question

A 92 yo female pt is being admitted to ED w/ severe SOB. Being aware of pt condition, what approach would you use to assess pt's lungs

answer

-base to apex -posterior then anterior

question

What keeps alveoli from collapsing

answer

Surfactant

question

What accurately describes alveolar sacs

answer

Terminal structures of respiratory tract

question

What covers the larynx during swallowing

answer

Epiglottis

question

A 75 yo pt who is breathing RA has following ABG: pH 7.40, PaO2: 74mm Hg, SaO2 92%, PaCO2 40 mm Hg. What is the most appropriate action

answer

Document results in pt record

question

A pt's ABGs include a PaO2 of 88 mm Hg, PaCO2 of 38 mm Hg, and mixed venous blood gases of PvO2 of 40 mm Hg and PvCO2 of 46 mm Hg. What do these findings indicate

answer

Normal capillary O2-CO2 exchange

question

A pulse ox indicates that a pt has a drop in SpO2 from 95% to 85% over several hrs. what should be first nursing action

answer

Check position of probe on finger/earlobe

question

Pulse ox may not be a reliable indicator of O2 sat in what pt

answer

Pt in hypovolemic shock

question

A 73 yo pt has a SpO2 of 70%. What other assessment should nurse consider before making judgement about adequacy of oxygenation

answer

compare pts current VS with normal VS

question

Values indicators of criteria needed for use of continuous O2 therapy

answer

SpO2 of 88% PaCO2 of 55 mm Hg

question

Why does a pt's RR increase when there is an excess of CO2 in blood?

answer

CO2 combines with water to form carbonic acid which lowers the pH of CSF

question

Which respiratory defense mechanism is most impaired by smoking

answer

Mucociliary clearance

question

Which age-related changes in respiratory system cause decreased secretion clearance

answer

-Decreased functional cilia -Decreased force of cough

question

The abnormal assessment findings of dullness and hyperresonance are found with which assessment technique

answer

Percussion

question

Palpation is the assessment technique used to find which abn assessment findings

answer

Tracheal deviation Limited chest expansion Increased tactile fremitus

question

Assessment of chest expansion via

answer

Place thumbs at midline of lower chest

question

When does the nurse record presence of increased AP diameter of the chest

answer

The width of the chest is equal to the depth of the chest

question

How is the presence of bronchovesicular breath sounds in peripheral lung fields described

answer

abnormal lung sounds

question

Abnormal Respiratory Assessment findings

answer

- Finger clubbing d/t chronic hypoxemia -Stridor d/t partial obstruction of trachea/larynx -Wheezes d/t bronchoconstriction -Pleural friction rub d/t pleurisy -Increased tactile fremitus d/t lung consolidation w/ fluid or exudate -Hyperresonance d/t air trapping -Fine crackles d/t interstitial filling with fluid -Absent breath sounds d/t atelactasis

question

A nurse has been exposed to TB during care of pt with TB and has a TB skin test performed. When is the nurse considered infected

answer

Testing causes a 10 mm red, indurated area at the injection site

question

What is a primary nursing responsibility after obtaining a blood specimen for ABGs

answer

Take specimen immediately to lab in iced container

question

What should the nurse do to prepare pt for pulmonary angiogram scan

answer

Assess pt for iodine allergy

question

The nurse is preparing the pt for and will assist provider with thoracentesis in pt's room. What is the sequential order of actions to take

answer

1. Obtain supplies needed 2. Direct family members to waiting room 3. Position pt sitting upright with elbows on over-the bed table 4. Instruct pt not to talk during procedure 5. Observe for signs of hypoxia during procedure 6. Verify breath sounds in all fields 7. Send labeled specimen containers to lab

question

After which test should the nurse observe pt for s/s of pneumothorax

answer

Thoracentesis

question

Hcare provider orders a pulmonary angiogram for pt admitted w/ dyspnea and hemoptysis. For which pb is this test more commonly used as dx measure

answer

Pulmonary embolism

question

Pulmonary capacities and fxn tests w/ descriptions

answer

Vt: Volume of air inhaled and exhaled with each breath RV: Amt of air remaining in lungs after forced expiration TLC: Max amt of air lungs can contain VC: Max amt of air that can be exhaled after max inhalation FVC: Amt of air that can be quickly and forcefully exhaled after max inspiration PEFR: Max rate of airflow during forced expiration FEV1: Amt of air exhaled in first second of forced vital capacity FRC: Vol of air in lungs after normal exhalation

question

Nursing action for epistaxis after removal of NG tube

answer

pinch the soft part of nose

question

nurse receives evening report on pt who underwent posterior nasal packing for epistaxis earlier in the day. What is first pt assessment

answer

O2 by pulse ox

question

What does nurse teach pt w/ intermittent allergic rhinitis is the most effective way to decrease allergic symptoms

answer

Identify and avoid triggers of allergic rxns

question

During assessment of pt with viral upper respiratory infection, nurse recognizes that antibiotics may be indicated for what findings

answer

dyspnea severe sinus pain

question

36 yo pt with type 1 DM asks nurse whether influenza vaccine is necessary every year. What should be the nurse's response?

answer

You should get the trivalent inactivated influenza vaccine that is injected every year

question

A pt with acute pharyngitis is seen at clinic w/ fever and severe throat pain that affects swallowing. On inspection, the throat is reddened and edematous with patchy yellow exudates. The nurse anticipates collaborative management will include

answer

Throat cx or rapid strep test

question

While nurse is feeding pt, pt appears to choke on food. What symptoms indicate partial airway obstruction

answer

stridor wheezing cyanosis

question

What is an advantage of tracheostomy over ET tube for long term management of upper airway obstruction

answer

A tracheostomy tube allows for more comfort and mobility

question

Characteristics of fenestrated tracheostomy tube

answer

-Airway obstruction is likely if exact steps aren't followed to produce speech -Airflow around tube and through window allows speech when cuff is deflated and plug is inserted

question

During care of pt with cuffed tracheostomy , nurse notes that tracheostomy tube has inner cannula. How do you care for the trach appropriately

answer

Remove the inner cannula and replace it per institution policy

question

What actions prevent dislodgement of trach tube in first 3 days after placement

answer

-Trach ties are not changed for 24 hrs post procedure -Suction trach tube when there is a moist cough or decreased SpO2 -A physician performs first tube change, no sooner than 7 days after trach

question

LPN can perform what trach interventions

answer

-Suction Trach -Provide trach care -Determine need for suctioning

question

What is included in nursing care of pt with a cuffed trach tube

answer

Monitor cuff pressure every 8 hrs

question

Pt's trach tube becomes dislodged w/ vigorous coughing. Nurse's first action

answer

Attempt to replace tube

question

When obtaining health hx from pt with possible cancer of mouth, what would nurse expect the pt to report

answer

Heavy tobacco and/or alcohol use

question

Pt diagnosed with early vocal cord malignancy. Nurse will explain that usual tx includes

answer

radiation therapy that preserves quality of the voice

question

During post-op teaching for pt scheduled for total laryngectomy what should nurse include

answer

Post-op use of nonverbal communication techniques

question

When assessing pt on return to surgery unit after a total laryngectomy and radical neck dissection what would the nurse expect to find

answer

A closed-wound drainage system

question

Following supraglottic laryngectomy, pt is taught to use supraglotic swallow to minimize risk of aspiration. What should the nurse teach pt to do with this technique

answer

Cough after swallowing to remove food from top of vocal cords

question

What should nurse include in d/c teaching for pt with total laryngectomy

answer

How to use a mirror to suction trach

question

What is the most normal functioning method of speech restoration in pt with total laryngectomy

answer

Transesophageal puncture

question

How do microorganisms reach the lungs and cause pneumonia

answer

-aspiration -inhalation of microbes in air -hematogenous spread from infections elsewhere in body

question

Why is classification of pneumonia as community-acquired pneumonia or medical care-associated pneumonia clinically useful

answer

Causative agents can be predicted and empiric tx is often effective

question

Microrganisms Pneumocystis jiroveci and cytomegalovirus are associated with which type of pneumonia

answer

Opportunistic pneumonia

question

What organisms are associated with both CAP and MCAP

answer

-Klebsiella -Staph a -Streptococcus pneumonia

question

Most common pathophysiologic stages of pneumonia in order

answer

1. Inflammatory response in lungs with neutrophils is activated to engulf and kill offending organism 2. Increased capillary permeability contributes to alveolar filling with organisms and neutrophils interrupt normal O2 transportation 3. Mucus production increases and can obstruct airflow and further decrease gas exchange 4. Macrophages lyse debris and normal lung tissue and fxn is restored

question

When obtaining health hx from 76 yo pt with suspected CAP, what would nurse expect for pt to report

answer

Confusion

question

What is initial antibiotic tx for pneumonia based on

answer

Hx + physical exam and characteristics of chest x-ray findings

question

After health care provider sees pt hospitalized with a stroke who developed fever and adventitious lung sounds, what order would the nurse implement first

answer

Sputum specimen for Gram stain and cx and sensitivity

question

What types of pts are at risk for aspiration pneumonia

answer

-altered LOC -feeding tube -local anesthetic to throat -dysphagia

question

Following assessment of pt with pneumonia, nurse identifies nursing dx of impaired gas exchange r/t what finding

answer

SpO2 of 86%

question

Pt with pneumonia has nursing dx or ineffective airway clearance r/t pain, fatigue, and thick secretions. what would be expected outcome

answer

Lungs clear to auscultation

question

Resurgence in TB resulting from emergence of multidrug-resistant strains of Mycobacterium tuberculosis related to

answer

Poor compliance w/ drug therapy in TB pts

question

A pt dx with class 3 TB 1 wk ago admitted to hospital w/ symptoms of chest pain and cough. Highest nurse priority action

answer

admit pt to an airborne infection isolation room

question

Health hx from pt suspected of having early TB, what manifestations should nurse ask about

answer

-fatigue, low-grade fever, night sweats

question

Meds used in four-drug tx for initial phase of TB

answer

-isoniazid (INH) -Rifampin (Rifadin) -Pyrazinamide (PZA) -Ethambutol (Myambutol)

question

Pt w/ active TB continues to have + sputum cx after 6 months of tx. She says she cannot remember to take meds all the time. What is best action for nurse to take

answer

Arrange for directly observed therapy by responsible family member or public health nurse

question

To reduce risk for most occupational lung diseases, most important measure the occupational nurse can promote is

answer

Use of masks and effective ventilation systems to reduce exposure to irritants

question

During health promotion program why should nurse plan to target women in discussion of lung cancer prevention

answer

-Women develop lung cancer at a younger age than men -More women die of lung cancer than die of breast cancer -Women are more likely to develop a small cell carcinoma than men -Nonsmoking women are at greater risk for developing lung cancer than men

question

A pt with a 40 pack-year smoking hx has recently stopped smoking bc of the fear of developing lung cancer. The pt asks the nurse what he can do to learn about whether he develops lung cancer. What does the nurse respond

answer

Screening measures for lung cancers are controversial but we can discuss the advantages and disadvantages of various measures

question

A pt with a lung mass found on chest x-ray is undergoing further testing. The nurse explains that a dx of lung cancer can be confirmed using what dx test

answer

Biopsy done via bronchoscopy

question

Tx for lung cancers and descriptions

answer

-Surgical Therapy: best procedure for cure -Radiation Therapy: used to treat both non-small cell lung cancer and SCLC -Chemotherapy: considered primary tx for SCLC -Prophylactic cranial radiation: prevent metastasis to brain -Bronchoscopic laser: palliative tx to remove obstructing bronchial tumors -Photodynamic therapy: drug activated by laser light that destroys cancer cells -Airway stenting: palliative tx for airway collapse or external compression -Radiofrequency ablation: electric current heats and destroys tumor cells -Biologic and targeted therapy: meds that block molecules involved in tumor growth

question

A pt with advanced lung cancer refuses pain meds saying "I deserve everything this cancer can give me." What is best response

answer

Can you tell me what the pain means to you

question

A male pt has COPD and is a smoker. The nurse notices respiratory distress and no breath sounds over the left chest. What type of pneumothorax should the nurse suspect

answer

Spontaneous pneumothorax

question

To determine whether a tension pneumothorax is developing in a pt w/ chest trauma for what does the nurse assess the pt

answer

Severe respiratory distress and tracheal deviation

question

Following MVA, nurse assesses driver for what distinctive sign of flail chest

answer

paradoxical chest movement

question

Function of Water seal chamber in chest drainage device

answer

One way valve

question

Function of suction control in chest drainage device

answer

suction to chest drainage

question

Function of collection chamber in chest drainage device

answer

Receives fluid and air from pleural/mediastinal space

question

Fxn of monitor bellows chamber in chest drainage device

answer

expands to show that suction is operating

question

When should nurse check for leaks in chest tube and pleural drainage system

answer

Constant bubbling of water in suction control chamber

question

An unlicensed assistive personnel is taking care of pt with a chest tube. Nurse should intervene if she observes UAP

answer

stripping or milking chest tube to promote drainage

question

Which chest sx is used for the stripping of a fibrous membrane

answer

Decortication

question

Purpose of video assisted thoracic surgery

answer

used to inspect, diagnose, and manage intrathoracic injuries

question

Following a thorectomy, pt has nursing dx of ineffective airway clearance r/t inability to cough as a result of pain and positioning. best nursing intervention?

answer

Medicate pt with analgesics 20-30 min before assisting to cough and deep breathe

question

Different restrictive lung conditions and mechanisms

answer

*Muscular dystrophy: paralysis of respiratory muscles *Atelactasis: presence of collapsed airless alveoli *Kyphoscoliosis: spinal angulation restricting ventilation *Opioid and Sedative overdose: central depression of RR and depth *Idiopathic pulmonary fibrosis: excessive scar tissue in connective tissue in lungs *Pleural effusion: lung expansion restricted by fluid in pleural space *Empyema: lung expansion restricted by pus in intrapleural space *Pleurisy: inflammation of pleura restricting lung mvmt *Pickwickian syndrome: excess fat restricts chest wall and diaphragmatic excursion

question

2 days after undergoing pelvic sx, pt develops marked dyspnea and anxiety. What is first nursing action

answer

Raise HOB

question

A pulmonary embolus is suspected in pt with DVT who develops hemoptysis, tachycardia and chest pain. Diagnostic testing is scheduled. What test will nurse be teaching pt about

answer

Spiral CT scan

question

Which condition contributes to secondary pulmonary arterial HTN by causing pulmonary capillary and alveolar damage

answer

COPD

question

While caring for a pt w/ idiopathic pulmonary arterial HTN, nurse observes exertional dyspnea and chest pain in addition to fatigue. These symptoms are related to what

answer

Right ventricular hypertrophy and dilation

question

Primary tx goal for cor pulmonale

answer

treat underlying pulmonary condition

question

6 days after lung transplant, pt develops low-grade fever, dyspnea, decreased SpO2. What should nurse recognize that this could indicate

answer

Acute rejection that could be treated with corticosteroids

question

When caring for a pt with acute bronchitis, the nurse will prioritize

answer

auscultating lung sounds

question

For which pts with pneumonia would the nurse suspect aspiration as likely cause

answer

-seizures -head injury -NG tube feeding

question

Appropriate nursing intervention for pt with pneumonia with nursing dx of ineffective airway clearance r/t thick secretions and fatigue

answer

Teach pt how to cough effectively to bring secretions to mouth

question

Pt w/ TB has been admitted to hospital and is placed in airborne infection isolation room. What should the pt be taught

answer

-Take all meds for full length of time to prevent multi-drug resistance -Wear standard isolation mask if leaving isolation room -Maintain precautions in airborne infection isolation room by coughing into paper tissue

question

Pt receiving high dose corticosteroids and broad spectrum ABO for tx secondary to traumatic injury and infection. Nurse plans care for pt knowing that pt is most susceptible to

answer

candidiasis

question

When caring for pt with lung abscess, what is nurses priority intervention

answer

ABO administration

question

ED caring for pt exposed to chlorine leak from local factory. Nurse should closely monitor pts for

answer

pulmonary edema

question

Nurse receives order for pt w/ lung cancer to receive influenza vaccine an pneumococcal vaccines. The nurse will

answer

administer both vaccines at the same time in different arms

question

Nurse identifies flail chest in trauma pt when

answer

paradoxic chest mvmt occurs during respiration

question

Nurse notes tidaling of water level in tube submerged in water-seal chamber in pt with closed chest tube drainage. The nurse should

answer

Continue to monitor pt

question

Appropriate nursing intervention for pt postpneumonectomy is

answer

ROM exercises on affected upper limb

question

Priority nursing intervention for pt who just underwent chemical pleurodesis for recurrent pleural effusion

answer

administer ordered analgesia

question

When planning care for pt at risk for pulmonary embolism what should be prioritized

answer

SCDs (sequential compression devices)

question

What statement describes nursing management of pt following lung transplantation

answer

-Lung biopsied using transtracheal method if rejection is suspected -Use of home spirometer will help monitor lung fxn -Immunosuppressant therapy usually involves 3 drug regimen

Nursing And Lower Respiratory Pbs (ch 26 27 – Flashcards

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