N364 Exam 2
Interventions for pleural effusion:
-treat underlying cause (could be pneumonia or HF) -keep them in Semi Fowlers -monitor breath sounds frequently -prepare for thoracentesis (may do pleurodesis or pleurectomy if recurrent or unresponsive to other tx)
Which of the following is a clinical manifestation of a pneumothorax? Select all that apply A. sudden chest pain B. asymmetry of chest movement C. unilateral retractions D. oxygen desaturation E. bilaterally equal breath sounds
A-D
Which of the following is the most effective intervention for preventing progression of vascular disease? A. Risk factor modification B. Use neutral soaps C. Avoid trauma D. Wear sturdy shoes
A. Risk factor modification
Do you need antibiotics with the cold?
NO - if symptoms go on longer than 10 days then go to the doctor, it may be something else
Coumadin/warfarin route:
PO
What do we do for a pt with pulmonary edema?
PRIORITY: make sure airway is clear -diuretics (bc probably have excess fluid) -antihypertensives (like Nipride, help vasodilate to get blood flowing out of lungs) -may need to give supplemental oxygen
When giving Warfarin (Coumadin), the nurse must monitor..
PT and INR
When giving Heparin, the nurse must monitor..
PTT and platelets
Dilation of terminal alveoli distal to the terminal bronchiole, with destruction of alveolar walls =
emphysema
Asthma patients have a prolonged _______________ phase
expiratory
Who is most at risk for influenza complications?
extremes of age: very young and very old
T/F Constipation is not possible for a patient with a colostomy
false - constipation is possible and patients may consider fiber supplements
T/F The timing of stool is sometimes predictable in a pt. with an ileostomy
false - it's not predictable
T/F Peristaltic movement of the stoma is abnormal and should be reported immediately to the provider
false - peristaltic movement of the stoma is normal
T/F Stomahesive paste/caulking may be used for ileal conduits
false - this isn't used but skin prep may be used
T/F You can get TB from kissing someone or making someone's bed
false - will not get it from kissing someone or making someone's bed
T/F You can rub, massage or palpate an AAA and it will not rupture
false- don't do this, it could rupture
Which has an abrupt onset - flu or cold?
flu
Stage 2 COPD (Moderate): What should be done to reduce risk factors at this stage?
flu vaccine and short-acting bronchodilator, add regular tx with 1 or more long-acting bronchodilators (when needed), add rehabilitation
Stage 3 COPD (Severe): What should be done to reduce risk factors at this stage?
flu vaccine and short-acting bronchodilator, regular tx with 1 or more long-acting bronchodilators (when needed), rehabilitation, add inhaled glucocorticosteroids if repeated exacerbations
Stage 4 COPD (Very Severe): What should be done to reduce risk factors at this stage?
flu vaccine and short-acting bronchodilator, regular tx with 1 or more long-acting bronchodilators (when needed), rehabilitation, inhaled glucocorticosteroids if repeated exacerbations, add long term oxygen if chronic respiratory failure and consider surgery
When would an ileoanal reservoir (J pouch) be installed?
for pts. with diseases limited to the colon such as ulcerative colitis and familial polyposis
What is a thoracentesis?
large bore needle into posterior chest, usually have patient sitting up and sitting over overhead table. large needle will draw out pleural fluid - this relieves a lot of stress that interferes with ability to breathe
Stool characteristic of transverse colostomy:
liquid to semi-formed/paste like
Stool characteristic of ascending colostomy:
liquid to semi-liquid and rich in digestive enzymes
How to handle a mild exacerbation when the asthma patient "can't get enough air":
manage at home with Short Acting Beta Agonist (SABA)
What is done before a bronchoscopy?
medication is given that will decrease the gag reflex (vagal stimulation) so that pulse and bp don't drop during the procedure
The classification of Stage II of COPD is defined as ______________ COPD.
moderate
Patients with DPI inhalers should avoid _____________
moisture
Central cyanosis is around the _____________
mouth
When are symptoms of asthma most commonly present?
night/early morning
TB incidences are high among which individuals?
-those with HIV bc immunocompromised -those who share needles -those who live in high concentration of people
How is TB transmitted?
It is airborne, and requires close repeated contact
When giving heparin/Lovonox/Coumadin, the nurse should monitor:
Labs: -H & H -aPTT -Bleeding (bruising, blood in urine, nose bleeds)
With chronic bronchitis you see _____________, and with emphysema you see ____________ _____ __________ that is not fully reversible
sputum; shortness of breath
_________ are placed in the ureters after surgery for a couple of weeks to make sure they stay open
stents
Stomas respond to ___________, not touch
stretch
What does sputum look like in a pt with asthma?
stringy
Low molecular heparin/Lovonox route = __________
subQ
Long-term administration of oxygen (>15 hrs per day) to patients with chronic respiratory failure has been shown to improve:
survival, exercise, sleep and cognitive performance
Gas is generally caused by..
swallowing air
How does pulmonary edema present?
tachycardia, tachypnea, coughing up pink (from blood) frothy (mixing with air) sputum, crackles on auscultation hx of SOB, orthopnea, anxiety restlessness
Why is a chest X-ray needed after a thoracentesis?
they could have a pneumothorax (if needle touches lung tissue and lung collapses), nurse also needs to listen closely to breath sounds afterwards
Where do arterial ulcers appear and what do they look like?
tips of toes or between toes, they are small, circular and deep in appearance
At a sign of infection, a pt with an acute exacerbation of COPD must see the doctor. Why?
to get an antibiotic
DVT risk factors:
trauma, surgery, post op, bedrest/immobility, dialysis, obesity, spinal cord injury, history of varicose veins
T/F A cough is always abnormal
true
T/F A decent amount (1/3) of patients with COPD are underweight. Therefore, weight gain with nutritional support can decrease mortality.
true
T/F A patient can take their pouch off before showering if they are okay with some leakage in the shower
true
T/F A positive d-dimer shows that there is most likely a clot, but we still need a scan to confirm
true
T/F AAA is often asymptomatic
true
T/F Always change a leaking ileal conduit pouch
true
T/F Any patient with persistent asthma needs to be on one controller medication
true
T/F Aortic dissections are medial emergencies
true
T/F Asthma is characterized by largely reversible airflow limitation, while COPD is a largely irreversible airflow limitation
true
T/F Blood in the urine after surgery to create an ileal conduit is normal
true
T/F Chronic cough associated with COPD could be intermittent and it could be unproductive, but with time, you would see a pattern of chronic sputum production
true
T/F Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease
true
T/F Chronic treatment with systemic glucoccortico-steroids should be avoided because of an unfavorable benefit-to-risk ratio (basically we don't want to be taking these meds long-term bc of side effects)
true
T/F Complementary/alternative therapies like Echinacea, zinc and vitamin C may reduce common cold symptoms by a day or 2 or lessen extremity of symptoms
true
T/F Counseling has been shown to increase smoking quit rates rather than just self motivation
true
T/F Early treatment of asthma exacerbation is the best strategy for management
true
T/F Every patient at any stage needs to have a relieve med (rescue med) like Albuterol, which is a short-acting inhaled beta 2 agonist
true
T/F Good idea to bring up Advanced Directives to the patient after an acute exacerbation of COPD
true
T/F Green, liquidy stool coming from an ileostomy is normal
true
T/F Guidelines say that nurses should be offering smokers some type of program to help them quit smoking EVERY time we see them
true
T/F If a patient has a Hartmann's pouch the procedure is reversible
true
T/F Incidence of TB is on the decline, but it is still high among some individuals
true
T/F It is important to set a smoking quit date when planning on stopping smoking
true
T/F It's recommended that patients with asthma do peak flow monitoring at home
true
T/F Loop ostomies are reversible
true
T/F Massive hemoptysis is a medical emergency and the pt should be admitted to the ICU
true
T/F Most ostomies are odor proof now
true
T/F None of the existing meds for COPD modify long-term decline in lung function that is the hallmark of the disease, but we can reduce symptoms making it easier for pts to exercise and reducing amount of exacerbations
true
T/F Patients with chronic bronchitis may not necessarily have airflow limitation
true
T/F Patients with ileal conduit are at a higher risk for urinary infections
true
T/F Patients with urinary and bowel diversions should wear a medical alert bracelet
true
T/F Physical findings associated with COPD are rarely diagnostic/we don't see them until there's a significant impairment
true
T/F Post AAA surgery, the patient should avoid lifting for 4-6 weeks
true
T/F Pt. should be on an antibiotic for pneumonia and it should match with the culture that it's sensitive to
true
T/F The further along in the intestine the stoma is, the more formed the feces becomes
true
T/F The timing of stool is sometimes predictable in a pt. with a colostomy
true
T/F There are no nerves for touch or pain in the intestine, so you don't have to worry about hurting the stoma
true
T/F With MDR-TB, compliance is often a problem
true
T/F You can get TB when in close, repeated contact with someone, especially if they are coughing on you
true
T/F You should always change a leaking ostomy pouch rather than try to fix it
true
T/F spirometry can determine if cause of lung problem is obstructive, restrictive, upper airway, neuromuscular disease pattern or obesity
true
T/F you cannot get the flu from the flu shot
true
T/F A patient with a colostomy may use laxatives, stool softeners or enemas
true - just patients with ileostomies should not use these
T/F Rhinoviruses and C. diff cannot be taken care of by hand sanitizer
true - we must wash hands with soap and water to get rid of these
What works for common cold?
-topical and nasal decongestants -antihistamines: help w congestion -expectorants: help cough up -humidified air and fluid intake: so mucus stays thin and easy to cough up
A stoma in the LLQ could be:
-transverse/descending/sigmoid colostomy
putting on stoma powder then blotting the powder with no sting pad to seal the powder and make the pouch stick better =
"crusting"
How is pneumonia diagnosed?
-Chest x-ray: will show area of consolidation -sputum culture: will identify the microorganism -WBC and ESR elevated (indicates infection and inflammation)
COPD risk factors:
-Cigarette smoking or passive smoking -Occupational chemicals & dust -Air pollution -Infection (severe recurring respiratory tract infections) -Gene environment interaction -Hereditary a1-Antitrypsin (AAT) deficiency -Aging (lung function decreases as we age)
Pulmonary embolism interventions:
-call rapid response if acute and not stable -administer oxygen -obtain ABG -positive d-dimer shows that there is most likely a clot, but we still need a scan to confirm -prepare to anticoagulate with heparin and later warfarin
What do asthma peak flow zones like green, yellow or red indicate?
-If you're in the green, keep doing what you're doing -If you're in yellow or red, may need to add more meds
Prevention of DVT:
-Low molecular Heparin (Lovonox) therapy -compression stockings -pneumatic compression devices -early ambulation/exercise -lifestyle modifications (weight loss/exercise, diet, smoking cessation)
What does the nurse need to monitor in a pt w Acute Exacerbation of COPD?
-O2 Sat -ABG (when severe): pt may be hypoxic, need to know if they've gone into respiratory acidosis -CXR: is it pneumonia? HF? -Labs: CBC (may or may not see WBCs rise), Chemistries (may be an electrolyte problem causing dyspnea) ~need to rule out other issues~ -Culture and sensitivity: need sputum to make sure antibiotics are appropriate
Factors influencing development and triggers of asthma:
-allergens -exercise -air pollutants -occupational factors -respiratory infections -nose and sinus problems -drugs and food additives -GERD
A stoma in the RLQ could be:
-ascending/transverse colostomy -ascending/transverse ileostomy -ileal conduit (urinary diversion)
Dry powder inhaler (DPIs like Advair) -how do you clean it? -how do you know when it's about to be empty? -shake or no? -can spacers be used?
-avoid moisture when cleaning -most preloaded dosage forms include counter -do not shake -spacers can't be used
Possible influenza complications:
-bacterial pneumonia -ear infection -dehydration -worsening of chronic medical conditions (HF, DM, asthma)
Diagnostic tests for TB:
-Tuberculin skin test (TST) or Interferon-gamma release assays (IGRAs) -if TST is positive, then you would do a CXR (a CT scan would be more sensitive than a CXR) -and you can take sputum for AFB and cultures to identify the organism
If there isn't an option for pulmonary rehab, what should COPD patients do?
-Walk 15-20 mins daily, 3x/week -use short-acting inhaler (Beta 2 agonist) 10 mins before they exercise -after they exercise, they should sit down and rest - respirations should return to baseline in 5 mins (sometimes pursed lip breathing helps)
Who should get the pneumonia vaccine?
-age 65 and older -high risk persons age 2-64: chronic illness, HIV, heart/lung problems, compromised immune system -current smokers
Multi-dose inhaler (MDI) -how do you clean it? -how do you know when it's about to be empty? -shake or no? -can spacers be used?
-can wipe it off with a damp cloth -keep track of how many doses they take (some have a counter on them) -shake it up so the med is dispersed well -spacers improve drug delivery from MDI
What is generally NOT recommended for an acute asthma attack?
-chest PT (no benefit) -beta blockers -mucolytics (may worsen cough and airflow) -sedatives, hypnotics and anxiolytics are contraindicated -ABGs unless suspected hypoventilation and severe distress
Upon assessment of a patient with pneumonia, you may see:
-chills -increased temp -may or may not have cough -tachypnea -pleuritic chest pain -rhonchi and wheezes -accessory muscle use -mental status changes like delirium (more common among the elderly)
What should patients with an ileostomy do to prevent food blockages?
-consume high fiber foods in moderation -chew food very well -eat smaller meals
When obtaining a history for someone who may have TB, the nurse should ask:
-country of origin/whether they have visited a foreign country -HIV -substance use -TB exposure -dates/results of PPD
Psychological considerations for pts with COPD:
-depression/anxiety -losing independence/physical functioning, sexual functioning, comfort (sleeping), their own self concept -they don't have a lot of energy at all
Signs/symptoms of food blockage/obstruction of a patient with an ostomy (particularly ileostomy):
-diminished output -cramps, nausea, and swelling around the stoma
Recommended fluid intake for patients with an ileostomy:
-drink 8-10 cups (8 oz) of fluid/day -30 mL/kg a day or until peeing is clear
Fluid intake recommendations for a patient with a colostomy:
-drink ~8 cups (8 oz) of fluid per day -30 mL/kg per day or until pee is clear
Fluid recommendations for patients with ileal conduit:
-drink ~8 cups (8 oz) of fluid per day -30mL/kg/day or until pee is clear
What would the nurse expect to see in an assessment of a pt. with pleural effusion?
-dull, flat sound when percussing over that part of the chest bc there's fluid there -pleuritic pain that increases with inspiration -dyspnea -decreased breath sounds and movement on affected side -can also see a mediastinal shift on CXR
What does an acute exacerbation of COPD look like?
-dyspnea more often -sputum volume has increased -sputum is purulent (thick, yellow/green, looks like pus) -if they've had an upper resp infection recently, you may see more coughing/wheezing
Signs/presentation of venous insufficiency:
-edema -altered pigmentation: brown -aching/cramping pain -stasis dermatitis: skin becomes dry, scaly looking and itchy
Influenza physical findings:
-elevated temp, rapid pulse -flushed skin -watery eyes -clear nasal discharge and minimal to moderate nasal obstruction -minimal pharyngeal erythema -tender anterior cervical nodes (maybe) -nonproductive cough, usually clear breath sounds -muscles may be tender on palpation
Management of venous insufficiency:
-elevation of extremity -prevention of ulcers (keep skin clean and dry) -encourage ambulation -make sure shoes are not too tight -avoid constricting garments -compression stockings
What should the nurse ask the pt when obtaining a respiratory assessment history?
-family history -occupation/exposures -allergies -smoking
Influenza signs/symptoms:
-fever (but not everyone will have this) -cough -sore throat -runny/stuffy nose -body aches -headache -chills -fatigue -maybe diarrhea and vomiting
What can a nurse do when a patient is undergoing a severe asthma exacerbation/heading for status asthmaticus?
-give pt oxygen so O2 sat >90% -be a calm coach, don't want to be anxious in front of pt -steroids will be ordered (may give IV) -may need to intubate
How is asthma diagnosed in pts >12 years old?
-if pt has wheezing -symptoms occur or worsen in presence of: exercise, viral infection, inhalant allergens, irritants (smoke), weather changes, strong emotional expression, stress, menstrual cycles -symptoms occur/worsen at night and awaken the patient BUT, gold standard of diagnosis is spirometry - this is needed to establish a diagnosis
What are non-modifiable risk factors for the development of PVD?
-increasing age -female gender -familial predisposition/genetics
Signs of acute arterial ischemia and occlusion:
-intermittent claudication -aching, cramping, fatigue -position of extremity may decrease pain
Skin characteristics of arterial insufficiency:
-thin, shiny, dependent rubor elevation pallor of foot -cool to cold temperature -loss of hair over toes -nails thickened and ridged
What should be monitored in pts. with a pneumonia?
-labs and vital signs frequently -signs of respiratory distress
How should stomahesive paste/caulking be used? Another way to protect the skin?
-little BEADS of stomahesive around stoma and then put wafer down on it -skin prep is optional
AAA Post-op management:
-maintain potency of graft -make sure pt is voiding adequately (renal perfusion) -monitor skin color and temp every 4 hours -monitor pulses -pain management -monitor site (make sure no hematomas, drainage, or infection) -maintain fluids/electrolytes through IV -avoid constipation (give fluids, Colace, high fiber diet)
Respiratory isolation in a hospital for a pt with TB involves:
-negative pressure rooms: air is coming from outside and air is going outside, it's not re-circulating in the room -there are 6 air exchanges per hour -may use HEPA filters in the room
What are modifiable risk factors for the development of PVD?
-nicotine -diet (contributing to hyperlipidemia) -hypertension -diabetes -hyperlipidemia -stress -sedentary lifestyle
Medical care for pneumonia:
-oxygen administration (want SaO2 92% or better) -antibiotics (send sputum culture first) -teach them about smoking cessation -teach them good hand hygiene -rest, fluids, antipyretic, analgesic if pain -bronchodilator for wheezing or reactive airway -follow up CXR in 6-8 weeks to make sure the lungs are still clear
Treatment for aortic dissection:
-pain and HTN management -surgery (endovascular repair)
Signs/symptoms of AAA:
-pain in chest, lower back or groin area -abdominal throbbing -auscultation reveals bruit over the aneurysm -pulsation may be seen at aneurysm
Risk factors for death from asthma:
-past hx of severe exacerbation (prior intubation or ICU admit for asthma) -2 or more hospitalizations or 3 or more ER visits for asthma in the past year -use of >2 cannisters/month of SABA -difficulty perceiving airflow obstruction or its severity -comorbidity from CVD or other chronic lung disease -major psychological diagnosis -low SES and inner city residence
Risk factors for pulmonary embolism include:
-pregnancy -prolonged travel when sitting still -prolonged immobilization] -obesity -history of DVT or PE
Severe acute and life threatening asthma presentation:
-pt dyspneic at rest -they talk in words/phrases (staccato speech) -accessory muscle use (neck, chest, sucking in (retraction) of muscles above sternum -positioning (must sit upright or lean forward) -RR >30 and pulse >120 -check for cyanosis around mouth
Post-acute asthma follow up care:
-pt should be doing peak flow daily monitoring -short burst of high dose oral prednisone (7-10 days) -asthma plan from provider, make sure pt knows how to use inhaler and has access to meds -spirometry for diagnosis
What is the typical presentation of asthma?
-rapid breathing, pulse -prolonged expiratory phase (short breath in, long breath out) -wheezes or high pitched sounds -may only cough (instead of wheezing) -speech may be affected - have them read/talk -stringy sputum -positional breathing -nervous
Presentation of pulmonary embolism:
-restlessness, apprehension (not enough oxygen circulating) -sense of impending doom -cough -crackles or wheezes -chest pain -dyspnea accompanied by pleuritic pain that worsens often with inspiration -tachypnea and tachycardia
Femoral artery bypass graft: -what is it? -what are nursing interventions/management post op?
-reverse saphenous vein is used as a graft to allow circulation to go around the occlusion -the pt will have an incision in the leg, nurses must monitor for s/sx of infection as well as do wound care to prevent infection
If asthma control is not achieved, what should the nurse do?
-review adherence to meds -proper technique with inhaler -environmental control
Signs/symptoms of TB:
-sputum (purulent or some hemoptysis) -night sweats -afternoon fevers -chest pain
What would you document in regards to a bowel or urinary diversion?
-stoma appearance -mucocutaneous junction (making sure it's still sutured to skin) -peristomal skin (making sure skin is intact/no skin breakdown) -effluent/urine appearance -presence of stents or rods -pouching system in use
Signs/symptoms of aortic dissection:
-sudden onset of pain in the chest and back which extends to shoulders or epigastric area -tearing/ripping sensation -hypotension/diaphoresis -pale -tachycardia
What do we do for patients with the flu?
-take antiviral drugs to shorten course by 1-2 days -symptom management
What should people with ostomies avoid to prevent gas?
-talking while eating -using straws -chewing gum -drinking carbonated beverages -sucking on hard candy -smoking
Examples of physical findings associated with COPD:
-thin -tachypnea -increased use of accessory muscles -increased AP chest diameter (barrel-chest) -hyper-resonance on percussion -decreased heart and breath sounds -prolonged expiration during quiet breathing -wheezes/rhonchi (not as indicative, won't always have this) -late stages: peripheral edema (cor pulmonale, hepatomegaly)
What would a nurse see in an assessment of a patient with an acute exacerbation of COPD: When assessing them what should you teach them?
-use of accessory muscles -central cyanosis (around mouth) TEACH: how to use their inhaler/evaluate device technique (consider spacer)
Characteristics of ileostomy stool:
-watery to oatmeal/applesauce thick (will not be formed because the ileum doesn't absorb that much water) -rich in digestive enzymes so it can be ~green~ which is normal, color changes depending on food eaten
DPIs: ______ inhalation(s) = 1 dose
1
How often does a person receive the pneumonia vaccine?
1 dose and then a booster 5 years later
Flu incubation: ____-____ days, and then symptoms last ____-____ days, but cough/malaise may last 1-2 weeks
1-4; 3-4
What is a phone resource to help patients quit smoking?
1-800-QUIT NOW
What medications may be used to help with smoking cessation?
1. Bupropion (Zyban) 2. Varenicline (Chantix) - newest
3 nursing diagnoses assoc w COPD:
1. Ineffective airway clearance r/t increased secretions and ineffective cough 2. Ineffective breathing pattern r/t increased work of breathing, anxiety 3. Impaired gas exchange: hypoxemia or hypercapnia r/t ventilation/perfusion mismatch, alveolar hypoventilation others - imbalanced nutrition, disturbed sleep pattern, risk for infection
What type of surgeries may be an option for certain pts w COPD?
1. Lung Volume Reduction Surgery (LVRS)/bullectomy if a pt has bullous emphysema confined to a localized area in the lung that can be removed (healthier lung will then function better) 2. Occasionally someone w COPD is still strong enough to undergo lung transplantation, this would be a case by case basis whether they would qualify for a transplant (would need to <65 and how severe the disease is)
The severity of the asthma diagnosis is understood by considering the impairment related to: What are the different stages?
1. Nighttime awakening 2. SABA use (short acting beta agonist) 3. Interference with normal activities 4. Risk for exacerbations (oral steroids) Intermittent Persistent: Mild, Moderate or Severe
Virchow's Triad:
1. Venous stasis 2. Injury 3. Hypercoagulability
Why would you not want to take prednisone long-term? Why is the pt weaned slowly off the drug?
1. affects immunity 2. in elderly, can decrease bone mass cannot stop it suddenly bc the adrenal gland won't pick up w making the steroid like it needs to, there will be a sudden drop of steroid in the blood
Most common cause of acute exacerbation of COPD is ______________ (_____%). Second most common cause is _____________ or _______ _____________ (_____%)
1. bacterial, 50% 2. viral or air pollution, 20%
Top 3 reasons for a colostomy:
1. cancer (colon/rectum) 2. trauma 3. Crohn's
Things to teach/reinforce with a patient after an acute exacerbation of COPD:
1. know exacerbation signals (do you get more dyspneic? go to dr before it gets too bad) 2. stay inside on ozone days 3. if they're having sleep issues it's probably related to breathing - see dr. 4. teach airway clearance techniques 5. reinforce smoking cessation 6. get flu vaccine every year and get pneumovax once and then boosters every so often 7. make sure they understand meds and different bt short acting (rescue inhaler) and long acting (one they need to take every day)
What 4 factors when done help the largest amount of patients quit smoking?
1. physician advice 2. group support 3. skills training 4. nicotine replacement therapy
What should COPD patients do in regards to eating to gain weight and decrease risk for mortality?
1. rest before eating (while eating, oxygen may decrease) 2. may need to eat small meals (bc fullness can put pressure on diaphragm) 3. take bronchodilator when eating 4. don't exercise 1 hour before or 1 hour after a meal 5. check teeth, are they able to chew well? do they need teeth repaired? 6. avoid gas-forming/stomach irritating foods
What is the only way to stop COPD progression/the most effective and cost-effective intervention to reduce risk? What's the second most important intervention?
1. stop smoking! 2. avoidance of indoor and outdoor occupational exposures
Wash hands with soap and water when?
1. when hands are soiled 2. when you use the toilet 3. when working w pts. with C. diff
After a patient with asthma has determined their personal best, when should they use their peak flow meter?
1. when they wake up before they've used their inhaler 2. 10 minutes after taking the medication 3. later in the day about 10-12 hours after the first peak flow measurement
For an ileal conduit, leave no more than _______ inch of skin exposed
1/4
Leave no more than ______ inch of skin exposed when applying wafer to stoma to protect the skin
1/8
After 48-72 hours, up to ______mm is okay in a healthy individual
10
If an AAA ruptures, there is a _____% survival rate
10
Approximately what percentage of people who are initially infected with TB develop active disease?
10%
Reference range for PT = _______-______ seconds with and INR of ________
12-15, 2.3
MDIs: ______ puff(s) = 1 dose
2
Rescue plan for all exacerbations of asthma:
2-4 puffs of albuterol every 20 minutes 3 times
COPD may develop over _____-_____ years. Most people are diagnosed around ______ years old
20-30, 40
COPD patients should aim to keep BMI around ________
25
Acute cough: <____ weeks Subacute cough: _____-_____ weeks Chronic cough: >____ weeks
3 3-8 8
Chronic bronchitis: presence of cough and sputum production for at least ________ months in each of ______ consecutive years.
3, 2
The ileostomy pouch/bag can be left on for ______-______ days, while the colostomy pouch/bag can be left on for ______-______ days
3-5, 5-7
Reference range for aPTT:
30-40 seconds
Read the TST reaction ____-____ hours after injection, measure only _________ and record the reaction in _____________
48-72; induration; millimeters
After 48-72 hours, >______mm is significant in persons at high risk (HIV positive, close contact with someone with active TB)
5
Cyanosis indicates that there are _____-_____ grams of hemoglobin unbound to oxygen
5-6
There's a ______ hour lag time between eating the gas-producing foods and actual flatulence for a person with a colostomy
6
Reference range for PTT:
60-70 seconds
Common cold usually lasts ____-____ days
7-10
An FEV of <________% confirms the diagnosis of COPD. What are other diagnostic tests for COPD?
70 -Chest xray: done to rule out other things (like pneumonia or HF) bc it doesn't specifically show emphysema -Serum alpha1 anti-trypsin in pts. 45 yrs or less
Green zone = ________% of personal best Yellow zone = _______-_______% of personal best Red zone = <_______% of personal best
80% 50-79% <50%
Stage I COPD (Mild): FEV > or equal to ______%. What should be done to reduce risk factors at this stage?
80, give the flu vaccine and add a short-acting bronchodilator (when needed)
>______% of people with positive PPD responses do not have active TB, but you still need to get CXR and sputum cultures to know this for sure
90
Goal for patients with COPD is to keep SpO2 >______% during rest, sleep and exertion
90
What is an aortic dissection?
A tear in the inner layer of the aorta
Nursing students are gathered for a study session about the pulmonary system. One student asks the others to name the primary causes for an acute exacerbation of COPD. Which of the following responses should be in the reply? Choose all that apply. A. air pollution B. tracheobronchial infection C. fractured hip D. gastrointestinal viruses E. hypertension
A, B
A patient is suspected to have a thoracic aortic aneurysm. What diagnostic test(s) does the nurse anticipate preparing the patient for? (Select all that apply.) A. Computed tomography B. Transesophageal echocardiography C. X-ray D. Electroencephalogram E. Electrocardiogram (ECG)
A, B and C
A nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? Choose all that apply. A. Status asthmaticus B. Respiratory failure C. Pertussis D. Atelectasis E. Thoracentesis
A, B and D
After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options. A. Alter smooth muscle tone B. Reduce airway obstruction C. Decrease alveolar ventilation D. Increase oxygen distribution
A, B and D
The nursing student recalls that the underlying pathophysiology of COPD includes the following components: (select all that apply) A. inflamed airways obstruct airflow B. mucus secretions block airways C. overinflated alveoli impair gas exchange D. dry airways obstruct airflow
A, B, C
Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.) A. Compromised gas exchange B. Decreased airflow C. Wheezes D. Jugular vein distention E. Ascites
A, B, C
A nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? Choose all that apply. A. status asthmaticus B. respiratory failure C. pertussis D. atelectasis E. thoracentesis
A, B, D
The nurse is teaching the client about the use of a spacer with a metered-dose inhaler (MDI). The nurse instructs the client as follows: A. take a slow, deep inhalation from the device B. use normal inhalations with the device C. activate the MDI once D. the device may increase delivery of the MDI medication E. it's not necessary to hold your breath after using
A, C, D Explanation: client will hold breath for 10 seconds
A nursing student knows that there are 3 most common symptoms of asthma. Choose the 3 that apply: A. cough B. wheezing C. dyspnea D. crackles
A-C
The diagnosis of pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD) is suspected when which of the following is noted? Select all that apply. A. Dyspnea and fatigue disproportionate to pulmonary function abnormalities B. Right ventricular enlargement C. Elevated plasma brain natriuretic peptide (BNP) D. Enlargement of central pulmonary arteries E. Left ventricular hypertrophy
A-D
Asthma is cause by which type of response? A. IgE-mediated B. IgA-mediated C. IgD-mediated D. IgM-mediated
A. IgE-mediated
Which of the following is accurate regarding status asthmaticus? A. A severe asthma episode that is refractory to initial therapy B. Patients have a productive cough. C. Usually occurs with warning D. Usually does not progress to severe obstruction
A. A severe asthma episode that is refractory to initial therapy
A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer? A. An inhaled beta2-adrenergic agonist B. An inhaled corticosteroid C. An IV beta2-adrenergic agonist D. An oral corticosteroid
A. An inhaled beta2-adrenergic agonist Explanation: an inhaled beta2-adrenergic agonist helps promote bronchodilation, which improves oxygenation. Although an IV form of the drug can be used, the client needs to be monitored bc of the drug's greater systemic effects. The IV form is typically used when the inhaled version doesn't work
A client with COPD is admitted to an acute care facility because of an acute respiratory infection. When assessing the client's respiratory status, which finding should the nurse anticipate? A. An inspiratory-expiratory (I:E) ratio of 2:1 B. a transverse chest diameters twice that of the anteroposterior diameter C. an O2 sat of 99% D. a RR of 12 breaths/minute
A. An inspiratory-expiratory (I:E) ratio of 2:1
A 55 year old client is scheduled for spirometry testing for evaluation of COPD. The nurse: A. Asks the client, "what are your allergies?" B. Explains to the client not to eat or drink before the spirometry test C. States that various blood tests must also be done D. Tells the client that arterial blood gas is performed after spirometry testing
A. Asks the client, "what are your allergies?"
An ED nurse is assessing a client who is complaining of dyspnea. Which sign would indicate the presence of a pleural effusion? A. Decreased chest wall excursion upon palpation B. Wheezing upon auscultation C. Resonance upon percussion D. Mottled skin seen during inspection
A. Decreased chest wall excursion upon palpation Explanation: symptoms of pleural effusion = SOB, pain, assumption of a position that decreases pain, absent breath sounds, decreased remits, a dull or flat sound upon percussion and decreased chest wall excursion
Which of the following is a symptom diagnostic of emphysema? A. Dyspnea B. Copious sputum production C. Normal elastic recoil D. The occurrence of cor pulmonale
A. Dyspnea
All of the following are consistent with poorly controlled asthma except for A. Increased sputum production B. Need for short acting beta agonist at least twice per week C. A cough that wakes the patient up at night at least twice per week D. One hospitalization in the last month
A. Increased sputum production (wouldn't see this in asthma, would see this in COPD)
A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess? A. Lung sounds B. Skin color C. Heart rate D. Respiratory rate
A. Lung sounds Rationale: A client with COPD is at risk for developing pneumothorax. The description given is consistent with possible pneumothorax. Though the nurse will assess all the data, auscultating the lung sounds will provide the nurse with the information if the client has a pneumothorax.
A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments? A. Oxygen through nasal cannula at 2 L/minute B. Intravenous methylprednisolone (Solu-Medrol) 120 mg C. Ipratropium bromide (Alupent) by metered-dose inhaler D. Vancomycin 1 gram intravenously over 1 hour
A. Oxygen through nasal cannula at 2 L/minute Rationale: All options listed are treatments that may be used for a client with an exacerbation of COPD. The first line of treatment is oxygen therapy.
The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment? A. Providing sufficient oxygen to improve oxygenation B. Avoiding the use of oxygen to decrease the hypoxic drive C. Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise D. Increasing pH
A. Providing sufficient oxygen to improve oxygenation Rationale: The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.
A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
A. Respiratory acidosis
A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? A. Respiratory rate of 22 breaths/minute B. Dilated and reactive pupils C. Urine output of 40 ml/hour D. Heart rate of 100 beats/minute
A. Respiratory rate of 22 breaths/minute Rationale: A respiratory rate of 22 breaths/minute indicates that the drug has achieved its therapeutic effect because fewer respirations are required to achieve oxygenation.
Which statement describes emphysema? A. a disease of the airways characterized by destruction of the walls of overdistended alvoeli B. a disease that results in reversible airflow obstruction, a common clinical outcome C. presence of cough and sputum production for at least a combined total of 2-3 months in each of 2 consecutive years D. chronic dilation of bronchus or bronchi
A. a disease of the airways characterized by destruction of the walls of overdistended alvoeli
A client is being treated in the ED for respiratory distress coupled with pneumonia. The client has no medical hx. However, the client works in a coal mine and smokes 10 cigarettes/day. The nurse anticipates which order based on the client's immediate needs? A. administration of antibiotics B. completion of a 12-lead ECG C. administration of corticosteroids and bronchodilators D. client education: avoidance of irritants like smoke and pollutants
A. administration of antibiotics
Which type of chest configuration is typical of a client with COPD? A. barrel chest B. pigeon chest C. flail chest D. funnel chest
A. barrel chest
Which of the following is a symptom diagnostic of emphysema? A. dyspnea B. copious sputum production C. normal elastic recoil D. the occurrence of cor pulmonale
A. dyspnea
The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client A. exhales hard and fast with a single blow B. inhales deeply and holds breath C. records in a diary the number achieved after 1 breath D. sits in a straight back chair and leans forward
A. exhales hard and fast with a single blow Explanation: you would repeat this twice and record personal best in diary and do this standing up
A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client: A. has wheezes in the right lung lobes B. has a respiratory rate of 28 C. reports SOB D. cannot perform ADLs
A. has wheezes in the right lung lobes
A client with symptoms of mild persistent asthma is now initiating treatment. Which of the following is the preferred therapy that the nurse will teach the client to use at home? A. inhaled beclomethasone (Beconase) B. oral sustained-release albuterol (Proventil) C. subcutaneous omalizumab (Xolair) D. oral prednisone (Deltasone)
A. inhaled beclomethasone (Beconase) Explanation: for mild persistent asthma, the preferred tx is an inhaled corticosteroid, such as beclamethasone
A nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? A. it helps prevent early airway collapse B. it increases inspiratory muscle strength C. it decreases use of accessory breathing muscles D. it prolongs the inspiratory phase of respiration
A. it helps prevent early airway collapse
A client has a history of COPD. Following a coughing episode, the client reports sudden and unrelieved SOB. Which of the following is most important for the nurse to assess? A. lung sounds B. skin color C. heart rate D. respiratory rate
A. lung sounds
A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with COPD. Which diet is appropriate for this client? A. full-liquid B. high protein C. 1800 calorie ADA D. low fat
B. high protein
A pt. with a pleural effusion is scheduled for a thoracentesis. Prior to the procedure, the nurse will plan to A. position the patient sitting upright on the edge of the bed and leaning forward B. instruct the pt about the importance of incentive spirometer use after the procedure C. start a peripheral intravenous line to administer the necessary sedative drugs D. remove the water pitcher and remind the patient not to eat or drink anything for 8 hours
A. position the patient sitting upright on the edge of the bed and leaning forward Explanation: you don't have to worry about oral intake since pt won't be sedated and will just be giving local anesthetics. no need for incentive spirometer since pt will be breathing deeply anyway
A mediastinal shift occurs in which type of chest disorder? A. tension pneumothorax B. traumatic pneumothorax C. simple pneumothorax D. cardiac tamponade
A. tension pneumothorax Explanation: tension pneumothorax causes the lung to collapse and the heart, great vessels and trachea to shift toward the unaffected side of the chest (mediastinal shift)
What are the 5 "A" strategies that help a patient willing to quit smoking?
ASK - ask the pt is they are willing to quit smoking in the next 30 days at every visit ADVISE - strongly urge all tobacco users to quit ASSESS - determine the patient's willingness to make a quit attempt ASSIST - aid the patient in quitting ARRANGE - schedule a follow up contact
On high ozone days, its w COPD should stay inside. Why?
Air pollution/high ozone days may cause acute exacerbation of COPD
Most common quick relief or rescue medication for asthma: Controller med for asthma:
Albuterol Inhaled corticosteroid (ICS)
What is used in an ileal conduit pouch to prevent back flow of urine?
Anti-reflux valve
_______________ like Ipratropium can be used for asthma patients if they can't tolerate albuterol
Anticholinergics
A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is: A. "Nicotine patches would be appropriate for you." B. "Have you tried to quit smoking before?" C. "I can refer you to the American Lung Association." D. "Many options are available for you."
B. "Have you tried to quit smoking before?" Rationale: All the options are appropriate statements; however, the nurse needs to assess the client's statement further. Assessment data include information about previous attempts to quit smoking.
A client with COPD reports increased SOB and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help the client's SOB and fatigue? A. "Raise your arms over your head" B. "Delay self-care activities for 1 hour" C. "Sit in a chair whenever doing an activity" D. "Drink fluids upon arising from bed"
B. "Delay self-care activities for 1 hour"
The nurse is reviewing pressurized metered dose inhaler (MDI) instructions with a client. Which statement by the client indicates the need for further instruction? A. "Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use" B. "I can't use a spacer or holding chamber with the MDI" C. "I will take a slow, deep breath in after pushing down on the MDI" D. "I will shake the MDI container before I use it"
B. "I can't use a spacer or holding chamber with the MDI"
The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? A. "Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use." B. "I can't use a spacer or holding chamber with the MDI." C. "I will take a slow, deep breath in after pushing down on the MDI." D. "I will shake the MDI container before I use it."
B. "I can't use a spacer or holding chamber with the MDI." Rationale: The client can use a spacer or a holding chamber to facilitate the ease of medication administration.
A home health nurse visits a client with COPD who requires oxygen. Which statement by the client indicates the need for additional teaching about home oxygen use? A. "I lubricate my lips and nose with KY jelly" B. "I make sure my oxygen mask is on tightly so it won't fall off while I nap" C. "I have a 'no smoking' sign posted at my front door to remind guests not to smoke" D. "I clean my mask with water after every meal"
B. "I make sure my oxygen mask is on tightly so it won't fall off while I nap" Explanation: applying the oxygen mask too tightly can cause skin breakdown, so the client should be cautioned against wearing it too tightly
The nurse is administering anticoagulant therapy with heparin. What International Normalized Ratio (INR) would the nurse know is within therapeutic range? A. 1.5 to 2.5 B. 2.0 to 2.5 C. 0.5 to 1.0 D. 3.0 to 3.5
B. 2.0 to 2.5 Explanation: Heparin must be continued until the INR is within a therapeutic range, typically 2 to 3
A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. The nurse knows this would probably be A. Atrovent B. Albuterol C. Foradil D. Isuprel
B. Albuterol
The pathophysiology of emphysema is directly related to airway obstruction. The end result of deterioration is respiratory acidosis from airway obstruction. Knowing this, the nursing student would choose which of the following as the highest priority action? A. Apply oxygen as ordered via nasal cannula. B. Assess vital signs every 2 hours including O2 saturations and ABG results. C. Educate the importance of pursed lip breathing. D. Refer to respiratory therapy if breathing becomes labored.
B. Assess vital signs every 2 hours including O2 saturations and ABG results.
Although many signs and symptoms lead to a diagnosis of emphysema, one symptom stands as the primary presenting symptom. Which of the following is the primary presenting symptom? A. Chronic and persistent cough B. Dyspnea C. Tachypnea D. Wheezing
B. Dyspnea
A client is admitted to the facility with a productive cough, night sweats, and a fever. Which action is most important in the initial care plan? A. Assessing the client's temp every 8 hrs B. Placing the client in respiratory isolation C. Monitoring the client's fluid intake and output D. Wearing gloves during all client contact
B. Placing the client in respiratory isolation Explanation: Because the client's signs and symptoms suggest a respiratory infection (possibly TB), respiratory isolation is indicated.
A client involved in a motor vehicle crash suffered a blunt injury to the chest wall and was brought to the ED. The nurse assesses the client for which clinical manifestation that would indicate the presence of a pneumothorax? A. Diminished breath sound B. Sucking sound at the site of injury C. Decreased respiratory rate D. Bloody, productive cough
B. Sucking sound at the site of injury Explanation: Open pneumothorax allows air to pass freely in and out of the thoracic cavity with each attempted respiration. Because the rush of air through the wound in the chest wall produces a sucking sound, such injuries are termed "sucking chest wounds"
A client experiencing an asthmatic attack is prescribed methylprednisolone intravenously. The nurse: A. aspirates for blood return before injecting the medication B. assesses fasting blood glucose levels C. encourages the client to decrease caloric intake d/t increased appetite D. informs the client to limit fluid intake d/t fluid retention
B. assesses fasting blood glucose levels Explanation: adverse effects of this med include abnormalities in glucose metabolism
Which measure may increase complications for a client with COPD? A. administration of antibiotics B. increased oxygen supply C. administration of antitussive agents D. decreased oxygen supply
B. increased oxygen supply Explanation: administering too much oxygen can result in the retention of carbon dioxide. Clients with alveolar hypoventilation can't increase ventilation to adjust for this increased load, and hypercapnia occurs.
A nursing student understands the importance of the psychosocial aspects of disease processes. When working with a patient with COPD, the student would rank which of the following nursing diagnoses as the MOST important when analyzing the psychosocial effects? A. disturbed sleep pattern related to cough B. ineffective coping related to anxiety C. high risk for ineffective therapeutic regimen management related to lack of knowledge D. activity intolerance related to fatigue
B. ineffective coping related to anxiety
Resistance to a first-line antituberculotic agent in a client who has not received previous treatment is referred to as: A. multidrug resistance B. primary drug resistance
B. primary drug resistance Explanation: Primary drug resistance refers to resistance to one of the first-line antituberculotic agents in people who haven't received previous tx
A nurse has just completed teaching with a patient who has been prescribed a meter-dosed inhaler for the first time. Which of the following statements would the nurse use to initiate further teaching and follow-up care? A. "I will make sure to take a slow, deep breath as I push on my inhaler" B. "After I breathe in, I will hold my breath for 10 seconds" C. "I do not need to rinse my mouth with this type of inhaler" D. "If I use the spacer, I know I am only supposed to push on the inhaler once"
C. "I do not need to rinse my mouth with this type of inhaler"
A physician orders metaproterenol (Alupent) by MDI four times daily for a client with acute bronchitis. Which statement by the client indicates effective teaching about this med? A. "I can stop using the drug when I begin to feel better" B. "I should use this inhaler whenever I get short of breath" C. "I need to hold my breath as long as possible after I take a deep inhalation" D. "I need to call the physician right away if I feel my heart beating fast after using the drug"
C. "I need to hold my breath as long as possible after I take a deep inhalation" Explanation: holding the breath increases the absorption of the drug into the alveoli
A client admitted to the facility for treatment for TB receives instructions about the disease. Which statement made by the client indicates the need for further instruction? A. "I'll have to take the medication for up to a year" B. "This disease may come back later if I'm under stress" C. "I'll stay in isolation for 6 weeks" D. "I'll always have a positive test for TB"
C. "I'll stay in isolation for 6 weeks" Explanation: Client needs addit'l teaching bc he needs to be in isolation for 2 weeks, not 6, while taking the TB drugs. After 2 weeks of anti tubercular therapy, the client is no longer considered contagious.
A pt taking isoniazid (INH) therapy for TB demonstrates understanding when making which statement? A. "I'm going to have a tuna fish sandwich for lunch" B. "It is all right if I drink a glass of red wine with my dinner" C. "It's all right if I have a grilled cheese sandwich with American cheese" D. "It is find if I eat sushi with a little bit of soy sauce"
C. "It's all right if I have a grilled cheese sandwich with American cheese" Explanation: Pts taking INH should avoid foods that contain tyramine and histamine (tuna, aged cheese, red wine, soy sauce, yeast extracts). Patients should also avoid alcohol.
A nurse is assessing the injection site of a client who has received a purified protein derivative test. Which finding indicates a need for further evaluation? A. A 5mm induration B. Reddened area C. 15mm induration D. A blister
C. 15mm induration Explanation: A 10mm induration strongly suggests a positive response in the TB screening test; a 15mm induration clearly requires further evaluation. A reddened area, 5mm induration and a blister aren't positive reactions to the test and req no further evaluation.
An elderly client is diagnosed with pulmonary TB. Upset and tearful, he asks the nurse how long her must be separated from his family. Which nursing diagnosis is most appropriate for this client? A. Anxiety B. Social isolation C. Deficient knowledge (disease process and treatment regimen) D. Impaired social interaction
C. Deficient knowledge (disease process and treatment regimen) Explanation: Tx of TB no longer req isolation, provided the client complies with the ordered medication regimen (so deficient knowledge)
A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 40% for a pt with COPD. What stage should the nurse document the patient is in? A. I B. II C. III D. IV
C. III Explanation: grade III is associated with an FEV1 of <30-50%
A nurse is assisting a client with mild COPD to set a goal related to the condition. Which of the following is an appropriate goal for this client? A. Maintain activity level of walking to the mailbox B. Continue with current level of mobility at home C. Increase walking distance around a city block without SOB D. Relieve SOB to a level as close as possible to tolerable
C. Increase walking distance around a city block without SOB Explanation: if the client has MILD COPD, goals are to increase exercise and prevent further loss of pulmonary function
The client with a lower respiratory airway infection is presenting with the following symptoms: fever, chills, dry hacking cough and wheezing. Which nursing diagnosis best supports the assessment by the nurse? A. Risk for infection B. Impaired gas exchange C. Ineffective airway clearance D. Ineffective breathing pattern
C. Ineffective airway clearance Explanation: The symptom of wheezing indicates a narrowing or partial obstruction of the airway from inflammation or secretions
Histamine, a mediator that supports the inflammatory process in asthma, is secreted by A. Eosiniphils B. Lymphocytes C. Mast cells D. Neutrophils
C. Mast cells
An alcoholic and homeless pt is diagnosed with active TB. Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen? A. giving the pt. written instruction about how to take the medications B. teaching to pt. about the high risk for infecting others unless treatment is followed C. arranging for a daily noontime meal at a community center and giving the medication then D. educating the pt. about the long-term impact of TB on health
C. arranging for a daily noontime meal at a community center and giving the medication then
A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: A. pleural effusion. B. pulmonary edema. C. atelectasis. D. oxygen toxicity.
C. atelectasis.
A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes A. teaching the family how to perform postural drainage. B. instructing the client on the signs of respiratory infection. C. implementing measures to clear pulmonary secretions. D. providing the client a low-calorie, high-fiber diet.
C. implementing measures to clear pulmonary secretions.
The nurse is educating a pt with asthma about preventative measures to avoid having an asthma attack. What does the nurse inform the pt is a priority intervention to prevent an asthma attack? A. using a long-acting steroid inhaler when an attack is coming B. avoiding exercise and any strenuous activity C. preparing a written action plan D. staying in the house if it's too cold or too hot
C. preparing a written action plan Explanation: written action plans are part of the overall effort to educate patients about self-management techniques
Which should a nurse encourage in clients who are at risk of pneumococcal and influenza infections? A. mobilizing early B. using incentive spirometry C. receiving vaccinations D. using prescribed opioids
C. receiving vaccinations
The classification of Stage III of COPD is defined as A. at risk for COPD. B. mild COPD. C. severe COPD. D. very severe COPD. E. moderate COPD.
C. severe COPD.
A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he: A. sits in tripod position B. has a pulse oximetry reading of 93% C. uses the sternocleidomastoid muscles D. wants the head of the bed raised to a 90-degree level
C. uses the sternocleidomastoid muscles Explanation: use of accessory muscles indicates worsening breathing conditions, the others don't indicate worsening conditions
If you're looking to rule out a pulmonary embolism you would do a _____ ________
CT scan
Diagnostic tests done to confirm AAA:
CT scan or MRI reveals the size and location
Diagnosis of an aortic dissection:
CT scan, MRI or TEE (Transesophageal Echocardiography)
How is a pulmonary embolism diagnosed? What do you need to check prior to this study?
CT with contrast; allergy to the shellfish or dye and renal function
What are the top 3 reasons for an ileostomy? Other reasons?
Cancer, Crohn's disease, Ulcerative colitis trauma, J-pouch, fistula, obstruction, familial polyposis
A nurse recognizes that a client with tuberculosis needs further teaching when the client states: A. "I'll have to take these meds for 9-12 months" B. "It won't be necessary for the people I work with to take medication" C. "I'll need to have scheduled lab tests while I'm on the medication" D. "The people I have contact with at work should be checked regularly"
D. "The people I have contact with at work should be checked regularly" Explanation: such casual contact needn't be tested for TB
The client asks the nurse to explain the reason for a chest tube insertion in treating a pneumothorax. Which is the best response by the nurse? A. "Chest tube will allow air to be restored to the lung" B. "The tube will drain secretions from the lung" C. "Chest tubes provide a route for med installation to the lung" D. "The tube will drain air from the space around the lung"
D. "The tube will drain air from the space around the lung"
The nurse at the beginning of the evening shift receives a report at 1900 on the following patients. Which patient would the nurse assess first? A. An 85 year old with COPD with wheezing and an O2 saturation of 89% on 2 L of oxygen B. A 62 year old with emphysema who has 300 mL of intravenous fluid remaining C. A 74 year old with chronic bronchitis who has BP 128/58, HR 104, and R 26 D. An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office
D. An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office
Nursing instruction during postural drainage should include telling the patient to: A. Lie supine to rest the lungs B. Sit upright to promote ventilation C. Remain in each position for 30-45 mins for best results D. Change positions frequently and cough up secretions
D. Change positions frequently and cough up secretions
A child is having an asthma attack and the parent can't remember which inhaler to use for quick relief. The nurse accesses the child's medication information and tells the parent to use which inhalant? A. Cromolyn sodium B. Theo-Dur C. Serevent D. Proventil
D. Proventil
A patient with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed? A. Atrovent B. Flovent C. Combivent D. Proventil
D. Proventil Explanation: Proventil, a SABA, is given to asthmatic patients for quick relief of symptoms
After 48 hours, a Mantoux test is evaluated. At the site, there is a 10mm induration. This finding would be considered: A. Not significant B. Negative C. Nonreactive D. Significant
D. Significant Explanation: An induration of 10mm or greater is usually considered significant and reactive in people who have normal or mildly impaired immunity. Erythema without induration isn't considered significant.
The nurse at the beginning of the evening shift receives a report at 1900 on the following patients. Which pt would the nurse assess first? A. an 85 yr old with COPD with wheezing and an O2 sat of 89% on 2 L of oxygen B. a 62yr old with emphysema who has 300 mL of IV fluid remaining C. a 74 yr old with chronic bronchitis who has BP 128/58, HR 104, and R 26 D. an 86 yr old with COPD who arrived on the floor 30 mins ago and is a direct admit from the doctor's office
D. an 86 yr old with COPD who arrived on the floor 30 mins ago and is a direct admit from the doctor's office
A physician determines that a client has been exposed to someone with TB. The nurse expects the physician to order which treatment? A. daily oral doses of isoniazid (Nydrazid) and rifampin (Rifadin) for 6 months-2 years B. isolation until 24 hours after antitubercular therapy begins C. nothing, until signs of active disease arise D. daily doses of isoniazid, 300 mg for 6 months-1 year
D. daily doses of isoniazid, 300 mg for 6 months-1 year Explanation: all clients exposed to persons with TB should receive prophylactic isoniazid in daily doses of 300 mg for 6 months-1 year to avoid the effects of the latent mycobacterium
A client diagnosed with asthma is preparing for discharge. The nurse is educating the client on the proper use of a peak flow meter. The nurse instructs the client to complete which action? A. move the indicator to the top of the numbered scale B. sit down while completing a peak flow reading C. take and record peak flow readings three times daily D. if coughing occurs during the procedure, repeat it
D. if coughing occurs during the procedure, repeat it
What is important/critical point for post care of a patient who has just had a bronchoscopy?
DO NOT give food or drink after surgery until you are sure that they have a gag reflex again by using tongue blade to back of throat
T/F A pt with a pleural effusion can cough up the fluid
False - patients can't cough up the fluid bc the fluid isn't actually in the lungs. Fluid is in the pleural sac outside of the lungs, pushing on the lungs
T/F Everyone who has the flu will have a fever
False - pts with the flu will not always have a fever
T/F Acute exacerbations of COPD cannot be treated at home
False - they can be treated at home or hospital, depending on the severity and the patient's stage of COPD
T/F If you stop hearing the wheeze during a patients asthma attack, the patient is getting better
False - when you stop hearing the wheeze it means the patient has gotten worse and there's not even enough airflow to produce a wheeze (heading for status asthmaticus)
How do we diagnose COPD?
First, look at symptoms - do they have the cough that's intermittent or persistent? sputum? dyspnea that's worsening over time and is consistent? Then, have they been exposed to risk factors - tobacco? occupation? indoor/outdoor pollution? Last, incentive spirometer
What is measured by incentive spirometry?
Forced Expiratory Volume (FEV)
Dark red/more acidic blood that coughed up is most likely coming from where?
GI tract
___________ is a major risk factor for TB development
HIV
Heparin route = __________, how is dose calculated?
IV, calculated based on patient's weight
Gold standard for diagnosis of COPD:
Incentive spirometry another option = body box spirometry
What meds are appropriate for Stage III, IV or repeated exacerbations?
Inhaled corticosteroids bc they improve FEV, improve health status and decrease exacerbations (doesn't affect mortality, but quality of life will be better)
Medication that is most consistently effective for long term control at all steps of care for persistent asthma and reduces risk of exacerbations:
Inhaled corticosteroids like Beclomethasone and Budesonide
____________________ can be given to treat constipation, to administer medicine, or to prepare the bowel for surgery for a patient with a sigmoid colostomy.
Irrigations
Multi-drug resistant (MDR) TB is resistant to ____________ and __________, and Extensively Drug Resistant (XDR) TB is resistant to those drugs, as well as some of the second-line TB drug
Isonazaid and rifampin
What are the 2 major first-line TB drugs?
Isonazaid and rifampin
How to handle a moderate exacerbation when the asthma patient comes to ED or office and peak flow is 40-60% of best:
SABA and oral corticosteroid give oxygen
What position should a pneumonia patient be in?
Semi Fowlers position (HOB elevated at 30-45 degrees to make it easier to breathe)
What is Curb 65 Criteria?
System developed to triage pts with pneumonia, and decide where to put them Confusion Uremia Respiratory Rate Low BP Age 65 or greater Meet 0-1 of the criteria: treat at home 2 criteria: admit to medical unit 3+ criteria: admit to ICU
_________ __________ like Prednisone, Solumedrol are used for asthma exacerbations
Systemic glucocorticosteroids
What is typical medical management of TB?
Usually multiple drugs (2-4) for at least 6 months (may be 9-12 months) of Direct Observational Therapy (DOT) which is when medication is given at a site and the provider watches the pt. take the medication After treatment, follow up with CXR and sputums. Ask pt if they are still experiencing symptoms.
Coumadin/warfarin's antidote:
Vitamin K
When should pouches be emptied?
When they're about 1/3 to 1/2 full
Pt who has O2 decreased (hypoxic) and CO2 increased (hypercapneic) during an asthma exacerbation will have respiratory _________________
acidosis
What is the major characteristic of COPD?
airflow limitation that is not fully reversible
The nurse is caring for a patient with status asthmaticus in the ICU. What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient? Respiratory ________________
alkalosis
How do you calculate smoking pack years?
amount of packs smoked/day x time in years = pack year history (2 ppd x 10 years = 20 pack year history)
Way to prevent DVTs:
ankle flexion and extension
Management of DVT:
anticoagulant (heparin weaned to low molecular weight heparin), daily measurement of the extremity, elevation, elastic stocking, avoid rubbing/massaging, monitor for signs of bleeding (do daily H/H since we're giving heparin)
Intermittent claudication to sharp, unrelenting, constant pain describes _________________ insufficiency
arterial
Pulses in ______________ insufficiency are diminished or absent
arterial
Foods/meds that may cause odor in urine:
asparagus, fish, coffee, garlic, spicy foods, multivitamins, antibiotics
Characterized by recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning
asthma
How is skin protected in a patient with an ileoanal reservoir (J pouch)? Why is it important to protect patients' skin with this?
barrier cream applied to rectal area to prevent breakdown d/t frequent stools (usually 4-6/day with liquid-paste consistency)
When should patients with asthma use their peak flow meter to figure out their personal best/determine what zone they're in?
between 12pm and 2pm
Most common cause of urinary diversions =
bladder cancer
Green compared to yellow sputum indicates what?
both indicate an infection (purulent), green shows that the pus has been static and accumulated over a while
COPD can be ______________ and/or _______________
bronchitis; emphysema
Mainstays of management of an acute asthma attack are:
bronchodilator, oxygen and systemic corticosteroid administration
Complications associated with aortic dissection:
cardiac tamponade (d/t leaks from dissection into the pericardial sac)
High fiber foods that may cause blockage:
celery, coleslaw, coconut, mushrooms, popcorn, kernels, whole fruits/veggies w rough skins or seeds, citrus fruits, dried fruits, nuts/seeds
S/Sx of UTI in patients with ileal conduit:
cloudy, malaise, malodorous, blood, fever, back pain
Would an ileum or colostomy have more odor?
colostomy bc more intestine is involved
Kock pouch is a diversion for patients with bowel ___________. How many times a day should patients irrigate their pouch? How many times a day should patients drain their pouch?
continence, 2x/day until clear, 4x.day (q 4-6 hours) and PRN
An ileoanal reservoir (J pouch) is a diversion for bowel __________. What will the stool be like?
continence, stool will be liquid to paste since it's coming straight from the ileum but consistency may depend on diet
Sigmoid colostomies are used for patients that are fecal ______________
continent
The goal of asthma therapy is asthma ___________. How is this done?
control Reduce impairment in the present by: -preventing frequent use of short acting beta 2 agonists -maintain (near) normal lung pulmonary function and normal activity levels Reduce risk in the future by: -preventing exacerbation and minimize need for ED or hospital care -prevent progressive loss of lung function -minimal or no adverse effects of therapy
Combination asthma meds = _______________+________________
corticosteroids + long acting beta 2 agonists
Hallmark sign of PVD =
intermittent claudication
With an ileostomy there is an increased risk for ____________, while with the colostomy there is an increased risk for __________.
dehydration, constipation
All COPD patients benefit from exercise training programs/pulmonary rehab as it improves exercise tolerance and symptoms of ____________ and ____________
dyspnea; fatigue
When does onset of asthma typically occur? Onset of COPD?
early in life; mid-life
Signs of DVT:
edema, pain, increased circumference of thigh and calf, warmth, tenderness
Systemic, preferably oral, __________________ are effective for the treatment of COPD exacerbations. What is a common name of a drug here?
glucocorticoids, prednisone
What should you do when the patient has a crackle in their lungs?
have the patient cough to see if they can clear it, then listen again
Foods that may cause gas/odor:
highly seasoned foods, onions, garlic, cabbages, broccoli, nuts, beans, peas, asparagus, fish, eggs, strong cheeses, carbonated beverages
AAA management:
if it's less than 2 inches: -antihypertensives -diuretics -Beta-blockers -ACE inhibitors if it's more than 2 inches: -bypass graft or endovascular graft
Why must you be careful when giving oxygen to a patient with an acute exacerbation of COPD?
if they receive too much oxygen, they will have CO2 narcosis and won't have a stimulus to breathe *this is why we must watch patients for alertness while they're on oxygen*
Because of the smaller diameter of the intestine, the chances for food blockage of the _____________ patient are higher
ileostomy
Ileal conduit is a diversion for patients with urinary ___________
incontinence
Ileal conduits are used for patients that are urinary _______________
incontinent
Ileostomies and colostomies are used for patients that are fecal __________________
incontinent
What recommendations would a dr make for a pt with an acute exacerbation of COPD at home?
increase bronchodilator B2 agonist or anticholinergic, may add a long-acting bronchodilator
How should TB patients cough?
into a tissue, they also must know how to properly dispose of their tissues
A Tuberculin skin test is injected _______________
intradermally
Mucoid sputum is hardest to cough up. Why?
it is the thickest, has the most viscosity
Peripheral cyanosis can be found in:
nose, fingers, ears
How often should patients get a flu shot?
once a year
Ostomy/stoma is the Greek word for ___________
opening
Closed-end pouches or caps can be worn with a sigmoid colostomy. Why?
output is predictable/bowel movements are continent
Wheezing suggests what?
partial airway obstruction
Characteristics of dyspnea associated with COPD:
persistent, worsens over time and worsens with exercise
Collection of fluid in the pleural space, can occur with many different conditions like HF, pneumonia or cancer tumors
pleural effusion
Chest x-ray is good for recognizing ______________, but if you want to look for nodules or small tumors you would need a _________ ________
pneumonia; CT scan
What is most often the cause of a cough?
post-nasal drip
Goal of management of pts with acute exacerbation of COPD:
prevent acute respiratory failure
The airflow limitation in COPD is usually ________________ and associated with an abnormal _______________ response of the lung to noxious particles or gases
progressive; inflammatory
Heparin's antidote:
protamine sulfate
Acute emergency caused by: -CHF (most often) -MI -HTN -aspiration of gastric contents -drowning
pulmonary edema
Occurs when a thrombus forms in a vein, detaches and travels back to the heart and lodges in the pulmonary artery
pulmonary embolism
If sputum tastes and smells horrible it is most likely _____________ mucus, indicating what?
purulent, indicates infection
What is a bronchoscopy?
putting a scope through the mouth and going down into the main bronchi to look around or take a biopsy
What blood gas problem would we expect in pts with acute exacerbation of COPD?
respiratory acidosis
Influenza is an acute ______________ illness caused by ___ or ___ viruses
respiratory; A or B
Asthma episodes are usually associated with widespread but variable airflow obstruction that is often ________________ either spontaneously or with treatment
reversible
What should a pt do after using a Dry Powder Inhaler (DPI)?
rinse mouth with water
How can you quantify dyspnea in a patient?
seeing how far the pt can walk on a flat surface in 6 minutes, then there's a scale to have them rate dyspnea and fatigue before and after the walk
Stool characteristic of descending/sigmoid colostomy:
semi-formed to formed because most of the water has been absorbed
What should the stoma look like?
similar to the inside of the cheek -pink to red color -moist surface -edema after surgery is normal -round to oval shape -usually helpful if it's protruding a bit from the skin
When using an MDI, inspiration should be _________, while with DPIs, inspiration should be __________
slow; rapid
When giving steroids for an acute asthma exacerbation, push the med _________
slowly
Most common cause of bladder cancer =
smoking (others: dyes/textiles)
Gold standard in diagnosis of COPD and asthma =
spirometry
measures rate lung changes volume during forced breathing
spirometry
How is DVT diagnosed?
ultrasound/doppler of the extremity
How would you want to position the patient with pulmonary edema?
upright, might have them with legs dangling or just keep in semi fowlers
Ileal conduit is made by connecting the ______________ into a piece of ileum, the ileum is the conduit that brings urine to the surface at a stoma
ureters
What should urine look like when it comes from an ileal conduit?
urine should be CLEAR with strands of mucous
What's the PLISSIT model?
used for sexual counseling Permission Limited info (not TMI) Specific suggestions Intensive therapy
Where do venous ulcers appear and what do they look like?
usually at medial or lateral malleolus (opposite sides of the ankle), they are large and superficial in appearance and usually have a lot of exudate
Pulses in ______________ insufficiency are present, but may be difficult to palpate through edema
venous
The classification of Stage IV of COPD is defined as ____________ COPD.
very severe
Most important thing to reduce common cold transmission:
wash your hands A LOT
Asthma often presents with _____________, but not always
wheezes
musical respiratory sounds that may be audible to the patient and others
wheezing
When does the staff wear a mask when they have a pt with TB?
when in pt room/working w pt
When should a TB pt wear a mask in the hospital?
when leaving their room
When is a colostomy irreversible?
when the rectum and anus have been taken out (there's nothing to connect it back to - usually with rectum cancer)
What is the preferred site for a stoma?
within the lower quadrant, not too close to the umbilicus or the rectus muscles
Which aneurysm results in bleeding into the layers of the arterial wall? A. Saccular B. Dissecting C. False D. Anastomotic
B. Dissecting
Which of the following is a potential complication of a low pressure in the endotracheal cuff? A. Aspiration pneumonia B. Tracheal bleeding C. Tracheal ischemia D. Pressure necrosis
A. Aspiration pneumonia
A victim has sustained a blunt force trauma to the chest. A pulmonary contusion is suspected. Which of the following clinical manifestations correlate with a moderate pulmonary contusion? A. Blood-tinged sputum B. Bradypnea C. Respiratory alkalosis D. Productive cough
A. Blood-tinged sputum
A community health nurse teaches a group of older adults about modifiable risk factors that contribute to the development of peripheral arterial disease (PAD). The nurse knows that the teaching was effective based on which statement? A. "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." B. "I will need to increase the amount of green leafy vegetables I eat to lower my cholesterol levels." C. "The older I get the higher my risk for peripheral arterial disease gets." D. "Because my family is from Italy, I have a higher risk of developing peripheral arterial disease."
A. "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." Rationale: The use of tobacco products may be one of the most important risk factors in the development of atherosclerotic lesions. Nicotine in tobacco decreases blood flow to the extremities and increases heart rate and blood pressure by stimulating the sympathetic nervous system. This causes vasoconstriction, thereby decreasing arterial blood flow. It also increases the risk of clot formation by increasing the aggregation of platelets.
A nurse is preparing dietary recommendations for a client with a lung abscess. Which statement would be included in the plan of care? A. "You must consume a diet rich in protein, such as chicken, fish, and beans." B. "You must consume a diet low in calories, such as skim milk, fresh fruits, and vegetables." C. "You must consume a diet high in carbohydrates, such as bread, potatoes, and pasta." D. "You must consume a diet low in fat by limiting dairy products and concentrated sweets."
A. "You must consume a diet rich in protein, such as chicken, fish, and beans."
A patient has a Mantoux skin test prior to being placed on an immunosuppressant for the treatment of Crohn's disease. What results would the nurse determine is not significant for holding the medication? A. 0 to 4 mm B. 5 to 6 mm C. 7 to 8 mm D. 9 mm
A. 0 to 4 mm
A client admitted with pneumonia has a history of lung cancer and heart failure. A nurse caring for this client recognizes that he should maintain adequate fluid intake to keep secretions thin for ease in expectoration. The amount of fluid intake this client should maintain is: A. 1.4 L. B. 2 L. C. 3 L. D. unspecified.
A. 1.4 L.
When administering heparin anticoagulant therapy, the nurse needs to make certain that the activated partial thromboplastin time (aPTT) is within the therapeutic range of: A. 1.5 to 2.5 times the baseline control. B. 2.5 to 3.0 times the baseline control. C. 3.5 times the baseline control. D. 4.5 times the baseline control.
A. 1.5 to 2.5 times the baseline control.
Which statement describes emphysema? A. A disease of the airways characterized by destruction of the walls of overdistended alveoli B. A disease that results in reversible airflow obstruction, a common clinical outcome C. Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years D. Chronic dilatation of a bronchus or bronchi
A. A disease of the airways characterized by destruction of the walls of overdistended alveoli
Which nursing diagnosis is most significant in planning the care for a client with Raynaud's disease? A. Acute Pain B. Disturbed Sensory Perception C. Self-Care Deficit D. Activity Intolerance
A. Acute Pain Rationale: The hallmark symptom of Raynaud's Disease is pain related to the arterial insufficiency.
The ICU nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following? A. Acute respiratory distress syndrome B. Lung cancer C. Bronchitis D. Tracheobronchitis
A. Acute respiratory distress syndrome
A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis? A. Anxiety B. Imbalanced nutrition: More than body requirements C. Impaired swallowing D. Unilateral neglect
A. Anxiety
The nurse knows that a sputum culture is necessary to identify the causative organism for acute tracheobronchitis. What causative fungal organism would the nurse suspect? A. Aspergillus B. Mycoplasma pneumoniae C. Streptococcus pneumoniae D. Haemophilus
A. Aspergillus
Health teaching includes advising patients on ways to reduce PAD. The nurse should always emphasize that the strongest risk factor for the development of atherosclerotic lesions is: A. Cigarette smoking. B. Lack of exercise. C. Obesity. D. Stress.
A. Cigarette smoking.
A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following? A. Constant, intense back pain and falling blood pressure B. Constant, intense headache and falling blood pressure C. Higher than normal blood pressure and falling hematocrit D. Slow heart rate and high blood pressure
A. Constant, intense back pain and falling blood pressure
Which of the following is a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot? A. Contrast phlebography B. Air plethysmography C. Lymphangiography D. Lymphoscintigraphy
A. Contrast phlebography
The nurse is auscultating the patient's lung sounds to determine the presence of pulmonary edema. What adventitious lung sounds are significant for pulmonary edema? A. Crackles in the lung bases B. Low-pitched rhonchi during expiration C. Pleural friction rub D. Sibilant wheezes
A. Crackles in the lung bases
The nurse assessing a client who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which characteristic? A. Diminished or absent pulses B. Superficial ulcer C. Aching, cramping pain D. Pulses that are present but difficult to palpate
A. Diminished or absent pulses
Which is a characteristic of arterial insufficiency? A. Diminished or absent pulses B. Superficial ulcer C. Aching, cramping pain D. Pulses are present but may be difficult to palpate
A. Diminished or absent pulses Rationale: A diminished or absent pulse is a characteristic of arterial insufficiency. Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses.
What is the reason for chest tubes after thoracic surgery? A. Draining secretions, air, and blood from the thoracic cavity is necessary. B. Chest tubes allow air into the pleural space. C. Chest tubes indicate when the lungs have re-expanded by ceasing to bubble. D. Draining secretions and blood while allowing air to remain in the thoracic cavity is necessary.
A. Draining secretions, air, and blood from the thoracic cavity is necessary. Rationale: allows the lungs to expand
Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)? A. Exposure to tobacco smoke B. Occupational exposure C. Passive smoking D. Ambient air pollution
A. Exposure to tobacco smoke
Which class of medication lyses and dissolves thrombi? A. Fibrinolytic B. Anticoagulant C. Platelet inhibitors D. Factor XA inhibitors
A. Fibrinolytic
The occupational nurse is completing routine assessments on the employees where you work. What might be revealed by a chest radiograph for a client with occupational lung diseases? A. Fibrotic changes in lungs B. Hemorrhage C. Lung contusion D. Damage to surrounding tissues
A. Fibrotic changes in lungs
You are an occupational health nurse in a large ceramic manufacturing company. How would you intervene to prevent occupational lung disease in the employees of the company? A. Fit all employees with protective masks. B. Insist on adequate breaks for each employee. C. Give workshops on disease prevention. D. Provide employees with smoking cessation materials.
A. Fit all employees with protective masks.
A client who underwent surgery 12 hours ago has difficulty breathing. He has petechiae over his chest and complains of acute chest pain. What action should the nurse take first? A. Initiate oxygen therapy. B. Administer a heparin bolus and begin an infusion at 500 units/hour. C. Administer analgesics as ordered. D. Perform nasopharyngeal suctioning.
A. Initiate oxygen therapy.
A client diagnosed with acute respiratory distress syndrome (ARDS) is restless and has a low oxygen saturation level. If the client's condition does not improve and the oxygen saturation level continues to decrease, what procedure will the nurse expect to assist with in order to help the client breathe more easily? A. Intubate the client and control breathing with mechanical ventilation B. Increase oxygen administration C. Administer a large dose of furosemide (Lasix) IVP stat D. Schedule the client for pulmonary surgery
A. Intubate the client and control breathing with mechanical ventilation
A client is diagnosed with peripheral arterial disease. Review of the client's chart shows an ankle-brachial index (ABI) on the right of 0.45. This indicates that the right foot has which of the following? A. Moderate to severe arterial insufficiency B. No arterial insufficiency C. Very mild arterial insufficiency D. Tissue loss to that foot
A. Moderate to severe arterial insufficiency Rationale: Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less.
A nurse reading a chart notes that the client had a Mantoux skin test result with no induration and a 1-mm area of ecchymosis. How does the nurse interpret this result? A. Negative B. Positive C. Borderline D. Uncertain
A. Negative
You are caring for a client with chronic respiratory failure. What are the signs and symptoms of chronic respiratory failure? A. Progressive loss of lung function associated with chronic disease B. Sudden loss of lung function associated with chronic disease C. Progressive loss of lung function with history of normal lung function D. Sudden loss of lung function with history of normal lung function
A. Progressive loss of lung function associated with chronic disease
The nurse is caring for a client with abdominal aortic aneurysm (AAA). Which assessment finding is most likely to indicate a dissection of the aneurysm? A. Severe back pain B. Hematemesis C. Rectal bleeding D. Hypertensive crisis
A. Severe back pain
The nurse is providing discharge instructions to a client with pulmonary sarcoidosis. The nurse concludes that the client understands the information if the client correctly mentions which early sign of exacerbation? A. Shortness of breath B. Weight loss C. Fever D. Headache
A. Shortness of breath
A nurse is providing education about the prevention of arterial constriction to a client with peripheral arterial disease. Which of the following includes priority information the nurse would give to the client? A. Stop smoking. B. Keep your feet elevated above your heart. C. Wear antiembolytic stockings daily to assist with blood return to the heart. D. Do not cross your legs for more than 30 minutes at a time.
A. Stop smoking.
To help prevent infections in clients with COPD, the nurse should recommend vaccinations against two bacterial organisms. Which of the following are the two vaccinations? A. Streptococcus pneumonia and Haemophilus influenzae B. Streptococcus pneumonia and varicella C. Haemophilus influenzae and varicella D. Haemophilus influenzae and Gardasil
A. Streptococcus pneumonia and Haemophilus influenzae
On a routine visit to the physician, a client with chronic arterial occlusive disease reports that he's stopped smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend? A. Taking daily walks B. Engaging in anaerobic exercise C. Reducing daily fat intake to less than 45% of total calories D. Abstaining from foods that increase levels of high-density lipoproteins (HDLs)
A. Taking daily walks Rationale: Taking daily walks relieves symptoms of intermittent claudication, although the exact mechanism is unclear.
A client is being discharged following pelvic surgery. What would be included in the patient care instructions to prevent the development of a pulmonary embolus? A. Tense and relax muscles in the lower extremities. B. Wear tight-fitting clothing. C. Consume the majority of daily fluid intake prior to bed. D. Begin estrogen replacement.
A. Tense and relax muscles in the lower extremities.
A mediastinal shift occurs in which type of chest disorder? A. Tension pneumothorax B. Traumatic pneumothorax C. Simple pneumothorax D. Cardiac tamponade
A. Tension pneumothorax
A nurse and physician are preparing to visit a hospitalized client with perepheral arterial disease. As you approach the client's room, the physician asks if the client has reported any intermittent claudication. The client has reported this symptom. The nurse explains to the physician which of the following details? A. The client can walk about 50 feet before getting pain in the right lower leg. B. The client's fingers tingle when left in one position for too long. C. The client experiences shortness of breath after walking about 50 feet. D. The client's legs awaken him during the night with itching.
A. The client can walk about 50 feet before getting pain in the right lower leg.
Which of the following is the most common site for a dissecting aneurysm? A. Thoracic area B. Lumbar area C. Sacral area D. Cervical area
A. Thoracic area
Which technique does the nurse suggest to a client with pleurisy while teaching about splinting the chest wall? A. Turn onto the affected side. B. Use a prescribed analgesic. C. Avoid using a pillow while splinting. D. Use a heat or cold application.
A. Turn onto the affected side.
The nurse caring for a client with tuberculosis anticipates administering which vitamin with isoniazid (INH) to prevent INH-associated peripheral neuropathy? A. Vitamin B6 B. Vitamin C C. Vitamin D D. Vitamin E
A. Vitamin B6
A client reports pain and cramping in the thigh when climbing stairs and numbness in the legs after exertion. Which diagnostic test with the physician likely perform right in the office to determine PAD? A. ankle-brachial index B. exercise electrocardiography C. electron beam computed tomography D. photoplethysmography
A. ankle-brachial index
A client who works construction and has been demolishing an older building is diagnosed with pneumoconiosis. This lung inflammation is most likely caused by exposure to: A. asbestos. B. silica. C. coal dust. D. pollen.
A. asbestos.
The nurse teaches the client with peripheral vascular disease (PVD) to refrain from smoking because nicotine A. causes vasospasm. B. slows the heart rate. C. depresses the cough reflex. D. causes diuresis.
A. causes vasospasm.
The classification of grade I COPD is defined as A. mild COPD. B. moderate COPD. C. severe COPD. D. very severe COPD.
A. mild COPD.
A nurse assesses arterial blood gas results for a patient in acute respiratory failure (ARF). Which results are consistent with this disorder? A. pH 7.28, PaO2 50 mm Hg B. pH 7.46, PaO2 80 mm Hg C. pH 7.36, PaCO2 32 mm Hg D. pH 7.35, PaCO2 48 mm Hg
A. pH 7.28, PaO2 50 mm Hg Rationale: ARF is defined as a decrease in arterial oxygen tension (PaO2) to less than 60 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO2) to >50 mm Hg (hypercapnia), with an arterial pH less than 7.35.
A physician stated to the nurse that the client has fluid in the pleural space and will need a thoracentesis. The nurse expects the physician to document this fluid as A. pleural effusion. B. pneumothorax. C. hemothorax. D. consolidation.
A. pleural effusion.
As the clinic nurse caring for a client with varicose veins, what is an appropriate nursing action for this client? A. Demonstrate how to self-administer IV infusions. B. Demonstrate how to apply and remove elastic support stockings. C. Assess for the sites of bleeding. D. Assess for skin integrity.
B. Demonstrate how to apply and remove elastic support stockings. Rationale: Varicose veins require the client to elevate legs regularly and perform leg exercises. However, it does not involve bleeding or skin lesions.
A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What should the nurse tell the patient? A. "Only wear your contact lenses during the day and take them out in the evening before bed." B. "You should switch to wearing your glasses while taking this medication." C. "The physician can give you eye drops to prevent any problems." D. "There are no significant problems with wearing contact lenses."
B. "You should switch to wearing your glasses while taking this medication." Rationale: The nurse informs the patient that rifampin may discolor contact lenses and that the patient may want to wear eyeglasses during treatment.
On auscultation, which finding suggests a right pneumothorax? A. Bilateral inspiratory and expiratory crackles B. Absence of breath sounds in the right thorax C. Inspiratory wheezes in the right thorax D. Bilateral pleural friction rub
B. Absence of breath sounds in the right thorax Rationale: In pneumothorax, the alveoli are deflated and no air exchange occurs in the lungs. Therefore, breath sounds in the affected lung field are absent.
Which is the strongest predisposing factor for asthma? A. Congenital malformations B. Allergy C. Male gender D. Air pollution
B. Allergy
A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection? A. Urine output of 15 ml/hour and 2+ hematuria B. Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute C. Urine output of 150 ml/hour and heart rate of 45 beats/minute D. Blood pressure of 82/40 mm Hg and heart rate of 45 beats/minute
B. Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute Rationale: Assessment findings that indicate possible bleeding or recurring dissection include hypotension with reflex tachycardia (as evidenced by a blood pressure of 82/40 mm Hg and a heart rate of 125 beats/minute), decreased urine output, and unequal or absent peripheral pulses.
Which medication is contraindicated in acute asthma exacerbations? A. Albuterol B. Cromolyn sodium C. Levalbuterol D. Ipratropium bromide
B. Cromolyn sodium
For a client with pleural effusion, what does chest percussion over the involved area reveal? A. Absent breath sounds B. Dullness over the involved area C. Friction rub D. Fluid presence
B. Dullness over the involved area
A patient is admitted to the hospital with pulmonary arterial hypertension. What assessment finding by the nurse is a significant finding for this patient? A. Ascites B. Dyspnea C. Hypertension D. Syncope
B. Dyspnea Rationale: Dyspnea, the main symptom of PH, occurs at first with exertion and eventually at rest.
The nurse is caring for a client with tuberculosis. Why should the nurse always encourage a client with tuberculosis to perform active range-of-motion (ROM) exercises three times a day? A. For medication absorption B. For maintaining muscle strength C. For use as a baseline for evaluation D. For effective pain control
B. For maintaining muscle strength
In a client with amyotrophic lateral sclerosis (ALS) and respiratory distress, which finding is the earliest sign of reduced oxygenation? A. Decreased heart rate B. Increased restlessness C. Increased blood pressure D. Decreased level of consciousness (LOC)
B. Increased restlessness Rationale: In ALS, an early sign of respiratory distress is increased restlessness, which results from inadequate oxygen flow to the brain. As the body tries to compensate for inadequate oxygenation, the heart rate increases and blood pressure drops.
Which type of lung cancer is characterized as fast growing and tends to arise peripherally? A. Bronchoalveolar carcinoma B. Large cell carcinoma C. Adenocarcinoma D. Squamous cell carcinoma
B. Large cell carcinoma
A client is brought to the emergency department following a motor vehicle accident. Which of the following nursing assessments is significant in diagnosing this client with flail chest? A. Respiratory acidosis B. Paradoxical chest movement C. Chest pain on inspiration D. Clubbing of fingers and toes
B. Paradoxical chest movement
A client has been diagnosed with peripheral arterial occlusive disease. Which of the following instructions is appropriate for the nurse to give the client for promoting circulation to the extremities? A. Keep the extremities elevated slightly. B. Participate in a regular walking program. C. Use a heating pad to promote warmth. D. Massage the calf muscles if pain occurs.
B. Participate in a regular walking program. Rationale: Clients diagnosed with peripheral arterial occlusive disease should be encouraged to participate in a regular walking program to help develop collateral circulation. They should be advised to rest if pain develops and to resume activity when pain subsides. Extremities should be kept in a dependent position to promote circulation; elevation of the extremities will decrease circulation. Heating pads should not be used by anyone with impaired circulation to avoid burns. Massaging the calf muscles will not decrease pain. Intermittent claudication subsides with rest.
A postoperative client is receiving heparin after developing thrombophlebitis. The nurse monitors the client carefully for bleeding and other adverse effects of heparin. If the client starts to exhibit signs of excessive bleeding, the nurse should expect to administer an antidote that is specific to heparin. Which agent fits this description? A. Phytonadione (vitamin K) B. Protamine sulfate C. Thrombin D. Plasma protein fraction
B. Protamine sulfate
A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms? A. Peripheral vascular disease B. Raynaud's disease C. Arterial occlusive diseases D. Buerger's disease
B. Raynaud's disease
A female client is readmitted to the facility with a warm, tender, reddened area on her right calf. Which contributing factor should the nurse recognize as most important? A. History of increased aspirin use B. Recent pelvic surgery C. An active daily walking program D. A history of diabetes mellitus
B. Recent pelvic surgery Rationale: The client shows signs of deep vein thrombosis (DVT). The pelvic area has a rich blood supply, and thrombophlebitis of the deep veins is associated with pelvic surgery. Aspirin, an antiplatelet agent, and an active walking program help decrease the client's risk of DVT. In general, diabetes mellitus is a contributing factor associated with peripheral vascular disease.
What symptoms should the nurse assess for in a client with lymphedema as a result of impaired nutrition to the tissue? A. Loose and wrinkled skin B. Ulcers and infection in the edematous area C. Evident scarring D. Cyanosis
B. Ulcers and infection in the edematous area Rationale: In a client with lymphedema, the tissue nutrition is impaired because of the stagnation of lymphatic fluid, leading to ulcers and infection in the edematous area.
The term for a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot is A. air plethysmography. B. contrast phlebography. C. lymphangiography. D. lymphoscintigraphy.
B. contrast phlebography.
You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia? A. Give antibiotics as ordered. B. Place client on bed rest. C. Encourage increased fluid intake. D. Offer nutritious snacks 2 times a day.
C. Encourage increased fluid intake. Rationale: Increased fluid intake is important to encourage because it helps to loosen secretions and replace fluids lost through fever and increased respiratory rate.
A patient with diabetes is being treated for a wound on the lower extremity that has been present for 30 days. What option for treatment is available to increase diffusion of oxygen to the hypoxic wound? A. Surgical debridement B. Enzymatic debridement C. Hyperbaric oxygen D. Vacuum-assisted closure device
C. Hyperbaric oxygen
The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation? A. "As soon as you feel pain, we will go back and elevate your legs." B. "If you feel pain during the walk, keep walking until the end of the hallway is reached." C. "Walk to the point of pain, rest until the pain subsides, then resume ambulation." D. "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room."
C. "Walk to the point of pain, rest until the pain subsides, then resume ambulation." Rationale: Helps develop collateral circulation
The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient? A. 3 months B. 3 to 5 months C. 6 to 12 months D. 13 to 18 months
C. 6 to 12 months
Which action should the nurse take first in caring for a client during an acute asthma attack? A. Obtain arterial blood gases. B. Send for STAT chest x-ray. C. Administer bronchodilator as ordered. D. Initiate oxygen therapy and reassess pulse oximetry in 10 minutes.
C. Administer bronchodilator as ordered. Rationale: The administration of oxygen is indicated, but without open bronchioles, the action will not be effective in an acute attack.
The nurse is collaborating with a community group to develop plans to reduce the incidence of lung cancer in the community. Which of the following would be most effective? A. Public service announcements on television to promote the use of high-efficiency particulate air (HEPA) filters in homes B. Advertisements in public places to encourage cigarette smokers to have yearly chest x-rays C. Classes at community centers to teach about smoking cessation strategies D. Legislation that requires homes and apartments be checked for asbestos leakage
C. Classes at community centers to teach about smoking cessation strategies
Which interventions does a nurse implement for clients with empyema? A. Institute droplet precautions B. Place suspected clients together C. Encourage breathing exercises D. Do not allow visitors with respiratory infection
C. Encourage breathing exercises
Which is a risk factor for venous disorders of the lower extremities? A. Trauma B. Pacing wires C. Obesity D. Surgery
C. Obesity Rationale: Clients with a history of varicose veins, hypercoagulation, neoplastic disease, cardiovascular disease, or recent major surgery or injury are at high risk. Other clients at high risk include those who are obese or older adults and women taking oral contraceptives.
A client with Raynaud's disease complains of cold and numbness in the fingers. Which of the following would the nurse identify as an early sign of vasoconstriction? A. Cyanosis B. Gangrene C. Pallor D. Clubbing of the fingers
C. Pallor
The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client's care plan? A. Restricting oral intake to 1,000 mL/day B. Providing the client a low-sodium diet C. Performing chest physiotherapy as ordered D. Discussing palliative care and end-of-life issues with the client
C. Performing chest physiotherapy as ordered
As status asthmaticus worsens, the nurse would expect which acid-base imbalance? A. Respiratory alkalosis B. Metabolic alkalosis C. Respiratory acidosis D. Metabolic acidosis
C. Respiratory acidosis Rationale: As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.
A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions? A. Decreasing blood pressure and increasing mobility B. Increasing blood pressure and reducing mobility C. Stabilizing heart rate and blood pressure and easing anxiety D. Increasing blood pressure and monitoring fluid intake and output
C. Stabilizing heart rate and blood pressure and easing anxiety Rationale: For a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture.
A junior-level nursing class has just finished learning about the management of clients with chronic pulmonary diseases. They learned that a new definition of COPD leaves only one disorder within its classification. Which of the following is that disorder? A. Asthma B. Bronchiectasis C. Cystic fibrosis D. Emphysema
D. Emphysema
Which statement is accurate regarding Reynaud disease? A. The disease generally affects the client bilaterally. B. It affects more than two digits on each hand or foot. C. It is most common in men 16 to 40 years of age. D. Episodes may be triggered by unusual sensitivity to cold.
D. Episodes may be triggered by unusual sensitivity to cold.
A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures? A. "I like to soak my feet in the hot tub every day." B. "I walk only to the mailbox in my bare feet." C. "I stopped smoking and use only chewing tobacco." D. "I have my wife look at the soles of my feet each day."
D. "I have my wife look at the soles of my feet each day." Rationale: A client with peripheral vascular disease should examine his feet daily for redness, dryness, or cuts. If a client isn't able to do this examination on his own, then a caregiver or family member should help him. A client with peripheral vascular disease should avoid hot tubs because decreased sensation in the feet may make him unable to tell if the water is too hot. The client should always wear shoes or slippers on his feet when he is out of bed to help minimize trauma to the feet. Any type of nicotine, whether it's from cigarettes or smokeless tobacco, can cause vasoconstriction and further decrease blood supply to the extremities.
When caring for a patient who has started anticoagulant therapy with warfarin (Coumadin), the nurse knows that therapeutic benefits will not occur for: A. At least 12 hours. B. The first 24 hours. C. 2 to 3 days. D. 3 to 5 days.
D. 3 to 5 days.
After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? A. 3 to 5 days B. 1 to 3 weeks C. 2 to 4 months D. 6 to 12 months
D. 6 to 12 months
To assess the dorsalis pedis artery, the nurse would use the tips of three fingers and apply light pressure to the: A. Inside of the ankle just above the heel. B. Exterior surface of the foot near the heel. C. Outside of the foot just below the heel. D. Anterior surface of the foot near the ankle joint.
D. Anterior surface of the foot near the ankle joint.
Which statement is true about both lung transplant and bullectomy? A. Both procedures cure COPD. B. Both procedures treat end-stage emphysema. C. Both procedures treat patients with bullous emphysema. D. Both procedures improve the overall quality of life of a client with COPD.
D. Both procedures improve the overall quality of life of a client with COPD.
A client is at risk for emphysema. When reviewing information about the condition with the client, which would the nurse emphasize as the most important environmental risk factor for emphysema? A. Air pollution B. Allergens C. Infectious agents D. Cigarette smoking
D. Cigarette smoking
While caring for a client with a chest tube, which nursing assessment would alert the nurse to a possible complication? A. Skin around tube is pink. B. Bloody drainage is seemed in the collection chamber. C. Absence of bloody drainage in the anterior/upper tube D. Crackling is heard when skin around tube is touched.
D. Crackling is heard when skin around tube is touched
The nurse is assessing a patient who has been admitted with possible ARDS. What findings would distinguish ARDS from cardiogenic pulmonary edema? A. Elevated white blood count B. Elevated troponin levels C. Elevated myoglobin levels D. Elevated B-type natriuretic peptide (BNP) levels
D. Elevated B-type natriuretic peptide (BNP) levels
A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism? A. Romberg's B. Phalen's C. Rinne D. Homans'
D. Homans'
When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems? A. Hypotension, hyperoxemia, and hypercapnia B. Hyperventilation, hypertension, and hypocapnia C. Hyperoxemia, hypocapnia, and hyperventilation D. Hypercapnia, hypoventilation, and hypoxemia
D. Hypercapnia, hypoventilation, and hypoxemia
The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin? A. Within 12 hours B. Within the first 24 hours C. In 2 days D. In 3 to 5 days
D. In 3 to 5 days
A client who has just had a triple-lumen catheter placed in his right subclavian vein complains of chest pain and shortness of breath. His blood pressure is decreased from baseline and, on auscultation of his chest, the nurse notes unequal breath sounds. A chest X-ray is immediately ordered by the physician. What diagnosis should the nurse suspect? A. Pulmonary embolism B. Myocardial infarction (MI) C. Heart failure D. Pneumothorax
D. Pneumothorax Rationale: Pneumothorax (air in the pleural space) is a potential complication of all central venous access devices.
When assessing a client with cellulitis of the right leg, which finding should the nurse expect to observe? A. Painful skin that is swollen and pale in color B. Cold, red skin C. Small, localized blackened area of skin D. Red, swollen skin with inflammation spreading to surrounding tissues
D. Red, swollen skin with inflammation spreading to surrounding tissues
You are caring for a client status post lung resection. When assessing your client you find that the bubbling in the water-seal chamber for the chest tubes is more than you expected. What should you check when bubbling in the water-seal chamber is excessive? A. See if the chest tube is clogged. B. See if the wall suction unit has malfunctioned. C. See if a kink has developed in the tubing. D. See if there are leaks in the system.
D. See if there are leaks in the system.
The nurse is caring for a patient with pleurisy. What symptoms does the nurse recognize are significant for this patient's diagnosis? A. Dullness or flatness on percussion over areas of collected fluid B. Dyspnea and coughing C. Fever and chills D. Stabbing pain during respiratory movement
D. Stabbing pain during respiratory movement Rationale: When the inflamed pleural membranes rub together during respiration (intensified on inspiration), the result is severe, sharp, knifelike pain. The key characteristic of pleuritic pain is its relationship to respiratory movement
A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse know is the most common organism that causes community-acquired pneumonia? A. Staphylococcus aureus B. Mycobacterium tuberculosis C. Pseudomonas aeruginosa D. Streptococcus pneumoniae
D. Streptococcus pneumoniae
The nurse is caring for a patient with venous insufficiency. What should the nurse assess the patient's lower extremities for? A. Rudor B. Cellulitis C. Dermatitis D. Ulceration
D. Ulceration
During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must: A. follow up with the physician in 2 weeks. B. turn and reposition himself every 2 hours. C. maintain fluid intake of 40 oz (1,200 ml) per day. D. continue to take antibiotics for the entire 10 days.
D. continue to take antibiotics for the entire 10 days.
The most important reason for a nurse to encourage a client with peripheral vascular disease to initiate a walking program is that this form of exercise: A. reduces stress. B. aids in weight reduction. C. increases high-density lipoprotein (HDL) level. D. decreases venous congestion.
D. decreases venous congestion. Rationale: Regular walking is the best way to decrease venous congestion because using the leg muscles as a pump helps return blood to the heart.
