AQ CH 28-31 (EXAM 2)

A patient with active tuberculosis is ordered to take isoniazid (INH), pyrazinamide (PZA), and rifampin (RIF) and asks the nurse why it is necessary to take three antibiotics. What is the nurse's best answer? 1. "Three antibiotics help prevent bacterial drug resistance." 2. "You will have fewer drug side effects with multidrug therapy." 3. "The dose of each drug can be reduced with multidrug therapy." 4. "Taking three drugs has a synergistic effect in eradicating the organism."

1. "Three antibiotics help prevent bacterial drug resistance." Multidrug therapy provides quicker destruction of organisms and combats drug resistance. It does not allow for lower dosing or decrease side effects. Taking these three drugs does not produce a synergistic effect.

The primary health care provider advises corticosteroid therapy for a patient with lung cancer. What could be the possible outcome of the treatment? 1. Cured skin issues 2. Decreased bronchospasm 3. Cured esophageal compression 4. Relief in pain due to bone metastasis

2. Decreased bronchospasm Corticosteroids and bronchodilators help decrease bronchospasm. They are not very effective for curing skin issues or esophageal compression or relieving pain due to bone metastasis. These symptoms are effectively cured by providing radiation therapy to the patient.

Which is an example of a low-flow oxygen delivery system used for long-term therapy? 1. T-piece 2. Face tent 3. A nasal cannula 4. Simple facemask

3. A nasal cannula A nasal cannula is an example of a low-flow oxygen delivery system that is used to treat chronic lung disease and for any patient in need of long-term oxygen therapy. A T-piece and face tent are examples of high-flow oxygen delivery systems. A simple facemask is used to deliver oxygen concentrations of 40% to 60% for short-term oxygen therapy or in an emergency.

The nurse is providing teaching to a patient who has been diagnosed with bacterial rhinosinusitis. Which instruction does the nurse include when teaching this patient about his diagnosis? 1. "Be sure to complete the full course of antibiotics." 2. "Fluid should be restricted to prevent excess mucous production." 3. "Decongestants may cause rebound rhinitis and should be avoided." 4. "Facial pain that is worse when bending forward is abnormal and should be reported to your provider."

1. "Be sure to complete the full course of antibiotics." Treatment for bacterial rhinosinusitis includes the use of broad-spectrum antibiotics. Facial pain that is worse when bending forward is a common manifestation of rhinosinusitis. Decongestants are commonly prescribed for rhinosinusitis. Fluids should be increased unless the patient has other medical conditions that require fluid restriction.

The nurse is assisting a patient who is learning to use the supraglottic method of swallowing after a partial laryngectomy. What does the nurse instruct the patient to do immediately after placing food in the mouth? 1. Bear down 2. Swallow twice 3. Clear the throat 4. Take a deep breath

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

What is a late manifestation of lung cancer? 1. Dysphagia 2. Polyphagia 3. Tachypnea 4. Weight gain

1. Dysphagia The patient with lung cancer can have inflammation of the food pipe that results in dysphagia. Lung cancer patients suffer from nausea and vomiting that can cause anorexia, so polyphagia is not likely to develop. Tachypnea is not likely, although the patient develops dyspnea due to decreased functional ability of the lungs. The patient with lung cancer is likely to have weight loss.

The nurse is caring for a pediatric patient with pertussis who is currently in the catarrhal phase of the illness. What manifestations will the nurse most likely find on assessment of this patient? 1. Mild cough 2. Severe cough 3. Bloody sputum 4. Pneumonia on chest x-ray

1. Mild cough Pertussis occurs in three distinct phases. During the first (catarrhal) phase, the patient may present with signs and symptoms of the common cold, including a mild cough. After 1 or 2 weeks, the paroxysmal phase occurs, characterized by a severe cough and bloody sputum, and potentially complicated by pneumonia. The third phase is the convalescent phase, which can last for several months.

The nurse notices a visitor walking into the room of a patient on airborne isolation with no protective gear. What does the nurse do? 1. Provides a mask to the visitor 2. Ensures that the patient is wearing a mask 3. Provides a particulate air respirator to the visitor 4. Tells the visitor that the patient cannot receive visitors at this time

1. Provides a mask to the visitor Because the visitor is entering the patient's isolation environment, the visitor must wear a mask. The patient typically must wear a mask only when he is outside of an isolation environment. Turning the visitor away is inappropriate and unnecessary. It would not be necessary for the visitor to wear an air respirator.

Which prescription for oxygen delivery does the nurse question? 1. 36% O 2 per Venturi mask 2. 48% O 2 per nasal cannula 3. 50% O 2 per simple facemask 4. 100% O 2 per nonrebreather mask

2. 48% O 2 per nasal cannula As a low-flow rate system, oxygen concentrations of 24% to 44% (1-6 L/min) are recommended with the nasal cannula. It is not intended to deliver more than 44% Fio 2 because at a higher rate, oxygenation doesn't increase due to the limitation of anatomic dead space. All other choices are valid prescriptions.

Inhaled corticosteroids are typically used to treat which symptom of asthma? 1. Bronchial spasms 2. Airway inflammation 3. Bronchial secretions 4. Airway hyperresponsiveness

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

A patient with a recent diagnosis of bacterial pharyngitis caused by group A streptococcal infection calls the health care provider stating his has developed a cough, fever, chills, shortness of breath, and severe chest pain. Which complication does the nurse suspect? 1. Mastoiditis 2. Pneumonia 3. Rheumatic fever 4. Acute glomerulonephritis

2. Pneumonia Pneumonia symptoms include a cough, fever, chills, shortness of breath, and chest pain. Symptoms of acute glomerulonephritis include hypertension, decreased urinary output, dark urine, cough, and facial puffiness. Ear drainage and swelling is associated with mastoiditis. Rheumatic fever symptoms include red, hot, painful joints.

Which medication is an example of a long-acting beta 2 agonist (LABA) used in asthma management? 1. Albuterol 2. Salmeterol 3. Terbutaline 4. Levalbuterol

2. Salmeterol Salmeterol is a LABA. Albuterol, levalbuterol, and terbutaline are all short-acting beta 2 agonists (SABAs).

When teaching a patient who has undergone a rhinoplasty about home care, which medication does the nurse recommend? 1. Antacid 2. Stool softener 3. Decongestant 4. Nonsteroidal anti-inflammatory drug (NSAID)

2. Stool softener Patients who have undergone rhinoplasty should avoid the Valsalva maneuver to help prevent bleeding. Stool softeners and laxatives can help with this. Decongestants are not recommended. Antacids are not indicated for this patient. NSAIDs are contraindicated due to the risk for bleeding.

What is a possible reason for the development of bronchopleural fistula in a patient with lung cancer? 1. Drug therapy 2. Thoracentesis 3. Pneumonectomy 4. Radiation therapy

3. Pneumonectomy Pneumonectomy is a surgical procedure that involves removal of a lung, which may create complications such as bronchopleural fistula. Drug therapy, thoracentesis, and radiation therapy are unassociated with development of bronchopleural fistula.

Which virus is a strain of the bird flu? 1. H1N7 2. H1N1 3. H1N5 4. H5N1

4. H5N1 H5N1 is the viral strain that causes bird flu. H1N7, H1N1, and H1N5 are the virus types that cause swine flu.

A patient has sleep apnea and chronic obstructive pulmonary disease. Which mechanism does the nurse use to help the patient sleep? 1. Venturi mask 2. Tracheostomy collar 3. Transtracheal oxygen therapy 4. Noninvasive positive pressure ventilation

4. Noninvasive positive pressure ventilation A patient with sleep apnea and chronic obstructive pulmonary disease may find relief with noninvasive positive pressure ventilation. A Venturi mask, tracheostomy collar, and transtracheal oxygen therapy are used to meet the oxygen requirements of the patient, not to treat sleep apnea.

Which viral agent is responsible for the most common community-acquired pneumonia? 1. Adenovirus 2. Rhinovirus 3. Parainfluenza virus 4. Respiratory syncytial virus

4. Respiratory syncytial virus Respiratory syncytial virus is responsible for the most common community-acquired pneumonia. The adenovirus, rhinovirus, and parainfluenza viruses are less common causes of community-acquired pneumonia.4. Respiratory syncytial virus

What questions should the nurse ask to determine an older adult patient's risk for developing pneumonia? Select all that apply. 1. "Do you have a habit of smoking?" 2. "Do you have a history of hypertension?" 3. "Do you have any family history of lung disease?" 4. "Have you had a pneumococcal vaccination in the last 3 years?" 5. "Have you had any symptoms of influenza in the previous months?"

1. "Do you have a habit of smoking?" 4. "Have you had a pneumococcal vaccination in the last 3 years?" 5. "Have you had any symptoms of influenza in the previous months?" Smoking is a risk factor of pneumonia. A one-time pneumococcal vaccination is necessary to prevent pneumonia, or if the patient has not received the vaccination in the past 5 years, he or she is at a risk to develop pneumonia. Patients with symptoms of influenza previously may develop pneumonia if it is left untreated. Hypertension and family history of lung disease may not precipitate pneumonia.

The nurse is preparing to suction an intubated patient on a ventilator. What are the best-practice actions by the nurse? Select all that apply. 1. Use protective eyewear. 2. Maintain Standard Precautions. 3. Preoxygenate the patient with 100% oxygen. 4. Quickly insert the catheter while suctioning. 5. Never suction longer than 10 to 15 seconds. 6. Repeat suctioning the tube until no secretions are obtained

1. Use protective eyewear. 2. Maintain Standard Precautions. 3. Preoxygenate the patient with 100% oxygen. 5. Never suction longer than 10 to 15 seconds. Patients should be preoxygenated with 100% oxygen for 30 seconds to 3 minutes to prevent hypoxemia and not continuously suctioned longer than 10 to 15 seconds. Nurses should wear protective eyewear and maintain Standard Precautions when suctioning. Suction should never be applied while inserting the catheter. There is a maximum of three suction passes for each suction attempt.

A patient is about to begin drug therapy for the treatment of tuberculosis (TB). What information is most important for the nurse to give to this patient prior to the start of therapy? 1. "Do not drink alcohol." 2. "Eat foods high in carbohydrates." 3. "Take medications in the morning." 4. "Limit ingestion of orange or grapefruit juice."

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

The nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). What questions asked by the nurse help in psychosocial assessment of the patient? Select all that apply. 1. "How many people live in your home?" 2. "How has your illness affected your lifestyle?" 3. "What do you eat and drink on a typical day?" 4. "When and how often do you use your inhaler?" 5. "Can you mark this line to show the amount of breathing difficulty you are having now?" 6. "Do you find it necessary to take a breath between every one or two words while speaking?"

1. "How many people live in your home?" 2. "How has your illness affected your lifestyle?" 4. "When and how often do you use your inhaler?" During the psychosocial assessment of a patient with COPD, the nurse should ask the patient about the number of people staying in the same home. Crowded living conditions promote the transmission of the respiratory infection. The nurse should also ask how the illness has affected the patient's lifestyle. Anxiety and fear from feelings of breathlessness can reduce the patient's ability to participate in a full life. Asking about limitations in lifestyle can also help in assessing the patient's use of support groups and community services. Inhalers are expensive, so many patients with limited incomes tend to use them only during exacerbations and not per the schedule; the nurse should ask about regular use of the inhaler during the psychosocial assessment of the patient. During the physical, not psychosocial, assessment, the nurse will ask about the food and fluid intake on a typical day, and also ask the patient to evaluate his or her shortness of breath by marking a line on a visual analog scale. The nurse asks whether the patient needs to take a breath between every one or two words that he or she speaks during the history assessment rather than during the psychosocial assessment.

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who is experiencing anxiety. Which of the patient's statements indicates that teaching about anxiety has been successful? Select all that apply. 1. "I will perform diaphragmatic breathing when I am anxious." 2. "I will attend counseling sessions during periods of emotional distress." 3. "I will seek medical assistance when I believe I may have an infection." 4. "I will take my prescribed antianxiety medication if I begin to feel panicky." 5. "I will ask for help if I have difficulty breathing while performing daily activities."

1. "I will perform diaphragmatic breathing when I am anxious." 2. "I will attend counseling sessions during periods of emotional distress." 4. "I will take my prescribed antianxiety medication if I begin to feel panicky." A patient with COPD can take self-care steps to reduce his or her anxiety. The patient may take antianxiety medication when experiencing severe anxiety, if prescribed. Performing diaphragmatic breathing when the patient is anxious can be calming. Counseling from a professional may help reduce stress and anxiety. The patient should seek medical help when the symptoms of infection are present, but this does not address the patient's anxiety. The patient asking for help when he or she has difficulty in breathing also does not address anxiety.

The nurse is counseling a patient whose parent has just been diagnosed with tuberculosis (TB). The patient tells the nurse that the parent was exposed several years ago, but developed symptoms only recently. What does the nurse tell this patient about the risk of contracting the disease? 1. "People are infectious to others only when symptoms are present." 2. "As soon as drug therapy is initiated, your parent will not be contagious." 3. "Since you have had prolonged contact with your parent, you are most likely infected." 4. "You will need to begin treatment for TB since you have been exposed to your parent."

1. "People are infectious to others only when symptoms are present." It is important to remind patients that people with TB are infectious only when manifestations of the disease occur. Patients being treated for TB are not considered contagious after 2 to 3 weeks of drug therapy. The only way to diagnose TB is with testing and by evaluation of symptoms. Treatment is initiated when the disease is confirmed.

The nurse is educating a patient and the caregivers at the time of discharge about home care after a tracheostomy. Which teachings would be beneficial for the patient? Select all that apply. 1. "Perform airway care." 2. "Wear a shower shield." 3. "Wear a medical alert bracelet." 4. "Maintain constant humidity at home." 5. "Avoid covering the opening of the stoma."

1. "Perform airway care." 2. "Wear a shower shield." 3. "Wear a medical alert bracelet." Airway care includes cleaning the stoma regularly, assessing the signs of infection, and using a clean suction technique to prevent infection. A shower shield should be worn over a tracheostomy tube to prevent water from entering the airway. A medical alert bracelet identifies a patient's inability to speak. The patient should maintain increased humidity at home as part of home care. Covering the openings will filter the air entering the stoma, which, in turn, keeps humidity in the airways and enhances the appearance.

Which of these are valuable instructions for the nurse regarding best practices for patient safety during oxygen therapy? Select all that apply. 1. "Position the tubing so it does not pull on the patient's face or the artificial airway." 2. "Mouth care should be infrequent to prevent irritation to the nasal cannula." 3. "The presence of smoking, lit matches, or candles in the immediate area is considered safe." 4. "Lubrication of the patient's nostrils, face, and lips is essential to prevent drying." 5. "Ensure that the oxygen and humidification equipment are functioning properly."

1. "Position the tubing so it does not pull on the patient's face or the artificial airway." 4. "Lubrication of the patient's nostrils, face, and lips is essential to prevent drying." 5. "Ensure that the oxygen and humidification equipment are functioning properly." During oxygen therapy, lubrication of the patient's nostrils, face, and lips with nonpetroleum cream is essential to relieve the drying effects of oxygen. For effective oxygen therapy, the oxygen and humidification equipment should be functioning properly. The tubing should be positioned in such a way that it does not pull on the patient's face or artificial airway. Mouth care is an integral part of caring for a patient who is undergoing oxygen therapy and should be provided every 8 hours or as needed. Care should be taken that smoking, lit matches, and candles are not present in the immediate vicinity of the oxygen therapy room or area because oxygen is combustible.

An adult has been diagnosed as having pulmonary tuberculosis. What direction should the nurse provide before the patient is started on isoniazid (INH) therapy? Select all that apply. 1. "Take a daily multivitamin." 2. "Avoid alcoholic beverages." 3. "Do not wear contact lenses." 4. "It is important to use contraceptives." 5. "Know the signs and symptoms of gout."

1. "Take a daily multivitamin." 2. "Avoid alcoholic beverages." Isoniazid (INH) can deplete the body of B-complex vitamins, so the patient should take a daily multivitamin. Alcoholic beverages should be avoided due to increased risk of liver damage. Rifampin causes staining of contact lenses and reduces the effectiveness of oral contraceptives. Gout is associated with the use of pyrazinamide and ethambutol.

A nurse is providing discharge instructions for a patient with active tuberculosis (TB) who has been prescribed isoniazid. What information about medication administration does the nurse include when providing discharge instructions? 1. "Take the drug on an empty stomach." 2. "Take the drug with food for better absorption." 3. "Take an antacid with the drug for better absorption." 4. "Take the drug with a full glass of water and increase your water intake."

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

A 75-year-old patient tells the nurse he is not planning to receive a "flu shot" this year because the shot makes him sick. What is the nurse's best response? 1. "The injectable flu vaccine is not a live virus and cannot cause influenza." 2. "If you had a 'flu shot' last year, you should still have immunity to influenza." 3. "If the shot makes you sick, your provider can order an antiviral medication." 4. "The virus in the injection is attenuated, meaning it can cause mild symptoms."

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

Which statement made by a student nurse indicates ineffective learning about dyspnea management? 1. "The patient should be resting in supine position." 2 "The patient should be sitting on a lounge or reclining chair." 3 "The patient should be provided with adequate oxygen supply." Incorrect4 "The patient should be provided with continuous morphine infusion."

1. "The patient should be resting in supine position." The patient with dyspnea should rest in a semi-Fowler's position to ease breathing. The patient should sit on a lounge or reclining chair because these chairs help maintain a semi-Fowler's position. Dyspnea can be reduced by adequate oxygen supply. The patient should be provided with a continuous morphine infusion to reduce pain.

A patient who had a rhinoplasty performed 1 day ago is to be discharged. Which instructions does the nurse include in discharge teaching? Select all that apply. 1. "Try to limit forceful coughing." 2. "Stay in a supine position and move slowly." 3. "You may take aspirin or ibuprofen for pain." 4. "Laxatives may be taken to prevent straining." 5. "Use cool compresses on your nose, eyes, and face." 6. "Do not blow your nose for a few days after packing is removed."

1. "Try to limit forceful coughing." 4. "Laxatives may be taken to prevent straining." 5. "Use cool compresses on your nose, eyes, and face." 6. "Do not blow your nose for a few days after packing is removed." For patients who have undergone rhinoplasty, cool compresses help reduce swelling. Bleeding can be caused by Valsalva maneuvers (coughing and straining with bowel movements) and blowing the nose too early in the healing process. Patients should stay in a semi-Fowler's position. Aspirin or NSAIDs should be avoided because they increase the risk for bleeding.

Which of these instructions reflects best practices for suctioning the artificial airway? Select all that apply. 1. "Wash hands." 2. "Don protective eyewear." 3. "Apply suction during insertion." 4. "Maintain standard precautions." 5. "Suction for longer than 10 to 15 seconds."

1. "Wash hands." 2. "Don protective eyewear." 4. "Maintain standard precautions." Best practices for patient safety and quality care while suctioning the artificial airway include washing hands, donning proper eyewear for protection, and maintaining standard precautions. Suction should not be applied during insertion or for longer than 10 to 15 seconds.

Which action does the nurse take if a patient develops bradycardia during nasopharyngeal suctioning? 1. Administer 100% oxygen by bag-valve-mask. 2. Complete the suctioning as quickly as possible. 3. Ask the patient to hold the breath and then cough. 4. Administer a bronchodilator using a small particle nebulizer.

1. Administer 100% oxygen by bag-valve-mask. Hyperoxygenating the patient can reverse bradycardia caused by vagal stimulation during suctioning. Bronchodilators are used if it becomes difficult to pass a suction tube to open the airways. Asking the patient to hold the breath will worsen the bradycardia because it will increase vagal stimulation. The nurse should oxygenate the patient before resuming suctioning.

A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The patient's 52-year-old caregiver asks the nurse if she should receive an annual influenza vaccination. What is the nurse's best response? 1. "Yes, you should receive the influenza vaccination by injection and should receive it every year." 2 "Yes, as long as you are healthy you can receive the intranasal spray influenza vaccine every year." 3. "No, as long as the patient has received the influenza vaccination by injection, you do not need it every year." 4. "No, as long as you are healthy you do not have an increased risk of spreading or becoming infected with influenza."

1. "Yes, you should receive the influenza vaccination by injection and should receive it every year." Yearly vaccination is recommended for those older than 50 years as well as those who care for those with chronic conditions. The live attenuated influenza vaccine (LAIV) by intranasal spray is recommended only for those who are healthy and only for those age 49 years or younger.

The nurse has been instructed to administer tuberculosis (TB) medication to a patient who has been noncompliant by directly observed therapy. Which statement by the nurse will assist the patient in understanding this therapy? 1. "You must swallow your pills in front of me." 2. "It is necessary for you to call me right after you take your medications." 3. "I will check your pill bottles every day to make sure you are taking your medications." 4. "I will meet you at the pharmacy to make sure you are picking up the correct prescriptions."

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

A 65-year-old patient with chronic obstructive pulmonary disease (COPD) asks the nurse about the best way to prevent pneumonia. What is the nurse's best response? 1. "You should get the pneumococcal polysaccharide vaccine." 2. "Stay away from large groups of people, especially children." 3. "See your health care provider at the first sign of respiratory infection." 4. "Ask your health care provider to prescribe prophylactic antibiotics."

1. "You should get the pneumococcal polysaccharide vaccine." Older patients with chronic lung disease should receive at least one PPV23 vaccine to prevent pneumonia. Prophylactic antibiotics are not widely used because of the increased risk of bacterial resistance. Making an appointment with the provider at the first sign of infection and staying away from large groups of people may be recommended, but are not the most important.

A patient is being admitted for pneumonia. The sputum culture is positive for streptococcus, and the patient asks about the length of the treatment. What is the best answer the nurse can give? 1. "You will be treated for 5 to 7 days." 2. "You must be afebrile for 24 hours." 3. "You will complete 6 days of therapy." 4. "You will require antibiotics for 7 to 10 days."

1. "You will be treated for 5 to 7 days." Anti-infectives usually are used for 5 to 7 days in uncomplicated community-acquired pneumonia (CAP) and for up to 21 days in an immune-compromised patient or one with hospital-acquired pneumonia (HAP). A patient may become afebrile early in the course of treatment with anti-infective medications; this may cause many patients to fail to complete their course of treatment.

A patient tells the nurse that after 3 weeks of multidrug therapy to treat tuberculosis (TB), the symptoms seem to have resolved. What does the nurse tell this patient? 1. "You will need to continue therapy for at least 6 months." 2. "Directly observed therapy will be necessary in your case." 3. "If a TB skin test is negative, you may stop taking the drugs." 4. "The provider may reduce the number of drugs you are taking."

1. "You will need to continue therapy for at least 6 months." Even though patients feel better and are no longer contagious, TB drug therapy must continue for 6 months or longer to avoid relapse and drug resistance. Directly observed therapy is used for patients who may have difficulty complying with treatment. It is important to continue taking all drugs in the regimen to avoid drug resistance.

The nurse performs follow-up care for a group of patients who have previously had tuberculosis. Which patients are most at risk for developing secondary tuberculosis (TB)? Select all that apply. 1. A 34-year-old with HIV infection 2. A 55-year-old who recently had abdominal surgery 3. A 14-year-old who is recovering from a broken femur 4. A 75-year-old who is recovering from a hip replacement 5. A 7-year-old who is undergoing chemotherapy for leukemia

1. A 34-year-old with HIV infection 4. A 75-year-old who is recovering from a hip replacement 5. A 7-year-old who is undergoing chemotherapy for leukemia Secondary TB is reactivation of the disease in a person previously infected. It is most likely to occur in patients with depressed immune systems such as the individual who has HIV, and the child undergoing chemotherapy. Another group of individuals at risk are older adults, so the 75-year-old recovering from the hip replacement would be at increased risk for developing secondary TB. A 55-year-old patient who recently had abdominal surgery would not be at risk because this patient is neither considered older or immunocompromised. Also, a 14-year-old recovering from a broken femur would not be considered high risk because the adolescent is not considered an older adult and is not immunocompromised.

Which clinical manifestations during status asthmaticus require immediate action? Select all that apply. 1. Absence of response to usual therapy 2. Irregular episodes of shortness of breath 3. Audible wheezing and increased respiratory rate 4. Sudden absence of wheezing, indicating airway obstruction 5. Development of pneumothorax and cardiac or respiratory arrest 6. Use of accessory muscles while breathing and distention of neck veins

1. Absence of response to usual therapy 4. Sudden absence of wheezing, indicating airway obstruction 5. Development of pneumothorax and cardiac or respiratory arrest 6. Use of accessory muscles while breathing and distention of neck veins Status asthmaticus is a severe and life-threatening condition. In this state, there is an absence of response to the usual therapy administered to acute asthma patients. The patient suddenly stops wheezing, which indicates an airway obstruction. If this condition is not reversed, the patient can develop a pneumothorax and go into cardiac or respiratory arrest. If the patient is using accessory muscles while breathing and distended neck veins are observed, the patient may require tracheotomy or intubation. Intermittent episodes of shortness of breath, audible wheezing, and increased respiratory rate are the usual symptoms observed during an asthma attack.

Which two factors in combination are the greatest risk factors for head and neck cancer? 1. Alcohol and tobacco use 2. Chronic laryngitis and voice abuse 3. Poor oral hygiene and use of chewing tobacco 4. Marijuana use and exposure to industrial chemicals

1. Alcohol and tobacco use The combination of alcohol and tobacco use is one of the greatest risk factors for head and neck cancer. Chronic laryngitis and voice abuse in combination are not the greatest risk factors; however, each one individually is a risk factor for head and neck cancer. No large, randomized, controlled studies have identified a relationship between marijuana use and head and neck cancer. Exposure to industrial chemicals may increase a person's risk. Poor oral hygiene is a risk factor, as is chewing tobacco; however, no studies have reported that a combination of the two will lead to increased risk. The same cancer-causing agents in smoking tobacco may be present in smokeless (chewing) tobacco.

An older patient is diagnosed with pneumonia. To assist with comfort during the admission interview, what does the nurse do? 1. Allows the patient to rest at frequent intervals 2. Gets the interview completed as quickly as possible 3. Places the patient in the bed immediately after arrival 4. Performs the physical assessment quickly and efficiently

1. Allows the patient to rest at frequent intervals Patients with pneumonia often have pain, fatigue, and dyspnea, which can cause anxiety. The nurse should allow frequent rest periods and should pace the interview and assessment according to the patient's fatigue level. The patient should be allowed to choose whether to get into bed or remain up in a chair.

Which statements about anthrax infection are correct? Select all that apply. 1. Although rarely occurring naturally, inhalation anthrax is nearly 100% fatal without treatment. 2. Toxins produced by the organisms in the lungs create massive edema, suppressing neutrophil action. 3. Dyspnea, diaphoresis, and sudden onset of breathlessness are common in late stages of the diseases. 4. Early on it is commonly accompanied by upper respiratory manifestations of sore throat or rhinitis. 5. As macrophages in the lungs engulf the anthrax spores, the organism leaves its capsule and replicates.

1. Although rarely occurring naturally, inhalation anthrax is nearly 100% fatal without treatment. 2. Toxins produced by the organisms in the lungs create massive edema, suppressing neutrophil action. 3. Dyspnea, diaphoresis, and sudden onset of breathlessness are common in late stages of the diseases. 5. As macrophages in the lungs engulf the anthrax spores, the organism leaves its capsule and replicates. Once inhaled, the anthrax organism forms a spore that is inactive. Once multiple spores are in the lungs, the macrophages in the lungs engulf them. The organism then leaves its capsule and replicates into active bacteria that produce toxins that are released into the infected tissues and blood. These toxins make the problem worse by creating massive edema in the infected tissues, suppressing neutrophil action, causing hemorrhage, and destroying lung cells and WBCs. Fulminant late-stage disease is characterized by sudden onset of breathlessness, dyspnea, diaphoresis and fever, stridor, hypoxia, pleural effusion, hypotension, and septic shock. During the early stage of the disease, a special feature of inhalation anthrax is that it is not accompanied by upper respiratory manifestations of sore throat or rhinitis; thus, it is difficult to diagnose early.

Which patients should receive education about pneumococcal vaccines? Select all that apply. 1. An adult older than 65 2. A patient who is pregnant 3. A patient who is HIV-positive 4. A patient who has alcoholism 5. A patient with chronic lung disease

1. An adult older than 65 3. A patient who is HIV-positive 4. A patient who has alcoholism 5. A patient with chronic lung disease Patients that should receive education about a pneumococcal vaccine include patients who are older than 65, have alcoholism, are HIV-positive, or have a chronic lung disease. A patient who is pregnant does not need to receive education about pneumococcal vaccines because this is not necessarily recommended for every pregnant patient.

A female patient presents to the ambulatory clinic with complaints of a cough. Which other signs or symptoms, if present, would cause the nurse to begin wearing an N-95 mask and place the patient in an isolated environment? Select all that apply. 1. Anorexia 2. Blood-streaked sputum 3. Menstrual irregularities 4. Sharp chest pain when coughing 5. Nighttime oral temperature greater than 101°F

1. Anorexia 2. Blood-streaked sputum 3. Menstrual irregularities Physical manifestations of tuberculosis include progressive fatigue, lethargy, nausea, anorexia, weight loss, irregular menses, and a low grade fever. A temperature of 101°F is not considered low grade. Other symptoms include blood-tinged rather than blood-streaked sputum and a dull aching pain upon coughing, not a sharp pain.

The nurse is reviewing home care instructions for a patient diagnosed with acute viral rhinitis. Which medication order does the nurse question? 1. Antibiotic 2. Antipyretic 3. Decongestant 4. Antihistamine

1. Antibiotic Antibiotics are prescribed for bacterial infections; the patient's infection is viral. A decongestant and antihistamine will decrease edema and help improve the stuffiness of rhinitis. An antipyretic is given to reduce any fever that patient might experience.

Which principles guide the nurse's support of the patient and family after a complete surgical laryngectomy? Select all that apply. 1. Aspiration cannot occur because the airway and esophagus have been completely separated. 2. The impact on quality of life is often poorly addressed by health care providers in the hospital. 3. Aspiration of food and liquids during swallowing will increase the risk for bronchial pneumonia. 4. With adequate speech and language training, communication can be understandable and meaningful. 5. Learning to swallow may be painful initially; persistence and emotional support are important.

1. Aspiration cannot occur because the airway and esophagus have been completely separated. 2. The impact on quality of life is often poorly addressed by health care providers in the hospital. 4. With adequate speech and language training, communication can be understandable and meaningful. 5. Learning to swallow may be painful initially; persistence and emotional support are important. Due to complete removal of the larynx, aspiration is not possible; therefore, aspiration of food and liquids during swallowing is not a concern. Swallow therapy is an important aspect of care during this time; learning to swallow may be painful and will require extensive support. Patients may develop bronchial pneumonia for other reasons and should be encouraged to maintain good bronchial hygiene. Multiple care needs during the postoperative acute phase often interfere with health care team members adequately hearing and addressing quality of life concerns. One important approach would be to connect the patient/family with community-based support resources and addressing their concerns as the patient stabilizes. Speech is also an important component of postoperative care and long-term management so that the patient can communicate with clarity and confidence.

The nurse is planning care for an 80-year-old long-term care patient who takes a histamine-2 blocker and who is confused most of the time. To help prevent pulmonary infection in this patient, which nursing action is included in the plan of care? 1. Assist the patient with all oral intake. 2. Provide postural drainage every 8 hours. 3. Administer prophylactic antibiotic medications. 4. Request an order for bronchodilator medications.

1. Assist the patient with all oral intake. Older patients who take H 2 blockers (which increase gastric pH) and who are confused are at risk for health-care acquired pneumonia. The nurse should plan to supervise the patient while eating. Prophylactic antibiotics are only used when an actual threat of pneumonia is likely. Bronchodilator medications and postural drainage are treatments for symptoms of pneumonia and are not used prophylactically unless bronchospasm or secretions are present.

Which points does the nurse include when educating an older patient and family about pneumonia prevention? Select all that apply. 1. Avoiding dehydration 2. Monitoring blood pressure 3. Avoiding crowded public places 4. Decreasing exposure to air pollutants 5. Receiving an annual influenza vaccine

1. Avoiding dehydration 3. Avoiding crowded public places 4. Decreasing exposure to air pollutants 5. Receiving an annual influenza vaccine Since pneumonia often follows influenza, an annual vaccination for the flu is important. It may also be beneficial to repeat the pneumonia vaccine if it has been more than 5 years since vaccination. Individuals with pneumonia or who are at risk for pneumonia are at increased risk for respiratory problems when exposed to air pollutants. Crowded public places should be avoided, especially during cold and flu season because of the risk of exposure to causative organisms. Dehydration, especially in older adults, will increase the difficulty of adequate bronchial hygiene. Although monitoring vital signs may be beneficial, blood pressure is probably less critical than monitoring for the presence of a fever.

Why are agonist and beta-adrenergic drugs ineffective in treating asthma in older adults? 1. Because of decreased sensitivity of receptors 2. Because of quick response to reliever therapy 3. Because of no response from reliever therapy 4. Because of the receptors causing bronchodilation

1. Because of decreased sensitivity of receptors With increasing age, the agonist and beta-adrenergic receptors become less sensitive. The decreased sensitivity of receptors leads to diminished response to agonist and beta receptor drugs. Aging slows, not quickens, response to reliever drug therapy, so the expected smooth muscle relaxation and bronchodilation is less. Despite the aging process, older adults still retain some response to reliever therapy. Bronchodilation is the desired response, so it is not a sign of ineffective drug therapy.

Which statements about chronic obstructive pulmonary disease (COPD) are correct? Select all that apply. 1. COPD includes emphysema and chronic bronchitis. 2. Because of increased mucus production, bronchitis leads to breathing problems in the alveoli. 3. Most emphysema is associated with smoking or chronic exposure to other inhalation irritants. 4. The increased risk of infection in COPD is related to increased mucus production and poor oxygenation. 5. Emphysematous lungs contain an increased number of proteases that destroy the normal lung tissue.

1. COPD includes emphysema and chronic bronchitis. 3. Most emphysema is associated with smoking or chronic exposure to other inhalation irritants. 4. The increased risk of infection in COPD is related to increased mucus production and poor oxygenation. 5. Emphysematous lungs contain an increased number of proteases that destroy the normal lung tissue. Although they are different diseases, both emphysema and chronic bronchitis fall under the COPD umbrella. Cigarette smoking is the greatest risk factor for COPD. Chronic inhalation of other irritants also contributes to this risk. Acute lung infections make COPD worse as a result of increased inflammation and mucus production and decreased oxygenation. Emphysematous lungs contain a higher number of proteases that damage the alveoli and the small airways by breaking down elastin. Chronic bronchitis leads to increased mucus production and airway problems; emphysema affects the alveoli.

A patient with an artificial airway is receiving oxygen at a rate of 4 L/min. The nurse notes that a humidifier bottle between the oxygen source and the patient is half-full of sterile water and that the water is bubbling. Which action by the nurse is correct? 1. Change the humidification device to a heated nebulizer. 2. Add water to the humidifier bottle until the water stops bubbling. 3. Remove the humidification device to minimize the risk of infection. 4. Increase the oxygen flow to 6 L/min to ensure adequate humidification.

1. Change the humidification device to a heated nebulizer. All patients receiving oxygen should have humidification to help minimize tissue trauma. Patients receiving oxygen through an artificial airway should have heated humidification to increase the humidity level. If the patient were receiving oxygen without an artificial airway, the water would be at an appropriate level and should be bubbling to be effective. Even though humidity increases the risk of infection, the correct action is to follow protocol for changing the equipment to prevent infection.

A patient has been started on ethambutol for tuberculosis. What adverse effect requires the patient to notify the provider? 1. Changes in vision 2. Darkening of the urine 3. Yellowing appearance of skin 4. Increased bruising or bleeding

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

The primary health care provider advises a patient with clubbed fingers, cyanosis on lips, dyspnea, and chest pain to undergo diagnostic assessment. Which is the first diagnostic assessment performed by the technician? 1. Chest X-ray 2. Thoracentesis 3. Cytology test of sputum 4. Computerized tomography

1. Chest X-ray Symptoms such as clubbed fingers, cyanosis on lips, dyspnea, and chest pain indicate lung cancer, and the first diagnostic assessment performed is a chest X-ray. Thoracentesis is a procedure of removing fluid from the pleural space. This fluid is taken for cytological assessment of the tumor. The cytological testing of early morning sputum may help identify tumor cells, but the tumor cells may or may not be present in the sputum. Following a chest X-ray, computerized tomography is performed for tumor cell identification.

A patient scheduled for a lobectomy to treat stage II cancer is anxious about the surgical procedure. Which preoperative teaching points may help decrease the patient's anxiety about the surgery? Select all that apply. 1. Chest tube and drainage system 2. Probable location for surgical incision 3. Shoulder exercises to increase comfort 4. Precautions to be taken about food before surgery 5. Postoperative risk of infection and interventions needed

1. Chest tube and drainage system 2. Probable location for surgical incision 3. Shoulder exercises to increase comfort Teaching the patient about the chest tube drainage system will prepare him or her to deal with the situation once the surgery is over. Teaching about the probable location of the surgery will help decrease the patient's anxiety. Teaching about shoulder exercises will help the patient deal with discomfort caused by the placement of the chest tube and the drainage system. Teaching the patient about dietary management, risks associated of postoperative infection, and necessary interventions will not decrease anxiety.

The nurse is caring for a patient who received bacille Calmette-Guérin (BCG) vaccine 2 years ago while living in another country. This patient is exhibiting signs and symptoms of tuberculosis. What methods does the nurse expect to be used to effectively evaluate this patient? Select all that apply. 1. Chest x-ray 2. Mantoux test 3. Sputum culture 4. Needle biopsy of lung 5. QuantiFERON-TB Gold test

1. Chest x-ray 5. QuantiFERON-TB Gold test The best way to evaluate an individual who received this vaccine 2 years ago for TB would be to perform a chest x-ray and/or a QuantiFERON-TB Gold test, which is a blood analysis using an enzyme-linked immunosorbent assay. It indicates the presence of TB within 24 hours. An individual who has received BCG vaccine within the last 10 years will react positively to a Mantoux test (intradermal tuberculin test). A sputum culture would not be ordered unless the chest x-ray indicated the possible presence of disease and a lung biopsy would not be indicated unless there were very definitive signs of TB and other tests had not been diagnostic.

Which disorders are lung diseases that cause chronic airflow limitation? Select all that apply. 1. Chronic bronchitis 2. Intermittent asthma 3. Upper lobe lung cancer 4. Subcutaneous emphysema 5. Inflammatory bronchospasm

1. Chronic bronchitis 2. Intermittent asthma Asthma, although usually presenting with intermittent attacks, is a chronic condition with reversible airflow obstruction in the airways. Chronic bronchitis is one of the conditions termed as chronic obstructive pulmonary disease (COPD) and involves increased mucus production, which can cause restricted airflow. Lung cancer, depending on its location in the lung, can cause restricted airflow in the lobe(s) of the lung that are obstructed; however, it is not regarded as part of the chronic airflow limitation (CAL) group of diseases, as the mechanism of restriction is different. Subcutaneous emphysema results when air has leaked into subcutaneous tissue—this is an acute situation that may be secondary to a tear in the trachea. Inflammatory bronchospasm actually combines the terms for the two mechanisms seen causing airway obstruction in asthma.

What is the greatest risk factor for lung cancer? 1. Cigarette smoking 2. Asbestos exposure 3. Smoking marijuana 4. Alcohol consumption

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

What are the two major categories of asthma medications? 1. Control and reliever 2. Preventive and quick acting 3. Steroids and bronchodilators 4. Bronchodilators and anti-inflammatories

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

A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen with a Venturi mask at a rate of 3 L/min. Prior to initiating oxygen therapy, the patient appeared anxious with gray skin, a respiratory rate of 24 breaths/min, and an oxygen saturation of 87%. After 15 minutes of oxygen therapy, the nurse observes the patient resting with closed eyes, pink coloration, a respiratory rate of 12 breaths/min, and an oxygen saturation of 95%. Which action by the nurse is correct? 1. Decrease the oxygen to 2 L/min to improve respiratory rate. 2. Increase the oxygen to 4 L/min to improve oxygen saturation. 3. Request an order for arterial blood gases to evaluate for hypercarbia. 4. Change the Venturi mask to a nasal cannula to further reduce anxiety.

1. Decrease the oxygen to 2 L/min to improve respiratory rate. Patients with chronic hypercarbia are at risk for oxygen-induced hypoventilation. Patients with COPD are more likely to have chronic hypercarbia. This patient has a slowed respiratory rate and an altered level of consciousness indicating hypoventilation, which can occur within the first 30 minutes of oxygen therapy. The nurse should reduce the oxygen flow to see if the respiratory rate improves. Although many patients with COPD become anxious with a facemask, this patient is currently not demonstrating signs of anxiety. Increasing the oxygen flow will only increase the risk for hypoventilation. An arterial blood gas will be a part of the ongoing assessment but will not distinguish between acute and chronic hypercarbia.

In a patient with a tracheostomy, the nurse notes that the cuff requires increasing amounts of air in order to maintain the seal and observes food particles in the tracheal secretions. Which tracheal complication does the nurse suspect occurred in this patient? 1. Dilation 2. Infection 3. Stenosis 4. Obstruction

1. Dilation Tracheomalacia occurs when the constant pressure from the cuff causes tracheal dilation and erosion of the cartilage. Manifestations of this condition are a need for increasing amounts of air in the tracheal tube cuff, food in tracheal secretions, and failure to receive the full tidal volume delivered by the ventilator. Tracheal infection is characterized by purulent drainage at the stoma site, along with redness, pain, and swelling. Tracheal stenosis involves scar formation caused by tracheal tube pressure and is usually observed after the tracheostomy tube is removed when stridor, difficulty breathing and swallowing, and coughing occur. Tracheal obstruction is characterized by an inability to move air in and out of the lungs.

Which method is the best way to prevent outbreaks of pandemic influenza? 1. Early recognition and quarantine 2. Avoiding public gatherings at all times 3. Widespread distribution of antiviral drugs 4. Vaccinating everyone with pneumonia vaccine

1. Early recognition and quarantine The recommended approach to disease prevention consists of early recognition of new cases and implementing community and personal quarantine to reduce exposure to the virus. Public gatherings should be avoided only if a widespread outbreak has occurred in a community. No vaccine is available for pandemic influenza. The pneumonia vaccine is recommended for high-risk populations because pneumonia may be a complication of influenza. The current influenza vaccine is updated, reevaluated, and changed yearly to meet anticipated changes in the virus. When a cluster of cases is discovered in an area, the antiviral drugs oseltamivir and zanamivir should be widely distributed to help reduce the severity of the infection and to decrease mortality.

Which is an example of a primary lung cancer prevention measure that the nurse can implement? 1. Educating about the risks associated with smoking 2. Encouraging early diagnosis and treatment for lung cancer 3. Providing evidence-based care for patients with lung cancer 4. Assisting a chemotherapy center to develop treatment protocols

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

A patient with pneumonia has difficulty clearing secretions in his airway, which are quite thick. Which nursing intervention does the nurse include in this patient's plan of care? 1. Encourage an intake of 2 liters of fluid per day. 2. Help the patient to ambulate several times daily. 3. Give intravenous antibiotics as ordered by the provider. 4. Administer pain medications on schedule to provide comfort.

1. Encourage an intake of 2 liters of fluid per day. Hydration is essential to help liquefy secretions so they can be mobilized more easily. The alert patient should be encouraged to drink at least 2 L per day. The other interventions may help indirectly and are part of the overall nursing management of pneumonia.

Which measure aids in reducing anxiety in a patient with head and neck cancer who is scheduled for surgery? 1. Encouraging the patient and family to discuss their fears 2. Discussing the cure rates and treatment options available to the patient and family 3. Teaching the patient and family about management of side effects of radiation therapy 4. Teaching the family how to administer emergency resuscitation with a tracheostomy

1. Encouraging the patient and family to discuss their fears Patients with head and neck cancer and their families can be extremely anxious before surgery as they face multiple unknowns. Attentive listening to their concerns, whatever they may be, serves to reduce some of the anxiety they are experiencing. No one can provide definite answers to all of the uncertainties they face; however, addressing the ones that are overwhelming them at this time will aid their comprehension of teaching and improve their overall experience. Teaching will be an important component of care; however, they must be able to effectively receive the information provided. Anxiety interferes with receptiveness and learning of new information. Cure rates and treatment options are important to discuss if that is their major concern and should be addressed when indicated but not as an automatic response to apparent anxiety.

Which nursing interventions are critical in caring for individuals with influenza? Select all that apply. 1. Encouraging the patient to rest and increase fluid intake 2. Supporting the patient and preventing the spread of the disease 3. Avoiding the use of oxygen as it has limited benefit and will be more likely to cause toxicity 4. Placing the patient in protective isolation until the patient's immune system fully recovers 5. Monitoring pulse rate and quality and urine output during rehydration in a patient with diarrhea

1. Encouraging the patient to rest and increase fluid intake 2. Supporting the patient and preventing the spread of the disease 5. Monitoring pulse rate and quality and urine output during rehydration in a patient with diarrhea Encouraging rest and promoting an increase in fluids is essential to promote healing. Influenza is highly contagious and emphasis should be placed on providing symptomatic support while preventing the spread of the disease to others. Assessment of pulse rate and quality and urine output will aid the health care team in monitoring the rehydration of patients who have lost significant body fluids secondary to diarrhea with the flu. Oxygen may be indicated as part of supportive care in an individual with hypoxia secondary to respiratory infections with the flu. The patient with influenza should be placed in isolation to prevent airborne spread of the disease to others.

A chest x-ray is ordered for an ambulatory patient receiving nasal oxygen. What does the nurse do when transport personnel come to get the patient? 1. Ensure portable oxygen is in place before transport to radiology. 2. Turn the oxygen rate up briefly before disconnecting for transport. 3. Call radiology and request that a portable chest x-ray be done at the bedside. 4. Since the patient will only be gone briefly, turn the oxygen off and then resume immediately upon return.

1. Ensure portable oxygen is in place before transport to radiology. Oxygen is a drug and should not be interrupted. It is the nurse's responsibility to ensure that the patient has an oxygen source during periods of transport so that oxygen delivery is not disrupted. A portable x-ray is not necessary if the patient is ambulatory. Neither hyperoxygenating nor disconnecting the oxygen is safe practice.

Which nursing assessment findings support a patient's new diagnosis of right-sided heart failure in a patient with chronic obstructive pulmonary disease (COPD)? Select all that apply. 1. Fatigue Incorrect2 Acidosis Incorrect3 Hypoxemia 4. Pulmonary hypertension 5. Enlarged and tender liver

1. Fatigue 4. Pulmonary hypertension 5. Enlarged and tender liver Fatigue, pulmonary hypertension, and an enlarged and tender liver are symptoms of cor pulmonale (right-sided heart failure). Acidosis and hypoxemia are complications of COPD, caused by reduced gas exchange; these symptoms lead to decreased oxygenation and increased carbon dioxide levels.

Which symptom of pneumonia may present differently in the older adult than in the younger adult? 1. Fever 2. Headache 3. Wheezing 4. Crackles on auscultation

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

The nurse suspects that a patient is in the prodromal stage of inhalation anthrax. Which assessment findings support the nurse's suspicion? Select all that apply. 1. Fever 2. Fatigue 3. Mild chest pain 4. Upper respiratory infection 5. Sudden onset of breathlessness

1. Fever 2. Fatigue 3. Mild chest pain The prodromal stage of inhalation anthrax is characterized by fever, fatigue, and mild chest pain. Upper respiratory infection and sudden onset of breathlessness may indicate the fulminant stage of inhalation anthrax.

Which of these are causative factors for hypoxia in a patient with tracheostomy? Select all that apply. 1. Frequent suctioning 2. Use of 14 Fr catheter 3. Limited suctioning time 4. Excessive suction pressure 5. Ineffective oxygenation before, during, and after suctioning

1. Frequent suctioning 4. Excessive suction pressure 5. Ineffective oxygenation before, during, and after suctioning In a patient with tracheostomy, hypoxia may be caused by frequent suctioning, excessive suction pressure, and ineffective oxygenation before, during, and after suctioning. Limited suctioning time is recommended. The standard catheter size is 12 Fr or 14 Fr; using 14 Fr sized catheter reduces the risk of hypoxia.

Which statement is true about community-acquired pneumonia (CAP) as compared to health care-associated pneumonia (HAP)? 1. HAPs are more likely to be resistant to some antibiotics. 2. In CAP, the fibrin and edema of inflammation stiffen the lung. 3. In CAP, capillary leak spreads the infection to areas of the lung. 4. CAPs are more difficult to treat due to their resistance to antibiotics.

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

An older adult patient was diagnosed with influenza 1 week ago. What direction should the nurse include in the teaching plan for the patient? Select all that apply. 1. Increase fluid intake. 2. Increase daily caloric intake. 3. Humidity can worsen symptoms. 4. Avoid the use of diphenhydramine. 5. Use appropriate hand-washing techniques.

1. Increase fluid intake. 4. Avoid the use of diphenhydramine. 5. Use appropriate hand-washing techniques. It is important to teach patients with influenza rhinitis the importance of increasing fluid intake to at least 2000 ml/day and appropriate infection prevention techniques such as hand washing. Older patients should avoid diphenhydramine because there is a risk for anticholinergic effects. There is no need to increase caloric intake with influenza. Humidifying the air helps relieve congestion.

A patient receiving oxygen via a simple facemask has a pulse oximetry level of 96% and a respiratory rate of 14 breaths per minute. Oxygen is being delivered at a flow rate of 4 L/min. What is the correct action by the nurse? 1. Increase the oxygen flow rate to 5 L/min and review the provider's orders. 2. Assess the patient at 30- to 60-minute intervals for evaluation of oxygenation status. 3. Suggest that the patient sit up straight and take several deep, slow breaths. 4. Request an order to decrease the flow rate to see if the patient can wean from oxygen.

1. Increase the oxygen flow rate to 5 L/min and review the provider's orders. A minimum flow rate of 5 L/min is needed for patients receiving oxygen via facemask to prevent the rebreathing of exhaled air. The nurse should increase the flow rate to this minimum level and then check the order. The nurse will assess the patient at regular intervals after ensuring the safe delivery of oxygen. If the patient can be weaned from oxygen, a nasal cannula will be used to prevent rebreathing of exhaled air. Asking the patient to sit up and take deep breaths is not necessary since the patient has an adequate respiratory rate and oxygen saturation.

A community health nurse is preparing teaching materials for an upcoming community health fair. What risk factors will the nurse include when teaching about community-acquired pneumonia? Select all that apply. 1. Increased age 2. Increased weight 3. Presence of a chronic condition 4. Administration of influenza vaccine within 3 years 5. Administration of pneumococcal vaccine within 3 years

1. Increased age 3. Presence of a chronic condition 4. Administration of influenza vaccine within 3 years Older adults and those with chronic conditions are at increased risk for developing community-acquired pneumonia. Additionally, those who have not received a yearly influenza vaccination are at increased risk for developing community-acquired pneumonia. While increased weight is a health problem, it is not a factor that increases the risk for developing community-acquired pneumonia. The pneumococcal vaccination is recommended every 5 years, not 3 years.

Which pulmonary diseases are caused by cigarette smoking? Select all that apply. 1. Lung cancer 2. Cystic fibrosis 3. Chronic bronchitis 4. Pulmonary arterial hypertension 5. Bronchiolitis obliterans organizing pneumonia

1. Lung cancer 3. Chronic bronchitis Lung cancer can occur because of repeated exposure to inhaled substances during smoking. Chronic bronchitis is caused by exposure to irritants such as cigarette smoke. Cystic fibrosis is caused by poor chloride transport. Drugs such as phentermine increase the risk for pulmonary arterial hypertension. Bronchiolitis obliterans organizing pneumonia is not caused by cigarette smoking.

Which groups are at greatest risk for drug-resistant Streptococcus pneumoniae? Select all that apply. 1. Individuals older than age 65 years 2. Those who have aspirated acidic stomach contents 3. People who have not received an influenza vaccine 4. People who have traveled outside the United States 5. Older adults exposed to children from a daycare environment

1. Individuals older than age 65 years 5. Older adults exposed to children from a daycare environment Individuals greater than age 65 and those exposed to children from a daycare environment are at greatest risk of drug-resistant Streptococcus pneumoniae. These factors should be part of the initial assessment of individuals presenting with symptoms of pneumonia. Although individuals who have aspirated acidic stomach contents are at risk for pneumonia, it is not as likely to be the drug-resistant Streptococcus pneumoniae variety. Since pneumonia often follows the flu, annual vaccination for influenza is important for all causative organisms. Individuals with respiratory symptoms should be queried regarding travel outside the United States; however, this is not a leading risk factor for drug-resistant Streptococcus pneumoniae.

Which statements about pulmonary tuberculosis (TB) are correct? Select all that apply. 1. Infected people are not infectious to others until manifestations of the disease occur. 2. Mycobacterium tuberculosis is transmitted from person to person via the airborne route. 3. An asymptomatic period of up to years or decades can follow the time of primary infection. 4. Foreign immigrants, especially from Mexico, the Philippines, and Vietnam, are at greatest risk. 5. Anergy is not a problem with the use of a TB skin test once a person presents with symptoms.

1. Infected people are not infectious to others until manifestations of the disease occur. 2. Mycobacterium tuberculosis is transmitted from person to person via the airborne route. 3. An asymptomatic period of up to years or decades can follow the time of primary infection. 4. Foreign immigrants, especially from Mexico, the Philippines, and Vietnam, are at greatest risk. Although lesions can spread to the brain, liver, kidney, or bone marrow once they invade the respiratory system, the human-to-human spread is via the airborne route and requires the use of appropriate precautions in individuals suspected to have TB until adequate treatment with drug therapy. Interestingly, the organism can actually remain inactive in the respiratory system for an extended period of time and then become active during immune suppression. Individuals who are free of symptoms during this time interval are not regarded as infectious to others and do not require isolation. In the United States, people who are at greatest risk for the development include immigrants who have been exposed to the organism prior to coming to the United States, especially those from Mexico, the Philippines, and Vietnam. Anergy is failure to have a skin response because of reduced immune function when infection is present and can be seen in older adults and individuals who are immunosuppressed.

A nurse is caring for a patient who is orally intubated and mechanically ventilated. The nurse understands that this patient is at an increased risk for developing ventilator associated pneumonia. When planning care for this patient, what pathophysiological concepts regarding an artificial airway does the nurse recognize as a contributing factor to the development of this condition? Select all that apply. 1. It bypasses the protective airway mechanisms 2. It alters and decreases the body's immune response 3. It prevents adequate gas exchange at the cellular level 4. It causes a hyperactive reaction of the mucociliary clearance 5. It allows aspiration of secretions from the oropharynx and stomach

1. It bypasses the protective airway mechanisms 5. It allows aspiration of secretions from the oropharynx and stomach An artificial airway, or endotracheal tube, bypasses the normal protective airway mechanisms when inserted into the trachea. It also allows aspiration of secretions from the oropharynx and stomach, increasing the risk for developing ventilator associated pneumonia. The immune response is not decreased by the presence of an artificial airway. Intubation and mechanical ventilation improve rather than prevent gas exchange at the cellular level. The mucociliary clearance of the lungs may be impaired rather than hyperactive in the presence of an artificial airway.

A patient with suspected initial infection of tuberculosis (TB) is admitted to the respiratory intensive care unit (ICU). The nurse caring for the patient reviews the patient's recent chest x-ray. Where on the patient's chest x-ray will the nurse most likely find evidence of the patient's infection? Select all that apply. 1. Left lower lobe 2. Left upper lobe 3. Right lower lobe 4. Right upper lobe 5. Right middle lobe

1. Left lower lobe 3. Right lower lobe 5. Right middle lobe Initial infection of tuberculosis (TB) is most often seen in the middle or lower lobes of the lung. The upper lobes of the lung are not the primary location of initial infection of TB.

What signs and symptoms does the nurse anticipate to find in a patient diagnosed with tuberculosis? Select all that apply. 1. Lethargy 2. Dyspnea 3. Weight gain 4. Night sweats 5. Low-grade fever

1. Lethargy 4. Night sweats 5. Low-grade fever Expected assessment findings in a patient diagnosed with tuberculosis include lethargy, night sweats, and a low-grade fever. Dyspnea does not occur with tuberculosis. Weight loss and anorexia occur in patients with tuberculosis.

A patient who is receiving radiation therapy for lung cancer is experiencing esophagitis. The nurse consults with a registered dietitian who recommends which element as part of the patient's diet? 1. Liquid nutrition supplements 2. Nasogastric enteral nutrition 3. Warm liquids such as broth or tea 4. Cool, clear liquids, such as popsicles

1. Liquid nutrition supplements Patients with esophagitis caused by radiation therapy will have difficulty meeting nutritional needs, and the nurse should recommend liquid nutrition supplements to boost calories. Cool, clear liquids or warm liquids are not calorie-dense and will not improve nutritional status. Enteral feedings are not recommended; a nasogastric tube will cause irritation of the esophagus.

Which is the leading cause of cancer-related deaths in North America? 1. Lung cancer 2. Colon cancer 3. Breast cancer 4. Prostate cancer

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

A patient taking antibiotics to treat rhinosinusitis reports facial pain over the affected sinuses. Which comfort measure does the nurse suggest in addition to the antibiotic therapy? 1. Moist heat packs over the affected sinuses 2. Tilting the head forward to relieve discomfort 3. Anticoagulant medications to reduce pressure 4. Frequent nose-blowing to clear sinus passages

1. Moist heat packs over the affected sinuses Moist heat packs over the sinuses can alleviate some discomfort. Decongestant medications are not indicated. Frequent nose-blowing is not recommended. Patients should be taught to avoid placing the sinuses in a dependent position.

The nurse finds a blood clot in the drainage tube from the chest tube of a patient who underwent a thoracotomy 8 hours ago. Which nursing intervention would be done to prevent complications? 1. Move the clot down the tube gently using both hands to help prevent obstruction of the system. 2 Ensure that the drainage system is lower than the level of the patient's chest so that the clot is collected in the drainage chamber. 3 Empty the collection chamber before the drainage makes contact with the bottom of the tube to prevent the clot from re-entering the patient's chest wall. Incorrect4 Gently apply a padded clamp temporarily on the drainage tubing to close the occlusive dressing that prevents the clot entering into the patient's chest.

1. Move the clot down the tube gently using both hands to help prevent obstruction of the system. When a blood clot is observed in the tubing of a chest tube drainage system, moving the tube gently between both hands without stopping ("milking" the tube) will help move the blood clot and prevent obstruction of the system. Ensuring that the drainage system is lower than the level of the patient's chest allows gravity to drain the pleural space. This action should always be done, not just in the case of a blood clot in the tubing. Emptying the collection chamber before the drainage makes contact with the bottom of the tube prevents the drained fluid from re-entering the body. This action should always be done, not just in the case of a blood clot in the tubing. Applying a padded clamp on the drainage tubing is to check for any air leaks within the chest. This is not correct management of a blood clot in the tubing.

A patient with tuberculosis (TB) who is homeless and has been living in shelters for the past 6 months asks the nurse why he must take so many medications. What information will the nurse provide in answering this question? Select all that apply. 1. Multiple drug regimens destroy organisms as quickly as possible. 2. Combination drug therapy is effective in preventing transmission. 3. Combination drug therapy is the most effective method of treating TB. 4. The use of multiple drugs reduces the emergence of drug-resistant organisms. 5. Combination drug therapy will decrease the length of required treatment to 2 months.

1. Multiple drug regimens destroy organisms as quickly as possible. 2. Combination drug therapy is effective in preventing transmission. 3. Combination drug therapy is the most effective method of treating TB. 4. The use of multiple drugs reduces the emergence of drug-resistant organisms. Combination drug therapy is the most effective method for treating TB and preventing transmission. Multiple drug regimens are able to destroy organisms as quickly as possible and reduce the emergence of drug-resistant organisms. Although combination drug therapy will decrease the required length of time for treatment, the length of treatment is decreased to 6 months from 6 to 12 months.

Which assessment findings does the nurse anticipate for the patient suspected of having pneumonia? Select all that apply. 1. Myalgia 2. Dyspnea 3. Bradypnea 4. Bradycardia 5. Hemoptysis

1. Myalgia 2. Dyspnea 5. Hemoptysis Assessment findings typical of pneumonia include myalgia, dyspnea, and hemoptysis. Tachypnea, not bradypnea, and tachycardia, not bradycardia, are expected findings in a patient with pneumonia.

What clinical manifestation related to respiratory difficulty does the nurse expect to observe in a patient who has experienced laryngeal trauma? 1. Nasal flaring 2. Increased nasopharyngeal secretions 3. Poor response to humidification of oxygen 4. Decreased oxygen saturation and CO 2 levels

1. Nasal flaring Laryngeal trauma is likely to cause obstruction of the trachea. Nasal flaring is a manifestation of the body's attempt to compensate and bring in more oxygen. If the patient cannot compensate and bring in adequate oxygen, the saturation level will gradually decrease. The CO 2 level will most likely increase. Humidification may be indicated for long-term use, especially for high-flow oxygen, but poor response to humidification is not a manifestation of respiratory difficulty. Increased nasopharyngeal secretions would not necessarily be present as a result of laryngeal trauma.

What is indicated if the laboratory report of a patient with suspected lung cancer shows purulent and copious sputum? 1. Necrosis 2. Bronchitis 3. Hemoptysis 4. Pneumonitis

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

Which principles are important for the nurse to remember about oxygen administration? Select all that apply. 1. Nitrogen helps prevent alveolar collapse, as it doesn't cross over capillary membranes. 2. When a patient experiences air hunger, increase the PaCO 2 to improve the balance. 3. It is important to keep the patient's PaO 2 at greater than 90 mm Hg for optimal outcomes. 4. Oxygen is harmless; it is part of what we breathe normally and toxicity is unlikely. 5. High levels of oxygen dilute the nitrogen in the lungs leading to alveolar collapse.

1. Nitrogen helps prevent alveolar collapse, as it doesn't cross over capillary membranes. Nitrogen, which is 79% of room air, helps to prevent alveolar collapse because it doesn't cross over the capillary membranes into the blood. High levels of oxygen administration dilute the nitrogen when it diffuses across the membrane into the circulation, and the alveoli collapse, leading to atelectasis. Oxygen administration can cause toxicity and must be monitored closely. An increased PaCO 2 will result when the patient is retaining CO 2; this is not a desirable state. PaO 2 levels of greater than 90 mm Hg should be reported to the health care provider.

A patient who has begun standard multidrug treatment for tuberculosis (TB) reports orange-tinged sputum and urine. The nurse tells the patient that this symptom represents which response to the treatment regimen? 1. Normal drug side effects of rifampin 2. Hemolysis and a potential for anemia 3. Drug resistance with spread of infection 4. Hepatotoxicity caused by drinking alcohol

1. Normal drug side effects of rifampin Orange-colored body secretions are an expected side effect of rifampin, one of the standard medications used for TB treatment. The orange color does not indicate spread of infection or hemolysis. Although alcohol and rifampin can cause hepatotoxicity, the orange color is not a sign of this complication.

The nurse is caring for a patient after extensive head and neck surgery and notes a small area of bright-red blood on the dressing, which is bigger 30 minutes later. Which nursing action is important to take? 1. Notify the Rapid Response Team. 2. Move the patient to an upright position. 3. Reinforce the dressing with clean gauze. 4. Apply pressure to the site to stop bleeding.

1. Notify the Rapid Response Team. Patients who have undergone extensive head and neck surgery are at increased risk for carotid rupture, which can be life-threatening. The nurse should notify the Rapid Response Team. Reinforcing the dressing does not help stop bleeding. Applying pressure could rupture the artery. Pressure should be applied in the event of a rupture.

The nurse is caring for a patient the day after tracheostomy placement and notes new swelling around the tube. When gently palpating the area, the nurse feels a crackling sensation. What is the appropriate response? 1. Notify the health care provider immediately. 2. Apply an occlusive pressure dressing around the tube. 3. Reevaluate in 2 hours as this is a normal finding after surgery. 4. Ensure the tracheostomy tube is well-secured and there is no tension.

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

Which actions known as the "ventilator bundle" have been shown to reduce the incidence of ventilator-associated pneumonia (VAP)? Select all that apply. 1. Oral care 2. Hand hygiene 3. Head-of-bed elevation 4. Equipment decontamination 5. Careful monitoring of oxygen levels

1. Oral care 2. Hand hygiene 3. Head-of-bed elevation Hand hygiene, oral care, and head-of-bed elevation are the three interventions known as a "ventilator bundle" aimed at reducing VAP. Diligent oral care using agents to reduce organisms and provide moisture is especially important for nurses to perform to accomplish this goal. Monitoring for hypoxia and diligent equipment decontamination are indeed important in the care of the patient with pneumonia, but not "packaged" as part of the "ventilator bundle."

Which pathological findings associated with pneumonia result in an increased respiratory rate and dyspnea? Select all that apply. 1. Pain 2. Anxiety 3. Alveolar consolidation 4. Stimulation of J receptors 5. Pulmonary capillary shunting

1. Pain 2. Anxiety 4. Stimulation of J receptors Pathological findings associated with pneumonia that result in an increased respiratory rate and dyspnea include pain, anxiety, and stimulation of the J receptors. Alveolar consolidation and pulmonary capillary shunting result in hypoxemia.

What is a key difference between seasonal influenza and pandemic influenza? 1. Pandemic influenza has the potential to spread globally because of its highly infectious nature in humans. 2. Seasonal influenza is caused by viral infections; pandemic influenza is more likely to be bacterial in nature. 3. People over the age of 50 who have chronic illness should be vaccinated yearly to decrease the risk of pandemic influenza. 4. Humans have a natural resistance to viral infections found in animals and birds and do not require immunization against pandemic influenza.

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

Which disorder of the lungs may feature a distinct "whooping" sound in children that may not be present in adults? 1. Pertussis 2. Tuberculosis 3. Inhalation anthrax 4. Coccidioidomycosis

1. Pertussis The distinct "whooping" sound of pertussis that is common in children at the end of a cough may not be present in adults. Tuberculosis, inhalation anthrax, and coccidioidomycosis are not associated with this "whooping" sound.

A patient is admitted to the emergency department (ED) with a possible diagnosis of avian influenza ("bird flu"). Which of these actions included in the hospital protocol for avian influenza should the nurse take first? 1. Place the patient in a negative air pressure room. 2. Ensure that ED staff members receive oseltamivir. 3. Start an IV line and administer rehydration therapy. 4. Obtain specimens for the H5 polymerase chain reaction test.

1. Place the patient in a negative air pressure room. If a patient is exhibiting symptoms of avian flu or any other pandemic influenza, he or she is assumed to be contagious until proven otherwise. Protecting the spread of disease to the community is the top priority, so placing the patient in a negative air pressure room is the nurse's first action. If avian influenza is diagnosed, it is important that those exposed receive oseltamivir or zanamivir within 48 hours of contact with the patient. Obtaining specimens will be important to determine whether the patient has avian influenza; this test takes approximately 40 minutes to complete. A patient with avian flu will become dehydrated because of diarrhea so starting an IV to administer rehydration fluid is important, but is not the first priority.

A patient has just been admitted to the emergency department and requires high-flow oxygen therapy after suffering facial burns and smoke inhalation. Which oxygen delivery device should the nurse use initially? 1.Face tent 2. Venturi mask 3. Nasal cannula 4. Non-rebreather mask

1.Face tent A patient with smoke inhalation and facial burns who requires high-flow oxygen should initially be placed on a face tent because this is the only noninvasive high-flow device that will minimize painful and contaminating contact with burned facial tissue. Although a Venturi mask and a non-rebreather mask are high-flow oxygen delivery devices, they require snug fitting on the face, which can be painful and can introduce infection to compromised facial skin. A nasal cannula is not a high-flow device.

A patient with a tracheostomy is receiving feedings via a nasogastric tube, during which the patient experiences increased coughing and choking. The nurse notes that the tracheostomy cuff requires increasing amounts of air to maintain the seal, and when suctioning the tracheostomy, food particles are present in the tracheal secretions. After notifying the provider of these observations, which procedure does the nurse expect to be performed? 1. Placement of a jejunostomy tube 2. Tracheal dilatation in the operating room 3. Insertion of a fenestrated tracheostomy tube 4. Reintubation with a larger tracheostomy tube

1. Placement of a jejunostomy tube This patient has signs of a tracheoesophageal fistula, where excessive cuff pressure causes an erosion of the posterior wall of the trachea and into the anterior esophagus. Patients who develop this should either be fed with a very small bore feeding tube or should have surgical placement of a gastrostomy or jejunostomy tube. A fenestrated tracheostomy tube is used to facilitate coughing or speaking. Placing a larger tracheostomy tube will increase pressure on the tracheal wall. The trachea does not need to be dilated.

Which may be the most common feature of pneumonia and lung abscesses? 1. Pleuritic chest pain 2. Rust-colored sputum 3. Foul-smelling sputum 4. Mucopurulent sputum

1. Pleuritic chest pain Pleuritic chest pain is the common feature of pneumonia and lung abscesses. Rust-colored sputum is seen in pneumonia. Foul-smelling sputum is seen in lung abscesses. Mucopurulent sputum is seen in tuberculosis.

Which nursing action will decrease the risk of aspiration in a patient with head and neck cancer who has undergone a supraglottic partial laryngectomy? 1. Positioning the patient upright for all meals and medications 2. Starting the patient on clear liquids before advancing the diet 3. Maintaining the nasogastric/feeding tube for adequate nutrition 4. Having the patient take multiple swallows of liquid with each bite of food

1. Positioning the patient upright for all meals and medications Upright positioning is an important intervention to decrease the risk of aspiration in patient with head and neck cancer during eating and drinking. The presence of a nasogastric/feeding tube actually increases the risk of aspiration as it interferes with the normal swallowing mechanism. In addition, taking multiple swallows of liquid with each bite of food "to wash it down" does not improve eating and actually increases the risk for aspiration. Evidence has shown that thickening the consistency of all liquids will help to decrease the risk of aspiration and improve swallowing.

Which factors assist the nurse in determining if fluid leaking from the nose is cerebrospinal fluid (CSF) or normal nasal secretions? Select all that apply. 1. Positive glucose test on a dipstick 2. Yellow halo ring on filter paper as the fluid dries 3. Characteristic color of the fluid on the nasal pack 4. Report by the patient of a "weird" taste in the mouth 5, Fluid that only drains from one side of the patient's nose

1. Positive glucose test on a dipstick 2. Yellow halo ring on filter paper as the fluid dries When patients have experienced facial trauma, it may be difficult to visually differentiate clear nasal drainage from a CSF leak. CSF contains glucose and will test positive on a dipstick for glucose. In addition, when CSF dries on filter paper, a yellow halo ring will appear around the dried fluid. Taste changes may occur for a variety of reasons, including medications, and are not indicative of CSF leaks. Both CSF and nasal drainage have a similar appearance on the nasal pack. Unilateral or bilateral drainage of fluid does not identify the source.

A patient is brought to the emergency department with labored breathing, wheezing, and marked use of accessory muscles. The patient has a low PaO 2 and low PaCO 2 and is receiving oxygen by nasal cannula at a rate of 2 L/min. After the patient has received an aerosolized bronchodilator medication, the nurse assesses no wheezes and an oxygen saturation of 82%. What is the next action by the nurse? 1. Prepare for emergency intubation. 2. Increase the oxygen flow to 4 L/min. 3. Administer a second aerosolized bronchodillator. 4. Request an order for a systemic steroid medication.

1. Prepare for emergency intubation. Sudden absence of wheezing in a patient with severe asthma symptoms can indicate complete airway obstruction and may require tracheotomy. The nurse should prepare for emergency intubation. Administering more medication or increasing the oxygen will not be effective if the airway is obstructed. Systemic steroid medications do not have a rapid onset.

A nurse is caring for a patient with community-acquired pneumonia. The patient's oxygen saturation is 88% on room air. The patient is writhing in pain and cries out, "It hurts so bad to take a deep breath. I can't even cough it hurts so bad." Understanding the patient's condition, what is the nurse's priority intervention for this patient? 1. Provide the patient with supplemental oxygen 2. Encourage the patient to deep breathe and cough 3. Administer the ordered opioid analgesic medication 4. Instruct the patient on splinting the chest when breathing

1. Provide the patient with supplemental oxygen The patient in the described scenario is experiencing impaired gas exchange, a potential life-threatening condition. The nurse's priority intervention is to provide the patient with supplemental oxygen. Encouraging the patient to deep breathe and cough, administering the ordered opioid analgesic medication, and instructing the patient on splinting the chest when breathing are all appropriate nursing interventions; however, these are not the priority interventions for this patient.

A patient who is taking isoniazid and rifampin to treat tuberculosis reports reddish-orange urine. Which action should the nurse take? 1. Reassure the patient that this is an expected drug side effect. 2. Encourage the patient to increase fluids to 2 L or more per day. 3. Request an order to change the isoniazid to another anti-tubercular drug. 4. Notify the provider and request an order for a complete blood count and creatinine clearance.

1. Reassure the patient that this is an expected drug side effect. Reddish-orange coloring of urine and other body fluids is a common, harmless side effect of rifampin therapy. The nurse would reassure the patient that this is an expected effect of the medication. The patient does not need to increase fluids since the color change does not indicate dehydration. The drug regimen does not need to be changed, since the discoloration is expected and harmless. Labs are not necessary since the discoloration does not indicate a change in white blood cells or kidney function.

The nurse is discussing pneumonia prevention techniques with a group of adults older than age 60. What information should this nurse tell this group? Select all that apply. 1. Receive an annual influenza vaccination. 2. Drink approximately 1 liter of fluid each day. 3. Avoid interacting with individuals who smoke. 4. Attempt to get 6 to 8 hours of sleep every night. 5. Receive an annual pneumococcal pneumonia vaccination.

1. Receive an annual influenza vaccination. 3. Avoid interacting with individuals who smoke. 4. Attempt to get 6 to 8 hours of sleep every night. Teachings that are important to communicate about pneumonia prevention include a yearly influenza vaccine and a pneumococcal vaccine as needed. Other teaching points include smoking cessation and the avoidance of secondhand smoke, and getting adequate sleep and rest. Patients should also be taught to drink at least 3 liters of fluid each day unless fluid restrictions are present. The pneumococcal vaccine is not given annually; it is usually only given once to patients aged 65 or older but may be given 5 years after the first vaccination to a patient at high risk for pneumonia.

A newly diagnosed patient with asthma says that his peak flow meter is reading 82% of his personal best. What does the nurse do? 1. Repeat the peak flow test. 2. Nothing. This is in the green zone. 3. Provide the rescue drug and reassess. 4. Provide the rescue drug and seek emergency help.

1. Repeat the peak flow test. Since the patient is newly diagnosed with asthma, this would be an excellent opportunity for the nurse to observe the patient using the peak flow meter to ensure that the patient is using it properly, so readings are accurate and in the green zone, at least 80% of the patient's personal best. The result of 82% is in the green zone, but this is not the best answer for a newly diagnosed patient. Rescue drugs should be used only in the yellow zone, between 50% and 80% of the patient's personal best. They should not be used in this situation, and the nurse does not need to seek emergency help until readings are in the red zone, or below 50% of the patient's personal best.

Which upper respiratory infection is often triggered by a hypersensitivity reaction to airborne allergens? 1. Rhinitis 2. Sinusitis 3. Tonsillitis 4. Pharyngitis

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

Following a bioterrorism attack with anthrax, the emergency department nurse checks the medication room for ample supply of which medications? Select all that apply. 1. Rifampin 2. Gentamicin 3. Amoxicillin 4. Vancomycin 5. Doxycycline 6. Ciprofloxacin

1. Rifampin 3. Amoxicillin 4. Vancomycin 5. Doxycycline 6. Ciprofloxacin Ciprofloxacin, in combination therapy with one or more of the drugs doxycycline, amoxicillin, rifampin, and vancomycin, is used for exposure and actual infection. Therefore, all of these medications should be on hand. Gentamicin is not a drug used to treat anthrax infection.

What should the nurse include when instructing a patient about safe practice for home-care oxygen therapy? Select all that apply. 1. Safety precautions 2. Maintenance of equipment 3. Equipment needed for home oxygen therapy 4. Nonnecessity of selecting a community health nursing agency 5. Nonnecessity of reevaluating the need for home oxygen therapy

1. Safety precautions 2. Maintenance of equipment 3. Equipment needed for home oxygen therapy When a patient is taught about self-management of home-care oxygen therapy, it includes safety precautions and how to maintain the equipment. The nurse should also instruct the patient about the equipment required for home oxygen therapy, which may include the oxygen source, delivery devices, and humidity sources. Reevaluation of the need for home oxygen therapy is required on a periodic basis. It is vital to have a community health nursing agency available for follow-up care in the home.

Which patient teaching point could conceivably prevent the majority of all lung cancers? 1. Smoking cessation 2. Genetic testing for risk 3. Use of respirators in at-risk jobs 4. Radiologic examination of smokers

1. Smoking cessation Cigarette smoking is responsible for 85% of all lung cancer deaths and is regarded as the major risk factor; it increases the risk for smokers as well as those exposed to passive smoke. Although more information is being gained about genes and lung cancer risks, knowledge does not yet enable prevention of the disease. Use of proper masks and respirators when exposed to carcinogenic inhalants would decrease the risk of lung cancer for a smaller population, but not to the extent of smoking cessation. In addition, smoking actually increases the risk of lung cancer in individuals exposed to other occupational carcinogenic inhalants. The use of radiologic screening of smokers has improved the early detection of disease, but it is not a preventive measure.

Respirations of a sedated patient with a new tracheostomy have become noisy, and the ventilator alarms indicate high peak pressures. The ventilator tube is clear. What is the best immediate action by the nurse? 1. Suctioning the patient 2. Increasing oxygenation 3. Humidifying the oxygen source 4. Removing the inner cannula of the tracheostomy

1. Suctioning the patient Suctioning the patient will likely result in clear lung sounds and lower peak pressure, and the appearance of the sputum will indicate whether bleeding is a concern. Humidifying the oxygen source will help mobilize secretions, but an active cough response is also required to clear the airway; a sedated patient has a weak cough. Increasing oxygenation does nothing to clear the airway of whatever is making it noisy and is elevating peak pressures. Removing the inner cannula of a ventilated patient is contraindicated.

The nurse is caring for a patient who comes to the clinic because of a cough. What symptom of the cough will lead the nurse to believe that the health care practitioner will order testing for pertussis? 1. The patient reports that the cough has lasted more than 3 weeks. 2. The patient states that sometimes it seems like he is wheezing when he coughs. 3. The patient states that the cough is caused by a "tickle" in the back of the throat. 4. The patient says that the cough is productive with green and yellow colored sputum.

1. The patient reports that the cough has lasted more than 3 weeks. An individual who reports a cough that lasts longer than 3 weeks should be tested for pertussis. The pertussis cough is not accompanied with wheezing, does not have green or yellow sputum, and is not caused by a "tickle" (drainage).

The nurse is performing health assessments at an ambulatory walk-in clinic. Which patients would the nurse consider at risk for tuberculosis? Select all that apply. 1. The patient who abuses alcohol 2. The patient who has congestive heart failure 3. The patient who recently emigrated from Spain 4. The patient who doesn't have a permanent residence 5. The patient recently released from a corrective facility

1. The patient who abuses alcohol 4. The patient who doesn't have a permanent residence 5. The patient recently released from a corrective facility Individuals who are most at risk for the development of tuberculosis are those who are in close contact with, among others, people who abuse drugs or alcohol, older homeless people, and people who live in crowded facilities such as homeless shelters or prisons. An individual with congestive heart failure and someone who is a recent immigrant from Spain would not be at risk for TB.

Which statements about surgical options for laryngeal cancer are correct? Select all that apply. 1. Total laryngectomy eliminates all natural voice. 2. Normal speech is unlikely with a laryngofissure. 3. Transoral cordectomy has a very low cure rate with cancer. 4. Laser surgery destroys tumor(s) and preserves vocal cords. 5. Vertical laryngectomy will require an artificial speech device.

1. Total laryngectomy eliminates all natural voice. 4. Laser surgery destroys tumor(s) and preserves vocal cords. There are multiple options for individuals with laryngeal cancer—the best option must be based on the type and extent of the disease. Since a total laryngectomy removes the entire larynx, all natural voice is eliminated. Laser surgery has become increasingly popular as it allows an increased focus on the preservation of the vocal cords. For individuals with an early lesion, the tumor can be resected through a laryngoscope, thus preserving the vocal cords and providing a high cure rate. In a vertical laryngectomy, one true cord, one false cord, and one-half of the thyroid cartilage are removed; these individuals will have the ability to speak, but their voice will sound hoarse. The laryngofissure is a beneficial procedure with curative potential for individuals with an early lesion and limited disease; no vocal cord is removed so the normal voice can be preserved.

What are typical postoperative concerns after a new tracheostomy? Select all that apply. 1. Tube obstruction 2. Tube dislodgement 3. Accidental decannulation 4. Securing the endotracheal tube 5. Plugging the tube for communication

1. Tube obstruction 2. Tube dislodgement 3. Accidental decannulation Maintaining patency of the airway is a primary concern after a new tracheostomy. Tube obstruction, dislodgement, or decannulation can cause an airway emergency. Plugging the tube for communication will not be a priority in the immediate postoperative period. Communication should rely on nonverbal techniques such as sign boards, etc. This patient would most likely not have an endotracheal tube.

A patient has been diagnosed with community-acquired pneumonia (CAP). What risk-factors are associated with CAP? Select all that apply. 1. Use of tobacco 2. Recent aspiration 3. History of chronic lung disease 4. Pneumococcal vaccine more than 5 years ago 5. Presence of gram-negative colonization of the mouth and throat

1. Use of tobacco 4. Pneumococcal vaccine more than 5 years ago Risk factors for community-acquired pneumonia include smoking and receiving the pneumococcal vaccine longer than 5 years ago. Recent aspiration, chronic lung disease, and gram-negative colonization are risk factors for health care-acquired pneumonia.

Which nursing interventions are focused on preventing the spread of severe acute respiratory syndrome (SARS) caused by coronaviruses? Select all that apply. 1. Using strict airborne isolation techniques 2. Handwashing before and after all patient care 3. Disinfecting contaminated surfaces and equipment 4. Using Contact Precautions with people suspected to have SARS 5. Reporting the occurrence to the Centers for Disease Control and Prevention (CDC)

1. Using strict airborne isolation techniques 2. Handwashing before and after all patient care 3. Disinfecting contaminated surfaces and equipment 4. Using Contact Precautions with people suspected to have SARS Since the SARS virus is spread via airborne droplets from infected people through sneezing, coughing, and talking, strict Airborne Precautions are essential. Hand hygiene and the use of gloves decrease the likelihood of spread to the mucous membranes, nose, and mouth and contamination of surfaces outside the patient's room. Individuals suspected to have SARS should be placed in Contact Precautions until a definitive diagnosis is made. Diagnosis is confirmed by the manifestation of symptoms and the use of a rapid SARS test within 2 days after symptoms begin. All equipment and surfaces that potentially have been contaminated must be disinfected by an individual wearing gloves. Although careful monitoring of the occurrence of SARS is important, preventing its spread is the initial focus to decrease the likelihood of a widespread epidemic.

Which statement indicates a need for further learning about dietary management in a patient who developed esophagitis while undergoing radiation therapy? 1 "I will eat soft foods." 2. "I will eat high-fiber foods." 3 "I will eat foods that have high calories." Incorrect4 "I will drink liquid nutrition 1 hour after meals."

2. "I will eat high-fiber foods." A complication of radiation therapy is esophagitis, which is inflammation of esophagus. The patient should eat foods that are low in dietary fiber. Soft foods that can easily pass through the esophagus are recommended. The patient is advised to consume high-calorie foods to maintain energy levels in the body. The patient is advised to drink liquid nutrition supplements between meals to maintain weight and energy.

The nurse is providing health education to a patient regarding ways to prevent influenza. Which statement made by the patient shows effective learning? 1. "I will refrain from taking drugs for at least 2 weeks." 2. "I will refrain from attending public meetings if I feel I am getting sick." 3. "I will refrain from giving non-perishable food for at least 2 weeks to all the family members." 4. "I will refrain from paying attention to public health announcements for disease outbreaks."

2. "I will refrain from attending public meetings if I feel I am getting sick." As the infected person may spread the disease, he or she must avoid public meetings to reduce the risk of spreading the disease. Drugs prescribed should be taken to reduce the risk of influenza. Paying attention to public health announcement will reduce the risk of spreading the disease. Similarly, giving non-perishable food to family members will avoid going out, thus reducing the risk of spreading the disease.

The nurse is providing health education to an older adult patient to prevent pneumonia. Which statements made by the patient demonstrate a need for further teaching? Select all that apply. 1. "I will refrain from smoking." 2. "I will refrain from drinking nonalcoholic fluids." 3. "I will refrain from exposure to indoor pollutants." 4. "I will refrain from going to public areas during flu season." 5. "I will refrain from obtaining the pneumococcal vaccination."

2. "I will refrain from drinking nonalcoholic fluids." 5. "I will refrain from obtaining the pneumococcal vaccination." Since drinking at least 3 liters of nonalcoholic fluids per day will reduce the risk for pneumonia the patient needs to follow this guideline. In addition, not getting the pneumococcal vaccination will increase the risk of developing pneumonia; therefore the patient should obtain the vaccination. Smoking is a precipitating factor for pneumonia; therefore, to prevent pneumonia the patient should stay away from smoking. Indoor pollutants like dust and aerosols should also be avoided to prevent pneumonia. Staying away from public areas during flu season will decrease the spread of the disease.

Which statement made by the student nurse indicates a need for further learning about the management of respirations in a patient who underwent a lobectomy? 1 "I will effectively manage the patient's pain." 2. "I will use spirometer for the patient during sleep." 3 "I will help the patient to sit in a semi-Fowler's position." 4 "I will take care of chest tubes while the patient is coughing."

2. "I will use spirometer for the patient during sleep." The spirometer should be used every hour when the patient is awake to prevent atelectasis and pneumonia. The patient's pain should be effectively managed to increase the ability to cough and breathe deeply. The patient should sit in a semi-Fowler's position to make breathing easier. The patient's chest tubes should be prevented from being pulled to ensure the link between the chest tube and drainage system doesn't break.

A patient has been diagnosed with asthma. Which statement below indicates that the patient correctly understands how to use an inhaler with a spacer correctly? 1. "I don't have to wait between the two puffs if I use a spacer." 2. "If the spacer makes a whistling sound, I am breathing in too rapidly." 3. "I should shake the inhaler only if I want to see whether it is empty." 4. "I should rinse my mouth and then swallow the water to get all of the medicine."

2. "If the spacer makes a whistling sound, I am breathing in too rapidly." Slow and deep breaths ensure that the medication is reaching deeply into the lungs. The whistling noise serves as a reminder to the patient of which technique needs to be used. The patient must wait 1 minute between puffs. The patient should rinse the mouth but not swallow the water. The mouth needs to be rinsed after using an inhaler with or without a spacer. This is especially important to prevent the development of an oral fungal infection if the inhaled medication is a corticosteroid. An empty inhaler will float on its side in water; a full inhaler will sink. Shaking an inhaler helps ensure that the same dose is delivered in each puff.

When widely distributed during a pandemic flu, which drugs reduce the severity of infection and mortality rate? Select all that apply. 1. Vepacel 2. Zanamivir 3. Oseltamivir 4. Ethambutol 5. Pyrazinamide

2. Zanamivir 3. Oseltamivir Zanamivir and oseltamivir are antiviral drugs that reduce the severity of infection and mortality rate when widely distributed during a pandemic flu. Vepacel is a vaccine for H5N1 outbreaks. Ethambutol and pyrazinamide are first-line drugs for the treatment of tuberculosis.

The nurse is preparing a patient who has chronic hypoxia to return home with an oxygen concentrator. Which statement made by the patient about the concentrator indicates teaching has been effective? 1. "It provides a flow of 100% oxygen." 2. "It does not require refilling with liquid oxygen." 3. "It is more portable than the compressed gas tank." 4. "It is safer around candles and other open flames."

2. "It does not require refilling with liquid oxygen." An oxygen concentrator acts by removing nitrogen, water vapor, and hydrocarbons from room air, which concentrates oxygen. It is large and not more portable than thermos bottle-sized oxygen tanks. Patients must still be cautioned to avoid open flames or smoking. The concentrator provides a concentration of oxygen that is greater than 90% but not 100%.

The nurse is instructing a patient with tuberculosis about combination drug therapy. What are common instructions that the patient should follow for all the anti-tubercular drugs? Select all that apply. 1. "Refrain from wearing soft contact lenses." 2. "Refrain from drinking alcoholic beverages." 3. "Refrain from taking the drug on an empty stomach." 4. "Drink at least 8 ounces of water when you take the medication." 5. "Report yellowing of the skin and any darkened urine immediately."

2. "Refrain from drinking alcoholic beverages." 5. "Report yellowing of the skin and any darkened urine immediately." All the anti-tubercular drugs cause liver damage. Therefore, alcoholic beverages should not be consumed. Yellowing of the skin and darkening of the urine should be reported immediately to reduce further complications of drug therapy. Rifampin causes permanent staining of soft contact lenses. Other anti-tubercular drugs may not cause this. Isoniazid is the only anti-tubercular drug that should be administered on an empty stomach. Drinking 8 ounces of water with the medication is necessary in patients who are using only pyrazinamide.

A patient who has undergone a partial laryngectomy for neck cancer has been a heavy smoker for many years and tells the nurse that it will be easy to avoid smoking now that this has occurred. How does the nurse respond? 1. "Now that you see the consequences, it should be easy to quit." 2. "Tell me about any times you have tried to quit smoking in the past." 3. "Since you have confidence that you can quit, it shouldn't be difficult." 4. "You will still need to join a support group since it's harder than you think."

2. "Tell me about any times you have tried to quit smoking in the past." Studies are mixed when correlating confidence about attempts to quit smoking and successfully quitting smoking. An important initial assessment should be to identify how difficult the patient perceives smoking cessation to be. Asking the patient to describe previous attempts will help to determine this perceived difficulty. Getting patients to participate in a smoking cessation group will increase the chances of success; excessive confidence may be detrimental because smokers who are confident that they can quit are less likely to join a group. The nurse should not reinforce excessive confidence and should also not discourage the patient.

A patient who has acute viral rhinitis cares for an older family member who is susceptible to respiratory infections. Which action does the nurse suggest to this patient to help prevent the spread of infection? 1. "Get an influenza vaccine immediately." 2. "Thoroughly wash hands after touching the face." 3. "Complete the full course of antibiotic medication." 4. "Wear a mask while providing care to the family member."

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

What is the priority nursing action for patients who have experienced facial trauma? 1. Pulse oximetry 2. Airway assessment 3. Checking for bruising 4. Monitoring for pulse changes

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

The nurse is caring for a patient who has just been diagnosed with pulmonary tuberculosis and will be discharged with a prescription for isoniazid 300 mg orally each day. At what time should the nurse teach this patient to take this medication? 1. An hour before bedtime 2. An hour before breakfast 3. Immediately after breakfast 4. Immediately before breakfast

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

Which patient has the most urgent need for frequent nursing assessment? 1. A middle-aged patient who was admitted yesterday with pneumonia and is receiving oxygen at 2 L/min through a nasal cannula 2. An older adult patient who was admitted 2 hours ago with emphysema and dyspnea, has a 45-year two-pack-per-day smoking history, and is receiving 50% oxygen through a Venturi mask 3. A young patient who has had a tracheostomy for 1 week, who is on room air with SpO 2 at percents in the upper 90s, who has been receiving antibiotic therapy for 16 hours, and who has foul-smelling drainage on the tracheostomy ties 4. An older adult patient who is anxious to go home with her new tank of oxygen and supply of nasal cannulas and is being discharged with a new prescription for home oxygen therapy

2. An older adult patient who was admitted 2 hours ago with emphysema and dyspnea, has a 45-year two-pack-per-day smoking history, and is receiving 50% oxygen through a Venturi mask The older adult with a long history of smoking and chronic lung disease is at elevated risk for respiratory depression owing to the hypoxic drive of respirations countered by high levels of oxygen; this patient must be assessed frequently while receiving high-flow oxygen. The young patient with no signs or symptoms of respiratory compromise and the patient who meets discharge criteria do not require frequent assessment. Although the middle-aged patient with pneumonia will require more frequent assessment than a patient who does not require oxygen therapy, the older patient on higher-flow oxygen is at greater risk for respiratory demise and therefore needs frequent assessment more urgently.

The RN is observing a new nurse providing care for a patient admitted with anterior epistaxis (nosebleed). What actions should the new nurse take which would be appropriate for this patient? Select all that apply. 1. Place the patient in a supine position. 2. Apply ice or cool compresses to the nose. 3. Maintain Universal Body Substances Precautions. 4. Instruct the patient not to blow the nose for 24 hours. 5. Apply direct lateral pressure to the nose for 10 minutes.

2. Apply ice or cool compresses to the nose. 3. Maintain Universal Body Substances Precautions. 4. Instruct the patient not to blow the nose for 24 hours. 5. Apply direct lateral pressure to the nose for 10 minutes. The correct position for a patient with an anterior nosebleed is upright and leaning forward to prevent blood from entering the stomach and to avoid aspiration. The nurse should instruct the patient to apply pressure for 10 minutes by pinching the nares. Standard Precautions should be utilized because bodily fluid is present. Ice or cool compresses will help stop the bleeding. The patient should not attempt to blow the nose for 24 hours because the newly formed clot can become dislodged.

The community health nurse is planning tuberculosis treatment for a patient who is homeless and heroin-addicted. Which action will be most effective in ensuring that the patient completes treatment? 1. Have the patient repeat medication names and side effects. 2. Arrange for a health care worker to watch the patient take the medication. 3. Give the patient written instructions about how to take prescribed medications. 4. Instruct the patient about the possible consequences of nonadherence.

2. Arrange for a health care worker to watch the patient take the medication. Because this patient is unlikely to adhere to long-term treatment unless directly supervised while taking medications, the best option is to arrange for directly observed therapy (DOT). Giving a patient who is homeless and addicted to heroin written instructions on how to take prescribed medications is placing too much responsibility on the patient to follow through. Also, the question does not indicate whether the patient can read. Simply because the patient can state the names and side effects of medications does not mean that the patient understands what the medications are and why he or she needs to take them. A patient who is homeless may be more concerned with obtaining shelter and food than with properly taking his or her medication.

Which laboratory tests provide valuable information to the nurse when caring for a patient requiring oxygen therapy? Select all that apply. 1. Serum magnesium 2. Arterial blood gases 3. White blood cell count 4. Hemoglobin and hematocrit 5. Partial thromboplastin time (PTT)

2. Arterial blood gases 4. Hemoglobin and hematocrit Hemoglobin and hematocrit indicate oxygen-carrying capacity and therefore play a vital role in evaluating oxygenation. Arterial blood gases directly measure alveolar gas exchange and oxygenation. White blood cell count, PTT, and serum magnesium do not directly reflect oxygenation.

A patient who has emphysema tells the nurse that the prescribed inhaled corticosteroid medication does not help at all. Which action by the nurse is correct? 1 Notify the patient's provider that the emphysema is worsening. 2. Ask the patient to describe how frequently the medication is used. 3 Suggest that the patient use the inhaled corticosteroid more often. 4 Request an order for an increased dose of the inhaled corticosteroid.

2. Ask the patient to describe how frequently the medication is used. Because inhaled corticosteroids are long-term medications that work by reducing mucosal inflammation, the patient should be taught that an immediate reduction in dyspnea is not expected with these medications. The nurse should first assess how the patient is using this medication to see if further teaching is necessary. Notifying the provider of the patient's worsening condition or requesting an increased dose are not indicated until medication use is assessed. Inhaled corticosteroids are generally used twice daily and increasing the dose frequency is not indicated.

An older patient with pneumonia has become more confused during the initial assessment. What action should the nurse take initially? 1. Notify the Rapid Response Team. 2. Assess the patient's oxygen saturation. 3. Evaluate orientation to person, place, and time. 4. Request a nebulized bronchodilator medication.

2. Assess the patient's oxygen saturation. Patients who have altered level of consciousness are often hypoxic. The nurse should assess oxygen saturation to evaluate the possible cause if this occurs. The nurse may evaluate orientation, but the oxygen saturation is more important and should be performed initially. It is not necessary to notify the Rapid Response Team at this time. A bronchodilator medication is not indicated.

A patient has been diagnosed with nasal fracture. What measure does the nurse plan to initiate immediately upon admission to prevent complications? 1. Prevention of a major posterior bleed 2. Assessment for an airway obstruction 3. Prevention of life-threatening infections 4. Decreasing the risk of aspiration when eating

2. Assessment for an airway obstruction Prompt recognition of an airway obstruction provides the opportunity to remedy the problem early. Although the other answers all address potential problems in patients with upper respiratory disorders, the immediate need at time of admission is to confirm and maintain a patent airway.

The nurse is teaching a patient newly diagnosed with tuberculosis (TB) about the medication and treatment regimen for this disease. What information does the nurse include when teaching this patient? 1. Most people can be effectively treated with one or two medications. 2. Avoid alcohol while taking the medications unless the provider says otherwise. 3. Do not participate in even nonstrenuous exercise while taking these medications. 4. Have the skin test repeated periodically to evaluate the drug therapy's effectiveness.

2. Avoid alcohol while taking the medications unless the provider says otherwise. Because many first-line medications for TB treatment can cause hepatotoxicity, the patient should be cautioned against consuming alcohol. It is not necessary to avoid exercise. The skin test is not used to evaluate the response to therapy; sputum specimens are evaluated every 2 to 4 weeks during drug therapy. Most patients require two to three medications to help combat both drug resistance and the disease.

What recommendations will the nurse make for a patient and his or her family about the prevention of pneumonia? Select all that apply. 1. Get plenty of exercise. 2. Avoid indoor pollutants. 3. Eat a healthy, balanced diet. 4. Drink at least 1 L of fluid a day. 5. Avoid crowded areas during flu season and holidays.

2. Avoid indoor pollutants. 3. Eat a healthy, balanced diet. 5. Avoid crowded areas during flu season and holidays. The nurse will recommend avoiding indoor pollutants, eating a healthy, balanced diet, and avoiding crowded areas during the flu season and holidays. Getting plenty of exercise and drinking at least 1 L of fluid a day is not included in the education for the prevention of pneumonia. The patient may not be able to exercise, and he or she should be encouraged to drink at least 3 L of non-alcoholic fluid a day.

The nurse is performing wound care on a tracheostomy placed 48 hours ago. While replacing the ties, the patient becomes agitated and moves unexpectedly, causing the tube to come out. Which actions does the nurse immediately take? Select all that apply. 1. Insert a nasal airway. 2. Call the Rapid Response Team. 3. Provide 100% oxygen via a nonrebreather mask. 4. Attempt to place the tracheostomy tube back into the surgical stoma. 5. Ventilate the patient using a manual resuscitation bag with facemask.

2. Call the Rapid Response Team. 5. Ventilate the patient using a manual resuscitation bag with facemask. When a newly placed tracheostomy tube comes out, the priority is to reestablish the airway. The nurse should manually ventilate the patient while another nurse calls the Rapid Response Team. The nurse should not attempt to manually replace the tube. A nasal airway is not indicated in this situation. A nonrebreather mask does not provide ventilation, which is vital.

Patients with which risk factor warrant close monitoring for and education about cancers of the nose and sinuses? 1. Presence of chronic, persistent nasal drainage 2. Chronic exposure to dust from wood, leather, or flour 3. Chronic history of allergies and sinus infections as a child 4. History of need to sleep with the head of the bed elevated

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

Which factors can increase the risk for head and neck cancer? Select all that apply. 1. History of laceration of the vocal cords 2. Chronic voice abuse and related laryngitis 3. Presence of squamous cells in the mucosa 4. Tobacco and alcohol use alone or in combination 5. Persistent hypercarbia with chronic lung disease

2. Chronic voice abuse and related laryngitis 4. Tobacco and alcohol use alone or in combination Tobacco and alcohol use are leading causative factors for head and neck cancer. Chronic voice abuse leading to chronic laryngitis will also contribute to the risk of head and neck cancer, especially in the presence of other risk factors. Squamous cells are normally found in the mucosa. Any laceration of the vocal cords that was adequately treated should not be a risk factor. Persistent hypercarbia with chronic lung disease will contribute to other respiratory difficulties but not cancer risk.

Which factors can increase the risk for head and neck cancer? Select all that apply. 1. History of laceration of the vocal cords 2. Chronic voice abuse and related laryngitis 3. Presence of squamous cells in the mucosa 4. Tobacco and alcohol use alone or in combination 5. Persistent hypercarbia with chronic lung disease

2. Chronic voice abuse and related laryngitis 4. Tobacco and alcohol use alone or in combination Tobacco and alcohol use are leading causative factors for head and neck cancer. Chronic voice abuse leading to chronic laryngitis will also contribute to the risk of head and neck cancer, especially in the presence of other risk factors. Squamous cells are normally found in the mucosa. Any laceration of the vocal cords that was adequately treated should not be a risk factor. Persistent hypercarbia with chronic lung disease will contribute to other respiratory difficulties but not cancer risk.

A patient with asthma describes wheezing, dyspnea, and coughing episodes once or twice a month lasting 1 to 2 days. The patient uses an inhaled bronchodilator for symptom relief but does not use medication between episodes. The patient requires an oral corticosteroid medication approximately once every 2 years when symptoms are more severe. The patient does not have limitations in activities or nighttime awakening with symptoms. Which plan of action does the nurse anticipate this patient will require? 1. Adding an inhaled corticosteroid as a maintenance medication 2. Continuation of the current therapy plan with no daily medication required 3. Treatment with a long-acting bronchodilator plus an inhaled corticosteroid 4. Supplementation with a leukotriene modifier and a daily bronchodilator

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

An emergency nurse is preparing to care for a patient arriving by ambulance after a motor vehicle crash. The patient has severe facial and neck injuries and emergency airway measures are taken. Which type of airway does the nurse prepare for? 1. Tracheotomy 2. Cricothyroidotomy 3. Endotracheal intubation 4. Nasal bi-level positive airway pressure (BiPAP)

2. Cricothyroidotomy Cricothyroidotomy is an emergency procedure performed by emergency medical personnel to hold an airway open until a tracheotomy may be performed. ET intubation is not likely in a patient with severe head and neck injuries. Nasal BiPAP depends on a patent upper airway. Tracheotomy is a surgical, not a field, procedure.

A patient is admitted to the hospital for chronic obstructive pulmonary disease (COPD), and the health care provider requests oxygen via nasal cannula at 2 L/min. Within 30 minutes, the patient's color improves. What does the nurse continue to monitor that may require immediate attention? 1. Increased coughing 2. Decreasing respiratory rate 3. Increasing carbon dioxide levels 4. Increasing adventitious breath sounds

2. Decreasing respiratory rate Respiratory rate and depth should be monitored closely while the patient receives oxygen because hypoventilation is seen during the first 30 minutes of oxygen therapy in patients with hypoxic drive for respiration. The patient's color will improve (from ashen or gray to pink) because of an increase in PaO 2 level before apnea or respiratory arrest occurs from loss of the hypoxic drive. The COPD patient is not sensitive to PaCO 2; oxygen administration can cause high PaO 2 levels. Monitoring for adventitious breath sounds is important, but these would not be a result of the oxygen that the patient is receiving. The ability to cough and breathe deeply is a positive sign.

What actions prevent tracheostomy decannulation during tie replacement? Select all that apply. 1. Always have a coworker assist with the procedure. 2. Do not remove the old ties until the new ones are in place. 3. Give the patient a cough suppressant to prevent coughing. 4. Hold the tracheostomy tube in place with one hand during the process. 5. Know the tracheostomy tube size and type if replacement is necessary.

2. Do not remove the old ties until the new ones are in place. 4. Hold the tracheostomy tube in place with one hand during the process. Holding the tracheostomy tube in place with one hand during the process and not removing the old ties until the new ones are in place are two approaches to ensure that the tracheostomy tube does not become dislodged. Although it is important to know the tracheostomy tube size and type in case of dislodgement, it doesn't prevent decannulation during tie replacement. Having a coworker assist with the tie change is helpful, but it does not directly prevent dislodgement like the other actions do. Manipulating the tracheostomy may trigger coughing; a cough suppressant is not likely to prevent this problem.

The nurse is assisting a patient with a tracheostomy to eat. Which is an important nursing action to help the patient swallow and avoid aspiration? 1. Offer fluids using a straw and avoid giving thickened fluids. 2. Elevate the head of the bed for at least 30 minutes after eating. 3. Encourage the patient to avoid swallowing between bites of food. 4. Increase the pressure in the tracheostomy cuff to block food particles.

2. Elevate the head of the bed for at least 30 minutes after eating. The nurse should elevate the head of the bed during eating and for at least 30 minutes after eating to prevent aspiration and reflux. The patient should be encouraged to take "dry swallows" between bites of food to clear the esophagus. Increasing the pressure puts pressure on the esophagus. Patients should take small amounts of fluids from a spoon to facilitate swallowing.

A patient with pneumonia is producing a smaller volume of thicker secretions than the day before. The patient is receiving intravenous antibiotics. What action does the nurse take? 1. Monitor peak flow levels every 4 hours. 2. Encourage the patient to drink more fluids. 3. Request an order to switch to an oral antibiotic. 4. Reassure the patient that the infection is improving.

2. Encourage the patient to drink more fluids. Thick secretions indicate decreased hydration and the patient is at risk for airway obstruction if these secretions cannot be cleared easily; the nurse should encourage increased fluid intake. Peak flow levels are used to monitor relative airway obstruction in patients with obstructive lung disease. A decrease in secretions does not necessarily indicate improvement in the infection, especially if the secretions are thick and not easily mobilized. The patient should continue intravenous antibiotics until there is evidence that the infection is improving.

A patient is hospitalized with posterior nasal bleeding and has a gauze pack in the posterior nasal cavity. The nurse assesses the patient and notes restlessness and anxiety and an oxygen saturation of 92%. Which initial action by the nurse is correct? 1. Assess for hypotension and tachycardia. 2. Evaluate the position of the packing string. 3. Check the patient's gag and cough reflexes. 4. Request an order for an antianxiety medication.

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

A patient has undergone nasal surgery. Which finding indicates a safety priority to the nurse? 1. Excessive sedation 2. Frequent swallowing 3. Nausea and vomiting 4. Persistent restlessness

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

What information is important to share with a patient who is being discharged after treatment for pneumonia? Select all that apply. 1. Resume regular activities 2. Get an annual influenza immunization 3. Avoid contact with all persons with colds or influenza 4. Stop or reduce any intake of tobacco and tobacco products 5. Because you have had pneumonia, you won't need a pneumococcal vaccination

2. Get an annual influenza immunization 3. Avoid contact with all persons with colds or influenza 4. Stop or reduce any intake of tobacco and tobacco products Individuals who have had pneumonia need to be instructed to avoid contact with ill persons, stop or reduce smoking, and get an annual influenza immunization and a pneumococcal immunization as recommended by the health care provider. The patient recovering from pneumonia is advised to avoid crowded places such as malls and churches, so the patient would not be able to resume all regular activities. Pneumococcal immunizations are usually given once after age 65 and may be given 5 years after that if the patient is at high risk.

A 76-year-old patient who is recovering from influenza A reports severe dry mouth and constipation. After reviewing the patient's medication list, the nurse suspects the patient is experiencing the anticholinergic effect of which medication? 1. Oseltamivir 2. Hydroxyzine 3. Phenylephrine 4. Cephalosporin

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

A patient reports experiencing chest pain, headache, and cough with sputum production, fever, and dyspnea. What does the nurse anticipate upon assessment? Select all that apply. 1. Sore throat 2. Tachycardia 3. Nasal drainage 4. Crackles upon auscultation 5. Diminished chest expansion

2. Tachycardia 4. Crackles upon auscultation 5. Diminished chest expansion This patient has symptoms of pneumonia. Symptoms include tachycardia due to hypoxemia, chest pain with decreased or unequal chest expansion, and crackles upon auscultation due to fluid in the interstitial and alveolar areas. A sore throat and nasal drainage are symptoms of an upper respiratory disorder.

Which factors should be taken into consideration when determining the type of oxygen delivery system to be used for a patient? Select all that apply. 1. Patient immobility 2. Importance of humidity 3. Patient body temperature 4. Oxygen concentration required by the patient 5. Oxygen concentration achieved by a delivery system

2. Importance of humidity 4. Oxygen concentration required by the patient 5. Oxygen concentration achieved by a delivery system The humidity level needs to be maintained in any oxygen delivery system to prevent dry nose and throat. Oxygen concentration required by the patient and the level of oxygen concentration achieved would determine the kind of delivery system to be used. The patient should be mobile. The patient's body temperature is not a deciding factor for the type of oxygen delivery system to be used.

A febrile patient presents to the emergency department with a headache, chills, fatigue, nausea, vomiting, and diarrhea. What illness does the nurse suspects that the patient has? 1. Influenza A 2. Influenza B 3. Influenza C 4. Influenza AB

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

A nurse is caring for a patient who appears cachectic and pale but appears in no acute distress. The patient tells the nurse that he has had a chronic cough for months and produces a large amount of foul-smelling sputum. He also states that he occasionally suffers from a stabbing pain when taking a deep breath. When reviewing the patient's history, the nurse notes that the patient has a recent history of influenza. Breath sounds reveal decreased sound with rhonchi to the right lower lobe and percussion to the right lower lobe is dull. What procedure does the nurse anticipate preparing for? 1. Administration of a bronchodilator 2. Insertion of a thoracentesis needle and drainage 3. Intubation and initiation of mechanical ventilation 4. Placement of a nasogastric tube and tube feedings

2. Insertion of a thoracentesis needle and drainage The patient likely has a lung abscess, which is a localized area of subacute infection necrosis of the lungs. Signs and symptoms of lung abscess include a cachectic and pale appearance, chronic cough with large amounts of foul-smelling sputum, pleurisy (a stabbing pain with deep breathing), and decreased lung sounds and dull percussion to the area of abscess. A thoracentesis is a procedure where the physician inserts a needle into the pleural space of the lungs and drains the fluid. The patient does not appear in acute respiratory distress. Therefore, intubation and initiation of mechanical ventilation is not the most appropriate procedure to prepare for. While the patient may eventually need a nasogastric tube and tube feedings, this is not the most appropriate procedure that the nurse will prepare for. The patient does not have wheezing or inflammation of the airway indicating that he or she would benefit from a bronchodilator.

An older adult patient presents with a persistent cough, fever, night sweats, and mucopurulent sputum. What should be the first line drug therapies used in treatment? Select all that apply. 1. Rifampin (RIF) 700 mg orally daily 2. Isoniazid (INH) 300 mg orally daily 3. Pyrazinamide 2500 mg twice a week 4. Pyrazinamide (PZA) 1500 mg orally daily 5. Ethambutol (EMB) 3000 mg twice a week

2. Isoniazid (INH) 300 mg orally daily 4. Pyrazinamide (PZA) 1500 mg orally daily 5. Ethambutol (EMB) 3000 mg twice a week Isoniazid 300 mg, pyrazinamide 1500 mg, and ethambutol 3000 mg are the first line drug therapy used in treating tuberculosis. Rifampin 700 mg would not be used in tuberculosis treatment as the normal dose is 500 to 600 mg. Similarly, pyrazinamide 2500 mg twice a week would not be used to treat tuberculosis as it is too low of a dose. The normal dose is 3,000 to 6,000 mg twice a week.

A patient who has been homeless and has spent the past 6 months living in shelters has been diagnosed with confirmed tuberculosis (TB). Which medications does the nurse expect to be ordered for the patient? 1. Metronidazole, acyclovir, flunisolide, rifampin 2. Isoniazid, rifampin, pyrazinamide (PZA), ethambutol 3. Prednisone, guaifenesin, ketorolac, pyrazinamide (PZA) 4. Salmeterol, cromolyn sodium, dexamethasone, isoniazid

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

An older patient presents to the emergency department (ED) with a 2-day history of cough, pain on inspiration, shortness of breath, and dyspnea. The patient never had a pneumococcal vaccine. The patient's chest x-ray shows density in both bases. The patient has wheezing upon auscultation of both lungs. Would a bronchodilator be beneficial for this patient? 1. It would not be beneficial for this patient. 2. It would help decrease the bronchospasm. 3. It would decrease the patient's pain on inspiration. 4. It would clear up the density in the bases of the patient's lungs.

2. It would help decrease the bronchospasm. A bronchodilator would help decrease bronchospasm and would open up the airways, so it would be beneficial for this patient. It would decrease dyspnea and feelings of shortness of breath. A bronchodilator would not be able to clear up the density in the bases of the patient's lung. The cause of the density is unknown; however, an infection such as pneumonia is likely, which bronchodilators do not treat. Although a bronchodilator would help a patient breathe easier, it does not have any analgesic properties.

A nurse is caring for a patient with coccidioidomycosis who has recently migrated from Mexico. When planning care for this patient, what manifestation noted on assessment does the nurse recognize as a sign of more severe coccidioidomycosis infection? 1. Cough 2. Joint pain 3. Chest pain 4. Night sweats

2. Joint pain Coccidioidomycosis, also known as valley fever, is a fungal infection that is caused by an organism commonly found in the desert southwest regions of the United States, Mexico, and Central and South America. Joint pain is a symptom of more serious coccidioidomycosis infection. Cough, chest pain, and night sweats are symptoms of coccidioidomycosis; however, these are common in all infections and are not symptoms of more serious infection.

Which is an orbital-zygoma fracture? 1. Le fort II 2. Le fort III 3. Nasal fracture 4. Maxillary fracture

2. Le fort III A Le fort III is an orbital-zygoma fracture called a craniofacial disjunction. A Le fort II is a maxillary and nasoethmoid complex fracture. Nasal and maxillary fractures are simple fractures of the bones after which they are named.

Which factors should be considered when determining which type of oxygen a patient will require for home oxygen therapy? Select all that apply. 1. There are young children living in the home with the patient. 2. Liquid oxygen is available in lightweight, easy-to-carry containers. 3. There are smokers in the family living in the house with the patient. 4. An oxygen concentrator is noisy and big and requires refilling for use. 5. Liquid oxygen tanks last longer than equal-sized gaseous oxygen tanks.

2. Liquid oxygen is available in lightweight, easy-to-carry containers. 5. Liquid oxygen tanks last longer than equal-sized gaseous oxygen tanks. Liquid oxygen can be placed in multiple sizes of containers based on ease and need for portability. Compared to gaseous oxygen in the same size container, liquid oxygen will last longer. Although the oxygen concentrator is large and can be noisy, it doesn't require refilling for use. All people living with the patient must be cautioned about open flames in the home, but a family member who smokes should not preclude a patient's access to home oxygen. Oxygen in the home will not harm children if proper precautions are taken.

A patient's family is expressing concern about the new diagnosis of chronic obstructive pulmonary disease (COPD) in their loved one. What should the nurse do next? 1 Discuss the importance of smoking cessation as it is a leading cause of emphysema. 2. Listen to the basis of the family's concerns and then develop a focused teaching plan. 3 Assure the family that with appropriate management, their loved one can lead a quality life. 4 Refer them to a community-based support group to meet other families with similar concerns

2. Listen to the basis of the family's concerns and then develop a focused teaching plan. It is important to determine the basis of the family's concerns before anything else. Do they have prior experience with COPD? Do they have accurate information? What is their greatest concern? Once the appropriate information is obtained, a well-developed teaching plan will be of greatest benefit to the patient and family. Assurance of the ability to lead a meaningful life is important, but their greatest concern may be financial or based on misinformation. Community support groups may be helpful in the future to meet other family members, but only if they see it as potentially beneficial. Smoking is indeed a leading cause for COPD, but it is not the time to focus on causation; hearing the family's concerns is the priority.

The radiology report of a patient who has had a chest x-ray shows consolidation in a segment of the patient's left lung. This is typical of which type of pneumonia? 1. Viral 2. Lobar 3. Bronchial 4. Bacterial

2. Lobar Lobar pneumonia manifests as consolidation in a segment or an entire lobe of the lung. Bronchopneumonia manifests as diffusely scattered patches around the bronchi. While lobar pneumonia is generally bacterial, the pattern of lung involvement does not necessarily indicate the etiology.

What is the most important reason a patient with lung cancer should be handled carefully while the nurse repositions and ambulates him or her? 1. Dysrhythmias 2. Low bone density 3. Cardiac tamponade 4. Super vena cava syndrome

2. Low bone density Lung cancer results in low bone density and the patient has a high risk of fractures. Lung cancer results in dysrhythmias, cardiac tamponade, and super vena cava syndrome, but these are not the most important reason the patient should be handled carefully. Dysrhythmia is an abnormal heart beat, which is due to pressure on the heart by the tumor. Cardiac tamponade is compression of the heart, which is the result of a tumor or fluid present around the heart. Super vena cava syndrome is the obstruction of super vena cava, which carries circulating blood to the heart.

What consideration is important for the nurse to remember when managing the care of a patient with hospital-acquired pneumonia? 1. Provide suctioning as needed. 2. Monitor for early signs of sepsis. 3. Provide stress ulcer prophylaxis. 4. Elevate the head of the bed at least 30 degrees.

2. Monitor for early signs of sepsis. It is important for the nurse to remember to monitor for early signs of sepsis in a patient with hospital-acquired pneumonia because the infecting agent is often an antibiotic resistant pathogen. Providing suctioning as needed, provision for stress ulcer prophylaxis, and elevating the head of the bed at least 30 degrees are management considerations for a patient with ventilator-associated pneumonia.

Which principle should guide the nurse's decision regarding oral care for a patient with a tracheostomy during the first 24 hours postoperative? 1. High protein intake is indicated to promote optimal healing. 2. Oral care is indicated to decrease the accumulation of organisms. 3. If the patient is not taking oral nutrition, it is not a concern at this time. 4. Oral care is not indicated if the patient is being suctioned on a regular basis.

2. Oral care is indicated to decrease the accumulation of organisms. Oral care helps decrease the accumulation of organisms present in the mouth that can contribute to pneumonia and should be a regular part of postoperative care. Good oral care is important even if the patient is not eating, which actually serves to facilitate cleansing of the oral cavity. Protein will aid healing but does not negate the need for oral care.

Which of these patients should the charge nurse assign to the LPN/LVN working on the medical-surgical unit? 1. Patient with group A beta-hemolytic streptococcal pharyngitis who has stridor 2. Patient with pulmonary tuberculosis who is receiving multiple medications 3. Patient with sinusitis who has just arrived after having endoscopic sinus surgery 4. Patient with tonsillitis who has a thick-sounding voice and difficulty swallowing

2. Patient with pulmonary tuberculosis who is receiving multiple medications The LPN/LVN scope of practice includes medication administration, so a patient receiving multiple medications can be managed appropriately by an LPN/LVN. Stridor is an indication of respiratory distress; this patient needs to be managed by the RN. A patient in the immediate postoperative period requires frequent assessments by the RN to watch for deterioration. A patient with a thick-sounding voice and difficulty swallowing is at risk for deterioration and needs careful assessment and monitoring by the RN.

The nurse is planning care for the non-English-speaking patient who is on complete voice rest. What alternative method of communication does the nurse implement? 1. Word board 2. Picture board 3. Alphabet board 4. Translator at the bedside

2. Picture board A picture board overcomes language barriers and can be used to communicate with patients who do not speak English well if a translator or a translation phone is not readily available. An alphabet board may or may not be useful if the patient does not speak English; this is not the best answer, but may be an option depending on what is available at the facility. A translator at the bedside would be beneficial for the nurse to speak with the patient, but not for the patient to ask questions or communicate concerns to the nurse. Unless the nurse is able to read the language the patient speaks, a word board would not be beneficial.

Which principle about anterior versus posterior nasal bleeding must the nurse consider the priority? 1. Anterior bleeding is more likely related to a vessel in a nasal polyp. 2. Posterior bleeding is an emergency because it cannot be easily reached. 3. The stimulus that triggered the initial nasal bleeding must be determined. 4. Include the amount and color of nasal drainage in any documentation.

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

What are the priority problems for patients with head and neck cancer? Select all that apply. 1. History of persistent gastric reflux 2. Potential risk for airway obstruction 3. Adherence to total voice rest to decrease edema 4. Potential for aspiration due to anatomical changes 5. Reduced self-concept related to tumor and treatment

2. Potential risk for airway obstruction 4. Potential for aspiration due to anatomical changes 5. Reduced self-concept related to tumor and treatment If cancers of the head and neck are not treated adequately, they can lead to respiratory obstruction. In addition, both the tumors and their surgical management can lead to changes in the normal anatomy involved in swallowing. Patients may require assistance to master swallowing in a manner to decrease the risk of aspiration. Reduced self-concept can lead to depression and is common in patients with head and neck cancer. The tumor and treatment modalities cause a change in physical appearance and can be a difficult adjustment for the patient. A history of gastric reflux may continue to be a problem; however, it is not a priority like the risk of respiratory obstruction or aspiration and reduced self-concept. Voice rest is most likely not an issue unless surgery involved the larynx.

Which interventions to improve oxygenation and decrease carbon dioxide retention does the nurse teach the patient with chronic obstructive pulmonary disease (COPD)? Select all that apply. 1. Limiting dietary intake to avoid weight gain, which will add to activity intolerance 2. Practicing diaphragmatic and pursed-lip breathing to manage episodes of dyspnea 3. Partnering with the family in COPD management by adhering to prescribed therapies 4. Maintaining hydration to loosen secretions and suctioning frequently to eliminate build up 5. Monitoring for changes in respiratory status including rate and rhythm and tolerance of activity

2. Practicing diaphragmatic and pursed-lip breathing to manage episodes of dyspnea 3. Partnering with the family in COPD management by adhering to prescribed therapies 5. Monitoring for changes in respiratory status including rate and rhythm and tolerance of activity Optimum COPD management requires an active partnership between the patient/family and the health care team. COPD is a chronic disease, and it is important for patients/families to learn symptom management and when to seek medical care. A change in respiratory rate and rhythm may indicate the presence of an infection or buildup of respiratory secretions. In addition, a change in activity tolerance should trigger more in-depth assessment of respiratory status changes. Breathing techniques may be helpful for managing dyspneic episodes; the amount of stale air in the lungs is reduced, and the patient gains confidence and control in managing dyspnea. Although hydration is important, routine suctioning of the patient with COPD is not indicated. Excessive weight gain from overeating is not desirable; however, COPD patients are more likely to experience inadequate nutrition and weight loss secondary to the work of breathing and decreased appetite.

The nurse is suctioning a patient's tracheostomy and notes a heart rate of 98 and an oxygen saturation of 89% during the procedure. Which action by the nurse is correct? 1. Continue suctioning to fully clear the airway of secretions. 2. Reoxygenate the patient with a 100% oxygen delivery system. 3. Stop suctioning until the heart rate and oxygen saturation return to normal. 4. Ask the patient to take three or four deep breaths before resuming suctioning.

2. Reoxygenate the patient with a 100% oxygen delivery system. If a patient becomes hypoxic during suctioning, the nurse should reoxygenate the patient with 100% oxygen. Patients are asked to take three to four deep breaths, if possible, prior to beginning suctioning. Continuing suctioning will increase the hypoxia.

A patient admitted to the hospital with an exacerbation of chronic obstructive pulmonary disease (COPD) and chronic malnutrition develops a cough, a temperature of 39°C, an oxygen saturation of 94%, and crackles in both lungs. Which action would the nurse take first? 1. Provide supplemental oxygen. 2. Request an order for a chest x-ray. 3. Monitor closely for respiratory failure. 4. Ask the provider to order a complete blood count.

2. Request an order for a chest x-ray. Patients with chronic lung disease who are malnourished are at increased risk for hospital-acquired pneumonia; a chest x-ray is necessary to diagnose this condition so that treatment can be initiated. The patient is not hypoxic and does not need supplemental oxygen at this time. There is not an indication of respiratory failure in this patient. A complete blood count will likely be ordered, but obtaining the chest x-ray is the priority for diagnostic and management purposes.

The nurse is caring for a patient who was admitted with pneumonia. Which position assumed by the patient leads the nurse to suspect that the patient is developing hypoxia? 1. Side-lying 2. Sitting in tripod position 3. Prone with head of bed at 30° angle 4. Supine with head of bed at 45° angle

2. Sitting in tripod position A patient with hypoxia will assume the tripod position (seated and positioned leaning on the hands, often leaning on an over-the-bed table). The patient who is hypoxic will not assume a side-lying or prone position because these positions will only increase a patient's feelings of inability to obtain enough air. Elevating the head of the bed 45° will not be adequate to relieve the smothering feelings associated with hypoxia.

A patient has a fenestrated tracheostomy tube in place. Which multidisciplinary team would be involved in the discharge planning process, specific to the tracheostomy? 1. Physical therapy 2. Speech therapy 3. Occupational therapy 4. Patient care assistant

2. Speech therapy A vital member of the multidisciplinary team for the patient with a fenestrated tracheostomy tube is speech therapy. A speech therapist can teach the patient about swallowing and communication with the tube in place. Physical therapy and occupational therapy may be beneficial to the patient for conditioning and strengthening, but they are not specific to the tracheostomy. The patient may utilize a patient care assistant as well, but this is not specific to the tracheostomy.

Which nonsurgical treatment for lung cancer involves inhibiting the tumor cell growth factors? 1. Chemotherapy 2. Targeted therapy 3. Radiation therapy 4. Photodynamic therapy

2. Targeted therapy Targeted therapy involves using drugs such as erlotinib, bevacizumab, and crizotinib; these drugs inhibit the growth of cancer cells by blocking growth factor receptors. Chemotherapy with platinum agents is usually used for small cell lung cancer. Radiation therapy is often used to treat locally advanced lung cancer that is confined to the chest by shrinking the tumor. Photodynamic therapy uses laser light to destroy sensitized cancer cells.

A patient with sleep apnea has a new prescription for a BiPAP device to be worn at night. What does the nurse include in the teaching for this assistive device? Select all that apply. 1. The BiPAP device only delivers room air. 2. The mask must fit tightly to form a proper seal. 3. BiPAP provides the same pressure during inhalation and exhalation. 4. BiPAP provides positive pressure during inhalation and exhalation to keep alveoli open. 5. BiPAP improves airflow during sleep and promotes comfort by reducing dyspnea.

2. The mask must fit tightly to form a proper seal. 4. BiPAP provides positive pressure during inhalation and exhalation to keep alveoli open. 5. BiPAP improves airflow during sleep and promotes comfort by reducing dyspnea. To ensure delivery of prescribed positive-pressure breaths, the mask must fit snugly with no leakage. The BiPAP device delivers positive-pressure ventilation to keep alveoli open and prevent atelectasis. It promotes rhythmic breathing and prevents apneic episodes, which cause dyspnea, thereby promoting comfort and restful sleep. It delivers oxygen as well as room air. The difference and benefit of BiPAP over the continuous positive airway pressure (CPAP) machine is that exhalation pressure is less than inspiratory pressure in BiPAP, providing less resistance and enhanced comfort.

Which statement is true regarding the stationary chest tube drainage system? 1. The first chamber acts as a suction regulator. 2. The tubes from the patient are connected to the first chamber. 3. The second chamber collects the fluid draining from the patient. 4. The first chamber prevents the air from moving back into the patient's chest.

2. The tubes from the patient are connected to the first chamber. There are three chambers used in the stationary chest tube drainage system. The first chamber is the drainage collecting chamber. The tubes from the patient are connected to this chamber. Regulation of suction activity is performed by the third chamber. The second chamber is the water seal, which prevents air from moving back up the tubing system and into the patient's chest.

What would be the most effective treatment for a patient with lung cancer who is diagnosed with pleural effusion? 1. Drug therapy 2. Thoracentesis 3. Pneumonectomy 4. Radiation therapy

2. Thoracentesis Thoracentesis involves fluid removal by suction, and it is very effective for curing pleural effusion. Drug therapy, pneumonectomy, and radiation therapy are unassociated with the treatment of pleural effusion. Drug therapy with bronchodilators and corticosteroids is used for the treatment of bronchospasm. Pneumonectomy is the surgical removal of lung. Radiation therapy helps cure obstruction of the bronchi and great veins (superior vena cava syndrome).

A patient comes to the emergency department with a sore throat. Examination reveals redness and swelling of the pharyngeal mucous membranes. Which diagnostic test does the nurse expect will be requested first? 1. Chest x-ray 2. Throat culture 3. Tuberculosis (TB) skin test 4. Complete blood count (CBC)

2. Throat culture A throat culture is important for distinguishing a viral infection from a group A beta-hemolytic streptococcal infection. A chest x-ray or TB skin test are not indicated by the symptoms given. A CBC might be indicated to evaluate infection and dehydration, but would not be the first action.

A patient with pulmonary tuberculosis is being started on combination therapy. What does the nurse explain to the patient as the purpose of combination therapy? 1. To allow for missed doses 2. To shorten therapy by 6 months 3. To treat highly resistant cases of tuberculosis 4 To improve the patient's ability to tolerate medications

2. To shorten therapy by 6 months Combination medication shortens therapy by 6 to 12 months. Tuberculosis medications should be taken as ordered without missing a dose. Combination therapy is not related to disease resistance. Medications may be changed based upon the patient's ability to tolerate drugs.

When caring for a patient with head and neck cancer following a total laryngectomy 12 hours ago, which potential complications are important for the nurse to address? Select all that apply. 1. Preparing the patient for radiation 2. Wound breakdown and hemorrhage 3. Comfort and nonverbal communication 4. Airway obstruction and inadequate oxygenation 5. Educating the patient about various types of chemotherapy

2. Wound breakdown and hemorrhage 3. Comfort and nonverbal communication 4. Airway obstruction and inadequate oxygenation Significant potential complications after surgery for head and neck cancer include wound breakdown, airway obstruction/compromise, pain management, and adequate nonverbal communication. This is an extremely stressful time for patients and their families; attentiveness to these aspects of the recovery process can prevent complications and delayed recovery. Once the patient is past the early postoperative period, preparation for teaching about radiation therapy will be needed if it is a recommended treatment. The nurse will not teach a patient about chemotherapy unless this is the prescribed course of treatment. It is also not a priority during the early postoperative period.

A patient with asthma reports diarrhea and vomiting. Which drug should be used with caution? 1. Ribavirin 2. Zanamivir 3. Amantadine 4. Rimantadine

2. Zanamivir Nausea, diarrhea, and vomiting are the symptoms of influenza B. Zanamivir should be used with caution in patients with asthma, as it may cause bronchospasms. Ribavirin is used to treat severe influenza B. Amantadine and rimantadine are used to treat influenza A.

A patient reports severe headache, nausea , and vomiting for one full day. Which drugs would be most effective in the patient? Select all that apply. 1. Ribavirin 2. Zanamivir 3. Oseltamivir 4. Amantadine 5. Rimantadine

2. Zanamivir 3. Oseltamivir A severe headache, nausea, and vomiting are the symptoms of influenza B. Zanamivir and oseltamivir are the most effective drugs that are used within 24 to 48 hours after the onset of symptoms. Ribavirin is the drug of choice to treat severe influenza B. Amantadine and rimantadine are the drugs that treat influenza A.

Which cuff pressure should be maintained in a tracheostomy or endotracheal tube to prevent mucosal ischemia? 1. 4-8 mm Hg 2. 10-12 mm Hg 3. 14-20 mm Hg 4. 22-28 mm Hg

3. 14-20 mm Hg A pressure range of 14-20 mm Hg is recommended to prevent an air leak around the cuff yet not be excessive to cause ischemia of the tracheal mucosa. Pressures below 14 mm Hg may lead to air leakage around the cuff. Pressures above 20 mm Hg can lead to ischemia of the tracheal mucosa.

A family member of a patient who has been diagnosed with severe acute respiratory syndrome (SARS) asks the nurse why the patient is not receiving an antibiotic. How does the nurse respond to this family member? 1. "The organism that causes SARS is resistant to all antibiotics." 2. "I will notify the provider to see if an antibiotic can be ordered." 3. "Antibiotics are not effective because SARS is caused by a virus." 4. "Antibiotics are usually given when the disease becomes more severe."

3. "Antibiotics are not effective because SARS is caused by a virus." SARS is a viral infection and antibiotics are not useful for treating this disease. Patients are provided with supportive care to allow their immune systems to fight the disease. Antibiotics are given only when a secondary infection is present.

Which teaching by the student nurse to a patient who underwent a rhinoplasty may result in complications during the postoperative period? 1. "Rest in a semi-Fowler's position." 2. "Eat soft foods after the procedure." 3. "Apply a hot water bottle to the nose." 4. "Drink at least 2500 mL of water daily."

3. "Apply a hot water bottle to the nose." Following rhinoplasty, a hot water bottle may increase the risk of bleeding due to tissue friability. Therefore, the student nurse should instruct the patient to use cool compresses, which helps to reduce swelling and bruising. The patient should rest in a semi-Fowler's position (30°-45°), which reduces pressure on the surgical area. Soft foods should be eaten to reduce pressure on the nearby tissues. Drinking lots of water will keep the patient well-hydrated.

A clinic nurse is providing teaching for a patient who has been diagnosed with a peritonsillar abscess. What does the nurse include in this patient's teaching? 1. "Gargling with warm saline may make discomfort worse." 2. "Take the prescribed antibiotics until the swelling subsides." 3. "Go to the emergency department if drooling or stridor occur." 4. "A tonsillectomy

3. "Go to the emergency department if drooling or stridor occur." Patients with peritonsillar abscess should be taught the signs of airway obstruction that include drooling and stridor and should be told to seek emergency medical care if these occur. Tonsillectomy is sometimes necessary to prevent recurrence, but not always. Gargling with warm saline is a comfort measure and should be encouraged. Patients should be taught to take prescribed antibiotics for the full course of treatment and not to stop when symptoms subside.

After receiving education on the correct use of emergency drug therapy for asthma, which statement by the patient indicates a correct understanding of the nurse's instructions? 1 "Preventive drugs can stop an attack." 2 "Asthma drugs help everybody breathe better." 3. "I must have my emergency inhaler with me at all times." 4 "I must carry my emergency inhaler only when activity is anticipated."

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

A patient who has just had a nosebleed successfully stopped using gauze packing will be sent home from the emergency department. Which statement by the patient indicates a need for further teaching about self-care at home? 1. "I should apply petroleum jelly to my nose." 2. "I will not lift heavy objects for at least a month." 3. "I should not blow my nose for the next 6 hours." 4. "I may use saline nasal spray to moisturize my nose."

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

A patient has a stoma after undergoing a laryngectomy, and the nurse is preparing the patient for discharge. Which statement by the patient indicates that more teaching is needed? 1. "I will clean the stoma with mild soap and water." 2. "I should cover the stoma while using an electric razor." 3. "I should not cover the stoma while coughing or sneezing." 4. "I will not swim but may shower using appropriate precautions.

3. "I should not cover the stoma while coughing or sneezing." Patients who have undergone a laryngectomy should be taught to cover the stoma when coughing or sneezing. They should also cover the stoma while shaving to prevent hair from getting inside. The stoma should be cleaned with soap and water. Patients should take appropriate precautions when around water and should not swim.

The nurse is instructing a nursing student on how to prevent pneumonia in an older adult who is receiving mechanical ventilation. Which statement by the student indicates a need for further teaching? 1. "I will suction subglottic secretions every 2 hours and as needed." 2. "I will provide meticulous oral care every 24 hours and as needed." 3. "I should not wear hand jewelry while providing care to this patient." 4. "I should keep the head of the bed elevated at least 30 degrees at all times."

3. "I should not wear hand jewelry while providing care to this patient." Patients who are ventilator-dependent require meticulous oral care, and this should be performed every 12 hours and more often if needed. Nurses should ensure that the head of the bed is elevated 30 degrees or more and should not wear hand jewelry while caring for these patients. Suctioning should be continuous if a separate lumen is available, or at least every 2 hours.

The nurse is teaching a patient with asthma about using a controller medication. Which statement by the patient indicates a need for further teaching? 1 "If I have an increased frequency of attacks, I should notify my provider." 2 "I will use this medication every day whether I am having symptoms or not." 3. "I should take this medication as needed when my symptoms become more severe." 4 "Controller medications are given to help prevent acute exacerbations of asthma."

3. "I should take this medication as needed when my symptoms become more severe." Controller medications are given to help prevent acute exacerbations and are not used on an "as-needed" basis. Patients should report any increase in frequency of episodes so adjustments in medications may be made. They should use controller medications daily whether they are having symptoms or not.

A patient is scheduled for a total laryngectomy. Which statement by the patient indicates the need for further teaching about the procedure? 1. "I hope I can learn esophageal speech." 2. "I won't be able to breathe through my nose anymore." 3. "I will have to take special care not to aspirate while eating." 4. "It is hard to believe that I will never hear my own voice again."

3. "I will have to take special care not to aspirate while eating." Aspiration cannot occur after a total laryngectomy because the airway is completely separated from the esophagus. The patient will not be able to breathe through the nose. The patient will be able to vocalize after working with a speech/language pathologist if he or she chooses; however, the voice will sound different than the patient is used to. Esophageal or mechanical speech will permit the patient to speak, but the voice will not sound like his or her own.

A nurse is diagnosed with seasonal influenza, and on the second day of treatment with oseltamivir, she asks the supervising nurse when she may return to work on a hospital unit. What does the supervising nurse tell her? 1. "You will need to remain off work for 2 weeks or longer." 2. "After initiation of antiviral therapy, you are no longer contagious." 3. "If you are feeling well and afebrile in 5 days, you may return to work." 4. "When you have a negative influenza test, you will be cleared for work."

3. "If you are feeling well and afebrile in 5 days, you may return to work." Individuals with influenza are contagious from 24 hours before the onset of symptoms and up to 5 days after symptoms begin. Antiviral medication only shortens the duration of symptoms but does not affect contagiousness. Those who continue to have symptoms, especially fever, should remain off work until those symptoms clear.

What is the most important information for the nurse to convey to a patient who is beginning pharmacological therapy for the treatment of tuberculosis to ensure suppression of the disease? 1. "Eat a diet rich in Vitamin K." 2. "Do not drink alcoholic beverages." 3. "Take the medication exactly as prescribed." 4. "Contact the health care provider if you become ill."

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

A patient with seasonal allergies has developed vocal cord polyps and asks the nurse what can be done to treat this condition. What does the nurse suggest? 1. "Allergy medications are used to treat polyps." 2. "Laser surgery will be necessary to treat polyps." 3. "Voice rest and avoiding heavy lifting are helpful." 4. "Whispering instead of speaking out loud will help."

3. "Voice rest and avoiding heavy lifting are helpful." Patients with polyps should be taught to rest the voice and to avoid heavy lifting that puts pressure on the vocal cords. Allergy medications may help prevent polyp formation but are not used to treat polyps. Laser surgery is performed when other measures fail. Whispering should be avoided.

A patient is being treated with ciprofloxacin 500 mg PO twice daily due to possible exposure to inhalation anthrax. What is the nurse's best answer when the patient asks how long this medication must be taken? 1. "You will need to take the medication for 10 days." 2. "You will need to take the medication for at least a year." 3. "You will need to take the medication for about 2 months." 4. "You will need to take the medication for at least 6 months."

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

Which symptoms may be observed in an older patient with pneumonia? Select all that apply. 1. Fever 2. Cough 3. Fatigue 4. Confusion 5. Poor appetite

3. Fatigue 4. Confusion 5. Poor appetite In older patients, pneumonia may be characterized by fatigue, confusion, and poor appetite. Fever and cough are not always present in these patients.

Which patient may be an ideal candidate for the surgical treatment of chronic obstructive pulmonary disease (COPD)? 1. A patient with acute emphysema and stable cardiac function 2. A patient with end-stage emphysema and pulmonary fibrosis 3. A patient with minimal chronic bronchitis and stable cardiac function 4. A patient with advanced chronic bronchitis and stable cardiac function

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

A patient who has thick, sticky respiratory secretions requires high-flow, humidified oxygen delivery. Which oxygen delivery equipment does the nurse use for this patient? 1. Face tent 2. Venturi mask 3. Aerosol mask 4. Nonrebreather mask

3. Aerosol mask An aerosol mask is used when high humidity is needed, as with thick secretions. A face tent is used for patients with burns or facial trauma. A nonrebreather mask is a low-flow oxygen delivery system. The Venturi mask is not the best method to deliver high-humidity oxygen.

The nurse is teaching a patient about isoniazid (INH) and rifampin (RIF) drug therapy for tuberculosis (TB). The nurse instructs that while on these medications, the patient should avoid consuming which food? 1. Eggs 2. Dairy 3. Alcohol 4. Red meat

3. Alcohol Isoniazid and rifampin can damage the liver, so alcohol should be avoided for the duration of the medication regimen, which can be 6 months to 2 years. Consuming foods high in tyramine while on these drugs can cause a severe increase in blood pressure. However, not all dairy products need to be avoided; only aged cheeses are high in tyramine. Red meat and eggs are not high in tyramine and can be consumed freely.

he nurse is assessing a patient with suspected lung cancer. While auscultating lung sounds, the nurse hears an increased loudness of the patient's voice. What does this finding indicate? 1. The presence of inflammation 2. A complete obstruction of the airway 3. An increased density of the lung tissue 4. A partial obstruction of the airflow in the narrowed passages

3. An increased density of the lung tissue During assessment of the breath sounds, an increased sound intensity of the patient's voice indicates an increased density of the lung tissue. This occurs due to tumor compression. During the assessment of breathing sounds, the presence of inflammation is indicated by pleural friction rub. A complete obstruction of the airway by a tumor or fluid is indicated by decreased breathing sounds. A partial obstruction of the airflow in the passages narrowed by tumors or fluids is indicated by wheezing sounds.

A patient comes to the emergency department (ED) with a bruised and swollen nose after being hit with a baseball 2 days ago. X-ray reveals a displaced fracture of the nose. Which order does the nurse anticipate implementing? 1. Assisting with a closed reduction with a local anesthetic in the ED 2. Packing the nose with gauze to minimize bleeding and limit swelling 3. Applying a cool compress and administering analgesic medication 4. Preparing the patient for an immediate rhinoplasty in the operating room

3. Applying a cool compress and administering analgesic medication A patient who has a displaced nasal fracture will require a closed reduction, which should be performed within 24 hours after the injury. After 24 hours, the fracture is difficult to reduce because of edema and scar formation, so the provider will wait up to several days until the swelling is gone to reduce the fracture. The nurse should expect to provide care that limits pain and swelling, which includes cold compresses and analgesics. Packing the nose is not necessary unless there is uncontrolled bleeding. A rhinoplasty is done for complex fractures or those that don't heal properly.

A patient returns to the provider's office three weeks after being diagnosed with pneumonia. The nurse notes that the patient reports fatigue, weakness, and cough. The patient is concerned the pneumonia is returning. What is the best action the nurse should take? 1. Arrange for the patient to be readmitted to the hospital. 2. Assess for patient noncompliance to treatment regimen. 3. Assure the patient that recovery from pneumonia is a long process. 4. Arrange for the patient to receive another treatment of anti-infective medications.

3. Assure the patient that recovery from pneumonia is a long process. The recovery from pneumonia is a long process and the nurse should instruct the patient to get plenty of rest and increase activity gradually. The nurse cannot arrange for readmission to hospital or order medications. Fatigue, weakness, and cough are part of the recovery process, there is no information to support noncompliance.

What two assessment findings are changes secondary to chronic obstructive pulmonary disease (COPD)? 1. Emphysema and bronchitis 2. Wheezing and excess mucus 3. Barrel chest and finger clubbing 4. Lung crackles and finger clubbing

3. Barrel chest and finger clubbing With a barrel chest, the ratio between the anteroposterior diameter of the chest and its lateral diameter is 2 : 2, rather than the normal ratio of 1:1.5. This shape change results from lung overinflation and diaphragm flattening. Finger clubbing is an indication of decreased arterial oxygen levels seen in COPD. Wheezing is likely to be present during an asthma attack and airway obstruction but would more likely be of limited duration. Excess mucus would be indicative of inflammation. Crackles in the lungs would indicate the air moving through mucus/fluid in the airways; this would potentially clear with pulmonary hygiene. Emphysema and bronchitis are two diseases under the COPD umbrella.

A patient taking ethambutol for tuberculosis is receiving discharge teaching from the nurse. What is the most important sign or symptom of a serious adverse reaction to this medication that the nurse should teach this patient? 1. Fatigue 2. Anorexia 3. Changes in vision 4. Aching of the feet

3. Changes in vision Ethambutol can cause optic neuritis leading to blindness. The damage can be reversed if the problem is caught in time, so the patient should be instructed to immediately report any changes in vision to the health care provider. Severe nausea and vomiting can occur in the presence of alcohol but fatigue and anorexia are not worrisome signs on their own. This drug may precipitate gout, which causes aching of the feet, so the patient should be taught to increase fluid intake; however, this adverse reaction is not as serious as potential blindness.

The patient with a tracheostomy who is using a T-piece mask reports a feeling of suffocation to the nurse. What is the first intervention that the nurse adopts in order to provide relief to the patient? 1. Empty condensation from the tubing. 2. Make sure that the humidifier creates enough mist. 3. Check that the exhalation port is open and uncovered. 4. Position the T-piece so that it does not pull on the tracheostomy

3. Check that the exhalation port is open and uncovered. The possible reason for the patient's feeling of suffocation could be occlusion of the exhalation port. So, to stabilize the patient's condition, the nurse should open the port and keep the port uncovered. The flow rate delivery of fraction of inspired oxygen (FiO 2) is affected by condensation. The humidifier should create enough mist to be visible during inspiration and expiration. If the weight of the T-piece pulls on the tracheostomy, it causes pain or erosion of skin at the insertion site; therefore, it is essential to see to it that it does not pull on the tracheostomy.

A local hunter is admitted to the intensive care unit with a diagnosis of inhalational anthrax. Which medications does the RN anticipate the health care provider will order? 1. Ceftriaxone 2 g IV every 8 hours 2. Amoxicillin 500 mg orally every 8 hours 3. Ciprofloxacin 400 mg IV every 12 hours 4. Pyrazinamide (PZA) 1000 to 2000 mg orally every day

3. Ciprofloxacin 400 mg IV every 12 hours Intravenous ciprofloxacin is a first-line drug for treatment of inhaled anthrax. A dose of 400 mg IV every 12 hours is typically used for treatment of anthrax, while a dose of 500 mg orally twice daily is usually prescribed for anthrax prophylaxis. Oral doses of amoxicillin are used only as prophylaxis, not as treatment, for inhaled anthrax. Cephalosporins such as ceftriaxone are not used for treatment of anthrax. Pyrazinamide (PZA) is used for treatment of tuberculosis.

Which manifestation in an older patient is the most common indicator for pneumonia? 1. Fever 2. Cough 3. Confusion 4. Increased white blood cell count

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

A patient with pneumonia caused by aspiration after alcohol intoxication has just been admitted. The patient is febrile and agitated. Which health care provider order should the nurse implement first? 1. Administer levofloxacin 500 mg IV. 2. Give lorazepam as needed for agitation. 3. Draw aerobic and anaerobic blood cultures. 4. Refer to social worker for alcohol counselling.

3. Draw aerobic and anaerobic blood cultures. Obtaining aerobic and anaerobic cultures is the first action the nurse should perform and is standard procedure in a febrile patient for whom antibiotics have been requested. Levofloxacin, an antibiotic, is important to administer, but blood cultures should be drawn before antibiotics are started. Unless this patient is a danger to self or staff, giving lorazepam for agitation is not the first action; the question indicates that the patient is agitated but does not indicate whether other attempts to control agitation have been tried, such as decreasing stimulation. A referral to social work for alcohol counselling will be initiated before the time of discharge; this patient is febrile and agitated, and a referral is not the immediate concern.

In which scenario is a patient likely to require emergency endotracheal intubation? 1. The patient is experiencing immediate coughing upon swallowing liquids. 2. The patient is unable to close a vocal cord due to paralysis and is coughing. 3. Dyspnea and stridor have occurred with bilateral vocal cord paralysis. 4. Polyps that have developed on the vocal cords have become edematous.

3. Dyspnea and stridor have occurred with bilateral vocal cord paralysis. Bilateral vocal cord paralysis will not allow airflow into the trachea; this leads to a respiratory emergency and may require intubation. When the patient is unable to close a vocal cord due to paralysis, the risk is for aspiration during eating and drinking. Immediate coughing upon swallowing liquids may indicate aspiration and require treatment, but not endotracheal intubation. Polyps on the vocal cord can become edematous and will then interfere with closure of the vocal cords; this would also contribute to the risk for aspiration.

What is recommended as safe nursing practice when caring for a patient with a tracheostomy and T-piece? 1. The T-piece should be padded to protect the skin. 2. Use the oral suctioning device to clear secretions from the T-piece. 3. Ensure that aerosol continuously comes out of the exhalation side of the T-piece. 4. When working in close proximity to the exhalation port, the nurse should drape it.

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

A "do not resuscitate" (DNR) patient has a nonrebreather oxygen mask, and breathing appears to be labored. What does the nurse do first? 1. Notify the chaplain and the family member of record. 2. Call the Rapid Response Team and prepare to intubate. 3. Ensure that the tubing is patent and that oxygen flow is high. 4. Comfort the patient and confirm that signed DNR orders are in the chart.

3. Ensure that the tubing is patent and that oxygen flow is high. Labored breathing and ultimately suffocation can occur if the reservoir bag on a nonrebreather mask kinks or if the oxygen source disconnects or is not set to high flow levels. The chaplain and the family member of record should not be notified because death is not imminent at this time. Equipment malfunction must be ruled out before intubation of the patient is performed. Additionally, the patient may not want to be intubated, as indicated in the DNR orders. Troubleshooting and reversal of nonresuscitative equipment is the standard of care; DNR does not mean "do not treat."

A patient is taking isoniazid, rifampin, pyrazinamide, and ethambutol for tuberculosis. The patient calls to report visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes? 1. Rifampin 2. Isoniazid 3. Ethambutol 4. Pyrazinamide

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

Which clinical manifestations are usually present when an older adult has pneumonia? Select all that apply. 1. Fever 2. Cough 3. Fatigue 4. Weakness 5. Confusion 6. Poor appetite

3. Fatigue 4. Weakness 5. Confusion 6. Poor appetite The most common manifestation of pneumonia in the older adult is acute confusion from hypoxia. The older adult also typically exhibits weakness, fatigue, and poor appetite when pneumonia is present. Fever and cough may be absent; the white blood cell count may not be elevated until the infection is severe.

Which factors are pathophysiologic bases for the clinical manifestations of pneumonia? Select all that apply. 1. A temperature greater than 38.5° C upon arising in the morning is typically present. 2. Suppression of fever with the use of acetaminophen will speed the recovery process in older adults. 3. Fluid accumulation in the receptors of the individual's respiratory system triggers the coughing mechanism. 4. Pulmonary capillary shunting and movement of red blood cells into the alveoli cause pleuritic chest discomfort. 5. Stimulation of chemoreceptors and decreased lung compliance lead to an increased respiratory rate and dyspnea

3. Fluid accumulation in the receptors of the individual's respiratory system triggers the coughing mechanism. 5. Stimulation of chemoreceptors and decreased lung compliance lead to an increased respiratory rate and dyspnea Stimulation of chemoreceptors in the respiratory system and the increased work of breathing secondary to decreased lung compliance lead to the clinical manifestation of increased respiratory rate and dyspnea. Fluid accumulation in the receptors of the trachea, bronchi, and bronchioles cause the coughing seen with pneumonia. Pulmonary capillary shunting leads to hypoxemia. Movement of red blood cells into the alveoli causes the presence of purulent, blood-tinged, or rust-colored sputum. Fever is secondary to the release of pyrogens that cause the hypothalamus to increase body temperature; this is a normal physiologic response—suppression of or masking the fever will not speed recovery. The presence of a fever is a clinical manifestation; fever upon arising in the morning is not a pathophysiologic mechanism.

A patient with small cell lung cancer (SCLC) has gynecomastia. This is most likely due to paraneoplastic syndrome caused by the tumor cells secreting which hormone? 1. Antidiuretic hormone 2. Parathyroid hormone 3. Follicle-stimulating hormone 4. Adrenocorticotropic hormone

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

A newly admitted patient with pneumonia has an oral temperature of 102°F, an oxygen saturation of 93%, diminished breath sounds bilaterally, and the patient is unable to cough effectively. The nurse has received orders for oxygen therapy, intravenous antibiotics, antipyretic medication, and sputum specimen collection. What should be the nurse's first action? 1. Provide humidified oxygen. 2. Obtain the sputum specimen. 3. Give the intravenous antibiotic. 4. Administer the antipyretic medication.

3. Give the intravenous antibiotic. The patient should receive the antibiotic as soon as possible since sepsis is a serious complication of pneumonia. While it is optimal to obtain the sputum culture before starting antibiotics, it is not always possible, and often the causative organism is not identified; moreover, this patient does not have an effective cough. The second action would be to apply oxygen; this patient has an oxygen saturation of 93%, which is acceptable. The third action would be to administer the antipyretic for comfort.

Which combination of personal protective equipment does the nurse wear when caring for a patient with severe acute respiratory syndrome (SARS)? 1. Gloves, gown, mask 2. Gloves, mask, goggles 3. Gloves, gown, goggles, mask 4. Gloves, gown, head cover, goggles

3. Gloves, gown, goggles, mask The SARS virus spreads easily by airborne droplets through sneezing, coughing, and talking. Portals of entry are the mucous membranes of the eyes, nose, and mouth. Therefore, gloves, gown, mask, and eye goggles are required. Head covering is not needed with SARS when the other personal protective equipment is used.

A patient with chronic obstructive pulmonary disease (COPD) reports having off-and-on symptoms of dyspnea, coughing, and sputum production. The patient's FEV 1/FVC is 65% of predicted value and the FEV 1 is 55% of predicted value. Which level of COPD severity does this patient have? 1. I - mild 2. III - severe 3. II - moderate

3. II - moderate This patient has intermittent symptoms and has an FEV 1/FVC of less than 70% of predicted value and an FEV 1 between 50% and 80% of predicted value, which means the patient has moderate COPD. Patients with mild COPD do not have dyspnea. Patients with severe COPD have an FEV 1 between 30% and 50% of predicted value with persistent symptoms. Patients with very severe COPD have an FEV 1 less than 30% or less than 50% of predicted value with respiratory failure along with more severe symptoms.

A patient is 1 day postoperative from a total laryngectomy for cancer and is experiencing pain. Pain management is best achieved with which medication? 1. IV ketorolac 2. IV midazolam 3. IV morphine sulfate 4. Oral acetaminophen

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

Which is considered the priority in treatment planning for patients with head and neck cancers? 1. Cures with radiation are unlikely; surgery is required. 2. Nonsurgical management is strictly palliative in nature. 3. Normal lifestyle and functional ability must be preserved. 4. Chemotherapy is only curative if used with radiation therapy.

3. Normal lifestyle and functional ability must be preserved. Preservation of normal function without compromising long-term effectiveness of treatment is a priority in patients with head and neck cancers, especially to decrease problems with swallowing/aspiration and speech to maximize quality of life. The likelihood of a cure with radiation is dependent on the extent of the disease and sensitivity to the therapy. Chemotherapy may actually be used alone or in combination with radiation and even surgical therapy. Nonsurgical management is not limited to palliative expectations in tumors identified early in a curable stage.

An older patient receiving mechanical ventilation with a tracheostomy has poor nutritional status and is dehydrated. Which nursing action is most important to prevent complications in this patient? 1. Provide warm, humidified air and suction the tube frequently. 2. Encourage the patient to cough frequently to clear secretions. 3. Keep the pressure on the tracheal tube cuff between 14 and 20 mm Hg. 4. Change the tracheostomy tube dressing and reposition the tube every 4 hours.

3. Keep the pressure on the tracheal tube cuff between 14 and 20 mm Hg. Older patients and those who are malnourished and dehydrated are at increased risk for tissue breakdown caused by tracheostomy tube pressure. Anything that causes movement of the tube causes friction and can contribute to tissue breakdown. Maintenance of cuff pressure between 14 mm Hg and 20 mm Hg will allow adequate circulation to the tracheal mucosa. The nurse should change dressings and suction the tube only as needed, taking care not to move the tube. Coughing will increase tube friction.

A patient with leukoplakia on the larynx has just received the results of a biopsy and is confirmed to have a very small, stage I squamous cell carcinoma. The health care provider is planning surgery to remove the tumor, and the patient is concerned about the effects of a surgical procedure on the voice. Which surgical procedure with the highest cure rate may leave the patient with a normal voice? 1. Laser surgery 2. Transoral cordectomy 3. Laryngofissure procedure 4. Supraglottic partial laryngectomy

3. Laryngofissure procedure The laryngofissure procedure does not remove the vocal cords and therefore does not change the normal voice quality for the patient. This procedure is appropriate for a very small and early lesion. A transoral cordectomy, laser surgery, and supraglottic partial laryngectomy all have hoarseness as a possible postoperative effect.

A patient who works in a furniture and woodworking factory reports that he is worried about his health because two coworkers have been diagnosed with sinus cancer in the past year. The nurse tells the patient that his risk of sinus cancer may increase with chronic exposure to which elements? Select all that apply. 1. Pollution 2. Liquid glue 3. Leather dust 4. Nasal sprays 5. Paint thinners 6. Wood particles

3. Leather dust 6. Wood particles Chronic exposure to fine particulates, especially wood and leather dust, is associated with an increased incidence of nose and sinus cancer. Nasal sprays, pollution, paint thinners, and liquid glue do not increase a person's risk for sinus cancer.

Which nursing action has the highest priority when caring for a patient with laryngeal trauma? 1. Managing pain 2. Assessing for bleeding 3. Maintaining a patent airway 4. Providing a communication method

3. Maintaining a patent airway Maintaining a patent airway remains the nursing priority until the trauma to the larynx has healed. Pain and bleeding management and communication are secondary priorities to a patent airway.

In a patient with pneumonia, what is the most important nursing intervention? 1. Preventing sepsis 2. Decreasing anxiety 3. Managing hypoxemia 4. Teaching safe oxygen management

3. Managing hypoxemia Managing hypoxemia is the critical or priority action for nursing care of the patient with pneumonia. Although decreasing anxiety is important, it is not the priority. Preventing sepsis is important but not as urgent as managing hypoxemia. Teaching safe oxygen management would be more important if the patient was being discharged.

The nurse is caring for a patient who is in fixed occlusion for a jaw fracture. The most important reason for the nurse to provide oral care with an electronic irrigation system (WaterPik) several times daily is to prevent which condition? 1. Gingivitis 2. Dental caries 3. Mandibular infection 4. Dry mucous membranes

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

What would be the most appropriate surgical intervention for a patient with a nasoethmoid complex fracture? 1. Resorbable devices 2. Inner maxillary fixation 3. Microplating surgical systems 4. Open reduction with internal fixation

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

A patient has been diagnosed with chronic bronchitis and started on a mucolytic. What is the rationale for ordering a mucolytic for this patient? 1. Mucolytics decrease secretion production. 2. Mucolytics increase gas exchange in the lower airways. 3. Mucolytics thin secretions, making them easier to expectorate. 4. Mucolytics provide bronchodilation in patients with chronic obstructive pulmonary disease (COPD).

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

Which of these oxygen delivery systems is known to deliver low-flow fraction of inspired oxygen (FiO 2)? 1. Face tent 2. Venturi mask 3. Nasal cannula 4. Tracheostomy

3. Nasal cannula The nasal cannula is the only type of oxygen delivery system which delivers low-flow FiO 2. Face tents, Venturi masks, and tracheostomies are examples of oxygen delivery systems that deliver high-flow FiO 2.

A patient is being admitted with severe respiratory distress and will require an Fio 2 greater than 80%. Prior to possible intubation and mechanical ventilation, the nurse anticipates using which oxygen delivery equipment? 1. Facemask 2. Venturi mask 3. Non-rebreather mask 4. Partial rebreather mask

3. Non-rebreather mask Non-rebreather masks allow the highest oxygen level of the low-flow systems and are often used for patients whose respiratory status is unstable and who may require intubation. The facemask and the partial rebreather mask are used for patients who are more stable. The Venturi mask is used for patients with chronic lung disease to allow for precise oxygen delivery.

A public health nurse is providing education to a community about preparation for a possible influenza epidemic leading to a worldwide pandemic. What does the nurse instruct community members to do upon learning that an influenza outbreak has occurred? 1. Attend meetings to learn how to manage the outbreak. 2. Take antiviral medications to prevent developing symptoms. 3. Obtain a vaccine if not already vaccinated against influenza. 4. Stock their homes with a 2-week supply of food and medicine.

3. Obtain a vaccine if not already vaccinated against influenza. People should be taught to receive vaccinations if not already vaccinated if an outbreak occurs. People should stay home as much as possible and avoid crowds. Stockpiling food and medicines should occur in anticipation of an outbreak, not at the onset when people should be advised to stay home. Antiviral medications are given to those who contract the virus to limit symptoms.

What is the most important reason for ordering inhaled, rather than oral, corticosteroids for patients with asthma? 1. Inhaled corticosteroids are easier to use. 2. Inhaled corticosteroids are more effective. 3. Oral corticosteroids have more adverse effects. 4 Oral corticosteroids have less predictable effects.

3. Oral corticosteroids have more adverse effects. Inhaled corticosteroids are given because they have direct actions on the target tissues in the lungs, causing fewer systemic adverse effects than oral corticosteroids. They are not necessarily more effective, nor are they easier to use. Oral corticosteroids do not have less predictable effects.

The normal balance of the body's oxygen intake and delivery system can be disrupted when there is a problem with normal oxygen delivery. Which statement is true in these situations? 1. Hypercarbia will provide the necessary stimulus to prevent dangerously low blood oxygen levels. 2. Oxygen will not cure the underlying disease adequately to prevent hypoxia; therefore, oxygen delivery is not indicated. 3. Oxygen administration will decrease the work of the heart to improve the delivery of oxygen to vital organs. 4. Oxygen administration is not needed; the body can adapt with an increase in red blood cells for oxygen delivery

3. Oxygen administration will decrease the work of the heart to improve the delivery of oxygen to vital organs. Since the problem is with oxygen delivery, the immediate need is supplemental oxygen. Although the heart may work harder to improve delivery of the available oxygen, the administration of oxygen will decrease the stress on the heart. An increase in red blood cells would take longer to accomplish. Hypercarbia is not the stimulus for breathing in individuals without chronic lung disease.

What could be the possible diagnosis for a patient who presents with pain in the throat, difficulty swallowing, swelling in the throat, and difficulty in opening the mouth? 1. Tonsillitis 2. Pharyngitis 3. Peritonsillar abscess 4. Retropharyngeal abscess

3. Peritonsillar abscess Pain and difficulty swallowing, swelling of the throat, and difficulty in opening the mouth are symptoms of peritonsillar abscess, a complication of acute tonsillitis. Pain and difficulty swallowing and swelling of the throat are also common symptoms of tonsillitis, pharyngitis, and retropharyngeal abscess; however, difficulty in opening the mouth is not associated with these conditions.

A patient has had chest tubes placed during a lobectomy for lung cancer. The nurse notices the tube is dislodged and lying on the floor. What should be the nurse's priority action? Incorrect1 Notify the surgeon immediately. 2 Attempt to reinsert the chest tube. 3. Place a gauze dressing over the chest tube site. 4 Ask the patient what caused the tube dislocation.

3. Place a gauze dressing over the chest tube site. The application of a sterile dry or Vaseline gauze dressing to the chest tube site will help to seal off the air leak. The provider should then be notified as the next step. Chest tube reinsertion will require the surgeon and a new sterile chest tube. Maintaining calm support of the patient is important at this time; the nurse should not use this opportunity to attempt to identify the cause of the chest tube dislodgement.

A patient who has recently traveled to Vietnam comes to the emergency department with fatigue, lethargy, bloody sputum, night sweats, and a low-grade fever. What is the nurse's first action? 1. Perform a TB skin test 2. Test all family members for TB 3. Place a respiratory mask on the patient 4. Contact the health care provider for tuberculosis (TB) medications

3. Place a respiratory mask on the patient The concern is that this patient has TB. A respiratory mask should be placed on the patient immediately. Requesting medications for TB is not appropriate until the patient has been evaluated and a diagnosis has been made. Performing a TB test will be important, but this is not the top priority. It is important to remember to let the patient know that results will not be available for at least 48 hours after the test is administered. Further testing of this patient needs to be completed and a diagnosis made before family members are tested.

A patient calls the nurse to report a nosebleed that started with a sneeze. What does the nurse do first? 1. Loosely pack the affected naris with gauze or nasal tampons. 2. Instruct the patient not to sneeze or blow the nose for 24 hours. 3. Position the patient upright and leaning forward over an emesis basin. 4. Reassure the patient to reduce anxiety and help lower blood pressure.

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

The nurse has an order to wean a patient from a tracheostomy. Several hours after capping the tube, the nurse assesses the patient and observes a heart rate of 90 beats/min, respirations of 22 breaths/min, and an oxygen saturation of 94%. The patient has a productive cough and expresses anxiety about weaning. Which action by the nurse is correct? 1. Suction the patient and recap the tube. 2. Recap the tube and reassess in 15 minutes. 3. Reassure the patient that everything is normal. 4. Notify the provider that the patient is not ready to wean.

3. Reassure the patient that everything is normal. Many patients express anxiety about weaning because of fears of hypoxia, so the nurse should reassure the patient that everything is normal. The patient's vital signs and oxygen saturation are within normal limits and do not indicate respiratory distress. A productive cough is not cause for suctioning since the patient is stable.

The nurse in the long-term care facility is concerned about the health status of an 80-year-old resident. What early symptom would alert the nurse that this patient is developing pneumonia? 1. Vomiting 2. Productive cough 3. Recent onset of confusion 4. Oral temperature of 101.1°F

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

Low-flow oxygen delivery systems typically include which types of components? Select all that apply. 1. Venturi mask 2 . Aerosol mask 3. Simple facemask 4. T-piece apparatus 5. Nonrebreather mask

3. Simple facemask 5. Nonrebreather mask Both simple and non-rebreather facemasks can deliver a low level of oxygen. The Venturi (or Venti) and aerosol masks are used in high-flow oxygen delivery systems and are set up to deliver 24% to 50% Fio 2 and 24% to 100% Fio 2, respectively. The T-piece apparatus is an adapter that is attached to an endotracheal or tracheostomy tube.

A patient who is about to undergo a supraglottic partial laryngectomy asks the nurse what the surgeon will remove during this procedure. The nurse explains to the patient that the surgeon will remove which structures? 1. The tumor only without other structures 2. The larynx and possible nodes in the neck 3. The hyoid bone, false cords, and the epiglottis 4. One true cord, one false cord, and one-half of the thyroid

3. The hyoid bone, false cords, and the epiglottis A supraglottic partial laryngectomy involves removal of the hyoid bone, false cords, and the epiglottis. A hemilaryngectomy involves removal of one true cord, one false cord, and one-half of the thyroid. A total laryngectomy involves removal of the entire larynx. Laser surgery involves removal of the tumor only.

A patient has recently been released from prison and has just tested positive for tuberculosis (TB). What teaching points does the community health nurse want to stress for this patient regarding medications? Select all that apply. 1. These medications may cause kidney failure. 2. These medications must be taken for 2 years. 3. The medications may cause nausea. The patient should take them at bedtime. 4. The patient is generally not contagious after 2 to 3 consecutive weeks of treatment. 5. Not taking the medication could lead to an infection that is difficult to treat or to total drug resistance.

3. The medications may cause nausea. The patient should take them at bedtime. 5. Not taking the medication could lead to an infection that is difficult to treat or to total drug resistance. Not taking the medication as prescribed could lead to an infection that is difficult to treat or to total drug resistance. The medications may cause nausea and are best taken at bedtime to prevent this. The patient is generally not contagious after 2 to 3 weeks of consecutive treatment AND improvement in the condition has been observed. The combination regimen for treatment of TB has decreased treatment time from 6 to 12 months to 6 months. TB medications may cause liver failure, not kidney failure.

The nurse finds that a patient is experiencing air hunger and has uncoordinated breathing. Laboratory tests reveal normal arterial blood gasses as well as a normal eosinophil count. What should the nurse infer from the diagnostic tests? 1. The patient has asthma. 2. The patient has allergic asthma. 3. The patient has acute emphysema. 4. The patient has severe emphysema.

3. The patient has acute emphysema. A patient with acute emphysema experiences weakening of the diaphragm muscle, which leads to an increased need for oxygen, or air hunger. Due to increased work of breathing and loss of alveolar tissue, gas exchange is affected. Arterial blood gas (ABG) values will be normal as the patient adjusts to it by increasing respiratory rate. Uncoordinated breathing is observed due to incomplete cycles of inhalation and exhalation. A patient with asthma shows irregular episodes of dyspnea, chest tightness, coughing, wheezing, and increased mucus production. Allergic asthma occurs due to inflammatory responses. A patient with severe emphysema shows an increased arterial carbon dioxide level (PaCO 2) level, indicating carbon dioxide retention.

A patient has developed subcutaneous emphysema after surgery for a tracheostomy. Why must the nurse notify the health care provider immediately? 1. Bleeding has occurred related to the surgical incision; hemoglobin is low. 2. Ventilator pressures are too high, forcing air into tissue, and must be lowered. 3. There is an opening or tear in the trachea, allowing air leakage into the tissues. 4. The patient has a pneumothorax and will require a chest tube for decompression.

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

To prevent aspiration during swallowing in a patient with a tracheostomy, what does the nurse suggest? 1. Hold the head high when swallowing. 2. Consume consecutive swallows of liquids. 3. Thicken all liquids to increase consistency. 4. Include moisture-producing fruits in the diet.

3. Thicken all liquids to increase consistency. Thickening the consistency of all liquids will facilitate swallowing with a decreased risk of aspiration. The patient should actually "tuck" the chin down and move the forehead forward when swallowing. Consecutive swallows of liquid will likely increase the risk of aspiration as would consuming moisture-producing fruits.

Which principles guide the nurse's teaching of a patient who has had surgical repair after facial trauma? Select all that apply. 1. Oral care must be avoided for approximately 6 weeks. 2. Repairs using reabsorbable materials are not as satisfactory long term. 3. Titanium plates are permanent and do not interfere with future MRI studies. 4. Patients with immunosuppression or history of alcohol abuse may not heal as well. 5. Wire cutters must always be readily available if inner maxillary fixation was used.

3. Titanium plates are permanent and do not interfere with future MRI studies. 4. Patients with immunosuppression or history of alcohol abuse may not heal as well. 5. Wire cutters must always be readily available if inner maxillary fixation was used. Repair after significant facial trauma may require the use of plates, which may be made of titanium; this product will not interfere with MRI studies in the future. If the patient who has had wire fixation of the maxilla suddenly develops vomiting or significant blockage of the nasal passages, it may be necessary to cut the wires to prevent aspiration and to open the airway. Patients on immunosuppressive agents and those with a history of alcohol abuse experience impaired and delayed healing; additional precautions may be required during healing. There are now newer materials for facial trauma repair that are absorbable so the patient is not left with any foreign body in the facial area. Oral care will be an important aspect of care to maintain mucosal integrity and prevent infections.

What is one of the purposes of oxygen therapy? 1. To cure the problem 2. To stop the disease process 3. To have an acceptable blood oxygen level 4. To use the highest fraction of inspired oxygen

3. To have an acceptable blood oxygen level One of the purposes of oxygen therapy is to have an acceptable blood oxygen level without causing harmful side effects. Oxygen therapy cannot cure a problem or stop a disease process. The lowest fraction of inspired oxygen is used.

While performing an assessment of a patient, the nurse notes that the patient has progressive fatigue, anorexia, weight loss, irregular menses, and a low-grade fever. Which condition does the nurse suspect in the patient? 1. Pharyngitis 2. Pneumonia 3. Tuberculosis 4. Rhinosinusitis

3. Tuberculosis Progressive fatigue, anorexia, weight loss, irregular menses, and a low-grade fever are clinical signs and symptoms of tuberculosis. Pharyngitis is manifested as throat soreness and dryness, throat pain, pain on swallowing (odynophagia), difficulty swallowing, and fever. Pneumonia is manifested as chest pain or discomfort, myalgia, headache, chills, fever, cough, tachycardia, dyspnea, tachypnea, hemoptysis, and sputum production. Rhinosinusitis is manifested as pain over the cheek radiating to the teeth, and fever, swelling, fatigue, ear pressure, referred pain to the temple, and general facial pain that is worse when bending forward.

A patient with a history of pain and difficulty swallowing ignored the symptoms and later developed neck swelling, muffled voice, and bad breath. What could the original symptoms have been? 1. Untreated rhinitis 2. Untreated sinusitis 3. Untreated tonsillitis 4. Untreated pharyngitis

3. Untreated tonsillitis Neck swelling, muffled voice, and bad breath are symptoms of peritonsillar abscess. Untreated or partially treated acute tonsillitis may lead to the complication of peritonsillar abscess. Untreated rhinitis, untreated sinusitis, and untreated pharyngitis will not cause peritonsillar abscess.

A patient is receiving oxygen therapy. What are potential sources of infection the nurse should address? Select all that apply. 1. Oxygen tubing pulling on the airway 2. Use of nonpetroleum lotion for dry skin 3. Use of a heated humidifier or nebulizer 4. Use of an oral suction catheter in the endotracheal tube 5. Rising white blood cell count noted on recent blood work

3. Use of a heated humidifier or nebulizer 4. Use of an oral suction catheter in the endotracheal tube Humidifiers and nebulizer containers can harbor organisms, which can lead to infections in patients receiving oxygen therapy. Organisms in the oral cavity can cause respiratory infections when transferred to the trachea via a suction catheter. Although oxygen tubing tension on an airway can cause pressure and potential breakdown, the more immediate concerns are the heated fluid in the containers and transference via suction catheters. The nonpetroleum lotions are preferred for dry skin that can result from oxygen therapy. A rise in the white blood cell count may indicate the presence of an infection, but it is not a source of infection.

A patient with pneumonia has a cough productive of thick green mucus, is in bed with the head of bed elevated to 30 degrees, and has an oxygen saturation of 94% with 3 L/min of oxygen via nasal cannula. The nurse notes that the patient is anxious and tense. Which is the priority nursing action for this patient? 1. Increasing the oxygen flow to 4 L/min 2. Placing the patient in an upright position 3. Using a calm, slow approach with the patient 4. Telling the patient to relax and take deep breaths

3. Using a calm, slow approach with the patient Patients who are anxious will become more dyspneic. The nurse should use a calm, quiet approach to help the patient relax. The patient is not hypoxic so the oxygen flow does not need to be increased. It is not necessary to ask the patient to sit upright. Telling the patient to relax belittles the patient's feelings.

A healthy patient expresses worries about developing tuberculosis (TB) after spending time at a family reunion and learning later that a family member is being treated for the disease. What does the nurse tell this patient? 1. "You have most likely been exposed to TB and will need to be tested." 2. "You should receive TB prophylaxis until your provider rules out active disease." 3. "TB is spread from person to person by sharing drinking cups and eating utensils. 4. "Among people exposed to the disease, only a small percentage develop active TB."

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

A patient with recurrent tonsillitis is admitted to the hospital with a peritonsillar abscess. The patient asks the nurse if surgery will be necessary. How does the nurse respond? 1. "You will most likely have a surgical tonsillectomy." 2. "Surgery will be delayed until the infection has been treated." 3. "The provider will drain the abscess and give you antibiotics." 4. "Antibiotics are usually an effective treatment for this disease."

4. "Antibiotics are usually an effective treatment for this disease." Tonsillectomy is performed for patients with recurrent tonsillitis. Surgery is generally delayed until after the patient recovers from the acute infection but will be done if acute peritonsillar abscess is present. Abscesses require antibiotics but often need to be drained or to have the affected tonsils removed.

Which statement by a patient with a laryngectomy indicates a need for further discharge teaching? 1. "I must avoid swimming." 2. "I can clean the stoma with soap and water." 3. "I can project mucus when I laugh or cough." 4. "I can't put anything over my stoma to cover it."

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

Which statements by the patient with rhinitis indicate ineffective learning about reducing the risk of spreading colds? Select all that apply. 1. "I will rest for 10 hours each day." 2. "I will dispose of tissues immediately after use." 3. "I will wash my hands after coughing, sneezing, and nose blowing." 4. "I will stop my cough reflex when I am in a crowded place or with the family." 5. "I will have minimal contact with people who have chronic respiratory problems."

4. "I will stop my cough reflex when I am in a crowded place or with the family." 5. "I will have minimal contact with people who have chronic respiratory problems." Trying to stop the cough reflexes when in a crowd is not recommended, because coughing promotes the removal of sputum from lungs. Since colds spread from person to person by droplets from coughing or sneezing and by direct contact, even minimal contact with people who have chronic respiratory problems should be avoided. Resting for 8 to 10 hours each day, disposing of used tissues immediately, and washing hands after coughing, sneezing, and nose blowing are interventions to reduce the risk of spreading colds.

A patient who will undergo a laryngofissure to remove a laryngeal tumor asks the nurse how the surgery will affect the ability to speak. What does the nurse tell this patient? 1. "Patients are often unable to speak after laser surgery." 2. "Patients are usually hoarse after having laser surgery." 3. "You will regain a normal voice with extensive therapy." 4. "People who have laser surgery will have a normal voice."

4. "People who have laser surgery will have a normal voice." Patients who undergo laryngofissure to remove a laryngeal tumor will have a normal voice after the procedure. Other surgical procedures like cordectomy and laryngectomy result in varying voice recovery from hoarseness to having no voice.

An asthmatic patient who is allergic to pollen is prescribed cromolyn sodium; however, the patient reports that it does not help relieve symptoms during an asthma attack. Which instruction would be beneficial to the patient? 1 "Include an exercise program in your daily life to improve your health." 2 "Refrain from exposure to allergens that will aggravate the allergic reaction." 3 "Use proper technique while inhaling the drug for maximum effectiveness." 4. "Use cromolyn sodium on a routine basis to prevent an asthma attack, not as a rescue inhaler."

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

A co-worker tells the nurse that she will not get the flu shot because she believes it is better to develop her own immunity to the flu. What does the nurse tell this co-worker? 1. "Getting the flu shot causes you to have influenza symptoms." 2. "Since you are healthy, you will probably only have a mild case of the flu." 3. "If you are exposed to influenza, you can take an antiviral medication." 4. "You are putting your patients at increased risk for serious respiratory illness."

4. "You are putting your patients at increased risk for serious respiratory illness." All people who provide direct care to patients should get the influenza vaccine to prevent the spread of influenza to patients who are at risk for serious respiratory illness. The flu vaccine does not cause influenza symptoms. Antiviral medications are only effective if given early and do not cure influenza. Even young, relatively healthy individuals can have severe influenza.

A patient who smokes is being discharged home on oxygen. The patient states, "My lungs are already damaged, so I'm not going to quit smoking." What is the discharge nurse's best response? 1. "It's never too late to quit." 2. "You can quit when you are ready." 3. "Just turn off your oxygen when you smoke." 4. "You are right, the damage has been done. But let's talk about why smoking around oxygen is dangerous."

4. "You are right, the damage has been done. But let's talk about why smoking around oxygen is dangerous." The nurse should use this opportunity to educate the patient about the dangers of smoking in the presence of oxygen, as well as the benefits of quitting. Telling the patient it is OK to quit when ready or that it's never too late to quit do not address the safety issue of smoking in the presence of oxygen. Recommending that the patient turn off the oxygen when smoking encourages the patient to remove his or her oxygen source, which could harm the patient.

A young adult patient refuses an influenza vaccine, saying, "I'm healthy and won't get that sick if I get the flu." Which is the best response by the nurse? 1. "If you get the flu, you can always take an antiviral medication." 2. "Not getting the vaccine increases the chances of a worldwide pandemic." 3. "If a flu pandemic begins, you should get the vaccine immediately." 4. "You may spread the disease to people who are more at risk for severe symptoms."

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

Based on the clinical data provided below, which age is most likely for this patient with pneumonia? 1. 10 years 2. 30 years 3. 50 years 4. 70 years

4. 70 years This patient would most likely be an older adult. This is based on the finding of a normal white blood cell (WBC) count despite the presence of infection (pneumonia). As people age, the ability of the immune system to mount a response in the form of increased WBCs diminishes. Generally, the WBC count is elevated in all age groups except older adults when significant infection is present. Weakness, cough, fever, and shortness of breath are common symptoms of pneumonia in all age groups. Increased respiratory rate, blood-tinged sputum, and hypoxemia are also seen in all age groups.

Which patient is most at risk for the development of either community- or hospital-acquired pneumonia? 1. An 8-month-old born at 32 weeks gestation 2. A 59-year-old who works in the textile industry 3. A 14-year-old who developed type 1 diabetes at age 9 4. A 76-year-old who has limited mobility because of osteoarthritis

4. A 76-year-old who has limited mobility because of osteoarthritis A 76-year-old patient with limited mobility is at high risk for both community- and hospital-acquired pneumonia. The 8-month-old is at a slightly increased risk but not as high as the 76-year-old who is limited in mobility. An individual who works in the textile industry is at an increased risk for community-acquired pneumonia, but not hospital-acquired pneumonia, as is the adolescent who has type 1 diabetes.

A patient with asthma performs a peak flow assessment, which is 60% of normal and in the yellow range, and has an oxygen saturation of 94% on room air. Which initial action should the nurse take? 1. Notify the Rapid Response Team. 2. Give the patient oxygen by nasal cannula. 3. Request an order for an oral corticosteroid medication. 4. Administer the ordered PRN short-acting beta 2 agonist.

4. Administer the ordered PRN short-acting beta 2 agonist. A peak flow assessment between 50% and 80% of normal indicates that the patient is in the yellow zone. A short-acting beta 2 agonist is indicated. If the patient is hypoxic, oxygen is indicated. An oxygen saturation of 94% or greater does not indicate hypoxia. It is not necessary to notify the Rapid Response Team unless the patient continues to deteriorate in spite of adequate treatment. If the patient progresses to the red zone, a systemic corticosteroid would be indicated.

Which ectopic hormone is involved in Cushing syndrome and may cause small cell lung cancer? 1. Antidiuretic hormone 2. Parathyroid hormone 3. Follicle-stimulating hormone 4. Adrenocorticotropic hormone

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

What best describes the pathophysiology involved in a patient who has asthma as a lower respiratory disease? 1. Genetic variation in the gene that controls the normal synthesis and activity of beta-adrenergic receptors 2. Chronic yet usually intermittent body response that can lead to night time awakening with respiratory symptoms 3. Collapse of the walls of bronchioles and alveolar air sacs secondary to lung proteases leading to airway structures 4. Airway obstruction secondary to inflammation and/or bronchoconstriction secondary to airway hyperresponsiveness

4. Airway obstruction secondary to inflammation and/or bronchoconstriction secondary to airway hyperresponsiveness Two processes are potentially involved in the pathophysiology of asthma: inflammation and airway hyperresponsiveness that leads to bronchoconstriction. Inflammation obstructs the internal aspect of the airways; constriction of the smooth muscle during hyperresponsiveness narrows the airways. Knowledge is being gained regarding the role of genetics in asthma; genetic variation is known to alter the response of beta-adrenergic receptors to treatment, but not pathophysiology of the disease process. People with asthma can experience nighttime awakenings with respiratory symptoms; however, this is not yet fully understood as part of the pathophysiology of the disease itself. The collapse of the walls of bronchioles and alveolar air sacs secondary to lung proteases leading to airway structures describes emphysema.

A patient is being evaluated for laryngeal cancer. Besides tobacco use, which aspect of the patient's history is important for the nurse to assess? 1. Dietary habits 2. Shortness of breath 3. Peptic ulcer disease 4. Alcohol consumption

4. Alcohol consumption The two most important risk factors for head and neck cancer are tobacco and alcohol use, especially in combination. Dietary habits may need to be assessed in the chronic alcohol user as part of a comprehensive health evaluation, but do not necessarily contribute to development of cancer. Patients who have severe gastroesophageal reflux disease (GERD) have an increased risk for head and neck cancers. Shortness of breath may be a symptom in a patient with head and neck cancer.

The occupational nurse is discussing a recent influenza outbreak with employees. Which medications are given to prevent influenza in individuals if they are exposed to someone with influenza? Select all that apply. 1. Ribavirin 2. Zanamivir 3. Oseltamivir 4. Amantadine 5. Rimantadine

4. Amantadine 5. Rimantadine Amantadine and rimantadine are both used for prevention of influenza for those individuals who have been exposed to influenza. Ribavirin is used for the treatment of severe influenza B. Zanamivir and oseltamivir are used to shorten the duration of both influenza A and B.

The nurse is caring for a pregnant patient who has a coccidioidomycosis fungal infection, which is also known as "valley fever." What medication would most likely be ordered for this patient? 1. Amoxicillin IV 2. Fluconazole PO 3. Ketoconazole PO 4. Amphotericin B IV

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

What is the nursing priority to provide safe and effective care for the patient with pneumonia? 1. Monitoring for signs of sepsis 2. Assisting with bronchial hygiene 3. Frequently assessing breath sounds 4. Applying principles of infection control

4. Applying principles of infection control The nursing priority for providing safe and effective care for the patient with pneumonia includes applying principles of infection control, such as performing hand hygiene and implementing isolation precautions. The nursing priority for interpreting vital sign assessments includes monitoring for signs of sepsis. Assisting with bronchial hygiene is a nursing priority that will improve gas exchange in the patient with pneumonia. Frequent assessment of breath sounds is a nursing priority for respiratory assessment.

After surgery for placement of a chest tube, the patient reports burning in the chest. What should the nurse do first? 1. Listen for breath sounds. 2. Call for the Rapid Response Team. 3. Check the patency of the chest tubes. 4. Assess the airway, breathing, and circulation (ABCs).

4. Assess the airway, breathing, and circulation (ABCs). Assessing the ABCs is the priority to determine possible causes of burning in the patient's chest. The patient's situation does not require the Rapid Response Team to be called. The patient's symptoms are not caused by a blockage of chest tubes. Listening for breath sounds would be an appropriate action for the nurse to take to evaluate the patient's reported symptoms; however, this would not be the nurse's first action.

A patient has lobar pneumonia. To help ensure that the expected outcome of maintaining an oxygen saturation of 95% or greater is met, which nursing intervention is most important? 1. Obtain complete blood count, sputum, and blood cultures. 2. Assess breath sounds and respiratory effort every 4 hours. 3. Monitor vital signs and effectiveness of antibiotics every 4 hours. 4. Assist with coughing, deep-breathing, and incentive spirometry every 2 hours.

4. Assist with coughing, deep-breathing, and incentive spirometry every 2 hours. Assisting the patient to clear the airway of secretions is most important for increasing oxygen saturation because it allows improved oxygenation. Assessing breath sounds and respiratory effort; monitoring vital signs; and obtaining a complete blood count, sputum, and blood cultures are important interventions but are not the priority.

The nurse assesses a patient who is receiving oxygen using a partial rebreather facemask at a flow rate of 12 L/min. The nurse notes the patient's oxygen saturation level is 90%. Which action would the nurse take next? 1. Obtain arterial blood gases. 2. Notify the Rapid Response Team. 3. Increase the oxygen flow rate to 15 L/min. 4. Change the mask to a non-rebreather mask.

4. Change the mask to a non-rebreather mask. Patients receiving oxygen by mask are prone to rebreathing exhaled air containing carbon dioxide and room air that has a lower oxygen concentration. A non-rebreather mask can deliver an FiO 2 greater than 90% at a flow rate of 10-15 L/min. Blood gases are not necessary in a patient with a saturation of 90%. There is no indication of respiratory instability in the patient described, so the Rapid Response Team is not needed. The partial rebreather only allows an oxygen flow rate of 6-11 L/min., so an increase to 12 L/min is not a correct action.

A patient who has chronic exposure to textile dust is fearful about the risk for sinus cancer after a coworker developed the disease. To help assess risk, the nurse asks the patient about which other risk factor? 1. Dietary fat 2. Alcohol intake 3. Exercise habits 4. Cigarette smoking

4. Cigarette smoking Patients who have exposure to common workplace substances have an increased risk of sinus cancer from these substances if they smoke. Alcohol intake, dietary fat, and exercise habits are all part of the usual health history, but they do not have a special concern for determining risk for sinus cancer.

Which disorder of the lungs is caused by a fungus? 1. Pertussis 2. Tuberculosis 3. Inhalation anthrax 4. Coccidioidomycosis

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

A patient with pneumococcal pneumonia is being treated with intravenous antibiotics. On the fifth day of treatment, the nurse notes a productive cough with white mucus. Which action should the nurse take? 1. Ask the provider for an order for nebulized albuterol. 2. Report the patient's worsening condition to the provider. 3. Request an order for a stronger antibiotic to combat bacterial resistance. 4. Continue the current plan of care and reassess the patient periodically.

4. Continue the current plan of care and reassess the patient periodically. The cough with pneumococcal pneumonia is typically productive of purulent rusty brown or yellow mucus; white mucus production indicates resolution of the infection. It is not necessary to administer a bronchodilator or a different antibiotic. The provider does not need to be notified.

The nurse is counseling a young woman about drug therapy with isoniazid and rifampin to treat tuberculosis. Before developing the teaching plan, what must the nurse assess for first? 1. History of gout 2. Color blindness 3. Susceptibility to sunburn 4. Contraceptive methods used

4. Contraceptive methods used Rifampin can interfere with oral contraceptives, and women using these should be taught to use a backup method of contraception during treatment and up to 1 month after treatment ends. Ethambutol can have effects on vision, including color vision, but isoniazid and rifampin do not. Other drugs can increase the risk of gout. Pyrazinamide can cause increased sensitivity to sunlight.

A new graduate RN discovers that her patient, who had a tracheostomy placed the previous day, has completely dislodged both the obturator and the tracheostomy tube. Which action should the nurse take first? 1. Replace the obturator while reinserting the tracheostomy tube. 2. Auscultate the patient's breath sounds while applying a nasal cannula. 3. Apply a 100% non-rebreather mask while administering high-flow oxygen. 4. Direct someone to call the Rapid Response Team while using a resuscitation bag and facemask.

4. Direct someone to call the Rapid Response Team while using a resuscitation bag and facemask. Because a fresh tracheostomy stoma will collapse, the patient will lose airway patency, which will require the nurse to ventilate the patient through the mouth and nose while waiting for assistance to recannulate the patient. Directing someone else to call the Rapid Response Team allows the nurse to provide immediate care required by the patient. Auscultation of the patient's breath sounds at this time will not improve the patient's respiratory status and will be ineffective until airway patency is restored. Further, auscultation should not be done while a nasal cannula is simultaneously applied. Effective use of a 100% non-rebreather mask requires a patent airway. During the first 72 hours following a tracheostomy, reinsertion of the tube is difficult and should not be attempted by the nurse. Reinsertion of the tracheostomy tube should be done once a Rapid Response Team is available to accomplish this.

The nurse is caring for a patient who has had abdominal surgery. Which action should the nurse take to help prevent pulmonary infection in this patient? 1. Provide adequate analgesia. 2. Give intravenous antibiotics. 3. Administer low-molecular-weight heparin. 4. Encourage regular use of an incentive spirometer.

4. Encourage regular use of an incentive spirometer. Postoperative patients, especially those who have had abdominal surgery, are less likely to take deep breaths and cough, so they do not clear their lungs of mucus, increasing their risk of pulmonary infection. Encouraging use of an incentive spirometer can help with this. Low-molecular-weight heparin is given to prevent blood clots and pulmonary emboli, but not infection. Intravenous antibiotics are usually not given prophylactically unless there is increased risk. Adequate analgesia may be a necessary adjunct to incentive spirometry to assist with comfort while taking deep breaths.

When administering oxygen to a patient at 5 L/min per nasal cannula, which intervention does the nurse include in the patient's plan of care? 1. Clean the nasal cannula every 4 hours. 2. Elevate the head of the bed 45 degrees. 3. Continuously monitor O 2 saturation with a pulse oximeter. 4. Ensure that oxygen bubbles through the water in the humidifier.

4. Ensure that oxygen bubbles through the water in the humidifier. When the oxygen flow rate is greater than 4 L/min, humidification should be used to prevent drying of the nasal mucosa. The nurse should ensure that there is adequate water in the humidifier chamber and that oxygen is bubbling through it. The nasal cannula should be cleaned as needed, but it does not require routine cleaning. Measurement of oxygen saturation using pulse oximetry should be done at intervals and does not need to be monitored continuously. Elevating the head of the bed 45 degrees is not necessary when administering nasal O 2.

The nurse is caring for a patient who has undergone a hemilaryngectomy for laryngeal cancer. Once a feeding tube has been placed and the patient's intestinal tract has recovered from the effects of anesthesia, which action by the nurse is appropriate for the next few days? 1. Providing clear liquids to improve hydration 2. Giving a high-carbohydrate, high-calorie diet 3. Teaching the patient to swallow without aspiration 4. Ensuring an individualized nutrition plan is followed for calorie needs

4. Ensuring an individualized nutrition plan is followed for calorie needs Once a feeding tube is placed, it is important for patients to receive adequate calories to promote tissue healing; a diet that provides 35-40 kcal/kg/day is recommended. Protein and fluids are also important, but a high-carbohydrate diet is not indicated. It is important to establish nutrition with adequate calories and protein, so a clear liquid diet will not be sufficient. The feeding tube should be maintained with tube feedings for 7-10 days and then removed once the patient can swallow; patients will not aspirate since the airway and the esophagus have been separated.

The standard laryngectomy plan of care for a patient admitted with laryngeal cancer includes these interventions. Which intervention will be most important for the nurse to accomplish before the surgery? 1. Educate the patient about ways to avoid aspiration when swallowing after the surgery. 2. Teach the patient and significant others about how to suction and do wound care of the stoma. 3. Discuss appropriate clothing to wear that will help cover the laryngectomy stoma and decrease social isolation after surgery. 4. Establish a means for communicating during the immediate postoperative period, such as a Magic Slate or an alphabet board.

4. Establish a means for communicating during the immediate postoperative period, such as a Magic Slate or an alphabet board. In the immediate postoperative period, relieving pain and anxiety is going to be a major priority. Because the patient will be unable to communicate verbally, establishing a way to communicate before the surgery will help by having a plan in place. Aspiration is not a risk after a total laryngectomy because no connection is present between the mouth and the respiratory system. It will be several weeks before the patient will need to address appropriate clothing; overloading the patient with too much information before surgery is unnecessary. Suctioning and wound care is discharge teaching that can be started after the surgery when the patient and significant others are more likely to retain the information owing to decreased preoperative anxiety. The significant others can observe the care and then can begin to take over more of the care while the patient is still in the hospital in a supervised environment.

What education will be provided for the family of a patient being treated for tuberculosis convalescing at home? 1. Use airborne precautions. 2. Place used tissues in a trash can. 3. Cover your mouth and nose when sneezing. 4. Everyone must undergo tuberculosis testing.

4. Everyone must undergo tuberculosis testing. The family members living with a patient diagnosed with tuberculosis will have to undergo testing. Airborne precautions are unnecessary because the family members have already been exposed to the TB. The patient should be instructed to place used tissues in a plastic bag, and cover mouth and nose when sneezing, but this instruction is not specific to family members.

The nurse is assessing a patient who underwent nasoseptoplasty 24 hours ago. Which finding requires immediate intervention by the nurse? 1. Edema 2. Sore throat 3. Ecchymosis 4. Excessive swallowing

4. Excessive swallowing Excessive swallowing in a patient who has undergone a nasoseptoplasty may indicate posterior nasal bleeding and requires immediate attention. Because of the very vascular nature of the face, ecchymosis is a normal finding in the patient who has undergone a nasoseptoplasty. Edema is a normal reaction to any kind of trauma, including that caused by surgery, so it is not an unexpected finding for this patient. A sore throat is a common side effect of endotracheal intubation.

The nurse assessing a patient with a chest tube after lobectomy surgery observes that the water in the water seal chamber remains at a constant level of 3 cm during inspiration and expiration. Which action should the nurse take next? Incorrect1 Add water to the water collection chamber. 2 Notify the provider that the lung has fully expanded. 3 Clamp the chest tube near the exit point using padded clamps. 4. Gently milk the tube to determine whether obstruction has occurred.

4. Gently milk the tube to determine whether obstruction has occurred. An absence of fluctuation of the water in the water seal chamber may mean that the lung has fully reexpanded or that there is obstruction in the chest tube. The nurse may evaluate for obstruction by gently milking the tubing. There is an adequate amount of water in the chamber, so water need not be added. Clamping the tubing is done if the drainage system is interrupted. Until the nurse has assessed the cause of the absence of fluctuation, it is not correct to assume that the lung has fully reexpanded.

What differentiates cerebrospinal fluid leakage from normal nasal secretions? 1. Viscosity 2. Lipid content 3. Protein content 4. Glucose content

4. Glucose content Cerebrospinal fluid contains glucose and this can be tested using a dipstick test. In other nasal secretions, glucose is absent. Viscosity refers to the thickness of a fluid and both cerebrospinal fluid and nasal secretions are thin. Cerebrospinal fluid and nasal secretions will not contain lipid.

An older patient has a persistent cough with hemoptysis and has a known exposure to tuberculosis. A tuberculin skin test reveals a reaction of 5 mm. The nurse documents that this test result indicates which condition? 1. Latent tuberculosis 2. Immunity to tuberculosis 3. Reduced immune function 4. Human immunodeficiency disease

4. Human immunodeficiency disease Patients with reduced immune function may have a negative skin response even when infected with tuberculosis. This can occur in older adults as well as people who are HIV positive. The negative skin test only represents reduced immune function and does not always indicate HIV. This result does not indicate latent TB or immunity to TB.

For patient safety and quality care, which technique is best for the nurse to use when suctioning the patient with a tracheostomy tube? 1. Suction for 30 seconds. 2. Repeat suctioning until the tube is clear. 3. Apply suction during insertion of the tube. 4. Hyperoxygenate before and after suctioning.

4. Hyperoxygenate before and after suctioning. The patient should be preoxygenated with 100% oxygen for 30 seconds to 3 minutes to prevent hypoxemia. After suctioning, the patient should be hyperoxygenated for 1 to 5 minutes or until the patient's baseline heart rate and oxygen saturation are within normal limits. Repeat suctioning as needed for up to three total suction passes; additional suctioning will cause or worsen hypoxemia. Applying suction during insertion is inappropriate because suction makes advancement of the suction tube difficult/traumatic. Suction is applied only when the suction tube is removed. Suctioning for 30 seconds is too long and can cause or worsen hypoxemia; never suction longer than 10 to 15 seconds.

A community health nurse is preparing a community education class on bioterrorism and the use of inhalation anthrax. When preparing to discuss the manifestations of the fulminant stage of the infection, what manifestation does the nurse include in the teaching? 1. Fever 2. Fatigue 3. Dry cough 4. Hypotension

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

Incentive spirometry for the treatment of pneumonia has which outcome objective? 1. Reduced sputum production and increased cough 2. Reduced crackles and wheezes and improved oxygenation 3. Improved expiratory air flow and increased respiratory effort 4. Increased inspiratory muscle action and decreased atelectasis

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

A patient is undergoing rhinoplasty for a severe nasal fracture. The nurse's plan of care should include which intervention? 1. Provide Motrin for pain relief. 2. Keep the patient in a prone position. 3. Instruct the patient to sneeze with the mouth closed. 4. Instruct the patient on changing the mustache dressing.

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

What is the best time to perform a closed reduction of a nasal fracture? Select all that apply. 1. After 1 week 2. 24 to 48 hours 3. After 48 hours 4. Just after injury 5. Within 24 hours

4. Just after injury 5. Within 24 hours The best time for a closed reduction is just after injury, or within 24 hours. In closed reduction, the bones are realigned by palpating under anesthesia. After 24 hours, closed reduction will be difficult to perform because of swelling and scars. Therefore, after 24 to 48 hours, after 1 week, and after 48 hours, closed reduction cannot be performed.

Which chemical is responsible for a prolonged inflammatory response, leading to airway obstruction? 1. Kinins 2. Heparin 3. Histamine 4. Leukotriene

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

Which condition is an indication for nasoseptoplasty? 1. Bruising 2. Crepitus 3. Nasal fracture 4. Nasal septum deviation

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

A patient with chronic obstructive pulmonary disease (COPD) is exhibiting increasing air hunger. The patient is receiving oxygen via nasal cannula at a flow rate of 2 L/min. The nurse contacts the provider to discuss which treatment option for this patient? 1.Aerosol facemask 2. Venturi mask with oxygen at 4 L/min 3. Intubation and mechanical ventilation 4. Noninvasive positive-pressure ventilation

4. Noninvasive positive-pressure ventilation Noninvasive positive-pressure ventilation helps keep airways open and improves gas exchange without the need for airway intubation. It is especially useful for patients with COPD. An aerosol facemask provides high-flow, high-humidity oxygen, which would not be helpful for the patient with an obstructive process. A Venturi mask may be used in patients with COPD who are stable, but this patient is not stable. Intubation is a last resort after other methods fail.

A patient is admitted to the hospital with a streptococcal peritonsillar abscess following incomplete treatment with an oral antibiotic. The nurse notes that the patient is experiencing stridor. Which action should the nurse take next? 1. Provide clear, cool oral liquids to help soothe the throat. 2. Elevate the head of the bed to at least a 30-degree angle. 3. Contact the provider to request an order for a steroid medication. 4. Notify the Rapid Response Team to assist with airway management.

4. Notify the Rapid Response Team to assist with airway management. If a patient with pharyngitis develops stridor or other indications of airway obstruction, the Rapid Response Team should be notified. Elevating the head of the bed is useful, but will not be sufficient to open the airway. Steroid medications will likely be ordered by the provider after the airway is opened. Offering liquids will increase the risk of aspiration.

A previously infected patient with a dormant tuberculosis (TB) infection has experienced a reactivation of the disease. Which was likely a factor in this occurrence? 1. Fracture of a rib 1 week ago 2. Allergy testing 6 months ago 3. Pneumonia vaccine 2 months ago 4. Taking prednisone for the past 3 weeks

4. Taking prednisone for the past 3 weeks Secondary TB is reactivation of the disease in a previously infected person. This most likely happens when the immune system is lowered, as occurs with corticosteroid drugs such as prednisone, which suppress the immune response. Allergy testing, receiving a vaccination, and fracturing a rib would not suppress the immune system enough to reactivate the disease.

A patient admitted to the medical surgical unit is suspected of having tuberculosis (TB). Which rapid screening for TB does the nurse anticipate to be ordered by the health care provider? 1. Mantoux test 2. Sputum culture 3. QuantiFERRON-TB Gold 4. Nucleic acid amplification test

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

The nursing instructor is preparing to teach a group of nursing students about treatment of patients infected during a pandemic outbreak of the H5N1 or "avian influenza." What should the nurse include in the teaching plan? 1. Oseltamivir vaccination is a two-step process. 2. Everyone should be vaccinated with Vepacel annually. 3. Once patients receive the initial dose of Vepacel, immunity follows. 4. Oseltamivir and zanamivir may reduce the mortality of the infection.

4. Oseltamivir and zanamivir may reduce the mortality of the infection. Oseltamivir and zanamivir may reduce mortality of H5N1 infection. The vaccine Vepacel, used to treat H5N1, is not part of the general influenza vaccine and is therefore not available for annual vaccination. When Vepacel is administered, it is a two-step process before a protective immune response occurs. Neither oseltamivir nor zanamivir includes a two-step process.

The nurse assesses a patient who has chronic obstructive pulmonary disease (COPD) 15 minutes after an aerosolized bronchodilator has been administered. Which finding prompts the nurse to notify the provider? Incorrect1 Barrel chest 2 PaCO 2 of 68 mm Hg 3 Clubbing of the fingers 4. Oxygen saturation of 87%

4. Oxygen saturation of 87% For patients with COPD, an oxygen saturation less than 88% indicates hypoxemia and should be reported. Findings of a barrel chest and clubbing of the fingers are typical of COPD and do not warrant notifying the provider since they do not improve with treatment. A PaCO 2 that is elevated is common in chronic lung disease.

Which nursing assessment has the highest priority when caring for a patient with facial trauma? 1. Infection 2. Pain level 3. Self-image 4. Oxygenation

4. Oxygenation Facial trauma has the potential to interfere with breathing by occluding the upper airways. The nurse should monitor the patient's oxygenation closely. Assessing for infection, pain level, and self-image are important but are not critical.

The medical-surgical unit has one negative airflow room. Which of these four newly arrived patients should the charge nurse admit to this room? 1. Patient with neutropenia and pneumonia caused by Candida albicans 2. Patient with bacterial pneumonia and a cough productive of green sputum 3. Patient with right empyema who has a chest tube and a fever of 103.2° F 4. Patient with possible pulmonary tuberculosis who currently has hemoptysis

4. Patient with possible pulmonary tuberculosis who currently has hemoptysis A patient with possible tuberculosis should be admitted to the negative airflow room to prevent airborne transmission of tuberculosis. A patient with bacterial pneumonia does not require a negative airflow room but should be placed in Droplet Precautions. A patient with neutropenia should be in a room with positive airflow. The patient with a right empyema who also has a chest tube and a fever should be placed in Contact Precautions but does not require a negative airflow room.

The nurse is performing an admission assessment on a 90-year-old patient and notes confusion with poor orientation to person, place, and time. The patient's daughter tells the nurse that this isn't normal. Which initial action should the nurse take? 1. Contact the provider to request an order for an intravenous antibiotic. 2. Notify the provider and request orders for serum electrolytes and kidney function tests. 3. Reassure the daughter that confusion is common in older patients who are admitted to the hospital. 4. Perform a detailed respiratory assessment including lung sounds, pulse oximetry, and temperature.

4. Perform a detailed respiratory assessment including lung sounds, pulse oximetry, and temperature. In patients, a frequent first indication of pneumonia is a change in mental status due to hypoxemia. The nurse should first perform a respiratory assessment and then notify the provider of the findings. Antibiotics are not indicated unless an assessment and tests indicate an infection is present. Lab work may be ordered by the provider as part of the ongoing evaluation of this patient. Nurses should listen to family members' reports about the usual status of patients and respond if a patient is not acting normally.

A patient returns to the clinic to have the tuberculosis (TB) Mantoux test analyzed by the nurse, which was administered 2 days ago. The patient's left forearm shows a red raised area, which measures 10 mm in diameter. How does the nurse document this finding? 1. Positive reaction that indicates the presence of active TB infection 2. Possible false-positive reading; the test will need to be read again at 72 hours 3. Possible false-negative reading; the test will need to be administered again 4. Positive reaction that indicates exposure to and the possible presence of TB infection

4. Positive reaction that indicates exposure to and the possible presence of TB infection An area of induration (raised soft tissue) measuring 10 mm or greater in diameter at 48 to 72 hours after the injection indicates exposure to and possible infection with TB. A positive reaction does not in itself mean TB is present until that has been confirmed with a chest x-ray and sputum culture. There are no false-positive readings, but the incidence of false-negative readings is greater at 48 hours and will need to be read again at 72 hours to confirm. The test will not be administered again in this situation.

What is the role of the second chamber in a chest tube drainage system? 1. Controls the suction of the system 2. Collects the fluid draining from the patient 3. Collects the bubbles produced during drainage 4. Prevents air from reentering the patient's pleural space

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

Community health nurses are tasked with providing education on the prevention of respiratory infection for diseases such as the flu. Which target audience is given the highest priority? 1. Politicians 2. Hospital staff 3. Homeless people 4. Prison staff and inmates

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

A patient with pneumonia develops increased fever, chills, and night sweats. The nurse auscultates decreased breath sounds in the right lung and observes decreased chest wall movement in that area. The nurse reports these findings to the provider and suspects which secondary infection has likely developed? 1. Tuberculosis 2. Lung abscess 3. Fungal infection 4. Pulmonary empyema

4. Pulmonary empyema Increased fever, chills, night sweats, and decreased breath sounds and chest wall movement on the affected side are signs of pulmonary empyema, an infection in the pleural space. A fungal infection may occur anywhere, often as an abscess in the lungs, which is characterized by fever, cough, and foul-smelling sputum. Tuberculosis is characterized by cough and blood-tinged sputum.

Xerostomia is a condition associated with which of the following types of treatment? 1. Biotherapy 2. Chemotherapy 3. Speech therapy 4. Radiation therapy

4. Radiation therapy Xerostomia is dryness of the mouth, which occurs with radiation therapy. It occurs when the salivary glands are in the irradiation path. The side effect is long term and may be permanent. Biotherapy effects typically include flu-like symptoms including chills, fever, muscle aches and weakness. The most common effects associated with chemotherapy include fatigue, hair loss, infection, anemia, nausea and vomiting, appetite changes, and constipation. There are no real detrimental conditions associated with speech therapy.

A patient with nasal congestion, fever, and cough has been using over-the-counter medications for a week without improvement. The patient exhibits tenderness to percussion over the sinuses and referred pain to the back of the head. These findings may indicate which condition? 1. Rhinitis 2. Tonsilitis 3. Pharyngitis 4. Rhinosinusitis

4. Rhinosinusitis Prolonged upper respiratory symptoms can indicate that a sinus infection has developed. Tenderness to percussion over the sinuses and referred pain to the back of the head are common manifestations of rhinosinusitis. Manifestations of rhinitis include headache, nasal irritation, sneezing, nasal congestion, rhinorrhea, and itchy, watery eyes. The patient with pharyngitis has throat soreness and dryness, throat pain, odynophagia, difficulty swallowing, and may have a fever. Tonsillitis is manifested by a sudden sore throat, fever, muscle aches, chills, and dysphagia. The tonsils are visibly swollen and red.

The nurse is preparing a patient for discharge who has been treated for the prodromal stage of inhalation anthrax. What information is most important for the nurse to communicate to this patient? 1. Have your antibiotics refilled if you begin to feel ill. 2. It is normal for you to feel worse before you feel better. 3. Contact the health care practitioner for mild chest pain. 4. Seek medical attention immediately if you begin to feel breathless.

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

A patient presents to the emergency department with facial trauma after a motor vehicle accident. The nurse notes extensive bruising behind the ears and suspects which of the following conditions? 1. Spinal fracture 2. Soft tissue injury 3. Mandibular fracture 4. Skull fracture and brain trauma

4. Skull fracture and brain trauma Extensive bruising in the mastoid area is associated with skull fracture and brain trauma. Lower jaw fractures and spinal fractures are not associated with extensive bruising behind the ear. Soft tissue injury may cause bruising, but this finding is related to more severe injury.

Which complication does the nurse expect when finding puffiness or crackling at the site of chest tube insertion in a patient with lung cancer? 1. Infection 2. Bone metastasis 3. Tracheal deviation 4. Subcutaneous emphysema

4. Subcutaneous emphysema Subcutaneous emphysema occurs when gas or air is present in the layer under the skin. During the management of chest tube drainage systems, the tube insertion site should be checked to assess the skin condition. If puffiness or crackling is found on palpation, it indicates subcutaneous emphysema. Infection is indicated by redness or purulent drainage. Bone metastasis is indicated by pain. Tracheal deviation indicates the presence of pressure caused by a disease in the trachea.

Which symptom would be found in a patient with respiratory muscle fatigue? 1 Silent chest on auscultation Incorrect2 Slow breathing with deep respirations 3 Respiratory rate of 25 to 35 per minute 4. Sucked-in abdominal wall during inspiration

4. Sucked-in abdominal wall during inspiration In patients with respiratory muscle fatigue, the abdominal wall is sucked in during inspiration. Patients with serious airflow obstruction or pneumothorax may have a silent chest on auscultation. Patients with respiratory muscle fatigue breathe with rapid, shallow respirations, and the respiratory rate could be as high as 40 to 50 breaths/min.

The nurse is preparing to change a cuffed tube tracheostomy to a fenestrated tracheostomy tube. Which action is most important prior to cuff deflation? 1. Ask the patient to perform the Valsalva maneuver. 2. Insert an oral airway to prevent airway obstruction. 3. Teach the patient how to use an incentive spirometer. 4. Suction the patient's oropharynx before deflating the cuff.

4. Suction the patient's oropharynx before deflating the cuff. Before deflating a cuff, the nurse should suction the airway above the cuff to remove any secretions that might be aspirated into the lungs. It is not necessary for the patient to perform the Valsalva maneuver or for the nurse to insert an oral airway. An incentive spirometer is not indicated.

What can be inferred from finding that the tracheostomy tube is pulsating in synchrony with the heartbeat in a patient brought to the health care unit in a critical state? 1. The patient has developed tracheomalacia. 2. The patient has developed tracheal stenosis. 3. The patient is having tracheoesophageal fistula (TEF). 4. The patient is having trachea-innominate artery fistula.

4. The patient is having trachea-innominate artery fistula. Tracheostomy tube pulsating in synchrony with the heartbeat is a manifestation of trachea-innominate artery fistula, which results in a critical and life-threatening situation. In tracheomalacia, there is constant pressure exerted by the cuff, causing tracheal dilation and erosion of the cartilage. In tracheal stenosis, there is narrowed lumen due to scar formation. TEF causes excess pressure on the cuff that leads to erosion of the posterior wall of the trachea.

A patient is admitted with asthma. How is this disease differentiated from other chronic lung disorders? 1. The patient is coughing. 2. The patient has dyspnea. 3. It affects only young people. 4. The patient is symptom-free between exacerbations.

4. The patient is symptom-free between exacerbations. The patient may be completely symptom-free between exacerbations. Asthma affects people of all ages. Dyspnea is a common symptom of many chronic lung diseases. Coughing occurs in many acute and chronic lung diseases.

Which condition causes subcutaneous emphysema in a patient with a new tracheostomy? 1. Hemorrhage from a nicked artery 2. Effusion from fluid in the pleural space 3. Inflammation from an infectious process 4. Trapping of air escaped into the tissues

4. Trapping of air escaped into the tissues Subcutaneous emphysema occurs when there is an opening or tear in the trachea and air escapes into the fresh tissue planes of the neck. Air can also progress throughout the chest and other tissues into the face. Hemorrhage from a nicked artery, effusion of fluid in the pleural space, and inflammation from an infectious process are all possible complications related to a new tracheostomy, but they do not cause subcutaneous emphysema.

The nurse is suctioning a patient who has a tracheostomy and notes a pulse oximetry reading of 90% during the procedure. Which action does the nurse take? 1. Administer oxygen by simple facemask while suctioning the patient. 2. Change to a larger-diameter tube to facilitate removal of secretions. 3. Encourage the patient to cough to assist with clearance of secretions. 4. Use a manual resuscitation bag to deliver 100% oxygen before resuming.

4. Use a manual resuscitation bag to deliver 100% oxygen before resuming. If hypoxia occurs while suctioning, the nurse should stop suctioning and reoxygenate the patient with 100% oxygen and manual resuscitation until hypoxia improves before resuming suctioning. It may be necessary to provide oxygen during the procedure to prevent hypoxia, but this should not be done if hypoxia is present and not via a facemask if a tracheostomy is the airway for this patient. In general, a larger-diameter tube increases the risk of hypoxia. It is not correct to ask the patient to cough to improve hypoxia.

The patient coughs and expels the tracheostomy tube. The nurse inserts a new tracheostomy tube and auscultates the lungs but cannot hear breath sounds. What is the nurse's next best action? 1.Apply oxygen via simple facemask. 2. Order a chest x-ray to assess for pneumothorax. 3. Assess for air under the skin around the tracheostomy. 4. Ventilate with a bag-valve-mask and ensure the Rapid Response Team is notified.

4. Ventilate with a bag-valve-mask and ensure the Rapid Response Team is notified. The nurse may request assistance from another nurse, a respiratory therapist, or a health care provider if needed and should ventilate the patient with a bag-valve-mask until the airway can be secured. The Rapid Response Team should be notified by another nurse. A simple facemask should not be used because the patient has a tracheostomy. Ordering a chest x-ray for a pneumothorax is not an appropriate intervention. Assessing for air under the tracheostomy should be done but is not a priority.

Upon assessment of a patient with chest pain, the nurse finds unequal chest expansion, crackles with diminished breath sounds, tachypnea, and a fever. Which laboratory data finding would lead the nurse to believe the patient has pneumonia? 1. WBC 5,100/mm 3 2. WBC 6,500/mm 3 3. WBC 9,500/mm 3 4. WBC 12,000/mm 3

4. WBC 12,000/mm 3 An elevated white blood count is associated with bacterial infections such as pneumonia. A WBC of 12,000/mm 3 is elevated. Any WBC below 10,000/mm 3 is considered normal.

The nurse is caring for a patient with severe acute respiratory syndrome (SARS). What is the most important precaution the nurse should take when preparing to suction this patient in order to prevent contracting the infection? 1. Performing oral care after suctioning the oropharynx 2. Keeping the head of the bed elevated 30 to 45 degrees 3. Washing hands and donning gloves prior to the procedure 4. Wearing a disposable particulate mask respirator and protective eyewear

4. Wearing a disposable particulate mask respirator and protective eyewear To protect healthcare workers during procedures that induce coughing or promote aerosolization of particles, nurses should wear a particulate mask respirator and protective eyewear to prevent the spread of infectious organisms. Keeping the head or the bed elevated 30 to 40 degrees is not the most important precaution. Performing oral care is a comfort measure. Washing hands and donning gloves is necessary, but not the most important measure.

A patient reports pain over the cheek radiating to the teeth and fever, swelling, fatigue, ear pressure, referred pain to the temple, and general facial pain that is worse when bending forward. Upon assessment, the nurse finds erythema and tenderness to percussion over the sinuses. Which medications does the nurse anticipate will be beneficial for the patient? Select all that apply. 1. Ibuprofen 2. Amoxicillin 3. Phenylephrine 4 Diphenhydramine 5 Chlorpheniramine

Rhinosinusitis is characterized by pain over the cheek radiating to the teeth and fever, swelling, fatigue, ear pressure, referred pain to the temple, and general facial pain that is worse when bending forward. The patient may also have erythema and tenderness to percussion over the sinuses. Ibuprofen, amoxicillin, and phenylephrine are used in the treatment of rhinosinusitis. Diphenhydramine and chlorpheniramine are used in the treatment of allergic rhinitis.