Respiratory

The nurse cares for a patient immediately after laryngoscopy. It is MOST important for the nurse to intervene if which of the following is observed? 1. The patient is talking with the nurse. 2. The patient coughs spontaneously. 3. The patient is drinking from a straw. 4. The patient is moving about in bed.

1) laryngoscopy used to detect or remove lesions in the larynx or to obtain tissue for biopsy; patient NPO prior to procedure to prevent aspiration; direct laryngoscopy performed under local or general anesthesia; nurse not concerned if patient talking after procedure; patient's throat will be sore 2) expectorating secretions is good 3) CORRECT - anesthesia is used during the procedure; patient should not take fluids orally immediately after the procedure to avoid the possibility of aspiration of fluid into the lungs; no fluid should be given until normal swallowing and gag reflex have returned 4) no problem with patient moving around in bed; the nurse intervenes if a complication is occurring The nurse cares for patients on the medical/surgical unit. The nurse expects postural drainage to be ordered for which of the following patients? 1. A patient diagnosed with cystic fibrosis. 2. A patient diagnosed with ascites due to cirrhosis. 3. A patient diagnosed with lymphedema. 4. A patient diagnosed with a subdural hematoma.

1) CORRECT - postural drainage is a treatment of choice for cystic fibrosis because of serious respiratory dysfunction; postural drainage involves using gravity, along with percussion and vibration to facilitate drainage of secretions from bronchi and lungs into the trachea where coughing and suctioning can expel them; involves patient assuming a range of positions, most of them with the head down 2) a complication of cirrhosis is ascites, which is abnormal accumulation of fluid in abdominal cavity; it is not secretions and it is not in the respiratory tract 3) lymphedema usually affects lower extremities and is accumulation of lymph, not of secretions and not in the respiratory tract; treatment may include elevation of extremities, elastic stockings, diuretics, dietary restrictions, surgery 4) subdural hematoma is a head injury and has bleeding and increased intracranial pressure (ICP) components; the head down postures of most postural drainage positions with the percussion and vibration, would create pressure and worsen both the bleeding and the ICP The nurse should lubricate catheter used to suction a patient's tracheostomy with which of the following?

1. Sterile water. 2. Mineral oil. 3. Hydrogen peroxide.

4. K-Y jelly.

1) CORRECT - sterile water is the preferred lubricant because it won't irritate the tissues; can also use sterile saline 2) lubricant laxative that increases water retention in stools 3) cleansing solution used to clean wound and inflamed mucous membranes; diluted with equal parts of water, can be used as a disinfectant in the nose or mucous membranes 4) water-soluble lubricant A patient is scheduled for rhinoplasty. Postoperatively, it is MOST important for the nurse to place the patient in which of the following positions? 1. Supine. 2. Left Sims'. 3. Modified Trendelenburg's. 4. Semi-Fowler's.

1) when selecting a position, determine what is the potential problem/complication and what position would best prevent the problem; patient is placed in supine (flat on back) position to prevent hip flexion 2) semi-prone position; will increase edema of the surgical area 3) feet elevated 20, trunk flat and head slightly elevated; increase blood return to the heart 4) CORRECT - the patient should be placed in semi-Fowler's position to decrease edema, promote drainage, and facilitate breathing The nurse should instruct a patient undergoing nasal surgery not to blow the nose after surgery because 1. it increases intracranial pressure. 2. it decreases the patient's oxygen supply. 3. it encourages bruising and edema. 4. it may cause a fracture.

1) increased intracranial pressure (ICP) not caused by nasal surgery; nasal surgery performed to treat fractures, improve airflow, or for cosmetic reasons; ICP caused by head injury, brain tumors, or subarachnoid hemorrhages; instruct patient to avoid Valsalva maneuver to prevent ICP 2) will not decrease patient's oxygen levels 3) CORRECT - patients undergoing nasal surgery are instructed not to blow their nose in the postoperative period because it can cause bruising and edema 4) nasal surgery performed to treat fracture An adult is eating lunch and suddenly starts to choke, gasp for breath, and grab the throat. Which of the following actions should the nurse take FIRST? 1. Instruct the patient lean forward and administer back blows. 2. Offer the patient water to drink. 3. Ask the patient to speak. 4. Finger-sweep the patient's mouth.

1) implementation; do not administer back blows 2) implementation; symptoms indicate that patient does not have patent airway; fluids will not establish an airway 3) CORRECT - assessment; if patient is able speak, airway is only partially obstructed; instruct her to take a deep breath and try to cough up object; if patient is unable to speak, airway is obstructed; begin abdominalthrust maneuver 4) finger-sweep can remove food from pharynx but not from the larynx or trachea The nurse cares for a patient receiving oxygen per nasal cannula. Which of the following observations requires an IMMEDIATE intervention by the nurse? 1. A visitor arrives with a strong odor of cigarettes on the clothing. 2. The electric plug for the suction machine has 3 prongs rather than 2. 3. The patient complains of a dry mouth and has a cracked lip. 4. A visitor is putting clear nail polish on the fingernails of the patient.

1) combustion is a major hazard of oxygen administration; no indication is given that visitor is currently smoking or planning to light cigarette at this time; remind visitor about no-smoking rules and the reason for them and the rules must be enforced

2) no concern; all electrical plugs and equipment must be properly grounded to prevent fire; grounding consists of 3 prongs rather than 2, and a red or green dot on the plate 3) of concern, but not most immediate; oxygen can be drying and irritating to mucosa; humidifying the oxygen can help prevent and/or ameliorate this; a nonpetroleum cream can be used to lubricate the lips and nostrils 4) CORRECT - no flammable solution containing oil or alcohol should be in a room where oxygen is being delivered; nail polish-clear or not-is such a solution; oils should not be used on a patient receiving oxygen or on the equipment; while oxygen itself does not burn, its presence will be a catalyst supporting and increasing combustion; all electrical equipment must be in perfect condition and grounded; using matches, lighter fluid, or smoking is prohibited The nurse performs nutritional counseling for a patient who diagnosed with chronic obstructive pulmonary disease (COPD). It is MOST important for the nurse to advise the patient to avoid consuming which of the following in high amounts? 1. Carbohydrates. 2. Calories. 3. Protein. 4. Fats.

1) CORRECT - excessive carbohydrate loads can increase carbon dioxide (CO2) production since they are broken down into glucose, CO2, and water when metabolized; this may render the COPD patient unable to exhale, and hypercapnic (increased CO2 in blood) respiratory failure could then result; COPD illness itself affects oxygen delivery to all tissues; there is decreased ability to exchange gas, decreased oxygenation in blood, increased CO2 levels in blood; COPD patients need a diet high in calories, protein, and less in carbohydrates 2) COPD patients need high calories to meet the increased metabolic requirements related to the increased work of breathing; issues of anorexia, dyspnea, nausea, abdominal bloating and feeling of fullness contribute to protein-calorie malnutrition, with one result being weakening of the respiratory muscles 3) COPD patients need high protein to meet the increased metabolic requirements related to the increased work of breathing; issues of anorexia, dyspnea, nausea, abdominal bloating and feeling of fullness contribute to protein-calorie malnutrition, with one result being weakening of respiratory muscles 4) COPD patients need to obtain more of their calories from fats than from carbohydrates

The nurse cares for a patient receiving aminophylline via continuous IV drip. The nurse understands that aminophylline is 1. an antimicrobial. 2. a mucolytic. 3. a bronchodilator. 4. an expectorant.

1) antimicrobials inhibit the growth of or kill bacteria or other microorganisms; antibiotics 2) mucolytics liquefy and loosen thick mucous secretions so that they can be expectorated; example is acetylcysteine (Mucomyst); administered with bronchodilators; give bronchodilator five minutes before the mucolytic; side effects include nausea and vomiting, stomatitis, and runny nose 3) CORRECT - aminophylline is a xanthine derivative that acts as a bronchodilator by relaxing smooth muscles; xanthines also stimulate the CNS, dilate coronary arteries, and pulmonary vessels, and cause diuresis; side effects include anorexia, nausea and vomiting, gastric pain, nervousness, dizziness, headache, tachycardia, palpitations 4) expectorants loosen bronchial secretions so that patient is able to cough up the secretions The nurse obtains a history from a man admitted to the hospital with chronic obstructive pulmonary disease (COPD). The nurse identifies which of the following factors is related to the patient developing COPD? 1. The patient smoked for more than 30 years. 2. The patient worked in an orchard for 20 years. 3. The patient drinks four cans of beer a day. 4. The patient had pancreatitis four times.

1) CORRECT - COPD is a group of conditions associated with obstruction of air flow entering or leaving the lungs; chronic bronchitis causes excessive mucus and secretions, which block the airways; emphysema causes destruction of the walls of overdistended alveoli; smoking is the most important risk factor for COPD 2) exposure to noxious gases and dust contributes to the development of COPD 3) does not contribute to COPD 4) inflammation of the pancreas; can be acute or chronic; symptoms include severe abdominal pain, nausea, vomiting, fever, jaundice, elevated serum amylase, and hyperglycemia The nurse prepares to suction the endotracheal tube of a patient on a mechanical ventilator. Which of the following ventilator settings should be adjusted by the nurse before and after this procedure?