Nursing 3Rd Semester: Exam 1: Resp. Unit Worksheet

Front 1

Amount of air exhaled in 1st second of force vital capacity (grades severity of airway obstruction)

Back 1

FEV1 -- Forced Expiratory Volume (in first second of expiration)

normal value- over 80% of predicted

Front 2

Amount of air remaining in the lungs after forced expiration (air available in lungs for gas exchange between breaths)

Back 2

RV- Residual Volume


normal value- 1.5 L

Front 3

Amount of Air that can be exhaled after maximum inspiration

Back 3

VC- Vital Capacity



normal value- 4.5 L

Front 4

Maximum rate of airflow during forced expiration
(aids in monitoring bronchoconstriction in asthma, can be measured with peak flow meter)

Back 4

PEFR- Peak Expiratory Flow Rate



normal value- up to 600 L/ min

Front 5

Maximum amount of air lungs can contain

Back 5

TLC- Total Lung Capacity



normal value- 6.0 L

Front 6

Volume of air inhaled and exhaled with each breath (only a small proportion of total capacity of lungs)

Back 6

VT- Tidal Volume

(Yes, VT not TV)


normal value- 0.5 L

Front 7

Amount of air that can be quickly and forcefully exhaled after maximum inspiration

Back 7

FVC- Forced Vital Capacity


normal value- over 80% of predicted

Front 8

Ratio useful to differentiate obstructive and restrictive respiratory dysfunction

Back 8

FEV1 / FVC ratio
(dividing of value for FEV1 by value for FVC)


normal value-
Age <50 greater than or equal to 75% of predicted

Age >50 greater than or equal to 70% of predicted

Front 9

In a ____ _____ oxygen delivery device, oxygen is delivered via plastic nasal prongs. This is a safe and simple method that allows some freedom of movement and the patient can eat, talk, or cough while wearing the device.

Back 9

nasal cannula

Front 10

True or false: the nasal cannula is the most commonly used oxygen delivery device

Back 10

true

Front 11

Nasal cannulas are useful for patients requiring low oxygen concentrations. What range of concentration and rate can be obtained with this device?

Back 11

O2 concentration of 24% (at 1 L per minute) to 44% (at 6L/min)

Front 12

With a nasal cannula, the amount of oxygen inhaled depends on room air and patient's breathing pattern. Nasal cannula should be stabilized when caring for a restless patient. Assess the patient's nares and ears for ____ _______. The cannula may need to be padded where it sits on the ears.

Back 12

skin breakdown

Front 13

If flow rates on a nasal cannula are greater than ___ L/ min, nasal membranes may dry and may cause pain in the frontal _____. Most COPD patients can tolerate __ L / min via cannula.

Back 13

If flow rates on a nasal cannula are > 5 L/ min, nasal membranes may dry and may cause pain in the frontal sinuses. Most COPD patients can tolerate 2 L / min via cannula.

Front 14

A simple mask is a low flow oxygen delivery device that covers the patient's nose and mouth. Is it used for short term or long term use? What is the concentration oxygen and rate available for this device? Mask provides adequate _____ of inspired air. What are the nursing responsibilities? Mask must fit _____. Nasal cannula may be provided when patient is ____.

Back 14

Used only for short periods, especially when transporting patients. Longer use is typically not tolerated as it is uncomfortable with tight seal and heat generated around nose/mouthe. Rate 6-12 L /min, concentration is 35-50%. Mask provides adequate humidification of inspired air. Wash and dry under mask q 2 h. Watch for pressure necrosis on patient's ears from elastic straps. Mask must fit snugly. Nasal cannula may be provided when patient is eating.

Front 15

A simple face mask provides adequate ______ of inspired air. What range of concentration and rate can be obtained with this device?

Back 15

A simple face mask provides adequate humidification of inspired air.
O2 concentration of 35-50% can be achieved with flow rates of 6-12 L/min

Front 16

For a patient using a simple face mask, a nasal cannula can be substituted during meals. What kinds of nursing interventions need to be taken care of for a simple face mask?

Back 16

Wash and dry under mask q 2h
Mask must fit snugly
Watch for pressure necrosis at top of ears from elastic straps if patient wears for a longer period of time (Gauze or other padding may be used to alleviate this problem).

Front 17

A partial/non-rebreathing mask is a type of low flow oxygen delivery device and is useful for short-term (___h) therapy for patients needing higher O2 concentrations: ___%-____% at ___-___ L/min. The oxygen flows into ______ bag and mask during inhalation. This bag allows patient to rebreathe about first 3rd of exhaled air (rich in O2) in conjunction with flowing O2. The vents remain open on partial mask only, some facilities prefer this over non-rebreather as a safety issue.

Back 17

A partial/ non-rebreathing mask is a type of low flow oxygen delivery device and is useful for short-term (24 h) therapy for patients needing higher O2 concentrations: 60%-90% at 10-15 L/min. The oxygen flows into reservoir bag and mask during inhalation. This bag allows patient to rebreathe about first 3rd of exhaled air (rich in O2) in conjunction with flowing O2. The vents remain open on partial mask only, some facilities prefer this over non-rebreather as a safety issue.

Front 18

A partial/ non-rebreathing mask required oxygen flow rates to be sufficient to keep bag from _____ during inspiration to avoid buildup of ____ ______. If deflation occurs, liter flow needs to be increased/decreased to keep bag inflated.

Back 18

A partial/ non-rebreathing mask required oxygen flow rates to be sufficient to keep bag from collapsing during inspiration to avoid buildup of carbon dioxide. If deflation occurs, liter flow needs to be increased to keep bag inflated.

Front 19

A partial/ non-rebreathing mask should fit snulgy. With non-rebreather masks, make sure valves are open during _______ and closed during ________ to prevent drastic decrease in FlO2. Monitor patient closely because _____ may be next required intervention.

Back 19

A partial/ non-rebreathing mask should fit snulgy. With non-rebreather masks, make sure valves are open during expiration and closed during inspiration to prevent drastic decrease in FlO2. Monitor patient closely because intubation may be next required intervention.

Front 20

An oxygen-conserving cannula is generally indicated for ___-term O2 therapy at home versus during hospitalization, such as with pulmonary _______ or pulmonary ______.

Back 20

An oxygen-conserving cannula is generally indicated for long-term O2 therapy at home versus during hospitalization, such as with pulmonary fibrosis or pulmonary HTN.

Front 21

The oxygen-conserving cannula may be a "moustache" (Oxymizer) or "pendant" type. The cannula has a built in reservoir that increases/decreases oxygen concentration and allows patient to use lower flow, usually ___ to ___% which increases comfort, lowers cost, and can be increased with activities. How much oxygen at what rate can be delivered?

Back 21

The oxygen-conserving cannula may be a "moustache" (Oxymizer) or "pendant" type. The cannula has a built in reservoir that increases oxygen concentration and allows patient to use lower flow, usually 30% - 50% which increases comfort, lowers cost, and can be increased with activities. Can deliver up to 8 L/ min O2.

Front 22

An oxygen-conserving cannula may cause _____ over tops of ears-- can be padded. The cannula cannot be ______, the manufacturer recommends _____ the cannula every ____. It is more/less expensive than standard cannulas and requires evaluation with ____ and ____ to determine correct flow for patient. Is the cannula highly visible or easily concealed?

Back 22

An oxygen-conserving cannula may cause necrosis over tops of ears-- can be padded. The cannula cannot be cleaned, the manufacturer recommends changing the cannula every week. It is more expensive than standard cannulas and requires evaluation with ABGs and oximetry to determine correct flow for patient. This cannula is highly visible.

Front 23

What are the 4 types of low-flow oxygen delivery devices?

Back 23

nasal cannula
simple face mask
partial & non-rebreathing masks
oxygen-conserving cannula

Front 24

The tracheostomy collar is a high-flow oxygen delivery device and attaches to the neck with an elastic strap and can deliver high _____ and ____ via _____. The oxygen concentration is ___ into the ______ because collar does not fit tightly. A ____ device can be attached to flow meter and thus can deliver exact amounts of oxygen via collar.

Back 24

The tracheostomy collar is a high-flow oxygen delivery device and attaches to the neck with an elastic strap and can deliver high humidity and oxygen via tracheostomy. The oxygen concentration is lost into the atmosphere because collar does not fit tightly. A venturi device can be attached to flow meter and thus can deliver exact amounts of oxygen via collar.

Front 25

In a tracheostomy collar, secretions collect inside collar and around tracheostomy. Collar should be removed and cleaned at least every ___ h to prevent aspiration of ____ and infection. ________ occurs in tubing and needs to be periodically drained proximally/distally to tracheostomy.

Back 25

In a tracheostomy collar, secretions collect inside collar and around tracheostomy. Collar should be removed and cleaned at least every 4 h to prevent aspiration of fluid and infection. Condensation occurs in tubing and needs to be periodically drained distally to tracheostomy.

Front 26

A tracheostomy T Bar is almost identical to tracheostomy collar, but it has a vent and a T connector that allow an inline catheter to be connected for _______. ____ fit allows better oxygen and humidity delivery than tracheostomy collar.

Back 26

A tracheostomy T Bar is almost identical to tracheostomy collar, but it has a vent and a T connector that allow an inline catheter to be connected for suctioning. Tight fit allows better oxygen and humidity delivery than tracheostomy collar.

Front 27

A venturi mask is another high-flow delivery device. This type of mask can deliver _____, high flow rates of oxygen. It is a lightweight plastic, ___-shaped device that is fitted to the face. Masks are available for delivery of what %'s of oxygen?

Back 27

A venturi mask is another high-flow delivery device. This type of mask can deliver precise, high flow rates of oxygen. It is a lightweight plastic, cone-shaped device that is fitted to the face. Masks are available for delivery of 24%, 28%, 31%, 35%, 40%, and 50% O2.

Front 28

The venturi mask uses a method that is especially helpful for administering low, constant O2 concentrations to patients with _____. Adaptors can be appled to increase _____. Why must the entrainment device on the mask be changed? Air entrainment ports must not be _____. Is the mask comfortable? When should it be removed. The patient will be able to talk but voice may be _____. Other care similar to simple face mask.

Back 28

The venturi mask uses a method that is especially helpful for administering low, constant O2 concentrations to patients with COPD. Adaptors can be applied to increase humidification. The entrainment device on the mask must be changed to deliver higher concentrations of O2. Air entrainment ports must not be occluded. The mask is uncomfortable and should be removed when the patient eats. The patient will be able to talk but voice may be muffled. Other care similar to simple face mask.

Front 29

In the blood study, ABG's, arterial blood is obtained through puncture of ______ or _____ artery or through arterial _____. What is it used to assess? (5) Continuous ABG monitoring is also possible via a sensor or electrode inserted into arterial catheter.

Back 29

In the blood study, ABG's, arterial blood is obtained through puncture of radial or femoral artery or through arterial catheter. ABG's are performed to assess acid-base balance, ventilation status, change in ventilator settings, need for oxygen therapy, or change in oxygen therapy. Continuous ABG monitoring is also possible via a sensor or electrode inserted into arterial catheter.

Front 30

Nursing responsibilities for ABGs include indicating whether patient is using ____ and at what percentage and rate. Avoid change in ____ therapy or interventions such as ____ or _____ change for ___ minutes before obtaining sample. Assist with positioning (palm up, wrist slightly hyperextended if radial artery used). Collect blood into _______ syringe. To ensure accurate results, ____ air bubbles, and place sample in ___, unless it will be analyzed in less than ____ min. Apply pressure to artery for ___ min after specimen is obtained to prevent ______ at arterial puncture site.

Back 30

Nursing responsibilities for ABGs include indicating whether patient is using oxygen and at what percentage and rate. Avoid change in oxygen therapy or interventions such as suctioning or position change for 20 minutes before obtaining sample. Assist with positioning (palm up, wrist slightly hyperextended if radial artery used). Collect blood into heparinized syringe. To ensure accurate results,expel air bubbles, and place sample in ice, unless it will be analyzed in less than 1 min. Apply pressure to artery for 5 min after specimen is obtained to prevent hematoma at arterial puncture site.

Front 31

Oximetry is a test that monitors arterial or venous oxygen saturation. Where can the probe be attached for SpO2 monitoring? It can also be contained in a pulmonary artery catheter for SvO2 monitoring. Oximetry is used for intermittent or continuous monitoring and ______ testing.

Back 31

Oximetry is a test that monitors arterial or venous oxygen saturation. The probe can be attached to finger, toe, earlobe, or bridge of nose for SpO2 monitoring. It can also be contained in a pulmonary artery catheter for SvO2 monitoring. Oximetry is used for intermittent or continuous monitoring and exercise testing.

Front 32

When interpreting values of SpO2 and SvO2, first assess patient status and presence of factors that can alter accuracy of pulse oximeter reading. What do these include for SpO2? For SvO2?

Back 32

SpO2- motion, low perfusion, cold extremities, bright lights, acrylic nails, dark skin color, carbon monoxide, anemia

SvO2- change in O2 delivery or O2 consumption

Front 33

In the sputum study, culture and sensitivity, a single sputum specimen is collected in a _____ container. The purpose is to diagnose bacterial infection, select antibiotic, and evaluate treatment. Instruct the patient on how to produce a good specimen (same as gram stain). If patient cannot produce specimen, ____ may be used. How long do results take?

Back 33

In the sputum study, culture and sensitivity, a single sputum specimen is collected in a sterile container. The purpose is to diagnose bacterial infection, select antibiotic, and evaluate treatment. Instruct the patient on how to produce a good specimen (same as gram stain). If patient cannot produce specimen, bronchoscopy may be used. Results take 48-72 h.

Front 34

For the sputum study, gram stain, the sputum specimen is stained which permits classification of bacteria into gram-negative and gram-positive studies. Results guide therapy until _____ and _____ results are obtained.

Back 34

For the sputum study, gram stain, the sputum specimen is stained which permits classification of bacteria into gram-negative and gram-positive studies. Results guide therapy until culture and sensitivity results are obtained.

Front 35

In obtaining a sputum sample for a gram stain (or a C & S), instruct patient to expectorate sputum into container after ____ing deeply. Obtain sputum (mucoidlike), not _____. When is specimen best obtained? If first attempt is unsuccessful, try increasing oral fluid intake unless fluids are restricted. Collect sputum in sterile container (sputum trap) during suctioning or by aspirating secretions from the ____. Send specimen to lab promptly.

Back 35

In obtaining a sputum sample for a gram stain (or a C & S), instruct patient to expectorate sputum into container after coughing deeply. Obtain sputum (mucoidlike), not saliva. Specimen is best obtained in early morning after mouth care because secretions collect during night. If first attempt is unsuccessful, try increasing oral fluid intake unless fluids are restricted. Collect sputum in sterile container (sputum trap) during suctioning or by aspirating secretions from the trachea. Send specimen to lab promptly.

Front 36

The sputum study, acid-fast smear and culture assess sputum for acid-fast bacilli such as _____ _____. A series of ____ early-_____ specimens is used. Instruct patient how to produce a good specimen (see gram stain) and cover specimen and send to lab for analysis.

Back 36

The sputum study, acid-fast smear and culture assess sputum for acid-fast bacilli such as Myobacterium tuberculosis. A series of 3 early-morning specimens is used. Instruct patient how to produce a good specimen (see gram stain) and cover specimen and send to lab for analysis.

Front 37

A chest x-ray is a type of radiology study used to screen, diagnose, and evaluate changes in the respiratory system. What are the most common views? Instruct patient to undress to ____, put on gown, and remove ___ between neck and waist.

Back 37

A chest x-ray is a type of radiology study used to screen, diagnose, and evaluate changes in the respiratory system. The most common views are anterior-posterior (AP) and lateral. Instruct patient to undress to waist, put on gown, and remove metal between neck and waist.

Front 38

Computed Tomography (CT) is a radiological study used to diagnose _____s difficult to assess by conventional x-ray studies such as mediastunum, hilum, and pleura. Common types are _____ or _____ CT where contrast media is usually used and high-_______, where contrast media is NOT used. Spiral CT is used to diagnose a _______ _______.

Back 38

Computed Tomography (CT) is a radiological study used to diagnose lesions difficult to assess by conventional x-ray studies such as mediastunum, hilum, and pleura. Common types are helical or spiral CT where contrast media is usually used and high-resolution, where contrast media is NOT used. Spiral CT is used to diagnose a pulmonary embolism.

Front 39

Nursing responsibilities for CT scan are similar to a chest x-ray. Contrast media may be given ___. Evaluation of ___ and serum ______ is done before contrast to assess _____ function. Assess if patient is allergic to ______ as the contrast is ____ based. Be sure the patient is well ____ before and after procedure (to excrete contrast). Contrast media may cause a feeling of being _____ and _____. Instruct the patient that he or she will need to lie very still on a hard table and the scanner will revolve around the body with ______ noises.

Back 39

Nursing responsibilities for CT scan are similar to a chest x-ray. Contrast media may be given IV. Evaluation of BUN and serum creatinine is done before contrast to assess renal function. Assess if patient is allergic to shellfish (iodine) as the contrast is iodine based. Be sure the patient is well hydrated before and after procedure (to excrete contrast). Contrast media may cause a feeling of being warm and flushed. Instruct the patient that he or she will need to lie very still on a hard table and the scanner will revolve around the body with clicking noises.

Front 40

An MRI (Magnetic Resonance Imaging) is used for diagnosis of lesions difficult to assess by CT scan such as a lung ____ and for distinguishing ____ from non____ structures. The nursing responsibilities are similar to chest x-ray and CT scan, except contrast medium is..... If closed MRI used and patient has claustrophobia, provide with relaxation or other coping strategies. Patient must remove all ____ before test. Who cannot undergo an MRI?

Back 40

An MRI (Magnetic Resonance Imaging) is used for diagnosis of lesions difficult to assess by CT scan such as a lung apex and for distinguishing vascular from nonvascular structures. The nursing responsibilities are similar to chest x-ray and CT scan, except contrast medium is not iodine based. If closed MRI used and patient has claustrophobia, provide with relaxation or other coping strategies. Patient must remove all metal before test. Patients with pacemakers and implantable cardioverterdefibrillators cannot undergo an MRI.

Front 41

Ventilation-Perfusion (V/Q) is a radiology test used to assess ventilation and perfusion in the lungs. IV _______ is given to assess perfusion. For the ventilation portion, the patient inhales ____ gas (xenon or krypton), which outlines the ____. Normal scans show __________ radioactivity. Diminished or absent radioactivity suggests lack of perfusion or _____. Ventilation without perfusion suggests a ______ ______. The preparation is same as for chest x-ray. Any other precautions needed? Why?

Back 41

Ventilation-Perfusion (V/Q) is a radiology test used to assess ventilation and perfusion in the lungs. IV radioisotope is given to assess perfusion. For the ventilation portion, the patient inhales a radioactive gas (xenon or krypton), which outlines the alveoli. Normal scans show homogeneous radioactivity. Diminished or absent radioactivity suggests lack of perfusion or airflow. Ventilation without perfusion suggests a pulmonary embolism. No precautions needed afterward because the gas and isotope transmit radioactivity for only a brief interval.

Front 42

A pulmonary angiogram is a radiology test used to visualize pulmonary _____ and locate _____ or pathologic conditions such as a __. Contrast medium is injected through a catheter threaded into _____ ____ or ____ side of heart. Series of x-rays are taken after contrast medium is injected. ____ ____ is replacing angiography as it is less invasive. Prep is same as chest x-ray (+ contrast media precautions). Check _____ dressing site after procedure. Monitor what 3 things? Report and record significant changes.

Back 42

A pulmonary angiogram is a radiology test used to visualize pulmonary vasculature and locate obstruction or pathologic conditions such as a PE. Contrast medium is injected through a catheter threaded into pulmonary artery or right side of heart. Series of x-rays are taken after contrast medium is injected. Chest CT is replacing angiography as it is less invasive. Check pressure dressing site after procedure. Monitor blood pressure, pulse, and circulation distal to injection site. Report and record significant changes.

Front 43

A bronchoscopy is a type of endoscopy with a flexible fiberoptic scope used for diagnosis, biopsy, specimen collection, or assessment of changes. It may also be done to suction mucous ____, _____ the lungs, or remove ____ ____. Instruct the patient to be on ____ status for ___ to ____ h before the test. Obtain ____ permit. Give a _____ if ordered. After procedure, keep patient NPO until ____ ____ returns and monitor for ______ edema. Monitor for recovery from sedatives. Blood-tinged mucus is abnormal/normal. If biopsy was done, monitor for ______ and ______.

Back 43

A bronchoscopy is a type of endoscopy with a flexible fiberoptic scope used for diagnosis, biopsy, specimen collection, or assessment of changes. It may also be done to suction mucous plug, lavage the lungs, or remove foreign objects. Instruct the patient to be on NPO status for 6 to 12 h before the test. Obtain signed permit. Give a sedative if ordered. After procedure, keep patient NPO until gag reflex returns and monitor for laryngeal edema. Monitor for recovery from sedatives. Blood-tinged mucus is normal. If biopsy was done, monitor for hemorrhage and pneumothorax.

Front 44

In a mediastinoscopy, a scope is inserted through a small ____ in the _____ notch and advanced into the mediastinum to inspect and biopsy the ____ _____. What is it used to diagnose? Prepare the patient for ______ intervention. Obtain signed permit. Performed in OR and patient is given a _____ _____. Afterward, monitor as for a _______.

Back 44

In a mediastinoscopy, a scope is inserted through a small incision in the suprasternal notch and advanced into the mediastinum to inspect and biopsy the lymph nodes. It is used to diagnose lung cancer, non-Hodgkins Lymphoma, granulomatous infections, and sarcoidosis. Prepare the patient for surgical intervention. Obtain signed permit. Performed in OR and patient is given a general anesthetic Afterward, monitor as for a bronchoscopy

Front 45

A pulmonary function test is used to evaluate lung function. It involves the use of a _____ to assess air movement as patient performs prescribed ______ ______. Avoid scheduling immediately after ______. Avoid administration of inhaled _______ within ___ h of procedure. Explain procedure; assess for respiratory distress before procedure and report. Provide ____ after procedure.

Back 45

A pulmonary function test is used to evaluate lung function. It involves the use of a spirometer to assess air movement as patient performs prescribed respiratory maneuvers. Avoid scheduling immediately after mealtime. Avoid administration of inhaled bronchodilator within 6 h of procedure. Explain procedure; assess for respiratory distress before procedure and report. Provide rest after procedure.

Front 46

Thoracentesis is used to obtain a specimen of ___ _____ for diagnosis, to remove ___ ___ or to instill _______. ___ ____ is always obtained after procedure to check for ________. Explain the procedure to patient and obtain signed permit before procedure, which is usually performed in the _____ room. Position patient ___ with _____ on overbed table and ___ supported. Instruct the patient not to ___ or ____ , and assist during procedure. Observe for signs of ____ and ____ and verify ____ ____ in all fields after procedure. Encourage ___ ____ to expand lungs. Send labeled specimens to laboratory.

Back 46

Thoracentesis is used to obtain a specimen of pleural fluid for diagnosis, to remove pleural fluid or to instill medication. Chest X-ray is always obtained after procedure to check for pneumothorax. Explain the procedure to patient and obtain signed permit before procedure, which is usually performed in the patient's room. Position patient upright with elbows on overbed table and feet supported. Instruct the patient not to cough or talk, and assist during procedure. Observe for signs of hypoxia and pneumothorax and verify breath sounds in all fields after procedure. Encourage deep breaths to expand lungs. Send labeled specimens to laboratory.

Front 47

In a lung biopsy, specimens may be obtained by trans_____ or p_______ biopsy or via ______ needle ________ (TTNA); ____-assisted thorascopic surgery (VATS); or o___ lung biopsy. Transbronchial biopsy and VATS can be performed in the ________ suite. TTNA is done under ___ guidance in _____. Open lung is performed in the ___. ____ can also be done in the OR. These tests are used to obtain specimens for laboratory analysis.

Back 47

In a lung biopsy, specimens may be obtained by transbronchial or percutaneous biopsy or via transthoracic needle aspiration (TTNA); video-assisted thorascopic surgery (VATS); or open lung biopsy. Transbronchial biopsy and VATS can be performed in the bronchoscopy suite. TTNA is done under CT guidance in radiology. Open lung is performed in the OR. VATS can also be done in the OR. These tests are used to obtain specimens for laboratory analysis.

Front 48

Nursing responsibilities for the lung biopsy are the same as a ____ if procedure done with bronchoscope, and same as ______ if open lung biopsy done. With a TTNA, check ___ ____ q__ h for __ h and report any _______ distress. Check ___ site for bleeding. A ___ ___ should be done after TTNA or transbronchial biopsy to check for ________. With VATS a ___ ___ may be in postprocedure until lung has re_______. Encourage ____ _____ for lung re_____. Obtain ____ ______ for all procedures.

Back 48

Nursing responsibilities for the lung biopsy are the same as a bronchoscopy if procedure done with bronchoscope, and same as thoractomy if open lung biopsy done. With a TTNA, check breath sounds q4 h for 24 h and report any respiratory distress. Check incision site for bleeding. A chest x-ray should be done after TTNA or transbronchial biopsy to check for pneumothorax. With VATS a chest tube may be in postprocedure until lung has reexpanded. Encourage deep breathing for lung reinflation. Obtain signed permit for all procedures.