Respiratory and Care of the child

How long do you suction a tracheostomy for?

not more than 10 seconds INTERMITTENTLY!!

A patient is admitted for joint replacement surgery and has a permanent tracheostomy. Which task is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? A. Suction the tracheostomy. B. Check stoma site for skin breakdown. C. Complete tracheostomy care using sterile technique. D. Provide oral care with a toothbrush and tonsil suction tube.

D. Provide oral care with a toothbrush and tonsil suction tube

Examples of antimicrobials (antibiotics)

-Penicillins: amoxicillin -Cephalosporins: cefazolin -Aminoglycosides: gentamicin -Flouroquinolones: cipro, levaquin -vancomycin

Examples of systemic corticosteroids

-Prednisone (PO) -Methylprednisolone (IV) taper off of these meds

Mantoux test

intradermal test to determine tuberculin sensitivity based on a positive reaction where the area around the test site becomes red and swollen TB test

What physical aspects should you see in a toddler from the ages 1-3?

-Walks without help -toilet learning

S/S of pneumonia

-chills -elevated temperature -chest pain -tachypnea -wheezes or rhonchi -use of accessory muscles for breathing -mental status changing -productive or non productive cough -fatigue -purulent sputum -hypoxia

Manifestations of bronchiolitis

-cold or mild URI -mild fever -clear nasal drainage -coughing -wheezing

Client and family teaching for appropriate antibiotic use

-complete full course of antibiotic prescription -antibiotics only work on bacterial infections -do not share antibiotics with anyone -discard any previously used prescribed leftovers

S/S of Hypoxia (late findings)

-confusion/stupor -cyanotic skin/mucus membranes -bradypnea -bradycardia -hypotension -cardiac dysrhythmias

Treatment for atelectasis

-cough and deep breath -incentive spirometer -early ambulation -oxygen for S/S of hypoemia

Nursing interventions for tracheostomy complications

-cough and deep breathe -humidification and suctioning -regular cleaning of inner cannula

What are clinical manifestations of atelectasis?

-decreased breath sounds -tachypnea, tachycardia, dyspnea -fever -signs of hypoxemia

Respiratory Acidosis causes

-decreased ventilation -respiratory depression: over sedation -altered diffusion: pulmonary edema, pneumonia, atelectasis, severe bronchospasm

S/S Acute Bronchitis

-dry hacking cough; productive in 2-3 days -fever -sore throat -wheezing -SOB -chills -body aches

Long term high dosage corticosteroid use can cause:

-easy bruising, adrenal suppression, decreased bone mineral density

Client's diagnosed with asthma have hyper-reactive airways and are easily triggered by multiple factors including:

-exercise -cold air -chemical fumes -smoke -dust -anger/stress -pets

What kind of trach tubes allow vocalization?

-fenestrated tubes -talking tracheostomy tubes -cuff-less tubes (don't require mechanical ventilation, not at risk for aspiration)

Acute pharyngitis clinical manifestations

-fever -malaise -dysphagia -anorexia -prominent red throat with or with out tonsillar exudate -swollen, tender lymph nodes

What two things does effect gas exchange require?

-good ventilation -good perfusion

A patient is admitted to the medical-surgical unit with a severe exacerbation of asthma. Which finding is of most concern to the nurse? 1. Unable to speak and sweating profusely 2. PaO2 of 80 mmHg and PaCO2 of 50 mmHg 3. Presence of inspiratory and expiratory wheezing 4.Peak expiratory flow rate at 60% of personal best

1. Unable to speak and sweating profusely

What affects gas exchange?

1. pressure gradient of gas 2. solubility of gas 3. respiratory membrane thickness 4. membrane area 5. ventilation-perfusion coupling

What is the range of oxygen flow (in literes) when using a non rebreather mask?

10-15L/min Delivers highest O2 concentration possible Suffocation can occur if reservoir kinks or O2 disconnects

How many hours a day would you expect a preschooler (3-6 years) to sleep?

12 hours per day gives up naps

Weighing a diaper

1gm= 1mL

ABG HCO3 range

22-26

The nurse if performing an assessment on a child with a suspected dx of epigottitis and avoids which of the following during the assessment? A. Performing throat exam B. Obtaining an axillary temp C. Monitoring for respiratory distress D. Asking the mother about precipitating events

A. Performing throat exam

Why would you expect a child with cystic fibrosis to be malnourished? [Select All That Apply] A. Malabsorption of fats and proteins B. Deficiency of vitamins and minerals C. Significant use of calories to maintain breathing D Thick, sticky mucus in the lungs

A, B, C

How is oxygen transported in the blood? (select all that apply) A. by hemoglobin B. by pulmonary surfactants C. dissolved in plasma D. as bicarbonate E. by while blood cells

A. by hemoglobin C. dissolved in plasma

What is the effect of contraction of the diaphragm and the intercostal muscles? A. increases the volume of the thoracic cavity B. forces air out of the lungs C. closes the epiglottis D. stimulates the secretion of pulmonary surfactants

A. increases the volume of the thoracic cavity

The nurse is analyzing a patient's ABG, which finding indicated the need for immediate action? A. The partial pressure of oxygen in the arterial blood (PaO2) is 59mmHg B. The arterial oxygen saturation is 92% C. The partial pressure of CO2 in arterial blood (PaCO2) is 31 mmhg D. The bicarbonate level is (HCO3) 29mEq/L

A. the partial pressure of oxygen in the arterial blood (PaO2) is 59mmHg

When ausclutating the chest of an older patient in respiratory distress, it is best to: A. begin listening at the apices B. begin listening at the lung bases C. begin listening on the anterior chest D. ask the patient to breathe through the nose with the mouth closed

B

When caring for a patient who is 3 hours postoperative laryngectomy, what is the nurse's highest priority assessment? A. Patient comfort B. Airway patency C. Incisional drainage D. Blood pressure and heart rate

B. Airway patency

When advising a patient who is beginning fluticasone propionate/salmeterol (Advair) therapy, which of the following instructions should a health care professional include? a. take the drug as needed for acute asthma b. follow a low-sodium diet c. use an alternate-day dosing schedule d. increase weight-bearing activity

d. increase weight-bearing activity

A patient whose tracheostomy was inserted 30 minutes ago is recovering in the postanesthesia recovery unit when the tracheostomy tube is expelled by coughing. What is the priority action by the nurse? A. Suction the tracheostomy opening. B. Maintain the airway with a sterile hemostat. C. Use an Ambu bag and mask to ventilate the patient. D. Insert the tracheostomy tube obturator into the stoma.

B. Maintain the airway with a sterile hemostat

Why does wheezing occur in asthma patients?

Airway is smaller from mucus build up

A nurse is reinforcing teaching about safety during the school age years to a group of parents. Which of the following information should the nurse include? (select all that apply) A. Gating stairs at the top and bottom B. Wearing helmets when riding bicycles or skateboarding C. Riding safely in beds of pickup trucks D. Implementing firearm safety E. Wearing seat belts

B, D, E

A patient is being discharged from the emergency department after being treated for epistaxis. In teaching first aid measures in the event the epistaxis would recur, what measures should the nurse suggest (select all that apply.)? A. Tilt patient's head backwards. B. Apply ice compresses to the nose. C. Tilt head forward while lying down. D. Pinch the entire soft lower portion of the nose. E. Partially insert a small gauze pad into the bleeding nostril.

B. Apply ice compresses to the nose D. Pinch the entire soft lower portion of the nose E. Partially insert a small gauze pad into the bleeding nostril

Which process does not occur in the nasal cavity? A. Trapping of large foreign bodies B. Exchange of gases C. Humidification of inhaled air D.. Warming of inhaled air

B. Exchange of gases

Which cells are responsible for remembering an antigen to recognize when it comes back into the body?

B-cells

The nurse is caring for a patient with chronic obstructive pulmonary disorder (COPD) and pneumonia who has an order for arterial blood gases to be drawn. What is the minimum length of time the nurse should plan to hold pressure on the puncture site? A. 2 minutes B. 5 minutes C. 10 minutes D. 15 minutes

B. 5 minutes

What is conjunctivitis? What are the S/S

inflammation of the conjunctiva -pink or red sclera -tearing -yellow/green discharge of affected eye(s)

A nurse is collecting data on an infant at a well-child check-up. By which of the following ages is the birth weight typically doubled? A. 3 months B. 6 months C. 9 months D. 12 months

B. 6 months

The nurse is caring for a patient with pneumonia unresponsive to two different antibiotics. Which action is most important for the nurse to complete before administering a newly prescribed antibiotic? A. Teach the patient to cough and deep breathe. B. Take the temperature, pulse, and respiratory rate. C. Obtain a sputum specimen for culture and Gram stain. D. Check the patient's oxygen saturation by pulse oximetry.

C. Obtain a sputum specimen for culture and Gram stain

Nasopharyngitis

inflammation of the nose and pharynx most common infection of respiratory tract and caused by rhinoviruses spread by coughing, sneezing, direct contact

A patient is diagnosed with a lung abscess. What should the nurse include when teaching the patient about this diagnosis? A. Lobectomy surgery is usually needed to drain the abscess. B. IV antibiotic therapy will be used for a 6-month period of time. C. Oral antibiotics will be used until there is evidence of improvement. D. Culture and sensitivity tests are needed for 1 year after resolving the abscess

C. Oral antibiotics will be used until there is evidence of improvement

The patient has been diagnosed with head and neck cancer. Along with the treatment for the cancer, what other treatment should the nurse expect to teach the patient about? A. Nasal packing B. Epistaxis balloon C. Gastrostomy tube D. Peripheral skin care

C. Gastrostomy tube

The abnormal finding in an evaluation of growth and development for a 6-month-old infant would be: A. Weight gain of 4-7 ounces per week B. Length increase of 1 inch in 2 months C. Head lag present D. Can sit alone for a few seconds

C. Head lag present

Which of the following pharmacologic treatment options are most likely to increase blood pressure and heart rate? (select all that apply) A. Nasal spray decongestants B. Mast cell stabilizers C. Oral decongestants D. Intranasal glucocorticosteroids E. Beta-2 adrenergic agonists

C. Oral decongestants E. Beta-2 adrenergic agonists

If someone has more than 1 inhaler, which one do you administer first?

Bronchodilator -albuterol Side effect of albuterol is tachycardia and shakiness

The nurse is teaching the patient with human immunodeficiency virus (HIV) about the diagnosis of Candida albicans. What statement made by the patient indicates to the nurse that further teaching is required? A. "I will be given amphotericin B to treat the fungus." B. "I got this fungus because I am immunocompromised." C. "I need to be isolated from my family and friends so they won't get it." D. "The effectiveness of my therapy can be monitored with fungal serology titers."

C. I need to be isolated from my family and friends so they won't get it

A nurse is assessing a 9 month old infant for potential developmental delay. Which of the following observations should the nurse expect to find to support this condition? A. Delayed startle reflex B. Inability to stand alone C. Inability to sit without support D. Powerlessness to pull self-up

C. Inability to sit without support

One week after a thoracotomy, a patient with chest tubes (CTs) to water-seal drainage has an air leak into the closed chest drainage system (CDS). Which patient assessment warrants follow-up nursing actions? A. Water-seal chamber has 5 cm of water. B. No new drainage in collection chamber C. Chest tube with a loose-fitting dressing D. Small pneumothorax at CT insertion site

C

The nurse can best determine adequate arterial oxygenation of the blood by assessing: A. heart rate B. hemoglobin level C. arterial oxygen partial pressure D. arterial carbon dioxide partial pressure

C

The nurse is caring for a group of patients. Which patient is at risk of aspiration? A.A 58-yr-old patient with absent bowel sounds 12 hours after abdominal surgery B.A 67-yr-old patient who had a cerebrovascular accident with expressive dysphasia C.A 26-yr-old patient with continuous enteral tube feedings through a nasogastric tube D.A 92-yr-old patient with viral pneumonia and coarse crackles throughout the lung fields

C

Where does gas exchange occur?

Capillaries that lay on top of the alveolar sacs or on the walls of the alveoli (between alveoli and a network of tiny blood vessels) and that is where exchange occurs

Conjunctivitis treatment and 3 main goals

Ciprofloxacin or ofloxacin drops 1. Increase patient comfort 2. Reduce or lesson the course of infection 3. Prevent the spread in contagious forms

A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching? A. Removes the cap and shakes the inhaler well before use B. Presses the canister down with finger as he breathes in C. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed D. Inhales the mist and quickly exhales

D. Inhales the mist and quickly exhales

Peritonsillar abscess

Collection of pus or fluid around the tonsil post strep infection

Which assessment finding of the respiratory system does the nurse interpret as normal? A. inspiratory chest expansion of 1 inch B. symmetric chest expansion and contraction C. resonance (to percussion) over the lung bases D. Bronchial breath sounds in the lower lung fields

D

Tracheomalacia

Constant pressure of cuff causes tracheal dilation and erosion of cartilage

Mast Cell Stabilizers

Cromolyn Stops mast cells from releasing inflammatory mediators(histamine and leukotrienes) -dry mouth -HA -bitter aftertaste -cough -tingling -burning of throat after inhalation

Which child would have the most difficulty in coping with separation from parents because of hospitalization? A. 3 month old B. 4 year olf C. 7 year old D. 16 month old

D. 16 month old

What kind of allergy do you need to be assessed for with the influenza?

Egg

Cough Aides

Expectorants: guaifenesin Mucolytics: acetylcysteine Antitussives: codeine, benadryl

What kind of sounds would you hear with crackles?

Fine & coarse; popping sounds as air passes through moist and or previously closed small airways

What age to girls and boys begin puberty and how long does it last?

Girls 8-14 years, complete in 3 years Boys 9-16 years, complete by age 18

Classification of COPD Severity

Gold 1: mild COPD, 80% normal lung function Gold 2: moderate COPD, 50-80% normal lung function Gold 3: servere COPD, 30-50% normal lung function Gold 4: very severe COPD, <30% normal lung function

What are the receptors in the body's cells that respond to histamine?

H1 receptors= allergic response H2 receptors= secretion of gastric acid

What is the cause of cervical cancer?

HPV; strains 18 and 16 reponsible for 70% of cervical cancers

Long term effects of OSA (obstructive sleep apnea) and treatment

HTN cardiac dysrhythmias arteriosclerosis heart failure cardiac related mortality CPAP(continues positive airway pressure)

Respiratory alkalosis causes

Hyperventilation -anxiety -pain -fever -head injury -hypoxemia/hypoxia -mechanical ventilation

If a spirometry machine does not determine asthma, what medication can be given that will cause a broncho constriction?

Metacholine

Legal restrictions apply to the purchase of pseudoephedrine because of which of the following risks? a. respiratory depression b. drug abuse c. drug tolerance d. rebound congestion

b. drug abuse

Tracheal stenosis

Narrowing of tracheal lumen due to scar formation, resulting from irritation of tracheal mucosa from the tracheal tube cuff

What kind of sounds would you hear with rhonchi?

low-pitched, continuous sounds. From narrowed or obstructed large airways, often from secretions. may disappear after coughing

Action of antihistamines

Prevents action of histamine -competes with histamine for specific unoccupied H1 receptor sites thus preventing histamine (allergic) response

What is allergic rhinitis? Medications available?

Seasonal allergies -nasal congestion -watery nasal discharge -itching of eyes -sneezing Meds: antihistamines, corticosteroids, decongestants, leukotriene receptor antagonists, immunotherapy (allergy shots)

What kind of sounds will you hear with wheezing?

Sound produced when air passes through partially obstructed or narrowed airways on inspiration or expiration

Levels of management for asthma

Step 1: Intermittent, no daily medications Step 2: Mild persistent, low dose ICS Step 3: Moderate persistent, los does ICS+ LABA Step 4: Severe persistent, medium dose ICS+ LABA Step 5: Severe persistent, low-dose ICS, LTAs prn

What is a tracheostomy?

Stoma/opening that results from a tracheotomy to provide airway

Where are histamines synthesized and stored?

mast cells and basophils

A health care professional who is advising a patient about the use of a mucolytic to treat a cough should explain that this type of drug is effective because it performs which of the following actions? a. suppresses the cough stimulus b. reduces inflammation c. thins and loosen mucus d. dries secretions

c. thins and loosen mucus

TV FVC PEFR IRV ERV RV

Tidal volume Forced vital capacity Peak expiratory flow rate Inspiratory reserve volume Expiratory reserve volume Residual volume

German Measles -cause -S/S -treatment

Viral disease S/S: low-grade fever, enlarged glands in neck, sore throat, rash begins on face and spreads on body Treatment: comfort measures (analgesics, rest, fluids) *droplet precautions

Bronchiolitis

Viral infection of bronchioles in lower respiratory tract. Small diameter

How do we determine that someone has asthma?

Using a spirometry machine to test total volume exhaled in the first second If it is less than 0.7, thats how you know there is a definite obstruction

Which antibiotics peak and trough can become toxic to the kidneys? (causing nephrotoxicity or ototoxicity)

Vancomycin and Gentamicin -after 3rd dose and right before 4th, draw blood and check levels of trough, also draw for peak

A health care professional is advising a patient about the adverse effects of pseudoephedrine. Which of the following should the health care professional include? (select all that apply) a. restlessness b. bradycardia c. insomnia d. muscle pain e. anxiety

a. restlessness c. insomnia e. anxiety

A health care professional is monitoring plasma drug levels in a patient who is taking the theophylline. Which of the following adverse effects should the health care professional expect to see if the patient's level indicates toxicity? a. seizures b. constipation c. vomiting d. restlessness

a. seizures

A health care professional cautions a patient who is taking guaifenesin about using combination OTC cold products because: a. they can also contain guaifenesin b. serious interactions are possible c. rebound congestion is likely d. drug tolerance is likely

a. they can also contain guaifenesin

Obstructive Sleep Apnea (OSA)

airway becomes blocked during sleep by: -narrowing of air passages with relaxation of muscle tone with sleep -tongue and soft palate falling backwards to partially or completely obstruct the pharynx leads to hypoxemia, hypercapnia

hypercapnia -S/S

an increase in the partial pressure of carbon dioxide in the blood S/S: dypnea, pursed lip breathing, HA, disorientation, dysrhythmias

hypoxia -S/S

an oxygen deficiency in body tissue S/S: tachycardia, tachypnea, restlessness, irritability, apprehension, dyspnea (SOB)

Before prescribing dextromethorphan to a patient, the primary care provider should know that, when given with an opioid, the drug can result in which of the following? a. reduced antitussive effect of dextromethorphan b. potentiation of the analgesic effect of the opioid c. increased renal reabsorption of the dextromethorphan d. delayed analgesic effect of the opioid

b. potentiation of the analgesic effect of the opioid

The primary chemical stimulus for breathing is the concentration of:

carbon dioxide in the blood

What is associative play?

children engage in separate activities but exchange toys and comment on one another's behavior

Hemoptysis

coughing up blood

hypoxemia -clinical manifestations

decreased oxygen tension of arterial blood clinical manifestations: dsypnea, tachypnea, nasal flaring, decreases SpO2, restless, confused

What is hypoxia?

deficiency in the amount of oxygen reaching the tissues

Tracheoesophageal fistula

excess cuff pressure erodes posterior wall of trachea creating a hole between trachea and anterior esophagus

Myringotomy

incision into the tympanic membrane to equalize pressure and restore hearing or drain fluid

What is an example of a LABA (long acting)?

salmeterol(Serevent) formoterol(Foradil) *never used by themselves

What can decrease swelling in the throat?

salt water gargles

SARS

severe acute respiratory syndrome result of resp diseases

Tracheal wall necrosis

tissue damage that results when pressure of inflated cuff impairs blood flow to tracheal wall

Action of histamine

vasodilation and increased capillary permeability: swelling, rash, hives, redness, itching, nasal congestion, sneezing triggers other inflammatory mediators increased secretions: watery eyes; rhinorrhea smooth muscle contraction especially in lungs: wheezing and coughing

COPD is a preventable and treatable disease characterized by persistent airflow limitation that is slowly progressive. What are the 2 types?

-Chronic bronchitis -Emphysema

Common pneumonia complications

-Hypoxemia -Septicemia: presence of pathogenic microorganisms in the blood -Pleural Effusion: abnormal collection of fluid in the pleural space -Pleurisy: sharp pain caused by friction or inflamed pleura -atelectasis

A patient with a persistent cough is diagnosed with pertussis. What treatment does the nurse anticipate administering to this patient? A. Antibiotic B. Corticosteroid C. Bronchodilator D. Cough suppressant

A

An older adult patient living alone is admitted to the hospital with a diagnosis of pneumococcal pneumonia. Which clinical manifestation, observed by the nurse, indicates that the patient is likely to be hypoxic? A. Sudden onset of confusion B. Oral temperature of 102.3oF C. Coarse crackles in lung bases D. Clutching chest on inspiration

A

During discharge teaching for an older adult patient with chronic obstructive pulmonary disease (COPD) and pneumonia, which vaccine should the nurse recommend that this patient receive? A. Pneumococcal B. Staphylococcus aureus C. Haemophilus influenzae D. Bacille-Calmette-Guérin (BCG)

A

The nurse is performing a respiratory assessment. Which finding best supports the nursing diagnosis of ineffective airway clearance? A. Basilar crackles B. Oxygen saturation of 85% C. Presence of greenish sputum D. Respiratory rate of 28 breaths/min

A

What are the muscarinic antagonists?

aka anticholinergics typically ending in -ium -Short acting: ipratropium(Atrovent) -Long acting Tiotropium(Spiriva)

A health care professional should explain to a patient who is prescribed diphenydramine that the most common side effect associated with the drug is: a. muscle tremors b. sedation c. anxiety d. insomnia

b. sedation

A health care professional should tell a patient who is taking albuterol to report which of the following possible indications of a serious adverse effects? a. fever b. bruising c. polyuria d. palpitations

d. palpitations

What can happen with an increased number of immature neutrophils (bands)?

Shift to the left

Mumps -cause -S/S -Treatment

Swelling of salivary and parotid glands; contagious few days before until 5 days after the onset Cause: paramyxovirus S/S: low grade fever, malaise and loss of appetite, headache, muscle aches, swollen parotid gland with tenderness Treatment: warm or cold packs to tender glands, analgesics *droplet

A student nurse asks the RN what can be measured by arterial blood gases (ABGs). The RN tells the student that the ABGs can measure (select all that apply). A. acid-base balance. B. oxygenation status. C. acidity of the blood. D. glucose bound to hemoglobin. E. bicarbonate (HCO3-) in arterial blood.

A, B, C, D

During admission of a patient diagnosed with non-small cell lung carcinoma, the nurse questions the patient related to a history of which risk factors for this type of cancer (select all that apply.)? A. Asbestos exposure B. Exposure to uranium C. Chronic interstitial fibrosis D. History of cigarette smoking E. Geographic area in which he was born

A, B, D

The nurse is caring for a patient with a nursing diagnosis of hyperthermia related to pneumonia. What assessment data does the nurse obtain that correlates with this nursing diagnosis (select all that apply.)? A. A temperature of 101.4°F B. Heart rate of 120 beats/min C. Respiratory rate of 20 breaths/min D. A productive cough with yellow sputum E. Reports of unable to have a bowel movement for 2 days

A, B, D

The nurse is admitting a patient with a diagnosis of pulmonary embolism. What risk factors is a priority for the nurse to assess (select all that apply.)? A. Obesity B. Pneumonia C. Malignancy D. Cigarette smoking E. Prolonged air travel

A, C, D, E

Which respiratory structures are grape-like sacs located very close to the pulmonary capillaires and primarily concerned with gas exchange? A. Alveoli B. Lungs C. Glottis D. Bronchioles

A. Alveoli

The patient with Parkinson's disease has a pulse oximetry reading of 72%, but he is not displaying any other signs of decreased oxygenation. What is most likely contributing to his low SpO2 level? A. Artifact B. Anemia C. Dark skin color D. Thick acrylic nails

A. Artifact

The nurse is obtaining a focused respiratory assessment of a 44-yr-old female patient who is in severe respiratory distress 2 days after abdominal surgery. What is most important for the nurse to assess? A. Auscultation of bilateral breath sounds B. Percussion of anterior and posterior chest walls C. Palpation of the chest bilaterally for tactile fremitus D. Inspection for anterior and posterior chest expansion

A. Auscultation of bilateral breath sounds

A frail 82-yr-old female patient develops sudden shortness of breath while sitting in a chair. What location on the chest should the nurse begin auscultation of the lung fields? A. Bases of the posterior chest area B. Apices of the posterior lung fields C. Anterior chest area above the breasts D. Midaxillary on the left side of the chest

A. Bases of posterior chest area

When initially teaching a patient the supraglottic swallow after a radical neck dissection, with which food or fluid should the nurse begin? A. Cola B. Applesauce C. French fries D. White grape juice

A. Cola

A nurse is assigned to a patient who has just been admitted for acute respiratory distress. Your initial history should focus on which priority? A. smoking history B. Nutritional history C. Events leading to the current admission D. Events leading to the previous admission

C. Events leading to the current admission

A 67-yr-old male patient had a right total knee replacement 2 days ago. Upon auscultation of the patient's posterior chest, the nurse detects discontinuous, high-pitched breath sounds just before the end of inspiration in the lower portion of both lungs. Which statement most appropriately reflects how the nurse should document the breath sounds? A."Bibasilar wheezes present on inspiration." B."Diminished breath sounds in the bases of both lungs." C."Fine crackles posterior right and left lower lung fields." D."Expiratory wheezing scattered throughout the lung fields."

C. Fine crackles posterior right and left lower lung fields

The nurse is performing a respiratory assessment for a patient admitted with pneumonia. Which clinical manifestation should the nurse expect to find? A.Hyperresonance on percussion B.Vesicular breath sounds in all lobes C.Increased vocal fremitus on palpation D.Fine crackles in all lobes on auscultation

C. Increased vocal fremitus on palpation

A nurse is obtaining the length and weight of a 6-month-old infant. Which of the following are appropriate actions? (select all that apply) A. Weigh the infant in a diaper B. Use a stadometer to measure the infant C. Place disposable covering on the scale D. Measure infant from crown o f head to heel of feet E. Ensure the scale is balanced to 0 prior to use

C. Place disposable covering on the scale D. Measure infant from crown of head to heel of feet E. Ensure the scale is balanced to 0 prior to use

To meet Erikson's developmental task of industry, the nurse caring for a 7-year-old would choose an activity such as: A. Completing a jigsaw puzzle B. Building a model C. Playing a board game D. Playing with hand puppets

C. Playing a board game

A patient admitted with pneumonia complains of sharp pain on her right lateral side, which increases when she takes a deep breath. The nurse suspects this is due to an inflammatory process. Which of the following assessment data would confirm this? A. Unilateral rhonchi B. Absent breath sounds C. Pleural friction rub D. Bronchial breath sounds

C. Pleural friction rub

The nurse is aware that the priority should be to monitor the child for which of the following? A. Hyperventilation B. Fibrosis of the lungs C. Respiratory infections D. High surfactant levels

C. Respiratory infections

The nurse is caring for a patient with a tracheostomy. What is the priority nursing assessment for this patient? A. Electrolyte levels and daily weights B. Assessment of speech and swallowing C. Respiratory rate and oxygen saturation D. Pain assessment and assessment of mobility

C. Respiratory rate and oxygen saturation

The nurse would expect a 4 month old to be able to: A. Holds a bottle B. Pulls to a standing position C. Roll from back to side D. Sits unsupported

C. Roll from back to side

A nurse is caring for a child who has a vesicular rash. The patient ask the nurse what illness can cause the rash. Which of the following is the most appropriate response for the nurse to give? A. Measles B. Fifth Disease C. Hep B D. Chicken pox

D. Chicken pox

After swallowing, a 73-yr-old patient is coughing and has a wet voice. What changes of aging could be contributing to this abnormal finding? A. Decreased response to hypercapnia B. Decreased number of functional alveoli C. Increased calcification of costal cartilage D. Decreased respiratory defense mechanisms

D. Decreased respiratory defense mechanisms

The volume of air that can be exhaled after normal exhalation is the: A. Tidal volume B. Residual volume C. Inspiratory reserve volume D. Expiratory reserve volume

D. Expiratory reserve volume

A patient overhearing the doctor say she has crackles asks the student "what causes crackles"? The student's best response would be: A. Secretions in the large airways B. An inflammation of the pleural lining C. Air passing through constricted airways D. Fluid or secretions in the small airways or alveoli

D. Fluids or secretions in the small airways or alveoli

A nurse is caring for a 10 month old infant. Which of the following would be unsafe for the nurse to give the infant? A. Scrambled egg B. Orange juice C. Dry cold cereal D. Grapes

D. Grapes

The nurse evaluates that discharge teaching for a patient hospitalized with pneumonia has been effective when the patient makes which statement about measures to prevent a relapse? A."I will seek immediate medical treatment for any upper respiratory infections." B."I should continue to do deep breathing and coughing exercises for at least 12 weeks." C."I will increase my food intake to 2400 calories a day to keep my immune system well." D."I must have a follow-up chest x-ray in 6 to 8 weeks to evaluate the pneumonia's resolution."

D. I must have a follow-up chest x-ray in 6-8 weeks to evaluate the pneumonia's resolution

The nurse teaches a patient about the use of budesonide intranasal spray for seasonal allergic rhinitis. The nurse determines that medication teaching is successful if the patient makes which statement? A."My liver function will be checked with blood tests every 2 to 3 months." B. "The medication will decrease the congestion within 3 to 5 minutes after use." C. "I may develop a serious infection because the medication reduces my immunity." D. "I will use the medication every day of the season whether I have symptoms or not."

D. I will use the medication every day of the season whether I have symptoms or not

The nurse is caring for a patient with ineffective airway clearance. What is the priority nursing action to assist this patient expectorate thick lung secretions? A. Humidify the oxygen as able. B. Administer cough suppressant q4hr. C. Teach patient to splint the affected area. D. Increase fluid intake to 3 L/day if tolerated.

D. Increase fluid intake to 3L/day if tolerated

When the patient is experiencing metabolic acidosis secondary to type 1 diabetes mellitus, what physiologic response should the nurse expect to assess in the patient? A. Vomiting B. Increased urination C. Decreased heart rate D. Increased respiratory rate

D. Increased respiratory rate

A nurse is caring for a child who is admitted with swollen, painful joints and is diagnosed with rheumatic fever. When educating the child's parent about the rheumatic fever, which of the following statements by the nurse would be appropriate? A. It occurs in children with congenital heart defects B. It is an opportunistic disease C. It has no known cause D. It is usually preceded by a streptococcal infection

D. It is usually preceded by a streptococcal infection

A patient had an open reduction repair of a bilateral nasal fracture. The nurse plans to implement an intervention that focuses on both nursing and medical goals for this patient. Which intervention should the nurse implement? A. Apply an external splint to the nose. B. Insert plastic nasal implant surgically. C. Humidify the air for mouth breathing. D. Maintain surgical packing in the nose.

D. Maintain surgical packing in the nose

The patient seeks relief from the symptoms of an upper respiratory infection (URI) lasting for 5 days. Which patient assessment should the nurse use to help determine if the URI has developed into acute sinusitis? A. Coughing B. Fever, chills C. Dust allergy D. Maxillary pain

D. Maxillary pain

An older adult patient is admitted with acute respiratory distress related to cor pulmonale. Which nursing action is most appropriate during admission of this patient? A. Perform a comprehensive health history with the patient to review prior respiratory problems. B. Complete a full physical examination to determine the effect of the respiratory distress on other body functions. C. Delay any physical assessment of the patient and review with the family the patient's history of respiratory problems. D. Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress.

D. Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress

A patient with a recent history of a dry cough has had a chest x-ray that revealed the presence of nodules. In an effort to determine whether the nodules are malignant or benign, what is the primary care provider likely to order? A. Thoracentesis B. Pulmonary angiogram C. CT scan of the patient's chest D. Positron emission tomography (PET)

D. Positron emission tomography

A health care professional is advising a patient about the use of cromolyn sodium to prevent bronchospasm. The health care professional should explain that the drug prevents bronchospasm because it performs which of the following actions? a. increases leukocyte activity b. blocks muscarinic receptors c. causes bronchodilation d. reduces inflammation

D. Reduces inflammation

The nurse is caring for an older adult patient who underwent a left total knee arthroplasty. On the third postoperative day, the patient reports shortness of breath, slight chest pain, and that "something is wrong." Temperature is 98.4°F, blood pressure is 130/88 mm Hg, respirations are 36 breaths/min, and oxygen saturation is 91% on room air. What is the priority nursing action? A. Notify the health care provider. B. Administer a nitroglycerin tablet sublingually. C. Conduct a thorough assessment of the chest pain. D. Sit the patient up in bed as tolerated and apply oxygen.

D. Sit the patient up in bed as tolerated and apply oxygen

Acute Viral Rhinitis clinical manifestations and treatments

"The common cold" (viral) -runny nose -watery eyes -nasal congestion -sneezing cough -sore throat -fever -headache -fatigue Treatments: rest, oral fluids, antipyretics and analgesics

Emphysema clinical manifestations

"pink puffer" -increased CO2 retention -purse lip breathing -dyspnea -orthopneic -barrel chest -prolonged expiratory time -thin apperance -anxious -use of accessory muscles to breath

Calculating Pack Years of smoking

(packs smoked per day)x(years as smoker)= # of pack years (# of cigs smoked/day)x(# of years smoked)/20 = # of pack years

Immunomodulators -most common prototype -how it works

*For severe cases of asthma omalizumab(Xolair) Decreases circulating free IgE levels Prevents IgE from attaching to mast cells, preventing relase of inflammatory mediators Rare risk of anaphylaxis

albuterol (Ventolin) -primary use -onset of action -patient teaching

*Primarily used as rescue medication -onset of action: few minutes, duration 4-8 hours -teach clients to carry everywhere with them

chronic bronchitis clinical manifestations

*airway flow problem "blue bloater" -color dusky to cyanotic -recurrent cough and increased sputum -hypoxia -hypercapnia (increased CO2) -respiratory acidosis -increased hemoglobin (trying to compensate) -increased RR (feeling out of breath) -resp. acidosis (because CO2 is acidic)

Leukotriene Antagonists -most common prototype -how it works -side effects

*not indicated for acute attacks Montelukast(singular) Blocks leukotrienes -HA -hepatotoxicity -tremor -depression -suicidality -anxiousness

Six types of drugs to treat airflow disorders

- Beta2 adrenergic agonists - Inhaled anticholinergics - Methylxanthines - Glucocorticoids - Mast cell stabilizers - Leukotriene modifiers

Nursing diagnoses for common pulmonary diseases

-Anxiety -Impaired gas exchange -ineffective airway clearance -ineffective coping -ineffective therapeutic regimen management -powerlessness

Tracheostomy complications

-Aspiration: ensure cuff is inflated for meals and 1 hr after -Swallowing: deflate uff when evaluating swallowing ability, prevent aspiration with elevated HOB, no thin liquids, small volumes

Antihistamine Medications

-Benadryl (diphenhypdramine) -Dramamine (dimenhydrinate) -Allegra (fexofenadine) -Claritin (loratadine) -Zyrtec (cetirizine hydrochloride) -Chlor-Trimenton (chlorpheniramine maleate) elderly can have prostate issues with urinary retention

Piaget's Theory of Cognitive Development -Birth to 2 years -2-7 years -7-12 years -13 to adulthood

-Birth to 2 years: Sensorimotor -2-7: Pre-operational -7-12: Concrete Operations -13-adulthood: Formal Operational

Directional patterns: -Cephalocaudal -Proximodistal -Mass-to-specific

-Cephalocaudal: head to toe -Proximodistal: center to extremeties -Mass to specific: simple to complex

Side effects of corticosteroids

-Hyperglycemia (take accu-checks) -mask infection -F&E imbalances -peptic uclers

Complications with Tracheostomy suctioning

-Hypoxia -Tissue trauma -Infection -Vagal stimulation and bronchospasm

Erikson's theory of personality -Infant (birth to 1 year) -Toddler (1-3 years) -Pre-schooler (3-6 years) -School age (6-12 years) -Adolescent (12-20)

-Infant: Trust vs. Mistrust -Toddler: Autonomy versus Shame and Doubt -Pre Schooler: Initiative vs. Guilt -School Age: Industry versus inferiority -Adolescent: Identity versus Role confusion

What are methylxanthines?

-Less effective long-term bronchodilator -alleviates early phase of attacks but has little effect on bronchial hyper-responsives -very narrow therapeutic range (10-20mg/dL) typically ending in -ine

Low-Flow Oxygen Delivery Systems

-Nasal cannula -Simple face mask -Partial rebreather mask -Nonrebreather mask

What do you notice in a client with respiratory distress?

-SOB -Cyanosis -Accessory muscles -labored breathing -low O2 -shallow respirations -increased RR rate -anxious/sweaty

What is a nasal fracture? and what do you do for that?

-Simple- little or no displacement -Complex- can involve damage to adjacent facial structures -realignment, prevent bruising, maintain airway, reduce edema and pain, reduce pain, prevent complications, provide emotional support, keep up right and provide ice for 10-20 min at a time

S/S of Hypoxia (early findings)

-Tachypnea -Tachycardia -Restlessness -Pale skin/mucus membranes -Elevated BP -s/s resp. distress

High-Flow Oxygen Delivery Systems

-Venturi mask -Face tent -Aerosol mask -Tracheostomy collar&T-piece -CPAP& BiPAP -Mechanical ventilation -High flow nasal cannula

Nursing interventions with antimicrobial therapy

-accurate allergy history before drug therapy -understand drug actions -know side effects -understand drug toxicity -client and family teaching

What are S/S of influzena?

-acute fever; chills -headache, muscle aches; fatigue -cough, sore throat, rhinorrhea

Pneumonia interventions

-antipyretics: aspirin, tylenol, ibuprofen (these decrease temp and inflammatory response) -monitor VS -O2 as needed -antibiotics if bacterial infection -monitor for complications

Epiglottitis interventions

-avoid sedation until airway secured -cool-mist oxygen therapy per order -monitor closely-VS; breath sounds; pulse oximetry -blood culture and antibiotic therapy -IV fluids

Side effects of B2 adrenergic agonists

-chest pain, palpitations -hypertension, tachycardia -dysrhyhmias -tremors -hyperglycemia -hypokalemia -paradoxical bronchoconstriction w/ inhalers (over use)

What viral illnesses treated with ASA are most associated with Reye Syndrome?

-chickenpox -influenza

What are the 4 types of pneumonia

-community acquired pneumonia: lower resp tract -hospital acquired pneumonia: within 48 hours of admission -ventilator associated pneumonia (VAP) -health care associated pneumonia (HCAP)

What physical aspects should you see in an infant from birth to 1 year?

-double birth weight in 6 months -triples birth weight by 1 year -sits unsupported

Symptoms of cystic fibrosis

-fatigue -chronic cough -reoccuring URI's -thick, sticky mucus -chronic hypoxia -abdominal distention -decreased digestive enzymes -rectal prolapse

Interventions and parent teaching in otitis media

-fluids -feed in upright postion -analgesic -ear drops -antibiotic -local heat application with affect ear -screening for hearing loss

After Care Instructions for Immunizations

-give acetaminophen or Motrin immediately after and every 4 hours PRN -apply cool washcloth to site to reduce swelling -monitor child's behavior for abnormals -maintain immunization record

Tonsillitis and Adenoiditis clinical manifestations

-headache -fever -sore throat -red tonsils -dysphagia -enlarged and tender cervical lymph nodes -ear pain -mouth and noisy breathing

Respiratory Acidosis S/S

-increased BP -CNS depression -lethargy/weakness -drowsiness -behavioral changes -headache -coma

Respiratory Alkalosis S/S

-lightheaded/dizzy -sweaty -numbness/tingling of fingers -muscle weakness -arrhythmias -convulsions

What are the causes of epistaxis (nosebleed)?

-low humidity -allergies -HTN -sinusitis -trauma -foreign bodies -over use of decongestants

Nursing interventions of bronchiolitis

-maintain airway -elevate HOB 30-60 degrees with neck slightly extended -cool humidified oxygen -encourage fluids -monitor for signs of dehydration -provide support of family

Home education for O2 therapy

-maintain proper oral care to prevent infections -clean nasal cannula with soap and water 1-2 times per week -cannula should be replaced every 2-4 weeks -unplug and clean compressor daily -no smoking signs posted -don't use flammable liquids or fabrics that carry a static charge -inform the electric company if you use a compressor in case of power failure -have fire extinguisher

Examples of medication devices

-metered dose inhalers(MDI) -Spacers -Dry Powder Inhalers (DPI) -Nebulizers

Assessment of client with a tracheostomy

-monitor VS, breathing pattern and SPO2 -ensure ordered FiO2 and flow rate -check humidification -ausculate lungs -assess tracheostomy site and tube

Impaired gas exchange interventions

-monitor change in mental status -monitor O2 sats -administer supplemental O2 -elevated HOB -deep slow or pursed lip breathing -expectoration of sputum -assist w/ positive pressure ventilation

ineffective breathing patterns interventions

-monitor resp and O2 status -monitor for resp fatigue -elevate HOB -splint when coughing for deep breathing -IS -meds to promote airway patency

Interventions for acute bronchitis

-monitor resp status -cool humidified air -fluid intake, monitor for dehydration -tylenol for fever -cough suppressant if prescribed -bronchodilators as ordered

Influenza interventions

-monitor resp status -encourage rest and fluids -supportive therapy:acetaminophen, antitussives, antivirils

Nasal decongestants -non-glucocorticosteroids -glucosteriods

-non-glucocorticosteroids Afrin Neo-Synephrine Sudafed -glucosteroids Flonase Nasonex Beconase AQ Nasacort

S/S of oxygen toxicity

-nonproductive cough -substernal pain -nasal stuffiness -nausea -vomiting -fatigue -headache -sore throat -hypoventilation

What causes atelectasis?

-obstructions: usually mucus plug -surfactant loss -compression -tumor

Nursing intereventions for patients with respiratory complications or obstruction

-offer resting period and lots of time for ADLs -talking down -pursed lip breathing -postural drainage with percussion(with cupped hand) -promote good nutrition (high protein and calorie, low carb)

Types of breathing observed:

-pursed lip -diaphragmatic breathing -orthopnea position -tri-pod position

Arterial puncture sites

-radial -femoral -brachial

H1N1: Swine flu -S/S

-runny nose -sore throat -eye irritation -nausea

Ineffective airway clearance interventions

-semi or high fowlers -frequent position changes -chest physiotherapy -hydration and humidification -suction secretions -encourage ambulation -IS and deep breathing and coughing -neb treatments

What kind of growth and development can you expect with 12-20 year olds?

-sweat glands active -acne can be a problem -females prone to dieting (anorexia) -increase need for protein and calcium -increase sleep

Meds for COPD

-tritropium(Spiriva) -azithromycin(Zithromax) -roflumilast(Daliresp) -ipratropium&albuterol (Combivent Respimat) -oxygen therapy

Indications for needing a tracheostomy

-upper airway obstruction -edema -copious secretions -need for long term ventilator -need for reconstruction after laryngeal trauma/cancer surgery

When does menarche occur? (first menustration)

2.5 years after puberty

ABG PaCO2 range

35-45

What is the range of oxygen flow (in liters) when using a partial rebreather mask?

6-10L/min keep reservoir bag inflated 2/3rds full during inspiration

How many liters of O2 do you want to cut off with a nasal cannula?

6L

What is the minimum flow of oxygen (in liters) with a simple face mask to be able to flush out all the CO2?

6L this mask if short term use

ABG pH ranges

7.35-7.45

ABG PaO2 normal range

80-100 >hyperoxia <hypoxia

The nurse is preparing the patient for a diagnostic procedure to remove pleural fluid for analysis. The nurse would prepare the patient for which test? A. thoracentesis B. bronchoscopy C. pulmonary angiography D. sputum culture and sensitivity

A

To promote the release of surfactant, the nurse encourages the patient to: A. Take deep breaths B. Cough 5 times per hour to prevent alveolar collapse C. Decrease fluid intake to reduce fluid accumulation in the alveoli D. Sit with the head of the bed elevated to promote air movement through the pores of Kohn

A

When assessing activity-exercise patterns related to respiratory health, the nurse inquires about: A. dyspnea during rest or exercise B. recent weight loss or weight gain C. ability to sleep through the entire night D. willingness to wear O2 equipment in public

A

When teaching a patient about the most important respiratory defense mechanism distal to the respiratory bronchioles, which topic would the nurse discuss? A. Alveolar macrophages B. Impaction of particles C. Reflex bronchoconstriction D. Mucociliary clearance mechanism

A

Scarlet Fever -S/S -treatment

A bacterial illness that develops in some people who has strep throat and is most common in children 5-15 years of age S/S: red rash and red lines in folds of skin, flushed face and strawberry tongue texture More severe S/S: fever over 101, sore throat, difficultly swallowing, enlarged glands, nausea/vomiting, headache Treament: supportive care(fluids, humidified air, lozenges), penicillin, analgesics for fever and discomfort

A nurse is providing health promotion teaching to the parents of a toddler. Which of the following conditions should the nurse identify as the leading cause of death among this age group? A. Congenital anomalies B. Heart disease C. Cancer D. Accidents

D. Accidents

B2 adrenergic agonists -SABA -LABA

SABA: Short acting inhaled B2 Adrenergic agonists (albuterol) LABA: Long acting inhaled B2 adrenergic agonists (salmetrol)

A patient with a gunshot wound to the right side of the chest arrives in the emergency department exhibiting severe shortness of breath with decreased breath sounds on the right side of the chest. Which action should the nurse take immediately? A. Cover the chest wound with a nonporous dressing taped on three sides. B. Pack the chest wound with sterile saline soaked gauze and tape securely. C. Stabilize the chest wall with tape and initiate positive pressure ventilation. D. Apply a pressure dressing over the wound to prevent excessive loss of blood.

A. Cover the chest wound with a nonporous dressing taped on three sides

A school nurse is providing information to high school students about influenza prevention. What should the nurse emphasize in teaching to prevent the transmission of the virus (select all that apply.)? Select all that apply. A. Cover the nose when coughing. B. Obtain an influenza vaccination. C. Stay at home when symptomatic. D. Drink noncaffeinated fluids daily. E. Obtain antibiotic therapy promptly.

A. Cover the nose when coughing B. Obtain an influenza vaccination C. Stay at home when symptomatic

When assessing a patient's sleep-rest pattern related to respiratory health, what should the nurse ask the patient (select all that apply)? A. Do you awaken abruptly during the night B. Do you sleep more than 8 hours per night C. Do you need to sleep with the head elevated D. Do you often need to urinate during the night E. Do you toss and turn when trying to fall asleep

A. Do you awaken abruptly during the night C. Do you need to sleep with the head elevated E. Do you toss and turn when trying to fall asleep

A nurse is told that an assigned client will have a fenestrated tracheostomy tube inserted. The nurse prepares the client for the procedure knowing that this type of tube: A. Enables the client to speak B. Prevents the client from speaking C. Is necessary for mechanical ventilation D. Prevents air from being inhaled through the trach opening

A. Enables the client to speak

What is a leaf-like structure which prevents the entry of food into the respiratory tract? A. Epiglottis B. Larynx C. Pharynx D. Tongue

A. Epiglottis

What should the nurse inspect when assessing a patient with shortness of breath for evidence of long-standing hypoxemia? A. Fingernails B. Chest excursion C. Spinal curvatures D. Respiratory pattern

A. Fingernails

A nurse is caring for a 3-year-old client whose parents report that she has an intense fear of painful procedures, such as injections. Which of the following strategies should the nurse add to the child's plan of care? A. Have a parent stay with the child during procedures B. Cluster invasive procedures whenever possible C. Perform the procedure as quickly as possible D. Allow the child to keep a toy from home with her E. Use mummy restraints during painful procedures

A. Have a parent stay with the child during procedures C. Perform the procedure as quickly as possible D. Allow the child to keep a toy from home with her

The nurse is scheduled to administer seasonal influenza vaccinations to the residents of a long-term care facility. What would be a contraindication to the administration of the vaccine to a resident? A. Hypersensitivity to eggs B. Age older than 80 years C. History of upper respiratory infections D. Chronic obstructive pulmonary disease (COPD)

A. Hypersensitivity to eggs

Upon pt. assessment the nurse notes a weak cough effort and rattling sounding breathing sounds bilaterally. Which nursing diagnosis is most appropriate? A. Ineffective airway clearance B. Impaired gas exchange C. Ineffective breathing pattern D. Self care deficit related to pulmonary hygiene

A. Ineffective airway clearance

The nurse is caring for a patient with an alteration in airway clearance. What nursing actions would be a priority to promote airway clearance (select all that apply.)? A. Maintain adequate fluid intake. B. Maintain a 30-degree elevation. C. Splint the chest when coughing. D. Maintain a semi-Fowler's position. E. Instruct patient to cough at end of exhalation.

A. Maintain adequate fluid intake C. Splint the chest when coughing E. Instruct patient to cough at end of exhalation

A patient with recurrent shortness of breath has just had a bronchoscopy. What is a priority nursing action immediately after the procedure? A. Monitor the patient for laryngeal edema. B. Assess the patient's level of consciousness. C. Monitor and manage the patient's level of pain. D. Assess the patient's heart rate and blood pressure.

A. Monitor the patient for laryngeal edema

The nurse observed three toddlers playing side by side with dolls. Closer observation revealed that the children were not interacting with one another. What type of play is this? A. Parallel B. Solitary C. Associative D. Cooperative

A. Parallel

The patient's arterial blood gas results show the PaO2 at 65 mmHg and SaO2 at 80%. What early manifestations should the nurse expect to observe in this patient? A. Restlessness, tachypnea, tachycardia, and diaphoresis B. Unexplained confusion, dyspnea at rest, hypotension, and diaphoresis C. Combativeness, retractions with breathing, cyanosis, and decreased output D. Coma, accessory muscle use, cool and clammy skin, and unexplained fatigue

A. Restlessness, tachypnea, tachycardia, and diaphoresis

A nurse is preparing a 7 year old child for a tonsillectomy. Which of the following nursing actions would be appropriate in this preparation? A. Schedule child for pre op visit to the hospital B. Ask the child if he has had a previous experience with the hospitalization C. Read the child a story about a cartoon character having a similar operation D. Tell the child the appointment is to have his throat checked

A. Schedule the child for a pre op visit to the hospital

The nurse observes clear nasal drainage in a patient newly admitted with facial trauma with a nasal fracture. What is the nurse's priority action? A. Test the drainage for the presence of glucose. B. Suction the nose to maintain airway clearance. C. Document the findings and continue monitoring. D. Apply a drip pad and reassure the patient this is normal.

A. Test the drainage for the presence of glucose

Why would a child with cystic fibrosis receive postural drainage? A. To loosen secretions from the lungs and remove them from the airways B. To impair the exchange of gases through the alveolar-capillary C. To weaken the chest muscles D. To increase perfusion to the brain

A. To loosen secretions from the lungs and remove them from the airways

After admitting a patient from home to the medical unit with a diagnosis of pneumonia, which physician orders will the nurse verify have been completed before administering a dose of cefuroxime to the patient? A. Orthostatic blood pressures B. Sputum culture and sensitivity C. Pulmonary function evaluation D. Serum laboratory studies ordered for AM

B

The nurse instructs a patient with a pulmonary embolism about administering enoxaparin after discharge. Which statement by the patient indicates understanding about the instructions? A. "I need to take this medicine with meals." B. "The medicine will be prescribed for 10 days." C. "I will inject this medicine into my upper arm." D. "The medicine will dissolve the clot in my lung."

B

The nurse is developing a plan of care for a patient with metastatic lung cancer and a 60-pack-year history of cigarette smoking. For what should the nurse monitor this patient? A. Cough reflex B. Mucociliary clearance C. Reflex bronchoconstriction D. Ability to filter particles from the air

B

To detect early signs or symptoms of inadequate oxygenation, the nurse would examine the patient for: a. dyspnea and hypotension b. apprehension and restlessness c. cyanosis and cool, clammy skin d. increased urine output and diaphoresis

B

Which of the following is most likely to increase the respiratory rate? A. an increase in blood volume B. an increase in blood co2 C. an increase in the concentration of bilirubin D. an increase in plasma calcium

B. An increase in blood co2

The nurse in the occupational health clinic prepares to administer the influenza vaccine by nasal spray to an employee. Which question should the nurse ask before administration of this vaccine? A. "Are you allergic to chicken?" B. "Could you be pregnant now?" C. "Did you ever have influenza?" D. "Have you ever had hepatitis B?"

B. Could you be pregnant now

The nurse is assessing the parents' understanding of immunizing their child who has cystic fibrosis. The nurse knows the teaching has been effective if the parents state which of the following? A. "The immunization schedule for my child should be delayed" B. "My child should receive an annual influenza vaccination" C. "My child should not receive any immunizations" D. "The immunization schedule should include everything but the polio vaccine."

B. My child should receive an annual influenza vaccination

After assisting at the bedside with a thoracentesis, the nurse should continue to assess the patient for signs and symptoms of what? A. Bronchospasm B. Pneumothorax C. Pulmonary edema D. Respiratory acidosis

B. Pneumothorax

A patient has a tracheostomy tube after reconstructive surgery for invasive head and neck cancer. What is most important for the nurse to assess before performing tracheostomy cannula care? A.Level of consciousness B.Quality of breath sounds C.Presence of the gag reflex D.Tracheostomy cuff pressure

B. Quality of breath sounds

A nurse is caring for a preschooler. Which of the following is an expected behavior of a preschool aged child? A. Describing manifestations of illness B. Relating fears to magical thinking C. Understanding cause of illness D. Awareness of body function

B. Relating fears to magical thinking

Which of the following is true about the bronchi? A. The bronchi play an important role in both the respiratory and digestive systems B. Small objects are more easily aspirated into the right bronchus because it is shorter, wider, and more vertical than the left bronchus C. The walls of the bronchi are identical in the composition to the alveoli D. The right bronchus is longer, narrower, and more horizontal than is the left bronchus

B. Small objects are more easily aspirated into the right bronchus because it is shorter, wider, and more vertical than the left bronchus

Which task can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) in the care of a stable patient who has a tracheostomy? A.Assessing the need for suctioning B.Suctioning the patient's oropharynx C.Assessing the patient's swallowing ability D.Maintaining appropriate cuff inflation pressure

B. Suctioning the patient's oropharynx

In assessment of the patient with acute respiratory distress, what should the nurse expect to observe (select all that apply.)? A. Cyanosis B. Tripod position C. Kussmaul respirations D. Accessory muscle use E. Increased AP diameter

B. Tripod D. Accessory muscle use

The nurse is caring for a patient who had abdominal surgery yesterday. Today the patient's lung sounds in the lower lobes are diminished. The nurse knows this could be related to the occurrence of A. pain. B. atelectasis. C. pneumonia. D. pleural effusion.

B. atelectasis

Bronchodilator respiratory medications

B2 Adrenergic agonists Methylxanthines Muscarinic antagonists Combination agents

The nurse is caring for a patient with unilateral malignant lung disease. What is the priority nursing action to enhance oxygenation in this patient? A. Positioning patient on right side B. Maintaining adequate fluid intake C. Positioning patient with "good lung" down D. Performing postural drainage every 4 hours

C

While ambulating a patient with metastatic lung cancer, the nurse observes a drop in oxygen saturation from 93% to 86%. Which nursing action is most appropriate? A. Continue with ambulation. B. Obtain a physician's order for arterial blood gas. C. Obtain a physician's order for supplemental oxygen. D. Move the oximetry probe from the finger to the earlobe.

C

During the respiratory assessment of an older adult, the nurse would expect to find (select all that apply): A. a vigorous reflex cough B. increased chest expansion C. increased residual volume D. diminished lung sounds at base of lungs E. increased anteroposterior (AP) chest diameter

C, D, E

The nurse is interpreting a tuberculin skin test (TST) for a 58-yr-old female patient with end-stage renal disease secondary to diabetes mellitus. Which finding would indicate a positive reaction? A. Acid-fast bacilli cultured at the injection site B. 15-mm area of redness at the TST injection site C. 11-mm area of induration at the TST injection site D. Wheal formed immediately after intradermal injection

C. 11-mm area of induration at the TST injection site

Which patient is exhibiting an early clinical manifestation of hypoxemia? A. A 48-yr-old patient who is intoxicated and acutely disoriented to time and place B. A 67-yr-old patient who has dyspnea while resting in the bed or in a reclining chair C. A 72-yr-old patient who has four new premature ventricular contractions per minute D. A 94-yr-old patient who has renal insufficiency, anemia, and decreased urine output

C. A 72-year-old patient who has four new premature ventricular contractions per minute

The patient is hospitalized with pneumonia. Which diagnostic test should be used to measure the efficiency of gas exchange in the lung and tissue oxygenation? A. Thoracentesis B. Bronchoscopy C. Arterial blood gases D. Pulmonary function tests

C. Arterial blood gases

A nurse is caring for a child with cystic fibrosis. The nurse is aware that the cause of cystic fibrosis is which of the following? A. Development of meconium ileus soon after birth B. Malabsorption of fats and proteins C. Both parents are carriers of a mutation for cystic fibrosis D. Frequent infections early in life

C. Both parents are carriers of a mutation of cystic fibrosis

The nurse, when auscultating the lower lungs of the patient, hears these breath sounds. How should the nurse document these sounds? A. Stridor B. Vesicular C. Coarse crackles D. Bronchovesicular

C. Coarse crackles

A patient with a history of tonsillitis reports difficulty breathing. Which patient assessment data warrants emergency interventions by the nurse? A. Bilateral erythema of especially large tonsils B. Temperature 102.2°F, diaphoresis, and chills C. Contraction of neck muscles during inspiration D. β-hemolytic streptococcus in the throat culture

C. Contraction of neck muscles during inspiration

The patient is calling the clinic with a cough. What assessment should be made first before the nurse advises the patient? A. Frequency, family history, hematemesis B. Weight loss, activity tolerance, orthopnea C. Cough sound, sputum production, pattern D. Smoking status, medications, residence location

C. Cough sound, sputum production, pattern

A nurse is planning care for a child that is admitted with mumps. Which of the following is an appropriate action for the nurse to make? A. Standard precautions B. Airborne C. Droplet D. Contact

C. Droplet

When assessing a 13-year-old boy, the nurse would keep in mind physical changes in the pubertal male, beginning with: A. Development of axillary and facial hair B. Enlargement of pectoral muscles C. Enlargement of testicles D. Voice changes

C. Enlargement of testicles

A client reports to the nurse that after using an albuterol inhaler several times a day, the client's respiratory symptoms appear to worsen. The nurse understands which of the following? A. The client is not administering the medication properly B. The client should be using the albuterol inhaler more frequently C. The albuterol should be held and the provider should be notified D. The client should lie down and rest

C. The albuterol should be held and the provider should be notified

During the assessment in the emergency department, the nurse is palpating the patient's chest. Which finding is a medical emergency? A. Increased tactile fremitus B. Diminished chest movement C. Tracheal deviation to the left D. Decreased anteroposterior (AP) diameter

C. Tracheal deviation to the left

Which transport mechanism causes the respiratory gases (oxygen and co2) to move across the pulmonary alveolar-capillary membrane? A. filtration B. osmosis C. diffusion D. active transport pump

C. diffusion

Which structure prevents food from entering the respiratory passages? A. glottis B. eustachian tubes C. epiglottis D. thyroid cartilage

C. epiglottis

Which ethnicity has the highest incidence of having cystic fibrosis?

Caucasians 1 in 3000

Epstein-Barr virus (EBV) or Mononucleosis -cause -S/S -Treatment

Cause: Epstein-Barr virus; very contagious several months/weeks after first infected S/S: fatigue, sore throat, fever, swollen lymph nodes in neck and armpit, swollen tonsils, headache, rash, swollen spleen Treatment: bedrest, nutrition, fluids, analgesics, treatment of secondary infections, decreased physical activity *standard precautions

Pertussis or Whooping cough -cause -S/S -treatment

Cause: bordetella pertussis bacteria S/S: common cold symptoms, violent and rapid coughing with whooping sound Treatment: antibiotics, cool mist tents, monitor O2 and administer supportive O2, fluids and nutrition *droplet precautions

Fifth's Disease (Erythema Infectiosum) or parvovirus -cause -contagious -S/S -Treatment

Cause: human parovirus B19 Contagious: week before rash appears S/S: fever, headache, runny nose, upset stomach Treatment: rest, fluids, analgesics *droplet precautions

Hand, Foot, and Mouth Disease (HFMD) -cause -S/S -treatment

Cause: infection with coxsackievireus 16 (first isolated in human feces) Contagious: during first week but may continue for weeks or until symptoms go away S/S: fever, malaise, poor appetite, rash, small blisters that ulcerate on palms of hands, soles of feet, mouth Treatment: resolves in approx. 10 days Prevention: hand washing!! avoid direct contact with infected child *standard precautions

What are examples of combination agents and what are they used for?

Combine a preventer with a symptom controller in the same delivery device. (research shows fewer attack than those on 2 separate inhalers) -ipratropium/albuterol (Combivent, Duoneb) -fluticasone/salmeterol (Advair) -budesonide/formoterol (Symbicort) -mometasone/formoterol (Dulera) -fluticasone/vilanerol (Breo Ellipta)

A patient with a respiratory condition asks "How does air get into my lungs?". The nurse bases her answer on knowledge that air moves into the lungs because of A. increase CO2 and decreased O2 in the blood B. Contraction of the accessory abdominal muscles C. Stimulation of the respiratory muscles by the chemoreceptors D. Decrease in intrathoracic pressure relative to pressure at the airway

D

A patient with idiopathic pulmonary fibrosis had bilateral lung transplantation and is now experiencing exertional dyspnea, nonproductive cough, and wheezing. What does the nurse determine is most likely occurring in this patient? A. Pulmonary infarction B. Pulmonary hypertension C. Cytomegalovirus (CMV) D. Bronchiolitis obliterans (BOS)

D

The nurse teaches a patient with hypertension and osteoarthritis about actions to prevent and control epistaxis. Which statement, if made by the patient, indicates further teaching is required? A. "I should avoid using ibuprofen for pain and discomfort." B. "It is important for me to take my blood pressure medication every day." C. "I will sit down and pinch the tip of my nose for at least 10 to 15 minutes." D. "If I get a nosebleed, I will lie down flat and raise my feet above my heart."

D

The patient had video-assisted thoracic surgery (VATS) to perform a lobectomy. What does the nurse know is the reason for using this type of surgery? A.The patient has lung cancer. B.The incision will be medial sternal or lateral. C.Chest tubes will not be needed postoperatively. D.Less discomfort and faster return to normal activity

D

A patient with COPD has a nursing diagnosis of impaired breathing pattern related to anxiety. Which nursing action is most appropriate to include in the plan of care? A. Titrate oxygen to keep saturation at least 90%. B. Discuss a high-protein, high-calorie diet with the patient. C. Suggest the use of over-the-counter sedative medications. D. Teach the patient how to effectively use pursed lip breathing.

D. Teach patient how to effectively use pursed lip breathing

The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful? A. The patient inhales rapidly through the peak flow meter mouthpiece. B. The patient takes montelukast (Singulair) for peak flows in the red zone. C. The patient calls the health care provider when the peak flow is in the green zone. D. The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone.

D. The patient uses albuterol metered dose inhaler for peak flows in the yellow zone

The patient has decided to use the voice rehabilitation that offers the best speech quality even though it must be cleaned regularly. The nurse knows that this is what kind of voice rehabilitation? A. Electromyography B. Intraoral electrolarynx C. Neck type electrolarynx D. Transesophageal puncture

D. Transesophageal

The nurse is caring for a hospitalized infant with a dx of bronchiolitis positions the infant: A. In supine, side lying position B. Prone with HOB 15 degrees C. Head of bed at 60 degree angle with slightly flexed D. With the head and chest at 30 degree angle with neck slightly extended

D. With the head and chest at 30 degree angle with neck slightly extended

What is the name of the substance secreted by cells of the alveoli that decreases surface tension? A. amylase B. serous fluid C. buffers D. surfactant

D. surfactant

As you get older, what kinds of effects are you going to have on your respiratory system?

Decreased number of functional alveoli and loss elasticity= less area for gases to be exchanged across compliance of the chest wall decreases (takes more effort to breathe in and out) resp muscles strength decreases Decreased pulmonary perfusion Decreased response to hypoexemia and hypercapnia Risk for pulmonary infection (lewis pg. 459)

What is droplet precautions, what do you use for it and what are examples of infections where this is necessary?

Droplets can travel 3 ft and are not suspended in air for a long time Use: -standard precautions -private room if available -mask must be worn if working within 3 ft of client and when entering room -mask client during transport Examples: -influenza -streptococcal -pertussis -mumps, rubella

Two developmental theories

Eriksons Piagets

What kinds of sounds does a stridor make?

High pitched sounds produced when air passes through a partially obstructed or narrowed upper airway on inspiration

Epiglottitis -S/S

Infection and inflammation of epigottis cause my influenza B and then streptococcus pneumoniae -acute high fever -sore inflammed throat -muffled voice -dysphagia -drooling -hypoxia/hypercarbia -respiratory distress

Otitis Media -S/S

Infection of middle ear -fever, ear pain; irritability -pulling on ear -loss of appetite -purulent ear drainage -red, opaque, bulging tympanic membrane

What is acute bronchitis?

Inflammation of major bronchi, swelling and mucus

What is pneumonia?

Inflammation of the lung tissue (interstitial spaces, alveoli and bronchioles) with consolidation

What cells attach to the receptor sites in the bronchioles which makes the smooth muscle swell and become inflamed?

Leukotrienes

Trachea-innominate artery fistula

Malpositioned tube causes distal tip to push against lateral wall which eventually erodes the innominate (brachiocephalic) artery. MEDICAL EMERGENCY

What is the Peak Expiratory Flow Rate (PEFR)? What are the values?

Measures how well air moves out of the lungs Green Zone: 80-100% Yellow Zone: 50-80% Red Zone: <50%

What can Benadryl cause in children?

Over excite them (bad dreams)

What is airborne precautions, what do you use for it, and what are examples of infections where this is necessary?

Protect from infection transmitted by aerosolization Use: -standard precautions -private negative airflow room -mask and gown when entering room if suspected TB -mask client during transport Examples: -measles (rubeola) -varicella-zoster -TB (tuberculosis) -MRSA pneumonia

Hep B -S/S -Nursing Interventions

S/S: fever, anorexia, jaundice Nursing Interventions: hep B vaccine, identify high-risk mothers and newborns, administer antiviral medication, bedrest, reduced activity *standard precautions

Chickenpox or varicella -S/S -treatment

S/S: fever, loss of appetite, headache, malaise Treatment: analgesics and antihistamine to relieve itching, antiviral medications for high risk patients *airborne

Hep A -S/S -Nursing interventions

S/S: fever, nausea, anorexia, diarrhea, abdominal pain, malaise, dark urine, jaundice Interventions: hep A vaccine, cook foods and drinks for at lease 1 min to 185 F, proper hand hygiene *standard and contact isolation

Measles "Rubeola" -S/S -treatment

S/S: mild to moderate fever, cough, runny nose, red eyes, sore throat, sensitivity to light Treament: analgesics for fever, fluids and rest, measures to decrease eye strain, antibiotics if bacterial infection develops

A health care professional is talking to a patient who is prescribed albuterol via inhaler and fluticasone (Advair) via inhaler for asthma management. The health care professional should tell the patient to use the albuterol inhaler before using the fluticasone inhaler for which of the following reasons? a. albuterol will increase the absorption of fluticasone b. albuterol will decrease inflammation c. albuterol will reduce nasal secretions d. fluticasone will reduce the adverse effects of albuterol

a. albuterol will increase the absorption of fluticasone

When advising a patient about taking prednisone for chronic asthma, a health care professional should include which of the following information? a. avoid taking NSAIDs b. rinse your mouth after taking the drug to prevent a yeast infection c. stop taking the drug if you become nauseated d. change position slowly when standing up

a. avoid taking NSAIDs

For which of the following reasons should a patient attach a spacer to a metered-dose inhaler? a. to increase the amount of drug delivered to the lungs b. to increased the amount of drug delivered to the oropharynx c. to increase the amount of drug delivered on exhalation d. to increase the speed of drug delivery

a. to increase the amount of drug delivered to the lungs

Respiratory Syncytial Virus (RSV) -treatment

airways are small and prone to obstruction by the thick mucus produced -contact precautions -adequate fluids -ribavirin (Virazole) -palivizumab (synagis)

A health care professional who is advising a patient about the use of an expectorant to treat a cough should explain that this type of drug is effective because it performs which of the following actions? a. suppresses the cough stimulus b. reduces surface tension c. reduces inflammation d. dries mucous membranes

b. reduces surface tension

A health care professional is caring for a patient who is taking ipratropium (Atrovent). The health care professional should explain which of the following adverse effects to the patient? (Select all that apply.) a. muscle tremors b. urinary retention c. dry mouth d. insomnia e. tachycardia

b. urinary retention c. dry mouth

When explaining how a patient should use ipratropium (Atrovent), a health care professional should include which of the following instructions? a. do not drink anything for 30 min after using the drug b. wait 5 min between using the drug and another inhaled drug c. use the drug to abort acute bronchoconstriction d. check pulse rate after inhaling the drug

b. wait 5 min between using the drug and another inhaled drug

A health care professional is caring for a patient who is having difficulty mobilizing thick respiratory secretions. Which of the following drugs should the health professional expect to administer? a. Ipratropium b. beclomethasone c. acetylcysteine d. azelastine

c. acetylcysteine

A health care professional who is advising a patient about using intranasal glucocorticoids should include which of the following instructions? a. starts at a low dose and gradually increase it b. take the drug as needed for nasal congestion c. allow at least 2 weeks for the full therapeutic effect d. use the drug prior to exercise

c. allow at least 2 weeks for the full therapeutic effect

A health care professional is advising a patient about the use of beclomethasone to treat asthma. The health care professional should explain that the drug treats asthma because it performs which of the following actions? a. thins mucus b. relaxes bronchial smooth muscle c. decreases inflammation d. increases the cough threshold

c. decreases inflammation Rational: Beclomethasone, an intranasal glucocorticoid, treats asthma by reducing inflammation

A health care professional is advising a patient about the use of cromolyn sodium. Which of the following instructions should the health care professional instruction should the health care professional include? a. report signs of jaundice b. anticipate difficulty sleeping c. expect a bitter aftertaste d. increase calcium and vitamin D intake

c. expect a bitter aftertaste

A health care professional who is advising a patient about the use of antihistamines to treat allergic rhinitis should explain that these drugs are effective because they perform which of the following actions? a. decreases viscosity of nasal secretions b. Blocks H2 receptors c. prevents histamine from binding to receptors d. reduces nasal congestion

c. prevents histamine from binding to receptors

A health care professional is caring for a patient who is taking codeine. Which of the following is the most important assessment following administration of the drug? a. blood pressure b. apical heart rate c. respirations d. level of consciousness

c. respirations

What kind of sounds would you hear with a pleural friction rub?

continiuous scratching/grating sound during inspiration and expiration. Often associated with pleurisy

A health care professional should recognize that using pseudoephedrine to treat allergic rhinitis requires cautious use with patients who have which of the following? a. peptic ulcer disease b. a seizure disorder c. anemia d. coronary artery disease

d. coronary artery disease

When advising a patient about using zileuton, a health care professional should include which of the following instructions? a. check the apical pulse before taking the drug b. take the drug prior to exercising c. rinse the mouth after using the drug d. have laboratory tests performed at regular intervals

d. have laboratory tests performed at regular intervals

Which of the following should a health care professional include when advising a patient about the use of montelukast? a. use a spacer to improve inhalation b. take the drug at the onset of bronchospasm c. rinse the mouth to prevent an oral fungal infection d. take the drug once a day in the evening

d. take the drug once a day in the evening

laryngotracheobronchitis (LTB): Croup -S/S

inflammation of the larynx, trachea, and bronchi -low grade fever -brassy, barking cough -hoarseness -inspiratory STRIDOR -fear; restlessness -tachycardia/tachypnea -anxiety and diaphoresis

What is sinusitis? -S/S

inflammation of the sinuses develops when inflammation or hypertrophy of mucosa narrows or blocks the openings (ostia) in the sinuses through which mucus drains into the nose -S/S: pain over sinuses, edematous mucosa, purulent nasal drainage, tenderness(face, teeth)

How you control a nosebleed?

keep patient quiet, sit upright, pinch soft lower portion of nose