a client with asthma has pronounced wheezing upon ausculation. suspecting an impending asthma attack, a nurse should

• have the client cough and deep breath
• prepare to intubate the client
• prepare to administer a nebulized beta-2 adrenergic agonist
• have the client lay on his or her right side

a client newly diagnosed with asthma is preparing for discharge. which point should a nurse emphasize during the client's teaching

• contact care provider only if nighttime wheezing becomes a concern
• limit exposure to sources that trigger an attack
• use peak flow meter only if symptoms are worsening
• use inhaled steroid medication as a rescue inhaler

a nurse is working with a client to update the client's asthma action plan. the nurse knows that this action plan should include information on

• medication adjustments that should made if peak flow is less than 50% normal
• timeline for allergy skin testing
• the most direct route when the client drives to the hospital
• the best methods for chest physiotherapy

a client learning about COPD self care at a community health class aska a nurse why the participants are being taught about the lip breathing. the nurse should respond by explaining that pursed lip breathing can help to

• reduce upper airway inflammation
• reduce anxiety through humor
• strengthen respiratory muscles
• increase effectiveness of inhaled medication

which finding should a nurse expect when completing an assessment on a client with chronic bronchitis

• minimal sputum with cough
• pink, frothy sputum
• barrel chest
• stridor on expiration

a home health nurse is visiting a client whose chronic bronchitis has recently worsened. which instruction should the nurse reinforce with this client

• increase amount of bedrest
• increase fluid intake
• decrease caloric intake
• reduce home oxygen use

a client with COPD is in the thrid postoperative day following right-sided thoracotomy. during the day shift the client has required 10 L oxygen by mask to keep his or her oxygen saturations greater than 88%. based on this information which action should be taken by the evening shift nurse

• work to wean oxygen down to 3L by mask
• call respiratory therapy for a nebulizer treatment
• check respiratory rate and notify the physician
• administer dose of ordered pain medication

a client with a suspected pulmonary embolus receives a VQ scan to evaluate regional lung ventilation of airflow and regional lung blood flow. in consulting with a physician a nurse learns there is a VQ mismatch. based on this information which action should be taken by the nurse

• tell the client that tuberculosis treatment will be needed
• reassure the client that he/she does not have a pulmonary embolism
• explain to the client that further testing will be needed
• inform the client that the test was normal

a nurse is assessing lung sounds on a client with pneumonia who is having pain during inspiration and expiration. the nurse hears loud grating sounds over the lung fields. the nurse should document the client's pain level and should document that

• lung sounds were clear upon auscultation
• fine crackles were heard upon auscultation
• wheezing was heard upon auscultation
• pleural friction rub was heard upon auscultation

a nurse is helping a client with obstructive sleep apnea to apply a CPAP mask before going to sleep. the nurse knows that the CPAP is intended to

• breath for the client during sleep
• reduce intrathoracic pressure
• deliver high concentrations of oxygen
• prevent alveolar collapse

a nurse begins to hear high pressure alarms in the room of a client requiring respiratory assistance with a ventilator. which is the best action by the nure

• wait and allow the client time to regulate breathing in coordination with the ventilator
• check ventilator tubing and connections
• silence the alarm and restart the ventilator
• lower the tidal volumes being delivered to the client

a nurse is caring for a client requiring positive pressure mechanical ventilation. the client has been fighting the ventilator assisted breaths, and the client's blood pressure has been steadily decreasing. which would be the most appropriate intervetnion by the nurse

• place the client in the prone position
• notify the respiratory therapist to increase the positive pressure settings
• call the physician to suggest sedatives and paralytics
• prepare to administer intravenous aminophylline

on the third postoperative day following a total laryngectomy a client's family asks a nurse when the client will be able to eat. which response by the nurse is best.

• we are going to start with a feeding tube but eventually he should be able to eat normally
• we are going to start with a feeding tube but eventually he will have to learn a different way of swallowing to prevent aspiratoin
• because of his surgery it will be several more days before his gastrointestinal tract bbegins functioning again
• he will probalby always have to be fed through a gastrostomy tube in his stomach

a nurse is designing the plan of care for a client following total laryngectomy. included in the plan of care is a referral to a nutritional support staff/dietician. the nurse understands that the referral is essential because the client

• is most like depressed and uninteresting in eating
• will have to relearn how to swallow
• may have lost his or her sense of smell and taste
• must learn strategies for preventing aspiration

a nurse is evaluating discharge teaching that has been completed for a client following total laryngectomy. which statement made by the client indicates that the client does not accept or understand the teaching

• i will be sure to carry an extra supply of facial tissue with me
• i probably will not be able to go swimming
• i will schedule an appointment for closure of my tracheostomy
• i will check the batteries on our smoke detectors

a client with a large facial tumor is scheduled for a radical neck dissection. a nurse in the preoperative best help the client considering the potential for an alteration in body image from the procedure

• show multiple photographs of clients who have had similar procedures
• closely assess and monitor the client's verbal and nonverbal communication
• direct the client's significant other to allow for the client's complete dependence on him or her
• remind the client that it is what is on the inside that counts

a 17 year old client with cystic fibrosis is visiting with a nurse in preparation for leaving home for college. the nurse knows that the client needs further education if the client states

• i will bring extra cough medicine so as to not wake up my roommate at night
• i will contact the college's health center and pass on my medical records
• i will check to make sure they have good workout facilities
• i will be really careful about washing my hands and staying away from sick friends

a public health nurse is planning a flu shot clinic. the nurse is working on advertising. which groups should be the highest priority to target when advertising the flu shot clinic. select all that apply

• pregnant women
• grade school children
• nursing assistants at a nursing home
• a hypertension clinic population
• outpatient psychiatric population
• spinal cord-injured population at an assisted living facility

• pregnant women
• nursing assistants at a nursing home
• spinal cord-injured population at an assisted living facility

a nurse is working at a telephone health service. which advice should the nurse give to a client who has had 3 days of symptoms that strongly suggest influenza

• reutrn to work after another day of rest
• rest and increase fluid intake to 3 liters of fluid per day
• use over the counter antihistamines
• make an appointment to get the flu shot

a client hospitalized for a severe case of pneumonia is asking a nurse why a sputum sample is needed. the nurse should reply that the primary reason is to

• complete the first of three samples to be collected
• differentiate between pneumonia and atelectasis
• encourage expectoration of secretions
• help select the appropriate antibiotic

a nurse is preparing to admit a client with a confirmed case of tuberculosis. which action is essential to infection control for this client

• providing a positive pressure airflow room
• wearing gown and gloves when handling the client's stool or urine
• using a NIOSH approved N95 respirator mask for staff and visitors
• keeping the client quarantined in the room until antibiotic therapy has been initiated

• using a NIOSH approved N95 respirator mask for staff and visitors

a nurse is planning care for a client with AIDS who has been hospitalized for Pneumocystitis carinii infection . which nursing diagnosis shoul be the nurse's first priority for this client

• fatigue related to hypermetabolism
• imbalanced nutrition more than body requirements related to hypometabolism
• ineffective cooping related to HIV diagnosis
• fluid volume excess related to oral and intravenous fluid intake

a client presents to an emergency department following a motorcycle crash. a nurse assesses the client and notes uncoordinated or paradoxical chest rise and fall as well as multiple bruises across the chest and torso, crepitus and tachypnea. based on this assessment the nurse should

• assist the placement of a cervical collar
• anticipate the need to intubate the client
• provide chest compressions
• tape the chest wall

a nurse who is caring for a client in an emergency department who has five fractured ribs from blunt chest trauma. the client is rating pain at 9 out of 10. for which pain managemnt modality should the nurse advocate

• nsaids
• oral analgesics
• regional/local analgesia (epidural or intercostal injection)
• IV bolus meperidine (Demerol)

following an unrestrained motor vehicle crash a client presents to an emergency department with multiple injuries including chest trauma. a physician notifies the care team that the client has progressed to ARDS and requests that the family be updated on the client's condition. the nurse should plan to discuss with the family that

• the condition generally stabilizes with positive prognosis
• the client can be discharged with home oxygen
• the condition is always fatal
• the condition is highly life-threatening and that end-of-life concerns should be addressed

a nurse is caring for a client with a left sided chest tube attached to a wet suction chest tube system. which obseration by the nurse would require immediate intervention

• bubbling in the suction chamber
• dependent loop hanging off the edge of the bed
• banded connections between tubing sections
• occlusive dressing over chest tube insertion site

a nurse checks on a client following lower lobectomy for lung cancer. the nurse finds that the client is dyspneic with respirations in the 40s, is hypotensive, has a SaO2 at 86% on 10L close-fitting oxygen mask, has a trachea that is deviated slightly to the left, and notes that the right side of chest is not expanding. which action should be taken first

• notify the physician
• give the client whatever medication was ordered to decrease anxiety
• check the chest tube to make sure it is not obstructed
• turn up the oxygen liter flow

a nurse is completing the health history for a client who has been taking echinacea for a head cold. the client asks "why isn't this helping me feel better" which of the following responses by the nurse would be the most accurate

• there is limited information as to the efectiveness of herbal products
• antibiotics are the agents needed to treat a head cold
• the head cold should be gone within th emonth
• combining herbal products with prescription antiviral medications is sure to help you

• there is limited information as to the efectiveness of herbal products

a nurse is teaching a client about taking antihistamines. which of the following instructions should the nurse include in the teaching plan. select all that apply

• operating machinery and driving may be dangerous while taking antihistamines
• continue taking antihistamines even if nasal infection develops
• the effect of antihistmines is not felt until a day later
• do not use alcohol with antihistamies
• increase fluid intake to 2000 ml/day

• operating machinery and driving may be dangerous while taking antihistamines
• do not use alcohol with antihistamies
• increase fluid intake to 2000 ml/day

a client with allergic rhinitis is instructed on the corrct technique for using an intranasal inhaler. which of the following statements would demonstrate to the nurse that the client understands the instructions

• i should limit the use of the inhaler to only morning and bedtime use
• it is important to not shake the canister because that can damage the spray device
• i should hold one nostril closed while i insert the spray into the other nostril
• the inhaler tip is inserted into the nostril and pointed toward the inside nostril wall

• i should hold one nostril closed while i insert the spray into the other nostril

which of the following would be an expected outcome for a client recovering from an upper respiatory tract infection. the client will

• maintain a fluid intake of 800 ml every 24 hours
• experience chills only once a day
• cough productively without chest discomfort
• experience less nasal obstruction and discharge

• experience less nasal obstruction and discharge

the nurse teaches the client how to instill nose drops. which of the following techniques is correct

• the client uses sterile technique when handling the dropper
• the client blows the nose gently before instilling drops
• the client uses a new dropper for each instillation
• the client sits in a semi folwer's position with the head tilted forward after administration of the drops

• the client blows the nose gently before instilling drops

the nurse should include which of the following instructions in the teaching plan for a client with chronic sinusitis

• avoid the use of caffeinated beverages
• perform postural drainage every day
• take hot showers twice daily
• report a temperature of 102 F or higher

• take hot showers twice daily

a client with allergic rhinitis asks the nurse what to do to decrease the rhinorrhea. which of the following instructions would be appropriate for the nurse to give the client

• user your nasal decongesant spray regularly to help clear your nasal passages
• ask the doctor for antibiotics. antibiotics wil help decrease the secretion
• it is important to increase your activity. a daily brisk walk will help promote drainage
• keep a diary of when your symptoms occur. this can help you identify what precipitates your attacks

• keep a diary of when your symptoms occur. this can help you identify what precipitates your attacks

pseudoephedrine (Sudafed) has been prescribed as a nasal decongestant. which of the following is a possible adverse effect of this drug

• constipation
• bradycardia
• diplopia
• restlessness

• restlessness

a health care provider has just inserted nasal packing for a client with epistaxis. the client is taking ramipril (Altace) for hypertension. what should the nurse instruct the client to do

• use 81 mg of aspirin daily for relief of discomfort
• omit the next dose of ramipril (Altace)
• remove the packing if there is difficulty swallowing
• avoid rigorous aerobic exercise

• avoid rigorous aerobic exercise

a client has had surgery for a deviated nasal septum. which of the following would indicate that bleeding was occuring even if the nasal drip pad remained dry and intact

• nausea
• repeated swallowing
• increased respiratory rate
• increased pulse

• repeated swallowing

a client who has undergone outpatient nasal surgery is ready for discharge and has nasal packing in place. which of the following discharge instructions would be appropriate for the client

• avoid activities that elicit the valsalva maneuver
• take aspirin to control nasal discomfort
• avoid brushing the teeth until the nasal packing is removed
• apply heat to the nasal area to control swelling

• avoid activities that elicit the valsalva maneuver

which of the following statements should indicate to the nurse that a client has understood the discharge instructions provided after nasal surgery

• i should no tshower until my packing is removed
• i will take stool softeners and modify my diet to prevent constipation
• coughing every 2 hours is important to prevent repiratory complications
• it is importatn to blow my nose each day to remove the dried secretions

• i will take stool softeners and modify my diet to prevent constipation

the nurse is planning to give preoperative instructions to a client who will be undergoing rhinoplasty. which of the following instructions should be included

• after surgery, nasal packing will be in place for 7 to 10 days
• normal saline nose drops will need to be administered preoperatively
• the results of the surgery will be immediately obvious postoperatively
• aspirin containing medications should not be taken for 2 weeks before surgery

• aspirin containing medications should not be taken for 2 weeks before surgery

which of the following assessments is a priority immediately after nasal surgery

• assessing the client's pain
• inspecting for periorbital ecchymosis
• assessing respiratory status
• measuring intake and output

• assessing respiratory status

after nasal surgery the client expresses concern about how to decrease facial pain and swelling while recovering at home. which of the following discaharge instruction would be most effective for decreasing pain and edema

• take analgesics every 4 hours around the clock
• use corticosteroid nasal spray as needed to control symptoms
• use a bedside humidifier while sleeping
• apply cold compresses to the area

• apply cold compresses to the area

a client is being discharged with nasal packing n place. the nurse should isntruct the client to

• perform frequent mouth care
• use normal sline nose drops daily
• sneeze and cough with mouth closed
• gargle every 4 hours with salt water

• perform frequent mouth care

which of the following activities should the nurse teach the client to implement after the removal of nasal packing on the 2nd postoperative day

• avoid cleaning the nares until swelling has subsided
• apply water soluble jelly to lubricate the nares
• keep a nasal drip pad in place to absorb secretions
• use a bulb syringe to gently irrigate nares

• apply water soluble jelly to lubricate the nares

the nurse is teaching a client how to manage a nosebleed. which of the folowing instruction would be appropriate to give the client

• tilt your head backward and pinch your nose
• lie down flat and place an ice compress over the bridge of the nose
• blow your nose getly with your neck flexed
• sit down, lean forward, and pinch the soft portion of your nose

• sit down, lean forward, and pinch the soft portion of your nose

an elderly client had posterior packing inserted to control a severe nosebleed. after insertion of the packing the client should be closely monitored for which of the following compications

• vertigo
• bell's palsy
• hypoventilation
• loss of gag reflex

• hypoventilation

postoperative nursing management of the client following a radical neck dissection for laryngeal cnacer requires

• complete bed rest miminizing head movement
• vital signs once a shift
• clear liquid diet started at 48 hours
• frequent suctioning of the laryngectomy tube

• frequent suctioning of the laryngectomy tube

a client who has had a total laryngectomy appears withdrawn and depressed. the client keeps the curtain drawn, refuses visitors, and indicates a desire to be left alone. which nursing intervention would most likely be therapeutic for the client

• discussing the behavior with the spouse to determine the cause
• exploring future plans
• respecting the need for privacy
• encouraging expression of feelings nonverbally and in writing

• encouraging expression of feelings nonverbally and in writing

the nurse is suctioning a client who had a laryngectomy. what is the maximum amount of time the nurse should suction the client

• 10 sec
• 15 sec
• 25 sec
• 30 sec

• 10 sec

when suctioning a tracheostomy tube 3 days following insertion the nurse should follow which of the following procedures

• use a sterile catheter each time the client is suctioned
• clean the catheter in sterile water after each use and reuse for no longer than 8 hours
• protect the catheter in sterile packaging between suctioning episodes
• use a clean catheter with each suctioning and disinfect it in hydrogen peroxide between uses

• use a sterile catheter each time the client is suctioned

the client with a laryngectomy does not want his family to see him. he indicates that he thinks the opening in his throat is disgusting. the nurse should

• initiate teaching about the care of a stoma
• explain that the stoma will not always look as it does now
• inform the client of the benefits of family support at this time
• explore why the client believes the stoma is disgusting

• explore why the client believes the stoma is disgusting

the nurse is making rounds and ovserves the client who had a tracheostomy tube inserted 2 days ago. the nursing policy manual recommends use of the gauze pad. the nurse should

• make sure the gauze pad is dry and the client is in a comfortable position
• ask the nursing assistant to tie the trachostomy tube ties in the back of the client's neck
• reposition the gauze pad around the stoma with the open end downward
• ask a registered nurse to change the ties and position another gauze pad around the stoma

• make sure the gauze pad is dry and the client is in a comfortable position

what areas of education should the nurse provide employees in a factory making products that cause respiratory irritation to reduce the risk of laryngeal cancer. select all that apply

• stopping smoking
• using a HEPA filter in the home
• limiting alcohol intake
• brushing teeth after every meal
• avoid rasing the voice to be heard over the noise in the factory

• stopping smoking
• limiting alcohol intake

a client has had hoarseness for more than 2 weeks. the nurse should

• refer the client to a health care provider for a prescription for an antibiotic
• instruct the client to gargle with salt water at home
• assess the client for dysphagia
• instrut the client to take a throat analgesic

• assess the client for dysphagia

a client has just returned from the postanesthesia care unit after undergoing a laryngectomy. which of the following interventions should the nurse include in the plan of care

• maintain the head of the bed at 30 to 40 degrees
• tach the client how to use esophageal speech
• initiate small feedings of soft foods
• irrigate drainage tubes as needed

• maintain the head of the bed at 30 to 40 degrees

which of the following is an expected outcomes or a client recovering from a total laryngectomy. the client will

• regain the ability to taste and smell food
• demonstrate appropriate care of the gastrostomy tube
• communicate feelings about body image changes
• demonstrate sterile suctioning technique for stoma care

• communicate feelings about body image changes

which of the following home care instructions would be appropriate for a client with a laryngectomy

• perform mouth care every morning and evening
• provide adequate humidity in the home
• maintain a soft bland diet
• limit physical activity to shoulder and neck exercises

• provide adequate humidity in the home

an elderly client with pneumonia and dementia has attempted several times to pull out the IV and foley catheter. the nurse obtains a prescritpion for bilateral soft wrist restraints. which nursing action is most appropriate

• perform circulation checks to bilateral upper extremities each shift
• attach the ties of the restraints to the bedframe
• reevaluat the need for restraints and document weekly
• ensure the restraint order has been signed by the physician within 72 hours

• attach the ties of the restraints to the bedframe

a 79 year old client is admitted to the hospital with a diagnosis of bacterial pneumonia. while obtaining the client's health history, the nurse learns that the client has osteoarthritis, follows a vegetarian diet, and is very concerned with cleanliness. which of the following would most likely be a predisposing factor for the diagnosis of pneumonia

• age
• osteoarthritis
• vegetarian diet
• daily bathing

• age

which of the following are significant data to gather form a client who has been diagnosed with pneumonia. select all that apply

• quality of breath sounds
• presence of bowel sounds
• occurence of chest pain
• amount of perpheral edema
• color of nail beds

• quality of breath sounds
• occurence of chest pain
• color of nail beds

a client with bacterial pneumonia is to be started on iv antibiotics. which of the following diagnostic test must be completed before antibiotic therapy begins

• urinalysis
• sputum culture
• chest radiograph
• red blood cell count

• sputum culture

when caring for the client who is receiving an aminoglycoside antibiotic the nurse shold monitor which of the following values

• serum sodium
• serum potassium
• serum creatinine
• serum calcium

• serum creatinine

penicillin has been prescribed for a client admitted to the hospital for treatment of pneumonia. prior to administering the first dose of penicillin the nurse should ask the client

• do you have a history of seizures
• do you have any cardiac history
• have you had any recent infections
• have you had a previous allergy to penicillin

• have you had a previous allergy to penicillin

a client with pneumonia has a temperature of 102.6 is diaphoretic and has a productive cough. the nurse should include which of the following measures in the plan of care

• position changes every 4 hours
• nasotracheal suctioning to clear secretions
• frequent linen changes
• frequent offering of a bedpan

• frequent linen changes

bed rest is prescribed for a client with pneumonia during the acute phase of the illness. the nurse should detemine the effectiveness of bedrest by assessing the client's

• decreased cellular demand for oxygen
• reduced episodes of coughing
• diminished pain when breathing deeply
• ability to expectorate secretions more easily

• decreased cellular demand for oxygen

the cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following

• decreased cardiac output
• pleural effusion
• inadequate peripheral circulation
• decreased oxygenation of the blood

• decreased oxygenation of the blood

a client with pneumonia is experiencing pleuritic chest pain. the nurse should assess the client for

• a mild but constant aching in the chest
• severe midsternal pain
• moderate pain that worsens on inspiration
• muscle spasm pain that accompanies coughing

• moderate pain that worsens on inspiration

which of the following measures would most likely be successful in reducing pleuritic chest pain in a client with pneumonia

• encourage the client to breathe shallowly
• have the client practice abdominal breathing
• offer the client incentive spirometry
• teach the client to splint the rib cage when coughing

• teach the client to splint the rib cage when coughing

the nurse administers two 325 mg aspirin every 4 hours to a client with pneumonia. the nurse should evaluate the outcome of administering the drug by assessing which of the following. select all that apply

• decreased pain when breathing
• prolonged clotting time
• decreased temperature
• decreased respiratory rate
• increased ability to expectorate secretions

• decreased pain when breathing
• decreased temperature

which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia

• coma
• apathy
• irritability 
• depression

• irritability 

the client with pneumonia develops mild constipation and the nurse administers docusate sodium (Colace) as prescribed. this drug works by 

• softening the stool
• lubricating the stool
• increasing stool bulk
• stimulating peristalsis

• softening the stool

which of the following is an expected outcome for an elderly client following treatment for bacterial pneumonia

• a respiratory rate of 25 to 30 bpm
• the ability to perform activities of daily living without dyspnea
• a maximum loss of 5 to 10 lb of body weight
• chest pain that is minimized by splinting the rib cage

• the ability to perform activities of daily living without dyspnea

a client newly diagnosed with tuberculosis is being admitted with the prescription for isolation precautions for tuberculosis. the nurse should assign the client to which type of room

• a room at the end of the hall for privacy
• a private room to implement contact precautions
• a room near the nurses' station to ensure confidentiality
• the implementation of contact precaustions for possible TB requires a private room assignment

• a room at the end of the hall for privacy

which of the following symptoms is common in clients with active tuberculosis

• weight loss
• increased appetite
• dyspnea on exertion
• mental status changes

• weight loss

the client is receiving streptomycin in the treatment regimen of tuberculosis. the nurse should assess for

• decreased serum creatinine
• difficulty swallowing
• hearing loss
• iv infiltration

• hearing loss

a client is receiving streptomycin for the treatment of tuberculosis. the nurse should assess the client for eight cranial nerve damage by observing the client for

• vertigo
• facial paralysis
• impaired vision
• difficulty swallowing

• vertigo

the nurse should teach clients that the most common route of trasmitting tubercle bacilli from person to person is through contaminated

• dust particles
• droplet nuclei
• water
• eating utensils

• droplet nuclei

what is the rationale that supports multidrug treatment for clients with tuberculosis

• multiple drugs potentiate the drugs' actions
• multiple drugs reduce undesirable drug adverse effects
• multiple drugs allow reduced drug dosages to be given
• multiple drugs reduce development of resistant strains of the bacteria

• multiple drugs reduce development of resistant strains of the bacteria

the client with tuberculosis is to be discharged home with community health nursing follow-up. of the following nursing interventions, which should have the highest priority

• offering the client emotional support
• teaching the client about the disease and its treatment
• coordinating various agency services
• assessing the client's environment for sanitation

• teaching the client about the disease and its treatment

which of the following techniques for administering the Mantoux test is correct

• hold the needle and syringe almost parallel to the client's skin
• pinch the skin when inserting the needle
• aspirate before injecting the medication
• massage the site after injecting the medicaiton

• hold the needle and syringe almost parallel to the client's skin

which of the following family members exposed to tuberculosis whould be at highest risk for contracting the disease

• 45 year old mother
• 17 year old daughter
• 8 year old son
• 76 year old grandmother

• 76 year old grandmother

the nurse is teaching a client who has been diagnosed with tuberculosis how to avoid spreading the disease to family members. which statems indicate that the client has understood the nurse's instructions. select all that apply

• i will need to dispose of my old clothing when i return home
• i should always cover my mouth and nose when sneezing
• it is important that i isolate myself from family when possible
• i should use paper tissues to cough in and dispose of them promptly
• i can use regular plates and utensils whenever I eat

• i should always cover my mouth and nose when sneezing
• i should use paper tissues to cough in and dispose of them promptly
• i can use regular plates and utensils whenever I eat

a client has a positive reaction to the mantoux test. the nurse interprets this reaction to mean that the client has

• active tuberculosis
• had contact with mycobacterium tuberculosis
• developed a resistance to the tubercle bacilli
• developed passive immunity to tuberculosis

• had contact with mycobacterium tuberculosis

a client with tuberculosis is taking isoniazin. to help prevent development of peripheral neuropathies the nurse should instruct the client to

• adhere to a low cholesterol diet
• supplement the diet with pyridoxine (vitamin B6)
• get extra rest
• avoid excessive sun exposure

• supplement the diet with pyridoxine (vitamin B6)

the nurse should caution sexually active female clients taking isoniazid that the drug has which of the following effects

• increases the risk of vaginal infection
• has mutagenic effects on ova
• decreases the effectiveness of hormonal contraceptives
• inhibits ovulation

• decreases the effectiveness of hormonal contraceptives

clients who have had active tuberculosis are at risk for recurrence. which of the following conditions increases that risk

• cool and damp weather
• active exercise and exertion
• physical and emotional stress
• rest and inactivity

• physical and emotional stress

in which areas of the united states is the incidence of tuberculosis highest

• rural farming areas
• inner city areas
• areas where clean water standards are low
• suburban areas with significant industrial pollution

• inner city areas

the nurse should include which of the following instructions when developing a teaching plan for a client who is receiving isoniazid and rifampin for treatment of tuberculosis

• take the medication with antacids
• double the dosage if a drug does is missed
• increase intake of dairy products
• limit alcohol intake

• limit alcohol intake

a client who has been diagnosed with tuberculosis has been placed on drug therapy. the medication regimen includes rifampin. which of the following instructions should the nurse include in the client's teaching plan related to the potential adverse effects of rifampin. select all that apply

• having eye examinations every 6 months
• maintaining follow up monitoring of liver enzymes
• decreasing protein intake in the diet
• avoiding alcohol intake
• the urine may have an orange color

• maintaining follow up monitoring of liver enzymes
• avoiding alcohol intake
• the urine may have an orange color

the nurse is providing follow up care to a client with tuberculosis who does not regularly take the prescribed medication. which nursing action would be most appropriate for this client

• ask the clients spouse to supervise the daily administration of the medications
• visit the client weekly to verify complaince with taking the medication
• notify the physician of the client's noncompliance and request a different prescription
• remind the client that the tuberculosis can be fatal if not treated promptly

• ask the clients spouse to supervise the daily administration of the medications

on the first postoperative day following right-sided thoracotomy, a nurse is assiting a client with arm and shoulder exercises. the client reports pain with the exercises and why they must be performed. the nurse should explain that the exercises

• promote respiratory function
• increase blood flow back to the heart and venous system
• improve muscle mass to compensate for muslce removed during the procedure
• prevent stiffening and loss of function

following a thoracotomy to remove a lung tumor a nurse is preparing a client to be discharged to home. which are appropriate teaching points for the client. select all that apply

• avoid lifting greater than 20 pounds
• build up exercise endurance
• continue to buid endurance even when dyspneic
• expect return to normal activity level and strength within 1 month
• make time for frequent rest periods with activity

• avoid lifting greater than 20 pounds
• build up exercise endurance
• make time for frequent rest periods with activity

a nurse is partnered with a PCA on a med-surg floor. the PCA provides information about the clients for whom the PCA has been caring. based on the information from the PCA which client should the nurse attend to first

• the client with a pulmonary embolus who has not had a bowel movement in 2 days
• the client who underwent a video thoracoscopy with oxygen saturation readings from 88% to 90% on oxygen at 4 L/NC
• the client who underwent a wedge resection of right lung and has a blood pressure of 100/65 mm Hg
• the client who has rib fractures and has not voided for 6 hours after the urinary catheter was removed

a nurse is caring for a client following an open thoracotomy for removal of a large tumor. extensive blood loss during the procedure required fluid resuscitation of the client. the client is cyanotic and in respiratory distress with pink, frothy sputum coming from the mouth. the nurse should immediately

• put the client in high fowler's position
• give a 200 ml fluid bolus
• activate the respiratory code system
• have the client cough and deep breathe

a nurse observes for early manifestation of ARDS in a client being treated for smoke inhalation. which signs indicate the possible onset of ARDS in this client

• cough with blood tinged sputum and respiratory alkalosis
• decrease in both white and red blood cell counts
• diaphoresis and low SaO2 unresponsive to increased oxygen administration
• hypertension and elevated PaO2

the nurse reviews an aterial blood gas report for a client with COPD the results are pH 7.35, PCO2 65; PO2 70; HCO3 34

• apply a 100% nonrebreather mask
• assess the vital signs
• reposition the client
• prepare for intubation

when developing a discharge plan to manage the care of a client with COPD the nurse should advise the client to expect to

• develop respiratory infections easily
• maintain current status
• require less supplemental oxygen
• show permanent improvement

the client with COPD is taking theophylline. the nurse should instruct the client to report which of the following signs of theophylline toxicity. select all that apply

• nausea
• vomiting
• seizures
• insomnia
• vision changes

• nausea
• vomiting
• seizures
• insomnia

which of the following indicates that the client with COPD who has been charged to home understands the care plan

• the client promises to do pursed lip breathing at home
• the client states actions to reduce pain
• the client will use oxygen via a nasal cannula at 5 L/min
• the client agrees to call the physician if dyspnea on exertion increases

which of the following physical assessment findings are normal for a client with advanced COPD

• increased anteroposterior chest diameter
• underdeveloped neck nuscles
• collapsed neck veins
• increased chest excursions with respiration

when instructing clients on how to decrease the risk of COPD the nurse should emphasize which of the following

• participate regularly in aerobic exercises
• maintain a high protein diet
• avoid exposure to people with known respiratory infections
• abstain from cigarette smoking

which of the following is an expected outcome of pursed lip breathing for clients with emphysema

• to promote oxygen intake
• to strengthen the diaphragm
• to strengthen the intercostal muscles
• to promote carbon dioxide elimination

which of the following is a prioirty goal for the client with COPD

• maintaining functional ability
• minimizing chest pain
• increasing carbon dioxide levels in the blood
• treating infectious agents

a client's arterial blood gas values are as follows: pH 7.31, PaO2 80; Pa CO2 65; HCO3 36. the nurse should assess the client for

• cyanosis
• flushed skin
• irritability
• anxiety

when teaching a client with COPD to conserve energy the nurse should teach the client to lift objects

• while inhaling through an open mouth
• while exhaing through pursed lips
• after exhaling but before inhaling
• while taking a deep breath and holding it

the nurse teaches a client with COPD to assess for signs and symptoms of right sided heart failure. which of the following signs and symptoms should be included in the teaching plan

• clubbing of the nail beds
• hypertension
• peripheral edema
• increased appetite

the nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. which of the following findings would be expected. which of the following findings would be expected

• normal breath sounds
• prolonged inspiration
• normal chest movement
• coarse crackles and rhonchi

a client with COPD is experiencing dyspnea and has a low PaO2 level. the nurse plans to administer  oxygen as prescribed. which of the following statements is true concerning oxygen administration to a client with COPD

• high oxygen concentrations will cause coughing and dyspnea
• high oxygen concentrations may inhibit the hypoxic stimulus to breathe
• increased oxygen use will caue the client to become dependent on the oxygen
• adminisration of oxygen is contraindicated in clients who are using bronchodilators

which of the following diets would be most appropriate for a client with chronic COPD

• low fat, low cholesterol diet
• bland, soft diet
• low sodium diet
• high calorie, high protein diet

the nurse administers theophylline to a client. when evaluating the effectiveness of this medication the nurse should assess the client for which of the following

• suppression of the client's respiratory infection
• decrease in bronchial secretions
• less difficulty breathing
• thinning of tenacious, purulent sputum

the nurse is planning to teach a client with COPD how to cough effectively. which of the following instructions should be included

• take a deep abdominal breath, bend forward and cough three or four times on exhalation
• lie flat on the back, splint the thorax, take two deep breaths, and cough
• take several rapid, shallow breaths and then cough forcefully
• assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing

a client uses a metered dose inhaler (MDI) to aid in management of asthma. which action indicates to the nurse that the client needs further instruction regarding its use. select all that apply

• activation of the MDI is not coordinated with inspiration
• the client inspires rapidly when using the MDI
• the client holds his breath for 3 seconds after inhaling with the MDI
• the client shakes the MDI after use
• the client performs puffs in rapid succession

• activation of the MDI is not coordinated with inspiration
• the client inspires rapidly when using the MDI
• the client holds his breath for 3 seconds after inhaling with the MDI
• the client shakes the MDI after use
• the client performs puffs in rapid succession

a 34 year old female with a history of asthma is admitted to the emergency department. the nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/min, nasal flaring, and use of accessory muscles. auscultation of the lung fields reveals greatly diminished breath sounds. based on these findings, which action should the nurse take to initate care of the client

• initiate oxygen therapy as prescribed and resasses the client in 10 minutes
• draw blood for an arterial blood gas
• encourage the client to relax and breathe slowly through the mouth
• administer bronchodilators as prescribed

a client experiencing a severe asthma attack has the following arterial blood gas results: pH 7.33, PCO2 48, PO2 58; HCO3 26

• albuterol (proventil) nebulizer
• chest xray
• ipratropium (atrovent) inhaler
• sputum culture

a client with acute asthma is prescribed short-term corticosteroid therapy. which is the expected outcome for the use of steroids in clients with asthma

• promote bronchodilation
• act as an expectorant
• have an anti-inflammatory effect
• prevent devleopment of respiratory infections

the nurse is teaching the client how to use a metered dose inhaler (MDI) to administer a corticosteroid. which of the following indicates that the client is using the MDI correctly. select all that apply

• the inhaler is held upright
• the head is tilted down while inhaling the medicine
• the client waits 5 minutes between puffs
• the client rinses the mouth with water following administration
• the client lies supine for 15 minutes following administration

• the inhaler is held upright
• the client rinses the mouth with water following administration

a client is prescribed metaproterenol (Alupent) via metered-dose inhaler, two puffs every 4 hours. the nurse instructs the client to report adverse effects. which of the following are potential adverse effects of metaproterenol

• irregular heartbeat
• constipation
• pedal edema
• decreased pulse rate

a client who has been taking flunisolide nasal spray (Nasalide) two inhalations a day for treatment of asthma has painful, white paatches in the mouth. which response by the nurse would be most appropriate

• this is an aticipated adverse efect of your medication. it should go away in a couple of weeks
• you are using your ihaler too much an it has irritated your mouth
• you have developed a fungal infection from your medication. it will need to be treated with an antifungal agent
• be sure to brush your teeth and floss daily. good oral hygiene will treat this problem

which of the following is an expected outcome for an adult client with well controlled asthma

• chest xray demonstrates minimal hyperinflation
• temperature remains lower than 100F
• arterial blood gas analysis demonstrates a decrease in PaO2
• breath sounds are clear

which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma

• incorporate physical exercise as tolerated into the daily routine
• monitor peak flow numbers after meals and at bedtime
• eliminate stressors in the work and home enviornment
• use sedatives to ensure uninterrupted sleep at night

the nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack

• occupational exposure to toxins
• viral respiratory infections
• exposure to cigarette smoke
• exercising in cold temperatures

which of the following findings would most likely indicate the presence of a respiratory infection in a client with asthma

• cough productive of yellow sputum
• bilateral expiratory wheezing
• chest tightness
• respiratory rate of 30 breaths/min

the nurse is caring for a client who has asthma. the nurse should conduct a focused assessment to detect which of the following

• increased forced expiratory voume
• normal breath sounds
• inspiratory and expiratory wheezing
• morning headaches

the nurse has assisted the physician at the bedside with insertion of a left subclavian, triple lumen catheter in a client admitted with lung cancer. suddenly the client becomes restless and tachypnic. the nurse should

• assess breath sounds
• remove the catheter
• insert a peripheral iv
• reposition the client

a female client diagnosed with lung cancer is to have a left lower lobectomy. which of the following increases the client's risk of developing postoperative pulmonary complications

• height is 5 feet, 7 inches and weight is 110 lb
• the client tends to keep her real feelings to herself
• she ambulates and can climb one flight of stairs without dyspnea
• the client is 58 years of age

the nurse in the perioperative area is preparing a client for surgery and notices that the client looks sad. the client says. "i'm scared of having cancer. it's so horrible and i brought it on myself. i should have quit smoking years ago." what would be the nurse's best response to the client

• it's okay to be scared. what is it about cancer that you're afraid of
• it's normal to be scared. i would be too. we'll help you through it
• don't be so hard on yourself. you don't know if our smoking caused the cancer
• do you feel guilty because you smoked

a client who underwent a left lower lobectomy has been out of surgery for 48 hours. the client is receiving morphine sulfate via a PCA system and reports having pain in the left thorax that worsens when coughing. the nurse should

• let the client rest, so that the client is not stimulated to cough
• encourage the client to take deep breaths to help control the pain
• check that the PCA device is functioning properly then reassure the client that the machine is working and will relieve the pain
• obtain a more detailed assessment of the client's pain using a pain scale

which of the following areas is a priority to evaluate when completing discharge planning for a client who has had a lobectomy for treatment of lung cancer

• the support available to assist the client at home
• the distance the client lives from the hopital
• the client's ability to do home blood pressure monitoring
• the client's knowledge of the causes of lung cancer

which of the following would be a significant intervention to help prevent lung cancer

• encourage cigarette smoker to have yearly chest radiographs
• instruct people about techniques for smoking cessation
• recommend that people have their houses and apartments checked for asbestos leakage
• encourage people to install central air filters in their homes

after a thoractomy the nurse instructs the client to perform deep breathing exercises. which of the following is an expected outcome of these exercises

• deep breathing elevates the diaphragm which enlarges the thorax and increases the lung surface available for gas exchange
• deep breathing increases blood flow to the lungs to allow them to recover from the trauma of surgery
• deep breathing controls the rate of air flow to the reamining lobe so that it will not become hyperinflated
• deep breathing expands the alveoli and increases the lung surface available for ventiation

following thoracotomy the client has severe pain. which of the following strategies for pain management will be most effective for this client

• repositioning the client immediately after administering pain medication
• reassessing the client 30 minutes after administering pain medication
• verbally reassuring the client after administering pain medication
• readjusting the pain medication dosage as needed according to the cleitn's condition

while assessing a throacotomy incisional area from which a chest tube exits the nurse feels a crackling sensation under the fingertips along the entire incision. which of the following should be the nurse's first action

• lower the head of the bed and call the physician
• prepare an aspiration tray
• mark the area with a skin pencil at the outer periphery of the crackling
• turn off the suction of the chest drainage system

when teaching a client to deep breathe effectively after a lobectomy the nurse should instruct the client to do which of the following

• contract the abdominal muscles, take a slow deep breath through the nose and hold it for 3 to 5 seconds then exhale
• contract the abdominal muscles, take a deep breath through the mouth, and exhale slowly as if trying to blow out a candle
• relax the abdominal muscles, take a deep breath through the nose, and hold it for 3 to 5 seconds
• relax the abdominal muscles, take a deep breath through the mouth and exhale slowly over 10 seconds

which of the following rehabilitative measures should the nurse teach the client who has undergone chest surgery to prevent shoulder ankylosis

• turn from side to side
• raise and lower the head
• raise the arm on the affected side over the head
• flex and extend the elbow on the affected side

when caring for a client with a chest tube and water seal drainage system the nurse should

• verify that the air vent on the water seal drainage system is capped when the suction is off
• strip the chest drainage tubes at least every 4 hours if excessive bleeding occurs
• ensure that the chest tube is clamped when moving the client out of the bed
• make sure that the drainage apparatus is always below the client's chest level

a client has a chest tube attached to a water seal drainage system and the nurse notes that the fluid in the chest tube and in the water seal column has stopped fluctuating. the nurse should determine that

• the lung has fully expanded
• the lung has collapsed
• the chest tube is in the pleural space
• the mediastinal space has decreased

the nurse observes a constant gentle bubbling in the water seal column of a water seal chest drainage system. the nurse should

• continue monitoring as usual; this is expected
• check the connectors between the chest and drainage tubes and where the drainage tube enters the collection bottle
• decrease the suction to -15 mc H2O and continue observing the sytem for changes in bubbling during the next several hours
• drain half of the water from the water-seal chamber

a client who underwent a lobectomy and has a water seal chest drainage system is breathing with a little more effort and at a faster rate than 1 hour ago. the client's pulse rate is also increased. the nurse should

• check the tubing to ensure that the client is not lying on it or kinking it
• increase the suction
• lower the drainage bottles 2 to 3 feet below the level of the client's chest
• ensure that the chest tube has two clamps on it to prevent leaks

which of the following should be readily available at the bedside of a client with a chest tube in place

• a tracheostomy tray
• another sterile chest tube
• a bottle of sterile water
• a spirometer

the nurse is preparing to assist with the removal of a chest tube. which of the following is appropriate at the site fro which the chest tube is removed

• adhesive strip (steri-strips)
• petroleum gauze
• 4 x 4 gauze with antibioitic ointment
• no dressing is necessary

a nurse shold interpret which of the following as an early sign of a tension pneumothroax in a client with chest trauma

• diministed bilateral breath sounds
• muffled heart sounds
• respiratory distress
• tracheal deviation

a young adult is admitted to the emergency department after an automobile accident .the client has severe pain in the right chest where there was an impact on the steering wheel. which is the primary client goal at this time

• reduce the client's anxiety
• maintain adequate oxygenation
• decrease chest pain
• maintain adequate circulating volume

a client with rib fractures and a pneumothorax has a chest tube inserted that is connected to a water seal chest tube drainage system. the nurse notes that the fluid in the water seal column is fluctuating with each breath that the client takes. what is the significance of this fluctuation

• an obstruction is present in the chest tube
• the client is developing subcutaneous emphysema
• the chest tube system is functioning properly
• there is a leak in the chest tube system

a client who is recovering from chest trauma is to be discharged home with a chest tube drainage system intact. the nurse should instruct the client to call the physician for which of the folowing

• respiratory rate greater than 16 breaths/min
• continuous bubbling in the water-seal chamber
• fluid in the chest tube
• fluctuation of fluid in the water seal chamber

which of the following findings would suggest pneumothorax in a trauma victim

• pronounced crackles
• inspiratory wheezing
• dullness on percussion
• absent breath sounds

for a client with rib fractures and a pneumothorax, the physician prescribes morphine sufate 1 to 2 mg/h given IV as needed for pain. the nursing care goal is to provide adequate pain control so that the client can breath effectively. which of the following outcomes would indicate successful achievement of this goal

• pain rating of 0/10 by the client
• decreased client anxiety
• respiratory rate of 26 breaths/min
• PaO2 of 70 mg Hg

pain rating of 0/10 by the client

(I think this answer is stupid b/c I think it's not realistic to expect 0/10 pain for a rib fracture, even with morphine)

a client undergoes surgery to repair lung injuries. postoperative prescriptions include the transfusion of one unit of packed red blood cells at a rate of 60 ml/hr. how long will this transfusion take to infuse

• 2 hours
• 4 hours
• 6 hours
• 8 hours

the primary reason for infusing blood at a rate of 60 ml/h is to help prevent which of the following complications

• emboli formation
• fluid volume overload
• red blood cell hemolysis
• allergic reation

a client has been in an automobile accident and the nurse is assessing the client for possible pneumothorax. the nurse should assess the client for

• sudden sharp chest pain
• wheezing breath sounds over affected side
• hemoptysis
• cyanosis

the physician has inserted a chest tube in a client with a pneumothorax. the nurse should evaluate the effectiveness of the chest tube

• for administration of oxygen
• to promote formation of lung scar tissue
• to insert antibiotics into the pleural space
• to remove air and fluid

a client is undergoing a thoracentesis the nurse should monitor the client during and immediately after the procedure for which of the following. select all that apply

• pneumothorax
• subcutaneous emphysema
• tension pneumothorax
• pulmonary edema
• infection

• pneumothorax
• subcutaneous emphysema
• tension pneumothorax
• pulmonary edema

when assessing a client with chest trauma the nurse notes that the client is taking small breaths at first then bigger breaths then a couple of small breaths then 10 to 20 seconds of no breaths. the nurse should chart the breathing pattern as

• cheyne stokes respiration
• hyperventilation
• obstructive sleep apnea
• bior's respiration

the nurse has placed the intubated client with ARDS in prone position for 30 minutes. which of the following would require the nurse to discontinue prone positioning and return the client to the supine position. select all that apply

• the family is coming in to visit
• the client has increased secrtions requiring frequent suctioning
• the SpO2 and PO2 have decreased
• the client is tachycardic with drop in blood presssure
• the face has increased skin breakdown and edema

• the SpO2 and PO2 have decreased
• the client is tachycardic with drop in blood presssure
• the face has increased skin breakdown and edema

the nurse has calculated a low PaO2/FIO2 ratio less than 150 for a client with ARDS. the nurse should place the client in which position to improve oxygenation, ventilation distribution, and drainage of secretions

• supine
• semi flowlers
• lateral side
• prone

a client with ARDS has fine crackles at lung bases and the respirations are shallow at a rate of 28 breaths/min. the client is restless and anxious. in addition to monitoring the arterial blood gas results, the nurse should do which of the following. select all that apply

• monitor serum creatine and BUN levels
• administer a sedative
• keep the head of the bed flat
• administer humidified oxygen
• auscultate the lungs

• monitor serum creatine and BUN levels
• administer humidified oxygen
• auscultate the lungs

which of the following interventions would be most likely to prevent the development of ARDS

• teaching cigarette smoking cessartion
• maintaining adequate serum potassium
• monitoring clients for signs of hypercapniaa
• replacing fluids adequately during hypovolemic states

the nurse interprets which of the following as an early sign of ARDS in a client at risk

• elevated carbon dioxide level
• hypoxia not responsive to oxygen therapy
• metabolic acidosis
• severe, unexplained electrolyte imbalance

a client with ARDS is on a ventilator. the clients peak inspiratory pressures and spontaneous respiratory rate are increasing and the PO2 is not improving. using SBAR technique for communication, the nurse calls the physician with the reccomendation for

• initiating iv sedation
• starting high protein diet
• providing pain medication
• increasing the ventilator rate

a client diagnosed with acute pancreatitis 5 days ago is experiencing respiratory distress. the nurse should report which of the following to the health care provider

• arterial oxygen level of 46 mm Hg
• respirations of 12
• lack of adventitious lung sounds
• oxygen saturation of 96% on room air

a client has the following arterial blood gas values: pH 7.52, PaO2 50 mm Hg; PaCO2 28 mm Hg; HCO3 24. based upon the client's PaO2 which of the following conclusions would be accurate

• the client is severely hypoxic
• the oxygen level is low but poses no risk for the client
• the client's PaO2 level is within normal range
• the client requires oxygen therapy with very low oxygen concentrations

a client has the following arterial blood gas values: pH 7.52, PaO2 50 mm Hg; PaCO2 28 mm Hg; HCO3 24.the nurse determines that which of the following is a possible cause for these findings

• COPD
• diabetic ketoacidosis with Kussmaul's respirations
• myocardial infarction
• pulmonary embolus

which of the following interventions should the nurse anticipate in a client who has been diagnosed with ARDS

• tracheostomy
• use of a nasal cannula
• mechanical ventilation
• insertion of a chest tube

which of the following conditions can place a client at risk for ARDS

• septic shock
• COPD
• asthma
• heart failure

which of the following assessments is most appropriate for determining the correct placement of an endotracheal tube in a mechanically ventilated client

• assessing the client's skin color
• monitoring the respiratory rate
• verifying the amount of cuff inflation
• auscultating breath sounds bilaterally

which of the following nursing interventions would promote effective airway clearance in a client with ARDS

• administering oxygen every 2 hours
• turning the client every 4 hours
• administering sedatives to promote rest
• suctioning if cough is ineffective

which of the following complication is associated with mechanical ventilation

• gastrointestinal hemmorhage
• immunosuppression
• increased cardiac output
• pulmonary emboli

a client is admitted to the emergency department with a headache, weakness, and slight confusion. the physician diagnoses carbon monoxide poisoning. what should the nurse do first

• initiate gastric lavage
• maintain body temperature
• administer 100% oxygen by mask
• obtain a psychiatric referral

a confused client with carbon monoxide poisoning experiences dizziness when ambulating to the bathroom. the nurse should

• put all four side rails up on the bed
• ask the CNA to place restraints on the client's upper extremities
• request that the client's roomate put the call light on when the client is attempting to get out of bed
• check on the client at regular intervals to ascertain the need to use the bathroom

which of the following is an expected outcome for a client with carbon dioxide poisoning

• a relatively matched v/q ratio
• a low v/q ratio
• a high v/q ratio
• an equal PaO2 and PaCO2 ratio

the nurse should place a client being admitted to the hospital with suspected tuberculosis on what type of isolation

• standard precautions
• contact precautions
• droplet precautions
• airborne precautions

a client has developed a hospital acquired pneumonia. when preparing to administer cephalexin (Keflex) 500 mg, the nurse notices that the pharmacy sent cefazolin (Kefzol). what should the nurse do. select all that apply

• administer the cefazolin (Kefzol)
• verify the medication prescription as written by the physician
• contact the pharmacy and speak to a pharmacist
• request that cephalexin (Keflex) be sent promptly
• return the cefazolin (Kefzol) to the pharmacy

• verify the medication prescription as written by the physician
• contact the pharmacy and speak to a pharmacist
• request that cephalexin (Keflex) be sent promptly
• return the cefazolin (Kefzol) to the pharmacy

which of the following individuals has the highest priority for receiving seasonal influenza vaccination

• a 60 year old man with a hiatal hernia
• a 36 year old woman with 3 children
• a 50 year old woman caring for a spouse with cancer
• a 60 year old woman with osteoarthritis

the nurse is a member of a team that is planning a client centered approach to care of clients with COPD using the chronic care model. the teach should focus on improving quality of care and delivery in which of the following areas. welect all that apply

• the community
• clinical information systems
• devliery system design
• administrative leadership
• emphasis on the acute care setting

• the community
• clinical information systems
• devliery system design

(no idea what "chronic care model" is, lol)

the nurse is caring for a client who has been placed on droplet precautions. which of the following protective gear is required to take care of this client. select all that apply

• gloves
• gown
• surgical mask
• glasses
• respirator

• gloves
• gown
• surgical mask
• glasses

(lippincott says glasses for droplet)

while making rounds, the nurse finds a client with COPD sitting in a wheelchair slumpted over a lunch tray. after determining the client is unresponsive and calling for help, the nurse's first action should be to

• push the code blue button
• call the rapid response team
• open the client's airway
• call for a defibrillator

a nurse performs an ABG sampling at 0930 on a client who has a heparin drip infusing. at which of the following times will it be appropriate for the nurse to discontinue holding pressure on the puncture site

• 0935
• 0940
• 0945
• 0950

which of the following can cause a low pulse ox reading. select all that apply

• nail polish
• inadequate peripheral circulation
• hyperthermia
• increased hgb level
• edema

• nail polish
• inadequate peripheral circulation
• edema

a nurse is caring for a client following a bronchoscopy. which of the following clien findings should the nurse report to the primary care provider?

• blood tinged sputum
• dry, non productive cough
• sore throat
• bronchospasms

a nurse is caring for a client who is scheduled for a thoracentesis at the bedsie. which of the following items should the nurse ensure is in the client's room . select all that apply

• oxygen equpiment
• incentive spirometer
• pulse oximeter
• thoracentesis tray
• suture removal kit

• oxygen equpiment
• pulse oximeter
• thoracentesis tray

which of the following are causes for concern following a throacentesis. select all that apply

• dyspnea
• localized bloody drainage contained on the dressing
• fever
• hypotension
• SaO2 of 95%
• soreness around puncture site

• dyspnea
• fever
• hypotension

which of the following items should the nurse have placed in the client with a chest tube's room select all that apply

• oxygen
• sterile water
• enclosed hemostat clamps
• indwelling urinary catheter
• occlusive dressing
• suction source
• bladder scan machine

• oxygen
• sterile water
• enclosed hemostat clamps
• occlusive dressing
• suction source

while assessing the client the nurse notices that the client's chest tube has become dislodged. which of the following actions should the nurse take first

• place the tubing into sterile water to restore the water seal
• apply sterile gauze to the site
• tape or clamp all connections
• assess the client's respiratory status

a nurse is assessing the functioning of a client's chest drainage system. which of the following are expected client findings. select all that apply

• continuous bubbling in the water seal chamber
• gentle constant bubbling in the suction control chamber
• rise and fall in the level of water in the water seal chamber with inspiration and expiration
• exposed sutures without dressing
• drainage system is upright at chest level

• gentle constant bubbling in the suction control chamber
• rise and fall in the level of water in the water seal chamber with inspiration and expiration

a nurse is assisting a provider with the removal of a chest tube. which of the following should the nurse instruct the client to do

• lie on his left side during removal
• hold his breath
• inhale deeply during removal
• perform the valsalva maneuver during removal

which of the following are indications that a nurse should suction a client. select all that apply

• spontaneous cough
• cyanosis
• SaO2 greater than 95%
• tachypnea
• visualization of secretions

• cyanosis
• tachypnea
• visualization of secretions

a nurse is caring for a client who has secretions in the airway. which of the following is the most effective method for clearing the secretions

• endotracheal suction
• oropharyngeal suction
• deep breathing and coughing
• nasopharyngeal suction

a nurse should measure a clients airway depth for nasopharyngeal and nasogtracheal suctioning by

• determining the distance from the nares to the sternum
• determining the distance from the corner of the mouth to the earlobe
• determining the distance from the tip of the nose to the earlobe
• inserting the catheter until resistance is met

• determining the distance from the tip of the nose to the earlobe

a nurse is caring for a client who has a tracheotomy. which of the following interventions should the nurse include. select all that apply

• use medical aseptic technique when performing tracheostomy care
• change the tracheostomy ties each time tracheostomy care is given
• provide the client with materials for nonverbal communication
• keep pressure greater than 30 mm Hg
• clean the stoma site with half-strength hydrogen peroxide followed by 0.9% sodium chloride

• provide the client with materials for nonverbal communication
• clean the stoma site with half-strength hydrogen peroxide followed by 0.9% sodium chloride

(these answers don't seem right at all to me)

the nurse prepares to perfrom endotracheal suctioning. which of the following are appropriate guidelines. select all that apply

• set wall suction at 150 mm Hg to ensure adequate suction
• apply intermittent suction while inserting and withdrawing the catheter
• provide hyperoxygenation to the client with 100% FiO2 before suctioning
• clear the catheter and tubing and save for later use
• maintain surgical aseptic technique

• provide hyperoxygenation to the client with 100% FiO2 before suctioning
• maintain surgical aseptic technique

delivers an FiO2 of 24% to 55% at flow rates of 2 to 10 L/min via different sized adaptors

• nasal cannula
• simple face mask
• nonrebreather mask
• venturi mask
• face tent

delivers an FiO2 of 24% to 100% at flow rates of at least 10 L/min and provides high humidification of oxygen

• nasal cannula
• simple face mask
• nonrebreather mask
• venturi mask
• face tent

delivers an FiO2 of 24% to 55% to 44% at a flow rate of 1 to 6L/min via tubing with two small prongs for insertion into the nares

• nasal cannula
• simple face mask
• nonrebreather mask
• venturi mask
• face tent

delivers an FiO2 of 40% to 60% at flow rates of 5 to 8 L/min for short term oxygen therapy

• nasal cannula
• simple face mask
• nonrebreather mask
• venturi mask
• face tent

delivers an FiO2 of 80% to 95% at flow rates of 10 to 15 L/min to keep the reservoir bag 2/3 full during inspiration and expiration

• nasal cannula
• simple face mask
• nonrebreather mask
• venturi mask
• face tent

a nurse is caring for a client who has dyspnea. in which of the following postions should the nurse place the client

• supine
• dorsal recumbent
• fowler's
• lateral

which of the following oxygen delivery devices is used when a prcise amount of oxygen must be delivered

• nonrebreather mask
• ventrui mask
• nasal cannula
• simple face mask

which of the following modes of ventilation can increase conditioning of the respiratory muscles. select all that apply

• assist-control
• syncrhonized intermittent mandatory ventilation
• continuous positive airway pressure
• pressure support ventilation
• independent lung ventilation

• syncrhonized intermittent mandatory ventilation
• continuous positive airway pressure
• pressure support ventilation

a nurse is training a newly licensed nurse who is caring for a client who is receiving mechanical ventilation. the ventilator has been placed on presure support ventilation PSV mode. the newly licensed nurse demonstrates an understanding of PSV by stating that pressure support maintains the amount of pressure

• in the lungs to open alveoli and prevent ateectasis
• on spontaneous ventilation to decrease the work of breathing
• on spontaneous ventilation to increase the work of breathing
• on continuous ventilation to decrease the work of breathing

a nurse is orienting a newly licensed nurse on how to complete a routine assessment for a client who is receiving mechanical ventilaton. which of the following should be included in the newly licensed nurse's assessment of the client

• assess blood pressure every 6 to 8 hr
• assess blood pressure every 2 to 4 hr
• assess breath sounds every 6 to 8 hr
• assess breath sounds every 2 to 4 hr

which of the following parameters indicate deterioration in the client's respiratory status. select all that apply

• SaO2 95%
• wheezing
• retraction of sternal muscles
• warm and pink extremities and mucous membranes
• premature ventricular complexes
• respiratory rate of 34/min
• anxiety

• wheezing
• retraction of sternal muscles
• premature ventricular complexes
• respiratory rate of 34/min
• anxiety

two hours after arriving on the medical-surgical unit, the client develops dyspnea. SaO2 is 91%, and the client is exhibiting audible wheezing and use of accessory muscles. which of the following medications should the nurse expect to administer

• antibiotic
• beta-blocker
• antiviral
• beta2 agonist

a nurse is completing discharge teaching with a client who has a new prescription for prednisone for asthma. which of the following client statements indicates a need for further teaching

• i will drink plenty of fluids while taking this medication
• i will tell the doctor if i have black, tarry stools
• i will take my medication on an empty stomach
• i will monitor my mouth for cold sores

when discharging a client home who is on oxygen, which of the following is most important for the nurse to teach

• smoking cessation
• equipment maintenance
• incorporating rest into ADLs
• anger management

a nurse is caing for a client who has COPD. upon discharge the client is concerned that he will never be able to leave his house now that he has been placed on continuous oxygen. which of the following statements should the nurse make

• there are portable oxygen delivery systems that you can take with you
• when you go out you can remove the oxygen and then reapply it when you get  home
• you probably will not be able to go out as much as you used to
• home health services will come to you so you will not need to get out

which of the following clients have an increased risk for developing pneumonia. select all that apply

• client who has dysphagia
• client who has AIDS
• client who was vaccinated for pneumoococcus and influenza 6 months ago
• client who is post operative and has received local anesthesia
• client who has a closed head injury and is receiving ventilation
• client who has myasthenia gravis

• client who has dysphagia
• client who has AIDS
• client who has a closed head injury and is receiving ventilation
• client who has myasthenia gravis

a nurse is caring for a 76 year old female client brought in to a clinic by her husband. the husband states that his wife woke up this morning and did not recognnize him or know where she was. the client reports chills and chest pain that worsens with inspiration. which of the following is the highet priority nursing task

• obtain baseline vital signs and oxygen saturation
• obtain a sputum culture
• obtain a complete history from the client
• provide a pneumococcal vaccination

a nurse is caring for a client who has pneumonia and has a prescription for prednisone. the nurse should monitor the client for which of the following. select all that apply

• fluid retention
• tremors
• hyperglycemia
• fever
• black, tarry stools

• fluid retention
• hyperglycemia
• fever
• black, tarry stools

a home health nurse is caring for an older adult client who has active TB. the client lives at home with her husband. she is prescribed the following medication regimen: isoniazid, rifampin, pyrazinamide, and ethambutol. which of the following statements indicate that the client understands appropirate care measure. select all that apply

• it is okay to substitute once mdication for another when i run out because they all fight the infection
• i will wash my hands each time i cough or sneeze
• i will increase my intake of citrus fruits, red meats, and whole grains
• i am glad that i don't have to collect any more sputum specimens
• i will make sure that i wear a mask when i am in a public place
• i do not need to worry about where i go one i start taking my medication

• i will wash my hands each time i cough or sneeze
• i will increase my intake of citrus fruits, red meats, and whole grains
• i will make sure that i wear a mask when i am in a public place

a client recently diagnosed with tuberculosis is placed on a multi-medication regimen. which of the following instructions should the nurse give the client in regard to ethambutol

• your urine may turn a dark orange
• watch for a change in the color of your sclera
• watch for any changes in vision
• take viatmin B6 daily

the nurse is caring for a client diagnosed with laryngeal cancer and is admitted for a total laryngectomy with a right radical neck dissection. the client asks the nurse if he will be able to speak after the surgery. which of the following is an appropriate response by the nurse

• there is a good chane that you will be able to speak in your natural voice
• you will have to use a written form of communication for the rest of your life
• you will not be able to speak again with your natural voice, but there are options for re-establishing speech
• the primary concern at this time is to remove the cancer, so you shouldn't worry about your voice at this time

after a radical neck dissection, the client reports that he is having difficulty raising his right arm above his head when dressing. which of the following responses is appropriate

• i wil call your provider and let her know that your right arm is weak
• this sometimes occurs as a complication after a radical neck dissection
• it is normal for you to be weak after this type of surgery
• you may need to wear your arm in a sling the rest of your life

• this sometimes occurs as a complication after a radical neck dissection

which of the following clients are at an increased risk for the development of laryngeal cancer. select all that apply

• a client who paints houses for a living
• a client who uses chewing tobacco
• a radiology technician who takes xrays of clients daily
• a client who smokes only cigars, not cigarettes
• a client who lives with a pouse who smokes cigarettes

• a client who paints houses for a living
• a client who uses chewing tobacco
• a client who smokes only cigars, not cigarettes
• a client who lives with a pouse who smokes cigarettes

a nurse in the ED is caring for a client who reports dyspnea and rust colored sputum that has persisted for nearly 3 weeks. lung cancer is suspected, and diagnostic tests are ordered. a CT scan reveals the presence of a mass at the base of the bronchial tree. the client asks "what is a bronchoscopy" an appropriate response by the nurse is "a bronchoscopy is when

• a needle is inserted between two ribs and a piece of the tumor is aspirated
• a set of xrays are taken that provide a three dimensional picture of your lungs
• magnetic fields and radio waves are used to obtain sectional pictures of your lungs that outline the tumor
• a flexible tube is inserted through your mouth and into your lungs to see the tumor and obtain a biopsy

• a flexible tube is inserted through your mouth and into your lungs to see the tumor and obtain a biopsy

a nurse in an ED is caring or a client who has advanced lung cancer. the client reports dyspnea on exertion and at rest, and her family states that she has become disoriented over the last 72 hr a chest xray reveals a baseball sized mediastinal tumor. vital signs are as follows: HR 104, BP 88/42, RR 38, T 100.2 F, SaO2 89% on RA. which of the following do these findings indicate

• cardiac tamponade
• sick sinus syndrome
• superior vena cava syndrome
• right heart block

a nurse in an ED is caring or a client who has advanced lung cancer. the client reports dyspnea on exertion and at rest, and her family states that she has become disoriented over the last 72 hr a chest xray reveals a baseball sized mediastinal tumor. vital signs are as follows: HR 104, BP 88/42, RR 38, T 100.2 F, SaO2 89% on RA. which of the following interventions should the nurse implement first

• notify the health care provider
• obtain a CT scan to determine the exact location of the tumor
• administer oxygen
• provide family support

a nurse is caring for several clients. which of the following clients are at risk for a pulmonary embolism. select all that apply

• a woman who is taking birth control pills
• a woman who is postmenopausal
• a client who has a fractured femur
• a client who smokes one pipe daily
• a client who is a marathon runner
• a client who has heart failure and chronic a-fib

• a woman who is taking birth control pills
• a client who has a fractured femur
• a client who smokes one pipe daily
• a client who has heart failure and chronic a-fib

a nurse is caring for a milddle adult female client who is admitted to the CCU with acute dyspnea and dipahoresis. the client states that she is anxious because she feels that she cannot get enough air. vital signs: hr 117, rr 38, temp 101.2 F, bp 100/54. which of the following actions is the highest prioity

• obtain an abg
• initiate a heparin drip
• administer oxygen therapy
• obtain a spiral CT scan

a nurse is caring for a client who has a new prescription for heparin therapy. which of the following statements by the client should pose an immediate concern for the nurse

• i am allergic to morphine
• i take antacids several times a day
• i had a blood clot in my leg several yeaers ago
• it hurts to take a deep breath

what is the rationale for this intervention for pulmonary embolism: administer cyrstalloids

• improves cardiac contractility
• restores intravascular volume
• assesses for thrombocytopenia

what is the rationale for this intervention for pulmonary embolism: administer dobutamine

• improves cardiac contractility
• restores intravascular volume
• assesses for thrombocytopenia

improves cardiac contractility

what is the rationale for this intervention for pulmonary embolism: monitor platelet count

• improves cardiac contractility
• restores intravascular volume
• assesses for thrombocytopenia

a nurse is caring for a client who is to receive fibrinolytic thrombolytic therapy. which of the following should the nurse recognize aas a contraindication to the therapy

• hip arthroplasty 2 weeks ago
• elevated sedimentation rate
• incident of exercise-induced asthma 1 week ago
• elevated platelet count

a nurse in an ED is caring for a young adult male client who was admitted with a gunshot wound. the client has a BP 108/55, HR 124, RR 36, temp: 101.4 F, SaO2 95% on 15 L/min nonrebreather mask. the client reports dyspnea and pain. The nurse reasses the client 30 min later. which of the following assessment findings should the nurse report to the health care provider:

• SaO2 of 90%
• tracheal deviation
• headache
• bp of 104/54
• HR of 154
• hemoptysis
• distended neck veins
• nausea

• SaO2 of 90%
• tracheal deviation
• HR of 154
• hemoptysis
• distended neck veins

a nurse is caring for a client who has a tension pneumothorax. the nurse knows that as a result of the tension pneumothorax, air continues to accumulate and the intraplueral pressure rises which

• causes small blebs to develop in the lung on the affected side
• allows air to flow freel through the chest wall during inspiration and expriation
• causes less air to enter on inspiration and exceed the barometric pressure
• will cause the mediastinum to shift away from the affected side and decrease venous return

a nurse in an ED is caring for a 40 year old male client who was admitted following an MVA. physical assessment reveals absent breath sounds in the left lower lobe. the client is dyspneic, bp 111/68, hr 124, rr 38, temp 101.4 F, SaO2 of 92% on RA. which of the following actions should the nurse take first

• obtain a chest xray
• prepare for chest tube insertion
• administer oxygen via high-flow mask
• obtain iv access

the client is receiving vecuronium (Norcuron) and is on a ventilator. which of the following medications should the nurse anticipate administering. select all that apply

• fentanyl
• furosemide
• midazolam
• famotidine
• dexamethasone

• fentanyl
• midazolam

which of the following clients are at risk for the devlopment of ARF and/or ARDS. select all that apply

• a 14 year old boy who serceived 2 min of CPR following a near drowning incident
• a client post coronary artery bypass graft with two chest tubes
• a client with a hemoglobin level of 14.5
• a client with an exacerbation of cystic fibrosis
• a client with dysphagia
• a client with a sinus infection

• a 14 year old boy who serceived 2 min of CPR following a near drowning incident
• a client post coronary artery bypass graft with two chest tubes
• a client with an exacerbation of cystic fibrosis
• a client with dysphagia

a nurse is caring for a client who has severe acute respiratory syndrome. treatment for this client may include. select all that apply

• antibiotics
• supplemental oxygen
• antiviral medications
• bronchodilators
• intubation

• supplemental oxygen
• antiviral medications
• intubation

a male client is admitted following an automobile accident. he is very anxious, dyspneic, and in severe pain. the left chest wall moves in during inspiratoin and balloons out when he exhales. what condition are these symptoms most suggestive of

• hemothorax
• flail chest
• atelectasis
• pleural effusion

a young man is admitted with a flail chest following a car accident. he is intubated with an endotracheal tube and is placed on a mechanical ventilator (control mode, positive pressure). which physical finding alerts the nurse to an additional problem in repiratory function

• dullness to percussion in the third to fifth intercostal space, midclavicular line
• decreased paradoxical motion
• louder breath sounds on the right chest
• pH of 7.36 in arterial blood gases

• louder breath sounds on the right chest

the nurse is caring for a client who has had a chest tube inserted and connected to a portable water seal drainage. the nurse determines the drainage system is functioning correctly when which of the following is observed

• continuous bubbling in the water seal chamber
• fluctuation in the water seal chamber
• suction tubing attached to a wall unit
• vesicular breath sounds throught the lung fields

the nurse is caring for a client who has just had a chest tube attached to a portable water seal drainage system

• observe for intermittent bubbling in the water-seal chamber
• flush the chest tube with 30 to 60 ml of NSS q4 to6 hours
• maintain the client in an extreme lateral position
• strip the chest tubes in the direction of the client

the nurse enters the room of a client who has a chest tube attached to a water seal drainage system and notices the chest tube is dislodged from the chest. what is the most appropriate nursing interventions

• notify the physician
• insert a new chest tube
• cover the insertion site with petroleum gauze
• instruct the client to breath deeply until help arrives

an adult is ordered oxygen via nasal prongs. what is true of administering oxygen this way

• mixes room air with oxygen
• delivers a precise concentration of oxygen
• requires humidity during elivery
• is less traumatic to the respiratory tract

an adult is receiving oxygen by nasal prongs. which statement by the client idnicates that client teaching regarding oxygen therapy has been effective

• i was feeling fine so i removed my nasal prongs
• it will be good to rest from taking deep breaths now that my oxygen is on
• dont' forget to come back quickly when you get me out of bed; i don't like to be without my oxygen for too long
• my family was angry when i told them they could not smoke in my room

my family was angry when i told them they could not smoke in my room

(well, this is obviously an OLD question!)

the client diagnosed with TB is taught prevention of disease transmission. which correct answer will the client state is a means of transmission

• hands
• droplet nuclei
• milk products
• eating utensils

the treatment plan for a client newly diagnosed with TB is likely to include which of the following medications as initial treament

• ethambutol and isoniazid
• streptomycin and penicillin G
• tetrcycline and thioridazine
• pyrdoxine and tetracycline

a 64 year old has been smoking since he was 11 years old. he has a long history of emphysema and is admitted to the hospital because of respiratory infection that has not improved with outpatient therapy. which finding would the nurse expect to observe during the client's nursing assessment

• electrocardiogram changes
• increased anterior-posterior chest diameter
• slow, labored respiatory pattern
• weight height relationship indicating obesity

supplemental low flow oxygen therapy is prescribed for a man with emphysema. which is the most essential action for the nurse to initiate

• anticipate the need for humidification
• notify the physician that this order is contraindicated
• place the client in an upright position
• schedule frequent pulse oximeter checks

when auscultating the lung fields a sound describes as rustling, like wind in the trees is heaerd. what is the correct term for this occurence

• crackles
• rhonchi
• wheeze
• vesicular

the nurse's assessment of a client with lung cancer reveals the following: copious secretions, dyspnea, and cough. based on these findings, what is the most appropriate nursing diagnosis

• impaired gas exchange
• ineffective airway clearance
• pain
• altered tissue perfusion

a client has just had arterial blood gases drawn. what will the nurse do with the specimen collected

• gently shake the syringe
• place the sample in a syringe of warm water
• aspirate 0.5 mL of heparin into the syringe
• have the specimen analyzed immediately

the nurse is to obtain a sputum specimen from a client. select the correct set of statements instructing the client in the proper technique for obtaining a sputum specimen

• collect the specimen right beore bed. spit carefully into the container
• brush your teeth, then cough into the container. do this first thing in the morning
• right after lunch, cough and spit into the container
• spit into the container then add two tablespoons of water

the nurse is checking tuberculin skin test results at a health clinic. one client has an area of induration measuring 12 mm in diameter, what does this finding indicate

• this finding is a normal reading
• this finding indicates active TB
• this is positive reaction and an indicate exposure to TB
• this client needs to come back in two more days and let the nurse look at the area of induration again

an adult has undergone a bronchoscopy. which assessment finding indicate to the nurse that he is ready for discharge

• use of accessory muscles for breathing, decreaed lung sounds
• stable vital signs, return of gag and cough reflex
• hemoptysis, rhonchi
• development of tachycaria with occasional PVCs able to eat and drink

an adult has a chest tube to a Pleur-evac drainage system attached to a wall suction. an order to ambulate the client has been received. how should the nurse ambulate the client safely

• clamp the chest tube and carefully ambulate the client a short distance
• question the order to ambulate the client
• carefully ambulate the client, keeping the pleur-evac lower than the client's chest
• disconnect the pleur-evac from the client's chest tube, leave it attached to the bed, ambulate the client, and then reconnect the chest tube when he is returned to bed

approximately 10 minutes after a client returns from surgery with a tracheostomy tube the nurse assesses increaing norisy respiratory and an increased pulse. what action should be taken immediately

• take the client's blood pressure
• suction the tracheostomy tube
• drain water from the O2 tubing
• change the tracheostomy tube

the nurse will be performing chest physiotherapy (CPT) on a client every 4 hours. what is the appropriate action by the nurse

• gently slap the chest wall
• use vibration techniques to move secretions from affected lung areas during the inspiratoin phase
• perform CPT at least 2 hours after meals
• plan apical drainage at the beginning of the CPT session

a client is on a ventilator. the ventilator alarm goes off. the nurse assesses the client and observes increased respiratory rate, use of accessory muscles and agitaiton. what should be the nurse's first action

• remove the client from the ventilator and ambubag the client while continuing to assess to determine the cause of the client's distress
• call respiratory therapy to check the ventilator
• notify the physician
• turn off the alarm

a client with respiratory failure is on a ventilator. the alarm goes off. what should be the nurse's first action

• notify the physician
• assess the client to determine the cause of the alarm
• turn off the alarm
• disconnect the client and use the ambu bag to ventilate the client

a nurse is setting up oxygen for an adult male. he is to receive oxygen at 2 L per nasal cannula. what should be included for this treatment

• adjust the flow rate to keep the reservoir bag inflated 2/3 full during inspiration
• monitor the client carefully for risk of aspiration
• make sure the valves and rubber flaps are patent, functional, and not stuck
• remind the client not to use vaseline lip balm

a long term COPD client is receiving oxygen at 1 L/min. a family member decides she "doesn't look too good" and increases her oxygen to 7 L/min. what should the nurse's initial action be

• thank the client's cousin and continue to observe the client
• immediately decrease the oygen
• notify the physician
• add humidity to the oxygen

an adult is receiving oxygen per face mask at 40%. the nurse should include which of the following in her plan of care

• provide good skin care making sure the mask fits well
• keep all visitors out of the room
• turn off the CPAP during the day
• keep the bag inflated at all times

an adult has a new tracheostomy in place. he has a small amount of thin white secretions. the stoma is pink with no drainage noted. how often should the nurse preform trach care

• 4 hours
• 8 hours
• 24 hours
• every hour

a female client is admitted to the hospital. she has smoked two packs per day for 30 years. while providing her history she becomes breathless, pauses frequently between words, and appears very anxious. she has a cough with thick white sputum production. her chest is barrel shaped. based on the data, on what condition will the nurse develop a plan of care

• pneumonia
• COPD
• TB
• asthma

a 68 year old male is being admitted to the hospital for an exacerbation of his COPD. what will most likely be included in the plan of care

• placed on 10 L of oxygen per NC
• placed in repiratory isolation
• require frequent rest periods throughout the day
• placed on fluid restriction

a client with suspected TB will mot likely relate which clinical manifestations

• fatigue, weight loss, low grade fevers, night sweats
• asymmetrical chest expansion
• rapid shallow breathing, prolonged labored expiration, stridor
• dyspnea, hypoxemia, decreased pulmonary compliance

an adult is being admitted to the nursing unit with a diagnosis of pneumonia. she has a history of arrested TB. what will the nurse's initial action

• place the client in respiratory isolation
• encourage cough and deep breathing
• force fluids
• administer O2

• place the client in respiratory isolation

an adult is being followed in the outpatient clinic for a dx of active T. she is reciving isoniazid, rifampin, steptomycin. which statement by the client best indicates she understands her therapeutic regimen

• i'm glad i only have to take these drugs for a couple of weeks
• i need to take these two drugs every day and come back to the clinic once a week for the shot
• it may work best to take these pills in the evening right before bed
• i'm glad my birth control pills aren't affected by these drugs - the doctor told me not to get pregnant

an elderly client has fallen and broken her eighth rib on her left side. the nurse should include which of the following when developing the plan of care

• bind the client's chest with a 6 inche Ace bandage
• keep the client on bed rest for 3 days
• encourage the client to use her incentive spriometer and cough and deep breathe
• administer large doses of narcotic alagestic so that the client will be able to more fully participate in pulmonary care

a man is injured in an industrial accident. the industrual nurse assesses him and observes use of accessory muscles, severe chest pain, agitation, shortness of breath. the nurse also notices one side of his chest moving differntly than the other. the nurse suspects flail chest. what will be the nurse's inital action

• apply a sandbag to the flail side of his chest
• prepare for intubation and mechanical ventilation
• prepare for chest tube placement
• administer pain medication

what manifestation would the client with pleural effusion display

• pain
• swelling
• dyspnea
• increased sputum production

an 86 year old female was admitted to

the hospital two days ago with pneumonia. she now has an order to be up in the chair as much as possible. how will the nurse plan the client's morning care

• get her up before breakfast. have her eat in the chair, then bathe while still lup
• allow her to eat breakfast in bed, rest for 30 minutes, get up in the chair, and rest for a few minutes. allow her to wash her hands and face - nurse to complete bath
• allow her to eat in bed, get her up, and provide her with a pan of water for her to bathe
• get her up before breakfast, have her bathe before breakfast, eat in the chair, then a rest in the chair

a client has been admitted to the hospital. lung assessment reveals the following: bronchial breath sounds over L lower lobe, diminished breath sounds L lower lobe, tactile fremitus present, percussion dulled in this area. based on the assessment findings, what condition does the nurse suspect

• pneumonia
• asthma
• emphysema
• early left-sided heart failure

a nurse is teaching a class in a community center about lung cancer. which statement best demonstrates the client's understanding of the risk factors for lung cancer

• my husband smokes but I don't. so ireally don't need to worry about getting lung cancer
• i guess i will need to eat more green and yellow vegetables
• just because i have COPD doesn't mean that i have a higher risk
• i've worked with asbestos all my life and have never had any problems

an adult male was diagnosed with lung cancer 18 months ago. he is now in the terminal stages and is experiencing severe generalized pain. he has ordered morphine sulfate 10 mg IM q 4-6 h prn. what is the most appropriate action by the nurse

• teach him that the pain medicine prescried will take away all his pain and he will have no discomfort
• cousel him about the addictive qualities of his prescribed narcotic
• inform him that he may only ask for the pain medicine every 4 hours and there is nothing else you can offer in between medication times
• encourage him to ask for the pain medicine before the pain becomes severe

• encourage him to ask for the pain medicine before the pain becomes severe

a client is admitted to the nursing unit from the recovery room following a left pneumonectomy. what will the nurse expect in the plan of care

• have a chest tube to water seal
• have a chest tube to suction
• be monitored closely for respiratory and cardiac complications
• have his left arm maintained in a sling to prevent pain and discomfort

the nurse may expect a client with suspected early ARDS to exhibit which of the following

• PaO2 of 90, PaCO2 of 45, Xray showing enlarged heart, bradycardia
• thick green sputum production, PaO2 of 75, pH 7.45
• restlessness, suprasternal retractions PaO2 of 65
• wheezes, slow deep respirations, PaCO2 of 55, pH of 7.25

the client had a removal of the larynx and a permanent opening made into the trachea. what is the correct name of this procedure

• total laryngectomy
• tracheostomy
• radical neck dissection
• partial laryngectomy

an adult will undergo a total laryngectomy tomorrow. she is concerned about communicating post op. the nurse should plan for her to communicate by which method the first 24 - 48 hours after surgery.

• using the artificial larynx
• writing or pointing on communication board
• using esophageal speech
• using a voice button

an adult has had a total larngectomy. the nurse is discussing options for verbal communication with the client. which statement indicatse the client understands the statement indicates the client understand the available options for verbal communication

• because of the arthritis in my hands, i think the voice button method would be easiest to use
• by the time i leave the hospital i will be able to talk
• if i use the esophageal speech, my voice will be high pitched and soft
• using an artifical larynx will make me sound sort of monotone

an adult is ready for discharge after undergoing a total laryngectomy. the nurse is discussing safety aspects of his home care. which statement by the client best indicates that he understands the safety aspects of his care at home

• it is ok to swim as long as i'm careful
• i shold use paper tissues to cover my stoma when i'm coughing
• i should not wear anyting to cover my stoma
• i will need to use a humidifier in my house