Resp 2 PREPU

A nurse is providing discharge teaching for a client who had a laryngectomy. Which instruction should the nurse include in her teaching? a) "Swimming is good exercise after this surgery." b) "Wear a tight cloth at the stoma to prevent anything from entering it." c) "Keep the humidity in your house low." d) "Cover the stoma whenever you shower or bathe."

"Cover the stoma whenever you shower or bathe."

A client seeks care for hoarseness that has lasted for 1 month. To elicit the most appropriate information about this problem, the nurse should ask which question? a) "Do you eat spicy foods?" b) "Have you strained your voice recently?" c) "Do you eat a lot of red meat?" d) "Do you smoke cigarettes, cigars, or a pipe?"

"Do you smoke cigarettes, cigars, or a pipe?"

A client undergoes a total laryngectomy and tracheostomy formation. On discharge, the nurse should give which instruction to the client and family? a) "Clean the tracheostomy tube with alcohol and water." b) "Family members should continue to talk to the client." c) "Limit the amount of protein in the diet." d) "Oral intake of fluids should be limited for 1 week only."

"Family members should continue to talk to the client."

A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia? a) A client who ambulates in the hallway every 4 hours b) A client with a nasogastric tube c) A client with a history of smoking two packs of cigarettes per day until quitting 2 years ago d) A client who is receiving acetaminophen (Tylenol) for pain

A client with a nasogastric tube

You are the home care nurse who is assessing the home environment of a new patient with a laryngectomy. You visit the patient in the hospital and inform the patient that he will need to arrange for installation of which system in the home? a) A radiant heating system b) An air conditioning system c) A water purification system d) A humidification system

A humidification system

A nurse caring for a patient recently diagnosed with lung disease encourages the patient not to smoke. What is the rationale behind this nursing action? a) Because smoking oxygenates the hemoglobin b) Because smoking damages the ciliary cleansing mechanism of the respiratory tract c) Because smoking inflates the alveoli in the lungs d) Because smoking decreases the amount of mucus production

Because smoking damages the ciliary cleansing mechanism of the respiratory tract

A nurse caring for a client with deep vein thrombosis must be especially alert for complications such as pulmonary embolism. Which findings suggest pulmonary embolism? a) Hypertension and lack of fever b) Nonproductive cough and abdominal pain c) Bradypnea and bradycardia d) Chest pain and dyspnea

Chest pain and dyspnea

Malignancy of the larynx can be a devastating diagnosis. What does a client with a diagnosis of laryngeal cancer require? a) Family counseling b) Emotional support c) Referral for vocational training d) Referral for counseling

Emotional support

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) Perform nasopharyngeal suctioning. d) Administer analgesics as ordered.

Initiate oxygen therapy.

A client with suspected severe acute respiratory syndrome (SARS) comes to the emergency department. Which physician order should the nurse implement first? a) Begin an I.V. infusion of dextrose 5% in half-normal saline solution at 100 ml/hour. b) Obtain a nasopharyngeal specimen for reverse-transcription polymerase chain reaction testing. c) Obtain a sputum specimen for enzyme immunoassay testing. d) Institute isolation precautions.

Institute isolation precautions.

You are assessing an adult patient following a motor vehicle accident. You observe that the patient has an increased use of accessory muscles and is complaining of pain and shortness of breath. What condition is the patient exhibiting symptoms of? a) Pneumothorax b) Anxiety c) Asthma d) Cardiac tamponade

Pneumothorax

Which of the following would be LEAST likely to contribute to a case of hospital-acquired pneumonia? a) A nurse washes her hands before beginning patient care. b) Host defenses are impaired. c) Inoculum of organisms reaches the lower respiratory tract and overwhelms the host's defenses. d) A highly virulent organism is present.

A nurse washes her hands before beginning patient care.

A 43-year-old client has had a laryngectomy as treatment for laryngeal cancer. After extensive education with the client and his wife regarding stoma and site care, which of the following postoperative instructions do you stress is of utmost importance to the client's health and safety? a) Avoid sponge baths b) Avoid covering the stoma c) Avoid coughing d) Avoid swimming

Avoid swimming

A patient has had a laryngectomy and was able to retain his airway, with no difficulty swallowing. There is no split of thyroid cartilage. The nurse would record this type of laryngectomy as which of the following? a) Supraglottic laryngectomy b) Hemilaryngectomy c) Total laryngectomy d) Partial laryngectomy

Partial laryngectomy

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

Progressive loss of lung function associated with chronic disease

Clients who have had a laryngectomy are devastated by their loss of the ability to speak normally. Why should a nurse provide extra time and support with these clients? a) These clients may be alert or confused after the procedure. b) These clients need support and help in understanding and choosing an alternative method of speech. c) These clients need to learn to use the continuous positive airway pressure (CPAP). d) These clients avoid an electric larynx or tracheoesophageal puncture (TEP).

These clients need support and help in understanding and choosing an alternative method of speech.

The client you are caring for has just been told they have advanced laryngeal cancer. What is the treatment of choice? a) Partial laryngectomy b) Total laryngectomy c) Laser surgery d) Radiation therapy

Total laryngectomy

As part of a primary cancer prevention program, an oncology nurse answers questions from the public at a health fair. When someone asks about laryngeal cancer, the nurse should explain that: a) inhaling polluted air isn't a risk factor for laryngeal cancer. b) laryngeal cancer occurs primarily in women. c) adenocarcinoma accounts for most cases of laryngeal cancer. d) laryngeal cancer is one of the most preventable types of cancer.

laryngeal cancer is one of the most preventable types of cancer.

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) Offer nutritious snacks 2 times a day. b) Encourage increased fluid intake. c) Give antibiotics as ordered. d) Place client on bed rest.

Encourage increased fluid intake.

Which of the following is a priority nursing intervention that the nurse should perform for a patient who has undergone surgery for a nasal obstruction? a) Ensure mouth breathing b) Apply pressure to the convex portion of the nose c) Apply a warm pack postoperatively d) Provide a splint postoperatively

Ensure mouth breathing

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) Provide employees with smoking cessation materials. d) Give workshops on disease prevention.

Fit all employees with protective masks.

During the cold and flu season each winter, rhinoviruses run rampant infecting those susceptible. What is the most important preventive factor to reduce the spread of this viral infection? a) Covering your mouth with your hand when coughing or sneezing b) Minimizing fluids c) Frequent handwashing d) Significant exercise

Frequent handwashing

You are caring for a patient who is scheduled for a laryngectomy. You are preparing the patient's care plan. Which nursing diagnoses should receive the highest priority for this surgery? a) Anxiety related to diagnosis of cancer b) Altered nutrition related to swallowing difficulties c) Ineffective airway clearance related to surgical alterations in the airway d) Impaired verbal communication related to removal of the larynx

Ineffective airway clearance related to surgical alterations in the airway

A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be: a) Ineffective breathing pattern. b) Ineffective airway clearance. c) Impaired tissue integrity. d) Risk for falls.

Ineffective airway clearance.

A client who sustained a pulmonary contusion in a motor vehicle crash develops a pulmonary embolism. Which nursing diagnosis takes priority with this client? a) Ineffective breathing pattern related to tissue trauma b) Activity intolerance related to insufficient energy to carry out activities of daily living c) Excess fluid volume related to excess sodium intake d) Acute pain related to tissue trauma

Ineffective breathing pattern related to tissue trauma

As a student nurse, you are doing research consisting of chart audits of 25 patients with a diagnosis of chronic pharyngitis. You are researching risk factors for the condition. Which patients would you find are at greatest risk for developing chronic pharyngitis? a) Patients who are eat a diet of spicy foods b) Patients who have Type A personalities c) Patients who are habitual users of alcohol and tobacco d) Patients who are habitual users of caffeine

Patients who are habitual users of alcohol and tobacco

A physician stated to the nurse that the patient has fluid noted in the pleural space and will need a thoracentesis. The nurse would expect that the physician will document this fluid as which of the following? a) Hemothorax b) Consolidation c) Pleural effusion d) Pneumothorax

Pleural effusion

In your presentation to the older adults at the Senior Center luncheon, you outline steps they can take to prevent falls in the home. Preventing falls in older adults directly correlates to preventing bone fractures. If an older adult falls and fractures one or more ribs, what is a possible complication that could develop after the fracture? a) Osteoporosis b) Bronchospasm c) Confusion d) Pneumonia

Pneumonia

A client admitted with multiple traumatic injuries receives massive fluid resuscitation. Later, the physician suspects that the client has aspirated stomach contents. The nurse knows that this client is at highest risk for: a) renal failure. b) bronchial asthma. c) acute respiratory distress syndrome (ARDS). d) chronic obstructive pulmonary disease (COPD).

acute respiratory distress syndrome (ARDS).

A patient who has an altered level of conscious is receiving a tube feeding. Patients receiving tube feeding should be placed into which of the following positions? a) Supine b) Semi-Fowler's or higher c) Trendelenburg d) Side-lying

Semi-Fowler's or higher

The nursing instructor is discussing aspiration with the level I nursing students. The instructor would tell the students that which client is at the greatest risk for aspiration? a) An ambulatory client with Alzheimer's disease b) A 92-year-old client who needs help with activities of daily living (ADLs) c) A stroke client with dysarthria d) A client with severe, deforming rheumatoid arthritis

A stroke client with dysarthria

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) Classes at community centers to teach about smoking cessation strategies b) Legislation that requires homes and apartments be checked for asbestos leakage c) Advertisements in public places to encourage cigarette smokers to have yearly chest x-rays d) Public service announcements on television to promote the use of high-efficiency particulate air (HEPA) filters in homes

Classes at community centers to teach about smoking cessation strategies

The nursing instructor is discussing pleurisy with her clinical group. The instructor lists patient actions that will increase pleuritic pain. Which action would the nursing instructor list? a) Coughing b) Ambulating c) Eating d) Talking

Coughing

A client has undergone a left hemicolectomy for bowel cancer. Which activities prevent the occurrence of postoperative pneumonia in this client? a) Coughing, breathing deeply, frequent repositioning, and using an incentive spirometer b) Administering oxygen, coughing, breathing deeply, and maintaining bed rest c) Coughing, breathing deeply, maintaining bed rest, and using an incentive spirometer d) Administering pain medications, frequent repositioning, and limiting fluid intake

Coughing, breathing deeply, frequent repositioning, and using an incentive spirometer

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) continue to take antibiotics for the entire 10 days. b) follow up with the physician in 2 weeks. c) maintain fluid intake of 40 oz (1,200 ml) per day. d) turn and reposition himself every 2 hours.

continue to take antibiotics for the entire 10 days.

The critical-care nurse is writing a care plan for a patient who has returned from surgery 2 hours prior. In planning the patient's care, which measure will the nurse implement to decrease the patient's risk of developing pulmonary emboli (PE)? a) Administering aspirin with warfarin b) Maintaining the patient in a supine position c) Increased dietary intake of protein d) Early ambulation

Early ambulation

You are doing preoperative teaching with a client scheduled for laryngeal surgery. What should you teach this client to help prevent atelectasis? a) Provide meticulous mouth care every 4 hours. b) Caution against frequent coughing. c) Encourage deep breathing every 2 hours. d) Monitor for signs of dysphagia.

Encourage deep breathing every 2 hours.

A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care? a) Encouraging increased fluid intake b) Elevating the head of the bed 30 degrees c) Turning the client every 2 hours d) Maintaining a cool room temperature

Encouraging increased fluid intake

You are caring for a patient in the outpatient clinic with suspicion of cancer due to recent weight losses for unidentifiable reasons. The patient has a 25-year history of smoking. You perform an assessment and ask the patient about symptoms related to laryngeal cancer. What is an early symptom associated with laryngeal cancer? a) Dysphagia b) Hoarseness c) Dyspnea d) Alopecia

Hoarseness

When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems? a) Hypercapnia, hypoventilation, and hypoxemia b) Hyperventilation, hypertension, and hypocapnia c) Hyperoxemia, hypocapnia, and hyperventilation d) Hypotension, hyperoxemia, and hypercapnia

Hypercapnia, hypoventilation, and hypoxemia

You are writing a care plan for a patient who is status post-total laryngectomy. Which major goal would you include in your plan of care? a) Patient is unable to handle own secretions b) Attainment of minimal levels of nutrition and hydration c) Minimum of complications d) Improvement in body image and self-esteem

Improvement in body image and self-esteem

The nurse is caring for a patient at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the patient. What is an example of a first-line measure to minimize atelectasis? a) Intermittent positive-pressure breathing (IPPB) b) Positive end-expiratory pressure (PEEP) c) Bronchoscopy d) Incentive spirometry

Incentive spirometry

A critical-care nurse is caring for a 68-year-old patient diagnosed with mycoplasmal pneumonia after a surgical procedure. The nurse documents that the patient has an increased work of breathing due to copious tracheobronchial secretions. What should the nurse encourage the patient to do? a) Increase oral fluids unless contraindicated b) Lie in a low Fowler's position c) Call the nurse for deep suctioning d) Increase activity

Increase oral fluids unless contraindicated

In a client with amyotrophic lateral sclerosis (ALS) and respiratory distress, which finding is the earliest sign of reduced oxygenation? a) Decreased level of consciousness (LOC) b) Decreased heart rate c) Increased restlessness d) Increased blood pressure

Increased restlessness

Which of the following is the priority nursing diagnosis for the patient undergoing a laryngectomy? a) Anxiety and depression b) Impaired verbal communication c) Imbalanced nutrition: Less than body requirements d) Ineffective airway clearance

Ineffective airway clearance

Your client is status post total laryngectomy and cannot talk. What intervention should you make to help this client communicate? a) Provide a lip reader as a translator. b) Provide alternative methods of communication. c) Teach the client esophageal speech. d) Teach the client about an artificial larynx

Provide alternative methods of communication.

The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation? a) Pulmonary contusion b) Tension pneumothorax c) Flail chest d) Cardiac tamponade

Tension pneumothorax

You are caring for a client who has just been told they have advanced laryngeal cancer and will have to have a total laryngectomy. You are doing preoperative teaching with this client. What do you know is a subject you should cover? a) Post operative nutrition b) Alternative methods of communication c) Pain before surgery d) Visiting hours

Alternative methods of communication

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) Bradypnea b) Respiratory alkalosis c) Productive cough d) Blood-tinged sputum

Blood-tinged sputum

A nurse is caring for a client who is at high risk for developing pneumonia. Which intervention should the nurse include on the client's care plan? a) Turning the client every 4 hours to prevent fatigue b) Providing oral hygiene daily c) Using strict hand hygiene d) Keeping the head of the bed at 15 degrees or less

Using strict hand hygiene

The nurse at an employee wellness clinic is meeting with a client who reports voice hoarseness for more than 2 weeks. To determine if the client may have symptoms of early laryngeal cancer, the next question the nurse should ask is, "Do you have a) a foul odor to your breath" b) a persistent cough or sore throat" c) trouble with your breathing" d) difficulty swallowing foods"

a persistent cough or sore throat"