Health and Illness Quizzes (1-3)
A patient who has severe pain associated with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective? The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs The patient states the nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0-10 pain scale) The patient agrees to take the medications by the IV route in order to improve analgesic effectiveness
The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs
Mr. S is a 65-year-old male who is admitted to the telemetry unit for treatment of pneumonia of the right middle lobe. His morning assessment reveals the following data: T: 100.4, Pulse: 110, RR: 24, B/P: 108/68, and O2 saturation 89% on room air. True or False: In this patient, abnormal breath sounds are the result of rumbling of mucus within the lower airways in clients with pneumonia.
True True, abnormal breath sounds are the result of rumbling of mucus within the lower airways in clients with pneumonia
True or False. A nurse should administer a bronchodilator to a patient before performing postural drainage and chest physiotherapy because it will open the airways and allow for easier removal of secretions
True True. A nurse should administer a bronchodilator to a patient before performing postural drainage and chest physiotherapy because it will open the airways and allow for easier removal of secretions.
A patient is admitted to the emergency department with a severe exacerbation of asthma. Which finding is of most concern to the nurse? Unable to speak and sweating profusely PaCO2 of 47 mm Hg Presence of inspiratory and expiratory wheezing Peak expiratory flow rate at 60% of personal best
Unable to speak and sweating profusely During a severe exacerbation of asthma the patient may not be able to speak (or may speak in words, not sentences) because of difficulty breathing; the patient may also be perspiring profusely. Other indicators of severe asthma include absence of wheezing because of limited airflow; arterial blood gas results with increased PaCO2 > 48 mmHg and peak expiratory flow rate at or below 40% of personal best.
Which findings indicate that a patient is developing status asthmaticus? (select all that apply) Unable to speak in complete sentences Extreme wheezing Lack of response to conventional treatment Positive sputum culture
Unable to speak in complete sentences Extreme wheezing Lack of response to conventional treatment Status Asthmaticus is a life-threatening episode and the patient may have the following findings indicating that they may be developing status asthmaticus: Airway obstruction unresponsive to common treatment (lack of response to conventional treatment), extreme wheezing, labored breathing, use of accessory muscles, distended neck veins, and the inability to speak in complete sentences.
A client has developed a hospital-acquired pneumonia. When preparing to administer cephalexin 500 mg, the nurse notices that the pharmacy sent cefazolin. What should the nurse do? Select all that apply. Scroll down to review the 5 answer choices. Verify the medication prescription as written by the healthcare provider (HCP) Request that cephalexin be sent promptly Administer the cefazolin Contact the pharmacy and speak to a pharmacist Return the cefazolin to the pharmacy
Verify the medication prescription as written by the healthcare provider (HCP) Request that cephalexin be sent promptly Contact the pharmacy and speak to a pharmacist Return the cefazolin to the pharmacy
The nurse is creating discharge instructions for a 65-year-old man with peripheral neuropathy from diabetes. The nurse would include: Check feet weekly for wounds Wear socks and shoes Walk barefoot to increase stimulation Soak feet in hot water daily
Wear socks and shoes Patient with peripheral neuropathy from diabetes, must protect their feet because loss of sensations will make injuries undetectable. Discharge instructions should include teaching these patients to wear socks and shoes. Feet should be checked daily, not weekly for wounds. Feet should not be soaked in hot water daily but can be soaked in cool or warm water daily. Walking barefoot is never encouraged for these patients.
Pneumonia is
a respiratory infection
High-pitched, coarse whistling sounds heard on auscultation is...
an asthma manifestation
A chronic incurable condition...
asthma ???
he plan of care for the patient with chronic obstructive pulmonary disease (COPD) should include: (select all that apply) use of peak flow meter to monitor the progression of COPD breathing exercises, such as pursed-lip breathing that focus on exhalation high flow rate of Oxygen administration exercise such as walking
breathing exercises, such as pursed-lip breathing that focus on exhalation exercise such as walking The plan of care for the patient with chronic obstructive pulmonary disease (COPD) should include encouragement to exercise (i.e. walking) and breathing exercises such as pursed-lip breathing that focus on exhalation as these can help manage the clinical manifestations of COPD, assisting with quality of life.
The major advantage of a Venturi mask is that it can: deliver up to 80% Oxygen provide continuous 100% humidity deliver a precise concentration of Oxygen be used while a patient eats and sleeps
deliver a precise concentration of Oxygen
A 56-year-old, normally healthy patient at the clinic, is diagnosed with bacterial community-acquired pneumonia. Before treatment is prescribed, the nurse asks the patient about an allergy to: cephalosporins amoxicillin erythromycin sulfonamides
erythromycin Outpatient drug therapy options for a healthy person with community-acquired pneumonia will consist of macrolides (erythromycin) or doxycycline. If the patient is allergic to macrolides, doxycycline would be prescribed.
Which findings are significant data to gather from a client who has been diagnosed with pneumonia? Select all that apply. Scroll down to view the 5 answer choices. occurrence of chest pain amount of peripheral edema presence of bowel sounds color of nail beds quality of breath sounds
occurrence of chest pain color of nail beds quality of breath sounds Auscultating bowel sounds and assessing for peripheral edema may be appropriate assessments, but these are not priority assessments for the client with pneumonia.
Crackles head on auscultation is a..
pneumonia manifestation
Asthma is..
reversible inflammation of the bronchioles
The client with pneumonia develops mild constipation, and the nurse administers docusate sodium as prescribed. This drug works by: lubricating the stool stimulating peristalsis softening the stool increasing stool bulk
softening the stool
Which finding is an expected outcome for an elderly client following treatment and recovering from bacterial pneumonia? a respiratory rate of 25 to 30 breaths/min the ability to perform activities of daily living without dyspnea chest pain that is minimized by splinting the rib cage a maximum loss of 5 to 10 lb. (2 to 5 kg) of body weight
the ability to perform activities of daily living without dyspnea An expected outcome for a client recovering from pneumonia would be the ability to perform activities of daily living without experiencing dyspnea. A respiratory rate of 25 to 30 breaths/min indicates the client is experiencing tachypnea, which would not be expected on recovery. A weight loss of 5 to 10 lbs. is undesirable; the expected outcome would be to maintain normal weight. A client who is recovering from pneumonia should experience decreased or no chest pain.
True or False. The #1 risk factor for COPD is cigarette smoking.
true
A patient is newly diagnosed with COPD due to chronic bronchitis. You're providing education to the patient about this disease process. Which statement by the patient indicates they understood your teaching about this condition? "I'm at risk for low levels of red blood cells due to hypoxia and may require blood transfusions during acute illnesses." "Complications from this condition can lead to pulmonary hypertension and right-sided heart failure." "My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than low oxygen levels. "If I stop smoking, it will cure my condition."
"Complications from this condition can lead to pulmonary hypertension and right-sided heart failure."
A patient with chronic neck pain is seen in the pain clinic for follow-up. To evaluate whether the pain management is effective, which question is best for the nurse to ask? "Does the pain keep you from activities that you enjoy?" "How would you rate your pain on a 0-10 scale?" "Has there been a change in pain location?" "Can you describe the quality of your pain?"
"Does the pain keep you from activities that you enjoy?"
The healthcare provider has prescribed penicillin for a client admitted to the hospital for treatment of pneumonia. Prior to administering the first dose of penicillin, the nurse should ask the client which of the following? "Have you had a previous allergy to penicillin?" "Do you have a history of seizures?" "Do you have any cardiac history?" "Have you had any recent infections?"
"Have you had a previous allergy to penicillin?"
The nurse assesses a patient with chronic cancer pain who is receiving imipramine (Tofranil) in addition to long-acting morphine (MS Contin). Which statement, if made by the patient indicates to the nurse that the patient is receiving adequate pain control? "I can accomplish activities without much discomfort." "Every night I get 8 hours of sleep." "I'm not anxious during the day" "I feel less depressed since I've been taking the Tofranil."
"I can accomplish activities without much discomfort."
The nurse has given instructions on pursed-lip breathing to a client with COPD. Which statement by the client would indicate effective teaching? "I should inhale through my mouth very deeply." "I should tighten my abdominal muscles with inhalation." "I should tighten my abdominal muscles with exhalation." "I should make inhalation twice as long as exhalation."
"I should tighten my abdominal muscles with exhalation." Contracting the abdominal muscles with exhalation is the proper technique for pursed-lip breathing. The other answers are incorrect. The goal is to increase the exhalation process, pushing out carbon dioxide.
Which statement indicates the patient with asthma requires further teaching about self-care? "I walk 30 minutes every day but sometimes I have to use my bronchodilator inhaler before walking to prevent me from getting short of breath." "I get a flu shot every year and see my HCP if I have an upper respiratory tract infection." "I use my inhaler before I visit my aunt who has a cat, but I only visit for a few minutes because of my allergies." "I use my corticosteroid inhaler when I feel short of breath."
"I use my corticosteroid inhaler when I feel short of breath." Corticosteroids are an anti-inflammatory drug for asthma. They reduce bronchial hyperresponsiveness, block late-phase response, and inhibit migrations of inflammatory cells. Corticosteroids are a most effective long-term control drug. Inhaled corticosteroids are prescribed for daily use ad should be taken on a fixed schedule. They are not prescribed to use 'as needed.'
A patient with chronic back pain has learned to control the pain with the use of imagery and hypnosis. The patient's spouse asks the nurse how these techniques work. Which response by the nurse is accurate? "These strategies prevent transmission of stimuli from the back to the brain." "The strategies work by affecting the perception of pain." "the therapies slow the release of chemicals in the spinal cord that cause pain." "These techniques block the pain pathways of the nerves.
"The strategies work by affecting the perception of pain."
The nurse is teaching a client about coughing and deep-breathing techniques to prevent postoperative complications. Which statement is most appropriate for the nurse to make to the client at this time as it relates to these techniques? "Administration of intravenous fluids will prevent or treat fluid imbalance." "Early ambulation and administration of blood thinners will prevent pulmonary embolism." "Close monitoring of your oxygen saturation will detect hypoxemia." "Use of the incentive spirometer will help prevent pneumonia."
"Use of the incentive spirometer will help prevent pneumonia." Use of an incentive spirometer helps prevent pneumonia and atelectasis.
The nurse caring for a client with emphysema walks into the client's hospital room and finds the client sitting on the side of the bed while leaning on the overbed table. Which statement is accurate? "Next time sit upright instead of leaning over the table." "You are demonstrating the correct position to enhance breathing." "Please call the staff before leaning over the table as it is unsafe." "You need to recline in the bed-side chair to relax the diaphragm."
"You are demonstrating the correct position to enhance breathing." Tripod breathing is a position used by COPD clients to maximize oxygenation and ventilation during distress. In the tripod position, the client sits or stands and leans forward while supporting the upper body with hands on the knees or other surfaces. This position optimizes the mechanics of breathing by taking advantage of the accessory muscles of the neck and upper chest in order to increase the amount of air within the lungs.
The healthcare provider has ordered Methylprednisolone 60 mg IV now. The available medication label reads 125 mg/mL. Calculate the mL the nurse will administer how many mL? 1.23 mL 0.48 mL 0.12 mL 2.32 mL
0.48 mL
The healthcare provider has ordered 100 mcg Albuterol-ipratropium bromide 4 times a day for a patient with COPD. Calculate the dose in mg in a 24-hour period. 200 mg 0.2 mg 0.4 mg 400 mg
0.4mg
The patient in the ER, has an order for Toradol (Ketorolac) 15 mg, for pain. Pharmacy has provided a vial in the the image below. How many mL will the nurse draw up to administer? Use the medication label below: 2 mL 4.4 mL 0.5 mL 1 mL
0.5 mL
A patient has a PCA pump, administering Dilaudid. The order states for the patient to have a demand dose of 0.2mg with a lock out interval of 10 minutes. The patient has successfully received 3 doses over the last hour. How much medication has the patient received? 1 mg 0.6mg 3 mg 4 mg
0.6 mg
A patient is unable to take oral steroids for their COPD exacerbation. The healthcare provider has ordered 150 mg of Hydrocortisone IV. The medication dispensing machine has Hydrocortisone 250 mg/mL. Calculate the mL the nurse will administer. How many mL will the nurse administer to the patient? 1.2 mL 0.3 mL 8.2 mL 0.6 mL
0.6 ml
The nurse is administering a Levaquin infusion and the label reads Levaquin 750 mg/150 mL. The order states to infuse over 90 minutes. Calculate the mL/hr the nurse will set the IV pump to infuse the medication. 200 mL/hr 150 mL/hr 300 mL/hr 100 mL/hr
100 mL/hr
A post-operative patient is receiving Demerol 25 mg, for shivering, every 15 minutes as needed. If the patient received a dose at 1222, what time can the patient receive another dose if the shivering persists? 1245 1232 1224 1237
1237
The patient is suffering from community acquired pneumonia. The healthcare provider has ordered 500 mg/250 mL of Azithromycin IV piggyback to infuse over 90 minutes. Calculate the mL/hr the nurse will administer the medication on the IV pump. 200 mL/hr 154 mL/hr 90 mL/hr 167 mL/hr
167 mL/hr
A post-operative patient, complaining of nausea and vomiting, has an order for Ondansetron 4mg IV now. How many mL will be administered? Use the medication label below to calculate how many mL to administer. 5 mL 20 mL 2 mL 1 mL
2 mL
The patient, complaining of heartburn, has an order for Reglan 10 mg. Calculate how many tablets the nurse will administer? Use the medication label below to answer this question. 3 tablets 4 tablets 2 tablets 8 tablets
2 tablets
The healthcare provider has ordered Dexamethasone 10 mg IV. The vial reads 20 mg/5 mL. How many mL will the nurse administer? 3.4 mL 2.5 mL 1.3 mL 0.5 mL
2.5 mL
A patient suffering from COPD has an order for Levalbuterol via nebulizer. The other states to 0.63 mg every 6 hours. Calculate the mg the patient will receive in a 24-hour period. 6.5 mg 1.2 mg 0.7 mg 2.5 mg
2.5mg
The nurse is preparing to administer Reslizumab as an IV infusion to a 75 kg patient suffering from COPD. The order states to administer 3mg/kg. Calculate the dose. How many mg will the patient receive? 123 mg 225 mg 536 mg 75 mg
225 mg
A post-operative patient, weighing 110 pounds, has an order for 0.5mcg/kg of Fentanyl for severe pain. This patient is complaining of operative site pain at a '10' on a 0-10 pain scale. How many mcg will the patient will receive? 30 mcg 25 mcg 100 mcg 40 mcg
25 mcg
A patient has an order for Acetylcysteine 600 mg daily as an inhaled agent. You have been provided the following medication from the pharmacy (see image below). Calculate the mL the nurse will add to the nebulizer treatment. How many mL will the nurse give to the patient? 3 mL 5 mL 6 mL 2 mL
3 ml
The healthcare provider has ordered Prednisone 1.5mg/kg/day in 2 divided doses for a 97-pound patient. How many mg will the patient receive per dose? 15 mg 66 mg 39 mg 33 mg
33 mg
The nurse is preparing to administer an IV infusion of Reslizumab to a patient for a total dose of 345 mg. Use the image provided to calculate the mL the nurse will add to the IV bag for the infusion. How many mL will the nurse add to the IV bag? 12.4 mL 34.5 mL 23.7 mL 65.4 mL
34.5 mL
A patient is being discharged home with a prescription for Tramadol 50mg every 6 hours as needed for moderate pain. Each tablet contains 50mg of Tramadol. In your discharge teaching related to this medication, how many tablets can this patient take in a 24 hour period? 1 tablet 4 tablets 2 tablets 6 tablets
4 tablets
The post-operative patient is complaining of nausea. You have received an order for 10 mg of Prochlorperazine 4 times a day. How many mg will the patient receive in a 24 hour period? 10 mg 50 mg 40 mg 60 mg
40 mg
A patient is febrile and requires Acetaminophen IV. The pharmacy has provided the medication below, with instructions to infuse over 15 minutes. Calculate the mL/hr the nurse will set the IV pump at. 500 mL/hr 200 mL/hr 400 mL/hr 100 mL/hr
400 mL
A patient has PCA Pump, administering Morphine, with a continuous infusion of 2mg/hr and a demand dose of 1mg every 10 minutes as needed (lockout). If the patient has received 4 successful doses, calculate how much Morphine (including the continuous infusion) the patient received in the last hour. 8 mg 10 mg 6 mg 4 mg
6 mg
The healthcare provider has written an order to administer 2 tablets of Oxycodone/apap 5/325mg every 4 hours as needed for pain. The order also states not to exceed 3 g of acetaminophen in a 24 hour period. How many tablets can the patient receive in 24 hours without exceeding the 3 g of acetaminophen in a 24 hour period? 6 2 9 10
9
The nurse develops a nursing care plan for a client at risk of having hospital-acquired pneumonia. Which factor(s) places this client at highest risk for developing hospital-acquired pneumonia? Select all that apply. A client who did not receive the pneumococcal vaccine A client with dysphagia A client on a ventilator A client with a decreased level of consciousness
A client with dysphagia A client on a ventilator A client with a decreased level of consciousness Hospital-acquired pneumonia (HAP) refers to any type of pneumonia that developed within 48-72 hours upon admission to a hospital. Clients who are admitted to the hospital are at risk for contracting HAP for many reasons. Ventilated clients are at risk for developing ventilator-associated pneumonia (VAP). A client with dysphagia and clients with decreased levels of consciousness are at risk for aspiration pneumonia as they are less likely to be able to protect their airways effectively.
The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which finding would the nurse expect to note on assessment of this client? Select all that apply. A low arterial PCO2 level A hyperinflated chest noted on the chest x-ray Decreased oxygen saturation with mild exercise A widened diaphragm noted on chest x-ray
A hyperinflated chest noted on the chest x-ray Decreased oxygen saturation with mild exercise Clinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and use of accessory muscles of respiration. Chest -rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.
Which action by the nurse will be most helpful to a patient who is expected to ambulate, deep breath, and cough on the first postoperative day? Administer prescribed analgesic medications before the activities Ask the patient to state two possible complications of immobility Encourage the patient to state the purpose of splinting the incision Schedule the activity to begin after the patient has taken a nap
Administer prescribed analgesic medications before the activities
A patient with metastatic cancer of the colon experiences severe vomiting after each administration of chemotherapy. Which action, if taken by the nurse, is appropriate? Administer prescribed antiemetics 1 hour before the treatments Have the patient eat large meals when nausea is not present Give the patient a glass of a citrus fruit beverage during treatments Offer dry crackers and carbonated fluids during chemotherapy
Administer prescribed antiemetics 1 hour before the treatments
A patient is ordered at 1400 to take Theophylline. You're assessing the patient's morning lab results and note that the Theophylline level drawn this morning reads: 15 mcg/mL. You're next nursing action is to? Hold the 1400 dose Administer the dose at 1400 as ordered Notify the physician for further orders Collect another blood sample to confirm the level
Administer the dose at 1400 as ordered A normal Theophylline level is 10-20 mcg/mL. Therefore, the level is normal and the nurse should administer the dose at 1400 as ordered.
A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic arthritic joint pain after a traumatic injury complains of nausea and abdominal fullness. Which action should the nurse take initially? Administer the ordered antiemetic medication Order the patient a clear liquid diet until the nausea decreases Consult with the health care provider about using a different opioid Tell the patient that the nausea should subside in about a week
Administer the ordered antiemetic medication
A patient who had knee surgery received IV ketorolac 30 minutes ago and continues to complain of pain at a level of 7 (0-10 scale). Which action is most effective for the nurse to take at this time? Reassure the patient that postoperative pain is expected after knee surgery Administer the prescribed prn IV morphine sulfate Teach the patient that the effects of ketorolac typically last about 6 to 8 hours Notify the health care provider about the ongoing pain
Administer the prescribed prn IV morphine sulfate
A patient with severe COPD is having an episode of extreme shortness of breath and requests their inhaler. Which type of inhaler ordered by the physician would provide the FASTEST relief for the patient based on this particular situation? Spiriva Symbicort Albuterol Salmeterol
Albuterol The patient would best benefit from a SHORT-ACTING bronchodilator to help with the shortness of breath. The only short-acting bronchodilator listed is Albuterol. Spiriva is a long-acting bronchodilator. Symbicort is a combination of long-acting bronchodilator and corticosteroid. Salmeterol is a long-acting bronchodilator.
A patient with osteoarthritis has been taking ibuprofen 400mg every 8 hours. The patient states that the drug doesn't seem to work as well as it used to in controlling the pain. The most appropriate response to the patient is based on what knowledge? Another NSAID may be indicated because of individual variations in response to drug therapy. If NSAIDS is not effective in controlling symptoms, systemic corticosteroids are the next line of drug therapy. The patient may not be taking the drug correctly, so the nurse must assess the patient's knowledge base and provide teaching. It may take several months for NSAIDS to reach its therapeutic levels in the blood and thus be effective.
Another NSAID may be indicated because of individual variations in response to drug therapy.
A client arrives at the emergency department with an exacerbation of chronic obstructive pulmonary disease (COPD) with SpO2 of 78%, hypercapnia, and a respiratory rate of 32 breaths per minute. Which action by the nurse is considered a priority? Apply a partial re-breather mask with FiO2 60-80% and call for a blood gas sample Educate on activity tolerance to minimize further episodes Begin an aminophylline drip and then prepare a tracheotomy tray and alert the HCP Apply a Venturi mask at 24% oxygen setting or nasal cannula 2L/min pending HCP determination.
Apply a Venturi mask at 24% oxygen setting or nasal cannula 2L/min pending HCP determination. This answer is correct because the nurse may initiate a Venturi mask at 24% for hypercapnia in a client with COPD, but will monitor for oxygen delivery settings, oxygen saturations, and a respiratory assessment. The respiratory drive of a client with healthy lungs is hypercapnia, or build-up of carbon dioxide within the lungs. The respiratory drive of a client with COPD is hypoxemia because COPD clients are chronically hypercapnic. Given that decreased oxygen concentration within the blood is the force behind what causes a COPD client to breathe, a Venturi mask is the perfect choice of an oxygen delivery device as the amount of FIO2 delivered to the client can be precisely regulated.
A nurse prepares an adult patient with a severe burn injury for a dressing change. The nurse knows that this is a painful procedure and wants to try providing music to help the patient relax. Which action is best for the nurse to take? Play music that does not have words Ask the patient about music preferences Select music that has 60 to 80 beats/minute Use music composed by Mozart
Ask the patient about music preferences
Prior to giving a requested pain medication to a patient, the nurse would: Call the doctor Assess their pain on a 0-10 pain scale Wait longer, the patient did not appear to be uncomfortable Assess vital signs
Assess their pain on a 0-10 pain scale Asking the patient to rate their pain on a 0-10 pain scale, as they are requesting pain medication, is important for assessment, evaluation and documentation. Second, vital signs should be taken before giving a pain medication. The nurse does not wait longer, we take the information that the patient reports. There is not a need to call the doctor at this time.
Which of the following is NOT a sign and symptom of chronic bronchitis? Shortness of breath Cyanosis Barrel chest Productive cough
Barrel chest most commonly found in patients with emphysema.
During the admission assessment, a hospitalized client with pneumonia is questioning the health care provider's order for bedrest. Which statement by the nurse best explains the reason for the bedrest order? Bed rest will give you the needed break from work and family. Bed rest will ease pain during coughing Bed rest will reduce demand for oxygen Bed rest will help you cough and deep breathe better.
Bed rest will reduce demand for oxygen Pneumonia is an inflammatory condition that affects the alveoli. The alveoli become inflamed and filled with fluids which decreases the effectiveness of gas exchange. Decreased gas exchange causes hypoxemia is exacerbated with activity. Bedrest decreases the client's oxygen demand, therefore bedrest is prescribed.
The clinical manifestations in a 'pink puffer' patient include all of the following except: Pink skin Blue Skin-'cyanotic' Sitting in a 'tripod' position Barrel chest
Blue Skin-'cyanotic'
A patient who has good control for chronic pain using a fentanyl patch (Duragesic) patch reports rapid onset pain at a level 9 (0-10 scale) and requests "something for pain that will work quickly." How will the nurse document the type of pain reported by this patient? Breakthrough pain Referred pain Neuropathic pain Somatic pain
Breakthrough pain
A Cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the side and adverse effects of the medication and should tell the client that which undesirable effect is associated with this medication? bronchospasm constipation Insomnia hypotension
Bronchospasm Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. Undesirable effects associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing. Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia.
The nurse is caring for a patient who had abdominal surgery yesterday and is receiving morphine through patient-controlled analgesia (PCA). What action by the nurse is a priority? Assessing for nausea Evaluating for sacral redness Auscultating bowel sounds Checking the respiratory rate
Checking the respiratory rate
Which assessment finding in a client with COPD indicates to the nurse that the client's respiratory problem is chronic? Productive cough Generalized cyanosis Clubbing in fingers Wheezing on exhalation
Clubbing in fingers The clinical manifestation of clubbing of the fingers takes time, indicating that the condition is chronic and not acute. The other answers are non-specific for chronicity, so they are incorrect.
A client begins therapy with theophylline. The nurse plans to teach the client to limit the intake of which items while taking this medication? Oysters, lobster, and shrimp Melons, oranges, and pineapple Cottage cheese, cream cheese, and dairy creamers Coffee, cola, and chocolate
Coffee, cola, and chocolate Theophylline is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. The foods include coffee, cola, and chocolate.
A nurse assesses a postoperative patient 2 days after chest surgery. What findings indicate that the patient requires better pain management? (select all that apply) Confusion Elevated temperature Shallow breathing Hypoglycemia
Confusion Elevated temperature Shallow breathing
A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition? Respirations of 18 breaths per minute Pulse rate of 90 beats per minute Warm, dry skin Decreased wheezing
Decreased wheezing sthma is a chronic inflammatory disease of the airways. Decreased wheezing in a child with asthma may be interpreted incorrectly as a positive sign when it may actually signal an inability to move air. A "silent chest" is an ominous sign during an asthma episode. With treatment, increased wheezing actually may signal that the child's condition is improving. Warm, dry skin indicates an improvement in the child's condition, because the child is normally diaphoretic during exacerbation. The normal pulse rate in a 10-year-old is 70 to 110 beats per minute. The normal respiratory rate in a 10-year-old is 16 to 20 breaths per minute.
The nurse is caring for a patient being treated with IV fluid therapy for severe vomiting. As the patient recovers and tolerates oral intake, which food choice would be most appropriate? Hot coffee Plain yogurt Iced tea Dry toast
Dry Toast
Mr. S is a 65-year-old male who is admitted to the telemetry unit for treatment of pneumonia of the right middle lobe. His morning assessment reveals the following data: T: 100.4, Pulse: 110, RR: 24, B/P: 108/68, and O2 saturation 89% on room air. Which diagnostic studies does the nurse anticipate for this client? Choose all that apply. Scroll down to review the 6 answer choices. Elevated WBC's > 10,000 EKG Chest -xray Sputum Culture ABG's Decreased WBC's
Elevated WBC'S > 10,000 Chest -xray Sputum Culture ABG's
Which statements are TRUE about chronic bronchitis and emphysema? Select all that apply: Patients with chronic bronchitis have the ability to fully exhale but have limited airflow. Emphysema and chronic bronchitis are irreversible. An incentive spirometer is used to diagnose both chronic bronchitis and emphysema. Patients with chronic bronchitis are sometimes referred to as "blue bloaters, while patients with emphysema are sometimes referred to as "pink puffers".
Emphysema and chronic bronchitis are irreversible. Patients with chronic bronchitis are sometimes referred to as "blue bloaters, while patients with emphysema are sometimes referred to as "pink puffers"
While providing home care instructions to the mother of a child diagnosed with right lobar pneumonia, which intervention will the registered nurse (RN) instruct her to implement? Select all that apply. Encourage child to take deep breaths frequently Position the child on the right side frequently Administer acetaminophen as needed for increased fever Administer cough syrup if cough becomes too strong
Encourage child to take deep breaths frequently Position the child on the right side frequently Administer acetaminophen as needed for increased fever Pneumonia is an inflammation of the pulmonary parenchyma. Care of the child diagnosed with pneumonia includes interventions to mobilize pulmonary secretions and expand the lungs. Implementation of chest physiotherapy and turn, cough, deep breath exercises can assist in mobilizing the secretions. Position the child in a high-fowler's position and as possible, lie with the bad lung down. Encourage increased fluid intake to loosen secretions. Administer antipyretics and antibiotics as ordered. Do not administer cough suppressants.
The mother of an 5-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child complains of discomfort on the right side and that ibuprofen is not effective. Which instruction should the nurse provide to the mother? Increase the dose of ibuprofen Encourage the child to lie on the left side Increase the frequency of ibuprofen Encourage the child to lie on the right side
Encourage the child to lie on the right side Pneumonia is an inflammation of the pulmonary parenchyma or alveoli, or both, caused by a virus, mycoplasmal agents, bacteria, or aspiration of foreign substances. Splinting of the affected side by lying on that side may decrease discomfort. It would be inappropriate to advise the mother to increase the dose or frequency of the ibuprofen. Lying on the left side would not be helpful in alleviating discomfort.
The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. What is the primary reason for the nurse to carefully inspect the chest wall of this patient? Monitor the patient for bilateral chest expansion Allow time to calm the patient Observe for signs of diaphoresis Evaluate the use of intercostal muscles
Evaluate the use of intercostal muscles The use of intercostal muscles is an indication of the degree of respiratory distress experienced by the patient. The nurse must observe for any accessory muscle use.
An elderly patient with chronic arthritis asks you for suggestions for pain relief and does not want to depend on pain medications. You advise the following possible measures: Choose all that apply. Scroll down to view the 6 answer choices. Massage Guided Imagery NSAIDS Massage Music Therapy Heat/Cold Therapies
Everything but NSAIDS NSAIDS are a pharmacological intervention.
True or false. COPD patient exhibits peripheral edema, jugular vein distention and weight gain. They may be experiencing left sided heart failure.
FALSE Patient with COPD may develop right sided heart failure, not left sided heart failure. Key signs are peripheral edema, jugular vein distention, weight gain and a heart murmur.
True or False. Patients with emphysema experience hypoventilation as a compensatory mechanism to help increase oxygen levels and decrease carbon dioxide levels in the body.
FALSE. Patients with emphysema experience HYPERventilation as a compensatory mechanism to help increase oxygen levels and decrease carbon dioxide levels in the body.
The nurse educator is explaining how to assess pain in infants to a group of new nurses. Which behaviors should be explained as the most consistent indicators of pain in infants? Increased heart rate Facial expression and withdrawing Squirming and jerking Increased respirations
Facial expression and withdrawing
True or False. Morphine may be given to a patient with COPD who is complaining of chest discomfort with coughing.
False Opioids (Morphine, hydromorphone, hydrocodone and oxycodone) are not given to COPD patients because it decreases respirations, creating less ventilation.
The nurse is performing an admission assessment for a hospitalized client with a diagnosis of asthma. The nurse questions the admitting order for ipratropium bromide (Atrovent) because the client has a history of which condition? Anticoagulation therapy Glaucoma Cushing disease Peripheral edema
Glaucoma Ipratropium bromide is an inhaled anticholinergic medication used to treat bronchoconstriction in clients with asthma and other respiratory illnesses. It is normally used in combination with a short-acting beta agonist to reverse bronchoconstriction. Side effects of anticholinergic medications include dry eyes, dry mouth, blurred vision, and urinary retention. Anticholinergics are contraindicated in clients with glaucoma because through their mechanism of action, they can dilate the pupil which can lead to a pupillary block.
Which question asked by the nurse will give the most information about the patient's metastatic bone cancer pain? "How much medication do you take for the pain?" "How would you describe your pain?" "How often do you take pain medication?" "How long have you had this pain?"
How would you describe your pain?"
The nurse is instructing the client on the use of a beclomethasone (Vanceril) inhaler. Which statement by the client indicates that teaching is successful? I will hold my diabetic medication for 2 hours before and after the inhaler I will rinse my mouth following each scheduled dose I will use the inhaler prior to sleep I will inhale then blow out forcefully
I will rinse my mouth following each scheduled dose Beclomethasone is a corticosteroid medication used to help decrease the inflammation within the airways of clients with certain respiratory conditions such as COPD. Corticosteroids, when inhaled can irritate the mucus membranes within the oral cavity leading to the development of oral candidiasis or thrush. The client should be taught to use their steroid inhaler last and to rinse the mouth after each use.
The nurse is caring for a patient with pneumonia. If a pleural effusion is developing, the nurse would expect which finding? Localized decreased breath sounds Paradoxical respirations Hyperresonance on percussion Barrel-shaped chest
Localized decreased breath sounds Clinical manifestations of pleural effusion include diminished breath sounds over the affected area, decreased movement of the chest on the affected side, dullness to percussion, dyspnea, cough, and occasional sharp and non-radiating chest pain that is worse on inhalation.
Patients with chronic bronchitis and emphysema can MOST COMMONLY experience what type of acid-base imbalance? High oxygen level and low carbon dioxide level High oxygen level and high carbon dioxide level Low oxygen level and low carbon dioxide level Low oxygen level and high carbon dioxide level
Low oxygen level and high carbon dioxide level
A patient with chronic pain who has been receiving morphine sulfate 20 mg IV over 24 hours is to be discharged home on oral sustained-release morphine (MS Contin) administered twice a day. What dosage of MS Contin will be needed for each dose to obtain an equianalgesic dose for the patient? (Morphine sulfate 10 mg IV is equianalgesic to morphine sulfate 30 mg orally.) MS Contin 120 mg/dose MS Contin 60 mg/dose MS Contin 30 mg/dose MS Contin 15 mg/dose
MS Contin 30 mg/dose Morphine sulfate 20 mg IV over 24 hours will be equianalgesic to MS Contin 60 mg in 24 hours. Because the total dose needs to be divided into two doses, each dose should be 30 mg.
A 2-day post-operative right-below-knee amputation patient complains of right foot pain at an '8' on 0-10 pain scale. The nurse's most appropriate response would be to: Refer the patient to psychiatry Explain to the patient that the pain is 'not real' because the foot is not there Encourage guided imagery Medicate the patient for pain, as ordered.
Medicate the patient for pain, as ordered. Medicating the patient for pain is the appropriate nursing response as the patient is rating his right foot pain at an '8' on a 0-10 pain scale. The patient does not to be referred to a psychiatrist and a nurse does not tell the patient thet their pain is not real. Guided imagery is inappropriate at this time.
Which of the following is NOT a treatment for chronic bronchitis or emphysema? Albuterol Spirvia Metoprolol Theophylline
Metoprolol This is a beta blocker used to treat heart conditions. Albuterol, Spirvia, and Theophylline are types of bronchodilators which are used to treat chronic bronchitis & emphysema.
Which clinical manifestations will the registered nurse (RN) expect to assess in a child diagnosed with pneumonia? Select all that apply. Mid-sternal retractions Shallow slow respiratory rate Presence of yellow/white sputum Auscultation of crackles
Mid-sternal retractions Presence of yellow/white sputum Auscultation of crackles Pneumonia is an inflammation of the pulmonary parenchyma. It is a common occurrence in infants and young children. The onset of symptoms may be insidious or acute. The cough may initially be unproductive and then become productive with expectoration of white to yellow sputum. Pallor, cyanosis, sternal retractions, and nasal flaring may be observed. A physical exam will reveal dullness with percussion of the chest, tachypnea, and auscultation of crackles. The child will present with an elevated temperature greater than 100.4 F (38 C).
The nurse is caring for a patient receiving morphine sulfate 10 mg IV push when necessary for pain. Upon assessment, the nurse finds the patient obtunded with a respiratory rate of 8 breaths/min. Which medication would the nurse prepare to administer to treat these symptoms? Protamine Sulfate Atropine Acetaminophen Naloxone
Naloxone
A patient is concerned that he may have asthma. Of the symptoms that he describes to the nurse, which ones suggest asthma or risk factors for asthma? (select all that apply) Obesity Prolonged inhalation Allergic rhinitis Gastric reflux or heartburn
Obesity Allergic rhinitis Gastric reflux or heartburn
Which patients have the greatest risk for aspiration pneumonia? (select all that apply) Patient with a head injury Patient who had a myocardial infarction Patient who is receiving nasogastric tube feeding Patient with seizures
Patient with a head injury Patient who is receiving nasogastric tube feeding Patient with seizures Aspiration pneumonia results from the abnormal entry of material from the mouth or stomach into the trachea and lungs. Conditions that increase the risk for aspiration include decreased level of consciousness (i.e. seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and insertion of nasogastric (NG) tubes with or without enteral feeding. With loss of consciousness, the gag and cough reflexes are depressed and aspiration is more likely to occur.
The nurse is discussing the techniques of chest physiotherapy and postural drainage (respiratory treatments) to a client having expectoration problems because of chronic thick, tenacious mucus production in the lower airway. The nurse explains that after the client is positioned for postural drainage the nurse will perform which action to help loosen secretions? Palpation and clubbing Hyperoxygenation and suctioning Percussion and vibration Administer a bronchodilator and monitor peak flow
Percussion and vibration Chest physiotherapy of percussion and vibration helps to loosen secretions in the smaller lower airways. Postural drainage positions the client so that gravity can help mucus move from smaller airways to larger ones to support expectoration of the mucus.
A nurse is caring postoperatively for an 8-year-old child in severe pain with multiple fractures and other trauma caused by a motor vehicle injury. Which is the most important consideration in managing the child's pain? Give the child a clock and explain when he or she can have pain medications. Give only an opioid analgesic at this time. Plan a preventive schedule of pain medication around the clock. Increase the dosage of analgesic until the child is adequately sedated.
Plan a preventive schedule of pain medication around the clock.
Causes fever...
Pneumonia
The nurse instructs a client to use the pursed-lip method of breathing and evaluates the teaching by asking the client about the purpose of this type of breathing. The nurse determines that the client understands if the client states that the primary purpose of pursed-lip breathing is to promote which outcome? Strengthen the intercostal muscles Strengthen the diaphragm Promote carbon dioxide elimination Promote oxygen intake
Promote carbon dioxide elimination Promote oxygen intake Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation.
A nurse instructs a COPD client to use the pursed-lip method of breathing and evaluates the teaching by asking that client about the purpose of this type of breathing. The nurse determines that the client understands if the client states that the primary purpose of pursed-lip breathing is to promote which outcome? Strengthen the diaphragm Strengthen the intercostal muscles Promote carbon dioxide elimination Promote oxygen intake
Promote carbon dioxide elimination Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation. The other options are NOT the purposes of this type of breathing.
The nurse begins the hospital shift by assessing a client with a diagnosis of exacerbation of chronic obstructive pulmonary disease (COPD). The nurse expects to document which findings? Select all that apply. Pursed-lip breathing Increased vital capacity on pulmonary function studies Hypercapnia Hematuria Oxygen desaturation when ambulating with physical therapy
Pursed-lip breathing Hypercapnia Oxygen desaturation when ambulating with physical therapy Clients with COPD will display many different expected clinical manifestations. Emphysema causes a loss of elasticity within the alveoli leading to the retention of CO2 and hypercapnia. Another common finding in clients with emphysema is a barrel chest caused by air trapping. COPD clients will often use pursed-lip breathing in an effort to fully ventilate by increasing the pressure within the lungs during exhalation. Oxygen desaturation with activity is also common due to destructive changes within the alveoli making gas exchange difficult.
Mr. S is a 65-year-old male who is admitted to the telemetry unit for treatment of pneumonia of the right middle lobe. His morning assessment reveals the following data: T: 100.4, Pulse: 110, RR: 24, B/P: 108/68, and O2 saturation 89% on room air. Which additional assessments should the nurse perform first? Choose all that apply. Respiratory effort and use of accessory muscles Cardiac sounds Mental status changes Breath Sounds
Respiratory effort and use of accessory muscles Mental status changes Breath Sounds The additional assessments that the nurse must complete are breath sounds, assessing for rales or rhonchi. Mental status changes as these could be early signs of early hypoxia (low oxygen) and respiratory effort with use of accessory muscles and a presence of cough, Cardiac sounds are not part of the additional assessments that must be performed first.
The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the client to assume? Sitting up and leaning on an overbed table Sitting up in a recliner chair Sitting up in bed Side-lying in bed
Sitting up and leaning on an overbed table Positions that will assist the client with emphysema with breathing include sitting up and leaning on an overbed table, sitting up and resting the elbows on the knees, and standing and leaning against the wall.
You are providing teaching to a patient with chronic COPD on how to perform diaphragmatic breathing. This technique helps do the following: Encourages the use of accessory muscles to help with breathing Decrease the use of the abdominal muscles Strengthen the diaphragm Increase the breathing rate to prevent hypoxemia
Strengthen the diaphragm Diaphragmatic breathing helps strengthen the diaphragm because it has become flatten due to the hyperinflation of the lungs. Due to the flattening of the diaphragm, the body is unable to breathe with ease and must use the accessory muscles to compensate. Therefore, diaphragmatic breathing helps DECREASE the breathing rate to prevent hypoxemia, INCREASES the use of the abdominal muscles RATHER than accessory muscles and strengthens the diaphragm.
A patient who has frequent migraines tell the nurse, "My life feels chaotic and out of my control. I could not manage if anything else happens." Which response should the nurse make initially? "Regular exercise may get your mind off the pain." "Tell me more about how your life has been recently." "Guided imagery can be helpful in regaining control." "Your previous coping resources can be helpful to you now."
Tell me more about how your life has been recently.
The nurse is conducting preoperative teaching with a client about the use of an incentive spirometer. The nurse should include which piece of information in discussions with the client? After maximum inspiration, hold the breath for 15 seconds and exhale Inhale as rapidly as possible The best results are achieved when sitting up or with the head of the bed elevated 45 to 90 degrees Keep a loose seal between the lips and the mouthpiece
The best results are achieved when sitting up or with the head of the bed elevated 45 to 90 degrees
A client with emphysema should receive only 1 to 3 L/minute of oxygen if needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive? The client breathes only when his oxygen levels dip below a certain point. The client breathes only when his oxygen levels climb above a certain point. The client doesn't notice he needs to breathe. The client breathes only when his carbon dioxide level dips below a certain point.
The client breathes only when his oxygen levels dip below a certain point. Clients with emphysema breathe when their oxygen levels drop to a certain level; this is known as the hypoxic drive. In the meantime, his carbon dioxide levels continue to climb, and the client will pass out, leading to a respiratory arrest. The hypoxic drive theory then goes on to say that if the healthcare provider gives these patients too much oxygen they blunt their hypoxic drive. As their chemoreceptors are already tolerant of high levels of carbon dioxide, and therefore they have also lost that drive, their respirations will begin to slow causing a further rise in carbon dioxide levels, and a consequent acidosis.
The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease (COPD). The nurse received a new order for a metered-dose inhaler (MDI) and immediately notifies the health care provider because of which important finding? Long-acting anticholinergic should be contraindicated in clients with COPD. The client has severe arthritis in both hands. The client has trouble hearing. The client is a smoker.
The client has severe arthritis in both hands. A client with arthritis will not be able to manipulate the inhaler properly in order to receive the full dose and this finding should be reported to the prescribing health care provider (HCP).
A nurse caring for a client with chronic obstructive pulmonary disease (COPD) auscultates wheezes and diminished breath sounds. The wheezes and diminished breath sounds indicate that the client is experiencing which complication of COPD? The client is experiencing hypersaturation in oxygen. The client has a complication of pneumonia. The client is experiencing pulmonary emboli. The client is experiencing a bronchospasm.
The client is experiencing a bronchospasm. Wheezes are a high pitched, musical sound mainly heard during exhalation but can also be heard upon inspiration. Wheezes are most commonly heard in clients with asthma but are also fairly common in clients with COPD. The sound produced when wheezes are auscultated is caused by narrowing of the airway during bronchospasm or bronchoconstriction.