Exam 3 Study Guide: 14, 24, 25, 26, 27, 28, 29

A patient is being treated with ciprofloxacin 500 mg orally twice daily because of possible exposure to inhalation anthrax. Which response would the nurse provide when the patient asks how long this medication must be taken? (28) "10 days" "2 months" "6 months" "12 months"

"2 months" When medication is given for prophylaxis related to inhalation anthrax exposure, the patient will need to take it for 60 days and may take it longer if exposure was heavy. Ten days is not enough time for adequate prevention, and 6 and 12 months are too long.

A patient who has a long-term tracheostomy tube in place communicates frustration to the nurse about not being able to talk. Which response would the nurse provide? (25) "You may never be able to speak again." "Cuffed tracheostomy tubes are necessary." "A fenestrated tube can be used to facilitate talking." "Until the tube is out, you will not be able to speak."

"A fenestrated tube can be used to facilitate talking."

A pH of 7.31 and an HCO3- of 18 indicates? (14)

metabolic acidosis

Kidney failure is associated with? (14)

metabolic acidosis

Which teaching would the nurse provide a patient with obstructive sleep apnea using continuous positive airway pressure (CPAP) on ways to prevent infection? (26) Give antibiotics. Clean the mask daily. Use sterile water. Monitor temperature.

Clean the mask daily

Which sputum characteristic is common in a smoker with chronic bronchitis? (24) Thin Thick Watery Mucoid

Mucoid

When providing preoperative education for a patient who is scheduled for a supraglottic partial laryngectomy, the nurse explains that which structures will be removed? (26) The tumor only without other structures The larynx and possible nodes in the neck The hyoid bone, false cords, and the epiglottis One true cord, one false cord, and one-half of the thyroid

The hyoid bone, false cords, and the epiglottis

Deep and rapid breaths consistent with Kussmaul respiration are found in patients with which type of acid-base imbalance? (14) Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis *happens in metabolic acidosis with respiratory compensation

Which acid-base imbalance would be expected in a patient who has been having acute diarrhea for more than 24 hours? (14) Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis diarrhea results in excessive elimination of bicarbonate, creating an imbalance between hydrogen ions and bicarbonate, leading to metabolic acidosis.

Which medication used in the management of idiopathic pulmonary fibrosis is classified as an immunosuppressant drug? Select all that apply. One, some, or all responses may be correct. (27) Methotrexate Dexamethasone Methylprednisolone Cyclophosphamide Mitogen-activated protein kinase inhibitors (MAPKIs)

Methotrexate Cyclophosphamide Methotrexate and cyclophosphamide are both immunosuppressant drugs prescribed for patients with idiopathic pulmonary fibrosis. Dexamethasone and methylprednisolone are not immunosuppressants; they are corticosteroids. MAPKIs are not immunosuppressants; they improve cellular regulation.

Which is the most appropriate surgical intervention for a patient with a nasoethmoid complex fracture? (26) Resorbable device Inner maxillary fixation Microplating surgical system Open reduction with internal fixation

Microplating surgical system a nasoethmoid complex fracture affects the central upper midface. In microplating surgical systems, the plates are made up of synthetic, inorganic, or biologically organic combinations to fix the bone defect. These plates help in holding bone fragments until new bones are developed. The plates can be removed or placed permanently. Resorbable devices are ineffective for nasoethmoid complex fractures because they are made of plastic that begins to biodegrade after 8 weeks. Inner maxillary fixation is also ineffective for a nasoethmoid complex fracture because it is used only for realignment of bones, and then wiring is done to keep the bones in place. Open reduction with internal fixation is mostly used in extensive jaw fractures

Which amount of breathlessness will a patient with a class II impairment of ADLs related to dyspnea exhibit? (24) None Mild Marked Moderate

Mild

Occupational exposure to which material increases a person's risk for lung cancer? (27) Copper Chlorine Citric acid Chromium

Chromium

Which complication will the nurse suspect in a patient with cystic fibrosis? (27) Hypoglycemia Hypothyroidism Respiratory failure Hyperpigmentation

Respiratory failure Respiratory failure is a complication of cystic fibrosis. Cystic fibrosis damages the lung tissue very badly until the lungs no longer work, leading to respiratory failure. Cystic fibrosis may cause diabetes mellitus, leading to hyperglycemia. Cystic fibrosis does not inhibit thyroxin secretion and therefore does not result in hypothyroidism. Cystic fibrosis does not stimulate overproduction of melanin, so it does not result in hyperpigmentation.

In which instance is treatment with continuous positive airway pressure (CPAP) considered less effective? (25) Atelectasis after surgery Cardiac-induced pulmonary edema Respiratory failure after extubation Chronic obstructive pulmonary disease (COPD)

Respiratory failure after extubation

Which infectious agent is responsible for the most common community-acquired pneumonia? (28) Adenovirus Rhinovirus Parainfluenza virus Respiratory syncytial virus

Respiratory syncytial virus Respiratory syncytial virus is responsible for the most common community-acquired pneumonia. The adenovirus, rhinovirus, and parainfluenza viruses are less common causes of community-acquired pneumonia.

Which upper respiratory condition is often triggered by a hypersensitivity reaction to airborne allergens? (28) Rhinitis Sinusitis Tonsillitis Pharyngitis

Rhinitis Allergic rhinitis (hay fever or allergies) is triggered by a hypersensitive reaction to airborne allergens, especially plant pollens or mold. The initial trigger of the hypersensitive allergic reaction can lead to infections in the sinuses (sinusitis) or throat (pharyngitis). Tonsillitis is a contagious airborne infection that has settled in the tonsils on either side (or both sides) of the throat.

A patient with nasal congestion, fever, and cough has been using over-the-counter medications for a week without improvement. The patient has tenderness to percussion over the sinuses and referred pain to the back of the head. Which condition would the nurse suspect? (28) Otitis media Tonsillitis Pharyngitis Rhinosinusitis

Rhinosinusitis Prolonged upper respiratory symptoms can indicate that a sinus infection has developed. Tenderness to percussion over the sinuses and referred pain to the back of the head are common manifestations of rhinosinusitis. Manifestations of otitis media include ear pain, headache, fever, decreased hearing acuity, and dizziness. The patient with pharyngitis has throat soreness and dryness, throat pain, odynophagia, and difficulty swallowing and may have a fever. Tonsillitis is manifested by a sudden sore throat, fever, muscle aches, chills, and dysphagia. The tonsils are visibly swollen and red.

After a bioterrorism attack with anthrax, the emergency department nurse would check with the pharmacy director to assure a supply of which medication? Select all that apply. One, some, or all responses may be correct. (28) Rifampin Gentamicin Amoxicillin Vancomycin Doxycycline Ciprofloxacin

Rifampin Amoxicillin Vancomycin Doxycycline Ciprofloxacin Ciprofloxacin, in combination therapy with one or more of the drugs doxycycline, amoxicillin, rifampin, and vancomycin, is used for exposure and actual infection. Therefore all of these medications should be on hand. Gentamicin is not a drug used to treat anthrax infection.

Which kind of sputum will the nurse anticipate in a patient with bacterial pneumonia? (24) Mucoid sputum Pink, frothy sputum Rust-colored sputum Hemoptysis (bloody sputum)

Rust-colored sputum

Which strategy is the focus of SECONDARY prevention of lung cancer? (27) Reducing air pollution Reducing tobacco smoking Screening adults at high risk Limiting exposure to secondhand smoke

Screening adults at high risk Secondary prevention by early detection involves screening adults at high risk for lung cancer development. Reducing air pollution is not a focus of secondary prevention. Reducing tobacco smoking is the focus of PRIMARY prevention. Limiting exposure to secondhand smoke is not the focus of secondary prevention.

Which strategy is the focus of secondary prevention of lung cancer? (27) Reducing air pollution Reducing tobacco smoking Screening adults at high risk Limiting exposure to secondhand smoke

Screening adults at high risk Secondary prevention by early detection involves screening adults at high risk for lung cancer development. Reducing air pollution is not a focus of secondary prevention. Reducing tobacco smoking is the focus of primary prevention. Limiting exposure to secondhand smoke is not the focus of secondary prevention.

Which physiologic change in cystic fibrosis (CF) may cause airway obstruction? (27) Secretion of thick and sticky mucus Constriction of the bronchiolar smooth muscle Secretion of mucus with excess water content Breakage of the elastin in the alveoli, leading to loss of lung elasticity

Secretion of thick and sticky mucus In CF, blocked chloride transportation causes the formation of sticky and thick mucus, which has less water content. This sticky mucus obstructs the airway, leading to difficulty in breathing. The constriction of smooth muscle causes bronchospasm. Mucus secretion with excess water content does not cause any obstruction in the airway. Excess secretion of the protease enzyme causes breaking of the elastin in the alveoli; this leads to chronic obstructive pulmonary diseases.

Which action would the nurse take to prevent accidental decannulation when performing tracheostomy care? (25) Assessing for skin breakdown Replacing the disposable cannula Securing new ties before removing the old ones Cleaning the stoma with half-strength hydrogen peroxide

Securing new ties before removing the old ones

Which structure forms part of the upper respiratory tract? (24) Lungs Bronchi Pharynx Trachea

Pharynx

Which medication is an example of a long-acting beta2 agonist (LABA) used in asthma management? (27) Albuterol Salmeterol Terbutaline Levalbuterol

Salmeterol

A patient has a fever of 104°F (40°C). In which direction, if any, does this shift the oxygen-hemoglobin dissociation curve? (24) Down To the left To the right Will not shift

To the right

A pH of 7.28 & CO2 of 54 indicates? (14)

respiratory acidosis

ROOM AIR lvl

21%

Respiratory Alkalosis is caused by: (14) HYPERventilation or HYPOventilation?

HYPERventilation

Which device is an example of a low-flow oxygen delivery system used for long-term therapy? (25) T-piece Face tent A nasal cannula Simple facemask

High Flow: nasual canula (FINISH)

After providing discharge education for a patient with a stoma after undergoing a laryngectomy, the nurse identifies that which statement by the patient indicates that more teaching is needed? (26) "I will clean the stoma with mild soap and water." "I should cover the stoma while using an electric razor." "I should not cover the stoma while coughing or sneezing." "I will not swim but may shower using appropriate precautions."

"I should not cover the stoma while coughing or sneezing."

Which statement by the parents of a child with asthma indicates a need for further teaching? Select all that apply. One, some, or all responses may be correct. (27) "Our child will not eat food containing metabisulfite." "If our child's lips or fingertips turn gray, we will go to the hospital." "Our child should not take aspirin, ibuprofen, acebutolol, or betaxolol unless recommended by our health care provider." "After 30 minutes of exercise, our child will use the bronchodilator." "We will wash all of our child's bedding in cold water."

"After 30 minutes of exercise, our child will use the bronchodilator." "We will wash all of our child's bedding in cold water." The child should use a bronchodilator inhaler 30 minutes before, not after, exercise to prevent or reduce bronchospasm. The family should wash the child's bedding in hot, not cold, water to get rid of any dust mites. The other statements indicate understanding. The child should not eat food prepared with metabisulfite because it is found to trigger asthma attacks. If the parents notice any graying of lips or fingertips, they should immediately seek emergency care for the patient. NSAIDs such as aspirin and ibuprofen should be avoided, and the parents should not give the patient beta blockers such as acebutolol and betaxolol to avoid complications.

A healthy patient expresses worries about developing tuberculosis (TB) after learning that a friend who visited recently is being treated for the disease. Which information would the nurse provide to this patient? (28) "You have most likely been exposed to TB and will need to be tested." "You should receive TB prophylaxis until your health care provider rules out active disease." "TB is spread from person to person by sharing drinking cups and eating utensils." "Among people exposed to the disease, only a small percentage develop active TB."

"Among people exposed to the disease, only a small percentage develop active TB." With the development of acquired immunity, few of those who are exposed and initially infected actually develop active TB. The disease is spread by inhaling respiratory droplets aerosolized by coughing, sneezing, singing, laughing, and whistling. Unless there is a strong suspicion that TB is present or the patient has had a close exposure, testing is not necessary. TB drugs are given only after the disease is identified.

A patient has deep vein thrombosis. The nurse is teaching the patient's caregiver about measures for preventing pulmonary embolism. Which statement made by the caregiver indicates effective learning? Select all that apply. One, some, or all responses may be correct. (29) "Help the patient to cross the legs." "Gently massage the patient's leg muscles." "Change the patient's position every 2 hours." "Avoid placing a pillow under the patient's knee." "Elevate the affected limb above the heart level."

"Change the patient's position every 2 hours." "Avoid placing a pillow under the patient's knee." "Elevate the affected limb above the heart level." Changing the patient's position every 2 hours may reduce the pressure in specific areas and promote blood circulation. Placing a pillow under the knees can cause pressure under the popliteal space. Elevation of the affected limb 20 degrees or more above the level of the heart improves the venous return. Crossing legs should be avoided to prevent pressure on the blood vessels in the affected limbs, which may result in clot formation. The caregiver should refrain from massaging the leg muscles to prevent dislodging of the clot and causing pulmonary embolism.

A patient who is concerned about getting a tracheostomy says, "I will be ugly with a hole in my neck." Which response would the nurse make? (25) "It won't take you long to learn to manage." "But you know you need this to breathe, right?" "Your family and friends probably won't even care." "Could you place a scarf or a loose collar over it?"

"Could you place a scarf or a loose collar over it?"

Which answer by the nurse is appropriate when a patient with asthma asks why it is necessary to use an inhaled corticosteroid every day? (27) "Daily medications help reduce the risk for irreversible changes in your lungs." "Using a daily steroid medication will prevent the need for rescue medication." "The inhaled corticosteroid stabilizes the mast cells to reduce inflammation." "Inhaled corticosteroid medications potentiate the effects of bronchodilators."

"Daily medications help reduce the risk for irreversible changes in your lungs." Daily maintenance medications are used to help maintain good control of asthma while reducing the underlying inflammation that contributes to asthma exacerbations. Patients with good control have a reduced risk for irreversible tissue changes caused by repeated asthma flares. Inhaled corticosteroid medications do not potentiate the effects of bronchodilators, and they do not have an effect on mast cells. They reduce, but do not prevent, the need for bronchodilators.

Which information is most important for the nurse to give to a patient who is about to begin drug therapy for the treatment of tuberculosis (TB)? (28) "Do not drink alcohol." "Eat foods high in carbohydrates." "Take medications in the morning." "Limit ingestion of orange or grapefruit juice."

"Do not drink alcohol." It is most important for patients who are beginning drug therapy for TB to refrain from alcohol use. This is because all medications that treat TB can cause damage to the liver. Some medications for TB should be taken at bedtime to help prevent nausea. The diet should include vitamins C and B and be rich in iron and protein, not carbohydrates.

Which question will the nurse ask a patient to establish his or her status as a social smoker? (24) "Do you smoke when you are ill?" "Do you ever smoke in social situations?" "Do you have a cigarette before going to sleep?" "Do you smoke in places where smoking is prohibited?"

"Do you ever smoke in social situations?"

Which question would the nurse ask to determine an older-adult patient's risk for developing pneumonia? Select all that apply. One, some, or all responses may be correct. (28) "Do you have a habit of smoking?" "Do you have a history of hypertension?" "Do you have any family history of lung disease?" "Have you had a pneumococcal vaccination in the last 3 years?" "Have you been exposed to persons with influenza recently?"

"Do you have a habit of smoking?" "Have you had a pneumococcal vaccination in the last 3 years?" "Have you been exposed to persons with influenza recently?" Smoking is a risk factor of pneumonia. A one-time pneumococcal vaccination is necessary to prevent pneumonia, and if the patient has not received the vaccination in the past 5 years, he or she is at a risk to develop pneumonia. Patients exposed to influenza may develop pneumonia. Hypertension and family history of lung disease may not precipitate pneumonia.

Which information would the nurse provide to an older-adult patient who is being discharged after treatment for pneumonia? Select all that apply. One, some, or all responses may be correct. (28) "Resume regular group and social activities." "Get an annual influenza immunization." "Avoid contact with all persons with colds or influenza." "Stop or reduce any intake of tobacco and tobacco products." "A pneumococcal vaccination will not be needed in the future."

"Get an annual influenza immunization." "Avoid contact with all persons with colds or influenza." "Stop or reduce any intake of tobacco and tobacco products." People who have had pneumonia need to be instructed to avoid contact with ill persons, stop or reduce smoking, and get an annual influenza immunization and a pneumococcal immunization as recommended by the health care provider. The patient recovering from pneumonia is advised to avoid crowded places such as malls and churches, so the patient would not be able to resume all regular social and group activities. Having pneumonia does not confer immunity. Pneumococcal immunizations are usually given once after age 65 and may be given 5 years after that if the patient is at high risk.

Which clinical finding is consistent with the diagnosis of idiopathic pulmonary fibrosis? (27) Increased force vital capacity Resistance to combination therapy "Honeycomb" pattern on the CT scan Elevated mitogen-activated protein kinase

"Honeycomb" pattern on the CT scan A honeycomb pattern in the affected long tissue on a high-resolution CT scan is anticipated in a patient with idiopathic pulmonary fibrosis. Increased force vital capacity is not consistent with this diagnosis. Resistance to combination therapy is not a diagnostic criterion. Elevated mitogen-activated protein kinase is not a diagnostic test.

A patient is being discharged home with a tracheostomy. Which statement by the patient indicates the need for further teaching about correct tracheostomy care? (25) "I can take baths but no showers." "I will have to learn to suction myself." "I should put cotton cloth or foam over the tracheostomy hole." "I can put normal saline in my tracheostomy to liquefy the secretions."

"I can take baths but no showers." patients can use shower shields

A patient is scheduled to undergo insertion of a catheter for transtracheal oxygen (TTO) therapy. Which statement by the patient indicates a need for further teaching about the procedure? (25) "I may be able to use less oxygen with this device." "I will have local anesthesia for this procedure." "I can use this method only when I am at home." "I'll need to adjust the flow rate for rest and activity."

"I can use this method only when I am at home." the TTO delivery system involves passing the catheter into an incision in the trachea; it may be concealed more easily than the nasal cannula, making it a more acceptable option for some patients. It may be used at home or when out in public. Many patients require less oxygen with TTO, and the flow rate may need to be adjusted for activity and rest. The procedure to insert the catheter requires local anesthesia

Which statement by a patient with a laryngectomy indicates the need for further discharge teaching? (26) "I must avoid swimming." "I can clean the stoma with soap and water." "I can project mucus when I laugh or cough." "I can't put anything over my stoma to cover it."

"I can't put anything over my stoma to cover it." loose clothing or a covering such as a scarf can be used to cover the stoma if the patient desires. To avoid aspiration, the patient with a laryngectomy should not swim. Mild soap and water is the proper way to clean the stoma; however, a shield should be used in the shower so a large amount of water does not enter it. The patient may project mucus when laughing or coughing; reinforce with the patient and the family that this is normal and to be expected

Which statement by a patient with chronic obstructive pulmonary disease (COPD) indicates the need for additional follow-up instruction? (27) "I need to eat more protein." "I don't need to get a flu shot." "I don't need to use my oxygen all the time." "It is normal to feel more tired than I used to."

"I don't need to get a flu shot."

Which statement by the patient indicates a need for further teaching about asthma medication management and the need to use a long-acting beta agonist (LABA) as directed? (27) "I may use the LABA as needed for wheezing and coughing." "The LABA is not used as the only medication for treating asthma." "I should use the LABA twice daily even when I am not having symptoms." "Overuse of the LABA may result in severe worsening of symptoms."

"I may use the LABA as needed for wheezing and coughing." LABAs are long-acting bronchodilators that take time to build up a therapeutic effect. They are used as controller medications and should not be used PRN. Overuse of the LABA may result in worsening of symptoms and death. LABAs are given twice daily every day and are not to be used as the only medication for treating asthma.

Which statement indicates an understanding of the correct use of emergency drug therapy for asthma? (27) "Preventive drugs can stop an attack." "Asthma drugs help everybody breathe better." "I must have my emergency inhaler with me at all times." "I must carry my emergency inhaler only when activity is anticipated."

"I must have my emergency inhaler with me at all times." Because asthma attacks cannot always be predicted, patients with asthma must always carry a rescue inhaler such as a short-acting beta agonist (SABA) like albuterol. Asthma medications are specific to the disease and should never be shared or used by anyone other than the person for whom they are prescribed. An emergency inhaler should be carried when activity is anticipated, as well as at other times. Preventive drugs are those that are taken every day to help prevent an attack from occurring. They are not able to stop an attack once it begins.

The nurse provides discharge education for a patient whose nosebleed was treated with gauze packing. Which statement by the patient indicates the need for further teaching? (26) "I can apply petroleum jelly to my nares." "I should not lift heavy objects for at least a month." "I should not blow my nose for the next 6 hours." "I may use saline nasal spray to moisturize my nose."

"I should not blow my nose for the next 6 hours." patients should be given instructions to help prevent dislodging clots after a nosebleed. Patients with epistaxis (nosebleed) should refrain from blowing their nose vigorously for the first 24 hours. Saline nasal sprays and petroleum jelly are recommended to keep the nose from getting dry. Patients should avoid strenuous activities such as heavy lifting for a month

The nurse is teaching a patient with a tracheostomy who is to be discharged about home tracheostomy management. Which statement by the patient indicates that further instruction may be needed? (25) "I should sleep in a room with a dehumidifier." "I should not lie down within 30 minutes after eating." "If I notice white spots in my mouth, I should call my health care provider." "I will change the tracheostomy holder at least once daily."

"I should sleep in a room with a dehumidifier." patients with tracheostomies should be taught to humidify (not dehumidify) homes to prevent drying of secretions. White spots may indicate Candida infection and should be reported. Patients should be upright to at least 30 degrees after eating to prevent aspiration. The tape ties or Velcro holder should be changed once daily and as needed if it becomes soiled

Which statement would lead to the nurse documenting a young patient as a smoker even after the patient initially denies smoking? (24) "My partner smokes at home." "I tried smoking when I was stressed, but it didn't help." "Smoking is an individual choice." "I smoke only when I am at big parties."

"I smoke only when I am at big parties."

The nurse provides discharge teaching for a patient who underwent inner maxillary fixation surgery for a mandibular fracture. Which statement made by the patient indicates effective learning? (26) "I will cut the wires if I vomit." "I will not use an irrigating device." "I will consume a semiliquid-only diet." "I will do the rewiring as soon as possible."

"I will cut the wires if I vomit." With inner maxillary fixation, bones are realigned and then wired in place with the closed bite. If the patient vomits after an inner maxillary fixation, the patient should immediately cut the wires to prevent aspiration. Irrigating devices are important for maintaining oral health because a patient cannot brush after surgery until completely healed. The patient should consume only a liquid diet because chewing is not possible after surgery. Rewiring should be done only by a licensed practitioner.

Which statement made by a patient indicates the need for further teaching about how to manage a breathing stoma? (26) "I will increase the humidity level at my home." "I will use a shower shield over the stoma while bathing." "I will limit the amount of water I drink to keep the stoma dry." "I will cover the stoma while I am shaving with an electric razor."

"I will limit the amount of water I drink to keep the stoma dry."

Which statement by the patient diagnosed with severe idiopathic pulmonary fibrosis demonstrates a clear understanding of the need for oxygen therapy? (27) "I will need oxygen all of the time." "I will need the oxygen when I am moving around." "I will only need oxygen when I'm sleeping at night." "I will need to use oxygen when I am short of breath."

"I will need oxygen all of the time." Continuous oxygen therapy is needed for patients with severe fibrosis because there is reduced gas exchange. They will need oxygen when they are moving around but also when they are not. They will not only need oxygen when they are sleeping; they will also need it while they are awake. They will need oxygen when they are short of breath, but they will also need it when they are not.

Which patient statement indicates that teaching about anxiety with chronic obstructive pulmonary disease (COPD) has been successful? Select all that apply. One, some, or all responses may be correct. (27) "I will perform diaphragmatic breathing when I am anxious." "I will attend counseling sessions during periods of emotional distress." "I will seek medical assistance when I believe I may have an infection." "I will take my prescribed antianxiety medication if I begin to feel panicky." "I will ask for help if I have difficulty breathing while performing daily activities."

"I will perform diaphragmatic breathing when I am anxious." "I will attend counseling sessions during periods of emotional distress." "I will take my prescribed antianxiety medication if I begin to feel panicky."

Which patient statement about an oxygen concentrator indicates teaching has been effective? (25) "It provides a flow of 100% oxygen." "It does not require refilling with liquid oxygen." "It is more portable than the compressed gas tank." "It is safe around candles and other open flames."

"It does not require refilling with liquid oxygen." an oxygen concentrator acts by removing nitrogen, water vapor, and hydrocarbons from room air, which concentrates oxygen

A patient is refusing to wear pneumatic compression stockings while in bed, stating he does not like how they feel and they keep him awake. Which response would the nurse provide? (29) "Let me talk to the health care provider about discontinuing them." "Would you like me to give you medication to help you sleep?" "It is important to wear them in bed so you don't develop a blood clot in your legs." "I'll give you a break from them for an hour, but then I'll need to put them back on."

"It is important to wear them in bed so you don't develop a blood clot in your legs." The continuous use of antiembolism and pneumatic compression stockings is an essential intervention in the prevention of venous thromboembolism. Providing education to patients may help with their refusal to wear compression stockings. It may be necessary to request a prescription for a sleep aid, but this is not the best response.

Which response is best when a patient asks the nurse how montelukast helps asthma? (27) "It is a monoclonal antibody that decreases the body's allergic response." "It is a corticosteroid that decreases inflammatory and immune responses in the airways." "It is a cholinergic antagonist that opens your airway and decreases lung secretions." "It prevents the synthesis of leukotrienes that can cause bronchoconstriction and inflammation."

"It prevents the synthesis of leukotrienes that can cause bronchoconstriction and inflammation." Montelukast, zafirlukast, and zileuton are all leukotriene modifiers, which prevent, but do not reverse, symptoms during an asthma attack. Montelukast is not a cholinergic agonist, steroid, or monoclonal antibody.

A patient who smokes cigarettes is being discharged home on oxygen. The patient states, "My lungs are already damaged, so I'm not going to quit smoking." Which response would the nurse provide? (25) "It's never too late to quit." "You can quit when you are ready." "Just turn off your oxygen when you smoke." "Let's talk about why smoking around oxygen is dangerous."

"Let's talk about why smoking around oxygen is dangerous."

Which statement regarding the growth and spread of lung cancer requires correction? (27) "Lung cancer can spread to other tissues, including bone." "Tumors can grow so large they can compress the airway." "Metastasis can occur through the blood but not through respiration." "Lung cancer can spread only to lung lymph nodes but not distant lymph nodes."

"Lung cancer can spread only to lung lymph nodes but not distant lymph nodes." The statement requiring correction is "Lung cancer can spread only to lung lymph nodes but not distant lymph nodes." Lung cancer may spread to the lung lymph nodes and to distant lymph nodes, as well as other tissues, including bone. It is true that tumors can grow so large they can compress the airway and that metastasis can occur through the blood but not through respiration.

Which statement by the patient about idiopathic pulmonary fibrosis reflects a need for further teaching? (27) "I may eventually need home oxygen." "Medications may help me with my breathing." "Methotrexate will keep my disease from progressing." "A lung transplant is the only chance I have of a cure."

"Methotrexate will keep my disease from progressing." Methotrexate will not stop the disease from progressing. The patient will likely eventually need home oxygen. Medication therapy may help the patient's breathing. A lung transplant is the only chance of a cure.

How does the nurse respond when a patient who is diagnosed with mild obstructive sleep apnea (OSA) asks if surgery will be necessary? (26) "Surgery is the only reliable treatment to treat OSA." "Drug therapy has been shown to help treat OSA and its symptoms." "Patients generally require treatment with a noninvasive positive-pressure device." "Mild symptoms can be treated by changing sleeping positions or by losing weight."

"Mild symptoms can be treated by changing sleeping positions or by losing weight."

How does the nurse respond when a patient who underwent radiation therapy for laryngeal cancer 2 weeks ago asks if the hoarseness will improve? (26) "Due to damage to the tissue, it is likely that the hoarseness will get slightly worse." "The hoarseness is an adverse effect of the therapy; an NSAID will be prescribed." "It only sounds hoarse to you; to us, it sounds like your actual voice." "Most patients have hoarseness for weeks after radiation."

"Most patients have hoarseness for weeks after radiation." Most patients have hoarseness, sore throat, dysphagia, skin problems, impaired taste, and dry mouth for weeks after radiation. The hoarseness may persist for 4 to 6 weeks. Unless the patient strains the voice, the hoarseness should not get worse. The hoarseness is not considered to be an adverse effect. NSAIDs increase the risk for bleeding and would not be prescribed. The patient's hearing of his or her own voice is accurate.

Which information would the nurse communicate to the family of a patient who is receiving mechanical ventilation? (29) "Paralytic and sedative medications help decrease the demand for oxygen." "Suctioning is important to remove organisms from the lower airway." "We are encouraging oral and IV fluids to keep your loved one hydrated." "Sedation is needed so your loved one does not remove the breathing tube."

"Paralytic and sedative medications help decrease the demand for oxygen." Paralytics and sedation decrease oxygen demand. Sedation is needed more for its effects on oxygenation than to prevent the patient from removing the endotracheal tube. Suctioning is performed to maintain airway patency. Oral fluids would increase the risk for aspiration and pneumonia while an artificial airway and mechanical ventilation are in use.

Which information would the nurse provide about pneumonia prevention to a group of adults older than age 60? Select all that apply. One, some, or all responses may be correct. (28) "Receive an annual influenza vaccination." "Drink about 1 L of fluid each day." "Avoid interacting with people who smoke." "Attempt to get 6 to 8 hours of sleep every night." "Receive an annual pneumococcal pneumonia vaccination."

"Receive an annual influenza vaccination." "Avoid interacting with people who smoke." "Attempt to get 6 to 8 hours of sleep every night." Teachings that are important to communicate about pneumonia prevention include a yearly influenza vaccine and a pneumococcal vaccine as needed. Other teaching points include smoking cessation and the avoidance of secondhand smoke and getting adequate sleep and rest. Patients should also be taught to drink at least 3 L of fluid each day unless fluid restrictions are present. The pneumococcal vaccine is not given annually; it is usually only given once to patients age 65 or older, but it may be given 5 years after the first vaccination to a patient at high risk for pneumonia.

A patient is receiving mechanical ventilation after developing acute respiratory distress syndrome (ARDS) from aspiration pneumonia. The patient's spouse asks the nurse how long it will take the patient to recover. Which response would the nurse provide? (29) "Patients eventually recover but require medications indefinitely." "Recovery time depends on the severity and progression of symptoms." "With appropriate medications and treatments, most patients recover fully." "Patients with ARDS have permanent lung damage and require long-term care."

"Recovery time depends on the severity and progression of symptoms."

The nurse is preparing a patient for discharge who has been treated for the prodromal stage of inhalation anthrax. Which information would the nurse communicate to this patient? (28) "Have your antibiotics refilled if you begin to feel ill." "It is normal for you to feel worse before you feel better." "Contact the health care practitioner for mild chest pain." "Seek medical attention immediately if you feel breathless."

"Seek medical attention immediately if you feel breathless." The fulminant stage of inhalation anthrax usually begins after the patient has been feeling better for a day or so. This stage follows the prodromal stage and often begins with the patient experiencing breathlessness, so it is important for the patient to seek help immediately if this symptom develops. A nurse should never encourage a patient to refill any medications unless it has been prescribed by the health care practitioner. The patient should be given information about all of the symptoms of the fulminating stage, not given the impression that it is normal to feel worse before feeling better, so that any symptom will cause the patient to seek appropriate medical attention. Mild chest pain is expected with the prodromal stage of inhalation anthrax.

Which information about isoniazid medication administration would the nurse include when providing discharge instructions? (28) "Take the drug on an empty stomach." "Take the drug with food for better absorption." "Take an antacid with the drug to avoid stomach upset." "Take the drug with a full glass of water, and increase your water intake."

"Take the drug on an empty stomach." Isoniazid is a first-line treatment for tuberculosis (TB). The nurse should teach the patient to take the drug on an empty stomach (1 hour before or 2 hours after meals) and to avoid taking antacids because food and antacids slow or prevent the absorption of the drug from the GI tract. Although taking the drug with a full glass of water is not incorrect, this is not a necessary instruction for this drug.

Which information for a patient who is beginning treatment of tuberculosis helps to ensure suppression of the disease? (28) "Eat a diet rich in vitamin K." "Do not drink alcoholic beverages." "Take the medication exactly as prescribed." "Contact the health care provider if you feel ill."

"Take the medication exactly as prescribed." It is most important for the nurse to teach the patient to take the medication regularly, exactly as prescribed, for as long as it is prescribed to ensure adequate suppression of the disease. The patient should be instructed to eat a diet rich in vitamins B and C. A diet rich in vitamin K will not assist the patient in any way. Staying away from alcoholic beverages will prevent liver damage from the medications, but it will not ensure suppression of the disease. It is important for the patient to understand that the health care provider should be contacted in the case of illness; however, it will not ensure suppression of the disease.

Which statement about the management of chest tube drainage systems indicates a need for further teaching? (27) "The chest tube of the patient should be securely taped." "The chest tube should be positioned as straight as possible." "The bubbling in the water seal chamber should be gentle during coughing." "The drainage system should be higher than the level of the patient's chest."

"The drainage system should be higher than the level of the patient's chest." The drainage system should be lower than the level of the patient's chest because gravity will help in proper drainage of air. The chest tube of the patient should be securely taped to avoid leakage. The chest tube should be placed as straight as possible to avoid hindrance in drainage. The bubbling in the water seal chamber should be gentle during coughing, indicating normal drainage.

Which statement by the patient with asthma indicates a need for further teaching? (27) "The fluticasone inhaler is used as a rescue medication." "I will use the albuterol inhaler when I am wheezing or short of breath." "I may need oral steroid medications when my asthma action plan is not working." "When I have symptoms in the yellow zone, I will need to take more medicine."

"The fluticasone inhaler is used as a rescue medication." Fluticasone is a maintenance medication to prevent or reduce the incidence of asthma flares. Albuterol is a rescue medication that is used to treat symptoms such as wheezing or shortness of breath. Systemic steroids are added when medications used in the yellow zone are not effective. The yellow zone requires an increase in medications.

How does the nurse respond when a patient with obstructive sleep apnea (OSA) who has been using herbal sleeping aids asks if a positive-pressure ventilation device is necessary? (26) "A positive-pressure device is curative for most patients." "The herbal therapy does not treat the underlying cause." "The positive-pressure device helps patients to inhale while asleep." "Using herbal therapy can delay the need for surgical intervention."

"The herbal therapy does not treat the underlying cause." Medications and herbal therapy can help with daytime sleepiness, but it does not treat the underlying cause of OSA. The positive-pressure device is not curative, but it does help patients get restful sleep. Positive-pressure devices provide positive airway pressure that helps keep small airways open. Using herbal therapy does not delay the need for surgery.

A 75-year-old patient tells the nurse he is not planning to receive a flu shot this year because the shot makes him get influenza. Which response would the nurse provide? (28) "The injectable flu vaccine is not a live virus and cannot cause influenza." "If you had a flu shot last year, you should still have immunity to influenza." "If the shot makes you sick, your health care provider can prescribe an antiviral medication." "The virus in the injection is attenuated, meaning it can cause mild symptoms."

"The injectable flu vaccine is not a live virus and cannot cause influenza." The influenza vaccine is not a live virus and cannot cause disease. The intranasal vaccine is a live, attenuated vaccine and is not given to people over age 49. Immunity to influenza is not conferred in subsequent years because the strains of influenza virus change each year.

The nurse is explaining thrombolytic therapy to a patient. Which information would the nurse include? (29) "You will receive a dose of enoxaparin IM for 3 days." "Therapy with warfarin is effective when your international normalized ratio (INR) is between 2 and 3." "If bleeding develops, we will give you platelets to reverse the anticoagulant." "As soon as the health care provider prescribes warfarin, we will stop the IV heparin."

"Therapy with warfarin is effective when your international normalized ratio (INR) is between 2 and 3." The INR, a measurement of anticoagulation with warfarin, is in the therapeutic range between 2 and 3. Enoxaparin is a low-molecular-weight heparin that is usually given by the subcutaneous route. Heparin and warfarin are overlapped until the INR is in the therapeutic range; then the heparin can be discontinued. Fresh-frozen plasma is used as an antidote for anticoagulant therapy, not platelets.

How does the nurse respond when a patient who is scheduled for a laryngofissure to treat laryngeal cancer asks how the surgery will affect the ability to speak? (26) "Patients are often unable to speak after this type of surgery." "Because a vocal cord is removed, hoarseness is usually the result." "You will regain a normal voice with extensive speech therapy." "This type of procedure results in a normal voice."

"This type of procedure results in a normal voice." Patients who undergo a laryngofissure surgery will have a normal voice after the procedure. Patients who undergo a total laryngectomy have no natural voice after the surgery. Hoarseness may result from a laser surgery, a transoral cordectomy, a supraglottic partial laryngectomy, or a hemilaryngectomy. Extensive speech therapy is not needed for the patient to regain his or her normal voice.

Which amount of initial blood loss may necessitate an open thoracotomy in a patient with a hemothorax? (29) 250 mL 500 mL 750 mL 1000 mL

1000 mL The minimum amount of blood loss required to perform a thoracotomy in a patient with a hemothorax is 1000 mL. Blood losses of 250 mL, 500 mL, or 750 mL do not indicate the need for a thoracotomy.

A patient who has acute viral rhinitis cares for an older family member who is susceptible to respiratory infections. Which action would the nurse suggest to help the patient prevent the spread of this infection? (28) "Get an influenza vaccine immediately." "Thoroughly wash hands after touching the face." "Complete the full course of antibiotic medication." "Wear a mask while providing care to the family member."

"Thoroughly wash hands after touching the face." Handwashing is an important part of preventing the spread of infection; those infected with a viral illness should be reminded to wash their hands thoroughly after blowing their nose or touching their face. Antibiotic medications are not effective in treating viral illness. All patients who care for older family members should have an influenza vaccine each year, but this will not prevent spread of an existing illness. Wearing a mask is less effective than careful handwashing.

Which statement made by the nurse would benefit the patient who has been diagnosed with asthma a few months ago and is using a salmeterol inhaler as a reliever therapy, but has no relief from the symptoms? (27) "Use oral prednisone during an acute asthma attack." "Use the salmeterol inhaler when you have an asthma attack." "Use the fluticasone inhaler when you have an asthma attack." "Use a short-acting inhaler such as albuterol for reliever therapy."

"Use a short-acting inhaler such as albuterol for reliever therapy." Albuterol is a short-acting beta2 agonist bronchodilator that relaxes the bronchiolar smooth muscle by binding to and activating pulmonary beta2 receptors. This drug can stop or reduce life-threatening bronchoconstriction. Oral agents such as prednisone do not work fast enough to stop an asthma attack. Prednisone is an anti-inflammatory drug used to prevent asthma attacks. Salmeterol is a long-acting beta2 agonist; its onset of action is slow, and it does not relieve symptoms during an asthma attack. Fluticasone is an anti-inflammatory drug that is also used to prevent asthma attacks.

Which instruction would be beneficial to an asthmatic patient who is allergic to pollen and is prescribed cromolyn sodium, but the patient reports that it does not help relieve symptoms during an asthma attack? (27) "Include an exercise program in your daily life to improve your health." "Refrain from exposure to allergens that will aggravate the allergic reaction." "Use proper technique while inhaling the drug for maximum effectiveness." "Use cromolyn sodium on a routine basis to prevent an asthma attack, not as a rescue inhaler."

"Use cromolyn sodium on a routine basis to prevent an asthma attack, not as a rescue inhaler." Anti-inflammatory drugs such as cromolyn sodium are useful as a controller drug. This drug decreases inflammation by releasing inflammatory chemicals or preventing mast cell membranes from opening when an allergen binds to immunoglobulin E. Therefore taking a controller drug instead of the reliever drug is the reason the patient's symptoms are not relieved during an asthma attack. Adding a reliever drug to the patient's medication regimen along with the controller drug will help decrease the symptoms during an asthma attack. A regular exercise routine, proper inhaler use, and refraining from allergen exposure are general self-management tips for patients with asthma.

A young adult patient declines an influenza vaccine, saying, "I'm healthy and won't get that sick if I get the flu." Which response would the nurse provide? (28) "If you get the flu, you can always take an antiviral medication." "Not getting the vaccine increases the chances of a worldwide pandemic." "If a flu pandemic begins, you should get the vaccine immediately." "You may spread the disease to people who are at risk for severe symptoms."

"You may spread the disease to people who are at risk for severe symptoms." Young children, older adults, and those with underlying chronic conditions are at risk for pneumonia and death if they become ill with influenza. Patients who refuse the influenza vaccine should be told that they are putting others at risk. Pandemic influenzas typically originate from mutated animal and bird viruses, and prevention is handled separately from seasonal influenza—pandemic influenza vaccines are typically stockpiled and are not part of general influenza vaccination. Antiviral medications are useful when given 24 to 48 hours after onset of symptoms, but usually shorten rather than cure the disease.

The nurse has been instructed to administer tuberculosis (TB) medication by directly observed therapy to a patient who has been noncompliant. Which statement by the nurse will assist the patient in understanding this therapy? (28) "You must swallow your pills in front of me." "Call me right after you take your medications." "I will check your pill bottles every day to make sure you are taking your medications." "I will meet you at the pharmacy to make sure you are picking up the correct prescriptions."

"You must swallow your pills in front of me." Directly observed therapy is used occasionally for patients who are noncompliant or are unable to understand how to regularly take TB medications. The nurse watches the patient as he or she swallows the pills. This technique leads to more treatment successes, fewer relapses, and less drug resistance. Asking the patient to call, checking pill bottles, and meeting the patient at the pharmacy are not examples of directly observed therapy.

A patient with community-acquired streptococcal pneumonia asks about the length of the treatment. Which response would the nurse provide? (28) "You will take medication for 5 to 7 days." "You must be afebrile for 24 hours before the medication is discontinued." "You will complete 10 to 14 days of antibiotics." "You will be reassessed every day to determine when to stop the medication."

"You will take medication for 5 to 7 days." Anti-infectives usually are used for 5 to 7 days in uncomplicated community-acquired pneumonia (CAP). A patient may become afebrile early in the course of treatment with anti-infective medications; this may cause many patients to fail to complete their course of treatment. The continuation of medication is not a daily decision; the course of antibiotics is intended to be completed.

Which tracheostomy cuff pressure would the nurse maintain to prevent mucosal ischemia or air leakage? (25) 0 to 6 mm Hg 8 to 12 mm Hg 14 to 20 mm Hg 22 to 28 mm Hg

14 to 20 mm Hg a pressure range of 14 to 20 mm Hg is recommended to prevent an air leak around the cuff without being excessive enough to cause ischemia of the tracheal mucosa pressures below 14 mm Hg may lead to air leakage around the cuff pressures above 20 mm Hg can lead to ischemia of the tracheal mucosa

Which expiratory volume value signifies a poor prognosis in patients with deep chest trauma? (29) 10 mL/kg 15 mL/kg 20 mL/kg 25 mL/kg

10 mL/kg An expiratory volume of less than 15 mL/kg is considered to be a sign of poor prognosis. The chances of survival are very bleak. An expiratory volume of 15 mL/kg, 20 mL/kg, and 25 mL/kg indicate fair prognosis in patients with chest trauma.

Which patient is at high risk for developing a pulmonary embolism (PE)? (29) 67-year-old man who works on a farm 45-year-old man admitted for a heart attack 23-year-old woman with a bleeding disorder 25-year-old woman who frequently flies internationally

25-year-old woman who frequently flies internationally People who engage in prolonged and frequent air travel are at high risk for PE. A 67-year-old man who works on a farm is not at high risk because he has an active lifestyle. A heart attack is usually caused by a thrombus or occlusion of the coronary arteries, not of the legs, where a venous clot could later become a PE. PE is a clotting disorder, not a bleeding disorder.

Which prescription for oxygen delivery would the nurse question? 36% O2 by Venturi mask 48% O2 by nasal cannula 50% O2 by simple facemask 100% O2 by nonrebreather mask

48% O2 by nasal cannula as a low-flow rate system, oxygen concentrations of 24% to 44% (1 to 6 L/min) are recommended with the nasal cannula. It is not intended to deliver more than 44% fraction of inspired oxygen (Fio2) because at a higher rate, oxygenation does not increase as a result of the limitation of anatomic dead space. All other choices are valid prescriptions

Which risk factor increases a patient's risk for a venous thromboembolism that may progress to a pulmonary embolism? Select all that apply. One, some, or all responses may be correct. (29) Nonsmoker 72 years of age Presence of a central venous catheter Admission weight of 290 lb (131.8 kg) Ability to ambulate with assistance of one person

72 years of age Presence of a central venous catheter Admission weight of 290 lb (131.8 kg) Several factors place a patient at an increased risk for developing a pulmonary embolism from a thromboembolism. Risk factors that should be assessed include prolonged immobility, central venous catheter, surgery, obesity, advanced age, history of thromboembolism, smoking history, pregnancy, estrogen therapy, heart failure, stroke, and cancer.

Which blood oxygen saturation percentage (SpO2) would the nurse set as a target for oxygen therapy for a patient with chronic obstructive pulmonary disease (COPD) who is hypoxemic and hypercarbic? (27) 75% 100% 85% 90%

90% In the past, a patient with COPD was thought to be at risk for extreme hypoventilation with oxygen therapy because of a decreased drive to breathe as blood oxygen levels rose. However, recent evidence does not support this. In fact, this idea has been responsible for ineffective management of hypoxia in patients with COPD. All hypoxic patients, even those with COPD and hypercarbia, should receive oxygen therapy at rates appropriate to reduce hypoxia and bring SpO2 levels up between 88% and 92%. Levels of 75% and 85% are not high enough to set as goals, and 100% is too high and may create unwanted symptoms in the patient with COPD.

The nurse performs follow-up care for a group of patients who have previously had tuberculosis (TB). Which patient is at high risk for developing secondary TB? Select all that apply. One, some, or all responses may be correct. (28) A 34-year-old with human immune deficiency virus (HIV) infection A 55-year-old who recently had abdominal surgery A 14-year-old who is recovering from a broken femur A 75-year-old who is recovering from a hip replacement A 7-year-old who is undergoing chemotherapy for leukemia

A 34-year-old with human immune deficiency virus (HIV) infection A 75-year-old who is recovering from a hip replacement A 7-year-old who is undergoing chemotherapy for leukemia Secondary TB is reactivation of the disease in a person previously infected. It is most likely to occur in patients with depressed immune systems such as the person who has HIV and the child undergoing chemotherapy. Another group of people at risk are older adults, so the 75-year-old recovering from a hip replacement would be at increased risk for developing secondary TB. A 55-year-old patient who recently had abdominal surgery would not be at risk because this patient is neither considered older or immunocompromised. Also, a 14-year-old recovering from a broken femur would not be considered high risk because the adolescent is not considered an older adult and is not immunocompromised.

For which reason would the nurse use caution in providing supplemental oxygen for the patient with hypercarbia? (25) Higher levels of arterial oxygen impair cellular gas exchange. A lower arterial oxygen level provides the stimulus to breathe. Carbon dioxide has a greater affinity to bind with hemoglobin than oxygen. The patient with hypercarbia is no longer sensitive to changing levels of arterial oxygen.

A lower arterial oxygen level provides the stimulus to breathe in the patient with elevated arterial carbon dioxide (hypercarbia), the brain becomes less sensitive to high CO2 levels as the stimulus to breathe. Instead, low arterial oxygen levels provide the drive to breathe. If excessive supplemental oxygen is given, the stimulus to breathe is lost and the patient will develop oxygen-induced hypoventilation

Which patient is at high risk for a pulmonary embolism (PE)? (29) A patient with diabetes admitted with cellulitis of the arm A patient receiving IV fluids through a peripheral line A patient with hypokalemia receiving oral potassium supplements A patient who had an open reduction and internal fixation of the tibia

A patient who had an open reduction and internal fixation of the tibia Surgery and immobility are risks for deep vein thrombosis (DVT) and PE. No evidence suggests that the patient with diabetes has been immobile, which is a risk factor for PE; the patient will be treated with antibiotics. For the patient with a peripheral line, no evidence indicates a problem with the IV or with breakage of the catheter, which could lead to an air embolism. For the patient with hypokalemia, no evidence reveals a risk for PE; no immobility or hypercoagulability is present.

Which patient may be an ideal candidate for the surgical treatment of chronic obstructive pulmonary disease (COPD)? (27) A patient with acute emphysema and stable cardiac function A patient with end-stage emphysema and pulmonary fibrosis A patient with minimal chronic bronchitis and stable cardiac function A patient with advanced chronic bronchitis and stable cardiac function

A patient with minimal chronic bronchitis and stable cardiac function Patients with minimal chronic bronchitis and stable cardiac function are ideal candidates for surgical treatment in chronic pulmonary disease. These patients may not develop complications related to surgery. A patient with acute emphysema may not be able to maintain respiratory functions during surgery and is not an ideal candidate. A patient with end-stage emphysema is an ideal candidate, but a patient with pulmonary fibrosis is not. A patient with advanced chronic bronchitis may not be able to maintain respiratory function during surgery.

Which person is at risk for developing respiratory acidosis? (14) An athlete in training A patient with tuberculosis A person with uncontrolled diabetes A pregnant woman with hyperemesis

A patient with tuberculosis

Which person is considered at higher risk for inheriting pulmonary arterial hypertension (PAH)? (27) A person whose sibling is affected A person whose parents are not affected A person whose second cousin is affected A person whose grandparents are affected

A person whose sibling is affected PAH is a common complication of lung disorders. In some people, it occurs because of gene mutation and unknown environmental factors. Autosomal dominant inheritance is frequently seen in this type of disease with reduced penetrance. The presence of the gene in a sibling indicates an increased risk for inheritance. A person who has both parents unaffected has a reduced risk for inheritance. The presence of the gene in the second-degree relatives decreases the risk for inheritance. The presence of the disease in the grandparents reduces the risk for inheritance.

Which pain medication will the nurse anticipate the health care provider will recommend for a patient with asthma who reports having chronic pain? (27) Aspirin Ibuprofen Hydrocodone Acetaminophen

Acetaminophen Acetaminophen is safe to give to patients who have asthma because it will not trigger an asthma exacerbation. Aspirin and ibuprofen can trigger symptoms in some patients. Hydrocodone would not be a first choice for chronic pain unless the pain becomes more severe.

Which medication would the nurse administer to a patient who underwent a modified uvulopalatopharyngoplasty (modUPPP) for the treatment of sleep apnea? Select all that apply. One, some, or all responses may be correct. (26) Aspirin Ketorolac Ibuprofen Acetaminophen Hydromorphone

Acetaminophen Hydromorphone The nurse may give prescribed acetaminophen or hydromorphone as these will not increase the amount of bleeding. Because aspirin or NSAIDs increase the risk for bleeding, the nurse should not administer aspirin, ketorolac, or ibuprofen.

Which physiologic imbalance is the patient at risk for developing if he or she has chronically low hemoglobin? (14) Acidosis Alkalosis Hypokalemia Ineffective ventilation

Acidosis

A patient admitted to the emergency department is in acute respiratory distress syndrome and has an arterial blood gas drawn. Which finding would explain the laboratory value of a pH of 7.31? (14) Acidosis in response to the presence of excessive ketoacids Alkalosis in response to the excessive loss of hydrogen ions Alkalosis in response to the excessive retention of bicarbonate Acidosis in response to the excessive retention of carbon dioxide

Acidosis in response to the excessive retention of carbon dioxide

A patient with pneumonitis caused by inhaling an irritant is receiving 100% oxygen for treatment of worsening hypoxemia. The patient has increasing dyspnea and work of breathing. A chest x-ray reveals a ground-glass appearance in both lungs. Which condition would the nurse suspect this patient has developed? (29) Aspiration pneumonia Oil or fat embolism Tension pneumothorax Acute respiratory distress syndrome (ARDS)

Acute respiratory distress syndrome (ARDS) Patients who have these symptoms most likely have ARDS. The ground-glass appearance on the x-ray confirms this diagnosis. Patients with pulmonary embolism may have normal chest x-rays or may have infiltrates localized to the area around the embolism. Patients with pneumonia typically have infiltration or consolidation of one or more lobes. A tension pneumothorax is visible on x-ray with one-sided lung involvement.

The nasopharynx contains which structures? (24) Muscles Adenoids Cartilage Air-filled cavities

Adenoids

Which information would the hospice nurse provide to a caregiver to facilitate pain management for a patient with terminal lung cancer? (27) Administer medications around the clock. Use only nonopioid analgesics PRN. Give medications only when the patient is in pain. Provide alternative pain management techniques.

Administer medications around the clock. The nurse should instruct the caregiver to administer pain medications on time around the clock with PRN analgesics in between for breakthrough pain. This would best manage the patient's pain. A patient with terminal cancer would require opioid analgesics. Medications would be administered on a routine basis, not just when the patient appears to be in pain. Alternative pain management techniques may also benefit the patient, but opioid analgesics administered around the clock are more effective for terminal cancer pain management.

Which treatment is the focus during the management of an uncomplicated rib fracture? (29) Splinting the chest Administering analgesics Stabilizing the chest surgically Applying positive-pressure ventilation

Administering analgesics An uncomplicated rib fracture can be managed by the administration of analgesics. Splinting the chest by tape or any other material is not preferred. Surgical stabilization is indicated for extreme cases of flail chest. Positive-pressure ventilation is usually a preferred treatment modality to stabilize a flail chest.

Which ectopic hormone is involved in Cushing syndrome and is associated with lung cancer? (27) Antidiuretic hormone Parathyroid hormone Follicle-stimulating hormone Adrenocorticotropic hormone

Adrenocorticotropic hormone Overproduction of ectopic adrenocorticotropic hormone causes Cushing syndrome, which may lead to small cell lung cancer. An abnormal production of antidiuretic hormone causes syndrome of inappropriate antidiuretic hormone (SIADH). An abnormal production of parathyroid hormone causes hypercalcemia. Abnormal production of follicle-stimulating hormone causes gynecomastia.

Which is the nurse assessing when auscultating the chest of a patient with asthma who is complaining of shortness of breath? (24) Fremitus Oxygenation status Respiratory excursion Adventitious breath sounds

Adventitious breath sounds

A patient who has thick, sticky respiratory secretions requires high-flow, humidified oxygen delivery. Which oxygen delivery equipment would the nurse use for this patient? (25) Face tent Venturi mask Aerosol mask Nonrebreather mask

Aerosol mask an aerosol mask is used when high humidity is needed, as with thick secretions

The nurse identifies which reason for increased vibrations on the chest wall of a patient with suspected lung cancer? (27) Displaced trachea Necrosis of the tissue Inflammation of pleura Air spaces of the lung replaced with tumor

Air spaces of the lung replaced with tumor An increased vibration on the chest wall, or fremitus, indicates that the air spaces of the lungs are being replaced by the tumor or fluid. When a tumor is present near the tracheal area, it results in the displacement of the trachea. In lung cancer, purulent and copious sputum indicates necrosis of the tissue. Pleura are the two membranes that surround and protect the lungs. Inflammation of pleura is indicated by chest pain and an elevated diaphragm.

Which is the priority nursing action for patients who have experienced facial trauma? (26) Pulse oximetry Airway assessment Checking for bruising Monitoring for pulse changes

Airway assessment it can be difficult to determine the extent of trauma with a facial injury, so these patients should be monitored closely for adequacy of their airway. Obstruction related to the trauma can lead to further respiratory complications. Assessment of pulse oximetry, checking for bruising, and monitoring for pulse changes would also be part of the patient's care; however, the priority is to ascertain that the airway is patent

Inhaled corticosteroids are typically used to treat which symptom of asthma? (27) Bronchial spasms Airway inflammation Bronchial secretions Airway hyperresponsiveness

Airway inflammation Inhaled corticosteroids are given to minimize inflammation and do so partly by preventing the synthesis of chemical mediators of inflammation. By preventing inflammation, they indirectly make hyperresponsive episodes less frequent and will decrease bronchial spasms and possibly bronchial secretions.

Which best describes the pathophysiology involved in a patient who has asthma as a lower respiratory disease? (27) Genetic variation in the gene that controls the normal synthesis and activity of beta-adrenergic receptors Chronic yet usually intermittent body response that can lead to night-time awakening with respiratory symptoms Collapse of the walls of bronchioles and alveolar air sacs secondary to lung proteases leading to airway structures Airway obstruction secondary to inflammation and/or bronchoconstriction secondary to airway hyperresponsiveness

Airway obstruction secondary to inflammation and/or bronchoconstriction secondary to airway hyperresponsiveness

Which person will the nurse identify as being more likely to have primary pulmonary arterial hypertension? A male child of 10 years An adult man of 40 years A female child of 14 years An adult woman of 30 years

An adult woman of 30 years Primary pulmonary arterial hypertension is common in women between the ages of 20 and 40 years. Therefore an adult woman of 30 years is most likely to have primary pulmonary arterial hypertension. A male child of 10 years, an adult man of 40 years, and a female child of 14 years are less likely to have primary pulmonary arterial hypertension.

Which prescribed medication would the nurse administer first to a patient with asthma who has pneumonia, is reporting increased shortness of breath, and has inspiratory and expiratory wheezes? (27) Albuterol 2 inhalations Salmeterol 2 inhalations Ipratropium 2 inhalations Fluticasone 2 inhalations

Albuterol 2 inhalations Albuterol is a beta2 agonist that acts rapidly as a bronchodilator. Salmeterol is a long-acting beta2 agonist (LABA) that must be used regularly over time; this patient needs a rescue medication. Ipratropium is an anticholinergic drug that allows the sympathetic system to dominate and cause bronchodilation; it is not as effective as a beta2 agonist, so it is not a first-line drug. Fluticasone is a corticosteroid; it is used to prevent asthma attacks and is not used as a rescue medication.

Which are the two major risk factors for head and neck cancer, especially when in combination? (26) Alcohol and tobacco use Chronic laryngitis and voice abuse Poor oral hygiene and use of chewing tobacco Marijuana use and exposure to industrial chemicals

Alcohol and tobacco use

Which condition may cause a left shift of the oxygen-hemoglobin dissociation curve of a patient with a head injury who is on mechanical ventilation and whose oxygen saturation is being monitored by a pulse oximeter? (24) Fever Acidosis Alkalosis Hypercapnia

Alkalosis

Which drug would the nurse expect to be prescribed for a patient experiencing massive pulmonary embolism who has shock symptoms? (29) Alteplase Enoxaparin Rivaroxaban Fondaparinux

Alteplase Fibrinolytic agents, such as alteplase, are used in the treatment of pulmonary embolism, specifically when the patient has shock and hemodynamic collapse. Enoxaparin is a low-molecular-weight heparin and is prescribed for a submassive pulmonary embolism. Rivaroxaban is an anticoagulant that prevents deep vein thrombosis and pulmonary embolism, and it is prescribed when the patient is at low risk for pulmonary embolism. Fondaparinux is a synthetic pentasaccharide factor Xa inhibitor, which is used unless the pulmonary embolism is massive or occurs with hemodynamic instability.

In patients with pulmonary fibrosis, inflammation resulting from lung injury makes gas exchange difficult by causing thickening of which type of tissue? (27) Alveolar Epithelial Bronchiolar Smooth muscle

Alveolar In patients with pulmonary fibrosis, once lung injury occurs, inflammation begins tissue repair. The inflammation continues beyond normal healing time, causing fibrosis and scarring. These changes thicken alveolar tissues, making gas exchange difficult. Epithelial, bronchiolar, and smooth muscle tissues are not affected in this way.

Gas exchange occurs in which area? (24) Acinus Carina Alveolus Bronchus

Alveolus

Which action helps to prevent tracheostomy decannulation during tie replacement? Select all that apply. One, some, or all responses may be correct. (25) Always have a co-worker assist with the procedure. Do not remove the old ties until the new ones are in place. Give the patient a cough suppressant to prevent coughing. Hold the tracheostomy tube in place with one hand during the process. Know the tracheostomy tube size and type if replacement is necessary.

Always have a co-worker assist with the procedure Do not remove the old ties until the new ones are in place Hold the tracheostomy tube in place with one hand during the process

Which ethnic group reports the highest prevalence of smoking in the United States? (24) Asian Caucasian American Indian African American

American Indian

A patient receiving IV alteplase after developing a pulmonary embolism develops bloody stools and bleeding gums. Which product would the nurse expect to administer as an antidote? (29) Phytonadione Protamine sulfate Aminocaproic acid Packed red blood cells

Aminocaproic acid The antidote for excessive bleeding for patients receiving alteplase is aminocaproic acid. Packed red blood cells may be given if blood loss is excessive to treat anemia, but they are not used as an antidote. Phytonadione is the antidote for warfarin. Protamine sulfate is the antidote for heparin.

Which drug may induce idiopathic pulmonary fibrosis? (27) Amiodarone Azathioprine Chlorambucil Cyclophosphamide

Amiodarone Patients with a history of using drugs such as amiodarone are at a higher risk for idiopathic pulmonary fibrosis. Azathioprine, chlorambucil, and cyclophosphamide are immunosuppressant drugs used in the treatment of idiopathic pulmonary fibrosis; they act on slowing the fibrotic process and managing dyspnea.

Which drug exposure is likely in the history of patients with pulmonary fibrosis? Select all that apply. One, some, or all responses may be correct. (27) Dasatinib Amiodarone Azathioprine Ambrisentan Fenfluramine/phentermine

Amiodarone Ambrisentan The patient with pulmonary fibrosis is usually an older adult with a history of cigarette smoking, chronic exposure to inhalation irritants, or exposure to the drugs amiodarone or ambrisentan. Dasatinib increases the risk for pulmonary arterial hypertension. Azathioprine is used in drug therapy for pulmonary fibrosis. Fenfluramine/phentermine increases the risk for pulmonary arterial hypertension.

Which patient should receive education about pneumococcal vaccine? Select all that apply. One, some, or all responses may be correct. (28) An adult older than 65 A patient who is pregnant A patient who is human immune deficiency virus (HIV) positive A patient who has alcoholism A patient with chronic lung disease

An adult older than 65 A patient who is human immune deficiency virus (HIV) positive A patient who has alcoholism A patient with chronic lung disease Patients that should receive education about a pneumococcal vaccine include patients who are older than 65, have alcoholism, are HIV positive, or have a chronic lung disease. A patient who is pregnant does not need to receive education about pneumococcal vaccines because this is not necessarily recommended for every pregnant patient.

Respiratory Acidosis is caused by: (14) HYPERventilation or HYPOventilation?

HYPOventilation

A patient has just been diagnosed with pulmonary tuberculosis and will be discharged with a prescription for isoniazid 300 mg orally daily. At which time would the nurse teach this patient to take this medication? (28) An hour before bedtime An hour before breakfast Immediately after breakfast Immediately before breakfast

An hour before breakfast Isoniazid must be taken on an empty stomach to ensure adequate medication absorption, so the best time for the patient to take this medication is an hour before breakfast. The patient would need to fast for 2 hours before taking the medication prior to bedtime to ensure that the stomach is empty. Taking the medication immediately before or after breakfast would not allow the stomach to be empty while the medication is absorbed.

A patient has developed subcutaneous emphysema after surgery for a tracheostomy. Which situation explains why the nurse would notify the health care provider immediately? (25) Bleeding has occurred related to the surgical incision; hemoglobin is low. Ventilator pressures are too high, forcing air into tissue, and must be lowered. An opening or tear in the trachea is allowing air leakage into the tissues. The patient has a pneumothorax and will require a chest tube for decompression.

An opening or tear in the trachea is allowing air leakage into the tissues subcutaneous emphysema occurs when there is an opening or tear in the trachea adjacent to the tracheostomy, allowing air to leak into the surrounding tissues. Air can also progress throughout the chest and other tissues into the face. This requires immediate action to maintain adequate oxygenation. A pneumothorax may occur in the apex of the lung; however, this is not likely to cause subcutaneous emphysema. When ventilator pressures are too high, lung damage may occur from this, rather than from subcutaneous emphysema. Some bleeding after surgery is not abnormal, and the incision area should be monitored for hematoma, leakage, or evidence of bruising; this is not related to the subcutaneous emphysema

A female patient presents to the ambulatory clinic reporting a cough. Which other sign or symptom, if present, would cause the nurse to begin wearing an N95 mask and place the patient in an isolated environment? Select all that apply. One, some, or all responses may be correct. (28) Anorexia Blood-streaked sputum Menstrual irregularities Sharp chest pain when coughing Nighttime oral temperature of 98°F (36.7° C)

Anorexia Blood-streaked sputum Menstrual irregularities Physical manifestations of tuberculosis include anorexia, blood-streaked sputum, irregular menses, progressive fatigue, lethargy, nausea, weight loss, and a low-grade fever. Other symptoms include a dull aching pain upon coughing, not a sharp pain. A temperature of 98°F (36.7° C) is normal.

Which ectopic hormone that is associated with lung cancer is a contributing factor to weight gain? (27) Ectopic insulin Antidiuretic hormone Parathyroid hormone Adrenocorticotropic hormone

Antidiuretic hormone Ectopic hormones are produced by tumors of tissues that are not associated with the production of that hormone. Antidiuretic hormone is associated with weight gain through fluid retention. Ectopic insulin is associated with hypoglycemia. Parathyroid hormone results in hypercalcemia. Cushing syndrome is caused by adrenocorticotropic hormone.

Which patient condition may be treated with oxygen therapy? (27) Edema Anxiety Empyema Bronchospasm

Anxiety Humidified oxygen may be prescribed to relieve dyspnea and anxiety. Edema cannot be treated by humidified oxygen. Empyema is a complication in which there is a purulent material present in the pleural space. Bronchospasms are treated by bronchodilators.

Which factor is associated with a cause of respiratory alkalosis? (14) Anxiety Antacid use Kidney failure Diuretic therapy

Anxiety hyperventilation is one cause of respiratory alkalosis, which can result from fear and anxiety.

The nurse observes a nursing orientee providing care for a patient with an anterior nosebleed and identifies that which action is appropriate? Select all that apply. One, some, or all responses may be correct. (26) Place the patient in a supine position. Apply ice or cool compresses to the nose. Maintain Body Substance Precautions. Instruct the patient not to blow the nose for 24 hours. Apply direct lateral pressure to the nose for 10 minutes.

Apply ice or cool compresses to the nose. Maintain Body Substance Precautions. Instruct the patient not to blow the nose for 24 hours. Apply direct lateral pressure to the nose for 10 minutes.

Which component is part of the nursing assessment of a patient to determine the presence of obstructive sleep apnea (OSA)? Select all that apply. One, some, or all responses may be correct. (26) Ask about the frequency of nightmares. Ask whether family members have ever observed the patient having a disturbed breathing pattern while sleeping. Have the patient complete a questionnaire regarding perceived sleep quality and the extent of daytime sleepiness. Ask about falling asleep while performing tasks such as using the computer, reading, or driving. Ask whether the patient can recall ever being awakened by his or her own snoring. Ask about "waking up tired."

Ask about the frequency of nightmares. Ask whether family members have ever observed the patient having a disturbed breathing pattern while sleeping. Have the patient complete a questionnaire regarding perceived sleep quality and the extent of daytime sleepiness. Ask about falling asleep while performing tasks such as using the computer, reading, or driving. Ask whether the patient can recall ever being awakened by his or her own snoring. Ask about "waking up tired." (all of them)

Which action would the nurse take for patient with asthma who tells the nurse that the prescribed montelukast does not help with symptoms during an asthma attack? (27) Contact the health care provider to discuss a possible increase in dose of this drug. Ask the patient to describe how and when the medication is taken. Instruct the patient to take the drug when known asthma triggers are present. Teach the patient to take the drug at the first indication of symptoms for best effect.

Ask the patient to describe how and when the medication is taken Montelukast is taken regularly by a patient with asthma to block inflammatory mediators and help prevent asthma symptoms. It is not given to relieve acute or exacerbated symptoms. It works best when taken consistently, even when symptoms are not present. The nurse should ask the patient to describe how the medication is taken to assess why it is not working. A dose increase is not necessarily needed, especially if the patient is not taking the medication as prescribed.

The nurse is extubating a patient who has been receiving mechanical ventilation for several days. Which action would the nurse plan to take directly after removal of the endotracheal (ET) tube? (29) Monitoring vital signs Suctioning the oropharynx Asking the patient to cough Hyperoxygenating the patient

Asking the patient to cough The patient should be asked to cough immediately after removal of the ET tube to help clear secretions. The nurse should hyperoxygenate the patient and suction the oropharynx before removal of the ET tube. After the ET tube is safely removed, the nurse should monitor vital signs every 5 minutes initially.

The patient with chronic obstructive pulmonary disease (COPD) reports increased difficulty sleeping, eating, and dressing and has trouble walking even short distances. Which part of the admission assessment will the nurse do next? (27) Initiates oxygen therapy at a rate of 2 L/min with a nasal cannula Addresses the remaining questions to the patient's family members Assists the patient to put on a hospital gown and lie down as quickly as possible Asks the patient to sit on the edge of the bed and lean forward over the bedside table

Asks the patient to sit on the edge of the bed and lean forward over the bedside table Patients with orthopnea have difficulty breathing while lying down. To help with comfort, the nurse will encourage the patient to sit leaning forward in an orthopnea position. Oxygen is given for low oxygen saturations, and this must be assessed before starting oxygen therapy. Talking to the patient directly allows the nurse to make observations about the patient's ability to speak and interact and its effect on breathing. Patients with orthopnea will not be able to lie down without exacerbating this symptom.

Which laboratory value would the nurse report to the primary care provider for a patient taking cyclophosphamide? (27) Hemoglobin (Hgb) 15 g/dL Platelets 175,000/µL White blood cell count 5000/µc Aspartate aminotransferase (AST) 50 units/L

Aspartate aminotransferase (AST) 50 units/L An AST level of 50 units/L is elevated, so the nurse would notify the health care provider. A Hgb level of 15 g/dL, a platelet count of 175,000/µL, and a white blood cell count of 5000/µL are all within normal parameters, so they do not need to be reported to the health care provider.

Which principle guides the nurse's support of the patient and family after a complete surgical laryngectomy? Select all that apply. One, some, or all responses may be correct. (26) Aspiration cannot occur because the airway and esophagus have been completely separated. The impact on quality of life is often poorly addressed by health care providers in the hospital. Aspiration of food and liquids during swallowing will increase the risk for bronchial pneumonia. With adequate speech and language training, communication can be understandable and meaningful. Learning to swallow may be painful initially; persistence and emotional support are important.

Aspiration cannot occur because the airway and esophagus have been completely separated. The impact on quality of life is often poorly addressed by health care providers in the hospital. With adequate speech and language training, communication can be understandable and meaningful. Learning to swallow may be painful initially; persistence and emotional support are important.

Kussmaul respiration would be seen as a compensatory mechanism with which situation? (14) Aspirin overdose Use of hydrochlorothiazide Administration of sodium bicarbonate Patient receiving mechanical ventilation

Aspirin overdose

The nurse will educate a patient taking bupropion for smoking cessation about which potential side effect? (24) Hallucinations Loss of appetite Throat dryness Excessive perspiration

Hallucinations

A patient in the ICU on mechanical ventilation appears increasingly restless and picks at the bedcovers. Which action would the nurse take? (29) Increase the sedation. Assess for adequate oxygenation. Request that the family members leave. Explain the breathing tube to the patient.

Assess for adequate oxygenation. Restlessness, agitation, anxiety, and tachycardia are early symptoms of hypoxemia. Increasing sedation may mask symptoms like hypoxemia or worsening respiratory failure. Although the nurse may explain that the patient is intubated, it does not take priority over assessing for hypoxemia. The presence of family members may comfort the patient.

A comatose patient is receiving oxygen via a simple facemask. Which nursing action is a priority for this patient? (24) Weaning from the oxygen as soon as possible Monitoring skin under the mask for skin breakdown Assessing the oropharynx for secretions and vomitus Providing emotional support to the family to minimize anxiety

Assessing the oropharynx for secretions and vomitus patients receiving oxygen via facemask have a limited ability to clear the mouth and thus have an increased risk for aspiration. Keeping the oropharynx clear is a priority for this patient. Weaning from oxygen, monitoring skin under the mask, and providing emotional support to the family are all appropriate nursing interventions for this patient, but the priority is to maintain an open airway

A postoperative patient is obese and reports smoking a pack of cigarettes a day. Which intervention would the nurse include in this patient's plan of care to help prevent venous thromboembolism? (29) Teach the patient about smoking-cessation techniques. Assist with passive and active range-of-motion exercises. Elevate the patient's legs by placing pillows under the knees. Encourage the patient to take deep breaths and cough frequently.

Assist with passive and active range-of-motion exercises. This patient is at risk for deep vein thrombosis (DVT) in the legs, which can cause pulmonary complications when a blood clot breaks loose and lodges in the lungs. Passive and active range-of-motion exercises can help prevent DVTs. Placing a pillow under the knees increases the risk for DVT because it puts pressure on the popliteal space. Coughing can help clear airways in patients who are not at risk for DVT, but coughing involves the Valsalva maneuver, which can increase the risk for clots. Smoking-cessation techniques are an important part of long-term management but will not help in the immediate time period to prevent clots.

Which condition would the nurse suspect in a patient with an eosinophil count of 700/mm3? (24) Asthma Tuberculosis Viral infection Bacterial infection

Asthma

Which disease of the lungs may occur as a result of exposure to occupational irritants? Select all that apply. One, some, or all responses may be correct. (27) Asthma Lung cancer Cystic fibrosis Pulmonary fibrosis Chronic obstructive pulmonary disease (COPD)

Asthma Lung cancer Pulmonary fibrosis Chronic obstructive pulmonary disease (COPD) Diseases of the lungs that may occur as a result of exposure to occupational irritants include asthma, lung cancer, pulmonary fibrosis, and COPD. Cystic fibrosis is a genetic disease.

Which condition may result from vagal stimulation during tracheal suctioning? Select all that apply. One, some, or all responses may be correct. (25) Asystole Heart block Bradycardia Hypertension Mucosal injury

Asystole (lethal heart arythmia) Heart block Bradycardia (slow HR)

Surfactant deficiency may cause which respiratory issue? (24) Atelectasis (partial/complete collapse of the lung) Emphysema Consolidation Pleural effusion

Atelectasis

Which action does the nurse take when, while assessing a patient with a chest tube after a lobectomy, the nurse observes 2 cm of water in chamber two of the three-chamber chest tube drainage system and that the water has stopped bubbling? (27) Add water to chamber two until bubbling resumes. Auscultate the lung sounds and assess respiratory status. Notify the Rapid Response Team to prevent respiratory arrest. Milk the chest tube to move blood clots and prevent obstruction.

Auscultate the lung sounds and assess respiratory status. The water level in chamber two is adequate. Bubbling stops when all of the air has been evacuated from the pleural space, so this is most likely a normal finding. The nurse should continue the assessment. It is not necessary to add water. The absence of bubbling is not a sign of tube obstruction. Notifying the Rapid Response Team is not indicated.

Which instruction would the nurse include to a patient diagnosed with idiopathic pulmonary fibrosis about preventing respiratory infections? (27) Avoid crowded areas. Use hand sanitizer when in crowds. Wear a N95 nonrebreather mask when leaving the house. Begin antibiotics when exposed to people who are ill.

Avoid crowded areas. Avoiding crowded areas can reduce the chance of infection for patients with idiopathic pulmonary fibrosis. Using hand sanitizer in crowds is not indicated. Wearing a 95 nonrebreather mask when leaving the house is not indicated. Beginning antibiotics when exposed to ill people is not indicated.

Which recommendation would the nurse make to a patient and family about the prevention of pneumonia? Select all that apply. One, some, or all responses may be correct. (28) Get plenty of exercise. Avoid indoor pollutants. Eat a healthy, balanced diet. Drink at least 1 L of fluid a day. Avoid crowded areas during flu season and holidays.

Avoid indoor pollutants. Eat a healthy, balanced diet. Avoid crowded areas during flu season and holidays. The nurse will recommend avoiding indoor pollutants, eating a healthy, balanced diet, and avoiding crowded areas during the flu season and holidays. Getting plenty of exercise and drinking at least 1 L of fluid a day is not included in the education for the prevention of pneumonia. The patient may not be able to exercise, and he or she should be encouraged to drink at least 3 L of nonalcoholic fluid a day.

Which assessment finding is associated with obstructive lung disease and not with interstitial lung disease? (27) Cough Dyspnea Barrel chest Reduced gas exchange

Barrel chest Interstitial lung diseases are restrictive, not obstructive, so they do not cause barrel chest, which is the result of air trapping. Both types of pulmonary disease cause cough, dyspnea, and reduced gas exchange.

Which two assessment findings are changes secondary to chronic obstructive pulmonary disease (COPD)? (27) Emphysema and bronchitis Wheezing and excess mucus Barrel chest and finger clubbing Lung crackles and finger clubbing

Barrel chest and finger clubbing

A patient is learning the supraglottic method of swallowing after a partial laryngectomy, and the nurse instructs the patient to perform which action immediately after placing food in the mouth? (26) Bear down. Swallow twice. Clear the throat. Take a deep breath.

Bear down after placing food in the mouth, the patient should perform the Valsalva maneuver by bearing down. The patient should clear the throat and take a deep breath prior to placing food in the mouth. The patient should swallow twice after the Valsalva maneuver

Why are agonist and beta-adrenergic drugs ineffective in treating asthma in older adults? (27) Because of decreased sensitivity of receptors Because of quick response to reliever therapy Because of no response from reliever therapy Because of the receptors causing bronchodilation

Because of decreased sensitivity of receptors

Which medication will the nurse suspect was administered when, after a laryngoscopy, the patient becomes cyanotic and unresponsive to supplemental oxygen, with chocolate-brown colored blood noted when assessing for blood return? (24) Diazepam Meperidine Phenobarbital Benzocaine spray

Benzocaine spray

Occupational exposure to which material increases a person's risk for lung cancer? (27) Basalt Beryllium Boric acid Benzoyl peroxide

Beryllium

After reviewing assessment data for a patient who was admitted for emergency treatment of an acute episode of emphysema, the nurse understands that which data suggest the patient is in an uncompensated acid-base imbalance? (14) Anxious Partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg Bicarbonate (HCO3-) of 24 mEq/L Temperature of 101.5°F (38.6°C)

Bicarbonate (HCO3-) of 24 mEq/L

A patient who does not wish to be intubated is extremely dyspneic and is developing respiratory muscle fatigue. Which measure might the nurse suggest for this patient? (29) Venturi mask Prone positioning Aerosolized bronchodilators Bilevel positive airway pressure (BiPAP)

Bilevel positive airway pressure (BiPAP) BiPAP provides noninvasive pressure support ventilation and may be used for patients with respiratory muscle fatigue to avoid more invasive measures, such as mechanical ventilation. An aerosolized bronchodilator will not help prevent respiratory muscle fatigue. Prone positioning is used in acute respiratory distress syndrome but does not decrease work of breathing; it is generally used when the patient is also mechanically ventilated. A Venturi mask will not help reduce respiratory muscle fatigue.

Which mode of ventilation would the nurse expect to be prescribed for a patient who has sleep apnea? (29) Flow-by ventilation Assist-control ventilation Bilevel positive airway ventilation (BiPAP) Synchronized intermittent mandatory ventilation (SIMV)

Bilevel positive airway ventilation (BiPAP) BiPAP provides noninvasive pressure support ventilation by nasal mask or face mask. It is most often used for patients with sleep apnea. Flow-by ventilation is beneficial for patients in whom weaning from mechanical ventilation is needed. Assist-control ventilation continues to deliver a preset tidal volume, even when the patient's spontaneous breathing rate increases. SIMV coordinates breathing between the ventilator and the patient and is not required in a patient with sleep apnea because continuous flow is needed.

Which term is used to refer to alveolar damage from an inflammatory response? (29) Biotrauma Barotrauma Volutrauma Atelectrauma

Biotrauma Biotrauma is a lung problem that occurs when a patient is on mechanical ventilation; it is the damage to the alveoli that is mediated by an inflammatory response. When the damage to the lungs is caused by excessive pressure, it is referred to as barotrauma. When excess volume of ventilation is delivered to only one lung, it is referred to as volutrauma. A shear injury to alveoli while opening and closing is termed atelectrauma.

Which condition places a patient at risk for developing metabolic alkalosis? Select all that apply. One, some, or all responses may be correct. (14) Fever Diarrhea Blood transfusion Hypovolemic shock Nasogastric suctioning Total parenteral nutrition

Blood transfusion Nasogastric suctioning Total parenteral nutrition

Which statement describes the anatomy of the trachea? (24) Starts at the carina Decreases in size and allows the gases to move Branches into the right and left mainstem bronchi Lined with a ciliated membrane that moves particles away

Branches into the right and left mainstem bronchi

Which finding indicates that the endotracheal tube remains correctly placed in the patient's trachea and is not in the esophagus? (29) Breath sounds are present equally over bilateral lung fields. Oxygen saturation by pulse oximetry is greater than 85%. A suction catheter is easily passed through the endotracheal tube. No air is heard in the stomach when auscultated with a stethoscope.

Breath sounds are present equally over bilateral lung fields. Bilateral positive breath sounds indicate the endotracheal tube is in the proper placement. If breath sounds are heard on the right but not the left, the breathing tube may be in the right mainstem bronchus and may need to be retracted until breath sounds are heard equally. The gold standard for endotracheal tube placement verification is a chest x-ray. If the endotracheal tube was in the esophagus or stomach, breath sounds would be heard over the stomach rather than the bilateral lung fields. Other indications of proper tube placement include positive end-tidal carbon dioxide (CO2) readings and condensation in the tube. The fact that air cannot be heard in the stomach or that a suction catheter is easily passed are not conclusive assessments of a correctly placed endotracheal tube. Although an increase in oxygen saturation after intubation and ventilation indicates that the patient has improved oxygenation, the saturation value alone does not assure correct tube location.

Which assessment finding is of greatest concern in a patient with emphysema? (24) Barrel-shaped chest Ribs lying horizontal Hyperresonance to percussion of the chest Bronchial breath sounds heard at the bases

Bronchial breath sounds heard at the bases

Which pathologic process is present in most patients with chronic obstructive pulmonary disease (COPD)? Select all that apply. One, some, or all responses may be correct. (27) Bronchitis Pneumonia Sarcoidosis Emphysema Cystic fibrosis Pulmonary tuberculosis

Bronchitis Emphysema Most patients with COPD experience emphysema and chronic bronchitis. Pneumonia and tuberculosis are respiratory infections for which patients with COPD are at risk, but they are not a usual occurrence. Sarcoidosis and cystic fibrosis are not seen in most patients with COPD.

Which prescribed treatment would the nurse administer to a patient admitted for an exacerbation of chronic obstructive pulmonary disease (COPD) whose laboratory values reveal a pH of 7.29 with a decreased partial pressure of arterial oxygen (PaO2) and an elevated partial pressure of arterial carbon dioxide (PaCO2)? (14) IV fluids Antiemetics Sodium bicarbonate Bronchodilator therapy

Bronchodilator therapy

Which procedure is listed on the informed consent form when the patient states, "A tube will be inserted into my airway to view airway structures and obtain tissue samples for biopsy"? (24) Bronchoscopy Thoracentesis Pulmonary function test Transthoracic needle aspiration

Bronchoscopy

Which component of a patient's family history is of particular importance to the home health nurse who is assessing a new patient with asthma? (24) Father is obese. Mother is diabetic. Sister is pregnant. Brother is allergic to peanuts.

Brother is allergic to peanuts

A patient has an endotracheal (ET) tube in place for mechanical ventilation. Which intervention would the nurse plan to prevent ventilator-associated pneumonia (VAP) in this patient? (28) Brushing the patient's teeth every 12 hours Assessing oxygen saturation every 4 hours Turning the patient from side to side every 2 hours Suctioning the ET tube every 6 hours

Brushing the patient's teeth every 12 hours A critical aspect of care to help prevent VAP for patients with ET tubes is meticulous oral care, including suctioning of the oral cavity, cleaning the tissues and gums with antiseptic agents, moisturizing the mucous membranes, and brushing the patient's teeth twice daily. Nurses should perform careful respiratory assessments to monitor for early signs of pneumonia, but these assessments are not preventive. Suctioning the ET tube on a routine schedule is not recommended. Turning the patient is helpful in preventing complications of immobility, but it is not included in the evidence-based practices to prevent VAP.

Which therapy will the nurse recognize as being beneficial for a patient who desires to quit smoking but is reluctant because of depression and irritation experienced with withdrawal during previous attempts? (24) Sertraline Bupropion Paroxetine Nicotine patch

Bupropion Bupropion encourages smoking cessation by decreasing cravings and withdrawal-related depression, so this patient may achieve success with this drug.

A nurse is caring for a patient who is orally intubated and being mechanically ventilated. Which factor regarding an artificial airway increases this patient's risk for developing ventilator-associated pneumonia? Select all that apply. One, some, or all responses may be correct. (28) Bypassing the protective airway mechanisms Altering and decreasing the body's immune response Preventing adequate gas exchange at the cellular level Causing a hyperactive reaction of mucociliary clearance Allowing aspiration of secretions from the oropharynx

Bypassing the protective airway mechanisms Allowing aspiration of secretions from the oropharynx An artificial airway, or endotracheal tube, bypasses the normal protective airway mechanisms when inserted into the trachea. It also allows aspiration of secretions from the oropharynx and stomach, increasing the risk for developing ventilator-associated pneumonia. The immune response is not decreased by the presence of an artificial airway. Intubation and mechanical ventilation improve rather than prevent gas exchange at the cellular level. The mucociliary clearance of the lungs may be impaired rather than hyperactive in the presence of an artificial airway.

Which statement about chronic obstructive pulmonary disease (COPD) is correct? Select all that apply. One, some, or all responses may be correct. (27) COPD includes emphysema and chronic bronchitis. Because of increased mucus production, bronchitis leads to breathing problems in the alveoli. Most emphysema is associated with smoking or chronic exposure to other inhalation irritants. The increased risk for infection in COPD is related to increased mucus production and poor oxygenation. Emphysematous lungs contain an increased number of proteases that destroy the normal lung tissue.

COPD includes emphysema and chronic bronchitis. Most emphysema is associated with smoking or chronic exposure to other inhalation irritants. The increased risk for infection in COPD is related to increased mucus production and poor oxygenation. Emphysematous lungs contain an increased number of proteases that destroy the normal lung tissue.

Which diagnostic test will the nurse expect to be prescribed for a patient complaining of chest pain, shortness of breath, and hypoxemia after a knee replacement? (24) Chest x-ray Bronchoscopy Thoracoscopy CT scan

CT scan CT scans, especially spiral or helical CT scans, with injected contrast can detect pulmonary emboli. A chest x-ray will rule out other causes of the symptoms but is not specific for pulmonary embolism.

The nurse is performing stoma care on a tracheostomy placed 24 hours ago. While replacing the ties, the patient becomes agitated and moves unexpectedly, causing the tube to come out. Which action would the nurse take? Select all that apply. One, some, or all responses may be correct. (25) Insert a nasal airway. Call the Rapid Response Team. Provide 100% oxygen via a nonrebreather mask. Attempt to place the tracheostomy tube back into the surgical stoma. Ventilate the patient using a manual resuscitation bag with facemask.

Call the Rapid Response Team Ventilate the patient using a manual resuscitation bag with facemask when a newly placed tracheostomy tube comes out, the priority is to *re-establish the airway.* The nurse should manually ventilate the patient while another nurse calls the Rapid Response Team. The nurse should not attempt to manually replace the tube. A nasal airway is not indicated in this situation. A nonrebreather mask does not provide ventilation, which is vital

Which is the priority action for the nurse when oozing bright red blood is noted on the dressing on the surgical site of a patient who recently underwent a laryngectomy? (26) Provide ventilations with a bag-valve-mask, and reassure the patient. Reinforce the dressing, and call the health care provider. Call the Rapid Response Team, and stay with the patient. Call the operating room, and place constant pressure over the site.

Call the Rapid Response Team, and stay with the patient

Which noninvasive diagnostic test measures the amount of carbon dioxide present when a patient exhales? (24) Capnography Pulse oximetry Arterial blood gases Pulmonary function test

Capnography

Which increased blood arterial level causes a compensatory increase in respiration rate? (14) pH Lactate Bicarbonate Carbon dioxide

Carbon dioxide

Which is the drug of choice for a patient whose cancer overexpresses the epidermal growth factor receptor? (26) Pilocarpine Artificial saliva spray Cisplatin Cetuximab

Cetuximab Cetuximab is prescribed to patients whose cancer overexpresses the epidermal growth factor receptor. It blocks epidermal growth factor receptors in the tumors and normal tissues. Pilocarpine is used in xerostomia because it acts as a saliva stimulant. Artificial saliva spray is also prescribed for xerostomia because it acts as artificial saliva. Cisplatin is chemotherapy used to destroy cancer cells.

Which instruction related to sildenafil would the nurse provide to a patient with pulmonary arterial hypertension (PAH)? (27) Change positions slowly. Report bleeding or bruising. Use a reliable form of birth control. Refrain from alcohol consumption.

Change positions slowly. Sildenafil is a guanylate cyclase stimulator that is used to relax and dilate pulmonary arteries. However, it causes considerable orthostatic hypotension, so the nurse should instruct the patient to change positions slowly. Bleeding and bruising would be reported when using warfarin. Endothelin-receptor antagonists such as bosentan can cause birth defects, which would necessitate the use of reliable birth control. Alcohol should be avoided with endothelin-receptor antagonists as well because of increased risk for hepatotoxicity.

Which finding is an adverse effect of ethambutol? (28) Changes in vision Darkening of the urine Yellowing appearance of skin Increased bruising or bleeding

Changes in vision When taking ethambutol for tuberculosis, the patient should report any vision changes to the health care provider as the medication can cause optic neuritis. Darkening of the urine, yellowing appearance of the skin, and increased bleeding or bruising is associated with liver toxicity or failure and may be seen with isoniazid, rifampin, and pyrazinamide.

Which treatment is often chosen for small cell lung cancer? (27) Chemotherapy Targeted therapy Radiation therapy Immunosuppression

Chemotherapy -Chemotherapy is often the treatment of choice for lung cancer, especially small cell lung cancer. -Targeted therapy is common in the treatment of non-small cell lung cancer. -Radiation therapy can be an effective treatment for locally advanced lung cancers confined to the chest. -Immunosuppression with neutropenia, which greatly increases the risk for infection, is the major dose-limiting side effect of chemotherapy for lung cancer.

A patient has been receiving 60% oxygen by simple facemask since admission 3 days ago. Which finding alerts the nurse to an early stage of oxygen toxicity? Select all that apply. One, some, or all responses may be correct. (25) Hemoptysis Chest pain Bradycardia High-grade fever Nonproductive cough GI upset

Chest pain Nonproductive cough GI upset

Which home-care therapy is most important for a patient with cystic fibrosis (CF) to help prevent exacerbations of the disease? (27) Diabetes prevention Chest physiotherapy Prophylactic antibiotics Nutritional management

Chest physiotherapy Patients with CF have thick, tenacious secretions, which are difficult to clear and serve as a reservoir for infections. Daily chest physiotherapy is central to ongoing management of CF. Nutritional management and diabetes prevention are necessary but not the most important therapy. Prophylactic antibiotics are used later in the disease course after repeated infections and colonization with bacteria.

After surgical placement of a tracheostomy tube, which method is recommended to verify correct placement? (25) Chest x-ray Bronchoscopy Symmetrical chest expansion Auscultation of bilateral lung sounds

Chest x-ray

Which snack selection is best for the nurse to advise to a patient with severe emphysema who asks for assistance with meal and snack choices for the next day? (27) Bean soup with crackers Apple slices and caramel dip Chocolate ice cream shake Salted cheese crackers

Chocolate ice cream shake High-calorie, high-protein meals are recommended to prevent weight loss in patients with severe lung disease. A chocolate ice cream shake is the best snack of those listed because it is high in calories and protein, and it is thick and cool on the throat, which promotes safer swallowing. Beans are gas-producing foods that can cause abdominal bloating. Apple slices are low in calories and protein. Salted cheese crackers are dry and can induce coughing.

Which disorder is a lung disease that causes chronic airflow limitation? Select all that apply. One, some, or all responses may be correct. (27) Chronic bronchitis Intermittent asthma Upper lobe lung cancer Subcutaneous emphysema Inflammatory bronchospasm

Chronic bronchitis Intermittent asthma Asthma, although usually presenting with intermittent attacks, is a chronic condition with reversible airflow obstruction in the airways. Chronic bronchitis is one of the conditions termed as chronic obstructive pulmonary disease (COPD) and involves increased mucus production, which can cause restricted airflow. Lung cancer, depending on its location in the lung, can cause restricted airflow in the lobe(s) of the lung that are obstructed; however, it is not regarded as part of the chronic airflow limitation (CAL) group of diseases, as the mechanism of restriction is different. Subcutaneous emphysema results when air has leaked into subcutaneous tissue—this is an acute situation that may be secondary to a tear in the trachea. Inflammatory bronchospasm actually combines the terms for the two mechanisms seen causing airway obstruction in asthma.

The nurse reviews a patient's medical record and identifies that which history finding is a risk factor for cancer of the nasal cavities and sinuses? (26) Presence of chronic, persistent nasal drainage Chronic exposure to dust from wood, leather, or flour Several allergies and frequent sinus infections as a child Patient report of the need to sleep with the head of the bed elevated

Chronic exposure to dust from wood, leather, or flour chronic exposure to dust from wood, leather, or flour is known to be a risk factor for cancers of the nose and sinuses; people routinely exposed to these materials in a dust form should be encouraged to wear an appropriate mask. A history of allergies and sinus infections does not increase the risk for nasal/sinus cancers. A history of needing to sleep with the head of the bed elevated should be explored further for cause but is not likely to be related. Although a patient with nasal/sinus cancer may experience respiratory symptoms, the presence of persistent nasal drainage is not a risk factor in and of itself

Which patient condition indicates a need for low-flow oxygen delivery? (25) Acute hypoxia Chronic hypoxia Acute hypercarbia Chronic hypercarbia

Chronic hypercarbia patients with chronic hypercarbia need lower levels of oxygen delivery because a low partial pressure of arterial oxygen (Pao2) level is this patient's primary stimulus for breathing. High-flow oxygen delivery will cause oxygen-induced hypoventilation and CO2 narcosis

Which diagnosis will the nurse anticipate for a patient with chronic respiratory symptoms who has an initial decrease in forced expiratory volume in 1 second (FEV1), but an increase in FEV1 of 5% after treatment with a bronchodilator medication? (27) Asthma Bronchitis Pneumonia Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) The patient demonstrated low FEV1, indicating decreased airway responsiveness and obstruction (COPD). If these symptoms are reversible, as with asthma, the FEV1 will rise 12% or more. Bronchitis does not affect the lower airways. Pneumonia is not necessarily an obstructive process.

Which factor can increase the risk for head and neck cancer? Select all that apply. One, some, or all responses may be correct. (26) History of laceration of the vocal cords Chronic voice abuse and related laryngitis Presence of squamous cells in the mucosa Tobacco and alcohol use alone or in combination Persistent hypercarbia with chronic lung disease

Chronic voice abuse and related laryngitis Tobacco and alcohol use alone or in combination chronic voice abuse leading to chronic laryngitis will also contribute to the risk for head and neck cancer, especially in the presence of other risk factors. Tobacco and alcohol use are leading causative factors for head and neck cancer. Squamous cells are normally found in the mucosa. Any laceration of the vocal cords that was adequately treated is not a risk factor. Persistent hypercarbia with chronic lung disease will contribute to other respiratory difficulties but not cancer risk

Which is the greatest risk factor for lung cancer? (27) Cigarette smoking Asbestos exposure Smoking marijuana Alcohol consumption

Cigarette smoking Cigarette smoking is the number-one risk factor for lung cancer and chronic obstructive pulmonary disease (COPD). Alcohol can cause some cancers and liver disease and can increase risky behaviors, but it is not a major cause of lung cancer. Although asbestos is carcinogenic and some components of marijuana are carcinogenic, neither is the major risk factor for lung cancer.

Which behavior by social smokers differentiates them from active smokers? (24) Smoking for stress relief Purchasing their own cigarettes Considering themselves to be smokers Claiming to prefer the company of nonsmokers

Claiming to prefer the company of nonsmokers

Which self-management instruction does the nurse provide to a patient recovering from a laryngectomy? (26) Lean backward to cough. Cover the stoma with tight clothing. Clean the stoma with mild soap and water. Lubricate the stoma with oil-based ointments.

Clean the stoma with mild soap and water. After a laryngectomy, the patient should be instructed to use mild soap and water to clean the stoma. The patient should lean forward, not backward, to cough. The stoma should be covered with loose, not tight, clothing or a stoma guard. The stoma should be lubricated with ointments that are not oil-based.

Which physical sign is expected in a patient diagnosed with lung cancer? Select all that apply. One, some, or all responses may be correct. (27) Intestinal obstruction Clubbing of the fingers Thick and sticky mucus Muffled heart sounds Cyanosis of the lips and fingertips

Clubbing of the fingers Muffled heart sounds Cyanosis of the lips and fingertips The symptoms of lung cancer are clubbing of the fingers, muffled heart sounds, and cyanosis of the lips and fingertips. Clubbing of the fingers is due to a decreased amount of oxygen in the blood. Heart sounds may be muffled by a tumor or fluid around the heart (cardiac tamponade). Cyanosis of the lips and fingertips is due to an inadequate supply of oxygen to the tissues. Intestinal obstruction along with thick and sticky mucus is a symptom of cystic fibrosis. Cystic fibrosis causes a blockage that restricts the passage of food or liquid through the small or large intestine. Thick and sticky mucus is a result of blocked chloride transport in the cell membranes.

Occupational exposure to which material increases a person's risk for lung cancer? (27) Coal Copper Chlorine Citric acid

Coal

Occupational exposure to which material increases a person's risk for lung cancer? (27) Cobalt Copper Chlorine Citric acid

Cobalt

Which disorder of the lungs is caused by a fungus? (28) Pertussis Tuberculosis Inhalation anthrax Coccidioidomycosis

Coccidioidomycosis Coccidioidomycosis is a fungal infection caused by the Coccidioides organism common in the desert southwest regions of the United States, Mexico, and Central and South America. Pertussis, tuberculosis, and inhalation anthrax are bacterial infections.

Which finding is the most common indicator for pneumonia in an older patient? (28) Fever Cough Confusion Increased white blood cell count

Confusion The most common indication of pneumonia in an older patient is confusion caused by hypoxemia. Cough and fever may be absent, and the white blood cell count may not be elevated until the infection is severe. Treatment should begin if the older patient is confused.

Which assessment finding suggests a patient has acidosis? Select all that apply. One, some, or all responses may be correct. (14) Confusion Hypertension Hyperreflexia Warm, flushed, dry skin Pounding peripheral pulse

Confusion Warm, flushed, dry skin

Which discharge teaching does the nurse provide for a patient who received radiation therapy for oral cancer in an area that includes the salivary glands? (26) Use mouthwashes and anesthetic throat sprays for increased comfort. Perform frequent brushing with a soft-bristled toothbrush. Implement voice rest, and alternate communication methods. Consume large quantities of fluids, and provide humidification of the environment.

Consume large quantities of fluids, and provide humidification of the environment. A common adverse effect of radiation therapy that occurs when the salivary glands are irradiated is xerostomia, which is not always reversible. Patients should be taught to take in large amounts of fluids and humidify the environment to help with this discomfort. Frequent brushing is not indicated, although good oral hygiene is recommended. Mouthwashes, anesthetic throat sprays, and voice rest are recommended for patients with vocal cord symptoms.

Which plan of action will the nurse anticipate for a patient with asthma who has the following manifestations: has wheezing, dyspnea, and coughing episodes once or twice a month lasting 1 to 2 days; symptom relief is controlled by an inhaled bronchodilator; about once every 2 years requires an oral corticosteroid medication when symptoms are more severe; and does not have limitations in activities or night-time awakening with symptoms? (27) Addition of an inhaled corticosteroid as a maintenance medication Continuation of the current therapy plan with no daily medication required Treatment with a long-acting bronchodilator plus an inhaled corticosteroid Supplementation with a leukotriene modifier and a daily bronchodilator

Continuation of the current therapy plan with no daily medication required This patient has intermittent symptoms that are easily managed with a bronchodilator medication. The reliever medication is used less than twice weekly, and the patient does not have night-time symptoms or changes in activity participation. The current treatment plan is effective and does not need to be changed. Adding an inhaled corticosteroid or a leukotriene modifier is done as part of step 2 management (of the step system for medication use in asthma control). A long-acting bronchodilator plus an inhaled corticosteroid is part of step 3 management.

Which oxygen device is also likely to increase ventilation? (25) Nasal cannula Simple facemask Partial rebreather mask Continuous positive airway pressure mask (CPAP)

Continuous positive airway pressure mask (CPAP)

Which two major categories are included in asthma medications? (27) Control and reliever Preventive and quick acting Steroids and bronchodilators Bronchodilators and anti-inflammatories

Control and reliever The categories for asthma drug therapy are control therapy (formerly called preventive drugs), which are designed to reduce airway responsiveness and prevent asthma attacks, and reliever drugs, which are those used to actually stop an attack once it has started. "Quick acting" is not a category of asthma medication. Bronchodilators, steroids, and anti-inflammatory drugs are medications that are given for asthma, but these are considered drug classes, not categories.

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who reports increased fatigue and nausea. The nurse notes distended neck veins, bounding peripheral pulses, dependent edema, and cyanosis of the lips and hands. The nurse notifies the health care provider of which condition? (27) Orthopnea Hypercapnia Cor pulmonale Respiratory distress

Cor pulmonale Patients develop cor pulmonale when air trapping, airway collapse, and stiff alveolar walls increase lung tissue pressure and make blood flow through lung vessels more difficult. The right side of the heart eventually enlarges and thickens, leading to right-sided heart failure with backup of blood into the general venous system. Orthopnea (difficulty breathing while lying down) is often a symptom of cor pulmonale. Hypercapnia is an increase in partial pressure of arterial carbon dioxide (PaCO2). Signs of respiratory distress include tachypnea, nasal flaring, anxiety, sternal retraction, shortness of breath, restlessness, decreased oxygen saturation, decreased level of consciousness, and stridor.

Which topic is most important for the nurse to include when reviewing asthma management with an older-adult patient? (27) Frequent peak flow assessments Need to reduce strenuous exercise Increased use of rescue medications Correct use of controller medications

Correct use of controller medications Correct use by older-adult patients of controller medications is the most important factor in helping avoid asthma attacks. Older-adult patients do not necessarily need to increase peak flowmeter use or to reduce strenuous exercise. Older-adult patients become less sensitive to bronchodilating medications, so increased use of rescue drugs is not effective.

Which respiratory system side effect will the nurse assess for in the patient prescribed angiotensin-converting enzyme (ACE) inhibiting drug? (24) Croup Cough Asthma Emphysema

Cough

Which term will the nurse use to document popping, discontinuous sounds on auscultation over the patient's anterior chest? (24) Crackles Rhonchi Wheeze Pleural friction rub

Crackles

Which medication will the nurse expect the health care provider to prescribe for a patient with asthma and elevated serum eosinophils and elevated immunoglobulin E (IgE) levels? (27) Albuterol Fluticasone Cromolyn sodium Ipratropium bromide

Cromolyn sodium Cromolyn sodium is a mast cell stabilizer that prevents mast cells from opening when an allergen binds to IgE and helps block this trigger of asthma. When patients have elevated eosinophils and elevated IgE, they have allergic asthma that is triggered by allergens binding to IgE. Albuterol, fluticasone, and ipratropium bromide may be prescribed for any patient with asthma, but not based on this finding.

Which statement would the nurse use to describe cystic fibrosis when teaching a patient about the disease? (27) Cystic fibrosis affects only the lungs. Cystic fibrosis is present only in older adult people. Cystic fibrosis is an autosomal dominant disorder. Cystic fibrosis is associated with the formation of thick mucus.

Cystic fibrosis is associated with the formation of thick mucus. Cystic fibrosis is associated with the formation of thick mucus because of poor chloride transport. Cystic fibrosis affects the lungs, pancreas, liver, salivary glands, and testes. Cystic fibrosis is present in a patient from birth. Cystic fibrosis is an autosomal recessive disorder.

Which medication exposure in a patient *increases the risk* for primary pulmonary arterial hypertension? (27) Warfarin Bosentan Dasatinib Verapami

Dasatinib Dasatinib is a multi-targeted tyrosine kinase inhibitor used in the treatment of leukemia. Exposure to dasatinib increases the risk for primary pulmonary arterial hypertension. Warfarin, bosentan, and verapamil are used in the management of primary pulmonary arterial hypertension.

Which finding indicates the treatment for obstructive sleep apnea with continuous positive airway pressure (CPAP) is effective? Select all that apply. One, some, or all responses may be correct. (26) Decrease in amount of snoring Overnight pulse oximetry greater than 97% CPAP system used every night No episodes of daytime sleepiness Blood pressure within normal range

Decrease in amount of snoring Overnight pulse oximetry greater than 97% CPAP system used every night No episodes of daytime sleepiness Blood pressure within normal range (all of them)

Which change would indicate that a patient with impaired kidney function is in metabolic acidosis? (14) Increase in arterial blood pH Increase in partial pressure of arterial oxygen Decrease in partial pressure of carbon dioxide Decrease in serum bicarbonate level

Decrease in serum bicarbonate level

A patient is receiving mechanical ventilation with a fraction of inspired oxygen (Fio2) of 85%. The health care provider has prescribed the positive end-expiratory pressure (PEEP) to be increased from 10 cm of H2O to 15 cm of H2O. If the increase in PEEP is successful, which change will the nurse anticipate being made to the ventilator settings? (29) Increase the tidal volume. Decrease the tidal volume. Increase the oxygen flow rate. Decrease the oxygen flow rate.

Decrease the oxygen flow rate. PEEP is added when patients cannot maintain adequate gas exchange even with high-flow oxygen. The effect of preventing atelectasis should increase arterial blood oxygenation and allow the oxygen flow rate to be decreased. Adding PEEP does not have a direct effect on tidal volume, which is determined by the patient's weight and lung capacity.

According to principles of the oxygen dissociation curve, which event occurs when tissue pH is decreased? (24) Hemoglobin increases. Hemoglobin decreases. Hemoglobin dissociates oxygen less rapidly. Hemoglobin dissociates oxygen more rapidly.

Hemoglobin dissociates oxygen more rapidly.

Which complication would the nurse anticipate for a patient who splints fractured ribs? Select all that apply. One, some, or all responses may be correct. (29) Increased pain Increased risk for flail chest Decreased breathing depth Increased risk for a pneumothorax Ineffective clearance of secretions

Decreased breathing depth Ineffective clearance of secretions Complications associated with splinting fractured ribs includes decreased breathing depth and ineffective clearance of secretions. A patient splints the fracture to decrease pain. Flail chest and pneumothorax are not risk factors of splinting fractured ribs.

Bupropion helps with smoking cessation in which way? (24) Decreases craving for nicotine Interferes with nicotine receptors Provides nicotine without tobacco Moderates the pleasure from nicotine

Decreases craving for nicotine

Which factor is monitored during a polysomnography for a patient suspected of having obstructive sleep apnea (OSA)? Select all that apply. One, some, or all responses may be correct. (26) Depth of sleep Muscle movement Respiratory efforts Heart abnormalities Carbon dioxide exhalation Oxygen saturation

Depth of sleep Muscle movement Respiratory efforts Heart abnormalities Carbon dioxide exhalation Oxygen saturation (all of them)

Which cause is associated with the development of metabolic acidosis because of an overproduction of hydrogen ions? Select all that apply. One, some, or all responses may be correct. (14) Hyperaldosteronism Diabetic ketoacidosis Salicylate intoxication Nasogastric suctioning Excessive fasting for 30 days

Diabetic ketoacidosis Salicylate intoxication Excessive fasting for 30 days

Which condition can cause metabolic acidosis? Select all that apply. One, some, or all responses may be correct. (14) Diarrhea Liver failure Kidney failure Prolonged vomiting Nasogastric suctioning

Diarrhea Liver failure Kidney failure

Which finding indicates tube obstruction in a patient with tracheostomy? (25) Quiet respirations Thick, wet secretions Difficulty breathing Lower peak pressures

Difficulty breathing as a result of tube obstruction, a patient with tracheostomy has difficulty breathing. The respirations may become noisy, rather than quiet, and are accompanied with thick, dry secretions, rather than thick, wet secretions. There are also unexplained high peak pressures noted

Which clinical manifestation in a patient recovering from an open lung biopsy will lead the nurse to suspect the presence of a pneumothorax? (24) Low respiratory rate Rapid capillary refill Diminished breath sounds Presence of a barrel chest

Diminished breath sounds

By which method does metastasis of lung cancer occur? Select all that apply. One, some, or all responses may be correct. Direct extension Through the blood Through respiration Invasion of endocrine glands Invasion of lymph glands and vessels

Direct extension Through the blood Invasion of lymph glands and vessels

A patient requiring mechanical ventilation for treatment of pneumonia becomes agitated, restless, and shows symptoms of respiratory distress. The mechanical ventilator high-pressure alarm has been activated. Which action would the nurse take? (29) Medicate the patient with a sedating agent. Increase oxygen delivery to 100% through the ventilator. Check the mechanical ventilator data for possible causes of the alarm. Disconnect the ventilator, and provide ventilation with a self-inflating bag.

Disconnect the ventilator, and provide ventilation with a self-inflating bag. When a patient shows signs of respiratory distress while being mechanically ventilated, the nurse should focus on the patient, not the mechanical ventilator. The first best action is to disconnect the ventilator and use a self-inflating bag to ventilate the patient while problem solving the cause of the alarm. Although it may be necessary to administer sedation to the patient, the nurse must attempt to stabilize the patient first. The nurse should not increase oxygen through the ventilator until the cause of the alarm is determined.

The spouse of a patient who is scheduled for a tracheostomy is expressing concern regarding the surgery's effect on their quality of life. Which action would the nurse focus on preoperatively? (25) Providing information about how to perform emergency resuscitation Emphasizing just getting through the surgery and postoperative period Teaching about the techniques explained previously for tracheostomy care Discussing approaches for the patient to use for communicating

Discussing approaches for the patient to use for communicating

Which action does the nurse take when a patient who underwent thoracic surgery coughs and the chest tube collection water seal chamber bubbles? (27) Strips the chest tube Documents the occurrence as a normal finding Checks the tube for blocks or kinks Contacts the health care provider immediately

Documents the occurrence as a normal finding Gentle bubbling in the water seal chamber is normal during the patient's exhalation, forceful cough, or position changes. Any bubbling that is occurring would stop if a kink or a blockage is present in the chest tube. The chest tube is functioning normally; there is no need to notify the health care provider. "Stripping the chest tube" greatly increases pressure inside the chest and could potentially damage lung tissue; any excessive manipulation should be avoided.

Which finding may signify a pulmonary contusion in a patient who was in a motor vehicle crash? Select all that apply. One, some, or all responses may be correct. (29) Dry cough Hemoptysis Bradycardia Tachycardia Hyperresonant to percussion

Dry cough Tachycardia Patients with a pulmonary contusion have a dry cough and tachycardia. Hemoptysis may occur with a pulmonary embolism. Bradycardia does not manifest in a pulmonary contusion. The sound of percussion in a patient with a pulmonary contusion is always dull. Hyperresonance on percussion occurs in patients with a pneumothorax.

Which is a late manifestation of lung cancer? (27) Dysphagia Polyphagia Tachypnea Weight gain

Dysphagia The patient with lung cancer can have inflammation of the food pipe that results in dysphagia. Patients with lung cancer experience nausea and vomiting that can cause anorexia, so polyphagia is not likely to develop. Tachypnea is not likely, though the patient develops dyspnea because of decreased functional ability of the lungs. The patient with lung cancer is likely to have weight loss.

***Which finding may indicate that a tracheostomy tube is obstructed? Select all that apply. One, some, or all responses may be correct. (25) Dyspnea Bradypnea Noisy respirations Edema around the stoma Asymmetrical chest movement Difficulty inserting a suction catheter

Dyspnea Noisy respirations Difficulty inserting a suction catheter

Which warning signal is associated with lung cancer? Select all that apply. One, some, or all responses may be correct. (27) Dyspnea Weight loss Leukonychia Osteoarthritis Clubbing of the fingers

Dyspnea Weight loss Clubbing of the fingers

Which is an example of a primary lung cancer prevention measure that the nurse can implement? (27) Educating about the risks associated with smoking Encouraging early diagnosis and treatment for lung cancer Providing evidence-based care for patients with lung cancer Assisting a chemotherapy center to develop treatment protocols

Educating about the risks associated with smoking Primary prevention measures are those that work to prevent diseases from occurring. Teaching about the risks of smoking can help reduce the risk for lung cancer. The other measures are examples of secondary and tertiary prevention because they involve actions that occur once the disease is present.

Which respiratory assessment findings will be documented as normal in a 79-year-old patient? (24) The patient has the ability to cough, and vital capacity increases. Alveolar surface increases, and residual volume decreases. Anteroposterior diameter decreases, and elasticity increases. Effectiveness of the cilia decreases, and risk for hypoxia increases.

Effectiveness of the cilia decreases, and risk for hypoxia increases

Which respiratory condition will the nurse suspect in a 70-year-old patient presenting with a barrel-shaped chest with a greater than 2-cm width of intercostal spaces and hyperresonance over all lung fields during percussion? (24) Pneumonia Lung cancer Emphysema Pneumothorax

Emphysema emphysema is characterized by air trapping, which expands the lungs and the thoracic cavity. Patients will develop a barrel-shaped chest with an increased anteroposterior diameter and increased space between ribs

Which intervention to facilitate adequate caloric intake for a patient who has chronic obstructive pulmonary disease (COPD) is included in the plan of care? (27) Administer bronchodilator medications after meals. Recommend a high-calorie, high-carbohydrate diet. Include high-calorie protein drinks as part of each meal. Encourage frequent rest periods, especially before meals.

Encourage frequent rest periods, especially before meals. Patients with chronic lung disease fatigue easily and are often unable to consume the amounts of food necessary to prevent weight loss. The nurse should encourage frequent rest periods to help patients with the energy necessary to eat. Bronchodilator medications should be given before meals to improve oxygenation. High-calorie protein drinks are recommended but not with meals because patients will be unable to consume both. Diets should be high in calories and protein.

How will the nurse initially assist a patient newly diagnosed with lung cancer to deal with anxiety? (24) Provide journals about cancer treatment. Leave the patient alone to deal with his or her own feelings. Medicate the patient with diazepam for anxiety every 8 hours. Encourage the patient to ask questions and verbalize concerns.

Encourage the patient to ask questions and verbalize concerns

Which type of chest trauma produces a dull sound on percussion of the affected side? (29) Rib fracture Hemothorax Pneumothorax Tension pneumothorax

Hemothorax A dull sound on percussion of the affected side is a typical feature of a hemothorax. Rib fractures do not alter the percussion tone. A pneumothorax or tension pneumothorax produce a hyperresonant tone on percussion.

Which action will be the most effective for the nurse to take when an older patient presents with a decreased ability to cough and decreased alveolar surface area, and diffusion capacity is noted on the laboratory reports? (24) Assess for breathlessness caused by hypoxia. Encourage increased rest periods during exercise. Encourage the patient to cough and take deep breaths. Assess the patient's level of consciousness and cognition.

Encourage the patient to cough and take deep breaths

Which assessment finding will the nurse anticipate in allergic rhinitis? (24) Perforated septum Red mucous membrane Pale, shiny, gelatinous lumps Engorged, bluish-gray mucous membrane

Engorged, bluish-gray mucous membrane

Which action would the nurse take when caring for a patient who has a tracheostomy and T-piece? (25) Pad the T-piece to protect the skin. Use the oral suctioning device to clear secretions from the T-piece. Ensure that aerosol continuously comes out of the T-piece. Drape a cloth over the exhalation port when working in close proximity to it.

Ensure that aerosol continuously comes out of the T-piece when oxygen flow rates are adequate through the humidifier, a mist or aerosol should continuously be seen from the exhalation port both during inhalation and exhalation. The exhalation port should be kept open and uncovered; draping it might occlude the airway. The T-piece does not touch the skin, so it does not need to be padded. An oral suctioning device should never be used to suction the T-piece because it is contaminated with oral flora and will introduce infection

Which action will the nurse take when preparing a patient for thoracentesis? (24) Ask the patient to sit up straight during the procedure. Stand beside the patient to prevent the patient from falling. Ensure that all personnel and assistants wear goggles and masks. Tell the patient that the procedure is done under general anesthesia.

Ensure that all personnel and assistants wear goggles and masks

Which intervention would the nurse include in the plan of care for a patient receiving oxygen at 5 L/min per nasal cannula? (25) Clean the nasal cannula every 4 hours. Elevate the head of the bed 45 degrees. Continuously monitor O2 saturation with a pulse oximeter. Ensure that oxygen bubbles through the water in the humidifier.

Ensure that oxygen bubbles through the water in the humidifier when the oxygen flow rate is greater than 4 L/min, humidification should be used to prevent drying of the nasal mucosa. The nurse should ensure that there is adequate water in the humidifier chamber and that oxygen is bubbling through it.

A chest x-ray is prescribed for an ambulatory patient receiving nasal oxygen. Which action would the nurse take when personnel arrive to transport the patient? (25) Ensure that portable oxygen is in place before the patient leaves for radiology. Turn the oxygen rate up briefly before disconnecting it during the transport. Call radiology and request that a portable chest x-ray be done at the bedside. Turn the oxygen off and then resume it immediately upon the patient's return.

Ensure that portable oxygen is in place before the patient leaves for radiology

A patient who has a do-not-resuscitate (DNR) order is using a nonrebreather oxygen mask, and breathing appears to be labored. Which action would the nurse take first? (25) Notify the chaplain and the family member of record. Auscultate the patient's lungs. Ensure that the tubing is patent and that oxygen flow is high. Confirm that signed DNR orders are in the chart.

Ensure that the tubing is patent and that oxygen flow is high

Which is the priority of care for the nurse when working with patients who are experiencing disorders of the upper respiratory tract? (26) Administering nasal oxygen Monitoring for signs of hypoxia Alleviating the patient's anxiety Ensuring a patent airway to promote oxygenation

Ensuring a patent airway to promote oxygenation

Which sign or symptom is an indicator of an asthma attack? Select all that apply. One, some, or all responses may be correct. (27) Eosinophils in the sputum Muscle retraction between the ribs Audible wheeze, especially on exhalation Increased, then decreased arterial carbon dioxide (PaCO2) level Decreased forced expiratory volume in the 1 second (FEV1) on flowmeter

Eosinophils in the sputum Muscle retraction between the ribs Audible wheeze, especially on exhalation Decreased forced expiratory volume in the 1 second (FEV1) on flowmeter During an acute episode of asthma, the most common manifestations are an audible wheeze and increased respiratory rate. At first, the wheeze is louder on exhalation; when inflammation occurs with asthma, coughing may increase. The patient may use accessory muscles to help breathe during an attack, which the retraction of muscles between the ribs would indicate. A decrease in either the FEV1 or the peak expiratory flow (PEF) of 15% to 20% below the expected value for age, gender, and size is common for the patient with asthma. In allergic asthma, the sputum may contain eosinophils and mucus plugs with shed epithelial cells. Early in an attack, the PaCO2 level may be decreased as the patient increases respiratory effort; later in the episode, PaCO2 rises, indicating carbon dioxide retention.

Which term describes the small, elastic flap attached to the top of the larynx that opens during breathing? (24) Glottis Epiglottis Costal cartilage Cricoid cartilage

Epiglottis

Which intervention listed on a standard laryngectomy plan of care is the most important for the nurse to accomplish during the immediate postoperative period? (26) Educate the patient about ways to avoid aspiration when swallowing after the surgery. Teach the patient's caregiver about how to suction and perform wound care of the stoma. Discuss appropriate clothing to wear that will help cover the laryngectomy stoma and decrease social isolation. Establish a means for communicating, such as a picture board, a computer, or a smart phone.

Establish a means for communicating, such as a picture board, a computer, or a smart phone

A patient taking isoniazid, rifampin, pyrazinamide, and ethambutol for tuberculosis reports visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes? (28) Rifampin Isoniazid Ethambutol Pyrazinamide

Ethambutol Ethambutol can cause optic neuritis leading to blindness at high doses. When discovered early and when the drug is stopped, problems can usually be reversed. Both isoniazid and pyrazinamide may cause liver failure; side effects of major concern include jaundice, bleeding, and abdominal pain. Rifampin will cause the urine and all other secretions to have a yellowish-orange color; this is harmless. Contact lenses will also be stained, and oral contraceptives will be less effective.

When caring for a patient with posterior nasal bleeding and a gauze pack in the posterior nasal cavity, which initial action does the nurse take when the assessment findings include restlessness, anxiety, and an oxygen saturation of 92%? (26) Assess for hypotension and tachycardia. Evaluate the position of the packing string. Check the patient's gag and cough reflexes. Request a prescription for an antianxiety medication.

Evaluate the position of the packing string patients with posterior packing in place are at risk for respiratory distress if the packing shifts and blocks the airway. The strings attached to the packing are threaded out through the nose and taped in place to prevent pack movement. The patient is anxious, with low oxygen saturation, so the nurse should assess for airway obstruction first. Hypotension and tachycardia are signs of hypovolemia, which may be caused by hemorrhage, and if the airway is patent, this would be the next assessment. Assessment of cough and gag reflexes is necessary to prevent aspiration, which would be the next assessment after the airway and circulation are assessed. If the patient is anxious after everything is determined to be stable, an antianxiety medication may be indicated

A patient who is admitted with severe diabetic ketoacidosis has an arterial blood gas result that reveals a pH of 7.21. Which factor is causing this patient's acidosis? (14) Anaerobic metabolism Excessive intake of insulin Excessive breakdown of fatty acids Excessive intake of alcoholic beverages

Excessive breakdown of fatty acids

The turbinates serve which function? (24) Decrease the weight of the skull on the neck. Separate two nasal passages down the middle. Move inspired particles from nose to throat for removal. Increase the surface area of the nose for heating and filtering.

Increase the surface area of the nose for heating and filtering

Which outcome does the abdominal thrust maneuver (formerly known as the Heimlich maneuver) for acute airway obstruction attempt to achieve? (26) Induce emptying of the victim's stomach. Increase the victim's systemic circulation. Expel the air remaining in the victim's lungs. Put pressure on the apex of the victim's heart.

Expel the air remaining in the victim's lungs The quick inward motion of the abdominal thrust maneuver expels the air remaining in the victim's lungs, and with it, the foreign body causing the obstruction. The abdominal thrust does not induce vomiting or alter the circulation of the choking victim in any way. There is no additional pressure put on the apex of the heart with an abdominal thrust maneuver, based on the hand placement for the intervention, which is below this anatomic landmark.

A patient receiving mechanical ventilation and anticoagulant medication after experiencing a pulmonary embolism appears tense and is unable to sleep or rest. Which action should the nurse take? (29) Request a prescription for pain medication, and remind the patient to report discomfort. Ask the health care provider if conscious sedation may be administered to help the patient rest. Explain all interventions to the patient, and provide reassurance that care is appropriate. Tell the patient's family that the patient is unstable, and suggest that they remain close by.

Explain all interventions to the patient, and provide reassurance that care is appropriate. Patients who have a pulmonary embolism are usually anxious. The nurse should communicate with the patient to explain interventions and offer reassurance that appropriate measures are being taken. The patient's anxiety is not related to pain. A sedative may be prescribed if other comfort measures are not effective; however, conscious sedation is a specific level of analgesia recommended during uncomfortable or painful procedures or when a mechanically ventilated patient is unable to be oxygenated adequately. Family presence may provide comfort; however, telling the patient's family that the patient is unstable will increase the level of anxiety for everyone involved.

The nurse identifies that which intervention is appropriate when a patient is experiencing airway obstruction because of the tongue falling back or excessive secretions? (26) Inserting a nasogastric tube Performing emergency endotracheal intubation Placing the patient in a prone position Extending the head and neck slightly

Extending the head and neck slightly Extending the patient's head and neck may actually be sufficient to alleviate the partial obstruction caused by the tongue falling back in the throat; this may especially help to align the neck to decrease the accumulation of any secretions in the throat. Placing the patient in prone position will make the situation worse. A nasogastric tube will not assist in removing secretions. The patient should first be repositioned, which may eliminate the need for intubation.

Which information is used to determine the stage of lung cancer at the time of diagnosis? (27) Histologic cell type Expected prognosis Recommended treatment Extent of disease identified

Extent of disease identified Lung cancers are staged using the TNM (tumor, node, metastasis) system. Histologic cell type is important for treatment planning recommendations but not staging. Both the extent of the disease and the histologic cell type influence the expected prognosis; the expected prognosis does not influence staging. The histologic cell type, the stage of the disease, and the patient's health influence treatment recommendations; recommended treatment does not determine the stage of disease.

The nurse will describe the anterior nares in which way? (24) External openings into the nasal cavities Bones that protrude into the nasal cavities Openings from the nasal cavity into the throat Air-filled cavities that surround the nasal passages

External openings into the nasal cavities

A patient admitted to the emergency department with facial burns and smoke inhalation requires high-flow oxygen therapy. Which oxygen delivery device would the nurse apply? (25) Face tent Venturi mask Nasal cannula Nonrebreather mask

Face tent

Which respiratory device can be used to provide a patient with an 80% fraction of inspired oxygen (Fio2)? Select all that apply. One, some, or all responses may be correct. (25) Face tent Aerosol mask T-piece Venturi mask Simple mask

Face tent Aerosol mask T-piece

Which mode of oxygen delivery is recommended for a patient with facial burns? (25) Face tent Venturi mask Nasal cannula Simple facemask

Face tent the face tent allows oxygen delivery without touching the face. It is recommended for facial trauma and facial burns to reduce the risk for pressure-related complications and to promote healing

Which symptom is commonly observed in an older patient with pneumonia? Select all that apply. One, some, or all responses may be correct. (28) Fever Cough Fatigue Confusion Poor appetite

Fatigue Confusion Poor appetite

Which finding would the nurse expect to note during mild activity of a patient with class III pulmonary arterial hypertension (PAH)? Select all that apply. One, some, or all responses may be correct. (27) Fatigue Dependent edema Dyspnea on exertion Jugular vein distention Ascites with hepatomegaly

Fatigue Dependent edema Dyspnea on exertion Jugular vein distention Ascites with hepatomegaly (all of them)

Which clinical manifestation is usually present when an older adult has pneumonia? Select all that apply. One, some, or all responses may be correct. (28) Fever Cough Fatigue Weakness Confusion Poor appetite

Fatigue Weakness Confusion Poor appetite The most common manifestation of pneumonia in the older adult is acute confusion from hypoxia. The older adult also typically exhibits weakness, fatigue, and poor appetite when pneumonia is present. Fever and cough may be absent; the white blood cell count may not be elevated until the infection is severe.

Which condition increases oxygen demand? (25) Anemia Fever Heart failure Poisoning

Fever

Which symptom of pneumonia may present differently in the older adult than in the younger adult? (28) Fever Headache Wheezing Crackle

Fever Older adults may not have a fever and may have a lower-than-normal temperature with pneumonia. Crackles on auscultation may be present in all age groups as the result of fluid in the lungs. All age ranges may have a headache with pneumonia. Wheezing is an indication of narrowed airways and can be found in all age groups.

Which finding is consistent with the prodromal (early) stage of inhalation anthrax? Select all that apply. One, some, or all responses may be correct. (28) Fever Diaphoresis Mild chest pain Pleural effusion Mediastinal "widening" (chest x-ray)

Fever Mild chest pain Mediastinal "widening" (chest x-ray) Manifestations of the prodromal (early) stage of inhalation anthrax include fever, dry cough, mild chest pain, fatigue, no upper respiratory symptoms, and mediastinal widening on chest x-ray. Pleural effusion and diaphoresis are symptoms of the fulminating (late) stage of the disease.

A patient who has been on a ventilator for the past week has become increasingly hypoxemic despite increased oxygen settings. Which phase of acute respiratory distress syndrome (ARDS) would the nurse suspect the patient is experiencing? (29) Increased compliance Exudative Resolution Fibrosing alveolitis

Fibrosing alveolitis In the fibrosing alveolitis phase, increasing lung involvement reduces gas exchange and oxygenation. ARDS decreases rather than increases lung compliance. In the exudative phase patients experience dyspnea and tachypnea and require oxygen via mask or nasal cannula. The resolution phase usually occurs after 14 days. Resolution of the injury can occur; if not, the patient either dies or has chronic disease.

Which condition is consistent with an x-ray report of three adjacent ribs each fractured in three different places? (29) Flail chest Pulmonary contusion Tension pneumothorax Tracheobronchial trauma

Flail chest Flail chest appears in CT as the fracture of at least three neighboring ribs in two or more places. The chest x-ray of a patient with a pulmonary contusion reveals hazy opacity in the lobes or parenchyma. A tension pneumothorax is indicated by the asymmetry of the thorax in the x-ray. In tracheobronchial trauma, the chest x-ray shows a tracheobronchial tear.

Which is the correct documentation when a high-pitched, soft intensity, extremely dull sound is noted when percussing over the sternum? (24) Flatness Dullness Tympany Resonance

Flatness Flatness over the lung field may indicate massive pleural effusion

Which factor is a pathophysiologic basis for the clinical manifestation of pneumonia? Select all that apply. One, some, or all responses may be correct. (28) Movement of red blood cells into the alveoli causes pleuritic chest discomfort. Suppression of fever with the use of acetaminophen speeds the recovery process in older adults. Fluid accumulation in the receptors of the respiratory system triggers the coughing mechanism. Pulmonary capillary shunting leads to hypoxemia. Stimulation of chemoreceptors and decreased lung compliance lead to an increased respiratory rate and dyspnea.

Fluid accumulation in the receptors of the respiratory system triggers the coughing mechanism. Pulmonary capillary shunting leads to hypoxemia. Stimulation of chemoreceptors and decreased lung compliance lead to an increased respiratory rate and dyspnea. Fluid accumulation in the receptors of the trachea, bronchi, and bronchioles cause the coughing seen with pneumonia. Pulmonary capillary shunting leads to hypoxemia. Stimulation of chemoreceptors in the respiratory system and the increased work of breathing secondary to decreased lung compliance lead to the clinical manifestation of increased respiratory rate and dyspnea. Movement of red blood cells into the alveoli causes the presence of purulent, blood-tinged, or rust-colored sputum but does not cause chest pain. Fever is secondary to the release of pyrogens that cause the hypothalamus to increase body temperature; this is a normal physiologic response—suppression of or masking the fever will not speed recovery.

Which concept is accurate regarding acid-base chemistry in acidosis? (14) Acids bind free hydrogen ions in solution. Acetic acid (CH3COOH) is a strong acid. Normally, blood is slightly acidic in nature. Fluids with lower pH have higher acidity.

Fluids with lower pH have higher acidity

Which action would the nurse take when providing wound care for a patient during the first few days after tracheostomy placement? (25) Applying Steri-Strips to secure the tube Folding standard gauze 4 × 4s to fit around the tube Cutting a slit in standard gauze 4 × 4s for ease of placement around tube Assessing the stoma site every 24 hours for drainage, redness, and swelling

Folding standard gauze 4 × 4s to fit around the tube it is recommended that intact 4 × 4s be folded and placed around the tube. Cutting the 4 × 4 gauze might release small pieces of gauze that may be aspirated. The stoma site should be assessed every shift. Steri-Strips are not used to stabilize the tube

Which condition may require the use of a chest tube to drain fluid from the pleura? (29) Flail chest Hemothorax Pneumothorax Tension pneumothorax

Hemothorax Chest tubes may be used in a patient with a hemothorax to empty the pleural space of accumulated blood. A pneumothorax and a tension pneumothorax may require a chest tube for removal of air from the pleural space. A flail chest does not require a chest tube unless other injuries are also present.

A patient with small cell lung cancer (SCLC) has gynecomastia (enlarged man breasts). This is most likely due to paraneoplastic syndrome caused by the tumor cells secreting which hormone? (27) Antidiuretic hormone Parathyroid hormone Follicle-stimulating hormone Adrenocorticotropic hormone

Follicle-stimulating hormone SCLC tumor cells can secrete an excess of specific hormones, with each resulting in a different paraneoplastic syndrome. Gynecomastia is the result of SCLC tumor cells secreting an excess of follicle-stimulating hormone (FSH). The excess secretion of antidiuretic hormone causes syndrome of inappropriate antidiuretic hormone (SIADH). Increased secretion of parathyroid hormone causes hypercalcemia, and the oversecretion of adrenocorticotropic hormone causes an excess of cortisol, which results in Cushing syndrome.

Which term describes increased vibrations felt on the chest wall that indicate areas of the lung where air spaces are replaced with tumor or fluid in patients with lung cancer? (27) Fremitus Palliation Mucositis Thrombocytopenia

Fremitus -Fremitus describes increased vibrations felt on the chest wall that indicate areas of the lung where air spaces are replaced with tumor or fluid in patients with lung cancer. -Palliation is the type of care given to patients when curative treatments are not available. -Mucositis is open sores on mucous membranes. -Thrombocytopenia is a decreased number of platelets.

Which factor may cause hypoxia in a patient with tracheostomy? Select all that apply. One, some, or all responses may be correct. (25) Frequent suctioning Use of 14 Fr catheter Limited suctioning time Excessive suction pressure Ineffective oxygenation before suctioning

Frequent suctioning Excessive suction pressure Ineffective oxygenation before suctioning

The nurse assesses a patient who has undergone nasal surgery and identifies that which finding should be reported to the health care provider immediately? (26) Excessive sedation Frequent swallowing Nausea and vomiting Persistent restlessness

Frequent swallowing Frequent swallowing may indicate a posterior nasal bleed that will require intervention by the surgeon. Restlessness may be present, especially if the patient is in pain. Excessive sedation may be related to residual anesthesia effects or pain medications. Nausea and vomiting, although important to treat, are not the safety risk the posterior bleed would be. Good care involves all of these aspects; however, the initial focus should be on the potential presence of bleeding.

Which action would the nurse plan when caring for a patient who is using a nonrebreather mask? (25) Assessment of the patency of both of the nostrils Frequent verification that the oxygen source is functioning Close monitoring to assess for patient feelings of claustrophobia Regular tightening of the mask for a secure fit over the nose and mouth

Frequent verification that the oxygen source is functioning

Which type of factors most likely explains the variance in lung cancer development among adults with similar smoking histories? (27) Social factors Genetic factors Occupational factors Environmental factors

Genetic factors Lung cancer development varies among adults with similar smoking histories, suggesting that genetic factors can influence susceptibility. Social, occupational, and environmental factors are less likely to explain this variance.

Which term describes the opening between the vocal cords? (24) Glottis Epiglottis Palatine tonsils Arytenoid cartilage

Glottis

Which factor differentiates cerebrospinal fluid (CSF) leakage from normal nasal secretions? (26) Viscosity Lipid content Protein content Glucose content

Glucose content CSF contains glucose, and this can be tested using a dipstick test. In nasal secretions, glucose is absent. Viscosity refers to the thickness of a fluid, and both CSF and nasal secretions are thin. Nasal secretions contain antimicrobial proteins and peptides as a first-line host defense against microbial invaders. CSF normally contains very little protein because serum proteins are large molecules that do not cross the blood-brain barrier. CSF and nasal secretions will not contain lipids

The nurse will obtain which information during a focused assessment of particulate matter exposure? (24) Hobbies Vital statistics Food preferences Exercise schedule

Hobbies respiratory problems may occur because of exposure to inhalation irritants found in the environment. The patient would be exposed to harmful chemicals and irritants if he or she has hobbies such as painting, ceramics, model airplanes, refinishing furniture, or woodworking

A 76-year-old patient who is recovering from rhinosinusitis reports severe dry mouth and constipation. Which medication may be causing these effects? (28) Oseltamivir Hydroxyzine Phenylephrine Cephalosporin

Hydroxyzine Hydroxyzine is a first-generation antihistamine that may cause anticholinergic effects such as constipation and dry mouth when used in older adults. Phenylephrine is a nasal decongestant that may cause rebound nasal congestion. Cephalosporin is an antibiotic used to treat bacterial infections. Oseltamivir is used in the treatment of influenza.

Which electrolyte abnormality would the nurse anticipate when reviewing laboratory data for a patient admitted with metabolic acidosis? (14) Hyponatremia Hypernatremia Hypokalemia Hyperkalemia

Hyperkalemia

A patient admitted with diabetic ketoacidosis was treated for metabolic acidosis with IV fluids and insulin. Which electrolyte imbalance would the nurse monitor for as the acid-base imbalance resolves? (14) Hyponatremia Hypokalemia Hyperkalemia Hypernatremia

Hypokalemia

A community health nurse is preparing a community education class on inhalation anthrax. Which manifestation would the nurse include in the teaching about the fulminant stage of the infection? (28) Fever Fatigue Dry cough Hypotension

Hypotension Inhalation anthrax infection has two stages: prodromal (early) and fulminant (late). Hypotension may occur in the fulminant stage of inhalation anthrax infection. Fever, fatigue, and dry cough occur in the prodromal stage of inhalation anthrax infection.

A patient with a pulmonary embolism is experiencing anxiety and asks the nurse for a sedative. Which risk would be increased by administering a sedative? (29) Increased clotting Hypoventilation Hyperventilation Abnormal bleeding

Hypoventilation Although a sedative can help manage a patient's anxiety, a health care provider is unlikely to prescribe it to a patient with a pulmonary embolism because sedatives carry the risk for hypoventilation as a side effect. Sedative agents do not carry a risk for increasing clots. Anticoagulants, not sedatives, may cause abnormal bleeding. Sedative agents slow, not quicken, breathing, so they are unlikely to cause hyperventilation.

Which condition manifests as delirium in patients on mechanical ventilation? (29) ICU paranoia ICU dementia ICU psychosis ICU depression

ICU psychosis The use of mechanical ventilation for a patient in the ICU can cause anxiety and delirium, a condition known as "ICU psychosis." -Paranoia involves a patient being overly suspicious, not delirious. -Dementia may manifest as delirium, but it is the result of cognitive disorders and aging, not anxiety. -Depression may occur in a patient on mechanical ventilation in the ICU, but it is not characterized by delirium.

Which dyspnea classification as it relates to employment will be documented for a patient who reports dyspnea when climbing stairs but is not dyspneic at rest? (24) I; can perform manual labor II; can perform a desk job III; minimally employable IV; must remain at home

II; can perform a desk job

Which clinical manifestation would the nurse observe in a patient with cystic fibrosis associated with infection? (27) Bradypnea Weight gain Bradycardia Intercostal retractions

Intercostal retractions Intercostal retractions are observed in a patient with cystic fibrosis associated with infection. Tachypnea, weight loss, and tachycardia are other manifestations associated with infection in cystic fibrosis (not bradypnea, weight gain, or bradycardia).

Which level of severity will the patient with chronic obstructive pulmonary disease (COPD) have with a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of 65% of predicted value and an FEV1 of 55% of the predicted value? (27) I; mild III; severe II; moderate IV; very severe

II; moderate -This patient has intermittent symptoms and has an FEV1/FVC of less than 70% of predicted value and an FEV1 between 50% and 80% of predicted value, which means the patient has moderate COPD. -Patients with mild COPD do not have dyspnea. -Patients with severe COPD have an FEV1 between 30% and 50% of predicted value with persistent symptoms. -Patients with very severe COPD have an FEV1 less than 30% or less than 50% of the predicted value with respiratory failure along with more severe symptoms.

The nurse is caring for a pregnant patient who has a severe coccidioidomycosis fungal infection. Which medication would most likely be prescribed for this patient? (28) IV amoxicillin Oral fluconazole Oral ketoconazole IV amphotericin B

IV amphotericin B Patients with coccidioidomycosis (valley fever) who are pregnant or have a severe infection will receive IV amphotericin B. Nonpregnant patients with mild infection may receive fluconazole, ketoconazole, or voriconazole orally. IV amoxicillin is an antibiotic and is not used to treat fungal infections.

The nurse expects that which pain medication will be listed on the treatment plan of the patient who is first day postoperative after a total laryngectomy? (26) IV ketorolac IV midazolam IV morphine sulfate Oral acetaminophen

IV morphine sulfate IV morphine sulfate or other opioids are the best choice for this patient in the immediate postoperative period. They can be given both as a bolus dose and continuously by patient-controlled analgesia (PCA). The patient's airway and respiratory status must be carefully observed. Although NSAIDs do provide pain relief, at this stage of the patient's recovery, ketorolac is not the best choice; it can increase the risk for bleeding. Midazolam is an antianxiety medication; it has no narcotic properties. Oral acetaminophen is not appropriate in the immediate postoperative period as it will not provide sufficient pain control and the patient still will be unable to take oral medication.

Which condition is characterized by the appearance of lung tissue in a honeycomb pattern in high-resolution CT? (27) Sarcoidosis Cystic fibrosis Idiopathic pulmonary fibrosis Chronic obstructive pulmonary diseases

Idiopathic pulmonary fibrosis With idiopathic pulmonary fibrosis, the affected lung tissue has the appearance of a honeycomb in high-resolution CT. With sarcoidosis, the patient may have cough, dyspnea, and an abnormal chest x-ray. With cystic fibrosis, the chest x-ray shows infiltrated lungs and increased anteroposterior diameter. In chronic obstructive pulmonary disease, the chest x-ray shows a hyperinflated and flattened diaphragm.

Which action would the nurse take when suctioning a tracheostomy or endotracheal tube? Select all that apply. One, some, or all responses may be correct. (25) Not suctioning longer than 20 seconds If needed, repeating suctioning up to three passes When suctioning, using a gentle twirling motion of the catheter Adjusting the pressure dial on the suction source to 140 to 160 mm Hg Applying suction while quickly inserting the catheter and slowly removing it Preoxygenating the patient with 100% oxygen before suctioning

If needed, repeating suctioning up to three passes When suctioning, using a gentle twirling motion of the catheter Preoxygenating the patient with 100% oxygen before suctioning preoxygenation is a proactive strategy to diminish suction-related hypoxemia. The technique of suctioning using a gentle twirling motion diminishes the risk for mucosal injury. No more than three suctioning passes are recommended to minimize hypoxemia, tissue hypoxia, and related complications. The recommended negative pressure for suction is 80 to 120 mm Hg. Suction should not be applied during catheter insertion, but rather only during removal. The rule is not to suction more than 10 to 15 seconds to prevent hypoxia and complications

Which is the best time to perform a closed reduction of a nasal fracture? Select all that apply. One, some, or all responses may be correct. (26) Immediately after the injury Within 24 hours after the injury Within 24 to 48 hours after the injury Within 48 to 96 hours after the injury About 7 to 10 days after the injury

Immediately after the injury Within 24 hours after the injury the primary health care provider performs a simple closed reduction (moving the bones by palpation to realign them) of the nasal fracture using local or general anesthesia within the first 24 hours after injury. After 24 hours the fracture is more difficult to reduce because of edema and scar formation. Therefore waiting until 24 hours, 48 hours, 96 hours, or 7 to 10 days after the injury to perform the procedure is inappropriate

Which action will the nurse take first when caring for a patient admitted to the medical unit immediately after a therapeutic bronchoscopy? (24) Monitor for signs of anaphylaxis. Assess the puncture site for drainage. Perform aggressive chest physiotherapy. Implement NPO status.

Implement NPO status

A patient has a pulse oximetry level of 96% and a respiratory rate of 14 breaths/min. Oxygen is being delivered via a simple facemask at a flow rate of 4 L/min. Which action would the nurse take? (25) Increase the oxygen flow rate to 5 L/min and review the health care provider's orders. Assess the patient at 30- to 60-minute intervals for evaluation of oxygenation status. Suggest that the patient sit up straight and take several deep, slow breaths. Request an order to decrease the mask flow rate to wean the patient from oxygen.

Increase the oxygen flow rate to 5 L/min and review the health care provider's orders

A community health nurse is preparing teaching materials for an upcoming community health fair. Which risk factor would the nurse include when teaching about community-acquired pneumonia? Select all that apply. One, some, or all responses may be correct. (28) Increased age Increased weight Presence of a chronic health condition Administration of influenza vaccine Administration of pneumococcal vaccine

Increased age Presence of a chronic health condition Older adults and those with chronic conditions are at increased risk for developing community-acquired pneumonia. Influenza vaccination or pneumococcal vaccination decreases the risk for developing community-acquired pneumonia. Although increased weight is a health problem, it is not a factor that increases the risk for developing community-acquired pneumonia.

Which assessment finding is a normal age-related change in the respiratory system? (24) Sputum production Shortness of breath Increased respiratory rate Increased anteroposterior (AP) diameter

Increased anteroposterior (AP) diameter

Which factor is a sign of tracheoesophageal fistula (TEF)? (25) Increased coughing and choking while eating Clear and thin tracheal secretions Receiving the set tidal volume on the ventilator Decreasing air in the cuff needed to achieve a seal

Increased coughing and choking while eating

Which expected outcome for a patient with pneumonia would be supported by the use of incentive spirometry? (28) Reduced sputum production and increased cough Reduced crackles and wheezes and improved oxygenation Improved expiratory airflow and increased respiratory effort Increased inspiratory muscle action and decreased atelectasis

Increased inspiratory muscle action and decreased atelectasis Incentive spirometry helps improve inspiratory muscle action and prevents or reverses atelectasis. It does not increase respiratory effort, reduce crackles and wheezes, or reduce sputum production.

Which mechanism does the body employ to facilitate the release of oxygen from hemoglobin molecules while performing strenuous exercise? (24) Increased tissue pH Decreased tissue temperatures Reduced glucose breakdown products Increased tissue carbon dioxide (CO2) production

Increased tissue carbon dioxide (CO2) production

Which mechanism in the body compensates for a low pH? (14) Increases respiratory rate Decreases respiratory rate Retains carbon dioxide Decreases release of bicarbonate

Increases respiratory rate when the body has an acid-base imbalance, it finds ways to compensate. Low pH indicates acidosis, which the body can combat with an increased respiratory rate to blow off carbon dioxide.

A febrile patient presents to the emergency department with a headache, chills, fatigue, nausea, vomiting, and diarrhea. Which illness would the nurse suspect? (28) Influenza A Influenza B Influenza C Influenza D

Influenza B Symptoms of influenza B may include nausea, vomiting, and diarrhea. The influenza viruses (A, B, and C) all include headache, muscle aches, fever, chills, fatigue, and weakness. Influenza is identified as A, B, or C; there is no D.

The nurse includes which intervention on the plan of care for a patient who is undergoing rhinoplasty for a severe nasal fracture? (26) Administer ibuprofen for pain relief. Maintain the patient in a prone position. Instruct the patient to sneeze with the mouth closed. Instruct the patient on changing the moustache dressing.

Instruct the patient on changing the moustache dressing A "moustache dressing" is a drip pad placed under the nose and is usually a folded 2" × 2" gauze. The nurse can change or teach the patient to change the drip pad as necessary. The patient should avoid aspirin and other NSAIDs (such as ibuprofen) to prevent bleeding. The patient should remain in a semi-Fowler position and move slowly. To prevent bleeding, the patient should limit Valsalva maneuvers and should not sneeze with the mouth closed for the first few days after the packing has been removed.

A patient has severe pain from three rib fractures after a workplace accident. Which intervention would the nurse suggest to the health care provider? (29) Intercostal nerve block Mechanical ventilation Splinting the ribs with tape Administering opioid analgesics

Intercostal nerve block Patients with severe pain often do not take deep breaths and thus do not maintain adequate ventilation. An intercostal nerve block is used for severe pain. Opioid analgesics suppress respiration and should be avoided. Splinting with tape is not done unless the fracture is complex, when seven or more ribs are involved, or if a flail chest is present. Mechanical ventilation is used as a last intervention after others have been attempted.

Which cause is associated with acidosis? (14) High altitudes Ingestion of antacids Kidney failure Prolonged vomiting

Kidney failure

A patient sitting upright and receiving high-flow oxygen with a nonrebreather mask appears anxious and has a respiratory rate of 30 breaths/min, a heart rate of 110 beats/min, and an oxygen saturation of 88%. The patient is using accessory muscles to breathe and appears fatigued. For which procedure would the nurse prepare to assist? (29) Insertion of an oral or nasal airway Chest x-ray and arterial blood gases Intubation and mechanical ventilation Thoracostomy and chest tube insertion

Intubation and mechanical ventilation The patient is hypoxic despite receiving oxygen and is showing signs of increasing distress and fatigue; intubation and mechanical ventilation are necessary to treat respiratory failure in this patient. A chest x-ray and arterial blood gases may be performed after the patient is stabilized as part of the ongoing assessment. An oral airway is used when the patient cannot maintain a patent airway. A thoracostomy and chest tube insertion would be performed for signs of a pneumothorax.

Occupational exposure to which material increases a person's risk for lung cancer? (27) Iodine Iron oxide Isopropanol India rubber

Iron oxide

Which symptom does the nurse expect to find upon assessing a patient who has obstructive sleep apnea (OSA)? Select all that apply. One, some, or all responses may be correct. (26) Irritability Heavy snoring Loss of appetite Daytime sleepiness Waking up energized

Irritability Heavy snoring Daytime sleepiness

A patient has been diagnosed with tuberculosis (TB). Which medications would the nurse expect to be prescribed for the patient? (28) Metronidazole, acyclovir, flunisolide, rifampin Isoniazid, rifampin, pyrazinamide (PZA), ethambutol Prednisone, guaifenesin, ketorolac, PZA Salmeterol, cromolyn sodium, dexamethasone, isoniazid

Isoniazid, rifampin, pyrazinamide (PZA), ethambutol The combination of isoniazid, rifampin, pyrazinamide, and ethambutol is used to treat TB. Metronidazole is used to treat anaerobic bacteria and some parasites but is not effective against TB Acyclovir is used to treat viral infection. Flunisolide is a corticosteroid that is useful in asthma or other airway diseases to prevent wheezing. Prednisone is a steroid. Guaifenesin is a mucolytic. Ketorolac is an NSAID that is used for short-term pain relief. Salmeterol and cromolyn sodium would most likely be given to patients with respiratory difficulties such as poorly controlled asthma from allergic sources. Dexamethasone is a steroid.

Which benefit will chest physiotherapy have on a patient with cystic fibrosis (CF)? (27) It increases vascular resistance in the lungs. It stops excess production of mucus in the lungs. It creates mini-coughs to dislodge the mucus from the lungs. It decreases the constriction of the bronchiolar smooth muscle.

It creates mini-coughs to dislodge the mucus from the lungs. Chest physiotherapy uses chest percussion, chest vibration, and dependent drainage to loosen secretions and promote drainage. This therapy encourages mini-coughs that dislodge the mucus from the bronchial walls and increase mobilization. This mucus moves toward the central airways where it can be removed by coughing or suctioning. Vascular resistance in the lungs is seen in patients with pulmonary arterial hypertension. Drug therapy helps in the management of excess mucus production in patients with CF. Bronchodilator drugs help in the relaxation of the smooth muscles in patients with asthma.

Which statement is true about health care-associated pneumonia (HAP) but not true about community-acquired pneumonia (CAP)? (28) It is likely to be resistant to some antibiotics. The fibrin and edema of inflammation stiffen the lung. Capillary leak spreads the infection to areas of the lung. It requires antibiotics for effective treatment.

It is likely to be resistant to some antibiotics. HAP is more likely to be resistant to some antibiotics, most likely related to the widespread use of antibiotics in the health care environment. Pneumonia acquired in the community is less likely to be caused by organisms that have been exposed to antibiotics and developed resistance. The fibrin and edema that accompanies the inflammation with pneumonia can stiffen the lung in both CAP and HAP. As red blood cells and fibrin move into the alveoli with pneumonia, the infection spreads to other areas of the lung in both CAP and HAP. Both CAP and HAP require antibiotics for effective treatment.

Which action would the nurse plan to take for an older patient with a tracheostomy who is receiving mechanical ventilation? (25) Provide warm, humidified air, and suction the tube hourly. Cut 4 × 4 gauze pads to place around the stoma site. Keep the pressure on the tracheal tube cuff between 14 and 20 mm Hg. Change the tracheostomy tube dressing and reposition the tube every 4 hours.

Keep the pressure on the tracheal tube cuff between 14 and 20 mm Hg older patients are at increased risk for tissue breakdown caused by tracheostomy tube pressure. Maintaining cuff pressure between 14 mm Hg and 20 mm Hg allows adequate circulation to the tracheal mucosa. The nurse should change dressings and suction the tube only as needed, taking care not to move the tube. Avoid cutting gauze dressings because threads may enter the stoma and cause irritation. Anything that causes movement of the tube causes friction and can contribute to tissue breakdown

Which disturbance is consistent with rapid weight loss because of starvation? (14) Ketosis Hypoxemia Urinary retention Insufficient ventilation

Ketosis

The right lung has which characteristic? (24) Is divided into two lobes Smaller and narrower than the left Largely affects gas exchange and perfusion Responsible for 30% of the lung function

Largely affects gas exchange and perfusion

Which surgical treatment for laryngeal cancer has a high cure rate with a normal resulting voice quality? (26) Laser surgery Laryngofissure Total laryngectomy Transoral cordectomy

Laryngofissure

The nurse provides education about surgical treatments for laryngeal cancer to a group of nursing students and explains that which procedure has a high cure rate and results in a normal voice? (26) Laser surgery Hemilaryngectomy Laryngofissure procedure Supraglottic partial laryngectomy

Laryngofissure procedure

The laryngopharynx is found behind which structure? (24) Larynx Oral and nasal cavities Nose Mouth

Larynx

Which type of facial trauma is a maxillary and nasoethmoid complex fracture plus an orbital-zygoma fracture? (26) Le Fort I Le Fort II Le Fort III Nasal fracture

Le Fort III Le Fort III combines I and II plus an orbital-zygoma fracture, called craniofacial disjunction because the midface has no connection to the skull. Le Fort I is a nasoethmoid complex fracture. Le Fort II is a maxillary and nasoethmoid complex fracture. A nasal fracture is a simple fracture of the bone after which it is named

A patient who is employed in a woodworking factory tells the nurse, "I have concern that I am being exposed to products at my job site that increase my risk for sinus cancer." The nurse recognizes that chronic exposure to which item increases the patient's risk for this type of cancer? Select all that apply. One, some, or all responses may be correct. (26) Pollution Liquid glue Leather dust Nasal sprays Paint thinners Wood particles

Leather dust Wood particles

A patient with suspected initial infection of tuberculosis (TB) is admitted to the respiratory ICU. In which location on the patient's chest x-ray would the nurse likely find evidence of the patient's infection? Select all that apply. One, some, or all responses may be correct. (28) Left lower lobe Left upper lobe Right lower lobe Right upper lobe Right middle lobe

Left lower lobe Right lower lobe Right middle lobe

Which survival period is common for most patients after being diagnosed with pulmonary fibrosis? (27) Less than 3 years Less than 5 years Less than 6 months Less than 12 months

Less than 5 years Even with proper treatment, most patients usually survive less than 5 years after diagnosis of pulmonary fibrosis. They typically survive longer than 3 years, 6 months, or 12 months.

Which sign or symptom would the nurse anticipate in a patient diagnosed with tuberculosis? Select all that apply. One, some, or all responses may be correct. (28) Lethargy Dyspnea Weight gain Night sweats Low-grade fever

Lethargy Night sweats Low-grade fever Expected assessment findings in a patient diagnosed with tuberculosis include lethargy, night sweats, and a low-grade fever. Dyspnea does not occur with tuberculosis. Weight loss and anorexia occur in patients with tuberculosis.

Which chemical is responsible for a prolonged inflammatory response, leading to airway obstruction? (27) Kinins Heparin Histamine Leukotrien

Leukotrien Leukotriene is a slow-acting chemical that is released slowly, causing a prolonged inflammatory response. Kinins dilate arterioles and increase capillary permeability. Heparin inhibits blood and protein clotting. Histamine starts immediate inflammatory response by constricting small veins, inhibiting blood flow, and decreasing the venous return.

The nurse provides postoperative care 3 days after a patient's laryngectomy and anticipates a prescription for which type of pain medication? (26) Liquid steroid Oral acetaminophen Liquid opioid analgesic Oral NSAIDs

Liquid opioid analgesic As the patient progresses after this type of surgery, liquid opioid analgesics can be given by feeding tube. Steroids will not help in pain relief and will delay healing. Acetaminophen will likely be insufficient in managing the patient's pain. NSAIDs increase the risk for bleeding and may be unsafe at this time.

Which factor would be considered when determining the type of oxygen that a patient will require for home oxygen therapy? Select all that apply. One, some, or all responses may be correct. (25) There are young children living in the home with the patient. Liquid oxygen is available in lightweight, easy-to-carry containers. There are smokers in the family living in the house with the patient. An oxygen concentrator is noisy and big and requires refilling for use. Liquid oxygen tanks last longer than equal-sized gaseous oxygen tanks.

Liquid oxygen is available in lightweight, easy-to-carry containers. Liquid oxygen tanks last longer than equal-sized gaseous oxygen tanks. liquid oxygen can be placed in multiple sizes of containers based on ease and need for portability. Compared to gaseous oxygen in the same size container, liquid oxygen will last longer. Although the oxygen concentrator is large and can be noisy, it does not require refilling for use. All people living with the patient must be cautioned about open flames in the home, but a family member who smokes should not preclude a patient's access to home oxygen therapy. Additionally, home oxygen therapy will not harm children if proper precautions are taken

Which type of pneumonia is consistent with a chest x-ray report of consolidation in a segment of the patient's left lung? (28) Viral Lobar Bronchial Bacterial

Lobar Lobar pneumonia manifests as consolidation in a segment or an entire lobe of the lung. Bronchopneumonia manifests as diffusely scattered patches around the bronchi. The pattern of lung involvement does not necessarily indicate that the pneumonia is of viral or bacterial etiology.

The nurse considers which complication of lung cancer when advising assistive personnel (AP) to handle the patient with this type of cancer very carefully when bathing or repositioning? (27) Dysrhythmias Low bone density Cardiac tamponade Superior vena cava syndrome

Low bone density Bones lose density with tumor invasion and break easily with little pressure and without trauma. The patient may have bone pain or pathologic fractures. Lung cancer results in dysrhythmias, cardiac tamponade, and superior vena cava syndrome, but these are not the most important reasons that the patient should be handled carefully. Dysrhythmia is an abnormal heartbeat, which is due to pressure on the heart by the tumor. Cardiac tamponade is compression of the heart, which is the result of a tumor or fluid present around the heart. Superior vena cava syndrome is the obstruction of the superior vena cava, which carries circulating blood to the heart.

A patient is to receive oxygen therapy at home by nasal cannula. Which information would the nurse provide to the patient? Select all that apply. One, some, or all responses may be correct. (25) Complete mouth care daily. Lubricate the nostrils with water-soluble jelly. Cleanse the skin under the tubing and straps daily. Do not smoke or use lit candles or matches in the immediate area. Cleanse the cannula by rinsing with clear warm water.

Lubricate the nostrils with water-soluble jelly Do not smoke or use lit candles or matches in the immediate area Cleanse the cannula by rinsing with clear warm water

Which is the leading cause of cancer-related deaths in North America? (27) Lung cancer Colon cancer Breast cancer Prostate cancer

Lung cancer Lung cancer is the leading cause of cancer-related deaths worldwide. In North America, the main cause of cancer-related deaths is lung cancer, when compared with colon cancer, breast cancer, and prostate cancer combined. The American Cancer Society estimates that more than 228,000 new cases of lung cancer are diagnosed each year and that more than 160,000 deaths occur each year because of it.

Which pulmonary disease is caused by cigarette smoking? Select all that apply. One, some, or all responses may be correct. (27) Lung cancer Cystic fibrosis Chronic bronchitis Pulmonary arterial hypertension Bronchiolitis obliterans organizing pneumonia

Lung cancer Chronic bronchitis Lung cancer can occur because of repeated exposure to inhaled substances during smoking. Chronic bronchitis is caused by exposure to irritants such as cigarette smoke. Cystic fibrosis is caused by poor chloride transport. Drugs such as phentermine increase the risk for pulmonary arterial hypertension. Bronchiolitis obliterans organizing pneumonia is not caused by cigarette smoking.

Which therapy for pulmonary fibrosis is curative? (27) Nebulized morphine Lung transplantation Home oxygen therapy Immunosuppressant therapy

Lung transplantation Lung transplantation is a curative therapy for pulmonary fibrosis; however, the selection criteria, cost, and availability of organs make this option unlikely for most patients. Nebulized morphine, home oxygen therapy, and immunosuppressant therapy are palliative.

The visceral pleura cover which area of the body? (24) Lungs Alveoli Diaphragm Chest cavity

Lungs

The lower respiratory tract includes which structure? Select all that apply. One, some, or all responses may be correct. (24) Lungs Larynx Bronchi Pharynx Trachea

Lungs Bronchi Trachea

Which organ plays a major role in maintaining pH balance in the body? Select all that apply. One, some, or all responses may be correct. (14) Lungs Brain Pancreas Kidneys Small intestines

Lungs Kidneys

Which activity would the nurse recommend that the patient avoid for several hours after extubation? (29) Using supplemental oxygen Lying supine to rest Using the spirometer Taking deep breaths

Lying supine to rest The patient should sit in a semi-Fowler position rather than lying down for resting after extubation because it reduces the risk for fluid accumulation and aspiration immediately after extubation. The patient who has recently been extubated is likely to require supplemental oxygen. Using the spirometer every 2 hours promotes gas exchange and is advisable. Taking deep breaths every half-hour improves gas exchange.

Which medication is an *endothelin-receptor* agonist used to treat pulmonary arterial hypertension that if prescribed requires a patient to use at least two reliable methods of contraception? (27) Warfarin Bosentan Macitentan Treprostinil

Macitentan Macitentan is an endothelin-receptor agonist and approved drug for pulmonary arterial hypertension, but it can cause birth defects. Therefore the primary health care provider instructs the patient to use at least two reliable methods of contraception. Warfarin is an anticoagulant. Bosentan is an endothelin receptor that causes minor effects in pregnant women. Treprostinil is a prostacyclin agent.

The nurse identifies that which intervention is appropriate to include on the plan of care for a patient with an anterior nosebleed? Select all that apply. One, some, or all responses may be correct. (26) Apply pressure to the bridge of the nose to decrease bleeding. Maintain Body Substance Precautions or Standard Precautions. Reassure the patient to reduce anxiety and elevated blood pressure. Recognize that the patient is at a high risk for decreased oxygenation. Instruct the patient not to blow the nose for 24 hours after bleeding ceases.

Maintain Body Substance Precautions or Standard Precautions Reassure the patient to reduce anxiety and elevated blood pressure Instruct the patient not to blow the nose for 24 hours after the bleeding ceases body Substance Precautions should always be used with potential exposure to any body fluid, including the patient with an anterior nosebleed. Spontaneously blowing the nose within 24 hours after a bleed can restart the bleed—always instruct the patient to avoid this for at least 24 hours. Increased anxiety and elevated blood pressure can increase the bleeding or interfere with stopping the bleeding. Pressure on the bridge of the nose may actually be placed above the site of the bleed. An anterior bleed should not cause a change in oxygenation unless there are other sources of airway obstruction or a significant rapid blood loss

Which technique or action would the nurse use to prevent a tracheoesophageal fistula (TEF) in a patient after a tracheostomy has been performed? (25) Maintain proper cuff pressure. Manually administer oxygen by mask. Prevent pulling or tugging on the tube. Apply direct pressure to the stoma site.

Maintain proper cuff pressure a TEF is a hole created between the trachea and the anterior esophagus caused by excessive cuff pressure. Three methods of preventing this complication are to progress to a deflated cuff or cuffless tube as soon as possible, maintain proper cuff pressure, and monitor the amount of air needed for inflation for any change. Manually administering oxygen by mask is an appropriate intervention once the fistula has formed, but it does not prevent the formation. Applying direct pressure is an intervention for a trachea-innominate artery fistula. Preventing pulling of and traction on the tracheostomy tube is a prevention measure for tracheal stenosis

Which nursing action is the highest priority when caring for a patient with laryngeal trauma? (26) Managing pain Assessing for bleeding Maintaining a patent airway Providing a communication method

Maintaining a patent airway

The nurse identifies which priority intervention when providing postoperative care 24 hours after a patient underwent a total laryngectomy with neck dissection? (26) Monitoring urinary output hourly Supporting the family emotionally Maintaining airway and ventilation Encouraging the patient to view the surgical site

Maintaining airway and ventilation

Which goal must the patient with diabetes mellitus strive for to decrease the risk for acid-base imbalance? (14) Drinking 3 L of fluid per day Eating regularly, every 4 to 8 hours Checking blood glucose levels once daily Maintaining blood glucose level within normal limits

Maintaining blood glucose level within normal limits

The nurse identifies that which potentially serious complication may be prevented by using an irrigating device for routine oral care in a patient who is in fixed occlusion for a jaw fracture? (26) Gingivitis Dental caries Mandibular infection Dry mucous membranes

Mandibular infection treatment delay, poor oral care, and tooth infection may contribute to mandibular bone infection, which may require antibiotic therapy and sometimes surgical débridement of the infected bone. Oral care can help to prevent dental caries, gingivitis, and dry oral mucous membranes, but these do not prolong treatment for this patient

Which will the nurse recommend for the patient with chronic lung disease regarding ambulatory care management for moderate breathlessness occurring with activity resolving with rest? (24) No activity restriction May work in a sedentary job Requires assistance for all care May need assistance with ADLs

May need assistance with ADLs

Which procedure is associated with a patient developing ICU psychosis? (29) Mechanical ventilation Cardiac catheterization Electrophysiological study (EPS) Intravascular ultrasonography

Mechanical ventilation ICU psychosis is observed most frequently in patients undergoing mechanical ventilation. Cardiac catheterization is an invasive test used in the diagnosis of heart diseases. An EPS is an invasive procedure during which programed electrical stimulation of the heart is used to cause and evaluate lethal dysrhythmias and conduction abnormalities. Intravascular ultrasonography is a technique that introduces a flexible catheter with a miniature transducer at the distal tip to view the coronary arteries. All these are diagnostic procedures and are not related to ICU psychosis.

Which information will the nurse include when teaching a patient about the long-term effects and treatment for idiopathic pulmonary fibrosis? (27) Aggressive treatment with immunosuppressant medications can be curative. Lung transplantation provides only a temporary respite from disease progression. Medications are used to improve quality of life and slow progression of symptoms. With proper management, patients can control symptoms indefinitely.

Medications are used to improve quality of life and slow progression of symptoms. Idiopathic pulmonary fibrosis is a progressive condition that generally leads to death within 5 years of initial diagnosis. Medications are useful to improve lung function but do not ultimately prevent disease progression. Medications are not curative. A lung transplant can be curative.

Which drug increases cardiac output by improving myocardial contractility? (29) Alteplase Milrinone Nitroprusside Phytonadione

Milrinone Milrinone is a positive inotropic drug that increases the contractility of the cardiac musculature, thereby increasing cardiac output. Alteplase is a fibrinolytic drug that prevents the formation of clots in blood vessels. Nitroprusside is a vasodilator that is used for lowering blood pressure. Phytonadione is an antidote for warfarin and is administered in cases of warfarin overdose.

Which priority action will the nurse perform in the postoperative period for a patient with severe chronic obstructive pulmonary disease (COPD) who has undergone lung reduction surgery? (27) Control the patient's anxiety levels by staying away from crowds. Control the patient's diet so that cough-stimulating foods are avoided. Monitor the patient's weight and other indicators of nutrition such as serum albumin. Monitor the patient's oxygen saturation levels continuously, and use the incentive spirometer.

Monitor the patient's oxygen saturation levels continuously, and use the incentive spirometer. For a patient who has undergone lung reduction surgery and has severe chronic pulmonary disease, the main objective is to improve oxygen saturation, which should be continuously monitored with the incentive spirometer. Crowds are usually not an issue in the hospital setting, so anxiety related to crowds is not a concern here. Care should be taken to stay away from foods that stimulate coughing. Monitoring nutrition levels and serum albumin levels helps to prevent malnutrition, but this is not a priority over oxygenation.

Which precautionary measure would the nurse plan to take while a patient is on heparin sodium therapy? Select all that apply. One, some, or all responses may be correct. (29) Monitor the platelet count. Have the antidote, vitamin K, readily available. Monitor the partial thromboplastin time (PTT). Monitor the international normalized ratio (INR). Have the antidote, protamine sulfate, readily available.

Monitor the platelet count. Monitor the partial thromboplastin time (PTT). Have the antidote, protamine sulfate, readily available. Monitoring the platelet count daily helps detect any heparin-induced thrombocytopenia because a decrease in platelet count is a common adverse effect caused by the use of heparin sodium. Regular monitoring of PTT is necessary because it helps detect side effects and prevent complications. Protamine sulfate is used as an antidote in emergency situations caused by heparin overdose because it reverses the anticoagulation effect by binding to heparin. While using warfarin, patients may experience adverse effects of the drug; vitamin K is used as an antidote because of its coagulating effect. Regular monitoring of INR is recommended when a patient is on warfarin therapy.

Which quality of the left bronchus differentiates it from the right bronchus? (24) Slightly wider and shorter Easily intubated accidentally More horizontally placed in the lungs Deposits aspirated foreign objects

More horizontally placed in the lungs

Which treatment is effective in thinning the secretions of a patient with chronic obstructive pulmonary disease (COPD), making them easier to cough up and expel? (27) Mucolytics Thoracentesis Antibiotic therapy Radiation therapy

Mucolytics Mucolytics dissolve thick mucus and sputum formed in the lungs and help ease removal. Thoracentesis is the removal of excess fluid though suction by a large needle or catheter placed into the intrapleural space. Antibiotic therapy treats bacterial infections. Radiation therapy is used to treat hemoptysis, which is obstruction of the bronchi and great veins.

Which rationale is appropriate for prescribing a mucolytic for a patient diagnosed with chronic bronchitis? (27) Mucolytics decrease secretion production. Mucolytics increase gas exchange in the lower airways. Mucolytics thin secretions, making them easier to expectorate. Mucolytics provide bronchodilation in patients with chronic obstructive pulmonary disease (COPD).

Mucolytics thin secretions, making them easier to expectorate The term mucolytic means "breaking down mucus." Mucolytics cause secretions to thin, making them easier to expectorate; this is important for a patient with chronic bronchitis. Mucolytics do not decrease secretion production. Mucolytics may increase gas exchange, but this is an indirect property and is not the main function. Mucolytics do not have any bronchodilation properties.

Which assessment finding would the nurse anticipate for the patient suspected of having pneumonia? Select all that apply. One, some, or all responses may be correct. (28) Myalgia (muscle pain) Dyspnea (labored breathing) Bradypnea (slow breathing) Bradycardia (slow heart rate) Hemoptysis (coughing up blood)

Myalgia (muscle pain) Dyspnea (labored breathing) Hemoptysis (coughing up blood) Assessment findings typical of pneumonia include myalgia, dyspnea, and hemoptysis. Tachypnea, not bradypnea, and tachycardia, not bradycardia, are expected findings in a patient with pneumonia.

Which device delivers low-flow oxygen? (25) Face tent Venturi mask Nasal cannula Tracheostomy collar

Nasal cannula

The nurse observes for which sign of respiratory difficulty in a patient who has experienced laryngeal trauma? (26) Nasal flaring Increased nasopharyngeal secretions Poor response to humidification of oxygen Decreased oxygen saturation and carbon dioxide (CO2) levels

Nasal flaring laryngeal trauma is likely to cause obstruction of the trachea. Nasal flaring is a manifestation of the body's attempt to compensate and bring in more oxygen. If the patient cannot compensate and bring in adequate oxygen, the saturation level will gradually decrease. The CO2 level will most likely increase. Humidification may be indicated for long-term use, especially for high-flow oxygen, but poor response to humidification is not a manifestation of respiratory difficulty. Increased nasopharyngeal secretions would not necessarily be present as a result of laryngeal trauma

Which condition is an indication for nasoseptoplasty? (26) Bruising Crepitus Nasal fracture Nasal septum deviation

Nasal septum deviation a nasoseptoplasty is done to straighten the nasal septum, which separates the two nostrils. The displacement of the nasal septum causes problems such as a chronic stuffy nose, snoring, and sinusitis, which can cause disturbance in breathing. Bruising, crepitus, and nasal fracture may not require nasoseptoplasty. Bruising and crepitus are signs of a fractured nose, which is treated with a rhinoplasty

Which surgical procedure is performed when a patient's lymph nodes, sternocleidomastoid muscle, jugular vein, and 11th cranial nerve are removed? (26) Tracheostomy Neck dissection Total laryngectomy Partial laryngectomy

Neck dissection Neck dissection includes removal of the lymph nodes, sternocleidomastoid muscle, jugular vein, 11th cranial nerve, and surrounding soft tissues. Tracheostomy helps to safeguard the airway. Total laryngectomy separates the upper airway from the throat and esophagus, and a permanent laryngectomy stoma is created. In a partial laryngectomy, a part of the larynx or voice box is removed.

Which condition is indicated when the laboratory report of a patient with suspected lung cancer shows purulent and copious sputum? (27) Necrosis Bronchitis Hemoptysis Pneumonitis

Necrosis Copious, purulent sputum indicates production of pus-containing sputum in large quantities. In lung cancer, the presence of necrosis leads to purulent and copious sputum. Bronchitis occurs with obstruction in lung cancer. Hemoptysis reflects bloody sputum because of lung cancer. Pneumonitis is indicated by chills, fever, and cough.

Which factor would the nurse consider when determining the type of oxygen delivery system for a patient? Select all that apply. One, some, or all responses may be correct. (25) Patient mobility Need for humidification Patient body temperature Oxygen concentration required by the patient Oxygen concentration achieved by a delivery system

Need for humidification Oxygen concentration required by the patient Oxygen concentration achieved by a delivery system

Which procedure would the nurse anticipate the health care provider will perform to treat a suspected tension pneumothorax in a patient with chest trauma? (29) Intercostal block Cricothyroidotomy Bronchoscopy Needle thoracostomy

Needle thoracostomy A tension pneumothorax is a life-threatening complication in which air escapes into the chest cavity, causing a complete collapse of the affected lung. A large-bore needle thoracostomy is the initial and immediate intervention in this situation. Thoracostomy is followed by placing chest tubes. An intercostal block is used to manage pain from serious rib fractures. A cricothyroidotomy is performed to establish an airway in cases of tracheobronchial trauma. A bronchoscopy is performed for diagnostic purposes or to remove something from the airway such as mucus or a foreign object.

Which initial management would the nurse anticipate for a patient with a tension pneumothorax? (29) Humidified oxygen Needle thoracostomy Splinting of the chest Mechanical ventilation

Needle thoracostomy Initial management of a tension pneumothorax is an immediate needle thoracostomy to remove excess air from around the lungs. A chest tube placement follows the thoracostomy. Splinting of the chest is not a routine practice for any chest injury because of the restriction of deep breathing and clearance secretion. Humidified oxygen is effective when gas exchange can occur. Mechanical ventilation would be used for a patient who is in respiratory failure.

Occupational exposure to which material increases a person's risk for lung cancer? (27) Nickel Nitric acid Nitric oxide N-acetylcysteine

Nickel

Which product is a type of nicotine replacement therapy (NRT)? (24) Candy cigars Nicotine gum Throat lozenges Mint-free candies

Nicotine gum

Which nicotine replacement therapy is only available by prescription? (24) Nicotine gum Nicotine patch Nicotine inhaler Nicotine lozenge

Nicotine inhaler

Which principle would the nurse apply to planning care for a patient receiving supplemental oxygen? Select all that apply. One, some, or all responses may be correct. (25) Nitrogen helps prevent alveolar collapse because it does not cross over capillary membranes. When a patient experiences air hunger, increasing the partial pressure of arterial carbon dioxide (PaCo2) improves the balance. It is important to keep the patient's partial pressure of arterial oxygen (Pao2) above 90 mm Hg for optimal outcomes. Oxygen is harmless; it is part of what we breathe normally, and toxicity is not possible. High levels of oxygen dilute the nitrogen in the lungs and lead to alveolar collapse.

Nitrogen helps prevent alveolar collapse because it does not cross over capillary membranes. High levels of oxygen dilute the nitrogen in the lungs and lead to alveolar collapse.

In which location are the palatine tonsils found? (24) Below the thyroid cartilage On the sides of the oropharynx Below the level of the vocal cords Below the throat at the base of the tongue

On the sides of the oropharynx

Which initial radiographic findings would the nurse expect in a patient with a pulmonary contusion? (29) No opacity in the lobes or parenchyma Hazy opacity in the lobes or parenchyma Highly dense opacity in the lobes or parenchyma Moderately dense opacity in the lobes or parenchyma

No opacity in the lobes or parenchyma Initial assessment of the chest x-ray may not reveal any abnormalities, but a hazy opacity in the lobes or parenchyma may develop over several days, and the density may increase as time progresses. Highly dense opacity or moderately dense opacity is seen at later stages of a pulmonary contusion as the condition of the patient progresses.

Which mechanism would the nurse expect to be prescribed for a patient who has sleep apnea? (25) Venturi mask Tracheostomy collar Transtracheal oxygen therapy Noninvasive positive-pressure ventilation

Noninvasive positive-pressure ventilation

A patient with chronic obstructive pulmonary disease (COPD) is exhibiting increasing air hunger while receiving oxygen via nasal cannula at a flow rate of 2 L/min. Which treatment option would the nurse discuss with the provider? (25) Aerosol facemask Venturi mask with oxygen at 4 L/min Intubation and mechanical ventilation Noninvasive positive-pressure ventilation

Noninvasive positive-pressure ventilation Noninvasive positive-pressure ventilation helps keep airways open and improves gas exchange without the need for airway intubation. It is especially useful for patients with COPD. An aerosol facemask provides high-flow, high-humidity oxygen, which would not be helpful for the patient with an obstructive process

A patient with chronic obstructive pulmonary disorder (COPD) who has been receiving oxygen via nasal cannula is becoming increasingly dyspneic with increased use of accessory muscles to breathe. The nurse auscultates markedly diminished breath sounds in all lung fields. Which oxygen delivery method would the nurse recommend that the provider prescribe? (25) Venturi mask Transtracheal oxygen catheter Noninvasive positive-pressure ventilation (NPPV) Face tent

Noninvasive positive-pressure ventilation (NPPV) a Venturi mask helps deliver a precise amount of oxygen but does not help open alveoli

Which oxygen delivery equipment could provide a fraction of inspired oxygen (Fio2) greater than 80%? (25) Simple facemask Venturi mask Nonrebreather mask Partial rebreather mask

Nonrebreather mask Nonrebreather masks allow the highest oxygen level of the low-flow systems and are often used for patients whose respiratory status is unstable and who may require intubation. The simple facemask provides 40% to 60% Fio2

When evaluating the laboratory results of a patient with diabetic ketoacidosis, which laboratory value indicates the body has fully compensated from this acid-base imbalance? (14) Normal serum glucose Normal serum potassium Normal pH on arterial blood gases Normal bicarbonate on arterial blood gases

Normal pH on arterial blood gases arterial blood gas pH returns to normal when the body's compensatory efforts are fully effective

Which oral hygiene product would the nurse recommend for a patient with a tracheostomy? (25) Glycerin swabs Normal saline rinses Hydrogen peroxide solutions Mouthwash containing alcohol

Normal saline rinses rinsing the oral cavity every 4 hours with normal saline is recommended. It prevents dryness in the oral cavity Glycerin swabs should not be used because it may cause dryness. Hydrogen peroxide may be used for removing crusted matter, but it may result in a breakdown of healing tissue. A mouthwash containing alcohol should not be used because this will dry the mouth, alter the pH, and promote bacterial growth.

The NASOpharynx is positioned in the throat behind which structure? (24) Nose Larynx Mouth Esophagus

Nose

Which action does the nurse take when a patient develops stridor and becomes short of breath immediately after a thyroidectomy? (26) Notify the Rapid Response Team. Contact the health care provider to obtain a prescription for a chest x-ray. Elevate the head of the bed to a 30-degree angle. Teach the patient to hold the breath while swallowing.

Notify the Rapid Response Team

During an assessment of a patient after an extensive neck surgery, which is a priority action when the nurse notes an area of bright red blood on the surgical dressing, which has increased in size? (26) Notify the Rapid Response Team. Move the patient to an upright position. Reinforce the dressing with clean gauze. Apply pressure to the site to stop bleeding.

Notify the Rapid Response Team Bright red blood may indicate a carotid artery leak, which can be life threatening. The nurse should notify the Rapid Response Team. Reinforcing the dressing does not help stop bleeding. Applying pressure could rupture the artery. Pressure should be applied in the event of a rupture.

The nurse is caring for a patient the day after tracheostomy placement and notes new swelling around the tube. When gently palpating the area, the nurse feels a crackling sensation. Which action would the nurse take? (25) Notify the health care provider immediately. Apply an occlusive pressure dressing around the tube. Re-evaluate in 2 hours because this is normal after surgery. Ensure that the tracheostomy tube is well-secured without tension.

Notify the health care provider immediately this assessment finding indicates there is subcutaneous emphysema. The health care provider should be notified immediately because this can worsen as air spreads into the surrounding tissues of the face and chest. An occlusive pressure dressing will not correct this complication. Routine care of securing and protecting the tracheostomy does not address the problem

The visceral pleura are found in which location? (24) On the surface of the lungs Attached to the thyroid cartilage On the upper surface of the diaphragm On the interior surface of the diaphragm

On the surface of the lungs

A patient who underwent a lobectomy has a chest tube drainage system in place, which had an initial output of 50 mL. Which action does the nurse take when, 3 hours later, the drainage output is 400 mL? (27) Empty the collection chamber. Notify the health care provider. Note the color of the drainage. Chart the amount on the intake and output record.

Notify the health care provider. Drainage of more than 70 mL/hr is excessive and indicative of hemorrhage. This should be reported to the health care provider immediately as the patient may have to return to surgery. Charting the amount and color of the drainage is important, but it is not the next action. The chamber is not emptied unless it is so full of fluid that it is in danger of coming into contact with the chest tube.

A patient admitted to the medical surgical unit is suspected of having tuberculosis (TB). Which rapid screening test for TB would the nurse anticipate to be prescribed? (28) Mantoux test Sputum culture QuantiFERON-TB Gold Nucleic acid amplification test

Nucleic acid amplification test The nurse can anticipate a prescription for the nucleic acid amplification test, the most rapid and accurate way to screen for TB. Results are available in 2 hours. The Mantoux test is read within 48 to 72 hours. A sputum culture confirms the diagnosis but can take up to 4 weeks for a valid result. The QuantiFERON-TB Gold blood test can show that a person is infected with TB but does not indicate whether the infection is latent or active.

Which clinical manifestation would the nurse likely assess in a patient with metabolic alkalosis? Select all that apply. One, some, or all responses may be correct. (14) Decrease in heart rate Numbness around the mouth Increase in handgrip strength Presence of Kussmaul respiration Hyperactivity of deep tendon reflexes

Numbness around the mouth Hyperactivity of deep tendon reflexes alkalosis overexcites the nervous system, leading to tingling or numbness around the mouth. Hypercalcemia occurs with alkalosis, which can cause hyperactivity of deep tendon reflexes. Overstimulation of the nerves may cause contraction of skeletal muscles, but the contractions are weaker because of hypokalemia. Therefore there is a decrease in handgrip strength. Alkalosis increases myocardial irritability and increases the heart rate. Kussmaul respiration (deep and rapid involuntary breathing) is seen in metabolic acidosis with respiratory compensation.

Which factor may contribute to obstructive sleep apnea (OSA)? (26) Obesity Sleep deprivation Daytime use of modafinil Uncontrolled hypertension

Obesity

Which factor increases a patient's risk for a venous thromboembolism (VTE)? Select all that apply. One, some, or all responses may be correct. (29) Obesity Malnutrition Advancing age Vitamin deficiency Prolonged immobility

Obesity Advancing age Prolonged immobility In VTE, blood tends to clot in the veins. Obesity contributes to the deposition of cholesterol in the veins, leading to clot formation. The elasticity of veins decreases with age, which leads to clot formation. Prolonged immobility increases the risk for VTE because of venous pooling. Malnutrition and vitamin deficiency are not risk factors for VTE; they are not associated with functions related to blood vessels and blood clotting mechanisms.

Which is a cause of upper airway impairment associated with obstructive sleep apnea (OSA)? Select all that apply. One, some, or all responses may be correct. (26) Obesity Alcohol Smoking Short neck Large uvula

Obesity Smoking Short neck Large uvula

A public health nurse is providing education to a community about preparation for a possible influenza epidemic. Which instruction would the nurse provide upon learning that an influenza outbreak has occurred? (28) Attend meetings to learn how to manage the outbreak. Take antiviral medications to prevent developing symptoms. Obtain a vaccine if not already vaccinated against influenza. Plan social events to avoid feeling isolated.

Obtain a vaccine if not already vaccinated against influenza. People should be taught to receive vaccinations if not already vaccinated if an outbreak occurs. People should stay home as much as possible and avoid gatherings such as meetings or social events and crowds. Antiviral medications are given to those who contract the virus to limit symptoms.

A patient with chronic obstructive pulmonary disease (COPD) suddenly becomes dyspneic with a respiratory rate of 32 breaths/min and an oxygen saturation of 94%. The patient appears pale and anxious and is using accessory muscles to breathe. Which action would the nurse take? (29) Notify the Rapid Response Team. Request an order for a chest x-ray. Obtain an order for arterial blood gases. Apply high-flow oxygen with a Venturi mask.

Obtain an order for arterial blood gases. The patient has developed respiratory distress. Even though the oxygen saturation level is within normal limits, a more accurate assessment of hypoxemia is with arterial blood gases. Giving high-flow oxygen with a Venturi mask may increase anxiety and cause oxygen-induced hypercapnia in patients with COPD. Unless the patient exhibits signs of respiratory failure with hypoxemia or cyanosis, notifying the Rapid Response Team is not necessary. A chest x-ray may be indicated after the patient is stabilized to help determine the cause of the respiratory distress.

Which action would the nurse take to evaluate the interventions in a plan of care to improve nutrition for a patient with tuberculosis? (28) Encourage eating 25% of meals. Advise the patient to refrain from alcohol. Obtain weekly weights. Encourage oral hygiene.

Obtain weekly weights. The nurse should monitor weekly weights to determine improved nutrition. The patient should consume 75% of meals to improve nutritional status. The patient should refrain from the empty calories of alcohol, but this does not improve nutrition. Encouraging oral hygiene may improve the taste of food, but this is not a way to evaluate nutrition.

Which statement does the nurse recognize as accurate regarding obstructive sleep apnea (OSA)? (26) Decreases blood carbon dioxide levels Occurs a minimum of five times in a day Occurs due to upper airway obstruction by the tongue Is a breathing disruption during sleep that lasts for at least 20 seconds

Occurs due to upper airway obstruction by the tongue OSA is a breathing disruption that occurs in sleep and is due to upper airway obstruction by the tongue. OSA occurs a minimum of five times in an hour. It also increases blood carbon dioxide levels and lasts for at least 10 seconds.

Which treatment strategy would the nurse expect the team to use for a patient with a 1400 mL hemothorax? (29) Tracheotomy Open thoracotomy Cricothyroidotomy Needle thoracostomy

Open thoracotomy An open thoracotomy is needed when there is severe blood loss from the chest (over 1 L) or persistent bleeding in patients with a hemothorax. A tracheotomy and cricothyroidotomy may be required in patients with tracheobronchial trauma. A needle thoracostomy is used in the initial management of a tension pneumothorax.

Which action from the "ventilator bundle" has been shown to reduce the incidence of ventilator-associated pneumonia (VAP)? Select all that apply. One, some, or all responses may be correct. (28) Oral care Hand hygiene Head-of-bed elevation Equipment decontamination Monitoring oxygen levels

Oral care Hand hygiene Head-of-bed elevation Hand hygiene, oral care, and head-of-bed elevation are the three interventions known as a "ventilator bundle" aimed at reducing VAP. Diligent oral care using agents to reduce organisms and provide moisture is especially important for nurses to perform to accomplish this goal. Monitoring for hypoxia and diligent equipment decontamination are indeed important in the care of the patient with pneumonia, but they not "packaged" as part of the "ventilator bundle" to prevent pneumonia.

Which principle should guide the nurse's decision regarding oral care for a patient with a tracheostomy during the first 24 hours postoperative? (25) Providing oral care may damage the tracheostomy stoma. Oral care is indicated to decrease the accumulation of organisms. If the patient is not taking oral nutrition, it is not a concern at this time. Oral care is not indicated if the patient is being suctioned on a regular basis.

Oral care is indicated to decrease the accumulation of organisms oral care helps decrease the accumulation of organisms present in the mouth that can contribute to pneumonia and should be a regular part of postoperative care. Providing oral care will not harm the tracheostomy stoma, which is in the anterior neck. Good oral care is important even if the patient is not eating, which actually serves to facilitate cleansing of the oral cavity

Which reason is the most important for prescribing inhaled, rather than oral, corticosteroids for patients with asthma? (27) Inhaled corticosteroids are easier to use. Inhaled corticosteroids are more effective. Oral corticosteroids have more adverse effects. Oral corticosteroids have less predictable effects.

Oral corticosteroids have more adverse effects.

Which therapy for patients with pulmonary fibrosis may be introduced in later stages of the disease to reduce the sensation of dyspnea? (27) Home oxygen therapy Energy conservation measures Oral, parenteral, or nebulized morphine Avoiding respiratory irritants, crowds, and people who are ill

Oral, parenteral, or nebulized morphine In the later stages of pulmonary fibrosis, the focus is to reduce the sensation of dyspnea. This is often accomplished with the use of oral, parenteral, or nebulized morphine. Home oxygen therapy, energy conservation measures, and avoiding respiratory irritants, crowds, and people who are ill are recommended throughout all stages of the disease.

The nursing instructor is preparing to teach a group of nursing students about planning for a pandemic outbreak of the H5N1, or "avian influenza." Which information would the nurse include in the teaching plan? (28) Social distancing is not useful for disease prevention. Antibacterial drugs may be used to prevent the disease. Travel to affected regions is safe. Oseltamivir may reduce the mortality of the infection.

Oseltamivir may reduce the mortality of the infection. Oseltamivir and zanamivir may reduce mortality of avian influenza infection. Social distancing is useful in decreasing the spread of influenza. Antibacterial drugs are not effective against influenza viruses. Travel to affected areas is discouraged to reduce the spread of disease.

Which mechanism causes acidosis in a patient in diabetic ketoacidosis? (14) Overproduction of hydrogen ions Underelimination of hydrogen ions Overelimination of bicarbonate ions Underproduction of bicarbonate ions

Overproduction of hydrogen ions

Which information about oxygen administration would the nurse explain to a patient who has severe heart failure? (25) Oxygen levels are dangerously low because heart failure causes hypercarbia. Oxygen will not cure heart failure; therefore oxygen is not indicated. Oxygen administration will decrease the work of the heart to deliver oxygen to vital organs. Oxygen administration is not needed; the body can adapt with an increase in red blood cells.

Oxygen administration will decrease the work of the heart to deliver oxygen to vital organs

Which information helps evaluate the adequacy of a patient's oxygenation? (25) Fraction of inspired oxygen (Fio2) Positive end-expiratory pressure (PEEP) Partial pressure of arterial oxygen (Pao2) The patient's acceptance of the continuous positive airway pressure (CPAP) machine

Partial pressure of arterial oxygen (Pao2)

Which value indicates clinical hypoxemia? (25) Partial pressure of arterial oxygen (Pao2) of 50 mm Hg Partial pressure of arterial carbon dioxide (PaCo2) of 30 mm Hg Hemoglobin of 22 g/dL Oxygen saturation of 90%

Partial pressure of arterial oxygen (Pao2) of 50 mm Hg

The older-adult patient with degenerative arthritis is admitted for tracheostomy surgery. Which communication method would the nurse recommend for this patient during the postoperative period? (25) Magic Slate Picture board Pen and paper Computer keyboard

Picture board

A patient is wearing a nonrebreather mask prescribed to deliver 95% fraction of inspired oxygen (Fio2). Which condition must be met to ensure that this concentration is delivered? Select all that apply. One, some, or all responses may be correct. (25) Oxygen flow rate should be set at 6 to 11 L/min. Oxygen flow rate should be set at 10 to 15 L/min. The reservoir bag should deflate completely during inhalation. Flaps should be removed to allow exhaled air to mix in the reservoir. Dial on the adapter is on the highest setting to deliver the prescribed Fio2. A one-way valve between the mask and reservoir should open during inhalation.

Oxygen flow rate should be set at 10 to 15 L/min A one-way valve between the mask and reservoir should open during inhalation the recommended flow rate for a nonrebreather mask is 10 to 15 L/min, not 6 to 11 L/min. The one-way valve on a nonrebreather mask opens during inhalation to allow oxygen to be inhaled from the reservoir bag; it closes during exhalation to prevent exhaled air (carbon dioxide) from entering the reservoir. The reservoir bag should never be completely deflated while a patient is using a nonrebreather mask; otherwise the patient will not have a source of air to breathe. The nurse should ensure that the flaps over the exhalation ports are intact and closed during inhalation so that room air does not enter (mix with) the oxygen in the reservoir bag. There is no adapter dial on a nonrebreather mask; a dial adapter is found on a Venturi mask

When providing suctioning through an endotracheal or tracheostomy tube, which finding would alert the nurse to stop suctioning? (25) The patient's heart rate increases from 72 to 78 beats/min. The patient coughs uncontrollably during suctioning. Oxygen saturation by pulse oximetry is less than 90%. Secretions are thick and occluding the suction catheter.

Oxygen saturation by pulse oximetry is less than 90%

A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated. The health care provider has prescribed10 cm H2O of positive end-expiratory pressure (PEEP). Which data would inform the nurse that the PEEP was effective? (29) Urine output increases to 45 mL/hr. Heart rate increases from 96 beats/min to 110 beats/min. Oxygen saturation increases from 85% to 92%. Blood pressure decreases from 120/80 mm Hg to 92/65 mm Hg.

Oxygen saturation increases from 85% to 92%. The patient with ARDS often requires intubation and mechanical ventilation with PEEP. PEEP improves oxygenation by enhancing gas exchange and preventing atelectasis. An improvement in oxygen saturation would be used to evaluate the effectiveness of adding PEEP to the patient's mechanical ventilation mode. Improving the patient's oxygenation status would help to stabilize the vital signs, not cause tachycardia or hypotension. Adjusting the patient's PEEP would not alter the urine output.

Which nursing assessment is the highest priority when caring for a patient with facial trauma? (26) Infection Pain level Self-image Oxygenation

Oxygenation

The nurse assists with the intubation of an 176-lb (80-kg) patient who will receive mechanical ventilation on assist/control mode with positive end-expiratory pressure (PEEP). Which ventilator setting would the nurse expect to be maintained over the next shift? (29) Fraction of inspired oxygen (Fio2) as high as possible Tidal volume of 400 mL Oxygen flow rate of 20 L/min PEEP between 5 and 15 cm H2O

PEEP between 5 and 15 cm H2O Patients receiving PEEP ventilation should have pressure settings between 5 and 15 cm H2O. Because prolonged use of high Fio2 can damage lungs, the Fio2 should be lowered to the lowest possible amount. The oxygen flow rate should be 40 L/min. The patient's tidal volume should be 6 to 8 mL/kg; for this patient, the range would be 480 to 640 mL.

Which information will the nurse include when providing patient education regarding pulmonary function tests (PFTs)? (24) The patient will be monitored during sleep. PFTs are useful to determine the cause of dyspnea. The patient should not smoke 24 hours before the test. Bronchodilator drugs must be withheld 12 hours before the test.

PFTs are useful to determine the cause of dyspnea

Which change associated with pneumonia results in an increased respiratory rate and dyspnea? Select all that apply. One, some, or all responses may be correct. (28) Pain Anxiety Alveolar consolidation Stimulation of J receptors Pulmonary capillary shunting

Pain Anxiety Stimulation of J receptors Pathologic findings associated with pneumonia that result in an increased respiratory rate and dyspnea include pain, anxiety, and stimulation of the J receptors. Alveolar consolidation and pulmonary capillary shunting result in hypoxemia.

Which statement provides accurate information about a key difference between seasonal influenza and pandemic influenza? (28) Pandemic influenza has the potential to spread globally because of its highly infectious nature in humans. Seasonal influenza is caused by viral infections; pandemic influenza is more likely to be bacterial in nature. People over the age of 50 who have chronic illness should be vaccinated yearly to decrease the risk for pandemic influenza. Humans have a natural resistance to viral infections found in animals and birds and do not require immunization against pandemic influenza.

Pandemic influenza has the potential to spread globally because of its highly infectious nature in humans. Mutated animal and bird viruses can be highly infectious to humans and spread globally very quickly because humans have no natural resistance to the mutated virus. Both seasonal and pandemic influenza are caused by viruses. Although there is the potential to develop a monovalent vaccine to a given mutated virus, widespread prophylactic vaccination is not realistic as a preventive measure. People over age 50 with chronic illnesses and those who are immunocompromised should receive a yearly flu vaccine for the seasonal variety.

A patient has developed a pulmonary embolism. Which laboratory test would the nurse anticipate being prescribed before beginning heparin therapy? (29) Kidney function tests Arterial blood gases (ABGs) Partial thromboplastin time (PTT) International normalized ratio (INR)

Partial thromboplastin time (PTT) A baseline PTT should be obtained before the administration of heparin. The other actions are also important to take for the patient with a pulmonary embolism but do not have to be done before heparin administration. Kidney function tests are not indicated for this patient.

Which critically ill patient is at high risk for developing acute respiratory distress syndrome (ARDS)? (29) Patient with atrial fibrillation Patient with acute kidney failure Patient with aspiration pneumonia Patient with diabetic ketoacidosis (DKA)

Patient with aspiration pneumonia Aspiration of acidic gastric contents is a risk for ARDS. Patients with DKA may develop metabolic acidosis, but not ARDS, which develops in lung injury. Atrial fibrillation does not cause lung injury unless embolization occurs. Acute kidney failure results in metabolic acidosis, not in acute lung injury.

Which is considered the priority in treatment planning for a patient after a laryngectomy for treatment of neck cancer? (26) Cures with radiation are unlikely; surgery is required. Nonsurgical management is strictly palliative in nature. Patients can resume many of their usual activities within 4 to 6 weeks after surgery. Chemotherapy is only curative if used with radiation therapy.

Patients can resume many of their usual activities within 4 to 6 weeks after surgery the many changes resulting from a laryngectomy (removal of the larynx) influence physical, social, and emotional functioning for both the patient and his or her significant other. The patient with a permanent stoma, tracheostomy tube, nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tube, and wounds has an altered body image. The nurse should stress the importance of returning to as normal a lifestyle as possible. Most patients can resume many of their usual activities within 4 to 6 weeks after surgery. Preservation of normal function without compromising long-term effectiveness of treatment is a priority in patients with head and neck cancers, especially to decrease problems with swallowing/aspiration and speech to maximize quality of life. The likelihood of a cure with radiation depends on the extent of the disease and sensitivity to the therapy. Chemotherapy may actually be used alone or in combination with radiation and even surgical therapy. Nonsurgical management is not limited to palliative expectations in tumors identified early in a curable stage

Which statement is true about surgical procedures for a patient with cystic fibrosis? (27) Patients having a double-lung transplant do not need a bypass. Patients undergoing a single-lung transplant require a bypass. Patients remain in the ICU for several days after transplantation. Patients having a lung transplantation will receive tissue only from a live donor.

Patients remain in the ICU for several days after transplantation. Patients remain in the ICU for several days after transplantation so they can be monitored for symptoms of transplant rejection. Patients having a double-lung transplant need a bypass. Patients having a single-lung transplant do not need a bypass because the single lung can deliver the oxygen. Patients undergoing a lung transplant can receive tissue from both a live donor and a cadaver.

Which group is at greatest risk for drug-resistant Streptococcus pneumoniae? Select all that apply. One, some, or all responses may be correct. (28) People older than age 65 years Those who have aspirated acidic stomach contents People who have not received an influenza vaccine People who have traveled outside the United States Adults with a chronic health condition requiring steroids

People older than age 65 years People who have not received an influenza vaccine Adults with a chronic health condition requiring steroids People older than age 65 and those with chronic health conditions that impair immunity, such as conditions requiring steroid treatment, are at greatest risk for drug-resistant S. pneumoniae. Because pneumonia often follows the flu, annual vaccination for influenza is important for all causative organisms. These factors should be part of the initial assessment of patients presenting with symptoms of pneumonia. Although patients who have aspirated acidic stomach contents are at risk for pneumonia, it is not as likely to be the drug-resistant S. pneumoniae variety. Patients with respiratory symptoms should be queried regarding travel outside the United States; however, this is not a leading risk factor for drug-resistant S. pneumoniae.

Which procedure would help identify a hemothorax in a patient who experienced blunt chest trauma? (29) Palpation Inspection Percussion Auscultation

Percussion Percussion produces a dull sound over the area of a hemothorax. A hemothorax is characterized by blood in the pleural space and is confirmed by x-ray or a CT scan. A thoracentesis is then performed to remove the blood from the pleural space. A thoracentesis is not performed before radiographic confirmation because of the risks associated with the procedure if a pneumothorax is not present. Palpation is a physical assessment method used to examine the size, tenderness, and location of organs in the body and would not detect blood in the pleural space. Inspection involves observing the appearance of the body and would not detect hemothorax. Auscultation is listening to internal sounds of the body.

Which action will the nurse take to address an oxygen saturation level of 90% for an African-American patient? (24) Notify the Rapid Response Team. Request an order for arterial blood gases. Perform a thorough respiratory system assessment. Administer oxygen to increase the oxygen saturation.

Perform a thorough respiratory system assessment African-American patients and other patients of color tend to show a lower oxygen saturation level (3% to 5% lower) than white patients, not because of lower oxygen status but because of deeper colorations of the nail bed. The nurse should perform a thorough respiratory assessment to confirm that the low saturation is due to this cause and not to respiratory distress.

Which sputum characteristic in a patient with a productive cough will require immediate attention? (24) Yellow discoloration Mucoid consistency Pink and frothy sputum Bloody sputum

Pink and frothy sputum Pink, frothy sputum is common with pulmonary edema and requires immediate attention and intervention to prevent the patient's condition from getting worse

Which quality of sputum may occur if bleeding from a CANCEROUS TUMOR in the lung is present? (27) Thick Minimal Purulent Pink-tinged

Pink-tinged

A patient formerly on synchronous intermittent mandatory ventilation is placed on a T-piece to begin weaning from mechanical ventilation. Seven minutes later, the patient's oxygen saturation decreases from 90% to 70%, and the patient becomes tachycardic, diaphoretic, and anxious. Which action would the nurse take? (29) Call the Rapid Response Team. Instruct the patient to breathe deeply and try to relax. Give sedation medication to help the patient continue the weaning. Place the patient back on the recent mechanical ventilator settings.

Place the patient back on the recent mechanical ventilator settings. The patient is showing signs of distress with the weaning process; the nurse should place the patient back on the ventilator or facilitate the process for having mechanical ventilator support reinitiated. The anxiety is a response to hypoxemia; a patient who has reached this level of distress is unlikely to be able to breathe more deeply or relax in response to instructions. A Rapid Response Team call is not indicated because weaning is a controlled process and the health care team works closely together to monitor the patient's tolerance of weaning and reinitiating mechanical ventilation. Giving sedation agents will decrease the patient's drive to breathe.

Which comfort measure would the nurse plan to use for a patient who has orthopnea? (29) Place the patient in an upright position to facilitate breathing. Encourage frequent ambulation to improve exercise tolerance. Suggest an order for a bronchodilator to open narrow airways. Provide low-flow oxygen by nasal cannula to alleviate hypoxia.

Place the patient in an upright position to facilitate breathing. Patients who have orthopnea have increased dyspnea when lying down and should be placed in an upright position to facilitate breathing. Dyspnea that occurs with exercise may be managed by a gradual increase in activity. The patient with orthopnea is not necessarily hypoxic and does not need oxygen unless oxygen saturation or blood gas measures indicate hypoxia. Patients who have wheezing may need bronchodilator therapy.

A patient who has been admitted for a pulmonary embolism is receiving a heparin infusion. Which laboratory result would the nurse monitor to detect a possible complication of heparin therapy? (29) Platelet count International normalized ratio (INR) Blood urea nitrogen (BUN) Serum prealbumin

Platelet count Daily platelet counts are a safety priority in assessing for thrombocytopenia; heparin-induced thrombocytopenia is a possible side effect. The INR would be monitored for a patient taking warfarin. BUN is a measure of hydration and renal function. Serum albumin is used as a measure of nutritional status.

A patient has been receiving heparin subcutaneously for 4 days. For which laboratory value would the nurse contact the health care provider? (29) Hemoglobin of 14.2 g/dL Platelet count of 50,000/mm 3 International normalized ratio (INR) of 1.1 Activated partial thromboplastin time of 35 seconds

Platelet count of 50,000/mm 3 The normal range for platelets is 200,000/mm3 to 400,000/mm3. Platelets are needed for blood clotting. This patient's platelet count is extremely low, and he or she is at risk for bleeding. The low platelet count may be an indication of an adverse reaction to heparin known as heparin-induced thrombocytopenia (HIT). The heparin must be discontinued, and the patient may need to receive platelet therapy before life-threatening hemorrhage occurs. The hemoglobin, INR, and activated partial thromboplastin time values are is normal.

Which clinical condition is characterized by a flatness percussed over the lung fields? (24) Asthma exacerbation Pneumothorax Pleural effusion Lung consolidation

Pleural effusion

Which adventitious breath sound will the nurse document when loud, rough, grating, scratching sounds are heard on auscultation in a patient with tuberculosis? (24) Wheeze Rhonchus Coarse crackles Pleural friction rub

Pleural friction rub a pleural friction rub is heard as a loud, rough, grating, scratching sound on auscultation. It is caused by inflamed surfaces of the pleura rubbing together and is often associated with pain on deep inspirations

Which finding would the nurse expect in a patient diagnosed with pneumonia? (28) Pleuritic chest pain Trismus Difficulty swallowing Muffled voice

Pleuritic chest pain Chest pain from the irritation of the pleural is common with pneumonia. Trismus, difficulty swallowing, and muffled voice are findings associated with peritonsillar abscess.

Which is a possible reason for the development of bronchopleural fistula in a patient with lung cancer? (27) Drug therapy Thoracentesis Pneumonectomy Radiation therapy

Pneumonectomy Pneumonectomy is a surgical procedure that involves removal of a lung, which may create complications such as bronchopleural fistula. Drug therapy, thoracentesis, and radiation therapy are not associated with development of bronchopleural fistula.

Which condition is associated with vocal resonance while auscultating breath sounds? (24) Asthma Pleural rub Pneumonia Subcutaneous crepitus

Pneumonia

Which documented condition is supported by bronchial sounds auscultated at the lung edges of an older patient? (24) No change in status Consistent with normal aging Pneumonia Chronic airway disease

Pneumonia when bronchial breath sounds are heard at the lung edges instead of over the trachea and main bronchus

A patient who just underwent a central venous access catheter insertion has a deviated trachea and absence of breath sounds on one side. Which complication would the nurse suspect? (29) Flail chest Hemothorax Pulmonary contusion Pneumothorax

Pneumothorax A deviated trachea and absence of breath sounds on one side are findings in patients with a pneumothorax. Patients with a flail chest may experience paradoxic chest movements. Patients with a hemothorax may have massive blood loss. Patients with pulmonary contusions would have decreased breath sounds or crackles and wheezes.

Which possible complication of a thoracentesis will the nurse be most concerned about when the patient calls the home health agency the day after the procedure complaining of extreme shortness of breath and anxiety? (24) Abscess Pneumonia Pneumothorax Pulmonary embolism

Pneumothorax a pneumothorax would be the complication of thoracentesis that causes the greatest concern, along with these symptoms

Which statement is accurate for management of a patient with a traumatic brain injury (TBI) who is mechanically ventilated? (26) An adequate cough reflex will protect the patient's airway. Poor oral hygiene can lead to respiratory crisis from secretions. A tracheotomy is needed and will interfere with the patient's ability to communicate. The patient may not realistically expect to regain normal speech with vocal cord damage.

Poor oral hygiene can lead to respiratory crisis from secretions. Many patients with TBI cannot perform their oral care unassisted and will potentially experience buildup of secretions and drying of the mucous membranes if they are mouth-breathing. Large amounts of accumulated and dried secretions can actually contribute to airway obstruction. Vocal cord damage is not usually directly associated with TBI. Tracheotomy is not always needed with a TBI. Although a cough reflex is important to protect the patient's airway, it does not negate the need for good oral hygiene.

A patient who has recently been extubated is hoarse and has a cough. Which action would the nurse take? (29) Suction the patient to remove secretions and encourage deep breathing. Notify the Rapid Response Team that the patient may need to be reintubated. Notify the health care provider, and request a prescription to administer racemic epinephrine. Position the patient in a semi-Fowler position, and continue to monitor.

Position the patient in a semi-Fowler position, and continue to monitor. Coughing and difficulty clearing secretions are early signs of possible obstruction; the nurse should monitor the patient closely and position the patient in a semi-Fowler position. Stridor is a late sign and signifies an emergency requiring racemic epinephrine and possible reintubation. Suctioning the patient may increase irritation and cause increased swelling of the airway.

Which action does the nurse perform first when a patient reports a nosebleed that started with a sneeze? (26) Loosely pack the affected naris with gauze or nasal tampons. Instruct the patient not to sneeze or blow the nose for 24 hours. Position the patient upright and leaning forward over an emesis basin. Reassure the patient to reduce anxiety and help lower blood pressure.

Position the patient upright and leaning forward over an emesis basin positioning the patient in an upright, forward-leaning position prevents possible aspiration of blood. The next action would be to apply pressure to the nose for 10 minutes. If that fails, packing is necessary. After the bleeding stops, the patient should receive instructions about ways to prevent a recurrence

Which factor assists the nurse in determining if fluid leaking from a patient's nose is cerebrospinal fluid (CSF) or normal nasal secretions? Select all that apply. One, some, or all responses may be correct. (26) Positive glucose test on a dipstick Yellow halo ring on filter paper as the fluid dries Characteristic color of the fluid on the nasal pack Report by the patient of a "weird" taste in the mouth Fluid that only drains from one side of the patient's nose

Positive glucose test on a dipstick Yellow halo ring on filter paper as the fluid dries

Which is the most common method for preventing collapse of the airway in patients with obstructive sleep apnea (OSA)? (26) Drug intervention Surgical intervention Change in sleeping position Positive-pressure ventilation

Positive-pressure ventilation Noninvasive positive-pressure ventilation is a common method for keeping the upper airway open and preventing it from collapsing during sleep. Drugs are used only to relieve the symptoms of OSA, such as daytime sleepiness. Change in sleeping position can improve gas exchange and relieve mild apnea. Surgical interventions such as adenoidectomy, uvulectomy, and tracheostomy are used to relieve very severe cases of apnea when moderate interventions do not provide expected results; this is less common than positive-pressure ventilation.

Which principle about anterior versus posterior nasal bleeding does the nurse consider the priority? (26) Anterior bleeding is more likely related to a vessel in a nasal polyp. Posterior bleeding is an emergency because it cannot be easily reached. The stimulus that triggered the initial nasal bleeding must be determined. The amount and color of nasal drainage must be documented.

Posterior bleeding is an emergency because it cannot be easily reached posterior bleeding is not as readily seen or as easy to treat with the application of pressure or ice, thus posterior bleeds are more likely to require emergency treatment. Anterior bleeding is more easily seen and treated with pressure. Documentation is important with both types of bleeds; however, it is more difficult to assess the amount of bleeding with a posterior bleed, and blood is more likely to be swallowed. Various stimuli can trigger a nosebleed, and sometimes no trigger can be identified

Which is a problem for patients with head and neck cancer? Select all that apply. One, some, or all responses may be correct. (26) Persistent gastric reflux Potential risk for airway obstruction Adherence to total voice rest to decrease edema Potential for aspiration because of anatomic changes Reduced self-concept related to tumor and treatment

Potential risk for airway obstruction Potential for aspiration because of anatomic changes Reduced self-concept related to tumor and treatment if cancers of the head and neck are not treated adequately, they can lead to respiratory obstruction. In addition, both the tumors and their surgical management can lead to changes in the normal anatomy involved in swallowing. Patients may require assistance to master swallowing in a manner to decrease the risk for aspiration. Reduced self-concept can lead to depression and is common in patients with head and neck cancer. The tumor and treatment modalities cause a change in physical appearance and can be a difficult adjustment for the patient. Persistent gastric reflux may continue to be a problem; however, it is not a priority like the risk for respiratory obstruction or aspiration and reduced self-concept. Voice rest is most likely not an issue unless surgery involved the larynx

The nurse is assessing a patient with possible pulmonary embolism (PE). For which symptom would the nurse assess? Select all that apply. One, some, or all responses may be correct. (29) Productive cough Bloody sputum Inspiratory chest pain Dizziness and fainting Shortness of breath (SOB) worsening over the last 2 weeks

Productive cough Bloody sputum Inspiratory chest pain Dizziness and fainting PE may cause a dry or productive cough with bloody sputum (hemoptysis). Syncope, hypotension, and fainting are symptoms associated with PE. Sharp, pleuritic, inspiratory chest pain is also characteristic of PE. Sudden, not gradual, SOB occurs with PE.

Which recommendation will the nurse give to a patient with asthma who reports being afraid to begin an aerobic exercise program because exercise sometimes triggers asthma symptoms? (27) Participating in a stretching and light calisthenics program instead Avoiding aerobic exercise because it will make symptoms worse Using oral corticosteroids to prevent severe asthma symptoms Premedicating with a short-acting beta-adrenergic (SABA) medication before exercise

Premedicating with a short-acting beta-adrenergic (SABA) medication before exercise Patients who have asthma should be encouraged to participate in aerobic exercise to maintain cardiac health, enhance skeletal muscle strength, and promote ventilation and perfusion. If exercise triggers asthma symptoms, a SABA medication used before exercise can help prevent symptoms. Patients should be encouraged to participate in stretching and calisthenics along with aerobic exercise, not instead of. Patients should not be told to avoid aerobic exercise. Oral steroids are not recommended to prevent symptoms.

Which action would the nurse include in the procedure for suctioning a tracheostomy? (25) Preoxygenate for 30 seconds to 3 minutes before suctioning. Suction for at least 30 seconds to maximize secretion removal. Apply suction during catheter insertion and withdrawal. Tell the patient not to cough during suctioning.

Preoxygenate for 30 seconds to 3 minutes before suctioning applying and/or increasing the oxygen level before suctioning a tracheostomy can improve presuctioning levels and thus decrease hypoxia with the procedure. Suction should be applied to the catheter only during withdrawal to minimize hypoxia. Suctioning for 30 seconds would cause hypoxia and be a safety risk for the patient. Suctioning may trigger a reflex cough, which can help move secretions in the direction of the catheter

Several hours after extubation, the patient reports a sore throat and cough, and the nurse notes a hoarse voice. Which action would the nurse take? (29) Notify the Rapid Response Team. Prepare for reintubation at the bedside. Encourage use of an incentive spirometer. Request a prescription for nebulized racemic epinephrine.

Prepare for reintubation at the bedside. The patient is experiencing signs of throat irritation, which are common after extubation. Incentive spirometry is used to prevent atelectasis and pneumonia. The Rapid Response Team should be notified if the patient experiences stridor or other signs of airway obstruction. Racemic epinephrine is used to treat stridor. Reintubation would be used if the patient could not maintain ventilation.

Which is a possible cause of a false low reading when assessing the hemoglobin saturation of a patient after surgery using pulse oximetry? Select all that apply. One, some, or all responses may be correct. (24) Presence of edema Decreased hemoglobin Decreased ambient light Presence of hypothermia Decreased peripheral flow

Presence of edema Decreased hemoglobin Presence of hypothermia Decreased peripheral flow

Which is the role of the second chamber in a chest tube drainage system? (27) Controls the suction of the system Collects the fluid draining from the patient Collects the bubbles produced during drainage Prevents air from reentering the patient's pleural space

Prevents air from reentering the patient's pleural space The second chamber of the chest tube drainage system prevents air from reentering the patient's pleural space. The third chamber controls the suction of the system. The first chamber collects the fluid draining from the patient. The bubbles are formed in the second chamber, which indicates the drainage status. These bubbles are not collected by the second chamber.

Which information would the nurse provide regarding the purpose of prescribed warfarin to treat a patient with pulmonary arterial hypertension (PAH)? (27) Causes blood vessel relaxation Increases pulmonary blood flow Decreases blood pressure in arteries Prevents clotting in narrowed vessels

Prevents clotting in narrowed vessels Pulmonary blood vessels are narrowed in patients with PAH, which increases the risk for clotting. Therefore the nurse should instruct the patient that warfarin prevents clotting in these narrowed vessel lumens. Endothelin-receptor antagonists such as macitentan relax blood vessels and decrease arterial blood pressure. Prostacyclin agonists increase pulmonary blood flow.

The epiglottis serves which function? (24) Acts as a passageway for food and air Facilitates gas exchange and perfusion Prevents food from entering the trachea Acts as an opening between the true vocal cords

Prevents food from entering the trachea

Which target audience would the community health nurse prioritize for education on preventing respiratory infections such as influenza? (28) Politicians Hospital staff Homeless people Prison staff and inmates

Prison staff and inmates High-risk groups for respiratory infection include those who live in crowded areas such as long-term care facilities, prisons, and mental health facilities. Although homeless people are a high priority, they are not the group at greatest risk of those listed. Education could be provided in shelters or during outreach activities. Hospital staff are at risk because of their contact with ill patients and family members; however, they are already aware of how to prevent respiratory infection. Politicians are not at higher risk for respiratory infection than any other group with public exposure.

The nurse recalls which reason that a patient's laboratory report shows dilution of serum electrolytes? (27) Production of ectopic insulin from a different tissue Production of antidiuretic hormone from a different tissue Production of parathyroid hormone from a different tissue Production of adrenocorticotropic hormone from a different tissue

Production of antidiuretic hormone from a different tissue Ectopic insulin, antidiuretic hormone, parathyroid hormone, and adrenocorticotropic hormone are ectopic hormones. When the antidiuretic hormone is produced from a tissue not associated with the production of the hormone, it leads to dilution of serum electrolytes. When the production of ectopic insulin occurs from a different tissue, it results in hypoglycemia. The production of parathyroid hormone from a different tissue results in hypercalcemia. Cushing syndrome is caused by adrenocorticotropic hormone when the hormone is produced from a different tissue.

Which class of drugs provides the best specific dilation of pulmonary blood vessels in a patient with pulmonary hypertension? (27) Anticoagulants Prostacyclin agents Calcium channel blockers Endothelin-receptor agonists

Prostacyclin agents Natural and synthetic prostacyclins provide the best specific dilation of pulmonary blood vessels in a patient with pulmonary hypertension. They reduce pulmonary pressure and increase lung blood flow. Anticoagulants prevent clot formation. Calcium channel blockers dilate blood vessels but are less specific than synthetic prostacyclins. Endothelin-receptor agonists dilate blood vessels but are less specific than synthetic prostacyclins.

A patient is receiving IV heparin therapy for a pulmonary embolism. Which antidote would the nurse confirm is available? (29) Vitamin K Protamine sulfate Aminocaproic acid Antihemophilic factor

Protamine sulfate Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for warfarin. Antihemophilic factor and aminocaproic acid are both antidotes for fibrinolytic therapy that attempts to break up established clots.

Which intervention would the nurse include in the plan of care for a patient with lung cancer receiving palliative care to manage dyspnea? Select all that apply. One, some, or all responses may be correct. (27) Provide frequent rest periods. Give oxygen via nasal cannula. Place the patient in high-Fowler position. Allow the patient to sleep in a reclining chair. Administer continuous narcotic analgesics.

Provide frequent rest periods. Give oxygen via nasal cannula. Place the patient in high-Fowler position. Allow the patient to sleep in a reclining chair. Administer continuous narcotic analgesics. (all of them) Patients with lung cancer become easily fatigued and require interventions to minimize dyspnea. Therefore the nurse should provide frequent rest periods and space out activities. The nurse should give oxygen via nasal cannula to improve oxygenation. Placing the patient in high-Fowler position and allowing the patient to sleep in a reclining chair promotes lung expansion and oxygenation. Managing pain helps relax the patient to improve ventilation.

The nurse is caring for a patient injured in a car crash. The patient has bruising on the chest, dry cough, and decreased breath sounds. The chest x-ray on admission shows no abnormalities. Which collaborative actions would the nurse expect for this patient? (29) Administer an intercostal nerve block. Administer antibiotics. Perform an immediate needle thoracostomy followed by insertion of a chest tube. Provide oxygen and IV fluids.

Provide oxygen and IV fluids. The patient injured in a car crash with chest bruising, dry cough, decreased breath sounds, and no chest x-ray abnormalities most likely has a pulmonary contusion, which is managed with oxygen, IV fluids, and placing the patient in a moderate-Fowler position. Severe pain related to rib fracture may be managed with an intercostal nerve block. Antibiotics are indicated for pneumonia. A tension pneumothorax is managed with an immediate needle thoracostomy, followed by the insertion of a chest tube.

Which cause of respiratory distress does the nurse suspect when a patient begins coughing and producing frothy, pink-colored sputum? (24) Cystic fibrosis Lung abscess Pulmonary edema Bacterial pneumonia

Pulmonary edema

A patient who had knee surgery 2 days ago now has extreme shortness of breath, agitation, and apprehension. A heart rate of 119 beats/min and a respiratory rate of 24 breaths/min with an oxygen saturation of 84% are also noted. Which condition would the nurse suspect? (29) Anaphylactic reaction Bronchospasm Pneumothorax Pulmonary embolism

Pulmonary embolism Venous thromboemboli are a potential complication after orthopedic surgery. Shortness of breath, agitation, apprehension, tachycardia, and a decreased oxygen saturation are findings consistent with a pulmonary embolism. Anaphylaxis and bronchospasm are characterized by wheezing. Pneumothorax is characterized by absent breath sounds on the affected side.

A patient with pneumonia develops increased fever, chills, and night sweats. The nurse auscultates decreased breath sounds in the right lung and observes decreased chest wall movement in that area. Which secondary infection would the nurse suspect has developed? (28) Tuberculosis Peritonsillar abscess Rhinosinusitis Pulmonary empyema

Pulmonary empyema Increased fever, chills, night sweats, and decreased breath sounds and chest wall movement on the affected side are signs of pulmonary empyema, an infection in the pleural space. Tuberculosis is characterized by cough and blood-tinged sputum. Peritonsillar abscess is a collection of pus behind a tonsil characterized by fever with throat pain, difficulty swallowing, and bad breath. Rhinosinusitis is characterized by sore throat, fever, postnasal drip, pain over the sinuses, and ear pressure.

A laboratory report for a patient shows the following results: pH 7.32; bicarbonate 24 mEq/L; partial pressure of arterial oxygen (PaO2) 77 mm Hg; and partial pressure of arterial carbon dioxide (PaCO2) 48 mm Hg. These findings are consistent with which acid-base imbalance? (14) Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis

Which common restrictive lung disease is an example of excessive wound healing with loss of cellular regulation? (27) Asthma Cystic fibrosis Pulmonary fibrosis Pulmonary arterial hypertension

Pulmonary fibrosis Idiopathic pulmonary fibrosis is a common restrictive lung disease and is an example of excessive wound healing with loss of cellular regulation. Asthma is a chronic disease in which reversible airway obstruction occurs intermittently, reducing airflow. Cystic fibrosis is a genetic disease that affects many organs and lethally impairs lung function. General pulmonary hypertension can occur as a complication of other lung disorders. Primary pulmonary arterial hypertension is a rare condition that occurs in the absence of other lung disorders; its cause is unknown.

Which diagnostic test is used to determine the diffusion capacity in a patient with pulmonary arterial hypertension? (27) CT Pulmonary function tests Ventilation-perfusion scans Right-sided heart catheterization

Pulmonary function tests Pulmonary function tests are used to determine the diffusion capacity in a patient with pulmonary arterial hypertension. CT is used to create detailed pictures or scans of the areas inside the body. Ventilation-perfusion scans are used to measure breathing and circulation. Right-sided heart catheterization is used to measure pulmonary pressure.

Which quality of sputum may occur if infection or necrosis is present in patients with lung cancer? (27) Thick Minimal Purulent (contains puss) Blood-tinged

Purulent If infection or necrosis is present, sputum may be purulent and copious. Thick, minimal, or blood-tinged sputum does not indicate infection or necrosis in patients with lung cancer.

Xerostomia is a condition associated with which type of treatment? (26) Biotherapy Chemotherapy Speech therapy Radiation therapy

Radiation therapy

The nurse expects that the patient who received which treatment for lung cancer will experience ongoing fatigue? (27) Surgical therapy Targeted therapy Radiation therapy Photodynamic therapy

Radiation therapy Radiation therapy may cause ongoing fatigue in a patient who is receiving the therapy. Surgical therapy for cancer may lead to change in appearance or lifestyle. The side effects of molecularly targeted therapy may include skin reactions, hypertension, and impaired wound healing. Photodynamic therapy used in the treatment of lung cancer does not cause fatigue.

When caring for a patient with kidney failure who has metabolic acidosis, which symptom would the nurse expect as evidence of the body's compensatory effort? (14) Pallor and diaphoresis Rapid and deep respirations Bradycardia and bounding pulse Hypotension and weak, thready pulse

Rapid and deep respirations kussmaul respiration (rapid, deep respirations) represent the body's attempt to compensate for metabolic acidosis >The skin is warm, dry, and flushed in metabolic acidosis

Which motion is most often the cause of a pulmonary contusion during a car crash? (29) Slow acceleration Slow deceleration Rapid acceleration Rapid deceleration

Rapid deceleration Pulmonary contusions, which are potentially lethal, occur most often by rapid deceleration during car crashes. Slow acceleration and deceleration are not associated with pulmonary contusions. Rapid acceleration does not lead to pulmonary contusions.

A patient who was just transferred to the ICU after developing a pulmonary embolism is receiving anticoagulant therapy and oxygen. The nurse notes clear breath sounds, an oxygen saturation of 95%, and a heart rate of 78 beats/min. The patient reports feeling scared that something bad will happen. Which action would the nurse take? (29) Request a prescription for an antianxiety medication. Reassure the patient that the treatment is working. Suggest that the patient take deep breaths to relax. Increase the oxygen flow to improve oxygen saturation.

Reassure the patient that the treatment is working. The patient with a pulmonary embolism is receiving appropriate treatment and has stable vital signs, so the nurse should stay with the patient and provide assurance that the measures are working. Anxiety is a common response to pulmonary embolism, even when the patient is stable. The patient has adequate oxygen saturation, so increasing the oxygen flow is not indicated. If reassurance is not effective, an antianxiety medication may be necessary at a later time. The patient may not be able to take deep breaths, so this is not recommended as a relaxation technique.

Which early symptom would alert the nurse that an 80-year-old resident in the long-term care facility is developing pneumonia? (28) Vomiting Productive cough Recent onset of confusion Oral temperature of 101.1°F (38.4°C)

Recent onset of confusion The most common manifestation of pneumonia in the older adult is acute confusion caused by hypoxia. Other symptoms may include poor appetite (not vomiting), lethargy, fatigue, and weakness. Fever and cough may be absent.

Which physiologic reason would the nurse give to explain the need for oxygen in a patient diagnosed with idiopathic pulmonary fibrosis? (27) Reduced gas exchange Decreased sputum clearance Decreased forced vital capacity Connective tissue plugs in the lower airway

Reduced gas exchange Reduced gas exchange results in the need for oxygen. Decreased sputum clearance does not relate to the need for home oxygen. Decreased forced vital capacity may lead to the need for home oxygen in the future but does not necessarily require home oxygen. Connective tissue plugs in the lower airway are not related to this diagnosis.

Which change would the nurse anticipate in a patient with worsening acute respiratory distress syndrome (ARDS)? Select all that apply. One, some, or all responses may be correct. (29) Increase in lung volume Expansion of lung channels Reduction in surfactant activity Damage to type II pneumocytes Edema around terminal airways

Reduction in surfactant activity Damage to type II pneumocytes Edema around terminal airways ARDS occurs as a result of an acute lung injury. The injury typically happens in the alveolar-capillary membrane. As a result of the injury, surfactant is diluted by extra fluid in the lungs. Type II pneumocytes are damaged, and edema forms around terminal airways. Surfactant activity is reduced because of the damage of type II pneumocytes. The collapsed alveoli cannot exchange gases, and edema forms around terminal airways. In ARDS, lung volume is decreased, and lung channels are compressed.

The nurse recognizes that which patient history finding is a risk factor for laryngeal cancer? (26) High-cholesterol diet Intermittent periods of shortness of breath Professional singer Regular alcohol consumption

Regular alcohol consumption

Which statement is correct regarding the drug management of asthma? Select all that apply. One, some, or all responses may be correct. (27) Anti-inflammatory medications are used to cause bronchodilation. Long-acting beta agonists are indicated to relieve acute attack symptoms. Reliever medications are used to stop an asthma attack once it has started. Control therapy medications are used to prevent asthma attacks from occurring. Control therapy medications are used to reduce airway responsiveness.

Reliever medications are used to stop an asthma attack once it has started. Control therapy medications are used to prevent asthma attacks from occurring. Control therapy medications are used to reduce airway responsiveness. Control (formerly called preventive) therapy is used to reduce airway responsiveness to prevent the occurrence of asthma attacks. This therapy is used every day, regardless of symptoms. Reliever drugs are indicated when symptoms of an attack occur to decrease the duration and severity of the attack. Long-acting beta agonists do not act quickly enough to relieve acute symptoms; they are indicated for their long-term impact on symptoms. Anti-inflammatory drugs decrease inflammation and can be beneficial in the treatment of asthma; however, they do not cause bronchodilation.

Which intervention would the nurse plan for reducing anxiety in a patient with a pulmonary embolism (PE)? (29) Offer the patient a mild sedative. Allow a family member to remain in the room. Remain with the patient, and provide oxygen. Have the patient breathe into a brown paper bag.

Remain with the patient, and provide oxygen. The underlying cause for anxiety with a PE is hypoxemia, which will be alleviated by oxygen; remaining with the patient in distress is appropriate. Rebreathing from a brown bag is an intervention that increases partial pressure of arterial carbon dioxide (Paco2) during hyperventilation, as in a panic attack; it will not provide needed oxygen. Sedation or allowing a family member to stay may calm the patient but will not improve oxygenation.

A patient's heart rate increases to 98 beats/min and oxygen saturation decreases to 88% during tracheostomy suctioning. Which action would the nurse take? (25) Continue suctioning to fully clear the airway of secretions. Reoxygenate the patient with a 100% oxygen delivery system. Instill normal saline into the tracheostomy before resuming suctioning. Ask the patient to take three or four deep breaths before resuming suctioning.

Reoxygenate the patient with a 100% oxygen delivery system if a patient becomes hypoxic during suctioning, the nurse should reoxygenate the patient with 100% oxygen. Continuing suctioning will increase the hypoxia. Instilling normal saline is likely to worsen the hypoxia. Patients are asked to take three to four deep breaths, if possible, before beginning suctioning

A patient with a new tracheostomy has a soiled dressing. What action would the nurse take? (25) Reinforce the dressing with sterile 4 × 4 gauze. Replace the dressing with clean, folded 4 × 4 gauze. Replace the dressing with sterile, folded 4 × 4 gauze. Cut sterile 4 × 4 gauze to fit around the tracheostomy tube.

Replace the dressing with sterile, folded 4 × 4 gauze

Which factor contributes to the development of metabolic acidosis? Select all that apply. One, some, or all responses may be correct. (14) Reported heavy alcohol consumption Chronic cirrhosis of the liver with liver failure Fractured wrist from an altercation at a local bar Seizure in the ambulance on the way to the hospital Blood pressure of 148/92 mm Hg upon admission to the emergency department (ED)

Reported heavy alcohol consumption Chronic cirrhosis of the liver with liver failure Seizure in the ambulance on the way to the hospital

A lunch tray is served to a patient wearing a Venturi mask. Which action would the nurse take? (25) Substitute a face tent for the patient's use at mealtime. Teach the patient to lift the lower edge of the mask for each bite of food. Increase the flow rate, loosen the strap, and allow the mask to drop down around the neck. Request a prescription for a nasal cannula to be used during mealtime.

Request a prescription for a nasal cannula to be used during mealtime

Which acid-base imbalance would the nurse anticipate that a patient with morbid obesity may develop? (14) Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis respiratory acidosis is related to carbon dioxide (CO2) retention secondary to respiratory depression, inadequate chest expansion, airway obstruction, or reduced alveolar-capillary diffusion. Respiratory acidosis is common in patients with morbid obesity who experience inadequate chest expansion because of their size and work of breathing

After a motor vehicle crash, the nurse is consoling a patient in the emergency department who is hysterical and hyperventilating after being notified of the death of a family member. Which acid-base imbalance is this patient likely to develop? (14) Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory alkalosis

Laboratory results for a patient show the following: pH 7.48; bicarbonate 26; partial pressure of arterial oxygen (PaO2) 90; and partial pressure of arterial carbon dioxide (PaCO2) 32. These findings are consistent with which acid-base imbalance? (14) Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory alkalosis

A patient with diabetes mellitus is admitted after vomiting for several days and has rapid, deep respirations. Which process does the nurse suspect is occurring with this patient? (14) Kidney compensation for metabolic acidosis Kidney compensation for metabolic alkalosis Respiratory compensation for metabolic acidosis Respiratory compensation for metabolic alkalosis

Respiratory compensation for metabolic acidosis patients with diabetes mellitus can develop metabolic acidosis. Respiratory compensation occurs through the lungs as the rate and depth of respirations increase to reduce hydrogen ion levels

The nurse will include information about which smoking-cessation strategy when conducting a counseling session for smoking cessation? (24) Set a date to quit smoking. Try sugar-coated gums. Do not keep your hands engaged. Try e-cigarettes instead of nicotine.

Set a date to quit smoking

Which category of medication is used as a rescue inhaler for a patient who is a marathon runner and who has asthma? (27) Corticosteroids Long-acting beta agonists Short-acting beta agonists NSAIDs

Short-acting beta agonists Short-acting beta agonist medications have a rapid onset and cause bronchodilation; they would be excellent for marathon running because some types of asthma may be exercise induced. Corticosteroids disrupt production pathways of inflammatory mediators. Maximum effectiveness requires 48 to 72 hours of continued use; therefore they are not appropriate as a rescue medication. Long-acting beta agonists do cause bronchodilation but have a slow onset; they are not used as rescue inhalers. NSAIDs stabilize the membranes of mast cells and prevent release of inflammatory mediators. They have a slow onset of action and are used for prevention of symptoms, not as rescue medication.

Which classical manifestation can be found in patients with class I primary pulmonary arterial hypertension (PAH)? (27) Shortness of breath is observed even during rest. Shortness of breath is not observed during any physical activity. Shortness of breath is observed during moderate physical activity. Fatigue and light-headedness are present, even during mild physical activity.

Shortness of breath is not observed during any physical activity. PAH is classified on the basis of clinical manifestations. Patients with class I primary PAH may not have shortness of breath during any kind of physical activity. Patients with class IV primary PAH may have shortness of breath even during rest. Patients with class II primary PAH may experience shortness of breath with moderate physical activity. In patients with class III primary PAH, fatigue, and light-headedness are observed during mild physical activity.

Which device is used in a low-flow oxygen delivery system? Select all that apply. One, some, or all responses may be correct. (25) Venturi mask Aerosol mask Simple facemask T-piece apparatus Nonrebreather mask

Simple facemask Nonrebreather mask

Which position assumed by a patient with pneumonia leads the nurse to suspect that the patient is developing hypoxia? (28) Side-lying Sitting in tripod position Prone with head of bed flat Supine with head of bed at 30 degree angle

Sitting in tripod position A patient with hypoxia will assume the tripod position (seated and positioned leaning on the hands, often leaning on an over-the-bed table). The patient who is hypoxic will not assume a side-lying or prone position because these positions will only increase a patient's feelings of inability to obtain enough air. Elevating the head of the bed 30 degrees will not be adequate to relieve the smothering feelings associated with hypoxia.

The nurse suspects which type of injury when a patient with facial trauma as a result of a motor vehicle accident presents to the emergency department with extensive bruising behind the ears? (26) Spinal fracture Soft tissue injury Mandibular fracture Skull fracture and brain trauma

Skull fracture and brain trauma

Which sensation is influenced by the respiratory system? (24) Smell Taste Touch Vision

Smell

A patient who underwent a uvulopalatopharyngoplasty (UPPP) returns for a follow-up appointment. Which assessment technique would the nurse use to detect local infection? (26) Smell for breath odor. Listen to the voice quality. Auscultate lung sounds. Assess for signs of bleeding.

Smell for breath odor. Signs of a postoperative infection in a patient who underwent a UPPP would be foul-smelling breath, purulent drainage, or beefy-red mucous membranes. The nurse should listen to the voice quality and auscultate lung sounds for signs of obstruction. The nurse should assess for signs of bleeding to detect postoperative hemorrhage.

Which patient teaching point could conceivably prevent most lung cancers? (27) Smoking cessation Genetic testing for risk Use of respirators in at-risk jobs Radiologic examination of smokers

Smoking cessation Cigarette smoking is responsible for 85% of all lung cancer deaths and is regarded as the major risk factor; it increases the risk for smokers as well as those exposed to passive smoke. Although more information is being gained about genes and lung cancer risks, knowledge does not yet enable prevention of the disease. Use of proper masks and respirators when exposed to carcinogenic inhalants would decrease the risk for lung cancer for a smaller population, but not to the extent of smoking cessation. In addition, smoking actually increases the risk for lung cancer in people exposed to other occupational carcinogenic inhalants. The use of radiologic screening of smokers has improved the early detection of disease, but it is not a preventive measure.

Which factor will the nurse assess to determine smoking habits? (24) Occupation Living conditions Smoking history Home conditions

Smoking history

Which statement describes the visceral pleura? (24) Ciliated, mucus-secreting membrane Smooth membrane that encloses the lungs Fluid that allows the surfaces to glide across Fatty proteins that reduce tension in the alveoli

Smooth membrane that encloses the lungs the pleura is a smooth membrane that facilitates the smooth movement of the lungs

Which is a symptom of obstructive sleep apnea (OSA)? Select all that apply. One, some, or all responses may be correct. (26) Neck pain Chest pain Snores heavily Waking up tired Daytime sleepiness

Snores heavily Waking up tired Daytime sleepiness

A patient has a fenestrated tracheostomy tube in place. Which multidisciplinary team member would be involved in the discharge planning process, specific to the tracheostomy? (25) Phyiscal therapist Speech therapist Occupational therapist Patient care assistant

Speech therapist a vital member of the multidisciplinary team for the patient with a fenestrated tracheostomy tube is the speech therapist. A speech therapist can teach the patient about swallowing and communication with the tube in place. Physical therapy and occupational therapy may be beneficial to the patient for conditioning and strengthening, but they are not specific to the tracheostomy. The patient may utilize a patient care assistant as well, but this is not specific to the tracheostomy

Which factor contributes to a patient with a flail chest developing atelectasis and pneumonia? (29) Splinting the chest Performing tracheal suction Elevating the head of the patient's bed Providing positive-pressure ventilation

Splinting the chest Splinting is contraindicated in patients with a flail chest as it may further reduce the ability to exert the extra effort to breathe and may contribute later to the failure to wean off mechanical ventilation. Performing tracheal suction is beneficial in clearing nasal secretions. Elevating the head of the patient's bed does not interrupt the patient's capacity to wean from the ventilator. Providing positive-pressure ventilation is indicated for the stabilization of flail chest and helps to prevent atelectasis.

Which condition may result in metabolic acidosis? Select all that apply. One, some, or all responses may be correct. (14) Starvation Blood transfusion Prolonged vomiting Prolonged diarrhea Nasogastric suctioning Total parenteral nutrition

Starvation Prolonged diarrhea

Which diagnostic test aids in the diagnosis of cystic fibrosis (CF)? Select all that apply. One, some, or all responses may be correct. (27) Stool for fat Bronchoscopy Stool for trypsin Sweat chloride analysis Biopsy of intestinal mucosa Gastric contents for hydrochloric acid levels

Stool for fat Sweat chloride analysis Sweat chloride analysis assesses for elevated chloride levels in the sweat. Levels of 60 to 200 mEq/L are diagnostic of CF. Steatorrhea or excessive fat in the stool is also present in CF because the pancreatic enzymes necessary for digestion are blocked due to the thick secretions produced. A bronchoscopy is usually done after a diagnosis of CF to look for any signs of infection. An intestinal mucosa biopsy will not aid in diagnosing CF because the pathology affects the GI tract, but it does not cause the disease. Duodenal fluid, not stool, should be tested for decreased or absence of trypsin.

The nurse assesses a patient with facial trauma and identifies that which clinical manifestation requires immediate attention? (26) Pain Stridor Bleeding Decreased visual acuity

Stridor stridor is an indication of a partial airway obstruction and requires immediate attention. Although bleeding is important in all trauma patients, it is not the first priority in assessing CAB (cardiac compressions; airway; rescue breathing). The question does not specify where the bleeding is occurring. The type (venous or arterial) and quantity of the bleeding need to be noted. Visual acuity will be assessed in the secondary survey because it is not considered life threatening. Pain must be addressed to fully evaluate a patient and complete a reliable examination; however, it is not the nurse's first priority

Which finding requires immediate intervention for a patient who underwent a modified uvulopalatopharyngoplasty (modUPPP) for the treatment of obstructive sleep apnea? (26) Pain level of 3 on a scale of 1 to 10 Alert and oriented to person and place Blood pressure of 149/84 mm Hg Stridor upon inspiration

Stridor upon inspiration A patient who underwent a modUPPP is at high risk for an airway obstruction. Clinical manifestations of this would be stridor, frequent salivation, and decreased oxygen saturation. Therefore these findings would lead the nurse to contact the Rapid Response Team. After the patient's respiratory status is stabilized, then the nurse could address the pain. The level of orientation may improve with a normal oxygen level. The patient's blood pressure is borderline high and only requires continued monitoring at this time.

Which condition is a long-term effect of chronic obstructive sleep apnea (OSA)? Select all that apply. One, some, or all responses may be correct. 926) Stroke Epistaxis Diabetes Hypertension Impaired voice box

Stroke Diabetes Hypertension

The nurse will discuss the risk for which issue when educating a patient about smoking during nicotine replacement therapy? (24) Depression Hallucinations Manic behavior Stroke or heart attack

Stroke or heart attack

Which complication does the nurse suspect when assessing puffiness at the site of chest tube insertion in a patient with lung cancer? (27) Infection Bone metastasis Tracheal deviation Subcutaneous emphysema

Subcutaneous emphysema Subcutaneous emphysema occurs when gas or air is present in the layer under the skin. During the management of chest tube drainage systems, the tube insertion site should be checked to assess the skin condition. If puffiness or crackling is found on palpation, it indicates subcutaneous emphysema. Infection is indicated by redness or purulent drainage. A bone metastasis is indicated by pain. Tracheal deviation indicates the presence of pressure caused by a disease in the trachea.

Which symptom would be found in a patient with respiratory muscle fatigue? (27) Silent chest on auscultation Slow breathing with deep respirations Respiratory rate of 25 to 35 breaths/min Sucked-in abdominal wall during inspiration

Sucked-in abdominal wall during inspiration In patients with respiratory muscle fatigue, the abdominal wall is sucked in during inspiration. Patients with serious airflow obstruction or pneumothorax may have a silent chest on auscultation. Patients with respiratory muscle fatigue breathe with rapid, shallow respirations, and the respiratory rate could be as high as 40 to 50 breaths/min.

A sedated patient with a new tracheostomy has noisy respirations and the ventilator alarms indicate high peak pressures. Which action would the nurse take? (25) Suction the patient. Increase oxygenation. Humidify the oxygen source. Remove the inner cannula.

Suction the patient

Which surgical procedure for laryngeal cancer involves removal of the hyoid bone? (26) Laser surgery Transoral cordectomy Vertical laryngectomy Supraglottic partial laryngectomy

Supraglottic partial laryngectomy Supraglottic partial laryngectomy involves removal of the hyoid bone. Laser surgery, transoral cordectomy, and vertical laryngectomy are not associated with the removal of the hyoid bone. Laser surgery reduces the tumor or destroys a tumor completely through laryngoscope. Transoral cordectomy involves cutting off a tumor through laryngoscope. Vertical laryngectomy involves removal of one true cord, one false cord, and one-half of the thyroid cartilage.

Which is a cause of tongue edema in a patient with upper airway obstruction? Select all that apply. One, some, or all responses may be correct. (26) Coma Surgery Trauma Angioedema Loss of gag reflex

Surgery Trauma Angioedema Surgery, trauma, and angioedema may result in tongue edema. Coma and loss of gag reflex are causes of tongue occlusion.

Which prognosis would the nurse anticipate for a patient with idiopathic pulmonary fibrosis? (27) Permanent resolution Survival of less than 5 years Unknown prognosis 10 to 15 years with treatment

Survival of less than 5 years Patients with idiopathic pulmonary fibrosis generally survive less than 5 years after diagnosis. Permanent resolution is not possible in patients with idiopathic pulmonary fibrosis. The prognosis for patients with idiopathic pulmonary fibrosis is known. Ten to 15 years with treatment is not realistic for these patients.

Which patient action during self-management after a laryngectomy can lead to complications? (26) Swimming Using saline in the stoma Cleaning the stoma with mild soap and water Taking a shower instead of a bath

Swimming Swimming should be avoided after laryngectomy to prevent an infection pathway related to the stoma. Crusting around the stoma should be prevented with a saline solution rinse of the area. The stoma should be cleaned with mild soap and water to prevent infection. The patient should use care when showering and shaving.

While the nurse is assessing a patient with metabolic acidosis, which finding supports that the patient has lactic acidosis? (14) Symptoms of hypoxia Low blood glucose levels History of excessive oral antacid use Inability of kidney tubules to secrete hydrogen ions into the urine

Symptoms of hypoxia lactic acidosis occurs when the body has too little oxygen to meet metabolic oxygen demands, such as during heavy exercise, seizure activity, fever, and reduced oxygen intake.

Which is a common exclusion criterion for a patient with cystic fibrosis preparing for lung transplantation? (27) Age restriction Systemic infection Severe lung damage Irreversible lung damage

Systemic infection A patient with cystic fibrosis having a systemic infection cannot undergo lung transplantation because of an increased risk for transplant rejection. The age of the patient undergoing transplantation is considered on an individual basis. Recipient criteria for a patient with cystic fibrosis include having severe lung damage and irreversible lung damage.

A patient reports experiencing chest pain, headache, and cough with sputum production, fever, and dyspnea. Which other finding would the nurse anticipate upon assessment? Select all that apply. One, some, or all responses may be correct. (28) Sore throat Tachycardia Nasal drainage Crackles upon auscultation Diminished chest expansion

Tachycardia Crackles upon auscultation Diminished chest expansion

A patient reports experiencing chest pain, headache, and cough with sputum production, fever, and dyspnea. Which other finding would the nurse anticipate upon assessment? Select all that apply. One, some, or all responses may be correct. (28) Sore throat Tachycardia Nasal drainage Crackles upon auscultation Diminished chest expansion

Tachycardia Crackles upon auscultation Diminished chest expansion This patient has symptoms of pneumonia. Symptoms include tachycardia due to hypoxemia, chest pain with decreased or unequal chest expansion, and crackles upon auscultation because of fluid in the interstitial and alveolar areas. A sore throat and nasal drainage are symptoms of an upper respiratory disorder.

Which action for the care of a patient who has just been extubated would the nurse delegate to assistive personnel (AP)? (29) Adjust the nasal oxygen flow rate. Take vital signs every 5 minutes. Assess the patient's ability to swallow liquids. Teach about incentive spirometer use.

Take vital signs every 5 minutes. Taking vital signs is included in AP education and scope of practice and can be delegated. The AP can report changes in vital signs to the nurse. Patient teaching is an activity performed by the professional nurse. Adjusting oxygen flow rates requires complex decision making and should be done by the registered nurse (RN). Assessing the ability to swallow safely after extubation should be done by the nurse or other qualified professional, such as a speech-language pathologist.

Occupational exposure to which material increases a person's risk for lung cancer? Tar Tin Turpentine Tartaric acid

Tar

Which nonsurgical treatment for lung cancer involves inhibiting tumor cell growth factors? (27) Chemotherapy Targeted therapy Radiation therapy Photodynamic therapy

Targeted therapy -Targeted therapy involves using drugs such as erlotinib, bevacizumab, and crizotinib; these drugs inhibit the growth of cancer cells by blocking growth factor receptors. -Chemotherapy with platinum agents is usually used for small cell lung cancer. -Radiation therapy is often used to treat locally advanced lung cancer that is confined to the chest by shrinking the tumor. -Photodynamic therapy uses laser light to destroy sensitized cancer cells.

Which treatment is often used for NON-small cell lung cancer? Chemotherapy Targeted therapy Radiation therapy Immunosuppression

Targeted therapy -Targeted therapy is often the treatment of choice for non-small cell lung cancer. -Radiation therapy can be an effective treatment for locally advanced lung cancers confined to the chest. -Chemotherapy is often the treatment of choice for small cell lung cancer. -Immunosuppression with neutropenia, which greatly increases the risk for infection, is the major dose-limiting side effect of chemotherapy for lung cancer.

Which nursing intervention will help prevent chronic fatigue in patients with chronic obstructive pulmonary diseases (COPD)? (27) Encouraging the patient to work with the arms raised Teaching the patient to not rush through morning activities Suggesting that the patient avoid high energy-use tasks such as walking Allowing the patient to eat, bathe, and groom himself or herself during acute exacerbations

Teaching the patient to not rush through morning activities

Which complication would the nurse suspect if a patient being mechanically ventilated with positive end-expiratory pressure (PEEP) suddenly experiences extreme respiratory distress? (29) Flail chest Hemothorax Pulmonary contusion Tension pneumothorax

Tension pneumothorax

Which condition involves air entering the pleural cavity under pressure? Flail chest Pulmonary contusion Tension pneumothorax Tracheobronchial trauma

Tension pneumothorax In patients with tension pneumothorax, air enters forcefully into the chest cavity, resulting in increased pressure. This rise in pressure may result in the complete collapse of the lungs. A flail chest occurs because of the fracture of two or more ribs in two or more places. A pulmonary contusion causes hemorrhage and edema between the alveoli. This reduces both lung movement and the area available for gaseous exchange, thus resulting in hypoxemia. Tracheobronchial trauma causes extensive air leakage, leading to subcutaneous emphysema.

Which type of chest trauma produces a hyperresonant sound on percussion of the affected area? (29) Hemothorax Flail chest Pulmonary contusion Tension pneumothorax

Tension pneumothorax A hyperresonant sound on percussion of the affected area is characteristic of a tension pneumothorax. A hemothorax produces a dull sound on percussion. A flail chest is associated with paradoxical chest wall movement on inspection, but not hyperresonance on percussion. A dull sound on percussion is seen in patients with a pulmonary contusion.

Which complication would the nurse expect in a patient with a torn mainstem bronchus who is rapidly intubated and ventilated with positive pressure? (29) Flail chest Hemothorax Pneumothorax Tension pneumothorax

Tension pneumothorax A patient with a torn mainstem bronchus may develop a tension pneumothorax rapidly when intubated and ventilated with positive pressure. A flail chest may occur after cardiopulmonary resuscitation. A hemothorax is caused by lung injury and massive blood loss. A pneumothorax may occur from blunt chest trauma and with some degree of hemothorax.

Which adverse effect is associated with the use of positive end-expiratory pressure (PEEP)? (29) Lung infection Ventilatory failure Pulmonary embolism Tension pneumothorax

Tension pneumothorax PEEP is used to prevent the alveoli from collapsing at the end of expiration. The most serious side effect of PEEP is tension pneumothorax, in which the alveoli rupture and air accumulates in the pleura. Infection is not associated with application of PEEP. PEEP is used for prevention of ventilatory failure. PEEP does not affect the clotting mechanism of the body; pulmonary embolism is not associated with PEEP.

Which factor increases the risk for aspiration with a tracheostomy tube in place? (25) Capping the tracheostomy tube for speaking Amount of xerostomia experienced by the patient The balloon interfering with food passage in the esophagus Increased length of time tracheostomy tube has been in place

The balloon interfering with food passage in the esophagus because of the close proximity of the trachea to the esophagus, the tracheostomy tube balloon can interfere with food passage in the esophagus. This increases the risk for aspiration

Which patient description suggests pulmonary (lung) pain in a patient? (24) The patient experiences a "rubbing" sensation. The patient states that pain is intense and "crushing." The patient feels the pain radiating to the arm and shoulder. The patient experiences an increase in pain when the area is touched.

The patient experiences a "rubbing" sensation the patient with pulmonary pain experiences a "rubbing" sensation caused by the inflamed pleural layers that line the lungs rubbing against each other every time the lungs expand to breathe in air.

Which medical emergency can lead to a life-threatening situation? (25) Tracheomalacia Tracheal stenosis Tracheoesophageal fistula (TEF) Trachea-innominate artery fistula

Trachea-innominate artery fistula a malpositioned tube triggers its distal tip to push against the lateral wall of the tracheostomy. This pressure causes necrosis and erosion of the innominate artery, resulting in massive bleeding, which is life-threatening

A patient who is on mechanical ventilation is setting off the high-pressure alarm. For which situation would the nurse insert an oral airway? (29) The patient has a decreased airway size. The patient has increased oral mucus secretions. The patient experiences decreased compliance of the lungs. The patient is biting on the endotracheal tube.

The patient is biting on the endotracheal tube. Inserting an oral airway helps prevent the patient from biting on the oral endotracheal tube. The high-pressure alarm may sound because of decreased airway size, increased mucus secretions, or decreased compliance of the lungs, but none of these problems can be solved by the insertion of an oral airway. When the patient has increased mucus secretions, suction should be provided. When decreased compliance of the lungs is experienced, the nurse should evaluate the underlying cause and try to alleviate the problem.

Which symptom is specific for asthma compared with other chronic lung disorders? (27) The patient is coughing. The patient has dyspnea. It affects only young people. The patient is symptom-free between exacerbations.

The patient is symptom-free between exacerbations.

A patient with a tracheostomy has been weaned from the mechanical ventilator and now has a decannulation cap over the end of the tracheostomy tube. Which finding would the nurse expect when assessing the patient? (25) The pilot balloon is flat. The tracheostomy cuff is inflated. A tracheostomy collar is providing humidified oxygen. Tracheostomy ties have been removed.

The pilot balloon is flat the pilot balloon is the external indicator that the cuff is deflated. The cuff must be deflated before placing the decannulation cap; otherwise, there will be no airway. If the tracheostomy is capped, there is no inlet for administering oxygen. Because the patient is using the natural airway, a cannula or mask is used to administer oxygen. The tracheostomy still needs to be stabilized with straps or ties

Which action would the nurse plan to include in the care of a patient with a recently placed tracheostomy who is on a mechanical ventilator? (25) The pilot balloon should remain inflated. A cuffed tube protects against aspiration. A noncuffed tracheostomy tube is used. The inner cannula is left out of the tube.

The pilot balloon should remain inflated the pilot balloon should remain inflated, indicating the cuff is inflated. A cuffed tube is used during mechanical ventilation. A cuffed tube does not guarantee that aspiration will not occur. Most newly placed tubes utilize a disposable inner cannula, which is replaced during tracheostomy care and is needed for correct fit of the ventilator tubing

The nurse is assessing a patient who is receiving mechanical ventilation with positive end-expiratory pressure (PEEP). Which findings would cause the nurse to suspect a left-sided tension pneumothorax? (29) The patient has bloody sputum and expiratory wheezes. The chest caves in on inspiration and "puffs out" on expiration. The trachea is deviated to the right side, and cyanosis is present. The left lung field is dull to percussion with crackles on auscultation.

The trachea is deviated to the right side, and cyanosis is present. Symptoms of tension pneumothorax include chest asymmetry, tracheal deviation toward the unaffected side, dyspnea, absent breath sounds, jugular venous distention (JVD), cyanosis, and hyperresonance to percussion over the affected area. Flail chest is manifested by paradoxical chest movement, which consists of "sucking inward" of the loose chest area during inspiration and puffing out of the same area during expiration. Open pneumothorax presents with decreased breath sounds, hyperresonance, and poor respiratory excursion on the affected side. Pulmonary contusion presents with hemoptysis, dullness to percussion, and crackles or wheezes.

Which statement is true regarding a stationary chest tube drainage system? (27) The first chamber acts as a suction regulator. The tubes from the patient are connected to the first chamber. The second chamber collects the fluid draining from the patient. The first chamber prevents the air from moving back into the patient's chest.

The tubes from the patient are connected to the first chamber There are three chambers used in the stationary chest tube drainage system. The first chamber is the drainage collecting chamber. The tubes from the patient are connected to this chamber. Regulation of suction activity is performed by the third chamber. The second chamber is the water seal, which prevents air from moving back up the tubing system and into the patient's chest.

Which reason is accurate as to why patients with asthma must avoid taking aspirin (ASA) or NSAIDs for pain or fever? (27) They allow increased production of leukotrienes. They increase the risk for gastroesophageal reflux disease (GERD). Aspirin and NSAIDs can cause bronchoconstriction. A patient with asthma is likely allergic to these drugs.

They allow increased production of leukotrienes. Patients with asthma are often restricted from taking ASA and NSAIDs because they can trigger an asthma attack by allowing increased production of leukotrienes as they suppress other inflammatory pathways. They do not directly cause bronchoconstriction or increase the risk for GERD. Patients who are sensitive to the effects of these drugs do not have a true allergy to them.

Which action would the nurse suggest to a patient with a tracheostomy to prevent aspiration? (25) Hold the head high when swallowing. Consume consecutive swallows of liquids. Thicken all liquids to increase consistency. Include moisture-producing fruits in the diet.

Thicken all liquids to increase consistency

Which information would the nurse include when teaching the patient with a new tracheostomy about preventing aspiration? (25) Raise the head of the bed 30 degrees when eating. Thicken liquids, including water. When swallowing, raise the chin as though looking at the ceiling. If not already inflated, inflate the tube cuff when eating or drinking.

Thicken liquids, including water

Which is an effective treatment for a patient with lung cancer who is diagnosed with pleural effusion? (27) Drug therapy Thoracentesis Pneumonectomy Radiation therapy

Thoracentesis Thoracentesis involves fluid removal by suction, and it is very effective for curing pleural effusion. Drug therapy, pneumonectomy, and radiation therapy are not associated with the treatment of pleural effusion. Drug therapy with bronchodilators and corticosteroids is used for the treatment of bronchospasm. Pneumonectomy is the surgical removal of lung. Radiation therapy helps cure obstruction of the bronchi and great veins (superior vena cava syndrome).

The nurse is evaluating medication compliance in a patient with tuberculosis. Which finding indicates the patient is no longer contagious and can go back to work? (28) Clear chest x-ray and lung sounds Patient reporting taking medications Oxygen saturation level 95% on room air Three consecutive negative sputum cultures

Three consecutive negative sputum cultures When the patient presents with three consecutive negative sputum cultures, this indicates the patient is no longer contagious and can return to activities. The chest x-ray and lung sounds will take longer to resolve than contagiousness of the infection. The patient reporting taking the medication indicates medication compliance. An oxygen saturation level of 95% on room air indicates improved oxygenation, but the patient may still be contagious.

Which cartilage in the larynx is the largest? (24) Costal Cricoid Thyroid Arytenoid

Thyroid the largest cartilage in the larynx is the thyroid cartilage, which is also known as the "Adam's apple."

After a patient's total laryngectomy, the nurse plans to remove the patient's feeding tube in preparation for oral feedings. For which reasons does the nurse ask the patient to swallow several small sips of water before removing the tube? (26) To minimize pain during the removal of the patient's tube To decrease the risk for aspiration To determine the patient's ability to tolerate oral nutrition To ease in the removal of the feeding tube

To determine the patient's ability to tolerate oral nutrition Before removing the feeding tube, the nurse should make sure the patient is able to swallow safely if nutrition is to be given by mouth. Because the airway and the esophagus have been completely separated, there is no risk for aspiration. Asking the patient to swallow water is not necessary to facilitate removal of the feeding tube or to minimize discomfort.

Which rationale is behind prescribing digoxin and diuretics to a patient with pulmonary arterial hypertension? (27) To reduce dyspnea To prevent clot formation To improve cardiac function To cure pulmonary arterial hypertension

To improve cardiac function The heart of a patient with pulmonary arterial hypertension undergoes hypertrophy and decreased cardiac function. Therefore digoxin and diuretics are prescribed to improve cardiac function. Calcium channel blockers are prescribed to dilate blood vessels. Oxygen therapy is used to reduce dyspnea and ensure proper oxygen supply. Digoxin and diuretics do not cure pulmonary arterial hypertension completely.

Which purpose does bronchoscopy serve? Select all that apply. One, some, or all responses may be correct. (24) To obtain tissue sample for culture and biopsy To remove secretions that do not clear with normal suctioning To drain pleural fluid to relieve lung compression To screen for lung disease before the onset of manifestations To measure the amount of carbon dioxide present in exhaled air

To obtain tissue sample for culture and biopsy To remove secretions that do not clear with normal suctioning

Which goal is a purpose of oxygen therapy? (25) To cure the condition To stop the disease process To provide an acceptable blood oxygen level To use the highest fraction of inspired oxygen

To provide an acceptable blood oxygen level

A patient with pulmonary tuberculosis is being started on combination therapy. What does the nurse explain to the patient as the purpose of combination therapy? (28) To allow for missed doses To reduce the length of treatment time To treat highly resistant cases of tuberculosis To improve the patient's ability to tolerate medications

To reduce the length of treatment time Combination medication shortens therapy by months. Tuberculosis medications should be taken as prescribed without missing a dose. Combination therapy reduces the emergence of resistant strains. Medications may be changed based upon the patient's ability to tolerate drugs.

Which location on the body will the nurse use when testing oxygen saturation levels? Select all that apply. One, some, or all responses may be correct. (24) Toes Nose Wrists Fingers Earlobes

Toes Nose Fingers Earlobes

Which condition, if untreated, is likely to lead to a patient experiencing neck swelling, muffled voice, and bad breath? (28) Rhinitis Sinusitis Tonsillitis Pharyngitis

Tonsillitis Neck swelling, muffled voice, and bad breath are symptoms of a peritonsillar abscess. Untreated or partially treated acute tonsillitis may lead to the complication of a peritonsillar abscess. Untreated rhinitis, untreated sinusitis, and untreated pharyngitis will not cause a peritonsillar abscess.

Which surgical procedure for neck cancer leads to the absence of a natural voice? (26) Total laryngectomy Transoral cordectomy Vertical laryngectomy Supraglottic partial laryngectomy

Total laryngectomy

Which surgical procedure involves the removal of the entire larynx? (26) Laser surgery Laryngofissure Total laryngectomy Transoral cordectomy

Total laryngectomy

Which condition would the nurse suspect is developing if a patient's tracheostomy tube is pulsating in synchrony with the heartbeat? (25) Tracheomalacia Tracheal stenosis Tracheoesophageal fistula (TEF) Trachea-innominate artery fistula

Trachea-innominate artery fistula

Which treatment is a *LAST RESORT* for very severe obstructive sleep apnea (OSA) that does not respond to moderate interventions? (26) Uvulectomy Tracheostomy Adenoidectomy Uvulopalatopharyngoplasty

Tracheostomy Tracheostomy is the option available to treat severe cases of OSA. Uvulectomy is a surgical procedure where a part of the uvula is removed; this is considered as an alternative therapy if tracheostomy is not suitable for the patient. Adenoidectomy is a surgical procedure that involves adenoid removal and is a moderate intervention for treating apnea. Uvulopalatopharyngoplasty is a surgical intervention that can be performed for OSA.

Which reason is common for the high drug error rate in IV treprostinil for a patient with pulmonary arterial hypertension? (27) Treprostinil requires continuous infusion. Treprostinil cannot be administered at home. Treprostinil cannot be delivered by the subcutaneous route. Treprostinil can be administered only by the IV route.

Treprostinil requires continuous infusion. Treprostinil is a prostacyclin agent that is used to treat pulmonary arterial hypertension. IV treprostinil requires continuous (24 hours/7 days a week) infusion. The unusual nature of continuous infusion, the need to keep an IV line dedicated strictly to prostacyclin infusion, and the varied dosages of the different brands of prostacyclins contribute to a high drug error rate for administration of this drug. The continuous infusions of treprostinil can be performed at home. Treprostinil can be delivered by the subcutaneous, IV, or inhalation route.

Which concern would be included in the plan of care after a patient returns from surgery with a new tracheostomy? Select all that apply. One, some, or all responses may be correct. (25) Tube obstruction Tube dislodgement Accidental decannulation Securing the endotracheal tube Plugging the tube for communication

Tube obstruction Tube dislodgement Accidental decannulation maintaining patency of the airway is a primary concern after a new tracheostomy. Tube obstruction, dislodgement, or decannulation can cause an airway emergency.

The nurse notes that the patient has progressive fatigue, anorexia, weight loss, irregular menses, and a low-grade fever. Which condition would the nurse suspect in the patient? (28) Pharyngitis Pneumonia Tuberculosis

Tuberculosis Progressive fatigue, anorexia, weight loss, irregular menses, and a low-grade fever are clinical signs and symptoms of tuberculosis. Pharyngitis is manifested as throat soreness and dryness, throat pain, pain on swallowing (odynophagia), difficulty swallowing, and fever. Pneumonia is manifested as chest pain or discomfort, myalgia, headache, chills, fever, cough, tachycardia, dyspnea, tachypnea, hemoptysis, and sputum production. Rhinosinusitis is manifested as pain over the cheek radiating to the teeth, and fever, swelling, fatigue, ear pressure, referred pain to the temple, and general facial pain that is worse when bending forward.

Which complication causes pain radiating to the arm in patients with advanced lung cancer? (27) Compression of blood vessels Compression of lymph vessels Tumor invasion of nerve plexuses Tumor obstruction of the bronchus

Tumor invasion of nerve plexuses In patients with advanced lung cancer, pain radiating to the arm results from tumor invasion of nerve plexuses. This type of pain does not result from compression of blood vessels or lymph vessels or tumor obstruction of the bronchus.

While percussing a patient's chest, the nurse detects a change from a low-pitched sound of long duration to a high-pitched, drumlike sound of short duration. How does the nurse identify the new high-pitched sound and its probable cause? (24) Tympany over a pneumothorax Flatness over a pleural effusion Hyperresonance over an asthmatic lung Resonance over a consolidation

Tympany over a pneumothorax

Which is the most frequent cause of disruption of breathing in patients with obstructive sleep apnea (OSA)? (26) Chronic airflow limitation Upper airway obstruction Sinus mucosa inflammation Nasal mucosa inflammation

Upper airway obstruction Upper airway obstruction is the most frequent cause of disruption of breathing in patients with OSA. The soft palate and tongue block the upper airway in cycles of disruptive breathing for 10 seconds each during sleep. Chronic airflow limitation occurs in chronic lung diseases like asthma, bronchitis, and pulmonary emphysema. Sinus mucosa inflammation, or rhinosinusitis, manifests as pain on the cheek radiating to the teeth, temple, or back of the head. Nasal mucosa inflammation, or rhinitis, manifests as nasal congestion, headache, and watery discharge from the nose.

The nurse determines that which is the most suitable position for a patient with epistaxis? (26) Prone position Supine position Semi-Fowler position Upright and leaning forward position

Upright and leaning forward position

The nurse is suctioning a patient who has a tracheostomy and notes a pulse oximetry reading of 90% during the procedure. Which action would the nurse take? (25) Administer oxygen by simple facemask while suctioning the patient. Change to a larger-diameter tube to facilitate removal of secretions. Encourage the patient to cough to assist with clearance of secretions. Use a manual resuscitation bag to deliver 100% oxygen before resuming.

Use a manual resuscitation bag to deliver 100% oxygen before resuming

Which risk factor is associated with community-acquired pneumonia (CAP)? Select all that apply. One, some, or all responses may be correct. (28) Use of tobacco Recent aspiration History of chronic lung disease Pneumococcal vaccine more than 5 years ago Presence of gram-negative colonization of the mouth

Use of tobacco Pneumococcal vaccine more than 5 years ago Risk factors for CAP include smoking and receiving the pneumococcal vaccine longer than 5 years ago. Recent aspiration, chronic lung disease, and gram-negative colonization are risk factors for health care-acquired pneumonia.

Which situation is a potential source of infection for a patient receiving oxygen therapy? Select all that apply. One, some, or all responses may be correct. (25) Oxygen tubing pulling on the endotracheal tube Applying nonpetroleum lotion for dry facial skin Using a heated humidifier or nebulizer Inserting an oral suction catheter in the endotracheal tube Encouraging the patient to deep-breathe and cough

Using a heated humidifier or nebulizer Inserting an oral suction catheter in the endotracheal tube

Which sign or symptom is significant in diagnosing asthma in a nonsmoker? (27) Dyspnea Wheezing Chest tightness Increased mucus

Wheezing Wheezing in a patient who is a nonsmoker is an indicator of airway obstruction. Although dyspnea, chest tightness, and increased mucus production can also be seen with asthma, these signs and symptoms are also more often present with other respiratory conditions.

Which nursing intervention is focused on preventing the spread of severe acute respiratory syndrome (SARS)? Select all that apply. One, some, or all responses may be correct. (28) Using strict airborne isolation techniques Handwashing before and after all patient care Disinfecting contaminated surfaces and equipment Using Contact Precautions with people suspected to have SARS Reporting occurrences to the Centers for Disease Control and Prevention (CDC)

Using strict airborne isolation techniques Handwashing before and after all patient care Disinfecting contaminated surfaces and equipment Using Contact Precautions with people suspected to have SARS Because the SARS virus is spread via airborne droplets from infected people through sneezing, coughing, and talking, strict Airborne Precautions are essential. Hand hygiene and the use of gloves decrease the likelihood of spread to the mucous membranes, nose, and mouth and contamination of surfaces outside the patient's room. Patients suspected to have SARS should be placed in Contact Precautions until a definitive diagnosis is made. Diagnosis is confirmed by the manifestation of symptoms and the use of a rapid SARS test within 2 days after symptoms begin. All equipment and surfaces that potentially have been contaminated must be disinfected by a person wearing gloves. Although careful monitoring of the occurrence of SARS is important, preventing its spread is the initial focus to decrease the likelihood of a widespread epidemic.

Which assessment finding would indicate a patient with tuberculosis is working towards a goal of maintaining adequate oxygenation? (28) Maintaining Airborne Precautions Using the incentive spirometer hourly Taking antitubercular medications Splinting the abdomen before coughing

Using the incentive spirometer hourly The nurse should determine the patient is working towards the goal of adequate oxygenation when the patient uses the incentive spirometer hourly. The staff should maintain Airborne Precautions to prevent the spread of infection. The antitubercular medications will help eradicate the infection but do not promote oxygenation. The patient with abdominal surgery should splint his or her abdomen before coughing.

The patient coughs and expels the tracheostomy tube. The nurse inserts a new tracheostomy tube and auscultates the lungs but cannot hear breath sounds. Which action would the nurse take? (25) Apply oxygen via simple facemask. Order a chest x-ray to assess for pneumothorax. Assess for air under the skin around the tracheostomy. Ventilate with a bag-valve-mask and call for the Rapid Response Team.

Ventilate with a bag-valve-mask and call for the Rapid Response Team the nurse may request assistance from another nurse, a respiratory therapist, or a health care provider if needed and should ventilate the patient with a bag-valve-mask until the airway can be secured. The Rapid Response Team should be notified by another nurse. A simple facemask should not be used because the patient has a tracheostomy. Ordering a chest x-ray for a pneumothorax is not an appropriate intervention while the patient does not have a secure airway. Assessing for air under the tracheostomy could be done later but is not an action that addresses the urgent needs

Which sound is an expected finding when auscultating the peripheral lung fields? (24) Vesicular Bronchovesicular Wheezes Bronchial tracheal

Vesicular the nurse should expect to auscultate vesicular breath sounds in the peripheral lung fields. Vesicular breath sounds like leaves rustling in the trees. Inspiration should be longer than expiration

Which laboratory finding regarding the white blood cell (WBC) count would the nurse expect to see for a patient who has pneumonia? (28) WBC 5100/mm3 WBC 6500/mm3 WBC 9500/mm3 WBC 12,000/mm3

WBC 12,000/mm3 An elevated WBC count is associated with bacterial infections such as pneumonia. A WBC count of 12,000/mm3 is elevated. Any WBC count below 10,000/mm3 is considered normal.

Which information would the nurse include in the discharge teaching of a patient with a laryngectomy and tracheostomy? (25) Cover the airway loosely with plastic wrap when showering. Use a dehumidifier in the home if secretions become excessive. Wear a loose-fitting scarf or decorative collar if you would like to minimize the appearance of the tube. When coughing, place a finger over the tracheostomy to expectorate secretions through the mouth.

Wear a loose-fitting scarf or decorative collar if you would like to minimize the appearance of the tube

The nurse is caring for a patient with severe acute respiratory syndrome (SARS). Which action would the nurse take to prevent contracting the infection when preparing to suction this patient? (28) Performing oral care after suctioning the oropharynx Keeping the head of the bed elevated 30 to 45 degrees Closing the door to the patient's room Wearing a fit-tested respirator and protective eyewear

Wearing a fit-tested respirator and protective eyewear To protect health care workers during procedures that induce coughing or promote aerosolization of particles, nurses should wear a respirator and protective eyewear to prevent the spread of infectious organisms. Keeping the head or the bed elevated 30 to 40 degrees helps to prevent aspiration pneumonia, but it does not protect the nurse. Performing oral care is a patient comfort measure, but it does not protect the nurse. Closing the door to the room may help prevent the spread to others outside, but it does not protect the nurse doing the suctioning.

Which long-term effect does the nurse anticipate in a patient with obstructive sleep apnea (OSA)? Select all that apply. One, some, or all responses may be correct. (26) Weight gain Daytime sleepiness Neurocognitive deficits Decrease in concentration Increase in blood pressure

Weight gain Neurocognitive deficits Increase in blood pressure

Which intervention does the nurse expect to find in the plan of care for a patient with mild obstructive sleep apnea (OSA)? Select all that apply. One, some, or all responses may be correct. (26) Uvulectomy Tracheostomy Weight reduction Use of a foam pillow Change in sleeping position

Weight reduction Change in sleeping position A patient with mild sleep apnea may find relief with weight loss and a change in sleeping position. Uvulectomy is recommended when sleep apnea is more severe and unimproved with milder interventions. Tracheostomy treats very severe sleep apnea. A certain type of pillow is not typically specified in a plan of care for a patient with OSA.

Which statement about obstructive sleep apnea (OSA) is correct? (26) Patients with OSA usually do not sleep at all. Recurrent OSA can result in irreversible brain changes and death. Unless OSA is treated, patients can develop neurologic apnea. With OSA, increased carbon dioxide levels stimulate neural centers to awaken the sleeper.

With OSA, increased carbon dioxide levels stimulate neural centers to awaken the sleeper.

The nurse monitors which concern during the early postoperative period after a patient's total laryngectomy to treat laryngeal cancer? Select all that apply. One, some, or all responses may be correct. (26) Anxiety related to radiation therapy Wound breakdown and hemorrhage Comfort and nonverbal communication Airway obstruction and inadequate oxygenation Knowledge deficit related to chemotherapy

Wound breakdown and hemorrhage Comfort and nonverbal communication Airway obstruction and inadequate oxygenation significant concerns after surgery for head and neck cancer include wound breakdown, airway obstruction/compromise, pain management, and adequate nonverbal communication. This is an extremely stressful time for patients and their families; attentiveness to these aspects of the recovery process can prevent complications and delayed recovery. Once the patient is past the early postoperative period, addressing anxiety about radiation therapy will be needed if it is a recommended treatment. The nurse will not teach a patient about chemotherapy unless this is the prescribed course of treatment. It is also not a priority during the early postoperative period

Which medication is given to prevent influenza in people exposed to someone with influenza? Select all that apply. One, some, or all responses may be correct. (28) Pneumococcal conjugate vaccine Zanamivir Oseltamivir Rifampin Ethambutol

Zanamivir Oseltamivir Zanamivir and oseltamivir are both used for prevention of influenza for those people who have been exposed to influenza. Pneumococcal conjugate vaccine is used to prevent pneumococcal pneumonia. Rifampin and ethambutol are used to treat tuberculosis.

Which drug reduces the severity of infection and mortality rate during a pandemic flu? Select all that apply. One, some, or all responses may be correct. (28) Zanamivir Oseltamivir Ethambutol Pyrazinamide

Zanamivir Oseltamivir Zanamivir and oseltamivir are antiviral drugs that reduce the severity of infection and mortality rate when widely distributed during a pandemic flu. Ethambutol and pyrazinamide are first-line drugs for the treatment of tuberculosis.

Kidney failure, pancreatitis, liver failure, and dehydration are causes of what? (14)

acidosis

High altitudes, ingestion of antacids, and prolonged vomiting are causes of what? (14)

alkalosis

Coarse Crackle breath sounds (24)

are lower-pitched, coarse, discontinuous rattling sounds caused by fluid or secretions in large airways and are associated with bronchitis and pneumonia

Rhonchi breath sounds (24)

are pitched, coarse, continuous snoring sounds which arise from the large airways

Wheezing breath sounds (24)

are squeaky, musical, continuous sounds associated with air rushing through narrowed airways and can be heard without a stethoscope

Which arterial blood gas reading would be expected in a patient who has had chronic obstructive pulmonary disease (COPD) for the last 15 years? (14) a) pH 7.33, PaO2 65 mm Hg, PaCO2 41 mm Hg, and HCO3 - 19 mEq/L b) pH 7.36, PaO2 63 mm Hg, PaCO2 52 mm Hg, and HCO3 - 32 mEq/L c) pH 7.48, PaO2 82 mm Hg, PaCO2 32 mm Hg, and HCO3 - 25 mEq/L d) pH 7.36, PaO2 72 mm Hg, PaCO2 30 mm Hg, and HCO3 - 18 mEq/L

b) pH 7.36, PaO2 63 mm Hg, PaCO2 52 mm Hg, and HCO3 - 32 mEq/L the kidneys will compensate to correct for changes in blood pH that occur when the respiratory system is unhealthy (i.e., COPD) or overwhelmed by increasing the absorption of bicarbonate and excreting hydrogen ions. -The reading of pH 7.36, partial pressure of arterial oxygen (PaO2) 63 mm Hg, partial pressure of arterial carbon dioxide (PaCO2) 52 mm Hg, and HCO3- 32 mEq/L reflects this state of compensated respiratory acidosis. -A reading of pH 7.33, PaO2 65 mm Hg, PaCO2 41 mm Hg, and HCO3- 19 mEq/L reflects an uncompensated metabolic acidosis -A reading of pH 7.48, PaO2 82 mm Hg, PaCO2 32 mm Hg, and HCO3-25 mEq/L reflects an uncompensated respiratory alkalosis -A reading of pH 7.36, PaO2 72 mm Hg, PaCO2 30 mm Hg, and HCO3- 18 mEq/L reflects a compensated metabolic acidosis state

Diuretic therapy and the use of antacids can result in? (14)

metabolic alkalosis

Which arterial blood gas laboratory values would be seen in metabolic alkalosis? (14) pH 7.49 bicarbonate (HCO3-) 32 pH 7.28 carbon dioxide (CO2) 54 pH 7.53 CO2 28 pH 7.31 HCO3- 18

pH 7.49 bicarbonate (HCO3-) 32

A pH of 7.53 and a CO2 of 28 indicates? (14)

respiratory alkalosis