Chapter 27: Lower Respiratory Problems Harding: Lewis’s Medical-Surgical Nursing
A patient with a possible pulmonary embolism reports chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/min, blood pressure of 100/60 mm Hg, and respirations of 42 breaths/min. Which action should the nurse take first?
Elevate the head of the bed to a semi-Fowler's position.
A patient with newly diagnosed lung cancer tells the nurse, "I don't think I'm going to live to see my next birthday." Which is the best initial response by the nurse?
"Can you tell me what makes you think you will die so soon?"
The nurse is performing tuberculosis (TB) skin tests in a clinic that has many patients who have immigrated to the United States. Which question is important for the nurse to ask before the skin test?
"Did you receive the bacille Calmette-Guérin (BCG) vaccine for TB?"
The nurse completes discharge teaching for a patient who has had a lung transplant. Which patient statement indicates that the teaching has been effective?
"I will call the health care provider right away if I develop a fever."
The nurse provides discharge teaching for a patient who has two fractured ribs from an automobile accident. Which patient statement indicates that teaching has been effective?
"I will use the incentive spirometer every hour or two during the day."
An experienced nurse instructs a new nurse about how to care for a patient with dyspnea caused by a pulmonary fungal infection. Which action by the new nurse indicates a need for further teaching?
Placing the patient on droplet precautions in a private hospital room
A patient is diagnosed with both human immunodeficiency virus (HIV) and active tuberculosis (TB) disease. Which information obtained by the nurse is most important to communicate to the health care provider?
The patient is being treated with antiretrovirals for HIV infection.
The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement by the patient indicates a good understanding of the instructions?
"I will continue to do deep breathing and coughing exercises at home."
The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB). Which statement, if made by the patient, indicates that teaching was effective?
"My spouse will sleep in another room."
A lobectomy is scheduled for a patient with stage I non-small cell lung cancer. The patienttells the nurse, "I would rather have chemotherapy than surgery."
"Tell me what you know about the treatments available."
Which health promotion information should the nurse include when teaching a patient with a 42 pack-year history of cigarette smoking? (Select all that apply.)
-Resources for support in smoking cessation -Computed tomography (CT) screening for cancer -Importance of obtaining a yearly influenza vaccination
The nurse monitors a patient in the emergency department after chest tube placement for a hemopneumothorax. Which assessment finding is of most concern?
400 mL of blood in the collection chamber
The nurse receives change-of-shift report on the following four patients. Which patient should the nurse assess first?
A 46-yr-old patient on bed rest who reports sudden onset of shortness of breath
After change-of-shift report, which patient should the nurse assess first?
A 64-yr-old with lung cancer and tracheal deviation after subclavian catheter
The nurse supervises a student nurse who is assigned to take care of a patient with active tuberculosis (TB). Which action, if performed by the student nurse, would require an intervention by the nurse?
A surgical face mask is applied before visiting the patient.
A patient who was admitted the previous day with pneumonia reports a sharp pain of 7 (on 0to 10 scale) "whenever I take a deep breath." Which action will the nurse take next?
Auscultate for breath sounds.
The emergency department nurse notes tachycardia and absent breath sounds over the right thorax of a patient who has just arrived after an automobile accident. For which intervention will the nurse prepare the patient?
Chest tube connected to suction
An hour after a left thoracotomy, a patient reports incisional pain at a level 7 (based on 0 to 10 scale) and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which action should the nurse take?
Administer the prescribed morphine.
Which factors will the nurse consider when calculating the CURB-65 score for a patient with pneumonia? (Select all that apply.)
Age Blood pressure Respiratory rate Presence of confusion BUN level
A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the nurse plan to include in the plan of teaching?
Appropriate use of cough suppressants
A patient diagnosed with active tuberculosis (TB) is homeless and has a history of chronic alcohol use. Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen?
Arrange for a daily meal and drug administration at a community center.
After 2 months of tuberculosis (TB) treatment with isoniazid, rifampin (Rifadin), pyrazinamide, and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next?
Ask the patient whether medications have been taken as directed.
A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first?
Blood cultures from two sites
A patient who has a right-sided chest tube after a thoracotomy has continuous bubbling in the suction-control chamber of the collection device.
Continue to monitor the collection device.
The nurse is caring for a patient who has a right-sided chest tube after a right lower lobectomy. Which nursing action can the nurse delegate to the unlicensed assistive personnel (UAP)?
Document the amount of drainage every 8 hours.
A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange discolored urine and tears. Which response by the nurse reflects accurate knowledgeabout the medication and the patient's illness?
Explain that orange discolored urine and tears are normal while taking this medication.
The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy.Which information should the nurse include about the patient's postoperative care?
Frequent use of an incentive spirometer
A patient with bacterial pneumonia has coarse crackles and thick sputum. Which action should the nurse plan to promote airway clearance?
Help the patient to splint the chest when coughing.
A patient with pneumonia has a fever of 101.4° F (38.6° C), a nonproductive cough, and an O2saturation of 88%. The patient is weak and needs assistance to get out of bed. Which patient problem should the nurse assign as the priority?
Impaired gas exchange
The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect?
Increased tactile fremitus
The nurse notes that a patient has incisional pain, a poor cough effort, and scattered coarse crackles after a thoracotomy. Which action should the nurse take first?
Medicate the patient with prescribed morphine.
The nurse is caring for a patient who has just had a thoracentesis. Which assessment information obtained by the nurse is a priority to communicate to the health care provider?
O2 saturation is 88%.
The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment could be used to evaluate the effectiveness of the therapies?
Observe for distended neck veins.
A patient has a chest wall contusion as a result of being struck in the chest with a baseball bat. Which initial assessment finding is of most concern to the emergency department nurse?
Paradoxical chest movement
Which finding indicates to the nurse that the administered nifedipine (Procardia) was effective for a patient who has idiopathic pulmonary arterial hypertension (IPAH)?
Patient reports a decrease in exertional dyspnea.
A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6° F with a frequent cough and severe pleuritic chest pain. Which prescribed medication should the nurse give first?
Piperacillin/tazobactam (Zosyn)
Which action should the nurse plan to prevent aspiration in a high-risk patient?
Place a patient with altered consciousness in a side-lying position.
Which action should the nurse take to prepare a patient with a pleural effusion for a thoracentesis?
Position the patient sitting up on the side of the bed.
An occupational health nurse works at a manufacturing plant where there is potential exposure to inhaled dust. Which action recommended by the nurse is intended to prevent lung disease?
Require the use of protective equipment.
A patient is hospitalized with active tuberculosis (TB). Which assessment finding indicates to the nurse that prescribed airborne precautions are likely to be discontinued?
Sputum smears for acid-fast bacilli are negative.
A patient is admitted to the emergency department with an open stab wound to the left chest. What action should the nurse take?
Tape a nonporous dressing on three sides over the wound.
Which intervention will the nurse include in the plan of care for a patient who is diagnosed with a lung abscess?
Teach about the need for prolonged antibiotic therapy after discharge from the hospital.
The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action should the nurse take?
Teach the patient about providing specimens for 3 consecutive days.
Which action by the nurse will be most effective in decreasing the spread of pertussis in a community setting?
Teaching patients about the need for adult pertussis immunizations
The nurse is caring for a patient with idiopathic pulmonary arterial hypertension (IPAH). Which assessment information requires the most immediate action by the nurse?
The epoprostenol (Flolan) infusion is disconnected.
A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days. Which assessment data obtained by the nurse indicates that the treatment is effective?
The patient's white blood cell (WBC) count is 6000/μL.
The nurse supervises unlicensed assistive personnel (UAP) providing care for a patient who has right lower lobe pneumonia. Which action by the UAP requires the nurse to intervene?
UAP lowers the head of the patient's bed to 15 degrees.
Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB and has never had a positive TB skin test before. Which information should the occupational health nurse plan to teach the staff nurse?
Use and side effects of isoniazid
Which finding by the nurse most specifically indicates that a patient is not able to effectively clear the airway?
Weak cough effort
An older adult is receiving standard multidrug therapy for tuberculosis (TB). Which finding should the nurse report to the health care provider?
Yellow-tinged sclera
The nurse notes new onset confusion in an older patient who is normally alert and oriented. In which order should the nurse take the following actions?
a. Obtain the O2 saturation. b. Check the patient's pulse rate c. Document the change in status. d. Notify the health care provider.