Nokea
A perioperative nurse is caring for a postoperative patient. The patient has a shallow respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address the patients increased risk for what complication?
- A. Acute respiratory distress syndrome (ARDS)
- B. Atelectasis
- C. Aspiration
- D. Pulmonary embolism
Correct Answer: B
Rationale: A shallow, monotonous respiratory pattern coupled with immobility places the patient at an increased risk of developing atelectasis. These specific factors are less likely to result in pulmonary embolism or aspiration. ARDS involves an exaggerated inflammatory response and does not normally result from factors such as immobility and shallow breathing.
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A new employee asks the occupational health nurse about measures to prevent inhalation exposure of the substances. Which statement by the nurse will decrease the patients exposure risk to toxic substances?
- A. Position a fan blowing on the toxic substances to prevent the substance from becoming stagnant in the air
- B. Wear protective attire and devices when working with a toxic substance
- C. Make sure that you keep your immunizations up to date to prevent respiratory diseases resulting from toxins
- D. Always wear a disposable paper face mask when you are working with inhalable toxins
Correct Answer: B
Rationale: When working with toxic substances, the employee must wear or use protective devices such as face masks, hoods, or industrial respirators. Immunizations do not confer protection from toxins and a paper mask is normally insufficient protection. Never position a fan directly blowing on the toxic substance as it will disperse the fumes throughout the area.
The nurse is caring for a patient who has been in a motor vehicle accident and the care team suspects that the patient has developed pleurisy. Which of the nurses assessment findings would best corroborate this diagnosis?
- A. The patient is experiencing painless hemoptysis
- B. The patients arterial blood gases (ABGs) are normal, but he demonstrates increased work of breathing
- C. The patients oxygen saturation level is below 88%, but he denies shortness of breath
- D. The patients pain intensifies when he coughs or takes a deep breath
Correct Answer: D
Rationale: The key characteristic of pleuritic pain is its relationship to respiratory movement. Taking a deep breath, coughing, or sneezing worsens the pain. The patients ABGs would most likely be abnormal and shortness of breath would be expected.
A patient is receiving thrombolytic therapy for the treatment of pulmonary emboli. What is the best way for the nurse to assess the patients oxygenation status at the bedside?
- A. Obtain serial ABG samples
- B. Monitor pulse oximetry readings
- C. Test pulmonary function
- D. Monitor incentive spirometry volumes
Correct Answer: B
Rationale: The nurse assesses the patient with pulmonary emboli frequently for signs of hypoxemia and monitors the pulse oximetry values to evaluate the effectiveness of the oxygen therapy. ABGs are accurate indicators of oxygenation status, but are not analyzed at the bedside. PFTs and incentive spirometry volumes do not accurately reveal oxygenation status.
A patient presents to the ED stating she was in a boating accident about 3 hours ago. Now the patient has complaints of headache, fatigue, and the feeling that he just cant breathe enough. The nurse notes that the patient is restless and tachycardic with an elevated blood pressure. This patient may be in the early stages of what respiratory problem?
- A. Pneumoconiosis
- B. Pleural effusion
- C. Acute respiratory failure
- D. Pneumonia
Correct Answer: C
Rationale: Early signs of acute respiratory failure are those associated with impaired oxygenation and may include restlessness, fatigue, headache, dyspnea, air hunger, tachycardia, and increased blood pressure. As the hypoxemia progresses, more obvious signs may be present, including confusion, lethargy, tachycardia, tachypnea, central cyanosis, diaphoresis, and, finally, respiratory arrest. Pneumonia is infectious and would not result from trauma. Pneumoconiosis results from exposure to occupational toxins. A pleural effusion does not cause this constellation of symptoms.
A 54-year-old man has just been diagnosed with small cell lung cancer. The patient asks the nurse why the doctor is not offering surgery as a treatment for his cancer. What fact about lung cancer treatment should inform the nurses response?
- A. The cells in small cell cancer of the lung are not large enough to visualize in surgery
- B. Small cell lung cancer is self-limiting in many patients and surgery should be delayed
- C. Patients with small cell lung cancer are not normally stable enough to survive surgery
- D. Small cell cancer of the lung grows rapidly and metastasizes early and extensively
Correct Answer: D
Rationale: Surgery is primarily used for NSCLCs, because small cell cancer of the lung grows rapidly and metastasizes early and extensively. Difficult visualization and a patients medical instability are not the limiting factors. Lung cancer is not a self-limiting disease.