Med Surg Exam 1

The nurse is monitoring the chest tube drainage system in a client with a chest tube. The nurse notes intermittent bubbling in the water seal chamber. Which is the most appropriate nursing action? 1. Check for an air leak. 2. Document the findings. 3. Notify the health care provider. 4. Change the chest tube drainage system.

. Document the findings.

Which signs/symptoms are indicators of an asthma attack? Select all that apply. 1. Audible wheeze, especially on exhalation 2. Muscle retraction between the ribs 3. Decreased forced expiratory volume in the first second (FEV1) on flowmeter 4. Eosinophils in the sputum 5. Increased, then decreased arterial carbon dioxide (PaCO2) level

1. Audible wheeze, especially on exhalation 2. Muscle retraction between the ribs 3. Decreased forced expiratory volume in the first second (FEV1) on flowmeter 4. Eosinophils in the sputum

The nurse is caring for a group of patients on the pulmonary unit. Which patient is at greatest risk for having pulmonary hypertension (PH)? 29-year old male who is overweight 32-year-old female with a family history of PH 43-year-old male with history of right-sided heart failure 50-year-old female with history of blood clots in the pulmonary artery

32-year-old female with a family history of PH

The client states that he has smoked three-fourths of a pack per day over the last 10 years. The nurse calculates that the client has a smoking history of how many pack-years? Fill in the blank and record your answer using one decimal place.

7.5 years

When the home care nurse arrives, the client with a diagnosis of emphysema is smoking. Which statement by the nurse would be most therapeutic? A."Well, I can see you never got to the stop smoking clinic." B. "Now that your secret is out, may we decide what you are going to do?" C. "Now that your secret is out, may we decide what you are going to do?" D. "I wonder if you realize that by smoking you are slowly killing yourself."

?

A client, experiencing a sudden onset of chest pain and dyspnea, is diagnosed with a pulmonary embolus. The nurse immediately implements which expected prescription for this client? Select all that apply. Supplemental oxygen High-Fowler's position Semi-Fowler's position Morphine sulfate intravenously Two tablets of acetaminophen with codeine Meperidine hydrochloride intravenously

Supplemental oxygen High-Fowler's position

The nurse has assisted a health care provider (HCP) with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water-seal chamber after the tube is inserted. Based on this assessment, which action is most appropriate? 1. Inform the HCP. 2. Continue to monitor the client. 3. Reinforce the occlusive dressing. 4. Encourage the client to deep breathe.

2. Continue to monitor the client.

Which statements are correct regarding the drug management of asthma? Select all that apply. 1. Long-acting beta agonists are indicated to relieve acute attack symptoms. 2. Control therapy medications are used to prevent asthma attacks from occurring. 3. Control therapy medications are used to reduce airway responsiveness. 4. Reliever medications are used to stop an asthma attack once it has started. 5. Anti-inflammatory medications are used to cause bronchodilation.

2. Control therapy medications are used to prevent asthma attacks from occurring. 3. Control therapy medications are used to reduce airway responsiveness. 4. Reliever medications are used to stop an asthma attack once it has started.

The nurse is assisting a health care provider with the removal of a chest tube. The nurse should instruct the client to take which action? 1. Exhale slowly. 2. Stay very still. 3. Inhale and exhale quickly. 4. Perform the Valsalva maneuver.

4. Perform the Valsalva maneuver.

A clinic nurse notes that large numbers of clients present with flulike symptoms. Which recommendations should the nurse include in the plan of care for these clients? Select all that apply. A. Get plenty of rest. B. Increase intake of liquids. C. Take antipyretics for fever. D. Get a flu shot immediately. E. Eat fruits and vegetables high in vitamin C.

A, B, C, E

The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse include on the list? Select all that apply. A. Activities should be resumed gradually. B. Avoid contact with other individuals, except family members, for at least 6 months. C. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. D. Respiratory isolation is not necessary because family members already have been exposed. E. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags. F. When 1 sputum culture is negative, the client is no longer considered infectious and usually can return to former employment.

A, C, D, E

The nurse knows that an inflated cuff for a tracheostomy is indicated for which client? Select all that apply. A. A client at risk for aspiration B. A client who is physically dependent C. A client who needs to be able to speak D. A client who requires mechanical ventilation E. A client who requires assistance with activities of daily living

A, D

A client did not seek medical treatment for a previous respiratory infection, and subsequently an empyema developed in the left lung. The nurse should assess the client for which signs and symptoms associated with this problem? A. Pleural pain and fever B. Decreased respiratory rate C. Diaphoresis during the day D. Hyperresonant breath sounds over the left thorax

A. Pleural pain and fever

The nurse is monitoring a client for bradypnea. Which description is characteristic of this respiratory pattern? A. Regular but abnormally slow B. Labored and increased in depth and rate C. Regular but interspersed with periods of apnea D. Abnormally deep, regular, with increased rate

A. Regular but abnormally slow

The nurse is suctioning a client who has an endotracheal tube in place. Which finding indicates that the client is experiencing an adverse effect of this procedure? A. Cardiac irregularities B. Oxygen saturation level of 95% C. A reddish coloration in the client's face D. Apical pulse rate of 80 beats per minute

A. cardiac irregularities

A client is diagnosed with a tumor of the larynx. The nurse determines that the client is in the late stage of the disease process if the client exhibits which finding? A. Dyspnea B. Hoarseness C. Hemoptysis D. Voice changes

A. dyspnea

A patient with a history of asthma is having shortness of breath. The nurse discovers that the peak flowmeter indicates a peak expiratory flow (PEF) reading that is in the red zone. What is the priority nursing action? Administer the rescue drugs. Take the patient's vital signs. Notify the patient's prescriber. Repeat the PEF reading to verify the results.

Administer the rescue drugs.

The nurse is delegating ambulation for a client to an experienced Patient Care Technician (PCT). Which teaching will the nurse provide to the UAP? (Select all that apply.) A. "Come and get me for lunch." B. "Ambulate the client every four hours." C. "Each ambulation should last 10 minutes." D. "Please let me know how the client does after each ambulation." E. "Be certain to use a gait belt when performing this activity."

B. "Ambulate the client every four hours." C. "Each ambulation should last 10 minutes." D. "Please let me know how the client does after each ambulation." E. "Be certain to use a gait belt when performing this activity."

The nurse observes that numerous clients on a medical-surgical respiratory unit seem to have increasingly frequent readmissions. What quality improvement step could the nurse implement to explore the readmission rate? A. Inform the unit manager of the concern. B. Evaluate trends and develop a plan for improvement. C. Contact the hospital quality improvement nurse to create an improvement strategy. D. Post a journal article on the unit that addresses national readmission rates for respiratory disorders.

B. Evaluate trends and develop a plan for improvement.

The nurse is caring for a client with a newly placed tracheostomy. Which emergency equipment should be available at the bedside? Select all that apply. A. Tongue blade B. Endotracheal tube C. Tracheostomy tube D. Tracheostomy insertion tray E. Manual resuscitation bag with face mask

C, D, E

A client arrives in the hospital emergency department with a bloody nose. What is the initial nursing action? A. Place the client in supine position B. Apply an ice collar around the patient's neck C. Assist the client to a sitting position with the head tilted forward D. Instruct the client to swallow the blood until the bleeding can be controlled

C. Assist the client to a sitting position with the head tilted forward

The nurse is assessing the respiratory status of the client after a thoracentesis has been performed. The nurse would become concerned with which assessment finding? A. Equal bilateral chest expansion B. Respiratory rate of 22 breaths per minute C. Diminished breath sounds on the affected side D. Few scattered wheezes, unchanged from baseline

C. Diminished breath sounds on the affected side

Which nursing documentation demonstrates the integration of patient-centered care? A. Social worker paged for consultation B. Steady gait observed when ambulating C. Discussed dietary preferences with client D. Nursing literature reviewed for best practice approaches

C. Discussed dietary preferences with client

A client seeks treatment in an ambulatory clinic for hoarseness that has persisted for 8 weeks. Based on the symptom, the nurse interprets that the client is at risk for which disorder? A. Thyroid cancer B. Acute laryngitis C. Laryngeal cancer D. Bronchogenic cancer

C. laryngeal cancer

The student nurse is listening to a respiratory lecture on wheezing. Which statement by the student nurse indicates that the teaching has been effective? A. "Wheezing is caused by a grating noise heard on expiration." B. "Wheezing consists of a gurgling noise heard on expiration." C. "A creaking noise heard on inspiration indicates wheezing." D. "Wheezing sounds like a musical or hissing noise heard on inspiration."

D. "Wheezing sounds like a musical or hissing noise heard on inspiration."

Which manifestations in a client receiving oxygen therapy at 60% for more than 24 hours alerts the nurse to the possibility of oxygen toxicity? A. Oxygen saturation greater than 100% B. Decreased rate and depth of respiration C. Wheezing on inhalation and exhalation D. Discomfort or pain under the sternum

D. Discomfort or pain under the sternum

A nurse is caring for a client with a chest tube drainage system. While the client is being assisted to sit up in bed in preparation for ambulation, the chest drainage system accidentally disconnects. Which is the initial nursing action? A. Call a respiratory therapist. B. Contact the health care provider (HCP). C. Encourage the client to perform the Valsalva maneuver. D. Place the end of the chest tube in a container of sterile water.

D. Place the end of the chest tube in a container of sterile water.

A client's baseline vital signs are as follows: temperature 98.8°F (37.1°C) oral, pulse 74 beats/min, respirations 18 breaths/min, and blood pressure 124/76 mm Hg. The client's temperature suddenly spikes to 103°F (39.4°C). Which corresponding respiratory rate should the nurse anticipate in this client as part of the body's response to the change in status? A. Respiratory rate of 12 breaths/min B. Respiratory rate of 16 breaths/min C. Respiratory rate of 18 breaths/min D. Respiratory rate of 22 breaths/min

D. Respiratory rate of 22 breaths/min

A client is experiencing difficulty coping with decreased ability to tolerate activity because of respiratory disease. The home care nurse determines that the client is showing an adaptive response when which behaviors are observed? A. Has learned to scale back expectations related to activity B. Increases the use of medication in order to sleep 8 hours nightly C. Spends most of the day in one room of the home to decrease fatigue D. Tries to increase ambulation and complete some small tasks each day

D. Tries to increase ambulation and complete some small tasks each day

A postoperative client suddenly develops chest pain and is experiencing dyspnea and tachypnea. The nurse suspects that the client has a pulmonary embolism and immediately plans to implement which intervention? Administering nasal oxygen Placing the client on a cardiac monitor Preparing the client for a perfusion scan Ensuring that the intravenous (IV) line is patent

administer nasal oxygen

A patient is admitted with cough, fever, sore throat, progressive shortness of breath, diarrhea, and vomiting that developed after returning from a business trip overseas. The nurse suspects which illness is the likely cause of the patient's symptoms? Pneumonia Viral influenza Avian influenza Tuberculosis exposure

avian influenza

The nurse understands that which of the following is the most common manifestation of pneumonia in the older adult patient? Fever Cough Confusion Weakness

confusion

A patient is experiencing hypotension, fever, chills, night sweats, and weight loss. Upon assessment, the nurse notes a displaced PMI. The nurse knows this collection of symptoms are associated most closely with which condition? Influenza Pneumonia Tuberculosis Pulmonary empyema

pulmonary empyema

The patient is assessed and a blood glucose level and vital signs are obtained upon arrival on the unit. Results are as follows: BG - 239 mg/dL BP - 138/88 mm Hg HR - 128 RR - 36 breaths/min O2 saturation - 88% (room air) Temp - 101.6º F Which vital sign or test result requires the nurse's immediate attention? Blood pressure Respiratory rate Temperature Blood glucose

respiratory rate