Med Surg 2 EAQ's

Which lung volumes and capacity is expressed as a forced expiratory volume (FEV)? 1. Volume of air expired during specified time intervals 2. Amount of air remaining in the lungs after normal expiration 3. Total volume of air that can be exhaled after maximum inspiration 4. Maximum volume of air that can be inhaled after a normal expiration

1. Volume of air expired during specified time intervals Forced expiratory volume is the volume of air expired during specified time intervals (0.5, 1.0, 2.0, 3.0 seconds). Functional residual capacity is the volume of air remaining in the lungs after normal expiration. Vital capacity is the total volume of air that can be exhaled after maximum inspiration. Inspiratory capacity is the maximum volume of air that can be inhaled after a normal expiration.

The nurse is observing a new graduate nurse during suctioning of a tracheostomy patient. Which action by the graduate nurse would require intervention? 1. Applying suction while inserting the catheter. 2. Limiting the suction time to 10 seconds or less. 3. Keeping the suction vent open while inserting the catheter 4. Providing preoxygenation for a minimum of 30 seconds before the procedure

1. Applying suction while inserting the catheter. Suction is NOT applied while inserting the catheter; intermittent suction is applied as the catheter is being withdrawn. Preoxygenation is also required before suctioning, and suction time should be limited to 10 seconds or less. To minimize depletion of oxygen, keep the suction vent open while inserting the catheter.

Which is the first step for performing the supraglottic swallow? 1. Ask the patient to take a deep breath to aerate lungs. 2. Ask the patient to place food in the mouth and swallow. 3. Perform the Valsalva maneuver to approximate the cords. 4. Ask the patient to cough to remove food from the top of the vocal cords.

1. Ask the patient to take a deep breath to aerate lungs. Asking the patient to take a deep breath to aerate the lungs would be the first step of the process of performing the supraglottic swallow. Then, the patient would bear down to perform the Valsalva maneuver, place food in the mouth and swallow, then cough as the patient breathes out to clear the cords.

Which disease process is a potentially reversible obstructive airway disorder characterized by airway inflammation, hyperresponsiveness, and obstruction? 1. Asthma 2. Emphysema 3. Cor pulmonale 4. Chronic bronchitis

1. Asthma Asthma is a potentially reversible obstructive airway disorder characterized by airway inflammation, hyperresponsiveness, and obstruction. Pulmonary emphysema is a degenerative nonreversible disease characterized by the enlargement of the airways beyond the terminal bronchioles. Cor pulmonale is the term used to describe right-sided heart failure, secondary to pulmonary disease. Chronic bronchitis is bronchial inflammation characterized by increased production of mucus and chronic cough that persists for a specific amount of time.

Which instructions should the nurse include when teaching self-care to a patient with acute pharyngitis? Select all that apply. 1. Avoid contact with individuals with compromised immune systems. 2. Restrict fluid intake. 3. A strawberry-red tongue is normal with pharyngitis. 4. Ice cream, pudding, and applesauce can be taken. 5. Use a humidifier in the home.

1. Avoid contact with individuals with compromised immune systems. 4. Ice cream, pudding, and applesauce can be taken. 5. Use a humidifier in the home. Symptom relief is a major goal of nursing management in a patient with acute pharyngitis. The patient should avoid contact with individuals with compromised immune systems as the patient is contagious for several days. Ice cream, pudding, and applesauce, or other soft or liquid diet items are encouraged. A humidifier may be prescribed to increase moisture in the room air. The patient should increase fluid intake to keep the secretions thin so they can be easily expectorated. A strawberry-red tongue is not normal and should be reported to the health care provider.

What would be included in the teaching plan for a patient with pneumonia? Select all that apply. 1. Avoid people with colds. 2. Maintain fluid restrictions. 3. Gradually increase activity. 4. Complete any prescribed drugs. 5. Maintain good nutrition and rest. 6. Avoid using antipyretic medications.

1. Avoid people with colds. 3. Gradually increase activity. 4. Complete any prescribed drugs. 5. Maintain good nutrition and rest. The plan of care for the patient with pneumonia would include avoiding people with colds, gradually increasing activity, completing any prescribed drugs, and maintaining good nutrition and rest. Patients with pneumonia should consume 3 liters of fluid per day. Patients with pneumonia can use antipyretics to reduce temperature.

The nurse is working with another nurse to change the tracheostomy dressing for a mechanically ventilated person. The nurse has removed the old dressing, cleansed the site, and is preparing to apply a fresh dressing and realizes that the gauze sponge is not a precut drain sponge. Which intervention is best? 1. Cut the gauze to create a drain sponge. 2. Retie the tracheostomy ties and get the correct dressing. 3. Use multiple pieces of gauze to create a drain sponge. 4. Keep tracheostomy ties secured and let the patient rest without a dressing.

2. Retie the tracheostomy ties and get the correct dressing. The nurse should retie the tracheostomy ties and obtain the correct dressing. Cutting gauze for tracheostomy dressing leads to the gauze fibers entering the stoma. If absolutely necessary, the nurse could use multiple pieces of gauze to create a drain sponge, but this is not the best intervention. The patient requires a dressing under the tracheostomy to prevent skin breakdown.

Which position is best for the nurse to assist a patient into after a tonsillectomy with general anesthesia? 1. Supine 2. Semiprone 3. Semi-Fowler 4. Trendelenburg

2. Semiprone A patient who is in recovery after a tonsillectomy with general anesthesia should be place on their side or semiprone. Patients would not be in the supine position nor Trendelenburg, because these positions can cause pooling of drainage that can be aspirated. Semi-Fowler position would be used for patients who received local anesthesia.

A patient's breathing pattern is regular, the depth is even, and the rate is faster than 20 beats per minute. Which breathing pattern will be documented by the Licensed Practical Nurse (LPN)? 1. Normal 2. Tachypnea 3. Hyperpnea 4. Bradypnea

2. Tachypnea This breathing pattern is tachypnea, which can result from fever, pain, and anxiety. Normal breathing has a regular pattern, an even depth, and a rate of 12 to 20 breaths per minute. Hyperpnea is characterized by a consistent pattern, increased depth, and a rate that is faster than 20 breaths per minute. Bradypnea is defined by a regular pattern, even depth, and a rate that is slower than 12 breaths per minute.

Which symptom indicates a patient's pharyngitis is caused by bacteria? 1. Fever 2. Tonsillar exudate 3. Absence of cough 4. Enlarged lymph nodes

3. Absence of cough A patient with bacterial pharyngitis would not have a cough. A cough is present in viral pharyngitis. Fever, tonsillar exudate, and enlarged lymph nodes are present in both viral and bacterial pharyngitis.

Which statement best describes influenza? 1. A bacterial respiratory condition 2. A broad-spectrum antibiotic agent 3. An acute viral respiratory infection that is accompanied by fever 4. A common condition that may come after a viral infection such as a cold

3. An acute viral respiratory infection that is accompanied by fever Influenza is an acute viral respiratory infection that is accompanied by fever. Influenza is not a bacterial infection. Treatment with a broad-spectrum antibiotic agent refers to bronchitis. Acute bronchitis is a common condition that may come after a viral infection such as a cold.

A patient has a fever and reports joint pain. There are no other symptoms. The patient is requesting that the nurse administer medication. Cultures taken were negative for strep throat and there is no evidence of nasal congestion or discharge. Which medication from the patient's prescribed as needed (PRN) list of medications should the nurse administer? 1. Antihistamines: diphenhydramine 50 mg 2. Sympathomimetics: pseudoephedrine 30 mg 3. Antipyretics: nonsteroidal antiinflammatory drugs, such as ibuprofen 200 mg 4. Opioid analgesics: codeine 30 mg with acetaminophen 325 mg

3. Antipyretics: nonsteroidal antiinflammatory drugs, such as ibuprofen 200 mg Antipyretics are used to reduce body temperature and inflammation. Antihistamines are used to block the effects of histamine, treat allergic reactions, and prevent motion sickness. Sympathomimetics are used to reduce congestion. Opioid analgesics are used to reduce pain.

A patient who has smoked for the past 40 years is diagnosed with emphysema and likely has which type? 1. Panlobular 2. Pneumonitis 3. Centrilobular 4. Pneumoconiosis

3. Centrilobular Centrilobular (centriacinar) emphysema is associated primarily with cigarette smoking, whereas panlobular (panacinar) emphysema is of hereditary origin. Pneumonitis is an allergic inflammatory response of the alveoli to organic particles, and pneumoconiosis is a disease caused by inhalation of various dusts.

Upon several visits to the clinic, it has been noted that the patient has a permanent thickening of the mucous membranes in the sinuses. Which condition is most likely related to this observation of the mucous membranes? 1. Laryngitis 2. Cocaine use 3. Chronic sinusitis 4. Nasal polyps and tumors

3. Chronic sinusitis Chronic sinusitis is a permanent thickening of the mucous membranes in the sinuses after repeated infections. Laryngitis, cocaine use, and nasal polyps and tumors do not cause permanent thickening.

Which additional symptom in a patient with a lump in the throat and hemoptysis would suggest possible laryngeal cancer? 1. Edema 2. Nausea 3. Dysphagia 4. Weight gain

3. Dysphagia Signs of laryngeal cancer include a lump in the throat, persistent hoarseness, hemoptysis, and dysphagia. Edema and nausea are unrelated symptoms. Later in the disease a patient may experience weight loss and pain.

Which structure of the throat prevents food and fluid from entering the airway? 1. Tonsils 2. Larynx 3. Epiglottis 4. Eustachian tubes

3. Epiglottis The epiglottis lies on top of the larynx; it is a flap that works like a trapdoor, closing during swallowing to prevent food and fluid from entering the airway. Tonsils and adenoids are masses of lymphatic tissue that guard against bacterial invasion of the respiratory and digestive tracts. The larynx is the passageway between the throat and the trachea. The eustachian tubes originate in the middle ear and open into the nasopharynx; they serve as pressure vents to prevent excessive pressure from building up in the middle ear.

Which assessment would concern the nurse the most immediately after a tonsillectomy? 1. Pain 2. Dysphagia 3. Excessive swallowing 4. Blood-tinged drainage

3. Excessive swallowing Excessive swallowing should be noted because it may indicate active bleeding after a tonsillectomy. Pain controlled by mild-to-moderate analgesics is expected after a tonsillectomy. Dysphagia is difficulty swallowing and is an expected assessment immediately after a tonsillectomy. Blood-tinged drainage is normal at first but should gradually decrease after a tonsillectomy.

Which assessment finding indicates continued bleeding in a patient with nasal packing? 1. Confusion 2. Productive cough 3. Frequent swallowing 4. Bilateral pulmonary crackles

3. Frequent swallowing Frequent swallowing indicates continued bleeding. Confusion, productive cough, and bilateral pulmonary crackles are symptoms related to lower respiratory disorders such as pneumonia. They are not signs of continued bleeding in a patient with nasal packing.

For a patient on pseudoephedrine, what instruction is the most important?? 1. "Do not attempt to breast-feed while taking this medication." 2. "You may expect to feel slightly agitated after taking the medication." 3. "Swallow the extended-release tablets whole; do not try to break or crush them." 4. "Call your health care provider if you feel dizzy, nauseous, or your heart is racing."

4. "Call your health care provider if you feel dizzy, nauseous, or your heart is racing." Reporting symptoms of dizziness, nausea, or tachycardia is most important because these signs could be evidence of toxicity. The patient should also be told that he or she should not breast-feed, might feel slightly agitated, and must swallow the extended-release tablets whole, but these instructions are less vital than the symptoms of toxicity.

Which statement by the patient would describe the pain associated with pleurisy? 1. "I don't have pain." 2. "The pain is diffuse and intermittent." 3. "The pain is a burning sensation over my entire chest." 4. "The pain is severe, only on one side, and when I cough or breathe the pain is worse."

4. "The pain is severe, only on one side, and when I cough or breathe the pain is worse." The most characteristic symptom of pleurisy is abrupt and severe pain. The pain almost always occurs on one side of the chest, and patients can usually point to the exact spot where the pain is occurring. Breathing and coughing aggravate the pain. Diffuse, intermittent, and burning pain are not characteristic of pleurisy.

What is the initial treatment for pulmonary embolism? 1. Embolectomy 2. Venous thrombectomy 3. Vena cava interruption 4. Anticoagulation therapy

4. Anticoagulation therapy Anticoagulation therapy is the cornerstone of treatment for pulmonary embolism. Embolectomy, surgical removal of the embolus from the obstructed pulmonary arteries, is a risky procedure and is reserved for patients who are not candidates for fibrinolytic therapy. Venous thrombectomy, removal of thrombi from veins, is not often done. Vena cava interruption is most often done by placing a filter in the inferior vena cava to strain clots before they reach the pulmonary circulation.

A patient's oxygen saturation reading is 88% on pulse oximetry and the patient has no previous history of respiratory disease. What would be the nurse's response to this assessment? 1. Increase oxygen. 2. Give the patient pain medication. 3. This is a normal reading, so do nothing. 4. Call your supervisor or the health care provider.

4. Call your supervisor or the health care provider. Pulse oximetry permits the noninvasive measurement of oxygen (O2) saturation. Normal pulse oximetry is 95% or higher; 88% is not a normal reading. Notify your supervisor or the health care provider of any reading less than 90%. The nurse would need an order to increase the oxygen level. Giving pain medication would not increase the oxygen saturation for this patient.

Which sound is caused by secretions accumulating in the large airways, and usually clears with coughing? 1. Wheeze 2. Rhonchus 3. Fine crackle 4. Coarse crackle

4. Coarse crackle A coarse crackle is a discontinuous, popping lung sound that usually results from secretions accumulating in the larger airways; these crackles usually clear with coughing. A wheeze is a high-pitched sound that might be present with asthma or chronic obstructive pulmonary disease. A rhonchus is a dry, rattling sound that has been compared with snoring and is caused by a partial bronchial obstruction. A fine crackle develops in response to fluid accumulation in the alveoli that is louder and lower than a coarse crackle. Unlike a coarse crackle, a fine crackle does not clear with coughing.

Which statement about a deviated septum is correct? 1. All septal deviations are symptomatic. 2. A septoplasty will not correct a deviated septum. 3. Epistaxis is a rare manifestation of a deviated septum. 4. Conservative treatment involves management of nasal allergies.

4. Conservative treatment involves management of nasal allergies. Conservative treatment of a deviated septum is focused on symptom control of nasal inflammation and congestion. All septal deviations are not symptomatic. A septoplasty will correct a deviated septum. Epistaxis is a common manifestation of a deviated septum.

What is the hereditary disease characterized by altered function of the exocrine glands? 1. Sickle cell disease 2. Tay-Sachs disease 3. Spinal muscular atrophy 4. Cystic fibrosis (CF)

4. Cystic fibrosis (CF) CF is a hereditary disease characterized by altered function of the exocrine glands. This defect primarily affects the lungs, pancreas, biliary tract, and sweat glands. Sweat glands excrete increased amounts of sodium and chloride. Although sickle cell disease, Tay-Sachs disease, and spinal muscular atrophy are all hereditary diseases, they are not characterized by altered function of the exocrine glands.

The nursing diagnosis of effective breathing patterns, in a patient with pleurisy, includes which nursing intervention? 1. Keep the patient supine. 2. Avoid the use of pain medications. 3. Reduce fluids to less than 1 liter per day. 4. Encourage the patient to turn, take deep breaths, and cough.

4. Encourage the patient to turn, take deep breaths, and cough. Encouraging the patient to turn, take deep breaths, and cough if permitted will mobilize secretions and maximize ventilation. Keeping the patient supine would not encourage effective breathing patterns, so the nurse should elevate the head of the bed. Pain medications may help with pain and encourage effective breathing patterns. Maintain fluids at 3 liters per day for a patient with pleurisy.

Which is the most appropriate diet for a patient immediately after a partial laryngectomy? 1. Regular 2. Semisolids 3. Clear liquids 4. Enteral feedings

4. Enteral feedings If a patient has a partial laryngectomy, a temporary tracheostomy for 2 to 5 days can be expected. Therefore intravenous fluids and enteral feedings are usually ordered at first. A regular diet would not be appropriate. When oral nourishment is resumed, semisolids are often easier to manage than thin liquids.

Which medication is considered a leukotriene inhibitor? 1. Streptokinase 2. Acetylcysteine 3. Cromolyn sodium 4. Montelukast sodium

4. Montelukast sodium Montelukast sodium is a leukotriene inhibitor that is useful in the treatment of asthma. Leukotriene inhibitors inhibit the allergic response, thereby helping prevent, but not interrupt, acute asthmatic attacks. Cromolyn sodium is a mast-cell stabilizer that reduces the production of chemicals by the mast cells that cause bronchoconstriction, edema, and inflammation; it is used to prevent acute asthma attacks but is not useful in stopping the attack after it starts. Streptokinase is a thrombolytic medication that may be used to dissolve blood clots in the lungs. Acetylcysteine is a mucolytic medication that reduces the viscosity and elasticity of mucus.

Which drug is an example of a bronchodilator? 1. Alteplase 2. Montelukast 3. Terbutaline sulfate 4. Ipratropium bromide

Ipratropium bromide Ipratropium bromide, which is an inhaled muscarinic drug, acts directly on the respiratory passages to cause bronchodilation. Alteplase is a thrombolytic. Montelukast is a leukotriene inhibitor. Terbutaline sulfate is a selective beta2-receptor agonist.

A patient is on oral theophylline and the health care provider orders a theophylline blood level to monitor effectiveness a nd also because of the risk for toxicity. The nurse would alert the health care provider at which blood levels? Select all that apply. 1. 1 to 5 mcg/mL 2. 5 to 15 mcg/mL 3. 15 to 25 mcg/mL 4. 25 to 35 mcg/mL 5. 35 to 45 mcg/mL

1. 1 to 5 mcg/mL 3. 15 to 25 mcg/mL 4. 25 to 35 mcg/mL 5. 35 to 45 mcg/mL The therapeutic blood level for theophylline is 5 to 15 mcg/mL. The nurse would alert the health care provider of any laboratory results that are less than 5 mcg/mL and more than 15 mcg/mL. A blood level less than 5 mcg/mL indicates that the dose is not high enough and that the patient is not receiving the therapeutic benefits of theophylline. A blood level greater than 15 mcg/mL indicates toxicity.

The nurse is assessing the respiratory system of an 87-year-old patient admitted with emphysema. Which assessment findings would the nurse expect? Select all that apply. 1. Barrel chest 2. Distended neck veins 3. Generalized edema 4. Decreased liver size 5. Increased excursion of chest with respirations

1. Barrel chest 2. Distended neck veins The nurse would likely note a barrel chest and distended neck veins. The edema would be in the extremities and could be pitting. There is decreased excursion of the chest with respirations and an enlarged liver.

The nurse is caring for a patient in status asthmaticus who has been severely wheezing for the past hour. The nurse enters the room to administer a corticosteroid and hears the wheezing stop. What would be the nurse's priority intervention? 1. Call a code. 2. Administer the medication. 3. Document the change in the patient's breathing. 4. Hold the medication; the patient's breathing has improved.

1. Call a code. A patient with severe asthma whose wheezing stops is in danger of respiratory arrest, and a code should be called immediately. The decision to administer a corticosteroid or not is not a priority because the patient is not breathing. Although the nurse would document the change in the patient's breathing, this is not a priority. The patient's breathing has not improved, it has worsened.

A student nurse is assigned a patient who is diagnosed with centrilobular (centriacinar) emphysema. The student learns that this type of emphysema is primarily associated with which factor? 1. Cigarette smoking 2. Asbestos exposure 3. Environmental allergens 4. History of pneumothorax

1. Cigarette smoking Centrilobular (centriacinar) emphysema is primarily associated with cigarette smoking and mainly affects the respiratory bronchioles. Centrilobular emphysema is not primarily associated with asbestos exposure, environmental allergens, or history of pneumothorax.

When caring for a patient with tuberculosis, the nurse would educate the patient to take which actions to avoid the spread of infection? Select all that apply. 1. Cover the nose and mouth with a tissue while coughing and sneezing. 2. Throw used tissues in a paper bag and dispose with the trash. 3. All household members should be tested for tuberculosis. 4. Complete the entire course of prescribed antitubercular medications. 5. Get out of bed and move freely about the hospital to keep up strength. 6. Drink plenty of water and maintain an erect posture.

1. Cover the nose and mouth with a tissue while coughing and sneezing. 2. Throw used tissues in a paper bag and dispose with the trash. 3. All household members should be tested for tuberculosis. 4. Complete the entire course of prescribed antitubercular medications. To prevent the spread of infection, patients with tuberculosis should be encouraged to cover the nose and mouth with tissues while coughing and sneezing, to throw used tissues in a paper bag, and to dispose tissues with the trash. Household members should be tested for tuberculosis. The patient should be encouraged to complete the entire course of antitubercular medications to prevent disease reactivation. Increasing the frequency of prolonged visits to other parts of the hospital is not advisable, as it can increase the chances of infection spread; instead, such visits should be limited. Drinking plenty of water and maintaining erect posture have no effect on controlling infection.

Which treatments may be used to treat lung cancer? Select all that apply. 1. Lobectomy 2. Mastectomy 3. Brachytherapy 4. Chemotherapy 5. Bilateral pneumonectomy

1. Lobectomy 3. Brachytherapy 4. Chemotherapy Lobectomy is one surgical intervention used for non-small cell lung cancer (NSCLC). Brachytherapy is direct irradiation by placement of the radiation source at the site of the tumor. Chemotherapy can be used alone or with radiation for small cell lung cancer (SCLC). Mastectomy is removal of the breast. Bilateral pneumonectomy would involve removal of both lungs.

Which statements are correct concerning cystic fibrosis? Select all that apply. 1. Most men with cystic fibrosis are infertile. 2. Cough is the first pulmonary symptom of cystic fibrosis. 3. Cystic fibrosis is characterized by a dysfunction of the exocrine glands. 4. A negative sweat chloride test contributes to the diagnosis of cystic fibrosis. 5. Those diagnosed with cystic fibrosis do not usually survive the early childhood years.

1. Most men with cystic fibrosis are infertile. 2. Cough is the first pulmonary symptom of cystic fibrosis. 3. Cystic fibrosis is characterized by a dysfunction of the exocrine glands. Cystic fibrosis is a hereditary disorder that is characterized by the dysfunction of the exocrine glands and the production of thick, tenacious mucus. Cough is the first pulmonary symptom of cystic fibrosis. In most men, the vas deferens is absent, rendering them infertile. At one time, people with cystic fibrosis were unlikely to survive the early childhood years. Improved treatment, however, has resulted in more people with cystic fibrosis surviving to adulthood. Consequently, this disease is now more commonly seen in adult care settings. A positive, not negative sweat chloride test contributes to the diagnosis of cystic fibrosis.

The nurse is caring for an African-American patient complaining of a dry cough, weakness, weight loss, and dyspnea. A relative of the patient told her that she had the same problem and the doctor said it was an inflammatory condition that affects the skin, eyes, liver, lungs, spleen, brain, bones, salivary glands, joints, and heart. The nurse recognizes that the patient is probably suffering from which of these diseases? 1. Sarcoidosis 2. Pneumonia 3. Tuberculosis 4. Cystic fibrosis

1. Sarcoidosis Sarcoidosis is an inflammatory condition that affects the skin, eyes, liver, lungs, spleen, brain, bones, salivary glands, joints, and heart. Many patients do not have symptoms, but others experience dry cough, dyspnea, chest pain, hemoptysis, fatigue, weakness, weight loss, and fever. Pneumonia and tuberculosis are caused by an infection that invades the lungs. Cystic fibrosis is a hereditary disorder characterized by dysfunction of the exocrine glands and includes those that secrete mucus, sweat, saliva, and digestive enzymes.

Which lung cancer diagnosis is associated with the fastest growth rate? 1. Small cell carcinoma 2. Squamous cell carcinoma 3. Sarcoid cell carcinoma 4. Adenocarcinoma

1. Small cell carcinoma Small cell carcinoma is the most malignant form of lung cancer, with a very rapid growth rate. Squamous cell carcinoma has a slow growth rate, owing to its tendency to not metastasize. Sarcoidosis is not a type of cancer and the term "sarcoid cell carcinoma" is not a term used to describe sarcoidosis. Adenocarcinoma does not grow as rapidly as small cell carcinoma.

The nurse is caring for a patient who is suspected of having asthma. What type of diagnostic test would confirm this diagnosis? 1. Spirometry 2. Chest x-ray 3. Arterial blood gas (ABG) 4. Computed tomography (CT) scan of the chest

1. Spirometry Spirometry can reveal that the airflow coming from the patient's lungs is significantly less than expected. Chest x-rays are not diagnostic but can show a flat diaphragm caused by hyperinflated lungs of COPD or some lung cancers. ABGs are used if the patient has moderate to severe symptoms. CT scans are not used routinely to diagnose asthma.

A patient with chronic obstructive pulmonary disease (COPD) is experiencing inadequate oxygenation. The nurse is aware that the patient will demonstrate which physical assessment findings? Select all that apply. 1. Tachycardia 2. Tachypnea 3. Increasing PaCO2 levels 4. Hemoptysis 5. Increasing pH levels

1. Tachycardia 2. Tachypnea 3. Increasing PaCO2 levels Inadequate gas exchange is evidenced tachycardia, tachypnea, and increasing PaCO2 levels. Hemoptysis, or expectoration of bloody sputum, is a finding that correlates with tuberculosis. The pH level decreases with impaired gas exchange.

A patient has been diagnosed with tuberculosis and is being treated with rifampin. The licensed practical nurse (LPN) would provide which instruction to the patient regarding the medication? 1. "Cover your mouth when coughing or sneezing." 2. "Expect your urine to be a reddish-orange color." 3. "Take your medication for the entire course of the therapy." 4. "Keep a list of foods that you should restrict from your diet."

2. "Expect your urine to be a reddish-orange color." Rifampin turns the patient's urine a reddish-orange color and will also stain soft contact lenses. Covering the mouth when coughing or sneezing and taking the medication for the entire course of therapy are general instructions required of any treatment used by the patient. Isoniazid would require instructions regarding diet restrictions.

Which instruction would the nurse provide the parents of a child with bacterial pharyngitis? Select all that apply. 1. Restrict fluids. 2. Administer antibiotics. 3. Provide soft or liquid diet. 4. Offer saline throat gargles. 5. Keep child home from school.

2. Administer antibiotics. 3. Provide soft or liquid diet. 4. Offer saline throat gargles. 5. Keep child home from school. The nurse would instruct parents to administer prescribed antibiotics, provide a soft or liquid diet if dysphagia occurs, use saline throat gargles, and keep the child home from school to prevent exposure to others. The parents would be instructed to increase, not restrict, the child's fluid intake.

A 78-year-old resident with asthma is suddenly exhibiting signs of dyspnea, use of accessory muscles, and audible expiratory wheezing. Which type of medication would assist with these acute symptoms? 1. Leukotriene modifier 2. Beta2-receptor agonist 3. Systemic corticosteroid 4. Long-acting beta-adrenergic agonist

2. Beta2-receptor agonist Drugs used to relieve acute symptoms are referred to as "relievers." Relievers are primarily bronchodilator agents. They include beta2-receptor agonists, anticholinergic agents, and less commonly methylxanthine agents. Leukotriene modifiers, systemic corticosteroids, and long-acting beta-adrenergic agonists are typically used to provide long-term control.

Which area of care for a patient with a chronic respiratory disease can be safely assigned to the certified nursing assistant (CNA)? 1. Auscultate breath sounds at every shift. 2. Count the respiratory rate every 4 hours. 3. Determine the position of the patient to prevent dyspnea. 4. Instruct the patient about the use of a metered-dose inhaler.

2. Count the respiratory rate every 4 hours. The CNA is educated to check the patient's vital signs, so counting the respiratory rate every 4 hours is appropriate. Auscultating breath sounds, determining the position of the patient, and instructing the patient on the use of a metered-dose inhaler cannot be assigned to a CNA because these areas of care require nursing judgment.

What is a daily monitoring practice for a patient with moderate to severe persistent asthma? 1. Daily chest x-rays 2. Daily peak flow monitoring 3. Daily arterial blood gas analysis 4. Daily white blood cell count measure

2. Daily peak flow monitoring Daily peak flow monitoring is advised for those with moderate to severe persistent asthma to evaluate symptoms and adjust therapy as needed before the condition worsens. Chest x-rays, arterial blood gases, and daily white blood cell counts are used based on symptom severity.

What strategy would the nurse teach the patient with chronic obstructive pulmonary disease (COPD) as essential to perform for exercise reconditioning? 1. Exercise training 2. Complete inactivity 3. Reduced water intake 4. Reduced food intake

2. Exercise training Exercise training leads to energy conservation, which is an important component in COPD rehabilitation. Complete inactivity may alleviate symptoms acutely but is not helpful in the long term, because the patient needs to learn effective ways to improve muscle function. It is also important to reduce dyspnea by exercise training. Reduced water and food intake is not advisable; instead, increased water and food intake is essential to maintain energy and to loosen the secretions.

Which position maintains an effective breathing pattern in a patient with asthma? 1. Prone 2. Fowler 3. Supine 4. Side-lying

2. Fowler The best position to maintain an effective breathing pattern in the patient diagnosed with asthma is the Fowler position because it promotes lung expansion and drainage of mucus. Prone, supine, and side-lying positions do not promote expansion of the lungs and mucus drainage.

The licensed practical nurse (LPN) is working with the local Department of Public Health to educate and screen patients for tuberculosis (TB). Which population of patients would be at highest risk for TB? 1. Caucasians of all age ranges 2. Immigrants from developing countries 3. Caucasians who are 25 to 44 years of age 4. African Americans who are older than 70 years of age

2. Immigrants from developing countries In the United States, the incidence of tuberculosis is high among nonwhite Americans and immigrants from Asia, Mexico, Africa, the Caribbean, and Latin America. Caucasians over the age of 70 years have the greatest incidence of tuberculosis. In the African-American population, those who are 25 to 44 years of age have the greatest incidence of tuberculosis.

For a patient admitted with cystic fibrosis, what is the priority in nursing care? 1. Examine peripheral pulses. 2. Maintain effective airway clearance. 3. Provide smoking cessation education. 4. Auscultate for hypoactive bowel sounds.

2. Maintain effective airway clearance. The goals of nursing care are maintaining effective airway clearance, preventing and treating infection, providing adequate nutrition, and fostering effective therapeutic regimen management by patients and their families.

The nurse is caring for a patient with chronic obstructive pulmonary disease who is undernourished and underweight. Which actions can the nurse take to improve the patient's nutritional status? Select all that apply. 1. Restrict fluid intake to 1 L/day. 2. Provide five to six small meals per day. 3. Assist with oral hygiene before the meal. 4. Provide a diet high in protein and calories. 5. Provide meals right after physical therapy sessions.

2. Provide five to six small meals per day. 3. Assist with oral hygiene before the meal. 4. Provide a diet high in protein and calories. A diet high in calories and protein, moderate in carbohydrates, and moderate to high in fat is recommended and can be divided into five or six small meals a day. High-protein, high-calorie nutritional supplements can be offered between meals. Assisting with oral hygiene before meals helps create a more pleasant environment for eating. Fluid intake should be at least 2500 to 3000 mL/day unless contraindicated by other medical conditions. Plan the patient's care so that the patient is not tired or coughing during meals.

Which value range for the partial pressure of carbon dioxide in arterial blood is normal for adults? 1. 7.35 to 7.45 2. 22 to 26 mEq/L 3. 35 to 45 mm Hg 4. 80 to 100 mm Hg

3. 35 to 45 mm Hg The normal range for the partial pressure of carbon dioxide in arterial blood is 35 to 45 mm Hg. The normal range for pH in adults is 7.35 to 7.45. The normal range for bicarbonate is 22 to 26 mEq/L. The normal range for the partial pressure of oxygen in arterial blood is 80 to 100 mm Hg (although some references give a lower limit of 75 mm Hg).

A pneumothorax is often caused by which condition? 1. Infection 2. Air embolism 3. Chest injury 4. Acute respiratory failure

3. Chest injury Chest injury often causes pneumothorax, which is an accumulation of air in the pleural cavity that results in complete or partial collapse of a lung. Pneumothorax occurs in nearly one half of patients who have chest injury. Infections, air embolism, and acute respiratory failure do not cause air or fluid to accumulate in the pleural cavity.

The nurse is teaching a patient about oxygen use at home. The patient asks the nurse, "Does this mean that I will not be able to leave my bedroom?" Which response by the nurse is appropriate? 1. Explain the need to minimize activity in the home to conserve oxygen use. 2. Point out that traveling may not be possible because oxygen tanks are so small. 3. Encourage the patient to use long oxygen tubing to move easily within the home. 4. Point out that traveling outside the home is not encouraged.

3. Encourage the patient to use long oxygen tubing to move easily within the home. Using longer tubing for oxygen allows the patient to move easily within the home. A patient can use a suitcase model to carry oxygen concentrators for travel. Explaining the need to minimize activity in the home to conserve oxygen use would most likely decrease the patient's mobility and lead to other health conditions. It is not necessary to point out that traveling outside the home is not recommended.

A patient with asthma is in acute respiratory distress and the nurse auscultates the lungs and notes a complete absence of wheezing. Also, the patient is confused and has retractions above the sternum. How would the nurse interpret this finding? 1. The patient has developed a pneumothorax. 2. Airflow has now improved through the bronchioles. 3. The patient may experience a respiratory arrest soon. 4. A mucous plug has developed within a main stem bronchus.

3. The patient may experience a respiratory arrest soon. When the patient in respiratory distress has inspiratory wheezing that then ceases, it is an indication of airway obstruction and requires emergency action to restore the airway. A pneumothorax would be evidenced by absent breath sounds. Absence of wheezing does not correlate with improved airflow if the patient is also in current respiratory distress. A mucous plug would result in crackles in the lungs.

A patient with a history of asthma is experiencing severe, persistent bronchospasm. If not corrected, this can result in which condition? 1. Metabolic alkalosis 2. Respiratory alkalosis 3. Worsening hypoxemia 4. Acute respiratory distress syndrome

3. Worsening hypoxemia Severe, persistent bronchospasm, called status asthmaticus, can lead to right-sided heart failure, pneumothorax, worsening hypoxemia, acidosis, and respiratory or cardiac arrest. Acidosis may be seen with status asthmaticus.

The nurse is providing discharge information to a newly diagnosed patient with asthma. When teaching the patient to use a peak expiratory flow rate (PEFR) meter, the nurse instructs the patient to notify the health care provider if the PEFR drops by which amount or greater than normal for the patient? 1. 5% 2. 10% 3. 15% 4. 20%

4. 20% If the PEFR drops 20% or more below the patient's usual level, the health care provider should be notified to allow adjustments to be made in the treatment plan. A drop of less than 20% is not severe enough to warrant notifying the health care provider.

The early phase of an acute asthma episode begins when triggers such as allergens cause which response? 1. Infiltration of the airways with red blood cells 2. Right-sided heart failure and respiratory failure 3. Infiltration of the airways with white blood cells 4. Activation of the inflammatory process constricting the airways

4. Activation of the inflammatory process constricting the airways With asthma, the early phase of an acute episode begins when triggers activate the inflammatory process where airways constrict and become edematous. Infiltration of airways with red blood cells and white blood cells, right-sided heart failure, and respiratory failure can be seen in the late phase.

For the patient with chronic obstructive pulmonary disease (COPD), there is a risk for malnutrition related to which aspect of the disease? 1. Weak cough 2. Increased activity 3. Decreased anxiety 4. Anorexia and dyspnea

4. Anorexia and dyspnea Weight loss for the patient with COPD is related to impaired pulmonary function causing dyspnea and loss of appetite or anorexia. Weak cough is a result of ineffective airway clearance. COPD causes a decrease in activity and an increase in anxiety. Anxiety is not directly related to the weight loss associated with COPD.

Upon admission to a long-term care facility, a resident's health history reveals a persistent productive cough for 3 to 4 months each winter for the past 3 years. These symptoms are typically seen with which disease? 1. Asthma 2. Emphysema 3. Tuberculosis 4. Chronic bronchitis

4. Chronic bronchitis Chronic bronchitis is a bronchial inflammation characterized by increased production of mucus and chronic cough that persists for at least 3 months of the year for 2 consecutive years. Asthma, emphysema, and chronic bronchitis characterize chronic obstructive pulmonary disease. Tuberculosis is a restrictive pulmonary disorder characterized by night sweats, low-grade fever, hemoptysis, chest pain, and chest tightness.

A patient has symptoms including chronic cough, sputum production, and dyspnea. On taking a detailed history, the nurse finds that this patient has had a prolonged exposure to smoke. The nurse realizes these symptoms correspond to which disease? 1. Influenza 2. Pneumonia 3. Tuberculosis 4. Chronic obstructive pulmonary disease (COPD)

4. Chronic obstructive pulmonary disease (COPD) COPD symptoms include cough, sputum production, and dyspnea. In addition, this patient has a history of exposure to allergens such as smoke. Tuberculosis is a bacterial infection with a low-grade fever and weight loss. Dyspnea is a late symptom of tuberculosis. Pneumonia is an infection with a cough, dyspnea, fever, chills, and pleuritic chest pain. Influenza is a viral infection with sneezing, watery eyes and nose, and fever.

A patient with emphysema is having increased dyspnea and is currently receiving oxygen via nasal cannula at 2 L/min. The family member asks to turn up the oxygen to 6 L/min. What is the appropriate nursing intervention? 1. Switch the patient to a facemask at 40%. 2. Ask the family members to leave the room at once. 3. Increase the oxygen to make the patient more comfortable. 4. Examine the patient, and report findings to the health care provider.

4. Examine the patient, and report findings to the health care provider. Oxygen administration for a patient with emphysema is usually administered at 1 to 3 L/min as ordered. Instruct the family not to increase the liter flow, because a sudden increase of oxygen in the blood can depress respirations in the patient. Asking the family members to leave the room is unnecessary and could further agitate the patient.

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD), who has been advised to stop smoking. Which facts about smoking would the nurse include in patient education? 1. About 75% of those who stop smoking can stop for life. 2. Smoking is a habit that could be stopped if the patient desires to stop. 3. Switch to smokeless tobacco. 4. Nicotine replacement gum can be chewed 8 to 10 times a day.

4. Nicotine replacement gum can be chewed 8 to 10 times a day. Nicotine replacement gum is a viable smoking cessation aid which can be chewed 8 to 10 times a day, for 20 to 30 minutes. When using nicotine gum, the user controls the dosage. Rates of successful smoking cessation using several types of therapies range from 10% to 25% of the individuals remaining smoke free for 1 year. Many patients find it difficult to stop smoking even when they would like to quit, and the nurse should be nonjudgmental of the patient. Smokeless tobacco has an adverse effect of oral cancer.

The nurse is caring for a patient with cystic fibrosis (CF). Which factor would the nurse consider? 1. Most patients with CF also develop diabetes. 2. Symptoms usually improve with aging. 3. Nurses who work in adult care settings rarely see CF patients. 4. Patients with CF often survive into adulthood.

4. Patients with CF often survive into adulthood. With improved treatment, more people with CF survive into adulthood. Most patients with CF do not develop diabetes, because the endocrine function of the pancreas continues to function. The symptoms do not improve with aging; the patient typically becomes more dyspneic and develops more symptoms. Nurses who work in adult care settings increasingly care for more patients with CF.

A patient is receiving corticosteroids for idiopathic pulmonary fibrosis. Which is the most important aspect to consider in the plan of care? 1. Possibility of infection related to poor oral hygiene 2. Risk of anxiety related to increased energy expenditure 3. Reduced cardiac output related to right-sided heart failure 4. Possibility of infection related to immune suppression of the steroids

4. Possibility of infection related to immune suppression of the steroids There is a possibility of infection related to immune suppression by corticosteroid agents. The possibility of infection related to poor oral hygiene is always present and not specific to corticosteroids. Reduced cardiac output related to right-sided heart failure in those with respiratory conditions is often seen with chronic obstructive pulmonary disease (COPD) conditions, and the risk of anxiety is usually related to dyspnea or possible disabling illness.

Which nutrient helps prevent peripheral neuritis, which is a side effect of isoniazid (INH)? 1. Iron 2. Vitamin A 3. Vitamin C 4. Pyridoxine (B6)

4. Pyridoxine (B6) Pyridoxine (B6) may be ordered with INH to prevent peripheral neuritis because it plays a major role in the synthesis of neurotransmitters. Iron is necessary for oxygen-carrying proteins such as hemoglobin. Vitamin A plays a major role in vision and skin. Vitamin C plays a major role in normal growth and development along with tissue repair.

The nurse is caring for a patient with bronchiectasis and is aware that the primary cause of this disease in adults is related to which factor? 1. Adult-onset asthma 2. Dysfunction of the exocrine glands 3. Heavy smoking for more than 20 years 4. Recurring inflammatory conditions and infections

4. Recurring inflammatory conditions and infections Bronchiectasis is correlated with recurrent inflammatory conditions, infections, or obstructions. Adult-onset asthma with no infection has no specific relationship to acquiring this disease. A patient's smoking history does not affect the cause of this condition. Cystic fibrosis involves dysfunction of the exocrine glands.

The licensed practical nurse (LPN) is caring for a patient with active tuberculosis. Which is the nursing action that assists in preventing the spread of the infection? 1. Wear disposable gloves when providing care. 2. Wear isolation gowns when caring for the patient. 3. Practice good hand-washing techniques when providing care. 4. Wear disposable particulate respirator masks when caring for the patient.

4. Wear disposable particulate respirator masks when caring for the patient. Because tuberculosis is primarily airborne, the use of disposable particulate respirator masks will most effectively prevent its spread. Disposable gloves should be worn during many aspects of patient care, but gloves will not prevent the spread of tuberculosis. Isolation gowns are not necessary unless gross contamination of the nurse's clothing occurs. Hand-washing techniques should be practiced during all aspects of patient care, but they will not prevent the spread of tuberculosis.

What would the nurse tell a patient about infection control, to prevent the spread of the cold virus to others and to protect them from a secondary bacterial infection? Select all that apply. 1. "Avoid sharing drinking glasses and eating utensils with others." 2. "Wash your hands frequently for at least 20 seconds with soap." 3. "Complete antibiotic therapy as ordered by the health care provider." 4. "Cover your mouth with a disposable tissue when you sneeze or cough." 5. "Avoid crowded places, especially during the first 3 days when the cold is most contagious."

1. "Avoid sharing drinking glasses and eating utensils with others." 2. "Wash your hands frequently for at least 20 seconds with soap." 4. "Cover your mouth with a disposable tissue when you sneeze or cough." 5. "Avoid crowded places, especially during the first 3 days when the cold is most contagious." The patient with a common cold should avoid sharing utensils with others to avoid spreading the virus. Frequent hand washing is the most effective infection prevention technique available. The patient should cover the mouth with disposable tissues when coughing or sneezing to prevent spreading of the virus by droplets. The patient should avoid close contact with others and crowded places, especially during the first 3 days when the patient is most contagious. When suffering from a common cold, the patient should avoid antibiotic therapy, because it is not effective against viral infections.

Which interventions are appropriate to control the bleeding with epistaxis not caused by trauma? Select all that apply. 1. Apply an ice pack or cold compress to the nose. 2. Place the patient in a sitting position with the head tilted forward. 3. Apply direct pressure by pinching the lower portion of the nose. 4. Administer saline nasal sprays to relieve congestion. 5. Ask the patient to blow the nose to remove all the collected blood.

1. Apply an ice pack or cold compress to the nose. 2. Place the patient in a sitting position with the head tilted forward. 3. Apply direct pressure by pinching the lower portion of the nose. An ice pack or cold compress should be applied to the nose. The patient should be asked to sit, leaning slightly forward, with the head tilted forward. Direct pressure should be applied by pinching the lower portion of the nose against the nasal septum for 10 to 15 minutes. If bleeding continues, consult the health care provider. Saline nasal sprays are not included in the treatment of epistaxis. Nose blowing will also remove the clot, which could lead to further bleeding.

Which statements accurately reflect alterations in lung volume and capacity? Select all that apply. 1. A decrease in thoracic gas is not significant. 2. An increase in total lung capacity is not significant. 3. Inspiratory capacity decreases in acute respiratory distress syndrome. 4. Forced expiratory volume decreases with restrictive or obstructive lung disease. 5. Functional residual capacity increases with chronic obstructive pulmonary disease. 6. A decrease in forced vital capacity occurs with obstructive or restrictive lung disease.

1. A decrease in thoracic gas is not significant. 4. Forced expiratory volume decreases with restrictive or obstructive lung disease. A decrease in thoracic gas, which is the total volume of air in the lungs, is not significant, whereas an increase indicates obstructive lung disease. Forced expiratory volume, defined as the volume of air expired during specified time intervals, decreases with restrictive or obstructive lung disease depending on measurements at time intervals. Functional residual capacity, which describes the volume of air remaining in the lungs after normal expiration, does increase with chronic obstructive pulmonary disease. A decrease in forced vital capacity, which represents the total volume of air exhaled rapidly and forcefully after maximum inhalation, does occur with obstructive or restrictive lung disease. It is not true that an increase in total lung capacity is not significant; it indicates overdistention of the lungs caused by obstructive lung disease. Inspiratory capacity, or the maximum volume of air that can be inhaled after normal expiration, does not decrease in acute respiratory distress syndrome, but functional residual capacity does decrease in individuals with this condition.

Which details will the licensed practical nurse (LPN) include when explaining a fiberoptic bronchoscopy to a patient? Select all that apply. 1. A local anesthetic will be applied to the patient's throat. 2. The patient should take nothing by mouth until the gag reflex returns. 3. If a lesion suggestive of malignancy is found, a biopsy will be scheduled shortly. 4. The procedure allows for the assessment, diagnosis, or removal of foreign bodies or mucus plugs. 5. Unlike other procedures, there is virtually no risk of pneumonia, hemorrhage, or pneumothorax.

1. A local anesthetic will be applied to the patient's throat. 2. The patient should take nothing by mouth until the gag reflex returns. 4. The procedure allows for the assessment, diagnosis, or removal of foreign bodies or mucus plugs. After local anesthetic of the patient's throat, a flexible fiberoptic scope will be inserted through the nose or mouth into the bronchial tree. It is accurate to instruct the patient to take nothing by mouth until the gag reflex returns. The procedure does allow for the assessment, diagnosis, or removal of foreign bodies or mucus plugs. It is not true that a biopsy will be scheduled shortly; the biopsy will be completed during the procedure if lesions suggestive of malignancy are located. Complications of fiberoptic bronchoscopy include pneumonia, hemorrhage, pneumothorax, bronchospasm, bacteremia, bronchial perforation, and laryngospasm.

A patient is diagnosed with acute viral rhinitis (common cold). The patient is requesting antibiotics. What information would be included in patient teaching? 1. A virus causes the common cold. 2. Antibiotics improve patient symptoms. 3. Bacteria are known to cause the common cold. 4. A person with a cold is contagious throughout the illness.

1. A virus causes the common cold. Explain to patients that antibacterial agents are not usually prescribed for the common cold, because antibacterial agents are effective only against bacteria (and a virus causes the common cold). Antibiotics do not improve patient symptoms because antibiotics do not treat a viral infection. Bacteria do not cause the common cold. Patients are only contagious for the initial 3 days, and antibiotics are not a treatment.

Which medication would be prescribed for acute sinusitis? Select all that apply. 1. Antibiotics 2. Decongestants 3. Antihistamines 4. Corticosteroids 5. Bronchodilators

1. Antibiotics 2. Decongestants 4. Corticosteroid Antibiotics are used to treat the underlying bacterial infection that causes sinusitis. Decongestants are used to promote drainage. Intranasal corticosteroids decrease inflammation. Antihistamines are used to decrease allergy symptoms, not treat acute sinusitis. Bronchodilators are given for lower respiratory tract disorders, but not acute sinusitis.

Drugs used to treat asthma can be classified as those that provide long-term control (controllers) and those that relieve acute symptoms (relievers). Which is an example of a reliever? 1. Anticholinergics 2. Mast cell stabilizers 3. Leukotriene modifiers 4. Inhaled glucocorticoids

1. Anticholinergics Relievers are primarily bronchodilators. They include anticholinergics, beta2-receptor agonists, and the less commonly used methylxanthines. Mast cell stabilizers, leukotriene modifiers, and inhaled glucocorticoids are considered controllers.

Which medical condition is most often associated with the development of a deep vein thrombosis? 1. Cancer 2. Diabetes 3. Hypertension 4. Chronic obstructive pulmonary disease

1. Cancer Cancer, which increases inflammation in the body and may compress blood vessels, is more likely than diabetes, hypertension, or chronic obstructive pulmonary disease to be linked to the development of a deep vein thrombosis.

Which factors stimulate the respiratory center? Select all that apply. 1. Changes in pH 2. Increased O2 levels 3. Changes in position 4. Decreased O2 levels 5. Increased carbon dioxide (CO2) levels 6. Air leaving the lungs

1. Changes in pH 4. Decreased O2 levels 5. Increased carbon dioxide (CO2) levels Changes in pH, decreased O2 levels, and increased CO2 levels cause signals to be sent to the phrenic nerves, which in turn send signals to the respiratory muscles to carry out the major work of breathing. Increasing O2 would not trigger phrenic nerves because the O2 levels would already be increased. Changes in position do not trigger phrenic nerves. Air leaving the lungs is normal expiration.

After a pneumothorax, a patient has a chest tube and the nurse notes continuous vigorous bubbling in the water-seal chamber. What would be the nurse's next action? 1. Check the system for leaks. 2. Check the amount of drainage. 3. Give the patient pain medication. 4. Decrease the amount of wall suction.

1. Check the system for leaks. The nurse should check the system for leaks because continuous bubbling in the water-seal chamber suggests an air leak. The nurse should check for drainage, chest fluid, and air drainage into the collection chamber, not the water-seal chamber. Giving the patient pain medication will not affect bubbling in the water-seal chamber. If suction is prescribed, bubbling will occur in the suction control chamber, not the water-seal chamber.

Which diagnostic test requires the nurse to ask if the patient has an allergy to shellfish? 1. Computed tomography 2. Ventilation-perfusion scan 3. Magnetic resonance imaging 4. Positron emission tomography

1. Computed tomography During computed radiography, a dye containing iodine may be injected intravenously, so it is imperative to find out whether the patient is allergic to iodine (shellfish contains iodine) before the examination. The dye containing iodine is not used during ventilation-perfusion scans, magnetic resonance imaging, or positron emission tomography.

Which assessment finding indicates aspiration? Select all that apply. 1. Cough 2. Dyspnea 3. Wheezing 4. Decreased sputum 5. Diminished breath sounds

1. Cough 2. Dyspnea 3. Wheezing Signs of aspiration include increased pulse and respiratory rates, dyspnea, cough and fever. Patients produce a frothy, pink sputum when aspirated. Breath sounds have crackles, rhonchi, and wheezing with aspiration.

Which assessment findings would the nurse recognize as progressive signs of acute respiratory distress syndrome (ARDS)? Select all that apply. 1. Crackles 2. Dyspnea 3. Cyanosis 4. Bleeding 5. Retractions 6. Increased pain

1. Crackles 2. Dyspnea 3. Cyanosis 5. Retractions Progressive worsening of ARDS is assessed by dyspnea with retractions, cyanosis, and diaphoresis. Diffuse crackles and rhonchi may be heard on auscultation in progressive ARDS. Bleeding and increased pain are not associated with progressive ARDS.

A patient with pneumonia has very thick sputum and the nurse suspects dehydration. What signs and/or symptoms indicate a fluid volume deficit? Select all that apply. 1. Dark urine 2. Low hemoglobin 3. Elevated hematocrit 4. Dry sticky oral mucosa 5. Decreased skin turgor 6. Output of 1800 milliliters of urine in 24 hours

1. Dark urine 3. Elevated hematocrit 4. Dry sticky oral mucosa 5. Decreased skin turgor Dark urine and inadequate output are signs of fluid volume deficit. Elevated hematocrit and dry, sticky mucous membranes are also signs of fluid volume deficit. Decreased or inelastic skin turgor is a sign of fluid volume deficit. A high hemoglobin is a sign of fluid volume deficit. An output of 1800 mL of urine in 24 hours is not an indicator of fluid deficit.

Which is a risk factor for tumor growth in the nasal passages and sinuses? Select all that apply. 1. Employed as carpenter 2. Working in landscaping 3. Has had herpes simplex 4. Job in furniture making 5. Diagnosed with human papilloma virus (HPV)

1. Employed as carpenter 4. Job in furniture making 5. Diagnosed with human papilloma virus (HPV Occupations with exposure to dust, such as carpentry and furniture making, can increase the risk of tumor growth in the nasal passages or sinuses. Having HPV also increases a person's risk for nasal passage and sinus tumor growth. Landscaping work and herpes simplex are not risk factors for nasal passage and sinus tumor growth.

Which would be included in the plan of care for a patient with fungal pharyngitis related to chemotherapy? Select all that apply. 1. Encourage rest. 2. Provide a soft diet. 3. Give nystatin. 4. Administer penicillin. 5. Use cool-mist vaporizer.

1. Encourage rest. 2. Provide a soft diet. 3. Give nystatin. 5. Use cool-mist vaporizer. Rest, soft diet, a cool-mist vaporizer to ease painful swallowing, and nystatin to treat fungal infection would be included in the plan for care for a patient with fungal pharyngitis related to chemotherapy. Penicillin is used to treat infections caused by bacteria, not fungus.

In which order would the nurse correctly obtain a throat culture? 1. Take the patient to a room with a bright light. 2. Examine the kit to ensure it contains a sterile swab or applicator and a tube of culture medium. 3. Immediately place the swab in the tube of culture medium and inform the patient that the results will be reported in 24 to 48 hours. 4. Tilt the patient's head back, depress the tongue with a tongue blade, insert the swab into the patient's mouth directly to the back of the throat, and gently rotate the swab over the back of the throat, tonsils, and any obvious lesion.

1. Examine the kit to ensure it contains a sterile swab or applicator and a tube of culture medium. 2. Take the patient to a room with a bright light. 3. Tilt the patient's head back, depress the tongue with a tongue blade, insert the swab into the patient's mouth directly to the back of the throat, and gently rotate the swab over the back of the throat, tonsils, and any obvious lesion. 4. Immediately place the swab in the tube of culture medium and inform the patient that the results will be reported in 24 to 48 hours. A throat culture specimen should be obtained before starting an antibiotic regimen. Kits containing a sterile swab or applicator and a tube of culture medium are available. Good lighting is essential for obtaining the specimen. The procedure is to tilt the patient's head back while depressing the tongue with a tongue blade and rotating the swab over the back of the throat, tonsils, and any obvious lesion. The swab is immediately placed in the tube of culture medium. Results are reported in 24 to 48 hours.

A trauma patient has two adjacent ribs in the same side of the chest broken into two segments. The patient has which type of injury? 1. Flail chest 2. Hemothorax 3. Pneumothorax 4. Pulmonary embolus

1. Flail chest Flail chest refers to an injury in which two adjacent ribs on the same side of the chest are each broken into two or more segments. Hemothorax is an accumulation of blood between the chest wall and the lung that is often associated with pneumothorax. Pneumothorax is an accumulation of air in the pleural cavity that results in a complete or partial collapse of a lung. An embolus is a foreign substance that is carried through the bloodstream.

Which radiologic study is most appropriate for measuring the speed and degree of lung expansion? 1. Fluoroscopy 2. Chest radiography 3. Fiberoptic bronchoscopy 4. Ventilation perfusion scan

1. Fluoroscopy Fluoroscopy can give information about the speed and degree of lung expansion and structural defects in the bronchial tree. Radiographic examination of the chest produces a picture in which the bony structures are visible and can be used for respiratory screening and diagnosis, as well as to assess the progression of a disease and response to treatment. Fiberoptic bronchoscopy is not a radiologic study and is performed by inserting a flexible fiberoptic scope through the nose or mouth into the bronchial tree. A ventilation-perfusion scan is used to assess lung ventilation and lung perfusion and is done to detect a pulmonary embolism or other obstruction.

The nurse is teaching a parent how to administer a child's nose drops for the first time. Which order would the nurse teach the parent to correctly administer the nose drops? 1. Push the tip of the nose upward. 2. Hold the head tilted back for several minutes. 3. Have the child sit or lie down with the head tilted back. 4. Place the dropper at the opening of the nostril and squeeze to deliver the medication.

1. Have the child sit or lie down with the head tilted back. 2. Nose drops must be administered in such a way that the drops will be effective. To administer nose drops, the patient must have the head tilted back so the solution can flow into the back of the nose. The tip of the nose should be pushed upward while the dropper is placed at the opening of the nostril. The dropper is squeezed to release the measured amount of medication. The head should be tilted back for several minutes to allow the drops to be absorbed.

For which adverse effects of corticosteroid therapy in acute bronchial constriction would the nurse assess? Select all that apply. 1. Hypertension 2. Water retention 3. Sodium retention 4. Potassium retention 5. Gastrointestinal distress 6. Low blood glucose levels

1. Hypertension 2. Water retention 3. Sodium retention 5. Gastrointestinal distress Corticosteroids may cause hypertension, water retention, sodium retention, and gastrointestinal distress. Corticosteroids cause potassium loss, rather than retention. Corticosteroids cause high blood glucose levels, not lower blood glucose levels.

The nurse is providing education to the spouse and caregiver of a patient with a tracheostomy. The spouse questions why suctioning is only performed as needed. Which effects of suctioning does the nurse use to base a response? 1. Hypoxia 2. Bronchodilation 3. Decreased mucus production 4. Decreased intracranial pressure

1. Hypoxia Suctioning of the tracheostomy tube is only performed as needed because it can cause hypoxia, bronchospasm (not bronchodilation), increased (not decreased) mucus production, and increased (not decreased) intracranial pressure, among other adverse effects.

Place the steps for data collection in the correct order. 1. Obtain information about the past medical history. 2. Identify the reason for the patient's visit (chief complaint). 3. Collect data about the symptoms such as presence of any discharge including color and amount, upper respiratory sounds, and level of present discomfort. 4. Ask the patient to describe a detailed history of the present illness.

1. Identify the reason for the patient's visit (chief complaint). 2. Ask the patient to describe a detailed history of the present illness. 3. Obtain information about the past medical history. 4. Collect data about the symptoms such as presence of any discharge including color and amount, upper respiratory sounds, and level of present discomfort. The nurse needs to know the chief complaint and the history of the present illness to proceed with a complete assessment of the patient's nasal and sinus health or problem. Once enough information is obtained about the reason for the current visit, then the nurse will proceed with the past medical history to determine if anything in the past is related to the current problem. The history and data collection is followed by a review of the involved systems and a physical assessment.

A patient comes to the clinic complaining of nasal congestion, a runny nose, sore throat, headache, and fatigue and has been taking pseudoephedrine. The patient reports a history of hypertension and coronary artery disease. Why does the nurse inform the patient to stop taking the drug? Select all that apply. 1. It can cause hypertension and tachycardia. 2. It is ineffective in treating congestion. 3. It will worsen the headache and fatigue. 4. It is contraindicated in coronary artery disease. 5. It can be used to manufacture methamphetamines.

1. It can cause hypertension and tachycardia. 4. It is contraindicated in coronary artery disease. Pseudoephedrine is contraindicated in patients with severe hypertension and coronary artery disease. Pseudoephedrine is a decongestant. Pseudoephedrine does not cause headache or fatigue to worsen. Pseudoephedrine can be used to manufacture methamphetamines, but that is not the reason for the nurse to instruct the patient with hypertension to stop taking the medication.

Which air passage is between the pharynx and the trachea in the respiratory system? 1. Larynx 2. Bronchi 3. Oropharynx 4. Nasopharynx

1. Larynx The larynx, or "voice box," is the air passage between the pharynx and the trachea; it contains the epiglottis. The bronchi provide a passageway for air going to and from the lungs. The oropharynx lies behind the mouth and is one of the three parts of the pharynx. The nasopharynx lies behind the nose and is one of the three parts of the pharynx.

Which recommendation would the nurse make to a patient with obstructive sleep apnea? Select all that apply. 1. Lose weight. 2. Quit smoking . 3. Correct snoring. 4. Sleep in supine position. 5. Don't take sedatives before bed.

1. Lose weight. 2. Quit smoking . 4. Sleep in supine position. 5. Don't take sedatives before bed. Managing obstructive sleep apnea can include attempting to lose weight, sleeping with the head of the bed elevated, quitting smoking, and avoiding sedative use before bed. Snoring can result from sleep apnea, but it does not cause the condition.

Which features/structures are part of the internal nose? Select all that apply. 1. Mucus 2. Cartilage 3. Vestibule 4. Turbinates 5. Olfactory cells 6. Branch of the external carotids

1. Mucus 3. Vestibule 4. Turbinates 5. Olfactory cells 6. Branch of the external carotids The outermost portion of the internal nose is called the vestibule. The internal nose is supplied with blood by branches of the internal and external carotids. A layer of mucus covers the membrane. The side walls of the internal nose have folds of tissue called turbinates. Olfactory cells line the roof of the nasal cavity. The external nose is made up of bone, cartilage, and mucous membrane.

What would the nurse assess/monitor a patient for after a thoracentesis? Select all that apply. 1. Vital signs 2. Lung sounds 3. Urine output 4. Chest movement 5. Bleeding at the puncture site 6. Amount and color of fluid removed

1. Vital signs 2. Lung sounds 4. Chest movement 5. Bleeding at the puncture site 6. Amount and color of fluid removed Changes in vital signs, lung sounds, chest movement, and bleeding would indicate complications such as air embolism, hemothorax, pneumothorax, hemorrhage, and pulmonary edema. Documentation of the amount and color of fluid removed are important to note in the patient record. Urine output is not routinely monitored after a thoracentesis.

The nurse is reviewing risk factors for laryngeal cancer. Which of these are considered risk factors for this type of cancer? Select all that apply. 1. Voice strain 2. Tobacco use 3. Female gender 4. Age 40 to 50 years 5. Excessive alcohol consumption

1. Voice strain 2. Tobacco use 5. Excessive alcohol consumption Risk factors for laryngeal cancer include tobacco use, excessive alcohol consumption (another major risk factor), voice strain, and male gender. Laryngeal cancer occurs more frequently in patients 50 to 60 years of age.

The nurse is caring for an older adult experiencing nasal dryness alternating with a watery discharge or mild bleeding at various times, sometimes after eating. Which assessment and care are appropriate for this patient? Select all that apply. 1. Nosebleeds are common in older adults, especially because of the use of anticoagulant medications. 2. The nose gets shorter and tends to turn upward with aging, which contributes to nasal obstruction. 3. The mucous membrane becomes thicker with aging and produces more mucus, which contributes to nasal dryness. 4. The patient may need to use hard candies or lozenges to stimulate the production of saliva because of drier tissues in the larynx. 5. The patient may have a reduced sense of taste and choose spicy foods more frequently, which can contribute to a runny nose.

1. Nosebleeds are common in older adults, especially because of the use of anticoagulant medications. 4. The patient may need to use hard candies or lozenges to stimulate the production of saliva because of drier tissues in the larynx. 5. The patient may have a reduced sense of taste and choose spicy foods more frequently, which can contribute to a runny nose. Epistaxis (nosebleed) is more common in older adults, especially in those taking anticoagulant agents to slow blood clotting. Spicy and hot foods may trigger a watery or runny nose upon consumption. There are many age-related changes in the nose, sinuses, and throat with the aging process. The nose gets longer and tends to droop, nasal obstruction is more common because of the softening of the cartilage in the external nose, and the mucous membrane becomes thinner and produces less mucus.

In a patient who underwent a total laryngectomy, which assessment finding would cue the nurse to suction the airway? Select all that apply. 1. Restlessness 2. Audible mucus 3. Increased pulse 4. Oxygen saturation 95% 5. Able to cough up secretions

1. Restlessness 2. Audible mucus 3. Increased pulse After a total laryngectomy, suctioning should be performed if a patient is restless, has an increased pulse, and has audible or visible mucus. An oxygen saturation of 95% is a normal finding and does not indicate respiratory distress. Suctioning would not be performed if a patient is able to cough up secretions independently.

A patient with pneumonia has impaired gas exchange. Which of these signs and symptoms indicate hypoxemia? Select all that apply. 1. Restlessness 2. Pulse rate of 102 beats per minute 3. Respiratory rate of 22 breaths per minute 4. Temperature of 101.4°F (38.6°C) 5. Cough productive of thick green sputum

1. Restlessness 2. Pulse rate of 102 beats per minute 3. Respiratory rate of 22 breaths per minute Restlessness is a hallmark of hypoxemia. Hypoxemia leads to tachycardia and an increased respiratory rate. An elevated temperature of 101.4°F (38.6°C) does not indicate hypoxemia. Thick sputum does not indicate hypoxemia.

Three days after a thoracotomy, a patient's assessment data includes a respiratory rate of 20 breaths/min, pulse 78 beats/min, blood pressure 118/72 mm Hg, oral temperature 99.2°F (37.3°C), pulse oximetry 96% and no bubbling in the water seal chamber of the chest drainage system. The nurse recognizes that this data supports which conclusions? Select all that apply. 1. The patient's lung has reinflated. 2. The chest tube suction is not adequate. 3. The patient's chest tube may be blocked. 4. The patient has a postoperative infection. 5. The patient is in respiratory distress.

1. The patient's lung has reinflated. 3. The patient's chest tube may be blocked. Lack of bubbling in the water seal chamber indicates that the lung has reinflated or the tubing is occluded. The patient's vital signs are within normal limits and do not indicate a postoperative infection or respiratory distress. Suction pressure is controlled by the suction chamber of the chest drainage system, not the water seal chamber.

Which statements describe the bronchi? Select all that apply. 1. Two primary bronchi split to the right and left from the trachea. 2. The left bronchus is shorter and broader than the right bronchus. 3. Foreign bodies from the trachea generally enter the left bronchus. 4. The exchange of oxygen and carbon dioxide takes place in the alveoli. 5. The right bronchus runs straighter up and down than the left bronchus.

1. Two primary bronchi split to the right and left from the trachea. 4. The exchange of oxygen and carbon dioxide takes place in the alveoli. 5. The right bronchus runs straighter up and down than the left bronchus. Two primary bronchi split to the right and left from the trachea and provide a passageway for air going to and from the lungs. The exchange of oxygen and carbon dioxide takes place in the alveoli. The right bronchus runs straighter up and down than the left bronchus, and it is shorter and broader than the left bronchus; because of this, foreign bodies from the trachea generally enter the right bronchus.

Place the steps in order that a nurse would follow when performing tracheostomy care: 1. Suction the tracheostomy before removing the old dressings 2. Change the tracheostomy ties if soiled 3. Replace the tracheostomy dressing with a sterile precut pad 4. Put on goggles and clean gloves 5. Tie the ties at the side of the neck with a square knot 6. Clean the stoma and surrounding skin

1.Put on goggles and clean gloves 2.Suction the tracheostomy before removing the old dressings 3. Clean the stoma and surrounding skin 4.Change the tracheostomy ties if soiled 5.Replace the tracheostomy dressing with a sterile precut pad 6.Tie the ties at the side of the neck with a square knot There are several steps to the procedure for providing tracheostomy care, and a procedure manual should be consulted. The nurse should use standard precautions and don goggles and clean gloves. The tracheostomy should be suctioned before removing the old dressings. After cleaning the inner cannula, clean the stoma and surrounding skin. Next, change the tracheostomy ties if they are soiled. If an assistant is not available, leave the old ties in place until the new ties are secure. Replace the tracheostomy dressing with a sterile precut pad and tie the ties at the side of the neck with a square knot.

The patient asks the nurse what to expect during a positron emission tomography (PET) scan. Which response is appropriate? 1. "This test is basically a simple x-ray and does not require any special preparation." 2. "This test requires two intravenous lines and uses nuclear scans to show patterns." 3. "This test uses radiofrequency waves and a strong magnet to generate computer images." 4. "This test uses a lighted tube inserted into the bronchi to scan pictures of suspicious tissues."

2. "This test requires two intravenous lines and uses nuclear scans to show patterns." A PET scan is not an x-ray, and requires two IVs—one for nuclear isotope delivery and one for blood draws. Scans can detect solid tumors or assess effectiveness of cancer treatment. Radiofrequency waves that use the presence of a magnetic field to produce pictures describes magnetic resonance imaging (MRI). Bronchoscopy uses a lighted tube inserted into the bronchi to visualize and take a specimen of suspicious tissue.

Which symptom is common among people with chronic respiratory disease? 1. Red pharynx 2. Clubbed fingers 3. Deviated trachea 4. Pleural friction rub

2. Clubbed fingers Clubbing of the fingers is associated with chronic respiratory problems and results from chronically low blood levels of oxygen. A red pharynx is a sign of infection. A deviated trachea is most often the result of a pulmonary embolism. A pleural friction rub is a grating, scratchy noise that indicates pleurisy, which is inflammation of the tissues that line the lungs and chest cavity.

Which finding indicates early signs of hypovolemia in a patient recovering from a tonsillectomy? Select all that apply. 1. Dyspnea 2. Restlessness 3. Increased pulse 4. Bluish nail beds 5. Frequent swallowing

2. Restlessness 3. Increased pulse Early signs of hypovolemia include restlessness and an increased pulse. Dyspnea and bluish nail beds are signs of inadequate oxygenation. Frequent swallowing indicates possible bleeding from the surgical site.

The health care provider has instructed the patient with a rib fracture to perform breathing exercises. The nurse informs the patient of which primary reasons for these exercises? Select all that apply. 1. Pain will be assessed using a pain scale and will be managed with medication. 2. Holding a pillow against the chest wall will support the area and make deep breathing easier. 3. Guided imagery, distraction, and rhythmic breathing can be effective in decreasing pain. 4. Deep breathing, coughing, and turning every 2 hours helps prevent pulmonary complications. 5. Exercises and firm but gentle taping and support of the rib fracture will enhance healing of the ribs.

2. Holding a pillow against the chest wall will support the area and make deep breathing easier. 3. Guided imagery, distraction, and rhythmic breathing can be effective in decreasing pain. 4. Deep breathing, coughing, and turning every 2 hours helps prevent pulmonary complications. Splinting or supporting the area of the chest wall during coughing and deep breathing will make breathing exercises, coughing, and turning more effective and comfortable. Nursing measures such as guided imagery, distraction, and rhythmic breathing can be an effective adjunct to analgesics. Deep breathing, coughing, and turning every 2 hours help prevent pneumonia and atelectasis. Taping, strapping, or binding the chest is discouraged because it restricts chest movement and lung expansion, which can contribute to decreased ventilation.

Which action would the school nurse take in response to a child with a sore throat and difficulty speaking? 1. Use a laryngeal mirror to examine larynx. 2. Instruct the patient to refrain from speaking. 3. Swab the throat for a culture for strep throat. 4. Call the child's parents to take the child home.

2. Instruct the patient to refrain from speaking. The school nurse should advise the child to avoid speaking, as voice rest would be recommended for laryngitis. The health care provider would examine the larynx, not the school nurse. The nurse cannot swab the throat without a prescription from the health care provider. A child does not need to be sent home for laryngitis.

A patient who has pharyngitis needs to be evaluated for type of pharyngitis. Which signs and symptoms are most indicative of bacterial pharyngitis? Select all that apply. 1. Rhinorrhea 2. Joint and muscle pain 3. Complications are acute 4. Mild temperature elevation 5. Elevated white blood cell count 6. Glomerulonephritis and rheumatic fever

2. Joint and muscle pain 3. Complications are acute 5. Elevated white blood cell count Bacterial pharyngitis is characterized by dysphagia, joint and muscle pain, malaise, abrupt onset, temperature greater than 101°F, and abnormal complete blood count (CBC). Complications of bacterial pharyngitis include glomerulonephritis and rheumatic fever. Viral pharyngitis rarely has complications and is characterized by rhinorrhea, headache, mild hoarseness, gradual onset, mild elevation in temperature, and normal CBC.

When caring for a patient with diabetic ketoacidosis, which abnormal breathing pattern would the nurse expect during auscultation? 1. Biot 2. Kussmaul 3. Obstructive 4. Cheyne-Stokes

2. Kussmaul Kussmaul respirations are a pattern of abnormal breathing associated with diabetic ketoacidosis and metabolic acidosis. Biot respirations are associated with neurological disorders. Obstructive respirations are associated with emphysema. Cheyne-Stokes respirations are associated with severe brain pathology.

Which action would be done first if it is suspected that a patient has acute epiglottis? 1. Performing a throat swab 2. Ordering radiographs of the neck 3. Performing a rapid antigen detection test 4. Starting antibiotics immediately

2. Ordering radiographs of the neck Radiographs of the neck should be ordered to confirm epiglottis. A throat swab should not be done because the swab could trigger spasms that block the airway. A rapid antigen detection test still involves a swab and also requires another throat swab to confirm the results. Antibiotics should not be initiated until the diagnosis is confirmed.

Which statements are true of the respiratory system and the mechanisms of breathing? Select all that apply. 1. The respiratory center is located in the hippocampus. 2. The phrenic nerve sends signals to the respiratory muscles. 3. Expiration involves an active contraction of the muscles and diaphragm. 4. About 1000 mL of air is inhaled and exhaled during normal, quiet breathing. 5. Chemoreceptors in the aorta and carotid artery monitor the pH and amount of carbon dioxide and oxygen in the arterial blood.

2. The phrenic nerve sends signals to the respiratory muscles. 5. Chemoreceptors in the aorta and carotid artery monitor the pH and amount of carbon dioxide and oxygen in the arterial blood. The phrenic nerve plays a vital role in breathing. Chemoreceptors are located in the aorta and carotid artery and they modify ventilation based on the pH and concentration of carbon dioxide and oxygen in the arterial blood. The respiratory center is located in the medulla, not the hippocampus. Inspiration involves an active contraction of the muscles and diaphragm, which is demonstrated by the enlargement of the chest cavity. About 500 mL, rather than 1000 mL, of air is inhaled and exhaled during normal, quiet breathing.

A patient with a pulmonary embolus receives which information about taking warfarin? Select all that apply. 1. The patient can expect to be on the same dosage of warfarin for life. 2. The therapeutic level of the international normalized ratio (INR) should be 2.0 to 3.0. 3. The patient should avoid excessive intake of foods high in vitamin K such as cabbage, broccoli, cauliflower, fish, and liver. 4. The patient's activated partial thromboplastin time (PTT) will be checked every 3 days after discharge to monitor response to the anticoagulant. 5. The patient will have blood drawn to measure prothrombin time (PT) and international normalized ratio (INR) to monitor response to the warfarin and receive education on scheduling subsequent blood draws.

2. The therapeutic level of the international normalized ratio (INR) should be 2.0 to 3.0. 3. The patient should avoid excessive intake of foods high in vitamin K such as cabbage, broccoli, cauliflower, fish, and liver. 5. The patient will have blood drawn to measure prothrombin time (PT) and international normalized ratio (INR) to monitor response to the warfarin and receive education on scheduling subsequent blood draws. While the patient is on warfarin, the INR will be monitored on a routine basis to achieve a therapeutic level of 2.0 to 3.0. Dosage will be adjusted as needed to achieve this level. Foods that are high in vitamin K decrease the anticoagulant effect of warfarin and should be avoided. PT is used to monitor the patient's response to warfarin. Activated PTT is not monitored routinely while the patient is on warfarin therapy, because this test is used to measure response to heparin. Dosages of warfarin are based on results of PT and INR test results and are frequently adjusted during the lifetime of the patient.

Which is the outermost portion of the internal nose that is covered by skin and contains nasal hairs called? 1. Nares 2. Vestibule 3. Turbinates 4. Nasal septum

2. Vestibule The nasal vestibule is the forward section within and above each nostril, which is covered by skin and contains nasal hairs. Nares are the nostrils on either side of the septum. The turbinates are the folds of tissues that made up the side walls off the internal nose. The nasal septum is the thin wall that creates the two passages of the nose.

The nurse is providing education to a patient who will be using an aerosol humidifier at home. Which statement made by the patient indicates an understanding of the teaching? 1. "I should clean the unit weekly." 2. "The aerosol humidifier creates steam." 3. "Sterile distilled water should be used in the reservoir." 4. "White vinegar should be added to the sterile water for clean humidification."

3. "Sterile distilled water should be used in the reservoir." The patient would be correct in stating that sterile distilled water should be used in the reservoir for an aerosol humidifier. The unit should be cleaned daily, not weekly. The aerosol humidifier aerosolizes water into tiny droplets in the air, not steam. Although white vinegar can be used to clean the unit, it should not be used for humidification.

The nurse finds that the patient's breathing pattern is regular, deep, and faster than 20 breaths/min. What type of respirations are present? 1. Biot respirations 2. Sighing respirations 3. Kussmaul respirations 4. Cheyne-Stokes respirations

3. Kussmaul respirations Kussmaul respirations are characterized by a regular breathing pattern with deep breaths and a respiratory rate faster than 20 breaths per minute. Biot respirations are characterized by an irregular breathing pattern with varying depth and comes after a sudden period of apnea. Sighing respirations are characterized by a regular breathing pattern followed by periodic deep breaths and a respiratory rate of 12 to 20 breaths per minute. Cheyne-Stokes respirations come after a period of apnea and are characterized by progressive deep breaths that become shallower.

Which type of breathing pattern is most likely to occur in a patient with renal failure? 1. Bradypnea 2. Biot respirations 3. Kussmaul respirations 4. Cheyne-Stokes respirations

3. Kussmaul respirations Kussmaul respirations can occur with metabolic acidosis, diabetic ketoacidosis, and renal failure. Sedatives, opioids, and alcohol cause bradypnea; brain, metabolic, and respiratory disorders. Biot respirations are abnormally shallow for several months, followed by irregular periods of apnea, and occur with neurologic disorders. Cheyne-Stokes respirations develop in patients with severe brain pathology.

A patient complains of difficulty with breathing when in a lying position. Which term describes this phenomenon? 1. Apnea 2. Dyspnea 3. Orthopnea 4. Emphysema

3. Orthopnea Orthopnea is shortness of breath that occurs when someone is lying flat. Apnea is the temporary cessation of breathing, which often occurs while someone is asleep. Dyspnea is difficult or labored breathing. Emphysema is a condition in which the air sacs of the lungs are damaged and enlarged, leading to difficulty breathing.

What is the best prevention for influenza? 1. Herbs to stimulate immune function 2. Prophylactic antibiotics given during "flu season" 3. Prevention through yearly influenza immunization 4. Prophylactic antiviral medications for high-risk individuals

3. Prevention through yearly influenza immunization The best prevention for influenza is through immunization. The U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Immunization Guidelines recommend an annual influenza vaccine. Herbs may not completely improve the immune system. Antibiotics are not used prophylactically during influenza season. Antiviral medications are not administered prophylactically.

Indications of a tension pneumothorax include which signs and/or symptoms? Select all that apply. 1. Progressive bradycardia, increased heart sounds, and dyspnea 2. Shifting of the heart and the apical pulse toward the affected side 3. Shifting of the trachea and esophagus toward the unaffected side 4. Progressive cyanosis, increasing dyspnea, and decreased cardiac output 5. Diminished breath sounds over the affected lung due to collapse of the lung

3. Shifting of the trachea and esophagus toward the unaffected side 4. Progressive cyanosis, increasing dyspnea, and decreased cardiac output 5. Diminished breath sounds over the affected lung due to collapse of the lung The trachea, esophagus, and contents of the mediastinum shift toward the unaffected side due to increasing pressure in the pleural space on the affected side. Because of the ineffective breathing pattern caused by ineffective lung expansion, progressive dyspnea and cyanosis occur. Cardiac output decreases because of the pressure on the heart. The breath sounds over the affected lung are diminished or absent because of collapse of the lung. Bradycardia does not occur with a tension pneumothorax; tachycardia results as a compensatory mechanism. Heart sounds shift to the unaffected side and may appear muffled. Dyspnea also occurs with a tension pneumothorax.

Which instructions should the nurse include when educating a patient about managing sinusitis without pharmacologic interventions? 1. Cool, dry cloths can be applied to the face. 2. Limit fluid intake to less than 1500 mL per day. 3. Take hot showers twice daily, and then blow the nose. 4. Use a dehumidifier device to remove moisture from the air.

3. Take hot showers twice daily, and then blow the nose. The patient should take hot showers twice daily, and then blow the noise to promote sinus drainage. Warm, moist packs can promote drainage and relieve pain. Fluids should be increased. The patient should be taught how to use a humidifier to promote drainage.

Which statements accurately describe the function of the throat? Select all that apply. 1. The trachea is commonly described as the "voice box." 2. The epiglottis opens when we swallow, to usher food into the stomach. 3. The eustachian tubes originate in the middle ear and empty into the nasopharynx. 4. Tonsils and adenoids protect against bacterial invasion of the respiratory and digest tracts. 5. The vocal cords tighten and relax, producing different pitch sounds, as air moves through them.

3. The eustachian tubes originate in the middle ear and empty into the nasopharynx. 4. Tonsils and adenoids protect against bacterial invasion of the respiratory and digest tracts. 5. The vocal cords tighten and relax, producing different pitch sounds, as air moves through them. The eustachian tube is a canal that connects the middle ear to the nasopharynx; it controls the pressure within the middle ear. The tonsils and adenoids trap germs coming in through the nose and mouth. The vocal cords are the two folds of mucous membranes that are responsible for voice production. The trachea is not described as the "voice box"; instead, the larynx is. The epiglottis closes when we swallow so that the food and fluid we've ingested can't enter the airway.

Which information is important for the nurse to know about epistaxis? Select all that apply. 1. Advise the patient not to blow the nose until the bleeding has stopped. 2. Nasal packing should be placed by the nurse into the anterior nasal cavity. 3. A Foley catheter is inserted into the nasal cavity to apply pressure to the blood vessels. 4. Epistaxis may be caused by trauma, clotting disorders, dryness, inflammation, or hypertension. 5. Posterior packing is complicated, can result in infection and blockage to the eustachian tube, and requires careful monitoring.

4. Epistaxis may be caused by trauma, clotting disorders, dryness, inflammation, or hypertension. 5. Posterior packing is complicated, can result in infection and blockage to the eustachian tube, and requires careful monitoring. Epistaxis is a nosebleed typically caused by trauma, clotting disorders, dryness, inflammation, or hypertension. Epistaxis may be treated by applying pressure with a nasal balloon catheter or anterior or posterior packing. Posterior packing requires careful monitoring as it is more complicated and can result in conditions that obstruct the airways. The patient should not blow the nose for several hours after the bleeding stops to prevent recurrence of bleeding. The health care provider places the nasal packing. A Foley catheter is passed through the urethra and bladder for urinary tract disorders.

The nurse is caring for a patient with chronic sinusitis. Which drug, if ordered by the health care provider, would the nurse clarify with the health care provider before administering? 1. Antibiotics 2. Analgesics 3. Decongestants 4. First-generation antihistamines

4. First-generation antihistamines First-generation antihistamines such as diphenhydramine are not recommended because they may dry secretions, making them more difficult to clear. Antibiotics are prescribed for sinusitis. Analgesics, decongestants, nasal corticosteroids, and antipyretics may be ordered to improve drainage or to relieve symptoms.

Which nursing action is the priority after a fiberoptic bronchoscopy? 1. Assess vital signs every 15 minutes. 2. Assess level of consciousness frequently. 3. Save all sputum for examination and testing. 4. Hold all food and fluids until the gag reflex returns.

4. Hold all food and fluids until the gag reflex returns. A topical anesthetic agent is used during the bronchoscopy, and the patient's gag reflex will be absent until the anesthetic effects are gone. Therefore the patient is assessed for return of the gag reflex before food and fluids are allowed. Vital signs and level of consciousness are assessed and monitored according to institutional policy. All sputum is not saved for examination and testing.

Which condition is a contraindication to chest percussion and vibration? 1. Renal failure 2. Cystic fibrosis 3. Congestive heart failure 4. Increased intracranial pressure

4. Increased intracranial pressure Increased intracranial pressure is a contraindication to percussion and vibration. Renal failure, cystic fibrosis, and congestive heart failure are not considered to be a contraindication to this therapy.

Which statement is true regarding eligibility for diagnostic tests and procedures? 1. It is essential to ensure that a patient has not eaten for 4 hours before computed tomography. 2. The patient should take nothing by mouth until the gag reflex returns after fluoroscopy. 3. Failure to determine sensitivity to iodine could result in an allergic reaction, anaphylaxis, and death during magnetic resonance imaging. 4. No metal may be worn within the magnetic resonance imaging scanner, except dental fillings, including pacemakers and orthopedic plates.

4. No metal may be worn within the magnetic resonance imaging scanner, except dental fillings, including pacemakers and orthopedic plates. No metal may be worn inside the magnetic resonance imaging unit (except for dental fillings). Patients with implanted devices such as pacemakers and orthopedic plates, pins, or screws may be ineligible for MRI scanning. It is critical to ensure that a patient has not eaten for 4 hours before positron emission tomography because glucose is the substance most often tagged with the radionuclides. The radioactive dye containing iodine may be injected intravenously during computed tomography, not magnetic resonance imaging.

A nurse is working with a new employee. The new nurse demonstrates understanding of positioning instructions if he or she assists the patient after a thoracentesis into which position? 1. In the lithotomy position with pillows placed under the thighs 2. In the semi-Fowler position with hands resting on the knees 3. In the prone position with both arms elevated above the head 4. On the bedside and leans the upper torso over the bedside table with the head resting on folded arms.

4. On the bedside and leans the upper torso over the bedside table with the head resting on folded arms. Thoracentesis is the insertion of a large-bore needle through the chest wall into the pleural space. The patient sits on the side of the bed and leans the upper torso over the bedside table with the head resting on folded arms or pillows. The lithotomy, semi-Fowler, and prone positions are inappropriate for a thoracentesis.

The nurse is teaching a patient at high risk for cancer of the larynx about the signs and symptoms of the condition. Which early symptom should be relayed in this patient teaching? 1. Dyspnea 2. Anorexia 3. Hemoptysis 4. Persistent hoarseness

4. Persistent hoarseness Early symptoms of cancer of the larynx include persistent hoarseness or sore throat and ear pain. Dyspnea, anorexia, and hemoptysis (blood in sputum) are later symptoms of cancer of the larynx.

Which disease often coexists with chronic bronchitis and is a degenerative and nonreversible disease that breaks down the alveolar septum distal to the terminal bronchioles? 1. Asthma 2. Pneumonitis 3. Pulmonary embolism 4. Pulmonary emphysema

4. Pulmonary emphysema Pulmonary emphysema is a condition that often coexists with chronic bronchitis and is characterized by a degenerative, nonreversible disease that breaks down the alveolar septum distal to the terminal bronchioles. Asthma is an obstructive reversible airway disorder characterized by bronchospasm. Pneumonitis is an allergic inflammatory response of the alveoli to inhaled organic particles. Pulmonary embolism is an emergency in which there is a sudden blockage of a pulmonary blood vessel.

The licensed practical nurse (LPN) is caring for a patient who is being treated with an opioid analgesic. Which finding warrants prompt notification of the registered nurse? 1. Urinary retention 2. Pupillary constriction 3. Uncomfortable constipation 4. Respirations 10 breaths per minute

4. Respirations 10 breaths per minute A respiratory rate of less than 12 breaths/minute indicates respiratory depression. The registered nurse or health care provider should be notified. Urinary retention, constipation, and pupil constriction are common side effects, but do not require immediate intervention.

Which change is often the first sign of acute respiratory distress syndrome (ARDS)? 1. Pulse rate 2. Mental status 3. Blood pressure 4. Respiratory rate

4. Respiratory rate The first sign of ARDS is usually increased respiratory rate. A decrease in pulse rate, change in mental status, and change in blood pressure are not the first signs of ARDS.

Which would the nurse include when teaching a patient with allergic rhinitis ways to decrease the severity of the response? 1. Avoid being in crowded areas or around sick children. 2. Take first-generation antihistamines first thing in the morning. 3. Take decongestants instead of antihistamines for your symptoms. 4. Start intranasal corticosteroids several weeks before allergy season.

4. Start intranasal corticosteroids several weeks before allergy season. Patients with allergic rhinitis should begin taking intranasal corticosteroids several weeks before allergy season to minimize the allergic response. Patients with allergic rhinitis do not have a weakened immune system and do not need to avoid crowds or sick children. First-generation antihistamines should not be used in the morning as they cause sedation. Antihistamines are preferred over decongestants to treat allergies, as the symptoms are the result of an inflammatory response.

The nurse is caring for a patient who is on a mechanical ventilator. The ventilator alarms for increased peak airway pressure. Which intervention should be the nurse's priority? 1. Decrease the patient's oxygen flow. 2. Reposition the patient and tube. 3. Increase the patient's oxygen flow. 4. Suction the patient's tracheostomy.

4. Suction the patient's tracheostomy. An indication for suctioning when a patient is on a ventilator is increased peak airway pressure. When a patient is on a mechanical ventilator, decreasing the patient's oxygen flow or repositioning the patient and the tube are not indicated when there is increased peak airway pressure. It may be necessary to increase the patient's oxygen flow, but this is not clear from the question.

Where does the exchange of oxygen and carbon dioxide take place in the respiratory system? 1. Within the trachea 2. Through the glottis 3. Within the bronchioles 4. Through the walls of the alveoli

4. Through the walls of the alveoli The exchange of oxygen and carbon dioxide takes place through the walls of the alveoli. The trachea, or windpipe, is a 4- to 5-inch tube that descends from the larynx into the bronchi. The trachea functions as a passageway for air to reach the lungs. The space between the folds of the vocal cords is known as the glottis. Sound is produced when air from the lungs causes a rapid, repeated opening and closing of the glottis. The tertiary bronchi divide into smaller units, called bronchioles, which eventually lead into tiny air sacs called alveoli, which are located in the lungs.

Which factor will interfere with accurate measurement of the oximeter? 1. Vasodilation 2. Hypertension 3. Hyperthermia 4. Vasoconstriction

4. vasoconstriction Vasoconstriction will interfere with accurate measurement of the oximeter. Vasodilation will not affect the measurement. Hypotension, rather than hypertension, and hypothermia, rather than hyperthermia, can result in an inaccurate measurement.