Hesi adaptive quizzing respiratory
A client with human immunodeficiency virus (HIV) infection is diagnosed with tuberculosis. Before starting antitubercular pharmacotherapy, what essential test results should the nurse review? Liver function studies Pulmonary function studies Electrocardiogram and echocardiogram White blood cell counts and sedimentation rate
Liver function studies (Rationale: Antitubercular drugs, such as isoniazid -INH- and rifampin -RIF-, are hepatotoxic; liver function should be assessed before initiation of pharmacologic therapy. Pulmonary function studies, electrocardiogram, and echocardiogram might be done; the results of these tests are not crucial for the nurse to review before administering antitubercular drugs. White blood cell counts and sedimentation will not provide information relative to starting antitubercular therapy or to its side effects.)
A client treated with antitubercular medications reports vision changes. Which medication may be responsible for the client's condition? Isoniazid Rifampin Pyrazinamide Ethambutol
Ethambutol (Rationale: Ethambutol, an antitubercular drug, can cause optic neuritis when given in high doses. Isoniazid may cause liver toxicity, and the client may report darkening of urine. Rifampin reduces the effectiveness of oral contraceptives, and the client may have to use an additional method of contraception. Pyrazinamide may cause kidney problems.)
Tuberculosis signs and symptoms
chronic/recurrent fevers diaphoresis at night (night sweats) Blood-tinged sputum (hemoptysis) cough is productive, purulent mucus weight loss
A client who is taking rifampin tells the nurse, "My urine looks orange." What action will the nurse take? Explain this is expected. Check the liver enzymes. Strain the urine for stones. Ask what foods were eaten.
Explain this is expected. (Rifampin causes a reddish-orange discoloration of secretions such as urine, sweat, and tears. Although liver enzymes should be monitored because of the risk of hepatitis, this action is not addressing the client's statement. Straining the urine for stones is indicated for renal calculi, which are not related to rifampin. The medication, not food, is responsible for the urine color.)
A nurse is caring for a client experiencing an acute episode of bronchial asthma. What should nursing interventions achieve? Curing the condition permanently Raising mucous secretions from the chest Limiting pulmonary secretions by decreasing fluid intake Convincing the client that the condition is emotionally based
Raising mucous secretions from the chest (Rationale: In addition to dilation of bronchi, treatment is aimed at expectoration of mucus. Mucus interferes with gas exchange in the lungs. Curing the condition permanently is an unrealistic goal; asthma is a chronic illness. Increased fluid intake helps liquefy secretions. Asthma has a psychogenic factor, but this is not the only cause; it may occur as an allergic response to an antigen, such as dust.)
The nurse is teaching a client with asthma about using a peak flow meter. Which statement by the client reflects a correct understanding of how to use a peak flow meter? Select all that apply . "Readings in the green zone mean that my asthma is under control." "If I get a reading in the yellow zone, I need to stop what I'm doing and rest, then recheck in an hour." "If I get a reading in the red zone, then I need to take my reliever drug and have my wife take me to the hospital." "I should check the peak flow readings at least twice a day." "I don't need to check my peak flow readings if I take a reliever drug."
"Readings in the green zone mean that my asthma is under control." "If I get a reading in the red zone, then I need to take my reliever drug and have my wife take me to the hospital." "I should check the peak flow readings at least twice a day." (Rationale: Peak flow meters are used to measure how well the client's asthma is controlled. Readings in the green zone mean the asthma is under control; however, readings in the red zone indicate a serious respiratory problem that needs to be addressed immediately. The client will need to take a reliever drug and seek emergency help immediately. Peak flow readings need to be measured twice a day. If a reading in the yellow zone occurs, the client should use the reliever drug and then measure the peak expiratory flow (PEF) again in a few minutes to determine whether the drug is working. Improvement in PEF should be seen. Clients need to check the PEF any time a reliever drug is used to determine the drug's effectiveness.)
A nurse is reviewing the history and physicals of several clients from the clinic who are taking rifampin for the treatment of tuberculosis. Which client presents a specific concern for the nurse? 45-year-old taking a loop diuretic 26-year-old taking oral contraceptives 32-year-old taking a proton pump inhibitor 72-year-old taking intermediate-acting insulin
26-year-old taking oral contraceptives (Rationale: Rifampin increases metabolism of oral contraceptives, which may result in an unplanned pregnancy. Rifampin does not interact with a loop diuretic, a proton pump inhibitor, or intermediate-acting insulin.)
The nurse is caring for a client admitted with chronic obstructive pulmonary disease (COPD). The nurse should monitor the results of which laboratory test to evaluate the client for hypoxia? Red blood cell count Sputum culture Arterial blood gas Total hemoglobin
Arterial blood gas (Rationale: Red blood cell count, sputum culture, and total hemoglobin tests assist in the evaluation of a client with respiratory difficulties; however, arterial blood gas analysis is the only test that evaluates gas exchange in the lungs. This provides accurate information about the client's oxygenation status.)
What is the priority goal for a client with asthma who is being discharged from the hospital with prescriptions for inhaled bronchodilators? Is able to obtain pulse oximeter readings Demonstrates use of a metered-dose inhaler Knows the healthcare provider's office hours Can identify the foods that may cause wheezing
Demonstrates use of a metered-dose inhaler (Rationale: Clients with asthma use metered-dose inhalers to administer medications prophylactically or during times of an asthma attack; this is an important skill to have before discharge. Pulse oximetry is rarely conducted in the home; home management usually includes self-monitoring of the peak expiratory flow rate. Although knowing the healthcare provider's office hours is important, it is not the priority; during a persistent asthma attack that does not respond to planned interventions, the client should go to the emergency department of the local hospital or call 911 for assistance. Not all asthma is associated with food allergies.)
The son of a 65-year-old client said, "My father is suffering from chronic lung disease. He wakes suddenly from sleep and is unable to breathe." What condition does the nurse suspect in the client? Orthopnea Hemoptysis Histoplasmosis Paroxysmal nocturnal dyspnea
The symptoms of paroxysmal nocturnal dyspnea (PND), which includes waking up suddenly with an inability to breathe, usually develop after the client has been lying down for several hours. PND often occurs in clients with chronic lung disease. Orthopnea is a condition that causes shortness of breath when lying down; this condition is relieved by sitting up. Hemoptysis is characterized by the presence of blood in the sputum; this condition is generally seen in clients with chronic bronchitis or lung cancer. Histoplasmosis is a fungal respiratory infection caused by the inhalation of contaminated dust.
What are the symptoms of tuberculosis? Select all that apply. Fatigue Nausea Weight gain Low-grade fever Increased appetite
Fatigue Nausea Low-grade fever (Rationale: Tuberculosis is an infectious respiratory disease caused by Mycobacterium tuberculosis. The symptoms of tuberculosis are fatigue, nausea, low-grade fever, weight loss, and anorexia.)
A client is admitted to the hospital with chronic asthma. Which complication should the nurse monitor in this client? Atelectasis Pneumothorax Pulmonary edema Respiratory alkalosis
Atelectasis (Rationale: As a result of narrowed airways, adequate ventilation of lung tissue is compromised, and alveoli may collapse. Pneumothorax is not a common complication of asthma; a collapsed lung is referred to as a pneumothorax. Pulmonary edema is not a common complication of asthma; pulmonary edema is caused by left-sided heart failure. Respiratory alkalosis is not a common complication of asthma; with narrowed air passages, the client with asthma is at risk for hypoxia and respiratory acidosis.)
A client with emphysema experiences shortness of breath and uses pursed-lip breathing and accessory muscles of respiration. The nurse determines that the cause of the dyspnea is for which reason? Spasm of the bronchi that traps the air Increase in the vital capacity of the lungs Too rapid expulsion of air from the bronchioles Difficulty in expelling the air trapped in the alveoli
Difficulty in expelling the air trapped in the alveoli (Rationale: Emphysema involves destructive changes in the alveolar walls, leading to dilation of the air sacs; there is subsequent air trapping and difficulty with expiration. Bronchospasm is characteristic of asthma, not emphysema. The vital capacity is decreased because of restriction of the diaphragm and thoracic movement. Expiration is slowed by pursed-lip breathing to keep the airways open so less air is trapped.)
A client with a history of emphysema is admitted with a diagnosis of acute respiratory failure with respiratory acidosis. Oxygen is being administered at 3 L/min nasal cannula. Four hours after admission, the client has increased restlessness and confusion followed by a decreased respiratory rate and lethargy. What should the nurse do? Question the client about the confusion. Change the method of oxygen delivery. Percuss and vibrate the client's chest wall. Discontinue or decrease the oxygen flow rate.
Discontinue or decrease the oxygen flow rate. (Rationale: With emphysema, it is believed that the respiratory center no longer responds to elevated carbon dioxide as the stimulus to breathe[1][2] but rather to lowered oxygen levels; therefore, the oxygen being delivered must be lowered to supply enough for oxygenation without being so elevated that it negates the stimulus to breathe. However, the results of one recent study of clients with stable chronic obstructive pulmonary disease (COPD) indicate that the hypercarbic drive is preserved. More research is needed before this theory is applied clinically. A confused client cannot answer questions about the confusion. There are no indications that respiratory secretions have increased.)
A nurse observes a client with acute bronchitis and emphysema sitting up in bed, appearing anxious and dyspneic. What should the nurse do first? a-Provide oxygen at 2 L per minute b-Encourage deep breathing and coughing c-Administer the prescribed sedative and encourage rest d-Suggest breathing into a paper bag for several minutes
a-Provide oxygen at 2 L per minute (Rationale: Low concentrations of oxygen will provide relief, do not reduce the stimulus to breathe, and prevent carbon dioxide narcosis. Respiratory obstruction causes difficulty on expiration; deep breathing may aggravate this problem. Pursed-lip breathing is advised to prevent the collapse of alveoli and promote the exhalation of carbon dioxide. Sedatives will depress further respirations and increase the carbon dioxide level. Chronic hypercapnia is present; additional carbon dioxide from breathing into a paper bag will add to the problem.)
A primary healthcare provider has prescribed pyrazinamide to a client with tuberculosis. Which instruction by the nurse will be beneficial to the client? Select all that apply. "Avoid drinking alcoholic beverages." "Drink at least 8 ounces of water with the medication." "Your soft contact lenses will be stained permanently." "Darkening of the urine is normal while you are using this drug." "Be sure to report any changes in vision such as diminished color perception."
"Avoid drinking alcoholic beverages." "Drink at least 8 ounces of water with the medication." "Be sure to report any changes in vision such as diminished color perception." (Rationale: A client undergoing pyrazinamide therapy may require extra fluids to help prevent uric acid formation from precipitating and causing gout or kidney problems. Therefore the client should drink at least 8 ounces of water with the medication. The client should also avoid alcoholic beverages, which could potentiate liver toxicity. Staining is a common problem with rifampin, not pyrazinamide. The client should also report any darkening of urine because this may be a sign of liver toxicity or damage. The client should report any vision changes if he or she is taking etambutol.)
A client is diagnosed with pulmonary tuberculosis, and the healthcare provider prescribes a combination of rifampin and isoniazid. The nurse evaluates that the teaching regarding the drug is effective when the client reports which action as most important? "Report any changes in vision." "Take the medicine with my meals." "Call my doctor if my urine or tears turn red-orange." "Continue taking the medicine even after I feel better."
"Continue taking the medicine even after I feel better." (Rationale: The medication should be taken for the full course of therapy; most regimens last from 6 to 9 months, depending on the state of the disease. Visual changes are not side effects of this medication. The medication should be taken 1 hour before meals or 2 hours after meals for better absorption. Urine or tears turning red-orange is a side effect of rifampin; although this should be reported, it is not an adverse side effect.)
A client with tuberculosis asks the nurse about the communicability of the disease. Which is the best response by the nurse? "Tuberculosis is not communicable at this time." "Untreated active tuberculosis is communicable." "Tuberculosis is communicable during the primary stage." "With the newer long-term therapies, tuberculosis is not communicable."
"Untreated active tuberculosis is communicable." (Rationale: The statement that untreated active tuberculosis is communicable is an accurate statement; treatment is necessary to stop communicability. The statement that tuberculosis is not communicable at this time is false reassurance; untreated active tuberculosis is communicable. Tuberculosis is not communicable when there is no active infection; the primary complex refers to the presence of a primary (Ghon) tubercle and enlarged lymph nodes and is the initial response to exposure; active disease may or may not occur. Tuberculosis is a communicable disease; close contacts should be screened via a skin test.)
For which illness should airborne precautions be implemented? Influenza Chickenpox Pneumonia Respiratory syncytial virus
Chickenpox (Rationale: Chickenpox is known or suspected to be transmitted by air. Diseases that are known or suspected to be transmitted by droplet include influenza and pneumonia. A disease that is known or suspected to be transmitted by direct contact is respiratory syncytial virus.)
The primary healthcare provider has prescribed different drugs for four clients with tuberculosis. Which client is at a risk of sunburn? Client 1 rifampin Client 2 isonazid Client 3 ethambutol Client 4 pyrazinamide
Client 4 pyrazinamide (Rationale: Client 4, who has been prescribed pyrazinamide, is at increased risk of sunburn. Pyrazinamide is a first-line anti-tubercular drug; it can cause photosensitivity and greatly increases the risk of sunburn. Client 1, prescribed rifampin, is at risk for unplanned pregnancy if also using an oral contraceptive. Client 2, prescribed isoniazid, is at risk for vitamin B-complex deficiency. Client 3, prescribed ethambutol, is at risk for optic neuritis.)
Which condition may lead to collapse of the walls of the bronchioles and alveolar air sacs? Asthma Emphysema Chronic bronchitis Centrilobular emphysema
Emphysema (Rationale: Emphysema is a condition in which a dysregulation of lung proteases may lead to the collapse of the walls of the bronchioles and alveolar air sacs. Asthma is a condition that involves a reversible airflow obstruction in the airways. In chronic bronchitis, infections or bronchial irritants cause increased secretions, edema, bronchospasm, and impaired mucociliary clearance. Centriacinar or centrilobular emphysema affect the respiratory bronchioles most severely.)
An arterial blood gas report indicates the client's pH is 7.25, PCO 2 is 35 mm Hg, and HCO 3 is 20 mEq/L. Which disturbance should the nurse identify based on these results? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis
Metabolic acidosis (Rationale: A low pH and low bicarbonate level are consistent with metabolic acidosis. The pH indicates acidosis, not alkalosis. The CO 2 concentration is within normal limits, which is inconsistent with respiratory acidosis; it is elevated with respiratory acidosis.)
A client with tuberculosis is prescribed rifampin. What does the nurse teach the client about this medication? Select all that apply. "Avoid drinking alcohol while you are on this drug." "Report immediately if you find a yellow appearance to the skin." "Wear a protective clothing and sunscreen when going out in sunlight." "Your soft contact lenses will become permanently stained with this drug." "Immediately consult your physician if you find reddish orange tinge in your urine."
"Avoid drinking alcohol while you are on this drug." "Report immediately if you find a yellow appearance to the skin." "Your soft contact lenses will become permanently stained with this drug." (Rifampin is an antitubercular drug that kills slow-growing organisms residing in the caseating granulomas. Rifampin may cause liver damage, so alcohol should be avoided as it potentiates liver damage. Yellow appearance to the skin is a sign of liver failure. Therefore, a client on rifampin therapy is taught to report the presence of any yellowing of the skin. Rifampin permanently stains soft contact lenses and therefore the client is made aware to avoid wearing them while on the medication. Pyrazinamide causes photosensitivity reactions and therefore a client on that drug therapy is advised to wear protective clothing and sunscreen when going outdoors. The nurse should inform the client that rifampin changes the color of body secretions, which is normal and harmless.)
A healthcare provider prescribes inhaled corticosteroids for a 6-year-old child with asthma. The nurse concludes that the mother understands the teaching about the side effects of this medication when the mother makes which statement? "I'll watch for frequent urination." "I'll check for white patches in the mouth." "I'll be alert for short episodes of not breathing." "I'll monitor for an increased blood glucose level."
"I'll check for white patches in the mouth." (Rationale: Oral candidiasis is a potential side effect of inhaled steroids because of steroids' anti-inflammatory effect; the child should be taught to rinse the mouth after each inhalation. Frequent urination is not a side effect of steroid therapy. Apneic episodes are not a side effect of steroid therapy. Hyperglycemia is not a side effect of inhaled steroid therapy; it may occur when steroids are administered for a systemic effect.)
A parent of three young children has contracted tuberculosis. Which does the nurse expect the healthcare provider to prescribe for members of the family who have a positive reaction to the tuberculin skin test and are candidates for treatment? Isoniazid Multiple-puncture test Bacille Calmette-Guérin Tuberculin purified protein derivative
Isoniazid (Rationale: Isoniazid is used as a prophylactic agent for people who have been exposed to tuberculosis; also, it is one of several drugs used to treat the disease. Multiple-puncture tests, such as the tine test, are used to test for tuberculosis; these are no longer recommended. They are not a treatment for the prevention or cure of tuberculosis. Bacille Calmette-Guérin is a vaccine that provides limited immunity; it is not recommended for use in the United States. Tuberculin purified protein derivative, the Mantoux test, is a widely used skin test for detecting tuberculosis; it is not a treatment for the prevention or treatment of tuberculosis.)
A client with chronic obstructive pulmonary disease will be taking long-term oral corticosteroid therapy. After the nurse conducts a teaching session, which statements by the client indicates that the nurse should follow up? Select all that apply . "My urine may become discolored." "I need to avoid crowds in enclosed areas." "I will lose weight while on this medication." "The medication should be taken between meals." "When I'm feeling better, I can stop taking this medication." "I will not take aspirin or ibuprofen while on this medication."
"My urine may become discolored." "I will lose weight while on this medication." "When I'm feeling better, I can stop taking this medication." "I will not take aspirin or ibuprofen while on this medication." (Rationale: Corticosteroids do not cause urine discoloration; they do cause weight gain. Corticosteroids must be taken with milk or food to reduce gastrointestinal upset. Corticosteroids must not be stopped abruptly because of the risk of acute adrenal insufficiency; the medication will be tapered before it is discontinued. Long-term use of corticosteroids results in depressed immunity and may cause a greater risk for infection; therefore it is important to avoid large crowds of people and those with infections. It is important to avoid taking aspirin and nonsteroidal antiinflammatory drugs -NSAIDs- such as ibuprofen because of the possibility of gastric irritation and possible gastric bleeding.)
A primary healthcare provider has prescribed isoniazid to a client with tuberculosis. Which instruction by the nurse will be most beneficial to the client? "You should take the drug on an empty stomach." "Your soft contact lenses will be stained permanently." "You must use an additional method of contraception." "You need to drink at least 8 ounces of water with the medication."
"You should take the drug on an empty stomach." (Rationale: Isoniazid is used as first-line drug therapy for tuberculosis. Absorption of the drug from the gastrointestinal tract can be prevented or slowed by the presence of food and antacids, so the client should be instructed to take the drug on an empty stomach. Staining of bodily fluids is commonly associated with rifampin. Rifampin reduces the effectiveness of oral contraceptives, so an additional method of contraception is required for any female client prescribed this drug who also uses birth control pills. The instruction to drink at least 8 ounces of water with the medication would be beneficial fora client who has been prescribed pyrazinamide.)
What breathing exercises should the nurse teach a client with the diagnosis of emphysema? An inhalation that is prolonged to promote gas exchange. Abdominal exercises to limit the use of accessory muscles. Sit-ups to help strengthen the accessory muscles of respiration. Diaphragmatic exercises to improve contraction of the diaphragm.
Diaphragmatic exercises to improve contraction of the diaphragm. (Rationale: With emphysema the diaphragm is flattened and weakened; strengthening the diaphragm is desirable to maximize exhalation. Prolonged exhalations are more desirable; clients with emphysema have an increased residual volume, which eventually causes a barrel chest. Abdominal exercises enhance, not limit, the accessory muscles of respiration that are needed as a compensatory mechanism for clients with emphysema. Sit-ups are too strenuous for clients with emphysema.)
The data presented indicate an infectious process within the lung. The classic clinical findings associated with pneumonia are a productive cough (sputum is purulent, blood-tinged, or rust-colored), fever, chills, pleuritic chest discomfort, and dyspnea. Percussion is dulled over areas of consolidation. The cardinal clinical findings associated with pleurisy are pain in the lower lobe at the height of inspiration and a pleural friction rub. Although fever and chills can occur later in bronchitis, the cardinal clinical findings associated with bronchitis are irritating productive cough, chest pain, and shortness of breath. The cardinal clinical findings associated with emphysema are barrel chest, resonance on percussion, and air trapping.
During the assessment of a client who was admitted to the hospital because of a productive cough, fever, and chills, the nurse percusses an area of dullness over the right posterior lower lobe of the lung. Which medical diagnosis will the nurse most likely observe documented in the client's electronic records? Pleurisy Bronchitis Pneumonia Emphysema
A client is admitted to the hospital with a diagnosis of an exacerbation of asthma. What should the nurse plan to do to best help this client? Determine the client's emotional state. Give prescribed drugs to promote bronchiolar dilation. Provide education about the impact of a family history. Encourage the client to use an incentive spirometer routinely.
Give prescribed drugs to promote bronchiolar dilation. (Rationale: Asthma involves spasms of the bronchi and bronchioles as well as increased production of mucus; this decreases the size of the lumina, interfering with inhalation and exhalation. Bronchiolar dilation will reduce airway resistance and improve the client's breathing. Although identifying and addressing a client's emotional state is important, maintaining airway and breathing are the priority. In addition, emotional stress is only one of many precipitating factors, such as allergens, temperature changes, odors, and chemicals. Although recent studies indicate a genetic correlation along with other factors that may predispose a person to develop asthma, exploring this issue is not the priority. Use of an incentive spirometer is not helpful because of mucosal edema, bronchoconstriction, and secretions, all of which cause airway obstruction.)
During the assessment of a client who was admitted to the hospital because of a productive cough, fever, and chills, the nurse percusses an area of dullness over the right posterior lower lobe of the lung. Which medical diagnosis will the nurse most likely observe documented in the client's electronic records? Pleurisy Bronchitis Pneumonia Emphysema
Pneumonia (Rationale: The data presented indicate an infectious process within the lung. The classic clinical findings associated with pneumonia are a productive cough (sputum is purulent, blood-tinged, or rust-colored), fever, chills, pleuritic chest discomfort, and dyspnea. Percussion is dulled over areas of consolidation. The cardinal clinical findings associated with pleurisy are pain in the lower lobe at the height of inspiration and a pleural friction rub. Although fever and chills can occur later in bronchitis, the cardinal clinical findings associated with bronchitis are irritating productive cough, chest pain, and shortness of breath. The cardinal clinical findings associated with emphysema are barrel chest, resonance on percussion, and air trapping.)