Test 2 Asthma/COPD/Chest Trauma/Respiratory Failure/ABG/TB.HIV

When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care for this patient? 1 Prescribe fruits and fruit juices to be offered between meals 2 Prescribe a high-calorie, high-protein diet with six small meals a day 3 Teach the patient to use frozen meals at home that can be microwaved 4 Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet

Answer: 2 Per PPT-*soft, high-calorie, low carbohydrate, high-fat, protein, small frequent feedings* *Don't want pressure on diaphragm-reduces lung function DON'T WANT fluids with meals (causes bloating=pressure), gassy foods, large meals*

The nurse caring for a client who is intubated and receiving mechanical ventilation notes that her oxygen saturation is 89%, her heart rate is 120 beats/min, and she is increasingly agitated and restless. On auscultation, the nurse finds the lung sounds are diminished on one side. Which action does the nurse perform first? A. Notify the provider and prepare for re-intubation or repositioning the tube. B. Document the findings and request sedation from the provider. C. Call respiratory therapy to obtain a set of arterial blood gasses. D. Reposition the tube, and call radiology for a stat chest x-ray.

Answer: A Rationale: With the decreased oxygen saturation and decreased breath sounds on one side, the endotracheal tube is incorrectly positioned into one bronchus. For effective gas exchange, the tube must be repositioned, which is a health care provider function, not a nursing function.

A patient is receiving positive pressure mechanical ventilation and has a chest tube. When assessing the water seal chamber what do you expect to find? A. The water in the chamber will increase during inspiration and decrease during expiration. B. There will be continuous bubbling noted in the chamber. C. The water in the chamber will decrease during inspiration and increase during expiration. D. The water in the chamber will not move.

C. The water in the chamber will decrease during inspiration and increase during expiration. When a patient is receiving mechanical ventilation the water in *the water seal chamber will oscillate oppositely than if the patient were breathing on their own*. Option A is correct if pt breathing on their own

A patient with a pneumothorax has a chest tube present. The water seal chamber has continuous bubbling. What intervention would you take? Notify the MD because there is a leak in the system. This is normal and expected because the patient has a pneumothorax. Increase the suction 2-5 mmHg until bubbling stops. None of the above are correct.

Notify the MD because there is a leak in the system. Intermittent bubbling is to be expected in a patient who has a pneumothorax in the water seal chamber BUT continuous bubbling is not normal. If continuous bubbling is noted the MD must be notified.

Your outside the patient's room when you hear a "thud". You run into the room and the patient has fallen and the patient's chest tube was *accidentally pulled out* You quickly do the following? Tell the patient to take a deep breath and hold it, apply a dry sterile dressing with petroleum gauze dressing with tape, and notify the MD Turn the patient on the affected side and call for help Clamp the tubing, cover with a Kerlix and tape, and notify the MD

Pinch the skin opening together, apply an occlusive sterile dressing, cover the dressing with 2 inch tape and notify the MD. If a chest tube is accidentally removed you should do the following: Pinch the skin opening together, apply an occlusive sterile dressing, cover the dressing with 2 inch tape and notify the MD. Telling the patient to take a deep breath and hold it, apply a dry sterile dressing with petroleum gauze dressing with tape, and notify the MD is what you do when the chest tube is removed by the MD. The other options are incorrect.

A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler. How should the patient take this medication? A. The patient should use the medications every 2 hours for acute episodes of shortness of breath. B. The patient should use the Spiriva first and then 5 minutes later the Pulmicort. C. The patient should use the Pulmicort first and then the Spiriva 5 minutes later. D. The patient should use the medications at the same exact time, regardless of the order.

The answer is B. The patient should use the bronchodilator first which is the Spiriva to open the airways and THEN the Pulmicort which is a corticosteroid. Using the inhalers in this order will allow the corticosteroid to work properly after the lung fields are opened due to bronchodilation. *IMPORTANT TEACHING-The patient should rinse the mouth after using any type of corticosteroid inhalers SUCH AS Pulmicort since it is a corticosteroid to remove the medication from the mouth. If left in the mouth, the patient can develop thrush*

A patient is newly diagnosed with COPD due to chronic bronchitis. You're providing education to the patient about this disease process. Which statement by the patient indicates they *understood your teaching* about this condition? A. "If I stop smoking, it will cure my condition." B. "Complications from this condition can lead to pulmonary hypertension and right-sided heart failure." C. "I'm at risk for low levels of red blood cells due to hypoxia and may require blood transfusions during acute illnesses." D. "My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than low oxygen levels.

The answer is B. This is the only correct statement. Option A is wrong because smoking cessation will NOT cure the condition but it may slow down the progress of it. Option C is wrong because the patient may develop HIGH LEVELS of red blood cells due to the body trying to compensate for hypoxia. Option D is wrong because patients with COPD are stimulated to breathe due to LOW OXYGEN LEVELS rather than high carbon dioxide levels.

During the morning assessment of your patient with a chest tube, you note that there is no fluctuation in the water seal chamber. The patient does not appear to be in respiratory distress. What could have caused this ceasing of fluctuation? The lung may have re-expanded. The water in the seal chamber is inadequate. The collection chamber is full. The dry suction is turned on high.

The lung may have re-expanded. If fluctuation in the water seal chamber stops it could be the following: the tube is obstructed, suction is not working properly or the lung has re-expanded. In this case, the lung had re-expanded.

Your patient has a chest tube. Your assessing the water seal chamber and you note that the water moves up as the patient inhales and then moves down when the patient exhales. What may be causing this to happen? This is normal and expected. The chest tube has a leak. The left chest tube is occluded. The water seal suction should be increased 2-5 mmHG.

This is normal and expected. This is a good sign and lets you know the water seal chamber is working correctly. If excessive bubbling was noted it would indicate an air leak in the chest tube system.

What is the purpose of pursed lip breathing? How is it done?

To control SOB & Releases trapped air in the lungs and keeps airways open. Breath in slowly through your nose (2 sec) pucker lips and exhale for 4 sec.

If a patient has a pneumonectomy, how do you position this patient after surgery?

pneumonectomy position on affected side (gravity allows fluid to fill the empty space on affected side and the good lung is up/can expand)

After a thoracentesis has been performed, the nurse will position the pt how?

position on the unaffected side thoracentesis is the treatment for pleural effusion

What nursing intervention would be *inappropriate in the immediate post-op care* of a pt who has had a bronchoscopy: 1.put pt in semi-fowler position 2. offer fluids to assess swallowing ability 3. assess for diminished breath sounds 4. assess for stridor

2. offer fluids to assess swallowing ability

The nurse assessing the CBC of a patient with chronic bronchitis identifies a typical feature of this disease, which is 1.decreased platelets. 2.decreased white blood cells. 3.increased eosinophils. 4.increased red blood cells

4. Increased red blood cells (RBCs)

A patient with a chest tube asks the nurse about the bubbling he sees in the water seal chamber of his drainage equipment. Which response by the nurse is MOST appropriate? 1. "It shows your lung has not yet re-expanded" 2 "It's supposed to bubble." 3. "Why don't we ask your doctor." 4. "We need to call a Rapid Response"

1. "It shows your lung has not yet re-expanded" It is normal to find intermittent (NOT CONTINUOUS) bubbling in the water seal chamber if the patient is recovery from a pneumothorax. Remember that a pneumothorax is an AIR leak between the lung and chest wall....therefore air will escape into the water seal chamber causing intermittent bubbles.

Two days after placement of a chest tube, the tube is accidentally pulled out of the chest wall. The nurse should first: 1. Immerse the tube in sterile water. 2. Apply an occlusive dressing such as petroleum jelly gauze. 3. Instruct the client to cough to expand the lung. 4. Auscultate the lung to determine whether it collapsed.

2. Apply an occlusive dressing such as petroleum jelly gauze.

The family member of the client, diagnosed with pneumothorax, reports to the nurse, "I think something is wrong with that drainage device. It just got very noisy." The nurse observes that bubbling in the underwater seal is continuous compared to several hours ago. Which action should the nurse take first? 1. Clamp the chest tube at the insertion site. 2. Add sterile water to the underwater seal chamber. 3. Notify the health care provider. 4. Observe the connections of the drainage system.

4) CORRECT — assessment, more information is needed; leak in drainage system can cause continuous bubbling; nurse should begin with that observation first

When caring for a patient with metabolic acidosis, what must the nurse keep in mind regarding acid-base chemistry? 1 Acids bind free hydrogen ions in solution. 2 Acetic acid (CH3COOH) is a strong acid. 3 Normally, blood is slightly acidic in nature. 4 Fluids with lower pH have higher acidity

4 Fluids with lower pH have a higher level of free hydrogen ions and, therefore, have higher acidity. Acids release hydrogen ions rather than bind with them when dissolved in water. Strong acids readily dissociate in water and release all of their hydrogen ions. Acetic acid (CH3COOH) is a weak acid. When dissolved in water, it releases only one of its four hydrogen molecules. Normally, blood has a pH of between 7.35 and 7.45, so it is slightly alkaline.

A nurse just administered a prescribed rescue bronchodilator to a patient experiencing an asthma attack. What signs indicate that the drug is effective? (select all that apply) A. Decreased respiratory rate B. Increased respiratory rate C. Increased heart rate D. Decreased or absent wheezes E. Pulse oximetry values of 95% or higher within 5 minutes

A, D. E Breathing improvements noted after administration of a short-acting bronchodilator include a slower respiratory rate, and not faster; decreased or absent wheezes; ; and pulse oximetry values of 95% or higher within 5 minutes of inhalation. Compare the patient's heart rate and blood pressure within 15 minutes after giving the drug to determine whether any systemic effects are present and ask about any chest pain. The heart rate may increase slightly but it is necessary to report any severe tachycardia, a rapid rise in blood pressure, or chest pain immediately to the prescriber.

Which physical assessment finding in a patient with a lower respiratory problem best supports the nursing diagnosis of ineffective airway clearance? Basilar crackles Respiratory rate of 28 Oxygen saturation of 85% Presence of greenish sputum

A-The presence of adventitious breath sounds indicates that there is accumulation of secretions in the lower airways. This would be consistent with a nursing diagnosis of ineffective airway clearance because the patient is retaining secretions. The rapid respiratory rate, low oxygen saturation, and presence of greenish sputum may occur with a lower respiratory problem, but do not definitely support the nursing diagnosis of ineffective airway clearance.

A nurse is providing information about tuberculosis to a group of clients at a local community center. Which of the following manifestations should the nurse include in the teaching? (Select all that apply.) A. Persistent cough B. Weight gain C. Fatigue D. Night sweats E. Purulent sputum F. Hemoptysis G. Dyspnea

ACDEFG A. CORRECT: The nurse should include in the teaching that a persistent cough is a manifestation of tuberculosis. C. CORRECT: The nurse should include in the teaching that fatigue is a manifestation of tuberculosis. D. CORRECT: The nurse should include in the teaching that night sweats is a manifestation of tuberculosis. E. CORRECT: The nurse should include in the teaching that purulent sputum is a manifestation of tuberculosis. F. CORRECT: Hemoptysis is a manifestation of tuberculosis G. Dyspnea is a manifestation of tuberculosis *B IS INCORRECT BECAUSE TB CAUSES WEIGHT LOSS*

An hour after a thoracotomy, a patient complains of incisional pain at a level 7 (based on 0 to 10 scale) and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which action is best for the nurse to take next? a. Milk the chest tube gently to remove any clots. b. Clamp the chest tube momentarily to check for the origin of the air leak. c. Assist the patient to deep breathe, cough, and use the incentive spirometer. d. Set up the patient controlled analgesia (PCA) and administer the loading dose of morphine.

ANS: D The patient is unlikely to take deep breaths or cough until the pain level is lower. A chest tube output of 100 mL is not unusual in the first hour after thoracotomy and would not require milking of the chest tube. An air leak is expected in the initial postoperative period after thoracotomy.

When assessing a patient who has just arrived after an automobile accident, the emergency department nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the patient? a. Emergency pericardiocentesis b. Stabilization of the chest wall with tape c. Administration of an inhaled bronchodilator d. Insertion of a chest tube with a chest drainage system

ANS: D The patient's history and absent breath sounds suggest a right-sided pneumothorax or hemothorax, which will require treatment with a chest tube and drainage. The other therapies would be appropriate for an acute asthma attack, flail chest, or cardiac tamponade, but the patient's clinical manifestations are not consistent with these problems

While helping a patient with a chest tube reposition in the bed, the chest tube becomes dislodged. What is your immediate nursing intervention? A. Stay with the patient and monitor their vital signs while another nurse notifies the physician. B. Place a sterile dressing over the site and tape it on three sides and notify the physician. C. Attempt to re-insert the tube. D. Keep the site open to air and notify the physician.

B. Place a sterile dressing over the site and tape it on three sides and notify the physician

A patient with a tracheostomy needs to be suctioned. What would you do first before suctioning the patient? Hyperoxygenate the patient before suctioning Assist the patient into Sim's position Disconnect pulse oximetry Have the patient bear down

Before suctioning a patient with a tracheostomy you would need to *hyperoxygenate the patient* because during suctioning you will be decreasing the patient's oxygen supply.

After a patient with right lower-lobe pneumonia has been treated with intravenous (IV) antibiotics for 2 days, which assessment data obtained by the nurse indicates that the treatment has been effective? a. Bronchial breath sounds are heard at the right base. b. Increased vocal fremitus is palpable over the right chest. c. The patient coughs up small amounts of green mucous. d. The patient's white blood cell (WBC) count is 9000/µl.

D Rationale: The normal WBC count indicates that the antibiotics have been effective. All the other data suggest that a change in treatment is needed. *know normal lab values*

You are providing care to a patient with a chest tube. On assessment of the drainage system, you note continuous bubbling in the water seal chamber and oscillation. Which of the following is the CORRECT nursing intervention for this type of finding? A. Reposition the patient because the tubing is kinked. B. Continue to monitor the drainage system. C. Increase the suction to the drainage system until the bubbling stops. D. Check the drainage system for an air leak.

D. Check the drainage system for an air leak. **Continuous bubbling in the water seal chamber is NOT normal and indicates there is an air leak**. However, oscillation of the water in the water seal chamber is normal.

The nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack? a. Occupational exposure to toxins. b. Viral respiratory infections. c. Exposure to cigarette smoke. d. Exercising in cold temperatures.

b-The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or a cold and should get yearly flu vaccinations. Environmental exposure to toxins or heavy particulate matter can trigger asthma attacks; however, far fewer asthmatics are exposed to such toxins than are exposed to viruses. Cigarette smoke can also trigger asthma attacks, but to a lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising in cold weather.

In the pt experiencing an asthma exacerbation, which of the following changes occur? bronchoconstriction bronchodilation airway edema hypotension airway narrowing

bronchoconstriction airway edema airway narrowing