Adult Health Chapter 28 Lower Respiratory Problems

Which blood vessel's clotting may lead to potentially lethal pulmonary emboli? A. Iliac vein B. Portal vein C. Jugular vein D. Lumbar vein

A Pulmonary embolism is a blockage of the pulmonary artery by thrombus, air or fat embolus, or tumor cells. About 90 percent of pulmonary emboli result from deep vein thrombosis in the deep veins of the legs such as the ileac vein. Lethal pulmonary emboli are less likely the result of thrombus in the portal vein, jugular vein, and lumbar vein, because they rarely migrate to the pulmonary circulation.

Which condition is suspected in a patient when the breath sounds are loud and squeaking during inhalation? A. Pleuritis B. Atelectasis C. Pleural effusion D. Pulmonary embolism

A Pleuritis is inflammation of the pleura and is associated with loud and squeaking breath sounds upon auscultation while the patient is inspiring. It occurs due to a frictional rub of inflamed visceral and parietal pleura. Diminished breath sounds are heard in a patient with atelectasis and pleural effusion. Crackling and wheezing sounds are heard in a patient with pulmonary embolism.

A patient is suspected of having lung cancer. What specific systemic symptom will the nurse question the patient regarding? A. Cough B. Nausea C. Anorexia D. Weight loss

A A cough is the systemic symptom of lung cancer. Nausea, vomiting, anorexia, and weight loss are nonspecific systemic symptoms of lung cancer.

The nurse cares for an immunocompetent patient. Which clinical manifestation is most indicative of pulmonary tuberculosis? A. Mucopurulent sputum B. Diarrhea and fatigue C. Lymph node enlargement D. Hematuria and dehydration

A A cough that progresses in frequency and produces mucoid or mucopurulent sputum is the most common symptom of pulmonary tuberculosis (TB). Diarrhea, hematuria, and dehydration are manifestations not directly associated with pulmonary TB. Fatigue and lymph node enlargement may be seen with TB but are not as indicative as is the production of mucopurulent sputum.

Which type of surgery involves the removal of one lobe of lung? A. Lobectomy B. Pneumonectomy C. Wedge resection D. Segmental resection

A A lobectomy is a type of chest surgery that involves removal of one lobe of lung. A pneumonectomy is a type of chest surgery that involves removal of entire lung. A wedge resection is a type of surgery that involves removal of only a small, localized lesion. A segmental resection is a type of surgery that involves removal of one or more lung segments.

While assessing a patient with lung cancer, the nurse suspects that the patient has brain metastasis. Which finding in the patient supports the nurse's inference? A. Unsteady gait B. Muscle wasting C. Pleural effusions D. Edema of face and neck

A A patient with lung cancer who has brain metastasis may have neurologic problems such as an unsteady gait. Muscle wasting is related to musculoskeletal problems, which are a late manifestation of lung cancer. Pleural effusions are respiratory system manifestations of lung cancer. Edema of the face and neck is observed in patients with superior vena cava syndrome.

Which parameter must be monitored in a patient taking ambrisentan? A. Liver function test B. Serum electrolytes C. Aspergillus infection D. Complete blood picture

A Ambrisentan is an endothelin receptor antagonist that may cause hepatotoxicity with prolonged use. Therefore, liver function tests should be performed every month on the patient receiving the medication. Serum and urine electrolytes are analyzed in the patient with cor pulmonale to evaluate the sodium level. Aspergillus infection is monitored in the patient who has undergone liver transplantation. A complete blood picture is evaluated in a patient with acute pulmonary embolism to find the differential white blood cell count.

Which condition may lead to intrapulmonary restrictive disease? A. Atelectasis B. Kyphoscoliosis C. Chest wall trauma D. Pickwickian syndrome

A Atelectasis is a complete or partial closure of the lungs leading to a reduced exchange of gases that can cause intrapulmonary restrictive disease. Kyphoscoliosis, chest wall trauma, and Pickwickian syndrome cause extrapulmonary restrictive disease, in which the lung tissue is normal.

A patient presents with traumatic hemothorax. What action should the nurse perform immediately? A. Assist the health care provider in inserting a chest tube. B. Conduct routine assessment. C. Observe for 24 hours prior to action. D. Have the patient lie down.

A Hemothorax is an accumulation of blood in the pleural space resulting from injury to the chest wall, lung, blood vessels, diaphragm, or mediastinum. In the case of traumatic hemothorax, the nurse should assist in the immediate insertion of a chest tube, which is required for evacuation of blood. This blood can be recovered and reinfused for a short time after the injury. Further assessment can be done later. Hemothorax needs immediate intervention, and observing for 24 hours is not advisable. Keeping the patient lying down has no effect and is not the immediate action to be performed.

When teaching the patient about reducing the risks of lung cancer, what is the most important topic for the nurse to address? A. Smoking cessation B. Drinking more fluids C. Eating more grains D. Using steam inhalation

A Lung cancer and the risks associated with it can be reduced by smoking cessation, and the patient should be counseled to discontinue use of tobacco and avoid secondhand smoke as much as possible. Drinking more fluids, eating more grains, and using steam inhalation are general measures to promote health and do not have much impact on reducing risks of lung cancer.

When the patient with a persistent cough is diagnosed with pertussis (instead of acute bronchitis), the nurse knows that treatment will include which type of medication? A. Antibiotic B. Corticosteroid C. Bronchodilator D. Cough suppressant

A Pertussis, unlike acute bronchitis, is caused by a gram-negative bacillus, Bordella pertussis, which 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 patient with lung cancer scheduled for a surgical resection received radiation therapy preoperatively. About which outcome does the nurse educate the patient after the radiation therapy? A. Reduction in the tumor mass B. Relief of dyspnea and hemoptysis C. Removal of lesions obstructing the airway D. Delay extension of the tumor into the airway lumen

A Radiation therapy is used preoperatively before a surgical resection to reduce the tumor size. Radiation therapy relieves symptoms of dyspnea and hemoptysis in patients having bronchial obstructive tumors. The removal of lesions obstructing the airway is done using bronchoscopic laser therapy and photodynamic therapy. Airway stenting helps to delay the extension of tumors into the airway lumen.

The nurse is caring for the patient with a productive cough. The nurse collects a sputum specimen for an acid-fast bacillus (AFB) smear. What collection time by the nurse is most appropriate? A. 6 AM B. 12 noon C. 6 PM D. 9 PM

A The correct answer is 6 AM because if the patient has a productive cough, early morning is the ideal time to collect sputum specimens for an AFB smear because secretions collect during the night. Twelve noon, 6 PM, and 9 PM are incorrect, because all of these times are afternoon or evening hours and the amount of secretions for the specimen may not be optimal.

A patient has had lung cancer and is suspected to have metastasis. On what system should the nurse focus the assessment to determine this complication? A. Liver B. Lungs C. Spleen D. Pancreas

A The liver is the most common site of metastasis in lung cancer and the nurse should focus the assessment on symptoms of liver dysfunction.

Which of the following disorders is the most likely cause of cor pulmonale? A. Chronic obstructive pulmonary disease (COPD) B. Left ventricular failure C. Renal failure D. Liver failure

A The most common cause of cor pulmonale is COPD. Left ventricular failure is not a likely cause of cor pulmonale. Cor pulmonale by definition is enlargement of the right ventricle caused by a primary disorder of the respiratory system. Renal failure may eventually result as a consequence of the disease process, but is not a cause of cor pulmonale. Liver failure may or may not eventually result as a consequence of the disease process, but is not a cause of cor pulmonale.

The nurse expects to find which pathologic change in a patient with pulmonary arterial hypertension? A. Increased pulmonary vascular resistance B. Decreased pulmonary vascular resistance C. Respiratory acidosis with failure to compensate D. Increased crackles upon auscultation of the lower posterior and lateral lungs

A The most common cause of pulmonary arterial hypertension (PAH) is increased pulmonary vascular resistance due to primary disease or as a secondary complication of respiratory, cardiac, autoimmune, hepatic, or connective tissue disorders. Increased pulmonary vascular resistance is caused by vasoconstriction, remodeling (vessel wall thickening), and thrombosis. PAH causes right ventricular hypertrophy and eventually right-sided heart failure. PAH does not cause decreased pulmonary vascular resistance or respiratory acidosis. Increased crackles in any area of the lungs would be present in left-sided heart failure, not right-sided heart failure.

A nurse is caring for a patient with a pulmonary embolism who is on warfarin therapy. Which parameter should the nurse monitor in this patient? A. Hematomas B. Polycythemia C. B type natriuretic peptide D. White blood cell differentials

A The nurse should monitor a patient with pulmonary embolism who is on warfarin therapy for complications such as hematomas, bruising, and bleeding. Polycythemia in a patient with cor pulmonale is secondary to chronic obstructive pulmonary disease. B type natriuretic peptide and serum troponin levels are elevated in patients with increased mortality due to pulmonary embolism. White blood cell differentials are helpful to assess pulmonary embolism.

During discharge teaching for a 65-year-old patient with chronic obstructive pulmonary disease (COPD) and pneumonia, which vaccine should the nurse recommend that this patient receive? A. Pneumococcal B. Staphylococcus aureus C. Haemophilus influenzae D. Bacille-Calmette-Guérin (BCG)

A The pneumococcal vaccine is important for patients with a history of heart or lung disease, recovering from a severe illness, age 65 or over, or living in a long-term care facility. An S. aureus vaccine has been researched but has not been proven effective yet. The H. influenzae vaccine would not be recommended, because adults do not need it unless they are immunocompromised. The BCG vaccine is for infants in parts of the world where tuberculosis (TB) is prevalent.

Which wound is described as a penetrating trauma on the chest wall? A. Wound caused by gunshot B. Wound caused by crush injury C. Wound caused by pedestrian accident D. Wound caused by motor vehicle accident

A The wound caused by a gunshot is a penetrating trauma, because it is an open injury into which a foreign object enters into the body. A wound caused by a motor vehicle accident, a crush injury, or a pedestrian accident are blunt injuries.

The nurse is preparing a patient for video-assisted thoracotomy surgery (VATS). The nurse knows that this type of procedure: A. Is a minimally invasive surgical approach B. Provides a real-time one-dimensional video C. Is contraindicated in patients with chest trauma D. Can only be used for patients in previously good health

A VATS is a minimally invasive surgical approach to the chest cavity to diagnose and treat diseases of the pleura, pulmonary masses and nodules, mediastinal masses, and interstitial lung disease. VATS involves a real-time two-dimensional video. VATS is a good option for debilitated patients and those with limited respiratory reserve. It is being used also for patients with chest trauma.

A patient is admitted to the hospital after being involved in a motor vehicle accident. The patient has asymmetrical chest excursion and an absence of breath sounds on the left side. The nurse suspects: A. Left pneumothorax B. Right pneumothorax C. Pulmonary embolism D. Adult respiratory distress syndrome

A When the left part of the chest is crushed, breathing is compromised and asymmetrical excursion is seen. This information, along with the absence of breath sounds, is an indication of a left pneumothorax. The injury is located on the left side of the chest. Pulmonary embolism does not present with the given history. There is not enough information to conclude that adult respiratory distress syndrome (ARDS) has developed. Risk for ARDS is greater after the initial injury, not at the time of the injury.

A patient has clinical manifestations that correlate with a diagnosis of lung cancer. For what test does the nurse initially prepare the patient? A. Biopsy B. Chest x-ray C. Computed tomography D. Sputum cytology studies

B A chest x-ray examination is the first diagnostic test for lung cance,r because it helps identify the lung mass or evident infiltrate. A biopsy is a diagnostic test for cancer that is performed after computed tomography scans. Computed tomography (CT) scans help to further evaluate the lung mass after the its identification on a chest x-ray. Sputum cytology studies help to identify the malignancy of cancer cells; they are not the first test performed to identify the lung cancer.

What is the pulmonary artery pressure in a patient with pulmonary hypertension, at rest? A. 15 mm Hg B. 25 mm Hg C. 30 mm Hg D. 45 mm Hg

B A low resistance and low pressure is maintained in the pulmonary circulation at normal conditions. A patient with pulmonary hypertension may have a pulmonary artery pressure of 25 mm Hg or more when at rest. Normal pulmonary artery pressure is 12 to 16 mm Hg. Therefore, 15 mm Hg is a normal pressure maintained in the pulmonary artery. About 30 mm Hg pressure is maintained in the patient after exercise. A pressure of 45 mm Hg may be lethal in the patient.

A patient had an intradermal tuberculin skin test (Mantoux) administered 48 hours ago. The nurse assesses the injection site and identifies a 12-mm area of palpable induration. How should the nurse interpret this result? A. Definitive evidence that the patient does not have tuberculosis B. A significant indication that the patient has been exposed to tuberculosis C. Delayed hypersensitivity with a high likelihood of infection with tuberculosis D. A negative test that cannot be interpreted as ruling out the presence of tuberculosis

B An area of 12 mm of induration at the injection site 48 hours after a Mantoux test is considered significant for a past or current tuberculin infection. An induration of less than 5 mm is considered a negative result. The other answer options are incorrect conclusions related to the findings.

The registered nurse is evaluating the student nurse performing aspiration of intrapleural fluid. Which action performed by the student nurse indicates the need for correction? A. Monitoring vital signs and oxygen saturation B. Aspirating 1500 mL of pleural fluid at one time C. Making the patient lean forward onto a table D. Injecting a local anesthetic at the intercostal area

B Aspiration of the intrapleural fluid is thoracentesis, which is used for diagnostic and therapeutic purposes. The nurse should aspire about 100 to 1200 mL of fluid at once; excess fluid drainage may lead to hypotension, hypovolemia, and pulmonary edema. The nurse should monitor vital signs, pulse oximetry (oxygen saturation), and signs for respiratory distress during and after the procedure. The patient is moved to the edge of the bed and is asked to lean forward onto a table. The nurse then applies a local anesthetic and injects the thoracentesis needle into the intercostal area to perform thoracentesis.

A patient recovering from thoracic surgery reports shortness of breath and the patient's atrial blood gas report reveals an oxygen saturation of 72 percent. The nurse suspects that the patient may have atelectasis. Which observation by the nurse upon auscultation confirms the diagnosis? A. Loud squeaking sounds during inspiration B. Diminished breath sounds with dullness to percussion C. Crackling, wheezing, and accentuation of pulmonic breath sound D. Increased pulmonic heart sound and right-sided fourth heart sound

B Atelectasis is a condition where the lungs are collapsed as a result of closure of the pores of Kohn and airless alveoli. After thoracic surgery, a patient should take complete bed rest. The patient with atelectasis has diminished sounds or the absence of breath sounds and there is a dullness upon percussion on the affected area. Loud breath sounds similar to the squeaking of a door can be heard in the patient with pleurisy during inspiration. Crackling, wheezing, and accentuation of pulmonic breath sound are heard in the patient with pulmonary embolism. The patient with secondary pulmonary arterial hypertension may have an increased pulmonic heart sound and right-sided fourth heart sound.

The nurse is monitoring a patient who is having a thoracentesis for recurrent pleural effusion. Which of these assessment findings would be of most concern? A. Removal of 1000 mL of pleural fluid B. Restlessness and sudden complaint of dyspnea C. SpO2 reading of 96% while on 2 L/minute of oxygen D. Patient complaint of pressure at the needle insertion site

B During and after a thoracentesis, monitor the patient's vital signs and pulse oximetry and observe the patient for any manifestations of respiratory distress, which may indicate a possible complication, such as pneumothorax or pulmonary edema. It is not unusual to remove up to 1000 to 1200 mL of pleural fluid at one time. The SpO2 reading of 96% and patient complaint of pressure at the needle insertion site are not abnormal findings.

While monitoring chest drainage in a patient with chest trauma, the primary health care provider orders that the drainage tubes be milked. What could be the reason for the order? A. The collection chamber is full. B. There is evidence of obstruction. C. The drainage system is overturned. D. There is a break in the drainage system.

B Milking of drainage takes place only if the primary health care provider orders it, which occurs when there is evidence of obstruction or the presence of clots. The drainage unit should be changed if the collection chamber is full. The patient should be encouraged to take few deep breaths, followed by forced exhalations and cough maneuvers if the drainage system is overturned. The distal end of the chest tubing connection should be placed in a sterile water container at a 2-cm level as an emergency water seal if the drainage system is broken.

The nurse is caring for a patient who will be treated with electric current to destroy tumor cells. For which treatment should the nurse prepare the patient? A. Photodynamic therapy B. Radiofrequency ablation C. Prophylactic cranial radiation D. Stereotactic body radiotherapy

B Radiofrequency ablation is a technique in which a needle-like probe is inserted through the skin into the tumor to deliver an electric current and destroy the tumor cells. Photodynamic therapy is a treatment that uses laser light to destroy tumor cells. Prophylactic cranial radiation is used to decrease the incidence of cerebral metastasis. Stereotactic body radiotherapy uses high doses of radiation to destroy the tumor cells.

After admitting a patient from home to the medical unit with a diagnosis of pneumonia, the nurse will verify that which health care provider prescriptions have been completed before administering a dose of cefuroxime to the patient? A. Orthostatic blood pressures (BP) B. Sputum culture and sensitivity C. Pulmonary function evaluation D. Serum laboratory studies prescribed for the morning

B The nurse should ensure that the sputum for culture and sensitivity was sent to the laboratory before administering the cefuroxime, because this is community-acquired pneumonia. It is important that the organisms are identified correctly (by the culture) before the antibiotic takes effect. The test also will determine whether the proper antibiotic has been prescribed (sensitivity testing). Although antibiotic administration should not be unduly delayed while waiting for the patient to expectorate sputum, orthostatic BP, pulmonary function evaluation, and serum laboratory tests will not be affected by the administration of antibiotics.

A patient with pneumonia is being treated at home and has reported fatigue to the nurse. What instructions should the nurse include when teaching the patient about care and recovery at home? Select all that apply. A. Resume work to build strength. B. Get adequate rest. C. Restrict fluid intake. D. Avoid alcohol and smoking. E. Take every dose of the prescribed antibiotic.

B, D, E To ensure complete recovery after pneumonia, the patient should be advised to rest, avoid alcohol and smoking, and take every dose of the prescribed antibiotic. The patient should not resume work if feeling fatigued and should be encouraged to drink plenty of fluids during the recovery period.

A patient with a history of epilepsy is admitted to the hospital for treatment of fever and shortness of breath. The patient is diagnosed with pneumonia. On taking history, the nurse finds that the patient had an episode of seizures four days ago with profuse vomiting. What type of pneumonia does the patient have? A. Hospital-associated pneumonia B. Community-acquired pneumonia C. Aspiration pneumonia D. Opportunistic pneumonia

C A patient who has seizures is at risk of developing aspiration pneumonia. The gastric contents enter the respiratory tract during the seizure and damage the lung tissue. Therefore this is the most probable reason for the patient's symptoms. The history of the patient does not suggest any exposure to pneumonia in the community. The patient has never been in the hospital; therefore hospital-associated pneumonia is highly unlikely. The patient does not have a history of HIV, intake of immunosuppressive drugs, corticosteroids, or any disorders leading to immunosuppression. Therefore opportunistic pneumonia did not occur in this patient.

While ambulating a patient with metastatic lung cancer, the nurse observes a drop in oxygen saturation from 93% to 86%. Which most appropriate nursing intervention is based upon these findings? A. Continue with ambulation because this is a normal response to activity. B. Obtain a health care provider's prescription for arterial blood gas (ABG) determinations to verify the oxygen saturation. C. Obtain a health care provider's prescription for supplemental oxygen to be used during ambulation and other activity. D. Move the oximetry probe from the finger to the earlobe for more accurate monitoring during activity.

C An oxygen saturation level that drops below 90% with activity indicates that the patient is not tolerating the exercise and needs to use supplemental oxygen. The patient will need to rest to resaturate. ABGs or moving the probe will not be needed, because the pulse oximeter was working at the beginning of the walk.

A 71-year-old patient with metastatic lung cancer has a decrease in oxygen saturation to 87% while completing activities of daily living. What is the priority nursing action? A. Maintain strict bed rest B. Administer a bronchodilator C. Apply supplemental oxygen with increased activity levels as needed (PRN) D. Obtain a stat arterial blood gas

C An oxygen-saturation level that drops below 90% with activity indicates that the patient is not tolerating the exercise and needs supplemental oxygen. Bed rest, bronchodilators, and arterial blood gases are not indicated at this time.

The nurse determines that additional discharge teaching is needed for a patient with pneumonia when the patient states: A. "I will seek medical attention if I develop a fever or productive cough." B. "Breathing exercises may help prevent future infections." C. "I should take antibiotics for all upper respiratory infections." D. "I will take all medications as prescribed."

C Antibiotics are not indicated for all upper respiratory tract infections. It is important for the patient to continue with coughing and deep-breathing exercises for at least six weeks, until all of the infection has cleared from the lungs. The patient should take all medications as prescribed and seek medical attention for signs or symptoms of new infection.

A nurse preparing educational information about lung cancer notes that the primary risk factor related to the development of lung cancer is: A. Genetics B. Chewing tobacco C. Cigarette smoking D. Occupational exposure

C As many as 90% of patients with lung cancer have a history of cigarette smoking. Cigarette smoke contains several organ-specific carcinogens. Genetics and occupational exposure are risks but not as high as cigarette smoking. Chewing tobacco is not associated with lung cancer; it is related to oral cancer.

A new nurse is observed caring for a patient who has a chest tube in place after a partial lobectomy. Which action by the nurse is inappropriate and requires a more experienced nurse to intervene? A. Positioning the patient in a semi-Fowler's position B. Encouraging the patient to increase his fluid intake C. Clamping the chest tube while the patient is ambulating to the bathroom D. Administering the patient's prescribed narcotic analgesic before activity

C Clamping of chest tubes is generally contraindicated. Clamping would allow a buildup of secretions or air in the pleural space and inhibit lung expansion. Patients with chest tubes are usually placed in the semi-Fowler's position for the sake of comfort and ease of breathing. Fluid intake is not a major concern in light of the information provided. Administering the patient's prescribed narcotic analgesic before activity is an expected standard of care for this patient.

When examining a patient after transthoracic needle aspiration, the nurse finds that the patient has excess air in the pleural space. What does the nurse interpret from this finding? A. The patient has hemothorax. B. The patient has cardiac tamponade. C. The patient has iatrogenic pneumothorax. D. The patient has spontaneous pneumothorax.

C Iatrogenic pneumothorax is chest trauma associated with laceration or puncture of the lung that results in excess air in the pleural space. This complication occurs when the patient undergoes procedures such as transthoracic needle aspiration or catheter insertion. Hemothorax is a complication that is characterized by the presence of blood in the pleural space. Cardiac tamponade is a type of lung injury that is manifested by the presence of blood in the pericardial space and compression of the myocardium. Spontaneous pneumothorax is a type of lung trauma that occurs due to rupture of blebs at the apex of the lung.

For what diagnostic test that is used to identify the location and extent of masses in the chest will the nurse prepare the patient with lung cancer? A. Chest x-ray B. Mediastinoscopy C. Computed tomography D. Video-assisted thoracoscopic surgery

C Identifying the location and extent of masses in the chest is done by a computed tomography (CT) scan. A chest x-ray is the initial diagnostic test used to identify the lung mass or infiltrate. A mediastinoscopy is used to obtain cells for biopsy. Similarly, video-assisted thoracoscopic surgery is also used to obtain cells for biopsy.

The nurse is assessing a patient who has been found to have a diffuse infiltrate on a chest x-ray. The patient states, "I am afraid that I have cancer." The nurse will assess the patient for which most common symptom of lung cancer? A. Hoarseness B. Hypercalcemia C. Persistent cough D. Anorexia and weight loss

C One of the most common symptoms of lung cancer, and often the one reported first, is a persistent cough. Other manifestations may occur but they are not the most common symptoms. The patient may complain of dyspnea or wheezing, and blood-tinged sputum may be produced by bleeding. Chest pain, if present, may be localized or unilateral, ranging from mild to severe. Later manifestations include nonspecific systemic symptoms such as anorexia, fatigue, weight loss, and nausea and vomiting. Hoarseness may be present as a result of laryngeal nerve involvement. Hypercalcemia may occur because of paraneoplastic syndrome.

A nurse is assessing a patient in whom lung cancer is suspected. Which symptom is the patient most likely to report first? A. Chest pain B. Diaphoresis C. Persistent cough D. Low-grade fever

C Persistent cough and hoarseness are two of the earliest signs of lung cancer. Chest pain, diaphoresis, and fever may develop along with later symptoms of lung cancer.

What is the reason that the nurse, while assisting with insertion of a chest tube, positions the patient with the arm raised above the head on the affected side? A. To minimize pain B. To reduce the risk of injury C. To expose the midaxillary area D. To avoid the intercostal nerves

C The midaxillary area is the standard site for insertion of a chest tube. Therefore, the nurse will position the patient with the arm raised above the head on the affected side to expose the midaxillary area. Analgesics will be given to the patient to minimize pain. The patient's head will be elevated to reduce the risk of injury. The chest tube will be advanced up over the over the top of the rib to avoid the intercostal nerves.

A patient has been admitted with a suspected lung abscess. During the assessment, the nurse is aware that the most common manifestation of a lung abscess is which of these? A. Fever B. Vomiting C. Purulent sputum that has a foul odor and taste D. Increased breath sounds on auscultation over the involved segment of lung.

C The most common manifestation of a lung abscess is cough-producing purulent sputum (often dark brown) that is foul smelling and foul tasting. Hemoptysis is common, especially when an abscess ruptures into a bronchus. Other common manifestations are fever, chills, prostration, night sweats, pleuritic pain, dyspnea, anorexia, and weight loss. Physical examination of the lungs indicates dullness to percussion and decreased breath sounds on auscultation over the involved segment of lung. Vomiting is not a manifestation of a lung abscess.

What instruction does the nurse give the patient while removing the chest tube? A. "You should sleep in a side-lying position." B. "You should sleep with your leg elevated." C. "You should hold your breath or bear down." D. "You should drink juice before the procedure."

CWhile removing the chest tube, the nurse instructs the patient to perform the Valsalva maneuver because it eases the process of removal. Therefore, the nurse instructs the patient to hold his or her breath or bear down. Sleeping in a side-lying position will reduce lung expansion. Therefore, the patient's condition may be aggravated. The nurse instructs the patient to elevate the leg when he or she has risk of thromboembolism. The nurse does not instruct the patient to drink juice because it may result in nausea.

The nurse is assessing a young male patient who came to the emergency department complaining of sudden shortness of breath. He has no other visible problems. The nurse notes that, upon auscultation, there are no breath sounds on the right upper lobe of the lung. The nurse suspects that the patient has which of these conditions? A. Tension pneumothorax B. Iatrogenic pneumothorax C. Traumatic pneumothorax D. Spontaneous pneumothorax

D A lack of breath sounds over a portion of the lung fields indicates the presence of a pneumothorax. A spontaneous pneumothorax typically occurs because of the rupture of small blebs (air-filled blisters) located on the apex of the lung. These blebs can occur in healthy, young individuals, especially tall, thin males. Tension pneumothorax occurs when air enters the pleural space but cannot escape. The continued accumulation of air in the pleural space causes increasingly elevated intrapleural pressures. Tension pneumothorax can occur with mechanical ventilation and resuscitative efforts. Iatrogenic pneumothorax can occur because of laceration or puncture of the lung during medical procedures. Traumatic pneumothorax can occur from either penetrating (open) or nonpenetrating (closed) chest trauma.

What is the priority nursing intervention in helping a patient expectorate thick lung secretions? A. Humidify the oxygen as able B. Administer cough suppressant q4hr C. Teach patient to splint the affected area D. Increase fluid intake to 3 L/day if tolerated

D Although several interventions may help the patient expectorate mucus, the highest priority should be on increasing fluid intake, which will liquefy the secretions so that the patient can expectorate them more easily. Humidifying the oxygen also is helpful, but is not the primary intervention. Teaching the patient to splint the affected area also may be helpful in decreasing discomfort, but does not assist in expectoration of thick secretions.

The nurse is reviewing the care of a patient with a pulmonary fungal infection. Which of these statements is true? A. The patient will be placed on droplet isolation. B. Opportunistic fungal infections occur in otherwise healthy people. C. Pulmonary fungal infections are transmitted from person to person. D. Amphotericin B is the standard therapy for treating serious systemic fungal infections.

D Amphotericin B remains the standard therapy for treating serious systemic fungal infections. These infections are not transmitted from person to person, and the patient does not have to be placed in isolation. Opportunistic fungal infections occur in immunocompromised patients (e.g., those being treated with corticosteroids, chemotherapy, and immunosuppressive drugs) and in patients with human immunodeficiency virus (HIV) and cystic fibrosis. Fungal infections are acquired by inhalation of spores.

A 71-year-old patient is admitted with acute respiratory distress related to cor pulmonale. Which nursing intervention is most appropriate during admission of this patient? A. Perform a comprehensive health history with the patient to review prior respiratory problems. B. Complete a full physical examination to determine the effect of the respiratory distress on other body functions. C. Delay any physical assessment of the patient and review with the family the patient's history of respiratory problems. D. Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress.

D Because the patient is having respiratory difficulty, the nurse should ask specific questions about this episode and perform a physical assessment of this system. Further history taking and physical examination of other body systems can proceed once the patient's acute respiratory distress is being managed.

Which risk factor is an absolute contraindication to receiving lung transplantation? A. Skin cancer B. Former smoker C. Reversible renal failure D. Chronic active hepatitis B

D Chronic active hepatitis, types B and C, are absolute contraindications for lung transplantation. Malignancy, with the exception of skin cancer, is an absolute contraindication. Skin cancer is not an absolute contraindication to receiving lung transplantation. Current smoking is an absolute contraindication. Former smoking is not, however, an absolute contraindication to lung transplantation. Untreatable advanced dysfunction of another major organ system, such as the kidneys, would be an absolute contraindication to lung transplantation. Reversible renal failure is not a contraindication.

The nurse is reviewing the laboratory reports for the patient receiving cefuroxime. The nurse determines that the medication is having the intended effect by noting which laboratory result? A. Blood urea nitrogen (BUN) 8 mmol/L B. Platelets 175,000 per µL C. Sodium 138 mEq/L D. White blood cell count 4500/mm³

D Depending on the source used, the normal white blood cell count is 4000 to 11,000/mm3or 5000 to 10,000/mm3. Because cefuroxime is a cephalosporin-type antibiotic, a white blood cell count within the normal range indicates resolution of infection. The BUN, platelet count, and sodium level are also normal; however, these results do not relate to antibiotic therapy.

A patient with human immunodeficiency virus (HIV) infection has been admitted with pneumonia. The nurse anticipates that this patient will receive treatment for which type of pneumonia? A. Aspiration pneumonia B. Hospital-associated pneumonia C. Community-acquired pneumonia D. Opportunistic pneumonia caused by Pneumocystis jiroveci

D Individuals at risk for opportunistic pneumonia include those with altered immune responses, such as HIV infection. In addition to the risk of bacterial and viral pneumonia, the immunocompromised person may develop an infection from microorganisms that do not normally cause disease, such as P.jiroveci (formerly carinii). The patient likely does not have aspiration pneumonia, hospital-associated pneumonia, or community-acquired pneumonia.

What will be the immediate nursing action if the nurse, while caring for a patient with chest trauma, finds that the drainage system in the patient is broken? A. Milking the drainage tubes B. Stripping the drainage tubes C. Emptying the collection chamber D. Placing the chest tubing in a sterile water container

D The drainage system should be properly checked to lessen the risk of complications. If the drainage system is found to be broken, then the distal end of the chest tubing connection should be placed in a sterile water container at a 2-cm level as an emergency water seal. Milking and stripping the drainage tubes are done only when there is an order from the physician. The collection chamber should never be emptied but should be replaced.

A patient with lung cancer is scheduled for surgery. What should the nurse assess to determine the patient's ability to withstand surgery? A. Neurologic function B. Integumentary function C. Musculoskeletal function D. Cardiopulmonary function

D The nurse should perform pulmonary function studies and arterial blood gases (ABGs) to assess the cardiopulmonary function because these studies can determine any risks associated with surgery. Neurologic assessments are performed if brain metastasis is suspected in the patient. Integumentary and musculoskeletal functions should be assessed in patients who are suspected to be at risk for distant metastasis.