MS2 Respiratory / Hematology Review Questions

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

. 2Report yellow eyes or skin immediately. isoniazid is hepatotoxic; therefore, the client is taught to immediately report signs and symptoms of hepatitis, such as yellow skin and sclera. For the same reason, alcohol would be avoided during therapy.

The nurse reads in the progress notes for a client with pneumonia that areas of the client's lungs are being perfused but are not being ventilated. How does the nurse correctly interpret this documentation? 1 A shunt unit exists. 2 Anatomical dead space is present. 3 Physiological dead space is present. 4 Ventilation-perfusion matching is occurring.

1 A shunt unit exists. When there is no ventilation to an alveolar unit but perfusion continues, a shunt unit exists. As a result, no gas exchange occurs, and unoxgenated blood continues to circulate. Anatomical dead space normally is present in the conducting airways, where pulmonary capillaries are absent.

A client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious, and the nurse suspects air embolism. What are the priority nursing actions? Select all that apply. 1 Administer oxygen to the client. 2 Continue dialysis at a slower rate after checking the lines for air. 3 Stop dialysis, and turn the client on the left side with head lower than feet. 4 Notify the primary health care provider (PHCP) and Rapid Response Team. 5 Bolus the client with 500 mL of normal saline to break up the air embolus.

1 Administer oxygen to the client. 3 Stop dialysis, and turn the client on the left side with head lower than feet. 4 Notify the primary health care provider (PHCP) and Rapid Response Team. If the client experiences air embolus during hemodialysis, the nurse would terminate dialysis immediately, position the client so that the air embolus is in the right side of the heart, notify the PHCP and Rapid Response Team, and administer oxygen as needed

A client in the postpartum unit complains of sudden, sharp chest pain. The client is tachycardic, and the respiratory rate is increased. The primary health care provider diagnoses a pulmonary embolism. Which actions would the nurse take? Select all that apply. 1 Administer oxygen. 2 Assess the blood pressure. 3 Start an intravenous (IV) line. 4 Prepare to administer warfarin sodium. 5 Prepare to administer morphine sulfate. 6 Place the client on bed rest in a supine position.

1 Administer oxygen. 2 Assess the blood pressure. 3 Start an intravenous (IV) line. 5 Prepare to administer morphine sulfate. If pulmonary embolism is suspected, oxygen is administered to decrease hypoxia. The client also is kept on bed rest, with the head of the bed elevated to reduce dyspnea. Morphine sulfate may be prescribed for the client to reduce pain and apprehension. An IV line also will be required, and vital signs must be monitored. Heparin therapy (not warfarin sodium) is administered.

The nurse is caring for a client diagnosed with tuberculosis (TB). Which assessments, if made by the nurse, are consistent with the usual clinical presentation of TB? Select all that apply. 1 Cough 2 Dyspnea 3 Weight gain 4 High-grade fever 5 Chills and night sweats

1 Cough 2 Dyspnea 5 Chills and night sweats The client with TB usually experiences cough (productive or nonproductive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweats (which may occur at night), and a low-grade fever.

The nurse is reviewing the pathophysiology of pleural effusion. The nurse knows that pleural fluid balance is managed by several mechanisms and correctly identifies which of the following as a cause for the development of pleural effusion? Select all that apply. 1 Decreased oncotic pressure 2 Lymphatic fluid outflow obstruction 3 Increased pulmonary capillary pressure 4 Decreased pulmonary capillary pressure 5 Increased pleural membrane permeability

1 Decreased oncotic pressure 2 Lymphatic fluid outflow obstruction 3 Increased pulmonary capillary pressure 5 Increased pleural membrane permeability Fluid volume in the pleural space is managed by a balance between hydrostatic pressure, oncotic pressure, capillary permeability and lymphatic fluid outflow.

The community health nurse is conducting an educational session with community members regarding the signs and symptoms associated with tuberculosis. The nurse informs the participants that tuberculosis is considered as a diagnosis if which signs and symptoms are present? Select all that apply. 1 Dyspnea 2 Headache 3 Night sweats 4 A bloody, productive cough 5 A cough with the expectoration of mucoid sputum

1 Dyspnea 3 Night sweats 4 A bloody, productive cough 5 A cough with the expectoration of mucoid sputum Tuberculosis should be considered for any client with a persistent cough with mucoid sputum production, weight loss, anorexia, night sweats, hemoptysis, shortness of breath, fever, or chills.

The nurse is doing volunteer work in a homeless shelter. The nurse would monitor the individuals for which initial signs and symptoms of tuberculosis? Select all that apply. 1 Fatigue 2 Lethargy 3 Chest pain 4 Morning cough 5 Low-grade fever 6Labored breathing

1 Fatigue 2 Lethargy 4 Morning cough 5 Low-grade fever the other symptoms listed are advanced, not initial

The nurse caring for a client with sepsis as a result of bacterial pneumonia is monitoring for signs of systemic inflammatory response syndrome (SIRS). Which conditions are indicative of this complication? Select all that apply. 1 Fever 2 Diabetes insipidus 3 Altered mental status 4 Development of severe hypotension 5 Development of acute respiratory distress syndrome (ARDS)

1 Fever 3 Altered mental status 4 Development of severe hypotension 5 Development of acute respiratory distress syndrome (ARDS) SIRS is a systemic inflammatory response characterized by generalized inflammation in organs separate from the initial affected area and is caused by severe bacterial infections, trauma, or pancreatitis. A fever will occur related to the infection.

A client experienced an open pneumothorax (sucking wound), which has been covered with an occlusive dressing. The client begins to experience severe dyspnea, and the blood pressure begins to fall. The nurse would first perform which action? 1 Remove the dressing. 2 Reinforce the dressing. 3 Call the primary health care provider (PHCP). 4 Measure oxygen saturation by oximetry.

1 Remove the dressing. Placement of a dressing over a chest wound could convert an open pneumothorax to a closed (tension) pneumothorax. This may result in a sudden decline in respiratory status, mediastinal shift with twisting of the great vessels, and circulatory compromise. If clinical changes occur, the nurse would remove the dressing immediately, allowing air to escape. Therefore, reinforcing the dressing is an incorrect action. The nurse would measure oxygen saturation by oximetry and would call the PHCP, but these would not be the first actions in this situation.

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. For which side and adverse effects of the medication would the nurse monitor? 1 Signs of hepatitis 2 Flulike syndrome 3 Low neutrophil count 4 Vitamin B6 deficiency 5 Ocular pain or blurred vision 6 Tingling and numbness of the fingers

1 Signs of hepatitis 2 Flulike syndrome 3 Low neutrophil count 5 Ocular pain or blurred vision Rifabutin may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side and adverse effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange-colored bodily secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flulike syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid.

A chest x-ray report for a client indicates the presence of a left apical pneumothorax. The nurse would assess the status of breath sounds in that area by placing the stethoscope in which location? 1 Just under the left clavicle 2 Midsternum, 1 inch to the left 3 Over the fifth intercostal space 4 Midsternum, 1 inch to the right

1) The apex of the lung is the rounded, uppermost part of the lung. Therefore, the nurse would place the stethoscope just under the left clavicle. All of the other options are incorrect locations for assessing the left apex.

The nurse working on a medical-surgical unit is reviewing the day's client assignment. Which client(s) in the day's assignment would the nurse determine is at risk for the development of pneumonia? Select all that apply. 1 An ambulatory client with a left-sided nephrolithiasis 2 A client who had a total open hysterectomy 2 days ago 3 A client with a fractured hip scheduled for a hip arthroplasty the following day 4 A client with chronic obstructive pulmonary disease (COPD) with a tracheostomy 5 A client who is nothing-by-mouth (NPO) receiving tube feeding via a nasogastric (NG) tube

2 A client who had a total open hysterectomy 2 days ago 3 A client with a fractured hip scheduled for a hip arthroplasty the following day 4 A client with chronic obstructive pulmonary disease (COPD) with a tracheostomy 5 A client who is nothing-by-mouth (NPO) receiving tube feeding via a nasogastric (NG) tube

The nurse is caring for a client who underwent a thoracentesis to treat pleural effusion. The pleural fluid testing results indicate the pleural fluid is cloudy and confirm the presence of white blood cells (WBCs). Which condition would the nurse suspect? 1 Cirrhosis 2 Malignancy 3 Chronic kidney disease 4 Congestive heart failure

2 Malignancy Exudative (cloudy pleural fluid) is indicative of inflammatory or infectious process including malignancy the other conditions listed can result in transudative (fluid, clear, pale, yellow) - associated with a lack of protein or cells in the fluid

The nurse is preparing to give a bed bath to an immobilized client with tuberculosis. The nurse would wear which items when performing this care? 1 Surgical mask and gloves 2 Particulate respirator, gown, and gloves 3 Particulate respirator and protective eyewear 4 Surgical mask, gown, and protective eyewear

2 Particulate respirator, gown, and gloves The nurse wears a gown when the possibility exists that the clothing could become contaminated, such as when giving a bed bath.

The nurse would anticipate that the primary health care provider (PHCP) would add which medication to the regimen of the client receiving isoniazid? 1 Niacin 2 Pyridoxine 3 Gabapentin 4 Cyanocobalamin

2 Pyridoxine (vit. B6) to prevent development of neuropathy

A client with tuberculosis receiving cycloserine orally twice daily must have blood drawn in 1 week to measure the serum concentration of the medication. The nurse prepares the client for this test by providing which information to the client? 1 Withhold the morning dose on the day of the scheduled blood test. 2 Take the morning dose, and have the blood drawn 2 hours after taking the dose. 3 Withhold the evening dose before the test and the dose scheduled for the morning of the test. 4 Double the dose the evening before the test, and withhold the morning dose on the day of the test.

2 Take the morning dose, and have the blood drawn 2 hours after taking the dose. Cycloserine is an antituberculosis medication that requires weekly serum medication level determinations to monitor for neurotoxicity and other adverse effects. Peak concentrations are measured 2 hours after dosing and would be between 25 and 35 mcg/mL.

Which is the nurse's priority assessment for monitoring for adverse effects for the client taking isoniazid? 1 Skin color 2 Urine color 3 Hydration status 4 Respiratory effort

2 Urine color discolored urine indicates hepatic damage discolored urine in any of the meds besides rifampin indicates the worst case scenario for TB meds it would seem

how long does erythropoietin therapy take to gain effectiveness

2-6 wk.

The client is admitted to the hospital with a diagnosis of Legionnaires' disease. The nurse is providing information on the disease and treatment expectations. Which statement by the client indicates an understanding of the disease and treatments? 1 "I would avoid all contact with my family." 2 "I would avoid large crowds for at least 3 weeks." 3 "I cannot give Legionnaires' disease to other people." 4 "I will have to take antibiotics until my symptoms disappear."

3 "I cannot give Legionnaires' disease to other people." Legionnaires' disease is spread through infected aerosolized water, not person to person

The nurse would report which assessment finding to the primary health care provider (PHCP) before initiating thrombolytic therapy in a client with pulmonary embolism? 1 Adventitious breath sounds 2 Temperature of 99.4° F (37.4° C) orally 3 Blood pressure of 198/110 mm Hg 4 Respiratory rate of 28 breaths/minute

3 Blood pressure of 198/110 mm Hg thrombolytic therapy is contraindicated in sever uncontrolled HTN due to the risk of cerebral hemorrhage

A client who has just suffered a severe flail chest is experiencing severe pain and dyspnea. The client's central venous pressure (CVP) is rising, and the arterial blood pressure is falling. Which condition would the nurse interpret that the client is experiencing? Correct Answer 1 Fat embolism 2 Mediastinal shift 3 Mediastinal flutter 4 Hypovolemic shock

3 Mediastinal flutter The client with severe flail chest will have significant paradoxical chest movement. This causes the mediastinal structures to swing back and forth with respiration. This movement can affect hemodynamics. Specifically, the client's CVP rises, the filling of the right side of the heart is impaired, and the arterial blood pressure falls. This is referred to as mediastinal flutter. The client with fat embolism experiences chest pain and dyspnea, but this condition occurs as a complication of a bone fracture. Mediastinal shift is a condition in which the structures of the mediastinum shift or move to the opposite side of the chest cavity; this may be caused by a pleural effusion or tension pneumothorax. In hypovolemic shock, the blood pressure falls and the pulse rises; this occurs following hemorrhage.

A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin for treatment. The nurse teaches the client to perform which action? 1 Report any change in urine color. 2 Take both medications with food. 3 Take both medications together once a day. 4 Expect to take the medications for 2 to 3 weeks.

3 Take both medications together once a day. to maximize absorption

A client who has been diagnosed with pneumonia has been given a prescription for erythromycin. Client teaching about this medication would include which best instruction? 1 Take the medication with juice. 2 Take the medication with a meal. 3 Take the medication on an empty stomach. 4 Take the medication at bedtime with a snack.

3 Take the medication on an empty stomach. to promote best absorption

The nurse witnesses an accident whereby a pedestrian is hit by an automobile. The nurse stops at the scene and assesses the victim. The nurse notes that the victim is responsive and has suffered trauma to the thorax resulting in a flail chest involving at least three ribs. What is the nurse's priority action for this victim? 1 Assist the victim to sit up. 2 Remove the victim's shirt. 3 Turn the victim onto the side opposite the flail chest. 4 Apply firm but gentle pressure with the hands to the flail segment.

4 Apply firm but gentle pressure with the hands to the flail segment. If flail chest is present, the nurse applies firm but gentle pressure to the flail segments of the ribs to stabilize the chest wall, which will ultimately help the victim's respiratory status. The nurse does not move an injured client for fear of worsening an undetected spinal injury. Removing the victim's shirt is of no value in this situation and could in fact result in chilling the victim, which is counterproductive. Injured clients need to be kept warm until help arrives at the scene.

A client with a documented exposure to tuberculosis is on medication therapy with isoniazid. The nurse is monitoring laboratory results and determines that which laboratory value indicates the need for follow-up? 1 Platelet count 325,000 mm3 (325 × 109/L) 2 Serum creatinine 1.0 mg/dL (88.3 mcmol/L) 3 Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) 4 Aspartate aminotransferase (AST) 55 U/L (55 U/L)

4 Aspartate aminotransferase (AST) 55 U/L (55 U/L) 0-35 u/L is normal level hepatotoxicity is the main SFX of isoniazid

A clinic nurse is assessing a client who has been on isoniazid for 6 months. Which client complaint would most concern the nurse? 1 Dry mouth 2 Cramping diarrhea 3 Frequent headaches 4 Difficulty tying shoes

4 Difficulty tying shoes indicative of neuropathy, a dose-related adverse effect

The parent of an 8-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The parent tells the nurse that the child complains of discomfort on the right side and that ibuprofen is ineffective. Which instruction would the nurse provide to the parent? 1 Increase the dose of ibuprofen. 2 Increase the frequency of ibuprofen. 3 Encourage the child to lie on the left side. 4 Encourage the child to lie on the right side.

4 Encourage the child to lie on the right side. Splinting to the affected side may be helpful in pneumonia

The nurse is teaching a client with tuberculosis about nutrition and foods that would be increased in the diet. The nurse would suggest that the client increase which food items? 1 Potatoes and rice 2 Eggs and spinach 3 Grains and broccoli 4 Meats and citrus fruits

4 Meats and citrus fruits The nurse teaches the client with tuberculosis to increase intake of protein, iron, and vitamin C. Foods rich in vitamin C include citrus fruits, berries, melons, pineapple, broccoli, cabbage, green peppers, tomatoes, potatoes, chard, kale, asparagus, and turnip greens. Food sources that are rich in iron and protein include liver and other meats. Less than 10% of iron is absorbed from eggs, and less than 5% is absorbed from grains and vegetables.

The nurse is caring for a client with tuberculosis (TB) who is fearful of the disease and anxious about the prognosis. In planning nursing care, the nurse would incorporate which intervention as the best strategy to assist the client in coping with the illness? 1 Allow the client to deal with the disease in an individual fashion. 2 Ask family members whether they wish a psychiatric consultation. 3 Encourage the client to visit with the pastoral care department's chaplain. 4 Provide reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease.

4 Provide reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease. A primary role of the nurse working with a client with TB is to teach the client about medication therapy. An anxious client may not absorb information optimally.

The nurse in an ambulatory clinic is preparing to administer a tuberculin skin test to a client who may have been exposed to a person with tuberculosis (TB). The client reports having received the bacillus Calmette-Guérin (BCG) vaccine before moving to the United States from a foreign country. Which interpretation would the nurse make? 1 The client has no risk of acquiring TB and needs no further workup. 2 The client is at increased risk for acquiring TB and needs immediate medication therapy. 3 The client's test result will be negative, and a sputum culture will be required for diagnosis. 4 The client's test result will be positive, and a chest x-ray study will be required for evaluation.

4 The client's test result will be positive, and a chest x-ray study will be required for evaluation. The BCG vaccine is routinely given in many foreign countries to enhance resistance to TB. The vaccine uses attenuated tubercle bacilli, so the results of skin testing in persons who have received the vaccine will always be positive.

The clinic nurse administers a tuberculin skin test to a client. The nurse tells the client to return to the clinic for the results in how long?

48 to 72 hours

pernicious anemia is caused by ________________

B12 deficiency

Primary medical intervention for pernicious anemia

B12 injections

induration measurements for special circumstances and populations

Induration measuring 10 mm or more is considered to be a positive result in children younger than 4 years of age and in children with chronic illness or at high risk for exposure to tuberculosis. A reaction of 5 mm or more is considered to be a positive result for the highest risk groups, such as a child with an immunosuppressive condition or a child with human immunodeficiency virus (HIV) infection. A reaction of 15 mm or more is positive in children 4 years or older without any risk factors.

high risk population for B-thalassemia

Mediterranean descent

A client who is human immunodeficiency virus (HIV)-positive has had a tuberculin skin test (TST). The nurse notes a 7-mm area of induration at the site of the skin test, how would the nurse interpret this finding?

Postive The client with HIV infection is considered to have positive results on tuberculin skin testing with an area of induration larger than 5 mm. The client without HIV is positive with an induration larger than 10 mm. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client. It is possible for the client infected with HIV to have false-negative readings because of the immunosuppression factor.

gastric surgery can result in ___________________ deficiency

Vitamin B12

high risk individuals for iron deficiency anemia include

alcoholics vegetarians individuals in childbearing years w/ poor diet older people w/ poor diets

iron preparations need to be taken ____________ meals

between (~1-2 hr)

signs of septicemia during a transfusion reaction include:

chills, fever, vomiting, diarrhea, hypotension, shock

medication used to treat iron overload

deferoxamine

precaution level for a client with pneumonia (droplet, airborne, contact...)

droplet precautions - surgical mask required

significant adverse effect of epoetin alfa (erythropoietin therapy)

hypertension

increased transferrin levels and decreased iron-binding capacity are indicative of ____________ ___________

iron deficiency

RBC count is decreased in

iron deficiency anemia

hematocrit is decreased in _______________________ and _______________ anemias

iron-deficiency anemia, hemolytic anemia

When assessing dark skinned clients for signs of anemia, focus assessments on _________ __________ and ____________

lips, conjunctiva, mucous membranes

pallor in dark skinned clients can be indicated by

loss of normal red tones in the skin

The nurse is performing an admission assessment on a client with tuberculosis (TB) and is collecting subjective and objective data. Which finding would the nurse expect to note?

low-grade fever, weight loss, pallor, chills, and night sweats, anorexia and fatigue. Pulmonary symptoms include a cough that is productive of a scant amount of mucoid sputum. Purulent, blood-stained sputum is present if cavitation occurs. Dyspnea and chest pain occur late in the disease.

folic acid deficiency leads to ____________ ______________ RBCs

macrocytic normochromic cells

iron deficiency leads to _____________ ______________ RBCs

microcytic hypochromic anemia

important adverse effect of ethambutol, characterized by new onset of red-green colorblindness

optic neuritis Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin

Common side effect of isoniazid - symptoms include numbness, paresthesia and tingling extremities

peripheral neuritis

elevated hematocrit is seen in ___________ , _______________ , and _____________

pernicious anemia, polycythemia vera, dehydration

good sources of iron include:

red meat, organ meat, spinach, whole wheat products, carrots, raisins, turnip tops, egg yolks, kidney beans, blackstrap molasses

most common initial symptom of a pulmonary embolism

sharp chest pain that occurs suddenly Other typical symptoms include apprehension and restlessness, tachycardia, cough, and cyanosis.

which of the following lab culture is important to monitor for effectiveness of pyrazinamide? urine blood wound sputum

sputum

______________ activities are contraindicated in sickle cell anemia

strenuous

common clinical manifestations of pulmonary embolism

tachypnea, tachycardia, dyspnea, and chest pain.

What precautions for family living with a TB (+) patient need to be taken initially, and how long does the client need to be medicated until they are no longer contagious?

the family will be medicated prophylactically. client will not be contagious after 2-3 wks. of medication.

how many negative sputum cultures are needed before a TB (+) patient can return to work or school?

three negative cultures

treatments for idiopathic autoimmune hemolytic anemia include;

transfusions splenectomy corticosteroids immunosuppressive agents

main adverse effect of ethambutol to monitor for

visual disturbance

What is the function of intrinsic factor?

vitamin B12 absorption

taking iron with _______________ can increase absorption

vitamin C