Evolve - Respiratory

A nurse must administer streptomycin 1 g intramuscularly (IM) to a client with tuberculosis. The vial contains 500 mg/mL. How much solution must the nurse administer? Record your answer using a whole number. ___ mL

2 mL

A nurse is providing tracheostomy care. Which action is priority?

The tracheostomy site is a portal of entry for microorganisms. Sterile technique must be used. The high-Fowler position promotes maximum aeration of lungs. Body temperature is not related to the suctioning procedure. The cannula, if it is not disposable, generally is cleaned with peroxide and saline.

Levofloxacin 750 mg intravenous piggyback (IVPB) is prescribed for a client with pneumonia. The dose is available in 150 mL of 5% dextrose and is to infuse over 90 minutes. The administration set has a drop factor of 15 drops per mL. At how many drops per minute should the nurse regulate the IVPB to infuse? Record your answer using a whole number. ___ gtt/minute

25 gtt/min

The primary healthcare provider has prescribed different drugs for four clients with tuberculosis. Which client is at a risk of sunburn?

Client 4, who has been prescribed pyrazinamide, is at increased risk of sunburn. Pyrazinamide is a first-line anti-tubercular drug; it can cause photosensitivity and greatly increases the risk of sunburn. Client 1, prescribed rifampin, is at risk for unplanned pregnancy if also using an oral contraceptive. Client 2, prescribed isoniazid, is at risk for vitamin B-complex deficiency. Client 3, prescribed ethambutol, is at risk for optic neuritis.

Which client would the nurse consider to have the highest risk of pneumonia?

Correct 4 Client 4 Client 4, who is an older adult with chronic lung disease and has received the pneumococcal vaccination more than 5 years ago, has the highest risk of pneumonia. An infection may occur because older adults with chronic lung disease are at a higher risk of infection. Client 1 received the pneumococcal vaccination in the last 3 months and thus has a lower risk of pneumonia. Client 2 received a pneumococcal vaccination in the last 2 years and may not have an elevated risk of pneumonia. Client 3 may have a lower risk of pneumonia due to receiving the pneumococcal vaccine a year ago.

A client with emphysema experiences shortness of breath and uses pursed-lip breathing and accessory muscles of respiration. The nurse determines that the cause of the dyspnea is for which reason?

Emphysema involves destructive changes in the alveolar walls, leading to dilation of the air sacs; there is subsequent air trapping and difficulty with expiration. Bronchospasm is characteristic of asthma, not emphysema. The vital capacity is decreased because of restriction of the diaphragm and thoracic movement. Expiration is slowed by pursed-lip breathing to keep the airways open so less air is trapped.

The nurse assesses a client with emphysema. The nurse expects to find which sign of chronic obstructive pulmonary disease (COPD)?

In a client with emphysema, there is an increased AP diameter (barrel chest) because of air trapping and enlargement of the lungs with a loss of recoil ability. Decreased breath sounds, not increased, result from reduced airflow, pleural effusion, and destruction of lung tissue. There is enlargement of accessory muscles that are used during the expiratory phase to help force air out of the lungs. There is an increased expiratory phase of the respiratory cycle because of entrapment of air and collapse of airways.

A client being treated for influenza A (H1N1) is scheduled for a computed tomography (CT) scan. To ensure client and visitor safety during transport, the nurse should take which precaution?

Nurses should provide influenza clients with face masks to wear for source control and tissues to contain secretions when outside of their room. Special precautions such as face masks should be taken to decrease the risk of further outbreak. Minimizing close physical contact is not indicated. Covering the client with a blanket is for comfort and privacy, not because of a transmission precaution.

The primary healthcare provider prescribed antitubercular medications to four clients with tuberculosis. Which client is at risk for hyperuricemia?

Pyrazinamide is an antitubercular medication that causes hyperuricemia. Client A is at risk for hyperuricemia. Client B, who is prescribed isoniazid, is at risk for hepatitis. Client C, who is prescribed ethambutol, is at risk for ocular toxicity. Client D, who is prescribed rifampin, is at risk for thrombocytopenia.

The nurse is teaching a group of parents about the side effects of vaccines. Which side effect should the nurse include in teaching about the Haemophilus influenzae (Hib) vaccine?

The Hib vaccine may cause a low-grade fever. Lethargy is not expected. Urticaria is more likely to occur with the tetanus and pertussis vaccines. There may be a mild reaction at the injection site, but a generalized rash is not expected.

The nurse instructed a client with asthma about the use of a peak flow meter at home. The client assesses the peak expiratory flow by using the peak flow meter. Which action performed by the client would be appropriate when the reading is in the yellow zone?

4 Reassess the asthma plan and change the controller medication Yellow is a range between 50% and 80% of personal best. When the reading is in this range, the client is recommended to use the prescribed reliever drug. After a few minutes of the intake of a prescribed reliever drug, the peak expiratory flow should be determined again to know the effect of the reliever medication. Prescribed drug therapy should not be increased without consulting the primary healthcare advisor. Reassessing the asthma plan and changing the controller medication would be required when there are frequents reading in the yellow zone.

An older client with shortness of breath is admitted to the hospital. The medical history reveals hypertension in the last year and a diagnosis of pneumonia three days ago. Which vital sign assessment would be seen as a sign that the client needs immediate medical attention?

An oxygen saturation less than 90% observed in a client with pneumonia indicates that the client is at risk of respiratory depression. Oxygen saturation would take priority in initiating the care. The client's body temperature indicates fever due to pneumonia, which should be considered secondary to the oxygen saturation problem. The blood pressure reading is normal. The increased respiratory rate may be due to fever, which would be considered secondary to the oxygen saturation problem.

What is the priority goal for a client with asthma who is being discharged from the hospital with prescriptions for inhaled bronchodilators?

Clients with asthma use metered-dose inhalers to administer medications prophylactically or during times of an asthma attack; this is an important skill to have before discharge. Pulse oximetry is rarely conducted in the home; home management usually includes self-monitoring of the peak expiratory flow rate. Although knowing the healthcare provider's office hours is important, it is not the priority; during a persistent asthma attack that does not respond to planned interventions, the client should go to the emergency department of the local hospital or call 911 for assistance. Not all asthma is associated with food allergies.

Which client would the nurse state shows symptoms of influenza?

Headache, muscle aches, fever, chills, fatigue, weakness, sore throat, cough, watery nasal discharge lasting for more than a week, nausea, vomiting, and diarrhea are the signs and symptoms of seasonal influenza, which is an acute, viral respiratory infection. Headache, nasal irritation, sneezing, nasal congestion, watery drainage from the nose, and itchy and watery eyes are the symptoms of rhinitis, an infection of the nose. A client with sinusitis, which is an infection of the sinuses, will show symptoms such as pain over the cheek, pain to the back of the head, and general facial pain that worsens when bending forward, purulent nasal drainage, and fever. Throat soreness and dryness, throat pain, pain on swallowing, difficulty swallowing, and fever are symptoms that may be experienced by a client with tonsillitis, which is an infection of the tonsils.

Which figure may indicate the client has a risk of emphysema?

In option 3 the angle between the nail plate and the proximal nail fold exceeds 180 degrees, which may be associated with emphysema. The angle of 160 degrees between the nail plate and the proximal nail fold with a slightly convex surface and palpated firm base (option 1) is a normal finding. The straightened angle between the nail plate and the proximal nail fold to 180 degrees (option 2) is depicted; it may indicate the risk of hypoxia. The flattening of the nail plate with an increased smoothness of the nail surface (option 4) may be associated with iron deficiency.

The nurse is evaluating the actions of a client with pneumonia performing incentive spirometry. Which action by the client indicates a need for correction?

Incentive spirometry is used to improve inspiratory muscle action and to prevent or reverse atelectasis in a client with pneumonia. The client is instructed to exhale fully and then insert the mouthpiece. Inhaling the air before inserting the mouthpiece may cause harm to the client and therefore needs correction. After the process is completed, the volume of air inspired is recorded. A client with pneumonia is instructed to perform 10 breaths per session every hour while awake. Taking a long, slow, deep breath keeping the mouthpiece in place helps to improve inspiratory muscle action.

A client with tuberculosis is prescribed rifampin. What does the nurse teach the client about this medication? Select all that apply.

Rifampin is an antitubercular drug that kills slow-growing organisms residing in the caseating granulomas. Rifampin may cause liver damage, so alcohol should be avoided as it potentiates liver damage. Yellow appearance to the skin is a sign of liver failure. Therefore, a client on rifampin therapy is taught to report the presence of any yellowing of the skin. Rifampin permanently stains soft contact lenses and therefore the client is made aware to avoid wearing them while on the medication. Pyrazinamide causes photosensitivity reactions and therefore a client on that drug therapy is advised to wear protective clothing and sunscreen when going outdoors. The nurse should inform the client that rifampin changes the color of body secretions, which is normal and harmless.

A client with a history of emphysema develops a respiratory infection and is admitted to the hospital in acute respiratory distress. The client's arterial blood studies indicate pH 7.30, PO2 60 mm Hg, PCO2 55 mm Hg, and HCO3 23 mEq/L (23 mmol/L). How should the nurse interpret these findings?

The client is experiencing respiratory acidosis. The pH is less than the norm of 7.35 to 7.45, indicating acidosis. The PO2 is less than the norm of 80 to 100 mm Hg. The PCO2 is increased more than the norm of 35 to 45 mm Hg. The HCO3 is within the norm of 21 to 28 mEq/L (21 to 28 mmol/L). These results indicate a respiratory etiology. The client's carbon dioxide level is increased (hypercapnia), not decreased. These values are unrelated to hyperkalemia; a serum potassium level of more than 5 mEq/L (5 mmol/L) indicates hyperkalemia. These values are unrelated to anemia; decreased levels of red blood cells (RBCs), hemoglobin, and hematocrit are related to anemia.

A client is being treated for influenza A (H1N1). The nurse has provided instructions to the client about how to decrease the risk of transmission to others. Which client statement indicates a need for further instruction?

The client should be encouraged to receive an influenza vaccine each year. Pneumococcal vaccines will not prevent influenza. The nurse should stress the importance of practicing respiratory hygiene/cough etiquette. The client should avoid contact with vulnerable populations such as the elderly and children. Visitors for clients in isolation for influenza should be limited to persons who are necessary for the client's emotional well-being and care. Visitors who have been in contact with the client before and during hospitalization are a possible source of influenza for other clients, visitors, and staff.

A nurse is suctioning a client's tracheostomy. Place the nursing actions in order of priority when performing this procedure.

The status of the client should be ascertained as a baseline before starting the procedure. The suction should be turned on to check its adequacy before beginning. Because oxygen will be lost during suctioning [1] [2], the client should be oxygenated using 100% oxygen before initiating the procedure. Then the nurse should don sterile gloves to protect the client from infection and guide the catheter into the tracheostomy tube without using negative pressure.

A primary healthcare provider has prescribed pyrazinamide to a client with tuberculosis. Which instruction by the nurse will be beneficial to the client? Select all that apply.

A client undergoing pyrazinamide therapy may require extra fluids to help prevent uric acid formation from precipitating and causing gout or kidney problems. Therefore the client should drink at least 8 ounces of water with the medication. The client should also avoid alcoholic beverages, which could potentiate liver toxicity. Staining is a common problem with rifampin, not pyrazinamide. The client should also report any darkening of urine because this may be a sign of liver toxicity or damage. The client should report any vision changes if he or she is taking etambutol.

The nurse is caring for a client with tuberculosis. Which suggestions from the nurse will be beneficial for the client? Select all that apply.

A client with tuberculosis should avoid exposure to any inhalation irritants because these can cause further lung damage. To increase physical stamina, the client should eat a well-balanced diet that includes foods that are rich in iron, protein, and vitamins C and B. While coughing or sneezing, the client should cover the mouth and nose with a tissue to prevent spread of infection. A client with tuberculosis should take the daily dose at nighttime to prevent nausea. Sputum specimens are usually needed every 2 to 4 weeks once the drug therapy is initiated. When the results of three consecutive sputum cultures are negative it indicates that the client is no longer infectious.

When helping a client with emphysema, the nurse employs several steps to teach pursed-lip breathing. Place these steps of the process in the correct sequence.

The sitting position [1] [2] allows for maximum lung expansion because gravity lowers abdominal organs and diaphragm. A deep, slow inspiration is taken to fully expand lungs. After the inspiration, the lips then are pursed to prevent rapid exhalation. The lungs are deflated through the pursed lips for a time equal to or exceeding that of inhalation. After being taught the skill, the client should provide a return demonstration as evidence that learning has taken place.

What are the symptoms of tuberculosis? Select all that apply.

Tuberculosis is an infectious respiratory disease caused by Mycobacterium tuberculosis. Signs include a persistent cough, anorexia, hemoptysis, night sweats, shortness of breath, and a high body temperature. Diarrhea and weight gain are not associated with tuberculosis.

When suctioning a client with a tracheostomy, an important safety measure for the nurse is to do what?

Use of suction upon withdrawal of a suction catheter reduces unnecessary removal of oxygen. In addition, suction should be applied intermittently during the withdrawal procedure to prevent hypoxia. A sterile catheter is used to prevent infection and the catheter should only be inserted approximately 1 to 2 cm past the end of the tracheostomy tube to prevent tissue trauma. Hyperventilating a client before suctioning should always be with oxygen, not room air. Inserting the catheter until the cough reflex is stimulated frequently occurs and does help to mobilize secretions, but is not a safety measure. Removal of the inner cannula before inserting the suction catheter is not necessary.