PrepU: Respiratory

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A client in the ICU has had an endotracheal tube in place for 3 weeks. The health care provider has ordered that a tracheostomy tube be placed. The client's family wants to know why the endotracheal tube cannot be left in place. What would be the nurse's best response?

"When an endotracheal tube is left in too long it can damage the lining of the windpipe."

The OR nurse is setting up a water-seal chest drainage system for a client who has just had a thoracotomy. The nurse knows that the amount of suction in the system is determined by the water level. At what suction level should the nurse set the system?

20 cm H2O

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 PFT measures how much air moves in and out of your lungs when you breathe."

The nurse is caring for a client diagnosed with pneumonia. The nurse assesses the client for tactile fremitus by completing which action?

Asking the client to repeat "ninety-nine" as the nurse's hands move down the client's thorax

A client's plan of care specifies postural drainage. What action should the nurse perform when providing this noninvasive therapy?

Assist the client into a position that will allow gravity to move secretions.

A nurse is teaching a client how to perform flow type incentive spirometry prior to his scheduled thoracic surgery. What instruction should the nurse provide to the client?

Breathe in deeply through the spirometer, hold your breath briefly, and then exhale."

A client is being admitted to the preoperative holding area for a thoracotomy. Preoperative teaching includes what?

Correct use of incentive spirometry

A client is exhibiting signs of a pneumothorax following tracheostomy. The surgeon inserts a chest tube into the anterior chest wall. What should the nurse tell the family is the primary purpose of this chest tube?

To remove air from the pleural space

The nurse is instructing the patient on the collection of a sputum specimen. What should be included in the instructions? (Select all that apply.)

-Initially, clear the nose and throat. -Take a few deep breaths before coughing. -Use diaphragmatic contractions to aid in the expulsion of sputum.

A client with a respiratory condition is receiving oxygen therapy. While assessing the client's PaO2, the nurse knows that the therapy has been effective based on which of the following reading.

84 mm Hg

What finding by the nurse may indicate that the patient has chronic hypoxia?

Clubbing of the fingers

The nurse is performing client education for a client who is being discharged on mini-nebulizer treatments. What information should the nurse prioritize in the client's discharge teaching?

How to perform diaphragmatic breathing

A client is being seen in the pediatric clinic for a middle ear infection. The client's mother reports that when the client develops an upper respiratory infection, an ear infection seems quick to follow. What contributes to this event?

eustachian tubes

A client is being treated for a pulmonary embolism and the medical nurse is aware that the client suffered an acute disturbance in pulmonary perfusion. This involved an alteration in what aspect of normal physiology?

Adequate flow of blood through the pulmonary circulation.

Swallowing down the wrong pipe" typically causes a significant coughing spasm and gasping for air, followed by recovery. Which upper airway structure malfunctions to cause the event?

epiglottis


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