ABGs
A patient’s ABGs show: pH 7.48, PaCO₂ 30, HCO₃ 22
What is uncompensated respiratory alkalosis
Criteria for Hospital Acquired Pneumonia (HAP)?
What is develops 48 hours AFTER hospital admission, dxn made 48-72 hours after admission
Risk factors: recent ABX, immunosuppressive therapy, chronic disease, treated within healthcare facilities such as dialysis clinics, rehab facilities, LTCA (close contact w/ healthcare personnel and other pts)
Calcified granuloma on a chest x-ray is a classic sign of this type of tuberculosis?
What is latent tuberculosis infection
A patient with asthma is prescribed two inhalers: albuterol (bronchodilator) and fluticasone (inhaled corticosteroid). The patient asks which to use first and how long to wait in between. What should the nurse teach?
1) Use the bronchodilator (albuterol) first and wait 1 minute in between if another dose is needed
2) Wait 5 minutes, then use the inhaled corticosteroid (fluticasone) to reduce inflammation and prevent exacerbations.
3) Rinse mouth after steroid use to prevent oral thrush (candidiasis)
What does COPD consist of?
What is emphysema and chronic bronchitis
Characterized by airflow limitations!Interpret the ABGs: pH 7.28, PaCO₂ 58, HCO₃ 24, PaO₂ 55.
What is uncompensated respiratory acidosis with hypoxemia
The provider orders a chest x-ray and sputum culture for a patient with suspected pneumonia. What must the nurse do before initiating antibiotic therapy, and why
What is obtain the sputum specimen and culture before starting antibiotics to ensure accurate identification of the causative organism and avoid false-negative results?
The Mantoux test uses ___ mL of purified protein derivative (PPD) intradermally and is measured after how ____ hours?
What is 0.1 mL and 48-72 hours
A patient with moderate persistent asthma uses their Peak Inspiratory Flow Meter at home. Their reading is 65% of their personal best, placing them in the yellow zone. What should the nurse instruct the patient to do next?
What is use their prescribed short-acting bronchodilator (rescue inhaler) immediately and repeat the peak flow in 20-30 minutes.
If it's still in yellow, follow asthma action plan (increase maintenance meds or contact provider)
A patient with COPD has a barrel-shaped chest and uses pursed-lip breathing. What causes these clinical findings?
What is air trapping and loss of alveolar elasticity, leading to hyperinflation of the lungs and structural chest changes characteristic of emphysema?
A COPD patient has ABGs: pH 7.37, PaCO₂ 60, HCO₃ 34. What does this indicate?
What is fully compensated respiratory acidosis
The nurse is reviewing lab results for a patient with pneumonia. Which combination of findings supports a bacterial infection?
What is elevated WBC count, increased neutrophils, and a positive sputum culture identifying the pathogen?
A patient who received the Bacille Calmette-Guérin (BCG) vaccine has a positive PPD. What test should be used to confirm infection and why?
What is an interferon gamma release assay (IGRA)
Individuals who received the BCG vaccine can cause a false-positive result during a PPD skin test. The IGRA detects immune sensitization to TB without being affected by prior BCG vaccination
Status asthmaticus treatment?
What is Oxygen, IV fluids, Systemic bronchodilators, and Steroids
--> open airways and decrease inflammation
A patient with COPD becomes increasingly dyspneic and anxious. The nurse observes shallow respirations and use of accessory muscles. What immediate interventions should the nurse implement?
What is sit the patient in high Fowler’s position, encourage pursed-lip breathing, provide low-flow O₂ (1–2 L/min) as ordered
A patient in status asthmaticus has ABGs: pH 7.25, PaCO₂ 68, HCO₃ 26, PaO₂ 50. Identify the acid–base imbalance and explain its cause.
What is acute respiratory acidosis due to air trapping and severe bronchoconstriction, preventing CO₂ elimination and causing hypoxemia?
Name 1 Common Causative Organisms of Pneumonia
Community acquired: Streptococcus pneumoniae, mycoplasma pneumoniae, haemophilus influenzae, legionella, MRSA, chlamydia pneumoniae
Hospital acquired: Pseudomonas aeruginosa, S. aureus, Klebsiella pneumoniae, E. colo, Enterobacter sp.
Healthcare associated: Staph. a, MRSA, P. aeruginosa, H. inflluenzae
A 58-year-old patient with active pulmonary tuberculosis also has chronic kidney disease (CKD stage 4). Which TB medications should be adjusted or avoided, and which can be safely used?
Isoniazid and Rifampin are safe to use without dose adjustment because they are primarily metabolized by the liver
Pyrazinamide and Ethambutol require dose adjustment because they are renally excreted and may accumulate, increasing toxicity risk
In CKD, monitor for hyperuricemia (Pyrazinamide) and optic neuritis (Ethambutol), and ensure close renal and visual assessments during therapy.
The nurse is teaching a patient with asthma how to perform Huff coughing to clear secretions. List the correct sequence of steps.
1️⃣ Sit upright and take a deep breath through the nose.
2️⃣ Hold for 2–3 seconds.
3️⃣ Exhale forcefully through an open mouth while saying “huff.”
4️⃣ Repeat 2–3 times, then rest with diaphragmatic breathing
A patient with COPD is prescribed a bronchodilator inhaler and a corticosteroid inhaler. Which instruction is correct?
Use bronchodilator first, wait 5 min, then corticosteroid inhaler
A COPD patient receiving high-flow oxygen now has ABGs:
pH 7.31, PaCO₂ 70, HCO₃ 30, PaO₂ 95.
Identify the imbalance and explain the physiologic reason.
What is partially compensated respiratory acidosis
oxygen-induced hypoventilation suppressed the patient’s hypoxic drive, leading to CO₂ retention and respiratory acidosis.
A patient with pneumonia has coarse crackles, RR 30, O₂ saturation 88% on room air, and a productive cough with thick sputum. What specific nursing interventions improve oxygenation and airway clearance?
✅ Place patient in high Fowler’s to maximize lung expansion.
✅ Encourage coughing, deep breathing, and use of incentive spirometer every hour.
✅ Encourage fluids (2–3 L/day) to thin secretions.
✅ Administer humidified oxygen as ordered.
A 42-year-old healthcare worker undergoes a Mantoux tuberculin skin test. After 48 hours, a 12-mm area of induration is measured. She reports no symptoms but works in a high-exposure clinical setting. How should the nurse interpret this finding?
What is a positive TB test, because an induration ≥10 mm is considered positive for individuals at moderate to high risk
The nurse is teaching a patient how to use a Peak Inspiratory (Peak Flow) Meter to monitor asthma control at home. List the correct steps and how to interpret the results.
1) Set the marker to zero before each use.
2) Stand up, take a deep breath, and place the mouthpiece in the mouth with lips tightly sealed around it.
3️) Blow out as hard and fast as possible in a single exhalation.
4️) Record the reading, then repeat three times and document the highest (best) value.
5) Compare the result to the patient’s personal best and interpret zones
The nurse is caring for a COPD patient on 2 L/min oxygen. A new nurse increases it to 6 L/min when the patient’s SpO₂ reads 88%. What is the next action?
What is intervene because high oxygen flow can suppress the hypoxic drive, causing hypoventilation and CO₂ retention?
The goal SpO₂ for COPD is ~88–92% (whateves ur book says), not normal range.