Respiratory (Exam One) Flashcards
1
Q
List the primary respiratory assessment techniques.
A
- Auscultation of lung sounds
- Palpation of thoracic cavity
2
Q
What is tactile fremitus?
A
Vibration of the chest wall
3
Q
How is tactile fremitus assessed?
A
Posterior chest is palpated while the patient says “99”
4
Q
List conditions in which fremitus is increased?
A
- Pleural effusion
- Pneumonia
- Tumors
- Thick secretions
5
Q
Will fremitus be increased or decreased if the lungs are hyper-inflated?
A
Decreased
6
Q
How would a patient with low or decreased fremitus appear?
A
Barrel chested
7
Q
The absence of fremitus is indicative of what condition(s)? What should the nurse do if fremitus is absent?
A
- Pneumothorax
- Atelectasis
-Auscultate for breath sounds
8
Q
List the priority nursing interventions for a patient with increased respirations.
A
- Apply oxygen
- Administer medications
9
Q
Describe clear/vesicular lung sounds.
A
- Breath sounds are normal
- No adventitious noises heard
10
Q
Describe course crackles. What is the cause of this sound? Is this sound heard upon inspiration or expiration? What disorders are associated with this sound?
A
- Moist, low pitch bubbling sound
- Caused by fluid in airway
- Heard upon inspiration
- Pulmonary edema, bronchitis, pneumonia
11
Q
Describe fine crackles. What is the cause of this sound? Is this sound heard upon inspiration or expiration? What disorders are associated with this sound?
A
- Sound of velcro being town apart
- Sound of hair being rolled between fingers
- Caused by alveoli popping open on inspiration
- Heart failure and atelectasis
12
Q
Describe wheezes. What is the cause of this sound? Is this sound heard upon inspiration or expiration? What disorders are associated with this sound?
A
- High pitched, squeaky, musical sound
- Caused by narrow airways
- Heard upon inspiration or expiration
- Asthma
13
Q
Describe pleural friction rub. What is the cause of this sound? Is this sound heard upon inspiration or expiration?
A
- Creaking or grating sound
- Caused by rough, inflamed pleural surfaces rubbing together
- Heard on inspiration or expiration
14
Q
What does serum/metabolic CO2 measure?
A
Amount of carbonic acid and bicarbonate dissolved in the blood
15
Q
Why is serum/metabolic CO2 often inaccurate?
A
Results are altered if the sample is exposed to air
16
Q
List the different methods used to obtain a sputum sample.
A
- Expectoration
- Tracheal suction
- Bronchoscopy
17
Q
Who is responsible for obtaining a sputum sample?
A
The nurse
18
Q
When is the best time of day to obtain a sputum sample?
A
Morning
19
Q
Describe sputum induction.
A
Patient inhales an irritating hypertonic solution that causes them to cough
20
Q
What type of solution is used during a sputum induction?
A
Hypertonic solution
21
Q
A sputum culture cannot contain _________.
A
Saliva
22
Q
The nurse should observe the patients sputum for what?
A
- Color
- Amount
- Consistency
- Presence of blood
23
Q
A culture and sensitivity (C&S) study is used to diagnose what? What does a culture and sensitivity (C&S) study help identify?
A
- Diagnoses bacterial infection
- Identifies infecting organism
24
Q
When would an acid fast bacteria smear (AFB) be obtained?
A
- Culture and sensitivity (C&S) study is positive for organisms
- Diagnose TB
25
Cytology is utilized to determine the presence of what? What might this indicate?
Abnormal cells that may indicate cancer
26
How are gram stain results utilized in relation to patient therapy?
Guide patient treatment until culture and sensitivity (C&S) results are complete
27
A skin test determines if the patient has been exposed to what disease?
Tuberculosis (TB)
28
When might a skin test give a false reading?
Serum is injected too deep into the skin
29
List nursing responsibilities prior to a bronchoscopy procedure?
- Obtain signed consent
- Baseline respiratory assessment
- NPO for 6-12 hours prior to test
- Administer sedative
30
What is the priority nursing care management for a patient following a bronchoscopy procedure?
- NPO until gag reflex returns
| - Semi-fowlers position
31
List nursing responsibilities for a patient who has had a transthoracic needle aspiration (TTNA)?
- Monitor lung sounds every four hours for 24 hours
| - Monitor incision for signs and symptoms of infection
32
A patient who has had a transthoracic needle aspiration (TTNA) is at an increased risk for developing what condition?
Pneumothorax
33
List nursing responsibilities for a patient who has had a video-assisted thoracic surgery (VATS)?
- Monitor chest tube
- Monitor lung sounds
- Encourage deep breathing
34
Why would a patient have a chest x-ray following a video-assisted thoracic surgery (VATS) or transthoracic needle aspiration (TTNA)?
Verify a pneumothorax has not occurred
35
The nurse must ensure what has been completed before a transthoracic needle aspiration (TTNA) or video-assisted thoracic surgery (VATS) is performed?
Patient has signed a consent form
36
If a patient has a pneumothorax what type of lung sounds will be heard upon auscultation?
- Nothing
| - Absent lung sounds
37
Describe a thoracentesis.
Insertion of large bore needle into chest wall to aspirate intrapleural fluid
38
What is the primary nursing responsibility during a thoracentesis?
Ensure position is maintained
39
The nurse should assess for what condition following a thoracentesis if the patients oxygen saturation is less than 90%?
Pneumothorax
40
How much fluid is typically removed during a thoracentesis?
1000 mL to 1200 mL
41
What conditions may occur if too much fluid is removed or if the fluid is removed too quickly during a thoracentesis?
- Hypertension
- Hypoxemia
- Pulmonary edema
42
Describe the patients oxygen saturation following a thoracentesis.
Improve to >90%
43
What is the most common complication of a thoracentesis?
Pneumothorax
44
How will the nurse position a patient fixing to undergo a thoracentesis?
Sitting up on side of bed leaning forward on bedside table with pillows
45
A pulmonary function test is used to determine what?
- Diagnose pulmonary disease
- Monitor disease progression
- Assess response to bronchodilators
46
What is the nurses responsibility in relation to a pulmonary function test?
Educate patient on how to perform the test
47
Describe how to perform a pulmonary function test.
- Mouthpiece in place
- Take a deep breath
- Exhale as hard, as fast, and for as long as possible
48
The six minute walking test is commonly performed on patients with type of disease?
Heart disease
49
The nurse can best determine adequate arterial oxygenation of the blood by assessing
A. Heart rate
B. Hemoglobin level
C. Arterial oxygen partial pressure (PaO2)
D. Arterial carbon dioxide partial pressure
C
50
```
A student nurse asks the RN what can be measured by arterial blood gas (ABG). The RN tells the student that ABG can measure? (SATA)
A. Acid-base balance
B. Oxygenation status
C. Acidity of the blood
D. Bicarbonate (HCO3)
E. Compliance and resistance
```
A, B, C, D
51
To detect early signs or symptoms of inadequate oxygenation, the nurse would examine the patient for?
A. Dyspnea and hypotension
B. Apprehension and restlessness
C. Cyanosis and cool, clammy skin
D. Increased urine output and diaphoresis
B
52
Which respiratory assessment finding does the nurse interpret as abnormal?
A. Inspiratory chest expansion of 1 inch
B. Symmetric chest expansion and contraction
C. Resonance (to percussion) over the lung bases
D. Bronchial breath sounds in the lower lung fields
D
53
```
The nurse is preparing the patient for a diagnostic procedure to remove pleural fluid for analysis. The nurse would prepare the patient for which test?
A. Thoracentesis
B. Bronchoscopy
C. Pulmonary angiography
D. Sputum culture and sensitivity
```
A
54
When assessing subjective data related to the respiratory health of a patient with emphysema, the nurse should ask about what?
- Dyspnea during rest or exercise
- Ability to sleep through the entire night
- Prescription and OTC medication
55
What diagnostic study is the least invasive?
Chest x-ray
56
List the nursing management for a patient who has had a CT scan with contrast?
- Hydration
- Monitor kidney function
- Assess for shellfish allergy
57
A spiral CT assess's for what condition?
Pulmonary embolism
58
What is necessary to perform a spiral CT?
- Contrast
| - 20 gauge IV
59
What type of medication is used during a V/Q scan?
Nuclear medication
60
The nurse should do what to maintain their own health and safety when administering a nuclear medication?
- Be aware of pregnancy
- Wear PPE
- Carefully dispose of patient urine
61
Describe the process of a V/Q scan.
Nuclear medication is injected into a vein that spreads to help visualize the lungs
62
List the nursing management for a patient undergoing an MRI?
- Ensure no metal is present
- Assess for contrast allergies
- Monitor renal function
63
What medication must be held if the patient has received contrast dye? How long is this medication held?
- Metformin
| - 24 to 48 hours
64
List the three mechanisms for acid-base regulation.
- Buffer system
- Respiratory system
- Renal system
65
Describe the action of the buffer system.
Changes stronger acids into weaker acids or binds them so they neutralize
66
What systems must be adequately working in order for the buffer system to work properly?
- Respiratory system
| - Renal system
67
Which acid-base regulation mechanism has the fastest and most immediate reaction?
Buffer system
68
Which of the three acid-base regulation mechanisms is considered the primary regulator?
Buffer system
69
The respiratory system will respond within _________ if the buffer system fails to correct the body pH.
Minutes
70
How long does it take the respiratory system to reach max capacity?
Hours
71
What anatomical structure within the brain controls the respiratory system and the rate of CO2 excretion?
Medulla
72
If the CO2 level is elevated within the body, how will the respiratory system respond?
Increase respiratory rate to blow off excess CO2
73
If the CO2 level is decreased within the body, how will the respiratory system respond?
Decrease respiratory rate to retain CO2
74
The renal system will respond within _________ ___ _______ if the respiratory system fails to correct the body pH.
Hours to days
75
Describe the functions of the renal system in relation to acid-base regulation.
- Absorb bicarbonate
- Increase blood pH
- Decrease urine acidity
76
What is the normal range for pH?
7.35 - 7.45
77
What is the normal range for PCO2?
35 - 45
78
What is the normal range for HCO3?
22 - 26
79
A pH less than 7.35 is referred to as what?
Acidosis
80
A pH greater than 7.45 is referred to as what?
Alkalosis
81
A PaCO2 less than 35 is referred to as what?
Alkalosis
82
A PaCO2 greater than 45 is referred to as what?
Acidosis
83
An HCO3 less than 22 is referred to as what?
Acidosis
84
An HCO3 greater than 26 is referred to as what?
Alkalosis
85
PaCO2 is regulated by the __________ system.
Respiratory
86
HCO3 is regulated by the _________ system.
Renal
87
List the three steps in ABG interpretation.
- Determine acidosis or alkalosis of pH
- Determine if its respiratory or metabolic
- Determine if its compensated or uncompensated
88
If the PaCO2 is within normal range, but the HCO3 is abnormal, the problem is __________.
Metabolic
89
If the HCO3 is within normal range, but the PaCO2 is abnormal, the problem is __________.
Respiratory
90
Complete the acid-base balance example:
pH = 7.56
PaCO2 = 28
HCO3 = 22
Respiratory Alkalosis
91
Complete the acid-base balance example:
pH = 7.56
PaCO2 = 40
HCO3 = 35
Metabolic Alkalosis
92
If the pH, PaCO2, and HCO3 values are all abnormal, is the problem compensated, partially compensated, or uncompensated?
Partially compensated
93
If the pH is normal, but the PaCO2 and HCO3 values are abnormal, is the problem compensated, partially compensated, or uncompensated?
Compensated
94
If the pH is normal or abnormal, and there is a normal PaCO2 or normal HCO3 value present, is the problem compensated, partially compensated, or uncompensated?
Uncompensated
95
Complete the acid-base balance example:
pH = 7.30
PaCO2 = 50
HCO3 = 49
What is the primary problem? What is the type of compensation?
What is the level of compensation?
- Primary: Respiratory acidosis
- Type: Metabolic alkalosis
- Level: Partial compensation
96
Complete the acid-base balance example:
pH = 7.50
PaCO2 = 51
HCO3 = 41
What is the primary problem? What is the type of compensation?
What is the level of compensation?
- Primary: Metabolic alkalosis
- Type: Respiratory acidosis
- Level: Partial compensation
97
Complete the acid-base balance example:
pH = 7.35
PaCO2 = 49
HCO3 = 30
What is the primary problem? What is the type of compensation?
What is the level of compensation?
- Primary: Respiratory acidosis
- Type: Metabolic alkalosis
- Level: Full compensation
98
Complete the acid-base balance example:
pH = 7.42
PaCO2 = 30
HCO3 = 20
What is the primary problem? What is the type of compensation?
What is the level of compensation?
- Primary: Respiratory alkalosis
- Type: Metabolic acidosis
- Level: Full compensation
99
Complete the acid-base balance example:
pH = 7.25
PaCO2 = 32
HCO3 = 20
What is the primary problem? What is the type of compensation?
What is the level of compensation?
- Primary: Metabolic acidosis
- Type: Respiratory alkalosis
- Level: Partial compensation
100
Complete the acid-base balance example:
pH = 7.35
PaCO2 = 42
HCO3 = 25
What is the primary problem? What is the type of compensation?
What is the level of compensation?
-Primary: None
-Type: None
-Level: None
Normal!
101
Complete the acid-base balance example:
pH = 7.52
PaCO2 = 38
HCO3 = 30
What is the primary problem? What is the type of compensation?
What is the level of compensation?
- Primary: Metabolic alkalosis
- Type: None
- Level: Uncompensated
102
Respiratory acidosis is common in what type of diagnoses?
- COPD
| - Respiratory failure
103
Oversedation, such as taking too many opioids or barbiturates, may result in what type of complication?
Respiratory acidosis
104
List health conditions related to respiratory acidosis.
- Brain stem trauma
- Immobility
- Respiratory muscle paralysis
- Pulmonary edema
- Emphysema
- Bronchitis
105
List the signs and symptoms of respiratory acidosis.
- Lethargy
- Dizziness
- Headache
- Blurred vision
- Restlessness
- Hypoventilation with hypoxia
- Hypotension
- Seizure activity
- Ventricular fibrillation
- Extracellular fluid shift in potassium
106
Is respiratory acidosis a consequence of hypoventilation or hyperventilation?
Hypoventilation
107
Describe the workload on the lungs during respiratory acidosis.
Lungs are working too hard and not effectively
108
What is the primary goal when attempting to correct respiratory acidosis?
- Improve respirations
| - Increase the release of CO2
109
List examples of medications used to correct a patients respiratory rate during respiratory acidosis.
- Albuterol
| - Ipratropium bromide
110
List examples of medications used to increase a patients respiratory drive during respiratory acidosis.
-Diamox/acetazolamide
111
What is the antidote for opioids?
Narcan/naloxone
112
What is the antidote for benzodiazepines?
Flumazenil
113
What is considered as a last resort to correct respiratory rate during respiratory acidosis?
- Endotracheal tube
| - Ventilation support
114
What is the main drive for breathing?
CO2
115
What is the main cause of respiratory alkalosis?
Hypoxemia
116
List the causes of hypoxemia.
- Hyperventilation
- Pneumonia
- Pulmonary embolism
117
Respiratory alkalosis is a ________ ________ during pregnancy.
Normal finding
118
List the signs and symptoms of respiratory alkalosis.
- Tachypnea
- Confusion
- Lightheadedness
- Seizure activity
- Dysrhythmias
- Epigastric pain
- Numbness/tingling of extremities
119
What types of medications are used in the correction of respiratory alkalosis?
Antidepressants
120
Should respiratory alkalosis be corrected quickly or slowly?
Slowly
121
What may happen if the CO2 correction is done too quickly?
Causes metabolic acidosis
122
The nurse recommends breathing into a paper bag to correct what condition?
Respiratory alkalosis
123
What is a sign or symptom that a patient on a ventilator is in stress?
- Hyperventilation
- Asynchronous breathing/respirations
- Working against ventilation machine
124
What is the most important nursing assessment for a patient who is currently on a ventilator?
Assessing CO2 level
125
What may occur if the settings on a ventilator are incorrect?
- Decreased tidal volume
| - Decreased respiratory rate
126
Metabolic acidosis is almost always accompanied by ___________.
Hyperkalemia
127
If a patient misses a session of dialysis, they may experience what condition?
Metabolic acidosis
128
List the causes of metabolic acidosis.
- Diabetic ketoacidosis
- Lactic acidosis
- Diarrhea
- Renal failure
- Shock
- Ileostomy
129
List the signs and symptoms of metabolic acidosis.
- Rapid shallow breathing
- Confusion
- Fatigue
- Headache
- Lack of appetite
- Increased heart rate
- Fruity breath
- Hyperkalemia
130
What medication may be given to correct metabolic acidosis if kidney disease or lactic acidosis is the underlying problem?
Sodium bicarbonate
131
What is the primary goal when correcting metabolic acidosis?
Returning pH back to a value of 7.2 or greater
132
If a patient is experiencing metabolic acidosis due to diabetic ketoacidosis, what type of treatment is recommended?
- Insulin
| - IV hydration
133
What is the best way to track the response to treatment of metabolic acidosis?
Serial ABGs
134
Metabolic alkalosis is always ___________ to an underlying condition.
Secondary
135
List the causes of metabolic alkalosis.
- Vomiting
- NG suctioning
- Diuretic therapy
- Hypokalemia
- Excess bicarb intake
136
Excess bicarb intake is often a result of what?
- Treatment of metabolic acidosis
| - Excess intake of antacids
137
Diuretic therapy excessively __________ the acid within the body causing metabolic alkalosis.
Decreases
138
List the signs and symptoms of metabolic alkalosis.
- Irritability
- Lethargy
- Confusion
- Headache
- Hypoventilation with compensation
- Tachycardia
- N/V/D
- Hypokalemia
139
Metabolic alkalosis is accompanied by ___________.
Hypokalemia
140
If a patient is in metabolic alkalosis with a respiratory rate of 10 breaths per minute and their O2 saturation declines to 88%, what is the priority nursing intervention?
Apply oxygen
141
What diuretics are given to decrease bicarb?
- Acetazolamide
| - Spironolactone
142
Describe the IV fluid treatment for a patient with metabolic alkalosis.
NS ran at 50 mL to 100 mL greater than the patients urine output
143
During metabolic alkalosis, a patients respiratory rate will _________.
Decrease
144
What type of precautions or monitoring devices should the nurse implement for a patient in metabolic alkalosis?
- Seizure precautions
| - Cardiac monitor
145
What is the most common type of facial fracture?
Nasal fracture
146
Trauma or force to the face that causes clear leakage from the nose should be what?
Test leakage to see if it is cerebrospinal fluid
147
How is cerebrospinal fluid identified?
- High glucose count
| - Presence of halo
148
List the complications of a nasal fracture.
- Airway obstruction
- Epistaxis
- Meningeal tears
- Cerebrospinal fluid leakage
149
List the classifications of a nasal fracture.
- Simple
| - Complex
150
A simple nasal fracture is either __________ or ___________.
- Unilateral
| - Bilateral
151
There is little to no ___________ in a simple nasal fracture.
Displacement
152
If a patient has a complex nasal fracture, the nurse knows they should also be assessed for what?
- Cervical spinal injury
- Orbital cavity fracture
- Mandibular joint fracture
153
What is the biggest complication of a nasal fracture?
Airway obstruction
154
What are the priority nursing interventions for a patient with a nasal fracture?
- Maintain airway
- Sit patient upright
- Assess bleeding
- Assess edema
- Assess ability to breath out of both nares
155
The nurse educates a patient to apply ice to their nasal fracture. The nurse instructs the patient to apply ice for what length of time?
10 to 20 minutes
156
What types of medication should not be given to a patient with a nasal fracture for at least 48 hours following the injury? Why?
- Aspirin
- NSAIDS
-These medications interfere with clotting
157
Why should a patient with a nasal fracture be educated to avoid alcohol and hot showers?
To decrease the swelling
158
What type of surgical procedure is performed to correct a deviated septum?
Septoplasty
159
Describe a rhinoplasty.
Total reconstruction of the nose
160
The nurse should educate a patient scheduled for a rhinoplasty to stop taking aspirin or NSAIDS ______ _____ prior to the surgery.
Five days
161
List the nursing management for a post-operational rhinoplasty patient.
- Maintain airway
- Pain management
- Bleeding
- Swelling
- Infection
162
A patient arrives at the ED with a severe epistaxis. What question is important for the nurse to asking while gathering the patients health history?
Are you currently taking or have you recently quit taking any antiplatelets or anticoagulants?
163
A patient should seek medical assistance if a nose bleed lasts longer than ______ _________.
15 minutes
164
_________ nose bleeds require medical assistance.
Posterior
165
What is the treatment for an epistaxis?
First aid measures
166
List the causes of an epistaxis.
- Trauma
- Hypertension
- Low humidity
- Upper respiratory infection
- Allergies
- Nasal sprays
167
Describe the method used to control and stop a nose bleed.
- Tilt head forward
- Apply pressure
- Squeeze soft part of nose
168
What type of medication is used to cauterize bleeding vessels during an epistaxis?
Silver nitrate
169
What method is used for severe bleeding during epistaxis episode? What does this method often require?
- Thermal cauterization
| - Local or general anesthesia
170
If a patient has nasal packing in place and an O2 saturation of 88%, what is priority nursing intervention?
- Apply oxygen!
| - Do not remove nasal packing
171
What is the number one risk factor for developing laryngeal cancer?
Tobacco use
172
______ of head and neck cancers are caused by tobacco.
85%
173
People over the age of _____ are at an increased risk for developing laryngeal cancer.
50
174
What is a predisposing risk factor for developing laryngeal cancer younger than age 50?
HPV
175
List the signs and symptoms of laryngeal cancer.
- Hoarse voice
- Pain
- Lump/swelling
- Long lasting cough
- Sore throat/earache
- Difficulty breathing in severe cases
176
What is used to diagnose laryngeal cancer?
Biopsy
177
A small tumor is graded as a _____.
T1
178
If a tumor overrides into other tissues, it is graded as a ______.
T4
179
If there is no node involvement, it is classified as an _____.
N0
180
If a tumor has spread to more than one node, it is classified as an ____.
N3
181
M0 is indicative of what?
No metastasis
182
M1 is indicative of what?
Metastasis is present
183
A slow growing tumor is graded as a ___.
Grade 1
184
A rapid growing tumor is graded as a ____.
Grade 3
185
List the treatment options for laryngeal cancer.
- Surgery
- Chemotherapy
- Radiation
186
Describe a partial laryngectomy.
- Remove part of larynx
- Vocal cords intact
- Able to speak
- Hoarse voice
- Tracheotomy needed for post-op phase
187
Describe a total laryngectomy.
- Larynx is removed
- Lymph nodes removed
- Permanent tracheotomy
188
What type of intervention should be implemented into a patients plan of care if the patient is experiencing hopelessness and powerlessness related to laryngeal cancer or placement of tracheostomy tube?
Involve the patient in their plan of care
189
List examples of how to involve patient in their plan of care.
Teach patient how to clean their own devices
190
What portion of a tracheostomy allows the patient to speak?
Fenestration
191
Humidity aids in what for a patient with a tracheostomy?
Decrease and thin secretions
192
Humidified air within the collar of the tracheostomy should remain at what temperature?
93.2 to 96.8 degrees
193
Before cleaning a tracheostomy, the nurse should ensure what?
Tracheotomy does not need to be suctioned
194
The nurse knows to assess for what before and after providing tracheostomy care?
Oxygen!
195
What type of dressing is required for a tracheostomy?
Sterile precut dressings
196
A patient is moved to the medical-surgical floor after having a tracheostomy inserted. Who is responsible for assessing the new trach?
The RN
197
A patient on the medical-surgical floor has had a tracheostomy for about a month. Who is able to perform care for the established trach?
UAP
198
The nurse knows that cotton-filled gauze may never be used on a tracheotomy due to what?
Patient may aspirate on cotton or gauze fibers
199
Tracheostomy care is a _______ procedure.
Sterile
200
How many seconds should the nurse suction a tracheostomy for at one time?
15 - 30 seconds
201
Care of a tracheostomy should be scheduled at least ____________ after meals. Why?
- 3 hours
| - Decrease risk of vomiting or aspirating
202
When suctioning a tracheostomy, the suction catheter should be advanced no further than the what?
Carina trachea
203
A patient is seen in the clinic for a nosebleed, which is controlled by placement of anterior nasal packing. During discharge teaching, the nurse teaches the patient what?
Avoid vigorous nose blowing and strenuous activity
204
The best method for determining the risk for aspiration in a patient with a tracheotomy is to what?
Consult a speech therapist for swallowing assessment
205
Which nursing action would be of highest priority when suctioning a patient with a tracheostomy?
Assessing the patients oxygen saturation before, during, and after suctioning
206
When planning health care teaching to prevent or detect early head and neck cancer, which people would be the priority to target? (SATA)
A. 65-year-old man who has used chewing tobacco most of his life
B. 45-year-old rancher who uses snuff to stay awake while driving his herds of cable
C. 21-year-old college student who drinks beer on weekends with his fraternity brothers
D. 78-year-old woman who has been drinking liquor since her husband died 15 years ago
E. 22-year-old woman who has been diagnosed with HPV of the cervix
A, B, D, E
207
While in the recovery room, a patient with a total laryngectomy is suctioned and has bloody mucus with some clots. Which nursing interventions would apply? (SATA)
A. Notify HCP at once
B. Place patient in semi-Fowlers position
C. Use a bag-valve-mask and begin rescue breathing
D. Instill 10 mL NS into the tracheostomy tube to loosen secretions
E. Continue patient assessment, including O2 saturation, respiratory rate and breath sounds
B, E
208
Appropriate discharge teaching for the patient with a permanent tracheostomy after a total laryngectomy for cancer would include? (SATA)
A. Encouraging regular exercise such as swimming
B. Washing around the stoma daily with moist washcloth
C. Encouraging participation in postlaryngectomy support group
D. Provide pictures and hands on instruction for tracheostomy care
E. Teaching how to hold breath and trying to gag to promote swallowing reflex
B, C, D
209
List the different types of pneumonia.
- Community acquired pneumonia
- Hospital acquired pneumonia
- Aspiration pneumonia
210
Hospital acquired pneumonia can occur within ___ ________ of hospital admission.
48 hours
211
What nursing intervention is used to prevent pneumonia development?
Patient repositioning
212
What position is maintained during eating and drinking to avoid aspiration?
High-Fowlers
213
Ventilation acquired pneumonia occurs within ___________ after ventilation.
48 hours or more
214
In order to be classified as community acquired pneumonia, a patient should not have been in a hospital facility in ___ _______ of acquiring the condition.
14 days
215
List the signs and symptoms of pneumonia.
- Cough
- Fever
- Chills
- Dyspnea
- Tachypnea
- Pleuritic chest pain
216
What sign or symptom is common and sometimes the only indicator of pneumonia in the geriatric population?
Altered mental status
217
What signs and symptoms are commonly associated with pneumococcal pneumonia?
- Loose thin secretions
| - Increased tactile fremitus
218
What type of diagnostic test is necessary to diagnose pneumonia?
Chest x-ray
219
What should be collected prior to starting antibiotic therapy in a patient with pneumonia?
Culture
220
If a sputum sample cannot be obtained for a culture, the nurse knows to do what regarding antibiotic therapy?
- Do not delay therapy!
| - Administer broad spectrum antibiotic
221
List the treatment options for pneumonia.
- Antibiotics
- Oxygen
- Analgesics
- Antipyretics
- Rest
222
The nurse educates a patient with pneumonia to expect improvement in symptoms within how many days?
3 to 5 days
223
What type of pneumonia is self-limiting and cannot be treated with antibiotics?
Viral pneumonia
224
If viral pneumonia is caused by influenza, what type of medication is given?
Antiviral
225
Why should the nurse educate a patient with pneumonia on maintaining semi-Fowlers or high-Fowlers position instead of lying flat on the back?
- Laying flat decreases lung expansion
- Laying flat decreases ventilation
- Decreased ventilation causes build-up of secretions
226
A pneumonia patient should receive a follow-up chest x-ray within what time frame?
6 to 8 weeks
227
Why is it important to assess pain in a patient with pneumonia?
Patient may not effectively cough due to pain
228
Besides the lungs, tuberculosis may affect what other organs?
- Bones
- Kidneys
- Brain
229
List the risk factors for developing tuberculosis?
- Homeless
- Residents of LTC facilities
- Prisoners
- Poor access to healthcare
- Immunosuppressed
230
Describe primary tuberculosis.
- Bacteria inhaled
- Causes inflammatory response
- Infection does not progress to disease
231
Describe latent tuberculosis.
- Not active
- Asymptomatic but will become reactive at some point
- Cannot be transmitted by these carriers
232
Describe reactivated tuberculosis. What are the causes of reactivated tuberculosis?
- Occurs 2+ years after initial infection
| - Caused by immunosuppression, diabetes, stress, pregnancy
233
What is the name of the gram positive bacteria that causes tuberculosis?
Mycobacterium tuberculosis
234
List pulmonary signs and symptoms of tuberculosis.
- Dry to wet cough
- Fatigue
- Malaise
- Anorexia
- Fever
- Dyspnea
235
List renal signs and symptoms of tuberculosis.
- Dysuria
| - Hematuria
236
List bone/joint signs and symptoms of tuberculosis.
Severe pain
237
How long can it take symptoms of tuberculosis to occur after initial exposure to the disease?
2 weeks
238
Hemoptysis is a _______ and _____ symptom of tuberculosis.
Rare and late
239
Describe the signs and symptoms of tuberculosis meningitis.
- Headache
- Nausea
- Vomiting
240
What diagnostic test is used to confirm tuberculosis if the patient has a positive PPD (skin test)?
Chest x-ray
241
List the side effects of tuberculosis medications such as isoniazid, rifampin, and pyrazinamide.
Reddish-orange discoloration of teeth, sweat, urine, saliva or tears
242
A patient is fixing to receive the tuberculosis vaccine. What education should the nurse provide?
PPD (skin test) will always be positive after receiving the vaccine
243
Therapy for tuberculosis should be ______ ________.
Directly observed
244
How is a pneumothorax diagnosed?
Chest x-ray
245
Describe a hemothorax.
Collection of blood
246
Describe a chylothorax.
Collection of lymphatic fluid
247
If the patient is experiencing a small pneumothorax, what signs and symptoms will they have?
- Tachycardia
| - Pain with breathing
248
What type of signs and symptoms are common with a large pneumothorax?
- Significant respiratory distress
- Air hunger
- Pain with breathing
- Increased respiratory rate
- Low oxygen saturation
249
List the risk factors for developing a spontaneous pneumothorax.
- Lung disease
- Smoking
- Previous occurrence
- Tall/thin
- Male
- Asthma
- Cystic fibrosis
- COPD
- Pneumonia
250
Describe a iatrogenic pneumothorax.
Laceration or puncture of lung during medical procedure
251
When will a iatrogenic pneumothorax occur?
During a thoracentesis
252
A tension pneumothorax is considered what?
Medical emergency!
253
What is affected during a tension pneumothorax?
- Cardiac function
| - Pulmonary function
254
Describe a tension pneumothorax.
Air enters pleural space and it cannot escape
255
List the clinical manifestations associated with a tension pneumothorax.
- Tracheal deviation
- Decreased cardiac output
- Increased respiratory rate
- Severe hypoxemia
256
List the causes of a tension pneumothorax.
- CPR
- Mechanical ventilation
- Clamped/obstructed chest tube
- Open chest wound
257
What is the primary intervention for a patient with a hemothorax?
Insertion of chest tube
258
List the causes of a hemothorax.
Injury to:
- Chest wall
- Diaphragm
- Lungs
- Blood vessels
259
Which ribs are most prone to fracture?
Ribs 5 - 9
260
Patients who have a fractured or splinted ribs are at an increased risk for what?
- Puncture of lung
- Puncture of lung covering
- Puncture of organ
261
List the nursing management for a patient with a fractured rib.
- Baseline pain assessment
- Baseline respiratory assessment
- Have narcan available
262
What is flail chest?
Fracture of two or more ribs in two or more places
263
What type of breathing is common in a patient with flail chest?
- Unsynchronized breathing
| - Paradoxical breathing
264
What is the priority concern for a patient with flail chest?
Gas exchange
265
List the clinical manifestations of flail chest.
- Paradoxical breathing
- Pain to chest wall
- Tachycardia
- Bruising to chest wall
266
How is placement of a chest tube confirmed?
Chest x-ray
267
The drainage system for a chest tube must be placed where?
Below entry level
268
Who determines or sets the suction amount on a chest tube?
HCP
269
If there is bubbling in the water seal of a chest tube container, the nurse knows this indicates what?
- Air coming from the patient
| - Pneumothorax is still present
270
If blood or fluid is removed too quickly from the patient, the patient is at an increased risk for what?
Hypovolemic shock
271
Dressing changes for a chest tube must be what?
Sterile
272
A patient with TB has been admitted to the hospital and is placed on airborne precautions and in an isolation room. What should the nurse teach the patient? (SATA)
A. Expect routine TB testing to evaluate infection
B. No visitors will be allowed while in airborne isolation
C. Adherence to precaution includes coughing into a paper tissue
D. Take all medications for full length of time to prevent multi-drug resistant TB
E. Wear a standard isolation mask if leaving the airborne infection isolation room
C, D, E
273
The patient should be instructed to do what when a chest tube is being removed?
Hold breath
274
What type of dressing is used on a chest tube insertion site?
Occlusive dressing
275
What is the most common cause of atelectasis?
Obstruction due to secretions
276
List the nursing interventions for a patient with atelectasis.
- Early mobility
- Incentive spirometer
- Turn
- Cough
- Deep breath
277
Pulmonary embolism may be caused by what other factors besides blood?
- Tumor tissue
- Amniotic fluid
- Air
- Fat
278
List the sudden signs and symptoms of a pulmonary embolism.
- Dyspnea
- Hypoxemia
- Tachypnea
- Cough
- Chest pain
279
What diagnostic test is used to diagnose a pulmonary embolism?
Spiral CT
280
What type of medications or agents are used to dissolve clots?
Fibrinolytic agents such as TPA
281
What is the antidote for heparin?
Protamine
282
What is the antidote for warfarin?
Vitamin K
283
List the contraindications for receiving a lung transplant.
- Cancer within two years
- Positive for hepatitis B, C,
- Positive for HIV
- Smoking
- Poor nutritional status
- Psychological unpreparedness
284
Rejection of a lung transplant is most common within ___________ following surgery.
5 to 10 days
285
List the signs and symptoms of organ rejection.
- Low grade fever
- SOB
- Dry cough
- Low oxygen saturation
286
A patient who had a lung transplant three days ago develops a low grade fever, what is the nurses priority intervention?
Notify the HCP immediately!
287
How is organ rejection diagnosed?
Biopsy
288
What type of medication will the patient be placed on if organ rejection is suspected?
High dose corticosteroids for 3 days followed by supplemental oral steroids
289
The nurse identifies a flail chest in a trauma patient when
A. Multiple rib fractures are determined by x-ray
B. A tracheal deviation to the unaffected side is present
C. Paradoxical chest movement occurs during respiration
D. There is decreased movement of the involved chest wall
C
290
The nurse notes tidaling of the water level in the water-seal chamber in a patient with closed chest tube drainage. The nurse should
A. Continue to monitor the patient
B. Check all connections for a leak in the system
C. Lower the drainage collector further from the chest
D. Clamp the tubing at a distal point away from the patient
A
291
When planning care for a patient at risk for pulmonary embolism, the nurse prioritizes
A. Maintaining the patient on bed rest
B. Using intermittent pneumatic compression devices
C. Encouraging the patient to cough and deep breath
D. Teaching the patient how to use an incentive spirometer
B
292
Which statements describes the management of a patient following a lung transplantation? (SATA)
A. High doses of O2 administered around the clock
B. Using a home spirometer to help monitor lung function
C. Immunosuppressant therapy usually involves a 3-drug regimen
D. Most patients have acute rejection within the first 2 days
E. A lung biopsy is done using trantracheal method if rejection is suspected
B, C, E
293
If a patient is at an increased risk for aspiration or aspiration pneumonia, how will the nurse position the patient?
Side-lying position
294
Which patients have the greatest risk for aspiration pneumonia? (SATA)
A. Patient with seizures
B. Patient with head injury
C. Patient who had thoracic surgery
D. Patient who had a myocardial infarction
E. Patient who is receiving NG tube feeding
A, B, E
295
An appropriate nursing intervention to assist a patient with pneumonia manage thick secretions and fatigue would be to
A. Perform postural drainage every hour
B. Provide analgesics as ordered to promote patient comfort
C. Administer O2 as prescribed to maintain optimal O2 levels
D. Teach the patient how to cough effectively and expectorate secretions
D
296
A bacteriologic study is performed after a positive PPD. The nurse knows what about a bacteriologic sputum study for TB?
Three consecutive sputum samples should be obtained over three different days
297
How is tuberculosis transmitted? What type of conditions need to exist to transmit tuberculosis?
- Airborne
| - Must be in close proximity for extended period of time
298
If a patients tracheostomy tube is dislodged, what is the nurses priority intervention?
- Attempt to reinsert the tube
| - Maintain the patient airway
299
Tuberculosis medications such as isoniazid, rifampin, and pyrazinamide are ____________. What laboratory values should be monitored while receiving these medications?
-Hepatotoxic
- ALT, AST, ALP
- Bilirubin
