Adult. Respiratory disorders exam

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.

The nurse is caring for an older adult client with a history of COPD. The client reports that his healthcare provider told him that he is having problems with his COPD because he continues to smoke cigarettes. The client tells the nurse that he was told many years ago that he had chronic bronchitis and is confused by the new diagnosis of COPD. The nurse provides the following explanation to the client.
Complete the following sentences by choosing the most likely options for the missing information from the lists of options provided.


COPD is a/an airflow limitation disease associated with a/an inflammatory response to cigarette smoking and other genetic and environmental factors.

is a/an   problem leading to of the lung and .


Inflammation of the   leads to and and is characteristic of

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.

Maria, a 37-year-old female, has been admitted to the hospital with a persistent cough lasting for more than three weeks, accompanied by weight loss and night sweats. A chest X-ray reveals findings consistent with pulmonary tuberculosis (TB). The nurse is preparing to admit Maria to the isolation ward.

When implementing transmission-based precautions for a patient diagnosed with pulmonary TB.

Which of the following components should be included in the patient's care?
Select all that apply.

James, a 68-year-old male, has been intubated and on mechanical ventilation in the ICU for the past five days following a severe case of pneumonia. The nurse reviews the plan of care to ensure the appropriate nursing strategies are being employed to reduce the risk of James developing ventilator-associated pneumonia (VAP).

Which of the following nursing implications and strategies should be incorporated into James's care to prevent ventilator-associated pneumonia? Select all that apply.

Linda, a 55-year-old female, recently underwent a thoracotomy to remove a benign lung tumor. Postoperatively, she has a chest tube in place to evacuate air and fluid and promote lung re-expansion. The nurse is monitoring the water-sealed chamber of Linda's chest drainage system and notices fluctuations in the water level.
What nursing interventions are appropriate for managing and assessing the water-sealed chamber in Linda's chest tube drainage system?
Select all that apply.

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.

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
           

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?

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.

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?

Maria, a 54-year-old female, has been admitted to the medical ward due to pneumonia. Upon assessment, the nurse notes that she has a temperature of 102.6°F (39.2°C). She is noticeably sweating, and her clothes and bedsheets appear damp. Maria's cough is productive, bringing up sputum. Despite her symptoms, she has maintained enough strength to ambulate when necessary. Given her current condition, the nurse needs to prioritize interventions that will provide the most immediate comfort and aid in her recovery.

Given Maria's presentation, which of the following interventions should the nurse prioritize for her care?

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?

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?

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.

Jordan, a 42-year-old male, is admitted to the medical ward following a chest trauma from a fall.
Based on the observed breathing pattern, how should the nurse document this respiratory rhythm?

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?

Ms. Jensen, a 52-year-old female, has been diagnosed with laryngeal cancer and is scheduled for a total laryngectomy.  The nurse realizes the importance of providing comprehensive preoperative care to Ms. Jensen.
Why is preoperative nursing care crucial for a client like Ms. Jensen who is undergoing a laryngectomy?
Select the most relevant reasons:
Select all that apply

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

Lucy, a 34-year-old female, visits the community health center for a follow-up appointment after being diagnosed with an upper respiratory tract infection (URTI) one week ago. She was given a teaching plan to follow during her recovery. The nurse now needs to evaluate the effectiveness of this teaching plan.

Based on Lucy's diagnosis and the implemented teaching plan, which of the following is an expected outcome that would indicate effective client teaching?

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.

A 34-year-old male patient who was recently diagnosed with HIV presents to the clinic for a follow-up after a Mantoux test. 
How should the nurse interpret the result of the Mantoux test for this patient?

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 components are essential for effective coughing?

During a routine checkup, a 40-year-old male patient showed signs of digital clubbing. The nurse recognizes the importance of this clinical sign.
What is the primary clinical significance of digital clubbing?

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?

Ms. Johnson, a 65-year-old woman, has recently undergone a tracheostomy. The nurse is preparing to provide tracheostomy care.
Which of the following is an essential aspect of tracheostomy care?

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?

Upon starting the morning assessment, the nurse approaches a 22-year-old patient recovering from an emergency surgery three days prior, following a severe accident that necessitated multiple blood transfusions. The patient appears notably anxious, and his respiratory rate is notably increased at 38 breaths per minute. Despite receiving 6 L/min of oxygen via a nasal cannula, the patient's oxygen saturation remains at 90%. Given the urgency of the situation, the nurse must decide on the best immediate intervention. What should the nurse do?

Complete the sentences by choosing from the list of options.
Mr. Taylor, a 38-year-old construction worker, was admitted to the emergency department after a fall from a scaffold. Upon examination, he was found to have four broken ribs on the right side.
As the nurse continuously assesses him for potential complications, she finds symptoms or changes in his assessment that might indicate the possibility of a tension pneumothorax.
 The symptoms more prominent will be , once confirmed the pneumothorax, the most immediate nursing action is