Flashcards in respiratory Deck (131):
In relation to the structure of the larynx, the cricoid cartilage is
the only complete cartilaginous ring in the larynx.
Which respiratory volume is the maximum volume of air that can be inhaled after maximal expiration?
Inspiratory reserve volume
A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess?
A client arrives in the emergency department reporting shortness of breath. She has 3+ pitting edema below the knees, a respiratory rate of 36 breaths per minute, and heaving respirations. The nurse auscultates the client's lungs to reveal coarse, moist, high-pitched, and non-continuous sounds that do not clear with coughing. The nurse will document these sounds as which type?
A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is:
"Have you tried to quit smoking before?"
A nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? Choose all that apply.
To help prevent infections in clients with COPD, the nurse should recommend vaccinations against two bacterial organisms. Which of the following are the two vaccinations?
Streptococcus pneumonia and Haemophilus influenzae
A nurse has just completed teaching with a patient who has been prescribed a meter-dosed inhaler for the first time. Which of the following statements would the nurse use to initiate further teaching and follow-up care?
"I do not need to rinse my mouth with this type of inhaler."
A nursing student understands that emphysema is directly related to which of the following?
Respiratory acidosis from airway obstruction
Which of the following alveolar cells secrete surfactant?
Millions of alveoli form most of the pulmonary mass. The squamous epithelial cells lining each alveolus consist of different types of cells. Which type of alveolar cells produce surfactant?
Type II cells
A client with newly diagnosed emphysema is admitted to the medical-surgical unit for evaluation. Which does the nurse recognize as a deformity of the chest wall that occurs as a result of overinflation of the lungs in this client population?
The nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurement best reflects the adequacy of alveolar ventilation?
PaCO2, when the minute ventilation falls, alveolar ventilation in the lungs also decreases, and the PaCO2 increases.
The nurse is instructing the patient on the collection of a sputum specimen. What steps should be included in the instructions?
Initially, clear the nose and throat.
Take a few deep breaths before coughing.
Use diaphragmatic contractions to aid in the expulsion of sputum.
Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse’s concern? Name three.
Compromised gas exchange
A child is having an asthma attack and the parent can’t remember which inhaler to use for quick relief. The nurse accesses the child’s medication information and tells the parent to use which inhalant?
The nurse auscultated a patient's middle lobe of the lungs for abnormal breath sounds. To do this, the nurse placed the stethoscope on the:
Anterior surface of the right side of the chest, between the fourth and fifth rib.
A patient visited a health care clinic for treatment of upper respiratory tract congestion, fatigue, and sputum production that was rust-colored. Which of the following diagnoses is likely based on this history and inspection of the sputum?
An infection with pneumococcal pneumonia
The nurse, caring for a patient with emphysema, understands that airflow limitations are not reversible. The end result of deterioration is:
A home health nurse sees a client with end-stage chronic obstructive pulmonary disease. An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met?
Decreased oxygen requirements
The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client
Exhales hard and fast with a single blow
A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply.
Inflamed airways that obstruct airflow
Mucus secretions that block airways
Overinflated alveoli that impair gas exchange
The nursing student recalls that the underlying pathophysiology of chronic obstructive pulmonary disease (COPD) includes the following components:
Inflamed airways obstruct airflow.
Mucus secretions block airways.
Overinflated alveoli impair gas exchange.
A client is being admitted to an acute healthcare facility with an exacerbation of chronic obstructive pulmonary disease (COPD). The client had been taking an antibiotic at home with poor relief of symptoms and has recently decided to stop smoking. The nurse is reviewing at-home medications with the client. The nurse is placing this information on the Medication Reconciliation Record. Which of the following is incomplete information?
salmeterol/fluticasone (Seretide) MDI daily at 0800
Which of the following is the key underlying feature of asthma?
Asthma is cause by which type of response?
Which diagnostic test is most accurate in assessing acute airway obstruction?
Pulmonary function studies
In which grade of COPD is the forced expiratory volume in 1 second (FEV1) greater than 80% predicted?
A physician orders triamcinolone (Azmacort) and salmeterol (Serevent) for a client with a history of asthma. What action should the nurse take when administering these drugs?
Administer the salmeterol and then administer the triamcinolone.
A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he:
uses the sternocleidomastoid muscles.
A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client
Has wheezes in the right lung lobes
A client experiencing an asthmatic attack is prescribed methylprednisolone (Solu–Medrol) intravenously. The nurse:
Assesses fasting blood glucose levels
A client is at risk for emphysema. When reviewing information about the condition with the client, which would the nurse emphasize as the most important environmental risk factor for emphysema?
Which measure may increase complications for a client with COPD? (Administering too much oxygen can result in the retention of carbon dioxide.)
Increased oxygen supply
Which of the following is a symptom diagnostic of emphysema?
The classification of Stage IV of COPD is defined as
very severe COPD.
A home health nurse visits a client with chronic obstructive pulmonary disease who requires oxygen. Which statement by the client indicates the need for additional teaching about home oxygen use?
"I make sure my oxygen mask is on tightly so it won't fall off while I nap."
A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for:
A young adult with cystic fibrosis is admitted to the hospital for aggressive treatment. The nurse first:
Collects sputum for culture and sensitivity
A client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem? Choose all that apply.
Swelling of bronchial membranes
A client is being admitted to the medical–surgical unit for the treatment of an exacerbation of acute asthma. Which medication is contraindicated in the treatment of asthma exacerbations?
The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction?
“I can’t use a spacer or holding chamber with the MDI.”
The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment?
Providing sufficient oxygen to improve oxygenation
A patient with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed?
A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 65% for a patient with COPD. What stage should the nurse document the patient is in?
A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer?
An inhaled beta2-adrenergic agonist
A client has been classified as status asthmaticus. The nurse understands that this client will likely initially exhibit symptoms of:
A client has intermittent asthma attacks. Which of the following therapies does the nurse teach the client to use at home when experiencing an asthma attack?
Inhaled albuterol (Ventolin)
In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid–base imbalances?
Which of the following is a leading cause of chronic obstructive pulmonary disease (COPD) exacerbation?
At 11 p.m., a client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He's anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client's arterial blood oxygen saturation is 86%, and he's still wheezing. The nurse should plan to administer:
A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes:
Implementing measures to clear pulmonary secretions.
The pathophysiology of emphysema is directly related to airway obstruction. The end result of deterioration is respiratory acidosis from airway obstruction. Knowing this, the nursing student would choose which of the following as the highest priority action?
Assess vital signs every 2 hours including O2 saturations and ABG results.
For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?
Using a Venturi mask to deliver oxygen as ordered
As status asthmaticus worsens, the nurse would expect which acid-base imbalance?
A nursing student understands the importance of the psychosocial aspects of disease processes. When working with a patient with COPD, the student would rank which of the following nursing diagnoses as the MOST important when analyzing the psychosocial effects?
Ineffective coping related to anxiety
A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure?
The nurse is instructing the patient with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in the education?
The patient should take the medication an hour before meals or 2 hours after a meal.
A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include:
diminished or absent breath sounds on the affected side.
A client is receiving moderate sedation while undergoing bronchoscopy. Which assessment finding should the nurse attend to immediately?
Oxygen saturation of 90%
The nurse is admitting a client who just had a bronchoscopy. Which assessment should be the nurse's priority?
Which statement describes emphysema?
A disease of the airways characterized by destruction of the walls of overdistended alveoli. A category of chronic obstructive pulmonary disease (COPD).
A client with chronic bronchitis is admitted to the health facility. Auscultation of the lungs reveals low-pitched, rumbling sounds. Which of the following describes these sounds?
A nurse is concerned that a client may develop postoperative atelectasis. Which nursing diagnosis would be most appropriate if this complication occurs?
Impaired gas exchange
The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction that leads to the collapse of alveoli. This complication is known as
A junior-level nursing class has just finished learning about the management of clients with chronic pulmonary diseases. They learned that a new definition of COPD leaves only one disorder within its classification. Which of the following is that disorder?
Which of the following is accurate regarding status asthmaticus?
A severe asthma episode that is refractory to initial therapy
The nurse is caring for a client whose respiratory status has declined since shift report. The client has tachypnea, is restless, and displays cyanosis. Which diagnostic test should be assessed first?
Which statement is true about both lung transplant and bullectomy?
Both procedures improve the overall quality of life of a client with COPD.
A nurse understands that a safe but low level of oxygen saturation provides for adequate tissue saturation while allowing no reserve for situations that threaten ventilation. What is a safe but low oxygen saturation level for a patient?
A patient comes to the emergency department complaining of a knifelike pain when taking a deep breath. What does this type of pain likely indicate to the nurse?
The nurse is assessing a patient in respiratory failure. What finding is a late indicator of hypoxia?
The nurse assessed a 28-year-old woman who was experiencing dyspnea severe enough to make her seek medical attention. The history revealed no prior cardiac problems and the presence of symptoms for 6 months' duration. On assessment, the nurse noted the presence of both inspiratory and expiratory wheezing. Based on this data, which of the following diagnoses is likely?
The classification of Stage II of COPD is defined as
A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction?
"Weigh yourself daily and report a gain of 2 lb in 1 day."
Pink, frothy sputum may be an indication of
Bradypnea is associated with which condition?
Increased intracranial pressure
Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)?
Exposure to tobacco smoke
A nurse would question the accuracy of a pulse oximetry evaluation in which of the following conditions?
A client experiencing hypothermia. (A probe or sensor is attached to the fingertip, forehead, earlobe, or bridge of the nose. SpO2 values obtained by pulse oximetry are unreliable in states of low perfusion such as hypothermia.)
A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments?
Oxygen through nasal cannula at 2 L/minute
The nurse is caring for a client diagnosed with asthma. While performing the shift assessment, the nurse auscultates breath sounds including sibilant wheezes, which are continuous musical sounds. What characteristics describe sibilant wheezes?
They can be heard during inspiration and expiration.
The nursing instructor is teaching a pre-nursing pathophysiology class. The class is covering the respiratory system. The instructor explains that the respiratory system is comprised of both the upper and lower respiratory system. The nose is part of the upper respiratory system. The instructor continues to explain that the nasal cavities have a vascular and ciliated mucous lining. What is the purpose of the vascular and ciliated mucous lining of the nasal cavities?
Warm and humidify inspired air
What is the difference between respiration and ventilation?
Ventilation is the movement of air in and out of the respiratory tract.
Respiration is the exchange of oxygen and CO2 between atmospheric air and the blood and between the blood and the cells.
The nurse is instructing the client on the normal sensations, which can occur when contrast medium is infused during pulmonary angiography. Which statement, made by the client, demonstrates an understanding?
“I will feel warm and an urge to cough.”
(During a pulmonary angiography a contrast medium is injected into the femoral artery, the client may also feel flushed and pressure when the catheter is inserted.)
The nurse receives an order to obtain a sputum sample from a client with hemoptysis. When advising the client of the physician’s order, the client states not being able to produce sputum. Which suggestion, offered by the nurse, is helpful in producing the sputum sample?
Take deep breaths and cough forcefully.
A client arrives at the physician’s office stating dyspnea; a productive cough for thick, green sputum; respirations of 28 breaths/minute, and a temperature of 102.8° F. The nurse auscultates the lung fields, which reveal poor air exchange in the right middle lobe. The nurse suspects a right middle lobe pneumonia. To be consistent with this anticipated diagnosis, which sound, heard over the chest wall when percussing, is anticipated?
High or increased compliance occurs in which condition?
A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient?
Sputum and a productive cough
For air to enter the lungs (process of ventilation), the intrapulmonary pressure must be less than atmospheric pressure so air can be pulled inward. Select the movement of respiratory muscles that makes this happen during inspiration.
Diaphragm contracts and elongates the chest cavity.
The classification of Stage III of COPD is defined as
A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis?
R/t dyspnea & bronchospasm
A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority to prevent asthma attacks?
Take ordered medications as scheduled.
In which position should the client be placed for a thoracentesis?
Sitting on the edge of the bed
The client is prescribed albuterol (Ventolin) 2 puffs as a metered–dose inhaler. The nurse evaluates client learning as satisfactory when the client does what with the inhaler?
Positions the inhaler 1 to 2 inches away from his open mouth
A son brings his father into the clinic, stating that his father's color has changed to bluish around the mouth. The father is confused, with a respiratory rate of 28 breaths per minute and scattered crackles throughout. The son states this condition just occurred within the last hour. Which of the following factors indicates that the client's condition has lasted for more than 1 hour?
The nurse enters the room of a client who is being monitored with pulse oximetry. Which of the following factors may alter the oximetry results?
Diagnosis of peripheral vascular disease
A client with chronic bronchitis is admitted with an exacerbation of symptoms. During the nursing assessment, the nurse will expect which of the following findings?
The client will have dyspnea requiring the use of accessory muscles to breathe, along with tachypnea and sputum production.
After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose three options.
Alter smooth muscle tone
Reduce airway obstruction
Increase oxygen distribution
Bronchodilators relieve bronchospasm by altering smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation.
A nursing student knows that there are three most common symptoms of asthma. Choose the most common that apply.
The three most common symptoms of asthma are cough, dyspnea, and wheezing. In some instances, cough may be the only symptom.
A patient diagnosed with diabetic ketoacidosis would be expected to have which type of respiratory pattern?
The nurse is assessing the lungs of a patient diagnosed with pulmonary edema. Which of the following would be expected upon auscultation?
Crackles at lung bases
Which hollow tube transports air from the laryngeal pharynx to the bronchi?
The trachea is a hollow tube composed of smooth muscle and supported by C-shaped cartilage.
A client experiences a head injury in a motor vehicle accident. The client’s level of consciousness is declining, and respirations have become slow and shallow. When monitoring a client’s respiratory status, which area of the brain would the nurse realize is responsible for the rate and depth?
The pons, when injury occurs or increased intracranial pressure results, respirations are slowed.
What finding by the nurse may indicate that the patient has chronic hypoxia?
Clubbing of the fingers, a change in the normal nail bed, sponginess and loss of the nail bed angle. It is a sign of lung disease in patients with chronic hypoxic conditions, chronic lung infections, or malignancies of the lung.
The goal for oxygen therapy in COPD is to support tissue oxygenation, decrease the work of the cardiopulmonary system, and maintain the resting partial arterial pressure of oxygen (PaO2) of at least ______ mm Hg and an arterial oxygen saturation (SaO2) of at least ___%.
PaO2: 60 mm Hg & SaO2: 90%
A nurse is preparing a client for bronchoscopy. Which instruction should the nurse give to the client?
Don't eat (or drink) for approximately 6 hrs before the procedure this will prevent aspiration of stomach contents into the lungs
A black client with asthma seeks emergency care for acute respiratory distress. Because of this client's dark skin, the nurse should assess for cyanosis by inspecting the:
While auscultating the lungs of a client with asthma, the nurse hears a continuous, high-pitched whistling sound on expiration. The nurse will document this sound as which of the following?
Wheezes, usually heard on expiration, are continuous, musical, high pitched, and whistle-like sounds caused by air passing through narrowed airways.
Upon palpation of the sinus area, what would the nurse identify as a normal finding?
No sensation during palpation
The nurse is caring for a client who is in respiratory distress. The physician orders arterial blood gases (ABGs) to determine various factors related to blood oxygenation. What site can ABGs be obtained from?
A puncture at the radial artery
The instructor of the pre-nursing physiology class is explaining respiration to the class. What does the instructor explain is the main function of respiration?
To exchange oxygen and CO2 between the atmospheric air and the blood and between the blood and the cells
Which of the following clinical manifestations should a nurse monitor for during a pulmonary angiography, which indicates an allergic reaction to the contrast medium?
Difficulty in breathing. Nurses must determine if the client has any allergies, particularly to iodine, shellfish, or contrast dye.
The nurse is caring for a client with recurrent hemoptysis who has undergone a bronchoscopy. Immediately following the procedure, the nurse should complete which action?
Assess the client for a cough reflex, the preoperative sedation and local anesthesia impair the protective laryngeal reflex and swallowing.
The nurse answers a client's call light. The client reports an irritating tickling sensation in the throat, a salty taste, and a burning sensation in the chest. Upon further assessment, the nurse notes a tissue with bright red, frothy blood at the bedside. The nurse can assume the source of the blood is likely from the
Lungs. Additional symptoms are bubbling sensation in the chest, and perhaps chest pain, in which case the client tends to splint the bleeding side. Blood is alkaline pH (>7.0) from this site.
A client has recently been diagnosed with malignant lung cancer. The nurse is calculating the client’s smoking history in pack-years. The client reports smoking two packs of cigarettes a day for the past 11 years. The nurse correctly documents the client’s pack-years as
22, number of packs of cigarettes smoked per day times the number of years the patient smoked.
A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client?
High-protein. Breathing is more difficult for clients with COPD, and increased metabolic demand puts them at risk for nutritional deficiencies.
Which is the strongest predisposing factor for asthma?
A physician has ordered that a client with suspected lung cancer undergo magnetic resonance imaging (MRI). The nurse explains the benefits of this study to the client. Included in teaching would be which of the following regarding the MRI?
MRI can view soft tissues and can help stage cancers.
If concern exists about fluid accumulation in a client's lungs, what area of the lungs will the nurse focus on during assessment?
Bilateral lower lobes
A client presents to the emergency department with fluid overload. The nurse is concerned about fluid accumulation in the lungs. On which of the following areas would the nurse focus the lung assessment?
Bilateral lower lobes
A client is being seen in the pediatric clinic for a middle ear infection. The client's mother reports that when the client develops an upper respiratory infection, an ear infection seems quick to follow. What contributes to this event?
A client has been newly diagnosed with emphysema. The nurse should explain to the client that by definition, ventilation:
is breathing air in and out of the lungs.
The nurse is caring for a client who is to undergo a thoracentesis. In preparation for the procedure, the nurse places the client in which position?
Sitting on the edge of the bed
Which exposure accounts for most cases of COPD?
Exposure to tobacco smoke accounts for an estimated 80% to 90% of COPD cases.
In which statements regarding medications taken by a client diagnosed with COPD do the the drug name and the drug category correctly match?
Theophylline, albuterol, and atropine are bronchodilators. Dexamethasone and prednisone are corticosteroids. Amoxicillin, ciprofloxacin, and cotrimoxazole are antibiotics.
A client presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands that goals of therapy should be achieved to improve the client’s condition. Which statements reflect therapy goals? (4 options)
Provide medical support for the current exacerbation.
Treat the underlying cause of the event.
Return the client to their original functioning abilities.
Provide long-term support for medical management.
The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client’s care plan?
Performing chest physiotherapy as ordered. Promoting removal of pulmonary secretions, breathing exercises, adequate fluid and dietary intake to promote removal of secretions and to ensure an adequate nutritional status.
A nurse caring for a patient with a pulmonary embolism understands that a high ventilation–perfusion ratio may exist. What does this mean for the patient?
Ventilation exceeds perfusion, this causes dead space.
The nurse inspects the thorax of a patient with advanced emphysema. What does the nurse expect the chest configuration to be for this patient?
Barrel chest as a result of overinflation of the lungs, which increases the anteroposterior diameter of the thorax.
A patient describes his chest pain as knife-like on inspiration. Which of the following is the most likely diagnosis?
Pleurisy, irritation of the parietal pleura is sharp