Chapter 27: Lower Respiratory Problems
What are the manifestations of pneumonia in an older client? SATA A. confusion or stupor B. hypothermia C. diaphoresis D. anorexia E. fatigue G. headache H crackles
A, B, C, D, E, F, G, H
What are manifestations of acute bronchitis? SATA A. cough * B. headache C. fever D. malasise E. malaise F. hoarseness G. dyspnea H. chest pain I. clear sputum
A, B, C, D, E, F, G, H, I cough is the most common symptom
Regardless of the type of pneumonia, what are the most common signs and symptoms? SATA A. cough, productive or nonproductive B. fever, chills C. dyspnea D. bradypnea E. pleuritic chest pain
A, B, C, E
During admission of a patient diagnosed with non-small cell lung cancer, the nurse questions the patient related to a history of which risk factors for this type of cancer? (Select all that apply.) A. Asbestos exposure B. Exposure to uranium C. Chronic interstitial fibrosis D. History of cigarette smoking E. Geographic area in which they were born
A, B, D
The nurse is caring for a patient with a fever due to pneumonia. What assessment data does the nurse obtain that correlates with the patient having a fever? (Select all that apply.) A. A temperature of 101.4° F B. Heart rate of 120 beats/min C. Respiratory rate of 20 breaths/min D. A productive cough with yellow sputum E. Reports of unable to have a bowel movement for 2 days
A, B, D
The nurse is admitting a patient with a diagnosis of pulmonary embolism. Which risk factors are a priority for the nurse to assess? (Select all that apply.) A. Cancer B.Obesity C. Pneumonia D. Cigarette smoking E. Prolonged air travel
A, B, D, E
Which patients have the greatest risk for aspiration pneumonia? SATA A. patients with serizures B. patients with head injury C. patient who had thoracic surgery D. patient who had a MI E. patient who is receiving NG tube feeding
A, B, E
Blunt trauma occurs when the chest strikes or is struck by an object. What are some examples of blunt trauma? SATA A. crush injury B. explosion C. arrow D. gunshot E. fall G. sports injury
A, B, E, G
How is CMV viral pneumonia treated? SATA A. antivirals B. antibiotics C. high-dose immunoglobulin D. surgery E. antifungals
A, C
What are the manifestations of a cardiac tamponade? SATA A. muffled, distant heart sounds B. hypertension C. neck vein distention D. decreased CVP
A, C medical emergency- pericardiocentesis
What does the lung assessment reveal with a patient who has a lung abscess? SATA A. dullness to percussion B. stridor C. decreased breath sounds D. crackles E. increased breath sounds
A, C, D
Culture is the gold standard for diagnosing TB. How is the specimen obtained? SATA A. three consecutive sputums B. at least one late at night C. one with myobacterial growth D. samples from gastric washings, CSF, or fluid or from an effusion or abscess E. sputum collected in 8 to 24 hour intervals
A, C, D, E
What are the s/s of a pulmonary ebolism? SATA A. DYSPNEA B. bradypnea C. cough D. chest pain E. crackles, wheezing F. bradycardia G. feelings of impending doom
A, C, D, E, G
A penetrating trauma is an injury in which a foreign object impales or passes through the body tissues, creating an open wound. What are some examples? SATA A. knife B. motor vehicle collision C. stick D. pedestrian accident E. gunshot
A, C, E
The nurse is caring for a postoperative patient with impaired airway clearance. What nursing actions would promote airway clearance? (Select all that apply.) A. Maintain adequate fluid intake. B. Maintain a 15-degree elevation. C. Splint the chest when coughing. D. Have the patient use incentive spirometry. E. Teach the patient to cough at end of exhalation.
A, C, E
A hemothorax and pneumothorax both have dyspnea and decreased/absent breath sounds. What else does a hemothorax have? A. dullness to percussion B. hyperresonance to percussion C. decreased Hgb D. decreased movement of chest wall E. shock
A, C, E chest tube; IV PRBC
How do you treat bronchitis? SATA A. prevent pneumonia B. cough stimulants C. encourage fluid restriction D. bronchodilators E. avoid smoking and secondhand smoke
A, D, E
PJP, the most common form of pneumonia in patients with HIV. How does it appear? SATA A. fever B. bradypnea C. bradycardia D. dyspnea E. nonproductive cough F. hypoxemia
A, D, E, F can be life-threatening causing acute respiratory failure and death
For the patients who have latent TB, what are some factors that can activate the disease? SATA A. immunosuppression B. diabetes C. poor nutrition D. aging E. pregnancy F. stress G. chronic disease
A-G
A patient has been receiving high-dose corticosteroids and broad-spectrum antibiotics for treatment of an infection after a traumatic injury. The nurse plans care for the patient knowing that the patient is most susceptibe to: A. candisiasis B. cryptococcosis C. histoplasmosis D. coccidioidomycosis
A
What are the manifestations of a lung abscess? SATA A. productive cough with dark sputum B. sputum is foul smelling and tasting C. hemoptysis D. weight gain E. hypothermia
A, B, C
A patient is diagnosed with a lung abscess. What should the nurse include when teaching the patient about this diagnosis? A. IV antibiotic therapy will be started as soon as possible. B. Lobectomy surgery is usually needed to drain the abscess. C. Oral antibiotics will be used until there is evidence of improvement. D. Culture and sensitivity tests are needed for 1 year after resolving the abscess.
A
A patient with a gunshot wound to the right side of the chest arrives in the emergency department with severe shortness of breath and decreased breath sounds on the right side of the chest. Which action should the nurse take immediately? A. Cover the chest wound with a nonporous dressing taped on three sides. B. Pack the chest wound with sterile saline soaked gauze and tape securely. C. Stabilize the chest wall with tape and initiate positive pressure ventilation. D. Apply a pressure dressing over the wound to prevent excessive loss of blood.
A
A patient with a persistent cough is diagnosed with pertussis. What medication does the nurse anticipate administering to this patient? A. Antibiotic B. Corticosteroid C. Bronchodilator D. Cough suppressant
A
A priority nursing intervention for a patient who has just under-gone a chemical pleurodesis for recurrent pleural effusion is: A. giving ordered anaglesia B. monitoring chest tube drainage C. sending pleural fluid for lab analysis D. monitoring the patient's LOC
A
An older adult patient living alone is admitted to the hospital with pneumococcal pneumonia. Which clinical manifestation is consistent with the patient being hypoxic? A. Sudden onset of confusion B. Oral temperature of 102.3° F C. Coarse crackles in lung bases D. Clutching chest on inspiration
A
During discharge teaching for an older adult patient with chronic obstructive pulmonary disease (COPD) and pneumonia, which vaccine should the nurse recommend that this patient receive? A. Pneumococcal B. Staphylococcus aureus C. Haemophilus influenzae D. Bacille-Calmette-Guérin (BCG)
A
How is a lung abscess diagnosed? A. chest x ray B. MRI C. sputum analysis D. culture and sensitivity
A
PJP's causative agent is fungal, but it does not respond to antifungal medications. How is it treated? Oral or IV based on patient's condition and response A. trime/sulfa B. amoxicillin C. erythromycin D. penicillin
A
The nurse is performing a respiratory assessment. Which finding best supports the presence of impaired airway clearance? A. Basilar crackles B. Oxygen saturation of 85% C. Presence of greenish sputum D. Respiratory rate of 28 breaths/min
A
The nurse notes tidaling of the water level in the water-seal chamber in a patient with closed chest tube drainage. The nurse should: A. continue to monitor the patient B. check all connections for a leak in the system C. lower the drainage collector further from the chest D. clamp the tubing at a distal point away from the patient
A
When caring for a patient with acute bronchitis, the nurse will prioritize interventions by: A. auscultating lung sounds B. encouraging fluid restriction C. administering antibiotic therapy D. teaching the patient to avoid cough suppressants
A
You are caring for patients exposed to a chlorine leak from a local factory. The nurse would closely monitor these patients for: A. pulmonary edema B. anaphylactic shock C. respiratory alkalosis D. acute tubular necrosis
A
A patient comes to the ED and is diagnosed with pertussis. They are exhibiting low-grade fever, runny nose, water eyes, generalized malaise, and a nonproductive cough. Which stage are they in? A. stage 1 B. stage 2 C. stage 3
A this stage mimics a mild URI; lasts 1-2 weeks
Match the following: A. bacteria is inhaled and starts an inflammatory reaction B. when active disease develops within 2 years of infection C. disease occurring 2 or more years after the initial infection, if it pulmonary or laryngeal, it can be transmitted D. positive skin test, asymptomatic, cannot transmit TB bacteria 1. post-primary TB or reactivation 2. primary TB infection 3. primary TB 4. latent TB infection
A = 2 B = 3 C = 1 D = 4
Pair the following: A. results from abnormal entry of material from the mouth or stomach into the lungs B. aspiration of acidic gastric content C. most common cause of pneumonia D. rare complication of bacterial lung infection; turns lung tissue into thick, liquid mass E. inflammation and infection of the lower respiratory tract in immunocompromised patients 1. opportunistic 2. aspiration 3. necrotizing 4. chemical pneumonitis 5. viral
A = 2 B = 4 C = 5 D = 3 E = 1
Match the following A. blood rapidly collects in pericardial sac, compresses myocardium bc peridcardium does not stretch, and prevents ventricles from filling B. fractures of 2 or more adjacent ribs in 2 or more places with loss of chest wall stability C. blood in the pleural space D. air in pleural space E. air in pleural space that does not escape; increased air shifts organs and increases intrathoracic pressure 1. hemothorax 2. flail chest 3. tension pneumothorax 4. cardiac tamponade 5. pneumothorax
A = 4 B = 2 C = 1 D = 5 E = 3
Why are chest tubes inserted? SATA A. to drain pleural space B. reestablish positive pressure C. allow for proper lung expansion
A, B, C
What are the manifestations of a flail chest? SATA A. paradoxical movement of chest wall (the affected {flail} area moves in opposite direction in respect to the intact part; insipration flail is sucked in, expiration, it bulges out) B. respiratory distress C. may be associated with hemothorax, pneumothorax, or pulmonary contusion D. bradycardia
A, B, C give O2; stabilize with positive pressure (intubation or mechanical ventilation)
What are some manifestations for a tension pneumothorax? SATA A. cyanosis, air hunger B. extreme agitation C. neck vein distention D. hyperresonance to percussion E. tracheal deviation away from affected side
A, B, C, D, E medical emergency; needle decompression; chest tube
How is pertussis diagnosed? SATA A. H&P B. polymerase chain reaction (pcr) of nasopharyngeal secretions C. serology testing D. chest x-ray E. culture and sensitivity
A, B, C
After admitting a patient from home to the medical unit with a diagnosis of pneumonia, which provider orders must the nurse verify have been completed before administering a dose of cefuroxime? A. Orthostatic blood pressures B. Sputum culture and sensitivity C. Pulmonary function evaluation D. Serum laboratory studies ordered for AM
B
Most acute bronchial infections are caused by: A. streptococcal B. virus C. inhalation of irritants D. asthma
B
The nurse is caring for a group of patients. Which patient is at risk of aspiration? A. A 58-yr-old patient with absent bowel sounds 12 hours after abdominal surgery B. A 26-yr-old patient with continuous enteral feedings through a nasogastric tube C. A 67-yr-old patient who had a cerebrovascular accident with expressive dysphasia D. A 92-yr-old patient with viral pneumonia and coarse crackles throughout the lung fields
B
The nurse is developing a plan of care for a patient with metastatic lung cancer and a 60-pack-year history of cigarette smoking. What should the nurse assess this patient for? A. Cough reflex B. Mucociliary clearance C. Reflex bronchoconstriction D. Ability to filter particles from the air
B
The nurse receives an order for a patient with lung cancer to receive influenza vaccine and pneumococcal vaccines. The nurse will: A. call the health care provider to question the order B. give both vaccines at the same time in different arms C. give the pneumococcal vaccine and obtain a nasal influenza vaccine D. give the flu shot and tell the patient to come back in 1 week to have the pneumococcal vaccine
B
The nurse teaches a patient with a pulmonary embolism how to administer enoxaparin after discharge. Which statement by the patient indicates understanding about the instructions? A. "I need to take this medicine with meals." B. "The medicine will be prescribed for 10 days." C. "I will inject this medicine into my upper arm." D. "The medicine will dissolve the clot in my lung."
B
When caring for a patient with a lung abscess, what is the nurse's priority intervention? A. postural drainage B. antibiotic administration C. obtaining a sputum specimen D. patient teaching about home care
B
When planning care for a patient at risk for pulmonary embolism, the nurse prioritizes: A. maintaining the patient on the bed B. using intermittent pneumatic compression devices C. encouraging the patient to cough and deep breathe D. teaching the patient how to use incentive spirometer
B
Which term is the absence of air or gas in 1 or more areas of the lung that may occur with pneumonia? A. cavitation B. atelectasis C. pneumothroax D. consolidation
B
What is the most common cause of pulmonary edema? A. ARDS B. left sided HF C. overhydration with IV fluids D. anaphylactic reaction
B can be lifethreatening
How is pertussis treated? A. penicillin B. erythromycin C. amoxicllin D. rest and hydration
B it is treated with macrolides, including erthromycin and azithromycin; if they can't take these, they are prescribed trimethropim/sulfamethoxazole
The patient with pertussis has paroxysms of a cough. It has been going on for the last five weeks. Which stage are they in? A. stage 1 B. stage 2 C. stage 3
B this stage lasts from the 2nd to the 10th week of infection
What are manifestations of nectrotizing pneumonia? SATA A. slow onset or respiratory insufficiency B. immediate onset of respiratory failure C. leukopenia D. bleeding into airway E. cavitation
B, C, D, E
What are some complications related to a lung abscess? SATA A. pneumonia B. pulmonary abscess C. bronchopleural fistula D. bronchoiectasis E. empyema
B, C, D, E
Which medications should the patient with pertussis not take? SATA A. macrolides B. cough suppressants C. antihistamines D. corticosteroids E. bronchodilators
B, C, D, E
What are s/s of active TB? SATA A. good cough that lasts longer than 3 weeks, with blood or sputum production B. angina C. weakness or fatigue D. weight gain and increased appetite E. fever, chills, night sweats
B, C, E
Which statements describe the management of a patient following lung transplantation? SATA A. high doses of O2 are administered around the clock B. using a home spirometer will help monitor lung function C. immunosuppressant therapy usually involves a 3-drug regimen D. most patients have an acute rejection episode within the first two days E. a lung biopsy is done use a transtracheal method if rejection is suspected
B, C, E
How do the pathogens that cause pneumonia get into the lungs? SATA A. cough reflex B. aspiration C. mucociliary clearance D. inhalation E. hematogenous spread
B, D, E
A hemothorax and pneumothorax both have dyspnea and decreased/absent breath sounds. What else does a pneumothorax have? A. dullness to percussion B. hyperresonance to percussion C. decreased Hgb D. decreased movement of chest wall E. shock F. mild tachycardia
B, D, F chest tube
How is nectrotizing pneumonia treated? SATA A. it's not curable, just symptomatic relief B. lifelong antibiotic therapy C. bed rest D. hydration E. surgery
B, E
After a pneumonectomy, an appropriate nursing intervention is: A. monitoring chest tube drainage and functioning B. positioning the patient on the unaffected side or back C. doing ROM exercises on the affected upper limb D. auscultating frequently for lung sounds on the affected side
C
Because of severe liver injury and death, the CDC does not recommend the combination of which drugs for LTBI? A. isoniazid and rifapentine B. ethamnutol and isoniazid C. pyrazinamide and rifampin D. rifampin and ethambutol
C
One week after a thoracotomy, a patient with chest tubes (CTs) to water-seal drainage has an air leak into the closed chest drainage system (CDS). Which patient assessment warrants follow-up nursing actions? A. Water-seal chamber has 5 cm of water B. No new drainage in collection chamber C. Chest tube with a loose-fitting dressing D. Small pneumothorax at CT insertion site
C
The nurse identifies a flail chest in a trauma patient when: A. multiple rib fractures are determined by x-ray B. a tracheal deviation to the unaffected side is present C. paradoxical chest movement occurs during respiration D. there is decreased movement of the involved chest wall
C
The nurse is caring for a patient with pneumonia unresponsive to two different antibiotics. Which action is most important for the nurse to complete before administering a newly prescribed antibiotic? A. Teach the patient to cough and deep breathe. B. Take the temperature, pulse, and respiratory rate. C. Obtain a sputum specimen for culture and Gram stain. D. Check the patient's oxygen saturation by pulse oximetry.
C
The nurse is caring for a patient with unilateral lung cancer. What is the priority nursing action to enhance oxygenation in this patient? A. Positioning patient on right side B. Maintaining adequate fluid intake C. Positioning patient with "good lung" down D. Performing postural drainage every 4 hours
C
The nurse is performing a respiratory assessment for a patient admitted with pneumonia. Which clinical manifestation would the nurse expect to find? A. Hyperresonance on percussion B. Vesicular breath sounds in all lobes C. Increased vocal fremitus on palpation D. Fine crackles in all lobes on auscultation
C
The nurse is teaching the patient with human immunodeficiency virus (HIV) about the diagnosis of a fungal lung infection with Candida albicans. What patient statement indicates to the nurse that further teaching is required? A. "I will be given amphotericin B to treat the fungus." B. "I got this fungus because I am immunocompromised." C. "I need to be isolated from my family and friends so they won't get it." D. "The effectiveness of my therapy can be monitored with fungal serology titers."
C
While ambulating a patient with metastatic lung cancer, the nurse observes a decrease in oxygen saturation from 93% to 86%. Which nursing action is most appropriate? A. Continue with ambulation. B. Obtain a provider's order for arterial blood gas. C. Obtain a provider's order for supplemental oxygen. D. Move the oximetry probe from the finger to the earlobe.
C
After a hematopoietic cell transplant, the nurse should the patient for which type of infection? A. PJP B. bacterial C. CMV D. HIV
C life-threatening!
Which does not occur with bronchitis, but suggests pneumonia? A. crackles B. wheezes C. consolidation D. normal x-ray
C occurs when fluid accumulates in the lungs
Does chemical pneumonitis need antibiotic therapy? A. yes B. no C. only if secondary infection occurs
C secondary bacterial infection can occur within 48-72 hours
The patient with pertussis has a mild cough and some weakness. Which stage are they in? A. stage 1 B. stage 2 C. stage 3
C this stage lasts 2-3 weeks
A patient with TB has been admitted to the hospital and is placed on airborne precautions and in an isolation room. What should the nurse teach the patient? SATA A. expect routine TB testing to evaluate the infection B. no visitors will be allowed while in airborne isolation C. adherence to precautions includes coughing into a paper tissue D. take all medications for full length of time to prevent multi-drug-resistant TB E. wear a standard isolation mask if leaving the airborne infection isolation room
C, D, E
An appropriate nursing intervention to assist a patient with pneumonia manage thick secretions and fatigue would be to: A. perform postural drainage every hours B. provide analgesics as ordered to promote patient comfort C. administer O2 as prescribed to maintain optimal O2 levels D. teach the patient how to cough effectively and expectorate secretions
D
An older adult patient is admitted with acute respiratory distress related to cor pulmonale. Which nursing action is most appropriate during admission of this patient? A. Perform a comprehensive health history with the patient to review prior respiratory problems. B. Complete a full physical examination to determine the effect of the respiratory distress on other body functions. C. Delay any physical assessment of the patient and review with the family the patient's history of respiratory problems. D. Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress.
D
A patient with idiopathic pulmonary fibrosis had bilateral lung transplantation and now has exertional dyspnea, nonproductive cough, and wheezing. What does the nurse determine is most likely occurring in this patient? A. Pulmonary infarction B. Pulmonary hypertension C. Cytomegalovirus (CMV) D. Bronchiolitis obliterans (BOS)
D
The nurse determines that discharge teaching for a patient hospitalized with pneumonia has been effective when the patient makes which statement about measures to prevent a relapse? A. "I will seek immediate medical treatment for any upper respiratory infections." B. "I should continue to do deep breathing and coughing exercises for at least 12 weeks." C. "I will increase my food intake to 2400 calories a day to keep my immune system well." D. "I must have a follow-up chest x-ray in 6 to 8 weeks to evaluate the pneumonia's resolution."
D
The nurse is caring for a patient with impaired airway clearance. What is the priority nursing action to assist this patient to expectorate thick lung secretions? A. Humidify the oxygen as able. B. Administer a cough suppressant q4hr. C. Teach patient to splint the affected area. D. Increase fluid intake to 3 L/day if tolerated.
D
The nurse is caring for an older adult patient who underwent a left total knee arthroplasty. On the third postoperative day, the patient reports shortness of breath, slight chest pain, and that "something is wrong." Temperature is 98.4° F, blood pressure is 130/88 mm Hg, respirations are 36 breaths/min, and oxygen saturation is 91% on room air. What is the priority nursing action? A. Notify the health care provider. B. Administer a nitroglycerin tablet sublingually. C. Conduct a thorough assessment of the chest pain. D. Sit the patient up in bed as tolerated and apply oxygen.
D
The patient had video-assisted thoracic surgery (VATS) to perform a lobectomy. What does the nurse understand is the reason for using this type of surgery? A. The patient has lung cancer. B. The incision will be medial sternal or lateral. C. Chest tubes will not be needed postoperatively. D. Less discomfort and faster return to normal activity.
D
Which term is when a normally air-filled alveoli becomes filled with water, fluid and/or debris that is associated with bacterial pneumonia? A. cavitation B. atelectasis C. pneumothorax D. consolidation
D
