270 Exam 5

Which questions should the nurse ask when assessing a patient's sleep/rest pattern related to respiratory health? Select all that apply. 1 "Do you have trouble falling asleep?" 2 "Do you need to urinate during the night?" 3 "Do you awaken abruptly during the night?" 4 "Do you sleep more than eight hours per night?" 5 "Do you need to sleep with the head elevated?"

1 "Do you have trouble falling asleep?" 3 "Do you awaken abruptly during the night?" 5 "Do you need to sleep with the head elevated?" The patient with sleep apnea may have insomnia or abrupt awakenings. Patients with cardiovascular disease (e.g., heart failure that may affect respiratory health) may need to sleep with the head elevated on several pillows (orthopnea). Sleeping more than eight hours per night or needing to urinate during the night is not indicative of impaired respiratory health.

A patient with pericarditis is admitted to the hospital. In which patient position would the nurse assess for a pericardial friction rub? 1 Ask the patient to sit and lean forward. 2 Place the patient in a standing position. 3 Maintain the patient in a supine position. 4 Place the patient in three positions: supine, sitting, and standing.

1 Ask the patient to sit and lean forward. In a patient with pericarditis, a high-pitched sound can be auscultated. This sound can be heard during heart sound S1 or S2 at the apex. The best position for hearing this sound is when the patient is in a sitting position and leaning forward. The sound is not well heard in other positions, such as supine or standing.

A patient is hospitalized with a diagnosis of pneumonia. When reviewing the patient's history, the nurse finds that the patient experienced a seizure with profuse vomiting four days prior to the hospital admission. Which type of pneumonia does the nurse suspect? 1 Aspiration pneumonia 2 Opportunistic pneumonia 3 Hospital-associated pneumonia 4 Community-acquired pneumonia

1 Aspiration pneumonia

The nurse reviews the process for setting up a wet suction system that is attached to a chest tube and questions which step that is listed in the procedure? 1 Keep the suction control chamber uncovered. 2 Maintain the suction amount at -20 cm H2O pressure. 3 Dial the wall suction regulator to 80 to 120 mm Hg. 4 Dial the wall suction regulator until there is gentle bubbling in the suction control chamber.

1 Keep the suction control chamber uncovered. The nurse should keep the cover over the suction control chamber in place to prevent rapid evaporation of water and to decrease the noise of the bubbling. The ordered suction amount is generally at -20 cm H2O pressure. The nurse should dial the wall suction regulator until there is continuous gentle bubbling in the suction control chamber (generally 80 to 120 mm Hg).

The nurse reviews the medical record of a patient with a pneumothorax and notes that the patient has a minimal amount of fluid accumulated in the intrapleural space and that the patient is stable. Which does the nurse infer? 1 No treatment may be needed. 2 The patient will require treatment with chest tube drainage. 3 Treatment will include aspiration using a large-bore needle. 4 The primary treatment plan will be needle decompression.

1 No treatment may be needed. Treatment of a pneumothorax depends on its severity, its underlying cause, and the hemodynamic stability of the patient. If the patient is stable and has minimal air and/or fluid accumulated in the intrapleural space, no treatment may be needed because the condition may resolve spontaneously. Chest tube drainage is helpful to drain the fluid; however, this procedure is performed when the patient has severe complications. Aspiration with a large-bore needle is thoracentesis. This procedure is performed when the patient has fluid accumulation in the complete lung. Needle decompression helps to resolve pneumothorax when the patient has a medical emergency.

A patient is diagnosed with left-sided heart failure. Which assessment finding would the nurse expect? 1 Orthopnea 2 Low BP 3 Pulsating neck veins 4 Edema in the lower extremities

1 Orthopnea Orthopnea, difficulty breathing except when sitting or standing, is a symptom of advanced heart failure, especially left-sided failure. When the heart fails as a pump, blood backs up into the lungs, causing fluid to leak from the alveolar membrane. As this process continues, pulmonary edema may develop. Patients may experience hypotension or hypertension, depending on the severity of the disease. Pulsating neck veins and edema in the lower extremities are characteristics of right-sided heart failure.

A patient is diagnosed with heart failure. Which factors may influence the patient's cardiac output (CO)? Select all that apply. 1 Stroke volume 2 Portal pressure 3 Respiratory rate 4 Ventricular filling 5 Myocardial contractility

1 Stroke volume 4 Ventricular filling 5 Myocardial contractility CO depends on various factors, such as stroke volume, filling of the ventricles, and myocardial contractility. Stroke volume × heart rate = CO. Decreased filling of the ventricles decreases CO. Impaired myocardial contractility decreases CO. Respiratory rate and portal pressure do not alter CO.

Which compensatory mechanisms are initially effective in maintaining adequate cardiac output (CO) in heart failure? Select all that apply. 1 Ventricular dilation 2 Ventricular hypertrophy 3 Production of endothelin 4 Release of renin by the kidneys 5 Activation of the sympathetic nervous system (SNS)

1 Ventricular dilation 2 Ventricular hypertrophy 5 Activation of the sympathetic nervous system (SNS) Increased contraction as a result of dilation initially leads to increased CO and maintenance of BP and perfusion. The increased contractile power of the heart's muscle fibers as a result of hypertrophy initially leads to an increase in CO and maintenance of tissue perfusion. The SNS responds by releasing catecholamines (epinephrine and norepinephrine), which enhance peripheral vasoconstriction and cause an increase in the heart rate and myocardial contractility. Initially, this compensatory mechanism is beneficial, with a result of increased CO. Endothelin is a potent vasoconstrictor; it contributes to the development of heart failure. The release of renin by the kidneys starts a cascade of events, which results in further water and sodium retention in an already-overloaded state.

A patient presents with a lung abscess. The nurse expects that which intervention will be included in the patient's treatment plan? 1 Postural drainage 2 Antibiotic therapy 3 Chest physiotherapy 4 Fluid restriction

2 Antibiotic therapy

A patient develops unexplained heart failure (HF) that remains unresponsive to usual therapy. For which diagnostic test would the nurse prepare the patient? 1 Chest x-ray 2 Echocardiogram 3 Cardiac catheterization 4 Electrocardiogram (ECG)

2 Echocardiogram An echocardiogram provides information on the ejection fraction (EF). It also provides information on the structure and function of the heart valves. Heart chamber enlargement or stiffness can also be assessed. An ECG and chest x-ray are also useful but are not as specific. Heart catheterization, such as coronary angiography, is performed to determine the EF and blockages.

Which items in a patient's medical history are risk factors for heart failure (HF)? Select all that apply. 1 Cirrhosis 2 Hypertension 3 Multiple sclerosis 4 Marfan's syndrome 5 Metabolic syndrome

2 Hypertension 5 Metabolic syndrome Hypertension and coronary artery disease (CAD) are the primary risk factors for HF. Other co-morbidities, such as diabetes, metabolic syndrome, advanced age, tobacco use, and vascular disease, contribute to the risk of the development of HF. Cirrhosis, multiple sclerosis, and Marfan's syndrome are not precipitating causes of HF.

How does splinting the incision with a pillow benefit a patient who underwent surgery to repair chest trauma? 1 It reduces pain perception. 2 It facilitates deep breathing. 3 It reduces the risk of an air leak. 4 It increases perfusion at the site.

2 It facilitates deep breathing. The patient will have difficulty breathing after surgery as a result of the incision on the chest. Splinting the incision facilitates deep breathing. The nurse administers analgesics to reduce pain. An occlusive dressing is applied over the site of surgery to reduce air leakage. The nurse instructs the patient to perform range-of-motion exercise to increase perfusion or oxygen supply to the injured site.

Which action would the nurse take to assess a patient for jugular venous distention? 1 Place the patient in a supine position. 2 Raise the patient to about 45 degrees. 3 Place the patient in a sitting position, leaning forward. 4 Observe the vein in three positions: supine, sitting, and standing.

2 Raise the patient to about 45 degrees. Jugular venous distention can be seen in right-sided heart failure. In this condition, the large veins in the neck are distended as a result of the back pressure exerted by the blood. It is best appreciated when the patient is raised to approximately 45 degrees or slightly less. This exerts pressure and helps in the visualization of the jugular veins. Placing the patient in other positions, such as supine, sitting, leaning, or standing, does not help in clear visualization of jugular venous distention.

Which abnormality is likely to result in a heart murmur? 1 Increased viscosity of the patient's blood 2 Turbulent blood flow across a heart valve 3 Friction between the heart and the pericardium 4 A deficit in heart conductivity that impairs contractility

2 Turbulent blood flow across a heart valve Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity or conductivity. Friction between the heart and pericardium may cause an audible friction rub.

A patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD) needs to receive precise amounts of oxygen. Which equipment should the nurse prepare to use? 1 Oxygen tent 2 Venturi mask 3 Nasal cannula 4 Oxygen-conserving cannula

2 Venturi mask The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern. The other methods are less precise in terms of amount of oxygen delivered.

Which blood component is a marker of inflammation reflecting an increased risk of cardiovascular disease? 1 Myoglobin 2 N-terminal pro-brain natriuretic peptide (NT-Pro-BNP) 3 C-reactive protein (CRP) 4 B-type natriuretic peptide (BNP)

3 C-reactive protein (CRP) CRP is a marker of inflammation that can predict the risk of cardiac events and cardiac diseases. Myoglobin is a low-molecular-weight protein that is sensitive to myocardial injury. NT-Pro-BNP helps in assessing the severity of heart failure. BNP is a peptide that causes natriuresis, and its elevation distinguishes a cardiac versus respiratory cause of dyspnea.

The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. What is the primary reason for the nurse to carefully inspect the chest wall of this patient? 1 Giving care will calm the patient 2 Observing for signs of diaphoresis 3 Evaluating the use of intercostal muscles 4 Monitoring the patient for bilateral chest expansion

3 Evaluating the use of intercostal muscles The nurse physically inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of respiratory distress. The other options may also occur, but they are not the primary reason for inspecting the chest wall of this patient.

The nurse observes a bluish tinge around the ears of a patient with cardiovascular disease. Which condition is likely to be present? 1 Diabetes 2 Endocarditis 3 Vasoconstriction 4 Venous thromboembolism

3 Vasoconstriction A bluish tinge around the ears or in the ears indicates peripheral cyanosis, which is characterized by vasoconstriction. Vasoconstriction is the narrowing of blood vessels as a result of the contraction of the muscular walls of the vessels, resulting in reduced blood flow. This reduced blood flow will result in insufficient oxygen supply by the heart to other parts of the body, causing a bluish tinge in the extremities of ears. Diabetes causes ulcers in patients with cardiovascular disease. Endocarditis causes clubbing of the nail beds. Venous thromboembolism results in asymmetry in limb circumference.

The pathophysiology of asthma occurs in which order? 1. Edema 2. Vasodilation 3. Irritant encountered 4. Immune activation 5. Inflammatory mediators

3. Irritant encountered 4. Immune activation 5. Inflammatory mediators 2. Vasodilation 1. Edema The pathophysiology of asthma begins with encountering an irritant, which causes immune activation. Immune activation leads to inflammatory mediator activation. Vasodilation follows, which leads to edema that contributes to constriction of the airway.

Which statement made by the patient with chronic obstructive pulmonary disease (COPD) indicates a need for further teaching about the use of an ipratropium inhaler? 1 "I should wait at least 1 to 2 minutes between each puff of the inhaler." 2 "I can rinse my mouth following the two puffs to get rid of the bad taste." 3 "Because this medication is not fast acting, I cannot use it in an emergency if my breathing is worse." 4 "If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily."

4 "If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily." The patient should not just keep taking extra puffs of the inhaler to make breathing easier. Excessive treatment could trigger paradoxical bronchospasm, which would worsen the patient's respiratory status. Rinsing the mouth after the puffs will eliminate a bad taste. Waiting 1 to 2 minutes between each puff will facilitate the effectiveness of the administration. Ipratropium is not used in an emergency for COPD.

The nurse provides care for a patient who experienced chest trauma. When the nurse assesses the right lung, which finding suggests a right-sided pneumothorax? 1 Inspiratory crackles 2 Pronounced crackles 3 Dullness on percussion 4 Absence of breath sounds

4 Absence of breath sounds A pneumothorax indicates that one of the lungs has collapsed and is not functioning. Manifestations of a pneumothorax include dyspnea, decreased movement of the involved chest wall, decreased or absent breath sounds on the affected side, and hyperresonance on percussion. Because no air movement occurs with a pneumothorax, no breath sounds, including crackles, will be heard. Assessment findings will include hyperresonance on percussion.

A patient is diagnosed with paroxysmal nocturnal dyspnea. Which clinical manifestation would the nurse expect the patient to report? 1 Decreased attention span 2 Breathlessness on exertion 3 Shortness of breath when lying down 4 Awakening with a feeling of suffocation

4 Awakening with a feeling of suffocation Paroxysmal nocturnal dyspnea occurs when the patient is asleep. The patient awakes in a state of panic with a feeling of suffocation and has a strong desire to sit or stand up. Breathlessness on exertion is called dyspnea. Shortness of breath when lying down, that is, orthopnea, often accompanies dyspnea. A decreased attention span is a behavioral change that may be a result of poor gas exchange or worsening heart failure.

Which condition causes the symptoms of right-sided heart failure? 1 Decreased preload 2 Increased cardiac output 3 Fluid congestion in the lungs 4 Systemic venous congestion

4 Systemic venous congestion The symptoms of right-sided heart failure are caused by the backup of blood into the venous system. Preload in right-sided heart failure is increased. Cardiac output is decreased in right-sided heart failure. Fluid congestion in the lungs is a symptom of left-sided heart failure

You continuously observe Joey during and after Proventil (albuterol) treatment. Which of the following may occur as side effects of Proventil (albuterol)? Select all that apply (there are 3 correct answers). Excitement Nausea Pulsus paradoxus Tachycardia Drowsiness

Excitement Nausea Tachycardia Central nervous system stimulation resulting in excitement and nervousness may occur as a side effect of Proventil (albuterol) administration. Gastrointestinal distress (nausea, vomiting) may occur as a side effect of Proventil (albuterol) administration. Proventil (albuterol) is a short-acting beta2-agonist. Tachycardia may occur as a side effect of Proventil (albuterol) administration.

You prepare to take four-point blood pressures on Katie. Which of the following are true about four-point blood pressures in newborns? Select all that apply (there are 4 correct answers). Four-point blood pressures involve obtaining BP measurements on all four extremities BPs should be taken while the infant is resting quietly Only upper extremity BPs will be accurate When BP is measured by auscultation, the point at which the first sound is heard is recorded as the systolic reading When BP is measured by auscultation, the point at which sound disappears is recorded as the diastolic reading For accurate BP readings, the BP cuff should totally encircle the extremity

Four-point blood pressures involve obtaining BP measurements on all four extremities BPs should be taken while the infant is resting quietly When BP is measured by auscultation, the point at which the first sound is heard is recorded as the systolic reading For accurate BP readings, the BP cuff should totally encircle the extremity

A patient with bronchiectasis has copious thick respiratory secretions. Which intervention should the nurse add to the plan of care? 1 Use the incentive spirometer for at least 10 breaths every 2 hours. 2 Give prescribed antibiotics and antitussives on a scheduled basis. 3 Increase intake to at least 12 eight-ounce glasses of fluid every 24 hours. 4 Provide nutritional supplements that are high in protein and carbohydrates.

Increase intake to at least 12 eight-ounce glasses of fluid every 24 hours. Adequate hydration helps to liquefy secretions and thus make it easier to remove them. Unless there are contraindications, the nurse should teach the patient to drink at least 3 L of fluid daily. Although nutrition, breathing exercises, and antibiotics may be indicated, these interventions will not liquefy or thin secretions. Antitussives may reduce the urge to cough and clear sputum, increasing congestion. Expectorants may be used to liquefy and facilitate clearing secretions.

When teaching how lisinopril (Zestril) will help lower the patient's blood pressure, which mechanism of action should the nurse explain? Blocks β-adrenergic effects. Relaxes arterial and venous smooth muscle. Inhibits conversion of angiotensin I to angiotensin II. Reduces sympathetic outflow from central nervous system.

Inhibits conversion of angiotensin I to angiotensin II. Lisinopril is an angiotensin-converting enzyme inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention. β-Blockers result in vasodilation and decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central-acting α-adrenergic antagonists reduce sympathetic outflow from the central nervous system to produce vasodilation and decreased systemic vascular resistance and blood pressure.

The nurse is teaching a women's group about ways to prevent hypertension. What information should the nurse include? (Select all that apply.) Lose weight. Limit beef consumption. Limit sodium and fat intake. Increase fruits and vegetables. Exercise 30 minutes most days

Limit beef consumption. Limit sodium and fat intake. Increase fruits and vegetables. Exercise 30 minutes most days. Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in BP. Along with exercise for 30 minutes on most days, the DASH eating plan is a healthy way to lower BP by limiting sodium and fat intake, increasing fruits and vegetables, and increasing nutrients that are associated with lowering BP. Beef includes saturated fats, which should be limited. Weight loss may or may not be necessary, depending on the person.

Infants with congenital heart defects often require surgical repair. After surgery, assessing for low cardiac output is critical. Which of the following assessments could be associated with a low cardiac output? Select all that apply (there are 3 correct answers). Bounding pulses Mottled skin Capillary refill time less than 2 seconds Extremities cool to touch Decreasing blood pressure Diuresis

Mottled skin Extremities cool to touch Decreasing blood pressure With a low cardiac output, peripheral tissue perfusion is diminished. Blood and oxygen to tissues is diminished. Skin color reflects poor circulation and/or hypoxia. Skin might be pale, cyanotic (bluish discoloration) or mottled (multicolored, usually blue and pale).

Which finding would the nurse monitor in the patient who has left-sided heart failure? 1 Pedal edema 2 Hepatomegaly 3 Splenomegaly 4 Pulmonary congestion

The most common form of heart failure is left-sided heart failure. It results from left ventricular dysfunction. This prevents normal, forward blood flow and causes blood to back up into the left atrium and pulmonary veins. There would be fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli; this manifests as pulmonary congestion and edema. Right-sided heart failure, which occurs when the right ventricle fails to contract effectively, causes pedal edema, hepatomegaly, and splenomegaly.

Which patients have the greatest risk for aspiration pneumonia? Select all that apply a. Patient with seizures b. Patient with head injury c. Patient who had thoracic surgery d. Patient who had a myocardial infarction e. Patient who is receiving nasogastric tube feeding

a. Patient with seizures b. Patient with head injury e. Patient who is receiving nasogastric tube feeding

With chest auscultation you also hear scattered mild expiratory wheezing in all lung fields. You know that wheezing associated with an asthma exacerbation is a result of: inspired air popping open closed airwaysInspired air popping open inflamed pleural spaces rubbing together air moving through small passages small ruptures in the distal alveoli

air moving through small passages The high-pitched squeaking sound produced when air moves through narrowed airways is called a wheeze. A wheeze is an abnormal (adventitious) sound. In asthma, airway edema, bronchoconstriction, and mucous plugging result in narrowing and obstruction of airways. With exhalation, wheezing is produced as air moves past obstructed areas. Wheezing is common during an asthma exacerbation.

If untreated, a moderate to large Ventricular Septal Defect (VSD) can lead to: hemorrhage congestive heart failure aortic aneurysm cardiac tamponade

congestive heart failure An untreated, moderate to large VSD can lead to congestive heart failure. With a significant left to right shunt, blood volume in the right ventricle and the pulmonary artery is greatly increased, and pulmonary vascular resistance increases. The workload of the right ventricle is increased, as the right side of the heart must work harder to pump blood. The right side of the heart may enlarge, and heart failure may develop. The left side of the heart must also work harder, and may also become inefficient as a pump.

Coarctation of the Aorta (COA) is characterized by pulses and pressures that may be abnormal. Pulse and pressure variations expected with COA include: Select all that apply (there are 2 correct answers). lower blood pressures on both left side limbs higher blood pressures on both upper limbs peripheral pulses in all extremities equal in strength bounding pulses in the lower extremities bounding pulses in the upper extremities

higher blood pressures on both upper limbs bounding pulses in the upper extremities Upper limb hypertension is consistent with COA. Because of increased blood volume proximal to the narrowed area of the aorta, pressure is high in the upper extremities, head, and neck. Because of building pressure proximal to the area where the aorta is narrowed, pressure is high in the upper extremities, head, and neck. This causes bounding pulses in the upper extremities. Carotid and brachial arteries are used for assessment of upper extremity pulses. Pulses are absent or weak in the lower extremities, because blood flow is decreased distal to the area where the aorta is narrowed. Since pedal pulses are difficult to assess in a newborn, femoral pulses are often used for lower extremity pulse assessment.

Proventil (albuterol) is used as frontline treatment for an asthma exacerbation. Its primary therapeutic action is to: induce bronchodilation decrease histamine release decrease coughing reduce the viscosity of respiratory mucous decrease bronchial edema

induce bronchodilation Proventil (albuterol) helps alleviate dyspnea and breathlessness in a child with asthma symptoms through its bronchodilator action. The drug maximizes airway size and improves clearance of secretions.

What are signs and symptoms the nurse should assess for in a patient taking Digoxin that could indicate toxicity of this drug? (they could be early or late symptoms) Select all that apply: tardive dyskinesia nausea vomiting anorexia drowsiness

nausea vomiting anorexia drowsiness GI-related signs and symptoms are the earliest indications that the patient may be having Digoxin toxicity. The other signs and symptoms occur later, especially dysrhythmias.

You observe Joey's respiratory rate to be 34 breaths per minute. Other assessments relevant in evaluating Joey's work of breathing include: Select all that apply (there are 5 correct answers). oxygen saturation chest auscultation for wheezing chest observation for retractions degree of dyspnea hydration status peak expiratory flow rate (PEFR) capillary refill

oxygen saturation chest auscultation for wheezing chest observation for retractions degree of dyspnea peak expiratory flow rate (PEFR)

A 44-yr-old man is diagnosed with hypertension and receives a prescription for benazepril (Lotensin). After providing teaching, which statement by the patient indicates correct understanding? "If I take this medication, I will not need to follow a special diet." "It is normal to have some swelling in my face while taking this medication." "I will need to eat foods such as bananas and potatoes that are high in potassium." "If I develop a dry cough while taking this medication, I should notify my doctor."

"If I develop a dry cough while taking this medication, I should notify my doctor." Benazepril is an angiotensin-converting enzyme inhibitor. The medication inhibits breakdown of bradykinin, which may cause a dry, hacking cough. Other adverse effects include hyperkalemia. Swelling in the face could indicate angioedema and should be reported immediately to the prescriber. Patients taking drug therapy for hypertension should also attempt lifestyle modifications to lower blood pressure such as a reduced sodium diet.

An 18-yr-old patient at the student health center with a history of frequent lung and sinus infections has manifestations consistent with undiagnosed CF. Which information would be accurate for the nurse to include when teaching the patient about a scheduled sweat chloride test? 1 "Sweat chloride greater than 60 mmol/L is consistent with a diagnosis of CF." 2 "The test measures the amount of sodium chloride in your postexercise sweat." 3 "If sweating occurs after an oral dose of pilocarpine, the test result for CP is positive." 4 "If the sweat chloride test result is positive on two occasions, genetic testing will be necessary."

1 "Sweat chloride greater than 60 mmol/L is consistent with a diagnosis of CF." The diagnostic criteria for CF involve a combination of clinical presentation, sweat chloride testing, and genetic testing to confirm the diagnosis. Values above 60 mmol/L for sweat chloride are consistent with the diagnosis of CF. However, a second sweat chloride test is recommended to confirm the diagnosis, unless genetic testing identifies a CF mutation. Genetic testing is used if the results from a sweat chloride test are unclear.

A patient with a sudden onset of respiratory distress is scheduled for a ventilation-perfusion scan. Which instruction does the nurse provide to the patient about the procedure? 1 "The test involves the injection of a radioisotope and the inhalation of a radioactive gas." 2 "You will be sedated during the test to prevent you from moving." 3 "It is important to verify that there is no metal in your body before performing the test." 4 "You will feel a sensation of chest pressure as the dye circulates through your body."

1 "The test involves the injection of a radioisotope and the inhalation of a radioactive gas." A ventilation-perfusion scan has two parts. In the perfusion portion, a radioisotope is injected into the blood, and the pulmonary vasculature is outlined. In the ventilation part, the patient inhales a radioactive gas that outlines the alveoli. Sedation is not required; magnetic imaging is not a component of the examination, so the patient can have the test even if there is metal in the body. Chest pressure may indicate an adverse reaction and is not normal.

Which action would the nurse take when caring for a patient who has a history of asthma and experiences wheezing after vigorous exercise? 1 Advise the patient to avoid breathing dry air. 2 Teach that breathing cold air will decrease wheezing. 3 Recommend continuing vigorous exercise despite dyspnea. 4 Instruct the patient to avoid swimming in indoor, heated pools.

1 Advise the patient to avoid breathing dry air The patient data indicate exercise-induced asthma (EIA). Cold and dry air can precipitate bronchospasm and should be avoided in patients with EIA. Since cold air is likely to cause bronchospasm, the patient should avoid breathing cold air. The patient should stop exercising if dyspnea develops until consulting with a health care provider about possible treatments to prevent EIA. Swimming in indoor, heated pools is encouraged, since warm and moist air is less likely to trigger an asthma attack.

Which inhaler would the nurse be prepared to administer to the patient at the onset of an asthma attack? 1 Albuterol 2 Fluticasone 3 Salmeterol 4 Tiotropium

1 Albuterol Albuterol is a short-acting bronchodilator that should be given first when the patient experiences an asthma attack. Fluticasone is an inhaled corticosteroid (ICS) used to prevent asthma attacks and does not result in rapid bronchodilation. Salmeterol is a long-acting bronchodilator and will not work rapidly to relieve bronchospasm in an acute attack. Tiotropium is a long-acting anticholinergic bronchodilator that is recommended only for use in chronic obstructive pulmonary disease and would not work to rapidly improve breathing in an asthma attack.

The patient has an order for each of the following inhalers. Which one should the nurse offer to the patient at the onset of an asthma attack? 1 Albuterol 2 Ipratropium bromide 3 Salmeterol (Serevent) 4 Beclomethasone (Qvar)

1 Albuterol Albuterol is a short-acting bronchodilator that should be given initially when the patient has an asthma attack. Salmeterol (Serevent) is a long-acting β2-adrenergic agonist, which is not used for acute asthma attacks. Beclomethasone (Qvar) is a corticosteroid inhaler and not recommended for an acute asthma attack. Ipratropium bromide is an anticholinergic agent that is less effective than β2-adrenergic agonists. It may be used in an emergency with a patient unable to tolerate short-acting β2-adrenergic agonists (SABAs).

When the patient with a persistent cough is diagnosed with pertussis, the nurse expects that which type of medication will be prescribed? 1 Antibiotic 2 Corticosteroid 3 Bronchodilator 4 Cough suppressant

1 Antibiotic Pertussis is caused by a gram-negative bacillus, Bordetella pertussis, and must be treated with antibiotics. Corticosteroids and bronchodilators are not helpful in reducing symptoms. Cough suppressants and antihistamines are ineffective and may induce coughing episodes with pertussis.

A 45-yr-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which manifestation would be an early indication of an exacerbation of asthma? 1 Anxiety 2 Cyanosis 3 Bradycardia 4 Hypercapnia

1 Anxiety An early manifestation of an asthma attack is anxiety because the patient is acutely aware of the inability to get sufficient air to breathe. He will be hypoxic early on with decreased PaCO2 and increased pH as he is hyperventilating. If cyanosis occurs, it is a later sign. The pulse and blood pressure will be increased.

A patient with chronic obstructive pulmonary disease (COPD) becomes dyspneic at rest. The baseline ABG results are PaO2 70 mm Hg, PaCO2 52 mm Hg, and pH 7.34. What updated patient assessment requires the nurse's priority intervention? 1 Arterial pH 7.26 2 PaCO2 50 mm Hg 3 Patient in tripod position 4 Increased sputum expectoration

1 Arterial pH 7.26 The patient's pH shows acidosis that supports an exacerbation of COPD along with the worsening dyspnea. The PaCO2 has improved from baseline, the tripod position helps the patient's breathing, and the increase in sputum expectoration will improve the patient's ventilation.

Which findings will the nurse expect when assessing a clinic patient with chronic obstructive pulmonary disease (COPD)? Select all that apply. 1 Barrel chest on inspection 2 Egophony on auscultation 3 Dullness on percussion 4 Wheezes on auscultation 5 Increased tactile fremitus on palpation

1 Barrel chest on inspection 4 Wheezes on auscultation Because of chest expansion caused by air trapping in COPD, patients develop a barrel chest. Breath sounds decrease because of less air movement caused by air trapping, and wheezes are heard because of narrowing of airways caused by inflammation and increased mucus production. Egophony is heard with consolidation of lung tissue, such as that which occurs in patients with pneumonia or pleural effusion. Dullness on percussion would indicate a consolidation of fluid or tissue in the lungs, which is not consistent with COPD. Tactile fremitus is decreased in COPD because trapped air leads to less transmission of vibration from the airways to the chest surface

The provider has prescribed salmeterol (Serevent) for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, what instructions should the nurse provide? 1 Close lips tightly around the mouthpiece and breathe in deeply and quickly." 2 "To administer a DPI, you must use a spacer that holds the medicine so that you can inhale it." 3 "You will know you have correctly used the DPI when you taste or sense the medicine going into your lungs." 4 "Hold the inhaler several inches in front of your mouth and breathe in slowly, holding the medicine as long as possible."

1 Close lips tightly around the mouthpiece and breathe in deeply and quickly." The patient should be instructed to tightly close the lips around the mouthpiece and breathe in deeply and quickly to ensure the medicine moves down deeply into the lungs. Dry powder inhalers do not require spacer devices. The patient may not taste or sense the medicine going into the lungs.

Which manifestations would the nurse identify with asthma? Select all that apply. 1 Cough 2 Crackles 3 Wheezing 4 Chest tightness 5 Pink, frothy sputum

1 Cough 3 Wheezing 4 Chest tightness Symptoms of asthma include cough, chest tightness, and wheezing. Crackles are heard when fluid has accumulated in the lungs, which is not consistent with asthma. Pink, frothy sputum is seen with pulmonary edema.

When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for what potential triggers? (Select all that apply.) 1 Exercise 2 Allergies 3 Emotional stress 4 Decreased humidity 5 Upper respiratory infections

1 Exercise 2 Allergies 3 Emotional stress 5 Upper respiratory infections Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, upper respiratory infections, drug and food additives, stress, and gastroesophageal reflux disease (GERD).

Which sputum characteristics, if present in the patient, may need further evaluation for a patient who is a smoker and has chronic obstructive pulmonary disease (COPD)? Select all that apply. 1 Frothy 2 Foul odor 3 Pink tinged 4 Brown specks 5 Yellowish color

1 Frothy 2 Foul odor 3 Pink tinged COPD may result in whitish to yellowish sputum; however, any change in the baseline characteristics of the sputum should be reported. Frothy sputum may indicate pulmonary edema and needs further evaluation. A foul odor in the sputum indicates presence of infection and needs immediate medical intervention. Pink-tinged sputum may indicate pulmonary edema and the patient may need further evaluation. Sputum with brown specks is a common finding in a person who smokes. Yellowish sputum is a normal finding in COPD.

The nurse is caring for a patient admitted to the hospital with pneumonia. Upon assessment, the nurse notes a temperature of 101.4° F, a productive cough with yellow sputum, and a respiratory rate of 20 breaths/minute. Which is an appropriate nursing diagnosis? 1 Hyperthermia related to infectious illness 2 Ineffective thermoregulation related to chilling 3 Ineffective breathing pattern related to pneumonia 4 Ineffective airway clearance related to thick secretions

1 Hyperthermia related to infectious illness Because the patient has spiked a temperature and has a diagnosis of pneumonia, the logical nursing diagnosis is hyperthermia related to infectious illness. There is no evidence of a chill, and the patient's breathing pattern is within normal limits at 20 breaths/minute. There is no evidence of ineffective airway clearance from the information given because the patient is expectorating sputum.

When teaching the patient with bronchiectasis about manifestations to report to the health care provider, which manifestation should be included? 1 Increasing dyspnea 2 Temperature below 98.6° F 3 Decreased sputum production 4 Unable to drink 3 L of low-sodium fluids

1 Increasing dyspnea The significant manifestations to report to the health care provider include increasing dyspnea, fever, chills, increased sputum production, bloody sputum, and chest pain. Although drinking at least 3 L of low-sodium fluid will help liquefy secretions to make them easier to expectorate, the health care provider does not need to be notified if the patient cannot do this one day.

While teaching a patient with asthma about the appropriate use of a peak flow meter, what should the nurse teach the patient to do? 1 Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse. 2 Increase the dose of the long-term control medication if the peak flow numbers decrease. 3 Use the flowmeter each morning after taking medications to evaluate their effectiveness. 4 Empty the lungs and then inhale quickly through the mouthpiece to measure how fast air can be inhaled.

1 Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse. It is important to keep track of peak flow readings daily, especially when the patient's symptoms are getting worse. The patient should have specific directions as to when to call the provider based on personal peak flow numbers. Peak flow is measured by exhaling into the flowmeter and should be assessed before and after medications to evaluate their effectiveness.

Which complication would the nurse expect in a patient with chronic obstructive pulmonary disease who has α1-antitrypsin (AAT) deficiency? 1 Liver disease 2 Renal disease 3 Intestinal dysfunction 4 Urinary tract dysfunction

1 Liver disease AAT deficiency can cause lung and liver disease, and the nurse will monitor for changes in liver function when caring for a patient with this disease. Renal disease is not an expected complication of AAT deficiency. Intestinal dysfunction is not expected with AAT deficiency. Urinary tract disease is not an expected complication of AAT deficiency.

Which action will the nurse take to prevent complications when a patient is using an oxygen-conserving cannula? 1 Pad the tubing over the patient's ears. 2 Adjust the tubing to fit tightly over the face. 3 Clean the cannula with a disinfectant solution daily. 4 Decrease the O2 flow rate when patient is exercising.

1 Pad the tubing over the patient's ears. To avoid tissue damage or necrosis of the tissue over the patient's ears caused by pressure from the tubing, the nurse will pad the tubing where it passes over the upper ear. The tubing does not fit over the face and does not need to be tight, but rather it positioned directly below the nares. The cannula cannot be disinfected, and the manufacturer recommends changing the tubing weekly. The O2 flow rate may need to be increased when the patient's O2 demands are increased with exercise.

Which disease processes are associated with a pleural friction rub? Select all that apply. 1 Pneumonia 2 Cystic fibrosis 3 Bronchospasm 4 Pulmonary edema 5 Pulmonary infarction

1 Pneumonia 5 Pulmonary infarction Pleural friction, characterized by a creaking or grating sound during inspiration or expiration, is caused by roughened, inflamed pleural surfaces rubbing together. Pneumonia and pulmonary infarction can lead to pleural friction. Cystic fibrosis causes continuous rumbling, snoring, or rattling sounds when rhonchi obstruct large airways. Wheezes are present in the patient with bronchospasm. Pulmonary edema is associated with coarse crackles caused by air passing through the airway when it is intermittently occluded by mucus.

Which description best characterizes chronic obstructive pulmonary disease (COPD)? 1 Progressive persistent expiratory airflow limitation 2 Airway obstruction due to increased mucus production 3 Difficulty clearing secretions due to dilated bronchioles 4 Variations in airflow over time with normal lung function in between

1 Progressive persistent expiratory airflow limitation COPD is characterized by persistent expiratory airflow limitations, which are progressive and not fully reversible. Although increased mucus production may occur with COPD, not all patients with COPD have this finding. Difficulty in clearing secretions may occur with COPD, but dilated bronchioles are more characteristic of bronchiectasis. Asthma is characterized by variations in airflow over time, while patients with COPD have chronic expiratory airflow limitation.

Which diagnostic test will the clinic nurse anticipate to confirm a diagnosis of chronic obstructive pulmonary disease (COPD) in a patient with dyspnea? 1 Spirometry 2 Chest x-ray 3 Arterial blood gas (ABG) 4 CT scan of the chest

1 Spirometry Spirometry is needed to confirm the presence of airflow obstruction and the severity of COPD. The patient is given a short-acting bronchodilator, and post-bronchodilator values are compared with a normal reference value. Chest x-rays are not diagnostic but can show a flat diaphragm caused by hyperinflated lungs. ABGs are used to determine gas exchange but are not diagnostic of COPD because many diseases can impact ABG results. CT scans are not used routinely to diagnose COPD.

The nurse is teaching a patient how to self-administer ipratropium via a metered-dose inhaler (MDI). Which instruction is most appropriate to help the patient learn the proper inhalation technique? 1 "Avoid shaking the inhaler before use." 2 "Breathe out slowly before positioning the inhaler." 3 "Using a spacer should be avoided for this type of medication." 4 "After taking a puff, hold the breath for 30 seconds before exhaling."

2 "Breathe out slowly before positioning the inhaler." It is important to breathe out slowly before positioning the inhaler. This allows the patient to take a deeper breath while inhaling the medication, thus enhancing the effectiveness of the dose. The inhaler should be shaken well. A spacer may be used. Holding the breath after the inhalation of medication helps keep the medication in the lungs, but 30 seconds will not be possible for a patient with COPD.

The nurse teaches a patient with chronic obstructive pulmonary disease (COPD) how to administer fluticasone by metered-dose inhaler (MDI). Which statement indicates a correct understanding of the instructions? 1 "I should not use a spacer device with this inhaler." 2 "I will rinse my mouth each time after I use this inhaler." 3 "I will feel my breathing improve over the next 2 to 3 days." 4 "I should use this inhaler immediately if I have trouble breathing."

2 "I will rinse my mouth each time after I use this inhaler." Fluticasone may cause oral candidiasis (thrush). The patient should rinse the mouth with water or mouthwash after use or use a spacer device to prevent oral fungal infections. Fluticasone is an inhaled corticosteroid and it may take 2 weeks of regular use for effects to be evident. This medication is not recommended for an acute asthma attack.

The nurse determines that the patient understood medication instructions about the use of a spacer device when taking inhaled medications after hearing the patient state what as the primary benefit? 1 "I will pay less for medication because it will last longer." 2 "More of the medication will get down into my lungs to help my breathing." 3 "Now I will not need to breathe in as deeply when taking the inhaler medications." 4 "This device will make it so much easier and faster to take my inhaled medications."

2 "More of the medication will get down into my lungs to help my breathing." A spacer assists more medication to reach the lungs, with less being deposited in the mouth and the back of the throat. It does not affect the cost or increase the speed of using the inhaler.

Which of these is a clinical manifestation of early chronic obstructive pulmonary disease (COPD)? 1 Dyspnea at rest 2 A chronic, intermittent cough 3 The presence of chest breathing 4 Increased numbers of red blood cells

2 A chronic, intermittent cough Clinical manifestations of COPD typically develop slowly. A chronic intermittent cough, which is often the first symptom to develop, may later be present every day as the disease progresses. Dyspnea initially occurs with exertion, and dyspnea at rest is a typical in the later stages of COPD. Use of chest muscles such as the intercostals for breathing occurs in the late stages of COPD. Polycythemia occurs in the later stages of COPD as hypoxemia develops and stimulates increased red blood cell production.

Which test result identifies that a patient with asthma is responding to treatment? 1 An increase in CO2 levels 2 A decreased exhaled nitric oxide 3 A decrease in white blood cell count 4 An increase in serum bicarbonate levels

2 A decreased exhaled nitric oxide Nitric oxide levels are increased in the breath of people with asthma. A decrease in the exhaled nitric oxide concentration suggests that the treatment may be decreasing the lung inflammation associated with asthma and adherence to treatment. An increase in CO2 levels, decreased white blood cell count, and increased serum bicarbonate levels do not indicate a positive response to treatment in a patient with asthma.

Which is the purpose of lung reduction surgery for the patient with chronic obstructive pulmonary disease (COPD)? 1 Returns lung function to normal level for age 2 Allows more room for normal alveoli to expand 3 Permits discontinuation of medications for COPD 4 Replaces diseased lung with healthy tissue from a donor

2 Allows more room for normal alveoli to expand Lung volume reduction surgery is done for patients with severe COPD to remove diseased lung tissue and allow room for the remaining healthy alveoli to expand and function in gas exchange. Improvement in pulmonary function is expected, but the patient will not return to normal function for age. Medications for COPD will continue to be needed after surgery. Lung volume reduction surgery does not involve transplant of tissue from a healthy donor, although lung transplant is another surgical option for patients with severe COPD.

Which time is best to obtain peak flow readings? 1 Five minutes after meals 2 Between noon and 2:00 p.m. 3 Early in the morning on an empty stomach 4 Two hours after inhaling a short-acting β2 agonist

2 Between noon and 2:00 p.m. The peak flow readings should be taken between noon and 2:00 p.m. because the peak flow is highest during this period. The patient may feel nauseous if the peak flow readings are taken five minutes after meals. The peak flow readings are not at a high level early in the morning. Since the peak effect of the short-acting β2 agonists occurs in about 20 minutes, peak flows would be measured about 20 minutes after administration of the medication.

Which patient findings indicate inadequate oxygenation? Select all that apply. 1 Anemia 2 Cyanosis 3 Tachypnea 4 Diaphoresis 5 Hypertension

2 Cyanosis 3 Tachypnea 4 Diaphoresis The symptoms of inadequate oxygenation in the patient include cyanosis, diaphoresis, and tachypnea. Cyanosis indicates inadequate perfusion due to compromised oxygenation. Diaphoresis and tachypnea occur due to sympathetic stimulation to compensate for inadequate oxygenation. Anemia occurs gradually and does not suddenly cause inadequate oxygenation. Hypertension does not indicate inadequate oxygenation in the patient.

The nurse, who has administered a first dose of oral prednisone to a patient with asthma, writes on the care plan to begin monitoring which patient parameters? 1 Apical pulse 2 Daily weight 3 Bowel sounds 4 Deep tendon reflexes

2 Daily weight Corticosteroids such as prednisone can lead to weight gain. For this reason, it is important to monitor the patient's daily weight. The drug should not affect the apical pulse, bowel sounds, or deep tendon reflexes

When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands the manifestations of the disease are related to what process? 1 An overproduction of the antiprotease a1-antitrypsin 2 Hyperinflation of alveoli and destruction of alveolar walls 3 Hypertrophy and hyperplasia of goblet cells in the bronchi 4 Collapse and hypoventilation of the terminal respiratory unit

2 Hyperinflation of alveoli and destruction of alveolar walls In COPD, structural changes include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity. An autosomal recessive deficiency of antitrypsin may cause COPD. Not all patients with COPD have excess mucus production by the increased number of goblet cells.

After the inhalation of puffs of mometasone, a patient develops oropharyngeal candidiasis, hoarseness, and dry cough. Which action would the nurse take to reduce the symptoms? 1 Recommend that the patient pauses between the puffs. 2 Instruct the patient to rinse the mouth with water after inhalation. 3 Assist the patient in obtaining a spacer or holding device for inhalation. 4 Wait until the cough subsides before administering the patient's next dose.

2 Instruct the patient to rinse the mouth with water after inhalation. Upon inhalation into the pharynx, mometasone may cause local irritation, such as oropharyngeal candidiasis, hoarseness, and dry cough. Hence, the patient should rinse the mouth either with water or with mouthwash after inhalation. The patient may not benefit from pausing between the puffs. Asking the patient to use a spacer or holding device for inhalation of corticosteroids can be helpful in getting more medication into the lungs. However, it does not reduce the symptoms of candidiasis. The next dose is given to the patient only upon further advice from the practitioner.

The nurse is evaluating if a patient understands how to safely determine whether a metered-dose inhaler (MDI) is empty. The nurse decides the patient understands this important information when the patient describes which method to check the inhaler? 1 Place it in water to see if it floats. 2 Keep track of the number of inhalations used. 3 Shake the canister while holding it next to the ear. 4 Check the indicator line on the side of the canister.

2 Keep track of the number of inhalations used.

The health care provider prescribes IV vancomycin for a patient with pneumonia. Which action does the nurse perform first? 1 Obtain a full set of vital signs. 2 Obtain sputum cultures for sensitivity. 3 Educate the patient about the adverse effects associated with the medication. 4 Draw a blood specimen to evaluate the white blood cell count

2 Obtain sputum cultures for sensitivity. The nurse should ensure that the sputum for culture and sensitivity has been sent to the laboratory before administering the antibiotic. It is important that the organisms be correctly identified (in the culture) before their numbers are affected by the antibiotic; the test also will determine whether the proper antibiotic has been prescribed (sensitivity testing). Vital signs, education, and white blood cell count measurement can be assessed following the obtainment of sputum cultures.

When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse determines that the patient's nutritional status is impaired after noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care for this patient? 1 Order fruits and fruit juices to be offered between meals. 2 Order a high-calorie, high-protein diet with six small meals a day. 3 Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet. 4 Encourage the patient to double carbohydrate consumption and decrease fat intake.

2 Order a high-calorie, high-protein diet with six small meals a day. Because the patient with COPD needs to use greater energy to breathe, there is often decreased oral intake because of dyspnea. A full stomach also impairs the ability of the diaphragm to descend during inspiration, thus interfering with the work of breathing. For these reasons, the patient with COPD should eat 6 small meals per day taking in a high-calorie, high-protein diet, with nonprotein calories divided evenly between fat and carbohydrate. The other interventions will not increase the patient's caloric intake.

The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone after what occurs? 1 Hypertension and pulmonary edema 2 Oropharyngeal candidiasis and hoarseness 3 Elevation of blood glucose and calcium levels 4 Adrenocortical dysfunction and hyperglycemia

2 Oropharyngeal candidiasis and hoarseness Oropharyngeal candidiasis and hoarseness are common adverse effects from the use of inhaled corticosteroids because the medication can lead to overgrowth of organisms and local irritation if the patient does not rinse the mouth following each dose.

Which assessment finding would the nurse expect when caring for a patient with asthma? 1 pH of 5.11 2 PaCO2 of 30 mm Hg 3 BP of 110/60 mm Hg 4 Respiratory rate of 25 breaths/minute

2 PaCO2 of 30 mm Hg The patient with acute asthma may reveal signs of hypoxemia and hyperventilation as a result of airflow limitation, indicated by a low level of the partial pressure of carbon dioxide in the blood (PaCO2), such as 30 mm Hg. This condition leads to a rise in pH, leading to respiratory alkalosis; however, a pH of 5.11 is low. The respiratory rate of the patient with asthma increases to more than 30 breaths/minute because of the use of accessory muscles. The patient with anxiety as a result of breathlessness has an increase in pulse and BP, which would be higher than 110/60 mm Hg.

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of metoprolol (Lopressor). The nurse should withhold the dose and consult the prescribing provider for which vital sign taken just before administration? 1 O2 saturation 93% 2 Pulse 48 beats/min 3 Respirations 24 breaths/min 4 Blood pressure 118/74 mm Hg

2 Pulse 48 beats/min Because metoprolol is a β1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the health care provider for parameters regarding pulse rate limits.

When teaching a patient about dietary management of stage 1 hypertension, which instruction is appropriate? 1 Increase water intake. 2 Restrict sodium intake. 3 Increase protein intake. 4 Use calcium supplements.

2 Restrict sodium intake. The patient should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Protein intake does not affect hypertension. Calcium supplements are not recommended to lower blood pressure.

A positron emission tomography (PET) scan is used for which respiratory assessment? 1 To assess ventilation and perfusion of lungs 2 To distinguish benign and malignant nodules 3 To visualize pulmonary vasculature and locate obstruction 4 To diagnose lesions difficult to see by CT scan

2 To distinguish benign and malignant nodules PET scans use an IV radioactive glucose preparation to demonstrate increased uptake of glucose in malignant lung cells. A ventilation/perfusion (VQ) scan is used to assess ventilation and perfusion of lungs. A pulmonary angiogram is used to visualize pulmonary vasculature and locate obstruction. An MRI test is used to diagnose lesions difficult to assess by CT scan.

The events of an allergic asthma response occur in which order? 1. Mast cells release histamine. 2. Allergen triggers B lymphocytes. 3. Plasma cells activate immunoglobulin E (IgE) antibodies. 4. Inflammation and mucous production occur.

2. Allergen triggers B lymphocytes. 3. Plasma cells activate immunoglobulin E (IgE) antibodies. 1. Mast cells release histamine. 4. Inflammation and mucous production occur.

Which statements about health disparities that contribute to chronic obstructive pulmonary diseases are accurate? Select all that apply. 1 "Men die more frequently from asthma than women." 2 "Cystic fibrosis is common in African Americans and Hispanics." 3 "Asthma prevalence and age-adjusted death rates are the highest among Puerto Ricans." 4 "Hispanics have lower death rates from chronic obstructive pulmonary diseases than other ethnic groups." 5 "Despite higher rates of smoking in other groups, whites have the highest incidence of chronic obstructive pulmonary diseases."

3 "Asthma prevalence and age-adjusted death rates are the highest among Puerto Ricans." 4 "Hispanics have lower death rates from chronic obstructive pulmonary diseases than other ethnic groups." 5 "Despite higher rates of smoking in other groups, whites have the highest incidence of chronic obstructive pulmonary diseases."

A patient with asthma has a body temperature of 102° F and produces purulent sputum. The nurse anticipates incorporating which medication into the plan of care? 1 A sedative 2 A mucolytic 3 An antibiotic 4 Epinephrine

3 An antibiotic The patient with a body temperature of 102° F and purulent sputum may have a bacterial infection. Hence, treatment with antibiotics would benefit the patient. Sedatives may result in respiratory depression and death. Mucolytics are not recommended because they are not beneficial to the patient suffering from asthma. Epinephrine helps to treat acute anaphylaxis.

When caring for a patient diagnosed with cor pulmonale, which finding will the nurse expect? 1 Jaundice 2 Bradycardia 3 Ankle edema 4 Concave abdomen

3 Ankle edema Cor pulmonale is right-sided heart failure caused by pulmonary hypertension secondary to chronic obstructive pulmonary disease (COPD) disease; symptoms include peripheral edema, jugular vein distension, and hepatomegaly. Polycythemia associated with COPD may cause a bluish tint of the skin; jaundice is associated with liver disease. Because of decreased cardiac output caused by right-sided heart failure, patients with cor pulmonale may have tachycardia. Fluid retention and hepatomegaly caused by right-sided heart failure causes a convex or protuberant abdomen.

Assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)? 1 Acute respiratory failure 2 Secondary respiratory infection 3 Fluid volume excess from cor pulmonale 4 Pulmonary edema caused by left-sided heart failure

3 Fluid volume excess from cor pulmonale Cor pulmonale is a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distention and pedal edema.

In which position should the nurse place a patient experiencing an asthma exacerbation? 1 Supine 2 Lithotomy 3 High Fowler's 4 Reverse Trendelenburg

3 High Fowler's The patient experiencing an asthma attack should be placed in high Fowler's position and may need to lean forward to allow for optimal chest expansion and enlist the aid of gravity during inspiration. The supine, lithotomy, and reverse Trendelenburg positions will not facilitation ventilation.

When a patient is experiencing an acute asthma attack, how will the nurse position the patient? 1 Supine 2 Lithotomy 3 High-Fowler's 4 Reverse Trendelenburg

3 High-Fowler's The goal for positioning during an asthma attack is to maximize the patient's ability to inhale and exhale deep breaths, and the semi-to-high-Fowler's position will allow optimal chest expansion. When the patient is supine, the abdomen can push up against the chest and it is more difficult to fully expand the chest. The abdomen will place pressure against the chest in the lithotomy position, making it more difficult to fully expand the lungs. While a reverse Trendelenburg position will decrease abdominal pressure on the chest, a more upright position is better for chest expansion.

A patient with pulmonary edema will likely present with which mucous characteristics? 1 Foul-smelling sputum 2 Clear, whitish, or yellow sputum 3 Large amounts of frothy, pink-tinged sputum 4 Clear to gray sputum with occasional specks of brown

3 Large amounts of frothy, pink-tinged sputum Large amounts of frothy, pink-tinged sputum support the diagnosis of pulmonary edema, which is characterized by a persistent cough. Foul-smelling sputum indicates an infection. Clear, whitish, or yellow sputum is often found in patients diagnosed with chronic obstructive pulmonary disease, especially in the early morning hours. Clear to gray sputum with brown specks indicates the patient is a smoker.

When a patient is diagnosed with a lung abscess, which does the nurse teach the patient? 1 Lobectomy surgery usually is needed to drain the abscess. 2 IV antibiotic therapy will be used for a prolonged period of time. 3 Oral antibiotics will be used when the patient and x-ray show evidence of improvement. 4 No further culture and sensitivity tests are needed if the patient takes the medication as prescribed.

3 Oral antibiotics will be used when the patient and x-ray show evidence of improvement. IV antibiotics are used until the patient and x-ray show evidence of improvement. Then oral antibiotics are used for a prolonged period of time. Lobectomy surgery is needed only when reinfection of a large cavitary lesion occurs or to establish a diagnosis when there is evidence of a neoplasm or other underlying problem. Culture and sensitivity testing is done during the course of antibiotic therapy to ensure that the infecting organism is not becoming resistant to the antibiotic, as well as at the completion of the antibiotic therapy.

When teaching the patient with cystic fibrosis about diet and medications, what priority information should you include? 1 Fat-soluble vitamins and dietary salt should be avoided. 2 Insulin may be needed with a diabetic diet if diabetes develops. 3 Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed. 4 Distal intestinal obstruction syndrome (DIOS) can be treated with increased water.

3 Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed. The patient must take pancreatic enzymes before each meal and snack and adequate fat, calories, protein, and vitamins should be eaten. Fat-soluble vitamins are needed because they are malabsorbed with the excess mucus in the gastrointestinal system. Insulin may be needed, but there is no longer a diabetic diet, and this is not priority information at this time. DIOS develops in the terminal ileum and is treated with balanced polyethylene glycol electrolyte solution (MiraLAX) to thin bowel contents.

Which information about the purpose of pursed-lip breathing will the nurse include when teaching a patient with chronic obstructive pulmonary disease about breathing exercises? 1 Conserving energy 2 Relieving chest pain 3 Preventing air trapping 4 Increasing respiratory rate

3 Preventing air trapping Pursed-lip breathing decreases air trapping and carbon dioxide retention by increasing positive pressure within the airways, which helps empty the lungs more fully during expiration. Pursed-lip breathing uses slightly more energy than normal exhalation because the patient needs to exhale against positive pressure; patients are taught to use "just enough" positive pressure to avoid increasing the work of breathing. Chest pain is not relieved by pursed-lip breathing. Since the expiratory phase of breathing is lengthened with pursed-lip breathing, respiratory rate is decreased.

The nurse teaches pursed-lip breathing to a patient who is newly diagnosed with chronic obstructive pulmonary disease (COPD). The nurse reinforces that this technique will assist respiration by which mechanism? 1 Loosening secretions so that they may be coughed up more easily 2 Promoting maximal inhalation for better oxygenation of the lungs 3 Preventing bronchial collapse and air trapping in the lungs during exhalation 4 Increasing the respiratory rate and giving the patient control of respiratory patterns

3 Preventing bronchial collapse and air trapping in the lungs during exhalation The purpose of pursed-lip breathing is to slow down the exhalation phase of respiration, which decreases bronchial collapse and subsequent air trapping in the lungs during exhalation. It does not affect secretions, inhalation, or increase the rate of breathing.

The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β-adrenergic bronchodilator and supplemental oxygen. If the patient's condition does not improve, the nurse should anticipate what as the most likely next step in treatment? 1 IV fluids 2 Biofeedback therapy 3 Systemic corticosteroids 4 Pulmonary function testing

3 Systemic corticosteroids Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is insufficient. IV fluids may be used but not to improve ventilation. Biofeedback therapy and pulmonary function testing may be used after recovery to assist the patient and monitor the asthma.

Which assessment finding by the nurse indicates a common adverse effect of a patient's prescribed albuterol inhaler? 1 Diarrhea 2 Headache 3 Tachycardia 4 Oral candidiasis

3 Tachycardia Tachycardia is a common adverse effect of the use of inhaled β2-adrenergic agonists because of its stimulant effect. Headache is not a common adverse effect of albuterol. Diarrhea is not commonly seen with albuterol use. Oral candidiasis may be seen with inhaled corticosteroid use, but it is not an adverse effect with albuterol.

The nurse is caring for a patient admitted for exacerbation of chronic obstructive pulmonary disease. The patient develops severe dyspnea at rest, with an increase in respiratory rate from 26 to 44 breaths/min. Which action by the nurse would be the most appropriate? 1 Have the patient perform huff coughing. 2 Perform chest physiotherapy for 5 minutes. 3 Teach the patient to use pursed-lip breathing. 4 Instruct the patient in diaphragmatic breathing.

3 Teach the patient to use pursed-lip breathing. Pursed-lip breathing (PLB) prolongs exhalation and prevents bronchiolar collapse and air trapping. PLB is simple and easy to teach and learn. It also gives the patient more control over breathing. Evidence from controlled studies does not support the use of diaphragmatic breathing in patients with COPD. Diaphragmatic breathing results in hyperinflation because of increased fatigue and dyspnea and abdominal paradoxical breathing rather than with normal chest wall motion. Chest physiotherapy (percussion and vibration) is used primarily for patients with excessive bronchial secretions who have difficulty clearing them. Huff coughing is a technique that helps patients with COPD to use a forced expiratory technique to clear secretions.

Which response by the nurse is best when a patient with asthma asks "How will I know when my metered-dose inhaler (MDI) is empty?" 1 "The canister will float in water." 2 "There will be no sound when shaking the canister." 3 "Your wheezing will not improve despite inhaler use." 4 "You need to keep track of how many puffs you have used."

4 "You need to keep track of how many puffs you have used." The MDI canister will state how many total doses are available, and the patient will need to track how many doses are used to avoid running out of medication. Floating the canister in water was recommended in the past, but is no longer recommended because water can enter the chamber. The canister may or may not produce a sound when shaking. It is not safe for the patient to wait for wheezing to worsen before getting a new inhaler.

Which information will the nurse include when educating a patient with asthma about use of a peak flow meter? 1 "The peak flow meter should be used weekly." 2 "The peak flow meter reduces asthma attacks." 3 "You will need to measure peak flows soon after arising in the morning" 4 "You should find your personal best peak flow reading for comparison."

4 "You should find your personal best peak flow reading for comparison." It is important that the patient initially determine the personal best readings when first using a peak flow meter to evaluate for decreasing airway function. It should be used at least twice a day for the first two weeks to determine the patient's personal best, which will be used to monitor airway constriction. After the personal best peak flow is determined, daily peak flow readings are recommended. The peak flow meter does not reduce asthma attacks; it helps monitor symptoms of asthma. Peak flows are ideally measured between 12 noon and 2:00 p.m. because peak flows are highest in the early afternoon.

A patient has been receiving oxygen per nasal cannula while hospitalized for chronic obstructive pulmonary disease (COPD). The patient asks the nurse whether oxygen use will be needed at home. What is the most appropriate response by the nurse? 1 "Long-term home oxygen therapy should be used to prevent respiratory failure." 2 "Oxygen will not be needed unless you are in the terminal stages of this disease." 3 "Long-term home oxygen therapy should be used to prevent heart problems related to COPD." 4 "You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia."

4 "You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia." Long-term oxygen therapy in the home will not be considered until the oxygen saturation is less than or equal to 88% and the patient has signs of tissue hypoxia, such as cor pulmonale, erythrocytosis, or impaired mental status. PaO2 less than 55 mm Hg will also allow home oxygen therapy to be considered

Which condition is associated with wheezing? 1 Atelectasis 2 Pleural effusion 3 Pulmonary edema 4 Chronic obstructive pulmonary disease

4 Chronic obstructive pulmonary disease Wheezes are continuous high-pitched squeaking sounds produced by the rapid vibration of the bronchial walls. The rapid vibration is caused by a blockage in the airways, which often occurs with chronic obstructive pulmonary disease. Fine crackles are heard with atelectasis. Diminished breath sounds are heard in pleural effusion. Fine or coarse crackles are heard in patients with pulmonary edema.

Which factor contributes to loss of lung elastic recoil in a patient with chronic obstructive pulmonary disease (COPD) due to cigarette smoking? 1 Increases in norepinephrine level 2 Erythropoiesis leading to polycythemia 3 Suppression of inflammatory mediators 4 Imbalance of protease and antiprotease activity

4 Imbalance of protease and antiprotease activity Cigarette smoking causes an imbalance in the ratio of protease and antiprotease activity that will result in the destruction of alveoli and the loss of elastic recoil in the lungs. Norepinephrine levels may change with smoking but do not contribute to alveolar destruction or loss of elastic recoil. Erythropoiesis may occur in COPD as a compensatory response to hypoxemia but is not a cause of loss of elastic recoil. Noxious chemicals in cigarette smoke cause chronic inflammation leading to increased levels of inflammatory mediators.

The nurse would monitor which comorbidity in the patient who requires high doses of inhaled corticosteroids (ICSs) for asthma management? 1 Hyperlipidemia 2 Hypothyroidism 3 Cholecystitis 4 Osteoporosis

4 Osteoporosis Although ICS use is generally not associated with systemic complications, patients who use high doses of ICSs will need monitoring for corticosteroid-induced osteoporosis. Hyperlipidemia is not a complication of ICS use. Thyroid function is not impaired by ICS use. Cholecystitis is not caused by ICS use.

Which is the most common organism found in heated nebulizers used for humidification during oxygen administration? 1 Staphylococcus aureus 2 Burkholderia cepacia 3 Hemophilus influenzae 4 Pseudomonas aeruginosa

4 Pseudomonas aeruginosa The constant use of humidity supports bacterial growth, with the most common organism being P. aeruginosa. Staphylococcus aureus may colonize nebulizers but is not the most common organism. Burkholderia cepacia is a possible serious chronic infection in patients with cystic fibrosis. Hemophilus influenza is a common infection in patients with cystic fibrosis or bronchiectasis.

Which nursing intervention assists a patient with pneumonia in managing thick secretions and fatigue? 1 Performing postural drainage every hour 2 Providing analgesics as prescribed to promote patient comfort 3 Administering oxygen as prescribed to maintain optimal oxygen saturation levels 4 Teaching the patient how to cough effectively and expectorate secretions

4 Teaching the patient how to cough effectively and expectorate secretions Although several interventions may help the patient expectorate mucus, the nursing interventions should focus on teaching the patient how to cough effectively and expectorate secretions. Postural drainage may help to loosen the secretions. Administering analgesics does not help to manage thick secretions. Administering oxygen also does not help the patient manage secretions.

Before discharge, the nurse discusses activity levels with a 61-yr-old patient with chronic obstructive pulmonary disease (COPD) and pneumonia. Which exercise goal is most appropriate once the patient is fully recovered from this episode of illness? 1 Slightly increase activity over the current level. 2 Swim for 10 min/day, gradually increasing to 30 min/day. 3 Limit exercise to activities of daily living to conserve energy. 4 Walk for 20 min/day, keeping the pulse rate less than 130 beats/min.

4 Walk for 20 min/day, keeping the pulse rate less than 130 beats/min. The patient will benefit from mild aerobic exercise that does not stress the cardiorespiratory system. The patient should be encouraged to walk for 20 min/day, keeping the pulse rate less than 75% to 80% of maximum heart rate (220—patient's age).

A 67-yr-old woman with hypertension is admitted to the emergency department with a blood pressure of 234/148 mm Hg and was started on nitroprusside (Nitropress). After 1 hour of treatment, the mean arterial blood pressure (MAP) is 55 mm Hg. Which nursing action is a priority? Start an infusion of 0.9% normal saline at 100 mL/hr. Maintain the current administration rate of the nitroprusside. Request insertion of an arterial line for accurate blood pressure monitoring. Stop the nitroprusside infusion and assess the patient for potential complications.

Stop the nitroprusside infusion and assess the patient for potential complications. Nitroprusside is a potent vasodilator medication. A blood pressure of 234/118 mm Hg would have a calculated MAP of 177 mm Hg. Subtracting 25% (or 44 mm Hg) = 133 mm Hg. The initial treatment goal is to decrease MAP by no more than 25% within minutes to 1 hour. For this patient, the goal MAP would be around 133 mm Hg. Minimal MAP required to perfuse organs is around 60 to 65 mm Hg. Lowering the blood pressure too rapidly may decrease cerebral, coronary, or renal perfusion and could precipitate a stroke, myocardial infarction, or renal failure. The priority is to stop the nitroprusside infusion and then use fluids only if necessary to support restoration of MAP.

Which information should the nurse consider when planning care for older adult patients with hypertension? (Select all that apply.) Systolic blood pressure increases with aging. White coat syndrome is prevalent in older patients. Volume depletion contributes to orthostatic hypotension. Blood pressures should be maintained near 120/80 mm Hg. Blood pressure drops 1 hour after eating in many older patients. Older patients require higher doses of antihypertensive medications.

Systolic blood pressure increases with aging. White coat syndrome is prevalent in older patients. Volume depletion contributes to orthostatic hypotension. Blood pressures should be maintained near 120/80 mm Hg. Blood pressure drops 1 hour after eating in many older patients. Systolic blood pressure increases with age and patients older than age 60 years should be maintained below 150/90 mm Hg. Older adults are more likely to have elevated blood pressure when taken by health care providers (white coat syndrome). Older patients have orthostatic hypotension related to dehydration, reduced compensatory mechanisms, and medications. One hour after eating, many older patients have a drop in blood pressure. Lower doses of medications may be needed to control blood pressures in older adults related to decreased absorption rates and excretion ability.

After receiving change-of-shift report, which of these patients admitted with heart failure should the nurse assess first? a. A patient who is cool and clammy, with new-onset confusion and restlessness b. A patient who is receiving IV nesiritide and has a blood pressure (BP) of 100/56 c. A patient who has crackles in both posterior lung bases and is receiving oxygen d. A patient who had dizziness after receiving the first dose of captopril

a. A patient who is cool and clammy, with new-onset confusion and restlessness The patient who has "wet-cold" clinical manifestations of heart failure is perfusing inadequately and needs rapid assessment and changes in management. The other patients also should be assessed as quickly as possible, but do not have indications of severe decreases in tissue perfusion.

A patient is diagnosed with hypertension and nadolol is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of a. asthma. b. peptic ulcer disease. c. alcohol dependency. d. myocardial infarction (MI).

a. asthma. Nonselective b-blockers block b1- and b2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. b-blockers will have no effect on the patient's peptic ulcer disease or alcohol dependency. b-blocker therapy is recommended after MI.

When caring for a patient with acute bronchitis, the nurse will prioritize interventions by a. auscultating lung sounds b. encouraging fluid restriction c. administering antibiotic therapy teaching the patient to avoid cough suppressants

a. auscultating lung sounds

A patient has been receiving high-dose corticosteroids and broad-spectrum antibiotics for treatment of an infection after a traumatic injury. The nurse plans care for the patient knowing that the patient is most susceptible to a. candidiasis b. cryptococcosis c. histoplasmosis d. coccidioidomycosis

a. candidiasis

A patient who has chronic heart failure tells the nurse, "I felt fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse will document this assessment information as a. paroxysmal nocturnal dyspnea. b. pulsus alternans. c. two-pillow orthopnea. d. acute bilateral pleural effusion.

a. paroxysmal nocturnal dyspnea. Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus alternans is the alternation of strong and weak peripheral pulses during palpation. Orthopnea indicates that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time period.

You recall that the pathophysiology of asthma includes: Select all that apply (there are 3 correct answers). airway inflammation airway infection bronchospasm thick tenacious respiratory mucous destruction of alveolar walls airway obstruction

airway inflammation bronchospasm airway obstruction Asthma is characterized by episodes of reversible lower airway obstruction. Episodes occur because of bronchoconstriction secondary to airway inflammation. In asthma, edema of the mucous membranes in the bronchial passages triggers bronchospasm and bronchoconstriction, with narrowed airways.

You know that Tilade (nedocromil sodium) is commonly used with children with mild asthma. Its primary therapeutic action is to: facilitate bronchodilation decrease histamine release decrease coughing reduce the viscosity of respiratory mucous

decrease histamine release Tilade (nedocromil sodium) is an anti-inflammatory drug. It decreases histamine release and blocks the inflammation response. It is used primarily to prevent episodes of acute asthma symptoms.

The nurse is caring for a patient with an acute exacerbation of asthma. After initial treatment, what finding indicates to the nurse that the patient's respiratory status is improving? 1 Wheezing becomes louder. 2 Cough remains nonproductive. 3 Vesicular breath sounds decrease. 4 Aerosol bronchodilators stimulate coughing.

1 Wheezing becomes louder. The primary problem during an exacerbation of asthma is narrowing of the airway and subsequent diminished air exchange. As the airways begin to dilate, wheezing gets louder because of better air exchange. Vesicular breath sounds will increase with improved respiratory status. After a severe asthma exacerbation, the cough may be productive and stringy. Coughing after aerosol bronchodilators may indicate a problem with the inhaler or its use.

The nurse determines that therapy with ipratropium is effective after noting which assessment finding? 1 Decreased respiratory rate 2 Increased respiratory rate 3 Increased peak flow readings 4 Decreased sputum production

3 Increased peak flow readings Ipratropium is a bronchodilator that should result in increased peak expiratory flow rates.

he nurse determines that the patient is not experiencing adverse effects of albuterol (Proventil) after noting which patient vital sign? 1 Temperature of 98.4° F 2 Oxygen saturation 96% 3 Pulse rate of 72 beats/min 4 Respiratory rate of 18/ breaths/min

3 Pulse rate of 72 beats/min Albuterol is a β2-agonist that can sometimes cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 72 beats/min indicates that the patient does not have tachycardia as an adverse effect.

When educating a patient with chronic obstructive pulmonary disease (COPD) who continues to smoke cigarettes, which complication of smoking would the nurse discuss with the patient? 1 Cachexia 2 Osteoporosis 3 Metabolic syndrome 4 Cardiovascular disease

4 Cardiovascular disease Since tobacco use is a risk factor for cardiovascular disease as well as for COPD, the nurse will educate the patient about the increased risk for coronary artery disease and myocardial infarction. Cachexia is caused by decreased appetite and increased metabolic needs with COPD. Osteoporosis may occur in COPD because of chronic inflammation and use of corticosteroid medications. Metabolic syndrome may occur as a complication of COPD because of chronic inflammation.

The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy? BP 128/78 mm Hg Weight loss of 2 lb Absence of ankle edema Output of 600 mL per 8 hours

BP 128/78 mm Hg Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Because the patient has been taking this medication for 10 years, the most direct measurement of its intended effect would be the blood pressure.

Ventricular Septal Defect (VSD) can cause congestive heart failure. Which of the following may be signs of congestive heart failure? Select all that apply (there are 4 correct answers). Sudden weight loss Breathing difficulty Swelling of Katie's hands or feet Decrease in diaper wetting Change in sleep/wake habits

Breathing difficulty Swelling of Katie's hands or feet Decrease in diaper wetting Change in sleep/wake habits

The nurse admits a 73-yr-old male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication? Clonidine (Catapres) Bumetanide (Bumex) Amiloride (Midamor) Spironolactone (Aldactone)

Bumetanide (Bumex) Bumetanide is a loop diuretic. Hypokalemia is a common adverse effect of this medication. Amiloride is a potassium-sparing diuretic. Spironolactone is an aldosterone-receptor blocker. Hyperkalemia is an adverse effect of both amiloride and spironolactone. Clonidine is a central-acting α-adrenergic antagonist and does not cause electrolyte abnormalities.

Which corticosteroid would the nurse administer to a patient directly through inhalation? 1 Fluticasone 2 Ciclesonide 3 Budesonide 4 Mometasone

Ciclesonide Ciclesonide has reduced local side effects, such as oropharyngeal candidiasis, hoarseness, and dry cough, because it activates the lungs and is administered directly through inhalation. Drugs such as fluticasone, budesonide, and mometasone cause local irritation as they are activated in the pharynx. Therefore these medications require a spacer for delivery into the lungs.

A nurse is caring for a 16-year-old male patient who has been hospitalized for an acute asthma exacerbation. Which testing methods might the nurse use to measure the patient's oxygen saturation? Select all that apply. a) Thoracentesis b) Spirometry c) Pulse oximetry d) Peak expiratory flow rate e) Diffusion capacity f) Maximal respiratory pressure

b, c, d Spirometers are used to monitor the health status of patients with respiratory disorders, such as asthma. Pulse oximetry is used to obtain baseline information about the patient's oxygen saturation level and is also performed for patients with asthma, along with PEFR to monitor airflow. These three tests may be administered by the nurse.

The nurse is explaining to a student nurse about impaired central perfusion. The nurse knows the student understands this problem when the student states, "Central perfusion a. is decreased with hypertension." b. involves the entire body." c. is monitored only by the physician." d. is toxic to the cardiac system."

b. involves the entire body." Central perfusion does involve the entire body as all organs are supplied with oxygen and vital nutrients. The physician does not control the body's ability for perfusion. Central perfusion is not decreased with hypertension. Central perfusion is not toxic to the cardiac system.

A patient who is being admitted to the emergency department with severe chest pain gives the following list of medications taken at home to the nurse. Which of the medications has the most immediate implications for the patient's care? a. captopril b. sildenafil c. diazepam d. furosemide

b. sildenafil The nurse will need to avoid giving nitrates to the patient because nitrate administration is contraindicated in patients who are using sildenafil because of the risk of sudden death caused by vasodilation. The other home medications also should be documented and reported to the health care provider but do not have as immediate an impact on decisions about the patient's treatment.

A patient with TB has been admitted to the hospital and is placed on airborne precautions and in an isolation room. What should the nurse teach the patient? Select all the apply a. Expect routine TB testing to evaluate the infection b. No visitors will be allowed while in airborne isolation c. Adherence to precautions includes coughing into a paper tissue d. Take all medications for full length of time to prevent multi-drug resistant TB e. Wear a standard isolation mask if leaving the airborne infection isolation room

c. Adherence to precautions includes coughing into a paper tissue d. Take all medications for full length of time to prevent multi-drug resistant TB e. Wear a standard isolation mask if leaving the airborne infection isolation room

A patient was diagnosed with hypertension. The patient asks the nurse how this disease could have happened to them. The nurse's best response is a. happens when people do not exercise, so you should walk every day." b. happens to everyone sooner or later. Don't be concerned about it." c. can happen from arterial changes that impede the blood flow." d. can happen from eating a poor diet, so change what you are eating."

c. can happen from arterial changes that impede the blood flow." Hardening of the arteries from atherosclerosis can cause hypertension in the patient. Hypertension does not happen to everyone. Changing the patient's diet and exercising may be a positive life change, but these answers do not explain to the patient how the disease could have happened.

A nurse is explaining to a student nurse about perfusion. The nurse knows the student understands the concept of perfusion when the student states, "Perfusion a. is monitored by the physician, and I just follow orders." b. varies as a person ages, so I would expect changes in the body." c. is monitored by vital signs and capillary refill." d. is a normal function of the body, and I don't have to be concerned about it."

c. is monitored by vital signs and capillary refill." The best method to monitor perfusion is to monitor vital signs and capillary refill. This allows the nurse to know if perfusion is adequate to maintain vital organs. The nurse does have to be concerned about perfusion. Perfusion is not only monitored by the physician but the nurse too. Perfusion does not always change as the person ages.

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow? a. Patent ductus arteriosus b. Atrial septal defect c. Ventricular septal defect d. Tetralogy of Fallot

d. Tetralogy of Fallot Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the ventricular septal defect. Atrial and ventricular septal defects and patent ductus arteriosus result in increased pulmonary blood flow.

An appropriate nursing intervention to assist a patent with pneumonia manage thick secretions and fatigue would be to a. perform postural drainage every hour b. provide analgesics as ordered to promote patient comfort c. administer oxygen as prescribed to maintain optimal oxygen levels d. teach the patient how to cough effectively and expectorate secretions

d. teach the patient how to cough effectively and expectorate secretions