Ch 27 ?'s

When caring for a patient with pertussis, the nurse will prioritize 1 Administering antibiotic therapy 2 Having the patient use an antihistamine at night 3 Teaching the patient how to use a bronchodilator 4 Instructing the patient to use cough suppressants

1 Treatment for pertussis is antibiotics, usually macrolides (erythromycin, azithromycin), to minimize symptoms and prevent spread of the disease. Cough suppressants and antihistamines should not be used, because they are ineffective and may induce coughing episodes. Corticosteroids and bronchodilators are not useful in reducing symptoms. Text Reference - p. 522

The nurse is caring for the patient with pulmonary hypertension. Which treatment(s) are appropriate? Select all that apply. 1 Vasodilators 2 Diuretics 3 Anticoagulants 4 Thrombolytics

1, 2, 3 Vasodilators, diuretics, and anticoagulants are correct because they are included in drug treatments for pulmonary hypertension. Vasodilators are especially important in the treatment of pulmonary hypertension, because they will aid in reducing the right ventricular workload by dilating pulmonary vessels. Diuretics decrease plasma volume and thereby reduce myocardial workload. Anticoagulants also are used, especially if the case is severe, because they work to prevent in situ thrombus formation and venous thrombosis. Warfarin would be given to keep the international normalized ratio (INR) in the 2 to 3 range. Thrombolytic therapy is not an appropriate drug treatment and would be used if the condition caused right ventricle hypertrophy, resulting in cor pulmonale. Text Reference - p. 582

What is the priority nursing intervention in helping a patient expectorate thick lung secretions? 1 Humidify the oxygen as able 2 Administer cough suppressant q4hr 3 Teach patient to splint the affected area 4 Increase fluid intake to 3 L/day if tolerated

4 Although several interventions may help the patient expectorate mucus, the highest priority should be on increasing fluid intake, which will liquefy the secretions so that the patient can expectorate them more easily. Humidifying the oxygen also is helpful, but is not the primary intervention. Teaching the patient to splint the affected area also may be helpful in decreasing discomfort, but does not assist in expectoration of thick secretions. Text Reference - p. 528

While planning a patients care, the nurse identifies nursing actions to minimize the patients pleuritic pain. Which intervention should the nurse include in the plan of care? A)Avoid actions that will cause the patient to breathe deeply. B)Ambulate the patient at least three times daily. C)Arrange for a soft-textured diet and increased fluid intake. 4)Encourage the patient to speak as little as possible

A

A patient is suspected of having lung cancer. What specific systemic symptom will the nurse question the patient regarding? 1 Cough 2 Nausea 3 Anorexia 4 Weight loss

1 A cough is the systemic symptom of lung cancer. Nausea, vomiting, anorexia, and weight loss are nonspecific systemic symptoms of lung cancer. Text Reference - p. 538

Which statement is true regarding a water seal chamber? 1 It contains 2 cm of water. 2 It acts as a two-way valve. 3 It receives fluid and air from the pleural space. 4 It applies suction to the chest drainage system

1 The water seal chamber is the second chamber of the chest drainage system. It contains 2 cm of water, which acts as a one-way valve. The first chamber of the drainage system receives fluid and air from the pleural space. The third chamber applies suction to the chest drainage system. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 545

The nurse is caring for a patient who has a nasogastric tube. What actions should the nurse perform to prevent aspiration in this patient? Select all that apply. 1 Elevate the head of the bed 30 to 45 degrees. 2 Monitor gastric residual volumes. 3 Encourage the patient to sit upright for all meals. 4 Lower the head of the bed to 10 degrees. 5 Feed the patient in a reclined positio

1, 2, 3 Although the nasogastric tubes are small, there is an increased risk for aspiration pneumonia; to prevent it, the head of the bed should be elevated to 30 to 45 degrees, gastric residual volumes should be monitored, and the patient should be made to sit upright for all meals. Lowering the head of the bed and reclining while eating are not advisable, because these positions can increase the risk of aspiration. Text Reference - p. 527

The nurse makes a nursing diagnosis of "impaired gas exchange" for a patient with pneumonia based upon which physical-assessment findings? Select all that apply. 1 SpO2 of 85% 2 PaO2 of 65 mm Hg 3 Absent breath sounds in right lung lobes 4 Presence of thick yellow mucus 5 Respiratory rate 24 breaths/minute

1, 2, 3 Impaired gas exchange is evidenced by low oxygen saturation and elevated PaCO2 with absent breath sounds. Yellow mucus would indicate clearance of secretions. An increased respiratory rate does not imply impaired gas exchange. Text Reference - p. 525

The nurse is caring for the patient with a pulmonary embolism. Which factor(s) are associated with a pulmonary embolism (PE)? Select all that apply. 1 Pregnancy 2 Pelvic surgery 3 Immobility 4 Herbal therapy

1, 2, 3 Pregnancy, pelvic surgery, and immobility are major risk factors associated with a pulmonary embolism. Risk factors among many for PE include immobility, pelvic surgery, pregnancy, oral contraceptives and hormone therapy. Herbal therapy is incorrect because herbal therapy is not associated with the development of a pulmonary embolism. Text Reference - p. 578

During admission of a patient diagnosed with non-small-cell lung carcinoma, the nurse questions the patient related to a history of which risk factors for this type of cancer? Select all that apply. 1 Asbestos exposure 2 Exposure to uranium 3 Chronic interstitial fibrosis 4 History of cigarette smoking 5 Geographic area in which the patient was born

1, 2, 4 Non-small-cell carcinoma is associated with cigarette smoking and exposure to environmental carcinogens, including asbestos and uranium. Chronic interstitial fibrosis is associated with the development of adenocarcinoma of the lung. Exposure to cancer-causing substances in the geographic area where the patient has lived for some time may be a risk, but not necessarily where the patient was born. Text Reference - p. 540

A patient has clinical manifestations that correlate with a diagnosis of lung cancer. For what test does the nurse initially prepare the patient? 1 Biopsy 2 Chest x-ray 3 Computed tomography 4 Sputum cytology studies

2 A chest x-ray examination is the first diagnostic test for lung cance,r because it helps identify the lung mass or evident infiltrate. A biopsy is a diagnostic test for cancer that is performed after computed tomography scans. Computed tomography (CT) scans help to further evaluate the lung mass after the its identification on a chest x-ray. Sputum cytology studies help to identify the malignancy of cancer cells; they are not the first test performed to identify the lung cancer. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies. Text Reference - p. 538

How will splinting the incision with a pillow benefit a patient who underwent surgery to repair chest trauma? 1 It will reduce pain perception. 2 It will facilitate deep breathing. 3 It will reduce the risk of air leak. 4 It will increase perfusion at the site

2 The patient will have difficulty breathing after surgery due to the incision on the chest. Splinting the incision facilitates deep breathing. The nurse administers analgesics to reduce pain. An occlusive dressing is applied over the site of surgery to reduce air leakage. The nurse instructs the patient to perform range of motion exercise to increase perfusion or oxygen supply to the injured site. Text Reference - p. 548

While monitoring a patient who is on a wet chest drainage system, the nurse covers the suction control chamber with a muffler. What is the reason for this intervention? 1 To reduce the pleural air leak 2 To reduce the noise of the chamber 3 To increase the bubbling of the water 4 To increase the suction from the chamber

2 The suction chamber is covered with a muffler because the continuous boiling is noisy and it may disturb the patient. The absence of bubbles in the chamber will reduce the pleural air leak but closing the chamber with a muffler will not. The muffler will reduce evaporation but will not increase the bubbling. The suction from the chamber is increased when slight bubbles form in the water. Text Reference - p. 546

Which statement made by the patient indicates effective learning about the interventions to be followed to reduce the risk of atelectasis while undergoing chest tube drainage? Select all that apply. 1 "I should change position slowly." 2 "I should cough at regular intervals." 3 "I should perform incentive spirometer." 4 "I should reduce intake of protein in my diet." 5 "I should perform range-of-motion exercises."

2, 3, 5 Coughing and deep breathing exercises will open the pores of Kohn in the lungs and relieve atelectasis. Incentive spirometer will assist in clearing the lungs and will reduce the risk of atelectasis. The nurse instructs the patient to perform range-of-motion exercises because doing so reduces the risk of atelectasis. The nurse instructs the patient to change position slowly if he or she has hypotension. Protein is essential and does not cause any complications for atelectasis.

A patient has a sucking chest wound due to a surgical thoracotomy. Which type of pneumothorax does the nurse expect? 1 Tension pneumothorax 2 Iatrogenic pneumothorax 3 Traumatic pneumothorax 4 Spontaneous pneumothorax

3 A penetrating wound of the chest may be referred to as a sucking chest wound, because air enters the pleural space during inspiration through the chest wall. Surgical thoracotomy can cause sucking chest wounds and result in traumatic pneumothorax. Tension pneumothorax is the condition associated with accumulation of air in pleural space, resulting in lung compression. Iatrogenic pneumothorax is trauma to the chest wall that occurs during a medical procedure such as thoracentesis. Spontaneous pneumothorax is chest wall trauma that is associated with rupture of small blebs. Text Reference - p. 542

The patient has acute bronchitis. What is the most important factor for the nurse to consider for this patient? 1 Clinical assessment finding of egophony 2 Presence of tactile fremitus 3 Therapy is mainly supportive 4 Abnormal chest x-ray

3 Acute bronchitis is usually self-limiting and treatment for acute bronchitis is supportive. Chest x-rays will differentiate acute bronchitis form pneumonia. In bronchitis, there is not consolidation or infiltrates on x-ray as there is in pneumonia. Text Reference - p. 549

An x-ray of a trauma patient reveals rib fractures and the patient is diagnosed with a small flail chest injury. Which intervention should the nurse include in the patients plan of care? A) Suction the patients airway secretions. B) Immobilize the ribs with an abdominal binder. C) Prepare the patient for surgery. D) Immediately sedate and intubate the patient.

A

When assessing a patient who has just arrived after an automobile accident, the emergency department nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the patient? a. Emergency pericardiocentesis b. Stabilization of the chest wall with tape c. Administration of an inhaled bronchodilator d. Insertion of a chest tube with a chest drainage system

ANS: D The patient's history and absent breath sounds suggest a right-sided pneumothorax or hemothorax, which will require treatment with a chest tube and drainage. The other therapies would be appropriate for an acute asthma attack, flail chest, or cardiac tamponade, but the patient's clinical manifestations are not consistent with these problems

A hospital has been the site of an increased incidence of hospital-acquired pneumonia (HAP). What is an important measure for the prevention of HAP? A) Administration of prophylactic antibiotics B) Administration of pneumococcal vaccine to vulnerable individuals C) Obtaining culture and sensitivity swabs from all newly admitted patients D) Administration of antiretroviral medications to patients over age 65

B

A patient with thoracic trauma is admitted to the ICU. The nurse notes the patients chest and neck are swollen and there is a crackling sensation when palpated. The nurse consequently identifies the presence of subcutaneous emphysema. If this condition becomes severe and threatens airway patency, what intervention is indicated? A) A chest tube B) A tracheostomy C) An endotracheal tube D) A feeding tube

B

A gerontologic nurse is teaching a group of medical nurses about the high incidence and mortality of pneumonia in older adults. What is a contributing factor to this that the nurse should describe? A) Older adults have less compliant lung tissue than younger adults. B) Older adults are not normally candidates for pneumococcal vaccination. C) Older adults often lack the classic signs and symptoms of pneumonia. D) Older adults often cannot tolerate the most common antibiotics used to treat pneumonia.

C

The nurse is providing discharge teaching for a patient who developed a pulmonary embolism after total knee surgery. The patient has been converted from heparin to sodium warfarin (Coumadin) anticoagulant therapy. What should the nurse teach the client? A) Coumadin will continue to break up the clot over a period of weeks B) Coumadin must be taken concurrent with ASA to achieve anticoagulation. C) Anticoagulant therapy usually lasts between 3 and 6 months. D) He should take a vitamin supplement containing vitamin K

C

A 54-year-old man has just been diagnosed with small cell lung cancer. The patient asks the nurse why the doctor is not offering surgery as a treatment for his cancer. What fact about lung cancer treatment should inform the nurses response? The cells in small cell cancer of the lung are not large enough to visualize in surgery. Small cell lung cancer is self-limiting in many patients and surgery should be delayed. Patients with small cell lung cancer are not normally stable enough to survive surgery. Small cell cancer of the lung grows rapidly and metastasizes early and extensively.

D

An 87-year-old patient has been hospitalized with pneumonia. Which nursing action would be a priority in this patients plan of care? A) Nasogastric intubation B) Administration of probiotic supplements C) Bedrest D) Cautious hydration

D

The home care nurse is monitoring a patient discharged home after resolution of a pulmonary embolus. For what potential complication would the home care nurse be most closely monitoring this patient? A) Signs and symptoms of pulmonary infection B) Swallowing ability and signs of aspiration C) Activity level and role performance D) Residual effects of compromised oxygenation

D

Which nursing interventions will the nurse implement to increase mucus production in a 72-year-old patient with bronchitis? Select all that apply. 1 Humidify the oxygen 2 Increase fluid intake to 3 L per day if tolerated 3 Administer a cough suppressant 4 Elevate the head of the bed to 45 degrees 5 Teach pursed lip breathing

1, 2, 4 Several interventions may help the patient expectorate mucus, including increasing fluid intake, which will liquefy the secretions so that the patient can expectorate them more easily, humidifying the oxygen to loosen secretions, and elevating the head of the bed to increase movement of mucous. Pursed lip breathing and a cough suppressant will not promote mucus production and expectoration. Text Reference - p. 527

The nurse cares for a patient with a diagnosis of tuberculosis. Which assessment finding best indicates that the patient has been following the prescribed treatment plan? 1 Negative sputum cultures 2 Clear breath sounds bilaterally 3 Decrease in the number of coughing episodes 4 Conversion of the Mantoux test from positive to negative

1 A patient's sputum is expected to convert to negative within three months of the beginning of treatment. If it does not, the patient is either not taking the medication or has drug-resistant organisms. Bilaterally clear breath sounds and a decrease in coughing are good indications that the patient is following the prescribed plan, but they are not as confirmatory as negative sputum cultures. Once a person has been exposed to the tuberculosis-causing organism, the Mantoux test will always elicit a positive result. Text Reference - p. 533

The nurse is providing a community program about lung cancer. What risk factor should the nurse be sure to include when discussing this topic? 1 Age of smoking onset 2 Use of filtered cigarettes 3 Prolonged exposure to nickel 4 Number of cigarettes smoked per day

1 Age of smoking onset is the directly related risk of lung cancer. Use of filtered cigarettes, number of cigarettes per day, and prolonged exposure to nickel may not be directly related. Text Reference - p. 536

Which complication does the nurse expect when a patient with fractured ribs is wearing a binder on the chest? 1 Atelectasis 2 Chylothorax 3 Hemopneumothorax 4 Pulmonary embolism

1 Applying a binder on fractured ribs can reduce the chest expansion and retain secretions. Therefore, the patient will have the risk of atelectasis. Chylothorax is complication of chest trauma, which results from disruption of the thoracic duct. Hemopneumothorax is the presence of blood in the pleural cavity due to chest trauma. Pulmonary embolism is a blockage of pulmonary a blood vessel due to thrombus formation; this complication is not associated with application of a binder.

Which clinical manifestation should the nurse expect to find during assessment of a patient admitted with pneumonia? 1 Hyperresonance on percussion 2 Vesicular breath sounds in all lobes 3 Increased vocal fremitus on palpation 4 Fine crackles in all lobes on auscultation

3 A typical physical examination finding for a patient with pneumonia is increased vocal fremitus on palpation. Other signs of pulmonary consolidation include bronchial breath sounds, egophony, and crackles in the affected area. With pleural effusion, there may be dullness to percussion over the affected area. Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these key words are rarely correct.

An hour after a thoracotomy, a patient complains of incisional pain at a level 7 (based on 0 to 10 scale) and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which action is best for the nurse to take next? a. Milk the chest tube gently to remove any clots. b. Clamp the chest tube momentarily to check for the origin of the air leak. c. Assist the patient to deep breathe, cough, and use the incentive spirometer. d. Set up the patient controlled analgesia (PCA) and administer the loading dose of morphine.

ANS: D The patient is unlikely to take deep breaths or cough until the pain level is lower. A chest tube output of 100 mL is not unusual in the first hour after thoracotomy and would not require milking of the chest tube. An air leak is expected in the initial postoperative period after thoracotomy

A nurse is caring for a patient who experiences shortness of breath, severe productive cough, and fever. The sputum, which is yellow, has been sent for laboratory testing, but the lab report is pending. What should be the next step in managing the patient? 1 Administer antibiotics. 2 Wait for the lab report. 3 Retake sputum sample and send to another lab. 4 Refer the patient for chest physiotherapy.

1 Culture and Gram stain of sputum is required for prescribing specific antibiotics. However, if there is a delay in obtaining the lab reports, antibiotic administration should not be delayed. Deferring the antibiotics may lead to increased morbidity and mortality because the infection can worsen. Taking the sample again to send to a different lab would not be helpful because the lab will take a similar amount of time to provide the report. Chest physiotherapy can be advised later once the antibiotic therapy is started.

Which condition in a patient with chest trauma requires treatment of positive pressure ventilation? 1 Flail chest 2 Cardiac tamponade 3 Hemopneumothorax 4 Tension pneumothorax

1 Flail chest results in loss of chest stability due to fracture of the ribs. The patient with loss of chest stability requires positive pressure ventilation to ensure proper respiration. The nurse performs needle decompression to treat the cardiac tamponade effectively. The patient with hemopneumothorax or tension pneumothorax requires treatment with chest tube drainage and positive pressure ventilation aggravates the patient's condition. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 542

The diagnostic studies of a patient with primary lung cancer indicate that the tumor is peripherally located and has a moderate growth rate. What does the nurse interpret from these findings? 1 The patient has adenocarcinoma. 2 The patient has small cell carcinoma. 3 The patient has squamous cell carcinoma. 4 The patient has undifferentiated carcinoma

1 In adenocarcinoma, the tumor is peripherally located and will have a moderate growth rate. A small cell carcinoma is a malignant lung cancer, which spreads through the lymphatics to the brain. In squamous cell carcinoma, the tumor is located in the central part of the lung and the patient may have a nonproductive cough and hemoptysis. Undifferentiated carcinoma has a rapid growth rate and is composed of anaplastic large cells, which arise on the bronchi. Test-Taking Tip: Having a thorough knowledge on different types of lung cancers helps in identifying the correct answer. Recall these findings to choose the correct answer. Text Reference - p. 537

A nurse is caring for a patient with a pulmonary embolism who is on warfarin therapy. Which parameter should the nurse monitor in this patient? 1 Hematomas 2 Polycythemia 3 B type natriuretic peptide 4 White blood cell differentials

1 The nurse should monitor a patient with pulmonary embolism who is on warfarin therapy for complications such as hematomas, bruising, and bleeding. Polycythemia in a patient with cor pulmonale is secondary to chronic obstructive pulmonary disease. B type natriuretic peptide and serum troponin levels are elevated in patients with increased mortality due to pulmonary embolism. White blood cell differentials are helpful to assess pulmonary embolism. Text Reference - p. 552

Which physical assessment finding in a patient with a lower respiratory problem best supports the nursing diagnosis of ineffective airway clearance? 1 Basilar crackles 2 Respiratory rate of 28 3 Oxygen saturation of 85% 4 Presence of greenish sputum

1 The presence of adventitious breath sounds indicates that there is accumulation of secretions in the lower airways. This would be consistent with a nursing diagnosis of ineffective airway clearance because the patient is retaining secretions. The rapid respiratory rate, low oxygen saturation, and presence of greenish sputum may occur with a lower respiratory problem, but do not support definitely the nursing diagnosis of ineffective airway clearance. Text Reference - p. 524

Which alteration to the suction control system in a wet suction system requires immediate correction? 1 The suction control chamber is open. 2 The suction control chamber shows bubbling. 3 The suction control chamber contains sterile water. 4 The suction tubing is connected to the wall section.

1 The suction control chamber should not be open; a muffler should be provided to cover the suction control chamber to prevent rapid evaporation of water. The suction control system should show the presence of bubbling; the absence of bubbling indicates that there is no suction. Sterile water is to be added to the suction control chamber to replace water lost from evaporation. The suction tubing should be connected to the wall section after filling the suction control chamber to the ordered suction amount. Text Reference - p. 546

When caring for a patient with tuberculosis, what measures should the nurse instruct the patient to take to avoid the spread of infection? Select all that apply. 1 Cover the nose and mouth with a tissue while coughing and sneezing. 2 Throw used tissues in a paper bag and dispose with the trash. 3 Carefully wash hands after handling sputum and soiled tissues. 4 Wear a standard isolation mask when outside the patient's room. 5 Get out of bed and move freely about the hospital to keep up strength. 6 Drink plenty of water and maintain an erect posture

1, 2, 3, 4 In order to prevent the spread of infection, patients with tuberculosis should be encouraged to cover the nose and mouth with tissues while coughing and sneezing, to throw used tissues in a paper bag and dispose of them with the trash, to carefully wash hands after handling sputum and soiled tissues, and to wear a standard isolation mask while moving out of their room. Increasing the frequency of prolonged visits to other parts of the hospital is not advisable, because it can increase the chances of infection spread; instead, such visits should be limited. Drinking plenty of water and maintaining erect posture have no effect on controlling infection. Text Reference - p. 533

To promote airway clearance in a patient with pneumonia, what should the nurse instruct the patient to do? Select all that apply. 1 Maintain adequate fluid intake 2 Splint the chest when coughing 3 Maintain a 30-degree elevation 4 Maintain a semi-Fowler's position 5 Instruct patient to cough at end of exhalation

1, 2, 5 Maintaining adequate fluid intake liquefies secretions, allowing easier expectoration. The nurse should instruct the patient to splint the chest while coughing. This will reduce discomfort and allow for a more effective cough. Coughing at the end of exhalation promotes a more effective cough. The patient should be positioned in an upright sitting position (high-Fowler's) with head slightly flexed. Text Reference - p. 527

The nurse is assessing a patient who was admitted from a nursing home with suspected tuberculosis (TB). Which of these are initial manifestations of tuberculosis? Select all that apply. 1 Anorexia 2 Dyspnea 3 Night sweats 4 Hemoptysis 5 Low-grade fever 6 Unexplained weight loss

1, 3, 5, 6 Active TB disease may manifest initially with constitutional symptoms such as fatigue, malaise, anorexia, unexplained weight loss, low-grade fevers, and night sweats. Dyspnea is a late symptom that may signify considerable pulmonary disease or a pleural effusion. Hemoptysis, which occurs in less than 10% of patients with TB, is also a late symptom. Text Reference - p. 529

The nurse is performing aspiration at the intercostal area on a patient with pleural effusion. Which condition may be observed in a patient after rapid draining of 1500 mL of fluid? 1 Cor pulmonale 2 Respiratory distress 3 Pulmonary hypertension 4 Diffuse parenchymal disorder

2 A patient on thoracentesis undergoes aspiration of the excess intrapleural fluid from the intercostal area. Usually 1000 to 1200 mL of fluid is drained at once. Rapid removal of large amounts of fluid may result in respiratory distress, hypotension, hypoxemia, or pulmonary edema. Cor pulmonale is a condition in which the right ventricle gets enlarged due to respiratory disorders. Pulmonary hypertension results in decreased blood flow to the lungs with increased pulmonary artery pressure to 20 to 30 mm Hg. Interstitial lung disease refers to the diffuse parenchymal disorder in which the tissues between the air sacs are inflamed or scarred. Text Reference - p. 550

A patient had an intradermal tuberculin skin test (Mantoux) administered 48 hours ago. The nurse assesses the injection site and identifies a 12-mm area of palpable induration. How should the nurse interpret this result? 1 Definitive evidence that the patient does not have tuberculosis 2 A significant indication that the patient has been exposed to tuberculosis 3 Delayed hypersensitivity with a high likelihood of infection with tuberculosis 4 A negative test that cannot be interpreted as ruling out the presence of tuberculosis

2 An area of 12 mm of induration at the injection site 48 hours after a Mantoux test is considered significant for a past or current tuberculin infection. An induration of less than 5 mm is considered a negative result. The other answer options are incorrect conclusions related to the findings. Text Reference - p. 530

Which strategy by the nurse would be most helpful in treating a patient with pneumonia and asthma who is experiencing chills? 1 Apply heat to the patient's posterior neck 2 Provide a blanket to the patient 3 Encourage the patient to bathe in hot water 4 Administer acetaminophen (Tylenol) 650 mg as prescribed

2 Chills often occur in cycles and last for 10 to 30 minutes at a time. They usually signal the onset of an increase in temperature. For this reason, the nurse should provide a light blanket for comfort, but avoid overheating the patient with heat on the neck or bathing in hot water. Acetaminophen would be used if the patient became febrile following the chills. Text Reference - p. 528

The nurse finds that a patient with chest trauma exhibits cyanosis, air hunger, distension of the neck vein, profuse diaphoresis, and an increase of intrathoracic pressure. What is the priority procedure in this situation? 1 Performing pericardiocentesis 2 Performing needle decompression 3 Insertion of chest tube with flutter valve 4 Insertion of chest tube with drainage system

2 Cyanosis, air hunger, distension of the neck vein, profuse diaphoresis, and an increase of intrathoracic pressure indicates tension pneumothorax in a patient with chest trauma. Tension pneumothorax is a complication associated with the presence of excess air in pleural thorax that cannot escape and is treated with needle decompression. Pericardiocentesis is helpful in aspirating fluid from the pleural space, which is more useful in cases of cardiac tamponade. Insertion of a chest tube with a flutter valve or a chest tube with drainage are techniques that help to drain air from the lung. However, these techniques are performed after needle decompression. Text Reference - p. 542

A patient with hypoxemia, sudden alterations in mental status, chest pain, and hemoptysis has a serum troponin level of 2.08 ng/mL and B type natriuretic peptide of 600 pg/mL. Which treatment is useful to control this patient's condition? 1 Diuretics 2 Anticoagulants 3 Endothelin receptor antagonists 4 Nonsteroidal antiinflammatory agents

2 Hypoxemia, sudden alterations in mental status, chest pain, and hemoptysis are manifestations of pulmonary embolism. Serum troponin of 2.08 ng/mL (normal value: below 0.01 to 0.09 ng/mL) and B type natriuretic peptide of 600 pg/mL (normal value: below 100 pg/mL) indicates increased mortality. Therefore, anticoagulants may provide relief from the symptoms by dissolving the embolus. Diuretics are beneficial in patients with pleural effusion and heart failure. Endothelin receptor antagonists are used in the treatment of pulmonary hypertension, because they reduce pulmonary arterial pressure and pulmonary vascular resistance. Nonsteroidal antiinflammatory agents are used in the treatment of pleurisy to reduce chest pain.

When planning appropriate nursing interventions for a patient with metastatic lung cancer and a 60-pack-per-year history of cigarette smoking, the nurse recognizes that the smoking most likely has decreased the patient's underlying respiratory defenses because of impairment of: 1 Cough reflex 2 Mucociliary clearance 3 Reflex bronchoconstriction 4 Ability to filter particles from the air

2 Smoking decreases the mucociliary action in the tracheobronchial tree, resulting in impaired clearance of respiratory secretions and particles, chronic cough, and frequent respiratory infections. Cough reflex, reflex bronchoconstriction, and ability to filter particles from the air do not increase underlying respiratory defenses. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer. Text Reference - p. 536

Which finding in a patient who is on a chest drainage system requires attention of the primary health care provider immediately? 1 The fluid has clear appearance. 2 The fluid level drained is 120 mL/hr. 3 The water level in suction chamber is 20 cm. 4 The water level in water seal chamber is 2 cm.

2 The normal flow of drainage is below 100 mL/hr. Fluid level drainage of 120 mL/hr indicates excessive drainage or/and increases the risk of further complications, and this requires the immediate attention of the primary health care provider. The presence of yellow or bloody fluid would indicate that the patient may have complications; however, the fluid is clear, indicating no risk of injury or infection. While adjusting the chest drainage tube, the nurse should ensure that the water level in the suction chamber is 20 cm and the water seal chamber is 2 cm. This will ensure that the suction is appropriate. Test-Taking Tip: Recall the normal values of fluid in the seal chamber and drainage. Which value do you think indicates deviation from normal value? This will help you choose the correct option. Text Reference - p. 546

The nurse is assessing a patient who has a closed chest tube drainage system attached to a water-seal chamber. The nurse notes that the tidaling has stopped. What is the priority intervention by the nurse? 1 Continue to monitor the patient. 2 Check all connections for a leak in the system. 3 Investigate the chest tube for a possible occlusion. 4 Lower the drainage collector further from the chest.

3 Normal fluctuation of the water within the water-seal chamber is called tidaling. This up and down movement of water in concert with respiration reflects the intrapleural pressure changes during inspiration and expiration. Investigate any sudden cessation of tidaling, because this may signify an occluded chest tube. Monitoring the patient will occur simultaneously. The nurse could check all connections for a leak, but the most common cause is occlusion, so this would occur after checking for an occlusion. The drainage collector is likely already in a low position. Text Reference - p. 546

A 72-year-old patient is in the emergency department with a temperature of 101.4° F and a productive cough with rust-colored sputum. The nurse notifies the health care provider, understanding these findings are indicative of which condition? 1 Tuberculosis 2 Chronic heart failure (CHF) 3 Pneumonia 4 Pulmonary embolus

3 Rust-colored sputum is indicative of pneumococcal pneumonia. Tuberculosis frequently presents with a dry cough. Pink frothy sputum would be present in CHF and pulmonary edema. A pulmonary embolus would produce hemoptysis. Text Reference - p. 524

What instruction does the nurse give the patient while removing the chest tube? 1 "You should sleep in a side-lying position." 2 "You should sleep with your leg elevated." 3 "You should hold your breath or bear down." 4 "You should drink juice before the procedure."

3 While removing the chest tube, the nurse instructs the patient to perform the Valsalva maneuver because it eases the process of removal. Therefore, the nurse instructs the patient to hold his or her breath or bear down. Sleeping in a side-lying position will reduce lung expansion. Therefore, the patient's condition may be aggravated. The nurse instructs the patient to elevate the leg when he or she has risk of thromboembolism. The nurse does not instruct the patient to drink juice because it may result in nausea.

The nurse is caring for a patient with a non-massive pulmonary embolism (PE). What is the best standard for treatment? 1 Tissue plasminogen activator 2 Alteplase 3 Warfarin 4 Enoxaparin

4 Subcutaneous administration of low-molecular-weight heparin has been found to be safer and more effective than use of unfractionated heparin. It is also the recommended choice of treatment for patients with non-massive PE. Criteria for fibrinolytic therapy in PE include hemodynamic instability and right ventricular dysfunction. Fibrinolytic therapy dissolves pulmonary embolisms and the source of the thrombus. Low-molecular-weight heparin is becoming more common for non-massive pulmonary embolism. Warfarin should be initiated within the first 24 hours s of heparinization and is typically administered for three to six months. Warfarin therapy is the standard treatment for non-massive PE.

A 71-year-old patient is admitted with acute respiratory distress related to cor pulmonale. Which nursing intervention is most appropriate during admission of this patient? 1 Perform a comprehensive health history with the patient to review prior respiratory problems. 2 Complete a full physical examination to determine the effect of the respiratory distress on other body functions. 3 Delay any physical assessment of the patient and review with the family the patient's history of respiratory problems. 4 Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress.

4 Because the patient is having respiratory difficulty, the nurse should ask specific questions about this episode and perform a physical assessment of this system. Further history taking and physical examination of other body systems can proceed once the patient's acute respiratory distress is being managed. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. Text Reference - p. 555

When planning care for a patient with pneumonia, the nurse recognizes which intervention as the highest priority? 1 Administering analgesics as needed for pain 2 Keeping the patient in a calm and quiet environment 3 Routinely checking vital signs and oxygen saturation 4 Increasing fluids to 2 to 3 L/day unless contraindicated

4 Forcing fluids is a priority of care in patients with pneumonia. Fluids keep secretions liquefied and loose so they can be more easily raised and expectorated. Analgesics are important as is keeping the patient calm to decrease oxygen needs, but fluids, either IV or oral, are the first priority. Vital signs should be checked every four hours or more often as indicated. Text Reference - p. 528

A patient has just been admitted to the intensive care unit with a suspected diagnosis of pulmonary embolism (PE). The patient's condition is stable. The nurse will prepare for which intervention? 1 Oral administration of warfarin 2 Thrombolytic therapy with alteplase 3 Intravenous administration of unfractionated heparin 4 Subcutaneous administration of enoxaparin

4 Immediate anticoagulation is required for patients with PE. Subcutaneous administration of low-molecular-weight heparin (LMWH; e.g., enoxaparin) has been found to be safer and more effective than use of unfractionated heparin. It is the recommended choice of treatment for patients with nonmassive PE. Warfarin should be initiated within the first three days of heparinization and typically is administered for three to six months. Thrombolytic therapy in PE is done in cases of hemodynamic instability and right ventricular dysfunction. Text Reference - p. 553

Which intervention should the nurse perform to reduce dyspnea in a patient with lung cancer? 1 Place the patient in postural drainage positions 2 Administer morphine 3 Teach the patient pursed-lip breathing 4 Elevate the head of the bed to 45 degrees

4 Maintaining a semi-Fowler's position allows gravity to enhance respirations and increase airflow into the lungs. This especially is helpful in reducing the amount of dyspnea that the patient experiences. Postural drainage positions are used in the setting of excess lung secretions. Morphine and pursed lip breathing may be used to reduce anxiety, which this patient is not experiencing. Text Reference - p. 540

What will be the immediate nursing action if the nurse, while caring for a patient with chest trauma, finds that the drainage system in the patient is broken? 1 Milking the drainage tubes 2 Stripping the drainage tubes 3 Emptying the collection chamber 4 Placing the chest tubing in a sterile water container

4 The drainage system should be properly checked to lessen the risk of complications. If the drainage system is found to be broken, then the distal end of the chest tubing connection should be placed in a sterile water container at a 2-cm level as an emergency water seal. Milking and stripping the drainage tubes are done only when there is an order from the physician. The collection chamber should never be emptied but should be replaced. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Text Reference - p. 546

A nurse is monitoring the chest drainage system of a patient and finds that bubbling has increased. The nurse then marks the whole tube with the numbers 1, 2, 3, 4, and 5 at increments and clamps the tube methodically. The nurse finds that the leak stopped when the clamps were between 3 and 4. What does this indicate? 1 The air leak was from the patient's chest. 2 The air leak was from the tube between points 1 and 2. 3 The air leak was from the tube between points 4 and 5. 4 The air leak was from the tube between points 3 and 4.

4 Whenever the bubbling increases, the nurse should suspect an air leak. To look for the point of leak, the nurse should clamp the tube to the chest and see if it is from the patient's chest. Then the nurse should mark the tube and move the clamps methodically away from the chest. If the leak stops at a particular point, this indicates that the leak was between these two points. Therefore the air leak was from the tube between points 3 and 4. Text Reference - p. 547

Why does the primary health care provider, while managing a patient who is on chest drainage, clamp the chest tube a few hours before removal? 1 To minimize the risk of atelectasis 2 To reduce the risk of shoulder stiffness 3 To reduce the incidence of infected sites 4 To assess the patient's tolerance after removal

4 While planning to remove the chest drainage tube, the primary health care provider clamps the chest tube a few hours before removal to assess the patient's tolerance after removal. Adequate patient teaching is provided to minimize the risk of atelectasis and to reduce the risk of shoulder stiffness. Meticulous sterile technique during dressing changes is followed to reduce the incidence of infected sites. Text Reference - p. 547

The nurse is caring for a patient who is scheduled for a lobectomy for a diagnosis of lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the clients oxygen saturation rapidly dropping. The patient complains of shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the presence of a pneumothorax include what? A)Diminished or absent breath sounds on the affected side B)Paradoxical chest wall movement with respirations C) Sudden loss of consciousness D)Muffled heart sounds

A

The nurse notes new onset confusion in an older patient who is normally alert and oriented. In which order should the nurse take the following actions? (Put a comma and a space between each answer choice [A, B, C, D].) a. Obtain the oxygen saturation. b. Check the patient's pulse rate. c. Document the change in status. d. Notify the health care provider

ANS: A, B, D, C Assessment for physiologic causes of new onset confusion such as pneumonia, infection, or perfusion problems should be the first action by the nurse. Airway and oxygenation should be assessed first, then circulation. After assessing the patient, the nurse should notify the health care provider. Finally, documentation of the assessments and care should be done

The clinic nurse teaches a patient with a 42 pack-year history of cigarette smoking about lung disease. Which information will be most important for the nurse to include? a. Options for smoking cessation b. Reasons for annual sputum cytology testing c. Erlotinib (Tarceva) therapy to prevent tumor risk d. Computed tomography (CT) screening for lung cancer

ANS: A Because smoking is the major cause of lung cancer, the most important role for the nurse is teaching patients about the benefits of and means of smoking cessation. CT scanning is currently being investigated as a screening test for high-risk patients. However, if there is a positive finding, the person already has lung cancer. Erlotinib may be used in patients who have lung cancer, but it is not used to reduce the risk of developing cancer

The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect? a. Increased tactile fremitus b. Dry, nonproductive cough c. Hyperresonance to percussion d. A grating sound on auscultation

ANS: A Increased tactile fremitus over the area of pulmonary consolidation is expected with bacterial pneumonias. Dullness to percussion would be expected. Pneumococcal pneumonia typically presents with a loose, productive cough. Adventitious breath sounds such as crackles and wheezes are typical. A grating sound is more representative of a pleural friction rub rather than pneumonia

The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies? a. Observe for distended neck veins. b. Auscultate for crackles in the lungs. c. Palpate for heaves or thrills over the heart. d. Review hemoglobin and hematocrit values.

ANS: A Cor pulmonale is right ventricular failure caused by pulmonary hypertension, so clinical manifestations of right ventricular failure such as peripheral edema, jugular venous distention, and right upper-quadrant abdominal tenderness would be expected. Crackles in the lungs are likely to be heard with left-sided heart failure. Findings in cor pulmonale include evidence of right ventricular hypertrophy on electrocardiogram ECG and an increase in intensity of the second heart sound. Heaves or thrills are not common with cor pulmonale. Chronic hypoxemia leads to polycythemia and increased total blood volume and viscosity of the blood. The hemoglobin and hematocrit values are more likely to be elevated with cor pulmonale than decreased

A patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurse's most appropriate action to promote airway clearance? a. Assist the patient to splint the chest when coughing. b. Teach the patient about the need for fluid restrictions. c. Encourage the patient to wear the nasal oxygen cannula. d. Instruct the patient on the pursed lip breathing technique.

ANS: A Coughing is less painful and more likely to be effective when the patient splints the chest during coughing. Fluids should be encouraged to help liquefy secretions. Nasal oxygen will improve gas exchange, but will not improve airway clearance. Pursed lip breathing is used to improve gas exchange in patients with COPD, but will not improve airway clearance

An older patient is receiving standard multidrug therapy for tuberculosis (TB). The nurse should notify the health care provider if the patient exhibits which finding? a. Yellow-tinged skin b. Orange-colored sputum c. Thickening of the fingernails d. Difficulty hearing high-pitched voices

ANS: A Noninfectious hepatitis is a toxic effect of isoniazid (INH), rifampin, and pyrazinamide, and patients who develop hepatotoxicity will need to use other medications. Changes in hearing and nail thickening are not expected with the four medications used for initial TB drug therapy. Presbycusis is an expected finding in the older adult patient. Orange discoloration of body fluids is an expected side effect of rifampin and not an indication to call the health care provider

The nurse cares for a patient who has just had a thoracentesis. Which assessment information obtained by the nurse is a priority to communicate to the health care provider? a. Oxygen saturation is 88%. b. Blood pressure is 145/90 mm Hg. c. Respiratory rate is 22 breaths/minute when lying flat. d. Pain level is 5 (on 0 to 10 scale) with a deep breath.

ANS: A Oxygen saturation would be expected to improve after a thoracentesis. A saturation of 88% indicates that a complication such as pneumothorax may be occurring. The other assessment data also indicate a need for ongoing assessment or intervention, but the low oxygen saturation is the priority

A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat. The emergency department nurse would be most concerned if which finding is observed during the initial assessment? a. Paradoxic chest movement b. Complaint of chest wall pain c. Heart rate of 110 beats/minute d. Large bruised area on the chest

ANS: A Paradoxic chest movement indicates that the patient may have flail chest, which can severely compromise gas exchange and can rapidly lead to hypoxemia. Chest wall pain, a slightly elevated pulse rate, and chest bruising all require further assessment or intervention, but the priority concern is poor gas exchange

A patient who was admitted the previous day with pneumonia complains of a sharp pain of 7 (based on 0 to 10 scale) "whenever I take a deep breath." Which action will the nurse take next? a. Auscultate breath sounds. b. Administer the PRN morphine. c. Have the patient cough forcefully. d. Notify the patient's health care provider.

ANS: A The patient's statement indicates that pleurisy or a pleural effusion may have developed and the nurse will need to listen for a pleural friction rub and/or decreased breath sounds. Assessment should occur before administration of pain medications. The patient is unlikely to be able to cough forcefully until pain medication has been administered. The nurse will want to obtain more assessment data before calling the health care provider

Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis? a. Weak, nonproductive cough effort b. Large amounts of greenish sputum c. Respiratory rate of 28 breaths/minute d. Resting pulse oximetry (SpO2) of 85%

ANS: A The weak, nonproductive cough indicates that the patient is unable to clear the airway effectively. The other data would be used to support diagnoses such as impaired gas exchange and ineffective breathing pattern

The nurse is caring for a patient who has a right-sided chest tube after a right lower lobectomy. Which nursing action can the nurse delegate to the unlicensed assistive personnel (UAP)? a. Document the amount of drainage every eight hours. b. Obtain samples of drainage for culture from the system. c. Assess patient pain level associated with the chest tube. d. Check the water-seal chamber for the correct fluid level.

ANS: A UAP education includes documentation of intake and output. The other actions are within the scope of practice and education of licensed nursing personnel

Which factors will the nurse consider when calculating the CURB-65 score for a patient with pneumonia (select all that apply)? a. Age b. Blood pressure c. Respiratory rate d. Oxygen saturation e. Presence of confusion f. Blood urea nitrogen (BUN) level

ANS: A, B, C, E, F Data collected for the CURB-65 are mental status (confusion), BUN (elevated), blood pressure (decreased), respiratory rate (increased), and age (65 and older). The other information is also essential to assess, but are not used for CURB-65 scoring

When caring for a patient who is hospitalized with active tuberculosis (TB), the nurse observes a student nurse who is assigned to take care of a patient. Which action, if performed by the student nurse, would require an intervention by the nurse? a. The patient is offered a tissue from the box at the bedside. b. A surgical face mask is applied before visiting the patient. c. A snack is brought to the patient from the unit refrigerator. d. Hand washing is performed before entering the patient's room.

ANS: B A high-efficiency particulate-absorbing (HEPA) mask, rather than a standard surgical mask, should be used when entering the patient's room because the HEPA mask can filter out 100% of small airborne particles. Hand washing before entering the patient's room is appropriate. Because anorexia and weight loss are frequent problems in patients with TB, bringing food to the patient is appropriate. The student nurse should perform hand washing after handling a tissue that the patient has used, but no precautions are necessary when giving the patient an unused tissue

A patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving nifedipine (Procardia). Which assessment would best indicate to the nurse that the patient's condition is improving? a. Blood pressure (BP) is less than 140/90 mm Hg. b. Patient reports decreased exertional dyspnea. c. Heart rate is between 60 and 100 beats/minute. d. Patient's chest x-ray indicates clear lung fields.

ANS: B Because a major symptom of IPAH is exertional dyspnea, an improvement in this symptom would indicate that the medication was effective. Nifedipine will affect BP and heart rate, but these parameters would not be used to monitor the effectiveness of therapy for a patient with IPAH. The chest x-ray will show clear lung fields even if the therapy is not effective

An experienced nurse instructs a new nurse about how to care for a patient with dyspnea caused by a pulmonary fungal infection. Which action by the new nurse indicates a need for further teaching? a. Listening to the patient's lung sounds several times during the shift b. Placing the patient on droplet precautions and in a private hospital room c. Increasing the oxygen flow rate to keep the oxygen saturation above 90% d. Monitoring patient serology results to identify the specific infecting organism

ANS: B Fungal infections are not transmitted from person to person. Therefore no isolation procedures are necessary. The other actions by the new nurse are appropriate

A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first? a. Chest x-ray via stretcher b. Blood cultures from two sites c. Ciprofloxacin (Cipro) 400 mg IV d. Acetaminophen (Tylenol) rectal suppository

ANS: B Initiating antibiotic therapy rapidly is essential, but it is important that the cultures be obtained before antibiotic administration. The chest x-ray and acetaminophen administration can be done last

The nurse receives change-of-shift report on the following four patients. Which patient should the nurse assess first? a. A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled b. A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath c. A 77-year-old patient with tuberculosis (TB) who has four antitubercular medications due in 15 minutes d. A 35-year-old patient who was admitted the previous day with pneumonia and has a temperature of 100.2° F (37.8° C)

ANS: B Patients on bed rest who are immobile are at high risk for deep vein thrombosis (DVT). Sudden onset of shortness of breath in a patient with a DVT suggests a pulmonary embolism and requires immediate assessment and action such as oxygen administration. The other patients should also be assessed as soon as possible, but there is no indication that they may need immediate action to prevent clinical deterioration

The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement, if made by the patient, indicates a good understanding of the instructions? a. "I will call the doctor if I still feel tired after a week." b. "I will continue to do the deep breathing and coughing exercises at home." c. "I will schedule two appointments for the pneumonia and influenza vaccines." d. "I'll cancel my chest x-ray appointment if I'm feeling better in a couple weeks."

ANS: B Patients should continue to cough and deep breathe after discharge. Fatigue is expected for several weeks. The Pneumovax and influenza vaccines can be given at the same time in different arms. Explain that a follow-up chest x-ray needs to be done in 6 to 8 weeks to evaluate resolution of pneumonia

The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB). Which statement, if made by the patient, indicates that teaching was effective? a. "I will avoid being outdoors whenever possible." b. "My husband will be sleeping in the guest bedroom." c. "I will take the bus instead of driving to visit my friends." d. "I will keep the windows closed at home to contain the germs."

ANS: B Teach the patient how to minimize exposure to close contacts and household members. Homes should be well ventilated, especially the areas where the infected person spends a lot of time. While still infectious, the patient should sleep alone, spend as much time as possible outdoors, and minimize time in congregate settings or on public transportation

A patient is admitted to the emergency department with an open stab wound to the left chest. What is the first action that the nurse should take? a. Position the patient so that the left chest is dependent. b. Tape a nonporous dressing on three sides over the chest wound. c. Cover the sucking chest wound firmly with an occlusive dressing. d. Keep the head of the patient's bed at no more than 30 degrees elevation.

ANS: B The dressing taped on three sides will allow air to escape when intrapleural pressure increases during expiration, but it will prevent air from moving into the pleural space during inspiration. Placing the patient on the left side or covering the chest wound with an occlusive dressing will allow trapped air in the pleural space and cause tension pneumothorax. The head of the bed should be elevated to 30 to 45 degrees to facilitate breathing

After 2 months of tuberculosis (TB) treatment with isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next? a. Teach about treatment for drug-resistant TB treatment. b. Ask the patient whether medications have been taken as directed. c. Schedule the patient for directly observed therapy three times weekly. d. Discuss with the health care provider the need for the patient to use an injectable antibiotic.

ANS: B The first action should be to determine whether the patient has been compliant with drug therapy because negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. Assessment is the first step in the nursing process. Depending on whether the patient has been compliant or not, different medications or directly observed therapy may be indicated. The other options are interventions based on assumptions until an assessment has been completed

The nurse monitors a patient after chest tube placement for a hemopneumothorax. The nurse is most concerned if which assessment finding is observed? a. A large air leak in the water-seal chamber b. 400 mL of blood in the collection chamber c. Complaint of pain with each deep inspiration d. Subcutaneous emphysema at the insertion site

ANS: B The large amount of blood may indicate that the patient is in danger of developing hypovolemic shock. An air leak would be expected immediately after chest tube placement for a pneumothorax. Initially, brisk bubbling of air occurs in this chamber when a pneumothorax is evacuated. The pain should be treated but is not as urgent a concern as the possibility of continued hemorrhage. Subcutaneous emphysema should be monitored but is not unusual in a patient with pneumothorax. A small amount of subcutaneous air is harmless and will be reabsorbed

A patient with newly diagnosed lung cancer tells the nurse, "I don't think I'm going to live to see my next birthday." Which response by the nurse is best? a. "Would you like to talk to the hospital chaplain about your feelings?" b. "Can you tell me what it is that makes you think you will die so soon?" c. "Are you afraid that the treatment for your cancer will not be effective?" d. "Do you think that taking an antidepressant medication would be helpful?"

ANS: B The nurse's initial response should be to collect more assessment data about the patient's statement. The answer beginning "Can you tell me what it is" is the most open-ended question and will offer the best opportunity for obtaining more data. The answer beginning, "Are you afraid" implies that the patient thinks that the cancer will be immediately fatal, although the patient's statement may not be related to the cancer diagnosis. The remaining two answers offer interventions that may be helpful to the patient, but more assessment is needed to determine whether these interventions are appropriate

The nurse develops a plan of care to prevent aspiration in a high-risk patient. Which nursing action will be most effective? a. Turn and reposition immobile patients at least every 2 hours. b. Place patients with altered consciousness in side-lying positions. c. Monitor for respiratory symptoms in patients who are immunosuppressed. d. Insert nasogastric tube for feedings for patients with swallowing problems.

ANS: B The risk for aspiration is decreased when patients with a decreased level of consciousness are placed in a side-lying or upright position. Frequent turning prevents pooling of secretions in immobilized patients but will not decrease the risk for aspiration in patients at risk. Monitoring of parameters such as breath sounds and oxygen saturation will help detect pneumonia in immunocompromised patients, but it will not decrease the risk for aspiration. Conditions that increase the risk of aspiration include decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and nasogastric intubation with or without tube feeding. With loss of consciousness, the gag and cough reflexes are depressed, and aspiration is more likely to occur. Other high-risk groups are those who are seriously ill, have poor dentition, or are receiving acid-reducing medications

A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure? a. Start a peripheral IV line to administer the necessary sedative drugs. b. Position the patient sitting upright on the edge of the bed and leaning forward. c. Obtain a large collection device to hold 2 to 3 liters of pleural fluid at one time. d. Remove the water pitcher and remind the patient not to eat or drink anything for 6 hours.

ANS: B When the patient is sitting up, fluid accumulates in the pleural space at the lung bases and can more easily be located and removed. The patient does not usually require sedation for the procedure, and there are no restrictions on oral intake because the patient is not sedated or unconscious. Usually only 1000 to 1200 mL of pleural fluid is removed at one time. Rapid removal of a large volume can result in hypotension, hypoxemia, or pulmonary edema

The nurse notes that a patient has incisional pain, a poor cough effort, and scattered rhonchi after a thoracotomy. Which action should the nurse take first? a. Assist the patient to sit upright in a chair. b. Splint the patient's chest during coughing. c. Medicate the patient with prescribed morphine. d. Observe the patient use the incentive spirometer.

ANS: C A major reason for atelectasis and poor airway clearance in patients after chest surgery is incisional pain (which increases with deep breathing and coughing). The first action by the nurse should be to medicate the patient to minimize incisional pain. The other actions are all appropriate ways to improve airway clearance but should be done after the morphine is given

A patient who has a right-sided chest tube following a thoracotomy has continuous bubbling in the suction-control chamber of the collection device. Which action by the nurse is most appropriate? a. Document the presence of a large air leak. b. Notify the surgeon of a possible pneumothorax. c. Take no further action with the collection device. d. Adjust the dial on the wall regulator to decrease suction.

ANS: C Continuous bubbling is expected in the suction-control chamber and indicates that the suction-control chamber is connected to suction. An air leak would be detected in the water-seal chamber. There is no evidence of pneumothorax. Increasing or decreasing the vacuum source will not adjust the suction pressure. The amount of suction applied is regulated by the amount of water in this chamber and not by the amount of suction applied to the system

A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the nurse plan to include in the teaching plan? a. Purpose of antibiotic therapy b. Ways to limit oral fluid intake c. Appropriate use of cough suppressants d. Safety concerns with home oxygen therapy

ANS: C Cough suppressants are frequently prescribed for acute bronchitis. Because most acute bronchitis is viral in origin, antibiotics are not prescribed unless there are systemic symptoms. Fluid intake is encouraged. Home oxygen is not prescribed for acute bronchitis, although it may be used for chronic bronchitis

A patient is diagnosed with both human immunodeficiency virus (HIV) and active tuberculosis (TB) disease. Which information obtained by the nurse is most important to communicate to the health care provider? a. The Mantoux test had an induration of 7 mm. b. The chest-x-ray showed infiltrates in the lower lobes. c. The patient is being treated with antiretrovirals for HIV infection. d. The patient has a cough that is productive of blood-tinged mucus.

ANS: C Drug interactions can occur between the antiretrovirals used to treat HIV infection and the medications used to treat TB. The other data are expected in a patient with HIV and TB.

A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days. Which assessment data obtained by the nurse indicates that the treatment has been effective? a. Bronchial breath sounds are heard at the right base. b. The patient coughs up small amounts of green mucus. c. The patient's white blood cell (WBC) count is 9000/µL. d. Increased tactile fremitus is palpable over the right chest.

ANS: C The normal WBC count indicates that the antibiotics have been effective. All the other data suggest that a change in treatment is needed

The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy for cancer of the lung. Which information should the nurse include about the patient's postoperative care? a. Positioning on the right side b. Bed rest for the first 24 hours c. Frequent use of an incentive spirometer d. Chest tube placement with continuous drainage

ANS: C Frequent deep breathing and coughing are needed after chest surgery to prevent atelectasis. To promote gas exchange, patients after pneumonectomy are positioned on the surgical side. Early mobilization decreases the risk for postoperative complications such as pneumonia and deep vein thrombosis. In a pneumonectomy, chest tubes may or may not be placed in the space from which the lung was removed. If a chest tube is used, it is clamped and only released by the surgeon to adjust the volume of serosanguineous fluid that will fill the space vacated by the lung. If the cavity overfills, it could compress the remaining lung and compromise the cardiovascular and pulmonary function. Daily chest x-rays can be used to assess the volume and space

A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange discolored urine and tears. Which is the best response by the nurse? a. Ask if the patient is experiencing shortness of breath, hives, or itching. b. Ask the patient about any visual abnormalities such as red-green color discrimination. c. Explain that orange discolored urine and tears are normal while taking this medication. d. Advise the patient to stop the drug and report the symptoms to the health care provider.

ANS: C Orange-colored body secretions are a side effect of rifampin. The patient does not have to stop taking the medication. The findings are not indicative of an allergic reaction. Alterations in red-green color discrimination commonly occurs when taking ethambutol (Myambutol), which is a different TB medication

An occupational health nurse works at a manufacturing plant where there is potential exposure to inhaled dust. Which action, if recommended by the nurse, will be most helpful in reducing the incidence of lung disease? a. Treat workers with pulmonary fibrosis. b. Teach about symptoms of lung disease. c. Require the use of protective equipment. d. Monitor workers for coughing and wheezing.

ANS: C Prevention of lung disease requires the use of appropriate protective equipment such as masks. The other actions will help in recognition or early treatment of lung disease but will not be effective in prevention of lung damage. Repeated exposure eventually results in diffuse pulmonary fibrosis. Fibrosis is the result of tissue repair after inflammation

The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action should the nurse take? a. Teach about the reason for the blood tests. b. Schedule an appointment for a chest x-ray. c. Teach about the need to get sputum specimens for 2 to 3 consecutive days. d. Instruct the patient to expectorate three specimens as soon as possible.

ANS: C Sputum specimens are obtained on 2 to 3 consecutive days for bacteriologic testing for M. tuberculosis. The patient should not provide all the specimens at once. Blood cultures are not used for tuberculosis testing. A chest x-ray is not bacteriologic testing. Although the findings on chest x-ray examination are important, it is not possible to make a diagnosis of TB solely based on chest x-ray findings because other diseases can mimic the appearance of TB

The nurse is caring for a patient with idiopathic pulmonary arterial hypertension (IPAH) who is receiving epoprostenol (Flolan). Which assessment information requires the most immediate action by the nurse? a. The oxygen saturation is 94%. b. The blood pressure is 98/56 mm Hg. c. The patient's central IV line is disconnected. d. The international normalized ratio (INR) is prolonged.

ANS: C The half-life of this drug is 6 minutes, so the nurse will need to restart the infusion as soon as possible to prevent rapid clinical deterioration. The other data also indicate a need for ongoing monitoring or intervention, but the priority action is to reconnect the infusion

Which action by the nurse will be most effective in decreasing the spread of pertussis in a community setting? a. Providing supportive care to patients diagnosed with pertussis b. Teaching family members about the need for careful hand washing c. Teaching patients about the need for adult pertussis immunizations d. Encouraging patients to complete the prescribed course of antibiotics

ANS: C The increased rate of pertussis in adults is thought to be due to decreasing immunity after childhood immunization. Immunization is the most effective method of protecting communities from infectious diseases. Hand washing should be taught, but pertussis is spread by droplets and contact with secretions. Supportive care does not shorten the course of the disease or the risk for transmission. Taking antibiotics as prescribed does assist with decreased transmission, but patients are likely to have already transmitted the disease by the time the diagnosis is made

Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse? a. Standard four-drug therapy for TB b. Need for annual repeat TB skin testing c. Use and side effects of isoniazid (INH) d. Bacille Calmette-Guérin (BCG) vaccine

ANS: C The nurse is considered to have a latent TB infection and should be treated with INH daily for 6 to 9 months. The four-drug therapy would be appropriate if the nurse had active TB. TB skin testing is not done for individuals who have already had a positive skin test. BCG vaccine is not used in the United States for TB and would not be helpful for this individual, who already has a TB infection

A patient with pneumonia has a fever of 101.4° F (38.6° C), a nonproductive cough, and an oxygen saturation of 88%. The patient complains of weakness, fatigue, and needs assistance to get out of bed. Which nursing diagnosis should the nurse assign as the highest priority? a. Hyperthermia related to infectious illness b. Impaired transfer ability related to weakness c. Ineffective airway clearance related to thick secretions d. Impaired gas exchange related to respiratory congestion

ANS: D All these nursing diagnoses are appropriate for the patient, but the patient's oxygen saturation indicates that all body tissues are at risk for hypoxia unless the gas exchange is improved

An alcoholic and homeless patient is diagnosed with active tuberculosis (TB). Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen? a. Arrange for a friend to administer the medication on schedule. b. Give the patient written instructions about how to take the medications. c. Teach the patient about the high risk for infecting others unless treatment is followed. d. Arrange for a daily noon meal at a community center where the drug will be administered.

ANS: D Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen, and arranging a daily meal will help ensure that the patient is available to receive the medication. The other nursing interventions may be appropriate for some patients but are not likely to be as helpful for this patient

A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6° F with a frequent cough and is complaining of severe pleuritic chest pain. Which prescribed medication should the nurse give first? a. Codeine b. Guaifenesin (Robitussin) c. Acetaminophen (Tylenol) d. Piperacillin/tazobactam (Zosyn)

ANS: D Early initiation of antibiotic therapy has been demonstrated to reduce mortality. The other medications are also appropriate and should be given as soon as possible, but the priority is to start antibiotic therapy

Which intervention will the nurse include in the plan of care for a patient who is diagnosed with a lung abscess? a. Teach the patient to avoid the use of over-the-counter expectorants. b. Assist the patient with chest physiotherapy and postural drainage. c. Notify the health care provider immediately about any bloody or foul-smelling sputum. d. Teach about the need for prolonged antibiotic therapy after discharge from the hospital.

ANS: D Long-term antibiotic therapy is needed for effective eradication of the infecting organisms in lung abscess. Chest physiotherapy and postural drainage are not recommended for lung abscess because they may lead to spread of the infection. Foul smelling and bloody sputum are common clinical manifestations in lung abscess. Expectorants may be used because the patient is encouraged to cough

The nurse completes discharge teaching for a patient who has had a lung transplant. The nurse evaluates that the teaching has been effective if the patient makes which statement? a. "I will make an appointment to see the doctor every year." b. "I will stop taking the prednisone if I experience a dry cough." c. "I will not worry if I feel a little short of breath with exercise." d. "I will call the health care provider right away if I develop a fever."

ANS: D Low-grade fever may indicate infection or acute rejection so the patient should notify the health care provider immediately if the temperature is elevated. Patients require frequent follow-up visits with the transplant team. Annual health care provider visits would not be sufficient. Home oxygen use is not an expectation after lung transplant. Shortness of breath should be reported. Low-grade fever, fatigue, dyspnea, dry cough, and oxygen desaturation are signs of rejection. Immunosuppressive therapy, including prednisone, needs to be continued to prevent rejection

A lobectomy is scheduled for a patient with stage I non-small cell lung cancer. The patient tells the nurse, "I would rather have chemotherapy than surgery." Which response by the nurse is most appropriate? a. "Are you afraid that the surgery will be very painful?" b. "Did you have bad experiences with previous surgeries?" c. "Surgery is the treatment of choice for stage I lung cancer." d. "Tell me what you know about the various treatments available."

ANS: D More assessment of the patient's concerns about surgery is indicated. An open-ended response will elicit the most information from the patient. The answer beginning, "Surgery is the treatment of choice" is accurate, but it discourages the patient from sharing concerns about surgery. The remaining two answers indicate that the nurse has jumped to conclusions about the patient's reasons for not wanting surgery. Chemotherapy is the primary treatment for small cell lung cancer. In non-small cell lung cancer, chemotherapy may be used in the treatment of nonresectable tumors or as adjuvant therapy to surgery

A patient is admitted with active tuberculosis (TB). The nurse should question a health care provider's order to discontinue airborne precautions unless which assessment finding is documented? a. Chest x-ray shows no upper lobe infiltrates. b. TB medications have been taken for 6 months. c. Mantoux testing shows an induration of 10 mm. d. Three sputum smears for acid-fast bacilli are negative.

ANS: D Negative sputum smears indicate that Mycobacterium tuberculosis is not present in the sputum, and the patient cannot transmit the bacteria by the airborne route. Chest x-rays are not used to determine whether treatment has been successful. Taking medications for 6 months is necessary, but the multidrug-resistant forms of the disease might not be eradicated after 6 months of therapy. Repeat Mantoux testing would not be done because the result will not change even with effective treatment

The nurse is performing tuberculosis (TB) skin tests in a clinic that has many patients who have immigrated to the United States. Which question is most important for the nurse to ask before the skin test? a. "Is there any family history of TB?" b. "How long have you lived in the United States?" c. "Do you take any over-the-counter (OTC) medications?" d. "Have you received the bacille Calmette-Guérin (BCG) vaccine for TB?"

ANS: D Patients who have received the BCG vaccine will have a positive Mantoux test. Another method for screening (such as a chest x-ray) will need to be used in determining whether the patient has a TB infection. The other information also may be valuable but is not as pertinent to the decision about doing TB skin testing

The nurse supervises unlicensed assistive personnel (UAP) who are providing care for a patient with right lower lobe pneumonia. The nurse should intervene if which action by UAP is observed? a. UAP splint the patient's chest during coughing. b. UAP assist the patient to ambulate to the bathroom. c. UAP help the patient to a bedside chair for meals. d. UAP lower the head of the patient's bed to 15 degrees.

ANS: D Positioning the patient with the head of the bed lowered will decrease ventilation. The other actions are appropriate for a patient with pneumonia

The nurse provides discharge teaching for a patient who has two fractured ribs from an automobile accident. Which statement, if made by the patient, would indicate that teaching has been effective? a. "I am going to buy a rib binder to wear during the day." b. "I can take shallow breaths to prevent my chest from hurting." c. "I should plan on taking the pain pills only at bedtime so I can sleep." d. "I will use the incentive spirometer every hour or two during the day."

ANS: D Prevention of the complications of atelectasis and pneumonia is a priority after rib fracture. This can be ensured by deep breathing and coughing. Use of a rib binder, shallow breathing, and taking pain medications only at night are likely to result in atelectasis

A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/minute, blood pressure of 100/60 mmHg, and respirations of 42 breaths/minute. Which action should the nurse take first? a. Administer anticoagulant drug therapy. b. Notify the patient's health care provider. c. Prepare patient for a spiral computed tomography (CT). d. Elevate the head of the bed to a semi-Fowler's position.

ANS: D The patient has symptoms consistent with a pulmonary embolism (PE). Elevating the head of the bed will improve ventilation and gas exchange. The other actions can be accomplished after the head is elevated (and oxygen is started). A spiral CT may be ordered by the health care provider to identify PE. Anticoagulants may be ordered after confirmation of the diagnosis of PE

After change-of-shift report, which patient should the nurse assess first? a. 72-year-old with cor pulmonale who has 4+ bilateral edema in his legs and feet b. 28-year-old with a history of a lung transplant and a temperature of 101° F (38.3° C) c. 40-year-old with a pleural effusion who is complaining of severe stabbing chest pain d. 64-year-old with lung cancer and tracheal deviation after subclavian catheter insertion

ANS: D The patient's history and symptoms suggest possible tension pneumothorax, a medical emergency. The other patients also require assessment as soon as possible, but tension pneumothorax will require immediate treatment to avoid death from inadequate cardiac output or hypoxemia