Chapter 19 Management of Patients with Chest and Lo Question and answers correctly solved, Exams of Nursing

Download Chapter 19 Management of Patients with Chest and Lo Question and answers correctly solved and more Exams Nursing in PDF only on Docsity! Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient? 3 months 3 to 5 months 6 to 12 months 13 to 18 months - correct answer 6 to 12 months Explanation: Pulmonary tuberculosis (TB) is treated primarily with anti-TB agents for 6 to 12 months. A prolonged treatment duration is necessary to ensure eradication of the organisms and to prevent relapse. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pulmonary Tuberculosis, p. 549. The nurse is assessing a client who, after an extensive surgical procedure, is at risk for developing acute respiratory distress syndrome (ARDS). The nurse assesses for which most common early sign of ARDS? Rapid onset of severe dyspnea Inspiratory crackles Bilateral wheezing Cyanosis - correct answer Rapid onset of severe dyspnea Explanation: The acute phase of ARDS is marked by a rapid onset of severe dyspnea that usually occurs less than 72 hours after the precipitating event. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Acute Respiratory Distress Syndrome, p. 571. The nurse is admitting a patient with COPD. The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia? PaO2 pH PCO2 HCO3 - correct answer PaO2 Explanation: Hypoxemic hypoxia, or hypoxemia, is a decreased oxygen level in the blood (PaO2) resulting in decreased oxygen diffusion into the tissues. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 556. You are caring for a client with chronic respiratory failure. What are the signs and symptoms of chronic respiratory failure? Progressive loss of lung function associated with chronic disease Sudden loss of lung function associated with chronic disease Progressive loss of lung function with history of normal lung function Sudden loss of lung function with history of normal lung function - correct answer Progressive loss of lung function associated with chronic disease Explanation: In chronic respiratory failure, the loss of lung function is progressive, usually irreversible, and associated with chronic lung disease or other disease. This makes options B, C, and D incorrect. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, OCCUPATIONAL LUNG DISEASE: PNEUMOCONIOSES, Veterans Considerations, p. 577. A recent immigrant is diagnosed with pulmonary tuberculosis (TB). Which intervention is the most important for the nurse to implement with this client? Client teaching about the cause of TB Reviewing the risk factors for TB Developing a list of people with whom the client has had contact Client teaching about the importance of TB testing - correct answer Developing a list of people with whom the client has had contact Explanation: To lessen the spread of TB, everyone who had contact with the client must undergo a chest X-ray and TB skin test. Testing will help determine if the client infected anyone else. Teaching about the cause of TB, reviewing the risk factors, and the importance of testing are important areas to address when educating high-risk populations about TB before its development. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pulmonary Tuberculosis, p. 548. A nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest bacterial pneumonia? Nonproductive cough and normal temperature Sore throat and abdominal pain Hemoptysis and dysuria Dyspnea and wheezing - correct answer Dyspnea and wheezing Explanation: In a client with bacterial pneumonia, retained secretions cause dyspnea, and respiratory tract inflammation causes wheezing. Bacterial pneumonia also produces a productive cough and fever, rather than a nonproductive cough and normal temperature. Sore throat occurs in pharyngitis, not bacterial pneumonia. Abdominal pain is characteristic of a GI disorder, unlike chest pain, which can reflect a respiratory infection such as pneumonia. Hemoptysis and dysuria aren't associated with pneumonia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, NURSING PROCESS The Patient with Bacterial Pneumonia, p. 543. The nurse is assisting a client with postural drainage. Which of the following demonstrates correct implementation of this technique? Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes. Use aerosol sprays to deodorize the client's environment after postural drainage. Perform this measure with the client once a day. Administer bronchodilators and mucolytic agents following the sequence. - correct answer Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes. Explanation: Postural drainage is usually performed two to four times daily, before meals (to prevent nausea, vomiting, and aspiration) and at bedtime. Prescribed bronchodilators, water, or saline may be nebulized and inhaled before postural drainage to dilate the bronchioles, reduce bronchospasm, decrease the thickness of mucus and sputum, and combat edema of the bronchial walls. The nurse instructs the client to remain in each position for 10 to 15 minutes and to breathe in slowly through the nose and out slowly through pursed lips to help keep the airways open so that secretions can drain while in each position. If the sputum is foul-smelling, it is important to perform postural drainage in a room away from other patients or family members. (Deodorizers may be used to counteract the odor. Because aerosol sprays can cause bronchospasm and irritation, they should be used sparingly and with caution.) Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Chart HOME CARE CHECKLIST 19-18, p. 568. 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? Staphylococcus aureus Mycobacterium tuberculosis Pseudomonas aeruginosa Streptococcus pneumoniae - correct answer Streptococcus pneumoniae Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, TABLE 19-1 Community-Acquired Pneumonia Microbial Causes by Site of Carea, p. 532. A nurse observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude? The system is functioning normally. The client has a pneumothorax. The system has an air leak. The chest tube is obstructed. - correct answer The system has an air leak. Explanation: Constant bubbling in the water-seal chamber indicates an air leak and requires immediate intervention. The client with a pneumothorax will have intermittent bubbling in the water-seal chamber. Clients without a pneumothorax should have no evidence of bubbling in the chamber. If the tube is obstructed, the fluid would stop fluctuating in the water-seal chamber. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, CHEST TRAUMA, Pneumothorax, p. 596. The nurse is providing discharge instructions to a client with pulmonary sarcoidosis. The nurse concludes that the client understands the information if the client correctly mentions which early sign of exacerbation? Initiate oxygen therapy. Administer a heparin bolus and begin an infusion at 500 units/hour. Administer analgesics as ordered. Perform nasopharyngeal suctioning. - correct answer Initiate oxygen therapy. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, PULMONARY VASCULAR DISORDERS, Pulmonary Embolism, p. 576. A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? Kinking of the ventilator tubing A disconnected ventilator circuit An ET cuff leak A change in the oxygen concentration without resetting the oxygen level alarm - correct answer Kinking of the ventilator tubing Explanation: Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing, bronchospasm, pulmonary embolus, mucus plugging, water in the tube, and coughing or biting on the ET tube. The alarm may also be triggered when the client's breathing is out of rhythm with the ventilator. A disconnected ventilator circuit or an ET cuff leak would trigger the low-pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm, not the high-pressure alarm. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, TABLE 19-5 Troubleshooting Problems with Mechanical Ventilation, p. 564. 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 which of the following? Acute respiratory distress syndrome Lung cancer Bronchitis Tracheobronchitis - correct answer Acute respiratory distress syndrome Explanation: Factors associated with the development of ARDS include aspiration related to near drowning or vomiting; drug ingestion/overdose; hematologic disorders such as disseminated intravascular coagulation or massive transfusions; direct damage to the lungs through prolonged smoke inhalation or other corrosive substances; localized lung infection; metabolic disorders such as pancreatitis or uremia; shock; trauma such as chest contusions, multiple fractures, or head injury; any major surgery; embolism; and septicemia. Smoke inhalation does not increase the risk for lung cancer, bronchitis, and tracheobronchitis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Acute Respiratory Distress Syndrome, p. 571. Which is a potential complication of a low pressure in the endotracheal tube cuff? Tracheal bleeding Aspiration pneumonia Tracheal ischemia Pressure necrosis - correct answer Aspiration pneumonia Explanation: Low pressure in the cuff can increase the risk for aspiration pneumonia. High pressure in the cuff can cause tracheal bleeding, ischemia, and pressure necrosis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Pneumonia, pp. 531-534. 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 pleural effusion. pneumothorax. hemothorax. consolidation. - correct answer pleural effusion. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Pleural Effusion, p. 554. 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? Fit all employees with protective masks. Insist on adequate breaks for each employee. Give workshops on disease prevention. Provide employees with smoking cessation materials - correct answer Fit all employees with protective masks. Explanation: The primary focus is prevention, with frequent examination of those who work in areas of highly concentrated dust or gases. Laws require work areas to be safe in terms of dust control, ventilation, protective masks, hoods, industrial respirators, and other protection. Workers are encouraged to practice healthy behaviors, such as quitting smoking. Adequate breaks, giving workshops, and providing smoking cessation materials do not prevent occupational lung diseases. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, OCCUPATIONAL LUNG DISEASE: PNEUMOCONIOSES, p. 577. A client is admitted to the health care facility with active tuberculosis (TB). What intervention should the nurse include in the client's care plan? Wearing a disposable particulate respirator that fits snugly around the face Instructing the client to wear a mask at all times Wearing a gown and gloves when providing direct care Keeping the door to the client's room open to observe the client - correct answer Wearing a disposable particulate respirator that fits snugly around the face Explanation: Because TB is transmitted by droplet nuclei from the respiratory tract, the nurse should put on a disposable particulate respirators that fit snugly around the face when entering the client's room. Occupation Safety and Health Administration standards require an individually fitted mask. Having the client wear a mask at all times would hinder sputum expectoration and respirations would make the mask moist. A nurse who doesn't anticipate contact with the client's blood or body fluids need not wear a gown or gloves when providing direct care. A client with TB should be in a room with laminar airflow, and the room's door should be shut at all times. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pulmonary Tuberculosis, p. 546. Which intervention does a nurse implement for clients with empyema? Encourage breathing exercises Place suspected clients together Institute droplet precautions Do not allow visitors with respiratory infections - correct answer Encourage breathing exercises Explanation: Empyema is an accumulation of thick fluid within the pleural space. To help the client with the condition, the nurse instructs the client in lung-expanding breathing exercises to restore normal respiratory function. Placing clients together, instituting precautions, and forbidding visitors would all be interventions that would depend upon what condition was causing the empyema. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 556. Which statement would indicate that the parents of child with cystic fibrosis understand the disorder? "Early treatment can stop the progression of the disease." "The mucus-secreting glands are abnormal." "There are fibrous cysts in the lungs." "Allergic reactions cause inflammation in the lungs." - correct answer "The mucus-secreting glands are abnormal." Explanation: Cystic fibrosis is caused by dysfunction of the exocrine glands with no cystic lesions present in the lungs. Early treatment can improve symptoms and extend the life of clients, but a cure for this disorder is presently not available. Allergens are responsible for allergic asthma and not associated with cystic fibrosis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pneumonia, p. 534. Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis? "I will come back in 1 week to have the test read." "If the test area turns red that means I have tuberculosis." "I will avoid contact with my family until I am done with the test." "Because I had a previous reaction to the test, this time I need to get a chest X-ray." - correct answer "Because I had a previous reaction to the test, this time I need to get a chest X-ray." Explanation: A client who previously had a positive PPD test (a reaction to the antigen) can't receive a repeat PPD test and must have a chest X-ray done instead. The test should be read 48 to 72 hours after administration. Redness at the test area doesn't indicate a positive test; an induration of greater than 10 mm indicates a positive test. The client doesn't need to avoid contact with people during the test period. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pulmonary Tuberculosis, p. 548. The public health nurse is administering Mantoux tests to children who are being registered for kindergarten in the community. How should the nurse administer this test? Administer intradermal injections into each child's inner forearm. Administer intramuscular injections into each child's vastus lateralis. Administer a subcutaneous injection into each child's umbilical area. Administer a subcutaneous injection at a 45-degree angle into each child's deltoid. - correct answer Administer intradermal injections into each child's inner forearm. Explanation: The purified protein derivative (PPD) is always injected into the intradermal layer of the inner aspect of the forearm. The subcutaneous and intramuscular routes are not utilized. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pulmonary Tuberculosis, p. 548. For a client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the care plan? Measuring and documenting the drainage in the collection chamber Maintaining continuous bubbling in the water-seal chamber Keeping the collection chamber at chest level Stripping the chest tube every hour - correct answer Measuring and documenting the drainage in the collection chamber Explanation: The nurse should regularly measure and document the amount of chest tube drainage to detect abnormal drainage patterns, such as may occur with a hemorrhage (if excessive) or a blockage (if decreased). Continuous bubbling in the water-seal chamber indicates a leak in the closed chest drainage system, which must be corrected. The nurse should keep the collection chamber below chest level to Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Weaning the Patient from the Ventilator, pp. 569-570. A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside? Tracheostomy cleaning kit Water-seal chest drainage set-up Manual resuscitation bag Oxygen analyzer - correct answer Manual resuscitation bag Explanation: The client with COPD depends on mechanical ventilation for adequate tissue oxygenation. The nurse must keep a manual resuscitation bag at the bedside to ventilate and oxygenate the client in case the mechanical ventilator malfunctions. Because the client doesn't have chest tubes or a tracheostomy, keeping a water-seal chest drainage set-up or a tracheostomy cleaning kit at the bedside isn't necessary. Although the nurse may keep an oxygen analyzer (pulse oximeter) on hand to evaluate the effectiveness of ventilation, this equipment is less important than the manual resuscitation bag. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Chart 19-15 Initial Ventilator Settings, p. 563. On auscultation, which finding suggests a right pneumothorax? Bilateral inspiratory and expiratory crackles Absence of breath sounds in the right thorax Inspiratory wheezes in the right thorax Bilateral pleural friction rub - correct answer Absence of breath sounds in the right thorax Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, CHEST TRAUMA, Pneumothorax, p. 594. What would the critical care nurse recognize as a condition that may indicate a client's need to have a tracheostomy? A client has a respiratory rate of 10 breaths per minute. A client requires permanent ventilation. A client exhibits symptoms of dyspnea. A client has respiratory acidosis. - correct answer A client requires permanent ventilation. Explanation: A tracheostomy permits long-term use of mechanical ventilation to prevent aspiration of oral and gastric secretions in the unconscious or paralyzed client. Indications for a tracheostomy do not include a respiratory rate of 10 breaths per minute, symptoms of dyspnea, or respiratory acidosis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 558. The nurse suctions a patient through the endotracheal tube for 20 seconds and observes dysrhythmias on the monitor. What does the nurse determine is occurring with the patient? The patient is hypoxic from suctioning. The patient is having a stress reaction. The patient is having a myocardial infarction. The patient is in a hypermetabolic state. - correct answer The patient is hypoxic from suctioning. Explanation: Apply suction while withdrawing and gently rotating the catheter 360 degrees (no longer than 10-15 seconds). Prolonged suctioning may result in hypoxia and dysrhythmias, leading to cardiac arrest. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 559. For a client with an endotracheal (ET) tube, which nursing action is the most important? Auscultating the lungs for bilateral breath sounds Turning the client from side to side every 2 hours Monitoring serial blood gas values every 4 hours Providing frequent oral hygiene - correct answer Auscultating the lungs for bilateral breath sounds Explanation: For the client with an ET tube, the most important nursing action is auscultating the lungs regularly for bilateral breath sounds to ensure proper tube placement and effective oxygen delivery. Although turning the client from side to side every 2 hours, monitoring serial blood gas values every 4 hours, and providing frequent oral hygiene are appropriate actions for this client, they're secondary to ensuring adequate oxygenation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Chart 19-12 Care of the Patient with an Endotracheal Tube, p. 557. The occupational nurse is completing routine assessments on the employees at a company. What might be revealed by a chest radiograph for a client with occupational lung diseases? Fibrotic changes in lungs Hemorrhage Lung contusion Damage to surrounding tissues - correct answer Fibrotic changes in lungs Explanation: For a client with occupational lung diseases, a chest radiograph may reveal fibrotic changes in the lungs. Hemorrhage, lung contusion, and damage to surrounding tissues are possibly caused by trauma due to chest injuries. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, TABLE 19-6 Occupational Lung Diseases: Pneumoconioses, p. 576. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, NURSING PROCESS The Patient with Bacterial Pneumonia, p. 543. Which of the following is a potential complication of a low pressure in the endotracheal cuff? Aspiration pneumonia Tracheal bleeding Tracheal ischemia Pressure necrosis - correct answer Aspiration pneumonia Explanation: Low pressure in the cuff can increase the risk for aspiration pneumonia. High cuff pressure can cause tracheal bleeding, ischemia, and pressure necrosis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 557. Which ventilator mode provides full ventilatory support by delivering a present tidal volume and respiratory rate? IMV SIMV Assist control Pressure support - correct answer Assist control Explanation: Assist-control ventilation provides full ventilator support by delivering a preset tidal volume and respiratory rate. IMV provides a combination of mechanically assisted breaths and spontaneous breaths. SIMV delivers a preset tidal volume and number of breaths per minute. Between ventilator-delivered breaths, the patient can breathe spontaneously with no assistance from the ventilator for those extra breaths. Pressure support ventilation assists SIMV by applying a pressure plateau to the airway throughout the client-triggered inspiration to decrease resistance within the tracheal tube and ventilator tubing. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Mechanical Ventilation, pp. 559-562. A client is diagnosed with mild obstructive sleep apnea after having a sleep study performed. What treatment modality will be the most effective for this client? Surgery to remove the tonsils and adenoids Medications to assist the patient with sleep at night Continuous positive airway pressure (CPAP) Bi-level positive airway pressure (BiPAP) - correct answer Continuous positive airway pressure (CPAP) Explanation: CPAP provides positive pressure to the airways throughout the respiratory cycle. Although it can be used as an adjunct to mechanical ventilation with a cuffed endotracheal tube or tracheostomy tube to open the alveoli, it is also used with a leak-proof mask to keep alveoli open, thereby preventing respiratory failure. CPAP is the most effective treatment for obstructive sleep apnea because the positive pressure acts as a splint, keeping the upper airway and trachea open during sleep. CPAP is used for clients who can breathe independently. BiPAP is most often used for clients who require ventilatory assistance at night, such as those with severe COPD or sleep apnea. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 560. Which type of ventilator has a preset volume of air to be delivered with each inspiration? Negative pressure Volume cycled Time cycled Pressure cycled - correct answer Volume cycled Explanation: With volume-cycled ventilation, the volume of air to be delivered with each inspiration is preset. Negative-pressure ventilators exert a negative pressure on the external chest. Time-cycled ventilators terminate or control inspiration after a preset time. When the pressure-cycled ventilator cycles on, it delivers a flow of air (inspiration) until it reaches a preset pressure, and then cycles off, and expiration occurs passively. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Mechanical Ventilation, pp. 559-560. The nurse is assessing a client who has a chest tube in place for the treatment of a pneumothorax. The nurse observes that the water level in the water seal rises and falls in rhythm with the client's respirations. How should the nurse best respond to this assessment finding? Gently reinsert the chest tube 1 to 2 cm and observe if the water level stabilizes. Inform the physician promptly that there is in imminent leak in the drainage system. Encourage the client to do deep breathing and coughing exercises. Document that the chest drainage system is operating as it is intended. - correct answer Document that the chest drainage system is operating as it is intended. Explanation: Fluctuation of the water level in the water seal shows effective connection between the pleural cavity and the drainage chamber and indicates that the drainage system remains patent. No further action is needed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, CHEST TRAUMA, Pneumothorax, p. 596. A client is being admitted to the preoperative holding area for a thoracotomy. Preoperative teaching includes what? Correct use of a ventilator Correct use of incentive spirometry Correct use of a mini-nebulizer Correct technique for rhythmic breathing - correct answer Correct use of incentive spirometry Explanation: A nurse assesses a client with pneumonia. Which assessments are diagnostic for pneumonia? Select all that apply. Presence of crackles Egophony Friction rubs Wheezes Whispered pectoriloquy Percussion dullness - correct answer Presence of crackles Egophony Wheezes Whispered pectoriloquy Percussion dullness Explanation: Physical examination findings may reveal bronchial breath sounds over consolidated lung areas: soft, high-pitched crackles, inspiratory vesicular sounds that are longer than expired normal breath sounds, increased tactile fremitus (vocal vibration detected on palpation), percussion dullness, egophony, wheezing, and whispered pectoriloquy (whispered sounds are easily auscultated through the chest wall). Friction rubs are not common assessment findings for clients with pneumonia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pneumonia, p. 536. A nurse has performed tracheal suctioning on a client who experienced increasing dyspnea prior to a procedure. When applying the nursing process, how can the nurse best evaluate the outcomes of this intervention? Determine whether the client can now perform forced expiratory technique (FET). Percuss the client's lungs and thorax. Measure the client's oxygen saturation. Have the client perform incentive spirometry. - correct answer Measure the client's oxygen saturation. Explanation: The client's response to suctioning is usually determined by performing chest auscultation and by measuring the client's oxygen saturation. FET, incentive spirometry, and percussion are not normally used as evaluative techniques. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, NURSING PROCESS The Patient Receiving Mechanical Ventilation, p. 565. A client with myasthenia gravis is receiving continuous mechanical ventilation. When the high-pressure alarm on the ventilator sounds, what should the nurse do? Check for an apical pulse. Suction the client's artificial airway. Increase the oxygen percentage. Ventilate the client with a handheld mechanical ventilator. - correct answer Suction the client's artificial airway. Explanation: A high-pressure alarm on a continuous mechanical ventilator indicates an obstruction in the flow of gas from the machine to the client. The nurse should suction the client's artificial airway to remove respiratory secretions that could be causing the obstruction. The sounding of a ventilator alarm has no relationship to the apical pulse. Increasing the oxygen percentage and ventilating with a handheld mechanical ventilator wouldn't correct the airflow blockage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, NURSING PROCESS The Patient Receiving Mechanical Ventilation, pp. 563- 564. A client has hypoxemia of pulmonary origin. What portion of arterial blood gas results is most useful in distinguishing between acute respiratory distress syndrome and acute respiratory failure? Partial pressure of arterial oxygen (PaO2) Partial pressure of arterial carbon dioxide (PaCO2) pH Bicarbonate (HCO3-) - correct answer Partial pressure of arterial oxygen (PaO2) Explanation: In acute respiratory failure, administering supplemental oxygen elevates the PaO2. In acute respiratory distress syndrome, elevation of the PaO2 requires positive end-expiratory pressure. In both situations, the PaCO2 is elevated and the pH and HCO3- are depressed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 556. When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems? Hypotension, hyperoxemia, and hypercapnia Hyperventilation, hypertension, and hypocapnia Hyperoxemia, hypocapnia, and hyperventilation Hypercapnia, hypoventilation, and hypoxemia - correct answer Hypercapnia, hypoventilation, and hypoxemia Explanation: The cardinal physiologic abnormalities of acute respiratory failure are hypercapnia, hypoventilation, and hypoxemia. The nurse should focus on resolving these problems. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 556. A client has been receiving 100% oxygen therapy by way of a nonrebreather mask for several days. Now the client complains of tingling in the fingers and shortness of breath, is extremely restless, and describes a pain beneath the breastbone. What should the nurse suspect? Oxygen-induced hypoventilation Oxygen toxicity Oxygen-induced atelectasis Hypoxia - correct answer Oxygen toxicity How to milk the chest tubing How to splint the incision when coughing How to take prophylactic antibiotics correctly How to manage the need for fluid restriction - correct answer How to splint the incision when coughing Explanation: Prior to thoracotomy, the nurse educates the client about how to splint the incision with the hands, a pillow, or a folded towel. The client is not taught how to milk the chest tubing because this is performed by the nurse. Prophylactic antibiotics are not normally used and fluid restriction is not indicated following thoracotomy. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, CHEST TUMORS, Lung Cancer (Bronchogenic Carcinoma), p. 580. A client diagnosed with acute respiratory distress syndrome (ARDS) is restless and has a low oxygen saturation level. If the client's condition does not improve and the oxygen saturation level continues to decrease, what procedure will the nurse expect to assist with in order to help the client breathe more easily? Intubate the client and control breathing with mechanical ventilation Increase oxygen administration Administer a large dose of furosemide (Lasix) IVP stat Schedule the client for pulmonary surgery - correct answer Intubate the client and control breathing with mechanical ventilation Explanation: A client with ARDS may need mechanical ventilation to assist with breathing while the underlying cause of the pulmonary edema is corrected. The other options are not appropriate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Acute Respiratory Distress Syndrome, p. 571. The nurse is educating a patient with COPD about the technique for performing pursed-lip breathing. What does the nurse inform the patient is the importance of using this technique? It prolongs exhalation. It increases the respiratory rate to improve oxygenation. It will assist with widening the airway. It will prevent the alveoli from overexpanding. - correct answer It prolongs exhalation. Explanation: The goal of pursed-lip breathing is to prolong exhalation and increase airway pressure during expiration, thus reducing the amount of trapped air and the amount of airway resistance. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders. A patient is admitted to the hospital with pulmonary arterial hypertension. What assessment finding by the nurse is a significant finding for this patient? Ascites Dyspnea Hypertension Syncope - correct answer Dyspnea Explanation: Dyspnea, the main symptom of PH, occurs at first with exertion and eventually at rest. Substernal chest pain also is common. Other signs and symptoms include weakness, fatigue, syncope, occasional hemoptysis, and signs of right-sided heart failure (peripheral edema, ascites, distended neck veins, liver engorgement, crackles, heart murmur). Anorexia and abdominal pain in the right upper quadrant may also occur. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, PULMONARY VASCULAR DISORDERS, Pulmonary Hypertension, p. 574. Hyperbaric oxygen therapy increases the blood's capacity to carry and deliver oxygen to compromised tissues. This therapy may be used for a client with: a compromised skin graft. a malignant tumor. pneumonia. hyperthermia. - correct answer a compromised skin graft. Explanation: A client with a compromised skin graft could benefit from hyperbaric oxygen therapy because increasing oxygenation at the wound site promotes wound healing. Hyperbaric oxygen therapy isn't indicated for malignant tumors, pneumonia, or hyperthermia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders. A nurse is administering a purified protein derivative (PPD) test to a client. Which statement concerning PPD testing is true? A positive reaction indicates that the client has active tuberculosis (TB). A positive reaction indicates that the client has been exposed to the disease. A negative reaction always excludes the diagnosis of TB. The PPD can be read within 12 hours after the injection. - correct answer A positive reaction indicates that the client has been exposed to the disease. Explanation: A positive reaction means the client has been exposed to TB; it isn't conclusive for the presence of active disease. A positive reaction consists of palpable swelling and induration of 5 to 15 mm. It can be read 48 to 72 hours after the injection. In clients with positive reactions, further studies are usually done to rule out active disease. In immunosuppressed clients, a negative reaction doesn't exclude the presence of active disease. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pulmonary Tuberculosis, p. 548. How should the nurse best assess whether a client receiving oxygen therapy is hypoxemic? Assess the client's level of consciousness (LOC). Assess the client's extremities for signs of cyanosis. The nurse is caring for a client who is ready to be weaned from the ventilator. In preparing to assist in the collaborative process of weaning, the nurse should anticipate that the weaning of the client will progress in what order? Removal from the ventilator, tube, and then oxygen Removal from oxygen, ventilator, and then tube Removal of the tube, oxygen, and then ventilator Removal from oxygen, tube, and then ventilator - correct answer Removal from the ventilator, tube, and then oxygen Explanation: The process of withdrawing the client from dependence on the ventilator takes place in three stages: the client is gradually removed from the ventilator, then from the tube, and, finally, oxygen. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 569. A nurse is teaching a client how to perform flow type incentive spirometry prior to his scheduled thoracic surgery. What instruction should the nurse provide to the client? "Hold the spirometer at your lips and breathe in and out like you normally would." "When you're ready, blow hard into the spirometer for as long as you can." "Take a deep breath and then blow short, forceful breaths into the spirometer." "Breathe in deeply through the spirometer, hold your breath briefly, and then exhale." - correct answer "Breathe in deeply through the spirometer, hold your breath briefly, and then exhale." Explanation: The client should be taught to lace the mouthpiece of the spirometer firmly in the mouth, breathe air in through the mouth, and hold the breath at the end of inspiration for about 3 seconds. The client should then exhale slowly through the mouthpiece. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Chart 19-1, p. 529. The ICU nurse caring for a 2-year-old near drowning victim monitors for what possible complication? Atelectasis Acute respiratory distress syndrome Metabolic alkalosis Respiratory acidosis - correct answer Acute respiratory distress syndrome Explanation: Factors associated with the development of ARDS include aspiration related to near drowning or vomiting; drug ingestion/overdose; hematologic disorders such as disseminated intravascular coagulation or massive transfusions; direct damage to the lungs through prolonged smoke inhalation or other corrosive substances; localized lung infection; metabolic disorders such as pancreatitis or uremia; shock; trauma such as chest contusions, multiple fractures, or head injury; any major surgery; embolism; and septicemia. Options A, C and D are incorrect. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Acute Respiratory Distress Syndrome, Chart 19-20, p. 571. The critical care nurse is precepting a new nurse on the unit. Together they are caring for a client who has a tracheostomy tube and is receiving mechanical ventilation. What action should the critical care nurse recommend when caring for the cuff? Deflate the cuff overnight to prevent tracheal tissue trauma. Inflate the cuff to the highest possible pressure in order to prevent aspiration. Monitor the pressure in the cuff at least every 8 hours Keep the tracheostomy tube plugged at all times. - correct answer Monitor the pressure in the cuff at least every 8 hours Explanation: Cuff pressure must be monitored by the respiratory therapist or nurse at least every 8 hours by attaching a handheld pressure gauge to the pilot balloon of the tube or by using the minimal leak volume or minimal occlusion volume technique. Plugging is only used when weaning the client from tracheal support. Deflating the cuff overnight would be unsafe and inappropriate. High cuff pressure can cause tissue trauma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 559. A patient taking isoniazid (INH) therapy for tuberculosis demonstrates understanding when making which statement? "I am going to have a tuna fish sandwich for lunch." "It is all right if I drink a glass of red wine with my dinner." "It is all right if I have a grilled cheese sandwich with American cheese." "It is fine if I eat sushi with a little bit of soy sauce." - correct answer "It is all right if I have a grilled cheese sandwich with American cheese." Explanation: Patients taking INH should avoid foods that contain tyramine and histamine (tuna, aged cheese, red wine, soy sauce, yeast extracts), because eating them while taking INH may result in headache, flushing, hypotension, lightheadedness, palpitations, and diaphoresis. Patients should also avoid alcohol because of the high potential for hepatotoxic effects. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pulmonary Tuberculosis, p. 550. A patient arrives in the emergency department after being involved in a motor vehicle accident. The nurse observes paradoxical chest movement when removing the patient's shirt. What does the nurse know that this finding indicates? Pneumothorax Flail chest ARDS Tension pneumothorax - correct answer Flail chest Explanation: During inspiration, as the chest expands, the detached part of the rib segment (flail segment) moves in a paradoxical manner (pendelluft movement) in that it is pulled inward during inspiration, reducing the amount of air that can be drawn into the lungs. On expiration, because the intrathoracic pressure exceeds atmospheric pressure, the flail segment bulges outward, impairing the patient's ability to Exercise tolerance tests Arterial blood gas values Chest x-ray - correct answer Pulmonary function studies Explanation: Pulmonary function studies are performed to determine whether the planned resection will leave sufficient functioning lung tissue. ABG values are assessed to provide a more complete picture of the functional capacity of the lung. Exercise tolerance tests are useful to determine if the client who is a candidate for pneumonectomy can tolerate removal of one of the lungs. Preoperative studies, such as a chest x-ray, are performed to provide a baseline for comparison during the postoperative period and to detect any unsuspected abnormalities. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, PULMONARY VASCULAR DISORDERS, Pulmonary Hypertension, p. 575. A nurse admits a new client with acute respiratory failure. What are the clinical findings of a client with acute respiratory failure? Insidious onset of lung impairment in a client who had normal lung function Sudden onset of lung impairment in a client who had normal lung function Insidious onset of lung impairment in a client who had compromised lung function Sudden onset of lung impairment in a client who had compromised lung function - correct answer Sudden onset of lung impairment in a client who had normal lung function Explanation: In acute respiratory failure, the ventilation or perfusion mechanisms in the lung are impaired. Acute respiratory failure occurs suddenly in a client who previously had normal lung function. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 556. A nurse is teaching a client about using an incentive spirometer. Which statement by the nurse is correct? "Breathe in and out quickly." "You need to start using the incentive spirometer 2 days after surgery." "Before you do the exercise, I'll give you pain medication if you need it." "Don't use the incentive spirometer more than 5 times every hour." - correct answer "Before you do the exercise, I'll give you pain medication if you need it." Explanation: The nurse should assess the client's pain level before the client does incentive spirometry exercises and administer pain medication as needed. Doing so helps the client take deeper breaths and help prevents atelectasis. The client should breathe in slowly and steadily and hold the breath for 3 seconds after inhalation. The client should start doing incentive spirometry immediately after surgery and aim to do 10 incentive spirometry breaths every hour. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Atelectasis, p. 529. The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment? Cough Hemoptysis Syncope Tachypnea - correct answer Tachypnea Explanation: Symptoms of PE depend on the size of the thrombus and the area of the pulmonary artery occluded by the thrombus; they may be nonspecific. Dyspnea is the most frequent symptom; the duration and intensity of the dyspnea depend on the extent of embolization. Chest pain is common and is usually sudden and pleuritic in origin. It may be substernal and may mimic angina pectoris or a myocardial infarction. Other symptoms include anxiety, fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis, and syncope. The most frequent sign is tachypnea (very rapid respiratory rate). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, PULMONARY VASCULAR DISORDERS, Pulmonary Embolism, p. 576. The nurse is having an information session with a women's group at the YMCA about lung cancer. What frequent and commonly experienced symptom should the nurse be sure to include in the session? Copious sputum production Coughing Dyspnea Severe pain - correct answer Coughing Explanation: The most frequent symptom of lung cancer is cough or change in a chronic cough. People frequently ignore this symptom and attribute it to smoking or a respiratory infection. The cough may start as a dry, persistent cough, without sputum production. When obstruction of airways occurs, the cough may become productive due to infection. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, CHEST TUMORS, Lung Cancer (Bronchogenic Carcinoma), p. 579. The clinic nurse is caring for a client with acute bronchitis. The client asks what may have caused the infection. What may induce acute bronchitis? Aspiration Drug ingestion Chemical irritation Direct lung damage - correct answer Chemical irritation Explanation: Chemical irritation from noxious fumes, gases, and air contaminants induces acute bronchitis. Aspiration related to near drowning or vomiting, drug ingestion or overdose, and direct damage to the lungs are factors associated with the development of acute respiratory distress syndrome. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Acute Tracheobronchitis, p. 531. Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Chart 19-1, p. 529. A client at risk for pneumonia has been ordered an influenza vaccine. Which statement from the nurse best explains the rationale for this vaccine? "Getting the flu can complicate pneumonia." "Influenza vaccine will prevent typical pneumonias." "Influenza is the major cause of death in the United States." "Viruses like influenza are the most common cause of pneumonia." - correct answer "Viruses like influenza are the most common cause of pneumonia." Explanation: Influenza type A is a common cause of pneumonia. Therefore, preventing influenza lowers the risk of pneumonia. Viral URIs can make the client more susceptible to secondary infections, but getting the flu is not a preventable action. Bacterial pneumonia is a typical pneumonia and cannot be prevented with a vaccine that is used to prevent a viral infection. Influenza is not the major cause of death in the United States. Combined influenza with pneumonia is the major cause of death in the United States. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pneumonia, p. 531. The nurse is preparing to perform tracheostomy care for a client with a newly inserted tracheostomy tube. Which action, if performed by the nurse, indicates the need for further review of the procedure? Cleans an infected wound and the plate with a sterile cotton tip moistened with hydrogen peroxide Dries and reinserts the inner cannula or replaces it with a new disposable inner cannula Puts on clean gloves; removes and discards the soiled dressing in a biohazard container Places clean tracheostomy ties then removes soiled ties after the new ties are in place without a second nurse assisting - correct answer Places clean tracheostomy ties then removes soiled ties after the new ties are in place without a second nurse assisting Explanation: For a new tracheostomy, two people should assist with tie changes to help make sure the new tracheostomy is not dislodged. A dislodged tracheostomy is a medical emergency. The other actions, if performed by the nurse during tracheostomy care, are correct. The wound and plate should be cleaned with sterile cotton-tipped applicators moistened with saline or sterile water or with hydrogen peroxide if infection is present. The inner cannula should be dried before reinsertion or if a disposable is being used, a new disposable cannula should be reinserted. The nurse should put on clean gloves and discard the soiled dressing in a biohazard container. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE>Tracheostomy, pp. 557-558. A client is being mechanically ventilated in the ICU. The ventilator alarms begin to sound. The nurse should complete which action first? Notify the respiratory therapist. Manually ventilate the client. Troubleshoot to identify the malfunction. Reposition the endotracheal tube. - correct answer Troubleshoot to identify the malfunction. Explanation: The nurse should first immediately attempt to identify and correct the problem; if the problem cannot be identified and/or corrected, the client must be manually ventilated with an Ambu bag. The respiratory therapist may be notified, but this is not the first action by the nurse. The nurse should not reposition the endotracheal tube as a first response to an alarm. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Mechanical Ventilation, pp. 559-564. A nurse is caring for a client after a thoracentesis. Which sign, if noted in the client, should be reported to the physician immediately? "Client is becoming agitated and complains of pleuritic pain." "Client is drowsy and complains of headache." "Client has subcutaneous emphysema around needle insertion site." "Client has oxygen saturation of 93%." - correct answer "Client is becoming agitated and complains of pleuritic pain." Explanation: After a thoracentesis, the nurse monitors the client for pneumothorax or recurrence of pleural effusion. Signs and symptoms associated with pneumothorax depend on its size and cause. Pain is usually sudden and may be pleuritic. The client may have only minimal respiratory distress, with slight chest discomfort and tachypnea, and a small simple or uncomplicated pneumothorax. As the pneumothorax enlarges, the client may become anxious and develop dyspnea with increased use of the accessory muscles. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Pneumothorax, p. 593. The nurse is administering anticoagulant therapy with heparin. What International Normalized Ratio (INR) would the nurse know is within therapeutic range? 0.5 to 1.0 1.5 to 2.5 2.0 to 2.5 3.0 to 3.5 - correct answer 2.0 to 2.5 Explanation: Low-molecular- weight heparin and fondaparinux (Arixtra) are the cornerstones of therapy, but IV unfractionated heparin may be used during the initial phase (ACCP, 2012). The early maintenance phase of anticoagulation typically consists of overlapping regimens of heparins or fondaparinux for at least 5 days with an oral vitamin K antagonist (e.g., warfarin [Coumadin]). A 3- to 6-month regimen of long-term maintenance with warfarin is typical but depends on the risks of recurrence and bleeding (ACCP, 2012). Heparin must be continued until the INR is within a therapeutic range, typically 2.0 to 3 (Kearon, Kahn, Agnelli, et al., 2008). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pneumonia, p. 541. A client who must begin oxygen therapy asks the nurse why this treatment is necessary? What would the nurse identify as the goals of oxygen therapy? Select all that apply. Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Pulmonary Tuberculosis, p. 550. Positive end-expiratory pressure (PEEP) therapy has which effect on the heart? Bradycardia Tachycardia Increased blood pressure Reduced cardiac output - correct answer Reduced cardiac output Explanation: Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, INFLAMMATORY AND INFECTIOUS PULMONARY DISORDERS, Atelectasis, p. 530. The nurse is assessing a patient with chest tubes connected to a drainage system. What should the first action be when the nurse observes excessive bubbling in the water seal chamber? Notify the physician. Place the head of the patient's bed flat. Milk the chest tube. Disconnect the system and get another. - correct answer Notify the physician. Explanation: Observe for air leaks in the drainage system; they are indicated by constant bubbling in the water seal chamber, or by the air leak indicator in dry systems with a one-way valve. In addition, assess the chest tube system for correctable external leaks. Notify the primary provider immediately of excessive bubbling in the water seal chamber not due to external leaks. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, CHEST TRAUMA, Pneumothorax, p. 596. A nurse is caring for a client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do? Place the end of the chest tube in a container of sterile saline. Apply an occlusive dressing and notify the physician. Clamp the chest tube immediately. Secure the chest tube with tape. - correct answer Place the end of the chest tube in a container of sterile saline. Explanation: If a chest drainage system is disconnected, the nurse may place the end of the chest tube in a container of sterile saline or water to prevent air from entering the chest tube, thereby preventing negative respiratory pressure. The nurse should apply an occlusive dressing if the chest tube is pulled out — not if the system is disconnected. The nurse shouldn't clamp the chest tube because clamping increases the risk of tension pneumothorax. The nurse should tape the chest tube securely to prevent it from being disconnected, rather than taping it after it has been disconnected. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, CHEST TRAUMA, Pneumothorax, p. 597. The nurse has instructed a client on how to perform pursed-lip breathing. The nurse recognizes the purpose of this type of breathing is to accomplish which result? Promote more efficient and controlled ventilation and to decrease the work of breathing Improve oxygen transport; induce a slow, deep breathing pattern; and assist the client to control breathing Promote the strengthening of the client's diaphragm Promote the client's ability to take in oxygen - correct answer Improve oxygen transport; induce a slow, deep breathing pattern; and assist the client to control breathing Explanation: Pursed-lip breathing, which improves oxygen transport, helps induce a slow, deep breathing pattern and assists the client to control breathing, even during periods of stress. This type of breathing helps prevent airway collapse secondary to loss of lung elasticity in emphysema. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Nursing Management of the Patient Having a Thoracotomy, p. 580. What is the reason for chest tubes after thoracic surgery? Draining secretions, air, and blood from the thoracic cavity is necessary. Chest tubes allow air into the pleural space. Chest tubes indicate when the lungs have re-expanded by ceasing to bubble. Draining secretions and blood while allowing air to remain in the thoracic cavity is necessary. - correct answer Draining secretions, air, and blood from the thoracic cavity is necessary. Explanation: After thoracic surgery, draining secretions, air, and blood from the thoracic cavity is necessary to allow the lungs to expand. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Chart 19-22 Thoracic Surgeries and Procedures, p. 581. Acute respiratory failure (ARF) occurs when oxygen tension (PaO2) falls to less than __________ mm Hg (hypoxemia) and carbon dioxide tension (PaCO2) rises to greater than __________ mm Hg (hypercapnia). 60; 50 60; 40 75; 50 75; 40 - correct answer 60; 50 Explanation: Acute respiratory failure (ARF) is classified as hypoxemic (decrease in arterial oxygen tension [PaO2] to less than 60 mm Hg on room air) and hypercapnic (increase in arterial carbon dioxide tension [PaCO2] to greater than 50 mm Hg with an arterial pH of less than 7.35). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, ACUTE RESPIRATORY FAILURE, p. 556. The client with a lower respiratory airway infection is presenting with the following symptoms: fever, chills, dry hacking cough, and wheezing. Which nursing diagnosis best supports the assessment by the nurse? The nurse is obtaining data from a client with a respiratory disorder. Which information would be considered a part of the functional assessment and would assist in the diagnosis of an occupational lung disease? Cough and dyspnea Black-streaked sputum Tenacious secretions Barrel chest - correct answer Black-streaked sputum Explanation: A functional assessment provides data on the lifestyle, living environment, and work environment of the client, which can contribute to lung disorders. A black-tinged sputum is suggestive of prolonged exposure to coal dust. Cough, dyspnea, and tenacious secretions are vague respiratory symptoms that are not specific to occupational lung disease. The presence of barrel chest is indicative of trapped oxygen in the lungs over a prolonged period of time. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, OCCUPATIONAL LUNG DISEASE: PNEUMOCONIOSES, p. 577. The nurse is caring for a client with a diagnosis of pleurisy. The client begins reporting right-sided chest pain that gets worse when he coughs or breathes deeply. Vital signs are within normal limits. What is the nurse's best action? Teach the client deep-breathing and coughing exercises Contact the respiratory therapist promptly Teach the client to splint the rib cage Teach the client pursed lip breathing - correct answer Teach the client to splint the rib cage Explanation: Because the client has pain on inspiration, the nurse educates the client to use the hands or a pillow to splint the rib cage while coughing. Deep breathing and coughing would cause more pain, and pursed lip breathing would provide relief. The client is not in obvious respiratory distress, so there is no immediate need to contact the respiratory therapist. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, CHEST TUMORS, Lung Cancer (Bronchogenic Carcinoma), p. 580. Which technique does a nurse suggest to a patient with pleurisy for splinting the chest wall? Turn onto the affected side. Use a prescribed analgesic. Avoid using a pillow while splinting. Use a heat or cold application. - correct answer Turn onto the affected side. Explanation: Teach the client to splint their chest wall by turning onto the affected side. The nurse instructs the patient with pleurisy to take analgesic medications as prescribed, but this not a technique related to splinting the chest wall. The patient can splint the chest wall with a pillow when coughing. The nurse instructs the patient to use heat or cold applications to manage pain with inspiration, but this not a technique related to splinting the chest wall. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, PLEURAL DISORDERS, Pleurisy, p. 554. 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 allow air to be restored to the lung." "The tube will drain secretions from the lung." "The tube will provide a route for medication instillation to the lung." "The tube will drain air from the space around the lung." - correct answer "The tube will drain air from the space around the lung." Explanation: Negative pressure must be maintained in the pleural cavity for the lungs to be inflated. An injury that allows air into the pleural space will result in a collapse of the lung. The chest tube can be used to drain fluid and blood from the pleural cavity and to instill medication, such as talc, to the cavity. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, CHEST TRAUMA, Pneumothorax, p. 593. For a client with pleural effusion, what does chest percussion over the involved area reveal? Absent breath sounds Dullness over the involved area Friction rub Fluid presence - correct answer Dullness over the involved area Explanation: Chest percussion reveals dullness over the involved area. The nurse may note diminished or absent breath sounds over the involved area when auscultating the lungs and may also hear a friction rub. Chest radiography and computed tomography show fluid in the involved area. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Pleural Effusion, p. 554. The nurse is assigned to care for a client with a chest tube. The nurse should ensure that which item is kept at the client's bedside? An Ambu bag A bottle of sterile water An incentive spirometer A set of hemostats - correct answer A bottle of sterile water Explanation: It is essential that the nurse ensure that a bottle of sterile water is readily available at the client's bedside. If the chest tube and drainage system become disconnected, air can enter the pleural space, producing a pneumothorax. To prevent the development of a pneumothorax, a temporary water seal can be established by immersing the open end of the chest tube in a bottle of sterile water. There is no need to have an Ambu bag, incentive spirometer, or a set of hemostats at the bedside. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders, Chest Drainage Systems, pp. 596-597. A nurse is attempting to wean a client after 2 days on the mechanical ventilator. The client has an endotracheal tube present with the cuff inflated to 15 mm Hg. The nurse has suctioned the client with