Prepare: The Nursing Care of Altered Gas Exchange

Diagnostic Tests – Altered Gas Exchange

• Looking for a cause of this altered gas exchange, the healthcare provider orders a sputum collection for gram stain, culture and sensitivity. What action is appropriate when collecting this sputum?

Interprofessional Care – Altered Gas Exchange

• The client is transferred from assisted living facility to emergency department due to shortness of breath. Based on the history of present illness, the client had episodes of respiratory distress for the past 2 days. The healthcare provider orders albuterol 2.5 mg inhaler via nebulization three times a day, and prednisone 30 mg orally daily for 14 days. What are the appropriate nursing actions when administering these medications? Select all that apply.

Assessment – Altered Gas Exchange Medications

• Review the client's medication list and select the items that should improve gas exchange. Select all that apply.

Self-Check: Interprofessional Care

Interprofessional Care Management – Altered Gas Exchange

• Select the assessment data that support altered gas exchange.

Self-Check: Altered Gas Exchange Management

• A client is admitted to the emergency department due to episodes of shortness of breath. The client has been coughing productively. The client described that whenever she coughs, it feels it is coming from the lower part of the lungs. The vital signs are T 102º F, RR 27 breaths/minute, HR 105 beats per minute, BP 150/80 mm Hg and 88% oxygen saturation in room air. Based on the assessment data, which nursing actions could improve gas exchange? Select all that apply.

Self-Check: Expected Outcome - Altered Gas Exchange

• A client with pleural effusion is admitted in the emergency department. The client undergone thoracentesis. What are the expected outcomes?

Drag the words from the choices below to fill in each blank found in the following sentences:

Self-Check: Highest Priority

• After receiving report from the morning shift, you visit each of your clients in the rehabilitation center. Which of the following identified issues is your highest priority?

Self-Check: Diagnostic Tests

Diagnostic Test – Altered Gas Exchange

• A client is admitted in the emergency department due to episodes of shortness of breath and inability to walk due to edema in his lower extremities. His wife verbalized that this has been happening for the past 2 weeks. Upon assessment, the client is pale, diaphoretic and confused. He has diabetes mellitus type I, emphysema and was admitted in the hospital last month due to pneumonia. Which of the following would give the nurse the most accurate information about an alteration in gas exchange?

Reflect: The Nursing Care of Altered Gas Exchange

Assessment – Altered Gas Exchange and Chest Tubes

• The client is transferred from the assisted living facility to emergency department due to acute respiratory distress secondary to pneumothorax. When preparing for chest tube insertion, the nurse takes into consideration which facts? Select all that apply.

Oxygen Therapy

• A client presents to the emergency department due to episodes of stools with streaks of blood. The spouse verbalizes that this has been happening for the past 3 days. Upon assessment, the client seems pale, lips are dry, and they are confused. The vital signs are T 97º F, RR 24 breaths/minute, HR 105 beats/minute, BP 90/50 mm Hg and 88% oxygen saturation on room air. What are the best options for delivering oxygen to this client? Select all that apply.

Nursing Actions

• Review the following nursing actions, and match to the rationale that best describes the reason for each action.

Nursing Care – Prevention of Altered Gas Exchange

• A client is admitted for an elective surgery. Prior surgery, the nurse teaches the client about the ways to prevent respiratory complications after surgery. Which of the following statements from the client may suggest further teaching is necessary?

Medications and Altered Gas Exchange

• A client is admitted with an altered gas exchange problem. The nurse understands that depending on the pathophysiologic problem, different medications may be needed. For each pathophysiologic problem, select the best medication class used for treatment and the nursing consideration for that medication class.

Prioritization and Delegation

• The registered nurse (RN) is delegating nursing care to an unlicensed assistive personnel (UAP). Which of the following tasks are appropriate to delegate for a client experiencing altered gas exchange? Select all that apply.

Arterial Blood Gas

• A client is admitted with an altered gas exchange. An arterial blood gas (ABG) is ordered. Complete the following statements about ABGs with the correct drop down choice:

Endotracheal Intubation

• In caring for a client with an endotracheal tube, which of the following statements suggests that more education on endotracheal tube safety is needed? Select all that apply.

Pneumonia

Prepare: Pneumonia

Assessment

• What are some possible clinical manifestations of pneumonia? Select all that apply.

Diagnostic Tests

• The client is transferred from assisted living facility to emergency department due to fever, chills and shortness of breath, and confusion. Pneumonia is the suspected cause. Which diagnostic tests could help identify pneumonia? Select all that apply.

Nursing Process

• Which assessment information is pertinent for a patient being admitted with an altered gas exchange in which pneumonia is suspected?

Self-Check: Assessment of Pneumonia

• Review the client situations below and indicate which type(s) of pneumonia these clients may be at higher risk for contracting. Each client may be at risk for more than one type of pneumonia.

Self-Check: CURB-65

• Review the information below. According to the CURB-65 score, identify the items that put this client at higher risk for a poor outcome:

Self-Check: Nursing Actions

• What is the most appropriate nursing action to assist a client with pneumonia to manage thick secretions and fatigue?

Self-Check: Interprofessional Care

• The client is admitted to the hospital with community acquired pneumonia. Which of the following nursing actions will improve gas exchange in this client? Select all that apply.

Self-Check: Expected Outcomes

• The client is transferred from assisted living facility to emergency department due to fever, chills and shortness of breath secondary to pneumonia. The vital signs are temperature 101º F, RR 26 breaths per minute, HR 105 beats per minute, BP 90/50 mm Hg and oxygen saturation of 90% in room air.

The nurse administered the following medications as prescribed by the healthcare provider such as acetaminophen rectally, 0.9% NaCl 250 ml intravenous (IV) bolus for one dose and oxygen at 2 liters per minute (LPM) via nasal cannula. The respiratory therapist administered albuterol via nebulization therapy and did some percussion and vibration to help the client expectorate some secretions. Choose the proper word from the drop downs to complete each sentence.

Reflect: Pneumonia

Nursing Actions

• The client is admitted to the hospital with community acquired pneumonia and shortness of breath. Reviewing the following orders, select the top three nursing actions that should be completed first:

Medication Orders

• The nurse is reviewing the following medication order: piperacillin/tazobactam 4.5 g in 100 ml 0.9% NaCl to be infuse in 1 hour. For each question below enter only a numeric value expressed as a whole number. What is the infusion rate of this medication in mL/hour?

Diagnostic Studies

• A client is admitted with pneumonia. The client has just started receiving antibiotics for pneumonia and is still experiencing shortness of breath. Which arterial blood gas (ABG) result does the nurse expect with this client?

Nursing Management

• A client with bacterial pneumonia has coarse crackles in the lower bases of the lungs and thick sputum. Which action should the nurse plan to promote airway clearance?

Nursing Actions

• Review the following nursing actions and match with the appropriate rationale

Evaluation – Vaccines

• In discussing vaccine administration with a nursing student, which statement indicates the student may need more education?

Clinical Manifestations

• Which clinical manifestations will the nurse consider when calculating the CURB-65 score for a client with pneumonia? Select all that apply.

Medication

• A client is admitted with aspiration pneumonia. Sputum cultures show that the client is infected with a gram-positive bacteria. The client is allergic to penicillin. Which medication would the client most likely be prescribed?

Chronic Obstructive Pulmonary Disease (COPD)

Prepare: Chronic Obstructive Pulmonary Disease

Assessment – Chronic Obstructive Pulmonary Disease

• What are the risk factors of chronic obstructive pulmonary disease (COPD)? Select all that apply.

Diagnostic Tests – COPD

• The client is admitted with shortness of breath. Which of the following diagnostics studies would help identify lung function and gas exchange caused by chronic obstructive pulmonary disease (COPD)? Select all that apply.

Assessment – Chronic Obstructive Pulmonary Disease

• Identify all pertinent findings suggesting an altered gas exchange.

Self-Check: Assessment: COPD

• Identify all pertinent findings suggesting an altered gas exchange.

Self-Check: Expected Outcome: COPD

• A client is admitted with chronic obstructive pulmonary disease (COPD) exacerbation. Which of the following interventions will improve their altered gas exchange, and why? Drag the rationale for each action into the second column.

Self-Check: Pharmacotherapy: COPD

• The client is admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD). Review the medications below and match their medication type.

Self-Check: Assessment: Pack Year History

• A client is admitted in emergency department due to shortness of breath. The client verbalized that he has been smoking 8 cigarettes per day for the past 30 years. How many pack years will it be based on the data given?

Self-Check: Assessment: Oxygen Therapy

Reflect: Chronic Obstructive Pulmonary Disease

Assessment – Chronic Obstructive Pulmonary Disease

• Review the assessment note below and select the items that are consistent with someone with chronic obstructive pulmonary disease having an exacerbation of their condition.

Interprofessional Care – Chronic Obstructive Pulmonary Disease

• Paul has a productive cough but still feels that there are more secretions deep within his lungs. When contacting the healthcare provider, what could the nurse recommend that could improve his altered gas exchange? Select all that apply.

Cor Pulmonale and Chronic Obstructive Pulmonary Disease

• The pulmonologist suspects that Paul has cor pulmonale. In addition to an alteration in gas exchange, which nursing diagnosis may require further nursing action in a patient with uncontrolled cor pulmonale?

Oxygen Use in Severe Chronic Obstructive Pulmonary Disease

• Paul underwent bedside spirometry which indicated he had a forced expiratory volume in 1 second (FEV1) of < 30. His oxygen saturation is at 86%. Which of the following oxygen orders would you expect given his severe chronic obstructive pulmonary disease (COPD) diagnosis?.

Health Prevention – Chronic Obstructive Pulmonary Disease

• Paul's family is asking how further complications of his chronic obstructive pulmonary disease (COPD) can be prevented. Which preventive practice should the nurse suggest to have the most impact?

Evaluation – Chronic Obstructive Pulmonary Disease

• In evaluating Paul, which of the following indicators suggest he is improving?

Prioritization and Delegation – Chronic Obstructive Pulmonary Disease

• The nurse supervises unlicensed assistive personnel (UAP) providing care for Paul who is on oxygen therapy. Which task should the nurse delegate?

Health Teaching – Oxygen Therapy

• Paul is about to go home with oxygen. What is the most appropriate health teaching that can promote client safety?

Asthma

Prepare: Asthma

Assessment – Asthma

• What are some things that can trigger an asthma exacerbation? Select all that apply.

Diagnostic Tests – Asthma

• What are the diagnostic assessments that will help in evaluate a client's asthma severity? Select all that apply.

Pharmacotherapy – Asthma

• What medication can cause bronchodilation?

Self-Check: Assessment: Asthma

• The client is experiencing shortness of breath. When assessing the client's breathing, which assessment finding is consistent with an exacerbation of asthma?

Self-Check: Assessment: Asthma

• When seeing a client with suspected asthma, the healthcare provider wants to know if a bronchodilator will be effective. Which diagnostic study can the nurse expect will be ordered?

Self-Check: Pharmacotherapy: Asthma

• The client is admitted with acute exacerbation of asthma secondary to allergic reaction to pollen. The client presented in emergency department with difficulty of breathing, 88% oxygen saturation in room air, restlessness, multiple hives on the upper chest and back. Which medications are likely to be used to treat this exacerbation of asthma? Select all that apply.

Self-Check: Preparing for Status Asthmaticus

• A client is being admitted to the unit with status asthmaticus. What are two priority nursing actions in preparing for this client's arrival? Select all that apply.

Self-Check: Health Teaching: Asthma

• The client is asking how to use peak expiratory flow meter. Which statement indicates an understanding about using the peak expiratory flow meter?

Reflect: Asthma

Management of Asthma

• Review the assessment note below and select the items that are consistent with risk factors and pertinent items for asthma exacerbation.

Interprofessional Care – Asthma

• The client is admitted due to status asthmaticus. Sally is alert and oriented. She has diffuse expiratory wheezes present. Vital signs: T: 97.8F, BP: 145/90, P: 110, RR: 28, O2 Sat: 87%. Which of the following nursing actions should the nurse recommend when notifying the healthcare provider? Select all that apply.

Interprofessional Care – Asthma

• Sally may need additional medication to treat her asthma exacerbation. Review the medication class below and match the medication class to mechanism of action and the nursing considerations.

Evaluation – Asthma

• A nurse is assessing a client who has been treated for an acute exacerbation of asthma. Which findings indicate the client’s condition has improved? Select all that apply.

Health Prevention – Asthma

• The nurse is preparing a discharge plan for Sally. What health prevention strategies could reduce or prevent exacerbation of her asthma? Select all that apply

Prioritization and Delegation – Asthma

• The nurse is preparing Sally for discharge. She has an unlicensed assistive personnel (UAP) working with her today. Which of the following items can the UAP assist the nurse with in preparing the discharge? Select all that apply.

Dry Powder Inhaler

• On discharge, Sally is receiving albuterol via metered dose inhaler and fluticasone via dry powder inhaler. What is the most appropriate health teaching that focused on using dry powder inhaler?

Health Teaching – Asthma

• Sally experienced shortness of breath at home during the day. At 1pm she decided to measure her peak flow. Her results averaged 175 mL/min. What should Sally do next?