patho/pharm exam 2 ch.27

The nurse is caring for a client with a right-sided chest tube secondary to a pneu- mothorax. Which interventions should the nurse implement when caring for this client? Select all that apply. 1. Place the client in a low-Fowler's position. 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. The system must be patent and intact to function properly. ***4. Looping the tubing prevents direct pres- sure on the chest tube itself and keeps tubing off the floor, addressing both a safety and an infection control issue. ***5. Subcutaneous emphysema is air under the skin, which is a common occurrence at the chest tube insertion site.

The nurse is presenting a class on chest tubes. Which statement describes a tension pneumothorax? 1. A tension pneumothorax develops when an air-filled bleb on the surface of the lung ruptures. 2. When a tension pneumothorax occurs, the air moves freely between the pleural space and the atmosphere. 3. The injury allows air into the pleural space but prevents it from escaping from the pleural space. 4. A tension pneumothorax results from a puncture of the pleura during a central line placement.

***3. This describes a tension pneumothorax. It is a medical emergency requiring immediate intervention to preserve life.

The client is admitted to the emergency department with chest trauma. When assess- ing the client, which signs/symptoms would the nurse expect to find that support the diagnosis of pneumothorax? 1. Bronchovesicular 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 would indicate a pneumothorax.

A patient reports fatigue and an inability to lie flat. During anassessment, the nurse finds the patient has an increased blood pressure and an increased pulse rate. Further assessment reveals that the patient is dizzy, unable to concentrate, and has a decreased level of consciousness. Which condition does the nurse suspect? 1Hypoxia 2Hypoxemia 3Hypovolemia 4Hyperventilation

1 Hypoxia

The physician has prescribed salmeterol (Serevent) for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, what instructions should the nurse provide? 1. "Close lips tightly around the mouthpiece and breathe in deeply and quickly." 2. "To administer a DPI, you must use a spacer that holds the medicine so that you can inhale it." 3. "You will know you have correctly used the DPI when you taste or sense the medicine going into your lungs." 4. "Hold the inhaler several inches in front of your mouth and breathe in slowly, holding the medicine as long as possible."

1. "Close lips tightly around the mouthpiece and breathe in deeply and quickly."a. The patient should be instructed to tightly close the lips around the mouthpiece and breathe in deeply and quickly to ensure the medicine moves down deeply into the lungs. Dry powder inhalers do not require spacer devices. The patient may not taste or sense the medicine going into the lungs.

When preparing to assist a patient who is at risk for aspiration with eating a meal, the nurse best ensures patient safety by first: 1. Assessing the patient's gag reflex. 2. Providing appropriate suction equipment. 3. Determining the need for a thickening agent. 4. Elevating the head of the bed to at least 45 degrees.

1. Assessing the patient's gag reflex.

An 86-year old woman is admitted to the unit with chills and a fever of 104*F. What physiological process explains why she is at risk for dyspnea? 1. Fever increases metabolic demands, requiring increased oxygen need 2. Blood glucose stores are depleted and the cells do not have energy to use oxygen 3. Carbon dioxide production increases due to hyperventilation 4. Carbon dioxide production decreases due to hypoventilation

1. Fever increases metabolic demands, requiring increased oxygen need

Which of the following actions should have priority in order to best ensure that the patient has the ability to swallow effectively? 1. Palpate the patient's larynx for movement while swallowing normally. 2. Ask the patient if he or she has a history of difficulty chewing or swallowing. 3. Interview the patient regarding specific foods that are difficult for him or her to swallow. 4. Arrange for a dietary consultation in order to fully assess the patient's risk for aspiration.

1. Palpate the patient's larynx for movement while swallowing normally.

The nurse is preparing a list of home care instructions for a client who is hospitalized and treated for tuberculosis. 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 culture 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 one sputum culture is negative the client is no longer considered infectious and usually can return to employment

1. activities should be resumed gradually 3. a sputum culture 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

the community health nurse is conducting an educational session with community members regarding signs and symptoms associated with TB. The nurse informs the participants that tuberculosis is considered a dx if which signs and symptoms 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. dyspnea 3. night sweats 4. a bloody, productive cough 5. a cough with the expectoration of mucoid sputum

What are the symptoms of hypoventilation? Select all that apply. 1Convulsions 2Dysrhythmias 3Sighing breaths 4Changes in mental status 5Numbness and tingling of hands

1Convulsions 2Dysrhythmias 4Changes in mental status

A patient wants to understand the mechanism of respiration. What should the nurse explain to the patient? Select all that apply. 1Normal breathing is quiet with minimum or no effort. 2Ventilation is the process of air moving in and out of lungs. 3Normal breathing is noisy and requires all the chest muscles. 4The diaphragm is an important muscle that helps in breathing. 5Ventilation is the process of oxygenated blood flowing in the body.

1Normal breathing is quiet with minimum or no effort. 2Ventilation is the process of air moving in and out of lungs. 4The diaphragm is an important muscle that helps in breathing.

A patient with chronic obstructive pulmonary disease (COPD) is on oxygen therapy. The arterial blood gas analysis after some time reveals that the carbon dioxide levels are high. The patient's condition improves when the amount of oxygen administered (fraction of inspired oxygen) is reduced. Which is the most probable reason for high levels of carbon dioxide in the patient? 1Hypoxia 2Hypoventilation 3Hyperventilation 4Respiratory alkalosis

2 Hypoventilation

A patient who has hypoxia is hospitalized. The nurse observes central cyanosis on the patient's tongue, soft palate, and conjunctiva. What should the nurse suspect based on this observation? 1Atelectasis 2Hypoxemia 3Hypovolemia 4Hyperventilation

2 Hypoxemia

The nurse assesses a patient who is short of breath and fatigued. The nurse finds that the oxygen saturation of the blood is reduced. The lab report indicates that the patient's red blood cell count is increased. What do these findings suggest? 1The patient has anemia. 2The patient has chronic hypoxemia. 3The patient has hypoventilation. 4The patient has an acute infection.

2 The patient has chronic hypoxemia.

A dependent patient at risk of aspiration needs help with eating breakfast. Which statement by the nurse maximizes the ancillary staff member's ability to manage the situation if aspiration occurs? 1. "What are you prepared to do if the patient starts gagging?" 2. "Remember to have the suction equipment readily available." 3. "Do you understand the importance of evaluating the ability to swallow?" 4. "If you have any reason to believe that the patient is choking, call me immediately."

2. "Remember to have the suction equipment readily available."

An elderly, confused patient with a history of choking while eating requires assistance with breakfast. Which statement, made by ancillary staff, reflects an understanding of the importance of appropriately communicating with the nurse regarding this intervention? 1. "Do you think I could encourage her to sit up in a chair when eating breakfast?" 2. "The patient began coughing when I gave her some coffee, so I didn't offer it again" 3. "How much of those thickened liquids on the tray should the patient actually drink?" 4. "The patient did very well eating the birthday cake the family brought in last evening"

2. "The patient began coughing when I gave her some coffee, so I didn't offer it again"

the nurses 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. Low arterial PCO2 level 2. A hyperinflated chest noted on x-ray 3. decreased O2 sat with mild exercise 4. A widened diaphragm noted on the chest x-ray 5. PFT that demonstrate increased vital capacity

2. A hyperinflated chest noted on x-ray 3. decreased O2 sat with mild exercise

A 45-year-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which clinical manifestation might be present as an early manifestation during an exacerbation of asthma? 1. Anxiety 2. Cyanosis 3. Bradycardia 4. Hypercapnia

2. Anxiety a. An early manifestation during an asthma attack is anxiety because the patient is acutely aware of the inability to get sufficient air to breathe. He will be hypoxic early on with decreased PaCO2 and increased pH as he is hyperventilating. If cyanosis occurs, it is a later sign. The pulse and blood pressure will be increased.

the nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic period. Which position should the nurse instruct the client to assume? 1. Sitting up in bed 2. side lying in bed 3. sitting in a recliner chair 4. sitting up and leaning on an overbed table

4. sitting up and leaning on an overbed table

A patient is admitted to the emergency department with suspected carbon monoxide poisoning. Even though the patient's color is ruddy and not cyanotic, the nurse understands the patient is at a risk for decreased oxygen-carrying capacity of blood because carbon monoxide does which of the following? 1. Stimulates hyperventilation, causing respiratory alkalosis 2. Forms a strong bond with hemoglobin, thus preventing oxygen binding in the lungs 3. Stimulates hypoventilation, causing respiratory acidosis 4. Causes alveoli to overinflate, leading to atelectasis

2. Forms a strong bond with hemoglobin, thus preventing oxygen binding in the lungs

a client who has been diagnosed with tuberculosis has been placed on drug therapy. the medication regimen includes rifampin. which instruction should the nurse give to the client about the potential adverse effects of rifampin. Select all that apply. 1. have eye examinations every 6 months 2. maintain follow up monitoring of liver enzymes 3. decrease protein intake in the diet 4. avoid alcohol intake 5. the urine may have an orange color

2. maintain follow up monitoring of liver enzymes 4. avoid alcohol intake 5. the urine may have an orange color

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

2. particulate respirator, mask, and gloves

A patient has a condition in which the lungs remove carbon dioxide faster than it is produced by cellular metabolism. Which predisposing factors contribute to this condition? Select all that apply. 1Cyanosis 2Infection 3Severe anxiety 4Acid-base imbalance 5Multiple rib fracture

2Infection 3Severe anxiety 4Acid-base imbalance

A registered nurse discusses physiological factors that affect oxygenation with a group of nursing students. Which statement if made by the nursing student is correct? 1"The metabolic rate decreases normally in pregnancy, wound healing, and exercise." 2"The physiological response to chronic hypoxia is an increase in white blood cell production." 3"Carbon monoxide is the most common toxic inhalant; it decreases the oxygen-carrying capacity of the blood." 4"The oxygen carrying capacity of the blood increases when there is a decline in inspired oxygen concentration.

3"Carbon monoxide is the most common toxic inhalant; it decreases the oxygen-carrying capacity of the blood

Which of the following patients should not be initially assigned to ancillary staff to assistwith feeding because of a potential risk for aspiration? 1. 66-year-old patient with a history of petit mal seizures 2. 76-year-old hospice patient currently experiencing dyspnea 3. 85-year-old patient diagnosed with advanced Alzheimer disease 4. 47-year-old patient recently diagnosed with an oral cancerous lesion

3. 85-year-old patient diagnosed with advanced Alzheimer disease Advanced Alzheimer patients have dysphagia

The nurse is caring for a client with bacterial pneumonia. The effectiveness of the client's oxygen therapy can best be determined by the: 1. Absence of cyanosis 2. Client's RR 3. ABG values 4. Client's level of conciousness

3. ABG values

The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. What is the primary reason for the nurse to carefully inspect the chest wall of this patient? 1. Allow time to calm the patient. 2. Observe for signs of diaphoresis. 3. Evaluate the use of intercostal muscles. 4. Monitor the patient for bilateral chest expansion.

3. Evaluate the use of intercostal muscles. a. The nurse physically inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of respiratory distress experienced by the patient. The other options may also occur, but they are not the primary reason for inspecting the chest wall of this patient.

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

3. sputum culture

In which condition do the lungs remove carbon dioxide faster than it is produced by cellular metabolism? 1Hypoxia 2Hypoxemia 3Hypovolemia 4Hyperventilation

4 Hyperventilation

The nurse has conducted a discharge teaching with a client dx with tb who has been recieving meds for 2 weeks. the nurse determines that the pt has understood the information if the client makes which statement? 1."i need to continue the medication therapy for one 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"

Which position is most appropriate for the nurse to place a patient experiencing an asthma exacerbation? 1. Supine 2. Lithotomy 3. High Fowler's 4. Reverse Trendelenburg

4. High Fowler's a. The patient experiencing an asthma attack should be placed in high Fowler's position and may need to lean forward to allow for optimal chest expansion and enlist the aid of gravity during inspiration. The supine, lithotomy, and reverse Trendelenburg positions will not facilitation ventilation.

Nurse is caring for a client with R sided chest tube that is accidentally pulled out of the pleural space. Which action should be implemented first? 1. Notify doctor to have chest tube reinserted STAT 2. Instruct client to take slow shallow breaths until chest tube is reinserted 3. Take no action and assess the client's resp status every 15 min 4. Tape a petroleum jelly occlusive dressing on 3 sides to insertion site.

4. Prevent development of tension pneumothorax

the nurse should indicate which instruction when developing a teaching plan for a client who is receiving isonaizid and rifampin for tx of tb? 1. take the medication with antacids 2. double the dosage if a drug dose is missed 3. increase intake of dairy products 4. avoid alcohol

4. avoid alcohol

The nurse is caring for a patient with an acute exacerbation of asthma. Following initial treatment, what finding indicates to the nurse that the patient's respiratory status is improving? 1. Wheezing becomes louder. 2. Cough remains nonproductive. 3. Vesicular breath sounds decrease. 4. Aerosol bronchodilators stimulate coughing.

5. Wheezing becomes louder. a. The primary problem during an exacerbation of asthma is narrowing of the airway and subsequent diminished air exchange. As the airways begin to dilate, wheezing gets louder because of better air exchange. Vesicular breath sounds will increase with improved respiratory status. After a severe asthma exacerbation, the cough may be productive and stringy. Coughing after aerosol bronchodilators may indicate a problem with the inhaler or its use.

The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma. In patients with asthma, the nurse assesses for which etiologic factor for this nursing diagnosis? 1. Work of breathing 2. Fear of suffocation 3. Effects of medications 4. Anxiety and restlessness

6. Work of breathing a. When the patient does not have sufficient gas exchange to engage in activity, the etiologic factor is often the work of breathing. When patients with asthma do not have effective respirations, they use all available energy to breathe and have little left over for purposeful activity. Fear of suffocation, effects of medications or anxiety, and restlessness are not etiologies for activity intolerance for a patient with asthma.

The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β-adrenergic bronchodilator and supplemental oxygen. If the patient's condition does not improve, the nurse should anticipate what as the most likely next step in treatment? 1. IV fluids 2. Biofeedback therapy 3. Systemic corticosteroids 4. Pulmonary function testing

7. Systemic corticosteroids a. Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is insufficient. IV fluids may be used, but not to improve ventilation. Biofeedback therapy and pulmonary function testing may be used after recovery to assist the patient and monitor the asthma.

While teaching a patient with asthma about the appropriate use of a peak flow meter, what should the nurse instruct the patient to do? 1. Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse. 2. Use the flow meter each morning after taking medications to evaluate their effectiveness. 3. Increase the doses of the long-term control medication if the peak flow numbers decrease. 4. Empty the lungs and then inhale quickly through the mouthpiece to measure how fast air can be inhaled.

9. Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse.a. It is important to keep track of peak flow readings daily, especially when the patient's symptoms are getting worse. The patient should have specific directions as to when to call the physician based on personal peak flow numbers. Peak flow is measured by exhaling into the flow meter and should be assessed before and after medications to evaluate their effectiveness.

2. The nurse will monitor for clinical manifestations of hypercapnia when a patient in the emergency department has a. chest trauma and multiple rib fractures. b. carbon monoxide poisoning after a house fire. c. left-sided ventricular failure and acute pulmonary edema. d. tachypnea and acute respiratory distress syndrome (ARDS).

A . chest trauma and multiple rib fractures. Rationale: Hypercapnia is caused by poor ventilatory effort, which occurs in chest trauma when rib fractures (or flail chest) decrease lung ventilation. Carbon monoxide poisoning, acute pulmonary edema, and ARDS are more commonly associated with hypoxemia.

A patient with COPD is admitted to the hospital. How can the nurse best position the patient to improve gas exchange? a. Sitting up at the bedside in a chair and leaning slightly forward b. Resting in bed with the head elevated to 45 to 60 degrees c. In the Trendelenburg's position with several pillows behind the head d. Resting in bed in a high-Fowler's position with the knees flexed

A Sitting up at the bedside in a chair and leaning slightly forward Rationale: Patients with COPD improve the mechanics of breathing by sitting up in the "tripod" position. Resting in bed with the head elevated would be an alternative position if the patient was confined to bed, but sitting in a chair allows better ventilation. The Trendelenburg's position or sitting upright in bed with the knees flexed would decrease the patient's ability to ventilate well.

The nurse makes a diagnosis of impaired gas exchange for a patient with COPD in acute respiratory distress, based on the assessment finding of a. a pulse oximetry reading of 86%. b. dyspnea and respiratory rate of 36. c. use of the accessory respiratory muscles. d. the presence of crackles in both lungs.

A pulse oximetry reading of 86%. Rationale: The best data to support the diagnosis of impaired gas exchange are abnormalities in the ABGs or pulse oximetry. The other data would support a diagnosis of risk for impaired gas exchange.

A client with a productive cough, chills, and night sweats is suspected of having active TB. The physician should take which of the following actions? AAdmit him to the hospital in respiratory isolation BPrescribe isoniazid and tell him to go home and rest CGive a tuberculin test and tell him to come back in 48 hours and have it read DGive a prescription for isoniazid, 300 mg daily for 2 weeks, and send him home

A) Admit him to the hospital in respiratory isolation The client is showing s/s of active TB and, because of the productive cough, is highly contagious. He should be admitted to the hospital, placed in respiratory isolation, and three sputum cultures should be obtained to confirm the diagnosis. He would most likely be given isoniazid and two or three other antitubercular antibiotics until the diagnosis is confirmed, then isolation and treatment would continue if the cultures were positive for TB. After 7 to 10 days, three more consecutive sputum cultures will be obtained. If they're negative, he would be considered non-contagious and may be sent home, although he'll continue to take the antitubercular drugs for 9 to 12 months.

A firefighter who was involved in extinguishing a house fire is being treated for smoke inhalation. He develops severe hypoxia 48 hours after the incident, requiring intubation and mechanical ventilation. Which of the following conditions has he most likely developed? A. Acute respiratory distress syndrome (ARDS). B. Atelectasis. C. Bronchitis. D. Pneumonia.

A. Acute respiratory distress syndrome (ARDS). Severe hypoxia after smoke inhalation typically is related to ARDS. The other choices aren't typically associated with smoke inhalation

A client with acute exacerbation of asthma has been admitted to the medical surgical unit for treatment. The client is reporting increased shortness of breath with inspiratory and expiratory wheezes. When planning care for this client, which medication will the nurse administer first? A. Albuterol-2 inhalations B. Fluticasone-2 inhalations C. Ipratropium-2 inhalations D. Salmeterol-2 inhalations

A. Albuterol-2 inhalations

The charge nurse is making assignments for clients cared for on the intensive care stepdown unit. Which client will the charge nurse assign to the RN who has floated from the pediatric unit? A. Client with acute asthma episode who is receiving oxygen at FiO2 of 60% by non-rebreather mask B. Client with chronic pleural effusions who is scheduled for a paracentesis in the next hour C. Client with emphysema who requires instruction about correct use of oxygen at home D. Client with lung cancer who has just been transferred from the intensive care unit after a left lower lobectomy yesterday

A. Client with acute asthma episode who is receiving oxygen at FiO2 of 60% by non-rebreather mask

Which signs and symptoms differentiate hypoxemic respiratory failure from hypercapnic respiratory failure (select all that apply)? A. Cyanosis B. Tachypnea C. Morning headache D. Paradoxic breathing E. Pursed-lip breathing

A. Cyanosis B. Tachypnea D. Paradoxic breathing Clinical manifestations that occur with hypoxemic respiratory failure include cyanosis, tachypnea, and paradoxic chest or abdominal wall movement with the respiratory cycle. Clinical manifestations of hypercapnic respiratory failure include morning headache, pursed-lip breathing, and decreased or increase respiratory rate with shallow breathing

A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism? A. Dyspnea B. Bradypnea C. Bradycardia D. Decreased respirations

A. Dyspnea The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea, and chest pain.

A patient is brought to the emergency department unconscious following a barbiturate overdose. Which potential complication will the nurse include when developing the plan of care? a. Hypercapnic respiratory failure related to decreased ventilatory effort b. Hypoxemic respiratory failure related to diffusion limitations c. Hypoxemic respiratory failure related to shunting of blood . d. Hypercapnic respiratory failure related to increased airway resistance

A. Hypercapnic respiratory failure related to decreased ventilatory effort The patient with an opioid overdose develops hypercapnic respiratory failure as a result of the decrease in respiratory rate and depth. Diffusion limitations, blood shunting, and increased airway resistance are not the primary pathophysiology causing the respiratory failure.

A client asks the nurse for ways of identifying and coping with a hyperventilation reaction. Which method would be appropriate for the nurse to recommend? (Select all that apply.) A. Increase exercise. B. Use guided imagery. C. Try not to react with anxiety. D. Completely avoid anything that induces anxiety. E. Recognize situations that can lead to increased anxiety.

A. Increase exercise. B. Use guided imagery. E. Recognize situations that can lead to increased anxiety. Rationale: Increasing exercise by taking walks or doing other enjoyable activities can help alleviate stress and decrease the instances of anxiety reaction. Guided imagery is utilizing relaxation techniques along with meditation to alleviate anxiety, and can prevent hyperventilation. Although all situations that lead to anxiety cannot be completely avoided, trying to identify known triggers for anxiety and hyperventilation reactions can help with making a plan for coping. Advising a client to try not to react with anxiety or to completely avoid anything that induces stress or anxiety is not effective.

A client has been stabilized in the emergency department after experiencing respiratory alkalosis secondary to hyperventilation. The client states this has occurred before, and she asks the nurse how to recognize a hyperventilation reaction to anxiety. Which clinical manifestation should the nurse instruct the client to watch for? (Select all that apply.) A. Increased anxiety B. Irritability and restlessness C. Chest tightness and heaviness D. Increased breathing rate the client cannot control E. A loss of interest in social activities and feeling withdrawn

A. Increased anxiety C. Chest tightness and heaviness D. Increased breathing rate the client cannot control Rationale: Hyperventilation reactions often occur as a result of anxiety. The client should be instructed to be aware of increased feelings of anxiety. The anxiety may progress to a feeling of chest heaviness or tightness. In response to this, the client may begin to increase the rate of breathing, which further progresses the feeling of anxiety. Anxiety is not usually accompanied by irritability and restlessness. Loss of interest in activities and feeling withdrawn are more closely associated with depression than anxiety.

A patient with a severe acute asthma exacerbation presents to the emergency department. Over the next hour, the patient remains in respiratory distress, but the respirations have slowed. What is the best explanation? A. The patient is developing respiratory muscle fatigue. B. The respirations are exchanging oxygen and carbon dioxide more efficiently. C. The patient's anxiety level is lessening. D. The body has compensated by retaining sodium bicarbonate.

A. The patient is developing respiratory muscle fatigue. A rapid respiratory rate requires a substantial amount of work. Change from a rapid rate to a slower rate in a patient in acute respiratory distress suggests extreme progression of respiratory muscle fatigue and increased probability of respiratory arrest. Ventilatory exchange, without other indications of improvement, is decreased. As long as the patient is in distress, there is no evidence that anxiety would lessen, and hypoxia would increase anxiety. Compensation through the renal system takes days.

Which statement by a client with chronic obstructive pulmonary disease (COPD) and a 10 pound (4.5 kg) weight loss indicates the need for additional follow-up instruction? A."I should consume plenty of fluids with my meal." B. "I will try eating smaller more frequent meals." C. "I will try to eat more protein." D. "I will perform mouth care prior to eating."

A."I should consume plenty of fluids with my meal."

A patient develops increasing dyspnea and hypoxemia 2 days after having cardiac surgery. To determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by left ventricular failure, the nurse will anticipate assisting with a. inserting a pulmonary artery catheter. b. obtaining a ventilation-perfusion scan. c. drawing blood for arterial blood gases. d. positioning the patient for a chest radiograph.

ANS: A . inserting a pulmonary artery catheter. Pulmonary artery wedge pressures are normal in the patient with ARDS because the fluid in the alveoli is caused by increased permeability of the alveolar-capillary membrane rather than by the backup of fluid from the lungs (as occurs in cardiogenic pulmonary edema). The other tests will not help in differentiating cardiogenic from noncardiogenic pulmonary edema.

After 2 months of tuberculosis (TB) treatment with a standard four-drug regimen, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next? a. Ask the patient whether medications have been taken as directed. b. Discuss the need to use some different medications to treat the TB. c. Schedule the patient for directly observed therapy three times weekly. d. Educate about using a 2-drug regimen for the last 4 months of treatment.

ANS: A Ask the patient whether medications have been taken as directed. The first action should be to determine whether the patient has been compliant with drug therapy because negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. Depending on whether the patient has been compliant or not, different medications or directly observed therapy may be indicated. A two-drug regimen will be used only if the sputum smears are negative for AFB.

A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat. The emergency department nurse would be most concerned if which finding is observed during the initial assessment? a. Paradoxic chest movement b. Complaint of chest wall pain c. Heart rate of 110 beats/minute d. Large bruised area on the chest

ANS: A Paradoxic chest movement Paradoxic chest movement indicates that the patient may have flail chest, which can severely compromise gas exchange and can rapidly lead to hypoxemia. Chest wall pain, a slightly elevated pulse rate, and chest bruising all require further assessment or intervention, but the priority concern is poor gas exchange.

Which information will the nurse include in the patient teaching plan for a patient who is receiving rifampin (Rifadin) for treatment of tuberculosis? a. "Your urine, sweat, and tears will be orange colored." b. "Read a newspaper daily to check for changes in vision." c. "Take vitamin B6 daily to prevent peripheral nerve damage." d. "Call the health care provider if you notice any hearing loss."

ANS: A Your urine, sweat, and tears will be orange colored." Orange-colored body secretions are a side effect of rifampin. The other adverse effects are associated with other antituberculosis medications.

A staff nurse has a tuberculosis (TB) skin test of 16-mm induration. A chest radiograph is negative, and the nurse has no symptoms of TB. The occupational health nurse will plan on teaching the staff nurse about the a. use and side effects of isoniazid (INH). b. standard four-drug therapy for TB. c. need for annual repeat TB skin testing. d. bacille Calmette-Guérin (BCG) vaccine.

ANS: A use and side effects of isoniazid (INH). The nurse is considered to have a latent TB infection and should be treated with INH daily for 6 to 9 months. The four-drug therapy would be appropriate if the nurse had active TB. TB skin testing is not done for individuals who have already had a positive skin test. BCG vaccine is not used in the United States and would not be helpful for this individual, who already has a TB infection.

Which nursing action will be most effective in preventing aspiration pneumonia in patients who are at risk? a. Turn and reposition immobile patients at least every 2 hours. b. Place patients with altered consciousness in side-lying positions. c. Monitor for respiratory symptoms in patients who are immunosuppressed. d. Provide for continuous subglottic aspiration in patients receiving enteral feedings.

ANS: B Place patients with altered consciousness in side-lying positions. The risk for aspiration is decreased when patients with a decreased level of consciousness are placed in a side-lying or upright position. Frequent turning prevents pooling of secretions in immobilized patients but will not decrease the risk for aspiration in patients at risk. Monitoring of parameters such as breath sounds and oxygen saturation will help detect pneumonia in immunocompromised patients, but it will not decrease the risk for aspiration. Continuous subglottic suction is recommended for intubated patients but not for all patients receiving enteral feedings.

A patient with acute respiratory distress syndrome (ARDS) and acute renal failure has the following medications prescribed. Which medication should the nurse discuss with the health care provider before administration? a. ranitidine (Zantac) 50 mg IV b. gentamicin (Garamycin) 60 mg IV c. sucralfate (Carafate) 1 g per nasogastric tube d. methylprednisolone (Solu-Medrol) 40 mg IV

ANS: B gentamicin (Garamycin) 60 mg IV Gentamicin, which is one of the aminoglycoside antibiotics, is potentially nephrotoxic, and the nurse should clarify the drug and dosage with the health care provider before administration. The other medications are appropriate for the patient with ARDS.

The nurse is caring for a 22-year-old patient who came to the emergency department with acute respiratory distress. Which information about the patient requires the most rapid action by the nurse? a. Respiratory rate is 32 breaths/min. b. Pattern of breathing is shallow. c. The patient's PaO2 is 45 mm Hg. d. The patient's PaCO2 is 34 mm Hg.

ANS: C The patient's PaO2 is 45 mm Hg. The PaO2 indicates severe hypoxemia and respiratory failure. Rapid action is needed to prevent further deterioration of the patient. Although the shallow breathing, rapid respiratory rate, and low PaCO2 also need to be addressed, the most urgent problem is the patient's poor oxygenation.

The nurse recognizes that the goals of teaching regarding the transmission of pulmonary tuberculosis (TB) have been met when the patient with TB a. demonstrates correct use of a nebulizer. b. washes dishes and personal items after use. c. covers the mouth and nose when coughing. d. reports daily to the public health department.

ANS: C covers the mouth and nose when coughing. Covering the mouth and nose will help decrease airborne transmission of TB. The other actions will not be effective in decreasing the spread of TB.

When caring for a patient who is hospitalized with active tuberculosis (TB), the nurse observes a family member who is visiting the patient. The nurse will need to intervene if the family member a. washes the hands before entering the patient's room. b. hands the patient a tissue from the box at the bedside. c. puts on a surgical face mask before visiting the patient. d. brings food from a "fast-food" restaurant to the patient.

ANS: C puts on a surgical face mask before visiting the patient. A high-efficiency particulate-absorbing (HEPA) mask, rather than a standard surgical mask, should be used when entering the patient's room because the HEPA mask can filter out 100% of small airborne particles. Hand washing before visiting the patient is not necessary, but there is no reason for the nurse to stop the family member from doing this. Because anorexia and weight loss are frequent problems in patients with TB, bringing food from outside the hospital is appropriate. The family member should wash the hands after handling a tissue that the patient has used, but no precautions are necessary when giving the patient an unused tissue.

An alcoholic and homeless patient is diagnosed with active tuberculosis (TB). Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen? a. Educating the patient about the long-term impact of TB on health b. Giving the patient written instructions about how to take the medications c. Teaching the patient about the high risk for infecting others unless treatment is followed d. Arranging for a daily noontime meal at a community center and giving the medication then

ANS: D Arranging for a daily noontime meal at a community center and giving the medication then Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen, and arranging a daily meal will help to ensure that the patient is available to receive the medication. The other nursing interventions may be appropriate for some patients, but are not likely to be as helpful with this patient.

When assessing a patient with chronic lung disease, the nurse finds a sudden onset of agitation and confusion. Which action should the nurse take first? a. Check pupil reaction to light. b. Notify the health care provider. c. Attempt to calm and reassure the patient. d. Assess oxygenation using pulse oximetry.

ANS: D Assess oxygenation using pulse oximetry. Since agitation and confusion are frequently the initial indicators of hypoxemia, the nurse's initial action should be to assess oxygen saturation. The other actions also are appropriate, but assessment of oxygenation takes priority over other assessments and notification of the health care provider.

When assessing a patient who has just arrived after an automobile accident, the emergency department nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the patient? a. Emergency pericardiocentesis b. Stabilization of the chest wall with tape c. Administration of an inhaled bronchodilator d. Insertion of a chest tube with a chest drainage system

ANS: D Insertion of a chest tube with a chest drainage system The patient's history and absent breath sounds suggest a right-sided pneumothorax or hemothorax, which will require treatment with a chest tube and drainage. The other therapies would be appropriate for an acute asthma attack, flail chest, or cardiac tamponade, but the patient's clinical manifestations are not consistent with these problems.

The nurse is caring for a patient who was hospitalized 2 days earlier with aspiration pneumonia. Which assessment information is most important to communicate to the health care provider? a. Cough that is productive of blood-tinged sputum b. Scattered crackles throughout the posterior lung bases c. Temperature of 101.5° F (38.6° C) after 2 days of IV antibiotic therapy d. Oxygen saturation (SpO2) has dropped to 90% with administration of 100% O2 by non-rebreather mask.

ANS: D Oxygen saturation (SpO2) has dropped to 90% with administration of 100% O2 by non-rebreather mask. The patient's low SpO2 despite receiving a high fraction of inspired oxygen (FIO2) indicates the possibility of acute respiratory distress syndrome (ARDS). The patient's blood-tinged sputum and scattered crackles are not unusual in a patient with pneumonia, although they do require continued monitoring. The continued temperature elevation indicates a possible need to change antibiotics, but this is not as urgent a concern as the progression toward hypoxemia despite an increase in O2 flow rate.

Which information about a patient who has a recent history of tuberculosis (TB) indicates that the nurse can discontinue airborne isolation precautions? a. Chest x-ray shows no upper lobe infiltrates. b. TB medications have been taken for 6 months. c. Mantoux testing shows an induration of 10 mm. d. Three sputum smears for acid-fast bacilli are negative.

ANS: D Three sputum smears for acid-fast bacilli are negative. Negative sputum smears indicate that M. tuberculosis is not present in the sputum, and the patient cannot transmit the bacteria by the airborne route. Chest x-rays are not used to determine whether treatment has been successful. Taking medications for 6 months is necessary, but the multidrug-resistant forms of the disease might not be eradicated after 6 months of therapy. Repeat Mantoux testing would not be done since it will not change even with effective treatment.

When taking an admission history of a patient with possible asthma who has new-onset wheezing and shortness of breath, the nurse will be most concerned about which information? a. The patient has a history of pneumonia 2 years ago. b. The patient takes propranolol (Inderal) for hypertension. c. The patient uses acetaminophen (Tylenol) for headaches. d. The patient has chronic inflammatory bowel disease.

B The patient takes propranolol (Inderal) for hypertension. Rationale: -blockers such as propranolol can cause bronchospasm in some patients. The other information will be documented in the health history but does not indicate a need for a change in therapy.

Which information given by an asthmatic patient during the admission assessment will be of most concern to the nurse? a. The patient says that the asthma symptoms are worse every spring. b. The patient's only asthma medications are albuterol (Proventil) and salmeterol (Serevent). c. The patient uses cromolyn (Intal) before any aerobic exercise. d. The patient's heart rate increases after using the albuterol (Proventil) inhaler.

B The patient's only asthma medications are albuterol (Proventil) and salmeterol (Serevent). Rationale: Long-acting 2-agonists should be used only in patients who are also using another medication for long-term control (typically an inhaled corticosteroid). Salmeterol should not be used as the first-line therapy for long-term control. The other information given by the patient requires further assessment by the nurse but is not unusual for a patient with asthma.

When teaching the patient with COPD about exercise, which information should the nurse include? a. "Stop exercising if you start to feel short of breath. "b. "Use the bronchodilator before you start to exercise." c. "Breathe in and out through the mouth while you exercise." d. "Upper body exercise should be avoided to prevent dyspnea."

B Use the bronchodilator before you start to exercise." Rationale: Use of a bronchodilator before exercise improves airflow for some patients and is recommended. Shortness of breath is normal with exercise and not a reason to stop. Patients should be taught to breathe in through the nose and out through the mouth (using a pursed-lip technique). Upper-body exercise can improve the mechanics of breathing in patients with COPD.

A patient with an acute attack of asthma comes to the emergency department, where ABGs are drawn. The nurse determines the patient is in the early phase of the attack, based on the ABG results of a. pH 7.0, PaCO2 50 mm Hg, and PaO2 74 mm Hg. b. pH 7.4, PaCO2 32 mm Hg, and PaO2 70 mm Hg. c. pH 7.36, PaCO2 40 mm Hg, and PaO2 80 mm Hg. d. pH 7.32, PaCO2 58 mm Hg, and PaO2 60 mm Hg.

B pH 7.4, PaCO2 32 mm Hg, and PaO2 70 mm Hg. Rationale: The initial response to hypoxemia caused by airway narrowing in a patient having an acute asthma attack is an increase in respiratory rate, which causes a drop in PaCO2. The other PaCO2 levels are normal or elevated, which would indicate that the attack was progressing and that the patient is decompensating.

When developing a teaching plan to help increase activity tolerance at home for a 70-year-old with severe COPD, the nurse should teach the patient that an appropriate exercise goal is to a. exercise until shortness of breath occurs. b. walk for a total of 20 minutes daily. c. limit exercise to activities of daily living (ADLs). d. walk until pulse rate exceeds 150.

B walk for a total of 20 minutes daily. Rationale: The goal for exercise programs for patients with COPD is to increase exercise time gradually to a total of 20 minutes daily. Shortness of breath is normal with exercise and not an indication that the patient should stop. Limiting exercise to ADLs will not improve the patient's exercise tolerance. A 70-year-old patient should have a pulse rate of 120 or less with exercise (80% of the maximal heart rate of 150).

Which statement by the COPD patient indicates that the nurse's teaching about nutrition has been effective? a. "I will drink lots of fluids with my meals." b. "I will have ice cream as a snack every day." c. "I should exercise for 15 minutes before meals." d. "I should avoid much meat or dairy products."

B"I will have ice cream as a snack every day." Rationale: High-calorie foods like ice cream are an appropriate snack for patients with COPD. Fluid intake of 3 L/day is recommended, but fluids should be taken between meals rather than with meals to improve oral intake of solid foods. The patient should avoid exercise for an hour before meals to prevent fatigue while eating. Meat and dairy products are high in protein and are good choices for the patient with COPD.

A client recently diagnosed with asthma has a prescription to use an inhaled medication with a spacer. The nurse evaluates the client has correct understanding of the use of an inhaler with a spacer when the client states which of these? (Select all that apply.) A. "I don't have to wait a minute between the two puffs if I use a spacer." B. "If the spacer makes a whistling sound, I am breathing in too rapidly." C. "I should rinse my mouth and then swallow the water to get all of the medicine." D. "I should shake the canister when I want to see whether it is empty." E. "I should hold my breath for at least ten seconds after inhaling the medication."

B. "If the spacer makes a whistling sound, I am breathing in too rapidly." E. "I should hold my breath for at least ten seconds after inhaling the medication."

The client says, "I hate this stupid COPD." What is the best response by the nurse? A. "Stopping smoking will help your lungs heal." B."You sound fed up with managing your illness." C. "Does anyone in your family have COPD?" D."Most clients get used to it after a few months."

B."You sound fed up with managing your illness."

Which patient is most likely going into respiratory failure? A. A patient who report that he feels short of breath while eating B. A patient with the following arterial blood gas values over the past 3 hours: pH 7.50, 7.45, and 7.40 C. A patient with an oxygen saturation value of 93% D. A patient with chronic obstructive pulmonary disease (COPD) who has distant breath sounds

B. A patient with the following arterial blood gas values over the past 3 hours: pH 7.50, 7.45, and 7.40 Manifestations of respiratory failure are related to the extent of change in PaO2 or PaCO2, the rapidity of change, and ability to compensate. It is important to monitor trends. Shortness of breath is a subjective report, and it can have many causes. A single borderline oxygen saturation reading is not as indicative of failure as a negative trend. Because of air trapping with COPD, the breath sounds are typically distant.

The change-of-shift report has just been completed on the medical-surgical unit. Which client will the oncoming nurse plan to assess first? A. Client with chronic obstructive pulmonary disease (COPD) who is ready for discharge, but is unable to afford prescribed medications. B. Client with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate of 38 breaths/min. C. Hospice client with end-stage pulmonary fibrosis and an oxygen saturation level of 89%. D. Client with lung cancer who needs an IV antibiotic administered before going to surgery.

B. Client with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate of 38 breaths/min.

A client has presented to the emergency department with hyperventilation. The client is anxious and breathing approximately 60 breaths per minute. What is the correct initial action the nurse should take? A. Have the client lie flat. B. Give the client a paper bag and have her breathe into it. C. Apply oxygen. D. Notify the physician and order labs to determine whether the client is in respiratory alkalosis

B. Give the client a paper bag and have her breathe into it. Rationale: Hyperventilation, or rapid breathing, results in the rapid expulsion of CO2from the body. The diminished CO2results in an increase in pH, which is respiratory alkalosis. If the client breathes into a paper bag, the CO2is reinhaled, preventing the drop inCO2 and alleviating the alkalosis. Having the client lie flat may be difficult, especially if the client is anxious, since the client may resist this position. Applying oxygen will not alleviate the decreasedCO2. Obtaining an order for labs may be part of the assessment, but it is not an appropriate initial action.

A black client with asthma seeks emergency care for acute respiratory distress. Because of this client's dark skin, the nurse should assess for cyanosis by inspecting the: A. Lips. B. Mucous membranes. C. Nail beds. D. Earlobes.

B. Mucous membranes. Skin color doesn't affect the mucous membranes. The lips, nail beds, and earlobes are less reliable indicators of cyanosis because they're affected by skin color.

The nurse is educating the client with COPD who requires home oxygen therapy for discharge. Which of these teaching points takes the highest priority? A. Correct performance when setting up the oxygen delivery system B. Removing combustion hazards present in the home C. Understanding the signs and symptoms of hypoxemia D. Demonstrating how to use a pulse oximetry device

B. Removing combustion hazards present in the home

When teaching a patient with chronic obstructive pulmonary disease (COPD) about reasons to quit smoking, the nurse will explain that long-term exposure to tobacco smoke leads to a a. weakening of the smooth muscle lining the airways. b. decrease in the area available for oxygen absorption. c. lesser number of red blood cells for oxygen delivery. d. decreased production of protective respiratory secretions.

B. decrease in the area available for oxygen absorption. Rationale: Tobacco smoke leads to an increase in proteolytic enzymes, which break down alveolar walls and lead to less alveolar surface area for gas exchange. Bronchial smooth muscle is not weakened by chronic smoking. Polycythemia is a common compensatory mechanism for patients with COPD. The quantity of respiratory secretions increases as a result of smoking.

A finding indicating to the nurse that a 22-year-old patient with respiratory distress is in acute respiratory failure includes a a. shallow breathing pattern. b. partial pressure of arterial oxygen (PaO2) of 45 mm Hg. c. partial pressure of carbon dioxide in arterial gas (PaCO2) of 34 mm Hg. d. respiratory rate of 32/min.

B. partial pressure of arterial oxygen (PaO2) of 45 mm Hg. The PaO2 indicates severe hypoxemia and that the nurse should take immediate action to correct this problem. Shallow breathing, rapid respiratory rate, and low PaCO2 can be caused by other factors, such as anxiety or pain.

When reading the chart for a patient with COPD, the nurse notes that the patient has cor pulmonale. To assess for cor pulmonale, the nurse will monitor the patient for a. elevated temperature. b. complaints of chest pain. c. jugular vein distension. d. clubbing of the fingers.

C jugular vein distension. Rationale: Cor pulmonale causes clinical manifestations of right ventricular failure, such as jugular vein distension. The other clinical manifestations may occur in the patient with other complications of COPD but are not indicators of cor pulmonale.

A patient who is experiencing an acute asthma attack is admitted to the emergency department. The nurse's first action should be to a. determine when the dyspnea started. b. obtain the forced expiratory flow rate. c. listen to the patient's breath sounds. d. ask about inhaled corticosteroid use.

C listen to the patient's breath sounds. Rationale: Assessment of the patient's breath sounds will help to determine how effectively the patient is ventilating and whether rapid intubation may be necessary. The length of time the attack has persisted is not as important as determining the patient's status at present. Most patients having an acute attack will be unable to cooperate with a FEV measurement. It is important to know about the medications the patient is using but not as important as assessing the breath sounds.

A patient with an acute exacerbation of COPD has the following ABG analysis: pH 7.32, PaO2 58 mm Hg, PaCO2 55 mm Hg, and SaO2 86%. The nurse recognizes these values as evidence of a. normal acid-base balance with hypoxemia. b. normal acid-base balance with hypercapnia. c. respiratory acidosis. d. respiratory alkalosis

C respiratory acidosis. Rationale: The elevated PaCO2 and low pH indicate respiratory acidosis. The patient is hypoxemic and hypercapnic, but the pH indicates acidosis, not a normal acid-base balance

A patient with COPD tells the nurse, "At home, I only have to use an albuterol (Proventil) inhaler. Why did the doctor add an ipratropium (Atrovent) inhaler while I'm in the hospital? The appropriate response by the nurse is a. "Atrovent will dilate the airways and allow the Proventil to penetrate more deeply." b. "Atrovent is being used to decrease airway inflammation and sputum production." c. "Atrovent works differently to dilate the bronchi, and the two drugs together are more effective." d. "Atrovent is a potent bronchodilator and patients need to be hospitalized when receiving it."

C"Atrovent works differently to dilate the bronchi, and the two drugs together are more effective." Rationale: Combining bronchodilators improves effectiveness. Atrovent does not have to be used before Proventil, it does not decrease airway inflammation, and it does not require hospitalization.

The nurse has completed teaching a patient about MDI use. Which patient statement indicates that further patient teaching is needed? a. "I will shake the MDI each time before giving the medication." b. "I will take a slow, deep breath in after pushing down on the MDI." c. "I will float the canister in water to decide whether I need to get a new MDI." d. "I will attach a spacer to the MDI to make it easier for me to

C"I will float the canister in water to decide whether I need to get a new MDI." Rationale: This method is no longer recommended as a means of determining whether the medication needs replacement. The other patient statements are accurate and indicate the patient understands how to use the MDI.

Isoniazid (INH) and rifampin (Rifadin) have been prescribed for a client with TB. A nurse reviews the medical record of the client. Which of the following, if noted in the client's history, would require physician notification? AHeart disease BAllergy to penicillin CHepatitis B DRheumatic fever

C) Hepatitis B Isoniazid and rafampin are contraindicated in clients with acute liver disease or a history of hepatic injury.

After receiving education on the correct use of emergency drug therapy for asthma, which statement by the client indicates a correct understanding of the nurse's instructions? A. "All asthma drugs help everybody breathe better." B. "I must carry my emergency inhaler when activity is anticipated." C. "I must have my emergency inhaler with me at all times." D. "Preventive drugs can stop an attack."

C. "I must have my emergency inhaler with me at all times."

You are admitting a 45-year-old asthmatic patient in acute respiratory distress. You auscultate the patient's lungs and notice cessation of inspiratory wheezing. The patient has not yet received any medication. What does this finding suggest? A. Spontaneous resolution of the acute asthma attack B. An acute development of bilateral pleural effusions C. Airway constriction requiring intensive interventions D. Overworked intercostal muscles resulting in poor air exchange

C. Airway constriction requiring intensive interventions When the patient in respiratory distress has inspiratory wheezing that ceases, it is an indication of airway obstruction, and it requires emergency action to restore the airway.

You are caring for a patient who is admitted with a barbiturate overdose. The patient is unresponsive, with a blood pressure of 90/60 mm Hg, apical pulse of 110 beats/minute, and respiratory rate of 8 breaths/minute. Based on the initial assessment findings, you recognize that the patient is at risk for which type of respiratory failure? A. Hypoxemic respiratory failure related to shunting of blood B. Hypoxemic respiratory failure related to diffusion limitation C. Hypercapnic respiratory failure related to alveolar hypoventilation D. Hypercapnic respiratory failure related to increased airway resistance

C. Hypercapnic respiratory failure related to alveolar hypoventilation The patient's respiratory rate is decreased because of barbiturate overdose, which causes respiratory depression. The patient is at risk for hypercapnic respiratory failure resulting from the decreased respiratory rate and decreased CO2 exchange.

For a patient with advance chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? A. Encouraging the patient to drink three glasses of fluid daily B. Keeping the patient in semi-fowler's position C. Using a high-flow venture mask to deliver oxygen as prescribe D. Administering a sedative, as prescribe

C. Using a high-flow venture mask to deliver oxygen as prescribe The patient with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily would not affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Patients with COPD and respiratory distress should be places in high-Fowler's position and should not receive sedatives or other drugs that may further depress the respiratory center.

The nurse is evaluating understanding of the treatment regimen for a client newly diagnosed with asthma. Which of these statements by the client indicates understanding of the regimen? A. "I will take albuterol when I go to sleep." B. "I will keep the rescue medication readily accessible on the first floor of my home." C."I will take the long acting beta agonist even when my breathing seems OK." D. "I will immediately take the anti-inflammatory medication for an acute asthma attack."

C."I will take the long acting beta agonist even when my breathing seems OK."

When assessing a patient with chronic lung disease, the nurse finds a sudden onset of agitation and confusion. Which action should the nurse take first? a. Monitor the patient every 10 to 15 minutes. b. Notify the patient's health care provider immediately. c. Attempt to calm and reassure the patient. d. Assess vital signs and pulse oximetry.

D Assess vital signs and pulse oximetry. Rationale: The nurse needs to collect additional clinical data to share with the health care provider and to start interventions quickly if appropriate (e.g., increased oxygen flow if hypoxic). The change in the patient's neurologic status may indicate deterioration in respiratory function, and the health care provider should be notified immediately but only after some additional information is obtained. Monitoring the patient and attempting to calm the patient are appropriate actions, but they will not prevent further deterioration of the patient's clinical status and may delay care.

4. A patient is diagnosed with a large pulmonary embolism. When explaining to the patient what has happened to cause respiratory failure, which information will the nurse include? a. "Oxygen transfer into your blood is slow because of thick membranes between the small air sacs and the lung circulation." b. "Thick secretions in your small airways are blocking air from moving into the small air sacs in your lungs." c. "Large areas of your lungs are getting good blood flow but are not receiving enough air to fill the small air sacs." d. "Blood flow though some areas of your lungs is decreased even though you are taking adequate breaths."

D "Blood flow though some areas of your lungs is decreased even though you are taking adequate breaths." Rationale: A pulmonary embolus limits blood flow but does not affect ventilation, leading to a ventilation-perfusion mismatch. The response beginning, "Oxygen transfer into your blood is slow because of thick membranes" describes a diffusion problem. The remaining two responses describe ventilation-perfusion mismatch with adequate blood flow but poor ventilation.

After teaching the patient with asthma about home care, the nurse will evaluate that the teaching has been successful if the patient states, a. "I will use my corticosteroid inhaler as soon as I start to get short of breath." b. "I will only turn the home oxygen level up after checking with the doctor first." c. "My medications are working if I wake up short of breath only once during the night." d. "No changes in my medications are needed if my peak flow is at 80% of normal."

D "No changes in my medications are needed if my peak flow is at 80% of normal." Rationale: Peak flows of 80% or greater indicate that the asthma is well controlled. Corticosteroids are long-acting, prophylactic therapy for asthma and are not used to treat acute dyspnea. Because asthma is an acute and intermittent process, home oxygen is not used. The patient who has effective treatment should sleep throughout the night without waking up with dyspnea.

The nurse has received a change-of-shift report about these patients with COPD. Which patient should the nurse assess first? a. A patient with loud expiratory wheezes b. A patient who has a cough productive of thick, green mucus c. A patient with jugular vein distension and peripheral edema d. A patient with a respiratory rate of 38

D A patient with a respiratory rate of 38 Rationale: A respiratory rate of 38 indicates severe respiratory distress, and the patient needs immediate assessment and intervention to prevent possible respiratory arrest. The other patients also need assessment as soon as possible, but they do not need to be assessed as urgently as the tachypneic patient

The nurse is caring for a patient who was hospitalized 2 days earlier with aspiration pneumonia. Which assessment information is most important to communicate to the health care provider? a. The patient has a cough that is productive of blood-tinged sputum. b. The patient has scattered crackles throughout the posterior lung bases. c. The patient's temperature is 101.5° F after 2 days of IV antibiotic therapy. d. The patient's SpO2 has dropped to 90%, although the O2 flow rate has been increased.

D The patient's SpO2 has dropped to 90%, although the O2 flow rate has been increased. Rationale: The patient's dropping SpO2 despite having an increase in FIO2 indicates the possibility of acute respiratory distress syndrome (ARDS). The patient's blood-tinged sputum and scattered crackles are not unusual in a patient with pneumonia, although they do require continued monitoring. The continued temperature elevation indicates a possible need to change antibiotics, but this is not as urgent a concern as the progression toward hypoxemia despite an increase in O2 flow rate.

All of these orders are received for a patient having an acute asthma attack. Which one will the nurse administer first? a. IV methylprednisolone (Solu-Medrol) 60 mg b. triamcinolone (Azmacort) 2 puffs per MDI c. salmeterol (Serevent) 50 mcg per DPI d. albuterol (Ventolin) 2.5 mg per nebulizer

D albuterol (Ventolin) 2.5 mg per nebulizer Rationale: Albuterol is a rapidly acting bronchodilator and is the first-line medication to reverse airway narrowing in acute asthma attacks. The other medications work more slowly.

A patient in acute respiratory failure as a complication of COPD has a PaCO2 of 65 mm Hg, rhonchi audible in the right lung, and marked fatigue with a weak cough. The nurse will plan to a. allow the patient to rest to help conserve energy. b. arrange for a humidifier to be placed in the patient's room. c. position the patient on the right side with the head of the bed elevated. d. assist the patient with augmented coughing to remove respiratory secretions.

D assist the patient with augmented coughing to remove respiratory secretions. Rationale: The patient's assessment indicates that assisted coughing is needed to help remove secretions, which will improve PaCO2 and will also help to correct fatigue. If the patient is allowed to rest, the PaCO2 will increase. Humidification may help loosen secretions, but the weak cough effort will prevent the secretions from being cleared. The patient should be positioned with the good lung down to improve gas exchange.

When a patient with COPD is receiving oxygen, the best action by the nurse is to a. avoid administration of oxygen at a rate of more than 2 L/min. b. minimize oxygen use to avoid oxygen dependency. c. administer oxygen according to the patient's level of dyspnea. d. maintain the pulse oximetry level at 90% or greater.

D maintain the pulse oximetry level at 90% or greater. Rationale: The best way to determine the appropriate oxygen flow rate is by monitoring the patient's oxygenation either by ABGs or pulse oximetry; an oxygen saturation of 90% indicates adequate blood oxygen level without the danger of suppressing the respiratory drive. For patients with an exacerbation of COPD, an oxygen flow rate of 2 L/min may not be adequate. Because oxygen use improves survival rate in patients with COPD, there is not a concern about oxygen dependency. The patient's perceived dyspnea level may be affected by other factors (such as anxiety) besides blood oxygen level.

A client with a positive skin test for TB isn't showing signs of active disease. To help prevent the development of active TB, the client should be treated with isoniazid, 300 mg daily, for how long? A 10 to 14 days B 2 to 4 weeks C 3 to 6 months D 9 to 12 months

D) 9 to 12 months Because of the increased incidence of resistant strains of TB, the disease must be treated for up to 24 months in some cases, but treatment typically lasts for 9-12 months. Isoniazid is the most common medication used for the treatment of TB, but other antibiotics are added to the regimen to obtain the best results.

The nurse should include which of the following instructions when developing a teaching plan for clients receiving INH and rifampin for treatment for TB? ATake the medication with antacids BDouble the dosage if a drug dose is forgotten CIncrease intake of dairy products DLimit alcohol intake

D) Limit alcohol intake INH and rifampin are hepatotoxic drugs. Clients should be warned to limit intake of alcohol during drug therapy. Both drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours after these drugs are administered. Clients should not double the dosage of these drugs because of their potential toxicity. Clients taking INH should avoid foods that are rich in tyramine, such as cheese and dairy products, or they may develop hypertension.

A patient is diagnosed with a large pulmonary embolism. When explaining to the patient what has happened to cause respiratory failure, which information will the nurse include? a. "Oxygen transfer into your blood is slow because of thick membranes between the small air sacs and the lung circulation." b. "Thick secretions in your small airways are blocking air from moving into the small air sacs in your lungs." c. "Large areas of your lungs are getting good blood flow but are not receiving enough air to fill the small air sacs." d. "Blood flow though some areas of your lungs is decreased even though you are taking adequate breaths."

D. "Blood flow though some areas of your lungs is decreased even though you are taking adequate breaths." A pulmonary embolus limits blood flow but does not affect ventilation, leading to a ventilation-perfusion mismatch. The response beginning, "Oxygen transfer into your blood is slow because of thick membranes" describes a diffusion problem. The remaining two responses describe ventilation-perfusion mismatch with adequate blood flow but poor ventilation.

The nurse is assessing a client admitted with status asthmaticus. The nurse finds a sudden absence of wheezing in the lung fields and sets which of these as the priority action? A. Education to prevent future exacerbations B. Administration of a bronchodilator C. Measures to reduce anxiety D. Activation of the rapid response team to secure an airway

D. Activation of the rapid response team to secure an airway

A male patient is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient? A. Activity intolerance related to fatigue B. Anxiety related to actual threat to health status C. Risk for infection related to retained secretions D. Impaired gas exchange related to airflow obstruction

D. Impaired gas exchange related to airflow obstruction A patient airway and an adequate breathing pattern are the top priority for any patient, making "impaired gas exchange related to airflow obstruction" the most important nursing diagnosis. The other options also may apply to this patient but less important.

The nurse is preparing to administer oxygen to a client with chronic obstructive pulmonary disease (COPD) who has hypoxemia and hypercarbia. The nurse recognizes that a positive outcome to therapy has been achieved by which of these findings? A. The pCO2 is within normal range. B. The client's face is very pink. C. The client reports decreased distress. D. The oxygen saturation is between 88% and 90%.

D. The oxygen saturation is between 88% and 90%.

Which patient is having the most difficulty breathing? A. The patient who reports one-pillow orthopnea B. The patient with an inspiratory to expiratory ratio of 1:2 C. The patient who speaks a sentence before breathing D. The patient with paradoxic breathing

D. The patient with paradoxic breathing Paradoxic breathing indicates severe distress. The thorax and abdomen normally move outward on inspiration and inward on exhalation. During paradoxic breathing, the abdomen and chest move in the opposite manner, and the pattern results from maximal use of the accessory muscles of respiration. Orthopnea, measured by the number of pillows needed to breathe comfortably, is associated with the use of one to four pillows. One pillow indicates a minor condition. Normal inspiratory to expiratory ratio is 1:2. Speaking in sentences before having to take a breath indicates mild or no distress

A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department complaining of acute respiratory distress. When monitoring the patient, which assessment by the nurse will be of most concern? a. The patient is sitting in the tripod position. b. The patient has bibasilar lung crackles. c. The patient's pulse oximetry indicates an O2 saturation of 91%. d. The patient's respiratory rate has decreased from 30 to 10/min.

D. The patient's respiratory rate has decreased from 30 to 10/min. A decrease in respiratory rate in a patient with respiratory distress suggests the onset of fatigue and a high risk for respiratory arrest; therefore, the nurse will need to take immediate action. Patients who are experiencing respiratory distress frequently sit in the tripod position because it decreases the work of breathing. Crackles in the lung bases may be the baseline for a patient with COPD. An oxygen saturation of 91% is common in patients with COPD and will provide adequate gas exchange and tissue oxygenation

While caring for a patient who has been admitted with a pulmonary embolism, the nurse notes a change in the patient's arterial oxyhemoglobin saturation (SpO2) from 94% to 88%. The nurse will a. assist the patient to cough and deep-breathe. b. help the patient to sit in a more upright position. c. suction the patient's oropharynx. d. increase the oxygen flow rate.

D. increase the oxygen flow rate. Increasing oxygen flow rate will usually improve oxygen saturation in patients with ventilation-perfusion mismatch, as occurs with pulmonary embolism. Because the problem is with perfusion, actions that improve ventilation, such as deep-breathing and coughing, sitting upright, and suctioning, are not likely to improve oxygenation.

The oxygen delivery system chosen for the patient in acute respiratory failure should A. always be a low-flow device, such as a nasal cannula. B. correct the PaO2 to a normal level as quickly as possible. C. administer positive-pressure ventilation to prevent CO2 narcosis. D. maintain the PaO2 at ≥60 mm Hg at the lowest O2 concentration possible.

D. maintain the PaO2 at ≥60 mm Hg at the lowest O2 concentration possible. The selected oxygen delivery system must maintain PaO2 at 55 to 60 mm Hg and SaO2 at 90% or greater at the lowest oxygen concentration possible.

A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? A. pH, 5.0; PaCO2 30 mm Hg B. pH, 7.40; PaCO2 35 mm Hg C. pH, 7.35; PaCO2 40 mm Hg D. pH, 7.25; PaCO2 50 mm Hg

D. pH, 7.25; PaCO2 50 mm Hg In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0 with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis. Options B and C represent normal ABG values, reflecting normal gas exchange in the lungs.

During an assessment of a 45-year-old patient with asthma, the nurse notes wheezing and dyspnea. The nurse interprets that these symptoms are related to what pathophysiologic change? 1. Laryngospasm 2. Pulmonary edema 3. Narrowing of the airway 4. Overdistention of the alveoli

Narrowing of the airway a. Narrowing of the airway by persistent but variable inflammation leads to reduced airflow, making it difficult for the patient to breathe and producing the characteristic wheezing. Laryngospasm, pulmonary edema, and overdistention of the alveoli do not produce wheezing.

A patient was admitted following a motor vechicle accident with multiple fractured ribs. Respiratory assessment includes signs/symptoms of secondary pneumothorax. Which are the most common findings in pneumothorax? (Select All that apply) a. Sharp pleuritic pain that worsens on inspiration b. Crackles over lung bases of affected lung c. Tracheal deviation toward affected lung d. Worsening dyspneae. Absent lung sounds to auscultation on affected side

a. Sharp pleuritic pain that worsens on inspiration d. Worsening dyspnea e. Absent lung sounds to auscultation on affected side

The nursing is caring for a patient who has labored breathing, is using accessory muscles, and is coughing of pink frothy sputum. The patient has diminished breath sounds In bilateral lung bases. What are the priority nursing assessments for the nuse to preform prior to notifying the patient's healthcare provider? (Select all that apply) a. SpO2 levels b. Amount, color, and consistency of sputum production c. Fluid status d. Change in RR and patterne. Pain in lower leg

a. SpO2 levels b. Amount, color, and consistency of sputum production d. Change in RR and pattern

The nurse is caring for a patient who has decreased mobility. Which intervention is a simple and cost-effective method for reducing the risks of pulmonary complication? a. Antibiotics b. Frequent change of position c. Oxygen humidification d. Chest physiotherapy

b. Frequent change of position

A client with pulmonary artery hypertension on a continuous IV epoprostenol infusion is in the emergency department with symptoms of possible sepsis. The health care provider prescribes a broad-spectrum antibiotic to be administered IV immediately. What is the nurse's best action? a. Request a prescription for an oral antibiotic. b. Start a peripheral IV line and administer the antibiotic. c. Administer the IV antibiotic through the continuous infusion's side port. d. Stop the epoprostenol infusion for 15 minutes to administer the IV antibiotic.

b. Start a peripheral IV line and administer the antibiotic.

A patient who has mild persistent asthma uses an albuterol (Proventil) inhaler for chest tightness and wheezing has a new prescription for cromolyn (Intal). To increase the patient's management and control of the asthma, the nurse should teach the patient to a. use the cromolyn when the albuterol does not relieve symptoms. b. use the cromolyn to prevent inflammatory airway changes. c. administer the cromolyn first for chest tightness or wheezing. d. administer the albuterol regularly to prevent airway inflammation.

b. use the cromolyn to prevent inflammatory airway changes. Rationale: Cromolyn is prescribed to reduce airway inflammation. It takes several weeks for maximal effect and is not used to treat acute asthma symptoms Albuterol is used as a rescue medication in mild persistent asthma and will not decrease inflammation.

1. A client newly diagnosed with moderate asthma asks whether he can just take salmeterol instead of salmeterol and albuterol, because he has read that they are both beta agonists. What is the nurse's best advice? a. Yes, both of these drugs have the same action, and you only need one. b. Yes, because they both need to be used daily whether you are having symptoms or not, just take a little more of the salmeterol and don't take any of the albuterol. c. No, albuterol is used to relieve the symptoms during an actual asthma attack and salmeterol is used to prevent an attack. Both are needed. d. No, albuterol is taken through the use of an aerosol inhaler and salmeterol is an oral drug (tablet) that is activated in the stomach. Both are needed.

c. No, albuterol is used to relieve the symptoms during an actual asthma attack and salmeterol is used to prevent an attack. Both are needed.

The nurse is reviewing the results of the patient's diagnostic testing. Of the following results, the finding that falls within the expected normal limits is: a. Palpable, elevated hardened area around tuberculosis skin testing site b. Sputum for culture and sensitivity identifies mycobacterium tuberculosis c. Presence of acid-fast bacilli in sputum d. Arterial Oxygen tension (PaO2) of 95 mmHg

d. Arterial Oxygen tension (PaO2) of 95 mmHg

A patient has been newly diagnosed with chronic lung disease. In discussing the lung disease with the nurse, which of the patient's statements would indicate a need for further teaching? a. "I will make sure that I rest between activities so I don't get so short of breath." b. "I will practice the pursed-lip breathing technique to improve my exercise tolerance" c. "If I have trouble breathing at night, I will use two or three pillows to prop up" d. If I get short of breath, I will turn up my oxygen level to 6 L/Min"

d. If I get short of breath, I will turn up my oxygen level to 6 L/Min"

Which arterial blood gas (ABG) results would most likely indicate acute respiratory failure in a patient with chronic lung disease? a. PaO252 mm Hg, PaCO256 mm Hg, pH 7.4 c. PaO248 mm Hg, PaCO254 mm Hg, pH 7.38 b. PaO2 46 mm Hg, PaCO2 52 mm Hg, pH 7.36 d. PaO250 mm Hg, PaCO254 mm Hg, pH 7.28

d. In a patient with normal lung function, respiratory failure is commonly defined as a PaO2 ≤60 mm Hg or aPaCO2>45 mm Hg or both. However, because the patient with chronic pulmonary disease normally maintains lowPaO2and high PaCO2, acute respiratory failure in these patients can be defined as an acute decrease in PaO2or an increase in PaCO2 from the patient's baseline parameters,accompanied by an acidic pH. The pH of 7.28 reflects an acidemia and a loss of compensation in the patient with chronic lung disease.