CH. 19 Management of Patients with Chest and Lower Respiratory Tract Disorders

Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis? A. "Because I had a previous reaction to the test, this time I need to get a chest X-ray." B. "I will avoid contact with my family until I am done with the test." C. "If the test area turns red that means I have tuberculosis." D. "I will come back in 1 week to have the test read."

A. "Because I had a previous reaction to the test, this time I need to get a chest X-ray."

Which action should the nurse take first when providing care for a client during an acute asthma attack? A. Administer prescribed short-acting bronchodilator. B. Send for STAT chest x-ray. C. Obtain arterial blood gases. D. Initiate oxygen therapy and reassess pulse oximetry in 10 minutes.

A. Administer prescribed short-acting bronchodilator.

A new ICU nurse is observed by her preceptor entering a patient's room to suction the tracheostomy after performing the task 15 minutes before. What should the preceptor educate the new nurse to do to ensure that the patient needs to be suctioned? A. Auscultate the lung for adventitious sounds. B. Assess the CO2 level to determine if the patient requires suctioning. C. Have the patient cough. D. Have the patient inform the nurse of the need to be suctioned.

A. Auscultate the lung for adventitious sounds.

A victim has sustained a blunt force trauma to the chest. A pulmonary contusion is suspected. Which of the following clinical manifestations correlate with a moderate pulmonary contusion? A. Blood-tinged sputum B. Productive cough C. Bradypnea D. Respiratory alkalosis

A. Blood-tinged sputum

A patient is being educated in the use of incentive spirometry prior to having a surgical procedure. What should the nurse be sure to include in the education? A. Encourage the patient to take approximately 10 breaths per hour, while awake. B. Have the patient lie in a supine position during the use of the spirometer. C. Inform the patient that using the spirometer is not necessary if the patient is experiencing pain. D. Encourage the patient to try to stop coughing during and after using the spirometer.

A. Encourage the patient to take approximately 10 breaths per hour, while awake.

A client who underwent surgery 12 hours ago has difficulty breathing. He has petechiae over his chest and complains of acute chest pain. What action should the nurse take first? A. Initiate oxygen therapy. B. Perform nasopharyngeal suctioning. C. Administer analgesics as ordered. D. Administer a heparin bolus and begin an infusion at 500 units/hour.

A. Initiate oxygen therapy.

The nurse is assessing a client's potential for pulmonary emboli. What finding indicates possible deep vein thrombosis? A. Localized calf tenderness B. Pain in the feet C. Coolness to lower extremities D. Decreased urinary output

A. Localized calf tenderness

The nurse is admitting a patient with COPD. The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia? A. PaO2 B. HCO3 C. PCO2 D. pH

A. PaO2

Which comfort technique does a nurse teach to a client with pleurisy to assist with splinting the chest wall? A. Turn onto the affected side B. Elevate the head of the bed C. Use a prescribed analgesic D. Use a heat application

A. Turn onto the affected side

A mechanically ventilated client is receiving a combination of atracurium and the opioid analgesic morphine. The nurse monitors the client for which potential complication? A. Venous thromboemboli B. Pulmonary hypertension C. Cor pulmonale D. Pneumothorax

A. Venous thromboemboli

A patient taking isoniazid (INH) therapy for tuberculosis demonstrates understanding when making which statement? A. "I am going to have a tuna fish sandwich for lunch." B. "It is all right if I have a grilled cheese sandwich with American cheese." C. "It is all right if I drink a glass of red wine with my dinner." D. "It is fine if I eat sushi with a little bit of soy sauce."

B. "It is all right if I have a grilled cheese sandwich with American cheese."

The nurse is caring for a client in the ICU who required emergent endotracheal (ET) intubation with mechanical ventilation. The nurse receives an order to obtain arterial blood gases (ABGs) after the procedure. The nurse recognizes that ABGs should be obtained how long after mechanical ventilation is initiated? A. 10 minutes B. 20 minutes C. 15 minutes D. 25 minutes

B. 20 minutes

Which would be least likely to contribute to a case of hospital-acquired pneumonia? A. Host defenses are impaired. B. A nurse washes her hands before beginning client care. C. A highly virulent organism is present. D. Inoculum of organisms reaches the lower respiratory tract and overwhelms the host's defenses.

B. A nurse washes her hands before beginning client care.

A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? A. A disconnected ventilator circuit B. Kinking of the ventilator tubing C. A change in the oxygen concentration without resetting the oxygen level alarm D. An ET cuff leak

B. Kinking of the ventilator tubing

A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse know is the most common organism that causes community-acquired pneumonia? A. Staphylococcus aureus B. Streptococcus pneumoniae C. Pseudomonas aeruginosa D. Mycobacterium tuberculosis

B. Streptococcus pneumoniae

The nurse is assisting a physician with an endotracheal intubation for a client in respiratory failure. It is most important for the nurse to assess for: A. Tracheal cuff pressure set at 30 mm Hg B. Symmetry of the client's chest expansion C. Cool air humidified through the tube D. A scheduled time for deflation of the tracheal cuff

B. Symmetry of the client's chest expansion

A client is being discharged following pelvic surgery. What would be included in the patient care instructions to prevent the development of a pulmonary embolus? A. Begin estrogen replacement. B. Tense and relax muscles in the lower extremities. C. Wear tight-fitting clothing. D. Consume the majority of daily fluid intake prior to bed.

B. Tense and relax muscles in the lower extremities.

A nurse is preparing dietary recommendations for a client with a lung abscess. Which statement would be included in the plan of care? A. "You must consume a diet high in carbohydrates, such as bread, potatoes, and pasta." B. "You must consume a diet low in fat by limiting dairy products and concentrated sweets." C. "You must consume a diet rich in protein, such as chicken, fish, and beans." D. "You must consume a diet low in calories, such as skim milk, fresh fruits, and vegetables."

C. "You must consume a diet rich in protein, such as chicken, fish, and beans."

After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? A. 1 to 3 weeks B. 2 to 4 months C. 6 to 12 months D. 3 to 5 days

C. 6 to 12 months

A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care? A. Turning the client every 2 hours B. Elevating the head of the bed 30 degrees C. Encouraging increased fluid intake D. Maintaining a cool room temperature

C. Encouraging increased fluid intake

A victim of a motor vehicle accident has been brought to the emergency room. The patient is exhibiting paradoxical chest expansion and respiratory distress. Which of the following chest disorders should be suspected? A. Pulmonary contusion B. Simple pneumothorax C. Flail chest D. Cardiac tamponade

C. Flail chest

A nurse is caring for a client with chest trauma. Which nursing diagnosis takes the highest priority? A. Anxiety B. Decreased cardiac output C. Impaired gas exchange D. Ineffective tissue perfusion (cardiopulmonary)

C. Impaired gas exchange

After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes? A. Suction control chamber B. Air-leak chamber C. Water-seal chamber D. Collection chamber

C. Water-seal chamber

A client is being admitted to the preoperative holding area for a thoracotomy. Preoperative teaching includes what? A. Correct use of a ventilator B. Correct use of a mini-nebulizer C. Correct technique for rhythmic breathing D. Correct use of incentive spirometry

D. Correct use of incentive spirometry