Thank you. Hi guys, it's me, Professor D, and welcome back to my YouTube channel. On this video, I'm going to be covering upper and lower respiratory disorders. Before I get into the questions, guys, if you haven't done so already, please don't forget to like and subscribe below. Don't forget to go ahead and check me out on TikTok and Instagram. My handle is still the same, Nexus Nursing. I also have audio lessons available on my website. If you're a current student and you're really struggling with the content and you want to hear my voice teaching you this information, check me out at Nexus Nursing Instagram. www.homelifeinstitute.com. All right, guys, without any further ado, let's get started. First question. The home health care nurse is talking on the telephone to a male client diagnosed with hypertension and hears the client sneezing. The client tells the nurse that he has been blowing his nose frequently. Which questions should the nurse ask the client? One, have you had the flu shot in the last two weeks? Two, are there any small children at home? three, are you taking over-the-counter medicine for these symptoms? Or four, do you have any cold sores associated with your sneezing? And guys, the correct answer is three. Are you taking any over-the-counter medicine for these symptoms? Guys, whenever you get a test question, and it's asking you what question you're going to ask, you have to say to yourself, when you're looking at the list of questions, which one makes a difference? Why should I even care? And the reason that you need to care if that client's taking any over-the-counter medications is because if you go back to the question, it says the client has hypertension. Well, okay, it says they have hypertension and that they're sneezing. if that client has hypertension and they're taking something over the counter to help with their sneezing, such as what, a decongestion, that can make the hypertension be even worse. It can make the patient's blood pressure go even higher. That's why we care if they're taking anything over the counter. This is the reason why we're going to be asking this question because what's that? What am I looking? Oral decongestants. Guys, oral decongestants causes vasoconstriction. That vasoconstriction, which will help decongest that patient's nose, will also increase the blood pressure. Now, let's look at our other choices. Choices one, two, and four, asking if they had the flu shot, if they had children, small children at home, have they had cold sores? that has nothing to do with that patient's hypertension and the sneezing. You are expected to connect hypertension and to know that any over-the-counter decongestants can cause the blood pressure to go even higher. So that's why that's your concern. All right, guys, second question. The school nurse is presenting a class to students at primary school on how to prevent the transmission of the common cold virus. Which information should the nurse discuss? 1. Instruct the children to always keep a tissue or handkerchief with them. 2. Explain that children with current immunizations will not get a cold. 3. Tell the children that they should go to the doctor if they get a cold. 4. Include a demonstration of how to wash hands correctly. And guys, the answer is four. I cannot tell you how many students on NCLEX, they will choose the wrong answer just because they think it's too easy. Let me make this clear to you. The number one way to prevent the transmission of infection is always going to be to wash your hands. Every single time, guys. Washing the hands. So that's why number four is the correct answer. Now, choice one. Telling them to always keep a tissue or handkerchief with them. Okay, that's great advice to give the children, but that's not going to prevent transmission. That's not going to help prevent transmission. choice two, telling them that if they get their shots, they won't get a cold. That's a lie. That's not true. And choice three, telling the children that they should go to the doctor if they get a cold. Well, these are children. They can't just get in their car and hop to go see a doctor. First of all, that's a conversation you'd be having with parents. And number two, the common cold, it's a viral. It's a viral. It's a virus. So the common cold will come and it's going to go. The only thing that we can treat are the symptoms. So the question is about... preventing the spread of infection is going to be hand washing hands down every single day of the week. The client has been diagnosed with chronic sinusitis. Which signs and symptoms would the nurse alert, which signs and symptoms would alert the nurse to a potentially life-threatening complication? One, muscle weakness. Two, purulent sputum. Three, nuchal rigidity. Or four, intermittent loss of muscle control. And guys, the correct answer is nuchal rigidity. There are not too many diseases or disorders that we see nuchal rigidity. You see nuchal rigidity, what should you be thinking? Meningitis. This is a life-threatening disease. Okay, that's what you need to be thinking about. Now, let's look at our other symptoms, guys. One, muscle weakness. You know, muscle weakness is a sign of symptoms, something like myalgia. two, purulent sputum. That's a sign and symptom of a lung infection such as pneumonia. Four, intermittent loss of muscle control. That's a sign and symptom of MS. But when we talk about life-threatening, nuchal rigidity. Because when you see nuchal rigidity, your mind needs to be going to meningitis. Or some patients have a lot of stress. let me go back because meningitis has nothing to do with upper lower respiratory symptoms but since i mentioned meningitis i want to make sure i tell you this because they love acting about this as it pertains to meningitis if you even suspect a patient has meningitis the very first thing you're going to do is put that patient in isolation That's the first step. The next thing you're going to do is get orders for the blood culture. You need to draw the blood culture. And after you draw the blood culture, give the patient antibiotics. We're not going to wait for the culture to come back before we give the patient antibiotics. Because remember, cultures take a couple days to grow for us to figure out what bacteria is growing, what antibiotic the patient will be sensitive to. you are going to give that antibiotic right after you give the culture, but it's important to draw the culture before you give the antibiotic. When it comes to meningitis, isolation, draw cultures, then antibiotics. When it comes to meningitis. All right, guys, moving on. The client diagnosed with tonsillitis is scheduled to have surgery in the morning. Which assessment data should the nurse notify the healthcare provider about prior to surgery? 1. The client has a hemoglobin of 12.2 and a hematocrit of 36.5. 2. The client has an oil temperature of 100.2 and a dry cough. 3. There are 1 to 2 WBCs in your analysis. 4. The INR is 1. and the one that you're going to call the doctor about is going to be that temperature number two, the temperature of 100.2 and a dry cough. Those are signs and symptoms of infection. If that patient has any signs and symptoms of infection, that surgery is going to be canceled and it's going to be rescheduled when that patient's asymptomatic. We do not do surgery on patients that are infectious. Very important, guys. That surgery is going to be canceled. Next question. The influenza vaccine is in short supply. Which group of clients would the public health nurse consider priority when administering the vaccine? Excuse me. One, elderly and chronically ill clients. Two, child care workers and children younger than the age of four. Three, hospital chaplains and health care workers. Or four, school teachers and students living in a dormitory. And guys, while all of these are great choices of patients that should be getting the flu vaccine, everyone should be getting a flu shot. If you have to choose between a group of people that only one of them can get the flu shot, it's going to be your elderly, your geriatric patients and your patients that are chronically ill. So the correct answer, guys, is going to be number one. So your older than your 65 or older group and your patients with chronic conditions such as asthma or sickle cell, those patients are the ones that you are going to have them get the flu shot first because their body will not be able to handle that virus. OK, next question. The client diagnosed with influenza A is being discharged from the emergency department with a prescription for antibiotics. Which statement by the client indicates an understanding of the prescription? One, these pills will make me feel better and I can return to work. Two, the antibiotics will help prevent me from developing a bacterial pneumonia. Three, if I had gotten this prescription sooner, I could have prevented this illness. Or four, I need to take these pills until I feel better so that I can stop. so that I can stop taking the rest? And guys, the correct answer is two. The patient's taking these antibiotics to prevent a secondary infection such as bacterial pneumonia. Think about it. What does the patient have right now? Viral pneumonia. Well, we can't do anything with a virus, right? There's no cure. It's a virus that needs to come and go. All we can do is treat the symptoms. However, when that patient has viral pneumonia, they can develop a secondary pneumonia, which is bacterial pneumonia. Bacterial pneumonia, we can do something about, and that's why that patient's getting antibiotics. We want to prevent them from getting bacterial pneumonia because with that viral pneumonia, it hurts for them to even take deep breaths. So the patient's not taking deep breaths. They're coughing all over the place. It's easy for those secretions that are just sitting there for bacteria to grow, and the patient develops bacterial pneumonia. pneumonia. Now let's look at our wrong answer choices. One, these pills make me feel better, fast, so I can return to work. Excuse me? You have the flu. You need to be home and resting for a solid 10 days. Don't go back to work. What? So you can infect everybody else? Wrong. Choice three, if I had gotten the prescription sooner, I could have prevented the illness. no, antibiotics do not prevent viral infections. Antibiotics don't even treat viral infections. So that's wrong. Choice number four, I need to take these pills until I feel better. You guys already know the answer to that. Whenever it comes to antibiotics, what is the number one thing we always teach patients? To take the full course of antibiotics. Because if they don't, that bacteria can grow faster and stronger and be resistant to antibiotics. So we teach the patient to take the full course as ordered. Or four, escort the client diagnosed with laryngitis outside to smoke a cigarette. And the correct answer is to encouraging the client that's diagnosed with a cold to drink orange juice. That client has a cold. What is a cold? That's a viral infection. So a UAP can encourage a client to drink orange juice. Orange juice is full of vitamin C to help them fight that infection. Wonderful. Now let's look at the wrong answer choices, guys. One, feed a client who's post-optomolectomy, their first meal. Excuse me? That patient... just had surgery here in their throat and they're having their first meal. Who's responsible for feeding that patient? You, the RN, because you have to assess that patient. You have to assess their gag reflex because if that gag reflex is weak, there's a chance of that patient aspirating. So the UAP will not know what to assess. So you are not going to give that to the UAP. So that's wrong. Choice number three, obtaining a throat culture on a client diagnosed with pharyngitis. You, the nurse, you're going to get that throat culture because when it comes to throat cultures, we tend to get lots of false negatives. So we need the nurse to be the one doing the throat culture so it can be done correctly. Choice four, escort the client diagnosed with pharyngitis to go out and do what? To smoke? Do we ever encourage our patients to smoke? No. So we're not walking with that patient. We're not escorting them to go smoke anything. Absolutely not. Absolutely not. Absolutely not. No smoking. So the correct answer is going to be choice number two, guys. Come on, get it together. You know you're not going to walk that patient outside to go get a smoke. Stop it. All right. Next question. The nurse is assessing a 79-year-old client diagnosed with pneumonia. What signs and symptoms would the nurse expect to find when assessing the client? 1. Confusion and lethargy. 2. Frothy sputum and edema. I'm sorry, 2. High fever and chills. 3. Frothy sputum and edema. Or 4. Bradypnea and jugular vein distension. And the correct answer, guys, is number 1, confusion and lethargy. Why confusion and lethargy? Because we're talking about pneumonia. The classic signs and symptoms that we see in pneumonia will be coughing, difficulty breathing, right? Those types of things. Fever. but confusion and lethargy, go back to the question, how old is the patient? 79. Remember, when it comes to the geriatric patients, guys, when they have infection, those classic signs and symptoms of infection that we normally see when it comes to the geriatric community, those signs and symptoms tend to be blunted. And the first sign and symptoms of infection that we tend to see in the geriatric community is what? change in level of consciousness, confusion. A patient who is otherwise awake, alert, oriented times three, all of a sudden thinks you're their grandmother. Okay. So confusion, lethargy. Why? Because the patient is an older patient. Now let's look at our wrong answer choices. I'm sorry. I keep scratching my eye because I feel like I got something in there. All right, guys, look at the wrong answer choices. Number two, high fever and chills. Those are the classic signs and symptoms of pneumonia, but we see those in younger patients, not the geriatric patients. Choice three, frobisputum and edema. Where do we see this in patients that are going through heart failure? Choice number four, bradypinia and jugular vein distension. Well, in heart failure, we actually see tachypnea. The breathing starts to increase. So we see tachypnea and jugular vein distension in patients who are going through heart failure. So for this pneumonia in the older adult, we're going to see a change in the level of consciousness. We're going to see confusion and lethargy. The nurse is planning care for a client diagnosed with pneumonia and writes a problem of impaired gas exchange. which would be an expected outcome for this problem. 1. Performs chest PT three times a day. 2. Is able to complete activities of daily living. 3. Ambulates in the hall and back several times during each shift. 4. Alert and oriented to person, place, time, and events. And guys, the correct answer is four, alert and oriented to person, place, time, and events. So if the patient is having impaired gas exchange, remember gas exchange, guys, happens in the alveoli, right? So if the patient's having impaired gas exchange, they're not getting enough what? oxygen. And what do we tend to see when patients aren't getting enough oxygen? They're not getting enough oxygen to their brain. We start to see a change in level of consciousness. So an expected outcome that we will want to see if they're getting enough oxygen, they're getting enough perfusion, they're getting enough gas exchange, is them being awake and alert to person, place, and time. Now, let's look at our other choices. You see choice number one, two, and three. those are interventions, not expected outcomes. So even if you didn't know what this answer was, guys, when you were going through the choices, you should have said to yourself, well, choice number one, two, and three are all interventions, but choice number four is an outcome, so I'm going to choose that, and number four is the correct answer. The nurse in the long-term care facility is planning care for a client with a percutaneous gastrostomy feeding tube. That's the PEG tube, guys. Which intervention would the nurse include in the plan of care? 1. Inspect insertion line at the Nair prior to instilling formula. 2. Elevate the head of the bed after feeding the client. 3. Place the client in sims position following each feeding. 4. Change the dressing on the feeding tube every three days. And guys, the correct answer is to elevate the head of the bed after feeding the client. Why? We want to prevent aspiration. When you elevate the head of the bed, gravity is going to help to get that. nutrition that you just gave the patient to go from the stomach to the small intestine to the large intestine, right? We want gravity to help. If you have that patient lying down, guess what? There's a chance that that patient may aspirate and we don't want that to happen. That's why we're going to elevate the head of the bed to prevent aspiration. The client diagnosed with a community-acquired pneumonia is being admitted to the medical unit. Which nursing intervention has the highest priority? 1. Administer the oral antibiotic stat. 2. Order the meal tray to be delivered as soon as possible. 3. Obtain a sputum specimen for culture and sensitivity. Or 4. Have the unlicensed nursing assistant weigh the client. what's going to be our priority? And guys, the correct answer is three. We want to get a sputum specimen. Why? It says in this question, the patient has pneumonia. The reason we want to get that sputum specimen right away is because the sputum specimen takes a couple days to grow. And we need to find out what is growing, what kind of infection this patient has, and what kind of medication will these pathogens be sensitive to. So the doctor can know what kind of antibiotics to prescribe for this patient. So that's why this is... the number one priority. Now let's look at our other choices. We have number one, administer the oral antibiotics. So you're going to give an antibiotic before you take that culture? Why? If you give a patient an antibiotic before you draw the culture, first of all, it's going to mess with the results of the culture. So you're going to draw the culture first, then give them antibiotics. So we're not going to do that. The first priority is to drop the culture first. Choice two, order the meal tray to be delivered as soon as possible. No, they can eat after we get those cultures. We need a culture now. Choice four, have the unlicensed nursing assistant weigh the client. That can wait. Our first priority, like I said, guys, is getting that culture so we can start getting the patient better, find out what's going on with the patient. All right, next question. The 56-year-old client diagnosed with TB is being discharged. Which statement made by the client indicates an understanding of the discharge instructions? One, I will take my medication for the full three weeks prescribed. Two, I must stay on the medication for months if I am to get well. Three, I can be around my friends because I've started taking antibiotics. Or four, I should get TB skin test every three months to determine if I am well. and the correct answer, guys, is number two, I must stay on my medication for months if I am to get well. When it comes to these anti-TB medications, the patient will be on those medications the least amount of time. A lot of the textbooks will say six months, but for testing purposes, and guys, I've been in the game for a long time. the least amount of time will be nine months. The patient's usually going to be on that medication for about a year, but you can expect that patient to at least be on that medication for a solid nine months. Okay. Choice number three, I can be around my friends because I have started taking the antibiotics. No, you can be around your friends after you've had not one, not two, but three negative sputum cultures. yeah, three. And remember guys, when we get those sputum cultures, don't forget, we have to get it early in the morning before the patient's eaten. And we want to get it after they've done oral care and you're going to have the patient cough it up. You don't want the spit, the saliva in their mouth, the culture you want, you're going to have the patient cough it up. Um, and the last one, I should get TB skin test every three months. Um, to determine if I'm well, guys, that's TB skin test, which is also known as the MANTU test, which is also known as the PPD. Those are all just screening tools. Those are not diagnostic measures. I cannot stress this enough. The only way 100% that patient can be diagnosed as TB, it's diagnostic is a sputum culture. When we actually do the sputum culture and we see the acid fast bacillus, okay? the PPD, MANTU, skin test, even the chest x-ray, those are screening tools. They are not diagnostic. The chest x-ray may show some inflammation, but it's not diagnostic. The only diagnostic test for tuberculosis is the sputum culture. And specifically, you're looking for the acid-fast bacillus. All right, next question. The employee health nurse is administering TB skin testing to employees who have possibly been exposed to a client with active TB. Which statement indicates the need for radiological evaluation instead of skin testing? 1. The client's first skin test indicates a purple flat area at the site of injection. 2. The client's second skin test indicates a red area measuring 4 millimeters. 3. The client's previous skin test was read as a positive. 4. The client has never shown a reaction to the tuberculin medication. and the correct answer is three, the client's previous skin test was read as positive. So they get a skin test and it's positive. We're going to do a chest x-ray and we're going to be looking for some positive, for some type of causation or inflammation. And if we see that causation of inflammation, we're going to do what? Get the sputum culture because that is the only 100% way that you can diagnose a patient with tuberculosis. I, guys, the reason I keep saying this to you is because I promise you, I promise you, this question has been shown on NCLEX over and over and over again. And students get it wrong because they think that a patient can be diagnosed with TB by a skin, a PPD or x-ray. And those are just screening tools. They are not diagnostic. So guys, the correct answer is three. Now let's talk about the wrong answer choices. One, the client's first skin test indicates a purple flat arid site of injection. Well guys, when we're using a screening tool such as the PPD skin test, MANTU test, do we care about the color? Do we care about erythema? No. What we care about is in duration. We care about the lump. Okay? we don't care about the redness. Don't fall for that. So it doesn't matter. That's wrong. Choice number two, the client's second skin test indicates a red area measuring four. Again, guys, we don't care about the color. We care about in duration. Let me go back to number one, because I didn't even read number one correctly. Number one said the client's first skin test indicates a purple flat area. We want it to be flat. Flat is good. It's when the patient has an induration of five or more that we have a problem. Let's look at our last choice. The client has never shown a reaction to tuberculin medication. Well, if the patient does not show a reaction, that test is negative and there's no reason to go do a secondary screening test such as a chest x-ray. That's why number three is the correct answer. The nurse is caring for the client diagnosed with pneumonia. Which information should the nurse include in the teaching plan? Select all that applies. Guys, how do we treat select all that applies? As true or false? Let's go. Number one, place the client on oxygen via nasal cannula. True. They have pneumonia, infection of the lungs. They're going to need oxygen because when you have infection of lungs, it hurts to even breathe. So you think that patient is going to be deep breathing? Absolutely not. They're going to need supplemental oxygen. Number two, plan for periods of rest during activities of daily living. Absolutely. That patient's going to need to conserve their energy and be able to take those deep breaths. Four, place the client on the fluid restrictions of 1,000 mLs per day. Absolutely not. Absolutely not. The patient needs to be drinking lots of fluids so they can break up those secretions. We're not going to put them on fluid restrictions. We want them drinking lots of fluids. So that's false. We're not going to choose that. Choice four. Restrict the client's smoking to two or three cigarettes per day. in what world? Not here on earth. Absolutely not. We tell the patient to cease. Stop. Do not smoke. We're not even accepting one cigarette. So that's false. We're not going to choose that. Choice five, monitor the pulse ox readings every four hours. Absolutely. We want to make sure that that patient, and we want the pulse ox to be between 98 and 100, but we'll take 95 to 100. 95 to 100 is acceptable. So we're going to continue to monitor the pulse ox to make sure that that patient is being adequately perfused. While feeding the client diagnosed with aspiration pneumonia, the client becomes dyspnea, begins to cough, and is turning blue. Which nursing interventions would the nurse implement first? 1. Suction the client's nares. 2. Turn the client to the side. 3. Place the client in Transdelenburg's position. 4. Notify the doctor. And guys, the correct answer is two. You're going to turn them to the side. Go back to the diagnosis. Look what it says. The patient already has aspiration pneumonia, which means that they've choked before. And food or fluid, instead of going to the stomach, it got in the patient's lungs. And the patient got infection. That's aspiration pneumonia. So the patient already has aspiration pneumonia. And then it says they're now unable to breathe. They're coughing. They're turning blue. You're going to turn them to the side. Turning them to the side, guys, is going to help the patient do what? Cough up whatever it is that they're choking on. Let's look at our wrong answer choices. One, suction the nares. This patient is choking. They're coughing. So they're coughing. It's right here. Why are you suctioning the nares? You want to get below the obstruction. You want to get this thing out. Why are you over here? False. We're not going to do that. Three, place them in Trendelinsburg position. While they're choking, you're going to make the matter worse. Absolutely not. That makes no sense. You're going to increase that patient's risk of aspiration. Why would you put them in Trendelinsburg? That's wrong. And then choice number four, notify the doctor. Yeah. Hey, doc. Yeah, my patient's choking. They're turning blue. What should I do? You're going to call the doctor after you've done your nursing intervention for the patient and see if there are any additional orders. But while that patient is having a hard time, you're going to turn them to the left to help them to cough up whatever it is that they're aspirating on. I can't believe this, guys. We are already down to our last question. Have I been mean on this video? I think I have. I didn't get my coffee today and I'm feeling irritant. Guys, I'm sorry if I've been mean on this video. Please forgive me. That's what happens when I don't drink my coffee. I'll be nicer next time, I promise. All right, guys, last question. The day shift charge nurse on the medical unit is making rounds after report. Which client should be seen first? 1. The 65-year-old client diagnosed with TB who has a sputum specimen to be sent to the lab. 2. The 76-year-old client diagnosed with aspiration pneumonia who has a clogged feeding tube. 3. The 45-year-old client diagnosed with pneumonia who has a pulse ox reading of 92. 4. The 39-year-old client diagnosed with bronchitis who has arterial oxygenation level of 89. And guys, the correct answer is choice number three, that patient whose pulse ox is reading 92. I just told you that. We want the pulse-offs to be between 98 and 100, but 95 to 100 is acceptable. Anything less than 95 means that that patient is not being perfused adequately, okay? That's the patient we're going to run to. Whenever you get a question asking you which patient's the priority, you have to say to yourself, which patient is likely to die first, and that's who you're going to run to. That's going to be your priority patient. All right, guys, I hope this video was helpful. If you want to see more upper and lower respiratory disorders, please go ahead and leave me a comment. Or if there's something else that you'd like to see me cover or just cover more of, leave me a comment, let me know, and I'll make sure I add it onto my list to cover those questions for you. Please do not forget, guys, I have audio lessons available on my website right now, www.NexusNursingInstitute.com. Also, be sure to check me out on all my other social media platforms, such as... Instagram, and TikTok. The handle is still the same, Nexus Nursing. Thank you so much for watching this video, and you'll see me on the next video.