KTP 1 Respiratory

1.The nurse cares for a patient receiving oxygen per nasal cannula. Which of the following observations requires an IMMEDIATE intervention by the nurse? A visitor is putting clear nail polish on the fingernails of the patient. NO flammable solution containing oil or alcohol should be in the room where oxygen is being delivered OXYGEN SAFETY; no candles, cigarettes in area: sign posted on door to room: grounded electrical outlets: avoid use of electrical razors, hairdryers, electrical blankets and heaters that may cause a spark; avoid use of flammable or oil based products; IF TANK USED SECURE IN UPRIGHT POSITION 2. The nurse reviews staff charting for a patient diagnosed with pleural effusion. The nurse expects to find which of the following notations in the patients chart? Decreased breath sounds noted in the LEFT LOWER LOBE: there would be absent or decreased breath sounds and a dull, flat sound when percussed: pleural effusion is the collection of fluid in the pleural space and is a complication of Heart Failure, TB, pneumonia, or cancer 3. Which of the following actions is essential for the nurse to take after arterial blood gases are drawn? Apply pressure to the puncture site: blood gases measure acid/base balance, following arterial puncture, pressure should be applied to the site for a full five minutes by the clock to prevent bleeding or hematoma formation. 4. To facilitate communication with a patient who has a tracheostomy, which of these nursing approaches is BEST? Tell the patient to nod his head to indicate YES and shake his head to indicate NO. TRACHEOSTOMY: surgical incision made into trachea by the way of throat: tube inserted through incision into trachea: CARE should be performed every 8hours and PRN: hyperoxygenate or deep breathe pt, suction tracheostomy tube, remove old dressings, open sterile kit, put on sterile gloves, remove inner canula, clean with hydrogen peroxide, rinse with sterile water and dry, reinsert into outer canula, clean stoma with hydrogen peroxide then sterile water and dry, change as needed, apply new sterile dressing without cutting gauze pads, indications for suctioning include noisy respirations, restlessness, increased pulse and respirations, and presence of mucus in airway. 5. The nurse should instruct a patient undergoing nasal surgery not to blow the nose after surgery because It encourages bruising and edema

6. The nurse performs teaching for a patient diagnosed with asthma. The nurse determines further teaching is necessary if the patient makes which of the following statements? I am going to have to establish a regular bedtime routine. 7. A patient diagnosed with COPD is drowsy and unable to expectorate secretions. The nurse should take which of the following actions? Perform nasotracheal suction: 8. The nurse observes a student nurse suction the right bronchus of a patient via the tracheostomy. The nurse determines care is appropriate if the student nurse places the patients head in which position? The patients head to the left. WHEN A TRACEOSTOMY is suctioned, the head should be positioned to the side opposite from that of the bronchus being suctioned 9. The clinic nurse instructs a client in the use of a metered dose inhaler (MDI). Which of the following statements by the client indicates the need for further teaching? I will be careful not to shake the canister before I use it. 10. 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?

Fraction of inspired oxygen (FIO2): FIO2 is the concentration of oxygen that is delivered to the
patient, it is determined by the ABG values & the condition of the patient; the range that can be provided is 21% to 100%; suctioning can cause desaturation or hypoxemia, so hyperoxygenation should be done before and after the procedure to prevent this occurrence, increasing the FIO2 is one way to do this; manually ventilating the patient is another; the nurse should put the original FIO2 back to the previous setting . MECHANICAL VENTILATION: Nursing care for mechanical ventilation includes performing and documenting ventilator & equipment checks, caring for patients FIRST, ventilator SECOND, checking ventilator settings as ordered by physician---tidal volume (TV)---respiratory rate, pO2 (fraction of inspired oxygen) maintained at end of expiration to open collapsed alveoli and improve oxygenation, draining condensation from tubing, verifying the tracheostomy or endotracheal cuff is inflated to insure TIDAL VOLUME. 11. The nurse expects which of the following modes of mechanical ventilation to be ordered for a patient with severe Gullian-Barre syndrome?

Controlled ventilation (CV): PTs have flaccidity or weakness that progresses upward from the lower extremities and often includes the trunk, with resultant respiratory compromise & possible failure: motor deficits can progress to total quadriplegia:

12. The pediatric nurse cares for a 3 year old child diagnosed with acute laryngotraceobronchitis is a croupette. The nurse is MOST concerned if which of the following is observed?

The grandmother gives the child a teddy bear. A CROUPETTE IS A HUMIDIFIED OXYGEN TENT: a
teddy bear can present a breeding ground for microorganisms by its absorption of moisture, also wool, polyester, rayon could be a fire hazard, vinyl or plastic are the best materials for toys in the croupette. No metal 13. The nurse performs nutritional counseling for a patient who is diagnosed with COPD. It is most important for the nurse to advise the patient to avoid consuming which nutrient in high amounts? CARBOHYDRATES: EXCESSIVE CARBOHYDRATE LOADS CAN INCREASE CO2 PRODUCTION SINCE THEY ARE BROKEN DOWN TO GLUCOSE, CO2, AND WATER. 14. Immediately following thoracentesis, the nurse notices a progressive swelling on the right side of the patients chest and neck. The nurse knows which of the following conditions is the MOST LIKELY cause of the swelling? Subcutaneous emphysema: which is a complication in which air leaks into the subcutaneous tissue and causes swelling: as more air enters the tissue, the swelling progresses: when there is an opening in the trachea, air escapes into fresh tissue planes of the neck; air can also progress throughout the chest and axillary tissues in the face; when areas with subcutaneous emphysema are palpated crepitus is felt as a crackling sensation beneath the fingertips. 15. A patient is started on rifampin and isoniazid. Which of the following explanations concerning these medications is MOST appropriate for the nurse to give? You will have to take this medicine for about a year 16. 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? The patient is drinking from a straw; Pt should not be swallowing after surgery until gag reflex is present 17. Which one of the following routes of administration should the nurse use when giving a mantoux test? INTRADERMAL INJECTION MANTOUX TEST Tubercle bacillus extract, purified protein derivative (PPD) given intrdermally in the forearm: read in 48-72 hours: 10mm induration (hard area under skin) is

positive reaction: IMMUNOCOMPRIMISED , greater than 5mm induration is positive reaction; either exposed or presence of inactive (dormant) disease.

18. The nurse should lubricate catheter used to suction a patients tracheostomy with which of the following? Sterile water because it wont irritate tissues. Sterile saline can be used 19. The nurse in the community health center identifies which of the following types of food is MOST likely to present problems for a client with respiratory difficulties? DAIRY Which is MUCUS PRODUCING also thickens secretions

20. A patient is admitted to the hospital after sustaining sever electrical burn. A tracheostomy is performed, and the patient is unable to use either hand. It is MOST important for the nurse to take which of the following actions? Obtain a blow tourch call bell 21. The nurse cares for a patient receiving aminophylline via IV DRIP. The nurse understands that the aminophylline is A bronchodialator by relaxing his 22. The nurse teaches pursed lip breathing to a paitent diagnosed with (COPD) the nurse understands which is the following BEST describes PREVENT AIR TRAPPING 23. A patient requires an emergency tracheostomy. When caring for the tracheostomy,

CLEAN EVERY 4 HOURS 24. A patient is scheduled for rhinoplasy. Postoperatively, it is MOST important for the nurse to place the patient in which of the following positions? Semi-fowlers: to decrese edema, promote drainage decrease edema facilitate breathing 25. The nurse understands which of the following is the cause of respiratory alkalosis?

Hyperventillation 26. The nurse cares for a patient diagnosed with active tuberculosis. Which of the following instructions should the nurse give the patient about follo-up care after discharge from the hosipital?

We would like you to come to the clinic monthly to check the effects of the medication you are taking: which the nurse can personally check for signs of hepatitis, such as jaundice, it also gives the nurse the opportunity to explain to the patient why she is taking the medication.

27. The nurse knows that it is essential to have which of the following pieces of equipment at the bedside of the patient receiving mechanical ventilation?

Resuscitation bagAMBU 28. The nurse obtains a history from a man admitted to the hospital with (COPD) The nurse identifies which of the following factors is related to the patient developing COPD? The patient smoked more than 30 years 29. 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? ASK THE PATIENT TO SPEAK 30. The nurse cares for patients on the medical surgical unit. The nurse expects postural drainage to be ordered for which of the following?

A patient with Cystic Firbrosis: this is a treatment for CF, because of the serious
respiratory dysfunction: which involves using gravity , along with percussion and vibration to facilitate drainage of secretions from the bronchi and lungs into the trachea where coughing and suctioning can expel them: involves patient assuming a range of positions, most of them HEAD DOWN