Exam 5 prepU questions
A client is reporting slight shortness of breath and lung auscultation reveals the presence of bilateral coarse crackles. The clients SaO2 is 90% on pulse OX. The nurse has applied a nasal cannula, recognizing that the flow rate by this method should not exceed
6L/minute
In which client should the nurse prioritize assessments for respiratory depression?
A client taking opioids for cancer pain
Which dietary guideline would be appropriate for the older adult homebound client with advanced respiratory disease who informs the nurse that she has no energy to eat?
Eat smaller meals that are high in protein.
The nurse is implementing an order for oxygen for a client with facial burns. Which delivery device will she use?
Face tent
A health care provider orders the collection of a sputum specimen from a client with a suspected bacterial infection. Which action best ensures a usable specimen?
Instruct the client to inhale deeply and then cough.
When a nurse observes an older adult clients skin is dry and shiny and his nails are thickened, the nurse determines that the client is most likely experiencing
Poor tissue perfusion
When a nurse observes that an older client's skin is dry and shiny and his nails are thickened, the nurse determines that the client is most likely experiencing
Poor tissue perfusion
When reviewing data collection on a client with a cardiac output of 2.5 liter/minute, the nurse inspects the clime for which symptom?
Rapid respirations
A nurse assessing a client's respiratory status gets a weak signal from the pulse oximeter. The client's other vital signs are within reference ranges. What is the nurse's best action?
Warm the client's hands and try again.
The nurse is assessing a newborn in the nursery. The nurse notes the infant has episodes in which breathing ceased for 20 seconds on 2 occasions. The nurse correctly recognizes this condition as:
apnea
A client has edema of the feet and ankles, along with crackles in the lower lobes and a frothy, productive cough. The client is suffering from:
congestive heart failure.
A woman comes to the emergency room with her 2-year-old son. She states he woke up and had a loud barking cough. The child is suffering from:
croup
A client has been put on oxygen therapy because of low oxygen saturation levels in the blood. What should the nurse use to regulate the amount of oxygen delivered to the client?
flow meter
To drain the apical sections of the upper lobes of the lungs, the nurse should place the client in which position?
high-Fowler's position
A nurse must deliver oxygen at a concentration of 85% to an infant. Which delivery device would be most appropriate for an infant?
oxygen hood
A nurse is assigned to care for a client admitted to the health care facility with the diagnosis of atelectasis. When interviewing the client, the nurse would anticipate a history of:
pneumonia.
While auscultating a client's chest, the nurse auscultates crackles in the lower lung bases. What condition does the nurse identify the client is experiencing?
presence of fluid in the lungs
The nurse is preparing discharge teaching for a client who has chronic obstructive pulmonary disease (COPD). Which teaching about deep breathing will the nurse include?
"Inhale slowly over three seconds, purse your lips, contract abdominal muscles, and exhale slowly."
A nurse is preparing to use a wall unit to suction the endotracheal tube of a 9 year old child. At what pressure should the suction be set?
80 to 125 mm Hg
The nurse is caring for a client receiving oxygen therapy via nasal cannula. The client suddenly becomes cyanosis with a pulse ox reading of 91%. What is the most appropriate action the nurse should take?
Assess oxygen tubing connection
Upon auscultation of a client's lung fields, the nurse hears loud, high pitched sounds over the larynx. What term will the nurse use in documentation to describe this breath sound?
Bronchial
A nurse is reading a journal article about pollutants and their effect on an individual's respiratory function. Which problem would the nurse most likely identify as an effect of exposure to automobile pollutants?
Bronchitis
The nurse is caring for a client who is wearing oxygen via nasal cannula. The client asks about the bubbling water attached to the oxygen. Which response by the nurse is appropriate?
It decreases dry mucous membranes by delivering small water droplets.
The nurse is suctioning a client's tracheostomy when the tracheostomy becomes dislodged and the nurse is unable to replace it easily. What is the nurse's most appropriate response?
Maintain the client's oxygenation and alert the health care provider immediately.
A client is prescribed a corticosteroid for treatment of asthma after having an asthma attack. What education should the nurse provide to the client regarding the administration of this medication?
Monitor blood pressure and blood sugar.
A nurse is caring for a client who has spontaneous respirations and needs to have oxygen administered at a FiO2 of 100%. Which oxygen delivery system should the nurse use?
Nonrebreather mask
A client is admitted to the emergency department with shortness of breath and oxygen saturation of 88%. The client has a barrel chest and clubbed fingers. What is the nurse's priority intervention?
Place client in the tripod position
Which diagnostic procedure measures lung size and airway patency, producing graphic representations of lung volumes and flows?
Pulmonary function tests
The nurse is observing the UAP perform oropharyngeal suctioning on a client. Which action, performed by the UAP, would indicate to the nurse that suctioning is being performed properly?
The UAP advances the catheter approximately 3-4 inches to reach the pharynx.
Which factors indicate that the nurse should stop delivery of breaths via a manual resuscitation bag and mask device? Select all that apply.
The client has a return of spontaneous breathing at 15 breaths per minute. The client has been intubated and is connected to a mechanical ventilator. The health care provider has ended the cardiopulmonary resuscitation effort.
A nurse takes a client's pulse oximetry reading and finds that it is normal. What does this finding indicate?
The client's available hemoglobin is adequately saturated with oxygen.
After insertion of a chest tube, fluctuations in the water-seal chamber that correspond with inspiration and expiration are an expected and normal finding.
True
Which medication is administered in the home or hospital to relieve inflammation in the lung tissue?
corticosteroids
Mr. Parks has chronic obstructive pulmonary disease (COPD). His nurse has taught him pursed-lip breathing, which helps him in which of the following ways?
decreases the amount of air trapping and resistance
A nurse is assigned to care for a client admitted to the health care facility with a diagnosis of atelectasis. When interviewing the client, the nurse would anticipate a history of
pneumonia
Which breathing technique(s) will the nurse teach to the client who has hypoxemia and hypercarbia? Select all that apply.
pursed-lip breathing diaphragmatic breathing
What structural changes to the respiratory system should a nurse observe when caring for older adults?
respiratory muscles become weaker
The nurse is caring for a client who has had a percutaneous tracheostomy (PCT) following a motor vehicle accident and has been prescribed oxygen. What delivery device will the nurse select that is most appropriate for this client?
tracheostomy collar
A nurse suctioning a client through a tracheostomy tube should be careful not to occlude the Y-port when inserting the suction catheter because it would cause what condition to occur?
trauma to the tracheal mucosa