: Beta-adrenergic blockers aren't used to treat asthma and can cause bronchoconstriction. The catecholamines, epinephrine, and norepinephrine bind to B1 receptors and increase cardiac automaticity as well as conduction velocity. B1 receptors also induce renin release, and this leads to an increase in blood pressure. In contrast, binding to B2 receptors causes relaxation of the smooth muscles along with increased metabolic effects such as glycogenolysis. • •Option B: Inhaled steroids may be given to reduce the inflammation but aren't used for emergency relief. Inhaled corticosteroids have potent glucocorticoid activity and work directly at the cellular level by reversing capillary permeability and lysosomal stabilization to reduce inflammation. The onset of action is gradual and may take anywhere from several days to several weeks for maximal benefit with consistent use. • •Option C: Corticosteroids produce their effect through multiple pathways. In general, they produce anti-inflammatory and immunosuppressive effects, protein and carbohydrate metabolic effects, water and electrolyte effects, central nervous system effects, and blood cell effects. Oral administration is more common for chronic treatment. Patients should receive non-systemic therapy whenever possible, to minimize systemic exposure.

The term "pink puffer" refers to the client with which of the following conditions? • A. ARDS • B. Asthma • C. Chronic obstructive bronchitis D. Emphysema

D Emphysema Because of the large amount of energy it takes to breathe, clients with emphysema are usually cachectic. They're pink and usually breathe through pursed lips, hence the term "puffer". Emphysema comes on very gradually and is irreversible. People with emphysema are sometimes called "pink puffers" because they have difficulty catching their breath and their faces redden while gasping for air. • •Option A: Clients with ARDS are usually acutely short of breath. Clients with ARDS have acute symptoms of and typically need large amounts of oxygen. Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by poor oxygenation and non-compliant or "stiff" lungs. The disorder is associated with capillary endothelial injury and diffuse alveolar damage. Once ARDS develops, patients usually have varying degrees of pulmonary artery vasoconstriction and may subsequently develop pulmonary hypertension. • •Option B: Clients with asthma don't have any particular characteristics. Asthma is a common disease and has a range of severity, from a very mild, occasional wheeze to acute, life-threatening airway closure. It usually presents in childhood and is associated with other features of atopy, such as eczema and hayfever. Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. • •Option C: Clients with chronic obstructive bronchitis are bloated and cyanotic in appearance. Clients with chronic obstructive bronchitis appear bloated; they have large barrel chests and peripheral edema, cyanotic nail beds, and, at times, circumoral cyanosis. People with chronic bronchitis are sometimes called "blue bloaters" because of their bluish-colored skin and lips. Blue bloaters often take deeper breaths but can't take in the right amount of oxygen.

A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. He's tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. This client has symptoms of which of the following respiratory disorders? • A. ARDS • B. Asthma • C. Chronic obstructive bronchitis • D. Emphysema

D Emphysema These are classic signs and symptoms of a client with emphysema. In the early stages of the disease, the physical examination may be normal. Patients with emphysema are typically referred to as "pink puffers," meaning cachectic and non-cyanotic. Expiration through pursed lips increases airway pressure and prevents airway collapse during respiration, and the use of accessory muscles of respiration indicates advanced disease. • •Option A: Clients with ARDS are acutely short of breath and require emergency care. The physical examination will include findings associated with the respiratory system, such as tachypnea and increased effort to breathe. Systemic signs may also be evident depending on the severity of illness, such as central or peripheral cyanosis resulting from hypoxemia, tachycardia, and altered mental status. Despite 100% oxygen, patients have low oxygen saturation. • •Option B: Those with asthma are also acutely short of breath during an attack and appear very frightened. Patients will usually give a history of a wheeze or a cough, exacerbated by allergies, exercise, and cold. There is often diurnal variation, with symptoms being worse at night. There may be some mild chest pain associated with acute exacerbations. Many asthmatics have nocturnal coughing spells but appear normal in the daytime. • •Option C: Clients with chronic obstructive bronchitis are bloated and cyanotic in appearance. The most common symptom of patients with chronic bronchitis is a cough. The history of a cough typical of chronic bronchitis is characterized to be present for most days in a month lasting for 3 months with at least 2 such episodes occurring for 2 years in a row. A productive cough with sputum is present in about 50% of patients.

It's highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which of the following reasons? • A. All clients are recommended to have these vaccines. • B. These vaccines produce bronchodilation and improve oxygenation. • C. These vaccines help reduce the tachypnea these clients experience. • D. Respiratory infections can cause severe hypoxia and possibly death in these clients.

D Respiratory infections can cause severe hypoxia and possibly death in these clients. It's highly recommended that clients with respiratory disorders be given vaccines to protect against respiratory infection. Infections can cause these clients to need intubation and mechanical ventilation, and it may be difficult to wean these clients from the ventilator. Another pneumococcal vaccine, PPSV23, is indicated in the United States for all adults 65 years of age and older, as well as younger patients with conditions that increase the risk for developing pneumococcal pneumonia or invasive pneumococcal disease. Conditions that would indicate PPSV23 in patients younger than 65 years of age are as follows: chronic heart disease excluding hypertension, chronic lung disease including asthma, diabetes mellitus, cerebrospinal fluid leak, cochlear implant, alcohol use disorder, chronic liver disease, cigarette smoking, hemoglobinopathy (including sickle cell disease), etc. • •Option A: Recommendations are that all patients who received PPSV23 before the age of 65 years be revaccinated at age 65 unless the vaccine is given less than ten years before the patient turns 65 years old, in which case patients should be revaccinated ten years following the first dose. Recommendations are that patients with functional or anatomic asplenia or immunocompromised individuals receive repeat doses of the vaccination every ten years after the first dose. • •Option B: The vaccines have no effect on bronchodilation or respiratory care. Both vaccines promote active immunization against the serotypes of the conjugate and capsular polysaccharides contained in the formulation of the vaccine. Immunity develops approximately 2 to 3 weeks after vaccination and lasts for five years. In children and the elderly, re-immunization may be necessary sooner.

A client is receiving nebulized levalbuterol every four hours. What side effect of this medication do you assess your client for? A. Hypoglycemia B. Petechiae C. Delayed wound healing D. Tachycardia

D Tachycardia is a side effect of albuterol

During the first 36 hours after the insertion of a chest tube, the nurse notes the water in the water seal chamber is not tidaling. The nurse suspects the chest tube is occluded. The initial nursing intervention should be to: A.Inform the physician B.Take the client's vital signs C.Milk the chest tube D.Instruct the client to cough

D increases the pressure within the system Never milk a chest tube

•A 68-year-old client with COPD is being seen for pulmonary rehabilitation. The nurse is instructing the client on exercise guidelines for managing the disease. Which information must the nurse include as part of exercise guidelines for this client? A.The client should be monitored during exercise to address safety B.The client should wear a Holter monitor when exercising at home C.The client should log exercise hours and bring in a copy to the rehab center D.The client will need to receive nebulizer treatments prior to starting exercise

D the patients should be pre-treated with a bronchodilator to optimize their condition prior to exercise

T/F: A bubbler uses 0.9% Normal Saline for fluid

F

T/F: Non-rebreathers are for long term use

F

T/F: Oxygen is a yellow port and medical air is a green port

F

T/F: You can give 15 L on a Nasal Cannula

F

•pH - 7.15 •PaCO2 - 62 •HCO3 - 12 •PaO2 - 58

Mixed respiratory and metabolic acidosis with severe hypoxemia

pH - 7.56 PaCO2 - 28 HCO3 - 42 PaO2 - 78 A.Respiratory Acidosis B.Respiratory Alkalosis C.Metabolic Acidosis D.Metabolic Alkalosis

No correct answer - this is a mixed respiratory and metabolic alkalosis - Key point - just because all numbers are abnormal does not imply partial compensation

T/F: A Venturi face mask is an appropriate option for a patient with COPD

T

T/F: Nasal Cannula is a low flow method

T