NUR314 EXAM 4
An asthmatic client is being discharged with a prescription for cromolyn. The nurse determines that teaching is effective when the client states "I should avoid gargling and rinsing my mouth after using my inhaler." "I should use my inhaler no more than one hour before I exercise." "I should use my inhaler whenever I feel an asthma attack coming on." "I should stop taking steroids if I need a dose of my inhaler."
"I should use my inhaler no more than one hour before I exercise."
Flow rates of a nasal cannula
1-6L/min
Flow rate of nonrebreather mask
10-15 L/min
fatality rate of inhalation anthrax if untreated
100%
O2 concentration of a Nasal Cannula
24-44%
flow rate of high flow nasal cannula
30-60L/min
Examples of history clinical manifestations for COPD patients
Ask about risk factors, lifestyle, activity tolerance, sputum production, coughing history, sleeping position
when taking Montelukast avoid
Aspirin and NSAIDs block drug action Clopidogrel (increases drug levels) abnormal liver function
Follow-up care after a lung biopsy
Asses vital signs, breath sounds at least every 4 hours for 24 hours
Which client condition would be of concern for the nurse who is about to administer ipratropium bromide? Client history of multiple sexual partners Client history of smoking and vaping Client history of narrow-angle glaucoma Client history of hypertension and diabetes
Client history of narrow-angle glaucoma
Two things to remember before patient has a bronchoscopy
Constant is required No drink/food 2 hours after
The nurse observes that a client with a history of panic attacks is hyperventilating. What action should the nurse take? Have the client breathe into a paper bag. Give the client a low concentration of oxygen by nasal cannula. Instruct the client to put the head between the knees. Tell the client to take several deep, slow breaths and exhale normally.
Have the client breathe into a paper bag.
ipratropium/ triotropium common side effects
Insomnia, dizziness, depression, headache, sinusitis, nasopharyngitis, cough, dry mouth, nausea, vomiting, abdominal pain, insomnia, constipation, urinary retention, arthralgia, myalgia, peripheral edema, blurred vision, oral ulceration, infection
A client is prescribed metaproterenol via a metered-dose inhaler, two puffs every 4 hours. The nurse instructs the client to report which adverse effect? Irregular heartbeat Pedal edema Decreased pulse rate Constipation
Irregular heartbeat
Combination drug therapy with strict adherence for tuberculosis
Isoniazid Rifampin Pyrazinamide Ethambutol
A client with Chronic Obstructive pulmonary disease (COPD) takes theophylline, 200 mg P.O. twice per day. During a routine clinic visit, the client asks the nurse how the drug works. What is the mechanism of action of theophylline in treating a nonreversible obstructive airway disease such as COPD? It stimulates adenosine receptors, causing bronchodilaton. It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive. It inhibits the enzyme phosphodiesterase, decreasing degradation or cyclic adenosine monophosphate, a bronchodilator It alters diaphragm movement, increasing chest expansion and enhancing the lung's capacity for gas exchange
It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive.
A client who has been treated for an acute episode of bronchial asthma is read for discharge. The nurse is instructing the client on medications that will be need at home for the long-term treatment of asthma. Which of the following medications should the nurse expect to review with the client regarding long-term treatment of asthma? Prednisone Montelukast Ipratropium Metaproterenol
Montelukast
A 12-year-old who has undergone a tonsillectomy refuses to let the nurse look at the tonsillar beds to check for bleeding. To assess whether this child is bleeding from the tonsillar beds, which measure would be most appropriate? Force open the mouth with a tongue blade Assess capillary refill. Monitor for decreased blood pressure Observe for frequent swallowing
Observe for frequent swallowing
The nurse is asked to assess a client prior to having an arterial blood gas (ABG) sample drawn to determine if the client can safely undergo this test. What assessment should the nurse conduct? Review the clients baseline AB resuts. Gather a full set of vital sians. Palpate the radial artery for strength and rhythm Perform an Allens test.
Perform an Allens test.
Life threatening side effects of Dextromethorphan
Respiratory depression Serotonin syndrome
Life threatening side effects of Montelukast
Respiratory depression Serotonin syndrome
To prevent oral complications when using a fluticasone metered-dose inhaler. The nurse should instruct the client to do what? Select all that apply. Rinse out the mouth after using the inhaler. Use the inhaler only as needed. Use the inhaler before meals Keep the mouth piece from becoming contaminated. Add a spacer to the metered dose inhaler.
Rinse out the mouth after using the inhaler. Keep the mouth piece from becoming contaminated. Add a spacer to the metered dose inhaler.
Sarcoid
Skin Arrhythmia Restrictive lung disease Calcium Elevation Ophthalmic Inflammation Immobile facial muscles Vitamin D
Examples of Relevant Patient History for Respiratory Assessment
Smoking Drug Use Allergies Travel, geographic area of residence
Severe, life-threatening, acute episode of airway obstruction. Intensifies once it begins, often does not respond to common therapy. Patient can develop pneumothorax and cardiac/respiratory arrest
Status Asthmaticus
_______________ can lead to serious medical complications!
Strep throat
A client reports having a dry, hacking cough that disturbs sleep at night. Which antitussive agent and intervention are most appropriate for this client? Providing a heat vaporizer and administering hydrocodone Increasing fluids to liquefy secretions and administering codeine Decreasing the room temperature and administering a benzonatate Using a cooling mist humiditer and administering dextrometorphan
Using a cooling mist humiditer and administering dextrometorphan
O2 concentration of nonrebreather masks
greater than 90%
The combination of heat and humidity minimizes damage to mucous membranes, improves oxygenation, and is often better tolerated than other forms of high-flow systems
high-flow nasal cannula
Venturi mask, aerosol mask, face tent, high-flow nasal cannula (HFNC), tracheostomy collar, and T-piece
high-flow systems
retention of CO2
hypercarbia
low levels of oxygen in the blood
hypoxemia
decreased tissue oxygenation
hypoxia
When assessing a client with advanced chronic obstructive pulmonary disease (COPD) which are expected findings? collapsed neck veins increased chest excursions with respiration increased anteroposterior chest diameter underdeveloped neck muscles
increased anteroposterior chest diameter
A client who weights 175 lb (79.4 kg) is receiving aminophylline (400 mg in 500 ml) at 50 ml/hour. The theophylline level is reported as 6 mcg/ml. The nurse calls the physician, who instructs the nurse to change the dosage to 0.45 mg/kg/hour. The nurse should: stop the infusion and have the laboratory repeat the theophylline measurement question the order because the dosage is too low set the pump at 43 mL/hour question the order because the dosage is too high
question the order because the dosage is too high
The client with chronic obstructive pulmonary disease (COPD) is taking theophylline. The nurse should instruct the client to report which signs of theophylline toxicity? Select all that apply. seizures nausea insomnia vision changes vomiting
seizures nausea insomnia vomiting
A nurse reviews the arterial blood aas (ABG) values of a client who reports difficulty breathing: pH, 7.51; PaCO2, 28 mm Hg: Pa02, 70 mm Hg; and HCO3, 24 mEq/L. What assessment finding would the nurse anticipate based on these blood gases? tachypnea bradypnea complaints of constipation nausea and vomiting
tachypnea
common side effects for metaproterenol
tremors, tachycardia
O2 concentration for a simple facemask
40-60%
O2 concentration of partial rebreather masks
40-70%
therapeutic ranges for aminophylline/ theophylline
5 to 10mcg/mL
flow rate of partial rebreather mask
6-11 L/min
Does not have bronchodilator properties but instead acts by inhibiting release of histamine and other inflammatory mediators from mast cells to prevent an asthma attack
Cromolym
Not for use in acute asthma attacks
Cromolym
________ must be taken daily
Cromolyn
Examples of cardiac changes clinical manifestations for COPD patients
Edema, tachycardia
These tests are performed on a treadmill or bicycle or by a self-paced 12-minute walking test.
Exercise Testing
After a lobectomy for lung cancer, the nurse instructs the client to perform deep breathing exercises. What is the expected outcome of these exercises? Control the rate of air flow to the remaining lobe to decrease the risk of hyperinflation. Decrease blood flow to the lungs for rest and increased surface alveoli ventilation. Expand the alveoli and increase lung surface available for ventilation Elevate the diaphragm to enlarge the thorax so that the lung surface area available for gas exchange is increased
Expand the alveoli and increase lung surface available for ventilation
pH: 7.36 CO2: 24 HcO3: 13 SaO2%: 98% The client has the following arterial blood gas (ABG) report. What is the analysis? Partially Compensated Metabolic Acidosis Fully Compensated Respiratory Alkalosis Fully Compensated Metabolic Acidosis Uncompensated Metabolic Acidosis
Fully Compensated Metabolic Acidosis
Research shows ______ to be a major trigger for asthma in some people
GERD
ordinary nasal cannula, simple facemask, partial rebreather mask, and nonrebreather mask
Low-flow systems
A client has a chest tube and water seal drainage system. What should the nurse do to ensure safe and effective use of the drainage system? Verify that the air vent on the water-seal drainage system is capped when the suction is off. Strip the chest drainage tubes at least every 4 hours if excessive bleeding occurs. Ensure that the chest tube is clamped when moving the client out of the bed Make sure that the drainage apparatus is always below the client's chest level.
Make sure that the drainage apparatus is always below the client's chest level.
A nurse is caring for a client with pulmonary edema w hose respiratory status is declining. Chronologically arrange the nursing interventions to prioritize care. Prepare suctioning equipment at the bedside Initiate oxygen via nasal cannula at 2 L/minute Position the client upright at a 45 angle Administer furosemide 40 m intravenously insert an indwelling urinary catheter Call the health care provider.
Position the client upright at a 45 angle Initiate oxygen via nasal cannula at 2 L/minute Prepare suctioning equipment at the bedside Call the health care provider. Administer furosemide 40 m intravenously insert an indwelling urinary catheter
Examples of general appearance clinical manifestations for COPD patients
Posture (orthopnea or tripod), respiratory effort, muscle mass
When assessing the neck look for
Symmetry
Remember, Capnography is a
Very Sensitive test
Normal Pressure of PETCO2 is
between 35-45mm Hg
common side effects of fluticasone
blurred vision and oral candidiasis
Following a laryngectomy, the nurse notices that the client has saliva collecting beneath the skin flaps. This finding is indicative of: carotid artery rupture. skin necrosis. stomal stenosis. development of a fistula.
development of a fistula.
what is the most common manifestation of interstitial pulmonary disease
dyspnea
common side effects for albuterol
excitability, tremors, tachycardia
One intervention for Pneumonia
manage empyema
A client with cystic fibrosis develops pneumonia. To decrease the viscosity of respiratory secretions, the physician orders acetylcysteine. Before administering the first dose, the nurse checks the client's history for asthma. Acetylcysteine must be used cautiously in a client with asthma because it may induce bronchospasm. is a respiratory depressant is a respiratory stimulant. inhibits the cough reflex
may induce bronchospasm.
Simple facemask flow rate
minimum 5L/min
this device is for unstable clients
nonrebreather masks
The nurse has received lab reports for several clients undergoing care. Which set of arterial blood gas (ABG) results will the nurse investigate first ? pH 7.35, PaCO2 48 mmHg, Pa02 91 mmHg, and HC03- 28 mEq/L pH 7.34, partial pressure of arterial carbon dioxide (PaC02) 36 mmHg, partial pressure of arterial oxygen (Pa02) 95 mmHg, bicarbonate (HC03-) 20 mEq/L pH 7.49, PaCO2 30 mmHa, Pa02 75 mmHg, and HCO3- 22 mEq/L pH 7.47, PaCO2 43 mmHg, Pa02 99 mmHg, and HC03- 29 mEq/L
pH 7.49, PaCO2 30 mmHa, Pa02 75 mmHg, and HCO3- 22 mEq/L
an induration of 10mm or greater in diameter means
positive for pulmonary tuberculosis
While suctioning a client's laryngectomy tube, the nurse should insert the catheter: until resistance is met, then withdraw it 0.4 to 0.8 inches (1 to 2 cm). about 1 to 2 inches (2.5 to 5 cm). as the client exhales. until the client begins coughing.
until resistance is met, then withdraw it 0.4 to 0.8 inches (1 to 2 cm).
When patient has seasonal influenza antiviral agents may be effective if started
within 24 to 48 hours of symptoms
Examples of respiratory changes clinical manifestations for COPD patients
AP diameter, use of accessory muscles, retractions, wheezing, clubbing, cyanosis
Caution taking Dextromethorphan in
Asthma, bronchitis, heart failure, tobacco smoking
Endothelin receptor antagonists
Bosentan
___________ may cause exacerbation of ASTHMA, use with extreme caution in these clients!!!
acetylcysteine
New onset of crackles and decreased breath sounds. When high oxygen levels are delivered, nitrogen is diluted, oxygen diffuses from the alveoli into the blood, and the alveoli collapse
Absorptive Atelectasis
Caution taking Montelukast in
Asthma, bronchitis, heart failure, tobacco smoking
Cycles different pressures at inspiration and at expiration. Delivers a set inspiratory positive airway pressure each time the patient begins to inspire. As he or she begins to exhale, the machine delivers a lower set end-expiratory pressure
BiPAP
loss of sensitivity to high levels of CO2
CO2 narcosis
Delivers a set positive airway pressure throughout each cycle of inhalation and exhalation. The effect is to open collapsed alveoli
CPAP
Common side effects of beclmethasone
Candidiasis Hyperglycemia
Measure amount of carbon dioxide present in exhaled air
Capnography
Which suggestions should the nurse include when teaching the parents of a 14-year-old who has viral tonsillitis? Select all that apply Supply a regular diet. Offer cough medicine every 2 hours Give acetaminophen for sore throat Gargle with warm salt water. Offer lots of fluids. Administer aspirin for fever control
Give acetaminophen for sore throat Gargle with warm salt water. Offer lots of fluids.
Lung and/or pancreatic transplants do not
cure
Evaluate the care of the patient with obstructive sleep apnea (OSA) based on the
priority patient problem
A nurse is caring for a client right after a lung biopsy. Which assessment findings would be anticipated? Select all that apply. Client stating pain level of 4 out of 10 that decreases with pain medication Oxygen saturation level of 94% on 3 L of oxygen Pink tinged sputum expectorated with coughing Respiratory rate of 28 breaths/minute Client exhibiting increased amount of flatus Client dozing when left alone but awakening easily
Client stating pain level of 4 out of 10 that decreases with pain medication Oxygen saturation level of 94% on 3 L of oxygen Pink tinged sputum expectorated with coughing Respiratory rate of 28 breaths/minute Client dozing when left alone but awakening easily
What should the nurse do first when a client with a head injury begins to have clear drainage from the nose? Administer an antihistamine for postnasal drip. Compress the nares. Tilt the head back. Collect the drainage.
Collect the drainage.
Which nursing intervention is the highest priority during the first 24 hours postoperatively for the client who had a total laryngectomy due to cancer of the larynx? Provide adequate nourishment. Prevent skin breakdown around the stoma. Maintain proper bowel elimination. Keep airway open
Keep airway open
A client has just returned from the postanesthesia care unit after undergoing a laryngectomy. Which priority intervention should the nurse include in the plan of care? Irrigate drainage tubes as needed Initiate small feedings of soft fonds Maintain the head of the bed at 30 to 40 degrees Teach the client how to use esophageal speech
Maintain the head of the bed at 30 to 40 degrees
Oxygen at the rate of 2 liters per minute through nasal cannula is prescribed for a client with chronic obstructive pulmonary disease (COPD). Which of the following statements best describes why the oxygen therapy is maintained at a relatively low concentration? The client's long history of respiratory problems indicates that he would be unable to absorb oxygen given at a higher rate The client's respiratory center is so used to high carbon dioxide and low oxygen levels that changing these levels may eliminate his stimulus for breathing The oxygen will be lost at the clients nostrils if given at a higher level with a nasal cannula The cells in the alveoli are so damaged by the clients long history of respiratory problems that increased oxygen levels and reduced carbon dioxide levels likely will cause the cells to burst
The client's respiratory center is so used to high carbon dioxide and low oxygen levels that changing these levels may eliminate his stimulus for breathing
administer by nebulizer 5 minutes after a bronchdilator
acetylcysteine
On admission, the client's arterial blood gas (ABG) values were: pH, 7:20; Pa02, 64mm Hg (8.5 kPa); PaCO2, 60 mm Hg (8 kPa); and HCO3-, 22 mEg/L (22 mmol/L). A chest tube is inserted, and oxygen at 4L/min is started 30 minutes later, repeat blood gas values are are: pH. 7.30: Pa02 76 mm Hg (10.1 kPa): PaCO2. 50 mm Hg (6.7 kPa): and HCO3-. 22 mEq/L (22 mmol/L). This change would indicate: developing respiratory alkalosis improving respiratory status Obstruction in the chest tubes Impending respiratory failure
improving respiratory status
A client with chronic obstructive disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? "Eat a high-sodium diet ' "Weigh yourself daily and report a gain of 2 lb (0.91 kg) in 1 day" "Limit yourself to smoking only 2 cigarettes per day." "Maintain bed rest"
"Weigh yourself daily and report a gain of 2 lb (0.91 kg) in 1 day"
A client with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/min, nasal flaring, and use or accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. What should the nurse do first? Initiate oxygen therapy as prescribed, and reassess the client in 10 minutes Encourage the client to relax and breathe slowly through the mouth. Draw blood for an arterial blood gas. Administer bronchodilators as prescribed
Administer bronchodilators as prescribed
A client is experencing an acute asthmatic attack. Prior to treatment with albuterol, respirations were 40 breaths/min, pulse 132 beats/min, oxygen saturation 86% on room air. and with audible wheezing Which findings indicate achievement of the desired outcome of asthma treatment? decreased peak expiratory flow (PEF) rate Inspiratory cycle twice as long as the expiratory cycle Pulse 96 bpm and SpO2 92% on room air Wheezing inaudible with diminished breath sounds
Pulse 96 bpm and SpO2 92% on room air
The nurse observes a constant gentle bubbling in the water seal column of a water seal chest drainage system. What should the nurse do next ? Decrease the suction and continue observing the system for changes in bubbling during the next several hours Notify the health care provider (HCP). Check the connectors between the chest and drainage tubes and where the drainage tube enters chest drainage system Continue monitoring as usual: this is expected
Check the connectors between the chest and drainage tubes and where the drainage tube enters chest drainage system
The client comes to the healthcare provider reporting nasal discharge, malaise, headache, and a nonproductive cough. The healthcare provider orders guaifenesin for the client. What interventions should the nurse suggest with this medication? Select all that apply. Drink coffee Use an inhaler Increase fluid intake Humidify the air Take a laxative
Increase fluid intake Humidify the air
increased effort of breathing make patients
air hungry
Asthma occurs not in the alveoli but in the
airway
For a client with asthma, the healthcare provider (HCP) prescribes albuterol. two puffs twice a day via MDI and beclomethasone, two puffs twice a day via MDI. The nurse should instruct the client to administer medications 1 hour apart. two times a day. albuterol on awakening and alternate the medications every 4 hours beclomethasone inhaler first and follow with albuterol. albuterol first and follow with beclolethasone two times a day
albuterol first and follow with beclolethasone two times a day
promotes bronchodilation
aminophylline/ theophylline
The nurse is caring for a client with bacterial pneumonia. The effectiveness of the client's oxygen therapy can be best determined by the: clients respiratory rate absence or cyanosis clients level of consciousness arterial blood gas values
arterial blood gas values
Common side effects for aminophylline/ theophylline
avoid coffee (mathylzathine drug and coffee will amplify its effects)
A client who has been hospitalized for treatment of a pneumothorax is ready for discharge. Which outcomes indicate that the client has adequate respiratory function. select all that apply use or accessory muscles with each breath breath sounds present and equal in al lobes oxygen saturation on room air is 95% respiratory rate of 12 to 20 breaths per minutes orthopneic breathing exhibited
breath sounds present and equal in al lobes oxygen saturation on room air is 95% respiratory rate of 12 to 20 breaths per minutes
Which findings are significant data to gather from a client who has been diagnosed with pneumonia? Select all that apply. Occurrence of chest pain Quality of breath sounds Color of nail beds Presence of bowel sounds Amount of peripheral edema
Occurrence of chest pain Quality of breath sounds Color of nail beds
Intervention for COPD patients
Prevent weight loss
