practice quizzes exam 3
Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the patient's caregiver is accurate
PEEP prevents the lung air sacs from collapsing during exhalation
a client is hospitalized for left pneumothorax, when assessing the clients left chest area, the nurse will expect to identify which finding?
absence of breath sounds on auscultation
a client experiences a complete pneumothorax. the nurse recognizes there is a danger of mediastinal shift, which could cause which life threatening condition?
decrease filling of the right side of the heart
a client sustains fractured ribs as a result of an accident. which clinical indicator suggests that the client may be experiencing a complication of fractured ribs?
diminished breath sounds on the affected side. the fractured rib has penetrated a lung.
a client with chest trauma is admitted in the ED. which intervention takes priority?
ensure patent airway
When admitting a patient with possible respiratory failure and a high PaCO2, which assessment information should be immediately reported to the health care provider
the patient is very somnolent
what nursing action is of highest priority when a clients chest tube has accidentally dislodged?
apply a petroleum gauze dressing over the site. this will prevent air from being sucked into the pleural space.
The oxygen saturation (SpO2) for a patient with left lower lobe pneumonia is 90%. The patient has wheezes, a weak cough effort, and complains of fatigue. Which action should the nurse take next?
assist the patient with staged coughing
when excessive bubbling is observed in the water seal chamber, which action would the nurse take?
check for system air leaks
which diagnostic procedure does the nurse discuss when to remove a clients chest tube?
chest xray to confirm lung re-expansion
A patient with respiratory failure has a respiratory rate of 6 breaths/min and an oxygen saturation (SpO2) of 88%. The patient is increasingly lethargic. Which intervention will the nurse anticipate
endotracheal intubation and positive pressure ventilation
A patient with acute respiratory distress syndrome (ARDS) and acute kidney injury has the following drugs ordered. Which drug should the nurse discuss with the health care provider before giving?
gentamicin 60mg IV
While caring for a patient who has been admitted with a pulmonary embolism, the nurse notes a change in the patient's oxygen saturation (SpO2) from 94% to 88%. Which action should the nurse take?
increase the patients o2
a patient develops increasing dyspnea and hypoxemia 2 days after heart surgery. To determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by heart failure, the nurse will plan to assist with a
insertion of a pulmonary artery catheter
when a client has a chest tube placed in the second intercostal space, how will the nurse evaluate for the effectiveness of the chest tube?
inspect the amount of bubbling in the water seal chamber. a chest tube placed in the second intercostal space is to treat pneumothorax. the chest tube will remove air, causing bubbling in the water seal chamber.
what is the purpose of an occlusive dressing over a clients sucking chest wound?
it maintains negative pressure within the chest cavity
A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a right pneumothorax. Which collaborative action will the nurse anticipate next?
lower the PEEP
A patient admitted with acute respiratory failure has ineffective airway clearance related to thick secretions. Which nursing intervention would specifically address this patient problem?
offer fluids
A nurse is caring for an obese patient with right lower lobe pneumonia. Which position will be best to improve gas exchange
on the left side
a client has chest tubes attached to a chest tube drainage system. which intervention would the nurse perform when caring for this client?
palpate the surrounding area for crepitus
after the initial assessment, which earthquake survivor with chest trauma would the disaster management nurse treat first?
patient with cyanosis, air hunger, violent agitation, tracheal deviation away from affected side
after being notified that a client with a sucking chest wound is being transported to the ED, the nurse will anticipate which initial collaborative intervention?
prepare for chest tube insertion
a client chest tube was separated from the drainage system and they are in respiratory distress. which action would the nurse take?
reconnect the tube to the drainage system
the nurse is caring for a patient with a pneumothorax and chest tube. which assessment finding indicated that the chest tube has been effective?
return of breath sounds
a client with emphysema experience sudden SOB and is diagnosed with spontaneous pneumothorax. what likely caused this?
rupture of sub pleural bleb
the nurse provides teaching to a client who is being discharged after treatment for a pneumothorax. the nurse instructs the client to notify the HCP immediately if experiencing which symptom of recurring pneumothorax?
severe shortness of breath
A nurse is caring for a patient with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP). Which assessment finding by the nurse indicates that the PEEP may need to be reduced
the patient has subcutaneous emphysema on the upper thorax