Medical-Surgical: Respiratory Conditions Flashcards
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Read the first 20 Medical-Surgical: Respiratory Conditions flashcards as text
A patient with COPD is admitted for exacerbation. Which oxygen delivery goal is most appropriate for this patient?
Answer: Maintain SpO2 at 88–92% to avoid suppressing hypoxic respiratory drive
COPD patients who are chronic CO2 retainers may rely on hypoxic drive (low O2) to breathe. Targeting SpO2 88–92% provides adequate oxygenation without suppressing respiratory drive or worsening hypercapnia.
A nurse is caring for a patient with a right-sided pneumothorax. On assessment, the nurse notes tracheal deviation to the left, absent breath sounds on the right, and severe respiratory distress. What condition does this represent?
Answer: Tension pneumothorax requiring immediate needle decompression
Tracheal deviation away from the affected side, absent breath sounds, and severe respiratory distress indicate tension pneumothorax — a life-threatening emergency requiring immediate needle decompression (2nd intercostal space, midclavicular line).
A patient is receiving mechanical ventilation and the nurse notes high-pressure alarms. Which assessment should the nurse perform first?
Answer: Assess the patient and ventilator circuit for obstruction — suctioning, kinking, patient biting tube, bronchospasm
High-pressure alarms indicate increased resistance or obstruction in the circuit or patient airway. Assessment should identify and correct the cause — secretions, tube kinking, bronchospasm, or pneumothorax.
A patient is admitted with community-acquired pneumonia (CAP). Which findings support this diagnosis?
Answer: Productive cough, fever, pleuritic chest pain, focal infiltrate on CXR, and elevated WBC
Community-acquired pneumonia presents with productive cough, fever, pleuritic chest pain, lobar or focal infiltrate on chest X-ray, and leukocytosis. Auscultation reveals bronchial breath sounds, crackles, and dullness to percussion over the affected area.
A patient is on continuous pulse oximetry. The SpO2 reads 97%, but the patient appears cyanotic, confused, and the waveform is poor. What action should the nurse take?
Answer: Assess the patient clinically, obtain an ABG, and consider pulse ox inaccuracy
Pulse oximetry has limitations: poor perfusion, nail polish, carbon monoxide poisoning (falsely normal), methemoglobinemia, and motion artifact cause inaccurate readings. Clinical assessment and ABG are more reliable when clinical findings don't match.
A patient with pulmonary embolism (PE) is being anticoagulated with IV heparin. Which goal best describes anticoagulation in acute PE?
Answer: Preventing clot propagation and recurrence while allowing natural fibrinolysis
Heparin (and other anticoagulants) do not dissolve existing clots — they prevent new clot formation and propagation. The body's natural fibrinolytic system gradually dissolves the clot over weeks to months.
A nurse is caring for a patient following a bronchoscopy with biopsy. Which postprocedure complication requires immediate intervention?
Answer: Frank hemoptysis with large amounts of blood, worsening dyspnea, and hypoxia
While minor hemoptysis and cough are expected after bronchoscopy with biopsy, frank significant hemoptysis with respiratory compromise indicates airway hemorrhage — a serious complication requiring immediate intervention.
A patient with asthma presents with severe dyspnea. On assessment, the nurse notes absent breath sounds bilaterally. What is the interpretation of this finding?
Answer: The patient is in severe bronchospasm ('silent chest') — a medical emergency indicating respiratory failure
A 'silent chest' in asthma indicates such severe bronchospasm and air trapping that virtually no air movement occurs — this is an ominous, life-threatening sign requiring immediate intervention, possibly intubation.
A nurse is preparing to administer the influenza vaccine to a patient. Which patient statement requires clarification?
Answer: I am allergic to eggs and have had anaphylaxis after eating eggs
A history of severe egg allergy with anaphylaxis requires special precautions as influenza vaccines were traditionally egg-based. Guidelines now allow vaccination in controlled settings or recommend egg-free alternatives (recombinant or cell-based vaccines).
A patient is placed on a 60% Venturi mask. The nurse notes the patient is still hypoxic with SpO2 of 85%. What is the appropriate action?
Answer: Switch to a non-rebreather mask to deliver higher FiO2
A Venturi mask's maximum FiO2 is approximately 60%. If higher oxygen concentrations are needed, a non-rebreather mask (up to 90–95% FiO2) is the next step in oxygen escalation before considering non-invasive or invasive ventilation.
A nurse is caring for a patient with a chest tube inserted for hemopneumothorax. Which finding requires immediate intervention?
Answer: Drainage of 250 mL/hr of bright red blood for 2 consecutive hours
Drainage of >200 mL/hr of bright red blood for 2+ hours from a chest tube indicates ongoing hemorrhage (massive hemothorax) and may require surgical intervention (thoracotomy/video-assisted thoracoscopic surgery).
A nurse is providing education to a patient about pursed-lip breathing. Which statement best describes the purpose of this technique?
Answer: It maintains positive pressure in the airways during exhalation, preventing alveolar collapse and air trapping
Pursed-lip breathing creates positive pressure during exhalation, keeping small airways open longer and reducing air trapping — beneficial for COPD and emphysema where small airways collapse prematurely during expiration.
A patient is diagnosed with acute respiratory distress syndrome (ARDS). Which ventilator strategy is evidence-based for this condition?
Answer: Lung-protective ventilation: low tidal volumes (6 mL/kg IBW), PEEP, and FiO2 titration to minimize ventilator-induced injury
ARDS requires lung-protective ventilation: tidal volumes 6 mL/kg IBW (ARDSNet protocol) to prevent volutrauma/barotrauma, PEEP to recruit alveoli, and FiO2 titrated to SpO2 88–95%.
A nurse is caring for a patient with a tracheostomy. Which action is correct when performing tracheostomy care?
Answer: Clean the inner cannula with a dedicated brush and solution, replace or re-insert, and change the ties while maintaining tube security
Tracheostomy care involves cleaning or replacing the inner cannula (disposable or reusable), cleaning the stoma with sterile saline, and changing tracheostomy ties/velcro collar while a second nurse maintains tube security.
A patient with a history of smoking presents with a chronic productive cough, dyspnea, and barrel chest. Spirometry reveals FEV1/FVC ratio of 0.55 (below the normal 0.70). Which diagnosis does this support?
Answer: Chronic obstructive pulmonary disease (COPD)
An FEV1/FVC ratio <0.70 post-bronchodilator indicates airflow obstruction (COPD). Combined with smoking history, barrel chest, chronic productive cough, and dyspnea, this is consistent with COPD (emphysema and/or chronic bronchitis).
A patient is diagnosed with active tuberculosis (TB). Which precautions should the nurse implement?
Answer: Airborne precautions: negative pressure room, N95 respirator, and limiting patient transport
TB is transmitted by airborne droplet nuclei (<5 microns) that remain suspended in air. Airborne precautions require a negative-pressure isolation room and N95 (or higher) respirator for anyone entering the room.
A patient is admitted with suspected pulmonary embolism. Which diagnostic test is the gold standard for definitive diagnosis?
Answer: CT pulmonary angiography (CTPA)
CT pulmonary angiography (CTPA) is the gold standard for diagnosing PE — it directly visualizes the pulmonary vasculature and identifies filling defects (clots) with high sensitivity (>95%) and specificity.
A nurse is caring for a patient with pleural effusion who undergoes thoracentesis. Which complication should the nurse monitor for immediately after the procedure?
Answer: Pneumothorax from inadvertent lung puncture
Pneumothorax is the most common serious complication of thoracentesis, caused by inadvertent puncture of the lung with the needle. Post-procedure chest X-ray and monitoring for respiratory distress are essential.
A nurse is teaching a patient about using an incentive spirometer after abdominal surgery. What is the correct technique?
Answer: Sit upright, exhale completely, seal lips around mouthpiece, inhale slowly and deeply to raise the indicator, hold for 3–5 seconds, perform 10 repetitions hourly
Proper incentive spirometry: sit upright (or high Fowler's), exhale fully, place lips around mouthpiece, inhale slowly and deeply to raise the piston/ball, hold 3–5 seconds. Perform 10 times per hour while awake to prevent atelectasis.
A patient is receiving BiPAP therapy for acute hypercapnic respiratory failure. Which finding indicates the therapy is effective?
Answer: Respiratory rate decreasing, improved comfort, and ABG showing improved pH and decreased PaCO2
Effective BiPAP therapy for hypercapnic respiratory failure is demonstrated by decreased respiratory rate, reduced dyspnea, improved comfort, and ABG improvement: pH normalization and PaCO2 reduction.