respiratory, cardiac, oncology

A client presents to a physician's office complaining of dyspnea with exertion, weakness, and coughing up blood. Further examination reveals peripheral edema, crackles, and jugular vein distention. The nurse anticipates the physician will make which diagnosis?

Dyspnea, weakness, hemoptysis, and right-sided heart failure are all signs of pulmonary hypertension. Clients with COPD present with chronic cough, dyspnea on exertion, and sputum production. Those with empyema are acutely ill and have signs of acute respiratory infection or pneumonia. Clients with pulmonary tuberculosis usually present with low-grade fever, night sweats, fatigue, cough, and weight loss.

A client with diabetes who has been maintained on metformin has been scheduled for a cardiac catheterization. The nurse should verify that the health care provider (HCP) has written which prescription for taking the metformin before the procedure?

The nurse should verify that the HCP has requested to withhold the metformin prior to any procedure requiring dye (e.g., cardiac catheterization) because of the increased risk for lactic acidosis. Additionally, the drug will usually be withheld for up to 48 hours following a procedure involving dye while it clears the client's system. The HCP may prescribe sliding-scale insulin during this time if needed. Regardless of how or when the medication is administered, the medication should be withheld. The amount of protein in the client's diet prior to the cardiac catheterization has no correlation with the medication or the test.

The nurse team leader is making rounds and observes a client who had a tracheostomy tube inserted 2 days ago (see figure). The nursing policy manual recommends the use of the gauze pad. What should the nurse do?

The tracheostomy tube, ties, and gauze pad are positioned correctly; the nurse team leader should be sure the client is comfortable. The tracheostomy tube ties should be tied in a square knot on the side of the neck and alternate sides of the neck when the ties are changed. The full part of the gauze square should be placed under the tracheostomy tube to absorb drainage. There is no indication the ties need to be changed; an additional gauze pad is not necessary; if necessary, the current gauze square should be changed rather than adding an additional pad.

A client arrives from surgery to the postanesthesia care unit. Which respiratory assessment should the nurse complete first?

Airway flow is always the first assessment. Once the nurse establishes that the client has a patent airway, the pulse oximeter is applied to measure the oxygen saturation, the respiratory rate is counted, and the breath sounds are auscultated bilaterally.

The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The decrease in pH exists because the client's lungs:

In clients with chronic respiratory acidosis, the client is unable to blow off carbon dioxide leaving in increased amount of hydrogen in the system. The increase in hydrogen ions leads to acidosis. In COPD, the client is able to breathe in oxygen and gas exchange can occur, but the lungs' ability to remove carbon dioxide from the system is compromised. Although individuals with COPD frequently have a history of smoking, impaired ciliary function is not the cause of the acidosis.

The nurse is preparing a client for a thoracentesis. How should the nurse position the client for the procedure?

In preparation for a thoracentesis, the client should be asked to sit forward and place his arms on the bedside table for support. This position provides access to the chest wall and intercostal spaces for insertion of the needle. The supine, Sims', or prone position would not provide adequate access to the chest wall or separate the intercostal spaces sufficiently for needle insertion. Remind the patient not to cough, breathe deeply, or move suddenly during the procedure to avoid puncture of the visceral pleura or lung. If the patient coughs, you'll need to halt the procedure and withdraw the needle slightly to prevent puncture. If ultrasound is unavailable, percuss the affected side posteriorly to determine the highest point of the pleural effusion. Identify the intercostal space below this point and 2" to 4" (5 to 10 cm) lateral to the spine. Mark the site with the sterile fine-tip marker. Complications of thoracentesis may include: shortness of breath coughing hemorrhage other bleeding puncture of the liver or spleen infection pain at the insertion site pneumothorax empyema vasovagal events reexpansion pulmonary edema.

The nurse is caring for a client who has undergone a pulmonary lobectomy 2 days ago. Which finding indicates the client may be experiencing internal bleeding?

Restlessness indicates cerebral hypoxia due to decreased circulating volume. Shortness of breath occurs because blood collecting in the pleural space faster than suction can remove it prevents the lung from reexpanding. Increased blood pressure and decreased pulse and respiratory rates are classic late signs of increased intracranial pressure. Decreasing blood pressure and increasing pulse and respiratory rates occur with hypovolemic shock. Sanguineous drainage that changes to serosanguineous drainage at a rate of less than 100 mL/hhr is normal in the early postoperative period. Urine output of 180 mL over the past 3 hours indicates normal kidney perfusion.

The nurse is planning to teach a client with chronic obstructive pulmonary disease (COPD) how to cough effectively. Which instruction should be included?

The goal of effective coughing is to conserve energy, facilitate the removal of secretions, and minimize airway collapse. The client should assume a sitting position with the feet on the floor if possible. The client should bend forward slightly and, using pursed-lip breathing, exhale. After resuming an upright position, the client should use abdominal breathing to inhale slowly and deeply. After repeating this process three or four times, the client should take a deep abdominal breath, bend forward, and cough three or four times upon exhalation ("huff" cough). Lying flat does not enhance lung expansion; sitting upright promotes full expansion of the thorax. Shallow breathing does not facilitate the removal of secretions, and forceful coughing promotes the collapse of airways. A side-lying position does not allow for adequate chest expansion to promote deep breathing.

The nursing staff is divided over withdrawing care from a competent, chronically ill client. The nurse-manager would take which step to meet the needs of the staff?

The institutional ethics committee can help the staff develop strategies to resolve their ethical dilemma. The Patient's Bill of Rights states that the client (not the family) has the right to make decisions about the care plan and to refuse recommended treatment. Arranging a meeting with the client's family is inappropriate, whether or not they are in agreement with the client's wishes. Assigning only nurses that agree with the client's wishes is not a reasonable staffing option. Talking to the client about their concerns is inappropriate as it takes the focus away from the client.

A nurse has received a change-of-shift report on four clients. Which client should the nurse assess first?

Tracheal deviation suggests possible tension pneumothorax, which is a medical emergency and needs to be evaluated immediately. Edema in a client with right-sided heart failure is a chronic condition and expected, it is not an emergency. Stabbing chest pain is expected with a pleural effusion and is also not an emergency situation. Pulmonary rehabilitation is completed by respiratory therapy and does not require the attention of the nurse.

For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

A Venturi mask allows the nurse to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking 3 glasses of fluid daily wouldn't affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Clients with COPD and respiratory distress should be placed in high Fowler's position and shouldn't receive sedatives or other drugs that may further depress the respiratory center.

The nurse monitors a client following the insertion of a chest tube for a hemopneumothorax. Which observation should the nurse report to the healthcare provider?

A blood loss of 600 mL may place the client in danger of developing hypovolemic shock. All of the other choices are normally expected with a chest tube.

The nurse is suctioning a client who had a laryngectomy. What is the maximum amount of time the nurse should suction the client?

A client should be suctioned for no longer than 10 seconds at a time. Suctioning for longer than 10 seconds may reduce the client's oxygen level so much that the client becomes hypoxic.

A client who had a left thoracoscopy sustained an injury secondary to the surgery position. The nurse should assess the client for which sign?

A client who had a left thoracoscopy is placed in the lateral position, in which the most common injury is an injury to the brachial plexus. Numbness and tingling in the arm suggest a brachial plexus injury. There is no undue pressure on the ankles or knees during thoracic surgery.

A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing, and breath sounds aren't audible. What is the likely cause of these assessment findings?

During an acute asthma attack, wheezing may stop and breath sounds become inaudible because the airways have swollen and gas exchange is limited. If the attack is over and bronchial swelling has decreased, there would be audible breath sounds and no more wheezing. If the administered albuterol was effective, the wheezing would diminish and gas exchange would improve. Pulmonary edema results in bilateral crackles on auscultation.

A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures?

A client with peripheral vascular disease should examine their feet daily for redness, dryness, or cuts. If a client isn't able to do this examination on their own, then a caregiver or family member should help. A client with peripheral vascular disease should avoid hot tubs because decreased sensation in the feet may make them unable to tell if the water is too hot. The client should always wear shoes or slippers on their feet when out of bed to help minimize trauma to the feet. Any type of nicotine, whether it's from cigarettes or smokeless tobacco, can cause vasoconstriction and further decrease blood supply to the extremities.

The nurse is conducting a focused assessment of a client at risk for acute respiratory distress syndrome (ARDS). Which finding indicates the client is becoming hypoxemic?

A hallmark of early ARDS is refractory hypoxemia. The client's partial pressure of arterial oxygen (PaO2) level continues to fall, despite higher concentrations of administered oxygen. Elevated carbon dioxide and metabolic acidosis occur late in the disorder. Severe electrolyte imbalances are not indicators of ARDS.

Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of:

An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several reasons, including brain injury, such as cerebral bleeding; skeletal muscle damage, which can result from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.

A client with pneumonia has pleuritic chest pain. Which action should the nurse take to help the client manage the pain?

The pleuritic pain is triggered by chest movement and is particularly severe during coughing. Splinting the chest wall will help reduce the discomfort of coughing. Deep breathing is essential to prevent further atelectasis. Abdominal breathing is not as effective in decreasing pleuritic chest pain as is splinting of the rib cage. Incentive spirometry facilitates effective deep breathing but does not decrease pleuritic chest pain.

A nurse assesses arterial blood gas results for a client in acute respiratory failure (ARF). Which result is consistent with this disorder?

ARF is defined as a decrease in the arterial oxygen tension (PaO2) to less than 50 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO2) to greater than 50 mm Hg (hypercapnia), with an arterial pH of less than 7.35.

A client has undergone a left hemicolectomy for bowel cancer. Which combination of activities is most effective in preventing the occurrence of postoperative pneumonia in this client?

Activities that help to prevent the occurrence of postoperative pneumonia are coughing, breathing deeply, frequent repositioning, medicating the client for pain, and using an incentive spirometer. Encouraging fluid intake and administering oxygen will not directly prevent pneumonia. Maintaining bed rest will increase the risk of pneumonia.

A physician orders prednisone to control inflammation in a client with interstitial lung disease. During client teaching, the nurse stresses the importance of taking prednisone exactly as ordered and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience

Administration of a corticosteroid such as prednisone suppresses the body's natural cortisol secretion, which may take weeks or months to normalize after drug discontinuation. Abruptly discontinuing such therapy may cause the serum cortisol level to drop low enough to trigger acute adrenocortical insufficiency. Hyperglycemia, glycosuria, GI bleeding, restlessness, and seizures are common adverse effects of corticosteroid therapy, not its sudden cessation.

A client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough, headache, and recurrent chills. Based on the client's history and physical findings, the physician suspects legionnaires' disease. While awaiting diagnostic test results, the client is admitted to the facility and started on antibiotic therapy. What's the drug of choice for treating legionnaires' disease?

Azithromycin is the drug of choice for treating legionnaires' disease. Rifampin is used to treat tuberculosis. Amantadine, an antiviral agent, and amphotericin B, an antifungal agent, are ineffective against legionnaires' disease, which is caused by bacterial infection. throw mice in Large Blue Containers

The nurse is caring for a client with cystic fibrosis (CF) who has increased dyspnea. Which intervention should the nurse include in the plan of care?

Airway clearance techniques are treatments that help people with cystic fibrosis (CF) stay healthy and breathe easier. ACTs loosen thick, sticky lung mucus so it can be cleared by coughing. Clearing the airways reduces lung infections and improves lung function. Routine scheduling of airway clearance using chest physiotherapy is an essential intervention for clients with CF. Fluid restrictions will worsen the thickening of secretions and suctioning the upper airway will not reach thick secretions in the lower lungs. A sweat chloride test is used to diagnose CF; it is not a treatment.

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority?

Although avoiding contact with fur-bearing animals, changing filters on heating and air conditioning units frequently, and avoiding goose down pillows are all appropriate measures for clients with asthma, taking ordered medications on time is the most important measure in preventing asthma attacks.

A client had a Mantoux test result of an 8-mm induration. When should the nurse interpret the test as positive? The client:

An induration (a palpable, raised, hardened area of skin) of more than 5 to 15 mm (depending upon the person's risk factors) after injection of 10 Mantoux units is considered a positive result, indicating tuberculosis (TB) infection. An induration of more than 5 mm is found in: HIV-positive individuals Individuals with recent contact with persons with TB Persons with nodular or fibrotic changes on chest x-ray consistent with old, healed TB Persons with organ transplants Persons who are immunosuppressed An induration of more than 10 mm is positive, and the client may be a recent arrival (less than 5 years) from a country with a high incidence of TB; a person with injection drug use disorder; a resident or an employee of high-risk congregate settings (e.g., prisons, long-term care facilities, hospitals, homeless shelters); or mycobacteriology lab personnel. An induration of more than 10 mm is also considered positive in persons with clinical conditions that place them at high risk (e.g., diabetes, prolonged corticosteroid therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight); a child younger than 4 years of age; or a child or adolescent exposed to adults in high-risk categories.

A client reports difficulty breathing and a sharp pain in the right side of the chest. The respiratory rate measures 40 breaths/minute. The nurse should assign highest priority to which care goal?

As suggested by the ABCs of cardiopulmonary resuscitation — airway, breathing, and circulation — the most important goal is to maintain a patent airway and effective respirations, regardless of the client's diagnosis or clinical presentation. Although maintaining an adequate circulatory volume, reducing anxiety, and relieving pain are pertinent for this client, they're secondary to maintaining effective respirations.

A young adult is admitted for elective nasal surgery for a deviated septum. Which sign would be an important indicator of bleeding even if the nasal drip pad remained dry and intact?

Because of the dense packing, it is relatively unusual for bleeding to be apparent through the nasal drip pad. Instead, the blood runs down the throat, causing the client to swallow frequently. The back of the throat can be assessed with a flashlight. An accumulation of blood in the stomach may cause nausea and vomiting, but it is not an initial sign of bleeding. Increased respiratory rate occurs in shock and is not an early sign of bleeding in the client after nasal surgery. Feelings of anxiety are not indicative of nasal bleeding.

A client has been diagnosed with peripheral arterial occlusive disease. To promote circulation to the extremities, what should the nurse instruct the client to do?

Clients diagnosed with peripheral arterial occlusive disease should be encouraged to participate in a regular walking program to help develop collateral circulation. They should be advised to rest if pain develops and resume activity when pain subsides. With arterial disease, extremities should be kept in a dependent position to promote circulation; elevation of the extremities will decrease circulation. To avoid burns, heating pads should not be used by anyone with impaired circulation. Massaging the calf muscles will not decrease pain. Intermittent claudication subsides with rest.

During the insertion of a rigid scope for bronchoscopy, a client experiences a vasovagal response. The nurse should expect

During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it, in turn, may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop in heart rate leading to syncope. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions.

A client with influenza is admitted to an acute care facility. The nurse monitors the client closely for complications. What is the most common complication of influenza?

Pneumonia is the most common complication of influenza. It may be either primary influenza, viral pneumonia, or pneumonia secondary to a bacterial infection. Other complications of influenza include myositis, exacerbation of chronic obstructive pulmonary disease, and Reye's syndrome. Myocarditis, pericarditis, transverse myelitis, and encephalitis are rare complications of influenza. Although septicemia may arise when any infection becomes overwhelming, it rarely results from influenza. Meningitis and pulmonary edema aren't associated with influenza.

After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH) as prophylaxis against tuberculosis. The client's family asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy?

Prophylactic isoniazid therapy must continue for 6 to 12 months at a daily dosage of 300 mg. Taking the drug for less than 6 months may not provide adequate protection against tuberculosis.

A nurse is caring for a client with type 2 diabetes who has had a myocardial infarction (MI) and is reporting nausea, vomiting, dyspnea, and substernal chest pain. Which is the priority intervention?

Support of breathing and ensuring adequate oxygenation are the two most important priorities. Reducing the substernal pain is also important because upset and anxiety will increase the demand for oxygen in the body. Controlling nausea, vomiting, and anxiety are all secondary in importance. Prevention of complications is important following initial stabilization and control of pain.

The nurse has received lab reports for several clients undergoing care. Which set of arterial blood gas (ABG) results will the nurse investigate first?

The ABG results pH 7.49, PaCO2 30 mmHg, PaO2 75 mmHg, and HCO3- 22 mEq/L indicate respiratory alkalosis. The pH level is increased, the PaCO2 levels are decreased and the HCO3 is normal. The decreased PaO2 indicates this client is in respiratory distress. Therefore, the nurse would investigate this result first. Normal values are pH 7.35 to 7.45, PaCO2 35 to 45 mmHg, and HCO3- 22 to 26 mEq/L. Results of pH 7.35, PaCO2 48 mmHg, PaO2 91 mmHg, and HCO3- 28 mEq/L indicate a fully compensated respiratory acidosis, making this less urgent. Results of pH 7.47, PaCO2 43 mmHg, PaO2 99 mmHg, and HCO3- 29 mEq/L indicate metabolic alkalosis, which is not the priority. Results of pH 7.34, PaCO2 36 mmHg, PaO2 95 mmHg, HCO3- 20 mEq/L indicate mild metabolic acidosis, which would also be less urgent than the respiratory alkalosis.

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?

The client with COPD depends on mechanical ventilation for adequate tissue oxygenation. The nurse must keep a manual resuscitation bag at the bedside to ventilate and oxygenate the client in case the mechanical ventilator malfunctions. Because the client doesn't have chest tubes or a tracheostomy, keeping a water-seal chest drainage set-up or a tracheostomy cleaning kit at the bedside isn't necessary. Although the nurse may keep an oxygen analyzer (pulse oximeter) on hand to evaluate the effectiveness of ventilation, this equipment is less important than the manual resuscitation bag.

A client has a chest tube and water-seal drainage system. What should the nurse do to ensure safe and effective use of the drainage system?

The drainage apparatus is always kept below the client's chest level to prevent the backflow of fluid into the pleural space. The air vent must always be open in the closed chest drainage system to allow air from the client to escape. Stripping a chest tube causes excessive negative intrapleural pressure and is not recommended. Clamping a chest tube when moving a client is not recommended.

A client diagnosed with tuberculosis is taking the prescribed chemotherapy of isoniazid, rifampin, and pyrazinamide. Although side effects are rare, the nurse should assess the client for which side effect of this drug combination?

The major side effect of these three drugs is liver toxicity. While the client is taking these drugs, the nurse should carefully monitor the client's liver function tests. Ototoxicity and nephrotoxicity are side effects of other drugs used to treat TB, such as streptomycin, kanamycin, and capreomycin. Optic neuritis can be a rare side effect of isoniazid.

A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important?

The most significant and direct indicator of the effectiveness of oxygen therapy is the PaO2 value. Based on the PaO2 value, the nurse may adjust the type of oxygen delivery (cannula, Venturi mask, or mechanical ventilator), flow rate, and oxygen percentage. The other options reflect the client's ventilation status, not oxygenation. The pH, HCO3-, and PaCO2

A client with severe acute respiratory syndrome privately informs the nurse of a desire not to be placed on a ventilator if the condition worsens. The client's partner and children have repeatedly expressed their desire that every measure be taken for the client. The most appropriate intervention by the nurse would be to:

The nurse is obligated to act as the client's advocate. A living will or power of attorney would clearly define the client's wishes. The nurse should not discuss the issue with the client's family unless the client gives permission. Assuring the family and client that all possible measures will be taken opposes the client's wishes and does not demonstrate client advocacy.

The nurse is suctioning a tracheostomy for a client who had the tracheostomy tube placed 3 days ago. Which is the correct procedure for suctioning at this time?

The recommended technique is to use a sterile catheter each time the client is suctioned. There is a danger of introducing organisms into the respiratory tract when strict aseptic technique is not used. Reusing a suction catheter is not consistent with aseptic technique. The nurse does not use a clean catheter when suctioning a tracheostomy or a laryngectomy; it is a sterile procedure.

A client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination. When percussing the client's chest wall, the nurse expects to elicit

When percussing the chest wall of a client with allergy-induced asthma, the nurse should expect to elicit resonant sounds - low-pitched, hollow sounds heard over normal lung tissue. Hyperresonant sounds indicate increased air in the lungs or pleural space; they're louder and lower pitched than resonant sounds. Although hyperresonant sounds occur in such disorders as emphysema and pneumothorax, they may be normal in children and very thin adults. Dull sounds, normally heard only over the liver and heart, may occur over dense lung tissue, such as from consolidation or a tumor. Dull sounds are thud-like and of medium pitch. Flat sounds, soft and high-pitched, are heard over airless tissue and can be replicated by percussing the thigh or a bony structure.

A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia?

a client with a nasogastric tube Nasogastric, orogastric, and endotracheal tubes increase the risk of pneumonia because of the risk of aspiration from improperly placed tubes. Frequent oral hygiene and checking tube placement help prevent aspiration and pneumonia. Although a client who smokes is at increased risk for pneumonia, the risk decreases if the client has stopped smoking. Ambulation helps prevent pneumonia. A client who receives opioids, not acetaminophen, has a risk of developing pneumonia because respiratory depression may occur.

What is the best way for the nurse to position a chest tube for a client to prevent dislocation?

coiled flat on the bed and secured without putting tension on the tube

A group of clients has been taught external cardiac compressions. Which hand placements would demonstrate that learning has occurred?

the heel of one hand on the sternum and the heel of the other on top of it, with the fingers interlocking. This provides the best leverage for depressing the sternum, adequately compressing the heart, and forcing blood into the arteries. Grasping the fingers keeps them off the chest and concentrates the energy expended in the heel of the hand while minimizing the possibility of fracturing the client's ribs. The other choices are not best practice or placement for cardiopulmonary resuscitation (CPR).

The nurse is aware that the best position for a client with impaired gas exchange is what?

For a client with impaired gas exchange, high Fowler's position is the best position because it allows maximal chest expansion. If the client cannot tolerate high Fowler's position, semi-Fowler's is the next best choice, because it increases comfort and allows for chest expansion. The lateral decubitus and supine positions do not promote chest expansion. Sims position is recommended for perineal inspection.

A client is prescribed metaproterenol via a metered-dose inhaler, two puffs every 4 hours. The nurse should instruct the client to report which adverse effect?

Irregular heartbeats should be reported promptly to the health care provider. Metaproterenol may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effect on beta-adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders. Metaproterenol does not cause constipation, pedal edema, or bradycardia.

A client is experiencing dryness in the nares while receiving oxygen via nasal cannula at 4 L/minute. Which medication should the nurse apply to help alleviate the dryness?

Lubricant jelly is a water-soluble agent that the nurse can apply safely during oxygen therapy to alleviate dryness of the nares. Petroleum jelly is combustible; it isn't safe to use with oxygen. The nurse shouldn't use sterile water or antibiotic ointment to alleviate dryness in the nares.

Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg?

The ABG results reveal respiratory alkalosis. The best intervention to raise the PaCO2 level would be to have the client breathe into a paper bag. Administering a decongestant, offering fluids frequently, and administering supplemental oxygen wouldn't raise the lowered PaCO2 level.

The nurse is aware that frequent repositioning in bed will assist in the prevention of which condition for a client?

By frequently changing positions in bed, the client can prevent the development of pneumonia, urinary stasis, and deep vein thrombosis. These movements promote blood, oxygen, and fluid circulation throughout the body systems and prevent stasis. Postural hypotension can often be associated with medications and no information is given about this in the question. Arterial thrombosis is incorrect because decreased movement would more likely result in a venous thrombosis.

A client undergoes a total laryngectomy and tracheostomy formation. On discharge, the nurse should give which instruction to the client and family?

Commonly, family members are reluctant to talk to the client who has had a total laryngectomy and can no longer speak. To promote a supportive environment, the nurse should encourage family members to continue normal communication. The nurse should teach the client to clean the tracheostomy tube with hydrogen peroxide and rinse it with sterile saline solution, to consume oral fluids as desired, and to eat protein-rich foods to promote healing.

The nurse is instructing a client with acute asthma who is taking short-term corticosteroid therapy. The nurse should tell the client that steroids will have which expected outcome?

Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.

A client who has just had a triple-lumen catheter placed in their right subclavian vein complains of chest pain and shortness of breath. The client's blood pressure is decreased from baseline and, on auscultation of the chest, the nurse notes unequal breath sounds. A chest X-ray is immediately ordered by the physician. What diagnosis should the nurse suspect?

Pneumothorax (air in the pleural space) is a potential complication of all central venous access devices. Signs and symptoms include chest pain, dyspnea, shoulder or neck pain, irritability, palpitations, light-headedness, hypotension, cyanosis, and unequal breath sounds. A chest X-ray reveals the collapse of the affected lung that results from pneumothorax. Triple-lumen catheter insertion through the subclavian vein isn't associated with pulmonary embolism, MI, or heart failure.

A client with emphysema is at a greater risk for developing what acid-base imbalance?

Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid, which causes the blood pH to drop below 7.35. Chronic respiratory acidosis is associated with disorders such as emphysema, bronchiectasis, bronchial asthma, and cystic fibrosis.

A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which outcome indicates that the client is responding favorably to therapy?

The ability to tolerate more activity without chest pain indicates a favorable response to therapy in a client who is recovering from an MI or who has a history of coronary artery disease. A heart rate within the normal limits of 60-100 per minute does not necessarily indicate a favorable response to treatment. Smoking is a cardiovascular risk factor that the client would be wise to eliminate, but it does not indicate favorable response to treatment. Knowledge of prescribed meds is a good thing, but again does not impact response to treatment.

A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn, yielding the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect?

The pH is below 7.40, PaCO2 is greater than 40, and the HCO3 is normal; therefore, respiratory acidosis exists and compensation by the kidneys has not begun, which indicates this was probably an acute event. The HCO3 of 24 is within the normal range so it is not metabolic alkalosis. The pH of 7.21 indicates acidosis, not alkalosis. The pH of 7.21 indicates it is an acidosis but the HCO3 of 24 is within the normal range, ruling out metabolic acidosis.

A client with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of:

Extreme anxiety can lead to hyperventilation, which is the most common cause of acute respiratory alkalosis. Hyperventilation may be a response to metabolic acidosis, as the body attempts to rid itself of excess CO2; hyperventilation does not cause metabolic acidosis. Increased CO2 levels are associated with acidosis, not alkalosis. There are a number of potential causes of acute CNS disturbances.

A client with rib fractures and a pneumothorax has a chest tube inserted that is connected to a water-seal chest tube drainage system. The nurse notes that the fluid in the water-seal column is fluctuating with each breath that the client takes. What is the significance of this fluctuation?

Fluctuation of fluid in the water-seal column with respirations indicates that the system is functioning properly. If an obstruction were present in the chest tube, fluid fluctuation would be absent. Subcutaneous emphysema occurs when air pockets can be palpated beneath the client's skin around the chest tube insertion site. A leak in the system is indicated when continuous bubbling occurs in the water-seal column.

A client with heart failure will take oral furosemide at home. To help the client evaluate the effectiveness of furosemide therapy, the nurse should teach the client to do which action?

Monitoring daily weight will help determine the effectiveness of diuretic therapy. A client who gains weight without diet changes most probably is retaining fluids, so the diuretic therapy should be adjusted. Blood pressure monitoring is useful when diuretics are prescribed to control blood pressure. However, in clients with heart failure, the primary indication is to promote sodium and water excretion by the kidneys. While it may be useful to monitor intake and urinary output in the hospital, daily weights are a sensitive indicator of fluid status and are more practical for home management. The client may be told to eat a potassium-rich diet; however, serum potassium levels are not used to determine the effectiveness of diuretic therapy.

A client has the following arterial blood gas values: pH 7.52 partial pressure of arterial oxygen (PaO2) 50 mm Hg (6.7 kPa) partial pressure of carbon dioxide (PaCO2) 28 mm Hg (3.72 kPa) HCO3− 24 mEq/L (24 mmol/L) Based upon the client's PaO2, which nursing clinical judgment should the nurse make?

Normal PaO2 level ranges from 80 to 100 mm Hg (10.7 to 13.3 kPa). When PaO2 falls to 50 mm Hg (6.7 kPa), the nurse should be alert for signs of hypoxia and impending respiratory failure. An oxygen level this low poses a severe risk for respiratory failure. The client will require oxygenation at a concentration that maintains the PaO2 at 55 to 60 mm Hg (7.3 to 8 kPa) or more.

A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when they say

Obesity and decreased pharyngeal muscle tone commonly contribute to sleep apnea; the client may need to become involved in a weight loss program. Using an inhaler won't alleviate sleep apnea, and the physician probably wouldn't order an inhaler unless the client had other respiratory complications. A high-protein diet and sleeping on the side aren't treatment factors associated with sleep apnea.

An adult with a peritonsillar abscess has been hospitalized. Upon assessment, the nurse determines the client has a temperature of 103°F (39.4°C), body chills, and leukocytosis. The client begins to have difficulty breathing. In what order from first to last should the nurse perform the actions? All options must be used.

Open the airway. Start an IV access site. Call the health care provider (HCP). Explain the situation to the family.

A client is scheduled to undergo percutaneous transluminal coronary angioplasty (PTCA). Which statement by the nurse best explains the procedure to the client?

PTCA is best described as the insertion of a balloon-tipped catheter into the coronary artery to compress a plaque, thereby opening a stenosed or blocked artery. Cutting away blockages with a special catheter is an atherectomy. Passing a catheter through the coronary arteries to find blocked arteries is a cardiac catheterization. Inserting grafts to divert blood from blocked arteries describes coronary artery bypass graft surgery.

After undergoing a thoracotomy, a client is receiving epidural analgesia. Which assessment finding indicates that the client has developed the most serious complication of epidural analgesia?

Respiratory depression is the most serious complication of epidural analgesia. Other potential complications include hypotension, decreased sensation and movement of the extremities, allergic reactions, and urine retention. Typically, epidural analgesia causes central nervous system depression (indicated by drowsiness) as well as a decreased heart rate and blood pressure.

A client diagnosed with lung cancer is to have a left lower lobectomy. The nurse should assess the client for which factor that increases the client's risk for developing postoperative pulmonary complications?

Risk factors for postoperative pulmonary complications include malnourishment, which is indicated by this client's height and weight. It is thought that emotional responses can affect overall health; however, not verbalizing one's feelings is not a contributing factor in postoperative pulmonary complications. The client's current activity level and age do not place them at increased risk for complications.

A client is chronically short of breath and yet has normal lung ventilation, clear lungs, and an arterial oxygen saturation SaO2 of 96% or better. The client most likely has

SaO2 is the degree to which hemoglobin (Hb) is saturated with oxygen. It doesn't indicate the client's overall Hb adequacy. Thus, an individual with a subnormal Hb level could have normal SaO2 and still be short of breath, indicating a possible hematologic problem. Poor peripheral perfusion would cause subnormal SaO2. There isn't enough data to assume that the client's problem is psychosomatic. If the problem were left-sided heart failure, the client would exhibit pulmonary crackles.

A nurse is reviewing orders for a client having an acute asthma attack. Which medication should the nurse administer?

Albuterol is a rapidly acting bronchodilator and is the first-line medication to reverse airway narrowing in acute asthma attacks. The other medications are used for long-term control of asthma and are not considered "rescue" inhalers since they are not immediate-acting bronchodilators.

What should the nurse do to help a client prevent atelectasis and pneumonia after surgery?

Deep-breathing exercises and use of incentive spirometry are more effective when pain is minimal. A client in severe pain tends to limit movement and to breathe shallowly to decrease the pain. Enough pain medication should be given to decrease pain without depressing respirations. Administration of oxygen or increasing fluids will not prevent atelectasis or pneumonia. Deep-breathing exercises and use of incentive spirometry should be done 10 times every hour while awake. The client's position should be changed every 1 to 2 hours to allow for full chest expansion. Ambulation, not just sitting in the chair, should be implemented as soon as approval from the health care provider is obtained.

A nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest bacterial pneumonia?

In a client with bacterial pneumonia, retained secretions cause dyspnea, and respiratory tract inflammation causes wheezing. Bacterial pneumonia also produces a productive cough and fever, rather than a nonproductive cough and normal temperature. Sore throat occurs in pharyngitis, not bacterial pneumonia. Abdominal pain is characteristic of a GI disorder, unlike chest pain, which can reflect a respiratory infection such as pneumonia. Hemoptysis and dysuria aren't associated with pneumonia.

A healthcare provider has entered orders for a client with chronic obstructive pulmonary disease (COPD). Which order should the nurse question?

People with COPD retain CO2, which is the normal trigger for respiratory rate. In clients with COPD and high levels of CO2, oxygen levels trigger breathing. Too much oxygen and the body slows breathing. Clients with COPD may quit breathing completely when given oxygen at very high levels (greater than 2 L).

The nurse is conducting a health history with a client with active tuberculosis. The nurse should ask the client about which symptom?

Tuberculosis typically produces anorexia and weight loss. Other signs and symptoms may include fatigue, low-grade fever, and night sweats. Increased appetite is not a symptom of tuberculosis; dyspnea on exertion and change in mental status are not common symptoms of tuberculosis.

After the client has a temporary pacemaker inserted, the nurse should verify documentation on the medical record about which information?

The cardiovascular status of the client is the first information documented and will validate the effectiveness of the temporary pacemaker. The client's emotional state and the type of sedation are important but not a high priority. The nurse will need to document the pacemaker information (settings of the pacemaker); this will be considered part of the cardiovascular information.

On the second day after surgery for an abdominal hysterectomy, the nurse is assessing the client's breath sounds to determine the effectiveness of the client's use of an incentive spirometer. The nurse auscultates the client's lungs and hears normal bronchial sounds. What action should the nurse take next?

The client has normal bronchial breath sounds, and the nurse can let the client know that the use of the incentive spirometer is effective. The client does not need to increase the use of the incentive spirometer or restrict fluid intake. It is not appropriate to request a prescription for a bronchodilator when the client's lungs are clear.

The nurse is teaching a client how to apply nitroglycerin topical ointment. Which statement indicates that the client needs additional clarification of the instructions?

The client should not rub or massage the ointment into the skin. The ointment should be allowed to absorb slowly. The client should use the applicator paper to measure the amount of ointment to apply. The client should rotate the application sites to avoid skin irritation. The client should remove any remaining ointment with a tissue before applying a new dose.

A client with emphysema is receiving continuous oxygen therapy. Depressed ventilation is likely to occur unless the nurse ensures that the oxygen is administered in which way?

The client with emphysema has a chronically elevated carbon dioxide level. As a result, the normal stimulus for breathing in the medulla becomes ineffective. Instead, peripheral pressoreceptors in the aortic arch and carotid arteries, which are sensitive to oxygen blood levels, stimulate respirations. This is in response to low oxygen levels that have developed over time. If the client receives high concentrations of oxygen, the blood level of oxygen will rise excessively, the stimulus for respiration will decrease, and respiratory failure may result. Oxygen is not cooled. Humidification or administration of the oxygen through a nasal cannula will not prevent depressed ventilation if the flow rate of the oxygen is too high.

A nurse is planning postoperative care for a client who has received a general anesthetic. During the immediate postoperative period, which nursing assessment should the nurse be most concerned about?

The nurse should check for bleeding, monitor the vital signs, and promote urine output after airway patency has been established. Heart rate of 130 bpm, blood pressure of 98/56 mm Hg, and inspirations of 24 indicates the early signs and symptoms of shock and the nurse should be most concerned about these.

After a tonsillectomy, a client is being prepared for discharge. The nurse should instruct the client to report which sign or symptom immediately?

The nurse should instruct the client to report bleeding immediately. Delayed bleeding may occur when the healing membrane separates from the underlying tissue — usually 7 to 10 days postoperatively. Difficulty swallowing and throat pain are expected after a tonsillectomy and typically are present even before the client is discharged. Sudden difficulty talking wouldn't occur after discharge if the client could talk normally at the time of discharge, because swelling doesn't take that long to develop.

For a client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the care plan?

The nurse should regularly measure and document the amount of chest tube drainage to detect abnormal drainage patterns, such as may occur with a hemorrhage (if excessive) or a blockage (if decreased). Continuous bubbling in the water-seal chamber indicates a leak in the closed chest drainage system, which must be corrected. The nurse should keep the collection chamber below chest level to allow fluids to drain into it. The nurse shouldn't strip chest tubes because doing so may traumatize the tissue or dislodge the tube.

The nurse is planning care for a client with acute respiratory distress syndrome (ARDS). Which action will be most helpful to promote effective airway clearance?

The nurse should suction the client if the client is not able to cough up secretions and clear the airway. Administering oxygen will not promote airway clearance. The client should be turned every 2 hours to help move secretions; every 4 hours is not often enough. Administering sedatives to promote rest is contraindicated in ARDS because sedatives can depress respirations.

The nurse is teaching a client to deep breathe effectively after a lobectomy. What should the nurse instruct the client to do?

The recommended procedure for teaching clients postoperatively to deep breathe includes contracting (pulling in) the abdominal muscles and taking a slow, deep breath through the nose. This breath is held for 3 to 5 seconds, which facilitates alveolar ventilation by improving the inspiratory phase of ventilation. Exhaling slowly as if trying to blow out a candle is a technique used in pursed-lip breathing to facilitate exhalation in clients with chronic obstructive pulmonary disease (COPD). It is recommended that the abdominal muscles be contracted, not relaxed, to promote deep breathing. The client should breathe through the nose.

The nurse is evaluating a client who received tissue plasminogen activator (t-PA) following a myocardial infarction (MI). What is the expected outcome of this drug?

The thrombolytic agent t-PA, administered intravenously, lyses the clot blocking the coronary artery. The drug is most effective when administered within the first 6 hours after the onset of an MI. The drug does not reduce coronary artery vasospasm; nitrates are used to promote vasodilation. Arrhythmias are managed by antiarrhythmic drugs. Surgical approaches are used to open the coronary artery and re-establish a blood supply to the area.

A client diagnosed with an empyema is scheduled for a thoracentesis. The nurse should prepare the client for this procedure with which action?

This procedure can be done at the bedside. The nurse should help to position the client correctly. The best position for the procedure is to place the client in a sitting position with arms raised and resting on an overbed table. This position helps to spread out the spaces between the ribs for needle insertion. It is not necessary for the client to receive a sedative or be sent to the catheterization lab. The client does not have to be NPO for this procedure.

A client has acute arterial occlusion. The health care provider has prescribed intravenous (IV) heparin. What should the nurse do before starting the medication?

Before starting a heparin infusion, the nurse needs to know the client's baseline blood coagulation values (hematocrit, hemoglobin, red blood cell count, and platelet count). In addition, the partial thromboplastin time should be monitored closely during the process. The client's stools would be tested only if internal bleeding is suspected. Although monitoring vital signs such as apical pulse is important in assessing potential signs and symptoms of hemorrhage or potential adverse reactions to the medication, vital signs are not the most important data to collect before administering the heparin. Intake and output are not important assessments for heparin administration unless the client has fluid and volume problems or kidney disease.

A nurse is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which intervention will most likely lower the client's arterial blood oxygen saturation?

Endotracheal suctioning removes secretions as well as gases from the airway and lowers the arterial oxygen saturation (SaO2) level. Coughing and using an incentive spirometer improve oxygenation and should raise or maintain oxygen saturation. Because of superficial vasoconstriction, using a cooling blanket can lower peripheral oxygen saturation readings, but SaO2 levels wouldn't be affected.

The nurse is assessing the respiratory status of a client who is experiencing an exacerbation of chronic obstructive pulmonary disease (COPD) secondary to an upper respiratory tract infection. Which finding is expected?

Exacerbations of COPD are commonly caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. In COPD, breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. Expiration, not inspiration, becomes prolonged. Chest movement is decreased as lungs become overdistended.

Which complication is associated with mechanical ventilation?

Gastrointestinal hemorrhage occurs in about 25% of clients receiving prolonged mechanical ventilation because of the development of stress ulcers. Clients who are receiving steroid therapy and those with a previous history of ulcers are most likely to be at risk. Other possible complications include incorrect ventilation, oxygen toxicity, fluid imbalance, decreased cardiac output, pneumothorax, infection, and atelectasis. Complications associated with positive pressure mechanical ventilation may include: damage to the lungspneumothoraxpneumomediastinumpneumopericardiumpneumoperitoneumsubcutaneous emphysema hemodynamic changesreduced venous returnincreased pulmonary vascular resistance, which can decrease cardiac output ventilator-associated pneumonia gastric bleeding from stress ulcers.

A client with chronic obstructive pulmonary disease tells a nurse that they feel short of breath. The client's respiratory rate is 36 breaths/minute and the nurse auscultates diffuse wheezes. The client's arterial oxygen saturation is 84%. The nurse calls the assigned respiratory therapist to administer an ordered nebulizer treatment. The therapist says, "I have several more nebulizer treatments to do on the unit where I am now. As soon as I'm finished, I'll come and assess the client." The nurse's most appropriate action is to

The client's needs are preeminent, so the nurse should administer the nebulizer treatment immediately. The nurse can deal with the respiratory therapist's lack of response after the client's condition is stabilized. There is no need to involve the physician in personnel issues. Staying with the client is important, but it isn't a substitute for administering the needed bronchodilator. The order is for a nebulizer treatment not a metered-dose inhaler, so the nurse can't change the route without a new order from the physician.

A client with bronchitis is ordered 300 mg of liquid guaifenesin every 4 hours. The container indicates that there is 200 mg/5 mL. How many milliliters should the nurse administer per dose? Record your answer using one decimal place.

The following formula is used to calculate the drug dosage: Dose on hand/Quantity on hand = Dose desired/X. Plug in the values for this equation: 200 mg/5 mL = 300 mg/X = 7.5 mL

A client with mild intermittent asthma is seen in the emergency department with a swollen ankle and a potential ankle sprain. A focused nursing history reveals that the client uses an albuterol inhaler but did not bring the inhaler. Also, the client has been taking antibiotics for a "sore throat." The client's heart rate is 110 bpm, and the respiration rate is 20 breaths/min. The nurse listens to the client's breath sounds and hears wheezes. What should the nurse do next?

The priority for this client is to maintain an open airway. The client has wheezes and should use an inhaler. After assuring an open airway, the nurse can obtain an ice pack for the swollen leg. The client does not require oxygen at this time. The nurse can later complete the health assessment and inspect the client's throat.

A positive tuberculin skin test indicates that a client

The tuberculin skin test is based on the antigen/antibody response and will show a positive reaction after an individual has been exposed to tuberculosis and has formed antibodies to the tuberculosis bacteria. Thus, a positive tuberculin skin test indicates the production of an immune response. Exposure doesn't confer immunity. A positive test doesn't confirm that a person has (or will develop) tuberculosis.

A client with asthma has been taking theophylline as ordered. Now, the client's blood theophylline level is 4.8 mcg/ml. Which dosage change will the physician order?

When the client's serum theophylline concentration falls below the therapeutic level, the daily dosage of the ordered methylxanthine agent should be increased by up to 25%, and the serum theophylline concentration should be rechecked before further dosage changes are made. Decreasing the dose, maintaining the dose, or omitting a dose wouldn't help increase the serum theophylline level to therapeutic levels. (10-20)

The nurse is supervising a student nurse who is performing tracheostomy care for a client. Which action performed by the student would require nurse intervention?

When tracheostomy care is performed, sterile technique is used and standard precautions are not enough (universal). The presence of an inner cannula provides direct access to the lungs for organisms, so sterile technique must be used to decrease the risk of infection. All other steps are appropriate.

A nurse instructs a client with allergic rhinitis about the correct technique for using an intranasal inhaler. Which statement indicates that the client understands the instructions?

When using an intranasal inhaler, it is important to close off one nostril while inhaling the spray into the other nostril to ensure the best inhalation of the spray. The use of the inhaler is not limited to mornings and bedtime. The canister should be shaken immediately before use. The inhaler tip should be inserted into the nostril and pointed toward the outside nostril wall to maximize inhalation of the medication.

An adult with a history of chronic obstructive pulmonary disease (COPD) and metastatic carcinoma of the lung has not responded to radiation therapy and is being admitted to the hospice program. The nurse should conduct a focused assessment for which symptom?

Dyspnea is a distressing symptom in clients with advanced cancer including metastatic carcinoma of the lung, previous radiation therapy, and coexisting COPD. Ascites does occur in clients with metastatic carcinoma; however, in the client with COPD and lung cancer, dyspnea is a more common finding. A pleural friction rub is usually associated with pneumonia, pleurisy, or pulmonary infarct.

The nurse is assigned to a client in the ICU. During the initial assessment, the nurse notes jugular vein distention and recognizes that the plan of care will follow which disorder?

Elevated venous pressure, exhibited as jugular vein distention, indicates the heart's failure to pump. Jugular vein distention is not a symptom of abdominal aortic aneurysm or pneumothorax. If severe enough, an MI can progress to heart failure, but an MI alone does not cause jugular vein distention.

The nurse is auscultating the lungs of a client with bacterial pneumonia. Which finding is expected?

Increased fremitus can be present in bacterial pneumonia, indicating the presence of pulmonary consolidation. Additional findings would include crackles, bronchial breath sounds, and dullness on percussion. Bilateral expiratory wheezing and resonance on percussion are not present in bacterial pneumonia. Vesicular breath sounds are normal and would not be an expected finding in bacterial pneumonia.

The nurse is preparing to suction a tracheostomy for a client with methicillin-resistant Staphylococcus aureus (MRSA) (see figure). What should the nurse do next?

The nurse is wearing protective personnel equipment appropriate for suctioning the client: goggles, gown, and respirator mask. It is not necessary to wear a PAPR face shield to suction a tracheostomy. A surgical mask does not provide maximum protection. The nurse must wear protective personnel equipment when caring for a client with a MRSA infection.

Which assessment finding puts a client at increased risk for epistaxis?

Using nasally inhaled illicit drugs, such as cocaine, increases the risk of epistaxis (nosebleed) because of the increased vascularity of the nasal passages. A dry environment (not a humidified one) increases the risk of epistaxis. Hypertension, not hypotension, increases the risk of epistaxis. A history of nasal surgery doesn't increase the risk of epistaxis.

A client is taking verapamil hydrochloride as an antihypertensive. Which statement made by the nurse instructs the client about an adverse effect of verapamil?

Verapamil can cause irregular cardiac rhythms. Clients should be taught to take their pulse and report any irregular heartbeats to their health care provider.Diarrhea is not a problem; constipation is the most common adverse effect of verapamil.Verapamil does not cause bone marrow depression.The client does not need to restrict fluids. Instead, a normal fluid intake is encouraged to prevent constipation. Verapamil = CCB

A client admitted to the facility for treatment for tuberculosis receives instructions about the disease. Which statement made by the client indicates the need for further instruction?

The client requires additional teaching if they state that they'll be in isolation for 6 weeks. The client needs to be in isolation for 2 weeks, not 6, while taking the tuberculosis drugs. After 2 weeks of antitubercular therapy, the client is no longer considered contagious. The client needs to receive the drugs for 9 months to a year. The client will be positive when tested and if they are sick or under some stress they could have a relapse of the disease.

A nurse is caring for a client who is at high risk for developing pneumonia. Which intervention should the nurse include on the client's care plan?

The nurse should use strict hand hygiene to help minimize the client's exposure to infection, which could lead to pneumonia. The head of the bed should be kept at a minimum of 30 degrees. The client should be turned and repositioned at least every 2 hours to help promote secretion drainage. Oral hygiene should be performed every 4 hours to help decrease the number of organisms in the client's mouth that could lead to pneumonia.