1355 Final

Assessment findings of pneumonia

-Coughing -Pleuritic chest pain -Tachycardia -Dyspnea -Sputum -Fever/chills -Imbalanced ABGs -Crackles in lungs -Dullness on percussion -Increased WBC -Use of accessory muscles

What should you teach patients about the flu and pneumonia vaccine?

-Get the flu vaccine every year -Get the pneumonia vaccine every 5 years unless directed by your PCP

Interventions for ARDS

-Intubation: PEEP (positive end expiratory pressure) -CPAP -Corticosteroids -Decrease WBC movement and stabilize cell membrane -Conservative fluid therapy

What drugs are used for TB?

-Isoniazid INH (prophylaxis) -Rifampin -Pyrazinamide -Streptomycin -Ethambutol used for at least 6 months

What should you teach a newly diagnosed asthma patient?

-Teach preventive techniques -Teach red light system -Teach triggers (GERD, allergens, airway irritants, respiratory infections, exercise, stress, ASA/NSAIDS, drug/food additives) -Peak flow meter use

What should you teach patient's about rescue inhalers?

-Used for emergency's -Not preventive -Keep device neutral (do not tilt up or down)

What discharge instructions should be given to a COPD patient?

-Wash your hands often -Get a flu shot qyr (ask HCP about pneumonia vaccine) -Stay away from crowds -Get enough sleep -Exercise -Eat a well-balanced diet

When do you draw a through blood level?

30 minutes before the dose

What are common assessment findings in a lung cancer patient?

A cough thats lasts over 3 months of the year or a cough that produces pink sputum

What should you do for an acute asthma attack?

Administer bronchodilators, steroids, and breathing treatments (can be repeated q2 min if necessary)

What type of ABG's do you expect a COPD patient to have?

Chronic respiratory acidosis High C02 Low pH Low O2

a nurse is caring for a client who had a modified uvulopalatopharyngoplasty (modUPPP) earlier in the day for obstructive sleep apnea. Which assessment finding indicates that a priority goal has been met?

Client is able to swallow own secretions without drooling.

What is an appropriate INR?

Healthy individual: less than or equal to 1.1 On Coumadin: 2-3 Valvular issues: 2.5-3.5

A nurse assesses a patient who has developed epistaxis. Which conditions in the patient's history should the nurse identify as potential contributors to this problem? (Select all that apply.)

Hypertension, cocaine use, clotting disorder

A client is on intravenous heparin to treat a pulmonary embolism. The clients most recent partial thromboplastin time (PTT) was 25 seconds. What order should the nurse anticipate?

Increase the heparin rate

A client has a tracheostomy tube in place. When the nurse suctions the client, food particles are noted. What action by the nurse is best?

Measure and compare cuff pressures.

A nurse assesses a client's respiratory status. Which information is most important for the nurse to obtain?

Occupation and hobbies.

The nurse encourages a patient to deep breathe periodically knowing that this exercise helps maintain respiratory function by:

Stretching the alveoli stimulating surfactant production

A nurse teaches a client who had a supraglottic laryngectomy. Which technique would the nurse teach the client to prevent aspiration?

Swallow twice while bearing down.

A nurse assesses a client who has a mediastinal chest tube. Which symptoms require the nurse's immediate intervention? a. Production of pink sputum b Tracheal deviation c. Pain at insertion site d. Sudden onset of shortness of breath e. Drainage greater than 70 mL/hr f. Disconnection at Y site

b, d, e, f

A nurse observes that a patient's anteroposterior (AP) chest diameter is the same as the lateral chest diameter. Which question should the nurse ask the patient in response to this finding?

"Do you have any chronic breathing problems?"

A clinic nurse is reviewing care measures with a client who has asthma, Step 3. What satement by the client indicates the need to review the information?

"I will always use the spacer with my dry powder inhaler."

A new nurse asks for an explanation of "refractory hypoxemia." What answer by the staff development nurse is best?

"It is hypoxemia that persists even with 100% oxygen administration."

A nurse is assessing a client who is suspected of having ARDS. The nurse is confused that although the client appears dyspneic and the oxygen saturation is 88% on 6 L/min of oxygen, the client's lungs are clear. What explanation does the more senior nurse provide?

"Lung edema is in the interstitial tissues, not the airways."

A nurse in a family practice clinic is preparing discharge instructions for a client reporting facial pain that is worse when bending over, tenderness across the cheeks, and postnasal discharge. What instruction will be most helpful?

"Try warm, moist heat packs on your face."

Precautions for TB

-Airborne precautions -N95 mask -Negative pressure room -Room air exchanged with outside air 6x qhr -Report case to the health department

What discharge instructions would you give a patient with pneumonia?

-Breathe warm, moist air to decrease mucous thickness -Get pneumonia vaccine q5yrs -Drink warm beverages

How do you diagnose ARDS?

-Chest x-ray -ABGs -CT -MRI

What are the main priorities for a post-op laryngectomy patient?

-Develop a form of communication before the procedure for afterwards -Maintain patent airway -Provide suctioning as needed

How is TB diagnosed and treated?

-Diagnosed: bloody sputum, CXR, culture -Therapy: Rifampin & Isoniazid (daily for 6-9 months)

What should you teach a patient about Singular?

-Do not stop taking this medication even if you start feeling better -This is a long-term medication used to prevent asthma attacks

Symptoms of a PE

-Dyspnea -Tachypnea -Tachycardia -Pleuritic chest pain -Hypotension -Syncope -Hemoptysis -S4 gallop -Anxious -Crackles -Fever -Petechiae

What nursing interventions are used for a Thoracentesis?

-Explain the procedure to the patient and what they should expect (stinging sensation from the local anesthetic and pressure as the needle is pushed through the posterior chest) -Instruct to stay still and stay in the proper position -Monitor vitals and assess lung sounds -Check puncture site for leakage or bleeding -Encourage deep breathing -Relieve anxiety -Assess q15 min for the first hour after to ensure proper breathing

What nursing interventions are used for Bronchoscopy?

-Keep pt NPO for 6 hrs prior and until gag reflex returns after procedure -Give pre-procedure medication as ordered -Monitor vital signs, O2 saturation, and assess for signs of bleeding, infection, and hypoxemia -Assess breath sounds q15 min for the first 2 hrs after the procedure -Maintain patent airway -Monitor for esophageal bleeds

What should a nurse do for a pulmonary embolism?

-Maintain a patent airway -Administer heparin -Relieve anxiety -Manage O2 therapy -Prevent venous stasis (encourage ambulation)

Nursing interventions for COPD

-O2 therapy -Education -Pursed lip breathing -Deep breathing -Effective coughing -Positioning (high fowlers), tripod

Common causes of obstructed sleep apnea

-Obesity -Age -Sedentary lifestyle -Upper airway obstruction -Smoking -HTN -Stroke -MI -3x more in MVAs

Methods used to stop a nose bleed/epitaxis

-Rhino rockets -Cauterized with silver nitrate or electrocautery -Nasal packing -Topical saline sprays or ointments -Gel tampons

What should you teach a patient about lung cancer and metastases?

-Smoking is the #1 risk factor for lung cancer -Type/degree of metastases will determine how aggressive the treatment will be

What diagnostic tests are used for PE?

-Spiral CT -ABG's -V/Q lung scan -Pulmonary angiography -ECG

What are some side effects of bronchodilators?

-Tachycardia -Irritability -N/V -Headache -Heart Palpitations -Dry mouth -Cough

A nurse assesses several clients who have a history of respiratory disorders. Which client would the nurse assess first?

A 27-yr old client with a heart rate of 120 bpm.

During morning assessment, a nurse assesses four clients. Which client is the priority for follow up?

A 73-year-old client who has pneumonia with coarse crackles, is receiving 2 L/min of oxygen, and has an IV line

A nurse is assessing a patient who is recovering from a lung biopsy. Which assessment finding requires immediate action?

Absent breath sounds

The parents of a 7-year-old patient who has been diagnosed with allergic asthma are being taught about their son's medication regimen. The nurse is teaching about the appropriate use of a "rescue drug" for acute exacerbations. What drug should the nurse suggests the parents to use in these situations?

Albuterol

A client has been diagnosed with a very large pulmonary embolism (PE) and has a dropping blood pressure. What medication would the nurse being most beneficial?

Alteplase

What medications are given for a PE?

Anticoagulants -Heparin -Warfarin (coumadin) -Dabigatran etexilate (PRADAXXA): thrombin inhibitor -Rivaroxaban (XARELTO): factor Xa inhibitor -Eliquis

What patient would you assess first?

Any patient with a brain or heart issue

A nurse cares for a patient with arthritis who reports frequent asthma attacks. Which action should the nurse take first?

Ask about the medications the patient is currently taking

A nurse assesses a patient who reports waking up feeling very tired, even after 8 hours of good sleep. Which action should the nurse take?

Ask the client if he or she has ever been evaluated for sleep apnea

A nurse is caring for a client on mechanical ventilation and finds the client agitated and thrashing about. What action by the nurse is most appropriate?

Assess the cause of the agitation.

A nurse cares for a client who has hypertension that has not responded well to several medications. The client states compliance is not an issue. What action would the nurse take next?

Assess the client for obstructive sleep apnea.

An unlicensed assistive personnel (UAP) was feeding a patient with a tracheostomy. Later that evening, the UP reports that the patient had a coughing spell during the meal. What action by the nurse takes priority?

Assess the patient's lung sounds

The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). The results are as follows: pH 7.35; Pco2 62 (8.25 kPa); P02 70 (9.31 kPa); HCO 34 mEq/L (34 mmol/L). What should the nurse do first?

Assess the vital signs

A nurse plans care for a client who is experiencing dyspnea and must stop multiple times when climbing a flight of stairs. Which intervention would the nurse include in this client's plan of care?

Assistance with activities of daily living.

What are the primary respiratory defense mechanisms?

Cilia, mucous membranes, turbinates, alveoli and surfactant

A nurse assesses a client who has a nasal fracture. The client reports constant nasal drainage, a headache, and difficulty with vision. What action would the nurse take next?

Collect the nasal drainage on a piece of filter paper.

A nurse working in a geriatric clinic sees clients with "cold" symptoms and rhinitis. The primary health care provider often leaves a prescription for diphenhydramine. What action by the nurse is best?

Consult with the PHCP about the medication.

While assessing a client who has facia trauma, the nurse auscultates stridor. The client is anxious and restless. What action would the nurse take first?

Contact the primary health care provider and prepare for intubation.

While assessing a patient who has facial trauma, the nurse auscultates stridor. The patient is anxious and restless. Which action should the nurse take first?

Contact the provider and prepare for intubation

Signs and symptoms of an acute asthma attack

Coughing, wheezing- expiratory wheezes often described as high pitched and musical.

A nurse auscultates a harsh hollow sound over a client's trachea and larynx. What action would the nurse take first?

Document the findings.

A client with ARDS is receiving minimal amounts of IV fluids. The new nurse notes the client is scheduled to receive a diuretic at this time. The nurse consults the Staff Development Nurse to determine the best course of action. What will the new nurse do?

Give the ordered diuretic as scheduled.

A client is admitted with suspected pneumonia from the emergency department. The client went to the primary health care provider a "few days ago" and show the nurse the results of what the client calls "an allergy test." The reddended area is firm. What action by the nurse is best?

Immediately place the client on Airborne Precautions.

A nurse cares for a client with a 40-yr smoking history who is experiencing distended neck veins and dependent edema. Which physiologic process would the nurse correlate with this client's history and clinical signs and symptoms?

Increased pulmonary pressure creating a high workload on the right side of the heart

A client seen in the emergency department reports fever, fatigue, and dry cough but no other upper respiratory symptoms. A chest x-ray reveals mediastinal widening. What action by the nurse is best?

Inform the client that oral antibiotics will be needed for 60 days.

A nurse is assisting the primary health care provider (PHCP) who is intubating a client. The PHCP has been attempting to intubate for 40 seconds. What action by the nurse is best?

Interrupt the procedure to give oxygen.

A nurse cares for a client who is infected with Burkholderia cepacia. What action would the nurse take first when admitting this client to a pulmonary care unit?

Keep the client separated from other clients with cystic fibrosis.

A patient with a chronic cough has a bronchoscopy. Following this procedure, the nurse should:

Keep the patient NPO until the gag reflex returns

A nurse obtains the health history of a client who is recently diagnosed with lung cancer and identifies that the client has a 60-pack-year smoking history. Which action is most important for the nurse to take when interviewing this client?

Maintain a nonjudgemental attitude to avoid causing the client to feel guilty.

A nurse cares for a patient who has packing inserted for posterior nasal bleeding. Which action should the nurse take first?

Make sure the string is taped to the patient's cheek

Lab tests for TB

Monitor AST & ALT (liver labs) because the medication is so intense

While caring for a patient with a smoking history, the nurse knows the patient has decreased respiratory defenses due to impaired:

Mucociliary clearance

A nurse cares for a client who has developed esophagitis after undergoing radiation therapy for lung cancer. Which diet selection would the nurse provide for the client?

Omelet, soft whole-wheat bread

What patient is at greatest risk for a PE?

Post-surgical and immobile pt's

A client in the emergency department has several broken ribs and reports severe pain. What care measure will best promote comfort?

Prepare to assist with intercostal nerve block.

A charge nurse is rounding on several older clients on ventilators in the ICU whom the nurse identifies as being at high risk for ventilator-associated pneumonia. To reduce this risk, what activity would the nurse delegate to the assistive personnel (AP)?

Provide oral care every 4 hours.

A nurse is assessing a client who has a tracheostomy. The nurse notes that the tracheostomy tube is pulsing with the heartbeat as the client's pulse is being taken. No other abnormal findings are noted. What action by the nurse is most appropriate?

Stay with the client and have someone else call the primary healthcare provider immediately.

A client is admitted with a pulmonary embolism (PE). The client is young, healthy, and active and has no known risk factors for PE. What action by the nurse is most appropriate?

Teach the client about factor V Leiden testing.

A nurse assesses a patient after a thoracentesis. Which assessment finding warrants immediate action?

The trachea is deviated toward the opposite side of the neck

A patient diagnosed with laryngeal cancer has had 4 weeks of radiation therapy to the neck and is c/o severe pain with swallowing. What rationale explains the pain?

The treatments are affecting the esophagus causing ulcerations

Why do you give low dose oxygen to a COPD patient?

These pt's can't blow off CO2 and retain it (hypercapnia). They can become hypoxic.

What do IV steroids do to the body?

They mask infection and can alter your BS

What should you teach a patient with multiple inhalers?

They must use a bronchodilator 5 min before med administration to open the airways so the medicine can get inhaled better and deeper

What is the TNM system used for?

Used to stage lung cancer T = Denotes tumor size, location, and degree of invasion N = Indicates regional lymph node involvement M = Presence or absence of metastasis (used for NSCLC)

A nurse assesses a patient who is 6 hours post-surgery for a nasal fracture and has nasal packing in place. Which actions should the nurse take? (Select all that apply.)

Watch the patient for frequent swallowing, assess for signs of bleeding, observe for clear drainage, ask the patient to open his or her mouth

A client is admitted to the hospital for exacerbation of chronic obstructive pulmonary disease (COPD). Which would the nurse expect to find during a nursing assessment?

Wheezing, tachycardia, and restlessness

A nurse is teaching a client about possible complications and hazards of home oxygen therapy. About which complications does the nurse plan to teach the client? a. Absorptive atelecstasis b. Combustion c. Dried mucous membranes d. Alveolar recruitment e. Toxicity

a, b, c, e

A nurse is assessing a client with lung cancer. What nonpulmonary signs and symptoms would the nurse be aware of? a. Gynecomastia in male patients b. Frequent shaking and sweating relieved by eating c. Positive Chvostek and Trousseau signs d. "Moon" face and "buffalo" hump e. Expectorating purulent sputum f. General edema

a, b, d, f

A client is taking ethambutol for tuberculosis. What instructions does the nurse provide the client regarding this drug? a. Contact the primary health care provider if preexisting gout becomes worse. b. Report any changes in vision immediately to the health care provider. c. Avoid drinking alcoholic beverages due to the chance of liver damage. d. Do not take antacids or eat within 2 hours after taking this medication. e. You will take this medication along with some others for 8 weeks. f. Take this medicine with a full glass of water.

a, b, e, f

A 100-kg client has developed ARDS and needs mechanical ventilation. Which of the following are potentially correct ventilator management choices? a. Tidal volume: 600 mL b. Volume-controlled ventilation c. PEEP based on oxygen saturation d. Suctioning every hour e. High-frequency oscillatory ventilation f. Limited turning for ventilator pressures

a, c, e

The nurse is learning about endemic pulmonary diseases. Which diseases are matched with correct information? a. Hanta virus: found in urine, droppings, and saliva of infected rodents. b. Aspergillosis: requires a prolonged course of antibiotics. c. Histoplasmosis: sources include soil containing bird and bat droppings. d. Blastomycosis: requires strict adherence to multi-antibiotic regimen. e. Cryptococcosis: has been eradicated due to strategic deforestation. f. Coccidiodomycosis: found in the southwest and far west of the United States.

a, c, f

A nurse assesses a client who has facial trauma. Which assessment findings require immediate intervention? a. Stridor b. Nasal stuffiness c. Edema of the cheek d. Ecchymosis behind the ear e. Eye pain f. Swollen chin

a, d

A nurse assesses a client who is prescribed verenicline for smoking cessation. Which signs and symptoms would the nurse identify as adverse effects of this medication? a. Visual hallucinations b. Tachycardia c. Decreased cravings d. Manic behavior e. Increased thirst f. Orangish urine

a, d

A nurse is caring for a client with a tracheostomy tube. Which actions may the nurse delegate to the assistive personnel (AP)? a. Applying water-soluble lip balm to the client's lips b. Ensuring that the humidification provided is adequate c. Performing oral care with alcohol-based mouthwash d. Reminding the client to cough and deep breathe often e. Suctioning excess secretions through the tracheostomy f. Holding the new tracheostomy tube while the RN changes the ties

a, d

A nurse teaches a client who has chronic obstruction pulmonary disease. Which statements related to nutrition would the nurse include in this client's teaching? a. "Avoid drinking fluids just before and during meals." b. "Rest before meals if you have dyspnea." c. "Have about six small meals a day." d. Eat high-fiber foods to promote gastric emptying." e. "Use pursed-lip breathing during meals." f. Choose soft, high-calorie, high-protein foods."

a. b, c, e, f

A client in the emergency department is taking rifampin for tuberculosis. The client reports yellowing of the sclera and skin and bleeding after minor trauma. What laboratory results correlate to this condition? a. Blood urea nitrogen (BUN): 19 mg/dL b. International normalized ratio (INR): 6.3 c. Prothrombin time: 35 seconds d. Serum sodium: 130 mEq/L e. White blood cell (WBC) count: 72,000/mm3

b, c

A nurse prepares a client who is scheduled for a bronchoscopy with transbronchial biopsy procedure at 0900. What actions would the nurse take? a. Provide a clear liquid breakfast. b. Verify that the informed consent was obtained. c. Document the client's allergies. d. Review laboratory results. e. Hold the client's bronchodilator. f. Monitor the client for at least 24 hours afterward.

b, c, d, f

A nurse teaches a client with epitaxis and recently had his nasal packing removed. Which statements indicate that this client correctly understood the teaching? a. "I will vigorously blow my nose multiple times each day." b. "Nasal saline sprays will help to prevent rebleeding." c. "I will wait at least 1 month before resuming weight lifting." d. "Ibuprofen will decrease nasal swelling and pain." e. "I will apply a small amount of petroleum jelly to my nares."

b, c, e

The emergency department nurse is participating in a bioterrorism drill which several "clients" are suspected to have inhalation anthrax. Which "clients" would the nurse see as the priorities? a. Widened mediastinum on chest x-ray b. Dry cough c. Stridor d. Oxygen saturation 91% e. Diaphoresis f. Oral temperature 99.9 degrees F

c, d, e