respiratory practice questions

The experienced nurse is teaching a new graduate nurse about tracheostomy care. The experienced nurse would determine teaching has been effective if the new graduate nurse states that which client has an immature tracheostomy?

A client who underwent a tracheotomy 2 days ago

The nurse is caring for a client with a tracheostomy tube who is receiving mechanical ventilation. The nurse is monitoring for complications related to the tracheostomy and suspects tracheoesophageal fistula when which occurs?

Aspiration of gastric contents occurs during suctioning.

A client is returned to the nursing unit after thoracic surgery with chest tubes in place. During the first few hours postoperatively, what type of drainage would the nurse expect?

Bloody In the first few hours after surgery, the drainage from the chest tube is bloody. After several hours, it becomes serosanguineous. The client would not experience frequent clotting. Proper chest tube function would allow for drainage of blood before it has the chance to clot in the chest or the tubing.

The nurse is caring for a client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate and notes that the client is receiving 2 L/min. The client's Spo2 level is 86%. Based on this assessment, which action would the nurse take first?

Check the client's record to determine the client's baseline SpO2.

A client has experienced pulmonary embolism. The nurse would assess for which symptom, which is most commonly reported?

Chest pain that occurs suddenly

he nurse is reviewing the pathophysiology of pleural effusion. The nurse knows that pleural fluid balance is managed by several mechanisms and correctly identifies which of the following as a cause for the development of pleural effusion? Select all that apply.

Decreased oncotic pressure Lymphatic fluid outflow obstruction Increased pleural membrane permeability Increased pulmonary capillary pressure

The nurse is caring for a client who suffered an inhalation injury from a wood stove. The carbon monoxide blood report reveals a level of 12%. Based on this level, the nurse would anticipate noting which sign in the client?

Flushing Carbon monoxide levels between 11% and 20% result in flushing, headache, decreased visual activity, decreased cerebral functioning, and slight breathlessness; levels of 21% to 40% result in nausea, vomiting, dizziness, tinnitus, vertigo, confusion, drowsiness, pale to reddish-purple skin, and tachycardia; levels of 41% to 60% result in seizure and coma; and levels higher than 60% result in death.

The nurse is assessing a client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse would assess for which earliest sign of acute respiratory distress syndrome?

Increased respiratory rate

A chest x-ray report for a client indicates the presence of a left apical pneumothorax. The nurse would assess the status of breath sounds in that area by placing the stethoscope in which location?

Just under the left clavicle The apex of the lung is the rounded, uppermost part of the lung. Therefore, the nurse would place the stethoscope just under the left clavicle. All of the other options are incorrect locations for assessing the left apex.

The nurse in the emergency department is reviewing laboratory results for a client with carbon monoxide poisoning. The client's carboxyhemoglobin level is 25%. How would the nurse interpret the severity of carbon monoxide poisoning?

Moderate poisoning

The client is returned to the nursing unit following thoracic surgery to treat lung cancer with a chest tube in place. During the first few hours postoperatively, the nurse assesses for drainage and expects to note which characteristics?

The drainage is bloody.

The nurse is caring for a client who underwent a pleurodesis procedure to treat a recurrent pleural effusion. The medication was instilled into the chest tube at 1600 and subsequently clamped. At what time will the nurse unclamp the chest tube?

2400

The nurse is assisting a pulmonologist with a pleurodesis to treat a client with recurrent pleural effusions. After the pulmonologist instills the medication into the pleural space, for how long would the nurse anticipate the chest tube drainage system will need to be clamped?

8 hours

Which nursing interventions are appropriate in caring for a client with emphysema? Select all that apply.

each diaphragmatic and pursed-lip breathing. Encourage alternating activity with rest periods. Teach the client techniques of chest physiotherapy.

A registered nurse who is orienting a new nursing graduate to the hospital emergency department instructs the new graduate to monitor a client for one-sided chest movement on the right side while the client is being intubated by the primary health care provider (PHCP). Which statement made by the new nursing graduate indicates understanding of the importance of this observation?

"It will enter the right main bronchus if inserted too far."

The nurse is monitoring the respiratory status of a client with laryngeal cancer after creation of a tracheostomy. Which coexisting condition in the client may cause an inaccurate pulse oximetry reading?

Hypotension

The nurse and an assistive personnel (AP) are assisting the respiratory therapist to position a client for postural drainage. The AP asks the nurse how the respiratory therapist selects the position to be used for the procedure. The nurse responds that a position is chosen that will use gravity to help drain secretions from which primary areas?

Lobes

The nurse is assisting a radiologist to facilitate a thoracentesis for a client with pleural effusion. The nurse assists the client to a position that widens the spaces between the ribs to help drain which area?

Pleural space

A client with long-standing empyema undergoes decortication of the affected lung area. Postoperatively the nurse would place the client in which position?

Semi-Fowler's

The nurse who is participating in a client care conference with other members of the health care team is discussing the condition of a client with acute respiratory distress syndrome (ARDS). The primary health care provider (PHCP) states that as a result of fluid in the alveoli, surfactant production is falling. What does the nurse anticipate as a physiological consequence?

Collapse of alveoli and decreased compliance

The nurse has assisted the primary health care provider and the anesthesiologist with placement of an endotracheal (ET) tube for a client in respiratory distress. What is the initial nursing action to evaluate proper ET tube placement?

Use an Ambu (resuscitation) bag to ventilate the client and assess for bilateral breath sounds.

A client with a history of silicosis is admitted to the hospital with respiratory distress and impending respiratory failure. Which item(s) would the nurse place at the client's bedside?

Intubation tray

The nurse is providing immediate postprocedure care to a client who had a thoracentesis to relieve a tension pneumothorax that resulted from rib fractures. The goal is that the client will exhibit normal respiratory functioning, and the nurse provides instructions to assist the client with this goal. Which client statement indicates that further instruction is needed?

"I will lie on the affected side for an hour." After the procedure the client usually is turned onto the unaffected side for 1 hour to facilitate lung expansion. Tachypnea, dyspnea, cyanosis, retractions, or diminished breath sounds, which may indicate pneumothorax, need to be reported to the primary health care provider. A chest x-ray may be performed to evaluate the degree of lung reexpansion or pneumothorax. Subcutaneous emphysema (crepitus) may follow this procedure because air in the pleural cavity leaks into subcutaneous tissues. The involved tissues feel like lumpy paper and crackle when palpated (crepitus). Usually subcutaneous emphysema causes no problems unless it is increasing and constricting vital organs, such as the trachea.

A client is diagnosed with a rib fracture and asks the nurse why strapping of the ribs is not being done. Which response by the nurse is most appropriate?

"That isn't done because people often would develop pneumonia from the constricting effect on the lungs."

The nurse is assessing the functioning of a chest tube drainage system in a client who has just returned from the recovery room following a thoracotomy with wedge resection to remove a cancerous tumor. Which are the expected assessment findings? Select all that apply.

- Drainage system maintained below the client's chest - 50 mL of drainage in the drainage collection chamber - Occlusive dressing in place over the chest tube insertion site - Fluctuation of water in the tube in the water seal chamber during inhalation and exhalation

A client who is intubated and receiving mechanical ventilation is at risk for infection. The nurse would include which measures in the care of this client? Select all that apply.

- Monitor the client's temperature. - Use sterile technique when suctioning. - Use the closed-system method of suctioning. - Monitor sputum characteristics and amounts.

The nurse is teaching a client with emphysema about positions that help breathing during dyspneic episodes. The nurse instructs the client that which positions alleviate dyspnea? Select all that apply.

- Sitting up and leaning on a table - Standing and leaning against a wall - Sitting up with the elbows resting on knees

A client who has undergone radical neck dissection for a tumor has a potential problem of obstruction related to postoperative edema, drainage, and secretions. To promote adequate respiratory function in this client, the nurse would implement which activities? Select all that apply.

- Suctioning the client as needed - Encouraging coughing every 2 hours - Supporting the neck incision when the client coughs - Monitoring the respiratory status frequently as prescribed

The nurse is caring for a group of clients on the clinical nursing unit. The nurse interprets that which of these clients is at most risk for the development of pulmonary embolism?

A 73-year-old client who has just had pinning of a hip fracture Clients frequently at risk for pulmonary embolism include those who are immobilized. This is especially true in the immobilized postoperative client. Other causes include those with conditions that are characterized by hypercoagulability, endothelial disease, or advancing age.

A client has been treated for pleural effusion with a thoracentesis. The nurse determines that this procedure has been effective if the nurse notes which assessment finding?

Absence of dyspnea The client who has undergone thoracentesis would experience relief of the signs and symptoms experienced before the procedure. Typical signs and symptoms of pleural effusion include dry, nonproductive cough; dyspnea (usually on exertion); decreased or absent tactile fremitus; and dull or flat percussion notes on respiratory assessment.

The nurse in the emergency department is preparing for the arrival of a client with suspected carbon monoxide poisoning. Which primary health care provider (PHCP) order would the nurse perform first upon the client's arrival?

Apply 100% oxygen via nonrebreather mask.

The nurse is reviewing the interventions for relieving an airway obstruction. Which initial action would be taken in this situation?

Assess for the cause of the obstruction

The nurse is caring for a client with a tracheostomy receiving supplemental oxygen via a tracheostomy mask and is preparing to perform tracheostomy care. While preparing the supplies, the nurse notes the tracheostomy tube is pulsing, there is bleeding from the stoma, and the client is increasingly restless. The nurse calls for a rapid response team (RRT) and removes the tracheostomy tube. Which action would the nurse take next?

Assist the primary health care provider (PHCP) with endotracheal intubation Bleeding from a tracheostomy can indicate a serious medical emergency known as trachea-innominate artery fistula. The tracheostomy tube will pulse simultaneously with the heartbeat, and heavy bleeding will be noted from the stoma. The tracheostomy tube needs to be removed immediately and an alternative airway will need to be secured. After calling for help, the nurse would first prepare for endotracheal intubation. Therefore, option 4 is correct. Options 1, 2, and 3 are appropriate actions by the nurse, but a patent airway is the priority. Furthermore, those nursing interventions can be carried out simultaneously with assistance from the RRT.

The nurse in the emergency department is caring for a client brought in from a house fire. The client is exhibiting dyspnea with clear breath sounds bilaterally and is complaining of a severe headache. The client is exhibiting signs of confusion and is oriented to self. The client's vital signs are as follows: temperature 98.2℉ (36.7℃), oxygen saturation 91%, respiratory rate 26 breaths per minute, heart rate 112 beats per minute, and blood pressure 100/62. Which of the following conditions would the nurse suspect?

Carbon monoxide poisoning

The nurse is reviewing the pleural fluid cytology report for a client with pleural effusion. The report describes the fluid as clear and pale yellow with no red blood cells (RBCs) or white blood cells (WBCs) detected. Based on these results, which underlying condition would the nurse suspect?

Congestive heart failure

The emergency department nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding indicates the presence of a pneumothorax in this client?

Diminished breath sounds

The nurse is caring for a client on a mechanical ventilator. The low-pressure alarm sounds. The nurse suspects that the most likely cause of the alarm is which finding?

Disconnection of the ventilator tubing

A client is suspected of having a pulmonary embolus. The nurse assesses the client, knowing that which is a common clinical manifestation of pulmonary embolism?

Dyspnea

The nurse is caring for a client at risk for acute respiratory distress syndrome (ARDS). As part of the plan, the nurse will assess for which sign or symptom for early detection of this disorder?

Dyspnea

A client is on continuous mechanical ventilation (CMV) and the high-pressure alarm sounds. Which action would the nurse take to eliminate the problem?

Empty excess accumulated water from the ventilatory circuit tubing. High-pressure alarms can be triggered by increased airway resistance caused by excess secretions in the airway, biting the tube, coughing, bronchospasm, a kinked ventilatory circuit, or excess condensation of water in the ventilator tubing. Excess water needs to be emptied from the tubing. Alarms would never be silenced until the cause has been identified and corrected. In addition, this will not eliminate the problem. The low-pressure alarm would sound with a disconnection. Filling the cuff to 25 mm Hg can result in impaired circulation to the tracheal mucosa.

The nurse is caring for a client with acute respiratory distress syndrome (ARDS). What would the nurse expect to note in the client?

Low arterial Pao2

The nurse is caring for a postoperative pneumonectomy client. Which finding on assessment of the client is an adverse sign or symptom indicating pulmonary edema?

Lung crackles in the remaining lung

The nurse is caring for a client who underwent a thoracentesis to treat pleural effusion. The pleural fluid testing results indicate the pleural fluid is cloudy and confirm the presence of white blood cells (WBCs). Which condition would the nurse suspect?

Malignancy

A client with an endotracheal tube who is being mechanically ventilated is visibly anxious. What is the best nursing action?

Provide reassurance to the client and give small doses of morphine sulfate intravenously as prescribed.

The nurse is assessing the respiratory status of a client who has suffered a fractured rib. The nurse would expect to note which finding?

Pain, especially with inspiration

The nurse is assessing a client's tracheostomy and notes that the skin around the stoma appears swollen with no redness or drainage present. Which action would the nurse take next?

Palpate the skin around the stoma.

A client did not seek medical treatment for a previous respiratory infection, and subsequently an empyema developed in the left lung. The nurse would assess the client for which signs and symptoms associated with this problem?

Pleural pain and fever

A client with a chest injury has suffered flail chest. The nurse assesses the client for which most distinctive sign of flail chest?

Paradoxical chest movement

A primary health care provider (PHCP) tells the nurse that a client's chest tube is to be removed since pneumothorax is resolved. The nurse would bring which dressing materials to the bedside for the PHCP's use?

Petrolatum gauze and sterile 4 × 4 gauze

The nurse is assisting a client with a tracheostomy turn in bed when the tube gets caught under the client, causing the tracheostomy tube to be pulled out. The nurse calls a rapid response team (RRT) and attempts to replace the tracheostomy tube with the same size tube as the tube that was pulled out and is unsuccessful. While waiting for the RRT, which action would the nurse take?

Reattempt the insertion with a tracheostomy tube that is one size smaller than the original tracheostomy tube.

The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position would the nurse instruct the client to assume?

Sitting up and leaning on an overbed table

A client who is experiencing respiratory difficulty asks the nurse, "Why is it so much easier to breathe out than in?" In providing a response, the nurse explains that breathing is easier on exhalation because of which respiratory responses?

The respiratory muscles relax.

The nurse caring for a client who has a pneumothorax notes continuous bubbling in the water seal chamber of the client's closed chest drainage system. How would the nurse interpret this finding?

There is an air leak somewhere in the system.

The nursing instructor is reviewing the various complications of a tracheostomy. The nursing instructor determines teaching has been effective if the nursing student correctly identifies which of the following conditions as tracheal dilation and cartilage erosion?

Tracheomalacia