Respiratory-Medsurge

Lists the signs & symptoms of TB?

-Low-grade fever, cough, night sweats, fatigue & weight loss -The cough may be nonproductive, or mucopurulent sputum may be expectorated

A nurse has provided a client with tuberculosis (TB) instructions on proper handling and disposal of respiratory secretions. The nurse determines that the client demonstrates understanding of the instructions when the client makes which statement? 1."I will discard used tissues in a plastic bag." 2."I need to wash my hands at least four times a day." 3."I will brush my teeth and rinse my mouth once a day." 4."I will turn my head to the side if I need to cough or sneeze.

1. ."I will discard used tissues in a plastic bag"

A client has been treated for pleural effusion with a thoracentesis. The nurse determines that this procedure has been effective if the nurse notes which assessment finding? 1.Absence of dyspnea 2.Increased severity of cough 3.Dull percussion notes over lung tissue 4.Decreased tactile fremitus over lung tissue

1. Absence of dyspnea Rationale: The client who has undergone thoracentesis should experience relief of the signs and symptoms experienced before the procedure. Typical signs and symptoms of pleural effusion include dry, nonproductive cough; dyspnea (usually on exertion); decreased or absent tactile fremitus; and dull or flat percussion notes on respiratory assessment

The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse include on the list? Select all that apply. 1. Activities should be resumed gradually. 2. Avoid contact with other individuals, except family members, for at least 6 months. 3. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. 4. Respiratory isolation is not necessary because family members already have been exposed. 5. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags. 6. When one sputum culture is negative, the client is no longer considered infectious and usually can return to former employment

1. Activities should be resumed gradually 3. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. 5. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags. 6. When one sputum culture is negative, the client is no longer considered infectious and usually can return to former employment Rationale: -The nurse should provide the client and family with information about tuberculosis and allay concerns about the contagious aspect of the infection. -Instruct the client to follow the medication regimen exactly as prescribed and always to have a supply of the medication on hand. -Advise the client of the side effects of the medication and ways of minimizing them to ensure compliance. -Reassure the client that after 2 to 3 weeks of medication therapy, it is unlikely that the client will infect anyone. -Inform the client that activities should be resumed gradually and about the need for adequate nutrition and a well-balanced diet that is rich in iron, protein, and vitamin C to promote healing and prevent recurrence of infection. -Inform the client and family that respiratory isolation is not necessary because family members already have been exposed. -Instruct the client about thorough handwashing and to cover the mouth and nose when coughing or sneezing and to put used tissues into plastic bags. -Inform the client that a sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. -When the results of three sputum cultures are negative, the client is no longer considered infectious and can usually return to former employment.

A nurse is monitoring the status of a client who is being treated for dyspnea. The nurse is aware that which factor will decrease the work of breathing for this client? 1.Bronchodilation 2.Increased airway resistance 3.Increased mucus production 4.Interstitial pulmonary edema

1. Bronchodilation Rationale: Bronchodilation decreases airway resistance and decreases the work of breathing for the client with dyspnea. Clients with dyspnea who have bronchospasm, increased mucus production, or edema exhibit increased airway resistance, which increases the work of breathing.

A nurse is caring for a client who had tuberculin skin testing (Mantoux test) 48 hours ago on admission to the nursing unit. The nurse reads the test result as positive. Which action by the nurse has the highest priority? 1.Contact the health care provider (HCP). 2.Document the finding in the client's record. 3.Call the employee health service department. 4.Call the radiology department for a chest radiographic study to be done.

1. Contact the (HCP Rationale: The nurse who obtains a positive Mantoux test reading should call the HCP immediately. The HCP will prescribe a chest x-ray study to determine whether the client has clinically active tuberculosis (TB) or old, healed lesions. A sputum culture would be obtained to confirm the diagnosis of active TB. The client can be placed on TB precautions prophylactically until a final diagnosis is made. Although the results of the test would be documented and the employee health service department would be notified, these are not the actions of highest priority among the options provided.

A client is suspected of having a pulmonary embolus. The nurse assesses the client, knowing that which is a common clinical manifestation of pulmonary embolism? 1.Dyspnea 2.Bradypnea 3.Bradycardia 4.Decreased respirations

1. Dyspnea Rationale: The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea, and chest pain.

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

1. Fatigue 2.Lethargy 4.Morning cough 5.Low-grade fever Rationale: The symptoms of TB include a slight morning cough, fatigue, lethargy, and low-grade fever. The other symptoms listed are advanced (not initial) signs/symptoms.

List the FOUR first-line medications used to treat TB?

1. INH 2. Rifampin (Rifadin) 3. Pyrazinamide (PZD) 4. Ethambutol (Myambutol)

The nurse enters a client's room with a pulse oximetry machine and tells the client that the health care provider (HCP) has prescribed continuous oxygen saturation readings. The client's facial expression changes to one of apprehension. The nurse can quickly and most effectively alleviate the client's anxiety by providing which information about pulse oximetry? 1.It is painless and safe. 2.It causes only mild discomfort at the site. 3.It requires insertion of only a very small catheter. 4.It has an alarm to signal dangerous drops in oxygen saturation levels.

1. It is painless and safe

A client did not seek medical treatment for a previous respiratory infection, and subsequently an empyema developed in the left lung. The nurse should assess the client for which signs and symptoms associated with this problem? 1.Pleural pain and fever 2.Decreased respiratory rate 3.Diaphoresis during the day 4.Hyperresonant breath sounds over the left thorax

1. Pleural pain and fever Rationale: The client with empyema usually experiences dyspnea, increased respiratory rate, pleural pain, night sweats, fever, anorexia, and weight loss. There is a decrease in breath sounds over the affected area, a flat sound to percussion, and decreased tactile fremitus

A client who is human immunodeficiency virus (HIV)-positive has had a tuberculin skin test (TST). The nurse notes a 7-mm area of induration at the site of the skin test and interprets the result as which finding? 1.Positive 2.Negative 3.Inconclusive 4.Need for repeat testing

1. Positive Rationale: -The client with human immunodeficiency virus (HIV) infection is considered to have positive results on tuberculin skin testing with an area of induration larger than 5 mm. -The client without HIV is positive with an induration larger than 10 mm. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client. It is possible for the client infected with HIV to have false-negative readings because of the immunosuppression factor. Options 2, 3, and 4 are incorrect interpretations.

A client who has undergone radical neck dissection for a tumor has a potential problem of obstruction related to postoperative edema, drainage, and secretions. To promote adequate respiratory function in this client, the nurse should implement which activities? Select all that apply. 1.Suctioning the client as needed 2.Encouraging coughing every 2 hours 3.Placing the bed in low Fowler's position 4.Supporting the neck incision when the client coughs 5.Monitoring the respiratory status frequently as prescribed

1. Suctioning the client as needed 2. Encouraging coughing every 2 hours 4. Supporting the neck incision when the client coughs 5. Monitoring the respiratory status frequently as prescribed Rationale: The client's respiratory status is promoted by the use of high Fowler's position after this surgery. Low Fowler's position is avoided because it could result in increased venous pressure on the surgical site and increased risk of regurgitation and aspiration. It also is helpful to encourage the client to cough and deep breathe every 2 hours, to support the neck incision when coughing, to suction periodically as needed, and to monitor the respiratory status frequently as prescribed.

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

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

A client with chronic obstructive pulmonary disease (COPD) is being evaluated for lung transplantation. The nurse performs the initial physical assessment. Which findings should the nurse anticipate in this client? Select all that apply. 1.Dyspnea at rest 2.Clubbed fingers 3.Muscle retractions 4.Decreased respiratory rate 5.Increased body temperature 6.Prolonged expiratory breathing phase

1.Dyspnea at rest 2.Clubbed fingers 3.Muscle retractions 6.Prolonged expiratory breathing phase Rationale: The client with COPD who is eligible for a lung transplantation has end-stage COPD and will have clinical manifestations of hypoxemia, dyspnea at rest, use of accessory muscle with retractions, clubbing, and prolonged expiratory breathing phase caused by retention of carbon dioxide. Option 4 is not correct because the client with COPD has an increased respiratory rate, not a decreased one. Option 5 is not correct because an elevated temperature would not be present unless the client has an infection.

A nurse is providing preoperative teaching with the client about the use of an incentive spirometer in the postoperative period. Which instructions should the nurse include? Select all that apply. 1.Sit upright in the bed or in a chair. 2.Inhale deeply and quickly as possible. 3.Hold the device in a downward position. 4.Place the mouthpiece in your mouth and seal your lips tightly around it. 5.After maximum inspiration, hold the breath for 2 to 3 seconds and exhale.

1.Sit upright in the bed or in a chair. 4.Place the mouthpiece in your mouth and seal your lips tightly around it. 5. After maximum inspiration, hold the breath for 2 to 3 seconds and exhale. Rationale: For optimal lung expansion with an incentive spirometer, the client should assume a semi-Fowler's or high Fowler's position while holding the incentive spirometer in an upright position. The mouthpiece should be covered completely with the lips while the client inhales slowly, with a constant flow through the unit. The breath should be held for 2 to 3 seconds before exhaling slowly.

A nurse is teaching a client with pulmonary disease about fundamental concepts of gas exchange. When asked for further details by the client, the nurse explains that gas exchange occurs through which process? 1.Osmosis 2.Diffusion 3.Ionization 4.Active transport

2. Diffusion

A nurse is reading a tuberculin skin test for a client with no documented health problems. The site has no induration and a 1-mm area of ecchymosis. How should the nurse interpret the result? 1.Positive 2.Negative 3.Uncertain 4.Borderline

2. Negative Rationale: A positive reading has an induration measuring 10 mm or larger and is considered abnormal. A small area of ecchymosis is insignificant and probably is related to injection technique. The remaining options are incorrect interpretations.

A client who is experiencing respiratory difficulty asks the nurse, "Why it is so much easier to breathe out than in?" In providing a response, the nurse explains that breathing is easier on exhalation because of which respiratory responses? 1.Air flows by gravity. 2.The respiratory muscles relax. 3.The respiratory muscles contract. 4.Air is flowing against a pressure gradient.

2. The respiratory muscles relax Rationale: Exhalation is less taxing for the client because it is a passive process in which the respiratory muscles relax. This allows air to flow upward out of the lungs. Air flows according to a pressure gradient from higher pressure to lower pressure. It does not flow by gravity or against a pressure gradient.

Which position would best help the breathing of a client with chronic obstructive pulmonary disease (COPD)? 1.Sitting position 2.Tripod position 3.Supine position 4.High Fowler's position

2. Tripod position Rationale: The tripod position (leaning forward with elbows flexed) helps to decrease the work of breathing in clients who have severe shortness of breath caused by asthma, COPD, or respiratory failure. Positioning the arms in this manner increases the anterior-posterior diameter of the chest, thereby changing the pressures within the chest cavity. The sitting position and high-Fowler's position decrease the anterior-posterior diameter. The supine position will make breathing more difficul

An oxygen delivery system is prescribed for a client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which oxygen delivery system would the nurse anticipate to be prescribed? 1.Face tent 2.Venturi mask 3.Aerosol mask 4.Tracheostomy collar

2. Venturi mask Rationale: The Venturi mask delivers the most accurate oxygen concentration. It is the best oxygen delivery system for the client with chronic airflow limitation because it delivers a precise oxygen concentration. The face tent, aerosol mask, and tracheostomy collar are also high-flow oxygen delivery systems but most often are used to administer high humidity.

The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which finding would the nurse expect to note on assessment of this client? Select all that apply. 1. Hypocapnia 2.A hyperinflated chest noted on the chest x-ray 3.Decreased oxygen saturation with mild exercise 4.A widened diaphragm noted on the chest x-ray 5.Pulmonary function tests that demonstrate increased vital capacity

2.A hyperinflated chest noted on the chest x-ray 3.Decreased oxygen saturation with mild exercise Rationale: Clinical manifestations of chronic obstructive pulmonary disease (COPD): hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, use of accessory muscles of respiration. Chest x-rays reveal: a hyperinflated chest a flattened diaphragm if the disease is advanced. Pulmonary function tests will demonstrate decreased vital capacity.

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

2.Particulate respirator, gown, and gloves Rationale: The nurse who is in contact with a client with tuberculosis should wear an individually fitted particulate respirator. The nurse also would wear gloves as per standard precautions. The nurse wears a gown when the possibility exists that the clothing could become contaminated, such as when giving a bed bath.

The nurse is discussing the techniques of chest physiotherapy and postural drainage (respiratory treatments) to a client having expectoration problems because of chronic thick, tenacious mucus production in the lower airway. The nurse explains that after the client is positioned for postural drainage the nurse will perform which action to help loosen secretions? 1.Palpation and clubbing 2.Percussion and vibration 3.Hyperoxygenation and suctioning 4.Administer a bronchodilator and monitor peak flow

2.Percussion and vibration

Which nursing interventions are appropriate in caring for a client with emphysema? Select all that apply. 1.Reduce fluid intake to less than 1500 mL/day. 2.Teach diaphragmatic and pursed-lip breathing. 3.Encourage alternating activity with rest periods. 4.Teach the client techniques of chest physiotherapy. 5.Keep the client in a supine position as much as possible.

2.Teach diaphragmatic and pursed-lip breathing. 3.Encourage alternating activity with rest periods. 4.Teach the client techniques of chest physiotherapy. Rationale: Fluids are encouraged, not reduced, to liquefy secretions for easier expectoration. Diaphragmatic and pursed-lip breathing assists in opening alveoli and ease dyspnea. The client should be encouraged to perform activities and exercise as tolerated, such as dressing and walking, with rest periods in between. Chest physiotherapy consists of percussion, vibration, and postural drainage. These techniques are helpful in removing secretions. Elevating the head of the bed assists with breathing.

The nurse is caring for a client after a bronchoscopy and biopsy. Which finding, if noted in the client, should be reported immediately to the health care provider? 1. Dry cough 2. Hematuria 3. Bronchospasm 4. Blood-streaked sputum

3. Bronchospasm Rationale: if a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected. -The client should be assessed for signs/symptoms of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. -Hematuria is unrelated to this procedure.

The nurse is caring for a client who is on strict bed rest and develops a plan of care with goals related to the prevention of deep vein thrombosis and pulmonary emboli. Which nursing action is most helpful in preventing these disorders from developing? 1.Restricting fluids 2.Placing a pillow under the knees 3.Encouraging active range-of-motion exercises 4.Applying a heating pad to the lower extremities

3. Encouraging active range-of-motion exercises Rationale: Clients at greatest risk for deep vein thrombosis and pulmonary emboli are immobilized clients. Basic preventive measures include early ambulation, leg elevation, active leg exercises, elastic stockings, and intermittent pneumatic calf compression. Keeping the client well hydrated is essential because dehydration predisposes to clotting. A pillow under the knees may cause venous stasis. Heat should not be applied without a health care provider's prescription.

A client with chronic obstructive pulmonary disease (COPD) is experiencing exacerbation of the disease. The nurse should determine that which finding documented in the client's record is an expected finding with this client? 1.Increased oxygen saturation with ambulation 2.A widened diaphragm documented by chest x-ray 3.Hyperinflation of lungs documented by chest x-ray 4.A shortened expiratory phase of the respiratory cycle

3. Hyperinflation of lungs documented by CXR Rationale: The clinical manifestations of COPD are several, including hypoxemia; hypercapnia; dyspnea on exertion and at rest; oxygen desaturation with exercise; use of accessory respiratory muscles; and prolonged exhalation. Chest x-ray results indicate a hyperinflated chest and may indicate a flattened diaphragm if the disease is advanced.

A nurse is reinforcing instructions to a client about the use of an incentive spirometer. The nurse tells the client to sustain the inhaled breath for 3 seconds. When the client asks the nurse about the rationale for this action, the nurse explains that which is the primary benefit? 1.Dilate the major bronchi. 2.Increase surfactant production. 3.Maintain inflation of the alveoli. 4.Enhance ciliary action in the tracheobronchial tree.

3. Maintain inflation of the alveoli

A nurse is providing instructions to a client about diaphragmatic breathing. The nurse tells the client that this technique is helpful because, in normal respiration, as the diaphragm contracts, it takes which action? 1.Aids in exhalation 2.Moves up and inward 3.Moves downward and out 4.Makes the thoracic cage smaller

3. Moves downward and out Rationale: As the diaphragm contracts, it moves downward and out, becoming flatter and expanding the thoracic cage, to promote lung expansion. This process occurs during the inspiratory phase of the respiratory cycle. The incorrect options occur with exhalation and relaxation of the diaphragm.

The nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of which diagnostic test that will confirm this diagnosis? 1.Chest x-ray 2.Bronchoscopy 3.Sputum culture 4.Tuberculin skin test

3. Sputum culture Rationale: -Tuberculosis is definitively diagnosed through culture and isolation of Mycobacterium tuberculosis. -A presumptive diagnosis is made based on a tuberculin skin test, a sputum smear that is positive for acid-fast bacteria, a chest x-ray, and histological evidence of granulomatous disease on biopsy.

The nurse is caring for a group of clients on the clinical nursing unit. The nurse interprets that which of these clients is at most risk for the development of pulmonary embolism? 1.A 25-year-old woman with diabetic ketoacidosis 2.A 65-year-old man out of bed 1 day after prostate resection 3.A 73-year-old woman who has just had pinning of a hip fracture 4.A 38-year-old man with pulmonary contusion sustained in an automobile crash

3.A 73-year-old woman who has just had pinning of a hip fracture Rationale: Clients frequently at risk for pulmonary embolism include clients who are immobilized. This is especially true in the immobilized postoperative client. Other causes include those with conditions that are characterized by hypercoagulability, endothelial disease, or advancing age

A nurse working on a medical respiratory nursing unit is caring for several clients with respiratory disorders. The nurse should determine that which client on the nursing unit is at the lowest risk for infection with tuberculosis? 1.An uninsured man who is homeless 2.A newly immigrated woman from Korea 3.A man who is an inspector for the US Postal Service 4.An older woman admitted from a long-term care facility

3.A man who is an inspector for the US Postal Service Rationale: Clients at high risk for acquiring tuberculosis include immigrants from Asia, Africa, Latin America, and Oceania; medically underserved populations (ethnic minorities, homeless); those with human immunodeficiency virus infection or other immunosuppressive disorders; residents in group settings (long-term care, correctional facilities); and health care workers.

A client has experienced pulmonary embolism. The nurse should assess for which symptom, which is most commonly reported? 1.Hot, flushed feeling 2.Sudden chills and fever 3.Chest pain that occurs suddenly 4.Dyspnea when deep breaths are take

3.Chest pain that occurs suddenly Rationale: The most common initial symptom in pulmonary embolism is chest pain that is sudden in onset. The next most commonly reported symptom is dyspnea, which is accompanied by an increased respiratory rate. Other typical symptoms of pulmonary embolism include apprehension and restlessness, tachycardia, cough, and cyanosis

The nurse is providing an educational session to community members regarding histoplasmosis. The nurse should provide which information about this disease? 1.It is caused by a tick bite. 2.It is caused by contamination from cat feces. 3.It can be caused by the inhalation of spores from bird droppings. 4.It can be contagious by respiratory contact with an infected person.

3.It can be caused by the inhalation of spores from bird droppings. Rationale: Histoplasmosis is caused by the inhalation of spores from bat or bird droppings. This disease cannot be transmitted from one person to another. Lyme disease is a multisystem infection that results from a bite by a tick that is usually carried by several species of deer. Toxoplasmosis is caused by the ingestion of cysts from contaminated cat feces.

The nurse is planning care for an 81-year-old unresponsive client admitted to the hospital with a medical diagnosis of pneumonia. The nurse has identified the problem of inability to clear the airway related to retained secretions. Which intervention is most appropriate? 1.Initiate and maintain supplemental oxygen as prescribed. 2.Plan activities with rest periods to conserve oxygen needs. 3.Provide nasotracheal suctioning as needed to remove secretions. 4.Monitor oxygenation (the oxygen saturation [SaO2]) during act

3.Provide nasotracheal suctioning as needed to remove secretions. Rationale: Ineffective airway clearance reflects the client's inability to expectorate secretions. The intervention specifically addressing retained secretions is in the correct option. Options 1 and 4 are interventions addressing impaired problem with gas exchange. Option 2 is an intervention aimed at addressing an activity intolerance problem.

The nurse monitors the respiratory status of the client being treated for acute exacerbation of chronic obstructive pulmonary disease (COPD). Which assessment finding would indicate deterioration in ventilation? 1.Cyanosis 2.Hyperinflated chest 3.Rapid, shallow respirations 4.Coarse crackles auscultated bilaterally

3.Rapid, shallow respirations Rationale: An increase in the rate of respirations and a decrease in the depth of respirations together indicate deterioration in ventilation. Cyanosis is not a good indicator of oxygenation in the client with COPD. Cyanosis may be present with some but not all clients. A hyperinflated chest (barrel chest) and hypertrophy of the accessory muscles of the upper chest and neck are common features of chronic COPD. During an exacerbation, coarse crackles are expected to be heard bilaterally throughout the lungs but do not indicate deterioration in ventilation.

The clinic nurse administers a tuberculin (Mantoux) skin test to a client. The nurse tells the client to return to the clinic for reading the results in how long? 1. 6 to 12 hours 2. 12 to 24 hours 3. 24 to 28 hours 4. 48 to 72 hours

4. 48-72 hours Rationale: The tuberculin skin test is an accurate and reliable test that will provide information to the health care provider about the client's possible exposure status to tuberculosis. Interpretation of the skin test result should be done 48 to 72 hours after the injection.

A client with long-standing empyema undergoes decortication of the affected lung area. Postoperatively the nurse should place the client in which position? 1.Sims 2.Supine 3.Side-lying 4.Semi-Fowler's

4. Semi-Fowler's Rationale: After any procedure involving lung surgery, the nurse should position the client in semi-Fowler's position. This position allows for maximal lung expansion and promotes drainage through chest tubes that may be placed during surgery. The positions identified in the remaining options will limit lung expansion

The nurse is assessing a client with the typical clinical manifestations of tuberculosis. The nurse should expect the client to report having fatigue and cough that have been present for how long? 1.1 or 2 days 2.1 to 2 weeks 3.Almost 1 week 4.Several weeks to months

4. Serval weeks to months Rationale: The client with tuberculosis may report signs and symptoms that have been present for weeks or even months. These may include fatigue, lethargy, chest pain, anorexia and weight loss, night sweats, low-grade fever, and cough with mucoid or blood-streaked sputum. It may be the production of blood-tinged sputum that finally forces some clients to seek care.

The community health nurse is conducting an educational session with community members regarding the symptoms associated with tuberculosis. Which is one of the first manifestations associated with tuberculosis? 1.Dyspnea 2.Chest pain 3.A bloody, productive cough 4.A cough with the expectoration of mucoid sputum

4.A cough with the expectoration of mucoid sputum Rationale: -One of the first pulmonary manifestations of tuberculosis is a slight cough with the expectoration of mucoid sputum. -Options 1, 2, and 3 are late manifestations and signify cavitation and extensive lung involvement

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

4.The client's test result will be positive, and a chest x-ray study will be required for evaluation

What is the usual course of medications treatment during the continual phase?

INH & rifampin OR INH & rifapentine (Rifadin)

What is the usual course of medications treatment during the initial phase?

consists of multiple-medication regiment: 1. INH 2. rifampin 3. parazinamide 4. ethambutol

Which types of foods patients should avoid while taking INH?

food contain tyramine and histamine: tuna, aged cheese, red wine, soy sauce, yeast extracts

A client with chronic obstructive pulmonary disease (COPD) who is beginning oxygen therapy asks the nurse why the flow rate cannot be increased to more than 2 to 4 L/min. The nurse responds that this would be harmful because a higher oxygen flow rate could lead to which physical responses? 1.Drying of nasal passages 2.Decrease in the client's oxygen-based respiratory drive 3.Increase for the risk of pneumonia from drier air passages 4.Decrease in the client's carbon dioxide-based respiratory drive

2.Decrease in the client's oxygen-based respiratory drive Rationale: Normally respiratory rate varies with the amount of carbon dioxide present in the blood. In clients with COPD, this natural regulator becomes ineffective owing to exposure to high carbon dioxide levels for prolonged periods. Thus, the level of oxygen provides the respiratory stimulus for these clients. The client with COPD should be instructed not to increase the oxygen flow rate level independently because a higher oxygen level could obliterate the respiratory drive, leading to respiratory failure. Options 1, 3, and 4 are not physical responses that would occur.

The nurse instructs a client regarding pursed-lip breathing and asks the client to demonstrate the breathing technique. Which observation by the nurse would indicate that the client is performing the technique correctly? 1.The client breathes in through the mouth. 2.The client breathes out slowly through the mouth. 3.The client avoids using the abdominal muscles to breathe out. 4.The client puffs out the cheeks when breathing out through the mouth.

2.The client breathes out slowly through the mouth Rationale: Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. The client should close the mouth and breathe in through the nose. The client then purses the lips and breathes out slowly through the mouth, without puffing the cheeks. The client should spend at least twice the amount of time breathing out that it took to breathe in. The client should use the abdominal muscles to assist in squeezing out all of the air. The client also is instructed to use this technique during any physical activity, inhale before beginning the activity, and exhale while performing the activity. The client is also instructed that he or she should never hold the breath.

A client diagnosed with tuberculosis is distressed over fatigue and the loss of physical stamina. What should the nurse tell the client? 1.This is expected and will last for at least 1 year. 2.This is expected, and the client should gradually increase activity as tolerated. 3.This is an unexpected finding with tuberculosis, but it should resolve within 1 month or so. 4.This is a short-lived problem that should be gone within 1 week after beginning drug therapy.

2.This is expected, and the client should gradually increase activity as tolerated Rationale: The client with tuberculosis has significant fatigue and loss of physical stamina. This can be very frightening for the client. The nurse teaches the client that this symptom will resolve as the therapy progresses and that the client should gradually increase activity as energy levels permit. Options 1, 3, and 4 are incorrect information.

The nurse reads a client's tuberculin (Mantoux) skin test as positive and notes that previous tests were negative. The client becomes upset and asks the nurse what this means. The nurse should base the response on which interpretation? 1.Systemic tuberculosis 2.Pulmonary tuberculosis 3.Exposure to tuberculosis 4.No evidence of tuberculosis

3. Exposure to TB Rationale: A client who tests positive on a tuberculin (Mantoux) skin test either has been exposed to tuberculosis or has inactive (dormant) tuberculosis. The client must then undergo chest radiography and sputum culture to confirm the diagnosis. Options 1, 2, and 4 are incorrect interpretations of the data presented in the question.

The nurse instructs a client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to promote which outcome? 1. Promote oxygen intake 2. Strengthen the diaphragm 3. Strengthen the intercostal muscles 4. promote carbon dioxide elimination

4. promote carbon dioxide elimination Rationale: Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation. Options 1, 2, and 3 are not the purposes of this type of breathing.

The nurse has conducted discharge teaching with a client diagnosed with tuberculosis, who has been receiving medication for 1½ weeks. The nurse determines that the client has understood the information if the client makes which statement? 1."I need to continue drug therapy for 2 months." 2."I can't shop at the mall for the next 6 months." 3."I can return to work if a sputum culture comes back negative." 4."I should not be contagious after 2 to 3 weeks of medication therapy."

4."I should not be contagious after 2 to 3 weeks of medication therapy." Rationale: -The client is continued on medication therapy for 6 to 12 months, depending on the situation. -The client generally is considered noncontagious after 2 to 3 weeks of medication therapy. -The client is instructed to wear a mask if there will be exposure to crowds until the medication is effective in preventing transmission. -The client is allowed to return to work when the results of three sputum cultures are negative.

A nurse is performing an admission assessment on a client with tuberculosis (TB) and is collecting subjective and objective data. Which finding would the nurse expect to note? 1.High fever 2.Flushed skin 3.Complaints of weight gain 4.Complaints of night sweats

4.Complaints of night sweats Rationale: The client with TB usually experiences a low-grade fever, weight loss, pallor, chills, and night sweats. The client also will complain of anorexia and fatigue. Pulmonary symptoms include a cough that is productive of a scant amount of mucoid sputum. Purulent, blood-stained sputum is present if cavitation occurs. Dyspnea and chest pain occur late in the disease.

A client with chronic obstructive pulmonary disease (COPD) has a respiratory rate of 24 breaths per minute, bilateral crackles, and cyanosis and is coughing but is unable to expectorate sputum. Which problem is the priority? 1.Low cardiac output secondary to cor pulmonale 2.Gas exchange alteration related to ventilation-perfusion mismatch 3.Altered breathing pattern secondary to increased work of breathing 4.Inability to clear the airway related to inability to expectorate sputum

4.Inability to clear the airway related to inability to expectorate sputum Rationale: COPD is a term that represents the pathology and symptoms that occur with clients experiencing both emphysema and chronic bronchitis. All the problems listed are potentially appropriate for a client with COPD. For the nurse prioritizing this client's problems, it is important first to maintain circulation, airway, and breathing. At present, the client demonstrates problems with ventilation because of ineffective coughing, so the correct option would be the priority problem. The bilateral crackles would suggest fluid or sputum in the alveoli or airways; however, the client is unable to expectorate this sputum. The client's respiratory rate is only slightly elevated, so option 3, altered breathing pattern is not as important as airway. The client is cyanotic, but this probably is owing to the ineffective clearance of the sputum, causing poor gas exchange. The data in the question do not support low cardiac output as being most important at this time

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

4.Provide reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease. Rationale: A primary role of the nurse working with a client with tuberculosis is to teach the client about medication therapy. An anxious client might not absorb information optimally. The nurse continues to reinforce teaching using a variety of methods (repetition, teaching aids) and teaches the family about the medications as well. The most effective way of coping with the disease is to learn about the therapy that will eradicate it. This gives the client a measure of power over the situation and outcome. Allowing the client to deal with the disease in an individual fashion gives no active assistance to the client. Asking family members whether they wish a psychiatric consultation does not involve the client. Although visiting with the pastoral care department chaplain may be helpful, it is not the best strategy among the options provided.

The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the client to assume? 1.Sitting up in bed 2.Side-lying in bed 3.Sitting in a recliner chair 4.Sitting on the side of the bed and leaning on an overbed table

4.Sitting on the side of the bed and leaning on an overbed table rationale: Positions that will assist the client with emphysema with breathing include sitting up and leaning on an overbed table, sitting up and resting the elbows on the knees, and standing and leaning against the wall.

What are the side effects if patients digest either tyramine while on INH treatment regiment?

If eaten while patient is on INH, it may result in headache, flushing, hypotension, lightheadedness, palpitations, and diaphoresis