Chapter 27 review questions

A patient experiences a chest injury as a result of a motor vehicle accident. The patient's assessment finding include asymmetric chest excursion and an absence of breath sounds on the left side. Which condition does the nurse suspect? A. Left- sided pneumothorax B. Left- sided pleural effusion C. Pulmonary embolism (PE) D. Adult respiratory distress syndrome (ARDS)

A, Left- sided pneumothorax

An older adult patient living alone is admitted to the hospital with pneumococcal pneumonia. Which clinical manifestation is consistent with the patient being hypoxic? A. Sudden onset of confusion B. Oral temperature of 102.3 F C. Coarse crackles in lung bases D. Clutching chest on inspiration

A, Sudden onset of confusion Rationale: Confusion or stupor (related to hypoxia) may be the only clinical manifestation of pneumonia in an older adult patient. An Elevated temperature, coarse crackles, and pleuritic chest pain with guarding may occur with pneumonia, but these symptoms do not indicate hypoxia

Which factor in the patient health history below puts her at increased risk for developing lung cancer A. Demographics: 57 year old Asian female B. Social history: 20 year pack smoker C. Medical history: hypertension D. Surgical history: tonsillectomy

B Social history: 20 year pack smoker

The nurse provides education for a patient about reducing the risk of atelectasis while undergoing chest tube drainage. Which statements made by the patient indicate effective learning? Select all that apply. A. "I should change positions slowly." B. "I should cough at regular intervals." C. "I should use my incentive spirometer." D. "I should reduce the intake of protein in my diet E. "I should perform range of motion exercises."

B. "I should cough at regular intervals." C. "I should use my incentive spirometer." E. "I should perform range of motion exercises."

The nurse is caring for a group of patients. Which patient is at risk of aspiration? A. A 58yr-old patient with absent bowel sounds 12 hrs after abdominal surgery B. A 26- yr-old patient with continuous enteral feedings through a nasogastric tube C. A 67 yr old patient who had a cerebrovascular accident with expressive dysphasia D. A 92 yr old patient with viral pneumonia and coarse crackles throughout the lung fields

B. A 26 yr old patient with continuous enteral feedings through a nasogastric tube Rationale: Conditions that increase the risk of aspiration include decreased level of consciousness, difficulty swallowing (dysphagia), and nasogastric intubation with or without enteral nutrition. With loss of consciousness, the gag and cough reflexes are depressed, and aspiration is more likely to occur. Dysphasia is difficulty with speech. Absent bowel sounds and coarse crackles do not increase the risk for aspiration

A patient presents with clinical manifestations that correlate with a diagnosis of lung cancer. For which test does the nurse initially prepare the patient? A. biopsy B. Chest x-ray C. CT scan D. Sputum cytology studies

B. Chest x-ray

Which common causes would the nurse identify for accumulation of fluid in the alveoli and interstitial spaces of the lungs? Select all that apply A. Pregnancy B. Heart failure C. Oxygen toxicity D. Opioid overuse E. Muscular dystrophy

B. Heart failure C. Oxygen toxicity D. Opioid overuse

The nurse is caring for a patient with pneumonia unresponsive to two different antibiotics. Which action is most important for the nurse to complete before administering a newly prescribed antibiotic? A. Teach the patient to cough and deep breathe B. Take the temperature, pulse, and respiratory rate. C. Obtain a sputum specimen for culture and Gram Stain. D. Check the patient's oxygen saturation by pulse oximetry.

C. Obtain a sputum specimen for culture and Gram Stain Rationale: A Sputum specimen for culture and Gram stain to identify the organism should be obtained before beginning antibiotic therapy. However, antibiotic administration should not be delayed if a specimen cannot be readily obtained because delays in antibiotic therapy can increase morbidity and mortality risks

The nurse is caring for a patient with unilateral lung cancer. What is the priority nursing action to enhance oxygenation in this patient? A. Positioning patient on right side B. Maintaining adequate fluid intake C. Positioning patient with "good lung" down D. Performing postural drainage every 4 hours

C. Positioning patient with "good lung" down Rationale: Therapeutic positionng identifeis the best position for the patient, thus assuring stable oxygenation status. Research indicated that positioning the patient with the unaffected lung (good lung) dependent best promotes oxygenation in patients with unilateral lung disease. For bilateral lung disease, the right lung down has best ventilation and perfusion. Increasing fluid intake and performing postural drainage will facilitate airway clearance, but positioning is most appropriate to enhance oxygenation.

A patient has a chest tube inserted to treat a pneumothorax. which observation causes the nurse to conclude that the water- seal chamber of the chest drainage unit (CDU) is functioning properly A. There is no bubbling in the suction control chamber B. The wall suction regulator is set to 150 mm Hg C. The level in the water- seal chamber fluctuates with respirations D. There is bloody drainage present in the water seal chamber

C. The level in the water- seal chamber fluctuates with respirations

An experienced nurse instructs a new nurse about how to care for a patient with dyspnea caused by a pulmonary fungal infection. Which action by the new nurse indicates a need for further teaching? a. Listening to the patients lung sounds several times during the shift b. Placing the patient on droplet precautions and in a private hospital room c. Increasing the oxygen flow rate to keep the oxygen saturation above 90% d. Monitoring patient serology results to identify the specific infecting organism

b. Placing the patient on droplet precautions and in a private hospital room rationale: Fungal infections are not transmitted from person to person. Therefore no isolation procedures are necessary. The other actions by the new nurse are appropriate

A patient with heart failure has a pulmonary arterial pressure of 28 mm Hg when at rest. Which intervention would the nurse implement? A. Supplying oxygen to the patient B. Infusing Iv fluids to the patient C. Applying warm and cold compresses to the patient D. Positioning the patient at an angle of 90 degrees

A. Supplying oxygen to the patient

The nurse is caring for a patient with a fever due to pneumonia. what assessment data does the nurse obtain that correlates with the patient having a fever? (Select all that apply) A. A temperature of 101.4 F B. Heart rate of 120 beats/ min C. Respiratory rate of 20 breaths/ min D. A productive cough with yellow sputum E. Reports of unable to have a bowel movement for 2 days.

A. A temperature of 101.4 F B. Heart rate of 120 beats/min D. A productive cough with yellow sputum Rationale: A fever is an inflammatory response related to the infectious process. A productive cough with discolored sputum (which should be clear) is an indication that the patient has pneumonia. A respiratory rate of 20 breaths/ min is within normal range. Inability to have a bowel movement is not related to a diagnosis of pneumonia. A heart rate of 120 beats/min indicates that there is increased metabolism due to the fever and is related to the diagnosis of pneumonia

A patient with a persistent cough is diagnosed with pertussis. What medication does the nurse anticipate administering to this patient? A. Antibiotic B. Corticosteroid C. Bronchodilator D. Cough suppressant

A. Antibiotic Rationale: Pertussis, unlike acute bronchitis, is caused by a gram- negative bacillus, Bordetella 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

during admission of a patient diagnosed with non-small cell lung caner, the nurse questions the patient related to a history of which risk factors for this type of cancer?(select all that apply) A. Asbestos exposure B. Exposure to uranium C. Chronic interstitial fibrosis History of cigarette smoking E. Geographic area in which they were born

A. Asbestos exposure B. Exposure to uranium D. History of cigarette smoking Rationale: non- small cell cancer is associated with cigarette smoking and exposure to environmental carcinogens, including asbestos and uranium

A patient reports shortness of breath one day after a cholecystectomy. The nurse assesses the right lung sounds and notes dullness to percussion and decreased breath sounds. Which is the most probable reason for the assessment findings? A. Atelectasis B. Pneumonia C. Pneumothorax D. Tension pneumothorax

A. Atelectasis

Which condition would the nurse identify as possibly leading to intrapulmonary restrictive disease in a patient? A. Atelectasis B. Kyphoscoliosis C. Chest wall trauma D. Pickwickian syndrome

A. Atelectasis

The nurse is performing a respiratory assessment. which finding best supports the presence of impaired airway clearance? A. Basilar crackles B. Oxygen saturation of 85% C. Presence of greenish sputum D. Respiratory rate of 28 breaths/min

A. Basilar crackles Rationale: The presence of adventitious breath sounds indicates that there is accumulation of secretions in the lower airways. This would be consistent with impaired airway clearance because the patient is retaining secretions. The rapid respiratory rate, low oxygen saturation, and presence of greenish sputum may occur with other lower respiratory problems

The nurse is admitting a patient with a diagnosis of pulmonary embolism. which risk factors are a priority for the nurse to assess? (select all that apply) A. Cancer B. Obesity C. Pneumonia D. Cigarette smoking E. Prolonged air travel

A. Cancer B. Obesity D. Cigarette Smoking E. Prolonged air travel Rationale: An increased risk of PE is associated with obesity, cancer, heavy cigarette smoking, and prolonged air travel with reduced mobility. Other risk factors include deep vein thrombosis, immobilization, and surgery within the previous 3 months, oral contraceptives and hormone therapy, heart failure, pregnancy and clotting disorders

The registered nurse is evaluating the actions of a nursing student who is maintaining a chest drainage unit (CDU) for a patient with chest trauma. The nurse intervenes when the student performs which actions? Select all that apply. A. Coils the tubing above the chest level B. Expects air fluctuations in the water-seal chamber C. Verifies the presence of an air- occlusive dressing over the insertion site D. Connects the chest tube to wall suction to check for tidaling E. Positions the tubing so that the drainage flows freely from the insertion site to the collection chamber

A. Coils the tubing above the chest level D. Connects the chest tube to wall suction to check for tidaling

Which factors are considered to be direct causes of lung cancer? Select all that apply? A. Smoking B. Chewing tobacco C. Genetic mutation D. Bronchial asthma E. Coal dust inhalation F. High levels of pollution

A. Smoking E. Coal dust inhalation F. High levels of pollution Rationale: Chewing tobacco is a precursor to oral cancer, not lung cancer. Bronchial asthma is a medical condition not associated with lung cancer, and genetic mutations are predispositions for cancer overall, not specifically lung cancer

A patient with a gunshot wound to the right side of the chest arrives in the emergency department with sever shortness of breath and decreased breath sounds on the right side of the chest. Which action should the nurse take immediately? A. Cover the chest wound with a nonporous dressing taped on three sides B. Pack the chest wound with sterile saline soaked gauze and tape securely. C. Stabilize the chest wall with tape and initiate positive pressure ventilation D. Apply pressure dressing over the wound to prevent excessive loss of blood

A. Cover the chest wound with a nonporous dressing taped on three sides Rationale: The patient has a sucking chest wound (Open pneumothorax). Air enters the pleural space through the chest wall during inspiration. Emergency treatment consists of covering the wound with an occlusive dressing that is secured on three sides. During inspiration, the dressing pulls against the wound, preventing air from entering the pleural space. During expiration, the dressing is pushed out and air escapes through the wound and from under the dressing.

Which condition in a patient with chest trauma requires treatment with positive pressure ventilation A. Flail chest B. Cardiac tamponade C. Hemopneumothorax D. Tension pneumothorax

A. Flail chest

Which instructions does the nurse provide to a patient with acute bronchitis? select all that apply A. Increase oral fluid intake B. Avoid secondhand smoke C. Maintain a 30- degree head elevation when in bed D. Avoid throat lozenges because they may induce coughing E. Eat a spoonful of honey to help relieve cough

A. Increase oral fluid intake B. Avoid Secondhand smoke E. Eat a spoonful of honey to help relieve cough

A patient who is diagnosed with a hamartoma asks the nurse for more information about the lung tumor. which explanation does the nurse give? A. It is a slow- growing congenital tumor. B. It is a benign tumor arising in the bronchi C. It is a tumor that originates from the visceral pleura D. It is a tumor that consists of columnar cystic spaces

A. It is a slow- growing congenital tumor.

A patient is diagnosed with a lung abscess. What should the nurse include when teaching the patient about this diagnosis? A. Iv antibiotic therapy will be started as soon as possible B. Lobectomy surgery is usually needed to drain the abscess C. Oral antibiotics will be used until there is evidence of improvement D. Culture and sensitivity tests are needed for 1 year after resolving the abscess

A. Iv antibiotic therapy will be started as soon as possible Rationale: Iv antibiotics are used until the patient and radiographs show evidence of improvement. Then oral antibiotics are used for a prolonged period of time. 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 at the completion of antibiotic therapy. Lobectomy surgery is only needed when reinfection of a large cavitary lesion occurs or to establish a diagnosis when there is evidence of a neoplasm or other underlying problem

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

A. Liver function test Rationale: 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 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 evaluate in a patient with acute pulmonary embolism to find the differential white blood cell count

The nurse is caring for a postoperative patient with impaired airway clearance. What nursing actions would promote airway clearance? (Select all that apply) A. Maintain adequate fluid intake B. Maintain a 15-degree elevation C. Splint the chest when coughing D. Have the patient use incentive spirometry. E. Teach the patient to cough at end of exhalation

A. Maintain adequate fluid C. Splint the chest when coughing E. Teach the patient to cough at end of exhalation Rationale: Maintaining adequate fluid intake liquefies secretions, allowing easier expectoration. The nurse should teach the patient to splint the chest while coughing. This will reduce discomfort and allow for a more effective cough. Coughing at the end of exhalation promotes a more effective cough. Incentive spirometry promotes lung expansion. The patient should be positioned in an upright sitting position (High Fowler's) with head slightly flexed.

The nurse cares for a patient who is immunocompetent and presents with pulmonary tuberculosis (TB). Which clinical manifestation does the nurse expect? A. Mucopurulent sputum B. Diarrhea C. Lymph node enlargement D. Dehydration

A. Mucopurulent sputum

During discharge teaching for an older adult 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- Guerin (BCG)

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

The nurse provides education for community members about lung cancer and includes information about which primary risk factor A. Smoking B. Pollution C. Radon exposure D. Asbestos

A. Smoking

When teaching a patient about reducing the risk for lung cancer, which is the most important topic for the nurse to address A. Smoking cessation B. Drinking more fluids C. Eating more grains D. Exercising regularly

A. Smoking cessation

A patient with a pneumothorax has a chest tube in place. The nurse verifies that there are no leaks in the tubing or at the insertion site. The nurse notes that there is no bubbling in the suction control chamber of the chest drainage unit (CDU). Which are the most probable reasons for the absence of bubbling? Select all that appyly A. There is no suctioning being applied B. The CDU is not working properly C. The Suction pressure is very low D. The pleural air leak is so large that the suction is not high enough to evacuate it. E. There is a collection of blood in the pleural space

A. There is no suctioning being applied C. The suction pressure is very low D. The pleural air leak is so large that the suction is not high enough to evacuate it.

The home health nurse provides which instruction for a patient being treated for pneumonia? A. Use a cool mist humidifier to help with breathing B. Drink at least 4 to 6 glasses of liquids/ day C. Schedule a follow- up chest x-ray in 8 to 10 weeks D. Expect that it may be several days before the usual sense of well- being returns

A. Use a cool mist humidifier to help with breathing

Which patient is experiencing restrictive lung disease from an intrapulmonary cause A. patient 1: antibiotic therapy for bacterial pneumonia B. patient 2: mechanical ventilation for opiate overdose C. patient 3: oxygen therapy for obesity- hypoventilation D. patient 4: acute exacerbation of muscular dystrophy

A. patient 1: antibiotic therapy for bacterial pneumonia

The nurse teaches a patient with a pulmonary embolism how to administer enoxaparin after discharge. Which statement by the patient indicated understanding about the instructions? A. "I need to take this medicine with meals." B. "The medicine will be prescribed for 10 days." C. "I will inject this medicine into my upper arm." D. "The medicine will dissolve the clot in my lung."

B. "The medicine will be prescribed for 10 days." Rationale: Enoxaparin is a low- molecular weight heparin that is administered for 10 to 14 days and prevents future clotting but does not dissolve existing clits. Fibrinolytic agents ( ex: tissue plasminogen activator or alteplase) dissolve an existing clot. Enoxaparin is administered subcutaneously by injection into the abdomen =

Which would the nurse identify as the pulmonary artery pressure at rest in a patient with pulmonary hypertension A. 15 mm Hg B. 25 mm Hg C. 30 mm Hg D. 45 mm Hg

B. 25 mm Hg Rationale: Normal pulmonary artery pressure 12 to 16 mm Hg Pulmonary artery pressure with pulmonary hypertension anything of 25 mm Hg or higher 45 mm Hg is lethal in a patient

Forty-eight hours after a patient received an intradermal tuberculin skin test (Mantoux), the nurse assesses the injection site and notes a 12-mm area of palpable induration how does 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 presence of tuberculosis

B. A significant indication that the patient has been exposed to tuberculosis Rationale: Induration, a palpable, raised, hardened area or swelling (not redness) at the injection site, means the person has been exposed to tuberculosis and have developed antibodies

A patient's initial purified protein derivative (PPD) skin test result is a positive. A repeat skin test test is also positive. No Signs or symptoms of tuberculosis or allergies are evident. Which medication therapy does the nurse anticipate will be prescribed A. Penicillin B. Isoniazid (INH) C. Theophylline D. INH plus an antibiotic

B. Isoniazid (INH)

The nurse is developing a plan of care for a patient with metastatic lung cancer and a 60-pack- year history of cigarette smoking. What should the nurse assess this patient for? A. Cough reflex B. Mucociliary clearance C. Reflex bronchoconstriction D. Ability to filter particles from the air

B. Mucociliary Clearance Rationale: smoking decreases the ciliary action in the tracheobronchial tree, resulting in impaired clearance of respiratory secretions and particles, chronic cough, and frequent respiratory infections.

The nurse finds that a patient with chest trauma exhibits cyanosis, air hunger, neck vein distention, and an increase in intrathoracic pressure. The nurse prepares for which procedure? A. Pericardiocentesis B. Needle decompression C. Insertion of a chest tube with a flutter valve D. Insertion of a chest tube with drainage system

B. Needle decompression

The nurse reviews the medical records of six adults and determines that the pneumococcal polysaccharide vaccine will be recommended for which patients? Select all that apply. A. Patient A: age 25, obesity B. Patient B: age 35; smokes cigarettes C. Patient C: age 45; diabetes D. Patient D: age 55; had spleen removed as a teenager E. Patient E: age 65; elevated cholesterol level F: Patient F: age 75; no significant medical history

B. Patient B: age 35; smokes cigarettes C. Patient C: age 45; diabetes D. Patient D: age 55; had spleen removed as a teenager E. Patient E: age 65; elevated cholesterol level F: Patient F: age 75; no significant medical history

Which condition would the nurse monitor for in a patient after a rapid draining of 1500 mL of fluid during a thoracentesis A. Cor pulmonale B. Respiratory distress C. Pulmonary hypertension D. Diffuse parenchymal disorder

B. Respiratory distress

After admitting a patient from home to the medical unit with a diagnosis of pneumonia, which provider orders must the nurse verify have been completed before administering a dose of cefuroxime A. Orthostatic blood pressures B. Sputum culture and sensitivity C. Pulmonary function evaluation D. Serum laboratory studies ordered for AM

B. Sputum culture and sensitivity Rationale: 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 correctly identified (by the culture) before the antibiotic takes effect. The test will also determine whether the proper antibiotic has been ordered (sensitivity testing). Although antibiotic administration should not be unduly delayed while waiting for the patient to expectorate sputum, orthostatic blood pressures, pulmonary function evaluation, and serum laboratory tests will not be affected by the administration of antibiotics

The nurse provides education for a patient with human immunodeficiency virus (HIV) who is diagnosed with an infection of the lungs caused by Candida albicans. Which statement made by the patient indicates the need for further teaching? A. "I will be given amphotericin B to treat the fungus." B. "I contracted this fungus because I am immunocompromised." C. "I need to be isolated from my family and friends so that they won't get the infection." D. "The effectiveness of my therapy can be monitored with fungal serology titers."

C. "I need to be isolated from my family and friends so that they won't get the infection."

The nurse is teaching the patient with human immunodeficiency virus (HIV) about the diagnosis of a fungal lung infection with Candida albicans. What patient statement indicates to the nurse that further teaching is required? A. "I will be given amphotericin B to treat the fungus." B. "I got this fungus because I am immunocompromised." C. "I need to be isolated from my family and friends so they won't get it." D. "The effectiveness of my therapy can be monitored with fungal serology titers."

C. "I need to be isolated from my family and friends so they won't get it Rationale: The patient with an opportunistic fungal infection does not need to be isolated because it is not transmitted from person to person. The rest of the answers are true

A patient has a chest tube with a chest drainage unit (CDU) in place. The nurse notes that the tidaling in the water- seal chamber has stopped. Which action does the nurse take? A. Continue to monitor the patient B. Check all connections for a leak in the system C. Assess the drainage system for occlusion D. Lower the collection unit

C. Assess the drainage system for occlusion Rationale: Normal fluctuation of the water within the water- seal chamber is called tidaling. This up- down movement of water in concert with respiration reflects the intrapleural pressure changes during inspiration and expiration If tidaling (rising with inspiration and falling with expiration in the spontaneously breathing patient) is not seen, the drainage system is blocked, the lungs are reexpanded, or the system is attached to suction. If tidaling is not seen, thenurse needs to determine the cause rather than simply continuing to monitor the patient. The nurse could check all connections for a leak but the most common cause is occlusion. The collection unit is likely already in a low position

One week after a thoracotomy, a patient with chest tubes (CTs) to water-seal drainage has an air leak into the closed chest drainage system (CDS). Which patient assessment warrants follow- up nursing actions? A. Water-seal chamber has 5 cm of water B. No new drainage in collection chamber C. Chest tube with a loose fitting dressing D. Small pneumothorax at CT insertion site

C. Chest tube with loose- fitting dressing Rationale: IF the dressing at the CT insertion site is loose, and air leak will occur and will need to be sealed. The water- seal chamber usually has 2cm of water. Having more water will not contribute to an air leak, and it should not be drained from the CDS. No- new drainage does not indicate an air leak but may indicate the CT is no longer needed. If there is a pneumothorax, the chest tube should remove the air

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

C. Cigarette smoking

The registered nurse mentors a new graduate nurse. The new graduate provides care for a patient who has a chest tube in place after a partial lobectomy. Which action by the new graduate requires the mentor to intervene? A. Positions the patient in the semi- Fowler's position B. Encourages the patient to increase fluid intake C. Clamps the chest tube while the patient is ambulating D. Administers the patient's prescribed narcotic analgesic before activity

C. Clamps the chest tube while the patient is ambulating

A patient with a spontaneous pneumothorax has a chest tube in place that is attached to a chest drainage unit (CDU) with no suction being applied. The water level in the water- seal chamber is fluctuating. Which action does the nurse take? A. Notify the health care provider immediately B. Decrease the amount of water in the water- seal chamber C. Continue to monitor and document the respiratory status D. Clamp the chest tube as close as possible to the insertion site

C. Continue to monitor and document the respiratory status

The nurse notes that a patient's treatment plan for chylothorax includes chemical pleurodesis. The nurse expects that which medication will be prescribed? A. Octreotide B. Prednisone C. Doxycycline D. Cyclosporine

C. Doxycycline Rationale: Chylothorax is the presence of lymphatic fluid in the pleural space. The thoracic duct is disrupted either traumatically or from cancer, allowing lymphatic fluid to fill the pleural space. Chemical pleurodesis is done to obliterate the pleural space and prevent reaccumulation of effusion fluid. This procedure first requires chest tube drainage of the effusion. once the fluid is drained, a chemical slurry is instilled into the pleural space. Talc is the most effective agent for pleurodesis. Other agents that can be used include doxycycline and bleomycin. Octreotide is a hormone- like drug that acts as a vasoconstrictor and reduces lymphatic flow; however, this medication is not used after pleurodesis. Prednisone is a corticosteroid used to reduce the progression of chronic pulmonary fibrosis. Cyclosporine is an immunosuppressive drug that treats pulmonary fibrosis

The nurse is performing a respiratory assessment for a patient admitted with pneumonia. Which clinical manifestation would the nurse expect to find A. Hyperresonance on percussion B. Vesicular breath sounds in all lobes C. Increased vocal fremitus on palpation D. Fine crackles in all lobes on auscultation

C. Increased vocal fremitus on palpation Rationale: A typical physical examination finding for a patient with pneumonia is increased vocal fremitus on palpation. Other signs of pulmonary consolidation include bronchial breath sounds, egophony, and crackles in the affected area. With pleural effusion, there may be dullness to percussion over the affected area.

While ambulating a patient with metastatic lung cancer, the nurse observes a decrease in oxygen saturation from 93% to 86%. Which nursing action is most appropriate? A. Continue with ambulation B. Obtain a provider's order for arterial blood gas C. Obtain a provider's order for supplemental oxygen D. Move the oximetry probe from the finger to the earlobe

C. Obtain a provider's order for supplemental oxygen Rationale: An oxygen saturation level that drops below 90% with activity indicates 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 as the pulse oximeter was working at the beginning of the walk

The nurse assesses a patient following a transthoracic needle aspiration and notes excess air in the pleural space. How does the nurse interpret the finding? A. The patient has a hemothorax B. The patient is experiencing cardiac tamponade C. The patient has an iatrogenic pneumothorax D. The patient is experiencing a spontaneous pneumothorax

C. The patient has an iatrogenic pneumothorax Rationale: iatrogenic pneumothorax can occur as a result of a laceration or puncture of the lung during medical procedurs.

The nurse reviews the medical records of patients diagnosed with community- acquired pneumonia (CAP) and identifies that the patients meet which criterion? A. The patients presented to the hospital with symptoms of pneumonia B. The patients were in close proximity with someone who had pneumonia within the past 10 days of the onset of symptoms. C. The patients have not been hospitalized or have not lived in a long- term care facility within 14 days of the onset of symptoms. D. The patients have a condition that weakens the immune system

C. The patients have not been hospitalized or have not lived in a long- term care facility within 14 days of the onset of symptoms

The nurse determines that discharge teaching for a patient hospitalized with pneumonia has been effective when the patient makes which statement about measures to prevent a relapse? A. "I will seek immediate medical treatment for any upper respiratory infections." B. "I should continue to do deep breathing and coughing exercises for at least 12 weeks." C. "I will increase my food intake to 2400 calories a day to keep my immune system well." D. "I must have a follow-up chest x-ray in 6 to 8 weeks to evaluate the pneumonia's resolution."

D. "I must have a follow- up chest x ray in 6 to 8 weeks to evaluate the pneumonia's resolution." Rationale: The follow- up chest x-ray examination will be done in 6 to 8 weeks to evaluate pneumonia resolution. A patient should seek medical treatment for upper respiratory infections that persist for more than 7 days. It mat be important for the patient to continue with coughing and deep breathing exercises for 6 to 8 weeks, not 12 weeks, until all the infection has cleared from the lungs. Increased fluid intake, not caloric intake, is required to liquefy secretions

The nurse determines effective discharge teaching for a patient with pneumonia when the patient makes which statement? A. "I should seek immediate medical treatment for any upper respiratory infections." B. "I should continue to do deep-breathing exercises for at least 12 weeks." C. "I will increase my food intake to 2400 calories a day to keep my immune system well." D. "I will need to have a follow- up chest x-ray in six to eight weeks to evaluate the pneumonia's resolution."

D. "I will need to have a follow- up chest x-ray in six to eight weeks to evaluate the pneumonia's resolution."

Which drug would the nurse identify as effective in treating New York Heart Association (NYHA) class II right sided heart failure patients? A. Sildenafil B. Nifedipine C. Treprostinil D. Ambrisentan

D. Ambrisentan

A patient presents with traumatic hemothorax. which immediate action does the nurse take? A. call the code blue team B. administer an autotransfusion C. Assist the health care provider with the needle decompression D. Assist the health care provider in inserting a chest tube

D. Assist the health care provider in inserting a chest tube

A patient with idiopathic pulmonary fibrosis had bilateral lung transplantation and now has exertional dyspnea, nonproductive cough, and wheezing. What does the nurse determine is most likely occurring in this patient? A. Pulmonary infarction B. Pulmonary hypertension C. Cytomegalovirus (CMV) D. Bronchiolitis obliterans (BOS)

D. Bronchiolitis obliterans (BOS) Rationale: BOS is a manifestation of chronic rejection and is characterized by airflow obstruction progressing over time with gradual onset of exertional dyspnea, nonproductive cough, wheezing, and/ or low- grade fever. Pulmonary infarction occurs with lack of blood flow to the bronchial tissue or preexisting lung disease. With pulmonary hypertension, the pulmonary pressures are elevated and can be idiopathic or secondarily due to parenchymal lung disease that causes anatomic or vascular changes leading to pulmonary hypertension. CMV pneumonia is the most common opportunistic infection 1 to 4 months after lung transplant.

Which disorder would the nurse recognize as the most likely cause of cor pulmonale? A. liver failure B. Renal failure C. Left ventricular failure D. Chronic obstructive pulmonary disease (COPD)

D. Chronic obstructive pulmonary disease (COPD)

A patient presents with pneumonia score of 5 on the Expanded CURB- 65 scale. which action does the nurse take? A. Advise no treatment B. Advise treating in an outpatient setting C. Consider admission to an inpatient medical- surgical unit D. Consider admission to an intensive care unit.

D. Consider admission to an intensive care unit. Rationale: 0 to 2 score treatment in an outpatient setting is advised 3 to4 score hospital admission is advised

A patient with chest wall trauma has diminished breath sounds on the affected side, dyspnea, and bleeding in the chest wall. A chest tube is inserted immediately after the injury. Which diagnosis does the nurse expect to find in the patient's medical record? A. Flail chest B. Chylothorax C. Cardiac tamponade D. Hemopneumothorax

D. Hemopneumothorax

Which condition would the nurse suspect in a patient with dyspnea, clubbing of the fingers, and nonproductive cough? A. Empyema B. Sarcoidosis C. Pulmonary embolism D. Idiopathic pulmonary fibrosis

D. Idiopathic pulmonary fibrosis Rationale: This is caused by chronic inflammation and scar tissue formation in the lung's connective tissue, which obstructs the chest walls from moving, impairing gas exchange.

The nurse is caring for a patient with impaired airway clearance. What is the priority nursing action to assist this patient to expectorate thick lung secreations? A. Humidify the oxygen as able B. Administer a cough suppressant q4h C. Teach patient to splint the affected area D. Increase fluid intake to 3 L/day if tolerated

D. Increase fluid intake to 3 L/day if tolerated Rationale: Although several intervention 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 is also helpful but is not the primary intervention, Teaching the patient to splint the affected area may also be helpful in decreasing discomfort but does not assist in expectoration of thick secretions

When planning care for a patient with pneumonia, the nurse recognizes that which is a high- priority intervention? A. Waiting until the patient is afebrile for 72 to 96 hours before stopping treatment B. Administering a bronchodilator every four hours C. Turning and repositioning the patient at least once per hour D. Increasing fluids to at least 6 to 10 glasses/day, unless contraindicated

D. Increasing fluids to at least 6 to 10 glasses/day, unless contraindicated

A patient who has tuberculosis (TB) is being treated with combination drug therapy is essential for which reason? A. It minimizes the required dosage of each of the medications B. It helps reduce the unpleasant side effects of the medication. C. It shortens the amount of time that the treatment regimen will be needed D. It discourages the development of resistant strains of the TB organism

D. It discourages the development of resistant strains of the TB organism

The patient had video-assisted thoracic surgery (VATS) to perform a lobectomy. What does the nurse understand is the reason for using this type of surgery? A. The patient has lung cancer B. The incision will be medial sternal or lateral C. Chest tubes will not be needed postoperatively D. Less discomfort and faster return to normal activity

D. Less discomfort and faster return to normal activity Rationale: The VATS procedure uses minimally invasive incisions that cause less discomfort and allow faster healing and return to normal activity as well as lower morbidity risk and fewer complications. Many surgeries can be done for lung cancer, but pneumonectomy via thoracotomy is the most common surgery for lung cancer. The incision for a thoracotomy is commonly a medial sternotomy or lateral approach. A chest tube will be needed needed postoperatively for VATS

An older adult patient is admitted with acute respiratory distress related to cor pulmonale. Which nursing action 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. Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress Rationale: 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 when the patient's acute respiratory distress is being managed.

Which is the most common symptom of lung cancer A. Fatigue B. Anorexia C. Hoarseness D. Persistent cough

D. Persistent cough

A patient with a diagnosis of chylothorax is prescribed octreotide. Which outcome does the nurse expect after the treatment? A. Adequate hydration B. Adequate pain control C. Reduced risk of hypoxemia D. Reduced flow of lymphatic fluid

D. Reduced flow of lymphatic fluid Rationale: Octreotide acts like the natural hormone somatostatin, which behaves as a vasoconstrictor and reduces the flow of lymphatic fluid into the pleural space

A patient with chest trauma has a chest tube on gravity drainage. While assessing the patient, the nurse finds that the fluid level in the water- seal chamber is very high. Which action does the nurse take? A. Apply a clamp to the tube B. Retape the tube connections C. Lower the water- seal column. D. Release the high - negativity valve

D. Release the high- negativity valve

The nurse is caring for an older adult patient who underwent a left total knee arthroplasty. on the third postoperative day, the patient reports shortness of breath, slight chest pain, and that "something is wrong." Temperature is 98.4F, blood pressure is 130/88 mm Hg, respirations are 36 breaths/ min, and oxygen saturation is 91% on room air. What is the priority nursing actions? A. Notify the health care provider B. Administer a nitroglycerin Tablet sublingually C. Conduct a thorough assessment of the chest pain D. Sit the patient up in the bed as tolerated and apply oxygen

D. Sit the patient up in bed as tolerated and apply oxygen Rationale: the patient's clinical picture is most likely PE, and the first action the nurse takes should be to assist with the patient's respirations.

Which pulmonary function test (PFT) result may indicate that restrictive lung disease is present A. FEV1: forced expiratory volume in first second of expiration is 59% B. PEFR: Peak expiratory flow rate is at 45% C. DLCO: Diffusing capacity of lung for carbon monoxide is at 85% D. TLC: Total lung capacity is at 70%

D. TLC: Total lung capacity is at 70% Rationale TLC is the value looked at to determine the presence of restrictive lung disease. PEF, FEV1, and DLCO are parts of the PFT, but TLC is the primary piece of information needed for diagnosis of restrictive disease

Which patient is experiencing restrictive lung disease from an extrapulmonary cause? A. patient 1: chest- tube placement for pneumothorax B. patient 2: acute respiratory distress syndrome C. patient 3: status post pleural effusion drainage D. patient 4: acute exacerbation of myasthenia gravis

D. patient 4: acute exacerbation of myasthenia gravis

A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure? a. Start a peripheral IV line to administer the necessary sedative drugs. b. Position the patient sitting upright on the edge of the bed and leaning forward. c. Obtain a large collection device to hold 2 to 3 liters of pleural fluid at one time. d. Remove the water pitcher and remind the patient not to eat or drink anything for 6 hours.

Position the patient sitting upright on the edge of the bed and leaning forward. rationale: When the patient is sitting up, fluid accumulates in the pleural space at the lung bases and can more easily be located and removed. The patient does not usually require sedation for the procedure, and there are no restrictions on oral intake because the patient is not sedated or unconscious. Usually only 1000 to 1200 mL of pleural fluid is removed at one time. Rapid removal of a large volume can result in hypotension, hypoxemia, or pulmonary edema.

Which factors will the nurse consider when calculating the CURB-65 score for a patient with pneumonia (select all that apply)? a. Age b. Blood pressure c. Respiratory rate d. Oxygen saturation e. Presence of confusion f. Blood urea nitrogen (BUN) level

a. Age b. Blood pressure c. Respiratory rate e. Presence of confusion f. Blood urea nitrogen (BUN) level rationale: Data collected for the CURB-65 are mental status (confusion), BUN (elevated), blood pressure (decreased), respiratory rate (increased), and age (65 and older). The other information is also essential to assess, but are not used for CURB-65 scoring.

A patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurses most appropriate action to promote airway clearance? a. Assist the patient to splint the chest when coughing. b. Teach the patient about the need for fluid restrictions. c. Encourage the patient to wear the nasal oxygen cannula. d. Instruct the patient on the pursed lip breathing technique.

a. Assist the patient to splint the chest when coughing. Rationale: Coughing is less painful and more likely to be effective when the patient splints the chest during coughing. Fluids should be encouraged to help liquefy secretions. Nasal oxygen will improve gas exchange, but will not improve airway clearance. Pursed lip breathing is used to improve gas exchange in patients with COPD, but will not improve airway clearance.

A patient who was admitted the previous day with pneumonia complains of a sharp pain of 7 (based on 0 to 10 scale) whenever I take a deep breath. Which action will the nurse take next? a. Auscultate breath sounds. b. Administer the PRN morphine. c. Have the patient cough forcefully. d. Notify the patients health care provider.

a. Auscultate breath sounds. rationale: The patients statement indicates that pleurisy or a pleural effusion may have developed and the nurse will need to listen for a pleural friction rub and/or decreased breath sounds. Assessment should occur before administration of pain medications. The patient is unlikely to be able to cough forcefully until pain medication has been administered. The nurse will want to obtain more assessment data before calling the health care provider.

The nurse is caring for a patient who has a right-sided chest tube after a right lower lobectomy. Which nursing action can the nurse delegate to the unlicensed assistive personnel (UAP)? a. Document the amount of drainage every eight hours. b. Obtain samples of drainage for culture from the system. c. Assess patient pain level associated with the chest tube. d. Check the water-seal chamber for the correct fluid level.

a. Document the amount of drainage every eight hours. rationale: UAP education includes documentation of intake and output. The other actions are within the scope of practice and education of licensed nursing personnel.

The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect? a. Increased tactile fremitus b. Dry, nonproductive cough c. Hyperresonance to percussion d. A grating sound on auscultation

a. Increased tactile fremitus Rationale: Increased tactile fremitus over the area of pulmonary consolidation is expected with bacterial pneumonias. Dullness to percussion would be expected. Pneumococcal pneumonia typically presents with a loose, productive cough. Adventitious breath sounds such as crackles and wheezes are typical. A grating sound is more representative of a pleural friction rub rather than pneumonia

. The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies? a. Observe for distended neck veins. b. Auscultate for crackles in the lungs. c. Palpate for heaves or thrills over the heart. d. Review hemoglobin and hematocrit values.

a. Observe for distended neck veins. rationale: Cor pulmonale is right ventricular failure caused by pulmonary hypertension, so clinical manifestations of right ventricular failure such as peripheral edema, jugular venous distention, and right upper-quadrant abdominal tenderness would be expected. Crackles in the lungs are likely to be heard with left-sided heart failure. Findings in cor pulmonale include evidence of right ventricular hypertrophy on electrocardiogram ECG and an increase in intensity of the second heart sound. Heaves or thrills are not common with cor pulmonale. Chronic hypoxemia leads to polycythemia and increased total blood volume and viscosity of the blood. The hemoglobin and hematocrit values are more likely to be elevated with cor pulmonale than decreased.

. The nurse notes new onset confusion in an older patient who is normally alert and oriented. In which order should the nurse take the following actions? (Put a comma and a space between each answer choice [A, B, C, D].) a. Obtain the oxygen saturation. b. Check the patients pulse rate. c. Document the change in status. d. Notify the health care provider.

a. Obtain the oxygen saturation. b. Check the patients pulse rate. d. Notify the health care provider. c. Document the change in status. rationale: Assessment for physiologic causes of new onset confusion such as pneumonia, infection, or perfusion problems should be the first action by the nurse. Airway and oxygenation should be assessed first, then circulation. After assessing the patient, the nurse should notify the health care provider. Finally, documentation of the assessments and care should be done.

The clinic nurse teaches a patient with a 42 pack-year history of cigarette smoking about lung disease. Which information will be most important for the nurse to include? a. Options for smoking cessation b. Reasons for annual sputum cytology testing c. Erlotinib (Tarceva) therapy to prevent tumor risk d. Computed tomography (CT) screening for lung cancer

a. Options for smoking cessation Rationale: Because smoking is the major cause of lung cancer, the most important role for the nurse is teaching patients about the benefits of and means of smoking cessation. CT scanning is currently being investigated as a screening test for high-risk patients. However, if there is a positive finding, the person already has lung cancer. Erlotinib may be used in patients who have lung cancer, but it is not used to reduce the risk of developing cancer.

The nurse cares for a patient who has just had a thoracentesis. Which assessment information obtained by the nurse is a priority to communicate to the health care provider? a. Oxygen saturation is 88%. b. Blood pressure is 145/90 mm Hg. c. Respiratory rate is 22 breaths/minute when lying flat. d. Pain level is 5 (on 0 to 10 scale) with a deep breath.

a. Oxygen saturation is 88%. rationale: Oxygen saturation would be expected to improve after a thoracentesis. A saturation of 88% indicates that a complication such as pneumothorax may be occurring. The other assessment data also indicate a need for ongoing assessment or intervention, but the low oxygen saturation is the priority.

2. A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat. The emergency department nurse would be most concerned if which finding is observed during the initial assessment? a. Paradoxic chest movement b. Complaint of chest wall pain c. Heart rate of 110 beats/minute d. Large bruised area on the chest

a. Paradoxic chest movement rationale: Paradoxic chest movement indicates that the patient may have flail chest, which can severely compromise gas exchange and can rapidly lead to hypoxemia. Chest wall pain, a slightly elevated pulse rate, and chest bruising all require further assessment or intervention, but the priority concern is poor gas exchange.

Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis? a. Weak, nonproductive cough effort b. Large amounts of greenish sputum c. Respiratory rate of 28 breaths/minute d. Resting pulse oximetry (SpO2 ) of 85%

a. Weak, nonproductive cough effort rationale: The weak, nonproductive cough indicates that the patient is unable to clear the airway effectively. The other data would be used to support diagnoses such as impaired gas exchange and ineffective breathing pattern.

An older patient is receiving standard multidrug therapy for tuberculosis (TB). The nurse should notify the health care provider if the patient exhibits which finding? a. Yellow-tinged skin b. Orange-colored sputum c. Thickening of the fingernails d. Difficulty hearing high-pitched voices

a. Yellow-tinged skin rationale: Noninfectious hepatitis is a toxic effect of isoniazid (INH), rifampin, and pyrazinamide, and patients who develop hepatotoxicity will need to use other medications. Changes in hearing and nail thickening are not expected with the four medications used for initial TB drug therapy. Presbycusis is an expected finding in the older adult patient. Orange discoloration of body fluids is an expected side effect of rifampin and not an indication to call the health care provider

. The nurse monitors a patient after chest tube placement for a hemopneumothorax. The nurse ismost concerned if which assessment finding is observed? a. A large air leak in the water-seal chamber b. 400 mL of blood in the collection chamber c. Complaint of pain with each deep inspiration d. Subcutaneous emphysema at the insertion site

b. 400 mL of blood in the collection chamber rationale: The large amount of blood may indicate that the patient is in danger of developing hypovolemic shock. An air leak would be expected immediately after chest tube placement for a pneumothorax. Initially, brisk bubbling of air occurs in this chamber when a pneumothorax is evacuated. The pain should be treated but is not as urgent a concern as the possibility of continued hemorrhage. Subcutaneous emphysema should be monitored but is not unusual in a patient with pneumothorax. A small amount of subcutaneous air is harmless and will be reabsorbed.

The nurse receives change-of-shift report on the following four patients. Which patient should the nurse assess first? a. A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled b. A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath c. A 77-year-old patient with tuberculosis (TB) who has four antitubercular medications due in 15 minutes d. A 35-year-old patient who was admitted the previous day with pneumonia and has a temperature of 100.2 F (37.8 C)

b. A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath Patients on bed rest who are immobile are at high risk for deep vein thrombosis (DVT). Sudden onset of shortness of breath in a patient with a DVT suggests a pulmonary embolism and requires immediate assessment and action such as oxygen administration. The other patients should also be assessed as soon as possible, but there is no indication that they may need immediate action to prevent clinical deterioration.

5. When caring for a patient who is hospitalized with active tuberculosis (TB), the nurse observes a student nurse who is assigned to take care of a patient. Which action, if performed by the student nurse, would require an intervention by the nurse? a. The patient is offered a tissue from the box at the bedside. b. A surgical face mask is applied before visiting the patient. c. A snack is brought to the patient from the unit refrigerator. d. Hand washing is performed before entering the patients room

b. A surgical face mask is applied before visiting the patient rationale: A high-efficiency particulate-absorbing (HEPA) mask, rather than a standard surgical mask, should be used when entering the patients room because the HEPA mask can filter out 100% of small airborne particles. Hand washing before entering the patients room is appropriate. Because anorexia and weight loss are frequent problems in patients with TB, bringing food to the patient is appropriate. The student nurse should perform hand washing after handling a tissue that the patient has used, but no precautions are necessary when giving the patient an unused tissue.

After 2 months of tuberculosis (TB) treatment with isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next? a. Teach about treatment for drug-resistant TB treatment. b. Ask the patient whether medications have been taken as directed. c. Schedule the patient for directly observed therapy three times weekly. d. Discuss with the health care provider the need for the patient to use an injectable antibiotic.

b. Ask the patient whether medications have been taken as directed. rationale: The first action should be to determine whether the patient has been compliant with drug therapy because negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. Assessment is the first step in the nursing process. Depending on whether the patient has been compliant or not, different medications or directly observed therapy may be indicated. The other options are interventions based on assumptions until an assessment has been completed.

. A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first? a. Chest x-ray via stretcher b. Blood cultures from two sites c. Ciprofloxacin (Cipro) 400 mg IV d. Acetaminophen (Tylenol) rectal suppository

b. Blood cultures from two sites rationale: Initiating antibiotic therapy rapidly is essential, but it is important that the cultures be obtained before antibiotic administration. The chest x-ray and acetaminophen administration can be done last

. A patient with newly diagnosed lung cancer tells the nurse, I dont think Im going to live to see my next birthday. Which response by the nurse is best? a. Would you like to talk to the hospital chaplain about your feelings? b. Can you tell me what it is that makes you think you will die so soon? c. Are you afraid that the treatment for your cancer will not be effective? d. Do you think that taking an antidepressant medication would be helpful?

b. Can you tell me what it is that makes you think you will die so soon? rationale: The nurses initial response should be to collect more assessment data about the patients statement. The answer beginning Can you tell me what it is is the most open-ended question and will offer the best opportunity for obtaining more data. The answer beginning, Are you afraid implies that the patient thinks that the cancer will be immediately fatal, although the patients statement may not be related to the cancer diagnosis. The remaining two answers offer interventions that may be helpful to the patient, but more assessment is needed to determine whether these interventions are appropriate

The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement, if made by the patient, indicates a good understanding of the instructions? a. I will call the doctor if I still feel tired after a week. b. I will continue to do the deep breathing and coughing exercises at home. c. I will schedule two appointments for the pneumonia and influenza vaccines. d. Ill cancel my chest x-ray appointment if Im feeling better in a couple weeks

b. I will continue to do the deep breathing and coughing exercises at home. Rationale: Patients should continue to cough and deep breathe after discharge. Fatigue is expected for several weeks. The Pneumovax and influenza vaccines can be given at the same time in different arms. Explain that a follow-up chest x-ray needs to be done in 6 to 8 weeks to evaluate resolution of pneumonia.

The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB). Which statement, if made by the patient, indicates that teaching was effective? a. I will avoid being outdoors whenever possible. b. My husband will be sleeping in the guest bedroom. c. I will take the bus instead of driving to visit my friends. d. I will keep the windows closed at home to contain the germs.

b. My husband will be sleeping in the guest bedroom. Rationale: Teach the patient how to minimize exposure to close contacts and household members. Homes should be well ventilated, especially the areas where the infected person spends a lot of time. While still infectious, the patient should sleep alone, spend as much time as possible outdoors, and minimize time in congregate settings or on public transportation.

A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days. Which assessment data obtained by the nurse indicates that the treatment has been effective? a. Bronchial breath sounds are heard at the right base. b. The patient coughs up small amounts of green mucus. c. The patients white blood cell (WBC) count is 9000/L. d. Increased tactile fremitus is palpable over the right chest.

c. The patients white blood cell (WBC) count is 9000/L. rationale: The normal WBC count indicates that the antibiotics have been effective. All the other data suggest that a change in treatment is needed.

A patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving nifedipine (Procardia). Which assessment would best indicate to the nurse that the patients condition is improving? a. Blood pressure (BP) is less than 140/90 mm Hg. b. Patient reports decreased exertional dyspnea. c. Heart rate is between 60 and 100 beats/minute. d. Patients chest x-ray indicates clear lung fields.

b. Patient reports decreased exertional dyspnea. rationale: Because a major symptom of IPAH is exertional dyspnea, an improvement in this symptom would indicate that the medication was effective. Nifedipine will affect BP and heart rate, but these parameters would not be used to monitor the effectiveness of therapy for a patient with IPAH. The chest x-ray will show clear lung fields even if the therapy is not effective.

The nurse develops a plan of care to prevent aspiration in a high-risk patient. Which nursing action will be most effective? a. Turn and reposition immobile patients at least every 2 hours. b. Place patients with altered consciousness in side-lying positions. c. Monitor for respiratory symptoms in patients who are immunosuppressed. d. Insert nasogastric tube for feedings for patients with swallowing problems.

b. Place patients with altered consciousness in side-lying positions. Rationale: The risk for aspiration is decreased when patients with a decreased level of consciousness are placed in a sidelying or upright position. Frequent turning prevents pooling of secretions in immobilized patients but will not decrease the risk for aspiration in patients at risk. Monitoring of parameters such as breath sounds and oxygen saturation will help detect pneumonia in immunocompromised patients, but it will not decrease the risk for aspiration. Conditions that increase the risk of aspiration include decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and nasogastric intubation with or without tube feeding. With loss of consciousness, the gag and cough reflexes are depressed, and aspiration is more likely to occur. Other high-risk groups are those who are seriously ill, have poor dentition, or are receiving acid-reducing medications.

A patient is admitted to the emergency department with an open stab wound to the left chest. What is the first action that the nurse should take? a. Position the patient so that the left chest is dependent. b. Tape a nonporous dressing on three sides over the chest wound. c. Cover the sucking chest wound firmly with an occlusive dressing. d. Keep the head of the patients bed at no more than 30 degrees elevation.

b. Tape a nonporous dressing on three sides over the chest wound. rationale: The dressing taped on three sides will allow air to escape when intrapleural pressure increases during expiration, but it will prevent air from moving into the pleural space during inspiration. Placing the patient on the left side or covering the chest wound with an occlusive dressing will allow trapped air in the pleural space and cause tension pneumothorax. The head of the bed should be elevated to 30 to 45 degrees to facilitate breathing.

A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the nurse plan to include in the teaching plan? a. Purpose of antibiotic therapy b. Ways to limit oral fluid intake c. Appropriate use of cough suppressants d. Safety concerns with home oxygen therapy

c. Appropriate use of cough suppressants rationale: Cough suppressants are frequently prescribed for acute bronchitis. Because most acute bronchitis is viral in origin, antibiotics are not prescribed unless there are systemic symptoms. Fluid intake is encouraged. Home oxygen is not prescribed for acute bronchitis, although it may be used for chronic bronchitis.

A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange discolored urine and tears. Which is the best response by the nurse? a. Ask if the patient is experiencing shortness of breath, hives, or itching. b. Ask the patient about any visual abnormalities such as red-green color discrimination. c. Explain that orange discolored urine and tears are normal while taking this medication. d. Advise the patient to stop the drug and report the symptoms to the health care provider.

c. Explain that orange discolored urine and tears are normal while taking this medication. rationale: Orange-colored body secretions are a side effect of rifampin. The patient does not have to stop taking the medication. The findings are not indicative of an allergic reaction. Alterations in red-green color discrimination commonly occurs when taking ethambutol (Myambutol), which is a different TB medication.

The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy for cancer of the lung. Which information should the nurse include about the patients postoperative care? a. Positioning on the right side b. Bed rest for the first 24 hours c. Frequent use of an incentive spirometer d. Chest tube placement with continuous drainage

c. Frequent use of an incentive spirometer rationale: Frequent deep breathing and coughing are needed after chest surgery to prevent atelectasis. To promote gas exchange, patients after pneumonectomy are positioned on the surgical side. Early mobilization decreases the risk for postoperative complications such as pneumonia and deep vein thrombosis. In a pneumonectomy, chest tubes may or may not be placed in the space from which the lung was removed. If a chest tube is used, it is clamped and only released by the surgeon to adjust the volume of serosanguineous fluid that will fill the space vacated by the lung. If the cavity overfills, it could compress the remaining lung and compromise the cardiovascular and pulmonary function. Daily chest x-rays can be used to assess the volume and space.

The nurse notes that a patient has incisional pain, a poor cough effort, and scattered rhonchi after a thoracotomy. Which action should the nurse take first? a. Assist the patient to sit upright in a chair. b. Splint the patients chest during coughing. c. Medicate the patient with prescribed morphine. d. Observe the patient use the incentive spirometer.

c. Medicate the patient with prescribed morphine rationale: A major reason for atelectasis and poor airway clearance in patients after chest surgery is incisional pain (which increases with deep breathing and coughing). The first action by the nurse should be to medicate the patient to minimize incisional pain. The other actions are all appropriate ways to improve airway clearance but should be done after the morphine is given.

An occupational health nurse works at a manufacturing plant where there is potential exposure to inhaled dust. Which action, if recommended by the nurse, will be most helpful in reducing the incidence of lung disease? a. Treat workers with pulmonary fibrosis. b. Teach about symptoms of lung disease. c. Require the use of protective equipment. d. Monitor workers for coughing and wheezing.

c. Require the use of protective equipment. rationale: Prevention of lung disease requires the use of appropriate protective equipment such as masks. The other actions will help in recognition or early treatment of lung disease but will not be effective in prevention of lung damage. Repeated exposure eventually results in diffuse pulmonary fibrosis. Fibrosis is the result of tissue repair after inflammation

A patient who has a right-sided chest tube following a thoracotomy has continuous bubbling in the suction- control chamber of the collection device. Which action by the nurse is most appropriate? a. Document the presence of a large air leak. b. Notify the surgeon of a possible pneumothorax. c. Take no further action with the collection device. d. Adjust the dial on the wall regulator to decrease suction.

c. Take no further action with the collection device. Rationale: Continuous bubbling is expected in the suction-control chamber and indicates that the suction-control chamber is connected to suction. An air leak would be detected in the water-seal chamber. There is no evidence of pneumothorax. Increasing or decreasing the vacuum source will not adjust the suction pressure. The amount of suction applied is regulated by the amount of water in this chamber and not by the amount of suction applied to the system.

The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action should the nurse take? . Teach about the reason for the blood tests. b. Schedule an appointment for a chest x-ray. c. Teach about the need to get sputum specimens for 2 to 3 consecutive days. d. Instruct the patient to expectorate three specimens as soon as possible.

c. Teach about the need to get sputum specimens for 2 to 3 consecutive days. rationale: Sputum specimens are obtained on 2 to 3 consecutive days for bacteriologic testing for M. tuberculosis. 4 patient should not provide all the specimens at once. Blood cultures are not used for tuberculosis testing. A chest x-ray is not bacteriologic testing. Although the findings on chest x-ray examination are important, it is not possible to make a diagnosis of TB solely based on chest x-ray findings because other diseases can mimic the appearance of TB.

Which action by the nurse will be most effective in decreasing the spread of pertussis in a community setting? a. Providing supportive care to patients diagnosed with pertussis b. Teaching family members about the need for careful hand washing c. Teaching patients about the need for adult pertussis immunizations d. Encouraging patients to complete the prescribed course of antibiotics

c. Teaching patients about the need for adult pertussis immunizations rationale: The increased rate of pertussis in adults is thought to be due to decreasing immunity after childhood immunization. Immunization is the most effective method of protecting communities from infectious diseases. Hand washing should be taught, but pertussis is spread by droplets and contact with secretions. Supportive care does not shorten the course of the disease or the risk for transmission. Taking antibiotics as prescribed does assist with decreased transmission, but patients are likely to have already transmitted the disease by the time the diagnosis is made.

A patient is diagnosed with both human immunodeficiency virus (HIV) and active tuberculosis (TB) disease. Which information obtained by the nurse is most important to communicate to the health care provider? a. The Mantoux test had an induration of 7 mm. b. The chest-x-ray showed infiltrates in the lower lobes. c. The patient is being treated with antiretrovirals for HIV infection. d. The patient has a cough that is productive of blood-tinged mucus.

c. The patient is being treated with antiretrovirals for HIV infection. rationale: Drug interactions can occur between the antiretrovirals used to treat HIV infection and the medications used to treat TB. The other data are expected in a patient with HIV and TB.

The nurse is caring for a patient with idiopathic pulmonary arterial hypertension (IPAH) who is receiving epoprostenol (Flolan). Which assessment information requires the most immediate action by the nurse? a. The oxygen saturation is 94%. b. The blood pressure is 98/56 mm Hg. c. The patients central IV line is disconnected. d. The international normalized ratio (INR) is prolonged.

c. The patients central IV line is disconnected. rationale: The half-life of this drug is 6 minutes, so the nurse will need to restart the infusion as soon as possible to prevent rapid clinical deterioration. The other data also indicate a need for ongoing monitoring or intervention, but the priority action is to reconnect the infusion.

Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse? a. Standard four-drug therapy for TB b. Need for annual repeat TB skin testing c. Use and side effects of isoniazid (INH) d. Bacille Calmette-Gurin (BCG) vaccine

c. Use and side effects of isoniazid (INH) rationale: The nurse is considered to have a latent TB infection and should be treated with INH daily for 6 to 9 months. The four-drug therapy would be appropriate if the nurse had active TB. TB skin testing is not done for individuals who have already had a positive skin test. BCG vaccine is not used in the United States for TB and would not be helpful for this individual, who already has a TB infection.

After change-of-shift report, which patient should the nurse assessfirst? a. 72-year-old with cor pulmonale who has 4+ bilateral edema in his legs and feet b. 28-year-old with a history of a lung transplant and a temperature of 101 F (38.3 C) c. 40-year-old with a pleural effusion who is complaining of severe stabbing chest pain d. 64-year-old with lung cancer and tracheal deviation after subclavian catheter insertion

d. 64-year-old with lung cancer and tracheal deviation after subclavian catheter insertion rationale: The patients history and symptoms suggest possible tension pneumothorax, a medical emergency. The other patients also require assessment as soon as possible, but tension pneumothorax will require immediate treatment to avoid death from inadequate cardiac output or hypoxemia.

An alcoholic and homeless patient is diagnosed with active tuberculosis (TB). Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen? a. Arrange for a friend to administer the medication on schedule. b. Give the patient written instructions about how to take the medications. c. Teach the patient about the high risk for infecting others unless treatment is followed. d. Arrange for a daily noon meal at a community center where the drug will be administered.

d. Arrange for a daily noon meal at a community center where the drug will be administered. Rationale: Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen, and arranging a daily meal will help ensure that the patient is available to receive the medication. The other nursing interventions may be appropriate for some patients but are not likely to be as helpful for this patient.

A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/minute, blood pressure of 100/60 mmHg, and respirations of 42 breaths/minute. Which action should the nurse take first? a. Administer anticoagulant drug therapy. b. Notify the patients health care provider. c. Prepare patient for a spiral computed tomography (CT). d. Elevate the head of the bed to a semi-Fowlers position.

d. Elevate the head of the bed to a semi-Fowlers position. rationale: The patient has symptoms consistent with a pulmonary embolism (PE). Elevating the head of the bed will improve ventilation and gas exchange. The other actions can be accomplished after the head is elevated (and oxygen is started). A spiral CT may be ordered by the health care provider to identify PE. Anticoagulants may be ordered after confirmation of the diagnosis of PE.

The nurse is performing tuberculosis (TB) skin tests in a clinic that has many patients who have immigrated to the United States. Which question is most important for the nurse to ask before the skin test? a. Is there any family history of TB? b. How long have you lived in the United States? c. Do you take any over-the-counter (OTC) medications? d. Have you received the bacille Calmette-Gurin (BCG) vaccine for TB?

d. Have you received the bacille Calmette-Gurin (BCG) vaccine for TB? rationale: Patients who have received the BCG vaccine will have a positive Mantoux test. Another method for screening (such as a chest x-ray) will need to be used in determining whether the patient has a TB infection. The other information also may be valuable but is not as pertinent to the decision about doing TB skin testing

The nurse completes discharge teaching for a patient who has had a lung transplant. The nurse evaluates that the teaching has been effective if the patient makes which statement? a. I will make an appointment to see the doctor every year b. I will stop taking the prednisone if I experience a dry cough. c. I will not worry if I feel a little short of breath with exercise. d. I will call the health care provider right away if I develop a fever.

d. I will call the health care provider right away if I develop a fever. rationale: Low-grade fever may indicate infection or acute rejection so the patient should notify the health care provider immediately if the temperature is elevated. Patients require frequent follow-up visits with the transplant team. Annual health care provider visits would not be sufficient. Home oxygen use is not an expectation after lung transplant. Shortness of breath should be reported. Low-grade fever, fatigue, dyspnea, dry cough, and oxygen desaturation are signs of rejection. Immunosuppressive therapy, including prednisone, needs to be continued to

The nurse provides discharge teaching for a patient who has two fractured ribs from an automobile accident. Which statement, if made by the patient, would indicate that teaching has been effective? a. I am going to buy a rib binder to wear during the day. b. I can take shallow breaths to prevent my chest from hurting. c. I should plan on taking the pain pills only at bedtime so I can sleep. d. I will use the incentive spirometer every hour or two during the day

d. I will use the incentive spirometer every hour or two during the day rationale: Prevention of the complications of atelectasis and pneumonia is a priority after rib fracture. This can be ensured by deep breathing and coughing. Use of a rib binder, shallow breathing, and taking pain medications only at night are likely to result in atelectasis.

34. A patient with pneumonia has a fever of 101.4 F (38.6 C), a nonproductive cough, and an oxygen saturation of 88%. The patient complains of weakness, fatigue, and needs assistance to get out of bed. Which nursing diagnosis should the nurse assign as the highest priority? a. Hyperthermia related to infectious illness b. Impaired transfer ability related to weakness c. Ineffective airway clearance related to thick secretions d. Impaired gas exchange related to respiratory congestion

d. Impaired gas exchange related to respiratory congestion rationale: All these nursing diagnoses are appropriate for the patient, but the patients oxygen saturation indicates that all body tissues are at risk for hypoxia unless the gas exchange is improved.

When assessing a patient who has just arrived after an automobile accident, the emergency department nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the patient? a. Emergency pericardiocentesis b. Stabilization of the chest wall with tape c. Administration of an inhaled bronchodilator d. Insertion of a chest tube with a chest drainage system

d. Insertion of a chest tube with a chest drainage system The patients history and absent breath sounds suggest a right-sided pneumothorax or hemothorax, which will require treatment with a chest tube and drainage. The other therapies would be appropriate for an acute asthma attack, flail chest, or cardiac tamponade, but the patients clinical manifestations are not consistent with these problems.

. A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6 F with a frequent cough and is complaining of severe pleuritic chest pain. Which prescribed medication should the nurse give first? a. Codeine b. Guaifenesin (Robitussin) c. Acetaminophen (Tylenol) d. Piperacillin/tazobactam (Zosyn)

d. Piperacillin/tazobactam (Zosyn) rationale: Early initiation of antibiotic therapy has been demonstrated to reduce mortality. The other medications are also appropriate and should be given as soon as possible, but the priority is to start antibiotic therapy.

An hour after a thoracotomy, a patient complains of incisional pain at a level 7 (based on 0 to 10 scale) and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which action is best for the nurse to take next? a. Milk the chest tube gently to remove any clots. b. Clamp the chest tube momentarily to check for the origin of the air leak. c. Assist the patient to deep breathe, cough, and use the incentive spirometer. d. Set up the patient controlled analgesia (PCA) and administer the loading dose of morphine.

d. Set up the patient controlled analgesia (PCA) and administer the loading dose of morphine. rationale: The patient is unlikely to take deep breaths or cough until the pain level is lower. A chest tube output of 100 mL is not unusual in the first hour after thoracotomy and would not require milking of the chest tube. An air leak is expected in the initial postoperative period after thoracotomy

Which intervention will the nurse include in the plan of care for a patient who is diagnosed with a lung abscess? a. Teach the patient to avoid the use of over-the-counter expectorants. b. Assist the patient with chest physiotherapy and postural drainage. c. Notify the health care provider immediately about any bloody or foul-smelling sputum. d. Teach about the need for prolonged antibiotic therapy after discharge from the hospital.

d. Teach about the need for prolonged antibiotic therapy after discharge from the hospital. rationale: Long-term antibiotic therapy is needed for effective eradication of the infecting organisms in lung abscess. Chest physiotherapy and postural drainage are not recommended for lung abscess because they may lead to spread of the infection. Foul smelling and bloody sputum are common clinical manifestations in lung abscess. Expectorants may be used because the patient is encouraged to cough.

. A lobectomy is scheduled for a patient with stage I nonsmall cell lung cancer. The patient tells the nurse, I would rather have chemotherapy than surgery. Which response by the nurse is most appropriate? a. Are you afraid that the surgery will be very painful? b. Did you have bad experiences with previous surgeries? c. Surgery is the treatment of choice for stage I lung cancer. d. Tell me what you know about the various treatments available.

d. Tell me what you know about the various treatments available. rationale: More assessment of the patients concerns about surgery is indicated. An open-ended response will elicit the most information from the patient. The answer beginning, Surgery is the treatment of choice is accurate, but it discourages the patient from sharing concerns about surgery. The remaining two answers indicate that the nurse has jumped to conclusions about the patients reasons for not wanting surgery. Chemotherapy is the primary treatment for small cell lung cancer. In nonsmall cell lung cancer, chemotherapy may be used in the

A patient is admitted with active tuberculosis (TB). The nurse should question a health care providers order to discontinue airborne precautions unless which assessment finding is documented? a. Chest x-ray shows no upper lobe infiltrates. b. TB medications have been taken for 6 months. c. Mantoux testing shows an induration of 10 mm. d. Three sputum smears for acid-fast bacilli are negative.

d. Three sputum smears for acid-fast bacilli are negative. rationale: Negative sputum smears indicate that Mycobacterium tuberculosis is not present in the sputum, and the patient cannot transmit the bacteria by the airborne route. Chest x-rays are not used to determine whether treatment has been successful. Taking medications for 6 months is necessary, but the multidrug-resistant forms of the disease might not be eradicated after 6 months of therapy. Repeat Mantoux testing would not be done because the result will not change even with effective treatment.

The nurse supervises unlicensed assistive personnel (UAP) who are providing care for a patient with right lower lobe pneumonia. The nurse should intervene if which action by UAP is observed? a. UAP splint the patients chest during coughing. b. UAP assist the patient to ambulate to the bathroom. c. UAP help the patient to a bedside chair for meals. d. UAP lower the head of the patients bed to 15 degrees

d. UAP lower the head of the patients bed to 15 degrees Positioning the patient with the head of the bed lowered will decrease ventilation. The other actions are appropriate for a patient with pneumonia.