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Flashcards in Respiratory Deck (7):
1

A nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and who becomes dyspneic. The nurse should take which action?

A: Instruct to breathe into a paper bag

B: Assist pt w/pursed-lip breathing

C: PLace pt in low Fowler's position

D: Administer O2 at 6L/min via NC

Pursed-lip breathing should be encouraged during periods of dyspnea in COPD to control rate and depth of respiration, to prevent alveolar collapse and to improve respiratory muscle coordination. Clients with COPD are usually on lower doses of oxygen, titrated to maintain an oxygen saturation of 88-91%. Semi-Fowler's position is usually most comfortable for someone with COPD, because this position allows the client's diaphragm to expand.

2

Nursing students are reviewing the various types of oxygen delivery systems. Which oxygen delivery system is the most accurate?

A: NC

B: PArtial nonrebreather mask

C: Simple face mask

D: Venturi mask

D: Venturi Mask

The most accurate way to deliver oxygen to the client is through a Venturi system such as the Venti Mask. The Venti Mask is a high flow device that entrains room air into a reservoir device on the mask and mixes the room air with 100% oxygen. The size of the opening to the reservoir determines the concentration of oxygen. The client’s respiratory rate and respiratory pattern do not affect the concentration of oxygen delivered. The maximum amount of oxygen that can be delivered by this system is 55%.

3

A nurse is teaching home care to the parents of a child diagnosed with acute spasmodic croup. What type of care would be most important to emphasize?

A: Humidified air w/an increase in oral fluids

B: Antihistamines to decrease allergic response

C: Abx tx for 10-14 days

D: Sedation as needed to prevent exhaustion

A: Humidified air w/an increase in oral fluids

The most important aspects of home care for a child diagnosed with acute spasmodic croup are humidified air and increased oral fluids. Humidified air helps reduce vocal cord swelling. Taking the child out into the cool night air for 10 to 15 minutes can also reduce night time symptoms. Adequate systemic hydration aids mucociliary clearance by keeping secretions thin and easy to remove with minimal coughing effort.

4

A nurse is teaching an older adult client to use a metered-dose inhaler (MDI) and is concerned that the client is unable to coordinate the release of the medication with the inhalation phase. What should the nurse recommend to improve the delivery of the medication?

A: Request a visiting nurse to follow the client at home

B: Add a spacer device to the MDI canister

C: Ask a family member to assist the client with the MDI

D: Nebulized treatments for home care

B: Add a spacer device to the MDI canister


Use of a spacer is especially useful with older adults because it allows more time to inhale and requires less eye-hand coordination. If the client is not using the MDI properly, the medication can get trapped in the upper airway with an outcome of a dry mouth and throat irritation. Using a spacer will allow more drug to be deposited in the lungs and less in the mouth.

5

A nurse is preparing a client for discharge following inpatient treatment for pulmonary tuberculosis (TB). Which of these instructions should be given to the client?

A: Take medication with aluminum hydroxide (Amphojel) if epigastric distress occurs

B: Avoid contact with children, pregnant women or immunosupressed persons

C: Continue taking medications as prescribed

D: Continue taking medications until findings are relieved

C: Continue taking medications as prescribed

Early cessation of treatment may lead to development of drug resistant TB. Active TB is usually treated with a combination of four different antibiotics (isoniazid, rifampin, ethambutol and pyrazinamide) and can take anywhere from 6 to 12 months to completely kill the bacteria. As with any antibiotics, clients should continue to take medications even after they begin to feel better. There is no reason to avoid contact with children, pregnant women or immunosupressed persons once discharged from the hospital and adhering to medication schedule. Isoniazid should be taken on an empty stomach; ethambutol can be taken with food to avoid stomach upset. If taken with TB medications, Amphojel will interfere with absorption of these medications.

6

A nurse is teaching a client with asthma about the correct use of the fluticasone inhaler (Flovent Diskus). Which statement, if made by the client, would indicate that the teaching was effective?

"The inhaler can be used whenever I feel short of breath."

"I should not use a spacer with my inhaler."

"If I forget a dose, I can double up on the next dose."

"I should rinse my mouth after using the inhaler."

"I should rinse my mouth after using the inhaler."

Fluticasone inhaled (Flovent Diskus) is an inhaled corticosteroid used to prevent asthma attacks. It is often used in conjunction with a bronchodilator. The client should be instructed to rinse the mouth after using the inhaler to wash away any steroid residue so as to reduce the risk of oral fungal infections.

7

The nurse is performing an assessment on an infant with severe airway obstruction. Which assessment finding would the nurse anticipate?

Rapid, shallow respirations

Chest pain aggravated by respiratory movement

Nasal flaring

Cyanosis and mottling of the skin

Nasal flaring

When the trachea or bronchioles become partially blocked, air flow is restricted. Nasal flaring is an exaggerated opening and closing of the nostrils with breathing, and is considered a subtle but important sign of acute respiratory distress in an infant. This is an emergency and requires rapid medical intervention.