Med-Surge Nursing Lower Respiratory
Prep U ch. 23
A client with a pulmonary embolus has the following arterial blood gas (ABG) values:
pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of
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arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What
should the nurse do first? - -Administer oxygen by nasal cannula as ordered.
When a pulmonary embolus places a client at risk for oxygen deprivation, the body
compensates by hyperventilating. This causes respiratory alkalosis, as reflected in
the client's ABG values. However, the most significant ABG value is the PaO2 value
of 60 mm Hg, which indicates hypoxemia. To manage hypoxemia, the nurse should
increase oxygenation by administering oxygen via nasal cannula as ordered.
Instructing the client to breathe into a paper bag would cause depressed
oxygenation when the client reinhaled carbon dioxide. Auscultating breath sounds or
encouraging deep breathing and coughing wouldn't improve oxygenation.
A physician determines that a client has been exposed to someone with
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tuberculosis. The nurse expects the physician to order which treatment? -
-Daily doses of isoniazid, 300 mg for 6 months to 1 year
All clients exposed to persons with tuberculosis should receive prophylactic isoniazid
in daily doses of 300 mg for 6 months to 1 year to avoid the deleterious effects of the
latent mycobacterium. Daily oral doses of isoniazid and rifampin for 6 months to 2
years are appropriate for the client with active tuberculosis. Isolation for 2 to 4 weeks
is warranted for a client with active tuberculosis.
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A client who has started therapy for drug-resistant tuberculosis demonstrates
understanding of tuberculosis transmission when he says: - -"I'll stop being
contagious when I have a negative acid-fast bacilli test."
A client with drug-resistant tuberculosis isn't contagious when he's had a negative
acid-fast test. A client with nonresistant tuberculosis is no longer considered
contagious when he shows clinical evidence of decreased infection, such as
significantly decreased coughing and fewer organisms on sputum smears. The
medication may not produce negative acid-fast test results for several days. The
client won't have a clear chest X-ray for several months after starting treatment.
Night sweats are a sign of tuberculosis, but they don't indicate whether the client is
contagious.
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Which technique does the nurse suggest to a client with pleurisy while teaching
about splinting the chest wall? - -Turn onto the affected side.
The nurse teaches the client to splint the chest wall by turning onto the affected side.
The nurse also instructs the client to take analgesic medications as prescribed and
to use heat or cold applications to manage pain with inspiration. The client can also
splint the chest wall with a pillow when coughing.
You are a clinic nurse caring for a client with acute tracheobronchitis. The client asks
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what may have caused the infection. Which of the following responses from the
nurse would be most accurate? - -Chemical irritation
Chemical irritation from noxious fumes, gases, and air contaminants can induce
acute tracheobronchitis. Aspiration related to near drowning or vomiting, drug
ingestion or overdose, and direct damage to the lungs are factors associated with
the development of acute respiratory distress syndrome.
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The nurse is assessing a client's potential for pulmonary emboli. What finding
indicates possible deep vein thrombosis? - -Localized calf tenderness
If the client were to complain of localized calf tenderness, the nurse would know this
is a possible indication of a deep vein thrombosis. The area of tenderness could also
be warm to touch. The client's urine output should not be impacted. Pain in the feet
is not an indication of possible deep vein thrombosis.
The nurse is obtaining data from a client with a respiratory disorder. Which
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information would be considered a part of the functional assessment and would
assist in the diagnosis of an occupational lung disease? - -Black-streaked
sputum
A functional assessment provides data on the lifestyle, living environment, and work
environment of the client, which can contribute to lung disorders. A black-tinged
sputum is suggestive of prolonged exposure to coal dust. Cough, dyspnea, and
tenacious secretions are vague respiratory symptoms that are not specific to
occupational lung disease. The presence of barrel chest is indicative of trapped
oxygen in the lungs over a prolonged period of time.
The nurse is assessing a patient who has been admitted with possible ARDS. What
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findings would distinguish ARDS from cardiogenic pulmonary edema? -
-Elevated B-type natriuretic peptide (BNP) levels
Common diagnostic tests performed in patients with potential ARDS include plasma
brain natriuretic peptide (BNP) levels, echocardiography, and pulmonary artery
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