Med Surg Exam 2 Respiratory

Which of the following would cause the medulla oblongata to increase the respiratory rate? A. Too much oxygen in blood stream B. Too much carbon dioxide in blood stream C. Decrease in metabolic needs

B. Too much carbon dioxide in blood stream

You are obtaining a health history from a 67-year-old patient with a 40 pack-year smoking history, complaints of hoarseness and tightness in the throat, and difficulty swallowing. Which question is most important to ask? A. "How much alcohol do you drink in an average week?" B. "Do you have a family history of head or neck cancer?" C. "Have you had frequent streptococcal throat infections?" D. "Do you use antihistamines for upper airway congestion?"

A. "How much alcohol do you drink in an average week?" Prolonged alcohol use and smoking are associated with the development of laryngeal cancer, which the patient's symptoms and history suggest. Family history is not a risk factor for head or neck cancer. Frequent antihistamine use would be asked about if the nurse suspected allergic rhinitis, but the patient's symptoms are not suggestive of this diagnosis. Streptococcal throat infections also may cause these clinical manifestations, but patients also will complain of pain and fever.

TB is suspected. A PPD test is ordered and administered. The result of Mr. B will be considered positive for TB if he, after 48 hours, develops an induration that measures which of the following? *Consider that he now has HIV+ diagnosis added to his health history. A. 5 mm B. 7 mm C. 8 mm D. 12 mm

A. 5 mm If diagnosed with HIV, you are immunocompromised and cannot even react to the TB test like a normal person

For which client is it most essential for the nurse to implement measures to prevent pulmonary embolism? A. 59-year-old who had a knee replacement B. 60-year-old who has bacterial pneumonia C. 68-year-old who had emergency dental surgery D. 76-year-old who has a history of thrombocytopenia

A. 59-year-old who had a knee replacement

You should place Mr. A in a room with which of the following patients? A. A 20-year-old in traction for multiple fractures of the left lower leg. B. A 35-year-old with recurrent fever of unknown origin. C. A 50-year-old who received chemotherapy 2 days ago D. An 89-year-old with Alzheimer's disease awaiting nursing home placement.

A. A 20-year-old in traction for multiple fractures of the left lower leg. Everyone else is immunocompromised

Which of the following is correct about PPD test? Select all that apply. A. Also known as Mantoux test. B. Determines antibody response to TB bacillus within 48 to 72 hours C. Positive finding confirms active TB. D. BCG vaccine of Mycobacterium bovis may cause a false positive reaction. E. Immunocompromised clients may not have a positive reaction despite being infected with M. tuberculosis.

A. Also known as Mantoux test. B. Determines antibody response to TB bacillus within 48 to 72 hours D. BCG vaccine of Mycobacterium bovis may cause a false positive reaction. E. Immunocompromised clients may not have a positive reaction despite being infected with M. tuberculosis.

How do you differentiate between anterior and posterior nasal bleeding? (Select all that apply) A. Anterior bleeding is easily visualized. B. Anterior bleeding account for 90% of nose bleeding. C. Posterior bleeding is more life-threatening. D. Posterior bleeding usually stops spontaneously.

A. Anterior bleeding is easily visualized. B. Anterior bleeding account for 90% of nose bleeding. C. Posterior bleeding is more life-threatening. Posterior bleeds do not usually stop spontaneously, anterior bleeds do.

Which of the following is true about the pathophysiology of asthma? Select all that apply. A. Asthma is a chronic inflammatory disease of the airways B. Mast cell release of histamine leads to a bronchoconstrictive process, bronchospasm, and obstruction. C. Asthma is a chronic inflammatory disease of the alveoli. D. Mast cell release of histamine leads to a bronchodilation and obstruction.

A. Asthma is a chronic inflammatory disease of the airways B. Mast cell release of histamine leads to a bronchoconstrictive process, bronchospasm, and obstruction.

M.J. has been prescribed Benadryl (diphenhydramine) to manage symptoms. Which of the following is true concerning the use of Benadryl? (Select all that apply) A. Benadryl is a 1st-generation antihistamine. B. Using Benadryl may cause bradycardia. C. Operating machinery and driving may be dangerous because of sedative effect. D. Use of this medication may cause constipation and dry mouth. E. Benadryl may also cause paradoxic stimulation

A. Benadryl is a 1st-generation antihistamine. C. Operating machinery and driving may be dangerous because of sedative effect. D. Use of this medication may cause constipation and dry mouth. E. Benadryl may also cause paradoxic stimulation Benadryl can cause tachycardia

Which of the following is part of the respiratory tract? Choose all that apply. A. Bronchi B. Pharynx C. Larynx D. Sinuses

A. Bronchi B. Pharynx C. Larynx D. Sinuses

Physical examination reveals mild pallor. His pulse is regular at 110 beats/min and his blood pressure is 120/82 mmHg. Respiratory rate is 26/min. The trachea is shifted to the left side and the apical impulse is shifted laterally. The right side of the chest moves less with respiration. Tactile vocal fremitus is reduced. On percussion, a stony dull note is elicited on the right side and this dullness does not shift with change in posture. Breath sounds and vocal resonance are almost absent on the right side. There is no succussion splash. Abdominal, cardiovascular and neurological examinations are normal. The rest of the physical examination is unremarkable. Which of the following diagnostic studies is appropriate to confirm the diagnosis of pleural effusion? A. CXR B. CBC C. PPD D. Sputum culture

A. CXR

One of your nursing diagnoses for Mr. A is "Ineffective Airway Clearance". Which of the following nursing interventions are appropriate for this nursing diagnosis? Select all that apply. A. Consult respiratory therapist for chest physiotherapy. B. Limit fluid intake. C. Administer bronchodilators as prescribed D. Have the patient on flat position. E. Teach and assist patient in performing coughing and breathing maneuvers.

A. Consult respiratory therapist for chest physiotherapy. C. Administer bronchodilators as prescribed E. Teach and assist patient in performing coughing and breathing maneuvers.

What intervention is unique to the isolation precautions related to Mr. B? A. Don an N95 respirator mask and then enter the room. B. Put on a nonpermeable gown before entering the room. C. Wear nonsterile gloves when touching the client's body. D. Maintain separation of 3 feet between the client and other individuals.

A. Don an N95 respirator mask and then enter the room.

Prior to developing a plan of care for M.B., you review the results of the other laboratory tests and the chest X-ray. Select the findings that you would expect to be present as a result of M.B.'s exacerbation of his COPD. Select all that apply. A. Electrolytes: HCO3 32 mEq/L (32 mmol/L) B. Chest x-ray: Flattened diaphragm C. CBC: Platelets 160,000/µl D. Electrolytes: HCO3 18 mEq/L (32 mmol/L) E. CBC: RBC 6.8 × 106/µl

A. Electrolytes: HCO3 32 mEq/L (32 mmol/L) B. Chest x-ray: Flattened diaphragm E. CBC: RBC 6.8 × 106/µl CBC platelet value is normal (not expecting a change) Not expecting electrolytes 18

Which of the following is true about the pharmacological management of TB? Select all that apply A. For active TB, drugs are given in combination over a prolonged time period. B. TB medication available in oral, IM, and IV forms. C. Isoniazid (INH, Nydrazid) interferes with mycobacterial cell-wall synthesis . D. Isoniazid (INH, Nydrazid) is given for inactive TB to prevent its activation. E. One of the major adverse reactions of TB drugs is hepatitis.

A. For active TB, drugs are given in combination over a prolonged time period. C. Isoniazid (INH, Nydrazid) interferes with mycobacterial cell-wall synthesis . D. Isoniazid (INH, Nydrazid) is given for inactive TB to prevent its activation. E. One of the major adverse reactions of TB drugs is hepatitis.

Which of the following diagnostic laboratory findings is expected in Mr. D's case? Why? A. High D-Dimer B. Low D-Dimer C. High PTT D. High INR

A. High D-Dimer D-Dimer is specific for PE, meaning positive test means you HAVE the condition. Therefore, high D-Dimer=PE

Based on the clinical presentation of Mr. A, which of the following nursing diagnoses should be a high-priority diagnosis? A. Impaired gas exchange B. Anxiety C. Knowledge deficient D. Hyperthermia

A. Impaired gas exchange

What would you expect to be TRUE about J.D.'s vital signs? (Select all that apply) A. Increased BP B. Decreased BP C. Increased HR D. Decreased RR

A. Increased BP C. Increased HR A before B because body will constrict causing increased blood pressure, and pain causes increased blood pressure. But if circulatory status is not restored, then B, then C. C increased HR due to 10/10 pain and compensating for blood loss. Increased RR because body is trying to oxygenate as much blood as possible.

Based on the history of Mr. B, it is very likely that he was exposed to TB many years ago but the exposure was not active until recently. Which of the following is correct about inactive TB? Select all that apply. A. It is also known as latent TB. B. The patient didn't show symptoms right after exposure because the incubation period for TB microorganism is several years. C. TB microorganism was engulfed by WBC and made inactive. D. The inactivation period depends on the microorganisms that cause TB. E. The inactive TB becomes active when the person's immunity is compromised.

A. It is also known as latent TB. C. TB microorganism was engulfed by WBC and made inactive. E. The inactive TB becomes active when the person's immunity is compromised.

Which of the following is correct? Select all that apply. A. Long-acting β-adrenergic agonist: Stimulates β-adrenergic receptors in bronchioles, effective for prevention of acute bronchospasm B. Short-acting β-adrenergic agonist: Stimulates β-adrenergic receptors in bronchioles, effective for treatment of acute bronchospasm C. Short-acting anticholinergic agent: Blocks bronchoconstrictive action of parasympathetic nervous system for 4 to 6 hours D. IgE antagonist: Decreases circulating free IgE levels

A. Long-acting β-adrenergic agonist: Stimulates β-adrenergic receptors in bronchioles, effective for prevention of acute bronchospasm B. Short-acting β-adrenergic agonist: Stimulates β-adrenergic receptors in bronchioles, effective for treatment of acute bronchospasm C. Short-acting anticholinergic agent: Blocks bronchoconstrictive action of parasympathetic nervous system for 4 to 6 hours D. IgE antagonist: Decreases circulating free IgE levels LABA effective for prevention SABA effective for treatment

Which client has the highest risk for developing a pulmonary embolism? A. Obese client with leg trauma B. Pregnant client with acute asthma C. Client with diabetes who has cholecystitis D. Client with pneumonia who is immunodeficient

A. Obese client with leg trauma

As you work to provide timely care to C.J., which nursing activity would be most appropriate to delegate to nursing assistive personnel? A. Obtain and set-up oxygen delivery system. B. Administer short-term bronchodilator as prescribed. C. Evaluate C.J.'s response to prescribed therapy. D. Explain prescribed treatments to C.J. to decrease anxiety.

A. Obtain and set-up oxygen delivery system.

In order to expedite M.B.'s admission, you delegate responsibilities to Amy, the nursing assistant. Which of the following actions would be appropriate for nursing assistive personnel (NAP) to complete? Select all that apply. A. Obtain patient's vital signs. B. Apply telemetry monitor. C. Obtain patient's past medical history. D. Auscultate patient's lung sounds. E. Orient patient to call bell system, TV controls, and bed controls.

A. Obtain patient's vital signs. B. Apply telemetry monitor. E. Orient patient to call bell system, TV controls, and bed controls.

When teaching Mr. M. B. about using MDI, what should you include? Select all that apply. A. Open your mouth and hold the inhaler 1 to 2 inches away. B. Hold breath for 10 seconds after inhaling the medication. C. Shake all inhalers before using. D. Ipratropium and albuterol (Combivent) cause bronchodilation in different ways and are therefore combined to improve the effect. E. Rinse your mouth with water after using Advair to prevent infection.

A. Open your mouth and hold the inhaler 1 to 2 inches away. B. Hold breath for 10 seconds after inhaling the medication. C. Shake all inhalers before using. D. Ipratropium and albuterol (Combivent) cause bronchodilation in different ways and are therefore combined to improve the effect. E. Rinse your mouth with water after using Advair to prevent infection.

Treatment for C.J. is started immediately. Select the initial interventions that you would anticipate to be implemented for C.J. Select all that apply. A. Oxygen by mask to keep SpO2 at 90% B. Albuterol (Proventil, Ventolin) by nebulizer q20min for three treatments C. Ipratropium (Atrovent) added to the initial short-term β-agonist treatment D. Insertion of intravenous catheter and IV fluids for hydration E. Administration of IV sodium bicarbonate F. IV methylprednisolone q4-6hr

A. Oxygen by mask to keep SpO2 at 90% B. Albuterol (Proventil, Ventolin) by nebulizer q20min for three treatments C. Ipratropium (Atrovent) added to the initial short-term β-agonist treatment D. Insertion of intravenous catheter and IV fluids for hydration

Per protocol, Mrs. D will need to be on Coumadin (Warfarin) after the sign of PE and DVT have subsided. To monitor the effectiveness of Coumadin, advise Mrs. D to monthly check her: A. PT/INR B. PTT C. D-Dimmer D. Coumadin level

A. PT/INR

Heparin IV drip starting at 700 units is ordered. To evaluate the effectiveness of heparin, you should be monitoring which of the following tests?  A. PTT B. PT C. INR D. D-Dimer

A. PTT PTT test tells us how long it takes for our blood to clot. We want to thin the blood to make it harder to clot but not too much

Patient #4: S.M. is a 19 year-old female complaining of "scratchy throat" You perform an examination and acute pharyngitis is suspected You see white patches and swollen, red tonsils You initiate steps to rule out strep infection in S.M. If left untreated, a Group A beta-hemolytic streptococcal infection may result in: (Select all that apply) A. Peritonsillar abscess B. Rheumatic fever C. Sepsis D. Cancer

A. Peritonsillar abscess B. Rheumatic fever C. Sepsis

To decrease the risk of recurrent pneumonia, pneumococcal vaccine is order. Which of the following statements regarding this vaccine is correct? Select all that apply A. Pneumococcal vaccine should be given every 5 years. B. Pneumococcal vaccine is given IV. C. Pneumococcal vaccine should be given at the time of discharge. D. Pneumococcal vaccine can be given at the same time with flu vaccine. E. If Mr. A cannot remember when received his pneumococcal vaccine, he should be vaccinated anyway.

A. Pneumococcal vaccine should be given every 5 years. C. Pneumococcal vaccine should be given at the time of discharge. D. Pneumococcal vaccine can be given at the same time with flu vaccine. E. If Mr. A cannot remember when received his pneumococcal vaccine, he should be vaccinated anyway.

The most reliable and sensitive test of gas exchange is: A. Pulse Oxymetry B. ABG C. Chest X- ray D. Respiration rate

A. Pulse Oxymetry

pH: 7.31 PaCO2: 49 mmHg PaO2: 65 mmHg HCO3: 24 mEq/L A. Respiratory Acidosis B. Respiratory Alkalosis C. Metabolic Acidosis D. Metabolic Alkalosis

A. Respiratory Acidosis

M.B.'s arterial blood gas results are: pH 7.31 PaO2 68 mm Hg PaCO2 58 mm Hg HCO3 32 mEq/L SaO2 85% You recognize that these findings indicate what respiratory status is present in M.B.? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

A. Respiratory acidosis

A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. You find a heart rate of 142, BP reading of 100/60, and respirations of 42. Your first action should be to A. elevate the head of the bed to 45 to 60 degrees. B. administer the ordered pain medication. C. notify the patient's health care provider. D. offer emotional support and reassurance.

A. elevate the head of the bed to 45 to 60 degrees.

Patient #8: Mr. A is a 68 year old man who developed a harsh, productive cough four days. The sputum is thick and yellow with streaks of blood . He developed a fever ,shaking, chills and malaise along with the cough. One day ago he developed pain in his right chest that intensifies with inspiration . The patient lost 15 lbs over the past few months but claims he did not lose his appetite. "I just thought I had the flu." Past history reveals that he had a chronic smoker's cough for "10 or 15 years" which he describes as being mild, non-productive and occurring most often in the early morning. He smoked 2 packs of cigarettes per day for the past 50 years. The patient is a retired truck driver who has been treated for mild hypertension, bronchitis, appendicitis (as a young adult), hemorrhoids and a fractured femur and splenic injury. (motorcycle accident). Patient reports having about 10 sexual partners in the last 5 years. What can you identify in the patient history that put him at risk for the present illness? Select all that apply. A. Smoking B. Recent flu C. Appendicitis D. Hemorrhoids E. Fractured femur

A. Smoking B. Recent flu

Which of the following isolation precautions should you use when caring for Mr. A? A. Standard B. Contact C. Droplet D. Airborne

A. Standard

A week later, Mr B reports difficulty hearing. Which medication should you consider is related to this response? A. Streptomycin B. Pyrazinamide C. Ethambutol D. Isoniazid (INH)

A. Streptomycin

Patient #6: M.B. is a 65-year-old male who is being admitted from the emergency department to the cardiopulmonary unit with an exacerbation of chronic obstructive pulmonary disease (COPD). M.B. has been using ipratropium (Atrovent) and albuterol (Proventil) metered-dose inhaler for control of his symptoms. His admission vital signs are as follows: blood pressure 158/86 mm Hg, heart rate 118 beat/min, respiratory rate 36 breaths/min, temperature 101.4° F (38.4° C), and SaO2 85%. He is 5 ft 10 in tall, weighs 180 lb, and has a marked barrel chest. While continuing M.B.'s assessment, you recognize that sometimes it is difficult to distinguish COPD from asthma. However, there are some clinical features that are different. Select the correct statements below about asthma vs. COPD. A. The onset of asthma usually before the age of 40. B. Smoking is the number one cause of COPD. C. There is always dyspnea with COPD but it is occasional with asthma. D. Thick, tenacious sputum is seen in asthma but not COPD. E. Asthma has a progressive disease course while COPD has a stable disease course.

A. The onset of asthma usually before the age of 40. B. Smoking is the number one cause of COPD. C. There is always dyspnea with COPD but it is occasional with asthma. Can see thick tenacious sputum with COPD Asthma is stable, COPD is progressive

Which of the following if shared by Mr.M. B would help most in confirming a diagnosis of chronic bronchitis? A. The patient complains about a productive cough every winter for 3 months. B. The patient denies having any respiratory problems until the last 6 months. C. The patient's history indicates a 40 pack-year cigarette history. D. The patient tells the nurse about a family history of bronchitis.

A. The patient complains about a productive cough every winter for 3 months.

A 75-year-old patient breathing room air has the following arterial blood gas (ABG) results: pH 7.40, PaO2 72 mm Hg, SaO2 92%, PaCO2 40 mm Hg. An appropriate action by the nurse is to A. encourage deep breathing and coughing to open the alveoli. B. repeat the ABGs within an hour to validate the findings. C. document the results in the patient's record D. initiate pulse oximetry for continuous monitoring of the patient's oxygen status.

A. encourage deep breathing and coughing to open the alveoli.

When administering albuterol (Proventil) to relieve severe asthma, you should be monitoring for which of the following common side effects? Select all that apply. A. Tremors B. Lethargy C. Palpitations D. Visual disturbances E. Decreased pulse rate

A. Tremors C. Palpitations

Patient #10: A 25 year old white female reports to the Emergency Room because of sharp left sided chest pain and shortness of breath of one day duration. The patient was in excellent health until yesterday. She was awakened from her sleep by sharp left sided chest pain. The pain worsened with motion and deep breathing. The pain has been progressively increasing in severity and she now has severe left shoulder pain. She complains of shortness of breath and is very apprehensive about dying. She denies any cough, fever, sputum production or hemoptysis. She is married and had one normal delivery three years ago. She is currently on birth control pills. She has never been hospitalized except for labor and delivery. Review of systems are negative. She denies any past history of venous problems. She works as a computer programmer. She smokes one pack of cigarettes a day for the past eight years. She considers herself a social drinker. What can you identify in the patient history that put her at risk for the present illness? Select all that apply. A. Use of birth control pills B. Smoking C. Occupation D. Previous pregnancies E. Female sex

A. Use of birth control pills B. Smoking C. Occupation

S.G. is discharging home with a tracheostoma valve. What will you include in your teaching? (Select all that apply) A. Wash around the stoma daily with a moist cloth B. A scarf or loose shirt can be used to hide the stoma C. He may return to his daily swimming routine D. A bedside humidifier should be used to keep air moist E. Do not cover the stoma when coughing or shaving

A. Wash around the stoma daily with a moist cloth B. A scarf or loose shirt can be used to hide the stoma D. A bedside humidifier should be used to keep air moist

While receiving an adrenergic beta2 agonist drug for asthma, CJ complains of increased palpitations, chest pain, and a throbbing headache. What is the most appropriate nursing action? A. Withhold the drug until additional orders are obtained B. Tell the client not to worry; these are expected side effects from the medicine. C. Ask the client to relax; then give instructions to breathe slowly and deeply for several minutes. D. Explain that the effects are temporary and will subside as the body becomes accustomed to the drug.

A. Withhold the drug until additional orders are obtained

Postural drainage with percussion and vibration is ordered twice daily for Mr. M. B. because of chronic bronchitis. You should plan to: A. carry out the procedure 3 hours after the patient eats. B. maintain the patient in the lateral position for 20 minutes. C. perform percussion before assisting the patient to the drainage position. D. give the ordered albuterol (Proventil) after the patient has received the therapy.

A. carry out the procedure 3 hours after the patient eats. Wait enough time after they eat because if they lay down laterally right after eating, they can aspirate and also hard to breathe with full stomach and pt may vomit during percussion 20 min laterally is typically too long Give albuterol before therapy to open airways and get more mucus out

The diet that you will order for M.B. to best meet his nutritional needs is a A. high-calorie, high-protein diet. B. low-fat diet with six small feedings a day. C. high-calorie, high-carbohydrate, bland diet. D. regular diet with extra fluids to be taken with meals.

A. high-calorie, high-protein diet. Byproduct of carbs is CO2, so pt should stay away from carbs otherwise it will increase their CO2 levels Low fat not appropriate because pt needs high calorie diet Don't want extra fluids taken AT meals otherwise stomach will fill up with water and not meet caloric needs

A CXR is ordered. To confirm the diagnosis of active TB, the CXR should confirm the presence of: A. numerous small, nodular lesions B. infiltrate or consolidation C. trachea is pushed to the one side. D. enlarged heart.

A. numerous small, nodular lesions

The parent of a child diagnosed with sickle-cell anemia asks the nurse about air travel with the child. Which of the following is the best response? A."Flying at high altitudes can be associated with less available oxygen, causing increased sickling." B."Flying will present a risk for infection secondary to crowds." C. "Flying does not pose any particular risks for the child with SCA." D."Air travel is not recommended, because of the unavailability of emergency medical care while in flight."

A."Flying at high altitudes can be associated with less available oxygen, causing increased sickling."

The thoracentesis is done; For which concerning response is it important to observe in Mr. B? Select all that apply A. Signs of infection B. Expectoration of blood C. Increased breath sounds D. Decreased or absent breath sounds

B. Expectoration of blood D. Decreased or absent breath sounds May have punctured lung and it's now bleeding Could have caused pneumothorax so absent breath sounds

Mr. B is admitted for active, infectious TB management. What type of isolation should you apply? A. Standard and contact. B. Airborne with negative pressure room. C. Airborne with positive pressure room. D. Droplet only.

B. Airborne with negative pressure room.

Patient #9: The patient is an elderly man who appears tired haggard and underweight. His complexion is sallow. He coughs continuously. Sitting in a chair, he leans to his right side, holding his right chest with his left arm. Vital signs are as follows: blood pressure 152/90, apical heart rate 112/minute and regular, respiratory rate 24/minute and somewhat labored, temperature 102.6 F. Both lungs are resonant by percussion with one exception: the right mid-anterior and right mid-lateral lung fields are dull. Auscultation reveals bilateral diminished vesicular breath sounds. Bronchial breath sounds, rhonchi and late inspiratory crackles (are heard) in the area of the right mid-anterior and right mid-lateral lung fields. The remainder of the lung fields is clear. The physician orders CBC with differentials. Which of the following findings in CBC would confirm the diagnosis of pneumonia? A. WBC 11,000 /mm3 B. Band Neutrophils 15% C. Hgb 9.9 mg/dL D. Platelets 110,000/mm3

B. Band Neutrophils 15%

Which of the following respiratory physiological changes occur as a result of aging? A. Increase elastic recoil B. Decrease functioning alveoli C. Increase cough force D. Increase response to high CO2 level

B. Decrease functioning alveoli

You obtain the following assessment data in a 76-year-old patient who has influenza. Which information will be most important to communicate to the health care provider? A. Fever of 100.4° F (38° C) B. Diffuse crackles in the lungs C. Sore throat and frequent cough D. Myalgia and persistent headache

B. Diffuse crackles in the lungs

Patient #3: C.D. 27 year-old male professional swimmer 2-day hx of purulent nasal drainage, congestion, fever, headache DX: Bacterial sinusitis You are discharging C.D. from the ED. Which of the following will you include in discharge instructions? (Select all that apply) A. It is OK to smoke or be around smoke. B. Drink 6-8 glasses of water daily to loosen secretions and stay hydrated. C. Report a temperature of over 38C. D. Perform vigorous exercise to increase circulation to the area. E. Take hot showers or use a humidifier to promote drainage of secretions.

B. Drink 6-8 glasses of water daily to loosen secretions and stay hydrated. C. Report a temperature of over 38C. E. Take hot showers or use a humidifier to promote drainage of secretions.

Patient #5: S.G. 63 year-old male. Mr. S.G. has been diagnosed with laryngeal cancer S.G. has had his total laryngectomy and you are his nurse on the floor. Which of the following is TRUE concerning his post-op care? A. He should be placed in a lateral, supine position. B. He will be receiving nutrition via nasogastric tube once bowel sounds return. C. You will be using the numeric pain scale to rate his pain. D. You will change his dressings if they are visibly soiled.

B. He will be receiving nutrition via nasogastric tube once bowel sounds return.

M.J. is prescribed Flunisolide spray (intranasal corticosteroid). Which of the following statements from M.J. requires CORRECTION by the nurse? A. This medication may take several days or weeks to have maximum effect. B. I should continue taking Flunisolide if I develop a sinus infection. C. I should use Flunisolide on a daily basis for it to work properly. D. There might be mild nasal burning and stinging when I use Flunisolide.

B. I should continue taking Flunisolide if I develop a sinus infection. Pt should STOP taking corticosteroids during an infection because they decrease immune response

Since Mr. B is having an active TB infection, you should anticipate the physician to prescribe: A. Isoniazid (INH) for 4-6 months. B. INH, rifampin, and PZA (Rifater) for 9-12 months. C. Isoniazid (INH) for 4-6 months in addition to broad spectrum antibiotics. D. INH, rifampin, and PZA (Rifater) for 3-4 months.

B. INH, rifampin, and PZA (Rifater) for 9-12 months.

You review J.D.'s pain medication options on the MAR. Which medication(s) should you QUESTION? (Select all that apply) A. Acetaminophen (Tylenol) B. Ibuprofen (Advil) C. Aspirin (ASA) D. Morphine

B. Ibuprofen (Advil) C. Aspirin (ASA) Due to blood thinning characteristics

Based on the results of M.B.'s ABGs, select the two interventions with the highest priority. A. Assist M.B. into a position of comfort. B. Increase the oxygen rate to 4 L/min after getting MD order. C. Teach M.B. to use relaxation techniques. D. Encourage M.B. to take deep breaths and cough, and use pursed-lip breathing.

B. Increase the oxygen rate to 4 L/min after getting MD order. D. Encourage M.B. to take deep breaths and cough, and use pursed-lip breathing.

M.J.'s symptoms have become worse and montelukast (Singulair) is added to her medication list. Before M.J. can begin taking Singulair, which lab test should the prescriber check FIRST? A. WBCs B. LFTs C. H/H D. Urinalysis

B. LFTs

Patient #1: J.D. 24 year-old male. J.D. is a boxer and he just had a boxing match that resulted in an injury to the nose D/t a heavy nosebleed he was sent to the emergency room (ER) J.D. is alert and oriented and did not lose consciousness during the injury. Patient reports 10/10 pain to his nose. No other symptoms reported at this time. In which position should you place J.D.? A. Semi-Fowler's B. Leaning slightly forward C. Sim's position D. Supine

B. Leaning slightly forward

Which nursing activity would be your highest priority at this point? A. Obtaining a detailed health history B. Obtaining C.J.'s pulse oximetry reading C. Administering oxygen via nasal cannula D. Asking C.J.'s tennis partner to call C.J.'s family

B. Obtaining C.J.'s pulse oximetry reading

The teaching plan for a patient with acute sinusitis will need to include of the following interventions EXCEPT A. Taking a hot shower will increase sinus drainage and decrease pain. B. Over-the-counter (OTC) antihistamines can be used to relieve congestion and inflammation. C. Saline nasal spray can be made at home and used to wash out secretions. D. Blowing the nose forcefully should be avoided to decrease nosebleed risk.

B. Over-the-counter (OTC) antihistamines can be used to relieve congestion and inflammation.

Which action should you take first when a patient develops a nosebleed? A. Pack both nares tightly with 1/2-inch ribbon gauze. B. Pinch the lower portion of the nose for 10 minutes. C. Prepare supplies that will be needed for cauterization. D. Apply ice compresses over the patient's nose and cheeks.

B. Pinch the lower portion of the nose for 10 minutes. The first nursing action for epistaxis is to apply direct pressure by pinching the nostrils. Application of cold packs may decrease blood flow to the area somewhat, but will not be sufficient to stop bleeding. Cauterization or nasal packing may be needed if pressure to the nares does not stop bleeding, but these are not the first actions to take for nosebleed.

Which diagnostic test will you plan to discuss with Mr. M. B? A. Eosinophil count B. Pulmonary function testing C. Immunoglobin E (IgE) levels D. Radioallergosorbent test (RAST)

B. Pulmonary function testing ACD may be more appropriate for asthma

pH: 7.50 PaCO2: 31 mmHg PaO2: 90 mmHg HCO3: 26 mEq/L A. Respiratory Acidosis B. Respiratory Alkalosis C. Metabolic Acidosis D. Metabolic Alkalosis

B. Respiratory Alkalosis

Few days after the TB drugs regimen started, you notice that Mr. B's urine color is orange. Which of the following TB medication causes that change in urine color? A. Ethambutol B. Rifampin C. INH D. Streptomycin

B. Rifampin

Which of these nursing actions can the RN working in a long-term care facility delegate to an experienced LPN/LVN who is caring for a patient with a permanent tracheostomy? A. Assessing the patient's risk for aspiration B. Suctioning the tracheostomy when needed C. Educating the patient about self-care of the tracheostomy D. Determining the need for replacement of the tracheostomy tub

B. Suctioning the tracheostomy when needed Suctioning of a stable patient can be delegated to LPN/LVNs. Assessments and patient teaching should be done by the RN.

You have completed patient teaching about the administration of salmeterol (Serevent) using a metered-dose inhaler (MDI). Which action by the patient indicates good understanding of the teaching? A. The patient activates the inhaler at the onset of expiration B. The patient attaches a spacer before using the MDI. C. The patient floats the MDI in water to see if it is empty. D. The patient coughs vigorously after using the inhaler.

B. The patient attaches a spacer before using the MDI.

A client has a total hip replacement. Which clinical indicators of pulmonary embolism indicate that the plan to prevent postoperative thrombus formation has been ineffective? Select all that apply. A. Flushing of the face B. Unilateral chest pain C. Elevation of temperature D. Sudden onset of shortness of breath E. Numeric pain scale rating increase from 2 to 8 in the hip

B. Unilateral chest pain D. Sudden onset of shortness of breath

On auscultation of a patient's lungs, you hear short, high-pitched sounds during exhalation in the lower 1/3 of both lungs. You should record this finding as A. expiratory crackles at the bases. B. expiratory wheezes in both lungs. C. abnormal lung sounds in the bases of both lungs. D. pleural friction rub in the right and left lower lobes.

B. expiratory wheezes in both lungs. Wheezes are high-pitched sounds. In this case they are heard during the expiratory phase of the respiratory cycle. Abnormal breath sounds are either bronchial or bronchovesicular sounds heard in the peripheral lung fields. Crackles are low-pitched, "bubbling" sounds. Pleural friction rubs are grating sounds that are usually heard during both inspiration and expiration

Patient #11: Mr. B is a 38 year old homeless male consults presents to ED c/o cough, sputum production and mild hemoptysis. He has had evening rise of temperature for the past one month and claims to have lost 30 lbs. over a three month period. Mr. B has been infected with TB through: A. ingesting droplets that contained the causing microorganism B. inhaling droplets that contained the causing microorganism C. having unprotected sex with an infectious partner. D. sharing a needle with an infected person.

B. inhaling droplets that contained the causing microorganism

You're about to collect a sputum culture from the patient. Which of the following statements is false about sputum collection? Select all that apply. A. a sterile sample is needed for the test. B. the specimen should be collected via nasotracheal suction only. C. the patient must brush his teeth before the specimen is obtained. D. the specimen must be collected before antibiotic administration E. the purpose of the sample is to identify the causing agent.

B. the specimen should be collected via nasotracheal suction only. C. the patient must brush his teeth before the specimen is obtained.

After discussing management of upper respiratory infections (URI) with a patient who has acute viral rhinitis, you determine that additional teaching is needed when the patient says: A. "I can take acetaminophen (Tylenol) to treat discomfort." B. "I will drink lots of juices and other fluids to stay hydrated." C. "I can use my nasal decongestant spray until the congestion is all gone." D. "I will watch for changes in nasal secretions or the sputum that I cough up."

C. "I can use my nasal decongestant spray until the congestion is all gone."

You are reviewing the charts for four patients who are scheduled for their yearly physical examinations in October. Which of the following patients will require the inactivated influenza vaccination? A. A 56-year-old patient who is allergic to eggs B. A 24-year-old patient who has allergies to penicillin and the cephalosporins C. A 30-year-old patient who takes corticosteroids for rheumatoid arthritis D. A 24-year-old patient who has allergies to penicillin and the cephalosporins

C. A 30-year-old patient who takes corticosteroids for rheumatoid arthritis

After you have received change-of-shift report about the following four patients, which patient should you assess first? A. A 77-year-old patient with tuberculosis (TB) who has four antitubercular medications due in 15 minutes B. A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled C. A 46-year-old patient who has a deep vein thrombosis and is complaining of sudden onset shortness of breath D. A 35-year-old patient who was admitted the previous day with pneumonia and has a temperature of 100.2° F (37.8° C)

C. A 46-year-old patient who has a deep vein thrombosis and is complaining of sudden onset shortness of breath

You palpate the posterior chest while the patient says "99" and note that no vibration is felt. How should this be charted? A. Diminished expansion B. Dullness to percussion C. Absent tactile fremitus D. Decreased breath sounds

C. Absent tactile fremitus To assess for tactile fremitus, the nurse should use the palms of the hands to assess for vibration when the patient repeats a word or phrase such as "99." Different techniques are used to assess for dullness to percussion, decreased breath sounds, and diminished expansion.

When assessing the respiratory system of a 78-year-old patient, which finding indicates that you should take immediate action? A. The chest appears barrel shaped. B. The patient has a weak cough effort. C. Crackles are heard from the lung bases to the midline. D. Hyperresonance is present across both sides of the chest.

C. Crackles are heard from the lung bases to the midline.

Based on the clinical presentation, pulmonary embolism is suspected as a result of DVT (deep vein thrombosis). What is the non-invasive diagnostic study that can identify DVT? A. Echocardiogram B. D-Dimer C. Doppler ultrasound D. Spiral CT-scan

C. Doppler ultrasound Spiral CT scan is more invasive

Percussion of lungs normally elicits resonant sounds, while in pneumonia it elicits: A. Hyperresonant sound B. Tympany sound C. Dull sound D. Flat sound

C. Dull sound

When teaching the patient with allergic rhinitis about management of the condition, you should explain that A. over-the-counter (OTC) antihistamines cause sedation, so prescription antihistamines are usually ordered. B. corticosteroid nasal sprays will reduce inflammation, but systemic effects limit their use. C. Identification and avoidance of environmental triggers are the best way to avoid symptoms. D. Use of oral antihistamines for a few weeks before the allergy season may prevent reactions.

C. Identification and avoidance of environmental triggers are the best way to avoid symptoms.

After a patient has undergone a septoplasty, which nursing intervention will be included in the plan of care? A. Educate the patient about how to safely remove and reapply nasal splint. B. Reassure the patient that the nose will look normal when the swelling subsides C. Instruct the patient to keep the head elevated for 48 hours to minimize swelling and pain. D. Teach the patient to use nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control.

C. Instruct the patient to keep the head elevated for 48 hours to minimize swelling and pain. Maintaining the head in an elevated position will decrease the amount of nasal swelling. NSAIDs increase the risk for postoperative bleeding and should not be used postoperatively. The patient would not be taught to remove or reapply nasal packing, which is usually removed by the surgeon on the day after surgery. Although return to a preinjury appearance is the goal of the surgery, it is not always possible to achieve this result.

J.D.'s epistaxis is now controlled. You observe a clear fluid draining from J.D.'s left ear. What might this indicate? A. J.D. is receiving too much IV fluid. B. J.D. had a pre-existing ear infection. C. J.D. may have sustained a skull fracture. D. This is a normal finding after epistaxis is controlled.

C. J.D. may have sustained a skull fracture. May be cerebrospinal fluid.

Observe the fingers of Mr. A (below). Mr. A's finger are clubbed due to: A. High CO2 in the blood B. Low CO2 in the blood C. Low O2 in the blood D. High O2 in the blood

C. Low O2 in the blood Low O2 is the driving force for clubbed fingers

pH: 7.31 PaCO2: 44 mmHg PaO2: 66 mmHg HCO3: 18 mEq/L A. Respiratory Acidosis B. Respiratory Alkalosis C. Metabolic Acidosis D. Metabolic Alkalosis

C. Metabolic Acidosis

Daily sputum specimens to be collected from Mr. B. When is the most appropriate time to collect these specimens? A. After activity B. Before meals C. On awakening D. Before a respiratory treatment

C. On awakening

Patient #7: Mr. C is a 25-year-old man presents with a 5-day history of right-sided chest pain and describes it as a 'catch in the breath'. It gets worse with deep breathing and coughing. During this period, he has developed a fever, which is more pronounced in the evening. He also complains of a dry cough. Over the past 2 days, he has developed breathlessness, which has worsened rapidly. He is an otherwise healthy bank clerk who has not suffered from any other illness. He does not smoke or drink alcohol and is not taking any medication. Based on the clinical presentation of Mr. C, what do you think his medical diagnosis would most likely be? Hint: Pleuritic pain that is sharp and increases with inspiration + progressive dyspnea with + dry, nonproductive cough. A. Asthma. B. Tuberculosis. C. Pleural effusion. D. Emphysema.

C. Pleural effusion.

Patient #2: M.J. is a 32 year-old female; hx: persistent allergic rhinitis Which of the following is NOT a common clinical manifestation of allergic rhinitis? A. Sneezing B. Watery eyes C. Purulent nasal discharge D. Watery nasal discharge

C. Purulent nasal discharge

Pleural effusion is suspected. When assessing Mr. C, you should expect to identify: A. Moist crackles at the posterior of the lungs B. Deviation of the trachea toward the involved side C. Reduced or absent breath sounds at the base of the lung D. Increased resonance with percussion of the involved area

C. Reduced or absent breath sounds at the base of the lung Crackles from fluid in alveoli Deviation of trachea is typically due to pneumothorax Should sound dull from fluid collection rather than resonance

For thoracentesis, you should assist Mr. C to assume what position? A. Supine. B. Prone. C. Sitting. D. Side-lying.

C. Sitting.

What must you determine before discontinuing airborne precautions for Mr. B.? A. TB medications administration started. B. Tuberculin skin test is negative C. Sputum is free of acid-fast bacteria. D. Patient is afebrile

C. Sputum is free of acid-fast bacteria.

A client is admitted to the hospital with a diagnosis of atrial fibrillation, and the practitioner suspects mitral valve stenosis. When obtaining a health history, the nurse determines that it is most significant if the client presents a history of: A. Cystitis at age 28 B. Pleurisy at age 20 C. Strep throat at age 12 D. German measles at age 6

C. Strep throat at age 12

Since this is a community-acquired pneumonia, what organisms are likely to be causing Mr. A's pneumonia? *Think most common for CAP A. Mycoplasma pneumoniae B. Chlamydia pneumoniae C. Streptococcus pneumoniae D. Legionella species

C. Streptococcus pneumoniae

A patient who had a total laryngectomy has a nursing diagnosis of hopelessness related to loss of control of personal care. Which information obtained by the nurse is the best indicator that the problem identified in this nursing diagnosis is resolving? A. The patient lets the spouse provide tracheostomy care. B. The patient allows the nurse to suction the tracheostomy. C. The patient asks how to clean the tracheostomy stoma and tube. D. The patient uses a communication board to request "No Visitors."

C. The patient asks how to clean the tracheostomy stoma and tube. Independently caring for the laryngectomy tube indicates that the patient has regained control of personal care and hopelessness is at least partially resolved. Letting the nurse and spouse provide care and requesting no visitors may indicate that the patient is still experiencing hopelessness.

When auscultating a patient's chest while the patient takes a deep breath, you hear loud, high-pitched, "blowing" sounds at both lung bases. You will document these as A. normal sounds. B. vesicular sounds. C. abnormal sounds D. adventitious sounds

C. abnormal sounds The description indicates that you hear bronchial breath sounds that are abnormal when heard at the lung base. Adventitious sounds are extra breath sounds such as crackles, wheezes, rhonchi, and friction rubs. Vesicular sounds are low-pitched, soft sounds heard over all lung areas except the major bronchi.

C.J. has a minimal-to-moderate response to the initial treatment, and the health care provider orders IV methylprednisolone (Solu-Medrol) to be given. When explaining this drug to C.J., you know that it is used to A. block the action of leukotrienes once they are formed. B. prevent bronchoconstriction caused by release of acetylcholine. C. suppress the inflammatory response and resulting mucus production. D. inhibit the release of histamine and SRS-A by acting directly on mast cells.

C. suppress the inflammatory response and resulting mucus production.

A patient scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx asks you, "How will I talk after the surgery?" Your best response is: A. "You will breathe through a permanent opening in your neck, but you will not be able to communicate orally." B. "You won't be able to talk right after surgery, but you will be able to speak again after the tracheostomy tube is removed." C. "You won't be able to speak as you used to, but there are artificial voice devices that will give you the ability to speak normally." D. "You will have a permanent opening into your neck, and you will need to have rehabilitation for some type of voice restoration."

D. "You will have a permanent opening into your neck, and you will need to have rehabilitation for some type of voice restoration." Voice rehabilitation is planned after a total laryngectomy, and a variety of assistive devices are available to restore communication. Although the ability to communicate orally is changed, it would not be appropriate to tell a patient that this ability would be lost. Artificial voice devices do not permit normal-sounding speech. In a total laryngectomy, the vocal cords are removed, so normal speech is impossible.

To confirm diagnosis of a PE, the nurse will anticipate preparing the patient for which of the diagnostic imaging test? (CT scan) Which of the following information may contraindicate the use of the above listed test? A. Apical pulse 104 B. Respiratory rate of 21 C. Oxygen saturation of 93% D. Allergies to shellfish

D. Allergies to shellfish CT scan is usually done with contrast

J.D. is discharging home with nasal packing in place. What teaching should you include? A. Remove the nasal packing later this evening. B. Use aspirin for pain relief. C. Skip your next dose of hypertension medication. D. Avoid vigorous nose blowing and strenuous activity.

D. Avoid vigorous nose blowing and strenuous activity.

Due to his dyspnea, oxygen 2 L/min via nasal cannula is ordered. In your recent assessment, Mr. A's respiration rate was 22 and SpO2 was 92%. What should be your next action? A. Call the physician B. Decrease the oxygen flow to 1 L/min. C. Increase the oxygen flow to 10 L/min. D. Increase the oxygen flow to 3 L/min.

D. Increase the oxygen flow to 3 L/min. D then A

pH: 7.48 PaCO2: 45 mmHg PaO2: 77 mmHg HCO3: 30 mEq/L A. Respiratory Acidosis B. Respiratory Alkalosis C. Metabolic Acidosis D. Metabolic Alkalosis

D. Metabolic Alkalosis

A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient? A. Complete a full physical examination to determine the systemic effect of the respiratory distress. B. Obtain a comprehensive health history to determine the extent of any prior respiratory problems. C. Delay the physical assessment and ask family members about any history of respiratory problems. D. Perform a respiratory system assessment and ask specific questions about this episode of respiratory distress.

D. Perform a respiratory system assessment and ask specific questions about this episode of respiratory distress.

A patient with complicated deviated septum is hospitalized to have septoplasty. Which of the following findings must you report to the surgeon before the surgery? A. Serum sodium is 134 mEq/L. B. PT 12 seconds. C. Serum potassium is 4.8 mEq/L. D. Platelets counts is 120,000/ L

D. Platelets counts is 120,000/ L Low platelets= high risk for bleeding (NL 150,000-400,000 per microliter)

Which of the following indicates that CJ is improving? Select all that apply. A. Decreased breath sounds B. Increased diaphoresis C. Inappropriate behavior D. SpO2 92% E. Louder wheezing

D. SpO2 92% E. Louder wheezing

You are caring for a hospitalized 82-year-old patient who has nasal packing in place to treat a nosebleed. Which of the following assessment findings will require the most immediate action? A. The patient complains of level 7 (0 to 10 scale) pain. B. The patient's temperature is 100.1° F (37.8° C). C. The nose appears red and swollen. D. The oxygen saturation is 89%.

D. The oxygen saturation is 89%. Older patients with nasal packing are at risk of aspiration or airway obstruction. An O2 saturation of 89% should alert the nurse to assess further for these complications. The other assessment data also indicate a need for nursing action but not as immediately as the fall in O2 saturation.

Which information will the nurse include when teaching the patient with asthma about the prescribed medications? A. Utilize the inhaled corticosteroid when shortness of breath occurs. B. Inhale slowly and deeply when using the dry-powder inhaler (DPI). C. Hold your breath for 5 seconds after using the bronchodilator inhaler. D. Tremors are an expected side effect of rapidly acting bronchodilators.

D. Tremors are an expected side effect of rapidly acting bronchodilators.

Based on the clinical presentation, the physician is suspecting pneumonia. Assuming the diagnosis is accurate, when you auscultate Mr. A's chest, you expect to hear: A. vesicular sounds B. pleural friction rub C. wheezes with inspiration D. bronchial breath sounds

D. bronchial breath sounds SHOULD hear vesicular breath sounds but if there is consolidation somewhere, you may hear bronchial sounds

You formulate the nursing diagnosis of imbalanced nutrition: less than body requirements for Mr. M. B. An appropriate intervention for this problem is to A. increase the patient's intake of fruits and fruit juices. B. have the patient exercise for 10 minutes before meals. C. assist the patient in choosing foods with a lot of texture. D. offer high calorie snacks between meals and at bedtime.

D. offer high calorie snacks between meals and at bedtime.

Due to the possible side effects of INH, Mr. B's meals should include: A. low-carbohydrate B. low-protein C. low-vitamin D. supplemental vitamin B6

D. supplemental vitamin B6 Neuropathy can occur with INH, B6 helps with that and helps neurotransmitter synthesis

Which of the following if found in Mr. B's chart history would explain why his inactive TB became active? A. Mr. B is homeless. B. Mr. B is homosexual. C. Mr. B has one functioning kidney. D. Mr. B is a heavy drinker. E. Mr. B is found to be HIV+

E. Mr. B is found to be HIV+

During thoracentesis and to prevent pneumothorax, you should encourage the patient to deep breath and cough. True False

False

Since Mr. B is most likely having an active TB, his PPD can be read after 6-12 hours. True False

False Has to be at least 48 hours, no more than 72 hours

The physician prescribed heparin IV drip. Heparin is prescribed for Mrs. D to dissolve her existing DVT and PE. True False

False Heparin is prophylaxis, does not dissolve the clot but can help prevent new clots

Because the pressure of CO2 is higher in the blood vessels than the pressure of CO2 in the lungs, the CO2 moves from the blood to the lungs. True False

True

Cervical lymph nodes are normally not palpable, but viral or bacterial infections can cause lymph nodes to swell. True False

True

Due to lung consolidation caused by pneumonia, the tactile fremitus is expected to increased in case of Mr. A. True False

True

Pneumothorax is one of the serious complications of thoracentesis. True False

True

You are caring for a variety of clients. For which client is it most essential for you to implement measures to prevent pulmonary embolism? a) 59-year-old who had a knee replacement b) 60-year-old who has bacterial pneumonia c) 68-year-old who had emergency dental surgery d) 76-year-old who has a history of thrombocytopenia

a) 59-year-old who had a knee replacement

After 2 months of tuberculosis (TB) treatment with a standard four-drug regimen, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should you take next? a) Ask the patient whether medications have been taken as directed. b) Discuss the need to use some different medications to treat the TB. c) Schedule the patient for directly observed therapy three times weekly. d) Educate about using a 2-drug regimen for the last 4 months of treatment.

a) Ask the patient whether medications have been taken as directed.

A patient with TB has been admitted to the hospital and is placed in an airborne infection isolation room. Which of the following should the patient be taught (select all that apply)? a) Expect routine TST to evaluate infection. b) Visitors will not be allowed while in airborne isolation. c) Take all medications for full length of time to prevent multidrug-resistant TB. d) Wear a standard isolation mask if leaving the airborne infection isolation room. e) Maintain precautions in airborne infection isolation room by coughing into a paper tissue.

a) Expect routine TST to evaluate infection. c) Take all medications for full length of time to prevent multidrug-resistant TB. d) Wear a standard isolation mask if leaving the airborne infection isolation room. e) Maintain precautions in airborne infection isolation room by coughing into a paper tissue.

A staff nurse has a tuberculosis (TB) skin test of 16-mm induration. A chest radiograph is negative, and the nurse has no symptoms of TB. The occupational health nurse will plan on teaching the staff nurse about the a) use and side effects of isoniazid (INH). b) standard four-drug therapy for TB. c) need for annual repeat TB skin testing. d) bacille Calmette-Guérin (BCG) vaccine.

a) use and side effects of isoniazid (INH).

Which information will you include in the patient teaching plan for a patient who is receiving rifampin (Rifadin) for treatment of tuberculosis? a. "Your urine, sweat, and tears will be orange colored." b. "Read a newspaper daily to check for changes in vision." c. "Take vitamin B6 daily to prevent peripheral nerve damage." d "Call the health care provider if you notice any hearing loss."

a. "Your urine, sweat, and tears will be orange colored."

Which of the following should be a priority nursing diagnosis for a patient who acquired bacterial pneumonia? a. Impaired gas exchange b. Fatigue c. Fluid volume excess d. Anxiety

a. Impaired gas exchange

Which of the following is expected to find in ABG of a patient with bilateral pneumonia? a. PaO2 60 mmHg b. PaO2 80 mmHg c. PaO2 90 mmHg d. PaO2 100 mmHg

a. PaO2 60 mmHg

Auscultating bronchial breath sounds over the lung fields is considered abnormal. a. True b. False

a. True

While receiving an adrenergic beta2 agonist drug for asthma, the client complains of palpitations, chest pain, and a throbbing headache. What is the most appropriate nursing action? a. Withhold the drug until additional orders are obtained. b. Tell the client not to worry; these are expected side effects from the medicine. c. Ask the client to relax; then give instructions to breathe slowly and deeply for several minutes. d. Explain that the effects are temporary and will subside as the body becomes accustomed to the drug.

a. Withhold the drug until additional orders are obtained.

When teaching the patient who is receiving standard multidrug therapy for tuberculosis (TB) about possible toxic effects of the antitubercular medications, you will give instructions to notify the health care provider if the patient develops a. yellow-tinged skin. b. changes in hearing. c. orange-colored sputum. d. thickening of the fingernails.

a. yellow-tinged skin.

The functional unit of the respiratory system is _______?

alveoli

You are performing tuberculosis (TB) screening in a clinic that has many patients who have immigrated to the United States. Before doing a TB skin test on a patient, which question is most important for you to ask? a) "Is there any family history of TB?" b) "Have you received the bacille Calmette-Guérin (BCG) vaccine for TB?" c) "How long have you lived in the United States?" d) "Do you take any over-the-counter (OTC) medications?"

b) "Have you received the bacille Calmette-Guérin (BCG) vaccine for TB?"

A patient with a pleural effusion is scheduled for a thoracentesis. Before the procedure, you will plan to a) start a peripheral intravenous line to administer the necessary sedative drugs. b) position the patient sitting upright on the edge of the bed and leaning forward. c) remove the water pitcher and remind the patient not to eat or drink anything for 6 hours. d) instruct the patient about the importance of incentive spirometer use after the procedure.

b) position the patient sitting upright on the edge of the bed and leaning forward.

The following 4 patients are diagnosed with pneumonia. Which one should you see the first? a. 30 years old; febrile; RR 18; SpO2 94%; hacking cough b. 45 years old; febrile; RR 23; SpO2 88%; think productive cough c. 64 years old; afebrile; RR 20; SpO2 96%; no cough d. 72 years old; febrile; RR 19; SpO2 94%; no cough

b. 45 years old; febrile; RR 23; SpO2 88%; think productive cough

A client is admitted to the hospital with a diagnosis of an exacerbation of asthma. What should you plan to do to best help this client? a. Determine the client's emotional state. b. Give prescribed drugs to promote bronchiolar dilation. c. Provide education about the impact of a family history. d. Encourage the client to use an incentive spirometer routinely.

b. Give prescribed drugs to promote bronchiolar dilation.

Vancomycin is prescribed for a client with bacterial pneumonia. The prescriber orders a trough level of Vancomycin. You should have the laboratory obtain a blood sample from the client: a. Halfway between two IVPB administrations b. Immediately before administering the IVPB c. Anytime it is convenient for the client and laboratory

b. Immediately before administering the IVPB

Pneumocystis pneumonia is a pulmonary fungal infection commonly seen is: a. Patients with lung cancer b. Patients with AIDS c. Patients with cystic fibrosis d. Patients with COPD

b. Patients with AIDS

Which of the following indicates pleural effusion? a) "Lately I can only breathe well if I sit up." b) "During the night I sometimes get the chills." c) "I get a sharp, stabbing pain when I take a deep breath." d) "I'm coughing up larger amounts of thicker mucus for the last several days."

c) "I get a sharp, stabbing pain when I take a deep breath."

When assessing a client with pleural effusion, you expect to identify: a) Moist crackles at the posterior of the lungs b) Deviation of the trachea toward the involved side c) Reduced or absent breath sounds at the base of the lung d) Increased resonance with percussion of the involved area

c) Reduced or absent breath sounds at the base of the lung

When caring for a patient who is hospitalized with active tuberculosis (TB), you observe a family member who is visiting the patient. You will need to intervene if the family member a) washes the hands before entering the patient's room. b) hands the patient a tissue from the box at the bedside. c) puts on a surgical face mask before visiting the patient. d) brings food from a "fast-food" restaurant to the patient.

c) puts on a surgical face mask before visiting the patient.

Which of the following is not a typical clinical manifestation of pneumonia? a. Dyspnea b. Productive cough c. Hoarseness d. Pleuritic pain

c. Hoarseness

Which of the following confirms the diagnosis of bacterial pneumonia? a. Dyspnea b. Hacking cough c. Leukocytosis d. Wheezes

c. Leukocytosis

The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action will you take? a. Repeat the tuberculin skin testing. b. Teach about the reason for the blood tests. c. Obtain consecutive sputum specimens from the patient for 3 days. d. Instruct the patient to expectorate three specimens as soon as possible.

c. Obtain consecutive sputum specimens from the patient for 3 days.

You recognize that the goals of teaching regarding the transmission of pulmonary tuberculosis (TB) have been met when the patient with TB a. demonstrates correct use of a nebulizer. b. washes dishes and personal items after use. c. covers the mouth and nose when coughing. d. reports daily to the public health department.

c. covers the mouth and nose when coughing.

Zosyn (Piperacellin) 3.375 g IVPB Q 6 hours is prescribed for a patient with bacterial pneumonia. The medication is mixed with a total of 50 mL of NS 0.9% and to be delivered over 30 minutes. At what mL/hr rate will you run the IV pump? a. 25 mL/hr. b. 50 mL/hr. c. 75 mL/hr. d. 100 mL/hr.

d. 100 mL/hr.

A 65-year-old client with exacerbation of chronic obstructive pulmonary disease (COPD) informs you that he received his pneumonia vaccine 6 years ago. Which of the following is essential to include in the plan of care during the client's hospital admission? a. No further nursing action is needed. b. Document the previous immunization on the client record. c. Explain to the client that he can only be revaccinated during the fall months. d. Explain to the patient that he will need another pneumonia vaccine.

d. Explain to the patient that he will need another pneumonia vaccine.

Review the following Culture and Sensitivity report of a sputum culture. What antibiotic do you expect the physician to prescribe for this patient? Ampicillin I Cephalothin R Erythromycin R Gentamicin S Oxacillin R a. Amoxicillin b. Cephacetrile c. Cefuroxime d. Gentamicin

d. Gentamicin

You're reviewing sputum culture procedure with a student nurse. Which of the following statements if the student says requires correction? a. I should obtain the specimen first thing in the morning. b. I should collect sputum not saliva. c. I should start the antibiotic administration as soon as I collect the specimen. d. I should follow up with the lab regarding the results by the end of the shift.

d. I should follow up with the lab regarding the results by the end of the shift.

Who of the following is at highest risk to acquire pneumonia? a. Patient who has been using corticosteroid for 3 days. b. Patient who is 45 year and has COPD. c. Patient who has been a smoker for 5 years. d. Patient whose WBC counts is 2,000/mm3 post chemotherapy.

d. Patient whose WBC counts is 2,000/mm3 post chemotherapy.

Which information about a patient who has a recent history of tuberculosis (TB) indicates that you can discontinue airborne isolation precautions? a. Chest x-ray shows no upper lobe infiltrates. b. TB medications have been taken for 6 months. c. Mantoux testing shows an induration of 10 mm. d. Three sputum smears for acid-fast bacilli are negative.

d. Three sputum smears for acid-fast bacilli are negative.