Chapter 37

A patient diagnosed with congestive heart failure has an arterial blood oxygen level (PaO2) of 89%. Which of the following terms should the nurse use to document a reduced oxygenation of arterial blood?
Hypoxemia
A patient with a 25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which of the following terms should the nurse use to document this finding?
Barrel chest
The health care provider suspects a newly admitted client may have a hemothorax. The client most likely experienced:
Fractured or dislocated ribs
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A client with primary lung disease has developed right heart failure. The health care provider would document this as:
Cor pulmonale
Which of the following clients is at risk for developing acute respiratory failure?
A middle-aged male diagnosed with amyotrophic lateral sclerosis (ALS) who has pneumonia with low O2 saturation
Pain is an expected assessment finding in patients who have which of the following lung diseases?
Pleuritis
A man sustained a puncture injury to his chest that caused a tension pneumothorax to form. This is a life-threatening condition because:
Trapped, inspired air collapses the lung.
Cystic fibrosis (CF) is an autosomal recessive disorder involving the secretion of fluids in specific exocrine glands. The genetic defect in CF inclines a person to chronic respiratory infections from a small group of organisms. Which organisms create chronic infection in a child with cystic fibrosis?
Pseudomonas aeruginosa and Staphylococcus aureus
There can be many reasons for a client to present with hypoxemia. For a client’s PO2 to fall, a respiratory disease is usually involved. Often, clients have involvement from more than one mechanism. Which of the following will result in hypoxemia? (Select all that apply.)
• Decreased oxygen in air
• Disease in respiratory system
• Dysfunction of neurologic system
The nurse is caring for the following clients. Select the client at highest risk for the development of atelectasis.
The client who is postop total knee replacement and receiving client-controlled analgesia
A 51-year-old man has been diagnosed with chronic bronchitis after a long history of recurrent coughing. Which of the man’s following statements demonstrates a sound understanding of his new diagnosis?
“If I had quit smoking earlier than I did, I think I could have avoided getting bronchitis.”
The nurse needs to assess the oxygen status of a client who is suddenly experiencing shortness of breath. The most appropriate noninvasive measurement techniques would be:
Pulse oximetry
The parents of a child diagnosed with cystic fibrosis (CF) ask about the risk of any future children having the condition. How should the nurse respond?
You have a 25% chance that your next child will have CF.
Which of the following clients is at risk for developing a preventable disorder related to prolonged immobility?
A postsurgical client who is refusing to get out of bed and walk and will not wear those “uncomfortable elastic stocking”
A car accident client is admitted with a chest tube following pneumothorax. He also has an elevated blood alcohol level. When the nurse enters his room, she notes the client is dyspneic, short of breath, and holding his chest tube in his hand. When the nurse pulls the linens back, she finds a “sucking” chest wound. After calling a “code blue,” the next priority intervention would be to:
Apply a Vaseline gauze (airtight) dressing over the insertion site
A 10-year-old male is experiencing an acute exacerbation of his asthma. The most appropriate treatment for this client would be:
β-adrenergic agonist
Soon after delivery, the mother grabs the nurses arm and states, “Something’s wrong…I can’t get my breath.” Which of the following assessments lead the nurse to suspect the client has had an amniotic emboli travel to the lungs? Select all that apply.
• BP 90/65; pulse 130, irregular; respiratory rate 35, shallow.
• Productive cough with blood-streaked sputum.
An elderly client who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which of the following treatment modalities is most likely to resolve the client’s most recent health problem?
Thoracentesis
A client has just been admitted to the postsurgical unit following a below-the-knee amputation. Which of the following measures should her care team prioritize to prevent atelectasis during the client’s immediate recovery?
Deep-breathing exercises and early mobilization
Acute-onset bronchial asthma causes wheezing and breathlessness as a result of which of the following?
Airway inflammation
Unilateral chest pain associated with respiratory movements is usually described as which of the following?
Pleuritic
The nurse determines that the client has clubbing of the fingertips. Which is the best intervention?
Check the patient’s O2 saturation level.
A nursing student asks if a client diagnosed with chronic obstructive pulmonary disease (COPD) is at risk if he receives oxygen at a level that increases the PO2 above 60 mm Hg. The best response would be:
The client’s ventilation will be severely depressed.
Oxygen has been prescribed for a client with chronic obstructive pulmonary disease (COPD). Select the most appropriate treatment for the client.
1 to 2 L/min via nasal cannula
A toddler seems to have a little “cold” and runny nose. At bedtime, he appears to be OK. A few hours later, parents awaken hearing a “tight” coughing sound. They recognize the child is not breathing well, so they rush to the emergency department. On arrival, the nurses suspect bronchial asthma based on which of the following assessment data? Select all that apply.
• Audible wheezing
• Respiratory rate—44 with prolonged exhalation
• Sitting upright, leaning forward, and using accessory muscles to breathe
A child is brought to the emergency department struggling to breathe with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which of the following is the most likely diagnosis?
Severe asthma attack
Which of the following is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma?
Pet dander
An elderly patient who was recently diagnosed with emphysema asks the nurse what caused the disease. Which of the following statements is the best response?
“One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?”
The parents of a child with cystic fibrosis ask the nurse to explain the sweat test performed on their newborn. How should the nurse respond?
The sweat test measures the concentration of salt in the infant’s sweat.
A child is brought to the emergency department with an asthma attack. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which of the following drugs will the nurse anticipate administering first?
Short-acting beta 2-adrenergic agonists such as albuterol (SABA)
A patient is admitted with pneumoconiosis. His history most likely reveals which of the following?
Work in a coal mine for 20 years
Which factors increase the risk that a client will develop chronic obstructive pulmonary disease (COPD)? Select all that apply.
• History of tobacco use
• History of asthma
Which are the earliest manifestations that a client is developing hypoxemia? Select all that apply.
• Diaphoresis
• Tachycardia
The nurse is caring for a client diagnosed with pneumonia. The client’s arterial blood gas results identify decreased level oxygen in the arterial blood and a decreased in the partial pressure of oxygen. The nurse would interpret this as:
Hypoxemia
Which manifestations are most common in clients with COPD that is predominantly emphysema? Select all that apply.
• hyperresonance
• increased A-P diameter
A young, male child is born with severe respiratory failure. Over the course of months, the parents note his body looks swollen. They ask, “Is our baby’s kidneys not working right? Why is he so swollen?” The nurse bases his or her reply on which of the following physiological principles?
“The right side of his heart (cor pulmonale) is not pumping effectively. Blood is backlogging in his body, which is why he is so swollen.”
A pulmonary embolism occurs when there is an obstruction in the pulmonary artery blood flow. Classic signs and symptoms of a pulmonary embolism include dyspnea, chest pain, and increased respiratory rate. What is a classic sign of pulmonary infarction?
Pleuritic pain
A patient is diagnosed with pulmonary embolism. Which of the following symptoms would most likely be present?
Chest pain and dyspnea
Chronic obstructive pulmonary disease (COPD) is a combination of disease processes. What disease processes have been identified as being part of COPD?
Chronic obstructive bronchitis and emphysema
Bronchiectasis is considered a secondary COPD, and, with the advent of antibiotics, it is not a common disease entity. In the past, bronchiectasis often followed specific diseases. Which disease did it not follow?
Chickenpox
A client tells the nurse that he is concerned he may be developing chronic bronchitis and asks how the diagnosis is made. The most appropriate information for the nurse to provide would be:
A diagnosis of chronic bronchitis requires a history of a chronic productive cough that has persisted for at least 3 consecutive months in at least 2 consecutive years.
A child is brought to the emergency department with an asthma attack. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which of the following drugs will the nurse anticipate administering first?
Short-acting beta 2-adrenergic agonists such as albuterol (SABA)
A client has developed chronic hypoxia and has developed pulmonary hypertension (HTN). The nurse recognizes that the most likely cause of pulmonary hypertension would be:
Constriction of the pulmonary vessels in response to hypoxemia
A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be:
Insertion of a large-bore needle or chest tube
The nurse is caring for four clients. Select the client at risk for the development of a pulmonary embolism.
A 62-year-old male postop repair of a fractured femur
Atelectasis is the term used to designate an incomplete expansion of a portion of the lung. Depending on the size of the collapsed area and the type of atelectasis occurring, the nurse may see a shift of the mediastinum and trachea. Which way does the mediastinum and trachea shift in compression atelectasis?
Away from the affected lung
What manifestations would the nurse expect to find when assessing a client with a right pleural effusion? Select all that apply.
• Dyspnea on exertion
• Diminished right breath sounds
• Hypoxemia
A patient recently had surgery for a hip fracture. Which of the following nursing interventions would be most effective for preventing pulmonary emboli in this patient?
Prevention of the development of a deep vein thrombosis
Three days following surgical repair of a hip fracture a client becomes anxious and complains of sudden shortness of breath. What disorder is the client most likely experiencing?
Pulmonary embolism
For a client with which of the following is the use of oxygen at a rate above 2 L/minute inappropriate?
Chronic obstructive pulmonary disease (COPD), sitting in bed with cyanosis and pulse oximeter reading 57%
An asthmatic patient comes to the emergency department very anxious due to increasing shortness of breath. Physical assessment reveals tachypnea, and an arterial blood gas shows decreased carbon dioxide levels and hypoxemia. Which of the following is the most likely cause?
Hyperventilation
What intervention is appropriate for a client with sarcoidosis?
Corticosteroids
Common results of respiratory failure are hypoxemia and which of the following?
Hypercapnia
Which alteration in acid-base balance could be expected as a compensatory response for a client with severe chronic respiratory impairment?
Increased arterial blood bicarbonate
A newly admitted critical head injury client presents to the neuro-ICU. The client is unresponsive to painful stimuli but able to breathe on his own. As the shift progresses, the nurses note a decrease in the client’s respiratory effort. The client cannot maintain his O2 saturation above 70%. The nurses should anticipate assisting in beginning what type of pulmonary support?
Prepare for mechanical ventilation.
A patient is diagnosed with pulmonary embolism. Which of the following symptoms would most likely be present?
Chest pain and dyspnea
Which manifestations are most common in clients with COPD that is predominantly chronic bronchitis? Select all that apply.
• Peripheral edema
• Cyanosis
• Increased mucus secretion

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