NGN. Respiratory disorders exam

Mr. Smith, a 45-year-old male, was brought to the emergency room after his family found him unconscious in his garage where he had been working on his car with the engine running.
Upon arrival, Mr. Smith complains of a severe headache, dizziness, and nausea. He is confused, slightly disoriented, and reports shortness of breath. His skin appears slightly pink, and his pulse oximetry reads 98%, despite the suspected carbon monoxide exposure. His carboxyhemoglobin level is elevated at 18%.
The nurse provides teaching about carbon monoxide poisoning and its prevention.

Which statement by Mr. Smith indicates that the nurse’s teaching about carbon monoxide poisoning has been effective?

A client is admitted to the emergency room with an acute respiratory condition.
The client reports a productive cough, shortness of breath, and purulent sputum. During the assessment, the client has difficulty speaking because of breathlessness, and wheezing with a low-grade fever is noted.
The client reports an unintended weight loss of 5 lb over the last couple of weeks.
The client reports that there have been a couple of episodes of night sweats that awaken him from sleep.
For each client finding, use an X to specify whether the finding is consistent with the disease process of asthma, bacterial pneumonia, and tuberculosis.
Each finding may support more than one disease process.

A 55-year-old woman is in post-operative care following lung surgery. The nurse is educating her on the importance of effective coughing to clear secretions.
Which two components are essential for effective coughing?

Mr. Gonzalez, a 70-year-old male, was recently treated for aspiration pneumonia after accidentally inhaling food while eating. The nurse is teaching him ways to prevent future episodes of aspiration, as he has a history of dysphagia.

Which statement by Mr. Gonzalez indicates that additional teaching is needed?

Jamie, a 16-year-old adolescent, approaches the school nurse during lunch break, clutching their chest and reporting chest pain. The nurse recalls that Jamie has a documented history of asthma in their health file but hasn't had an asthma-related incident in the school for years.

Given the provided clinical presentation and history, what should the nurse do next?

Mrs. Brown, a 55-year-old woman, is newly diagnosed with obstructive sleep apnea (OSA) and has been prescribed continuous positive airway pressure (CPAP) therapy. She expresses apprehension to the nurse, stating, "I have no idea how to use this machine, and it looks complicated." The nurse decides to provide education on the use and benefits of the CPAP machine.
Which of the following steps should the nurse include in her instruction to Mrs. Brown about the correct use of the CPAP machine? Select all that apply

Jordan, a 42-year-old male, is admitted to the medical ward following a chest trauma from a fall. During assessment, the nurse observes a distinct breathing pattern where Jordan’s respirations fluctuate between deep and rapid breaths, followed by periods of shallow breathing, and then a temporary stop in breathing

Based on the observed breathing pattern, how should the nurse document this respiratory rhythm?

Mr. Smith, a 50-year-old patient, recently had a chest tube insertion. The nurse is monitoring the collection chamber of the chest tube system.
Which nursing intervention is crucial with regard to the collection chamber in a chest tube?

Maria, a 56-year-old female, is in the Intensive Care Unit (ICU) with acute respiratory distress syndrome (ARDS). She has been intubated, and as part of the intervention to improve her oxygenation, the nurse placed her in the prone position. After 30 minutes in this position, the nurse starts to assess specific factors to determine if it is safe for Maria to remain prone or if she should be returned to the supine position.
Given the clinical presentation, which of the following factors, if observed by the nurse, would necessitate discontinuing the prone positioning and returning the client to the supine position? Select all that apply.

John, a 58-year-old male, was admitted to the ICU with acute respiratory distress syndrome (ARDS) secondary to sepsis. He has been on mechanical ventilation for 4 days, receiving a positive end-expiratory pressure (PEEP) of 10 cm H2O and a fraction of inspired oxygen (FiO2) of 70%.
During the nurse's assessment, she notes a sudden increase in peak inspiratory pressures on the ventilator, a significant drop in John’s oxygen saturation from 94% to 88%, and absent breath sounds on the right side of the chest.
John has become increasingly agitated, with rapid, shallow breathing (respiratory rate of 36 breaths per minute).
The nurse suspects the development of a tension pneumothorax as a result of barotrauma.

What should the nurse do first?

John, a 67-year-old male, was recently diagnosed with lung cancer. Today, he's in a hospital room where the nurse assists the healthcare provider in inserting a left subclavian, triple-lumen catheter. Moments after the procedure, John displays a sudden change in behavior: he becomes visibly restless and starts breathing rapidly.
Given the sequence of events and the clinical scenario, the nurse must immediately determine the best action to address a potential complication.

In light of the client's sudden change in respiratory status following the insertion of a left subclavian catheter, what is the most appropriate initial action for the nurse to take?

Mr. Roberts, a 65-year-old male, has been admitted to the Intensive Care Unit (ICU) following a severe respiratory failure secondary to a complicated pneumonia. He has been intubated and is now on mechanical ventilation. The on-duty nurse needs to ensure appropriate care for Mr. Roberts while he is on the ventilator.

What are the three major nursing interventions essential for ensuring optimal care for Mr. Roberts during mechanical ventilation?

Katie, a 29-year-old female, is brought to the emergency room after experiencing difficulty breathing. The nurse immediately placed a pulse oximeter on Katie's finger to measure her oxygen saturation.
The readings fluctuate and seem abnormally low, despite Katie's respiratory rate and depth appearing adequate.
The nurse must now assess for factors that might be affecting the accuracy of the oxygen saturation reading.

Given the inconsistent oxygen saturation readings from the pulse oximeter, which of the following factors should the nurse assess Katie for, that could interfere with the accuracy of the test? Select all that apply.

Michael, a 52-year-old male, presents to the outpatient clinic for a routine checkup. His wife, who accompanied him, reports that he snores loudly at night and has noticed pauses in his breathing followed by a choking or gasping sound.

Based on the clinical presentation, which of the following clinical manifestations are typical with a diagnosis of Obstructive Sleep Apnea (OSA)? Select all that apply.

Ms. Brown, a 55-year-old female with a recent diagnosis of obstructive sleep apnea (OSA), has been prescribed continuous positive airway pressure (CPAP) therapy. She expresses concern about using the machine and asks the nurse for clarification on how it works and how to use it correctly.

Which of the following statements made by Ms. Brown indicate that she understands the nurse's teaching about CPAP therapy? Select All That Apply

Ms. Clark, a 50-year-old female, is diagnosed with severe pneumonia caused by Legionella bacteria. She recently stayed in a hotel with a hot tub and central air conditioning. The nurse educates her about Legionnaires' disease.

Which of the following points should the nurse include in the education? Select all that apply

The nurse arrives for a morning shift at a respiratory ward. Four patients, all with respiratory conditions, have needs that require attention.
Based on the priority of care, which patient should the nurse assess first?

Mr. Jenkins, a 47-year-old male, underwent a thoracotomy 2 days ago. He now has a chest tube in place. On assessment, the nurse observed swelling around Mr. Jenkins's upper chest and neck accompanied by pain in the chest. Upon palpation, there is a crackling sensation, similar to touching bubble wrap, a sensation that Mr.Jenkins has described as identical to touching warm Rice Krispies. 
Complete the diagram below by dragging from the choice below what condition the client is most likely experiencing, 2 actions the nurse would take to address that condition and two parameters the nurse would monitor to access this condition.

The nurse is assigned to Ahmed, a 38-year-old homeless male who was admitted because of a persistent cough for six weeks, night sweats, and unintentional weight loss of about 8 kilograms over the past two months.
Complete the diagram below by dragging (or selecting) from the choices below what condition the client is most likely experiencing, two actions the nurse would take to address that condition, and two parameters the nurse would monitor to assess the client’s condition
           

Josh, a 39-year-old male, is admitted to the intensive care unit (ICU) with acute respiratory distress syndrome (ARDS).  The nurse is waiting for the arterial blood gas (ABG) results. In the meantime, the nurse must decide which immediate nursing interventions are appropriate.

Given the current presentation of the client with ARDS, what nursing interventions should the nurse prioritize? Select all that apply.

Maria, a 72-year-old female, underwent a tracheostomy procedure 3 days ago due to persistent respiratory issues. Today, the nurse is preparing to suction Maria's tracheostomy to clear any secretions and ensure an open airway. The nurse needs to decide on the most appropriate procedure for suctioning that maintains both patient safety and the integrity of the tracheostomy site.

Given that Maria's tracheostomy tube was placed 3 days ago, which is the most appropriate procedure for suctioning at this time?

Mr. Thompson, 35, is diagnosed with walking pneumonia and reports a persistent dry cough and fatigue. The nurse provides discharge teaching to help him manage his symptoms and prevent spreading the infection.

Which statement by Mr. Thompson indicates that additional teaching is needed?

Mr. Taylor, a 65-year-old male with COPD, is admitted with acute exacerbation and is placed on bilevel positive airway pressure (BiPAP). After stabilizing, the nurse provides education on the purpose and use of noninvasive ventilation.

Which statement by Mr. Taylor indicates that the nurse’s teaching was effective?

Robert, a 76-year-old male, is admitted to the medical ward with a primary diagnosis of bacterial pneumonia.
Given this background, the nurse needs to determine which of Robert's shared details might have predisposed him to develop pneumonia.
Based on the provided health history, which factor is most likely to have predisposed Robert to bacterial pneumonia?