respiratory hard ati
a nurse is preparing a client for a bronchoscopy. Which of the following actions should the nurse take? SATA A. Explain that the client will receive sedation and will not remember the procedure. B. verify that the client understands the purpose and nature of the procedure. C. offer the client sips of clear liquids until 1 hr before the test. D. obtain a pre procedural sputum specimen. E. instruct the client to keep his neck in a neutral position.
A. Explain that the client will receive sedation and will not remember the procedure. B. verify that the client understands the purpose and nature of the procedure.
a nurse is planning postoperative education for a client who will undergo a radical neck dissection for cancer of the larynx. the nurse should include which of the following topics? A. NPO status B. alternative methods of communication C. endotracheal intubation D. change in body image E. swallowing exercises.
A. NPO status B. alternative methods of communication D. change in body image E. swallowing exercises.
a charge nurse receives notification of the admission of a client who is coughing frequently and whose sputum is pink, frothy, and copious. The client has a history of night sweats, anorexia, and weight loss. Which of the following actions should the nurse take? SATA A. assign the client to a private room with negative pressure airflow. B. add contact precautions to the client's plan of care. C. wears an N95 respirator when entering the client's room. D. ensure the client's environment provides 4 exchanges of fresh air per minute. E. institute protective environment precautions as soon as the client arrives on the unit.
A. assign the client to a private room with negative pressure airflow. C. wears an N95 respirator when entering the client's room. rationale B. tuberculosis is a communicable infection that mandates a different type of transmission-based precautions in addition to standard precautions. D. tuberculosis mandates the provision of a well-ventilated room with 6-12 exchanges of fresh air per minute. E. protective environment precautions are for immunocompromised clients who are at high risk of infection (e.g. clients who had chemotherapy)
a nurse in an argument care clinic is collecting data from a client who reports exposure to anthrax. Which of the following findings is an indication of the prodromal stage of inhalation anthrax? A. dry cough B. rhinitis C. sore throat D. swollen lymph nodes
A. dry cough
a nurse on a medical-surgical unit is assessing a client who recently transferred from the ICU following endotracheal extubation. which of the following findings should the nurse identify as a possible manifestation of tracheal stenosis and report to the provider? A. increased coughing B. diaphragmatic breathing C. hemoptysis D. kussmaul respirations
A. increased coughing
A nurse is caring for a client following a right pleural thoracentesis. The nurse measures a total of 35 mL of purulent drainage. which of the following findings should the nurse recognize as an indication of a tension pneumothorax? A. tracheal deviation to the left B. temperature of 38.8 C (102F) C. absent breath sounds on the right side D. neck vein distension E. bradypnea
A. tracheal deviation to the left C. absent breath sounds on the right side D. neck vein distension
a nurse is providing preoperative teaching to a client who has lung cancer and will undergo a pneumonectomy. Which of the following statements should the nurse include? SATA A. you will have a chest tube in place after surgery B. we'll frequently help you turn, cough, and breath deeply after surgery. C. you will have to remain in bed for about 2 days after the surgery D. well give you oxygen to support your breathing if you need it. E. you should expect pain for the first few days after surgery/
A. you will have a chest tube in place after surgery B. we'll frequently help you turn, cough, and breath deeply after surgery. D. well give you oxygen to support your breathing if you need it.
a nurse is assisting a provider with a comprehension physical examination of a client. When the provider uses transillumination, the nurse should explain to the client that this technique helps evaluate which of the following structures? A. lymph nodes B. maxillary sinuses C. intercostal spaces D. salivary glands
B. maxillary sinuses
a nurse is providing discharge teaching to a client who had a pulmonary embolism. Which of the following statements indicates that the client understands the information? A. Ill expect a little leg swelling since I wont be that active for awhile. B. Ill see the doctor every week to change my vena cava filter C. ill call the doctor if I see any blood in my urine or stool. D. Ill have to take the blood thinner for a few more days
C. Ill call the doctor if I see any blood in my urine or stool.
A nurse is caring for a client for whom the respiratory therapist has just removed the endotracheal tube. Which of the following actions should the nurse take first? A. instruct the client to cough B. administer oxygen via face mask C. evaluate the client for stridor D. keep the client in s semi to high folwer position
C. evaluate the client for stridor
a nurse is caring for a client who has a 20-year history of COPD and is receiving oxygen at 2L/min via nasal cannula. The client is dyspenic and has an oxygen saturation via pulse oximetry of 85%. which of the following actions should the nurse take? A. place a nonbreather mask on the client and increase the oxygen flow to 3L/min B. prepare the client for possible endotracheal intubation and mechanical ventilation. C. increase oxygen flow and request an arterial blood gas determination D. position the client supine and administer an antianxiety medication.
C. increase oxygen flow and request an arterial blood gas determination
a nurse is caring for a client who is scheduled to have his chest tube removed. Which of the following actions should the nurse take? A. cover the insertion site with a hydrocolloid dressing after removal B. provide pain medication immediately after removal C. instruct the client to perform the Valsalva maneuver during removal D. delegate removal of the chest tube to a licensed practical nurse.
C. instruct the client to perform the Valsalva maneuver during the removal the nurse should instruct the client to perform the Valsalva maneuver during removal to maintain the appropriate amount of negative pressure in the chest in order to prevent air entry into the pleural space.
A nurse is caring for a client who had left lower lobectomy to treat lung cancer. Which of the following factors will have a significant impact on the plan of care for this client? A. the client will need intensive smoking cessation education. B. after surgery, the prognosis for clients with lung cancer is usually good. C. lung cancer usually has metastasized before the client presents with symptoms. D. oxygen therapy is ineffective following a lobectomy.
C. lung cancer usually has metastasized before the client presents with symptoms.
a nurse is assessing the respiratory status of a client who has COPD. which of the following manifestations should the nurse identify as an indication of impeding respiratory failure? A. wheezing B. bradypnea C. tachycardia D. diaphoresis
C. tachycardia
a nurse is planning care for a client following placement of a chest tube 1 hr ago. Which of the following actions should the nurse include in the plan of care? A. clamp the chest tube if there is continuous bubbling in the water seal chamber. B. keep the chest tube drainage system at the level of the right atrium. C. tape all connections between the chest tube and drainage system. D. empty the collection chamber and record the amount of drainage every 8 hr.
C. tape all connections between the chest tube and drainage system.
a nurse is providing preoperative teaching to a client who will undergo a total laryngectomy. Which of the following statements indicates that the client understands the impact of the surgery. A. im not going to be able to cough for awhile after the surgery. B. after i recover form the anesthesia, ill be able to eat regular food again. C. after the surgery, my voice will gradually return but might be weak. D. i understand that i will have a permanent tracheostomy after the surgery.
D. I understand that i will have a permanent tracheostomy after the surgery.
a nurse is the PACU is assessing a newly admitted client and observes intercostal retractions and high pitched inspiratory sound. The nurse should identify these findings as manifestations of which of the following complications? A. pulmonary edema B. tension pneumothorax C. flail chest D. respiratory obstruction
D. respiratory obstruction
a nurse is preparing to administer crisplatin IV to a client who has lung cancer. The nurse should identify that which of the following findings is an adverse effect of this medication? A. hallucinations B. pruritus C. hand and foot syndrome D. tinnitus
D. tinnitus hallucinations are an adverse effect of asparaginase, which is an antineoplastic medication used to treat lymphocytic leukemia pruritus is and adverse effect of methotrexate, which is used to treat cancer and rheumatoid arthritis hand and foot symptom is an adverse effect of capecitabine, an antineoplastic medication used to treat breast and colorectal cancer.
Valsalva maneuver
forcible exhalation against a closed glottis, resulting in increased intrathoracic pressure