Brunner Ch 23: Management of Patients with Chest and Lower Respiratory Tract Disorders Flashcards
(40 cards)
A perioperative nurse is caring for a postoperative patient. The patient has a shallow respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address the patients increased risk for
what
complication?
A) Acute respiratory distress syndrome (ARDS)
B) Atelectasis
C) Aspiration
D) Pulmonary embolism
Ans: B
A shallow, monotonous respiratory pattern coupled with immobility places the patient at an increased risk of developing atelectasis. These specific factors are less likely to result in pulmonary embolism or aspiration. ARDS involves an exaggerated inflammatory response and does not normally result from factors such as immobility and shallow breathing.
A critical-care nurse is caring for a patient diagnosed with pneumonia as a surgical complication. The nurses assessment reveals that the patient has an increased work of breathing due to copious tracheobronchial secretions. What should the nurse encourage the patient to do?
A) Increase oral fluids unless contraindicated.
B) Call the nurse for oral suctioning, as needed.
C) Lie in a low Fowlers or supine position.
D) Increase activity.
Ans: A
Feedback:
The nurse should encourage hydration because adequate hydration thins and loosens pulmonary secretions. Oral suctioning is not sufficiently deep to remove tracheobronchial secretions. The patient should have the head of the bed raised, and rest should be promoted to avoid exacerbation of symptoms.
The public health nurse is administering Mantoux tests to children who are being registered for kindergarten in the community. How should the nurse administer this test?
A) Administer intradermal injections into the childrens inner forearms.
B) Administer intramuscular injections into each childs vastus lateralis.
C) Administer a subcutaneous injection into each childs umbilical area.
D) Administer a subcutaneous injection at a 45-degree angle into each childs deltoid.
Ans: A
Feedback:
The purified protein derivative (PPD) is always injected into the intradermal layer of the inner aspect of the forearm. The subcutaneous and intramuscular routes are not utilized.
The nurse is caring for a patient who has been in a motor vehicle accident and the care team suspects that the patient has developed pleurisy. Which of the nurses assessment findings would best corroborate this diagnosis?
A) The patient is experiencing painless hemoptysis.
B) The patients arterial blood gases (ABGs) are normal, but he demonstrates increased work of breathing.
C) The patients oxygen saturation level is below 88%, but he denies shortness of breath.
D) The patients pain intensifies when he coughs or takes a deep breath.
Ans: D
Feedback:
The key characteristic of pleuritic pain is its relationship to respiratory movement. Taking a deep breath, coughing, or sneezing worsens the pain. The patients ABGs would most likely be abnormal and shortness of breath would be expected.
The nurse caring for a patient recently diagnosed with lung disease encourages the patient not to smoke. What is the primary rationale behind this nursing action?
A) Smoking decreases the amount of mucus production.
B) Smoke particles compete for binding sites on hemoglobin.
C) Smoking causes atrophy of the alveoli.
D) Smoking damages the ciliary cleansing mechanism.
Ans: D
In addition to irritating the mucous cells of the bronchi and inhibiting the function of alveolar macrophage (scavenger) cells, smoking damages the ciliary cleansing mechanism of the respiratory tract. Smoking also increases the amount of mucus production and distends the alveoli in the lungs. It reduces the oxygen-carrying capacity of hemoglobin, but not by directly competing for binding sites.
A patient has been brought to the ED by the paramedics. The patient is suspected of having ARDS. What intervention should the nurse first anticipate?
A) Preparing to assist with intubating the patient
B) Setting up oxygen at 5 L/minute by nasal cannula
C) Performing deep suctioning
D) Setting up a nebulizer to administer corticosteroids
Ans: A
A patient who has ARDS usually requires intubation and mechanical ventilation. Oxygen by nasal cannula would likely be insufficient. Deep suctioning and nebulizers may be indicated, but the priority is to secure the airway.
The nurse is caring for a patient who is scheduled for a lobectomy for a diagnosis of lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the clients oxygen saturation rapidly dropping. The patient complains of shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the presence of a pneumothorax include what?
A) Diminished or absent breath sounds on the affected side
B) Paradoxical chest wall movement with respirations
C) Sudden loss of consciousness
D) Muffled heart sounds
Ans: A
Feedback:
In the case of a simple pneumothorax, auscultating the breath sounds will reveal absent or diminished breath sounds on the affected side. Paradoxical chest wall movements occur in flail chest conditions. Sudden loss of consciousness does not typically occur. Muffled or distant heart sounds occur in pericardial tamponade.
The nurse is providing discharge teaching for a patient who developed a pulmonary embolism after total knee surgery. The patient has been converted from heparin to sodium warfarin (Coumadin) anticoagulant therapy. What should the nurse teach the client?
A) Coumadin will continue to break up the clot over a period of weeks
B) Coumadin must be taken concurrent with ASA to achieve anticoagulation.
C) Anticoagulant therapy usually lasts between 3 and 6 months.
D) He should take a vitamin supplement containing vitamin K
Ans: C
Feedback:
Anticoagulant therapy prevents further clot formation, but cannot be used to dissolve a clot. The therapy continues for approximately 3 to 6 months and is not combined with ASA. Vitamin K reverses the effect of anticoagulant therapy and normally should not be taken.
A new employee asks the occupational health nurse about measures to prevent inhalation exposure of the substances. Which statement by the nurse will decrease the patients exposure risk to toxic substances?
A) Position a fan blowing on the toxic substances to prevent the substance from becoming stagnant in the air.
B) Wear protective attire and devices when working with a toxic substance.
C) Make sure that you keep your immunizations up to date to prevent respiratory diseases resulting from toxins.
D) Always wear a disposable paper face mask when you are working with inhalable toxins.
Ans: B
When working with toxic substances, the employee must wear or use protective devices such as face masks, hoods, or industrial respirators. Immunizations do not confer protection from toxins and a paper mask is normally insufficient protection. Never position a fan directly blowing on the toxic substance as it will disperse the fumes throughout the area.
An x-ray of a trauma patient reveals rib fractures and the patient is diagnosed with a small flail chest injury. Which intervention should the nurse include in the patients plan of care?
A) Suction the patients airway secretions.
B) Immobilize the ribs with an abdominal binder.
C) Prepare the patient for surgery.
D) Immediately sedate and intubate the patient.
Ans: A
Feedback:
As with rib fracture, treatment of flail chest is usually supportive. Management includes clearing secretions from the lungs, and controlling pain. If only a small segment of the chest is involved, it is important to clear the airway through positioning, coughing, deep breathing, and suctioning. Intubation is required for severe flail chest injuries, and surgery is required only in rare circumstances to stabilize the flail segment.
The nurse is caring for a patient who is receiving oxygen therapy for pneumonia. How should the nurse best assess whether the patient is hypoxemic?
A) Assess the patients level of consciousness (LOC).
B) Assess the patients extremities for signs of cyanosis.
C) Assess the patients oxygen saturation level.
D) Review the patients hemoglobin, hematocrit, and red blood cell levels.
Ans: C
Feedback:
The effectiveness of the patients oxygen therapy is assessed by the ABG analysis or pulse oximetry. ABG results may not be readily available. Presence or absence of cyanosis is not an accurate indicator of oxygen effectiveness. The patients LOC may be affected by hypoxia, but not every change in LOC is related to oxygenation. Hemoglobin, hematocrit, and red blood cell levels do not directly reflect current oxygenation status.
An adult patient has tested positive for tuberculosis (TB). While providing patient teaching, what information should the nurse prioritize?
A) The importance of adhering closely to the prescribed medication regimen
B) The fact that the disease is a lifelong, chronic condition that will affect ADLs
C) The fact that TB is self-limiting, but can take up to 2 years to resolve
D) The need to work closely with the occupational and physical therapists
Ans: A
Feedback:
Successful treatment of TB is highly dependent on careful adherence to the medication regimen. The disease is not self-limiting; occupational and physical therapy are not necessarily indicated. TB is curable.
The nurse is assessing an adult patient following a motor vehicle accident. The nurse observes that the patient has an increased use of accessory muscles and is complaining of chest pain and shortness of breath. The nurse should recognize the possibility of what condition? A) Pneumothorax B) Anxiety C) Acute bronchitis D) Aspiration
Ans: A
Feedback:
If the pneumothorax is large and the lung collapses totally, acute respiratory distress occurs. The patient is anxious, has dyspnea and air hunger, has increased use of the accessory muscles, and may develop central cyanosis from severe hypoxemia. These symptoms are not definitive of pneumothorax, but because of the patients recent trauma they are inconsistent with anxiety, bronchitis, or aspiration.
The nurse at a long-term care facility is assessing each of the residents. Which resident most likely faces the greatest risk for aspiration?
A) A resident who suffered a severe stroke several weeks ago
B) A resident with mid-stage Alzheimers disease
C) A 92-year-old resident who needs extensive help with ADLs
D) A resident with severe and deforming rheumatoid arthritis
Ans: A
Feedback:
Aspiration may occur if the patient cannot adequately coordinate protective glottic, laryngeal, and cough reflexes. These reflexes are often affected by stroke. A patient with mid-stage Alzheimers disease does not likely have the voluntary muscle problems that occur later in the disease. Clients that need help with ADLs or have severe arthritis should not have difficulty swallowing unless it exists secondary to another problem.
The nurse is caring for a patient suspected of having ARDS. What is the most likely diagnostic test ordered in the early stages of this disease to differentiate the patients symptoms from those of a cardiac etiology? A) Carboxyhemoglobin level B) Brain natriuretic peptide (BNP) level C) C-reactive protein (CRP) level D) Complete blood count
Ans: B
Feedback:
Common diagnostic tests performed for patients with potential ARDS include plasma brain natriuretic peptide (BNP) levels, echocardiography, and pulmonary artery catheterization. The BNP level is helpful in distinguishing ARDS from cardiogenic pulmonary edema. The carboxyhemoglobin level will be increased in a client with an inhalation injury, which commonly progresses into ARDS. CRP and CBC levels do not help differentiate from a cardiac problem.
The nurse is caring for a patient at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the patient. What is an example of a first-line measure to minimize atelectasis?
A) Incentive spirometry
B) Intermittent positive-pressure breathing (IPPB)
C) Positive end-expiratory pressure (PEEP)
D) Bronchoscopy
Ans: A
Strategies to prevent atelectasis, which include frequent turning, early ambulation, lung-volume expansion maneuvers (deep breathing exercises, incentive spirometry), and coughing, serve as the first- line measures to minimize or treat atelectasis by improving ventilation. In patients who do not respond to first-line measures or who cannot perform deep-breathing exercises, other treatments such as positive end-expiratory pressure (PEEP), continuous or intermittent positive-pressure breathing (IPPB), or bronchoscopy may be used.
While planning a patients care, the nurse identifies nursing actions to minimize the patients pleuritic pain.
Which intervention should the nurse include in the plan of care?
A) Avoid actions that will cause the patient to breathe deeply.
B) Ambulate the patient at least three times daily.
C) Arrange for a soft-textured diet and increased fluid intake.
D) Encourage the patient to speak as little as possible
Ans: A
Feedback:
The key characteristic of pleuritic pain is its relationship to respiratory movement. Taking a deep breath, coughing, or sneezing worsens the pain. A soft diet is not necessarily indicated and there is no need for the patient to avoid speaking. Ambulation has multiple benefits, but pain management is not among them.
The perioperative nurse is writing a care plan for a patient who has returned from surgery 2 hours prior. Which measure should the nurse implement to most decrease the patients risk of developing pulmonary emboli (PE)?
A) Early ambulation
B) Increased dietary intake of protein
C) Maintaining the patient in a supine position
D) Administering aspirin with warfarin
Ans: A
Feedback:
For patients at risk for PE, the most effective approach for prevention is to prevent deep vein thrombosis. Active leg exercises to avoid venous stasis, early ambulation, and use of elastic compression stocking are general preventive measures. The patient does not require increased dietary intake of protein directly related to prevention of PE, although it will assist in wound healing during the postoperative period. The patient should not be maintained in one position, but frequently repositioned, unless contraindicated by the surgical procedure. Aspirin should never be administered with warfarin because it will increase the patients risk for bleeding.
The school nurse is presenting a class on smoking cessation at the local high school. A participant in the class asks the nurse about the risk of lung cancer in those who smoke. What response related to risk for lung cancer in smokers is most accurate?
A) The younger you are when you start smoking, the higher your risk of lung cancer.
B) The risk for lung cancer never decreases once you have smoked, which is why smokers need annual chest x-rays.
C) The risk for lung cancer is determined mostly by what type of cigarettes you smoke.
D) The risk for lung cancer depends primarily on the other risk factors for cancer that you have.
Ans: A
Feedback:
Risk is determined by the pack-year history (number of packs of cigarettes used each day, multiplied by the number of years smoked), the age of initiation of smoking, the depth of inhalation, and the tar and nicotine levels in the cigarettes smoked. The younger a person is when he or she starts smoking, the greater the risk of developing lung cancer. Risk declines after smoking cessation. The type of cigarettes is a significant variable, but this is not the most important factor.
The nurse is assessing a patient who has a 35 pack-year history of cigarette smoking. In light of this known risk factor for lung cancer, what statement should prompt the nurse to refer the patient for further assessment?
A) Lately, I have this cough that just never seems to go away.
B) I find that I dont have nearly the stamina that I used to.
C) I seem to get nearly every cold and flu that goes around my workplace.
D) I never used to have any allergies, but now I think Im developing allergies to dust and pet hair.
Ans: A
Feedback:
The most frequent symptom of lung cancer is cough or change in a chronic cough. People frequently ignore this symptom and attribute it to smoking or a respiratory infection. A new onset of allergies, frequent respiratory infections and fatigue are not characteristic early signs of lung cancer.
A client presents to the walk-in clinic complaining of a dry, irritating cough and production of a minute amount of mucus-like sputum. The patient complains of soreness in her chest in the sternal area. The nurse should suspect that the primary care provider will assess the patient for what health problem? A) Pleural effusion B) Pulmonary embolism C) Tracheobronchitis D) Tuberculosis
Ans: C
Feedback:
Initially, the patient with tracheobronchitis has a dry, irritating cough and expectorates a scant amount of mucoid sputum. The patient may report sternal soreness from coughing and have fever or chills, night sweats, headache, and general malaise. Pleural effusion and pulmonary embolism do not normally cause sputum production and would likely cause acute shortness of breath. Hemoptysis is characteristic of TB.
A hospital has been the site of an increased incidence of hospital-acquired pneumonia (HAP). What is an important measure for the prevention of HAP?
A) Administration of prophylactic antibiotics
B) Administration of pneumococcal vaccine to vulnerable individuals
C) Obtaining culture and sensitivity swabs from all newly admitted patients
D) Administration of antiretroviral medications to patients over age 65
Ans: B
Pneumococcal vaccination reduces the incidence of pneumonia, hospitalizations for cardiac conditions, and deaths in the general older adult population. A onetime vaccination of pneumococcal polysaccharide vaccine (PPSV) is recommended for all patients 65 years of age or older and those with chronic diseases. Antibiotics are not given on a preventative basis and antiretroviral medications do not affect the most common causative microorganisms. Culture and sensitivity testing by swabbing is not performed for pneumonia since the microorganisms are found in sputum.
When assessing for substances that are known to harm workers lungs, the occupational health nurse should assess their potential exposure to which of the following? A) Organic acids B) Propane C) Asbestos D) Gypsum
Ans: C
Feedback:
Asbestos is among the more common causes of pneumoconiosis. Organic acids, propane, and gypsum do not have this effect.
A patient presents to the ED stating she was in a boating accident about 3 hours ago. Now the patient has complaints of headache, fatigue, and the feeling that he just cant breathe enough. The nurse notes that the patient is restless and tachycardic with an elevated blood pressure. This patient may be in the early stages of what respiratory problem? A) Pneumoconiosis B) Pleural effusion C) Acute respiratory failure D) Pneumonia
Ans: C
Feedback:
Early signs of acute respiratory failure are those associated with impaired oxygenation and may include restlessness, fatigue, headache, dyspnea, air hunger, tachycardia, and increased blood pressure. As the hypoxemia progresses, more obvious signs may be present, including confusion, lethargy, tachycardia, tachypnea, central cyanosis, diaphoresis, and, finally, respiratory arrest. Pneumonia is infectious and would not result from trauma. Pneumoconiosis results from exposure to occupational toxins. A pleural effusion does not cause this constellation of symptoms.
