Patho Exam 3 PrepU Questions

A client calls the health care provider's office and frantically tells the nurse his TB test is red, and he is afraid this means he has tuberculosis. The best response by the nurse would be: "This result definitely confirms the diagnosis; we will begin treatment now." "Wait until tomorrow to see if things change." "A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques." "Have you eaten anything unusual to cause this reaction?"

"A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques." Explanation: A definitive diagnosis of active pulmonary tuberculosis requires identification of the organism from cultures or DNA amplification techniques. Culture remains the gold standard for laboratory confirmation of infection and is required for drug sensitivity testing. The local reaction is not influenced by food consumption.

An adult client with a history of worsening respiratory symptoms has presented for care. Which assessment question will best allow the clinician to address the possibility of chronic bronchitis? "Do you know if you had respiratory syncytial virus as a child?" "Do you tend to have a cough even when you don't feel sick?" "Have you ever been immunized against pneumococcal pneumonia?" "Do you have a family history of lung disease?"

"Do you tend to have a cough even when you don't feel sick?" Explanation: A clinical diagnosis of chronic bronchitis requires the history of a chronic productive cough for at least 3 consecutive months over 2 consecutive years. This is not noted to be a strong genetic component of the disease, and childhood RSV is not a risk factor. Immunization status is normally linked to the development of bronchitis.

A client has been diagnosed with chronic obstructive arterial disease. Which client statement indicates she understands how to manage this disease? "I should have my LDL monitored." "Diabetes mellitus has no effect on my condition." "I should stay in bed with my legs elevated." "I don't need to monitor my blood pressure."

"I should have my LDL monitored." Explanation: Intermittent claudication is the primary symptom of chronic obstructive arterial disease. The two goals of treatment are to decrease the considerable cardiovascular risk and to reduce symptoms. Walking (slowly) to the point of claudication is encouraged because it increases collateral circulation. Addressing blood pressure and high lipid levels are measures to reduce cardiovascular risk. People with diabetes mellitus (DM) develop more extensive and rapidly progressive vascular disease than do people who do not have DM.

An older adult client who was recently diagnosed with emphysema asks the nurse what caused the disease. Which statement is the best response? "There is no known cause for emphysema; however, it does seem to run in families. Has anyone in your family been diagnosed with this disease?" "This disease is seen most commonly in middle-aged men and is associated with chronic irritation from smoking and recurrent infections." "One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?" "Emphysema is a permanent dilation of the bronchi and bronchioles caused by destruction of the muscle and elastic supporting tissue as the result of infection and inflammation."

"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?" Explanation: The causes of emphysema are smoking, which incites lung injury, and an inherited deficiency of alpha 1-antitrypsin, an antiprotease enzyme that protects the lung from injury.

A client with pulmonary arterial hypertension asks the health care provider, "Why are you giving me sildenafil? It is my lungs that are my problem, not erectile dysfunction." Which statement by the health care provider is the most appropriate response? "People with pulmonary arterial hypertension also have similar problems in their penile vessels." "Since pulmonary arterial hypertension causes such fatigue, you will still be able to enjoy an intimate relationship with your spouse." "Sildenafil causes vasodilation, which will help treat the high pressure in your lung vessels." "Xildenafil is a misrespresented drug and can be given for many other conditions that have constriction problems."

"Sildenafil causes vasodilation, which will help treat the high pressure in your lung vessels." Explanation: Sildenafil acts in a manner similar to nitric oxide to produce vasodilation, and is another treatment for pulmonary arterial hypertension. It is not being prescribed for erectile dysfunction in this population of clients. Health care providers should not assume a client is experiencing erectile dysfunction, unless the client has verbalized this directly to them.

A client newly diagnosed with lung cancer asks the nurse why the health care provider has ordered a positron emission tomography (PET) scan. Which response by the nurse is best? "This test will tell the doctor how well your immune system is working." "This diagnostic procedure will let the doctor know if you have any metastatic lesions in your body." "This procedure will evaluate every inch of your brain to see if there are any tumors there." "This test will evaluate whether your tumor cells will be receptive to chemotherapy treatment."

"This diagnostic procedure will let the doctor know if you have any metastatic lesions in your body." Explanation: Positron emission tomography (PET) is a noninvasive alternative for identifying metastatic lesions in the mediastinum or distant sites. Persons with SCLC should also have a CT scan or MRI of the brain for detection of metastasis.

A 29-year-old pregnant woman who considers herself active and health conscious is surprised to have been diagnosed with preeclampsia in her second trimester. What should her care provider teach her about this change in her health status? "Hypertension is a common result of all the hormonal changes that happen during pregnancy." "This is likely a result of your nervous system getting overstimulated by pregnancy." "Even though you're a healthy person, it could be that you have an underlying heart condition." "We don't really understand why some women get high blood pressure when they're pregnant."

"We don't really understand why some women get high blood pressure when they're pregnant." Explanation: The cause of pregnancy-induced hypertension is largely unknown. During pregnancy, levels of estrogen, progesterone, renin, angiotensin II and aldosterone are elevated, and women who develop preeclampsia may be especially sensitive to their vasoconstrictive and sodium and water retaining properties.

An older adult client newly diagnosed with systolic hypertension asks her health care provider why this happens. Which response is most accurate? "Your heart has to work harder to pump blood through your vessels as you get older." "Everyone over the age of 50 tends to have their blood pressure creep up over the years." "If you slow down and rest more, your blood pressure will more than likely return to its normal level." "With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer."

"With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer." Explanation: Systolic blood pressure rises almost linearly between 30 and 84 years of age, whereas diastolic pressure rises until 50 years of age and then levels off or decreases. This rise in systolic pressure is thought to be related to increased stiffness of the large arteries. With aging, the elastin fibers in the walls of the arteries are gradually replaced by collagen fibers that render the vessels stiffer and less compliant.

A client diagnosis with tuberculosis asks the nurse how long the antitubercular medication will need to be taken. What is the best response? "You will be on multiple drug therapy for the rest of your life." "Drug therapy will continue unless a drug resistance develops." "You can expect to take multiple drugs possibly for as long as 24 months or until all tubercle bacilli are eliminated." "Drug therapy will continue until all symptoms of tuberculosis have stopped."

"You can expect to take multiple drugs possibly for as long as 24 months or until all tubercle bacilli are eliminated." Explanation: The goal of treatment is to eliminate all tubercle bacilli from an infected person while avoiding emergence of significant drug resistance. Treatment of active tuberculosis requires the use of multiple drugs. Tuberculosis is an unusual disease in that drug therapy is required for a relatively long period.

Oxygen has been prescribed for a client with chronic obstructive pulmonary disease (COPD). Which amount of oxygen is considered most appropriate for the COPD client? 4 to 6 L/min 1 to 2 L/min 5 L/min 10 L/min

1 to 2 L/min Explanation: The goal of oxygen delivery for a client with COPD is to keep the PO2 at about 60 mm Hg or less, which can be accomplished with delivery of 1 to 2 L/min of oxygen (this will result in a PO2 at 55 to 65 mm Hg). All the other options would increase the PO2 above 60 mm Hg, which tends to depress the hypoxic stimulus for ventilation and often leads to hypoventilation and carbon dioxide retention.

At an influenza vaccination clinic, a nurse is screening clients who are requesting the vaccine. The nurse determines that which client is unable to receive the vaccine? An 82-year-old male with uncontrolled diabetes A 20-year-old healthy female reporting an allergy to eggs A 64-year-old female reporting a latex allergy A 6-year-old male with a history of asthma

A 20-year-old healthy female reporting an allergy to eggs Explanation: Influenza vaccines are contraindicated in persons with allergy to eggs or to other components of the vaccine, persons with a history of a Guillain-Barré syndrome, and persons with acute febrile illness.

The nurse is caring for four clients. Select the client at risk for the development of a pulmonary embolism. An 80-year-old female client with diabetes A 62-year-old male who is postoperative for repair of a fractured femur A 36-year-old female smoker with an intrauterine device (IUD) A 32-year-old male with viral pneumonia

A 62-year-old male who is postoperative for repair of a fractured femur Explanation: A client with surgery to the lower extremities is at higher risk for the development of deep vein thrombosis that could lead to a pulmonary embolism. There is increased risk for pulmonary embolism among users of oral contraceptives, particularly in women who smoke, but not with the use of IUD.

Which client most likely faces the highest risk of developing secondary pulmonary hypertension? A client with asthma who uses her inhaled bronchodilator more often than prescribed A client with COPD and a 35 pack-year smoking history. An older adult client who has been hospitalized for the treatment of community-acquired pneumonia A client who suffered a thermal injury to his lungs in a fire

A client with COPD and a 35 pack-year smoking history. Explanation: COPD is a major risk factor for secondary pulmonary hypertension. Pneumonia, bronchodilator use, and thermal injury are not noted to be among the more common causes of the disease.

Which client is at risk for developing acute respiratory failure? A toddler in daycare who has been sharing toys with peers before the staff could sanitize properly A teenager in a high school who has had an increase in student absences due to an outbreak of strep throat An older adult female living in senior housing who has been exposed to a "cold" while her grandchildren visited A middle-aged male diagnosed with amyotrophic lateral sclerosis (ALS) who has pneumonia with low O2 saturation

A middle-aged male diagnosed with amyotrophic lateral sclerosis (ALS) who has pneumonia with low O2 saturation Explanation: Acute respiratory failure may occur in previously healthy persons as the result of acute disease or trauma involving the respiratory system, or it may develop in the course of a chronic neuromuscular or lung disease. ALS is a neurodegenerative disease with various causes. It is characterized by rapidly progressive weakness due to muscle atrophy and muscle spasticity and difficulty in speaking (dysarthria), swallowing (dysphagia), and breathing (dyspnea). A common cold, strep throat, or sharing toys in daycare will not necessarily place one at risk for respiratory failure.

A young man and his friend started a business sandblasting and refinishing wrought iron. Following a rapid onset of respiratory symptoms, the client was diagnosed with silicosis. What aspect of silicosis should underlie the nurse's care planning? The client will likely need to take inhaled corticosteroids for the rest of his life. Silicosis is likely to be self-limiting, unless the client is a cigarette smoker. The client has a greatly heightened risk of pulmonary embolism as a result of silicosis. A quick decline in lung function is likely, and the client is likely to face an early death.

A quick decline in lung function is likely, and the client is likely to face an early death. Explanation: Acute silicosis has poor outcomes; severe disability and death can take place in just a few years. The disease is not self-limiting. Corticosteroids are not a mainstay of treatment. Pulmonary embolism is not noted to be a common sequela.

What intervention is appropriate for a client with sarcoidosis? Corticosteroids Antihistamines Lymph node radiation Antifungal agents

Corticosteroids Explanation: Sarcoidosis treatment is directed at interrupting the inflammatory process with corticosteroid medications. Sarcoidosis is overgrowth of granulomas and does not have a fungal or allergy component.

When trying to educate a client about the release of free radicals and the role they play in formation of atherosclerosis, which statement is most accurate? Activated cells roam the vascular system looking for inflammatory cells to engulf. The end result of oxidation is rupture of the plaque, resulting in hemorrhage. Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. Oxidized free radicals produce toxic metabolic waste that can kill liver cells.

Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. Explanation: Activated macrophages release free radicals that oxidize LDL. Oxidized LDL is toxic to the endothelium, causing endothelial loss and exposure of the subendothelial tissue to the blood components. This leads to platelet adhesion and aggregation and fibrin deposition.

A client in the emergency department reports sudden onset of coughing with a feeling of chest tightness. Lung sounds are diminished with wheezing in all lung fields, skin is moist, and the client appears anxious. What is the first intervention the nurse should implement? Provide the influenza vaccine. Give an inhaled corticosteroid. Administer a beta-2 agonist. Educate about limiting exposure to dust.

Administer a beta-2 agonist. Explanation: During an acute asthma attack, bronchospasm prolongs expiration, trapping air and decreasing inspiratory capacity. A beta-2 agonist, such as albuterol, will relieve the bronchospasm within 30 minutes. A corticosteroid can prevent inflammation, but will not stop an attack in progress. The influenza vaccine and avoiding environmental triggers are measures to prevent asthma attacks.

Which intervention(s) is important for the nurse caring for a child admitted with bronchiolitis, using the latest evidence in the research literature? Select all that apply. Administer supplemental oxygen when the oxygen saturation consistently falls below 90%. Elevate the head to facilitate respiratory movements. Administer antibiotics once blood cultures have been obtained and sent to the laboratory. Call a "code blue" if the child displays wheezing and appears listless. Give corticosteroids on time, at least 4 times/day to help with tissue swelling.

Administer supplemental oxygen when the oxygen saturation consistently falls below 90%. Elevate the head to facilitate respiratory movements. Explanation: The latest evidence does not recommend that health care providers administer albuterol or corticosteroids to children with a diagnosis of bronchiolitis. However, nebulized hypertonic saline may be given to hospitalized children. Treatment is supportive and includes administration of supplemental oxygen when the oxygen saturation consistently falls below 90%. Elevation of the head facilitates respiratory movements and avoids airway compression. Because the infection is viral, antibiotics are not effective and only given if a secondary bacterial infection occurs. It would be inappropriate to call a "code blue" if the child displays wheezing and appears listless, since these are manifestatins of bronchiolitis and the reason the child was admitted to the hospital in the first place.

A client sustained a puncture injury to the chest resulting in development of a tension pneumothorax. What is the pathogenesis behind a tension pneumothorax? Blebs on the lung surface rupture due to increased intrapleual pressure. Air is permitted to enter but not leave the pleural space, causing lung collapse. The opposite lung hyperinflates to compensate for the collapsed lung. Expired air exits the bleeding wound at a faster rate than inhalation.

Air is permitted to enter but not leave the pleural space, causing lung collapse. Explanation: Tension pneumothorax occurs when the intrapleural pressure exceeds atmospheric pressure. It is a life-threatening condition and occurs when injury to the chest or respiratory structures permits air to enter but not leave the pleural space. Spontaneous pneumothorax occurs when an air-filled bleb, or blister, on the lung surface ruptures. Rupture of these blebs allows atmospheric air from the airways to enter the pleural cavity. This results in a rapid increase in pressure in the chest with a compression atelectasis of the unaffected lung.

Acute-onset bronchial asthma causes wheezing and breathlessness as a result of which of the following? Airway inflammation Compression atelectasis Pulmonary hypertension Alveolar collapse

Airway inflammation Explanation: Bronchial asthma represents a reversible form of obstructive airway disease caused by narrowing of airways due to bronchospasms, inflammation, and increased airway secretions; this inflammatory process produces recurrent episodes of airway obstruction, characterized by wheezing, breathlessness, chest tightness, and cough. Vascular flow through the lungs is unaffected by the airway inflammation and bronchospasms. Hyperinflated alveoli are characteristic of the emphysema type of obstructive pulmonary disease. Compression atelectasis is associated with high external pressure that blocks lung expansion.

Which client would the nurse recognize as needing to be assessed for orthostatic hypotension? A 78-year-old client who has begun reporting frequent headaches unrelieved by over-the-counter analgesics An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom A 65-year-old client whose vision has become much less acute in recent months and who has noticed swelling in the ankles A 42-year-old client who has a history of poorly controlled type 1 diabetes

An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom Explanation: Dizziness, blurred vision, palpitations, and syncope (i.e., fainting) are characteristic signs and symptoms of orthostatic hypotension, and both predispose an individual to falls; this is especially the case among older adults. Headaches, edema, diabetes, and vision changes are not associated with orthostatic hypotension.

A client taking an antihypertensive drug for several months comes to the physician's office with a dry, persistent cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs? Beta-blockers Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers Calcium channel blockers

Angiotensin-converting enzyme (ACE) inhibitors Explanation: ACE inhibitors inhibit bradykinin degradation in the lungs, which can cause a common side effect of a dry, nonproductive cough.

The nurse is providing instructions to a client for the treatment of a common cold. The mostappropriate information would be: Antibiotics administered for 7 days Complete isolation and bed rest Antibiotics and antihistamines Antipyretic medications and rest

Antipyretic medications and rest Explanation: The common cold virus does not respond to antibiotics and should be treated with antipyretic medications and rest. Bed rest is recommended, but complete isolation is not required.

Which are primary treatment options for a client with acute venous thrombosis? Select all that apply. Sitting Elastic support Application of heat Elevation of the legs with flexion at the knees Bed rest

Application of heat Bed rest Elastic support Explanation: The objectives of treatment of venous thrombosis are to prevent the formation of additional thrombi, prevent extension and embolization of existing thrombi, and minimize venous valve damage. A 15- to 20-degree elevation of the legs prevents stasis. It is important that the entire lower extremity or extremities be carefully extended to avoid acute flexion of the knee or hip. Heat often is applied to the leg to relieve venospasm and to aid in the resolution of the inflammatory process. Bed rest usually is maintained until local tenderness and swelling have subsided. Gradual ambulation with elastic support is then permitted. Standing and sitting increase venous pressure and are to be avoided. Elastic support is needed for 3 to 6 months to permit recanalization and collateralization and to prevent venous insufficiency.

Which vascular changes can occur in older adults because of the increase in blood pressure during the aging process? Increased elasticity in venous connective tissue Decreased elasticity in arterial connective tissue Decreased elasticity in venous connective tissue Increased elasticity in arterial connective tissue

Decreased elasticity in arterial connective tissue Explanation: With aging, the elastin fibers in the walls of the arteries are gradually replaced by collagen fibers that render the vessels stiffer and less compliant. Arterial elasticity decreases as one ages, causing increased systemic vascular resistance and increased blood pressure and afterload. Elasticity does not increase in arterial tissue or venous tissue.

The nurse in the emergency department is assessing a toddler suspected of epiglottitis. Which intervention is considered the priority when working with this client? Examine the throat by inserting a tongue blade to see the tonsils. Get a coworker to help restrain the toddler so blood samples can be obtained. Assess if airway is compromised and call for health care provider assistance with intubation to establish an airway, if needed. Have the parents lie the toddler on the back to allow for stethoscope examination of all lobes of the lungs. Place the toddler in respiratory isolation due to the possibility of spreading the virus to surrounding clients.

Assess if airway is compromised and call for health care provider assistance with intubation to establish an airway, if needed. Explanation: Epiglottitis is a medical emergency and immediate establishment of an airway by endotracheal tube or tracheotomy usually is needed. The toddler should be kept calm, if possible. The toddler should never be forced to lie down because this causes the epiglottis to fall backward and may cause complete airway obstruction. Examination of the throat with a tongue blade may cause cardiopulmonary arrest. It is unwise to attempt any procedure, such as drawing blood, which would heighten the toddler's anxiety, which could precipitate airway spasm and cause death. Isolation is not the priority for this toddler who is having a medical emergency.

The nurse is preparing to auscultate for a mitral valve stenosis murmur. Where is the best location to place the stethoscope? At the apex of the heart At the carotid arteries Over the sternum Over the aorta

At the apex of the heart Explanation: The murmur of mitral valve stenosis is heard during diastole when blood is flowing through the constricted valve; it is characteristically a low-pitched, rumbling murmur best heard at the apex of the heart. The other locations would not be effective.

Prolonged immobility is implicated in the development of which disorder? Pulmonary hypertension and cor pulmonale Bronchitis and bronchiectasis Atelectasis and pulmonary embolism Sarcoidosis and idiopathic pulmonary fibrosis

Atelectasis and pulmonary embolism Explanation: Lack of mobility can result in secondary atelectasis (through incomplete lung expansion) and pulmonary embolism (from deep vein thrombosis). This is not the case with the other listed disorders of ventilation and gas exchange.

A nurse is participating in a health fair and is addressing many of the varied factors that can contribute to hypertension. The nurse should be cognizant of the higher incidence and prevalence of hypertension in which groups? Aboriginal and South Asian people East Asian and black people Native American/First Nation and white people Black and South Asian people

Black and South Asian people Explanation: A 2006 Canadian study showed that the ethnic groups consisting of South Asians (30%) and blacks (31%) in Canada are more likely to have hypertension in comparison to the primarily white population (21%). East Asians are the least likely to have hypertension (19%).

A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess. Blood pressure 130/88 and hyperglycemia occurring during the 22nd week of pregnancy Blood pressure 140/90 and glucose in the urine during the 36th week of pregnancy Blood pressure 90/60 and proteinuria in the second trimester Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy

Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy Explanation: Preeclampsia-eclampsia is defined as an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg) and proteinuria (300 or greater in 24 hours) developing after 20 weeks of gestation.

The nurse knows that which statements regarding the physiology of blood pressure are accurate? Select all that apply. Constant elevation of blood pressure can be lethal. A decrease in blood flow can be an immediate threat to life. Blood pressure is poorly regulated. Blood pressure is very variable. Blood flow is equally vital to all body organs.

Blood pressure is very variable. Constant elevation of blood pressure can be lethal. A decrease in blood flow can be an immediate threat to life. Explanation: Blood pressure is a very variable yet highly regulated function in healthy persons. Blood flow is most vital to heart, brain, and kidneys; other tissues can better survive periods of decreased blood flow. Constant elevation of blood pressure (hypertension) can cause severe damage to heart, blood vessels, and kidneys, leading to premature disability and death. A sudden decrease in blood flow, especially to the heart and brain, can rapidly be deadly: these organs, vital to survival, require a constant supply of oxygen to function effectively.

With bronchiectasis, persistent airway obstruction and chronic infection results in which physiologic response? Bronchial rupture Bronchial infarction Bronchial dilation Bronchial thickening

Bronchial dilation Explanation: Two processes are critical to the pathogenesis of bronchiectasis: obstruction and chronic persistent infection. Regardless of which may come first, both cause damage to the bronchial walls, leading to weakening (rather than thickening) and dilation. These bronchi become severely dilated and end blindly in dilated sacs with collapse and fibrosis of more distal lung tissue. Pulmonary blood flow is unaffected by the obstructed and dilated airways.

An infant born 10 weeks premature was placed on mechanical ventilation. Eight weeks later a nursing assessment reveals a barrel chest, tachycardia, rapid and shallow breathing, hypoxemia, hypercapnia, and poor weight gain. Based on this assessment, which diagnosis is most likely? Respiratory distress syndrome (RDS) Bronchopulmonary dysplasia Pneumonia Bronchiolitis

Bronchopulmonary dysplasia Explanation: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that develops in premature infants who were treated with long-term mechanical ventilation. High-inspired oxygen concentration and injury from positive-pressure ventilation have been implicated. BPD is characterized by chronic respiratory distress, persistent hypoxemia when breathing room air, reduced lung compliance, increased airway resistance, and severe expiratory flow limitation. The infant with BPD often demonstrates a barrel chest, tachycardia, rapid and shallow breathing, chest retractions, cough, and poor weight gain.

Which elevated serum marker for systemic inflammation is now considered a major risk factor for atherosclerosis and vascular disease? C-reactive protein Homocysteine Leukocytosis Serum lipoprotein

C-reactive protein Explanation: C-reactive protein (CRP) is an acute-phase reactant synthesized in the liver that is a marker for systemic inflammation. A number of population-based studies have demonstrated that baseline CRP levels can predict future cardiovascular events among apparently healthy individuals. High-sensitivity CRP (hs-CRP) may be a better predictor of cardiovascular risk than lipid measurement alone. Homocysteine and serum lipoprotein are also serum markers, but they do not identify inflammation. Leukocytosis is an indicator of infection rather than inflammation alone.

A client is diagnosed with pulmonary embolism. Which symptom would most likely be present? Shallow respirations and wheezing Left arm pain and diaphoresis Cough and crackles Chest pain and dyspnea

Chest pain and dyspnea Explanation: The manifestations of pulmonary embolism depend on the size and location of the obstruction. Chest pain, dyspnea, and increased respiratory rate are the most frequent signs and symptoms of pulmonary embolism.

Bronchiectasis is considered a secondary COPD, and with the advent of antibiotics, it is not a common disease entity. In the past, bronchiectasis often followed specific diseases. Which disease did it not follow? Chickenpox Complicated measles Influenza Necrotizing bacterial pneumonia

Chickenpox Explanation: In the past, bronchiectasis often followed a necrotizing bacterial pneumonia that frequently complicated measles, pertussis, or influenza. Chickenpox has never been linked to bronchiectasis.

A middle-aged client with a 30-year history of smoking was diagnosed with lung cancer. A health history revealed previous exposure to air pollution, asbestos, and radiation. Which factor most likely had the greatest impact on development of the lung cancer? Cigarette smoke Asbestos Radiation Air pollution

Cigarette smoke Explanation: Cigarette smoking causes more than 80% of cases of lung cancer. The risk for lung cancer among cigarette smokers increases with duration of smoking and the number of cigarettes smoked per day. Cigarette smokers can benefit at any age from smoking cessation. Industrial hazards also contribute to the incidence of lung cancer. A commonly recognized hazard is exposure to asbestos. The mean risk for lung cancer is significantly greater in asbestos workers compared to the general population. In addition, tobacco smoke contributes heavily to the development of lung cancer in people exposed to asbestos.

A client has developed chronic hypoxia and has developed pulmonary hypertension (HTN). The nurse recognizes that the most likely cause of pulmonary hypertension would be: Constriction of the pulmonary vessels in response to hypoxemia Decreased vascular resistance in the pulmonary vessels Hardening of the pulmonary vessels due to increased fat deposits Constant dilation of the pulmonary vessels in response to hypoxia

Constriction of the pulmonary vessels in response to hypoxemia Explanation: Pulmonary HTN occurs as a result of chronic hypoxia. In response to hypoxia, the pulmonary vessels constrict. The pulmonary vessels differ from the systemic circulation vessels, which dilate in response to hypoxia and hypercapnia. Smooth muscle hypertrophy and proliferation of the vessel intima occur in pulmonary HTN.

An expectant mother is 23 weeks into her pregnancy when she goes into labor. Regarding fetal lung development, what is of greatest concern to the attending medical team? Development of bronchial tree Development of respiratory musculature Development of type II alveolar cells Saccular development of alveoli

Development of type II alveolar cells Explanation: Type II alveolar cells begin to develop at approximately 24 weeks and produce surfactant, a substance capable of lowering the surface tension of the air-alveoli interface. By 28 to 30 weeks, sufficient amounts of surfactant are available to prevent alveolar collapse when breathing begins. The respiratory musculature, alveoli, and bronchial tree are all developed by the 23rd week.

A client presents to the emergency department with a sudden onset of acute pain in his left lower leg. The practitioner is unable to palpate pedal pulses and finds the client to be in atrial fibrillation. Which test will the practitioner order to find the source of the emboli? Echocardiogram CT of the head Ultrasound of the kidney Chest x-ray

Echocardiogram Explanation: Most acute arterial occlusions are the result of an embolus or thrombus. Most emboli arise in the heart and are caused by conditions (such as atrial fibrillation) that cause blood clots to develop on the wall of a heart chamber or valve surface. An echocardiogram looks at the structure of the heart. The other tests do not demonstrate blood clots in the heart.

When developing the plan of care for a child with respiratory distress, what nursing intervention can the nurse provide that will facilitate respiratory movements and avoid airway compression? Administer intravenous fluids. Elevate the head of the bed. Handle the child frequently to keep her stimulated to breathe. Administer antibiotics.

Elevate the head of the bed. Explanation: Elevation of the head of the bed facilitates respiratory movements and avoids airway compression. Handling is kept at a minimum to avoid tiring. Administration of IV fluids will prevent dehydration from insensible loss from rapid respirations but will not facilitate respiratory movements or prevent airway compression. Because the infection is viral, antibiotics are not effective and are given only for a secondary bacterial infection.

A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect? Decreased VLDL Elevation of triglycerides Elevation of HDL Decreased LDL

Elevation of triglycerides Explanation: In diabetes mellitus and the metabolic syndrome, typical dyslipidemia is seen with elevation of triglycerides, low HDL, and minimal or modest elevation of LDL. High calorie intake and diabetes mellitus increase the production of VLDL.

A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms? Stupor and hyperreflexia Restlessness and nervousness Headache and confusion Papilledema and lethargy

Headache and confusion Explanation: Cerebral vasoconstriction probably is an exaggerated homeostatic response designed to protect the brain from excesses of blood pressure and flow. The regulatory mechanisms often are insufficient to protect the capillaries, and cerebral edema frequently develops. As it advances, papilledema (i.e., swelling of the optic nerve at its point of entrance into the eye) ensues, giving evidence of the effects of pressure on the optic nerve and retinal vessels. The client may have headache, restlessness, confusion, stupor, motor and sensory deficits, and visual disturbances. In severe cases, convulsions and coma follow. Lethargy, nervousness, and hyperreflexia are not signs or symptoms of cerebral edema in malignant hypertension.

The nurse in a hospital is caring for a child with respiratory distress. What oxygen delivery method would be appropriate for the child when the oxygen saturation consistently falls below 90%? Endotracheal tube High-flow oxygen via nasal cannula Non-rebreather mask Venturi mask

High-flow oxygen via nasal cannula Explanation: Treatment is supportive and includes administration of supplemental oxygen if the oxygen saturation consistently falls below 90%. Evidence suggests that children with respiratory distress needing oxygen should first be given high-flow oxygen via a nasal cannula since it tends to increase oxygen saturation, increase comfort, and increase the overall respiratory condition.

Which intervention by the client will decrease overall cardiovascular risk? Excess alcohol consumption, especially red wine Higher levels of fitness and exercise Psychological counseling to deal with stress Activity limitations to control glucose levels

Higher levels of fitness and exercise Explanation: Research indicates that higher levels of fitness and exercise are associated with lower blood pressure and more favorable blood lipid levels. Overall cardiovascular risk is decreased with higher fitness/exercise levels. Psychological counseling and antidepressants are not an integral part of treatment for all diseases. Increased activity will assist with controlling glucose levels in persons with diabetes. Higher levels of alcohol consumption may account for as much as 10% of the population occurrence of hypertension.

The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be: Physical inactivity and high serum high-density lipoprotein cholesterol Advanced age and low serum total and low-density lipoprotein cholesterol High serum high-density lipoprotein and diabetes History of cigarette smoking and elevated blood pressure

History of cigarette smoking and elevated blood pressure Explanation: The major risk factors for CAD include cigarette smoking, elevated blood pressure, elevated LDL cholesterol, low HDL cholesterol, diabetes, advancing age, abdominal obesity, and physical inactivity.

The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be: 55 years of age Hypertension Family history of heart disease Being male

Hypertension Explanation: The major risk factors that can be modified by a change in health care behaviors include cigarette smoking, obesity, hypertension, hyperlipidemia and elevated LDL cholesterol, and diabetes mellitus, all of which are traditional cardiovascular risk factors. The other options are nonmodifiable risk factors for atherosclerosis.

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death? Takotsubo cardiomyopathy Hypertrophic cardiomyopathy (HCM) Dilated cardiomyopathy (DCM) Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)

Hypertrophic cardiomyopathy (HCM) Explanation: The most frequent symptoms of HCM are dyspnea and chest pain in the absence of coronary artery disease. Syncope (fainting) is also common and is typically postexertional, when diastolic filling diminishes and outflow obstruction increases. Ventricular dysrhythmias are also common, and sudden death may occur, often in athletes after extensive exertion. Risk factors for sudden cardiac death among clients with HCM include a family history of syncope or sudden cardiac death, certain mutations, and extreme hypertrophy of the left ventricle. HCM is characterized by a massively hypertrophied left ventricle with a reduced chamber size.

Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells? Hypertrophy Dysplasia Hyperplasia Atrophy

Hypertrophy Explanation: Myocardial hypertrophy is a compensatory mechanism in heart failure as the heart attempts to maintain adequate pumping ability. Paradoxically, hypertrophy can gradually decrease cardiac efficiency.

A client diagnosed with congestive heart failure has an arterial blood oxygen level (PaO2) of 89%. Which term should the nurse use to document a reduced oxygenation of arterial blood? Hypocapnia Ventilation Hypoxemia Ischemia

Hypoxemia Explanation: Hypoxemia refers to a reduction in arterial blood O2 levels, which is considered a PaO2 less than 95 mm Hg (12.64 kPa). Hypoxemia can result from an inadequate amount of O2 in the air, a disorder of the respiratory system, dysfunction of the neurologic system, or alterations in circulatory function.

When will the nurse plan to assess a client's blood pressure to confirm the possible diagnosis of orthostatic hypotension? Within a half-hour after the heaviest meal of the day In the morning before arising from bed In the evening just before sleep Midmorning right after taking a short walk

In the morning before arising from bed Explanation: To confirm orthostatic hypotension, blood pressure should be assessed while the client is supine and then after standing for 1 minute and 3 minutes. A fall of 20 mm Hg or more in systolic pressure, or 10 mm Hg or more in diastolic pressure, are considered orthostasis.

A child has developed respiratory stridor and is displaying a crowing sound. The parents ask the nurse what is causing this sound. The best response would be: Increased turbulence of air moving through the obstructed airways The collapse of intrathoracic airways because of air trapping Nasal obstruction and inhalation occurring through the mouth rather than the nares Pulling in of the soft tissue surrounding the cartilaginous and bony thorax

Increased turbulence of air moving through the obstructed airways Explanation: The crowing sound of stridor occurs with the increased turbulence of air moving through the obstructed airways. Pulling in of the soft tissue surrounding the cartilaginous and bony thorax describes the mechanisms that produce inspiratory retractions. The collapse of intrathoracic airways because of air trapping describes the mechanism for the production of wheezing.

An 86-year-old client is disappointed to learn that he or she has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which age-related change predisposes older adults to the development of heart failure? Increased vascular stiffness Increased cardiac contractility Loss of action potential Orthostatic hypotension

Increased vascular stiffness Explanation: Increased vascular stiffness in older adults causes a progressive increase in systolic blood pressure with advancing age, which in turn contributes to the development of left ventricular hypertrophy and altered diastolic filling. A loss of action potential does not typically accompany aging, and contractility tends to decrease as a result of cardiac stiffness. Orthostatic hypotension is neither a normal age-related change nor a cause of heart failure.

The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which lipoprotein is the main carrier of cholesterol? LDL HDL VLDL IDL

LDL Explanation: LDL is the main carrier of cholesterol. HDL is 50 percent protein; VLDL carries a large amount of triglycerides. IDLs are fragments of VLDLs after the triglycerides are removed and can be recycled to form VLDLs or converted to LDLs.

Most respiratory disorders in infants make it difficult to get air into their lungs. This is due to a decrease in which factor? Airway resistance Oxygen demand Respiratory rate Lung compliance

Lung compliance Explanation: Most respiratory disorders in infants produce a decrease in lung compliance or an increase airway resistance. Therefore, it takes more effort to inflate the lungs. Respiratory disorders increase the cellular demand for oxygen because the alveolar-capillary membrane is often impaired by the disease process. A compensatory tachypnea is an attempt to deliver more oxygenated blood to hypoxic lung tissue.

A client has been admitted to a medical unit of a hospital for the treatment of pneumonia that is attributable to S. pneumonia. Which consideration is the priority in this client's treatment? Preventing and treating the client's fever Maintaining the client's airway Maintaining the client's activities of daily living Monitoring and treating the client's pain

Maintaining the client's airway Explanation: Fever, pain, and activity are all relevant considerations in the treatment of clients with pneumonia, but the maintenance of the client's airway is always the first priority.

The nurse's brother is not convinced that he should quit smoking. He asks his sister (the nurse) to demonstrate for him the more immediate effects of smoking on his health. Which of the following could be used to help convince the brother to stop smoking? Measure his pulse and show him how much lower it is when he is smoking. Measure his blood pressure and show him how much higher it is when he is smoking. Have him listen to his heart for the obvious murmur that presents when smoking. Measure his temperature and show him how much higher it is when he is smoking.

Measure his blood pressure and show him how much higher it is when he is smoking. Explanation: Although a relationship between smoking and hypertension has not been established, vasoconstriction from nicotine in cigarette smoke will raise blood pressure. Elevated blood pressure and cigarette smoking are independent risk factors for heart disease.

The nurse is developing a community program since a recent increase in admissions to the acute care facility with tuberculosis infection. What is the most frequent form of tuberculosis that the nurse should focus on? Pneumocystis jirovecii tuberculosis Mycobacterium avium-intracellulare complex Mycobacterium tuberculosis Ghon tuberculosis

Mycobacterium tuberculosis Explanation: Mycobacterium tuberculosis hominis is the most frequent form of tuberculosis that threatens humans. Other mycobacteria, including mycobacterium avium-intracellulare complex, are much less virulent than M. tuberculosis hominis. These mycobacteria rarely cause disease except in severely immunosuppressed people, such as those with HIV infection. Generally, MAI complex is transmitted from eating contaminated food or water. Pneumocystis jirovecii is a type of pneumonia that generally occurs when a client is immunocompromised.

A client was admitted 3 days ago and is developing signs and symptoms of pneumonia. Select the correct documentation of the diagnosis. Typical pneumonia Community-acquired pneumonia Antibiotic-resistant pneumonia Nosocomial pneumonia

Nosocomial pneumonia Explanation: Pneumonia can be classified according to the type of organism causing the infection (typical or atypical), location of the infection—lobar pneumonia or bronchopneumonia—and setting in which it occurs—community- or nosocomial/hospital-acquired pneumonia. Community-acquired pneumonia involves infections from organisms that are present more often in the community than in the hospital or nursing home. Hospital-acquired (nosocomial) pneumonia is defined as a lower respiratory tract infection occurring 48 hours or more after admission.

Which of the following are characteristic signs of acute arterial embolism? Paralysis, warmth, and paranoia Pallor, pulselessness, and pain Pain, increased blood pressure, and warmth Purpura, muscle weakness, and shortness of breath

Pallor, pulselessness, and pain Explanation: The presentation of acute arterial embolism is often described as that of the seven Ps: pistol shot (acute onset), pallor, polar (cold), pulselessness, pain, paresthesia, and paralysis.

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process? Release of stress hormones Rigidity of the ventricular walls Peripheral vascular resistance Electrical impulses in the heart

Peripheral vascular resistance Explanation: The systolic and diastolic components of blood pressure are determined by cardiac output and total peripheral vascular resistance and can be expressed as the product of the two (blood pressure = cardiac output × total peripheral resistance). The body maintains its blood pressure by adjusting the cardiac output to compensate for changes in peripheral vascular resistance, and it changes the peripheral vascular resistance to compensate for changes in cardiac output. Electrical impulses from the SA node regulate heart rate. Release of stress hormones and rigidity of the ventricular walls do not primarily influence BP; however, they may impact this secondarily.

Which factor is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma? Pet dander Stress Respiratory tract infections Cold weather

Pet dander Explanation: Extrinsic or atopic asthma is typically initiated by a type I hypersensitivity reaction induced by exposure to an extrinsic antigen or allergen such as pet dander. Intrinsic or nonatopic asthma triggers include respiratory tract infections, exercise, hyperventilation, cold air, drugs and chemicals, hormonal changes and emotional upsets, airborne pollutants, and gastroesophageal reflux.

A client recently had surgery for a hip fracture. Which nursing intervention would be mosteffective for preventing pulmonary emboli in this client? Prevention of the development of a deep vein thrombosis Encourage increase fluid intake Use of oxygen and incentive spirometer following surgery Monitor hematocrit and hemoglobin levels

Prevention of the development of a deep vein thrombosis Explanation: Almost all pulmonary emboli are thrombi that arise from deep vein thrombosis in the lower and upper extremities. The presence of thrombosis in the deep veins of the legs or pelvis often is unsuspected until an embolism occurs.

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be: Avoiding frequent dental examinations Prompt diagnosis and treatment of streptococcal infections Annual blood specimen assessed for rheumatoid factor Yearly electrocardiography after the age of 50

Prompt diagnosis and treatment of streptococcal infections Explanation: Rheumatic heart disease is normally caused by streptococcal infections; therefore, early diagnosis of these would decrease the risk for the disease. Frequent EKG may be required after a client has a history of rheumatic heart disease. Rheumatoid factor is not related to rheumatic heart disease. The client should have regular dental examinations.

A 3-year-old child has been admitted to the pediatric unit for the treatment of croup. The nurse should include which action in the child's plan of care? Establishing IV access and administering sulfa antibiotics as ordered Administering antiviral medications such as zanamivir and oseltamivir as ordered Providing a low-stimulation environment to relieve bronchospasm Providing cool, moist air for the child to breathe

Providing cool, moist air for the child to breathe Explanation: Moist air is effective in relieving the bronchospasm associated with croup for many children. Croup has a viral etiology, so antibiotics are ineffective. Zanamivir and oseltamivir are antiviral medications given to treat influenza, not croup. A low-stimulation environment is of no significant clinical benefit.

A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for: Polyarteritis nodosa Arterial insufficiency Vasculitis Pulmonary embolism

Pulmonary embolism Explanation: Deep venous thrombosis (DVT) most commonly occurs in the lower extremities. DVT of the lower extremity is a serious disorder, complicated by pulmonary embolism, recurrent episodes of DVT, and development of chronic venous insufficiency. Isolated calf thrombi often are asymptomatic. If left untreated, they may extend to the larger, more proximal veins, with an increased risk of pulmonary emboli.

The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent: Acute myocardial infarction Loss of pulses in the limb Cerebrovascular accident Pulmonary embolism

Pulmonary embolism Explanation: The most common site of a deep vein thrombosis (DVT) is in the venous sinuses in the soleus muscle and posterior tibial and peroneal veins. The risk of pulmonary embolism emphasizes the need for early detection and treatment of DVT. The other options are caused by occlusions in the arterial system.

Pulmonary hypertension is usually caused by long-term exposure to hypoxemia. When pulmonary vessels are exposed to hypoxemia, what is their response? Pulmonary vessels constrict Pulmonary vessels dilate Pulmonary vessels infarct Pulmonary vessels spasm

Pulmonary vessels constrict Explanation: Continued exposure of the pulmonary vessels to hypoxemia is a common cause of pulmonary hypertension. Unlike blood vessels in the systemic circulation, most of which dilate in response to hypoxemia and hypercapnia, the pulmonary vessels constrict.

The neonatal ICU nurse is assessing a client with severe bronchopulmonary dysplasia (BPD). The nurse knows that this client will likely exhibit which clinical manifestations? Select all that apply. Clubbing of the fingers Coughing blood Rapid, shallow breathing Productive yellow-colored sputum Chest retractions with accessory muscle use

Rapid, shallow breathing Chest retractions with accessory muscle use Clubbing of the fingers Explanation: The infant with BPD often demonstrates tachycardia, rapid and shallow breathing, chest retractions, cough, and poor weight gain. Clubbing of the fingers occurs in children with severe disease. Yellow-sputum is associated with pneumonia. Blood in sputum could be an infection, trauma in airway, etc.

A client with coccidioidomycosis has developed a severe headache with neck stiffness, has a fever, and states he feels very ill. What does the nurse recognize these symptoms may indicate? The client might have meningitis, which is the most common cause of death. The client is having side effects from the treatment of the disease. These symptoms accompany the disease process and are not significant. The client has developed acquired immune deficiency syndrome

The client might have meningitis, which is the most common cause of death. Explanation: Meningitis is the most common cause of death.

The neonatologist explains to the parents of a neonate born at 35 weeks' gestation that their premature infant will be monitored for complications. Which respiratory complication is the most common? Periodic breathing Respiratory distress syndrome Intraventricular hemorrhage Asthma

Respiratory distress syndrome Explanation: The respiratory distress syndrome is the most common complication of prematurity (neonates born before 37 weeks' gestation). In these neonates, pulmonary immaturity, together with surfactant deficiency, leads to alveolar collapse. Periodic breathing, asthma, and intraventricular hemorrhage may also be complications of prematurity, but are not the most common.

Which organism is a common cause of bacterial pneumonia in both community and hospital settings? S. pneumoniae S. aureus E. coli Enterobacter

S. aureus Explanation: Common community-acquired pneumonia-causing pathogens include Staphylococcus aureus, Haemophilus influenzae, S. pneumoniae, and gram-negative bacilli. Organisms responsible for hospital-acquired pneumonia include S. aureus, Enterobacter species, Klebsiella species, and E. coli.Immunocompromised people are predisposed to pneumonia caused by S. aureus, Aspergillus, gram-negative bacilli, and Candida.

A child struggling to breathe is brought to the emergency department with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. What is the most likely diagnosis? Severe asthma attack Chronic obstructive pulmonary disease Cystic fibrosis Pulmonary embolism

Severe asthma attack Explanation: Severe asthma attacks are accompanied by use of the accessory muscles, distant breath sounds due to air trapping, and loud wheezing. As the condition progresses, fatigue develops, the skin becomes moist, and anxiety and apprehension are obvious. Sensations of shortness of breath may be severe, and often the person is able to speak only one or two words before taking a breath. At the point at which airflow is markedly decreased, breath sounds become inaudible with diminished wheezing, and the cough becomes ineffective despite being repetitive and hacking. This point often marks the onset of respiratory failure.

A child is brought to the emergency department with an asthma attack. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which drug will the nurse anticipate administering first? Oral corticosteroids Anti-inflammatory agents such as sodium cromolyn Anticholinergic medications such as ipratropium Short-acting beta 2-adrenergic agonists such as albuterol (SABA)

Short-acting beta 2-adrenergic agonists such as albuterol (SABA) Explanation: The quick-relief medications such as SABA (e.g., albuterol, levalbuterol, pirbuterol) relax bronchial smooth muscle and provide prompt relief of symptoms, usually within 30 minutes. They are administered by inhalation (i.e., metered-dose inhaler or nebulizer), and their recommended use is in alleviating acute attacks of asthma.

Which characteristic of the lungs of infants and small children creates an increased risk of respiratory disorders? The pneumotaxic center in the pons is underdeveloped until 8 years of age. Type II alveoli in children may overproduce surfactant. There are fewer chemoreceptors in the young medulla. Smaller airways create a susceptibility to changes in airway resistance and airflow.

Smaller airways create a susceptibility to changes in airway resistance and airflow. Explanation: Because the resistance to airflow is inversely related to the fourth power of the radius (resistance = 1/radius), relatively small amounts of mucus secretion, edema, or airway constriction can produce marked changes in airway resistance and airflow. Surfactant production is low early in life, and the respiratory center and chemoreceptors are present and functional in infants and children.

A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. About which topics should the nurse educate the client? Select all that apply. Dietary measures to reduce LDL levels Smoking cessation Decreasing physical activity Weight reduction if overweight Increased intake of fats and sodium

Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight Explanation: The management of hypercholesterolemia focuses on dietary and therapeutic lifestyle changes; when these are unsuccessful, pharmacologic treatment may be necessary. Therapeutic lifestyle changes include an increased emphasis on physical activity, dietary measures to reduce LDL levels, smoking cessation, and weight reduction for people who are overweight. Increased intake of fats and sodium would cause weight gain and hypertension and result in a negative consequence.

An immunocompromised host is open to pneumonia from all types of organisms. There is, however, a correlation between specific types of immunologic deficits and specific invading organisms. What organism is most likely to cause pneumonia in an immunocompromised host with neutropenia and impaired granulocyte function? Haemophilus influenzae Gram-positive bacilli Beta-hemolytic streptococcus Staphylococcus aureus Eosinophilic bacillus subtilis

Staphylococcus aureus Explanation: Neutropenia and impaired granulocyte function, as occurs in persons with leukemia, chemotherapy, and bone marrow depression, predispose to infections caused by S. aureus, Aspergillus, Gram-negative bacilli, and Candida. All the other organisms can cause pneumonia, but they are not usually seen in people with neutropenia and impaired granulocyte function.

A client has developed bacterial pneumonia and is admitted to the hospital. The nurse obtains sputum cultures upon admission. What bacteria does the nurse anticipate finding when the results are complete? Staphylococcus aureus Pseudomonas aeruginosa Escherichia coli Streptococcus pneumoniae

Streptococcus pneumoniae Explanation: Streptococcus pneumoniae (pneumococcus) remains the most common cause of bacterial pneumonia.S. pneumoniae is a gram-positive diplococcus, possessing a capsule of polysaccharide. The virulence of the pneumococcus is a function of its capsule, which prevents or delays digestion by phagocytes.

A social worker is counseling the family of an 85-year-old woman who has just been diagnosed with non-small cell lung cancer. What concerns should she convey to the family regarding the unintended effects of treating the disease? Surgical treatment may have the consequence of weakening the client. Older adults cannot metabolize chemotherapeutic agents, resulting in a buildup of medication. The client will react to the therapy exactly the same as a younger client. Older adults cannot tolerate radiation, and therefore it is not used.

Surgical treatment may have the consequence of weakening the client. Explanation: Surgery remains the mainstay for older persons with stages I to III NSCLC. Curative resection is feasible in older persons. The challenge for surgical treatment for older persons is age-related physiologic changes in cardiovascular and respiratory systems that may affect tolerance of surgery. Radiation can be given with curative intent for older persons who are not surgical candidates, and older persons with good performance status may receive standard chemotherapy for limited disease and combination chemotherapy for extensive-stage disease.

A client diagnosed with giant cell arteritis will likely experience pain located in which region of the head? Temporal Ophthalmic Carotid Vertebral

Temporal Explanation: Giant cell (temporal) arteritis, the most common of the large vessel vasculitides, is an acute and chronic inflammation of large to small arteries. It mainly affects arteries of the head—especially the temporal arteries—but may include the vertebral and ophthalmic arteries. The most common clinical presentations are headache and tenderness over the superficial temporal artery.

The nurse is preparing to auscultate a client's blood pressure. Which information obtained from the client would indicate that the nurse should wait 30 minutes prior to obtaining a reading? The client left work 1 hour ago. The client ate a hamburger 45 minutes prior to the reading. The client took her antihypertensive medication 2 hours ago. The client just smoked a cigarette.

The client just smoked a cigarette. Explanation: People should be seated when blood pressure is taken, and should not have ingested caffeine or have smoked 30 minutes before the measurement.

The postoperative client has a catheter in his brachial artery for continuous blood pressure monitoring. Which assessment would be a concern for the nurse? The client states his feet are cold. The client states his hand is numb. The nail beds are pink. Pulses are present in the radial artery.

The client states his hand is numb. Explanation: Arterial spasm caused by arterial cannulation can be a cause of acute arterial occlusion. Occlusion in an extremity causes sudden onset of acute pain, numbness, tingling, weakness, pallor, and coldness of the affected limb. Pulses are absent below the level of the occlusion.

The nurse is caring for the following clients. Select the client at highest risk for the development of atelectasis. The client diagnosed with pneumonia who performs frequent coughing and deep-breathing exercises The client with a lower leg cast who changes position every 2 hours The client who is postoperative after a total knee replacement and receiving patient-controlled analgesia The client who is mobile within 24 hours after abdominal surgery

The client who is postoperative after a total knee replacement and receiving patient-controlled analgesia Explanation: The danger of obstructive atelectasis increases after surgery as anesthesia, pain, administration of narcotics, and immobility tend to promote retention of viscid bronchial secretions and hence airway obstruction. The encouragement of coughing and deep breathing, frequent change of position, adequate hydration, and early ambulation decrease the likelihood of atelectasis developing. Coughing and deep-breathing exercises are the most beneficial option to prevent atelectasis. Repositioning needs to occur more frequently (about every 2 hours), ambulating prior to 24 hours postoperatively, and increasing oral fluids will assist with the prevention of atelectasis.

An infant born prematurely is in the neonatal intensive care unit (NICU) for observation and to ensure hemodynamic stability when the nurse observes the infant beginning to have nasal flaring. What does the nurse understand that this may indicate? The infant is attempting to decrease oxygen consumption. The infant is using nasal flaring to take in more air. The infant is attempting to rid the lungs of fluid. The infant is having atelectasis.

The infant is using nasal flaring to take in more air. Explanation: Nasal flaring is a method that infants use to take in more air. This method of breathing increases the size of the nares and decreases the resistance of the small airways.

A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis (TB) and has subsequently developed latent tuberculosis infection. Which statement is accurate regarding this nurse? The nurse is now immune to more severe TB infection. The nurse can spread TB to others. The nurse is likely asymptomatic. The nurse has active TB infection.

The nurse is likely asymptomatic. Explanation: Latent TB infection is not an active form of TB, and affected individuals are asymptomatic and cannot pass on the disease to others. It does not confer immunity. However, small numbers of organisms may remain viable for years. Later, if immune mechanisms decline or fail, latent TB infection has the potential to develop into secondary TB.

A client has been diagnosed with aortic stenosis and asks the nurse what this means. The mostappropriate response would be: The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. The valve opening is incompetent, thereby allowing blood to flow back from the pulmonary artery and into the left atrium. The valve opens backward, permitting blood to flow from the right ventricle into the right atrium. The valve opening permits backward flow to occur when the valve should be closed.

The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. Explanation: Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally. This increases the work and volume of the chamber emptying through the narrowed valve—the left atrium in the case of mitral stenosis and the left ventricle in aortic stenosis. An incompetent or regurgitant valve permits backward flow to occur when the valve should be closed—flowing back into the left ventricle during diastole when the aortic valve is affected and back into the left atrium during systole when the mitral valve is diseased.

An older adult client who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which treatment modality is mostlikely to resolve the client's most recent health problem? Administration of corticosteroids Thoracentesis Administration of bronchodilators Supplementary oxygen therapy

Thoracentesis Explanation: With large effusions, thoracentesis may be used to remove fluid from the intrapleural space and allow for reexpansion of the lung.

A client is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as: Valvular stenosis Valvular regurgitation Infective endocarditis Pericardial effusion

Valvular regurgitation Explanation: When cardiac valves such as the aortic or mitral fail to close properly, blood does not efficiently exit from the left ventricle. This condition is valvular regurgitation. Valvular stenosis is a narrowing of the lumen of the valve. Pericardial effusion, an accumulation of fluid in the pericardial sac, causes obstructive shock, as it impedes ventricular filling. Infective endocarditis could trigger septic shock.

A parent brings a child into the urgent care clinic. The health care provider suspects the child has a "common cold" based on which clinical manifestations? Select all that apply. Watery, clear nasal secretions Photosensitivity Mild fever Nuchal rigidity Coughing

Watery, clear nasal secretions Coughing Mild fever Explanation: The condition usually begins with a sore and scratchy throat followed by profuse and watery rhinorrhea, nasal congestion, sneezing, and coughing. Other cold symptoms include malaise, fatigue, headache, hoarseness, sinus congestion, and myalgia. Fever is a common sign in children. Photosensitivity and nuchal rigidity are signs of meningitis.

A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have? Will prevent the conversion of angiotensin I to angiotensin II Will increase extracellular fluid and decrease venous pressure Will have a direct vasoconstrictive effect on vessels of splanchnic circulation Will increase oxygen consumption of the heart

Will prevent the conversion of angiotensin I to angiotensin II Explanation: Among the drugs used in the treatment of hypertension are ACE inhibitors. The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction, aldosterone levels, intrarenal blood flow, and glomerular filtration rate. ACE inhibitors are increasingly used as the initial medication in mild to moderate hypertension.

A client is diagnosed with pneumoconiosis. Which aspect of the client's history is most likely the cause of this diagnosis? Has 20 pack-years history of smoking Has congestive heart failure Exposed to tuberculosis recently Worked in a coal mine for 20 years

Worked in a coal mine for 20 years Explanation: People who work in a coal mine can develop coal worker's pneumoconiosis (CWP). Heart failue and tuberculosis exposure are not causes of this diagnosis. Smoking will likely cause chronic obstructive pulmonary disease (COPD) and not a cause of pneumoconiosis.

The parents of a child diagnosed with cystic fibrosis (CF) ask about the risk of any future children having the condition. How should the nurse respond? CF is autosomal dominant, so you have a 50% risk in another child. Since the male carries the CF gene, you might consider a sperm donor. Now that you have one child with CF, the rest will also have it. You have a 25% chance that your next child will have CF.

You have a 25% chance that your next child will have CF. Explanation: Cystic fibrosis is autosomal recessive, meaning that two defective genes are needed for a child to be born with the disorder. Both parents must either be carriers (having one defective gene, but no symptoms) or have the disease (two defective genes). If both parents are carriers, each child has 1 in 4 chance of receiving two normal genes, a 50 percent chance of inheriting at least one gene, and a 1 in 4 chance of receiving two abnormal genes and having CF.

A client involved in a car accident is admitted with a chest tube following pneumothorax. He also has an elevated blood alcohol level. When the nurse enters his room, she notes the client is dyspneic, short of breath, and holding his chest tube in his hand. When the nurse pulls the linens back, she finds a "sucking" chest wound. After calling a "code blue," the next priority intervention would be to: apply a Vaseline gauze (airtight) dressing over the insertion site. place the client's meal napkin over the wound. try to calm down the client by maintaining therapeutic communication. observe and wait for the "code blue" team to bring equipment.

apply a Vaseline gauze (airtight) dressing over the insertion site. Explanation: The client has a medical emergency. Sucking chest wounds, which allow air to pass in and out of the chest cavity, should be treated by promptly covering the area with an airtight covering. Chest tubes are inserted as soon as possible. The other interventions will not help minimize the amount of air entering the pleural space.

The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of deep vein thrombosis (DVT). Which nursing intervention should the nurse implement? apply sequential pneumatic compression devices to lower extremities apply ice compresses to the site of the DVT hourly massage legs to maintain blood flow ensure that the client remains on bed rest

apply sequential pneumatic compression devices to lower extremities Explanation: The application of sequential pneumatic compression devices augments blood flow and reduces stasis. Early ambulation is encouraged. Ice applications would not be recommended due to venous constriction.

A child is experiencing an acute exacerbation of asthma. Which quick-acting treatment is most appropriate for this client? Antileukotrienes beta-adrenergic agonists Anti-inflammatory agents Leukotrienes

beta-adrenergic agonists Explanation: A beta-adrenergic agonist would be the best option to use in an acute exacerbation of asthma. The quick-relief medications include the short-acting beta-adrenergic agonists, anticholinergic agents, and systemic corticosteroids. The short-acting beta-adrenergic agonists relax bronchial smooth muscle and provide prompt relief of symptoms, usually within 30 minutes. All of the other drugs would be used as maintenance treatment.

A mother in premature labor asks the nurse why her doctor has prescribed corticosteroids. The nurse's response is based on the fact that: cortisol can accelerate maturation of type II cells and stimulate the formation of surfactant. corticosteroids cause blood glucose levels to rise, thus preventing hypoglycemia in premature infants. cortisol administration will enhance the secretion of insulin, which is needed for surfactant production. corticosteroids can perform anti-inflammatory acts that may prevent infections.

cortisol can accelerate maturation of type II cells and stimulate the formation of surfactant. Explanation: Surfactant synthesis is influenced by several hormones, including insulin and cortisol. Insulin tends to inhibit surfactant production. Cortisol can accelerate maturation of type II cells and formation of surfactant. These observations have led to administration of corticosteroid drugs before delivery to mothers with infants at high risk for development of respiratory distress syndrome.

The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be: placing a stent for fluid drainage from the heart. improving quality of life by relieving symptoms. eliminating CHF through curing the disease. maintaining higher oxygen levels to decrease the work of breathing.

improving quality of life by relieving symptoms. Explanation: A primary treatment goal for a client with CHF is to improve the quality of life through symptom management. CHF will not be cured, and maintaining a higher oxygen level will assist with dyspnea associated with CHF. A stent is not an option for treatment of CHF.

A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be: administration of oxygen by face mask. chest x-ray. insertion of a large-bore needle or chest tube. arterial blood gas analysis.

insertion of a large-bore needle or chest tube. Explanation: Emergency treatment of tension pneumothorax involves the prompt insertion of a large-bore needle or chest tube into the affected side of the chest along with one-way valve drainage or continuous chest suction to aid in lung reexpansion. Other listed options may be implemented after the emergency measure.

Assessment of an older adult client reveals bilateral pitting edema of the client's feet and ankles; difficult to palpate pedal pulses; breath sounds clear on auscultation; oxygen saturation level of 93% (0.93); and vital signs normal. What is this client's most likely health problem? pericarditis cardiogenic shock cor pulmonale right-sided heart failure

right-sided heart failure Explanation: A major effect of right-sided heart failure is the development of peripheral edema. A client who is in shock would not have stable vital signs. Cor pulmonale would be accompanied by manifestations of lung disease. Pericarditis is an inflammation of the pericardium exhibited by fever, precordial pain, dyspnea, and palpitations.