Respiratory

white blood cells count

5, 000-10.000

A nurse is teaching a parent of a child who has hemophilia how to control a minor bleeding episode. Which of the following statements by the parent indicates a need for further teaching?

"I will apply heat."

.A nurse is assessing a client who is to undergo a left lobectomy to treat lung cancer. The client tells the nurse that she is scared and wishes she had never smoked. Which of the following responses should the nurse make?

"It's okay to feel scared. Let's talk about what you are afraid of." It is the nurse's responsibility to acknowledge the client's statement, encourage verbalization, and explore the client's feelings.

A nurse is caring for a client who has lung cancer and is scheduled for a lobectomy. The nurse should prepare the client to expect which of the following after the procedure

A chest tube. A lobectomy is a major surgery that involves a large posterolateral or anterolateral incision into bone, muscle, and cartilage. Chest tubes are placed to drain air and fluid and remain in place for several days postoperatively.

A nurse is reviewing a client's laboratory values and discovers the client has a serum potassium of 6.2 mEq/L. Which of the following interventions should the nurse anticipate?

Administering sodium polystyrene sulfonate. The nurse should expect to administer sodium polystyrene sulfonate, which absorbs excessive potassium and excretes it through the stool. Other treatments include hemodialysis and IV glucose and insulin.

A nurse is teaching a client who has a new diagnosis of aplastic anemia. Which of the following information should the nurse include in the teaching?

Aplastic anemia results from decreased bone marrow production of RBCs. Aplastic anemia is hypo-proliferative anemia resulting from decreased production of RBC within the bone marrow.

A nurse is providing teaching to a client who has neutropenia. Which of the following information should the nurse include in the teaching?

Avoid crowds. The nurse should inform the client to avoid crowds due to his suppressed immune system.

A nurse is preparing a teaching plan for a client who has neutropenia as a result of radiation therapy for the treatment of lung cancer. Which of the following should the nurse plan to include in the teaching?

Bottled water is an appropriate choice to increase fluid intake. Clients who have neutropenia are at risk for foodborne illness. Bottled water prevents client exposure to pathogens that may be found in other water sources.

A nurse in a provider's office is reviewing the laboratory results of a client who takes furosemide for hypertension. The nurse notes that the client's potassium level is 3.3 mEq/L. The nurse should monitor the client for which of the following complications?

Cardiac dysrhythmias This client's potassium level is below the expected reference range. Hypokalemia can cause a number of cardiac effects including flattened T waves, prominent U waves, and S-T depression.

A nurse is caring for a client who has a three-chamber closed chest tube system. Which of the following actions should the nurse take after noticing a rise in the water seal chamber with client inspiration?

Continue to monitor the client. The fluid in the water seal chamber rises 2 to 4 inches during inhalation and falls during exhalation. This is a process called tidaling. An absence of tidaling might indicate a fully expanded lung or an obstruction in the chest tube.

A nurse is caring for a client who is 12 hr. postoperative and has a chest tube to a disposable water-seal drainage system with suction. The nurse should intervene for which of the following observations?

Continuous bubbling in the water-seal chamber. Continuous or excessive bubbling in the water-seal chamber indicates an air leak between the water seal and the client's chest. However, gentle bubbling on forceful exhalation or coughing is normal.

A nurse is reviewing the provider's history and physical form for a client who has advanced multiple myeloma. Which of the following findings should the nurse expect

Ecchymoses A client who has multiple myeloma has an overgrowth of plasma cells in the bone marrow, which leads to a reduction in other types of blood cells. As the platelets are affected, the client is prone to bleeding and bruising.

When blood enters the pleural space

Hemothorax

Dextrose 5% in 0.9% sodium chloride

Hypertonic. Dextrose enters cells rapidly, leaving 0.9% sodium chloride

Pneumothorax caused by a thoracentesis

Iatrogenic

Vomiting and thiazide diuretic causes

Metabolic alkalosis due to acid loss

A nurse is assessing a preschooler who has a calcium level of 8.0 mg/dL. Which of the following findings should the nurse expect?

Muscle tremors A serum calcium level of 8.0 mg/dL is below the expected reference range. A preschooler who has hypocalcemia is likely to have muscle tremors and cramps that can progress to tetany and convulsions.

Treatment for a tension pneumothorax

Needle decompression

A nurse is caring for a client who has hemophilia A and hemarthrosis of the left knee. Which of the following actions should the nurse take?

Obtain a stool specimen. The nurse should obtain a stool specimen, as the client is at risk for bleeding in the gastrointestinal track. The stool specimen would show presence of blood.

A nurse is reviewing the laboratory data on a client who has a new prescription for heparin for treatment of a pulmonary embolism. Which of the following data should the nurse report to the provider?

Platelets 74,000/mm3 an adverse effect of heparin that causes the activation of platelets, resulting in widespread clot formation and depletion of platelets. The expected reference range for platelets is 150,000-400,000/mm3.

A nurse is caring for a client who has osteoporosis and takes a daily calcium supplement. Which of the following adverse effects of calcium should the nurse suspect when the client reports having flank pain?

Renal stones Calcium supplements can cause renal stones. Clients should increase their water intake while taking calcium supplements to hydrate the kidneys and should report any blood in the urine or flank pain

A nurse is assessing a client who is receiving a blood transfusion. Which of the following findings is a manifestation of a hemolytic transfusion reaction?

Report of low-back pain Low-back pain, fever, and chills are manifestations of a hemolytic transfusion reaction. The nurse should discontinue the transfusion and administer 0.9% sodium chloride through new IV tubing.

A nurse is preparing to administer magnesium sulfate IV to a client who is experiencing preterm labor. Which of the following is the priority nursing assessment for this client?

Respiratory Rate Magnesium sulfate is typically administered to a client in preterm labor to achieve the tocolytic (uterine relaxation) effect. Magnesium sulfate depresses the function of the central nervous system, causing respiratory depression. Baseline assessment of respiratory status, checking the respiratory rate frequently, and reassessment of respiratory status with each change in

A nurse is monitoring a client who reports having chills and back pain during a blood transfusion. Which of the following actions is nurse's priority

Stopping the transfusion The greatest risk to this client is injury from a transfusion reaction, which is indicated by chills and back pain. Therefore, the priority intervention is to stop the infusion.

Lactated Ringer's

isotonic

Partial Thromboplastin Time (PTT)

normal 30-40 ; heparin 53-70

symptom of a pneumothorax

tachycardia

Hematocrit (Hct)

• Females 37-47% • Males 42-52%

.A nurse is assessing four clients for fluid balance. The nurse should identify that which of the following clients is exhibiting manifestations of dehydration

A client who has a temperature of 39° C (102° F) his temperature is greater than the expected reference range of 36° C (96.8° F) to 37° C(98.6° F). An elevated temperature is a manifestation of dehydration.

A nurse is reviewing the medical records of four clients who have an acid-base imbalance. The nurse should recognize that which of the following clients is at risk for metabolic acidosis?

A client who has diarrhea. Diarrhea can cause metabolic acidosis due to the loss of bicarbonate.

Complication of a rib fracture

Atelectasis

A nurse is caring for a client who has a prescription for potassium chloride (KCL) 20 mEq PO daily. The nurse reviews the client's most recent laboratory results and finds the client's potassium level is 5.2 mEq/L. Which of the following actions should the nurse take

Call the prescribing physician and inform her of the client's serum potassium level results As a potassium level of 5.2 mEq/L is above the expected reference range, the nurse should hold the medication and notify the provider of the client's serum potassium level.

Common treatment of a pneumothorax

Chest tube

Treatment for a sucking chest wound

Vent dressing

A nurse is assessing a client who has disseminated intravascular coagulation (DIC). Which of the following findings should the nurse expect?

Excessive thrombosis and bleeding. The nurse should expect excessive thrombosis and bleeding of mucous membranes because both DIC impairs both coagulation and anticoagulation pathways.

Salicylate intoxication causes

Respiratory alkalosis due to carbon dioxide loss due to tachypnea.

A nurse is caring for a client who is 1-day postoperative following a left lower lobectomy and has a chest tube in place. When assessing the client's three-chamber drainage system, the nurse notes that there is no bubbling in the suction control chamber. Which of the following actions should the nurse take

Verify that the suction regulator is on and check the tubing for leaks. A lack of bubbling may indicate that either the suction regulator is turned off or that there is a leak in the tubing.

A nurse is caring for a client who has hypernatremia and requires IV fluid therapy due to his NPO status. Which of the following solutions should the nurse prepare to infuse for this client?

0.45% sodium chloride A client who has an elevated sodium level and is NPO requires a hypotonic IV solution, such as .45% sodium chloride or 0.225% sodium chloride.

A nurse is caring for a client who develops a pulmonary embolism. Which of the following interventions should the nurse implement first?

Administer oxygen therapy. The greatest risk to the safety of a client who has a pulmonary embolism is hypoxemia with respiratory distress and cyanosis. Oxygen therapy should be applied by the nurse using a nasal cannula or mask. Pulse oximetry should be initiated to monitor oxygen saturation.

A nurse is assessing a client who is postoperative and has anemia due to excess blood loss following surgery. Which of the following findings should the nurse expect?

Fatigue The nurse should identify that the client who has anemia due to blood loss following surgery will experience fatigue. This is due to the body's decreased ability carry oxygen to vital tissues and organs.

A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take?

Obtain a 12-lead ECG This client's potassium level is above the expected reference range of 3.5-5.0 mEq/L and is at risk for dysrhythmias as well as cardiac arrest. Therefore, the nurse should obtain a 12-leadECG to monitor for cardiac changes.

A nurse is reviewing the laboratory values of a client who has respiratory acidosis. Which of the following findings should the nurse expect?

PaCO2 50 mm Hg This laboratory value is an expected finding for a client who has respiratory acidosis.

A client is admitted to the emergency room with a respiratory rate of 7/min. Arterial blood gases (ABG) reveal the following values. Which of the following is an appropriate analysis of the ABGs? pH 7.22 PaCO2 68 mm Hg Base excess -2 PaO2 78 mm Hg Saturation 80% Bicarbonate 26 mEq/L

Respiratory acidosis Respiratory acidosis occurs when there is retention of CO2 due to an impairment of respiratory function. It can be the result of respiratory depression, seen with anesthesia or opioid administration; inadequate chest expansion, due to a weakness of the respiratory muscles or constriction to the thorax; an obstruction of the airway, seen in aspiration, bronchoconstriction, or laryngeal edema; or from an inability of the lungs to adequately diffuse gases (O2 and CO2), resulting from conditions such as pneumonia, COPD, chest trauma, or pulmonary emboli. Arterial blood gases will reveal a pH that is lower than the normal reference range (7.35 - 7.45)and a CO2 level that is higher than the normal reference range (35 - 45 mm Hg).

A nurse is caring for a client who has a new prescription for ferrous sulfate tablets twice daily for iron-deficiency anemia. The client asks the nurse why the provider instructed that she take the ferrous sulfate between meals. Which of the following responses should the nurse make?

"Taking the medication between meals will help you absorb the medication more efficiently." Ferrous sulfate provides the iron needed by the body to produce red blood cells. Taking iron supplements between meals helps to increase the bioavailability of the iron.

.A nurse in a community clinic is assessing an older adult client for manifestations of dehydration. Which of the following findings should the nurse expect?

Furrows in the tongue In an older adult clients who have dehydration, the surface of the tongue will be dry with deep furrows.

A nurse is assessing a client who has a pneumothorax with a chest tube in place. For which of the following findings should the nurse notify the provider?

Movement of the trachea toward the unaffected side. A chest tube inserted for a spontaneous pneumothorax may result in the development of a tension pneumothorax, a medical emergency. This results from air in the pleural space compressing the blood vessels of the thorax and limiting blood return to the heart. An assessment of tracheal deviation, or movement of the trachea toward the unaffected side, is indicative of tension pneumothorax and should be reported to the provider immediately.

A nurse is giving a presentation about preventing deep-vein thrombosis (DVT). Which of the following should the nurse include as a risk factor for this disorder? (Select all that apply.)

Oral contraceptive use, and immobility

A nurse is providing instruction to a new nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia?

Spironolactone Spironolactone is a potassium-sparing diuretic. It blocks the effects of aldosterone in the renal tubules, causing a loss of sodium and water and the retention of potassium. The possible adverse reactions include hyperkalemia and hyponatremia.