Respiratory

A nurse is providing teaching to a client about pulmonary function testing. Which of the following tests measures the volume of air the lungs can hold at the end of maximum inhalation? a. total lung capacity b. vital lung capacity c. functional residual capacity d. residual volume

a. total lung capacity pulmonary function tests are used to examine the effectiveness of the lungs and to identify lung problems. total lung capacity measures the amount of air the lungs can hold after maximum inhalation

A nurse is caring for a client who is experiencing acute opioid toxicity. Which of the following actions should the nurse identify as the priority? a.. insert a large-bore IV catheter b. ensure an adequate airway c. obtain an accurate medication history d. prepare to administer an antagonist

b. ensure an adequate airway the first action the nurse should take when using the airway, breathing, and circulation approach to client care is to ensure the client's airway is adequate, as respiratory depression is a manifestation of opioid toxicity.

A client is admitted to the emergency department following a motorcycle crash. The nurse notes a crackling sensation upon palpation of the right side of the client's chest. After notifying the provider, the nurse should document this finding as which of the following? a. friction rub b. crackles c. crepitus d. tactile fremitus

c. crepitus crepitus, also called subcutaneous emphysema, is a coarse crackling sensation that the nurse can feel when palpating the skin surface over the client's chest. crepitus indicates an air leak into the subcutaneous tissue, which is often a clinical manifestation of pneumothorax

A nurse is caring for a client who has a 20-year history of COPD and is receiving oxygen at 2L/min via nasal cannula. The client is dyspneic and has an oxygen saturation via pulse oximetry of 85%. Which of the following actions should the nurse take? a. place a nonrebreather mask on the client and increase the oxygen flow to 3L/min b. prepare the client for possible endotracheal intubation and mechanical ventilation c. increase the oxygen flow and request an arterial blood gas determination d. position the client supine and administer an antianxiety medication

c. increase the oxygen flow and request an arterial blood has determination the client requires oxygen therapy at a rate that will keep the oxygen saturation between 88% and 92%. the nurse should increase the client's oxygen flow and evaluate its effectiveness with ABG results and oxygen saturation via pulse oximetry measurements

A nurse is caring for a client who is scheduled to have his chest tube removed. Which of the following actions should the nurse take? a. cover the insertion site with a hydrocolloid dressing after removal b. provide pain medication immediately after removal c. instruct the client to perform the valsalva maneuver during removal d. delegate removal of the chest tube to a licensed practical nurse

c. instruct the client to perform the valsalva maneuver during removal the nurse should instruct the client to perform the valsalva maneuver during removal to maintain the appropriate amount of negative pressure in the chest in order to prevent air entry into the pleural space

A client comes to the emergency department in severe respiratory distress following left-sided blunt chest trauma. The nurse notes absent breath sounds on the client's left side and a tracheal shift to the right. For which of the following procedures should the nurse prepare the client? a. tracheostomy placement b. thoracentesis c. CT scan of the chest d. chest tube insertion

d. chest tube insertion the client's manifestations indicate pneumothorax due to blunt chest trauma. The nurse should prepare for the provider to insert a chest tube and connect it to a water-seal drainage system

A nurse is caring for a client who has a chest tube. The nurse notes that the chest tube has become disconnected from the chest drainage system. Which of the following actions should the nurse take? a. place the drainage system at the head of the client's bed b. increase the suction to the chest drainage system c. place the client on low-flow oxygen via nasal cannula d. immerse the end of the chest tube in a bottle of sterile water

d. immerse the end of the chest tube in a bottle of sterile water if the chest tube and drainage system have become disconnected, air can enter the pleural space, producing a pneumothorax that can result in severe respiratory distress. to prevent a pneumothorax from developing, a temporary water seal can be established by immersing the end of the chest tube in an open bottle of sterile water. this allows air to escape and not enter the pleural space. a bottle of sterile water should always be readily available at the bedside for a client who has a chest tube

A nurse is caring for a client who had a left lower lobectomy to treat lung cancer. Which of the following factors will have significant impact on the plan of care for this client? a. the client will need intensive smoking-cessation education b. after surgery, the prognosis for clients with lung cancer is usually good c. lung cancer usually has metastasized before the client present with symptoms d. oxygen therapy is ineffective following a lobectomy

d. lung cancer usually has metastasized before the client presents with symptoms the nurse should be aware that lung cancer is usually at an advanced stage before the client has any manifestations. this has implications for both short-term and long-term care options for the client

A nurse is auscultating the lungs of a client who is having an acute asthma attack. Which of the following sounds should the nurse expect to hear? a. soft blowing b. loud bubbling c. dry grating d. noisy wheezing

d. noisy wheezing asthma causes the bronchioles of the lungs to constrict, creating a wheezing sound

A nurse is preparing to administer cisplatin IV to a client who has lung cancer. The nurse should identify that which of the following findings is an adverse effect of this medication? a. hallucinations b. pruritus c. hands and foot syndrome d. tinnitus

d. tinnitus an adverse effect of cisplatin is ototoxicity, which can cause tinnitus