NUR 109 Respiratory
A nurse assesses a 66-year-old client who is wants to quit smoking. The client states, "I started smoking at age 16, and have smoked half a pack each day ever since." How many pack-years should the nurse document for this client? (Record your answer using a whole number.)
25
The nurse is assessing a 50-year-old female during an initial assessment. When asked about smoking history the patient reports smoking 2 packs a day for the last 15 years. How many pack-years should the nurse document for this client? (Record your answer using a whole number.)
30
The 75-year-old patient asks the nurse if the Pneumonia immunization (Pneumonax) he took when he was 65 is still protecting him. The nurse's most helpful reply is: a. "No. A second dose is needed 5 years after the first for full immunity." b. "No. The immunity afforded you by Pneumovax only lasts 2 years." c. "Yes. Pneumovax protects you your for your lifetime." d. "Yes; but it loses strength and may not protect you from all 23 pneumococcal organisms anymore."
a. "No. A second dose is needed 5 years after the first for full immunity." Response Feedback: Pneumovax, an immunization that protects against 23 pneumococcal organisms, is repeated 6 years after the first dose.
The client with asthma asks about why she must hold her breath for at least 10 seconds after breathing in the medication from her inhaler. The nurse's best response is: a. "To allow the medication to reach deep into the lungs." b. "To allow the medication time to dissolve." c. "To allow the medication to reach the trachea." d. "To allow the medication to travel to the heart and decrease constriction in the vessels."
a. "To allow the medication to reach deep into the lungs."
A 35-year-old male patient with no health problems states that he had a flu shot last year and asks if it is necessary to have it again this year. What is the best response by the nurse? a. "Yes. The vaccine is only effective for one year." b. "No. The flu shot lasts for several years and is effective against many different viruses." c. "Yes. The vaccine should be taken by all individuals regardless of health history. " d. "No. The flu shot is only for high-risk patients."
a. "Yes. The vaccine is only effective for one year."
A nurse cares for a client who tests positive for alpha1-antitrypsin (AAT) deficiency. The client asks, "What does this mean?" How should the nurse respond? a. "Your risk for chronic obstructive pulmonary disease is higher, especially if you smoke." b. "I will contact a genetic counselor to discuss your condition." c. "Your children will be at high risk for the development of chronic obstructive pulmonary disease." d. "This is a recessive gene and should have no impact on your health."
a. "Your risk for chronic obstructive pulmonary disease is higher, especially if you smoke." Response Feedback: The gene for AAT is a recessive gene. Clients with only one allele produce enough AAT to prevent chronic obstructive pulmonary disease (COPD) unless the client smokes. A client with two alleles is at high risk for COPD even if not exposed to smoke or other irritants. The client is a carrier, and children may or may not be at high risk depending on the partner's AAT levels. Contacting a genetic counselor may be helpful but does not address the client's current question.
After being treated in the emergency department for a posterior nosebleed, the patient is admitted to the hospital. The nasal packing is in place and vital signs are stable. The patient has an IV with normal saline at 125 ml/hr. What is the priority for the nursing care? a. Airway management b. Managing potential decreased cardiac output c. Managing potential dehydration d. Monitoring for potential infection
a. Airway management
A patient having respiratory difficulty has a pH of 7.48. What is the nurse's best interpretation of this value? a. Alkalosis b. Acidosis c. Hypoxia d. Hypercarbia
a. Alkalosis
Which patient(s) does the nurse monitor for the development of a pulmonary embolism? (Select all that apply.) a. An 83 year old wheelchair bound patient. b. A 65 year old patient who underwent a knee replacement yesterday c. A 35 year old returning to the medical unit after undergoing a colonoscopy. d. A 55 year old patient being seen in the clinic reporting a 30 pack year history of smoking. e. A 29 year old being seen in the clinic for cough, congestion, and severe headache.
a. An 83 year old wheelchair bound patient. b. A 65 year old patient who underwent a knee replacement yesterday d. A 55 year old patient being seen in the clinic reporting a 30 pack year history of smoking.
A patient with a tracheostomy is unable to speak. He is not in acute distress, but is gesturing and trying to communicate with the nurse. Which nursing intervention is the best approach in this situation? a. Ask questions that can be answered with a "yes" or "no" response b. Encourage the patient to rest rather than struggle with communication c. Obtain an immediate consult with the speech therapist d. Rely on the family to interpret for the patient
a. Ask questions that can be answered with a "yes" or "no" response
The nurse is caring for a patient that is tachypneic and restless. Upon her assessment of the chest tube drainage system she notices no bubbling in the water seal chamber. What should be the nurse's first action? a. Assess the connection between the chest tube and drainage system b. Notify the physician immediately c. Place the patient in the High-Fowler's position d. Increase the patient's oxygen delivery
a. Assess the connection between the chest tube and drainage system
A patient's pulse oximetry reading is 89%. What is the nurse's first action? a. Assess the patient for respiratory distress and recheck the oximeter reading. b. Apply oxygen c. Assess the patient for cyanosis d. Place the patient in High-Fowler's position
a. Assess the patient for respiratory distress and recheck the oximeter reading.
The patient receiving oxygen therapy is at risk for skin breakdown. Which nursing interventions are should the nurse perform to prevent this complication? (Select all that apply.) Selected Answers: a. Assess the patient's ears, back of neck, and face at least every 4 hours. b. Use petroleum jelly on nostrils, face, and lips to relieve dryness. c. Assess nasal and mucous membranes for dryness and cracks. d. Provide oral care once a day. e. Obtain an order for humidification when oxygen is being delivered at 4L/min or more.
a. Assess the patient's ears, back of neck, and face at least every 4 hours. c. Assess nasal and mucous membranes for dryness and cracks. e. Obtain an order for humidification when oxygen is being delivered at 4L/min or more.
Which patient is at highest risk for developing pneumonia? a. Disabled 540year-old with osteoporosis being discharged home b. 32-year-old trauma patient on a mechanical ventilator c. Any patient who has not received the vaccine for pneumonia d. Any hospitalized patient between the ages of 18 and 65 years
b. 32-year-old trauma patient on a mechanical ventilator
The nurse is caring for a client scheduled to undergo a CT scan with contrast in the AM for a lung mass. What assessments does the nurse perform to ensure safety of the patient during the CT scan? (Select all that apply.) a. BUN and creatinine levels b. Allergies to iodine or shellfish c. WBC count d. Family history of lung cancer e. Potassium level f. Medication administration record for Metformin
a. BUN and creatinine levels b. Allergies to iodine or shellfish f. Medication administration record for Metformin
The home health nurse has been caring for a patient with a chronic respiratory disorder. Today the patient is confused when she is normally alert and oriented. What is the priority nursing action? a. Check the pulse oximeter reading. b. Notify the provider about the mental status change. c. Ask the patient's family when this behavior started. d. Perform a mental status examination.
a. Check the pulse oximeter reading.
After the nurse has instructed a patient with COPD in the proper coughing technique, which action the next day by the patient indicates the need for additional teaching or intervention? a. Coughing after meals b. Coughing before meals c. Coughing before bedtime d. Coughing upon rising in the morning
a. Coughing after meals
While assessing a client who is 12 hours postoperative after a thoracotomy for lung cancer, a nurse notices that the lower chest tube is dislodged. Which action should the nurse take first? a. Cover the insertion site with sterile gauze. b. Assess for drainage from the site. c. Reinsert the tube using sterile technique. d. Contact the provider and obtain a suture kit.
a. Cover the insertion site with sterile gauze Response Feedback: Immediately covering the insertion site helps prevent air from entering the pleural space and causing a pneumothorax. The area will not reseal quickly enough to prevent air from entering the chest. The nurse should not leave the client to obtain a suture kit. An occlusive dressing may cause a tension pneumothorax. The site should only be assessed after the insertion site is covered. The provider should be called to reinsert the chest tube or prescribe other treatment options.
Which of the following should not be provided to promote smoking cessation? a. E-Cigarettes b. Oral smoking cessation aides c. Nicotine Replacement Products d. Information about distraction techniques
a. E-Cigarettes
The nurse is developing a teaching plan for her patient with COPD using the priority patient problem of insufficient knowledge related to energy conservation. What does the nurse advise the patient to avoid? a. Eating three large meals per day b. Talking and performing activities separately c. Performing activities at a relaxed pace throughout the day with rest periods d. Working on activities that require using arms at chest level or lower
a. Eating three large meals per day
The nurse is caring for an older adult who uses a wheelchair and spends over half of each day in bed. Which intervention is most important in promoting pulmonary care? a. Encouraging the patient to turn, cough, and deep breathe b. Reassuring the patient that immobility is temporary. c. Monitoring the patient's respiratory rate. d. Obtaining an order for PRN (as-needed) oxygen via nasal cannula
a. Encouraging the patient to turn, cough, and deep breathe
The nurse has just received a patient from the recovery room who is somewhat drowsy, but capable of following instructions. Pulse oximetry has dropped from 95% to 90%. What is the priority nursing intervention? a. Have the patient perform coughing and deep-breathing exercises then reassess. b. Withhold narcotic pain medication to reduce sedation effects. c. Administer naloxone (Narcan) to reverse narcotic sedation effect. d. Administer 2L/min by nasal cannula then reassess
a. Have the patient perform coughing and deep-breathing exercises then reassess.
The patient is receiving oxygen at 5L/min by nasal cannula. What priority intervention must the nurse use at this time? a. Humidify the oxygen with sterile water b. Switch to a mask delivery system c. Add extension tubing for patient mobility d. Monitor for manifestations of oxygen toxicity
a. Humidify the oxygen with sterile water
An ER nurse is caring for a patient is experiencing an acute asthma attack. The patient has been treated with albuterol, but is not responding to the medication. The physician orders Theo-Dur (theophylline). The should monitor for which of the following side effects of this drug? (Select All That Apply.) a. Hypertension b. Bradycardia c. Seizures d. Dysrhythmias e. Bloody Sputum
a. Hypertension c. Seizures d. Dysrhythmias
A patient with COPD has come in for a routine check-up. The nurse notices he has lost 5lbs since his check-up a month ago. The nurse knows that this finding may be related to which of the following? a. Increased metabolism from increased work of breathing b. Severe swelling of the airways leading to dysphagia c. Increased amounts of carbon dioxide in the blood resulting in confusion d. Thick mucus production leading to dysphagia
a. Increased metabolism from increased work of breathing
A client is being discharged home after having a tracheostomy placed. What suggestions does the nurse offer to help the client maintain self-esteem? (Select all that apply.) a. Maintain public activities b. Create a communication system. c. Do not participate in any hobbies. d. Wear fashionable scarves. e. Try loose-fitting shirts with collars.
a. Maintain public activities b. Create a communication system. d. Wear fashionable scarves. e. Try loose-fitting shirts with collars.
A client is wearing a simple face mask to deliver oxygen at 5 L/min and the dinner tray has arrived. What action by the nurse is best? a. Obtain a physician's order for a nasal cannula at 5 L/min b. Have the client lift the mask off the face when taking bites of food. c. Assess the client's oxygen saturation and, if normal, turn off the oxygen. d. Turn the oxygen off while the client eats the meal and then restart it.
a. Obtain a physician's order for a nasal cannula at 5 L/min
The patient developed flu symptoms less than 24 hours ago. Which drug therapy does the nurse expect the health care provider to order this time? a. Oseltamivir (Tamiflu) b. IV steroid therapy c. Penicillin therapy d. Amantadine (Symmetrel)
a. Oseltamivir (Tamiflu)
The patient has been on oxygen therapy at 70% for over 2 days. For which complication must the nurse monitor? a. Oxygen toxicity b. Hypercarbia c. Absorptive atelectasis d. Oxygen-induced hypoventilation
a. Oxygen toxicity
The nurse is caring for a patient with multiple fractures to the jaw that had to be immobilized in order to heal. What priority intervention does the nurse implement to prevent aspiration of emesis? a. Place a pair of wire cutters at the bedside b. Place the patient in the left lateral position c. Provide the patient with a Sprite to calm the stomach d. Place an NG tube to decompress the stomach
a. Place a pair of wire cutters at the bedside
A patient with chronic obstructive pulmonary disease (COPD) is likely to have which findings on assessment? (Select all that apply.) a. Sitting in a chair leaning forward with elbows on knees b. Decreased appetite c. Unexplained weight loss d. Increased anteroposterior (AP) diameter of the chest e. Unintentional weight gain
a. Sitting in a chair leaning forward with elbows on knees b. Decreased appetite c. Unexplained weight loss d. Increased anteroposterior (AP) diameter of the chest
What is the best position for the patient to assume for a thoracentesis? a. Sitting up, leaning forward on the overbed table b. Side-lying, affected side exposed, head slightly raised c. Prone position with arms above the head d. Lying flat with arm on affected side across the chest
a. Sitting up, leaning forward on the overbed table
While assessing a client who has facial trauma, the nurse notes clear fluid from the nasal passages. Which action would be a priority for the nurse? a. Test present drainage for glucose b. Ask the patient if they have had a recent cold c. Ask patient to produce a sputum specimen for collection d. Provide the patient with a tissue to remove the mucous from their nose.
a. Test present drainage for glucose
To reduce the spread of colds which teaching points must the nurse include when teaching patients? (Select all that apply.) a. Thorough handwashing is essential b. Stay home from work, school, or other place where people gather. c. Always dispose of used tissues properly d. Cover both the nose and the mouth with the elbow when sneezing e. Seek medical attention at the first sign of on oncoming cold
a. Thorough handwashing is essential b. Stay home from work, school, or other place where people gather. c. Always dispose of used tissues properly d. Cover both the nose and the mouth with the elbow when sneezing
When caring for a patient who is on a closed-chest drainage system with chest tubes, the nurse should report which finding as abnormal to the primary care provider? a. constant bubbles in the water-seal chamber. b. the suction has been attached. c. the level of fluid in the collection chamber rises. d. the water level in the water-seal chamber fluctuates with breaths.
a. constant bubbles in the water-seal chamber. Response Feedback: If the level of the water in the water-seal chamber rises and falls with the patient's respiration, the system is intact. Constant bubbles in the water-seal chamber indicate a leak in the system. The fluid in the collection container drains by gravity whether the closed-chest drainage system is intact or not. Suction is not significant with respect to whether the system is intact.
The nurse is preparing discharge instructions for a 25-year-old male patient who has been recently diagnosed with asthma. Which of the following instructions should the nurse be prepared to give? a. "You should wait 5 minutes between each puff of the inhaler." b. "A spacer is not required when using your medication inhalers." c. "A spacer should be used when using you medication inhalers to achieve the best results." d. "The peak flow meter should only be used during an acute attack."
b. "A spacer is not required when using your medication inhalers."
The nurse is instructing a patient regarding complications of COPD. Which statement by the patient indicates the need for additional teaching? a. "The lack of oxygen could cause my heart to beat in an irregular pattern." b. "My COPD is serious, but it can be reversed if I follow my doctor's orders." c. "I have to be careful because I am susceptible to respiratory infections." d. "I could develop heart failure which could be fatal if untreated."
b. "My COPD is serious, but it can be reversed if I follow my doctor's orders."
A nurse teaches a client who is prescribed nicotine replacement therapy. Which statement should the nurse include in this client's teaching? a. "Stopping this medication suddenly increases your risk for a heart attack." b. "Smoking while taking this medication will increase your risk of a stroke." c. "Rise slowly when getting out of bed in the morning." d. "Make a list of reasons why smoking is a bad habit."
b. "Smoking while taking this medication will increase your risk of a stroke." Response Feedback: Clients who smoke while using drugs for nicotine replacement therapy increase the risk of stroke and heart attack. Nurses should teach clients not to smoke while taking this drug. The other responses are inappropriate.
The clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The patient asks the nurse what he could have done to minimize the risk of developing this disease. What would be the nurse's best answer? a. "The most important risk factor for COPD is inadequate nutrition." b. "The most important risk factor for COPD is cigarette smoking." c. "The most important risk factor for COPD is regular exercise." d. "The most important risk factor for COPD is exposure to dust and pollen."
b. "The most important risk factor for COPD is cigarette smoking." Response Feedback: The most important risk factor for COPD is cigarette smoking. Nutrition, exercise, and exposure to dust and pollen are not risk factors for COPD.
Which patient has the greatest risk for developing ARDS? a. 56-year-old with uncontrolled diabetes b. 74-year-old who aspirates tube feeding c. 34-year-old with chronic renal failure d. 18-year-old with a fractured femur
b. 74-year-old who aspirates tube feeding
An older adult patient experiences an episode of status asthmaticus. Which medication is best to use for the acute symptoms? a. Fluticasone (Flovent) b. Albuterol (Proventil) c. Omalizumab (Xolair) d. Salmeterol (Serevent)
b. Albuterol (Proventil)
A patient has undergone a nasoseptoplasty. Upon discharge the nurse provides self-care education. Which of the following should the nurse include? a. Stay in the left-lateral position b. Apply cold compresses to the nose and eye areas as needed c. Blow the nose daily to remove any excess secretions d. Take NSAIDS every 4 hours as needed for pain
b. Apply cold compresses to the nose and eye areas as needed
A patient has developed pulmonary hypertension. What is the goal of treatment for this patient? a. Maintain and manage pulmonary exacerbation b. Dilate pulmonary vessels c. Decrease pain and make the patient comfortable d. Improve or maintain gas exchange
b. Dilate pulmonary vessels
Which is an example of third-hand passive smoking? a. Entering a room where several people have been smoking b. Exposure to smoke on the clothes of a smoker c. Sitting in a car with a person who is smoking d. Walking through a group of people smoking outside
b. Exposure to smoke on the clothes of a smoker
The nurse is reviewing laboratory results for a patient who has pneumonia. Which laboratory value does the nurse expect to see for the patient? a. Increased red blood cells (RBCs) b. Increased white blood cells (WBCs) c. Decreased neutrophils d. Decreased hemoglobin
b. Increased white blood cells (WBCs)
After receiving the subcutaneous Mantoux skin test, a patient with no risk factors returns to the clinic in the required 48 to 72 hours for the test results. Which assessment finding indicates a positive result? a. Induration or a hard nodule of any size at the site b. Induration/hardened area measures 10mm or greater c. Test area is red, warm, and tender to touch d. Induration/hardened area measures 5mm or greater
b. Induration/hardened area measures 10mm or greater
A patient with cystic fibrosis (CF) is admitted to the medical-surgical unit for an elective surgery. Which infection control measure is best for this patient? a. Droplet isolation precautions b. Limiting close contact between people with CF c. Standard precautions including handwashing are sufficient d. Contact isolation precautions
b. Limiting close contact between people with CF
The healthcare provider has prescribed varenicline (Chantix) for the patient who wishes to quit smoking. What is an education priority for the patient/caregivers? a. Reporting any appetite changes b. Monitoring and reporting any behavior changes c. Avoiding sunlight d. Reporting any vivid, strange dreams
b. Monitoring and reporting any behavior changes
A patient presents to the walk-in clinic with extremely labored breathing and a history of asthma that is unresponsive to prescribed inhalers or medications. What is the priority nursing intervention? a. Obtain the equipment and prepare the patient for intubation b. Place the patient in a high Fowler's position and start oxygen c. Call 911 and report that the patient has probable status asthmaticus d. Establish IV access to give emergency medications
b. Place the patient in a high Fowler's position and start oxygen
The patient is currently receiving 40% oxygen via a nasal cannula. The patient's 02 saturation is 87%. What action should the nurse plan to do first? a. Place the patient on a aerosol mask at 5L/min b. Place the patient on a simple facemask at 8L/min c. Place the patient on a Venturi mask at 6L/min d. Reposition the patient from Semi-Fowler's to High-Fowler's position
b. Place the patient on a simple facemask at 8L/min
Correct A patient who has had a thoracentesis is now experiencing the following clinical manifestations: rapid shallow respirations, rapid heart rate, decreased oxygen saturations, and severely diminished breath sounds on the left side. What complication does the nurse suspect this patient has developed? a. Subcutaneous emphysema b. Pneumothorax c. Hemoptysis d. Allergic reaction
b. Pneumothorax
A patient returns from the operating room after having a tracheostomy. While assessing the patient which observations made by the nurse warrant immediate notifications of the provider? a. Patient is alert but unable to speak and has difficulty communicating his needs b. Skin is puffy at the neck area with a crackling sensation c. Respirations are audible with an increased respiratory rate d. Small amount of bleeding present at the incision
b. Skin is puffy at the neck area with a crackling sensation
The patient with sleep apnea is fitted with a continuous positive airway pressure (CPAP) mask, which: a. delivers negative pressure to stimulate respiration b. delivers steady air pressure to keep airways from collapsing c. delivers different pressure during inspiration and expiration d. delivers oxygen only when patient becomes apneic.
b. delivers steady air pressure to keep airways from collapsing Response Feedback: The CPAP mask delivers a constant positive pressure to keep the airway open. CPAP does not require intubation
A patient, age 69, has emphysema. On assessing him, the nurse notes the presence of a "barrel chest." This pathology results from a(n) a. decrease in anteroposterior diameter caused by chronic dilation of the bronchi. b. increased anteroposterior diameter caused by chronic hyperinflation of the alveoli. c. increase in the anteroposterior diameter from hypertrophy of mucous glands in the bronchi. d. widening of the sternocostal area secondary to chronic constriction of smooth muscles in the airways leading to bronchospasms.
b. increased anteroposterior diameter caused by chronic hyperinflation of the alveoli. Response Feedback: The patient will eventually appear barrel chested (an increased anteroposterior diameter caused by overinflation).
The school nurse is caring for a 10-year-old girl who is having an asthma attack on the school ground at recess. What is the preferred treatment to alleviate this client's airflow obstruction? a. salmeterol (Serevent) b. levalbuterol (Xopenex) c. prednisone d. tiotropium (Spiriva)
b. levalbuterol (Xopenex) Response Feedback: Asthma exacerbations are best managed by early treatment and education of the patient. Quick-acting beta-adrenergic medications are the first used for prompt relief of airflow obstruction. Systemic corticosteroids may be necessary to decrease airway inflammation in patients who fail to respond to inhaled beta-adrenergic medication.
Which statement made by the student nurse indicates a further need for understanding concerning pulmonary function tests (PFTs)? a. "Pulmonary function tests will help your doctor distinguish between airway disease and restrictive lung disease." b. "I should instruct my patient not to smoke at least six hours prior to the test." c. "I should give my patient a bronchodilator medication before the test." d. "Pulmonary function tests will measure a patient's inhaled lung volumes and residuals after exhale."
c. "I should give my patient a bronchodilator medication before the test."
After teaching a client who is prescribed salmeterol (Serevent), a nurse assesses the client's understanding. Which statement indicates the client comprehends the teaching? a. "I will carry this medication with me at all times in case I need it." b. "I will be weaned off this medication when I no longer need it." c. "I will take this medication every morning to help prevent an acute attack." d. "I will take this medication when I start to experience an asthma attack."
c. "I will take this medication every morning to help prevent an acute attack." Response Feedback: Long-acting beta2 agonist medications will help prevent an acute asthma attack because they are long acting. The client will take this medication every day for best effect. The client does not have to always keep this medication with him or her because it is not used as a rescue medication. This is not the medication the client will use during an acute asthma attack because it does not have an immediate onset of action. The client will not be weaned off this medication because this is likely to be one of his or her daily medications.
The nurse is giving discharge instructions to a patient diagnosed with viral pharyngitis. Which statement by the patient indicates a need for further teaching? a. "I should try to rest, increase my fluid intake, and get a humidifier for the house." b. "I should gargle several times a day with warm salt water and use throat lozenges." c. "I will wait for my test results then I can get a prescription for antibiotics." d. "Over-the-counter analgesics, like Tylenol or ibuprofen, can be used for pain"
c. "I will wait for my test results then I can get a prescription for antibiotics."
The nurse is teaching a patient how to interpret peak expiratory flow readings and to use this information to manage drug therapy at home. Which of the following statements made by the patient indicates a need for further teaching? a. "If the reading is in the yellow zone, I should use my rescue inhaler, wait several minutes, and use the peak flow meter again." b. "If the reading is in the red zone, I should use my rescue inhaler and seek medical attention immediately." c. "If the reading is in the yellow zone, I should use my rescue inhaler and seek emergency help immediately." d. "If the reading is in the green zone, I simply continue my preventive drug regimen."
c. "If the reading is in the yellow zone, I should use my rescue inhaler and seek emergency help immediately."
A nurse cares for a client who had a partial laryngectomy 10 days ago. What should the nurse instruct the patient to do while eating? a. "You should always eat your meals while in bed so that you may rest while eating." b. "You should continue to eat as you always have." c. "Make sure you are sitting as upright as possible and that the liquids you are consuming are thickened." d. "You should see a speech therapist to learn different swallowing techniques."
c. "Make sure you are sitting as upright as possible and that the liquids you are consuming are thickened."
An active 45-year-old schoolteacher with chronic obstructive pulmonary disease (COPD) taking prednisone asks if it is necessary to get the flu shot. What is the best response by the nurse? a. "Yes, it will help minimize the risk of triggering an exacerbation of COPD." b. "No, patients who are active, not living in a nursing home, and not health care providers do not need the flu shot." c. "Yes, the flu shots are highly recommended for patient with chronic illness and/or patients who are receiving medications that decrease their immune responses." d. "No, the flu shots are only recommended for patients 50 years old and older."
c. "Yes, the flu shots are highly recommended for patient with chronic illness and/or patients who are receiving medications that decrease their immune responses."
A patient with COPD had meal-related dyspnea. To address this issue, which drug does the nurse offer the patient 30 minutes before the meal? a. Fluticasone (Flovent) b. Pantoprazole sodium (Protonix) c. Albuterol (Ventolin) d. Guaifenesin (Mucinex)
c. Albuterol (Ventolin)
A client has been brought to the emergency department with a life-threatening chest injury. What action by the nurse takes priority? a. Apply 100% oxygen b. Apply an oxygen saturation monitor. c. Assess airway d. Start two large-bore IV lines
c. Assess airway Response Feedback: The priority for any chest trauma client is airway, breathing, circulation. The nurse first ensures the client has a patent airway. Assessing respiratory rate and applying oxygen are next, followed by inserting IVs.
The nurse is performing trach suctioning. Which nursing intervention does the nurse use to prevent hypoxia for this patient? a. Allow the patient to breathe room air prior to suctioning b. Suction frequently when the patient is coughing c. Avoid suctioning for more than 10-15 seconds. d. Use the largest available catheter
c. Avoid suctioning for more than 10-15 seconds.
Which of the following is used to measure carbon dioxide levels in exhaled air? a. Plethysmography b. Electrocardiograms c. Capnography d. Arterial carbon dioxide
c. Capnography
Which client is a priority for the nurse on the medical unit to assess? a. Client with pneumonia who has a temperature of 100.4 b. Client with allergic rhinitis complaining of a headache c. Client with a pleural effusion who has absent lung sounds on the left side d. Client with emphysema who is complaining of dyspnea
c. Client with a pleural effusion who has absent lung sounds on the left side
A patient sustained laryngeal trauma and is being treated in the emergency department with humidified oxygen and is being monitored every 15 to 30 minutes for respiratory distress. Which assessment finding indicates the urgent need for further intervention? a. Pulse oximetry 96%, anxious, fatigued, blood in sputum, abdominal breathing b. Anxious, respiratory rate 30, talking rapidly about the accident, warm touch c. Confused and disoriented, difficulty producing sounds, pulse oximetry 80% d. Respiratory rate of 24, pulse oximetry 99%, no difficulty with communication
c. Confused and disoriented, difficulty producing sounds, pulse oximetry 80%
A patient is admitted to the hospital for treatment of pneumonia. Which nursing assessment finding best indicates that the patient is responding to antibiotics? a. Temperature of 99 degrees, Lung sounds clear, pulse oximetry at 98%, cough with yellow sputum b. Wheezing, oxygen at 2L/min, respiratory rate of 26, no shortness of breath or chills c. Cough, clear sputum, temperature 99 degrees, pulse oximetry at 96% on room air d. Feeling tired, respiratory rate of 28 on 2L/min of oxygen, audible breath sounds
c. Cough, clear sputum, temperature 99 degrees, pulse oximetry at 96% on room air
Which side effects would a patient report with obstructive sleep apnea? a. Excessive production of sputum and irritability b. Daytime hyperactivity and irritability c. Daytime sleepiness, inability to concentrate, irritability d. Facial swelling, hypertension, and heart failure
c. Daytime sleepiness, inability to concentrate, irritability
The nurse is caring for a patient admitted with a COPD exacerbation. Upon her assessment, she notes that the patient is on 4L/min of oxygen via nasal cannula with an 02 saturation of 88%. What is the best course of action for the nurse? a. Reposition the patient and ask them to cough b. Increase the oxygen to 6L/min c. Document the findings d. Notify the physician
c. Document the findings
The nurse is placing a nonrebreather mask on her patient experiencing respiratory distress. Which of the following should be the priority for the nurse? a. Turning the humidifier is turned on. b. Ensuring the oxygen regulator is set to deliver 4L/min c. Ensuring the reservoir bag on the mask is fully inflated. d. Ensuring there is adequate space between the mask and the patient's face
c. Ensuring the reservoir bag on the mask is fully inflated.
On a postoperative assessment, the nurse notes that the patient with a rhinoplasty repeatedly swallows. What is the nurse's best first action? a. Provide ice chips to ease swallowing b. Notify the healthcare provider c. Examine the throat for bleeding d. Ask if the patient is hungry
c. Examine the throat for bleeding
The nurse is assessing her patient who is experiencing an asthma exacerbation. What finding is expected? a. Bradypnea b. Oxygen toxicity c. Expiratory wheezes d. Crackles and rhonchi
c. Expiratory wheezes
Which of the following techniques properly describes pursed-lip breathing? a. Inhale slowly through the mouth, then exhale quickly through pursed lips. b. Inhale through the nose, making his inhalation last three times as long as his exhalation. c. Inhale slowly through the nose, then exhale more slowly through pursed lips. d. Inhale through the mouth, then make his exhalation last three times as long as his inhalation.
c. Inhale slowly through the nose, then exhale more slowly through pursed lips Response Feedback: The nurse should instruct the patient and family on effective breathing techniques (such as pursed-lip breathing) and relaxation exercises for anxiety control.
Drugs for the treatment of chronic obstructive pulmonary disease (COPD) are the same as those used for management of asthma. Which additional class of medications would the nurse expect to administer for a patient with COPD? a. Beta-blockers b. Xanthines c. Mucolytics d. Corticosteroids
c. Mucolytics
A patient is being treated with heparin therapy for a pulmonary embolism. The patient has the potential for bleeding with the administration of heparin. What laboratory assessment should the nurse monitor? a. PT values b. Hematocrit values c. PTT values d. Platelet values
c. PTT values
The nursing student is assisting in the care of a patient on a mechanical ventilator. Which action by the student contributes to the prevention of ventilator acquired pneumonia (VAP)? a. Suctions the patient frequently b. Encourages visitors to wear masks c. Performs oral care every 2 hours d. Obtains a sputum specimen for culture
c. Performs oral care every 2 hours
A patient reports throat soreness and dryness, throat pain, pain on swallowing, and difficulty swallowing. Which disorder does the nurse suspect? a. Rhinosinusitis b. Tonsillitis c. Pharyngitis d. Pneumonia
c. Pharyngitis
The nurse is caring for a patient on a partial nonrebreather mask receiving 75% oxygen and whose O2 saturation is 89%. What is the nurse's first action? a. Turn and reposition the patient b. Notify the respiratory therapist c. Place the patient on a nonrebreather mask d. Place the patient on a simply facemask
c. Place the patient on a nonrebreather mask
The student nurse is developing a teaching plan for a patient with bacterial pharyngitis. Which teaching point has the highest priority and should be included in the plan of care the student is developing? a. Avoid contact with irritants b. Change filters on heating and air conditioning units frequently c. Take prescribed medications as scheduled regardless of symptoms d. Avoid goose-down pillows
c. Take prescribed medications as scheduled regardless of symptoms Response Feedback: Although all of the measures are appropriate for a client with asthma, taking prescribed medications on time is the most important measure in preventing asthma attacks.
The nurse is caring for a patient receiving anticoagulant therapy, Warfarin (Coumadin), to prevent a pulmonary embolism (PE) following a surgical procedure. What is the nursing responsibility related to Warfarin? a. Have protamine sulfate available as an antidote. b. Monitor the patient's platelet count. c. Teach the patient about foods high in Vitamin K. d. Administer NSAIDs and Aspirin for postoperative pain.
c. Teach the patient about foods high in Vitamin K.
A patient with a chronic cough with blood-tinged sputum undergoes a bronchoscopy. Following the bronchoscopy, the nurse should a. check vital signs every 15 minutes for 4 hours. b. elevate the head of the bed to 80 to 90 degrees. c. keep the patient NPO until the gag reflex returns. d. place the patient on bed rest for at least 4 hours.
c. keep the patient NPO until the gag reflex returns Response Feedback: Because a local anesthetic is used to suppress the gag/cough reflexes during bronchoscopy, the nurse should monitor for the return of these reflexes before allowing the patient to take oral fluids or food. Vital signs are monitored immediately after the procedure but should not need to be obtained every 15 minutes for 2 hours. The patient does not need to be on bed rest, and the head of the bed does not need to be in the high-Fowler's position.
Which of the following medications would be given to a patient being seen in emergency room suffering from status asthmaticus. The patient has been given an albuterol (Proventil) nebulizer with no change in their respiratory status. What is the next course of action the nurse would expect? a. aminophylline (Truphylline) b. formoterol (Foradil) c. methylprednisone (Solu-Medrol) d. ipratropium (Atrovent)
c. methylprednisone (Solu-Medrol)
A family member of a patient with COPD questions why the patient should be coughing on a routine basis. What is the nurse's best response? a. "If he cannot cough, the provider may elect to do a tracheostomy." b. "We don't want him to feel embarrassed when coughing in public, so we actively encourage it." c. "We have to check the color and consistency of his sputum." d. "It improves air exchange by increasing airflow in the larger airways."
d. "It improves air exchange by increasing airflow in the larger airways."
A nurse in a family practice clinic is preparing discharge instructions for a client reporting facial pain that is worse when bending over, tenderness across the cheeks, and postnasal discharge. What instruction will be most helpful? a. "Limit fluids to dry out your sinuses." b. "We will schedule you for a computed tomography scan this week." c. "Ice packs may help with the facial pain." d. "Try warm, moist heat packs on your face."
d. "Try warm, moist heat packs on your face." Response Feedback: This client has rhinosinusitis. Comfort measures for this condition include breathing in warm steam, hot packs, nasal saline irrigations, sleeping with the head elevated, increased fluids, and avoiding cigarette smoke. The client does not need a CT scan.
A nursing student caring for a client removes the client's oxygen as prescribed. The client is now breathing what percentage of oxygen? a. 14% b. 28% c. 31% d. 21%
d. 21% Response Feedback: Room air is 21% oxygen.
After a bronchoscopy procedure, the patient coughs up sputum which contains a scant amount of blood. What is the best nursing action at this time? a. Continue to monitor the patient for 24 hours b. Send the sputum to the lab for a cytology report c. Assess vital signs, respiratory status, and notify the provider d. Document the findings
d. Document the findings
In patient taking heparin, what should be one of the nurse's primary safety concerns? a. Nutrition b. Infection c. Knowledge deficit d. Falls
d. Falls
A patient with an active anterior nosebleed is admitted to the emergency department. Which intervention does the nurse use first to attempt to stop the bleeding? a. Apply direct unilateral pressure to the nose b. Insert nasal packing c. Position the patient in High Fowlers position with their head flexed backwards. d. Have the patient sit upright with the head flexed forward
d. Have the patient sit upright with the head flexed forward
A nurse cares for a client who has packing inserted for posterior nasal bleeding. Which action should the nurse take first? a. Teach the client about the causes of nasal bleeding. b. Assess the client's pain level. c. Keep the client's head elevated. d. Make sure the string is taped to the client's cheek.
d. Make sure the string is taped to the client's cheek. Response Feedback: The string should be attached to the client's cheek to hold the packing in place. The nurse needs to make sure that this does not move because it can occlude the client's airway. The other options are good interventions, but ensuring that the airway is patent is the priority objective.
The nurse is caring for a patient who had reconstructive neck surgery and observes bright red blood oozing from the carotid artery. Which action must the nurse take first? a. Apply immediate, direct pressure b. Secure the airway c. Reassess in 15 minutes d. Notify the physician
d. Notify the physician
A patient requiring home oxygen therapy is discharged home. Which of the following would be considered a potential hazard? a. Computer with a three prong plug b. Electrical outlet with safety covers c. Bottle of wine in the kitchen area d. Package of cigarettes on coffee table
d. Package of cigarettes on coffee table
A patient returns from surgery following a rhinoplasty. Which action should the nurse first take? a. Provide the patient with discharge information concerning positioning b. Post a notice at the head of the bed to remind personnel of positioning c. Explain the purpose of the semi-Fowler's position to the patient d. Place the patient in the semi-Fowler's position
d. Place the patient in the semi-Fowler's position
The nurse is assessing a patient's skin at the site of radiation therapy to the neck. Which skin condition is expected in relation to the radiation treatments? a. Pale, dry, and cool b. Puffy and edematous c. Shiny, pale, and tight d. Red, tender, and peeling
d. Red, tender, and peeling
The nurse is assessing a patient with significant and obvious facial trauma. Which finding is the priority and requires immediate intervention? a. Asymmetry of the mandible b. Nonparallel extraocular movements c. Pain upon palpation over the nasal bridge d. Restlessness with high pitched respirations
d. Restlessness with high pitched respirations
A patient demonstrates labored, shallow respirations and a respiratory rate of 32/min with a pulse oximetry reading of 85%. What is the priority nursing intervention? a. Provide the patient with a breathing treatment b. Obtain an order for a stat arterial blood gases (ABG) c. Encourage coughing and deep breathing exercises. d. Start oxygen via nasal cannula at 2L/min
d. Start oxygen via nasal cannula at 2L/min
Which complication listed should the nurse monitor her patient for if a cuffed tracheostomy is present? a. Airway obstruction b. Increased gas exchange c. Infection d. Tracheomalsia
d. Tracheomalsia
While caring for a patient with respiratory disease, the nurse observes that the patient's oxygen saturation drops from 94% to 85% when the patient ambulates in the hall. The nurse determines that a. arterial blood gas analysis should be done to verify the patient's SpO2. b. the response is normal and the patient should continue at this activity level. c. the patient activity should be limited until the disease process is resolved. d. supplemental oxygen should be used whenever the patient exercises.
d. supplemental oxygen should be used whenever the patient exercises. Response Feedback: The drop in SpO2 to 85% indicates that the patient is hypoxemic and needs supplemental oxygen when exercising. ABG measurements are unnecessary and would increase patient discomfort and expense. The patient will need to continue to ambulate to avoid the many complications of immobility.
The 30-year-old American Indian female who is taking rifampin, isoniazid, and pyrazinamide complains that she is tired of taking medicine. She asks, "When can I stop all this and get on with my life?" The nurse's best response is that she will no longer be considered contagious when: a. the sputum culture comes back negative. b. the tuberculin skin test (TST) is no longer positive. c. the medication has been taken for 9 months. d. three consecutive sputum cultured are negative.
d. three consecutive sputum cultured are negative. Response Feedback: The active tuberculosis patient is considered noncontagious when three consecutive sputum cultures are negative. Taking the medication for a given period of time does not make the patient noncontagious. The TST will always be positive.
The appropriate nursing intervention for a patient, age 40, who is diagnosed with active tuberculosis would be a. it is inappropriate to place this patient in any isolation precautions. b. maintain the patient in enteric isolation. c. to place the patient on contact precautions with no visitors d. to place the patient on airborne precautions and in a negative pressure room.
d. to place the patient on airborne precautions and in a negative pressure room.
