Deck 63: Management of Clients with Acute Pulmonary Disorders

Question 1

The nurse monitoring a client with adult respiratory distress syndrome (ARDS) would closely assess for

A) atelectasis.
B) cor pulmonale.
C) pneumonia.
D) pulmonary edema.

Answer 1

pulmonary edema.

Question 2

As part of the immediate care plan for a client with pulmonary edema and a nursing diagnosis of Impaired Gas Exchange, the nurse would

A) administer oxygen as ordered using a high-flow rebreather bag.
B) bring a tracheostomy set to the bedside.
C) monitor vital signs every 30 to 45 minutes until stable.
D) position the client's legs above heart level.

Answer 2

administer oxygen as ordered using a high-flow rebreather bag.

Question 3

A client who underwent surgery is intubated and receiving mechanical ventilation. The client is receiving a neuromuscular blocking agent to stop spontaneous breathing that is not in synchrony with the ventilator. The appropriate approach by the nurse to the client's postoperative pain control would be

A) a sedative should be given with an anxiolytic and the neuromuscular blocker to control pain.
B) an analgesic is needed specifically for pain control and must be given as needed along with the neuromuscular blocker and a sedative or anxiolytic.
C) sedatives should be given with the neuromuscular blocking agent, and together these will control pain.
D) the neuromuscular blocking agent will prevent pain impulse transmission, so the prn analgesic order is unnecessary.

Answer 3

an analgesic is needed specifically for pain control and must be given as needed along with the neuromuscular blocker and a sedative or anxiolytic.

Question 4

A client who sustained a head injury is intubated and receiving volume-cycled mechanical ventilation via the controlled mechanical ventilation (CMV) mode. The nurse would explain that this means

A) a preset amount of pressure stays in the client's lungs at the end of exhalation.
B) spontaneous inspiratory effort triggers the ventilator to deliver a preset tidal volume.
C) the client's own breaths can become "stacked" with the ventilator breaths.
D) the ventilator delivers the preset volume regardless of the client's efforts.

Question 5

A client is being transported to the ED after sustaining carbon monoxide (CO) poisoning in a house fire. The nurse would prepare to administer

A) 100% oxygen therapy.
B) intermittent positive-pressure breathing.
C) suctioning.
D) ventilation with 50% oxygen by manual resuscitation bag.

Question 6

When a client is admitted to the ED with a sucking chest wound, the nurse initially would

A) cover the wound with whatever is available.
B) leave the wound open.
C) notify the physician.
D) obtain a sterile gauze petroleum dressing to cover the wound.

Question 7

A client who was extubated 2 hours ago is becoming increasingly restless. The last vital signs before extubation were pulse 88 beats/min, respirations 18 breaths/min, blood pressure (138/78)mm Hg, and PaCO₂ 45 mm Hg. Current vital signs include pulse 104 beats/min, respirations 26 breaths/min, blood pressure (140/80) mm Hg, and PaCO₂ 62 mm Hg. The nurse would

A) administer a nebulized bronchodilator.
B) assist with reintubation.
C) obtain a complete blood count (CBC).
D) prepare the client for a tracheostomy.

Question 8

The nurse would explain that the use of positive end-expiratory pressure (PEEP) assists the client on mechanical ventilation by

A) gradually increasing the amount of oxygen delivered.
B) increasing the amount of expired carbon dioxide.
C) keeping the alveoli open.
D) using a pressure of 30 cm H₂O.

Question 9

When a client is admitted to the ED with tension pneumothorax and mediastinal shift following an automobile accident, the nurse would know that the client would exhibit

A) a sucking chest wound.
B) bradycardia.
C) mediastinal flutter.
D) severe hypotension.

Question 10

When the ED nurse receives a radio call from an ambulance transporting a client who sustained chest trauma and has a severe flail chest, the nurse would set up the treatment area with

A) an intubation tray.
B) petroleum jelly gauze.
C) a pulse oximeter.
D) rib spreaders.

Question 11

In the nursing care of a client recently intubated and placed on mechanical ventilation, the nursing action that would take highest priority is

A) assessing for pedal pulses regularly.
B) monitoring blood pressure frequently.
C) monitoring temperature every 4 hours.
D) turning the client every 2 hours.

Question 12

The nurse would explain that emergency treatment of a tension pneumothorax requires

A) a small stab wound with a skin blade made into the pleural space.
B) covering the chest wall wound with gauze.
C) immediate tracheostomy.
D) insertion of an 18-gauge needle into the pleural space.

Question 13

The nurse would determine that a client with fractured ribs needs further self-care instructions when the client says

A) "I can take pain medication every 4 hours if I need it."
B) "I'll be sure to take it really easy for the next several weeks."
C) "I'll strap the ribs snugly so they can't move around."
D) "That heating pad in the closet at home will come in handy now."

Question 14

When a client developed a hemothorax, the physician inserted a chest catheter connected to a drainage system. In the first 2 hours, 900 ml of blood drainage was collected. The nurse would

A) clamp the tubing.
B) continue observation of the drainage.
C) monitor the client's vital signs.
D) report this to the physician immediately.

Question 15

A client admitted to the emergency department (ED) with severe chest injuries and significant hypovolemia caused by hemorrhage would be transfused to replace blood loss initially with

A) albumin.
B) dextrose 5% in normal saline.
C) type AB-negative blood.
D) type O-negative blood.

Question 16

A client with respiratory failure was intubated with an oral endotracheal (ET) tube 2 hours ago. Suspecting that the tube has changed position slightly since insertion, the nurse would assess the

A) results of the chest x-ray film taken 2 hours earlier.
B) current oxygen saturation readings.
C) status of the client's breath sounds.
D) position of the numbers on the ET tube at the lip line.

Question 17

Once a near-drowning victim is stabilized, the nurse would continue to assess the client for

A) bronchospasm.
B) dyspnea.
C) electrolyte imbalances.
D) shock.

Question 18

The nurse would determine that a client is having a dysfunctional ventilatory weaning response if the client's respiratory rate rises to

A) 20 breaths per minute.
B) 25 breaths per minute.
C) 30 breaths per minute.
D) 35 breaths per minute.

Question 19

When a client with a cuffed ET tube reports shortness of breath, the nurse would

A) give the ordered pain medication.
B) assess for a cuff leak.
C) increase the level of O2 delivery.
D) elevate the head of the bed.

Question 20

After dressing a sucking chest wound, the nurse notes that the client is developing severe dyspnea, tachypnea, cyanosis, tachycardia, and asymmetrical chest movements. The nurse would

A) check the chest dressing for any air leakage.
B) insert an 18-gauge needle into the pleural space.
C) notify the physician.
D) remove the chest dressing.

Question 21

A client has rapidly progressing ARDS. Which actions by the nurse can help the family during this crisis? (Select all that apply.)

A) Avoid disturbing them in the waiting room.
B) Limit visiting time so the family does not fatigue.
C) Provide frequent condition updates.
D) Use clear communication.

Question 22

A client's ventilator alarm begins to ring. The nurse enters the room and notes that the "low expired minute volume" alarm is sounding. After quickly determining that the client is in no acute distress, the nurse would

A) add more water to the humidifier.
B) look for a kink in the tubing.
C) look for a leak or disconnection in the system.
D) suction the client's secretions.

Question 23

A nurse is providing community education on home safety. An important safety measure to prevent carbon monoxide poisoning is to instruct clients to

A) have furnaces maintained professionally on a regular basis.
B) inspect all electrical plugs before using them.
C) install smoke detectors on each floor of the house.
D) store a fire extinguisher near or in the kitchen.

Question 24

As part of the care of a mechanically ventilated client, the nursing action that would be inappropriate is

A) providing oral care every 2 hours.
B) keeping the head of the bed flat while intubated.
C) using aseptic technique for suctioning.
D) washing the hands before and after care.

Question 25

A client has severe adult (acute) respiratory distress syndrome (ARDS) and has not responded to several different treatments. An independent nursing action that might help the client would be to

A) administer antioxidants as ordered.
B) place the client in a prone position.
C) turn the client every 2 hours.
D) use meticulous hand-washing before client care.

Question 26

The nurse planning care for an intubated client includes which interventions to prevent accidental extubation? (Select all that apply.)

A) Avoid opioid analgesics to prevent confusion and sedation.
B) Do not reposition the client unless absolutely necessary.
C) Keep tubing out of the client's reach.
D) Provide adequate sedation and pain control.
E) Use wrist restraints according to hospital policy.

Question 27

A client with pulmonary edema is receiving intravenous nitroglycerin. The spouse becomes upset and says "Nobody told me my spouse had a heart attack!" The best response by the nurse is to say "The nitroglycerin

A) can prevent a heart attack brought on by the stress to the heart."
B) helps get rid of extra fluid in the body."
C) helps the heart to not work so hard."
D) treats the chest pain that goes along with pulmonary edema."

Question 28

A client with ARDS has severe air hunger and is extremely anxious. The nurse would administer which medication to help both problems?

A) Lorazepam (Ativan)
B) Morphine sulfate (morphine)
C) Furosemide (Lasix)
D) Nitroglycerin (Tridil)