Quiz #2 Respiratory

Question 1

COPD diagnosis

Answer 1

Productive cough for 3 months
Encompassing both: emphysema and bronchitis
Irreversible disease

Question 2

COPD client education

Answer 2

Eat high calorie foods to promote energy
Rest as needed
Obtain immunizations to prevent infection
Ensure fluid intake of at least 2 L daily to thin secretions

Question 3

Bronchitis

Answer 3

Inflammation of bronchi and bronchioles due to X chronic exposure of irritants

Examples: cigarette smoking and air pollution

Question 4

Emphysema

Answer 4

Loss of lung, elasticity, and hyper inflation(air gets trapped into lungs when breathing out) of tissue

Also causes destruction of alveoli, leading to decrease the gas exchange carbon dioxide and respiratory acidosis

Question 5

Normal O2 range for COPD

Answer 5

80-90%

Question 6

Respiratory rate for pts with COPD

Answer 6

40-50 / min

Question 7

Emphysema manifestations

Answer 7

P. I. N. K
P: pursed lip breathing
I: increased chest (barrel chest, clubbed fingers)
N: no chronic cough (dyspnea with productive cough)
K: keep tripoding (sitting, leaning forward with hands on knees to help with air exchange)

Question 8

Bronchitis manifestations

Answer 8

B. L. U. E
B: blue (cyanotic due to lack of oxygen)
L: long term (cough lasting longer than 3 months)
U: unusual cough (productive cough, purulent, crackles, and wheezing)
E: edema (usually overweight)

Question 9

Polycythemia

Answer 9

Usually occurs with bronchitis
A lot of extra RBCs are made due to hypoxia
Height hemoglobin levels —> therefore anemia is not common

Question 10

PFT

Question 11

Bronchodilators (inhalers)

Answer 11

Short acting
- albuterol, levoalbuterol
- salmeterol

cholinergic antagonists
- ipratropium

Methylxanthines
- theophylline

Question 12

Anti-inflammatory agents

Answer 12

Glucocorticoids
- beclomethasone
- prednisone

Leukotriene antagonists
- montelukast

Monoclonal antibodies
- omalizumab

Question 13

Client has emphysema and a new Rx for theophylline, which of the following instructions should the nurse provide?

Answer 13

Avoid caffeine because it’s a stimulant

Question 14

A nurse is caring for a client who was hospitalized with acute pulmonary tuberculosis and has started ethambutol therapy the nurse should understand which of the following should be monitored

Answer 14

Visual acuity

Changes in vision should be reported immediately
Stop if ocular toxicity occurs
obtain baseline visual acuity tests, and complete monthly after starting treatment

Question 15

Active pulmonary TB

Answer 15

TB can lie dormant for years before producing the disease
*individuals who have been exposed to TB but not have developed the disease can have latent TB.

if not treated, it can lie dormant for many years then become active as the individual becomes older or immunocompromised

*A chest X ray or QuantiFERON-TB gold can test for an active TB infection

Question 16

TB expected findings

Answer 16

Purulent sputum
Cough lasting longer than 3 weeks
Fatigue
Hemoptysis- late sign (blood in sputum from forceful cough
Dyspnea (late sign)
Weight loss and anorexia
Night sweats

(Remember: people. Cough. Frequently. He. Doesn’t. Weigh. Nothing)

Older adult clients present with altered mental status, fever, anorexia, and weight loss

Question 17

TB medications

Answer 17

R. I. P and E. S (RIPes)
Rifampin
Isonazid
Pyrazinamide
Ethambutol
Streptomycin sulfate

Question 18

Rifampin client education

Answer 18

Urine and other secretions will be orange-red color
Immediately report pain or swelling of joints, loss of appetite, jaundice, or malaise
Interfere with oral contraceptives

nurse should observe for hepatotoxicity

Question 19

Isoniazid client education

Answer 19

Do not drink alcohol with this—> can increase risk for hepatotoxicity

Question 20

A nurse is instructing a client who is newly diagnosed with pulmonary TB about the use of anti tuberculosis medication, what should nurse include in teaching

Answer 20

A typical course treatment involves 6-9 months of consistent medication use

generally 6-12 months, medication adherence and follow up for one full year

Question 21

Community-acquired pneumonia

Answer 21

Spread through droplets (streptococcus pneumoniae)

Is the most common type and often occurs as a complication of influenza

Immobility is a contributing factor in the development of pneumonia

Question 22

A nurse in the emergency department is assessing an older adult client who has community-acquired pneumonia. Which of the following findings should the nurse expect?

Answer 22

Confusion

Question 23

Beclomethasone purpose and considerations

Answer 23

A glucocorticoid (inhalation)
Anti inflammatory
Reduction in airway mucosa edema

Complications: difficulty speaking, hoarseness, and candidiasis
- use a spacer with inhaler

Question 24

A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. Which of the following instructions should the nurse provide?

Answer 24

Rinse mouth after administration

Question 25

A nurse is providing instructions to a client who has a new prescription for albuterol and beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching?

Answer 25

Administer the albuterol inhaler prior to using the beclomethasone inhaler.

albuterol is a bronchodilator, so using this before can enhance absorption of glucocorticoid

Question 26

Status Asthmaticus

Answer 26

Airway obstruction unresponsive to treatment
Involves extreme wheezing, labored breathing, use of accessory muscles, distended neck veins, and risk for cardiac or respiratory arrest

Question 27

Status Asthmaticus Nursing actions

Answer 27

Prepare for emergency intubation
Administer IV fluids, oxygen, bronchodilators, and epinephrine

Question 28

Rx for Fluticasone and salmeterol

Answer 28

Administer the bronchodilator first to increase absorption of anti-inflammatory agent

Ex: Salmeterol before Fluticasone
Salmeterol is bronchodilator
Fluticasone is corticosteroid

Question 29

Asthma attack prevention medication

Answer 29

Salmeterol

Question 30

Asthma attack medication uses and considerations

Answer 30

Albuterol: rapid relief of acute manifestations and exercise induced asthma

Ipratropium: Bronchospams and increased bronchodilation and decreased pulmonary secretions

Theophylline: narrow therapeutic and used when only other treatments are ineffective

Question 31

COPD Plan of care

Answer 31

Position client into high-Fowler to maximize ventilation
Encourage coughing, or suction to remove secretions
Use of incentive spirometer
Oxygen levels should be maintained between 88% and 92%
Increased work of breathing increases caloric demands
Practice breathing exercises
**provide rest periods for older adults who have dyspnea, design the room with opportunities for relaxation

Question 32

Aspiration pneumonia: what is it?

Answer 32

An infection caused by inhaling saliva, food, liquid, vomit, and foreign objects—> resulting in infection

• swollen bronchioles and fluid filled air spaces making breathing difficult
• oral or gastric material in lower airway

Question 33

Trendelenburg position

Answer 33

Where feet and legs are above the level of the heart to redirect blood from lower extremities into central circulation
— increases lung compliance and delivers more tidal volume
— with patient with foreign material in lower right airway you would wanna place the patient on their left

Question 34

Metered dose inhaler

Answer 34

Hold inhaler 1-2 inches 2-4 centimeters away from clients mouth
Ask client to take deep breath and exhale completely
Inhale slowly and deeply while pressing the inhaler
Breath in from 3-5 seconds then hold breath for 10 seconds
Medication reaches lower airways then the back of the throat

Question 35

Findings for left sided heart failure

Answer 35

Hacking cough

Question 36

A nurse is caring for a client who has emphysema and has difficulty with immobility. Client spends most of his days in reclining chair, which of the following physiological responses to prolonged immobility should the nurse expect?

Answer 36

Increased calcium excretion

Question 37

Airborne precautions

Answer 37

Examples
Measles, Tuberculosis, and Varicella

N95 mask
Negative airflow room (6-12 exchanges per hour)