Med Surg Final Exam
RESPIRATORY: 26 questions
1. Medication modalities: nebulizers/inhalers, etc. to include teaching & purpose – Ch. 21
- From powerpoint: incentive spirometer, O2, handheld nebulizers, inhalers
The nurse is preparing to discharge a patient after thoracotomy. The patient is going home on
oxygen therapy and requires wound care. As a result, he will receive home care nursing. What
should the nurse include in discharge teaching for this patient?
- Correct and safe use of oxygen therapy equipment
Respiratory care and other treatment modalities (oxygen, incentive spirometry, chest
physiotherapy [CPT], and oral, inhaled, or IV medications) may be continued at home.
Therefore, the nurse needs to instruct the patient and family in their correct and safe use. The
scenario does not indicate the patient needs help with suctioning, postural drainage, or
tracheostomy care.
A nurse is teaching a patient how to perform flow type incentive spirometry prior to his
scheduled thoracic surgery. What instruction should the nurse provide to the patient?
- “Breathe in deeply through the spirometer, hold your breath briefly, and then exhale.”
The patient should be taught to lace the mouthpiece of the spirometer firmly in the mouth,
breathe air in through the mouth, and hold the breath at the end of inspiration for about 3
seconds. The patient should then exhale slowly through the mouthpiece.
The nurse is performing patient education for a patient who is being discharged on mini-
nebulizer treatments. What information should the nurse prioritize in the patient's discharge
teaching?
- How to perform diaphragmatic breathing
Diaphragmatic breathing is a helpful technique to prepare for proper use of the small-volume
nebulizer. Patient teaching would not include counting respirations and the patient should not
wean herself from treatment without the involvement of her primary care provider. Serial
sputum samples are not normally necessary.
,The nurse has explained to the patient that after his thoracotomy, it will be important to adhere
to a coughing schedule. The patient is concerned about being in too much pain to be able to
cough. What would be an appropriate nursing intervention for this client?
- Teach him how to perform huffing.
The technique of “huffing” may be helpful for the patient with diminished expiratory flow rates
or for the patient who refuses to cough because of severe pain. Huffing is the expulsion of air
through an open glottis. Inhalers, nebulizers, and postural drainage are not substitutes for
performing coughing exercises.
A patient is being admitted to the preoperative holding area for a thoracotomy. Preoperative
teaching includes what?
- Correct use of incentive spirometry
Instruction in the use of incentive spirometry begins before surgery to familiarize the patient
with its correct use. You do not teach a patient the use of a ventilator; you explain that he may
be on a ventilator to help him breathe. Rhythmic breathing and mini-nebulizers are
unnecessary.
2. Inhalers: short/long term
- Short: acute asthma attack
- Long: COPD?
3. Flu: think priority pts to receive the vaccine….questions to ask prior to administration
- Influenza is an acute viral respiratory disease. Older people are more susceptible to it.
- If the correct influenza agents have been included in that year’s vaccine, the vaccine offers 70-
90% protection for healthy children and adults younger than 65. It is less effective in preventing
disease in older adults but decreases the severity of illness in those who become infected.
- Injection: w/ inactivated virus
- Nasal spray: w/ live attenuated virus
- Transmission by small-particle aerosols- droplets from cough, sneeze
- Contact with respiratory droplets, then touches own mouth or nose.
- Priority patients: Those people at greatest risk for complications of the flu and those most
likely to get or spread the flu should be immunized as soon as the vaccine is available**:
- All children (6 months- 5y/o)
- Adults aged greater than 65 y/o
- Adults 50-64 y/o
, - Persons aged 2-64 y/o with underlying chronic medical conditions
- Persons greater than 2 y/o with conditions that can cause breathing problems
- All women who will be pregnant during the influenza season
- Residents of nursing homes and long-term care facilities
- Children aged 6 months to 18 years on chronic aspirin therapy
- ALL HEALTHCARE WORKERS
- Out-of-home caregivers and household contacts of persons in the high-risk groups
- ASK: if they have any egg allergies; ever had a severe allergy to the influenza vaccine before;
ask current health status: NOT to be given in the presence of a moderate or severe acute illness
with or without a fever.
What is the best rationale for health care providers receiving the influenza vaccination on a
yearly basis?
- To decrease risk of transmission to vulnerable patients
To reduce the chance of transmission to vulnerable patients, health care workers are advised to
obtain influenza vaccinations. The vaccine will not decrease nurses' risks of developing health
care-associated infections, eradicate the influenza virus, or decrease the risk of developing new
strains of the influenza virus.
A public health nurse promoting the annual influenza vaccination is focusing health promotion
efforts on the populations most vulnerable to death from influenza. The nurse should focus on
which of the following groups?
- Older adults with compromised health status
Influenza vaccination is particularly beneficial in preventing death among older adults,
especially those with compromised health status or those who live in institutional settings. It is
recommended for children and adults, but carries the greatest reduction in morbidity and
mortality in older adults.
4. Respiratory modalities: IS/tcdb/cpt (in general)/breathing techniques
- IS: incentive spirometer (helps increase lung function) for COPD, Pneumonia
- TCDB: turn, cough, deep breathe (specially when activity is decreased), important for post-
op pts.
- CPT: chest physiotherapy
RESPIRATORY: 26 questions
1. Medication modalities: nebulizers/inhalers, etc. to include teaching & purpose – Ch. 21
- From powerpoint: incentive spirometer, O2, handheld nebulizers, inhalers
The nurse is preparing to discharge a patient after thoracotomy. The patient is going home on
oxygen therapy and requires wound care. As a result, he will receive home care nursing. What
should the nurse include in discharge teaching for this patient?
- Correct and safe use of oxygen therapy equipment
Respiratory care and other treatment modalities (oxygen, incentive spirometry, chest
physiotherapy [CPT], and oral, inhaled, or IV medications) may be continued at home.
Therefore, the nurse needs to instruct the patient and family in their correct and safe use. The
scenario does not indicate the patient needs help with suctioning, postural drainage, or
tracheostomy care.
A nurse is teaching a patient how to perform flow type incentive spirometry prior to his
scheduled thoracic surgery. What instruction should the nurse provide to the patient?
- “Breathe in deeply through the spirometer, hold your breath briefly, and then exhale.”
The patient should be taught to lace the mouthpiece of the spirometer firmly in the mouth,
breathe air in through the mouth, and hold the breath at the end of inspiration for about 3
seconds. The patient should then exhale slowly through the mouthpiece.
The nurse is performing patient education for a patient who is being discharged on mini-
nebulizer treatments. What information should the nurse prioritize in the patient's discharge
teaching?
- How to perform diaphragmatic breathing
Diaphragmatic breathing is a helpful technique to prepare for proper use of the small-volume
nebulizer. Patient teaching would not include counting respirations and the patient should not
wean herself from treatment without the involvement of her primary care provider. Serial
sputum samples are not normally necessary.
,The nurse has explained to the patient that after his thoracotomy, it will be important to adhere
to a coughing schedule. The patient is concerned about being in too much pain to be able to
cough. What would be an appropriate nursing intervention for this client?
- Teach him how to perform huffing.
The technique of “huffing” may be helpful for the patient with diminished expiratory flow rates
or for the patient who refuses to cough because of severe pain. Huffing is the expulsion of air
through an open glottis. Inhalers, nebulizers, and postural drainage are not substitutes for
performing coughing exercises.
A patient is being admitted to the preoperative holding area for a thoracotomy. Preoperative
teaching includes what?
- Correct use of incentive spirometry
Instruction in the use of incentive spirometry begins before surgery to familiarize the patient
with its correct use. You do not teach a patient the use of a ventilator; you explain that he may
be on a ventilator to help him breathe. Rhythmic breathing and mini-nebulizers are
unnecessary.
2. Inhalers: short/long term
- Short: acute asthma attack
- Long: COPD?
3. Flu: think priority pts to receive the vaccine….questions to ask prior to administration
- Influenza is an acute viral respiratory disease. Older people are more susceptible to it.
- If the correct influenza agents have been included in that year’s vaccine, the vaccine offers 70-
90% protection for healthy children and adults younger than 65. It is less effective in preventing
disease in older adults but decreases the severity of illness in those who become infected.
- Injection: w/ inactivated virus
- Nasal spray: w/ live attenuated virus
- Transmission by small-particle aerosols- droplets from cough, sneeze
- Contact with respiratory droplets, then touches own mouth or nose.
- Priority patients: Those people at greatest risk for complications of the flu and those most
likely to get or spread the flu should be immunized as soon as the vaccine is available**:
- All children (6 months- 5y/o)
- Adults aged greater than 65 y/o
- Adults 50-64 y/o
, - Persons aged 2-64 y/o with underlying chronic medical conditions
- Persons greater than 2 y/o with conditions that can cause breathing problems
- All women who will be pregnant during the influenza season
- Residents of nursing homes and long-term care facilities
- Children aged 6 months to 18 years on chronic aspirin therapy
- ALL HEALTHCARE WORKERS
- Out-of-home caregivers and household contacts of persons in the high-risk groups
- ASK: if they have any egg allergies; ever had a severe allergy to the influenza vaccine before;
ask current health status: NOT to be given in the presence of a moderate or severe acute illness
with or without a fever.
What is the best rationale for health care providers receiving the influenza vaccination on a
yearly basis?
- To decrease risk of transmission to vulnerable patients
To reduce the chance of transmission to vulnerable patients, health care workers are advised to
obtain influenza vaccinations. The vaccine will not decrease nurses' risks of developing health
care-associated infections, eradicate the influenza virus, or decrease the risk of developing new
strains of the influenza virus.
A public health nurse promoting the annual influenza vaccination is focusing health promotion
efforts on the populations most vulnerable to death from influenza. The nurse should focus on
which of the following groups?
- Older adults with compromised health status
Influenza vaccination is particularly beneficial in preventing death among older adults,
especially those with compromised health status or those who live in institutional settings. It is
recommended for children and adults, but carries the greatest reduction in morbidity and
mortality in older adults.
4. Respiratory modalities: IS/tcdb/cpt (in general)/breathing techniques
- IS: incentive spirometer (helps increase lung function) for COPD, Pneumonia
- TCDB: turn, cough, deep breathe (specially when activity is decreased), important for post-
op pts.
- CPT: chest physiotherapy
