Respiratory-Medsurge

The nurse has conducted discharge teaching with a client diagnosed with tuberculosis, who has been receiving medication for 1½ weeks. The nurse determines that the client has understood the information if the client makes which statement?

"I should not be contagious after 2 to 3 weeks of medication therapy."

A nurse has provided a client with tuberculosis (TB) instructions on proper handling and disposal of respiratory secretions. The nurse determines that the client demonstrates understanding of the instructions when the client makes which statement?

"I will discard used tissues in a plastic bag"

The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which finding would the nurse expect to note on assessment of this client? Select all that apply.

-A hyper-inflated chest noted on the chest x-ray -Decreased oxygen saturation with mild exercise

The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse include on the list? Select all that apply.

-Activities should be resumed gradually -A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. -Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags. -When one sputum culture is negative, the client is no longer considered infectious and usually can return to former employment

A nurse is caring for a client diagnosed with tuberculosis (TB). Which assessments, if made by the nurse, are consistent with the usual clinical presentation of TB? Select all that apply.

-Cough -Dyspnea -Chills and night sweat

A client with chronic obstructive pulmonary disease (COPD) is being evaluated for lung transplantation. The nurse performs the initial physical assessment. Which findings should the nurse anticipate in this client? Select all that apply.

-Dyspnea at rest -Clubbed fingers -Muscle retractions -Prolonged expiratory breathing phase

The nurse is doing volunteer work in a homeless shelter. The nurse should monitor the individuals for which initial signs/symptoms of tuberculosis (TB)? Select all that apply.

-Fatigue -Lethargy -Morning cough -Low-grade fever

Lists the signs & symptoms of TB?

-Low-grade fever, cough, night sweats, fatigue & weight loss -The cough may be nonproductive, or mucopurulent sputum may be expectorated

A nurse is providing preoperative teaching with the client about the use of an incentive spirometer in the postoperative period. Which instructions should the nurse include? Select all that apply.

-Sit upright in the bed or in a chair. -Place the mouthpiece in your mouth and seal your lips tightly around it. -After maximum inspiration, hold the breath for 2 to 3 seconds and exhale.

A client who has undergone radical neck dissection for a tumor has a potential problem of obstruction related to postoperative edema, drainage, and secretions. To promote adequate respiratory function in this client, the nurse should implement which activities? Select all that apply.

-Suctioning the client as needed -Encouraging coughing every 2 hours -Supporting the neck incision when the client coughs -Monitoring the respiratory status frequently as prescribed

Which nursing interventions are appropriate in caring for a client with emphysema? Select all that apply.

-Teach diaphragmatic and pursed-lip breathing. -Encourage alternating activity with rest periods. -Teach the client techniques of chest physiotherapy.

List the FOUR first-line medications used to treat TB?

1. INH 2. Rifampin (Rifadin) 3. Pyrazinamide (PZD) 4. Ethambutol (Myambutol)

The clinic nurse administers a tuberculin (Mantoux) skin test to a client. The nurse tells the client to return to the clinic for reading the results in how long?

48-72 hours

The nurse is caring for a group of clients on the clinical nursing unit. The nurse interprets that which of these clients is at most risk for the development of pulmonary embolism?

A 73-year-old woman who has just had pinning of a hip fracture

The community health nurse is conducting an educational session with community members regarding the symptoms associated with tuberculosis. Which is one of the first manifestations associated with tuberculosis?

A cough with the expectoration of mucoid sputum

A nurse working on a medical respiratory nursing unit is caring for several clients with respiratory disorders. The nurse should determine that which client on the nursing unit is at the lowest risk for infection with tuberculosis?

A man who is an inspector for the US Postal Service

A client has been treated for pleural effusion with a thoracentesis. The nurse determines that this procedure has been effective if the nurse notes which assessment finding?

Absence of dyspnea

A nurse is monitoring the status of a client who is being treated for dyspnea. The nurse is aware that which factor will decrease the work of breathing for this client?

Bronchodilation

The nurse is caring for a client after a bronchoscopy and biopsy. Which finding, if noted in the client, should be reported immediately to the health care provider?

Bronchospasm

A client has experienced pulmonary embolism. The nurse should assess for which symptom, which is most commonly reported?

Chest pain that occurs suddenly

A nurse is performing an admission assessment on a client with tuberculosis (TB) and is collecting subjective and objective data. Which finding would the nurse expect to note?

Complaints of night sweats

What is the usual course of medications treatment during the initial phase?

Consists of multiple-medication regiment: 1. INH 2. Rifampin 3. Parazinamide 4. Ethambutol

A nurse is caring for a client who had tuberculin skin testing (Mantoux test) 48 hours ago on admission to the nursing unit. The nurse reads the test result as positive. Which action by the nurse has the highest priority?

Contact the (HCP)

A client with chronic obstructive pulmonary disease (COPD) who is beginning oxygen therapy asks the nurse why the flow rate cannot be increased to more than 2 to 4 L/min. The nurse responds that this would be harmful because a higher oxygen flow rate could lead to which physical responses?

Decrease in the client's oxygen-based respiratory drive

A nurse is teaching a client with pulmonary disease about fundamental concepts of gas exchange. When asked for further details by the client, the nurse explains that gas exchange occurs through which process?

Diffusion

A client is suspected of having a pulmonary embolus. The nurse assesses the client, knowing that which is a common clinical manifestation of pulmonary embolism?

Dyspnea

The nurse is caring for a client who is on strict bed rest and develops a plan of care with goals related to the prevention of deep vein thrombosis and pulmonary emboli. Which nursing action is most helpful in preventing these disorders from developing?

Encouraging active range-of-motion exercises

The nurse reads a client's tuberculin (Mantoux) skin test as positive and notes that previous tests were negative. The client becomes upset and asks the nurse what this means. The nurse should base the response on which interpretation?

Exposure to TB

Which types of foods patients should avoid while taking INH?

Food contain tyramine and histamine: tuna, aged cheese, red wine, soy sauce, yeast extracts

A client with chronic obstructive pulmonary disease (COPD) is experiencing exacerbation of the disease. The nurse should determine that which finding documented in the client's record is an expected finding with this client?

Hyperinflation of lungs documented by CXR

What is the usual course of medications treatment during the continual phase?

INH & rifampin OR INH & rifapentine (Rifadin)

What are the side effects if patients digest either tyramine while on INH treatment regiment?

If eaten while pt is on INH, it may result in headache, flushing, hypotension, lightheadedness, palpitations, and diaphoresis

A client with chronic obstructive pulmonary disease (COPD) has a respiratory rate of 24 breaths per minute, bilateral crackles, and cyanosis and is coughing but is unable to expectorate sputum. Which problem is the priority?

Inability to clear the airway related to inability to expectorate sputum

The nurse is providing an educational session to community members regarding histoplasmosis. The nurse should provide which information about this disease?

It can be caused by the inhalation of spores from bird droppings.

The nurse enters a client's room with a pulse oximetry machine and tells the client that the health care provider (HCP) has prescribed continuous oxygen saturation readings. The client's facial expression changes to one of apprehension. The nurse can quickly and most effectively alleviate the client's anxiety by providing which information about pulse oximetry?

It is painless and safe

A nurse is reinforcing instructions to a client about the use of an incentive spirometer. The nurse tells the client to sustain the inhaled breath for 3 seconds. When the client asks the nurse about the rationale for this action, the nurse explains that which is the primary benefit?

Maintain inflation of the alveoli

A nurse is providing instructions to a client about diaphragmatic breathing. The nurse tells the client that this technique is helpful because, in normal respiration, as the diaphragm contracts, it takes which action?

Moves downward and out

A nurse is reading a tuberculin skin test for a client with no documented health problems. The site has no induration and a 1-mm area of ecchymosis. How should the nurse interpret the result?

Negative

The nurse is preparing to give a bed bath to an immobilized client with tuberculosis. The nurse should wear which item when performing this care?

Particulate respirator, gown, and gloves

The nurse is discussing the techniques of chest physiotherapy and postural drainage (respiratory treatments) to a client having expectoration problems because of chronic thick, tenacious mucus production in the lower airway. The nurse explains that after the client is positioned for postural drainage the nurse will perform which action to help loosen secretions?

Percussion and vibration

A client did not seek medical treatment for a previous respiratory infection, and subsequently an empyema developed in the left lung. The nurse should assess the client for which signs and symptoms associated with this problem?

Pleural pain and fever

A client who is human immunodeficiency virus (HIV)-positive has had a tuberculin skin test (TST). The nurse notes a 7-mm area of induration at the site of the skin test and interprets the result as which finding?

Positive

The nurse instructs a client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to promote which outcome?

Promote carbon dioxide elimination

The nurse is planning care for an 81-year-old unresponsive client admitted to the hospital with a medical diagnosis of pneumonia. The nurse has identified the problem of inability to clear the airway related to retained secretions. Which intervention is most appropriate?

Provide nasotracheal suctioning as needed to remove secretions.

The nurse is caring for a client with tuberculosis who is fearful of the disease and anxious about the prognosis. In planning nursing care, the nurse should incorporate which intervention as the best strategy to assist the client in coping with the illness?

Provide reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease.

The nurse monitors the respiratory status of the client being treated for acute exacerbation of chronic obstructive pulmonary disease (COPD). Which assessment finding would indicate deterioration in ventilation?

Rapid, shallow respirations

A client with long-standing empyema undergoes decortication of the affected lung area. Postoperatively the nurse should place the client in which position?

Semi-Fowler's

The nurse is assessing a client with the typical clinical manifestations of tuberculosis. The nurse should expect the client to report having fatigue and cough that have been present for how long?

Serval weeks to months

The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the client to assume?

Sitting on the side of the bed and leaning on an overbed table

The nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of which diagnostic test that will confirm this diagnosis?

Sputum culture

The nurse instructs a client regarding pursed-lip breathing and asks the client to demonstrate the breathing technique. Which observation by the nurse would indicate that the client is performing the technique correctly?

The client breathes out slowly through the mouth

A nurse in an ambulatory clinic is preparing to administer a tuberculin skin test (Mantoux test) to a client who may have been exposed to a person with tuberculosis (TB). The client reports having received the bacille Calmette-Guérin (bCG) vaccine before moving to the United States from a foreign country. Which interpretation should the nurse make?

The client's test result will be positive, and a chest x-ray study will be required for evaluation

A client who is experiencing respiratory difficulty asks the nurse, "Why it is so much easier to breathe out than in?" In providing a response, the nurse explains that breathing is easier on exhalation because of which respiratory responses?

The respiratory muscles relax

A client diagnosed with tuberculosis is distressed over fatigue and the loss of physical stamina. What should the nurse tell the client?

This is expected, and the client should gradually increase activity as tolerated

Which position would best help the breathing of a client with chronic obstructive pulmonary disease (COPD)?

Tripod position

An oxygen delivery system is prescribed for a client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which oxygen delivery system would the nurse anticipate to be prescribed?

Venturi mask