Chapter 19: Management of Patients with Chest and Lower Respiratory Tract Disorders

The public health nurse is administering Mantoux tests to children who are being registered for kindergarten in the community. How should the nurse administer this test? a) Administer intradermal injections into each child's inner forearm. b) Administer intramuscular injections into each child's vastus lateralis. c) Administer a subcutaneous injection into each child's umbilical area. d) Administer a subcutaneous injection at a 45-degree angle into each child's deltoid.

a

Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy? a) Vitamin B6 b) Vitamin C c) Vitamin D d) Vitamin E

a

A client has been discharged home after thoracic surgery. The home care nurse performs the initial visit and finds the client discouraged and saddened. The client states, "I am recovering so slowly. I really thought I would be better by now." What nursing action should the nurse prioritize? a) Provide emotional support to the client and family. b) Schedule a visit to the client's primary physician within 24 hours. c) Notify the physician that the client needs a referral to a psychiatrist. d) Place a referral for a social worker to visit the client.

a

A client reports dyspnea, fatigue, and having had a persistent productive cough for the last few months, which the client attributes to a bout with the flu. The nurse suspects that this client may have: a) lung cancer. b) pleurisy. c) pleural effusion. d) lung abscess.

a

A nurse is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which intervention will most likely lower the client's arterial blood oxygen saturation? a) Endotracheal suctioning b) Encouragement of coughing c) Use of a cooling blanket d) Incentive spirometry

a

A nurse is caring for a client who has just been diagnosed with lung cancer. What is a cardinal sign of lung cancer? a) Cough or change in chronic cough b) Pain on inspiration c) Obvious trauma d) Shortness of breath

a

A nurse is preparing dietary recommendations for a client with a lung abscess. Which statement would be included in the plan of care? a) "You must consume a diet rich in protein, such as chicken, fish, and beans." b) "You must consume a diet low in calories, such as skim milk, fresh fruits, and vegetables." c) "You must consume a diet high in carbohydrates, such as bread, potatoes, and pasta." d) "You must consume a diet low in fat by limiting dairy products and concentrated sweets."

a

A victim has sustained a blunt force trauma to the chest. A pulmonary contusion is suspected. Which of the following clinical manifestations correlate with a moderate pulmonary contusion? a) Blood-tinged sputum b) Bradypnea c) Respiratory alkalosis d) Productive cough

a

For a client with an endotracheal (ET) tube, which nursing action is the most important? a) Auscultating the lungs for bilateral breath sounds b) Turning the client from side to side every 2 hours c) Monitoring serial blood gas values every 4 hours d) Providing frequent oral hygiene

a

Hyperbaric oxygen therapy increases the blood's capacity to carry and deliver oxygen to compromised tissues. This therapy may be used for a client with: a) a compromised skin graft. b) a malignant tumor. c) pneumonia. d) hyperthermia.

a

The nurse is admitting a patient with COPD. The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia? a) PaO2 b) pH c) PCO2 d) HCO3

a

The nurse is caring for a client who is ready to be weaned from the ventilator. In preparing to assist in the collaborative process of weaning, the nurse should anticipate that the weaning of the client will progress in what order? a) Removal from the ventilator, tube, and then oxygen b) Removal from oxygen, ventilator, and then tube c) Removal of the tube, oxygen, and then ventilator d) Removal from oxygen, tube, and then ventilator

a

The nurse is caring for a client who works construction with a focus on restoring and demolishing older buildings and who is diagnosed with pneumoconiosis. The nurse understands that the inflammation in the client's lungs is likely due to which substance? a) asbestos b) silica c) coal dust d) pollen

a

The nurse suctions a patient through the endotracheal tube for 20 seconds and observes dysrhythmias on the monitor. What does the nurse determine is occurring with the patient? a) The patient is hypoxic from suctioning. b) The patient is having a stress reaction. c) The patient is having a myocardial infarction. d) The patient is in a hypermetabolic state.

a

The occupational nurse is completing routine assessments on the employees at a company. What might be revealed by a chest radiograph for a client with occupational lung diseases? a) Fibrotic changes in lungs b) Hemorrhage c) Lung contusion d) Damage to surrounding tissues

a

The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation? a) Tension pneumothorax b) Cardiac tamponade c) Flail chest d) Pulmonary contusion

a

A client diagnosed with acute respiratory distress syndrome (ARDS) is restless and has a low oxygen saturation level. If the client's condition does not improve and the oxygen saturation level continues to decrease, what procedure will the nurse expect to assist with in order to help the client breathe more easily? a) Intubate the client and control breathing with mechanical ventilation b) Increase oxygen administration c) Administer a large dose of furosemide (Lasix) IVP stat d) Schedule the client for pulmonary surgery

a

A client has been brought to the ED by the paramedics. The client is suspected of having acute respiratory distress syndrome (ARDS). What intervention should the nurse first anticipate? a) Preparing to assist with intubating the client b) Setting up oxygen at 5 L/minute by nasal cannula c) Performing deep suctioning d) Setting up a nebulizer to administer corticosteroids

a

You are caring for a client with chronic respiratory failure. What are the signs and symptoms of chronic respiratory failure? a) Progressive loss of lung function associated with chronic disease b) Sudden loss of lung function associated with chronic disease c) Progressive loss of lung function with history of normal lung function d) Sudden loss of lung function with history of normal lung function

a

A new ICU nurse is observed by her preceptor entering a patient's room to suction the tracheostomy after performing the task 15 minutes before. What should the preceptor educate the new nurse to do to ensure that the patient needs to be suctioned? a) Auscultate the lung for adventitious sounds. b) Have the patient inform the nurse of the need to be suctioned. c) Assess the CO2 level to determine if the patient requires suctioning. d) Have the patient cough.

a) Auscultate the lung for adventitious sounds.

The nurse is assisting a physician with an endotracheal intubation for a client in respiratory failure. It is most important for the nurse to assess for: a) Symmetry of the client's chest expansion b) Tracheal cuff pressure set at 30 mm Hg c) Cool air humidified through the tube d) A scheduled time for deflation of the tracheal cuff

a) Symmetry of the client's chest expansion

A client who is undergoing thoracic surgery has a nursing diagnosis of "Impaired gas exchange related to lung impairment and surgery" on the nursing care plan. Which of the following nursing interventions would be appropriately aligned with this nursing diagnosis? Select all that apply. a) Monitor pulmonary status as directed and needed. b) Regularly assess the client's vital signs every 2 to 4 hours. c) Encourage deep breathing exercises. d) Request order for patient-controlled analgesia pump e) Monitor and record hourly intake and output.

a, b, c

A client who must begin oxygen therapy asks the nurse why this treatment is necessary? What would the nurse identify as the goals of oxygen therapy? Select all that apply. a) To provide adequate transport of oxygen in the blood b) To decrease the work of breathing c) To reduce stress on the myocardium d) To clear respiratory secretions e) To provide visual feedback to encourage the client to inhale slowly and deeply

a, b, c

A client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which oxygen delivery method would give the greatest level of inspired oxygen? a) Simple mask b) Nonrebreather mask c) Face tent d) Nasal cannula

b

A client has been receiving 100% oxygen therapy by way of a nonrebreather mask for several days. Now the client complains of tingling in the fingers and shortness of breath, is extremely restless, and describes a pain beneath the breastbone. What should the nurse suspect? a) Oxygen-induced hypoventilation b) Oxygen toxicity c) Oxygen-induced atelectasis d) Hypoxia

b

A client is being admitted to the preoperative holding area for a thoracotomy. Preoperative teaching includes what? a) Correct use of a ventilator b) Correct use of incentive spirometry c) Correct use of a mini-nebulizer d) Correct technique for rhythmic breathing

b

A client with myasthenia gravis is receiving continuous mechanical ventilation. When the high-pressure alarm on the ventilator sounds, what should the nurse do? a) Check for an apical pulse. b) Suction the client's artificial airway. c) Increase the oxygen percentage. d) Ventilate the client with a handheld mechanical ventilator.

b

A nurse admits a new client with acute respiratory failure. What are the clinical findings of a client with acute respiratory failure? a) Insidious onset of lung impairment in a client who had normal lung function b) Sudden onset of lung impairment in a client who had normal lung function c) Insidious onset of lung impairment in a client who had compromised lung function d) Sudden onset of lung impairment in a client who had compromised lung function

b

A nurse is reviewing a client's X-ray. The X-ray shows an endotracheal (ET) tube placed 3/4" (2 cm) above the carina and reveals nodular lesions and patchy infiltrates in the upper lobe. Which interpretation of the X-ray is accurate? a) The X-ray is inconclusive. b) A disease process is present. c) The ET tube must be advanced. d) The ET tube must be pulled back.

b

A patient is admitted to the hospital with pulmonary arterial hypertension. What assessment finding by the nurse is a significant finding for this patient? a) Ascites b) Dyspnea c) Hypertension d) Syncope

b

During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must: a) follow up with the physician in 2 weeks. b) continue to take antibiotics for the entire 10 days. c) turn and reposition himself every 2 hours. d) maintain fluid intake of 40 oz (1,200 ml) per day.

b

The ICU nurse caring for a 2-year-old near drowning victim monitors for what possible complication? a) Atelectasis b) Acute respiratory distress syndrome c) Metabolic alkalosis d) Respiratory acidosis

b

The nurse is assigned to care for a client with a chest tube. The nurse should ensure that which item is kept at the client's bedside? a) An Ambu bag b) A bottle of sterile water c) An incentive spirometer d) A set of hemostats

b

The nurse is caring for a client who is scheduled to have a thoracotomy. When planning preoperative teaching, what information should the nurse communicate to the client? a) How to milk the chest tubing b) How to splint the incision when coughing c) How to take prophylactic antibiotics correctly d) How to manage the need for fluid restriction

b

The nurse is caring for a client with an endotracheal tube (ET). Which nursing intervention is contraindicated? a) Deflating the cuff before removing the tube b) Routinely deflating the cuff c) Checking the cuff pressure every 6 to 8 hours d) Ensuring that humidified oxygen is always introduced through the tube

b

Which is a potential complication of a low pressure in the endotracheal tube cuff? a) Tracheal bleeding b) Aspiration pneumonia c) Tracheal ischemia d) Pressure necrosis

b

Which type of ventilator has a preset volume of air to be delivered with each inspiration? a) Negative pressure b) Volume cycled c) Time cycled d) Pressure cycled

b

Which type of ventilator has a preset volume of air to be delivered with each inspiration? a) Negative-pressure b) Volume-controlled c) Time-cycled d) Pressure-cycled

b

A client is on a positive-pressure ventilator with a synchronized intermittent mandatory ventilation (SIMV) setting. The ventilator is set for 8 breaths per minute. The client is taking 6 breaths per minute independently. The nurse: a) Consults with the physician about removing the client from the ventilator b) Changes the setting on the ventilator to increase breaths to 14 per minute c) Continues assessing the client's respiratory status frequently d) Contacts the respiratory therapy department to report the ventilator is malfunctioning

c

A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? a) pH b) Bicarbonate (HCO3-) c) Partial pressure of arterial oxygen (PaO2) d) Partial pressure of arterial carbon dioxide (PaCO2)

c

A client who is post-thoracotomy is retaining secretions. What is the nurse's initial intervention? a) Perform chest physiotherapy b) Perform nasotracheal suctioning c) Encourage the client to cough d) Perform postural drainage

c

A client with a respiratory condition is receiving oxygen therapy. While assessing the client's PaO2, the nurse knows that the therapy has been effective based on which of the following readings? a) 45 mm Hg b) 58 mm Hg c) 84 mm Hg d) 120 mm Hg

c

A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside? a) Tracheostomy cleaning kit b) Water-seal chest drainage set-up c) Manual resuscitation bag d) Oxygen analyzer

c

A nurse has performed tracheal suctioning on a client who experienced increasing dyspnea prior to a procedure. When applying the nursing process, how can the nurse best evaluate the outcomes of this intervention? a) Determine whether the client can now perform forced expiratory technique (FET). b) Percuss the client's lungs and thorax. c) Measure the client's oxygen saturation. d) Have the client perform incentive spirometry.

c

A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia? a) A client with a history of smoking two packs of cigarettes per day until quitting 2 years ago b) A client who ambulates in the hallway every 4 hours c) A client with a nasogastric tube d) A client who is receiving acetaminophen (Tylenol) for pain

c

A nurse is teaching a client about using an incentive spirometer. Which statement by the nurse is correct? a) "Breathe in and out quickly." b) "You need to start using the incentive spirometer 2 days after surgery." c) "Before you do the exercise, I'll give you pain medication if you need it." d) "Don't use the incentive spirometer more than 5 times every hour."

c

A nurse observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude? a) The system is functioning normally. b) The client has a pneumothorax. c) The system has an air leak. d) The chest tube is obstructed.

c

An elderly client is diagnosed with pulmonary tuberculosis. Upset and tearful, he asks the nurse how long he must be separated from his family. Which nursing diagnosis is most appropriate for this client? a) Anxiety b) Social isolation c) Deficient knowledge (disease process and treatment regimen) d) Impaired social interaction

c

The client with a lower respiratory airway infection is presenting with the following symptoms: fever, chills, dry hacking cough, and wheezing. Which nursing diagnosis best supports the assessment by the nurse? a) Infection risk b) Impaired gas exchange c) Ineffective airway clearance d) Ineffective breathing pattern

c

The critical care nurse is precepting a new nurse on the unit. Together they are caring for a client who has a tracheostomy tube and is receiving mechanical ventilation. What action should the critical care nurse recommend when caring for the cuff? a) Deflate the cuff overnight to prevent tracheal tissue trauma. b) Inflate the cuff to the highest possible pressure in order to prevent aspiration. c) Monitor the pressure in the cuff at least every 8 hours d) Keep the tracheostomy tube plugged at all times.

c

The nurse is preparing to suction a client with an endotracheal tube. What should be the nurse's first step in the suctioning process? a) Explain the suctioning procedure to the client and reposition the client. b) Turn on suction source at a pressure not exceeding 120 mm Hg. c) Assess the client's lung sounds and SaO2 via pulse oximeter. d) Perform hand hygiene and don nonsterile gloves, goggles, gown, and mask.

c

You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia? a) Give antibiotics as ordered. b) Place client on bed rest. c) Encourage increased fluid intake. d) Offer nutritious snacks 2 times a day.

c

A nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest bacterial pneumonia? a) Nonproductive cough and normal temperature b) Sore throat and abdominal pain c) Hemoptysis and dysuria d) Dyspnea and wheezing

d

A nurse is teaching a client how to perform flow type incentive spirometry prior to his scheduled thoracic surgery. What instruction should the nurse provide to the client? a) "Hold the spirometer at your lips and breathe in and out like you normally would." b) "When you're ready, blow hard into the spirometer for as long as you can." c) "Take a deep breath and then blow short, forceful breaths into the spirometer." d) "Breathe in deeply through the spirometer, hold your breath briefly, and then exhale."

d

A nurse should include what instruction for the client during postural drainage? a) Lie supine to rest the lungs. b) Sit upright to promote ventilation. c) Remain in each position for 30 to 45 minutes for best results. d) Change positions frequently and cough up secretions.

d

After 48 hours, a Mantoux test is evaluated. At the site, there is a 10 mm induration. This finding would be considered: a) Not significant b) Negative c) Nonreactive d) Significant

d

After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? a) 3 to 5 days b) 1 to 3 weeks c) 2 to 4 months d) 6 to 12 months

d

The most diagnostic clinical symptom of pleurisy is: a) Dullness or flatness on percussion over areas of collected fluid. b) Dyspnea and coughing. c) Fever and chills. d) Stabbing pain during respiratory movements.

d

The nurse is assessing a client's potential for pulmonary emboli. What finding indicates possible deep vein thrombosis? a) Pain in the feet b) Coolness to lower extremities c) Decreased urinary output d) Localized calf tenderness

d

The nurse is caring for a client who has started therapy for tuberculosis. The client demonstrates an understanding of tuberculosis transmission when stating: a) "My tuberculosis isn't contagious after I take the medication for 24 hours." b) "I'm clear when my chest X-ray is negative." c) "I'm not contagious even if I have night sweats." d) "I'll follow airborne precautions until I have three negative sputum specimens."

d

What assessment method would the nurse use to determine the areas of the lungs that need draining? a) Inspection b) Chest X-ray c) Arterial blood gas (ABG) levels d) Auscultation

d

You are caring for a client status post lung resection. When assessing your client you find that the bubbling in the water-seal chamber for the chest tubes is more than you expected. What should you check when bubbling in the water-seal chamber is excessive? a) See if the chest tube is clogged. b) See if the wall suction unit has malfunctioned. c) See if a kink has developed in the tubing. d) See if there are leaks in the system.

d

A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse know is the most common organism that causes community-acquired pneumonia? a) Staphylococcus aureus b) Mycobacterium tuberculosis c) Pseudomonas aeruginosa d) Streptococcus pneumoniae

d.