Med-Surg Ch 27 Lower Respiratory Problems

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?

"Can you tell me what it is that makes you think you will die soon?"

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?

"I will call the HCP right away if I develop a fever."

The nurse provides discharge teaching for a patient who has two fractured ribs from an automobile accident. Which statement made by the patient would indicate that teaching has been effective?

"I will use the incentive spirometer every hour or two during the day."

A lobectomy is scheduled for a patient with stage I nonsmall cell lung cancer. The patient tells the nurse, "I would rather have chemotherapy than surgery." Which response by the nurse is most appropriate?

"Tell me what you know about the various treatments available."

Which factors will the nurse consider when calculating the CURB-65 score for a patient with pneumonia?

-Age -Blood pressure -Respiratory rate -Presence of confusion -Blood urea nitrogen (BUN) level

The nurse notes new onset of confusion in an older patient who is normally alert and oriented. In which order should the nurse take the following actions?

1.Obtain the oxygen saturation 2.Check the patients pulse rate 3.Notify the HCP 4.Document the change in status

The nurse monitors a patient after chest tube placement for a hemopneumothorax. The nurse is most concerned if which assessment finding is observed?

400 mL of blood in the collection chamber

After change of shift report, which patient should the nurse assess first?

64-year-old with lung cancer and tracheal deviation after subclavian catheter insertion

The nurse receives change-of-shift report on the following patients. Which patient should the nurse assess first?

A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath

When caring for a patient who is hospitalized with active TB, the nurse observes a student nurse who is assigned to take care of a patient. Which action performed by the student nurse would require an intervention by the nurse?

A surgical face mask is applied before visiting the patient

A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the nurse plan to include in the teaching plan?

Appropriate use of cough suppressants

An alcoholic and homeless patient is diagnosed with active TB. Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen?

Arrange for a daily noon meal at a community center where the drug will be administered

After 2 months of 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?

Ask the patient whether medications have been taken as directed

A patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurse's most appropriate action to promote airway clearance?

Assist the patient to splint the chest when coughing

A patient who was admitted the previous day with pneumonia complains of a sharp pain of 7 (based on 0 to 10 scale) whenever they take a deep breath. Which action will the nurse take next?

Auscultate breath sounds

A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first?

Blood cultures from two sites

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 UAP?

Document the amount of drainage every 8 hours

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?

Elevate the head of the bed to semi-Fowlers position

A patient who is taking rifampin (Rifadin) for TB calls the clinic and reports having orange discolored urine and tears. Which is the best response by the nurse?

Explain that orange discolored urine and tears are normal while taking this medication

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 patients postoperative care?

Frequent use of an incentive spirometer

The nurse is performing 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?

Have you received the bacilli Calmette-Gurin (BCG) vaccine for TB?

The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement made by the patient indicates a good understanding of the instructions?

I will continue to do the deep breathing and coughing exercises at home

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?

Impaired gas exchange related to respiratory congestion

The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect?

Increased tactile fremitus

When assessing a patient who has just arrived after an automobile accident, the ER nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the patient?

Insertion of a chest tube with a chest drainage system

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?

Medicate the patient with prescribed morphine

The nurse teaches a patient about the transmission of pulmonary TB. Which statement made by the patient indicates that teaching was effective?

My husband will be sleeping in the guest bedroom

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?

Observe for distended neck veins

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?

Options for smoking cessation

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 HCP?

Oxygen saturation is 88%

A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat. The ER nurse would be most concerned if which finding is observed during the initial assessment?

Paradoxic chest movement

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?

Patient reports decreased exertional dyspnea

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?

Piperacillin/tazobactam (Zosyn)

The nurse develops a plan of care to prevent aspiration in a high-risk patient. Which nursing action will be most effective?

Place patients with altered consciousness in side-lying positions

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?

Placing the patient on droplet precautions and in a private hospital room

A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure?

Position the patient sitting upright on the edge of the bed and leaning forward

An occupational health nurse works at a manufacturing plant where there is potential exposure to inhaled dust. Which action recommended by the nurse will be most helpful in reducing the incidence of lung disease?

Require the use of protective equipment

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?

Set up the patient controlled analgesia (PCA) and administer the loading dose of morphine

A patient is admitted to the ER with an open stab wound to the left chest. What is the first action that the nurse should take?

Take a nonporous dressing on three sides over the chest wound

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?

Take no further action with the collection device

Which intervention will the nurse include in the plan of care for a patient who is diagnosed with a lung abscess?

Teach about the need for prolong antibiotic therapy after discharge from the hospital

The HCP writes an order for bacteriologic testing for a patient who has a positive TB skin test. Which action should the nurse take?

Teach about the need to get sputum specimens for 2 to 3 consecutive days

Which action by the nurse will be most effective in decreasing the spread of pertussis in a community setting?

Teaching patients about the need for adult pertussis immunizations

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 HCP?

The patient is being treated with antiretroviral for HIV infection

The nurse is caring for patient with idiopathic pulmonary arterial hypertension (IPAH) who is receiving epoprostenol (Flolan). Which assessment information requires the most immediate action by the nurse?

The patient's central IV line is disconnected

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?

The patients WBC count is 9000/L

A patient is admitted with active tuberculosis (TB). The nurse should question a health care providers order to discontinue airborne precautions unless which assessment finding is documented?

Three sputum smears for acid-fast bacilli are negative

The nurse supervises UAP who are providing care for a patient with right lower lobe pneumonia. The nurse should intervene if which action by the UAP is observed?

UAP lowers the head of the patient's bed to 15 degrees

Employee health test results reveal a 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?

Use and side effects of isoniazid (INH)

Following the assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis?

Weak, nonproductive cough effort

An older patient is receiving standard multidrug therapy for TB. The nurse should notify the HCP if the patient exhibits which finding?

Yellow-tinged skin