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Timby/Smith: Introductory Medical-Surgical Nursing, 10th Edition

Chapter 21: Caring for Clients with Lower Respiratory Disorders

Answers to Stop, Think, and Respond Exercises

21-1: Instruct them in careful handwashing technique. Teach the client to cover his mouth and

nose with a tissue when coughing and to wash his hands frequently. In addition, the client must

dispose of soiled tissues in a separate container. He should incinerate or dispose of soiled tissues

according to the local community’s guidelines for disposal of biohazardous waste. The couple

must keep the apartment well ventilated.

21-2: Instruct the client to avoid environmental irritants, which include inhaled cigarette smoke.

Explain that cigarette smoke contributes to irritation of the bronchial mucosa, leading to

increased inflammation and mucus production. Advise the client that continued smoking would

also affect his future health. Even though this episode is acute, smoking increases the risk of

future episodes of acute bronchitis and eventually chronic bronchitis. If the client expresses

interest, refer him or her to a smoking cessation program.

21-3: Possibilities include the following:

•      Keep filters clean in air conditioners and furnaces.

•      Use washable blankets on the bed.

•      Damp mop and dust daily.

•      Use lightweight washable cotton or synthetic fiber curtains.

•      Keep floors bare except for washable cotton throw rugs.

21-4: Encourage the client to walk regularly and exercise her legs. Suggest that she wear support

or antiembolism stockings. Tell her not to cross her legs when sitting and to avoid massaging her

legs. If she feels that she has thrombophlebitis again, she needs to see her physician promptly.

21-5: Tell him that he needs to see his physician. A persistent nonsmoker’s cough with blood-

tinged mucus is a possible sign of lung cancer. Early diagnosis improves a client’s chance of


Suggested Answers to Critical Thinking Exercises

1.      Suspecting that the client has a pulmonary embolus, quickly ask the client when the

symptoms started, if the onset was sudden, and if anything relieves the symptoms. Also ask if the

client is experiencing a cough productive of blood-tinged sputum.

2.      It is essential to obtain information including an accurate medication history, with client’s

use of rescue and maintenance medications; observe the client’s use of inhalers and peak flow

meter; triggers for asthma attacks that the client identifies and how to avoid them; and the

client’s knowledge of when rescue treatment is needed and when it is necessary to seek medical


3.      Assist the client to splint the chest wall with pillows or blanket packs while deep

breathing and coughing. In addition, positioning in a bed with the head elevated or in a chair will

promote the client’s ability to perform these exercises.

4.      Teach the client to lie on stomach with a large pillow(s) under his abdomen. This position

places his head lower than his abdomen and promotes drainage of secretions from the lower left

lobe. Also use this technique on the client’s right side.

Answers to NCLEX-Style Review Questions

1.      Answer: 3. Rationale: Pulse oximetry is an immediate, noninvasive procedure to check

the blood’s oxygen status. The result determines if oxygen exchange and perfusion to the tissues

are sufficient.

2.      Answer: 2. Rationale: The most common symptom of pleurisy is excruciating pain.

During the acute phase, pleurae are inflamed, thick, and swollen. With inspiration, they rub

together, causing severe, sharp pain. Sputum, hot flashes, chills, and fever may be present with

varying severity.

3.      Answer: 1. Rationale: Most clients find that raising sputum is easiest when they first

awaken. A sputum sample must contain respiratory secretions, not simply saliva.

4.      Answer: 3. Rationale: Peak flow meters measures the peak expiratory flow rate (PEFR),

which is the point of highest flow during forced expiration. The other options are measures used

when assessing overall pulmonary function, but are not measured with a peak flow meter.

5.      Answers: 3, 4, 5. Rationale: Interventions related to impaired gas exchange focus on the

client’s respiratory status. An elevated temperature may indicate inadequate ventilation because

of a lung infection. Reminding the client to deep breathe and cough frequently promotes

expansion of the alveoli and prevents atelectasis. Repositioning the client in an upright position

promotes lung expansion. The other actions are important, but are not related to “Impaired gas


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