ATI Respiratory

Question 1

COPD intervention?

Answer 1

Provide a diet that is high in calories and protein.

(Resp tx should be scheduled before meals not after, have short activities followed by short rest periods in between. Don’t combine too many activities)

Question 2

Prep for discharge following bronchoscopy, priority assessment?

Answer 2

Assess gag reflex- risk is aspiration, gag reflex needs to return.

(Percussing lung sounds, auscultating heart sounds, and palpating peripheral pulses are important but not priority)

Question 3

Best position for emphysema to promote effective breathing?

Answer 3

High fowlers with arms supported on overbed table- allows for expansion of chest

Question 4

Med during asthma attack?

Answer 4

Albuterol (Proventil)- short acting beta 2 adrenergic agonist- bronchodilates quickly

(Cromolyn sodium (intal) is an anti-inflammatory used for maintenance. Fluticasone and salmeterol (Advair) is a glucocorticoid and long acting beta 2 adrenergic agonist for maintenance. Prednisone is a steroid that may be used after a severe exacerbation for anti-inflammatory effects.)

Question 5

Assessment used to evaluate the effectiveness of mechanical ventilation?

Answer 5

ABGs- provide important info regarding serum oxygen saturation and the acid bace balance of blood. Will show if ventilator is providing adequate oxygenation to maintain lung fx.

(BP & HR- circulatory status. Breath sounds- tube placement and adequacy of air exchange)

Question 6

Pt with ARDS, what indicates work of breathing has worsened?

Answer 6

Increase in respiratory rate- indicates increased work of breathing and need for improved oxygen delivery.

Question 7

Risk for pulmonary embolus?

Answer 7

Total hip arthroplasty- surgery, decreased mobility

Question 8

TB taking rifampin, teaching?

Answer 8

Urine and other secretions will be orange.

Ppd test won’t improve, med should be taken on empty stomach once per day

Question 9

Bacterial pneumonia assessment finding?

Answer 9

Temperature 38.8c (101.8f)- high temp

Resp will be fast, cough will be productive

Question 10

What to do when obtaining an ABG?

Answer 10

Hold pressure at site for 5 minutes, obtain specimen in heparinized syringe, perform Allen test before, don’t insert air bubble before capping syringe, transport to lab immediately.

Question 11

Respiratory acidosis:

Answer 11

pH 7.30, PO2 80 mmhg, PaCO2 55 mmhg, HCO3 22 meq/L.

Question 12

What precautions for active TB?

Answer 12

Airborne

Droplet- rubella, Contact- scabies, mrsa

Question 13

Singulair (montelukast) teaching?

Answer 13

Take every evening even when there are no symptoms. Used for prophylaxis of asthma exacerbation.

Question 14

Chest tube problem?

Answer 14

Continuous bubbling in the water seal chamber- suggests an air leak

(drainage should fluctuate in tubing during inspiration, small dark red clots are normal)

Question 15

Monitor pt on albuterol for what SE?

Answer 15

Tachycardia- most common side effect.

Candidiasis is a SE of inhaled glucocorticoids such as beclomethasone (QVAR

Question 16

Pt with COPD, report what to provider?

Answer 16

Productive cough with green sputum- indicates infection.

Expected findings- o2sat 89, clubbing, pursed lip breathing

Question 17

Post total laryngectomy for laryngeal cancer, priority assessment?

Answer 17

Airway patency- greatest risk is airway obstruction.

Gag reflex, o2sat, and breath sounds are important but not the most important

Question 18

Post thoracentesis, priority assessment?

Answer 18

Decreased breath sounds- could be developing pneumo.

Hemoptysis, incision site pain, and temp 100 are important but not priority

Question 19

Emphysema assessment finding to report?

Answer 19

Cyanotic lips- indicates pt is not efficiently oxygenating blood.

(Fatigue, crackles, and barrel chest are expected findings)

Question 20

Pt on vent, low pressure alarm?

Answer 20

Artificial airway cuff leak- interferes with oxygenation and causes low pressure alarm.

(Excess secretion, kinks in tubing, and biting ET tube cause the high pressure alarm)

Question 21

Indicator of tension pneumothorax following chest trauma?

Answer 21

Tracheal deviation to unaffected site

Question 22

Procedure during ET suctioning?

Answer 22

Remove suction catheter using rotating motion- reduces risk of tissue trauma, suction with sterile technique, suction the nonsterile oropharyngeal cavity after the ET tube not before to prevent cross contamination, suction PRN not on a schedule.

Question 23

Acute respiratory failure, what labs?

Answer 23

PaO2 58mmhg, decreased with ARF

Resp acidosis results, decreased ph, paco2 will rise, o2 sat will be decreased

Question 24

Post chest tube insertion, what should be at bedside?

Answer 24

Pair of padded clamps in case tube becomes disconnected.

Don’t need extra drainage system, suture removal set, or nonadherant pads

Question 25

Pulmonary embolism highest priority intervention?

Answer 25

Administer IV heparin at 1300 units/hr- will prevent further clot formation, pt is at risk for respiratory arrest r/t extension of clot.

(Cardiac monitor, quiet environment, and incentive spirometer are important but not priority)

Question 26

Postoperative pt develops acute onset of severe chest pain that is worse with inspiration, anxious, tachypnic. What should nurse do?

Answer 26

Apply supplemental oxygen first.

Auscultating lungs, administering pain meds, and initiating heparin therapy are important but not priority

Question 27

Lung cancer expected finding?

Answer 27

Blood tinged sputum- secondary to bleeding tumor

(Tactile fremitus is usually increased due to air spaces being replaced with tumor tissue or fluid, masses will sound dull or flat in percussion, no peripheral edema present)

Question 28

Post tracheostomy discharge instructions?

Answer 28

Inspect stoma for irritation
Clean cannula with half strength peroxide and rinse with saline
Remove old twill tape once new is in place
Don’t such potion while inserting catheter only when withdrawing to prevent tracheal tissue trauma

Question 29

Respiratory distress, how to provide highest level of oxygen via low flow system?

Answer 29

Nonrebreather mask- greater than 90% fio2, has reservoir bag from which the client obtains oxygen, one way valve to prevent exhaled air from entering reservoir bag, exhalation ports with flaps that prevent room air from entering the mask.

(Nasal cannula- 2-6L/min 28-44%o2. Simple face mask- o2 conc between 40-60%, has open exhalation ports that allow room air in and exhaled air out. Partial rebreather- o2 conc 60-75%, exhalation ports are open which allow room air in and exhaled air out.)

Question 30

Don’t nasopharyngeal suction a patient who has?

Answer 30

Closed head injury and lethargic- nasopharyngeal suctioning can further increase ICP.

Question 31

Indicators for suctioning:

Answer 31

dont suction routinely. If nurse identifies coarse crackles, ronchi, moist cough, hears or sees secretions in tube

Question 32

crepitus

Answer 32

subcutaneous emphysema, coarse crackling sensation palpated over the skin surface, indicates air leak into the subcutaneous tissue often indicating a pneumothorax

Question 33

Friction rub

Answer 33

scratching or squeeking sound that persists throughout the respiratory cycle and does not clear with coughing, may indicate pericarditis or pleurisy.

Question 34

Crackles

Answer 34

sometimes called rales. wet popping sounds, created by air moving thorugh liquid or by collapsed alveoli snapping open on inspiration. crackles indicate fluid or mucous in small airways.

Question 35

Tactile fremitus

Answer 35

vibration felt on palpation of the chest while the client repeats a syllable such as ninety nine. fremitus is increased over solid tissue or a tumor.

Question 36

what to discuss with the pt about asthma

Answer 36

the pts perception of the disease process and what may have triggered the current attack. gives the nurse valuable information about the clients knowledge and misconceptions about asthma and potential environmental triggers.

Question 37

Flail Chest

Answer 37

refers to the paradoxical movement of the chest wall of a client who has fractured two or more adjacent ribs in two or more places. results in a floating segment of the chest wall that moves inward on inspiration and outward on expiration.

Question 38

Pleural Friction rub

Answer 38

sound that originates outside the airways and is associated with inflammation such as pleurisy

Question 39

Inspiratory stridor

Answer 39

associated with narrowing of the middle airways, such as with croup

Question 40

Pt at risk for ARDS

Answer 40

increased restlessness, apprehension, and anxiety after increasing oxygen concentration is a sign of progressive hypoxemia and ARDS

Question 41

Pt with pneumonia

Answer 41

provide oral hygeine care after respiratory aerosol therapy treatments and before meals. oral hygiene removes the unpleasant or lingering taste from expected mucus, inhaled medications, and antibiotics. it helps improve the taste of food and stimulates the clients appetite.

Question 42

Postop pneumonectomy

Answer 42

teach to splint incision when coughing, pt must cough to clear secretions from the remaining lung. also give pain meds to facilitate deep breathing and coughing

Question 43

Pneumonectomy

Answer 43

removal of entire lung, there is no lung left to reexpand, eliminates need for upper chest tube which is placed to evacuate air from the pleural space, also lower chest tube is not needed as it is expected that fluid will gradually fill in the space left by the excised lung.

Question 44

CM of pneumothorax

Answer 44

absence of breath sounds/ severely diminished on affected side

Question 45

Pursed lip breathing

Answer 45

used by clients with emphysema when they experience dyspnea. Slows the clients pace of breathing, making each breath more effective. releases trapped air in the lungs and prolongs exhalation to slow the breathing rate. this improved breathing pattern moves carbon dioxide out of the lungs more efficiently.

Question 46

Respiratory acidosis

Answer 46

decreased exhalation of carbon dioxide because of chronic lung disease lungs can’t recoil.

Question 47

Chest physiotherapy (CPT)

Answer 47

mobilizes secretions in the airways. may give bronchodilators prior to CPT, encourage pt to breathe deeply and cough after CPT

Question 48

Thoracentesis positioning

Answer 48

sitting while leaning over the bedside table. THroacentesis is for aspirating fluid or air from the pleural space. the upright position ensures that the diaphragm is most dependent and facilitates the removal of accumulated fluid, which tends to pool in the bases of the pleural space.

Question 49

Chest tube system

Answer 49

Leak- bubbling in the water seal chamber
Tape all connections
Keep chest tube system below level of chest