medsurg exam #1

A patient is diagnosed with obstructive sleep apnea and provided with a CPAP mask and device to use. The patient returns a month later and reports no reduction in symptoms. Which question by the nurse would elicit the most appropriate additional information from the patient?

"Are you experiencing problems with your mask?"

A 22-year-old patient with cystic fibrosis is receiving a pneumonia vaccine. The patient asks the nurse why it is necessary to have the vaccine at such a young age. What is the best response by the nurse?

"Because of your health history, you should receive the vaccine even though you are not 65 years old."

Which statement by the patient demonstrates an understanding of treatment for obstructive sleep apnea?

"CPAP can improve my concentration."

A patient is being treated for pneumonia. Which statements, by the patient, indicate that patient teaching was successful?

"Every year I should get a flu vaccine."

which statement make by a patient with asthma indicates ineffective learning about medication to prevent further asthma attacks?

"I should use the inhaler only when I have an asthma attack"

A family member of a patient asks the nurse how a person develops pneumonia. What is the best response by the nurse?

"Pneumonia develops when bacteria invade the lower airways."

A patient with pneumonia is ordered an arterial blood gas (ABG). A family member asks about the purpose of this test. Which response by the nurse is best?

"To determine the oxygenation status of the patient."

What is an appropriate response to a patient with a history of heart failure who asks why it is important to treat sleep apnea?

"Untreated sleep apnea can worsen heart failure."

A patient calls the clinic and reports upper respiratory symptoms. Which statement is most appropriate by the nurse?

"When did your symptoms begin?"

A patient presents with signs and symptoms of pneumonia. What patient history should the nurse obtain to learn more about the type of pneumonia the patient may have?

"When was the last time you were hospitalized?"

An otherwise healthy patient with no history of tuberculosis elicits a significant reaction (Class 2) on a routine tuberculin skin test for employment. The patient asks the nurse what the reaction means. How should the nurse respond to the patient?

"You have an inactive TB infection with no sign of the disease."

A patient presents with symptoms of pneumonia. A sputum culture identifies the infectious agent as bacterial in nature and the patient is placed on IV antibiotics. Within 48 hours, the patient's vital signs return to normal, the patient has switched to oral antibiotics, is drinking fluids normally, and has had two formed bowel movements. The patient asks the nurse, "When may I go home?" Based on the patient's condition, what is the best response by the nurse?

"You will likely be discharged soon."

which information about engaging in exercise will the nurse give a patient with asthma?

"adjust your exercise routine as needed to avoid asthma triggers"

A nurse is teaching a client who is taking prednisone for chronic asthma. Which of the following instructions should the nurse include?

"avoid taking non steroidal anti-inflammatory drugs"

which of these statements made by a client with cystic fibrosis indicates an understanding of the pathophysiology?

"cystic fibrosis is an autosomal-recessive disorder resulting in excessive mucous production with chronic obstructive lung disease"

which answer by the nurse is appropriate when a patient with asthma asks why it is necessary to use an inhaled corticosteroid every day?

"daily medications help reduce the risk for irreversible changes in your lungs"

which information is most important for the nurse to give to a patient who is about to begin drug therapy for the treatment of tuberculosis (TB)?

"do not drink alcohol"

a patient receiving INH, rifampin, PZA, and ethambutol develops diminished visual acuity and exhibits symptoms of color blindness. the patient asks which medication is causing the side effects. what is the best response by the nurse?

"ethambutol"

the nurse is counseling a patient whose parent has just been diagnosed with tuberculosis (TB). the patient tells the nurse that the parent was exposed several years ago but developed symptoms only recently. which information would the nurse provide to the patient about the risk for contracting the disease?

"people are infectious to others only when symptoms are present"

which information would the nurse provide to a patient with chronic obstructive pulmonary disease (COPD) who is using home oxygen at a flow rate of 4 L/min via nasal cannula but experiencing only moderate improvement in shortness of breath?

"shortness of breath may continue even with oxygen therapy"

a patient with latent tuberculosis infection and HIV says, "I have stopped taking my medication since I am not sick." what is an appropriate response by the nurse?

"taking the medication is critical to prevent the latent infection from becoming an active infection"

a patient tells the nurse that after 3 weeks of multi drug therapy to treat tuberculosis (TB), the symptoms have resolved. which information would the nurse clarify for the patient?

"you will need to continue therapy for at least 6 months"

a patient is being discharged home with active tuberculosis (TB). which information would the nurse include in the discharge teaching plan?

"you will need to have your household undergo TB testing"

a patient is receiving INH, rifampin, PZA, and ethambutol for an active TB infection. the results of the susceptibility testing of his sample reveal that the bacteria are resistant to INH and rifampin. the patient asks how this will change the treatment. what is the best response by the nurse?

"you will now receive bed aquiline and levofloxacin instead of what you were taking"

which patient statement indicates that teaching about anxiety with chronic obstructive pulmonary disease (COPD) has been successful? select all that apply

- "I will perform diaphragmatic breathing when I am anxious" - "I will attend counseling sessions during periods of emotional distress" - "I will take my prescribed anti anxiety medication if I begin to feel panicky"

which question would the nurse ask to determine an older-adult patient's risk for developing pneumonia? select all that apply

- "do you have a habit of smoking?" - "have you had a pneumococcal vaccination in the last 3 years?" - "have you been exposed to persons with influenza recently?"

which information would the nurse provide to an older-adult patient who is being discharged after treatment for pneumonia? select all that apply

- "get an annual influenza immunization" - "avoid contact with all persons with colds or influenza" - "stop or reduce any intake of tobacco and tobacco products"

which question would the nurse ask a patient with COPD to help the psychosocial assessment? select all that apply

- "how many people live in your home?" - "how has your illness affected your lifestyle?" - "when and how often do you use your inhaler?"

which information would the nurse provide about pneumonia prevention to a group of adults older than age 60? select all that apply

- "receive an annual influenza vaccination" - "avoid interacting with people who smoke" - "attempt to get 6 to 8 hours of sleep every night"

Mr. Wimmer is prescribed an antibiotic treatment regimen. Which patient teaching topics are most important?

- How to remember to take the medication - Importance of taking all medication on time - Importance of taking the medications in front of the nurse

A patient with acute tuberculosis is treated with INH, rifampin, PZA, and ethambutol for eight weeks. Drug susceptibility testing indicates the bacteria are susceptible to all four drugs. The patient asks the nurse if this means the therapy will change. The nurse explains the patient will likely receive which drugs as a continuous therapy?

- PZA - INH - rifampin [discontinue ethambutol]

which individuals are at risk for developing tuberculosis?

- a prison guard - a student born in south africa - a homeless IV drug user - an individual with a low socioeconomic status

which clinical manifestation during status asthmatics requires immediate action? select all that apply

- absence of response to usual therapy - sudden absence of wheezing, indicating airway obstruction - development of pneumothorax and cardiac or respiratory arrest - use of accessory muscles while breathing and distention of neck veins

which patient characteristic increases the risk for tuberculosis (TB)? select all that apply

- alcohol abuse - lack of a permanent residence - recent release from a correctional facility

which interventions would be most important to include in the plan of care for a client with pneumonia? select all that apply: - place client in negative pressure room - assist client in using a bedside commode - limit oral fluids - teach client to cough and deep breathe - evaluate effectiveness of the use of an incentive spirometer

- assist client in using a bedside commode - teach client to cough and deep breathe - evaluate effectiveness of the use of an incentive spirometer

which diseases of the lungs may occur as a result of exposure to occupational irritants? select all that apply

- asthma - lung cancer - pulmonary fibrosis - COPD

which information would the nurse include when educating an older patient and family about pneumonia prevention? select all that apply

- avoiding dehydration - avoiding crowded public places - decreasing exposure to air pollutants - receiving an annual influenza vaccine

a client is continuing to take prednisone orally at home after discharge. she should watch for and report which of the following to her usual provider?

- black, tarry stools - sore throat - muscle weakness

which intervention does the nurse include in the plan of care for a patient with chronic obstructive pulmonary disease who is experiencing anxiety during acute dyspneic episodes? select all that apply

- exploring the use of biofeedback - using diaphragmatic breathing techniques - helping the patient write a plan to use for symptom flare-ups

which nursing assessment findings supports a patient's new diagnosis of right-sided heart failure in a patient with COPD? select all that apply

- fatigue - pulmonary hypertension - enlarged and tender liver

which clinical assessment findings would the nurse document for a client with TB? select all that apply: - distant breath sounds - excessive drooling - hemoptysis - night sweats - weight gain

- hemoptysis - night sweats

a provider prescribes a stat parenteral dose of a glucocorticoid. recognizing the adverse effects of glucocorticoids, you should monitor the client for which of the following?

- hyperglycemia - infection - gastric bleeding

a community health nurse is preparing teaching materials for an upcoming community health fair. which risk factor would the nurse include when teaching about community-acquired pneumonia? select all that apply

- increased age - presence of a chronic health condition

which statement will the nurse recognize as accurate regarding self-management of asthma? select all that apply

- peak expiratory flow rates should be monitored twice daily - avoid any foods that have been prepared with monosodium glutamate (MSG)

a patient presents with flu-like symptoms including fever, chills, chest pain, and a cough with blood-tinged sputum. which classifications of tuberculosis would the nurse anticipate?

- pulmonary tuberculosis - active tuberculosis disease

which of these clinical assessment findings would indicate a client is experiencing early signs of hypoxia?select all that apply: bradycardia cyanosis restlessness tachycardia tachypnea

- restlessness - tachycardia - tachypnea

A nurse is teaching a client about ipratropium. The nurse should include that this drug has which of the following adverse effects?

- urinary retention - dry mouth

you are obtaining a health history from a client who is to start using a new ipraropium inhaler. which of the following information from the client's history alerts you to take further action?

- urinary retention - glaucoma

A patient with Mycoplasma pneumonia is being discharged to the home. Which statements should the nurse include in the teaching plan for this patient?

-"You should get a yearly influenza vaccination." -"You need to drink six to ten glasses of clear liquids per day." -"You must take your antibiotic until it is gone regardless of how well you are feeling."

A nurse is caring for a patient in the medical unit with altered consciousness. Which nursing interventions should be included in the plan of care to prevent this patient from getting pneumonia?

-Raise the patient's head of bed to 30 degrees. -Reposition patient every two hours while in bed. -Perform hand hygiene before and after providing patient care.

A nurse is teaching a client about the adverse effects of pseudoephedrine. Which of the following should the nurse include

-Restlessness -Insomnia -Anxiety

Place the pathological process of pneumonia in order.

1. Release of cytokines, histamines, and prostaglandins 2. Obstruction of the airway with mucus 3. Impaired CO2 and O2 exchange 4. Mucus and debris removed by alveolar macrophages 5. Lung tissue functioning normally

you are instructing a client about using cromolyn via inhalation to treat exercise-induced bronchospasm. you advise the client to take the drug

15 minutes before exercising

which blood oxygen saturation percentage (spo2) would the nurse set as a target for oxygen therapy for a patient with COPD who is hypoxemic and hypercarbic?

90%

Which patient has the greatest risk for developing pneumonia?

A patient with tube feeding lying flat

Which patient is most likely experiencing an acute asthma attack?

A patient with wheezing and nasal flaring Wheezing and nasal flaring indicate lower airway obstruction and use of accessory muscles, which are signs of an acute asthma attack.

For which patient would the nurse most likely prepare a Bacille-Calmette-Guerin (BCG) vaccine?

A physician caring for TB patients in endemic regions

Which patient conditions increase the risk of contracting pneumonia?

AIDs Coma Congenital heart defect

A patient presents with a productive cough with green sputum, a temperature of 102.5°F, and a SpO2 of 88%. Additionally, the patient reports severe pleural chest pain. The patient is diagnosed with viral pneumonia. What is the appropriate collaborative care for this patient?

Acetaminophen Supplemental oxygen Frequent liquid intake

Select the risk factors that increase the likelihood of obstructive sleep apnea.

Age, Smoking, Facial fracture

A patient arrives in the emergency department with severe wheezing and dyspnea that started 10 minutes ago. Which medications should the nurse anticipate administering to this patient?

Albuterol Albuterol is a short acting β2-agonist and would be given to dilate the bronchioles in patients with acute asthma exacerbations. Intravenous (IV) methylprednisolone Methylprednisolone is a corticosteroid that may be used to treat inflammation in acute asthma exacerbations. IV corticosteroids are used for management of acute asthma exacerbations.

A patient presents to the emergency department with dyspnea. The patient's vital signs are temperature 98.6° F, blood pressure 160/100 mm Hg, heart rate 90 beats/minute, respiratory rate 25 breaths/min, and functional oxygen saturation of 80%. Peak expiratory flow rate (PEFR) is 52%. Which orders should the nurse prioritize for this patient?

Albuterol Albuterol, a short-acting β2-agonist, would be given to a patient with an acute asthma exacerbation. Supplemental oxygen Supplemental oxygen should be administered to treat the patient's hypoxemia.

A patient is experiencing an acute asthma attack. The nurse understands that which common triggers may be the cause of this attack?

Allergic reaction to cats Allergic asthma can result from exposure to allergens. Intake of dairy products Dairy products can cause excessive mucus production and lead to asthma exacerbations in patients with asthma. Exposure to air pollution Exposure to air pollution can lead to lung irritation and an acute asthma attack.

A patient reports severe flu-like symptoms that have worsened over the past 36 hours. The patient is coughing intensely and has an oral temperature of 101.7 °F. The patient questions why she has not received any antibiotics. Which response by the nurse is appropriate?

Antibiotics treat bacterial infections. Your infection is viral in nature."

What happens to the patient physiologically during an apneic period?

Blood carbon dioxide levels rise

Which signs and symptoms are clinical manifestations of obstructive sleep apnea?

Changes in mood, Falling asleep during work, Waking up several times per night

A patient presents to the hospital with symptoms of pneumonia. The patient is treated with IV antibiotics for five days and remains afebrile for 24 hours. What is the next step in the collaborative care of this patient?

Continue treatment

The nurse reviews the polysomnogram report of a patient not previously treated for sleep apnea. The patient experienced 23 apnea/hypopnea events per hour for most of the night. What treatment would the nurse anticipate being prescribed for this patient?

Continuous positive airway pressure (CPAP)

If a patient's sleep apnea is left untreated, which serious consequences may develop?

Death, Marital problems, Difficulty holding a job

Which nursing assessment finding during an acute asthma attack suggests a serious complication requiring immediate intervention?

Diminished breath sounds Diminished breath sounds indicate poor air movement and require immediate intervention.

The nurse is caring for a patient with chest tightness and difficulty breathing. The nurse notes accessory muscle use, wheezes, and a peak flow of 50%. After oral corticosteroids and a short-acting β2-agonist have been administered, which assessment findings would indicate the need for further treatment?

Diminished breath sounds Diminished breath sounds indicate impeded air flow in the lungs and would require further treatment.

List the pathophysiologic mechanisms that occur in asthma in order.

Exposure to trigger Blood vessels dilate Bronchioles constrict Lung dysfunction

A patient presents to the emergency department with difficulty breathing and tightness in the chest. The patient reports being confined to bed or the couch all day, unable to perform any activities. The patient's peak flow measures 67% of the patient's personal best, according to the electronic medical record. Which action should the nurse take first?

Give albuterol. Albuterol is a short-acting β2-agonist and is administered, sometimes with an oral corticosteroid, to control a mild-to-moderate exacerbation of asthma.

A nurse is teaching a client who has a prescription for zileuton. Which of the following instructions should the nurse include?

Have laboratory tests performed at regular intervals

Obstructive sleep apnea is associated with which pathologic conditions?

Hypopnea, Hypoxemia, Decreased airflow, Narrowing of air passages

A patient with a history of asthma presents with wheezing and dyspnea and reports tightness of the chest. On assessment, the patient appears agitated and is fidgeting. The patient's vital signs are: blood pressure 160/90 mm Hg, temperature 99.0° F, heart rate 95 beats/min, and respiratory rate 19 breaths/min. Which complication of asthma is this patient likely experiencing?

Hypoxemia Hypoxemia can lead to agitation and irritability.

Which patient education is critical for Ms. Asher to prevent and/or prepare for future attacks?

Identification of asthma triggers Ms. Asher should be encouraged to identify triggers to prevent future attacks.

Match each diagnostic study for pneumonia to its purpose.

Identifies lung infection—Chest X-ray Determines the exact cause for infection—Sputum Culture Provides oxygen, carbon dioxide, and pH levels in the blood—Arterial Blood Gas Confirms leukocytosis—Complete Blood Cell Count with Differential

A patient presents with nasal flaring, intercostal retractions, and chest tightness. The nurse notes diminished breath sounds over both lungs. After administering albuterol and intravenous magnesium sulfate, which assessment finding indicates treatment has been effective?

Inspiratory and Expiratory wheezing Inspiratory and expiratory wheezing heard after treatment indicates improved movement of air in the lungs and effectiveness of treatment.

A patient with pneumonia reports a loss of appetite and a weight loss of six pounds over the last week. Which interventions by the nurse are most appropriate for this patient?

Instruct the patient to eat small, frequent meals. Instruct the patient to choose their favorite foods at mealtime.

Which aspects of the immune response are thought to be involved in the development of asthma?

Lack of conditioning Lack of conditioning is a part of the immune response in the development of asthma. Children who are not exposed to pathogens, in day care or school settings for example, are at higher risk. Immunoglobulin E (IgE) response to allergens An IgE response to allergens is seen in the development of asthma.

The nurse is caring for a patient who reports sudden onset of dyspnea and chest tightness. Oxygen saturation is 79%. The nurse notes a peak flow of 42%. Nebulized albuterol is administered without improvement. Oxygen saturation after administration of albuterol is 81% and the patient is becoming fatigued. Which action would the nurse take next?

Notify the provider The nurse would notify the provider if the patient's symptoms have not improved after treatment.

A patient with obstructive sleep apnea is still experiencing daytime sleepiness and cognitive problems after using continuous positive airway pressure (CPAP) during sleep. What is the next step in this patient's treatment?

Obtain a consult for an uvulopalatopharyngoplasty

A patient undergoes a genioglossal advancement and hyoid myotomy. Which nursing education topic is appropriate to discuss with this patient following surgery?

Potential complications

A nurse should identify that dextromethorphan can have which of the following effects when combined with morphine?

Potentiation of depression of CNS actions

Which actions have priority during Ms. Asher's current asthma attack to ensure she is calm and focused on normal breathing?

Provide a comfortable place for her to sit. Finding a comfortable place for Ms. Asher to sit will help her to remain calm. Reassure her that the attack will eventually end. The nurse should reassure Ms. Asher that the attack will end with proper treatment. Providing reassurance will help keep this patient calm.

The nurse is caring for a patient with a history of asthma who reports severe dyspnea and the presence of chest tightness for 3 days that has escalated in the last few hours. The nurse notes, functional oxygen saturation of 87%, inspiratory and expiratory wheezes, and forced expiratory volume in 1 second (FEV1) of 23%. Which nursing actions are appropriate for this patient?

Provide supplemental oxygen. The patient's symptoms indicate a moderate, acute asthma exacerbation. Supplemental oxygen is administered to treat the patient's hypoxemia. Administer intravenous (IV) corticosteroids. The patient's symptoms indicate a moderate, acute asthma exacerbation. IV corticosteroids would be administered for an acute asthma exacerbation

Mr. Wimmer has stated that he cannot have TB because he has not had sexual contact with anyone infected with tuberculosis. Which response is most appropriate?

Provide teaching on how tuberculosis is spread from person to person

A patient is being seen in the emergency department for an acute asthma attack. Initial forced expiratory volume in 1 second (FEV1) is 70%. After the initial dose of albuterol, FEV1 is 75%. Which provider order would the nurse carry out first?

Repeat albuterol dose. The nurse would administer another dose of albuterol to continue to help reduce the patient's symptoms. Initially, three doses of albuterol are usually given in the ED depending on the patient's response to the medication.

A nurse is caring for a child with a history of asthma. The nurse anticipates that the provider will order which test to determine whether the child's asthma is related to allergies?

Serum immunoglobulin E (IgE) IgE and eosinophil counts can be used to determine if the child's asthma is due to an allergic tendency.

During a routine wellness visit, a patient reports asthma symptoms occurring approximately three times per week. The symptoms do not interfere with the patient's sleep, and on assessment, forced expiratory volume in 1 second is within normal range. Which intervention can the nurse anticipate for this patient?

Short-acting β2 agonist A short-acting β2-agonist would be given to a patient with a mild asthma exacerbation.

A patient reports daytime sleepiness and indicates that he thinks he has sleep apnea. What is the initial assessment performed to evaluate this patient's suspicion?

Sleep history review

A patient with asthma presents with complaints of dyspnea on exertion. The nurse notes hyperresonance on percussion. Which action should the nurse take?

Teach the patient the pursed-lip breathing technique. Hyperresonance on percussion indicates air trapping. The nurse should teach the patient the pursed-lip breathing technique to prevent hyperinflation.

For which of the following reasons should a client attach a spacer to a metered-dose inhaler?

To increase the amount of drug delivered to the lungs

which patient is at high risk for the development of both community- and hospital-acquired pneumonia?

a 76 year old with limited mobility because of osteoarthritis

which of these clients with COPD should be assessed initially following the shift report?

a client presenting with a HR 110, RR 28, o2 sat 90%

the nurse notes a 5 mm of induration following tuberculin skin test. for which patient would this be considered a positive test?

a patient who has been on high dose prednisone therapy for over a month to treat multiple sclerosis

which of these clients would be a priority for the nurse to assess immediately following shift report? - a client with COPD who is presenting with distant breath sounds - a client with TB who is complaining of night sweats - a post-op client presents with sudden onset of pleuritic pain and acute dyspnea - a client with pneumonia with a T-100.4F, HR-90 with a cough

a post-op client presents with sudden onset of pleuritic pain and acute dyspnea

you should instruct a client who is taking zileuton to report which of the following possible indications of a serious adverse effect of this drug?

abdominal pain

a nurse is caring for a client who is having difficulty mobilizing thick respiratory secretions. which of the following drugs should the nurse expect to administer to the client?

acetylcysteine

which action would the nurse plan to take when managing the care of a patient being admitted with community-acquired pneumonia?

administer antibiotics within 6 hours

you are instructing a client who has a prescription for cetirizine. which of the following information should you be sure to include?

administer the drug prophylactically during allergy seasons

a patient with tuberculosis presents with a high-grade fever, chills, and pleuritic chest pain and reports losing 10 pounds over the last month. the patient reports photophobia and an inability to maintain normal daily functioning due to the symptoms. how should this patient be cared for?

admission to the hospital

what is the appropriate nursing management for a patient with anorexia, recent 12 lb weight loss, fever, and hemoptysis?

airborne infection isolation

which medication will the nurse teach the patient with asthma to use first?

albuterol 2 puffs

A nurse is teaching a client who has a prescription for albuterol via inhaler and fluticasone/salmeterol via inhaler who asthma management. For which of the following reasons should the nurse instruct the client to use the albuterol inhaler before using the fluticasone inhaler?

albuterol will increase the absorption of fluticasone

an older patient with pneumonia gradually has become confused during the initial assessment. which action would the nurse take?

assess the patient's oxygen saturation

pt symptoms for meningitis tuberculosis

blood in urine

the nurse is developing a plan of care to prevent infection for an older adult admitted for an exacerbation of COPD. which finding would lead the nurse to suspect an infection is beginning?

changes in level of consciousness

Asthma

chronic illness characterized by inflammation of the airways and obstruction of airflow

A patient presents with bacterial pneumonia and a productive, blood-tinged sputum. The patient's vital signs are an oral temperature of 102.8 °F, a respiratory rate 28 respirations per minute, an oxygen saturation of 85%, a heart rate of 80 beats per minute, and a blood pressure reading of 125/90. Which of the reported information indicates that the antibiotic therapy is effective?

clear breath sounds

what early symptom would an older adult present with when experiencing hypoxia? confusion congested cough temperature- 102.4 degrees WBC- 18,000 mm3

confusion

A nurse should recognize that using pseudoephedrine to treat allergic rhinitis requires cautious use with clients who have which of the following conditions?

coronary artery disease

which topic is most important for the nurse to include when reviewing asthma management with an older-adult patient?

correct use of controller medications

a patient with COPD is receiving oxygen at a rate of 4L/min with a nasal cannula. before initiating oxygen therapy, the patient appeared anxious with gray skin, a respiratory rate of 24 breaths/min, and an oxygen saturation of 87%. after 15 minutes of oxygen therapy, the nurse observes the patient resting with closed eyes, pink skin, a respiratory rate of 8 breaths/min, and an oxygen saturation of 95%. which action would the nurse expect to take?

decrease the oxygen to 2 L/min to improve the respiratory rate

A nurse is teaching a client about the use of beclomethasone to treat asthma. The nurse should explain that the drug has which of the following therapeutic effects?

decreases inflammation

a patient with pneumonia who is febrile and agitated has just been admitted. the patient has a history of alcohol abuse. which prescribed action would the nurse implement first?

draw aerobic and anaerobic blood cultures

A nurse is teaching an adult client about diphenhydramine. The nurse should inform the client to expect which of the following adverse effects while taking this drug?

drowsiness

legal restrictions apply to the purchase of pseudoephedrine because of which of the following risks?

drug abuse

you should monitor a client taking dextromethorphan because of the potential for which of the following?

drug abuse

you should recognize that which of the following is a contraindication for taking codeine?

emphysema

pt symptoms for hepatic tuberculosis

fever & night sweats

which finding would the nurse expect to see on a patient's chest x-ray who has COPD with a barrel chest and expiratory wheezes in the lower lobes, decreased remits, and hyper resonance with chest percussion?

flattening of the diaphragm

which topic will the nurse include when teaching a patient who has COPD about the need to prevent respiratory infections?

getting an annual influenza vaccine

A nurse is preparing to administer phenylephrine to a client. The nurse should identify that which of the following manifestations is an adverse effect of this drug?

headache

which position would be most effective for a client who is in respiratory distress?

high fowler's position

a patient is prescribed prednisone by mouth. you review her history and the drugs she has been taking. which of the following drugs might interact adversely with prednisone?

ibuprofen

a nurse is teaching a client who is beginning fluticasone propionate/salmeterol therapy. which of the following instructions should the nurse include?

increase weight-bearing activity

A patient who is HIV-positive tests positive on a tuberculin skin test. The patient has no signs of active TB and a normal chest x-ray. Which treatment regimen does the nurse anticipate administering?

isoniazid (INH) for nine months

pt symptoms for renal tuberculosis

jaundice and abdominal pain

you should instruct a client using phenylephrine spray for nasal congestion to do which of the following to avoid rebound congestion?

limit the drug's use to 3 to 5 days

which action will the nurse do next when a patient's family is expressing concern about the new diagnosis of COPD in their loved one?

listen to the basis of the family's concerns, and then develop a focused teaching plan

which goal would the nurse prioritize in the plan of care for a patient with pneumonia?

managing hypoxemia

which nursing action is the greatest priority in the plan of care for a patient recovering from an acute episode of chronic obstructive pulmonary disease?

monitor the respiratory rate and effort hourly

a patient with COPD is exhibiting increasing air hunger while receiving oxygen via nasal cannula at a flow rate of 2L/min. which treatment option would the nurse discuss with the provider?

noninvasive positive-pressure ventilation

which action would the nurse take when performing an admission assessment on a patient with COPD who is admitted for treatment of pneumonia and exhibits pursed-lip breathing?

note the breathing pattern, and continue the assessment

a patient with COPD suddenly becomes dyspneic with a respiratory rate of 32 breaths/min and an oxygen saturation of 94%. the patient appears pale and anxious and is using accessory muscles to breathe. which action would the nurse take?

obtain an order for arterial blood gases

which of these nursing actions require the charge nurse to intervene with a LPN who is providing care for a young child who is drooling, presenting with a deep "barking" cough?

obtains a throat culture as ordered

For which of the following reasons should a nurse instruct a client to avoid taking guaifenisin with combination over-the-counter cold products?

over-the-coundter cold products can also contain guaifenesin

when caring for a patient diagnosed with pneumonia and subsequent hypoxia, the nurse understands that which finding would indicate the patient's goal has been met?

oxygen saturation 95% on room air

which finding prompts the nurse to notify the health care provider when assessing a patient who has chronic obstructive pulmonary disease (COPD) 15 minutes after an aerosolized bronchodilator has been administered?

oxygen saturation of 87%

A nurse is teaching a client about albuterol. The nurse should instruct the client to monitor for and report which of the following as an adverse effect of this drug?

palpitations

a patient with tuberculosis presents with a productive cough, dyspnea, and fatigue. a chest x-ray indicates fluid in the pleural cavity. which is an appropriate goal for this patient?

patient will have normal pulmonary function

which patient will the oncoming registered nurse plan to assess first on the medical-surgical unit?

patient with cystic fibrosis who has an elevated temperature and a respiratory rate of 38 breaths/min

the medical-surgical unit has one negative airflow room. which of these four newly arrived patients would the charge nurse admit to this room?

patient with respiratory symptoms who has recently travelled to a pandemic area

Mr. Wimmer's tuberculin skin test was positive. Which nursing intervention should be performed first?

place the patient in airborne infection isolation

a patient returns to the clinic to have the tuberculosis (TB) Mantoux test, which was administered 2 days ago, analyzed by the nurse. the patient's left forearm shows a red raised area, which measures 10 mm in diameter. which interpretation of this finding would the nurse make?

positive reaction that indicates exposure to and possible presence of TB infection

which recommendation will the nurse give to a patient with asthma who reports being afraid to begin an aerobic exercise program because exercise sometimes triggers asthma symptoms?

premeditating with a short-acting beta-adrenergic (SABA) medication before exercise

a patient presents with the following manifestations: labored breathing, wheezing, marked use of accessory muscles, a low partial pressure of arterial oxygen (PaO2), and a low partial pressure of arterial carbon dioxide (PaCO2). the patient is receiving oxygen by nasal cannula at a rate of 2 L/min and has received an aerosolized bronchodilator medication. which action would be next, after the nurse assesses no wheezes and an oxygen saturation of 82%?

prepare for emergency intubation

a nurse is teaching a client about the use of antihistamines to treat allergic rhinitis. the nurse should explain that these drugs are effective because they perform which of the following actions?

prevent histamine from binding to receptors

what is the appropriate nursing management for an injured homeless man being discharged to homeless shelter?

provide education about TB risk factors

a nurse is caring for a patient with community-acquired pneumonia. the patient is writhing in pain and cries out, "it hurts so bad to take a deep breath. I can't even cough it hurts so bad." the patient's oxygen saturation is 88% on room air. which action would the nurse take first?

provide the patient with supplemental oxygen

A nurse is teaching a client about the use of cromolyn sodium to prevent bronchospasm. The nurse should explain that the drug has which of the following therapeutic effects?

reduces inflammation

A nurse is teaching a client about the use of an expectorant to treat a cough. The nurse should include that an expectorant has which of the following therapeutic effects?

reduces surface tension

a nurse is caring for a client who is taking codeine. the nurse should identify that which of the following assessments is priority to make?

respirations

a patient with pneumonia has a productive cough, dyspnea with ambulation, and increased work of breathing with use of accessory muscles. the patient's oxygen saturation is 92%, and arterial blood gas monitoring reveals a partial pressure of arterial oxygen (Pa02) of 88 mm Hg. which condition would the nurse report to the health care provider?

respiratory distress

A nurse is monitoring plasma drug levels in a client who is taking theophylline. Which of the following findings should the nurse expect to see if the client's drug level indicates toxicity?

seizures

which situation represents the most risk for spread of tuberculosis?

sitting next to an infected person on an airplaine

A nurse is teaching a client about montelukast. Which of the following instructions should the nurse include?

take the drug once a day in the evening

which of these clinical findings indication expected outcome after the client has been suctioned?

the breath sounds are clear and equal bilaterally

which of the following information indicates that a client who is taking theophylline needs further instruction?

the client drinks two cups of coffee each morning

which is an expected outcome for a patient with moderate chronic obstructive pulmonary disease (COPD) who usually has an oxygen saturation of 88% to 90% with 2 L/min of oxygen via nasal cannula and walks to the end of the driveway and back each day? the patient's ideal body weight is 150 lb, but the patient currently weighs 130 lb.

the patient will be able to increase weight to at least 135lb

a nurse is teaching a client about the use of a mucolytic to treat a cough. the nurse should include that a mucolytic has which of the following therapeutic effects?

thins and loosens mucus

which of the following information should you include when teaching a client about the use of an albuterol inhaler for asthma management?

use it periodically to prevent exercise-induced asthma

a patient with an acute exacerbation of asthma exhibits wheezing, dyspnea, and intercostal retractions. an arterial blood gas shows partial pressure of arterial oxygen (PaP2) of 55 mmHg, a partial pressure of arterial carbon dioxide (PaCO2) of 50 mmHg, and a pH of 7.25. which condition is this patient experiencing?

ventilatory and oxygenation failure

A patient arrives at the emergency department reporting flu-like symptoms that have progressively worsened over the past two to three days. The nurse bases the plan of care on which likely cause of the patient's symptoms?

viral infection

A nurse is teaching a client about ipratropium. Which of the following instructions should the nurse include?

wait 5 min between using the drug and another inhaled drug

when instructing a client about using an MDI, you should include which of the following information?

wait at least 1 minute before inhaling the second puff

which action should be taken by the nurse when caring for a patient diagnosed with tuberculosis (TB)?

wear a powdered air-purifying respirator (PAPR)

what is the appropriate nursing management when giving a bath to a patient with a positive tuberculin test?

where a HEPA mask

you should advise a client who is using a beclomethasone oral inhaler to watch for which of the following possible indications of an adverse effect of this drug?

white coating in the mouth