Chapter 23 book questions
B
A patient arrives in the emergency department after being involved in a motor vehicle crash. The nurse observes paradoxical chest movement when removing the patients shirt. What does the nurse know that this finding indicates? A. Pneumothorax B. Flail chest C. ARDS D. Tension pneumothorax
D
A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse recognize is the most common organism that causes community-acquired pneumonia? A. staphylococcus aureus B. mycobacterium tuberculosis C. pseudomonas aeruginosa D. streptococcus pneumoniae
A
A patient has a mantoux skin test prior to being placed on an immunosuppressant for the treatment of Chrohn's disease. What results would the nurse determine is not significant for holding the medication? A. 0 to 4 mm B. 5 to 6 mm C. 7 to 8 mm D. 9mm
B
A patient is admitted to the hospital with pulmonary arterial hypertension. What assessment finding by the nurse is a significant finding for this patient? A. Ascites B. Dyspnea C. Hypertension D. Syncope
C
A patient taking isoniazid (INH) therapy for tuberculosis demonstrates understanding when making which statement? A. "I am going to have a tuna fish sandwich for lunch." B " It is all right if I drink a glass of red wine with my dinner." C. " It is all right if I have a grilled cheese sandwich with American cheese" D. " It is fine if I eat sushi with a little bit of soy sauce"
A
A patient who had a colon resection 3 days ago reports discomfort in the left calf. How should the nurse assess Homan sign to determine if the patient may have a thrombus formation in the leg? A. Dorsiflex the foot while the leg is elevated to check for calf pain B. Elevate the patients legs for 20 minutes and then lower them slowly while checking for areas of inadequate blood return C. Extend the leg, plantar flex the foot, and check for patency of the dorsalis pedis pulse D. Lower the patients legs and massage the calf muscles to note any areas of tenderness
B
A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What information should the nurse provide to the patient? A. "Only wear your contact lenses during the day and take them out in the evening before bed" B " You should switch to wearing your glasses while taking this medication" C. " The health care provider can give you eye drops to prevent any problems" D. "There are no significant problems with wearing contact lenses"
A
A patient with pulmonary hypertension has a positive vasoreactivity test. What medication does the nurse anticipate administering to this patient? A. Calcium channel blockers B. Angiotensin converting enzyme inhibitor C. Beta blockers D. Angiotensin receptor blockers
empyema
A(n) ___________________ is an accumulation of thick, purulent fluid within the pleural space, often with fibrin development and a loculated area where infection is located
impaired central nervous system (CNS) function, neuromuscular, musculoskeletal, pulmonary dysfunction
Four respiratory system mechanisms that can lead to acute respiratory failure (ARF) are:
48
Hospital-acquired pneumonia develops ___________________________ hours or more after admission and does not appear to be incubating at the time of admission.
rifampin, pyrazinamide, ethambutol, isoniazid
In current tuberculosis (TB) treatment, four first line medications are used
dyspnea, cough, sputum production, tachycardia, tachypnea, pleural space, central cyanosis
Name 7 possible clinical manifestations of atelectasis
alcoholism, chronic obstructive pulmonary disease (COPD), acquired immune deficiency syndrome (AIDS), diabetes, heart failure
Pneumonia tends to occur in patients with one or more of these five underlying disorders
D
The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment? A. cough B. Hemoptysis C. Syncope D. Tachypnea
C
The nurse is administering anticoagulant therapy with heparin. What international normalized ratio (INR) would the nurse know is within therapeutic range? A. 0.5 to 1.0 B. 1.5 to 2.5 C. 2.0 to 2.5 D. 3.0 to 3.5
D
The nurse is assessing a patient who has been admitted with a possible acute respiratory distress syndrome (ARDS). What findings would distinguish ARDS from cardiogenic pulmonary edema? A. elevated white blood count B. elevated troponin levels C. elevated myoglobin levels D. elevated B-type natriuretic peptide (BNP) levels
A
The nurse is auscultating the patient's lung sounds to determine the presence of pulmonary edema. What adventitious lung sounds are significant for pulmonary edema? A. crackles in the lung bases B. low-pitched rhonchi during expiration C. pleural friction rub D. sibilant wheezes
D
The nurse is caring for a patient with pleurisy. What symptoms does the nurse recognize are significant for this patient's diagnosis? A. dullness or flatness on percussion over areas of collected fluid B. dyspnea and coughing C. fever and chills D. stabbing pain during respiratory movement
A
The nurse is caring for a patient with suspected acute respiratory distress syndrome (ARDS) with a PO2 of 53. The patient is placed on oxygen via face mask and the PO2 remains the same. What does the nurse recognize as a key characteristic of ARDS? A. unresponsive arterial hypoxemia B. diminished alveolar dilation C. tachypnea D. increased PaO2
A
The nurse is collecting a sputum culture to identify the causative organism for a patient with acute tracheobronchitis. What causative fungal organism does the nurse suspect? A. Aspergillus B. Haemophilus C. Mycoplasma pneumoniae D. Streptococcus pneumoniae
C
The nurse is conducting a community program about the prevention of respiratory illness. What illness does the nurse recognize is the most common cause of death in the United States? A. Atelectasis B. pulmonary embolus C. pneumonia D. tracheobronchitis
A,B,C
The nurse is developing a plan of care for a patient with acute tracheobronchitis. What nursing interventions should be included in the plan of care? (select all that apply) A. increasing fluid intake to remove secretions B. encouraging the patient to remain in bed C. using cool vapor therapy to relieve laryngeal and tracheal irritation D. giving 3 L fluid per day E. administering a narcotic analgesic for pain
C
The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse ,"How long will I have to be on these medications?" What should the nurse tell the patient? A. 3 months B. 3 to 5 months C. 6 to 12 months D. 13 to 18 months
B
The nurse is having an information session with a womens group at the YMCA about lung cancer. What frequent and commonly experienced symptom should the nurse be sure to include in the session? A. Copious sputum production B. Coughing C. Dyspnea D. Severe pain
A,B,D,E
The nurse is planning the care for a patient at risk of developing pulmonary embolism. What nursing interventions should be included in the care plan? (select all that apply) A. encouraging a liberal fluid intake B. Assisting the patient to do leg elevations above the level of the heart C. Instructing the patient to dangle the legs over the side of the bed for 30 minutes, four times a day D. Using elastic stockings, especially when decreased mobility would promote venous stasis E. Applying a sequential compression device
Streptococcus pneumoniae, Haemophilus influenzae, staphylococcus aureus
Three common pathogens that cause aspiration pneumonia are _____________________________ , _____________________________, and __________________________.
hypotension, shock, respiratory failure
Three severe complications of pneumonia are :
silent aspiration
When a nonfunctioning nasogastric tube allows the gastric contents to accumulate in the stomach, a condition known as _______________________ may result
tachypnea, dyspnea, mild to moderate hypoxemia
______________________, _____________________, and _________________ are hallmarks of the severity of atelectasis
superinfection
a subsequent infection occurs with another bacterium during antibiotic therapy