Respiratory questions unit 2 nur1130

The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which findings would the nurse expect to note on assessment of this client? select all that apply. 1. A low arterial pco2 level 2.A hyperinflated chest noted on the chest x-ray 3.Decreased oxygen saturation with mild exercise 4.A widened diaphragm noted on the chest x-ray 5.Pulmonary function tests that demonstrate increased vital capacity

2,3 Clinical manifestations of chronic obstructive pulmonary disease include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise and the use of accessory muscles of respiration. Chest x ray reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced. Pulmonary function tests will demonstrate decreased vital capacity.

A medical nurse has admitted a client to the unit with a diagnosis of failure to thrive. The client has developed a fever and cough, so a sputum specimen has been obtained. The nurse notes that the sputum is greenish and that there is a large quantity of it. The nurse notifies the client's physician because these symptoms are suggestive of what? A.Infection B.Pulmonary edema C.Pneumothorax D.Lung tumors

A >>The nature of the sputum is often indicative of its cause. A profuse amount of purulent sputum (thick and yellow, green, or rust-colored) or a change in color of the sputum is a common sign of a bacterial infection. Pink-tinged mucoid sputum suggests a lung tumor. Profuse, frothy, pink material, often welling up into the throat, may indicate pulmonary edema. A pneumothorax does not result in copious, green sputum.

A client with end-stage chronic obstructive pulmonary disease (COPD) requires bi-level positive airway pressure (BiPAP). While caring for the client, the nurse determines that bilateral wrist restraints are required to prevent compromised care. Which client care outcome is associated with restraint use in the client who requires BiPAP? A.The client will maintain adequate oxygenation. B.The client will remain pain-free. C.The client will maintain adequate urine output. D.The client will remain infection-free.

A >>BiPAP is a type of continuous positive airway pressure in which both inspiratory and expiratory pressures are set above atmospheric pressure. This type of ventilatory support assists clients with COPD who retain PaCO2. Restraints are necessary in this client to maintain BiPAP therapy if the client attempts to dislodge the mask despite instruction not to do so. Maintaining oxygenation is the expected outcome in this client. Remaining infection- and pain-free and maintaining adequate urine output aren't direct outcomes of the client who requires BiPAP and needs restraints to maintain his safety.

A sputum study has been ordered for a client who has developed coarse chest crackles and a fever. At what time should the nurse best collect the sample? A.First thing in the morning B.At bedtime C.Immediately after a meaL D.After a period of exercise

A >>Sputum samples ideally are obtained early in the morning before the client has had anything to eat or drink.

The nurse is performing client education for a client who is being discharged on mini-nebulizer treatments. What information should the nurse prioritize in the client's discharge teaching? A.How to perform diaphragmatic breathing B.How to independently wean herself from treatment C.How to collect serial sputum samples D.How to count her respirations accurately

A Diaphragmatic breathing is a helpful technique to prepare for proper use of the small-volume nebulizer. Client teaching would not include counting respirations and the client should not wean herself from treatment without the involvement of her primary care provider. Serial sputum samples are not normally necessary.

The nurse is completing a client's health history with regard to potential risk factors for lung disease. What interview question addresses the most significant risk factor for respiratory diseases? A."Have you ever lived in an area that has high levels of air pollution?" B."Do you currently smoke, or have you ever smoked?" C."Does anyone in your family have any form of lung disease?" C."Have you ever been employed in a factory, smelter, or mill?"

B >>Smoking the single most important contributor to lung disease, exceeds the significance of environmental, occupational, and genetic factors.

A nurse prepares to perform postural drainage. How should the nurse ascertain the best position to facilitate clearing the lungs? A.Chest X-ray B.Auscultation C.Arterial blood gas (ABG) levels D.Inspection

B >>The nurse should assess breath sounds before doing postural drainage to determine the areas that need draining. Inspection, chest X-rays, and ABG levels are all assessment parameters that give good information about respiratory function but aren't necessary to determine lung areas requiring postural drainage.

A patient is being educated in the use of incentive spirometry prior to having a surgical procedure. What should the nurse be sure to include in the education? A. Have the patient lie in a supine position during the use of the spirometer. B. Encourage the patient to take approximately 10 breaths per hour, while awake. C. Inform the patient that using the spirometer is not necessary if the patient is experiencing pain. D. Encourage the patient to try to stop coughing during and after using the spirometer.

B >>The patient should be instructed to perform the procedure approximately 10 times in succession, repeating the 10 breaths with the spirometer each hour during waking hours. The patient should assume a semi-Fowler's position or an upright position before initiating therapy, not be supine. Coughing during and after each session is encouraged, not discouraged. The patient should Splint the incision when coughing postoperatively. The patient should still use the spirometer when in pain.

The nurse is preparing to perform chest physiotherapy (CPT) on a client. Which statement by the client tells the nurse that the procedure is contraindicated. A. "I received my pain medication 10 minutes ago, let's do my CPT now." B. "I just finished eating my lunch, I'm ready for my CPT now." C. "I have been coughing all morning and am barely bringing anything up." D."I just changed into my running suit; we can do my CPT now."

B >>When performing CPT, the nurse ensures that the client is comfortable, is not wearing restrictive clothing, and has not just eaten. The nurse gives medication for pain, as prescribed, before percussion and vibration, splints any incision, and provides pillows for support, as needed. A goal of CPT is for the client to be able to mobilize secretions; the client who has an unproductive cough is a candidate for CPT.

A patient is newly diagnosed with COPD due to chronic bronchitis. You're providing education to the patient about this disease process. Which statement by the patient indicates they understood your teaching about this condition? A. "If I stop smoking, it will cure my condition." B. "Complications from this condition can lead to pulmonary hypertension and right-sided heart failure." C. "I'm at risk for low levels of red blood cells due to hypoxia and may require blood transfusions during acute illnesses." D. "My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than low oxygen levels.

B Chronic bronchitis is one type of COPD (chronic obstructive pulmonary disease). The inflamed bronchial tubes produce a lot of mucus. This leads to coughing and difficulty breathing pulmonary hypertension and right-sided heart failure. In cases of chronic bronchitis, however, the bronchial tubes are constantly irritated and inflamed. For a person to be diagnosed with chronic (rather than acute) bronchitis their mucus-filled cough must last three months of the year for two years in a row. Breathing in air pollution, fumes, or dust over a long period of time may also cause it.

A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside? A.Oxygen analyzer B.Manual resuscitation bag C.Tracheostomy cleaning kit D.Water-seal chest drainage set-up

B The client with COPD depends on mechanical ventilation for adequate tissue oxygenation. The nurse must keep a manual resuscitation bag at the bedside to ventilate and oxygenate the client in case the mechanical ventilator malfunctions. Because the client doesn't have chest tubes or a tracheostomy, keeping a water-seal chest drainage set-up or a tracheostomy cleaning kit at the bedside isn't necessary. Although the nurse may keep an oxygen analyzer (pulse oximeter) on hand to evaluate the effectiveness of ventilation, this equipment is less important than the manual resuscitation bag.

A 58 year old client with a 40-year history if 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 if the following conditons? A.Asthma B.Emphysema C.Chronic bronchitis D.Adult respiratory distress syndrome

C >>

A client arrive to the hospital with multiple stab wounds to the chest. Before assessing the patient, the nurse knows that the patient is at risk for what type of atelectasis? A. Obstructive B. Non-Obstructive C. Compressive D. Cyanosis

C >>Compressive atelectasis is excessive pressure on the lung which restricts normal lung expansion. Such pressure can be produced by fluid accumulation within the pleural space (pleural effusion), air in the pleural space (pneumothorax) or blood in the pleural space (hemothorax).

A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? A.A change in the oxygen concentration without resetting the oxygen level alarm B. A disconnected ventilator circuit C. Kinking of the ventilator tubing D.An ET cuff leak

C >>Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing, bronchospasm, pulmonary embolus, mucus plugging, water in the tube, and coughing or biting on the ET tube. The alarm may also be triggered when the client's breathing is out of rhythm with the ventilator. A disconnected ventilator circuit or an ET cuff leak would trigger the low-pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm, not the high-pressure alarm.

If concern exists about fluid accumulation in a client's lungs, what area of the lungs will the nurse focus on during assessment? A.Posterior bronchioles B.Anterior bronchioles C.Bilateral lower lobes D.Left lower lobe

C >>Crackles are secondary to fluid in the alveoli and create a soft, discontinuous popping sound. Because fluid creates these adventitious sounds, the principle of gravity will remind the nurse to focus the assessment on the lower portion of the thorax or the lower lobes of the lungs.

The mother of a hospitalized 2-year-old child with viral laryngotracheobronchitis (croup) asks the nurse why the health care provider did not prescribe antibiotics. Which response should the nurse make? A, "The child may be allergic to antibiotics." B, "The child is too young to receive antibiotics." C, "Antibiotics are not indicated unless a bacterial infection is present." D, "The child still has the maternal antibodies from birth and does not need antibiotics."

C >>Croup is a viral respiratory illness, antibiotics would not be effective. Options A, B, D: Options A, B, D are incorrect and not related to croup.

Your client is scheduled for a bronchoscopy to visualize the larynx, trachea, and bronchi. What precautions would you recommend to the client before the procedure? A.Avoid atropines as they dry the secretions. B.Practice holding the breath for short periods. C.Abstain from food for at least 6 hours before the procedure. D.Avoid sedatives or narcotics as they depress the vagus nerve.

C >>For at least 6 hours before bronchoscopy, the client must abstain from food or drink to decrease the risk of aspiration. Risk is increased because the client receives local anesthesia, which suppresses the reflexes to swallow, cough, and gag. The client receives medications before the procedure. Typically, atropine is given to dry secretions and a sedative or narcotic is given to depress the vagus nerve. The client may need to hold his or her breath for short periods during lung scans and for bronchoscopy.

The nurse is assisting a client with postural drainage. Which of the following demonstrates correct implementation of this technique? A.Perform this measure with the client once a day. B.Administer bronchodilators and mucolytic agents following the sequence. C.Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes. D.Use aerosol sprays to deodorize the client's environment after postural drainage.

C >>Postural drainage is usually performed two to four times daily, before meals (to prevent nausea, vomiting, and aspiration) and at bedtime. Prescribed bronchodilators, water, or saline may be nebulized and inhaled before postural drainage to dilate the bronchioles, reduce bronchospasm, decrease the thickness of mucus and sputum, and combat edema of the bronchial walls. The nurse instructs the client to remain in each position for 10 to 15 minutes and to breathe in slowly through the nose and out slowly through pursed lips to help keep the airways open so that secretions can drain while in each position. If the sputum is foul-smelling, it is important to perform postural drainage in a room away from other patients or family members. (Deodorizers may be used to counteract the odor. Because aerosol sprays can cause bronchospasm and irritation, they should be used sparingly and with caution.)

The nurse has instructed a client on how to perform pursed-lip breathing. The nurse recognizes the purpose of this type of breathing is to accomplish which result? A.Promote the strengthening of the client's diaphragm B.Promote more efficient and controlled ventilation and to decrease the work of breathing C.Improve oxygen transport; induce a slow, deep breathing pattern; and assist the client to control breathing D.Promote the client's ability to take in oxygen

C >>Pursed-lip breathing, which improves oxygen transport, helps induce a slow, deep breathing pattern and assists the client to control breathing, even during periods of stress. This type of breathing helps prevent airway collapse secondary to loss of lung elasticity in emphysema.

The nurse teaches a client with COPD to assess for signs and symptoms of right-sided heart failure. Which of the following signs and symptoms should be included in the teaching plan? A.Clubbing of nail beds. B.Hypertension. C.Peripheral edema. D.Increase appetite.

C >>Right-sided heart failure is a complication of COPD that occurs because of pulmonary hypertension. Signs and symptoms of right-sided heart failure include peripheral edema, jugular venous distention, and weight gain due to increased fluid volume. Clubbing of nail beds is associated with conditions of chronic hypoxemia. Hypertensions is associated with left-sided heart failure. Clients with heart failure have decreased appetites.

The nurse is caring for a client with a lower respiratory tract infection. When planning a focused respiratory assessment, the nurse should know that this type of infection most often causes what? A.Necrosis of the alveoli B.Closed bronchial tree C.Impaired gas exchange D.Collapsed bronchial structures

C >>The lower respiratory tract consists of the lungs, which contain the bronchial and alveolar structures needed for gas exchange. A lower respiratory tract infection does not collapse bronchial structures or close the bronchial tree. An infection does not cause necrosis of lung tissues.

A nurse is teaching a client about using an incentive spirometer. Which statement by the nurse is correct? A."Breathe in and out quickly." B."You need to start using the incentive spirometer 2 days after surgery." C."Before you do the exercise, I'll give you pain medication if you need it." D."Don't use the incentive spirometer more than 5 times every hour."

C >>The nurse should assess the client's pain level before the client does incentive spirometry exercises and administer pain medication as needed. Doing so helps the client take deeper breaths and help prevents atelectasis. The client should breathe in slowly and steadily, and hold his breath for 3 seconds after inhalation. The client should start doing incentive spirometry immediately after surgery and aim to do 10 incentive spirometry breaths every hour.

The nurse is taking a respiratory history for a patient who has come into the clinic with a chronic cough. What information should the nurse obtain from this patient? (Select all that apply.) A.Social support B.Financial ability to pay the bill C.Occupational and environmental influences D.Previous history of lung disease in the patient or family E.Previous history of smoking

C,D,E >>Risk factors associated with respiratory disease include smoking, exposure to allergens and environmental pollutants, and exposure to certain recreational and occupational hazards. Financial ability and social support are not pertinent to a chronic cough.

You are caring for a client admitted with chronic bronchitis. The client is having difficulty breathing, and the family asks you what causes this difficulty. What would be your best response? A."Anytime there is a chronic disease process it is hard for the person to breathe." B."Having a chronic respiratory disease scars the lung and affects the effort it takes to breathe." C."In this particular case your family member is just overly tired and having problems breathing." D."Conditions such as chronic bronchitis cause thickening of the bronchial mucosa so it makes it harder to breathe."

D >>Conditions that may alter bronchial diameter and affect airway resistance include contraction of bronchial smooth muscle (e.g., asthma); thickening of bronchial mucosa (e.g., chronic bronchitis); airway obstruction by mucus, a tumor, or a foreign body; and loss of lung elasticity (e.g., emphysema). Option A is incorrect, not all chronic diseases make it hard to breathe. Option B is incorrect; not all chronic respiratory diseases caused scarring in the lung. Option C is incorrect; this response negates the families question and belittles their concern.

A gerontologic nurse is analyzing the data from a client's focused respiratory assessment. The nurse is aware that the amount of respiratory dead space increases with age. What is the effect of this physiologic change? A.Increased diffusion of gases B.Decreased shunting of blood C.Increased ventilation D.Decreased diffusion capacity for oxygen

D >>The amount of respiratory dead space increases with age. Combined with other changes, this results in a decreased diffusion capacity for oxygen with increasing age, producing lower oxygen levels in the arterial circulation. Decreased shunting and increased ventilation do not occur with age.

A nurse is teaching a client how to perform flow type incentive spirometry prior to his scheduled thoracic surgery. What instruction should the nurse provide to the client? A. "Hold the spirometer at your lips and breathe in and out like you normally would." B."Take a deep breath and then blow short, forceful breaths into the spirometer." C. "When you're ready, blow hard into the spirometer for as long as you can." D."Breathe in deeply through the spirometer, hold your breath briefly, and then exhale."

D >>The client should be taught to lace the mouthpiece of the spirometer firmly in the mouth, breathe air in through the mouth, and hold the breath at the end of inspiration for about 3 seconds. The client should then exhale slowly through the mouthpiece.

A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? A. pH B.Bicarbonate (HCO3-) C.Partial pressure of arterial carbon dioxide (PaCO2) D.Partial pressure of arterial oxygen (PaO2)

D >>The most significant and direct indicator of the effectiveness of oxygen therapy is the PaO2 value. Based on the PaO2 value, the nurse may adjust the type of oxygen delivery (cannula, Venturi mask, or mechanical ventilator), flow rate, and oxygen percentage. The other options reflect the client's ventilation status, not oxygenation. The pH, HCO3-, and PaCO2

, A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the MOST APPROPRIATE nursing action? A, Tell the mother that the child must stay in the tent. B, Place a toy in the tent to make the child feel more comfortable. C, Call the health care provider and obtain a prescription for a mild sedative. D, Let the mother hold the child and direct the cool mist over the child's face.

D >>To decrease the child's anxiety, the mother may hold and accompany the child in the tent. Option A: The child's anxiety may increase and worsen the respiratory distress. Option B: Toys may introduce pathogens that may be harmful to the child. Option C: A mild sedative is unnecessary.

The nurse auscultates lung sounds that are harsh and cracking, sounding like two pieces of leather being rubbed together. The nurse would be correct in documenting this finding as A.pleural friction rub. B.sonorous wheezes. C.crackles. D.sibilant wheezes.

A >>A pleural friction rub is heard secondary to inflammation and loss of lubricating pleural fluid. Crackles are soft, high-pitched, discontinuous popping sounds that occur during inspiration. Sonorous wheezes are deep, low-pitched rumbling sounds heard primarily during expiration. Sibilant wheezes are continuous, musical, high-pitched, whistlelike sounds heard during inspiration and expiration.

A client who must begin oxygen therapy asks the nurse why this treatment is necessary? What would the nurse identify as the goals of oxygen therapy? Select all that apply. A.To reduce stress on the myocardium B.To provide visual feedback to encourage the client to inhale slowly and deeply C.To clear respiratory secretions D.To decrease the work of breathing E.To provide adequate transport of oxygen in the blood

A,D,E >>Oxygen therapy is designed to provide adequate transport of oxygen in the blood while decreasing the work of breathing and reducing stress on the myocardium. Incentive spirometry is a respiratory modality that provides visual feedback to encourage the client to inhale slowly and deeply to maximize lung inflation and prevent or reduce atelectasis. A mini-nebulizer is used to help clear secretions.

A client receives a prescription for aerosol therapy to treat bronchitis. . Which statement by the client indicates an accurate understanding of the purpose of aerosol therapy? 1. "Aerosol therapy relieves tissue irritation." 2. "This therapy kills infectious organisms." 3. "Aerosolization dries respiratory passages." 4. "Aerosol therapy helps to slow breathing."

1 >>. Aerosol therapy involves depositing small droplets of moisture onto respiratory tissue. The warmed, moist air soothes the respiratory passages, relieves tissue irritation, and liquefies secretions produced as a result of the inflammation. Other benefits are obtained by adding medications to the vaporized water. Individuals with acute bronchitis are generally bothered initially by a nonproductive cough aggravated by dry air. Oral or parenteral antibiotic therapy, not aerosol therapy, is used to kill infectious organisms. Respiratory mucosa is moist. The respiratory rate is lowered as ventilation is improved. However, this is a secondary benefit of aerosol therapy and is not its primary purpose.

The parent of a child with croup tells the nurse that her other child just had croup and it cleared up in a couple of days without intervention. She asks the nurse why this child is exhibiting worse symptoms and needs to be hospitalized. Which is the nurse's best response? 1. "Some children just react differently to viruses. It is best to treat each child as an individual." 2. "Younger children have wider airways that make it easier for bacteria to enter and colonize." 3. "Younger children have short and wide eustachian tubes, making them more susceptible to respiratory infections." 4. "Children younger than 3 years usually exhibit worse symptoms because their immune systems are not as developed."

4

A nurse provides care for a client receiving oxygen from a nonrebreather mask. Which nursing intervention has the highest priority? A.Assessing the client's respiratory status, orientation, and skin color B.Changing the mask and tubing daily C.Applying an oil-based lubricant to the client's mouth and nose D.Posting a "No smoking" sign over the client's bed

A >>A nonrebreather mask can deliver high concentrations of oxygen to the client in acute respiratory distress. Assessment of a client's status is a priority for determining the effectiveness of therapy. There is no need for the nurse to post a "No smoking" sign over the client's bed. Smoking is a fire hazard and is prohibited in hospitals regardless of whether the client is receiving oxygen from a nonrebreather mask. Oil-based lubricants can cause pneumonia by promoting bacteria growth. Equipment should be changed daily, but this is a lower priority than assessing respiratory status, orientation, and skin color.

The nurse auscultates the lung sounds of a client during a routine assessment. The sounds produced are harsh and cracking, sounding like two pieces of leather being rubbed together. The nurse would be correct in documenting this finding as A.Pleural friction rub. B.sonorous wheezes. C.crackles. D.sibilant wheezes.

A >>A pleural friction rub is heard secondary to inflammation and loss of lubricating pleural fluid. Crackles are soft, high-pitched, discontinuous popping sounds that occur during inspiration. Sonorous wheezes are deep, low-pitched rumbling sounds heard primarily during expiration. Sibilant wheezes are continuous, musical, high-pitched, whistlelike sounds heard during inspiration and expiration.

A nurse enters a client's room and observes a container with sputum. Upon questioning about the specimen, which of the following items of information from the client would necessitate the nurse to obtain a new specimen? A."I coughed that up about 8 hours ago." B."The specimen is from a deep cough." C."The lid is secured with tape." D."The container used is sterile.

A >>A sputum specimen is obtained for analysis to identify pathogenic organisms. Expectoration is the usual method for collecting a sputum specimen. After a few deep breaths, the client coughs, using the diaphragm, and expectorates into a sterile container. The specimen is delivered to the laboratory within 2 hours. Allowing the specimen to stand for several hours in a warm room results in overgrowth of organisms and may make it difficult to identify the organisms.

A nurse assesses a client's respiratory status. Which observation indicates that the client is having difficulty breathing? A.Diaphragmatic breathing B.Use of accessory muscles C.Controlled breathing D.Pursed-lip breathing

B >>The use of accessory muscles for respiration indicates the client is having difficulty breathing. Diaphragmatic and pursed-lip breathing are two controlled breathing techniques that help the client conserve energy.

The nurse is teaching the client in respiratory distress ways to prolong exhalation to improve respiratory status. The nurse tells the client to A.Sit in an upright position only. B.Purse the lips when exhaling air from the lungs. C.Hold the breath for 5 seconds and then exhale. D.Initially inhale through the mouth.

B >>To prolong exhalation, the client may perform breathing while sitting in a chair or walking. The client is to inhale through the nose and then exhale against pursed lips. There is no holding the breath.

While auscultating the lungs of a client with asthma, the nurse hears a continuous, high-pitched whistling sound on expiration. The nurse will document this sound as which of the following? A.Rhonchi B.Wheezes C.Crackles D.Pleural friction rub

B >>Wheezes, usually heard on expiration, are continuous, musical, high pitched, and whistle-like sounds caused by air passing through narrowed airways. Often, wheezes are associated with asthma.

An older client is receiving postural drainage treatments but is unable to expel the secretions. The client is confused, and having difficulty following instructions. The best response by the nurse would be to: A. Frequently change the patient's position B. Ambulate the patient C. Suction out the secretions. D. Have the patient drink water

C >>Postural drainage loosens secretions, which patients usually cough out when loosened. Since the client is confused, and cannot follow instructions, the nurse must suction the secretions to enhance effective breathing.

The ED nurse is assessing the respiratory function of a teenage girl who presented with acute shortness of breath. Auscultation reveals continuous wheezes during inspiration and expiration. This finding is most suggestive of what? A.Pneumonia B.Pleurisy C.Asthma D.Emphysema

C >>Sibilant wheezes are commonly associated with asthma. They do not normally accompany pleurisy, emphysema, or pneumonia.

The home care nurse is making an initial visit to a client just discharged after admission for severe exacerbation of chronic obstructive pulmonary disease (COPD). The nurse observes wall-to-wall stacks of old newspapers and magazines in every room, with pathways that just allow passage from one room to another. What is the priority nursing action? A.Call the mobile community mental health crisis unit. B.Contact a service to remove the newspapers and magazines. C.Reconcile the client's discharge medications. D.Teach the safe use of oxygen.

D

When instructing clients on how to decrease the risk of COPD, the nurse should emphasize which of the following? A.Participate regularly in aerobic exercises. B.Maintain a high-protein diet. C.Avoid exposure to people with known respiratory infections. D.Abstain from cigarette smoking.

D >>Cigarette smoking is the primary cause of COPD. Other risk factors include exposure to environmental pollutants and chronic asthma. Participating in an aerobic exercise program, although beneficial, will not decrease the risk of COPD. Insufficient protein intake and exposure to people with respiratory infections do not increase the risk of COPD.

After suctioning a tracheostomy tube, the nurse assesses the client to determine the effectiveness of the suctioning. Which findings indicate that the airway is now patent? A.A respiratory rate of 28 breaths/minute with accessory muscle use B.Restlessness, pallor, increased pulse and respiratory rates, and bubbling breath sounds C.Increased pulse rate, rapid respirations, and cyanosis of the skin and nail beds D. Effective breathing at a rate of 16 breaths/minute through the established airway

D >>Proper suctioning should produce a patent airway, as demonstrated by effective breathing through the airway at a normal respiratory rate of 12 to 20 breaths/minute. The other options suggest ineffective suctioning. A respiratory rate of 28 breaths/minute and accessory muscle use may indicate mild respiratory distress. Increased pulse rate, rapid respirations, and cyanosis are signs of hypoxia. Restlessness, pallor, increased pulse and respiratory rates, and bubbling breath sounds indicate respiratory secretion accumulation.

The nurse is caring for a client who is experiencing mild shortness of breath during the immediate postoperative period, with oxygen saturation readings between 89% and 91%. What method of oxygen delivery is most appropriate for the client's needs?

NASAL CANOLA >>A nasal cannula is used when the client requires a low to medium concentration of oxygen for which precise accuracy is not essential. The Venturi mask is used primarily for clients with COPD because it can accurately provide an appropriate level of supplemental oxygen, thus avoiding the risk of suppressing the hypoxic drive. The client's respiratory status does not require a partial- or non-rebreathing mask.

The nurse is caring for an adolescent client injured in a snowboarding accident. The client has a head injury, a fractured right rib, and various abrasions and contusions. The client has a blood pressure of 142/88 mm Hg, pulse of 102 beats/minute, and respirations of 26 breaths/minute. Which laboratory test best provides data on a potential impairment in ventilation? A.Serum alkaline phosphate B.Blood gases C.Blood chemistry D.Complete blood count

B >>Blood gases report the partial pressure of oxygen, which is dissolved in the blood. Normal readings are 80 to 100 mm Hg. By documenting oxygen levels in the blood, the nurse recognizes the current ventilation. The complete blood count provides information regarding number of blood cells, which can relate to the disease processes such as anemia and infection. The blood chemistry provides information on liver/renal function and electrolytes within the system. Serum alkaline phosphate is a laboratory test used to help detect liver disease and bone disorders.

Which is a late sign of hypoxia? A.Cyanosis B.Restlessness C.Somnolence D.Hypotension

A >>Cyanosis is a late sign of hypoxia. Hypoxia may cause restlessness and an initial rise in blood pressure that is followed by hypotension and somnolence.

A client with a respiratory condition is receiving oxygen therapy. While assessing the client's PaO2, the nurse knows that the therapy has been effective based on which of the following readings? A.84 mm Hg B.45 mm Hg C.58 mm Hg D.120 mm Hg

A >>In general, clients with respiratory conditions are given oxygen therapy only to increase the arterial oxygen pressure (PaO2) back to the client's normal baseline, which may vary from 60 to 95 mm Hg.

A nonverbal client has just finished undergoing a bronchoscopy procedure and writes that he want to eat lunch now. Which intervention is necessary for the nurse to complete at this time? A.Call dietary services to send the client's tray now. B.Assess for a cough reflex. C.Perform mouth care. D.Assess for bowel sounds.

B >>Before a bronchoscopy procedure, the nurse will administer preoperative medications, usually atropine and a sedative. These are prescribed to inhibit vagal stimulation, suppress the cough reflex, sedate the client, and relieve anxiety. After the procedure, it is important that the client take nothing by moth until the cough reflex returns. This is because the preoperative medication impairs the protective laryngeal reflex and swallowing for several hours. Once the client demonstrates a cough reflex or the nurse positively assesses one, then the nurse may offer ice chips and fluids.

The nurse is caring for a client who has been scheduled for a bronchoscopy. How should the nurse prepare the client for this procedure? A.Administer a bolus of IV fluids. B.Withhold food and fluids for several hours before the test. C.Administer nebulized bronchodilators every 2 hours until the test. D.Arrange for the insertion of a peripherally inserted central catheter.

B >>Food and fluids are withheld for 4 to 8 hours before the test to reduce the risk of aspiration when the cough reflex is blocked by anesthesia. IV fluids, bronchodilators, and a central line are unnecessary.

A client's plan of care specifies postural drainage. What action should the nurse perform when providing this noninvasive therapy? A.Apply percussion firmly to bare skin to facilitate drainage. B.Assist the client into a position that will allow gravity to move secretions. C.Perform the procedure immediately following the client's meals. D.Administer the treatment with the client in a high Fowler's or semi-Fowler's position.

B >>Postural drainage is usually performed two to four times per day. The client uses gravity to facilitate postural draining. The skin should be covered with a cloth or a towel during percussion to protect the skin. Postural drainage is not given in an upright position or directly following a meal.

The instructor of the pre-nursing physiology class is explaining respiration to the class. What does the instructor explain is the main function of respiration? A.To move O2 out of the atmospheric air and into the retained air B.To exchange oxygen and CO2 between the atmospheric air and the blood and between the blood and the cells C.To move CO2 out of the atmospheric air and into the expired air D.To exchange atmospheric air between the blood and the cells

B >>The main function of the respiratory system is to exchange oxygen and CO2 between the atmospheric air and the blood and between the blood and the cells. This process is called respiration. The purpose of respiration is not to move any gas into the expired air; retained air is simply a distractor for this question; and atmospheric air is not exchanged between the blood and the cells.

A client with newly diagnosed emphysema is admitted to the medical-surgical unit for evaluation. Which does the nurse recognize as a deformity of the chest wall that occurs as a result of overinflation of the lungs in this client population? A.Funnel chest B.Kyphoscoliosis C.Barrel chest D.Pigeon chest

C >>A barrel chest occurs as a result of over inflation of the lungs. The anteroposterior diameter of the thorax increases. Barrel chest occurs with aging and is a hallmark sign of emphysema and chronic obstructive pulmonary disease (COPD). In a client with emphysema, the ribs are more widely spaced and the intercostal spaces tend to bulge upon expiration. Funnel chest occurs when a depression occurs in the lower portion of the sternum, which may result in murmurs. Pigeon chest occurs as a result of displacement of the sternum, resulting in an increase in the anteroposterior diameter. Kyphoscoliosis is characterized by elevation of the scapula and a corresponding S-shaped spine. This deformity limits lung expansion within the thorax.

The home care nurse is planning to begin breathing retraining exercises with a client newly admitted to the home health service. The home care nurse knows that breathing retraining is especially indicated if the client has what diagnosis? A.Pneumonia B.Asthma C.COPD D.Lung cancer

C >>Breathing retraining is especially indicated in clients with COPD and dyspnea. Breathing retraining may be indicated in clients with other lung pathologies, but not to the extent indicated in clients with COPD.

Which term is used to describe the inability to breathe easily except in an upright position? A.Hypoxemia B.Dyspnea C.Orthopnea D.Hemoptysi

C >>Clients with orthopnea are placed in a high Fowler's position to facilitate breathing. Dyspnea refers to labored breathing or shortness of breath. Hemoptysis refers to expectoration of blood from the respiratory tract. Hypoxemia refers to low oxygen levels in the blood.

A client has just undergone bronchoscopy. Which nursing assessment is most important at this time? A.Intellectual ability B.Memory C.Level of consciousness (LOC) D.Personality changes

C >>Following bronchoscopy, LOC is the most important assessment because changes in the client's LOC may alert the nurse to serious neurologic problems. Memory, personality changes, and intellectual ability are important but don't take precedence at this time.

The nurse is caring for a client who has returned to the unit following a bronchoscopy. The client is asking for something to drink. Which criterion will determine when the nurse should allow the client to drink fluids? A.Absence of nausea B.Ability to demonstrate deep inspiration C.Oxygen saturation of ≥92% D.Presence of a cough and gag reflex

D >>After the procedure, it is important that the client takes nothing by mouth until the cough reflex returns because the preoperative sedation and local anesthesia impair the protective laryngeal reflex and swallowing for several hours. Deep inspiration, adequate oxygen saturation levels, and absence of nausea do not indicate that oral intake is safe from the risk of aspiration.

Which is the most reliable and accurate method for delivering precise concentrations of oxygen through noninvasive means? A.Venturi mask B.Partial-rebreathing mask C.Nasal cannula D.T-piece

A >>The Venturi mask is the most reliable and accurate method for delivering a precise concentration of oxygen through noninvasive means. The mask is constructed in a way that allows a constant flow of room air blended with a fixed flow of oxygen. Nasal cannula, T-piece, and partial-rebreathing masks are not the most reliable and accurate methods of oxygen administration.

A client with a severe exacerbation of COPD requires reliable and precise oxygen delivery. Which mask will the nurse expect the health care provider to prescribe? A.Tracheostomy collar B.Venturi mask C.Face tent D.Non-rebreather air mask

B >>.The Venturi mask provides the most accurate method of oxygen delivery. Other methods of oxygen delivery include the aerosol mask, tracheostomy collar, and face tents, but these do not match the precision of a Venturi mask.

A 5-year - old brought to the ER with a temperature of 99.5F (37.5C), a barky cough, stridor, and hoarseness. Which of the following interventions should the nurse prepare for? A. Immediate IV placement. B. Respiratory treatment of racemic epinephrine. C. A tracheostomy set at the bedside. D. Informing the child's parents about a tonsillectomy.

B >>The child has stridor, indicating airway edema, which can be relieved by aerosolized racemic epinephrine.

The nurse reviews discharge instructions with a client who has advanced chronic obstructive pulmonary disease. Which client statement indicates appropriate understanding? Select all that apply. A."I need to take iron to prevent anemia." B."I should report an increase in sputum." C."I will eat a low-calorie diet." D."I will get a pneumoccocal vaccine." E."I will use albuterol if I am short of breath."

B,D,E

A 58 year old client with a 40-year history if 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 if the following conditons? A.Asthma B.Emphysema C.Chronic bronchitis D.Adult respiratory distress syndrome

C >>Because of the client's smoking history and his symptoms he most likely has chronic bronchitis. Clients with asthma and emphysema tend to not have a chronic cough or peripheral edema.

When performing endotracheal suctioning, the nurse applies suctioning while withdrawing and gently rotating the catheter 360 degrees for how long? A.30 to 35 seconds B.20 to 25 seconds C. 0 to 5 seconds D.10 to 15 second

D >>In general, the nurse should apply suction no longer than 10 to 15 seconds. Applying suction for 20-25 or 30-35 seconds is hazardous and may result in the development of hypoxia, which can lead to dysrhythmias and, ultimately, cardiac arrest. Applying suction for 0-5 seconds would provide too little time for effective suctioning of secretions.

Which of the following is a noninvasive method of continuously monitoring the oxygen saturation of hemoglobin (SaO2)? A.Arterial blood gas analysis B.Pulmonary function testing C.Sputum studies D.Pulse oximetry

D >>Pulse oximetry is a noninvasive method of continuously monitoring SaO2. Measurements of blood pH of arterial oxygen and carbon dioxide tensions are obtained when managing patients with respiratory problems and adjusting oxygen therapy as needed. This is an invasive procedure. Pulmonary function testing assesses respiratory function and determines the extent of dysfunction. Sputum studies are done to identify if any pathogenic organisms or malignant cells are in the sputum.