Chapter 23: Management of Patients with Chest and Lower Respiratory Tract Disorders Prep U
Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis? "Because I had a previous reaction to the test, this time I need to get a chest X-ray." "I will avoid contact with my family until I am done with the test." "If the test area turns red that means I have tuberculosis." "I will come back in 1 week to have the test read."
"Because I had a previous reaction to the test, this time I need to get a chest X-ray."
Which statement would indicate that the parents of child with cystic fibrosis understand the disorder? "Early treatment can stop the progression of the disease." "There are fibrous cysts in the lungs." "Allergic reactions cause inflammation in the lungs." "The mucus-secreting glands are abnormal."
"The mucus-secreting glands are abnormal." Cystic fibrosis is caused by dysfunction of the exocrine glands with no cystic lesions present in the lungs. Early treatment can improve symptoms and extend the life of clients, but a cure for this disorder is presently not available. Allergens are responsible for allergic asthma and not associated with cystic fibrosis.
A nurse is assessing the injection site of a client who has received a purified protein derivative test. Which finding indicates a need for further evaluation? A blister Reddened area 5-mm induration 15-mm induration
15-mm induration
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? 3 to 5 days 6 to 12 months 1 to 3 weeks 2 to 4 months
6 to 12 months
The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient? 13 to 18 months 6 to 12 months 3 months 3 to 5 months
6 to 12 months
A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia? A client who ambulates in the hallway every 4 hours A client with a history of smoking two packs of cigarettes per day until quitting 2 years ago A client who is receiving acetaminophen (Tylenol) for pain A client with a nasogastric tube
A client with a nasogastric tube
A nurse is reviewing a client's X-ray. The X-ray shows an endotracheal (ET) tube placed 3/4" (2 cm) above the carina and reveals nodular lesions and patchy infiltrates in the upper lobe. Which interpretation of the X-ray is accurate? The ET tube must be pulled back. The X-ray is inconclusive. The ET tube must be advanced. A disease process is present.
A disease process is present.
Which would be least likely to contribute to a case of hospital-acquired pneumonia? Host defenses are impaired. Inoculum of organisms reaches the lower respiratory tract and overwhelms the host's defenses. A nurse washes her hands before beginning client care. A highly virulent organism is present.
A nurse washes her hands before beginning client care.
The ICU nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following? Lung cancer Bronchitis Tracheobronchitis Acute respiratory distress syndrome
Acute respiratory distress syndrome
Which of the following is a potential complication of a low pressure in the endotracheal cuff? Aspiration pneumonia Tracheal ischemia Pressure necrosis Tracheal bleeding
Aspiration pneumonia
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? Blood-tinged sputum Productive cough Respiratory alkalosis Bradypnea
Blood-tinged sputum
The nurse is auscultating the patient's lung sounds to determine the presence of pulmonary edema. What adventitious lung sounds are significant for pulmonary edema? Sibilant wheezes Pleural friction rub Low-pitched rhonchi during expiration Crackles in the lung bases
Crackles in the lung bases
A recent immigrant is diagnosed with pulmonary tuberculosis (TB). Which intervention is the most important for the nurse to implement with this client? Developing a list of people with whom the client has had contact Reviewing the risk factors for TB Client teaching about the cause of TB Client teaching about the importance of TB testing
Developing a list of people with whom the client has had contact
A nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest bacterial pneumonia? Dyspnea and wheezing Sore throat and abdominal pain Nonproductive cough and normal temperature Hemoptysis and dysuria
Dyspnea and wheezing
Which interventions does a nurse implement for clients with empyema? Encourage breathing exercises Do not allow visitors with respiratory infection Place suspected clients together Institute droplet precautions
Encourage breathing exercises
A nurse is caring for a patient diagnosed with empyema. Which of the following interventions does a nurse implement for patients with empyema? Institute droplet precautions. Place suspected patients together. Do not allow visitors with respiratory infection. Encourage breathing exercises.
Encourage breathing exercises.
You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia? Encourage increased fluid intake. Offer nutritious snacks 2 times a day. Give antibiotics as ordered. Place client on bed rest.
Encourage increased fluid intake.
A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care? Elevating the head of the bed 30 degrees Encouraging increased fluid intake Turning the client every 2 hours Maintaining a cool room temperature
Encouraging increased fluid intake
The nurse knows the mortality rate is high in lung cancer clients due to which factor? Increased exposure to industrial pollutants Increased incidence among the elderly Few early symptoms Increase in women smokers
Few early symptoms
The occupational nurse is completing routine assessments on the employees where you work. What might be revealed by a chest radiograph for a client with occupational lung diseases? Fibrotic changes in lungs Lung contusion Damage to surrounding tissues Hemorrhage
Fibrotic changes in lungs
A patient arrives in the emergency department after being involved in a motor vehicle accident. The nurse observes paradoxical chest movement when removing the patient's shirt. What does the nurse know that this finding indicates? Pneumothorax Flail chest Tension pneumothorax ARDS
Flail chest
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? Cardiac tamponade Pulmonary contusion Flail chest Simple pneumothorax
Flail chest
A client who sustained a pulmonary contusion in a motor vehicle crash develops a pulmonary embolism. What is the priority nursing concern with this client? Excess fluid volume Ineffective breathing pattern Activity intolerance Acute pain
Ineffective breathing pattern
A client with suspected severe acute respiratory syndrome (SARS) comes to the emergency department. Which physician order should the nurse implement first? Begin an I.V. infusion of dextrose 5% in half-normal saline solution at 100 ml/hour. Institute isolation precautions. Obtain a nasopharyngeal specimen for reverse-transcription polymerase chain reaction testing. Obtain a sputum specimen for enzyme immunoassay testing.
Institute isolation precautions.
The nurse is assessing a client's potential for pulmonary emboli. What finding indicates possible deep vein thrombosis? Pain in the feet Localized calf tenderness Coolness to lower extremities Decreased urinary output
Localized calf tenderness
The nurse is conducting a community program about prevention of respiratory illness. What illness does the nurse know is the most common cause of death from infectious diseases in the United States? Pneumonia Pulmonary embolus Tracheobronchitis Atelectasis
Pneumonia
You are caring for a client with chronic respiratory failure. What are the signs and symptoms of chronic respiratory failure? Progressive loss of lung function associated with chronic disease Sudden loss of lung function associated with chronic disease Progressive loss of lung function with history of normal lung function Sudden loss of lung function with history of normal lung function
Progressive loss of lung function associated with chronic disease
The nurse is assessing a client who, after an extensive surgical procedure, is at risk for developing acute respiratory distress syndrome (ARDS). The nurse assesses for which most common early sign of ARDS? Cyanosis Rapid onset of severe dyspnea Bilateral wheezing Inspiratory crackles
Rapid onset of severe dyspnea
You are caring for a client status post lung resection. When assessing your client you find that the bubbling in the water-seal chamber for the chest tubes is more than you expected. What should you check when bubbling in the water-seal chamber is excessive? See if there are leaks in the system. See if a kink has developed in the tubing. See if the wall suction unit has malfunctioned. See if the chest tube is clogged.
See if there are leaks in the system.
After 48 hours, a Mantoux test is evaluated. At the site, there is a 10 mm induration. This finding would be considered: Not significant Significant Negative Nonreactive
Significant
The nurse is caring for a patient with pleurisy. What symptoms does the nurse recognize are significant for this patient's diagnosis? Fever and chills Dullness or flatness on percussion over areas of collected fluid Stabbing pain during respiratory movement Dyspnea and coughing
Stabbing pain during respiratory movement
The most diagnostic clinical symptom of pleurisy is: Dyspnea and coughing. Fever and chills. Dullness or flatness on percussion over areas of collected fluid. Stabbing pain during respiratory movements.
Stabbing pain during respiratory movements.
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? Mycobacterium tuberculosis Pseudomonas aeruginosa Streptococcus pneumoniae Staphylococcus aureus
Streptococcus pneumoniae
A nurse admits a new client with acute respiratory failure. What are the clinical findings of a client with acute respiratory failure? Insidious onset of lung impairment in a client who had compromised lung function Sudden onset of lung impairment in a client who had normal lung function Sudden onset of lung impairment in a client who had compromised lung function Insidious onset of lung impairment in a client who had normal lung function
Sudden onset of lung impairment in a client who had normal lung function
The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment? Syncope Tachypnea Hemoptysis Cough
Tachypnea
A mediastinal shift occurs in which type of chest disorder? Simple pneumothorax Traumatic pneumothorax Tension pneumothorax Cardiac tamponade
Tension pneumothorax
The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation? Flail chest Pulmonary contusion Cardiac tamponade Tension pneumothorax
Tension pneumothorax
A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition? The client exhibits restlessness and confusion. The client exhibits bronchial breath sounds over the affected area. The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. The client has a partial pressure of arterial carbon dioxide (PaCO2) value of 65 mm Hg or higher.
The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher.
Which comfort technique does a nurse teach to a client with pleurisy to assist with splinting the chest wall? Use a prescribed analgesic Turn onto the affected side Use a heat application Elevate the head of the bed
Turn onto the affected side
Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy? Vitamin C Vitamin E Vitamin D Vitamin B6
Vitamin B6
A client is admitted to the health care facility with active tuberculosis (TB). What intervention should the nurse include in the client's care plan? Keeping the door to the client's room open to observe the client Instructing the client to wear a mask at all times Wearing a gown and gloves when providing direct care Wearing a disposable particulate respirator that fits snugly around the face
Wearing a disposable particulate respirator that fits snugly around the face
A client who works construction and has been demolishing an older building is diagnosed with pneumoconiosis. This lung inflammation is most likely caused by exposure to: asbestos. pollen. silica. coal dust.
asbestos
A nurse assesses arterial blood gas results for a patient in acute respiratory failure (ARF). Which results are consistent with this disorder? pH 7.28, PaO2 50 mm Hg pH 7.36, PaCO2 32 mm Hg pH 7.35, PaCO2 48 mm Hg pH 7.46, PaO2 80 mm Hg
pH 7.28, PaO2 50 mm Hg
Resistance to a first-line antituberculotic agent in a client who has not received previous treatment is referred to as multidrug resistance. primary drug resistance. tertiary drug resistance. secondary drug resistance.
primary drug resistance.
A nurse is giving a speech addressing "Communicable Diseases of Winter" to a large group of volunteer women, most of whom are older than 60 years. What preventive measures should the nurse recommend to these women, who are at the risk of pneumococcal and influenza infections? Select all that apply. vaccinations prescribed opioids incentive spirometry hand antisepsis
vaccinations hand antisepsis
