Respiratory

A 21-year-old male presents with sudden onset shortness of breath. He has no history of smoking, alcohol use, recent injuries or trauma. He is 5’11” tall, weighs 130 pounds, and works as a forklift driver. His vital signs are: BP 115/64 mm Hg, HR 104 bpm, RR 26, Temp 99.0 F, and O2 Sat 91%. The nurse suspects which condition?

Which assessment is most indicative of a pleural effusion?

The nurse uses which technique to counsel a patient with chronic obstructive pulmonary disorder (COPD) about quitting smoking? 

The nurse is caring for a 45-year-old patient undergoing treatment with doxorubicin for small cell lung cancer. The nurse focuses education on which adverse effects? Select all that apply.

The nurse learns the patient uses nasal irrigation to help prevent sickness during flu season. Which statement by the nurse is the most important?

The nurse notes inspiratory stridor upon auscultating the breath sounds of a 2-year-old child and suspects obstruction at which structure?

The new mother reports the baby makes snoring noises while trying to breastfeed. The nurse anticipates an examination will reveal narrowing at which level of the airway?

The nurse caring for the patient with pulmonary tuberculosis requests which personal protective equipment?

A 30-year-old female presents in the emergency room with symptoms of a lower respiratory infection with a productive cough, but there are no N95 respirators for the staff to utilize. Which action by the nurse is appropriate?

The patient in the intensive care unit who is intubated and mechanically ventilated abruptly requires a drastically increased fraction of inspired oxygen (FiO2) and is hypoxic, hypotensive, and tachycardic. Which intervention does the nurse perform first?

The intubated patient is receiving bolus enteral nutrition. In which position does the nurse place the patient to prevent aspiration?

The nurse is creating a tool to automatically screen for patients who are at an increased risk for aspiration pneumonia. Which patient conditions or medical histories does the nurse include in the screening tool? Select all that apply.

The 82-year-old patient from the long-term care facility is brought to the emergency department with wet-sounding cough and increased work of breathing. Vital signs are normal with the exception of tachypnea and an oxygen saturation of 91% on room air. Upon auscultation, the nurse notes diminished breath sounds over the right upper lobe. Chest radiograph indicates consolidation in the right upper lobe of the lung. The nurse prepares the patient for which test?

The nurse is teaching the nursing student the care of a patient with a tracheostomy. Which action by the nursing student when preparing to change the tracheostomy tube would prompt the nurse to intervene immediately?

The 32-year-old patient presents to the emergency department complaining of difficulty breathing, cough, and chills. Vital signs are notable for a temperature of 38.4°C, heart rate 118 bpm, respiratory rate 24, oxygen saturation 87% on room air, and blood pressure of 98/62 mmHg. Upon assessment, the nurse notes nasal flaring, diminished breath sounds in the right upper lobe, and subcostal retractions. Capillary refill time is 4 seconds. The patient admits waking up in a pool of vomit after binge drinking 3 nights ago. Which orders does the nurse anticipate? Select all that apply.

The nurse is vigilant for which signs of complications in the patient with Zenker diverticulum?

The patient was intubated in the field following a severe motor vehicle accident and is being managed in the intensive care unit. One day after the accident, increased oxygen requirement and diminished lung sounds are noted, and a radiograph is obtained. The chest x-ray reveals consolidation in bilateral lower lobes. The nurse anticipates which diagnosis for this patient?

The mechanically ventilated patient has a chest tube in place for the treatment of a tension pneumothorax. Which safety supplies does the nurse ensure are at bedside to prevent complications of an accidentally-removed chest tube? Select all that apply.

The oncoming nurse learns the patient has a right chest tube for the treatment of a chylothorax. The nurse anticipates which color of drainage in the chest tube chamber?

The patient with pneumonia who is intubated, sedated, and chemically paralyzed has developed a pleural effusion that is causing significant respiratory decompensation. The nurse assists the provider to insert the chest tube in which location?

During hourly rounding assessment of the patient with a chest tube for treatment of a pneumothorax, the nurse notes the patient’s chest and neck are markedly more edematous than on previous assessment. Upon palpation, crepitus is noted. Which action does the nurse take first?

The nurse is performing an initial shift assessment of a patient with a chest tube and notes the water in the water-seal level is fluctuating. Which action by the nurse is appropriate?

Upon assessment of the patient with a chest tube, the nurse notes intermittent bubbling in the water-seal chamber that follow the patient’s respirations. During rounds the provider instructs the nurse to clamp the chest tube in preparation for removal later in the day. Which response by the nurse is appropriate?

The nurse assesses the patient with a chest tube and notes continuous bubbling in the water seal of the chest tube drainage system. Which action does the nurse take first?

An unlicensed assistive personnel (UAP) reports that a patient has greenish discharge around the tracheostomy. Which response by the nurse is most appropriate?

The nurse is planning care for the patient with severe liver disease who has substantial ascites and peripheral edema. Which interventions are included in the care plan? 

The patient with a hearing deficit has been stabilized in the emergency department following a spontaneous pneumothorax. Which action does the nurse take first?

The patient is brought to the emergency department after being pulled from a structure fire by rescue personnel. A stat bronchoscopy is ordered. The nurse informs the patient's spouse of which rationale for this order?

What is the role of PEEP (positive end expiratory pressure) in managing mechanically ventilated patients? 

The nurse is caring for the patient with fever, chills, and a cough productive of green sputum. The chest X-ray shows a hazy opacity. The nurse checks the patient's medical history for sensitivity to which medication? 

Which physiologic event causes the functional closure of the foramen ovale after birth?

The nurse is preparing for the delivery of a 35-week gestation neonate being born via cesarean section for maternal preeclampsia with severe features. The nurse sets the fraction of inspired oxygen (FiO2) for the flow-inflating bag to which percentage?

Which normal characteristic of the preterm infant places them at a higher risk for evaporative heat loss via the respiratory tract?

The 7-day-old neonate born at 32-weeks’ gestation has an axillary temperature of 38.9°C. The nurse notes the infant is lethargic, with pale extremities and flash central capillary refill. Which nursing action is appropriate?

The 23-week gestation neonate is being cared for in a double-walled, heated isolette with ambient humidity set to 85%. The patient is at risk for sepsis due to which organism related to the care environment?

The nurse assists with a pericardiocentesis to drain a pericardial effusion and notes serosanguinous fluid. The nurse suspects which condition?

A nurse is caring for a patient with hemiplegia who has excess oral secretions. Which action best demonstrates safe and effective suctioning technique?

The patient with a lung mass that was discovered on imaging is scheduled for a flexible bronchoscopy. Which nursing action is appropriate to prepare the patient for the procedure?

A man who has remediated water-damaged basements for over thirty years presents to an acute care clinic for ongoing breathing problems. He has never smoked, has never been exposed to asbestos, and is afebrile. The nurse knows the man is most likely suffering from what condition?

The patient with a severe peanut allergy was inadvertently exposed to peanuts at work. Dyspnea persists despite the patient using the epinephrine autoinjector and emergency medical services was contacted. Which concentration of epinephrine does the first responder prepare for intramuscular injection?

The nurse assesses the cuff pressure of the patient's tracheostomy. Which cuff pressure prompts the nurse to document the finding and proceed with the assessment?

Which is the most common symptom of the child with bronchiectasis?

The nurse is preparing to perform open tracheostomy suctioning for a patient with methicillin-sensitive Staphylococcus aureus (MSSA) tracheitis. Which personal protective equipment does the nurse utilize for this procedure? Select all that apply.

The nurse learns in shift report the 1-year-old with respiratory distress due to parainfluenza virus has had increased nasal and oral secretions and has had increased coughing fits. Which personal protective equipment does the nurse don prior to caring for the patient? Select all that apply.

The patient admitted with asthma is receiving beclomethasone HFA PRN and nebulized albuterol PRN. Which patient assessment is most appropriate to report to the respiratory therapist assigned to care for the patient?

The nurse is caring for a patient on the night shift in respiratory distress due to influenza. Over the last few hours, the patient has become increasingly confused, perfusion has decreased, and urine output has fallen to zero. The nurse contacts the resident physician to come assess the patient and requests an order for transfer to the intensive care unit. The physician orders the nurse to administer 1L 0.9% NaCl via IV infusion. One hour after the infusion is complete, the patient has made no improvement. What is the nurse’s next action?

The patient in the intensive care unit is being weaned off of a continuous morphine infusion after being extubated 6 hours ago. Which assessments indicate the patient is failing to tolerate the treatment plan? Select all that apply.

The nonverbal patient is improving in the intensive care unit following a motor vehicle accident; as such, the continuous hydromorphone infusion is being weaned according to a schedule. The nurse provides education to the patient’s guardian about which signs and symptoms that the pain medicine is being weaned too quickly? Select all that apply.

The patient receiving patient-controlled analgesia (PCA) with morphine is found to be sleeping deeply and minimally responsive. Which action does the nurse take first?

The nurse is setting up a patient-controlled analgesia (PCA) for the infusion of hydromorphone. Which drugs does the nurse have readily available? Select all that apply.