Front | Back |
When a nurse assesses a 78-year old client with pneumonia, which finding should be evaluated first?
-breath sounds -airway patency -respiratory rate -percussion sounds |
Airway patency
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A 45-year old man has been admitted to the hospital with pumonary embolism. which of the following symptoms should the nurse report to the primary health practitioner immediately?
-chest pain -shortness of breath -respirations 20 breaths/minute -productive cough |
Chest pain
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A 62 year old woman comes to the clinic with an exacerbation of asthma. which of the following findings indicate worsening status of her asthma?
-increased wheezing -bloody sputum -increased tympany -flushed red skin |
Increased wheezing
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A 3 year old boy is in the emergency department with stridor, intercostal and supraclivicular retractions, and respiratory rate of 40. what type of situation is this?
-stable -acute -urgent -emergency |
Emergency
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A 92 year-old woman with a history of COPD presents with increasing shortness of breath, decreased lung sounds in the bases, increased edema, and weight gain. what is the most likely problem?
-impaired gas exchange -ineffective airway clearance -activity intolerance -excess fluid volume |
Excess fluid volume
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Which of the following factors is most likely to increase the risk of a patient developing COPD?
-increased age -immune suppression -smoking -occupational exposure |
Smoking
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When the nurse assesses the client with respiratory symptoms, which of the following complaints should be evaluated first?
-chest pain -shortness of breath -cough -sputum |
Shortness of breath
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When assessing the client with atelectasis, what assessment findings are expected? choose all that appy.
-shortness of breath -decreased breath sounds -decreased oxygen saturation -increased tactile fremitus -hyper-resonance |
The first four
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Which assessments would indicate that the inhaled bronchodilators have their desired effect?
-wheezing, O2Saturation 94%, pallor -Vesicular breath sounds, O2saturation 96%, pink -bronchial breath sounds, O2 saturation 100% Erythema -crackles, O2 Saturation 90%, cyanosis |
Vesicular breath sounds, O2Saturation 96%, pink
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The nurse auscultates bronchovesicular breath sounds in the 2nd ICS near the sternum. The nurse interprets this as:
-a normal finding over the trachea -a normal finding over the bronchi -an abnormal finding over the lung -an abnormal finding over the trachea |
-a normal finding over the bronchi
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Anterior and posterior landmarks are used for?
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To identify the location of lung fields
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Reference lines include:
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-the midsternal anterior axillary
-mid-clavicular line -verbral line -posterior axillary line -midaxillary line |
Give location of lung
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Anteriorly, the apex of the lung extends approximately 2 to 4cm above the inner third of the clavicle and posteriorly the base is near T10
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With aging the lungs lose:
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Elasticity
respiratory strength decreases cartilage loses flexibility bones lose density |
Dyspnea
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Decreased level of consciousness, respirations greater than 30 breaths/min, oxygen saturation less than 90, retractions, and accessory muscle use may indicate an acute or emergency situation
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