respiratory questions part 2 1130

When assessing for substances that are known to harm workers' lungs, the occupational health nurse should assess their potential exposure to which of the following? A.Solvents B.Asbestos C.Gypsum D.Organic acids

B Asbestos is among the more common causes of pneumoconiosis. Organic acids, solvents, and gypsum do not have this effect.

A new employee asks the occupational health nurse about measures to prevent inhalation exposure to toxic substances. What should the nurse recommend? A."Wear protective attire and devices when working with a toxic substance." B."Always wear a disposable paper face mask when you are working with inhalable toxins." C."Make sure that you keep your immunizations up to date to prevent respiratory diseases resulting from toxins." D."Position a fan blowing toxic substances away from you to prevent you from being exposed."

A

Which action should the nurse take first in caring for a client during an acute asthma attack? A.Administer bronchodilator as ordered. B.Send for STAT chest x-ray. C.Obtain arterial blood gases. D.Initiate oxygen therapy and reassess pulse oximetry in 10 minutes.

A Administering bronchodilator will dilate the airway and allow oxygen to reach the lungs. Although ABGs and chest x-ray are valid diagnostic tests for lung disorders, immediate action to restore gas exchange is a priority in an acute attack. The administration of oxygen is indicated, but without open bronchioles, the action will not be effective in an acute attack.

A nurse caring for a client with deep vein thrombosis must be especially alert for complications such as pulmonary embolism. Which findings suggest pulmonary embolism? A.Chest pain and dyspnea B.Nonproductive cough and abdominal pain C.Bradypnea and bradycardia D.Hypertension and lack of fever

A As an embolus occludes a pulmonary artery, it blocks the supply of oxygenated blood to the heart, causing chest pain. It also blocks blood flow to the lungs, causing dyspnea. The client with pulmonary embolism typically has a cough that produces blood-tinged sputum (rather than a nonproductive cough) and chest pain (rather than abdominal pain). Hypertension, absence of fever, bradypnea, and bradycardia aren't associated with pulmonary embolism.

The nurse at a long-term care facility is assessing each of the residents. Which resident most likely faces the greatest risk for aspiration? A.A resident with mid-stage Alzheimer disease B.A 92-year-old resident who needs extensive help with C.ADLs A resident who suffered a severe stroke several weeks ago D.A resident with severe and deforming rheumatoid arthritis

A Aspiration may occur if the client cannot adequately coordinate protective glottic, laryngeal, and cough reflexes. These reflexes are often affected by stroke. A client with mid-stage Alzheimer disease does not likely have the voluntary muscle problems that occur later in the disease. Clients that need help with ADLs or have arthritis should not have difficulty swallowing unless it exists secondary to another problem.

Which would be least likely to contribute to a case of hospital-acquired pneumonia? A.A nurse washes her hands before beginning client care. B.Host defenses are impaired. C.Inoculum of organisms reaches the lower respiratory tract and overwhelms the host's defenses. D.A highly virulent organism is present.

A HAP occurs when at least one of three conditions exists: host defenses are impaired, inoculums of organisms reach the lower respiratory tract and overwhelm the host's defenses, or a highly virulent organism is present.

During a community health fair, a nurse is teaching a group of seniors about promoting health and preventing infection. Which intervention would best promote infection prevention for senior citizens who are at risk of pneumococcal and influenza infections? A.Receive vaccinations B.Take all prescribed medications C.Exercise daily D.Drink six glasses of water daily

A Identifying clients who are at risk for pneumonia provides a means to practice preventive nursing care. The nurse encourages clients at risk of pneumococcal and influenza infections to receive vaccinations against these infections.

An adult client has tested positive for tuberculosis (TB). While providing client teaching, what information should the nurse prioritize? A.The importance of adhering closely to the prescribed medication regimen B.The fact that TB is self-limiting, but can take up to 2 years to resolve C.The need to work closely with the occupational and physical therapists D.The fact that the disease is a lifelong, chronic condition that will affect ADLs

A Successful treatment of TB is highly dependent on careful adherence to the medication regimen. The disease is not self-limiting; occupational and physical therapy are not necessarily indicated. TB is curable.

When interpreting the results of a Mantoux test, the nurse explains to the client that a reaction occurs when the intradermal injection site shows A.redness and induration. B.tissue sloughing. C.drainage. D.bruising.

A The injection site is inspected for redness and palpated for hardening. Drainage at the injection site does not indicate a reaction to the tubercle bacillus. Sloughing of tissue at the injection site does not indicate a reaction to the tubercle bacillus. Bruising of tissue at the site may occur from the injection but does not indicate a reaction to the tubercle bacillus.

A client is receiving thrombolytic therapy for the treatment of pulmonary emboli. What is the best way for the nurse to assess the client's oxygenation status at the bedside? A.Monitor incentive spirometry volumes. B.Monitor pulse oximetry readings. C.Obtain serial ABG samples. D.Perform chest auscultation.

B

The nurse is interpreting blood gases for a client with acute respiratory distress syndrome (ARDS). Which set of blood gas values indicates respiratory acidosis? A.pH 7.47, PaCO2 28, HCO3 30 B.pH 7.25, PaCO2 48, HCO3 24 C.pH 7.87, PaCO2 38, HCO3 28 D.pH 7.49, PaCO2 34, HCO3 25

B

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.hemothorax. B.pleural effusion. C.consolidation. D.pneumothorax.

B Fluid accumulating within the pleural space is called a pleural effusion. A pneumothorax is air in the pleural space. A hemothorax is blood within the pleural space. Consolidation is lung tissue that has become more solid in nature as a result of the collapse of alveoli or an infectious process.

You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia? A.Place client on bed rest. B.Encourage increased fluid intake. C.Give antibiotics as ordered. D.Offer nutritious snacks 2 times a day.

B The nurse places the client in semi-Fowler's position to aid breathing and increase the amount of air taken with each breath. Increased fluid intake is important to encourage because it helps to loosen secretions and replace fluids lost through fever and increased respiratory rate. The nurse monitors fluid intake and output, skin turgor, vital signs, and serum electrolytes. He or she administers antipyretics as indicated and ordered. Antibiotics are not given for viral pneumonia. The client's activity level is ordered by the physician, not decided by the nurse.

The perioperative nurse is writing a care plan for a client who has returned from surgery 2 hours ago. Which measure should the nurse implement to most decrease the client's risk of developing pulmonary emboli (PE)? A.Administering aspirin with warfarin B.Increased dietary intake of protein C.Early ambulation D.Maintaining the client in a supine position

C For clients at risk for PE, the most effective approach for prevention is to prevent deep vein thrombosis. Active leg exercises to avoid venous stasis, early ambulation, and use of elastic compression stockings are general preventive measures. The client does not require increased dietary intake of protein directly related to prevention of PE, although it will assist in wound healing during the postoperative period. The client should not be maintained in one position, but frequently repositioned, unless contraindicated by the surgical procedure. Aspirin should never be given with warfarin because it will increase the client's risk for bleeding.

On auscultation, which finding suggests a right pneumothorax? A.Bilateral inspiratory and expiratory crackles B.Bilateral pleural friction rub C.Absence of breath sounds in the right thorax D.Inspiratory wheezes in the right thorax

C In pneumothorax, the alveoli are deflated and no air exchange occurs in the lungs. Therefore, breath sounds in the affected lung field are absent. None of the other options are associated with pneumothorax. Bilateral crackles may result from pulmonary congestion, inspiratory wheezes may signal asthma, and a pleural friction rub may indicate pleural inflammation.

A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care? A.Maintaining a cool room temperature B.Elevating the head of the bed 30 degrees C.Encouraging increased fluid intake D.Turning the client every 2 hours

C Increasing the client's intake of oral or I.V. fluids helps liquefy thick, tenacious secretions and ensures adequate hydration. Turning the client every 2 hours would help prevent pressure ulcers but wouldn't help with the secretions. Elevating the head of the bed would reduce pressure on the diaphragm and ease breathing but wouldn't help the client with secretions. Maintaining a cool room temperature wouldn't help the client with secretions.

A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse know is the most common organism that causes community-acquired pneumonia? A.Staphylococcus aureus B.Mycobacterium tuberculosis C.Streptococcus pneumoniae D.Pseudomonas aeruginosa

C Streptococcus pneumoniae (pneumococcus) is the most common cause of community-acquired pneumonia in people younger than 60 years without comorbidity and in those 60 years and older with comorbidity (Wunderink & Niederman, 2012). S. pneumoniae, a gram-positive organism that resides naturally in the upper respiratory tract, colonizes the upper respiratory tract and can cause disseminated invasive infections, pneumonia and other lower respiratory tract infections, and upper respiratory tract infections such as otitis media and rhinosinusitis. It may occur as a lobar or bronchopneumonic form in patients of any age and may follow a recent respiratory illness.

A client who underwent surgery 12 hours ago has difficulty breathing. He has petechiae over his chest and complains of acute chest pain. What action should the nurse take first? A.Administer a heparin bolus and begin an infusion at 500 units/hour. B.Perform nasopharyngeal suctioning. C.Initiate oxygen therapy. D.Administer analgesics as ordered.

C The client's signs and symptoms suggest pulmonary embolism. Therefore, maintaining respiratory function takes priority. The nurse should first initiate oxygen therapy and then notify the physician immediately. The physician will most likely order an anticoagulant such as heparin or an antithrombolytic to dissolve the thrombus. Analgesics can be administered to decrease pain and anxiety but administering oxygen takes priority. Suctioning typically isn't necessary with pulmonary embolism.

You are an occupational health nurse in a large ceramic manufacturing company. How would you intervene to prevent occupational lung disease in the employees of the company? A.Provide employees with smoking cessation materials. B.Give workshops on disease prevention. C.Insist on adequate breaks for each employee. D.Fit all employees with protective masks.

D

A client admitted with multiple traumatic injuries receives massive fluid resuscitation. Later, the physician suspects that the client has aspirated stomach contents. The nurse knows that this client is at highest risk for: A.bronchial asthma. B.chronic obstructive pulmonary disease (COPD). C.renal failure. D.acute respiratory distress syndrome (ARDS).

D A client who receives massive fluid resuscitation or blood transfusions or who aspirates stomach contents is at highest risk for ARDS, which is associated with catastrophic events, such as multiple trauma, bacteremia, pneumonia, near drowning, and smoke inhalation. COPD refers to a group of chronic diseases, including bronchial asthma, characterized by recurring airflow obstruction in the lungs. Although renal failure may occur in a client with multiple trauma (depending on the organs involved), this client's history points to an assault on the respiratory system secondary to aspiration of stomach contents and massive fluid resuscitation.

A client with acquired immunodeficiency syndrome (AIDS) develops Pneumocystis carinii pneumonia. Which nursing diagnosis has the highest priority? A.Impaired oral mucous membranes B.Activity intolerance C.Imbalanced nutrition: Less than body requirements D.Impaired gas exchange

D Although all of these nursing diagnoses are appropriate for a client with AIDS, Impaired gas exchange is the priority nursing diagnosis for a client with P. carinii pneumonia. Airway, breathing, and circulation take top priority for any client.

A client who sustained a pulmonary contusion in a motor vehicle crash develops a pulmonary embolism. Which nursing diagnosis takes priority with this client? A.Acute pain related to tissue trauma B.Excess fluid volume related to excess sodium intake C.Ineffective breathing pattern related to tissue trauma D.Activity intolerance related to insufficient energy to carry out activities of daily living

D Although all of these nursing diagnoses are appropriate for this client, Ineffective breathing pattern takes priority. According to Maslow's hierarchy of needs, air is essential to maintain life and is assigned highest priority, along with the other physiologic needs, such as food, elimination, temperature control, sex, movement, rest, and comfort.

The nurse is conducting a community program about prevention of respiratory illness. What illness does the nurse know is the most common cause of death from infectious diseases in the United States? A.Tracheobronchitis B.Atelectasis C.Pulmonary embolus D.Pneumonia

D Pneumonia and influenza are the most common causes of death from infectious diseases in the United States.

During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must: A.turn and reposition himself every 2 hours. B.maintain fluid intake of 40 oz (1,200 ml) per day. C.follow up with the physician in 2 weeks. D.continue to take antibiotics for the entire 10 days.

D The client demonstrates understanding of how to prevent relapse when he states that he must continue taking the antibiotics for the prescribed 10-day course. Although the client should keep the follow-up appointment with the physician and turn and reposition himself frequently, these interventions don't prevent relapse. The client should drink 51 to 101 oz (1,500 to 3,000 ml) per day of clear liquids.