RESPIRATORY

Question 1

What are clinical manifestations of pneumonia?

Answer 1

1. pleuritic chest pain
2. increased vocal tactile fremitus: palpable vibrations that are increased when transmitted through consolidated lung tissue
3. bronchial breath sounds in peripheral lung fields
4. unequal chest expansion
5. dullness on percussion

Question 2

What is the priority during tracheostomy dislodgement?

Answer 2

dislodgement of the traeostomy tube is a MEDICAL EMERGENCY due to airway loss. the nurse should attempt to open the airway by inserting a curved hemostat to maintain stoma patency and insert a new tracheostomy tube with an obturator

Question 3

What type of dressing is used for tracheostomies?

Answer 3

Covering the stoma with an occlusive dressing (petroleium gauze or foam tape) is what is commonly used if the tube cannot be reinserted or if the stoma is immature (<7 days). dry gauze does not adequately seal the stoma for ventilation

Question 4

When is suctioning performed during mechanical ventilation?

Answer 4

suctioning is performed when removing the catheter, NOT inserting as to minimize amount of oxygen removed and mucosal trauma

Question 5

What is a bronchoscopy?

Answer 5

procedure in which bronchi are visualized witha bronchoscope. the client receives mild sedation to provide relaxation. a topical anesthetic such as lidocaine is applied to the nares and throat to suppress gag reflexes.

Question 6

What is a major complication of bronchoscopy?

Answer 6

hemoptysis (coughing up blood) can occur which indicates hemorrhage, especially if a biopsy was performed

Question 7

What are priority interventions for rib fractures?

Answer 7

interventions focus on pain management and pulmonary hygiene techniques such as deep breathing and use of incentive spirometer.it is normal to have shallow breathing and pain on inspiration due to rib fractures so giving pain medications is a priority treatment here

Question 8

What intervention can greatly reduce dust mites?

Answer 8

duste mite allergen exposure can be greatly reduced by washing linens every 1-2 weeks with hot water. high temperatures are needed to kill dust mites so use hot temperatures. Also washing pillow covers and vacuuming mattresses are important.

Question 9

What is hallmark sign of acute respiratory distress syndrome or ARDS?

Answer 9

refractory hypoxemia is the hallmark sign of ARDS.

Question 10

What is an open or traumatic pneumothorax?

Answer 10

air rushes through the wound (collapsed lung) with each inspiration creating a sucking sound and fills the pleural space. the lungs cannot expand so the client develops respiratory distress and air hunger.

Question 11

What intervention is a PRIORITY during an open pneumothorax?

Answer 11

the priority action in this medical emergency is to apply a sterile occlusive dressing taped on three sides, preventing inward air flow while allowing air to escape the pleural space

Question 12

What is a pleural friction rub characterized by?

Answer 12

stabbing pleuritic chest pain that increases on inspiration. when inflamed, the two pleurals become inflamme and rub together causing the pleuritic pain

Question 13

Who is contraindicated for receiving nasopharyngeal airway?

Answer 13

NPAs should NEVER be inserted in clients who have any form of head trauma (facial or basillar skull fractures). The nurse must immediately clarify this prescription with the HCP if the client also has any form of head trauma before insertion of the tube.

Question 14

What can the nurse specfically not change unless prescribed by the doctor for with a chest drainage system?

Answer 14

1. changing the suction level
2. milking chest tubes

Question 15

What type of medication is guaifenesin?

Answer 15

guaifenesin is an expectorant that reduces the viscosity of thick secretions by increasing respiratory tract fluid

Question 16

What is modafinil and when should it be taken?

Answer 16

stimuant medication used to treat excessive sleepiness cause by daytime sleepiness. Avoid taking this medication at night because it can cause insomnia

Question 17

What maneuver helps to open the airway?

Answer 17

head tilt and chin left maneuver is used to open the airway. this is the most appropriate INITIAL intervention to perform when oxygen saturation drops after general anesthesia

Question 18

What are clinical features of a pneumothorax?

Answer 18

Question 19

What indicates an air leak in the chest tube?

Answer 19

presence of an air leak is indicated by continuos bubbling of fluit at the base of the water seal chamber.

Question 20

What is bronchitis?

Answer 20

inflammation of the bronchi. rhonchi which are wheezes are low pitched breath sounds that occur when thick secretions obstruct airflow in the upper airways. rhonchi is commonly heard in bronchitis and cystic fibrosis.

Question 21

What is the priority intervention for a patient with carbon monoxide poisioning?

Answer 21

carbon monoxide has a much stronger bond with hemoglobin than oxygen does. so, the CO displaces oxygen from hemogblonin causing hypoxia that is not reflected by a pulse oximeter. the nurse’s primary ation is to administer highly concentrated oxygen using a nonrebreather mask in order to reverse this displacement of oxygen.

Question 22

How should the client be breathing during removal of the chest tube?

Answer 22

the client should be instructed to take a deep breath, hold it, and bear down while the tube is being removed. this will prevent air from being pulled back into the pleural space and possibly causing a pneumothorax.

Question 23

How does a client get carbon monoxide?

Answer 23

carbon monoxide is a coloress, gas procuded by burning fuel in a poorly ventilated setting.

Question 24

When can birght red drainage occur in a chest tube?

Answer 24

it is normal for there to be bright red drainage for several hours following a thoracotomy .

it is also normal for a rush of dark blood drainage to occur when the client is turning due to retained blood.

Question 25

What is the priority action for a client with a new tracheostomy?

Answer 25

preventing accidental dislodgement of the tube and loss of airway. the priority nursing action is to ensure the tube is placed securely by checking the tightness of the ties and allowing for 1 finger to fit under the ties.

Question 26

What characteristic usually indicates atelectasis?

Answer 26

fine crackles indicate atelectasis (partially collapsed lung) –> use incentive spirometer to breathe deeply with maximum inspiration

Question 27

What is the pursed lip breathing technique?

Answer 27

1. inhale for 2 seconds through the nose with mouth closed
2. exhale for 4 seconds through pursed lips

this prevents airway colapse because it opens the airways and air is expelled from alveoli and helps to eliminate carbon dioxide

Question 28

What are risk factors for developing COPD?

Answer 28

1. tobacco smoking
2. occupational exposure to chemicals and dust
3. air pollution
4. genetics

Question 29

What does an elevated eosinophil count indicate?

Answer 29

elevated eosinophils indicate an allergic trigger.

Question 30

Where in the chest tube is continuous bubbling appropriate?

Answer 30

continuous gentle bubbling in the suction control chamber is considered appropriate.

Question 31

What assessment in a cystic fibrosis patient requires immediate intervention?

Answer 31

drop in oxygen saturation because this can indicate a possible pneumothorax