assessment of the respiratory system (test 4, chp. 23)

Changes related to muscle function in elderly & what kind of impact does this have?

-Decrease in strength of diaphragm -Decrease in strength of intercostals The decrease in function/strength of the intercostals and diaphragm increases inspiratory effort to maintain adequate ventilation

gas exchange changes in elderly & what kind of impact does this have?

-Depressed cough reflex and ventilatory response to hypoxia and hypercapnia -Delays in gas exchange across the alveolar membrane Increased potential for episodes of hypercapnia and hypoxia

Immunological changes in elderly & what kind of impact does this have?

-Increase in the neutrophils in respiratory tissue -Decrease in the macrophages in respiratory tissue The increase in neutrophils and decrease in macrophages create chronic inflammation of the lung tissue, which hinders gas exchange

Your pt has a sputum culture at 9am and they ask what to expect, what do you tell them?

-Patients with a natural airway will be given a sterile collection device and asked to cough and deposit expectorated sputum into the container. -Prior to collection, patients should rinse the mouth to limit the contamination of normal mouth flora in the culture -patients should be instructed to collect sputum as early in the morning as possible because secretions accumulate overnight, increasing the volume of sputum collected and increasing the potential to identify microorganisms -During collection of the sputum, the patient should be instructed to deeply inspire and expire, with the patient coughing during expiration. -Patients with an endotracheal tube or tracheostomy will have the sputum culture collected by suctioning the airway and placing the contents into a sterile collection device. Suctioning may cause some discomfort to the patient, although the discomfort will be temporary.

structural changes in elderly & what kind of impact does this have?

-Stiffening of the thoracic cage -Decrease in height of thoracic vertebrae from osteoporosis -Kyphosis -Decrease in chest-wall compliance Kyphosis and osteoporosis of the thoracic vertebrae cause a decrease in chest-wall compliance which increases the residual volume, which decreases the function of the diaphragm. Therefore, elderly patients have increased residual volumes and respiratory effort during inspiration.

A pt scheduled for a percutaneous lung biopsy wants to speak to you about what to expect...the patients sister just received a bronchoscopy and is wondering if her procedure is alike.

-The pre-procedure preperation is the same as a bronchoscopy so it is alike in that way -NPO 8 hours prior -you will need to sign a consent form -you will receive general anesthesia -I will educate you on post op procedure -depending on your resp. function, you may require intubation and mechanical ventilation in the postoperative period.

Heart chest x-rays

-able to identify only abnormalities involving the size, shape, or placement of the heart -If abnormalities of the heart are noted, additional diagnostic tests are indicated

lung biopsy

-allows for a small piece of lung tissue to be removed and analyzed under a microscope. -can be performed percutaneously or through an open procedure. -The type of biopsy performed is based on the location and size of the tissue requiring biopsy. -typically ordered to confirm lung cancer, sarcoidosis, or pulmonary fibrosis. -Abnormal values may indicate an infectious process or malignancy.

thoracentesis

-can be used as a diagnostic test or treatment depending on the disease process. -a needle is inserted into the pleural space to remove excess fluid/air. -can be used as a treatment option to remove fluid from the pleural space

lung chest x-rays

-can identify masses, air or fluid in the pleural space, pneumonia, atelectasis, and possible TB infections. -Many times, additional diagnostic tests are needed to confirm chest x-ray results.

Nursing implications during open lung biopsies

-consent form must be signed -time out performed -general anesthesia -will be monitored by an anesthesiologist or CRNA -thoracotomy will be performed which will require a chest tube to allow for reexpansion of lungs -monitor pt during post op period to assess for complications arising from surgery and anesthesia

Nursing implications during percutaneous lung biopsies

-consent form must be signed -time out performed assess the pt in same position as thoracentesis (sitting position, leading over table) -ensure local anesthetic is injected at site of biopsy -monitor vitals and pulse ox -remind pt not to cough or move

chest x-ray

-diagnostic studies of the thorax that may identify problems with the lungs, heart, and pleural space. -normally a first-line diagnostic test for patients with respiratory complaints because they are widely available and relatively inexpensive.

The most valuable CO2 reading is the what?

-end-tidal CO2 level. -measures the maximal partial pressure of CO2 obtained at the end of an exhaled breath. -Normal readings are 2 to 5 mm Hg less than PaCO2 readings for healthy patients.

For flexible and rigid bronchoscopies, what are your responsibilites as the nurse?

-ensure IV access -continuous cardiac monitoring -pulse ox monitoring -BP monitoring -ensure emergency equipment is available at bedside (oxygen and suction) -constantly evaluate condition and vitals -monitor after the test for vitals, lung sounds, and mental status every 15 min until LOC returns to baseline -assess for complications of procedure like bleeding or hypoxia -NPO until pt is alert and gag reflex is intact

What are nursing responsibilities prior to a thoracentesis?

-ensure consent is signed -time out procedure has been completed -assist the pt into a seated position on side of bed with bedside table in front of them -assess for potential complications that may arise by monitoring vitals and pulse ox -know that changes in vitals may indicated a complication and the need to stop the procedure -know that pt's who report SOB prior to procedure feel immediate relief of symptoms once the fluid or air is removed from the pleural space -at the end of procedure, reevaluate vitals and lungs to assess for possible implications of pneumothroax -encourage pt to cough and deep breathe to decrease risk of atelectasis and promote good lung expansion

turbinates

-filter the air, and any foreign matter is filtered out through the cilia -responsible for humidifying and warming the air

Increase in end-tidal CO2 levels

-from an increase in cellular metabolism, resulting in an increase in CO2 production or hyperventilation that causes an increase in the excretion of CO2 from the lungs. -hyperthermia, trauma, burns, and sepsis

ventilation-perfusion (V/Q) mismatch

-may be caused by dead space and shunt -when there is no perfusion of functioning alveoli by the pulmonary capillaries (dead space) because of an obstruction of blood flow through the pulmonary capillaries, there is a high ventilation-perfusion mismatch, or adequate ventilation with poor perfusion. -This can occur when there is a pulmonary embolism obstructing flow through the pulmonary artery. -When there is adequate perfusion through poorly functioning alveoli (shunt), there is a low ventilation-perfusion mismatch, or poor ventilation with adequate perfusion -A low V/Q mismatch can occur when a patient has pneumonia.

ventilation

-occurs as air moves into and out of the respiratory system through the process of inspiration and exhalation. -the structures of the respiratory system filter and humidify the air entering the system.

Decrease in end-tidal CO2 levels

-result from inadequate ventilation, respiration, or pulmonary perfusion -slow cellular metabolism, resulting in less CO2 production -hypoventilation, resulting in a decrease in the excretion of CO2 from the lungs -conditions that cause an increase in alveolar dead space and shunt, which causes inadequate pulmonary capillary perfusion. -hypothermia, sedation, pulmonary embolism, hypoperfusion of the pulmonary system, endotracheal tube placement in the esophagus, systemic hypotension, and cardiac arrest.

surfactant

-secreted by alveoli -prevents collapse, or atelectasis, from occurring. If atelectasis occurs, the alveoli are unable to participate in gas exchange, thus limiting the gas-exchange capacity of the lungs.

Your pt had a thoracentesis done this morning and wants to know about the dry sterile dressing applied to the site, what will you tell them?

-this area will be assessed for drainage and bleeding immediately following the procedure and prior to discharge if the patient is having the procedure completed as an outpatient -a minimal amount of blood on dressing is normal

Pulse oximetry

-utilizes wavelengths of light to measure the saturation of hemoglobin with oxygen. -noninvasive way to monitor changes in the patient's oxygenation status. -obtained by placing a probe on a patient's finger, although some devices may be applied to the ear, toes, or forehead. -95% and 99%. -Patients with chronic respiratory diseases may have baseline readings below 95%. -readings may be inaccurate if there is poor perfusion in the extremity being monitored.

You are the nurse and your pt is scheudled for a thoracentesis today. What pt education will you prove them with?

-you will need to sign a consent form and I will tell you the risks and benefits of the procedure -you will be under local anesthesia so you will be fully awake -you will need to remain still and not move -you will be in a sitting position -there will be a bedside table in front of you so you can lean against it during the procedure -it is normal for you to feel the need to cough but just try to breathe and avoid coughing

Your pt has a sputum collection scheduled for tomorrow and they have an endotracheal tube. They ask you if the tube will affect how the collection is done, what is your response?

-you will require hyperoxygenation prior to suctioning -once you are hyperoxygenated, I will insert the endotracheal tube utlizing sterile technique. -during your procedure I will monitor your R & HR -if i see any abnormal vital signs, I will note them, stop the procedure, and will hyperoxgenate you until your vitals return to baseline.

You are caring for a patient who is currently receiving continuous pulse oximetry. Which of the following findings might indicate inaccurate readings? A. The patient has a core body temperature of 94°F (34.5 °C). B. The heart rate obtained through pulse oximetry correlates with the electrocardiogram heart rate. C. The patient has the probe attached to her earlobe. D. The patient's pulse oximetry is 95%, and the patient denies shortness of breath.

A. Pulse oximetry values obtained on individuals whose core body temperature is below normal levels should be interpreted cautiously because hypothermia may cause poor perfusion in the extremity being monitored, affecting pulse oximetry values.

Your pt is scheduled for a bronchoscopy this afternoon, what statement by the patient needs further teaching? A. This is not an invasive procedure B. I need to sign a consent form prior C. I should not eat 8 hours prior to the procedure D. I should not drink 8 hours prior to the procedure

A. this is an invasive procedure, that is why the consent form is needed

The provider has ordered an arterial blood gas analysis for a patient. The nurse has selected the left radial artery to collect the specimen. Which of the following is essential to ensure adequate perfusion during the procedure? A. Placing the specimen immediately on ice following collection B. Assessing for left ulnar artery perfusion C. Holding pressure for 30 seconds post procedure D. Assessment of the radial pulse

B

You are the nurse monitoring a patient during a flexible bronchoscopy, what would require immediate action by you? select all that apply: a. the patient is responding to verbal stimuli and gentle touch b. the patient experiences respiratory depression c. the patient experiences bradycardia d. the patient experiences hypotension

B, C, D A is expected under moderate sedation

Your pt got a sputum analysis done this morning and you just got the results back. It was positive for abnormal cell growth, what should the nurse do next? A. call the lab back and have them redo the test because the pt should not have an abnormal result B. Order an analysis to determine if the cells are malignant or nonmalignant C. Call the provider D. Tell the pt they only have 6 months to live

B.

You are using the teach back method with a patient scheldued for a pulmonary function test. Which statement by the patient needs further education? A. I cannot smoke or eat 8 hours before my test B. I can take my bronchodilator (beta-2 agonist) 1 hour before my test C. You will be monitoring me during the test to avoid any complications like SOB or bronchospasm D. I will be asked to inspire and exhale into a mouthpiece during my test

B. bronchodilators (beta-2 agonist) should not be taken 4-6 hours prior to the test, not 1 hour

The nurse is caring for John, a 42-year-old male who was admitted to the hospital for pneumonia. He has a past medical history of hypertension. Which of the following abnormal assessment findings should the nurse expect as a result of the history obtained from John? A. An AP to lateral diameter of 1:2 B. Vesicular lung sounds over the trachea C. A productive cough D. Symmetrical chest expansion

C

Which of the following assessment findings indicates an emergency and the need for immediate action on the part of the nurse? A. Clubbing of the fingernails B. Contraction of the diaphragm C. Tracheal deviation D. Auscultation of rhonchi throughout the lungs

C

Which of the following is included in an arterial blood gas analysis? A. End-tidal CO2 B. Hemoglobin C. PaCO2 D. Sodium

C.

Your pt got a sputum analysis done this morning and you just got the results back. It was positive for microorganisms, what should the nurse do next? A. call the lab back and have them redo the test because the pt should not have an abnormal result B. Call the provider C. Order a sensitivity test to be performed to determine if there is an effective antibiotic therapy D. start the pt on antibiotics

C.

Your pt just got their lung chest x-ray back and shows possibly TB, what is the nurses next action? a. notify the provider b. start them on treatment for tb c. confirm the TB results with a diagnostic sputum culture d. send the patient home to get better on their own

C.

You are the head nurse with a freshly graduated RN following you around for the day. You have pt scheduled for a chest x-ray this afternoon. Which statement by the new nurse requires further teaching? A. The patient has on such a pretty necklace, its a shame she has to remove them prior to radiography B. We need to remind the patient she will need to remove her bra prior C. The whole body will be exposed during the x-ray D. Women of child bearing age need a pregnancy test confirmed prior to the test, and women who are pregnant should receive education regarding the risk to the fetus prior to undergoing x-ray and the test should be performed only if the benefits outweigh the risks to the fetus.

C. the x-ray technician should drape all body areas not being x-rayed in a lead shield to minimize radiation exposure

Your pt gets their pulmonary function test back and their results are: decreases in forced expiratory volume , what does this mean?

COPD or may be caused by age-related changes

Your pt gets their pulmonary function test back and their results are: Decreases in forced vital capacity , what does this mean?

COPD, sarcoidosis, pulmonary fibrosis, or neuromuscular diseases such as myasthenia gravis

Your pt gets their pulmonary function test back and their results are: increase in TLC, what does this mean?

Chronic obstructive pulmonary disease (COPD)

The nurse should monitor the site of the thoracentesis because excess drainage more than 500 ml may cause what? A. brain damage B. death C. dehydration D. hypotension

D.

Which of the following is a finding attributable to age-related changes? A. Kyphosis B. AP-to-lateral diameter of 1:1 C. PaCO2 of 47 on an arterial blood gas D. PaCO2 of 60 on an arterial blood gas

D. A PaO2 reading of 60 is an indication of hypoxemia and should be treated immediately

Which of the following is not a function of the respiratory system? A. Acid-base balance B. Facilitating speech C. Fluid balance D. Tissue perfusion

D. The circulatory system is responsible for tissue perfusion, not the respiratory system.

anatomical dead space

All of the structures from the nose or mouth to the level of the respiratory bronchioles are filled with air but do not participate in gas exchange

Tissue changes in elderly & what kind of impact does this have?

Decrease in elasticity of tissue The decrease in the elasticity of lung tissue increases the residual volume while decreasing vital capacity.

Your pt gets their pulmonary function test back and their results are: decreases in forced expiratory flow , what does this mean?

Disease processes related to obstructions such as asthma or COPD

sense of smell

The movement of air through the nose allows an individual to smell odors in the environment.

speech

The movement of air through the vocal cords allows vocalization of words.

pleural space

The space between the parietal and visceral pleurae

fluid balance

Water is excreted as water vapor through the exhalation process. This helps to maintain the body's fluid balance.

open lung biopsies require the use of what during the post op period?

a chest tube

Apnea

absent respirations

A capnometry value equal to or greater than 20 mm Hg indicates

adequate CPR compressions

Nurising implications prior to a bronchosocpy

all consent forms have been signed, patients identity is confirmed, and a time out has been performed

bronchoscopy

allows for direct visualization of the respiratory tract down to the level of the secondary bronchi

sinuses

are empty, air-filled cavities that humidify and warm inspired air; absorb shock, providing protection from facial trauma; provide voice resonance; and decrease the weight of the skull

Capnography and capnometry are both noninvasive and not uncomfortable unless...?

attached to an artificial airway (endotracheal tube or tracheostomy) because the artificial airway may cause discomfort.

fluid aspirated from pleural space during thoracentesis

can be analyzed to determine if microorganisms or abnormal cells are present.

Respiratory membrane

capillaries carry deoxygenated blood returning from systemic circulation. The deoxygenated blood flows through microscopic capillary beds to allow the red blood cells to come into contact with the capillary wall...the contact = RM -allows for the diffusion of oxygen into the red blood cells and carbon dioxide into the alveoli. The diffusion of these gases occurs because of a difference in the concentrations and thus pressures exerted by these gases between the red blood cell and alveoli. The concentration of oxygen is higher within the alveoli, causing oxygen to diffuse across the respiratory membrane into the red blood cell. The concentration of carbon dioxide is higher within the red blood cell, causing the diffusion of carbon dioxide into the alveoli.

Capnography

continuously monitors the PaCO2 in the airway during inhalation and exhalation and provides a written tracing.

sputum analysis

done to check for microorganisms and/or abnormal cell growth. If microorganisms are identified, then a sensitivity test is performed to determine an effective antibiotic therapy. If abnormal cells are identified, analysis to determine if the cells are malignant or nonmalignant is indicated. -5 ML is collected

Your pt has an abnormal capnography and capnometry reading, what does this mean?

dysfunction of the respiratory system in expelling CO2

Capnometry is typically utilized to confirm what?

endotracheal tube placement after intubation. It is applied to the end of the endotracheal tube. The device will show a color change to blue, indicating the presence of CO2 and intubation of the trachea. -Endotracheal tube placement should also be confirmed by auscultation and chest x-ray.

Pulmonary function tests

evaluate lung volumes to determine the functioning of the lungs. The patient is asked to inspire and exhale into a mouthpiece. During the test, the patient is given instructions to alter his or her breathing patterns, allowing for different tests to be obtained.

adenoids and palatine tonsils

filter out any foreign objects or microorganisms.

Before a pulmonary function test, normal values based on what are calculated to ensure the accuracy of the readings?

gender, weight, height, smoking history

Visceral pleura

inner thin layer of pleura lying closer to the lung tissue

trachial deviation

is an emergency and it's going to impair air movement into and out of the lungs -demonstrates unequal intrathoracic pressure and tension pneumothorax

capnometry

measures the amount of CO2 exhaled without continuous tracing.

upper respiratory tract

nose, mouth, sinuses, pharynx (throat), and larynx

retractions

occur when muscles pull inward during inspiration, sometimes causing the skin to pull in around ribs. This signifies increased work of breathing and respiratory distress.

Crepitus

occurs when air is trapped under the skin and is best described as a crackling feeling. -can be caused by a pneumothorax or trauma to the chest.

Alveolar dead space

occurs when there is impaired or absent respiration at the level of the alveoli. This can occur when there is a lack of perfusion of the alveoli by the pulmonary capillaries.

Parietal pleura

outer layer of pleura lying closer to the ribs and chest wall...covers the inside of a chest cavity

thyroid cartilage

protrudes from the neck and forms what is commonly known as the "Adam's apple."

Shunt

refers to blood that does not participate in gas exchange, or blood that returns to the left heart without being oxygenated. The two types of shunts are anatomical and physiological. Anatomical shunt refers to blood moving from the right to the left heart without traveling through the lungs. This can be caused by congenital heart defects. Physiological shunt occurs when alveoli are not functioning even though there is perfusion by the pulmonary capillaries. As a result, a portion of the blood returns to the left side of the heart deoxygenated. A shunt unit can occur as a result of atelectasis or collapse of the alveoli.

bradypnea

respiratory rates less than 12

pleural fluid

secreted by the pleural cells, is secreted between the two layers and acts as a lubricant. This allows the lungs to move freely during inspiration and expiration

Prior to using the device, the nurse should ensure what?

that the capnography equipment is calibrated and zeroed.

What does a abnormal finding on bronchoscopy assist in?

the diagnosis of respiratory conditions. Tissue specimens are analyzed to determine the presence of infectious processes or cellular abnormalities.

respiration

the exchange of oxygen and carbon dioxide between the outside air and the lungs occurs at the alveoli level

dyspnea

the patient's perception of being short of breath -is a subjective finding, objective data are needed to identify the cause; dyspnea may be caused by nonrespiratory disease processes such as anxiety.

Physiological dead space

the sum of both anatomical and alveolar dead space. In patients with normal or healthy respiratory function, physiological dead space is typically equal to anatomical dead space.

air aspirated from pleural space during thoracentesis

this is consistent with a pneumothorax diagnosis

Capnography measuring devices can be applied where?

to the end of an artificial airway or noninvasive oxygen delivery devices such as a nonrebreather mask. If the device is utilized on a mechanically ventilated patient, care must be taken not to disrupt the artificial airway, ventilator tubing, or capnography device.

lower respiratory tract

trachea and lungs

Rigid bronchoscopy

used to remove obstructions or large amounts of secretions from the respiratory tract. -typcially requires general anethesia and is performed in the OR

Flexible bronchoscopy

used to take tissue specimens or replace an endotracheal tube -can be performed at the bedside with the pt receiving moderate sedation and an IV pain med -will be able to respond to verbal stimuli or gentle touch

Patients may be discharged home following a thoracentesis with education as to signs and symptoms of complications and told to immediately report any of the following symptoms to their provider:

• Elevated heart rate/heart palpitations • Dyspnea/shortness of breath (SOB) • Chest pain • Hemoptysis (bloody secretions)

Mucociliary elevator

How the mucous moves up by the beating motion of the cilia

Reactivity of airway changes in elderly & what kind of impact does this have?

Increase in potential for bronchoconstriction The airways of older adults are more reactive than those of younger adults. Older adults have a delayed response to bronchodilators, increasing the possibility of hypoxia and hypercapnia from bronchoconstriction.

tachypnea

Respiratory rates greater than 20

Your pt gets their pulmonary function test back and their results are: decrease in TLC, what does this mean?

Sarcoidosis or pulmonary fibrosis

Your pt just got their sputum analysis back and it is positive for microorganisms...what infectious process could this be?

TB or pneumonia

acid-base balance

The exchange of carbon dioxide for oxygen in the lungs and the renal secretion of bicarbonate maintain the body's pH between 7.35 and 7.45. If carbon dioxide levels rise within the body, this results in a decrease in the pH level: acidosis. If carbon dioxide levels decrease, this results in an increase in the pH level: alkalosis.

CASE STUDY -Mr. Larry Thomas is a 66-year-old male complaining of shortness of breath for the past 2 weeks. He has come to his provider's office for evaluation of his symptoms. History of present illness: -Mr. Thomas reports chest pain that increases with coughing. He reports thick green/yellow sputum for the past week. His current weight is stable at 100 kg from his previous visit 6 months ago. He admits to occasionally smoking cigarettes ... -Past medical history: chronic obstructive pulmonary disease (COPD) and hypertension. He is unsure of his immunization status and does not remember receiving a PPD, or purified protein derivative skin test (most commonly a Mantoux test) to assess for TB, and denies receiving a flu shot. -Past surgical history: Denies -Allergies: No known medication, food, or environmental allergies -In addition to Mr. Thomas's complaint of shortness of breath, he reports chest pain that increases with coughing and thick yellow/green sputum for several days. His assessment is as follows: Inspection upper respiratory system: Nasal and mouth mucosa are pink; no bleeding, masses, or deformities are noted in the upper respiratory system. -Inspection lower respiratory system: Patient has a respiratory rate of 20, with even and unlabored respirations. During the history, the patient is speaking freely and does not report any shortness of breath while talking. The patient has skin that is appropriate for his ethnic background, with no skin integrity issues noted during inspection. -Palpation: No masses, deformities, or crepitus are noted. Trachea is midline and nontender. The patient has equal lung expansion anterior and posterior; the patient reports pain that increases with inspiration. -Percussion: Dullness over right lower lobe, otherwise hyperresonance Auscultation: Fine crackles in right lower lobe with inspiration and expiratory wheezes and diminished breath sounds noted throughout. Vital signs: -Temperature: 100°F (38°C) -Respiratory rate: 22 -Pulse oximetry on room air: 91% to 93% -Heart rate: 90 bpm -Blood pressure: 130/80 mm Hg -The chest x-ray notes pneumonia on the right lower lobe of the lung. On the basis of the diagnostic studies and assessment findings, the provider diagnoses Mr. Thomas with pneumonia and exacerbation of his COPD. Oral antibiotics are prescribed, and Mr. Thomas is advised to stay home from work until the symptoms subside. 1. Which of the following nursing diagnoses is the priority for Mr. Thomas on the basis of his diagnosis and symptoms? A. Impaired gas exchange B. Deficient knowledge C. Risk for infection D. Fluid volume deficit 2. Which of the following instructions should the nurse include in Mr. Thomas's teaching plan about the management of his pneumonia? (Select all that apply.) A. Begin a robust exercise program. B. Stop taking the antibiotics once his cough resolves. C. Smoking will exacerbate symptoms and should be avoided during recovery. D. To cough and deep breathe at least 10 times per hour to assist with airway clearance. E. Stay in bed to rest as much as possible. 3. Which statement by the patient with pneumonia indicates that teaching has been effective? A. "I will return to my provider's office if my symptoms are not improved 5 days after starting the antibiotics." B. "I can continue to smoke following my illness, and it will not have any impact on my respiratory status." C. "I will stop taking my blood pressure medication because it will increase my risk for developing pneumonia." D. "A fever is expected until I am finished with my course of antibiotics." 4. Which of the following indicates a worsening of Mr. Thomas's respiratory condition? A. Mr. Thomas is having difficulty speaking during the assessment. B. Mr. Thomas has wheezes bilaterally. C. Mr. Thomas's blood pressure has increased to 140/85 mm Hg. D. Mr. Thomas's pulse oximetry is 93% on room air. 5. On the basis of Mr. Thomas's past medical history, which of the following assessment findings will the nurse expect as a result? A. Clubbing of fingernails B. Wheezes upon auscultation C. Retractions on inspiration D. Poor skin turgor

1. A 2. D 3. A 4. A 5. A

The nurse is caring for a patient following a thoracentesis. Which of the following indicates the patient needs additional teaching regarding his or her discharge instructions? A. "I will be short of breath following the procedure, and my symptoms should resolve by the morning." B. "There may be a small amount of drainage noted on the dressing." C. "I will come back to the hospital if I experience chest pain." D. "I can eat my normal diet following discharge."

A

dead space

Areas of the tracheobronchial tree that do not participate in gas exchange or respiration

Mr. Jones is undergoing an open lung biopsy in the morning, and the nurse is educating the patient regarding the postoperative period. Which of the following statements should be included in the education? A. "You will be discharged home immediately following the procedure." B. "You most likely will have a chest tube inserted to allow your lung to re-expand." C. "You will need to collect a sputum specimen." D. "You will not need any supplemental oxygen."

B