Chapter 19- Lower Respiratory Disorders

Acute respiratory failure (ARF) occurs when oxygen tension (PaO2) falls to less than __________ mm Hg (hypoxemia) and carbon dioxide tension (PaCO2) rises to greater than __________ mm Hg (hypercapnia). 75; 40 75; 50 60; 40 60; 50

60, 50

The nurse is caring for a client following a wedge resection. While the nurse is assessing the client's chest tube drainage system, constant bubbling is noted in the water seal chamber. This finding indicates which problem? Increased drainage Tension pneumothorax Air leak Tidaling

Air leak

A client arrived in the emergency department with a sharp object penetrating the diaphragm. When planning nursing care, which client need would the nurse identify as a priority? Acute pain Ineffective airway clearance Infection risk Impaired gas exchange

Impaired gas exchange

The most diagnostic clinical symptom of pleurisy is: Stabbing pain during respiratory movements. Dyspnea and coughing. Fever and chills. Dullness or flatness on percussion over areas of collected fluid.

Stabbing pain during respiratory movements. *Friction rub (grating lung sounds) is another symptom

A nurse is giving a speech addressing "Communicable Diseases of Winter" to a large group of volunteer women, most of whom are older than 60 years. What preventive measures should the nurse recommend to these women, who are at the risk of pneumococcal and influenza infections? Select all that apply. prescribed opioids vaccinations hand antisepsis incentive spirometry

vaccine hand antisepsis

A patient taking isoniazid (INH) therapy for tuberculosis demonstrates understanding when making which statement? "It is fine if I eat sushi with a little bit of soy sauce." "It is all right if I have a grilled cheese sandwich with American cheese." "I am going to have a tuna fish sandwich for lunch." "It is all right if I drink a glass of red wine with my dinner."

"It is all right if I have a grilled cheese sandwich with American cheese." Patients should avoid tyramine and histamine (tuna, aged cheese, red wine, soy sauce, yeast extracts), because eating them while taking INH may result in headache, flushing, hypotension, lightheadedness, palpitations, and diaphoresis.

A nurse is caring for a client with COPD who needs teaching on pursed-lip breathing. Place the steps in order in which the nurse will instruct the client. 1 "Inhale through your nose." 2 "Exhale slowly through pursed lips." 3 "Slowly count to 7." 4 "Slowly count to 3."

1-4-2-3

A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia? A client with a nasogastric tube A client who ambulates in the hallway every 4 hours A client with a history of smoking two packs of cigarettes per day until quitting 2 years ago A client who is receiving acetaminophen (Tylenol) for pain

A client with a nasogastric tube Nasogastric, orogastric, and endotracheal tubes increase the risk of pneumonia because of the risk of aspiration from improperly placed tubes. Frequent oral hygiene and checking tube placement help prevent aspiration and pneumonia. Although a client who smokes is at increased risk for pneumonia, the risk decreases if the client has stopped smoking

The nurse is caring for a client following a thoracotomy. Which finding requires immediate intervention by the nurse? Moderate amounts of colorless sputum Chest tube drainage, 190 mL/hr Heart rate, 112 bpm Pain of 5 on a 1-to-10 scale

Chest tube drainage, 190 mL/hr The nurse should monitor and document the amount and character of drainage every 2 hours. The nurse must notify the primary provider if drainage is ≥150 mL/hr. The other findings are normal following a thoracotomy and no intervention would be required.

The nurse is collaborating with a community group to develop plans to reduce the incidence of lung cancer in the community. Which of the following would be most effective? Classes at community centers to teach about smoking cessation strategies Advertisements in public places to encourage cigarette smokers to have yearly chest x-rays Public service announcements on television to promote the use of high-efficiency particulate air (HEPA) filters in homes Legislation that requires homes and apartments be checked for asbestos leakage

Classes at community centers to teach about smoking cessation strategies

The nurse is auscultating the patient's lung sounds to determine the presence of pulmonary edema. What adventitious lung sounds are significant for pulmonary edema? Pleural friction rub Low-pitched rhonchi during expiration Sibilant wheezes Crackles in the lung bases

Crackles in the lung bases

A physician determines that a client has been exposed to someone with tuberculosis. The nurse expects the physician to order which treatment? Daily oral doses of isoniazid (Nydrazid) and rifampin (Rifadin) for 6 months to 2 years Isolation until 24 hours after antitubercular therapy begins Daily doses of isoniazid, 300 mg for 6 months to 1 year Nothing, until signs of active disease arise

Daily doses of isoniazid, 300 mg for 6 months to 1 year Explanation: All clients exposed to persons with tuberculosis should receive prophylactic isoniazid in daily doses of 300 mg for 6 months to 1 year to avoid the deleterious effects of the latent mycobacterium. Daily oral doses of isoniazid and rifampin for 6 months to 2 years are appropriate for the client with active tuberculosis. Isolation for 2 to 4 weeks is warranted for a client with active tuberculosis.

What is the reason for chest tubes after thoracic surgery? Draining secretions, air, and blood from the thoracic cavity is necessary. Chest tubes allow air into the pleural space. Chest tubes indicate when the lungs have re-expanded by ceasing to bubble. Draining secretions and blood while allowing air to remain in the thoracic cavity is necessary.

Draining secretions, air, and blood from the thoracic cavity is necessary. chest tubes treats pneumothorax, hemothorax, empyema

A client is recovering from thoracic surgery needed to perform a right lower lobectomy. Which of the following is the most likely postoperative nursing intervention? Assist with positioning the client on the right side. Restrict intravenous fluids for at least 24 hours. Encourage coughing to mobilize secretions. Make sure that a thoracotomy tube is linked to open chest drainage.

Encourage coughing to mobilize secretions.

A client recovering from thoracic surgery is on long-term mechanical ventilation and becomes very frustrated when he tries to communicate. What intervention should the nurse perform to assist the client? Assure the client that everything will be all right and that remaining calm is the best strategy. Ask the physician to wean the client off the mechanical ventilator to allow the patient to speak freely. Ask a family member to interpret what the client is trying to communicate. Express empathy and then encourage the client to write, use a picture board, or spell words with an alphabet board

Express empathy and then encourage the client to write, use a picture board, or spell words with an alphabet board. this comforts the pt and allow for effective communication between pt and nurse

A client with myasthenia gravis is receiving continuous mechanical ventilation. When the high-pressure alarm on the ventilator sounds, what should the nurse do? Ventilate the client with a handheld mechanical ventilator. Increase the oxygen percentage. Check for an apical pulse. Suction the client's artificial airway.

Suction the client's artificial airway. The nurse should suction the client's artificial airway to remove respiratory secretions that could be causing the obstruction.

A mediastinal shift occurs in which type of chest disorder? Simple pneumothorax Tension pneumothorax Traumatic pneumothorax Cardiac tamponade

Tension pneumothorax A tension pneumothorax causes the lung to collapse and the heart, the great vessels, and the trachea to shift toward the unaffected side of the chest (mediastinal shift). A traumatic pneumothorax occurs when air escapes from a laceration in the lung itself and enters the pleural space or enters the pleural space through a wound in the chest wall. A simple pneumothorax most commonly occurs as air enters the pleural space through the rupture of a bleb or a bronchopleural fistula. Cardiac tamponade is compression of the heart resulting from fluid or blood within the pericardial sac.

After undergoing a left thoracotomy, a client has a chest tube in place. When caring for this client, the nurse must: encourage coughing and deep breathing. milk the chest tube every 2 hours. clamp the chest tube once every shift. report fluctuations in the water-seal chamber

encourage coughing and deep breathing. milk the tube only if blood drainage is stuck clamping is not necessary fluctuations are supposed to happen

The nurse is caring for a client who is receiving oxygen therapy for pneumonia. The nurse should best assess whether the client is hypoxemic by monitoring the client's: oxygen saturation level. extremities for signs of cyanosis. level of consciousness (LOC). hemoglobin, hematocrit, and red blood cell levels.

oxygen saturation level.

A nurse is caring for a client who was intubated because of respiratory failure. The client is now receiving mechanical ventilation with a preset tidal volume and number of breaths each minute. The client has the ability to breathe spontaneously between the ventilator breaths with no ventilator assistance. The nurse should document the ventilator setting as: synchronized intermittent mandatory ventilation (SIMV). continuous positive airway pressure (CPAP). pressure support ventilation (PSV). assist-control (AC) ventilation.

synchronized intermittent mandatory ventilation (SIMV). In SIMV mode, the ventilator delivers a preset number of breaths at a preset tidal volume. The client can breathe on his own in between the breaths delivered by the ventilator. In PSV, a pressure plateau is added to the ventilator to prevent the airway pressure from falling beneath a preset level. In AC ventilation, the ventilator delivers a preset number of breaths at a preset tidal volume and any breaths that the client takes on his own are assisted by the ventilator so they reach the preset tidal volume. In CPAP, the ventilator provides only positive airway pressure; it doesn't provide any breaths to the client.

The nurse caring for a 2-year-old near-drowning victim monitors for what possible complication? Respiratory acidosis Acute respiratory distress syndrome Atelectasis Metabolic alkalosis

Acute respiratory distress syndrome Factors associated with the development of acute respiratory distress syndrome include aspiration related to near drowning or vomiting; drug ingestion/overdose; hematologic disorders such as disseminated intravascular coagulation or massive transfusions; direct damage to the lungs through prolonged smoke inhalation or other corrosive substances; localized lung infection; metabolic disorders such as pancreatitis or uremia; shock; trauma such as chest contusions, multiple fractures, or head injury; any major surgery; embolism; and septicemia.

A nurse is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which intervention will most likely lower the client's arterial blood oxygen saturation? Endotracheal suctioning Incentive spirometry Encouragement of coughing Use of a cooling blanket

Endotracheal suctioning Endotracheal suctioning removes secretions as well as gases from the airway and lowers the arterial oxygen saturation (SaO2) level. Coughing and using an incentive spirometer improve oxygenation and should raise or maintain oxygen saturation. Because of superficial vasoconstriction, using a cooling blanket can lower peripheral oxygen saturation readings, but SaO2 levels wouldn't be affected.

A nurse is attempting to wean a client after 2 days on the mechanical ventilator. The client has an endotracheal tube present with the cuff inflated to 15 mm Hg. The nurse has suctioned the client with return of small amounts of thin white mucus. Lung sounds are clear. Oxygen saturation levels are 91%. What is the priority nursing diagnosis for this client? Impaired physical mobility related to being on a ventilator Impaired gas exchange related to ventilator setting adjustments Risk for trauma related to endotracheal intubation and cuff pressure Risk for infection related to endotracheal intubation and suctioning

Impaired gas exchange related to ventilator setting adjustments * O2 should between 95-100%