Lewis Ch-30: Lower Respiratory Problems Flashcards
(43 cards)
Following assessment of a client with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which of the following information best supports this diagnosis?
a. Weak, nonproductive cough effort
b. Large amounts of greenish sputum
c. Respiratory rate of 28 breaths/minute
d. Resting pulse oximetry of 85%
a. Weak, nonproductive cough effort
The nurse is conducting a chest assessment on a client with pneumococcal pneumonia. Which of the following findings should the nurse expect to assess?
a. Vesicular breath sounds
b. Increased tactile fremitus
c. Dry, nonproductive cough
d. Hyper-resonance to percussion
b. Increased tactile fremitus
Tactile fremitus
This is the vibration you feel when a patient speaks—like when you place your hands on their chest and make them say something exciting like “99” (a tragically boring number chosen by medical tradition and zero imagination).
Normally, sound waves travel well through solids, less so through air, and even worse through fluids like in pleural effusion. So:
• In pneumonia, you get consolidation—solid gunk (pus, bacteria, white blood cells) filling the alveoli.
• That denser stuff actually transmits vibration better, so you feel increased tactile fremitus
The nurse is caring for a client with bacterial pneumonia who has pleurisy. which of the following actions should the nurse implement to promote airway clearance?
a. Assist the client to splint the chest when coughing.
b. Educate the client about the need for fluid restrictions
c. Encourage the client to wear the nasal oxygen cannula.
d. Instruct the client on the pursed lip breathing technique.
a. Assist the client to splint the chest when coughing.
Pleurisy = inflammation of the pleura, which is the lining around your lungs. It’s like your lungs are wearing clingy, irritated saran wrap.
• Every time you breathe, that inflamed lining rubs against itself.
• The result? Stabbing chest pain with each breath or cough.
• It’s basically your lungs going, “Could you not?”
Pleurisy often shows up when you’ve got pneumonia, viral infections, or just bad life choices and worse luck.
⸻
And “splint the chest”? No, it’s not putting a literal splint on your ribs like a DIY cast.
Splinting means:
• The patient hugs a pillow, or holds their hands over the painful spot, to support the chest wall while coughing.
• It reduces pain and makes it easier to actually cough up the gross stuff (which is the point of this entire tragic lung party).
Because without splinting, the pain from pleurisy makes patients go:
“Oh, never mind, I’ll just not cough.”
Which = mucus buildup = more infection = deeper hole of lung regret.
⸻
TL;DR:
• Pleurisy = angry lung lining, stabbing pain.
• Splinting the chest = giving your ribs a hug so you can cough without screaming.
The nurse is providing teaching to a client with pneumonia. Which of the following client statements indicates a good understanding of the discharge instructions given by the nurse?
a. “I will call the doctor if I still feel tired after a week.”
b. “I will need to use home oxygen therapy for 3 months.”
c. “I will continue to do the deep-breathing and coughing exercises at home.”
d. “I will schedule two appointments for the pneumonia and influenza vaccines.”
d. “I will schedule two appointments for the pneumonia and influenza vaccines.”
Bingo. Yes, once you’ve had pneumonia, your lungs are like, “Cool trauma, let’s never recover properly.” So yes, you are more likely to get it again — especially if you:
• Are over 65
• Have a chronic illness (like COPD, asthma, diabetes, heart failure — basically a full bingo card of medical conditions)
• Smoke, vape, or just breathe in an aggressively urban area
• Have a weakened immune system (from meds, diseases, or the sheer stress of daily life)
Also, post-pneumonia lungs are kind of like a cluttered garage — less efficient, more prone to messes, and easily overwhelmed when another infection shows up uninvited (like influenza or COVID-19).
That’s why getting both the pneumococcal vaccine and the flu shot is like hiring bouncers for your lungs — they might not stop everything, but they’ll keep the worst repeat offenders from waltzing back in and trashing the plac
Which of the following nursing actions is most effective in preventing aspiration pneumonia in clients who are at risk?
a. Turn and reposition immobile clients at least every 2 hours
b. Place clients with altered consciousness in side-lying positions.
c. Monitor for respiratory symptoms in clients who are immuno-suppressed.
d. Provide for continuous subglottic aspiration in clients receiving enteral feedings.
b. Place clients with altered consciousness in side-lying positions.
When a patient has altered consciousness, their protective reflexes (like gagging and coughing) are on a coffee break. If they aspirate—whether it’s secretions, vomit, or food—their lungs become the world’s worst soup pot. That’s aspiration pneumonia just waiting to RSVP.
Side-lying position (a.k.a. lateral) helps:
• Drain secretions from the mouth/throat
• Prevent them from trickling into the trachea
• Keep your patient from literally inhaling their own dinner
The nurse is caring for a client with right lower-lobe pneumonia who has been treated with intravenous (IV) antibiotics for 2 days. Which of the following assessment data obtained by the nurse indicates that the treatment has been effective?
a. Bronchial breath sounds are heard at the right base.
b. The client coughs up small amounts of green mucus.
c. The client’s white blood cell count is 9 x 10^9/L
d. Increased tactile fremitus is palpable over the right chest.
c. The client’s white blood cell count is 9 x 10^9/L
The health care provider writes a prescription for bacteriological testing for a client who has a positive tuberculosis skin test. Which of the following actions should the nurse take?
a. Repeat the tuberculin skin testing
b. Teach about the reason for the blood tests
c. Obtain consecutive sputum specimens from the client for 3 days
d. Instruct the client to expectorate three specimens as soon as possible.
c. Obtain consecutive sputum specimens from the client for 3 days
Right, so if someone has a positive TB skin test, the next step isn’t to poke them again or panic — it’s to confirm active infection by checking their sputum for the bacteria.
The gold standard:
Three early morning sputum samples on three consecutive days.
Because M. tuberculosis is a diva and doesn’t always show up on the first try.
Which of the following information about a client who has a recent hx of tuberculosis indicates that the nurse can discontinue airborne isolation precautions?
a. Chest x-ray shows no upper lobe infiltrates
b. TB medications have been taken for 6 months
c. Mantoux testing shows an induration of 10 mm.
d. Three sputum smears for acid-fast bacilli are negative.
d. Three sputum smears for acid-fast bacilli are negative.
The nurse is providing teaching to a client with pulmonary tuberculosis (TB) regarding the transmission of TB. Which of the following client actions indicates that the teaching had been effective?
a. Demonstrates correct us of a nebulizer
b. Washes dishes and personal items after use.
c. Covers the mouth and nose when coughing
d. Reports daily to the public health department
c. Covers the mouth and nose when coughing
Which of the following information should the nurse include in the teaching plan for a client who is receiving rifampin for treatment of tuberculosis?
a. “your urine, sweat, and tears will be orange colored.”
b. “read a newspaper daily to check for changes in vision.”
c. “Take vitamin b6 daily to prevent peripheral nerve damage.”
d. “Call the health care provider if you notice any hearing loss.”
a. “your urine, sweat, and tears will be orange colored.”
The nurse is teaching a client who is receiving standard multidrug therapy for tuberculosis (TB) about possible toxic effects of the antitubercular medications. Which of the following findings should the nurse instruct the client to report to the health care provider?
a. Yellow-tinged skin
b. Changes in hearing
c. Orange-coloured sputum
d. Thickening of the fingernails
a. Yellow-tinged skin
The nurse is caring for clients with active tuberculosis who misuse alcohol and/or are homeless. Which of the following interventions by the nurse will be most effective in ensuring adherence with the treatment regimen?
a. Educating the client about the long-term impact of TB on health
b. Giving the client written instructions about how to take the medications
c. Teaching the client about the high risk for infecting others unless treatment is followed
d. Arranging for a daily noontime meal at a community centre and giving the medication then
d. Arranging for a daily noontime meal at a community centre and giving the medication then
After 2 months of tuberculosis treatment with a standard four-drug regimen, a client continues to have positive sputum smears for acid-fast bacilli. Which of the following actions should the nurse take next?
a. Ask the client whether medications have been taken as directed.
b. Discuss the need to use some different medications to treat the TB.
c. Schedule the client for directly observed therapy 3x weekly.
d. Educate about using a 2-drug regimen for the last 4 months of treatment.
a. Ask the client whether medications have been taken as directed.
A staff nurse has a tuberculosis skin test of 16mm induration. A chest radiograph is negative, and the nurse has no symptoms of TB. Which of the following information should the occupational health nurse provide to the staff nurse?
a. Use and adverse effects of isoniazid
b. Standard four-drug therapy for TB
c. Need for annual repeat TB skin testing
d. Bacille Calmette-guerin (BCG) vaccine
a. Use and adverse effects of isoniazid
The nurse is caring for a client who is hospitalized with active TB and the nurse observes a family member who is visiting the client. Which of the following actions by the visitor should cause the nurse to intervene?
a. Washes hands before entering the client’s room
b. Hands the client a tissue from the box at the bedside
c. Puts on a surgical face mask before visiting the client
d. Brings food from a “fast-food” restaurant to the client
c. Puts on a surgical face mask before visiting the client
A high-efficiency particulate air (HEPA) mask, rather than a standard surgical mask, should be used when entering the clients room because HEPA mask can filter out 100% of small airborne particles.
Which of the following actions by the occupational health nurse at a manufacturing plant where there is potential exposure to inhaled dust is most helpful in reducing incidence of lung disease?
a. Teach about symptoms of lung disease
b. Treat workers who inhale dust particles
c. Monitor workers for shortness of breath
d. Require the use of protective equipment
d. Require the use of protective equipment
The nurse is developing a teaching plan for a client with a 42-pack-year history of cigarette smoking. Which of the following information should the nurse include in the plan of care?
a. Computed tomography (CT) screening for lung cancer
b. Options for smoking cessation
c. Reasons for annual sputum cytology testing
d. Erlotinub therapy to prevent tumour risk
b. Options for smoking cessation
The nurse is caring for a client with stage 1 non-small cell lung cancer who is scheduled for a lobectomy. The client tells the nurse “I would rather have radiation than surgery.” Which of the following responses by the nurse is best?
a. “are you afraid that the surgery will be very painful”
b. “Did you have bad experiences with previous surgeries”
c. “Surgery is the treatment of choice for stage 1 lung cancer”
d. “tell me what you know about the carious treatments available”
d. “tell me what you know about the carious treatments available”
The nurse is caring for a client who had a thoracotomy 1 hour ago and reports incisional pain at a level 7 out of 10 and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which of the following actions is best for the nurse to take next?
a. Administer the prescribed PRN morphine
b. Assist the client to deep breath and cough
c. Milk the chest tube gently to remove any clots
d. Tape the area around the insertion site of the chest tube
a. Administer the prescribed PRN morphine
A client with newly diagnosed lung cancer tells the nurse, “I think I am going to die pretty soon.” Which of the following responses by the nurse is best?
a. “Would you like to talk to the hospital chaplain about your feelings”
b. “Can you tell me what it is that makes you think you will die so soon?”
c. “Are you afraid that the treatment for your cancer will not be effective?”
d. “Do you think that taking an antidepressant medication would be helpful?”
b. “Can you tell me what it is that makes you think you will die so soon?”
The health care provider inserts a chest tube in a client with a hemopneumothorax. When monitoring the client after the chest tube placement, which of the following findings is of greatest concern?
a. A large air leak in the water-seal chamber
b. 400 mL of blood in the collection chamber
c. Complaint of pain with each deep inspiration
d. Subcutaneous emphysema at the insertion site
b. 400 mL of blood in the collection chamber
The nurse is caring for a client who has a steering wheel injury as a result of an automobile accident. Which of the following findings should be of most concern to the nurse during the initial assessment?
a. Paradoxical chest movement
b. The complaint of chest wall pain
c. A heart rate of 110 beats/minute
d. A large bruised area on the chest
a. Paradoxical chest movement
The nurse is assessing a client who has just arrived after an automobile accident and the nurse notes that the breath sounds are absent on the right side. Which of the following actions should the nurse anticipate?
a. Emergency pericardiocentesis
b. Stabilization of the chest wall with tape
c. Administration of an inhaled bronchodilator
d. Insertion of a chest tube with a chest drainage system
d. Insertion of a chest tube with a chest drainage system
The nurse is caring for a client who has a right-sided chest tube following a thoracotomy and has continuous bubbling in the suction-control chamber of the collection device. Which of the following actions should the nurse implement?
a. Document the presence of a large air leak.
b. Obtain and attache a new collection device
c. Notify the surgeon of a possible pneumothorax
d. Take no further action with the collection device
d. Take no further action with the collection device
