NURS327 Exam 2

A patient with emphysema informs the nurse, "The surgeon will be removing about 30% of my lung so that I will not be so short of breath and will have an improved quality of life." What surgery does the nurse understand the surgeon will perform?

A lung volume reduction

A client presents to the ED after being in a boating accident about 3 hours ago. Now the client reports headache, fatigue, and the feeling that he "just can't breathe enough." The nurse notes that the client is restless and tachycardic with an elevated blood pressure. This client may be in the early stages of what respiratory problem?

Acute respiratory failure

The nurse is caring for a client who is demonstrating signs of increased respiratory distress related to laryngeal obstruction. The nurse is calling the physician to report on the client's condition. Which of the following will the nurse report? Select all that apply.

Arterial blood gases reporting a PaCO2 of 48 and a PaO2 of 84 Nasal flaring with abdominal retractions Lung sounds of wheezing Increased respiratory effort

While assessing an acutely ill client's respiratory rate, the nurse assesses four normal breaths followed by an episode of apnea lasting 20 seconds. How should the nurse document this finding?

Biot's respirations

What do bronchodilators do?

Bronchodilators relieve bronchospasm by improving expiratory flow through widening of the airways and promoting lung emptying with each breath. These medications alter smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation.

A thoracentesis is performed to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnostic purposes. What does serous fluid indicate?

Cancer

Acute Pharyngitis Self-Care

Complete course of antibiotics. Stay in bed during the febrile stage of illness!!! Dispose of used tissues properly. Can use warm saline gargles or throat irrigations. An ice collar also can relieve severe sore throats!!! Don't go to work till 24hrs after antibiotics are started. liquid or soft diet during acute stage!!!

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.) Jugular vein distention Ascites Decreased airflow Wheezes Compromised gas exchange

Compromised gas exchange, Decreased airflow, Wheezes

A client arrives in the emergency department reporting shortness of breath. She has 3+ pitting edema below the knees, a respiratory rate of 36 breaths per minute, and heaving respirations. The nurse auscultates the client's lungs to reveal coarse, moist, high-pitched, and non-continuous sounds that do not clear with coughing. The nurse will document these sounds as which type?

Crackles

When the nurse is assessing the older adult patient, what gerontologic changes in the respiratory system should the nurse be aware of? (Select all that apply.)

Decreased gag reflex Increased presence of collagen in alveolar walls Decreased presence of mucus

Cuff Complications

High cuff pressure can cause tracheal bleeding, ischemia, and pressure necrosis. Low cuff pressure can increase the risk of aspiration pneumonia. Routine deflation of the cuff is not recommended because of the increased risk of aspiration and hypoxia

How to get a sputum specimen

Ideally are obtained early in the morning before the patient has had anything to eat or drink. Clear the nose and the throat and rinse the mouth to decrease contamination of the sputum. Do not to simply spit saliva into the container. Take a few deep breaths, cough deeply and expectorate sputum from the lungs into a sterile container. If the patient cannot expel an adequate sputum, coughing can be induced by administering an aerosolized hypertonic solution via a nebulizer. Other methods include endotracheal or transtracheal aspiration or bronchoscopic removal.

A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply. Mucus secretions that block airways Inflamed airways that obstruct airflow Decreased numbers of goblet cells Overinflated alveoli that impair gas exchange Dry airways that obstruct airflow

Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange

A patient comes to the clinic with a cold and wants something to help relieve the symptoms. What should the nurse include in educating the patient about the uncomplicated common cold? (Select all that apply.)

Inform the patient about the symptoms of secondary infection. Suggest that the patient take adequate fluids and get plenty of rest. Inform the patient that the virus is contagious for 2 days before symptoms appear and during the first part of the symptomatic phase.

A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply. Decreased goblet cells Mucus secretions that block airways Overinflated alveoli that impair gas exchange Inflamed airways that obstruct airflow

Mucus secretions that block airways Overinflated alveoli that impair gas exchange Inflamed airways that obstruct airflow

Tonsillectomy self-care

Need to take full course of prescribed anitbiotics. Know signs of hemorrhage. bleeding may occur up to 8 days post-op. Alkaline mouthwashes and warm saline solutions are useful in coping with the thick mucus and halitosis that may be present after surgery. A sore throat, stiff neck, minor ear pain, and vomiting may occur in the first 24 hours. The patient should eat an adequate diet with soft foods, which are more easily swallowed than hard foods. The patient should avoid spicy, hot, acidic, or rough foods. Milk and milk products (ice cream and yogurt) may be restricted because they make removal of mucus more difficult for some patients. Maintain good hydration. Avoid vigorous tooth brushing or gargling because these activities can cause bleeding. Use a cool-mist vaporizer or humidifier in the home postoperatively. Avoid smoking and heavy lifting or exertion for 10 days.

The nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurement best reflects the adequacy of alveolar ventilation?

PaCO2

Why would a client with COPD report feeling fatigued? Select all that apply. Patient is using all expendable energy just to breathe. Lung function gradually decreases over time in clients with COPD. Patient is using all expendable energy on ADLs

Patient is using all expendable energy just to breathe. Lung function gradually decreases over time in clients with COPD.

The nurse is performing a nutritional assessment on a client who has been diagnosed with cancer of the larynx. Which laboratory values would be assessed when determining the nutritional status of the client? Select all that apply. Protein level Albumin level White blood cell count Glucose level

Protein level Albumin level Glucose level

what do breathing exercises do?

Pursed-lip breathing helps slow expiration, prevents collapse of small airways, and helps the patient control the rate and depth of respiration. It also promotes relaxation, enabling the patient to gain control of dyspnea and reduce feelings of panic. Diaphragmatic breathing reduces the respiratory rate and increases alveolar ventilation.

A client has a nursing diagnosis of ineffective airway clearance related to excessive mucus production. The best short-term goal is for the client to

Report decreased congestion

The nurse, caring for a patient with emphysema, understands that airflow limitations are not reversible. The end result of deterioration is:

Respiratory acidosis.

In the prevention of occupational lung diseases, the nurse would direct preventive teaching to which high-risk occupations? Select all that apply. Mechanic Rock quarry worker Nurse Miner Banker

Rock quarry worker, Miner

An adult client has just been diagnosed with small cell lung cancer. The client asks the nurse why the doctor is not offering surgery as a treatment for his cancer. What fact about lung cancer treatment should inform the nurse's response?

Small cell cancer of the lung grows rapidly and metastasizes early and extensively.

An x-ray of a trauma client reveals rib fractures and the client is diagnosed with a small flail chest injury. Which intervention should the nurse include in the client's plan of care?

Suction the client's airway secretions.

Which homeostatic mechanism would the body of a critically ill client use to maintain normal pH?

The lungs eliminate carbonic acid by blowing off more CO2.

How to confirm bronchodilator worked for a bronchospasm

The relief of bronchospasm is confirmed by measuring improvement in expiratory flow rates and volumes (the force of expiration, how long it takes to exhale, and the amount of air exhaled) as well as by assessing the dyspnea and making sure that it has lessened.

An client is described as having pectus carinatum. What would be the physical manifestation of this condition?

The sternum protrudes and the ribs are sloped backward.

The mother of a client with cancer comes to the nurse concerned with her daughter's safety. She states that the dose of morphine that her daughter requires to control her pain is getting "higher and higher." As a result, the mother is afraid that her daughter will overdose. The nurse should educate the mother about what aspect of her daughter's pain management?

There is no absolute maximum opioid dose and her daughter is becoming more tolerant to the drug.

The nurse is assigned to care for a patient in the ICU who is diagnosed with status asthmaticus. Why does the nurse include fluid intake as being an important aspect of the plan of care? (Select all that apply.) To loosen secretions To facilitate expectoration To assist with the effectiveness of the corticosteroids To combat dehydration To relieve bronchospasm

To combat dehydration To loosen secretions To facilitate expectoration

risk factors for laryngeal cancer

Tobacco Combined effects of alcohol and tobacco Asbestos Secondhand smoke Paint fumes Wood dust Cement dust Chemicals Tar products Mustard gas Leather and metals age, gender, race, genetics

A client with a decreased level of consciousness is in a recumbent position. How should the nurse best assess the lung fields for a client in this position?

Turn the client to enable assessment of all the patient's lung fields.

A mechanically ventilated client is receiving a combination of atracurium and the opioid analgesic morphine. The nurse monitors the client for which potential complication?

Venous thromboemboli

The nurse is caring for a client with a decrease in airway diameter causing airway resistance. The client experiences coughing and mucus production. Upon lung assessment, which adventitious breath sounds are anticipated?

Wheezes

Limitations of Pulse Oximetry

anemia, abnormal hemoglobin, high carbon monoxide level, the use of dyes (methylene blue), or if the patient has dark skin or is wearing nail polish. Bright light, particularly sunlight, fluorescent and xenon lights also affect accuracy. SpO2 values cannot reliably detect hypoventilation when oxygen is in use. HYPOTHERMIA, HYPOTENSION.

Which of the following is a clinical manifestation of a pneumothorax? Select all that apply. Oxygen desaturation Sudden chest pain Bilaterally equal breath sounds Asymmetry of chest movement Unilateral retractions

asymmetry of chest movement O2 desat unilateral retractions sudden chest pain

how to use nebulizer treatment

breathe through the mouth, taking slow, deep breaths, and then to hold the breath for a few seconds at the end of inspiration to increase intrapleural pressure and reopen collapsed alveoli. The nurse encourages the patient to cough and to monitor the effectiveness of the therapy.

S&S of bronchospasm

dyspnea!!! static secretions!!! hypoxemia infection increased mucus production cough, pain, tightness compromised gas exchange!!! decreased airflow!!! wheezes/diminished!!!

Administering pre-anesthetic meds (safety)

it is usually given in the preoperative holding area. If a preanesthetic medication is given, the patient is kept in bed with the side rails raised, because the medication can cause lightheadedness or drowsiness. During this time, the nurse observes the patient for any untoward reaction to the medications. The immediate surroundings are kept quiet to promote relaxation, and some facilities use soft classical music

nursing management for status asthmaticus

main focus is to assess airway and response to treatment. Nurse monitors patient VIGILANTLY for first 12-24hrs. Nurse assesses skin turgor, admins IV fluids(up to 4L/day), BP and cardiac rhythm, patient in quiet room, room free of respiratory irritants.

It is important for the nurse to provide required information and appropriate explanations of diagnostic procedures to clients with respiratory disorders in order to

manage decreased energy levels.

The nurse is caring for a client following a tonsillectomy and adenoidectomy. Two hours after the procedure, the client begins to vomit large amounts of dark blood at frequent intervals and is tachycardic and febrile. After notifying the surgeon, the nurse

obtains a light, mirror, gauze, and curved hemostats.

medical management for bronchiectasis

postural drainage, percussion, smoking cessation. Anitbiotics. Bronchodilators. Adequate hydration. Surgical intervention.

S&S Oxygen Toxicity

substernal discomfort paresthesias dyspnea restlessness fatigue malaise progressive respiratory difficulty refractory hypoxemia alveolar atelectasis and alveolar infiltrates evident on chest x-rays

A nurse is giving a speech addressing "Communicable Diseases of Winter" to a large group of volunteer women, most of whom are older than 60 years. What preventive measures should the nurse recommend to these women, who are at the risk of pneumococcal and influenza infections? Select all that apply. vaccinations prescribed opioids incentive spirometry hand antisepsis

vaccinations hand antisepsis

A client has suspected fluid accumulation in the pleural space of the lungs and is scheduled for a thoracentesis. The nurse will implement which of the following for this procedure? Select all that apply. -Place the client in the prone position. -Complete a respiratory assessment after the procedure. -Educate the client about the need to cleanse the thoracic area. -Prepare the client for magnetic resonance imaging after the procedure to verify tube placement. -Apply pressure to the puncture site after the procedure.

-Complete a respiratory assessment after the procedure. -Educate the client about the need to cleanse the thoracic area. -Apply pressure to the puncture site after the procedure.

Side effects of ACE inhibitors

A dry, irritative cough is COMMON. Hyperkalemia, renal tubular damage, decreased B/P, dizziness, fatigue

A client with thoracic trauma is admitted to the ICU. The nurse notes the client's chest and neck are swollen and there is a crackling sensation when palpated. The nurse consequently identifies the presence of subcutaneous emphysema. If this condition becomes severe and threatens airway patency, what intervention is indicated?

A tracheostomy

A patient is brought into the emergency department with carbon monoxide poisoning after escaping a house fire. What should the nurse monitor this patient for?

Anemic hypoxia

The nurse practitioner treats a patient diagnosed with the common cold by recommending the most common treatment. What is that treatment?

Antihistamines

The nurse should monitor a client receiving mechanical ventilation for which of the following complications?

Gastrointestinal hemorrhage

Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply. Tobacco smoke Occupational dust Air pollution Infection Second-hand smoke

Tobacco smoke Occupational dust Air pollution Infection Second-hand smoke