PrepU Resp
The nurse is caring for a client who is scheduled for a lobectomy for lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the client's oxygen saturation rapidly dropping. The client reports shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. What further assessment findings support the presence of a pneumothorax? A. Diminished or absent breath sounds on the affected side B. Paradoxical chest wall movement with respirations C. Sudden loss of consciousness D. Muffled heart sounds
A
The nurse is caring for a client with a serum potassium concentration of 6.0 mEq/L (6.0 mmol/L) and a fluid volume excess. The client is ordered to receive oral sodium polystyrene sulfonate and furosemide. What other order should the nurse anticipate giving? A. Discontinue the intravenous lactated Ringer solution. B. Increase the rate of the intravenous lactated Ringer solution. C. Change the lactated Ringer solution to 3% saline. D. Change the lactated Ringer solution to 2.5% dextrose.
A
The physician has prescribed 0.9% sodium chloride IV for a hospitalized client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. A. Compare ABG findings with previous results. B. Maintain intake and output records. C. Document presenting signs and symptoms. D. Administer IV bicarbonate. E. Suction the client's airway.
A, B, C
A client has a sucking stab wound to the chest. Which action should the nurse take first? A. Draw blood for a hematocrit and hemoglobin level. B. Apply a dressing over the wound and tape it on three sides. C. Prepare a chest tube insertion tray. D. Prepare to start an I.V. line.
B
A client with myasthenia gravis is receiving continuous mechanical ventilation. When the high-pressure alarm on the ventilator sounds, what should the nurse do? A. Check for an apical pulse. B. Suction the client's artificial airway. C. Increase the oxygen percentage. D. Ventilate the client with a handheld mechanical ventilator.
B
A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client? A. Full-liquid B. High-protein C. 1,800-calorie ADA D. Low-fat
B
A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder? a) Metabolic alkalosis b) Metabolic acidosis c) Respiratory acidosis d) Respiratory alkalosis
B) Metabolic acidosis This client's pH value is below normal, indicating acidosis. The HCO3- value also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of base, which suggests metabolic acidosis. The PaCO2 value is normal, indicating absence of respiratory compensation. These ABG values eliminate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis.
A client has undergone a left hemicolectomy for bowel cancer. Which activities prevent the occurrence of postoperative pneumonia in this client? A. Administering oxygen, coughing, breathing deeply, and maintaining bed rest B. Coughing, breathing deeply, maintaining bed rest, and using an incentive spirometer C. Coughing, breathing deeply, frequent repositioning, and using an incentive spirometer D. Administering pain medications, frequent repositioning, and limiting fluid intake
C
T or F The insertion of a chest tube into the pleural space restores the positive intra-thoracic pressure needed for lung re-expansion after surgery or trauma.
FALSE- NEEDS NEGATIVE PRESSURE
T or F To detect pneumothorax, expect the patient to get an ectocardiogram.
FALSE- X ray
T or F Patient is undergoing a chest tube insertion for a pneumothorax, should be placed in the lateral position.
FALSE- leaning over a table, upright seated, OR lateral supine with affected side up (sedated pt)
T or F During chest removal, the nurse should have the patient breathe deeply.
FALSE- patient should (hold breath) BEAR DOWN/Val-salva maneuver
T or F When palpating around your patient's chest tube you detect crepitus. Tension pneumothorax is suspected.
FALSE- subcutaneous emphysema suspected.
T or F The chest tube has stopped fluctuating, the nurse checks and there is no kinking int he tubing. another common reason for the chest tube to stop fluctuating is that the lung has re-expanded.
TRUE
T or F when an air leak is suspected, the nurse should clamp the tubing at intervals to identify the location of the air leak.
TRUE
tracheostoma/laryngeal stoma
hole in trachea that connects to outside of neck
difference between partial and total laryngectomy
partial: you can speak, remove tumor, some larynx, one vocal cords total: you cannot speak, separate trachea
The nurse is assessing the lungs of a patient diagnosed with pulmonary edema. Which of the following would be expected upon auscultation? A. Crackles at lung bases B. Egophony C. Absent breath sounds D. Bronchial breath sounds
A
Which of the following is a clinical manifestation of fluid volume excess (FVE)? Select all that apply. A. Distended neck veins B. Crackles in the lung fields C. Shortness of breath D. Decreased blood pressure E. Bradycardia
A, B, C
A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level? A. No effect B. Increases arterial pH C. Decreases arterial pH D. Provides long-term pH regulation
B
A nurse is caring for a client after lung biopsy. Which assessment findings requires immediate intervention? A. Client stating pain level of 7 out of 10 that decreases with pain meds B. Respiratory rate 44 breaths/min C. Oxygen sat at 96% on 3 L of oxygen D. Pt dozing when left alone
B
The nurse is assessing an adult client following a motor vehicle accident. The nurse observes that the client has an increased use of accessory muscles and is reporting chest pain and shortness of breath. The nurse should recognize the possibility of what condition? A. Aspiration B. Pneumothorax C. Cardiac ischemia D. Acute bronchitis
B
A client is on a ventilator. Alarms are sounding, indicating an increase in peak airway pressure. The nurse assesses first for A. Higher than normal endotracheal cuff pressure B. A cut or slice in the tubing from the ventilator C. A kink in the ventilator tubing D. Malfunction of the alarm button
C
A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? A. pH B. Bicarbonate (HCO3-) C. Partial pressure of arterial oxygen (PaO2) D. Partial pressure of arterial carbon dioxide (PaCO2)
C
The nurse is completing a physical assessment of a client's trachea. The nurse inspects and palpates the trachea for A. evidence of exudate. B. color of the mucous membranes. C. deviation from the midline. D. evidence of muscle weakness.
C
A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate? A.Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
D
On arrival at the intensive care unit, a critically ill client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client's arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values? A. Fever B. Tachypnea C. Tachycardia D. Hypotension
D
A client is being treated in the ICU 24 hours after having a radical neck dissection completed. The client's serum calcium concentration is 7.6 mg/dL (1.9 mmol/L). Which physical examination finding is consistent with this electrolyte imbalance? A. Presence of Trousseau sign B. Slurred speech C. Negative Chvostek sign D. Muscle weakness
A
A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect? A.Respiratory acidosis B. Metabolic alkalosis C. Respiratory alkalosis D. Metabolic acidosis
A
A nurse is providing client teaching about the body's plasma pH and the client asks the nurse what is the major chemical regulator of plasma pH. What is the best response by the nurse? A. renin-angiotensin-aldosterone system B. bicarbonate-carbonic acid buffer system C. sodium-potassium pump D. ADH-ANP buffer system
B
The acute medical nurse is preparing to wean a client from the ventilator. Which assessment parameter is most important for the nurse to assess? A. Fluid intake for the last 24 hours B. Baseline arterial blood gas (ABG) levels C. Prior outcomes of weaning D. Electrocardiogram (ECG) results
B
The nurse is caring for a respiratory client who uses a noninvasive positive pressure device. Which medical equipment does the nurse anticipate to find in the client's room? A. A ventilator B. A face mask C. A rigid shell D. A nasal cannula
B
The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas. What is one of the most important indications of an acid-base imbalance shown in an ABGs? A. PaO2 B. PO2 C. Carbonic acid D. Bicarbonate
Bicarbonate
A client is being mechanically ventilated in the ICU. The ventilator alarms begin to sound. The nurse should complete which action first? A. Notify the respiratory therapist. B. Manually ventilate the client. C. Troubleshoot to identify the malfunction. D. Reposition the endotracheal tube.
C
The Emergency Department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? A. PaO2 B. PO2 C. Carbonic acid D. Bicarbonate
D
The nurse is assessing a client who has a chest tube in place for the treatment of a pneumothorax. The nurse observes that the water level in the water seal rises and falls in rhythm with the client's respirations. How should the nurse best respond to this assessment finding? A. Gently reinsert the chest tube 1 to 2 cm and observe if the water level stabilizes. B. Inform the physician promptly that there is in imminent leak in the drainage system. C. Encourage the client to do deep breathing and coughing exercises. D. Document that the chest drainage system is operating as it is intended.
D
While caring for a client with a chest tube, which nursing assessment would alert the nurse to a possible complication? A. Skin around tube is pink. B. Bloody drainage is observed in the collection chamber. C. Absence of bloody drainage in the anterior/upper tube D. The tissues give a crackling sensation when palpated.
D
A critical care nurse is caring for a client with an endotracheal tube who is on a ventilator. The nurse knows that meticulous airway management of this client is necessary. What is the main rationale for this? A. Maintaining a patent airway B. Preventing the need for suctioning C. Maintaining the sterility of the client's airway D. Increasing the client's lung compliance
A
A physician stated to the nurse that the client has fluid in the pleural space and will need a thoracentesis. The nurse expects the physician to document this fluid as A. pleural effusion. B. pneumothorax. C. hemothorax. D. consolidation.
A
The clinic nurse is caring for a client who has been diagnosed with emphysema and who has just had a pulmonary function test (PFT) ordered. The client asks, "What exactly is this test for?" What would be the nurse's best response? A. "A PFT measures how much air moves in and out of your lungs when you breathe." B. "A PFT measures how much energy you get from the oxygen you breathe." C. "A PFT measures how elastic your lungs are." D. "A PFT measures whether oxygen and carbon dioxide move between your lungs and your blood."
A
The nurse is caring for a client following a wedge resection. While the nurse is assessing the client's chest tube drainage system, constant bubbling is noted in the water seal chamber. This finding indicates which problem? A. Air leak B. Tidaling C. Tension pneumothorax D. Increased drainage
A
The nurse is caring for a client who is ready to be weaned from the ventilator. In preparing to assist in the collaborative process of weaning, the nurse should anticipate that the weaning of the client will progress in what order? A. Removal from the ventilator, tube, and then oxygen B. Removal from oxygen, ventilator, and then tube C. Removal of the tube, oxygen, and then ventilator D. Removal from oxygen, tube, and then ventilator
A
The critical care nurse and the other members of the care team are assessing the client to see if he is ready to be weaned from the ventilator. What are the most important predictors of successful weaning that the nurse should identify? A. Stable vital signs and ABGs B. Pulse oximetry above 80% and stable vital signs C. Stable nutritional status and ABGs D. Normal orientation and level of consciousness
A
You are a nurse caring for a client who has just had a tracheostomy. What should you monitor frequently? A. Airway patency B. Level of consciousness C. Psychologic status D. Pain level
A
A nurse is working with a client being extubated from the ventilator. Before weaning a client from a ventilator, which assessment parameter is the most important for the nurse to obtain? A. Fluid intake for the past 24 hours B. Baseline arterial blood gas (ABG) levels C. Complete blood count results D. Electrocardiogram (ECG) results
B
A patient arrives in the emergency department after being involved in a motor vehicle accident. The nurse observes paradoxical chest movement when removing the patient's shirt. What does the nurse know that this finding indicates? A. Pneumothorax B. Flail chest C. ARDS D. Tension pneumothorax
B
A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. What drug would the nurse know to administer to the client? A. Ipratropium bromide B. Albuterol C. Formoterol D. Isoproterenol
B
The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? A. Respiratory alkalosis. B. Metabolic alkalosis C. Respiratory acidosis D. Metabolic acidosis
B
Which type of ventilator has a preset volume of air to be delivered with each inspiration? A. Negative-pressure B. Volume-controlled C. Time-cycled D. Pressure-cycled
B
A client with a history of anxiety experiences respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.6° F (37° C). To help correct respiratory alkalosis, the nurse should: A. insert a nasogastric tube (NG) as ordered. B. administer acetaminophen as ordered. C. instruct the client to breathe into a paper bag. D. administer antibiotics as ordered.
C
A client with chronic bronchitis is admitted to the health facility. Auscultation of the lungs reveals low-pitched, rumbling sounds. Which term should the nurse document? A. Crackles B. Pleural friction rub C. Rhonchi D. Bronchial
C
A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside? A. Tracheostomy cleaning kit B. Water-seal chest drainage set-up C. Manual resuscitation bag D. Oxygen analyzer
C
A nurse is monitoring a client being evaluated who has a potassium level of 7 mEq/L (mmol/L). Which electrocardiogram changes will the client display? A. prolonged T waves B. elevated ST segment C. peaked T waves D. shortened PR interval
C
The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? A. Kidney and liver B. Heart and lungs C. Lungs and kidney D. Pancreas and stomach
C
A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects: A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory Alkalosis
D
A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
D
A client on long-term mechanical ventilation becomes very frustrated when he tries to communicate. Which intervention should the nurse perform to assist the client? A. Assure the client that everything will be all right and that he shouldn't become upset. B. Ask a family member to interpret what the client is trying to communicate. C. Ask the physician to wean the client off the mechanical ventilator to allow the client to talk. D. Ask the client to write, use a picture board, or spell words with an alphabet board.
D
T or F Chest tube systems and respiratory status should be assessed at a minimum of every 4 hours
TRUE
T or F Continuous bubbling in water seal chamber is a sign of a water leak.
TRUE
T or F Since air rises, high chest tubes around the second intercostal space drain air, while chest tubes in the intercostal space drain fluid.
TRUE
describe tracheal esophageal prosthesis
device placed in wall that separates the trachea and esophagus so that enables the patient to make a voice, allows air to enter esophagus, allows pt to speak without vocal cords, often places finger over hole
risk factors for Laryngeal cancer
smoking, drinking, 65 yrs, male
tension pneumothorax signs
trachea and heart moves to side opposite of side of pneumothorax
T or F The closed chest drainage system uses wet suction contains three chambers: water seal, wet suction chamber, and drainage chamber.
TRUE
T or F The purpose of a chest tube system can include; the re-expansion of the lung after a thoracotomy and to remove air, fluid and blood.
TRUE
T or F Titling or fluctuation reflects proper functioning of chest tube
TRUE
A victim of a motor vehicle accident has been brought to the emergency room. The patient is exhibiting paradoxical chest expansion and respiratory distress. Which of the following chest disorders should be suspected? A. Flail chest B. Cardiac tamponade C. Pulmonary contusion D. Simple pneumothorax
A
T or F drainage from the chest tube is considered part of I&Os
TRUE
After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes? A. Water-seal chamber B. Air-leak chamber C. Collection chamber D. Suction control chamber
A
nursing diagnoses for pts with laryngeal cancer both pre op and post op
Post: disturbed body image, risk for bleeding Pre: insufficient airway clearance
A client with emphysema is at a greater risk for developing which acid-base imbalance? A. Chronic respiratory acidosis B. Metabolic alkalosis C. Metabolic acidosis D. Respiratory alkalosis
A
To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results? Select all that apply. A. pH B. PaCO2 C. HCO3 D. Glucose E. Na+ F. K+
A, B, C
T or F For a water seal system, (dry suction), suction is usually set at 100 cm of water
FALSE: -20
T or F The purpose of the water seal is to prevent the introduction of organisms into the pleural space.
FALSE- PREVENT AIR instead of organisms (also detects air leaks)
Which statement describes emphysema? A. A disease of the airways characterized by destruction of the walls of overdistended alveoli B. A disease that results in reversible airflow obstruction, a common clinical outcome C. Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years D. Chronic dilatation of a bronchus or bronchi
A
The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis? A. pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L B. pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L C. pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 mEq/L D. pH: 7.42, PaCO2: 45 mm Hg, HCO3-: 22 mEq /L
A
A nurse is caring for a client who was intubated because of respiratory failure. The client is now receiving mechanical ventilation with a preset tidal volume and number of breaths each minute. The client has the ability to breathe spontaneously between the ventilator breaths with no ventilator assistance. The nurse should document the ventilator setting as: A. pressure support ventilation (PSV). B. synchronized intermittent mandatory ventilation (SIMV). C. assist-control (AC) ventilation. D. continuous positive airway pressure (CPAP)
B
A client who has an altered level of consciousness is receiving tube feedings. Clients receiving tube feeding should be placed in which position? A. Side-lying B. Supine C. Trendelenburg D. Semi-Fowler's or higher
D