Respiratory

A client had thoracic surgery. The nurse should monitor for what clinical manifestations that may indicate acute pulmonary edema? Select all that apply. 1 . Crackles 2 . Cyanosis 3 . Dyspnea 4 . Bradypnea 5 . Frothy sputum

1 . Crackles 2 . Cyanosis 3 . Dyspnea 5 . Frothy sputum

A nurse is preparing to insert a nasogastric tube. During insertion, which response indicates that the client is experiencing difficulty? 1. Gagging 2. Discomfort 3. Flushed face 4. Inability to speak

4. Inability to speak

A nurse is caring for several postoperative clients. For what clinical manifestations of a pulmonary embolus should the nurse monitor these clients? (Select all that apply.) 1. Apathy 2. Dyspnea 3. Hemoptysis 4. Bronchial wheezes 5. Feeling of impending doom

2. Dyspnea 3. Hemoptysis 5. Feeling of impending doom

A client with laryngeal cancer has a partial laryngectomy and tracheostomy. To best facilitate communication postoperatively, the nurse should: 1. Provide a means for the client to write. 2. Allow the client more time for articulation. 3. Use visual clues, such as gestures and objects. 4. Face the client and speak slowly and distinctly

1. Provide a means for the client to write.

A client is hospitalized with a diagnosis of emphysema. The nurse provides teaching and should begin with which aspect of care? 1. The disease process and breathing exercises 2. How to control or prevent respiratory infections 3. Using aerosol therapy, especially nebulizers 4. Priorities in carrying out everyday activities

1. The disease process and breathing exercises

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

2. Cystic fibrosis

In addition to Pneumocystis jiroveci, a client with acquired immunodeficiency syndrome (AIDS) also has an ulcer 4 cm in diameter on the leg. Considering the client's total health status, the most critical concern is: 1. Skin integrity 2. Gas exchange 3. Social isolation 4. Nutritional status

2. Gas exchange *P. jiroveci , now believed to be a fungus, causes pneumonia in immunosuppressed hosts; it can cause death in 60% of the clients. The client's respiratory status is the priority.

A client develops increased respiratory secretions because of radiation therapy to the lung, and the health care provider prescribes postural drainage. What client assessment leads the nurse to determine that the postural drainage is effective? 1. Is free of crackles 2. Has a productive cough 3. Is able to expectorate saliva 4. Can breathe deeply through the nose

2. Has a productive cough

When assessing the breath sounds of a client with chronic obstructive pulmonary disease (COPD), the nurse hears coarse rhonchi. They are described best as: 1.Snorting sounds during the inspiratory phase 2. Moist rumbling sounds that clear after coughing 3. Musical sounds more pronounced during expiration 4. Crackling inspiratory sounds unchanged with coughing

2. Moist rumbling sounds that clear after coughing

A client develops subcutaneous emphysema after a chest injury with suspected pneumothorax. What assessment by the nurse is the best method for detecting this complication? 1. Percussing the neck and chest. 2. Palpating the neck or face. 3. Auscultating for abnormal breath sounds. 4. Observing for asymmetry of chest movement.

2. Palpating the neck or face. *Subcutaneous emphysema refers to the presence of air in the tissue that surrounds an opening in the normally closed respiratory tract; the tissue appears puffy, and a crackling sensation is detected when trapped air is compressed between the nurse's palpating fingertips and the client's tissue.

The nurse who is teaching the client with chronic obstructive pulmonary disease (COPD) to use pursed-lip breathing (PLB) is aware that this is beneficial for the client through which mechanism? 1. Increased respiratory rate to improve arterial oxygenation 2. Prolonged exhalation to decrease air trapping 3. Shortened inhalation to reduce bronchial swelling 4. Use of the diaphragm to increase the amount of inspired air

2. Prolonged exhalation to decrease air trapping

A nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD) who develops a pneumothorax and has a chest tube inserted. What is the primary purpose of the chest tube? 1. Lessens the client's chest discomfort 2. Restores negative pressure in the pleural space 3. Drains accumulated fluid from the pleural cavity 4. Prevents subcutaneous emphysema in the chest wall

2. Restores negative pressure in the pleural space

A client with emphysema is admitted to the hospital with pneumonia. On the third hospital day, the client complains of a sharp pain on the right side of the chest. The nurse suspects a pneumothorax. What breath sound is most likely to be present when the nurse assesses the client's right side? 1. Crackling 2. Wheezing 3. Decreased sounds 4. Adventitious sounds

3. Decreased sounds

A health care provider prescribes oxygen given in low concentration rather than in high concentration to a client with chronic obstructive pulmonary disease (COPD). What does this prevent? 1. Decrease in red cell formation 2. Rupture of emphysematous bullae 3. Depression of the respiratory center 4. Excessive drying of the respiratory mucosa

3. Depression of the respiratory center

Polycythemia frequently is associated with chronic obstructive pulmonary disease (COPD). When assessing for this complication, the nurse should monitor for: 1. Pallor and cyanosis 2. Dyspnea on exertion 3. Elevated hemoglobin 4. Decreased hematocrit

3. Elevated hemoglobin

What response provides evidence that a client with chronic obstructive pulmonary disease (COPD) understands the nurse's instructions about an appropriate breathing technique? 1. Inhales through the mouth. 2. Increases the respiratory rate. 3. Holds each breath for a second at the end of inspiration. 4. Progressively increases the length of the inspiratory phase.

3. Holds each breath for a second at the end of inspiration. *Holding each breath for a second at the end of inspiration allows added time for gaseous exchange at alveolar capillary beds.

A client is admitted to the hospital for a surgical resection of the lower left lobe of the lung. After surgery the client has a chest tube to a closed-chest drainage system. What should the nurse do to determine if the chest tube is patent? 1. Milk the chest tube toward the drainage unit 2. Check the amount of bubbling in the suction control chamber 3. Observe for fluctuations of the fluid in the water-seal chamber 4. Assess for extent of chest expansion in relation to breath sounds

3. Observe for fluctuations of the fluid in the water-seal chamber *Fluctuations of the fluid in the water-seal chamber indicate effective communication between the pleural cavity and the drainage system.

What data about the fluid in the water-seal chamber of a closed chest drainage system provide support for the nurse's conclusion that the system is functioning correctly? 1. Contains many small air bubbles. 2. Bubbles vigorously on inspiration. 3. Rises with inspiration and falls with expiration. 4. Remains at a consistent level during the respiratory cycle

3. Rises with inspiration and falls with expiration. *During inspiration, negative pressure in the pleural space increases, causing fluid to rise in the chamber; during expiration, negative pressure in the pleural space decreases, causing fluid to drop in the chamber.

A client, complaining of fatigue, is admitted to the hospital with a diagnosis of chronic obstructive pulmonary disease (COPD). To prevent fatigue, the nurse should: 1. Provide small, frequent meals 2. Encourage pursed-lip breathing 3. Schedule nursing activities to allow for rest 4. Encourage bed rest until energy level improves

3. Schedule nursing activities to allow for rest

When providing discharge teaching for a young female client who had a pneumothorax, it is important that the nurse include the signs and symptoms of a recurring pneumothorax. What is the most important symptom that the nurse should teach the client to report to the healthcare provider? 1. Substernal chest pain 2. Episodes of palpitation 3. Severe shortness of breath 4. Dizziness when standing up

3. Severe shortness of breath

The nurse is reviewing the client's health history. With which diagnosis is a client most likely to exhibit hemoptysis? 1. Anemia 2. Pneumonia 3. Tuberculosis 4. Leukocytosi

3. Tuberculosis *Hemoptysis is expectoration of blood-stained sputum derived from the lungs, bronchi, or trachea; this is a clinical manifestation of tissue erosion caused by tuberculosis

A client complains of left-sided chest pain after the client finished playing racquetball. The client is hospitalized and diagnosed with left pneumothorax. When assessing the client's left chest area, the nurse expects to identify: 1. Dull sound on percussion 2. Vocal fremitus on palpation 3. Rales with rhonchi on auscultation 4. Absence of breath sounds on auscultation

4. Absence of breath sounds on auscultation

A client is admitted to the hospital for medical treatment of bronchopneumonia. What test result should the nurse examine to help determine the effectiveness of the client's therapy? 1. Bronchoscopy 2. Pulse oximetry 3. Pulmonary function studies 4. Culture and sensitivity tests of sputum

4. Culture and sensitivity tests of sputum *The aim of therapy is to eliminate the causative agent, which is determined from culture and sensitivity tests of sputum.

What breathing exercises should the nurse teach a client with the diagnosis of emphysema? 1. An inhalation that is prolonged to promote gas exchange. 2. Abdominal exercises to limit the use of accessory muscles. 3. Sit-ups to help strengthen the accessory muscles of respiration. 4. Diaphragmatic exercises to improve contraction of the diaphragm

4. Diaphragmatic exercises to improve contraction of the diaphragm

A client with bronchial pneumonia is having difficulty maintaining airway clearance because of retained thick secretions. To decrease the amount of secretions retained, the nurse plans to: 1. Administer continuous oxygen 2. Instruct the client to gargle deep in the throat using warmed normal saline 3. Place the client in a high Fowler position 4. Increase fluid intake to at least 2 L a day

4. Increase fluid intake to at least 2 L a day *Increased fluid intake helps to liquefy respiratory secretions, which promotes expectoration.

A client with chronic obstructive pulmonary disease has increased hemoglobin and hematocrit levels. The nurse concludes that the altered blood levels are caused by: 1. Increased leukocyte development in response to infection 2. Decreased extracellular fluid volume secondary to infection 3. Decreased red blood cell proliferation because of hypercapnia 4. Increased erythrocyte production as a result of chronic hypoxia

4. Increased erythrocyte production as a result of chronic hypoxia *Hypoxia stimulates production of large quantities of erythrocytes in an attempt to compensate for the lack of oxygen. White blood cell production increases with infection; infection is not the cause of the increase in the hemoglobin and hematocrit.

The nurse provides instructions to a client who will be using an incentive spirometer postoperatively. During the client's return demonstration, the nurse concludes that the teaching has been effective when the client: 1. Coughs twice before inhaling deeply through the mouthpiece 2. Uses the incentive spirometer for 10 consecutive breaths an hour 3. Inhales deeply, seals the lips around the mouthpiece, and then exhales 4. Inhales deeply through the mouthpiece, holds the breath for two seconds, and then exhales

4. Inhales deeply through the mouthpiece, holds the breath for two seconds, and then exhales

The nurse reinforces instructions about how to use a nebulizer to a client with chronic obstructive pulmonary disease (COPD). The nurse concludes that additional teaching is needed when the client: 1. Places the tip of the mouthpiece an inch beyond the lips 2. Holds the inspired breath for at least three seconds 3. Exhales slowly through the mouth with lips pursed slightly 4. Inhales with the lips tightly sealed around the mouthpiece of the nebulizer

4. Inhales with the lips tightly sealed around the mouthpiece of the nebulizer

A nurse is teaching a preoperative client about postoperative breathing exercises. What information should the nurse include? (Select all that apply.) 1. Take short, frequent breaths 2 Exhale with the mouth open wide 3. Perform the exercises twice a day 4. Place a hand on the abdomen while feeling it rise 5. Hold the breath for several seconds at the height of inspiration

4. Place a hand on the abdomen while feeling it rise 5. Hold the breath for several seconds at the height of inspiration

A nurse is teaching a preoperative client about postoperative breathing exercises. What information should the nurse include? (Select all that apply.) 1. Take short, frequent breaths 2. Exhale with the mouth open wide 3. Perform the exercises twice a day 4. Place a hand on the abdomen while feeling it rise 5. Hold the breath for several seconds at the height of inspiration

4. Place a hand on the abdomen while feeling it rise 5. Hold the breath for several seconds at the height of inspiration

A client with a spontaneous pneumothorax asks, "Why did they put this tube into my chest?" The nurse explains that the purpose of the chest tube is to: 1. Check for bleeding in the lung 2. Monitor the function of the lung 3. Drain fluid from the pleural space 4. Remove air from the pleural space

4. Remove air from the pleural space

The nurse is caring for a client who recently returned from another country who exhibits signs and symptoms suspicious of severe acute respiratory syndrome (SARS). Which clinical manifestations support this diagnosis? (Select all that apply.) 1.Dry cough 2. Chest pain 3. Hemoptysis 4. Shortness of breath 5 . Fever greater than 100.4° F

1.Dry cough 4. Shortness of breath 5 . Fever greater than 100.4° F

What nursing action will limit hypoxia when suctioning a client's airway? 1. Apply suction only after catheter is inserted. 2. Limit suctioning with catheter to half a minute. 3. Lubricate the catheter with saline before insertion. 4. Use a sterile suction catheter for each suctioning episode.

1. Apply suction only after catheter is inserted.

A client has an endotracheal tube and is receiving mechanical ventilation. Periodic suctioning is necessary and the nurse follows a specific protocol when performing this procedure. Select in order of priority the nursing actions that should be taken when suctioning. 1. Assess client's vital signs and lung sounds 2. Insert the catheter without applying suction 3. Rotate the catheter while suction is applied 4. Administer oxygen via a ventilation bag

1. Assess client's vital signs and lung sounds, 4. Administer oxygen via a ventilation bag , 2. Insert the catheter without applying suction, 3. Rotate the catheter while suction is applied

A client enters the emergency department reporting shortness of breath and epigastric distress. What should be the triage nurse's first intervention 1. Assess vital signs 2. Insert a saline lock 3. Place client on oxygen 4. Draw blood for troponins

1. Assess vital signs

A client has chronic asthma. For which complication should the nurse monitor this client? 1. Atelectasis 2. Pneumothorax 3. Pulmonary edema 4. Respiratory alkalosis

1. Atelectasis

A client is admitted to the hospital with a tentative diagnosis of pneumonia. The client has a high fever and is short of breath. Bed rest, oxygen via nasal cannula, an intravenous antibiotic, and blood and sputum specimens for culture and sensitivity (C&S) are prescribed. Place these interventions in the order in which they should be implemented. 1. Bed rest 2. Administration of an antibiotic 3. Oxygen via nasal cannula 4. Specimens for C&S

1. Bed rest 3. Oxygen via nasal cannula 4. Specimens for C&S 2. Administration of an antibiotic

A client diagnosed with asthma has received a prescription for an inhaler. The nurse teaches the client how to determine when the inhaler is empty, instructing the client to: 1. Count the number of doses taken 2. Taste the medication when sprayed into the air 3. Shake the canister 4. Place the canister in water to see if it floats

1. Count the number of doses taken

The primary responsibility of a nurse when caring for a client with a chest tube attached to a three-chamber underwater-seal drainage system is to: 1. Ensure maintenance of the closed system 2. Maintain mechanical suction to the system 3. Encourage the client to deep breathe and cough 4. Keep the client in the dorsal recumbent position

1. Ensure maintenance of the closed system

The nurse is caring for a client two days after the client was admitted with burn injury. When performing the respiratory assessment, the nurse observes for sputum that is: 1. Sooty 2. Frothy 3. Yellow 4. Tenacious

1. Sooty

The nurse is caring for a 75-year-old client that had radical head and neck surgery. Thirty minutes after awakening from anesthesia, the client becomes agitated, disoriented, and confused. The nurse should: 1. Notify the health care provider immediately of the findings 2. Administer the prescribed oxygen 3. Record the observations and continue to observe the client 4. Administer the prescribed antianxiety medication

2. Administer the prescribed oxygen

A client is diagnosed with emphysema. For what long-term problem should the nurse monitor this client? 1. Localized tissue necrosis 2. Carbon dioxide retention 3. Increased respiratory rate 4. Saturated hemoglobin molecules

2. Carbon dioxide retention

After thoracic surgery a client has a chest tube connected to a water-seal drainage system that is attached to suction. When excessive bubbling is observed in the water-seal chamber, the nurse should: 1. Strip the chest tube catheter 2. Check the system for air leaks 3. Decrease the amount of suction pressure 4. Recognize that the system is functioning correctly

2. Check the system for air leaks

A client admitted to the hospital with a diagnosis of chronic obstructive pulmonary disease (COPD) has received a prescription for a medication that is delivered via a nebulizer. When teaching about use of the nebulizer, the nurse should teach the client to: 1. Hold the breath while spraying the medication into the mouth 2. Position the lips loosely around the mouthpiece and take rapid, shallow breaths 3. Seal the lips around the mouthpiece and breathe in and out taking slow, deep breaths 4. Inhale the medication from the nebulizer, remove the mouthpiece from the mouth, and then exhale

3. Seal the lips around the mouthpiece and breathe in and out taking slow, deep breaths *Sealing the lips around the mouthpiece ensures that medication is delivered on inspiration; slow, deep breaths promote better deposition and efficacy of medication deep into the lungs.

A client is admitted to the hospital with a tentative diagnosis of pneumonia. The client has a high fever and is short of breath. Bed rest, oxygen via nasal cannula, an intravenous antibiotic, and blood and sputum specimens for culture and sensitivity (C&S) are prescribed. Place these interventions in the order in which they should be implemented. Incorrect 1. Specimens for C&S 2. Oxygen via nasal cannula 3. Administration of an antibiotic 4. Bed rest

4. Bed rest 2. Oxygen via nasal cannula 1. Specimens for C&S 3. Administration of an antibiotic

A nurse is caring for clients with various health problems. These problems include scarlet fever, otitis media, bacterial endocarditis, rheumatic fever, and glomerulonephritis. What common factor linking these diseases should the nurse consider? 1. Are self-limiting infections caused by spirilla 2. Can be controlled through childhood vaccination 3. Are caused by parasitic bacteria that normally live outside the body 4. Result from streptococcal infections that enter via the upper respiratory tract

4. Result from streptococcal infections that enter via the upper respiratory tract

A client has a chest tube inserted to treat a right hemopneumothorax. In which position should the nurse place the client to facilitate chest drainage? 1. Supine 2. Left Sims 3. Immobilized 4. Right side-lying

4. Right side-lying

A client with emphysema has a history of smoking two packs of cigarettes a day. What is the best approach for the nurse to help the client stop smoking? 1. Teach pursed-lip breathing 2. Encourage the client to reduce emotional stress 3. Obtain a referral to a smoking cessation program in the community 4. Suggest that the client limit smoking to one pack of cigarettes a day

4. Suggest that the client limit smoking to one pack of cigarettes a day

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

4. Tachycardia *The heart rate increases in an attempt to compensate for the lack of oxygen to body cells.

After the removal of a cast from a fractured arm, an 82-year-old client is to receive physical therapy. In an older adult, mild exercise is expected to cause respirations to: 1. Increase to 24 breaths per minute 2. Become progressively more difficult 3. Decrease in rate as their depth increases 4. Become irregular but remain within normal rates

1. Increase to 24 breaths per minute

A client is admitted to the emergency department with a stab wound of the left thorax. The nurse should position the client: 1. On the left side with the head of the bed elevated 2. In the Trendelenburg position with knees gatched 3. In the high-Fowler position with the left side supported 4. On the right side flat in bed with a pillow supporting the left arm

1. On the left side with the head of the bed elevated

A client with terminal cancer signs a do-not-resuscitate (DNR) order upon admission to the hospital. When the client goes into respiratory arrest a week later, the client is not resuscitated. Which factor does the nurse determine is most relevant to the legal aspects of a DNR order? 1. Policies of the agency establish the status of DNR orders 2. Age is an important factor in the decision not to resuscitate 3. Decisions regarding resuscitation reside with the client's primary health care provider 4. Once a DNR order is signed, it remains in force for the entire hospitalization

1. Policies of the agency establish the status of DNR orders

A client who is a pipe smoker is diagnosed with cancer of the tongue. A hemiglossectomy and right radical neck dissection are performed. To ensure airway patency during the first hours after surgery, the nurse should: 1. Suction as needed 2. Apply an ice collar 3. Maintain a high-Fowler position 4. Encourage expectoration of secretions

1. Suction as needed