Q/A Respiratory chapter 30 and 31

All of these clients are being cared for on the intensive care step down unit. Which client should the charge nurse assign to an RN who has floated from the pediatric unit? A. Client with acute asthma episode who is receiving oxygen at FiO2 of 60% by non-rebreather mask. B. Client with chronic pleural effusions who is scheduled for a paracentesis in the next hour. C. Client with emphysema who requires instruction about correct use of oxygen at home. D. Client with lung cancer who has just been transferred from the intensive care unit after having a left lower lobectomy the previous day.

Answer: A Rational: Because asthma is a common pediatric diagnosis, the pediatric nurse would be familiar with the assessment and care needed for a client with this diagnosis. Although chronic pleural effusions can occur in the pediatric population, this diagnosis is more common in the adult population. If this client has not already received teaching for this procedure, he or she may have questions that the pediatric nurse would not be as comfortable answering as a nurse who is regularly assigned to the stepdown unit. Emphysema is a diagnosis associated with an adult population; although an RN could instruct a client about home oxygen therapy, this client might have questions that would be better answered by an RN with adult experience. The adult client who has just had a lobectomy needs careful assessment from an RN with adult stepdown unit experience.

A nurse is caring for an 89-year-old client admitted with pneumonia. He has an IV of normal saline running at 100 mL/hr and antibiotics that were initiated in the emergency department 3 hours ago. He has oxygen at 2 liters/nasal cannula. What assessment finding by the nurse indicates that goals for a priority diagnosis have been met for this client? A. The client is alert and oriented to person, place, and time. B. Blood pressure is within normal limits and client's baseline. C. Skin behind the ears demonstrates no redness or irritation. D. Urine output has been >30 mL/hr per Foley catheter.

Answer: A Rationale: One of the first manifestations of pneumonia in an older adult is acute confusion as a result of impaired gas exchange. A client with pneumonia who is alert and oriented to person, place, and time is responding well to appropriate therapy for the disorder. The blood pressure is not an indicator of effective management of pneumonia, and neither is urine output. The skin behind his ears being intact is important and desirable but is not an outcome indicator for pneumonia management.

A client with asthma has pneumonia, is reporting increased shortness of breath, and has inspiratory and expiratory wheezes. All of these medications are prescribed. Which medication should the nurse administer first? A. Albuterol (Proventil) 2 inhalations B. Fluticasone (Flovent) 2 inhalations C. Ipratropium (Atrovent) 2 inhalations D. Salmeterol (Serevent) 2 inhalations

Answer: A Rational: Albuterol is a beta2 agonist that acts rapidly as a bronchodilator. Fluticasone is a corticosteroid; it is used to prevent asthma attacks and is not used as a rescue medication. Ipratropium is an anticholinergic drug that allows the sympathetic system to dominate and cause bronchodilation; it is not as effective as a beta2 agonist, so it is not a first-line drug. Salmeterol is a long-acting beta2 agonist that must be used regularly over time; this client needs a rescue medication

Which assessment finding is associated with obstructive lung disease and not with interstitial lung disease? A. Barrel chest B. Cough C. Dyspnea D. Reduced gas exchange

Answer: A Rational: Interstitial lung diseases are restrictive, not obstructive, so they do not cause barrel chest, which is the result of air trapping. Both types of pulmonary disease cause cough, dyspnea, and reduced gas exchange

A client has been admitted to the hospital with suspected TB. What drugs should the nurse plan to teach the client about before discharge? Select all that apply. A. Rifampin (Rifadin); contact lenses can become stained orange B. Isoniazid (INH); report yellowing of the skin or darkened urine C. Pyrazinamide (PZA); maintain a fluid restriction of 1200 mL/day D. Ethambutol (Myambutol); report any changes in vision E. Amoxicillin (Amoxil); take this drug with food or milk

Answer: A, B, D Rationale: Amoxicillin is not prescribed for TB. Pyrazinamide, although prescribed for TB, calls for an increase in fluids, not fluid restriction. Rifampin, isoniazid, and ethambutol are first-line drugs for TB therapy and have side effects. The side effects listed with these drugs are appropriate to teach the client.

What does the nurse do first when setting up a safe environment for the new client on oxygen? A. Ensures that staff members wear protective clothing B. Ensures that no combustion hazards are present in the room C. Sets the oxygen delivery to maintain no fewer than 16 breaths/min D. Uses a pulse oximetry unit .

Answer: B Rational:Oxygen is highly flammable. The nurse must ensure that no open flames or combustion hazards are present in a room where oxygen is in use. Protective clothing is not necessary for a client who requires oxygen therapy other than the use of Standard Precautions. The oxygen delivery setting is usually determined in conjunction with the respiratory therapy care partner. Although the setting is important for safe administration, it is not necessary for a safe environment. Pulse oximetry would be useful for monitoring the client's oxygenation status, but is not necessary for a safe environment

Which parameter indicates to the nurse that the short-acting beta-adrenergic agonist the client used 5 minutes ago for an acute asthma attack is effective? A. SpO2 decreased from 85% to 78% B. Peak expiratory flow increase from 50% to 70% C. The obvious use of accessory muscles during inhalation D. Active bubbling in the humidifier chamber of the oxygen delivery system

Answer: B Rationale: Peak flow measures the effectiveness of expiratory efforts. An increased peak flow rate indicates less obstruction and greater movement of air with expiratory effort. Decreased SpO2 would indicate a worsening of the condition, not effectiveness of the therapy. The use of accessory muscles indicates that the work of breathing has increased. The active bubbling in the humidification chamber is not related to the client's respiratory effort or the drug therapy's effectiveness.

The charge nurse at an assisted living facility receives report from an emergency department (ED) nurse about one of the resident clients. The client was sent to the ED with a fever, chills, muscle aches, and headache. The ED nurse reports the client's rapid influenza report came back from the laboratory positive for influenza A. What action by the nurse at the assisted living facility is most appropriate? A. Prepare to administer antibiotics. B. Have the resident eat meals in his room. C. Provide oseltamivir (Tamiflu) to the staff. D. Arrange a follow up chest x-ray in 2 weeks.

Answer: B Rationale: This client is most likely going to be managed at the assisted living facility. Influenza is highly contagious. Keeping the client in his room rather than having him go to the dining room and eat with other residents helps prevent infection spread. Antibiotics are not used for influenza. The staff should not, at this time, require oseltamivir unless they have manifestations of influenza. This is not a pandemic influenza, and oseltamivir is not used for prophylaxis in this situation. Unless the client develops manifestations of pneumonia, radiography is not indicated.

A client has been diagnosed with asthma. Which statement below indicates that the client correctly understands how to use an inhaler with a spacer? A. "I don't have to wait between the two puffs if I use a spacer." B. "If the spacer makes a whistling sound, I am breathing in too rapidly." C. "I should rinse my mouth and then swallow the water to get all of the medicine." D. "I should shake the inhaler only if I want to see whether it is empty."

Answer: B Rational:Slow and deep breaths ensure that the medication is reaching deeply into the lungs. The whistling noise serves as a reminder to the client of which technique needs to be used. The client must wait 1 minute between puffs. The client should rinse the mouth but not swallow the water. The mouth needs to be rinsed after using an inhaler with or without a spacer. This is especially important if the inhaled medication is a corticosteroid, to prevent the development of an oral fungal infection. An empty inhaler will float on its side in water; a full inhaler will sink. Shaking an inhaler helps ensure that the same dose is delivered in each puff.

The chest tube of a client 16 hours postoperative from a lobectomy is accidentally pulled out by a portable x-ray machine. What is the nurse's best first action? A. Clamp the tubing with padded clamps as close as possible to the insertion site. B. Reposition the client on the nonoperative side and support the tube(s) with pillows. C. Cover the insertion site with a sterile occlusive dressing and tape down on three sides. D. Don sterile gloves and attempt to reinsert the chest tube at the original insertion site.

Answer: C Rationale: Although the client had a pneumonectomy and sometimes chest tubes are not even used, the insertion site should be covered immediately to prevent infection. If this were a chest tube placed for any other reason, the action of covering the insertion site is still the best first action to prevent air from being sucked into the chest cavity. Clamping the tubing that has already fallen out of the chest does nothing to help the client or prevent a problem. Repositioning the client would cause neither harm nor benefit. Reinserting a contaminated chest tube is wrong and beyond the scope of nursing practice.

A client has asthma that gets worse during the summer. She tells the nurse that she takes a medication every day so she does not get short of breath when she walks to work. About which medicine does the nurse need to educate the client? A. Albuterol (Proventil) inhaler B. Guaifenesin (Organidin) C.Montelukast (Singulair) D. Omalizumab (Xolair)

Answer: C Rational: Montelukast is a leukotriene antagonist that works well for asthma that occurs during certain seasons. It is taken on a daily basis as a preventive medication. Albuterol inhalers are beta2 agonists that are rescue medications used on an as-needed basis only. Guaifenesin is a mucolytic that does not provide any bronchodilation; it may or may not be taken daily. Omalizumab is an immunomodulator that is injected subcutaneously every 2 to 3 weeks; it is not commonly used because a high rate of anaphylaxis is associated with it.

The client is a marathon runner who has asthma. Which category of medication is used as a rescue inhaler? A. Corticosteroids B. Long-acting beta agonists C. Nonsteroidal anti-inflammatory drugs (NSAIDs) D. Short-acting beta agonists

Answer: D Rational: Short-acting beta agonist medications have a rapid onset and cause bronchodilation; they would be excellent for marathon running because some types of asthma may be exercise-induced. Corticosteroids disrupt production pathways of inflammatory mediators. Maximum effectiveness requires 48 to 72 hours of continued use; therefore, they are not appropriate as a rescue medication. Long-acting beta agonists do cause bronchodilation, but have a slow onset; they are not used as rescue inhalers. NSAIDs stabilize the membranes of mast cells and prevent release of inflammatory mediators. They have a slow onset of action and are used for prevention of symptoms, not as rescue medication.

The nurse is preparing to administer oxygen to a client with chronic obstructive pulmonary disease (COPD) who is hypoxemic and hypercarbic. How will the nurse administer the oxygen for this client? A. By nasal cannula at a rate of no more than 1 to 3 L/min B. By nasal cannula at a rate of no more than 2 to 4 L/min C. By Venturi mask at a rate of at least 60% D. By maintaining oxygen saturations greater than 88%

Answer: D Rational:In the past, a client with COPD was thought to be at risk for extreme hypoventilation with oxygen therapy because of a decreased drive to breathe as blood oxygen levels increased. However, recent evidence does not support this; this idea has been responsible for ineffective management of hypoxia in clients with COPD. All hypoxic clients, even those with COPD and hypercarbia, should receive oxygen therapy at rates appropriate to reduce hypoxia and bring SpO2 levels up between 88% and 92%

Which precaution is most important for the nurse to teach a client who has cystic fibrosis? A. Report a weight change of 2 pounds to your health care provider immediately. B. Use supplemental oxygen whenever your oxygen saturation is less than 95%. C. Eat six small meals each day instead of only three larger ones. D. Avoid crowds and people who are ill.

Answer: D Rationale: The most common cause of death for a client with CF is respiratory failure from a respiratory infection. Avoiding infection in this population is critical for survival. Although many clients who have CF are underweight and need to maintain good nutrition, changes in weight and food intake patterns are not as critical as avoiding infection. Supplemental oxygen use is based on client manifestations. Its use is not as critical as avoiding infection.

A client with chronic obstructive pulmonary disease (COPD) prescribed a long-acting inhaled beta2 agonist reports hating the inhaler and asks why the drug can't be taken as a pill. What is the nurse's best response? A. "Drugs taken by inhaler work more slowly and remain in the system longer." B. "Drugs taken by inhaler have no side effects and are less expensive." C. "Drugs taken by mouth are more expensive because they must be sterile." D. "Drugs taken by mouth have systemic side effects and are harder to control."

Answer: D Rationale: When used as prescribed, inhaler drugs go more to the site where the intended responses are needed (the airways), and less drug is absorbed systemically. Thus, inhaled drugs have fewer side effects (but still have side effects). Oral drugs always have systemic side effects.

An environmental assessment of a factory finds inhalation exposure with a high level of particulate matter. What does the factory nurse do to generate the quickest compliance? A. Encourages proper building ventilation B. Refers workers to a tobacco cessation program C. Suggests that workers find another job D. Teaches workers how to use a mask

Answer: D Rational:Teaching everyone to use a mask when working in areas with high levels of particulate matter can reduce individual exposure. Proper building ventilation often requires work orders, reconstruction, time, and money; this will need to be implemented, but it will not occur quickly. Particulate matter can be emitted from a variety of sources; smoking may be unrelated to the question. Suggesting that workers find another job does not solve the problem of particulate matter in a rapid or safe manner.

A client is being admitted for pneumonia. The sputum culture is positive for streptococcus, and the client asks about the length of the treatment. On what does the nurse base the answer? 1. The client will be treated for 5 to 7 days. 2. The client will require IV antibiotics for 7 to 10 days. 3. The client will complete 6 days of therapy. 4. The client must be afebrile for 24 hours.

Answer:1 Rational: Anti-infectives usually are used for 5 to 7 days in uncomplicated community-acquired pneumonia, and for up to 21 days in an immunocompromised client or one with hospital-acquired pneumonia. A client may become afebrile early in the course of treatment with anti-infective medications; this may cause many clients to fail to complete their course of treatment.

A 70-year-old client has a complicated medical history, including chronic obstructive pulmonary disease. Which client statement indicates the need for further teaching about the disease? 1. "I am here to receive the yearly pneumonia shot again." 2. "I am here to get my yearly flu shot again." 3. "I should avoid large gatherings during cold and flu season." 4. "I should cough into my upper sleeve instead of my hand."

Answer:1 Rational: Clients 65 years and older, as well as those who have chronic health problems, should be encouraged to receive the pneumonia vaccine, which is not given annually but only once. Older clients are encouraged to receive a flu shot annually because the vaccine changes, depending on anticipated strains for the upcoming year. It is a good idea to avoid large gatherings during cold and flu season. New recommendations from the Centers for Disease Control and Prevention for controlling the spread of flu include coughing or sneezing into the upper sleeve rather than into the hand.

A client is taking isoniazid, rifampin, pyrazinamide, and ethambutol for tuberculosis. The client calls to report visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes? 1. Ethambutol 2. Isoniazid 3. Pyrazinamide 4. Rifampin

Answer:1 Rational: Ethambutol can cause optic neuritis, leading to blindness at high doses. When discovered early and the drug is stopped, problems can usually be reversed. Both isoniazid and pyrazinamide may cause liver failure; side effects of major concern include jaundice, bleeding, and abdominal pain. Rifampin will cause the urine and all other secretions to have a yellowish-orange color; this is harmless. Contact lenses will also be stained and oral contraceptives will be less effective.

A client who has been homeless and has spent the past 6 months living in shelters has been diagnosed with confirmed tuberculosis (TB). Which medications does the nurse expect to be ordered for the client? 1. Isoniazid (INH), rifampin (Rifadin), pyrazinamide (Zinamide), ethambutol (Myambutol) 2. Metronidazole (Flagyl), acyclovir (Zovirax), flunisolide (AeroBid), rifampin (Rifadin) 3. Prednisone (Prednisone), guaifenesin (Organidin), ketorolac (Toradol), pyrazinamide (Zinamide) 4. Salmeterol (Serevent), cromolyn sodium (Intal), dexamethasone (Decadron), isoniazid (INH)

Answer:1 Rational: The combination of isoniazid, rifampin, pyrazinamide, and ethambutol is used to treat TB. Metronidazole is used to treat anaerobic bacteria and some parasites, but is not effective against TB. Acyclovir is used to treat viral infection. Flunisolide is a corticosteroid that is useful in asthma or other airway disease to prevent wheezing. Prednisone is a steroid. Guaifenesin is a mucolytic. Ketorolac is a nonsteroidal anti-inflammatory drug that is used for short-term pain relief. Salmeterol and cromolyn sodium would most likely be given to clients with respiratory difficulties such as poorly controlled asthma from allergic sources. Dexamethasone is a steroid.

An older adult resident in a long-term-care facility becomes confused and agitated, telling the nurse, "Get out of here! You're going to kill me!" Which action will the nurse take first? 1. Check the resident's oxygen saturation. 2. Do a complete neurologic assessment. 3. Give the prescribed PRN lorazepam (Ativan). 4. Notify the resident's primary care provider.

Answer:1 Rational:A common reason for sudden confusion in older clients is hypoxemia caused by undiagnosed pneumonia. The nurse's first action should be to assess oxygenation by checking the pulse oximetry. Determining the cause of the confusion is the primary goal of the RN. A complete neurologic examination may give the RN other indicators of the cause for the client's confusion and agitation; this will take several minutes to complete. Administering lorazepam may make the client more confused and agitated because antianxiety drugs may cause a paradoxical reaction, or opposite effect, in some older clients. Depending on the results of the client's pulse oximetry and neurologic examination, notifying the primary care provider may be an appropriate next step.

The community health nurse is planning tuberculosis treatment for a client who is homeless and heroin-addicted. Which action will be most effective in ensuring that the client completes treatment? 1. Arrange for a health care worker to watch the client take the medication. 2. Give the client written instructions about how to take prescribed medications. 3. Have the client repeat medication names and side effects. 4. Instruct the client about the possible consequences of nonadherence.

Answer:1 Rational:Because this client is unlikely to adhere to long-term treatment unless directly supervised while taking medications, the best option is to arrange for directly observed therapy. Giving a client who is homeless and addicted to heroin written instructions on how to take prescribed medications is placing too much responsibility on the client to follow through. Also, the question does not indicate whether the client can read. The fact that the client can state the names and side effects of medications does not mean that the client understands what the medications are and why he or she needs to take them. A client who is homeless may be more concerned with obtaining shelter and food than with properly taking his or her medication.

A client with tuberculosis (TB) who is homeless and has been living in shelters for the past 6 months asks the nurse why he must take so many medications. What information will the nurse provide in answering this question? (Select all that apply.) 1. Combination drug therapy is effective in preventing transmission. 2. Combination drug therapy is the most effective method of treating TB. 3. Combination drug therapy will decrease the length of required treatment to 2 months. 4. Multiple drug regimens destroy organisms as quickly as possible. 5. The use of multiple drugs reduces the emergence of drug-resistant organisms.

Answer:1,2,4,5 Rational: Combination drug therapy is the most effective method for treating TB and preventing transmission. Multiple drug regimens are able to destroy organisms as quickly as possible and reduce the emergence of drug-resistant organisms. Although combination drug therapy will decrease the required length of time for treatment, the length of treatment is decreased to 6 months from 6 to 12 months.

A client with pneumonia caused by aspiration after alcohol intoxication has just been admitted. The client is febrile and agitated. Which health care provider order should the nurse implement first? 1. Administer levofloxacin (Levaquin) 500 mg IV. 2. Draw aerobic and anaerobic blood cultures. 3. Give lorazepam (Ativan) as needed for agitation. 4. Refer to social worker for alcohol counseling.

Answer:2 Rational:Obtaining aerobic and anaerobic cultures is the first action the nurse should perform and is standard procedure in a febrile client for whom antibiotics have been requested. Levofloxacin, an antibiotic, is important to administer, but blood cultures should be drawn before antibiotics are started. Unless this client is a danger to self or staff, giving lorazepam (Ativan) for agitation is not the first action; the question indicates that the client is agitated but does not indicate whether other attempts to control agitation have been tried, such as decreasing stimulation. A referral to social work for alcohol counseling will be initiated before the time of discharge; this client is febrile and agitated, and a referral is not the immediate concern.

Which symptom of pneumonia may present differently in the older adult than in the younger adult? 1. Crackles on auscultation 2. Fever 3. Headache 4. Wheezing

Answer:2 Rational: Older adults may not have fever and may have a lower-than-normal temperature with pneumonia. Crackles on auscultation may be present in all age groups as the result of fluid in the lungs. All age ranges may have a headache with pneumonia. Wheezing is an indication of narrowed airways and can be found in all age groups.

A client is being discharged home with active tuberculosis. Which information does the nurse include in the discharge teaching plan? 1. "You are not contagious unless you stop taking your medication." 2. "You will not be contagious to the people you have been living with." 3. "You will have to take these medications for at least 1 year." 4. "Your sputum may turn a rust color as your condition gets better."

Answer:2 Rational: The people the client has been living with have already been exposed and need to be tested. They cannot be re-exposed simply because the diagnosis has now been confirmed. The client with active tuberculosis is contagious, even while taking medication. The length of time for treatment is 6 months. Fluid from the pulmonary capillaries and red blood cells moving into the alveoli is a result of the inflammatory process. Rust-colored sputum is an indication that the tuberculosis

An older client presents to the emergency department with a 2-day history of cough, pain on inspiration, shortness of breath, and dyspnea. The client never had a pneumococcal vaccine. The client's chest x-ray shows density in both bases. The client has wheezing upon auscultation of both lungs. Would a bronchodilator be beneficial for this client? 1. It would not be beneficial for this client. 2. It would help decrease the bronchospasm. 3. It would clear up the density in the bases of the client's lungs. 4. It would decrease the client's pain on inspiration.

Answer:2 Rational:A bronchodilator would help decrease bronchospasm and would open up the airways, so it would be beneficial for this client. It would decrease dyspnea and feelings of shortness of breath. A bronchodilator would not be able to clear up the density in the bases of the client's lung. The cause of the density is unknown; however, an infection such as pneumonia is likely, which bronchodilators do not treat. Although a bronchodilator would help a client breathe easier, it does not have any analgesic properties.

Which of these clients should the charge nurse assign to the LPN/LVN working on the medical-surgical unit? 1. Client with group A beta-hemolytic streptococcal pharyngitis who has stridor 2. Client with pulmonary tuberculosis who is receiving multiple medications 3. Client with sinusitis who has just arrived after having endoscopic sinus surgery 4. Client with tonsillitis who has a thick-sounding voice and difficulty swallowing

Answer:2 Rational:The LPN/LVN scope of practice includes medication administration, so a client receiving multiple medications can be managed appropriately by an LPN/LVN. Stridor is an indication of respiratory distress; this client needs to be managed by the RN. A client in the immediate postoperative period requires frequent assessments by the RN to watch for deterioration. A client with a thick-sounding voice and difficulty swallowing is at risk for deterioration and needs careful assessment and monitoring by the RN.

A client who has recently traveled to Vietnam comes to the emergency department with fatigue, lethargy, night sweats, and a low-grade fever. What is the nurse's first action? 1. Contact the health care provider for tuberculosis (TB) medications. 2. Perform a TB skin test. 3. Place a respiratory mask on the client. 4. Test all family members for TB.

Answer:3 Rational: The concern is that this client has TB. A respiratory mask should be placed on the client immediately. Requesting medications for TB is not appropriate until the client has been evaluated and a diagnosis has been made. Performing a TB test will be important, but this is not the top priority. It is important to remember to let the client know that results will not be available for at least 48 hours after the test is administered. Further testing of this client needs to be completed and a diagnosis made before family members are tested.

The medical-surgical unit has one negative-airflow room. Which of these four clients who have just arrived on the unit should the charge nurse admit to this room? 1. Client with bacterial pneumonia and a cough productive of green sputum 2. Client with neutropenia and pneumonia caused by Candida albicans 3. Client with possible pulmonary tuberculosis who currently has hemoptysis 4. Client with right empyema who has a chest tube and a fever of 103.2° F

Answer:3 Rational:A client with possible tuberculosis should be admitted to the negative-airflow room to prevent airborne transmission of tuberculosis. A client with bacterial pneumonia does not require a negative-airflow room but should be placed in Droplet Precautions. A client with neutropenia should be in a room with positive airflow. The client with a right empyema who also has a chest tube and a fever should be placed in Contact Precautions but does not require a negative-airflow room.

A client comes to the emergency department with a sore throat. Examination reveals redness and swelling of the pharyngeal mucous membranes. Which diagnostic test does the nurse expect will be requested first? 1. Chest x-ray 2. Complete blood count (CBC) 3. Tuberculosis (TB) skin test 4. Throat culture

Answer:4 Rational: A throat culture is important for distinguishing a viral infection from a group A beta-hemolytic streptococcal infection. A chest x-ray or TB skin test is not indicated by the symptoms given. A CBC might be indicated to evaluate infection and dehydration, but would not be the first action.

The nurse is preparing to admit an adult client with pertussis. Which symptom does the nurse anticipate finding in this client? 1. "Whooping" after a cough 2. Hemoptysis 3. Mild cold-like symptoms 4. Post-cough emesis

Answer:4 Rational: Clients with pertussis will have paroxysms of coughing often followed by changes in color and/or vomiting. Adults do not usually have the characteristic whooping sound associated with coughing that children with pertussis exhibit. Hemoptysis may occur after the acute phase when changes in the respiratory mucosa occur. Mild, cold-like symptoms occur in the initial stages of pertussis and generally do not require hospitalization.

Community health nurses are tasked with providing education on prevention of respiratory infection for diseases such as the flu. Which target audience is given the highest priority? 1. Homeless people 2. Hospital staff 3. Politicians 4. Prison staff and inmates

Answer:4 Rational: High-risk groups for respiratory infection include those who live in crowded areas such as long-term care facilities, prisons, and mental health facilities. Although homeless people are a high priority, they are not the group at greatest risk of those listed. Education could be provided in shelters or during outreach activities. Hospital staff are at risk owing to their contact with ill clients and family members; however, they are already aware of how to prevent respiratory infection. Politicians are not at higher risk for respiratory infection than any other group with public exposure.

The nurse is caring for a client with severe acute respiratory syndrome. What is the most important precaution the nurse should take when preparing to suction this client? 1. Keeping the head of the bed elevated 30 to 45 degrees 2. Performing oral care after suctioning the oropharynx 3. Washing hands and donning gloves prior to the procedure 4. Wearing a disposable particulate mask respirator and protective eyewear

Answer:4 Rational: To protect health care workers during procedures that induce coughing or promote aerosolization of particles, nurses should wear a particulate mask respirator and protective eyewear to prevent the spread of infectious organisms. Keeping the head of the bed elevated 30 to 45 degrees is not the most important precaution. Performing oral care is a comfort measure. Washing hands and donning gloves is necessary, but not the most important measure.

The nurse notices a visitor walking into the room of a client on airborne isolation with no protective gear. What does the nurse do? 1. Ensures that the client is wearing a mask 2. Tells the visitor that the client cannot receive visitors at this time 3. Provides a particulate air respirator to the visitor 4. Provides a mask to the visitor

Answer:4 Rational:Because the visitor is entering the client's isolation environment, the visitor must wear a mask. The client typically must wear a mask only when he or she is outside of an isolation environment. Turning the visitor away is inappropriate and unnecessary. It would not be necessary for the visitor to wear an air respirator.

After surgery for placement of a chest tube, the client reports burning in the chest. What does the nurse do first? A. Assess the airway, breathing, and circulation. B. Call for the Rapid Response Team. C. Check the patency of the chest tubes. D. Listen for breath sounds.

Answer:A Rational: Assessing the "ABCs" is the priority to determine possible causes of burning in the client's chest. The client's situation does not require the Rapid Response Team to be called. The client's symptoms are not caused by a blockage of chest tubes. Listening for breath sounds would be an appropriate action for the nurse to take to evaluate the client's reported symptoms; however, this would not be the nurse's first action.

Which statement by a client with chronic obstructive pulmonary disease (COPD) indicates the need for additional follow-up instruction? A. "I don't need to use my oxygen all the time." B. "I don't need to get a flu shot." C. "I need to eat more protein." D. "It is normal to feel more tired than I used to."

Answer:B Rational: An annual influenza vaccine (flu shot) is important for all clients with COPD. At the same time, a pneumonia vaccine could be offered, since pneumonia is one of the most common complications of COPD. The client who is hypoxemic and also has chronic hypercarbia requires lower levels of oxygen delivery, and may not need it all the time. Increased work of breathing in a client with COPD raises calorie and protein needs, which can lead to protein-calorie malnutrition. Clients with COPD often have chronic fatigue.

The client says, "I hate this stupid COPD." What is the best response by the nurse? A. "Then you need to stop smoking." B. "What is bothering you?" C. "Why do you feel this way?" D. "You will get used to it."

Answer:B Rational: Encourage the client, and the family, to express their feelings about limitations on their lifestyle and about disease progression. This is not the time to lecture the client regarding his smoking habits; the client is expressing a need for support. "Why" questions can seem accusatory and may make a client less likely to talk about what he or she is feeling. The client's feelings should never be minimized.

After receiving education on the correct use of emergency drug therapy for asthma, which statement by the client indicates a correct understanding of the nurse's instructions? A. "Asthma drugs help everybody breathe better." B. "I must carry my emergency inhaler only when activity is anticipated." C. "I must have my emergency inhaler with me at all times." D. "Preventive drugs can stop an attack."

Answer:C Rational: Because asthma attacks cannot always be predicted, clients with asthma must always carry a rescue inhaler such as a short-acting beta agonist (e.g., albuterol [Proventil]). Asthma medications are specific to the disease and should never be shared or used by anyone other than the person for whom they are prescribed. An emergency inhaler should be carried when activity is anticipated, as well as at other times. Preventive drugs are those that are taken every day to help prevent an attack from occurring. They are not able to stop an attack once it begins.

The nurse has been teaching improved airflow techniques to the client, who has continued to have restrictive breathing problems. Which is the best indicator of success? A. Peak flowmeter readings that are yellow after the third reading B. Productive cough C. SpO2 level of 92% after ambulating 50 feet D. Stable arterial blood gases (ABGs)

Answer:C Rational: Maintaining a baseline SpO2 of 92% after ambulating 50 feet is an excellent indicator that the client has achieved better airflow, and that the nurse's teaching has been effective. A yellow reading means "caution," which indicates narrowing airways. Although a productive cough may be an indication of success, it can also be an indication of infection. ABGs are invasive, costly, and painful and are not the most effective indicator of successful teaching in this situation.

A client has been diagnosed with chronic bronchitis and started on a mucolytic. What is the rationale for ordering a mucolytic for this client? A. Mucolytics decrease secretion production. B. Mucolytics increase gas exchange in the lower airways. C. Mucolytics provide bronchodilation in clients with chronic obstructive pulmonary disease. D. Mucolytics thin secretions, making them easier to expectorate.

Answer:D Rational: The term mucolytic means "breaking down mucus." Mucolytics cause secretions to thin, making them easier to expectorate; this is important for a client with chronic bronchitis. Mucolytics do not decrease secretion production. Mucolytics may increase gas exchange, but this is an indirect property and is not the main function. Mucolytics do not have any bronchodilation properties.

A client is admitted with asthma. How is this disease differentiated from other chronic lung disorders? A. It affects only young people. B. The client has dyspnea. C. The client is coughing. D. The client is symptom-free between exacerbations.

Answer:D Rational: The client may be completely symptom-free between exacerbations. Asthma affects people of all ages. Dyspnea is a common symptom of many chronic lung diseases. Coughing occurs in many acute and chronic lung diseases.

A newly diagnosed client with asthma says that his peak flowmeter is reading 82% of his personal best. What does the nurse do? A. Nothing. This is in the green zone. B. Provide the rescue drug and reassess. C. Provide the rescue drug and seek emergency help. D. Repeat the peak flow test.

Answer:D Rational:Since the client is newly diagnosed with asthma, this would be an excellent opportunity for the nurse to observe the client using the peak flowmeter to ensure that the client is using it properly, so readings are accurate and in the green zone, at least 80% of the client's personal best. The result of 82% is in the green zone, but this is not the best answer for a newly diagnosed client. Rescue drugs should be used only in the yellow zone, between 50% and 80% of the client's personal best. They should not be used in this situation, and the nurse does not need to seek emergency help until readings are in the red zone, or below 50% of the client's personal best.