Chapter 31. Nursing Care of Patients With Lower Respiratory Tract Disorders

A patient asks the nurse what can be done to prevent the development of lung cancer. What measure should the nurse explain as the most effective way to prevent this disease? a. Avoid smoking. b. Eat a balanced diet. c. Avoid excessive sun exposure. d. Avoid exposure to air pollution.

a

A patient is diagnosed with a pulmonary embolism. To be effective, how soon should thrombolytic agents be administered? a. 4 to 6 hours b. 7 to 9 hours c. 10 to 12 hours d. 14 to 24 hours

a

A patient is diagnosed with a pulmonary embolism. Which medication should the nurse anticipate administering to this patient? a. Heparin b. Expectorant c. Theophylline d. Corticosteroid

a

A patient prescribed theophylline for asthma has a theophylline level of 3 mcg/dL. What should the nurse do? a. Notify the physician. b. Double the next dose of theophylline. c. No action is necessary; this is a therapeutic level. d. Hold the next dose of theophylline until further orders are given.

a

A patient with suspected TB is prescribed a Candida skin test. What should the nurse explain as the purpose of this test? a. Provides a control test b. Tests for skin superinfection c. Potentiates the purified protein derivative (PPD) test d. Determines if the patient has a Candida albicans infection

a

A patients arterial blood gas analysis shows a PaCO2 of 62 mm Hg. What action should the nurse take? a. Notify the RN; this is abnormally high. b. Have the patient breathe into a paper bag. c. Increase the flow rate of the patients nasal oxygen. d. No action is necessary; this is a normal PaCO2 level.

a

A summer camp worker reports to the camp nurse with complaints of shortness of breath and audible wheezing. Which inhaled medication should the nurse provide? a. Albuterol (Proventil) b. Cromolyn sodium (Intal) c. Triamcinolone (Azmacort) d. Nedocromil sodium (Tilade)

a

The nurse is assisting in the preparation of content that focuses on respiratory health for a community health fair. What should the nurse include as a major risk factor for many respiratory problems? a. Smoking b. Eating spicy foods c. Eating a high-fat diet d. Excessive sun exposure

a

The nurse is providing care for a patient prescribed tiotropium (Spiriva). Which statement should be included in the patient education? a. Do not swallow the capsules. b. This medication can cause blurred vision and anorexia. c. It is important to alert the doctor to any abdominal pain or bloating. d. You may experience a headache and sensitivity to light while taking this medication.

a

The nurse is reviewing data collected on a patient with a respiratory disorder. Which factor should the nurse identify that places the patient at risk for lung cancer? a. Smoking and exposure to radon gas b. Living in a cold climate and having pets c. Eating foods high in beta carotene and fiber d. Living in crowded conditions and lack of sunlight

a

The nurse is reviewing medication orders for a patient with TB. Which drugs should the nurse expect to have prescribed for this patient? a. Isoniazid and rifampin b. Claforan and penicillin c. Aspirin and guaifenesin d. Alupent and theophylline

a

The nurse needs to collect a sputum specimen for culture from a patient with a chronic cough. What actions should the nurse take when collecting this specimen? (Select all that apply.) a. Obtain the specimen first thing in the morning b. Obtain the specimen before the patient eats breakfast c. Administer an antibiotic before collecting the specimen d. Provide the patient with warm water to drink before obtaining the specimen e. Have the patient rinse the mouth with warm water before collecting the specimen

a,b

A patient is prescribed long-term anticoagulant therapy as treatment for pulmonary emboli. What should the nurse ensure the patient is instructed before being discharged home? (Select all that apply.) a. Wear shoes at home. b. Use an electric razor. c. Use a soft toothbrush. d. Expect bruising to occur. e. Restrict the intake of citrus fruits.

a,b,c

The nurse is assisting in the planning of care for a patient with chronic obstructive pulmonary disease. What should be the goals of care for this patient? (Select all that apply.) a. Smoking cessation b. Improve activity tolerance c. Prevent disease progression d. Complete an advance directive e. Prevent and treat exacerbations

a,b,c,e

The nurse is caring for a patient with a suspected pulmonary embolism. Which diagnostic tests or procedures should the nurse expect to be prescribed for this patient? (Select all that apply.) a. D-dimer b. Spirometry c. Angiogram d. Bronchoscopy e. Ventilation-perfusion lung scan f. Spiral computed tomography (CT) scan

a,c,e,f

A patient diagnosed with a pleural effusion is very dyspneic. With which procedure should the nurse anticipate assisting? a. Tracheostomy b. Thoracentesis c. Bronchoscopy d. Pericardiocentesis

b

A patient has a positive response to a Candida test, in addition to a positive purified protein derivative (PPD) skin test. Which interpretation of these results is correct? a. The patient is anergic. b. The patients PPD test is reliable. c. The patient has a Candida infection. d. The patient has active TB infection.

b

A patient with TB who is in respiratory isolation must go to the x-ray department. Which action should the nurse take? a. Place a gown and gloves on the patient. b. Place a mask over the patients nose and mouth. c. Notify the x-ray department that the test must be cancelled. d. Call the x-ray department to make sure the waiting room is empty.

b

A patient with a lung infection has blood-tinged sputum. What term should the nurse use to document this finding? a. Hypoxemia b. Hemoptysis c. Hypercarbia d. Hematemesis

b

A patient with cystic fibrosis has ineffective airway clearance. What intervention would worsen this problem? a. Fluids b. Bedrest c. Mucolytics d. Percussion and postural drainage

b

An older adult patient who reports difficulty breathing and a productive cough and has a low-grade fever is admitted to the hospital for diagnosis and treatment. Which new-onset symptom should take priority? a. Fatigue b. Confusion c. Blood-tinged sputum d. Crackles on lung auscultation

b

The nurse answers a call light and finds the patient gasping for breath and looking very anxious. Based on the patients history, the nurse believes the patient may be experiencing a pulmonary embolism (PE). Which action should the nurse take first? a. Contact the physician. b. Call for help and start oxygen. c. Check the patients vital signs. d. Place the patient in a left lateral position.

b

The nurse develops a plan for impaired gas exchange for a patient with end-stage chronic obstructive pulmonary disease (COPD). Which finding best helps the nurse to know when the goal has been reached? a. The patient is alert and oriented. b. The patients oxygen saturation is 92%. c. The patient is able to clear the airway with coughing. d. The patient correctly demonstrates pursed lip breathing.

b

The nurse enters the room of a patient who is acutely short of breath. Which action should the nurse take first? a. Assist the patient into Sims position. b. Encourage use of pursed-lip breathing. c. Ask the patient what caused the dyspnea. d. Teach the patient use of accessory muscles.

b

The nurse is beginning morning care after receiving report. Which patient should the nurse monitor most closely for symptoms of a pulmonary embolism (PE)? a. A patient who smokes b. A patient with a deep vein thrombosis in the leg c. A patient with a history of radiation therapy for lung cancer d. A patient with chronic obstructive pulmonary disease (COPD)

b

The nurse is caring for a patient with end-stage chronic obstructive pulmonary disease. Which medication can help reduce acute dyspnea associated with this disease? a. PO cortisone b. IV morphine c. IV propranolol (Inderal) d. IM meperidine (Demerol)

b

The nurse is providing discharge teaching for a patient with newly diagnosed asthma. What should be included in the discharge teaching? a. Fluid fills the tiny sacs in the lungs and makes breathing difficult. b. Symptoms are caused by inflammation in the lining of your airways. c. You may notice large amounts of pus-like sputum that has a foul odor. d. The chest wall becomes stiff and air movement is restricted in individuals with asthma.

b

A young adult is admitted with manifestations associated with cystic fibrosis. What should the nurse expect to find when collecting data from this patient? (Select all that apply.) a. Extreme thirst b. Finger clubbing c. Body mass index 16 d. Thick sputum production e. Complaints of frequent foul-smelling stool

b,c,d,e

According to Centers for Disease Control and Prevention (CDC) guidelines, which individuals should the nurse consider as being positive for the TB skin test? (Select all that apply.) a. A 5-mm induration in a foreign-born individual b. A 5-mm induration in an HIV-infected individual c. A 10-mm induration in a child younger than 4 years old d. A 5-mm induration in an individual from a low-income group e. A 10-mm induration in an individual with no risk factors for TB f. A 10-mm induration in an HIV-negative individual who uses illicit injected drugs

b,c,f

A nurse is providing care for a patient with Ineffective Airway Clearance. Which are appropriate interventions to address this problem? (Select all that apply.) a. Weigh patient every day. b. Teach patient proper use of an incentive spirometer. c. Place patient in supine position and turn every 2 hours. d. Assess respiratory rate and pattern every 4 hours and prn. e. Encourage patient to deep breathe and cough every 2 hours. f. Administer guaifenesin (Mucinex) every 4 to 6 hours prn as ordered.

b,d,e,f

A nurse is providing home care for a patient with chronic obstructive pulmonary disease (COPD). Which order should the nurse question? a. Low-sodium diet b. Increase activity as tolerated c. Oxygen 4 L/min per nasal cannula d. Tiotropium (Spiriva) inhalation once daily

c

A nurse performs purified protein derivative and Candida skin tests on a patient suspected of TB. After 48 hours, what finding at the injection sites should the nurse document as a positive result? a. Warmth b. Redness c. Induration d. Purulent discharge

c

A patient is diagnosed with respiratory failure. Which acid-base abnormality should the nurse expect the patient to demonstrate? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

c

A patient with lung cancer develops pleural effusion. Which explanation by the nurse would help the patient understand this problem? a. Pus has developed in your alveoli that must be removed to improve your breathing. b. You have large amounts of fluid collecting in your airways because of the lung cancer. c. Fluid has collected in the space between your lungs and the sac surrounding your lungs. d. Fluid in your pericardial sac places pressure on your lungs, making it difficult to breathe.

c

A patient with lung cancer who is scheduled to begin a course of radiation therapy asks the nurse, How will they know if Im cured? The nurses best response is based on which understanding of the disease process? a. Lung cancer is never a curable disease; prolonged life is the goal. b. Eighty percent of lung cancers are curable with radiation therapy. c. Radiation in lung cancer is most often used to increase comfort, not cure disease. d. Radiation therapy reduces inflammation; chemotherapy is used to shrink the tumor.

c

An LPN is collecting data on a patient recovering from thoracic surgery. Vital signs following surgery were: blood pressure 156/94 mm Hg, pulse 100 beats/min, respirations 14/min, and temperature 97.4F (approximately 36.3C). Which new finding should the nurse report immediately to the physician? a. Pulse 88 beats/min b. Respirations 18/min c. Blood pressure 110/76 mm Hg d. Temperature 98.4F (approximately 36.9C)

c

The nurse auscultates the lung sounds of a patient with a pneumothorax every 4 hours. What is the nurse listening for during this auscultation? a. Evidence of obstruction b. Presence of crackles or wheezes c. Evidence of bilateral lung sounds d. Presence of secretions in the lungs

c

The nurse is assisting in the preparation of an inservice on infections. What should the nurse include as being the most common cause of death from infection? a. AIDS b. Influenza c. Pneumonia d. TB

c

The nurse is caring for a patient with long-standing bronchiectasis. Which manifestation should the nurse report immediately? a. Copious sputum b. Periodic episodes of harsh coughing c. Distended neck veins and dependent edema d. Fever of 100.6F (approximately 38C) and dyspnea

c

The nurse is concerned that a patient with a chronic low oxygen saturation level should be wearing home oxygen. Which oxygenation level should be used to make this decision? a. 95% b. 90% c. 88% d. 72%

c

A patient has difficulty raising pulmonary secretions, and the nurse writes a nursing diagnosis of Ineffective Airway Clearance related to weak cough and fatigue. What would best help the patient maintain a clear airway? a. Teach relaxation exercises. b. Allow rest periods between activities. c. Encourage fluids; suction prn as ordered. d. Instruct in abdominal and pursed-lip breathing.

d

A patient is admitted to a respiratory unit with a diagnosis of left lower lobe pneumonia. The nursing assessment reveals the patient to be febrile and experiencing a weak, congested-sounding cough. The patient has moist crackles throughout the lung fields. Based on the data provided, which nursing diagnosis is most appropriate? a. Anxiety b. Impaired Gas Exchange c. Ineffective Breathing Pattern d. Ineffective Airway Clearance

d

A patient is having a therapeutic thoracentesis to remove pleural fluid. What volume of pleural fluid should the nurse recognize as being abnormal? a. 5 mL b. 7 mL c. 13 mL d. 30 mL

d

A patient is unable to maintain a clear airway effectively with coughing and has a respiratory rate of 22/min with coarse crackles bilaterally. Which intervention should the nurse provide first? a. Encourage fluids. b. Encourage bedrest. c. Perform tracheal suctioning. d. Assess the patients coughing technique.

d

A patient with TB takes the prescribed drugs until the bottle runs out and then feels better and does not refill the prescription. The home health nurse explains that continuing the drugs is important for which reason? a. If taken consistently, your drugs will prevent hemoptysis. b. If you dont take all your drugs you can develop a superinfection. c. The drugs will keep you pain free so you can cough more effectively. d. You must take all the drugs to prevent development of resistant bacteria.

d

A patient with a pneumothorax has a chest drainage system. The family asks when the chest tube will be removed. What should the nurse respond to the family? a. The tube is removed when serous drainage has stopped collecting in the system. b. The tube is taken out when the patient is able to cough and deep breathe effectively. c. When the adventitious lung sounds are resolved, it is usually safe to remove the tube. d. When tidaling stops and lung sounds are equal on both sides, the tube can be removed.

d

A patient with chronic obstructive pulmonary disease is prescribed methylprednisolone (Solu-Medrol). For what reason should the nurse realize that corticosteroids are used in the treatment of this health problem? a. Dry secretions b. Treat infection c. Improve the oxygen-carrying capacity of hemoglobin d. Reduce airway inflammation

d

A patient with chronic obstructive pulmonary disease works with the nurse to set a goal of ambulating to the bathroom with oxygen. Which statement best documents progress toward this goal? a. Dyspnea is controlled with oxygen and rest. b. Arterial blood gases are within normal limits. c. Patient assisted to bathroom three times today. d. Ambulated to bathroom with oxygen, dyspnea level 3 on a 0-to-10 scale.

d

The nurse is assisting with the development of content on lung diseases to be provided during an upcoming health fair. What should the nurse include as being the disease that one-third of the worlds population is currently infected? a. AIDS b. Cancer c. Pneumonia d. TB

d

The nurse is caring for a patient with pneumonia. Which laboratory test would best help the nurse to monitor the condition of this patient? a. Electrolytes, serum creatinine b. Complete blood count (CBC), urinalysis c. Partial thromboplastin time (PTT), serum potassium d. White blood cell (WBC) count, arterial blood gases (ABGs)

d

The nurse is providing routine follow-up care for a young adult with asthma who has been on a 3-month course of maintenance therapy. Which activity would best help the nurse to determine if the patients treatment plan was effective? a. Obtain an ABG analysis. b. Determine the patients pulse oximeter reading. c. Evaluate the patients use of an incentive spirometer. d. Examine daily tracking records of the peak expiratory flow rate.

d

The nurse is reviewing the health histories for an assigned group of patients. Which patient should the nurse identify as being the most at risk for TB? a. The patient with lung cancer b. The patient with a history of alcohol abuse c. The patient with chronic airflow limitation d. The patient with acquired immunodeficiency syndrome

d

The nurse is reviewing the health statuses for assigned patients to determine the risk for pneumonia. Which type of pneumonia occurs most often as a nosocomial infection in hospitalized patients, very young patients, and older patients? a. Viral pneumonia b. Lobar pneumonia c. Fungal pneumonia d. Bronchopneumonia

d

The nurse observes a newly admitted patient in the hospital room and determines that data collection should be focused on chronic obstructive pulmonary disease. What did the nurse observe to make this decision? a. The patient is coughing. b. The patient is lying supine in bed. c. The patient is walking around the room. d. The patient is sitting in the tripod position.

d

The nurse teaches a patient with TB about drug therapy. Which patient statement indicates that teaching has been effective? a. I will have to take the antibiotics for 10 days. b. I will get a prescription for 2 weeks of antibiotics. c. I will have to take antibiotics for the rest of my life. d. I will probably need to be on antibiotic therapy for 6 months to 2 years.

d

While reinforcing discharge teaching for a patient with emphysema, which patient statement indicates that teaching was effective? a. There are bacteria in my lungs so my body is trying to wall off the infection. b. My disease is caused by spasm of the smooth muscles in my breathing pipes. c. Emphysema causes swelling in the airways and an increase in mucus production. d. Air gets trapped when damage to the air sacs makes it hard for air to move in and out.

d