Med Surg Quiz 2

A patient with asthma has a personal best peak expiratory flow rate (PEFR) of 400 L/min. When explaining the asthma action plan, the nurse will teach the patient that a change in therapy is needed when the PEFR is less than _____ L/minute.

320 L/minute

Which finding in a patient hospitalized with bronchiectasis is most important to report to the health care provider? A. Cough productive of bloody, purulent mucus B. Report of sharp chest pain with deep breathing C. Scattered crackles and wheezes heard bilaterally D. Respiratory rate 28 breaths/min while ambulating

A. Cough productive of bloody, purulent mucus

A 30-year-old patient who denies any history of smoking is seen in the clinic with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which topic would the nurse plan to teach the patient? A. 1-Antitrypsin testing B. Leukotriene modifiers C. Use of the nicotine patch D. Continuous pulse oximetry

A. 1-Antitrypsin testing

Which factors will the nurse consider when calculating the CURB-65 score for a patient with pneumonia? (Select all that apply.) A. Age B. Blood pressure C. Respiratory rate D. O2 saturation E. Presence of confusion F. Blood urea nitrogen (BUN) level

A. Age B. Blood pressure C. Respiratory rate E. Presence of confusion F. Blood urea nitrogen (BUN) level

A patient with acute dyspnea is scheduled for a spiral computed tomography (CT) scan. Which information obtained by the nurse is a priority to communicate to the health care provider before the CT? A. Allergy to shellfish B. Apical pulse of 104 C. Respiratory rate of 30 D. O2 saturation of 90%

A. Allergy to shellfish

A patient is scheduled for a computed tomography (CT) scan of the chest with contrast media. Which assessment findings would the nurse report to the health care provider before the patient goes for theCT? (Select all that apply.) A. Allergy to shellfish B. Patient reports claustrophobia C. Elevated serum creatinine level D. Recent bronchodilator inhaler use

A. Allergy to shellfish C. Elevated serum creatinine level

A patient who was admitted the previous day with pneumonia reports a sharp pain of 7 (on 0 to 10 scale) "whenever I take a deep breath." Which action will the nurse take first? A. Auscultate for breath sounds. B. Administer as-needed morphine C. Have the patient cough forcefully. D. Notify the patient's health care provider.

A. Auscultate for breath sounds.

The nurse is caring for a patient who has a right-sided chest tube after a right lower lobectomy. Which nursing action can the nurse delegate to the unlicensed assistive personnel (AP)? A. Document the amount of drainage every 8 hours. B. Obtain samples of drainage for culture from the system. C. Assess patient pain level associated with the chest tube. D. Check the water-seal chamber for the correct fluid level.

A. Document the amount of drainage every 8 hours.

Which action by the nurse would support ventilation for a patient with chronic obstructive pulmonary disease (COPD).? A. Encourage the patient to sit upright and lean forward. B. Have the patient rest with the head elevated 15 degrees. C. Place the patient in the Trendelenburg position with pillows behind the head. D. Ask the patient to rest in bed in a high-Fowler's position with the knees flexed

A. Encourage the patient to sit upright and lean forward.

The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect? A. Increased tactile fremitus B. Dry, nonproductive cough C. Hyperresonance to percussion D. A grating sound on auscultation

A. Increased tactile fremitus

On auscultation of a patient's lungs, the nurse hears low-pitched, bubbling sounds during inhalation in the lower third bilaterally. How should the nurse document this finding? A. Inspiratory crackles at the bases B. Expiratory wheezes in both lungs C. Abnormal lung sounds in the apices of both lungs D. Pleural friction rub in the right and left lower lobes

A. Inspiratory crackles at the bases

A patient who is experiencing an acute asthma attack is admitted to the emergency department. Which assessment would the nurse complete first? A. Listen to the patient's breath sounds. B. Ask about inhaled corticosteroid use. C. Determine when the dyspneastarted. D. Measure forced expiratory volume (FEV) flow rate.

A. Listen to the patient's breath sounds

Which nursing action for a patient with chronic obstructive pulmonary disease (COPD) could the nurse delegate to experienced assistive personnel (AP)? A. Measure O2 saturation using pulse oximetry. B. Monitor for increased O2 need with exercise. C. Teach the patient about safe use of O2 at home. D. Adjust O2 to keep saturation in prescribedparameters.

A. Measure O2 saturation using pulse oximetry.

A patient who is experiencing an asthma attack develops bradycardia and a decrease in wheezing. Which action would the nurse take first? A. Notify the health care provider. B. Document changes in respiratory status. C. Encourage the patient to cough and deep breathe. D. Administer IV methylprednisolone (Solu-Medrol)

A. Notify the health care provider.

The nurse is caring for a patient who has just had a thoracentesis. Which assessment information obtained by the nurse is a priority to communicate to the health care provider? A. O2 saturation is 88%. B. Blood pressure is 155/90 mm Hg. C. Respiratory rate is 24 breaths/min when lying flat. D. Pain level is 5 (on 0 to 10 scale) with a deep breath.

A. O2 saturation is 88%.

The emergency department nurse is evaluating the outcomes for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective? A. O2 saturation is >90%. B. No wheezes are audible. C. Respiratory rate is 16 breaths/min. D. Accessory muscle use has decreased.

A. O2 saturation is >90%.

A patient hospitalized with chronic obstructive pulmonary disease (COPD) is being discharged home on O2 therapy. Which instruction would the nurse include in the discharge teaching? A. O2 use can improve the patient's quality of life. B. Travel is not possible with the use of O2 devices. C. O2 flow should be increased if the patient has more dyspnea. D. Storage of O2 requires large metal tanks that last 4 to 6 hours

A. O2 use can improve the patient's quality of life.

The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment could be used to evaluate the effectiveness of the therapies? A. Observe for distended neck veins. B. Auscultate for crackles in the lungs. C. Palpate for heaves or thrills over the heart. D. Monitor for elevated white blood cell count.

A. Observe for distended neck veins.

Which health promotion information would the nurse include when teaching a patient with a 42 pack-year history of cigarette smoking? (Select all that apply.) A. Resources for support in smoking cessation B. Reasons for annual sputum cytology testing C. Erlotinib (Tarceva) therapy to prevent tumor risk D. Computed tomography (CT) screening for cancer E. Importance of obtaining a yearly influenza vaccination

A. Resources for support in smoking cessation D. Computed tomography (CT) screening for cancer E. Importance of obtaining a yearly influenza vaccination

The nurse assesses a patient with chronic obstructive pulmonary disease (COPD) who has been admitted after increasing dyspnea over the past 3 days. Which finding is important for the nurse to report to the health care provider? A. Respirations are 36 breaths/min. B. Anterior-posterior chest ratio is 1:1. C. Lung expansion is decreased bilaterally. D. Hyperresonance to percussion is present.

A. Respirations are 36 breaths/min.

Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The staff nurse has no symptoms of TB and has not had a positive TB skin test before. Which information would the occupational health nurse plan to teach the staff nurse? A. Use and side effects of isoniazid B. Standard four-drug therapy for TB C. Need for annual repeat TB skin testing D. Bacille Calmette-Guérin (BCG) vaccine

A. Use and side effects of isoniazid

Which finding by the nurse most specifically indicates that a patient is not able to effectively clear the airway? A. Weak cough effort B. Profuse green sputum C. Respiratory rate of 28 breaths/min D. Resting pulse oximetry (SpO2) of 85%

A. Weak cough effort

An older adult is receiving standard multidrug therapy for tuberculosis (TB). Which finding would the nurse report to the health care provider? A. Yellow-tinged sclera B. Orange-colored sputum C. Thickening of the fingernails D. Difficulty hearing high-pitched voices

A. Yellow-tinged sclera

A young adult patient with cystic fibrosis (CF) is admitted to the hospital with increased dyspnea. Which intervention would the nurse include in the plan of care? A. Schedule a sweat chloride test. B. Arrange for a hospice nurse visit. C. Place the patient on a low-sodium diet. D. Perform chest physiotherapy every 4 hours.

D. Perform chest physiotherapy every 4 hours.

The nurse in the emergency department receives arterial blood gas results for 4 recently admitted patients with obstructive pulmonary disease. The results for which patient will require the most rapid action by the nurse? A. pH 7.28, PaCO2 50 mm Hg, and PaO2 58 mm Hg B. pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg C. pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg D. pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg

A. pH 7.28, PaCO2 50 mm Hg, and PaO2 58 mm Hg

The nurse receives a change-of-shift report on the following patients with chronic obstructive pulmonary disease (COPD). Which patient would the nurse assess first? A. A patient with loud expiratory wheezes B. A patient with a respiratory rate of 38 breaths/min C. A patient who has a cough productive of thick, green mucus D. A patient with jugular venous distention and peripheral edema

B. A patient with a respiratory rate of 38 breaths/min

A patient with newly diagnosed lung cancer tells the nurse, "I don't think I'm going to live to see my next birthday." Which initial response would the nurse provide? A. "Are you ready to talk with family members about dying?" B. "Can you tell me what makes you think you will die so soon?" C. "Do you think that an antidepressant medication would be helpful?" D. "Would you like to talk to the hospital chaplain about your feelings?"

B. "Can you tell me what makes you think you will die so soon?"

The nurse provides dietary teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a low body mass index (BMI). Which patient statement indicates that the teaching has been effective? A. "I will drink lots of fluids with my meals." B. "I can have ice cream as a snack every day." C. "I will exercise for 15 minutes before meals." D. "I will decrease my intake of beef and poultry."

B. "I can have ice cream as a snack every day."

A young adult female patient with cystic fibrosis (CF) tells the nurse that she is considering trying to become pregnant. Which initial response would the nurse provide? A. "Are you aware of the normal lifespan for patients with CF?" B. "Would like more information to help you with that decision?" C. "You should have genetic counseling before making that choice." D. "Many women with CF do not have difficulty conceiving children."

B. "Would like more information to help you with that decision?"

The nurse receives change-of-shift report on the following four patients. Which patient would the nurse assess first? A. A 77-yr-old patient with tuberculosis (TB) who has four medications due B. A 46-yr-old patient on bed rest who reports sudden onset of shortness of breath C. A 35-yr-old patient with pneumonia who has a temperature of 100.2 F (37.8 C) D. A 23-yr-old patient with cystic fibrosis who has pulmonary function testing scheduled

B. A 46-yr-old patient on bed rest who reports sudden onset of shortness of breath

Which action, if performed by a nurse who is assigned to take care of a patient with active tuberculosis (TB), would require an intervention by the nurse supervisor? A. The patient is offered a tissue from the box at the bedside. B. A surgical face mask is applied before visiting the patient. C. A snack is brought to the patient from the unit refrigerator. D. Hand washing is performed before entering the patient's room.

B. A surgical face mask is applied before visiting the patient.

A patient with respiratory disease experiences a decrease in SpO2 from 93% to 87% while ambulating. Which action would be thenurse's priority? A. Notify the health care provider. B. Administer PRN supplemental O2. C. Document the response to exercise. D. Encourage the patient to pace activity

B. Administer PRN supplemental O2.

A patient seen in the asthma clinic has recorded daily peak flow rates that are 70% of the baseline. Which action will the nurse plan to take next? A. Teach the patient about the use of oral corticosteroids. B. Administer a bronchodilator and recheck the spirometry. C. Recommend increasing the dose of the leukotriene inhibitor. D. Instruct the patient to keep the scheduled follow-up appointment.

B. Administer a bronchodilator and recheck the spirometry.

An hour after a left thoracotomy, a patient reports incisional pain at a level 7 (based on 0 to 10 scale) and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which action would the nurse take? A. Turn and reposition the patient. B. Administer prescribed morphine. C. Clamp the chest tube in two places. D. Assist the patient with incentive spirometry.

B. Administer prescribed morphine.

The nurse reviews the medication administration record (MAR) for a patient having an acute asthma attack. Which medication would the nurse administer first? A. Methylprednisolone (Solu-Medrol) 60 mg IV B. Albuterol (Ventolin HFA) 2.5 mg per nebulizer C. Salmeterol (Serevent) 50 mcg per dry-powder inhaler (DPI) D. Ipratropium (Atrovent) 2 puffs per metered-dose inhaler (MDI)

B. Albuterol (Ventolin HFA) 2.5 mg per nebulizer

A patient has just been admitted with probable bacterial pneumonia and sepsis.Which prescribed action would the nurse implement first? A. Chest x-ray via stretcher B. Blood cultures from two sites C. Ciprofloxacin (Cipro) 400 mg IV D. Acetaminophen (Tylenol) suppository

B. Blood cultures from two sites

Which assessment finding in a patient who has received omalizumab (Xolair) is most important to report immediately to the health care provider? A. Pain at injection site B. Flushing and dizziness C. Respiratory rate 24 breaths/min D. Peak flow reading 75% of normal

B. Flushing and dizziness

A patient in the clinic with cystic fibrosis (CF) reports increased sweating and weakness during the summer months. Which action would the nurse take? A. Teach the patient signs of hypoglycemia. B. Have the patient add dietary salt to meals. C. Suggest decreasing intake of dietary fat and calories. D. Teach the patient about pancreatic enzyme replacement.

B. Have the patient add dietary salt to meals.

The arterial blood gas (ABG) results of a patient with diabetes show metabolic acidosis. Which compensatory finding would the nurse expect? A. Intercostal retractions B. Kussmaul respirations C. Low oxygen saturation (SpO2) D. Decreased venous O2 pressure

B. Kussmaul respirations

Which action could the nurse delegate to assistive personnel (AP)? A. Listen to a patient's lung sounds for wheezes or crackles. B. Label specimens obtained during percutaneous lung biopsy. C. Instruct a patient about how to use home spirometry testing. D. Measure induration at the site of a patient's intradermal skin test.

B. Label specimens obtained during percutaneous lung biopsy.

Which action by thenurse indicates a need to review respiratory assessment skills? A. Compares breath sounds from side to side at each level. B. Listens during the inspiratory phase, then moves the stethoscope. C. Starts at the apices of the lungs, moving down toward the lung bases. D. Instructs the patient to breathe slowly and deeply through the mouth.

B. Listens during the inspiratory phase, then moves the stethoscope.

A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, "I wish I were dead! I'm just a burden on everybody." Based on this information, which patient problem would the nurse identify? A. Fear of death B. Low self-esteem C. Anticipatory grieving D. Lack of knowledge

B. Low self-esteem

The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD). How would the nurse determine the appropriate O2 flow rate? A. Minimize O2 use to avoid O2 dependency. B. Maintain the pulse oximetry level at 90% or greater. C. Administer O2 according to the patient's level ofdyspnea. D. Avoid administration of O2 at a rate of more than 2 L/min

B. Maintain the pulse oximetry level at 90% or greater.

An experienced nurse instructs a new nurse about how to care for a patient with dyspnea caused by a pulmonary fungal infection. Which action by the new nurse indicates a need for further teaching? A. Listening to the patient's lung sounds several times during the shift B. Placing the patient on droplet precautions in a private hospital room C. Monitoring patient serology results to identify the infecting organism D. Titrating the O2 flowrate as prescribed to keep the O2 saturation over 90%

B. Placing the patient on droplet precautions in a private hospital room

Which assessment finding is most useful in evaluating the effectiveness of treatment to improve gas exchange? A. Even, unlabored respirations B. Pulse oximetry reading of 92% C. Absence of wheezes or crackles D. Respiratory rate of 18 breaths/min

B. Pulse oximetry reading of 92%

Which action would the nurse plan to prevent aspiration in a high-risk patient? A. Turn and reposition an immobile patient at least every 2 hours. B. Raise the head of the bed for a patient who is receiving tube feedings. C. Insert a nasogastric tube for feeding a patient with high-calorie needs. D. Monitor respiratory symptoms in a patient who is immunosuppressed.

B. Raise the head of the bed for a patient who is receiving tube feedings.

An occupational health nurse works at a manufacturing plant where there is potential exposure to inhaled dust. Which action would the nurse recommended to prevent lung disease? A. Teach about symptoms of lung disease. B. Require the use of protective equipment. C. Treat workers who have pulmonary fibrosis. D. Monitor workers for coughing and wheezing.

B. Require the use of protective equipment.

A patient admitted to the emergency department with a sudden onset of shortness of breath is diagnosed with a possible pulmonary embolus. How would the nurse prepare the patient for diagnostic testing to confirm the diagnosis? A. Ensure that the patient has been NPO. B. Review lab results to evaluate renal function. C. Inform radiology that radioactive glucose preparation is needed. D. Instruct the patient to expect to inspire deeply and exhale forcefully.

B. Review lab results to evaluate renal function.

The home health nurse is visiting a patient with chronic obstructive pulmonary disease (COPD). Which action would the nurse implement for a patient who has an impaired breathing pattern due to anxiety? A. Titrate O2 to keep saturation at least 90%. B. Teach the patient how to use the pursed-lip technique. C. Discuss a high-protein, high-calorie diet with the patient. D. Suggest the use of over-the-counter sedative medications.

B. Teach the patient how to use the pursed-lip technique.

The clinic nurse makes a follow-up telephone call to a patient with asthma. The patient reports having a baseline peak flow reading of 600 L/min, and the current peak flow is 420 L/min. Which action would the nurse take first? A. Tell the patient to go to the hospital emergency department. B. Teach the patient to use the prescribed albuterol (Ventolin HFA). C. Ask about recent exposure to any new allergens or asthma triggers. D. Question the patient about use of the prescribed inhaled corticosteroids.

B. Teach the patient to use the prescribed albuterol (Ventolin HFA).

The nurse teaches a patient who has chronic bronchitis about a new prescription for combined fluticasone and salmeterol (Advair Diskus) in a dry powder inhaler. Which patient action indicates to the nurse that teaching about medication administration has been successful? A. The patient shakes the device before use. B. The patient rapidly inhales the medication. C. The patient attaches a spacer to the device. D. The patient performs huff coughing after inhalation.

B. The patient rapidly inhales the medication.

The home health nurse teaches a patient how to administer formoterol (Perforomist) through a nebulizer. Which action by the patient indicates good understanding of the teaching? A. The patient lies in supine position when using the nebulizer. B. The patient removes the facial mask when the misting stops. C. The patient reports washing the nebulizer mouthpiece weekly. D. The patient inhales while holding the mask 4 inches away from the face.

B. The patient removes the facial mask when the misting stops.

When preparing a clinic patient who has chronic obstructive pulmonary disease (COPD) for pulmonary spirometry, which question would the nurse ask? A. "Are you claustrophobic?" B. "Are you allergic to shellfish?" C. "Have you taken any bronchodilators today?" D. "Do you have any metal implants or prostheses?"

C. "Have you taken any bronchodilators today?"

The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement by the patient indicates a good understanding of the instructions? A. "I will call my health care provider if I still feel tired after a week." B. "I will cancel my follow-up chest x-ray appointment if I feel better." C. "I will continue to do deep breathing and coughing exercises at home." D. "I will schedule two appointments for the pneumonia and influenza vaccines."

C. "I will continue to do deep breathing and coughing exercises at home."

The nurse teaches a patient about pulmonary spirometrytesting. Which statement by thepatient indicates teaching was effective? A. "I should use my inhaler right before thetest." B. "I won't eat or drink anything 8 hours before the test." C. "I will inhale deeply and blow out hard during the test." D. "My blood pressure and pulse will be checked every 15 minutes."

C. "I will inhale deeply and blow out hard during the test."

The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB). Which statement by the patient indicates that teaching was effective? A. "I will take the bus instead of driving." B. "I will stay in doors whenever possible." C. "My spouse will sleep in another room." D. "I will keep the windows closed at home."

C. "My spouse will sleep in another room."

A lobectomy is scheduled for a patient with stage I non-small cell lung cancer. The patient tells the nurse, "I would rather have chemotherapy than surgery." Which initial response would the nurse provide? A. "Are you afraid that it will be very painful?" B. "Did you have bad experiences with surgeries?" C. "Tell me what you know about the treatments available." D. "Surgery is the treatment of choice for stage I lung cancer."

C. "Tell me what you know about the treatments available."

Which instruction would the nurse include in an exercise teaching plan for a patient with chronic obstructive pulmonary disease (COPD)? A. "A void upper body exercises to prevent dyspnea." B. "Stop exercising if you start to feel short of breath." C. "Use the bronchodilator before you start to exercise." D. "Breathe in and out through the mouth while exercising."

C. "Use the bronchodilator before you start to exercise."

The nurse monitors a patient in the emergency department after chest tube placement for a hemopneumothorax. Which assessment finding is of most concern? A. A large air leak in the water-seal chamber B. Report of pain with each deep inspiration C. 400 mL of blood in the collection chamber D. Subcutaneous emphysema at the insertion site

C. 400 mL of blood in the collection chamber

After change-of-shift report, which patient would the nurse assess first? A. A 40-yr-old with a pleural effusion who reports severe stabbing chest pain B. A 72-yr-old with cor pulmonale who has 4+ bilateral edema in his legs and feet C. A 64-yr-old with lung cancer and tracheal deviation after subclavian catheter insertion D. A 28-yr-old with a history of a lung transplant 1 month ago and a fever of 101 F (38.3C)

C. A 64-yr-old with lung cancer and tracheal deviation after subclavian catheter

After the nurse has received change-of-shift report, which patient would the nurse assess first? A. A patient with pneumonia who has crackles in the right lung base B. A patient with chronic bronchitis who has a low forced vital capacity C. A patient with possible lung cancer who has just returned after bronchoscopy D. A patient with hemoptysis and a 16-mm induration after tuberculin skin testing

C. A patient with possible lung cancer who has just returned after bronchoscopy

A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic would the nurse plan to include in the teaching plan? A. Purpose of antibiotic therapy B. Ways to limit oral fluid intake C. Appropriate use of cough suppressants D. Safety concerns with home O2 therapy

C. Appropriate use of cough suppressants

A patient diagnosed with active tuberculosis (TB) is homeless and has a history of chronic alcohol use. Which intervention by the nurse expect to be most effective in ensuring adherence with the TB treatment regimen? A. Repeat warnings about the high risk for infecting others several times. B. Give the patient written instructions about how to take the medications. C. Arrange for a daily meal and drug administration at a community center. D. Arrange for the patient's friend to administer the medication on schedule.

C. Arrange for a daily meal and drug administration at a community center.

A patient who has a history of chronic obstructive pulmonary disease (COPD) was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of 89% to 90%). Which action by the nurse will be most effective in improving the patient's adherence with discharge teaching? A. Have the patient repeat the instructions immediately after teaching. B. Accomplish the patient teaching just before the scheduled discharge. C. Arrange for the patient's caregiver to be present during the teaching. D. Start giving the patient discharge teaching during the admission process.

C. Arrange for the patient's caregiver to be present during the teaching.

A patient with acute shortness of breath is admitted to thehospital. Which action should thenurse take during theinitial assessment of thepatient? A. Ask thepatient to lie down for complete a full physical assessment. B. Complete thehealth history and check for allergies before treatment. C. Briefly ask specific questions about this episode of respiratory distress. D. Delay the physical assessment to first complete pulmonary function tests

C. Briefly ask specific questions about this episode of respiratory distress.

The nurse completes a shift assessment on a patient admitted in theearly phase of heart failure. Which sounds would thenurse most likely hear on auscultation? A. Continuous rumbling, snoring, or rattling sounds mainly on expiration B. Continuous high-pitched musical sounds on inspiration and expiration C. Discontinuous high-pitched sounds of short duration during inspiration D. Discontinuous low-pitched sounds of long duration during inspiration

C. Discontinuous high-pitched sounds of short duration during inspiration

A patient with bacterial pneumonia has coarse crackles and thick sputum. Which action would the nurse plan to promote airway clearance? A. Restrict oral fluids during the day. B. Encourage pursed-lip breathing technique. C. Help the patient to splint the chest when coughing. D. Encourage the patient to wear the nasal O2 cannula.

C. Help the patient to splint the chest when coughing.

While listening to the posterior chest of a patient who is experiencing acute shortness of breath, the nurse hears these sounds. How would the nurse document the lung sounds? A. Pleural friction rub B. Low-pitched crackles C. High-pitched wheezes D. Bronchial breath sounds

C. High-pitched wheezes

A patient with a chronic cough is scheduled to have a bronchoscopy with biopsy. Which intervention will the nurse implement directly after the procedure? A. Encourage the patient to drink clear liquids. B. Place the patient on bed rest for at least 4 hours. C. Keep the patient NPO until the gag reflex returns. D. Maintain the head of the bed elevated 90 degrees.

C. Keep the patient NPO until the gag reflex returns.

The nurse notes that a patient has incisional pain, a poor cough effort, and scattered coarse crackles after a thoracotomy. Which action would the nurse take first? A. Assist the patient to sit upright in a chair. B. Splint the patient's chest during coughing. C. Medicate the patient with prescribed morphine. D. Observe the patient use the incentive spirometer.

C. Medicate the patient with prescribed morphine.

A patient with chronic obstructive pulmonary disease (COPD) has been eating very little and has lost weight. Which intervention would be most important for the nurse to include in the plan of care? A. Encourage increased intake of whole grains. B. Increase the patient's menu order of fruits and fruit juices. C. Offer high-calorie protein snacks between meals and at bedtime. D. Assist the patient in choosing foods with high vegetable content.

C. Offer high-calorie protein snacks between meals and at bedtime.

A patient has a chest wall contusion as a result of being struck in the chest with a baseball bat. Which initial assessment finding is of most concern to the emergency department nurse? A. Report of chest wall pain B. Heart rate of 110 beats/min C. Paradoxical chest movement D. Large, bruised area on the chest

C. Paradoxical chest movement

Which finding indicates to the nurse that the administered nifedipine (Procardia) was effective for a patient who has idiopathic pulmonary arterial hypertension (IPAH)? A. Heart rate is between 60 and 100 beats/min. B. Patient's chest x-ray indicates clear lung fields. C. Patient reports a decrease in exertional dyspnea. D. Blood pressure (BP) is less than 140/90 mm Hg.

C. Patient reports a decrease in exertional dyspnea.

Which finding would the nurse expect when assessing a patient with cor pulmonale? A. Chest pain B. Finger clubbing C. Peripheral edema D. Elevated temperature

C. Peripheral edema

Using the illustrated technique, the nurse is assessing for which finding in a patient with chronic obstructive pulmonary disease (COPD)? A. Hyperresonance B. Tripod positioning C. Reduced excursion D. Accessory muscle use

C. Reduced excursion

A patient with cystic fibrosis has blood glucose levels that are consistently between 180 to 250 mg/dL. Which action will the nurse expect to implement? A. Discuss the role of diet in blood glucose control. B. Evaluate the patient's use of pancreatic enzymes. C. Teach the patient about administration of insulin. D. Give oral hypoglycemic medications before meals.

C. Teach the patient about administration of insulin.

The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action would the nurse take? A. Teach about the reason for the blood tests. B. Schedule an appointment for a chest x-ray. C. Teach the patient about providing specimens for 3 consecutive days. D. Instruct the patient to collect several separate sputum specimens today.

C. Teach the patient about providing specimens for 3 consecutive days.

Which action by the nurse will be most effective in decreasing the spread of pertussis in a community setting? A. Providing supportive care to patients diagnosed with pertussis B. Teaching family members about the need for careful hand washing C. Teaching patients about the need for adult pertussis immunizations D. Encouraging patients to complete the prescribed course of antibiotics

C. Teaching patients about the need for adult pertussis immunizations

The nurse is caring for a patient with idiopathic pulmonary arterial hypertension (IPAH). Which assessment information requires the most immediate action by the nurse? A. The O2 saturation is 90%. B. The blood pressure is 98/56 mm Hg. C. The epoprostenol (Flolan) infusion is disconnected. D. The international normalized ratio (INR) is prolonged.

C. The epoprostenol (Flolan) infusion is disconnected.

A patient with pneumonia has a fever of 101.4 F (38.6 C), a nonproductive cough, and an O2 saturation of 88%. The patient is weak and needs assistance to get out of bed. Which patient problem would the nurse assign as the priority? A. Fatigue B. Altered temperature C. Musculoskeletal problem D. Impaired respiratory function

D. Impaired respiratory function

The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is specific in confirming a diagnosis of chronic bronchitis? A. The patient relates a family history of bronchitis. B. The patient has a 30 pack-year cigarette smoking history. C. The patient reports a productive cough for 3 months of every winter. D. The patient has respiratory problems that began during the past 12 months.

C. The patient reports a productive cough for 3 months of every winter.

The nurse takes an admission history on a patient with possible asthma who has new-onset wheezing and shortness of breath. Which information may indicate a need for a change in therapy? A. The patient has chronic inflammatory bowel disease. B. The patient has a history of pneumonia 6 months ago. C. The patient takes propranolol (Inderal) for hypertension. D. The patient uses acetaminophen (Tylenol) for headaches.

C. The patient takes propranolol (Inderal) for hypertension.

The nurse teaches a patient who has asthma about peak flowmeter use. Which action by the patient indicates that teaching was successful? A. The patient inhales rapidly through the peak flowmeter mouthpiece. B. The patient takes montelukast (Singulair) for peak flows in the red zone. C. The patient uses albuterol (Ventolin HFA) for peak flows in the yellow zone. D. The patient calls the health care provider when the peak flow is in the green zone

C. The patient uses albuterol (Ventolin HFA) for peak flows in the yellow zone.

A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days. Which assessment data indicates that the treatment is effective? A. Bronchial breath sounds are heard at the right base. B. The patient coughs up small amounts of green mucus. C. The patient's white blood cell (WBC) count is 6000/mL. D.Increased tactile fremitus is palpable over the right chest.

C. The patient's white blood cell (WBC) count is 6000/mL.

Which assessment finding for a patient with a history of asthma indicates that the nurse would take immediate action? A. Pulse oximetry reading of 91% B. Respiratory rate of 26 breaths/min C. Use of accessory muscles in breathing D. Peak expiratory flow rate of 240 L/min

C. Use of accessory muscles in breathing

The nurse develops a teaching plan to help increase activity tolerance at home for an older adult with severe chronic obstructive pulmonary disease (COPD). Which instructions would be appropriate for the nurse to include in the plan of care? A. Walk until pulse rate exceeds 130 beats/min. B. Stop exercising when you feel short of breath. C. Walk 15 to 20 minutes a day at least 3 times/wk. D. Limit exercise to activities of daily living (ADLs).

C. Walk 15 to 20 minutes a day at least 3 times/wk.

Which action would the nurse take to prepare a patient for spirometry? A. Give the rescue medication immediately before testing. B. Administer oral corticosteroids 2 hours before the procedure. C. Withhold bronchodilators for 6 to 12 hours before the examination. D. Ensure that the patient has been NPO for several hours before the test.

C. Withhold bronchodilators for 6 to 12 hours before the examination

The nurse is performing tuberculosis (TB) skin tests in a clinic that has many patients who have immigrated to the United States. Which question is important for the nurse to ask before the skin test? A. "Do you take any over-the-counter (OTC) medications?" B. "Do you have any family members with a history of TB?" C. "How long has it been since you moved to the United States?" D. "Did you receive the Bacille Calmette-Guérin (BCG) vaccine for TB?"

D. "Did you receive the Bacille Calmette-Guérin (BCG) vaccine for TB?"

The nurse completes discharge teaching for a patient who has had a lung transplant. Which patient statement indicates that the teaching has been effective? A. "I will make an appointment to see the doctor every year." B. "I will stop taking the prednisone if I experience a dry cough." C. "I will not worry if I feel a little short of breath with exercise." D. "I will call the health care provider right away if I develop a fever."

D. "I will call the health care provider right away if I develop a fever."

The nurse provides discharge teaching for a patient who has two fractured ribs from an automobile accident. Which patient statement indicates that teaching has been effective? A. "I am going to buy a rib binder to wear during the day." B. "I can take shallow breaths to prevent my chest from hurting." C. "I should plan on taking the pain pills only at bedtime so I can sleep." D. "I will use the incentive spirometer every hour or two during the day."

D. "I will use the incentive spirometer every hour or two during the day."

Which patient statement indicates that a patient admitted with acute asthma may need teaching regarding medication use? A. "I have not had any acute asthma attacks during the past year." B. "I became short of breath an hour before coming to the hospital." C. "I've been taking acetaminophen every 6 hours for chest wall pain." D. "I've used my albuterol inhaler frequently over the last 4 days."

D. "I've used my albuterol inhaler frequently over the last 4 days.

The nurse supervises assistive personnel (AP) providing care for a patient who has right lower lobe pneumonia. Which action by the AP requires the nurse to intervene? A. AP assists the patient to ambulate to the bathroom. B. AP helps splint the patient's chest during coughing. C. AP transfers the patient to a bedside chair for meals. D. AP lowers the head of the patient's bed to 15 degrees

D. AP lowers the head of the patient's bed to 15 degrees

After 2 months of prescribed treatment with isoniazid, rifampin, pyrazinamide, and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action would the nurse take next? A. Teach about drug-resistant T B. Schedule directly observed therapy. C. Discuss injectable antibiotics with the health care provider. D. Ask the patient whether medications were taken as directed.

D. Ask the patient whether medications were taken as directed.

The nurse palpates the posterior chest and notes absent fremitus while the patient says "toy boat". Which action would the nurse take next? A. Palpate the anterior chest and observe for barrel chest. B. Encourage the patient to turn, cough, and deep breathe. C. Review the chest x-ray report for evidence of pneumonia. D. Auscultate anterior and posterior breath sounds bilaterally.

D. Auscultate anterior and posterior breath sounds bilaterally.

Which assessment finding for an older patient indicates that thenurse should take immediate action? A. Weak cough effort B. Barrel-shaped chest C. Dry mucous membranes D. Bilateral basilar crackles

D. Bilateral basilar crackles

The emergency department nurse notes tachycardia and absent breath sounds over the right thorax of a patient who has just arrived after an automobile accident. For which intervention will the nurse prepare the patient? A. Emergency pericardiocentesis B. Stabilization of the chest wall C. Bronchodilator administration D. Chest tube connected to suction

D. Chest tube connected to suction

A patient with a possible pulmonary embolism reports chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/min, blood pressure of 100/60 mm Hg, and respirations of 42 breaths/min. Which action would the nurse take first? A. Administer anticoagulant drug therapy. B. Notify the patient's health care provider. C. Prepare patient for a spiral computed tomography (CT). D. Elevate the head of the bed to a semi-Fowler's position.

D. Elevate the head of the bed to a semi-Fowler's position.

A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange discolored urine and tears. Which response by the nurse reflects accurate knowledge about the medication and the patient's illness? A. Asking the patient about any visual changes in red-green color discrimination B, Questioning the patient about experiencing shortness of breath, hives, or itching C. Advising the patient to stop the drug and report the symptoms to the health care provider D. Explaining that orange discolored urine and tears are normal while taking this

D. Explaining that orange discolored urine and tears are normal while taking this

A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6 F with a frequent cough and severe pleuritic chest pain. Which prescribed medication would the nurse give first? A. Codeine B. Guaifenesin C. Acetaminophen (Tylenol) D. Piperacillin/tazobactam (Zosyn)

D. Piperacillin/ tazobactam (Zosyn)

A patient newly diagnosed with asthma is being discharged. Which topic would the nurse include in the discharge teaching? A. Complications associated with O2 therapy B. Use of long-acting -adrenergic medications C. Side effects of sustained-release theophylline D. Self-administration of inhaled corticosteroids

D. Self-administration of inhaled corticosteroids

The nurse prepares a patient who has a left-sided pleural effusion for a thoracentesis. How should thenurse position the patient? A. High-Fowler's position with the left arm extended B. Supine with the head of the bed elevated 30 degrees C. On the right side with the left arm extended above the head D. Sitting upright with the arms supported on an over bed table

D. Sitting upright with the arms supported on an over bed table

A patient is hospitalized with active tuberculosis (TB). Which assessment finding indicates to the nurse that prescribed airborne precautions are likely to be discontinued? A. Chest x-ray shows no upper lobe infiltrates. B. TB medications have been taken for 6 months. C. Mantoux testing shows an induration of 10 mm. D. Sputum smears for acid-fast bacilli are negative.

D. Sputum smears for acid-fast bacilli are negative.

A patient is admitted to the emergency department with an open stab wound to the left chest. Which action would the nurse take? A. Keep the head of the patient's bed positioned flat. B. Cover the wound tightly with an occlusive dressing. C. Position the patient so that the left chest is dependent. D. Tape a nonporous dressing on three sides over the wound.

D. Tape a nonporous dressing on three sides over the wound.

Which intervention would the nurse include in the plan of care for a patient who is diagnosed with a lung abscess? A. Assist the patient with chest physiotherapy and postural drainage. B. Teach the patient to avoid the use of over-the-counter expectorants. C. Notify the health care provider immediately about any bloodyor foul-smelling sputum. D. Teach about the need for prolonged antibiotic therapy after discharge from the hospital.

D. Teach about the need for prolonged antibiotic therapy after discharge from the hospital.

The nurse analyzes the results of a patient's arterial blood gases (ABGs). Which finding requires immediate action? A. The bicarbonate level (HCO3-) is 31 mEq/L. B. The arterial oxygen saturation (SaO2) is 92%. C. The partial pressure of CO2 in arterial blood (PaCO2) is 31 mmHg. D. The partial pressure of oxygen in arterial blood (PaO2) is 62 mm Hg..

D. The partial pressure of oxygen in arterial blood (PaO2) is 62 mm Hg..

The nurse completes an admission assessment on a patient with asthma. Which information indicates a need for discussion with the health care provider about a change in therapy? A. The patient uses an albuterol inhaler before aerobic exercise. B. The patient's only medications are albuterol and salmeterol inhalers. C. The patient's heart rate increases slightly after using the albuterol inhaler. D. The patient used albuterol more often when symptoms were worse in the spring.

D. The patient used albuterol more often when symptoms were worse in the spring.

Which information will the nurse include in the teaching plan for a patient newly diagnosed with asthma? A. Use the inhaled corticosteroid when shortness of breath occurs. B. Inhale slowly and deeply when using the dry powder inhaler(DPI). C. Hold your breath for 2 seconds after using the bronchodilator inhaler. D. Tremors are an expected side effect of rapidly acting bronchodilators.

D. Tremors are an expected side effect of rapidly acting bronchodilators.