ATI: Respiratory Med/Surg
A nurse on a medical unit is assisting with the care of a client who has a possible closed pneumothorax and significant bruising of the left chest following a motor vehicle crash. The client reports severe left chest pain on inspiration. The nurse should hear which of the following findings when auscultating the clients lung sounds?
Absence of breath sounds
A nurse is preparing to assist a provider to withdraw arterial blood from a clients radial artery for measurement of ABG. Which of the following actions should the nurse plan to take?
Check the circulation in the client ulnar artery prior to obtaining the specimen
A nurse is assisting with the care for a client who had a chest tube inserted 12 hr ago. The nurse notes a crackling sensation upon palpation of the skin on the right side of the clients chest. The nurse should notify the charge nurse that the client is demonstrating a clinical manifestation of which of the following complications?
Crepitus
A nurse is assisting with the development of a teaching plan about how to prevent an acute asthma attack for a young adult client. Which of the following points should the nurse plan to discuss first?
Determine the clients perception of the disease process and what might have triggered the current attack
A nurse in an urgent care clinic is collecting data from a client who reports exposure to anthrax. Which of the following findings is an indication of the prodromal stage of inhalation anthrax?
Dry cough
A nurse is assisting with the plan of care for a client who has COPD and is malnourished. Which of the following recommendations to promote nutritional intake should the nurse include in the plan?
Eat high-calorie food first
A nurse is reinforcing preoperative teaching with a client who is to undergo a pneumonectomy. The client states I am afraid it will hurt to cough after the surgery. Which of the following statements should the nurse make?
I will show you how to splint your incision while coughing
A nurse is reinforcing teaching about pursed lip breathing for a client who has COPD and emphysema. The nurse should explain that this breathing does which of the following?
Keeps the airways open on exhalation
A nurse is assisting with discharge teaching for a client who is postoperative following a rhinoplasty. Which of the following instructions should the nurse include?
Lie on you back with you head elevated 30 degrees when resting
A nurse in a providers office is collecting data from a client who is states he was recently exposed to TB. Which of the following findings is a clinical manifestation of pulmonary TB?
Night sweats
A nurse on a medical unit is assisting with the care of a client who aspirated gastric contents prior to admission. The provider prescribed 100% oxygen by nonrebreather mask after the client reported severe dyspnea. Which of the following findings is a clinical manifestation of acute respiratory distress syndrome?
PaO2 50 mmHg
A nurse is caring for an older adult client who has COPD and pneumonia. The nurse should monitor the client for which of the following acid base imbalances?
Respiratory acidosis
A nurse is assisting the provider to prepare a client for a thoracentesis. The nurse should instruct the client that which of the following positions will be used for this procedure?
Sitting while leaning forward over the bedside table
A nurse on a medical surgical unit is caring for a client who is postoperative following a hip replacement surgery. The client reports feeling apprehensive and restless. The nurse collects additional data from the client. Which of the following findings is an indication of pulmonary embolism?
Sudden onset of dyspnea
A nurse is assisting with the plan of care for a client following placement of a chest tube 1 hr ago. Which of the following actions should the nurse include in the plan of care?
Tape all connections between the chest tube and drainage system
A nurse is caring for a client who has a tracheostomy with an inflated cuff in place. Which of the following findings indicates that the nurse should suction the clients airway secretions?
The client has coarse crackles in the lung fields
A nurse is collecting data from a client who has a prescription for cisplatin IV to treat lung cancer. Which of the following client findings is an adverse effect of this medication?
Tinnitus
A nurse is reinforcing teaching with a client who has cystic fibrosis and a prescription for daily chest physiotherapy. The nurse should instruct the client that which of the following is the purpose of these treatments?
To mobilize secretions in the airways
A nurse is reinforcing teaching with a client about pulmonary function tests. Which of the following tests measures the volume of air the lungs can hold at the end of maximum inhalation?
Total lung capacity
A nurse in a clinic is reinforcing teaching with a client who is to have a tuberculin skin test. Which of the following information should the nurse include?
You must return to the clinic to have the test read in 2 or 3 days
