Study guide final nursing 1355

The nurse is assessing a client with chronic obstructive pulmonary disease. Which finding requires immediate intervention? A. inability to speak B. distant heart sounds C. pursed lip breathing D. diminished lung sounds

A. inability to speak

Primary respiratory defense

Alveolar macrophages Mucociliary clearance

A nurse is assessing a client with chronic airflow limitation and notes that the client has a "barrel chest." The nurse interprets that this client has which of the following forms of chronic airflow limitation? A. Chronic obstructive bronchitis B. Emphysema C. Bronchial asthma D. Bronchial asthma and bronchitis

B. Emphysema

A client had posterior packing inserted to control a severe nosebleed. After insertion of the packing, the nurse should observe the client for which finding? A. Bell's palsy B. hypoventilation C. vertigo D. loss of gag reflex

B. hypoventilation

Your patient's aPTT level is 32 seconds. The nurse would interpret this lab result as? A. Too high, the patient is at risk for bleeding B. Too low C. Normal D. Therapeutic level

C. Normal

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? A. pulmonary embolism B. heart failure C. myocardial infarction (MI) D. pneumothorax

D. pneumothorax

INH

Interferes with DNA metabolism -Bacteriostatic & bacteriocidal Side effects: -Peripheral neuritis -Liver toxicity (monitor liver function labs, ALT, AST) Patient education -Vitamin B6

Prevent transmission of TB during hospitalization

Private isolation rooms Negative air pressure in room Air exchanges 6 times/hour Particulate respirator worn (N95-must be fit tested)

What is trough level and when should it be drawn?

Take 30 minutes before you give a med Lowest blood level of a drug

What tests are used to dx TB?

Tuberculin skin test (Mantoux) Chest x-ray Sputum smear & culture (AFB)

The nurse is developing a care plan for a client with tuberculosis. Which measures would be implemented for staff prior to entering the room? A. Wear a gown and gloves when in contact with the client. B. Wear a mask, gown, and gloves when providing care. C. Prevent visitors from visiting to reduce the possibility of transmission. D. Wear a mask at all times when entering the room.

D. Wear a mask at all times when entering the room.

A 70-year-old client has a complicated medical history, including chronic obstructive pulmonary disease. Which client statement indicates the need for further teaching about prevention of complications? A. "I am here to receive the yearly pneumonia shot again." B. "I am here to get my yearly flu shot again." C. "I should avoid large gatherings during cold and flu season." D. "I should cough into my upper sleeve instead of my hand."

A. "I am here to receive the yearly pneumonia shot again."

Which of the following ABG abnormalities should the nurse anticipate in a client with advanced COPD? A. Increased PaCO2 B. Increased PaO2 C. Increased pH D. Increased oxygen saturation

A. Increased PaCO2

The nurse is planning to teach a client with COPD how to cough effectively. Which of the following instructions should be included? A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation. B. Lie flat on back, splint the thorax, take two deep breaths and cough. C. Take several rapid, shallow breaths and then cough forcefully. D. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.

A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.

The nurse is providing education for a client who is taking isoniazid, rifampin, and ethambutol for tuberculosis. Which of these points does the nurse include in the plan of care? Select all that apply. A. Take a supplement containing B vitamins. B. Avoid alcohol-containing beverages. C. Have kidney function tests monthly. D. Report changes in vision to the health care provider. E. Notify the health care provider for red-orange urine

A. Take a supplement containing B vitamins. B. Avoid alcohol-containing beverages. D. Report changes in vision to the health care provider.

Dx of PE

ABG'S -Arterial hypoxemia, hypocapnia, & respiratory alkalosis (turn into metabolic acidosis) V/Q lung scan -Illustrates perfusion & ventilation Spiral CT -HALLMARK TEST Pulmonary angiography ECG

Tuberculosis

An infectious communicable disease caused by mycobacterium tuberculosis Spread by airborne droplet nuclei -Cough, sneeze, speak, sing Increasing due to HIV and MDR organisms At risk populations: -Homeless -HIV + -Alcohol, drug abusers -Immigrants -Living in crowded conditions

A client is scheduled to have a tracheostomy placed in an hour. What action by the nurse is the priority? A. Administer prescribed anxiolytic medication. B. Ensure informed consent is on the chart. C. Reinforce any teaching done previously. D. Start the preoperative antibiotic infusion.

B. Ensure informed consent is on the chart.

The nurse knows that which medications are used in the initial treatment of TB? A. Penicillin and Ceftriaxone B. Rifampin and Isoniazid C. Doxycycline and Amoxicillin D. Rifampin and Vancomycin

B. Rifampin and Isoniazid

Ethambutol

Bacteriostatic Inhibits synthesis of RNA Used to treat multi-drug resistant organisms Side effects -Optic neuritis (reversible) -GI irritation Patient education -Have vision checked monthly -Instruct to give with food

A client is receiving oxygen at 4 liters per nasal cannula. What comfort measure may the nurse delegate to unlicensed assistive personnel (UAP)? A. Apply water-soluble ointment to nares and lips. B. Periodically turn the oxygen down or off. C. Remove the tubing from the client's nose. D. Turn the client every 2 hours or as needed.

A. Apply water-soluble ointment to nares and lips.

An unlicensed assistive personnel (UAP) was feeding a client with a tracheostomy. Later that evening, the UAP reports that the client had a coughing spell during the meal. What action by the nurse takes priority? A. Assess the client's lung sounds. B. Assign a different UAP to the client. C. Report the UAP to the manager. D. Request thicker liquids for meals.

A. Assess the client's lung sounds.

The nurse is teaching the client about completely antibiotic therapy for bacterial pharyngitis. The nurse hears the client tell her husband that she hates taking pills and will stop taking the medicine when she feels 100% better. What is the nurse's best action? A. Educate the client about the importance of completely finishing the antibiotics to prevent resistant bacterial infections B. Do nothing because the client has already been told to complete the antibiotic therapy C. Let the client know that is ok because the infection is gone when the symptoms are gone D. Inform the client that if she does not finish the antibiotics she can use them for future infections without the need for another doctor's appointment

A. Educate the client about the importance of completely finishing the antibiotics to prevent resistant bacterial infections

A client has been diagnosed with tuberculosis (TB). What action by the nurse takes highest priority? A. Educating the client on adherence to the treatment regimen B. Encouraging the client to eat a well-balanced diet C. Informing the client about follow-up sputum cultures D. Teaching the client ways to balance rest with activity

A. Educating the client on adherence to the treatment regimen

An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she developed a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the nurse best interpret these assessment findings? A. It is likely that the client is developing a secondary bacterial pneumonia. B. The assessment findings are consistent with influenza and are to be expected. C. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions D. The client has not been taking her decongestants and bronchodilators as prescribed

A. It is likely that the client is developing a secondary bacterial pneumonia.

The nurse is caring for a patient with a post-operative complication of PE. The patient has been receiving treatment for several days. Which factors are indicators of adequate perfusion in the patient? (Select all that apply.) A. Pulse oximetry of 95% B. Arterial blood gas, pH of 7.28 C. Patient's subjective desire to ho home D. Absence of pallor or cyanosis E. Mental status at patient's baseline

A. Pulse oximetry of 95% D. Absence of pallor or cyanosis E. Mental status at patient's baseline

Which are the risk factors for pulmonary embolism (PE) and deep vein thrombosis (DVT)? (Select all that apply.) A. Trauma B. Swimming activity C. Heart failure D. Chronic obstructive pulmonary disease (COPD) E. Cancer (particularly lung or prostate)

A. Trauma C. Heart failure E. Cancer (particularly lung or prostate)

A nurse is caring for a client with a traumatic injury and developing tension pneumothorax. Which assessment data would be of concern? Select all that apply. A. hypotension B. bradypnea C. decreased cardiac output D. tracheal deviation to the affected side E. tracheal deviation to the opposite side F. flattened jugular veins

A. hypotension C. decreased cardiac output E. tracheal deviation to the opposite side

A client asks a nurse a question about the tuberculin skin test for tuberculosis. The nurse should base their response on the fact that the A. skin test doesn't differentiate between active and dormant tuberculosis infection. B. area of redness is measured in 3 days and determines whether tuberculosis is present. C. presence of a wheal at the injection site in 2 days indicates active tuberculosis. D. test stimulates a reddened response in some clients and requires a second test in 3 months.

A. skin test doesn't differentiate between active and dormant tuberculosis infection.

A client admitted for pneumonia has been tachypneic for several days. When the nurse starts an IV to give fluids, the client questions this action, saying "I have been drinking tons of water. How am I dehydrated?" What response by the nurse is best? A."Breathing so quickly can be dehydrating." B."Everyone with pneumonia is dehydrated." C."This is really just to administer your antibiotics." D."Why do you think you are so dehydrated?"

A."Breathing so quickly can be dehydrating."

A client has been taking isoniazid (INH) for tuberculosis for 3 weeks. What laboratory results need to be reported to the health care provider immediately? A. Albumin: 5.1 g/dL B. Alanine aminotransferase (ALT): 180 U/L C. Red blood cell (RBC) count: 5.2/mm3 D. White blood cell (WBC) count: 12,500/mm3

B. Alanine aminotransferase (ALT): 180 U/L INH can cause liver damage, especially if the client drinks alcohol. The ALT (one of the liver enzymes) is extremely high and needs to be reported immediately. The albumin and RBCs are normal. The WBCs are slightly high, but that would be an expected finding in a client with an infection.

An older client presents to the emergency department with a 2-day history of cough, pain, wheezing, and dyspnea. The medical record states the client has not received the pneumococcal vaccine. While collaborating with the interprofessional team, which one of these medications does the nurse anticipate the health care provider will recommend as the priority? A. Corticosteroid B. Beta agonist C. Pneumococcal vaccine D. Antibiotic

B. Beta agonist The priority medication the nurse would expect the HCP to order is a beta-2 agonist or bronchodilator to help decrease bronchospasm and wheezing. This medication allows for adequate oxygenation by relaxing bronchial smooth muscle in the airways, and acts quickly to maintain airway patency. A corticosteroid will decrease airway swelling but takes many hours to days to become effective. A diagnosis of pneumonia has not been validated. However, if documented, the client should receive pneumococcal vaccine as an inpatient The anti-infective medication may be ordered after the cause of the symptoms is determined, but restoring adequate airway patency and reducing dyspnea take priority.

A client with deep vein thrombosis suddenly develops dyspnea, tachypnea, and chest discomfort. What should the nurse do first? A. Contact the health care provider (HCP). B. Elevate the head of the bed 30 to 45 degrees. C. Encourage the client to cough and deep breathe. D. Auscultate the lungs to detect abnormal breath sounds.

B. Elevate the head of the bed 30 to 45 degrees.

A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client? A. Encouraging additional fluids for the next 24 hours B. Ensuring the return of the gag reflex before offering foods or fluids C. Administering atropine intravenously D. Administering small doses of midazolam (Versed).

B. Ensuring the return of the gag reflex before offering foods or fluids

A client diagnosed with TB is currently taking combination drug therapy. The nurse should immediately intervene if the client makes which statement? A. I will take these medications for 6-12 months as prescribed B. I will still be able to go out to the bar with my friends every Saturday night C. Taking this combination of drugs helps prevent drug-resistant organisms D. I will need to tak a B-complex vitamin while taking these drugs

B. I will still be able to go out to the bar with my friends every Saturday night

A nurse is caring for a client using oxygen while in the hospital. What assessment finding indicates that goals for a priority diagnosis are being met?A. 100% of meals being eaten by the client B. Intact skin behind the ears C. The client understanding the need for oxygen D. Unchanged weight for the past 3 days

B. Intact skin behind the ears

A patient is being treated with heparin therapy for a PE. The patient has the potential for bleeding with the administration of heparin. What does the nurse monitor in relation to the heparin therapy? A. Lab values for any elevation of prothrombin time (PT) or partial thromboplastin time (PTT) value B. PTT values for greater than 2.5 times the control and/or the patient for bleeding. C. Occurrence of a pulmonary infarction by blood in sputum. D. PT values for International Normalized Ratio (INR) for a therapeutic range of 2 to 3 and/or the patient for bleeding.

B. PTT values for greater than 2.5 times the control and/or the patient for bleeding.

The nurse suspects a patient has a PE and notifies the provider who orders an arterial blood gas. The provider is en route to the facility. The nurse anticipates and prepares the patient for which additional diagnostic test? A. Ultrasound B. Pulmonary angiography C. 12-lead ECG D. Ventilation and perfusion scan

B. Pulmonary angiography

A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes the: A. Brachial and radial arteries, and then releases them and observes the circulation of the hand. B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery. C. Radial artery and observes for color changes in the affected hand. D. Ulnar artery and observes for color changes in the affected hand.

B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery.

The provider orders heparin therapy for a patient with a relatively small PE. The patient states, "I didn't tell the doctor my complete medical history." Which condition may affect the provider's decision to immediately start heparin therapy? A. Type 2 diabetes mellitus B. Recent cerebral hemorrhage C. Newly diagnosed osteoarthritis D. Asthma since childhood

B. Recent cerebral hemorrhage

A client experienced a pneumothorax after the placement of a central venous pressure line. Which of the following assessments supports a diagnosis of pneumothorax? A. Tracheal deviation toward the affected side. B. Sudden, sharp pain on the affected side. C. Presence of crackles and wheezes. D. Bradypnea and elevated blood pressure.

B. Sudden, sharp pain on the affected side.

A client has a chest tube attached to a water seal drainage system, and the nurse notes that the fluid in the chest tube and in the water seal column has stopped fluctuating. How should the nurse interpret this finding? A. The chest tube is in the pleural space. B. The lung has fully expanded. C. The lung has collapsed. D. The mediastinal space has decreased.

B. The lung has fully expanded.

During morning assessment, a nurse assesses four clients. Which client is the priority for follow up? A. a 48-year-old client with chronic obstructive pulmonary disease with occasional atrial fibrillation B. a 73-year-old client who has pneumonia with coarse crackles, is receiving 2 L/minute of oxygen, and has an I.V. line C. an 84-year-old client with heart failure who's on telemetry and 2 L/minute of oxygen D. a 42-year-old client who has left lower lobe pneumonia and an I.V. line

B. a 73-year-old client who has pneumonia with coarse crackles, is receiving 2 L/minute of oxygen, and has an I.V. line

Antibiotic therapy key terms

Bacteriocidal -Kill bacteria Bacteriostatic -Prevent microorganisms from multiplying and growing Broad-spectrum -Used to treat large numbers of bacteria (used when the organism infecting the person is unknown, cultures not back yet) Narrow spectrum -Specific types of organisms (when we get C&S back) Superinfection -Mix of different bacteria causing infection Aerobic, anaerobic -Aerobic needs fresh oxygen to multiply, anaerobic can multiply in oxygen-free environments Peak, trough levels

Streptomycin

Bacteriocidal Disrupts protein synthesis Side effects: -Nephro & ototoxicity -Monitor hearing & renal function -Given parenterally

Rifampin

Bacteriocidal Inhibits RNA synthesis Can be hepatotoxic Patient education -Urine & other body fluids will turn orange (will stain clothes) -Effectiveness of oral contraceptives decrease

Vancomycin

Bacteriocidal Inhibits cell wall synthesis Uses: -Severe staph infections (MRSA) -Pseudomembranous colitis (C. Difficile) Side effects Similar to aminoglycosides- Monitor for red neck syndrome

Pyrazinamide (PZA)

Bacteriocidal Side effects -Hepatitis -Hyperuricemia -Skin rash -GI upset -Monitor uric acid, AST (SGOT), ALT (SGPT) Patient education -Have patient drink 2 liters of fluid daily -Take with food

A nurse has educated a client on isoniazid (INH). What statement by the client indicates teaching has been effective? A. "I need to take extra vitamin C while on INH." B. "I should take this medicine with milk or juice." C. "I will take this medication on an empty stomach." D. "My contact lenses will be permanently stained."

C. "I will take this medication on an empty stomach."

Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza vaccination? A. A 60-year-old man with a hiatal hernia. B. A 36-year-old woman with 3 children. C. A 50-year-old woman caring for a spouse with cancer. D. A 60-year-old woman with osteoarthritis.

C. A 50-year-old woman caring for a spouse with cancer.

When assessing a client diagnosed with pneumonia, the nurse auscultates crackles. Which is the best action? A. Decrease the amount of fluid the client receives. B. Notify the healthcare provider. C. Document the findings as the only action. D. Have another RN auscultate the client's lungs.

C. Document the findings as the only action. Crackles are an expected finding with pneumonia. The healthcare provider should be notified only if there is a significant change. There is no need to have another RN auscultate, and fluids should be encouraged in a client with pneumonia.

A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be A. Risk for falls. B. Ineffective breathing pattern. C. Ineffective airway clearance. D. Impaired tissue integrity.

C. Ineffective airway clearance.

A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching? A. Removes the cap and shakes the inhaler well before use. B. Press the canister down with your finger as he breathes in. C. Inhales the mist and quickly exhales. D. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.

C. Inhales the mist and quickly exhales.

An elderly patient is discussing pneumonia prevention with the nurse. The nurse would include which statement in the teaching? A. You need to have to the pneumonia vaccination once a year to fully protect yourself B. If you have had the pneumonia vaccine in the last 10 years you will not need to repeat the vaccination C. It is recommended that you repeat the pneumonia vaccination if it has been longer than 5 years since you've received it D. There is no vaccination that can protect you from pneumonia

C. It is recommended that you repeat the pneumonia vaccination if it has been longer than 5 years since you've received it

The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s would be included in the teaching plan? A. Clubbing of nail beds B. Hypertension C. Peripheral edema D. Increased appetite

C. Peripheral edema

A nurse is caring for several older clients in the hospital that the nurse identifies as being at high risk for healthcare-associated pneumonia. To reduce this risk, what activity should the nurse delegate to the unlicensed assistive personnel (UAP)? A. Encourage between-meal snacks. B. Monitor temperature every 4 hours. C. Provide oral care every 4 hours. D. Report any new onset of cough.

C. Provide oral care every 4 hours.

A patient in the hospital being treated for a PE is receiving a continuous infusion of heparin. When the nurse comes to take vital signs, the patient has blood on the front of his chest and nose, and is holding a tissue saturated with blood to his nose. What is the first priority action the nurse must take? A. Have the patient sit up and lean forward, pinching the nostrils. B. Have a patient care technician set up oral suctioning to suction excess blood from patient's mouth. C. Stop the heparin IV infusion. D. Obtain laboratory results for prothrombin time and complete blood count.

C. Stop the heparin IV infusion.

A nurse is caring for a client who had a chest tube inserted 12 hours ago for treatment of a pleural effusion. Which assessment is most important in determining the client's response to the treatment? A. client resting quietly without reports of pain B. intermittent bubbling in the water seal chamber C. client verbalization of decreased dyspnea D. serous drainage in the collection chamber

C. client verbalization of decreased dyspnea

The nurse auscultates the lungs of a client who has been diagnosed with a tumor in the lung and notes wheezing over one lung. What additional assessment should the nurse make? A. an indication of pleural effusion B. the client's history of smoking C. obstruction of the airway D. the presence of exudate in the airways

C. obstruction of the airway

A client reports having a dry, hacking cough that disturbs sleep at night. Which antitussive agent and intervention are most appropriate for this client? A. decreasing the room temperature and administering a benzonatate B. increasing fluids to liquefy secretions and administering codeine C. using a cooling mist humidifier and administering dextromethorphan D. providing a heat vaporizer and administering hydrocodone

C. using a cooling mist humidifier and administering dextromethorphan

Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will: A. Maintain a fluid intake of 800 ml every 24 hours. B. Experience chills only once a day. C. Cough productively without chest discomfort. D. Experience less nasal obstruction and discharge.

D. Experience less nasal obstruction and discharge.

A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect of this medication? A. Constipation B. Diarrhea C. Bradycardia D. Tachycardia

D. Tachycardia Side effects that can occur from a beta 2 agonist include tremors, nausea, nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of the mouth or throat. Due to the vasodilatory effect of peripheral vasculature and subsequent decrease in cardiac venous return, compensatory mechanisms manifest as tachycardia are relatively common, especially within the first weeks of usage.

Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema? A. To promote oxygen intake. B. To strengthen the diaphragm. C. To strengthen the intercostal muscles. D. To promote carbon dioxide elimination.

D. To promote carbon dioxide elimination.

The nurse is caring for a client with acute respiratory distress syndrome. What portion of arterial blood gas results does the nurse find most concerning, requiring intervention? A. partial pressure of arterial carbon dioxide (PaCO2) of 51 mm Hg B. pH of 7.29 C. bicarbonate (HCO3-) of 28 mEq/L D. partial pressure of arterial oxygen (PaO2) of 69 mm Hg

D. partial pressure of arterial oxygen (PaO2) of 69 mm Hg

Emphysema "pink puffer"

Primary symptom -Dyspnea on exertion "Pink puffer" -Alveolar (diffusion) problem -Increased CO2 retention (pink) -Minimal cyanosis -Pursed-lip breathing -Dyspnea/increased RR -Hyperresonance on chest percussion -Othropneic -Barrel chest -Exertional dyspnea -Prolonged expiratory time -Speaks in short jerky sentences -Anxious -Use of accessory muscles to breath -Thin appearance

What is an approximate normal range for a PT (prothrombin) level? a) 10 - 12 seconds b) 2 - 3 seconds c) 30 - 40 seconds d) 60 - 80 seconds

a) 10 - 12 seconds

A patient is prescribed Warfarin (Coumadin) for the treatment of a blood clot. What is the therapeutic INR range for this medication to be effective? a) 2 - 3 b) 1 - 3 c) 4 - 8 d) 0.5 - 2.5

a) 2 - 3 The answer is A. The therapeutic INR range is 2-3. It may be slightly higher if a patient is at a high risk for clot formation....(ex: up to 4.5)

Your patient, who is prescribed Warfarin for blood clots, has an INR of 1. As the nurse you know that this means? a) The medication is therapeutic b) The medication is not effective at preventing blood clots c) The patient is at a risk for bleeding d) The patient is experiencing Warfarin toxicity

b) The medication is not effective at preventing blood clots

A patient is receiving continuous IV Heparin. In order for this medication to have a therapeutic effect on the patient, the aPTT should be? a) 0.5 - 2.5 times the normal value range b) 2 - 3 times the normal value range c) 1. 5 - 2. 5 times the normal value range d) 1 - 3.5 times the normal value range

c) 1. 5 - 2. 5 times the normal value range

What is the most common site of origin for a clot to occur, causing a PE? A. Right side of the heart B. Deep veins of the legs and pelvis C. Antecubital vein in upper extremities D. Subclavian veins

B. Deep veins of the legs and pelvis

Time frame for the pneumonia vaccine

5 years

Red neck/man syndrome

Allergic reaction from the neck up Will still give, use Benadryl to help

S/S TB

Cough Afternoon Fever Blood Stained Sputum Dyspnea Fatigue Weight Loss *Nights Sweats* (profusely)

pH - 7.46 PCO2 - 26 mmHg PO2- 63 mmHg O2Sat - 92% HCO3 - 14 mEq/L

Partially compensated respiratory alkalosis with hypoxemia

PE S/S

Sudden onset of dyspnea Tachycardia Tachypnea Pleuritic chest pain Hypotension Syncope Hemoptysis Crackles Fever Audible S3 or S4 heart sounds Petechiae

TNM system

T- tumor spread N- node involvement M- presence of distant metastasis

Clinical manifestations of asthma

-Dyspnea -Wheezing -Coughing -Chest tightness -Tachypnea, tachycardia -Fatigue

Common causes of OSA

-Excess weight -Increased neck circumference -Tongue falling to back of throat

Why do you give low dose oxygen to a COPD patient?

-For most people chemoreceptors in the blood sense changes in CO2 levels and increase the depth and rate of respiration -Some patients with COPD lose this compensatory reaction -For these people it is the fall in arterial O2 that stimulates the change in respiration -This makes administering too much O2 dangerous current evidence-based practice is to increase O2 to a rate that keeps sPO2 between 90% and 92% during exacerbation -Low flow is best

Bronchodilators

-Relax bronchiole smooth muscles -Short-acting beta2 agonists -Long-acting beta2 agonists -Methylxanthines -Cholinergic antagonists -terol" is a suffix for the Beta2 agonists, both short & long acting Short-acting are rescue inhalers: Fast-acting, short-term relief Monitor heart rate for tachycardia Use bronchodilators 5 min before other inhaled drugs DO NOT use long-acting to relieve acute symptoms SHAKE WELL!

The physician orders Heparin 50 units/kg/dose subcutaneous daily. The patient weighs 204.6 lbs. Heparin is supplied in a vial that reads 5,000 units/ml. How many mL/dose will you administer?

0.93mL

The physician orders 20 units/kg/hr of Heparin infusion to be started. The patient weighs 191.4 lbs. You are supplied with a bag of Heparin that reads 100 units/mL. How many mL/hr will you administer?

17.4mL/hr

Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse administers the medication, knowing that the primary action of this medication is to: A. Promote expectoration. B. Suppress the cough. C. Relax smooth muscles of the bronchial airway. D. Prevent infection.

C. Relax smooth muscles of the bronchial airway.

What is peak level and when should it be drawn?

30 minutes after the medication has gone in Highest concentration of medication in the body

Which of the following outcomes would be appropriate for a client with COPD who has been discharged to home? The client: A. Promises to do pursed lip breathing at home. B. States actions to reduce pain. C. States that he will use oxygen via a nasal cannula at 5 L/minute. D. Agrees to call the physician if dyspnea on exertion increases.

D. Agrees to call the physician if dyspnea on exertion increases.

A client is wearing a Venturi mask to deliver oxygen and the dinner tray has arrived. What action by the nurse is best? A. Assess the client's oxygen saturation and, if normal, turn off the oxygen. B. Determine if the client can switch to a nasal cannula during the meal. C. Have the client lift the mask off the face when taking bites of food. D. Turn the oxygen off while the client eats the meal and then restart it.

B. Determine if the client can switch to a nasal cannula during the meal.

Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage strength of the liquid is 200mg/5ml. How many mL should the nurse administer each dose?

7.5mL

The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected? A. Normal breath sounds B. Prolonged inspiration C. Normal chest movement D. Coarse crackles and rhonchi

D. Coarse crackles and rhonchi

After teaching a client who is prescribed salmeterol (Serevent), the nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching? A. "I will be certain to shake the inhaler well before I use it." B. "It may take a while before I notice a change in my asthma." C. "I will use the drug when I have an asthma attack." D. "I will be careful not to let the drug escape out of my nose and mouth."

C. "I will use the drug when I have an asthma attack." Salmeterol is designed to prevent an asthma attack; it does not relieve or reverse symptoms. Salmeterol has a slow onset of action; therefore, it should not be used as a rescue drug. The drug must be shaken well because it has a tendency to separate easily. Poor technique on the client's part allows the drug to escape through the nose and mouth.

Chronic bronchitis "blue bloater"

Etiology -Inhaled irritants -Continuous exposure to infections Primary symptom -Productive cough "blue bloater" -Airway flow problem -Color dusky to cyanotic -Recurrent cough and high sputum production -Hypoxia -Hypercapnia (high PaCO2) -Respiratory acidosis -High hgb -High RR -Exertional dyspnea -High incidence in smokers (any inhaled irritants) -Digital clubbing -Cardiac enlargement -Use of accessory muscles to breathe -Leads to right-sided heart failure, bilateral pedal edema, high JVD

A patient with a PE asks for an explanation of heparin therapy. What is the nurse's best response? A. "It keeps the clot from getting larger by preventing platelets from sticking together to improve blood flow." B. "It will improve your breathing and decrease chest pain by dissolving the clot in your lung." C. "It promotes the absorption of the clot in your leg that originally caused the PE." D. "It increase the time it takes for blood to clot, therefore preventing further clotting and improving blood flow."

D. "It increases the time it takes for blood to clot, therefore preventing further clotting and improving blood flow."

A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the following instructions would be appropriate for the nurse to give the client? A. "Use your nasal decongestant spray regularly to help clear your nasal passages." B. "Ask the doctor for antibiotics. Antibiotics will help decrease the secretion." C. "It is important to increase your activity. A daily brisk walk will help promote drainage." D. "Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks."

D. "Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks."

A client has been admitted for suspected inhalation anthrax infection. What question by the nurse is most important? A. "Are any family members also ill?" B. "Have you traveled recently?" C. "How long have you been ill?" D. "What is your occupation?"

D. "What is your occupation?"

Which of the following diets would be most appropriate for a client with COPD? A. Low fat, low cholesterol B. Bland, soft diet C. Low-Sodium diet D. High calorie, high-protein diet

D. High calorie, high-protein diet

A client has been diagnosed with tuberculosis (TB). What action by the nurse takes highest priority? A. Educating the client on adherence to the treatment regimen B. Encouraging the client to eat a well-balanced diet C. Informing the client about follow-up sputum cultures D. Teaching the client ways to balance rest with activity

A. Educating the client on adherence to the treatment regimen

A nursing student caring for a client removes the client's oxygen as prescribed. The client is now breathing what percentage of oxygen in the room air? A. 14% B. 21% C. 28% D. 31%

B. 21%

Acute respiratory failure is classified by which critical values of PaCO2? (Select all that apply.) A. 39 mm Hg B. 52 mm Hg C. < 60 mm Hg D. 77 mm Hg E. > 50 mm Hg with a pH value of < 7.3

B. 52 mm Hg C. < 60 mm Hg E. > 50 mm Hg with a pH value of < 7.3

The nurse is caring for a client scheduled for a bronchoscopy. Which interventions should the nurse perform to prepare the client for this procedure? Select all that apply. A. Withhold food and fluids for 2 hours before the test. B. Administer prescribed atropine and a sedative. C. Confirm that a signed informed consent form has been obtained. D. Ask the client to remove any dentures. E. Provide a clear liquid diet for 6 to 12 hours before the test.

B. Administer prescribed atropine and a sedative. C. Confirm that a signed informed consent form has been obtained. D. Ask the client to remove any dentures.

Inhaled steroids

Flovent Pulmicort Beclomethasone(Vanceril) Advair* Monitor for oral candidiasis Teach to use water or mouthwash after, swish and spit Use a spacer for better results

S/S acute asthma attack

Status asthmaticus Life-threatening asthmatic episode Clinical findings -Extreme anxiety -Tachypnea, wheezing -Tachycardia Treatment -Drug therapy -Oxygen -Possible intubation