Med-surg Exam2 Notes
A nurse is discharging a client who has COPD. The client is concerned about not being able to leave the house due to the need for staying on continuous oxygen. Which of the following responses should the nurse make? a. "There are portable oxygen delivery systems that you can take with you" b. "When you go out, you can remove the oxygen and then reapply it when you get home" c. "You probably will no be able to go out as much as you used to" d. "Home health service will come to you so you will not need to get out"
a
A patient has a BP of 222/148 mm Hg and confusion, nausea, and vomiting. Which goal should the nurse try to achieve by titrating medications? a. Decrease the mean arterial pressure (MAP) to 129 mm Hg b. Lower the BP to the patient's normal within the second to third hour c. Decrease the SBP to 160 mm Hg and the DBP to 100 mm Hg as quickly as possible d. Reduce the SBP to 158 mm Hg and the DBP to 90 mm Hg within the first 2 hours
a
A patient hospitalized with chronic obstructive pulmonary disease (COPD) is being discharged home on O2 therapy. Which instruction should the nurse include in the discharge teaching? a. O2 use can improve the patient's quality of life. b. Travel is not possible with the use of O2 devices. c. O2 flow should be increased if the patient has more dyspnea. d. Storage of O2 requires large metal tanks that last 4 to 6 hours.
a
A patient is scheduled for exercise nuclear imaging stress testing. The nurse explains to the patient that this test involves a. IV administration of a radioisotope at the maximum heart rate during exercise to identify the heart's response to physical stress. b. placement of electrodes inside the right-sided heart chambers through a vein to record the electrical activity of the heart directly. c. exercising on a treadmill or stationary bicycle with continuous ECG monitoring to detect ischemic changes in the heart during exercise. d. placement of a small transducer in 4 positions on the chest to record the direction and flow of blood through the heart by the reflection of sound waves.
a
A patient with active TB continues to have positive sputum cultures after 6 months of treatment. She says she cannot remember to take the medication all the time. What is the best action for the nurse to take? a. Arrange for directly observed therapy (DOT) by a public health nurse. b. Schedule the patient to come to the clinic every day to take the medication. c. Have a patient who has recovered from TB tell the patient about his successful treatment. d. Schedule more teaching sessions so that the patient will understand the risks of noncomplianc
a
A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would support the patient's ventilation? a. Encourage the patient to sit in a chair and lean forward. b. Have the patient rest with the head elevated 15 degrees. c. Place the patient in the Trendelenburg position with pillows behind the head. d. Ask the patient to rest in bed in a high-Fowler's position with the knees flexed.
a
A young adult patient who denies any history of smoking is seen in the clinic with a new diagnosis of chronic obstructive pulmonary disease (COPD). What topic should the nurse plan to teach the patient? a. 1-antitrypsin testing b. Leukotriene modifiers c. Use of the nicotine patch d. Continuous pulse oximetry
a
An ambulatory care nurse measures the blood pressure of a client and finds it to be 156/94 mm Hg. Which statement indicates that the client needs additional education? a. "It is important that I limit protein intake." b. "I need to maintain a regular exercise program." c. "I understand that I need to avoid adding salt to foods." d. "It is important that I begin reducing and then maintaining weight."
a
An older adult is receiving standard multidrug therapy for tuberculosis (TB). Which finding should the nurse report to the health care provider? a. Yellow-tinged sclera b. Orange-colored sputum c. Thickening of the fingernails d. Difficulty hearing high-pitched voices
a
Collaboration: The nurse is caring for a patient with COPD. Which intervention could be delegated to unlicensed assistive personnel (UAP)? a. Assist the patient to get out of bed. b. Auscultate breath sounds every 4 hours. c. Plan patient activities to minimize exertion. d. Teach the patient pursed-lip breathing technique.
a
Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB and has never had a positive TB skin test before. Which information should the occupational health nurse plan to teach the staff nurse? a. Use and side effects of isoniazid b. Standard four-drug therapy for TB c. Need for annual repeat TB skin testing d. Bacille Calmette-Guérin (BCG) vaccine
a
The charge nurse is making rounds. Which client should the nurse assess first? a. The 29-year-old client diagnosed with reactive airway disease who is complaining the nurse caring for him was rude. c. The 76-year-old client diagnosed with heart failure who has 2+ edema of the lower extremities. d. The 15-year-old client diagnosed with diabetic ketoacidosis after a bout with the flu who has a blood glucose reading of 189 mg/dL. e. The 62-year-old client diagnosed with COPD and pneumonia who is receiving O2 by nasal cannula at two (2) liters per minute.
a
The client diagnosed with an exacerbation of COPD is in respiratory distress. Which intervention should the nurse implement first? a. Assist the client into a sitting position at 90 degrees. b. Administer oxygen at six (6) LPM via nasal cannula. c. Monitor vital signs with the client sitting upright. d. Notify the health-care provider about the client's status.
a
The client diagnosed with essential hypertension asks the nurse, "I don't know why the doctor is worried about my blood pressure. I feel just great." Which statement by the nurse would be the most appropriate response? a. "Damage can be occurring to your heart and kidneys even if you feel great." b. "Unless you have a headache, your blood pressure is probably within normal limits." c. "When is the last time you saw your doctor? Does he know you are feeling great?" d. "Your blood pressure reflects how well your heart is working."
a
The client diagnosed with lung cancer has been told the cancer has metastasized to the brain. Which intervention should the nurse implement? a. Discuss implementing an advance directive. b. Explain the use of chemotherapy for brain involvement. c. Teach the client to discontinue driving. d. Have the significant other make decisions for the client.
a
The client diagnosed with lung cancer is being discharged. Which statement made by the client indicates more teaching is required? a. "It doesn't matter if I smoke now. I already have cancer." b. "I should see the oncologist at my scheduled appointment." c. "If I begin to run a fever, I should notify the HCP." d. "I should plan for periods of rest throughout the day."
a
The emergency department nurse is evaluating the outcomes for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective? a. O2 saturation is >90%. b. No wheezes are audible. c. Respiratory rate is 16 breaths/min. d. Accessory muscle use has decreased.
a
The nurse is discharging a client newly diagnosed with restrictive airway disease (asthma). Which statement indicates the client understands the discharge instructions? a. "I will call 911 if my medications don't control an attack." b. "I should wash my bedding in warm water." c. "I can still eat at the Chinese restaurant when I want." d. "If I get a headache, I should take a nonsteroidal anti-inflammatory drug."
a
The nurse is planning the care of a client diagnosed with asthma and has written a problem of "anxiety." Which nursing intervention should be implemented? a. Remain with the client. b. Notify the health-care provider. c. Administer an anxiolytic medication. d. Encourage the client to drink fluids.
a
The nurse is teaching a client about changes in body image related to chronic obstructive pulmonary disease (COPD). Which statement by the client would indicate that teaching was successful? a. "My nails may become clubbed." b. "My nails may have multiple small pits." c. "I may develop flattening of the nail plate." d. "I may develop horizontal depressions on my nails."
a
The nurse is teaching the Dietary Approaches to Stop Hypertension (DASH) diet to a client diagnosed with essential hypertension. Which statement indicates that the client understands teaching concerning the DASH diet? a. "I should eat at least four (4) to five (5) servings of vegetables a day." b. "I should eat meat that has a lot of white streaks in it." c. "I should drink no more than two (2) glasses of whole milk a day." d. "I should decrease my grain intake to no more than twice a week."
a
The nurse is teaching the client recently diagnosed with essential hypertension. Which instruction should the nurse provide when discussing heart healthy exercise? a. Walk at least 30 minutes a day on flat surfaces. b. Perform light weight lifting three (3) times a week. c. Recommend high-intensity aerobics daily. d. Encourage the client to swim laps once a week.
a
What early manifestation(s) is the patient with primary hypertension likely to report? a. No symptoms b. Cardiac palpitations c. Dyspnea on exertion d. Dizziness and vertigo
a
What should the nurse emphasize when teaching a patient who is newly prescribed clonidine (Catapres)? a. The drug should never be stopped abruptly. b. The drug should be taken early in the day to prevent nocturia. c. The first dose should be taken when the patient is in bed for the night. d. Because aspirin will decrease the drug's effectiveness, Tylenol should be used instead.
a
Which condition contributes to secondary pulmonary arterial hypertension by causing pulmonary capillary and alveolar damage? a. COPD b. Sarcoidosis c. Pulmonary fibrosis d. Pulmonary embolis
a
Which method of low, constant oxygen administration is the safest system to use for a patient with COPD exacerbation? a. Venturi mask b. Nasal cannula c. Simple face mask d. Nonrebreather mas
a
Which outcome is appropriate for the client problem "ineffective gas exchange" for the client recently diagnosed with COPD? a. The client demonstrates the correct way to pursed-lip breathe. b. The client lists three (3) signs/symptoms to report to the HCP. c. The client will drink at least 2,500 mL of water daily. d. The client will be able to ambulate 100 feet with dyspnea.
a
Which statement made by the client indicates the nurse's discharge teaching is effective for the client diagnosed with COPD? a. "I need to get an influenza vaccine each year, even when there is a shortage." b. "I need to get a vaccine for pneumonia each year with my influenza shot." c. "If I reduce my cigarettes to six (6) a day, I won't have difficulty breathing." d. "I need to restrict my drinking liquids to keep from having so much phlegm."
a
The case manager is arranging a care planning meeting regarding the care of a 65-year-old client diagnosed with adult-onset asthma. Which health-care disciplines should participate in the meeting? Select all that apply. a. Nursing. b. Pharmacy. c. Social work. d. Occupational therapy. e. Speech therapy.
abc
Which client problems are appropriate for the nurse to include in the plan of care for the client diagnosed with COPD? Select all that apply. a. Impaired gas exchange. b. Inability to tolerate temperature extremes. c. Activity intolerance. d. Inability to cope with changes in roles. e. Alteration in nutrition.
abcde
The nurse writes a problem of "impaired gas exchange" for a client diagnosed with cancer of the lung. Which interventions should be included in the plan of care? Select all that apply. a. Apply O2 via nasal cannula. b. Have the dietitian plan for six (6) small meals per day. c. Place the client in respiratory isolation. d. Assess vital signs for fever. e. Listen to lung sounds every shift.
abde
The nurse and a licensed practical nurse (LPN) are caring for five (5) clients on a medical unit. Which clients would the nurse assign to the LPN? Select all that apply. a. The 32-year-old female diagnosed with exercise-induced asthma who has a forced vital capacity of 1,000 mL. b. The 45-year-old male with adult-onset asthma who is complaining of difficulty completing all of the ADLs at one time. c. The 92-year-old client diagnosed with respiratory difficulty who is beginning to be confused and keeps climbing out of bed. d. The 6-year-old client diagnosed with intrinsic asthma who is scheduled for discharge and the mother needs teaching about the medications. e. The 20-year-old client diagnosed with asthma who has a pulse oximetry reading of 95% and wants to sleep all the time.
abe
ncreases in which blood studies are diagnostic for acute coronary syndrome (ACS) (select all that apply)? a. Copeptin b. Creatine kinase (CK-MM) c. Cardiac troponin T (cTnT) d. B-type natriuretic peptide (BNP) e. High-sensitivity C-reactive protein (hs-CRP) f. Lipoprotein-associated phospholipase A2 (Lp-PLA2)
ac
A nurse is providing information about tuberculosis to a group of clients at a local community center. Which of the following manifestations should the nurse include? (Select all that apply.) a. Persistent cough b. Weight gain c. Fatigue d. Night sweats e. Purulent sputum
acde
The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse include on the list? Select all that apply. a. Activities should be resumed gradually. b. Avoid contact with other individuals, except family members, for at least 6 months. c. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. d. Respiratory isolation is not necessary because family members already have been exposed. e. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags. f. When 1 sputum culture is negative, the client is no longer considered infectious and usually can return to former employment.
acde
What are nonmodifiable risk factors for primary hypertension (select all that apply)? a. Age b. Obesity c. Gender d. Ethnicity e. Genetic link
acde
A nurse is preparing to administer an initial dose of prednisone to a client who has COPD. The nurse should monitor for which of the following adverse effects of this medication?(Select all that apply.) a. Hypokalemia b. Tachycardia c. Fluid retention d. Nausea e. Black, tarry stools
ace
A 78-year-old patient is admitted with a BP of 180/98 mm Hg. Which age-related physical changes may contribute to this patient's hypertension (select all that apply)? a. Decreased renal function b. Increased baroreceptor reflexes c. Increased peripheral vascular resistance d. Increased adrenergic receptor sensitivity e. Increased collagen and stiffness of the myocardium f. Loss of elasticity in large arteries from arteriosclerosis
acef
Which health promotion information should the nurse include when teaching a patient with a 42 pack-year history of cigarette smoking? (Select all that apply.) a. Resources for support in smoking cessation b. Reasons for annual sputum cytology testing c. Erlotinib (Tarceva) therapy to prevent tumor risk d. Computed tomography (CT) screening for cancer e. Importance of obtaining a yearly influenza vaccination
ade
A client diagnosed with tuberculosis (TB) is distressed over fatigue and the loss of physical stamina. What should the nurse tell the client? a. This is expected and will last for at least 1 year b. This is expected, and the client should gradually increase activity as tolerated c. This is an unexpected finding with TB, but is should resolve within 1 month or so. d. This is a short-lived problem that should be gone within 1 week after beginning medication therapy.
b
A nurse is assessing a client who has a history of asthma. Which of the following factors should the nurse identify as a risk for asthma? a. sex b. Environmental allergies c. Alcohol use d. History of diabetes
b
A nurse is reinforcing teaching with a client on the purpose of taking bronchodilator. Which of the following client statements indicates understanding? a. "This medication can decrease my immune response" b. "I take this medication to prevent asthma attacks" c. "I need to take this medication with food" d. "This medication has a slow onset to treat my symptoms"
b
A nurse is teaching a client who has tuberculosis. Which of the following statements should the nurse include? a. "You will need to continue to take the multi-medication regiment for 4 months" b. "You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication" c. "You will need to remain hospitalized for treatment" d. "You will need to wear a mask at all times"
b
A patient is admitted to the emergency department with an acute asthma attack. Which patient assessment is of greatest concern to the nurse? a. The presence of a pulsus paradoxus b. Markedly decreased breath sounds with no wheezing c. A respiratory rate of 34 breaths/min and increased pulse and BP d. Use of accessory muscles of respiration and a feeling of suffocation
b
A patient is receiving 35% O2 via a Venturi mask. Which action by the nurse will help ensure the correct dosage of O2? a. Teach the patient to keep the mask on during meals. b. Keep the air entrainment ports clean and unobstructed. c. Use a high enough flowrate to keep the bag from collapsing. d. Drain moisture condensation from the corrugated tubing hourly.
b
A patient seen in the asthma clinic has recorded daily peak flowrates that are 75% of the baseline. Which action will the nurse plan to take next? a. Teach the patient about the use of oral corticosteroids. b. Administer a bronchodilator and recheck the spirometry. c. Recommend increasing the dose of the leukotriene inhibitor. d. Instruct the patient to keep the scheduled follow-up appointment.
b
A patient with newly diagnosed lung cancer tells the nurse, "I don't think I'm going to live to see my next birthday." Which is the best initial response by the nurse? a. "Are you ready to talk with family members about dying?" b. "Can you tell me what makes you think you will die so soon?" c. "Do you think that an antidepressant medication would be helpful?" d. "Would you like to talk to the hospital chaplain about your feelings?"
b
A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, "I wish I were dead! I'm just a burden on everybody." Based on this information, which patient problem should the nurse identify? a. Fear of death b. Low self-esteem c. Extended grieving d. Inadequate knowledge
b
A patient with stage 2 hypertension who is taking chlorothiazide (Diuril) and lisinopril (Zestril) has prazosin (Minipress) added to the medication regimen. What is most important for the nurse to teach the patient to do? a. Weigh every morning to monitor for fluid retention. b. Change position slowly and avoid prolonged standing. c. Use sugarless gum or candy to help relieve dry mouth. d. Take the pulse daily to note any slowing of the heart rate
b
The 66-year-old male client has his blood pressure (BP) checked at a health fair. The BP is 168/98. Which action should the nurse implement first? a. Recommend that the client have his blood pressure checked in one (1) month. b. Instruct the client to see his health-care provider as soon as possible. c. Discuss the importance of eating a low-salt, low-fat, low-cholesterol diet. d. Explain that this BP is within the normal range for an elderly person.
b
The client diagnosed with asthma is admitted to the emergency department with difficulty breathing and a blue color around the mouth. Which diagnostic test will be ordered to determine the status of the client? a. Complete blood count. b. Pulmonary function test. c. Allergy skin testing. d. Drug cortisol level.
b
The client diagnosed with essential hypertension is taking a loop diuretic daily. Which assessment data would require immediate intervention by the nurse? a. The telemetry reads normal sinus rhythm. b. The client has a weight gain of 2 kg within 1 to 2 days. c. The client's blood pressure is 148/92. d. The client's serum potassium level is 4.5 mEq
b
The client diagnosed with lung cancer is in an investigational program and receiving a vaccine to treat the cancer. Which information regarding investigational regimens should the nurse teach? a. Investigational regimens provide a better chance of survival for the client. b. Investigational treatments have not been proven to be helpful to clients. c. Clients will be paid to participate in an investigational program. d. Only clients who are dying qualify for investigational treatments.
b
The client diagnosed with restrictive airway disease (asthma) has been prescribed a glucocorticoid inhaled medication. Which information should the nurse teach regarding this medication? a. Do not abruptly stop taking this medication; it must be tapered off. b. Immediately rinse the mouth following administration of the drug. c. Hold the medication in the mouth for 15 seconds before swallowing. d. Take the medication immediately when an attack starts.
b
The client is diagnosed with mild intermittent asthma. Which medication should the nurse discuss with the client? a. Daily inhaled corticosteroids. b. Use of a "rescue inhaler." c. Use of systemic steroids. d. Leukotriene agonists.
b
The client is four (4) hours post-lobectomy for cancer of the lung. Which assessment data warrant immediate intervention by the nurse? a. The client has an intake of 1,500 mL IV and an output of 1,000 mL. b. The client has 450 mL of bright-red drainage in the chest tube. c. The client is complaining of pain at a "10" on a 1-to-10 scale. d. The client has absent lung sounds on the side of the surgery.
b
The emergency department nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding indicates the presence of a pneumothorax in this client? a. A low respiratory rate b. Diminished breath sounds c. The presence of a barrel chest d. A sucking sound at the site of injury
b
The home health nurse is visiting a patient with chronic obstructive pulmonary disease (COPD). Which nursing action is appropriate to implement for a patient who has an impaired breathing pattern due to anxiety? a. Titrate O2 to keep saturation at least 90%. b. Teach the patient how to use the pursed-lip technique. c. Discuss a high-protein, high-calorie diet with the patient. d. Suggest the use of over-the-counter sedative medications
b
The nurse is administering a beta blocker to the client diagnosed with essential hypertension. Which intervention should the nurse implement? a. Notify the health-care provider if the potassium level is 3.8 mEq. b. Question administering the medication if the BP is less than 90/60 mm Hg. c. Do not administer the medication if the client's radial pulse is greater than 100. d. Monitor the client's BP while he or she is lying, standing, and sitting.
b
The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD). How should the nurse determine the appropriate O2 flowrate? a. Minimize O2 use to avoid O2 dependency. b. Maintain the pulse oximetry level at 90% or greater. c. Administer O2 according to the patient's level of dyspnea. d. Avoid administration of O2 at a rate of more than 2 L/min.
b
The nurse is assessing the client diagnosed with COPD. Which data require immediate intervention by the nurse? a. Large amounts of thick white sputum. b. Oxygen flowmeter set on eight (8) liters. c. Use of accessory muscles during inspiration. d. Presence of a barrel chest and dyspnea.
b
The nurse is discussing the care of a child diagnosed with asthma with the parent. Which referral is important to include in the teaching? a. Referral to a dietitian. b. Referral for allergy testing. c. Referral to the developmental psychologist. d. Referral to a home health nurse.
b
The nurse is teaching a class on arterial essential hypertension. Which modifiable risk factors would the nurse include when preparing this presentation? a. Include information on retinopathy and nephropathy. b. Discuss sedentary lifestyle and smoking cessation. c. Include discussions on family history and gender. d. Provide information on a low-fiber and high-salt diet.
b
The nurse observes the unlicensed assistive personnel (UAP) removing the nasal cannula from the client diagnosed with COPD while ambulating the client to the bathroom. Which action should the nurse implement? a. Praise the UAP because this prevents the client from tripping on the oxygen tubing. b. Place the oxygen back on the client while sitting in the bathroom and say nothing. c. Explain to the UAP in front of the client oxygen must be left in place at all times. d. Discuss the UAP's action with the charge nurse so appropriate action can be taken.
b
The nurse recognizes that additional teaching is needed when the patient with asthma says a. "I should exercise every day if my symptoms are controlled." b. "I may use over-the-counter bronchodilator drugs occasionally if I develop chest tightness." c. "I should inform my spouse about my medications and how to get help if I have a severe asthma attack." d. "A diary to record my medication use, symptoms, PEF rates, and activity levels will help in adjusting my therapy.
b
The nurse supervises a student nurse who is assigned to take care of a patient with active tuberculosis (TB). Which action, if performed by the student nurse, would require an intervention by the nurse? a. The patient is offered a tissue from the box at the bedside. b. A surgical face mask is applied before visiting the patient. c. A snack is brought to the patient from the unit refrigerator. d. Hand washing is performed before entering the patient's room.
b
The nurse teaches a patient about pursed-lip breathing. Which action by the patient would indicate to the nurse that further teaching is needed? a. The patient inhales slowly through the nose. b. The patient puffs up the cheeks while exhaling. c. The patient practices by blowing through a straw. d. The patient's ratio of inhalation to exhalation is 1:3.
b
The patient has had COPD for years, and his ABGs usually show hypoxia (PaO2 <60 mm Hg or SaO2 <88%) and hypercapnia (PaCO2 >45 mm Hg). Which ABG results show movement toward respiratory acidosis and further hypoxia indicating respiratory failure? a. pH 7.35, PaO2 62 mm Hg, PaCO2 45 mm Hg b. pH 7.34, PaO2 45 mm Hg, PaCO2 65 mm Hg c. pH 7.42, PaO2 90 mm Hg, PaCO2 43 mm Hg d. pH 7.46, PaO2 92 mm Hg, PaCO2 32 mm Hg
b
The patient who is being admitted has had a history of uncontrolled hypertension. High SVR is most likely to cause damage to which organ? a. Brain b. Heart c. Retina d. Kidney
b
The unit is very busy and short staffed. What could the RN delegate to the unlicensed assistive personnel (UAP)? a. Administer antihypertensive medications to stable patients. b. Obtain orthostatic BP readings for older patients. c. Check BP readings for the patient receiving IV sodium nitroprusside. d. Teach about home BP monitoring and use of automatic BP monitoring equipment.
b
To decrease the patient's sense of panic during an acute asthma attack, what is the best action for the nurse to do? a. Leave the patient alone to rest in a quiet, calm environment. b. Stay with the patient and encourage slow, pursed-lip breathing. c. Reassure the patient that the attack can be controlled with treatment. d. Let the patient know that frequent monitoring is being done by measuring vital signs and arterial oxygen
b
What causes most organ damage in hypertension? a. Increased fluid pressure exerted against organ tissue b. Atherosclerotic changes in vessels that supply the organs c. Erosion and thinning of blood vessels in organs from constant pressure d. Increased hydrostatic pressure causing leakage of plasma into organ interstitial space
b
What causes the pulmonary vasoconstriction leading to the development of cor pulmonale in the patient with COPD? a. Increased viscosity of the blood b. Alveolar hypoxia and hypercapnia c. Long-term low-flow oxygen therapy d. Administration of high concentrations of oxyge
b
Which assessment finding in a patient with impaired gas exchange is most useful in evaluating the effectiveness of treatment? a. Even, unlabored respirations b. Pulse oximetry reading of 92% c. Absence of wheezes or crackles d. Respiratory rate of 18 breaths/min
b
Which dietary modification helps meet the nutritional needs of patients with COPD? a. Eating a high-carbohydrate, low-fat diet b. Avoiding foods that require a lot of chewing c. Preparing most foods of the diet to be eaten hot d. Drinking fluids with meals to promote digest
b
Which finding is associated with a blue color around the lips and conjunctiva? a. Finger clubbing b. Central cyanosis c. Peripheral cyanosis d. Delayed capillary filling time
b
A home health nurse is teaching a client who has active tuberculosis and is following a medication regimen that includes a combination of isoniazid, rifampin, pyrazinamide, and ethambutol. Which of the following client statements indicate understanding? (Select all that apply). a. "I can substitute one medication for another if I run out because they all fight infection" b. "I will wash my hands each time I cough" c. "I will wear a mask when I am in a public area" d. "I am glad I don't have any more sputum specimens" e. "I don't need to worry where I go once I start taking my medications"
bc
The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which findings would the nurse expect to note on assessment of this client? Select all that apply. a. A low arterial PCO2 level b. A hyperinflated chest noted on the chest x-ray c. Decreased oxygen saturation with mild exercise d. Pulmonary function tests that demonstrate increased vital capacity
bc
A nurse in the emergency department is caring for a client who is experiencing an acute asthma attack. Which of the following assessments indicates that the respiratory status is declining? ( Select all that apply). a. SaO2 95% b. Wheezing c. Retraction of sternal muscles d. Pink mucous membranes e. Tachycardia
bce
Pulmonary rehabilitation (PR) is designed to reduce symptoms and improve the patient's quality of life. Along with improving exercise capacity, what are anticipated results of PR (select all that apply)? a. Decreased FEV1 b. Decreased depression c. Increased oxygen need d. Decreased fear of exercise e. Decreased hospitalization
bde
Which effects result from sympathetic nervous system stimulation of β-adrenergic receptors (select all that apply)? a. Vasoconstriction b. Increased heart rate c. Decreased heart rate d. Increased rate of impulse conduction e. Decreased rate of impulse conduction f. Increased force of cardiac contraction
bdf
A 38-year-old man is treated for hypertension with triamterene and hydrochlorothiazide and metoprolol (Lopressor). Four months after his last clinic visit, his BP returns to pretreatment levels, and he admits he has not been taking his medication regularly. What is the nurse's best response to this patient? a. "Try always to take your medication when you carry out another daily routine so that you do not forget to take it." b. "You probably would not need to take medications for hypertension if you would exercise more and stop smoking." c. "The drugs you are taking cause sexual dysfunction in many patients. Are you experiencing any problems in this area?" d. "You need to remember that hypertension can be only controlled with medication, not cured, and you must always take your medication."
c
A client has experienced pulmonary embolism. The nurse should assess for which symptom, which is most commonly reported? a. Hot, flushed feeling b. sudden chills and fever c. chest pain that occurs suddenly d. Dyspnea when deep breaths are taken
c
A nurse is caring for a client who has a new diagnosis of tuberculosis and has been placed on a multi-medication regimen. Which of the following instructions should the nurse give the client related to ethambutol? a. "Your urine can turn a dark orange" b. "Watch for a change in the sclera of your eyes" c. "Watch for any changes in vision" d. "Take vitamin B6 daily"
c
A nurse is planning to instruct a client on how to perform pursed-lip breathing. Which of the following statements should the nurse include? a. "Take quick breaths upon inhalation" b. "Place your hand over your stomach" c. "Take a deep breath in through you nose" d. "Puff your cheeks upon exhalation"
c
A nurse is preparing to administer a new prescription for isoniazid (INH) to a light-skinned client who has tuberculosis. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication? a. "You might notice yellowing of you skin" b. "You might experience pain in you joints" c. "You might notice tingling of you hands" d. "You might experience a loss of appetite"
c
A nurse is providing discharge teaching to a client who has COPD and a new prescription for albuterol. Which of the following statements by the client indicates an understanding of the teaching? a. "This medication can increase my blood sugar levels" b. "This medication can decrease my immune response" c. "I can have an increase in my heart rate while taking this medication." d. "I can have mouth sores while taking this medication"
c
A nurse is providing discharge teaching to a client who has a new prescription for prednisone for asthma. Which of the following client statements indicates understanding? a. "I will decrease my fluid intake while taking this medication" b. "I will expect to have black, tarry stools" c. "I will take my medication with meals" d. "I will monitor for weight loss while on this medication"
c
A patient diagnosed with active tuberculosis (TB) is homeless and has a history of chronic alcohol use. Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen? a. Repeat warnings about the high risk for infecting others several times. b. Give the patient written instructions about how to take the medications. c. Arrange for a daily meal and drug administration at a community center. d. Arrange for the patient's friend to administer the medication on schedule.
c
A patient diagnosed with secondary hypertension asks why it is called secondary and not primary. What is the best explanation for the nurse to provide? a. Has a more gradual onset than primary hypertension b. Does not cause the target organ damage that occurs with primary hypertension c. Has a specific cause, such as renal disease, that often can be treated by medicine or surgery d. Is caused by age-related changes in BP regulatory mechanisms in people over 65 years of age
c
A patient with chronic obstructive pulmonary disease (COPD) has been eating very little and has lost weight. Which intervention would be most appropriate for the nurse to include in the plan of care? a. Encourage increased intake of whole grains. b. Increase the patient's menu order of fruits and fruit juices. c. Offer high-calorie protein snacks between meals and at bedtime. d. Assist the patient in choosing foods with high vegetable content.
c
A pulmonary embolus is suspected in a patient with a deep vein thrombosis who develops dyspnea, tachycardia, and chest pain. Diagnostic testing is scheduled. Which test should the nurse plan to teach the patient about? a. D-dimer b. Chest x-ray c. Spiral (helical) CT scan d. Ventilation-perfusion lung scan
c
After 2 months of tuberculosis (TB) treatment with isoniazid, rifampin (Rifadin), pyrazinamide, and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next? a. Teach about drug-resistant TB. b. Schedule directly observed therapy. c. Ask the patient whether medications have been taken as directed. d. Discuss the need for an injectable antibiotic with the health care provider
c
Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic obstructive pulmonary disease. Which intervention should the nurse include in the plan of care? a. Schedule the procedure 1 hour after the patient eats. b. Maintain the patient in the lateral position for 20 minutes. c. Give the prescribed albuterol (Ventolin HFA) before the therapy. d. Perform percussion before assisting the patient to the drainage position.
c
The client diagnosed with essential hypertension asks the nurse, "Why do I have high blood pressure?" Which response by the nurse would be most appropriate? a. "You probably have some type of kidney disease that causes the high BP." b. "More than likely you have had a diet high in salt, fat, and cholesterol." c. "There is no specific cause for hypertension, but there are many known risk factors." d. "You are concerned that you have high blood pressure. Let's
c
The client diagnosed with exercise-induced asthma (EIA) is being discharged. Which information should the nurse include in the discharge teaching? a. Take two (2) puffs on the rescue inhaler and wait five (5) minutes before exercise. b. Warm-up exercises will increase the potential for developing the asthma attacks. c. Use the bronchodilator inhaler immediately prior to beginning to exercise. d. Increase dietary intake of food high in monosodium glutamate (MSG).
c
The client is admitted to the outpatient surgery center for a bronchoscopy to rule out cancer of the lung. Which information should the nurse teach? a. The test will confirm the results of the MRI. b. The client can eat and drink immediately after the test. c. The HCP can do a biopsy of the tumor through the scope. d. There is no discomfort associated with this procedure.
c
The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action should the nurse take? a. Teach about the reason for the blood tests. b. Schedule an appointment for a chest x-ray. c. Teach the patient about providing specimens for 3 consecutive days. d. Instruct the patient to collect several separate sputum specimens today.
c
The health-care provider prescribes an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with essential hypertension. Which statement is the most appropriate rationale for administering this medication? a. ACE inhibitors prevent beta receptor stimulation in the heart. b. This medication blocks the alpha receptors in the vascular smooth muscle. c. ACE inhibitors prevent vasoconstriction and sodium and water retention. d. ACE inhibitors decrease blood pressure by relaxing vascular smooth muscle.
c
The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients on a medical unit. Which information provided by the UAP warrants immediate intervention by the nurse? a. The client diagnosed with cancer of the lung has a small amount of blood in the sputum collection cup. b. The client diagnosed with chronic emphysema is sitting on the side of the bed and leaning over the bedside table. c. The client receiving Procrit, a biologic response modifier, has a T 99.2°F, P 68, R 24, and BP of 198/102. d. The client receiving prednisone, a steroid, is complaining of an upset stomach after eating breakfast.
c
The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is specific in confirming a diagnosis of chronic bronchitis? a. The patient relates a family history of bronchitis. b. The patient has a 30 pack-year cigarette smoking history. c. The patient reports a productive cough for 3 months of every winter. LEWIS'S MEDICAL SURGICAL NURSING 11TH TEST BANK BY HARDING WWW.NURSINGDB.COM N U R S I N G D B . C O M d. The patient has respiratory problems that began during the past 12 months.
c
The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which information would prompt the nurse to consult with the health care provider before administering the prescribed theophylline? a. The patient reports a recent 15 pound weight gain. LEWIS'S MEDICAL SURGICAL NURSING 11TH TEST BANK BY HARDING WWW.NURSINGDB.COM N U R S I N G D B . C O M b. The patient denies shortness of breath at present. c. The patient takes cimetidine (Tagamet HB) daily. d. The patient reports coughing up some green mucus.
c
The nurse is caring for the client diagnosed with COPD. Which outcome requires a revision in the plan of care? a. The client has no signs of respiratory distress. b. The client shows an improved respiratory pattern. c. The client demonstrates intolerance to activity. d. The client participates in establishing goals.
c
The nurse is completing the admission assessment on a 13-year-old client diagnosed with an acute exacerbation of asthma. Which signs and symptoms would the nurse expect to find? a. Fever and crepitus. b. Rales and hives. c. Dyspnea and wheezing. d. Normal chest shape and eupnea.
c
The nurse just received the a.m. shift report. Which client should the nurse assess first? a. The client diagnosed with coronary artery disease who has a BP of 170/100. b. The client diagnosed with DVT who is complaining of chest pain. c. The client diagnosed with pneumonia who has a pulse oximeter reading of 98%. d. The client diagnosed with ulcerative colitis who has non-bloody diarrhea.
c
The nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of which diagnostic test that will confirm this diagnosis? a. Chest x-ray b. Bronchoscopy c. Sputum culture d. Tuberculin skin test
c
The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB). Which statement, if made by the patient, indicates that teaching was effective? a. "I will take the bus instead of driving." b. "I will stay indoors whenever possible." c. "My spouse will sleep in another room." d. "I will keep the windows closed at home."
c
The nurse teaches a patient who has asthma about peak flowmeter use. Which action by the patient indicates that teaching was successful? a. The patient inhales rapidly through the peak flowmeter mouthpiece. b. The patient takes montelukast (Singulair) for peak flows in the red zone. c. The patient uses albuterol (Ventolin HFA) for peak flows in the yellow zone. d. The patient calls the health care provider when the peak flow is in the green zone.
c
The nursing staff on an oncology unit is interviewing applicants for the unit manager position. Which type of organizational structure does this represent? a. Centralized decision making. b. Decentralized decision making. c. Shared governance. d. Pyramid with filtered-down decisions.
c
What does the nurse include when planning for postural drainage for the patient with COPD? a. Schedules the procedure 1 hour before and after meals b. Has the patient cough before positioning to clear the lungs c. Assesses the patient's tolerance for dependent (head-down) positions d. Ensures that percussion and vibration are done before positioning th
c
What is the primary BP effect of β-adrenergic blockers, such as atenolol (Tenormin)? a. Vasodilation of arterioles by blocking movement of calcium into cells b. Decrease Na+ and water reabsorption by blocking the effect of aldosterone c. Decrease CO by decreasing rate and strength of the heart and renin secretion by the kidneys d. Vasodilation caused by inhibiting sympathetic outflow from the central nervous system (CNS)
c
What should the nurse include when teaching the patient with COPD about the need for physical exercise? a. All patients with COPD should be able to increase walking gradually up to 20 minutes per day. b. A bronchodilator inhaler should be used to relieve exercise-induced dyspnea immediately after exercise. c. Shortness of breath is expected during exercise but should return to baseline within 5 minutes after the exercise. d. Monitoring the heart rate before and after exercise is the best way to determine how much exercise can be tolerated.
c
When caring for a patient after a cardiac catheterization with coronary angiography, which finding should be of most concern to the nurse? a. Swelling at the catheter insertion site b. Development of raised wheals on the patient's trunk c. Absence of pulses distal to the catheter insertion site d. Patient pain at the insertion site at 4 on a scale of 0 to 10
c
When preparing a clinic patient who has chronic obstructive pulmonary disease (COPD) for pulmonary spirometry, what question the nurse should ask? a. "Are you claustrophobic?" b. "Are you allergic to shellfish?" c. "Have you taken any bronchodilators today?" d. "Do you have any metal implants or prostheses?"
c
When teaching the patient with mild asthma about the use of the peak flow meter, what should the nurse teach the patient to do? a. Always carry the flowmeter in case an asthma attack occurs. b. Use the flowmeter to check the status of the patient's asthma every time the patient takes quick-relief medication. c. Follow the written asthma action plan (e.g., take quick-relief medication) if the expiratory flow rate is in the yellow zone. d. Use the flowmeter by emptying the lungs, closing the mouth around the mouthpiece, and inhaling through the meter as quickly as possible.
c
Which breathing technique should the nurse teach the patient with moderate COPD to promote exhalation? a. Huff coughing b. Thoracic breathing c. Pursed lip breathing d. Diaphragmatic breathing
c
Which clinical manifestation should the nurse expect to assess in the client recently diagnosed with COPD? a. Clubbing of the client's fingers. b. Infrequent respiratory infections. c. Chronic sputum production. d. Nonproductive hacking cough.
c
Which manifestation is an indication that a patient is having hypertensive emergency? a. Symptoms of a stroke with an elevated BP b. A systolic BP (SBP) >180 mm Hg and a diastolic BP (DBP) >110 mm Hg c. A sudden rise in BP accompanied by neurologic impairment d. A severe elevation of BP that occurs over several days or weeks
c
Which referral is most appropriate for a client diagnosed with end-stage COPD? a. The Asthma Foundation of America. b. The American Cancer Society. c. The American Lung Association. d. The American Heart Association.
c
Which arteries are the major providers of coronary circulation (select all that apply)? a. Left marginal artery b. Right marginal artery c. Left circumflex artery d. Right coronary artery e. Posterior descending artery f. Left anterior descending artery
cdf
Which medications are the most effective in improving asthma control by reducing bronchial hyperresponsiveness, blocking the late-phase reaction, and inhibiting migration of inflammatory cells (select all that apply)? a. Zileuton (Zyflo CR) b. Omalizumab (Xolair) c. Fluticasone (Flovent HFA) d. Salmeterol (Serevent) e. Montelukast (Singulair) f. Budesonide g. Beclomethasone (Qvar) h. Theophylline i. Mometasone (Asmanex Twisthaler
cfgi
A female patient has a total cholesterol level of 232 mg/dL (6.0 mmol/L) and a high-density lipoprotein (HDL) of 65 mg/dL (1.68 mmol/L). A male patient has a total cholesterol level of 200 mg/dL (5.172 mmol/L) and an HDL of 32 mg/dL (0.83 mmol/L). Based on these findings, which patient has the highest cardiac risk? a. The man, because his HDL is lower b. The woman, because her HDL is higher c. The woman, because her cholesterol is higher d. The man, because his cholesterol-to-HDL ratio is higher
d
A male patient has chronic obstructive pulmonary disease (COPD) and is a smoker. The nurse notices respiratory distress and no breath sounds over the left chest. Which type of pneumothorax should the nurse suspect is occurring? a. Tension pneumothorax b. Iatrogenic pneumothorax c. Traumatic pneumothorax d. Spontaneous pneumothorax
d
A nurse has been caring for a patient with tuberculosis (TB) and has a TB skin test performed. When is the nurse considered infected? a. There is no redness or induration at the injection site. b. There is an induration of only 5 mm at the injection site. c. A negative skin test is followed by a negative chest x-ray. d. Testing causes a 10-mm red, indurated area at the injection site.
d
A nurse is caring for a client 2 hr. after admission. The client has an SaCO2 of 91%, exhibits audible wheezes, and is using accessory muscles when breathing. Which of the following classes of medications should the nurse expect to administer? a. Antibiotic b. Beta-blocker c. Antiviral d. Beta2 agonist
d
A nurse is instructing a client on the use of an incentive spirometer. Which of the following statements by the client indicates an understanding of the teaching? a. "I will place the adapter on my finger to read my blood oxygen saturation level" b. "I will lie on my back with my knee bent " c. "I will rest my have over my abdomen to create resistance" d. "I will take in a deep breath and hold it before exhaling"
d
A patient is hospitalized with active tuberculosis (TB). Which assessment finding indicates to the nurse that prescribed airborne precautions are likely to be discontinued? 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. Sputum smears for acid-fast bacilli are negative.
d
Dietary teaching that includes eating dietary sources of potassium is indicated for the hypertensive patient taking which drug? a. Enalapril b. Labetalol c. Spironolactone d. Hydrochlorothiazide
d
During an acute exacerbation of mild COPD, the patient is severely short of breath. The nurse identifies a nursing diagnosis of impaired breathing, etiology: alveolar hypoventilation and anxiety. What is the best nursing action? a. Prepare and administer routine bronchodilator medications. b. Perform chest physiotherapy to promote removal of secretions. c. Administer oxygen at 5 L/min until the shortness of breath is relieved. d. Position the patient upright with the elbows resting on the over-the-bed table.
d
In addition to smoking cessation, what treatment is included for COPD to slow the progression of the disease? a. Use of bronchodilator drugs b. Use of inhaled corticosteroids c. Lung volume reduction surgery d. Prevention of respiratory tract infections
d
The client diagnosed with oat cell carcinoma of the lung tells the nurse, "I am so tired of all this. I might as well just end it all." Which statement should be the nurse's first response? a. Say, "This must be hard for you. Would you like to talk?" b. Tell the HCP of the client's statement. c. Refer the client to a social worker or spiritual advisor. d. Find out if the client has a plan to carry out suicide.
d
The clinic nurse administers a tuberculin skin test to a client. The nurse tells the client to return to the clinic for the results in how long? a. 6 to 12 hours b. 12 to 24 hours c. 24 to 28 hours d. 48 to 72 hours
d
The clinic nurse is interviewing clients. Which information provided by a client warrants further investigation? a. The client uses Vicks VapoRub every night before bed. b. The client has had an appendectomy. c. The client takes a multiple vitamin pill every day. d. The client has been coughing up blood in the mornings.
d
The male client diagnosed with essential hypertension has been prescribed an alpha- adrenergic blocker. Which intervention should the nurse discuss with the client? a. Eat at least one (1) banana a day to help increase the potassium level. b. Explain that impotence is an expected side effect of the medication. c. Take the medication on an empty stomach to increase absorption. d. Change position slowly when going from a lying to sitting position.
d
The nurse caring for a patient immediately following a transesophageal echocardiogram (TEE) should consider which action to be the highest priority? a. Monitor the ECG. b. Monitor pulse oximetry. c. Assess vital signs (BP, HR, RR, temperature). d. Maintain NPO status until gag reflex has returned
d
The nurse develops a teaching plan to help increase activity tolerance at home for an older adult with severe chronic obstructive pulmonary disease (COPD). Which instructions would be appropriate for the nurse to include in the plan of care? a. Walk until pulse rate exceeds 130 beats/min. b. Stop exercising when you feel short of breath. c. Walk 15 to 20 minutes a day at least 3 times/wk. d. Limit exercise to activities of daily living (ADLs).
d
The nurse has conducted discharge teaching with a client diagnosed with tuberculosis who has been receiving medication for 2 weeks. The nurse determines that the client has understood the information if the client makes which statement? a. "I need to continue medication therapy for 1 month." b. "I can't shop at the mall for the next 6 months." c. "I can return to work if a sputum culture comes back negative." d. "I should not be contagious after 2 to 3 weeks of medication therapy."
d
The nurse instructs a client with chronic obstructive pulmonary disease (COPD) to use the pursed-lip method of breathing and evaluates the teaching by asking the client about the purpose of this type of breathing. The nurse determines that the client understands if the client states that the primary purpose of pursed-lip breathing is to promote which outcome? a. Promote oxygen intake b. Strengthen the diaphragm c. Strengthen the intercostal muscles d. Promote carbon dioxide elimination
d
The nurse is assessing a client with the typical clinical manifestations of tuberculosis (TB). During history-taking the nurse anticipates that the client will report presence of cough and fatigue for what period of time? a. 1 to 2 days b. 1 to 2 weeks c. Almost 1 week d. Several weeks to months
d
The nurse is assessing the client with COPD. Which health promotion information is most important for the nurse to obtain? a. Number of years the client has smoked. b. Risk factors for complications. c. Ability to administer inhaled medication. d. Willingness to modify lifestyle.
d
The nurse is caring for a client with tuberculosis (TB) who is fearful of the disease and anxious about the prognosis. In planning nursing care, the nurse should incorporate which intervention as the best strategy to assist the client in coping with the illness? a. Allow the client to deal with the disease in an individual fashion b. Ask family members whether they wish a psychiatric consultation c. Encourage the client to visit with the pastoral care department's chaplain d. Provided reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease.
d
The nurse is caring for the client diagnosed with end-stage COPD. Which data warrant immediate intervention by the nurse? a. The client's pulse oximeter reading is 92%. b. The client's arterial blood gas level is 74. c. The client has SOB when walking to the bathroom. d. The client's sputum is rusty colored.
d
The nurse is performing tuberculosis (TB) skin tests in a clinic that has many patients who have immigrated to the United States. Which question is important for the nurse to ask before the skin test? a. "Do you take any over-the-counter (OTC) medications?" b. "Do you have any family members with a history of TB?" c. "How long has it been since you moved to the United States?" d. "Did you receive the bacille Calmette-Guérin (BCG) vaccine for TB?"
d
The nurse is taking the social history from a client diagnosed with small cell carcinoma of the lung. Which information is significant for this disease? a. The client worked with asbestos for a short time many years ago. b. The client has no family history for this type of lung cancer. c. The client has numerous tattoos covering both upper and lower arms. d. The client has smoked two (2) packs of cigarettes a day for 20 years.
d
The patient asks the nurse about valsartan (Diovan), the new medication prescribed for blood pressure. What is the best explanation the nurse can use to explain the action of this medication? a. Prevents the conversion of angiotensin I to angiotensin II b. Acts directly on smooth muscle of arterioles to cause vasodilation c. Decreases extracellular fluid volume by increasing Na+ and Cl− excretion with water d. Vasodilation, prevents the action of angiotensin II, and promotes increased salt and water excretion
d
Tobacco smoke causes defects in multiple areas of the respiratory system. What is a long-term effect of smoking? a. Bronchospasm and hoarseness b. Decreased mucus secretions and cough c. Increased function of alveolar macrophages d. Increased risk of infection and hyperplasia of mucous gland
d
What does the nursing responsibility in the management of the patient with hypertensive urgency include? a. Monitoring hourly urine output for drug effectiveness b. Titrating IV drug dosages based on BP and HR measurements every 2 to 3 minutes c. Providing continuous electrocardiographic (ECG) monitoring to detect side effects of the drugs d. Instructing the patient to follow up with a health care provider within 24 hours after outpatient treatment
d
What is a significant finding in the health history of a patient during an assessment of the cardiovascular system? a. Metastatic cancer b. Calcium supplementation c. Frequent viral pharyngitis d. Frequent use of recreational drugs
d
What is included in the correct technique for BP measurements? a. Always take the BP in both arms. b. Position the patient supine for all readings. c. Place the cuff loosely around the upper arm. d. Take readings at least 2 times at least 1 minute apart.
d
What should the nurse teach a patient with intermittent asthma about identifying specific triggers of asthma? a. Food and drug allergies do not cause respiratory symptoms. b. Exercise-induced asthma is seen only in persons with sensitivity to cold air. c. Asthma attacks are psychogenic in origin and can be controlled with relaxation techniques. d. Viral upper respiratory infections are a common precipitating factor in acute asthma attack
d
When palpating the patient's popliteal pulse, the nurse feels a vibration at the site. How should the nurse record this finding? a. Thready, weak pulse b. Bruit at the artery site c. Bounding pulse volume d. Thrill of the popliteal artery
d
When teaching the patient about going from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI), which patient statement indicates to the nurse that the patient needs more teaching? a. "I do not need to use the spacer like I used to." b. "I will hold my breath for 10 seconds or longer if I can." c. "I will not shake this inhaler like I did with my old inhaler." d. "I will store it in the bathroom, so I will be able to clean it when I need to.
d
Which drugs are most commonly used to treat hypertensive crises? a. Labetalol and bumetanide (Bumex) b. Esmolol (Brevibloc) and captopril (Captopril) c. Enalaprilat (Vasotec) and minoxidil (Minoxidil) d. Fenoldopam (Corlopam) and sodium nitroprusside (Nitropress)
d
Which information will the nurse include in the teaching plan for a patient newly diagnosed with asthma? a. Use 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
Which medication is a long-acting β2-adrenergic agonist and DPI that is used only for COPD? a. Roflumilast (Daliresp) b. Salmeterol (Serevent) c. Ipratropium (Atrovent HFA) d. Indacaterol (Arcapta Neohaler)
d
Which medication should the nurse anticipate being used first in the emergency department for relief of severe respiratory distress related to asthma? a. Prednisone orally b. Tiotropium inhaler c. Fluticasone inhaler d. Albuterol nebulizer
d
Which method is used to evaluate the ECG responses to normal activity over a period of 1 or 2 days? a. Serial ECGs b. Holter monitoring c. 6-minute walk test d. Event monitor or loop recorder
d
Which statement indicates to the nurse the client diagnosed with asthma understands the teaching regarding mast cell stabilizer medications? a. "I should take two (2) puffs when I begin to have an asthma attack." b. "I must taper off the medications and not stop taking them abruptly." c. "These drugs will be most effective if taken at bedtime." d. "These drugs are not good at the time of an attack."
d
Which statement made by the client diagnosed with chronic bronchitis indicates to the nurse more teaching is required? a. "I should contact my health-care provider if my sputum changes color or amount." b. "I will take my bronchodilator regularly to prevent having bronchospasms." c. "This metered-dose inhaler gives a precise amount of medication with each dose." d. "I need to return to the HCP to have my blood drawn with my annual physical."
d
he husband of a patient with severe COPD tells the nurse that he and his wife have not had any sexual activity since she was diagnosed with COPD because she becomes too short of breath. What is the nurse's best response? a. "You need to discuss your feelings and needs with your wife so that she knows what you expect of her." b. "There are other ways to maintain intimacy besides sexual intercourse that will not make her short of breath." c. "You should explore other ways to meet your sexual needs since your wife is no longer capable of sexual activity." d. "Would you like me to talk with you and your wife about some modifications that can be made to maintain sexual activity?
d