When teaching a patient about antihistamine use, which of the following is not true?

• they are best tolerated when taken with meals
• for dry mouth the patient can suck on dry candy or chew gum
• the main side effect of antihistamines is drowsiness
• OTC medications are generally safe with antihistamine

which of the following medications is a nonsedating antihistamine

• loratadine (Claritin)
• diphenhdramine (Benadryl)
• dimenhydrinate (Dramanine)
• meclizine (Antivert)

which agents are considered first line agents for the treatment of nasal congestion

• antihistamines such as diphenhydramine
• decongesetants such as naphazoline
• antitussives such as dextromethorphan
• expectorants such as guaifenesin

antitussives are used primarily to

• relieve nasal congestion
• thin secretions to ease removal of excessive secretions
• stop the cough reflex when the cough is nonproductive
• suppress productive and nonproductive coughs

which patient teaching is appropriate for the patient receiving an expectorant

• avoid fluids for 30 to 35 minutes after the dose
• force fluids, unless contraindicated, to aid in expectoration of sputum
• avoid driving or operating heavy machinery while on this medication
• patients should expect their secretions to become thicker

frequent use of bronchodilators may cause all of the following side effects except

• blurred vision
• increased heart rate
• nervousness
• tremors

maggie will be taking cromolyn sodium inhalers to treat her asthma. it is important to teach her which of the following regarding this medication

• a dose is missed, she may take a double dose to maintain blood levels
• in order to maintain the inhaled medications effect, she should not gargle or rinse her mouth after using the inhaler
• she should take this inhaler at the first sign of bronchospasm
• she should administer the medication consistently and be aware that up to 4 weeks may be needed to see therapeutic effects

which drug acts by blocking leukotrienes thus reducing inflammation in the lungs

• albuterol (Proventil)
• cromolyn (Intal)
• theophylline (Theo-Dur)
• zafirlukast (Accolate)

which drug is used for status asthmaticus in patients who have not responded to epinephrine

• albuterol (Proventil)
• aminophylline
• theophylline (Theo-Dur)
• montelukast (Singulair)

when testing a metered-dose inhaler (MDI) canister to estimate whether it is empty, the inhaler canister (not the mouthpiece) is dropped into a container that is wider and longer than the inhaler and filled up to three-quarters full with water. which indicates that the inhaler canister is nearly empty

• the canister floats on top of the water line
• the canister floats halfway in the water and halfway out of the water
• the canister drops to the bottom of the water container and lies on its side
• the canister drops to the bottom of the water container, but the bottom of the canister points upwards

upper or lower airway:

traps particles not filtered by nares

upper or lower airway:

traps organisms entering nose and mouth

upper or lower airway:

trachea

upper or lower airway:

contains cilia to move mucus to trachea

movement of air in and out of the lungs

• diffusion
• perfusion
• ventilation

exchange of oxygen and carbon dioxide in the capillary-alveolar network

• diffusion
• perfusion
• ventilation

pumping of oxygenated blood through the body

• diffusion
• perfusion
• ventilation

the patient comes to the physician's office for an annual physical. the patient reports having a persistent nagging cough. which questions does the nurse ask first about this symptom

• when did the cough start
• do you have a family history of lung cancer
• have you been running a fever
• do you have sneezing and congestion

the patient reports smoking a pack of cagarettes a day for 9 years. he then quit for 2 years then smoked 2 packs a day for the last 30 years. what are the pack-years for this patient

• 39 years
• 69 years
• 19.5 years
• 41 years

pulmonary function tests are scheduled for a patient with a history of smoking who reports dyspnea and chronic cough. what will patient teaching information about this procedure include

• do  not smoke for at least 2 weeks before the test
• bronchodilator drugs may be withheld 2 days before the test
• the patient will breathe through the mouth and wear a nose clip during the test
• the patient will be expected to walk on a treadmill during the test

the patient is scheduled to have a pulmonary function test (PFT). which type of information does the nurse include in the nursing history so that PFT results can be appropriately determined.

• age, gender, race, height, weight, and smoking status
• occuptational status, activity tolerance for activities of daily living
• medication history and history of allergies to contrast media
• history of chronic medical conditions and surgical procedures

maximal amount of forced air that can be exhaled after maximal inspiration

• forced expiratory volume (FEV)
• functional residual capacity (FRC)
• forced vital capacity (FVC)
• residual volume (RV)
• total lung capacity (TLC)
• vital capacity (VC)
• diffusion

amount of air in lungs at the end of maximal inhalation

• forced expiratory volume (FEV)
• functional residual capacity (FRC)
• forced vital capacity (FVC)
• residual volume (RV)
• total lung capacity (TLC)
• vital capacity (VC)
• diffusion

amount of air remining in the lungs after normal exhalation

• forced expiratory volume (FEV)
• functional residual capacity (FRC)
• forced vital capacity (FVC)
• residual volume (RV)
• total lung capacity (TLC)
• vital capacity (VC)
• diffusion

maximal amount of air that can be exhaled over a specific time

• forced expiratory volume (FEV)
• functional residual capacity (FRC)
• forced vital capacity (FVC)
• residual volume (RV)
• total lung capacity (TLC)
• vital capacity (VC)
• diffusion

amount of air remaining in lungs at the end of full, forced exhalation

• forced expiratory volume (FEV)
• functional residual capacity (FRC)
• forced vital capacity (FVC)
• residual volume (RV)
• total lung capacity (TLC)
• vital capacity (VC)
• diffusion

measure of carbon monoxide uptake across alveolar-capillary membrane

• forced expiratory volume (FEV)
• functional residual capacity (FRC)
• forced vital capacity (FVC)
• residual volume (RV)
• total lung capacity (TLC)
• vital capacity (VC)
• diffusion capacity of carbon monoxide (DLCO)

maximum amount of gas that can be exhaled after maximal inspiration

• forced expiratory volume (FEV)
• functional residual capacity (FRC)
• forced vital capacity (FVC)
• residual volume (RV)
• total lung capacity (TLC)
• vital capacity (VC)
• diffusion

the nurse is caring for the older adult who is temporarily confined to bed. which intervention is important in promoting pulmonary hygiene related to age and decreased mobility

• obtain an order for PRN oxygen via nsal cannula
• encourage the patient to turn, cough, and deep breath
• reassure the patient that immobility is temporary
• monitor the respiratory rate and check pulse oximetry readings

the nurse is assessing an older adult patient who reports a decreased tolerance for exercise and that she must work harder to breath. which question assists the nurse in determining if these are normal changes related to aging

• how old are you
• when did you first notice these symptoms
• do you or have you ever smoked cigarettes
• how often do you exercise

the patient has had a bronchoscopy and was NPO for several hours before the test. now a few hours after the test the patient is hungry and would like to eat a meal. what will the nurse do

• order a meal because the patient is now alert and oriented
• check pulse oximetry to be sure oxygen saturation has returned to normal
• check for a gag reflex before allowing the patient to eat
• assess for nausea from the medictions given for the test

after a bronchoscopy procedure the patient coughs up sputum which contains blood. what is the best nursing interventions for this patient

• assess vital signs and respiratory status and notify the physician of the findings
• monitor thepatient for 24 hours to see if blood continues in the sputum
• send the sputum to the lab for cytology for possible lung cancer
• reassure the patient this is a normal response after a bronchoscopy

before a bronchoscopy procedure the patient received benzocaine spray as a topical anesthetic to numb the oropharynx. the nurse is assessing the patient after the procedure. which finding suggests that the patient is developing methemoglobinemia

• the patient has a decreased hematocrit level
• the patient does not respond to supplemental oxygen
• the blood sample is a bright cherry red color
• the patient experiences sedation and amnesia

the nurse is caring for several patients who had diagnostic testing for respiratory disorders. which diagnostic test has the ighest risk for the post procedure complication of pneumothorax

• bronchoscopy
• laryngoscopy
• computed tomography of lungs
• percutaneous lung biopsy

the patient's pulse oximetry reading is 89%. what is the nurse's priority action

• recheck the reading with a different oximeter
• apply supplemental oxygen and recheck the oximeter reading in 15 minutes
• assess the patient for respiratory distress and recheck the oximeter reading
• place the patient in the recovery position and monitor frequently

the patient demonstrates labored shallow respirations and a respiratory rate of 32/min with a pulse oximetry reading of 85%. what is the priority nursing intervention

• notify respiratory therapy to give the patient a braething treatment
• start oxygen via nasal cannula at 2 L/min
• obtain an order for a stat arterial blood gas
• encourage coughing and deep breathing exercises

the older patient is confined to bed and is therefore prone to decreased alveolar surface and elastic recoil. which intervention is best to address these physiologic changes

• adequate nutritional intake
• coughing and deep breathing
• fluids to thin secreations
• periods of rest and sleep

the nurse is reviewing ABG results from an 86 year old patient . which results would be considered normal findings for a patient of this age

• normal pH, normal PaO2, normal PaCO2
• normal pH, decreased PaO2, normal PaCO2
• decreased pH, decreased PaO2, normal PaCO2
• decreased pH, decreased PaO2, decreased PaCO2

the nurse is caring for an older patient and identifies a nursing diagnosis of ineffective airway clearance. which etiology for this diagnosis is related to the normal aging process

• decreased muscle strength and cough
• increased carbon dioxide exchange
• decreased residual volume
• increased elastic recoil of the lungs

the nurse is performing a physical assessment of the respiratory system. although the patient is currently confined to bed, he has the strength and mobility to move and reposition himself. the nurse instructs him to assume which position for this assessment

• side lying
• semi-fowlers
• supine
• sitting upright

upon performing a lung sound assessment of the anterior chest, the nurse hears moderately loud sound on inspiration that are equal in length with expiration. in what area is this lung sound considered normal

• trachea
• primary bronchi
• lung fields
• larynx

which sounds in the smaller bronchioles and the alveoli indicate normal lung sounds

• harsh, hollow, and tubular blowing
• nothing; normally no sounds are heard
• soft, low rustling; like wind in the trees
• flat and dull tones with a moderate pitch

what is the characteristic of normal lung sounds that should be heard throughout the lung fields

• short inspiration, long expiration, loud, harsh
• soft sound, long inspiration, short quiet expiration
• mixed sounds of harsh and soft, long inspiration and long expirations
• loud, long inspiration and short, loud expiration

upon assessing the lungs, the nurse hears short, discrete popping sounds "like hair being rolled between fingers near the ear" in the bilateral lower lobes. how is this assessment documented

• rhonchi
• wheezes
• fine crackles
• coarse crackles

the nurse is taking a history on a patient who reports sleeping in a recliner chair at night becuase lying on the bed causes shortness of breath. how is this documented

• orthopnea
• paroxysmal nocturnal dyspnea
• orthostatic nocturnal dyspnea
• tachypnea

which patient has an increased risk for problems of the respiratory system

• 45 year old man who breeds and raises racing pigeons
• 25 year old woman who enjoys body surfing in the ocean
• 68 year old woman who does needlework for relaxation
• 56 year old man to ties flies for trout fishing

what observations does the nurse make when performing a general assessment of the patient's lungs and thorax (select all that apply)

• symmetry of chest movement
• rate, rhythm, and depth of respirations
• use of accessory muscles for breathing
• comparison on the anteroposterior diameter with the lateral diameter
• measurement of the length of the chest cavity
• assessment of chest expansion and respiratory excursion

• symmetry of chest movement
• rate, rhythm, and depth of respirations
• use of accessory muscles for breathing
• comparison on the anteroposterior diameter with the lateral diameter

which assessment finding is an objective sign of chronic oxygen deprivation

• continuous cough productive of clear sputum
• audible inspiratory and expiratory wheeze
• chest pain that increases with deep inspiration
• clubbing of fingernails and a barrel shaped chest

the nurse is palpating the patient's chest and identifies an increased tactile fremitus or vibration of the chest wall produced when the patient speaks. what does the nurse do next

• observe for other findings associtated with subcutaneous emphysema
• document the obersvation as an expected normal finding
• observe the patient for other findings asociated with a pneumothorax
• document the observation as a pleural friction rub

the nurse reviews the complete blood count results for the patient who has COPD and lives in a high mountain area. what lab results does the nurse expect to see for this patient

• increased red blood cells
• decreased neutrophils
• decreased eosinophils
• increased lympohocytes

the nurse is inspecting the patient's chest and observes an increase in anteroposterior diameter of the chest. when is this an expected finding

• with a pulmonary mass
• upon deep inhalation
• in older adult patients
• with chest trauma

while percussing the patient's chest and lung fields, the nurse notes a high, loud, musical, drumlike sound similar to tapping a cheek that is puffed out with air. what is the nurse's priority action

• document this expected finding using words like high, loud, and hollow
• immediately notify the physician because the patient has an airway obstruction
• assess the patient for air hunger or pain at the end of inhalation and exhalation
• palpate for crackling sensation underneath the skin or for localized tenderness

what is the best position for the patient to assume for a thoracentesis

• side lying affected side exposed, head slightly raised
• lying flat with arm on affected side across the chest
• sitting up, leaning forward on the overbed table
• prone position with arms above the head

which procedure has a risk for the complication of pneumothorax

• thoracentesis
• bronchoscopy
• PFT
• ventilation perfusion scan

the patient i admitted for a deep vein thrombosis and later becomes short of breath. a pulmonary embolus is suspected. the nurse should prepare the patient for which type of diagnostic testing

• computed tomography
• ventilation perfusion scanning
• magnetic resonance imaging
• digital chest radiograpy

the respiratory therapist consults with and reports to the nurse on the sputum production of several respiratory patients. the patient producing which kind of sputum needs priority attention

• thick and yellow
• watery mucoid
• pink and frothy
• rust colored

the patient with chronic respiratory disease presents with a decreased level of consciousness, dusky skin, pale mucous membranes, decreased capillary refill, and an increased respiration rate. what is the priority nursing diagnosis

• ineffective airwary clearance
• ineffective tissue perfusion
• decreased cardiac output
• acute confusion

while caring for a patient who had a routine surgical procedure, the nurse suspects that the patient may be having decreased tissue perfusion. which assesment finding is considered the earliest sign of decreased oxygenation

• cyanosis
• unexplained restlessness
• cool, clammy skin
• paleness, shortness of breath

the nurse has just recieved a patient from the recovery room who is somewhat drowsy, but is capable of following instructions. pulse oximetry has dropped from 95% to 90%. what is the priority nursing intervention

• administer oxygen at 2 L/min by nasal cannula then reassess.
• have the patient perform coughing and deep breathing exercises , then reassess
• administer narcan to reverse narcotic sedation effect
• withhold narcotic pain medication to reduce sedation effect

reduced in patients with obstructive disease ind increased with exercise or congestive heart failure

• forced vital capacity (FVC)
• forced expiratory volume in 1 sec (FEV1)
• forced expiratory flow (FEF)
• functional residual capacity (FRC)
• total lung capacity (TLC)
• residual volume (RV)
• diffusion capacity of carbon monoxide (DLCO)

air left in lung after a forced exhalation

• forced vital capacity (FVC)
• forced expiratory volume in 1 sec (FEV1)
• forced expiratory flow (FEF)
• functional residual capacity (FRC)
• total lung capacity (TLC)
• residual volume (RV)
• diffusion capacity of carbon monoxide (DLCO)

largest amount of air the lungs can hold

• forced vital capacity (FVC)
• forced expiratory volume in 1 sec (FEV1)
• forced expiratory flow (FEF)
• functional residual capacity (FRC)
• total lung capacity (TLC)
• residual volume (RV)
• diffusion capacity of carbon monoxide (DLCO)

after a maximum deep breath, amount of air quickly exhaled

• forced vital capacity (FVC)
• forced expiratory volume in 1 sec (FEV1)
• forced expiratory flow (FEF)
• functional residual capacity (FRC)
• total lung capacity (TLC)
• residual volume (RV)
• diffusion capacity of carbon monoxide (DLCO)

not used to measure larger airway obstructions

• forced vital capacity (FVC)
• forced expiratory volume in 1 sec (FEV1)
• forced expiratory flow (FEF)
• functional residual capacity (FRC)
• total lung capacity (TLC)
• residual volume (RV)
• diffusion capacity of carbon monoxide (DLCO)

after a maximum deep breath, the maximum amount of air exhaled in the first 1 second

• forced vital capacity (FVC)
• forced expiratory volume in 1 sec (FEV1)
• forced expiratory flow (FEF)
• functional residual capacity (FRC)
• total lung capacity (TLC)
• residual volume (RV)
• diffusion capacity of carbon monoxide (DLCO)

the patient is scheduled for a ventilation perfusion scan. what does the nurse explain to the patient about the procedure

• being NPO before the examination is necessary to prevent aspiration of the dye
• after the test, isolation in necessary for 8 hours because of the radioactive dye
• the procedure is painless and the radioactive substance leaves the body in about 8 hours
• the test screens for pulmonary embolus; a CT scan will follow if needed

what is a pluse oximieter used to measure

• oxygen perfusion in the extremities
• pulse and perfusion in the extremities
• generalized tissue perfusion
• oxygen saturation in the red blood cells

which aspect of PFTs would be considered a normal result in the older adult

• increased forced vital capacity
• decline in forced expiratory volume in 1 second
• decrease in diffusion capacity of carbon monoxide
• increased functional residual capacity

in the older adult there is a loss of elastic recoiling of the lung and decreased chest wall compliance. what is the result of this occurence

• the thoracic area becomes shrter
• the patient has an increased activity tolerance
• there is an increase in anteroposterior ratio
• the patient has severe shortness of breath

the nurse teaches the patient about the impact of cigarette smoking on the lower respiratory tract. which statement by the patient indicates an understanding of the information

• smoking increases my susceptibility to respiratory infection
• if i stop smoking the damage to my lungs will be reversed
• cigarette smoke affects my ability to cough out secretions from the lungs
• smoking makes the large and small airways get bigger

smoking increases my susceptibility to respiratory infection

the patient reports fatigue and shortness of breath when getting up to walk to the bathroom; however the pulse oximetry reading is 99%. the nurse identifies a diagnosis of activity intolerance. which laboratory value is consistent with the patient's subjective symptoms

• BUN of 15
• WBC if 8000
• hemoglobin of 9
• glucose 160

the patient who had neck surgery for removal of a tumor reports " not being able to breathe very well" the nurse observes that the patient has decreased chest movement and an elevated pulse. a bronchoscopy is ordered. for what reason did the physician order a bronchoscopy for this patient

• reverse and relieve any obstruction caused during the neck surgery
• assess the function of vocal cords or remove foreign bodies from the larynx
• aspirate pleural fluid or air from the pleural space
• visualize airway structures and obtaining tissue samples

the patient returns to the unit after bronchoscopy. in addition to respiratory status assessment, which assessment does the nurse make in order to prevent aspiration

• presence of pain or soreness in throat
• time and amount of last oral fluid intake
• type and location of chest pain
• presence or absence of gag reflex

the nurse hears fine crackles during a lung assessment of the patient who is in the initial postoperative period. which nursing intervention helps relieve this respiratory problem

• monitor the patient with a pulse oximeter
• encourage coughing and deep breathing
• obtain an order for a chest x ray
• obtain an order for high flow oxygen

in performing a respiratory assessment, which finding is considered the principal or main sign of respiratory disease

• sputum production
• continuous cough
• fever with congestion
• increased respiratory rate

the patient is admitted for a pneumothorax. which clinical assessment findings are most likely to be documented in the patient's admission record

• progressive fatigue and shortness of breath that has been increasing over a period of years
• cough, high fever, rusty-colored sputum production with decreased breath sounds particularly in lower lobes
• frequent cough and copious sputum production and wheezing and coarse crackles heard throughout the lung fields
• sudden onset of sharp pain after sneezing with lung sounds diminished over the left upper lobe

for a health adult what is the expected normal range for the respiratory rate per minute

• 10 to 12
• 12 to 15
• 12 to 20
• 20 or more

the nurse is reviewing partial pressure of arterial oxygen (PaO2) levels for several adult patients. which patient has a PaO2 that is lower than expected for his age

• 40 year old man with a PaO2 of 96
• 85 year old man with a PaO2 of 83.5
• 65 year old man with a PaO2 of 92
• 50 year old man with a PaO2 of 84

the nurse is performing a respiratory assessment on the older adult patient. which question is not appropriate to ask when using the gordon's functional health pattern assessment approach

• how has your general health been
• have you had any colds this past year
• do you have sufficient energy to do what you like to to
• when was the last time you were hospitalized

the patient has previously reported several chronic health conditions including hypertension and heart problems, and has stated a new drug was recently added to his drug regimen. today the patient reports a new onset of cough. which drug does the nurse suspect teh patient has recently been prescribed.

• ACE inhibitor
• vasodilator
• diuretic
• calcium channel blocker

the nurse makes observations about several respiratory patients' abilities to perform activities of daily living in order to quantify the level of dysnea. which patient is considered to have Class V dyspnea

• experiences subjective shortness of breath when walking up a flight of stairs
• limited to bed or chair and experiences shortness of breath at rest
• can independently shower and dress but cannot keep pace with similarly aged people
• experiences shortness of breath during aerobic exercise such as jogging

the nurse is reviewing the arterial blood gas results for a 25 year old trauma patient who has new onset of shortness of breath and demonstrates shallow and irregular respirations. the pH is 7.266. what imablance does the nurse suspect this patient has.

• respiratory acidosis
• respiratory alkalosis
• metabolic acidosis
• metabolic alkalosis

the patient is HIV positive and reports feeling tired with shortness of breath, weight loss, and occasionally coughing up blood-tinged sputum. after considering these symptoms in conjucntion with the patient's HIV status, what disorder does the nurse suspect this patient has

• tuberculosis
• bronchitis
• pneumococcal pneumonia
• lung abscess

the patient requires home oxygen therapy. when the home health nurse enters the patient's home for the initial visit, he observes several issues that are safety hazareds related to the patient's oxygen therapy. what hazards do these include (select all that apply)

• bottle of wine in the kitchen area
• package of cigarettes on the coffee table
• several decorative candles on the mantlepiece
• grounded outlet with a green dot on the plate
• electric fan with a frayed cord in the bathroom
• computer with a three-pronged plug

• package of cigarettes on the coffee table
• several decorative candles on the mantlepiece
• electric fan with a frayed cord in the bathroom

before completing the morning assessment the nurse conlcludes that the patient is experiencing inadequate oxygenation and tissue perfusion as a result of respiratory problems. which assessment findings support the nruse's conclusion (select all that apply)

• inspiratory and expiratory effort is shallow even and quiet
• patient must take a breath after every third or fourth word
• skin is pale, pink, and dry
• patient appears strained and fatigued
• pulse of 95 bpm, respiratory rate of 30/min
• patient does not want to eat

• patient must take a breath after every third or fourth word
• patient appears strained and fatigued
• pulse of 95 bpm, respiratory rate of 30/min

the home health nurse has been caring for a patient with a chronic respiratory disorder. today the patient seems confused when she is normally alert and oriented x 3. what is the priority nursing action

• notify the physician about the mental status change
• take vital signs and check the pulse ox readings
• ask the patient's family when this behavior started
• perform a mental status examination

the nurse is caring for several patients on a general med-surg unit. the nurse would question the necessity of oxygen therapy for the patient with which condition

• pulmonary edema with decreased arterial PO2 levels
• valve replacement with increased cardiac output
• anemia with a decreased hemoglobin and hematocrit
• sustained fever with an increased metabolic demand

whan a patient is requiring oxygen therapy what is important for the nurse to know

• patients require 1 to 10 L/min by nasal cannula inorder for oxygen to be effective
• oxygen induced hypoventilation is the priority when the PaCO2 levels are unknown
• why the patient is receiving oxygen, expected outcomes, and complications
• the goal is the highest FiO2 possible for the particular device being used

the patient with COPD is admitted to the hospital with oxygen induced hypoventilation. what is the respiratory stimulus to breathe for this patient

• high carbon dioxide (60 to 65 mm Hg)
• low level of carbon dioxide concentration in the blood, as sensged by the chemoreceptors in the brain
• low level of oxygen concentration in the blood as sensed by the peripheral chemoreceptors
• oxygen narcosis which stimulates central chemoreceptors in the brain

the nurse is administering oygen to the patient who is hypoxic and has chronic high levels of carbon dioxide. which oxygen therapy prevents a repsiratory complication for this patient

• FiO2 higher than the usual 2 to 4 L/min per nasal cannula
• venuri mask of 40% for the delivery of oxygen
• lower concentration of oxygen (1 to 2 L/min) per nasal cannula
• variable FiO2 via partial rebreather mask

the patient is at high risk or unknown risk for oxygen induced hypoventilation. what must the nurse monitor for

• signs of nonproductive cough, chest pain, crackles, and hypoxemia
• change of skin tone from pink to gray color after several minutes of oxygen therapy
• signs and symptoms of hypoventilation rather than hypoxemia
• changes in level of consciousness, apnea, and respiratory pattern

the patient is receiving a high concentration of oxygen as a temporary emergency measure. which nursing action is the most appropriate to prevent complicatoins associated with high flow oxygen

• auscultate the lungs every 4 hours for oxygen toxicity
• increase the oxygen if the PaO2 level is less than 93 mm Hg
• monitor the prescribed oxygen level and length of therapy
• decrease the oxygen if the patient's condition does not respond

the patient is receiving humidified oxygen which places the patient at high risk for which nursing diagnosis

• risk for injury related to the moisture in the tube
• risk for infection related to the condensation in the tubing
• impaired physical mobility related to reliance on equipment
• risk for impaired skin integrity related to the mask

increased risk for oxygen toxicity is related to which factors (select all that apply)

• continuous delivery of oxygen at greater than 50% concentration
• delivery of a high concentration of oxygen over 24 to 48 hours
• the severity and extent of lung disease
• neglecting to monitor the patient's status and reducing oxygen concentraton as soon as possible
• excluding measures such as continuous positive airway pressure or positive end exipratory pressure

• continuous delivery of oxygen at greater than 50% concentration
• delivery of a high concentration of oxygen over 24 to 48 hours
• the severity and extent of lung disease
• neglecting to monitor the patient's status and reducing oxygen concentraton as soon as possible
• excluding measures such as continuous positive airway pressure or positive end exipratory pressure

the patient is receiving warmed and humidified oxygen. the respiratory therapist informs the nurse that several other patients on other units have developed hospital acquired infections and Pseudomonas aeruginosa has been identified as the organism. what does the nurse do

• place the patient in respiratory isolation
• obtain an order for a sputum culture
• change the humidifier every 24 hours
• obtain an order to discontinue the humidifies

nursing interventions to prevent infection in patients with humidified oxygen includ which actions

• use steril normal saline to provide moisture
• drain condensation into the humidifier
• drain condensation from the water trap
• maintain a sterile closed system at all times

which factors are considered hazards associated with oxygen therapy (select all that apply)

• increased combustion
• oxygen narcosis
• oxygen toxicity
• absorption atelectasis
• hypoxic drive
• oxygen induced hypoventilation

• increased combustion
• oxygen toxicity
• absorption atelectasis
• oxygen induced hypoventilation

the patient is receiving warmed and dehumidified oxygen. in discarding the moisture formed by condensation, why does the nurse minimze the time the tubing is disconnected

• to prevent the patient from desaturating
• to reduce the patient's risk of infection
• to minimize the distrubance to the patient
• to facilitate overall time management

what is the best description of the nurse's role in the delivery of oxygen therapy

• receiving the therapy report from the respiratory therapist
• evaluating the response to oxygen therapy
• contacting respiratory therapy for the devices
• being familiar with the deveices and techniques used in order to provide proper care

the patient with an oxygen delivery device would like to ambulate to the bathroom but the tubing is too short. extension tubing is added. what is the maximum length of the tubing that can be added in order to deliver the amount of oxygen needed for that device

• 25 feet
• 35 feet
• 45 feet
• 50 feet

the patient is being discharged and requires home oxygen therapy with a reservoir type nasal cannula. he asks the nurse "why can't i just take this nasal cannula that i have been using in the hospital?" what is the nurse's best response

• the doctor ordered the cannula, so your insurance company should cover the cost
• with the used cannula there is a risk of a hospital acquired infection
• this special nasal cannula allows you to decrease the oxygen flow by 50%
• this nasal cannula is much better. it is more flexible and comfortable to wear

the patient is receiving oxygen therapy through a non-rebreather mask. what is the correct nursing intervention

• maintain liter flow so that the reservoir bag is up to one half full
• maintain 60% to 75% FiO2 at 6 to 11 L/min
• ensure that valves and rubber flaps are patent, functional and not stuck
• assess for effectiveness and switch to partial rebreather for more precise FiO2

• ensure that valves and rubber flaps are patent, functional and not stuck

the patient with a face mask a 5 L/min is able to eat. which nursing intervention is performed at mealtimes

• change the mask to nasal cannula of 6 L/min or more
• have the patient work around the face mask as best as possible
• obtain a physician order for a nasal cannula at 5 L/min
• obtain a physician order to remove the mast at meals

the physician orders transtracheal oxygen therapy for the patient with respiratory difficulty. what does the nurse tell the patient's family is the purpose of this type of oxyten delivery system

• delivers oxygen directly into the lungs
• keeps the small air sacs oepn to improve gas exchange
• prevents the need for an endotracheal tube
• provides high  humidity with oxygen delivery

the nursing diagnosis for the patient receiving oxygen therapy is risk for impaired skin integrity. which nursing interventions are related to prevention of skin breakdown (select all taht aply)

• assess the patient's ears, back of neck, and face at least every 4 to 8 hours for irritation
• apply padding on tubing to prevent pressure on skin
• use petroleum jelly on nostrils, face and lips to relieve dryness
• assess nasal and mucous membranes for dryness and cracks
• obtain an order for humidification when oxygen is being delivered at 6 L/min or more
• provide mouth care every 8 hours and as needed
• position tubing so it will not pull on patient's ears

• assess the patient's ears, back of neck, and face at least every 4 to 8 hours for irritation
• apply padding on tubing to prevent pressure on skin
• assess nasal and mucous membranes for dryness and cracks
• obtain an order for humidification when oxygen is being delivered at 6 L/min or more
• provide mouth care every 8 hours and as needed
• position tubing so it will not pull on patient's ears

the patient is receiving oxygen therapy for respiratory problems. according to NIC interventions for administration and monitoring of its effectiveness, what does the nurse do

• monitor the effectiveness of oxygen therapy at least once every 8 hours
• monitor for signs of oxygen toxicity and absorption atelectasis
• instruct the patient ot replace the oxygen mask when the devie is removed
• ask the respiratory therapist to monitor the oxygen flow and patient response

the patient requires long term airway maintenance following surgery for cancer of the neck. the nurse is using a piece of equipment to explain the procedure and mechanism that are associated with this long term therapy. which piece of equipment does the nurse most likely use for this patient teaching session

• tracheostomy tube
• nasal trumpet
• endotracheal tube
• nasal cannula

the patient is receiving preoperative teaching for a partial laryngectomy and will have a tracheostomy postoperatively. how does the nurse define a tracheostomy to the patient

• opening in the trachea that enables breathing
• temporary procedure that will be reversed at a later date
• technique using positive pressure to improve gas exchange
• procedure that holds open the upper airways

the patient returns from the operating room and the nurse assesses for subcutaneous emphysema which is a potential complication associated with tracheostomy. how does the nurse assess for this complication

• checking the volume of the pilot balloon
• listening for airflow through the tube
• inspecting and palpating for air under the skin
• assessing the tube for patentcy

the patient with a tracheostomy develops increased coughing, inability to expectorate secretions and difficulty breathing. what are these assessment findings related to

• overinflation of the pilot balloon
• tracheoesophageal fistula
• cuffleak and rupture
• tracheal stenosis

the patient returns from the operating room after having a tracheostomy. while assessing the patient, which observations made by the nurse warrant immediate notification of the physician

• patient is alert but unable to speak and has difficulty communicating his needs
• small amount of bleeding present at the incision
• skin is puffy at the neck area with a crackling sensation
• respirations are audible and noisy with an increased respiratory rate

the patient was intubated for acute respiratory failure and there is an endotracheal tube in place. which nursing intervention is not appropriate for this patient

• ensure that the oxygen is warmed and humidified
• suction the airway then the mouth and give oral care
• suction the airway with the oral suction equipment
• position the tubing so it does not pull on the airway

to prevent accidental decannulation of a tracheostomy tube what does the nurse do

• obtain an order for continuous upper extremity restrints
• secure the tube in place using ties or fabric fasteners
• allow some flexibility in motion of the tube while coughing
• instruct the patient to hold the tube with a tissue while coughing

the patient has a recent tracheostomy. what necessary equipment does the nurse ensure is kept at the bedside

• pair of wire cutters
• pocket mask and code cart
• ambu bag and oxygen tubing
• tracheostomy tube with obturator

which statement by the nursing student indicates an understanding of the deflation of the tracheostomy cuff

• the cuff is deflated to allow the patient to speak
• the cuff is deflated to permit suctioning more easily
• the cuff should never be deflated because the patient will choke
• the cuff should be deflated to facilitate access for tracheostomy care

the patient has a temporary tracheostomy following surgery to the neck area to remove a benign tumor. which nursing intervention is perormed to prevent obstruction of the tracheostomy tube

• provide tracheal suctioning when there are noisy respirations
• provide oxygenation to maintain pulse oximeter readings
• inflate the cuff to maximum pressure and check it once per shift
• suction regularly and PRN with a Yankauer suction

• provide tracheal suctioning when there are noisy respirations

the patient sustained a serious crush injury to the neck and had a tracheostomy tube placed yesterday. as the nurse is performing tracheostomy care, the patient suddenly sneezes very forecfully and the tracheostomy tube falls out onto the bed linens. what does the nurse due

• ventilate the patient with 100% oxygen and notify the physician
• quickly and gently replace the tube with a clean cannula kept at the bedside
• quickly rense the tube with sterile solution and gently replace it
• give the patient oxygen; call for assistance and a new tracheostomy kit

the patient required emergency intubation and currently has an artificial airway in place. oxygen is being administered directly from the wall source. why would warmed and humidified oxygen be a more appropriate choice for this patient

• helps prevent tracheal damage
• promotes thick secretions
• is more comfortable for the patient
• is less likely to cause oxygen toxicity

the patient has an endotracheal tube and requires frequent suctioning for copious secretions. what is a complication of tracheal suctioning

• atelectasis
• hypoxia
• hypercarbia
• bronchodilation

• hypoxia

the nurse has explained the endotracheal suctioning procedure to the patient, gathered equipment, washed hands, and set low wall suction. indicate the correct steps of completing the suctioning procedure in order using 1 - 9.

• open the suction kit
• pour sterile saline into sterile container
• preoxygenate the patient
• discard supplies, wash hands, document
• put on sterile gloves
• keep catheter sterile; attach to suction
• withdraw catheter applying suction and twirling catheter
• insert catheter into trachea without suctioning
• lubricate catheter tip in sterile saline solution

1. open the suction kit
2. pour sterile saline into sterile container
3. put on sterile gloves
4. keep catheter sterile; attach to suction
5. lubricate catheter tip in sterile saline solution
6. preoxygenate the patient
7. insert catheter into trachea without suctioning
8. withdraw catheter applying suction and twirling catheter
9. discard supplies, wash hands, document

the nurse has explained the tracheostomy care procedure to the patient, gathered equipment, and washed hands. indicate the correct steps of completing the tracheostomy care procedure in order using 1 - 10

• remove old dressing and excess secretions
• wash hands, dispose of  equipment, document
• suction tracheostomy tube if necessary
• put on sterile gloves
• reinsert inner cannula into outer cannula
• open tracheostomy kit and pour peroxide into one side of container and saline into another
• clean stoma site and plate
• rinse inner cannula insterile saline
• remove inner cannula; place it in peroxide solution use brush to clean
• change tracheostomy ties if needed and place new tracheostomy dressing

1. suction tracheostomy tube if necessary
2. remove old dressing and excess secretions
3. open tracheostomy kit and pour peroxide into one side of container and saline into another
4. put on sterile gloves
5. remove inner cannula; place it in peroxide solution use brush to clean
6. rinse inner cannula insterile saline
7. reinsert inner cannula into outer cannula
8. clean stoma site and plate
9. change tracheostomy ties if needed and place new tracheostomy dressing
10. wash hands, dispose of  equipment, document

while the nursing student changes the patient's tracheostomy dressing, the nurse observes the student using a pair of scissors to cut a 4x4 gauze pad to make a split dressing that will fit around the tracheostomy tube. what is the nurse's best action

• give the student positive reinforcement for use of materials and technique
• report the student to the instructor to the instructor for remediation of the skill
• change the dressing immediately after the student has left the room
• direct the student in the correct use of materials and explain the rationale

the nurse is caring for a patient with a tracheostomy who has recently been transferred from the ICU but he has had no unusual occurrences related to the tracheostomy or his oxygenation status. what does the routine care for this patient include

• thorough respiratory assessment at least every 2 hours
• maintaining the cuff pressure between 50 and 100 mm Hg
• suctioning as needed; maximum suction time of 20 seconds
• changing the tracheostomy dressing once a day

the patient with a tracheostomy is being discharged to home. in patient teaching, what does the nurse instruct the patient to do

• use sterile technique when suctioning
• instill tap water into the artificial airway
• clean the trachostomy with soap and water
• increase the humidity in the home

the patient with a permanent trachostomy is interested in developing an exercise regimen. which activity does the nurse advise the patient to avoid

• aerobics
• tennis
• golf
• swimming

the patient with an endotracheal tube in place has dry mucous membranes and lips relate to the tube ad the partial open mouth position. what techniques does the nurse use to provide this patient with frequent oral care

• cleanses the mouth with glycerin swabs
• provides alcohol based mouth rinse and oral suction
• cleanses with a mixture of hydrogen peroxide and water
• uses toothettes or a soft-bristles brush moistened in water

the patient with a tracheostomy tube is able to speak and is no longer on mechanical ventilation. which type of tracheostomy tube does this patient have

• cuffless tube
• standard cuffed tube
• cuffed fenestrated tube
• tube without an obturator

used with patient who can speak while on a ventilator for a long-term basis

• double lumen tube
• single lumen tube
• cuffed tube
• cuffless tube
• fenestrated tube
• cuffed fenestrated tube
• metal tracheostomy tube
• talking tracheostomy tube

has a cuff that seals airway when inflated

• double lumen tube
• single lumen tube
• cuffed tube
• cuffless tube
• fenestrated tube
• cuffed fenestrated tube
• metal tracheostomy tube
• talking tracheostomy tube

used for long term management of patients not on mechanical ventilation or at high risk for aspiration

• double lumen tube
• single lumen tube
• cuffed tube
• cuffless tube
• fenestrated tube
• cuffed fenestrated tube
• metal tracheostomy tube
• talking tracheostomy tube

has three parts - outer cannula, inner cannula, obturator

• double lumen tube
• single lumen tube
• cuffed tube
• cuffless tube
• fenestrated tube
• cuffed fenestrated tube
• metal tracheostomy tube
• talking tracheostomy tube

used for permanent tracheostomy

• double lumen tube
• single lumen tube
• cuffed tube
• cuffless tube
• fenestrated tube
• cuffed fenestrated tube
• metal tracheostomy tube
• talking tracheostomy tube

metal tracheostomy tube

used often for patient with spinal cord paralysis or muscular disease who do not require a ventilator all the time

• double lumen tube
• single lumen tube
• cuffed tube
• cuffless tube
• fenestrated tube
• cuffed fenestrated tube
• metal tracheostomy tube
• talking tracheostomy tube

has no inner cannula and is used for patients with long or extra thick necks

• double lumen tube
• single lumen tube
• cuffed tube
• cuffless tube
• fenestrated tube
• cuffed fenestrated tube
• metal tracheostomy tube
• talking tracheostomy tube

used when weaning a patient from a ventilator; allows the patient to speak

• double lumen tube
• single lumen tube
• cuffed tube
• cuffless tube
• fenestrated tube
• cuffed fenestrated tube
• metal tracheostomy tube
• talking tracheostomy tube

the patient has a cuffed tracheostomy tube without a pressure relief valve. to prevent tissue damage of the tracheal mucosa what does the nurse do

• deflate the cuff every 2 to 4 hours and maintain as needed
• change the tracheostomy tube every 3 days or per hospital policy
• assess and record cuff pressures each shift using the occlusive technique
• assess and record cuff pressures each shift using minimal leak technique

an older adult patient is at risk for aspirating food or fluids. what is the most appropriate nursing action to assess for and prevent this problem

• monitor for increased amount of secretions when patient is coughing
• add food coloring to fluids or enteral feedings and monitor the color of the secretions
• obtain an order for a clear liquid diet and offer small but frequent amounts
• obtain an order for a chest xray to determine the presence of aspiration pneumonia

add food coloring to fluids or enteral feedings and monitor the color of the secretions

(I don't think they do this anymore due to allergies to the food coloring)

an older adult patient sustained a stroke several weeks ago and is having difficulty swallowing. to prevent aspiration during mealtimes, what does the nurse do

• hyperextend the head to allow food to enter the stomach and not the lungs
• give thin liquids after each bit of food to help wash the food down
• encourage dry swallowing after each bite to clear residue from the throat
• maintain a low fowler's position during eating and for 2 hours afterwards

the patient with a tracheostomy tube is currently alert and cooperative but seems to be coughing more frequently and prodcuing more secretions than usual. the nurse determines that there is a need for suctioning. which nursing intervention does the nurse use to prevent hypoxia for this patient

• allow the patient ot breathe room air prior to suctioning
• avoid prolonged suctioning time
• suction frequently when the patient is couging
• use the largest avialable catheter

the patient with a tracheostomy is unable to speak. he is not in acute distress but is gesturing and trying to communicate with the nurse. which nursing intervention is the best approach in this situation

• rely on the family to interpret for the patient
• ask questions that can be answered with a yes or no response
• obtain an immediate consult with the speech terapist
• encourage the patient to rest rather than struggle with communication

which clinical finding in the patient with a recent tracheostomy is the most serious and requires immediate intervention

• increased cough and difficulty expectorating secretions
• food particles in the tracheal secretions
• pulsating tracheostomy tube in synchrony with the heartbeat
• set tidal volume on the ventilator not being received by the patient

the nurse is providing discharge instructions for the patient who must perform self-care of a tracheostomy. the patient has been cheerful and cooperative during the hospital stay and has demonstrated interest and capability in performing self-care. but now the patient begins crying and refuses to leave the hospital. what is the nurse's best response

• you have done so well with your self care. i am sure that you will be okay
• let me call your family. they can help you get home and get settled
• you have been brave and cheerful, but there is something that is worrying you
• we'll delay this teaching until later. let's choose a scarf for you to wear home

the nurse is caring for several patients who are at risk because of problems related to the upper airway. what is the priority assessment for these patients

• thickness of oral secretions; encourage ingestion of oral fluids
• anxiety and pain; provide reassurance and NSAIDs
• adequacy of oxygenation; ensure an unobstructed air passageway
• evidence of spinal cord injuries; obtain order for xrays

the patient's wife is concerned that her overweight husband has sleep apnea becaue of his heavy snoring. which questions are appropriate to ask to elicit information related to sleep apnea. select all that apply

• is your husband a heavy smoker
• does he have a breathing interruption that lasts at least 10 seconds
• does he complain of waking up feeling tired
• does your husband eat late night sancks and sleep on his back
• is there a history of frequent throat or sinus infections
• have you noticed a change in his personality

• is your husband a heavy smoker
• does he have a breathing interruption that lasts at least 10 seconds
• does he complain of waking up feeling tired
• have you noticed a change in his personality

the nurse is instructing the patient about a scheduled polysomnograph. which patient statement indicates understanding of the procedure

• the test can be done in the doctor's office and will take 2 to 3 hours
• i shouldn't eat anything after midnight the night before and someone must accompany me
• the test determines the depth and type of sleep and muscle movement
• the test determines the amount of sleep i need for adequate rest

the patient has been diagnosed with sleep apnea. which assessment findings indicate that the patient is having complications associated with sleep apnea

• side effects of hypoxemia, hypercapnia, sleep deprivation
• decrease in arterial carbon dioxide levels and sleep deprivation
• respiratory alkalosis with retention of carbon dioxide
• irritability, obesity, enlarged tonsils or adenoids

the patient has been diagnosed with airway obstruction during sleep. the nurse most likely includes patient edustion about which device for home use

• CPAP to deliver a positive airway pressure
• oxygen via face mask to prevent hypoxia
• neck brace to support the head and facilitate breathing
• nebulizer treatments with bronchodilators

the patient is at risk for aspiration related to vocal cord paralysis. what does the nurse teach the patient to do

• raise the chin while swallowing
• breathe slowly through an open mouth immediately after swallowing
• hold the breath during swallowing
• tilt the head backward during and immediately after swallowing

the patient has been diagnosed with vocal nodules. the physician recommends conservative treatment that includes lifestyle modifications. what does the nurse teach the patient to do

• whisper instead of speaking loadly
• avoid humid climate conditions
• use stool softeners to decrease straining
• limit intake of caffeinated beverages

the nurse is assessing the patient who reports being struck in the face and head several times. during the assessment a pink tinged drainage from the nares is observed. which nursing action provides relevant assessment data

• have the patient gently blow the nose and observe for bloody mucus
• test the drainage with a reagent to check the pH
• ask the patient to describe the appearance of the face before the incident
• place a drop of the drainage on a filter paper and look for a yellow ring

while playing football at school the patient injured his nose resulting in a possible simple fracture. the patient's parents call the nurse seeking advice. what does the nurse tell the parents to do

• ask the school nurse to insert a nasal airway to ensure patency
• apply an ice pack and allow the patient to rest in a supine position
• seek medical attention within 24 hours to minimize further complications
• monitor the symptoms for 24 hours and contact the physician if there is bleeding

the patient had a rhinoplasty and is preparing for discharge home. a family member is instructed by the nurse to monitor the patient for postnasal driip by using a flashlight to look in the back of the throat. if bleeing is noted what does the nurse tell the family member to do

• place ice packs on the back of the neck and apply pressure to the nose
• hyperextend the neck and apply pressure and ice packs as needed
• seek immediate medical attention for the bleeding
• monitor for 24 hours if the bleeding appears to be a small amount

the nurse is teaching the patient about post rhinoplasty care. which patient statement indicates an understanding of the instruction

• i will have a very large dressing on my nose
• i will  have bruising around my eyes, nose, face
• there will be swelling that will cause a loss of sense of smell
• my nose will be three times its normal size for 3 weeks

the patient with an active nosebleed is admitted to the emergency department. how does the nurse attempt to stop the nosebleed

• administer sedation/relaxation medication, apply ice packs and pressure to the nose, monitor respiratory status
• immediately pack the nose, apply ice packs, have the patient sit with head forward, monitor the amout of bleeding
• have the patient sit with head forward, monitor the color and mount of blood, monitor vital signs, apply an ice pack and pressure to the nose
• apply pressure and ice, have the patient blow the nose hard to remove obstructing clots administer humidfied oxygen

the nurse is caring for the older patient with a history of noncompliance with prescribed metoprolol and recurrent nosebleeds. which assessment finding is the most significant in relation to this patient's risk for repeated nosebleeds

• irregular apical pulse of 58 bpm
• open mouth breathing with respiratory rate of 28/min
• asymptomatic blood pressure of 180/110
• subjective chills and oral temperature of 87.2

after being treated in the emergency department for posterior nosebleed, the patient is admitted to the hospital. the nasal packing is in place and vital signs are stable. the patient has an iv of normal saline at 125 ml/hr. what is thre piority nursing diagnosis

• risk for impaired gas exchange
• risk for fluid volume deficit
• risk for decreased cardiac output
• risk for infection

the patient is admitted for a posterior nosebleed. posterior packing is in place and in addition the patien is on oxygen therapy, antibiotics, and opiod anlgesics. what is the priority assessment

• tolerance of packing or tubes
• gag and cough reflexes
• mouth breathing
• skin breakdown around the nares

the patient reports noticing a change in the character of nasal discharge and speech quality and a subjective feeling of blockage in the nasal passages. to gather additional relevant information which question is the most appropriate  to ask this patient

• are you experiencing any soreness or tightness in your throat
• do you have a history of nasal polyps
• do you take over the counter medications on a regular basis
• do your have a history of frequent nosebleeds

the nurse is caring for the patient who has just returned from rhinoplasty surgery. which assessment finding warrants additional assesment and concern

• bilateral packing of both nares in place
• moustache pad in place
• demonstrated repeated swallowing
• traces of bruising around the eyes

the patient returns from surgery following a rhinoplasty. the nursing assistant places the patient in a supine position to encourage rest and sleep. which action should the nurse take first

• teach the patient how to use the bed controls to position herself
• explain the purpose of the semi fowlers position to the nursing assistant
• place the patient in a semi fowler's position and assess for aspiration
• post a notice at the head of the bed to remind personnel about positioning

the nurse is caring for the patient who had a nasoseptoplasty. which action is the best to delgate to the licensed practical nurse

• administer a stool softener to ease bowel movements
• assess the patient's airway and breathing after general anesthesia
• evaluate the patient's emotional reaction the ote facial edema and bruising
• take vital signs every 4 hours as ordered by the physician

after the patient has a rhinoplasty postoperative instructions are given to the patient and family. which instruction set does the nurse provide

• place ice packs over the eyes and face and swelling and discoloration should be relieved quickly
• resume food and fluids as tolerated but minimize fluids to decrease nasal secretions
• use mild analgesics only such as tylenol, excedrin with aspirin, and motrin to relieve discomfort
• avoid constipation for the first few days after surgery to prevent straining, which puts pressure on the incision

the nurse is montioring the child who has been admitted for a fever of unknown origin. the child also reports a sore throat and demonstrates reluctance to eat and drink. which assessment finding indicates an upper airway obstruction which requires immediate intervention

• stridor
• crepitus
• weak cough
• subcutaneous emphysema

• stridor

the patient arrives in the emergency department with a severe crush injury to the face with blood gurgling from the mouth and nose and obvious respiratory distress. the nurse prepares to assist the physician with which procedure to manage the airway

• performing a needle thoracotomy
• inserting a endotracheal tube
• performing a tracheostomy
• inserting a nasal airway and giving oxygen

• performing a tracheostomy

the patient with facial trauma has undergone surgical intervention to wire the jaw shut. in performing discharge teaching with this patient, which topics does the nurse cover

• bleeding, oral care and nutrition, pain control, activity
• oral care, nutrition, pain, communication, aspiration prevention
• prevention of airway obstructions, bleeding and oral infection, pain control
• activity, diet communication, bleeding shock

• oral care, nutrition, pain, communication, aspiration prevention

the nurse is assessing the patient with significant and obvious facial trauma after being struck repeatedly in the face. which finding is the priority and requires immediate intervention

• asymmetry of the mandible
• restlessness and gurgling respirations
• nonparallel extraocular movement
• pain upon palpation of the nasal bridge

• restlessness and gurgling respirations

the nurse enters the room and the patient is crying. when the nurse asks the patient what happened, the patient says, "the doctor told me I have a LeFort I fracture of my face" what is the nurse's best response

• don't worry; a lefort i fracture is much less serious than a lefort iii
• you have an excellent doctor who will take good care of you
• let me get you a mirror and you will see that it's not so bad
• what is your main concern about the lefort i fracture

the patient has an inner maxillary fixation. the nurse encourages the patient to eat which kind of food

• milkshakes
• cottage cheese
• tea and toast
• tuna and noodle casserole

• milkshakes

the patient enters the emergency department after being punched in the throat. what does the nurse monitor for

• aphonia
• dry cough
• crepitus
• loss of gag reflex

• aphonia

the patient has sustained a mandible fracture and the surgeon has explained that the repair will be made using a resorbable plate. the patient discloses to the nurse that he has not told the surgeon about this substance abuse and illicit drug dependence. what is the nurse's best respons

• why didn't you talk to your surgeon about this issue
• you should tell the surgeon but it is your choice
• it is important for your surgeon to know about this information
• you shouldn't be ashamed; your surgeon will still repair your fracture

• it is important for your surgeon to know about this information

the patient has had an inner maxillary fixation for a mandibular fracture. which piece of equipment should be kept at bedside at all times

• water pik
• wire cutters
• pair of hemostats
• emesis basin

• wire cutters

the patient who was in a motor vehicle accident and sustained laryngeal tauma is being treated in the emergency departhment with humidified oxygen and is being monitored every 15 to 30 minutes for respiratory distress. which assessment finding may indicate the need for further assessment

• respiratory rate of 24, PaO2 80 to 100, no difficulty with communication
• pulse oximetry 96%, anxious, fatigued, blood in sputum, abdominal breathing
• confused and disoriented, difficulty producing sounds, pulse ox 80%
• anxious, respiratory rate 30, talking rapidly about the accident, warm to touch

• confused and disoriented, difficulty producing sounds, pulse ox 80%

the patient in the emergency department with laryngeal trauma has developed shortness of breath with stridor and decreased oxygen saturation. what is the priority action

• insert an oral or nasal airway
• assess for tachypnea, anxiety, and nasal flaring
• obtain the equpment for a tracheostomy
• apply oxygen and stay with the patient

the older adult patient who is talking and laughing while eating begins to choke on a piece of meat. what is the inital emergency management for this patient

• several sharp blows between the scapulae
• call the rapid response teach
• nasotracheal suction
• abdominal thrusts (Heimlich maneuver)

• abdominal thrusts (Heimlich maneuver)

the nursing student is preparing patient teaching materials about head and neck cancer. which statement is accurate and included in the patient teaching information

• it metastasizes often to the brain
• it usually develops over a short time
• it is often seen as red edematous areas
• it is often seen as white patching mucosal lesions

the nurse is interviewing the patient to assess for risk factors related to head and neck cancer. which questions are appropriate to inclue (select all that apply)

• how many servings per day of alcohol would you typically drink
• have you had frequent episodes of acute or chronic visual problems
• have you had a problem with sores in your mouth
• when was the last time you saw your dentist
• do you have recurrent laryngitis or frequent episodes of sore throat
• how many packs per day do you smoke and for how many years

• how many servings per day of alcohol would you typically drink
• have you had a problem with sores in your mouth
• do you have recurrent laryngitis or frequent episodes of sore throat
• how many packs per day do you smoke and for how many years

which patient has the highest risk for developing cancer of the larynx and should be alerted about relevant liefstyle modifications to decrease this risk

• 57 year old male with alcoholism
• 18 year old marijuana smoker
• 28 year old female with diabetes
• 34 year old male who snorts cocaine

• 57 year old male with alcoholism

the nurse is caring for the patient with a laryngeal tumor. in order to facilitate comfort and breathing for the patient, which type of position does the nurse use

• sims
• supine
• fowler's
• prone

• fowler's

the patient suffers from chronic xerostomia related to past radiation therapy treatments. which intervention does the nurse use to assist the patient with this symptom

• offer small frequent meals
• suggest chewing sugarless gum
• explain fluid restrictions
• teach to wash with mild soap and water

• suggest chewing sugarless gum

the nurse is assessing the patient's skin at the site of radiation therapy to the neck. which skin condition is expected in relation to the radiation treatments

• red, tender, and peeling
• shiny, pale and tight
• puffy and edematous
• pale, dry and cool

• red, tender, and peeling

which surgical procedure of the neck area poses no risk postoperatively for aspiration

• total laryngectomy
• transoral cordectomy
• hemilaryngectomy
• partial laryngectrmy

• total laryngectomy

the nurse is caring for the postoperative patient who had a radical neck dissection. which assessment finding is expected

• bulky gauze dresing is present that is dry and intact over the site
• the patient can speak normally but reports a sore throat
• permanent gastrostomy tube is present with continuous tube feedings
• the patient has shoulder muscle weakness and limited range of motion

• bulky gauze dresing is present that is dry and intact over the site

the nursing student is caring for the older adult patient who sustained a stroke and is confused and having trouble swallowing. which statement by the nursing student indicates an understanding of aspiration precautions for this patient

• i will administer pills as whole tablets; they are easier to swallow
• if the patient coughs, i will discontinue feeding and contacts the physician
• i will keep the head of bed elevated during and after feeding
• i will encourage small amounts of fluids such as water tea or juices

• i will keep the head of bed elevated during and after feeding

the nurse observes that the patient is having difficulty swallowing and has initiated aspiration precautions. which procedure does the nurse expect the physician to order for this patient

• chest xray of the neck and chest
• ct scan of the head and neck
• barium swallow under fluoroscopy
• direct and indirect laryngoscopy

• barium swallow under fluoroscopy

the patient has had a radical neck dissection surgery with a reconstrucdtive flap over the carotid artery. which intervention is appropriate for the flap care

• evaluate the flap every hour for the first 72 hours
• monitor the flap by gently placing a doppler on the flap
• position the patient so that the flap is in the dependent position
• apply a wet to dry dressing to the flap

• evaluate the flap every hour for the first 72 hours

the nurse is caring for several patients who require treatment for laryngeal cancer. which treatment/procedure requires patient education about aspiration precautions

• total laryngectomy
• laser surgery
• radiation therapy
• supraglottic laryngectomy

• supraglottic laryngectomy

which statement by the patient indicates understanding about radiation therapy for neck cancer

• my voice will initially be hoarse but should improve over time
• there are no side effects other than a hoarse voice
• dry mouth after radiation therapy is temporary and short term
• my throat is not directly affected by radiation

• my voice will initially be hoarse but should improve over time

what does the nurse include in the teaching session for the patient who is scheduled to have a partial laryngectomy

• supraglottic method of swallowing
• presence of a tracheostomy tube and nasogastric tube for feeding due to postoperative swelling
• note being able to eat solid foods
• premanence of the tracheostomy, referred to as a laryngectomy stoma

the patient has been transferred from the intensive care unit to the medical surgical unit after a laryngectomy. what does the nurse suggest to encourage the patient to participate in self-care

• changing the tracheostomy collar
• suctioning the mouth with a yankaur suction
• checking the stoma with a flashlight
• observing the color of the reconstructive flap

• suctioning the mouth with a yankaur suction

the nurse is caring for the patient who had reconstructive neck surgery and observes bright red blood spurting from the tissue flap that is covering the carotid artery. what is the priority action

• call the surgeon and alert the operating room
• call the rapid response team
• apply immediate, direct pressure to the site
• apply a bulky sterile dressing and secure the airway

• apply immediate, direct pressure to the site

the patient is experiencing acute anxiety related to hospitalization stress and an inability to accept changes related to laryngeal cancer. the patient wants to leave the hospital but agrees to try a medicatio to "help me calm down" for which medication does the nurse obtain a PRN order

• amitriptyline (Elavil)
• modafinil (Provigil)
• morphine sulfate
• lorazepam (Ativan)

the patient with a recent diagnosis of sinus cancer states that he wants another course of antibiotics because he believes he simply has another sinus infection. what is the nurse's best response

• i'll call the pysician for the antibiotic prescription
• why are you doubting your doctor's diagnosis
• let me bring you some information about sinus cancer
• what did the doctor say to you about your condition

the nurse identifies a nursing diagnosis of disturbed body image related to perceived disfigurement created by tracheostomy for the young female patient. what is the priority action

• ecnourage the family to bring several attractive scarves
• assist the patient to identify realistic goals
• redirect conversation topics away from body image
• obtain an order for a psychiatric social services consult

the patient is unable to speak following a cordectomy. which action is delegated to the nursing assitant to assist the patient in dealing with communication issues

• politely tell the patient not to communicate
• teach the patient how to use hand signals
• allow extra time to accomplish ADLs because of communication limitations
• give step-by-step instructions during the adls and discourage two way communication

the nurse is assessing the patient who has had a neck dissection with removal of muscle tussue, lymph nodes, and eleventh cranial nerve. which assessment finding is anticipated because of the surgical procedure

• shoulder drop with a decreased limitation of movement
• asymmetrical eye movements and a change of visual acuity
• blood and serous fluid under the reconstructie flap
• facial swelling iwht discoloration and bruising around the eyes

the patient is having radiation therapy to the neck and reports a sore throat and difficulty swallowing. which statement by the nursing student indicates a correct understanding of symptom relief for this patient

• the patient should not swallow anything too cold or too hot
• i will give the patient a mouthwash with an alcohol base
• i will help the patient with a saline gargle
• the patient should be reassured that the sore throat is temporary

the physician orders the discontinuation of the nasogastric tube for the patient with a total laryngectomy. before discontinuing the tube which action is performed

• the physician and the nurse will assess the patient's ability to swallow
• reassure the patient that eating and swallowing will be painless and natural
• the nutritionist will evaluate the patient's nutritional status
• the patient wil be offered a prn analgesic or an anxiolytic medicaiton

the patient is learning esophageal speech and reports that he feels bloated after a practice sessionl to assit the patient with this issue, what does the nurse do

• refer the patient to the american cancer society visitor program
• obtain an order for prn antacids
• reassure the patient that the discomfort is worht the long term benefit
• notify the speech therapist about the symptom

• obtain an order for prn antacids

the patient has had surgery for cancer of the neck. which behavior indicates that the patient understands how to perform self-care to prevent aspiration

• chooses thin liquids that cause coughng, but knows to take small sips
• eats small frequent meals that include a variety of textures and nutrients
• asks for small frequent sips of nustrition supplement as a bedtime snack
• positions self upright before eating or drinking anything

the patient is receiving enteral feedings and a nasogastric tube is in place. in order to prevent aspiration, wihch precautions are used (select all that apply)

• no bolus feedings are given at night
• hold the feeding if the residual volume exceeds 20 ml
• vary the time of feedings according to the patient's preference
• check the pH of the secretions
• elevate the head of the bed during and after feedings
• evaluate the patient's tolerance of the feedings

• no bolus feedings are given at night
• check the pH of the secretions
• elevate the head of the bed during and after feedings
• evaluate the patient's tolerance of the feedings

the patient has demonstrated anxiety since a diagnosis of neck cancer. the surgery and radiation therapy are completed. which behavior indicates the patient's anxiety is decreasing

• repeatedly asks the same questions and seeks to revalidate all information
• states that he is less anxious but is irritable and tense whenever questioned
• makes a plan to contact the american cancer society visitor program
• makes a plan to share personal belongings with friends and family

affects smaller airways

• asthma
• chronic bronchitis
• pulmonary emphysema

• asthma
• chronic bronchitis

chronic thickening of bronchial walls

• asthma
• chronic bronchitis
• pulmonary emphysema

decreased surface area of alveoli

• asthma
• chronic bronchitis
• pulmonary emphysema

destruction of alveolar walls

• asthma
• chronic bronchitis
• pulmonary emphysema

hypercapnia

• asthma
• chronic bronchitis
• pulmonary emphysema

chronic bronchitis

pulmonary emphysema

impaired mucociliary clearance

• asthma
• chronic bronchitis
• pulmonary emphysema

increased airway resistance

• asthma
• chronic bronchitis
• pulmonary emphysema

chronic bronchitis

pulmonary emphysema

increased eosinophils

• asthma
• chronic bronchitis
• pulmonary emphysema

increased secretions

• asthma
• chronic bronchitis
• pulmonary emphysema

affects work of breathing

• asthma
• chronic bronchitis
• pulmonary emphysema

• asthma
• chronic bronchitis
• pulmonary emphysema

intermittent bronchospasm

• asthma
• chronic bronchitis
• pulmonary emphysema

intermittent mucosal edema

• asthma
• chronic bronchitis
• pulmonary emphysema

intermittent excess mucus production

• asthma
• chronic bronchitis
• pulmonary emphysema

loss of elastic recoil

• asthma
• chronic bronchitis
• pulmonary emphysema

mast cell destabilization

• asthma
• chronic bronchitis
• pulmonary emphysema

elastin broken down by proteases

• asthma
• chronic bronchitis
• pulmonary emphysema

stimulation of disease process by allergies

• asthma
• chronic bronchitis
• pulmonary emphysema

possibly results in respiratory acidosis

• asthma
• chronic bronchitis
• pulmonary emphysema

chronic bronchitis

pulmonary emphysema

narrowed airway lumen due to inflammation

• asthma
• chronic bronchitis
• pulmonary emphysema

narrowing of airway from smooth muscle constriction

• asthma
• chronic bronchitis
• pulmonary emphysema

disease triggered by anti-inflammatory drugs used to treat disease

• asthma
• chronic bronchitis
• pulmonary emphysema

the nurse is caring for the older adult patient with a chronic respiratory disorder. which interventions are best to use in caring for this patient. select all that apply

• provide rest periods between activities, such as bathing meals and ambulation
• place the patient in a supine position after meals to allow for rest
• schedule drug administration around routine activities to increase adherence to drug therapy
• arranging chairs in strategic locations to allow the patient to walk and rest
• teach the patient to avoid getting the pneumonococcal vaccine
• encourage the patient to have an annual flu vaccination

• provide rest periods between activities, such as bathing meals and ambulation
• schedule drug administration around routine activities to increase adherence to drug therapy
• arranging chairs in strategic locations to allow the patient to walk and rest
• encourage the patient to have an annual flu vaccination

the nurse is caring for an older adult patient with a history of chronic asthma. whch problem related to aging can influence the care and treatment of this patient

• asthma usually resolves with age so the condition is less severe in older patients
• it is more difficult to teach older adult patients about asthma than to teach younger patients
• with aging, the beta adrenergic drugs do not work as quickly or strongly
• older adult patients have difficulty manipulating handheld inhaler

the nurse is presenting a community eduction lecture about respiratory disorders. which statement by a participant indicates a correct understanding of the information

• bronchitis is a genetic disease that effects many organs
• in bronchial asthma an airway obstruction can be caused by inflammation
• in chronic bronchitis, the tissue damage is only temporary and is reversible
• smoking cessation reverses the tissue damage caused by emphysema

which statement is true about asthma and COPD as chronic diseases of the lower respiratory system

• COPD causes respiratory distress episodes with no permanent alveoli damage
• in asthma the lungs lose elasticity and become hyperinflated
• asthma manifests as acute episodes of reversible airway distress
• in COPD a twitchy airway can cause an airway obstruction

• asthma manifests as acute episodes of reversible airway distress

the nurse is helping the patient learn about managing her asthma. what does the nurse instruct the patient to do

• keep a symptom diary to identify what triggers the asthma attacks
• make an appointment with an allergist for allergy therapy
• take a low dose of aspirin every day for the anti-inflammatory action
• drink large amounts of clear fluid to keep mucus thin and watery

the nurse is taking a medical history on the new patient who has come to the office for a checkup. the patient states that he was supposed to take a medication called Singulair (montelukast) but that he never got the prescription filled. what is the best response by the nurse

• when did you first get diagnosed with a respiratory disorder
• why didn't you get the prescription filled
• tell me how you feel about your decision to not fill the presciption
• are you having any problems with your asthma

• are you having any problems with your asthma

the nurse teaches the patient with asthma to monitor for which problem while exercising

• increased peak expiratory flow rates
• wheezing from bronchospasm
• swelling in the feet and ankles
• respiratory muscle fatigue

the high school student desires to participate in sports. his mother is very reluctant to give permission because her son has had asthma since early childhood. what does the nurse recommend

• participating in a sport like basketball would be a good choice
• premedicating with an inhaler such as salmeterol (Serevent) would help
• avoid exercising in cold, dry air because this may trigger an attack
• avoid exercising because exercise itself can trigger attacks

the child attending day camp has asthma and her parent packed and sent with her all of her medicine in a small carry bag. the child has an asthma attack that is severe enough to warrant a rescue drug. which medication from the child's bag is best to use for the acute symptoms

• omalizumab (Xolair)
• fluticasone (Flovent)
• salmetrerol (Serevent)
• albuterol (Proventil)

which assessment findings are expected for the patient with chronic airflow limitation (select all that apply)

• cyanosis
• cough
• dyspnea
• tachypnea
• wheezing

• cough
• dyspnea
• tachypnea
• wheezing

for the patient who is a nonsmoker, which classic assessment finding of chroic airflow limitation is particularly important in diagnosing asthma

• cough
• dyspnea
• audible wheezing
• tachypnea

the patient who is allergic to dogs experiences a sudden asthma attack. which assesment findings does the nurse expect for this patient

• slow deep pursed lip respirations
• breathlessness and difficulty completing sentences
• clubbing of the fingers and cyanosis of the nair bedls
• bradycardia and irregular pulse

• breathlessness and difficulty completing sentences

the patient is experiencing an asthma attack and shows an increased respiratory efforts

which arterial blood gas is more associated with the early phase of the attack

• PaCO2 of 60 mm Hg
• PaCO2 of 30 mm Hg
• pH of 7.40
• PaO2 of 98 mm Hg

the patient tells the nurse "the doctor told me i had a barrel chest. is that a bad thing? i don't know what tht means" what is the best response by the nurse

• your chest has become barrel shaped because you breath hard and your muscles have increased the front to back ratio of your chest
• when a person has chronic asthma, air gets trapped in the lungs and this gradually causes a change in the front to back shape of your chest
• it's really noting to worry about. it just means the shape of your chest has changed to look like a barrel. it's because you have asthma
• i'll ask the doctor to come back in and explain it to you. it's really frightening when these strange terms are used and you are not sure what they mean

the nurse is teaching the patient how to interpret peak expiratory flow readings and to use this information to manage drug therapy at home. which statement by the patient indicates a need for additional teaching

• if the reading is in the green zone, there is no need to increase the drug therapy
• red is 50% below my personal best; i should try a rescue drug and seek help
• if the reading is in the yellow zone, i should increase my use of my inhalers
• if frequent yellow readings occur, i should see my doctor for a chang ein medications

the patient with chronic bronchitis often shows signs of hypoxia. which clinical manifestation is the priority to look out for in this patient

• chronic nonproductive dry cough
• clubbing of fingers
• large amounts of thick mucus
• barrel chest

the nurse is taking a history for the patient with chronic pulmonary disease. the patient reports often sleeping in a chair that allows his head to be elevated rather than going to bed. the patient's behavior is a strategy to deal with which condition

• paroxysmal nocturnal dyspnea
• orthopnea
• tachypnea
• cheyne-stokes

the patient has chronic bronchitis. the nurse plans interventions for impaired gas exchange based on which set of clinical manifestation

• chronic cough, thin secretions and chronic infection
• respiratory alkalosis decreased PaCO2 and increased PaO2
• areas of chest tenderness and sputum production (often with hemoptysis)
• large amounts of thick secretions and repeated infections

the patient has COPD with chronic difficult breathing. in planning this patient's care what condition must the nurse acknoledge is present in this patient

• decreased need for calories and protein requirements since dyspnea causes activity intolerance
• COPD has no effect on calorie and protein needs, meal tolerance, satiety, appetite, and weight
• increased metabolism and the need for additional calories and protein supplements
• anabolic state, which creates conditions for building body strength and muscle mass

increased metabolism and the need for additional calories and protein supplements

in obtaining a history for the patient with chronic airflow limitation which risk factor is not related to potentially causing or triggering the disease process

• cigarette smoking
• occupational and air pollution
• genetic tendencies
• smokeless tobacco

which statement is true about the relationship of smoking sessation to the pathophysiology of COPD

• smoking cessation completely reverses the damage to the lungs
• smoking cessation slows the rate of disease progression
• smoking cessation is an important therapy for asthma but not for COPD
• smoking cessation reverses the effects on the airways but not the lungs

the patient has a history of COPD but is admitted for a surgical procedure that is unrelated tot he respiratory system. nevertheless, to prevent any complications related to the patient's COPD what does the nurse do

• assess the patient's respiratory system every 8 yours
• monitor for signs and symptoms of pneumonia
• give high-flow oxygen to maintain pulse oximetry readings
• instruct the patient to use a tissue if coughing or sneezing

the nurse is instructing the patient regarding complicatoins of COPD. which statement by the patient indicates the need for additional teaching

• i have to be careful because i am susceptible to respiratory infections
• i could develop heart failure, which could be fatal if untreated
• my COPD is serious, but it can be reversed if I follow my doctor's orders
• the lack of oxygen could cause my heart to beat in an irregular pattern

the nurse is reviewing a summary of pulmonary function testing. the physician has asked the nurse to call the results of the most significant reading realted to obstructie pulmonary disease. which portion of the PFT is of primary interest

• FEV1/FVC ratio
• functional residual capacity
• total lung capacity
• residual volume

• FEV1/FVC ratio

the patient with chronic ariflow limitation (CAL) is informed by the physician that over time there has been a decrease in the FEV1/FVC ratio. after the physician leaves, the patient appears to be unsure about the meaning of the results and their relationship to her health condition. what does the nurse tell this patient

• her disease process is stable
• the CAL is progressing
• the CAL is improving
• further diagnostic testing is needed

what s the purpose of pulmonary function testing

• determines the oxygen liter flow rates required by the patient
• measures blood gas levels before bronchodilators are administered
• evaluates the movement of oxygenated blood from the lung to the heart
• distinguishes airway disease form restrictive lung disease

the patient with respiratory difficulty has completed a PFT before starting any treatment. the peak expiratory flow is 15% to 20% below what is expected for this adult patient's age, gender, and size. the nurse anticipates this patien twill need additional information about which topic

• further diagnostic tests to confirm pulmonary hypertension
• how to manage asthma medications and identify triggers
• smoking cessation and its relationship to COPD
• how to manage the acute episode of respiratory infection

patient with asthma are taught self care actvities and treatment modalities accroding to the step method. which symptoms and medications routines relate to step iii

• symptoms occur daily; daily use of inhaled corticosteroid add a long acting beta agonist
• symptoms occur more than once per week ; daily use of anti inflammatory inhaler
• symptoms occur less than once per week; use of rescue inhalers once per week
• frequent exacerbations with limited physical activity; increased use of rescue inhalers

why is a high liter flow of oxygen contraindicated in the patient with COPD

• the patient depends on hypercapnic drive to breath
• the patient depends on a hypoxic drive to breathe
• receiving too much oxygen over a short time results in headache
• tolerance develops; therefore hgih doses needed later will be ineffective

in assisting the patient with chronic airflow limitation to relieve dyspnea, which sitting position offers the patient no benefit

• on edge of chair leading forward with arms folded and resting on a small table
• in a low semi reclining position with the shoulders back and knees apart
• forward in a chair with feet spread apart and elbows placed on the knees
• head slightly flexted with feet spread apart and shoulders relaxed

the nurse is developing a teaching plan for the patient with chronic airflow limitation using the nursing diagnosis of deficient knowledge related to energy conservation. what does the nurse advise the patient to avoid

• performing activities at a relaxed pace throughout the day with rest periods
• working on activities that require using arms at chest level or lower
• eating three large meals per day
• talking and performing activities separately

the patient with COPD has meal related dyspnea. to address this issue which drug does the nurse offer the patient 30 minutes before the meal

• albuterol (Ventolin)
• guaifenesin (Organidin)
• fluticasone (Flovent)
• pantoprazole sodium (Protonix)

the laboratory result for the patient's theophylline level is 18 mcg/ml. what action does the nurse take

• place the results in the patient's chart because the value is within therapeutic range
• immediately alert the physician because the value indicates that the dose is too high
• contact the physician during am rounds to get a prescription to increase the dose
• immediately assess the patient for adverse reactions related to a toxic level

the patient is receiving ipratropium (Atrovent) and reports nausea, blurred vision, headache and inability to sleep. what action does the nurse take

• administer a PRN medication for nausea and a mild PRN sedative
• report these symptoms to the physician as signs of overdose
• obtain a physician's request for an ipratropium level
• tell the patient that these side effects are normal and not to worry

the patient with asthma has been prescribed a Flovent inhaler. what is the purpose of this drug for the patient

• relaxes the smooth muscles of the airway
• acts as a bronchodilator in severe episodes
• reduces obstruction of airways be decreasing inflammation
• reduces the histamine effect of the triggering agent

what is the advantage of using the aerosol route for administering short acting beta 2 agonists

• achieves a rapid and effective anti infalmmatory action
• reduces the risk for fungus infections
• increases patient compliance because it is easy to use
• provides rapid therapy with fewer systemic side effects

the nurse is teaching the patient with chronic airflow limitation about his medications. which is the correct sequence for administering aerosol treatments

• bronchodilator should be taken 5 to 10 minutes after the steroid
• bronchodilator should be taken at least 5 minutes before other inhaled drugs
• bronchodilator should be taken immediately after the steroid
• bronchodilator and steroid are two different classes of drugs so sequence is irrelevant

the patient has been prescribed cromolyn sodium (Intal) for the treatment of astham. which statement by the patient indicates a correct understanding of this drug

• it opens my airways and provides short term relief
• it is the medication that should be used 30 minutes before exercise
• it is not intended for use during acute episodes of asthma attacks
• it is a steroid medication so there are severe side effects

after the nurse has instructed the patient with COPD in the proper coughing technique which action the next day by the patient indicates the need for additional teaching or intervention

• coughing upon rising in the morning
• coughing before meals
• coughing after meals
• coughing at bedtime

• coughing after meals

a family member of the patient with COPD asks the nurse, what is the purpose of making him cough on a routine basis? what is the nurse's best response

• we have to check the color and consistency of his sputum
• we don't want him to feel embarrassed when coughing in public so we actively encourage it
• it improves air exchange by increasing airflow in the larger airways
• if he cannot cough, the physician may elect to do a traceostomy

the nurse is teaching and assisting the patient with controlled coughing. place the steps for the controlled coughing in the correct order

• turns shoulders inward bends head downward and hugs pillow to stomach
• repeats the procedure at least twice
• returns to a sitting position and then takes a comfortable deep breath
• takes three to five deep breaths
• bends forward slowly while coughing two or three times from the same breath
• rests and performs mouth care
• sits in a chair or on the side of a bed with feet placed firmly on the floor

• sits in a chair or on the side of a bed with feet placed firmly on the floor
• turns shoulders inward bends head downward and hugs pillow to stomach
• takes three to five deep breaths
• bends forward slowly while coughing two or three times from the same breath
• returns to a sitting position and then takes a comfortable deep breath
• repeats the procedure at least twice
• rests and performs mouth care

the patient has COPD and develops cor pulmonale. which assessment finding does the nurse expect to observe with this condition

• left ventricular hypertrophy
• weak pulse
• fatigue
• dehydration

the patient is admitted with asthma. which assessment findings are most likely to indicate that the patient's asthma condition is deteriorating and progressing toward respiratory failure

• rales, rhonchi, and productive cough with yellow sputum
• tachypnea, thick, tenacious sputum, and hemoptysis
• inaudible breath sounds, wheezing, and use of accessory muscles
• respiratory alkalosis, slow shallow respiratory rate

the patient has returned several times to the clinic for treatment of respiratory problems. which action does the nurse perform first

• obtain a history of the patient's previous respiratory problems and response to therapy
• ask the patien to describe his compliance to the prescribed therapies
• obtain a request for diagnostic testing including a tuberculosis and HIV evaluation
• listen to the patient's lung, obtain a pulse oximitry reading and count the respirations

the patient is undergoing diagnostic testing for possible cystic fibrosis. which nonpulmonary assessment findings does the nurse expect to observe ina patient with CF

• abdominal distention, gastroesophageal reflux, steatorrhea
• diarrhea, nausea, vomiting, anorexia, and a thin slender body frame
• cough, congestion, sputum production, and use of accessory muscles
• peripheral edema, weight gain, and water retention

the nurse is caring for the patient who has cystic fibrosis. which assessment findings indicte the need for exacerbation therapy. select all that apply

• new onset crackles
• increased activity tolerance
• increased frequency of coughing
• increased chest congestion
• increased SaO2
• at least a 10% decrease in FEV1

• new onset crackles
• increased frequency of coughing
• increased chest congestion
• at least a 10% decrease in FEV1

the patient with cystic fibrosis is admitted to the med-surg unit for an elective surgery. which infection control measure is best for this patient

• it is best to put two patients with cf in the same room
• standard precautions including handwashing are sufficient
• the patient is to be placed on contact isolation
• measures that limit close contact between people with CF are needed

the nurse is working for a manufacturing company and is responsible for routine employee health issues. which primary prevention is most imporatnt for those employees at high risk for occupational pulmonary disease

• screen all employees by use of chest x ray films twice a year
• advise employees not to smoke and to use masks and ventilation equipment
• perform PFTs once a year on all employees
• refer at risk employees to a social worker for information about pensions

the patient had a prolonged occupational exposure to peroleum distillates and subsecquently developed a chronic lung disease. this patient is advised to seek frequent health examinations because there is a high risk for devleoping which respiratory disease condition

• tuberculosis
• cystic fibrosis
• lung cancer
• pulmonary hypertension

the nurse has completed a community presentation about lung cancer. which statement from a participant demonstrates an understanding of the information presented

• the primary prevention for reducing the risk of lung cancer is to stop smoking and avoid secondhand smoke
• the overall 5 year survival rate for all patients with lung cnacer is 85%
• the death rate for lung cancer is less than prostat, breat, and colon cancer combined
• cures are most likely for patients who undergo treatment for state iii disease