Lower Respiratory Problems Flashcards
(15 cards)
A patient is transported to the emergency department by the emergency response system (ERS) with a sudden change in mental status and a feeling of impending doom. The nurse reviews the patient’s medical history and notes recent international air travel. The nurse suspects that the patient is experiencing which condition?
1-Pneumonia
2-Unstable angina
3-Pulmonary embolism (PE)
4-Chronic obstructive pulmonary disease (COPD) exacerbation
3-Pulmonary embolism (PE)
The symptoms and history are indicative of massive PE. Massive PE may cause a sudden change in mental status, hypotension, and feelings of impending doom. Risk factors include prolonged air travel. Pneumonia would be evident if the patient had a fever; elevated white blood cell count; and a productive cough with yellow, green, or rust-colored sputum. Unstable angina would present with chest pain occurring at rest; COPD exacerbation would present with wheezing, cough, and shortness of breath.
A patient presents to the emergency department with a temperature of 101.4°F (38.6°C) and a productive cough with rust-colored sputum. The nurse suspects which diagnosis?
1-Tuberculosis
2-Pneumonia
3-Acute bronchitis
4-Congestive heart failure (CHF)
2-Pneumonia
Sputum associated with pneumonia may be green, yellow, or even rust colored (bloody). Tuberculosis frequently presents with a dry cough. With acute bronchitis, clear sputum is often present, although some patients have purulent sputum. Pink, frothy sputum would be present in CHF and pulmonary edema.
The nurse is caring for a patient with a diagnosis of active tuberculosis (TB) and anticipates that which item will be included in the patient’s treatment plan?
1-Use directly observed therapy only in the initial phase.
2-Administer drug therapy in three phases (initial, interim, and continuation).
3-Initiate liver function tests (LFTs) 14 days after the start of treatment.
4-Avoid alcohol because it increases the hepatotoxicity associated with isoniazid (INH).
4-Avoid alcohol because it increases the hepatotoxicity associated with isoniazid (INH).
Alcohol must be avoided because it increases the hepatotoxicity of INH. Directly observed therapy must be continued through both phases in patients who are at risk for noncompliance with drug therapy. Drug therapy includes a two-phase process, with an initial and continuation phase. Baseline LFTs are done before treatment is begun and then monitored monthly.
A patient’s initial purified protein derivative (PPD) skin test result is positive. A repeat skin test is also positive. No signs or symptoms of tuberculosis or allergies are evident. Which medication therapy does the nurse anticipate will be prescribed?
1-Penicillin
2-Isoniazid (INH)
3-Theophylline
4-INH plus an antibiotic
2-Isoniazid (INH)
The standard treatment regimen for latent tuberculosis infection (LTBI) is nine months of daily isoniazid. It is an effective and inexpensive drug that the patient can take orally. Penicillin and theophylline would not be prescribed for the treatment of TB exposure. INH plus an antibiotic would not likely be prescribed for this scenario.
A patient is admitted to an intensive care unit in stable condition with suspected acute pulmonary embolism (PE). The nurse prepares for the administration of which medication?
1-Oral apixaban
2-IV alteplase
3-Subcutaneous enoxaparin
4-IV unfractionated heparin
3-Subcutaneous enoxaparin
Immediate anticoagulation is required for patients with PE. Subcutaneous administration of low-molecular-weight heparin (LMWH) (e.g., enoxaparin [Lovenox]) or fragmin [Dalteparin] or fondaparinux) is the recommended treatment for patients with acute PE. Subcutaneous administration of LMWH has been found to be safer and more effective than the use of unfractionated heparin. Oral warfarin (vs. apixaban) is the most widely used oral anticoagulant. Warfarin should be given for at least three months and then reevaluated. Thrombolytic therapy (e.g., alteplase) to treat PE is prescribed in cases of hemodynamic instability and right ventricular dysfunction.
The health care provider prescribes IV vancomycin for a patient with pneumonia. Which action does the nurse perform first?
1-Obtain a full set of vital signs.
2-Obtain sputum cultures for sensitivity.
3-Educate the patient about the adverse effects associated with the medication.
4-Draw a blood specimen to evaluate the white blood cell count.
2-Obtain sputum cultures for sensitivity.
The nurse should ensure that the sputum for culture and sensitivity has been sent to the laboratory before administering the antibiotic. It is important that the organisms be correctly identified (in the culture) before their numbers are affected by the antibiotic; the test also will determine whether the proper antibiotic has been prescribed (sensitivity testing). Vital signs, education, and white blood cell count measurement can be assessed following the obtainment of sputum cultures.
The nurse observes another staff member providing care for a patient who has a chest tube in place. Which action by the staff member may result in increased air in the pleural space and requires the nurse to intervene?
1-Clamps the chest tube while ambulating the patient in the hallway
2-Seals the wound around the chest tube with a petroleum (airtight) gauze
3-Moves the clamp down the tubing while assessing for an air leak
4-Provides instructions related to bearing down when the tube is removed
1-Clamps the chest tube while ambulating the patient in the hallway
Clamping of chest tubes during transport or when the tube is accidentally disconnected is no longer advocated. The danger of rapid accumulation of air in the pleural space, causing tension pneumothorax, is far greater than that of a small amount of atmospheric air that enters the pleural space. Most health care providers prefer to seal the wound around the chest tube with petroleum (airtight) gauze. Moving the clamp down the tubing to assess for an air leak is brief and will not cause an accumulation of air in the pleural space. Bearing down (Valsalva maneuver) during tube removal prevents air from entering the pleural space.
A nursing student asks the nurse how much drainage from a patient’s chest tube warrants the need to contact the health care provider (HCP). Which criterion does the nurse give to the student?
1-If the drainage increases by 25% in one hour
2-If the drainage system is overturned and the amount is inaccurate
3-If the collection chamber is full
4-If the drainage is greater than 100 mL/hr
4-If the drainage is greater than 100 mL/hr
The nurse should report any change in the quantity or characteristics of drainage (e.g., clear yellow to bloody) to the HCP and record the change. The nurse should notify the HCP if drainage is greater than 100 mL/hr. There are no guidelines for drainage percentage changes that warrant notification of the HCP. The nurse should change the unit if the collection chamber is full. If the drainage system is overturned and the water seal is disrupted, the nurse should return it to an upright position and encourage the patient to take a few deep breaths, followed by forced exhalations and cough maneuvers.
The nurse finds that a patient with chest trauma exhibits cyanosis, air hunger, neck vein distention, and an increase in intrathoracic pressure. The nurse prepares for which procedure?
1-Pericardiocentesis
2-Needle decompression
3-Insertion of a chest tube with a flutter valve
4-Insertion of a chest tube with a drainage system
2-Needle decompression
Cyanosis, air hunger, extreme agitation, subcutaneous emphysema, neck vein distention, hyperresonance to percussion, and tracheal deviation away from affected side (late sign) are manifestations of a tension pneumothorax in a patient with chest trauma. A tension pneumothorax is a complication associated with the presence of excess air in the pleural thorax that cannot escape and is treated with needle decompression. Pericardiocentesis is helpful in aspirating fluid from the pleural space, which is more useful in cases of cardiac tamponade. Insertion of a chest tube with a flutter valve or a chest tube with drainage are techniques that help to drain air from the lung. However, these techniques are performed after needle decompression.
The nurse provides education for a patient about reducing the risk of atelectasis while undergoing chest tube drainage. Which statements made by the patient indicate effective learning? Select all that apply.
1-“I should change positions slowly.”
2-“I should cough at regular intervals.”
3-“I should use my incentive spirometer.”
4-“I should reduce the intake of protein in my diet.”
5-“I should perform range-of-motion exercises.”
2-“I should cough at regular intervals.”
3-“I should use my incentive spirometer.”
5-“I should perform range-of-motion exercises.”
Nursing care and patient teaching can minimize the risk of atelectasis. The nurse should encourage coughing, deep breathing, incentive spirometer use, and range-of-motion exercises. The nurse instructs the patient to change position slowly if he or she has hypotension. Protein is essential and does not reduce the risk of atelectasis.
A patient presents with a traumatic hemothorax. Which immediate action does the nurse take?
1-Call the Code Blue team.
2-Administer an autotransfusion.
3-Assist the health care provider with needle decompression.
4-Assist the health care provider in inserting a chest tube.
4-Assist the health care provider in inserting a chest tube.
A hemothorax is an accumulation of blood in the pleural space resulting from injury to the chest wall, lung, blood vessels, diaphragm, or mediastinum. The patient with a traumatic hemothorax needs immediate insertion of a chest tube for evacuation of the blood. The Code Blue team is called if a patient experiences a respiratory or cardiac arrest. An autotransfusion cannot occur until the blood has been collected in the chest drainage unit (CDU). A needle decompression is the treatment for a tension pneumothorax.
The nurse provides which information about the water-seal chamber on a chest drainage unit (CDU) when educating a group of nursing students?
1-It contains 2 cm of water.
2-It acts as a two-way valve.
3-It receives fluid and air from the pleural space.
4-It applies suction to the chest drainage system.
1-It contains 2 cm of water.
The water-seal chamber is the second chamber of the chest drainage system. It contains 2 cm of water, which acts as a one-way valve. The first chamber of the drainage system receives fluid and air from the pleural space. The third chamber applies suction to the chest drainage system.
Which disorder would the nurse recognize as the most likely cause of cor pulmonale?
1-Liver failure
2-Renal failure
3-Left ventricular failure
4-Chronic obstructive pulmonary disease (COPD)
4-Chronic obstructive pulmonary disease (COPD)
The most common cause of cor pulmonale is COPD. Left ventricular failure is not a likely cause of cor pulmonale. Cor pulmonale, by definition, is enlargement of the right ventricle caused by a primary disorder of the respiratory system. Renal failure may eventually result from the disease process but is not a cause of cor pulmonale. Liver failure may or may not eventually result from the disease process but is not a cause of cor pulmonale.
A patient with heart failure has a pulmonary arterial pressure of 28 mm Hg when at rest. Which intervention would the nurse implement?
1-Supplying oxygen to the patient
2-Infusing IV fluids to the patient
3-Applying warm and cold compresses to the patient
4-Positioning the patient at an angle of 90°
1-Supplying oxygen to the patient
A patient with heart failure and a pulmonary arterial pressure of 28 mm Hg when at rest may have pulmonary hypertension. This may lead to hypoxia; therefore the patient must be supplied with low oxygen flow to provide symptomatic relief. Positioning the patient at an angle of 90° indicates full Fowler’s position, which may exacerbate symptoms in this patient. IV fluid infusion may not relieve the patient’s symptoms. Warm and cold compresses may benefit the patient with chest pain.
The nurse is assisting the health care provider with a chemical pleurodesis for a patient with a pleural effusion. Arrange the series of actions in chronological order.
- -Install chemical slurry.
- -Provide chest tube drainage.
- -Attach chest tube to drainage unit.
- -Drain until no air leaks are noticed.
- -Turn the patient in different positions.
- -Install chemical slurry.
- -Turn the patient in different positions.
- -Attach chest tube to drainage unit.
- -Provide chest tube drainage.
- -Drain until no air leaks are noticed.
Chemical pleurodesis is a procedure that requires chest tube drainage in the patient with pleural effusion. Installation of chemical slurry, such as talc or doxycycline and bleomycin, can drain the fluids from the pleural cavity. The tube is clamped for eight hours, and the patient is situated in different positions to allow the chemical to cleanse the entire pleural space. Then the tube is unclamped and attached to the drainage unit to drain out no more than 150 mL per day and until no air leaks are noticed.
