Respiratory LvL 1 - 7

Which task may be safely delegated to a licensed practical nurse (LPN)? Changing the dressing of a client who underwent surgery 2 days ago (x) Admitting a client who underwent a thoracotomy to the nursing unit from the post- anesthesia care unit Administering an I.V. bolus dose of morphine sulfate to a client experiencing incisional pain Teaching a client newly diagnosed with diabetes mellitus about insulin administration When teaching a client with chronic obstructive pulmonary disease to conserve energy, the nurse should teach the client to lift objects: while taking a deep breath and holding it. while exhaling through pursed lips. (x) after exhaling but before inhaling. while inhaling through an open mouth. The client is taking triamcinolone acetonide inhalant to treat bronchial asthma. The nurse should assess the client for: oral candidiasis. (x) fluid retention. gastric ulcer. hyperglycemia. A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder? Metabolic alkalosis Respiratory acidosis Metabolic acidosis (x) Respiratory alkalosis A client has a positive reaction to the Mantoux test. The nurse interprets this reaction to mean that the client has: developed a resistance to tubercle bacilli. developed passive immunity to tuberculosis. been exposed to Mycobacterium tuberculosis. (x) active tuberculosis.

LvL 1 - 2

Which of the following would provide the nurse with the most valuable information to assess the breathing of a client with chronic obstructive pulmonary disease (COPD)? Select all that apply. Auscultation and percussion (x) Palpation of peripheral pulses Exertional effects on breathing (x) Inspection and palpation for vibrations (x) Inspection for pursed-lip breathing technique (x) A client with suspected inhalation anthrax is admitted to the emergency department. Which action by the nurse takes the highest priority? Monitor vital signs and oxygen saturation every 15 to 30 minutes. (x) Suction the client as needed to obtain a sputum specimen for culture and sensitivity. Assess intake and output and maintain adequate hydration. Reassure the client that intubation and mechanical ventilation will be temporary. A nurse prepares to perform postural drainage. How should the nurse ascertain the best position to facilitate clearing the lungs? Inspection Chest X-ray Arterial blood gas (ABG) levels Auscultation (x) The client is to receive theophylline 500 mg IV in 500 mL of normal saline solution to run over 4 hours. The tubing delivers 60 gtt/mL. The nurse should set the infusion pump to administer the solution at how many milliliters per hour? Record your answer using a whole number. ans: 125 mL/h (x) Which is a priority goal for the client with chronic obstructive pulmonary disease (COPD)? maintaining functional ability (x) minimizing chest pain increasing carbon dioxide levels in the blood treating infectious agents

LvL 2 - 3

A client with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid-base balance? Excreting bicarbonate in the urine Returning bicarbonate to the body's circulation (x) Returning acid to the body's circulation Sequestering free hydrogen ions in the nephrons As status asthmaticus worsens, the nurse would expect which acid-base imbalance? Metabolic alkalosis Respiratory alkalosis Metabolic acidosis Respiratory acidosis (x) The nurse is developing a care plan for a client with tuberculosis. Which of the following measures would be implemented for staff prior to entering the room? Wear a mask, gown, and gloves when providing care. Prevent visitors from visiting to reduce the possibility of transmission. Wear a mask at all times when entering the room. Wear a gown and gloves when in contact with the client. The nurse is aware that the best position for a client with impaired gas exchange is what? Sims Side-lying Semi-Fowler's High Fowler's (x) The nurse is making rounds and observes the client who had a tracheostomy tube inserted 2 days ago (see figure). The nursing policy manual recommends use of the gauze pad. The nurse should: reposition the gauze pad around the stoma with the open end downward. make sure the gauze pad is dry and the client is in a comfortable position. (x) ask a registered nurse (RN) to change the ties and position another gauze pad around the stoma. ask the unlicensed assistive personnel (UAP) to tie the tracheostomy tube ties in the back of the client's neck. A client with acute bronchitis is admitted to the health care facility and is receiving supplemental oxygen via nasal cannula. When monitoring this client, the nurse suddenly hears a high-pitched whistling sound. What is the most likely cause of this sound? The client has a nasal obstruction. The oxygen concentration is above 44%. The oxygen tubing is pinched. (x) The water level in the humidifier reservoir is too low. After a client has had a bronchoscopy under local anesthesia, the nurse should: observe the abdomen for signs of distention and board-like rigidity. offer 200 ml of oral fluids every hour to liquefy lung secretions. restrict oral intake until the gag reflex returns. (x) irrigate the nasogastric (NG) tube with 30 ml of normal saline every 2 hours To more easily remove thick, tenacious secretions when suctioning a tracheostomy, the nurse should liquefy the secretions before suctioning by instilling the tracheostomy tube with 1 to 2 mL of sterile: water. bacteriostatic water. Normal saline normal saline solution. (x) a solution of 5% dextrose in water. The nurse is caring for a client with bacterial pneumonia. The effectiveness of the client's oxygen therapy can be best determined by the: client's level of consciousness. absence of cyanosis. client's respiratory rate. arterial blood gas values. (x) A nurse is teaching a client with chronic obstructive pulmonary disease (COPD) who is being discharged after treatment for an acute exacerbation. Which statement by the client indicates proper understanding of the discharge instructions? "I should take my bronchodilator at bedtime to prevent insomnia." "I should do my most difficult activities when I first get up in the morning." "I should try to eat several small meals during the day." (x) "I should plan to do most of my exercises after I eat."

LvL 4 - 5

After nasal surgery, the client expresses concern about how to decrease facial pain and swelling while recovering at home. Which instruction would be most effective for decreasing pain and edema? Use a bedside humidifier while sleeping. Use corticosteroid nasal spray as needed to control symptoms. Apply cold compresses to the area. (x) Take analgesics every 4 hours around the clock. Bed rest is prescribed for a client with pneumonia during the acute phase of the illness. The nurse should determine the effectiveness of bed rest by assessing the client's: reduced episodes of coughing. decreased cellular demand for oxygen. (x) diminished pain when breathing deeply. ability to expectorate secretions more easily. explain: Exudate in the alveoli interferes with ventilation and the diffusion of gases in clients with pneumonia. During the acute phase of the illness, it is essential to reduce the body's need for oxygen at the cellular level; bed rest is the most effective method for doing so. Bed rest does not decrease coughing or promote clearance of secretions, and it does not reduce pain when taking deep breaths. Sucking chest wound: explain: The first course of action for a client with a sucking chest wound is to stop air from entering the chest cavity. Air entry will cause the lung to collapse. Stopping air entry is best done in an emergency situation by applying an air-occlusive dressing over the wound. A client has a tracheostomy but doesn't require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for: 5 to 20 minutes. (x) 30 to 40 minutes. 15 to 60 seconds. 1 to 2.5 minutes. explain: Initially, the nurse should plug the opening in the tracheostomy tube for 5 to 20 minutes, then gradually lengthen this interval according to the client's respiratory status. A client who doesn't require continuous mechanical ventilation already is breathing without assistance, at least for short periods; therefore, plugging the opening of the tube for only 15 to 60 seconds wouldn't be long enough to reveal the client's true tolerance to the procedure. Plugging the opening for more than 20 minutes would increase the risk of acute respiratory distress because the client requires an adjustment period to start breathing normally. Which information should the nurse include in a teaching plan for the client newly diagnosed with chronic obstructive pulmonary disease? Select all that apply: High humidity may increase your work of breathing. (x) Smoking cessation is important to slow or stop disease progression. (x) Pneumococcal vaccination is contraindicated for clients with lung disease. A bronchodilator with meter-dose inhaler should be readily available. (x) Pulmonary rehabilitation programs offer very little benefit. Which nursing action does not aid in meeting the goal of clear breath sounds? offering pain relief before having the client cough assisting with early ambulation. using an incentive spirometer providing a minimum of 1,000 mL of fluid per day (X) explain: should be > than 2500 mL per day. A nurse is providing discharge teaching for a client who had a laryngectomy. Which instruction should the nurse include in her teaching? "Swimming is good exercise as long as you don't go under water." "Cover the stoma with a loose plastic cloth whenever you shower or bathe." (x) "Cover the stoma with your hand to prevent anything from entering it." "Keep the humidity in your house low." A 6-year-old boy is admitted to a pediatric unit for the treatment of osteomyelitis. Which essential medication classification would the nurse anticipate as documented on the medication report? Antipyretic Anti-inflammatory Antibiotic (x) Analgesic The nurse is assessing the client (see photo) who has recently returned from a 2-month mission in Africa. What type of respiratory protection is appropriate for the staff? explain: Any type of blistering lesion, such as smallpox, requires extreme care to prevent exposure. Transmission-based precautions for smallpox includes airborne, droplet, and contact precautions. The N95 mask filters at least 95% of airborne particles. To prevent exposure through the respiratory tract, the N95 mask must be fitted and worn properly.

LvL 5 - 6

After receiving an oral dose of codeine for an intractable cough, a client asks the nurse, "How long will it take for this drug to work?" How should the nurse respond? 1 hour 30 minutes (x) 4 hours 2.5 hrs To promote effective airway clearance in a client with acute respiratory distress, what should the nurse do? Administer oxygen every 2 hours. Turn the client every 4 hours. Suction if cough is ineffective. (x) Administer sedatives to promote rest. The nurse should suction the client if the client is not able to cough up secretions and clear the airway. Administering oxygen will not promote airway clearance. The client should be turned every 2 hours to help move secretions; every 4 hours is not often enough. Administering sedatives is contraindicated in acute respiratory distress because sedatives can depress respirations. A client is admitted to a health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client? Activity intolerance related to shortness of breath Anxiety related to difficulty breathing Risk for infection related to retained secretions Impaired gas exchange related to airflow obstruction (x) A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? pH Bicarbonate (HCO3-) Partial pressure of arterial oxygen (PaO2) (x) Partial pressure of arterial carbon dioxide (PaCO2) During the insertion of a rigid scope for bronchoscopy, a client experiences a vasovagal response. The nurse should expect: the client's pupils to become dilated. the client to experience bronchodilation. a decrease in the client's gastric secretions. a drop in the client's heart rate. (x) What is an expected outcome for an adult client with well-controlled asthma? Chest X-ray demonstrates minimal hyperinflation. Temperature remains lower than 100° F (37.8° C). Arterial blood gas analysis demonstrates a decrease in PaO2. Breath sounds are clear. (x) A client with emphysema is at a greater risk for developing what acid-base imbalance? Chronic respiratory acidosis (x) Metabolic alkalosis Chronic metabolic acidosis Respiratory alkalosis The nurse should use which type of precautions for a client being admitted to the hospital with suspected tuberculosis? contact precautions hand hygeine airborne precautions (x) droplet precautions A client with bacterial pneumonia is to be started on IV antibiotics. Which diagnostic tests must be completed before antibiotic therapy begins? urinalysis sputum culture (x) chest radiograph red blood cell count To more easily remove thick, tenacious secretions when suctioning a tracheostomy, the nurse should liquefy the secretions before suctioning by instilling the tracheostomy tube with 1 to 2 mL of sterile: water. Normal saline normal saline solution. (x) bacteriostatic water. a solution of 5% dextrose in water. A Spanish-speaking client admitted with tuberculosis notes, through an interpreter, concerns about paying for needed medications. The nurse should: collaborate with the social worker to investigate possible availability of funds. contact the community's free clinic for medications. call the public health nurse to research free medications. coordinate with the pharmaceutical company for free samples. A chest tube drains blood, fluid, and air from around the lungs. The drainage system, which the nurse measures each shift, is on the right. It has three calibrated chambers that show the amount of drainage collected. When the first chamber fills, drainage empties into the second; when the second chamber fills, drainage flows into the third. The water seal chamber is located in the center. The suction control chamber is on the left: A nurse is caring for a client with a chest tube connected to a three-chamber drainage system without suction. On the illustration below, identify which chamber that the nurse will mark to record the current drainage level. To promote comfort and optimal respiratory expansion for a client with chronic obstructive pulmonary disease during sexual intimacy, the nurse can suggest that the couple: use pillows to raise the affected partner's head and upper torso. (x) limit the duration of the sexual activity. use a foam mattress. have the affected partner assume a dependent position. Which action should the nurse anticipate in a client who has been diagnosed with acute respiratory distress syndrome (ARDS)? mechanical ventilation (x) insertion of a chest tube use of a nasal cannula tracheostomy A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition? The client has a partial pressure of arterial carbon dioxide (PaCO2) value of 65 mm Hg or higher. The client exhibits bronchial breath sounds over the affected area. The client exhibits restlessness and confusion. The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. (x) explain: As the acute phase of bacterial pneumonia subsides, normal lung function returns and the PaO2 typically rises, reaching 85 to 100 mm Hg. A PaCO2 of 65 mm Hg or higher is above normal and indicates CO2 retention — common during the acute phase of pneumonia. Restlessness and confusion indicate hypoxia, not an improvement in the client's condition. Bronchial breath sounds over the affected area occur during the acute phase of pneumonia; later, the affected area should be clear on auscultation. The nurse understands that a client with acute respiratory distress related to asthma may experience: an exacerbation of goiter and low-pitched stridor. dyspnea, wheezing, and polycythemia. (x) nasophaygeal drainage with oxygen saturation of 95%. acute laryngotracheitis and itchy eyes. The nurse is caring for a group of clients on a pulmonary unit. The nurse can delegate which task to unlicensed assistive personnel (UAP)? Assisting a client with adjusting his or her nasal cannula (x) Making adjustments to flow rates based on client responses Monitoring a client for adverse effects of oxygen therapy Assessing a client for the best method of oxygen delivery Administer sedatives to promote rest.

lvL 1

A nurse notices that a client admitted for exacerbation of chronic obstructive pulmonary disease is short of breath. The client has signed an advance directive indicating that he doesn't want to be resuscitated. The nurse should: get the crash cart. call the physician. check the client's oxygen saturation. not provide any care. In which areas of the United States and Canada is the incidence of tuberculosis highest? inner-city areas rural farming areas suburban areas with significant industrial pollution areas where clean water standards are low A client with respiratory acidosis is admitted to the intensive care unit for close observation. The nurse should stay alert for which complication associated with respiratory acidosis? Stroke (not associated) Hyperglycemia (not associated) Seizures Shock (x) An elderly client admitted with pneumonia and dementia has attempted several times to pull out the IV and Foley catheter. After trying other options, the nurse obtains a prescription for bilateral soft wrist restraints. Which nursing action is most appropriate? Reevaluate the need for restraints and document weekly. Perform circulation checks to bilateral upper extremities each shift. Attach the ties of the restraints to the bedframe. Ensure the restraint prescription has been signed by the health care provider (HCP) within 72 hours.

LvL 6 - 7