Test 5- Acid / Base and Gas Exchange

the client is admitted with a diagnosis of rule-out TB. which type of isolation procedures should the nurse implement? 1. standard 2. contact 3. droplet 4. airborne

4. airborne rationale: clients with TB are placed in negative air pressure rooms

The nurse begins the hospital shift by assessing a client with a diagnosis of exacerbation of COPD. The nurse expects to document which of the following expected findings? (select all that apply) A. hypercapnia B. increased vital capacity on pulmonary function studies C. oxygen desaturation when ambulating with physical therapy D. hematuria

A, C

The client is being discharged with a diagnosis of TB. Which important instructions will the nurse provide? (select all that apply) A. Take the medication but may stop if the side effects interfere with life B. Use other methods of birth control in addition to prescribed contraceptives C. family and others living in the home need to be tested D. practice secretion/ Resp. hygiene by placing used tissue in closed bag.

B, C, D.

The nurse is instructing the client on use of beclomethasone ( Vanceril ) inhaler. which statement by the client indicates that teaching is successful A. "i will hold my diabetic medication for two hours before and after the inhaler" B. " I will rinse my mouth following each scheduled dose" C. " I will use the inhaler prior to sleep" D. " I will inhale then blow out forcefully"

B.

an obese client with a history of smoking and type 2 diabetes arrives to the clinic with respiratory symptoms of bronchitis. which of the following is a priority to include in instructions? A. Lose 20 pounds B. Avoid cigarette smoking C. Drink plenty of fluids D. Decrease activity

B.

the nurse is preforming an admission assessment of a 26 y/o client with a preliminary diagnosis of tuberculosis. the nurse will provide a plan of care which includes which of the following actions? (select all that apply) A. wear gloves and gown when handling body fluids and bowel movements. B. make sure the room is positive pressured for positive airflow C. wear an N96 respirator mask prior to entering the clients room D. Administer the first round of tuberculosis medication.

C, D

the client diagnosed with respiratory distress has ABG's of pH 7.45; PaCO2 54; HCO3 25; PaO2 52. which should the nurse implement? SELECT ALL THAT APPLY 1. apply oxygen via nonrebreather mask 2. call the RRT 3. elevate the HOB 4. stay with the client 5. notify the HCP

all of the above

when examining a client with emphysema, what physical findings is the nurse likely to see?

barrel chest, dry or productive cough, decreased breath sounds dyspnea crackles in lung fields.

what symptoms of pneumonia might the nurse expect to see in an older adult client?

confusion, lethargy, anorexia, rapid respiration rate

During mechanical ventilation, what are three major nursing interventions?

monitor client's respiratory status and secure connections; establish a communication mechanism with the client; keep airway clear by coughing and suctioning

list four common symptoms of pneumonia the nurse might note on physical examination

tachypnea, fever with chills, productive cough, bronchial breath sounds

the nurse is caring for the client diagnosed with pneumonia. which information should the nurse include in the teaching plan? SELECT ALL THAT APPLY 1. place the client on oxygen delivered by NC 2. plan for periods of rest during ADLs 3. place the client on a fluid restriction of 1000mL/day 4. restrict the client's smoking to 2-3 cigarettes/day 5. monitor the client's pulse ox q4h

1 , 2 , 5

the community health nurse is conducting an educational session with community members regarding the s/s associated with TB. the nurse informs the participants that TB is considered as a diagnosis if which s/s are present? SELECT ALL THAT APPLY 1. dyspnea 2. headache 3. night sweats 4. a bloody, productive cough 5. a cough with the expectoration of mucoid sputum

1 , 3 , 4 , 5

the nurse is preparing a list of homecare instructions for a client who has been hospitalized and treated for TB. which instructions should the nurse include on the list? SELECT ALL THAT APPLY 1. activities should be resumed gradually 2. avoid contact with other individuals, except family members, for at least 6 months 3. a sputum collection is needed every 2-4 weeks once medication therapy is initiated 4. respiratory isolation is not necessary, because family members have already been exposed 5. cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags 6. when 1 sputum culture is negative, the client is no longer considered infectious and usually can return to employment

1 , 3 , 4 , 5

the nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by RSV. which interventions should the nurse include in the plan of care? SELECT ALL THAT APPLY 1. place the infant in a private room 2. ensure that the infant's head is in a flexed position 3. wear a mask, gown, and gloves when in contact with the infant 4. place the infant in a tent that delivers warm humidified air 5. position the infant on the side, with the head lower than the chest 6. ensure that nurses caring for the infant with RSV do not care for other high-risk children

1 , 3 , 6

which statement made by the client indicates the nurse's discharge teaching is effective for the client diagnosed with COPD? 1. " i need to get an influenza vaccine each year, even when there is a shortage' 2. " i need to get a vaccine for pneumonia each year with my influenza shot" 3. "if i reduce my cigarettes to 6/day, i won't have difficulty breathing" 4. "i need to restrict my drinking liquids to keep from having so much phlegm"

1. " i need to get an influenza vaccine each year, even when there is a shortage' rationale: clients with COPD should receive the influenza vaccine each year. if there is a shortage, these clients receive top priority

the nurse is discharging a client newly diagnosed with asthma. which statement indicates the client understands discharge instructions? 1. "i will call 911 if my medications dont control an attack" 2. " i should wash my bedding in warm water" 3. " i can still eat at the chinese restaurant when i want" 4. " if i get a headache, i should take an NSAID

1. "i will call 911 if my medications dont control an attack" rationale: the client must be able to recognize a life-threatening situation and initiate the correct procedure

the nurse is applying oxygen via NC to a client diagnosed with COPD. the client complains of extreme SOB. at which rate should the nurse set the flow meter? 1. 2L 2. 4L 3. 6L 4. 10L

1. 2L rationale: the client with COPD develops carbon dioxide narcosis, which does not allow the brain to recognize high levels of CO2 as a stimulus to breathe. giving high levels of oxygen removes the client's stimulus to breathe

the client is diagnosed with an exacerbation of COPD is in respiratory distress. which intervention should the nurse assess first? 1. assist the client into a sitting position at 90 degrees 2. administer oxygen at 6L via NC 3. monitor v/s with the client sitting upright 4. notify the HCP about the client's status

1. assist the client into a sitting position at 90 degrees rationale: this position decreases the work of breathing.

the nurse is assessing a 79 year old client diagnosed with pneumonia. which s/s should the nurse expect to assess in the client? 1. confusion and lethargy 2. high fever and chills 3. frothy sputum and edema 4. bardypnea and JVD

1. confusion and lethargy rationale: the elderly client diagnosed with pneumonia may present with weakness, fatigue, lethargy, confusion and poor appetite but not have any of the classic s/s of pneumonia

the client is admitted to the nursing unit with a diagnosis of pneumonia. which s/s should the nurse assess in the client? 1. pleuritic chest discomfort and anxiety 2. asymmetrical chest expansion and pallor 3. leukopenia and CRT < 3 sec 4. substernal chest pain and diaphoresis

1. pleuritic chest discomfort and anxiety rationale: pleuritic chest pain and anxiety from diminished oxygenation occur along with fever, chills, dyspnea, and cough

the nurse is planning care for a client diagnosed with asthma and has written a problem of "anxiety". which nursing intervention should be implemented? 1. remain with the client 2. notify the HCP 3. administer an anixolytic 4. encourage the client to drink fluids

1. remain with the client rationale: anxiety is expected, and staying with the client lets the client know the nurse will intervene and the client is not alone

the charge nurse is making rounds. which client should the nurse assess first? 1. the 29 year old client diagnosed with reactive airway disease who is complaining the nurse caring for him was rude 2. the 76 year old client diagnosed with heart failure who has 2+ edema of the lower extremities 3. the 15 year old client diagnosed with DKA after a bout with the flu who has a blood glucose reading of 189 4. the 62 year old client diagnosed with COPD and pneumonia who is receiving O2 by NC at 2L/min

1. the 29 year old client diagnosed with reactive airway disease who is complaining the nurse caring for him was rude rationale: at times it is necessary to see the client with a psychosocial need before other clients who have expected and non-life threatening situations

which outcome is appropriate for the client problem "ineffective gas exchange" for the client recently diagnosed with COPD? 1. the client demonstrates the correct way to pursed-lip breathe 2. the client lists 3 s/s to report to the HCP 3. the client will drink at least 2500mL of water daily 4. the client will be able to ambulate 100 ft with dyspnea

1. the client demonstrates the correct way to pursed-lip breathe rationale: pursed-lip breathing helps keep the alveoli open to allow for better gas exchange

the nurse is caring for a client hospitalized with acute exacerbation of COPD. 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. PFTs that demonstrate increased vital capacity

2 , 3

the nurse is caring for a client with a right-sided chest tube secondary to a pneumothorax. which interventions should the nurse implement when caring for this client? SELECT ALL THAT APPLY 1. place the client in low fowlers 2. assess chest tube drainage system frequently 3. maintain strict bed rest for the client 4. secure a loop of drainage tubing to the sheet 5. observe the site for subcutaneous emphysema

2 , 4 , 5

the 56 year old client diagnosed with TB is being discharged. which statement made by the client indicates an understanding of the discharge instructions? 1. "i will take my medication for the full 3 weeks prescribed" 2. " i must stay on the medication for months if i am to get well" 3. " i can be around my friends because i have started taking antibiotics" 4. " i should get a TB skin test every 3 months to determine if i am well"

2. " i must stay on the medication for months if i am to get well" rationale: compliance with the treatment regimen for TB includes multidrug therapy for 6-12 months for the client to be free of TB bacteria

the client diagnosed with asthma is admitted to the ED with difficulty breathing and a blue color around the mouth. which diagnostic test will be ordered to determine the status of the client? 1. CBC 2. PFT 3. allergy skin testing 4. drug cortisol level

2. PFT

a 10 year old child with asthma is treated for an acute exacerbation in the ED. the nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition? 1. warm, dry skin 2. decreased wheezing 3. pulse of 90 bpm 4. respirations of 18 breaths per minute

2. decreased wheezing rationale: decreased wheezing indicates worsening of the episode and could contribute to a further obstructed airway. in cases of asthma exacerbation, wheezing is considered a positive sign.

the nurse is caring for an infant with bronchiolitis and diagnostic tests confirm RSV. on the basis of this finding, which is the most appropriate nursing action? 1. initiate strict enteric precautions 2. move the infant to a private room 3. leave the infant in the present room, because RSV is not contagious 4. inform the staff that using standard precautions is all that is necessary when caring for the child

2. move the infant to a private room rationale: RSV is a highly communicable disorder and is transmitted via droplets and direct contact with respiratory secretions. use of contact, droplet, and standard precautions during care is necessary. an infant should be placed in a private room to prevent transmission.

the alert and oriented client is diagnosed with a spontaneous pneumothorax and the HCP is preparing to insert a left sided chest tube. which intervention should the nurse implement first? 1. gather the needed supplies for the procedure 2. obtain a signed consent form 3. assist the client into a side-lying position 4. discuss the procedure with the client

2. obtain a signed consent form rationale: the insertion of a chest tube is an invasive procedure and requires informed consent. without a consent form, this procedure should not be done on an alert and oriented client.

the nurse is assessing the client diagnosed with COPD. which data requires immediate intervention by the nurse? 1. large amounts of thick white sputum 2. oxygen flow meter set on 8L 3. use of accessory muscles during inspiration 4. presence of barrel chest and dyspnea

2. oxygen flow meter set on 8L rationale: patients with COPD should never have more than 4L via NC because hypoxemia is the stimulus for breathing in clients with COPD.

the nurse is preparing to give a bed bath to an immobilized client with TB. the nurse should wear which items when performing this care? 1. surgical mask and gloves 2. particulate respirator, gown and gloves 3. particulate respirator and protective eyewear 4. surgical mask, gown and protective eyewear

2. particulate respirator, gown and gloves

the nurse is discussing the care of a child diagnosed with asthma with the parent. which referral is important to include in the teaching? 1. referral to a dietitian 2. referral for allergy testing 3. referral to the developmental psychologist 4. referral to a home health nurse

2. referral for allergy testing rationale: because asthma may be related to an allergen, it is important to determine which substances trigger an attack

the nurse is feeding the client diagnosed with aspiration pneumonia who becomes dyspneic, begins to cough, and is turning blue. which nursing intervention should the nurse implement first? 1. suction the client's nares 2. turn the client to the side 3. place the client in trendelenburg position 4. notify the HCP

2. turn the client to the side rationale: turning the client to the side allows for the food to be coughed up and come out of the mouth, rather than be aspirated into the lungs

the client is admitted to the ED with chest trauma. which s/s indicate to the nurse the diagnosis of pneumothorax? 1. bronchiovesicular lung sounds and bradypnea 2. unequal lung expansion and dyspnea 3. frothy, bloody sputum and consolidation 4. barrel chest and polycythemia

2. unequal lung expansion and dyspnea rationale: unequal lung expansion and dyspnea indicate a pneumothorax

the client is diagnosed with mild intermittent asthma. which medication should the nurse discuss with the client? 1. daily inhaled corticosteroids 2. use of a "rescue inhaler" 3. use of systemic steroids 4. leukotriene agonists

2. use of a "rescue inhaler" rationale: clients with intermittent asthma will have exacerbations treated with rescue inhalers.

the client had a right sided chest tube inserted 2 hours ago for a pneumothorax. which action should the nurse implement if there is no fluctuation (tidaling) in the water-seal compartment? 1. obtain an order for a STAT chest x-ray 2. increase the amount of wall suction 3. check the tubing for kinks or clots 4. monitor the client's pulse ox reading

3. check the tubing for kinks or clots rationale: the air from the pleural space is not able to get to the water-seal compartment, the nurse should try to determine why. usually the client is laying on the tube or it is kinked

which clinical manifestation should the nurse expect to assess in the ? client recently diagnosed with COPD? 1. clubbing of the fingers 2. infrequent respiratory infections 3. chronic sputum production 4. nonproductive hacking cough

3. chronic sputum production rationale: sputum production, along with cough and dyspnea on exertion, are the early s/s of COPD

the nurse is completing an admission assessment on a 13 year old client diagnosed with an acute exacerbation of asthma. which s/s would the nurse expect to find? 1. fever and crepitus 2. rales and hives 3. dyspnea and wheezing 4. normal chest shape and eupnea

3. dyspnea and wheezing rationale: during an asthma attack, the muscles surrounding the bronchioles constrict, causing a narrowing of the bronchioles. the lungs then respond with the production of secretions that further narrow the lumen. the resulting symptoms include wheezing from the air passing through the narrow, clogged spaces and dyspnea

the client diagnosed with a community-acquired pneumonia is being admitted to the medical unit. which nursing intervention is the highest priority? 1. administer the ordered oral antibiotic immediately (STAT) 2. order the meal tray to be delivered asap 3. obtain a sputum specimen for culture and sensitivity 4. have the NA weigh the client

3. obtain a sputum specimen for culture and sensitivity rationale: specimen collections are always obtained before beginning antibiotic therapy

the client diagnosed with community-acquired pneumonia is admitted to the medical unit. which HCP order should the nurse implement first? 1. start IV with 1000mL 0.9% saline 2. ceftriaxone 1gm IVPB every 12 hours 3. obtain sputum and blood cultures 4. CBC and BMP

3. obtain sputum and blood cultures rationale: culture specimens should be obtained before any antibiotic medications are initiated to prevent the skewing of results

the nurse performs an admission assessment on a client with a diagnosis of TB. the nurse should check the results of which diagnostic test that will confirm this diagnosis? 1. chest x-ray 2. bronchoscopy 3. sputum culture 4. tuberculin skin test

3. sputum culture rationale: a presumptive diagnosis is made based on a tuberculin skin test, a sputum smear that is positive for acid-fast bacteria, a chest x-ray, and histological evidence of granulomatous disease on biopsy, but a confirmation is made through a sputum culture

the nurse is caring for clients on a medical unit. which assessment data indicates a critical oxygenation problem for the client? 1. the client with an anterior upper left chest tube is splinting the dressing with a pillow 2. the male client on oxygen is coughing forcefully, making it hard to catch his breath 3. the client who is at rest and has circumoral cyanosis and is difficult to arouse 4. the female client complains of SOB when ambulating in the hallway

3. the client who is at rest and has circumoral cyanosis and is difficult to arouse rationale: this client with a lack of oxygenation at rest, blueness around the mouth, and who is difficult to arouse indicates a decrease in neurological function

the client diagnosed with exercise induced asthma is being discharged. which information should the nurse include in the discharge teaching? 1. take 2 puffs of the rescue inhaler and wait 5 min before exercise 2. warm up exercises will increase the potential for asthma attacks 3. use the bronchodilator inhaler immediately prior to beginning exercise 4. increase dietary intake of food high in monosodium glutamate

3. use the bronchodilator inhaler immediately prior to beginning exercise rationale: using a bronchodilator immediately prior to exercise will help reduce bronchospasms

the nurse has conducted discharge teaching with a client diagnosed with TB who has been receiving medication for 2 weeks. the nurse determines that the client has understood the information if the client makes which statement? 1. " i need to continue medication therapy for 1 month" 2. "i can't shop at the mall for the next 6 months" 3. "i can return to work if a sputum culture comes back negative" 4. " i should not be contagious after 2-3 weeks of medication therapy"

4. " i should not be contagious after 2-3 weeks of medication therapy" rationale: the client is continued on medication therapy for up to 12 months, depending on the situation. the client generally is considered noncontagious after 2-3 weeks of medication therapy

the clinic nurse is providing instructions to a parent of a child with cystic fibrosis regarding the immunization schedule for the child. which statement should the nurse make to the parent? 1. "the immunization schedule will have to be altered" 2. "the child should not receive any hepatitis vaccines" 3. "the child will receive all of the immunizations except for the polio series" 4. "the child will receive the recommended basic series of immunizations along with a yearly flu vaccine"

4. "the child will receive the recommended basic series of immunizations along with a yearly flu vaccine" rationale: adequately protecting children with cystic fibrosis from communicable diseases by immunization is essential. in addition to the basic series of immunizations, a yearly immunization for influenza is recommended.

the nurse is planning care for a client diagnosed with pneumonia and writes a problem of "impaired gas exchange". which is an expected outcome for this problem? 1. performs chest physiotherapy 3x a day 2. able to complete ADLs 3. ambulates in the hall several times each shift 4. alert and oriented x4

4. alert and oriented x4 rationale: impaired gas exchange results in hypoxia, the earliest s/s of which is a change in LOC

A new parent expresses concern to the nurse regarding sudden infant death syndrome (SIDS). She asks the nurse how to position her new infant for sleep. In which position should the nurse tell the parent to place the infant? 1. Side or prone 2. Back or prone 3. Stomach with the face turned 4. Back rather than on the stomach

4. back rather than stomach rationale: nurses should encourage parents to place the infant on the back (supine) for sleep, decreasing the risk of suffocation

the mother of an 8 year old child being treated for RLL pneumonia at home calls the clinic nurse. the mother tells the nurse that the child complains of discomfort on the right side and that ibuprofen is not effective. which instruction should the nurse provide to the mother? 1. increase the dose of ibuprofen 2. increase the frequency of ibuprofen 3. encourage the child to lie on the left side 4. encourage the child to lie on the right side

4. encourage the child to lie on the right side rationale: splinting of the affected side by lying on that side may decrease discomfort. laying on the unaffected side will not provide relief of discomfort.

the nurse observes the client sitting on the side of the bed with the arms propped on the over-bed table. the chest is barrel shaped and the client is breathing through lips spaced close together and is exhaling slowly. which concept is priority for this client? 1. mobility 2. nutrition 3. activity intolerance 4. oxygenation

4. oxygenation rationale: the symptoms are seen in a client with COPD. oxygenation is the highest priority

the nurse is caring for a client with end-stage COPD. which data warrant immediate intervention by the nurse? 1. the client's pulse ox is 92% 2. the client's arterial blood gas is 74 3. the client has SOB when walking to the bathroom 4. the client's sputum is rusty colored

4. the client's sputum is rusty colored rationale: rusty-colored sputum indicates blood in the sputum and requires further assessment by the nurse

the nurse is assessing the client with COPD. which health promotion information is most important for the nurse to obtain? 1. number of years the client has smoked 2. risk factors for complications 3. ability to administer inhaled medication 4. willingness to modify lifestyle

4. willingness to modify lifestyle rationale: the client's attitude toward lifestyle changes is most important consideration in health promotion, in this case, smoking cessation.

A client arrives to the emergency department with exacerbation of COPD with SpO2 of 78% hypercapnia, and respiratory rate of 32 bpm. which action by the nurse is considered priority A. Apply a partial re-breather mask with Fio2 of 60-80% and call for a blood gas sample B. Apply Venturi mask at 24% oxygen setting or nasal canula at 2 L/min. pending health provider determination C. Begin an aminophylline drip then prepare a tracheostomy tray and alert health provider D. Educate on activity tolerance to minimize further episodes

A

The infection control nurse is providing education on early warning system for tuberculosis. which of the following characteristics may warrant for further testing to determine if a client has tuberculosis A. coughing up blood and night sweats B. hacking unproductive cough and diarrhea C. chest pain on breathing and blue nail beds. D. recent exposure to influenza

A

The nurse plans for a nursing diagnosis of ineffective airway clearance for a client with pneumonia. which intervention will will the nurse identify as a priority in the plan of care? A. instruct on coughing, deep breathing, and hydration B. give the client supplemental oxygen C. contact physician for blocked airway and prepare tracheostomy set-up D. client will maintain head of bed in mid-fowlers for the next 48 hours

A

the nurse is admitting a client with a diagnosis of TB. which type of isolation precaution will the nurse prepare prior to admission? A. Airborne B. Droplet C. Contact D. MRSA

A

the nurse is assessing a client with left-sided heart failure who is suspected of progression into pulmonary edema. which finding will the nurse report to the health care provider that is a manifestation of pulmonary edema A. Bilateral Crackles B. Peripheral 4+ edema C. Increased Temperature D. Respiratory rate of 26 bpm

A

the nurse is caring for a client following a thoracentesis, the nurse contacts the HCP because of which finding? A. Diminished breath sounds on the affected side B. Crackles remain unchanged since the previous assessment C. Symmetrical chest expansion D. Respiratory rate of 26 bpm

A

The nurse is instructing a client on using a metered dosed inhaler and will include which instructions (select all that apply) A. Hold the MDI 1-2 inches from mouth and use a spacer B. After inhalation, close mouth and hold breath for 5-10 seconds C. Take short quick breaths with each inhalation D. Exhale deeply after inhalation of medication

A, B

the nure develops a nursing care plan for a patient at risk for HAP (hospital-acquired pneumonia), which risk factor places this client at higher risk for having HAP (select all that apply) A. A client on a ventilator B. A client with dysphagia C. A client who did not receive the pneumococcal vaccine D. A client who did not relieve the Flu vaccine

A, B

The clinic nurse will be sure to alert which of the following clients on the importance of receiving the flu vaccine (select all that apply) A. A 66 y/o client with rheumatoid arthritis B. A 32 y/o father of two children in elementary school C. a 46 y/o wife caring for her spouse who has renal disease D. a 52 y/o post surgical cholecystectomy

A, C

the nurse will privide teaching on side effects of rifampin, isoniazid, ethambutol to a client with TB. These medications will have which adverse reactions? (select all that apply) A. Isoniazid may cause dark urine and yellowing of the skin B. Ethambutol causes contact lenses to be stained orange\ C. Rifampin causes contact lenses to become stained orange D. Ethambutol may cause visual disturbances

A, C, D

During the admission assessment, a hospitalized client with pneumonia is questioning the health care providers order for bedrest. which statement by the nurse best explains the reason for the bed rest order? A. "bedrest will reduce the demand for oxygen" B. "bedrest will help you cough and deep breath better" C. "bedrest will help ease pain on coughing" D. bedrest will give you a needed break from work and family"

A.

the nurse is assessing a client following a thoracentesis and immediately reports which finding to the HCP? A. crepitus B. serous oozing from puncture sight C. increased temp of 100.4 D. diminished breath sounds on the affected side

A. rational: Crepitus following a thoracentesis may be a sign of pneumothorax, and is to be immediately reported

the nurse is caring for a client with a diagnosis of COPD. the nurse received a new order for a metered-dose inhaler and immediately notifies the health care provider because of which important finding? A. the client has sever arthritis in both hands. B. the client is a smoker C. long-acting anticholinergic should be contradicted in persons with COPD D. the client is hard of hearing

A. rational: a patient with arthritis in both m=hands may not be able to manipulate a metered dosed inhaler

A hospitalized client with an upper respiratory infection and frequent bladder infections is admitted to the medical surgical floor. the nurse assigned to the client should question which ordered medication. A. Aspirin 325mg PO ever 4-6 hours as needed for pain or fever >101 B. Ipratropium bromide metered aerosol inhalation 21 mcg/per inhaled dose. two inhaled doses every 4 hours C. Methylpredisone 30 mg IV every 6 hours D. Amoxicillin 500mg PO every 6 hours

A. rational: aspirins is contraindicated in clients with asthma since it may trigger bronchospasm

the nurse assesses a client with pneumonia after the tech reports the client is having chest pain. the nurse determines the client may have pleuritic chest pain based on which finding A. rapid, shallow, painful respirations. B. coughing that triggers muscle spams C. chest pain that worsens on inspiration D. Complaints of mild but constant aching in the chest.

C

the nurse is preparing instructions for a client with COPD. which demonstration by the client will be master for pursed-lipped breathing technique? A. the client will take a deep breath with lips pursed then exhale fully with mouth open. B. the client will breath in longer than breathing out C. the client will inhale with mouth closed, pursed lips and exhale while counting to four. D. the client will inhale while counting to four, and then forcefully blow out on exhalation.

C

A client enters the ED because of being awakened in the night with a bronchospasm. the client is diagnosed with asthma and the nurse provides instructions on which medications to utilize for onset of bronchospasms A. montelukast B. Futicasone-salmeterol C. albuterol inhaler D. budesonide- formoterol

C.

the clinic nurse is providing instructions to a client with chronic sinusitis, what should the nurse instruct the client to do? A. keep family and friend visits to a minimum until well B. have a family member to assist with postural drainage daily C. take warm showers at least twice daily D. take four weeks of antibiotic therapy to lessen episodes

C.

the nurse is preforming an admission assessment for a hospitalized client with a diagnosis of asthma. the nurse questions the admitting order for ipratropium bromide (Atrovent) because the client had a history of what condition? A. Cushing's syndrome B. edema C. Glaucoma D. Anticoagulation therapy

C. Rational: Atrovent is an anticholinergic, which is contradicted in patients with angle-closure glaucoma since it might raise intraocular pressure

a nurse caring for a client with COPD auscultates wheezes and diminished breath sounds. The sounds indicate that the client is experiencing which complication of COPD A. The client is experiencing hypersaturation in oxygen B. the client is experiencing pulmonary emboli. C. the client is experiencing bronchospasm D. the client has the complication of pneumonia

C. rational: bronchospasm and diminished breath sounds are characteristics of inflammation of large airways that cause narrowing and subsequent wheezing sound on auscultation. it occurs frequently with COPD and asthma

the nurse is caring for a client with bacterial pneumonia who is receiving gentamycin. which lab value is most important to monitor by the nurse? A. serum potassium B. serum sodium C. serum creatinine D. Serum alkaline phosphate (ALP)

C. rational: serum creatinine must be monitored while on aminoglycosides like gentamycin because the medication may cause tubular necrosis and the kidneys via glomerular filtration primarily excrete the drug

the nurse caring for a client with emphysema walks into the clients hospital room and finds the client sitting on the side of the bed while leaning on the overbed table. which statement best reflects whether the position of the client is correct or incorrect? A. please call the staff before leaning over the table as it is unsafe. B. next time sit upright instead of leaving over the table. C. you need to recline in the bed-side chair to relax the diaphragm. D. You are demonstrating the correct position which will enhance your breathing

D

Isoniazid is prescription to a client with TB. How will the nurse instruct the client to take the meds. A. take the medication with the evening meal for best absorption B. Take the medication with and antacid to relieve GI upset C. Take the medication 30 minutes following the first meal of the day D. Take the medication on and empty stomach

D.

the nurse caring for a client who had right who had a right wedge resection of the lung recognizes an early sign of pulmonary embolism. which assessment finding is an early sign of pulmonary embolism? A. cyanosis localized to upper extremity B. increased wheezing bilaterally' C. increase in respirations by 10 breaths per minutes over two hours D. sudden onset of apprehension, anxiety, and dyspnea

D.

what precautions are required for client with TB when placed on respiratory isolation?

a mask for anyone entering the room; private rooms; client must wear mask if leaving

which client problems are appropriate for the nurse to include in the plan of care for the client diagnosed with COPD? SELECT ALL THAT APPLY 1. impaired gas exchange 2. inability to tolerate temperature extremes 3. activity intolerance 4. inability to cope with changes in roles 5. alteration in nutrition

all of the above

the nurse is assessing a client with viral pneumonia. which areas in the focused assessment may determine significant findings in a client with pneumonia. (select all that apply) A. color of nailbeds B. Quality of breath sounds on auscultation C. chest pain D. Peripheral edema

all the above

list four components of teaching for the client with tuberculosis

cough into tissues and dispose of immediately in a special bag. Long term need for daily medications. Good handwashing technique. report symptoms for deterioration, e.g., blood in secretions

how does the nurse prevent hypoxia while suctioning a trach?

deliver 100% O2 before and after each endotracheal suctioning

state four nursing interventions for assisting the client cough productively

encourage deep breathing, increase fluid intake to 2/L a day, use humidity to loosen secretions, suction airway to stimulate coughing