a 40 year old architect with a malginaant parotid tumor is treated aggressively with radiation therapy and surgery. postsurgical laboratory results indicater ABG values are pH 7.32, PCO2 53, HCO3 25. which action should be taken by the nurse

• obtaining an order and administering a diuretic
• having the client breathe into a rebreather bag at a slower rate
• asking the client to cough productively and take deep breaths
• obtaining an order for administration of sodium bicarbonate

the nurse performs preoperative teaching related to a subtoatal thyroidectomy. the nurse evaluates that the client understands the teaching about the local effects of the administration of a general anesthetic when the client states, immediately after surgery i may experience

• transient headaches
• feelings of chilliness
• paroxysmal hiccoughs
• discomfort swallowing

after a gastroscopy the nurse assesses the client for the return of the gag reflex by

• touching the pharynx with a tongue depressor
• giving a small amount of water using a syringe
• observing for when the client gags and spits out airway
• instructing the client to breathe deeply and cough gently

when caring for clients in the operating suite, the nurse expects that the last physiological function the client loses during the induction of anesthetic is

• gag reflex
• eyelid reflexs
• voluntary control
• respiratory movement

when a client returns from a bronchoscopy the nurse wthholds food and fluid for several hours to prevent

• aspiration
• dysphasia
• projectile vomiting
• abdominal distention

an 84 year old client with a history of hemoptysis and cough for the last 6 months is suspected of having lung cancer. a bronchoscopy is performed. two hours after the procedure the nurse identifies an increase in the amount of bloody sputum. the nurse's priority is to

• notify the practitioner of the observation
• continue to monitor the amount of sputum
• monitor vital signs every hour for four hours
• increase the coughing and deep breathing regimen

an older adult confined to bed in a nursing home develops bronchitis and atelectasis of the right lower lobe. when discussing the treatment regimen with the client the nurse includes the need to

• lie on the affected side to relieve chest pain
• lie on the unaffected side to promote drainage
• sleep in the position of most comfort to promote rest
• sleep with the head elevated to stimulate deep breathing

a client with bronchial pneumonia is having difficulty maintaining airway clearance because of retained secretions. which intervention will help to decrease retained secretions

• administering oxygen as ordered
• gargling deeply with warm normal saline
• placing the client in a high fowler's position
• increasing fluid intake to at least two liters a day

after a laryngectomy a client becomes concerned about frequent coughing episodes and copious production of secretions. to what is this increase of coughing and secretions related

• irritation of the stoma by the tracheostomy tube
• upper respirtory inflammation due to allergie
• inadequate turning coughing and deep breathing
• the mucous membranes' reaction to air that is dry and unwarmed

an important nursing intervention that ensures adquate ventilatory exchange after surgery is

• maintining humidified oxygen via nasal cannula
• positioning the client laterally with the neck extended
• assessing for hypoventilation by auscultating the lungs
• removing the airway only when the client is fully conscious

positioning the client laterally with the neck extended

(I guess they mean immediately after surgery?)

which condition identified by researchers is related to the SARS virus

• malaria
• tularemia
• common cold
• legionnaires' disease

the nurse is assessing a client with emphysema. which sign of COPD does the nurse expect to identify

• decreased breath sounds
• atrophic accessory muscles
• chest with decreased ap diameter
• shortened expiratory phase of the respiratory cycle

an obese adult who smokes three packs of cigarettes daily is admitted for major abdominal surgery. postoperatively the most appropriate lab value that the nurse should moitor routinely that reflects the client's respiratory status is the

• PO2
• PCO2
• hemoglobin
• oxygen saturation

what should the nurse document after hearing soft swishing sounds of normal breathing when auscultating a client's chest

• adventitious sounds
• fine crackling sounds
• vesicular breath sounds
• diminshed breath sounds

a client who had a left sided pneumonectomy is in the PACU. the nurse's primary concern at this time is to maintain

• blood replacement
• ventilatory exchange
• closed chest drainage
• supplemental oxygenation

when assessing the breath sounds of a client with COPD the nurse hears coarse crackles (rhonchi). they are best described as

• snorting sounds during the inspiratory phase
• moist rumbling sounds that clear after coughing
• musical sounds more pronounced during expiration
• crackling inspiratory sounds unchanged with coughing

a client is brought to the emergency department with deep partial thickness burns on the face and full thickness burns on the neck, entire anterior chest, and right arm. when assessing for heat inhalation, the nurse should first observe for

• changes in the xray finding
• sputum that contains particles of blood
• nasal discharge containing carbon particles
• changes in the ABGs consistent with acidosis

the nurse's physical assessment of a client with heart failure reveals tachypnea and bilateral crackles. what should the nurse do next

• initiate oxygen therapy
• obtain chest x ray film immediately
• place client in a high fowler's position
• assess the client for a pleural friction rub

what is the best method to assess a client for stridor in the immediate postoperative period after a radical neck dissection

• listen with a stethoscope over the trachea
• determine the client's ability to do neck exercises
• listen with a stephoscope over the base of the lungs
• determine the client's ability to cough and deep breathe

a nurse is teaching a preoperative client about postoperative breathing exercises. what information should the nurse include. select all that apply

• take short frequent breaths
• exhale with the mouth open
• plan to do the exercises twice a day
• place a hand on the abdomen while feeling it rise
• hold the breath for several seconds at the height of inspiration

• place a hand on the abdomen while feeling it rise
• hold the breath for several seconds at the height of inspiration

a client is admitted to the ICU with a dx of ARDS. what should the nurse expect to identify when assessing this client

• hypertension
• tenacious sputum
• altered mental status
• slow rate of breathing

endotracheal intubation and positive pressure ventilation are instituted because of a client's deteriorating respiratory status. what is the priority nursing intervention at this time

• facilitate verbal communication
• prepare the client for emergency surgery
• maintain sterility of the ventilation system
• assess the client's response to the mechanical ventilation

a client is admitted to the ED with multiple injuries including fractured ribs. because of the client's fractured ribs the nurse should assesss for signs of

• pneumonitis
• hematemesis
• pulmonary edema
• respiratory acidosis

a client is placed on a ventilator. because hyperventilation can occur when mechanical ventilation is usd the nurse should monitor the client for signs of

• hypoxia
• hypercapnia
• metabolic acidosis
• respiratory alkalosis

a client is on a ventilator. one of he nurses asks what should be done when condensation, resulting from humidity, collects in the ventilator tubing. what should the nurse in charge instruct the other nurse to do

• notify the respiratory therapist
• empty the fluid from the tubing
• decrease the amount of humidity
• record the amount of fluid removed from the tubing

after surgery in the inguinal area, the client complains of pain on the right side of the chest, becomes dyspneic, and begins to cough violently. the nurse suspects that a pulmonary embolus has occured. what is the priority nursing action

• auscultate the chst
• obtain the vital signs
• elevate the head of the bed
• position the client on the right side

a client with a pulmonary embolus is intubated and placed on mechanical ventilation. when suctioning the endotracheal tube, the nurse should

• apply suction while inserting the cathetr
• hyperoxygenate with 100% oxygen before and after suctioning
• use short, jabbing movements of the catheter to loosen secretions
• suction two or three times in quick succession to remove the secretions

the respiratory status of a lient with buillain barre syndrome progresively deteriorates and a tracheostomy is performed. nasogastric tube feedings are ordered. the nurse should

• deflate the tracheostomy cuff before starteing the tube feeding
• inflate the tracheostomy cuff for 1 our before and afrer each feeding
• deflate the tracheostomy cuff after the tube feeding has been completed
• inflate the tracheostomy cuff before and for 30 minutes after each feeding

the nurse considers that when a client has a racheostomy tube with a high volume, low pressure cuff, it is used primarily to prevent

• leakage of air
• lung infection
• mucosal necrosis
• tracheal secretion

a 21 year aspiring actress is admitted for a rhinoplasty to improve her appearance and facilitate her breathing. when monitoring for hemorrhage afer this surgery ,teh nurse should assess psecifically for the presence of

• facial edema
• excessive swallowing
• pressure around the eyes
• serossanguineous drainage on the dressing

a female college student who had a rhinoplasty is having the nasal packing removed several days after surgery. the nurse should recommend that the client

• avoid sneezing for two days
• brush her teeth after any intake
• take fluid at a tepid temperature
• sleep on her back with one pillow

a client with emphysema is short of breath and is using pursed lip breathing and accessory muscles of respiration. what does the nurse identify as the cause of the client's dyspnea

• spasm of the bronchi that traps the air
• increase in the vital capacity of the lungs
• too rapid expulsion of the air from the alveoli
• difficulty in expelling the air trapped in the alveoli

a client with an acute emphysemic episode is dyspneic and anxious. to decrease the dyspnea the nurse's first action is to

• increase the client's oxygen intake
• have the client breathe into a paper bag
• teach the client to do rhythmic breathing
• check the client's vital signs, including the bp

a client with a 10 year history of emphysema is admittied in acute respiratory distress. the nurse's assessment of this client includes monitoring for

• signs of chest pain
• use of accessory muscles of respiration
• signs and symptoms of respiratory alkalosis
• prolonged inspiration and expenditure of considerable effort

a client with COPD is predisposed to the development of CO2 intoxication (CO2 narcosis). therefore the nurse should

• initiate pulmonary hygiene to clear air passages of trapped mucus
• incourage continuous rapid panting to promote respiratory exchange
• administer oxygen a low concentration to maintain respiratory drive
• encourage slow, deep breathing with inhalation longer than exhalation to increase intake

a client with a history of emphysema is in acute respiratory failure with respiratory acidosis. low level oxygen is administered by nasal cannula. four hours latre the nurse identifies that the client has increased restlessness and confusion followed by a decreased respiratory rate and lethargy. the nurse should

• question the client about the confusion
• increase the oxygen in small increments
• percuss and vibrate the client's chest wall
• discontinue or decrease the oxygen flow rate

if a client undergoing peritoneal diaglysis develops symptoms of severe respiratory difficulty during the infusion of the dialysate the nurse should

• slow the rate of the client's infusion
• place the client in a low fowler's position
• auscultate the client's lungs for breath sounds
• drain the fluid from the client's peritoneal cavity

a nurse evaluates that a client understands the instructions about an appropriate breathing technique for COPD resulting from emphysema when the client

• inhales through the mouth
• increases the respirator rate
• holds each breath for a second at the end of inspiration
• progressively increases the length of the inspiratory phase

a client who is admitted with emphysema has a PCO2 of 60. the nurse determines that this is excessively high and calls the practioner to obtain an order for

• mucolytics
• bronchodilators
• mechanical ventilation
• intermittent positive pressure breathing

a nurse is teaching a client how to perform diaphragmatic breathing. the nurse advises the client to

• take a rapid, deep breaths
• breath with hands on the hips
• expand the abdomen on inhalation
• perform exercises leaning forward while in a sitting position

a nurse is teaching a community based course on smoking cessation. the statement by a male client with COPD that provides evidence that he is ready to quit smoking is

• i'll just finish this carton
• i'll cut back to half pack a day
• i am quitting the only relaxation i have
•  i should find this easy because i don't drink when i smoke

a client who has emphysema for many years develops an enlarged liver. the nurse concludes that this results from

• liver hypoxia
• hepatic acidosis
• esophageal varices
• portal hypertension

a nurse is auscultating the chest of a client with COPD. what should the nurse expect to hear

• diminished sounds
• pleural friction rub
• crackles and gurgles
• expiratory wheeze and cough

a client with COPD complains of a weight gain of 5 pounds in 1 week. the complication that may have precipitated this weight gain is

• polycythemia
• cor pulmonale
• compensated acidosis
• left ventricular failure

a client with COPD complains of chest congestion especially in the morning. the nurse should suggest that the client

• use a humidifier in the room
• sleep with two or more pillows
• cough even when it is nonproductive
• deep breathe and cough before retiring

the nurse is observing a client with COPD using a nebulizer. what indicates that additional teaching is necessary

• place the tip of the nebulizer just beyond the lips
• holding the inspired breath for at least three seconds
• exhaling slowly through the mouth with lips pursed slightly
• inhaling with the lips tightly sealed around the mouthpiece of the nebulizer

a 70 year old client with cancer of the right lung has a lobectomy. after surgery the client has a chst tube attached to suction. what observation should the nurse report to the practitioner

• clots in the tubing during the first postoperative day
• subcutaneous emphysema on the second postoperative day
• decreased bubbling in the water seal chamber on the thrid postoperative day
• bloody fluid in the drainage-collection chamber on the first postoperative day

a 21 year old client comes to the ED with the chief complaint of left side chest pain after a racquetball game. a chest x ray examination reveals a left pneumothorax. what should the nurse expect to identify when assessing the client's left chest area

• dull sound on percussion
• vocal fremitus on palpation
• rales with rhonchi on auscultation
• absence of breath sounds on auscultation

a client with a spontaneous pneumothorax asks, why did they put this tube into my chest. the nurse exlains that the purpose of the chest tube is to

• check for bleeding in the lung
• monitor the function of the lung
• drain fluid from the pleural space
• remove air from the pleural space

when evaluating the effectiveness of a chest tube inserted in a client with a pneumothorax, the nurse assesses for

• productive coughing
• return of breath sounds
• increased pleural drainage in the chamber
• constant bubbling in the water seal chamber

when inspecting a dressing after a partial pneumonectomy for cancer of the lung, the nurse observes somepuffines of the tissue around the area. when the area is palpated, the tissue feels spongy and cracles. when documenting the nurse describes this assessment as

• stridor
• crepitus
• pitting edema
• chest distention

on the first day after a right pneumonectomy a male client suddenly sits straight up in bed. his respirations are labored and he is making a crowing sound. this skin is pale, cool, and moist. the nurse immediately should

• notify the practitioner
• auscultate the left lung
• inspect the incision for bleeding
• check the chest tube for patency

a client in the post anesthesia care unit has just regained consciousness after a right pneumonectomy. the nurse should now

• assess for pain
• remove the airway
• encourage deep breathing
• place the client on the left side

a client has COPD and cor pulmonale. when teaching about nutition, the nurse instructs the client to

• eat small meals six times a day to limit oxygen needs
• drink large amounts of fluid to help liequefy secretions
• lie down after eating to conserve energy needed for digestion
• increase the intake of protein to decrease intravascular hydrostatic pressure

when turning a client after a right pneumonectomy, the nurse plans to place the client in either the

• right or left side lying position
• high fowler's or supine position
• supine or right side lying position
• left side lying or low fowlere's position

the nurse should be vigilant for unique complications associated with a pneumonectomy by observing the client for

• signs of cardiac overload
• increased pulse and respirations
• cardiac irregularities with premature beats
• elevated bp, decreased temperature, and old, most skin

the most appropriate breathing and coughing routine for a client who has had a pneumonectomy is every

• hour for the first 24 hours and then every 2 hours
• two hours for the first 24 hours and then every 3 hours
• thirty minutes for the first 24 hours and then every 2 hours
• fifteen minutes for the first 24 hours and then every 2 hours

a client with oat cell lung cancer is scheduled for a mediastinoscopy and biopsy. the nurse should

• tell the client the chest tubes will be present after the procedure
• advise the client that this is an endoscopic examination of lymph nodes
• explain to the client the procedure will visualize the mainstem bronchus
• inform the client that some pleural fluid will be removed during the procedure

when assessing a client with pleural effusion the nurse expects to identify

• moist crackles at the poterior of the lungs
• deviation of the trachea toward the involved side
• reduced or absent breath sounds at the base of the lung
• increased resonance with percussion of the involved area

after a thoracentesis for pleural effusion, a client returns to the outpatient clinic for a follow up visit. the nurse suspects a recurrence of pleural effusion when the client says.

• lately i can only breath well if i sit up
• during the night i somtimes get the chills
• i get a sharp, stabbing pain when i take deep breath
• i'm coughing up larer amounts of thicker muscus for te last several days

a client with an exacerbation of a chronic inflammatory bowel disorder cannot tolerate food. a subclavian catheter is inserted. immediately after insertion of the catheter, the priority nursing action is to

• obtain a chest x ray to determine placement
• auscultate the client's lungs to evaluate breath sounds
• draw a blood sample to assess the client's blood glucose level
• assess the upper extremity on the side of insertion for a neurlogical deficit

during the immediate postoperative period after a laryngectomy a nursing priority for the cliet is to

• provide emotional support
• observe for signs of infection
• keep the trachea free of secretions
• promote a means of communcation

after surgery the practitioner orders an incentive spirometer for a client. the nurse evaluates that the spirometer is being used correctly when observint the client

• coughing twice beofre inhaing deeply through the mouthpiece
• using the incentive spirometer for 10 consecutive breaths an hour
• inhaling deeply, sealing the lips around the mouthpiece and exhaling
• inhaling deeply through the mouthpiece, holding the breath for 2 seconds and then exhaling

a 60 year old male is returned to the surgical unit after a laryngoscopy. the primary nurse who is being supervised by the nurse manger, reminds the client not to take anything by mouth until instructed to do so. the nurse manager determines that this nursing intervention is

• inappropriate because the client is not unconscious and may be thirsty after being NPO
• appropriate because these clients usually experience painful swallowing for several days
• appropriate because early drinking and eating after the client's laryngoscopy may result in aspiration
• inappropriate because the client is likely to be anxious and probably will not be aware of feeling thirst

a total laryngectomy and radical neck dissection are scheduled for a client with cancer of the larynx. when reinforcing the surgeon's statements to the client, the nurse should review what the surgery entails and what abilities will be lost. the discussion also should focus on what abilities will be retained such as the ability to

• blow the nose
• sip through a straw
• chew and swallow food
• smell and differentiate odors

after a radical neck resection a client returns from surgery with two portable wound drainage systems at the operative site. inspection of the neck incision reveals moderate edema of the tissues. because of this problem th nruse should assess the client for

• loss of the gag reflex
• cloudy wound drainage
• restlessness and dyspnea
• edema and dehiscence of the suture line

the practitioner orders a progressive diet as tolerated for a client who had head and neck surgery. the nurse should

• keep suction apparatus readily availabe in case aspiration occurs
• administer the diet through a nasogastric tube until the suture line heals
• encourage the intake of pureed foods becaue they promote the swallowing reflex
• administer the prescribed pain medication a half hour before meals to limit discomfort that may occur

a nurse expects that the initial treatment for a client who has a leak of the thoracic duct after radical neck surgery includes inserting a

• gastrostomy tube to instill feedings, a high fat diet, and bed rest
• chest tube to drain the fluid, total parenteral nutrition, and bed rest
• rectal tube to prevent distention, a low fat diet and increased activity
• nasogastric tube to drain the fluid, a moderate fat diet
• and increased activity

• chest tube to drain the fluid, total parenteral nutrition, and bed rest

a 79 year old pipe smoker is diagnosed as having a cancer of the tongue. a hemiglossectomy and right radical neck dissection are performed. after surgery the client is transferred to the postanesthesia care unti. when providing for a patent airway a primary nursing intervention is to

• suction frequently
• apply an ice collar
• maintain a high fowler's position
• encourage expectoration of secretions

a half hour after awakening from anesthesia in the PACU a 75 yaer old client who had radical head and neck surgery becomes agitated, disoriented and confused. the nurse should

• notify the practitioner
• administer the prescribed oxygen
• record the observations on the progress notes
• medicate the client with the ordered antianxiety medication

a client who has a hemiglossectomy and right radical neck dissection arrives in the postanesthesia care unit with two portable drainage catheters in the area of the incision which are attached to hemovacs. six hours later one hemovac accumulates 180 ml of seosanguineous drainage. the priority nursing intervention is to

• turn the client onto the right side
• notify the practioner immediately
• document the output because it is expected
• empty the container to reestablish negative pressure

a client is scheduled for CABG surgrey. the nurse explains to the client that chest tubes will be inserted during surgery to

• prevent atelectasis post operatively
• drain fluid from the pericardial sac
• restablish negative intrapleural pressure
• monitor the amount of blood loss after surgery

when giving a client care on the second day after CABG the nurse observe that the fluid in the water-seal chamber of the chest drainage device stops fluctuating. the nurse should

• look for tube obstructions
• increase the amount of suction
• add sterile water to the chamber
• consider this an expected occurrence

a nurse is instructed to measure and document the amount of drainage from a client's chest tube. the nurse should

• mark the time and fluid level on the outside of the drainage collection chamber of the closed chest drainage system
• aspirate fluid from the drainage collection chamber of the closed chest drainage system and then measure the drainage
• connect a new closed chest drainage system, measure the fluid in the drainage collection chamber of the old system, and discard the old system
• clamp the chest tube, empty the fluid from the drainage collection chamber of the closed chest drainage system into a measureing cup, and reconnect the system

after thoracic surgery a client has a chest tube connected to a water-seal drainage system attached to suction. when excessive bubbling is observed in the water-seal chamber the nurse should

• strip the chest tube catheter
• check the system for air leaks
• decrease the amount of suction pressure
• recognize that the system is functioning correctly

the nurse evaluates that further teaching is necessary when a client who has had thoracic surgrey performs post thoracotmy exercises by

• extending the arm up and back, then rotating it to the side
• climbing a wall with fingers of the hand, fully extendeding the arm
• trying a rope to a doorknob and swinging the arm in wide circles
• extending the arm and bringing it up to touch the nose with a finger

a nurse in the ED is notified that a person who sustained a gunshot wound to the right side of the chest will arive soon. what should the nurse plan to do

• reserve an operating room
• prepare equipment for a tracheotomy
• arrange for a portable xray examination
• obtain equipment for chest tube insertion

a nurse is caring for a client after a crushing chest injury. a chest tube is inserted. which observation indicates a desired response to this treatment

• increased breath sounds
• increased respiratory rate
• crepitus detected on palpation of the chest
• constant bubbling in the drainage collection chamber

on the way to an xray examination a client with a chest tube becomes confused and pulls the chest tube out. what it the nurse's immediate action

• place the client in the supine position
• use a clamp to hold the insertion site open
• obtain sterile Vaseline gauze to cover the opening
• cover the opening with the cleanest material available

a client has a chest tube for pneumothorax. the nurse identifies that the chet tube is separated from the drainage system and the client is experiencing respiratory difficulty. what should the nurse do

• obtain a new sterile drainage system
• use two clamps to clamp the drainage tubing
• reconnect the client's tube to the drainage system
• place the client in the high fowler's position immediately

to promote continued improvement in a client's respiratory status after a chest tube is removed the nurse should

• continue observing for dyspnea and crepitus
• encourage frequent coughing and deep breathing
• encourage bed rest with range of motion exercises
• remind the client to turn from side to side at least every two hours

when using personal protective equipment during a physical assessment of a homeless client who is admitted for alcohol withdrawal the nurse considres that this client also may be at risk for

• prostatitis
• tuberculosis
• osteoarthritis
• diverticulosis

a client has a tentative diagnosis of pulmonary tuberculosis and the chest xray film reveals a lesion in the right upper lobe. which client complaint supports this diagnosis

• frothy sputum and fever
• dry cough and pulmonary congestion
• night sweats and blood tinged sputum
• productive cough and engorged neck veins

a nurse administers a mantoux test for TB to a client who has COPD and is HIV negative. the test results indicate a 10 mm area of induration with 5 mm of erythema. the nurse should

• record a false result and readminister the mantoux test
• indicate the degree of erythema and record the results as positive
• take the client's history into account and determine that the response to the test is positive
• identify that the extent of induration is significant and the client has been exposed to the pathogen that causes tuberculosis

to make a definitive diagnosis of tuberculosis the nurse expects that the practioner will order a

• chest x ray film
• tuberculin skin test
• pulmonary function test
• sputum for acid fast testing

a client newly dx with TB has a productive cough. the most appropriate nursing intervention is to teach the client to

• exercise daily
• use disposable tissues
• avoid foods high in sodium
• monitor blood pressure weekly

a client with pulmonary TB is being treated at home. to help control the spread of the disease the nurse instructs the client to

• have visitors sit across the room from the client
• keep personal articles away from the rest of the family
• open the windows slightly to allow air to circulate throughout the house
• avoid putting used dishes in the dishwasher with the rest of the family's dishes

a client's PPD test and chest x ray film results indicate pulmonary TB. the practioner orders sputum specimens for acid fast bacilli. the nurse evaluates that additional teaching is necessary when the client states that the sputum specimens must be

• coughed up from deep in the lungs
• collected in the early morning hours
• refrigerated until brought to the laboratory
• brought to the clinic as soon as possible after collection

when teaching a client with TB about recovery after discharge from the hospital the nurse reinforces that the treatment measure with the highest priority is

• having sufficient rest
• getting plenty of fresh air
• changing the current lifestyle
• consistently taking prescribed medication

a client with TB asks the nurse how long th emedication must be continued. the nurse's most accurate reply is

• 1 to 2 weeks
• 4 to 5 months
• 6 to 12 months
• 3 years or longer