Med surg respiratory disorders review

Rifabutin is prescribed for a client with active mycobacterium avian complex disease and tuberculosis. The nurse should monitor for effects of the medication? Select all that apply. 1. Signs of hepatitis 2. Flu-like syndrome 3 Low neutrophil count 4Vitamin B, deficiency 5. Ocular pain or blurred vision 6. Tingling and numbness of the fingers

1,2,3,5 Rifabutin may be prescribed for a client with active MẠC disease and tuberculosis. It inhibits mycobacterial DNA- dependent RNA polymerase and suppresses protein synthesis. Side effects include rash, GI disturbances, neutropenia (low and numbness and tingling in the extremities are associated with dyspnea, and flu-like syndrome. Vitamin B6 deficiency vision and eye pain), myositis, arthralgia, hepatitis, chest pain neutrophil count), red-orange body secretions, uveitis (blurred with the use of isoniazid. Ethambutol also causes peripheral neuritis.

The client is diagnosed with pleurisy. The nurse should expect to see which signs and symptoms? Select all that apply. 1. Pleural friction rub 2. Sharp, knife-like pain 3. Cyanosis of lips and nailbeds 4. Pain that occurs on both sides of the chest 5. Pain occurs most often during inspiration

1,2,5 Pleurisy is inflammation of the pleura. The most characteristic symptom of pleurisy is abrupt and severe pain. The pain almost always occurs on one side of the chest. Pleurisy pain is sharp, knife-like, and abrupt in onset and is most evident during inspiration. This causes shallow breathing. A pleural friction rub may be heard.

The nurse is preparing a list of homecare instuctions for the client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse reinforce? Select all that apply. 1. Activities should be resumed gradually. 2. Avoid contact with other individuals except family members for at least 6 months. 3. Asputum culture is needed every 2 to 4 weeks once medication therapy is initiated. 4. Respiratory isolation is not necessary because family members have already been exposed 5. Cover the mouth and nose when coughing or sneezing and confine used tissue to plastic bags 6. When one sputum culture is negative the client is no longer considered infectious and can usually return to his or her former employment lol

1,3,4,5 The nurse should provide the client and family with information about tuberculosis and allay concerns about the contagious aspect of the infection. The client is reassured that after 2 to 3 weeks of medication therapy, it is unlikely that the client will infect anyone. The client is also informed that activities should be resumed gradually. The cli- ent and family are informed that respiratory isolation is not necessary because family members have already been exposed. The client is instructed about thorough hand wash- ing, to cover the mouth and nose when coughing or sneez- ing, and to confine used tissues to plastic bags. The client is informed that a sputum culture is needed every 2 to 4 weeks once medication is initiated and that when the results of three sputum cultures are negative, the client is no longer considered infectious and can usually return to his or her former employment.

The nurse is assigned to care for a client after a left pneumonectomy. Which position is contraindi- cated for this client? 1. Lateral position 2. Low Fowler's position 3. Semi-Fowler's position 4. Head of the bed elevation at 40 degrees

1. Lateral postion Complete lateral positioning is contraindicated for a client following pneumonectomy. Because the medias- tinum is no longer held in place on both sides by lung tissue, lateral positioning may cause mediastinal shift and compres- sion of the remaining lung. The head of the bed should be elevated.

The nurse notes that a hospitalized client has expe- rienced a positive reaction to the tuberculin skin test. Which action by the nurse is priority? 1. Report the findings. 2. Document the finding in the client's record. 3. Call the employee health service department. 4. Call the radiology department for a chest x-ray.

1. Report the findings The nurse who interprets a tuberculin skin test a. positive notifies the PHCP immediately. The PHCP would prescribe a chest x-ray to determine whether the client has clini cally active tuberculosis or old healed lesions. A sputum culture would be done to confirm the diagnosis of active tuber- culosis. The client is placed on tuberculosis precautions pro- phylactically until a final diagnosis is made. The findings are documented in the client's record, but this action is not the highest priority. Calling the employee health service would be of no benefit to the client.

A client has a prescription to take guaifenesin every 4 hours, as needed. The nurse determines that the client understands the most effective use of this medication if the client makes which statement? 1. "I will watch for irritability as a side effect." 2. "I will take the tablet with a full glass of water." 3. "I will take an extra dose if the cough is accompanied by fever." 4. "I will crush the sustained-release tablet if immediate relief is needed."

2. I will take the tablet with a full glass of water Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease the viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The medication may occasionally cause dizziness, headache, or drowsiness. The client should contact The PHCP if the cough last longer than one week or is accompanied by fever rash sore throat or a persistent headache

A client has been taking isoniazid for 2 months. The client complains to the nurse about numb- ness, paresthesia, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation

2. Peipheral neuritis A common adverse effect of isoniazid is peripheral neuritis. This is manifested by numbness, tingling, and pares- thesias in the extremities. This adverse effect can be minimized by pyridoxine intake. Options 1, 3, and 4 are incorrect.

A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to provide which information to the client? 1. Drink alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy.

2. Report yellow eyes or skin immediately Isoniazid is hepatotoxic, and therefore the client is taught two report signs and symptoms of hepatitis immediately (which include yellow skin and sclera). For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods con- taining tyramine because they may cause a reaction character- ized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or light-headedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine during the course of isoniazid therapy.

The nurse is caring for a client after pulmonary angi- ography via catheter insertion into the left groin. The nurse monitors for an allergic reaction to the contrast medium by observing for the presence of which? 1. Hypothermia 2. Respiratory distress 3. Hematoma in the left groin 4. Discomfort in the left groin instructions

2. Respiratory distress Signs of allergic reaction to the contrast medium include localized itching and edema, respiratory distress, stri- dor, and decreased blood pressure. Hypothermia is an unre- lated event. Hematoma formation a complication of the procedure, but does not indicate an allergic reaction. Discom- fort is expected.

Cycloserine is added to the medication regimen for a client with tuberculosis. Which instruction should the nurse reinforce in the client-teaching plan regarding this medication? 1. To take the medication before meals 2. To return to the clinic weekly for serum drug level testing 3. It is not necessary to restrict alcohol intake with this medication 4. It is not necessary to call primary healthcare provider if a skin rash occurs

2. Return to the clinic weekly for serum drug level testing Cycloserine is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. Serum drug levels lower than 30 mcg/mL reduce the incidence of neurotoxicity. The medica- tion must be taken after meals to prevent GI irritation. The cli- ent must be instructed to notify the PHCP if a skin rash or signs of CNS toxicity are noted. Alcohol must be avoided because it increases the risk of seizure activity.

The low-pressure alarm sounds on the ventilator. The nurse checks the client and then attempts to determine the cause of the alarm but is unsuccess- ful. Which initial action should the nurse take? 1. Administer oxygen. 2. Ventilate the client manually. 3. Check the client's vital signs. 4. Start cardiopulmonary resuscitation (CPR).

2. Ventilate the client manually If an alarm is sounding at any time and the nurse cannot quickly ascertain the problem, the client is disconnected from the ventilator and a manual resuscitation device is used to support respirations until the problem can be corrected. Although oxygen is helpful, it will not provide ventila- tion to the client. Checking vital signs is not the initial action. There is no reason to begin CPR.

The client has been started on long-term therapy of rifampin which information about this medication should the nurse provide to the client? 1. Should always be taken with food or antacids 2. Should be double-dosed if one dose is forgotten 3. Causes red-orange discoloration of sweat, tears, urine, and feces 4. May be discontinued independently if symp- toms are gone in 3 months

3 causes red orange discoloration of sweat tears urine and feces Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a PHCP. The medication should be administered on an empty stomach unless it causes G.I. upset and then it may be taken with food antacids if prescribed should be taken at least one hour before medication rifampin causes red orange discoloration of body secretions and will permanently stain soft contact lenses

The nurse is caring for several clients with respira- tory disorders. Which client is at least risk for devel- oping a tuberculosis infection? 1. I am insured man who is homeless 2. A woman newly immigrated from Korea 3. A man who is the inspector for the US Postal Service 4. An older woman admitted for a long-term care facility

3. A man who is an inspector for the US Postal Service People at high risk for acquiring tuberculosis include children younger than 5 years of age; homeless individ- uals or those from a lower socioeconomic group, minority groups, or immigrant group; individuals in constant, frequent contact with an untreated or undiagnosed individual; individ- uals living in crowded areas such as long-term care facilities, prisons, and mental health facilities; older clients; malnour- ished individuals, those with an infection, or an immune dys- function or human immunodeficiency virus infection, or individuals who are immunosuppressed as a result of medica- tion therapy; and individuals who abuse alcohol or are IV drug users.

The nurse is caring for a client after a bronchoscopy and biopsy. Which finding should be reported immediately to the primary health care provider (PHCP)? 1. Dry cough 2. Hematuria 3. Bronchospasm 4. Blood-tinged sputum

3. Bronchospasm If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. Hematuria is unrelated to this procedure.

A client with tuberculosis is being started on anti- tuberculosis therapy with isoniazid. Before giving the client the first dose, the nurse ensures that which baseline study has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level

3. Liver enzyme level Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the ent who is greater than age 50 or abuses alcohol.

The nurse is gathering data on a client with a diagnosis of tuberculosis. The nurse should review the results of which diagnostic test to confirm this diagnosis? 1. Chest x-ray 2. Bronchoscopy 3. Sputum culture 4. Tuberculin skin test

3. Sputum culture A definitive diagnosis of tuberculosis is confirmed through culture and isolation of Mycobacterium tuberculosis. A presumptive diagnosis is made on the basis of a tuberculin skin test, A sputum smear that is positive for acid fast bacteria a chest x-ray and histological evidence of granulomatous disease on biopsy

A postoperative client has received a dose of nal- oxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from care unit. After administration the postanesthesia of the medication, the nurse should check the cli- ent for which sign/symptom? 1. Pupillary changes 2. Scattered lung wheezes 3. Sudden increase in painnt 4. Sudden episodes of diarrhea

3. Sudden increase in pain Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respi- ratory depression. When given to the postoperative client for also reverse the effects of analge- respiratory depression, it may sics. Therefore, the nurse must check the client for a sudden increase in the level of pain experienced. Options 1, 2, and 4 are not associated with this medication.

The nurse is reinforcing discharge teaching to a cli. ent diagnosed with tuberculosis who has been tak. ing medication for 12 weeks. The nurse knows that the client has understood the information if which statement is made? 1. "I can't shop at the mall for the next 6 months. 2. "I need to continue medication therapy for 2 months." 3. "I can return to work if a sputum culture comes back negative." 4 "I should not be contagious after 2 to 3 weeks of medication therapy."

4 I should not be contagious after 2 to 3 weeks after medication therapy The client continues medication therapy for 6 to 12 months depending on the situation. The client is gen- erally considered to not be contagious after 2 to 3 weeks of medication. The client is instructed to wear a mask if there will be exposure to crowds until the medication is effective in preventing transmission. The client is allowed to return to employment when the results of three sputum cultures are negative.

The nurse is instructing a client about pursed lip breathing, and the client asks the nurse about its purpose. The nurse should tell the client that the primary purpose of pursed lip breathing is which? 1. Promote oxygen intake 2. Strengthen the diaphragm 3. Strengthen the intercostal muscles 4. Promote carbon dioxide elimination

4. Promote carbon dioxide elimination Pursed lip breathing facilitates maximal expiration for clients with obstructive lung disease and promotes carbon dioxide elimination. This type of breathing allows better expiration by increasing airway pressure, which keeps air passages open during exhalation. Options 1, 2, and 3 are not the pur- poses of this type of breathing.

The nurse is reinforcing discharge instructions to the client with pulmonary sarcoidosis. The nurse knows that the client understands the information if the cli- ent verbalizes which early sign of exacerbation? 1. Fever 2. Fatigue 3. Weight loss 4. Shortness of breath

4. Shortness of breath Shortness of breath is an early sign of exacerbation of pulmonary sarcoidosis. Others include chest pain, hemop- tysis, and pneumothorax. Systemic signs and symptoms that occur later include a weakness and fatigue and malaise fever and weight loss

The nurse is reinforcing instructions to a hospitalized client with a diagnosis of emphysema about positions that will enhance the effectiveness of breathing during dyspneic episodes. Which posi- tion should the nurse instruct the client to assume? 1. Side-lying in bed 2. Sitting in a recliner chair 3. Sitting up in bed at a 90 degree angle 4. Sitting on the side of the bed leaning on an overbed table

4. Sitting on the side of the bed leaning on an overbed table Positions that will assist the client with breathing include sitting up and leaning on an overbed table, sitting up and resting with the elbows on the knees, or standing or leaning against the wall. The positions in options 1, 2, and 3 will not enhance the effectiveness of breathing.

A client is receiving acetylcysteine, 20% solution diluted in 0.9% normal saline by nebulizer. The nurse should have which item available for a pos- sible adverse event after giving this medication? 1. Ambu bag 2. Intubation tray 3. Nasogastric tube 4. Suction equipment

4. Suction equipment acetylcysteine can be given orally for Nuro gastric tube to treat acetaminophen overdose or maybe given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction equipment available in case the client cannot manage to clear the increased volume of liquefied secretions.

A client being discharged from the hospital to home with a diagnosis of tuberculosis is worried about the possibility of infecting family members and others. Which information should reassure the client that contaminating family members and others is not likely? 1. The family does not need therapy, and the will not be contagious after 1 month of medication therapy. 2. The family does not need therapy and the client will not be contagious after six consecutive weeks of medication therapy 3. The family will receive prophylactic therapy and the client will not be contagious after one continuous week of medicine therapy 4. The family will receive prophylactic therapy and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy

4. The family will receive prophylactic therapy and client will not be contagious after 2 to 3 consecutive weeks of medication therapy Family members or others who have been in close contact with a client diagnosed with tuberculosis are placed on prophylactic therapy with isoniazid for 6 to 12 months. The cli- ent is usually not contagious after taking medication for 2 to 3 consecutive weeks. However, the client must take the full course of therapy (for 6 months or longer) to prevent reinfec- tion or drug-resistant tuberculosis.

3. The nurse is assisting a dlient with chest tubes to the bedside commode when the tube becomes disconnected and falls on the floor. What is the priority action by the nurse? a. Reconnect the tubing. b. Double clamp tube close to the chest wall. c. Allow the client to ambulate to the bathroom. d. Place the client in the supine position.

B

5. The nurse is caring for a client in the clinic who is diagnosed with the common cold. What education should the nurse reinforce to help aleviate symptoms? a. Take antibiotics as prescribed. b. Drink plenty of fluids. c. Increase activity level. d. Avoid contact with others for 2 weeks.

B

2. A cient has a positive tuberculin skin test. What action by the nurse is appropriate? a. Administer another tuberculin skin test. b. Administer a tine test. c. Prepare the client for a chest x-ray. d. Prepare the client for a bronchoscopy.

C

The nurse is preparing a client for a bronchoscopy. What nursing actions essertial prior to the procedure? Select al that apply. a. Administer an enema. b. Detail the complications that can occur. c. Give mouth care. d. Observe for any loose teeth. e. Explain the procedure

C,D,E

The nurse is preparing a client for abdominal surgery. What action by the nurse prevent postoperative atelectasis? a. Suction the client every 2 hours. b. Administer supplemental oxygen. C. Administer an inhaled bronchodilator. d. Instruct the client about the use of incentive spirometry.

D.