Medsurg Exam 3 - Respiratory

Pair the signs and symptoms with the appropriate treatment regimen listed as options to the right. 1. Inspiratory stridor with barky, brassy cough, worse at night 2. Abrupt onset of dyspnea, drooling and frog like croaking 3. Lymphadenopathy, tonsillitis, hepatosplenomegaly 4. Enlarged tonsils with exudate, fever, red pharynx A. IV antibiotics, hospitalization B. Humidity or cold air, possibly steroids C) PO antibiotics, fluids D. Rest, fluids, no contact sports

1. - B 2. - A 3. - D 4. - C

The ED nurse is assessing a client complaining of dyspnea. The nurse auscultates the client's chest and hears wheezing throughout the lung fields. What might this indicate about the client? A) A narrowed airway B) Pneumonia C) The need for physiotherapy D) Hemothorax

A) A narrowed airway

Which of the following would be appropriate in the nursing care management of a child diagnosed with infectious mononucleosis? Select all that apply A) Analgesics and/or salt water gargles as needed B) Clear liquid diet C) Limited daily fluid intake D) Removal from contact sports in PE class and after-school activities for approximately 6 weeks E) Encourage limited non-contact physical activity as tolerated F) Complete entire course of prescribed antibiotics

A) Analgesics and/or salt water gargles as needed D) Removal from contact sports in PE class and after-school activities for approximately 6 weeks E) Encourage limited non-contact physical activity as tolerated

The nurse is preparing to perform chest physiotherapy on the child with CF. When should the nurse plan to perform the treatment? A) At least 30 minutes before or 1 hour after meals B) Before performing postural drainage C) Before a nebulized aerosol treatment D) After suctioning the upper respiratory tract

A) At least 30 minutes before or 1 hour after meals

The parent of a child with cystic fibrosis is asking the nurse about complications that may arise surrounding this condition. The nurse knows cystic fibrosis complications can include: (select all that apply) A) Constipation B) Diabetes mellitus C) Increased risk for respiratory infection D) Growth restriction E) Prolapsed rectum

A) Constipation B) Diabetes mellitus C) Increased risk for respiratory infection D) Growth restriction E) Prolapsed rectum

Which tasks are appropriate to assign to the unlicensed assistive personal (UAP)? A) Perform mouth care on the client with pneumonia B) Apply oxygen via nasal cannula to the client C) Empty the trashcans in the clients' rooms D) Take the empty blood bag back to the laboratory E) Show the client how to ambulate on the walker

A) Perform mouth care on the client with pneumonia D) Take the empty blood bag back to the laboratory

What is the recommended first-line treatment for the child experiencing a cough, respiratory distress with retractions, and suspected to have a diagnosis of RSV? A) Supportive measures including oxygen, suctioning, and fluids B) IV antibiotics C) IV steroids D) Alternating doses of tylenol and motrin

A) Supportive measures including oxygen, suctioning, and fluids

An adult client has tested positive for tuberculosis (TB). While providing client teaching, what information should the nurse prioritize? A) The importance of adhering closely to the prescribed medication regimen B) The fact that the disease is a lifelong chronic condition that will affect ADLs C) The fact that TB is self-limiting, but can take up to 2 years to resolve D) The need to work closely with the occupational and physical therapists

A) The importance of adhering closely to the prescribed medication regimen

A nurse is teaching a client with asthma about the proper use of the prescribed inhaled corticosteroid. Which adverse effects should the nurse be sure to address in client teaching? A) Thrush B) Decreased level of consciousness C) Nausea and vomiting D) Temporarily increased respiratory secretions

A) Thrush

The client with a right-sided pneumothorax had chest tubes inserted 2 hours ago. There is no fluctuation in the water-seal chamber of the Pleurovac. Which intervention should the nurse implement first? A) Assess the client's lung sounds B) Checks for any kinks in the tubing C) Ask the client to take deep breaths D) Turn the client from side to side

B) Checks for any kinks in the tubing

An admitting nurse is assessing a client with COPD. The nurse auscultates diminished breath sounds. These findings indicate to the nurse to monitor the client for what? A) Kyphosis and clubbing of the fingers B) Dyspnea and hypoxemia C) Sepsis and pneumothorax D) Bradypnea and pursed-lip breathing

B) Dyspnea and hypoxemia

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). The client has been receiving high-flow oxygen therapy for an extended time. What symptoms would suggest that the client is experiencing oxygen toxicity? A) Bradycardia and frontal headache B) Dyspnea and substernal pain C) Peripheral cyanosis and restlessness D) Hypotension and tachycardia

B) Dyspnea and substernal pain

The nurse is providing patient education to a newly diagnosed asthmatic. The nurse provides the steps for proper use of a metered dose inhaler. Which of the following are the correct steps? A) Exhale, place inhaler between open lips, press down canister, inhale quickly, hold for 10 seconds B) Exhale, place inhaler between open lips, start inhaling slowly, press down canister, continue inhaling, hold for 10 seconds C) Place inhale between open lips, press down on canister, start inhaling slowly, hold for 10 seconds, exhale D) Place inhaler between open lips, start inhaling slowly, press down canister, blow for 10 seconds

B) Exhale, place inhaler between open lips, start inhaling slowly, press down canister, continue inhaling, hold for 10 seconds

The nurse is providing care for a client who has recently been diagnosed with COPD. When educating the client about exacerbations, the nurse should prioritize what topic? A) Prompt administration of corticosteroids during exacerbations B) Identifying specific causes of exacerbations C) The importance of prone positioning during exacerbations D) The relationship between activity level and exacerbations

B) Identifying specific causes of exacerbations

A nurse's assessment reveals that a client with COPD may be experiencing bronchospasm. What assessment finding would suggest that the client is experiencing bronchospasm? A) Fine or coarse crackles on auscultation B) Wheezes or diminished breath sounds on auscultation C) Reduced respiratory rate or lethargy D) Slow, deliberate respirations and diaphoresis

B) Wheezes or diminished breath sounds on auscultation

A client presents to the ED after being in a boating accident about 3 hours ago. Now the client reports headache, fatigue, and the feeling that he just can't breathe enough. The nurse notes that the client is restless and tachycardic with an elevated blood pressure. This client may be in the early stages of what respiratory problem? A) Pneumoconiosis B) Pleural effusion C) Acute respiratory failure D) Pneumonia

C) Acute respiratory failure

The nurse is caring for a client admitted with an acute exacerbation of chronic obstructive pulmonary disease. During assessment, the nurse finds that the client is experiencing increased dyspnea. What is the most accurate measurement of the concentration of oxygen in the client's blood? A) A capillary blood sample B) Pulse oximetry C) An arterial blood gas study D) A complete blood count

C) An arterial blood gas study

The nurse is caring for the client after a bronchoscopy and biopsy. Which finding, if noted in the client, should be reported immediately to the health care provider? A) Dry cough B) Hematuria C) Bronchospasm D) Blood-streaked sputum

C) Bronchospasm

A client has experienced a pulmonary embolism. The nurse should assess for which symptom, which is the most commonly reported? A) Hot, flushed feeling B) Sudden chills and fever C) Chest pain that occurs suddenly D) Dyspnea when deep breaths are taken

C) Chest pain that occurs suddenly

The parents of a 9-year-old patient were informed by the nurse that the asthma attacks may occur spontaneously or in response to a trigger. Which of the following common irritants might trigger an asthma attack? Select all that apply A) Fatigue B) Acetaminophen C) Environmental allergies D) New pillow E) Viral upper respiratory infection F) Cold air

C) Environmental allergies D) New pillow E) Viral upper respiratory infection F) Cold air

Which information will be most helpful in teaching parents about the primary prevention of foreign body aspiration? A) Signs and symptoms of foreign body aspiration. B) Therapeutic management of foreign body aspiration. C) Most common objects that toddlers can aspirate. D) Risks associated with foreign body aspiration.

C) Most common objects that toddlers can aspirate.

A client with a chest injury has suffered flail chest. The nurse assesses the client for which most distinctive sign on flail chest A) Cyanosis B) Hypotension C) Paradoxical chest movements D) Dyspnea, especially on exhalation

C) Paradoxical chest movements

A nursing student is discussing a client with viral pharyngitis with the preceptor at the walk-in clinic. What should the preceptor tell the student about nursing care for clients with viral pharyngitis? A) Teaching focuses on safe and effective use of antibiotics B) The client should be preliminarily screened for therapy C) Symptom management is the main focus of medical and nursing care D) The focus of care is resting the voice to prevent chronic hoarseness

C) Symptom management is the main focus of medical and nursing care

A nurse is admitting a new client who has been admitted with a diagnosis of COPD exacerbation. How can the nurse best help the client achieve the goal of maintaining effective oxygenation? A) Teach the client to perform airway suctioning B) Assist the client in developing an appropriate exercise program C) Teach the client strategies for promoting diaphragmatic breathing D) Administer supplementary oxygen by simple face mask

C) Teach the client strategies for promoting diaphragmatic breathing

A 3-year-old is seen in the clinic for croup. The child's parent asks the nurse what to do for the child at home to alleviate symptoms. Which suggestion by the nurse is most appropriate? A) "Just let your child rest and call the health care provider if your child gets worse." B) "Place a pan of water below the window in the bedroom and leave the window open." C) "Place your child in the bathroom with cold water running and leave your child there until there is improvement." D) "Stand with your child in front of an open freezer."

D) "Stand with your child in front of an open freezer."

A client's plan of care specifies postural drainage. What action should the nurse perform when providing this noninvasive therapy? A) Administer the treatment with the client in a high Fowler's or semi-Fowler's position. B) Perform the procedure immediately following the client's meals. C) Apply percussion firmly to bare skin to facilitate drainage. D) Assist the client into a position that will allow gravity to move secretions

D) Assist the client into a position that will allow gravity to move secretions

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

D) Have the client perform incentive spirometry

A client visiting the clinic is diagnosed with acute sinusitis. To promote sinus drainage, the nurse should instruct the client to perform what action? A) Apply a cold pack to the affected area. B) Apply heat to the forehead C) Perform postural drainage D) Increase fluid intake

D) Increase fluid intake

The nurse is assessing a client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse should assess for which earliest sign of acute respiratory distress syndrome? A) Bilateral wheezing B) Inspiratory crackles C) Intercostal retractions D) Increased respiratory rate

D) Increased respiratory rate

The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the client to assume? A) Sitting up in bed B) Side-lying in bed C) Sitting in a recliner D) Sitting up and leaning on an overbed table

D) Sitting up and leaning on an overbed table

The nurse is caring for a client who has been in a motor vehicle accident and the care team suspects that the client has developed pleurisy. Which of the nurse's assessment findings would best corroborate this diagnosis? A) The client is experiencing painless hemoptysis B) The client's ABGs are normal, but he demonstrates increased work of breathing C) The client's oxygen saturation is below 88%, but he denies SOB D) The client's pain intensifies when he coughs or takes a deep breath

D) The client's pain intensifies when he coughs or takes a deep breath

A newly diagnosed asthmatic is being instructed on proper use of a metered dose inhaler. The patient asks how he will know when the canister is empty. The nurse should respond: A) Check if the canister floats in water B) Count each dose you take C) Shake the canister and listen for fluid D) The number of remaining doses will be on the inhaler

D) The number of remaining doses will be on the inhaler

The nurse is caring for a child with acute otitis media. The child weighs 22 lbs. The medication order reads: Amoxicillin 160 mg PO every 8 hours. Amoxicillin is supplied as 200 mg/5 mL. How many mL's will the nurse administer each dose? Round the number to the nearest whole number, if needed.

4 mL

The client presents to the emergency department with the following assessment findings: Temp 101.5, HR 110/min, RR 30/min, and SAO2 90% on room air. The provider's diagnosis is pneumonia. Prioritize the following nursing interventions. 1. Obtain sputum culture. 2. Instruct the client to obtain a yearly influenza vaccination. 3. Administer antibiotics. 4. Administer oxygen therapy at 2 LPM.

4. Administer oxygen therapy at 2 LPM. 1. Obtain sputum culture. 3. Administer antibiotics. 4. Instruct the client to obtain a yearly influenza vaccination.

The nurse is caring for a client who has a chest tube. List the following in the priority in which the nurse should complete them. 1 highest priority and 5 last. 1. Place a bottle of sterile saline at the bedside 2. Make sure the chest tube is securely taped 3. Check the chest tube for drainage 4. Assess the client lung sounds 5. Note the amount of suction being used

4. Assess the client's lung sounds 2. Make sure the chest tube is securely taped 3. Check the chest tube dressing for drainage 5. Note the amount of suction being used 1. Place a bottle of sterile saline at the bedside

For the following conditions, answer whether they are viral, bacterial, neither, or could be either viral or bacterial (both). A) Acute streptococcal pharyngitis B) Infectious mononucleosis C) Acute nasopharyngitis D) Pertussis E) Pneumonia F) Cystic fibrosis

A - Bacterial B - Viral C - Viral D - Bacterial E - Either viral or bacterial F - Neither viral or bacterial

A 3-year-old girl is seen in the emergency department for aspirating a coin. Upon assessment, the child has a violent cough, dyspnea, and is choking. Chest x-ray reveals the presence of a radiopaque object. The child undergoes a bronchoscopy in order to remove the coin. After the procedure, the nurse's first action is to: A) Assess for signs of airway obstruction B) Check for the return of gag reflex C) Keep the child NPO D) Administer anti-emetics as needed for nausea

A) Assess for signs of airway obstruction

A nurse is working with a client who is undergoing a diagnostic workup for suspected asthma. What are the signs and symptoms that are consistent with a diagnosis of asthma? Select all that apply. A) Chest tightness B) Crackles C) Bradypnea D) Wheezing E) Cough

A) Chest tightness D) Wheezing E) Cough

The nurse is caring for a client who is scheduled for a lobectomy for lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the client's oxygen saturation rapidly dropping. The client reports shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. What further assessment findings support the presence of a pneumothorax? A) Diminished or absent breath sounds on the affected side B) Paradoxical chest wall movement with respiration C) Sudden loss of consciousness D) Muffled heart sounds

A) Diminished or absent breath sounds on the affected side

The medical nurse who works on a pulmonology unit is aware that several respiratory conditions can affect lung tissue compliance. The presence of what condition would lead to an increase in lung compliance? A) Emphysema B) Pulmonary fibrosis C) Pleural effusion D) Acute respiratory distress syndrome (ARDS)

A) Emphysema

The nurse is caring for a client at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the client. What is an example of a first-line measure to minimize atelectasis? A) Incentive spirometry B) Intermittent positive-pressure breathing (IPPB) C) Positive end-expiratory pressure (PEEP) D) Bronchoscopy

A) Incentive spirometry

A 4-year-old child is brought to the emergency department in the tripod position, drooling, and making a frog-like croaking sound. The nurse should intervene if she witnesses the LPN doing which of the following? A) Inserting a tongue depressor to view the pharynx B) Instructing the parents the condition is bacterial, thus we will need to administer antibiotics C) Placing an emergency trach kit at the bedside D) Applying a pulse oximeter to monitor the patient's oxygen saturation

A) Inserting a tongue depressor to view the pharynx

The parent of a child with cystic fibrosis asks the nurse how her child got this condition. The nurse knows: (select all that apply) A) Two carriers of the disease may have a child with cystic fibrosis B) A carrier of the disease will also have the disease C) A carrier and a diagnosed parent will always have children with the disease D) A carrier and a diagnosed parent will never have children with the disease E) All children of a parent diagnosed with CF and one unaffected (non-carrier, non-diagnosed) parent will always be a carrier

A) Two carriers of the disease may have a child with cystic fibrosis E) All children of a parent diagnosed with CF and one unaffected (non-carrier, non-diagnosed) parent will always be a carrier

A client is brought to the ED by ambulance after a motor vehicle accident in which the client received blunt trauma to the chest. The client is in acute respiratory failure, is intubated, and is transferred to the ICU. What assessment parameters should the nurse monitor most closely? Select all that apply. A) Vital signs B) Coping C) Level of consciousness D) Oral intake E) Arterial blood gases

A) Vital signs C) Level of consciousness E) Arterial blood gases

Which child is in the greatest need of emergency medical treatment? A) A 3-year-old who has a barky cough, is afebrile, and has mild intercostal retractions. B) A 6-year-old who has a high fever, no spontaneous cough, and frog-like croaking C)A 7-year-old who has abrupt onset on moderate respiratory distress, a mild fever, and a barky cough. D) A 13-year-old who has a high fever, stridor, and purulent secretions.

B) A 6-year-old who has a high fever, no spontaneous cough, and frog-like croaking

A perioperative nurse is caring for a postoperative client. The client has a shallow respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address the client's increased risk for what complication? A) Acute respiratory distress syndrome (ARDS) B) Atelectasis C) Aspiration D) Pulmonary embolism

B) Atelectasis

The nurse is caring for a client with bronchiectasis. Chest auscultation reveals the presence of copious secretions. What intervention should the nurse prioritize in this client's care? A) Oral administration of diuretics B) Intravenous fluids to reduce the viscosity of secretions C) Postural chest drainage D) Pulmonary function testing

C) Postural chest drainage

The nurse has noted the emergence of a significant amount of fresh blood at the drain site of a client who is postoperative day 1 following total laryngectomy. What is the nurse's best action? A) Remove the client's drain and apply pressure with a sterile gauze. B) Assess the client, reposition the client supine, and apply wall suction to the drain. C) Rapidly assess the client and notify the surgeon about the client's bleeding. D) Administer a STAT dose of vitamin K to aid coagulation.

C) Rapidly assess the client and notify the surgeon about the client's bleeding.

The nurse is caring for a school-age child in the post-op setting that has just undergone a tonsillectomy. The mother reports the child is in pain. Which of the following findings would be of most concern to the nurse? A) The child complains of a sore throat B) The child is refusing to eat solid foods C) The child is swallowing frequently D) Vital signs reveal an elevated HR and BP

C) The child is swallowing frequently

The nurse is caring for a child with asthma. The child weighs 37.5 lbs. The medication order reads methylprednisolone 20 mg IV twice a day. The Pediatric Dosage Handbook provides a recommended dose for asthma of 1-2 mg/kg/day in 2 divided doses. Is the ordered dose safe?

No