exam 1 Flashcards
An acute cough lasts for less than __ weeks,
3
subacute cough lasts for __-__ weeks
3 to 8 weeks
cough lasting longer than __ weeks is considered chronic
8
You are doing a cerumen extraction and touch the external meatus of your patient‘s ear. He winces and starts coughing. What is the name of this reflex?
Baker phenomenon
Arnold reflex
Cough reflex
Tragus reflex
Arnold reflex
Julie has a postnasal drip along with her cough. You assess her for:
Asthma
Sinusitis
Allergic or vasomotor rhinitis
Influenza
Allergic or vasomotor rhinitis
A patient with hypertension comes in and insists that one of his new medications is causing him to cough. When looking at his list of medications, you think the cough must be from
Metoprolol
Clopidogrel
Tadalafil
Captopril
Captopril
African American patients seem to have a negative reaction to which of the following asthma medications?
Inhaled corticosteroids
Long-term beta-agonist bronchodilators
Leukotriene receptor agonists
Oral corticosteroids
Long-term beta-agonist bronchodilators
Sam, age 78, presents to the clinic with respiratory symptoms. His pulmonary function tests are as follows: a normal total lung capacity, a decreased PaO2, and an increased PaCO2. On assessment, you auscultate coarse crackles and forced expiratory wheezes. What is your diagnosis?
Asthma
Emphysema
Chronic bronchitis
Influenza
Chronic bronchitis
You are using the CURB-65 clinical prediction tool to decide whether Mabel, whom you have diagnosed with community-acquired pneumonia (CAP), should be hospitalized or treated at home. Her score is 3. What should you do?
Consider home treatment.
Plan for a short inpatient hospitalization.
Closely supervise her outpatient treatment.
Hospitalize and consider admitting her to the intensive care unit
Hospitalize and consider admitting her to the intensive care unit
Whydo you suspect that your patient may have a decreased response to the tuberculin skin test (TBT)?
She is on a high-protein diet.
She is an adolescent.
She has been on long-term corticosteroid therapy.
She just got over a cold.
She has been on long-term corticosteroid therapy
Marci has been started on a tuberculosis (TB) regimen. Because isoniazid (INH) may cause peripheral neuropathy, you consider ordering which of the following drugs prophylactically?
Pyridoxine
Thiamine
Probiotic
Phytonadione
Pyridoxine
Nathan, a 32-year-old policeman, has a 15-pack-a-year history of smoking and continues to smoke heavily. During every visit, he gets irate when you try to talk to him about quitting. What should you do?
Hand him literature about smoking cessation at every visit.
Wait until he is ready to talk to you about quitting.
Document in the record that he is not ready to quit.
Continue to ask him at every visit if he is ready to quit.
Continue to ask him at every visit if he is ready to quit.
Your patient has decided to try to quit smoking with Chantix. You are discussing his quit date, and he will begin taking the medicine tomorrow. When should he plan to quit smoking?
He should stop smoking today.
He should stop smoking tomorrow.
His quit date should be in 1 week.
He will be ready to quit after the first 30 days.
His quit date should be in 1 week.
Which information should be included when you are teaching your patient about the use of nicotine gum?
The gum must be correctly chewed to a softened state and then placed in the buccal mucosa.
Patients should not eat for 30 minutes prior to or during the use of the gum.
Initially, one piece is chewed every 30 minutes while awake.
Acidic foods and beverages should be encouraged during nicotine therapy.
The gum must be correctly chewed to a softened state and then placed in the buccal mucosa
Your patient states he has a strep throat infection. Which of the following symptoms makes you consider a viral etiology instead?
Fever
Headache
Exudative pharyngitis
Rhinorrhea
Rhinorrhea
What is the first–hemolytic streptococci (GABHS), the most common cause of bacterial pharyngitis?
Penicillin
Quinolone
Cephalosporin
Macrolide
Penicillin
Cydney presents with a history of asthma. She has not been treated for a while. She complains of daily but not continual symptoms, greater than 1 week and at nighttime. She has been using her rescue inhaler. Her FEV1 is 60% to 80% predicted. How would you classify her asthma severity?
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
Moderate persistent
Joyce is taking a long-acting beta agonist for her asthma. What additional medication should she be taking?
Inhaled corticosteroid
Leukotriene receptor antagonist
Systemic corticosteroid
Methyl xanthenes
Inhaled corticosteroid
Your patient is on Therabid for his asthma. You want to maintain his serum levels between
0 to 5 mcg/mL
5 to 10 mcg/mL
5 to 15 mcg/mL
10 to 20 mcg/mL
5 to 15 mcg/mL
George has chronic obstructive pulmonary disease (COPD) and an 80% forced expiratory volume in 1 second. How would you classify the severity of his COPD?
Stage 1 mild COPD
Stage 2 moderate COPD
Stage 3 severe COPD
Stage 5 very severe COPD
Stage 1 mild COPD
Most nosocomial pneumonias are caused by:
Fungi
Viruses
Gram-negative bacteria
Pneumococcal pneumonia
Gram-negative bacteria
Which of the following statements regarding TST is true?
Tests should be read 48 hours after the injection.
The size of the TST reaction has nothing to do with erythema but is based solely on induration.
It is a type V T cell-mediated immune response.
The diameter of the induration is measured in centimeters.
The size of the TST reaction has nothing to do with erythema but is based solely on induration.
Which obstructive lung disease is classified as reversible?
Asthma
Chronic bronchitis
Emphysema
COPD
Asthma
You have taught Jennifer, age 15, about using a flow meter to assess how to manage her asthma exacerbations. She calls you today because her peak expiratory flow rate is 65%. What would you tell her?
Take your short-acting beta-2 agonist, remain quiet, and call back tomorrow.
Use your rescue inhaler, begin the prescription of oral glucocorticoids you have, and call back tomorrow.
Drive to the emergency room now.
Call 911.
Use your rescue inhaler, begin the prescription of oral glucocorticoids you have, and call back tomorrow.
Which statement about adenocarcinoma of the lung is accurate?
It is the least common type of lung cancer, representing approximately 5% to 10% of cases
It is the most prevalent carcinoma of the lungs in both sexes and in nonsmokers, representing 35% to 40% of all tumors.
It is more common in men than in women and occurs almost entirely in cigarette smokers.
It is aggressive, with rapid growth and early local and distant metastases via the lymphatic and blood vessels.
It is the most prevalent carcinoma of the lungs in both sexes and in nonsmokers, representing 35% to 40% of all tumors.
Jason, age 62, has obstructive sleep apnea. What do you think is one of his contributing factors?
He is a recovering alcoholic of 6 years.
His collar size is 17 inches.
He is the only person in his family who has this.
He is extremely thin.
His collar size is 17 inches.
The forced vital capacity is decreased in
Asthma
Chronic bronchitis
Emphysema
Restrictive disease
Restrictive disease
The most common cause of CAP is?
Streptococcus pneumoniae
Klebsiella pneumoniae
Legionella pneumoniae
Pseudomonas aeruginosa
Streptococcus pneumoniae
Which of the following patients would you expect to have a decreased response to TST?
Julie, a 50-year-old postal worker
Sandy, a 40-year-old patient who recently survived a fire that left 40% of her total body surface covered in burns
Jill, a 16-year-old cheerleader
Mark, a 29-year-old tennis player
Sandy, a 40-year-old patient who recently survived a fire that left 40% of her total body surface covered in burns
Which of the following is a possible consequence of sleep apnea?
Asthma
Increased white blood cells
Insulin resistance
Hyperactivity
Insulin resistance
Which of the following conditions is associated with cigarette smoking?
Glaucoma
Increased sperm quality
Bladder cancer
Eczema
Bladder cancer
Marta is taking TB drugs prophylactically. How do you instruct her to take them?
Take them on an emptystomach to facilitate absorption.
Take them with aspirin (ASA) to prevent flushing.
Take them with ibuprofen to prevent a headache.
Take them with food to prevent nausea.
Take them on an emptystomach to facilitate absorption.
Which of the following statements regarding pulmonary function is true?
Cigarette smoking accelerates the decline in pulmonary function tenfold.
Smoking cessation can reverse most pathological changes.
Cigarette smoking decreases mucus production.
There is a normal age-related decline in pulmonary function.
There is a normal age-related decline in pulmonary function
The barrel chest characteristic of emphysema is a result of:
Chronic coughing
Hyperinflation
Polycythemia
Pulmonary hypertension
Hyperinflation**
34
Supplemental oxygen for how many hours per day has been shown to improve the mortality associated with COPD?
3 to 5 hours
6 to 10 hours
11 to 14 hours
15 to 18 hours
15 to 18 hours
Which ethnic group has the highest lung cancer incidence and mortality rates?
African American men
Scandinavian men and women
Caucasian women
Asian men
African American men
clinical presentations
Cough
Wheezing
Dyspnea
Chest Tightness
Triggers
Inspiratory & Expiratory wheezing
Accessory muscle use
Decreased Peak Expiratory Flow values
Variable Spirometry findings
Tactile Fremitus
Hyperresonance
asthma
acute cough treatment
self limiting
rest and fluids
asthma is considered an exacerbation if
there are symptoms.
(rescue meds can be used)
two gold standards for treatment of asthma
GINA
NAEPP
Non-Pharmacological Management
Avoidance of Triggers
Patient Education
Monitoring and Follow-up
asthma
Pharmacological Management
Long-Term Control Medication
Inhaled Corticosteroids (ICS)
Long-Acting Beta-Agonists (LABAs)
Quick-Relief (Rescue) Medications
Short-Acting Beta-Agonists (SABAs
asthma
Classification of Asthma Severity
**Symptoms:**
Frequency: Symptoms occur ≤2 days per week.
Nighttime Symptoms: ≤2 times per month.
Activity Limitations: None or minimal.
Peak Expiratory Flow (PEF): Normal between exacerbations.
FEV1/FVC: Normal.
medication use.
intermittent
Classification of Asthma Severity
Symptoms: >2 days per week but not daily.
Nighttime Symptoms: 3-4 times per month.
Activity Limitations: Minor limitations.
PEF: Normal or slightly reduced.
FEV1/FVC: Normal.
mild
Classification of Asthma Severity
Symptoms: Daily.
Nighttime Symptoms: More than once per week.
Activity Limitations: Some limitations.
PEF: 60-80% of predicted.
FEV1/FVC: Reduced.
moderate
Classification of Asthma Severity
Symptoms:
Frequency: Throughout the day.
Nighttime Symptoms: Often 7 times per week.
Activity Limitations: Extremely limited.
PEF: <60% of predicted.
FEV1/FVC: Significantly reduced.
severe
Management of Asthma
Medications:
Quick-Relief: Short-acting beta-agonists (SABAs) as needed (e.g., Albuterol).
Monitoring: Assess symptoms and peak flow regularly.
Action Plan: Ensure patients know how to use their SABA inhaler effectively.
Step 1: Intermittent Asthma
Management of Asthma
Medications:
Daily: Low-dose inhaled corticosteroids (ICS) (e.g., Fluticasone).
Quick-Relief: SABAs as needed.
Monitoring: Regular follow-ups to adjust medication based on symptom control.
Step 2: Mild Persistent Asthma
Management of Asthma
Medications:
Daily: Low to medium-dose ICS plus a long-acting beta-agonist (LABA) (e.g., Salmeterol).
Quick-Relief: SABAs as needed.
Management:
Assess: Regularly assess control and adjust treatment based on frequency of symptoms.
Moderate Persistent Asthma
Management of Asthma
Medications:
Daily: High-dose ICS plus LABA; consider adding a leukotriene receptor antagonist (LTRA) or a biologic if needed (e.g., Montelukast or Omalizumab).
Quick-Relief: SABAs as needed.
Additional Treatments:
Oral Corticosteroids: May be needed for severe exacerbations or persistent symptoms.
Oxygen Therapy: For patients with significant hypoxemia.
Management:
Frequent Monitoring: Close follow-ups to adjust treatment and prevent exacerbations.
Patient Education: Ensure understanding of proper medication use, action plans, and recognizing worsening symptoms.
Step 4: Severe Persistent Asthma
The use of a continuous positive airway pump in the treatment of sleep apnea will:
reduce bronchospasm.
force expansion of pleural membranes.
maintain an open airway.
awaken the person and increase respirations
maintain an open airway
The nurse is reviewing clients for risk factors in the development of pneumonia. Which of the
following clients would be at the highest risk for developing this disorder?
A 48-year-old client experiencing menopause
An 18-year-old client with abdominal pain
A 23-year-old client diagnosed with sickle-cell anemia and a cough
A 3-year-old client with fever
.A 23-year-old client diagnosed with sickle-cell anemia and a cough
High-risk groups for acquiring pneumonia are people with diabetes, infants 6- to 23-months old,
and those with a chronic illness such as sickle-cell anemia. Menopause and abdominal pain are
not symptoms associated with pneumonia. Fever in a 3-year-old client could be caused by many
disorders and not necessarily pneumonia
A client diagnosed with chronic obstructive pulmonary disease is experiencing pneumonia.
The nurse applies oxygen at 2 L/min via nasal cannula. When the nurse leaves the room, a family
member increases the oxygen to 5 L. Which complication may occur?
Angina
Apnea
Metabolic acidosis
Respiratory alkalosis
Apnea
client has been smoking for the last 40 years and has a history of emphysema. Which of the following findings would the nurse not expect to find?
Decreased forced vital capacity (FVC)
Increased anterior-posterior chest diameter
Increased forced expiratory volume (FEV1)
Pursed lip breathing
Increased forced expiratory volume (FEV1)
The FEV1 does not increase; it decreases. The FVC does decrease, and the client can exhibit increased anterior-posterior chest diameter and pursed lip breathing
The nurse is caring for a patient with lung cancer who is receiving chemotherapy. Which
assessment finding suggests that the patient is experiencing pericardial effusion?
Bruising and tarry stools
Edema and shortness of breath
Nausea and decreased bowel sounds
Peripheral numbness and tingling
Edema and shortness of breath
Pericardial effusion, or cardiac tamponade, is a condition usually caused by direct invasion of
the cancer, causing the pericardial sac to fill with fluid. Nursing care for the patient with cardiac
tamponade includes monitoring respiratory status, vital signs, and intake and output; keeping the
head of the bed elevated for maximum lung expansion; and assessing for edema
client states, I dont know why I should quit smoking. It cant improve anything. The nurse responds by informing the client about the decrease in lung cancer rates over time after a person quits smoking. Which of the following is correct?
The lung cancer rate corresponds to that of nonsmokers 1 year after quitting smoking.
The lung cancer rate corresponds to that of nonsmokers 2 years after quitting smoking.
The lung cancer rate corresponds to that of nonsmokers 5 years after quitting smoking.
The lung cancer rate corresponds to that of nonsmokers 10 years after quitting smoking.
The lung cancer rate corresponds to that of nonsmokers 10 years after quitting smoking.
Ten years after quitting smoking, the clients lung cancer rate will correspond to a nonsmokers
rate. After 1 year of no smoking, the risk of coronary heart disease decreases to half that of a
smoker.
After 2 years of no smoking, the risk of coronary heart disease equals that of a nonsmoker. After
5 years of no smoking, the lung cancer rate drops by half.
Apatient with lung cancer is receiving chemotherapy. Why should the nurse closely
monitor the patients white blood cell (WBC) count?
Chemotherapy drugs cause polycythemia and can precipitate thrombosis.
Chemotherapy drugs attack WBCs and shorten their life span, which increases risk for infection.
Chemotherapy drugs cause proliferation of blood cells, which can lead to sluggish circulation.
Chemotherapy drugs depress the bone marrow, which can lead to infection and anincrease in WBC count
Chemotherapy drugs depress the bone marrow, which can lead to infection and anincrease in WBC count
Chemotherapy is toxic to the bone marrow, where the blood cells are produced.Numbers of blood cells, especially WBCs, drop after approximately 7 to 14 days, depending on
The nurse is reviewing clients for risk factors in the development of pneumonia. Which of the
following clients would be at the highest risk for developing this disorder?
A 48-year-old client experiencing menopause
An 18-year-old client with abdominal pain
A 23-year-old client diagnosed with sickle-cell anemia and a cough
A 3-year-old client with fever
A 23-year-old client diagnosed with sickle-cell anemia and a cough
High-risk groups for acquiring pneumonia are people with diabetes, infants 6- to 23-months old,
and those with a chronic illness such as sickle-cell anemia. Menopause and abdominal pain are
not symptoms associated with pneumonia. Fever in a 3-year-old client could be caused by many
disorders and not necessarily pneumonia.
The nurse has a positive PPD during the last testing cycle for tuberculosis. Which of the following is indicated for this nurse?
Nothing
Chest x-rays every 2 months
Pharmacological treatment
Admission for inpatienttreatment
Pharmacological treatment
Latent tuberculosis infection occurs when a person exposed to the mycobacterium has a positive
PPDtest. This person is without an active clinical picture and has a 10% chance of developing
TBif preventive pharmacological treatment is not initiated. The nurse needs pharmacological
treatment.
Doing nothing could result in active disease. The nurse does not need chest x-rays every 2
months or admission for inpatient treatment.
.A client undergoes a purified protein derivative (PPD) test. The test should be read:
1.immediately after the test
2.24 to 48 hours after the test.
3. 48 to 72 hours after the test.
4. .anytime after 72 hours.
48 to 72 hours after the test.
Asmall amount of tuberculin is injected directly under the skin at the site and is read 48 to 72
hours after the test. The test should not be read immediately afterwards or within 24 to 48 hours.
If the test is read after 72 hours, the test may need to be repeated.
The nurse is instructing a client on ways to reduce the transmission of tuberculosis. Which of the following should be included in these instructions?
The disease is transmitted by inhaling droplets exhaled by an infected person.
The disease is transmitted by not fully cooking foods.
The disease is transmitted by not washing hands.
The disease is transmitted by sexual contact
The disease is transmitted by inhaling droplets exhaled by an infected person.
Tuberculosis is transmitted by inhaling the bacillus present in the air. The bacillus is present in
the air after an infected person has coughed, sneezed, or expectorated.Tuberculosis is not
transmitted through poorly cooked foods, poor handwashing, or sexual contact.
.A client receiving oral medications for the treatment of tuberculosis develops hepatitis. Which of the following medications would be indicated for the client at this time?
Ethambutol
Isoniazid
Rifampin
Streptomycin
Streptomycin
Streptomycin is a medication that can be used until the cause of hepatitis is identified or the liver
tissue heals. It is also given for those who have a first-line drug intolerance. First-line drugs are
isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA)
.The spouse of a client diagnosed with tuberculosis is to begin isoniazid prophylactic therapy. Which of the following should the nurse instruct the spouse regarding length of time to take this medication? The medication should be taken for:
10 to 24 days.
1 to 3 months.
4 to 7 months.
6 to 12 months
6 to 12 months.
Isoniazid therapy lasts 6 to 12 months. Taking the medication less than 6 months can be ineffective. The spouse should not be instructed to take the medication for 10 to 24 hours, 1 to 3 months, or 4 to 7 months.
A client diagnosed with a lung abscess is being prescribed antibiotic therapy. Which of the
following medications would be indicated if this client has a history of penicillin allergy?
Metronidazole
Clindamycin
Ampicillin
Steroid
Clindamycin
Clients allergic to penicillin are often given clindamycin since this medication is not part of the
penicillin family. Metronidazole and ampicillin should not be administered to this client. Steroid is not an antibiotic.
A client diagnosed with a hemothorax has had a chest tube inserted and attached to a portable
water-seal drainage system. Which of the following interventions would be inappropriate for this
client?
Clamp the tubing when ambulating
Date and mark the amount of drainage in the collection chamber every shift.
Monitor the suction chamber for continuous bubbling.
.Watch the water-seal chamber for fluctuation.
Clamp the tubing when ambulating
The chest tube should not be clamped or raised above the chest when ambulating. All other
options are appropriate.
A clients chest tube has been accidentally dislodged while the client was being transferred from the bed to a stretcher. Which of the following should the nurse do to help this client?
Cover the site with occlusive petroleum jelly gauze and tape to four sides.
.Cover the site with occlusive petroleum jelly gauze and tape to three sides.
Cover the site with occlusive petroleum jelly gauze and tape to two sides.
Cover the site with occlusive petroleum jelly gauze and tape to one side
.Cover the site with occlusive petroleum jelly gauze and tape to three sides.
In the case of accidental dislodging of the chest tube, the site should be covered with occlusive
petroleum jelly gauze and taped on three sides to prevent the development of a tension
pneumothorax. If the gauze is taped on all four sides, the client can develop a tension
pneumothorax. Taping the gauze on one or two sides will not be effective to support this client
and should not be done.
.A client is diagnosed with fractured ribs. Which of the following should the nurse instruct this client?
Engage in routine activities of daily living after taking pain medication.
Splint the rib cage when deep breathing and coughing.
Restrict fluids.
Stay on bed rest until the ribs heal
Splint the rib cage
when deep breathing and coughing.
Nursing care for a client recovering from fractured ribs include splinting the rib cage when deep
breathing and coughing. The client should be encouraged to avoid dangerous activities when
taking pain medication. Fluids should not be restricted. Bed rest would not be necessary for
fractured ribs.
.A client is prescribed a diuretic for treatment of pulmonary hypertension. Which of the following should the nurse instruct the client regarding this medication?
This medication expands the blood vessels.
This medication causes smooth muscle relaxation to reduce pulmonary engorgement
This medication reduces the amount of water in the body.
This medication keeps the blood from clotting.
This medication reduces the amount of water in the body.
Diuretics in the treatment of pulmonary hypertension are used to reduce the amount of water in the body. Vasodilators expand the blood vessels. Sildenafil causes smooth muscle relaxation to reduce pulmonary engorgement. Anticoagulants keep the blood from clotting.
The nurse is assessing a client experiencing manifestations of cor pulmonale. Which of the
following will the nurse most likely assess in this client?
Low blood pressure
Low heart rate
Hoarseness
Lumbar pain
Hoarseness
Manifestations of cor pulmonale include hoarseness, chest pain, distended neck veins, liver enlargement, peripheral edema, abnormal heart sounds. Low blood pressure, low heart rate, and lumbar pain are not manifestations of cor pulmonale.
.The nurse is planning to administer the pneumococcus vaccination to a client. Which of the
following would indicate that a client is a candidate for this vaccination? (Select all that apply.)
Age 70
Age 55
Diagnosis of heart failure
Recovering from knee replacement surgery Diagnosis of asthma
Age 70
Diagnosis of heart failure
Diagnosis of asthma
The nurse is planning care for a client diagnosed with bronchiolectasis. Which of the following
would be goals for this clients care? (Select all that apply.)
Treat the infection.
Reduce the heart rate.
Minimize further damage.
Improve urine output.
Promote breathing.
Remove secretions
Treat the infection.
Minimize further damage
Promote breathing
Remove secretions.
The nurse, planning care for a client diagnosed with a pneumothorax, identifies which types of
pneumothorax?
Spontaneous
Radical
Traumatic
Incomplete
Iatrogenic
Tension
.
.Spontaneous
.Traumatic
Iatrogenic
.Tension
The four types of pneumothorax are spontaneous, traumatic, iatrogenic, and tension. Radical and
incomplete are not types of pneumothorax
.Which of these instructions are for a client diagnosed with a pneumothorax?
Remove air from the pleural space.
Correct acid-base imbalances.
Treat infection.
Minimize damage.
Reexpand the lung.
Improve fluid balance
Remove air from the pleural space.
Correct acid-base imbalances.
Minimize damage
Reexpand the lung
Treatment goals for pneumothorax include removing the air and fluid from the pleural space, correcting acid-base imbalance, minimizing further damage, and reexpanding the lung. Treating infection and improving fluid balance are not treatment goals for a pneumothorax.
Howdoes pursed lip breathing assist patients with asthma during an attack?
It distracts the patient with breathing technique to reduce anxiety.
It gets rid of CO2 faster.
It opens bronchioles by backflow air pressure.
It increases PACO2
It opens bronchioles by backflow air pressure.
The resistance or the expiration through the pursed lips causes a backflow of air and helps to open the bronchioles.
Howdoleukotriene modifiers reduce the symptoms of asthma?
By drying up mucus
By causing bronchodilation and anti-inflammation effects
By suppressing cough
By liquefying mucus
Bycausing bronchodilation and anti-inflammation effects
Leukotriene modifiers reduce the symptoms of asthma by causing bronchodilation and anti
inflammatory processes.
Howshould a patient be positioned after a thoracentesis is completed and the dressing
applied?
High Fowler
Semi-Fowler
Side lying on unaffected side
Prone
Side lying on unaffected side
After a thoracentesis the patient is placed in a side-lying position on the unaffected side.
What should the nurse do to keep the chest tubes from becoming occluded?
Irrigate tubes as needed
Prevent dependent loops
Loop the tube over the bed rail
Milk the tube frequently
Prevent dependent loops
To keep the tubes patent, the tubes should be kept straight without dependent loops. These tubes
are not irrigated and should not be milked frequently.
Which patient assessment indicates the most severe respiratory distress?
Nasal flaring, symmetrical chest wall expansion, SaO2 88%
Abdominal breathing, SaO2 97%
Substernal retraction, SaO2 84%
Substernal retraction, SaO2 90%
Substernal retraction, SaO2 84%
Observe the patients facial expressions and signs of respiratory distress, such as flaring nostrils, substernal or clavicular retractions, asymmetrical chest wall expansion, and abdominal breathing.
The lower the SaO2, the more severe the respiratory distress
Which preoperative teaching should a nurse include for a person scheduled for a partial laryngectomy? (Select all that apply.
Tracheal suction will be frequent
The presence of a temporary tracheotomy
That isolation will be required for 24 hours
The surgery involves removal of a diseased vocal cord
Some speech will be retained
The sense of smell and taste will be lost
Tracheal suction will be frequent
The presence of a temporary tracheotomy
The surgery involves removal of a diseased vocal cord
Some speech will be retained
Apartial laryngectomy involves the removal of the diseased cord and possible thyroid cartilage.
There will be a temporary tracheostomy that will be closed once edema is under control.Tracheal suctioning will be done frequently. There will be some vocal ability retained. Isolation is not required. Sense of smell and taste are lost with a total laryngectomy.
Which independent nursing measures are effective in aiding a patient to expectorate?
(Select all that apply.)
Positioning in orthopneic position
Suctioning
Assisting to cough
Providing hydration
Starting IV fluids
Starting mucolytic agents
Positioning in orthopneic position
Suctioning
Assisting to cough
Providing hydration
Independent nursing intervention to help a patient to expectorate would include positioning, assisting to cough, suctioning, and providing hydration IV therapy; provision of a mucolytic agent requires a physicians order and is not an independent nursing action.
Identify the purposes of chest drainage
Drains air, blood, and fluid from pleural space
Restores positive pressure in chest cavity
Restores negative intrapleural pressure
Allows lung to collapse and rest
Allows route for medication administration
Drains air, blood, and fluid from pleural space
Restores negative intrapleural pressure
Achest tube or tubes may be inserted for continuous drainage of fluid, blood, or air from the
pleural cavity and for medication instillation. To prevent the lung from collapsing, a closed drainage
system is used, which maintains the lung cavitys normal negative pressure. The chest tubes are
connected to a pleural drainage system with collection, water seal, and suction control chambers
to drain secretions and reestablish negative pressure in the pleural space.
What are age-related changes in the older adult that make them at risk for respiratory diseases? (Select all that apply.)
Moist mucous membranes
Kyphosis
Decrease in pulmonary blood flow
Stasis pooling of secretions
Reduced number of cilia
Kyphosis
Decrease in pulmonary blood flow
Stasis pooling of secretions
Reduced number of cilia
Age-related changes that affect the respiratory system are dryer mucous membranes, which
reduce ability to humidify inspired air, kyphosis, which restricts the expansion of the lung, stasis
pooling of respiratory secretions, and reduced number of cilia, which make infection of the upper
and lower airway more likely.
The nurse explains to the person with pneumonia in the left lung that being positioned in the good lung down offers the advantage of (select all that apply)
PaO2 rising in the good lung
blood flow to bad lung being increased.
the dependent lung being better perfused.
dyspnea disappearing.
decreased hypoxia
PaO2 rising in the good lung.
the dependent lung being better perfused.
decreased hypoxia.
The good lung down position increases the PaO2 in the good lung and also allows for better perfusion, consequently decreasing hypoxia, although dyspnea may still be evident.
How would the nurse examining a patient with pleurisy document a low-pitched grating lung sound?
Sonorous wheeze
Friction rub
Coarse crackles
Crackles
Friction rub
Alow-pitched grating sound in the presence of an inflammatory disorder is a friction rub
Symptoms:
Chronic Cough: Persistent cough with sputum production.
Dyspnea: Progressive shortness of breath, especially on exertion.
Sputum Production: Chronic production of mucus, often thick and clear or yellowish.
Wheezing: Especially during expiration.
COPD
Characterized by dyspnea and a barrel chest with minimal cough.
Emphysema
More likely to present with a productive cough and cyanosis.
chronic bronchitis
Inspection
Barrel Chest: Increased anterior-posterior diameter, especially in emphysema.
Use of Accessory Muscles: Indication of respiratory distress.
**Auscultation: **
Wheezing: High-pitched whistling sounds during expiration.
Rhonchi: Low-pitched, rattling sounds indicating mucus in the airways.
Decreased Breath Sounds: Common in severe cases or when air trapping occurs.
**Palpation and Percussion: **
Hyperresonance: May be noted due to air trapping in emphysema.
*Decreased Tactile Fremitus: *Suggestive of obstructed airflow.
COPD
diagnostic tests for COPD
Spirometry:
Findings: Reduced FEV1/FVC ratio (_____) indicates airflow limitation; post-bronchodilator improvement confirms reversibility.
<70%
diagnostic tests for COPD
Chest X-Ray: Findings: _____ of lungs and flattened diaphragms in emphysema; may also show signs of chronic bronchitis.
Hyperinflation
diagnostic tests for COPD
Findings: Detailed imaging may reveal emphysema and__________.
bronchial wall thickening
diagnostic tests for COPD
Arterial Blood Gas (ABG): Findings: Assess for chronic __________________
respiratory acidosis and hypoxemia.
Measures airflow and volumes during inhalation and exhalation.
how much and how quickly air can be exhaled from the lungs
Spirometry
: Measures the different volumes of air in the lungs, such as Total Lung Capacity (TLC) and Residual Volume (RV). This can be measured using methods like body plethysmography or gas dilution techniques.
Lung Volumes
Measures how well gases (like oxygen) are transferred from the lungs into the blood. This assesses the integrity of the alveolar-capillary membrane.
Diffusion Capacity (DLCO):
Measures the highest speed at which air can be expelled from the lungs, often used in asthma management.
Peak Expiratory Flow (PEF):
spirometry
The total amount of air that can be forcibly exhaled from the lungs after taking the deepest breath possible.
Forced Vital Capacity (FVC):
Spirometry
The amount of air that can be forcibly exhaled in the first second of the FVC maneuver
Forced Expiratory Volume in 1 Second (FEV1):
Spirometry
The ratio of FEV1 to FVC, which helps diagnose obstructive and restrictive lung diseases
FEV1/FVC Ratio:
A ratio of less than 70% (post-bronchodilator) confirms persistent airflow limitation
GOLD Stage I (Mild): FEV1: __% predicted. N Symptoms: May be minimal or absent.
≥80
GOLD Stage II (Moderate): FEV1: _____% predicted. Symptoms: Typically, noticeable and may impact daily activities.
50-79%
GOLD Stage IV (Very Severe): FEV1: ____% predicted or FEV1 ____% predicted with chronic respiratory failure. Symptoms: Severe limitation in daily activities and may have complications such as respiratory failure.
<30%
<50%
GOLD Stage III (Severe): FEV1: _______% predicted. Symptoms: More severe and may significantly limit activities.
30-49%
Clinical Presentation
Cough (with or without sputum)
May produce burning substernal pain with
inspiration
May have low grade fever
Acute Bronchitis
what diagnostic test for acute bronchitis
Not necessary to diagnose Acute Bronchitis. Useful to exclude other illnesses.
Chest X-ray (r/o pneumonia)
Patient presents with cough longer than 7 days and normal vital signs –»» Acute Bronchitis
5 acute bronchitis management
Antitussive
Bronchodilator (as indicated)
Bed rest, increased fluid consumption to tin secretions
Codeine or Hydrocodone at bedtime
No Antibiotics
Common Symptoms:
Cough: Often productive with purulent sputum.
Fever: High temperature, often with chills.
Dyspnea: Shortness of breath.
Pleuritic Chest Pain: Sharp pain that worsens with breathing or coughing.
pneumonia
Physical Exam Findings
Inspection:
Signs of Respiratory Distress: Use of accessory muscles, tachypnea.
Cyanosis: Bluish discoloration of lips or extremities (in severe cases).
Palpation:
Increased Tactile Fremitus: Vibration felt on the chest wall due to consolidation.
Percussion:
Dullness: Over areas of consolidation, indicating fluid or solid material in the alveoli.
Auscultation:
Bronchial Breath Sounds: Heard over areas of consolidation, normally heard over larger airways.
Crackles: Rales indicating fluid in the alveoli.
Pneumonia
Diagnostic Testing
Chest X-Ray
Sputum Culture
Complete Blood Count (CBC)
C-Reactive Protein (CRP)
Pulse Oximetry/ABG
Procalcitonin
Pneumonia
Pneumonia management
Antibiotic Therapy: Empirical Treatment: Based on likely pathogens and patient risk factors (e.g., macrolides, cephalosporins).
Targeted Therapy: Adjust based on culture results.
Supportive Care:
Hydration: To help thin mucus and improve expectoration.
Fever Management: Antipyretics (e.g., acetaminophen) for fever and discomfort.
Oxygen Therapy: Indication: For patients with hypoxemia.
Hospitalization: Criteria: Severe cases, elderly patients, or those with comorbid conditions
The acronym CURB-65 stands for:
Confusion
Urea >7 mmol/L (or >20 mg/dL)
Respiratory Rate ≥30 breaths per minute
Blood Pressure (systolic <90 mmHg or diastolic ≤60 mmHg)65: Age ≥65 years
what CURB-65 score would be appropriate for home management
0-1
what CURB-65 score would be close outpatient management vs inpatient
2
what CURB-65 score would need ICU admission
3-5
Symptoms
Cough
Fever
Weight Loss
Fatigue
Chest Pain
TB
Physical Exam Findings
Inspection:
General Appearance: Cachexia or signs of chronic illness.
Palpation: Lymphadenopathy is possible
**Percussion: **
Dullness: Over areas of consolidation or effusion.
**Auscultation: **
Rales: Crackles or wheezes in the lung fields.
Decreased Breath Sounds: May indicate localized infection or effusion.
TB
diagnostic testing for TB
TB skin test
: Positive for high-risk individuals (e.g., HIV-positive, recent contacts of TB cases, immunosuppressed).
Positive for moderate-risk individuals (e.g., recent immigrants, healthcare workers, people with chronic conditions).
: Positive for individuals with no known risk factors (general population).
≥5 mm
≥10 mm:
≥15 mm
drug therapy for TB
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
Duration: Typically 6-9 months for drug-susceptible TB.
4 Major Histological Types
lung cancer
Squamous-cell (epidermoid) carcinoma
small-cell (oat cell) carcinoma
large-cell carcinoma
adenocarcinoma
Check the ears for cerumen or hairs impinging on the tympanic membrane, which may cause cough
this is called
arnold reflex
Examine the nose for discharge, edema, polyps, and sinus tenderness. In the throat, look for cobblestoning of the oropharynx, which suggests ____________
postnasal drip
may be useful to rule out sinusitis when the patient presents with a history of chronic postnasal drip or chronic sinus infections.
Sinus films
should be done to identify coccidioidomycosis, histoplasmosis, or aspergillosis, if there is a positive history of exposure or if the patient is immunosuppressed (e.g., patients with AIDS).
Fungal serology
A complete blood count (CBC) with differential is helpful in diagnosing a
bacterial infection
Because patients should be encouraged to expectorate during the day, these drugs have a limited role and should only be used on a short-term basis and only at nigh
antitussives
When sleeping or eating is interrupted by persistent cough, the preferred choice is ________
___ to __mg every 3 to 4 hours, but only on a short-term basis.
codeine, 8 to 30 mg
Patients with terminal lung cancer and patients with cystic fibrosis at the end of life should receive codeine in sufficient doses to keep them comfortable, although codeine may cause constipation.
____________and ___________, alone or in combination, are indicated in cases of allergic rhinitis and postnasal drip.
Decongestants and antihistamines,
are useful for those who have allergic upper airway disease but should usually be avoided in patients with asthma because they may thicken secretions and inhibit expectoration, due to their anticholinergic effects.
Antihistamines
Levels greater than 20% may cause dyspnea and headache, and levels greater than 40% may cause seizures and death.
carboxyhemoglobin (COHb)
If hemoptysis occurs in patients aged __________
it is likely caused by mitral stenosis, TB, bronchiectasis, or a lung abscess.
45 years or younger
For patients aged
common causes of hemoptysis include bronchogenic carcinoma, bronchitis, TB, and pulmonary embolus with infarction.
older than 45 years,
Sleep apnea is defined as a temporary pause in breathing during sleep that lasts at least 10 seconds. For a confirmed diagnosis, this should occur a minimum of _____ times an hour
five times an hour
Epworth Sleepiness Scale (ESS) measures sleepiness as a reflection of a patient’s tendency to fall asleep during eight specific nonstimulating situations. Each situation is scored from 0 to 3. A total score of ____ is considered abnormal.
10
The SSS is used to record the degree of sleepiness experienced by a patient at a given time and does not necessarily relate to their overall propensity to fall asleep.
It is an introspective measure of sleepiness in which the patient rates his or her alertness on a 7-point scale at different times during the day. If the score falls below a ____ when the patient should be feeling alert, a serious sleep deficit exists.
3
he definitive test for sleep apnea is an
overnight polysomnogram.
thiocyanate, cotinine, nicotine, and COHb in urine, blood, breath, or saliva can be performed to verify
reports of smoking status or abstinence
with COHb. A value of __% suggests that smoking has occurred.
2%
Smokers tend to have unique laboratory findings
albumin.
HCT
leukocytes
vitamin C level
total white blood cell count
platelet count.
serum uric acid
albumin decreased
HCT increased
leukocytes decreased
vitamin C level decreased
total white blood cell count increased
platelet count increased
serum uric acid decreased
CLINICAL PRESENTATION
abrupt onset
fever
chills
malaise
myalgia
headache
nasal stuffiness
sore throat
nausea
nonproductive cough
influenza
CLINICAL PRESENTATION
headache
myalgia
nasal congestion
watery rhinorrhea
sneezing
foul breath
“scratchy throat.
common cold
CLINICAL PRESENTATION
hoarseness
aphonia
pain when swallowing
Laryngitis
found on a complete blood count (CBC) with differential may help diagnose a bacterial infection.
Leukocytosis
Although most cases of acute rhinosinusitis (including bacterial sinusitis) resolve without antibiotics, if symptoms persist longer than ________,days antibiotic therapy should be considered for _________ days.
10 days
5 to 7 days.
Treatment
omplete voice rest
steam inhalations
codeine or nonnarcotic cough suppressants
liquid or soft diet.
laryngitis
If throat cultures are positive for group A beta-hemolytic Streptococcus,__________ should be prescribed if the patient is not allergic
penicillin
requires IV antibiotic therapy with nafcillin or an appropriate cephalosporin
bacterial tracheitis
If a fever persists for more than days, the white blood cell count rises to _________ cells/μL or higher, or the cough becomes productive, bacterial infection should be ruled out or verified and treated.
4 days
12,000 cells/μL or highe
a disease of exocrine gland function that involves multiple organ systems including the digestive system with pancreatic enzyme insufficiency, sweat glands, and the reproductive tract.
cystic fibrosis
a chest x-ray showing hyperinflation of the lung fields, and pulmonary function tests consistent with obstructive airway disease
cystic fibrosis
Sweat chloride of less than __ mmol/L is considered normal,
_________ mmol/L is considered intermediate
greater than ______mmol/L is abnormal.
Sweat chloride of less than 29 mmol/L is considered normal,
30 to 59 mmol/L is considered intermediate
greater than 60 mmol/L is abnormal.
CLINICAL PRESENTATION
sudden onset
fever
cough
chest pain
fatigue
productive cough
rusty coloration; purulent sputum
pneumonia
Objective Findings
Crackles
Dullness on percussion
Bronchophony, egophony, whispered pectoriloquy
Pleural friction rub (severe consolidation)
Decreased or absent breath sounds
Dense, homogenous shadows in one or more lung lobes on chest x-ray
pneumonia
The three most helpful tests used in the initial establishment of a diagnosis of pneumonia include
chest x-ray
leukocyte count
Gram stain of sputum specimens.
on a chest x-ray
Lobar infiltrates strongly suggest a _________ infection.
bacterial
show dense homogeneous shadows involving one or more lobes
Although there is no clear distinction, total white blood cell counts of more than ________cells/μLsuggest a bacterial infection.
15,000 cells
Large numbers of epithelial cells (more than _____ cells per low-power field) reflect contamination of the specimen with oral contents and mandate that another specimen be collected.
25
clinical presentation
anorexia
fatigue
digestive disturbances
slow weight loss
irregular menses
lack of stamina.
low-grade elevation of temperature that appears characteristically in the afternoon.
tb
clincial presentaion
productive cough
purulent sputum,
repeated occurrences of coryza-like symptoms with rhinorrhea and nasal congestion.
tb
with asthma
check PEFR after inhalation of SABA. Diagnosis is confirmed if:
There is a ___% increase in PEFR after 15 to 20 minutes.
PEFR varies more than ____% between arising and 12 hours later in clients taking bronchodilators (or 10% without bronchodilators).
There is a greater than ___% decrease in PEFR after 6 minutes of running or exercise.
15%
20%
15%
COPD
Stage I: mild obstruction: forced expiratory volume in 1 second (FEV1) greater than ___% of predicted value, some sputum, and chronic cough.
80%
COPD
Stage II: moderate obstruction: FEV1 between ___% and ____% of predicted value, shortness of breath on exertion, and chronic symptoms.
50% and 80%
Stage III: severe obstruction: FEV1 between ___% and ____% of predicted value, dyspnea, reduced exercise tolerance, and exacerbations affecting QOL.
30% and 50%
COPD
tage IV: very severe obstruction chronic respiratory failure: FEV1 less than _____% of predicted value or moderate obstruction FEV1 less than ____% of the predicted value, dyspnea at rest, and chronic respiratory failure. Of clients admitted for COPD exacerbation, 14% die within 3 months of admission.
30%
50%
COPD meds
Stage I (mild FEV1 80% or greater): The client may be unaware that they have COPD. Give influenza vaccine and use ______________ & ___________________ as needed.
short-acting beta-2 agonists (SABA) bronchodilators
COPD meds
Stage II (moderate FEV1 between 50% and 79%): Give influenza vaccine, plus _______________, as needed, plus _______________________________) plus ________________________ rehabilitation.
SABA bronchodilators, as needed, plus long-acting bronchodilator(s) plus cardiopulmonary rehabilitation.
COPD meds
Stage III (severe FEV1 between 30% and 49%): Give influenza vaccine, plus____________ as needed, plus _____________________s)— plus ____________ rehabilitation, plus _____________________ if client has repeated exacerbations
SABA bronchodilators as needed, plus long-acting bronchodilator(s)—for example, a long-acting antimuscarinic antagonist (LAMA), plus cardiopulmonary rehabilitation, plus inhaled glucocorticoid steroids if client has repeated exacerbations
COPD meds
_Stage IV (very severe FEV1 less than 30%): Give influenza vaccine, plus _________________, as needed, plus _______________) ______________________ rehabilitation, plus _______________________ if repeated exacerbations plus _______________________ (if the client meets the criteria). Medicare guidelines require a client’s PaO2 (partial pressure of oxygen) to be less than 55 mmHg or the resting oxygen saturation to be less than 88% on room air.
SABA bronchodilator, as needed, plus long-acting bronchodilator(s) (e.g., LAMA), plus cardiopulmonary rehabilitation, plus inhaled glucocorticoid steroids if repeated exacerbations plus long-term oxygen therapy (if the client meets the criteria for O2). Medicare guidelines require a client’s PaO2 (partial pressure of oxygen) to be less than 55 mmHg or the resting oxygen saturation to be less than 88% on room air.
asthma meds
First-line defense for acute attack; may be used prophylactically when necessary before exercise; provides smooth muscle relaxation for bronchodilation. Increased need (usage) indicates need to change treatment regimen.
Short-Acting Beta-Agonists (SABAs)
Albuterol
Levalbuterol
AccuNeb inhalation
Ventolin
Proventil
Ventolin hydrofluoroalkane
asthma meds
Not indicated for initial treatment of acute attacks where rescue therapy is required for rapid response; may be used as daily controller therapy or for rescue therapy in limited doses under medical supervision.
Anticholinergics
Ipratropium bromide (Atrovent HFA)
asthma meds
Long-term controller medication; prophylaxis and treatment of chronic asthma; ineffective for acute attacks
Leukotriene Receptor Antagonists (LTRAs)
Montelukast
pranlukast
zafirlukast
zileuton
asthma meds
Long-term controller medication; prophylaxis and treatment of chronic asthma; ineffective for acute attacks
Inhaled Corticosteroids (ICS)
Mometasone furoate
Beclomethasone
Budesonide
Fluticasone
asthma meds
Long-term controller medication for moderate to severe persistent asthma; prophylaxis and treatment of chronic asthma; ineffective for acute attacks
Combination Inhaled Corticosteroids and Long-Acting Beta-Agonists (ICS + LABAs)
Fluticasone and salmeterol (Advair Diskus)
Budesonide and formoterol (Symbicort)
Fluticasone furoate and vilanterol (BREO Ellipta)
Mometasone furoate and formoterol fumarate dihydrate(Dulera)
asthma meds
For long-term treatment of severe persistent asthma that cannot be controlled with other medication classes, including ICSs combined with LABAs
Short courses or “bursts” effective for establishing control when initiating therapy or during a period of gradual deterioration or as a supplement to rescue bronchodilator therapy during acute attacks to prevent late-phase bronchospasm
Systemic Corticosteroids
Methylprednisolone (Medrol)
Prednisolone (Orapred)
Prednisone
