Respiratory chap 21

the icu nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. the nurse knows that this client is at increased risk for fwhich of the following.

acute respiratory distress syndrome

the nurse caring for a 2 year old near drowning victim monitors for what possible complication.

acute respiratory syndrome

which action should the nurse take first in caring for a client during an acute asthma attack

administer bronchodilator as ordered

a client is admitted to the er with a stab wound and is now presenting dyspnea tachypnea and sucking noise heard on inspiration and expiration the nurse should care for the wound which manner

apply airtight dressing

the nurse is obtaining data from a client with a respiratory disorder which information would be considered a part of the functional assessment and assist in the diagnosis of an occupational lung disease

black streaked sputum

following a femur fracture surgical repair the client develops hemoptysis wheezing and cyanosis the suspects a pulmonary embolus that originated from which site

bone marrow

the client has self been self medicating with antitussives which assessment finding would alert the nurse to a adverse effect of this medication

crackles in the bases

while caring for a client with a chest tube which nursing assessment would alert the nurse to a possible complication

crackling is heard when skin around tube is touched

what is the reason for chest tubes after thoracic surgery.

draining secretions, air, and blood from the thoracic cavity is necessary

which of the following provides the best example of documentation for a client who is presenting with acute bronchitis

dry, frequent cough with occasional productive sputum

the nurse knows the mortality rate is high in lung cancer clients due to which factor

few early syptoms

the occupational nurse is completing routine assessments on the employees. what might be revealed by a chest radiograph for a client with occupational lung disease.

fibrotic changes in lungs

when the nurse monitors the water sealed drainage system which finding suggests the system is working properly

fluid rises and falls with respiration

the nurse is preparing a client for emergency thoracic surgery. what would the nurse document in the assessment.

general statement of the clients condition

what are the conditions that make up vichows triad

hypercoagulability, disruption of the vessel lining, venostasis

the client with a lower respiratory airway infection, is presenting with symptoms such a fever chills dry hacking cough and wheezing, which nursing diagnosis best supports the assessment by the nurse

ineffective airway clerence

the client with acute respiratory distress syndrome present with severe hypoxemia in spite of oxygen administered via face mask which intervention would the nurse anticipate and prepare for

insertion of endotracheal tube

the nurse is assessing a clients potential for pulmonary emboli. what findings indicates possible deep vein thrombosis

localized calf tenderness

the nurse identifies which finding to be most consistent prior to the onset for acute respiratory distress

normal lung function

a client is brought to the er following a mva which of the following nursing assessment is significant in diagnosing the client with frail chest

paradoxical chest movement

the nurse is caring for a client who just been diagnosis with lung cancer. what is a cardinal sign of lung cancer.

persistent cough and blood streaked sputum

which is a primary nursing intervention in caring for a client with the diagnosis of bronchiectasis

postural drainage

when managing the postoperative pain after a pneumonectomy the nurse is most concerned about which data

respirations 10 breaths/min

upon assessing a client with emphysema the nursing notes increased difficulty with inspiration

rigid chest cage

in the prevention of occupational lung disease the nurse would direct prevention teaching to which high risk occupations

rock quarry worker , miner, mechanic

which statement would indicate that the parents of a child with cystic fibrosis understand the disorder

the mucus secreting glands are abnormal

a client with pulmonary hypertension asks the nurse to explain the heart changes that can occur with this disorder

the right side of the heart enlarges as pressure backs from the lungs

the client admitted with a deep vein thrombosis is now complaining of chest pain and dyspnea which primary intervention for the nurse to take

apply oxygen mask

the clinical nurse is caring for a client with acute bronchitis. the client asks what may have caused the infection. what may induce acute bronchitis,

chemical irritation

the nurse is caring for a client with a closed chest drainage system while repositioning the client the tube dislodges what is the immediate nursing intervention

cover the exist site

which nursing assessment would alert a nurse to the development of a mediastinal shift in the client with tension pneumothorax

shift of trachea esophagus heart and great vessels

the client asks the nurse to explain the reason for a chest tube insertion in treating a pneumothorax which is the best response by the nurse

the tube will drain air from the space around the lung

a client who is at risk for pneumonia has been ordered influenza vaccine which statement from the nurse best explains the rationale for this vaccine

viruses like influenza are common causes of pneumonia