CORRECT QUESTION AND ANSWER FOR MED-SURG PROCTORED ATI

CORRECT QUESTION AND ANSWER FOR MED-SURG PROCTORED ATI Arterial Blood Gas - CORRECT ANSWER-ABG's via arterial puncture or arterial line: allows the most accurate method of assessing respiratory function. Steps for collecting ABG's - CORRECT ANSWER-a. Perform Allen test if no arterial line b. sample is drawn into heparinized syringe c. keep on ice and transport to laboratory immediately d. document amount and method of oxygen delivered for accurate results e. apply direct pressure to puncture site at least 5 min (longer for clients at risk for bleeding) Bronchoscopy - CORRECT ANSWER-visualizes the larynx, trachea, bronchi; obtains tissue biopsy; and removes foreign bodies. Steps for a bronchoscopy procedure - CORRECT ANSWER-a. obtain informed consent b. maintain NPO 8 to 12 hr. c. Provide local anesthetic throat spray d. position upright e. administer medications as prescribed, such as atropine (to reduce oral secretions), sedation, and/or anti-anxiety. f. label specimen g. observe postprocedure -gag reflex -bleeding -respiratory status, vital signs, and level of consciousness Mantoux test - CORRECT ANSWER-Positive test indicates exposure to tuberculosis. Diagnosis must be confirmed with sputum culture for presence of acid-fast bacillus (AFB). Mantoux test steps - CORRECT ANSWER-a. administer 0.1 mL of purified protein derivation intradermal to upper half inner surface of forearm (insert needle bevel up) b. Assess for reaction in 48 to 72 hr following injection; induration (hardening) of 10 mm or greater is considered a positive test; 5 mm may be considered significant if immunocompromised. QuantiFERON-TB Gold test (QFT-GT) and T-SPOT.TB - CORRECT ANSWER-Identify the presence of Mycobacterium tuberculosis infection by measuring the immune response to the TB bacteria in whole blood. Thoracentesis - CORRECT ANSWER-Surgical perforation of the pleural space to obtain specimen, to remove fluid or air, or to instill medication. Steps for Thoracentesis - CORRECT ANSWER-a. informed consent b. educate client: remain still, feeling of pressure, positioning c. position upright d. monitor respiratory status and vital signs e. label specimens f. Document client response, amount, color and viscosity of fluid (maximum amount of fluid to be removed at a time is 1L). g. Chest tube at bedside h. Obtain CXR before and after procedure Asthma - CORRECT ANSWER-Chronic inflammatory disorder of the airways resulting in intermittent and reversible airflow obstruction of the bronchioles. Contributing factors of asthma - CORRECT ANSWER--Extrinsic: antigen-antibody reaction triggered by food, medications, or inhaled substances -Intrinsic: pathophysiological abnormalities within the respiratory tract -Older clients: beta receptors are less responsive to agonist and trigger bronchospasms. Manifestations of asthma - CORRECT ANSWER--Sudden, severe dyspnea with use of accessory muscles -sitting up, leaning forward -diaphoresis and anxiety -wheezing, gasping -coughing -cyanosis (late sign) -barrel chest Diagnostic procedures for asthma - CORRECT ANSWER--ABGs -sputum cultures -pulmonary function tests Nursing interventions for asthma - CORRECT ANSWER--remain with the client during the attack -position in high-fowler's -assess lung sounds and pulse oximetry -administer oxygen therapy -maintain oxygen access Medications for athma - CORRECT ANSWER-Administer bronchodilators before antiinflammatory 1. Bronchodilators -short-acting inhaled: albuterol; for rapid relief -Methylxanthines: theophylline; monitor therapeutic range for toxicity. 2. Anti-inflammatory -corticosteriods: fluticasone and prednisone -Leukotriene antagonist: montelukast 3. Combination agents -Ipratropium and albuterol (Combivent) -Fluticasone and salmeterol (Advair) Therapeutic measures for asthma - CORRECT ANSWER--respiratory treatments -oxygen administration Client Education for asthma - CORRECT ANSWER--avoidance of allergens and triggers -proper use of inhaler and peak flow monitoring Status asthmaticus - CORRECT ANSWER-life-threatening episode of airway obstruction this is often unresponsive to treatment Manifestations of status asthmaticus - CORRECT ANSWER--extreme wheezing -labored breathing -use of accessory muscles -distended neck veins -high risk for cardiac and/or respiratory arrest Nursing interventions for status asthmaticus - CORRECT ANSWER--place in highfowler's -prepare for emergency intubation -administer oxygen, epinephrine, and systemic steroid as prescribed -provide emotional support Chronic Obstructive Pulmonary Disease - CORRECT ANSWER-encompasses pulmonary emphysema and chronic bronchitis. COPD is not reversible. Pulmonary emphysema - CORRECT ANSWER--destruction of alveoli, narrowing of bronchioles, and trapping of air resulting in loss of lung elasticity Contributing factors of pulmonary emphysema - CORRECT ANSWER--cigarette smoking (main causative factor); passive smoke inhalation -advanced age -exposure to air pollution -Alpha-antitrypsin deficiency (inability to break down pollutants) -Occupational dust and chemical exposure Manifestations of emphysema - CORRECT ANSWER--dyspnea with productive cough -difficult exhalation, use of pursed-lip breathing -wheezing, crackles -