RESP: CH 21, 23, 24

A client asks the nurse how long he should use oxymetazoline (Afrin) nasal spray for nasal congestion. What is the nurse's best response?

"Consult with your primary care provider." Rationale: Overuse of topical nasal decongestants, such as Afrin, can make the symptoms worse, causing rebound congestion. The client should consult with the primary care provider. Not all over-the-counter medications are safe for long-term use. Afrin should not be used long term without nasal burning or stinging, or until symptoms are relieved. The primary care provider should be notified to provide medication use information.

You have just finished teaching your 15-year-old patient how to use his inhaler to treat his asthma. What statement, made by your patient, suggests that he understands what you've taught him?

"I need to shake the inhaler well before taking the medication." Rationale: Just before each use, the patient should shake the inhaler well. After shaking, proper technique involves exhaling before placing the inhaler in the mouth; taking a slow, deep breath while delivering the medication into the mouth; and holding the breath for approximately ten seconds before exhaling slowly. A subsequent dose can be administered within a few minutes of the first.

Which statement by a client who is prescribed triamcinolone indicates the need for additional teaching?

"I should see some results in about 3 to 4 days." Rationale: Inhaled steroids, such as triamcinolone, can take from 2 to 3 weeks to reach effective levels, so the client should be encouraged to take them to reach and then maintain the effective levels. The drug is not effective for acute attacks. It can cause hoarseness and sore throat. The client should rinse his mouth after using the inhaler to decrease the risk of systemic absorption and decrease gastrointestinal upset and nausea.

The client has been prescribed cromolyn (Intal) for the treatment of asthma, and the nurse is evaluating the client's understanding of the medication. Which of the following statements by the client indicate the need for further education?

"I will use this medication when I am having an asthma attack." Rationale: Cromolyn (Intal) is a mast cell stabilizer used in combination with other drugs in the treatment of asthma and other allergic disorders. Adverse reactions include drying of the throat and coughing or wheezing. It should not be used during an acute asthma attack because it may worsen the bronchospasm.

After teaching a client who is receiving an antitussive about the drug, which statement indicates the need for additional teaching?

"I'll keep the room warm and toasty." Rationale: Measures to assist with cough control when using antitussives include cool temperatures, humidification, lozenges, and increased fluids.

You are teaching a 61-year-old client about the narcotic antitussive syrup that his physician has prescribed. Which of the following client statements suggests that he understands what you've taught him?

"This medication might cause drowsiness, so I will avoid driving while I use it." Rationale: Although narcotic antitussives include only small doses of narcotics, some of the adverse effects of that drug category (e.g., drowsiness, dizziness) are still possible. To decrease the risk of adverse effects, clients should take antitussives at the prescribed schedule and dosage. They should not dilute the medications with fluids or take them with food because doing so may clear the medications from the pharynx, reducing their benefit. Antitussives are intended to suppress only non-purposeful cough; suppression of all coughing can prevent the clearance of secretions.

After teaching a group of parents about the use of over-the-counter cough and cold products with their children, which statement indicates the need for additional teaching?

"We can use the adult brand, but we just have to decrease the amount." Rationale: Parents should use the children's, pediatric, or infant formulations of the drug. Over-the-counter cough and cold preparations should not be used in children under the age of 2 years. The parents need to read the label carefully to determine the dosage and frequency, and they need to use the device that comes with the drug to ensure a proper dosage.

A pt is hospitalized with blunt chest trauma following a car crash. When analyzing the pt's arterial blood gases (ABG), the nurse recognizes which value as a reflecting acute respiratory failure? SaO2 90%, pH 7.36, PaO2 80 mm Hg, PaCO2 62 mmHg

* NOT SaO2 90%--An oxygen saturation of 90% is slightly below the expected reference range of 95% to 100%, but this does not indicate respiratory acidosis. * NOT pH 7.36--A pH of 7.36 is within the expected reference range of 7.35 to 7.45 * NOT PaO2 80 mm Hg--it's low compared to the expected reference range of 80 to 100 mm Hg, but does not indicate respiratory acidosis *CORRECT PaCO2 62 mm Hg--high compared to the expected reference range of 35 o 45 mm Hg and indicates respiratory acidosis.

(Can't upload the chart for the question, so here are some facts from the answer. Good info, even out of context) Data: Times (0800, 1000, 1400) pH 7.36, 7.32, 7.30 pCO2 44, 49, 56 Base Excess +1, 0,--1 PO2 98, 86, 78 O2 sat 99, 92, 80 Bicarb 22, 24, 32

* Respiratory Acidosis is correct. The falling pH and rising PaC02 indicate that the pt is becoming more acidotic and that the cause has a respirator mechanism. The base excess is within the normal limits in all three blood gases, and would be affected if the imbalance has a metabolic cause. The bicarb is rising and would fall if the acidosis had a metabolic cause. *Respiratory alkalosis is characterized by a rising pH and falling PaCO2 * The falling pH and rising PaCO2 indicate that the pt is becoming more acidotic and that the cause has a respiratory mechanism. A falling pH, falling bicarb, and a base excess of less than -2 characterize metabolic acidosis

Acute Trancheobronchitis?

- Acute inflammation of the mucous membranes of the trachea and broncial tree.

Aerosol nebulizer treatments - What does it relieve? - What does it reduce?

- Aerosol therapy allows the delivery of medications, humidity, or both to the mucosa of the respiratory tract and pulmonary alveoli. - relieve spasm of the bronchial muscles - reduce edema of the mucous membranes

How does atelectasis occur? - How does the lung collapse?

- After the trapped alveolar air is absorbed into the bloodstream, no additional air can enter into the alveoli. As a result the part of the lung that is affected will be " AIRLESS" & lung will collapse.

Pneumothorax?

- Air in the pleural space

What medication can cause atelectasis? (2)

- Anesthesia - Analgesic agents

How does excess of mucous plus lead to atelectasis?

- Block airflow

Central cyanosis? - This is a sign of?

- Bluish skin - Late sign of hypoxia

Treatment of upper respiratory system will prevent acute ___.

- Bronchitis

Symptoms of atelectasis? (3)

- Dyspnea - Cough - sputum production

"Atelectasis" What happens if patient has a massive atelectasis & respiratory failure?

- Endotracheal intubation - Mechanical ventilation

Pleural effusion?

- Fluid accumlation in the pleural space.

- Pressure on the lung tissues will cause? (3 things)

- Fluid accumlation in the pleural space. - Air in the pleural space - blood in the pleural space

Patients with viral infections have lower __ system and can develop a secondary bacterial infection. Where?

- Immune - In the lower respiratory system

Atelectasis resulting by bronchial obstruction by secretions may also occur in patients with____

- Impaired mechanism, muscoloskeletal and neurolegic disorders.

"Atelectasis" Management -Goal? (2) Medication? (2)

- Improve ventilation - Remove secretions - Opioids & sedatives to prevent respiratory depression - Nebulizer

Atelectasis should also be observed on a patient with a chronic airway obstruction in the ____ (Other than the nasal airway) - What kind of obstruction can this be?

- Lung - Cancer!

Pressure may also be produced by? (3) -related to the heart - related to growth -related to respiration

- Pericardium distented with fluid - Tumor growth in the thorax - Elevated diaphragm.

Atelectasis cause by physicial movements includes?

- Pressure on the lung tissues

Atelectasis caused by tumor. What to do? (2)

- Radiation or surgery

How does atelectasis occur in adults?

- Reduced of ventilation or blockage that obstruct passage airway

Chronic atelectasis?

- Similar signs to acute but patients may catch infections!

What position can cause atelectasis?

- Supine position

Acute atelectasis? - respiration? -pain, where? - Skin?

- Tachypnea - Pleural pain - central cyanosis

A monotonous low tidal breathing pattern may cause airway ___ and ___ ___.

- closure - alveolar collapse

Thorancentesis? to prevent what?

- removal of fluid with needle aspiration. "Large pleural effusion"

1)Preventing Atelectasis from occurring in a patient whose respiratory system is compromise falls into the category of management and goal treatment to improve ___ and remove ___.

- ventilation -secretion

A nurse is assisting w/ thoracentesis. What actions are appropriate for the nurse to take when assisting w/ this procedure?

- wear goggles and mask during the procedure - cleanse the are w/ an antiseptic solution - apply pressure to the site after the needle is withdrawn.

6 Things which could cause atelectasis?

1) Altered breathing patterns 2) Retained secretions 3) Pain 4) Alterations in airway functions 5) Reduced lung volume due to muskuloskeletal problems 6) Restrictive defect.

Two types of atelectasis?

1) Chronic 2) Acute

"Atelectasis" The use of incentive spirometry with breathing and coughing exercise. (Benefits?) (2)

1) Enhance lung expansion 2) Decrease potential airway closeure

Atelectasis usually occurs in patients who are ___. -Have what kind of breathing? -What else can cause atelectasis?

1) Immobilized 2) Shallow monotonous breathing 3) Excess secretiosn or mucous plugs.

"Atelectasis " Secretion management techniques? - 2 kinds of suctioning

1) Suctioning (nasal & endotracheal suctioning catherers) 2) Directed cough 3) Aerosol nebulizer treatments 4) Postural drainage 4) chest percussion 5) Bronchoscopy 6) Meteredosein inhaler.

"Atelectasis" Nebulizer? (contain 2 things) - Used for?

1) bronchodilator 2) Sodium bicarbonate used for: -Expectoration of secretion

How to prevent atelectasis?

1) frequent turning 2) Mobilization 3) Use incentive spirometry with breathing and coughing exercise.

A nurse is assisting with the care of a client who has a trach in place. The nurse determines that the client's airway secretions require suctioning after auscultating the lung fields and prepares to apply suction using the open method.

1. Explain the procedure 2. Increase the flow of oxygen 3. Insert the suction catheter 4. Apply suction

The nurse assesses the serum theophylline of a patient. Which finding would the nurse identify as being therapeutic?

15 mcg/mL Rationale: Therapeutic theophylline levels range from 10 to 20 mcg/mL. A value of 15 mcg/mL would be considered therapeutic.

A client is using an inhaled bronchodilator as treatment for exercise-induced asthma. The nurse would instruct the client to use the inhaler at which time?

15 minutes before engaging in exercise Rationale: The client should use the inhaler approximately 15 minutes before exercising to achieve the maximum therapeutic effects.

A client who is experiencing anaphylaxis with severe wheezing receives a dose of epinephrine intravenously. The nurse would expect the drug to exert it full effects within which time frame?

20 minutes Rationale: When given intravenously, epinephrine peaks in approximately 20 minutes. It would be at this time that the drug is most effective.

23. The critical care nurse and the other members of the care team are assessing the patient to see if he is ready to be weaned from the ventilator. What are the most important predictors of successful weaning that the nurse should identify? A) Stable vital signs and ABGs B) Pulse oximetry above 80% and stable vital signs C) Stable nutritional status and ABGs D) Normal orientation and level of consciousness

A Feedback: Among many other predictors, stable vital signs and ABGs are important predictors of successful weaning. Pulse oximetry must greatly exceed 80%. Nutritional status is important, but vital signs and ABGs are even more significant. Patients who are weaned may or may not have full level of consciousness.

38. Postural drainage has been ordered for a patient who is having difficulty mobilizing her bronchial secretions. Before repositioning the patient and beginning treatment, the nurse should perform what health assessment? A) Chest auscultation B) Pulmonary function testing C) Chest percussion D) Thoracic palpation

A Feedback: Chest auscultation should be performed before and after postural drainage in order to evaluate the effectiveness of the therapy. Percussion and palpation are less likely to provide clinically meaningful data for the nurse. PFTs are normally beyond the scope of the nurse and are not necessary immediately before postural drainage.

7. A patient is exhibiting signs of a pneumothorax following tracheostomy. The surgeon inserts a chest tube into the anterior chest wall. What should the nurse tell the family is the primary purpose of this chest tube? A) To remove air from the pleural space B) To drain copious sputum secretions C) To monitor bleeding around the lungs D) To assist with mechanical ventilation

A Feedback: Chest tubes and closed drainage systems are used to re-expand the lung involved and to remove excess air, fluid, and blood. The primary purpose of a chest tube is not to drain sputum secretions, monitor bleeding, or assist with mechanical ventilation.

20. A nurse is caring for a patient who has been admitted with an exacerbation of chronic bronchiectasis. The nurse should expect to assess the patient for which of the following clinical manifestations? A) Copious sputum production B) Pain on inspiration C) Pigeon chest D) Dry cough

A Feedback: Clinical manifestations of bronchiectasis include hemoptysis, chronic cough, copious purulent sputum, and clubbing of the fingers. Because of the copious production of sputum, the cough is rarely dry. A pigeon chest is not associated with the disease and patients do not normally experience pain on inspiration.

18. A pediatric nurse practitioner is caring for a child who has just been diagnosed with asthma. The nurse has provided the parents with information that includes potential causative agents for an asthmatic reaction. What potential causative agent should the nurse describe? A) Pets B) Lack of sleep C) Psychosocial stress D) Bacteria

A Feedback: Common causative agents that may trigger an asthma attack are as follows: dust, dust mites, pets, soap, certain foods, molds, and pollens. Lack of sleep, stress, and bacteria are not common triggers for asthma attacks.

6. A nurse is evaluating the diagnostic study data of a patient with suspected cystic fibrosis (CF). Which of the following test results is associated with a diagnosis of cystic fibrosis? A) Elevated sweat chloride concentration B) Presence of protein in the urine C) Positive phenylketonuria D) Malignancy on lung biopsy

A Feedback: Gene mutations affect transport of chloride ions, leading to CF, which is characterized by thick, viscous secretions in the lungs, pancreas, liver, intestine, and reproductive tract as well as increased salt content in sweat gland secretions. Proteinuria, positive phenylketonuria, and malignancy are not diagnostic for CF.

21. A critical care nurse is caring for a client with an endotracheal tube who is on a ventilator. The nurse knows that meticulous airway management of this patient is necessary. What is the main rationale for this? A) Maintaining a patent airway B) Preventing the need for suctioning C) Maintaining the sterility of the patient's airway D) Increasing the patient's lung compliance

A Feedback: Maintaining a patent (open) airway is achieved through meticulous airway management, whether in an emergency situation such as airway obstruction or in long-term management, as in caring for a patient with an endotracheal or a tracheostomy tube. The other answers are incorrect.

10. A nurse is caring for a 6-year-old patient with cystic fibrosis. In order to enhance the child's nutritional status, what intervention should most likely be included in the plan of care? A) Pancreatic enzyme supplementation with meals B) Provision of five to six small meals per day rather than three larger meals C) Total parenteral nutrition (TPN) D) Magnesium, thiamine, and iron supplementation

A Feedback: Nearly 90% of patients with CF have pancreatic exocrine insufficiency and require oral pancreatic enzyme supplementation with meals. Frequent, small meals or TPN are not normally indicated. Vitamin supplements are required, but specific replacement of magnesium, thiamine, and iron is not typical.

30. A nurse is planning the care of a client with bronchiectasis. What goal of care should the nurse prioritize? A) The patient will successfully mobilize pulmonary secretions. B) The patient will maintain an oxygen saturation level of 98%. C) The patient's pulmonary blood pressure will decrease to within reference ranges. D) The patient will resume prediagnosis level of function within 72 hours.

A Feedback: Nursing management focuses on alleviating symptoms and helping patients clear pulmonary secretions. Pulmonary pressures are not a central focus in the care of the patient with bronchiectasis. Rapid resumption of prediagnosis function and oxygen saturation above 98% are unrealistic goals.

17. The nurse has admitted a patient who is scheduled for a thoracic resection. The nurse is providing preoperative teaching and is discussing several diagnostic studies that will be required prior to surgery. Which study will be performed to determine whether the planned resection will leave sufficient functioning lung tissue? A) Pulmonary function studies B) Exercise tolerance tests C) Arterial blood gas values D) Chest x-ray

A Feedback: Pulmonary function studies are performed to determine whether the planned resection will leave sufficient functioning lung tissue. ABG values are assessed to provide a more complete picture of the functional capacity of the lung. Exercise tolerance tests are useful to determine if the patient who is a candidate for pneumonectomy can tolerate removal of one of the lungs. Preoperative studies, such as a chest x-ray, are performed to provide a baseline for comparison during the postoperative period and to detect any unsuspected abnormalities.

17. A nurse has been asked to give a workshop on COPD for a local community group. The nurse emphasizes the importance of smoking cessation because smoking has what pathophysiologic effect? A) Increases the amount of mucus production B) Destabilizes hemoglobin C) Shrinks the alveoli in the lungs D) Collapses the alveoli in the lungs

A Feedback: Smoking irritates the goblet cells and mucous glands, causing an increased accumulation of mucus, which, in turn, produces more irritation, infection, and damage to the lung.

24. The OR nurse is setting up a water-seal chest drainage system for a patient who has just had a thoracotomy. The nurse knows that the amount of suction in the system is determined by the water level. At what suction level should the nurse set the system? A) 20 cm H2O B) 15 cm H2O C) 10 cm H2O D) 5 cm H2O

A Feedback: The amount of suction is determined by the water level. It is usually set at 20 cm H2O; adding more fluid results in more suction.

40. A nurse is admitting a new patient who has been admitted with a diagnosis of COPD exacerbation. How can the nurse best help the patient achieve the goal of maintaining effective oxygenation? A) Teach the patient strategies for promoting diaphragmatic breathing. B) Administer supplementary oxygen by simple face mask. C) Teach the patient to perform airway suctioning. D) Assist the patient in developing an appropriate exercise program.

A Feedback: The breathing pattern of most people with COPD is shallow, rapid, and inefficient; the more severe the disease, the more inefficient the breathing pattern. With practice, this type of upper chest breathing can be changed to diaphragmatic breathing, which reduces the respiratory rate, increases alveolar ventilation, and sometimes helps expel as much air as possible during expiration. Suctioning is not normally necessary in patients with COPD. Supplementary oxygen is not normally delivered by simple face mask and exercise may or may not be appropriate.

16. The nurse is caring for a patient who is ready to be weaned from the ventilator. In preparing to assist in the collaborative process of weaning the patient from a ventilator, the nurse is aware that the weaning of the patient will progress in what order? A) Removal from the ventilator, tube, and then oxygen B) Removal from oxygen, ventilator, and then tube C) Removal of the tube, oxygen, and then ventilator D) Removal from oxygen, tube, and then ventilator

A Feedback: The process of withdrawing the patient from dependence on the ventilator takes place in three stages: the patient is gradually removed from the ventilator, then from the tube, and, finally, oxygen.

32. A patient has been discharged home after thoracic surgery. The home care nurse performs the initial visit and finds the patient discouraged and saddened. The client states, "I am recovering so slowly. I really thought I would be better by now." What nursing action should the nurse prioritize? A) Provide emotional support to the patient and family. B) Schedule a visit to the patient's primary physician within 24 hours. C) Notify the physician that the patient needs a referral to a psychiatrist. D) Place a referral for a social worker to visit the patient.

A Feedback: The recovery process may take longer than the patient had expected, and providing support to the patient is an important task for the home care nurse. It is not necessary, based on this scenario, to schedule a visit with the physician within 24 hours, or to get a referral to a psychiatrist or a social worker.

5. A patient with emphysema is experiencing shortness of breath. To relieve this patient's symptoms, the nurse should assist her into what position? A) Sitting upright, leaning forward slightly B) Low Fowler's, with the neck slightly hyperextended C) Prone D) Trendelenburg

A Feedback: The typical posture of a person with COPD is to lean forward and use the accessory muscles of respiration to breathe. Low Fowler's positioning would be less likely to aid oxygenation. Prone or Trendelenburg positioning would exacerbate shortness of breath.

Meteredosein inhaler.

A metered dose inhaler is a way to deliver respiratory medication into the lungs.

Acute lung injury?

A term for hypoxemic (hypoxia), respiratory failure, acute respiration distress syndrome is a severe form of acute lung injury.

30. A nurse educator is reviewing the indications for chest drainage systems with a group of medical nurses. What indications should the nurses identify? Select all that apply. A) Post thoracotomy B) Spontaneous pneumothorax C) Need for postural drainage D) Chest trauma resulting in pneumothorax E) Pleurisy

A, B, D Feedback: Chest drainage systems are used in treatment of spontaneous pneumothorax and trauma resulting in pneumothorax. Postural drainage and pleurisy are not criteria for use of a chest drainage system.

34. A nurse is working with a child who is undergoing a diagnostic workup for suspected asthma. What are the signs and symptoms that are consistent with a diagnosis of asthma? Select all that apply. A) Chest tightness B) Crackles C) Bradypnea D) Wheezing E) Cough

A, D, E Feedback: Asthma is a chronic inflammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema, and mucus production. This inflammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnea. Crackles and bradypnea are not typical symptoms of asthma.

A client w/ Respiratory Failure who is receiving mechanical ventilation. Which assessment is the priority for the nurse to evaluate the effectiveness of the ventilation.

ABG (When using the airway, breathing, circulation approach to client care, the nurse should place priority on evaluating arterial blood gasses to determine serum oxygen saturation and acid-base balance)

Following a motor-vehicle crash a client is admitted with multiple trauma, including significant bruising of the left chest from striking the steering wheel. The client is alert and reports severe left pain on inspiration. The nurse should assess the client for manifestations of pneumothorax, including:

Absence of breath sounds A pt with pneumothorax has severely diminished or absent breath sounds on the affected side.

A patient is admitted to the emergency room after consuming 50 acetaminophen tablets in a suicide attempt. What medication will be administered to counteract the effect of the acetaminophen?

Acetylcysteine (Mucomyst) Rationale: Acetylcysteine is effective in the treatment of acetaminophen overdose. Oxymetazoline hydrochloride is used for nasal congestion, not acetaminophen overdose. Daptomycin and darbepoetin alfa are not used for acetaminophen overdose.

Name the common respiratory infection?

Acute Tracheobronchitis, Pneumonia and pulmonary tubercolosis

acute bronchitis

Acute inflammation of the mucous membranes of the trachea and bronchial tree.

A client w/ pulmonary embolism. What intervention is priority?

Administering heparin via continuous IV infusion (The nurse should prioritize stabilizing circulation to the lungs with heparin to prevent further clot formation)

A nurse is caring for a client with active TB. What isolation precautions should be taken.

Airborne (TB is a respiratory infection, and it's spread through the air)

A 5-year-old boy is brought to the ED with an asthma exacerbation, including wheezing (a high-pitched, whistling sound caused by turbulent airflow through an obstructed airway). Those who have asthma chronically present with what signs, even when they may appear symptom free? Select all that apply.

Airway inflammation Damaged airway mucosa Rationale: Inflammation and damaged airway mucosa are chronically present in asthma, even when clients appear symptom free.

Which of the following is an example of a short acting Beta 2 Agonist (SABA)?

Albuterol

A male client presents with symptoms of bronchospasm that occurred during a birthday party for his grandson. What medication would the nurse expect the physician to give him?

Albuterol Rationale: A selective, short-acting, inhaled beta2-adrenergic agonist (e.g., albuterol) is the initial rescue drug of choice for acute bronchospasm; subcutaneous epinephrine may also be considered.

During the summer, a female client experiences increased periods of acute symptoms of her asthma. The physician increases the dose frequency of which of her medications?

Albuterol Rationale: Albuterol is the initial drug of choice for acute bronchospasm.

Mr. Ashum is prescribed an albuterol inhaler as part of his treatment regimen for asthma. What is the mechanism of action for this medication?

Albuterol causes relaxation of the bronchial smooth muscles. Rationale: The main result of albuterol binding to beta-2 receptors in the lungs is relaxation of bronchial smooth muscles. This relaxation of bronchial smooth muscle relieves bronchospasm, reduces airway resistance, facilitates mucous drainage, and increases vital capacity.

The asthmatic client is being treated with two inhalers, albuterol and flunisolide. The nurse teaches the client that the two medications should be administered in what order?

Albuterol first, wait five minutes and then follow with flunisolide Rationale: Albuterol is a bronchodilator and should be used first, given time to open the airways, and then the inhaled corticosteroid is administered.

A nurse is planning care for a client w/ asthma. Which medication should be administered during an acute asthma attack?

Albuterol. (Albuterol is a short-acting beta 2 adrenergic agonist, and acts quickly to produce bronchodilation.)

When collecting data from a client with reactive airway disease who is experiencing an acute asthma attack, the nurse should expect to auscultate for which of the following?

An expiratory wheeze Expiratory wheeze is associated with air movement throughout narrow airways, as with the bronchospasm associated with asthma. In addition, the expiratory phase with an acute asthma attack may also be prolonged.

6. A patient has been brought to the ED by the paramedics. The patient is suspected of having ARDS. What intervention should the nurse first anticipate? A) Preparing to assist with intubating the patient B) Setting up oxygen at 5 L/minute by nasal cannula C) Performing deep suctioning D) Setting up a nebulizer to administer corticosteroids

Ans: A Feedback: A patient who has ARDS usually requires intubation and mechanical ventilation. Oxygen by nasal cannula would likely be insufficient. Deep suctioning and nebulizers may be indicated, but the priority is to secure the airway.

10. An x-ray of a trauma patient reveals rib fractures and the patient is diagnosed with a small flail chest injury. Which intervention should the nurse include in the patient's plan of care? A) Suction the patient's airway secretions. B) Immobilize the ribs with an abdominal binder. C) Prepare the patient for surgery. D) Immediately sedate and intubate the patient.

Ans: A Feedback: As with rib fracture, treatment of flail chest is usually supportive. Management includes clearing secretions from the lungs, and controlling pain. If only a small segment of the chest is involved, it is important to clear the airway through positioning, coughing, deep breathing, and suctioning. Intubation is required for severe flail chest injuries, and surgery is required only in rare circumstances to stabilize the flail segment.

14. The nurse at a long-term care facility is assessing each of the residents. Which resident most likely faces the greatest risk for aspiration? A) A resident who suffered a severe stroke several weeks ago B) A resident with mid-stage Alzheimer's disease C) A 92-year-old resident who needs extensive help with ADLs D) A resident with severe and deforming rheumatoid arthritis

Ans: A Feedback: Aspiration may occur if the patient cannot adequately coordinate protective glottic, laryngeal, and cough reflexes. These reflexes are often affected by stroke. A patient with mid-stage Alzheimer's disease does not likely have the voluntary muscle problems that occur later in the disease. Clients that need help with ADLs or have severe arthritis should not have difficulty swallowing unless it exists secondary to another problem.

18. The perioperative nurse is writing a care plan for a patient who has returned from surgery 2 hours prior. Which measure should the nurse implement to most decrease the patient's risk of developing pulmonary emboli (PE)? A) Early ambulation B) Increased dietary intake of protein C) Maintaining the patient in a supine position D) Administering aspirin with warfarin

Ans: A Feedback: For patients at risk for PE, the most effective approach for prevention is to prevent deep vein thrombosis. Active leg exercises to avoid venous stasis, early ambulation, and use of elastic compression stocking are general preventive measures. The patient does not require increased dietary intake of protein directly related to prevention of PE, although it will assist in wound healing during the postoperative period. The patient should not be maintained in one position, but frequently repositioned, unless contraindicated by the surgical procedure. Aspirin should never be administered with warfarin because it will increase the patient's risk for bleeding.

13. The nurse is assessing an adult patient following a motor vehicle accident. The nurse observes that the patient has an increased use of accessory muscles and is complaining of chest pain and shortness of breath. The nurse should recognize the possibility of what condition? A) Pneumothorax B) Anxiety C) Acute bronchitis D) Aspiration

Ans: A Feedback: If the pneumothorax is large and the lung collapses totally, acute respiratory distress occurs. The patient is anxious, has dyspnea and air hunger, has increased use of the accessory muscles, and may develop central cyanosis from severe hypoxemia. These symptoms are not definitive of pneumothorax, but because of the patient's recent trauma they are inconsistent with anxiety, bronchitis, or aspiration.

7. The nurse is caring for a patient who is scheduled for a lobectomy for a diagnosis of lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the client's oxygen saturation rapidly dropping. The patient complains of shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the presence of a pneumothorax include what? A) Diminished or absent breath sounds on the affected side B) Paradoxical chest wall movement with respirations C) Sudden loss of consciousness D) Muffled heart sounds

Ans: A Feedback: In the case of a simple pneumothorax, auscultating the breath sounds will reveal absent or diminished breath sounds on the affected side. Paradoxical chest wall movements occur in flail chest conditions. Sudden loss of consciousness does not typically occur. Muffled or distant heart sounds occur in pericardial tamponade.

19. The school nurse is presenting a class on smoking cessation at the local high school. A participant in the class asks the nurse about the risk of lung cancer in those who smoke. What response related to risk for lung cancer in smokers is most accurate? A) "The younger you are when you start smoking, the higher your risk of lung cancer." B) "The risk for lung cancer never decreases once you have smoked, which is why smokers need annual chest x-rays." C) "The risk for lung cancer is determined mostly by what type of cigarettes you smoke." D) "The risk for lung cancer depends primarily on the other risk factors for cancer that you have."

Ans: A Feedback: Risk is determined by the pack-year history (number of packs of cigarettes used each day, multiplied by the number of years smoked), the age of initiation of smoking, the depth of inhalation, and the tar and nicotine levels in the cigarettes smoked. The younger a person is when he or she starts smoking, the greater the risk of developing lung cancer. Risk declines after smoking cessation. The type of cigarettes is a significant variable, but this is not the most important factor.

16. The nurse is caring for a patient at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the patient. What is an example of a first-line measure to minimize atelectasis? A) Incentive spirometry B) Intermittent positive-pressure breathing (IPPB) C) Positive end-expiratory pressure (PEEP) D) Bronchoscopy

Ans: A Feedback: Strategies to prevent atelectasis, which include frequent turning, early ambulation, lung-volume expansion maneuvers (deep breathing exercises, incentive spirometry), and coughing, serve as the first-line measures to minimize or treat atelectasis by improving ventilation. In patients who do not respond to first-line measures or who cannot perform deep-breathing exercises, other treatments such as positive end-expiratory pressure (PEEP), continuous or intermittent positive-pressure breathing (IPPB), or bronchoscopy may be used.

12. An adult patient has tested positive for tuberculosis (TB). While providing patient teaching, what information should the nurse prioritize? A) The importance of adhering closely to the prescribed medication regimen B) The fact that the disease is a lifelong, chronic condition that will affect ADLs C) The fact that TB is self-limiting, but can take up to 2 years to resolve D) The need to work closely with the occupational and physical therapists

Ans: A Feedback: Successful treatment of TB is highly dependent on careful adherence to the medication regimen. The disease is not self-limiting; occupational and physical therapy are not necessarily indicated. TB is curable.

17. While planning a patient's care, the nurse identifies nursing actions to minimize the patient's pleuritic pain. Which intervention should the nurse include in the plan of care? A) Avoid actions that will cause the patient to breathe deeply. B) Ambulate the patient at least three times daily. C) Arrange for a soft-textured diet and increased fluid intake. D) Encourage the patient to speak as little as possible

Ans: A Feedback: The key characteristic of pleuritic pain is its relationship to respiratory movement. Taking a deep breath, coughing, or sneezing worsens the pain. A soft diet is not necessarily indicated and there is no need for the patient to avoid speaking. Ambulation has multiple benefits, but pain management is not among them.

20. The nurse is assessing a patient who has a 35 pack-year history of cigarette smoking. In light of this known risk factor for lung cancer, what statement should prompt the nurse to refer the patient for further assessment? A) "Lately, I have this cough that just never seems to go away." B) "I find that I don't have nearly the stamina that I used to." C) "I seem to get nearly every cold and flu that goes around my workplace." D) "I never used to have any allergies, but now I think I'm developing allergies to dust and pet hair."

Ans: A Feedback: The most frequent symptom of lung cancer is cough or change in a chronic cough. People frequently ignore this symptom and attribute it to smoking or a respiratory infection. A new onset of allergies, frequent respiratory infections and fatigue are not characteristic early signs of lung cancer.

2. A critical-care nurse is caring for a patient diagnosed with pneumonia as a surgical complication. The nurse's assessment reveals that the patient has an increased work of breathing due to copious tracheobronchial secretions. What should the nurse encourage the patient to do? A) Increase oral fluids unless contraindicated. B) Call the nurse for oral suctioning, as needed. C) Lie in a low Fowler's or supine position. D) Increase activity.

Ans: A Feedback: The nurse should encourage hydration because adequate hydration thins and loosens pulmonary secretions. Oral suctioning is not sufficiently deep to remove tracheobronchial secretions. The patient should have the head of the bed raised, and rest should be promoted to avoid exacerbation of symptoms.

3. The public health nurse is administering Mantoux tests to children who are being registered for kindergarten in the community. How should the nurse administer this test? A) Administer intradermal injections into the children's inner forearms. B) Administer intramuscular injections into each child's vastus lateralis. C) Administer a subcutaneous injection into each child's umbilical area. D) Administer a subcutaneous injection at a 45-degree angle into each child's deltoid.

Ans: A Feedback: The purified protein derivative (PPD) is always injected into the intradermal layer of the inner aspect of the forearm. The subcutaneous and intramuscular routes are not utilized.

31. The occupational health nurse is assessing new employees at a company. What would be important to assess in employees with a potential occupational respiratory exposure to a toxin? Select all that apply. A) Time frame of exposure B) Type of respiratory protection used C) Immunization status D) Breath sounds E) Intensity of exposure

Ans: A, B, D, E Feedback: Key aspects of any assessment of patients with a potential occupational respiratory history include job and job activities, exposure levels, general hygiene, time frame of exposure, effectiveness of respiratory protection used, and direct versus indirect exposures. The patient's current respiratory status would also be a priority. Occupational lung hazards are not normally influenced by immunizations.

1. A perioperative nurse is caring for a postoperative patient. The patient has a shallow respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address the patient's increased risk for what complication? A) Acute respiratory distress syndrome (ARDS) B) Atelectasis C) Aspiration D) Pulmonary embolism

Ans: B Feedback: A shallow, monotonous respiratory pattern coupled with immobility places the patient at an increased risk of developing atelectasis. These specific factors are less likely to result in pulmonary embolism or aspiration. ARDS involves an exaggerated inflammatory response and does not normally result from factors such as immobility and shallow breathing.

38. A firefighter was trapped in a fire and is admitted to the ICU for smoke inhalation. After 12 hours, the firefighter is exhibiting signs of ARDS and is intubated. What other supportive measures are initiated in a patient with ARDS? A) Psychological counseling B) Nutritional support C) High-protein oral diet D) Occupational therapy

Ans: B Feedback: Aggressive, supportive care must be provided to compensate for the severe respiratory dysfunction. This supportive therapy almost always includes intubation and mechanical ventilation. In addition, circulatory support, adequate fluid volume, and nutritional support are important. Oral intake is contraindicated by intubation. Counseling and occupational therapy would not be priorities during the acute stage of ARDS.

15. The nurse is caring for a patient suspected of having ARDS. What is the most likely diagnostic test ordered in the early stages of this disease to differentiate the patient's symptoms from those of a cardiac etiology? A) Carboxyhemoglobin level B) Brain natriuretic peptide (BNP) level C) C-reactive protein (CRP) level D) Complete blood count

Ans: B Feedback: Common diagnostic tests performed for patients with potential ARDS include plasma brain natriuretic peptide (BNP) levels, echocardiography, and pulmonary artery catheterization. The BNP level is helpful in distinguishing ARDS from cardiogenic pulmonary edema. The carboxyhemoglobin level will be increased in a client with an inhalation injury, which commonly progresses into ARDS. CRP and CBC levels do not help differentiate from a cardiac problem.

28. A patient with thoracic trauma is admitted to the ICU. The nurse notes the patient's chest and neck are swollen and there is a crackling sensation when palpated. The nurse consequently identifies the presence of subcutaneous emphysema. If this condition becomes severe and threatens airway patency, what intervention is indicated? A) A chest tube B) A tracheostomy C) An endotracheal tube D) A feeding tube

Ans: B Feedback: In severe cases in which there is widespread subcutaneous emphysema, a tracheostomy is indicated if airway patency is threatened by pressure of the trapped air on the trachea. The other listed tubes would neither resolve the subcutaneous emphysema nor the consequent airway constriction.

22. A hospital has been the site of an increased incidence of hospital-acquired pneumonia (HAP). What is an important measure for the prevention of HAP? A) Administration of prophylactic antibiotics B) Administration of pneumococcal vaccine to vulnerable individuals C) Obtaining culture and sensitivity swabs from all newly admitted patients D) Administration of antiretroviral medications to patients over age 65

Ans: B Feedback: Pneumococcal vaccination reduces the incidence of pneumonia, hospitalizations for cardiac conditions, and deaths in the general older adult population. A onetime vaccination of pneumococcal polysaccharide vaccine (PPSV) is recommended for all patients 65 years of age or older and those with chronic diseases. Antibiotics are not given on a preventative basis and antiretroviral medications do not affect the most common causative microorganisms. Culture and sensitivity testing by swabbing is not performed for pneumonia since the microorganisms are found in sputum.

26. A patient is receiving thrombolytic therapy for the treatment of pulmonary emboli. What is the best way for the nurse to assess the patient's oxygenation status at the bedside? A) Obtain serial ABG samples. B) Monitor pulse oximetry readings. C) Test pulmonary function. D) Monitor incentive spirometry volumes.

Ans: B Feedback: The nurse assesses the patient with pulmonary emboli frequently for signs of hypoxemia and monitors the pulse oximetry values to evaluate the effectiveness of the oxygen therapy. ABGs are accurate indicators of oxygenation status, but are not analyzed at the bedside. PFTs and incentive spirometry volumes do not accurately reveal oxygenation status.

33. A patient who involved in a workplace accident suffered a penetrating wound of the chest that led to acute respiratory failure. What goal of treatment should the care team prioritize when planning this patient's care? A) Facilitation of long-term intubation B) Restoration of adequate gas exchange C) Attainment of effective coping D) Self-management of oxygen therapy

Ans: B Feedback: The objectives of treatment are to correct the underlying cause of respiratory failure and to restore adequate gas exchange in the lung. This is priority over coping and self-care. Long-term ventilation may or may not be indicated.

9. A new employee asks the occupational health nurse about measures to prevent inhalation exposure of the substances. Which statement by the nurse will decrease the patient's exposure risk to toxic substances? A) "Position a fan blowing on the toxic substances to prevent the substance from becoming stagnant in the air." B) "Wear protective attire and devices when working with a toxic substance." C) "Make sure that you keep your immunizations up to date to prevent respiratory diseases resulting from toxins." D) "Always wear a disposable paper face mask when you are working with inhalable toxins."

Ans: B Feedback: When working with toxic substances, the employee must wear or use protective devices such as face masks, hoods, or industrial respirators. Immunizations do not confer protection from toxins and a paper mask is normally insufficient protection. Never position a fan directly blowing on the toxic substance as it will disperse the fumes throughout the area.

34. A patient is brought to the ED by ambulance after a motor vehicle accident in which the patient received blunt trauma to the chest. The patient is in acute respiratory failure, is intubated, and is transferred to the ICU. What parameters of care should the nurse monitor most closely? Select all that apply. A) Coping B) Level of consciousness C) Oral intake D) Arterial blood gases E) Vital signs

Ans: B, D, E Feedback: Patients are usually treated in the ICU. The nurse assesses the patient's respiratory status by monitoring the level of responsiveness, ABGs, pulse oximetry, and vital signs. Oral intake and coping are not immediate priorities during the acute stage of treatment, but would become more important later during recovery.

8. The nurse is providing discharge teaching for a patient who developed a pulmonary embolism after total knee surgery. The patient has been converted from heparin to sodium warfarin (Coumadin) anticoagulant therapy. What should the nurse teach the client? A) Coumadin will continue to break up the clot over a period of weeks B) Coumadin must be taken concurrent with ASA to achieve anticoagulation. C) Anticoagulant therapy usually lasts between 3 and 6 months. D) He should take a vitamin supplement containing vitamin K

Ans: C Feedback: Anticoagulant therapy prevents further clot formation, but cannot be used to dissolve a clot. The therapy continues for approximately 3 to 6 months and is not combined with ASA. Vitamin K reverses the effect of anticoagulant therapy and normally should not be taken.

23. When assessing for substances that are known to harm workers' lungs, the occupational health nurse should assess their potential exposure to which of the following? A) Organic acids B) Propane C) Asbestos D) Gypsum

Ans: C Feedback: Asbestos is among the more common causes of pneumoconiosis. Organic acids, propane, and gypsum do not have this effect.

24. A patient presents to the ED stating she was in a boating accident about 3 hours ago. Now the patient has complaints of headache, fatigue, and the feeling that he "just can't breathe enough." The nurse notes that the patient is restless and tachycardic with an elevated blood pressure. This patient may be in the early stages of what respiratory problem? A) Pneumoconiosis B) Pleural effusion C) Acute respiratory failure D) Pneumonia

Ans: C Feedback: Early signs of acute respiratory failure are those associated with impaired oxygenation and may include restlessness, fatigue, headache, dyspnea, air hunger, tachycardia, and increased blood pressure. As the hypoxemia progresses, more obvious signs may be present, including confusion, lethargy, tachycardia, tachypnea, central cyanosis, diaphoresis, and, finally, respiratory arrest. Pneumonia is infectious and would not result from trauma. Pneumoconiosis results from exposure to occupational toxins. A pleural effusion does not cause this constellation of symptoms.

21. A client presents to the walk-in clinic complaining of a dry, irritating cough and production of a minute amount of mucus-like sputum. The patient complains of soreness in her chest in the sternal area. The nurse should suspect that the primary care provider will assess the patient for what health problem? A) Pleural effusion B) Pulmonary embolism C) Tracheobronchitis D) Tuberculosis

Ans: C Feedback: Initially, the patient with tracheobronchitis has a dry, irritating cough and expectorates a scant amount of mucoid sputum. The patient may report sternal soreness from coughing and have fever or chills, night sweats, headache, and general malaise. Pleural effusion and pulmonary embolism do not normally cause sputum production and would likely cause acute shortness of breath. Hemoptysis is characteristic of TB.

39. The nurse is reviewing the electronic health record of a patient with an empyema. What health problem in the patient's history is most likely to have caused the empyema? A) Smoking B) Asbestosis C) Pneumonia D) Lung cancer

Ans: C Feedback: Most empyemas occur as complications of bacterial pneumonia or lung abscess. Cancer, smoking, and asbestosis are not noted to be common causes.

25. The nurse is caring for a 46-year-old patient recently diagnosed with the early stages of lung cancer. The nurse is aware that the preferred method of treating patients with non-small cell tumors is what? A) Chemotherapy B) Radiation C) Surgical resection D) Bronchoscopic opening of the airway

Ans: C Feedback: Surgical resection is the preferred method of treating patients with localized non-small cell tumors with no evidence of metastatic spread and adequate cardiopulmonary function. The other listed treatment options may be considered, but surgery is preferred.

29. The nurse is caring for a patient in the ICU admitted with ARDS after exposure to toxic fumes from a hazardous spill at work. The patient has become hypotensive. What is the cause of this complication to the ARDS treatment? A) Pulmonary hypotension due to decreased cardiac output B) Severe and progressive pulmonary hypertension C) Hypovolemia secondary to leakage of fluid into the interstitial spaces D) Increased cardiac output from high levels of PEEP therapy

Ans: C Feedback: Systemic hypotension may occur in ARDS as a result of hypovolemia secondary to leakage of fluid into the interstitial spaces and depressed cardiac output from high levels of PEEP therapy. Pulmonary hypertension, not pulmonary hypotension, sometimes is a complication of ARDS, but it is not the cause of the patient becoming hypotensive.

35. A gerontologic nurse is teaching a group of medical nurses about the high incidence and mortality of pneumonia in older adults. What is a contributing factor to this that the nurse should describe? A) Older adults have less compliant lung tissue than younger adults. B) Older adults are not normally candidates for pneumococcal vaccination. C) Older adults often lack the classic signs and symptoms of pneumonia. D) Older adults often cannot tolerate the most common antibiotics used to treat pneumonia.

Ans: C Feedback: The diagnosis of pneumonia may be missed because the classic symptoms of cough, chest pain, sputum production, and fever may be absent or masked in older adult patients. Mortality from pneumonia in the elderly is not a result of limited antibiotic options or lower lung compliance. The pneumococcal vaccine is appropriate for older adults.

11. The nurse is caring for a patient who is receiving oxygen therapy for pneumonia. How should the nurse best assess whether the patient is hypoxemic? A) Assess the patient's level of consciousness (LOC). B) Assess the patient's extremities for signs of cyanosis. C) Assess the patient's oxygen saturation level. D) Review the patient's hemoglobin, hematocrit, and red blood cell levels.

Ans: C Feedback: The effectiveness of the patient's oxygen therapy is assessed by the ABG analysis or pulse oximetry. ABG results may not be readily available. Presence or absence of cyanosis is not an accurate indicator of oxygen effectiveness. The patient's LOC may be affected by hypoxia, but not every change in LOC is related to oxygenation. Hemoglobin, hematocrit, and red blood cell levels do not directly reflect current oxygenation status.

27. The nurse is caring for an 82-year-old patient with a diagnosis of tracheobronchitis. The patient begins complaining of right-sided chest pain that gets worse when he coughs or breathes deeply. Vital signs are within normal limits. What would you suspect this patient is experiencing? A) Traumatic pneumothorax B) Empyema C) Pleuritic pain D) Myocardial infarction

Ans: C Feedback: The key characteristic of pleuritic pain is its relationship to respiratory movement. Taking a deep breath, coughing, or sneezing worsens the pain. Pleuritic pain is limited in distribution rather than diffuse; it usually occurs only on one side. The pain may become minimal or absent when the breath is held. It may be localized or radiate to the shoulder or abdomen. Later, as pleural fluid develops, the pain decreases. The scenario does not indicate any trauma to the patient, so a traumatic pneumothorax is implausible. Empyema is unlikely as there is no fever indicative of infection. Myocardial infarction would affect the patient's vital signs profoundly.

36. A patient has just been diagnosed with lung cancer. After the physician discusses treatment options and leaves the room, the patient asks the nurse how the treatment is decided upon. What would be the nurse's best response? A) "The type of treatment depends on the patient's age and health status." B) "The type of treatment depends on what the patient wants when given the options." C) "The type of treatment depends on the cell type of the cancer, the stage of the cancer, and the patient's health status." D) "The type of treatment depends on the discussion between the patient and the physician of which treatment is best."

Ans: C Feedback: Treatment of lung cancer depends on the cell type, the stage of the disease, and the patient's physiologic status (particularly cardiac and pulmonary status). Treatment does not depend solely on the patient's age or the patient's preference between the different treatment modes. The decision about treatment does not primarily depend on a discussion between the patient and the physician of which treatment is best, though this discussion will take place.

37. A patient in the ICU is status post embolectomy after a pulmonary embolus. What assessment parameter does the nurse monitor most closely on a patient who is postoperative following an embolectomy? A) Pupillary response B) Pressure in the vena cava C) White blood cell differential D) Pulmonary arterial pressure

Ans: D Feedback: If the patient has undergone surgical embolectomy, the nurse measures the patient's pulmonary arterial pressure and urinary output. Pressure is not monitored in a patient's vena cava. White cell levels and pupillary responses would be monitored, but not to the extent of the patient's pulmonary arterial pressure.

5. The nurse caring for a patient recently diagnosed with lung disease encourages the patient not to smoke. What is the primary rationale behind this nursing action? A) Smoking decreases the amount of mucus production. B) Smoke particles compete for binding sites on hemoglobin. C) Smoking causes atrophy of the alveoli. D) Smoking damages the ciliary cleansing mechanism.

Ans: D Feedback: In addition to irritating the mucous cells of the bronchi and inhibiting the function of alveolar macrophage (scavenger) cells, smoking damages the ciliary cleansing mechanism of the respiratory tract. Smoking also increases the amount of mucus production and distends the alveoli in the lungs. It reduces the oxygen-carrying capacity of hemoglobin, but not by directly competing for binding sites.

40. An 87-year-old patient has been hospitalized with pneumonia. Which nursing action would be a priority in this patient's plan of care? A) Nasogastric intubation B) Administration of probiotic supplements C) Bedrest D) Cautious hydration

Ans: D Feedback: Supportive treatment of pneumonia in the elderly includes hydration (with caution and with frequent assessment because of the risk of fluid overload in the elderly); supplemental oxygen therapy; and assistance with deep breathing, coughing, frequent position changes, and early ambulation. Mobility is not normally discouraged and an NG tube is not necessary in most cases. Probiotics may or may not be prescribed for the patient.

32. A 54-year-old man has just been diagnosed with small cell lung cancer. The patient asks the nurse why the doctor is not offering surgery as a treatment for his cancer. What fact about lung cancer treatment should inform the nurse's response? A) The cells in small cell cancer of the lung are not large enough to visualize in surgery. B) Small cell lung cancer is self-limiting in many patients and surgery should be delayed. C) Patients with small cell lung cancer are not normally stable enough to survive surgery. D) Small cell cancer of the lung grows rapidly and metastasizes early and extensively.

Ans: D Feedback: Surgery is primarily used for NSCLCs, because small cell cancer of the lung grows rapidly and metastasizes early and extensively. Difficult visualization and a patient's medical instability are not the limiting factors. Lung cancer is not a self-limiting disease.

30. The home care nurse is monitoring a patient discharged home after resolution of a pulmonary embolus. For what potential complication would the home care nurse be most closely monitoring this patient? A) Signs and symptoms of pulmonary infection B) Swallowing ability and signs of aspiration C) Activity level and role performance D) Residual effects of compromised oxygenation

Ans: D Feedback: The home care nurse should monitor the patient for residual effects of the PE, which involved a severe disruption in respiration and oxygenation. PE has a noninfectious etiology; pneumonia is not impossible, but it is a less likely sequela. Swallowing ability is unlikely to be affected; activity level is important, but secondary to the effects of deoxygenation.

4. The nurse is caring for a patient who has been in a motor vehicle accident and the care team suspects that the patient has developed pleurisy. Which of the nurse's assessment findings would best corroborate this diagnosis? A) The patient is experiencing painless hemoptysis. B) The patient's arterial blood gases (ABGs) are normal, but he demonstrates increased work of breathing. C) The patient's oxygen saturation level is below 88%, but he denies shortness of breath. D) The patient's pain intensifies when he coughs or takes a deep breath.

Ans: D Feedback: The key characteristic of pleuritic pain is its relationship to respiratory movement. Taking a deep breath, coughing, or sneezing worsens the pain. The patient's ABGs would most likely be abnormal and shortness of breath would be expected.

Acetylcysteine may be used as a mucolytic agent. Which of the following is an additional indication for the drug?

Antidote for acetaminophen poisoning Rationale: Oral acetylcysteine is widely used in the treatment of acetaminophen overdosage.

Your client is complaining of a hacking cough. She asks if taking an antihistamine would be helpful. Your best response is:

Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough. Rationale: Many cold remedies are over-the-counter formulations. Although antihistamines are popular over-the-counter drugs because they dry nasal secretions, they are not recommended because they can also dry lower respiratory secretions and worsen secretion retention and cough.

Your client asks, "What is the difference between antitussive medications and expectorants?" Your best response is:

Antitussives suppress coughing, and expectorants loosen bronchial secretions. Rationale: Antitussive agents suppress cough by depressing the cough center in the medulla oblongata or the cough receptors in the throat, trachea, or lungs. Expectorants are agents given orally to liquefy respiratory secretions and allow for their easier removal.

A client is taking pseudoephedrine. The nurse would assess the client for which of the following adverse effects?

Anxiety Rationale: Adverse effects related to the sympathomimetic effects of pseudoephedrine are more likely to occur, including feelings of anxiety, restlessness, hypertension, sweating, tenseness, tremors, arrhythmias, and pallor.

A client who is postoperative and develops acute onset of severe chest pain that worsens upon inspiration. Client is anxious and tachypneic. What should the nurse do?

Apply supplemental oxygen (the greatest risk to the patient is hypoxemia)

What is the pleura space?

Area between the parietal and the visceral pleaurae.

A nurse caring for a client receiving mech ventilation. The low pressure alarm sounds. What should the nurse expect caused the alarm?

Artificial airway cuff leak. (an artificial cuff leak interferes w/ oxygenation and causes the low pressure alarm to sound)

3. A nurse is caring for a young adult patient whose medical history includes an alpha1-antitrypsin deficiency. This deficiency predisposes the patient to what health problem? A) Pulmonary edema B) Lobular emphysema C) Cystic fibrosis (CF) D) Empyema

B Feedback: A host risk factor for COPD is a deficiency of alpha1-antitrypsin, an enzyme inhibitor that protects the lung parenchyma from injury. This deficiency predisposes young patients to rapid development of lobular emphysema even in the absence of smoking. This deficiency does not influence the patient's risk of pulmonary edema, CF, or empyema.

28. A nurse is developing a teaching plan for a patient with COPD. What should the nurse include as the most important area of teaching? A) Avoiding extremes of heat and cold B) Setting and accepting realistic short- and long-range goals C) Adopting a lifestyle of moderate activity D) Avoiding emotional disturbances and stressful situations

B Feedback: A major area of teaching involves setting and accepting realistic short-term and long-range goals. The other options should also be included in the teaching plan, but they are not areas that are as high a priority as setting and accepting realistic goals.

20. The nurse is caring for a patient who is experiencing mild shortness of breath during the immediate postoperative period, with oxygen saturation readings between 89% and 91%. What method of oxygen delivery is most appropriate for the patient's needs? A) Non-rebreathing mask B) Nasal cannula C) Simple mask D) Partial-rebreathing mask

B Feedback: A nasal cannula is used when the patient requires a low to medium concentration of oxygen for which precise accuracy is not essential. The Venturi mask is used primarily for patients with COPD because it can accurately provide an appropriate level of supplemental oxygen, thus avoiding the risk of suppressing the hypoxic drive. The patient's respiratory status does not require a partial- or non-rebreathing mask.

3. What would the critical care nurse recognize as a condition that may indicate a patient's need to have a tracheostomy? A) A patient has a respiratory rate of 10 breaths per minute. B) A patient requires permanent ventilation. C) A patient exhibits symptoms of dyspnea. D) A patient has respiratory acidosis.

B Feedback: A tracheostomy permits long-term use of mechanical ventilation to prevent aspiration of oral and gastric secretions in the unconscious or paralyzed patient. Indications for a tracheostomy do not include a respiratory rate of 10 breaths per minute, symptoms of dyspnea, or respiratory acidosis.

38. An asthma nurse educator is working with a group of adolescent asthma patients. What intervention is most likely to prevent asthma exacerbations among these patients? A) Encouraging patients to carry a corticosteroid rescue inhaler at all times B) Educating patients about recognizing and avoiding asthma triggers C) Teaching patients to utilize alternative therapies in asthma management D) Ensuring that patients keep their immunizations up to date

B Feedback: Asthma exacerbations are best managed by early treatment and education, including the use of written action plans as part of any overall effort to educate patients about self-management techniques, especially those with moderate or severe persistent asthma or with a history of severe exacerbations. Corticosteroids are not used as rescue inhalers. Alternative therapies are not normally a high priority, though their use may be appropriate in some cases. Immunizations should be kept up to date, but this does not necessarily prevent asthma exacerbations.

35. A nurse is caring for a patient who has been hospitalized with an acute asthma exacerbation. What drugs should the nurse expect to be ordered for this patient to gain underlying control of persistent asthma? A) Rescue inhalers B) Anti-inflammatory drugs C) Antibiotics D) Antitussives

B Feedback: Because the underlying pathology of asthma is inflammation, control of persistent asthma is accomplished primarily with regular use of anti-inflammatory medications. Rescue inhalers, antibiotics, and antitussives do not aid in the first-line control of persistent asthma.

10. The acute medical nurse is preparing to wean a patient from the ventilator. Which assessment parameter is most important for the nurse to assess? A) Fluid intake for the last 24 hours B) Baseline arterial blood gas (ABG) levels C) Prior outcomes of weaning D) Electrocardiogram (ECG) results

B Feedback: Before weaning a patient from mechanical ventilation, it is most important to have baseline ABG levels. During the weaning process, ABG levels will be checked to assess how the patient is tolerating the procedure. Other assessment parameters are relevant, but less critical. Measuring fluid volume intake and output is always important when a patient is being mechanically ventilated. Prior attempts at weaning and ECG results are documented on the patient's record, and the nurse can refer to them before the weaning process begins.

27. The nurse is caring for a client with an endotracheal tube who is on a ventilator. When assessing the client, the nurse knows to maintain what cuff pressure to maintain appropriate pressure on the tracheal wall? A) Between 10 and 15 mm Hg B) Between 15 and 20 mm Hg C) Between 20 and 25 mm Hg D) Between 25 and 30 mm Hg

B Feedback: Complications can occur from pressure exerted by the cuff on the tracheal wall. Cuff pressures should be maintained between 15 and 20 mm Hg.

13. A nurse is developing the teaching portion of a care plan for a patient with COPD. What would be the most important component for the nurse to emphasize? A) Smoking up to one-half of a pack of cigarettes weekly is allowable. B) Chronic inhalation of indoor toxins can cause lung damage. C) Minor respiratory infections are considered to be self-limited and are not treated. D) Activities of daily living (ADLs) should be clustered in the early morning hours.

B Feedback: Environmental risk factors for COPD include prolonged and intense exposure to occupational dusts and chemicals, indoor air pollution, and outdoor air pollution. Smoking cessation should be taught to all patients who are currently smoking. Minor respiratory infections that are of no consequence to the person with normal lungs can produce fatal disturbances in the lungs of the person with emphysema. ADLs should be paced throughout the day to permit patients to perform these without excessive distress.

33. A patient is being admitted to the preoperative holding area for a thoracotomy. Preoperative teaching includes what? A) Correct use of a ventilator B) Correct use of incentive spirometry C) Correct use of a mini-nebulizer D) Correct technique for rhythmic breathing

B Feedback: Instruction in the use of incentive spirometry begins before surgery to familiarize the patient with its correct use. You do not teach a patient the use of a ventilator; you explain that he may be on a ventilator to help him breathe. Rhythmic breathing and mini-nebulizers are unnecessary.

15. While caring for a patient with an endotracheal tube, the nurses recognizes that suctioning is required how often? A) Every 2 hours when the patient is awake B) When adventitious breath sounds are auscultated C) When there is a need to prevent the patient from coughing D) When the nurse needs to stimulate the cough reflex

B Feedback: It is usually necessary to suction the patient's secretions because of the decreased effectiveness of the cough mechanism. Tracheal suctioning is performed when adventitious breath sounds are detected or whenever secretions are present. Unnecessary suctioning, such as scheduling every 2 hours, can initiate bronchospasm and cause trauma to the tracheal mucosa.

1. The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The patient has been receiving high-flow oxygen therapy for an extended time. What symptoms should the nurse anticipate if the patient were experiencing oxygen toxicity? A) Bradycardia and frontal headache B) Dyspnea and substernal pain C) Peripheral cyanosis and restlessness D) Hypotension and tachycardia

B Feedback: Oxygen toxicity can occur when patients receive too high a concentration of oxygen for an extended period. Symptoms of oxygen toxicity include dyspnea, substernal pain, restlessness, fatigue, and progressive respiratory difficulty. Bradycardia, frontal headache, cyanosis, hypotension, and tachycardia are not symptoms of oxygen toxicity.

39. An asthma educator is teaching a patient newly diagnosed with asthma and her family about the use of a peak flow meter. The educator should teach the patient that a peak flow meter measures what value? A) Highest airflow during a forced inspiration B) Highest airflow during a forced expiration C) Airflow during a normal inspiration D) Airflow during a normal expiration

B Feedback: Peak flow meters measure the highest airflow during a forced expiration.

13. The physician has ordered continuous positive airway pressure (CPAP) with the delivery of a patient's high-flow oxygen therapy. The patient asks the nurse what the benefit of CPAP is. What would be the nurse's best response? A) CPAP allows a higher percentage of oxygen to be safely used. B) CPAP allows a lower percentage of oxygen to be used with a similar effect. C) CPAP allows for greater humidification of the oxygen that is administered. D) CPAP allows for the elimination of bacterial growth in oxygen delivery systems.

B Feedback: Prevention of oxygen toxicity is achieved by using oxygen only as prescribed. Often, positive end-expiratory pressure (PEEP) or CPAP is used with oxygen therapy to reverse or prevent microatelectasis, thus allowing a lower percentage of oxygen to be used. Oxygen is moistened by passing through a humidification system. Changing the tubing on the oxygen therapy equipment is the best technique for controlling bacterial growth.

5. The nurse is caring for a patient who is scheduled to have a thoracotomy. When planning preoperative teaching, what information should the nurse communicate to the patient? A) How to milk the chest tubing B) How to splint the incision when coughing C) How to take prophylactic antibiotics correctly D) How to manage the need for fluid restriction

B Feedback: Prior to thoracotomy, the nurse educates the patient about how to splint the incision with the hands, a pillow, or a folded towel. The patient is not taught how to milk the chest tubing because this is performed by the nurse. Prophylactic antibiotics are not normally used and fluid restriction is not indicated following thoracotomy.

22. An older adult patient has been diagnosed with COPD. What characteristic of the patient's current health status would preclude the safe and effective use of a metered-dose inhaler (MDI)? A) The patient has not yet quit smoking. B) The patient has severe arthritis in her hands. C) The patient requires both corticosteroids and beta2-agonists. D) The patient has cataracts.

B Feedback: Safe and effective MDI use requires the patient to be able to manipulate the device independently, which may be difficult if the patient has arthritis. Smoking does not preclude MDI use. A modest loss of vision does not preclude the use of an MDI and a patient can safely use more than one MDI.

21. A nurse is reviewing the pathophysiology of cystic fibrosis (CF) in anticipation of a new admission. The nurse should identify what characteristic aspects of CF? A) Alveolar mucus plugging, infection, and eventual bronchiectasis B) Bronchial mucus plugging, inflammation, and eventual bronchiectasis C) Atelectasis, infection, and eventual COPD D) Bronchial mucus plugging, infection, and eventual COPD

B Feedback: The hallmark pathology of CF is bronchial mucus plugging, inflammation, and eventual bronchiectasis. Commonly, the bronchiectasis begins in the upper lobes and progresses to involve all lobes. Infection, atelectasis, and COPD are not hallmark pathologies of CF.

29. The nurse has explained to the patient that after his thoracotomy, it will be important to adhere to a coughing schedule. The patient is concerned about being in too much pain to be able to cough. What would be an appropriate nursing intervention for this client? A) Teach him postural drainage. B) Teach him how to perform huffing. C) Teach him to use a mini-nebulizer. D) Teach him how to use a metered dose inhaler.

B Feedback: The technique of "huffing" may be helpful for the patient with diminished expiratory flow rates or for the patient who refuses to cough because of severe pain. Huffing is the expulsion of air through an open glottis. Inhalers, nebulizers, and postural drainage are not substitutes for performing coughing exercises.

24. An admitting nurse is assessing a patient with COPD. The nurse auscultates diminished breath sounds, which signify changes in the airway. These changes indicate to the nurse to monitor the patient for what? A) Kyphosis and clubbing of the fingers B) Dyspnea and hypoxemia C) Sepsis and pneumothorax D) Bradypnea and pursed lip breathing

B Feedback: These changes in the airway require that the nurse monitor the patient for dyspnea and hypoxemia. Kyphosis is a musculoskeletal problem. Sepsis and pneumothorax are atypical complications. Tachypnea is much more likely than bradypnea. Pursed lip breathing can relieve dyspnea.

26. A nurse's assessment reveals that a client with COPD may be experiencing bronchospasm. What assessment finding would suggest that the patient is experiencing bronchospasm? A) Fine or coarse crackles on auscultation B) Wheezes or diminished breath sounds on auscultation C) Reduced respiratory rate or lethargy D) Slow, deliberate respirations

B Feedback: Wheezing and diminished breath sounds are consistent with bronchospasm. Crackles are usually attributable to other respiratory or cardiac pathologies. Bronchospasm usually results in rapid, inefficient breathing and agitation.

29. A nurse is assessing a patient who is suspected of having bronchiectasis. The nurse should consider which of the following potential causes? Select all that apply. A) Pulmonary hypertension B) Airway obstruction C) Pulmonary infections D) Genetic disorders E) Atelectasis

B, C, D Feedback: Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles. Under the new definition of COPD, it is considered a disease process separate from COPD. Bronchiectasis may be caused by a variety of conditions, including airway obstruction, diffuse airway injury, pulmonary infections and obstruction of the bronchus or complications of long-term pulmonary infections, or genetic disorders such as cystic fibrosis. Bronchiectasis is not caused by pulmonary hypertension or atelectasis.

31. An interdisciplinary team is planning the care of a patient with bronchiectasis. What aspects of care should the nurse anticipate? Select all that apply. A) Occupational therapy B) Antimicrobial therapy C) Positive pressure isolation D) Chest physiotherapy E) Smoking cessation

B, D, E Feedback: Chest physiotherapy, antibiotics, and smoking cessation are cornerstones of the care of patients with bronchiectasis. Occupational therapy and isolation are not normally indicated.

A nurse caring for a client in the hospital is being discharged today with a prescription for benzonatate (Tessalon Perles) 200 mg one capsule 3 times daily. What would you tell the patient about this prescription during discharge counseling? (Select all that apply)

Benzonatate can cause GI upset and sedation. The patient should drink plenty fluids. Rationale: The adverse effects of benzonatate include sedation, headache, dizziness, constipation, nausea, GI upset, pruritus, and nasal congestion. It is recommended that patients with cough drink plenty of fluids (1500 to 2000 mL daily) unless fluids are contraindicate due to another disease state. Benzonatate should not be crushed or chewed due to a local anesthetic effect resulting in possible choking. Consumption of alcohol while taking benzonatate can increase CNS depression and increased sedation. The maximum daily dose of benzonatate is 600 mg daily.

Which of the following would a nurse identify as a surfactant?

Beractant Rationale: Beractant is a lung surfactant. Cromolyn is a mast cell stabilizer. Zileuton is a leukotriene receptor antagonist. Theophylline is a xanthine.

A nurse is caring for a patient who has been prescribed a nasal decongestant. Which of the following factors should the nurse assess before administering the drug?

Blood pressure Rationale: As a pre-administration assessment before giving a nasal decongestant, the nurse should assess the patient's blood pressure, pulse, and respiratory rates. Assessments for disturbed coordination, blurred vision, or auditory tests may be done as an ongoing assessment to check for signs of adverse effects.

____ is an expected finding w/ a client who has lung cancer.

Blood-tinged sputum (Blood tinged sputum secondary to bleeding from the tumor)

A patient has been prescribed a decongestant drug for congestion associated with rhinitis. Which of the following possible side effects of the drug should the nurse caution the patient about?

Blurred vision Rationale: The nurse should inform the patient that blurred vision is a possible side effect of decongestant drugs. Additionally, an increased and not decreased pulse rate may also be seen. Drowsiness is not seen with decongestant usage. Dryness of the nasal mucosa and not the throat may be seen with decongestant drugs, which are used mostly as topical sprays and drops.

Your patient, an elderly woman, insists her asthma is exacerbated by her least favorite television show. While explaining that her dislike for the show's host may be a contributing factor, you explain that an asthma attack is caused by substances released from mast cells, which cause:

Bronchoconstriction and inflammation. Rationale: When lung tissues are exposed to causative stimuli, mast cells release substances that cause bronchoconstriction and inflammation.

8. A student nurse is developing a teaching plan for an adult patient with asthma. Which teaching point should have the highest priority in the plan of care that the student is developing? A) Gradually increase levels of physical exertion. B) Change filters on heaters and air conditioners frequently. C) Take prescribed medications as scheduled. D) Avoid goose-down pillows.

C Feedback: Although all of the measures are appropriate for a client with asthma, taking prescribed medications on time is the most important measure in preventing asthma attacks.

22. The nurse is preparing to suction a patient with an endotracheal tube. What should be the nurse's first step in the suctioning process? A) Explain the suctioning procedure to the patient and reposition the patient. B) Turn on suction source at a pressure not exceeding 120 mm Hg. C) Assess the patient's lung sounds and SAO2 via pulse oximeter. D) Perform hand hygiene and don nonsterile gloves, goggles, gown, and mask.

C Feedback: Assessment data indicate the need for suctioning and allow the nurse to monitor the effect of suction on the patient's level of oxygenation. Explaining the procedure would be the second step; performing hand hygiene is the third step, and turning on the suction source is the fourth step.

7. A school nurse is caring for a 10-year-old girl who is having an asthma attack. What is the preferred intervention to alleviate this client's airflow obstruction? A) Administer corticosteroids by metered dose inhaler B) Administer inhaled anticholinergics C) Administer an inhaled beta-adrenergic agonist D) Utilize a peak flow monitoring device

C Feedback: Asthma exacerbations are best managed by early treatment and education of the patient. Quick-acting beta-adrenergic medications are the first used for prompt relief of airflow obstruction. Systemic corticosteroids may be necessary to decrease airway inflammation in patients who fail to respond to inhaled beta-adrenergic medication. A peak flow device will not resolve short-term shortness of breath.

36. A nurse is teaching a patient with asthma about Azmacort, an inhaled corticosteroid. Which adverse effects should the nurse be sure to address in patient teaching? A) Dyspnea and increased respiratory secretions B) Nausea and vomiting C) Cough and oral thrush D) Fatigue and decreased level of consciousness

C Feedback: Azmacort has possible adverse effects of cough, dysphonia, oral thrush (candidiasis), and headache. In high doses, systemic effects may occur (e.g., adrenal suppression, osteoporosis, skin thinning, and easy bruising). The other listed adverse effects are not associated with this drug.

9. A student nurse is preparing to care for a patient with bronchiectasis. The student nurse should recognize that this patient is likely to experience respiratory difficulties related to what pathophysiologic process? A) Intermittent episodes of acute bronchospasm B) Alveolar distention and impaired diffusion C) Dilation of bronchi and bronchioles D) Excessive gas exchange in the bronchioles

C Feedback: Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles that results from destruction of muscles and elastic connective tissue. It is not characterized by acute bronchospasm, alveolar distention, or excessive gas exchange.

2. A nurse is creating a health promotion intervention focused on chronic obstructive pulmonary disease (COPD). What should the nurse identify as a complication of COPD? A) Lung cancer B) Cystic fibrosis C) Respiratory failure D) Hemothorax

C Feedback: Complications of COPD include respiratory failure, pneumothorax, atelectasis, pneumonia, and pulmonary hypertension (corpulmonale). Lung cancer, cystic fibrosis, and hemothorax are not common complications.

11. While assessing the patient, the nurse observes constant bubbling in the water-seal chamber of the patient's closed chest-drainage system. What should the nurse conclude? A) The system is functioning normally. B) The patient has a pneumothorax. C) The system has an air leak. D) The chest tube is obstructed.

C Feedback: Constant bubbling in the chamber often indicates an air leak and requires immediate assessment and intervention. The patient with a pneumothorax will have intermittent bubbling in the water-seal chamber. If the tube is obstructed, the nurse should notice that the fluid has stopped fluctuating in the water-seal chamber.

9. The critical care nurse is precepting a new nurse on the unit. Together they are caring for a patient who has a tracheostomy tube and is receiving mechanical ventilation. What action should the critical care nurse recommend when caring for the cuff? A) Deflate the cuff overnight to prevent tracheal tissue trauma. B) Inflate the cuff to the highest possible pressure in order to prevent aspiration. C) Monitor the pressure in the cuff at least every 8 hours D) Keep the tracheostomy tube plugged at all times.

C Feedback: Cuff pressure must be monitored by the respiratory therapist or nurse at least every 8 hours by attaching a handheld pressure gauge to the pilot balloon of the tube or by using the minimal leak volume or minimal occlusion volume technique. Plugging is only used when weaning the patient from tracheal support. Deflating the cuff overnight would be unsafe and inappropriate. High cuff pressure can cause tissue trauma.

34. A patient in the ICU has had an endotracheal tube in place for 3 weeks. The physician has ordered that a tracheostomy tube be placed. The patient's family wants to know why the endotracheal tube cannot be left in place. What would be the nurse's best response? A) "The physician may feel that mechanical ventilation will have to be used long-term." B) "Long-term use of an endotracheal tube diminishes the normal breathing reflex." C) "When an endotracheal tube is left in too long it can damage the lining of the windpipe." D) "It is much harder to breathe through an endotracheal tube than a tracheostomy."

C Feedback: Endotracheal intubation may be used for no longer than 2 to 3 weeks, by which time a tracheostomy must be considered to decrease irritation of and, trauma to, the tracheal lining, to reduce the incidence of vocal cord paralysis (secondary to laryngeal nerve damage), and to decrease the work of breathing. The need for long-term ventilation would not be the primary rationale for this change in treatment. Endotracheal tubes do not diminish the breathing reflex.

36. The nurse is performing nasotracheal suctioning on a medical patient and obtains copious amounts of secretions from the patient's airway, even after inserting and withdrawing the catheter several times. How should the nurse proceed? A) Continue suctioning the patient until no more secretions are obtained. B) Perform chest physiotherapy rather than nasotracheal suctioning. C) Wait several minutes and then repeat suctioning. D) Perform postural drainage and then repeat suctioning.

C Feedback: If additional suctioning is needed, the nurse should withdraw the catheter to the back of the pharynx, reassure the patient, and oxygenate for several minutes before resuming suctioning. Chest physiotherapy and postural drainage are not necessarily indicated.

4. The nurse is assessing a patient whose respiratory disease in characterized by chronic hyperinflation of the lungs. What would the nurse most likely assess in this patient? A) Signs of oxygen toxicity B) Chronic chest pain C) A barrel chest D) Long, thin fingers

C Feedback: In COPD patients with a primary emphysematous component, chronic hyperinflation leads to the barrel chest thorax configuration. The nurse most likely would not assess chest pain or long, thin fingers; these are not characteristic of emphysema. The patient would not show signs of oxygen toxicity unless he or she received excess supplementary oxygen.

19. A nurse is providing discharge teaching for a client with COPD. When teaching the client about breathing exercises, what should the nurse include in the teaching? A) Lie supine to facilitate air entry B) Avoid pursed lip breathing C) Use diaphragmatic breathing D) Use chest breathing

C Feedback: Inspiratory muscle training and breathing retraining may help improve breathing patterns in patients with COPD. Training in diaphragmatic breathing reduces the respiratory rate, increases alveolar ventilation, and, sometimes, helps expel as much air as possible during expiration. Pursed-lip breathing helps slow expiration, prevents collapse of small airways, and controls the rate and depth of respiration. Diaphragmatic breathing, not chest breathing, increases lung expansion. Supine positioning does not aid breathing.

32. A patient's severe asthma has necessitated the use of a long-acting beta2-agonist (LABA). Which of the patient's statements suggests a need for further education? A) "I know that these drugs can sometimes make my heart beat faster." B) "I've heard that this drug is particularly good at preventing asthma attacks during exercise." C) "I'll make sure to use this each time I feel an asthma attack coming on." D) "I've heard that this drug sometimes gets less effective over time."

C Feedback: LABAs are not used for management of acute asthma symptoms. Tachycardia is a potential adverse effect and decreased protection against exercise-induced bronchospasm may occur with regular use.

11. A patient arrives in the emergency department with an attack of acute bronchiectasis. Chest auscultation reveals the presence of copious secretions. What intervention should the nurse prioritize in this patient's care? A) Oral administration of diuretics B) Intravenous fluids to reduce the viscosity of secretions C) Postural chest drainage D) Pulmonary function testing

C Feedback: Postural drainage is part of all treatment plans for bronchiectasis, because draining of the bronchiectatic areas by gravity reduces the amount of secretions and the degree of infection. Diuretics and IV fluids will not aid in the mobilization of secretions. Lung function testing may be indicated, but this assessment will not relieve the patient's symptoms.

25. The nurse is preparing to discharge a patient after thoracotomy. The patient is going home on oxygen therapy and requires wound care. As a result, he will receive home care nursing. What should the nurse include in discharge teaching for this patient? A) Safe technique for self-suctioning of secretions B) Technique for performing postural drainage C) Correct and safe use of oxygen therapy equipment D) How to provide safe and effective tracheostomy care

C Feedback: Respiratory care and other treatment modalities (oxygen, incentive spirometry, chest physiotherapy [CPT], and oral, inhaled, or IV medications) may be continued at home. Therefore, the nurse needs to instruct the patient and family in their correct and safe use. The scenario does not indicate the patient needs help with suctioning, postural drainage, or tracheostomy care.

19. A patient with a severe exacerbation of COPD requires reliable and precise oxygen delivery. Which mask will the nurse expect the physician to order? A) Non-rebreather air mask B) Tracheostomy collar C) Venturi mask D) Face tent

C Feedback: The Venturi mask provides the most accurate method of oxygen delivery. Other methods of oxygen delivery include the aerosol mask, tracheostomy collar, and face tents, but these do not match the precision of a Venturi mask.

37. A nurse has performed tracheal suctioning on a patient who experienced increasing dyspnea prior to a procedure. When applying the nursing process, how can the nurse best evaluate the outcomes of this intervention? A) Determine whether the patient can now perform forced expiratory technique (FET). B) Percuss the patient's lungs and thorax. C) Measure the patient's oxygen saturation. D) Have the patient perform incentive spirometry.

C Feedback: The patient's response to suctioning is usually determined by performing chest auscultation and by measuring the patient's oxygen saturation. FET, incentive spirometry, and percussion are not normally used as evaluative techniques.

12. A nurse is completing a focused respiratory assessment of a child with asthma. What assessment finding is most closely associated with the characteristic signs and symptoms of asthma? A) Shallow respirations B) Increased anterior-posterior (A-P) diameter C) Bilateral wheezes D) Bradypnea

C Feedback: The three most common symptoms of asthma are cough, dyspnea, and wheezing. There may be generalized wheezing (the sound of airflow through narrowed airways), first on expiration and then, possibly, during inspiration as well. Respirations are not usually slow and the child's A-P diameter does not normally change.

14. The home care nurse is assessing a patient who requires home oxygen therapy. What criterion indicates that an oxygen concentrator will best meet the needs of the patient in the home environment? A) The patient desires a low-maintenance oxygen delivery system that delivers oxygen flow rates up to 6 L/min. B) The patient requires a high-flow system for use with a tracheostomy collar. C) The patient desires a portable oxygen delivery system that can deliver 2 L/min. D) The patient's respiratory status requires a system that provides an FiO2 of 65%.

C Feedback: The use of oxygen concentrators is another means of providing varying amounts of oxygen, especially in the home setting. They can deliver oxygen flows from 1 to 10 L/min and provide an FiO2 of about 40%. They require regular maintenance and are not used for high-flow applications. The patient desiring a portable oxygen delivery system of 2L/min will benefit from the use of an oxygen concentrator.

The nurse should complete which of the following during acute breathing distress before initiation of a broncodilator? Select all that apply:

Check pulse. Check blood pressure. Check respiratory rate Rationale: Prior to initiation of a bronchodilator during acute breathing distress, the nurse needs to take a blood pressure, pulse, and respiratory rate.

Following a bronchoscopy, a client is sleepy but asks for a drink. Nurse's first action?

Check the client's gag reflex After a bronchoscopy, all fluids are withheld until the pt can cough and has a gag reflex. This is necessary because local anesthetics the pt received numbed the pharynx and suppressed the gag reflex. If the gag reflex remains suppressed, the pt could choke or aspirate the fluid.

A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following?

Cigarette smoking Rationale: Nicotine increases the metabolism of xanthines; therefore, an increased dosage would be necessary. Hyperthyroidism, gastrointestinal, upset or alcohol intake requires cautious use of the drug because these conditions may be exacerbated by the systemic effects of the drug. The drug dosage may need to be decreased in these situations.

Which of the following would a nurse identify as a first generation antihistamine? Select all that apply.

Clemastine Dimenhydrinate Rationale: First generation antihistamines include clemastine and dimenhydrinate.

A nurse should question nasopharyngeal suctioning for which client?

Closed-head injury and is lethargic (A recent head injury is a contraindication for nasopharyngeal suctioning because suctioning can increase intracranial pressure

Atelectasis

Closure or collapse of alveoli.

The client's theophylline levels are increased. The nurse questions the client about his intake of which of the following?

Coffee Rationale: Xanthines are found in colas, coffee, chocolate, and charcoal-prepared foods. This could cause the client's theophylline levels to increase. Neither tea, carrots, nor cheese affect theophylline levels.

The nurse is caring for a client who is receiving IV theophylline for treatment of severe bronchospasm. The nurse will ensure that which item on the client's food tray will be held while the client is receiving theophylline?

Coffee Rationale: Theophylline is a xanthine, which has properties that are close to caffeine; therefore, the nurse will ensure that the client doesn't have anything on the tray that has caffeine in it.

What should the nurse plan to have while caring for a client following the insertion of a chest tube?

Container of sterile water (The nurse should plan to place the open end of the tubing if it becomes disconnected into sterile water to prevent pneumothorax. The tubing and sterile water are then placed below the client's chest)

A nurse assessing client who has a chest tube in place following thoracic surgery. what finding indicates a need for intervention?

Continuous bubbling in the water seal chamber. (Continuous bubbling in the water seal chamber suggests an air leak)

A client is admitted to the emergency dept following a motorcycle crash. The nurse notes a crackling sensation while palpating the skin on the client's r chest. The nurse notifies the charge nurse and documents the presence of?

Crepitus Also called subcutaneous emphysema, is a coarse crackling sensation palpated over the skin surface. Crepitus indicates an air leak in the subcutaneous tissue often indicating a pneumothorax.

A patient is experiencing an acute asthma attack. Which of the following medications are contraindicated for the treatment of acute asthma?

Cromolyn (Intal) Rationale: Cromolyn stabilizes mast cells and is not used in acute bronchospasm. Aminophylline is used in limited cases, but is administered for acute asthma attack. Albuterol is used for acute asthma attack. Corticosteroids are administered for acute asthma attack to decrease inflammation.

33. A nurse is providing health education to the family of a patient with bronchiectasis. What should the nurse teach the patient's family members? A) The correct technique for chest palpation and auscultation B) Techniques for assessing the patient's fluid balance C) The technique for providing deep nasotracheal suctioning D) The correct technique for providing postural drainage

D Feedback: A focus of the care of bronchiectasis is helping patients clear pulmonary secretions; consequently, patients and families are taught to perform postural drainage. Chest palpation and auscultation and assessment of fluid balance are not prioritized over postural drainage. Nasotracheal suctioning is not normally necessary.

14. A nursing is planning the care of a patient with emphysema who will soon be discharged. What teaching should the nurse prioritize in the plan of care? A) Taking prophylactic antibiotics as ordered B) Adhering to the treatment regimen in order to cure the disease C) Avoiding airplanes, buses, and other crowded public places D) Setting realistic short-term and long-range goals

D Feedback: A major area of teaching involves setting and accepting realistic short-term and long-range goals. Emphysema is not considered curable and antibiotics are not used on a preventative basis. The patient does not normally need to avoid public places.

35. The home care nurse is planning to begin breathing retraining exercises with a client newly admitted to the home health service. The home care nurse knows that breathing retraining is especially indicated if the patient has what diagnosis? A) Asthma B) Pneumonia C) Lung cancer D) COPD

D Feedback: Breathing retraining is especially indicated in patients with COPD and dyspnea. Breathing retraining may be indicated in patients with other lung pathologies, but not to the extent indicated in patients with COPD.

15. A nurse is documenting the results of assessment of a patient with bronchiectasis. What would the nurse most likely include in documentation? A) Sudden onset of pleuritic chest pain B) Wheezes on auscultation C) Increased anterior-posterior (A-P) diameter D) Clubbing of the fingers

D Feedback: Characteristic symptoms of bronchiectasis include chronic cough and production of purulent sputum in copious amounts. Clubbing of the fingers also is common because of respiratory insufficiency. Sudden pleuritic chest pain is a common manifestation of a pulmonary embolism. Wheezes on auscultation are common in patients with asthma. An increased A-P diameter is noted in patients with COPD.

6. A nurse is educating a patient in anticipation of a procedure that will require a water-sealed chest drainage system. What should the nurse tell the patient and the family that this drainage system is used for? A) Maintaining positive chest-wall pressure B) Monitoring pleural fluid osmolarity C) Providing positive intrathoracic pressure D) Removing excess air and fluid

D Feedback: Chest tubes and closed drainage systems are used to re-expand the lung involved and to remove excess air, fluid, and blood. They are not used to maintain positive chest-wall pressure, monitor pleural fluid, or provide positive intrathoracic pressure.

26. The nurse is performing patient education for a patient who is being discharged on mini-nebulizer treatments. What information should the nurse prioritize in the patient's discharge teaching? A) How to count her respirations accurately B) How to collect serial sputum samples C) How to independently wean herself from treatment D) How to perform diaphragmatic breathing

D Feedback: Diaphragmatic breathing is a helpful technique to prepare for proper use of the small-volume nebulizer. Patient teaching would not include counting respirations and the patient should not wean herself from treatment without the involvement of her primary care provider. Serial sputum samples are not normally necessary.

40. The nurse is assessing a patient who has a chest tube in place for the treatment of a pneumothorax. The nurse observes that the water level in the water seal rises and falls in rhythm with the patient's respirations. How should the nurse best respond to this assessment finding? A) Gently reinsert the chest tube 1 to 2 cm and observe if the water level stabilizes. B) Inform the physician promptly that there is in imminent leak in the drainage system. C) Encourage the patient to do deep breathing and coughing exercises. D) Document that the chest drainage system is operating as it is intended.

D Feedback: Fluctuation of the water level in the water seal shows effective connection between the pleural cavity and the drainage chamber and indicates that the drainage system remains patent. No further action is needed.

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

D Feedback: If the patient uses an alternative method of communication, he will feel in better control and likely be less frustrated. Assuring the patient that everything will be all right offers false reassurance, and telling him not to be upset minimizes his feelings. Neither of these methods helps the patient to communicate. In a patient with an endotracheal or tracheostomy tube, the family members are also likely to encounter difficulty interpreting the patient's wishes. Making them responsible for interpreting the patient's gestures may frustrate the family. The patient may be weaned off a mechanical ventilator only when the physiologic parameters for weaning have been met.

23. A nurse is preparing to perform an admission assessment on a patient with COPD. It is most important for the nurse to review which of the following? A) Social work assessment B) Insurance coverage C) Chloride levels D) Available diagnostic tests

D Feedback: In addition to the patient's history, the nurse reviews the results of available diagnostic tests. Social work assessment is not a priority for the majority of patients. Chloride levels are relevant to CF, not COPD. Insurance coverage is not normally the domain of the nurse.

8. A patient's plan of care specifies postural drainage. What action should the nurse perform when providing this noninvasive therapy? A) Administer the treatment with the patient in a high Fowler's or semi-Fowler's position. B) Perform the procedure immediately following the patient's meals. C) Apply percussion firmly to bare skin to facilitate drainage. D) Assist the patient into a position that will allow gravity to move secretions.

D Feedback: Postural drainage is usually performed two to four times per day. The patient uses gravity to facilitate postural draining. The skin should be covered with a cloth or a towel during percussion to protect the skin. Postural drainage is not administered in an upright position or directly following a meal.

37. A nurse is explaining to a patient with asthma what her new prescription for prednisone is used for. What would be the most accurate explanation that the nurse could give? A) To ensure long-term prevention of asthma exacerbations B) To cure any systemic infection underlying asthma attacks C) To prevent recurrent pulmonary infections D) To gain prompt control of inadequately controlled, persistent asthma

D Feedback: Prednisone is used for a short-term (3-10 days) "burst" to gain prompt control of inadequately controlled, persistent asthma. It is not used to treat infection or to prevent exacerbations in the long term.

16. A patient is having pulmonary-function studies performed. The patient performs a spirometry test, revealing an FEV1/FVC ratio of 60%. How should the nurse interpret this assessment finding? A) Strong exercise tolerance B) Exhalation volume is normal C) Respiratory infection D) Obstructive lung disease

D Feedback: Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of forced expiration volume in 1 second to forced vital capacity. Obstructive lung disease is apparent when an FEV1/FVC ratio is less than 70%.

4. The medical nurse is creating the care plan of an adult patient requiring mechanical ventilation. What nursing action is most appropriate? A) Keep the patient in a low Fowler's position. B) Perform tracheostomy care at least once per day. C) Maintain continuous bedrest. D) Monitor cuff pressure every 8 hours.

D Feedback: The cuff pressure should be monitored every 8 hours. It is important to perform tracheostomy care at least every 8 hours because of the risk of infection. The patient should be encouraged to ambulate, if possible, and a low Fowler's position is not indicated.

1. A clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The patient asks the nurse what he could have done to minimize the risk of contracting this disease. What would be the nurse's best answer? A) "The most important risk factor for COPD is exposure to occupational toxins." B) "The most important risk factor for COPD is inadequate exercise." C) "The most important risk factor for COPD is exposure to dust and pollen." D) "The most important risk factor for COPD is cigarette smoking."

D Feedback: The most important risk factor for COPD is cigarette smoking. Lack of exercise and exposure to dust and pollen are not risk factors for COPD. Occupational risks are significant but are far exceeded by smoking.

31. The home care nurse is visiting a patient newly discharged home after a lobectomy. What would be most important for the home care nurse to assess? A) Resumption of the patient's ADLs B) The family's willingness to care for the patient C) Nutritional status and fluid balance D) Signs and symptoms of respiratory complications

D Feedback: The nurse assesses the patient's adherence to the postoperative treatment plan and identifies acute or late postoperative complications. All options presented need assessment, but respiratory complications are the highest priority because they affect the patient's airway and breathing.

18. The nurse is discussing activity management with a patient who is postoperative following thoracotomy. What instructions should the nurse give to the patient regarding activity immediately following discharge? A) Walk 1 mile 3 to 4 times a week. B) Use weights daily to increase arm strength. C) Walk on a treadmill 30 minutes daily. D) Perform shoulder exercises five times daily.

D Feedback: The nurse emphasizes the importance of progressively increased activity. The nurse also instructs the patient on the importance of performing shoulder exercises five times daily. The patient should ambulate with limits and realize that the return of strength will likely be gradual and likely will not include weight lifting or lengthy walks.

28. The decision has been made to discharge a ventilator-dependent patient home. The nurse is developing a teaching plan for this patient and his family. What would be most important to include in this teaching plan? A) Administration of inhaled corticosteroids B) Assessment of neurologic status C) Turning and coughing D) Signs of pulmonary infection

D Feedback: The nurse teaches the patient and family about the ventilator, suctioning, tracheostomy care, signs of pulmonary infection, cuff inflation and deflation, and assessment of vital signs. Neurologic assessment and turning and coughing are less important than signs and symptoms of infection. Inhaled corticosteroids may or may not be prescribed.

39. A nurse is teaching a patient how to perform flow type incentive spirometry prior to his scheduled thoracic surgery. What instruction should the nurse provide to the patient? A) "Hold the spirometer at your lips and breathe in and out like you normally would." B) "When you're ready, blow hard into the spirometer for as long as you can." C) "Take a deep breath and then blow short, forceful breaths into the spirometer." D) "Breathe in deeply through the spirometer, hold your breath briefly, and then exhale."

D Feedback: The patient should be taught to lace the mouthpiece of the spirometer firmly in the mouth, breathe air in through the mouth, and hold the breath at the end of inspiration for about 3 seconds. The patient should then exhale slowly through the mouthpiece.

2. The nurse caring for a patient with an endotracheal tube recognizes several disadvantages of an endotracheal tube. What would the nurse recognize as a disadvantage of endotracheal tubes? A) Cognition is decreased. B) Daily arterial blood gases (ABGs) are necessary. C) Slight tracheal bleeding is anticipated. D) The cough reflex is depressed.

D Feedback: There are several disadvantages of an endotracheal tube. Disadvantages include suppression of the patient's cough reflex, thickening of secretions, and depressed swallowing reflexes. Ulceration and stricture of the larynx or trachea may develop, but bleeding is not an expected finding. The tube should not influence cognition and daily ABGs are not always required.

27. The case manager for a group of patients with COPD is providing health education. What is most important for the nurse to assess when providing instructions on self-management to these patients? A) Knowledge of alternative treatment modalities B) Family awareness of functional ability and activities of daily living (ADLs) C) Knowledge of the pathophysiology of the disease process D) Knowledge about self-care and their therapeutic regimen

D Feedback: When providing instructions about self-management, it is important for the nurse to assess the knowledge of patients and family members about self-care and the therapeutic regimen. This supersedes knowledge of alternative treatments or the pathophysiology of the disease, neither of which is absolutely necessary for patients to know. The patient's own knowledge is more important than that of the family.

25. A nurse is caring for a patient with COPD. The patient's medication regimen has been recently changed and the nurse is assessing for therapeutic effect of a new bronchodilator. What assessment parameters suggest a consequent improvement in respiratory status? Select all that apply. A) Negative sputum culture B) Increased viscosity of lung secretions C) Increased respiratory rate D) Increased expiratory flow rate E) Relief of dyspnea

D, E Feedback: The relief of bronchospasm is confirmed by measuring improvement in expiratory flow rates and volumes (the force of expiration, how long it takes to exhale, and the amount of air exhaled) as well as by assessing the dyspnea and making sure that it has lessened. Increased respiratory rate and viscosity of secretions would suggest a worsening of the patient's respiratory status. Bronchodilators would not have a direct result on the patient's infectious process.

Which of the following effects would result from the action of montelukast?

Decreased eosinophil migration Rationale: Montelukast selectively and competitively blocks receptors for the production of leukotrienes D4 and E4, which are components of slow-reacting substance of anaphylaxis. As a result, the drug blocks many of the signs and symptoms of asthma, such as neutrophil and eosinophil migration, neutrophil and monocyte aggregation, leukocyte adhesion, increased capillary permeability, and smooth muscle contraction.

An older adult client is admitted with respiratory acidosis as a complication of COPD. The nurse suspects that this is related to which of the following?

Decreased exhalation of co2 Pt's with chronic lung disease have difficulty exhaling carbon dioxide due to a loss of elastic recoil in the lungs. This results in respiratory acidosis.

Ms. Thompson, age 45, is being seen in the physician's office today for complaints of a dry, hacking cough that is keeping her up at night. The physician prescribes dextromethorphan for the cough. Which statement is true about dextromethorphan?

Dextromethorphan works in the medulla to suppress the cough reflex. Rationale: Dextromethorphan is related chemically to the opiate agonists and can suppress coughing as effectively as narcotics. Cough suppression occurs by several mechanisms, but mainly the drug directly affects the cough center in the medulla. Therapeutic doses do not affect ciliary activity.

A client calls the clinic and complains of symptoms of a cold. The client is most concerned because the cold symptoms are preventing him from sleeping. The nurse would inform the client that what medication relieves cold symptoms and aids sleep?

Diphenhydramine Rationale: Antihistamines are clearly useful in allergic conditions, but their use to relieve cold symptoms is controversial. First-generation antihistamines (e.g., chlorpheniramine, diphenhydramine) have anticholinergic effects that may reduce sneezing, rhinorrhea, and cough. Also, their sedative effects may aid sleep. Many multi-ingredient cold remedies contain an antihistamine.

What adverse effect of most oral antihistamines presents a priority safety concern for older adult clients?

Drowsiness Rationale: Older adults are more likely to experience anticholinergic effects (dryness of mouth, nose, throat), dizziness, sedation, hypotension, and confusion from the use of antihistamines. Drowsiness and sedation present the greatest safety concerns compared to other effects such as dry mouth and nonproductive cough. Nasal burning may occur due to nasal spray use.

A female client is prescribed a first-generation antihistamine for her allergies. The nurse would expect her to experience what adverse effect?

Dry mouth Rationale: First-generation antihistamines have substantial anticholinergic effects; therefore, they may cause dry mouth, urinary retention, constipation, and blurred vision.

A nurse is assessing a client who has emphysema. The nurse should report?

Elevated temp (Clients who have emphysema are at risk for development of pneumonia and other respiratory infections. A nurse should report an elevated temp. to the provider, as this indicates a possible resp. infection.)

Second generation antihistamines are associated with a higher risk of sedation than first generation antihistamines.

False Rationale: The risk for sedation is higher with first generation antihistamines than with second generation antihistamines.

While observing a client who is unconscious following major trauma, the nurse notes that a portion of the client's chest pulls inward on inspiration. On expiration, the same portion expands outward. The nurse documents the presence of which of the following?

Flail chest The paradoxical movement of the chest wall of a pt who has fractured two or more adjacent ribs in two or more places. This results in a floating segment of the chest wall that moves inward on inspiration and outward on exhalation.

The client has mild, persistent asthma. The nurse anticipates the health care provider prescribing which of the following daily medications?

Fluticasone Rationale: Terbutaline, albuterol, and levalbuterol are all short-acting beta-2 agonists that are used for acute symptom relief. Fluticasone is a daily inhaled corticosteroid.

A nurse is preparing a client for d/c following a bronchoscopy w/ the use of moderate (conscious) sedation. what assessment is priority?

Gag reflex (The greatest risk to the client is aspiration due to the depressed gag reflex. Therefore, the priority assessment by the nurse is to determine the return of the gag reflex)

Decongestants should be used cautiously in clients with which of the following? Select all that apply:

Glaucoma Diabetes Rationale: Clients with diabetes, heart disease, hypertension, hyperthyroidism, benign prostatic hypertrophy, and glaucoma should contact their physician before taking over the counter decongestants.

Which drug is classified as an expectorant?

Guaifenesin (Robitussin) Rationale: Robitussin is an expectorant that contains guaifenesin. Mucomyst is a mucolytic that contains acetylcysteine. Delsym is a centrally acting antitussive that contains dextromethorphan. Tessalon Perles are a peripherally acting antitussive that contain benzonatate.

A nurse is caring for a client who is admitted in an extremely anxious state. The client's ABG values are pH 7.47, PO2 94, PCO2 30, and HCO3 25. What should the nurse do?

Have the client breathe slowly into a paper bag

A nurse is positioning a client with emphysema to promote effective breathing. The client should be placed in what position?

High-fowler's with arms supported on over bed table.

A patient is using oxymetazoline (Afrin). Which of the following conditions will contraindicate the use of this adrenergic drug?

Hypertension Rationale: Oxymetazoline is contraindicated in patients with severe hypertension or coronary artery disease because of its cardiac stimulating and vasoconstricting effects. Oxymetazoline is prescribed for nasal congestion. Oxymetazoline is not contraindicated in cough or skin rash.

While a nurse is reinforcing preop teaching for a client scheduled for a r pneumonectomy, the client tells the nurse I cough all the time, and I'm really afraid it will hurt when I cough after surgery. What is an appropriate response?

I will show you how to splint your incision while coughing

A nurse is providing instructions to a client on how to use montelukast to treat chronic asthma. The following statement indicates they understand.

I will take this medication every evening, even when I don't have symptoms. (montelukast is used for prophylaxis of asthma exacerbation and is taken on a daily basis, and should taken every day as maintenance therapy)

With theophylline, the home care nurse needs to assess the client and the environment for certain products that can cause what to occur? (Select all that apply.)

Increase adverse effects Decrease therapeutic effects Affect metabolism of theophylline Rationale: With theophylline, the home care nurse needs to assess the client and the environment for substances that may affect metabolism of theophylline and decrease therapeutic effects or increase adverse effects. Issues with excretion of theophylline are rarely an issue.

A nurse is caring for a client who has acute resp. distress syndrome. Which assessment finding indicates a decline the client's condition?

Increase in resp rate. (An increase in resp. rate indicates the increased work of breathing and the need for improvement in O2 delivery)

A pulse oximeter reading from a client diagnosed with smoke inhalation is 85% with a 40% face mask. The provider prescribes an increase of the o2 to 50%. Because the client is at high risk for adult respiratory distress syndrome (ARDS), the nurse must observe for which?

Increased restlessness The hallmark of ARDS is progressive hypoxemia despite supplemental oxygen administration. The initial manifestation of hypoxemia are restlessness, apprehension and anxiety.

A patient is prescribed salmeterol. The nurse would expect this drug to be administered by which route?

Inhalation Rationale: Salmeterol is administered via inhalation.

A nurse is administering levalbuterol to a client. The nurse would administer this drug by which route?

Inhalation Rationale: Levalbuterol is administered only as an inhalant by nebulizer.

A patient is instructed on the administration of inhaled corticosteroid agents to treat asthma. How do inhaled corticosteroid agents assist in the treatment of asthma?

Inhaled corticosteroid agents will reduce airway inflammation. Rationale: Inhaled corticosteroid agents suppress the release of inflammatory mediators, block the generations of cytokines, and decrease the recruitment of airway eosinophils. Inhaled corticosteroid agents do not depress the central nervous system. Inhaled corticosteroid agents do not affect bronchodilation or constriction.

Mark, 8 years old, is prescribed flunisolide. The physician advises Mark and his parents to use a spacer when administering this medication. What is the benefit of such use?

It helps decrease systemic absorption. Rationale: Spacers help decrease systemic absorption, because less flunisolide is swallowed. Spacers may also help alleviate dysphonia by filtering larger aerosol particles that ordinarily deposit in the oropharynx and extrathoracic airways (this precaution also reduces the risk for oropharyngeal candidiasis). The use of a spacer does not prevent intrapulmonary delivery of the drug; nor does it reduce the risk of tachycardia and sinusitis.

Lobar atelectasis?

Large amount of lung tissues

Which agents would the nurse identify as selectively and competitively blocking the receptors for the production of two substances that are components of SRSA?

Leukotriene receptor antagonists Rationale: Leukotriene receptor antagonists selectively and competitively block or antagonize receptors for the production of leukotrienes D4 and E4, components of SRSA. Xanthines are thought to work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins, resulting in smooth muscle relaxation. Xanthines also inhibit the release of slow-reacting substance of anaphylaxis (SRSA) and histamine. Mast cell stabilizers work at the cellular level to inhibit the release of histamine (released from mast cells in response to inflammation or irritation) and inhibits the release of SRSA. Anticholinergics are used as bronchodilators because of their effect on the vagus nerve, which is to block or antagonize the action of the neurotransmitter acetylcholine at vagal-mediated receptor sites.

A nurse is caring for a client who has acute respiratory failure and is being treated with mechanical ventilation. The low pressure alarm on the ventilator begins to sound continuously. Which of the following is an appropriate nursing action?

Look for loose connections

A patient is prescribed oxymetazoline, a decongestant, for the treatment of hay fever. Which of the following should the nurse evaluate to assess the efficacy of therapy?

Maintenance of effective airway clearance Rationale: Evaluation of the maintenance of effective airway clearance helps in assessing the efficacy of oxymetazoline, which is a decongestant drug. The hydration of the skin, the heart rate and the urine output are usually not changed in decongestant therapy.

Which of the following is used to treat acute air flow obstruction?

Metaproterenol (Alupent) Rationale: Metaproterenol (Alupent) is a short acting Beta 2 agonist used as a quick relief medication. Qvar is an inhaled corticosteroid used as a long-term control medication. Singulair is a leukotriene antagonist used for prophylactic treatment of chronic asthma. Astelin is a second-generation antihistamine.

An 8-year-old child with an acute asthmatic attack is receiving metaproterenol via nebulizer. Which of the following would be most appropriate?

Mix the drug with saline. Rationale: Metaproterenol is mixed with saline in the nebulizer chamber for administration. The child should sit upright or be in a semi-Fowler's position. He should breathe slowly and deeply during the treatment. The treatment is completed when all of the solution (liquid) is gone from the chamber.

A client diagnosed with pneumonia is prescribed chest physiotherapy (CPT) q4h. in planning the client's care, the nurse understands that the purpose of CPT is which of the following?

Mobilize secretions in the airway The goal of CPT is to mobilize secretions in the airways. Bronchodilators may be given prior to CPT, and the pt should be encouraged to breathe deeply and cough after CPT.

Your client states that he is taking medication to liquefy secretions in his respiratory tract. However, he cannot recall the name of the medication. He states that the medication is added to a nebulizer. You suspect he is taking which of the following medications?

Mucomyst Rationale: Mucolytics are administered by inhalation to liquefy mucus in the respiratory tract. Solutions of mucolytic drugs may be nebulized into a face mask or mouthpiece or instilled directly into the respiratory tract through a tracheostomy. Sodium chloride solution and acetylcysteine (Mucomyst) are the only agents recommended for use as mucolytics.

Decongestants are available in which of the following dosage forms? (Select all that apply)

Nasal sprays Oral tablets Nasal drops Rationale: Decongestants are available as oral tablets, nasal sprays, and nasal drops.

The physician has ordered promethazine (Phenergan) for a client who is having a severe allergic reaction. The nurse is aware that this medication is also used to treat what condition?

Nausea and vomiting Rationale: Promethazine is most commonly used in the treatment of nausea and vomiting.

A nurse is preparing a presentation for a local elementary school parent group about over-the-counter cold medications and their use in children. Which of the following would be most appropriate to include? Select all that apply.

Need to follow the directions for how often to give the drug Avoidance of use in children under age 2 Importance of reading the label for ingredients and dosage Rationale: OTC cough and cold preparations should not be used in children under the age of 2 years. Accurate dosing is essential. Following the directions is essential to prevent inadvertent overdosage. Measuring devices that come with the medication should be used to ensure accurate dosages. Parents should look for the formula for children, infants, or pediatrics.

A client with COPD takes theophylline. The nurse identifies that the client is still experiencing severe dyspnea. Upon review of labs, the theophylline level remains nontherapeutic. The nurse evaluates the client for which of the following drugs that may cause decreased theophylline levels?

Nicotine Rationale: When combined with nicotine, theophylline levels are decreased. Allopurinol, cimetidine, and corticosteroids can increase theophylline levels.

A nurse is caring for a client transferred from the PACU following a l pneumonectomy for adenocarcinoma. Which type of chest drainage?

No chest drainage A pneumonectomy is the removal of an entire lung. Consequently, there is no lung left to re-expand, eliminating the need for an upper-chest tube which is placed to evacuate air from the pleural space. Likewise, a lower-chest tube is not needed as it is expected that fluid will gradually fill in the space left by the excised lung.

Acute respiratory distress syndrome?

Non specific pulmonary response to a variety of pulmonary and nonplumonary insults to the lung : characterized by interstitial infiltrates, alveolar hemorrhage, atelectasis, decreased compliance and refractory hypoxemia.

A client w/ resp. distress. Which device should the nurse use to provide the highest level of oxygen via a low-flow system?

Non-rebreather mask

client who is 4 hour PO a total laryngectomy for laryngeal cancer. what is the priority assessment? - bleeding at the surgical site -oxygen saturation -urinary retention -level of consciousness

Oxygen saturation (A client post-op total laryngectomy is at risk for hypoxia r/t airway obstruction. A decreased O2 sat is an indication of an obstructed airway)

A client who has acute resp failure. Which lab findings should the nurse expect? - Arterial PH 7.5 -PaCO2 - 25 SaO2 - 92% PaO2 - 58

PaO2 58 (the nurse should expect the client who has acute respiratory failure to have lower partial pressures of oxygen)

While reviewing a client's history, an allergy to which of the following would alert the nurse to a possible problem with the use of ipratropium?

Peanuts Rationale: The use of ipratropium is contraindicated in the presence of known allergy to the drug or to peanuts or soy products because the vehicle used to make ipratropium, an aerosol, contains a protein associated with peanut allergies.

A nurse plans to obtain a blood sample for a pt's preoperative arterial blood gas (ABG) analysis. Prior to withdrawing the blood, the nurse should...

Perform an Allen's test As most ABG samples are obtained from teh radial artery, the nurse performs an Allen's test to ensure collateral circulation to the pt's hand. To do this, the nurse compresses both the ulnar and radial artery at the wrist while the clent makes a fist until blanching occurs. The nurse then releases the pressure on the ulnar artery while maintaining pressure on the radial artery. Color should return to the palm of the pt's hand withing 15 seconds. This indicates that the ulnar artery can supply the hand with blood, and the radial artery can be used to obtain the sample.

A nurse is carping for a client with COPD. Which of the following finding should be reported?

Productive cough with green sputum. (A productive cough with green sputum indicates an infection.)

A nurse is reinforcing teaching for a client with emphysema about pursed lip breathing. The nurse reminds the client that pursed lip breathing will help do which of the following?

Promote carbon dioxide elimination Pt's with emphysema should use pursed-lip breathing whenever they experience dyspnea. it is one of the simplest ways to control dyspnea. It slows the pt's pace of breathing making each breath more effective. Pursed-lip breathing releases trapped air in the lungs and prolongs exhalation to slow the breathing rate. This improved breathing pattern moves carbon dioxide out of the lungs more efficiently.

A nurse is planning care for COPD client. What intervention should the nurse include?

Provide a diet high in calories and protein. Also low on carbs

To meet the goal of maintaining an adequate nutritional status for a client who has pneumonia, the nurse includes?

Provide oral hygiene care after respiratory aerosol therapy treatments and before meals Oral hygiene removes the unpleasant or lingering taste from expectorated mucus, inhaled medications, and antibiotics. It helps improve the taste of food and stimulates the pt's appetite.

Which agent would the nurse instruct a client to use orally?

Pseudoephedrine Rationale: Pseudoephedrine is the only oral decongestant. Phenylephrine, tetrahydrozoline, and xylometazoline are topical decongestants.

Your client complains that he has had severe nasal congestion for the last 8 days. He has been using an OTC nasal decongestant spray. You know that this is indicative of:

Rebound nasal congestion. Rationale: With nasal decongestants, topical preparations are often preferred for short-term use. They are rapidly effective because they come into direct contact with nasal mucosa. However, if used longer than the recommended 3 days or in excessive amounts, these products may produce rebound nasal congestion. Oral drugs are preferred for long-term use.

A male client presents to the physician's office with complaints of inability to breathe freely. When the nurse reviews his use of over-the-counter medications, it is discovered that the client routinely uses nasal spray three times a day for 1 year. The nurse knows that what may be causing this client's continuous nasal congestion?

Rebound nasal swelling Rationale: Rebound nasal swelling can occur with excessive or extended use of nasal sprays.

Which changing soiled Velcro ties for a client w a tracheotomy, the client suddenly coughs, dislodging the trach tube. Which nursing action is appropriate?

Reinsert the tracheostomy tube The pt breathes directly via the tracheal stoma, thus the nurse should reinsert the tracheostomy tube immediately to keep the airway patent. An extra trach tube of the proper size and an obturator should be kept at the client's bedside at all times.

The nurse is teaching a client how to prevent Candida infections. Which of the following would the nurse include in the instructions?

Rinse mouth with water after each use. Rationale: The client should be taught to rinse his mouth out with water after using oral inhalers to prevent a Candida oral infection.

Bronchoscopy

Scope is inserted into the airways. This scope contains a viewing device that allows the visual examination of the lower airways.

A client is scheduled for a thoracentesis. Into which position should the nurse assist the client?

Sitting while leaning forward over the bedside table Thoracentesis is a procedure for aspirating fluid or air from the pleural space. The upright position ensures that the diaphragm is most dependent and facilitates the removal of accumulated fluid, which tends to pool at the bases of the pleural space.

When describing the action of mast cell stabilizers, which of the following would the nurse include as being inhibited?

Slow-reacting substance of anaphylaxis Rationale: Mast cell stabilizers work at the cellular level to inhibit the release of histamine and the release of slow-reacting substance of anaphylaxis. Epinephrine is not affected by mast cell stabilizers. Xanthines are thought to work by directly affecting the mobilization of calcium within the cell by stimulating two prostaglandins.

A history of an allergy to which of the following would be a contraindication to the use of anticholinergics? Select all that apply.

Soy Peanuts Rationale: The use of ipratropium and tiotropium, anticholinergics, is contraindicated in the presence of known allergy to soy products or peanuts.

A nurse is caring for a client in respiratory distress needing endotracheal suctioning. What action should the nurse take?

Sterile technique. Use a rotating motion to remove the catheter. Only suction when needed to reduce hypoxia, tissue damage, and bronchospasams.

When antihistamines result in dryness of the mouth, the nurse should recommend which actions to relieve the dryness? Select all that apply.

Suck on sugarless hard candy. Take frequent sips of water. Offer ice chips. Rationale: Offering the client frequent sips of water or ice chips, and suggesting use of sugarless gum or candy are appropriate suggestions to relieve dry mouth. An intravenous fluid bolus is invasive and not a first-line suggestion to relieve dryness. The client should run a humidifier, not a dehumidifier, to add moisture to the air at home and help relieve dryness.

The nurse should monitor for _____ adverse effect after administration of albuterol?

Tachycardia

A patient is started on albuterol (Proventil). What reaction should the patient be instructed on?

Tachycardia will occur. Rationale: The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The patient will not experience polydipsia, hypotension, or diarrhea.

A 62-year-old patient has been prescribed an antihistamine to alleviate vasomotor rhinitis. He complains that he has gastric irritation on taking the tablet. Which of the following instructions should the nurse provide to help alleviate the patient's condition?

Take the tablet with food. Rationale: If the patient has gastric irritation following ingestion of the antihistamine, the nurse should instruct the patient to take the tablet with food and not before food. Taking an antacid before the tablet may reduce the absorption of the antihistamine. Drinking ample water before taking the tablet will not help to alleviate the patient's condition.

A nurse is reviewing a care plan for a client admitted following chest tube placement for a spontaneous pneumothorax. Which of the following interventions is appropriate?

Tape all connections between the chest tube and drainage system Prevents air leaks in the system

A nurse is caring for client w/ bacterial pneumonia. the nurse should expect which of the following findings?

Temperature 101.8 Degrees F

A nurse is reviewing the discharge teaching plan with a client hospitalized following an acute exacerbation of reactive airway disease. When reminding the client how to prevent acute asthma attacks, what should the nurse plan to discuss first?

The client's perception of the disease process and what may have triggered the current attack According to teaching-learning theory, the nurse must first assess the learner. This step gives the nurse valuable information about the PT's knowledge & misconceptions about asthma and potential environmental triggers.

A nurse is caring for a client who has a trach with an inflated cuff in place. Which of the following indicates that the nurse should suction the client's airway secretions?

The nurse auscultates coarse crackles in the lung fields

A man who smokes one pack of cigarettes daily has been diagnosed with chronic bronchitis. He has been prescribed theophylline by his family doctor. What effect will the patient's smoking status have on the therapeutic use of theophylline?

The patient may require higher doses of theophylline than a nonsmoker Rationale: Smoking cigarettes may decrease serum theophylline levels. In fact, some patients who smoke require an increase in theophylline dosage of up to 50%. Theophylline is not associated with a risk of anaphylactoid reaction. Theophylline doses do not need to be concurrent with the use of bronchodilators.

Which of the following should be observed during ongoing assessment of a client taking an antitussive? Select all that apply:

Therapeutic effect Frequency of cough Lung sounds Pain assessment Rationale: Vital signs, lung sounds, therapeutic effect, and assessment of pain induced by cough should be part of the ongoing client assessment. Auscultation of heart sounds are not part of the ongoing client assessment.

A male client presents to the physician's office for his annual visit. When questioned about over-the-counter medication use, he states that he uses Echinacea to prevent colds. What statement is true about Echinacea?

There is limited or no support for the use of Echinacea to prevent or treat symptoms of the common cold. Rationale: There is limited or no support for the use of dietary or herbal supplements to prevent or treat symptoms of the common cold.

Aerosols are often the drugs of choice to treat asthma because of what characteristics? (Select all that apply.)

They act directly on the airways. They can usually be given in smaller doses. They produce fewer adverse effects than oral or parenteral drugs. They relieve symptoms quickly. Rationale: Because aerosol products act directly on the airways, drugs given by inhalation can usually be given in smaller doses and produce fewer adverse effects than oral or parenteral drugs. Aerosol products also produce a relief of asthma symptoms in a quick fashion.

Which client is at the greatest risk for pulmonary embolism. -pt 12 hr post-op total hip arthroplasty -pt 8 hr post-op open surgical appendectomy -pt 2 hr post-op open reduction external fixation of right radius -pt 4 hr post-op laparoscopic cholecystectomy

Total hip arthroplasty (Total hip surgery is th egreatest risk due to decreased mobility of the affected extremity)

A client who is 1 hour post-op following thoracentesis. what condition is the priority assessment finding?

Tracheal deviation to the unaffected side (tracheal deviation indicates a tension pneumothorax, which is a medical emergency)

You are a nurse working in the emergency department w/ a client following a chest trauma. Which finding indicates a tension pneumothorax?

Tracheal deviation to the unaffected side. (a tracheal pneumothorax results from free air filling the chest cavity, causing the lung to collapse and forcing the trachea to deviate to the unaffected side)

Cromolyn should not be used during an acute asthmatic attack.

True

Leukotriene receptor antagonists are administered orally.

True

Meclizine is used to relieve the nausea and vomiting that occurs with motion sickness.

True Rationale:

Patient taking rifampin for tuberculosis. What is an important teaching?

Urine and other secretions will be orange

A patient is being assessed by the home care nurse on the administration of the inhalers. Which of the following will assist in proper administration of the inhaler?

Use of a spacer Rationale: The patient should be instructed to use a spacer to increase compliance and accuracy of administration. The corticosteroid should be administered after the bronchodilator. The increase in fluids will not affect the administration of the inhaler. The patient should hold his breath for several seconds after administration of the inhaler.

Decongestants elicit their effect by which of the following mechanisms? (Choose one)

Vasoconstriction of small blood vessels of the nasal membranes Rationale: Vasoconstriction of small blood vessels of the nasal membrane is the mechanism of action for decongestants. First-generation antihistamines act to nonselectively bind to peripheral H1 receptors; the mechanism of action for second-generation antihistamines is to selectively bind to peripheral H1 receptors; and peripherally acting antitussives anesthetize stretch receptors in the respiratory passages.

After teaching a group of students about zafirlukast, the students demonstrate understanding when they identify which of the following as possible adverse effects? Select all that apply.

Vomiting Myalgia Dizziness Rationale: Myalgia is a possible adverse effect of zafirkulast. Dizziness is a possible adverse effect of zafirkulast. Vomiting is a possible adverse effect of zafirkulast. Constipation is not associated with zafirlukast. Chills are not associated with zafirkulast.

The nursing instructor is teaching the students about antitussives and their side effects. What ingredient found in some antitussives does the instructor tell students sometimes can cause drowsiness?

antihistamine Rationale: Antitussives that contain an antihistamine may cause drowsiness. The others are not found in antitussives and therefore do not cause the adverse reaction of drowsiness.

Splinting of the chest wall and abdominal distention can also result in___

atelectasis

Hemopthorax?

blood in the pleural space.

A high school student was diagnosed with asthma when he was in elementary school and has become accustomed to carrying and using his "puffers". In recent months, he has become more involved in sports and has developed a habit of administering albuterol up to 10 times daily. The nurse should teach the student that overuse of albuterol can lead to

rebound bronchoconstriction. Rationale: Patients who self-administer albuterol may use their MDIs more frequently than recommended. This practice can result in rebound bronchoconstriction, which may motivate the patient to increase MDI use, stimulating the cycle of rebound congestion. Overuse of albuterol is not linked to pneumonia or hepatotoxicity. Albuterol is not an anticholinergic drug.

PH - 7.30 PaCO2 - 55 HCO3 - 22

respiratory acidosis

These strategies include: (5)

• Changing patient's position frequently, especially from supine to upright position. • Encourage mobilization and physical activities or mobilization from bed to chair followed by early ambulation. • Encourage appropriate breathing and coughing exercises using the incentive spirometry. • Administer prescribed opioids and sedatives to prevent respiratory depression. • Perform postural drainage and chest percussion as needed. • Perform suctioning to remove tracheobronchial secretions, as needed.